title: Concussion treatment after combat trauma: development of a telephone based, problem solving intervention for service members.
abstract: Military service members (SMs) and veterans who sustain mild traumatic brain injuries (mTBI) during combat deployments often have co-morbid conditions but are reluctant to seek out therapy in medical or mental health settings. Efficacious methods of intervention that are patient-centered and adaptable to a mobile and often difficult-to-reach population would be useful in improving quality of life. This article describes a new protocol developed as part of a randomized clinical trial of a telephone-mediated program for SMs with mTBI. The 12-session program combines problem solving training (PST) with embedded modules targeting depression, anxiety, insomnia, and headache. The rationale and development of this behavioral intervention for implementation with persons with multiple co-morbidities is described along with the proposed analysis of results. In particular, we provide details regarding the creation of a treatment that is manualized yet flexible enough to address a wide variety of problems and symptoms within a standard framework. The methods involved in enrolling and retaining an often hard-to-study population are also highlighted.
authors.affiliation: Department of Rehabilitation Medicine, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, United States. Electronic address: krbell@uw.edu.
authors.forename: Kathleen R
authors.initials: KR
authors.lastname: Bell
authors.affiliation: Department of Rehabilitation Medicine, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, United States. Electronic address: brockja@uw.edu.
authors.forename: Jo Ann
authors.initials: JA
authors.lastname: Brockway
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, United States. Electronic address: fann@uw.edu.
authors.forename: Jesse R
authors.initials: JR
authors.lastname: Fann
authors.affiliation: Defense and Veterans Brain Injury Center, General Dynamics Information Technology, Department of Brain Injury Medicine, WAMC, Fort Bragg, NC 28310, United States. Electronic address: wesley.r.cole.ctr@mail.mil.
authors.forename: Wesley R
authors.initials: WR
authors.lastname: Cole
authors.affiliation: Department of Neurological Surgery, University of Washington, 325 9th Avenue, Seattle, WA 98104, United States. Electronic address: saint@uw.edu.
authors.forename: Jef
authors.initials: J
authors.lastname: St De Lore
authors.affiliation: National Center for Telehealth and Technology, 9933 West Hayes Street, Joint Base Lewis McChord, Tacoma, WA 98431, United States. Electronic address: nigel.e.bush.civ@mail.mil.
authors.forename: Nigel
authors.initials: N
authors.lastname: Bush
authors.affiliation: Department of Psychiatry, University California San Diego, 9500 Gilman Drive (MC 0855), La Jolla, CA 92093, United States. Electronic address: ajlang@ucsd.edu.
authors.forename: Ariel J
authors.initials: AJ
authors.lastname: Lang
authors.affiliation: Moss Rehabilitation Research Institute, 50 Township Line Road, Elkins Park, PA 19027, United States. Electronic address: thart@einstein.edu.
authors.forename: Tessa
authors.initials: T
authors.lastname: Hart
authors.affiliation: Clinical Psychology Doctoral Intern, Fielding Behavioral Health, 10200 132nd Street, Kirkland, WA 98034, United States. Electronic address: mwarren@email.fielding.edu.
authors.forename: Michael
authors.initials: M
authors.lastname: Warren
authors.affiliation: Department of Rehabilitation Medicine, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, United States; Department of Neurological Surgery, University of Washington, 325 9th Avenue, Seattle, WA 98104, United States. Electronic address: dikmen@uw.edu.
authors.forename: Sureyya
authors.initials: S
authors.lastname: Dikmen
authors.affiliation: Department of Rehabilitation Medicine, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, United States; Department of Neurological Surgery, University of Washington, 325 9th Avenue, Seattle, WA 98104, United States; Department of Biostatistics, University of Washington, F-600, Health Sciences Building, Box 357232, Seattle, WA 98195, United States. Electronic address: temkin@uw.edu.
authors.forename: Nancy
authors.initials: N
authors.lastname: Temkin
authors.affiliation: Department of Family and Preventive Medicine, University of California, 9500 Gilman Drive, La Jolla, CA 92093, United States. Electronic address: sojain@ucsd.edu.
authors.forename: Sonia
authors.initials: S
authors.lastname: Jain
authors.affiliation: Department of Family and Preventive Medicine, University of California, 9500 Gilman Drive, La Jolla, CA 92093, United States. Electronic address: reraman@ucsd.edu.
authors.forename: Rema
authors.initials: R
authors.lastname: Raman
authors.affiliation: Department of Psychiatry, University California San Diego, 9500 Gilman Drive (MC 0855), La Jolla, CA 92093, United States; Department of Family and Preventive Medicine, University of California, 9500 Gilman Drive, La Jolla, CA 92093, United States. Electronic address: mstein@ucsd.edu.
authors.forename: Murray B
authors.initials: MB
authors.lastname: Stein
mesh_terms: D001007:Anxiety / Q000523:psychology; D001924:Brain Concussion / Q000523:psychology / Q000628:therapy*; D001930:Brain Injuries / Q000523:psychology / Q000628:therapy; D003863:Depression / Q000523:psychology; D006261:Headache / Q000523:psychology; D006801:Humans; D054542:Iraq War, 2003-2011; D008603:Mental Health; D008889:Military Personnel; D011340:Problem Solving; D011788:Quality of Life; D012107:Research Design; D007319:Sleep Initiation and Maintenance Disorders / Q000523:psychology; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology; D017216:Telemedicine / Q000379:methods*; D013689:Telephone
keywords: Brain Injury; Concussion; Military; Problem solving training; Telehealth; Telephone intervention