Computerized Tailored Intervention for Behavioral Sequelae of PTSD in Veterans

This proof of concept project develops and pilot tests a viable Internet-based intervention
to assist veterans with Post-Traumatic Stress symptoms to progress toward changing negative
health behaviors that are associated with PTSD and are often difficult to change. Most
commercially available CTIs and software applications have limited impact, because of the
lack of theory-driven material and empiricism. The proposed CTI is supported by more than 30
years of scientific evidence, and uses the Transtheoretical Model of Behavior Change (TTM) as
the theoretical basis for generating personalized interventions (Prochaska & Velicer, 1997;
Velicer, Prochaska, & Redding, 2006). The TTM is ideally suited to those who are resistant to
change and unlikely to take action in the near future, as well as those prone to relapse.

The intervention will be primarily targeted at negative coping strategies that confound or
exacerbate Post-Traumatic Stress symptoms and hinder progress toward remission. Progress in a
Transtheoretical Model of Behavior Change (TTM) conceptual framework may be defined as
movement from one TTM stage of change to the next level of the change process, rather than
the elimination or significant reduction of smoking, depression, or stress per se. The CTI
system that will be modified during this project has been empirically tested and validated
with a general population and has demonstrated significant outcomes for the three proposed
modules — smoking cessation, depression prevention, and stress management. The CTI system
provides an intervention that emphasizes advancement through the processes of change at one's
own pace as the focus of project, rather than the linear progression through a structured
behavior change program to achieve changes in the undesired behaviors.

Hypothesis 1: The structure and TTM-based content of the adapted Smoking Cessation,
Depression Prevention, and Stress Management systems and consequent CTI will be appropriate
for veterans.

Primary Aim 1: To modify TTM-based Smoking Cessation, Depression Prevention, and Stress
Management behavioral intervention modules, originally developed for general adult
populations, to be appropriate and relevant for veterans with Post-Traumatic Stress symptoms.

Secondary Aim 1a: To conceptualize the CTI program's approach, content, and design based on
input from a diverse sample of military veterans and expert consultants.

Hypothesis 2: A multi-behavioral CTI can be successfully implemented with veterans who have
Post-Traumatic Stress symptoms

Primary Aim 2: To demonstrate that a multi-behavioral CTI can be successfully implemented
with veterans with Post-Traumatic Stress symptoms.

Secondary Aim 2a: To conduct usability interviews with veterans to ensure that the target
population can navigate through the computerized intervention and understand the intervention
content.

Secondary Aim 2b: To demonstrate the feasibility of CTI by: a) recruiting veterans to the
project and delivery of the proposed intervention; and b) assessing the acceptability and
perceived usefulness of the intervention from the perspective of veterans with Post-Traumatic
Stress symptoms.

Secondary Aim 2c: To demonstrate feasibility of CTI to increase motivation to change targeted
behaviors, i.e., smoking cessation, depression prevention, and stress management.

Secondary Aim 2d: To demonstrate positive change in assessment outcomes for Post-Traumatic
Stress symptoms, depression, quality of life, and perceived stress.

Inclusion Criteria:

- Military Veterans, Operation Iraqi Freedom (OIF)/Operation Enduring Freedom (OEF)
service preferred

- 18 years or older

- Ability to read and comprehend English

- Mild to moderate PTSD symptoms

- Cigarette smoking (preferred)

- Mild to moderate depression (preferred)

- Difficulty managing stress

- Comfortable using a computer and access to the Internet

Exclusion Criteria:

- Present with psychosis, bipolar disorder, active substance use, or cognitive
impairment

- Severe depression or suicidal ideation (Patient Health Questionnaire-9)(PHQ-9 >19)

- Severe PTSD symptoms (PTSD Symptom Checklist)(PCL-M >73)