CONTACT Study Background

CONTACT Study Background


Since 2000, over 327,000 US service members have been diagnosed with traumatic brain injury (TBI), most of which were mild TBI (mTBI)1. While most people with mTBI recover well, some continue to experience symptoms such as memory problems, headache and sensitivity to sound and light, known as persistent post-concussive symptoms (PPCS). Anxiety, post-traumatic stress, depression and sleep problems complicate the picture. PPCS can interfere with ability to work, engagement in usual activities, and interpersonal relationships, impacting quality of life and troop readiness.

Service members (SM) may be difficult to engage in treatment due to military obligations, mobility from base-to-base, transportation, financial resources and concern about stigma. Only about one third of SMs with post-deployment adjustment problems seek treatment2,3. As many as two-thirds of SMs believe that admitting to mental health concerns and seeking treatment will negatively impact their military career4.

Telephone-delivered interventions, which have been shown to result in high satisfaction5,6, may help overcome these barriers. One survey of active duty SM found that 33% who were not willing to engage in in-person counseling were amenable to a technology-based service7.

The CONTACT intervention was based on a problem solving training (PST) framework, which provides a flexible algorithm of steps for assessing a problem, concern or goal, then planning, carrying out and evaluating a strategy for dealing with the issue at hand. PST has been shown to be effective for dealing with problems of everyday life, as well as chronic pain, general distress, anxiety, depression and suicidal thoughts8,9. Further, telephone delivery of PST has been effective in other populations10,11, and has been used successfully to improve quality of life by persons with cognitive impairment due to TBI12,13.

References

1Dvbic.org/dod-worldwide-numbers-tbi. [cited 2015 May 15].

2Pfeiffer PN, et al. Peers and peer-based interventions in supporting reintegration and mental health among National Guard soldiers: a qualitative study. Mil Med 2012;177(12):1471–6.

3Hoge CW, et al. Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. N Engl J Med 2004;351(1):13–22. http://dx.doi.org/10.1056/NEJMoa040603.

4Britt TW, et al. Perceived stigma and barriers to care for psychological treatment: implications for reactions to stressors in different contexts. J Soc Clin Psychol 2008;27(4):317–35. http://dx.doi.org/10.1521/jscp.2008.27.4.317.

5Wilson JA, et al. Soldier attitudes about technology-based approaches to mental health care. Cyberpsychol Behav 2008;11(6):767–9. http://dx.doi.org/10.1089/cpb.2008.0071.

6Rosen CS, et al. Telephonemonitoring and support for veteranswith chronic posttraumatic stress disorder: a pilot study. Community Ment Health J 2006;42(5):501–8. http://dx.doi.org/10.1007/s10597-006-9047-6.

7Wilson JA, et al. Soldier attitudes about technology-based approaches to mental health care. Cyberpsychol Behav 2008;11(6):767–9. http://dx.doi.org/10.1089/cpb.2008.0071.

8Bell AC & D'Zurilla TJ. Problem-solving therapy for depression: a meta-analysis. Clin Psych Rev, 2009;29(4):348-353. doi: 10.1016/j.cpr.2009.02.003

9Malouff JM, Thorsteinsson EB & Schutte NS. (2007). The efficacy of problem solving therapy in reducing mental and physical health problems: a meta-analysis. Clin Psych Rev; 2007:27(1):46-57. doi: 10.1016/j.cpr.2005.12.005

10Bell KR, et al. The effect of a scheduled telephone intervention on outcome after moderate to severe traumatic brain injury: a randomized trial. Arch Phys Med Rehabil 2005;86(5):851–6. http://dx.doi.org/10.1016/j.apmr.2004.09.015.

11Bell KR, et al. The effect of telephone counselling on reducing posttraumatic symptoms aftermild traumatic brain injury: a randomised trial. J Neurol Neurosurg Psychiatry 2008;79(11):1275–81. http://dx.doi.org/10.1136/jnnp.2007.141762.

12Levine B, et al. Rehabilitation of executive functioning: an experimentalclinical validation of goal management training. J Int Neuropsychol Soc 2000;6(3):299–312.

13Rath JF, et al. Group treatment of problem‐solving deficits in outpatients
with traumatic brain injury: a randomised outcome study. Neuropsychol Rehabil 2003;13(4):461–88.