Treating Mood Symptoms: Is the Therapeutic Response in Veterans At-Risk for mTBI Similar to Veterans with No-Risk for mTBI?

Purpose: Active theater combat veterans serving in Iraq and Afghanistan wars encounter more blasts and explosions than any previous war which increases their risk for mild traumatic brain injury (mTBI). Returning veterans often seek behavioral health services to help them overcome traumatic wartime experiences associated with depression and anxiety. Cognitive behavioral therapy (CBT) is a ‘gold standard’ treatment strategy for returning veterans. However, there are few studies comparing the response-to-treatment of CBT for depression and anxiety between veterans at-risk for mTBI versus those with no-risk. We hypothesize that active theater veterans at-risk for mTBI will have a more severe posttraumatic stress disorder (PTSD), more depression and anxiety and will have a slower response-to-treatment time than veterans with no-risk. Methods: In this hypothesis-generating pilot study, we examined the clinical characteristics of veterans at-risk for mTBI compared to veterans with no-risk and evaluated the longitudinal effectiveness of 12-weeks of CBT and the response-to-treatment using secondary data analyses. Data from male veterans (24-57-years old) serving in Iraq and Afghanistan of all race/ethnicities receiving CBT were analyzed as no women in this sample served in active theatre. The PTSD checklist, Beck Depression Inventory, and Beck Anxiety Inventory were used to examine response-to-treatment. Chi-square, ANOVA, and repeated measures ANOVA were used to evaluate between-group differences. Results: Veterans at-risk for mTBI (n=136) had more severe PTSD, higher depression and anxiety scores than no-risk veterans (n=38). Almost 61% of veterans at-risk for mTBI had PTSD compared to 26% of veterans at no-risk. All veterans experienced reduced depression and anxiety symptoms with 12-weeks of therapy [Wilk's Lambda=.59, F(4,76)=13.27, p=0.0005, n2=.41]. However, mood scores for veterans at-risk for mTBI were almost 50% higher at baseline, 6- and 12-week time points than veterans at no-risk. Conclusions: These results inform clinical practice about the psychological consequences of serving in active theater and the long-term treatment needs of veterans with mTBI and PTSD. Clinicians who treat returning veterans should inquire about active theater exposures to blasts and explosions which predisposes them to risks for mTBI and severe PTSD. Clinicians should expect longer and slower responses to CBT in active theater veterans compared to non-combat.