Adapting the multifamily group model to the Veterans Affairs system: The REACH Program.

[Correction Notice: An erratum for this article was reported in Vol 41(4) of Professional Psychology: Research and Practice (see record 2010-17073-006). The copyright for this article was incorrectly listed. This article is in the Public Domain. The online version has been corrected.] The Oklahoma City Veterans Affairs (VA) Medical Center modified an evidence-based model of family psychoeducation (the multifamily group model; McFarlane, 2002) and implemented it for the first time in a VA setting and with veterans living with posttraumatic stress disorder (PTSD). Named the REACH Program (Reaching out to Educate and Assist Caring, Healthy Families), the 3-phase program begins with 4 weekly “joining sessions” with the individual veteran and his/her family focused on rapport building, assessment, and goal setting. Phase II consists of 6 weekly diagnosis-specific educational/support sessions for cohorts of 4 to 6 veterans and their families. In Phase III, veterans/families attend 6 monthly multifamily groups to support the maintenance of gains. This article describes the rationale for modifying the original Multifamily Group Program (MFG) for a unique setting (the VA) and the needs of families of veterans in a new diagnostic group (PTSD). The changes to the MFG curriculum are specifically described, and details of the new REACH intervention are explained. Attendance, retention, and satisfaction data for 2 diagnostic cohorts, PTSD and affective disorders, are also presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluating a Cognitive-Behavioral Group Treatment Program for Veterans With Posttraumatic Stress Disorder.

The need to develop and further refine efficient and effective treatments for individuals with posttraumatic stress disorder (PTSD) in a climate of reduced mental health resources is critical. This study examined the impact of a series of cognitive-behavioral groups administered in an urban VA setting. The participants were veterans with chronic and severe PTSD, many of them struggling with additional physical and mental health problems. The data indicate modest improvements in the distress level of the veterans. Additional research is needed to further isolate the key elements of treatment that are most effective, palatable for patients, and cost-effective for the providers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Improving Success in a Veterans Homeless Domiciliary Vocational Program: Model Development and Evaluation.

Objective: Determine predictors of success in a vocational rehabilitation component of a Veterans Affairs Rehabilitation Program. Design: The 1st of 2 experiments evaluated risk factors for failure to find competitive employment. The 2nd assessed attainment of employment following program changes based on identified risk factors. Participants: Eighty-four and 82 homeless veterans in Experiments 1 and 2, respectively. Results/Experiment 1: Eight factors were found to be significant and were combined into a Risk Factor Scale. Results/Experiment 2: The authors assigned patients to a competitive job-search-only track or a hybrid program combining competitive job search and the potential for supported employment. Overall employment rates increased, and success rates for those seeking only competitive employment rose. Employment rates of those unlikely to find competitive employment increased. Conclusion: Findings demonstrated the effect of developing systematic data on risk factors for failing to find employment, implementing changes based on the data, and applying the benefit of these changes to program functioning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of Age and Hypertension Status on Cognition: The Veterans Affairs Normative Aging Study.

The authors examined the influence of age and hypertensive status (normotensive, controlled, untreated, or uncontrolled) on several cognitive tests via multiple regression in 357 nondemented, community-dwelling older men (mean age = 67 years) whose hypertensive status was stable over 3 years and who had no medical comorbidities. Age was negatively associated with performance on all but 1 test. Age interacted with hypertensive status on verbal fluency and word list immediate recall; older uncontrolled hypertensives exhibited significantly larger age decrements on these tests compared with normotensives. These findings suggest that uncontrolled hypertension produces specific cognitive deficits beyond those attributable to age alone. These and previous findings illustrate that health conditions such as hypertension should be regularly considered in studies of "normal" cognitive aging. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment of Department of Veterans Affairs primary care patients with posttraumatic stress disorder.

Posttraumatic stress disorder (PTSD) is common among Veterans Affairs (VA) primary care patients and may be managed via multiple treatment pathways. Using the Behavioral Model of Health Service Use (Anderson, 1995), this retrospective study based on medical chart review examined factors associated with three types of mental health treatment: intervention by a 1) primary care provider (PCP), 2) primary care-mental health integration (PC-MHI) provider, and 3) specialty mental health (SMH) provider. A second goal was to describe PTSD treatment services for patients not receiving SMH by detailing the content of mental health treatment provided by PCPs and PC-MHI providers. Electronic medical record data for a five year time period for 133 Veterans were randomly selected for review from a population 6,637 primary care patients with PTSD. Results indicated that the evaluated needs of participants (i.e., number of unique medical and psychiatric disorders) were associated with Veterans receiving more intensive services (i.e., SMH). PCPs commonly addressed patients' mental health concerns, but patients often declined referrals for mental health treatment. PC-MHI consultations most often focused on medication management and supportive psychotherapy. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Psychotherapy in the veterans health administration: Missed opportunities?

Informed by data on the dose-response effect, the authors assessed use of psychotherapy in the Veterans Health Administration (VA). The authors identified 410,923 patients with newly diagnosed depression, anxiety, or posttraumatic stress disorder using VA databases (October 2003 through September 2004). Psychotherapy encounters were identified by Current Procedural Terminology codes for the 12 months following patients' initial diagnosis. Psychotherapy was examined for session exposure received within the 12-month follow-up period and time (in days) between diagnosis and treatment. Of the cohort, 22% received at least one session of psychotherapy; 7.9% received four or more sessions; 4.2% received eight or more sessions; and 2.4% received 13 or more sessions. Delays between initial mental health diagnosis and initiation of care averaged 57 days. Patient variables including age, marital status, income, travel distance, psychiatric diagnosis, and medical-illness burden were significantly related to receipt of psychotherapy. Treatment delays and general underuse of psychotherapy services are potential missed opportunities for higher-quality psychotherapeutic care in integrated health care settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychologists: The Backbone of the VA Health Care System.

Veterans returning from Iraq and Afghanistan are presenting in large numbers with serious mental health needs. Chairman Akaka addresses this concern and the role of the Department of Veterans Affairs in caring for those in need of mental health services. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A Longitudinal Study of Retirement in Older Male Veterans.

In this study, the authors examined the effect of retirement on psychological and physical symptoms in 404 older male veterans who were taking part in an ongoing longitudinal study. Hierarchical linear modeling was used to analyze symptom trajectories from preretirement, peri-retirement, and postretirement periods in veterans with either lifetime full or partial posttraumatic stress disorder (PTSD), trauma exposure only, or no traumatic exposure. As expected, the PTSD group experienced greater increases in psychological and physical symptoms during retirement, relative to the other groups. Retirement due to poor health in the PTSD group did not account for the findings regarding physical symptoms. Results indicate that clinicians should recognize and address the potential for older individuals with PTSD to experience difficulties during retirement. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The need for inclusion of psychological trauma in the professional curriculum: A call to action.

An appreciable disparity exists between the need for services by professionals with expertise in psychological trauma and the availability of these services. Despite the establishment of a solid base of scientific literature on trauma and the growing attunement of society and the media to the adverse psychological impact of traumatic events, this area has yet to be decisively incorporated into the core curriculum of graduate training in psychology and other professions. This paper provides an overview of the prevalence, scope, and impact of trauma in the general population and the current lack of adequate resources to address the psychological difficulties engendered by traumatic experiences. Existing models of trauma training are discussed, and strategies for expanding the availability of trauma training are recommended. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Responding to the psychological impact of war on the Iraqi people and U.S. veterans: Mixing icing, praying for cake.

The psychological impact of the war in Iraq stimulated major initiatives to build a modern mental health care system for the Iraqi people and to improve mental health services for U.S. veterans of the Iraq war. Although these two initiatives differ in important respects, they are both informed by general principles of psychology concerning the nature of social problem definition, the process of human adaptation to extreme stress and its aftermath, and the role and limits of mental health services. Building on these common themes and my own experiences, I describe how two nations are trying to address the colossal psychological damage wrought by the war in Iraq. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Underdiagnosing and nontreatment of posttraumatic stress disorder in community mental health: A case study.

Research indicates that trauma is extremely prevalent among populations seeking community-based services. However, underdiagnosis and nontreatment of trauma-related disorders is widespread. This study explored how one urban community mental health center (CMHC), serving a severely mentally ill (SMI) population, assessed, diagnosed, and treated reported trauma histories. Results indicate that of the 72 consumers in this sample who reported trauma histories (51%), only 2 were diagnosed with posttraumatic stress disorder (PTSD). Instead, those with a reported trauma history were likely to be diagnosed with affective disorders and were almost seven times as likely to be recommended therapy as were those without a trauma history. However, even those recommended therapy were not likely to receive it. Findings indicate significant barriers to PTSD diagnoses and the receipt of therapy services. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Passage meditation reduces perceived stress in health professionals: A randomized, controlled trial.

The authors evaluated an 8-week, 2-hr per week training for physicians, nurses, chaplains, and other health professionals using nonsectarian, spiritually based self-management tools based on passage meditation (E. Easwaran, 1978/1991). Participants were randomized to intervention (n = 27) or waiting list (n = 31). Pretest, posttest, and 8- and 19-week follow-up data were gathered on 8 measures, including perceived stress, burnout, mental health, and psychological well-being. Aggregated across examinations, beneficial treatment effects were observed on stress (p = .0013) and mental health (p = .03). Treatment effects on stress were mediated by adherence to practices (p = .05). Stress reductions remained large at 19 weeks (84% of the pretest standard deviation, p = .006). Evidence suggests this program reduces stress and may enhance mental health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Making sense of posttraumatic stress disorder: Illness perceptions among traumatic injury survivors.

More than 1.5 million persons in the United States sustain traumatic physical injuries each year. A significant proportion of traumatic injury survivors develop serious mental health problems, such as posttraumatic stress disorder (PTSD), yet few obtain professional mental health care. According to the commonsense model of self-regulation (Leventhal, Diefenbach, & Leventhal, 1992), illness-related perceptions can influence coping responses, including the use of professional treatment. Using the commonsense model as a guiding framework, we conducted semistructured interviews with nontreatment-seeking trauma injury survivors with PTSD (N = 23). Illness perceptions regarding the following key conceptual dimensions were examined: PTSD symptoms (identity), experienced or perceived consequences of PTSD symptoms, and beliefs about the causes, controllability, and course of PTSD symptoms. Results revealed that no respondents identified their symptoms as indicative of PTSD. Common illness perceptions included believing that symptoms would be short-lived, that symptoms were reflective of poor physical health or were a natural reaction to life in a violent community, and that symptoms were functionally adaptive. Respondents also reported exerting some limited control over symptoms by relying on religious forms of coping. None of the respondents perceived professional treatment as being able to completely control symptoms. Findings indicated that respondents' conceptualizations of PTSD symptoms might have inhibited the recognition of symptoms as a serious mental health condition that warrants professional treatment. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

A randomized controlled trial of cognitive-behavioral treatment for posttraumatic stress disorder in severe mental illness.

A cognitive-behavioral therapy (CBT) program for posttraumatic stress disorder (PTSD) was developed to address its high prevalence in persons with severe mental illness receiving treatment at community mental health centers. CBT was compared with treatment as usual (TAU) in a randomized controlled trial with 108 clients with PTSD and either major mood disorder (85%) or schizophrenia or schizoaffective disorder (15%), of whom 25% also had borderline personality disorder. Eighty-one percent of clients assigned to CBT participated in the program. Intent-to-treat analyses showed that CBT clients improved significantly more than did clients in TAU at blinded posttreatment and 3- and 6-month follow-up assessments in PTSD symptoms, other symptoms, perceived health, negative trauma-related beliefs, knowledge about PTSD, and case manager working alliance. The effects of CBT on PTSD were strongest in clients with severe PTSD. Homework completion in CBT predicted greater reductions in symptoms. Changes in trauma-related beliefs in CBT mediated improvements in PTSD. The findings suggest that clients with severe mental illness and PTSD can benefit from CBT, despite severe symptoms, suicidal thinking, psychosis, and vulnerability to hospitalizations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Trauma exposure and posttraumatic stress disorder predictors of mental health treatment use in college students.

The authors examined trauma exposure and posttraumatic stress disorder (PTSD) associations with previous mental health (MH) treatment use in college students while statistically controlling for gender and treatment attitudes. A total of 300 students were recruited for an Internet survey and were administered a modified version of the demographic survey, the Stressful Life Events Screening Questionnaire (L. Goodman, C. Corcoran, K. Turner, N. Yuan, & B. L. Green, 1998), PTSD Symptom Scale-Self-Report (PSS; E. B. Foa, D. S. Riggs, C. V. Dancu, & B. O. Rothbaum, 1993), Attitudes Toward Seeking Professional Psychological Help Scale-Short Form (ATSPPH; E. H. Fischer & A. Farina, 1995), and a MH treatment use survey. Univariate analyses demonstrated that previous MH treatment use was associated with violent crime and noncrime trauma frequency, and treatment attitudes. Controlling for gender and MH treatment attitudes, regression analyses including violent and noncrime trauma and PTSD significantly predicted previous MH service use and recent visit counts; only noncrime trauma and treatment attitudes were significant for service use, and only treatment attitudes was significant for visit counts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The impact of killing on mental health symptoms in Gulf War veterans.

This study examined the impact of killing on posttraumatic stress symptomatology (PTSS), depression, and alcohol use among 317 U.S. Gulf War veterans. Participants were obtained via a national registry of Gulf War veterans and were mailed a survey assessing deployment experiences and postdeployment mental health. Overall, 11% of veterans reported killing during their deployment. Those who reported killing were more likely to be younger and male than those who did not kill. After controlling for perceived danger, exposure to death and dying, and witnessing killing of fellow soldiers, killing was a significant predictor of PTSS, frequency and quantity of alcohol use, and problem alcohol use. Military personnel returning from modern deployments are at risk of adverse mental health symptoms related to killing in war. Postdeployment mental health assessment and treatment should address reactions to killing in order to optimize readjustment. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

A tale of two studies of two disasters: Comparing psychosocial responses to disaster among Oklahoma City bombing survivors and Hurricane Katrina evacuees.

Purpose: An accumulation of disaster mental health research literature in the last few decades has contributed knowledge to direct disaster mental health interventions. However, no single set of principles can necessarily outline all anticipated mental health needs to be encountered in a particular disaster. Methods: To illustrate how different disaster scenarios may yield a divergence of mental health needs, this article compares mental health findings from two distinctly different studies of two very different populations affected by two very different disasters: directly exposed survivors the Oklahoma City bombing and sheltered evacuees from Hurricane Katrina. Results: Research on the two disasters reviewed illustrates many facets and complexities of postdisaster mental health needs in different populations in different settings after different types of disasters. The major findings of the Oklahoma City bombing study related to posttraumatic stress disorder and the main findings of the Hurricane Katrina study involved need for treatment of preexisting chronic mental health and substance abuse problems. Conclusion: The disaster studies in this review diverged in type of disaster, affected populations, setting, and timing of the study, and these studies yielded a divergence of findings. One disaster mental health model clearly cannot adequately describe all postdisaster scenarios. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychology in the public sector: Addressing the psychological effects of combat in the U.S. Navy.

The response of military psychology in times of war or other great public crises may presage the success of the profession in less perilous times. The ability of public-sector psychologists to provide assistance and improve the common welfare during conflict or turmoil is generally followed by an increased demand for psychological services. This likely reflects the success of the psychological response during those crises, and it underscores the fact that psychological consequences of war or disaster require both immediate clinical attention and long-term policy development. The U.S. Navy serves as a model for public-sector psychological service provision. A brief history of Navy psychology is provided, followed by an examination of how Navy psychologists are responding to the issues raised by the current conflict in the Middle East and the problems associated with stigma in the treatment of posttraumatic stress disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)