The Impact of Integrating Physical Health into a Brief CBT Approach for Medically Ill Veterans

  • Charles P. Brandt
  • Frances Deavers
  • Natalie E. Hundt
  • Terri L. Fletcher
  • Jeffrey A. CullyEmail author


The current study explored the use and preliminary outcomes of physical health treatment elements integrated into a traditional brief cognitive behavioral therapy (bCBT) approach for medically ill veterans with depression and/or anxiety. Data were collected as part of a pragmatic randomized trial examining patient outcomes of bCBT versus an enhanced usual care condition. bCBT was delivered to participants by Veterans Health Administration (VA) mental health providers in the primary care setting. Using a skill-based approach, providers and participants selected modules from a list of intervention strategies. Modules included Taking Control of Your Physical Health, Using Thoughts to Improve Wellness, Increasing Pleasant Activities, and Learning How to Relax. Skill module use and impact on treatment completion and clinical outcomes were explored for participants randomized to bCBT who received at least one skill module (n = 127). Utilization data showed that participants and providers most commonly selected the physical health module for the first skill session. Receiving the “physical health” and “thoughts” modules earlier in treatment were associated with a higher likelihood of treatment completion (defined as four or more sessions). Preliminary outcome data suggest that the physical health skill module was equally effective or superior to other bCBT skill modules. Results suggest that incorporating physical health elements with a bCBT approach hold the potential to positively impact treatment engagement/completion and may result in improved outcomes for medically ill patient populations.


CBT COPD Heart failure Anxiety Depression 



This research was supported by a grant from the Department of Veterans Affairs HSR&D 09-088 (PI: J. Cully), partially supported by a Career Development Award (13-264) awarded to the third author, and partially supported by the resources of the VA HSR&D Houston Center for Innovations in Quality, Effectiveness and Safety (CIN 13-413), Michael E. DeBakey VA Medical Center, Houston, Texas. The views expressed reflect those of the authors and not necessarily the policy or position of the Department of Veterans Affairs, the U.S. Government, or Baylor College of Medicine. None of these bodies played a role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication.

Compliance with Ethical Standards

Conflict of Interest

Charles P. Brandt, Frances Deavers, Natalie E. Hundt, Terri L. Fletcher, and Jeffrey A. Cully declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

The study was approved by the Veterans Health Administration (VA) Central Institutional Review Board as well as the Houston and Oklahoma City VA facility Research and Development Offices and was reviewed annually by VA’s national Data Safety Monitoring Board.


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Copyright information

© This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2019

Authors and Affiliations

  • Charles P. Brandt
    • 1
    • 2
  • Frances Deavers
    • 3
  • Natalie E. Hundt
    • 2
    • 4
    • 5
  • Terri L. Fletcher
    • 2
    • 4
    • 5
  • Jeffrey A. Cully
    • 2
    • 4
    • 5
    Email author
  1. 1.The Houston OCD ProgramHoustonUSA
  2. 2.Menninger Department of Psychiatry and Behavioral SciencesBaylor College of MedicineHoustonUSA
  3. 3.Michael E. DeBakey Veterans Affairs Medical CenterHoustonUSA
  4. 4.Houston VA HSR &D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center (MEDVAMC 152)HoustonUSA
  5. 5.VA South Central Mental Illness Research, Education and Clinical Center (A Virtual Center)HoustonUSA

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