Decreasing PTSD and Depression Symptom Barriers to Weight Loss Using an Integrated CBT Approach

Abstract

This is a single-case study of an obese African American female Veteran who has posttraumatic stress disorder (PTSD) and depression. Her presenting psychological symptoms included clinically significant night terrors, insomnia, low self-worth, low motivation, and social isolation. Poor dietary and physical activity responses to her psychological symptoms contributed to her weight gain, as well as interfered with weight-loss efforts. A telephone-based cognitive behavioral treatment integrating mental and behavioral health principles was provided. Over the course of eight sessions, the Veteran learned psychological symptom and behavioral monitoring, thought stopping, cognitive restructuring, deep breathing, calming thoughts, social support, sleep hygiene, and problem-solving skills. Client-centered PTSD and weight-management treatment goals were integrated into each session. The client evidenced weight loss, improved dietary and physical activity habits, and experienced a reduction in PTSD and depression symptoms. This case study demonstrates that an integrated cognitive behavioral treatment approach can be beneficial for decreasing PTSD and depression barriers to weight loss.

Virtual Trauma-Focused Therapy for Military Members, Veterans, and Public Safety Personnel With Posttraumatic Stress Injury: Systematic Scoping Review

“…A number of facilitators were identified regarding the virtual delivery of trauma therapies to military members, veterans, and PSP ( Table 2 ). These included (1) the convenience of accessing teletherapy, particularly for clients in rural and remote areas [ 79 , 85 , 87 ], (2) the comfort of participating in therapy from the client’s home [ 57 , 59 , 85 , 87 ] resulting in less stress [ 55 , 58 ] and stigma, [ 86 , 87 ], (3) the efficaciousness of several different evidence-based PTSD treatment modalities delivered using digital health, including PE, CPT, CBT, and BA-TE [ 25 , 53 , 56 , 77 ], and (4) the ability to see a therapist from a central health clinic or the location of their choosing reduced travel time and transportation and missed work costs [ 25 , 55 , 82 ]. Many clients found that participating in teletherapy provided the same opportunities for relationship building with the therapist as in-person treatment [ 52 , 81 ].…”

“…“It is more convenient and it is not like waiting at the office knowing you just have 1 hour to talk.” [ 59 ]…”

“…Multiple barriers were also identified ( Table 3 ), including (1) issues with technology related to connectivity, inconsistent access to a secure, high-quality internet connection, and hardware that disrupts and limits the high quality and secure service delivery [ 25 , 52 , 53 , 55 , 64 , 79 , 81 , 85 , 89 ], (2) client openness to digital health services [ 59 ], (3) challenges to client privacy and comfort, including lack of a quiet, private space, experiences of isolation or disruption in the home environment, and client discomfort with communication over video conferencing [ 56 , 59 , 79 , 84 , 85 ], (4) limits to the therapeutic alliance and therapist comfort with intervention activities that may impact clinical utility and effectiveness [ 57 , 58 , 65 , 66 , 79 ], (5) the ease of abrupt disengagement from treatment and engagement in social avoidant behaviors [ 55 - 57 , 59 , 79 ], and (6) safety concerns and risk management [ 52 , 59 , 81 ].…”

“…“...Veterans may require leaving their home and attending face-to-face sessions as part of the therapeutic process.” [ 59 ]…”

“…“... patients who have concerns related to safety or hesitate due to technical concerns may benefit from receiving assistance from a peer before deciding whether or not to try [home telemental health] HTmental health.” [ 59 ]…”