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CDA 13-017 – HSR Study

CDA 13-017
Problem-Solving Therapy for Gulf War Illness
Lisa Marie McAndrew, PhD
East Orange Campus of the VA New Jersey Health Care System, East Orange, NJ
East Orange, NJ
Funding Period: May 2014 - April 2019
There are almost 700,000 Gulf War Veterans (GWV) with 25-30% suffering from a devastating multi-symptom illness coined Gulf War Illness (GWI). GWV with GWI report significant activity limitations and chronic cognitive problems consistent with problem-solving deficits. Problem-solving is considered the most complex of cognitive abilities and is what enables us to conduct complicated behaviors such as setting goals, sequencing and multi-tasking. Problem-solving deficits are prospectively related to a greater risk of disability. Despite published reports documenting these problems there are no treatments that target the problem-solving deficits of GWI. This proposal seeks to determine whether Problem-Solving Therapy, a patient centered cognitive rehabilitation therapy, can reduce disability by compensating for problem-solving deficits.

I will execute a research program to adapt and test a promising cognitive rehabilitation treatment, Problem-Solving Therapy. Problem-Solving Therapy, a top down approach, teaches patients skills to overcome problems like cognitive dysfunction that impact problem-solving. Compensating for problem-solving deficits would reduce disability and provide information on the effect of treating one component of GWI on other symptoms of GWI. It has been found to be efficacious among civilians with mild traumatic brain injury. This is the first trial of cognitive rehabilitation therapy for GWI.

I will use qualitative methods to better understand GWVs' views on GWI and our proposed intervention. I will modify Problem-Solving Therapy for use with GWV with GWI. I will examine the efficacy of this modified Problem-Solving Therapy for reducing the disability associated with GWI in a multi-site randomized controlled trial (n=258) of telephone delivered Problem-Solving Therapy versus Health Education. Future work will include broader dissemination and implementation of best practices for Problem-Solving Therapy for GWV and other populations.

Not yet available.

In January 2013, the Institute of Medicine released their report "Gulf War and Health: Treatment for Chronic Multisymptom Illness." They recommend that "The Department of Veterans Affairs should fund and conduct studies of interventions that evidence suggests may hold promise for treatment of [GWI]." In response, I propose Problem-Solving Therapy, an innovative and targeted cognitive rehabilitation approach that improves the situations and problems of the patient's choice. The direct benefits for GWVs are hypothesized to include improvements in problem-solving and reductions in disability, defined as participation and daily activity deficits.

External Links for this Project

NIH Reporter

Grant Number: IK2HX001369-01A1

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None at this time.

DRA: Military and Environmental Exposures, Mental, Cognitive and Behavioral Disorders
DRE: Technology Development and Assessment, Treatment - Efficacy/Effectiveness Clinical Trial
Keywords: Career Development
MeSH Terms: none

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