It is common for Veterans with injuries, illnesses, or physical disabilities to experience depression, post-traumatic stress disorder (PTSD), chronic pain, and other concerns. They may also have goals like becoming happier or better able to cope with challenges that life brings. The purpose of this research study is to learn whether Veterans like and benefit from a 5-week, group-based positive psychology program aimed at improving mental health, resilience, well-being, and quality of life. Participants will be asked to complete several assessments (surveys/interviews) over the course of the study that are not considered part of standard care. Additionally, participants will be asked to participate in a focus group at the end of the study to provide feedback about their experiences in the group.

To participate in this study, Veterans must first be enrolled in the Resilience and Well-Being Program, a 5-week, group-based positive psychology program held at VA Puget Sound as part of standard care. After enrollment, Veterans may choose to enroll in this research study which evaluates the effectiveness of, and satisfaction with, the Resilience and Well-Being Program.

This research study includes two study visits at VA Puget Sound and three assessments over the phone.

Informed Consent Process

This process will take place at the VA Puget Sound. A research staff member will review the details of the study with the participant and answer any questions s/he may have to see if they are interested in participating.

Assessments

1. Baseline Assessment: A research staff member will ask the participant a number of standard questions. The most straightforward of these questions will ask about age, gender, race, ethnicity, education level, employment status, marital status, and military service. Participants will also be asked questions about their medical and mental health treatment use, and any other health problems they may experience. Participants will also be asked questions about potentially stressful life experiences.

2. Post-Group Satisfaction Survey: This survey will happen following the completion of the 5-week group as long as a participant has attended at least one session. Participants will be asked to complete this survey in-person at the end of Session 5. In this survey, participants will be asked questions about how satisfying, engaging, and helpful they thought the program was; what they thought about the program, and whether they experienced any negative effects from participating in the program.

3. Telephone Assessments: Throughout participation in the study, participants will be asked to complete three telephone assessments. Within each assessment, participants will be asked questions relating to:

   • How the participant is feeling
   • Satisfaction with life and well-being
   • Positive and negative emotions
   • Participation and satisfaction with social activities
   • Problems related to very stressful experiences
   • Physical pain and how it is affecting the participant's life
   • Current and past mental health treatment use
   • How likely the participant is to seek mental health treatment
   • Changes in medications, psychological treatment, or new major life events
   • How illness/injury has impacted the participant's life
   • Whether the participant noticed any changes in their life after the group (once the group is over)

The three telephone assessments will occur at the following stages of the study:

• Pre-Group Assessment must be completed before the first group session.
• Post-Group Assessment will occur at the end of the 5-week group period.
• 5-Week Follow-Up Assessment will occur about 5 weeks after the end of the 5-week group period.

Focus Group (Optional)

Participants will be invited to complete a focus group that will last about 60-90 minutes six to eight weeks after the completion of the group to talk about their experiences and satisfaction with the program. Completing the focus group is optional, but encouraged, as researchers would like to receive participant feedback through open discussion to better improve this program for other Veterans. The focus group leaders will use prepared questions to help guide the flow of discussion.

Inclusion Criteria:

1. Veteran status (defined as prior service in the US Armed Forces and eligible to receive health care services through Veterans Health Affairs)
2. 18 years of age or older
3. Enrolled, or eligible and willing to enroll, in the Resilience and Well-Being group treatment program (offered as part of standard clinical care in VA Puget Sound Rehabilitation Care Services)
4. Able to read, speak, and understand English
5. Has been seen at least once in the past 12 months in a VAPSHCS clinic that provides rehabilitation services to individuals with rehabilitation needs related to conditions including (but not limited to) multiple sclerosis (MS), traumatic brain injury (TBI), amyotrophic lateral sclerosis (ALS), spinal cord injury (SCI), stroke, myocardial infarction, limb loss, polytrauma, neuromuscular conditions, musculoskeletal problems, impairing but medically unexplained symptoms, and/or pain, OR has a diagnosis of such a condition
6. Positive screen for depression, PTSD, or chronic pain

Exclusion Criteria:

1. Primary psychotic or major thought disorder as listed in participant's medical record or self-reported
2. Psychiatric or behavioral conditions in which symptoms were unstable or severe (e.g., current delirium, mania, psychosis, suicidal ideation, homicidal ideation, active substance use disorder, psychiatric hospitalization) as listed in participant's medical record or self-reported within the past six months
3. Any behavioral, cognitive, or psychiatric issues that would indicate the participant may be inappropriate in a group setting or for this particular group-format intervention, subject to clinician discretion
4. Difficulties or limitations communicating over the telephone

The study population will be Veterans enrolled in the VA Puget Sound Resilience and Well-Being Program, which is offered through VA Puget Sound Rehabilitation Care Services as part of standard clinical care.