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Fernando M, Tu JW, Grau PP, Koch EI, Blevins EJ, Jefferson S, Sexton MB. Differential Associations Between Posttraumatic Cognitions, Posttraumatic Stress Disorder Symptoms, and Race Among Black and White Veterans Seeking Treatment for Assaultive Military Sexual Trauma. JOURNAL OF INTERPERSONAL VIOLENCE 2024; 39:631-650. [PMID: 37714821 DOI: 10.1177/08862605231197773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
Past research supports the role of negative posttraumatic cognitions (NPCs) in the development and maintenance of posttraumatic stress disorder (PTSD). The relationship between NPCs and PTSD may be uniquely impacted by racial status and experiences of military sexual trauma (MST), both of which may have a unique impact on one's understanding of self, others, and the world. We explored racial differences in the association between NPCs and PTSD symptom clusters in a sample of veterans endorsing MST (N = 139; 74.8% White, 25.2% Black). A path model was created and analyzed both with the full sample and separately by racial group. In the full sample, NPCs about the self and world were significantly associated with intrusion, negative alterations in cognitions and mood (NACM), and arousal, but not avoidance. Self-blame was not a significant predictor of negative alterations in cognition in mood. This model was consistent in the White veteran model, whereas only negative cognitions about the self were associated with NACM in the Black veteran path model. NPCs about the self and world appear important to non-avoidance PTSD symptomatology related to MST and thus should be targeted in treatment. For Black veterans endorsing distress related to NACM symptoms, negative beliefs about the self should be specifically considered for intervention.
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Affiliation(s)
- Michelle Fernando
- VA Ann Arbor Healthcare System, MI, USA
- VA Boston National Center for PTSD, USA
- Eastern Michigan University, Ypsilanti, USA
- Boston University Chobanian & Avedisian School of Medicine, USA
| | - Joseph W Tu
- VA Ann Arbor Healthcare System, MI, USA
- Eastern Michigan University, Ypsilanti, USA
| | - Peter P Grau
- VA Ann Arbor Healthcare System, MI, USA
- Michigan Medicine, USA
| | | | - Emily J Blevins
- VA Ann Arbor Healthcare System, MI, USA
- Michigan Medicine, USA
| | | | - Minden B Sexton
- VA Ann Arbor Healthcare System, MI, USA
- Michigan Medicine, USA
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Stein J, Vöhringer M, Wagner B, Stammel N, Nesterko Y, Böttche M, Knaevelsrud C. Exposure Versus Cognitive Restructuring Techniques in Brief Internet-Based Cognitive Behavioral Treatment for Arabic-Speaking People With Posttraumatic Stress Disorder: Randomized Clinical Trial. JMIR Ment Health 2023; 10:e48689. [PMID: 38090792 PMCID: PMC10753431 DOI: 10.2196/48689] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/15/2023] [Accepted: 09/16/2023] [Indexed: 12/30/2023] Open
Abstract
BACKGROUND Cognitive behavioral interventions delivered via the internet are demonstrably efficacious treatment options for posttraumatic stress disorder (PTSD) in underserved, Arabic-speaking populations. However, the role of specific treatment components remains unclear, particularly in conflict-affected areas of the Middle East and North Africa. OBJECTIVE This study aims to evaluate 2 brief internet-based treatments in terms of efficacy, including change in PTSD symptom severity during treatment. Both treatments were developed in line with Interapy, an internet-based, therapist-assisted cognitive behavioral therapy protocol for PTSD and adapted to the specific research question. The first treatment comprised self-confrontation and social sharing (exposure treatment; 6 sessions); the second comprised cognitive restructuring and social sharing (cognitive restructuring treatment; 6 sessions). The 2 treatments were compared with each other and with a waitlist control group. METHODS In total, 365 Arabic-speaking participants from the Middle East and North Africa (mean age 25.49, SD 6.68 y) with PTSD were allocated to cognitive restructuring treatment (n=118, 32.3%), exposure treatment (n=122, 33.4%), or a waitlist control group (n=125, 34.2%) between February 2021 and December 2022. PTSD symptom severity, posttraumatic maladaptive cognitions, anxiety, depressive and somatoform symptom severity, and quality of life were assessed via self-report at baseline and after treatment or waiting time. PTSD symptom severity was also measured throughout treatment or waiting time. Treatment satisfaction was assessed after treatment completion. Treatment use and satisfaction were compared between the 2 treatment conditions using appropriate statistical tests (eg, chi-square and Welch tests). Multiple imputation was performed to address missing data and evaluate treatment-associated changes. These changes were analyzed using multigroup change modeling in the completer and intention-to-treat samples. RESULTS Overall, 200 (N=240, 83.3%) participants started any of the treatments, of whom 123 (61.5%) completed the treatment. Treatment condition was not significantly associated with the proportion of participants who started versus did not start treatment (P=.20) or with treatment completion versus treatment dropout (P=.71). High treatment satisfaction was reported, with no significant differences between the treatment conditions (P=.48). In both treatment conditions, PTSD, anxiety, depressive and somatoform symptom severity, and posttraumatic maladaptive cognitions decreased, and quality of life improved significantly from baseline to the posttreatment time point (P≤.001 in all cases). Compared with the baseline assessment, overall PTSD symptom severity decreased significantly after 4 sessions in both treatment conditions (P<.001). Moreover, both treatment conditions were significantly superior to the waitlist control group regarding overall PTSD symptom severity (P<.001) and most other comorbid mental health symptoms (P<.001 to P=.03). Differences between the 2 conditions in the magnitude of change for all outcome measures were nonsignificant. CONCLUSIONS Internet-based cognitive behavioral treatments for PTSD focusing primarily on either self-confrontation or cognitive restructuring are applicable and efficacious for Arabic-speaking participants. TRIAL REGISTRATION German Clinical Trials Register DRKS00010245; https://drks.de/search/de/trial/DRKS00010245.
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Affiliation(s)
- Jana Stein
- Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
- Department for Transcultural and Traumatic Stress Studies, Center ÜBERLEBEN, Berlin, Germany
| | - Max Vöhringer
- Department for Transcultural and Traumatic Stress Studies, Center ÜBERLEBEN, Berlin, Germany
| | - Birgit Wagner
- Clinical Psychology and Psychotherapy, Medical School Berlin, Berlin, Germany
| | - Nadine Stammel
- Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Yuriy Nesterko
- Department for Transcultural and Traumatic Stress Studies, Center ÜBERLEBEN, Berlin, Germany
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Maria Böttche
- Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Christine Knaevelsrud
- Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
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3
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Alpert E, Carpenter JK, Smith BN, Woolley MG, Raterman C, Farmer CC, Kehle-Forbes SM, Galovski TE. Leveraging observational data to identify in-session patient and therapist predictors of cognitive processing therapy response and completion. J Trauma Stress 2023; 36:397-408. [PMID: 36987703 PMCID: PMC10228524 DOI: 10.1002/jts.22924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 01/04/2023] [Accepted: 01/06/2023] [Indexed: 03/30/2023]
Abstract
Cognitive processing therapy (CPT) is an evidence-based treatment for posttraumatic stress disorder (PTSD), but little is known about in-session process variables that predict symptom reduction and treatment completion during CPT. Examining potentially malleable factors that may promote or impede recovery can inform care delivery and enhance outcomes. The current study used observational ratings of CPT session recordings to examine in-session patient and therapist factors in cognitive, affective, and interpersonal domains to identify their relative contributions to predicting symptom outcomes and treatment completion. Participants were 70 adult survivors of interpersonal violence who received CPT. Predictors of better posttreatment PTSD outcomes included less patient fear, β = .32, and less patient avoidance of engaging with the therapist, β = .35. When using the last available PTSD score, less fear, β = .23, and avoidance, β = .28, continued to predict better outcomes, and more patient cognitive flexibility emerged as a stronger predictor of outcome, β = -.33. Predictors of a higher likelihood of treatment completion included more therapist use of Socratic dialogue, OR = 6.75, and less therapist encouragement of patient affect, OR = 0.11. Patient sadness and anger and therapist expression of empathy did not predict symptom outcomes or treatment completion versus dropout. The results highlight the importance of patients' cognitions, emotions, and engagement with their therapist in CPT as well as the role of therapist behaviors in patient completion of treatment.
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Affiliation(s)
- Elizabeth Alpert
- National Center for PTSD Women's Health Sciences Division at VA Boston Healthcare System, Boston, Massachusetts, USA
- Boston University Chobanian & Avedisian School of Medicine Department of Psychiatry, Boston, Massachusetts, USA
| | - Joseph K. Carpenter
- National Center for PTSD Women's Health Sciences Division at VA Boston Healthcare System, Boston, Massachusetts, USA
- Boston University Chobanian & Avedisian School of Medicine Department of Psychiatry, Boston, Massachusetts, USA
| | - Brian N. Smith
- National Center for PTSD Women's Health Sciences Division at VA Boston Healthcare System, Boston, Massachusetts, USA
- Boston University Chobanian & Avedisian School of Medicine Department of Psychiatry, Boston, Massachusetts, USA
| | - Mercedes G. Woolley
- National Center for PTSD Women's Health Sciences Division at VA Boston Healthcare System, Boston, Massachusetts, USA
| | | | | | - Shannon M. Kehle-Forbes
- National Center for PTSD Women's Health Sciences Division at VA Boston Healthcare System, Boston, Massachusetts, USA
- Center for Care Delivery & Outcomes Research at Minneapolis VA Healthcare System, Minneapolis, Minnesota, USA
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Tara E. Galovski
- National Center for PTSD Women's Health Sciences Division at VA Boston Healthcare System, Boston, Massachusetts, USA
- Boston University Chobanian & Avedisian School of Medicine Department of Psychiatry, Boston, Massachusetts, USA
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Haven SE, Brown WJ, Berfield JB, Bruce SE. Predictors of Attrition and Response in Cognitive Processing Therapy for Interpersonal Trauma Survivors with PTSD. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP19759-NP19780. [PMID: 34498510 DOI: 10.1177/08862605211043584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
With the establishment of empirically validated treatments for posttraumatic stress disorder (PTSD), concerns remain regarding the effectiveness of such treatments in real-world clinical settings. Specifically, premature termination and treatment response limit the effectiveness of these interventions. The current study investigated factors potentially related to premature termination and treatment response in Cognitive Processing Therapy with Account (CPT-A). Participants in this study included 42 women (Mage = 30.70 SDage = 9.40) with PTSD from exposure to interpersonal trauma. Demographic characteristics, pre-treatment symptoms of PTSD and depression, and transdiagnostic factors were examined as predictors of attrition and treatment response. Hierarchical regression and logistic regression models were analyzed to test the variance explained and predictive value of these factors. The present study revealed that age was a significant factor related to dropout from CPT-A whereas baseline PTSD symptom severity was significantly related to treatment response. Results of this study suggest the importance of the interrelationships among pre-treatment predictors as well as the consideration of attrition and treatment response as distinct metrics of treatment outcome. Further, these results inform the application of CPT-A for PTSD in survivors of interpersonal trauma, as consideration of the identified predictors of dropout and non-response at intake may contribute to treatment retention and response.
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Socioeconomic Deprivation and Dropout from Contemporary Psychological Intervention for Common Mental Disorders: A Systematic Review. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 49:490-505. [PMID: 34837573 PMCID: PMC9005422 DOI: 10.1007/s10488-021-01178-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2021] [Indexed: 10/29/2022]
Abstract
Dropout during psychological intervention is a significant problem. Previous evidence for associations with socioeconomic deprivation is mixed. This study aimed to review the evidence for associations between deprivation and dropout from contemporary adult psychological interventions for common mental disorders (CMDs). Systematic review, narrative synthesis and random effects meta-analysis of peer-reviewed English language journal articles published June 2010-June 2020 was conducted. Data sources included medline, PsycInfo, databases indexed by web of science, ProQuest social science database and sociology collection, and the Cochrane Library, supplemented by forward and backward citation searching. Five studies were eligible for inclusion (mean N = 170, 68% female, 60% White Caucasian, 32% dropout rate, predominantly cognitive behaviour therapy/cognitive processing therapy). Narrative synthesis indicated an overall non-significant effect of deprivation on dropout. Meta-analytic significance of controlled (k = 3) and uncontrolled (k = 4) effects depended on the measure of deprivation included for those studies using more than one measure (controlled OR 1.21-1.32, p = 0.019-0.172, uncontrolled OR 1.28-1.76, p = 0.024-0.423). The low number of included studies meant sub-group comparisons were limited, despite some tentative indications of potential differential effects. A comparator set of excluded studies showed similar uncertainty. There was limited evidence that did not overall suggest a clear significant effect of deprivation on dropout from contemporary individual CMD interventions. However, more contemporary research is needed, as effects may vary according to clinical and methodological factors, and for dropout versus non-initiation.
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6
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Acierno R, Jaffe AE, Gilmore AK, Birks A, Denier C, Muzzy W, Lopez CM, Tuerk P, Grubaugh AL. A randomized clinical trial of in-person vs. home-based telemedicine delivery of Prolonged Exposure for PTSD in military sexual trauma survivors. J Anxiety Disord 2021; 83:102461. [PMID: 34391978 DOI: 10.1016/j.janxdis.2021.102461] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 07/27/2021] [Accepted: 07/27/2021] [Indexed: 11/26/2022]
Abstract
Posttraumatic stress disorder (PTSD) is common in women who experienced Military Sexual Trauma (MST). Despite Veterans Affairs Medical Center-wide screening and tailored MST services, substantial barriers to care exist, and about 50 % of those who start evidence-based treatment for PTSD drop out prematurely. Home-based telemedicine (HBT) may reduce logistical and stigma related barriers to mental health care, thereby reducing dropout. The current randomized clinical trial (NCT02417025) for women veterans with MST-related PTSD (N = 136) compared the efficacy of HBT delivery of Prolonged Exposure (PE) to in-person delivery of PE on measures of PTSD and depression, as well as on "PE dose" received. Hypotheses predicted that women in the HBT PE group would complete more sessions, and evince greater PTSD and depression symptom reduction compared to in-person PE. Results revealed that there were no differences in dose received or PTSD symptom reduction between in-person and HBT conditions; however, dose (i.e., more sessions) was related to reduced PTSD symptom severity. Future research should examine other factors associated with high PTSD treatment dropout among MST patients.
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Affiliation(s)
- Ron Acierno
- Faillace Department of Psychiatry, University of Texas Health Science Center at Houston, United States; Ralph H. Johnson VA Medical Center, Charleston, SC, United States.
| | - Anna E Jaffe
- Department of Psychology, University of Nebraska-Lincoln, NE, United States
| | - Amanda K Gilmore
- Department of Psychology, Georgia State University, GA, United States
| | - Anna Birks
- Ralph H. Johnson VA Medical Center, Charleston, SC, United States
| | - Carol Denier
- Ralph H. Johnson VA Medical Center, Charleston, SC, United States
| | - Wendy Muzzy
- Department of Psychiatry, Medical University of South Carolina, United States
| | - Cristina M Lopez
- College of Nursing, Medical University of South Carolina, United States
| | - Peter Tuerk
- School of Education and Human Development, University of Virginia, United States
| | - Anouk L Grubaugh
- Ralph H. Johnson VA Medical Center, Charleston, SC, United States; Department of Psychiatry, Medical University of South Carolina, United States
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7
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Anger and predictors of drop-out from PTSD treatment of veterans and first responders. Behav Cogn Psychother 2021; 50:237-251. [PMID: 34569465 DOI: 10.1017/s1352465821000382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Drop-out is an important barrier in treating post-traumatic stress disorder (PTSD) with consequences that negatively impact clients, clinicians and mental health services as a whole. Anger is a common experience in people with PTSD and is more prevalent in military veterans. To date, no research has examined if anger may predict drop-out in military veterans or first responders. AIMS The present study aimed to determine the variables that predict drop-out among individuals receiving residential treatment for PTSD. METHOD Ninety-five military veterans and first responders completed pre-treatment measures of PTSD symptom severity, depression, anxiety, anger, and demographic variables. Logistic regression analyses were used to determine if these variables predicted drop-out from treatment or patterns of attendance. RESULTS Female gender was predictive of drop-out. However, when analysed by occupation female gender was predictive of drop-out among first responders and younger age was predictive of drop-out in military participants. Anger, depression, anxiety and PTSD symptom severity were not predictive of drop-out in any of the analyses. No variables were found to predict attendance patterns (consistent or inconsistent) or early versus late drop-out from the programme. CONCLUSION These results suggest that although anger is a relevant issue for treating PTSD, other factors may be more pertinent to drop-out, particularly in this sample. In contrast with other findings, female gender was predictive of drop-out in this study. This may indicate that in this sample, there are unique characteristics and possible interacting variables that warrant exploration in future research.
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8
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Meis LA, Noorbaloochi S, Hagel Campbell EM, Erickson EPG, Velasquez TL, Leverty DM, Thompson K, Erbes C. A Theory of Planned Behavior Scale for Adherence to Trauma-Focused Posttraumatic Stress Disorder Treatments. J Trauma Stress 2021; 34:440-453. [PMID: 33200475 DOI: 10.1002/jts.22620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/25/2020] [Accepted: 09/16/2020] [Indexed: 11/10/2022]
Abstract
Evidence-based psychotherapies for posttraumatic stress disorder (PTSD), such as cognitive processing therapy and prolonged exposure (CPT/PE), greatly reduce suffering for veterans, but many veterans fail to complete treatment. Developing a theory-based understanding of adherence is necessary to inform interventions to improve treatment retention. We developed and tested a series of scales applying the theory of planned behavior (TPB) to CPT/PE adherence. The scales were administered in mailed surveys as part of a larger mixed-methods study of veteran adherence to PE/CPT. Surveys were sent to 379 veterans who were initiating CPT/PE across four U.S. Veterans Affairs (VA) hospitals and 207 of their loved ones. Subsequent session attendance and homework compliance were coded via a review of electronic medical records. We examined item-level characteristics, factor structure, and the convergent and discriminant validity of the resultant scales. The findings support four subscales: two related to attitudes (i.e., Treatment Makes Sense and Treatment Fits Needs), one related to perceived behavioral control over participation (i.e., Participation Control), and one related to perceived family attitudes about CPT/PE participation (i.e., Subjective Norms). Scale validity was supported through significant associations with theoretically relevant constructs, including intentions to persist in CPT/PE, rs = .19-.38; treatment completion, rs = .21-.25; practical treatment barriers, rs = -.19 to -.24; and therapeutic alliance, rs = .39-.57.
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Affiliation(s)
- Laura A Meis
- Center for Care Delivery & Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA.,Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA.,Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Siamak Noorbaloochi
- Center for Care Delivery & Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA.,Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA.,Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Emily M Hagel Campbell
- Center for Care Delivery & Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA.,Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA
| | - Emily P G Erickson
- Center for Care Delivery & Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA.,Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA
| | - Tina L Velasquez
- Center for Care Delivery & Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA.,Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA
| | - David M Leverty
- Center for Care Delivery & Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA.,Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA
| | - Katie Thompson
- Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA
| | - Christopher Erbes
- Center for Care Delivery & Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA.,Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA.,Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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Zhu X, Suarez-Jimenez B, Zilcha-Mano S, Lazarov A, Arnon S, Lowell AL, Bergman M, Ryba M, Hamilton AJ, Hamilton JF, Turner JB, Markowitz JC, Fisher PW, Neria Y. Neural changes following equine-assisted therapy for posttraumatic stress disorder: A longitudinal multimodal imaging study. Hum Brain Mapp 2021; 42:1930-1939. [PMID: 33547694 PMCID: PMC7978114 DOI: 10.1002/hbm.25360] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/09/2021] [Accepted: 01/21/2021] [Indexed: 12/17/2022] Open
Abstract
Background While effective treatments for posttraumatic stress disorder (PTSD) exist, many individuals, including military personnel and veterans fail to respond to them. Equine‐assisted therapy (EAT), a novel PTSD treatment, may complement existing PTSD interventions. This study employs longitudinal neuro‐imaging, including structural magnetic resonance imaging (sMRI), resting state‐fMRI (rs‐fMRI), and diffusion tensor imaging (DTI), to determine mechanisms and predictors of EAT outcomes for PTSD. Method Nineteen veterans with PTSD completed eight weekly group sessions of EAT undergoing multimodal MRI assessments before and after treatment. Clinical assessments were conducted at baseline, post‐treatment and at 3‐month follow‐up. Results At post‐treatment patients showed a significant increase in caudate functional connectivity (FC) and reduction in the gray matter density of the thalamus and the caudate. The increase of caudate FC was positively associated with clinical improvement seen immediately at post‐treatment and at 3‐month follow‐up. In addition, higher baseline caudate FC was associated with greater PTSD symptom reduction post‐treatment. Conclusions This exploratory study is the first to demonstrate that EAT can affect functional and structural changes in the brains of patients with PTSD. The findings suggest that EAT may target reward circuitry responsiveness and produce a caudate pruning effect from pre‐ to post‐treatment.
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Affiliation(s)
- Xi Zhu
- Department of Psychiatry, Columbia University, New York, New York, USA.,New York State Psychiatric Institute, New York, New York, USA
| | - Benjamin Suarez-Jimenez
- Department of Psychiatry, Columbia University, New York, New York, USA.,New York State Psychiatric Institute, New York, New York, USA.,Neuroscience Department, University of Rochester, Rochester, New York, USA
| | | | - Amit Lazarov
- Department of Psychiatry, Columbia University, New York, New York, USA.,School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Shay Arnon
- New York State Psychiatric Institute, New York, New York, USA
| | - Ari L Lowell
- Department of Psychiatry, Columbia University, New York, New York, USA.,New York State Psychiatric Institute, New York, New York, USA.,Memphis Veterans Administration Medical Center, Memphis, Tennessee, USA
| | - Maja Bergman
- New York State Psychiatric Institute, New York, New York, USA
| | - Matthew Ryba
- New York State Psychiatric Institute, New York, New York, USA
| | | | - Jane F Hamilton
- Rancho Bosque Equestrian Center of Excellence, House Hamilton Business Group, PLC, Tucson, Arizona, USA
| | - J Blake Turner
- Department of Psychiatry, Columbia University, New York, New York, USA.,New York State Psychiatric Institute, New York, New York, USA
| | - John C Markowitz
- Department of Psychiatry, Columbia University, New York, New York, USA.,New York State Psychiatric Institute, New York, New York, USA
| | - Prudence W Fisher
- Department of Psychiatry, Columbia University, New York, New York, USA.,New York State Psychiatric Institute, New York, New York, USA
| | - Yuval Neria
- Department of Psychiatry, Columbia University, New York, New York, USA.,New York State Psychiatric Institute, New York, New York, USA.,Department of Epidemiology, Columbia University Irving Medical Center, New York, New York, USA
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10
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Gilmore AK, Lopez C, Muzzy W, Brown WJ, Grubaugh A, Oesterle DW, Acierno R. Emotion Dysregulation Predicts Dropout from Prolonged Exposure Treatment among Women Veterans with Military Sexual Trauma-Related Posttraumatic Stress Disorder. Womens Health Issues 2020; 30:462-469. [PMID: 32843240 DOI: 10.1016/j.whi.2020.07.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 03/19/2020] [Accepted: 07/17/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Military sexual trauma (MST) is notably prevalent among military personnel and can result in mental and physical health problems, including post-traumatic stress disorder (PTSD). Although there are several evidence-based treatments for MST-related PTSD, including prolonged exposure (PE) therapy, it is unclear what factors are associated with premature termination (i.e., dropout) from this treatment. Given the popularity of PE as an evidence-based treatment for PTSD, the examination of variables that influence dropout from PE among women veterans with MST is warranted. Identification of these specific factors may assist clinicians in addressing the unique symptom profiles and potential barriers to treatment access for individual MST survivors. METHODS The current study presents secondary data analyses from an ongoing randomized clinical trial that compared the effectiveness of PE delivered in person to delivery via telemedicine for women veterans with MST-related PTSD (n = 136). RESULTS A total of 50% of participants dropped out from the study (n = 68). Difficulties with emotion regulation at baseline were associated with treatment dropout (odds ratio, 1.03; p < .01), whereas baseline PTSD and demographic factors were not. CONCLUSIONS Findings from the current study indicate that emotion regulation skills deficits contribute to PE dropout and may be an appropriate target to address in future clinical trials for PTSD treatment.
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Affiliation(s)
- Amanda K Gilmore
- Department of Health Policy and Behavioral Sciences and Mark Chaffin Center for Healthy Development, School of Public Health, Georgia State University, Atlanta, Georgia.
| | - Cristina Lopez
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina
| | - Wendy Muzzy
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina
| | - Wilson J Brown
- School of Humanities & Social Sciences, Pennsylvania State University, The Behrend College, Erie, Pennsylvania
| | - Anouk Grubaugh
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina; Military Sciences Division, Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Daniel W Oesterle
- Department of Health Policy and Behavioral Sciences and Mark Chaffin Center for Healthy Development, School of Public Health, Georgia State University, Atlanta, Georgia; Department of Psychological Sciences, College of Health and Human Sciences, Purdue University, West Lafayette, Indiana
| | - Ron Acierno
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina; University of Texas Health Science Center at Houston, Houston, Texas
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Nursey J, Sbisa A, Knight H, Ralph N, Cowlishaw S, Forbes D, O’Donnell M, Hinton M, Cooper J, Hopwood M, McFarlane A, Herring S, Fitzgerald P. Exploring Theta Burst Stimulation for Post-traumatic Stress Disorder in Australian Veterans—A Pilot Study. Mil Med 2020; 185:e1770-e1778. [DOI: 10.1093/milmed/usaa149] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 05/04/2020] [Accepted: 06/01/2020] [Indexed: 12/20/2022] Open
Abstract
Abstract
Introduction
Post-traumatic stress disorder (PTSD) is a severe and debilitating condition affecting a significant proportion of the veteran community. A substantial number of veterans with PTSD fail to benefit from trauma-focused psychological therapies or pharmacotherapy or are left with residual symptoms, and therefore, investigation of new and innovative treatment is required. Theta Burst Stimulation (TBS) is a novel form of Repetitive Transcranial Magnetic Stimulation, which has been shown to improve depression symptoms and associated cognitive deficits. The current pilot study aimed to explore the acceptability, safety, and tolerability of intermittent TBS (iTBS) as a treatment for PTSD in Australian veterans.
Materials and Methods
This study employed a case series, repeated-measures design. Eight Australian Defence Force veterans with PTSD received 20 bilateral iTBS treatments (1 session per day, 5 days per week over a 4-week period) and were assessed on a range of mental health and neuropsychological measures, including the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) and Hamilton Depression Rating Scale (HAM-D), at pretreatment, post-treatment, and a 3-month follow-up.
Results
Treatment was generally welltolerated, with reported side-effects including mild to moderate site-specific cranial pain and headaches during stimulation, which were relieved with the use of low dose analgesics. No serious side effects or adverse events were reported. Participants exhibited reductions in both PTSD and depression symptom severity (the repeated-measures effect size [dRM] for the CAPS-5 was −1.78, and the HAM-D was −1.16 post-treatment), as well as improvements in working memory and processing speed. Although significance cannot be inferred, these preliminary estimates of effect size indicate change over time.
Conclusions
Bilateral iTBS appears to be welltolerated by Australian veterans. Within this repeated-measures case series, iTBS treatment shows promise in reducing both PTSD and mood symptoms, as well as improving cognitive difficulties associated with these disorders. Large-scale randomized controlled trials of this promising treatment are warranted.
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Affiliation(s)
- Jane Nursey
- Phoenix Australia - Centre for Post-traumatic Mental Health, Department of Psychiatry, University of Melbourne, Level 3, Alan Gilbert Building, 161 Barry Street, Carlton, Victoria 3053, Australia
| | - Alyssa Sbisa
- Phoenix Australia - Centre for Post-traumatic Mental Health, Department of Psychiatry, University of Melbourne, Level 3, Alan Gilbert Building, 161 Barry Street, Carlton, Victoria 3053, Australia
| | - Holly Knight
- Phoenix Australia - Centre for Post-traumatic Mental Health, Department of Psychiatry, University of Melbourne, Level 3, Alan Gilbert Building, 161 Barry Street, Carlton, Victoria 3053, Australia
| | - Naomi Ralph
- Phoenix Australia - Centre for Post-traumatic Mental Health, Department of Psychiatry, University of Melbourne, Level 3, Alan Gilbert Building, 161 Barry Street, Carlton, Victoria 3053, Australia
| | - Sean Cowlishaw
- Phoenix Australia - Centre for Post-traumatic Mental Health, Department of Psychiatry, University of Melbourne, Level 3, Alan Gilbert Building, 161 Barry Street, Carlton, Victoria 3053, Australia
| | - David Forbes
- Phoenix Australia - Centre for Post-traumatic Mental Health, Department of Psychiatry, University of Melbourne, Level 3, Alan Gilbert Building, 161 Barry Street, Carlton, Victoria 3053, Australia
| | - Meaghan O’Donnell
- Phoenix Australia - Centre for Post-traumatic Mental Health, Department of Psychiatry, University of Melbourne, Level 3, Alan Gilbert Building, 161 Barry Street, Carlton, Victoria 3053, Australia
| | - Mark Hinton
- Phoenix Australia - Centre for Post-traumatic Mental Health, Department of Psychiatry, University of Melbourne, Level 3, Alan Gilbert Building, 161 Barry Street, Carlton, Victoria 3053, Australia
| | - John Cooper
- Phoenix Australia - Centre for Post-traumatic Mental Health, Department of Psychiatry, University of Melbourne, Level 3, Alan Gilbert Building, 161 Barry Street, Carlton, Victoria 3053, Australia
| | - Malcolm Hopwood
- University of Melbourne Professorial Psychiatry Unit, Albert Road Clinic, 31 Albert Road, Melbourne, Victoria 3004, Australia
| | - Alexander McFarlane
- Centre for Traumatic Stress Studies, The University of Adelaide, Adelaide, South Australia 5005, Australia
| | - Sally Herring
- Epworth Centre for Innovation in Mental Health (ECIMH), 888 Toorak Rd, Camberwell, Victoria 3124, Australia
| | - Paul Fitzgerald
- Epworth Centre for Innovation in Mental Health (ECIMH), 888 Toorak Rd, Camberwell, Victoria 3124, Australia
- Monash Alfred Psychiatry Research Centre, Monash University, Central Clinical School and the Alfred, The Alfred Centre, 99 Commercial Rd, Melbourne, Victoria 3004, Australia
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