Military to Civilian: Trial of an Intervention to Promote Postdeployment Reintegration

Veterans returning from combat deployments face the interrelated challenges of processing
their combat experiences and transitioning back to civilian life. Unfortunately, many
veterans wait years or decades before seeking help for post-deployment problems, if they
seek it at all. This study seeks to determine whether Internet-Based Expressive Writing
(IB-EW), a brief, low-cost, easily disseminated, and resource-efficient intervention, can
reduce psychological symptoms and improve functioning among Operation Iraqi Freedom (OIF)
and Operation Enduring Freedom (OEF) veterans as they navigate this transition, while also
attempting to reduce barriers to help-seeking. Expressive Writing, a highly private, readily
accessible, and non-stigmatizing intervention, has a strong evidence-base in civilian
populations, but its efficacy in combat veterans has not been tested. This study therefore
seeks to test the efficacy of Expressive Writing in a veteran population while further
enhancing its accessibility by delivering it over the internet (Internet-Based Expressive
Writing; IB-EW). This study will comprise a randomized controlled trial with three
conditions: (a) Internet-Based Expressive Writing, (b) Internet-Based Control Writing, and
(c) No Writing/Treatment As Usual, with a total of 1152 OIF/OEF veterans randomized across
these groups. Expressive Writing participants will write with feeling about their transition
from being a soldier to being a civilian; Control Writing participants will write factually
about the information needs of new veterans; and Treatment as Usual participants will
complete the assessments but not engage in any writing assignments. Participants will
complete standardized self-report measures of psychological symptoms, psychosocial
functioning, and life satisfaction at baseline (Session 1) and at three months (Session 6)
and six months (Session 7) post-intervention. Participants in writing conditions will write
for 20 minutes on four consecutive days (Sessions 2-5) following completion of baseline
measures (participants in the TAU condition will not complete Sessions 2-5). The study will
also attempt to identify individual difference characteristics related to the efficacy of
the treatment, to see who may be most likely to benefit from the treatment. Analyses will
primarily entail multivariate analyses of variance. Power is adequate to detect even a small
effect.