Multifamily Group to Reduce Marital Conflict and Disability in Veterans With mTBI
Condition: Mild Traumatic Brain Injury; Posttraumatic Stress Disorders; Depression
MeSH terms: Brain Injuries; Brain Injuries, Traumatic; Brain Concussion; Depression; Stress Disorders, Traumatic; Stress Disorders, Post-Traumatic
Study type: Interventional

Summary: 
      This project addresses the rehabilitation and mental health needs of married combat Veterans
      post-deployed from Iraq or Afghanistan with a mild traumatic brain injury (mTBI) and/or
      significant posttraumatic stress (PTS) or combat-related stress (CS) by providing
      psychoeducation, communication and problem solving skills in a multifamily group (MFG)
      setting. In this group, Veterans and spouses/cohabiting partners learn customized therapeutic
      strategies to help compensate for deficits and promote Veteran community integration,
      interpersonal and emotion regulation skills, and marital satisfaction. The effectiveness of
      the skills-based MFG will be compared to that of a health education group which offers a
      supportive environment and basic education without skills training through a randomized
      clinical trial. As there is currently no family-based intervention for Operation Enduring
      Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans with mTBI offered within the VA spectrum
      of services, this intervention fills a crucial gap in healthcare for our newest Veterans.
    

Detailed description: 
      Mild traumatic brain injury (mTBI), an injury or concussion associated with brief loss of
      consciousness or altered mental state, has affected as many as 35% of soldiers wounded during
      recent military actions in Iraq and Afghanistan. Up to 30% of those injured report persistent
      somatic, emotional and cognitive post-concussive symptoms (PCS) which may adversely impact
      family life and community re-integration. Marital conflict and intimate partner violence,
      reported by 54% of OEF/OIF couples, and co-occurring mental health problems may exacerbate
      cognitive dysfunction and delay rehabilitation. A key contributor to marital conflict is a
      lack of knowledge about the Veteran's condition and the skills needed to help him compensate
      for common deficits in memory and planning which create challenges in household management.
      Despite a growing evidence base for couples treatment for PTSD, there is no established
      family-based treatment for OEF/OIF Veterans with mTBI, creating a critical research and
      services gap. The proposed research aims to fill this gap by evaluating a novel form of
      multi-family group treatment designed to improve community integration (CI) among
      married/cohabiting OEF/OIF Veterans with mTBI and/or significant posttraumatic stress (PTS)
      or combat-related stress (CS) by training spouse/partners to aid with rehabilitation and
      employing disability-adapted communication and problem-solving skills to reduce marital
      conflict and improve marital satisfaction.

      Veterans (N=150) with a positive Defense and Veterans Brain Injury Center (DVBIC) screen for
      mTBI sustained during the OEF/OIF era, confirmed by the VA Identification Clinical Interview
      and a Montreal Cognitive Assessment (MoCA) score 19 or if they either meet diagnostic
      criteria for PTSD or have trauma- or CS of at least moderate severity, as defined by either
      a) PTSD Checklist (PCL) score >34 or b) Customer Effort Score (CES) score of >23, will be
      randomized to receive either: 1) Multifamily Group for TBI for Couples (MFG-mTBI-C), a
      psychoeducational, rehabilitation and skills-building intervention consisting of a 2-session
      multifamily educational workshop providing information about TBI and 12 bi-monthly
      multifamily group meetings providing skills training in problem-solving and communication
      related to cognitive/emotional deficits; or 2) 14 bi-monthly multifamily group sessions
      delivering health education without skills training. Both treatments will be preceded by 2-3
      individual couples sessions. Participants will be assessed pre- and post-treatment and 6
      months post-treatment. Data will be analyzed using an intent-to-treat analysis with paired
      comparisons between treatment groups on primary (Veteran CI, caregiver burden) and secondary
      (anger management, use of social supports) outcome variables using mixed effects regression
      models. It is hypothesized that Veterans treated with MFG-mTBI-C will show improved CI, anger
      management and use of social support, and spouse/partners will show reduced burden compared
      with those treated in the health education group. If efficacious, MFG-mTBI-C has the
      potential to assist Veterans with mTBI and their partners throughout the VA Health Care
      System.
    

Intervention name(s): Multifamily Group for mTBI for Couples; Group Health Education (GHE)
Intervention type(s): Behavioral; Behavioral
Intervention description(s): MFG-mTBI-C uses a structured problem-solving and skills training approach to provide Veterans and partners with tools and information to improve coping and help couples reconnect through positive behavioral exchanges.; GHE is a 14-session, highly structured educational intervention providing general information on health problems that are common among the general OEF/OIF cohort including sleep and sleep problems, physical activity and exercise, and alcohol and drug use, as well as guidelines for improving health behavior in these areas.
Other intervention name(s): MFG-mTBI-C; GHE
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Stress Disorders, Post-traumatic; Mild Traumatic Brain Injury; Veterans Health; Veterans; Spouses; Couples; Psychotherapy, Group; Depression; Couples Therapy; Family Therapy; PTSD; posttraumatic stress disorder