Evaluating symptom reduction and functional recovery among combat veterans undergoing the Stress Inoculation Training Health Sustainment and Restoration (SIT-HSR) protocol.

Abstract

This study reports a multisite program evaluation of Stress Inoculation Training-Health Sustainment and Restoration, a manualized, group-based intervention delivered within routine Veterans Affairs care for veterans with posttraumatic stress, depression, and related comorbidity. The purpose of the evaluation was to examine feasibility across implementation periods and delivery contexts and to describe symptom and functional improvement during participation, rather than to test intervention efficacy. A total of 281 veterans enrolled across three implementation periods and multiple Veterans Affairs sites; measure availability varied by period and outcome. The Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, fifth edition; Beck Depression Inventory-II; Alcohol Use Disorders Identification Test; Brief Addiction Monitor; and Situational Adaptation to Stress Scale were used as available at pre- and posttreatment. Linear mixed-effects models were treated as the primary inferential analyses because they accounted for repeated measurement, site-level clustering, and incomplete data, whereas measure-specific Wilcoxon signed-rank tests and site/period comparisons were treated as secondary sensitivity analyses. Participants improved during program participation on posttraumatic stress disorder, depression, alcohol use, and stress adaptation outcomes, with the largest gains observed for stress adaptation and functioning. Mean Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, fifth edition, scores decreased from 50.56 to 42.52, and mean Beck Depression Inventory-II scores decreased from 31.35 to 25.46, while mean Situational Adaptation to Stress Scale scores increased from 20.82 to 31.13. Improvement patterns were observed across implementation periods and in both in-person and telehealth delivery contexts. An overall difference in Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, fifth edition, scores was observed between Periods 2 and 3, but change over time did not differ significantly by period. Overall, these findings support the feasibility of implementing Stress Inoculation Training-Health Sustainment and Restoration across Veterans Affairs settings and suggest that participation in the program was associated with symptom reduction and functional improvement. As the design was observational and lacked a comparison condition, the results should not be interpreted as establishing intervention effectiveness, equivalence across formats, or scalability beyond the contexts studied. (PsycInfo Database Record (c) 2026 APA, all rights reserved).