Pilot study of Internet-based early intervention for combat-related mental distress

This article evaluates an Internet-based early intervention combining online cognitive-behavioral therapy (CBT) with electronic peer-to-peer support intended to promote mental health and well-being among combat veterans. We conducted a phase 1 clinical trial of 50 Iraq and Afghanistan veterans using a pre and post single-arm design. We evaluated feasibility and changes in mental health symptoms (depression and posttraumatic stress disorder PTSD), functional status, and attitudes toward treatment seeking at baseline and weeks 4, 8, and 12. A diverse group of veterans was enrolled (26% ethnic minority, 90% male, 66% with income <30, 000/year, 88% with no prior treatment for depression). Participants completed a mean of 4 of 6 lessons (standard deviation = 2. 54). From baseline to week 12, there were significant declines in the Center for Epidemiologic Studies-Depression scale score (effect size ES = 0. 41) and PTSD Checklist-Military version score (ES = 0. 53). There were significant improvements in willingness to accept diagnosis (ES = 1. 08) and perceived social norms and stigma regarding friends (ES = 1. 51). Although lack of a control group is a limitation, the Internet-based program combining CBT-based coping skills training and peer-to-peer support demonstrated potential feasibility and evidenced benefit in symptom remediation for depression and PTSD.