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Hansen C, Iannos M, Van Hooff M. Assistance dogs help reduce mental health symptoms among Australian Defence Force veterans and emergency services personnel: A pilot study. Psychiatry Res 2023; 324:115212. [PMID: 37079934 DOI: 10.1016/j.psychres.2023.115212] [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: 11/28/2022] [Revised: 04/11/2023] [Accepted: 04/13/2023] [Indexed: 04/22/2023]
Abstract
The aim of this pilot study was to evaluate the effectiveness of two specialized Australian PTSD assistance dog programs in reducing PTSD and mental health symptoms over a one-year period. A total of 44 participants who were partnered with an assistance dog were analysed. Using an intent to treat analysis, compared to the baseline measures, all mental health outcomes exhibited statistically significant reductions in scores at the 3-month follow-up, and persisted at the 6-month, and 12-month follow-up. When comparing baseline to 3-month follow-up the effect size (Cohen's d) was strongest for stress (d = 0.993), followed by PTSD (d = 0.892), anxiety (d = 0.837). Analyses among those who also completed the waitlist-baseline assessment (n = 23) showed slight reductions in stress and depression prior to receiving their dog (whilst waiting for their dog). However, larger reductions were yielded across all mental health measures when comparing waitlist-baseline to 3-month follow-up.
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Affiliation(s)
- C Hansen
- Military and Emergency Services Health Australia (MESHA), The Hospital Research Foundation Group, Adelaide, South Australia, Australia; The University of Adelaide, South Australia, Australia.
| | - M Iannos
- Military and Emergency Services Health Australia (MESHA), The Hospital Research Foundation Group, Adelaide, South Australia, Australia
| | - M Van Hooff
- Military and Emergency Services Health Australia (MESHA), The Hospital Research Foundation Group, Adelaide, South Australia, Australia; The University of Adelaide, South Australia, Australia
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King L, Campbell D, Finkbeiner M, Gallimore J, Kennedy J, McCarthy E, Ketcheson F. The mySELF group: Recreation- and art-based group therapy as adjunct treatment for posttraumatic stress disorder. JOURNAL OF MILITARY, VETERAN AND FAMILY HEALTH 2023. [DOI: 10.3138/jmvfh-2022-0062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
LAY SUMMARY Military personnel and Veterans receiving psychotherapy for mental health diagnoses such as posttraumatic stress disorder (PTSD) often have only modest symptom improvement. The authors wondered whether participating in a therapeutic recreation and creative arts group along with psychotherapy would aid recovery. A 12-week program called the my Social life, Expression, Leisure and Food (mySELF) group was created that offered therapeutic recreation, art, and music therapy. A total of 36 clients, most with PTSD, who had been receiving psychotherapy for an average of three years completed the program and submitted pre- and post-group questionnaires. The authors examined leisure attitudes, quality of life, and mental health symptoms before, immediately after, and four months after the group. Results showed significant improvements in leisure attitudes, environmental quality of life and depression, anxiety, stress, and PTSD symptoms. These preliminary results suggest that therapeutic recreation, art, and music therapy are beneficial for military personnel, Veterans, and Royal Canadian Mounted Police receiving psychotherapy.
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Affiliation(s)
- Lisa King
- St. Joseph’s Health Care Parkwood Institute, Operational Stress Injury Clinic, London, Ontario, Canada
| | - Doreen Campbell
- St. Joseph’s Health Care Parkwood Institute, Veterans Care, London, Ontario, Canada
| | - Marie Finkbeiner
- St. Joseph’s Health Care Parkwood Institute, Veterans Care, London, Ontario, Canada
| | - Jane Gallimore
- St. Joseph’s Health Care Parkwood Institute, Operational Stress Injury Clinic, London, Ontario, Canada
| | - Jill Kennedy
- St. Joseph’s Health Care Parkwood Institute, Veterans Care, London, Ontario, Canada
| | - Emily McCarthy
- St. Joseph’s Health Care Parkwood Institute, Veterans Care, London, Ontario, Canada
| | - Felicia Ketcheson
- St. Joseph’s Health Care Parkwood Institute, Operational Stress Injury Clinic, London, Ontario, Canada
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3
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Comparing Trauma Treatment Outcomes Between Homeless and Housed Veterans in a VA PTSD Clinical Program. Community Ment Health J 2022; 59:797-807. [PMID: 36459286 DOI: 10.1007/s10597-022-01061-2] [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: 06/09/2022] [Accepted: 11/18/2022] [Indexed: 12/03/2022]
Abstract
Homeless veterans are likely to experience Post Traumatic Stress Disorder (PTSD). Homelessness itself is traumatic, and PTSD may exacerbate homelessness risk for veterans. Often, PTSD goes untreated in this subpopulation of veterans. Our study examined trauma-focused treatment (TFT) and non-TFT initiation and completion in a sample of housed and homeless veterans being served by a PTSD clinical team in Washington, DC. Findings included a high percentage of veterans who experienced homelessness in the sample and lower treatment completion rates among homeless veterans compared to housed veterans. This difference was no longer significant when comparing only those veterans who engaged in treatment, reinforcing the critical role of treatment engagement in successful treatment completion across populations.
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4
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Bahji A, Di Nota PM, Groll D, Carleton RN, Anderson GS. Psychological interventions for post-traumatic stress injuries among public safety personnel: a systematic review and meta-analysis. Syst Rev 2022; 11:255. [PMID: 36434683 PMCID: PMC9701019 DOI: 10.1186/s13643-022-02112-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 11/02/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Public safety personnel (PSP) are exposed to potentially psychologically traumatic events (PPTE) far more often than the general public, which increases the risk for various post-traumatic stress injuries (PTSIs). While there are many evidence-based psychological interventions for PTSI, the effectiveness of each intervention for PSP remains unclear. OBJECTIVES The current study assessed the effectiveness and acceptability of psychological interventions for PTSI among PSPs. METHODS A systematic review and random-effects meta-analysis were performed on the effectiveness and acceptability of psychotherapies for PTSIs (i.e., symptoms of depression, anxiety, post-traumatic stress disorder) among PSP. The review adhered to the PRISMA reporting guidelines and used standardized mean differences (Cohen's d), rate ratios (RR), and their 95% confidence intervals (95% CI) to measure pooled effect sizes across studies; negative d values and RR values less than one indicated a reduction in symptoms compared to baseline or control groups. In addition, heterogeneity was quantified using I2, and publication bias was evaluated using Egger's test. RESULTS The analyses included data from eight randomized controlled trials representing 402 PSP (79.4% male, 35.3 years). Psychological interventions included narrative exposure therapy (n = 1), cognitive behavioral therapy (n = 2), eclectic psychotherapy (n = 2), eye-movement desensitization and reprocessing (n = 1), supportive counseling (n = 2), and group critical incident stress debriefing (n = 1). The interventions were associated with statistically significant reductions in symptoms associated with PTSD (d = - 1.23; 95% CI - 1.81, - 0.65; 7 studies; I2 = 81%), anxiety (- 0.76; 95% CI - 1.28, - 0.24; 3 studies; I2 = 47%), and depression (d = - 1.10; 95% CI - 1.62, - 0.58; 5 studies; I2 = 64%). There were smaller but statistically significant improvements at follow-up for symptoms of PTSD (d = - 1.29 [- 2.31, - 0.27]), anxiety (d = - 0.82 [- 1.20, - 0.44]), and depression (d = - 0.46 [- 0.77, - 0.14]). There were no statistically significant differences in dropout rates (RR = 1.00 [0.96, 1.05]), suggesting high acceptability across interventions. CONCLUSIONS There is preliminary evidence that psychotherapies help treat PTSIs in PSP; however, the shortage of high-quality studies on PSP indicates a need for additional research into treating PTSI among PSP. SYSTEMATIC REVIEW REGISTRATION PROSPERO: CRD42019133534.
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Affiliation(s)
- Anees Bahji
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Paula M Di Nota
- Office of Applied Research and Graduate Studies, Justice Institute of British Columbia, Vancouver, BC, Canada
| | - Dianne Groll
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
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5
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Sullivan KS, Dodge J, Park Y, Kale C, Merrill JC, Clarke-Walper K, Castro CA, Riviere LA. Predictors of reintegration adjustment among female U.S. Army spouses: A preliminary exploration. JOURNAL OF MILITARY, VETERAN AND FAMILY HEALTH 2022. [DOI: 10.3138/jmvfh-2021-0125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
LAY SUMMARY Little is known about how military families navigate the challenges they experience during reintegration, the period after a deployment separation when a service member returns home and families must readjust to their presence. This study considers how family risk factors such as the mental health of both partners and protective factors such as social support and participation in military-sponsored training influence family adjustment during reintegration. Military spouses who reported having more social support were likely to report that their families adjusted more quickly during reintegration. However, spouses who expressed concern about a partner’s mental health were less likely to feel prepared for reintegration and, in turn, were more likely to report that their families adjusted more slowly. The results of this study suggest that supporting military spouses in feeling more prepared for reintegration may be an important means to shorten the adjustment period after a deployment.
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Affiliation(s)
- Kathrine S. Sullivan
- Silver School of Social Work, New York University, New York, New York, United States
| | - Jessica Dodge
- Center for Clinical Management Research, Ann Arbor Veterans Affairs Hospital, Ann Arbor, Michigan, United States
| | - Yangjin Park
- Silver School of Social Work, New York University, New York, New York, United States
| | - Caroline Kale
- Silver School of Social Work, New York University, New York, New York, United States
| | - Julie C. Merrill
- U.S. Army Medical Research Directorate-West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, Washington, District of Columbia, United States
| | - Kristina Clarke-Walper
- Center for Military Psychiatry & Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States
| | - Carl A. Castro
- Center for Innovation and Research on Veterans and Military Families, University of Southern California, Los Angeles, California, United States
| | - Lyndon A. Riviere
- Center for Military Psychiatry & Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States
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6
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Bredemeier K, Larsen S, Shivakumar G, Grubbs K, McLean C, Tress C, Rosenfield D, DeRubeis R, Xu C, Foa E, Morland L, Pai A, Tsao C, Crawford J, Weitz E, Mayinja L, Feler B, Wachsman T, Lupo M, Hooper V, Cook R, Thase M. A comparison of prolonged exposure therapy, pharmacotherapy, and their combination for PTSD: What works best and for whom; study protocol for a randomized trial. Contemp Clin Trials 2022; 119:106850. [PMID: 35842108 DOI: 10.1016/j.cct.2022.106850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/22/2022] [Accepted: 07/10/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Several efficacious psychological and pharmacological treatments for posttraumatic stress disorder (PTSD) are available; however, the comparative effectiveness of these treatments represents a major gap in the literature. The proposed study will compare the effectiveness of two leading PTSD treatments - Prolonged Exposure (PE) therapy and pharmacotherapy with paroxetine or venlafaxine extended release - as well as the combination of PE and medication. METHODS In a randomized clinical trial, veterans with PTSD (N = 450) recruited across six Veterans Affairs Medical Centers will complete assessments at baseline, mid-treatment (Week 7), post-treatment (Week 14), and follow-up (Weeks 27 and 40). The primary outcome will be change in (both clinician-rated and self-reported) PTSD severity. Depression symptoms, quality of life, and functioning will also be measured and examined as secondary outcomes. Baseline demographic and clinical data will be used to develop "personalized advantage indices" (PAIs), with the goal of identifying who is most likely to benefit from which treatment. CONCLUSIONS This planned trial will yield findings to directly inform clinical practice guidelines for PTSD, by providing comparative effectiveness data to support recommendations about what can be considered the "first-line" treatment option(s) for PTSD. Further, findings from this trial have the potential to guide treatment planning for individual patients, through implementation of PAIs developed from study data, in service of "personalized medicine." TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT04961190.
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Affiliation(s)
- Keith Bredemeier
- University of Pennsylvania, 3535 Market Street, Suite 600, Philadelphia, PA 19104, USA.
| | - Sadie Larsen
- Milwaukee VA Medical Center, 5000 West National Avenue, Milwaukee, WI 53295-1000, USA; Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI 53226, USA.
| | - Geetha Shivakumar
- Dallas VA Medical Center, 4500 South Lancaster Road, Dallas, TX 75216-7167, USA; University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA.
| | - Kathleen Grubbs
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161-0002, USA; University of California San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA.
| | - Carmen McLean
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025, USA; Stanford University, 450 Serra Mall, Stanford, CA 94305, USA.
| | - Carmella Tress
- Coatesville VA Medical Center, 1400 Black Horse Hill Road, Coatesville, PA 19320-2096, USA.
| | - David Rosenfield
- Southern Methodist University, 6425 Boaz Lane, Dallas, TX 75205, USA.
| | - Rob DeRubeis
- University of Pennsylvania, 3535 Market Street, Suite 600, Philadelphia, PA 19104, USA.
| | - Colin Xu
- University of Pennsylvania, 3535 Market Street, Suite 600, Philadelphia, PA 19104, USA.
| | - Edna Foa
- University of Pennsylvania, 3535 Market Street, Suite 600, Philadelphia, PA 19104, USA.
| | - Leslie Morland
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161-0002, USA; University of California San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA.
| | - Anushka Pai
- Dallas VA Medical Center, 4500 South Lancaster Road, Dallas, TX 75216-7167, USA; University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA.
| | - Carol Tsao
- Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI 53226, USA.
| | - Jaclyn Crawford
- Coatesville VA Medical Center, 1400 Black Horse Hill Road, Coatesville, PA 19320-2096, USA.
| | - Erica Weitz
- University of Pennsylvania, 3535 Market Street, Suite 600, Philadelphia, PA 19104, USA.
| | - Lindiwe Mayinja
- University of Pennsylvania, 3535 Market Street, Suite 600, Philadelphia, PA 19104, USA; Coatesville VA Medical Center, 1400 Black Horse Hill Road, Coatesville, PA 19320-2096, USA.
| | - Bridget Feler
- University of Pennsylvania, 3535 Market Street, Suite 600, Philadelphia, PA 19104, USA.
| | - Tamara Wachsman
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161-0002, USA.
| | - Margaret Lupo
- Dallas VA Medical Center, 4500 South Lancaster Road, Dallas, TX 75216-7167, USA.
| | - Vaughan Hooper
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025, USA.
| | - Riley Cook
- Dallas VA Medical Center, 4500 South Lancaster Road, Dallas, TX 75216-7167, USA.
| | - Michael Thase
- University of Pennsylvania, 3535 Market Street, Suite 600, Philadelphia, PA 19104, USA; Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104, USA.
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7
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Williams MW, King-Casas B, Chiu PH, Sciarrino N, Estey M, Hunt C, McCurry K, Graham DP. Do early responders and treatment non-responders offer guidance to make CPT group a more effective treatment? J Clin Psychol 2022; 78:1376-1387. [PMID: 35170058 PMCID: PMC9203865 DOI: 10.1002/jclp.23307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/26/2021] [Accepted: 12/21/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Treatment dropout has been problematic with evidence-based treatments for posttraumatic stress disorder (PTSD), including cognitive processing therapy (CPT). This study sought to evaluate whether CPT group contributed to symptom improvement among treatment completers and non-completers. METHODS Sixty-one Iraq and Afghanistan combat Veterans self-selected CPT group or treatment as usual (TAU) forming a convenience sample. Defining treatment completion as attending at least nine sessions: 18 completed treatment, 20 dropped-out (DOs); 20 completed TAU, 3 lost to TAU follow-up. RESULTS Multiple Regression revealed significant pre-post-treatment improvement, the Clinician-Administered PTSD Scale (CAPS-IV, F(5, 40.1) = 2.53, p = 0.0436). Reviewing DOs' last available PTSD Checklist-Military Version scores before leaving treatment, six achieved clinically significant improvement of >10 points; seven a clinically reliable change of 5-10 points. CONCLUSION These findings highlight that CPT group may be effective at reducing trauma-related symptoms among treatment completers and dropouts and point to the utility of a clinical definition of good treatment end-state.
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Affiliation(s)
- M Wright Williams
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX
| | - Brooks King-Casas
- Salem Veterans Affairs Medical Center, University of Virginia School of Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
- Virginia Tech Carilion Research Institute, Roanoke, Virginia, USA
| | - Pearl H Chiu
- Salem Veterans Affairs Medical Center, University of Virginia School of Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
- Virginia Tech Carilion Research Institute, Roanoke, Virginia, USA
| | - Nicole Sciarrino
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC
| | | | - Christopher Hunt
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
- The University of Minnesota, Minneapolis, Minnesota
| | - Katherine McCurry
- Salem Veterans Affairs Medical Center, University of Virginia School of Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
- Virginia Tech Carilion Research Institute, Roanoke, Virginia, USA
| | - David P. Graham
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX
- Houston VA Health Services Research and Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
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Tanev KS, Lynch EA, Blackburn AM, Terry D, Goetter EM, Wright EC, Gupta C, Stasko CE, Spencer T. Associations between residual hyperarousal and insomnia symptoms in veterans following a 2-week intensive outpatient program for posttraumatic stress disorder. J Trauma Stress 2022; 35:461-472. [PMID: 34811818 DOI: 10.1002/jts.22758] [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: 10/23/2020] [Revised: 07/23/2021] [Accepted: 08/02/2021] [Indexed: 11/09/2022]
Abstract
Many returning military service members and veterans who were deployed following the September 11, 2001, terrorist attacks (9/11) suffer from posttraumatic stress disorder (PTSD) and insomnia. Although intensive treatment programs for PTSD have shown promise in the treatment of PTSD symptoms, recent research has demonstrated that sleep disturbance shows little improvement following intensive trauma-focused treatment. The aim of the present study was to evaluate changes in self-reported insomnia symptoms among veterans and service members following participation in a 2-week intensive program for PTSD. We further aimed to investigate if residual PTSD symptoms, specifically hyperarousal, were associated with residual insomnia symptoms. Participants (N = 326) completed self-report assessments of insomnia, PTSD symptoms, and depressive symptoms at pre- and posttreatment. At pretreatment, 73.9% of participants (n = 241) met the criteria for moderate or severe insomnia, whereas at posttreatment 67.7% of participants (n = 203) met the criteria. Results of paired t tests demonstrated statistically significant differences between pre- and posttreatment Insomnia Severity Index scores; however, the effect size was small, d = 0.34. Analyses revealed that posttreatment hyperarousal symptoms were associated with posttreatment insomnia. These findings suggest that although an intensive program for service members and veterans with PTSD may significantly reduce insomnia symptoms, clinically meaningful residual insomnia symptoms remain. Further research is warranted to elucidate the association between residual hyperarousal and insomnia symptoms following intensive trauma-focused treatment.
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Affiliation(s)
- Kaloyan S Tanev
- Home Base: A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, Massachusetts, USA.,Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Elyse A Lynch
- Home Base: A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, Massachusetts, USA
| | - Allyson M Blackburn
- Home Base: A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, Massachusetts, USA.,Department of Psychology, University of Illinois in Urbana-Champaign, Champaign, Illinois, USA
| | - Douglas Terry
- Home Base: A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, Massachusetts, USA.,Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
| | - Elizabeth M Goetter
- Home Base: A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, Massachusetts, USA.,Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Edward C Wright
- Home Base: A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, Massachusetts, USA.,Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Carina Gupta
- Home Base: A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, Massachusetts, USA
| | - Cory E Stasko
- Home Base: A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, Massachusetts, USA
| | - Tom Spencer
- Home Base: A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, Massachusetts, USA.,Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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9
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Schnitzer G, Holttum S, Huet V. "My heart on this bit of paper": A grounded theory of the mechanisms of change in art therapy for military veterans. J Affect Disord 2022; 297:327-337. [PMID: 34715166 DOI: 10.1016/j.jad.2021.10.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 10/12/2021] [Accepted: 10/23/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND A proportion of veterans experience post-traumatic stress disorder (PTSD). Research has shown reduced effectiveness of commonly offered psychotherapies in military personnel. Some research suggested the usefulness of art therapy for veterans with PTSD, but its mechanism of operation has been unclear. The current project aimed to establish participants' perceptions of any impact of group art therapy and some of the perceived mechanisms of change. METHOD In a grounded theory design, single semi-structured interviews were conducted with nine veterans who had received group art therapy, two art therapists, and a veteran's wife. Interviews were transcribed and analysed. FINDINGS Theorised categories included (a) art therapy group as "the family", (b) "the gentle conductor", (c) trust, (d) doing the work, (e) art therapy as "a communication tool", (f) "points of recognition", (g) "making things concrete", and (h) "not a cure". LIMITATIONS Shortcomings included a homogenous sample who all attended art therapy alongside other interventions, reliance on subjective and unmeasured symptom change, and researcher effects related to qualitative methodology. CONCLUSION The developed grounded theory is consistent with existing evidence and neuropsychological theory. Group art therapy may enable some veterans to prepare for verbal-only therapy, by offering a safe space in which to approach non-verbal traumatic and trauma-related contextual material in a controlled way. Artworks may provide a bridge to facilitate communication of experiences within subsequent verbal therapy and with loved-ones. It is suggested to replicate the project at different sites. Elements of the developed theory may be investigated further to establish its transferability.
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Affiliation(s)
- Gabriel Schnitzer
- Salomons Institute for Applied Psychology, Canterbury Christ Church University, Tunbridge Wells BN2 3EW, United Kingdom.
| | - Sue Holttum
- Salomons Institute for Applied Psychology, Canterbury Christ Church University, Tunbridge Wells BN2 3EW, United Kingdom; British Association of Art Therapists, London, United Kingdom
| | - Val Huet
- British Association of Art Therapists, London, United Kingdom
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10
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Martinho R, Correia G, Seixas R, Oliveira A, Silva S, Serrão P, Fernandes-Lopes C, Costa C, Moreira-Rodrigues M. Treatment With Nepicastat Decreases Contextual Traumatic Memories Persistence in Post-traumatic Stress Disorder. Front Mol Neurosci 2021; 14:745219. [PMID: 34630037 PMCID: PMC8498196 DOI: 10.3389/fnmol.2021.745219] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 08/31/2021] [Indexed: 11/13/2022] Open
Abstract
Post-traumatic stress disorder (PTSD) is a common anxiety mental disorder and can be manifested after exposure to a real or perceived life-threatening event. Increased noradrenaline and adrenaline in plasma and urine have been documented in PTSD. Dopamine-β-hydroxylase (DBH) catalyzes the conversion of dopamine to noradrenaline and consequently, DBH inhibition reduces catecholamines. Our aim was to evaluate if nepicastat treatment decreases PTSD signs in an animal model. Wild-type (129x1/SvJ) female mice were submitted to PTSD induction protocol. DBH-inhibitor nepicastat (30 mg/kg) or vehicle (0.2% HPMC) were administered once daily since day 0 until day 7 or 12. The percentage of freezing was calculated on days 0, 1, 2, and 7, and behavioral tests were performed. Quantification of nepicastat in plasma and DBH activity in the adrenal gland was evaluated. Catecholamines were quantified by HPLC with electrochemical detection. mRNA expression of Npas4 and Bdnf in hippocampus was evaluated by qPCR.Mice in the PTSD-group and treated with nepicastat showed a decrease in freezing, and an increase in the time spent and entries in open arms in elevated plus maze test. In mice treated with nepicastat, adrenal gland DBH activity was decreased, and catecholamines were also decreased in plasma and tissues. On day 7, in mice treated with nepicastat, there was an increase of Npas4 and Bdnf mRNA expression in the hippocampus.In conclusion, DBH inhibitor nepicastat has an effect consistent with a decrease in the persistence of traumatic memories and anxiety-like behavior in this PTSD mice model. The disruption of traumatic memories through interference with the formation, consolidation, retrieval, and/or expression processes may be important to decrease PTSD symptoms and signs. The increase in Npas4 and Bdnf mRNA expression in the hippocampus may be important to develop a weaker traumatic contextual memory after nepicastat treatment.
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Affiliation(s)
- Raquel Martinho
- Laboratory of General Physiology, Institute of Biomedical Sciences Abel Salazar, University of Porto (ICBAS/UP), Porto, Portugal.,Center for Drug Discovery and Innovative Medicines, University of Porto (MedInUP), Porto, Portugal
| | - Gabriela Correia
- Laboratory of General Physiology, Institute of Biomedical Sciences Abel Salazar, University of Porto (ICBAS/UP), Porto, Portugal.,Center for Drug Discovery and Innovative Medicines, University of Porto (MedInUP), Porto, Portugal
| | - Rafaela Seixas
- Laboratory of General Physiology, Institute of Biomedical Sciences Abel Salazar, University of Porto (ICBAS/UP), Porto, Portugal.,Center for Drug Discovery and Innovative Medicines, University of Porto (MedInUP), Porto, Portugal
| | - Ana Oliveira
- Laboratory of General Physiology, Institute of Biomedical Sciences Abel Salazar, University of Porto (ICBAS/UP), Porto, Portugal.,Center for Drug Discovery and Innovative Medicines, University of Porto (MedInUP), Porto, Portugal
| | - Soraia Silva
- Laboratory of General Physiology, Institute of Biomedical Sciences Abel Salazar, University of Porto (ICBAS/UP), Porto, Portugal.,Center for Drug Discovery and Innovative Medicines, University of Porto (MedInUP), Porto, Portugal
| | - Paula Serrão
- Center for Drug Discovery and Innovative Medicines, University of Porto (MedInUP), Porto, Portugal.,Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto (FMUP), Porto, Portugal
| | | | | | - Mónica Moreira-Rodrigues
- Laboratory of General Physiology, Institute of Biomedical Sciences Abel Salazar, University of Porto (ICBAS/UP), Porto, Portugal.,Center for Drug Discovery and Innovative Medicines, University of Porto (MedInUP), Porto, Portugal
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Jensen BS, Andersen N, Petersen J, Nyboe L. Enhanced Mental Health with Virtual Reality Mental Hygiene by a Veteran Suffering from PTSD. Case Rep Psychiatry 2021; 2021:5576233. [PMID: 34285821 PMCID: PMC8275405 DOI: 10.1155/2021/5576233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 06/06/2021] [Accepted: 06/21/2021] [Indexed: 12/02/2022] Open
Abstract
This paper describes the application and feasibility of the use of Virtual Reality Mental Hygiene (VRMH) as a mean to reduce anxiety and stress in a Danish veteran suffering from posttraumatic stress disorder (PTSD) and enduring personality change after a catastrophic experience. The results from this case study provide preliminary evidence that VRMH can be used as a mean to reduce arousal in patients with severe PTSD.
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Affiliation(s)
| | | | | | - Lene Nyboe
- Clinic for PTSD and Anxiety, Aarhus University Hospital Skejby, Denmark
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12
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Grove AB, Kurtz ED, Wallace RE, Sheerin CM, Scott SM. Effectiveness of a Rational Emotive Behavior Therapy (REBT)-Informed Group for Post-9/11 Veterans with Posttraumatic Stress Disorder (PTSD). MILITARY PSYCHOLOGY 2021; 33:217-227. [PMID: 34334948 PMCID: PMC8324018 DOI: 10.1080/08995605.2021.1897496] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 01/05/2021] [Indexed: 10/21/2022]
Abstract
Various treatments aimed for posttraumatic stress disorder (PTSD) have been developed for veterans, but many are not formatted for use in groups, do not address common psychiatric comorbidities, and include inherent barriers (e.g., substantial time commitment). This program evaluation study aimed to examine the effectiveness of a five-session treatment, a Rational Emotive Behavior Therapy (REBT)-Informed Group focused on changing irrational beliefs to address comorbid depression and anxiety (as well as anger and guilt) among post-9/11 veterans with PTSD. Participants (n = 47) completing the REBT-Informed Group demonstrated significant reductions at posttreatment in depression and PTSD symptoms. Compared to veterans in a ten-session treatment-as-usual group (n = 47), there was no significant difference in PTSD symptom improvement despite the reduction in number of sessions. The study demonstrates that a five-week group treatment for PTSD comorbid with depression or anxiety in post-9/11 veterans - a therapy that may be uniquely suited to a military or veteran population, but potentially generalizable to civilians as well - can lead to significant reductions in depression and PTSD symptoms. Future directions include development of a manual for dissemination and replication of findings of the REBT-Informed Group to other military or Veterans Affairs medical centers.
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Affiliation(s)
- Allen B. Grove
- Department of Mental Health, Central Virginia VA Health Care System, Richmond, Virginia, USA
| | - Erin D. Kurtz
- Department of Mental Health, Central Virginia VA Health Care System, Richmond, Virginia, USA
- Primary Care Service Line, VA St. Louis Health Care System, St. Louis, Missouri, USA
| | - Rachel E. Wallace
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Christina M. Sheerin
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Sarah M. Scott
- Department of Mental Health, Central Virginia VA Health Care System, Richmond, Virginia, USA
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
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13
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Duek O, Pietrzak RH, Petrakis I, Hoff R, Harpaz-Rotem I. Early discontinuation of pharmacotherapy in U.S. veterans diagnosed with PTSD and the role of psychotherapy. J Psychiatr Res 2021; 132:167-173. [PMID: 33126010 DOI: 10.1016/j.jpsychires.2020.10.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 10/07/2020] [Accepted: 10/12/2020] [Indexed: 01/22/2023]
Abstract
More than 50% of individuals who enter treatment for posttraumatic stress disorder (PTSD) are prescribed a psychotropic medication. To date, however, data are limited regarding the prevalence and determinants of discontinuation of psychotropic medication in this population. To address this gap, we analyzed data from 154,953 veterans newly diagnosed with PTSD who were seeking VA treatment and followed them for one year to identify the prevalence and determinants of medication discontinuation. A hazard analysis was conducted to identify factors associated with discontinuation of antidepressant, anxiolytic/hypnotic and antipsychotic medications. Binomial regressions examined the role of these factors in early discontinuation (within 30 days). Results revealed that 71.8% of veterans discontinued medication treatment within 180 days, and 34.6% within 30 days. The strongest risk factors associated with discontinuing medication were no engagement in adjunctive psychotherapy and prescription of a single medication. Older veterans were less likely than younger veterans to discontinue treatment. Similar risk factors were associated with medication discontinuation in the first 30 days. These results suggest that psychiatric comorbidities, age, and race are key risk factors for poor medication adherence, and underscore the importance of early intervention and patient education in promoting adherence to pharmacotherapy for PTSD.
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Affiliation(s)
- Or Duek
- Yale University School of Medicine, United States; The National Center for PTSD, VA CT Healthcare System, West Haven CT, USA.
| | - Robert H Pietrzak
- Yale University School of Medicine, United States; The National Center for PTSD, VA CT Healthcare System, West Haven CT, USA
| | - Ismene Petrakis
- Yale University School of Medicine, United States; The National Center for PTSD, VA CT Healthcare System, West Haven CT, USA
| | - Rani Hoff
- Yale University School of Medicine, United States; The National Center for PTSD, VA CT Healthcare System, West Haven CT, USA; The VA Northeast Program Evaluation Center (NEPEC), West Haven CT, USA
| | - Ilan Harpaz-Rotem
- Yale University School of Medicine, United States; The National Center for PTSD, VA CT Healthcare System, West Haven CT, USA; The VA Northeast Program Evaluation Center (NEPEC), West Haven CT, USA
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14
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Natesan Batley P, Contractor AA, Caldas SV. Bayesian Time-Series Models in Single Case Experimental Designs: A Tutorial for Trauma Researchers. J Trauma Stress 2020; 33:1144-1153. [PMID: 33205545 PMCID: PMC8246830 DOI: 10.1002/jts.22614] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 09/25/2020] [Accepted: 09/26/2020] [Indexed: 01/15/2023]
Abstract
Single-case experimental designs (SCEDs) involve obtaining repeated measures from one or a few participants before, during, and, sometimes, after treatment implementation. Because they are cost-, time-, and resource-efficient and can provide robust causal evidence for more large-scale research, SCEDs are gaining popularity in trauma treatment research. However, sophisticated techniques to analyze SCED data remain underutilized. Herein, we discuss the utility of SCED data for trauma research, provide recommendations for addressing challenges specific to SCED approaches, and introduce a tutorial for two Bayesian models-the Bayesian interrupted time-series (BITS) model and the Bayesian unknown change-point (BUCP) model-that can be used to analyze the typically small sample, autocorrelated, SCED data. Software codes are provided for the ease of guiding readers in estimating these models. Analyses of a dataset from a published article as well as a trauma-specific simulated dataset are used to illustrate the models and demonstrate the interpretation of the results. We further discuss the implications of using such small-sample data-analytic techniques for SCEDs specific to trauma research.
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15
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Wheeler M, Cooper NR, Andrews L, Hacker Hughes J, Juanchich M, Rakow T, Orbell S. Outdoor recreational activity experiences improve psychological wellbeing of military veterans with post-traumatic stress disorder: Positive findings from a pilot study and a randomised controlled trial. PLoS One 2020; 15:e0241763. [PMID: 33237906 PMCID: PMC7688151 DOI: 10.1371/journal.pone.0241763] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 10/15/2020] [Indexed: 11/19/2022] Open
Abstract
Exposure to the natural environment is increasingly considered to benefit psychological health. Recent reports in the literature also suggest that outdoor exposure that includes recreational pursuits such as surfing or fishing coupled with opportunities for social interaction with peers may be beneficial to Armed Forces Veterans experiencing Post-Traumatic Stress Disorder (PTSD). Two studies were conducted to evaluate this possibility. In particular, these studies aimed to test the hypothesis that a brief group outdoor activity would decrease participants’ symptoms as assessed by established measures of PTSD, depression, anxiety and perceived stress, and increase participants’ sense of general social functioning and psychological growth. Experiment one employed a repeated measures design in which UK men and women military veterans with PTSD (N = 30) participated in a group outdoor activity (angling, equine care, or archery and falconry combined). Psychological measures were taken at 2 weeks prior, 2 weeks post, and at 4 month follow up. We obtained a significant within participant main effect indicating significant reduction in PTSD symptoms. Experiment two was a waitlist controlled randomised experiment employing an angling experience (N = 18) and 2 week follow up. In experiment 2 the predicted interaction of Group (Experimental vs. Waitlist Control) X Time (2 weeks pre vs. 2 weeks post) was obtained indicating that the experience resulted in significant reduction in PTSD symptoms relative to waitlist controls. The effect size was large. Additional analyses confirmed that the observed effects might also be considered clinically significant and reliable. In sum, peer outdoor experiences are beneficial and offer potential to complement existing provision for military veterans with Post Traumatic Stress Disorder.
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Affiliation(s)
- Mark Wheeler
- Department of Psychology, University of Essex, Colchester, Essex, United Kingdom
| | - Nicholas R. Cooper
- Department of Psychology, University of Essex, Colchester, Essex, United Kingdom
- * E-mail:
| | - Leanne Andrews
- Department of Health and Social Care, University of Essex, Colchester, Essex, United Kingdom
| | - Jamie Hacker Hughes
- Northern Hub for Veterans and Families Research, University of Northumbria, Newcastle upon Tyne, United Kingdom
| | - Marie Juanchich
- Department of Psychology, University of Essex, Colchester, Essex, United Kingdom
| | - Tim Rakow
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience; King’s College, London, United Kingdom
| | - Sheina Orbell
- Department of Psychology, University of Essex, Colchester, Essex, United Kingdom
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16
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Miles SR, Kent TA, Stanley M, Thompson KE, Sharp C, Niles BL, Young-McCaughan S, Mintz J, Roache JD, Litz BT, Hale WJ, Stanford MS, Keane TM, Peterson AL. Manage Emotions to Reduce Aggression: A Pilot Study of a Brief Treatment to Help Veterans Reduce Impulsive Aggression. J Nerv Ment Dis 2020; 208:897-903. [PMID: 32947454 DOI: 10.1097/nmd.0000000000001229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Veterans with posttraumatic stress disorder (PTSD) report more aggression than civilians with PTSD. Because emotion regulation difficulties mediated the relationship between PTSD symptoms and impulsive aggression in veterans, we developed an intervention to increase emotion regulation skills. This pilot study tested the feasibility and acceptability of a three-session treatment, Manage Emotions to Reduce Aggression (MERA), and examined its effectiveness at reducing aggression and emotion dysregulation. Male combat veterans with PTSD and impulsive aggression completed assessments before and 4 weeks after MERA. Overt Aggression Scale measured frequency of aggression; Difficulties in Emotion Regulation Scale assessed emotion dysregulation. Most veterans (95%) who completed MERA and the posttreatment assessment (n = 20) reported MERA was helpful. Veterans in the intent-to-treat sample demonstrated a significant decrease in their frequency of aggression (Cohen's d = -0.55) and emotion dysregulation (Cohen's d = -0.55). MERA may be an innovative treatment that helps veterans reduce aggression.
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Affiliation(s)
| | | | | | | | - Carla Sharp
- Department of Psychology, University of Houston, Houston, Texas
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Abstract
There is increasing theoretical, clinical, and empirical support for the hypothesis that psychospiritual development, and more specifically, postconventional religious reasoning, may be related to moral injury. In this study, we assessed the contributions of exposure to potentially morally injurious events, posttraumatic stress symptoms, and psychospiritual development to moral injury symptoms in a sample of military veterans (N = 212). Psychospiritual development was measured as four dimensions, based on Wulff’s theory juxtaposing conventional vs. postconventional levels of religious reasoning, with decisions to be an adherent or a disaffiliate of faith. After controlling for exposure to potentially morally injurious events and severity of posttraumatic stress symptoms, veterans who were conventional disaffiliates reported higher scores on the Moral Injury Questionnaire than conventional adherents, postconventional adherents, or postconventional disaffiliates. We conclude that the role of psychospiritual development offers a theoretical approach to moral injury that invites collaboration between social scientists, philosophers, theologians, and medical professionals.
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18
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Effect of Stress on Autonomic and Cardiovascular Systems in Military Population: A Systematic Review. Cardiol Res Pract 2020; 2020:7986249. [PMID: 32850146 PMCID: PMC7439199 DOI: 10.1155/2020/7986249] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 07/24/2020] [Indexed: 11/18/2022] Open
Abstract
Stress is regulated by the autonomous nervous system, increasing the sympathetic modulation when a threat is perceived. A multifactorial response usually leads to significant behavioural modifications and alterations on homeostasis and physical and psychological status. Moreover, stress is an emotional response that can lead to psychosocial and psychophysiological adversity. Regarding military population, military operations and combat exposure are important stressors that influence acute and chronic stress response in soldiers, affecting their performance and health. A bibliographic search was carried out between April and May 2019, focusing on recent studies (2013–2019) that analysed psychophysiological response, stress, stress regulation, heart rate, heart rate variability, and posttraumatic stress disorder in military population. Autonomic and cardiovascular chronic stress seems to be modulated by experience and previous specific training of each military unit. Physical exercise, music embedded with binaural beat technology, bidirectional sensory motor rhythm training, heart rate variability biofeedback, and transcutaneous vagal nerve stimulation are the main techniques applied to balance stress and to recover body homeostasis. Since military population are usually exposed to multiple stressors, knowing previous training and experience, together with developing techniques to balance stress, is the main practical application in this field of study to balance autonomic and cardiovascular systems.
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19
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Graham K, Dipnall J, Van Hooff M, Lawrence-Wood E, Searle A, Ao AM. Identifying clusters of health symptoms in deployed military personnel and their relationship with probable PTSD. J Psychosom Res 2019; 127:109838. [PMID: 31698167 DOI: 10.1016/j.jpsychores.2019.109838] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 09/09/2019] [Accepted: 09/21/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Among military personnel posttraumatic stress disorder is strongly associated with non-specific health symptoms and can have poor treatment outcomes. This study aimed to use machine learning to identify and describe clusters of self-report health symptoms and examine their association with probable PTSD, other psychopathology, traumatic deployment exposures, and demographic factors. METHOD Data were from a large sample of military personnel who deployed to the Middle East (n = 12,566) between 2001 and 2009. Participants completed self-report measures including health symptoms and deployment trauma checklists, and several mental health symptom scales. The data driven machine learning technique of self-organised maps identified health symptom clusters and logistic regression examined their correlates. RESULTS Two clusters differentiated by number and severity of health symptoms were identified: a small 'high health symptom cluster' (HHSC; n = 366) and a large 'low health symptom cluster' (LHSC; n = 12,200). The HHSC had significantly higher proportions of (Gates et al., 2012 [1]) scaled scores indicative of PTSD (69% compared with 2% of LHSC members), Unwin et al. (1999a) [2] scores on other psychological scales that were indicative of psychopathology, and (Graham et al., n.d. [3]) deployment trauma. HHSC members with probable PTSD had a stronger relationship with subjective (OR 1.25; 95% CI 1.12, 1.40) and environmental (OR 1.08; 95% CI 1.03, 1.13) traumatic deployment exposures than LHSC members with probable PTSD. CONCLUSION These findings highlights that health symptoms are not rare in military veterans, and that PTSD is strongly associated with health symptoms. Results suggest that there may be subtypes of PTSD, differentiated by health symptoms.
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Affiliation(s)
- Kristin Graham
- Centre for Traumatic Stress studies, The University of Adelaide, Level 1/30 Frome Rd, Adelaide, SA 5000, Australia.
| | - Joanna Dipnall
- Research Fellow, Pre-hospital, Emergency and Trauma Unit., Public Health and Preventive Medicine, Monash University, Level 2, 553 St Kilda Road, Melbourne, VIC 3004, Australia
| | - Miranda Van Hooff
- Centre for Traumatic Stress studies, The University of Adelaide, Level 1/30 Frome Rd, Adelaide, SA 5000, Australia
| | - Ellie Lawrence-Wood
- Centre for Traumatic Stress studies, The University of Adelaide, Level 1/30 Frome Rd, Adelaide, SA 5000, Australia
| | - Amelia Searle
- Centre for Traumatic Stress studies, The University of Adelaide, Level 1/30 Frome Rd, Adelaide, SA 5000, Australia
| | - Alexander McFarlane Ao
- Centre for Traumatic Stress studies, The University of Adelaide, Level 1/30 Frome Rd, Adelaide, SA 5000, Australia
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20
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Miles SR, Dillon KH, Jacoby VM, Hale WJ, Dondanville KA, Wachen JS, Yarvis JS, Peterson AL, Mintz J, Litz BT, Young‐McCaughan S, Resick PA. Changes in anger and aggression after treatment for PTSD in active duty military. J Clin Psychol 2019; 76:493-507. [DOI: 10.1002/jclp.22878] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Shannon R. Miles
- James A. Haley Veterans’ Hospital Tampa Florida
- Department of Psychiatry & Behavioral Neurosciences, Morsani College of Medicine University of South Florida Tampa Florida
| | - Kirsten H. Dillon
- Research and Development Durham VA Medical Center Durham North Carolina
- Department of Psychiatry and Behavioral Sciences Duke University Medical Center Durham North Carolina
| | - Vanessa M. Jacoby
- Department of Psychiatry and Behavioral Sciences University of Texas Health Science Center at San Antonio San Antonio Texas
| | - Willie J. Hale
- Department of Psychiatry and Behavioral Sciences University of Texas Health Science Center at San Antonio San Antonio Texas
- Department of Psychology University of Texas at San Antonio San Antonio Texas
| | - Katherine A. Dondanville
- Department of Psychiatry and Behavioral Sciences University of Texas Health Science Center at San Antonio San Antonio Texas
| | - Jennifer Schuster Wachen
- National Center for PTSD VA Boston Healthcare System Boston Massachusetts
- Department of Psychiatry Boston University School of Medicine Boston Massachusetts
| | - Jeffrey S. Yarvis
- Department of Behavioral Health Carl R. Darnall Army Medical Center Fort Hood Texas
| | - Alan L. Peterson
- Department of Psychiatry and Behavioral Sciences University of Texas Health Science Center at San Antonio San Antonio Texas
- Research and Development Service South Texas Veterans Health Care System San Antonio Texas
| | - Jim Mintz
- Department of Psychiatry and Behavioral Sciences University of Texas Health Science Center at San Antonio San Antonio Texas
- Department of Epidemiology and Biostatistics University of Texas Health Science Center at San Antonio San Antonio Texas
| | - Brett T. Litz
- Department of Psychiatry Boston University School of Medicine Boston Massachusetts
- Massachusetts Veterans Epidemiological Research and Information Center VA Boston Healthcare System Boston Massachusetts
| | - Stacey Young‐McCaughan
- Department of Psychiatry and Behavioral Sciences University of Texas Health Science Center at San Antonio San Antonio Texas
| | - Patricia A. Resick
- Department of Psychiatry and Behavioral Sciences Duke University Medical Center Durham North Carolina
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21
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van den Berk Clark C, Moore R, Secrest S, Tuerk P, Norman S, Myers U, Lustman PJ, Schneider FD, Barnes J, Gallamore R, Ovais M, Plurad JA, Scherrer JF. Factors Associated With Receipt of Cognitive-Behavioral Therapy or Prolonged Exposure Therapy Among Individuals With PTSD. Psychiatr Serv 2019; 70:703-713. [PMID: 31010409 PMCID: PMC6702958 DOI: 10.1176/appi.ps.201800408] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The aim of this study was to systematically review variables associated with initiation of trauma-centered cognitive-behavioral therapy (TC-CBT) among individuals with posttraumatic stress disorder (PTSD). METHODS PubMed, PsycINFO, Web of Science, Published International Literature on Traumatic Stress (PILOTS), and Scopus were searched in a systematic manner up to 2018, and 26 relevant studies were recovered and analyzed. RESULTS The average weighted initiation rate was 6% in larger hospital systems with a high rate of trauma and 28% in outpatient mental health settings (range 4%-83%). Older age (odds ratio [OR]=1.56, 95% confidence interval [CI]=0.51-1.61), female gender (OR=1.18, 95% CI=1.08-1.27), black or other racial-ethnic minority group (OR=1.16, 95% CI=1.03-1.28), Veterans Affairs PTSD service connection status (OR=2.30, 95% CI=2.18-2.42), mental health referral (OR=2.28, 95% CI=1.05-3.50), greater staff exposure to TC-CBT (OR=2.30, 95% CI=2.09-2.52), adaptability of TC-CBT to staff workflow (OR=4.66, 95% CI=1.60-7.72), greater PTSD severity (OR=1.46, 95% CI=1.13-1.78), and comorbid depression (OR=1.21, 95% CI=1.14-1.29) increased the likelihood of TC-CBT initiation, whereas delayed treatment reduced the likelihood of TC-CBT initiation (OR=0.93, 95% CI=0.92-0.95). Qualitative studies showed that mental health beliefs (stigma and lack of readiness), provider organizational factors (low availability, privacy issues), and patient lack of time (logistics) were perceived as barriers to initiation by patients and providers. CONCLUSIONS TC-CBT initiation increased among patients who were older and female. Initiation was also higher among providers who had more exposure to TC-CBT in their work environment and when TC-CBT fit into their existing workflow.
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Affiliation(s)
- Carissa van den Berk Clark
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis (Clark, Moore, Secrest, Barnes, Gallamore, Ovais, Plurad, Scherrer); Research and Development Program, Veterans Affairs St. Louis Health Care System, St. Louis (Clark); Research Service, Harry S. Truman Veteran's Hospital, Columbia, Missouri (Scherrer); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston and PTSD Clinical Team, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina (Tuerk); PTSD Consultation Program, National Center of PTSD, White River Junction, Vermont, and Department of Psychiatry, University of California, San Diego (Norman); U.S. Department of Veterans Affairs, Washington, D.C. (Myers); Department of Psychiatry, Washington University School of Medicine, St. Louis (Lustman); Department of Family and Community Medicine, University of Texas Southwestern, Dallas (Schneider)
| | - Rachel Moore
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis (Clark, Moore, Secrest, Barnes, Gallamore, Ovais, Plurad, Scherrer); Research and Development Program, Veterans Affairs St. Louis Health Care System, St. Louis (Clark); Research Service, Harry S. Truman Veteran's Hospital, Columbia, Missouri (Scherrer); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston and PTSD Clinical Team, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina (Tuerk); PTSD Consultation Program, National Center of PTSD, White River Junction, Vermont, and Department of Psychiatry, University of California, San Diego (Norman); U.S. Department of Veterans Affairs, Washington, D.C. (Myers); Department of Psychiatry, Washington University School of Medicine, St. Louis (Lustman); Department of Family and Community Medicine, University of Texas Southwestern, Dallas (Schneider)
| | - Scott Secrest
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis (Clark, Moore, Secrest, Barnes, Gallamore, Ovais, Plurad, Scherrer); Research and Development Program, Veterans Affairs St. Louis Health Care System, St. Louis (Clark); Research Service, Harry S. Truman Veteran's Hospital, Columbia, Missouri (Scherrer); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston and PTSD Clinical Team, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina (Tuerk); PTSD Consultation Program, National Center of PTSD, White River Junction, Vermont, and Department of Psychiatry, University of California, San Diego (Norman); U.S. Department of Veterans Affairs, Washington, D.C. (Myers); Department of Psychiatry, Washington University School of Medicine, St. Louis (Lustman); Department of Family and Community Medicine, University of Texas Southwestern, Dallas (Schneider)
| | - Peter Tuerk
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis (Clark, Moore, Secrest, Barnes, Gallamore, Ovais, Plurad, Scherrer); Research and Development Program, Veterans Affairs St. Louis Health Care System, St. Louis (Clark); Research Service, Harry S. Truman Veteran's Hospital, Columbia, Missouri (Scherrer); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston and PTSD Clinical Team, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina (Tuerk); PTSD Consultation Program, National Center of PTSD, White River Junction, Vermont, and Department of Psychiatry, University of California, San Diego (Norman); U.S. Department of Veterans Affairs, Washington, D.C. (Myers); Department of Psychiatry, Washington University School of Medicine, St. Louis (Lustman); Department of Family and Community Medicine, University of Texas Southwestern, Dallas (Schneider)
| | - Sonya Norman
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis (Clark, Moore, Secrest, Barnes, Gallamore, Ovais, Plurad, Scherrer); Research and Development Program, Veterans Affairs St. Louis Health Care System, St. Louis (Clark); Research Service, Harry S. Truman Veteran's Hospital, Columbia, Missouri (Scherrer); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston and PTSD Clinical Team, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina (Tuerk); PTSD Consultation Program, National Center of PTSD, White River Junction, Vermont, and Department of Psychiatry, University of California, San Diego (Norman); U.S. Department of Veterans Affairs, Washington, D.C. (Myers); Department of Psychiatry, Washington University School of Medicine, St. Louis (Lustman); Department of Family and Community Medicine, University of Texas Southwestern, Dallas (Schneider)
| | - Ursula Myers
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis (Clark, Moore, Secrest, Barnes, Gallamore, Ovais, Plurad, Scherrer); Research and Development Program, Veterans Affairs St. Louis Health Care System, St. Louis (Clark); Research Service, Harry S. Truman Veteran's Hospital, Columbia, Missouri (Scherrer); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston and PTSD Clinical Team, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina (Tuerk); PTSD Consultation Program, National Center of PTSD, White River Junction, Vermont, and Department of Psychiatry, University of California, San Diego (Norman); U.S. Department of Veterans Affairs, Washington, D.C. (Myers); Department of Psychiatry, Washington University School of Medicine, St. Louis (Lustman); Department of Family and Community Medicine, University of Texas Southwestern, Dallas (Schneider)
| | - Patrick J Lustman
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis (Clark, Moore, Secrest, Barnes, Gallamore, Ovais, Plurad, Scherrer); Research and Development Program, Veterans Affairs St. Louis Health Care System, St. Louis (Clark); Research Service, Harry S. Truman Veteran's Hospital, Columbia, Missouri (Scherrer); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston and PTSD Clinical Team, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina (Tuerk); PTSD Consultation Program, National Center of PTSD, White River Junction, Vermont, and Department of Psychiatry, University of California, San Diego (Norman); U.S. Department of Veterans Affairs, Washington, D.C. (Myers); Department of Psychiatry, Washington University School of Medicine, St. Louis (Lustman); Department of Family and Community Medicine, University of Texas Southwestern, Dallas (Schneider)
| | - F David Schneider
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis (Clark, Moore, Secrest, Barnes, Gallamore, Ovais, Plurad, Scherrer); Research and Development Program, Veterans Affairs St. Louis Health Care System, St. Louis (Clark); Research Service, Harry S. Truman Veteran's Hospital, Columbia, Missouri (Scherrer); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston and PTSD Clinical Team, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina (Tuerk); PTSD Consultation Program, National Center of PTSD, White River Junction, Vermont, and Department of Psychiatry, University of California, San Diego (Norman); U.S. Department of Veterans Affairs, Washington, D.C. (Myers); Department of Psychiatry, Washington University School of Medicine, St. Louis (Lustman); Department of Family and Community Medicine, University of Texas Southwestern, Dallas (Schneider)
| | - Jacqueline Barnes
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis (Clark, Moore, Secrest, Barnes, Gallamore, Ovais, Plurad, Scherrer); Research and Development Program, Veterans Affairs St. Louis Health Care System, St. Louis (Clark); Research Service, Harry S. Truman Veteran's Hospital, Columbia, Missouri (Scherrer); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston and PTSD Clinical Team, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina (Tuerk); PTSD Consultation Program, National Center of PTSD, White River Junction, Vermont, and Department of Psychiatry, University of California, San Diego (Norman); U.S. Department of Veterans Affairs, Washington, D.C. (Myers); Department of Psychiatry, Washington University School of Medicine, St. Louis (Lustman); Department of Family and Community Medicine, University of Texas Southwestern, Dallas (Schneider)
| | - Randy Gallamore
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis (Clark, Moore, Secrest, Barnes, Gallamore, Ovais, Plurad, Scherrer); Research and Development Program, Veterans Affairs St. Louis Health Care System, St. Louis (Clark); Research Service, Harry S. Truman Veteran's Hospital, Columbia, Missouri (Scherrer); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston and PTSD Clinical Team, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina (Tuerk); PTSD Consultation Program, National Center of PTSD, White River Junction, Vermont, and Department of Psychiatry, University of California, San Diego (Norman); U.S. Department of Veterans Affairs, Washington, D.C. (Myers); Department of Psychiatry, Washington University School of Medicine, St. Louis (Lustman); Department of Family and Community Medicine, University of Texas Southwestern, Dallas (Schneider)
| | - Muhammad Ovais
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis (Clark, Moore, Secrest, Barnes, Gallamore, Ovais, Plurad, Scherrer); Research and Development Program, Veterans Affairs St. Louis Health Care System, St. Louis (Clark); Research Service, Harry S. Truman Veteran's Hospital, Columbia, Missouri (Scherrer); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston and PTSD Clinical Team, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina (Tuerk); PTSD Consultation Program, National Center of PTSD, White River Junction, Vermont, and Department of Psychiatry, University of California, San Diego (Norman); U.S. Department of Veterans Affairs, Washington, D.C. (Myers); Department of Psychiatry, Washington University School of Medicine, St. Louis (Lustman); Department of Family and Community Medicine, University of Texas Southwestern, Dallas (Schneider)
| | - James Alex Plurad
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis (Clark, Moore, Secrest, Barnes, Gallamore, Ovais, Plurad, Scherrer); Research and Development Program, Veterans Affairs St. Louis Health Care System, St. Louis (Clark); Research Service, Harry S. Truman Veteran's Hospital, Columbia, Missouri (Scherrer); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston and PTSD Clinical Team, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina (Tuerk); PTSD Consultation Program, National Center of PTSD, White River Junction, Vermont, and Department of Psychiatry, University of California, San Diego (Norman); U.S. Department of Veterans Affairs, Washington, D.C. (Myers); Department of Psychiatry, Washington University School of Medicine, St. Louis (Lustman); Department of Family and Community Medicine, University of Texas Southwestern, Dallas (Schneider)
| | - Jeffrey F Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis (Clark, Moore, Secrest, Barnes, Gallamore, Ovais, Plurad, Scherrer); Research and Development Program, Veterans Affairs St. Louis Health Care System, St. Louis (Clark); Research Service, Harry S. Truman Veteran's Hospital, Columbia, Missouri (Scherrer); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston and PTSD Clinical Team, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina (Tuerk); PTSD Consultation Program, National Center of PTSD, White River Junction, Vermont, and Department of Psychiatry, University of California, San Diego (Norman); U.S. Department of Veterans Affairs, Washington, D.C. (Myers); Department of Psychiatry, Washington University School of Medicine, St. Louis (Lustman); Department of Family and Community Medicine, University of Texas Southwestern, Dallas (Schneider)
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Hale AC, Bohnert KM, Ganoczy D, Sripada RK. Predictors of Treatment Adequacy During Evidence-Based Psychotherapy for PTSD. Psychiatr Serv 2019; 70:367-373. [PMID: 30784379 DOI: 10.1176/appi.ps.201800361] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The U.S. Department of Veterans Affairs (VA) has placed increased emphasis on the availability and use of evidence-based psychotherapies (EBPs) for posttraumatic stress disorder (PTSD). However, many individuals do not complete a full course of EBP. The current study aimed to quantify the percentage of veterans receiving adequate EBP in VA hospitals and identify factors related to treatment completion. METHODS A national sample of 16,559 VA patients who began cognitive processing therapy (CPT) or prolonged exposure (PE) during fiscal year 2015 was obtained via administrative data. Generalized estimating equations were used to evaluate individual-level predictors of treatment adequacy, defined as eight sessions within 14 weeks. Generalized linear models were used to examine facility-level factors. RESULTS A total of 5,142 (31.1%) veterans completed eight or more sessions of psychotherapy. Older age was associated with greater odds of completing eight or more sessions (odds ratio OR=1.02, 95% confidence interval [CI]=1.01, 1.02, p<0.001), and comorbid bipolar or psychotic disorders were associated with reduced odds of completion (OR=0.89, 95% CI=0.80, 0.99, p=0.03). The percentage of patients who completed eight or more sessions was higher at facilities with higher percentages of EBP use among all patients with PTSD (β=6.55, SE=1.97, p=0.001) and greater numbers of EBP-certified providers (β=0.004, SE=0.002, p=0.038) and lower at facilities with a higher percentage of patients receiving a PTSD Checklist (β=-1.16, SE=0.46, p=0.011). CONCLUSIONS A minority of VA patients with PTSD complete an adequate dose of EBPs for PTSD. Individual and facility-level factors related to treatment adequacy may point to opportunities for intervention.
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Affiliation(s)
- Andrew C Hale
- U.S. Department of Veterans Affairs (VA) Center for Clinical Management Research, Ann Arbor, Michigan; Department of Psychiatry, University of Michigan, Ann Arbor (Hale, Bohnert, Sripada)
| | - Kipling M Bohnert
- U.S. Department of Veterans Affairs (VA) Center for Clinical Management Research, Ann Arbor, Michigan; Department of Psychiatry, University of Michigan, Ann Arbor (Hale, Bohnert, Sripada)
| | - Dara Ganoczy
- U.S. Department of Veterans Affairs (VA) Center for Clinical Management Research, Ann Arbor, Michigan; Department of Psychiatry, University of Michigan, Ann Arbor (Hale, Bohnert, Sripada)
| | - Rebecca K Sripada
- U.S. Department of Veterans Affairs (VA) Center for Clinical Management Research, Ann Arbor, Michigan; Department of Psychiatry, University of Michigan, Ann Arbor (Hale, Bohnert, Sripada)
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23
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An Intensive Outpatient Program for Veterans With Posttraumatic Stress Disorder and Traumatic Brain Injury. COGNITIVE AND BEHAVIORAL PRACTICE 2019. [DOI: 10.1016/j.cbpra.2018.07.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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24
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Lewis-Schroeder NF, Kieran K, Murphy BL, Wolff JD, Robinson MA, Kaufman ML. Conceptualization, Assessment, and Treatment of Traumatic Stress in First Responders: A Review of Critical Issues. Harv Rev Psychiatry 2019; 26:216-227. [PMID: 29975339 PMCID: PMC6624844 DOI: 10.1097/hrp.0000000000000176] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
First responders are regularly confronted with exposure to traumatic events, including potentially life-threatening situations as well as the grave injuries and deaths of colleagues and civilians. Evidence indicates that the prevalence of posttraumatic stress disorder (PTSD) is substantially higher among first responders than the general population. This article provides information about the outpatient trauma services at McLean Hospital's LEADER (Law Enforcement, Active Duty, Emergency Responder) program to assist clinicians who encounter these first responders in their practices or who are specifically interested in working with this patient population. We begin by synthesizing the literature on the prevalence of PTSD in first responders following work-related exposure to traumatic stress, and by addressing the occupation-specific risk factors and the third-variable risk factors that may contribute to potentiated risk. We then discuss assessment strategies and treatment options used in our program, which is tailored for individuals who are dealing with mental health issues stemming from occupation-specific traumatic-stress exposure. We also address the unique challenges of treating traumatized first responders with more complex issues such as traumatic stress exposure across the lifespan and safety issues, including acute suicidality. We conclude by discussing notable gaps in the literature, including the need to investigate why and how women present with different PTSD symptoms than men and how these differences need to be taken into account in determining appropriate treatment for women.
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Affiliation(s)
- Nina F Lewis-Schroeder
- From Harvard Medical School (Drs. Lewis-Schroeder, Murphy, Robinson, and Kaufman) and McLean Hospital, Belmont, MA (all)
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25
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Tuerk PW, Rauch SAM, Rothbaum BO. Effect size matters: a key neglected indicator of comparative trial quality. Lancet Psychiatry 2019; 6:e4. [PMID: 30686400 DOI: 10.1016/s2215-0366(18)30505-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 12/06/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Peter W Tuerk
- Department of Human Services, University of Virginia, Charlottesville, VA 22904, USA.
| | - Sheila A M Rauch
- Emory University School of Medicine, Atlanta, GA, USA; Atlanta VA Medical Center, Decatur, GA, USA
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26
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Greer M, Vin-Raviv N. Outdoor-Based Therapeutic Recreation Programs Among Military Veterans with Posttraumatic Stress Disorder: Assessing the Evidence. ACTA ACUST UNITED AC 2019. [DOI: 10.1080/21635781.2018.1543063] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Michael Greer
- School of Social Work, College of Health and Human Sciences, Colorado State University, Fort Collins, Colorado
| | - Neomi Vin-Raviv
- School of Social Work, College of Health and Human Sciences, Colorado State University, Fort Collins, Colorado
- University of Northern Colorado Cancer Rehabilitation Institute, School of Sport and Exercise Science, University of Northern Colorado, Greeley, Colorado
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27
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Hundt NE, Ecker AH, Thompson K, Helm A, Smith TL, Stanley MA, Cully JA. "It didn't fit for me:" A qualitative examination of dropout from prolonged exposure and cognitive processing therapy in veterans. Psychol Serv 2018; 17:414-421. [PMID: 30475041 DOI: 10.1037/ser0000316] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Trauma-focused psychotherapies, such as prolonged exposure and cognitive processing therapy, are the most effective forms of treatment for posttraumatic stress disorder. These treatments are commonly delivered in the Veterans Health Administration; however, dropout means that some veterans fail to benefit. Ending treatment prematurely is a common problem across psychotherapies, with on average, 20% to 25% of patients dropping out. The purpose of this study was to examine veterans' self-reported reasons for dropping out of prolonged exposure or cognitive processing therapy. Veterans who dropped out from prolonged exposure or cognitive processing therapy (N = 28) completed qualitative interviews about their experiences. Interviews were coded by 2 coders using grounded theory. Therapy-related barriers were the largest category reported, and included lack of buy-in to the rationale or specific therapy tasks, believing that treatment was not working, alliance issues, or switching to a different treatment. Practical barriers and finding treatment "too stressful" were also common reasons for dropout. This research provides information that can shape how PTSD treatments are delivered in health care settings. Therapy-related barriers were the largest group, suggesting that providers may need to find more effective ways to communicate the rationale for these therapies or to tailor them to individual patients' needs. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Natalie E Hundt
- VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center
| | - Anthony H Ecker
- VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center
| | | | - Ashley Helm
- VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center
| | - Tracey L Smith
- VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center
| | - Melinda A Stanley
- VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center
| | - Jeffrey A Cully
- VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center
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28
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Schuman DL, Killian MO. Pilot Study of a Single Session Heart Rate Variability Biofeedback Intervention on Veterans’ Posttraumatic Stress Symptoms. Appl Psychophysiol Biofeedback 2018; 44:9-20. [DOI: 10.1007/s10484-018-9415-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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29
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Aronson KR, Welsh JA, Fedotova A, Morgan NR, Perkins DF, Travis W. Treating PTSD in active duty service members using cognitive processing therapy or prolonged exposure therapy: Examining everyday practice at a military outpatient clinic. MILITARY PSYCHOLOGY 2018. [DOI: 10.1080/08995605.2018.1478550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | - Janet A. Welsh
- Pennsylvania State University, University Park, Pennsylvania
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30
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Cook JM, Simiola V, McCarthy E, Ellis A, Wiltsey Stirman S. Use of Reflective Journaling to Understand Decision Making Regarding Two Evidence-Based Psychotherapies for PTSD: Practice Implications. ACTA ACUST UNITED AC 2018; 3:153-167. [PMID: 30906873 DOI: 10.1037/pri0000070] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
As part of a longitudinal investigation on implementation of 2 evidence-based psychotherapies (EBPs) for posttraumatic stress disorder, psychotherapists from 38 Department of Veterans Affairs residential treatment programs across the United States were asked to complete reflective journals every 4 months for a 1-year time period in regard to their successes and challenges in using prolonged exposure and cognitive processing therapy. This paper provides content analysis on the reflective journals of 24 of these providers. Five main themes were identified: EBPs are great but not sufficient for patients in residential treatment with chronic posttraumatic stress disorder and complicated life circumstances, and thus, more treatment is necessary after discharge. Modifications were made or thought needed for optimal outcome and successful delivery of these 2 EBPs; some providers blended aspects of prolonged exposure and cognitive processing therapy; what happens when providers and patients do not agree on choice of which EBP to first implement; and provider concerns on when to discontinue an EBP. Reflective journaling appears to be a promising way for trainers and treatment developers to gather important information about the clinical application and decision-making process for front-line providers, which may offer insight into how to improve EBP implementation and sustainability. Incorporating reflective journaling and strategies for accomplishing this into training, supervision, and consultation may also be 1 strategy for increasing feedback, expanding implementation, and informing ways to increase sustainability of EBPs in populations with multiple clinical and psychosocial needs.
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Affiliation(s)
- Joan M Cook
- Department of Psychiatry Yale School of Medicine and National Center for PTSD, West Haven, Connecticut
| | - Vanessa Simiola
- Department of Psychiatry, Yale School of Medicine and Kaiser Permanente, Honolulu, Hawaii
| | | | - Amy Ellis
- Institutional Center for Scientific Research, Albizu University, Miami, Florida
| | - Shannon Wiltsey Stirman
- Department of Psychiatry and Behavioral Sciences, National Center for PTSD, Palo Alto, California and Stanford University of Medicine
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31
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Is Integrated CBT Effective in Reducing PTSD Symptoms and Substance Use in Iraq and Afghanistan Veterans? Results from a Randomized Clinical Trial. COGNITIVE THERAPY AND RESEARCH 2018. [DOI: 10.1007/s10608-018-9931-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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32
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Kip KE, Diamond DM. Clinical, Empirical, and Theoretical Rationale for Selection of Accelerated Resolution Therapy for Treatment of Post-traumatic Stress Disorder in VA and DoD Facilities. Mil Med 2018; 183:e314-e321. [DOI: 10.1093/milmed/usy027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 12/06/2017] [Accepted: 02/06/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kevin E Kip
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL
| | - David M Diamond
- Departments of Psychology and Molecular Pharmacology and Physiology, Center for Preclinical/Clinical Research on PTSD, University of South Florida, Tampa, FL
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33
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Beyond war and PTSD: The crucial role of transition stress in the lives of military veterans. Clin Psychol Rev 2018; 59:137-144. [DOI: 10.1016/j.cpr.2017.11.007] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 10/31/2017] [Accepted: 11/18/2017] [Indexed: 11/24/2022]
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Gray R, Budden-Potts D, Bourke F. Reconsolidation of Traumatic Memories for PTSD: A randomized controlled trial of 74 male veterans. Psychother Res 2017; 29:621-639. [PMID: 29241423 DOI: 10.1080/10503307.2017.1408973] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Design: A randomized waitlist-controlled design (n = 74) examined the efficacy of Reconsolidation of Traumatic Memories (RTM) among male veterans with current-month flashbacks and nightmares. Volunteers were randomly assigned to immediate treatment (three 120-minute sessions of RTM), or to a 3-week waiting condition before receiving the RTM treatment. Blinded psychometricians evaluated the symptoms at intake, 2 weeks, and 6 weeks post. Wait-listed participants were re-evaluated and then treated. Sixty-five volunteers completed the treatment. Results: Of those treated, 46 (71%) lost DSM diagnosis for post-traumatic stress disorder (PTSD) by one of the following definitions: 42 persons (65%) were in complete remission (PTSD Symptom Scale Interview (PSS-I) ≤ 20 and DSM criteria not met). Four others (6%) lost the DSM diagnosis or were otherwise sub-clinical by dichotomous criteria (PSS-I < 20 and absence of flashbacks and nightmares) but non-ambiguous on the PTSD Checklist Military Version measures. Within-group RTM effect sizes (Hedges' g) for PSS-I score changes ranged from 1.45 to 2.3. The between-group comparison between the treatment group and the untreated controls was significant (p < .001) with an effect size equivalent to two standard deviations (g = 2.13; 95% CI [1.56, 2.70]). Patient satisfaction with the intervention was high. Conclusions: RTM shows promise as a brief, cost-effective intervention for PTSD characterized primarily by intrusive symptoms. Clinical or methodological significance of this article: The article provides evidence to support a fast (5 hours or fewer) robust intervention for PTSD characterized by intrusive symptoms including current-month flashbacks, nightmares, and accompanied by sympathetic arousal in response to trauma narratives. The intervention is well tolerated and has demonstrated efficacy up to one year.
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Affiliation(s)
- Richard Gray
- a The Research and Recognition Project , Corning , NY , USA
| | | | - Frank Bourke
- a The Research and Recognition Project , Corning , NY , USA
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35
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Brown W, Grubaugh AL, Knapp RG, Acierno RE. Interplay Between Service Era, PTSD Symptom Expression, and Treatment Completion Among Veterans. MILITARY PSYCHOLOGY 2017. [DOI: 10.1037/mil0000133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Wilson Brown
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, and Center for the Treatment and Study of Traumatic Stress, Summa St. Thomas Hospital, Akron, Ohio
| | - Anouk L. Grubaugh
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, and Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina
| | - Rebecca G. Knapp
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina
| | - Ronald E. Acierno
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, and Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina
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36
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Psychosocial rehabilitation after war trauma with adaptive disclosure: Design and rationale of a comparative efficacy trial. Contemp Clin Trials 2017; 61:10-15. [DOI: 10.1016/j.cct.2017.07.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 07/06/2017] [Accepted: 07/13/2017] [Indexed: 12/31/2022]
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Köbach A, Schaal S, Hecker T, Elbert T. Psychotherapeutic Intervention in the Demobilization Process: Addressing Combat-related Mental Injuries with Narrative Exposure in a First and Second Dissemination Stage. Clin Psychol Psychother 2017; 24:807-825. [PMID: 26676201 PMCID: PMC5573918 DOI: 10.1002/cpp.1986] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 08/10/2015] [Accepted: 09/21/2015] [Indexed: 11/05/2022]
Abstract
BACKGROUND Depending on the exposure to traumatic stressors and combat, 20% to 50% of ex-combatants present with trauma-related disorders, and more than half of the members of armed groups have a proclivity to violence. Therefore, psychotherapeutic assistance should address both, trauma-related suffering and the lowered threshold for aggressive behaviour. OBJECTIVE Supporting the demobilization process of ex-combatants in the eastern DR-Congo, we implemented a version of Narrative Exposure Therapy adapted for Forensic Offender Rehabilitation (FORNET). METHOD In two successive dissemination stages (DS), local counsellors conducted FORNET. In DS1, they were trained by clinical experts, and in DS2, the by then experienced counsellors trained and supervised a second group of local counsellors (DS2). The training consisted of a 3-week workshop covering theoretical concepts and practical therapeutic skills. In DS1 and DS2, a total of 98 demobilizing combatants received an intervention; treatment-as-usual served as the control condition. Posttraumatic stress disorder, appetitive aggression, depression severity and drug dependence were assessed prior to the intervention and 6 and 12 months later; additionally, we assessed reintegration success. RESULTS Six months post-intervention, FORNET significantly reduced Posttraumatic stress disorder symptoms but had less effect on the trait of appetitive aggression; moreover, beneficial effects were found for depression severity and drug dependence as well as for reintegration indices. Treatment gains were retained at 12 months. CONCLUSIONS Individuals without previous training in psychotherapy can learn to effectively apply the brief intervention FORNET and support the demobilization process in ongoing conflicts. The study suggests that it is possible to pass down psychotherapeutic techniques over generations of counsellors. © 2015 The Authors. Clinical Psychology & Psychotherapy published by John Wiley & Sons Ltd. KEY PRACTITIONER MESSAGE Posttraumatic stress symptoms, depression and clinically relevant levels of drug dependence can effectively be reduced with a version of Narrative Exposure Therapy (NET) adapted for Forensic Offender Rehabilitation (FORNET). The intervention is effective in the context of ongoing conflict. Individuals without previous training in psychotherapy can learn to effectively apply the brief intervention FORNET. It is possible to pass down psychotherapeutic techniques like FORNET over generations of counsellors. Psychotherapeutic interventions like FORNET may facilitate the transition to peace in war-torn regions.
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Affiliation(s)
- Anke Köbach
- Department of PsychologyUniversity of KonstanzKonstanzGermany
- vivo internationalKonstanzGermany
| | - Susanne Schaal
- vivo internationalKonstanzGermany
- Department of PsychologyUniversity of UlmUlmGermany
| | - Tobias Hecker
- vivo internationalKonstanzGermany
- Department of PsychologyUniversity of ZürichZürichSwitzerland
| | - Thomas Elbert
- Department of PsychologyUniversity of KonstanzKonstanzGermany
- vivo internationalKonstanzGermany
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Li W, Ma YB, Yang Q, Li BL, Meng QG, Zhang Y. Effect and safety of sertraline for treat posttraumatic stress disorder: a multicenter randomised controlled study. Int J Psychiatry Clin Pract 2017; 21:151-155. [PMID: 28266242 DOI: 10.1080/13651501.2017.1291838] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Although several previous studies have examined the efficacy of sertraline in the treatment of posttraumatic stress disorder (PTSD), none involved Chinese PTSD patients. This study aimed to evaluate sertraline efficacy and adverse events in Chinese patients with PTSD over 12 weeks. METHODS In total, 72 PTSD patients were randomly assigned to receive sertraline (135 mg daily) or a placebo for 12 weeks. Impact of Event Scale-Revised subscores constituted the primary outcome, with Clinical Global Impression Scale-Severity scores and adverse events as secondary outcomes. RESULTS Sixty-five subjects completed the study, and their data were included in the final analysis. Sertraline showed greater efficacy in enhancing Impact of Event Scale-Revised and Clinical Global Impression Scale-Severity scores at 6 and 12 weeks relative to that of the placebo. The most common adverse event was nausea, which occurred in 12 (33.3%) and 8 (22.2%) patients in the sertraline and placebo groups, respectively. No sertraline-related deaths were recorded. CONCLUSIONS In summary, we demonstrated that 12 weeks of sertraline was efficacious and well-tolerated in Chinese patients with PTSD.
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Affiliation(s)
- Wei Li
- a Department of Medical Science Institute of Harbin , The First Hospital of Harbin City, Harbin Medical University , Harbin , China
| | - Yu-Bo Ma
- b Department of Orthopedic , Affiliated Hospital of Mudanjiang Medical University , Mudanjiang , China
| | - Qi Yang
- a Department of Medical Science Institute of Harbin , The First Hospital of Harbin City, Harbin Medical University , Harbin , China
| | - Bao-Lin Li
- a Department of Medical Science Institute of Harbin , The First Hospital of Harbin City, Harbin Medical University , Harbin , China
| | - Qing-Gang Meng
- a Department of Medical Science Institute of Harbin , The First Hospital of Harbin City, Harbin Medical University , Harbin , China
| | - Yi Zhang
- c Department of Psychiatry , The First Hospital of Harbin City , Harbin , China
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Banducci AN, Connolly KM, Vujanovic AA, Alvarez J, Bonn-Miller MO. The impact of changes in distress tolerance on PTSD symptom severity post-treatment among veterans in residential trauma treatment. J Anxiety Disord 2017; 47:99-105. [PMID: 28109673 DOI: 10.1016/j.janxdis.2017.01.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 11/17/2016] [Accepted: 01/05/2017] [Indexed: 12/01/2022]
Abstract
Given that rates of PTSD, particularly among military populations, are increasing, it is critical to gain a better understanding of factors associated with treatment response. Low distress tolerance (DT), conceptualized as the perceived or actual inability to tolerate negative emotional states, may impacts veterans' responses to PTSD treatment. Low DT has been associated with more severe PTSD symptoms in clinical and non-clinical samples; however, its impact on PTSD symptomatology across treatment has yet to be assessed. We examined the impact of changes in DT, from intake to discharge, on post-treatment PTSD symptom severity within two samples of veterans recruited from Veterans Affairs residential PTSD treatment facilities in the northwestern and southern United States (Total N=86; 87% male; 46% White, 39% Black, 9% Latino, 6% Other). Veterans completed the Distress Tolerance Scale and PTSD Checklist (PCL) at intake and discharge from residential PTSD treatment. Regression analyses revealed that, within each veteran sample, those with the greatest improvements in DT had the lowest PCL total and subscale scores at discharge after controlling for respective intake PCL scores. This suggests increases in DT across treatment help explain the degree of benefits experienced by veterans following PTSD treatment.
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Affiliation(s)
- Anne N Banducci
- National Center for PTSD, VA Palo Alto Health Care System, 795 Willow Road (NC-PTSD 324), Menlo Park, CA 94025, United States; Stanford University, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, United States; G.V. (Sonny) Montgomery Veterans Affairs Medical Center, 1500 E Woodrow Wilson Ave, Jackson, MS 39216, United States; University of Mississippi Medical Center. 2500 N State St. Jackson, MS 39216, United States.
| | - Kevin M Connolly
- G.V. (Sonny) Montgomery Veterans Affairs Medical Center, 1500 E Woodrow Wilson Ave, Jackson, MS 39216, United States; University of Mississippi Medical Center. 2500 N State St. Jackson, MS 39216, United States
| | - Anka A Vujanovic
- University of Houston, Department of Psychology, 3695 Cullen Bouleva rd, Houston, TX 772014, United States
| | - Jennifer Alvarez
- VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025, United States
| | - Marcel O Bonn-Miller
- National Center for PTSD, VA Palo Alto Health Care System, 795 Willow Road (NC-PTSD 324), Menlo Park, CA 94025, United States; Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road(152-MPD), Menlo Park, CA 94025, United States; Center of Excellence in Substance Abuse Treatment and Education, Philadelphia VA Medical Center, 3900 Woodland Ave., Philadelphia, PA 19104, United States; Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3440 Market St, Suite 370, Philadelphia, PA 19104, United States
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Tylee DS, Gray R, Glatt SJ, Bourke F. Evaluation of the reconsolidation of traumatic memories protocol for the treatment of PTSD: a randomized, wait-list-controlled trial. JOURNAL OF MILITARY VETERAN AND FAMILY HEALTH 2017. [DOI: 10.3138/jmvfh.4120] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
| | - Richard Gray
- Research and Recognition Project, Corning, New York, USA
| | | | - Frank Bourke
- Research and Recognition Project, Corning, New York, USA
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Abstract
The efficacy of combat-related trauma-focused group therapy (TFGT) was tested using a unique technique that combines principles from prolonged exposure, cognitive processing therapy, and art therapy. Eighty Israeli male veterans exposed to traumatic events participated in the study. They were divided into eight therapeutic groups led by four pairs of trained therapists. Posttraumatic stress disorder and depression symptoms and levels of functioning were taken at pretherapy, end of therapy, and 6 months posttherapy. Analyses found that therapy helped in reducing posttraumatic and depressive symptoms at the end of therapy and at 6 months follow-up. It also showed that patients' functioning had significantly improved by the end of therapy and at 6 months follow-up. A significant clinical change in each parameter over time was also observed. In conclusion, the study provides preliminary evidence that combat-related TFGT may be efficacious in reducing psychological suffering and enhancing actual functioning. Follow-up randomized controlled trials to determine treatment efficacy are needed.
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Hundt NE, Barrera TL, Arney J, Stanley MA. “It’s Worth It in the End”: Veterans’ Experiences in Prolonged Exposure and Cognitive Processing Therapy. COGNITIVE AND BEHAVIORAL PRACTICE 2017. [DOI: 10.1016/j.cbpra.2016.02.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Acute delivery of attention bias modification training (ABMT) moderates the association between combat exposure and posttraumatic symptoms: A feasibility study. Biol Psychol 2017; 122:93-97. [DOI: 10.1016/j.biopsycho.2016.01.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 01/12/2016] [Accepted: 01/13/2016] [Indexed: 11/27/2022]
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Niles BL, Mori DL, Polizzi CP, Pless Kaiser A, Ledoux AM, Wang C. Feasibility, qualitative findings and satisfaction of a brief Tai Chi mind-body programme for veterans with post-traumatic stress symptoms. BMJ Open 2016; 6:e012464. [PMID: 27899398 PMCID: PMC5168527 DOI: 10.1136/bmjopen-2016-012464] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To examine feasibility, qualitative feedback and satisfaction associated with a 4-session introduction to Tai Chi for veterans with post-traumatic stress symptoms. DESIGN We observed and reported recruitment and retention rates, participant characteristics, adherence, and satisfaction across 2 cohorts. We also examined qualitative feedback provided by questionnaires, focus groups and individual interviews. MAIN OUTCOME MEASURES Rates of recruitment and retention, focus group and individual feedback interviews, self-reported satisfaction. PARTICIPANTS 17 veterans with post-traumatic stress symptoms. RESULTS Almost 90% (17/19) of those eligible following the telephone screen enrolled in the programme. Three-quarters (76.4%) of the participants attended at least 3 of the 4 Tai Chi sessions. Qualitative data analysis revealed themes indicating favourable impressions of the Tai Chi sessions. In addition, participants reported feeling very engaged during the sessions, and found Tai Chi to be helpful for managing distressing symptoms (ie, intrusive thoughts, concentration difficulties, physiological arousal). Participants also reported high satisfaction: 93.8% endorsed being very or mostly satisfied with the programme. All participants (100%) indicated that they would like to participate in future Tai Chi programmes and would recommend it to a friend. CONCLUSIONS Tai Chi appears to be feasible and safe for veterans with symptoms of post-traumatic stress disorder (PTSD), is perceived to be beneficial and is associated with high rates of satisfaction. This study highlights the need for future investigation of Tai Chi as a novel intervention to address symptoms of PTSD.
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Affiliation(s)
- Barbara L Niles
- National Center for PTSD, VA Boston Healthcare System and Boston University School of Medicine, Boston, Massachusetts, USA
| | - DeAnna L Mori
- VA Boston Healthcare System and Boston University School of Medicine, Boston, Massachusetts, USA
| | - Craig P Polizzi
- National Center for PTSD and VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Anica Pless Kaiser
- National Center for PTSD, VA Boston Healthcare System and Boston University School of Medicine, Boston, Massachusetts, USA
| | - Annie M Ledoux
- National Center for PTSD and VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Chenchen Wang
- Division of Rheumatology, Center for Integrative Medicine, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
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Summers MR, Nevin RL. Stellate Ganglion Block in the Treatment of Post-traumatic Stress Disorder: A Review of Historical and Recent Literature. Pain Pract 2016; 17:546-553. [DOI: 10.1111/papr.12503] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 06/27/2016] [Accepted: 07/11/2016] [Indexed: 12/14/2022]
Affiliation(s)
- Mary R. Summers
- Department of Mental Health; Johns Hopkins Bloomberg School of Public Health; Baltimore Maryland U.S.A
| | - Remington L. Nevin
- Department of Environmental Health & Engineering; Johns Hopkins Bloomberg School of Public Health; Baltimore Maryland U.S.A
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Ghaffarzadegan N, Ebrahimvandi A, Jalali MS. A Dynamic Model of Post-Traumatic Stress Disorder for Military Personnel and Veterans. PLoS One 2016; 11:e0161405. [PMID: 27716776 PMCID: PMC5055362 DOI: 10.1371/journal.pone.0161405] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 07/11/2016] [Indexed: 11/19/2022] Open
Abstract
Post-traumatic stress disorder (PTSD) stands out as a major mental illness; however, little is known about effective policies for mitigating the problem. The importance and complexity of PTSD raise critical questions: What are the trends in the population of PTSD patients among military personnel and veterans in the postwar era? What policies can help mitigate PTSD? To address these questions, we developed a system dynamics simulation model of the population of military personnel and veterans affected by PTSD. The model includes both military personnel and veterans in a “system of systems.” This is a novel aspect of our model, since many policies implemented at the military level will potentially influence (and may have side effects on) veterans and the Department of Veterans Affairs. The model is first validated by replicating the historical data on PTSD prevalence among military personnel and veterans from 2000 to 2014 (datasets from the Department of Defense, the Institute of Medicine, the Department of Veterans Affairs, and other sources). The model is then used for health policy analysis. Our results show that, in an optimistic scenario based on the status quo of deployment to intense/combat zones, estimated PTSD prevalence among veterans will be at least 10% during the next decade. The model postulates that during wars, resiliency-related policies are the most effective for decreasing PTSD. In a postwar period, current health policy interventions (e.g., screening and treatment) have marginal effects on mitigating the problem of PTSD, that is, the current screening and treatment policies must be revolutionized to have any noticeable effect. Furthermore, the simulation results show that it takes a long time, on the order of 40 years, to mitigate the psychiatric consequences of a war. Policy and financial implications of the findings are discussed.
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Affiliation(s)
- Navid Ghaffarzadegan
- Industrial and Systems Engineering, Virginia Tech, Blacksburg, Virginia, United States of America
| | - Alireza Ebrahimvandi
- Industrial and Systems Engineering, Virginia Tech, Blacksburg, Virginia, United States of America
| | - Mohammad S. Jalali
- Sloan School of Management, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
- * E-mail:
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47
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Fogger SA, Moore R, Pickett L. Posttraumatic Stress Disorder and Veterans: Finding Hope and Supporting Healing. J Nurse Pract 2016. [DOI: 10.1016/j.nurpra.2016.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wald I, Fruchter E, Ginat K, Stolin E, Dagan D, Bliese PD, Quartana PJ, Sipos ML, Pine DS, Bar-Haim Y. Selective prevention of combat-related post-traumatic stress disorder using attention bias modification training: a randomized controlled trial. Psychol Med 2016; 46:2627-2636. [PMID: 27377418 DOI: 10.1017/s0033291716000945] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Efficacy of pre-trauma prevention for post-traumatic stress disorder (PTSD) has not yet been established in a randomized controlled trial. Attention bias modification training (ABMT), a computerized intervention, is thought to mitigate stress-related symptoms by targeting disruptions in threat monitoring. We examined the efficacy of ABMT delivered before combat in mitigating risk for PTSD following combat. METHOD We conducted a double-blind, four-arm randomized controlled trial of 719 infantry soldiers to compare the efficacy of eight sessions of ABMT (n = 179), four sessions of ABMT (n = 184), four sessions of attention control training (ACT; n = 180), or no-training control (n = 176). Outcome symptoms were measured at baseline, 6-month follow-up, 10 days following combat exposure, and 4 months following combat. Primary outcome was PTSD prevalence 4 months post-combat determined in a clinical interview using the Clinician-Administered PTSD Scale. Secondary outcomes were self-reported PTSD and depression symptoms, collected at all four assessments. RESULTS PTSD prevalence 4 months post-combat was 7.8% in the no-training control group, 6.7% with eight-session ABMT, 2.6% with four-session ABMT, and 5% with ACT. Four sessions of ABMT reduced risk for PTSD relative to the no-training condition (odds ratio 3.13, 95% confidence interval 1.01-9.22, p < 0.05, number needed to treat = 19.2). No other between-group differences were found. The results were consistent across a variety of analytic techniques and data imputation approaches. CONCLUSIONS Four sessions of ABMT, delivered prior to combat deployment, mitigated PTSD risk following combat exposure. Given its low cost and high scalability potential, and observed number needed to treat, research into larger-scale applications is warranted. The ClinicalTrials.gov identifier is NCT01723215.
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Affiliation(s)
- I Wald
- School of Psychological Sciences,Tel Aviv University,Tel Aviv,Israel
| | - E Fruchter
- Division of Mental Health,Medical Corps,Israel Defense Forces,Israel
| | - K Ginat
- Division of Mental Health,Medical Corps,Israel Defense Forces,Israel
| | - E Stolin
- Division of Mental Health,Medical Corps,Israel Defense Forces,Israel
| | - D Dagan
- Division of Mental Health,Medical Corps,Israel Defense Forces,Israel
| | - P D Bliese
- Darla Moore School of Business,University of South Carolina,SC,USA
| | - P J Quartana
- Center for Military Psychiatry and Neuroscience,Walter Reed Army Institute of Research,US Army Medical Research and Materiel Command,MD,USA
| | - M L Sipos
- Center for Military Psychiatry and Neuroscience,Walter Reed Army Institute of Research,US Army Medical Research and Materiel Command,MD,USA
| | - D S Pine
- National Institutes of Mental Health,MD,USA
| | - Y Bar-Haim
- School of Psychological Sciences,Tel Aviv University,Tel Aviv,Israel
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Baseline psychophysiological and cortisol reactivity as a predictor of PTSD treatment outcome in virtual reality exposure therapy. Behav Res Ther 2016; 82:28-37. [PMID: 27183343 DOI: 10.1016/j.brat.2016.05.002] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 05/04/2016] [Accepted: 05/04/2016] [Indexed: 12/14/2022]
Abstract
Baseline cue-dependent physiological reactivity may serve as an objective measure of posttraumatic stress disorder (PTSD) symptoms. Additionally, prior animal model and psychological studies would suggest that subjects with greatest symptoms at baseline may have the greatest violation of expectancy to danger when undergoing exposure based psychotherapy; thus treatment approaches which enhanced the learning under these conditions would be optimal for those with maximal baseline cue-dependent reactivity. However methods to study this hypothesis objectively are lacking. Virtual reality (VR) methodologies have been successfully employed as an enhanced form of imaginal prolonged exposure therapy for the treatment of PTSD. Our goal was to examine the predictive nature of initial psychophysiological (e.g., startle, skin conductance, heart rate) and stress hormone responses (e.g., cortisol) during presentation of VR-based combat-related stimuli on PTSD treatment outcome. Combat veterans with PTSD underwent 6 weeks of VR exposure therapy combined with either d-cycloserine (DCS), alprazolam (ALP), or placebo (PBO). In the DCS group, startle response to VR scenes prior to initiation of treatment accounted for 76% of the variance in CAPS change scores, p < 0.001, in that higher responses predicted greater changes in symptom severity over time. Additionally, baseline cortisol reactivity was inversely associated with treatment response in the ALP group, p = 0.04. We propose that baseline cue-activated physiological measures will be sensitive to predicting patients' level of response to exposure therapy, in particular in the presence of enhancement (e.g., DCS).
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50
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Gurak KK, Freund B, Ironson G. The Use of Both Prolonged Exposure and Cognitive Processing Therapy in the Treatment of a Person With PTSD, Multiple Traumas, Depression, and Suicidality. Clin Case Stud 2016. [DOI: 10.1177/1534650116641214] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Despite a high prevalence of comorbid disorders such as major depressive disorder (MDD), the empirical guidelines for how to manage co-occurring conditions in the treatment of posttraumatic stress disorder (PTSD) are lacking. In the context of a complicated presentation of PTSD, this case illustration demonstrates the application of an integrated treatment approach with “Amanda,” a 28-year-old female with a history of multiple traumas, undiagnosed PTSD for 10 years, and comorbid MDD. In addition, Amanda began having suicidal thoughts mid-treatment. This case study demonstrates how the integration of coping skills training and cognitive processing therapy, in conjunction with prolonged exposure, helped Amanda successfully complete treatment and be able to discuss her traumatic events with minimal distress. At discharge, Amanda no longer met criteria for PTSD, had experienced significant improvements in depression and anxiety symptoms, and was no longer experiencing suicidal thoughts. These improvements were maintained at both 3 and 6 months post treatment.
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