Behavioral Activation for Posttraumatic Stress Disorder (PTSD)/ Depression Treatment in Operations Iraqi Freedom and Enduring Freedom (OIF/OEF) Veterans

• Clinician Administered PTSD Scale (CAPS-IV) (Blake et al., 1990; Blake et al., 1995, Kaloupek, Charney, Blake, Newman, Weathers, Nagy, Schnurr & Keane, 2004) [ Time Frame: Pre-treatment, post-treatment, and 3-month follow-up ] [ Designated as safety issue: Yes ]
  

• Posttraumatic Stress Disorder Checklist-Military Version (PCL-M) (Blanchard, Jones-Alexander, Buckley, & Forneris, 1996; Weathers, Litz, Herman, Huska, & Keane, 1994) [ Time Frame: Pre-treatment, mid-treatment, post-treatment, 3-month follow-up ] [ Designated as safety issue: Yes ]
  
• Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) (First et al., 1997) [ Time Frame: Pre-treatment ] [ Designated as safety issue: Yes ]
  
• Beck Depression Inventory-II (BDI-II) (Beck, Steer, & Brown, 1996) [ Time Frame: Pre-treatment, mid-treatment, post-treatment, 3-month follow-up ] [ Designated as safety issue: Yes ]
  
• Quality of Life Inventory (QOLI) (Frisch, Cornell, & Villanueva, 1992) [ Time Frame: Pre-treatment, post-treatment, 3-month follow-up ] [ Designated as safety issue: No ]
  
• Sheehan Disability Scale (SDS) (Sheehan, 2000) [ Time Frame: Pre-treatment, post-treatment, 3-month follow-up ] [ Designated as safety issue: No ]
  
• Medical Outcomes Study 12-Item Short-Form Health Survey (SF-12) (Ware, Snow, Kosinski, & et. al., 1993) [ Time Frame: Pre-treatment, post-treatment, 3-month follow-up ] [ Designated as safety issue: No ]
  
• Overall health care utilization (Zatzick et al, 2004) [ Time Frame: Pre-treatment, post-treatment, 3-month follow-up ] [ Designated as safety issue: No ]
  
• Credibility/Expectation Scales (Borkovec & Nau, 1972) [ Time Frame: Pre-treatment ] [ Designated as safety issue: No ]
  
• Client Satisfaction Questionnaire (CSQ) [ Time Frame: post-treatment, 3-month follow-up ] [ Designated as safety issue: No ]
  
• Social Support Questionnaire (SSQ) (Sarason, Levine, Basham, & Sarason, 1983) [ Time Frame: Pre-treatment, post-treatment, 3-month follow-up ] [ Designated as safety issue: No ]
  
• Behavioral Activation Scale (BAS) (Kanter, Mulick, & Martell, 2004) [ Time Frame: Pre-treatment, mid-treatment, post-treatment, 3-month follow-up ] [ Designated as safety issue: No ]
  
• Cognitive-Behavioral Avoidance Scale (CBAS) (Ottenbreit & Dobson, 2004) [ Time Frame: Pre-treatment, mid-treatment, post-treatment, 3-month follow-up ] [ Designated as safety issue: No ]
  
• Action and Acceptance Questionnaire (AAQ) (Hayes et al., 2004) [ Time Frame: Pre-treatment, mid-treatment, post-treatment, 3-month follow-up ] [ Designated as safety issue: No ]
  
• The Male Role Norms Scale (MRNS) (Thompson & Pleck, 1986) [ Time Frame: Pre-treatment ] [ Designated as safety issue: No ]
  
• Deployment Risk and Resilience Inventory (DRRI) (King, King & Vogt, 2003). [ Time Frame: pre-treatment ] [ Designated as safety issue: No ]
  
• Defense and Veteran Brain Injury Center Traumatic Brain Injury Screening Tool (DVBIC) (Schwab, Baker, Ivins, Sluss-Tiller, Lux & Warden, 2006). [ Time Frame: pre-treatment ] [ Designated as safety issue: No ]
  

A sizable proportion of soldiers involved in the Iraq and Afghanistan conflicts are experiencing mental health and adjustment problems on their return, including posttraumatic stress disorder and depression (Hoge et al., 2004). Both PTSD and depression can be chronic and debilitating disorders, associated with impairments in social, occupational, and physical functioning, as well as high health care utilization (Katon, Unutzer, & Simon, 2004; Stein et al., 2005).

Although empirically supported treatments exist for established PTSD and depression, much less is known about effective early interventions for these conditions. Exploration of early intervention options is necessary, particularly in the case of the new veteran population, as such interventions could address social, occupational and physical impairments before they become too intractable. Also, successful early interventions could curtail high health care utilization dramatically across time. The development of such early interventions for PTSD and depression must also take into account any specifications of accessibility and acceptability that are particular to the OIF/OEF veteran population.

The present study is a randomized, controlled trial that compares Behavioral Activation (BA), to Usual VA Care (UC) as early interventions for OIF/OEF veterans with posttraumatic stress disorder (PTSD), or PTSD and major depressive disorder (PTSD/MDD). Participants will be recruited from the primary health care setting (to increase acceptability and accessibility to the veteran population). Both BA and UC treatment groups will be administered by psychotherapists who specialize in the treatment of PTSD. Both groups will be assessed at pre-, mid- and two post-treatment time points to determine maintenance of diagnostic change over time, health care utilization and treatment satisfaction. This is a dual-site study that will be carried out at both the Portland VA Medical Center (PVAMC) and the VA Puget Sound Health Care Center (VA PSHCS) and coordinated at the PVAMC.