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RCD 06-020 – HSR&D Study

 
RCD 06-020
Mental Health Services Interventions for Veterans with PTSD
Jennifer L Strauss BA MS PhD
Durham VA Medical Center, Durham, NC
Durham, NC
Funding Period: January 2007 - July 2011

BACKGROUND/RATIONALE:
Relative to the general populations, military veterans are disproportionately impacted by traumatic events, including sexual trauma during the course of military service (military sexual trauma; MST) and exposure to combat. Although increasingly available through VA, current evidence-based therapies for posttraumatic stress disorder (PTSD) are not well-tolerated or available to all veterans, and require substantial clinical training and clinician-patient contact to administer. A pressing challenge for VA is to develop effective, low-cost interventions that can be rapidly disseminated, particularly to those who may not otherwise access VA care (e.g., not geographically located near a VA or work schedule precludes regular attendance at VA). Hence, we developed a guided imagery skills training intervention for veterans with PTSD that is largely self-administered with regular telephone contact and support from a mental health clinician.

OBJECTIVE(S):
Two primary research projects are proposed. (1) Conduct a randomized clinical trial of the Guided Imagery for Trauma (GIFT) intervention in women veterans with MST-related PTSD. (2) Adapt GIFT for Veterans with Combat-Related PTSD.


METHODS:
For project #1, 50 women veterans with MST-related PTSD were recruited by clinician-referral from the Durham VAMC's women's mental health clinic and randomized either to the 12-week GIFT intervention or a relaxing music control condition. Both groups received 2, 50-minute, individual sessions with a clinical social worker, and weekly, 10-minute telephone calls during the 12-week study period. GIFT patients received guided imagery skills training audios whereas control patients received a relaxing music audio, in lieu of the guided imagery exercises. Change in PTSD symptoms (assessed with the Clinician-Administered PTSD Scale) was the primary outcome. For project #2, the GIFT protocol was revised on the basis of pilot findings, including feedback received during Project #1. Intervention length was reduced from 12 to 8 weeks, additional guided imagery audio tracks were introduced to broader options for skills training, including management of specific PTSD symptoms such as sleep. Finally, in order to broadly appeal to male and female veterans, and minimize stigma, the intervention as renamed: Self-Management Audio for Recovery from Trauma (SMART). We enrolled 20, clinician-referred male veterans with combat-related PTSD into an open trial of the SMART intervention.


FINDINGS/RESULTS:
Not yet available.

IMPACT:
SMART is a brief, clinician-facilitated, skills training intervention designed to be administered remotely with minimal clinical contact. If effective, SMART may improve treatment access, engagement, and outcomes for veterans with PTSD, and expand VA's ability to provide patient-centered, cost-effective treatment.


External Links for this Project

Dimensions for VA

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PUBLICATIONS:

Journal Articles

  1. Naylor JC, Kilts JD, Hulette CM, Steffens DC, Blazer DG, Ervin JF, Strauss JL, Allen TB, Massing MW, Payne VM, Youssef NA, Shampine LJ, Marx CE. Allopregnanolone levels are reduced in temporal cortex in patients with Alzheimer's disease compared to cognitively intact control subjects. Biochimica Et Biophysica Acta. 2010 Aug 1; 1801(8):951-9. [view]
  2. Youssef NA, Marx CE, Bradford DW, Zinn S, Hertzberg MA, Kilts JD, Naylor JC, Butterfield MI, Strauss JL. An open-label pilot study of aripiprazole for male and female veterans with chronic post-traumatic stress disorder who respond suboptimally to antidepressants. International Clinical Psychopharmacology. 2012 Jul 1; 27(4):191-6. [view]
  3. Naylor JC, Hulette CM, Steffens DC, Shampine LJ, Ervin JF, Payne VM, Massing MW, Kilts JD, Strauss JL, Calhoun PS, Calnaido RP, Blazer DG, Lieberman JA, Madison RD, Marx CE. Cerebrospinal fluid dehydroepiandrosterone levels are correlated with brain dehydroepiandrosterone levels, elevated in Alzheimer's disease, and related to neuropathological disease stage. The Journal of clinical endocrinology and metabolism. 2008 Aug 1; 93(8):3173-8. [view]
  4. Hayes AM, Laurenceau JP, Feldman G, Strauss JL, Cardaciotto L. Change is not always linear: the study of nonlinear and discontinuous patterns of change in psychotherapy. Clinical Psychology Review. 2007 Jul 1; 27(6):715-23. [view]
  5. Henderson C, Jackson C, Slade M, Young AS, Strauss JL. How should we implement psychiatric advance directives? Views of consumers, caregivers, mental health providers and researchers. Administration and policy in mental health. 2010 Nov 1; 37(6):447-58. [view]
  6. Calhoun PS, Stechuchak KM, Strauss J, Bosworth HB, Marx CE, Butterfield MI. Interpersonal trauma, war zone exposure, and posttraumatic stress disorder among veterans with schizophrenia. Schizophrenia Research. 2007 Mar 1; 91(1-3):210-6. [view]
  7. Strauss JL, Marx CE, Weitlauf JC, Stechuchak KM, Straits-Troster K, Worjoloh AW, Sherrod CB, Olsen MK, Butterfield MI, Calhoun PS. Is military sexual trauma associated with trading sex among women veterans seeking outpatient mental health care? Journal of trauma & dissociation : the official journal of the International Society for the Study of Dissociation (ISSD). 2011 Jan 1; 12(3):290-304. [view]
  8. Youssef NA, Ege M, Angly SS, Strauss JL, Marx CE. Is obstructive sleep apnea associated with ADHD? Annals of clinical psychiatry : official journal of the American Academy of Clinical Psychiatrists. 2011 Aug 1; 23(3):213-24. [view]
  9. Kilts JD, Tupler LA, Keefe FJ, Payne VM, Hamer RM, Naylor JC, Calnaido RP, Morey RA, Strauss JL, Parke G, Massing MW, Youssef NA, Shampine LJ, tVeterans Affairs Mid-Atlantic Mental Illness, Research, Education and Clinical Center Workgroup, Marx CE. Neurosteroids and self-reported pain in veterans who served in the U.S. Military after September 11, 2001. Pain medicine (Malden, Mass.). 2010 Oct 1; 11(10):1469-76. [view]
  10. Allen KD, Bosworth HB, Brock DS, Chapman JG, Chatterjee R, Coffman CJ, Datta SK, Dolor RJ, Jeffreys AS, Juntilla KA, Kruszewski J, Marbrey LE, McDuffie J, Oddone EZ, Sperber N, Sochacki MP, Stanwyck C, Strauss JL, Yancy WS. Patient and provider interventions for managing osteoarthritis in primary care: protocols for two randomized controlled trials. BMC musculoskeletal disorders. 2012 Apr 24; 13(1):60. [view]
  11. Marx CE, Bradford DW, Hamer RM, Naylor JC, Allen TB, Lieberman JA, Strauss JL, Kilts JD. Pregnenolone as a novel therapeutic candidate in schizophrenia: emerging preclinical and clinical evidence. Neuroscience. 2011 Sep 15; 191:78-90. [view]
  12. Zervakis JB, Stechuchak KM, Olsen MK, Swanson JW, Oddone EZ, Weinberger M, Bryce ER, Butterfield ML, Swartz MS, Strauss JL. Previous Involuntary Commitment is Associated with Current Perceptions of Coercion in Voluntarily Hospitalized Patients. International Journal of Forensic Mental Health. 2007 Nov 1; 6(No. 2):105-112. [view]
  13. Marx CE, Keefe RS, Buchanan RW, Hamer RM, Kilts JD, Bradford DW, Strauss JL, Naylor JC, Payne VM, Lieberman JA, Savitz AJ, Leimone LA, Dunn L, Porcu P, Morrow AL, Shampine LJ. Proof-of-concept trial with the neurosteroid pregnenolone targeting cognitive and negative symptoms in schizophrenia. Neuropsychopharmacology. 2009 Jul 1; 34(8):1885-903. [view]
  14. Hayes JP, LaBar KS, McCarthy G, Selgrade E, Nasser J, Dolcos F, VISN 6 Mid-Atlantic MIRECC workgroup, Morey RA. Reduced hippocampal and amygdala activity predicts memory distortions for trauma reminders in combat-related PTSD. Journal of psychiatric research. 2011 May 1; 45(5):660-9. [view]
Journal Other

  1. Perlick DA, Straits-Troster K, Dyck DG, Dennis G, Norell DM, Strauss JL, Henderson C, Close J, Berger N, Bonuck ER, Taber KH, Kalvin CD, Trygve CA. Multifamily group treatment for veterans with traumatic brain injury. [Abstract]. Professional Psychology, Research and Practice. 2011 Feb 2; 42(1):70-78. [view]
Books

  1. Williams JW, Gierisch JM, McDuffie J, Strauss JL, Nagi A. An Overview of Complementary and Alternative Medicine Therapies for Anxiety and Depressive Disorders: Supplement to Efficacy of Complementary and Alternative Medicine Therapies for Posttraumatic Stress Disorder. 8/11 ed. Washington (DC): Department of Veterans Affairs; 2011. 20 p. [view]
Book Chapters

  1. Strauss JL, Calhoun PS. Adherence and Psychotherapy. In: Improving Patient Treatment Adherence: A Clinician's Guide. New York, NY: Springer; 2010. Chapter 9. 215-240 p. [view]
  2. Eggleston AM, Strauss JL, Guerra VS, Calhoun PS. Adherence and Substance Use. In: Improving Patient Treatment Adherence: A Clinician's Guide. New York, NY: Springer; 2010. Chapter 12. 289-310 p. [view]
  3. Kilts JD, Naylor JC, Payne VM, Strauss JL, Calhoun PS, Marx CE. Chemical Messengers. In: Steffens D, Blazer DG, editors. Textbook of Geriatric Psychiatry. 4th ed. Arlington, VA: American Psychiatric Publishing, Inc; 2009. 95-118 p. [view]
  4. Strauss JL. Guided Imagery as a Therapeutic Tool in Post-traumatic Stress Disorder. In: Shiromani PJ, Keane TM, LeDoux JE, editors. Post-Traumatic Stress Disorder: Basic Science and Clinical Practice. New York, NY: Springer; 2009. Chapter 17. 363-375 p. [view]
  5. Strauss JL, Marx CE, Calhoun PS. Guided imagery as a therapeutic tool in PTSD. In: Keane T, LeDoux J, Shiromani P, editors. Neurobiology of PTSD. Totowa, NJ: Humana Press, Inc.; 2009. 363-374 p. [view]
  6. Straits-Troster K, Gierisch JM, Calhoun PS, Strauss JL, Voils CI, Kudler H. Living in Transition: Veterans’ perspectives on the post-deployment shift to civilian and family life. In: Treating Young Veterans: Promoting Resilience through Practice and Advocacy. New York, NY: Springer Publishing Company; 2011. 384 p. [view]
Newspaper Articles

  1. Strauss. Duke, VA study focuses on women's sexual trauma while on military duty. The Durham Herald-Sun. 2007 Feb 19. [view]
  2. Strauss. Treating PTSD in non-traditional ways. Veterans of Foreign War Magazine. 2007 Feb 1. [view]
Reports

  1. Strauss JL, Coeytaux R, McDuffie J, Williams JW. Efficacy of Complementary and Alternative Medicine Therapies for Posttraumatic Stress Disorder. Washington, DC: HSR&D; 2011 Aug 1. 79 p. [view]
Conference Presentations

  1. Strauss JL, Marx CE, Morey RA, Jeffreys A, Almirall D, Olsen M, Coffman C, O'Loughlin S, Oddone EZ, Butterfield ML. A Brief, Transportable Intervention for Women Veterans with PTSD Related to Military Sexual Trauma. Paper presented at: Force Health Protection Annual Conference; 2007 Aug 15; Louisville, KY. [view]
  2. Strauss JL, Jeffreys AL, Marx CE, Morey RA, Almirall D, Oloughlin SH, Close J, Chaudhry N, Oddone EZ. A Clinician-Facilitated, Self-Management Intervention to Improve Access and Outcomes for Women Survivors of Military Sexual Trauma: RCT Results. Poster session presented at: VA HSR&D Career Development Annual Meeting; 2010 Feb 27; San Francisco, CA. [view]
  3. Strauss JL, Oddone EZ. A Novel Self-Management Intervention for PTSD Related to Military Sexual Trauma: Early RCT Findings. Paper presented at: International Society for Traumatic Stress Studies Annual Meeting; 2008 Nov 15; Chicago, IL. [view]
  4. Strauss JL, Coffman CJ, Olsen MK, Marx CE, Oddone EZ, O'Loughlin SH, Butterfield MI. A self-management intervention to improve outcomes of PTSD related to military sexual trauma. Paper presented at: Futures Without Violence Health and Domestic Violence National Biennial Conference; 2007 Mar 1; San Francisco, CA. [view]
  5. Strauss JL, Jeffreys AL, Marx CE, Morey R, Almirall D, Oloughlin SH, Butterfield MI, Oddone EZ. A Tele-health Approach to Enhancing Treatment Engagement and Symptom Self-management for Women Veterans with PTSD Related to Military Sexual Trauma: RCT Results. Poster session presented at: VA Implementing a Public Health Model for Meeting the Mental Health Needs of Veterans Annual Mental Health Conference; 2010 Jul 1; Baltimore, MD. [view]
  6. Strauss JL, Marx CE, Jeffreys AL, Almirall D, Chaudhry N, Oddone EZ. A telemental health-self-management intervention to improve symptoms, access, and treatment engagement for women Veterans with PRSD related to military sexual trauma: RCT results. Paper presented at: VA HSR&D Field-Based Mental Health and Substance Use Disorders Meeting; 2010 Apr 1; Little Rock, AR. [view]
  7. Strauss, Jeffreys, Almirall, Marx, Morey, Olsen, O'Loughlin, Close, Chaudhry, Oddone, Butterfield. A Transportable, Self-Management Intervention for PTSD Related to Military Sexual Trauma: Preliminary Findings from a Randomized Trial. Paper presented at: VA Career Development Award Program Annual Conference; 2008 Feb 13; Baltimore, MD. [view]
  8. Straits-Troster K, Perlick D, Kline A, Norell D, Strauss JL. Adaptation of multi-family group treatment for Veterans with traumatic brain injury and their families. Poster session presented at: International Society for Traumatic Stress Studies Annual Meeting; 2009 Nov 10; Atlanta, GA. [view]
  9. Payne, Naylor, Hamer, Kilts, Strauss, Herzberg, Davidson, Marx. Adjunctive Pregnenolone in PTSD: Proof-of-Concept Findings Consistent with Antidepressant and Resilience-Enhancing Actions. Paper presented at: VA MIRECC Annual Best Practices in Mental Health Conference; 2008 Jul 10; Arlington, VA. [view]
  10. Naylor JC, Strauss JL. Adjunctive Treatment with Aripiprazole for OEF/OIF-Era Veterans with PTSD. Poster session presented at: VA Mental Health Leadership Conference; 2010 Jul 27; Baltimore, MD. [view]
  11. Youssef NA, Kilts J, Payne V, Strauss JL. Amino acids as candidate biomarkers for suicidality in Operation Enduring Freedom/Operation Iraqi Freedom era Veterans. Poster session presented at: American College of Neuropsychopharmacology Annual Meeting; 2009 Dec 1; Hollywood, FL. [view]
  12. Strauss JL, Marx CE, Weitlauf JC, Stechuchak KM, Straits-Troster K, Worjoloh AW, Olsen MK, Butterfield MI, Calhoun PS. Associations between military sexual trauma and trading sex for payment among women veterans receiving outpatient mental health treatment. Poster session presented at: VA HSR&D Field-Based Women's Health Meeting; 2010 Jul 10; Arlington, VA. [view]
  13. Strauss JL. Associations between trading sex for payment and trauma history in male Veterans with severe mental illness. Poster session presented at: International Society for Traumatic Stress Studies Annual Meeting; 2009 Nov 10; Atlanta, GA. [view]
  14. Cho A, Jackson GL, McDuffie J, Strauss JL, Bolton K, Yancy WS. Baseline psychosocial predictors of six-month weight loss outcomes among participants in a clinical trial of diet-based strategies. Paper presented at: AcademyHealth Annual Research Meeting; 2007 Jun 7; Orlando, FL. [view]
  15. Strauss JL, O'Loughlin S, Keng SL, Stechuchak K, Olsen M, Zervakis J, Elbogen E, Oddone EZ, Weinberger M, Swartz M, Butterfield ML. Content analysis of psychiatric advance directives: treatment preferences expressed by veterans with sever mental illness. Poster session presented at: VA HSR&D National Meeting; 2006 Nov 1; Arlington, VA. [view]
  16. Strauss JL, Marx CE, Morey RA, Jeffreys A, Almirall D, Olsen M, Coffman C, O'Loughlin S, Oddone EZ, Butterfield ML. Effects of Military Sexual Trauma on Women Veterans. Paper presented at: American Veterans (AMVETS) Annual Convention; 2007 Aug 10; Greensboro, NC. [view]
  17. Strauss, Marx, Morey, Jeffreys, Almirall, O'Loughlin, Close, Chaudhry, Oddone. Effects of Military Sexual Trauma on Women Veterans. Paper presented at: American Veterans (AMVETS) Annual Convention; 2008 Aug 20; Orlando, FL. [view]
  18. Newman CF, Strauss JL. Finding the "golden mean" of stress and growth in the therapeutic relationship with patients with personality disorders. Presented at: World Congresses of Cognitive and Behaviour Therapy Triennial Meeting; 2007 Jul 1; Barcelona, Spain. [view]
  19. Strauss JL. GIFT: A Tele-Mental Health, Self-Management Intervention for Women Veterans with PTSD Related to Military Sexual Trauma - RCT Results. Paper presented at: North Carolina Governor's Focus on Servicemembers, Veterans, and Their Families Meeting; 2010 Sep 15; Raleigh, NC. [view]
  20. Strauss JL, Jeffreys A, Almiral D, Marx C, Morey R, Olsen M, Oloughlin S, Close J, Chaudhry C, Butterfield M, Oddone EZ. Guided Imagery for Military Sexual Trauma-Related PTSD. Paper presented at: VA VHA Senior Leadership Conference; 2008 Aug 14; Washington, DC. [view]
  21. Strauss JL, Marx CE, Morey RA, Jeffreys AS, Almirall D, Olsen MK, Chaudhry N, Oloughlin SH, Oddone EZ, Butterfield MI. Guided Imagery for Trauma (GIFT): Preliminary Findings of a Randomized Trial in Women Veterans with Posttraumatic Stress Disorder Related to Military Sexual Trauma. Paper presented at: Natural Health Research Institute Annual Symposium; 2008 Feb 1; El Paso, TX. [view]
  22. Strauss JL, Henderson RC, Jackson C, Slade M, Young AS, Strauss JL. How should we implement psychiatric advance directives? Paper presented at: Institute on Psychiatric Services Annual Meeting; 2009 Oct 15; New York, NY. [view]
  23. Strauss JL. Imagery in the Treatment of PTSD in Female Veterans. Paper presented at: Samueli Institute's Brain, Mind and Healing Annual Seminar; 2010 Jan 15; Alexandria, VA. [view]
  24. Jackson GL, Cho A, Strauss JL, McDuffie J, Grambow SC, Jeffreys AL, Yancy WS. Impact of Perceived Ability to Cope with Stress on Desired and Actual Weight Loss. Paper presented at: AcademyHealth Annual Research Meeting; 2010 Jun 28; Boston, MA. [view]
  25. Becker M, Calhoun P, Beckham J, Strauss JL. Lifespan implications of childhood adversity in women veterans: domestic environments as risk/resilience factors. Poster session presented at: International Society for Traumatic Stress Studies Annual Meeting; 2006 Nov 1; Hollywood, CA. [view]
  26. Strauss JL, Lapp K, Bosworth HB, Stechuchak KM, Calhoun PS, Bryce ER, Zervakis JB, Butterfield MI. Lifetime sexual and physical victimization among male veterans with combat-related PTSD. Paper presented at: Futures Without Violence Health and Domestic Violence National Biennial Conference; 2007 Mar 1; San Francisco, CA. [view]
  27. Perlick D, Straits-Troster K, Kline A, Dyck D, Strauss JL. Multi-Group Intervention for OEF/OIF Veterans with Traumatic Brain Injury and their Families. Poster session presented at: Department of Defense / Congressionally Directed Medical Research Programs Military Health Research Forum; 2009 Aug 15; Kansas City, MO. [view]
  28. Payne V, Youssef NA, Strauss JL. Pilot randomized controlled trial of adjunctive aripiprazole for PTSD in Veterans who served in the U.S. military after September 11,2001. Poster session presented at: American College of Neuropsychopharmacology Annual Meeting; 2009 Dec 5; Hollywood, FL. [view]
  29. Strauss JL, Weitlauf JC, Stechuchak KM, Calhoun PS, Straits-Troster K, Marz CE, Olsen MK, Oloughlin SH, Close J, Butterfield MI, Oddone EZ. Prevalence and Correlates of Trading Sex for Payment Among Male Veterans with Severe Mental Illness. Poster session presented at: VA MIRECC Annual Best Practices in Mental Health Conference; 2009 Jul 15; Washington, DC. [view]
  30. Straits-Troster K, Calhoun PS, Strauss JL, Gierisch JM, Kudler H. Programmatic Expansion of Tailored Post-Deployment Mental Health Services through Needs Assessment. Poster session presented at: International Society for Traumatic Stress Studies Annual Meeting; 2012 Nov 16; Los Angeles, CA. [view]
  31. Straits-Troster K, Calhoun P, Butterfield MI, Boggs C, Strauss JL. PTSD and hepatitis C infection: Association with quality of life and health behaviors. Poster session presented at: International Society for Traumatic Stress Studies Annual Meeting; 2006 Nov 1; Hollywood, CA. [view]
  32. Calhoun P, Boggs C, Straits-Troster K, Becker M, Strauss JL. PTSD mediates the relationship between trauma and health service use in women with depression. Poster session presented at: International Society for Traumatic Stress Studies Annual Meeting; 2006 Nov 1; Hollywood, CA. [view]
  33. Calhoun PS, Becker M, Boggs C, Straits-Troster K, Strauss JL. Quality of life, medication adherence, and health service use in women with depression and posttraumatic stress disorder. Poster session presented at: International Society for Traumatic Stress Studies Annual Meeting; 2006 Nov 1; Hollywood, CA. [view]
  34. Strauss JL. Results from a randomized controlled trial to facilitate the use of psychiatric advance directives: Lessons learned. Poster session presented at: VA HSR&D National Meeting; 2008 Feb 14; Baltimore, MD. [view]
  35. Strauss JL. Self-Management and Complementary-Alternative Interventions for Veterans with PTSD. Poster session presented at: VA HSR&D Career Development Annual Meeting; 2011 Feb 16; National Harbor, MD. [view]
  36. Naylor JC, Strauss JL, Payne VM, Kilts JD. Subthreshold PTSD in Veterans who Served During Operation Enduring Freedom (OEF) / Operation Iraqi Freedom (OIF): A Pilot Randomized Controlled Trial with Paraxetine. Paper presented at: American College of Neuropsychopharmacology Annual Meeting; 2008 Dec 1; Scottsdale, AZ. [view]
  37. Weitlauf JC, Strauss JL, Calhoun PS. Trading sex for payment associated with trauma history in male Veterans with severe mental illness. Poster session presented at: International Society for Traumatic Stress Studies Annual Meeting; 2009 Nov 5; Atlanta, GA. [view]


DRA: Military and Environmental Exposures, Mental, Cognitive and Behavioral Disorders, Health Systems
DRE: Treatment - Observational, Treatment - Efficacy/Effectiveness Clinical Trial
Keywords: PTSD
MeSH Terms: none

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