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.
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.


BACKGROUND
Clinicaltrials.gov NCT01680419; https://clinicaltrials.gov/ct2/show/NCT01680419 (Archived by WebCite at http://www.webcitation.org/6jJuadfzj).
College of Medicine, Department of Psychiatry, University of Vermont, Burlington, VT, United States. Janet.Kahn@uvm.edu.
Janet R
http://orcid.org/0000-0002-8069-4529
JR
Kahn
William
http://orcid.org/0000-0001-8478-8111
W
Collinge
Robert
http://orcid.org/0000-0002-1342-502X
R
Soltysik
PTSD; Web-based program; compassion; mind-body therapies; mindfulness; moral injury; patient-centered care; reintegration; veterans
Clin Psychol Rev. 2010 Nov;30(7):849-64
20363063
J Pers Soc Psychol. 2004 Feb;86(2):320-33
14769087
Eur J Psychol. 2015 May 29;11(2):323-34
27247660
J Health Soc Behav. 1983 Dec;24(4):385-96
6668417
Pain Med. 2015 Jan;16(1):81-7
25312858
Mil Med. 2012 Dec;177(12):1477-85
23397692
J Trauma Stress. 2014 Aug;27(4):397-405
25158633
Pain Med. 2016 May 10;:null
27165971
J Support Oncol. 2013 Sep;11(3):133-43
24400393
J Rehabil Res Dev. 2003 Sep-Oct;40(5):371-9
15080222
Psychol Serv. 2014 Aug;11(3):273-80
24635041
Support Care Cancer. 2013 May;21(5):1405-14
23262808
Prev Sci. 2011 Dec;12(4):339-48
21761154
Fam Process. 2011 Jun;50(2):235-47
21564063
Psychol Rep. 2008 Dec;103(3):836-44
19320220
J Clin Psychol Med Settings. 2011 Jun;18(2):145-54
21626354
J Couple Relatsh Ther. 2010 Apr;9(2):149-160
20634994
Science. 1977 Apr 8;196(4286):129-36
847460
J Affect Disord. 2012 Jul;139(2):154-65
22381952
JAMA. 2007 Nov 14;298(18):2141-8
18000197
Int Rev Psychiatry. 2011 Apr;23(2):192-200
21521089
J Pers Soc Psychol. 2008 Nov;95(5):1045-62
18954193
J Med Internet Res. 2011 Dec 31;13(4):e126
22209829
J Pers Assess. 1990 Winter;55(3-4):610-7
2280326
Mil Med. 2011 Feb;176(2):161-9
21366078
Clin J Pain. 2012 Feb;28(2):163-7
21677563
Soc Work Public Health. 2016 Oct;31(6):537-48
27254385
Complement Ther Clin Pract. 2014 Nov;20(4):224-9
25172313
J Rehabil Res Dev. 2014;51(4):559-70
25144169
Psychiatry Res. 1989 May;28(2):193-213
2748771
J Trauma Stress. 2010 Feb;23(1):59-68
20135699
J Fam Psychol. 2012 Feb;26(1):26-35
22229880
Prof Psychol Res Pr. 2011 Feb 1;42(1):8-15
21475611
Mil Med. 2014 Apr;179(4):348-55
24690957