Telephone-Based Versus In-Person Delivery of Cognitive Behavioral Treatment for Veterans with Chronic Multisymptom Illness: A Controlled, Randomized Trial

ABSTRACT

The goal of this randomized clinical trial was to examine the efficacy of a cognitive behavioral stress reduction treatment for reducing disability among veterans with chronic multisymptom illness (CMI). Veterans (N = 128) who endorsed symptoms of CMI were randomized to: usual care (n = 43), in-person (n = 42), or telephone-delivered cognitive behavioral stress management (n = 43). Assessments were conducted at baseline, 3 months, and 12 months. The primary outcome was limitation in roles at work and home (i.e., “role physical”). Reductions in catastrophizing cognitions were evaluated as a mechanism of action. Intent-to-treat analyses showed no statistically significant main effect, F(2, 164) = .58, p = .56, or interaction effect, F(4,164) = .94, p = .45, for role physical. Over time, veterans improved in their physical function, F(2,170) = 5.34, p < .01; η²_partial = .06, posttraumatic stress disorder (PTSD) symptoms, F(2,170) = 9.39, p < .01; η²_partial = .10, depressive symptoms, F(2,170) = 10.81, p < .01, η²_partial = .11, and physical symptoms, F(2, 172) = 12.65, p < .01; η²_partial = .13, but these improvements did not differ across study arms over time. Completer analyses yielded similar results. There were no differences in catastrophizing between arms. Findings suggest stress reduction may not be the right target for improving disability among veterans with CMI. Veterans with CMI may need intervention that directly impacts medical self-management to improve disability.

KEYWORDS:

• Chronic multisymptom illness
• disability
• clinical trial
• cognitive behavioral therapy
• stress management
• null results
• medically unexplained syndrome
• veteran
• catastrophizing
• quality of life

Acknowledgments

This study was approved by the Veterans Affairs New Jersey Healthcare System Institutional Review Board and Research and Development Committee. The contents do not represent the views of the U.S. Department of Veterans Affairs or the United States government.

Funding

This work, Telemedicine Treatment for Veterans with Gulf War Illness Clinical Trials #NCT00129454, is supported by the War Related Illness & Injury Study Center, VA Health Services Research & Development Grant Nos. GWI04-355 and CDA 13-017.