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Ragsdale KA, Nichols AA, Mehta M, Maples-Keller JL, Yasinski CW, Hyatt CS, Watkins LE, Loucks LA, Carbone E, Rauch SAM, Rothbaum BO. Comorbid treatment of traumatic brain injury and mental health disorders. NeuroRehabilitation 2024:NRE230235. [PMID: 38277308 DOI: 10.3233/nre-230235] [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: 01/28/2024]
Abstract
BACKGROUND The Emory Healthcare Veterans Program (EHVP) is a multidisciplinary intensive outpatient treatment program for post-9/11 veterans and service members with invisible wounds, including posttraumatic stress disorder (PTSD), traumatic brain injury (TBI), substance use disorders (SUD), and other anxiety- and depression-related disorders. OBJECTIVE This article reviews the EHVP. METHODS The different treatment tracks that provide integrated and comprehensive treatment are highlighted along with a review of the standard, adjunctive, and auxiliary services that complement individualized treatment plans. RESULTS This review particularly emphasizes the adjunctive neurorehabilitation service offered to veterans and service members with a TBI history and the EVHP data that indicate large reductions in PTSD and depression symptoms across treatment tracks that are maintained across 12 months follow up. Finally, there is a discussion of possible suboptimal treatment response and the pilot programs related to different treatment augmentation strategies being deploying to ensure optimal treatment response for all. CONCLUSION Published data indicate that the two-week intensive outpatient program is an effective treatment program for a variety of complex presentations of PTSD, TBI, SUD, and other anxiety- and depression-related disorders in veterans and active duty service members.
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Affiliation(s)
- Katie A Ragsdale
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Anastacia A Nichols
- Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Mansi Mehta
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Jessica L Maples-Keller
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Carly W Yasinski
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Courtland S Hyatt
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Laura E Watkins
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Laura A Loucks
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Elizabeth Carbone
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Sheila A M Rauch
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
- Joseph Maxwell Cleland Atlanta VA Medical Center, Decatur, GA, USA
| | - Barbara O Rothbaum
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
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Shapira I, Richman J, Pace TWW, Lim KO, Polusny MA, Hamner MB, Bremner JD, Mumba MN, Jacobs ML, Pilkinton P, Davis LL. Biomarker Response to Mindfulness Intervention in Veterans Diagnosed with Post-traumatic Stress Disorder. Mindfulness (N Y) 2022; 13:2448-2460. [PMID: 36938380 PMCID: PMC10022677 DOI: 10.1007/s12671-022-01969-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/18/2022] [Indexed: 10/14/2022]
Abstract
Objectives This study evaluates the effects of treatment with mindfulness-based stress reduction (MBSR) compared to the active control, present-centered group therapy (PCGT), on morning plasma cortisol, interleukin-6 (IL-6), and C-reactive protein (CRP) in veterans diagnosed with post-traumatic stress disorder (PTSD). Methods In a post hoc exploratory analysis, we pooled biomarkers and clinical outcomes of mindfulness, PTSD, and depression from two randomized controlled trials comparing MBSR (n = 104) to PCGT (n = 106) in U.S. military veterans diagnosed with PTSD. Linear mixed-effects modeling was used to evaluate associations between changes in biomarkers and clinical outcomes from baseline to 9-week primary endpoint and 16-week follow-up endpoint. Results Cortisol levels were inversely related to self-reported PTSD symptoms at baseline (p = 0.02). Cortisol increased from baseline to 9-week endpoint for both groups, but significantly less so in the MBSR group compared to PCGT group (mean difference 1.69 ± 0.8 SE; p = 0.035). Changes in IL-6 and CRP did not differ between groups at either baseline or week 9. From baseline to week 9, increased mindfulness was significantly associated with increased cortisol (p = 0.02) and decreased PTSD and depression severity (p < 0.01). Increased IL-6 and CRP were significantly associated with decreased PTSD severity (p < 0.05), but not depression. Pooled analysis corroborated earlier findings that MBSR is significantly better than PCGT in improving clinical outcomes. Increased mindfulness was strongly associated with improved symptoms. Conclusions Increased mindfulness is associated with a recalibration of cortisol levels which may be indicative of therapeutic response, especially in patients with lower baseline cortisol. Furthermore, mindfulness-based practices improve symptoms of PTSD and depression in a significant correlation with self-reported levels of mindfulness. Clinical Trial Registration clinicaltrialsgov NCT01532999 and NCT01548742.
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Affiliation(s)
- Itamar Shapira
- School of Medicine, UAB Heersink School of Medicine, 1670 University Blvd, Birmingham, AL 35233, USA
| | - Joshua Richman
- Department of Surgery, UAB Heersink School of Medicine, Birmingham, AL, USA
- Birmingham VA Health Care System, Research Service, Birmingham, AL, USA
| | | | - Kelvin O. Lim
- Department of Psychiatry and Behavioral Science, University of Minnesota, Minneapolis, MN, USA
- Geriatric Research, Education, and Clinical Centers, Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Melissa A. Polusny
- Department of Psychiatry and Behavioral Science, University of Minnesota, Minneapolis, MN, USA
- Center for Care Delivery Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Mark B. Hamner
- Ralph H. Johnson VA Medical Center, Charleston, SC, USA
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - J. Douglas Bremner
- Departments of Psychiatry and Radiology, Emory University School of Medicine, Atlanta, GA, USA
- Atlanta VA Medical Center, Mental Health Service, Decatur, GA, USA
| | - Mercy N. Mumba
- Research Service, Tuscaloosa VA Medical Center, Tuscaloosa, AL, USA
- University of Alabama, Capstone College of Nursing, Tuscaloosa, AL, USA
| | - M. Lindsey Jacobs
- Research Service, Tuscaloosa VA Medical Center, Tuscaloosa, AL, USA
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
| | - Patricia Pilkinton
- Research Service, Tuscaloosa VA Medical Center, Tuscaloosa, AL, USA
- Department of Psychiatry and Behavioral Medicine, University of Alabama College of Community Health Sciences, Tuscaloosa, AL, USA
| | - Lori L. Davis
- Research Service, Tuscaloosa VA Medical Center, Tuscaloosa, AL, USA
- Department of Psychiatry and Behavioral Neurobiology, UAB Heersink School of Medicine, Birmingham, AL, USA
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