STEP-Home Intervention Improves Inhibitory and Anger Control, Reintegration, and Neurobehavioral Symptoms in Post-9/11 Veterans with TBI and Other Common Comorbidities

Post-9/11 U.S. Veterans are clinically complex with multiple co-occurring health conditions contributing to morbidity/mortality and decreased quality of life. TBI diagnosis can worsen these outcomes. STEP-Home is a cognitive-behavioral transdiagnostic intervention for TBI and common comorbidities. This study determines if STEP-Home improves anger control, frontal system function, civilian readjustment, neurobehavioral symptoms, and work/life functioning in post-9/11 Veterans. TBI may influence Veterans' ability to learn core skills and, thus, impact response to treatment. Treatment outcomes for Veterans with and without TBI will be explored.56 (39 M/17F; mean age = 39.9) post-9/11 Veterans with high rates of psychiatric comorbidity, with and without TBI received 12 weeks of the STEP-Home cognitive-behavioral intervention. Assessments at baseline, posttreatment (12 weeks), and follow-up (12 weeks posttreatment) included: State-Trait Anger Expression Inventory 2 (STAXI-2); Military to Civilian Questionnaire (M2CQ); Post-Deployment Readjustment Inventory (PDRI); Frontal Systems Behavioral Scale (FrSBe); Neurobehavioral Symptom Inventory (NSI); World Health Disability Scale (WHODAS); PTSD Checklist (PCL-5); Depression Anxiety and Stress Scale (DASS-21).STEP-Home significantly improved anger expression (STAXI-2 p = 0.0320), inhibitory control (FrSBe p = 0.0001), and reintegration status (MC2Q p = 0.0001; PDRI p = 0.0097) posttreatment. Similar improvements were seen in neurobehavioral symptoms, work/life functioning, PTSD, depression, and stress (p's < 0.01). Treatment gains were maintained at follow-up (p's < 0.001). Treatment response did not differ by TBI status.STEP-Home teaches Veterans cognitive-behavioral skills to improve anger and impulse control, executive functioning, reintegration, and work/life functioning. Treatment gains were comparable for Veterans with and without TBI. This is critical given TBI prevalence among post-9/11 Veterans and the need for additional palatable treatment options.