Cognitive Rehabilitation for Gulf War Illness

Gulf War Illness (GWI) is a complex multi-dimensional illness which causes as much disability
as other major medical diseases. Previous clinical trials (i.e. cognitive behavioral therapy
and graded exercise) for GWI have sought to improve disability by increasing activity
regardless of symptom presentation. These previous trials for GWI have shown limited efficacy
and poor adherence. An innovative treatment approach is to target a specific component of
GWI, namely problem-solving ability, known to be associated with disability.

Impairment in problem-solving ability affects Gulf War Veterans (GWV) with GWI and is
prospectively related to greater risk of disability. This impairment is also related to
poorer adherence to medical regimes, making it difficult for GWV to manage other aspects of
GWI. Problem-solving is considered one of the most complex of cognitive abilities and is
related to complicated behaviors such as setting goals, sequencing and multi-tasking. Despite
published reports documenting these deficits there are no treatments that target the
problem-solving deficits of GWI in order to reduce disability.

The investigators propose a targeted treatment, Problem-Solving Therapy, to compensate for
the problem-solving deficits of GWI and thereby reducing disability. Problem-Solving Therapy,
a top down approach, teaches patients skills to overcome problems like cognitive dysfunction
or physical symptoms that impact problem-solving. Compensating for problem-solving deficits
would reduce disability and provide information on the effect of treating one component of
GWI on other symptoms of GWI. This is the first trial of cognitive rehabilitation therapy for
GWI.

Inclusion Criteria:

Inclusion:

- deployed to first Gulf War and meets Kansas definition for GWI (see definition in
measures section);

- scores at least a half a standard deviation worse than the mean on the World Health
Organization Disability Schedule (WHO-DAS II).

Exclusion Criteria:

Exclusion:

- current suicidal/homicide intent or plan assessed by The Columbia Suicide Severity
Rating Scale, schizophrenia or current psychotic symptoms

- self-reported diagnosis of a degenerative brain disorder or serious psychiatric or
medical illness which may limit generalizability of the findings, limit safety or
account for the symptoms of GWI.

Exclusionary medical illnesses include: Class 3 and 4 heart failure, cancer diagnosed
within the past year and/or undergoing active treatment (chemotherapy or radiation
therapy), chronic renal insufficiency, hospitalization due to myocardial infarct, stroke in
the past year, a neurodegenerative disorder, or another medical or psychiatric disorder
that may limit generalizability, limit participants safety or account for the symptoms of
GWI at the discretion of the PI.

- a disability that would preclude telephone use.