Professor Helene Moriarty, PhD, RN, FAAN, the Diane & Robert Moritz Jr. Endowed Chair in Nursing Research at the Villanova University M. Louise Fitzpatrick College of Nursing (FCN), received notification in November of a two-year Veterans Health Administration grant funded for nearly $230,000 for a feasibility study of behavioral activation (BA) for post-TBI depression. She is also nurse scientist at the Corporal Michael J. Crescenz Veterans Affairs (VA) Medical Center, Philadelphia and has dedicated decades of her career to advancing the health and health care of veterans and their families. Her co-investigators are FCN senior research associate and VA Medical Center research psychologist Laraine Winter, PhD; Keith Robinson, MD, also at the VA Medical Center; and Tracey Vause-Earland, PhD, OTR/L of Thomas Jefferson University. The grant will provide preliminary data for a future larger trial of behavioral activation.
Why this study? TBI is the signature injury of the Global Wars on Terror, with nearly 380,000 U.S. service members diagnosed since 2000. Depression, one of TBI’s most common psychiatric sequela, can have serious effects, interfering with rehabilitation and its key goal of community reintegration (CR). Additionally, post-TBI depression has been found to lower quality of life (QOL), heighten suicide risk, and increase caregiver burden.
Yet, “Post-TBI depression remains under-assessed, undertreated, and under-studied, especially in veterans,” explains Dr. Moriarty, noting that frequently used treatments, such as antidepressant medications and cognitive behavioral therapy (CBT), have limitations. A promising approach to post-TBI depression is BA, a brief, pragmatic treatment for depression that has its roots in CBT but differs in ways that improve its fit to post-TBI depression. Dr. Moriarty says BA “helps individuals set goals, create plans, and engage in activities that maintain or restore social connectedness – making it well-suited to treating depression in a TBI population that struggles to set goals and carry out plans and is prone to social isolation and poor CR. BA connects persons to meaningful and rewarding experiences by enhancing engagement in activity, thereby improving reintegration and quality of life.”
Dr. Moriarty’s study assesses the feasibility of a 6-session, 3-month BA intervention designed for implementation in an outpatient VA rehabilitation medicine service. The sample will consist of 40 veterans with TBI diagnoses (mild or moderate severity) and clinically significant depressive symptoms. Occupational therapists will be trained as BA interventionists. This line of research has the potential to add a powerful clinical tool for treating depression in VA rehabilitation settings and thus improve access to an important form of care for veterans with post-TBI depression.