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

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.

Examining the effects of a novel training program and use of psychiatric service dogs for military-related PTSD and associated symptoms.

“…The measure has demonstrated good internal consistency in different populations with chronic illness (α = .82 to .92; Burckhardt et al, 1989) as well as high test–retest reliability and evidence for convergent and discriminant validity (Burckhardt & Anderson, 2003). The QOLS has been utilized in a number of studies to assess for perception of quality of life with military veterans diagnosed with PTSD (e.g., Jordan, Evers, Burke, King, & Nigg, 2011; Resnik, Gray, & Borgia, 2011). Burckhardt and Anderson (2003) report that there is some evidence that the QOLS is sensitive to symptom change.…”

Understanding and addressing populations whose prior experience has led to mistrust in healthcare

“…Recent studies emphasize the relevance and benefits of audience segmentation and tailoring messages to specified populations [ 64 ]. For instance, tailored internet-based messages were found to be beneficial for intervening with patients with mental health issues such as trauma, because they offer anonymity, reduce fear of stigma, and increase self-disclosure [ 65 ]. Rayens et al have indicated the need to tailor smoke-free media campaigns in the U.S. to the rural populations that are more exposed to tobacco, focusing more on the benefits of smoke-free environments in gain-framed ads, as opposed to the different approaches recommended for use with urban residents [ 66 ].…”

A systematic review of technology-based interventions for co-occurring substance use and trauma symptoms

“…The majority of these publications (n ¼ 5) described interventions that were designed for US military veterans (Table 3). [43][44][45][46][47] Two other interventions were designed for civilian populations who had experienced mass disaster. 48,49 Most interventions utilized webbased modules, although one included telehealth treatment with a handheld electronic device.…”

“…While one research group did combine a module-based approach with telehealth from a health care provider, 43,46 most of the feasibility and protocol publications did not include technology-facilitated human contact. 44,45,[47][48][49] Generally, these approaches also incorporate treatment for several types of substance use, including alcohol, drug use and smoking. This range of treatment options may allow for application to a wider patient population, since it allows for users to opt into relevant treatment modules based upon screening information.…”