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Mengin AC, Nourry N, Severac F, Berna F, Bemmouna D, Costache ME, Fritsch A, Frey I, Ligier F, Engel N, Greth P, Khan A, Chauvet-Gelinier JC, Chabridon G, Haffen E, Nicolier M, Zinetti-Bertschy A, Vidailhet P, Weiner L. Efficacy of the my health too online cognitive behavioral therapy program for healthcare workers during the COVID-19 pandemic: A randomized controlled trial. Internet Interv 2024; 36:100736. [PMID: 38617386 PMCID: PMC11015127 DOI: 10.1016/j.invent.2024.100736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 02/23/2024] [Accepted: 03/16/2024] [Indexed: 04/16/2024] Open
Abstract
Background Healthcare workers' mental health has been impacted by the COVID-19 pandemic, emphasizing the need for mental health interventions in this population. Online cognitive behavioral therapy (CBT) is efficient to reduce stress and may reach numerous professionals. We developed "MyHealthToo", an online CBT program to help reduce stress among healthcare workers during the COVID-19 pandemic. Objective The aim of our study is to investigate the efficacy of an online CBT program on stress and mental health conditions among healthcare workers during a health crisis. Methods We performed a multicentric randomized controlled trial among 155 participants allocated either to the experimental or active control group (bibliotherapy). The primary outcome was the decrease of perceived stress scores (PSS-10) post-treatment. Secondary outcomes included depression, insomnia and PTSD symptoms along with self-reported resilience and ruminations. Assessments were scheduled pretreatment, mid-treatment (4 weeks), post-treatment (8 weeks), and at 1-month and 4-months follow-up. Results For both interventions, mean changes on the PSS-10 were significant post-therapy (W8), as at 1-month (W12) and 4-months (W24) follow-ups. The between-group comparison showed no difference at any time point (ps > 0.88). Work-related ruminations significantly decreased in the experimental group with a significant between-group difference at W8 (Δ = -1.83 [-3.57; -0.09], p = 0.04). Posttraumatic stress symptoms significantly decreased in the experimental group with a significant between-group difference at W12 (Δ = -1.41 [-2.68; -0.14], p = 0.03). The decrease in work-related ruminations at W8 mediated the decrease in posttraumatic stress symptoms at W12 (p = 0.048). Conclusion The "MyHealthToo" online CBT intervention may help reduce ruminations about work and posttraumatic stress symptoms among healthcare workers during a major health crisis. Work-related ruminations may represent a relevant target of online interventions to improve mental health among healthcare workers.
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Affiliation(s)
- Amaury C. Mengin
- Department of Psychiatry, Mental Health & Addictology, Strasbourg University Hospital, Strasbourg, France
- Regional Great East Center for Psychotraumatism, Strasbourg, France
- Strasbourg University, Faculty of Medicine, Strasbourg, France
- INSERM U1329, Strasbourg Translational NEuroscience and Psychiatry (STEP), Team Psychiatry, Strasbourg, France
- Fédération de Médecine Translationnelle de Strasbourg, France
| | - Nathalie Nourry
- Strasbourg University, Faculty of Medicine, Strasbourg, France
- Fédération de Médecine Translationnelle de Strasbourg, France
- Hôpitaux Universitaires de Strasbourg, Service de Pathologies Professionnelles et Médecine du Travail, Strasbourg, France
| | - François Severac
- Hôpitaux Universitaires de Strasbourg, Département de Santé Publique, GMRC, Strasbourg, France
- Université de Strasbourg, Laboratoire de Biostatistique et Informatique Médicale, iCUBE UMR, 7357 Illkirch, France
| | - Fabrice Berna
- Department of Psychiatry, Mental Health & Addictology, Strasbourg University Hospital, Strasbourg, France
- Strasbourg University, Faculty of Medicine, Strasbourg, France
- INSERM U1329, Strasbourg Translational NEuroscience and Psychiatry (STEP), Team Psychiatry, Strasbourg, France
- Fédération de Médecine Translationnelle de Strasbourg, France
| | - Doha Bemmouna
- Strasbourg University, Faculty of Psychology, Strasbourg, France
| | - Mădălina Elena Costache
- Strasbourg University, Faculty of Psychology, Strasbourg, France
- Laboratoire de Psychologie des Cognitions, Université de Strasbourg, Strasbourg, France
| | - Aurélie Fritsch
- Strasbourg University, Faculty of Psychology, Strasbourg, France
- Laboratoire de Psychologie des Cognitions, Université de Strasbourg, Strasbourg, France
| | - Isabelle Frey
- Department of Psychiatry, Mental Health & Addictology, Strasbourg University Hospital, Strasbourg, France
| | - Fabienne Ligier
- PUPEA, Centre Psychothérapeutique de Nancy, Laxou; EA 4360 APEMAC, Université de Lorraine, Nancy, France
- Centre Psychothérapeutique de Nancy, Laxou, France
| | - Nadia Engel
- PUPEA, Centre Psychothérapeutique de Nancy, Laxou; EA 4360 APEMAC, Université de Lorraine, Nancy, France
- Centre Psychothérapeutique de Nancy, Laxou, France
| | - Philippe Greth
- Pôle de Psychiatrie et Santé Mentale du Groupe Hospitalier Mulhouse Sud Alsace, Mulhouse, France
| | - Anastasia Khan
- Pôle de Psychiatrie et Santé Mentale du Groupe Hospitalier Mulhouse Sud Alsace, Mulhouse, France
| | - Jean-Christophe Chauvet-Gelinier
- Service de Psychiatrie Adultes, Centre Hospitalier Universitaire Dijon-Bourgogne, Unité INSERM LNC-UMR 1231, Université de Bourgogne, Dijon, France
| | - Guillaume Chabridon
- Service de Psychiatrie Adultes, Centre Hospitalier Universitaire Dijon-Bourgogne, Unité INSERM LNC-UMR 1231, Université de Bourgogne, Dijon, France
| | - Emmanuel Haffen
- Service de Psychiatrie, CIC-1431 INSERM, CHU de Besançon, Laboratoire de Neurosciences, Université Bourgogne-Franche-Comté, Besançon, France
| | - Magali Nicolier
- Service de Psychiatrie, CIC-1431 INSERM, CHU de Besançon, Laboratoire de Neurosciences, Université Bourgogne-Franche-Comté, Besançon, France
| | - Anna Zinetti-Bertschy
- Department of Psychiatry, Mental Health & Addictology, Strasbourg University Hospital, Strasbourg, France
- Strasbourg University, Faculty of Psychology, Strasbourg, France
| | - Pierre Vidailhet
- Department of Psychiatry, Mental Health & Addictology, Strasbourg University Hospital, Strasbourg, France
- Regional Great East Center for Psychotraumatism, Strasbourg, France
- Strasbourg University, Faculty of Medicine, Strasbourg, France
- INSERM U1329, Strasbourg Translational NEuroscience and Psychiatry (STEP), Team Psychiatry, Strasbourg, France
- Fédération de Médecine Translationnelle de Strasbourg, France
| | - Luisa Weiner
- Department of Psychiatry, Mental Health & Addictology, Strasbourg University Hospital, Strasbourg, France
- Strasbourg University, Faculty of Psychology, Strasbourg, France
- Laboratoire de Psychologie des Cognitions, Université de Strasbourg, Strasbourg, France
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Meyer K, Schoofs N, Hildebrandt A, Bermpohl F, Priebe K. What to think or how to think - is symptom reduction in posttraumatic symptomatology associated with change in posttraumatic cognitions or perseverative thinking? A latent change score model approach. Psychother Res 2024:1-16. [PMID: 38412334 DOI: 10.1080/10503307.2024.2316009] [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: 08/31/2023] [Accepted: 02/01/2024] [Indexed: 02/29/2024] Open
Abstract
OBJECTIVE Patients with posttraumatic stress disorder (PTSD) report changes in what they think of the world and themselves, referred to as posttraumatic cognitions, and changes in how they think, reflected in increased perseverative thinking. We investigated whether pre-post therapy changes in the two aspects of thinking were associated with pre-post therapy changes in posttraumatic symptom severity. METHOD 219 d clinic patients with posttraumatic stress symptoms received trauma-focused psychotherapy with cognitive behavioral and metacognitive elements. The posttraumatic cognitions inventory (PTCI), the perseverative thinking questionnaire (PTQ), and the Davidson trauma scale (DTS) were applied at two occasions, pre- and post-therapy. Using latent change score models, we investigated whether change in PTCI and change in PTQ were associated with change in DTS and its subscales. We then compared the predictive value of PTQ and PTCI in joint models. RESULTS When jointly modeled, change in overall DTS score was associated with change in both PTCI and PTQ. Concerning DTS subscales, reexperiencing and avoidance were significantly associated with change in PTCI, but not in PTQ. CONCLUSION Results indicate that both aspects of cognition may be valuable targets of psychotherapy. A focus on posttraumatic cognitions might be called for in patients with severe reexperiencing and avoidance.
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Affiliation(s)
- Kristina Meyer
- Department of Psychiatry and Neurosciences, Psychiatric University Clinic of the Charité at St. Hedwig-Hospital, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Nikola Schoofs
- Department of Psychiatry and Neurosciences, Psychiatric University Clinic of the Charité at St. Hedwig-Hospital, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Andrea Hildebrandt
- Department of Psychology, Psychological Methods and Statistics, Carl von Ossietzky Universität Oldenburg, Berlin, Germany
| | - Felix Bermpohl
- Department of Psychiatry and Neurosciences, Psychiatric University Clinic of the Charité at St. Hedwig-Hospital, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Kathlen Priebe
- Department of Psychiatry and Neurosciences, Psychiatric University Clinic of the Charité at St. Hedwig-Hospital, Charité Universitätsmedizin Berlin, Berlin, Germany
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Alpert E, Shotwell Tabke C, Cole TA, Lee DJ, Sloan DM. A systematic review of literature examining mediators and mechanisms of change in empirically supported treatments for posttraumatic stress disorder. Clin Psychol Rev 2023; 103:102300. [PMID: 37320986 DOI: 10.1016/j.cpr.2023.102300] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 05/27/2023] [Indexed: 06/17/2023]
Abstract
Despite the availability of empirically supported treatments (ESTs) for posttraumatic stress disorder (PTSD), relatively little is known regarding these treatments' mechanisms of change. This systematic review moves beyond previous reviews by summarizing the findings and reviewing the methodological quality of literature that specifically examined mediators/mechanisms of change in ESTs for PTSD. Studies were included if they were written in English, empirical, peer-reviewed, claimed to study mediators/mechanisms of a recommended PTSD treatment, measured the mediator/mechanism during or before and after treatment, and included a posttreatment PTSD or global outcome (e.g., functioning). PsycINFO and PubMed were searched on October 7, 2022. Two coders screened and coded studies. Sixty-two eligible studies were identified. The most consistent mediator/mechanism was reduction in negative posttraumatic cognitions, followed by between-session extinction and decreased depression. Only 47% of studies measured the mediator/mechanism before the outcome and measured the mediator/mechanism and outcome at least three times, and 32% also used growth curve modeling to establish temporal precedence of change in the mediator/mechanism and outcome. Many of the mediators/mechanisms examined had weak or no empirical support. Results highlight the need for improved methodological rigor in treatment mediator and mechanism research. Implications for clinical care and research are discussed. PROSPERO ID: 248088.
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Affiliation(s)
- Elizabeth Alpert
- National Center for PTSD, United States of America; VA Boston Healthcare System, United States of America; Boston University Chobanian & Avedisian School of Medicine, United States of America.
| | - Chelsea Shotwell Tabke
- National Center for PTSD, United States of America; VA Boston Healthcare System, United States of America; Boston University Chobanian & Avedisian School of Medicine, United States of America
| | - Travis A Cole
- National Center for PTSD, United States of America; VA Boston Healthcare System, United States of America
| | - Daniel J Lee
- National Center for PTSD, United States of America; VA Boston Healthcare System, United States of America; Boston University Chobanian & Avedisian School of Medicine, United States of America
| | - Denise M Sloan
- National Center for PTSD, United States of America; VA Boston Healthcare System, United States of America; Boston University Chobanian & Avedisian School of Medicine, United States of America
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4
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Alpert E, Hayes AM, Barnes JB, Sloan D. Using Client Narratives to Identify Predictors of Outcome in Written Exposure Therapy and Cognitive Processing Therapy. Behav Ther 2023; 54:185-199. [PMID: 36858753 PMCID: PMC9991074 DOI: 10.1016/j.beth.2022.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 08/29/2022] [Accepted: 09/06/2022] [Indexed: 11/19/2022]
Abstract
Written exposure therapy (WET) is a brief, five-session treatment for posttraumatic stress disorder (PTSD) that aims to improve access to care. WET has been demonstrated to be an efficacious PTSD treatment with lower rates of dropout and noninferior PTSD symptom outcome compared to cognitive processing therapy (CPT), a 12-session, gold-standard treatment. To identify predictors of treatment outcome in both WET and CPT, the current study examined the content of participants' written narratives. Participants were 123 adults with PTSD who were randomly assigned to receive WET (n = 61) or CPT (n = 62). The Change and Growth Experiences Scale (CHANGE) coding system was used to code all available narratives in both treatment conditions for variables hypothesized to be relevant to therapeutic change. Linear regression analyses revealed that in WET, higher average levels of accommodated (healthy, balanced) beliefs and an increase in accommodated beliefs from the first to the final impact statement predicted better PTSD symptom outcome at 12 weeks postrandomization. In CPT, higher average levels of overgeneralized and accommodated beliefs and lower levels of avoidance expressed in the narratives predicted better PTSD outcome. There were no significant predictors of outcome in analyses of change from the first to final impact statement in CPT. These findings add to research identifying predictors of change in WET and CPT by highlighting the importance of low avoidance in CPT and of trauma-related cognitions in both CPT and WET, even though WET is a brief written intervention that does not explicitly target cognitive change.
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Affiliation(s)
- Elizabeth Alpert
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, USA
| | - Adele M. Hayes
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, USA
| | - J. Ben Barnes
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, USA
| | - Denise Sloan
- National Center for PTSD Behavioral Science Division, VA Boston Healthcare System, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
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Yiğitoğlu GT, Keskin G, Köktaş NÇ. The traumatic impact of the COVID-19 pandemic: the possible role of rumination and uncertainty. CURRENT PSYCHOLOGY 2023:1-10. [PMID: 36855641 PMCID: PMC9950700 DOI: 10.1007/s12144-023-04379-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2023] [Indexed: 03/02/2023]
Abstract
The COVID-19 pandemic has caused some traumatic injuries to individuals due to the isolation, loneliness, and uncertainty it has created. Ruminative thoughts and uncertain situations are known to affect trauma. It aimed to evaluate the traumatic effect of the pandemic based on the ruminative thoughts and intolerance of uncertainty in the study. The sample for the descriptive and cross-sectional study consisted of 402 participants. Data were collected by using the questionnaire form, the Post Traumatic Stress Disorder Scale (PTSD), the Ruminative Reactions Scale (RRS), and the Intolerance of Uncertainty Scale (IUS). A positive correlation was discovered between the PTSD mean scores of the study participants and their RRS and IUS scores (p < .05). Furthermore, RRS (β = 0.280) was identified as a variable that primarily affected PTSD (p < .05). It was concluded that both ruminative thoughts and intolerance of uncertainty were predictors of post-traumatic stress disorder in the COVID-19 pandemic. Considering the possible effects of the pandemic, it is recommended to reduce the intolerance to uncertainty, to rework the ruminative thought content with appropriate and effective methods, and to create some programs for gaining problem-solving skills.
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Affiliation(s)
- Gülay Taşdemir Yiğitoğlu
- Department of Nursing, Faculty of Health Sciences, Pamukkale University, Floor 3, Block C, Kınıklı Campus, 20160 Denizli, Turkey
| | - Gülseren Keskin
- Atatürk Vocational School of Health Services, Ege University, İzmir, Turkey
| | - Nesrin Çunkuş Köktaş
- Department of Nursing, Faculty of Health Sciences, Pamukkale University, Floor 3, Block C, Kınıklı Campus, 20160 Denizli, Turkey
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6
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Miethe S, Wigger J, Wartemann A, Fuchs FO, Trautmann S. Posttraumatic Stress Symptoms and its Association with Rumination, Thought Suppression and Experiential Avoidance: a Systematic Review and Meta-Analysis. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2023. [DOI: 10.1007/s10862-023-10022-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
AbstractPosttraumatic stress disorder (PTSD) is a severe mental disorder causing high individual and societal costs. The use of maladaptive emotion regulation (ER) strategies has been identified as a potential contributing factor. This meta-analysis aimed to quantify the associations between PTSD symptoms and rumination, thought suppression and experiential avoidance. The systematic literature search resulted in 5574 studies, 75 of which were included in the analysis. From those eligible studies 189 effect sizes were obtained. For symptoms of posttraumatic stress, large effects were found for associations with rumination (r = .52) and experiential avoidance (r = .48), whereas a medium effect size was found for thought suppression (r = .29). With respect to different PTSD symptom clusters, associations ranged between r = .35 and r = .41 for associations with intrusive re-experiencing, between r = .39 and r = .41 for associations with avoidance, between r = .50 and r = .53 for associations with alterations in cognitions and mood and between r = .41 and r = .45 for associations with alterations in arousal and activity. Few available studies provide some evidence that associations might be somewhat reduced but still substantial in longitudinal compared to cross-sectional studies. These findings provide valuable targets for future investigations with the long-term goal of improving targeted interventions for the prevention and treatment of PTSD symptoms.
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7
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Wisco BE, Vrshek-Schallhorn S, May CL, Campbell AA, Nomamiukor FO, Pugach CP. Effects of trauma-focused rumination among trauma-exposed individuals with and without posttraumatic stress disorder: An experiment. J Trauma Stress 2023; 36:285-298. [PMID: 36655347 DOI: 10.1002/jts.22905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 10/19/2022] [Accepted: 11/16/2022] [Indexed: 01/20/2023]
Abstract
Rumination, or thinking repetitively about one's distress, is a risk factor for posttraumatic stress disorder (PTSD). Current theories suggest that rumination contributes to PTSD symptoms directly, by increasing negative reactions to trauma cues (i.e., symptom exacerbation), or represents a form of cognitive avoidance, if verbal ruminations are less distressing than trauma imagery. The goal of this study was to test the symptom exacerbation and cognitive avoidance accounts of trauma-focused rumination. We recruited 135 trauma-exposed participants (n = 60 diagnosed with PTSD) and randomly assigned them to ruminate about their trauma, distract themselves, or engage in trauma imagery. For individuals with and without PTSD, rumination led to larger increases in subjective distress (i.e., negative affect, fear, sadness, subjective arousal, valence) than distraction, ηp 2 s = .04-.13, but there were no differences between rumination and imagery ηp 2 s = .001-.02. We found no evidence that rumination or imagery elicited physiological arousal, ds = 0.01-0.19, but did find that distraction reduced general physiological arousal, as measured by heart rate, relative to baseline, d = 0.84, which may be due to increases in parasympathetic nervous system activity (i.e., respiratory sinus arrhythmia), d = 0.33. These findings offer no support for the avoidant function of rumination in PTSD. Instead, the findings were consistent with symptom exacerbation, indicating that rumination leads directly to emotional reactivity to trauma reminders and may be a fruitful target in PTSD intervention.
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Affiliation(s)
- Blair E Wisco
- Department of Psychology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Suzanne Vrshek-Schallhorn
- Department of Psychology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Casey L May
- Department of Psychology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Allison A Campbell
- Department of Psychology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Faith O Nomamiukor
- Department of Psychology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Cameron P Pugach
- Department of Psychology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
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