Treatment preferences among Veterans with TBI: A mixed-methods pilot study

Maral Aghvinian, San Francisco Veterans Affairs Health Care System, San Francisco, United States
Kristine Yaffe, University of California San Francisco (UCSF) Department of Psychiatry and Behavioral Sciences, San Francisco, United States
Hannah Gelfond, San Francisco Veterans Affairs Health Care System, San Francisco, United States
Erica Kornblith, University of California San Francisco (UCSF) Department of Psychiatry and Behavioral Sciences, San Francisco, United States


Mild to moderate traumatic brain injury (mmTBI) is common among US Veterans and can result in short-term neurobehavioral sequelae, including impairments in cognition, mood, sleep, and occupational functioning, and is associated with long-term risk for dementia.  However, despite clear evidence documenting the large and growing scope of the problem, there is a dearth of research examining preferences for treatment addressing mmTBI sequelae among US Veterans. Furthermore, though evidence based TBI treatments exist [e.g., mindfulness, manualized psychotherapy such as cognitive behavioral therapy for insomnia (CBT-I), cognitive training targeting individual treatment domains (e.g., mood, cognition, sleep)], no accessible, multimodal treatment exists that comprehensively addresses the full spectrum of mmTBI symptoms.  As such, the present qualitative needs assessment aimed to identify preferences for intervention content (i.e., cognitive, mood/emotional, sleep) and format using self-report questionnaires, surveys, and semi-structured interview.

Participants and Methods:

Six (n = 6; Mean age = 46.83; Gender = 67% Male) Veterans with a history of chronic mmTBI were recruited through the San Francisco VA Medical Center.  Eligibility measures included the Ohio State University TBI Identification Method (OSU TBI ID) and Neurobehavioral Symptom Inventory (NSI). Open-ended feedback regarding TBI treatment preferences and needs was elicited using a semi structured interview guide. Responses were audio recorded, transcribed, and thematically coded using Rapid Qualitative Analysis[1], a technique utilized for efficient thematic extraction specifically for health services research.  Self-report symptom questionnaire data (i.e., Beck Depression Inventory-II, PTSD Checklist for DSM-5, Pittsburgh Sleep Quality Index, and Profile of Mood States) were also collected.

1. Hamilton, A.B., Qualitative Methods in Rapid Turn-Around Health Services Research, in VA HSR&D Cyberseminar.




100% of Veterans in our sample had a history of multiple TBIs (range: 3-6). Participants reported high levels of symptoms across domains (e.g., mean PCL = 43.67).  Findings from this pilot study indicate that most respondents (n=5, 83%) consider cognition the primary topic area of interest for a multimodal telehealth TBI intervention. All respondents highlighted memory difficulties as a primary complaint. Further, cognitive training was ranked as the most-desired intervention type by more than half (n=4; 67%) of participants, compared to physical activity, manualized psychotherapy, and mindfulness. Veterans provided diverse responses regarding preferences for intervention format (e.g., group, telehealth, smartphone app), as well as highlighting the benefits of social connectedness, individually tailored interventions, and TBI-related psychoeducational materials.


The present findings represent a novel, Veteran-centered examination of patient preferences for TBI treatment. Analysis of qualitative interviews elicited key themes (e.g., cognitive training) related to patient preferences, as well as illustrative quotes related to past treatment experiences and current treatment priorities among a Veteran sample. This stakeholder input can be harnessed to iteratively inform the development of a comprehensive TBI treatment designed to meet Veterans’ needs and preferences.

Category: Acquired Brain Injury (TBI/Cerebrovascular Injury and Disease - Adult)

Keyword 1: traumatic brain injury
Keyword 2: concussion/ mild traumatic brain injury
Keyword 3: cognitive rehabilitation