Lead/Presenter: Sarah Campbell, COIN - Seattle/Denver
All Authors: Campbell SB (Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, University of Washington Department of Health Services ), Simpson, TL (VA Puget Sound Health Care System, University of Washington Department of Psychiatry and Behavioral Sciences), Jakupcak, M (VA Salt Lake City Health Care System, University of Washington Department of Psychiatry and Behavioral Sciences) Wagner, AW (VA Portland Health Care System, Oregon Health & Science University, Department of Psychiatry) Fortney, JC (Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, University of Washington Department of Psychiatry and Behavioral Sciences)
Most Veterans with post-traumatic stress disorder (PTSD) are initially treated for PTSD in Primary Care Mental Health Integration (PCMHI). Poor social support in this population is a risk factor for lack of engagement, non-response to treatment, and suicide. Social support should be assessed and addressed early in treatment, per the VA/DoD Clinical Practice Guidelines for the treatment of PTSD. Thus, there is a need for brief, acceptable and accessible social support enhancement interventions to produce optimal outcomes in PCMHI or prepare Veterans for Evidence-Based Psychotherapies delivered in specialty care.
Behavioral Activation (BA) for PTSD was tested in two separate studies. The first randomized controlled trial compared 8 60-90 -minute sessions of BA to treatment as usual (TAU) in an outpatient specialty mental health setting (n = 80). In the second trial, BA was adapted for PCMHI by reducing the number of sessions and time in session, and offering telephone modality for some sessions. The second feasibility trial delivered 6 45-minute sessions of BA in PCMHI (n = 17).
In the first trial, number of social supports increased significantly from baseline to post-treatment (p < .05), and PTSD (p < .01) and depression (p < .05) symptoms significantly decreased for those receiving BA, but not those in TAU. In the second trial, improvement from baseline to post-treatment was significant for PTSD and depression symptoms (p < .05) and signaled in the appropriate direction for feelings of social connectedness, negative network orientation, and use of emotional support to cope.
Both standard-length BA and brief BA tailored for the PCMHI environment may facilitate an increase in the number of social supports. Given the importance of both structural (e.g., number of supports) and functional (e.g., type of support provided) support, however, future research should attend to strengthening functional elements of support in this population.
The results of the trials presented here demonstrate that BA is effective at increasing social support for this population and may therefore help mitigate a prominent risk factor for poor treatment engagement, treatment non-response, and suicide. Explicitly attending to social support is an important component of PTSD treatment.