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Armer JS, Oh W, Davis MT, Issa M, Sexton MB, Muzik M. Post-traumatic change and resilience after childhood maltreatment: Impacts on maternal mental health over the postpartum period. J Affect Disord 2024; 361:1-9. [PMID: 38844162 DOI: 10.1016/j.jad.2024.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 05/28/2024] [Accepted: 06/03/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Mothers with a history of childhood maltreatment (CM) are particularly vulnerable to postpartum mental health changes. Variability in mental health trajectories is present over the first 18-months postpartum. Little is known about the potentially unique impacts of post-traumatic change or resilience on later postpartum mental health. METHODS Participants (N = 97) completed questionnaires over the first 18-months postpartum measuring demographic risk, mental health symptoms, traumatic experiences, and resilience. Mothers also completed an interview measure coded for post-traumatic changes at 6-months postpartum. Multinomial logistic regression models examined post-traumatic change and resilience factors as predictors of mothers' longitudinal latent mental health trajectory. RESULTS Three classes of latent postpartum mental health emerged: low-symptom, vulnerable, and chronic high-risk. Mothers reporting stronger positive post-traumatic changes were more likely to be in the low-symptom class than the chronic high-risk class (B = -1.082, p = .01). Mothers reporting stronger negative post-traumatic changes were more likely to be in the vulnerable class (B = 0.778, p = .006) or chronic high-risk class (B = 0.906, p = .046) than the low-symptom class. Resilience was not predictive of mental health class. LIMITATIONS Findings are correlational, and causal effects between post-traumatic growth and mental health symptoms cannot be assumed. Mothers who consented to the interview may not be fully representative of all women who have experienced CM, limiting generalizability of findings. CONCLUSIONS Positive post-traumatic change is associated with reduced psychopathology. These findings may assist in identification of mothers at greater risk of adverse postpartum outcomes and futher inform interventions focused on enhancing positive changes in post-traumatic cognitions.
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Affiliation(s)
- Jessica S Armer
- Mental Health Service (116c), VA Ann Arbor Healthcare System, Ann Arbor, MI, United States of America; Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States of America
| | - Wonjung Oh
- Department of Human Development and Family Sciences, Texas Tech University, Lubbock, TX, United States of America
| | - Margaret T Davis
- Deparment of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America
| | - Meriam Issa
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States of America
| | - Minden B Sexton
- Mental Health Service (116c), VA Ann Arbor Healthcare System, Ann Arbor, MI, United States of America; Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States of America.
| | - Maria Muzik
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States of America; Department of Obstetrics & Gynecology, University of Michigan, Ann Arbor, MI, United States of America
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Stuart S, Schultz J, Molina AP, Siber-Sanderowitz S. Interpersonal Psychotherapy: A Review of Theory, History, and Evidence of Efficacy. Psychodyn Psychiatry 2024; 52:370-407. [PMID: 39254940 DOI: 10.1521/pdps.2024.52.3.370] [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] [Indexed: 09/11/2024]
Abstract
Interpersonal psychotherapy (IPT) is an empirically validated treatment for mood disorders, anxiety disorders, eating disorders, and trauma. IPT is based on the concept of "relational frame"-that an individual's experience of psychological distress impacts those around them, and that their social support network impacts the distressed individual. This concept, along with the specific techniques and tools that flow from it and the theoretical bases of IPT (attachment and interpersonal theory) make IPT unique. In this article we review the theoretical bases of IPT (attachment and communication) and provide a brief history of IPT, as well as the evidence supporting its use for a variety of disorders. We also describe its application to groups, adolescents, and other diverse populations. Future directions for research and treatment development are proposed, particularly research in the area of combining IPT with other psychotherapeutic modalities.
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Affiliation(s)
- Scott Stuart
- Director, IPT Institute; Adjunct Professor, University of Southern California, Department of Psychiatry; Professor Emeritus, University of Iowa Department of Psychiatry
| | - Jessica Schultz
- Associate Professor of Psychology, Augustana College, Rock Island, Illinois
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Keefe JR, Kimmel D, Weitz E. A Meta-Analysis of Interpersonal and Psychodynamic Psychotherapies for Posttraumatic Stress Disorder. Am J Psychother 2024; 77:119-128. [PMID: 39104248 DOI: 10.1176/appi.psychotherapy.20230043] [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] [Indexed: 08/07/2024]
Abstract
OBJECTIVE Established trauma-focused cognitive-behavioral therapies for posttraumatic stress disorder (PTSD) have remission rates of approximately 30%-40%. Alternatively, interpersonal psychotherapy (IPT) and psychodynamic psychotherapy (PDT) focus on disrupted attachment, mentalization, and social connection in PTSD and may help some patients. The authors conducted a meta-analysis on these interpersonal and affect-oriented approaches to treating PTSD. METHODS Building on a prior meta-analysis, the authors searched for randomized controlled trials (RCTs) comparing IPT or PDT with other established PTSD treatments or control conditions for adults diagnosed as having PTSD. Random-effects meta-analyses were conducted to assess outcome effect sizes and dropout rates. RCTs were rated via the Randomized Controlled Trial Psychotherapy Quality Rating Scale. RESULTS Ten RCTs (eight of IPT) comparing IPT or PDT with control (k=7) or active treatment (k=4) conditions were identified, nine of which were of adequate quality. IPT (k=5) and PDT (k=2), when analyzed together, were superior to control conditions overall (g=-1.14, p=0.011 [as was IPT alone: g=-0.88, p=0.034]) and to waitlist (g=-1.49) and treatment-as-usual (g=-0.70) groups. Effect sizes, however, may have been inflated by outliers or publication bias. IPT (k=3) and PDT (k=1), when analyzed together, were equally efficacious compared with other active PTSD treatments (primarily exposure-based psychotherapies), as was IPT alone, and had lower dropout rates (relative risk=0.63, p=0.049 for IPT and PDT analyzed together; relative risk=0.61, p=0.098 for IPT alone). CONCLUSIONS Affect-focused therapies hold promise in the treatment of PTSD. IPT has demonstrated efficacy in multiple trials, whereas the evidence base for PDT is sparse.
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Affiliation(s)
- John R Keefe
- Department of Psychology, Long Island University Brooklyn, and Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York City (Keefe); Department of Psychiatry, University of Maryland-Sheppard Pratt Psychiatry Residency Program, Baltimore (Kimmel); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Weitz)
| | - Duncan Kimmel
- Department of Psychology, Long Island University Brooklyn, and Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York City (Keefe); Department of Psychiatry, University of Maryland-Sheppard Pratt Psychiatry Residency Program, Baltimore (Kimmel); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Weitz)
| | - Erica Weitz
- Department of Psychology, Long Island University Brooklyn, and Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York City (Keefe); Department of Psychiatry, University of Maryland-Sheppard Pratt Psychiatry Residency Program, Baltimore (Kimmel); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Weitz)
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Yang Y, Yi Y, Shi X, Yang X. Comparative efficacy of psychological interventions on anxiety and depression in patients with cancer: A systematic review and network meta-analysis. Medicine (Baltimore) 2024; 103:e38155. [PMID: 38787974 PMCID: PMC11124676 DOI: 10.1097/md.0000000000038155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 04/16/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Numerous studies have demonstrated that psychological interventions are effective in alleviating anxiety and depression in patients with cancer. However, the optimal psychological intervention to alleviate anxiety and depression in patients with cancer remains unknown. This study was carried out to compare and rank the comparative effectiveness of various psychological interventions on anxiety and depression in patients with cancer. METHODS Databases, namely PubMed, Embase, Cochrane Library, Web of Science, PsycINFO, CNKI, WanFang, VIP and CBM were systematically searched from their inception dates to December 2023 for randomized controlled trials of psychological interventions for anxiety and depression in patients with cancer. Utilizing the Cochrane Review Manager 5.4, we evaluated the risk of bias in the studies included in the current study based on the Cochrane Handbook 5.1.0 Methodological Quality Evaluation Criteria. The NMA was conducted using STATA 15.0. This study did not involve human participants and therefore did not require ethical approval. RESULTS Thirty-one randomized controlled trials involving 3471 participants were included. MT [SMD = 1.35, 95% CI (0.76, 1.93)] and cognitive behavioral therapy (CBT) [SMD = 0.97, 95% CI (0.53, 1.42)] were superior to usual care in alleviating anxiety. Besides, interpersonal psychotherapy (IPT) [SMD = 1.17, 95% CI (0.06, 2.28)], CBT [SMD = 0.97, 95 % CI (0.63, 1.30)], and MT [SMD = 0.93, 95% CI (0.35, 1.50)] were superior to usual care in alleviating depression. In addition, CBT was superior to family therapy in alleviating depression [SMD = 0.73, 95% CI (0.08, 1.38)]. The MT, CBT, and IPT ranked in the top three in alleviating anxiety, while IPT, CBT, and MT ranked in the top three in alleviating depression. CONCLUSION MT and IPT would be a more appropriate option in alleviating anxiety and depression in patients with cancer, respectively. This study also suggested that CBT had a significant effect in alleviating negative emotions in patients with cancer. However, the results need to be validated by high-quality and large-sample studies.
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Affiliation(s)
- Yinhao Yang
- School of Nursing, Hubei University of Medicine, Shiyan, China
- Institute of Cancer Clinical Prevention and Control, Medical Department of Jingchu University of Technology, Jingmen, China
| | - Yingying Yi
- School of Nursing, Hubei University of Medicine, Shiyan, China
| | - Xixi Shi
- Institute of Cancer Clinical Prevention and Control, Medical Department of Jingchu University of Technology, Jingmen, China
| | - Xueqin Yang
- Institute of Cancer Clinical Prevention and Control, Medical Department of Jingchu University of Technology, Jingmen, China
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Drožđek B, Rodenburg J. Healing wounded trees: clinicians' perspectives on treatment of complex posttraumatic stress disorder. Front Psychiatry 2024; 15:1356862. [PMID: 38654731 PMCID: PMC11035878 DOI: 10.3389/fpsyt.2024.1356862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 03/25/2024] [Indexed: 04/26/2024] Open
Abstract
While treatment guidelines agree on the first-line interventions for the treatment of posttraumatic stress disorder (PTSD), there is an ongoing debate between experts regarding the treatment of complex posttraumatic stress disorder (C-PTSD). As scientific research is slowly emerging, different treatment approaches are used in clinical practice This article aims to provide a set of treatment options for C-PTSD in adult survivors of repeated exposure to severe violence and abuse, both in childhood and later on in life. The developmental-contextual perspective on mental health forms the basis of this approach. This perspective is elaborated using the tree metaphor. Then, several treatment strategies are suggested. The presented strategies are a combination of the existing evidence-based approaches for the treatment of PTSD and personality disorders. They target psychological damage in survivors while taking their developmental trajectories and ecological environments into consideration. The treatment model presented is based on longstanding clinical practice and it may be a promising framework for treating C-PTSD. However, it still needs to be scientifically examined for acceptability and effectiveness.
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Alshahrani KM, Johnson J, Prudenzi A, O’Connor DB. The effectiveness of psychological interventions for reducing PTSD and psychological distress in first responders: A systematic review and meta-analysis. PLoS One 2022; 17:e0272732. [PMID: 36001612 PMCID: PMC9401173 DOI: 10.1371/journal.pone.0272732] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 07/25/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND First responders are faced with stressful and traumatic events in their work that may affect their psychological health. The current review examined the effectiveness of psychological interventions to treat posttraumatic stress disorder (PTSD), anxiety, depression, stress and burnout in first responders. METHODS Four databases were searched to identify controlled studies that examined the efficacy of psychological interventions to reduce PTSD symptoms (primary outcome) in first responders (including firefighters, police/law enforcement officers, search and rescue personnel, emergency and paramedics teams). Secondary outcomes were anxiety, depression, burnout, and stress. RESULTS 15 studies were identified, including 10 studies that measured PTSD, 7 studies for anxiety, 10 studies for depression, 7 studies for stress and 1 for burnout. Interventions were associated with a significant reduction in PTSD (SDM = -0.86; 95% CI = -1.34 -- 0.39), depression (SDM = -0.63; 95% CI = -0.94 --0.32), and anxiety (SDM = -0.38; 95% CI = -0.71 --0.05) but not stress (SDM = -0.13; 95% CI = -0.51-0.25). CBT-based and clinician-delivered interventions were associated with significantly greater reductions in PTSD than other types of interventions and non-clinician interventions, but no differences were found for depression. There was evidence of moderate to high risk of bias across all studies. CONCLUSIONS Psychological interventions are effective in reducing PTSD, depression and anxiety symptoms but not stress in first responders. Further research is needed using high quality randomised designs over longer periods of follow-up.
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Affiliation(s)
- Khalid M. Alshahrani
- School of Psychology, University of Leeds, Leeds, United Kingdom
- Psychology Department, Faculty of Arts and Humanity, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Judith Johnson
- School of Psychology, University of Leeds, Leeds, United Kingdom
- Bradford Institute for Health Research, Bradford Royal Infirmary, Temple Bank House, Duckworth Lane, Bradford, United Kingdom
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Arianna Prudenzi
- School of Psychology, University of Birmingham, Birmingham, United Kingdom
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Yue JL, Li N, Que JY, Hu SF, Xiong NN, Deng JH, Ma N, Sun SW, Chi R, Shi J, Sun HQ. Workforce situation of the Chinese mental health care system: results from a cross-sectional study. BMC Psychiatry 2022; 22:562. [PMID: 35996107 PMCID: PMC9394058 DOI: 10.1186/s12888-022-04204-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 08/05/2022] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND High-quality mental health services can improve outcomes for people with mental health problems and abate the burden of mental disorders. We sought to identify the challenges the country's mental health system currently faces and the human resource situation related to psychological services and to provide recommendations on how the mental health workforce situation could be addressed in China. METHODS This study used a cross-sectional survey design. A web-based questionnaire approach and a convenience sampling method were adopted. It was carried out from September 2020 to January 2021 in China, and we finally included 3824 participants in the analysis. Descriptive statistical analysis of the characteristics of the study sample was performed. The risk factors for competence in psychological counseling/psychotherapy were assessed using multiple linear regression analysis. RESULTS Workforce related to psychotherapy is scarce in China, especially in Western China and community mental health sectors. Psychiatrists (39.1%) and nurses (38.9%) were the main service providers of psychotherapy in psychiatric hospitals, and clinical psychologists (6.9%) and counsellors (5.0%) were seriously scarce in mental health care sectors. A total of 74.2% of respondents had no systematic psychological training, and 68.4 and 69.2% of them had no self-experience and professional supervision, respectively. Compared with clinical psychologists and counselors, psychiatrists and nurses had less training. Systematic psychological training (β = - 0.88), self-experience (β = - 0.59) and professional supervision (β = - 1.26) significantly influenced psychotherapy capacity (P<0.001). CONCLUSIONS Sustained effort will be required to provide a high-quality, equitably distributed psychotherapy workforce in China, despite challenges for community mental health sectors and western China being likely to continue for some time. Because mental illness is implicated in so many burgeoning social ills, addressing this shortfall could have wide-ranging benefits.
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Affiliation(s)
- Jing-Li Yue
- grid.11135.370000 0001 2256 9319Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Huayuanbei Road 51, Haidian District, Beijing, 100191 China
| | - Na Li
- grid.11135.370000 0001 2256 9319Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Huayuanbei Road 51, Haidian District, Beijing, 100191 China
| | - Jian-Yu Que
- grid.11135.370000 0001 2256 9319Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Huayuanbei Road 51, Haidian District, Beijing, 100191 China
| | - Si-Fan Hu
- grid.11135.370000 0001 2256 9319Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Huayuanbei Road 51, Haidian District, Beijing, 100191 China
| | - Na-Na Xiong
- grid.11135.370000 0001 2256 9319Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Huayuanbei Road 51, Haidian District, Beijing, 100191 China
| | - Jia-Hui Deng
- grid.11135.370000 0001 2256 9319Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Huayuanbei Road 51, Haidian District, Beijing, 100191 China
| | - Ning Ma
- grid.11135.370000 0001 2256 9319Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Huayuanbei Road 51, Haidian District, Beijing, 100191 China
| | - Si-Wei Sun
- grid.11135.370000 0001 2256 9319Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Huayuanbei Road 51, Haidian District, Beijing, 100191 China
| | - Rui Chi
- grid.11135.370000 0001 2256 9319Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Huayuanbei Road 51, Haidian District, Beijing, 100191 China
| | - Jie Shi
- grid.11135.370000 0001 2256 9319National Institute on Drug Dependence, Peking University, Beijing, China
| | - Hong-Qiang Sun
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Huayuanbei Road 51, Haidian District, Beijing, 100191, China.
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Asch RH, Esterlis I, Wendt FR, Kachadourian L, Southwick SM, Gelernter J, Polimanti R, Pietrzak RH. Polygenic risk for traumatic loss-related PTSD in US military veterans: Protective effect of secure attachment style. World J Biol Psychiatry 2021; 22:792-799. [PMID: 33821766 PMCID: PMC8925016 DOI: 10.1080/15622975.2021.1907721] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/15/2020] [Accepted: 12/28/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To examine whether attachment style moderates the relationship between polygenic risk scores (PRS) for posttraumatic stress disorder (PTSD) re-experiencing (PTSDREX) symptoms and the severity of and positive screen for traumatic loss-related PTSD. METHODS Data were analysed from 631 US veterans who endorsed 'unexpected death of a loved one' as their 'worst' traumatic event. Multivariable models evaluated the association between PRS for PTSDREX, attachment style, and their interaction in predicting severity and positive screen for PTSD. A gene enrichment analysis was conducted to identify possible molecular mechanisms underlying the association between PTSDREX PRS and PTSD. RESULTS PTSDREX PRS (β = 0.17; odds ratio [OR] = 1.85), attachment style (β= -0.33; OR = 0.14), and PTSDREX PRS × attachment style interaction (β= -0.12; OR = 0.53) were significant predictors of the severity and positive screen for PTSD. The most significant gene set detected was the gene ontology (GO) cellular component podosome set (GO:0002102, p < 3.95 × 10-5). CONCLUSIONS Having a secure attachment style may help mitigate polygenic risk for developing traumatic loss-related PTSD in US veterans. Podosomes, which are implicated in inflammatory and neuroplasticity processes, may contribute to the genetic liability to developing loss-related PTSD. Psychological treatments targeting attachment security may help mitigate increased polygenic risk for loss-related PTSD in this population.
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Affiliation(s)
- Ruth H. Asch
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Irina Esterlis
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Clinical Neurosciences Division, U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Frank R. Wendt
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Clinical Neurosciences Division, U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Lorig Kachadourian
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Clinical Neurosciences Division, U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Steven M. Southwick
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Clinical Neurosciences Division, U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Joel Gelernter
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Clinical Neurosciences Division, U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Renato Polimanti
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Clinical Neurosciences Division, U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Robert H. Pietrzak
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Clinical Neurosciences Division, U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA
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Shu K. The effect of cognitive behavioral therapy on the release of interpersonal stress. Work 2021; 69:625-636. [PMID: 34120940 DOI: 10.3233/wor-213504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND interpersonal communication in workplace is a problem that is faced by every employee. It is common in all industries and increasingly lethal. When they are unable to bear such overload of psychological pressure, they tend to suffer from anxiety, irritability, depression, and other psychological disorders and even mental diseases. It is urgent to explore how to help employees relieve psychological stress. OBJECTIVE the study aimed to analyze the effects of cognitive behavioral therapy (CBT) on workplace interpersonal stress, and provide help for professionals, especially newcomers, to relieve social pressure. METHODS 125 employees of Internet enterprises were given multi-baseline designed CBT (with baseline phase, treatment phase, and post-baseline phase). 43 subjects who did not finish the therapist program were set as the control group and 82 subjects who finished the treatment program were set as the experimental group. First, the differences of interpersonal stress of subjects with different gender, age, educational background, and monthly salary were analyzed. Then, social avoidance, distress, anxiety, and depression scores in baseline, treatment, and post-baseline periods were compared. Finally, the effects of gender, age, educational background, and monthly salary on social avoidance, distress, anxiety, and depression scores of the experimental group were analyzed by multiple regression. and the influence paths of the workplace interpersonal pressure was constructed. RESULTS Social avoidance, distress, anxiety, and depression of employees earning 10000 or more per month were less than those earning 10000 or more per month. Social avoidance, distress, anxiety, and depression of employees aged 30-50 were higher than those aged < 30 and > 50 (P < 0.05). Social avoidance, social distress, and depression in males were lower than those in females (P < 0.05). Social distress, anxiety, and depression of employees with master's degree or above were less than those with bachelor's degree or junior college degree. There were significant differences between the two groups in the post baseline phase. The monthly salary had the greatest influence on the social avoidance and distress, anxiety, and depression scores of the employees after treatment, with the path coefficients of -0.183, -0.169, and -0.184, respectively. CONCLUSIONS CBT can effectively relieve social avoidance and distress of workplace employees and can improve the symptoms of anxiety and depression. Educational level, age, and monthly salary had a certain influence on the improvement of social avoidance, distress, anxiety and depression.
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Affiliation(s)
- Kunyao Shu
- School of Marxism, Wuhan University of Technology, Hubei, Wuhan, China.,Social Science Division, North China University of Water Resources and Electric Power, Zhengzhou, Henan, China. E-mail:
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Illingworth BJ, Lewis DJ, Lambarth AT, Stocking K, Duffy JM, Jelen LA, Rucker JJ. A comparison of MDMA-assisted psychotherapy to non-assisted psychotherapy in treatment-resistant PTSD: A systematic review and meta-analysis. J Psychopharmacol 2021; 35:501-511. [PMID: 33345689 DOI: 10.1177/0269881120965915] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
RATIONALE Novel, evidence-based treatments are required for treatment-resistant post-traumatic stress disorder (PTSD). 3,4-Methylenedioxymethamphetamine (MDMA) has beneficially augmented psychotherapy in several small clinical trials. OBJECTIVE To review the use of MDMA-assisted psychotherapy in treatment-resistant PTSD. METHODS Systematic searches of four databases were conducted from inception to February 2020. A meta-analysis was performed on trials which were double-blinded, randomised, and compared MDMA-assisted psychotherapy to psychotherapy and placebo. The primary outcomes were the differences in Clinician Administered PTSD Scale (CAPS-IV) score and Beck's Depression Inventory (BDI). Secondary outcome measures included neurocognitive and physical adverse effects, at the time, and within 7 days of intervention. RESULTS Four randomised controlled trials (RCTs) met inclusion criteria. When compared to active placebo, intervention groups taking 75 mg (MD -46.90; 95% (confidence intervals) CI -58.78, -35.02), 125 mg (MD -20.98; 95% CI -34.35, -7.61) but not 100 mg (MD -12.90; 95% CI -36.09, 10.29) of MDMA with psychotherapy, had significant decreases in CAPS-IV scores, as did the inactive placebo arm (MD -33.20; 95% CI -40.53, -25.87). A significant decrease in BDI when compared to active placebo (MD -10.80; 95% CI -20.39, -1.21) was only observed at 75 mg. Compared to placebo, participants reported significantly more episodes of low mood, nausea and jaw-clenching during sessions and lack of appetite after 7 days. CONCLUSION These results demonstrate potential therapeutic benefit with minimal physical and neurocognitive risk for the use of MDMA-assisted psychotherapy in TR-PTSD, despite little effect on Beck's Depression Inventory. Better powered RCTs are required to investigate further. INTERNATIONAL PROSPECTIVE REGISTER OF SYSTEMATIC REVIEWS CRD42019109132 available online at www.crd.york.ac.uk/prospero.
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Affiliation(s)
| | | | - Andrew T Lambarth
- North Middlesex Hospital, North Middlesex University Hospital NHS Trust, London, UK
| | - Kate Stocking
- Centre for Biostatistics, The University of Manchester, Manchester, UK
| | - James Mn Duffy
- Institute for Women's Health, University College London, London, UK.,The Fetal Medicine Research Institute, King's College Hospital NHS Foundation Trust, London, UK
| | - Luke A Jelen
- Centre for Affective Disorders, King's College London, London, UK
| | - James J Rucker
- Centre for Affective Disorders, King's College London, London, UK
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Asch RH, Esterlis I, Southwick SM, Pietrzak RH. Risk and resilience factors associated with traumatic loss-related PTSD in U.S. military veterans: Results from the National Health and Resilience in Veterans Study. Psychiatry Res 2021; 298:113775. [PMID: 33578060 DOI: 10.1016/j.psychres.2021.113775] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 01/28/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Sudden death of a loved one is the most prevalent potentially traumatic event worldwide, yet little is known about risk and resilience factors associated with traumatic loss-related posttraumatic stress disorder (PTSD). METHODS Data from a nationally representative sample of U.S. military veterans were analyzed to identify sociodemographic, military, health and psychosocial correlates of traumatic loss-related PTSD. RESULTS Loneliness, somatic symptoms, and attachment style were the strongest correlates of PTSD symptom severity and positive screens for traumatic loss-related PTSD. CONCLUSION Loneliness, somatic symptoms, and attachment style may represent therapeutic targets to help mitigate traumatic loss-related PTSD in U.S. veterans.
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Affiliation(s)
- Ruth H Asch
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Irina Esterlis
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; US Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Steven M Southwick
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Robert H Pietrzak
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; US Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA
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Shea MT, Krupnick JL, Belsher BE, Schnurr PP. Non-Trauma-Focused Psychotherapies for the Treatment of PTSD: a Descriptive Review. ACTA ACUST UNITED AC 2020. [DOI: 10.1007/s40501-020-00214-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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