Anticipated Impacts on Veteran's Healthcare: This study explores an innovative method of delivering cognitive-behavioral treatment for recently returning Veterans who have panic disorder and live in rural communities. The potential impact of this study high, as a brief and intensive weekend intervention for anxiety overcomes many help-seeking barriers inherent in conventional psychosocial treatment approaches currently offered in most VA settings. Project Background: Panic disorder ranks among one of the most debilitating and costly anxiety disorders in the country and is accompanied by a host of distressing physical and psychological symptoms. Consequences of panic include medication and substance abuse/dependence, social and emotional dysfunction, vocational problems, and increased social withdrawal. Research indicates that many U.S. military personnel returning from Iraq and Afghanistan do not seek treatment because of time and financial constraints, inability to access immediate care (particularly those living in rural areas), and stigma associated with mental illness. Unfortunately, standard psychosocial treatments for anxiety disorders require multiple appointments and usually occur during the week when most people are in school or at work, which further contributes to the underutilization of services. Project Objectives: The current project proposes to examine the feasibility of implementing an intensive treatment for returning service members with panic disorder in three rural outpatient clinics.
The specific aims are to (1) conduct focus groups with stakeholders to identify potential barriers associated with offering the treatment at each clinic;(2) Adapt the treatment to enhance its fit within existing program structures based on information obtained;and (3) pilot the adapted treatment by offering it over a single weekend at each of the three sites. Project Methods: Three focus groups will be conducted with administrators, providers, and patients at three community based outpatient clinics that serve Veterans living in rural areas. The interviews will focus on gathering information regarding the feasibility of offering an intensive two-day treatment at their facilities, which will be used to adapt the existing treatment protocol. The brief evidence-based intervention consists of two, 6-hour days of treatment and will be offered over a single weekend at each site. The total sample expected across the three sites will be 15 Veterans. The sample will consist of Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans with a current diagnosis of panic disorder. Persons with substance dependence, psychosis, bipolar disorder and severe depression will be excluded from the study. Assessments will be conducted over the telephone one-week before and after treatment, and include a 3-month follow-up. Effect sizes for the primary outcome variables consisting of frequency and severity of panic attacks will be calculated and analyzed using paired samples t-tests. Treatment satisfaction and quality of life will also be evaluated.
Proposal Narrative The purpose of this project is to improve access to mental health treatment for returning service members who have panic disorder and live in rural areas. The goals of this study are to explore the feasibility of delivering an intensive two-day treatment at three VA community-based outpatient clinics by conducting focus groups with key stakeholders, followed by the delivery of a single weekend of treatment to a small group of Veterans with panic disorder at each of these clinics. The intervention is an evidence-based cognitive-behavioral treatment that takes place over two consecutive days for six hours each day. Feasibility of delivering this treatment in rural outpatient clinics and the potential effectiveness of the intervention will be examined. The potential impact of this study is high, as a brief and intensive weekend intervention for anxiety overcomes many help-seeking barriers present in conventional psychosocial treatment approaches that can ultimately improve access to services for returning Veterans.