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01-12-2011

A computerized, tailored intervention to address behaviors associated with PTSD in veterans: rationale and design of STR²IVE

Authors: Patricia J. Jordan, PhD, Kerry E. Evers, PhD, Katherine Y. M. Burke, MPH, Laurel A. King, PhD, Claudio R. Nigg, PhD

Published in: Translational Behavioral Medicine | Issue 4/2011

ABSTRACT

Combat exposure among military personnel results in increased risk of posttraumatic stress disorder (PTSD), major depression, substance use, and related health risks. PTSD symptoms require innovative approaches to promote effective coping postdeployment. PTSD's nature and scope requires an approach capable of integrating multiple health risks while reaching large populations. This article provides the rationale and approach to adapt and evaluate a Pro-Change computerized tailored intervention (CTI) targeted at behavioral sequelae (i.e., smoking, stress, and depression) for veterans with or at risk for PTSD. The three-phase approach includes: 1) focus groups to review and, subsequently, adapt content of the existing CTI programs; 2) usability testing; and 3) feasibility testing using a three-month pre–postdesign. Effective, theory-based, real-time, multiple behavior interventions targeting veterans' readiness to quit smoking, manage stress, and depression are warranted to provide potential health impact, opportunities for learning veteran-specific issues, and advance multiple health behavior change knowledge.

Cook JM, Elhai JD, Cassidy EL, et al. Assessment of trauma exposure and post-traumatic stress in long-term care veterans—Preliminary data on psychometrics and post-traumatic stress disorder prevalence. Mil Med. 2005;170(10):5.

Hoge CW, Auchterlonie JL, Milliken CS. Mental health problems, use of mental health services, and attrition from military service after returning from deployment to Iraq or Afghanistan. J Am Med Assoc. 2006;295(9):1023-1032.CrossRef

Hoge CW, Terhakopian A, Castro CA, Messer SC, Engel CC. Association of posttraumatic stress disorder with somatic symptoms, health care visits, and absenteeism among Iraq war veterans. Am J Psychiatry. 2007;164(1):150-153.PubMedCrossRef

Seal KH, Bertenthal D, Miner CR, Sen S, Marmar C. Bringing the war back home: Mental health disorders among 103,788 US veterans returning from Iraq and Afghanistan seen at Department of Veterans Affairs facilities. Arch Intern Med. 2007;167(5):476-482.PubMedCrossRef

Tanielian TL, Corporation R, eds. Invisible wounds of war: Psychological and cognitive injuries, their consequences, and services to assist recovery. Rand Corporation; 2008:453.

Davidson JRT. Recognition and treatment of posttraumatic stress disorder. J Am Med Assoc. 2001;286(5):584-588.CrossRef

Greene-Shortridge TM, Britt TW, Castro CA. The stigma of mental health problems in the military. Mil Med. 2007;172(2):157-161.PubMed

Gellis LA, Gehrman PR, Mavandadi S, Oslin DW. Predictors of sleep disturbances in Operation Iraqi Freedom/Operation Enduring Freedom veterans reporting a trauma. Mil Med. 2010;175(8):567-573.PubMed

Lapierre CB, Schwegler AF, Labauve BJ. Posttraumatic stress and depression symptoms in soldiers returning from combat operations in Iraq and Afghanistan. J Trauma Stress. 2007;20(6):933-943.PubMedCrossRef

10.

Forbes D, Creamer MC, Phelps AJ, et al. Treating adults with acute stress disorder and post-traumatic stress disorder in general practice: A clinical update. Med J Aust. 2007;187(2):120-123.PubMed

11.

Jankowski K. PTSD and physical health. National Center for PTSD Fact Sheet. 2007. Available at: http://www.ncptsd.va.gov/ncmain/ncdocs/fact_shts/fs_physical_health.html.

12.

Department of Defense Task Force on Mental Health. An achievable vision: Report of the Department of Defense Task Force on Mental Health. Falls Church, VA; 2007:1-100.

13.

Munsey C. Transforming military mental health. Monit Psychol. 2007;38(8):38-55.

14.

Feldner MT, Monson CM, Friedman MJ. A critical analysis of approaches to targeted PTSD prevention: Current status and theoretically derived future directions. Behav Modif. 2007;31(1):80-116.PubMedCrossRef

15.

Foa EB, Meadows EA. Psychosocial treatments for posttraumatic stress disorder: A critical review. Annu Rev Psychol. 1997;48:449-480.PubMedCrossRef

16.

National Center for PTSD. Empirical evidence regarding behavioral treatments for PTSD (Fact Sheet). 2007.

17.

Erbes C, Westermeyer J, Engdahl B, Johnsen E. Post-traumatic stress disorder and service utilization in a sample of service members from Iraq and Afghanistan. Mil Med. 2007;172(4):5.

18.

Frueh BC. Procedural and methodological issues in telepsychiatry research and program development. Psychiatr Serv. 2000;51(12):1522-1527.PubMedCrossRef

19.

Beckham JC, Kirby AC, Feldman ME, et al. Prevalence and correlates of heavy smoking in Vietnam veterans with chronic posttraumatic stress disorder. Addict Behav. 1997;22(5):637-647.PubMedCrossRef

20.

Zweben JE, Clark HW, Smith DE. Traumatic experiences and substance abuse: Mapping the territory. J Psychoactive Drugs. 1994;26(4):327-344.PubMed

21.

Green BL, Lindy JD, Grace MC, Leonard AC. Chronic posttraumatic stress disorder and diagnostic comorbidity in a disaster sample. J Nerv Ment Dis. 1992;180(12):760-766.PubMedCrossRef

22.

Beckham JC, Moore SD, Feldman ME, et al. Health status, somatization, and severity of posttraumatic stress disorder in Vietnam combat veterans with posttraumatic stress disorder. Am J Psychiatry. 1998;155(11):1565-1569.PubMed

23.

McFall M, Atkins DC, Yoshimoto D, et al. Integrating tobacco cessation treatment into mental health care for patients with posttraumatic stress disorder. Am J Addict. 2006;15(5):336-344.PubMedCrossRef

24.

Buckley TC, Mozley SL, Bedard MA, Dewulf A-C, Greif J. Preventive health behaviors, health-risk behaviors, physical morbidity, and health-related role functioning impairment in veterans with post-traumatic stress disorder. Mil Med. 2004;169(7):536-540.PubMed

25.

Beckham JC, Roodman AA, Shipley RH, et al. Smoking in Vietnam combat veterans with post-traumatic stress disorder. J Trauma Stress. 1995;8(3):461-472.PubMedCrossRef

26.

Riggs DS, Byrne CA, Weathers FW, Litz BT. The quality of the intimate relationships of male Vietnam veterans: Problems associated with posttraumatic stress disorder. J Trauma Stress. 1998;11(1):87-101.PubMedCrossRef

27.

Taft C, Niles B. Assessment and treatment of anger in combat-related PTSD. In: National Center for PTSD and Walter Reed Army Medical Center, ed. Iraq war clinician guide. 2nd ed. White River Junction, VT: Department of Veterans Affairs/National Center for PTSD; 2004.

28.

Sinha R. How does stress increase risk of drug abuse and relapse? Psychopharmacology. 2001;158(4):343-359.PubMedCrossRef

29.

Grieger TA, Cozza SJ, Ursano RJ, et al. Posttraumatic stress disorder and depression in battle-injured soldiers. Am J Psychiatry. 2006;163(10):1777-1783. quiz 1860.PubMedCrossRef

30.

Kreuter MW, Strecher VJ, Glassman B. One size does not fit all: The case for tailoring print materials. Ann Behav Med. 1999;21(4):276-283.PubMedCrossRef

31.

Skinner CS, Campbell MK, Rimer BK, Curry S, Prochaska JO. How effective is tailored print communication? Ann Behav Med. 1999;21(4):290-298.PubMedCrossRef

32.

Ruggiero KJ, Resnick HS, Acierno R, et al. Internet-based intervention for mental health and substance use problems in disaster-affected populations: A pilot feasibility study. Behav Ther. 2006;37(2):190-205.PubMedCrossRef

33.

Velicer WF, Prochaska JO, Redding CA. Tailored communications for smoking cessation: Past successes and future directions. Drug Alcohol Rev. 2006;25(1):49-57.PubMedCrossRef

34.

Hirai M, Clum GA. A meta-analytic study of self-help interventions for anxiety problems. Behav Ther. 2006;37(2):99-111.PubMedCrossRef

35.

Marlatt GA, Witkiewitz K. Harm reduction approaches to alcohol use: Health promotion, prevention, and treatment. Addict Behav. 27(6):867-886.

36.

Bewick BM, Trusler K, Barkham M, et al. The effectiveness of web-based interventions designed to decrease alcohol consumption—A systematic review. Prev Med. 2008;47(1):17-26.PubMedCrossRef

37.

Parks KA, Pardi AM, Bradizza CM. Collecting data on alcohol use and alcohol-related victimization: A comparison of telephone and web-based survey methods. J Stud Alcohol. 2006;67(2):318-323.PubMed

38.

Sobell LC, Cunningham JA, Sobell MB. Recovery from alcohol problems with and without treatment: Prevalence in two population surveys. Am J Public Health. 1996;86(7):966-972.PubMedCrossRef

39.

Fotheringham MJ, Owies D, Leslie E, Owen N. Interactive health communication in preventive medicine: Internet-based strategies in teaching and research. Am J Prev Med. 2000;19(2):113-120.PubMedCrossRef

40.

Atkinson NL, Gold RS. The promise and challenge of eHealth interventions. Am J Heal Behav. 26(6):494-503.

41.

Wantland DJ, Portillo CJ, Holzemer WL, Slaughter R, McGhee EM. The effectiveness of web-based vs. non-web-based interventions: A meta-analysis of behavioral change outcomes. J Med Internet Res. 2004;6(4):e40.PubMedCrossRef

42.

Marcus BH, Nigg CR, Riebe D, Forsyth LH. Interactive communication strategies: Implications for population-based physical-activity promotion. Am J Prev Med. 2000;19(2):121-126.PubMedCrossRef

43.

Glanz K, Rimer B, Lewis F. Theory, research, and practice on health behavior and health education. In: Glanz K, Rimer B, Lewis F, eds. Health behavior and health education: Theory, research and practice. San Francisco, CA: Wiley; 2002:22-44.

44.

Prochaska JO, DiClemente CC. Stages and processes of self-change of smoking: Toward an integrative model of change. J Consult Clin Psychol. 1983;51(3):390-395.PubMedCrossRef

45.

Prochaska JO, Velicer WF. The transtheoretical model of health behavior change. Am J Health Promot. 1997;12(1):38-48.PubMedCrossRef

46.

Prochaska JO, Velicer WF, Fava JL, et al. Counselor and stimulus control enhancements of a stage-matched expert system intervention for smokers in a managed care setting. Prev Med. 2001;32(1):23-32.PubMedCrossRef

47.

Prochaska JO, DiClemente CC, Velicer WF, Rossi JS. Standardized, individualized, interactive, and personalized self-help programs for smoking cessation. Health Psychol. 1993;12(5):399-405.PubMedCrossRef

48.

Evers KE, Prochaska JO, Johnson JL, et al. A randomized clinical trial of a population- and transtheoretical model-based stress-management intervention. Health Psychol. 2006;25(4):521-529.PubMedCrossRef

49.

Levesque D, Marter D Van, Schneider R, et al. (in press) Randomized trial of a transtheoretical model intervention for depression in primary care. Am J Heal Promot.

50.

Prochaska JO, Velicer WF, Rossi JS, et al. Multiple risk expert systems interventions: Impact of simultaneous stage-matched expert system interventions for smoking, high-fat diet, and sun exposure in a population of parents. Health Psychol. 2004;23(5):503-516.PubMedCrossRef

51.

Prochaska JO, Velicer WF, Redding C, et al. Stage-based expert systems to guide a population of primary care patients to quit smoking, eat healthier, prevent skin cancer, and receive regular mammograms. Prev Med. 2005;41(2):406-416.PubMedCrossRef

52.

Prochaska JJ, Velicer WF, Prochaska JO, Delucchi K, Hall SM. Comparing intervention outcomes in smokers treated for single versus multiple behavioral risks. Health Psychol. 2006;25(3):380-388.PubMedCrossRef

53.

Murphy RT, Thompson KE, Murray M, Rainey Q, Uddo MM. Effect of a motivation enhancement intervention on veterans' engagement in PTSD treatment. Psychol Serv. 2009;6(4):264-278.CrossRef

54.

Brogan MM, Prochaska JO, Prochaska JM. Predicting termination and continuation status in psychotherapy using the transtheoretical model. Psychother Theory Res Pract Train. 1999;36(2):105-113.CrossRef

55.

Hoge CW, Castro CA, Messer SC, et al. Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. N Engl J Med. 2004;351(1):13-22.PubMedCrossRef

56.

Ruzek J, Curran E, Friedman M, et al. Treatment of the returning Iraq war veteran (fact sheet). 2007.

57.

Wierzbicki M, Pekarik G. A meta-analysis of psychotherapy dropout. Prof Psychol Res Pract. 1993;24(2):190-195.CrossRef

58.

Patterson R. Changing patient behavior: Improving outcomes in health and disease management. Jossey-Bass; 2001:238.

59.

Prochaska JO, Velicer WF, Prochaska JM, Johnson JL. Size, consistency, and stability of stage effects for smoking cessation. Addict Behav. 2004;29(1):207-213.PubMedCrossRef

60.

Johnson SS, Paiva AL, Cummins CO, et al. Transtheoretical model-based multiple behavior intervention for weight management: Effectiveness on a population basis. Prev Med. 2008;46(3):238-246.PubMedCrossRef

61.

Jones H, Edwards L, Greene G, et al. The efficacy of stages of change interventions in diabetes self-care and control. In: 61st Annual Conference of the American Diabetes Association. Philadelphia, PA; 2001.

62.

Jones H, Edwards L, Vallis TM, et al. Changes in diabetes self-care behaviors make a difference in glycemic control: The Diabetes Stages of Change (DiSC) study. Diabetes Care. 2003;26(3):732-737.PubMedCrossRef

63.

Rossi J, ed. The healthy changes trial biomedical results. In L. Ruggiero (Chair), Helping people change: The impact of stage-based behavior change interventions in diabetes care. In: 28th Annual Conference of the American Association of Diabetes Educators. Louisville, KY; 2001.

64.

Prochaska JO, Velicer WF, Fava JL, Rossi JS, Tsoh JY. Evaluating a population-based recruitment approach and a stage-based expert system intervention for smoking cessation. Addict Behav. 2001;26(4):583-602.PubMedCrossRef

65.

Prochaska JJ, Velicer WF, Nigg CR, Prochaska JO. Methods of quantifying change in multiple risk factor interventions. Prev Med. 2008;46(3):260-265.PubMedCrossRef

66.

Lewis CH. Using the “thinking aloud” method in cognitive interface design (technical report IBM RC-9265). Yorktown Heights, NY; 1982.

67.

Lewis CH, Rieman J. Task-centered user interface design: A practical introduction. 2011.

68.

Kelley JF. An empirical methodology for writing user-friendly natural language computer applications. New York, New York, USA: ACM Press; 1983:193-196.

69.

Kelley JF. An iterative design methodology for user-friendly natural language office information applications. ACM Trans Inf Syst. 1984;2(1):26-41.CrossRef

70.

National Cancer Institute. Making health communication programs work: A planner's guide (publication no. 89–1493). Bethesda, MD; 1989.

71.

Cardinal BJ. Development and evaluation of stage-matched written materials about lifestyle and structured physical activity. Percept Mot Skills. 1995;80(2):543-546.PubMedCrossRef

72.

Rimer BK, Orleans CT, Fleisher L, et al. Does tailoring matter? The impact of a tailored guide on ratings and short-term smoking-related outcomes for older smokers. Health Educ Res. 1994;9(1):69-84.PubMedCrossRef

73.

Weathers FW, Litz BT, Herman DS, Huska JA, Keane MT. The PTSD Checklist (PCL): Reliability, validity, and diagnostic utility. In: The 9th Annual Meeting of the International Society for Traumatic Stress Studies, October 24–27; 1993.

74.

Schell T, Tanielian T, eds. A needs assessment of New York State Veterans. RAND Corporation; 2011.

75.

Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24:385-396.PubMedCrossRef

76.

Spitzer R, Kroenke K. The PHQ-9: A new depression diagnostic and severity measure. Psychiatr Ann. 2002;32(9):1-7.

77.

Kroenke K, Spitzer RL, Williams JB. The PHQ-9: Validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606-613.PubMedCrossRef

78.

Kroenke K, Spitzer RL, Williams JBW, Löwe B. The patient health questionnaire somatic, anxiety, and depressive symptom scales: A systematic review. Gen Hosp Psychiatry. 32(4):345-359.

79.

Flanagan JC. A research approach to improving our quality of life. Am Psychol. 1978;33:138-147.CrossRef

80.

Flanagan JC. Measurement of quality of life: Current state of the art. Arch Phys Med Rehabil. 1982;63(2):56-59.PubMed

81.

Burckhardt CS, Anderson KL. The quality of life scale (QOLS): Reliability, validity, and utilization. Health Qual Life Outcomes. 2003;23(1):60.CrossRef

82.

DiClemente CC, Prochaska JO, Fairhurst SK, et al. The process of smoking cessation: An analysis of precontemplation, contemplation, and preparation stages of change. J Consult Clin Psychol. 1991;59(2):295-304.PubMedCrossRef

83.

Miles M, Huberman AM. Qualitative data analysis: A sourcebook of new methods. Beverly Hills, CA: SAGE; 1984:264.

84.

Morgan DL, Krueger RA, King JA. Analyzing and reporting focus group results, volume 6. SAGE; 1998:139.

Title: A computerized, tailored intervention to address behaviors associated with PTSD in veterans: rationale and design of STR2IVE
Authors: Patricia J. Jordan, PhD
Kerry E. Evers, PhD
Katherine Y. M. Burke, MPH
Laurel A. King, PhD
Claudio R. Nigg, PhD
Publication date: 01-12-2011
Publisher: Springer-Verlag
Published in: Translational Behavioral Medicine / Issue 4/2011
Print ISSN: 1869-6716
Electronic ISSN: 1613-9860
DOI: https://doi.org/10.1007/s13142-011-0088-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

A computerized, tailored intervention to address behaviors associated with PTSD in veterans: rationale and design of STR²IVE

ABSTRACT

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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