Brief Cognitive Behavioral Treatment of Deployment-Related PTSD Symptoms in Primary Care Settings

A significant number of veterans of the wars in Iraq and Afghanistan are affected by
posttraumatic stress disorder (PTSD) yet relatively few are receiving evidence-based
treatments (Tanielian, Jaycox, Schell, Marshall, Burnham, Eibner, et al. 2008). The limited
reach of effective treatments for PTSD into the veteran population is at least partially due
to the perceived stigma by service members for seeking help in traditional specialty mental
health clinics (Hoge, Castro, Messer, McGurk, Cotting, & Koffman, 2004). A comprehensive
approach to PTSD treatment in a veteran population should provide alternative sources for
accessing effective psychotherapy treatments. This study builds upon a pilot study conducted
at Brooke Army Medical Center and the Wilford Hall Medical Center (now the Wilford Hall
Ambulatory Surgical Center) (C.2009.022, IRBNet 363516). Using the treatment protocol
developed and found to be effective as part of this pilot, the purpose of study is to
conduct a randomized clinical trial comparing a brief (four 30-minute sessions delivered
over 6 weeks) cognitive-behavioral therapy (CBT) protocol designed specifically for use by
behavioral health consultants working in an integrated primary care setting to a minimal
contact 6-week control. Up to 75 Service Members with deployment-related PTSD symptoms will
be consented, enrolled, and treated until treatment has been completed for 60. The primary
outcome measure is PTSD symptom relief.

OBJECTIVES/SPECIFIC AIMS/RESEARCH QUESTIONS:

1. Will Operation Iraqi Freedom/Operation Enduring Freedom/Operation New Dawn
(OIF/OEF/OND) veterans with PTSD symptoms accept an offer of cognitive behavioral
therapy (CBT) treatment in the primary care setting versus a referral to specialty
care?

2. Will a brief (four 30-minute appointments) CBT protocol designed for use by behavioral
health consultants working in primary care significantly reduce PTSD symptom severity
in OIF/OEF/OND veterans in comparison to a minimal contact condition?

3. Are there characteristics of patients at pre-treatment, e.g., demographic variables,
level of co-morbid depression, that predict a relatively better or worse response to
PTSD treatment in primary care?

Inclusion Criteria:

1. active duty, reserve, guard, separated, or retired OIF/OEF/OND veterans seeking care
in primary care for deployment-related PTSD symptoms

2. Symptomatic for PTSD will be defined as a minimum score of 32 on the PTSD CheckList
-Stressor-specific (PCL-S)

3. English speaking

4. If individuals are taking psychotropic medication, a 4-week stabilization period may
be required prior to enrollment, depending upon the medication, half-life, and
anticipated interaction with the ability to engage in behavioral therapy

Exclusion Criteria:

1. moderate to severe suicide risk

2. current alcohol dependence, psychotic disorder, significant dissociative disorder

3. severe brain injury

4. Patients who are currently receiving talk therapy for trauma-related symptoms will
also be excluded