Window to Hope-Evaluating a Psychological Treatment for Hopelessness Among Veterans With Traumatic Brain Injury (WtoH)

• Change in Beck Hopelessness Scale (BHS) [ Time Frame: Change in BHS Score from Time 1 to Time 2 for Treatment Group and Change in BHS Score from Time 2 to Time 3 for Waitlist Control Group ] [ Designated as safety issue: Yes ]
  Time 1 (Baseline for both groups), Time 2 (Post-Intervention for Treatment Group and Baseline 2 for Waitlist Control Group), and Time 3 Assessment (3 month follow up for Intervention Group and Post-Intervention for Waitlist Control Group. The BHS is a 20-item true-false self-report scale that measures the level of negative expectations about the future held by respondents over the previous week. Scores range from 0 to 20 representing nil (0-3), mild (4-8), moderate (9-14), and severe (>14) levels of hopelessness. Beck et al. found that BHS scores equal to or greater than 9 were associated with significantly elevated levels of suicide risk (Beck et al., 1985). As such, to be eligible to participate in this treatment trial individuals must have a score of 9 on the BHS at the time of screening and at the baseline assessment.
  
  

• Change in Beck Scale for Suicidal Ideation (BSS) [ Time Frame: Change in BSS Score from Time 1 to Time 2 for Treatment Group and Change in BSS Score from Time 2 to Time 3 for Waitlist Control Group ] [ Designated as safety issue: Yes ]
  The BSS is a 19-item scale that assesses severity of suicide ideation within the previous week with total scores ranging from 0 (no suicide ideation) to 38. High levels of internal consistency (Cronbach's α = .93) and concurrent validity have been reported with the Beck Depression Inventory (r =.64 to r =.75, Beck & Steer, 1993) as well as the BHS in TBI (r =.60, Simpson & Tate, 2002) and non-brain-damaged populations (r =.52 to r = .63, Beck & Steer, 1993).
  
  
• Change in Beck Depression Inventory (BDI -II) [ Time Frame: Change in BDI-II Score from Time 1 to Time 2 for Treatment Group and Change in BDI-II Score from Time 2 to Time 3 for Waitlist Control Group ] [ Designated as safety issue: No ]
  

Prior to implementing the intervention, Dr. Simpson will work with VA study team members (e.g., Drs. Brenner, Matarazzo, Signoracci) to modify WtoH manual semantics and graphics to meet the needs of the U.S. Veteran population. Dr. Brenner has a long history of working within the VHA and is a Diplomate in Rehabilitation Psychology. An expert committee (up to 15 participants) will also be convened for a meeting focused on the cross-cultural adaptation of WtoH. All efforts will be made to include experts in treating TBI and stakeholders (e.g., Veterans with or without TBI and/or family members/support persons) on the committee. Members of the research team will contact potential committee members by phone, email, mail or in person. Presentations may also be made to Veterans/family members/support persons receiving care, participating in patient advocacy activities, or providing peer support. Prior to reviewing the content, the expert committee will be provided background on the current state of knowledge about suicidality and hopelessness after TBI, available treatment options, and information regarding the underlying theoretical basis and key features of the WtoH program. The committee will then review the ten sessions to identify potential changes required to the therapeutic content, exercises, language and graphics to ensure that it is culturally appropriate for the VAMC context. Modifications will be made employing a consensus approach among the expert committee.

The adapted program will then be trialed across four pilot groups. Once the pilot groups have been completed (see below) the expert committee will be reconvened for a final review of the program. Data collected on acceptability and feasibility will be presented to the committee and test therapists. Any necessary final modifications to assessment procedures and/or the intervention to ensure that the program is appropriate for the Veterans' condition will be made employing a consensus approach.

The revised version of the manual will be used to conduct the RCT. Up to 90 Veterans will participate.