{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T16:59:29Z","timestamp":1782320369031,"version":"3.54.5"},"reference-count":48,"publisher":"American Medical Association (AMA)","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Few evidence-based treatments are available for Gulf War illness (GWI). Behavioral treatments that target factors known to maintain the disability from GWI, such as problem-solving impairment, may be beneficial. Problem-solving treatment (PST) targets problem-solving impairment and is an evidence-based treatment for other conditions.<\/jats:p><\/jats:sec>Objective<\/jats:title>To examine the efficacy of PST to reduce disability, problem-solving impairment, and physical symptoms in GWI.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This multicenter randomized clinical trial conducted in the US Department of Veterans Affairs compared PST with health education in a volunteer sample of 511 Gulf War veterans with GWI and disability (January 1, 2015, to September 1, 2019); outcomes were assessed at 12 weeks and 6 months. Statistical analysis was conducted between January 1, 2019, and December 31, 2020.<\/jats:p><\/jats:sec>Interventions<\/jats:title>Problem-solving treatment taught skills to improve problem-solving. Health education provided didactic health information. Both were delivered by telephone weekly for 12 weeks.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The primary outcome was reduction from baseline to 12 weeks in self-report of disability (World Health Organization Disability Assessment Schedule). Secondary outcomes were reductions in self-report of problem-solving impairment and objective problem-solving. Exploratory outcomes were reductions in pain, pain disability, and fatigue.<\/jats:p><\/jats:sec>Results<\/jats:title>A total of 268 veterans (mean [SD] age, 52.9 [7.3] years; 88.4% male; 66.8% White) were randomized to PST (n\u2009=\u2009135) or health education (n\u2009=\u2009133). Most participants completed all 12 sessions of PST (114 of 135 [84.4%]) and health education (120 of 133 [90.2%]). No difference was found between groups in reductions in disability at the end of treatment. Results suggested that PST reduced problem-solving impairment (moderate effect, 0.42; P<\/jats:italic>\u2009=\u2009.01) and disability at 6 months (moderate effect, 0.39; P<\/jats:italic>\u2009=\u2009.06) compared with health education.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this randomized clinical trial of the efficacy of PST for GWI, no difference was found between groups in reduction in disability at 12 weeks. Problem-solving treatment had high adherence and reduced problem-solving impairment and potentially reduced disability at 6 months compared with health education. These findings should be confirmed in future studies.<\/jats:p><\/jats:sec>Trial Registration<\/jats:title>ClinicalTrials.gov Identifier: NCT02161133<\/jats:ext-link><\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2022.45272","type":"journal-article","created":{"date-parts":[[2022,12,6]],"date-time":"2022-12-06T17:06:26Z","timestamp":1670346386000},"page":"e2245272","source":"Crossref","is-referenced-by-count":12,"title":["Effect of Problem-solving Treatment on Self-reported Disability Among Veterans With Gulf War Illness"],"prefix":"10.1001","volume":"5","author":[{"given":"Lisa M.","family":"McAndrew","sequence":"first","affiliation":[{"name":"War Related Illness and Injury Study Center, Veterans Affairs (VA) New Jersey Health Care System, East Orange"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen S.","family":"Quigley","sequence":"additional","affiliation":[{"name":"Bedford VA Medical Center, Bedford, Massachusetts"},{"name":"Department of Psychology, Northeastern University, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shou-En","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Litke","sequence":"additional","affiliation":[{"name":"War Related Illness and Injury Study Center, Veterans Affairs (VA) New Jersey Health Care System, East Orange"},{"name":"Department of Rehabilitation Medicine, New York University School of Medicine, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph F.","family":"Rath","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, New York University School of Medicine, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gudrun","family":"Lange","sequence":"additional","affiliation":[{"name":"War Related Illness and Injury Study Center, Veterans Affairs (VA) New Jersey Health Care System, East Orange"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan L.","family":"Santos","sequence":"additional","affiliation":[{"name":"War Related Illness and Injury Study Center, Veterans Affairs (VA) New Jersey Health Care System, East Orange"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Anastasides","sequence":"additional","affiliation":[{"name":"War Related Illness and Injury Study Center, Veterans Affairs (VA) New Jersey Health Care System, East Orange"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beth Ann","family":"Petrakis","sequence":"additional","affiliation":[{"name":"Bedford VA Medical Center, Bedford, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Greenberg","sequence":"additional","affiliation":[{"name":"War Related Illness and Injury Study Center, Veterans Affairs (VA) New Jersey Health Care System, East Orange"},{"name":"VA Palo Alto Health Care System, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Drew A.","family":"Helmer","sequence":"additional","affiliation":[{"name":"War Related Illness and Injury Study Center, Veterans Affairs (VA) New Jersey Health Care System, East Orange"},{"name":"Center for Innovations in Quality, Effectiveness and Safety at Michael E. 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