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SHP 08-168 – HSR&D Study

SHP 08-168
A Pilot of PTSD-Focused Cognitive Behavior Therapy for Partner Violence
Casey Tyler Taft, PhD
VA Boston Healthcare System Jamaica Plain Campus, Jamaica Plain, MA
Boston, MA
Funding Period: June 2008 - September 2008
IPV is a significant problem among military veterans. Studies using military samples not selected on the basis of psychopathology have found rates of up to three times higher than those found in representative studies of the general population. In addition to the myriad negative consequences for military families, relationship conflict and poor family functioning is associated with a range of negative consequences for the veteran, including mental and physical health problems, increased use of medical and psychiatric services, and lost workdays.

Rates of IPV among veterans with PTSD are two-to-three times higher than those among men without PTSD7 and men in representative community samples. In addition, PTSD symptoms account for the influence of trauma variables on IPV, and strongly predict IPV even while controlling for a range of other factors, such as early life stressors, personality disorders, and war-zone exposure. Taken together, these findings serve as the basis for PFCBT. That is, given the robust relationship between PTSD symptomatology and IPV perpetration, interventions incorporating techniques targeting PTSD and its mechanisms of action should lead to a reduction or a cessation in IPV.

Unfortunately, there is no empirically validated IPV intervention for military veterans, highlighting a need for program modification efforts to meet the needs of military families. We have developed PFCBT in an attempt to address this gap in terms of health service delivery for veterans and their families. Our goal is to use information gathered from pilot data from this project to inform a subsequent, larger-scale health services grant application for a controlled service provision trial. If PFCBT is shown to be effective, we plan on disseminating the intervention to the larger VHA community in order to reduce the occurrence and persistence of IPV among this population.

The primary objective of the proposed work is to further develop and standardize PFCBT for male combat veterans with PTSD. This aim will be fulfilled by accomplishing the following subaims:
(1) To conduct pilot treatment of 15 cases in PFCBT, using information and feedback from clinicians, expert consultants, and session tapes to further develop the treatment manual.
(2) To obtain expert input on PFCBT techniques and treatment manual development by having study personnel review pilot treatment session tapes and drafts of the treatment manual.
(3) To begin to examine the effectiveness of PFCBT using a simple pre-post design.

For the first 16 weeks of the project, one session of the manual was sent to study personnel for review and written feedback. Monthly telephone meetings were held with study personnel to discuss conceptual and implementation issues. Participants were recruited for the pilot PF-RET groups through VA, Vet Center, and community clinical service providers. Their female partners were also included to provide feedback and to facilitate the examination of outcomes.

The outcome of this phase involved the development of a clinician-friendly treatment manual detailing PFCBT and revisions to the client workbook. In addition, 7 veterans enrolled in the study and completed an initial assessment. Four veterans enrolled in the first pilot group which began October 7, 2008 and remains ongoing. The remaining 3 veterans enrolled after the initial group started and will participate in a second pilot group to begin in February 2009. One objective of this study shifted from conducting pilot treatment to developing a thorough recruitment strategy. In the initial months of funding, study staff focused their efforts on building a referral network and recruitment materials. While this was outside the scope of the original proposal, these efforts were tremendously valuable to the development of the project in preparation for a clinical trial.

IPV is a serious national public health problem, and the proposed intervention may help to reduce the deleterious impact of IPV and IPV perpetration recidivism.

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None at this time.

DRA: none
DRE: none
Keywords: none
MeSH Terms: none

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