Feasibility of multimodal group treatment for veterans with PTSD, depression, and high-risk drinking: A pilot study
Abstract: U.S. military veterans experience a wide range of postdeployment psychological problems, including disproportionate rates of posttraumatic stress disorder (PTSD), depression, and high-risk drinking. First-line psychological treatments for these conditions (e.g., cognitive-behavioral therapy) are effective but can be lengthy and intensive, leading many veterans to drop out of treatment. A novel brief multimodal group treatment (MMGT) program has been developed as an alternative to these first-line treatments. It was hoped that this brief treatment would exhibit lower dropout compared to lengthier first-line treatments, while still helping veterans learn emotion-regulation and interpersonal skills to reduce symptoms of PTSD, depression, and high-risk drinking. Cohorts of up to 18 group members meet for this 5-day program that integrates cognitive-behavioral instruction, mindfulness practice, and emotion-focused principles into didactic and experiential group activities. For several years pretreatment and posttreatment follow-up data have been collected from group members, including symptoms of moral injury, posttraumatic stress, depression, and high-risk drinking. We report pilot data from 50 veterans who participated in this program and completed a posttreatment follow-up survey and program evaluation. Scores on measures of posttraumatic stress, depression, and high-risk drinking were significantly reduced at posttreatment follow-up. The dropout rate for this program (2.9%) was lower than veterans’ average dropout rate across all types of PTSD treatment (36%). Veterans’ perceptions of the program are discussed. Based on these findings, we discuss implications for working with veterans in brief MMGTs and conducting research on these interventions.
Abstract: IMPORTANCE: Veterans with occupational performance (e.g., activities of daily living [ADL]) limitations who are receiving inpatient psychiatric care may benefit from outpatient occupational therapy upon discharge, but access disparities have not been investigated. OBJECTIVE: To investigate whether ADL limitations, an indicator of need, are associated with outpatient occupational therapy utilization after inpatient psychiatric hospitalization in the Veterans Health Administration (VHA) and whether this relationship differs by facility characteristics. DESIGN: Secondary analysis of VHA medical record data. Modified Poisson regression was used to model outpatient occupational therapy utilization (yes or no) as a function of ADL limitations, facility characteristics, and sociodemographic and clinical characteristics. Interactions were used to estimate whether the relationship between ADL limitations and outpatient occupational therapy utilization differs across facility characteristics. SETTING: VHA outpatient setting. PARTICIPANTS: Veterans who received VHA inpatient psychiatric care from 2015 to 2020 and lived