Faculty Bibliography

Social workers play an essential role in facilitating veterans' reintegration into their communities and daily lives. Many veterans, particularly those who have been deployed, experience comorbid physical, psychological, and neurocognitive problems that significantly impact their health function in multiple domains. Veterans deployed to Operation Desert Shield/Operation Desert Storm have reported a wide range of persistent, diverse, medically unexplained symptoms that have come to be known as Gulf War Illness (GWI). These symptoms make it difficult for veterans to participate in daily activities, thereby impacting health function. There are few effective treatments to improve the health function for those with GWI. The goals of this article are to provide social workers with information about GWI, and describe how we modified an evidence-based treatment, problem-solving therapy, for veterans with GWI. This tailoring of an existing treatment may serve as a model for adapting evidence-based treatments for veterans and civilians with multiple chronic symptoms and other complex health concerns. Furthermore, the detailed description provided may facilitate dissemination of problem-solving therapy among social workers and trainees.

Objective: The goal of this paper is to illustrate how the lessons learned in over 20 years of randomized clinical trials have advanced cognitive rehabilitation beyond traditional approaches to problem solving by more explicitly integrating subjective self-appraisal factors in routine clinical practice. Results: The concept of problem orientation, as proposed by cognitive-behavioral psychologists, provides a much-needed framework for conceptualizing interventions to address the impact of subjective experience on cognitive functioning, within the context of cognitive remediation. By explicitly focusing on the beliefs, assumptions, and expectations that individuals with acquired brain injury have about their own cognitive functioning, the concept of problem orientation allows rehabilitation psychologists to add an element to interventions, not systematically addressed in standard approaches to cognitive remediation. Targeting objective deficits in cognitive remediation is necessary, but not sufficient: For optimal benefit, remedial interventions must address objective cognitive deficits and the patient's subjective experience of such deficits in tandem. Conclusion: Contemporary evidence-based treatment recommendations now typically include incorporating interventions to address motivational, attitudinal, and affective factors in cognitive remediation. Further research is needed to directly compare the effectiveness of cognitive rehabilitative interventions that systematically address subjective factors with those that do not. (PsycINFO Database Record (c) 2011 APA, all rights reserved)