ABSTRACT
OBJECTIVE: Military personnel returning from Iraq and Afghanistan with traumatic brain injury (TBI) present with a complex array of stressors encountered during combat as well as upon re-entry, often with additional physical and mental health comorbidities. This requires an intensive approach to treatment that includes family intervention as a part of rehabilitation. There is a small but growing literature addressing the needs of families when a family member has sustained a TBI. An established treatment intervention for individuals with serious mental illness, such as family focused therapy (FFT), is uniquely suited to address the complexity of issues presented by returning military personnel, and may be adapted for moderate to severe TBI populations. In this article, we discuss the rationale for adapting this family intervention for this population and present a case vignette illustrating adaptations for TBI. CONCLUSIONS: The adaptation of an existing family intervention for a chronic condition that focuses on enhancing both individual and family functioning is a useful starting point. With further research to modify FFT for this unique population and establish feasibility, this approach may supplement existing models of family intervention.
Subject(s)
Brain Injuries/psychology , Brain Injuries/rehabilitation , Family Therapy/methods , Veterans/psychology , Adult , Afghan Campaign 2001- , Brain Injuries/complications , Family Therapy/trends , Humans , Iraq War, 2003-2011 , Male , Severity of Illness Index , Stress Disorders, Post-Traumatic/complications , Stress Disorders, Post-Traumatic/psychology , Stress Disorders, Post-Traumatic/rehabilitation , United States , Veterans/statistics & numerical dataABSTRACT
A 30-year-old veteran with a diagnosis of schizoaffective disorder and his mother were referred for family-focused therapy (FFT), an empirically-supported, manual-based treatment. The veteran had had multiple hospitalizations and experienced chronic auditory hallucinations for self-harm. Minor modifications to FFT were made for implementation via videoconferencing (at a bandwidth of 384 kbit/s). This may have enhanced the treatment by making the process of communication and problem-solving more explicit. The course of FFT was successfully completed, and the veteran and family showed a high level of satisfaction with care as well as improved medication adherence, good quality of life, high levels of hope, good interpersonal functioning, and very mild negative and positive psychiatric symptoms. This veteran had previous exposure to telemental health, which may have influenced his willingness to receive tele-FFT and perhaps affected the outcome of the case. The ability to provide this type of service to people in rural areas is important.
Subject(s)
Family Therapy/methods , Hallucinations/therapy , Schizophrenia/therapy , Videoconferencing , Adult , Health Status , Humans , Male , Medication Adherence , Patient Satisfaction , Quality of Life , Treatment OutcomeABSTRACT
The development of the Responses to Stress Questionnaire-cancer version (RSQ-CV) to assess coping with and responses to the stress of breast cancer is described. The RSQ-CV was completed by 232 women with breast cancer near the time of their diagnosis. Confirmatory factor analyses verified a model that includes three voluntary coping factors (primary control engagement coping, secondary control engagement coping, disengagement coping) and two involuntary stress response factors (involuntary engagement, involuntary disengagement). Internal consistency reliability, and stability over 12 weeks for the five factors were adequate to excellent. Convergent and discriminant validity was examined through correlations with measures of intrusive thoughts, avoidance, and dimensions of perceived control. Significant correlations with symptoms of anxiety and depression are also reported. Applications of the RSQ-CV for research with breast cancer patients are discussed.
Subject(s)
Adaptation, Psychological , Breast Neoplasms/psychology , Stress, Psychological/diagnosis , Stress, Psychological/etiology , Surveys and Questionnaires , Female , Humans , Middle Aged , Neoplasm Staging , PsychologyABSTRACT
OBJECTIVE: Diagnosis and treatment of breast cancer can be a stressful experience, putting women at risk of posttraumatic stress disorder (PTSD). The current study investigated morning cortisol levels in newly diagnosed (i.e., within 6 months) breast cancer patients. METHODS: Structured DSM-IV interviews determined current and past incidence of PTSD and major depressive disorder (MDD) in 71 women with Stage 0-3 breast cancer. RESULTS: Significantly decreased plasma cortisol was found in women meeting current or lifetime criteria for PTSD or past diagnosis of MDD. CONCLUSIONS: These results reinforce the importance for both psychological and physiological outcomes of a clinical evaluation of both current and past psychiatric status in newly diagnosed cancer patients.
