THE Challenge Vol. 12 Iss. 2 Research

The first step in this line of work
was to adapt Dr. Simpson’s program
to apply to U.S. Veterans. The team
assembled a stakeholder panel that
included experts in TBI and mental
health, including those living with TBI.
The panel unanimously agreed on a
number of changes to the Australian
model. Some were simple changes,
like inserting the U.S. food pyramid
in place of its Australian counterpart,
while others were more substantive,
such as modifying the manual to
include “tactical breathing,” a type
of deep breathing that U.S. service
members are taught to use, instead
of the original breathing exercises
designed for use by Australian
civilians.
The next step was to test the revised
program among U.S. veterans
with moderate to severe TBI. The
pilot study was carried out with
four different groups of veterans.
Results suggested that the revised
program was indeed feasible to
implement within a Veterans Health
Administration (VHA) setting as well as acceptable
to those seeking care within VHA. Most encouraging
were the comments from the veterans enrolled in the
study, several of whom reported that the program
did indeed help them build hope. In 2014, the
group published a report in the journal Brain Injury
describing this process (Matarazzo et al., 2014).
Second Trial Confirms Positive
Impact of Window to Hope
The team then engaged in a randomized clinical
trial designed to test the efficacy of the intervention
to reduce hopelessness among veterans. Brenner
and colleagues randomized 44 veterans, each with
moderate to severe TBI and moderate to severe
feelings of hopelessness. To evaluate whether
the treatment worked, the researchers measured
veterans’ feelings of hopelessness, depression, and
thoughts of suicide at the beginning, middle, and end
of the six-month enrollment period.
The core Window to Hope therapeutic strategies are represented
by each of the four window panes.
Design courtesy of Rachel Warden, Rocky Mountain MIRECC.
Participating in WtoH resulted in a reduction of
hopelessness and depressive symptoms among
veterans with TBI, and the favorable results were
recently published in the Journal of Head Trauma
Rehabilitation (Brenner et al., 2018). This rare
replication of a psychological trial – with a different
sample of participants, in a different country, and
with different clinicians – increases the likelihood
that changes observed among the participants were
due to their participation in the intervention. Brenner
and Simpson are now exploring strategies to provide
and further evaluate this intervention to an even
broader audience.
References available at www.biausa.org.
www.biausa.org 15