BACKGROUND/RATIONALE:
While exposure therapies for posttraumatic stress disorder (PTSD) result in clinically significant symptom relief for many patients, these interventions still leave room for improvement. Treatment dropout rates are high, and lower effect sizes are found for Veteran populations. Involving intimate partners, one's primary source of social support, may provide a powerful method for promoting treatment adherence and, as a result, optimize symptom reductions among Veterans receiving exposure therapy. Despite recommendations by VA, NIMH, APA, national practice guidelines, and Congressional legislation to prioritize family involvement in the treatment of PTSD, evidence-based guidelines for precisely how to involve intimate partners in exposure based PTSD treatments have yet to be developed. The overarching goal of my CDA is to develop and test an innovative intervention promoting Veterans' adherence to Prolonged Exposure (PE), the most extensively validated treatment for PTSD, through systematically involving intimate partners in Veterans' care (i.e., Partner Enhanced PE; PE2).

OBJECTIVE(S):
1) Acquire insiders' (national PE experts, PE consultants, and former PE participants and their intimate partners) perspectives to (A) refine and expand a conceptual model of how intimate relationships influence adherence to PE and (B) develop hypotheses for best methods for involving intimate partners. 2) Survey veterans referred for evidence-based treatments for PTSD and their intimate partners to (A) assess adherence to exposure therapies, (B) describe veterans' and significant others' preferences for adjunctive intervention components for enhancing adherence, and (C) test associations between conceptual model elements and treatment adherence and outcome. 3) Pilot PE2 to identify strengths and flaws of the intervention and assess feasibility, acceptability, and initial effect sizes.

METHODS:
For Objective 1, a series of qualitative interviews will be conducted. Objective 2 will be achieved through a mixed methods project including mailed surveys and qualitative interviews of veterans and their significant others as they participate in evidence-based treatments for PTSD. For objective 3, I will draft an initial treatment manual informed through work from the prior two objectives, then conduct a small randomized pilot comparing PE2 to treatment-as-usual (standard PE).

FINDINGS/RESULTS:
Not yet available.

IMPACT:
Untreated, symptoms of PTSD persist chronically for many, and for those who attend empirically supported treatments, poor adherence can greatly handicap participants' potential for recovery. Including partners in PE may provide a compelling means to promote adherence and optimize treatment response. Such family-centered approaches may promote better overall health, quality of life, and successful reintegration. The agenda set in motion by this CDA supports a pivotal shift within the VA from a restrictive focus on traditional individual-level mental health treatments to family-centered, evidence-based approaches that promote adherence, quality of life, family adjustment, and better comprehensive care for veterans. Manuscripts generated from the research conducted during the course of this award are in preparation. The PI received notice of intent-to-fund an HSR&D IIR proposal generated from this work and plans to begin work on this IIR in the next year.

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External Links for this Project

NIH Reporter

Grant Number: IK2HX000755-01
Link: https://reporter.nih.gov/project-details/8202312

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PUBLICATIONS:

Journal Articles

1. Rosen CS, Matthieu MM, Wiltsey Stirman S, Cook JM, Landes S, Bernardy NC, Chard KM, Crowley J, Eftekhari A, Finley EP, Hamblen JL, Harik JM, Kehle-Forbes SM, Meis LA, Osei-Bonsu PE, Rodriguez AL, Ruggiero KJ, Ruzek JI, Smith BN, Trent L, Watts BV. A Review of Studies on the System-Wide Implementation of Evidence-Based Psychotherapies for Posttraumatic Stress Disorder in the Veterans Health Administration. Administration and policy in mental health. 2016 Nov 1; 43(6):957-977. [view]
2. Reddy MK, Meis LA, Erbes CR, Polusny MA, Compton JS. Associations among experiential avoidance, couple adjustment, and interpersonal aggression in returning Iraqi war veterans and their partners. Journal of consulting and clinical psychology. 2011 Aug 1; 79(4):515-20. [view]
3. Griffin JM, Lee MK, Bangerter LR, Van Houtven CH, Friedemann-Sánchez G, Phelan SM, Carlson KF, Meis LA. Burden and mental health among caregivers of veterans with traumatic brain injury/polytrauma. The American Journal of Orthopsychiatry. 2017 Jan 1; 87(2):139-148. [view]
4. Erbes CR, Meis LA, Polusny MA, Compton JS. Couple adjustment and posttraumatic stress disorder symptoms in National Guard veterans of the Iraq war. Journal of family psychology : JFP : journal of the Division of Family Psychology of the American Psychological Association (Division 43). 2011 Aug 1; 25(4):479-87. [view]
5. Meis LA, Griffin JM, Greer N, Jensen AC, Macdonald R, Carlyle M, Rutks I, Wilt TJ. Couple and family involvement in adult mental health treatment: a systematic review. Clinical Psychology Review. 2013 Mar 1; 33(2):275-86. [view]
6. Griffin JM, Meis LA, Greer NL, MacDonald R, Jensen AC, Rutks IR, Carlyle M, Wilt TJ. Effectiveness of Caregiver Interventions on Patient Outcomes in Adults With Dementia or Alzheimer’s Disease: A Systematic Review. Gerontology & geriatric medicine. 2015 Jul 21; doi: 10.1177/2333721415595789:1-17. [view]
7. Griffin JM, Meis LA, MacDonald R, Greer N, Jensen A, Rutks I, Wilt TJ. Effectiveness of family and caregiver interventions on patient outcomes in adults with cancer: a systematic review. Journal of general internal medicine. 2014 Sep 1; 29(9):1274-82. [view]
8. Polusny MA, Ries BJ, Meis LA, DeGarmo D, McCormick-Deaton CM, Thuras P, Erbes CR. Effects of parents' experiential avoidance and PTSD on adolescent disaster-related posttraumatic stress symptomatology. Journal of family psychology : JFP : journal of the Division of Family Psychology of the American Psychological Association (Division 43). 2011 Apr 1; 25(2):220-9. [view]
9. Hanson KT, Carlson KF, Friedemann-Sanchez G, Meis LA, Van Houtven CH, Jensen AC, Phelan SM, Griffin JM. Family caregiver satisfaction with inpatient rehabilitation care. PLoS ONE. 2019 Mar 15; 14(3):e0213767. [view]
10. Renshaw KD, Campbell SB, Meis L, Erbes C. Gender differences in the associations of PTSD symptom clusters with relationship distress in U.S. Vietnam veterans and their partners. Journal of traumatic stress. 2014 Jun 1; 27(3):283-90. [view]
11. Meis LA, Polusny MA, Erbes CR. Interest in Partner-Involved Services Among Veterans Seeking Mental Health Care From a VA PTSD Clinic. Psychological trauma : theory, research, practice and policy. 2012 Aug 20. [view]
12. Meis LA, Noorbaloochi S, Hagel Campbell EM, Erbes CR, Polusny MA, Velasquez TL, Bangerter A, Cutting A, Eftekhari A, Rosen CS, Tuerk PW, Burmeister LB, Spoont MR. Sticking it out in trauma-focused treatment for PTSD: It takes a village. Journal of consulting and clinical psychology. 2019 Mar 1; 87(3):246-256. [view]
13. Meyers L, Voller EK, McCallum EB, Thuras P, Shallcross S, Velasquez T, Meis L. Treating Veterans With PTSD and Borderline Personality Symptoms in a 12-Week Intensive Outpatient Setting: Findings From a Pilot Program. Journal of traumatic stress. 2017 Apr 1; 30(2):178-181. [view]
14. Kehle-Forbes SM, Meis LA, Spoont MR, Polusny MA. Treatment initiation and dropout from prolonged exposure and cognitive processing therapy in a VA outpatient clinic. Psychological trauma : theory, research, practice and policy. 2016 Jan 1; 8(1):107-14. [view]
15. Meis LA, Erbes CR, Kramer MD, Arbisi PA, Kehle-Forbes SM, DeGarmo DS, Shallcross SL, Polusny MA. Using reinforcement sensitivity to understand longitudinal links between PTSD and relationship adjustment. Journal of family psychology : JFP : journal of the Division of Family Psychology of the American Psychological Association (Division 43). 2017 Feb 1; 31(1):71-81. [view]
16. Thompson-Hollands J, Burmeister LB, Rosen CS, O'Dougherty M, Erickson EPG, Meis LA. Veterans with poor PTSD treatment adherence: Exploring their loved ones' experience of PTSD and understanding of PTSD treatment. Psychological Services. 2021 May 1; 18(2):216-226. [view]

Books

1. Meis L, Griffin J, Greer N, Jensen A, Carlyle M, MacDonald R, Rutks I, Wilt TJ. Family Involved Psychosocial Treatments for Adult Mental Health Conditions: A Review of the Evidence. Washington (DC): Department of Veterans Affairs; 2012. [view]

HSR&D or QUERI Publications

1. Griffin JM, Meis LA, Wilt TJ. Effectiveness of Family and Caregiver Interventions on Patient Outcomes among Adults with Cancer or Memory-Related Disorders: A Systematic Review. 2013 Apr 1. [view]
2. Spoont MR, Fu SS, Kehle-Forbes SM, Meis LA, Wilt TJ. Screening for Post-Traumatic Stress Disorder (PTSD) in Primary Care: A Systematic Review. 2013 Jan 1. [view]

Conference Presentations

1. Meis LA, Spoont MR, Erbes CR, Polusny MA, Noorbaloochi S, Hagel Campbell EM, Eftekhari M, Kattar A, Rosen K, Tuerk P, Velasquez TL, Erickson E, Thompson K, Stewart K, Vang T. Because I asked you to: The role of family in Veterans' engagement in trauma-focused treatment for PTSD. Presented at: International Society for Traumatic Stress Studies Annual Symposium; 2015 Nov 5; New Orleans, LA. [view]
2. Meis LA, Spoont MR, Noorbaloochi S, Hagel Campbell EM, Erbes CR, Polusny MA, Eftekhari A, Rosen C, Tuerk PW, Kattar KA, Velasquez TL, Cutting AH, Burmeister LB, Henriksen KR, Baltutis E, Rynda KM. Can Families Help Shape Former Service Members' Adherence to Trauma-Focused Treatments for PTSD? Poster session presented at: Military Health System Research Symposium; 2016 Aug 16; Orlando/Kissimmee, FL. [view]
3. Meis LA, Spoont MR, Erbes CR, Polusny MA, Noorbaloochi S, Hagel Campbell EM, Bangerter AK, Eftekhari A, Kattar K, Tuerk P. Can Families Help Shape Veteran's Opinions of and Response to Evidence Based Treatments for PTSD? Poster session presented at: International Society for Traumatic Stress Studies Annual Symposium; 2014 Nov 6; Miami, FL. [view]
4. Spoont MR, Nelson DB, Kehle-Forbes SM, Meis LA. Inequity in Psychotherapy Services among Racial and Ethnic Minority Veterans with PTSD. Presented at: VA HSR&D / QUERI National Meeting; 2015 Jul 10; Philadelphia, PA. [view]
5. Meis L, Spoont M, Erbes C, Polusny M, Noorbaloochi S, Hagel EC, Bangerter A, Eftekhari A, Kattar K, Tuerk PW. The Role of Individual Beliefs and Family Involvement in Understanding Veterans’ Commitment to Evidence Based Treatments for PTSD. Paper presented at: International Society for Traumatic Stress Studies Annual Symposium; 2014 Nov 6; Miami, FL. [view]

DRA: Military and Environmental Exposures, Mental, Cognitive and Behavioral Disorders
DRE: Treatment - Observational, Treatment - Comparative Effectiveness
Keywords: none
MeSH Terms: none