Post-9/11 Veterans and Their Partners Improve Mental Health Outcomes with a Self-directed Mobile and Web-based Wellness Training Program: A Randomized Controlled Trial

Janet R Kahn, William Collinge, Robert Soltysik, Janet R Kahn, William Collinge, Robert Soltysik

Abstract

Background: Veterans with history of deployment in the Global War on Terror face significant and ongoing challenges with high prevalences of adverse psychological, physical, spiritual, and family impacts. Together, these challenges contribute to an emerging public health crisis likely to extend well into the future. Innovative approaches are needed that reach veterans and their family members with strategies they can employ over time in their daily lives to promote improved adjustment and well-being.

Objective: The objective of this study was to evaluate effects of use of a Web-based, self-directed program of instruction in mind- and body-based wellness skills to be employed by Global War on Terror veterans and their significant relationship partners on mental health and wellness outcomes associated with postdeployment readjustment.

Methods: We recruited 160 veteran-partner dyads in 4 regions of the United States (San Diego, CA; Dallas, TX; Fayetteville, NC; and New York, NY) through publicity by the Iraq and Afghanistan Veterans of America to its membership. Dyads were randomly allocated to 1 of 4 study arms: Mission Reconnect (MR) program alone, MR plus the Prevention and Relationship Enhancement Program (PREP) for Strong Bonds weekend program for military couples, PREP alone, and waitlist control. We administered a battery of standardized and investigator-generated instruments assessing mental health outcomes at baseline, 8 weeks, and 16 weeks. Dyads in the MR arms were provided Web-based and mobile app video and audio instruction in a set of mindfulness-related stress reduction and contemplative practices, as well as partner massage for reciprocal use. All participants provided weekly reports on frequency and duration of self-care practices for the first 8 weeks, and at 16 weeks.

Results: During the first 8-week reporting period, veterans and partners assigned to MR arms used some aspect of the program a mean of 20 times per week, totaling nearly 2.5 hours per week, with only modest declines in use at 16 weeks. Significant improvements were seen at 8 and 16 weeks in measures of posttraumatic stress disorder, depression, sleep quality, perceived stress, resilience, self-compassion, and pain for participants assigned to MR arms. In addition, significant reductions in self-reported levels of pain, tension, irritability, anxiety, and depression were associated with use of partner massage.

Conclusions: Both veterans and partners were able to learn and make sustained use of a range of wellness practices taught in the MR program. Home-based, self-directed interventions may be of particular service to veterans who are distant from, averse to, or prohibited by schedule from using professional services. Leveraging the partner relationship may enhance sustained use of self-directed interventions for this population. Use of the MR program appears to be an accessible, low-cost approach that supports well-being and reduces multiple symptoms among post-9/11 veterans and their partners.

Trial registration: Clinicaltrials.gov NCT01680419; https://ichgcp.net/clinical-trials-registry/NCT01680419 (Archived by WebCite at http://www.webcitation.org/6jJuadfzj).

Keywords: PTSD; Web-based program; compassion; mind-body therapies; mindfulness; moral injury; patient-centered care; reintegration; veterans.

Conflict of interest statement

The Mission Reconnect program is owned and distributed by Mission Reconnect LLC, which was founded by Drs Kahn and Collinge to make this program widely available.

Figures

Figure 1
Figure 1
Mission Reconnect Video Menu.
Figure 2
Figure 2
Mission Reconnect Practice Menu.
Figure 3
Figure 3
Mission Reconnect What If? Menu.
Figure 4
Figure 4
CONSORT Flow Diagram.

References

    1. Otis J, McGlinchey R, Vasterling J, Kerns R. Complicating factors associated with mild traumatic brain injury: impact on pain and posttraumatic stress disorder treatment. J Clin Psychol Med Settings. 2011;18(2):145–54.
    1. Sharpless B, Barber J. A clinician's guide to PTSD treatments for returning veterans. Prof Psychol Res Pr. 2011;42(1):8–15.
    1. Outcalt SD, Ang DC, Wu J, Sargent C, Yu Z, Bair MJ. Pain experience of Iraq and Afghanistan Veterans with comorbid chronic pain and posttraumatic stress. J Rehabil Res Dev. 2014;51(4):559–70. doi: 10.1682/JRRD.2013.06.0134.
    1. Ramchand R, Schell TL, Karney BR, Osilla KC, Burns RM, Caldarone LB. Disparate prevalence estimates of PTSD among service members who served in Iraq and Afghanistan: possible explanations. J Trauma Stress. 2010 Feb;23(1):59–68. doi: 10.1002/jts.20486.
    1. Matthias MS, McGuire AB, Kukla M, Daggy J, Myers LJ, Bair MJ. A brief peer support intervention for veterans with chronic musculoskeletal pain: a pilot study of feasibility and effectiveness. Pain Med. 2015 Jan;16(1):81–7. doi: 10.1111/pme.12571.
    1. Kerns RD, Otis J, Rosenberg R, Reid MC. Veterans' reports of pain and associations with ratings of health, health-risk behaviors, affective distress, and use of the healthcare system. J Rehabil Res Dev. 2003;40(5):371–9.
    1. Haskell SG, Ning Y, Krebs E, Goulet J, Mattocks K, Kerns R, Brandt C. Prevalence of painful musculoskeletal conditions in female and male veterans in 7 years after return from deployment in Operation Enduring Freedom/Operation Iraqi Freedom. Clin J Pain. 2012 Feb;28(2):163–7. doi: 10.1097/AJP.0b013e318223d951.
    1. Alschuler KN, Otis JD. An examination of the impact of clinically significant levels of posttraumatic stress disorder symptomatology on the classification of pain as mild, moderate, or severe in a sample of veterans with chronic pain. Psychol Serv. 2014 Aug;11(3):273–80. doi: 10.1037/a0036201.
    1. Schuman D. A value-critical choice analysis of a policy to prevent suicide in veterans and service members. Soc Work Public Health. 2016:2–12.
    1. Milliken CS, Auchterlonie JL, Hoge CW. Longitudinal assessment of mental health problems among active and reserve component soldiers returning from the Iraq war. JAMA. 2007 Nov 14;298(18):2141–8. doi: 10.1001/jama.298.18.2141.
    1. Tanielian T, Jaycox L. Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery. Santa Monica, CA: Rand Center for Military Health Policy Research; 2008.
    1. Tanielian T. Bridging the Gaps in Treating Veterans With Post-Deployment Mental Health Problems. Rand Corporation; 2011. Dec 5, [2016-09-09]. .
    1. Baker MS. Casualties of the Global War on Terror and their future impact on health care and society: a looming public health crisis. Mil Med. 2014 Apr;179(4):348–55. doi: 10.7205/MILMED-D-13-00471.
    1. Hourani L, Bender R, Weimer B, Peeler R, Bradshaw M, Lane M, Larson G. Longitudinal study of resilience and mental health in Marines leaving military service. J Affect Disord. 2012 Jul;139(2):154–65. doi: 10.1016/j.jad.2012.01.008.
    1. Department of Veterans Affairs Office of Research and Development. National Institute of Mental Health. United States Army Medical Research and Materiel Command Mapping the Landscape of Deployment Related Adjustment and Mental Disorders: A Meeting Summary of a Working Group to Inform Research. 2006. [2016-09-14]. .
    1. The White House Strengthening Our Military Families: Meeting America's Commitment. Presidential Study Directive/PSD-9. 2011. Jan, [2016-09-14]. .
    1. Allen ES, Rhoades GK, Stanley SM, Markman HJ. On the home front: stress for recently deployed Army couples. Fam Process. 2011 Jun;50(2):235–47. doi: 10.1111/j.1545-5300.2011.01357.x.
    1. de Burgh HT, White CJ, Fear NT, Iversen AC. The impact of deployment to Iraq or Afghanistan on partners and wives of military personnel. Int Rev Psychiatry. 2011 Apr;23(2):192–200. doi: 10.3109/09540261.2011.560144.
    1. McLeland KC, Sutton GW, Schumm WR. Marital satisfaction before and after deployments associated with the Global War on Terror. Psychol Rep. 2008 Dec;103(3):836–44. doi: 10.2466/pr0.103.3.836-844.
    1. Allen ES, Rhoades GK, Stanley SM, Loew B, Markman HJ. The effects of marriage education for army couples with a history of infidelity. J Fam Psychol. 2012 Feb;26(1):26–35. doi: 10.1037/a0026742.
    1. Beardslee W, Lester P, Klosinski L, Saltzman W, Woodward K, Nash W, Mogil C, Koffman R, Leskin G. Family-centered preventive intervention for military families: implications for implementation science. Prev Sci. 2011 Dec;12(4):339–48. doi: 10.1007/s11121-011-0234-5.
    1. VA San Diego Healthcare System . From Warrior to Soul Mate Weekend Couples Retreats: Reclaim your Relationship after Military Service. Washington, DC: US Department of Veterans Affairs; 2016. Jun 30, [2016-09-09]. .
    1. Collinge W, Kahn J, Soltysik R. Promoting reintegration of National Guard veterans and their partners using a self-directed program of integrative therapies: a pilot study. Mil Med. 2012 Dec;177(12):1477–85.
    1. Engel GL. The need for a new medical model: a challenge for biomedicine. Science. 1977 Apr 8;196(4286):129–36.
    1. Walker RL, Clark ME, Sanders SH. The “Postdeployment multi-symptom disorder”: an emerging syndrome in need of a new treatment paradigm. Psychol Serv. 2010;7(3):136–47. doi: 10.1037/a0019684.
    1. Hempel S, Taylor S, Marshall N, Miake-Lye I, Beroes J, Shanman R, Solloway M, Shekelle P. Evidence map of mindfulness. QUERI. 2014 Oct;:1–36.
    1. Canadian Agency for Drugs and Technologies in Health Mindfulness interventions for the treatment of post-traumatic stress disorder, generalized anxiety Disor der, Depression, and substance use disorders: a review of the clinical effectiveness and guidelines. CADTH Rapid Response Reports. 2015 Jun;:1–43.
    1. Field T. Massage therapy research review. Complement Ther Clin Pract. 2014 Nov;20(4):224–9. doi: 10.1016/j.ctcp.2014.07.002.
    1. Crawford C, Boyd C, Paat CF, Price A, Xenakis L, Yang E, Zhang W, Evidence for Massage Therapy (EMT) Working Group The impact of massage therapy on function in pain populations: a systematic review and meta-analysis of randomized controlled trials: part I, patients experiencing pain in the general population. Pain Med. 2016 May 10;:pii. doi: 10.1093/pm/pnw099.
    1. Fredrickson B. Cultivating positive emotions to optimize health and well-being. Prev Treatment. 2000 Mar 07;3(1):1–25. doi: 10.1037/1522-3736.3.1.31a.
    1. Caputo A. The relationship between gratitude and loneliness: the potential benefits of gratitude for promoting social bonds. Eur J Psychol. 2015 May;11(2):323–34. doi: 10.5964/ejop.v11i2.826.
    1. Tugade MM, Fredrickson BL. Resilient individuals use positive emotions to bounce back from negative emotional experiences. J Pers Soc Psychol. 2004 Feb;86(2):320–33. doi: 10.1037/0022-3514.86.2.320.
    1. Kozak L, Vig E, Simons C, Eugenio E, Collinge W, Chapko M. A feasibility study of caregiver-provided massage as supportive care for Veterans with cancer. J Support Oncol. 2013 Sep;11(3):133–43.
    1. Collinge W, Kahn J, Walton T, Kozak L, Bauer-Wu S, Fletcher K, Yarnold P, Soltysik R. Touch, Caring, and Cancer: randomized controlled trial of a multimedia caregiver education program. Support Care Cancer. 2013 May;21(5):1405–14. doi: 10.1007/s00520-012-1682-6.
    1. Collinge W, Kahn J. Mission Reconnect. 2014. [2016-09-09].
    1. Stanley SM, Allen ES, Markman HJ, Rhoades GK, Prentice DL. Decreasing divorce in army couples: results from a randomized controlled trial using PREP for Strong Bonds. J Couple Relatsh Ther. 2010 Apr;9(2):149–60. doi: 10.1080/15332691003694901.
    1. Markman HJ, Stanley SM, Blumberg SL. Fighting for Your Marriage: A Deluxe Revised Edition of the Classic Best-Seller for Enhancing Marriage and Preventing Divorce. San Francisco, CA: Jossey-Bass; 2010.
    1. Iran and Afghanistan Veterans of America . Be Part of the Movement. New York, NY: IAVA; [2016-09-09].
    1. Dallal GE. . 2013. Mar 29, [2016-09-09].
    1. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983 Dec;24(4):385–96.
    1. Beck A, Steer R. Beck Depression Inventory Manual. San Antonio, TX: Harcourt Brace; 1996. pp. 1–38.
    1. Weathers F, Huska J, Keane T. PCL-C for DSM-IV. Boston, MA: National Center for PTSD Behavioral Science Division; 1991. [2016-03-23]. .
    1. Neff K. The development and validation of a scale to measure self-compassion. Self Identity. 2003;2:223–50.
    1. Johnson DC, Polusny MA, Erbes CR, King D, King L, Litz BT, Schnurr PP, Friedman M, Pietrzak RH, Southwick SM. Development and initial validation of the Response to Stressful Experiences Scale. Mil Med. 2011 Feb;176(2):161–9.
    1. Zimet GD, Powell SS, Farley GK, Werkman S, Berkoff KA. Psychometric characteristics of the Multidimensional Scale of Perceived Social Support. J Pers Assess. 1990;55(3-4):610–7. doi: 10.1080/00223891.1990.9674095.
    1. Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989 May;28(2):193–213.
    1. Busby DM, Christensen C, Crane DR, Larson JH. A revision of the Dyadic Adjustment Scale for use with distressed and nondistressed couples: construct hierarchy and multidimensional scales. J Marital Fam Ther. 1995;32(3):289–308. doi: 10.1111/jmft.12095.
    1. Yarnold P, Soltysik R. Optimal Data Analysis: A Guidebook with Software for Windows. Washington, DC: APA Books; 2004.
    1. Eysenbach G, CONSORT- EHEALTH Group CONSORT-EHEALTH: improving and standardizing evaluation reports of Web-based and mobile health interventions. J Med Internet Res. 2011;13(4):e126. doi: 10.2196/jmir.1923.
    1. Fredrickson BL, Cohn MA, Coffey KA, Pek J, Finkel SM. Open hearts build lives: positive emotions, induced through loving-kindness meditation, build consequential personal resources. J Pers Soc Psychol. 2008 Nov;95(5):1045–62. doi: 10.1037/a0013262.
    1. Garland EL, Fredrickson B, Kring AM, Johnson DP, Meyer PS, Penn DL. Upward spirals of positive emotions counter downward spirals of negativity: insights from the broaden-and-build theory and affective neuroscience on the treatment of emotion dysfunctions and deficits in psychopathology. Clin Psychol Rev. 2010 Nov;30(7):849–64. doi: 10.1016/j.cpr.2010.03.002.
    1. Seppälä EM, Nitschke JB, Tudorascu DL, Hayes A, Goldstein MR, Nguyen DTH, Perlman D, Davidson RJ. Breathing-based meditation decreases posttraumatic stress disorder symptoms in U.S. military veterans: a randomized controlled longitudinal study. J Trauma Stress. 2014 Aug;27(4):397–405. doi: 10.1002/jts.21936.
    1. Williams J, Gierisch J, McDuffie J, Strauss J, Nagi A. An Overview of Complementary and Alternative Medicine Therapies for Anxiety and Depressive Disorders: Supplement to Efficacy of Complementary and Alternative Medicine Therapies for Posttraumatic Stress Disorder. Evidence-based Synthesis Program. Washington, DC: Department of Veterans Affairs; 2011. pp. 1–23.

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