Pilot Study of a Resiliency Based and Trauma Informed Intervention for Veterans
Jose Betancourt
Round 1
Reviewer 1 Report
Comments and Suggestions for AuthorsCommentary Review for “Pilot Study of the Community Resiliency Model Intervention for Veterans”
Page 1, Abstract: The abstract is succinct, informative and well-written.
Page 2, Line 64: The Authors refer to “veteran post service experience . . .” Recommend the Authors insert a hyphen to improve Reader comprehension. The new sentence fragment should read as follows: “veteran post-service experience . . .”
Page 5, Line 187: The Authors state “ . . . post intervention . . .” Recommend that a comma be inserted between the words “post” and “intervention” to improve Reader comprehension. The new sentence fragment should read as follows: “ . . . post-intervention . . .”
Page 6, Line 240: The Authors state “ . . . The data was also examined . . .” Recommend the Authors correct the noun/verb agreement as the word “data” is plural. The new sentence fragment should read as follows: “The data were also examined . . . “
Page 6, Line 259: The Authors state “ . . . our data suggests . . .” Recommend the Authors correct the noun/verb agreement as the word “data” is plural. The new sentence fragment should read as follows: “ .. . our data suggest . . . “
Concluding comments: This Reviewer commends the Authors for a good scoping review in the very important topic of the behavioral health of the US Veteran population . . . a VERY deserving group who has sacrificed for our Nation. This Reviewer looks forward to these minor revisions, full publication as well as to follow-on studies. Thank you.
Author Response
Page 1, Abstract: The abstract is succinct, informative and well-written.
Page 2, Line 64: The Authors refer to “veteran post service experience . . .” Recommend the Authors insert a hyphen to improve Reader comprehension. The new sentence fragment should read as follows: “veteran post-service experience . . .”
Response: The new sentence fragment now reads as “veteran post-service experience…”
Page 5, Line 187: The Authors state “ . . . post intervention . . .” Recommend that a comma be inserted between the words “post” and “intervention” to improve Reader comprehension. The new sentence fragment should read as follows: “ . . . post-intervention . . .”
Response: The new sentence fragment now reads as “post-intervention…”
Page 6, Line 240: The Authors state “ . . . The data was also examined . . .” Recommend the Authors correct the noun/verb agreement as the word “data” is plural. The new sentence fragment should read as follows: “The data were also examined . . . “
Response: The new sentence fragment now reads as “The data were also examined…”
Page 6, Line 259: The Authors state “ . . . our data suggests . . .” Recommend the Authors correct the noun/verb agreement as the word “data” is plural. The new sentence fragment should read as follows: “ .. . our data suggest . . . “
Response: The new sentence fragment now reads as “…our data suggest…”
Concluding comments: This Reviewer commends the Authors for a good scoping review in the very important topic of the behavioral health of the US Veteran population . . . a VERY deserving group who has sacrificed for our Nation. This Reviewer looks forward to these minor revisions, full publication as well as to follow-on studies. Thank you.
Response: We greatly appreciate the reviewer’s comments and recommendations on how we could strengthen this manuscript.
Reviewer 2 Report
Comments and Suggestions for AuthorsManuscript ID: traumacare-2825454
Reviewer Comments
1. Overall I found this to be an interesting and well-written report.
2. Abstract, line 14: "...veterans'... The sample is vague. There are details on line 156. At a minimum, include the sample size in the abstract.
3. Line 46: The citation for incidence of suicide dates from 2015 (9 years ago). Can you find a more recent reference?
4. Line 59: Missing the opening parentheses.
5. Line 62: "...most evidence-based models..." - the approximation "most" is vague and there is no source. It is preferred to identify (name) specific models.
6. Lines 62-75: The concept of resilience is introduced but not defined. Please provide a definition.
7. Lines 93-99: How does the CRM define resilience?
8. Line 101: "...no published CRM studies..." is an overstatement. Are you 100% sure there are no studies? Stating your search did not reveal published studies is defensible.
9. Line 109: move the word briefly before summarizes... "...briefly summarizes..."
10. Line 129: In the figure legend, "resilient zone" is unclear. You might explain this when you describe the CRM (lines 93-117).
11. Line 189: Did the TRUSS ask about usefulness of each of the five skills separately? If so, please specify.
12. Lines 208-213: It is not clear if psychometrics cited are from a prior study (which one?) in the literature or from this study. If psychometrics are based on this study, move this information to the Results section.
13. Line 312: break Discussion into more than one paragraph.
14. Line 320: veterans are "who" not "that".
15. Line 324: What are you considering as behavioral health to make this statement?
16. Line 325: start a new paragraph.
17. Sentence starting 333: reword "a larger group to begin with" to "a larger sample."
18. Line 345: Heading should be Study Strengths and Limitations (include strengths).
19. This section is one long paragraph and should be broken into multiple separate paragraphs corresponding to each new idea. Then you might develop ideas further.
20. Line 373: something isn't right in sentence wording.
Comments on the Quality of English LanguageThere are a few awkward sentences.
Author Response
1. Overall I found this to be an interesting and well-written report.
Response: We thank the reviewer for the detailed, insightful feedback to improve the clarity and flow of the manuscript.
2. Abstract, line 14: "...veterans'... The sample is vague. There are details on line 156. At a minimum, include the sample size in the abstract.
Response: Included more information regarding the participants, adding the sentence “A sample of 46 English-speaking, ethnically diverse veterans were recruited for this study” to the abstract. [line 11]
3. Line 46: The citation for incidence of suicide dates from 2015 (9 years ago). Can you find a more recent reference?
Response: The citation has been replaced with the 2023 National Veteran Suicide Prevention Annual Report by the U.S. Department of Veteran Affairs and now reads as: “According to the 2023 National Veteran Suicide Prevention Annual Report by the U.S. Department of Veteran Affairs, approximately 16 veterans died by suicide daily in 2021 and accounted for 14% of average suicides per day for all U.S. adults.” [line 43 – 46]
4. Line 59: Missing the opening parentheses.
Response: The opening parentheses was added. [line 59]
5. Line 62: "...most evidence-based models..." - the approximation "most" is vague and there is no source. It is preferred to identify (name) specific models.
Response: Added the names of specific models and citations to support the modified sentence. It now reads as “Aside from access and stigma, evidence-based models are such as Cognitive Behavioral Therapy (e.g. Cognitive Processing Therapy, Prolonged Exposure Therapy, Trauma-Focused Cognitive Behavioral Therapy) and Eye Movement Desensitization Reprocessing [11], presume that the trauma participants experienced is in the past, and is therefore no longer occurring, or will not occur again [15].” [line 61 – 65]
6. Lines 62-75: The concept of resilience is introduced but not defined. Please provide a definition.
Response: The definition from the Trauma Resource Institute was used and is stated as “…an individual’s and community’s ability to identify and use individual and collective strengths in living fully with compassion in the present moment, and to thrive while managing the activities of daily living.” [line 71 – 74]
7. Lines 93-99: How does the CRM define resilience?
Response: The definition from the Trauma Resource Institute was used and is stated as “…an individual’s and community’s ability to identify and use individual and collective strengths in living fully with compassion in the present moment, and to thrive while managing the activities of daily living.” [line 71 – 74]
8. Line 101: "...no published CRM studies..." is an overstatement. Are you 100% sure there are no studies? Stating your search did not reveal published studies is defensible.
Response: Specifically stated that “While none of the 15 published CRM studies have been conducted with veterans….” [line 102 – 103]
9. Line 109: move the word briefly before summarizes... "...briefly summarizes..."
Response: Changed the word order to now state “…briefly summarizes…” [line 111]
10. Line 129: In the figure legend, "resilient zone" is unclear. You might explain this when you describe the CRM (lines 93-117).
Response: Provided more details about the resiliency zone in the text, which now states “…CRM teaches participants a set of skills which seek to help them get back into their “resiliency zone”, or more emotionally balanced…” [line 108 – 109]
11. Line 189: Did the TRUSS ask about usefulness of each of the five skills separately? If so, please specify.
Response: Clarified that TRUSS was used to assess the preparedness and use of CRM overall as well as for each individual skill. It now states “TRUSS was specifically developed to assess the participants’ level of understanding and preparedness to use CRM overall as well as for each individual skill…” [line 185 – 187]
12. Lines 208-213: It is not clear if psychometrics cited are from a prior study (which one?) in the literature or from this study. If psychometrics are based on this study, move this information to the Results section.
Response: The psychometrics were based on the studies listed below and is also cited in text. [line 209-210]
Benasi, G.; Fava, G. A.; & Rafanelli, C. Kellner’s symptom questionnaire, a highly sensitive patient-reported outcome measure: systematic review of clinimetric properties.Psychotherapy and psychosomatics (2020).,89(2), 74-89.
Kellner, R. (1987). A symptom questionnaire.The Journal of clinical psychiatry.
13. Line 312: break Discussion into more than one paragraph.
Response: The discussion was broken into four paragraphs with the first paragraph focusing on the feasibility of CRM on the veteran population, the second reporting the relevance, usefulness, and sustainability of CRM, the third addressing the limitations such as the lack of 6 month follow-up data and adapting CRM to address the daily functioning variables more directly, and the last paragraph summarizing overall results.
14. Line 320: veterans are "who" not "that".
Response: Changed “that” to “who”. [line 319]
15. Line 324: What are you considering as behavioral health to make this statement?
Response: Changed “behavioral health” to well-being due to using measurement tools that assessed well-being and distress (i.e. symptoms questionnaire). [line 323]
16. Line 325: start a new paragraph.
Response: The discussion was broken up into four paragraphs.
17. Sentence starting 333: reword "a larger group to begin with" to "a larger sample."
Response: Reworded to state “a larger sample”. [line 333 – 334]
18. Line 345: Heading should be Study Strengths and Limitations (include strengths).
Response: Added the word Strengths to the header. [line 348]
19. This section is one long paragraph and should be broken into multiple separate paragraphs corresponding to each new idea. Then you might develop ideas further.
Response: The paragraph was broken up into several smaller paragraphs. The main changes focused on recommendations for future studies.
20. Line 373: something isn't right in sentence wording.
Response: Deleted the sentence.
Round 2
Reviewer 1 Report
Comments and Suggestions for AuthorsThe revised manuscript reads very well. I applaud the Authors for their revisions. Well done!
Reviewer 2 Report
Comments and Suggestions for AuthorsRevisions have improved the manuscript. I have no further comments.
