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Cited by 67Posttraumatic Stress Disorder ResearchDigital Mental Health InterventionsSubstance Abuse Treatment and Outcomes

Web-Delivered CBT Reduces Heavy Drinking in OEF-OIF Veterans in Primary Care With Symptomatic Substance Use and PTSD

Open access
Acosta, Michelle C., Possemato, Kyle, Maisto, Stephen A., Marsch, Lisa A., Barrie, Kimberly, Lantinga, Larry, Fong, Chunki, Xie, Haiyi +2 more·2017·Behavior Therapy
DOI 10.1016/j.beth.2016.09.001PMC PMC5345259
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Abstract

Veterans from conflicts such as the wars in Iraq and Afghanistan commonly return with behavioral health problems, including Post-Traumatic Stress Disorder (PTSD) and hazardous or harmful substance use. Unfortunately, many veterans experience significant barriers to receiving evidence-based treatment, including poor treatment motivation, concerns about stigma, and lack of access to appropriate care. To address this need, the current study developed and evaluated a web-based self-management intervention based on cognitive behavioral therapy (CBT), targeting PTSD symptoms and hazardous substance use in a group of symptomatic combat veterans enrolled in VA primary care. Veterans with PTSD/subthreshold PTSD and hazardous substance use were randomized to primary care treatment as usual (TAU; n=81) or to TAU plus a web-based CBT intervention called Thinking Forward (n=81). Thinking Forward consisted of 24 sections (approximately 20 minutes each), accessible over 12 weeks. Participants completed baseline and 4-, 8-, 12-, 16- and 24-week follow-up assessments. Three primary outcomes of PTSD, alcohol and other drug use, and quality of life were examined. Significant treatment effects were found for heavy drinking, but not for PTSD or quality of life. The effect of the intervention on heavy drinking was mediated by intervening increases in coping, social support, self-efficacy, and hope for the future. These results demonstrate the promise of a web-based, self-management intervention for difficult-to-engage OEF/OIF veterans with behavioral health and substance use concerns.

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  • Social processes that can vary between cultural groups, such as forms of social support, or styles of family functioning, are known empirically to mediate outcomes.

    “Social processes that can vary between cultural groups, such as forms of social support, or styles of family functioning, are known empirically to mediate outcomes 112 .”

    From “Third-wave” cognitive and behavioral therapies and the emergence of a process-based approach to intervention in psychiatry (2021) · cites this paper as [112]

    The Results (Mediation analyses; page not provided) report that social support partially mediated the treatment effect on heavy-drinking days among OEF-OIF veterans. The paper does not report mediation by family functioning or examine variation between cultural groups, so it supports only the social-support example, not the broader claim. (LLM, conf=0.88)

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Research works printed but not linked: 4

  1. Fitzmaurice GM Laird NM Ware JH Applied longitudinal analysis 2011 John Wiley & Sons, Inc. New Jersey 2nd ed.
  2. Jarrett TA Warrior Resilience and Thriving (WRT): Rational Emotive Behavior Therapy (REBT) as a Resiliency and Thriving Foundation to Prepare Warriors and Their Families for Combat Deployment and Posttraumatic Growth in Operation Iraqi Freedom, 2005–2009. Journal of Rational-Emotive and Cognitive-Behavior Therapy 2013 31 2 93 107
  3. Marsch L Computer-delivered psychosocial treatment for substance use disorders. Presentation in symposium on Neurobehavioral and Technological Mechanisms to Improve the Efficacy and Effectiveness of Substance Abuse Treatment 2011 Paper presented at the American Psychological Association Annual Meeting
  4. Morland L Frueh B Pierce K Miyahira S PTSD and telemental health: Updates and future directions. National Center for PTSD Clinical Quarterly 2003 12 1 1 5

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Authors
Acosta, M. C., Possemato, K., Maisto, S. A., Marsch, L. A., Barrie, K., Lantinga, L., Fong, C., Xie, H., Grabinski, M., & Rosenblum, A.
Affiliations
  • National Development and Research Institutes (US)
  • Syracuse VA Medical Center (US)
  • Dartmouth College (US)
Corresponding author
Acosta, Michelle C.
ORCID
Venue
Behavior Therapy
Publisher
Elsevier BV
Published
2017-03
Volume
48
Issue
2
Pages
262-276
ISSN
0005-7894 (ISSN-L)
DOI
10.1016/j.beth.2016.09.001
PMC
PMC5345259
OpenAlex
W2523560878
Semantic Scholar
79b5ab9a27fe438bca297af0493780d02d218df4
Cited by
67
References
75
Citations by year
2026: 2 · 2025: 10 · 2024: 4 · 2023: 4 · 2022: 10 · 2021: 12 · 2020: 6 · 2019: 7 · 2018: 11 · 2017: 1
FWCI
8.47
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Behavior Therapy (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institute on Alcohol Abuse and Alcoholism (R01AA020181)
  • National Institute on Drug Abuse (P30DA029926)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
Keywords
internet-based cognitive behavioral therapy, heavy drinking, post-traumatic stress disorder, combat veterans, OEF/OIF veterans, primary care, self-management interventions, coping, social support, self-efficacy, hope for the future, quality of life, treatment engagement
MeSH terms
Adaptation, Psychological, Adult, Alcoholism, Female, Follow-Up Studies, Humans, Male, Social Support, Stress Disorders, Post-Traumatic, Veterans, Cognitive Behavioral Therapy, Treatment Outcome, Telemedicine, Substance-Related Disorders, Internet, Iraq War, 2003-2011, Afghan Campaign 2001-

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