Assessment and diagnosis of mild traumatic brain injury, posttraumatic stress disorder, and other polytrauma conditions: Burden of adversity hypothesis.

Objective/Method: Military personnel returning from Iraq and Afghanistan have been exposed to physical and emotional trauma. Challenges related to assessment and intervention for those with posttraumatic stress disorder (PTSD) and/or history of mild traumatic brain injury (TBI) with sequelae are discussed, with an emphasis on complicating factors if conditions are co-occurring. Existing literature regarding cumulative disadvantage is offered as a means of increasing understanding regarding the complex symptom patterns reported by those with a history of mild TBI with enduring symptoms and PTSD. Implications: The importance of early screening for both conditions is highlighted. In addition, the authors suggest that current best practices include treating symptoms regardless of etiology to decrease military personnel and veteran burden of adversity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Multifamily group treatment for veterans with traumatic brain injury.

A common clinical problem encountered by clinicians treating veterans who incurred traumatic brain injury (TBI) while serving in Afghanistan in support of Operation Enduring Freedom (OEF) or in Iraq in support of Operation Iraqi Freedom (OIF) is lack of knowledge about TBI on the part of the veterans' family members. Insufficient information can exacerbate marital or family conflict and lead to psychological distress and social isolation for the veteran and family, and suboptimal illness management for the veteran. To address this problem, we adapted Multifamily Group Treatment (MFGT), an evidence-based practice for treatment of serious mental illness (SMI), for treatment of OEF/OIF veterans with TBI and their families. We have implemented the adapted treatment (MFG-TBI) in four groups of veterans and families (N = 20 veterans and 20 family members) across two sites: the Durham VA Medical Center (VAMC) in North Carolina and the JJ Peters VAMC in the Bronx, New York. Adaptations focused on contents and format of the educational components, specification of a protocol for conjugal couples, and the addition of an ecomap to identify support systems during the joining (i.e. assessment) phase, a shorter (9 months) intervention duration, and a more active clinician role including use of motivational enhancement, intersession support, and coordination with other service providers. Biweekly group sessions were supervised and rated for adherence. We illustrate how MFG-TBI both educates and builds problem-solving skills with clinical examples. Suggestions for effective use of problem-solving skills with this population are offered. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

"Loss of self" in the narratives of people with traumatic brain injuries: a qualitative analysis

To discover how people with traumatic brain injuries (TBI) experience themselves, narrative data from ten individuals with TBI were analyzed. The findings suggest that people with TBI experience loss of self in various forms although they may successfully use strategies to avoid or minimize the sense of loss. First, people with TBI find it difficult to develop clear self-knowledge about how they have become as they are and what they can and cannot do. Second, loss of self is conspicuous when they compare their present status with their past in many aspects of their lives. Third, their senses of self are threatened by labels that they feel the society imposes upon them. This categorization of loss of self can serve for rehabilitation counseling of this population. It may assist counselors to enhance their understanding of emotional distress after TBI and to make use of their clients' narratives for the intervention.     

Immediate family crisis intervention as preventive mental health: The family consultant service.

The service employs mental health personnel who work closely with the police in order to respond immediately to family-related crises. This paper reports a preliminary evaluation of the program with respect to 5 issues: (a) whether the program is redundant with existing community services, (b) the advantages of early intervention approaches, (c) whether the program is a preventative service to any degree, (d) the evaluation of the program by the police and social agencies, and (e) whether cooperation between mental health and law enforcement professionals is enhanced. Available data collected over a 2-yr period concerning these 5 issues indicated the success of the program. It is concluded that it can serve as a model for community prevention approaches to family crises and mental health problems. (11 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment of Posttraumatic Stress Disorder in Military and Veteran Populations.

While concerns about the psychological effects of war are not new, only recently has systematic attention been paid to such problems among past and present military personnel. There is increasing recognition that mental health has serious implications for operational performance, retention, and compensation. Although little controlled research exists with this population, preliminary evidence suggests that psychological treatments for posttraumatic stress disorder may be beneficial, albeit less so than for civilian populations. This article reviews evidence for each of several psychological treatment stages: stabilization and engagement, psychoeducation, symptom management, prolonged exposure, cognitive restructuring, and relapse prevention, with particular reference to the clinical issues raised by military personnel. Possible explanations for reduced treatment effects in this population compared with civilians are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Traumatic brain injury, polytrauma, and pain: Challenges and treatment strategies for the polytrauma rehabilitation.

Problem: Chronic pain conditions are common sequelae of traumatic brain injury (TBI). Unfortunately, the incidence of TBI among personnel deployed for Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) is significant, and there is growing evidence that ongoing pain, particularly headaches, will be a primary concern for these individuals. Objective: This article synthesizes empirical data from civilian and veteran populations and clinical experience with OEF/OIF personnel with polytrauma to provide recommendations for the assessment and treatment of chronic pain among those with TBI. Conclusions: The available data signal the need for the incorporation of early and aggressive pain management strategies into existing treatment models. Challenges to providing effective pain management for OEF/OIF veterans are numerous and include comorbid cognitive, medical, and emotional impairments that complicate readjustment to civilian life. It is likely that the problem of polytrauma pain and associated comorbid conditions such as posttraumatic stress disorder and postconcussive syndrome will require the development of integrated approaches to clinical care which bridge traditional subspecialty divisions. A proposed model of treatment is presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An introduction to the special section on U.S. Military operations: Effects on military members' partners and children.

[Correction Notice: An erratum for this article was reported in Vol 25(5) of Journal of Family Psychology (see record 2011-22678-001). An author’s name cited in the text and the reference section was misspelled as Knoblock. The correct reference is Knobloch, L. K., & Theiss, J. A. (2011). Depressive symptoms and mechanisms of relational turbulence as predictors of relationship satisfaction among returning service members. Journal of Family Psychology, 25, 470–478. The online versions of this article have been corrected.] The deployment of U.S. military personnel to global hot spots, whether as combatants or as peacekeepers, has increased attention to the psychological well-being of military personnel and their family members. Despite the growing awareness that deployments have reverberating effects on all family members, theoretical explanations and empirical research on the impact of deployment on couple, family, and child adjustment, factors that serve to protect families from the demands of military employment, and effective methods of treating the mental health needs of military families are needed. The seven papers in this section increase our understanding of how the demands of U.S. military operations impact couples, family functioning, parenting, and child psychological adjustment and provide an additional resource for mental health professionals who work with these families. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Response to "Programming for occupational outcomes following traumatic brain injury".

Responds to an article Programming for occupational outcomes following traumatic brain injury by William J. Haffey and Frank D. Lewis (see record 1990-02644-001). The dramatic upsurge in attention paid in the past 10 years to the rehabilitation of persons with traumatic brain injury (TBI) has resulted in an accelerating proliferation of treatment programs purporting to apply specialized techniques that will "remediate" the cognitive and behavioral deficits of this population, with implicit or explicit promises of functional gain. Specifically, given the epidemiologic realities of the TBI population, returning to work is a major goal of the rehabilitation process. With the movement of TBI rehabilitation programs out of academic medical centers and into the private sector, increasing numbers of zealous professionals are ready to apply a variety of treatment approaches, thousands of families are eager to find the "best" program, and more and more nervous insurers are both mandated and requested to pay for expensive treatments that hold out the promise of return to work. Unfortunately, the field of TBI rehabilitation has been more eager to provide services than critically evaluate the effectiveness of those services. The first major contribution of the Haffey and Lewis article is to call attention both to the paucity of posttreatment vocational outcome studies, and to emphasize the need to evaluate the success of various models of vocational rehabilitation. The second major contribution of the Haffey and Lewis article is their offering of a concrete example of one approach to systematic programming for vocational outcomes. Our experience is that vocational potential—and therefore reasonable goals—only emerge as the product of a process that involves testing the client's capacities not just cognitively and behaviorally, but also his or her capacity to conform to a series of messages and procedures that will determine the viability of any given vocational plan. Readers should take from the concrete programming suggestions in this article the laudable objective of making vocational goals, obstacles, and critical events specific and public, but beware of mechanically applying the approach without appreciating the complex subtleties in enabling a brain-injured person to become a productive worker. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Treatment Beliefs Questionnaire (TBQ): An instrument to assess beliefs about children's mood disorders and concomitant treatment needs.

Parent and child beliefs about the child's mood disorder and need for treatment may affect the willingness of the patient and his or her family to participate in and adhere to treatment recommendations. Such beliefs may also affect mental health treatment outcomes. However, there is a paucity of research in this area, which is further reflected in a lack of assessment instruments. The present study describes the creation and initial psychometric evaluation of parent and child versions of the Treatment Beliefs Questionnaire (TBQ) in a sample of 8- to 11-year-old children with a primary mood disorder and comorbid psychiatric conditions. Preliminary results support the reliability and validity of these scales in this population. The role of health beliefs in mental health treatment adherence and treatment outcome is addressed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Correction to Kelley and Jouriles (2011).

Reports an error in "An introduction to the special section on U.S. Military operations: Effects on military members' partners and children" by Michelle L. Kelley and Ernest N. Jouriles (Journal of Family Psychology, 2011[Aug], Vol 25[4], 459-460). An author’s name cited in the text and the reference section was misspelled as Knoblock. The correct reference is Knobloch, L. K., & Theiss, J. A. (2011). Depressive symptoms and mechanisms of relational turbulence as predictors of relationship satisfaction among returning service members. Journal of Family Psychology, 25, 470–478. The online versions of this article have been corrected. (The following abstract of the original article appeared in record 2011-17889-001.) The deployment of U.S. military personnel to global hot spots, whether as combatants or as peacekeepers, has increased attention to the psychological well-being of military personnel and their family members. Despite the growing awareness that deployments have reverberating effects on all family members, theoretical explanations and empirical research on the impact of deployment on couple, family, and child adjustment, factors that serve to protect families from the demands of military employment, and effective methods of treating the mental health needs of military families are needed. The seven papers in this section increase our understanding of how the demands of U.S. military operations impact couples, family functioning, parenting, and child psychological adjustment and provide an additional resource for mental health professionals who work with these families. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The effect of attempted thought suppression in acute stress disorder

The debate continues over whether a posttraumatic response occurs in those who have sustained a traumatic brain injury (TBI). The aim of this study was to investigate the incidence of acute stress disorder (ASD) in the mild TBI population. Patients who sustained a mild TBI after a motor vehicle accident (N = 79) were assessed for the presence of ASD. ASD was diagnosed in 13.9% of patients, and 5.1% were diagnosed with subsyndromal ASD. Dissociative, reexperiencing, and avoidance symptoms were found to have moderate to high predictive power. This study highlights the significant number of patients who experience an acute trauma response after TBI and raises the possibility that those with ASD denote those for whom an early intervention may prevent longer-term psychopathology. Diagnostic difficulties in defining ASD after TBI are discussed.     

Effect of some cooked food mutagens on unscheduled DNA synthesis in cultured precision-cut rat, mouse and human liver slices

The present study investigated the rates and perceived effects of past traumatic brain injury (TBI) and substance use in a prison population. Responses to a questionnaire indicated that 86.4% of the 118 respondents had sustained a TBI, with 56.7% reporting more than one, and rates of illicit substance use were higher than the general population. Maori reported 12% more TBI and more substance use than non-Maori. All those with TBI reported difficulties with general memory and socialization on a problem rating scale, but there was no relationship between level of difficulty and severity of TBI, problems with interpersonal relationships, family, and finances were associated with greater substance use.     

The efficacy of an online cognitive-behavioral family intervention in improving child behavior and social competence following pediatric brain injury.

Objective: To examine whether an online cognitive-behavioral intervention could improve child adjustment following traumatic brain injury (TBI). Participants: Thirty-nine families of children with moderate to severe TBI. Intervention: Families were randomly assigned to the online family problem-solving (FPS) group or to the Internet resources comparison (IRC) group. Main Outcome Measures: Outcomes included child behavior problems, social competence, and self-management/compliance. Results: The FPS group reported better child self-management/compliance at follow-up than did the IRC group. The child's age and socioeconomic status (SES) moderated treatment effects, with older children and those of lower SES who received FPS showing greater improvements in self-management and behavior problems, respectively. Conclusions: Findings suggest that an online cognitive- behavioral approach can improve child adjustment after TBI, particularly in older children and children of lower SES. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An online family intervention to reduce parental distress following pediatric brain injury.

This study examined whether an online problem-solving intervention could improve parental adjustment following pediatric traumatic brain injury (TBI). Families of children with moderate-to-severe TBI were recruited from the trauma registry of a large children's hospital and randomly assigned to receive online family problem solving therapy (FPS; n = 20) or Internet resources (IRC; n = 20) in addition to usual care. The FPS group reported significantly less global distress, depressive symptoms, and anxiety at follow-up than did the IRC group after controlling for baseline symptoms. The FPS group also reported significant improvements in problem-solving skills, although the groups did not differ significantly at follow-up. Findings suggest that an online, skill-building approach can be effective in facilitating parental adaptation after TBI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Developing community capacity to treat post-deployment mental health problems: A public health initiative.

Meeting the mental health needs of Veterans returning from recent deployment requires the coordinated effort of partnerships across Department of Defense (DoD), Department of Veterans Affairs (VA), and state and local communities. Although the proportion of Veterans of Iraq and Afghanistan who have accessed VA health care has grown, the majority of these new combat Veterans have yet to present for VA care. The stigma associated with reporting a deployment-related mental health problem may be one factor in this, but access to treatment may also be an important concern among the one third of American Veterans who live in rural or highly rural areas. As these Veterans are more likely to present to a primary care, faith-based or mental health provider in their own community, partnerships between community providers, DoD, and VA are of critical importance in ensuring appropriate care, regardless of treatment setting. In an effort to improve services and access to services, especially to rural Veterans, an educational public health initiative was created to educate community providers about military culture, deployment-related mental health issues, VA resources, and evidence-based treatments. We describe the development, dissemination and evaluation of this initiative, as well as lessons learned for future similar endeavors. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Suicidality and veterans with a history of traumatic brain injury: Precipitating events, protective factors, and prevention strategies.

Objectives: To increase understanding regarding precipitating and preventative factors of suicidal behavior and to highlight past experiences and recommendations regarding services aimed at suicide prevention among Veterans with a history of traumatic brain injury (TBI). Study Design: Qualitative. Participants: Sample of 13 Veterans with a history of TBI, and a history of clinically significant suicidal ideation or behavior. Method: In-person interviews were conducted and data were analyzed using a hermeneutic approach. Results: Shared precipitants noted included loss-of-self post-TBI, cognitive sequelae, and psychiatric and emotional disturbances. Common protective factors noted included social supports, a sense of purpose regarding the future, religion and spirituality, and mental health care. Means of improving care were also identified (e.g., increasing the availability of services and mental health professionals’ knowledge regarding TBI, providing more structured treatment). Conclusions: Findings highlight potential areas of importance in the assessment and treatment of suicidal Veterans with a history of TBI. Recommendations regarding means of improving care are also presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Neurochemical changes and current pharmacological approaches in craniocerebral trauma

In recent years, our knowledge concerning pathophysiological changes in brain metabolism after traumatic brain injury (TBI) has greatly expanded. This, in turn, has enabled the development of specific pharmacological strategies for the supplementary treatment of brain-injured patients with the aim of reducing secondary brain damage. The present article focuses on the pathophysiology of TBI and the possibilities for pharmacological intervention. While some of the substances reviewed and presently used in the treatment of TBI, others are under experimental and clinical evaluation at different stages.     

The role of psychologists in the care of Iraq and Afghanistan veterans in primary care settings.

Although military personnel serving in Iraq and Afghanistan are at high risk of developing mental health problems, many report significant barriers to care and few seek help. Integrated primary care is a comprehensive model of health care that aims to improve access to care and provides a framework to assess and meet the complex psychiatric needs of newly returning veterans by embedding mental health specialists within primary care. We describe the role of psychologists in a Department of Veterans Affairs (VA) integrated primary care clinic that serves veterans of Iraq and Afghanistan. Psychologists based in primary care can assist veterans with reintegration to civilian life by providing rapid mental health assessment, normalizing re-adjustment concerns, planning for veterans’ safety, implementing brief interventions within primary care, facilitating transition to additional mental health care, and informing veterans of other available psychosocial services. A case example demonstrating the psychologist’s role highlights the benefits of an integrated care model. Implications of employing this model include reduction of symptoms and impairment by reducing stigma and barriers to seeking mental health care, increased motivation to engage in treatment, and implementation of early interventions. This model may also be beneficial in the civilian health care sector with groups that are at high risk for mental health problems, yet experience barriers to care, particularly stigma. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evidence-Based Solutions for Overcoming Access Barriers, Decreasing Attrition, and Promoting Change With Underserved Families.

Various definitions exist for what constitutes family therapy. In this article, we consider family therapy to encompass any intervention that targets family interactions and conceptualizes problems as existing beyond individual clients. Numerous individual studies and several quantitative reviews have established family therapy as an effective treatment modality and the treatment of choice for many disorders. However, critiques of existing service provision highlight the unfortunate fact that numerous barriers to treatment exist at multiple levels of the broader ecology, preventing many families from benefiting from these services. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Play, aggression, the preschool child, and the family: A review of literature to guide empirically informed play therapy with aggressive preschool children.

Preschool-aged children displaying high levels of aggression repeatedly have been shown to be at significant risk for continued behavior problems and other social and emotional challenges throughout their lifetimes. The present literature review seeks to summarize and integrate findings across the fields of developmental psychology, family studies, child development, and play therapy to inform play therapists' practices with this population. Specifically, findings from research in these fields hold substantial implications for empirically informed ways in which play therapists can include parents within play therapy processes. Affective quality of parent- child interactions emerges as the common theme across all existing literature and is emphasized as a critical focus for play-based therapeutic intervention. Topics for future research by play therapists focusing on this population are suggested. (PsycINFO Database Record (c) 2010 APA, all rights reserved)