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Newsletter | Spring 2023 Article 6 | South Central MIRECC

Publication Highlights

Articles and books authored by our affiliates enable us to share research and knowledge about mental health treatment with our Veteran, caregiver, provider and research communities.

Highlighted Articles

Dr. Mark Kunik (coauthor) published an article on the cost-effectiveness of providing behavioral activation to homebound older adults with depression through videoconference with lay counselors in BMC Psychiatry. The researchers compared the strategy to clinician-delivered problem-solving therapy and telephone support calls. Findings showed that the costs of videoconference- and lay-counselor-delivered depression treatment are modest and cost effective relative to providing telephone support. Additionally, lay counselors can fill the professional geriatric mental health workforce shortage gap and behavioral activation delivered through videoconference by lay counselors can also improve homebound older adults' access to evidence-and skills-based, cost effective depression care.

Drs. Michael Cucciare (first author) and Traci Abraham published an article on adapting the eliminating medications through patient ownership of end results (EMPOWER) protocol to promote benzodiazepine cessation among U.S. Military Veterans for electronic delivery in the Journal of Medical Internet Research. The researchers held focus groups with VHA-enrolled Veterans who have medical chart evidence of long-term benzodiazepine use and national VHA leaders who have expertise in in setting VHA policy for prescription benzodiazepine use and developing electronically delivered educational tools for Veterans. The focus groups revealed Veterans' feelings about self-tapering from benzodiazepines, experiences attempting to self-taper without support, and general thoughts on the content and accessibility of the protocol. The policy leaders emphasized self-tapering with provider assistance if needed to help prevent medication stockpiling. Both groups also emphasized the importance of ensuring that self-tapering can be personalized and that the taper instructions were clear. The next step in this line of research is to evaluate EMPOWER-ED in a randomized controlled trial.

Drs. Amanda Raines (first author) Jessica Walton, Gala True, and Laurel Franklin published an article on the acceptability, feasibility, and utility of a safety aid treatment in underserved Veterans in Cognitive Behaviour Therapy. This pilot study replicates and extends prior research on civilians by examining the acceptability, feasibility, and utility of Safety Aid Reduction Treatment (START) among Veterans, particularly those living in underserved communities, and across a wider array of diagnoses. The majority of Veterans found START useful and acceptable. Additionally, recruitment and retention rates suggest that the treatment was feasible. Results revealed reductions in overall anxiety, depression, and safety aid usage, which were maintained throughout the brief follow-up period. These findings add to a growing body of literature highlighting the utility of transdiagnostic approaches in the amelioration of various anxiety and related disorders.

Dr. Jeffrey Pyne coauthored an article on the economic costs of implementing evidence-based telemedicine outreach for posttraumatic stress disorder (TOP) in VA in Implementation Research and Practice. The researchers determined costs by conducting a stepped wedge cluster randomized trial at five VA sites. All sites started with a standard implementation strategy (i.e., facilitation, internal facilitators operational guide, funded care manager, care managing training, technical support) while some were randomized to enhanced implementation (i.e., external facilitation to incorporate TOP clinical processes into existing clinic workflows) if they failed to meet performance metrics. Findings detail the expected costs of implementing TOP during standard and enhanced implementation for sites and patients.

Last updated: July 25, 2023