The purpose of this CDA is to help Dr. Lisa McAndrew become a national leader in developing and improving patientcenteredself-managementinterventionsforVeteranswithcomplexpost-deployment health concerns. Dr.McAndrewhassignificanttrainingintheoreticalmodelsforunderstandingpatientself-managementand evidence based behavioral treatments. This CDA will allow her to obtain additional skills in (1) health services research, particularly clinical trials and implementation methods (2) qualitative and quantitative methods (3) clinical neuroscience, and (4) grant writing. To support her training goals, Dr. McAndrew will adapt, develop and test a promising cognitive rehabilitation treatment, Problem-Solving Therapy for Gulf War Illness (GWI). Problem-solving is considered one of the most complex of cognitive abilities and is related to complicated behaviors such as setting goals, sequencing and multi-tasking. Impairment in problem-solving ability affects over 70% of Gulf War Veterans (GWV) with GWI and is prospectively related to 1.5 times greater risk of disability. Despite published reports documenting these deficits there are no treatments that target the problem- solving deficits associated with GWI in order to reduce disability. Problem-Solving Therapy teaches patients skills to compensate for problem-solving deficits in order to improve disability, defined as deficits in daily activities and social participation. It has been found to be effective among civilians with mild traumatic brain injury. To modify this intervention, Dr. McAndrew will use qualitative methods to better understand GWVs with GWI as well as VA providers' views on GWI and the proposed problem-solving intervention. She will then use this information to modify Problem-Solving Therapy for use with GWVs with GWI. Finally, she will examine the efficacy of this modified Problem-Solving Therapy for reducing the disability associated with GWI in a pilot randomized controlled trial. Dr.

Public Health Relevance

There are almost 700,000 Persian Gulf War Veterans (GWV), with an estimated 25-30% suffering from a devastating multi-symptom illness coined Gulf War Illness (GWI). To date, existing treatments for GWI have limited efficacy and adherence, suggesting that it is time to try something new. We propose an innovative and targeted approach to reducing problem-solving deficits that are known to be associated with disability, Problem- Solving Therapy. This CDA will also allow Dr. McAndrew to develop expertise in patient-centered interventions and GWI. There is a need for young investigators with the interest and drive to cultivate expertise in developing treatments for GWVs with GWI. This CDA will allow Dr. McAndrew the structured time to gain the methodological training needed to ensure her success as an independent investigator.

National Institute of Health (NIH)
Veterans Affairs (VA)
Veterans Administration (IK2)
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HSR&D Career Development Award (CDA0)
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VA New Jersey Health Care System
East Orange
United States
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