SBIR-STTR Award

The overall goal of this project is to produce a multimedia educational intervention that will support recently returned veterans of Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) and their relationship partners (spouse, family or friend) with instruction in cognitive and behavioral processes at home that promote personal resiliency and relationship re-integration. The final product will be an integrated multimedia program that delivers effective support at their convenience while avoiding two common obstacles to serving this population--lack of proximity to formal services, and resistance to using formal services. The elements of the program include (1) a psycho-educational component addressing common mental health needs and vulnerabilities of returning post-deployed veterans and their family members, (2) instruction in mindfulness-based practices for stress reduction and self-support, (3) instruction in a contemplative practice to promote interpersonal connectedness with a relationship partner, and (4) instruction in simple touch and massage techniques to promote both stress reduction and interpersonal connectedness. Phase I will develop and refine the content, processes, and individual elements of the program through a combination of focus groups, experiential workshops, and usability testing of prototype materials, and evaluate feasibility of the approach. Specific aims: 1. Evaluate qualitative data from pre-intervention focus groups. 2. {Produce prototype multimedia components that deliver instruction in cognitive and touch-based health promotion practices for participants to use at home.} 3. {Conduct a 12-week trial of the multimedia educational program with 40 veterans and their chosen partners.} 4. Evaluate qualitative data from follow-up focus groups. 5. Evaluate utilization and perceived helpfulness of the intervention. 6. Evaluate impact of massage on symptoms. 7. Assess longitudinal within-subject effects of the intervention. 8. Identify predictors of response. Hypotheses: 1. There will be significant improvements in depression, stress levels, quality of life, selfcompassion and compassion for others during the intervention period compared to the control period, for both veterans and partners. 2. The frequency of use of the intervention techniques will predict levels of depression, stress levels, quality of life, self-compassion and compassion for others in both the veteran and the partner. Design: Waiting-list controlled repeated measures (AABB) design, single-subject statistical pre-processing, and hierarchically optimal classification tree analysis (CTA). Feasibility will be determined by assessing (1) utilization and perceived helpfulness of the intervention, and (2) evidence of potential impact on well-being in veterans and their participating partners. Impact: The proposed program will offer a convenient, private resource that may reduce suffering and improve quality of life of potentially tens of thousands of OIF/OEF veterans and their family members, as well as millions of veterans and family members from other service eras still living with the wounds of war.

Public Health Relevance:
An urgent and growing need exists for interventions that respond to the adjustment and mental health needs of veterans of Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) returning to their communities. This project will produce an educational intervention for home use that will support recently returned veterans and their relationship partners with multimedia instruction in cognitive and behavioral processes that promote personal resiliency and relationship re-integration post-deployment. Reduced suffering of veterans and loved ones, increased family cohesion, and increased functional well-being of users of the program will have long-term benefits for community and public health.

Thesaurus Terms:
Active Follow-Up; Address; Anxiety; Area; Attitude; Behavioral; Biological Preservation; Classification; Clinical Trials, Phase Ii; Cognitive; Comment; Comment (Pt); Comment [publication Type]; Commentary; Commentary (Pt); Communities; Compassion; Complement; Complement Proteins; Complementary Therapies; Data; Dependence; Depression; Development; Editorial Comment; Editorial Comment (Pt); Education For Intervention; Educational Intervention; Educational Workshop; Elements; Esthesia; Family; Family Member; Focus Groups; Fostering; Freedom; Frequencies (Time Pattern); Frequency; Friends; Future; Goals; Health Promotion; Home; Home Environment; Human Resources; Individual; Instruction; Instruction Intervention; Intervention; Intervention Strategies; Liberty; Life; Manpower; Manuals; Married Persons; Massage; Measures; Mental Depression; Mental Health; Mental Hygiene; Methods And Techniques; Methods, Other; Mission; Multimedia; Multimedium; Operation; Operative Procedures; Operative Surgical Procedures; Pain; Painful; Participant; Personal Satisfaction; Phase; Phase 2 Clinical Trials; Phase Ii Clinical Trials; Population; Preservation, Biologic; Preservation, Biological; Process; Program Evaluation; Programs (Pt); Programs [publication Type]; Psychological Health; Public Health; Published Comment; Qol; Quality Of Life; Recommendation; Research Design; Research Resources; Resistance; Resources; Subgp; Salutogenesis; Sampling; Sensation; Services; Social Environment; Spouses; Stress; Study Type; Subgroup; Surgical; Surgical Interventions; Surgical Procedure; Symptoms; Systematics; Target Populations; Techniques; Testing; Touch; Touch Sensation; Training Intervention; Trees; Trust; Veterans; Viewpoint; Viewpoint (Pt); Waiting Lists; War; Workshop; Base; Beneficiary; Cohesion; Design; Designing; Evidence Base; Experience; Follow-Up; Improved; Innovate; Innovation; Innovative; Instructional Intervention; Intervention Effect; Interventional Strategy; Loved Ones; Massage Therapy; Mindfulness; Personnel; Phase 2 Study; Phase 2 Trial; Phase Ii Trial; Positive Emotion; Positive Emotional State; Preservation; Programs; Protocol, Phase Ii; Prototype; Public Health Medicine (Field); Public Health Relevance; Resilience; Resistant; Response; Social; Social Climate; Social Context; Socioenvironment; Study Design; Study, Phase Ii; Surgery; Usability; Week Trial; Well-Being

There is an urgent and growing need for mental health interventions supporting both short- and long-term reintegration of veterans of OIF and OEF into their communities and significant relationships. Innovative approaches are needed to support the well-being of veterans who may not access or be reached by formal services. Objectives. This Phase II project will complete development and evaluation of a self-directed, home- based intervention to be used by OIF/OEF veterans and their loved ones to aid in the readjustment process. ""Mission Reconnect"" is an integrated program of (1) guided mind/body stress reduction and relaxation practices, (2) contemplative practices to engender and support appreciation, empathy and forgiveness for oneself and one's loved ones, and (3) video instruction in use of simple massage techniques with a partner for connection and stress reduction. Feasibility was established in Phase I with high user satisfaction and significant impact on measures of stress, depression, PTSD, and self-compassion, as well as qualitative data. In Phase II We will complete and evaluate the full program in a four-arm randomized controlled trial. Specific Aims: 1. Revise program content based on Phase I quantitative and qualitative data. 2. Film a diverse group of ten 10 veteran/partner dyads receiving and using revised material;use video footage for the final program. 3. Produce high quality audio and video components of the revised program. 4. Produce a multi-modal system for delivery of instructional components that leverages innovations in web-based and mobile device technologies to maximize access, utilization, and data collection. 5. Conduct an RCT with 160 dyads of OIF/OEF veterans and their chosen partners. 6. Evaluate impact of intervention on measures of stress, depression, PTSD symptoms, sleep quality, self-compassion, social support and relationship satisfaction. 7. Evaluate program utilization and satisfaction, massage effects, self-efficacy and satisfaction in users of the revised program. Impact on the field. Mission Reconnect offers a convenient, low cost resource helping users develop wellness skills to reduce current and future distress, enhance empathy and improve quality of life. The intervention can complement formal mental health services, or be used alone. This is a potential aid to the two million OIF/OEF veterans, their partners and families, as well as the 20 million living veterans of other eras, whose wounds of war can last for decades if unaddressed. Innovation. The project leverages the dyadic relationship as a context for reciprocal and mutual use of complementary therapies for health promotion in both the veteran and partner. Project technology utilizes state of the art mobile app design, seamless integration across multiple devices, automated background data collection, and device-specific reminder alerts. Commercial application. The product will be marketed to family support programs of all branches of the military, VA system, and the private sector, including non-profit veterans'associations. Product. Mission Reconnect is an integrated multimedia program deliverable over the Internet and mobile devices, and hard copy (DVD, CD, manual).

Public Health Relevance:
An urgent and growing need exists for interventions that support the long-term adjustment and mental health needs of OIF/OEF veterans and their relationship partners after the return from deployment. This project will complete production of a multimedia intervention program for autonomous use, delivered by Internet and mobile app technology, that teaches couples selected mind/body interventions and massage techniques to promote stress reduction, compassion, resiliency and relationship re-integration. A four-armed randomized trial will evaluate mental health outcomes as a free-standing program and as complementary to a current standard of care structured group program.