MIRECC / CoE

BRAVE - Building Relationships With Vitality and Engagement

Dr. Lilian Dindo and the BRAVE Team

Since 2018, with support from the VHA Office of Rural Health (ORH) our team has partnered with rural Veteran-serving nonprofit community-based organizations in Southeast Texas, to identify rural Veterans experiencing distress. In 2019-2021, we conducted a 1-day Acceptance and Commitment Therapy (ACT) workshop for these Veterans in rural community-based organizations. Following the workshop, Veterans reported improvements in community reintegration and decreased distress. Veterans appreciated the workshop being offered in a rural community setting, recommended the workshop to other Veterans experiencing distress, and had more positive perceptions of the VA as a result of attending the workshop (Dindo et al. 2020)

In 2022, we developed a couples-focused workshop (BRAVE) in response to Veteran feedback to include their intimate partners. Of relevance, relationship distress impacts 75% of Veterans seeking mental health services and is associated with negative outcomes (e.g., hopelessness, suicide) (Cigrang et al. 2014; Till et al. 2017). In contrast, stable relationships are a source of resilience (Kiecolt-Glaser et al. 2017).

Due to COVID-19 and restrictions on in-person activities, we created a virtual delivery of both the workshops using Zoom.

The BRAVE project aims to provide 2-day workshops for rural Veterans and their intimate partners (Day 1 Veterans only; Day 2 Veterans and partners) to strengthen the mental health and intimate relationships of Veterans. Veterans can attend only the 1-day ACT workshop or the couple's workshop or both, either virtually or in-person at a community-based organization. Each workshop, led by two ACT trained co-facilitators, lasts approximately 5 hours, and includes 4-8 Veterans or 4-6 couples. Attendees receive patient workbooks and a card deck (that serve as quick reminders of the skills taught at the workshop). Self-report follow-up assessments are conducted at 3 months post-workshop. Participants in the couple's workshop also complete qualitative interviews to explore the workshop's impact on their relationship and provide recommendations for future sessions. Although there is no compensation for attending the workshop, travel allowance is provided (for in-person workshops) and all follow up surveys and phone-interviews prior and after the workshop are compensated. Upcoming workshops will take place in October 2023 through February 2024.

Below are some quotes from Veterans and their partners regarding the BRAVE couple’s workshop:

• “I would tell them the BRAVE workshop is the workshop to be a part of. Young and old. It doesn’t matter how long you’ve been married. It doesn’t matter how long you've been together, married or not. Even if you’re in the dating or engaged phase, I would encourage you to. I would encourage everybody to definitely participate, money or no money involved.”
• “I think this is nothing like we have had at the VA before, and the format was wonderful, the facilitators were awesome, and it was only a 1 day virtual.”
• “I’ve already shared it with two Veterans that it’s a go-to, they must attend this workshop. I think it will help them learn how to, how to express themselves in a different way, if they haven’t already had these skills. But even if not then it exposes their spouse to a way to, to, that we can open up and express it and for them to accept it as well, in both ways.”
• “It meant a lot to both of us actually, ‘cause we wasn't sure what to expect and we actually got probably more than we thought we would out of it.”
• “The presentation and the presenters were phenomenal. They are all very caring and thoughtful people, and their experience presenting this workshop was noticeable. It was also comforting to be able to share with other couples who go through similar challenges as the ones we have at times.”

Quotes from couples on the workshop materials provided:

• “It was good, it was thorough, matter of fact we still have it and matter of fact we looked at it a few more times afterwards, I think it’s very good, very useful stuff.”
• “I still have all my books… I use it as a reference guide… the material itself is very informative and it’s very, it was very good. Y’all put together a good program”
• “Oh the workbooks were good. The card’s actually, we hung it on the refrigerator, so we get a chance to see it quite often.”

Below are some quotes from community partners we collaborated with for the BRAVE couple’s workshop:

• “Thank you for continuing to send these resources. As you can see below my program manager is very supportive and shared with all the program managers at our VA. Thanks again.” - VISN 16 VA Gulf Coast Veterans Health Care System
• “So happy we were able to host the in-person BRAVE workshop! Hopefully there is more to come.” - Montgomery County Tri-County Healthcare
• “We think our student veterans could benefit from your projects and look forward to working with you” - University of Houston Veteran Services Office

References

1. Cigrang JA, Talcott GW, Tatum J, et al. (2014). Impact of combat deployment on psychological and relationship health: A longitudinal study. Journal of Traumatic Stress, 27(1), 58-65.
2. Dindo L, Roddy MK, Boykin D, et al. (2020). Combination outreach and wellness intervention for distressed rural Veterans: Results of a multimethod pilot study. Journal of Behavioral Medicine, 44(4), 440-453.
3. Kiecolt-Glaser JK & Wilson SJ. (2017). Lovesick: How couples' relationships influence health. Annual Review of Clinical Psychology, 13, 421-443.
4. Till B, Tran US, & Niederkrotenthaler T. (2017). Relationship satisfaction and risk factors for suicide. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 38(1), 7–16.

Last updated: October 23, 2023