STEP-Home Improves Neurobehavioral Symptoms and Reintegration in Veterans With TBI and Differentially Impacts Anger Control.

OBJECTIVE

To explore if the STEP-Home (SH) group workshop improves neurobehavioral symptoms, civilian readjustment, anger control, and frontal system function in post-9/11 Veterans with and without a TBI. This is a secondary analysis from a 2-arm randomized controlled trial (RCT).

PARTICIPANTS

One hundred and ninety-five male and female post-9/11 Veterans participated in a multisite RCT of SH versus Present Centered Group Therapy; a subset of 66 who received the SH intervention and completed all assessments were selected for this analysis. Participants were grouped based on TBI diagnosis. Almost half had a history of TBI (TBI+ n = 28; 42.4%; mean age 38.6 ± 9.1 years) whereas 38 had no history of TBI (TBI- mean age 41.0 ± 12.2 years).

SETTING

VA Healthcare System and telehealth.

INTERVENTION: SH was a 12-week, 90 minute/week, transdiagnostic, skills-based group intervention focused on problem solving, emotion regulation, and anger control skill building.

MAIN MEASURES: Outcomes were neurobehavioral symptoms, anger control, reintegration status, and frontal system function. Data were collected at pre-treatment (T1), post-treatment (T2), and at 12-week post-treatment follow-up (T3).

RESULTS

Both groups (TBI+ and TBI-) showed significant improvements in neurobehavioral symptoms, reintegration status, and aspects of frontal system function. Anger control was only improved in the TBI+ group. Treatment benefits were maintained over time.

CONCLUSIONS

The STEP-Home intervention shows promise for improving persistent neurobehavioral symptoms in Veterans with and without a history of TBI. Treatment benefits were maintained over time in both groups. Veterans with a history of TBI showed significant improvement in anger control, which is critical to improving daily functional status after brain injury. SH offers an acceptable, transdiagnostic alternative treatment approach to improve functioning for Veterans with TBI and those at risk for TBI/brain injury due to military service.