Supporting Military Families with Young Children Throughout the Deployment Lifecycle

Jan 22, 2016

Post-9/11 U.S. military service has placed tremendous demands on families of those who serve. That includes more than 2 million children who have experienced parental deployment, with many being under the age of 5 years old, which is a time that is critical to developmental growth.

Currently, no evidence-based and military-specific parenting interventions are available to target this population despite increasing evidence that deployment can have a negative impact on young children and their families.

To combat this problem, Ellen DeVoe, MSW, PhD, of Boston University is leading a STRONG STAR-affiliated study to adapt and test the Strong Families Strong Forces Parenting Program, a universal preventive intervention for active duty parents with young children. The program works with families across the deployment cycle, from the pre-deployment phase through deployment and reintegration. It is designed to reduce deployment-related parenting stress and promote family resilience by supporting parental roles, parenting/co-parenting, and parent-child relationships. As part of the study, the Strong Families Strong Forces Parenting Program will be compared to an alternate intervention called Strong Parents Self-Care.

Helping where it’s needed most

In previous research, the efficacy of Strong Families was established with National Guard and Reservist families. Now, Dr. DeVoe and her study collaborators will evaluate Strong Families Strong Forces at Fort Hood in Killeen, Texas. The Fort Hood community has experienced a disproportionately high number of deployments in the post-9/11 era and has deployed more troops to Iraq and Afghanistan than any other military installation.

How the study works

Dr. DeVoe’s study involves multiple phases. Preliminary phases included a needs assessment of contemporary military families with young children throughout the deployment cycle and, based on that assessment, the adaptation and pilot testing of Strong Families Strong Forces with military parents and their young children.

For the main phase of the study, the research team will conduct a randomized clinical trial involving 150 military families with young children who have a parent scheduled to deploy in the next six months. Participating families will be randomly placed into one of two groups. One group will be enrolled in the Strong Families Strong Forces Parenting Program, in which study providers will work with families in their homes, delivering a program designed to reduce the impact of deployment separation on parenting stress and co-parenting. The other group will be assigned to the Strong Parents Self-Care program, designed to support parents to focus on the importance of self-care throughout the deployment cycle. At the end of the clinical trial, study investigators will compare the two groups on parenting stress, quality of parent-child relationships, parenting/co-parenting, and family and child well-being.

In a final phase of the study, investigators also will conduct a cost-effectiveness analysis comparing the costs of benefits achieved with Strong Families Strong Forces versus Strong Parents on (1) parenting and psychosocial outcomes and (2) secondary outcomes of health care and social service use, such as emergency department visits and child maltreatment reports.

Expected benefits

This study will be one of the first to examine the efficacy of a preventive intervention for active duty parents and their families across military-related deployments and separations. The investigators believe that evidence-based parenting programs can build resilience in military families, contribute to mission readiness and safety for deployed parents, and facilitate positive reintegration for all family members.

A collaborated effort

This study involves the expert collaboration of a team of investigators from Boston University (principal investigator, Ellen DeVoe, MSW, PhD; co-investigators Tim Brown, PsyD, and Renee Spencer, EdD; training director Michelle Acker, PsyD), The University of Texas Health Science Center at San Antonio (co-investigators Katherine Dondanville, PsyD, ABPP, and Abby Blankenship, PhD), and the RAND Corporation (co-investigators Rebecca Kilburn, PhD, and Anita Chandra, PhD), with the support of our military partners at Fort Hood.

Variable-Length Cognitive Processing Therapy for Combat-Related PTSD

Aug 20, 2015

People are different. Traumatic experiences are different. So it’s understandable that different people with different life experiences and personality traits, and who live through a trauma unique to them, might respond differently to the same form of treatment for posttraumatic stress disorder, or PTSD.

In an age when doctors see more and more the benefits of individualized medicine, investigators affiliated with the STRONG STAR Consortium see the need to personalize PTSD care. Recent research supports that idea.

Civilian studies with Cognitive Processing Therapy (CPT), delivered in its standard format for 12 sessions, have shown that it is successful in treating 80% of PTSD patients to the point of remission. But one study showed that more than half (58%) of CPT patients did not need the full course of treatment; they recovered in fewer than 12 sessions. However, 27% still met diagnostic criteria for PTSD after 12 sessions but improved with additional treatment. Three months after treatment, only 2 of the 50 participants (4%) still had a PTSD diagnosis.

Now Dr. Patricia Resick of Duke University Medical Center, the developer of CPT and CPT-C, wants to see if similar results can be achieved with an active duty military population affected by combat-related PTSD. She and STRONG STAR colleagues Dr. Jennifer Wachen, PhD and Dr. Alan Peterson have designed a study with CPT-C that allows clinicians to adjust the length of treatment to meet individual patient needs, with a limit of 24 treatment sessions.

Study aims

By doing away with a “one-size-fits-all” approach to PTSD care and tailoring treatment to the individual, these researchers hope to achieve several goals:

Improve the overall efficacy of CPT-C for combat-related PTSD.
Identify predictors of who will benefit from shorter or longer courses of treatment, helping guide therapists in the treatment of future patients.
Evaluate the effect of variable-length CPT-C on co-occurring psychological problems (e.g., depression), health risk factors (e.g., substance abuse), and psychosocial functioning (e.g., return to work, family functioning).

Expected benefits for the military, mental health providers, and patients

Because this research is being conducted in a military setting, study findings should be directly applicable to military mental health providers. They will be better enabled to tailor CPT-C to meet the needs of individual patients, both by adjusting the length of treatment and more directly targeting individual factors that influence treatment outcomes.

For patients, the greatest expected benefit is an overall improvement in the quality of their care, and with that, a greater chance at defeating PTSD. The variable format may improve patient satisfaction with CPT and encourage them to complete treatment. Those who are able to shorten the required treatment time will be able to resume their daily responsibilities more quickly. On the other hand, those who respond to treatment more slowly will be able to extend their care and increase their chance of full recovery.

Cognitive and Neuronal Markers in Posttraumatic Stress Disorder

Jun 02, 2015

Researchers have found increasing evidence that a dysfunction in the prefrontal cortex of some individuals’ brains plays a role in the development of posttraumatic stress disorder (PTSD). The dysfunction affects cognitive flexibility (CF), or the capacity to shift thought and action according to changing demands in the environment. That can include the ability to inhibit incorrect response.

Cognitive flexibility and higher order thinking are influenced by a protein, brain-derived neurotrophic factor (BDNF). A genetic variation, or single nucleotide polymorphism (SNP), on the BDNF gene has been shown to influence BDNF function and cognition. Previous research also has associated that genetic variation, known as BDNF Val66Met SNP, with risk for PTSD.

But little is known about the nature of the relationship between those factors and how they influence speed of response to therapy for PTSD.

In this STRONG STAR-affiliated study, Principal Investigator M. Danet Lapiz-Bluhm, PhD, RN, and her research team will measure CF and BDNF function in military members with PTSD prior to treatment with Cognitive Processing Therapy (CPT) and then following therapy. The study piggybacks on a Department of Defense-funded clinical trial led by Patricia Resick, PhD, providing CPT therapy to active-duty military members with PTSD after service in Iraq and Afghanistan. That study features an individualized approach to therapy by providing it at variable lengths until symptoms are resolved, rather than the standard regimen of 12 one-hour CPT sessions.

CPT was designed by STRONG STAR investigator Patricia Resick, PhD, of Duke University Medical Center. CPT is a cognitive-behavioral therapy that gives patients an understanding of how their thoughts about a traumatic event influence their feelings and reactions to it, then helps them develop a new way of thinking that alleviates their distress and allows them to regain control of their lives

Dr. Lapiz-Bluhm’s team will recruit participants from Dr. Resick’s parent CPT study, who will provide saliva and blood samples. Saliva and plasma will be analyzed for BDNF. Whole blood will undergo genetic analysis to identify which of the patients have the Val66Met SNP variation.

Study aims

With a goal of improving understanding of various factors influencing PTSD treatment outcome, this study will:

Test active-duty military members with PTSD for cognitive flexibility performance and determine whether speed of response to CPT treatment is related to presence of the Val66Met SNP and the amount of BDNF detected in plasma and saliva. The researchers hypothesize that poor performance in tests for CF, presence of Val66Met SNP, and abnormal peripheral BDNF levels will be associated with delayed treatment response to CPT.
Determine the relationship between change in performance in tests for CF and peripheral BDNF levels with the change in symptom severity following CPT. The researchers hypothesize that the amount of PTSD symptom reduction will be associated with changes in CF performance and BDNF levels.

Expected benefits

Understanding of cognitive and neurotrophic mechanisms in PTSD and following treatment with CPT will potentially contribute to the development of improved strategies to treat or prevent PTSD.