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Wästlund M, Salvesen KT, Stige SH. Clients' experiences with a Trauma-sensitive mindfulness and compassion group intervention: a first-person perspective on change and change mechanisms. Psychother Res 2024; 34:81-95. [PMID: 36795941 DOI: 10.1080/10503307.2023.2170295] [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: 04/23/2022] [Accepted: 01/15/2023] [Indexed: 02/18/2023] Open
Abstract
Background: Trauma-related symptoms are common and there is a need for treatment interventions targeting underlying core vulnerabilities regardless of the client's diagnosis. Mindfulness and Compassion interventions have shown promising results in trauma treatment. However, little is known of how clients experience such interventions. Objective: This study describes clients' experiences of change after participating in a transdiagnostic group intervention, Trauma-sensitive Mindfulness and Compassion Group (TMC). Method: All 17 participants from two TMC groups were interviewed within one month of completing treatment. Transcripts were analysed using reflexive thematic analysis with a focus on how the participants experienced change and change mechanisms. Results: Three main themes of experienced change were developed: Becoming empowered; A new relationship to oneself and one's body; and Gaining more freedom in relationships and life. Four main themes were developed to capture clients' experiences of change mechanisms: New perspectives give understanding and hope; Accessing tools facilitates agency; Significant moments of awareness open up to new possibilities, and Circumstances in life that facilitate change. Conclusion: We discuss and reflect upon participants' experiences of the effects of participating in a TMC group and the mental and emotional costs of doing the work and present a broader perspective on change processes overall.
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Affiliation(s)
- Malin Wästlund
- Department of Psychiatry, Telemark Hospital Trust, Skien, Norway
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2
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Davis AK, Xin Y, Sepeda N, Averill LA. Open-label study of consecutive ibogaine and 5-MeO-DMT assisted-therapy for trauma-exposed male Special Operations Forces Veterans: prospective data from a clinical program in Mexico. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2023; 49:587-596. [PMID: 37734158 DOI: 10.1080/00952990.2023.2220874] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/28/2023] [Indexed: 09/23/2023]
Abstract
Background: Research in psychedelic medicine has focused primarily on civilian populations. Further study is needed to understand whether these treatments are effective for Veteran populations.Objectives: Here, we examine the effectiveness of psychedelic-assisted therapy among trauma-exposed Special Operations Forces Veterans (SOFV) seeking treatment for cognitive and mental health problems in Mexico.Methods: Data were collected from an ibogaine and 5-methoxy-N,N-dimethyltryptamine (5-MeO-DMT) clinical treatment program for SOFV with a history of trauma exposure. This clinical program collects prospective clinical program evaluation data, such as background characteristics, symptom severity, functioning (e.g., satisfaction with life, posttraumatic stress disorder symptoms, depression symptoms, anxiety symptoms, sleep disturbance, psychological flexibility, disability in functioning, cognitive functioning, neurobehavioral symptoms, anger, suicidal ideation), and substance persisting/enduring effects through online surveys at four timepoints (baseline/pre-treatment, one-, three-, and six-months after treatment).Results: The majority of the sample (n = 86; Mean Age = 42.88, SD = 7.88) were Caucasian (87.2%), non-Hispanic (89.5%), and males (100%). There were significant and large improvements in self-reported PTSD symptoms (p < .001, d = .414), depression (p < .001, d = .275), anxiety (p < .001, d = .276), insomnia severity (p < .001, d = .351), and post-concussive symptoms (p < .001, d = .389) as well as self-reported satisfaction with life (p < .001, d = .371), psychological flexibility (p < .001, d = .313) and cognitive functioning (p < .001, d = .265) from baseline to one-month follow-up.Conclusions: Data suggest combined ibogaine and 5-MeO-DMT assisted therapy has potential to provide rapid and robust changes in mental health functioning with a signal of durable therapeutic effects up to 6-months. Future research in controlled settings is warranted.
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Affiliation(s)
- Alan Kooi Davis
- Center for Psychedelic Drug Research and Education, College of Social Work, The Ohio State University, Columbus, OH, USA
- Center for Psychedelic and Consciousness Research, Johns Hopkins University, Baltimore, MD, USA
| | - Yitong Xin
- Center for Psychedelic Drug Research and Education, College of Social Work, The Ohio State University, Columbus, OH, USA
| | - Nathan Sepeda
- Center for Psychedelic Drug Research and Education, College of Social Work, The Ohio State University, Columbus, OH, USA
- Center for Psychedelic and Consciousness Research, Johns Hopkins University, Baltimore, MD, USA
| | - Lynnette A Averill
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- Michael E. DeBakey VA Medical Center, US Department of Veteran Affairs, Houston, TX, USA
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3
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Javakhishvili J, Makhashvili N, Winkler P, Votruba N, van Voren R. Providing immediate digital mental health interventions and psychotrauma support during political crises. Lancet Psychiatry 2023; 10:727-732. [PMID: 37392753 DOI: 10.1016/s2215-0366(23)00120-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/24/2023] [Accepted: 03/27/2023] [Indexed: 07/03/2023]
Abstract
We describe the development and provision of a digital mental health intervention and trauma support platform for victims of political and social repression in Belarus. The Samopomoch platform provides secure and effective support tailored to the needs of such victims, and individuals are provided with access to the service via a modern, encrypted, and protected communication platform. The service involves personal health tracking (e-mental health self-screening), targeted and untargeted client communication (psychoeducation and self-help information), and psychological counselling sessions. The Samopomoch platform is also collecting evidence to show the effectiveness of the service and proposes a model for replication in similar settings. To our knowledge, this is the first immediate digital mental health-care response to a political crisis, and the high needs and increasing demand for this service within the targeted population indicate the necessity for its continuation and scaling-up. We urge policy makers to provide immediate responses for establishing digital mental health interventions and psychological trauma support.
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Affiliation(s)
- Jana Javakhishvili
- Federation Global Initiative on Psychiatry, Hilversum, Netherlands; Foundation Global Initiative on Psychiatry-Tbilisi, Tbilisi, Georgia; Institute of Addiction Studies, Faculty of Arts and Science, Ilia State University, Tbilisi, Georgia.
| | - Nino Makhashvili
- Federation Global Initiative on Psychiatry, Hilversum, Netherlands; Foundation Global Initiative on Psychiatry-Tbilisi, Tbilisi, Georgia; Mental Health Resource Centre, Ilia State University, Tbilisi, Georgia
| | - Petr Winkler
- National Institute of Mental Health, WHO Collaborating Centre for Public Mental Health Research and Service Development, Klecany, Czech Republic
| | - Nicole Votruba
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK; The George Institute for Global Health, London, UK
| | - Robert van Voren
- Federation Global Initiative on Psychiatry, Hilversum, Netherlands; Institute of Addiction Studies, Faculty of Arts and Science, Ilia State University, Tbilisi, Georgia; Political Science and Diplomatic Studies, Vytautas Magnus University, Kaunas, Lithuania
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4
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Lau W, Chisholm K, Gallagher M, Felmingham K, Murray K, Pearce A, Doyle N, Alexander S, O'Brien H, Putica A, Khatri J, Bockelmann P, Hosseiny F, Librado A, Notarianni M, O'Donnell M. Comparing the unified protocol for transdiagnostic treatment of emotional disorders to prolonged exposure for the treatment of PTSD: Design of a non-inferiority randomized controlled trial. Contemp Clin Trials Commun 2023; 33:101134. [PMID: 37228903 PMCID: PMC10205430 DOI: 10.1016/j.conctc.2023.101134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/21/2023] [Accepted: 04/10/2023] [Indexed: 05/27/2023] Open
Abstract
Background Prolonged Exposure (PE), a trauma-focused therapy, is one of the most efficacious treatments available for PTSD. However, many people with PTSD do not lose their diagnosis following delivery of PE. The Unified Protocol (UP) for Transdiagnostic Treatment of Emotional Disorders is a non-trauma focused treatment that may offer an alternative treatment for PTSD. Methods This paper describes the study protocol for IMPACT, an assessor-blinded randomized controlled trial that examines the non-inferiority of UP relative to PE for participants who meet DSM-5 criteria for current PTSD. One hundred and twenty adult participants with PTSD will be randomized to receive either 10 × 90-min sessions of UP or PE with a trained provider. The primary outcome is severity of PTSD symptoms assessed by the Clinician Administered PTSD Scale for DSM-5 (CAPS-5) at post-treatment. Discussion While evidence-based treatments are available for PTSD, high levels of treatment dropout and non-response require new approaches to be tested. The UP is based on emotion regulation theory and is effective in treating anxiety and depressive disorders, however, there has been limited application to PTSD. This is the first rigorous study comparing UP to PE in a non-inferiority randomized controlled trial and may help improve clinical outcomes for those with PTSD. Trial registration This trial was prospectively registered with the Australian New Zealand Clinical Trials Registry, Trial ID (ACTRN12619000543189).
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Affiliation(s)
- W. Lau
- Phoenix Australia – Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Victoria, Australia
| | - K. Chisholm
- Phoenix Australia – Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Victoria, Australia
| | - M.W. Gallagher
- Department of Psychology, The University of Houston, TX, USA
| | - K. Felmingham
- Melbourne School of Psychological Sciences, The University of Melbourne, Victoria, Australia
| | - K. Murray
- Phoenix Australia – Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Victoria, Australia
| | - A. Pearce
- Phoenix Australia – Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Victoria, Australia
| | - N. Doyle
- Phoenix Australia – Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Victoria, Australia
| | - S. Alexander
- Phoenix Australia – Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Victoria, Australia
| | - H. O'Brien
- Phoenix Australia – Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Victoria, Australia
| | - A. Putica
- Phoenix Australia – Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Victoria, Australia
| | - J. Khatri
- Canberra Health Services, Australian Capital Territory Government, Canberra, Australia
| | - P. Bockelmann
- Phoenix Australia – Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Victoria, Australia
| | - F. Hosseiny
- Atlas Institute for Veterans and Families, Ottawa, Canada
- University of Ottawa Institute of Mental Health Research at The Royal, Canada
| | - A. Librado
- Atlas Institute for Veterans and Families, Ottawa, Canada
| | - M. Notarianni
- Atlas Institute for Veterans and Families, Ottawa, Canada
- University of Ottawa Institute of Mental Health Research at The Royal, Canada
| | - M.L. O'Donnell
- Phoenix Australia – Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Victoria, Australia
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5
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Lipov E, Sethi Z, Nandra G, Frueh C. Efficacy of combined subanesthetic ketamine infusion and cervical sympathetic blockade as a symptomatic treatment of PTSD/TBI in a special forces patient with a 1-year follow-up: A case report. Heliyon 2023; 9:e14891. [PMID: 37089345 PMCID: PMC10119561 DOI: 10.1016/j.heliyon.2023.e14891] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 03/13/2023] [Accepted: 03/21/2023] [Indexed: 03/29/2023] Open
Abstract
Co-occurrence of posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) symptoms are particularly prevalent in the special operations forces' community, along with other related conditions (e.g., endocrine dysregulation, sleep disorders, chronic pain). Ketamine infusion (KI) has been shown to increase neuroplasticity as well as memory improvement and cervical sympathetic block (CSB) has been shown to improve cognitive function, reduce sympathetic overactivity, and improve other symptoms of PTSD. We want to report the efficacious use of a single intervention consisting of bilateral CSB technique with subanesthetic KI X5 in a Special Operations Forces patient, diagnosed with PTSD with comorbid TBI, evaluated during treatment and at 1-year follow-up. We postulated KI and CSB would have a synergistic effect. Our patient received KI starting at 0.5 mg/kg, which was escalated daily. KI was combined with right-sided ultrasound-guided CSB (C6 and C4 levels). This was followed the next day by left-sided CSB and KI. Patient's PTSD symptoms were evaluated using the Posttraumatic Stress Disorder Checklist (PCL-5), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), suicidal ideation and other related factors by Concise Health Risk Tracking Self Report (CHRTSR). All measures were assessed prior to treatment, during treatment, and 394 days after. KI combined with CSB showed immediate and prolonged benefits 394 days later regarding the symptoms of PTSD, anxiety, depression, suicidal ideation, and cognitive deterioration (patient report). KI combined with CSB can markedly reduce symptoms of PTSD, psychiatric comorbidities, and cognitive dysfunction.
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Affiliation(s)
- Eugene Lipov
- Stella Center, Chicago, United States
- Corresponding author.
| | - Zubin Sethi
- Midwestern University Chicago College of Osteopathic Medicine, United States
| | | | - Christopher Frueh
- Department of Psychology, University of Hawaii, Hilo, HI, United States
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6
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Pedraza LK, Sierra RO, de Oliveira Alvares L. Systems consolidation and fear memory generalisation as a potential target for trauma-related disorders. World J Biol Psychiatry 2022; 23:653-665. [PMID: 35001808 DOI: 10.1080/15622975.2022.2027010] [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] [Indexed: 01/25/2023]
Abstract
Fear memory generalisation is a central hallmark in the broad range of anxiety and trauma-related disorders. Recent findings suggest that fear generalisation is closely related to hippocampal dependency during retrieval. In this review, we describe the current understanding about memory generalisation and its potential influence in fear attenuation through pharmacological and behavioural interventions. In light of systems consolidation framework, we propose that keeping memory precision could be a key step to enhance therapeutic outcomes.
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Affiliation(s)
- Lizeth K Pedraza
- Laboratório de Neurobiologia da Memória, Biophysics Department, Biosciences Institute, 91.501-970, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.,Department of Physiology, University of Szeged, Szeged, Hungary
| | - Rodrigo O Sierra
- Laboratório de Neurobiologia da Memória, Biophysics Department, Biosciences Institute, 91.501-970, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.,Department of Physiology, University of Szeged, Szeged, Hungary
| | - Lucas de Oliveira Alvares
- Laboratório de Neurobiologia da Memória, Biophysics Department, Biosciences Institute, 91.501-970, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.,Graduate Program in Neuroscience, Institute of Health Sciences, Porto Alegre, Brazil
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7
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Improving quality of life post-tumor craniotomy using personalized, parcel-guided TMS: safety and proof of concept. J Neurooncol 2022; 160:413-422. [DOI: 10.1007/s11060-022-04160-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 10/05/2022] [Indexed: 10/31/2022]
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8
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Schäfer I, Hiller P, Milin S, Lotzin A. A multicenter, randomized controlled trial to compare the effectiveness of STARC-SUD (Skills Training in Affect Regulation - a Culture-sensitive approach) versus treatment as usual in trauma-exposed refugees with substance use problems. Trials 2022; 23:915. [PMID: 36307862 PMCID: PMC9617425 DOI: 10.1186/s13063-022-06761-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Refugees often report high levels of psychological distress due to traumatic experiences before and during flight as well as many post-migration stressors. Refugees with hazardous substance use or existing substance use disorder (SUD) are a particularly vulnerable group for whom few preventive and therapeutic measures are available. The aim of this study is to investigate the effectiveness of an integrative culturally sensitive group therapy approach (STARC-SUD) to improve affect regulation in refugees with substance-related problems. METHODS The study aims to include N = 286 male refugees with psychological distress (GHQ-12 > 13) and hazardous substance use or SUD (AUDIT > 7 or DUDIT > 6). Therapists working supported by interpreters will deliver the STARC-SUD intervention in addiction aid facilities in six metropolitan regions of Germany. The primary endpoint is severity of psychological distress (GHQ-12). The effectiveness of STARC-SUD is compared with treatment as usual (TAU) post-intervention and 3 months later. DISCUSSION This trial will be one of the first RCTs on a culturally sensitive transdiagnostic intervention for trauma-exposed refugees with hazardous substances or SUD. The trial might gain new insights into the efficacy of such an intervention. TRIAL REGISTRATION OSF Registry osf.io/nhxd4 . Registered prospectively on September 22, 2020, doi: 10.17605/OSF.IO/NHXD4. DRKS DRKS00017668.
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Affiliation(s)
- Ingo Schäfer
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Philipp Hiller
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sascha Milin
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Annett Lotzin
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg Eppendorf, Hamburg, Germany.
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9
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de la Rosa-Gómez A, Flores-Plata LA, Esquivel-Santoveña EE, Santillán Torres Torija C, García-Flores R, Dominguez-Rodriguez A, Arenas-Landgrave P, Castellanos-Vargas RO, Berra-Ruiz E, Silvestre-Ramírez R, Miranda-Díaz GA, Díaz-Sosa DM, Hernández-Posadas A, Flores-Elvira AI, Valencia PD, Vázquez-Sánchez MF. Efficacy of a transdiagnostic guided internet-delivered intervention for emotional, trauma and stress-related disorders in Mexican population: study protocol for a randomized controlled trial. BMC Psychiatry 2022; 22:537. [PMID: 35941557 PMCID: PMC9360670 DOI: 10.1186/s12888-022-04132-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Emotional and stress-related disorders show high incidence, prevalence, morbidity, and comorbidity rates in Mexico. In recent decades, research findings indicate that cognitive behavioral interventions, from a disorder-specific perspective, are the effective front-line treatment for anxiety and depression care. However, these treatments are not often used. Reasons include limited access and low availability to effective interventions and comorbidity between mental disorders. Emotional deregulation of negative affectivity has been found to be a mediating factor in addressing emotional disorders from a transdiagnostic perspective, aimed at two or more specific disorders. In addition, technological advancement has created alternatives for psychological assistance, highlighting the possibilities offered by technologies since Internet-supported intervention programs have been empirically tested for effectiveness, efficiency and efficacy and can be key to ensuring access to those who are inaccessible. The aim of the study is to evaluate the efficacy, moderators of clinical change and acceptability of a transdiagnostic guided Internet-delivered intervention versus a transdiagnostic self-guided Internet-delivered intervention for emotional, trauma and stress-related disorders, and waiting list in community sample. METHODS A three-armed, parallel group, superiority randomized controlled clinical trial with repeated measurements at four times: pretest, posttest, follow-up at 3, 6 and 12 months. Outcomes assessor, participant, care provider and investigator will be blinded. Participants aged 18 to 70 years will be randomly allocated 1:1:1 to one of three study arms: a) Transdiagnostic guided internet-delivered intervention with synchronous assistance, b) Transdiagnostic self-guided internet-delivered intervention, c) Waiting list group. Based on sample size estimation, a minimum of 207 participants (69 in each intervention group) will be included. DISCUSSION The study could contribute to improving the efficacy of transdiagnostic internet-delivered interventions to promote the dissemination of evidence-based treatments and eventually, to decrease the high prevalence of emotional and trauma-related disorders in the Mexican population. TRIAL REGISTRATION ClinicalTrial.gov: NCT05225701 . Registered February 4, 2022.
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Affiliation(s)
- Anabel de la Rosa-Gómez
- Faculty of Higher Studies Iztacala, National Autonomous University of Mexico, State of Mexico, Mexico.
| | - Lorena A. Flores-Plata
- grid.9486.30000 0001 2159 0001Faculty of Higher Studies Iztacala, National Autonomous University of Mexico, State of Mexico, Mexico
| | | | - Carolina Santillán Torres Torija
- grid.9486.30000 0001 2159 0001Faculty of Higher Studies Iztacala, National Autonomous University of Mexico, State of Mexico, Mexico
| | - Raquel García-Flores
- grid.466844.c0000 0000 9963 8346Department of Psychology, Technological Institute of Sonora, Sonora, Mexico
| | | | - Paulina Arenas-Landgrave
- grid.9486.30000 0001 2159 0001Faculty of Psychology, National Autonomous University of Mexico, Mexico City, Mexico
| | - Rosa O. Castellanos-Vargas
- grid.441213.10000 0001 1526 9481Health Sciences Department, Autonomous University of Ciudad Juarez, Ciudad Juárez, Mexico
| | - Enrique Berra-Ruiz
- grid.412852.80000 0001 2192 0509Faculty of Health Sciences, Autonomous University of Baja California, Tijuana Baja California, Mexico
| | | | - Germán Alejandro Miranda-Díaz
- grid.9486.30000 0001 2159 0001Faculty of Higher Studies Iztacala, National Autonomous University of Mexico, State of Mexico, Mexico
| | - Dulce M. Díaz-Sosa
- grid.9486.30000 0001 2159 0001Faculty of Higher Studies Iztacala, National Autonomous University of Mexico, State of Mexico, Mexico
| | - Alejandrina Hernández-Posadas
- grid.9486.30000 0001 2159 0001Faculty of Higher Studies Iztacala, National Autonomous University of Mexico, State of Mexico, Mexico
| | - Alicia I. Flores-Elvira
- grid.9486.30000 0001 2159 0001Faculty of Higher Studies Iztacala, National Autonomous University of Mexico, State of Mexico, Mexico
| | - Pablo D. Valencia
- grid.9486.30000 0001 2159 0001Faculty of Higher Studies Iztacala, National Autonomous University of Mexico, State of Mexico, Mexico
| | - Mario F. Vázquez-Sánchez
- grid.9486.30000 0001 2159 0001Faculty of Higher Studies Iztacala, National Autonomous University of Mexico, State of Mexico, Mexico
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10
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Barrio-Martínez S, González-Blanch C, Priede A, Muñoz-Navarro R, Medrano LA, Moriana JA, Carpallo-González M, Ventura L, Ruiz-Rodríguez P, Cano-Vindel A. Emotion Regulation as a Moderator of Outcomes of Transdiagnostic Group Cognitive-Behavioral Therapy for Emotional Disorders. Behav Ther 2022; 53:628-641. [PMID: 35697427 DOI: 10.1016/j.beth.2022.01.007] [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: 02/04/2021] [Revised: 01/17/2022] [Accepted: 01/19/2022] [Indexed: 11/02/2022]
Abstract
The aim of this study was to examine the potential moderating effect of baseline emotion regulation skills-cognitive reappraisal and expressive suppression-on the relationship between treatment allocation and treatment outcomes in primary care patients with emotional symptoms. A total of 631 participants completed scales to evaluate emotion regulation, anxiety, depression, functioning, and quality of life (QOL). The moderation analysis was carried out using the SPSS PROCESS macro, version 3.5. Expressive suppression was a significant moderator in the relationship between treatment allocation and treatment outcomes in terms of symptoms of anxiety (b = -0.530, p = .026), depression (b = -0.812, p = .004), and QOL (b = 0.156, p = .048). Cognitive reappraisal acted as a moderator only in terms of QOL (b = 0.217, p = .028). The findings of this study show that participants with higher scores of expressive suppression benefited more from the addition of transdiagnostic cognitive-behavioral therapy to treatment as usual (TAU) in terms of anxiety and depressive symptoms, and QOL. Individuals with higher levels of cognitive reappraisal obtained a greater benefit in terms of QOL from the addition of psychological treatment to TAU. These results underscore the relevant role that emotion regulation skills play in the outcomes of psychological therapy for emotional symptoms.
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Affiliation(s)
| | | | - Amador Priede
- Valdecilla Biomedical Research Institute, Hospital de Laredo
| | | | | | - Juan Antonio Moriana
- Universidad de Córdoba and Maimónides Institute for Research in Biomedicine of Cordoba
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11
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Al-Tamimi SAGA, Leavey G. Community-Based Interventions for the Treatment and Management of Conflict-Related Trauma in Low-Middle Income, Conflict-Affected Countries: a Realist Review. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:441-450. [PMID: 35600528 PMCID: PMC9120315 DOI: 10.1007/s40653-021-00373-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/07/2021] [Indexed: 06/15/2023]
Abstract
Where low- and middle-income countries have limited economic resources to provide individualized mental health services to people exposed to conflict, community-based interventions may be more appropriate. We aimed to evaluate community level interventions for improving mental health outcomes in Low- and Middle-income countries (LMIC). A realist review of community-based interventions (CBIs) to improve mental health for people in LMIC following conflict. Five databases (Cochrane, PubMed, PsychINFO, Medline, and CINAHL) and a manual search of individual papers. We found 1318 articles, of which 29 were selected. Out of the 29 primary articles, 19 showed successful results, 4 showed mixed results, 1 showed inconclusive results, and 1 showed unsuccessful results. After analyzing the results, we found 3 mechanisms that may influence the effectiveness of these CBIs: the use of lay community members as intervention deliverers, the application of transdiagnostic approaches, and customized outcome assessment tools. Community-based approaches to improve mental health in LMICs are rare and evidence for their effectiveness is limited. Interventions that have a wide scope, train lay mental health workers, and use contextually adapted outcome assessment tools show promise.
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12
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Cohen JR, McNeil S, Menon SV. Childhood Maltreatment and Anhedonic Symptoms: Test of a Dual-risk Model in Emerging Adults. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP7447-NP7469. [PMID: 33118458 DOI: 10.1177/0886260520969242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Anhedonia, defined as deficits in positive affect and approach related behaviors, remains an understudied trauma response. As anhedonic responses to interpersonal violence are associated with a more severe course of psychopathology that is more difficult to treat, an increased focus on risk factors for anhedonia is necessary. The present study sought to address this gap in the literature by testing a theoretical model that highlights two transdiagnostic pathways leading to anhedonic responses in emerging adults attending college. Specifically, our study examined how childhood maltreatment subtypes (a) uniquely associate with depressive and post-traumatic stress (PTS) manifestations of anhedonia and (b) how temperament (i.e., anticipatory positive affect) and distress (i.e., negative mood) explain these relations. At baseline, a racially diverse sample of 462 emerging adults (AgeMean = 19.45; 75.5% female; 45.5% White) completed self-report forms on childhood abuse and neglect, anticipatory positive affect, negative mood, and anhedonia. Individuals completed measures of temperament and psychological distress again 6-weeks, and 12-weeks later. Latent growth curve models were utilized to test our model. Consistent with hypotheses, deficits in anticipatory positive affect uniquely explained the relation between neglect and depressive/PTS anhedonic symptoms. Meanwhile, negative mood mediated the relation between abuse and both forms of anhedonia. These findings support the theory that two separate risk pathways lead to anhedonia. Support for our model suggests that distinguishing between pathways for anhedonic responses may be the key to a more targeted, transdiagnostic, trauma-informed approach for treating and preventing these deleterious, treatment-resistant, internalizing symptoms.
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Affiliation(s)
| | | | - Suvarna V Menon
- University of Illinois at Urbana Champaign, IL, USA
- Northern Illinois University, DeKalb, IL, USA
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13
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Howard J, Fisher Z, Kemp AH, Lindsay S, Tasker LH, Tree JJ. Exploring the barriers to using assistive technology for individuals with chronic conditions: a meta-synthesis review. Disabil Rehabil Assist Technol 2022; 17:390-408. [PMID: 32663110 DOI: 10.1080/17483107.2020.1788181] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 06/23/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Assistive technology can provide a key tool to enabling independence, greater inclusion and participation in society for individuals with chronic conditions. This potential is currently not always realized due to barriers to accessing and using assistive technology. This review aims to identify the common barriers to acquiring and using assistive technology for users with chronic conditions through a systematic meta-synthesis. This differs from other systematic reviews by applying a transdiagnostic approach to identify if barriers are common across chronic conditions. MATERIALS AND METHODS A systematic literature search of five scientific databases (PubMed, SCOPUS, PsycINFO, CINAHL and Medline) was conducted to identify relevant qualitative studies. The search was conducted in November 2019. For the identified articles, thematic content analysis was conducted and the methodological quality was evaluated using the Critical Appraisal Skills Programme (CASP) checklist for qualitative research. RESULTS Forty papers met the inclusion criteria and were included in the analysis. Fifty-one descriptive themes grouped into six overarching analytical themes were identified from the studies. The analytical themes identified were: the design and function of the assistive technology, service provision, information and awareness, psychological barriers, support network and societal barriers. CONCLUSIONS The barriers are interconnected and common across different health conditions. More involvement in personalized care for developing strategies, adaptation of home technologies and provision of assistive technology could overcome the service provision and design barriers to assistive technology. Accessible information and providing greater awareness will be important to overcoming information, psychological and societal barriers to assistive technology.Implications for rehabilitationIndividuals with chronic conditions face complex barriers to acquiring and using assistive technology as a result of the devices themselves, their individual context, the healthcare context where assistive technology is provided and wider societal barriers.The provision of assistive technology needs to change away from the traditional medical model of the "expert" clinician and instead focus on more user involvement to deliver personalised care that utilises the users lived knowledge and experiences.Assistive technology provision should be considered alongside how to adapt everyday mainstream technology to meet user needs; the provision of devices should encourage creative problem solving rather then relying on pre-defined prescription lists of assistive technology.
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Affiliation(s)
- Jonathan Howard
- Department of Psychology, College of Human and Health Sciences, Swansea University, Swansea, UK
- Rehabilitation Engineering Unit, Swansea Bay University Health Board, Morriston Hospital, Swansea, UK
| | - Zoe Fisher
- Health and Wellbeing Academy, College of Human and Health Sciences, Swansea University, Swansea, UK
- Traumatic Brain Injury Service, Swansea Bay University Health Board, Morriston Hospital, Swansea, UK
| | - Andrew H Kemp
- Department of Psychology, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - Stephen Lindsay
- Department of Computer Science, College of Science, Swansea University, Swansea, UK
| | - Lorna H Tasker
- Rehabilitation Engineering Unit, Swansea Bay University Health Board, Morriston Hospital, Swansea, UK
| | - Jeremy J Tree
- Department of Psychology, College of Human and Health Sciences, Swansea University, Swansea, UK
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14
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Balkin RS, Lenz AS, Russo GM, Powell BW, Gregory HM. Effectiveness of EMDR for decreasing symptoms of over‐arousal: A meta‐analysis. JOURNAL OF COUNSELING AND DEVELOPMENT 2021. [DOI: 10.1002/jcad.12418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Richard S. Balkin
- Department of Leadership and Counselor Education University of Mississippi Oxford Mississippi USA
| | - A. Stephen Lenz
- Department of Leadership and Counselor Education University of Mississippi Oxford Mississippi USA
| | - G. Michael Russo
- Department of Leadership and Counselor Education University of Mississippi Oxford Mississippi USA
| | - Brent W. Powell
- Department of Leadership and Counselor Education University of Mississippi Oxford Mississippi USA
| | - Halie M. Gregory
- Department of Leadership and Counselor Education University of Mississippi Oxford Mississippi USA
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15
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Hood CO, Southward MW, Bugher C, Sauer-Zavala S. A Preliminary Evaluation of the Unified Protocol among Trauma-Exposed Adults with and without PTSD. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11729. [PMID: 34770243 PMCID: PMC8583442 DOI: 10.3390/ijerph182111729] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/04/2021] [Accepted: 11/05/2021] [Indexed: 01/20/2023]
Abstract
The purpose of this study was to evaluate whether the Unified Protocol (UP)-a mechanistically transdiagnostic psychological treatment-provides benefit to individuals with a range of trauma histories, psychological difficulties, and diagnostic comorbidity. Using data from a sequential multiple-assignment randomized trial (SMART), this exploratory analysis included a sample of 69 community-recruited adults seeking outpatient mental health treatment. We examined reductions in anxiety and depressive symptoms and changes in aversive and avoidant reactions to intense emotions-the UP's putative mechanism-first by comparing individuals with and without trauma histories and then specifically among participants with PTSD. Findings suggest that the UP may lead to similar improvements in clinical diagnostic severity, anxiety, and depression among patients with trauma exposure as those without trauma exposure. Roughly half of participants with PTSD demonstrated reductions in PTSD clinical severity, anxiety, depression, and distress aversion, suggesting the UP may be an efficacious treatment for people with PTSD and comorbid conditions.
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Affiliation(s)
- Caitlyn O. Hood
- Department of Psychology, University of Kentucky, Lexington, KY 40506, USA; (M.W.S.); (C.B.); (S.S.-Z.)
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16
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Adverse Childhood Experiences and Chronic Pain Rehabilitation Treatment Outcomes in Adults. Clin J Pain 2021; 37:321-329. [PMID: 33830091 DOI: 10.1097/ajp.0000000000000924] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 01/22/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Adverse childhood experiences (ACEs) are commonly reported by individuals with chronic pain. However, little is known about how ACE exposure influences treatment outcomes. The goal of the current study was to evaluate group and treatment-related differences among adults with varying levels of ACE exposure participating in a pain rehabilitation treatment program. METHODS Adult participants (N=269) were categorized as 0 ACEs (n=65), 1 to 2 ACEs (n=87), or ≥3 ACEs (n=117). Participants completed self-report measures of pain, physical functioning, and psychosocial functioning at intake and discharge from a 10-week interdisciplinary pain rehabilitation program. RESULTS ACE exposure was frequently endorsed in this sample, with the majority of participants (78.5%) reporting at least 1 form of childhood adversity. Adults in the ≥3 ACEs group reported a greater level of impairment in mental health symptoms and adjustment to chronic pain; however, all groups endorsed treatment improvements and there were no differences in response to treatment. There were also no differences between groups on measures of pain or physical functioning at intake or discharge. DISCUSSION ACE exposure appears common among treatment-seeking adults with chronic pain and is associated with increased clinical complexity. However, adults with and without exposure to ACEs endorsed significant improvements in pain and functioning following participation in an interdisciplinary pain rehabilitation program. This model of treatment may be especially well situated to address the biopsychosocial contributions to pain among those with a history of adversity.
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17
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O'Donnell ML, Lau W, Chisholm K, Agathos J, Little J, Terhaag S, Brand R, Putica A, Holmes ACN, Katona L, Felmingham KL, Murray K, Hosseiny F, Gallagher MW. A Pilot Study of the Efficacy of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Treating Posttraumatic Psychopathology: A Randomized Controlled Trial. J Trauma Stress 2021; 34:563-574. [PMID: 33453140 DOI: 10.1002/jts.22650] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 12/08/2020] [Accepted: 12/08/2020] [Indexed: 12/29/2022]
Abstract
The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) is an intervention that targets common mechanisms that maintain symptoms across multiple disorders. The UP has been shown to be effective across many disorders, including generalized anxiety disorder, major depressive episode (MDE), and panic disorder, that commonly codevelop following trauma exposure. The present study represented the first randomized controlled trial of the UP in the treatment of trauma-related psychopathology, including posttraumatic stress disorder (PTSD), depression, and anxiety symptoms. Adults (N = 43) who developed posttraumatic psychopathology that included PTSD, MDE, or an anxiety disorder after sustaining a severe injury were randomly assigned to receive 10-14 weekly, 60-min sessions of UP (n = 22) or usual care (n = 21). The primary treatment outcome was PTSD symptom severity, with secondary outcomes of depression and anxiety symptom severity and loss of diagnosis for any trauma-related psychiatric disorder. Assessments were conducted at intake, posttreatment, and 6-month follow-up. Posttreatment, participants who received the UP showed significantly larger reductions in PTSD, Hedges' g = 1.27; anxiety, Hedges' g = 1.20; and depression symptom severity, Hedges' g = 1.40, compared to those receiving usual care. These treatment effects were maintained at 6-month follow-up for PTSD, anxiety, and depressive symptom severity. Statistically significant posttreatment loss of PTSD, MDE, and agoraphobia diagnoses was observed for participants who received the UP but not usual care. This study provides preliminary evidence that the UP may be an effective non-trauma-focused treatment for PTSD and other trauma-related psychopathology.
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Affiliation(s)
- Meaghan L O'Donnell
- Phoenix Australia Centre for Posttraumatic Mental Health, Melbourne, Australia.,Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Winnie Lau
- Phoenix Australia Centre for Posttraumatic Mental Health, Melbourne, Australia.,Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Katherine Chisholm
- Phoenix Australia Centre for Posttraumatic Mental Health, Melbourne, Australia.,Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - James Agathos
- Phoenix Australia Centre for Posttraumatic Mental Health, Melbourne, Australia.,Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Jonathon Little
- Phoenix Australia Centre for Posttraumatic Mental Health, Melbourne, Australia.,Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Sonia Terhaag
- Phoenix Australia Centre for Posttraumatic Mental Health, Melbourne, Australia.,Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Rachel Brand
- Phoenix Australia Centre for Posttraumatic Mental Health, Melbourne, Australia
| | - Andrea Putica
- Phoenix Australia Centre for Posttraumatic Mental Health, Melbourne, Australia.,Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Alexander C N Holmes
- Department of Psychiatry, University of Melbourne, Melbourne, Australia.,Royal Melbourne Hospital, Melbourne, Australia
| | - Lynda Katona
- Alfred Hospital, Melbourne, Australia.,Department of Psychology, Swinburne University, Melbourne, Australia
| | - Kim L Felmingham
- School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Kim Murray
- Phoenix Australia Centre for Posttraumatic Mental Health, Melbourne, Australia
| | - Fardous Hosseiny
- Centre of Excellence on Post-Traumatic Stress Disorder, Ottawa, Canada
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18
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Mordeno IG, Gallemit IMJS, Ferolino MAL, Sinday JV. DSM-5-Based ASD Models: Assessing the Latent Structural Relations with Functionality in War-Exposed Individuals. Psychiatr Q 2021; 92:347-362. [PMID: 32748123 DOI: 10.1007/s11126-020-09804-8] [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] [Indexed: 11/28/2022]
Abstract
There is a dearth of studies investigating the latent structure of Acute Stress Disorder (ASD) following the changes in the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5). To date, there is no consensus on the best representation of ASD. This study addressed this gap by examining four latent ASD models in a sample of war-exposed individuals (N = 424). Investigation on the relationship of the best-fitting model to functionality in the latent level was also conducted. The five-factor model, composed of intrusion, avoidance, numbing, dysphoric arousal, and anxious arousal factors, yielded the best-fitting model. Latent associations between the factors of the model and functionality suggest that symptoms of functionality do not significantly affect the factor structure of ASD. These findings have implications for understanding the underlying mechanism of ASD and can inform the development of more nuanced trauma-related interventions, particularly addressing ASD symptoms and functionality separately.
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Affiliation(s)
- Imelu G Mordeno
- Department of Professional Education, Mindanao State University - Iligan Institute of Technology, Andres Bonifacio Ave., Tibanga, 9200, Iligan City, Philippines.
| | - I Marie Joy S Gallemit
- School of Graduate Studies, College of Education, Mindanao State University - Iligan Institute of Technology, Iligan City, Philippines
| | - Michelle Anne L Ferolino
- School of Graduate Studies, College of Education, Mindanao State University - Iligan Institute of Technology, Iligan City, Philippines
| | - Jonahliza V Sinday
- School of Graduate Studies, College of Education, Mindanao State University - Iligan Institute of Technology, Iligan City, Philippines
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19
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Smith BP, Coe E, Meyer EC. Acceptance and Commitment Therapy Delivered via Telehealth for the Treatment of Co-Occurring Depression, PTSD, and Nicotine Use in a Male Veteran. Clin Case Stud 2020. [DOI: 10.1177/1534650120963183] [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] [Indexed: 12/26/2022]
Abstract
Symptoms of depression, posttraumatic stress, and substance use disorders commonly co-occur and are a tremendous health burden among the U.S. military veteran population. Acceptance and Commitment Therapy (ACT) is an evidence-based, transdiagnostic, integrated approach that has been used to treat these problems. Delivering psychotherapy via telehealth helps to break down barriers to care. This case study describes the application of ACT via telehealth with a male veteran with co-occurring symptoms of depression, PTSD and nicotine addiction. His depressive symptoms, PTSD symptoms, and nicotine use decreased substantially over the course of therapy. He demonstrated increased willingness to experience negatively evaluated internal experiences such as emotions and urges to use nicotine, defusion from self-critical and other unhelpful thoughts, more consistent engagement in values-consistent behaviors, and increased behavioral engagement in his social life. Treatment implications and unique aspects of the telehealth modality are discussed. Recommendations are made for training clinicians who may be considering providing services via telehealth or using ACT.
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Affiliation(s)
- Brandon P. Smith
- Baylor Scott & White Health, Waco, TX, USA
- Texas A&M University, College Station, TX, USA
| | | | - Eric C. Meyer
- Baylor Scott & White Health, Waco, TX, USA
- Texas A&M University Health Science Center, College Station, TX, USA
- Baylor University, Waco, TX, USA
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20
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Farmer CC, Rossi FS, Michael EM, Kimerling R. Psychotherapy Utilization, Preferences, and Retention among Women Veterans with Post-traumatic Stress Disorder. Womens Health Issues 2020; 30:366-373. [PMID: 32680627 DOI: 10.1016/j.whi.2020.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 05/18/2020] [Accepted: 06/05/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Psychotherapy is the gold standard treatment for post-traumatic stress disorder (PTSD), yet psychotherapy use and retention among veterans is low. Little is known about the barriers to care and factors associated with women veterans' PTSD psychotherapy use and retention. Using a nationally representative sample of 986 women Veterans Health Administration primary care users with PTSD and a perceived need for mental health care, we examined 1) the proportion of women who used psychotherapy, 2) retention in psychotherapy among women who used any psychotherapy, and 3) individual factors related to psychotherapy use and retention. METHODS Women completed a survey on their mental health care experiences. Outpatient mental health care use in the year before the survey was obtained from Veterans Health Administration administrative data. RESULTS Most women (79.1%) used psychotherapy, and 41.7% of those women had a minimal therapeutic dose of psychotherapy (≥8 visits). Mental health diagnostic comorbidity and being African American/Black or identifying as neither African American/Black nor White were significantly associated with higher psychotherapy use. Mental health diagnostic comorbidity, exposure to military sexual trauma, and receiving treatment aligned with gender-related and group-related preferences were associated with higher psychotherapy retention. Being a parent was associated with lower retention. CONCLUSIONS Although a significant proportion of women veterans with PTSD are using psychotherapy, retention is enhanced when women are able to obtain treatment aligned with their preferences. Thus, efforts to promote patient-centered, shared decisions regarding mental health treatment options could increase the efficacy and efficiency of treatment for PTSD among women.
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Affiliation(s)
- Courtney C Farmer
- PGSP-Stanford Psy.D. Consortium, Palo Alto University, Palo Alto, California
| | - Fernanda S Rossi
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California; Center for Primary Care and Outcomes Research and Center for Health Policy, Stanford University School of Medicine, Palo Alto, California
| | - Elizabeth M Michael
- PGSP-Stanford Psy.D. Consortium, Palo Alto University, Palo Alto, California
| | - Rachel Kimerling
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California; National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, California.
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21
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Basu A, Farkas DK, Jiang T, Koenen KC, Lash TL, Sørensen HT, Gradus JL. Incident psychiatric comorbidity following stress disorder diagnoses in Danish school-aged children: prospective population-based study. Br J Psychiatry 2020; 217:377-382. [PMID: 31755399 PMCID: PMC7242129 DOI: 10.1192/bjp.2019.247] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Prospective population-based studies of psychiatric comorbidity following trauma and severe stress exposure in children are limited. AIMS To examine incident psychiatric comorbidity following stress disorder diagnoses in Danish school-aged children using Danish national healthcare system registries. METHOD Children (6-15 years of age) with a severe stress or adjustment disorder (ICD-10) between 1995 and 2011 (n = 11 292) were followed prospectively for an average of 5.8 years. Incident depressive, anxiety and behavioural disorder diagnoses were examined relative to an age- and gender-matched comparison cohort (n = 56 460) using Cox proportional hazards regression models. Effect modification by gender was examined through stratified analyses. RESULTS All severe stress and adjustment disorder diagnoses were associated with increased rates for all incident outcome disorders relative to the comparison cohort. For instance, adjustment disorders were associated with higher rates of incident depressive (rate ratio RR = 6.8; 95% CI 6.0-7.7), anxiety (RR = 5.3; 95% CI 4.5-6.4), and behavioural disorders (RR = 7.9; 95% CI 6.6-9.3). Similarly, PTSD was also associated with higher rates of depressive (RR = 7.4; 95% CI 4.2-13), anxiety (RR = 7.1; 95% CI 3.5-14) and behavioural disorder (RR = 4.9; 95% CI 2.3-11) diagnoses. There was no evidence of gender-related differences. CONCLUSIONS Stress disorders varying in symptom constellation and severity are associated with a range of incident psychiatric disorders in children. Transdiagnostic assessments within a longitudinal framework are needed to characterise the course of post-trauma or severe stressor psychopathology.
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Affiliation(s)
- Archana Basu
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Kresge Building, Boston, MA, USA 02115
| | | | - Tammy Jiang
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Karestan C. Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Timothy L. Lash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Jaimie L. Gradus
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
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22
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Mordeno IG, Luzano JGC, Mordeno ER, Ferolino MAL. Investigating the latent dimensions of posttraumatic stress disorder and the role of anxiety sensitivity in combat-exposed Filipino soldiers. MILITARY PSYCHOLOGY 2020; 32:223-236. [PMID: 38536310 PMCID: PMC10013399 DOI: 10.1080/08995605.2020.1724594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 01/27/2020] [Indexed: 12/31/2022]
Abstract
Identifying the optimal factor structure of posttraumatic stress disorder (PTSD) has recently been reinvigorated in literature due to the substantial changes to its diagnostic criteria in the fifth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Currently, six models of PTSD are supported in literature, but there is no consensus on the best-fitting factor structure. Additionally, the extant literature examining the relationship between PTSD symptom-grouping and AS in the latent level has been scarce. The present study's objectives are two-fold: first, we aimed to identify the best-fitted model of PTSD by comparing the six empirically-supported models, and; second, we examined the relationship between the best-fitting model with anxiety sensitivity (AS). Utilizing a sample of 476 combat-exposed soldiers, the results suggest that both the anhedonia and hybrid models provide the best fit to the data, with the anhedonia model achieving slightly better fit indices. Further, the examination on the influence of AS to PTSD reveal that while there is a pattern of decreasing factor loadings and factor correlations when accounting for AS, the changes are not significant to alter the PTSD symptom-structure. Based on these results, our findings suggest further investigation on the possible mediating or moderating mechanisms by which AS may influence PTSD.
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Affiliation(s)
- Imelu G. Mordeno
- Department of Professional Education, College of Education, Mindanao State University – Iligan Institute of Technology, Iligan City, Philippines
| | - Jelli Grace C. Luzano
- Graduate Studies, College of Education, Mindanao State University - Iligan Institute of Technology, Iligan City, Philippines
| | - Emelyn R. Mordeno
- Department of Psychology, College of Arts and Social Sciences, Mindanao State University - Iligan Institute of Technology, Iligan City, Philippines
| | - Michelle Anne L. Ferolino
- Graduate Studies, College of Education, Mindanao State University - Iligan Institute of Technology, Iligan City, Philippines
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23
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Grau PP, McDonald JE, Clark MN, Wetterneck CT. The relationship between three ACT core processes of change, PTSD, and depressive symptoms. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2020. [DOI: 10.1016/j.jcbs.2020.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Winders S, Murphy O, Looney K, O'Reilly G. Self‐compassion, trauma, and posttraumatic stress disorder: A systematic review. Clin Psychol Psychother 2020; 27:300-329. [DOI: 10.1002/cpp.2429] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 01/12/2020] [Accepted: 01/13/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Sarah‐Jane Winders
- Department of Clinical PsychologyUniversity College Dublin Dublin Ireland
| | - Orlagh Murphy
- Department of Clinical PsychologyUniversity College Dublin Dublin Ireland
| | - Kathy Looney
- Department of Clinical PsychologyUniversity College Dublin Dublin Ireland
| | - Gary O'Reilly
- Department of Clinical PsychologyUniversity College Dublin Dublin Ireland
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25
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Haroz EE, Kane JC, Nguyen AJ, Bass JK, Murray LK, Bolton P. When less is more: reducing redundancy in mental health and psychosocial instruments using Item Response Theory. Glob Ment Health (Camb) 2020; 7:e3. [PMID: 32076573 PMCID: PMC7003529 DOI: 10.1017/gmh.2019.30] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 12/10/2019] [Accepted: 12/11/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND There is a need for accurate and efficient assessment tools that cover a range of mental health and psychosocial problems. Existing, lengthy self-report assessments may reduce accuracy due to respondent fatigue. Using data from a sample of adults enrolled in a psychotherapy randomized trial in Thailand and a cross-sectional sample of adolescents in Zambia, we leveraged Item Response Theory (IRT) methods to create brief, psychometrically sound, mental health measures. METHODS We used graded-response models to refine scales by identifying and removing poor performing items that were not well correlated with the underlying trait, and by identifying well-performing items at varying levels of a latent trait to assist in screening or monitoring purposes. RESULTS In Thailand, the original 17-item depression scale was shortened to seven items and the 30-item Posttraumatic Stress Scale (PTS) was shortened to 10. In Zambia, the Child Posttraumatic Stress Scale (CPSS) was shortened from 17 items to six. Shortened scales in both settings retained the strength of their psychometric properties. When examining longitudinal intervention effects in Thailand, effect sizes were comparable in magnitude for the shortened and standard versions. CONCLUSIONS Using Item Response Theory (IRT) we created shortened valid measures that can be used to help guide clinical decisions and function as longitudinal research tools. The results of this analysis demonstrate the reliability and validity of shortened scales in each of the two settings and an approach that can be generalized more broadly to help improve screening, monitoring, and evaluation of mental health and psychosocial programs globally.
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Affiliation(s)
- Emily E. Haroz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jeremy C. Kane
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Amanda J. Nguyen
- Curry School of Education, University of Virginia, Charlottesville, Virginia, USA
| | - Judith K. Bass
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Laura K. Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Paul Bolton
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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26
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Pourabdol S, Molavi P, Azarkolah A. The effectiveness of acceptance and commitment therapy on posttraumatic cognitions and psychological inflexibility among students with trauma exposure. ARCHIVES OF TRAUMA RESEARCH 2020. [DOI: 10.4103/atr.atr_100_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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27
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Davis AK, Averill LA, Sepeda ND, Barsuglia JP, Amoroso T. Psychedelic Treatment for Trauma-Related Psychological and Cognitive Impairment Among US Special Operations Forces Veterans. CHRONIC STRESS (THOUSAND OAKS, CALIF.) 2020; 4:2470547020939564. [PMID: 32704581 PMCID: PMC7359647 DOI: 10.1177/2470547020939564] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 06/15/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND U.S. Special Operations Forces Veterans are at increased risk for a variety of mental health problems and cognitive impairment associated with military service. Current treatments are lacking in effectiveness and adherence. Therefore, this study examined psychedelic treatment with ibogaine and 5-methoxy-N,N-dimethyltryptamine for trauma-related psychological and cognitive impairment among U.S. Special Operations Forces Veterans. METHOD We conducted a survey of Veterans who completed a specific psychedelic clinical program in Mexico between 2017 and 2019. Questions probed retrospective reports of mental health and cognitive functioning during the 30 days before and 30 days after treatment. A total of 65 people completed treatment during this time frame and were eligible for contact. Of these, 51 (78%) completed the survey and were included in data analyses (mean age = 40; male = 96%; married = 55%; Caucasian/White = 92%; Operation Enduring Freedom/Operation Iraqi Freedom Service = 96%). RESULTS Results indicated significant and very large reductions in retrospective report of suicidal ideation (p < .001; d = -1.9), cognitive impairment (p < .001; d = -2.8), and symptoms of posttraumatic stress disorder (p < .001; d = -3.6), depression (p < .001; d = -3.7), and anxiety (p < .001; d = -3.1). Results also showed a significant and large increase in retrospective report of psychological flexibility (p < .001; d = 2.9) from before-to-after the psychedelic treatment. Increases in the retrospective report of psychological flexibility were strongly associated with retrospective report of reductions in cognitive impairment, and symptoms of posttraumatic stress disorder, depression, and anxiety (rs range -0.61 to -0.75; p < .001). Additionally, most participants rated the psychedelic experiences as one of the top five personally meaningful (84%), spiritually significant (88%), and psychologically insightful (86%) experiences of their lives.Limitations: Several limitations should be considered including the retrospective, self-report, survey design of the study, and the lack of randomization and blinding, thus making these finding preliminary. CONCLUSION U.S. Special Operations Forces Veterans may have unique treatment needs because of the sequela of problems associated with repeated trauma exposure and the nature of the exposure. Psychedelic-assisted therapy with these under-researched psychedelics may hold unique promise for this population. However, controlled studies are needed to determine whether this treatment is efficacious in relieving mental health and cognitive impairment among U.S. Special Operations Forces Veterans.
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Affiliation(s)
- Alan K. Davis
- College of Social Work, The Ohio State University, Columbus, OH, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Lynnette A. Averill
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Clinical Neurosciences Division, National Center for PTSD, West Haven, CT, USA
| | - Nathan D. Sepeda
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
| | | | - Timothy Amoroso
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Clinical Neurosciences Division, National Center for PTSD, West Haven, CT, USA
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Simons JS, Simons RM, Walters KJ, Keith JA, O'Brien C, Andal K, Stoltenberg SF. Nexus of despair: A network analysis of suicidal ideation among veterans. Arch Suicide Res 2020; 24:314-336. [PMID: 30734645 PMCID: PMC7206527 DOI: 10.1080/13811118.2019.1574689] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The objective of this study was to estimate a network model of risk and resilience factors of suicidal ideation among veterans. Two network models of suicidal ideation among Operation Iraqi Freedom/Operation Enduring Freedom/Operation New Dawn veterans (N = 276) incorporated key disorders, traumatic stress, and resilience constructs to contextualize suicidal ideation. Childhood trauma was positively connected with suicidal ideation and harassment and inversely connected with social support and distress tolerance. This exemplifies long-lasting associations between childhood trauma and re-victimization, emotion regulation, and ability to form supportive social relationships. A subsequent model including lower-order facets indicated that combat trauma was predominantly associated with posttraumatic stress disorder-intrusion symptoms. This study highlights the importance of addressing both risk and resilience to reduce suicide risk among veterans and increases understanding of factors that contribute to suicidal ideation.
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Affiliation(s)
- Jeffrey S Simons
- The University of South Dakota, Vermillion, South Dakota.,Sioux Falls VA Health Care System, Sioux Falls, South Dakota
| | - Raluca M Simons
- The University of South Dakota, Vermillion, South Dakota.,Sioux Falls VA Health Care System, Sioux Falls, South Dakota
| | - Kyle J Walters
- The University of South Dakota, Vermillion, South Dakota
| | | | | | - Kate Andal
- Sioux Falls VA Health Care System, Sioux Falls, South Dakota
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Kim H, Kim S, Kong S, Kim NH. Social provision partially mediates the complex associations among posttraumatic stress, obsessive-compulsive and depressive symptoms in traumatized patients. J Adv Nurs 2019; 76:566-576. [PMID: 31713885 DOI: 10.1111/jan.14263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 10/22/2019] [Accepted: 11/03/2019] [Indexed: 12/26/2022]
Abstract
AIM To identify the associations among posttraumatic stress, depressive and obsessive-compulsive symptoms (OCS) in outpatients with psychological trauma and to examine the mediating effect of social provision. BACKGROUND Psychologically traumatized patients simultaneously experience depressive and OCS. Social provision may mediate multiple symptoms differently compared with social support. DESIGN Cross-sectional and correlational study. METHODS Data were collected between August 2016-May 2017. Psychiatric outpatients (N = 151) completed a structured questionnaire consisting of the Korean versions of the Social Provision Scale, Beck Depression Inventory-II, Maudsley Obsessional-Compulsive Inventory and Impact of Event Scale-Revised. Structural equation modelling was used to examine the recursive association among the three symptoms and the mediation of social provision. RESULTS There was a recursive association between posttraumatic stress symptoms (PTSS) and depressive symptoms, which were simultaneously associated with OCS with a one-way direction. OCS and social provision partially mediated these identified associations among three symptoms. CONCLUSIONS Our findings provide insight into the complex associations of multiple symptoms experienced by traumatized outpatients and the partial mediation of social provision. Psychiatric and mental health professionals may enhance social functioning and interpersonal interactions based on social provision components used for helping traumatized patients with obsessive-compulsive and depressive symptoms. IMPACT There was a recursive association between PTSS and depressive symptoms that were simultaneously associated with OCS with a one-way direction. Social provision functions as a partial mediator when working with OCS. Mental health nurses can develop social provision interventions for depressive symptoms for traumatized outpatients with OCS.
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Affiliation(s)
- Heejung Kim
- College of Nursing and Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Republic of Korea
| | - Sunah Kim
- College of Nursing and Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Republic of Korea
| | - Seongsook Kong
- School of Nursing, College of Medicine, Soonchunhyang University, Cheonan, Republic of Korea
| | - Nam Hee Kim
- Maumtodac Psychiatric Clinic, Ansan, Republic of Korea
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30
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Gutner CA, Presseau C. Dealing with complexity and comorbidity: Opportunity for transdiagnostic treatment for PTSD. ACTA ACUST UNITED AC 2019; 6:119-131. [PMID: 31886118 DOI: 10.1007/s40501-019-00170-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Purpose of Review This review synthesizes literature on transdiagnostic treatments for PTSD and trauma-related psychopathology over the last three years and discusses their across diverse contexts. Recent Findings Global and domestic studies suggest that a transdiagnostic approach has the potential to address many challenges providers encounter when treating traumatized populations. Existing research shows that transdiagnostic approaches (including the Unified Protocol, Common Elements Treatment Approach, and Modular Approach to Therapy for Children) are effective across low and high resourced settings, populations, and with comorbid mental health symptoms. Moreover, transdiagnostic approaches offer flexibility in treatment delivery, adaptability across contexts, and parsimonious training to treatment providers. They also provide a standalone alternative for unable or unwilling individuals to engage in traditional single diagnosis trauma-focused treatment, or those presenting with complex presentations that might otherwise require sequential courses of targeted interventions. Summary The promise of transdiagnostic treatment for trauma-populations is strong. Research is needed to examine patient and therapist perceptions of these approaches for optimally addressing PTSD and related symptoms, the extent to which they offer comparable, or perhaps better, outcomes than existing single diagnosis PTSD treatments, and their sustainability overtime. Considerations of adaptations to transdiagnostic treatment manuals across settings are also needed.
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Affiliation(s)
- Cassidy A Gutner
- Boston University School of Medicine, Department of Psychiatry
- National Center for PTSD, Women's Health Sciences Division
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31
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Meyer EC, Szabo YZ, Frankfurt SB, Kimbrel NA, DeBeer BB, Morissette SB. Predictors of recovery from post-deployment posttraumatic stress disorder symptoms in war veterans: The contributions of psychological flexibility, mindfulness, and self-compassion. Behav Res Ther 2019; 114:7-14. [DOI: 10.1016/j.brat.2019.01.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 12/21/2018] [Accepted: 01/04/2019] [Indexed: 12/23/2022]
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32
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Forbes D, Pedlar D, Adler AB, Bennett C, Bryant R, Busuttil W, Cooper J, Creamer MC, Fear NT, Greenberg N, Heber A, Hinton M, Hopwood M, Jetly R, Lawrence-Wood E, McFarlane A, Metcalf O, O'Donnell M, Phelps A, Richardson JD, Sadler N, Schnurr PP, Sharp ML, Thompson JM, Ursano RJ, Hooff MV, Wade D, Wessely S. Treatment of military-related post-traumatic stress disorder: challenges, innovations, and the way forward. Int Rev Psychiatry 2019; 31:95-110. [PMID: 31043106 DOI: 10.1080/09540261.2019.1595545] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Post-traumatic stress disorder (PTSD) is one of the common mental disorders in military and veteran populations. Considerable research and clinical opinion has been focused on understanding the relationship between PTSD and military service and the implications for prevention, treatment, and management. This paper examines factors associated with the development of PTSD in this population, considers issues relating to engagement in treatment, and discusses the empirical support for best practice evidence-based treatment. The paper goes on to explore the challenges in those areas, with particular reference to treatment engagement and barriers to care, as well as treatment non-response. The final section addresses innovative solutions to these challenges through improvements in agreed terminology and definitions, strategies to increase engagement, early identification approaches, understanding predictors of treatment outcome, and innovations in treatment. Treatment innovations include enhancing existing treatments, emerging non-trauma-focused interventions, novel pharmacotherapy, personalized medicine approaches, advancing functional outcomes, family intervention and support, and attention to physical health.
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Affiliation(s)
- David Forbes
- a Centenary of Anzac Centre, Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry , University of Melbourne , Carlton , Australia
| | - David Pedlar
- b Canadian Institute for Military and Veteran Health Research , Kingston , ON, Canada
| | - Amy B Adler
- c Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research , Silver Spring , MD , USA
| | - Clare Bennett
- d New Zealand Defence Force , Wellington , New Zealand
| | - Richard Bryant
- a Centenary of Anzac Centre, Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry , University of Melbourne , Carlton , Australia.,e School of Psychology , University of New South Wales , Sydney , Australia
| | | | - John Cooper
- a Centenary of Anzac Centre, Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry , University of Melbourne , Carlton , Australia
| | - Mark C Creamer
- a Centenary of Anzac Centre, Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry , University of Melbourne , Carlton , Australia
| | - Nicola T Fear
- g King's Centre for Military Health Research, King's College London , London , UK.,h Academic Centre for Military Mental Health Research , London , UK
| | - Neil Greenberg
- g King's Centre for Military Health Research, King's College London , London , UK
| | - Alexandra Heber
- i Veterans Affairs Canada , Charlottetown , Canada.,j Department of Psychiatry , University of Ottawa , Ottawa , Canada
| | - Mark Hinton
- a Centenary of Anzac Centre, Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry , University of Melbourne , Carlton , Australia
| | - Mal Hopwood
- a Centenary of Anzac Centre, Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry , University of Melbourne , Carlton , Australia
| | - Rakesh Jetly
- k Directorate of Mental Health , Canadian Armed Forces , Ottawa , Canada
| | - Ellie Lawrence-Wood
- l Centre for Traumatic Stress Studies , University of Adelaide , Adelaide , Australia
| | - Alexander McFarlane
- a Centenary of Anzac Centre, Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry , University of Melbourne , Carlton , Australia.,l Centre for Traumatic Stress Studies , University of Adelaide , Adelaide , Australia
| | - Olivia Metcalf
- a Centenary of Anzac Centre, Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry , University of Melbourne , Carlton , Australia
| | - Meaghan O'Donnell
- a Centenary of Anzac Centre, Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry , University of Melbourne , Carlton , Australia
| | - Andrea Phelps
- a Centenary of Anzac Centre, Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry , University of Melbourne , Carlton , Australia
| | - J Don Richardson
- m Department of Psychiatry , Western University , London , Canada.,n McDonald/Franklin OSI Research Centre , London , Canada
| | - Nicole Sadler
- a Centenary of Anzac Centre, Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry , University of Melbourne , Carlton , Australia
| | - Paula P Schnurr
- o National Center for PTSD , White River Junction , VT , USA.,p Department of Psychiatry , Geisel School of Medicine , Hanover , NH , USA
| | - Marie-Louise Sharp
- g King's Centre for Military Health Research, King's College London , London , UK
| | - James M Thompson
- i Veterans Affairs Canada , Charlottetown , Canada.,q Department of Public Health Sciences , Queen's University , Kingston , ON , Canada
| | - Robert J Ursano
- r Center for the Study of Traumatic Stress, Department of Psychiatry , Uniformed Services University School of Medicine , Bethesda , MD , USA
| | - Miranda Van Hooff
- l Centre for Traumatic Stress Studies , University of Adelaide , Adelaide , Australia
| | - Darryl Wade
- a Centenary of Anzac Centre, Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry , University of Melbourne , Carlton , Australia
| | - Simon Wessely
- g King's Centre for Military Health Research, King's College London , London , UK
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González-Robles A, Díaz-García A, Miguel C, García-Palacios A, Botella C. Comorbidity and diagnosis distribution in transdiagnostic treatments for emotional disorders: A systematic review of randomized controlled trials. PLoS One 2018; 13:e0207396. [PMID: 30440020 PMCID: PMC6237379 DOI: 10.1371/journal.pone.0207396] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 10/30/2018] [Indexed: 12/17/2022] Open
Abstract
The advantages of transdiagnostic protocols for emotional disorders (ED) (anxiety and depression) include the ability to treat multiple psychological disorders using the same treatment protocol, and the capacity to better address comorbidity. Comorbidity in ED has been associated with higher rates of severity, functional impairment, and chronicity. However, no attempts have been made in the literature to systematically review whether these studies include assessments to evaluate the treatment response in comorbid diagnoses, in addition to the principal diagnosis. Moreover, transdiagnostic treatments have been developed for a range of ED, but to date no study has analyzed the real distribution of diagnoses in these studies. The current study aimed to analyze: a) whether treatment response in comorbidity is evaluated in transdiagnostic treatments for ED; b) what diagnoses are targeted in transdiagnostic treatments for ED; and c) the real distribution of the diagnoses at baseline in these studies. A systematic search of the literature was conducted in PsycINFO, PubMed, EMBASE, and the Cochrane Library. Fifty-two randomized controlled trials were identified, with a total of 7007 adult participants. The results showed that, although most of the studies reported data on comorbidity at baseline, only 40% of them examined the effects of the intervention on the comorbid disorders. The most commonly targeted diagnoses in transdiagnostic protocols were panic/agoraphobia, generalized anxiety, social anxiety, and depression. Other disorders, such as obsessive-compulsive disorder, posttraumatic stress disorder, and anxiety/depression not otherwise specified, were marginally included in these studies. Regarding the distribution of diagnoses at baseline, generalized anxiety, panic/agoraphobia, social anxiety, and depression were the most frequently observed, whereas depression not otherwise specified was the least represented. The results highlight the importance of assessing comorbidity in addition to the principal diagnoses in transdiagnostic treatments, in order to draw conclusions about the true potential of these interventions to improve comorbid symptoms. Implications of the current study and directions for future research are discussed.
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Affiliation(s)
- Alberto González-Robles
- Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellon, Spain
| | - Amanda Díaz-García
- Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellon, Spain
| | - Clara Miguel
- Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellon, Spain
| | - Azucena García-Palacios
- Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellon, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
| | - Cristina Botella
- Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellon, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
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34
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Meyer EC, Walser R, Hermann B, La Bash H, DeBeer BB, Morissette SB, Kimbrel NA, Kwok OM, Batten SV, Schnurr PP. Acceptance and Commitment Therapy for Co-Occurring Posttraumatic Stress Disorder and Alcohol Use Disorders in Veterans: Pilot Treatment Outcomes. J Trauma Stress 2018; 31:781-789. [PMID: 30338561 DOI: 10.1002/jts.22322] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 05/10/2018] [Accepted: 05/21/2018] [Indexed: 12/11/2022]
Abstract
Posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) frequently co-occur and are associated with worse outcomes together than either disorder alone. A lack of consensus regarding recommendations for treating PTSD-AUD exists, and treatment dropout is a persistent problem. Acceptance and Commitment Therapy (ACT), a transdiagnostic, mindfulness- and acceptance-based form of behavior therapy, has potential as a treatment option for PTSD-AUD. In this uncontrolled pilot study, we examined ACT for PTSD-AUD in 43 veterans; 29 (67%) completed the outpatient individual therapy protocol (i.e., ≥ 10 of 12 sessions). Clinician-assessed and self-reported PTSD symptoms were reduced at posttreatment, ds = 0.79 and 0.96, respectively. Self-reported symptoms of PTSD remained lower at 3-month follow-up, d = 0.88. There were reductions on all alcohol-related outcomes (clinician-assessed and self-reported symptoms, total drinks, and heavy drinking days) at posttreatment and 3-month follow-up, dmean = 0.91 (d range: 0.65-1.30). Quality of life increased at posttreatment and follow-up, ds = 0.55-0.56. Functional disability improved marginally at posttreatment, d = 0.35; this effect became significant by follow-up, d = 0.52. Fewer depressive symptoms were reported at posttreatment, d = 0.50, and follow-up, d = 0.44. Individuals experiencing suicidal ideation reported significant reductions by follow-up. Consistent with the ACT theoretical model, these improvements were associated with more between-session mindfulness practice and reductions in experiential avoidance and psychological inflexibility. Recommendations for adapting ACT to address PTSD-AUD include assigning frequent between-session mindfulness practice and initiating values clarification work and values-based behavior assignments early in treatment.
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Affiliation(s)
- Eric C Meyer
- U.S. Department of Veterans Affairs Veterans Integrated Service Network 17 Center of Excellence for Research on Returning War Veterans at Central Texas Veterans Healthcare System, Waco, Texas, USA.,Texas A&M University Health Science Center, College of Medicine, College Station, Texas, USA
| | - Robyn Walser
- National Center for PTSD Training and Dissemination Division, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA.,Department of Psychology, University of California, Berkeley, California, USA
| | | | - Heidi La Bash
- U.S. Department of Veterans Affairs Veterans Integrated Service Network 17 Center of Excellence for Research on Returning War Veterans at Central Texas Veterans Healthcare System, Waco, Texas, USA.,Texas A&M University Health Science Center, College of Medicine, College Station, Texas, USA
| | - Bryann B DeBeer
- U.S. Department of Veterans Affairs Veterans Integrated Service Network 17 Center of Excellence for Research on Returning War Veterans at Central Texas Veterans Healthcare System, Waco, Texas, USA.,Texas A&M University Health Science Center, College of Medicine, College Station, Texas, USA
| | | | - Nathan A Kimbrel
- Durham VA Medical Center, Durham, North Carolina, USA.,VA Mid-Atlantic Mental Illness Research Education and Clinical Center, Durham, North Carolina, USA.,School of Medicine, Duke University Health System, Durham, North Carolina, USA
| | - Oi-Man Kwok
- Texas A&M University, College Station, Texas, USA
| | - Sonja V Batten
- Mental Health Services, Department of Veterans Affairs, Washington, D.C., USA.,Booz Allen Hamilton, Washington, D.C., USA
| | - Paula P Schnurr
- National Center for PTSD, Executive Division, White River Junction, Vermont, USA.,Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
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Boffa JW, Short NA, Gibby BA, Stentz LA, Schmidt NB. Distress tolerance as a mechanism of PTSD symptom change: Evidence for mediation in a treatment-seeking sample. Psychiatry Res 2018; 267:400-408. [PMID: 29960937 PMCID: PMC6434692 DOI: 10.1016/j.psychres.2018.03.085] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 03/26/2018] [Accepted: 03/29/2018] [Indexed: 11/30/2022]
Abstract
Low distress tolerance, the perceived or actual inability to tolerate negative emotional states, is a transdiagnostic risk marker associated with greater PTSD symptoms and poorer treatment outcomes. However, the role of distress tolerance in PTSD symptom trajectories has not yet been explored. This study examined the mediating role of distress tolerance in PTSD symptom change among outpatients participating in a trial of computerized interventions for anxiety-related and mood-related risk factors. It was hypothesized that pre- to post-intervention change in distress tolerance would predict PTSD symptoms at three- and six-month follow-up, and mediate the effect of condition on PTSD symptoms above and beyond the effects of a competing mediator, anxiety sensitivity. Although condition differences in distress tolerance change were non-significant, distress tolerance change predicted month-three PTSD symptoms and mediated the direct effect of condition on month-three PTSD symptoms. After accounting for the direct effect of condition on month-six PTSD symptoms, distress tolerance change did not predict month-six PTSD symptoms. Findings suggest distress tolerance does play a longitudinal role in PTSD symptom change, and distress tolerance interventions may benefit certain samples who may otherwise not be able to immediately access, or remain in PTSD treatments.
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Affiliation(s)
| | | | | | | | - Norman B. Schmidt
- Correspondence concerning this article should be addressed to Norman B. Schmidt, Department of Psychology, Florida State University, Tallahassee, FL, 32306. ; Telephone: (850) 644-1707; Fax: (850) 644-1707
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Contractor AA, Brown LA, Caldas SV, Banducci AN, Taylor DJ, Armour C, Shea MT. Posttraumatic stress disorder and positive memories: Clinical considerations. J Anxiety Disord 2018; 58:23-32. [PMID: 30025253 DOI: 10.1016/j.janxdis.2018.06.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 06/02/2018] [Accepted: 06/22/2018] [Indexed: 12/31/2022]
Abstract
Encoding and retrieval difficulties, and avoidance of both traumatic and positive memories, are associated with posttraumatic stress disorder (PTSD) symptoms. However, most PTSD research and clinical work has solely examined the role of traumatic memories in the maintenance/resolution of PTSD symptoms. This review provides a comprehensive discussion of the literature on positive memories and PTSD. First, we review theories and evidence on the relations between trauma, PTSD, and memory processes (particularly positive memories). Next, we propose a conceptual model that integrates evidence from experimental and positive/memory-based intervention research and highlights hypothesized mechanisms underlying the potential effectiveness of targeting positive memories in PTSD interventions. Specifically, we discuss how targeting positive memories could (1) increase positive affect and reduce negative affect, (2) correct negative cognitions, (3) increase specificity of retrieving autobiographical memories, and (4) be effectively integrated/sequenced with and enhance the effects of trauma-focused interventions. Lastly, we suggest clinical research avenues for investigating the relations between positive memories and PTSD, to possibly alter the current PTSD intervention paradigm focused only on traumatic memories. Overall, our proposed model drawing from experimental and intervention research, and outlining potential effects of targeting positive memories to reduce PTSD severity, needs further empirical investigation.
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Affiliation(s)
| | - Lily A Brown
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Daniel J Taylor
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Cherie Armour
- Institute of Mental Health Sciences, School of Psychology, Ulster University, Northern Ireland, UK
| | - M Tracie Shea
- Providence Veterans Affairs Medical Center, Providence, USA; Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, USA
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Young G. PTSD in Court II: Risk factors, endophenotypes, and biological underpinnings in PTSD. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2017; 51:1-21. [PMID: 28262266 DOI: 10.1016/j.ijlp.2017.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 02/06/2017] [Indexed: 06/06/2023]
Abstract
The second article in the series of three for the journal on "PTSD in Court" especially concerns the biological bases that have been found to be associated with PTSD (posttraumatic stress disorder). The cohering concepts in this section relate to risk factors; candidate genes; polygenetics; "gene×environment" interactions; epigenetics; endophenotypes; biomarkers; and connective networks both structurally and functionally (in terms of intrinsic connectivity networks, ICNs, including the DMN, SN, and CEN; that is, default mode, salience, and central executive networks, respectively). Risk factors related to PTSD include pre-event, event- and post-event ones. Some of the genes related to PTSD include: FKBP5, 5-HTTLPR, and COMT (which are, respectively, FK506-binding protein 5 gene, serotonin-transporter linked polymorphic region, catechol-O-methyl-transferase). These genetic findings give an estimate of 30% for the genetic influence on PTSD. The typical brain regions involved in PTSD include the amygdala, hippocampus, and prefrontal cortex, along with the insula. Causal models of behavior are multifactorial and biopsychosocial, and these types of models apply to PTSD, as well. The paper presents a multilevel systems model of psychopathology, including PTSD, which involves three levels - a top-down psychological construct one, a bottom-up symptom connection one, and a middle one involving symptom appraisal. Legally, causality refers to the event at issue needing to meet the bar of being materially contributory to the outcome. Finally, this section of the article reviews empirically-supported therapies for PTSD and the dangers of not receiving treatment for it.
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Affiliation(s)
- Gerald Young
- Glendon Campus, York University, Toronto, Ontario, Canada.
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38
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Gallagher MW. Transdiagnostic mechanisms of change and cognitive-behavioral treatments for PTSD. Curr Opin Psychol 2016; 14:90-95. [PMID: 28813326 DOI: 10.1016/j.copsyc.2016.12.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 12/18/2016] [Accepted: 12/19/2016] [Indexed: 11/27/2022]
Abstract
This paper reviews the current status of transdiagnostic mechanisms of change targeted in cognitive-behavioral interventions, with a focus on mechanisms that are also relevant to emotional disorders that frequently co-occur with PTSD. First, an overview of the rationale for and key features of identifying mechanisms of change is presented, with a discussion of why it is crucial to examine mechanisms that are relevant across diagnostic boundaries. A review of the current evidence for five promising transdiagnostic mechanisms (hope, neuroticism, emotion regulation, cognitive reappraisal, and anxiety sensitivity) is then provided. Finally, the implications of the increasing evidence of transdiagnostic mechanisms of change are discussed in relation to recently developed transdiagnostic treatment protocols that provide an alternative treatment approach for PTSD.
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Affiliation(s)
- Matthew W Gallagher
- Department of Psychology & Texas Institute for Measurement, Evaluation, and Statistics, University of Houston, 4849 Calhoun Rd., Rm 373, Houston, TX 77204-6022, USA.
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Colston MJ, Belsher BE, Beech EH, Curry JC, Tyberg YA, Melmed AZ, McGraw KL, Stoltz RF. Posttraumatic Stress Disorder, Depression, and Other Comorbidities: Clinical and Systems Approaches to Diagnostic Uncertainties. Fed Pract 2016; 33:37-45. [PMID: 30766149 PMCID: PMC6373700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Overlap in the clinical presentation and significant rates of comorbidity complicate effective management of depression and PTSD, each presenting major health burdens for veterans and active-duty service members.
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Affiliation(s)
- Michael J Colston
- and are all affiliated with the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury in Silver Spring, Maryland
| | - Bradley E Belsher
- and are all affiliated with the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury in Silver Spring, Maryland
| | - Erin H Beech
- and are all affiliated with the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury in Silver Spring, Maryland
| | - Justin C Curry
- and are all affiliated with the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury in Silver Spring, Maryland
| | - Yonatan A Tyberg
- and are all affiliated with the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury in Silver Spring, Maryland
| | - Andrew Z Melmed
- and are all affiliated with the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury in Silver Spring, Maryland
| | - Kate L McGraw
- and are all affiliated with the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury in Silver Spring, Maryland
| | - Richard F Stoltz
- and are all affiliated with the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury in Silver Spring, Maryland
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