Dissertations and Theses (Open Access)
Date of Award
Summer 8-2026
Degree Name
Doctor of Philosophy in Nursing (PhD)
Advisor(s)
Jennifer Beauchamp, PhD
Second Advisor
Carina Katigbak, PhD
Third Advisor
William LaFrance, JR., M.D.
Abstract
Background: Veterans with epilepsy experience high rates of psychiatric comorbidity, most commonly major depressive disorder (MDD). Barriers to accessing mental health care—including geographic distance, transportation limitations related to seizure-related driving restrictions, and fragmented care between neurology and psychiatry, contribute to the underdiagnosis and undertreatment of MDD in this population. Neurobehavioral Therapy (NBT), a Cognitive Behavioral Therapy (CBT)-informed psychotherapy developed for individuals with seizures, has demonstrated benefits for psychological distress and quality of life. Internet-based interventions and short message service (SMS) text messaging offer promising strategies to address access barriers; however, limited research has examined the feasibility and acceptability of delivering clinician-guided online group NBT with SMS text support to Veterans with epilepsy and MDD.
Aims: The primary objective of this study was to examine the feasibility and acceptability of a clinician-guided online group NBT intervention with SMS text support for Veterans with epilepsy and MDD. A secondary objective was to descriptively examine changes in depressive symptoms, quality of life, psychological resilience, and self-efficacy from baseline to post-intervention to inform the design of future, adequately powered efficacy trials.
Methods: This single-group, pretest-posttest pilot study enrolled 8 Veterans with epilepsy and a clinical diagnosis of MDD from a Veterans Health Administration medical center. Participants completed a 12-session clinician-guided online group NBT intervention supported by SMS text reminders. Feasibility outcomes included enrollment, retention, session attendance, and homework completion rates. Acceptability was assessed using perceived usefulness, perceived ease of use, and participant satisfaction measures. Secondary outcomes included depressive symptoms, quality of life, psychological resilience, and self-efficacy, assessed at baseline and immediately following the intervention. Analyses were limited to descriptive statistics.
Results: The enrollment rate was 72.7%, and retention was 100%. Participants attended a mean of 11.25 sessions (93.8% attendance), and homework completion was 96.8%. Acceptability scores indicated high perceived ease of use (M = 4.27, SD = 0.32), satisfaction (M = 4.00, SD = 0.53), and favorable perceived usefulness (M = 3.69, SD = 0.56). Descriptive trends across secondary outcomes demonstrated reductions in depressive symptoms (mean change = -3.25) and improvements in quality of life (mean change = -0.10), resilience (mean change = +2.87), and self-efficacy (mean change = +7.63).
Conclusion: Findings support the feasibility and acceptability of a clinician-guided online group NBT intervention with SMS text support for Veterans with epilepsy and MDD. Descriptive trends suggest potential improvements in mental health and patient-reported outcomes. These results provide preliminary support for this intervention model and inform the design of future, adequately powered controlled trials.
Recommended Citation
Fadipe, Melissa F., "Online Group Neurobehavioral Therapy (NBT) for Veterans with Epilepsy and Major Depressive Disorder (MDD)" (2026). Dissertations and Theses (Open Access). 78.
https://digitalcommons.library.tmc.edu/uthson_etd/78
Keywords
Veterans, Epilepsy, Major Depressive Disorder, Internet-based psychotherapy, Neuro-behavioral therapy