Implementation of Multifamily Group Treatment for Veterans With Traumatic Brain Injury

Traumatic brain injury affects an estimated 22% of Iraq and Afghanistan veterans. Deficits in memory and functioning among these veterans, who may also have PTSD and depression, can create challenges in household management and lead to friction among family members. Veterans with TBI who participated in a multifamily group intervention reported less anger expression and more social support and occupational activity. Their family members reported decreased burden and described “powerful experiences” of connecting with a wider social network and reconnecting with their loved ones. ObjectiveThis study evaluated the initial efficacy and feasibility of implementing multifamily group treatment for veterans with traumatic brain injury (TBI).MethodsVeterans at two Veterans Affairs medical centers were prescreened by their providers for participation in an open trial of multifamily group treatment for TBI. Enrollment was limited to consenting veterans with a clinical diagnosis of TBI sustained during the Operation Enduring Freedom–Operation Iraqi Freedom era, a family member or partner consenting to participate, and a score ≥20 on the Mini-Mental State Examination. The nine-month (April 2010–March 2011) trial consisted of individual family sessions, an educational workshop, and bimonthly multifamily problem-solving sessions. Interpersonal functioning and symptomatic distress among veterans and family burden, empowerment, and symptomatic distress among families were assessed before and after treatment.ResultsProviders referred 34 (58%) of 59 veterans screened for the study; of those, 14 (41%) met criteria and consented to participate, and 11 (32%) completed the study. Severity of TBI, insufficient knowledge about the benefits of family involvement, and access problems influenced decisions to exclude veterans or refuse to participate. Treatment was associated with decreased veteran anger expression (p≤.01) and increased social support and occupational activity (p≤.05), with effect sizes ranging from .6 to 1.0. Caregivers reported decreased burden (p≤.05) and increased empowerment (p≤.01).ConclusionsThe results supported implementation of a randomized controlled trial, building in education at the provider and family level.