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Published Online: June 2013

Implementation of Multifamily Group Treatment for Veterans With Traumatic Brain Injury

Deborah A. Perlick, Ph.D., Kristy Straits-Troster, Ph.D., A.B.P.P., Jennifer L. Strauss, Ph.D., Diane Norell, M.S.W., O.T.R./L., Larry A. Tupler, Ph.D., Bruce Levine, M.D., Xiaodong Luo, Ph.D., Caroline Holman, B.A., Tara Marcus, M.S., Lisa B. Dixon, M.D., M.P.H., and Dennis G. Dyck, Ph.D.Authors Info & Affiliations
Publication: Psychiatric Services
Volume 64, Number 6
https://doi.org/10.1176/appi.ps.001622012
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Abstract

Traumatic brain injury affects an estimated 22% of Iraq and Afghanistan veterans. Deficits in memory and functioning among these veterans, who may also have PTSD and depression, can create challenges in household management and lead to friction among family members. Veterans with TBI who participated in a multifamily group intervention reported less anger expression and more social support and occupational activity. Their family members reported decreased burden and described “powerful experiences” of connecting with a wider social network and reconnecting with their loved ones.

Abstract

Objective

This study evaluated the initial efficacy and feasibility of implementing multifamily group treatment for veterans with traumatic brain injury (TBI).

Methods

Veterans at two Veterans Affairs medical centers were prescreened by their providers for participation in an open trial of multifamily group treatment for TBI. Enrollment was limited to consenting veterans with a clinical diagnosis of TBI sustained during the Operation Enduring Freedom–Operation Iraqi Freedom era, a family member or partner consenting to participate, and a score ≥20 on the Mini-Mental State Examination. The nine-month (April 2010–March 2011) trial consisted of individual family sessions, an educational workshop, and bimonthly multifamily problem-solving sessions. Interpersonal functioning and symptomatic distress among veterans and family burden, empowerment, and symptomatic distress among families were assessed before and after treatment.

Results

Providers referred 34 (58%) of 59 veterans screened for the study; of those, 14 (41%) met criteria and consented to participate, and 11 (32%) completed the study. Severity of TBI, insufficient knowledge about the benefits of family involvement, and access problems influenced decisions to exclude veterans or refuse to participate. Treatment was associated with decreased veteran anger expression (p≤.01) and increased social support and occupational activity (p≤.05), with effect sizes ranging from .6 to 1.0. Caregivers reported decreased burden (p≤.05) and increased empowerment (p≤.01).

Conclusions

The results supported implementation of a randomized controlled trial, building in education at the provider and family level.

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Information & Authors

Information

Published In

Go to Psychiatric Services
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Cover: Sir Charles, Alias Willie Harris, by Barkley Leonnard Hendricks, 1972. Oil on canvas. William C. Whitney Foundation, 1973.19.1. National Gallery of Art, Washington, D.C.

Psychiatric Services
Volume 64 • Number 6 • June 2013
Pages: 534 - 540
PubMed: 23450320

History

Published in print: June 2013
Published online: 15 October 2014

Authors

Details

Deborah A. Perlick, Ph.D.
Dr. Perlick and Dr. Luo are affiliated with the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029 (e-mail: [email protected]). Dr. Perlick is also affiliated with the U.S. Department of Veterans Affairs (VA) Mental Illness Research, Education and Clinical Center (MIRECC), Bronx, New York, where Dr. Levine, Ms. Holman, and Ms. Marcus are also affiliated. Dr. Straits-Troster and Dr. Tupler are with the Mid-Atlantic Region MIRECC, and Dr. Strauss is with the Health Services Research and Development Service, Durham VA Medical Center, North Carolina. Dr. Strauss is also with the Department of Psychiatry, Duke University, Durham. Ms. Norell is with the Department of Occupational Therapy at Eastern Washington University, Cheney. Dr. Dixon is with the Department of Psychiatry, Columbia University, and with the Center for Practice Innovations, New York State Psychiatric Institute, both in New York City. Dr. Dyck is with the Department of Psychology, Washington State University, Spokane.
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Kristy Straits-Troster, Ph.D., A.B.P.P.
Dr. Perlick and Dr. Luo are affiliated with the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029 (e-mail: [email protected]). Dr. Perlick is also affiliated with the U.S. Department of Veterans Affairs (VA) Mental Illness Research, Education and Clinical Center (MIRECC), Bronx, New York, where Dr. Levine, Ms. Holman, and Ms. Marcus are also affiliated. Dr. Straits-Troster and Dr. Tupler are with the Mid-Atlantic Region MIRECC, and Dr. Strauss is with the Health Services Research and Development Service, Durham VA Medical Center, North Carolina. Dr. Strauss is also with the Department of Psychiatry, Duke University, Durham. Ms. Norell is with the Department of Occupational Therapy at Eastern Washington University, Cheney. Dr. Dixon is with the Department of Psychiatry, Columbia University, and with the Center for Practice Innovations, New York State Psychiatric Institute, both in New York City. Dr. Dyck is with the Department of Psychology, Washington State University, Spokane.
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Jennifer L. Strauss, Ph.D.
Dr. Perlick and Dr. Luo are affiliated with the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029 (e-mail: [email protected]). Dr. Perlick is also affiliated with the U.S. Department of Veterans Affairs (VA) Mental Illness Research, Education and Clinical Center (MIRECC), Bronx, New York, where Dr. Levine, Ms. Holman, and Ms. Marcus are also affiliated. Dr. Straits-Troster and Dr. Tupler are with the Mid-Atlantic Region MIRECC, and Dr. Strauss is with the Health Services Research and Development Service, Durham VA Medical Center, North Carolina. Dr. Strauss is also with the Department of Psychiatry, Duke University, Durham. Ms. Norell is with the Department of Occupational Therapy at Eastern Washington University, Cheney. Dr. Dixon is with the Department of Psychiatry, Columbia University, and with the Center for Practice Innovations, New York State Psychiatric Institute, both in New York City. Dr. Dyck is with the Department of Psychology, Washington State University, Spokane.
View all articles by this author
Diane Norell, M.S.W., O.T.R./L.
Dr. Perlick and Dr. Luo are affiliated with the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029 (e-mail: [email protected]). Dr. Perlick is also affiliated with the U.S. Department of Veterans Affairs (VA) Mental Illness Research, Education and Clinical Center (MIRECC), Bronx, New York, where Dr. Levine, Ms. Holman, and Ms. Marcus are also affiliated. Dr. Straits-Troster and Dr. Tupler are with the Mid-Atlantic Region MIRECC, and Dr. Strauss is with the Health Services Research and Development Service, Durham VA Medical Center, North Carolina. Dr. Strauss is also with the Department of Psychiatry, Duke University, Durham. Ms. Norell is with the Department of Occupational Therapy at Eastern Washington University, Cheney. Dr. Dixon is with the Department of Psychiatry, Columbia University, and with the Center for Practice Innovations, New York State Psychiatric Institute, both in New York City. Dr. Dyck is with the Department of Psychology, Washington State University, Spokane.
View all articles by this author
Larry A. Tupler, Ph.D.
Dr. Perlick and Dr. Luo are affiliated with the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029 (e-mail: [email protected]). Dr. Perlick is also affiliated with the U.S. Department of Veterans Affairs (VA) Mental Illness Research, Education and Clinical Center (MIRECC), Bronx, New York, where Dr. Levine, Ms. Holman, and Ms. Marcus are also affiliated. Dr. Straits-Troster and Dr. Tupler are with the Mid-Atlantic Region MIRECC, and Dr. Strauss is with the Health Services Research and Development Service, Durham VA Medical Center, North Carolina. Dr. Strauss is also with the Department of Psychiatry, Duke University, Durham. Ms. Norell is with the Department of Occupational Therapy at Eastern Washington University, Cheney. Dr. Dixon is with the Department of Psychiatry, Columbia University, and with the Center for Practice Innovations, New York State Psychiatric Institute, both in New York City. Dr. Dyck is with the Department of Psychology, Washington State University, Spokane.
View all articles by this author
Bruce Levine, M.D.
Dr. Perlick and Dr. Luo are affiliated with the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029 (e-mail: [email protected]). Dr. Perlick is also affiliated with the U.S. Department of Veterans Affairs (VA) Mental Illness Research, Education and Clinical Center (MIRECC), Bronx, New York, where Dr. Levine, Ms. Holman, and Ms. Marcus are also affiliated. Dr. Straits-Troster and Dr. Tupler are with the Mid-Atlantic Region MIRECC, and Dr. Strauss is with the Health Services Research and Development Service, Durham VA Medical Center, North Carolina. Dr. Strauss is also with the Department of Psychiatry, Duke University, Durham. Ms. Norell is with the Department of Occupational Therapy at Eastern Washington University, Cheney. Dr. Dixon is with the Department of Psychiatry, Columbia University, and with the Center for Practice Innovations, New York State Psychiatric Institute, both in New York City. Dr. Dyck is with the Department of Psychology, Washington State University, Spokane.
View all articles by this author
Xiaodong Luo, Ph.D.
Dr. Perlick and Dr. Luo are affiliated with the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029 (e-mail: [email protected]). Dr. Perlick is also affiliated with the U.S. Department of Veterans Affairs (VA) Mental Illness Research, Education and Clinical Center (MIRECC), Bronx, New York, where Dr. Levine, Ms. Holman, and Ms. Marcus are also affiliated. Dr. Straits-Troster and Dr. Tupler are with the Mid-Atlantic Region MIRECC, and Dr. Strauss is with the Health Services Research and Development Service, Durham VA Medical Center, North Carolina. Dr. Strauss is also with the Department of Psychiatry, Duke University, Durham. Ms. Norell is with the Department of Occupational Therapy at Eastern Washington University, Cheney. Dr. Dixon is with the Department of Psychiatry, Columbia University, and with the Center for Practice Innovations, New York State Psychiatric Institute, both in New York City. Dr. Dyck is with the Department of Psychology, Washington State University, Spokane.
View all articles by this author
Caroline Holman, B.A.
Dr. Perlick and Dr. Luo are affiliated with the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029 (e-mail: [email protected]). Dr. Perlick is also affiliated with the U.S. Department of Veterans Affairs (VA) Mental Illness Research, Education and Clinical Center (MIRECC), Bronx, New York, where Dr. Levine, Ms. Holman, and Ms. Marcus are also affiliated. Dr. Straits-Troster and Dr. Tupler are with the Mid-Atlantic Region MIRECC, and Dr. Strauss is with the Health Services Research and Development Service, Durham VA Medical Center, North Carolina. Dr. Strauss is also with the Department of Psychiatry, Duke University, Durham. Ms. Norell is with the Department of Occupational Therapy at Eastern Washington University, Cheney. Dr. Dixon is with the Department of Psychiatry, Columbia University, and with the Center for Practice Innovations, New York State Psychiatric Institute, both in New York City. Dr. Dyck is with the Department of Psychology, Washington State University, Spokane.
View all articles by this author
Tara Marcus, M.S.
Dr. Perlick and Dr. Luo are affiliated with the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029 (e-mail: [email protected]). Dr. Perlick is also affiliated with the U.S. Department of Veterans Affairs (VA) Mental Illness Research, Education and Clinical Center (MIRECC), Bronx, New York, where Dr. Levine, Ms. Holman, and Ms. Marcus are also affiliated. Dr. Straits-Troster and Dr. Tupler are with the Mid-Atlantic Region MIRECC, and Dr. Strauss is with the Health Services Research and Development Service, Durham VA Medical Center, North Carolina. Dr. Strauss is also with the Department of Psychiatry, Duke University, Durham. Ms. Norell is with the Department of Occupational Therapy at Eastern Washington University, Cheney. Dr. Dixon is with the Department of Psychiatry, Columbia University, and with the Center for Practice Innovations, New York State Psychiatric Institute, both in New York City. Dr. Dyck is with the Department of Psychology, Washington State University, Spokane.
View all articles by this author
Lisa B. Dixon, M.D., M.P.H.
Dr. Perlick and Dr. Luo are affiliated with the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029 (e-mail: [email protected]). Dr. Perlick is also affiliated with the U.S. Department of Veterans Affairs (VA) Mental Illness Research, Education and Clinical Center (MIRECC), Bronx, New York, where Dr. Levine, Ms. Holman, and Ms. Marcus are also affiliated. Dr. Straits-Troster and Dr. Tupler are with the Mid-Atlantic Region MIRECC, and Dr. Strauss is with the Health Services Research and Development Service, Durham VA Medical Center, North Carolina. Dr. Strauss is also with the Department of Psychiatry, Duke University, Durham. Ms. Norell is with the Department of Occupational Therapy at Eastern Washington University, Cheney. Dr. Dixon is with the Department of Psychiatry, Columbia University, and with the Center for Practice Innovations, New York State Psychiatric Institute, both in New York City. Dr. Dyck is with the Department of Psychology, Washington State University, Spokane.
View all articles by this author
Dennis G. Dyck, Ph.D.
Dr. Perlick and Dr. Luo are affiliated with the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029 (e-mail: [email protected]). Dr. Perlick is also affiliated with the U.S. Department of Veterans Affairs (VA) Mental Illness Research, Education and Clinical Center (MIRECC), Bronx, New York, where Dr. Levine, Ms. Holman, and Ms. Marcus are also affiliated. Dr. Straits-Troster and Dr. Tupler are with the Mid-Atlantic Region MIRECC, and Dr. Strauss is with the Health Services Research and Development Service, Durham VA Medical Center, North Carolina. Dr. Strauss is also with the Department of Psychiatry, Duke University, Durham. Ms. Norell is with the Department of Occupational Therapy at Eastern Washington University, Cheney. Dr. Dixon is with the Department of Psychiatry, Columbia University, and with the Center for Practice Innovations, New York State Psychiatric Institute, both in New York City. Dr. Dyck is with the Department of Psychology, Washington State University, Spokane.
View all articles by this author

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