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Morgan-López AA, Saavedra LM, Prakash K, West SG, Hien DA. The Hidden Psychometric Model Underlying the DSM: What Happens When It Fails to Fit Psychiatric Data. Psychiatr Serv 2024:appips20230370. [PMID: 38769910 DOI: 10.1176/appi.ps.20230370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Affiliation(s)
- Antonio A Morgan-López
- RTI International, Research Triangle Park, North Carolina (Morgan-López, Saavedra); Department of Psychology, Eastern Michigan University, Ypsilanti (Prakash); Department of Psychology, Arizona State University, Tempe, and Methods and Evaluation Division, Freie Universität Berlin, Berlin (West); Center of Alcohol and Substance Use Studies, Rutgers University, Piscataway, New Jersey (Hien)
| | - Lissette M Saavedra
- RTI International, Research Triangle Park, North Carolina (Morgan-López, Saavedra); Department of Psychology, Eastern Michigan University, Ypsilanti (Prakash); Department of Psychology, Arizona State University, Tempe, and Methods and Evaluation Division, Freie Universität Berlin, Berlin (West); Center of Alcohol and Substance Use Studies, Rutgers University, Piscataway, New Jersey (Hien)
| | - Krithika Prakash
- RTI International, Research Triangle Park, North Carolina (Morgan-López, Saavedra); Department of Psychology, Eastern Michigan University, Ypsilanti (Prakash); Department of Psychology, Arizona State University, Tempe, and Methods and Evaluation Division, Freie Universität Berlin, Berlin (West); Center of Alcohol and Substance Use Studies, Rutgers University, Piscataway, New Jersey (Hien)
| | - Stephen G West
- RTI International, Research Triangle Park, North Carolina (Morgan-López, Saavedra); Department of Psychology, Eastern Michigan University, Ypsilanti (Prakash); Department of Psychology, Arizona State University, Tempe, and Methods and Evaluation Division, Freie Universität Berlin, Berlin (West); Center of Alcohol and Substance Use Studies, Rutgers University, Piscataway, New Jersey (Hien)
| | - Denise A Hien
- RTI International, Research Triangle Park, North Carolina (Morgan-López, Saavedra); Department of Psychology, Eastern Michigan University, Ypsilanti (Prakash); Department of Psychology, Arizona State University, Tempe, and Methods and Evaluation Division, Freie Universität Berlin, Berlin (West); Center of Alcohol and Substance Use Studies, Rutgers University, Piscataway, New Jersey (Hien)
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Hill ML, Kline AC, Saraiya TC, Gette J, Ruglass LM, Norman SB, Back SE, Saavedra LM, Hien DA, Morgan-López AA. Cannabis use and trauma-focused treatment for co-occurring posttraumatic stress disorder and substance use disorders: A meta-analysis of individual patient data. J Anxiety Disord 2024; 102:102827. [PMID: 38266511 PMCID: PMC11138203 DOI: 10.1016/j.janxdis.2024.102827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/22/2023] [Accepted: 01/05/2024] [Indexed: 01/26/2024]
Abstract
High rates of cannabis use among people with posttraumatic stress disorder (PTSD) have raised questions about the efficacy of evidence-based PTSD treatments for individuals reporting cannabis use, particularly those with co-occurring alcohol or other substance use disorders (SUDs). Using a subset of four randomized clinical trials (RCTs) included in Project Harmony, an individual patient meta-analysis of 36 RCTs (total N = 4046) of treatments for co-occurring PTSD+SUD, we examined differences in trauma-focused (TF) and non-trauma-focused (non-TF) treatment outcomes for individuals who did and did not endorse baseline cannabis use (N = 410; 70% male; 33.2% endorsed cannabis use). Propensity score-weighted mixed effects modeling evaluated main and interactive effects of treatment assignment (TF versus non-TF) and baseline cannabis use (yes/no) on attendance rates and within-treatment changes in PTSD, alcohol, and non-cannabis drug use severity. Results revealed significant improvements across outcomes among participants in all conditions, with larger PTSD symptom reductions but lower attendance among individuals receiving TF versus non-TF treatment in both cannabis groups. Participants achieved similar reductions in alcohol and drug use across all conditions. TF outperformed non-TF treatments regardless of recent cannabis use, underscoring the importance of reducing barriers to accessing TF treatments for individuals reporting cannabis use.
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Affiliation(s)
- Melanie L Hill
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA.
| | | | - Tanya C Saraiya
- Center of Alcohol & Substance Use Studies, Rutgers University, Piscataway, NJ, USA; Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Jordan Gette
- Center of Alcohol & Substance Use Studies, Rutgers University, Piscataway, NJ, USA
| | - Lesia M Ruglass
- Center of Alcohol & Substance Use Studies, Rutgers University, Piscataway, NJ, USA; Department of Psychology, The City College of New York, New York, NY, USA
| | - Sonya B Norman
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA; Veterans Affairs San Diego Healthcare System, San Diego, CA, USA; National Center for PTSD, Executive Division, White River Junction, VT, USA
| | - Sudie E Back
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA; Ralph H. Johnson Veterans Affairs Healthcare System, Charleston, SC, USA
| | | | - Denise A Hien
- Center of Alcohol & Substance Use Studies, Rutgers University, Piscataway, NJ, USA
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Saavedra LM, Lochman JE, Morgan-López AA, McDaniel HL, Bradshaw CP, Powell NP, Qu L, Budavari A, Yaros AC. Collateral effects of Coping Power on caregiver symptoms of depression and long-term changes in child behavior. Dev Psychopathol 2024:1-13. [PMID: 38179693 DOI: 10.1017/s095457942300144x] [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: 01/06/2024]
Abstract
A large body of research demonstrates positive impacts of the Coping Power Program as a preventive intervention for youth behavioral outcomes, but potential collateral effects for caregivers is less known. The current study examined whether the youth-focused Coping Power Program can have a secondary impact on caregiver self-reported symptoms of depression and in turn result in longer-term impacts on child disruptive behavior problems including aggression, conduct problems and hyperactivity. Data from 360 youth/caregiver pairs across 8 waves of data (grades 4 through 10) were analyzed. We used two methodological approaches to (a) assess indirect effects in the presence of potential bidirectionality using timepoint-to-timepoint dynamic effects under Autoregressive Latent Trajectory modeling and (b) estimate scale scores in the presence of measurement non-invariance. Results showed that individually delivered Coping Power (ICP) produced greater direct effects on conduct problems and indirect effects on general externalizing and hyperactivity (through reductions in caregiver self-reported symptoms of depression), compared to group Coping Power (GCP). In comparison to GCP, ICP produced similar direct effects on reductions in caregiver depression. Child-focused prevention interventions can have an indirect impact on caregiver depression, which later shows improvements in longer-term reductions for child disruptive problems.
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Affiliation(s)
- Lissette M Saavedra
- Community Health Research Division, RTI International, Research Triangle Park, NC, USA
| | - John E Lochman
- Center for Youth Development and Intervention, University of Alabama, Tuscaloosa, AL, USA
| | | | - Heather L McDaniel
- School of Education and Human Development, University of Virginia, Charlottesville, VA, USA
| | - Catherine P Bradshaw
- School of Education and Human Development, University of Virginia, Charlottesville, VA, USA
| | - Nicole P Powell
- Center for Youth Development and Intervention, University of Alabama, Tuscaloosa, AL, USA
| | - Lixin Qu
- Center for Youth Development and Intervention, University of Alabama, Tuscaloosa, AL, USA
| | - Alexa Budavari
- School of Education and Human Development, University of Virginia, Charlottesville, VA, USA
| | - Anna C Yaros
- Community Health Research Division, RTI International, Research Triangle Park, NC, USA
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Morgan-López AA, Bradshaw CP, Musci RJ. Introduction to the Special Issue on Innovations and Applications of Integrative Data Analysis (IDA) and Related Data Harmonization Procedures in Prevention Science. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:1425-1434. [PMID: 37943445 DOI: 10.1007/s11121-023-01600-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2023] [Indexed: 11/10/2023]
Abstract
This paper serves as an introduction to the special issue of Prevention Science entitled, "Innovations and Applications of Integrative Data Analysis (IDA) and Related Data Harmonization Procedures in Prevention Science." This special issue includes a collection of original papers from multiple disciplines that apply individual-level data synthesis methodologies, including IDA, individual participant meta-analysis, and other related methods to harmonize and integrate multiple datasets from intervention trials of the same or similar interventions. This work builds on a series of papers appearing in a prior Prevention Science special issue, entitled "Who Benefits from Programs to Prevent Adolescent Depression?" (Howe, Pantin, & Perrino, 2018). Since the publication of this prior work, the use of individual-level data synthesis has increased considerably in and outside of prevention. As such, there is a need for an update on current and future directions in IDA, with careful consideration of innovations and applications of these methods to fill important research gaps in prevention science. The papers in this issue are organized into two broad categories of (1) evidence synthesis papers that apply best practices in data harmonization and individual-level data synthesis and (2) new and emerging design, psychometric, and methodological issues and solutions. This collection of original papers is followed by two invited commentaries which provide insight and important reflections on the field and future directions for prevention science.
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Affiliation(s)
| | - Catherine P Bradshaw
- School of Education and Human Development, University of Virginia, Charlottesville, VA, USA
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Rashelle J Musci
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Saavedra LM, Morgan-López AA, West SG, Alegría M, Silverman WK. Mitigating Multiple Sources of Bias in a Quasi-Experimental Integrative Data Analysis: Does Treating Childhood Anxiety Prevent Substance Use Disorders in Late Adolescence/Young Adulthood? PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:1622-1635. [PMID: 36057023 DOI: 10.1007/s11121-022-01422-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2022] [Indexed: 11/26/2022]
Abstract
Psychiatric epidemiologists, developmental psychopathologists, prevention scientists, and treatment researchers have long speculated that treating child anxiety disorders could prevent alcohol and other drug use disorders in young adulthood. A primary challenge in examining long-term effects of anxiety disorder treatment from randomized controlled trials is that all participants receive an immediate or delayed study-related treatment prior to long-term follow-up assessment. Thus, if a long-term follow-up is conducted, a comparison condition no longer exists within the trial. Quasi-experimental designs (QEDs) pairing such clinical samples with comparable untreated epidemiological samples offer a method of addressing this challenge. Selection bias, often a concern in QEDs, can be mitigated by propensity score weighting. A second challenge may arise because the clinical and epidemiological studies may not have used identical measures, necessitating Integrative Data Analysis (IDA) for measure harmonization and scale score estimation. The present study uses a combination of propensity score weighting, zero-inflated mixture moderated nonlinear factor analysis (ZIM-MNLFA), and potential outcomes mediation in a child anxiety treatment QED/IDA (n = 396). Under propensity score-weighted potential outcomes mediation, CBT led to reductions in substance use disorder severity, the effects of which were mediated by reductions in anxiety severity in young adulthood. Sensitivity analyses highlighted the importance of attending to multiple types of bias. This study illustrates how hybrid QED/IDAs can be used in secondary prevention contexts for improved measurement and causal inference, particularly when control participants in clinical trials receive study-related treatment prior to long-term assessment.
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Affiliation(s)
- Lissette M Saavedra
- Community Health Research Division, RTI International, Research Triangle Park, NC, USA.
| | | | - Stephen G West
- Department of Psychology, Arizona State University, Tempe, AZ, USA
| | - Margarita Alegría
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Wendy K Silverman
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA
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Haeny AM, McCuistian C, Burlew AK, Ruglass LM, Espinosa A, Jordan A, Roundtree C, Lopez J, Morgan-López AA. Integrative data analysis of clinical trials network studies to examine the impact of psychosocial treatments for black people who use cocaine: Study protocol. Contemp Clin Trials 2023; 133:107329. [PMID: 37652354 PMCID: PMC10635737 DOI: 10.1016/j.cct.2023.107329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 08/22/2023] [Accepted: 08/28/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Cocaine overdose death rates among Black people are higher than that of any other racial/ethnic group, attributable to synthetic opioids in the cocaine supply. Understanding the most effective psychostimulant use treatment interventions for Black people is a high priority. While some interventions have proven effective for the general population, their comparative effectiveness among Black people remains unknown. To address this gap, our NIDA-funded Clinical Trials Network (CTN) study (0125), will use Integrative Data Analysis (IDA) to examine treatment effectiveness across 9 CTN studies. This manuscript describes the study protocol for CTN-0125. METHODS Of the 59 completed randomized clinical trials in the CTN with available datasets, nine met our inclusion criteria: 1) behavioral intervention, 2) targeted cocaine use or use disorder, 3) included sub-samples of participants who self-identified as Black and 4) included outcome measures of cocaine and psychostimulant use and consequences. We aim to 1) estimate scale scores of cocaine use severity while considering study-level measurement non-invariance, 2) compare the effectiveness of psychosocial treatments for psychostimulant use, and 3) explore individual (e.g., concomitant opioid use, age, sex, employment, pre-treatment psychiatric status) and study-level moderators (e.g., attendance/retention) to evaluate subgroup differences in treatment effectiveness. CONCLUSION The NIDA CTN provides a unique collection of studies that can offer insight into what interventions are most efficacious for Black people. Findings from our CTN-0125 study have the potential to substantially inform treatment approaches specifically designed for Black people who use psychostimulants.
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Affiliation(s)
- Angela M Haeny
- Department of Psychiatry, Yale School of Medicine, United States of America
| | - Caravella McCuistian
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, United States of America.
| | - A Kathleen Burlew
- Department of Psychology, University of Cincinnati, United States of America
| | - Lesia M Ruglass
- Department of Psychology, The City College of New York and The Graduate Center, CUNY, United States of America
| | - Adriana Espinosa
- Department of Psychology, The City College of New York and The Graduate Center, CUNY, United States of America
| | - Ayana Jordan
- Department of Psychiatry, Department of Population Health, NYU Grossman School of Medicine, United States of America
| | | | - Joel Lopez
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, United States of America
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Morgan‐López AA, Saavedra LM, Hien DA, Norman SB, Fitzpatrick SS, Ye A, Killeen TK, Ruglass LM, Blakey SM, Back SE. Differential symptom weighting in estimating empirical thresholds for underlying PTSD severity: Toward a "platinum" standard for diagnosis? Int J Methods Psychiatr Res 2023; 32:e1963. [PMID: 36789653 PMCID: PMC10485310 DOI: 10.1002/mpr.1963] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 12/22/2022] [Accepted: 01/26/2023] [Indexed: 02/16/2023] Open
Abstract
OBJECTIVE Symptom counts as the basis for Post-Traumatic Stress Disorder (PTSD) diagnoses in the DSM presume each symptom is equally reflective of underlying disorder severity. However, the "equal weight" assumption fails to fit PTSD symptom data when tested. The present study developed an enhanced PTSD diagnosis based on (a) a conventional PTSD diagnosis from a clinical interview and (b) an empirical classification of full PTSD that reflected the relative clinical weights of each symptom. METHOD Baseline structured interview data from Project Harmony (N = 2658) was used. An enhanced diagnosis for full PTSD was estimated using an empirical threshold from moderated nonlinear factor analysis (MNLFA) latent PTSD scale scores, in combination with a full conventional PTSD diagnosis based on interview data. RESULTS One in 4 patients in the sample had a PTSD diagnosis that was inconsistent with their empirical PTSD grouping, such that the enhanced diagnostic standard reduced the diagnostic discrepancy rate by 20%. Veterans, and in particular female Veterans, were at greatest odds for discrepancy between their underlying PTSD severity and DSM diagnosis. CONCLUSION Psychometric methodologies that differentially weight symptoms can complement DSM criteria and may serve as a platform for symptom prioritization for diagnoses in future editions of DSM.
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Affiliation(s)
| | - Lissette M. Saavedra
- Community Health Research DivisionRTI InternationalResearch Triangle ParkNorth CarolinaUSA
| | - Denise A. Hien
- Center of Alcohol & Substance Use StudiesRutgers University–New BrunswickPiscatawayNew JerseyUSA
| | - Sonya B. Norman
- Department of PsychiatryUniversity of CaliforniaSan DiegoVirginiaUSA
| | | | - Ai Ye
- Department of Psychology & NeuroscienceL.L. Thurstone Psychometric LaboratoryUNC‐Chapel HillChapel HillNorth CarolinaUSA
- Department PsychologieLudwig‐Maximilians‐UniversitätMunichGermany
| | - Therese K. Killeen
- Department of Psychiatry and Behavioral SciencesMedical University of South CarolinaCharlestonSouth CarolinaUSA
- Ralph H. Johnson VA Medical CenterCharlestonSouth CarolinaUSA
| | - Lesia M. Ruglass
- Department of PsychologyCity College of New YorkNew YorkNew YorkUSA
| | - Shannon M. Blakey
- Community Health Research DivisionRTI InternationalResearch Triangle ParkNorth CarolinaUSA
| | - Sudie E. Back
- Department of Psychiatry and Behavioral SciencesMedical University of South CarolinaCharlestonSouth CarolinaUSA
- Ralph H. Johnson VA Medical CenterCharlestonSouth CarolinaUSA
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Sanchez M, Amaro H. Cumulative exposure to traumatic events and craving among women in residential treatment for substance use disorder: The role of emotion dysregulation and mindfulness disposition. Front Psychol 2022; 13:1048798. [PMID: 36506948 PMCID: PMC9730726 DOI: 10.3389/fpsyg.2022.1048798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/03/2022] [Indexed: 11/25/2022] Open
Abstract
Objective Strong evidence links exposure to traumatic life events with subsequent substance use disorders (SUD). Compared to men, women in SUD treatment are more likely to have a history of trauma, characterized in part by emotion dysregulation known to negatively influence treatment outcomes. Existing research has been conducted with predominantly male and non-Hispanic White samples, with an emphasis on adverse childhood experiences. Little is known about how exposure to cumulative traumatic events across the lifespan affects emotion dysregulation and how this may influence craving, particularly among racial and ethnic minoritized women with SUD. Mindfulness disposition may serve as a protective factor that could buffer the impact of trauma exposure and emotion dysregulation on substance use craving among underrepresented minoritized women with SUD. This study examined the association between cumulative exposure to traumatic events, emotion dysregulation, and mindfulness disposition on substance use craving in a sample of predominantly Hispanic and non-Hispanic Black women in residential treatment for SUD. Method Cross-sectional data were analyzed for a baseline sample of 241 women (56.96% Hispanic, 20.7% non-Hispanic White, 20.7% non-Hispanic Black; age: M = 32.11) entering a SUD residential treatment facility who agreed to participate in a parent randomized controlled trial. Results Findings indicated that greater cumulative exposure to traumatic events and emotion dysregulation were associated with higher levels of craving. Cumulative traumatic event exposure was indirectly associated with higher craving via lower levels in the mindfulness dimension of acting with awareness. Interaction effects also revealed greater exposure to traumatic events was associated with higher levels of craving among women with low and average (but not high) levels of mindfulness disposition. Conclusion These findings provide insight into the potential benefits of targeting emotion regulation and mindfulness-building strategies such as acting with awareness in interventions among racial-ethnically diverse women with SUD. These strategies may be particularly beneficial among those that have experienced extensive histories of trauma exposure. Overall, knowledge gained from the present study can be particularly valuable towards informing treatment models in minoritized groups that currently experience disparities in treatment utilization and outcomes.
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Affiliation(s)
- Mariana Sanchez
- Department of Health Promotion & Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, United States,*Correspondence: Mariana Sanchez,
| | - Hortensia Amaro
- Department of Health Promotion & Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, United States,Herbert Wertheim College of Medicine, Florida International University, Miami, FL, United States
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Saavedra LM, Morgan-López AA, Back SE, Patel SV, Hien DA, Killeen TK, Norman SB, Fitzpatrick S, Ebrahimi CT, Ruglass LM. Measurement Error-Corrected Estimation of Clinically Significant Change Trajectories for Interventions Targeting Comorbid PTSD and Substance Use Disorders in OEF/OIF Veterans. Behav Ther 2022; 53:1009-1023. [PMID: 35987532 DOI: 10.1016/j.beth.2022.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 04/07/2022] [Accepted: 04/10/2022] [Indexed: 11/02/2022]
Abstract
In randomized control trials (RCTs), a focus on average differences between treatment arms often limits our understanding of whether individuals show clinically significant improvement or deterioration. The present study examined differences in individual-level clinical significance trajectories between Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure (COPE) and Relapse Prevention (RP). Eighty-one treatment-seeking veterans with a comorbid PTSD/SUD diagnosis were randomized to COPE or RP; data from an additional n = 48 patients who did not meet criteria for both disorders was used to establish a normative threshold. A newly developed, modernized approach to the Jacobson and Truax (1991) clinically significant change framework, using (a) moderated nonlinear factor analysis (MNLFA) scale scoring and (b) measurement error-corrected multilevel modeling (MEC-MLM) was used; this approach was compared to other approaches using conventional total scores and/or assuming no measurement error. Using a conventional approach to estimating the Reliable Change Index (RCI) yielded no differences between COPE and RP in the percentage of patients achieving statistically significant improvement (SSI; 88.9% for both groups). However, under MNLFA/MEC-MLM, higher percentages of patients receiving COPE (75.0%) achieved SSI compared to RP (40.7%). Findings suggest that, even though COPE and RP appear to reduce the same number of PTSD symptoms, MNLFA scoring of outcome measures gives greater weight to interventions that target and reduce "hallmark" PTSD symptoms.
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Affiliation(s)
| | | | | | | | - Denise A Hien
- Center of Alcohol & Substance Use Studies, Rutgers University-New Brunswick
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