Internet Disclosure Treatment for Multi-Symptom Illness
Principal Investigator: Helena K. Chandler, PhD
Objective: The primary aim of the proposed study is to determine whether writing about stressful episodes on-line decreases the use of healthcare utilization by veterans with chronic multisymptom illness (CMI). Prior research has demonstrated the efficacy of therapeutic writing for reducing medical utilization in healthy populations and individuals with known medical illness but this approach has yet to be evaluated in veterans with multiple somatic symptoms. The second aim of the study is to evaluate the process by which therapeutic writing may influence reliance on healthcare services.
We will specifically measure changes in beliefs about what causes symptoms and determine whether changes in these illness attributions account for change in healthcare utilization. Finally, we will measure satisfaction with healthcare services to determine whether adding an on-line therapeutic writing treatment to usual care improves satisfaction with overall VA healthcare.
Research Plan: The current sample will consist of veterans evaluated at the War-Related Illness and Injury Center (WRIISC) who meet criteria for CMI. They reside throughout the U.S. and often lack access to effective interventions. Consistent with "Healthy People 2010," which identifies access to health care as a leading health indicator, providing treatment via the Internet has the potential to decrease structural barriers that prevent patients from receiving specialized treatment. Participants with multisymptom illness will be recruited from the War-Related Illness and Injury Study Center (WRIISC) and randomized to receive either usual WRIISC care or On-Line Treatment + WRIISC care. The primary outcome variable is number of outpatient visits. Physical functioning, symptom reporting, psychological distress and satisfaction with services will also be assessed at enrollment and 6 and 12 months post-intervention. The effect of treatment on utilization will be determined by analysis of co-variance, controlling for pre-intervention scores, medical comorbidity and demographic characteristics.
Impact: If effective, the On-Line treatment could provide a brief, low-cost, and accessible intervention for individuals with CMI.
Status: Project is ongoing.