Hostname: page-component-586b7cd67f-t8hqh Total loading time: 0 Render date: 2024-11-28T09:42:50.508Z Has data issue: false hasContentIssue false

Developing a Peer Support Protocol for Improving Veterans’ Engagement to Computer-Delivered Cognitive Behavioural Therapy

Published online by Cambridge University Press:  22 March 2017

John M. Ray*
Affiliation:
Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR 72114, USA VA South Central Mental Illness Research, Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR 72114, USA Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
Lakiesha L. Kemp
Affiliation:
Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR 72114, USA VA South Central Mental Illness Research, Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR 72114, USA Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
Amanda Hubbard
Affiliation:
Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR 72114, USA VA South Central Mental Illness Research, Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR 72114, USA Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
Michael A. Cucciare
Affiliation:
Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR 72114, USA VA South Central Mental Illness Research, Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR 72114, USA Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
*
Correspondence to John M. Ray, Postdoctoral Research Fellow, South Central Mental Illness Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR 72114–1706, USA. E-mail: [email protected]

Abstract

Background: Computer-delivered cognitive behavioural therapy (cCBT) is an effective alternative to provider-delivered treatment for depression and anxiety, but high attrition poses a significant challenge to its use. Peer support is a feasible approach to improving cCBT engagement, but less is known about its acceptability among Veterans. Aims: To obtain feedback from Veterans (n = 24) with depression and/or anxiety on their preferences for (a) activities of Veterans Administration Peer Support Specialists (VA PSS) in helping Veterans use Moving Forward, a cCBT-based protocol developed by VA, and (b) methods for delivering support to Veterans using this programme. Method: Four focus groups (5–7 Veterans per group) provided feedback to be used in the development of a peer-supported engagement intervention to help Veterans with depression and anxiety use Moving Forward. Content areas included roles that a VA PSS might play in supporting the use of and engagement in Moving Forward, as well as methods of delivering that support. Results: Veteran preferences for PSS activity focused on practical aspects of using Moving Forward, including orientation to the programme, technical support, and monitoring progress. Feedback also suggested that Veterans preferred more personal roles for the PSS, including emotional support, as well as application of Moving Forward to ‘real life’ problems. Conclusions: The findings extend the literature on online, patient-facing mental health protocols by identifying emotional support and ‘real life’ skills application as Veteran-preferred components of a peer-support protocol designed to enhance use of and engagement in cCBT for depression and anxiety.

Type
Research Article
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Andersson, G. and Cuijpers, P. (2009). Internet-based and other computerized psychological treatments for adult depression: a meta-analysis. Cognitive Behaviour Therapy, 38, 196205.Google Scholar
Andersson, G., Cuijpers, P., Carlbring, P., Riper, H. and Hedman, E. (2014). Guided internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: a systematic review and meta-analysis. World Psychiatry, 13, 288295.Google Scholar
Andrews, G., Cuijpers, P., Craske, M. G., McEvoy, P. and Titov, N. (2010). Computer therapy for the anxiety and depressive disorders is effective, acceptable and practical health care: a meta-analysis. PLoS One, 5, e13196.Google Scholar
Basch, C. E. (1987). Focus group interview: An underutilized research technique for improving theory and practice in health education. Health Education and Behavior, 14, 411448.Google Scholar
Beck, J. S. (1979). Cognitive Therapy. Wiley Online Library.Google Scholar
Cavanagh, K. (2010). Turn on, tune in and (don't) drop out: engagement, adherence, attrition, and alliance with internet-based interventions. Oxford Guide to Low Intensity CBT Interventions, pp. 227233. Oxford University Press.CrossRefGoogle Scholar
Chinman, M., George, P., Dougherty, R. H., Daniels, A. S., Ghose, S. S., Swift, A. et al. (2014). Peer support services for individuals with serious mental illnesses: assessing the evidence. Psychiatric Services, 65, 429441.Google Scholar
Chinman, M., Lucksted, A., Gresen, R., Davis, M., Losonczy, M., Sussner, B. et al. (2008). Early experiences of employing consumer-providers in the VA. Psychiatric Services, 59, 13151321.Google Scholar
Chinman, M., Oberman, R. S., Hanusa, B. H., Cohen, A. N., Salyers, M. P., Twamley, E. W. et al. (2013). A cluster randomized trial of adding peer specialists to intensive case management teams in the Veterans Health Administration. Journal of Behavioral Health Services and Research, 42, 109121.Google Scholar
Chinman, M., Young, A. S., Hassell, J. and Davidson, L. (2006). Toward the implementation of mental health consumer provider services. Journal of Behavioral Health Services and Research, 33, 176195.Google Scholar
Cohen, S. I., Suri, P., Amick, M. M. and Yan, K. (2013). Clinical and demographic factors associated with employment status in US military veterans returning from Iraq and Afghanistan. Work (Reading, Mass.), 44, 213219.Google Scholar
Craig, T., Doherty, I., Jamieson-Craig, R., Boocock, A. and Attafua, G. (2004). The consumer-employee as a member of a Mental Health Assertive Outreach Team. I. Clinical and social outcomes. Journal of Mental Health, 13, 5969.Google Scholar
Cuijpers, P., Donker, T., Johansson, R., Mohr, D. C., van Straten, A. and Andersson, G. (2011). Self-guided psychological treatment for depressive symptoms: a meta-analysis. PLoS One, 6, e21274.Google Scholar
Curry, J. F., Aubuchon-Endsley, N., Brancu, M., Runnals, J.J. VA Mid-Atlantic Mirecc Women Veterans Research Workgroup, VA Mid-Atlantic Mirecc Registry Workgroup and Fairbank, J. A. (2014). Lifetime major depression and comorbid disorders among current-era women veterans. Journal of Affective Disorders, 152, 434440.CrossRefGoogle ScholarPubMed
de Graaf, L. E., Gerhards, S. A. H., Arntz, A., Riper, H., Metsemakers, J. F. M., Evers, S. M. A. A. et al. (2009). Clinical effectiveness of online computerised cognitive-behavioural therapy without support for depression in primary care: randomised trial. The British Journal of Psychiatry, 195, 7380.Google Scholar
Fox, A. B., Meyer, E. C. and Vogt, D. (2015). Attitudes about the VA health-care setting, mental illness, and mental health treatment and their relationship with VA mental health service use among female and male OEF/OIF veterans. Psychological Services, 12, 4958.Google Scholar
Garcia, H. A., Finley, E. P., Ketchum, N., Jakupcak, M., Dassori, A. and Reye, S. C. (2014). A survey of perceived barriers and attitudes toward mental health care among OEF/OIF veterans at VA outpatient mental health clinics. Military Medicine, 179, 273278.Google Scholar
Gilbody, S., Littlewood, E., Hewitt, C., Brierley, G., Tharmanathan, P., Araya, R. et al. (2015). Computerised cognitive behaviour therapy (cCBT) as treatment for depression in primary care (REEACT trial): large scale pragmatic randomised controlled trial. British Medical Journal, 351, h5627.Google Scholar
Griffiths, K. M., Farrer, L. and Christensen, H. (2010). The efficacy of internet interventions for depression and anxiety disorders: a review of randomised controlled trials. Medical Journal of Australia, 192, S4.Google Scholar
Hoge, C. W., Castro, C. A., Messer, S. C., McGurk, D., Cotting, D. I. and Koffman, R. L. (2004). Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. New England Journal of Medicine, 351, 1322.Google Scholar
King, N., Cassell, C. and Symon, G. (2004). Using templates in the thematic analysis of texts. In Cassell, C. and Symon, G. (eds), Essential Guide to Qualitative Methods in Organizational Research (pp. 256270). Thousand Oaks, CA: Sage Publications.Google Scholar
Knowles, S. E., Lovell, K., Bower, P., Gilbody, S., Littlewood, E. and Lester, H. (2015). Patient experience of computerised therapy for depression in primary care. BMJ Open, 5.Google Scholar
Kroenke, K., Spitzer, R. L. and Williams, J. B. (2001). The Phq-9. Journal of General Internal Medicine, 16, 606613.CrossRefGoogle ScholarPubMed
Laffaye, C., Cavella, S., Drescher, K. and Rosen, C. (2008). Relationships among PTSD symptoms, social support, and support source in veterans with chronic PTSD. Journal of Traumatic Stress, 21, 394401.CrossRefGoogle ScholarPubMed
Marks, I. and Cavanagh, K. (2009). Computer-aided psychological treatments: evolving issues. Annual Review of Clinical Psychology, 5, 121141.Google Scholar
Masters, J. C. and Burish, T. G. (1987). Behavior Therapy: Techniques and Empirical Findings. Harcourt College Publishing.Google Scholar
McHugh, R. K., Murray, H. W. and Barlow, D. H. (2009). Balancing fidelity and adaptation in the dissemination of empirically-supported treatments: the promise of transdiagnostic interventions. Behaviour Research and therapy, 47, 946953.Google Scholar
Mittal, D., Drummond, K. L., Blevins, D., Curran, G., Corrigan, P. and Sullivan, G. (2013). Stigma associated with PTSD: Perceptions of treatment seeking combat veterans. Psychiatric Rehabilitation Journal, 36, 8692.Google Scholar
Mott, J. M., Hundt, N. E., Sansgiry, S., Mignogna, J. and Cully, J. A. (2014). Changes in psychotherapy utilization among veterans with depression, anxiety, and PTSD. Psychiatric Services, 65, 106112.Google Scholar
Murray, E. (2012). Web-based interventions for behavior change and self-management: potential, pitfalls, and progress. Medicine 2.0, 1, e3.Google Scholar
Nadin, S. & Cassell, C. (2004). Using data matrices. In Cassell, C. and Symon, G. (eds), Essential Guide to Qualitative Methods in Organizational Research, pp. 271287. Thousand Oaks, CA: Sage Publications.Google Scholar
Nelson, C. B., Abraham, K. M., Walters, H., Pfeiffer, P. N. and Valenstein, M. (2014). Integration of peer support and computer-based CBT for veterans with depression. Computers in Human Behavior, 31, 5764.CrossRefGoogle Scholar
Newman, M. G., Szkodny, L. E., Llera, S. J. and Przeworski, A. (2011). A review of technology-assisted self-help and minimal contact therapies for anxiety and depression: is human contact necessary for therapeutic efficacy? Clinical Psychology Review, 31, 89103.Google Scholar
Nezu, A. M., Nezu, C. M. and D'Zurilla, T. J. (2012). Problem-Solving Therapy: A Treatment Manual. Springer Publishing Company.Google Scholar
Pfeiffer, P. N., Ganoczy, D., Ilgen, M., Zivin, K. and Valenstein, M. (2009). Comorbid anxiety as a suicide risk factor among depressed veterans. Depression and Anxiety, 26, 752757.Google Scholar
Pietrzak, R. H., Johnson, D. C., Goldstein, M. B., Malley, J. C. and Southwick, S. M. (2009). Perceived stigma and barriers to mental health care utilization among OEF-OIF veterans. Psychiatric Services, 60, 11181122.CrossRefGoogle ScholarPubMed
Proudfoot, J., Ryden, C., Everitt, B., Shapiro, D. A., Goldberg, D., Mann, A. et al. (2004). Clinical efficacy of computerised cognitive-behavioural therapy for anxiety and depression in primary care: randomised controlled trial. British Journal of Psychiatry, 185, 4654.Google Scholar
Repper, J. and Carter, T. (2011). A review of the literature on peer support in mental health services. Journal of Mental Health, 20, 392411.Google Scholar
Runnals, J. J., Van Voorhees, E., Robbins, A. T., Brancu, M., Straits-Troster, K., Beckham, J. C. et al. (2013). Self-reported pain complaints among Afghanistan/Iraq era men and women veterans with comorbid posttraumatic stress disorder and major depressive disorder. Pain Medicine, 14, 15291533.CrossRefGoogle ScholarPubMed
Sayer, N. A., Noorbaloochi, S., Frazier, P., Carlson, K., Gravely, A. and Murdoch, M. (2010). Reintegration problems and treatment interests among Iraq and Afghanistan combat veterans receiving VA medical care. Psychiatric Services, 61, 589597.Google Scholar
Seal, K. H., Maguen, S., Cohen, B., Gima, K. S., Metzler, T. J., Ren, L. et al. (2010). VA mental health services utilization in Iraq and Afghanistan veterans in the first year of receiving new mental health diagnoses. Journal Of Traumatic Stress, 23, 516.Google Scholar
Sells, D., Davidson, L., Jewell, C., Falzer, P. and Rowe, M. (2006). The treatment relationship in peer-based and regular case management for clients with severe mental illness. Psychiatric Services, 57, 11791184.Google Scholar
Spek, V., Cuijpers, P., Nyklicek, I., Riper, H., Keyzer, J. and Pop, V. (2007). Internet-based cognitive behaviour therapy for symptoms of depression and anxiety: a meta-analysis. Psychological Medicine, 37, 319328.Google Scholar
Spitzer, R. L., Kroenke, K., Williams, J. B. and Lowe, B. (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of Internal Medicine, 166, 10921097.Google Scholar
Tenhula, W. N., Nezu, A. M., Nezu, C. M., Stewart, M. O., Miller, S. A., Steele, J. et al. (2014). Moving forward: A problem-solving training programme to foster veteran resilience. Professional Psychology: Research and Practice, 45, 416.Google Scholar
van Ballegooijen, W., Cuijpers, P., van Straten, A., Karyotaki, E., Andersson, G., Smit, J. H. et al. (2014). Adherence to Internet-based and face-to-face cognitive behavioural therapy for depression: a meta-analysis. PLoS One, 9, e100674.Google Scholar
Waller, R. and Gilbody, S. (2009). Barriers to the uptake of computerized cognitive behavioural therapy: a systematic review of the quantitative and qualitative evidence. Psychological Medicine, 39, 705712.Google Scholar
Submit a response

Comments

No Comments have been published for this article.