Original Research Using an Avatar-Based Simulation to Train Families to Motivate Veterans with Post-Deployment Stress to Seek Help at the VA Glenn Albright, PhD, 1,2 Ron Goldman, BBA, 2 Kristen M. Shockley, PhD, 1 Fiona McDevitt, LMSW, 2 and Sam Akabas, MSW 2 Abstract Objective: This study examines the effectiveness of ‘‘Family of Heroes,’’ an online avatar-based post-deployment stress and resiliency training simulation, in increasing families’ engagement in motivating their veterans who exhibit signs of post-deployment stress, including post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), depression, and suicide ideation, to seek help at the Veterans Administration (VA). Materials and Methods: Participants were randomly assigned to an experimental group (n = 50) that completed the online training and pre- and post-intervention and 1-month follow-up surveys or a control group (n = 44) who only completed a pre-test and a 1-month follow-up survey. Results: The experimental group exhibited significantly greater changes in its preparedness and likelihood to recognize signs of post-deployment stress and in approaching their veteran to discuss their concern and moti- vate them to seek help at the VA. This group also reported significant change in actual behavior in terms of discussing their concern with their veteran (79 percent approached to discuss vs. 56 percent for the control group). Finally, seven (22 percent) of the veterans who were approached by the experimental group started to receive mental health treatment (five at the VA). All seven were previously diagnosed with PTSD and/or depression but never before started treatment at the VA. Conclusion: Results strongly suggest that ‘‘Family of Heroes’’ is an effective tool to engage families in taking an active role in motivating their veterans who exhibit signs of post-deployment stress to seek help at the VA. Results also suggest that the training can increase the actual number of veterans experiencing post-deployment stress who begin to receive treatment at the VA. Introduction R ecent data gathered on veterans of the U.S. Armed Forces has demonstrated an increased risk for post- deployment stress reactions, such as post-traumatic stress disorder (PTSD), substance abuse, depression, suicide, and functional impairments including interpersonal conflict and homelessness. 1 In a Department of Defense–sponsored study, The RAND Corporation found that approximately one-third of previously deployed military personnel and veterans showed symptoms of PTSD, traumatic brain injury (TBI), and/or major depression. 1(p xxi) Furthermore, despite re- presenting 12.7 percent of the general population, veterans account for approximately 20 percent of suicides per year in the United States (roughly 6,000–6,400 veterans). 2,3 However, many of those at-risk veterans do not seek help. Studies have shown that about half (53 percent) of those who meet the criteria for PTSD or major depression seek treatment from a mental health provider or primary care physician. 1(p 251) Beyond its effects on the individual, post-deployment stress in veterans is likely to impact veterans’ relationships with family members and also the well-being of those family members. 4 For example, two common symptoms of PTSD— numbing and anger—have been linked to increased marital dissatisfaction and interpersonal conflict among spouses of veterans with PTSD. 5,6 Male veterans with PTSD are more likely to become physically or verbally abusive towards their partners or children than male veterans without PTSD, 7 and divorces occur at a higher rate for those with PTSD than for those without the symptoms. 8 Finally, family members of 1 Department of Psychology, Baruch College, New York, New York. 2 Kognito Interactive, New York, New York. GAMES FOR HEALTH: Research, Development, and Clinical Applications Volume 1, Number 1, 2011 ª Mary Ann Liebert, Inc. DOI: 10.1089/g4h.2011.0003 1 G4H-2011-0003-ver9-Albright_2P.3d 09/30/11 12:34pm Page 1