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CDA 13-017 – HSR&D Study

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CDA 13-017
Problem-Solving Therapy for Gulf War Illness
Lisa Marie McAndrew PhD
East Orange Campus of the VA New Jersey Health Care System, East Orange, NJ
East Orange, NJ
Funding Period: May 2014 - April 2019

BACKGROUND/RATIONALE:
There are almost 700,000 Gulf War Veterans (GWV) with 25-30% suffering from a devastating multi-symptom illness coined Gulf War Illness (GWI). GWV with GWI report significant activity limitations and chronic cognitive problems consistent with problem-solving deficits. Problem-solving is considered the most complex of cognitive abilities and is what enables us to conduct complicated behaviors such as setting goals, sequencing and multi-tasking. Problem-solving deficits are prospectively related to a greater risk of disability. Despite published reports documenting these problems there are no treatments that target the problem-solving deficits of GWI. This proposal seeks to determine whether Problem-Solving Therapy, a patient centered cognitive rehabilitation therapy, can reduce disability by compensating for problem-solving deficits.


OBJECTIVE(S):
I will execute a research program to adapt and test a promising cognitive rehabilitation treatment, Problem-Solving Therapy. Problem-Solving Therapy, a top down approach, teaches patients skills to overcome problems like cognitive dysfunction that impact problem-solving. Compensating for problem-solving deficits would reduce disability and provide information on the effect of treating one component of GWI on other symptoms of GWI. It has been found to be efficacious among civilians with mild traumatic brain injury. This is the first trial of cognitive rehabilitation therapy for GWI.

METHODS:
I will use qualitative methods to better understand GWVs' views on GWI and our proposed intervention. I will modify Problem-Solving Therapy for use with GWV with GWI. I will examine the efficacy of this modified Problem-Solving Therapy for reducing the disability associated with GWI in a multi-site randomized controlled trial (n=258) of telephone delivered Problem-Solving Therapy versus Health Education. Future work will include broader dissemination and implementation of best practices for Problem-Solving Therapy for GWV and other populations.

FINDINGS/RESULTS:
Not yet available.

IMPACT:
In January 2013, the Institute of Medicine released their report "Gulf War and Health: Treatment for Chronic Multisymptom Illness." They recommend that "The Department of Veterans Affairs should fund and conduct studies of interventions that evidence suggests may hold promise for treatment of [GWI]." In response, I propose Problem-Solving Therapy, an innovative and targeted cognitive rehabilitation approach that improves the situations and problems of the patient's choice. The direct benefits for GWVs are hypothesized to include improvements in problem-solving and reductions in disability, defined as participation and daily activity deficits.

PUBLICATIONS:

Journal Articles

  1. McAndrew LM, Helmer DA, Lu SE, Chandler HK, Slotkin S, Quigley KS. Longitudinal relationship between onset of physical symptoms and functional impairment. Journal of behavioral medicine. 2018 Dec 1; 41(6):819-826.
  2. McAndrew LM, Friedlander ML, Alison Phillips L, L Santos S, Helmer DA. Concordance of illness perceptions: The key to improving care of medically unexplained symptoms. Journal of psychosomatic research. 2018 Aug 1; 111:140-142.
  3. McAndrew LM, Greenberg L, Ciccione D, Helmer DA, Chandler H. Therapy for Veterans with Chronic Multisymptom Illness. Military Behavioral Health. 2018 Jan 1; 6(1):56-65.
  4. McAndrew LM, Phillips LA, Helmer DA, Maestro K, Engel CC, Greenberg LM, Anastasides N, Quigley KS. High healthcare utilization near the onset of medically unexplained symptoms. Journal of psychosomatic research. 2017 Jul 1; 98:98-105.
  5. Phillips LA, McAndrew L, Laman-Maharg B, Bloeser K. Evaluating challenges for improving medically unexplained symptoms in US military veterans via provider communication. Patient education and counseling. 2017 Aug 1; 100(8):1580-1587.
  6. McAndrew LM, Held RF, Abbi B, Quigley KS, Helmer DA, Pasupuleti RV. Less engagement in pleasurable activities is associated with poorer quality of life for veterans with comorbid post-deployment conditions. Military psychology : the official journal of the Division of Military Psychology, American Psychological Association. 2017 Jan 1; 29(1):74-81.
  7. McAndrew LM, Markowitz S, Lu SE, Borders A, Rothman D, Quigley KS. Resilience during war: Better unit cohesion and reductions in avoidant coping are associated with better mental health function after combat deployment. Psychological trauma : theory, research, practice and policy. 2017 Jan 1; 9(1):52-61.
  8. Carlson KF, O'Neil ME, Forsberg CW, McAndrew LM, Storzbach D, Cifu DX, Sayer NA. Risk of hospitalization due to motor vehicle crashes among Iraq and Afghanistan War Veterans diagnosed with traumatic brain injury. Neurorehabilitation. 2016 Jun 30; 39(3):351-61.
  9. McAndrew LM, Chandler HC, Serrador J, Quigley KS, Natelson B, Lange G. Comparison of the Functional Health Limitations of Veterans Deployed to Iraq or Afghanistan to Veterans Deployed to Desert Shield/Storm With Chronic Fatigue Syndrome. Military Behavioral Health. 2016 Apr 13; 4(3):299-306.
  10. McAndrew LM, Helmer DA, Phillips LA, Chandler HK, Ray K, Quigley KS. Iraq and Afghanistan Veterans report symptoms consistent with chronic multisymptom illness one year after deployment. Journal of rehabilitation research and development. 2016 Feb 1; 53(1):59-70.
  11. Mohanty AF, Helmer DA, Muthukutty A, McAndrew LM, Carter ME, Judd J, Garvin JH, Samore MH, Gundlapalli AV. Fibromyalgia syndrome care of Iraq- and Afghanistan-deployed Veterans in Veterans Health Administration. Journal of rehabilitation research and development. 2016 Feb 1; 53(1):45-58.
  12. Mohanty AF, Muthukutty A, Carter ME, Palmer MN, Judd J, Helmer D, McAndrew LM, Garvin JH, Samore MH, Gundlapalli AV. Chronic multisymptom illness among female Veterans deployed to Iraq and Afghanistan. Medical care. 2015 Apr 1; 53(4 Suppl 1):S143-8.
Journal Other

  1. Mohanty AF, McAndrew LM, Helmer D, Samore MH, Gundlapalli AV. Chronic Multisymptom Illness Among Iraq/Afghanistan-Deployed US Veterans and Their Healthcare Utilization Within the Veterans Health Administration. [Letter to the Editor]. Journal of general internal medicine. 2018 Sep 1; 33(9):1419-1422.
  2. Sullivan N, McAndrew LM, Quigley K, Pigeon W, Litke D, Graff F, Phillips LA, Helmer DA. Behavioral responses to Gulf War Illness: Implications for reducing disability among our veteran. [Abstract]. Annals of behavioral medicine : a publication of the Society of Behavioral Medicine. 2018 Apr 1;(52):S80.
  3. McAndrew LM, Pigeon W, Quigley KS, Litke D, Lu S, Rath J, Chiusano C, Helmer DA. Preliminary analysis of the impact of problem-solving treatment on suicidal ideation among Veterans with chronic pain. [Abstract]. Annals of behavioral medicine : a publication of the Society of Behavioral Medicine. 2018 Jan 1;(52):S79.
  4. Greenberg LM, Pigeon WR, Gonzalez CG, Anastasides N, Presnall-Shvorin J, Litke DR, McAndrew LM. Suicidality among Veterans with Gulf War Illness. [Abstract]. Annals of behavioral medicine : a publication of the Society of Behavioral Medicine. 2017 Mar 1;(51):S2668-2669.
  5. McAndrew LM, Anastasides N, Chelenza M, Chiusano C, Gonzalez C, Graff F, Greenberg L, Helmer DA, Litke D, Lu SE, McDonald E, Petrakis BA, Pigeon W, Presnall-Shvorin J, Quigley KS, Rath J. Life and Treatment Goals of Veterans with Gulf War Illness. [Abstract]. Annals of behavioral medicine : a publication of the Society of Behavioral Medicine. 2017 Jan 1; 51(S2116-S2117):233.
  6. McAndrew LM, Pasupuleti R, Chandler H, Serrador J, Natelson B, Quigley K, Lange G. Is history repeating?: Comparison of the functional limitations of OEF/OIF Veterans to Gulf War Veterans with chronic fatigue. [Abstract]. Annals of behavioral medicine : a publication of the Society of Behavioral Medicine. 2015 Apr 2; 49(1):S111.
  7. Pasupuleti R, McAndrew LM, Anastasides N, Quigley KS. Health beliefs of soldiers about seeking physical health services over time. [Abstract]. Annals of behavioral medicine : a publication of the Society of Behavioral Medicine. 2015 Apr 2; 49(1):S209.
Conference Presentations

  1. Slotkin SD, Maestro KJ, Galipeau B, McAndrew LM. Academic Outcomes of Student Veterans with Muscle/Joint Pain. Poster session presented at: Society of Behavioral Medicine Annual Meeting and Scientific Sessions; 2016 Apr 1; Washington, DC.
  2. Anastasides N, McAndrew LM, Litke DR, Helmer DA, Quigley KS. Delays in seeking healthcare by Veterans with and without chronic multi symptom illness (CMI). Poster session presented at: Society of Behavioral Medicine Annual Meeting and Scientific Sessions; 2016 Mar 1; Washington, DC.
  3. Greenberg L, McAndrew LM, Chandler HK, Quigley KS. The mediating role of somatic symptoms in the relationship between PTSD one year and five years post-deployment. Poster session presented at: Society of Behavioral Medicine Annual Meeting and Scientific Sessions; 2016 Mar 1; Washington, DC.
  4. McAndrew LM, Chandler HK, Greenberg L, Helmer DA. Cognitive Behavioral Therapy delivered in person to telephone to usual care for Veterans with chronic multi symptom illness. Poster session presented at: Society of Behavioral Medicine Annual Meeting and Scientific Sessions; 2016 Mar 1; Washington, DC.
  5. Litke D, McAndrew LM, Rath JF. Adapting problem-solving therapy for veterans with gulf war illness. In J.F. Rath (Chair) Problem Solving Symposium. Paper presented at: American Psychological Association Rehabilitation Psychology Annual Conference; 2016 Feb 1; Atlanta, GA.
  6. McAndrew LM, Pasupuleti R, Fobler M, Chiusano C, Slotkin S, Phillips A. Veterans’ beliefs about their physical symptoms. Poster session presented at: American Psychological Association Annual Convention; 2015 Aug 1; Toronto, Canada.
  7. McAndrew LM, Maestro KJ, Slotkin S. The Role of Mental Health Treatment Beliefs in Veterans’ Use of Self-Help Sources. Presented at: Society of Behavioral Medicine Annual Meeting and Scientific Sessions; 2015 Apr 22; San Antonio, TX.
  8. McAndrew LM, Slotkin S, Maestro K. The Relationship between Familial Support and Mental Health Care Seeking in Veterans. Presented at: Society of Behavioral Medicine Annual Meeting and Scientific Sessions; 2015 Apr 22; San Antonio, TX.
  9. Phillips LA, McAndrew LM. The Challenge and Potential for Improving Medically Unexplained Symptoms Via Provider Communication. Presented at: Society of Behavioral Medicine Annual Meeting and Scientific Sessions; 2015 Apr 22; San Antonio, TX.
  10. Phillips LA, Laman-Maharg B, McAndrew LM. Military Veterans’ Perceptions of Disagreement with their Provider Regarding their Medically Unexplained Symptoms are Associated with Lower Satisfaction and Intentions to Adhere to Treatment and Poorer Health-Outcome Expectations. Presented at: International Society for Pharmacoeconomics and Outcomes Research Annual Meeting; 2014 Jun 2; Montreal, Canada.


DRA: Military and Environmental Exposures, Mental, Cognitive and Behavioral Disorders
DRE: Technology Development and Assessment, Treatment - Efficacy/Effectiveness Clinical Trial
Keywords: Career Development
MeSH Terms: none