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Grubbs KM, Knopp KC, Khalifian CE, Wrape ER, Mackintosh MA, Sohn MJ, Macdonald A, Morland LA. Discrepancies in perceptions of PTSD symptoms among veteran couples: Links to poorer relationship and individual functioning. FAMILY PROCESS 2024. [PMID: 39354674 DOI: 10.1111/famp.13041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/24/2024] [Accepted: 07/01/2024] [Indexed: 10/03/2024]
Abstract
Veteran and intimate partner perceptions of posttraumatic stress disorder (PTSD) may differ, and little is known about how agreement or disagreement on symptom severity is related to relationship satisfaction. Veterans and their partners (N = 199 couples) completed a baseline assessment for a clinical trial evaluating two couple-based PTSD interventions. Veterans completed the PTSD Checklist for DSM-5 (PCL-5). Partners completed the collateral PCL-5 (PCL-5-C), which asked them to rate the severity of the veteran's PTSD symptoms. Both partner and veteran completed the Couples Satisfaction Index (CSI-32). Intraclass correlations (ICC) assessed agreement between PCL-5 and PCL-5-C total and subscale scores, which was low for total PCL and for all subscales (ICC = 0.15-0.46). Actor-Partner Interdependence Models (APIMs; actor-only pattern) tested associations between relationship satisfaction and PTSD symptom severity (total PCL and subscales), and the magnitude and direction of difference between PCL-5 and PCL-5-C (total and subscales). For veterans, more severe total PTSD and negative cognition/mood scores were associated with lower relationship satisfaction, and the direction of discrepancy for negative cognition/mood (i.e., higher veteran-rated PTSD symptoms relative to partner's collateral report) was also associated with lower satisfaction. For partners, more severe collateral-reported symptoms for total PTSD and all four subscales were associated with lower relationship satisfaction; further, a larger discrepancy between veterans' and partners' reports of total PTSD, negative cognition/mood, and hyperarousal were associated with lower satisfaction. These results suggest that partners may have different perceptions of PTSD symptoms, and support the potential of fostering a shared understanding of PTSD symptom severity in couples.
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Affiliation(s)
- Kathleen M Grubbs
- Department of Veterans Affairs, VA San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, California, USA
- Center for Mental Health Outcomes Research, Central Arkansas VA Healthcare System, Little Rock, Arkansas, USA
| | - Kayla C Knopp
- Department of Veterans Affairs, VA San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Chandra E Khalifian
- Department of Veterans Affairs, VA San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Elizabeth R Wrape
- Department of Veterans Affairs, VA San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Margaret-Anne Mackintosh
- National Center for PTSD Dissemination and Training Division, VA Palo Alto Healthcare System, Palo Alto, California, USA
| | - Min Ji Sohn
- Department of Veterans Affairs, VA San Diego Healthcare System, San Diego, California, USA
| | - Alexandra Macdonald
- The Citadel, Military College of South Carolina, Charleston, South Carolina, USA
| | - Leslie A Morland
- Department of Psychiatry, University of California, San Diego, California, USA
- National Center for PTSD - Women's Health Science Division, VA Boston Healthcare System, San Diego, California, USA
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2
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Wells SY, Knopp K, Wachsman TR, Dillon KH, Walker HE, Sippel L, Morland L, Glassman LH. Examining the impact of brief couples-based posttraumatic stress disorder treatments on anger and psychological aggression in veterans and their partners. J Trauma Stress 2024. [PMID: 39318041 DOI: 10.1002/jts.23099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 07/16/2024] [Accepted: 07/17/2024] [Indexed: 09/26/2024]
Abstract
Anger can adversely impact functioning in veterans. Psychological aggression, which is related to but distinct from anger, is particularly detrimental to veterans' mental health. Research examining anger and psychological aggression following individual therapy for posttraumatic stress disorder (PTSD) has demonstrated small effect sizes. Treatments that directly target conflict management and interpersonal functioning, both regarding content and delivery to veterans and their loved ones (e.g., couples-based PTSD treatments), may be more effective in alleviating anger symptoms. This study examined whether larger reductions in anger and psychological aggression would be observed in a couples-based intervention compared to an active comparator at posttreatment and follow-up. Data were derived from a randomized trial comparing brief cognitive-behavioral conjoint therapy for PTSD (bCBCT) and PTSD family education (PFE). Participants were 137 veterans and their intimate partners (bCBCT: n = 92, PFE: n = 45). We observed within-condition significant reductions in angry temperament, d = -0.47, p < .001, and angry reaction, d = -0.26, p = .004, among veterans in bCBCT but not PFE, |d|s = 0.13-0.17, ps = .166-.268. Veterans and partners in both conditions reported reductions in psychological aggression, |d|s = 1.09-1.46, ps < .001. There were no significant differences between the treatment conditions on any outcome, ps = .103-.443, and there were no significant changes in anger between posttreatment and follow-up, |d|s = 0.07-0.24, ps = .052-.582. Couples-based interventions for PTSD, including bCBCT and PFE, can be effective in improving aspects of anger among veterans and their intimate partners.
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Affiliation(s)
- Stephanie Y Wells
- Durham VA Health Care System, Durham, North Carolina, USA
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, North Carolina, USA
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, North Carolina, USA
| | - Kayla Knopp
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Tamara R Wachsman
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - Kirsten H Dillon
- Durham VA Health Care System, Durham, North Carolina, USA
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | | | - Lauren Sippel
- Department of Veterans Affairs Northeast Program Evaluation Center, West Haven, Connecticut, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
- Evaluation Division, Department of Veterans Affairs National Center for PTSD, West Haven, Connecticut, USA
| | - Leslie Morland
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
- Women's Health Sciences Division, Department of Veterans Affairs National Center for PTSD, Boston, Massachusetts, USA
| | - Lisa H Glassman
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
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Shaw R, Pengelly C, Crinnin C, Amina E, Wutz AV, King PR. Scoping review of the role of social support in women veterans' psychosocial and health outcomes. J Women Aging 2024:1-25. [PMID: 39252402 DOI: 10.1080/08952841.2024.2395111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 06/04/2024] [Accepted: 07/16/2024] [Indexed: 09/11/2024]
Abstract
Women veterans are a steadily growing population and have unique military experiences (e.g., report high rates of sexual harassment and assault) that are impactful across the lifespan. High levels of positive social support have been linked to a range of positive outcomes in both civilian and military populations. However, research has not consistently explored social support and interpersonal functioning in women veterans, or as potential mechanisms of change within interventions for women veterans. This is a scoping review of peer-reviewed articles that evaluated social support. Articles with at least 10% women or formally evaluated sex or gender in reference to social support were included. A total of 69 studies evaluated social support in relation to women veterans' health outcomes. From a biopsychosocial perspective, social support is an important construct to examine relative to health care engagement and response. Limited research considered aging women veterans needs or focused on the intersectional identities of women veterans. Positive social support can have major physical and mental health benefits, yet limited research and disparate methodological approaches minimize the ability to draw conclusions on how social support can best be leveraged to support women veterans. Women veterans' roles and military experiences (e.g., increased likelihood of combat exposure) are changing and this population is aging. Research is needed to inform best practices for this growing segment of the veteran population.
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Affiliation(s)
- Rachael Shaw
- VA Center for Integrated Healthcare, Buffalo, New York, USA
- Department of Psychology, University at Buffalo, Buffalo, New York, USA
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Charlotte Crinnin
- VA Center for Integrated Healthcare, Buffalo, New York, USA
- School of Education & Human Services, Canisius College, Buffalo, New York, USA
| | - Evodie Amina
- VA Center for Integrated Healthcare, Buffalo, New York, USA
- School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
| | | | - Paul R King
- VA Center for Integrated Healthcare, Buffalo, New York, USA
- Department of Rehabilitation Science, University at Buffalo, Buffalo, New York, USA
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Benfer N, Darnell BC, Rusowicz-Orazem L, Litz BT. Reciprocal changes in functioning and PTSD symptoms over the course of psychotherapy. J Anxiety Disord 2024; 107:102918. [PMID: 39213829 DOI: 10.1016/j.janxdis.2024.102918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 08/02/2024] [Accepted: 08/21/2024] [Indexed: 09/04/2024]
Abstract
Psychotherapies for posttraumatic stress disorder (PTSD) assume that PTSD symptom improvement will lead to improvements in functioning. Yet, few studies have examined the dynamic interplay between these constructs. Using a random intercepts cross-lagged panel model, we examined the association between functioning and PTSD, both modeled as a total score and as the DSM-5 subclusters, across twelve sessions of treatments that chiefly target functioning. Participants were 161 Veterans with PTSD enrolled in a randomized controlled trial comparing present centered therapy and an enhanced version of adaptive disclosure. Overall, PTSD symptoms, measured as the total PTSD score, led to changes in functioning more frequently than functioning predicting PTSD symptoms, although these effects did not appear until session 7. In terms of subclusters, functioning predicted changes in the PTSD subclusters B (intrusions), C (avoidance), and E (alterations in arousal and reactivity) at more timepoints compared to timepoints at which these subclusters predicted functioning. The dynamic relationships between PTSD and functioning in the context of functioning-focused treatments are complex, with functioning playing an important role in reduction of some of the core symptoms of PTSD.
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Affiliation(s)
- Natasha Benfer
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA, United States
| | - Benjamin C Darnell
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA, United States; Department of Psychiatry, Boston University, Boston, MA, United States
| | - Luke Rusowicz-Orazem
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA, United States; School of Public Health, Boston University, Boston, MA, United States
| | - Brett T Litz
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA, United States; Department of Psychiatry, Boston University, Boston, MA, United States; Department of Psychological and Brain Sciences, Boston University, Boston, MA, United States.
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Kehle-Forbes SM, Baier AL, Ackland PE, Spoont M, Polusny MA, Schnurr PP, Galovski T, Meis L. "It made me feel more alive": A qualitative analysis of quality of life improvements following completion of trauma-focused therapy for posttraumatic stress disorder. J Trauma Stress 2024. [PMID: 39095940 DOI: 10.1002/jts.23091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 06/25/2024] [Accepted: 06/26/2024] [Indexed: 08/04/2024]
Abstract
Posttraumatic stress disorder (PTSD) is associated with poor quality of life. Although randomized clinical trial data show improvements in quality of life following trauma-focused therapies (TFTs), including prolonged exposure therapy (PE) and cognitive processing therapy (CPT), less is known about how these improvements are experienced from the trauma survivor's perspective. A national sample of 60 veterans who recently completed TFT as part of routine care at U.S. Department of Veterans Affairs facilities participated in semistructured qualitative interviews during which the impact of treatment on quality of life was explored. Following a mixed deductive/inductive approach, six interrelated themes describing changes in quality of life emerged: full participation in social activities, greater emotional intimacy in relationships, improvements in parenting, expanded engagement in hobbies and community, increased occupational commitment and confidence, and more joy in life. The data highlight the positive impact of treatment on quality of life and provide depth to quantitative findings demonstrating improvements in quality of life following TFT.
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Affiliation(s)
- Shannon M Kehle-Forbes
- National Center for PTSD Women's Health Sciences Division at VA Boston Healthcare System, Boston, Massachusetts, USA
- Center for Care Delivery & Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, Minnesota, USA
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Allison L Baier
- National Center for PTSD Women's Health Sciences Division at VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Princess E Ackland
- Center for Care Delivery & Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, Minnesota, USA
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Michele Spoont
- Center for Care Delivery & Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, Minnesota, USA
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Melissa A Polusny
- Center for Care Delivery & Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, Minnesota, USA
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, Minnesota, USA
| | - Paula P Schnurr
- National Center for PTSD Executive Division, White River Junction, Vermont, USA
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
| | - Tara Galovski
- National Center for PTSD Women's Health Sciences Division at VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Laura Meis
- National Center for PTSD Women's Health Sciences Division at VA Boston Healthcare System, Boston, Massachusetts, USA
- Center for Care Delivery & Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, Minnesota, USA
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
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Sippel LM, Wachsman TR, Kelley ME, Knopp KC, Khalifian CE, Maglione JE, Glynn SM, Macdonald A, Monson CM, Flanagan JC, Holtzheimer PE, Morland LA. Design of a randomized clinical trial of brief couple therapy for PTSD augmented with intranasal oxytocin. Contemp Clin Trials 2024; 141:107534. [PMID: 38614447 DOI: 10.1016/j.cct.2024.107534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 04/02/2024] [Accepted: 04/10/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Leveraging military veterans' intimate relationships during treatment has the potential to concurrently improve posttraumatic stress disorder (PTSD) symptoms and relationship quality. Cognitive-Behavioral Conjoint Therapy (CBCT) and an 8-session Brief Cognitive-Behavioral Conjoint Therapy (bCBCT) are manualized treatments designed to simultaneously improve PTSD and relationship functioning for couples in which one partner has PTSD. Although efficacious in improving PTSD, the effects of CBCT on relationship satisfaction are small, especially among veterans. Intranasal oxytocin, which targets mechanisms of PTSD and relationship quality, may enhance the efficacy of bCBCT. METHOD/DESIGN The purpose of this 4-year clinical trial is to compare the outcomes of bCBCT augmented with intranasal oxytocin versus bCBCT plus placebo. We will also explore potential mechanisms of action: self-reported communication skills, empathy, and trust. We will recruit 120 dyads (i.e., veteran with PTSD and their intimate partner) from the VA San Diego Healthcare System. Veterans will be administered 40 international units of oxytocin (n = 60) or placebo (n = 60) 30 min before each of 8 bCBCT sessions delivered via telehealth. Clinical and functioning outcomes will be assessed at five timepoints (baseline, mid-treatment, post-treatment, and 3- and 6-month follow-up). CONCLUSION Study findings will reveal the efficacy of oxytocin-assisted brief couple therapy for PTSD, which could serve as highly scalable option for couples coping with PTSD, as well as provide preliminary evidence of interpersonal mechanisms of change. CLINICALTRIALS govIdentifier:NCT06194851.
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Affiliation(s)
- Lauren M Sippel
- Department of Veterans Affairs Northeast Program Evaluation Center, 950 Campbell Avenue, West Haven, CT 06516, USA; Department of Psychiatry, Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, NH 03755, USA; Department of Veterans Affairs National Center for PTSD Evaluation Division, 950 Campbell Avenue, West Haven, CT 06516, USA.
| | - Tamara R Wachsman
- Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, USA.
| | - Mary E Kelley
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health at Emory University, Atlanta, GA 30322, USA; Department of Veterans Affairs National Center for PTSD Executive Division, 215 North Main St., White River Junction, VT 05009, USA.
| | - Kayla C Knopp
- Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CT 92093, USA.
| | - Chandra E Khalifian
- Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CT 92093, USA.
| | - Jeanne E Maglione
- Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CT 92093, USA.
| | - Shirley M Glynn
- VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA 90073, USA; Semel Institute for Neuroscience and Human Behavior, University of California, 760 Westwood Plaza, Los Angeles, CA 90024, USA.
| | - Alexandra Macdonald
- The Citadel, Military College of South Carolina, 171 Moultrie Street, Charleston, SC 29409, USA.
| | - Candice M Monson
- Toronto Metropolitan University, 350 Victoria Street, Toronto, Ontario M5B 2K3, Canada.
| | - Julianne C Flanagan
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, Charleston, SC 29425, USA; Ralph H. Johnson Veterans Affairs Health Care System, 109 Bee Street, Charleston, SC 29401, USA.
| | - Paul E Holtzheimer
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, NH 03755, USA; Department of Veterans Affairs National Center for PTSD Executive Division, 215 North Main St., White River Junction, VT 05009, USA.
| | - Leslie A Morland
- Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, USA; Department of Veterans Affairs National Center for PTSD Women's Health Sciences Division, 150 South Huntington Street, Boston, MA 02130, USA.
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Pless Kaiser A, Daks JS, Korsun L, Heintz H, Moye J, Sloan DM, Cook JM, Vogt D, Spiro A. Enhancing social functioning in older veterans with PTSD: Rationale and design of an intervention and initial RCT. Contemp Clin Trials 2024; 139:107485. [PMID: 38432471 DOI: 10.1016/j.cct.2024.107485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 02/06/2024] [Accepted: 02/28/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Older Veterans with Posttraumatic Stress Disorder (PTSD) are often socially isolated and have complex comorbid physical health problems. Aging-related stressors can exacerbate PTSD symptoms. These factors contribute to greater impairment in social functioning and decreased quality of life (QoL). Evidence-based psychotherapies for PTSD often address these issues, but not all older Veterans with PTSD seek help for these challenges, some don't want to engage in trauma-focused treatment, some drop out prematurely, and some still have residual symptoms upon completion. Thus, additional interventions that directly target social functioning among older Veterans with PTSD are needed. METHODS In this paper we describe the development of and feasibility evaluation plan for, "Enhancing Social Functioning for older Veterans with PTSD (ESVP)," a social functioning group intervention for older (>60 years) Veterans with PTSD. This project involved four phases of work: 1) Intervention development, 2) Review of intervention and potential modifications using focus groups, 3) Intervention pilot testing and modification, and 4) A randomized feasibility trial comparing the intervention with a support group control. Intervention modules address interpersonal relationships, effective communication, anger management, social skills, social support/activities, and behavioral activation. CONCLUSION This project details the iterative process used to develop the ESVP intervention designed to enhance social functioning in older Veterans with PTSD, and to evaluate feasibility. Analyses are underway to examine feasibility of conducting ESVP with a sample of older Veterans with PTSD. Findings from the final project phase, the randomized feasibly trial, will inform the design and implementation of a future trial. CLINICALTRIALS gov Identifier: NCT02803125.
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Affiliation(s)
- Anica Pless Kaiser
- National Center for PTSD, Boston, MA, United States of America; VA Boston Healthcare System, Boston, MA, United States of America; Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States of America; New England Geriatric Research Education and Clinical Center (GRECC), Boston, MA, United States of America.
| | - Jennifer S Daks
- VA Boston Healthcare System, Boston, MA, United States of America; New England Geriatric Research Education and Clinical Center (GRECC), Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Lynn Korsun
- VA Boston Healthcare System, Boston, MA, United States of America
| | - Hannah Heintz
- VA Boston Healthcare System, Boston, MA, United States of America; New England Geriatric Research Education and Clinical Center (GRECC), Boston, MA, United States of America
| | - Jennifer Moye
- VA Boston Healthcare System, Boston, MA, United States of America; New England Geriatric Research Education and Clinical Center (GRECC), Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Denise M Sloan
- National Center for PTSD, Boston, MA, United States of America; VA Boston Healthcare System, Boston, MA, United States of America; Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States of America
| | - Joan M Cook
- Yale School of Medicine, New Haven, CT, United States of America
| | - Dawne Vogt
- National Center for PTSD, Boston, MA, United States of America; VA Boston Healthcare System, Boston, MA, United States of America; Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States of America
| | - Avron Spiro
- VA Boston Healthcare System, Boston, MA, United States of America; Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States of America; Boston University School of Public Health, Boston, MA, United States of America; Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), United States of America
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8
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DeViva JC, McCarthy E, Fischer I, Pietrzak RH. Differences in the phenotypic expression of posttraumatic stress disorder symptoms in US military veterans with and without clinical insomnia. J Clin Sleep Med 2024; 20:345-351. [PMID: 38426846 PMCID: PMC11019204 DOI: 10.5664/jcsm.10872] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 10/11/2023] [Accepted: 10/11/2023] [Indexed: 03/02/2024]
Abstract
STUDY OBJECTIVES The goal of this study was to examine the phenotypic expression of posttraumatic stress disorder (PTSD) symptoms in veterans with probable PTSD and clinical insomnia relative to those with probable PTSD alone. METHODS Data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study, which surveyed a nationally representative sample of 4,069 US military veterans. RESULTS A total of 3.9% of the full sample screened positive for probable PTSD and clinical insomnia and 3.2% for probable PTSD alone. Relative to veterans with probable PTSD alone, those with probable PTSD and clinical insomnia reported significantly greater severity of intrusions, avoidance, and anxious and dysphoric arousal symptoms. Post hoc analyses of individual symptoms revealed that trauma-related nightmares; flashbacks; trauma-related emotional and physiological reactivity; avoidance of trauma-related thoughts, feelings, and external reminders; exaggerated startle response; concentration difficulties; and trauma-related sleep difficulties differed between groups. A multivariable logistic regression analysis further revealed that trauma-related sleep difficulties, trauma-related physiological reactivity, and exaggerated startle response independently predicted probable PTSD and clinical insomnia relative to PTSD alone. CONCLUSIONS Results of this study suggest that trauma-related reactivity and arousal symptoms differentiate veterans with probable PTSD and clinical insomnia from those with probable PTSD alone. They further underscore the importance of utilizing nuanced models of PTSD symptom expression as part of assessment and treatment planning efforts in this population. CITATION DeViva JC, McCarthy E, Fischer I, Pietrzak RH. Differences in the phenotypic expression of posttraumatic stress disorder symptoms in US military veterans with and without clinical insomnia. J Clin Sleep Med. 2024;20(3):345-351.
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Affiliation(s)
- Jason C. DeViva
- Veterans Affairs Connecticut Health Care System, West Haven, Connecticut
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | | | - Ian Fischer
- US Department of Veterans Affairs National Center for PTSD, VA Connecticut Healthcare System, West Haven, Connecticut
| | - Robert H. Pietrzak
- Veterans Affairs Connecticut Health Care System, West Haven, Connecticut
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
- US Department of Veterans Affairs National Center for PTSD, VA Connecticut Healthcare System, West Haven, Connecticut
- Department of Social and Behavioral Sciences, Yale School of Public Health, Laboratory of Epidemiology and Public Health, New Haven, Connecticut
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Brinckman B, Alfaro E, Wooten W, Herringa R. The promise of compassion-based therapy as a novel intervention for adolescent PTSD. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2024; 15:100694. [PMID: 38283688 PMCID: PMC10817702 DOI: 10.1016/j.jadr.2023.100694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024] Open
Abstract
In this review, we summarize current evidence for compassion-based approaches for PTSD and the potential for their application to the adolescent PTSD population. Exposure to traumatic events is common in adolescence and PTSD remains a public health crisis. Accessibility, willingness, and engagement are significant barriers to established treatments for PTSD, with attrition rates as high as 50 %. Compassion-based therapies provide potential solutions to treatment obstacles by providing a non-threatening, transdiagnostic option unburdened by aspects of current trauma treatment which may be associated with treatment resistance (e.g., exposure, trauma narrative, induction of fear). Compassion-based approaches are intuitive for trauma treatment, as compassion activates the self-soothing system, thereby disarming the fear system and promoting affect regulation. Compassion-based treatments demonstrate reductions across a substantial range of PTSD symptoms in adults, however, in adolescents extant literature is sparse, with cross-sectional studies suggesting self-compassion is inversely associated with trauma-related psychopathology. Understanding the impact of compassion-based approaches on adolescent PTSD is warranted as the adolescent developmental period may be a particularly opportune time for this approach. Evaluation of the impact of compassion-based treatment on adolescent PTSD in clinical populations via randomized-controlled studies and comparison of its relative efficacy to current evidence-based practices is warranted.
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Affiliation(s)
- Bridget Brinckman
- University of Wisconsin-Madison, BRAVE Research Lab, 6001 Research Park Blvd., Madison, WI 53719-1176, United States
| | - Elena Alfaro
- University of Wisconsin-Madison, BRAVE Research Lab, 6001 Research Park Blvd., Madison, WI 53719-1176, United States
| | - William Wooten
- University of Wisconsin-Madison, BRAVE Research Lab, 6001 Research Park Blvd., Madison, WI 53719-1176, United States
| | - Ryan Herringa
- University of Wisconsin-Madison, BRAVE Research Lab, 6001 Research Park Blvd., Madison, WI 53719-1176, United States
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10
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Truhan TE, Armour C. Perceived friendships protect against the development of anger following childhood adversities in UK military veteran men residing in Northern Ireland. Eur J Psychotraumatol 2023; 14:2289286. [PMID: 38084998 PMCID: PMC10993811 DOI: 10.1080/20008066.2023.2289286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 11/18/2023] [Indexed: 12/18/2023] Open
Abstract
Background: Experience of childhood adversity is associated with greater anger as an adult, particularly in men. Soldiers and veterans report higher incidence of adverse childhood experiences, many of whom also experience elevated rates of PTSD and anger. However, little is known about factors which may protect against the development of anger after experiencing childhood adversity.Objective: This study aims to assess the potential protective aspects of perceived social support in military veterans.Methods: Data from the Northern Ireland Veterans' Health and Wellbeing Study (N = 590, Mage = 56) was utilised in regression models to examine perceived social support (family, friend, partner; MSPSS) as a moderator of the association between adverse childhood experiences (ACEQ-10) and anger (DAR-7). This sample comprised men who were UK Armed Forces veterans residing in Northern Ireland.Results: Significant interaction effects, visualised using interaction plots, were found between perceived friend support and both child abuse and household challenge. When men perceived high friend support, there was no association between child abuse or household challenge and anger. For veteran men who perceived the maximum amount of partner support, there was no association between child abuse and anger. Family support did not change the positive association between child abuse, child neglect or household challenge and future anger.Conclusions: This study indicates that it is especially important to foster supportive and empathetic friendships for men that have experienced adversity as a child, perhaps through programmes such as Men's Sheds, as these friendships may alleviate the negative influences of child abuse and household challenge on anger.
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Affiliation(s)
- Tayler E. Truhan
- Stress Trauma and Related Conditions (STARC) Research Centre, School of Psychology, Queen’s University Belfast, Belfast, UK
| | - Cherie Armour
- Stress Trauma and Related Conditions (STARC) Research Centre, School of Psychology, Queen’s University Belfast, Belfast, UK
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11
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Shea MT, Krupnick JL, Sautter FJ, Mete M, Green BL, Norman SB, Finley SL, Eaton E. A randomized clinical trial comparing Interpersonal Psychotherapy with Prolonged Exposure for the treatment of PTSD in veterans. J Anxiety Disord 2023; 99:102770. [PMID: 37738685 DOI: 10.1016/j.janxdis.2023.102770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 07/25/2023] [Accepted: 09/03/2023] [Indexed: 09/24/2023]
Abstract
Trauma-focused therapies are recommended as first-line treatments for posttraumatic stress disorder (PTSD), but many veterans do not complete or sufficiently respond to these treatments. Interpersonal Therapy (IPT) is a non-trauma focused approach that directly addresses the interpersonal and social impairments associated with PTSD. This two-site randomized controlled equivalence trial compared IPT with Prolonged Exposure (PE) in improving PTSD symptoms and interpersonal functioning in 109 veterans with PTSD. Secondary outcomes included functioning and quality of life. We hypothesized that IPT would be statistically equivalent to PE in reducing PTSD symptoms, and superior to PE in improving interpersonal functioning and secondary outcomes of work and social adjustment and quality of life. PTSD symptom severity decreased significantly in both treatments from pre- to post-treatment. Although IPT improved as much as PE and treatments did not differ significantly, the 95 % confidence interval for the difference between the groups did not fall completely within the margin of equivalence. IPT was not superior to PE in improvement in interpersonal functioning or on secondary outcomes. Findings from multi-level linear mixed models using longitudinal data (posttreatment, three and six month follow up) for the primary outcomes of PTSD and interpersonal functioning were consistent with the post-treatment analyses. Although statistically inconclusive in terms of equivalence, the comparable reduction in PTSD symptoms slightly favoring IPT suggests that IPT is an acceptable alternative to gold-standard trauma-focused treatments for veterans with PTSD.
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Affiliation(s)
- M Tracie Shea
- Department of Veterans Affairs Providence Healthcare System, Providence, RI, United States of America; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States of America.
| | - Janice L Krupnick
- Department of Psychiatry, Georgetown Medical School, Washington, DC, United States of America
| | - Frederic J Sautter
- Southeast Louisiana Veterans Health Care System, New Orleans, LA, United States of America; Tulane University Health Sciences Center, New Orleans, LA, United States of America
| | - Mihriye Mete
- MedStar Health Research Institute, Washington, DC, United States of America
| | - Bonnie L Green
- Department of Psychiatry, Georgetown Medical School, Washington, DC, United States of America
| | - Sonya B Norman
- National Center for PTSD, Executive Division, VA Medical Center, White River Junction, VT, United States of America; Department of Psychiatry, University of California San Diego School of Medicine, San Diego, CA, United States of America
| | - Shauna L Finley
- Brown Medicine Primary Care, Providence, RI, United States of America
| | - Erica Eaton
- Department of Veterans Affairs Providence Healthcare System, Providence, RI, United States of America; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States of America
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12
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Zalta AK, Vanderboll K, Dent AL, Contreras IM, Malek N, Lascano XN, Zellner KL, Grandhi J, Araujo PJ, Straka K, Liang CZ, Czarny JE, Martinez J, Burgess HJ. Sleep timing, chronotype, and posttraumatic stress disorder: An individual participant data meta-analysis. Psychiatry Res 2023; 321:115061. [PMID: 36706561 DOI: 10.1016/j.psychres.2023.115061] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 01/12/2023] [Accepted: 01/14/2023] [Indexed: 01/19/2023]
Abstract
Sleep disturbance is a major component of posttraumatic stress disorder (PTSD). The role of circadian disruption is largely overlooked, though many PTSD studies collect proxy markers of circadian timing. This individual participant data (IPD) meta-analysis examined the correlation between sleep timing / chronotype and PTSD severity among individuals diagnosed with PTSD, the standardized mean difference in sleep timing / chronotype for individuals with and without PTSD, and moderators of these relationships. A systematic search was conducted; authors provided IPD for 27 studies and aggregate data for 16 studies (3,011 participants with PTSD; 2,703 participants without PTSD). Two-step meta-analyses were conducted using a random-effects multivariate approach with robust variance estimation. Bedtime and wake time were not significantly associated with PTSD symptoms or diagnosis. Less total sleep time / time in bed was weakly associated with greater PTSD symptoms. Moderator analyses revealed that effect sizes were stronger in certain populations and when using wrist actigraphy to measure sleep timing; however, gap maps revealed few studies in moderator categories with the strongest effects. Only two studies measured chronotype, prohibiting strong conclusions. Our findings indicate that the relationship between sleep timing and PTSD is weak; however, key gaps in the literature warrant further study.
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Affiliation(s)
- Alyson K Zalta
- Department of Psychological Sciences, University of California, Irvine, United States.
| | | | - Amy L Dent
- Department of Psychological Sciences, University of California, Irvine, United States
| | - Isaias M Contreras
- Department of Psychological Sciences, University of California, Irvine, United States
| | - Nadia Malek
- Department of Psychological Sciences, University of California, Irvine, United States; Dissemination and Training Division, National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, CA, United States
| | - Xrystyan N Lascano
- Department of Psychological Sciences, University of California, Irvine, United States
| | - Kelly L Zellner
- Department of Psychological Sciences, University of California, Irvine, United States
| | - Jyotsna Grandhi
- Department of Psychological Sciences, University of California, Irvine, United States; Department of Counseling and Psychological Services, Georgia State University, United States
| | - Precious J Araujo
- Department of Psychological Sciences, University of California, Irvine, United States
| | - Kelci Straka
- Department of Psychological Sciences, University of California, Irvine, United States; School of Social Work, Virginia Commonwealth University, United States
| | - Cathy Z Liang
- Department of Psychological Sciences, University of California, Irvine, United States
| | - Jordyn E Czarny
- Kresge Hearing Research Institute and Department of Otolaryngology, University of Michigan, Ann Arbor, United States; Department of Psychiatry, University of Michigan, United States
| | - Jazmin Martinez
- Department of Psychological Sciences, University of California, Irvine, United States
| | - Helen J Burgess
- Department of Psychiatry, University of Michigan, United States
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13
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Thompson-Hollands J. Introduction to the special section on social relationships and posttraumatic stress disorder treatment: Harnessing the power of significant relationships. J Trauma Stress 2023. [PMID: 36853594 DOI: 10.1002/jts.22922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 01/25/2023] [Indexed: 03/01/2023]
Abstract
This article introduces the special section in the Journal of Traumatic Stress focused on social relationships and their connection to treatment among individuals with posttraumatic stress disorder (PTSD). Interpersonal relationships have the potential to influence treatment-seeking, retention, and outcomes. For individuals with PTSD, social relationships have long been understood to be intimately and bidirectionally tied to symptom levels. In light of somewhat modest rates of treatment response to current first-line interventions for PTSD, there is growing interest in engaging these relationships, as well as relationship-relevant beliefs and behaviors, to enhance PTSD treatment. This introductory article frames the rationale for examining these social factors to better understand and improve treatments and provides an overview of the collection of articles contained herein.
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Affiliation(s)
- Johanna Thompson-Hollands
- National Center for PTSD, Behavioral Science Division, at VA Boston Healthcare System, Boston, MA.,Boston University Chobanian & Avedisian School of Medicine, Boston, MA
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14
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Staples JK, Gibson C, Uddo M. Complementary and Integrative Health Interventions for Insomnia in Veterans and Military Populations. Psychol Rep 2023; 126:52-65. [PMID: 34855539 DOI: 10.1177/00332941211048473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Insomnia can be a serious problem diminishing quality of life for Veterans and military populations with and without posttraumatic stress disorder (PTSD). Sleep disturbances are one of the symptoms of PTSD but even after evidence-based PTSD treatments, insomnia symptoms often remain. The primary approaches for treating insomnia are cognitive behavioral therapy for insomnia (CBT-I) and pharmacotherapy. However, each of these treatments has drawbacks. Complementary and Integrative Health (CIH) approaches such as mindfulness meditation, mantram meditation, yoga, and tai chi may provide alternative treatments for insomnia in military populations. This paper provides a brief review of studies on CIH interventions for sleep disturbances in Veterans. It also proposes possible mechanisms by which CIH practices may be effective, including increasing hippocampal volume and gamma-aminobutyric acid acid (GABA). Finally, the acceptability of CIH approaches among Veterans is discussed.
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Affiliation(s)
- Julie K Staples
- Psychology Service, 20022Southeast Louisiana Veterans Health Care System, New Orleans, LA, USA.,Biochemistry and Molecular & Cellular Biology, 12231Georgetown University Medical Center, Washington, DC, USA.,Awareness Technologies, Inc., Taos, NM, USA
| | - Courtney Gibson
- Psychology Service, 20022Southeast Louisiana Veterans Health Care System, New Orleans, LA, USA
| | - Madeline Uddo
- Psychology Service, 20022Southeast Louisiana Veterans Health Care System, New Orleans, LA, USA
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15
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Swerdlow BA, Baker SN, Leifker FR, Straud CL, Rozek DC, Sippel LM. The impact of trauma-focused psychotherapy for posttraumatic stress disorder on interpersonal functioning: A systematic review and meta-analysis of randomized clinical trials. J Trauma Stress 2023. [PMID: 36628929 DOI: 10.1002/jts.22906] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 10/27/2022] [Accepted: 11/14/2022] [Indexed: 01/12/2023]
Abstract
Interpersonal functioning is a common concern for people with postttraumatic stress disorder (PTSD) but is not a key target of most trauma-focused psychotherapies (TFPs). We preregistered and undertook a systematic review and meta-analysis of randomized clinical trials (RCTs) examining the efficacy of TFPs for improving interpersonal functioning. Studies were identified through the PTSD Trials Standardized Data Repository, scholarly databases, and the solicitation of unpublished data from the PTSD research community following current PRISMA guidelines. We used random effects meta-analysis to estimate within-group change (i.e., pre- to posttreatment) in interpersonal functioning. Meta-analytic findings yielded a medium total effect of TFP on interpersonal functioning, g = 0.54, 95% CI [0.37, 0.72], with high between-study heterogeneity. Sensitivity analyses yielded substantively equivalent point estimates when outliers were excluded, g = 0.55, and when only the most well-established individual TFPs were included, g = 0.57. In contrast, allocation to a control condition was associated with little average change in interpersonal functioning, g = 0.04 [-0.12, 0.21]. Formal tests did not yield clear evidence of publication bias. Bias-corrected estimates varied but centered around a medium effect, gs = 0.41-1.11. There was a medium-to-large association between change in interpersonal functioning and change in PTSD symptoms, rs = -.35--.44. The extant literature on TFPs and interpersonal functioning is small and heterogeneous, indicating the need for more focused attention on this outcome. Results suggest that, on average, TFPs are moderately efficacious for improving interpersonal functioning; however, additional treatment may be needed to meet the desired level of improvement.
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Affiliation(s)
| | - Shelby N Baker
- Department of Psychology, University of Central Florida, Orlando, Florida, USA
| | - Feea R Leifker
- Department of Psychology, University of Utah, Salt Lake City, Utah, USA
| | - Casey L Straud
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.,Department of Psychology, University of Texas at San Antonio, San Antonio, Texas, USA.,South Texas Veterans Healthcare System, San Antonio, Texas, USA
| | - David C Rozek
- Department of Psychology, University of Central Florida, Orlando, Florida, USA.,Department of Psychology, University of Utah, Salt Lake City, Utah, USA
| | - Lauren M Sippel
- Department of Veterans Affairs Northeast Program Evaluation Center, West Haven, Connecticut, USA.,Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.,Department of Veterans Affairs National Center for PTSD, West Haven, Connecticut, USA
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16
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Hamrick L, Larsen SE, Sippel LM, Sherman K, Resick P, Galovski T. Benchmarking quality of life to posttraumatic stress disorder symptom changes in cognitive processing therapy. J Anxiety Disord 2023; 93:102647. [PMID: 36436386 DOI: 10.1016/j.janxdis.2022.102647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 10/24/2022] [Accepted: 11/07/2022] [Indexed: 11/10/2022]
Abstract
Although there is ample evidence that PTSD is effectively treated by first-line therapies such as Cognitive Processing Therapy (CPT), it is less clear to what degree these treatments improve quality of life (QOL), a common presenting concern of treatment-seeking individuals (Rosen et al., 2013). Only two studies, both conducted in military veteran samples, have examined the magnitude of PTSD symptom change needed in order to achieve corresponding changes in QOL during treatment. The current study aimed to replicate and extend these two previous studies by benchmarking multi-faceted QOL in a civilian sample of primarily female interpersonal violence survivors (N = 115) treated with CPT. We grouped participants into categories of increasingly greater PTSD symptom change: no response, response, loss of diagnosis, and remission. Outcomes were clinically meaningful change and good endpoint across five measures of QOL. Some QOL measures showed clinically meaningful change and/or good endpoint after a response to treatment or loss of diagnosis, but only remission from PTSD was associated with both clinically meaningful change and a good endpoint across all QOL indicators. These findings add to the emerging literature showing that treating PTSD to remission may maximize the likelihood of improvements in quality of life.
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Affiliation(s)
- Lauren Hamrick
- Bruce W. Carter VAMC, 1201 NW 16th Street, Miami, FL 33125, USA; Clement J. Zablocki VAMC, 5000 W National Avenue, Milwaukee, WI 53295, USA
| | - Sadie E Larsen
- Clement J. Zablocki VAMC, 5000 W National Avenue, Milwaukee, WI 53295, USA; Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA.
| | - Lauren M Sippel
- VA Northeast Program Evaluation Center, 950 Campbell Avenue, West Haven, CT 06516, USA; Department of Psychiatry, Geisel School of Medicine at Dartmouth, 1 Hope Ferry Road, Hanover, NH 03755, USA; National Center for PTSD (Evaluation Division), 950 Campbell Avenue, West Haven, CT 06516, USA
| | - Kate Sherman
- Clement J. Zablocki VAMC, Research Division, 5000 W National Avenue, Milwaukee, WI 53295, USA
| | - Patricia Resick
- Duke Psychiatry & Behavioral Sciences, 2400 Pratt Street Room 7001, DUMC Box 102508, Durham, NC 27710, USA
| | - Tara Galovski
- National Center for PTSD (Women's Health Sciences Division), Boston, MA, USA; Boston University, One Sibler Way, Boston, MA 02215, USA
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17
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Campbell SB, Rau H, Fortney JC, Batten L, Simpson TL. Behavioral Activation and Social Engagement for Posttraumatic Stress Disorder: Preliminary Acceptability and Clinical Outcomes in an Open Pilot Trial. COGNITIVE AND BEHAVIORAL PRACTICE 2022. [DOI: 10.1016/j.cbpra.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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18
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Doherty WJ, Harris SM. Relationship-undermining statements by psychotherapists with clients who present with marital or couple problems. FAMILY PROCESS 2022; 61:1195-1207. [PMID: 35388908 PMCID: PMC9543449 DOI: 10.1111/famp.12774] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 03/02/2022] [Accepted: 03/03/2022] [Indexed: 06/08/2023]
Abstract
This study examined the prevalence of relationship undermining statements by psychotherapists as reported by clients in individual therapy who presented with relationship problems, and whether these statements were associated with worse outcomes for client relationships. Participants (n = 101) reported on recollections of whether their therapist had suggested that their partner would never change, had a diagnosable personality/mental health disorder, had negative motives, that the relationship was doomed from the start or beyond repair now, or that divorce/breakup was their best option. Findings showed high prevalence of these undermining statements and associations with poorer relationship outcomes and shorter duration of therapy. We discuss potential explanations for this phenomenon and offer implications for the training of therapists who treat individual clients with relationship problems.
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19
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Ranney RM, Gloria R, Metzler TJ, Huggins J, Neylan TC, Maguen S. Brief behavioral treatment for insomnia decreases trauma-related nightmare frequency in veterans. J Clin Sleep Med 2022; 18:1831-1839. [PMID: 35393934 DOI: 10.5664/jcsm.10002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Trauma-related nightmares are highly prevalent among veterans and are associated with higher severity insomnia and PTSD. Cognitive behavioral therapy for insomnia (CBT-I, typically 6-8 sessions) has been shown to reduce trauma-related nightmares. Brief behavioral treatment for insomnia (BBTI, 4 sessions) has been found to be comparable to CBT-I in decreasing insomnia severity; however, the effects of BBTI on nightmares have not been investigated. The current study tested the effects of BBTI on both trauma-related nightmares and non-trauma-related bad dreams using an active control group, progressive muscle relaxation therapy (PMRT). Additionally, we tested whether baseline trauma-related nightmare frequency and baseline non-trauma-related bad dream frequency moderated changes in insomnia severity. METHODS Participants were 91 military veterans with insomnia disorder randomized to BBTI or PMRT. Participants reported insomnia severity on the Insomnia Severity Index and reported trauma-related nightmare frequency and non-trauma-related bad dream frequency on the Pittsburgh Sleep Quality Index--PTSD Addendum. RESULTS We found that BBTI significantly reduced trauma-related nightmares from baseline to post-treatment while PMRT did not. However, reductions in trauma-related nightmares were not maintained at six month follow up. Neither BBTI nor PMRT reduced non-trauma-related bad dreams from baseline to post-treatment. We also found that neither baseline trauma-related nightmare frequency nor baseline non-trauma-related bad dream frequency moderated changes in insomnia symptom severity. CONCLUSIONS Findings from the current study suggest that BBTI may help to reduce trauma-related nightmares. Further research is needed to better understand potential mechanisms underlying how improved sleep may reduce trauma-related nightmares. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: Brief Behavioral Insomnia Treatment Study (BBTI); Identifier: NCT02571452; URL: https://clinicaltrials.gov/ct2/show/NCT02571452.
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Affiliation(s)
- Rachel M Ranney
- Veterans Affairs San Francisco Health Care System, San Francisco, CA.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco School of Medicine, San Francisco, CA.,Sierra Pacific Mental Illness Research Education, and Clinical Center, San Francisco, CA
| | - Rebecca Gloria
- Veterans Affairs San Francisco Health Care System, San Francisco, CA
| | - Thomas J Metzler
- Veterans Affairs San Francisco Health Care System, San Francisco, CA.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco School of Medicine, San Francisco, CA.,Sierra Pacific Mental Illness Research Education, and Clinical Center, San Francisco, CA
| | - Joy Huggins
- Veterans Affairs San Francisco Health Care System, San Francisco, CA
| | - Thomas C Neylan
- Veterans Affairs San Francisco Health Care System, San Francisco, CA.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco School of Medicine, San Francisco, CA.,Sierra Pacific Mental Illness Research Education, and Clinical Center, San Francisco, CA
| | - Shira Maguen
- Veterans Affairs San Francisco Health Care System, San Francisco, CA.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco School of Medicine, San Francisco, CA.,Sierra Pacific Mental Illness Research Education, and Clinical Center, San Francisco, CA
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20
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Shea MT, Stout RL, Reddy MK, Sevin E, Presseau C, Lambert J, Cameron A. Treatment of anger problems in previously deployed post-911 veterans: A randomized controlled trial. Depress Anxiety 2022; 39:274-285. [PMID: 34878695 PMCID: PMC9299859 DOI: 10.1002/da.23230] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/08/2021] [Accepted: 11/20/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Problems with anger and aggression affect many veterans who have deployed to a warzone, resulting in serious impairment in multiple aspects of functioning. Controlled studies are needed to improve treatment options for these veterans. This randomized controlled trial compared an individually delivered cognitive behavioral therapy adapted from Novaco's Anger Control Therapy to a manualized supportive therapy to control for common therapeutic factors. METHODS Ninety-two post-911 veterans deployed during Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), or Operation New Dawn (OND) with moderate to severe anger problems were randomized to receive the cognitive behavioral intervention (CBI) or the supportive intervention (SI). Anger, aggression, multiple areas of functioning and quality of life were assessed at multiple time points inclu\ding 3- and 6-month follow-up. RESULTS Hierarchical linear modeling (HLM) analyses showed significant treatment effects favoring CBI for anger severity, social and interpersonal functioning, and quality of life. The presence of a PTSD diagnosis did not affect outcomes. CONCLUSIONS CBI is an effective treatment for OEF/OIF/OND veterans with anger problems following deployment, regardless of PTSD diagnosis.
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Affiliation(s)
- M. Tracie Shea
- VA Providence Healthcare SystemProvidenceRhode IslandUSA,Department of Psychiatry and Human BehaviorAlpert Medical School of Brown UniversityProvidenceRhode IslandUSA
| | - Robert L. Stout
- Pacific Institute for Research and EvaluationPawtucketRhode IslandUSA
| | | | | | - Candice Presseau
- VA Connecticut Health Care SystemWest HavenConnecticutUSA,Department of PsychiatryYale University School of MedicineNew HavenConnecticutUSA
| | - Jennifer Lambert
- VA Providence Healthcare SystemProvidenceRhode IslandUSA,Department of Psychiatry and Human BehaviorAlpert Medical School of Brown UniversityProvidenceRhode IslandUSA
| | - Amy Cameron
- VA Providence Healthcare SystemProvidenceRhode IslandUSA,Department of Psychiatry and Human BehaviorAlpert Medical School of Brown UniversityProvidenceRhode IslandUSA
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21
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Boelen PA, Eisma MC, de Keijser J, Lenferink LIM. Concurrent associations of dimensions of anger with posttraumatic stress, depression, and functional impairment following non-fatal traffic accidents. Eur J Psychotraumatol 2022; 13:2068912. [PMID: 35572388 PMCID: PMC9103591 DOI: 10.1080/20008198.2022.2068912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Anger is associated with dysfunction following potentially traumatic events. It is still unclear to what extent different types of anger are differentially related to poor outcomes. To advance knowledge in this area, the Posttraumatic Anger Questionnaire (PAQ) was designed, measuring anger directed at (i) the justice system, (ii) other people, (iii) the self, (iv) people held accountable for the potential traumatic event, and (v) a desire for revenge to those held responsible. Preliminary evidence shows that these types of anger are distinguishable and differentially associated with posttraumatic stress (PTS). No studies have yet examined whether such findings can be generalized to victims of non-fatal traffic accidents, one of the most common potentially traumatic events. OBJECTIVE This study's aims were (i) to establish if the five-factor structure of the PAQ found in prior studies could be replicated, (ii) to explore whether the intensity of emerging types of anger differed, and (iii) to explore the associations of anger-types with levels of PTS, depression, and functional impairment. METHOD Two-hundred and fifty adults who experienced a traffic accident completed the PAQ and instruments measuring PTS, depression, and functional impairment. They also answered questions about their socio-demographic characteristics and features of the accident. RESULTS Confirmatory factor analysis confirmed that the PAQ measures five types of anger. Levels of anger at people held accountable were the highest. Structural equation modelling showed that both anger at others and anger at the self, but not the other three anger types, were associated with PTS, depression, and functional impairment, when controlling for the shared variance between the anger types, socio-demographic variables, and features of the accident. CONCLUSIONS Findings illustrate the potential importance of considering different types of anger when assessing and treating PTS following traffic accidents. HIGHLIGHTS Based on data from people confronted with a traffic accident, we found the Posttraumatic Anger Questionnaire (PAQ) to represent distinguishable dimensions of anger.Anger dimensions were: anger directed at (i) the justice system, (ii) other people, (iii) the self, (iv) people held accountable for the event, and (v) a desire for revenge to those held responsible.Scores on items measuring anger at people held accountable for the event were significantly higher than scores on items measuring other anger types.Anger at the self and other people were most strongly associated with posttraumatic stress, depression, and functional impairment.
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Affiliation(s)
- Paul A Boelen
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, The Netherlands.,ARQ National Psychotrauma Centre, Diemen, The Netherlands
| | - Maarten C Eisma
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - Jos de Keijser
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - Lonneke I M Lenferink
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, The Netherlands.,Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands.,Department of Psychology, Health, & Technology, Faculty of Behavioural, Management, and Social Sciences, University of Twente, Enschede, The Netherlands
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22
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Anger and predictors of drop-out from PTSD treatment of veterans and first responders. Behav Cogn Psychother 2021; 50:237-251. [PMID: 34569465 DOI: 10.1017/s1352465821000382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Drop-out is an important barrier in treating post-traumatic stress disorder (PTSD) with consequences that negatively impact clients, clinicians and mental health services as a whole. Anger is a common experience in people with PTSD and is more prevalent in military veterans. To date, no research has examined if anger may predict drop-out in military veterans or first responders. AIMS The present study aimed to determine the variables that predict drop-out among individuals receiving residential treatment for PTSD. METHOD Ninety-five military veterans and first responders completed pre-treatment measures of PTSD symptom severity, depression, anxiety, anger, and demographic variables. Logistic regression analyses were used to determine if these variables predicted drop-out from treatment or patterns of attendance. RESULTS Female gender was predictive of drop-out. However, when analysed by occupation female gender was predictive of drop-out among first responders and younger age was predictive of drop-out in military participants. Anger, depression, anxiety and PTSD symptom severity were not predictive of drop-out in any of the analyses. No variables were found to predict attendance patterns (consistent or inconsistent) or early versus late drop-out from the programme. CONCLUSION These results suggest that although anger is a relevant issue for treating PTSD, other factors may be more pertinent to drop-out, particularly in this sample. In contrast with other findings, female gender was predictive of drop-out in this study. This may indicate that in this sample, there are unique characteristics and possible interacting variables that warrant exploration in future research.
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23
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de Pinho LG, Lopes MJ, Correia T, Sampaio F, do Arco HR, Mendes A, Marques MDC, Fonseca C. Patient-Centered Care for Patients with Depression or Anxiety Disorder: An Integrative Review. J Pers Med 2021; 11:776. [PMID: 34442420 PMCID: PMC8400282 DOI: 10.3390/jpm11080776] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/06/2021] [Accepted: 08/07/2021] [Indexed: 12/23/2022] Open
Abstract
People have specific and unique individual and contextual characteristics, so healthcare should increasingly opt for person-centered care models. Thus, this review aimed to identify and synthesize the indicators for the care process of the person with depression and/or anxiety disorders, based on patient-centered care, going through the stages of diagnostic assessment and care planning, including intervention. An integrative literature review with research in seven scientific databases and a narrative analysis were carried out. Twenty articles were included, with indicators for diagnostic evaluation and care/intervention planning being extracted. Care planning focused on people with depression and/or anxiety disorder must be individualized, dynamic, flexible, andparticipatory. It must respond to the specific needs of the person, contemplating the identification of problems, the establishment of individual objectives, shared decision making, information and education, systematic feedback, and case management, and it should meet the patient's preferences and satisfaction with care and involve the family and therapeutic management in care. The existence of comorbidities reinforces the importance of flexible and individualized care planning in order to respond to the specific health conditions of each person.
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Affiliation(s)
- Lara Guedes de Pinho
- Escola Superior de Enfermagem São João de Deus, Universidade de Évora, 7000-811 Évora, Portugal; (M.J.L.); (M.d.C.M.); (C.F.)
- Comprehensive Health Research Centre (CHRC), 7000-811 Évora, Portugal;
| | - Manuel José Lopes
- Escola Superior de Enfermagem São João de Deus, Universidade de Évora, 7000-811 Évora, Portugal; (M.J.L.); (M.d.C.M.); (C.F.)
- Comprehensive Health Research Centre (CHRC), 7000-811 Évora, Portugal;
| | - Tânia Correia
- Abel Salazar Institute of Biomedical Sciences, University of Porto, 4050-313 Porto, Portugal;
- NursID: Innovation & Development in Nursing Research Group, CINTESIS—Center for Health Technology and Services Research, 4200-450 Porto, Portugal;
| | - Francisco Sampaio
- NursID: Innovation & Development in Nursing Research Group, CINTESIS—Center for Health Technology and Services Research, 4200-450 Porto, Portugal;
- Higher School of Health Fernando Pessoa, 4249-004 Porto, Portugal
| | - Helena Reis do Arco
- Comprehensive Health Research Centre (CHRC), 7000-811 Évora, Portugal;
- Superior School of Health, Polytechnic Institute of Portalegre, 7300-555 Portalegre, Portugal
| | - Artur Mendes
- Psychiatry Department, Hospital Espírito Santo, 7000-811 Évora, Portugal;
| | - Maria do Céu Marques
- Escola Superior de Enfermagem São João de Deus, Universidade de Évora, 7000-811 Évora, Portugal; (M.J.L.); (M.d.C.M.); (C.F.)
- Comprehensive Health Research Centre (CHRC), 7000-811 Évora, Portugal;
| | - César Fonseca
- Escola Superior de Enfermagem São João de Deus, Universidade de Évora, 7000-811 Évora, Portugal; (M.J.L.); (M.d.C.M.); (C.F.)
- Comprehensive Health Research Centre (CHRC), 7000-811 Évora, Portugal;
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24
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Trusty WT, Swift JK, Rasmussen EB. A Behavioral Economic Model of Help-Seeking for Depression. Perspect Behav Sci 2021; 44:541-560. [DOI: 10.1007/s40614-021-00308-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2021] [Indexed: 11/28/2022] Open
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25
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Hinton M, O'Donnell M, Cowlishaw S, Kartal D, Metcalf O, Varker T, McFarlane AC, Hopwood M, Bryant RA, Forbes D, Howard A, Lau W, Cooper J, Phelps AJ. Defining post-traumatic stress disorder recovery in veterans: Benchmarking symptom change against functioning indicators. Stress Health 2021; 37:547-556. [PMID: 33336551 DOI: 10.1002/smi.3019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/07/2020] [Accepted: 12/11/2020] [Indexed: 11/08/2022]
Abstract
Improved metrics of Post-traumatic stress disorder (PTSD) treatment response that extend beyond a focus on symptom reduction to incorporate meaningful, patient-centred indicators of functioning are needed in veteran populations. The aim of this study was to extend previous research by investigating whether indicators of functioning can successfully distinguish against symptom response categories derived from the Post-Traumatic Stress Disorder Checklist (PCL-5) pre- and post- PTSD treatment. Participants were 472 veterans receiving hospital-based treatment for PTSD. In addition to the PCL-5, measures included quality of life, social relationships, physical health and psychological distress. Four mutually exclusive, progressive response categories were used to define treatment response including: No Response, Response, Response and Below Threshold, and Remission. PTSD symptom reductions were associated with corresponding improvements in broader indicators of functioning. However, it was only when the magnitude of symptom reduction placed the individual in the 'Response and Below Threshold' category that improvement on functioning measures achieved levels indicative of a good end state. Traditional metrics of treatment 'response' in PTSD treatment do not necessarily indicate recovery on important functioning indicators. Only when an individual both responds to treatment and drops below threshold for probable disorder are they likely to report having meaningful levels of functioning.
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Affiliation(s)
- Mark Hinton
- Department of Psychiatry, Phoenix Australia- Centre for Posttraumatic Mental Health, University of Melbourne, Melbourne, Australia
| | - Meaghan O'Donnell
- Department of Psychiatry, Phoenix Australia- Centre for Posttraumatic Mental Health, University of Melbourne, Melbourne, Australia
| | - Sean Cowlishaw
- Department of Psychiatry, Phoenix Australia- Centre for Posttraumatic Mental Health, University of Melbourne, Melbourne, Australia.,Bristol Medical School, University of Bristol, Bristol, UK
| | - Dzenana Kartal
- Department of Psychiatry, Phoenix Australia- Centre for Posttraumatic Mental Health, University of Melbourne, Melbourne, Australia
| | - Olivia Metcalf
- Department of Psychiatry, Phoenix Australia- Centre for Posttraumatic Mental Health, University of Melbourne, Melbourne, Australia
| | - Tracey Varker
- Department of Psychiatry, Phoenix Australia- Centre for Posttraumatic Mental Health, University of Melbourne, Melbourne, Australia
| | - Alexander C McFarlane
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Kensington, Australia
| | - David Forbes
- Department of Psychiatry, Phoenix Australia- Centre for Posttraumatic Mental Health, University of Melbourne, Melbourne, Australia
| | - Alexandra Howard
- Department of Psychiatry, Phoenix Australia- Centre for Posttraumatic Mental Health, University of Melbourne, Melbourne, Australia
| | - Winnie Lau
- Department of Psychiatry, Phoenix Australia- Centre for Posttraumatic Mental Health, University of Melbourne, Melbourne, Australia
| | - John Cooper
- Department of Psychiatry, Phoenix Australia- Centre for Posttraumatic Mental Health, University of Melbourne, Melbourne, Australia
| | - Andrea J Phelps
- Department of Psychiatry, Phoenix Australia- Centre for Posttraumatic Mental Health, University of Melbourne, Melbourne, Australia
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26
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Eshel N, Maron-Katz A, Wu W, Abu-Amara D, Marmar CR, Etkin A. Neural correlates of anger expression in patients with PTSD. Neuropsychopharmacology 2021; 46:1635-1642. [PMID: 33500557 PMCID: PMC8280145 DOI: 10.1038/s41386-020-00942-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/10/2020] [Accepted: 12/09/2020] [Indexed: 01/30/2023]
Abstract
Anger is a common and debilitating symptom of post-traumatic stress disorder (PTSD). Although studies have identified brain circuits underlying anger experience and expression in healthy individuals, how these circuits interact with trauma remains unclear. Here, we performed the first study examining the neural correlates of anger in patients with PTSD. Using a data-driven approach with resting-state fMRI, we identified two prefrontal regions whose overall functional connectivity was inversely associated with anger: the left anterior middle frontal gyrus (aMFG) and the right orbitofrontal cortex (OFC). We then used concurrent TMS-EEG to target the left aMFG parcel previously identified through fMRI, measuring its cortical excitability and causal connectivity to downstream areas. We found that low-anger PTSD patients exhibited enhanced excitability in the left aMFG and enhanced causal connectivity between this region and visual areas. Together, our results suggest that left aMFG activity may confer protection against the development of anger, and therefore may be an intriguing target for circuit-based interventions for anger in PTSD.
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Affiliation(s)
- Neir Eshel
- Department of Psychiatry, Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA. .,Sierra-Pacific Mental Illness Research, Education, and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.
| | - Adi Maron-Katz
- grid.168010.e0000000419368956Department of Psychiatry, Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA USA ,grid.280747.e0000 0004 0419 2556Sierra-Pacific Mental Illness Research, Education, and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA USA
| | - Wei Wu
- grid.168010.e0000000419368956Department of Psychiatry, Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA USA ,grid.79703.3a0000 0004 1764 3838School of Automation Science and Engineering, South China University of Technology, Guangzhou, China
| | - Duna Abu-Amara
- grid.240324.30000 0001 2109 4251Department of Psychiatry and Center for Alcohol Use Disorder and PTSD, New York University Grossman School of Medicine, New York, NY USA
| | - Charles R. Marmar
- grid.240324.30000 0001 2109 4251Department of Psychiatry and Center for Alcohol Use Disorder and PTSD, New York University Grossman School of Medicine, New York, NY USA
| | - Amit Etkin
- grid.168010.e0000000419368956Department of Psychiatry, Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA USA ,grid.511021.6Alto Neuroscience, Los Altos, CA USA
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27
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Wells SY, Dietch JR, Edner BJ, Glassman LH, Thorp SR, Morland LA, Aarons GA. The Development of a Brief Version of the Insomnia Severity Index (ISI-3) in Older Adult Veterans with Posttraumatic Stress Disorder. Behav Sleep Med 2021; 19:352-362. [PMID: 32475177 DOI: 10.1080/15402002.2020.1760278] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective/Background: The Insomnia Severity Index (ISI) is an insomnia self-report measure used to identify individuals at risk for insomnia disorder. Although the full ISI is only seven questions, a briefer version would allow more efficient and pragmatic administration in routine practice settings. Reliable and valid brief measures can support measurement-based care. The present study was a proof-of-concept study that developed a brief version of the ISI, the ISI-3, in a sample of older adult veterans with posttraumatic stress disorder (PTSD), a group which is at increased risk for insomnia.Patients/Methods: Participants included 86 older veterans with combat- or military-related PTSD. Veterans completed a clinician-administered PTSD diagnostic interview, self-report measures of insomnia and other psychosocial questionnaires, and two neuropsychological assessments. The factor structure of the ISI was examined to reduce the measure into a brief version. The reliability and validity of the ISI-3 were examined.Results: Principal axis factoring yielded a one-factor solution, which reproduced 59% of the item variance. Item reduction procedures resulted in three items, which best represented this factor ("Insomnia Impact;" ISI-3). For the ISI-3, internal consistency was good (α =.89). Convergent validity was demonstrated via moderate to high positive correlations between the ISI-3 and other measures of sleep disturbance. Divergent validity was demonstrated via non-significant correlations between the ISI-3 and unrelated measures and moderate correlations with self-reported depression.Conclusions: The ISI-3 is a psychometrically valid brief version of the ISI. Clinicians can administer the ISI-3 to screen for insomnia and monitor changes in insomnia during treatment.
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Affiliation(s)
- Stephanie Y Wells
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California San Diego, San Diego, California.,San Diego VA Health Care System, San Diego, California.,VA Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham, North Carolina.,Durham VA Health Care System, Durham, North Carolina
| | - Jessica R Dietch
- Department of Psychology, University of North Texas, Denton, Texas
| | - Benjamin J Edner
- Department of Counseling and Human Development Services, University of Georgia, Athens, Georgia
| | - Lisa H Glassman
- Veterans Medical Research Foundation, San Diego, California.,Department of Psychiatry, University of California, La Jolla, California
| | - Steven R Thorp
- California School of Professional Psychology, Alliant University, San Diego, California
| | - Leslie A Morland
- Veterans Medical Research Foundation, San Diego, California.,Department of Psychiatry, University of California, La Jolla, California.,National Center for PTSD- Pacific Islands Division, Honolulu, Hawaii
| | - Gregory A Aarons
- Child and Adolescent Services Research Center, San Diego, California.,UCSD Dissemination and Implementation Science Center, La Jolla, California
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28
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Rationale, design, and methods of a two-site randomized controlled trial: Comparative effectiveness of two treatments for posttraumatic stress disorder in veterans. Contemp Clin Trials 2021; 105:106408. [PMID: 33872802 DOI: 10.1016/j.cct.2021.106408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/09/2021] [Accepted: 04/14/2021] [Indexed: 11/23/2022]
Abstract
PTSD is associated with serious problems in interpersonal functioning, including higher rates of marital conflict and divorce, disrupted relationships with family and friends, estrangement from others and social isolation. Cognitive behavioral and trauma focused treatments are effective for treating PTSD symptoms, but a substantial proportion of individuals, particularly veterans, with PTSD, do not engage, complete, or fully respond to these treatments, and the effects of these treatments on interpersonal functioning are unknown. There is a critical need for alternative treatments with established efficacy, and for treatments that directly address problems in relationship functioning. Interpersonal Psychotherapy for PTSD (IPT-PTSD) is a promising candidate for such a treatment. This paper describes the rationale, design, and methods of the first randomized controlled equivalence trial comparing IPT-PTSD with a first-line gold standard treatment for PTSD (Prolonged Exposure; PE) in the treatment of PTSD in veterans. Both treatments include up to 12 weekly individual sessions. Assessments were conducted at baseline, following sessions four and eight, end of treatment, and 3 and 6 months post-treatment. Primary hypotheses are that IPT-PTSD will be statistically equivalent to PE in reducing the severity of PTSD symptoms, and superior to PE in improving interpersonal functioning. Secondary hypotheses propose that IPT will be superior to PE in improving overall social adjustment and quality of life, and in reducing suicidal ideation. Findings from this study have the potential to improve treatment options for veterans struggling with PTSD and interpersonal problems.
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29
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Sciarrino NA, Warnecke AJ, Teng EJ. A Systematic Review of Intensive Empirically Supported Treatments for Posttraumatic Stress Disorder. J Trauma Stress 2020; 33:443-454. [PMID: 32598561 DOI: 10.1002/jts.22556] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 03/23/2020] [Accepted: 04/12/2020] [Indexed: 01/03/2023]
Abstract
Various clinical practice guidelines for the treatment of posttraumatic stress disorder (PTSD) have consistently identified two frontline evidence-based psychotherapies (EBPs)-prolonged exposure (PE) and cognitive processing therapy (CPT)-as well as other empirically supported treatments (EST), such as eye movement desensitization and reprocessing (EMDR) and cognitive therapy for PTSD (CT for PTSD). However, researchers and clinicians continue to be concerned with rates of symptom improvement and patient dropout within these treatments. Recent attempts to address these issues have resulted in intensive, or "massed," treatments for PTSD. Due to variability among intensive treatments, including treatment delivery format, fidelity to the EST, and the population studied, we conducted a systematic review to summarize and integrate the literature on the impact of intensive treatments on PTSD symptoms. A review of four major databases, with no restrictions regarding publication date, yielded 11 studies that met all inclusion criteria. The individual study findings denoted a large impact of treatment on reduction of PTSD symptoms, ds = 1.15-2.93, and random-effects modeling revealed a large weighted mean effect of treatment, d = 1.57, 95% CI [1.24, 1.91]. Results from intensive treatments also noted high rates of treatment completion (i.e., 0%-13.6% dropout; 5.51% pooled dropout rate across studies). The findings suggest that intensive delivery of these treatments can be an effective alternative to standard delivery and contribute to improved treatment response and reduced treatment dropout.
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Affiliation(s)
| | | | - Ellen J Teng
- Michael E. DeBakey VA Medical Center, Houston, Texas, USA.,Menninger Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine, Houston, Texas, USA.,South Central Mental Illness Research, Education, and Clinical Center, Houston, Texas, USA
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30
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Isaksson J, Sukhodolsky DG, Koposov R, Stickley A, Ruchkin V. The Role of Gender in the Associations Among Posttraumatic Stress Symptoms, Anger, and Aggression in Russian Adolescents. J Trauma Stress 2020; 33:552-563. [PMID: 32384585 DOI: 10.1002/jts.22502] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 11/01/2019] [Accepted: 11/05/2019] [Indexed: 11/10/2022]
Abstract
Symptoms of posttraumatic stress disorder (PTSD) have been linked to anger and aggressive behavior in adult and veteran populations. However, research on the associations among anger, aggression, and PTSD in adolescents is lacking, particularly regarding differences between the sexes. To address this research gap, we used self-report data from Russian adolescents (N = 2,810; age range: 13-17 years) to perform a full path analysis examining the associations between PTSD symptoms and the emotional (anger traits) and cognitive (rumination) components of anger as well as physical/verbal and social aggression, after adjusting for depressive symptoms. We also examined the interaction effects between PTSD symptoms and sex on anger and aggression. The results indicated that girls scored higher on measures of anger and PTSD symptoms, ds = 0.20-0.32, whereas boys scored higher on measures of physical and verbal aggression, d = 0.54. Clinical levels of PTSD symptoms were associated with anger rumination, β = .16, and trait anger, β = .06, and an interaction effect for PTSD symptoms and sex was found for aggression, whereby boys with clinical levels of PTSD symptoms reported more physical/verbal and social aggression, βs = .05 and .20, respectively. Our findings suggest that PTSD symptoms may have an important impact on anger, anger rumination, and aggression during adolescence. In particular, boys seem to have an increased risk for aggressive behavior in the presence of PTSD symptoms. The present results highlight the importance of taking anger and aggression into account when evaluating PTSD.
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Affiliation(s)
- Johan Isaksson
- Department of Neuroscience, Child and Adolescent Psychiatry Unit, Uppsala University, Uppsala, Sweden.,Department of Women's and Children's Health, Pediatric Neuropsychiatry Unit, Centre for Neurodevelopmental Disorders at Karolinska Institutet (KIND), Karolinska Institutet, Stockholm, Sweden
| | - Denis G Sukhodolsky
- Child Study Centre, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Roman Koposov
- Regional Centre for Child and Youth Mental Health and Child Welfare, The Arctic University of Norway, Tromsö, Norway
| | - Andrew Stickley
- Stockholm Centre for Health and Social Change (SCOHOST), Sodertorn University, Huddinge, Sweden.,Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Vladislav Ruchkin
- Department of Neuroscience, Child and Adolescent Psychiatry Unit, Uppsala University, Uppsala, Sweden.,Child Study Centre, Yale University School of Medicine, New Haven, Connecticut, USA.,Säter Psychiatric Clinic, Säter, Sweden
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31
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Zalta AK, Pinkerton LM, Valdespino-Hayden Z, Smith DL, Burgess HJ, Held P, Boley RA, Karnik NS, Pollack MH. Examining Insomnia During Intensive Treatment for Veterans with Posttraumatic Stress Disorder: Does it Improve and Does it Predict Treatment Outcomes? J Trauma Stress 2020; 33:521-527. [PMID: 32216141 PMCID: PMC7529651 DOI: 10.1002/jts.22505] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 10/17/2019] [Accepted: 10/22/2019] [Indexed: 01/30/2023]
Abstract
Previous research has demonstrated that sleep disturbances show little improvement with evidence-based psychotherapy for posttraumatic stress disorder (PTSD); however, sleep improvements are associated with PTSD treatment outcomes. The goal of the current study was to evaluate changes in self-reported insomnia symptoms and the association between insomnia symptoms and treatment outcome during a 3-week intensive treatment program (ITP) for veterans with PTSD that integrated cognitive processing therapy (CPT), mindfulness, yoga, and other ancillary services. As part of standard clinical procedures, veterans (N = 165) completed self-report assessments of insomnia symptoms at pre- and posttreatment as well as self-report assessments of PTSD and depression symptoms approximately every other day during treatment. Most veterans reported at least moderate difficulties with insomnia at both pretreatment (83.0%-95.1%) and posttreatment (69.1-71.3%). Statistically significant reductions in self-reported insomnia severity occurred from pretreatment to posttreatment; however, the effect size was small, d = 0.33. Longitudinal mixed-effects models showed a significant interactive effect of Changes in Insomnia × Time in predicting PTSD and depression symptoms, indicating that patients with more improvements in insomnia had more positive treatment outcomes. These findings suggest that many veterans continued to struggle with sleep disruption after a 3-week ITP, and successful efforts to improve sleep could lead to better PTSD treatment outcomes. Further research is needed to establish how adjunctive sleep interventions can be used to maximize both sleep and PTSD outcomes.
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Affiliation(s)
- Alyson K. Zalta
- Department of Psychological Science, University of California, Irvine, Irvine, California, USA,Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Linzy M. Pinkerton
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Dale L. Smith
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA,Department of Psychology, Olivet Nazarene University, Bourbonnais, Illinois, USA
| | - Helen J. Burgess
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA,Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Philip Held
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Randy A. Boley
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Niranjan S. Karnik
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Mark H. Pollack
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
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32
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Morland LA, Wells SY, Glassman LH, Greene CJ, Hoffman JE, Rosen CS. Advances in PTSD Treatment Delivery: Review of Findings and Clinical Considerations for the Use of Telehealth Interventions for PTSD. ACTA ACUST UNITED AC 2020; 7:221-241. [PMID: 32837831 PMCID: PMC7261035 DOI: 10.1007/s40501-020-00215-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Purpose of review Effective treatments for posttraumatic stress disorder (PTSD) remain underutilized and individuals with PTSD often have difficulty accessing care. Telehealth, particularly clinical videoconferencing (CVT), can overcome barriers to treatment and increase access to care for individuals with PTSD. The purpose of this review is to summarize the literature on the delivery of PTSD treatments through office-based and home-based videoconferencing, and outline areas for future research. Recent findings Evidence-based PTSD treatments delivered through office-based and home-based CVT have been studied in pilot studies, non-randomized trials, and randomized clinical trials. The studies have consistently demonstrated feasibility and acceptability of these modalities as well as significant reduction in PTSD symptoms, non-inferior outcomes, and comparable dropout rates when compared with traditional face-to-face office-based care. Finally, it has been shown that using CVT does not compromise the therapeutic process. Summary Office-based and home-based CVT can be used to deliver PTSD treatments while retaining efficacy and therapeutic process. The use of these modalities can increase the number of individuals that can access efficacious PTSD care.
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Affiliation(s)
- Leslie A Morland
- VA San Diego Healthcare System, 3375 La Jolla Village Drive, San Diego, CA USA.,University of California, San Diego, San Diego, USA.,Pacific Island Division, National Center for PTSD, Honolulu, HI USA
| | - Stephanie Y Wells
- Durham VA Health Care System, Durham, NC USA.,VISN 6 Mid-Atlantic MIRECC, Durham, NC USA
| | - Lisa H Glassman
- VA San Diego Healthcare System, 3375 La Jolla Village Drive, San Diego, CA USA
| | - Carolyn J Greene
- Department of Veterans Affairs Healthcare System, Little Rock, AR USA.,University of Arkansas for Medical Sciences (UAMS), Little Rock, AR USA
| | - Julia E Hoffman
- Behavioral Health Strategy, Livongo Health, Inc, Silicon Valley, CA USA
| | - Craig S Rosen
- Dissemination & Training Division, National Center for PTSD, Palo Alto, CA USA.,Stanford University School of Medicine, Palo Alto, CA USA
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33
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Shea MT, Krupnick JL, Belsher BE, Schnurr PP. Non-Trauma-Focused Psychotherapies for the Treatment of PTSD: a Descriptive Review. ACTA ACUST UNITED AC 2020. [DOI: 10.1007/s40501-020-00214-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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34
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Etingen B, Grubbs KM, Harik JM. Drivers of Preference for Evidence-Based PTSD Treatment: A Qualitative Assessment. Mil Med 2020; 185:303-310. [DOI: 10.1093/milmed/usz220] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 07/02/2019] [Accepted: 06/03/2019] [Indexed: 11/13/2022] Open
Abstract
ABSTRACT
Introduction
Mental health treatment utilization among persons with posttraumatic stress disorder (PTSD) tends to be low but may be improved by aligning treatment with patient preferences. Our objective was to characterize the reasons that drive a person’s selection of a specific evidence-based PTSD treatment.
Materials and Methods
Data were collected using an online survey of adults who screened positive for PTSD. Participants viewed descriptions of five evidence-based PTSD treatments (cognitive processing therapy, prolonged exposure, eye movement desensitization and reprocessing, stress inoculation training, antidepressant medication) and identified their most preferred treatment. Participants then explained why they selected their top choice. These free-text responses (n = 249) were analyzed using thematic coding and constant comparative methods.
Results
Identified themes included (1) perceived effectiveness, (2) perceived suitability, (3) requirements of participation, (4) familiarity with the modality, (5) perception of the option as ‘better than alternatives,’ (6) perception of the option as ‘not harmful,’ (7) accessibility, and (8) delivery format. Differences in themes were also examined by treatment modality.
Conclusions
By highlighting which pieces of information may be most important to detail when presenting different treatment options, these results can help guide treatment planning conversations, as well as the development of shared decision-making tools.
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Affiliation(s)
- Bella Etingen
- Research Health Scientist, Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research & Development Service, US Department of Veterans Affairs, Hines VA Hospital, 5000 South 5th Avenue, Hines, IL, 60141
| | - Kathleen M Grubbs
- Clinical Psychologist, San Diego VA Health Care System, Department of Veterans Affairs, 3350 La Jolla Village Dr., San Diego, California, 92161
- Assistant Professor, Department of Psychiatry, University of California at San Diego, 9500 Gilman Dr., La Jolla, CA 92093
| | - Juliette M Harik
- Clinical Psychologist, National Center for PTSD (NCPTSD), VA Medical Center (116D), 215 North Main St., White River Junction, VT 05009
- Assistant Professor, Geisel School of Medicine, Dartmouth College, 1 Rope Ferry Rd., Hanover, NH 03755
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35
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Felton JW, Hailemariam M, Richie F, Reddy MK, Edukere S, Zlotnick C, Johnson JE. Preliminary efficacy and mediators of interpersonal psychotherapy for reducing posttraumatic stress symptoms in an incarcerated population. Psychother Res 2020; 30:239-250. [PMID: 30857489 PMCID: PMC6739190 DOI: 10.1080/10503307.2019.1587192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 01/31/2019] [Accepted: 02/18/2019] [Indexed: 10/27/2022] Open
Abstract
AbstractObjective: Incarcerated individuals have high rates of trauma exposure. IPT reduces posttraumatic stress disorder (PTSD) symptoms in non-incarcerated adults, but has not been examined in prison populations. Moreover, little is known about the mechanisms through which IPT reduces PTSD symptoms. The current study investigated the direct and indirect effects of IPT on PTSD symptoms. We hypothesized that IPT would decrease PTSD symptoms by enhancing social support and decreasing loneliness (theorized IPT mechanisms). Method: A sub-sample of trauma-exposed participants (n = 168) were drawn from a larger randomized trial (n = 181) of IPT for major depressive disorder among prisoners. We examined a series of mediation models using non-parametric bootstrapping procedures to evaluate the indirect effect of IPT on PTSD symptoms. Results: Contrary to hypotheses, the relation between IPT and PTSD symptoms was significantly mediated through improvements in hopelessness and depressive symptoms (mechanisms of cognitive behavioral interventions), rather than through social support and loneliness. Increased social support and decreased loneliness were associated with decreased PTSD symptoms, but IPT did not predict changes in social support or loneliness. Conclusions: IPT may reduce PTSD symptoms in depressed prisoners by reducing hopelessness and depression. (ClinicalTrials.gov number NCT01685294).
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Affiliation(s)
- Julia W Felton
- Division of Public Health, Michigan State University, Flint, MI, USA
| | - Maji Hailemariam
- Division of Public Health, Michigan State University, Flint, MI, USA
| | - Fallon Richie
- Division of Public Health, Michigan State University, Flint, MI, USA
| | - Madhavi K Reddy
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - Sophia Edukere
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - Caron Zlotnick
- Department of Psychiatry, Butler Hospital and Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Mackintosh M. Delivering Anger Management Treatment through a Web-Based Intervention Supplemented with Brief Coaching: A Pilot Study (Preprint). JMIR Form Res 2020. [DOI: 10.2196/17694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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37
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Rosen RC, Cikesh B, Fang S, Trachtenberg FL, Seal KH, Magnavita AM, Bovin MJ, Green JD, Bliwise DL, Marx BP, Keane TM. Posttraumatic Stress Disorder Severity and Insomnia-Related Sleep Disturbances: Longitudinal Associations in a Large, Gender-Balanced Cohort of Combat-Exposed Veterans. J Trauma Stress 2019; 32:936-945. [PMID: 31800135 DOI: 10.1002/jts.22462] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 05/03/2019] [Accepted: 05/07/2019] [Indexed: 11/11/2022]
Abstract
Few studies have investigated the range and severity of insomnia-related sleep complaints among veterans with posttraumatic stress disorder (PTSD), and the temporal association between insomnia and PTSD severity has yet to be examined. To examine these associations, a large, gender-balanced cohort of veterans (N = 1,649) of the Iraq and Afghanistan conflicts participated in longitudinal assessments of PTSD and insomnia-related symptoms over a period of 2.5 years following enrollment (range: 2-4 years). Data were obtained from multiple sources, including interviews, self-report assessments, and electronic medical record data. Three-fourths (74.0%) of veterans with PTSD diagnoses at Time 1 (T1) reported insomnia-related sleep difficulties on at least half the nights during the past 30 days, and one-third of participants had received a prescription for a sedative-hypnotic drug in the past year. Veterans without PTSD had fewer sleep problems overall, although the prevalence of sleep problems was high among all study participants. In longitudinal, cross-lagged panel models, the frequency of sleep problems at T1 independently predicted increases in PTSD severity at Time 2 (T2), B = 0.27, p < .001, after controlling for gender and relevant comorbidities. Conversely, T1 PTSD severity was associated with increasing sleep complaints at T2 but to a lesser degree, B = 0.04, p < .001. Moderately high rates of sedative-hypnotic use were seen in veterans with PTSD, with more frequent use in women compared to men (40.4% vs. 35.0%). Sleep complaints were highly prevalent overall and highlight the need for increased clinical focus on this area.
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Affiliation(s)
- Raymond C Rosen
- HealthCore/New England Research Institutes, Watertown, Massachusetts, USA
| | - Bryanna Cikesh
- HealthCore/New England Research Institutes, Watertown, Massachusetts, USA
| | - Shona Fang
- Harvard School of Public Health, Boston, Massachusetts, USA
| | | | - Karen H Seal
- San Francisco VA Health Care System, University of California San Francisco, San Francisco, California, USA
| | - Ashley M Magnavita
- HealthCore/New England Research Institutes, Watertown, Massachusetts, USA
| | - Michelle J Bovin
- National Center for PTSD at VA Boston Healthcare System, Boston, Massachusetts, USA.,Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jonathan D Green
- National Center for PTSD at VA Boston Healthcare System, Boston, Massachusetts, USA.,Boston University School of Medicine, Boston, Massachusetts, USA.,O'Connor Professional Group, Boston, Massachusetts, USA
| | - Donald L Bliwise
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Brian P Marx
- National Center for PTSD at VA Boston Healthcare System, Boston, Massachusetts, USA.,Boston University School of Medicine, Boston, Massachusetts, USA
| | - Terence M Keane
- National Center for PTSD at VA Boston Healthcare System, Boston, Massachusetts, USA.,Boston University School of Medicine, Boston, Massachusetts, USA
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Jackson C, Weiss BJ, Cloitre M. STAIR Group Treatment for Veterans with PTSD: Efficacy and Impact of Gender on Outcome. Mil Med 2019; 184:e143-e147. [PMID: 30007286 DOI: 10.1093/milmed/usy164] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction Group Skills Training in Affective and Interpersonal Regulation (STAIR) is an evidence-based, manualized treatment for individuals with post-traumatic stress symptoms, that focuses on improving functioning through mood management (e.g., emotion regulation) and relationship skills development. To date, no study has evaluated the potential benefit of group STAIR among Veterans. Feasibility of delivering STAIR in a mixed-gender group format and the potential impact of gender on outcome were examined. Materials and Methods Participants (n = 39) were Veterans enrolled in a post-traumatic stress disorder (PTSD) Clinic at a large VA Medical Center. Veterans participated in one of four mixed-gender STAIR groups and completed self-report questionnaires of PTSD symptoms and general psychological distress at pre-treatment and post-treatment. Institutional review board approval was obtained for this study. Results There was significant pre-treatment to post-treatment improvements in PTSD symptoms as measured by the Post-traumatic Stress Checklist (PCL) (Cohen's d = 0.91), as well as in general psychological distress as measured by the Brief Symptom Inventory (BSI) (Cohen's d = 0.90). Change in PTSD symptoms from pre-treatment to post-treatment did not differ across gender. However, the interaction between gender and time on change in (BSI) was significant, where change in general psychological distress significantly decreased from pre-treatment to post-treatment for male Veterans but not for female Veterans. Conclusion The results from this study demonstrate the feasibility and initial effectiveness of STAIR delivered in a mixed-gender group format for Veterans with PTSD. It should be noted, however, that male Veterans benefited more from this approach than female Veterans. The findings suggest the value of investigating Veterans' attitudes and beliefs about the benefits and drawbacks of mixed-gender group therapy for trauma-related difficulties.
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Affiliation(s)
- Christie Jackson
- New York Harbor Healthcare System - Manhattan Campus, 423 East 23rd Street, New York, NY
| | - Brandon J Weiss
- National Center for PTSD Dissemination and Training Division, VA Palo Alto Health Care System, 795 Willow Rd., Menlo Park, CA
| | - Marylene Cloitre
- National Center for PTSD Dissemination and Training Division, VA Palo Alto Health Care System, 795 Willow Rd., Menlo Park, CA
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39
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Zalta AK, Bravo K, Valdespino-Hayden Z, Pollack MH, Burgess HJ. A placebo-controlled pilot study of a wearable morning bright light treatment for probable PTSD. Depress Anxiety 2019; 36:617-624. [PMID: 30995350 PMCID: PMC6721597 DOI: 10.1002/da.22897] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 03/15/2019] [Accepted: 03/22/2019] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Evidence-based treatments for post-traumatic stress disorder (PTSD) have poor uptake and remission rates, suggesting that alternative treatments are needed. Morning bright light may be an effective treatment for PTSD given its established effects on mood and sleep, however, there are no published trials. METHODS We conducted a placebo-controlled pilot trial of a wearable light device, the Re-timer®, for individuals with probable PTSD. Individuals were randomly assigned to the active Re-timer® (n = 9) or a placebo Re-timer® dimmed with neutral density filters (n = 6). Participants self-administered the treatment at home 1 hr each morning over 4 weeks. PTSD and depression symptoms were assessed at pre- and post-treatment. RESULTS The Re-timer® was well tolerated and the perceived benefit was high, though treatment adherence was only moderate. Those in the active group were more likely to achieve a minimal clinically important change in PTSD and depression symptoms and had larger symptom reductions than those in the placebo group CONCLUSIONS: A wearable morning light treatment was acceptable and feasible for patients with probable PTSD. This study provides initial proof-of-concept that light treatment can improve PTSD. A larger trial is warranted to establish treatment efficacy. NCT#: 03513848.
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Affiliation(s)
- Alyson K. Zalta
- Department of Psychological Science, University of California, Irvine, Irvine, CA,Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL
| | - Karyna Bravo
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL
| | - Zerbrina Valdespino-Hayden
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL,Department of Psychology, Montclair State University, Montclair, NJ
| | - Mark H. Pollack
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL
| | - Helen J. Burgess
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL,Department of Psychiatry, University of Michigan, Ann Arbor, MI
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Lang AJ, Malaktaris AL, Casmar P, Baca SA, Golshan S, Harrison T, Negi L. Compassion Meditation for Posttraumatic Stress Disorder in Veterans: A Randomized Proof of Concept Study. J Trauma Stress 2019; 32:299-309. [PMID: 30929283 DOI: 10.1002/jts.22397] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 12/04/2018] [Accepted: 12/21/2018] [Indexed: 01/07/2023]
Abstract
There is considerable interest in developing complementary and integrative approaches for ameliorating posttraumatic stress disorder (PTSD). Compassion meditation (CM) and loving-kindness meditation appear to offer benefits to individuals with PTSD, including symptom reduction. The present study was a pilot randomized controlled trial of CM for PTSD in veterans. The CM condition, an adaptation of Cognitively-Based Compassion Training (CBCT®), consists of exercises to stabilize attention, develop present-moment awareness, and foster compassion. We compared CM to Veteran.calm (VC), which consists of psychoeducation about PTSD, rationale for relaxation, relaxation training, and sleep hygiene. Both conditions consist of 10 weekly 90-min group sessions with between-session practice assignments. A total of 28 veterans attended at least one session of the group intervention and completed pre- and posttreatment measures of PTSD severity and secondary outcomes as well as weekly measures of PTSD, depressive symptoms, and positive and negative emotions. Measures of treatment credibility, attendance, practice compliance, and satisfaction were administered to assess feasibility. A repeated measures analysis of variance revealed a more substantive reduction in PTSD symptoms in the CM condition than in the VC condition, between-group d = -0.85. Credibility, attendance, and satisfaction were similar across CM and VC conditions thus demonstrating the feasibility of CM and the appropriateness of VC as a comparison condition. The findings of this initial randomized pilot study provide rationale for future studies examining the efficacy and effectiveness of CM for veterans with PTSD.
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Affiliation(s)
- Ariel J Lang
- VA San Diego Center of Excellence for Stress and Mental Health, San Diego, California, USA.,Department of Psychiatry, University of California San Diego, La Jolla, California, USA.,Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California, USA
| | - Anne L Malaktaris
- VA San Diego Center of Excellence for Stress and Mental Health, San Diego, California, USA.,Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Pollyanna Casmar
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA.,VA San Diego Healthcare System, San Diego, California, USA
| | - Selena A Baca
- Veterans Medical Research Foundation, San Diego, California, USA
| | - Shahrokh Golshan
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA.,VA San Diego Healthcare System, San Diego, California, USA
| | | | - Lobsang Negi
- Department of Religion, Emory University, Atlanta, Georgia, USA
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41
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Etingen B, Hill JN, Miller LJ, Schwartz A, LaVela SL, Jordan N. An Exploratory Pilot Study to Describe Shared Decision-Making for PTSD Treatment Planning: The Provider Perspective. Mil Med 2019; 184:467-475. [PMID: 30901448 DOI: 10.1093/milmed/usy407] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 09/25/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To describe current practices used by Veterans Administration (VA) mental health (MH) providers involved in post-traumatic stress disorder (PTSD) treatment planning to support engagement of veterans with PTSD in shared decision-making (SDM). METHODS Semi-structured interviews with MH providers (n = 9) were conducted at 1 large VA, audio-recorded, and transcribed verbatim. Transcripts were analyzed deductively, guided by a published account of the integral SDM components for MH care. RESULTS While discussing forming a cohesive team with patients, providers noted the importance of establishing rapport and assessing treatment readiness. Providers' clinical knowledge/expertise, knowledge of the facility's treatment options, knowledge of how to navigate the VA MH care system, and patient factors (goals/preferences, factors influencing treatment engagement) were noted as important to consider when patients and providers exchange information. When negotiating the treatment plan, providers indicated that conversations should include treatment recommendations and concurrent opportunities for personalization. They also emphasized the importance of discussions to finalize a mutually agreeable patient- and provider-informed treatment plan and measure treatment impact. CONCLUSION These results offer a preliminary understanding of VA MH providers' facilitation of SDM for PTSD care. Findings may provide insights for MH providers who wish to engage patients with PTSD in SDM.
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Affiliation(s)
- Bella Etingen
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, 5000 South 5th Avenue, Hines, IL
| | - Jennifer N Hill
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, 5000 South 5th Avenue, Hines, IL
| | - Laura J Miller
- Women's Mental Health, Mental Health Service Line, Hines VA Hospital, 5000 South 5th Avenue, Hines, IL
| | - Alan Schwartz
- Department of Medical Education & Department of Pediatrics, University of Illinois at Chicago, 1853 W. Polk (MC 785), Chicago, IL
| | - Sherri L LaVela
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, 5000 South 5th Avenue, Hines, IL.,Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, 710 North Lake Shore Drive, Chicago, IL
| | - Neil Jordan
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, 5000 South 5th Avenue, Hines, IL.,Departments of Psychiatry & Behavioral Sciences and Preventive Medicine, Feinberg School of Medicine, Northwestern University, 446 East Ontario (#7-200), Chicago, IL
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Tribble JE, Fanselow MS. Pair-housing rats does not protect from behavioral consequences of an acute traumatic experience. Behav Neurosci 2019; 133:232-239. [PMID: 30628802 DOI: 10.1037/bne0000295] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Posttraumatic stress disorder (PTSD) is an extremely debilitating disease with a broad array of associated symptoms, making the disorder difficult to diagnose and treat. In humans, patients seem to benefit from group therapy or other means of promoting social behavior. To test these effects on our rodent model of PTSD, adult, male rats were housed in either single or pair conditions prior to and during an acute stressor to induce PTSD-like behaviors in these rats. Subsequently, rats were assessed for PTSD-like symptoms to determine the effect of social housing on stress-induced phenotypes. Posttrauma phenotypes, including enhanced fear conditioning and anxiety-related behavior, persisted regardless of the animal's housing condition. It is possible that any housing driven improvements to stress-induced phenotypes would require longer periods of pair housing than were used in these experiments. Although PTSD patients show improved health outcomes following social interaction or group therapy, the fear and anxiety phenotypes seen following an acute stressor in an animal model of the disease endured despite an animal's housing condition. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Sippel LM, Watkins LE, Pietrzak RH, Hoff R, Harpaz-Rotem I. Heterogeneity of posttraumatic stress symptomatology and social connectedness in treatment-seeking military veterans: a longitudinal examination. Eur J Psychotraumatol 2019; 10:1646091. [PMID: 31489133 PMCID: PMC6713134 DOI: 10.1080/20008198.2019.1646091] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 07/02/2019] [Accepted: 07/03/2019] [Indexed: 11/21/2022] Open
Abstract
Elucidating whether PTSD symptoms predict poorer social connectedness over time (i.e. social erosion) and/or that poor social connectedness contributes to maintenance of PTSD (i.e. social causation) has implications for PTSD treatment and relapse prevention. Most extant research has been cross-sectional and examined overall PTSD symptoms. Evidence of longitudinal associations among heterogeneous PTSD symptom clusters and social connectedness could provide insight into more nuanced targets for intervention. Using data from 1,491 U.S. military veterans in residential treatment for PTSD at 35 Department of Veterans Affairs facilities, we evaluated a two-wave cross-lagged panel model including a five-factor model of PTSD and two aspects of social connectedness. PTSD, quality of connectedness (i.e. degree of distress related to interpersonal conflict), and structural social support (i.e. number of days of contact with supportive loved ones) in the past 30 days were assessed at baseline and 4 months after discharge. The largest effect was greater severity of PTSD dysphoric arousal symptoms (i.e. irritability/anger, poor concentration, and sleep problems) at baseline predicting more conflict-related distress at follow-up (β = 0.43). Post-hoc symptom-level analyses indicated that irritability/anger drove this association. In addition, conflict-related distress predicted greater PTSD symptom severity across all five clusters (β's = 0.10 to 0.14, p's < 0.01). More days of contact predicted lower severity of avoidance and numbing symptoms (β's = -.05 and -.07, p's < 0.01), along with individual symptoms within these clusters, plus flashbacks. Results support both social erosion and social causation models. Engaging loved ones in veterans' treatment and targeting dysphoric arousal symptoms, particularly anger and irritability, may improve long-term PTSD and relationship outcomes, respectively.
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Affiliation(s)
- Lauren M Sippel
- National Center for PTSD Executive Division, White River Junction, VT, USA.,Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Laura E Watkins
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Robert H Pietrzak
- National Center for PTSD Clinical Neurosciences Division, West Haven, CT, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Rani Hoff
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.,National Center for PTSD Evaluation Division, West Haven, CT, USA
| | - Ilan Harpaz-Rotem
- National Center for PTSD Clinical Neurosciences Division, West Haven, CT, USA.,National Center for PTSD Evaluation Division, West Haven, CT, USA
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Sripada RK, Hoff R, Pfeiffer PN, Ganoczy D, Blow FC, Bohnert KM. Latent classes of PTSD symptoms in veterans undergoing residential PTSD treatment. Psychol Serv 2018; 17:84-92. [PMID: 30284867 DOI: 10.1037/ser0000284] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Although most veterans in the Department of Veterans Affairs (VA) health system are treated for posttraumatic stress disorder (PTSD) in the outpatient setting, the VA has approximately 40 residential PTSD treatment facilities across the country for those requiring more intensive care. The symptom profiles of these veterans are poorly understood. Thus, the current study was designed to characterize classes of PTSD symptoms in a national sample of veterans undergoing residential treatment. We analyzed latent classes of PTSD symptoms among 2,452 veterans entering VA PTSD residential treatment in fiscal year 2013. The model with the best fit was a 4-class model comprising a low symptom class, moderate symptom class with high reexperiencing symptoms, a moderate symptom class with high emotional numbing, and a high symptom class. Compared to classes identified in outpatient samples, these classes were similar in type but greater in severity. Classes differed by age, race/ethnicity, trauma type, co-occurring medical conditions, co-occurring psychiatric conditions, and social functioning. Compared to the moderate class with high emotional numbing, those in the moderate class with high reexperiencing symptoms were more likely to be non-White, have greater pain severity, greater sleep problems, and were less likely to be depressed. Our findings suggest that veterans in residential treatment who have more severe PTSD symptoms also experience other medical and psychosocial stressors. A better understanding of symptom profiles may help to create more individualized treatment planning and thus potentially improve care for these veterans. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | - Rani Hoff
- Veteran Affairs Northeast Program Evaluation Center
| | | | - Dara Ganoczy
- Veterans Affairs Center for Clinical Management Research
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45
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Don Richardson J, King L, St. Cyr K, Shnaider P, Roth ML, Ketcheson F, Balderson K, Elhai JD. Depression and the relationship between sleep disturbances, nightmares, and suicidal ideation in treatment-seeking Canadian Armed Forces members and veterans. BMC Psychiatry 2018; 18:204. [PMID: 29921268 PMCID: PMC6011186 DOI: 10.1186/s12888-018-1782-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 06/11/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Research on the relationship between insomnia and nightmares, and suicidal ideation (SI) has produced variable findings, especially with regard to military samples. This study investigates whether depression mediated the relationship between: 1) sleep disturbances and SI, and 2) trauma-related nightmares and SI, in a sample of treatment-seeking Canadian Armed Forces (CAF) personnel and veterans (N = 663). METHOD Regression analyses were used to investigate associations between sleep disturbances or trauma-related nightmares and SI while controlling for depressive symptom severity, posttraumatic stress disorder (PTSD) symptom severity, anxiety symptom severity, and alcohol use severity. Bootstrapped resampling analyses were used to investigate the mediating effect of depression. RESULTS Approximately two-thirds of the sample (68%; N = 400) endorsed sleep disturbances and 88% (N = 516) reported experiencing trauma-related nightmares. Although sleep disturbances and trauma-related nightmares were both significantly associated with SI on their own, these relationships were no longer significant when other psychiatric conditions were included in the models. Instead, depressive symptom severity emerged as the only variable significantly associated with SI in both equations. Bootstrap resampling analyses confirmed a significant mediating role of depression for sleep disturbances. CONCLUSIONS The findings suggest that sleep disturbances and trauma-related nightmares are associated with SI as a function of depressive symptoms in treatment-seeking CAF personnel and veterans. Treating depression in patients who present with sleep difficulties may subsequently help mitigate suicide risk.
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Affiliation(s)
- J. Don Richardson
- Parkwood Institute Operational Stress Injury Clinic, London, ON Canada
- Department of Psychiatry, Western University, London, ON Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON Canada
| | - Lisa King
- Parkwood Institute Operational Stress Injury Clinic, London, ON Canada
| | - Kate St. Cyr
- Parkwood Institute Operational Stress Injury Clinic, London, ON Canada
| | - Philippe Shnaider
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON Canada
- Anxiety Treatment and Research Centre, St. Joseph’s Healthcare Hamilton, Hamilton, ON Canada
| | - Maya L. Roth
- Parkwood Institute Operational Stress Injury Clinic, London, ON Canada
- Department of Graduate Studies, Ryerson University, Toronto, ON Canada
| | - Felicia Ketcheson
- Parkwood Institute Operational Stress Injury Clinic, London, ON Canada
| | - Ken Balderson
- Parkwood Institute Operational Stress Injury Clinic, London, ON Canada
- Department of Psychiatry, University of Toronto, Toronto, ON Canada
| | - Jon D. Elhai
- Departments of Psychology and Psychiatry, University of Toledo, Toledo, OH USA
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Ng A, Reddy M, Zalta AK, Schueller SM. Veterans' Perspectives on Fitbit Use in Treatment for Post-Traumatic Stress Disorder: An Interview Study. JMIR Ment Health 2018; 5:e10415. [PMID: 29907556 PMCID: PMC6026306 DOI: 10.2196/10415] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 04/19/2018] [Accepted: 04/26/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The increase in availability of patient data through consumer health wearable devices and mobile phone sensors provides opportunities for mental health treatment beyond traditional self-report measurements. Previous studies have suggested that wearables can be effectively used to benefit the physical health of people with mental health issues, but little research has explored the integration of wearable devices into mental health care. As such, early research is still necessary to address factors that might impact integration including patients' motivations to use wearables and their subsequent data. OBJECTIVE The aim of this study was to gain an understanding of patients' motivations to use or not to use wearables devices during an intensive treatment program for post-traumatic stress disorder (PTSD). During this treatment, they received a complementary Fitbit. We investigated the following research questions: How did the veterans in the intensive treatment program use their Fitbit? What are contributing motivators for the use and nonuse of the Fitbit? METHODS We conducted semistructured interviews with 13 veterans who completed an intensive treatment program for PTSD. We transcribed and analyzed interviews using thematic analysis. RESULTS We identified three major motivations for veterans to use the Fitbit during their time in the program: increase self-awareness, support social interactions, and give back to other veterans. We also identified three major reasons certain features of the Fitbit were not used: lack of clarity around the purpose of the Fitbit, lack of meaning in the Fitbit data, and challenges in the veteran-provider relationship. CONCLUSIONS To integrate wearable data into mental health treatment programs, it is important to understand the patient's perspectives and motivations in using wearables. We also discuss how the military culture and PTSD may have contributed to our participants' behaviors and attitudes toward Fitbit usage. We conclude with possible approaches for integrating patient-generated data into mental health treatment settings that may address the challenges we identified.
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Affiliation(s)
- Ada Ng
- People, Information, and Technology Changing Health Lab, Technology and Social Behavior Program, Northwestern University, Evanston, IL, United States
| | - Madhu Reddy
- People, Information, and Technology Changing Health Lab, School of Communication, Northwestern University, Evanston, IL, United States
| | - Alyson K Zalta
- Departments of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Stephen M Schueller
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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Ford JD, Grasso DJ, Greene CA, Slivinsky M, DeViva JC. Randomized clinical trial pilot study of prolonged exposure versus present centred affect regulation therapy for PTSD and anger problems with male military combat veterans. Clin Psychol Psychother 2018; 25:641-649. [DOI: 10.1002/cpp.2194] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 03/20/2018] [Accepted: 03/20/2018] [Indexed: 11/07/2022]
Affiliation(s)
- Julian D. Ford
- Department of Psychiatry; University of Connecticut Health Center; Farmington CT USA
| | - Damion J. Grasso
- Department of Psychiatry; University of Connecticut Health Center; Farmington CT USA
| | - Carolyn A. Greene
- Department of Psychiatry; University of Connecticut Health Center; Farmington CT USA
| | - Michelle Slivinsky
- Department of Psychiatry; University of Connecticut Health Center; Farmington CT USA
| | - Jason C. DeViva
- Department of Psychology; Department of Veterans Affairs Connecticut Healthcare System and Yale School of Medicine; West Haven CT USA
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Efficacy of the Mantram Repetition Program for Insomnia in Veterans With Posttraumatic Stress Disorder: A Naturalistic Study. ANS Adv Nurs Sci 2018; 40:E1-E12. [PMID: 27525960 DOI: 10.1097/ans.0000000000000144] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Statistics show that more than 80% of Veterans mention posttraumatic stress disorder (PTSD)-related symptoms when seeking treatment. Sleep disturbances and nightmares are among the top 3 presenting problems. Current PTSD trauma-focused therapies generally do not improve sleep disturbances. The mantram repetition program (MRP), a mind-body-spiritual intervention, teaches a portable set of cognitive-spiritual skills for symptom management. The aim of this study was to evaluate the efficacy of the MRP on insomnia in Veterans with PTSD in a naturalistic, clinical setting. Results show that participation in the MRP significantly reduced insomnia, as well as decreased self-reported and clinician-assessed PTSD symptom burden.
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Post-training Beliefs, Intentions, and Use of Prolonged Exposure Therapy by Clinicians in the Veterans Health Administration. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2018; 44:123-132. [PMID: 26487392 DOI: 10.1007/s10488-015-0689-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
To examine how changes in beliefs during the training process predict adoption of prolonged exposure therapy (PE) by veterans health administration clinicians who received intensive training in this evidence-based treatment. Participants completed a 4-day PE workshop and received expert consultation as they used PE with two or more training cases. Participants were surveyed prior to the workshop, after the workshop, after case consultation (n = 1.034), and 6 months after training (n = 810). Hierarchical regression was used to assess how pre-training factors, and changes in beliefs during different stages of training incrementally predicted post-training intent to use PE and how many patients clinicians were treating with PE 6 months after training. Post-training intent to use PE was high (mean = 6.2, SD = 0.81 on a 1-7 scale), yet most participants treated only 1 or 2 patients at a time with PE. Pre-training factors predicted intent to use and actual use of PE. Changes in beliefs during the workshop had statistically significant yet modest effects on intent and use of PE. Changes in beliefs during case consultation had substantial effects on intent and actual use of PE. Pre-training factors and changes in beliefs during training (especially during case consultation) influence clinicians' adoption of PE. Use of PE was influenced not only by its perceived clinical advantages/disadvantages, but also by contextual factors (working in a PTSD specialty clinic, perceived control over one's schedule, and ability to promote PE to patients and colleagues).
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50
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Tuepker A, Zickmund SL, Nicolajski CE, Hahm B, Butler J, Weir C, Post L, Hickam DH. Providers' Note-Writing Practices for Post-traumatic Stress Disorder at Five United States Veterans Affairs Facilities. J Behav Health Serv Res 2018; 43:428-42. [PMID: 26228929 DOI: 10.1007/s11414-015-9472-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The capacity of electronic health records (EHRs) to capture desired information depends on the practices of health care providers. These practices have not been well studied in relation to post-traumatic stress disorder (PTSD). This qualitative study investigated how providers write EHR notes on PTSD through 38 interviews with providers working at five Veterans Affairs (VA) hospitals across the United States of America. Two overarching themes were prominent in the results. Providers used progress notes primarily to remember and access details for direct patient care, but only rarely for care coordination. Providers infrequently recorded information not judged to directly contribute to improved care, sometimes deliberately omitting information perceived to jeopardize patients' access to, or quality of, care. Omitted information frequently included sexual or non-military trauma. Understanding providers' thought processes can help clinicians be aware of the limitations of EHR notes as a tool for learning the histories of new patients. Similarly, researchers relying on EHR data for PTSD research should be aware of likely areas of missing data.
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Affiliation(s)
- Anaïs Tuepker
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, 3710 SW US Veterans Hospital Road, Portland, OR, 97239, USA. .,Division of General Internal Medicine, Oregon Health & Science University, Portland, OR, USA.
| | - Susan L Zickmund
- Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Bridget Hahm
- James A. Haley Veterans Hospital, Tampa, FL, USA
| | - Jorie Butler
- Consortium for Healthcare Informatics Research, VA Salt Lake City Healthcare System, Salt Lake City, UT, USA
| | - Charlene Weir
- Consortium for Healthcare Informatics Research, VA Salt Lake City Healthcare System, Salt Lake City, UT, USA
| | - Lori Post
- Department of Emergency Medicine, Yale University, New Haven, CT, USA
| | - David H Hickam
- Patient Centered Outcomes Research Institute (PCORI), Washington, DC, USA
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