ARLINGTON, VA.– A 10-week psychoeducational workshop aimed at increasing resilience in Iraq and Afghanistan war veterans had a significant effect among those who completed the workshop, including those with lower resilience scores at baseline.
However, those with lower baseline resilience scores were also more likely to drop out of the workshop. This finding highlights the potential utility of measuring baseline resilience in veterans as a way to improve retention in time-limited, effective psychotherapeutic intervention programs, especially for participants who are less resilient and have the most to gain from such a program, according to Dr. Matig Mavissakalian of the Cleveland Veterans Affairs Medical Center and Case Western Reserve University, Cleveland.
Characteristics of resilience – a trait that has been associated with optimal coping skills and helping prevent the development and promote recovery of posttraumatic stress disorder (PTSD) –include commitment, dynamism, patience, optimism, faith, altruism, and the ability to show humor when faced with adversity, Dr. Mavissakalian said at the annual conference of the Anxiety and Depression Association of America (ADAA).
The 10-week psychoeducational program, provided at the Cleveland VAMC, is designed specifically for returning soldiers, to promote the use of resources and increase resilience, with an emphasis on understanding and normalizing stress responses, building on strengths, learning new cognitive skills, and improving family relationships, with some family member involvement and individual counseling.
To evaluate the impact of the workshop, the Connor-Davidson Resilience Scale (CD-RISC), a 25-item self-rating measure of resilience, was administered to 65 mostly male veterans with at least one deployment, participating in the workshop over a 4-year period. Their median age was almost 30 years; about 34% had sustained an injury while deployed. Almost 80% were diagnosed with PTSD, 88% were diagnosed with depression/anxiety, and 92% had nightmares; other issues included alcohol and substance abuse in 35%; and family and marital problems in 48%. Over 10 weeks, the use of medications included "any" psychotropics in 69%, which included antidepressants in 61%.
The CD-RISC was re-administered to the 46 veterans who completed the workshop, indicating significant improvements in resilience scores, with a "fairly decent moderate effect size" of about 15%, Dr. Mavissakalian said. There were no differences in baseline resilience scores between those who dropped out and those who had completed the workshop.
But among those who completed the program, there was a trend toward a greater degree of improvement among those with lower resilience scores at baseline than those with higher scores at baseline who completed the program, suggesting a differential effect of initial resilience level on outcome, he added.
The VA has been successful in recruiting veterans for such programs, "but special efforts to increase retention should also be made," he said, noting that a veteran’s resilience score could be an important measure to help identify those individuals who need special efforts to keep them treatment.
An incidental finding was that the cohort of 34 veterans enrolled earlier in the study period, from 2005 to about 2007, had higher baseline resilience scores than those enrolled later in the 4 year period, he said. "So as the war went on, there was less resilience in the soldiers," but because this was a small sample, more data are needed to explain this finding and to see if it persists in a larger study.
He had no disclosures. Until recently, the ADAA was called the Anxiety Disorders Association of America.