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Pile V, Williamson G, Saunders A, Holmes EA, Lau JYF. Harnessing emotional mental imagery to reduce anxiety and depression in young people: an integrative review of progress and promise. Lancet Psychiatry 2021; 8:836-852. [PMID: 34419188 DOI: 10.1016/s2215-0366(21)00195-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 04/23/2021] [Accepted: 05/12/2021] [Indexed: 11/15/2022]
Abstract
Emotional mental imagery is a powerful part of our mental landscape. Given its capacity to depict, process, and generate emotional events, mental imagery could have an important role in psychological therapies. This Series paper explores whether harnessing emotional mental imagery is meaningful to young people; ways in which interventions use emotional mental imagery; contextual and individual factors influencing intervention effectiveness; and mechanisms underpinning imagery techniques. We completed a systematic review of imagery interventions and consulted young people with lived experience (n=10) and leading international experts (n=7). The systematic search identified 86 papers covering a diverse range of imagery interventions. Across the seven categories of techniques reviewed, imagery rescripting for aversive memories, techniques targeting positive imagery, and imagery-enhanced protocols indicated the most potential. The report suggests that harnessing emotional mental imagery in psychological interventions could be a promising approach to reduce anxiety and depression and that mental health science could inform the development of new interventions and help to maximise intervention effectiveness.
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Affiliation(s)
- Victoria Pile
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Department of Psychology, Royal Holloway, University of London, Egham, UK.
| | - Grace Williamson
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Aleks Saunders
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Emily A Holmes
- Department of Psychology, Uppsala University, Uppsala, Sweden; Division of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jennifer Y F Lau
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Dansiger S, Chabra R, Emmel L, Kovacs J. The MET(T)A Protocol: Mindfulness and EMDR Treatment Template for Agencies. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2020; 14:1178221820977483. [PMID: 33311983 PMCID: PMC7716072 DOI: 10.1177/1178221820977483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 10/31/2020] [Indexed: 12/05/2022]
Abstract
Evidence indicating the relationship between trauma and substance use disorders (SUDs), in addition to relapse and treatment retention rates for this population, suggests there is a need for a trauma-focused solution to treat SUDs. Eye movement desensitization and reprocessing (EMDR) therapy has been studied extensively as an effective approach for treating trauma and Posttraumatic Stress Disorder (PTSD). The research evaluating its treatment for other mental health disorders such as SUDs is promising. Merging mindfulness and ethical mindfulness practices with EMDR therapy lends additional evidence-based elements to make the case for this integrative system of treatment to be studied as a trauma-focused primary psychotherapy to treat SUDs. The resulting treatment, the MET(T)A Protocol (Mindfulness and EMDR Treatment Template for Agencies), has been created to address the need for a trauma-focused solution to treat SUDs. Procedures of the MET(T)A Protocol as applied in each of the 8 phases of EMDR therapy are described in detail. Clinical examples are provided to explain the application of the MET(T)A Protocol.
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Hagerty SL, Wielgosz J, Kraemer J, Nguyen HV, Loew D, Kaysen D. Best Practices for Approaching Cognitive Processing Therapy and Prolonged Exposure During the COVID-19 Pandemic. J Trauma Stress 2020; 33:623-633. [PMID: 32865850 DOI: 10.1002/jts.22583] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/23/2020] [Accepted: 07/27/2020] [Indexed: 11/10/2022]
Abstract
The COVID-19 pandemic presents major challenges for mental health care providers. In particular, providers who treat posttraumatic stress disorder (PTSD) are now tasked with determining whether to initiate trauma-focused therapy during the pandemic and, if so, whether and how to adapt treatment. The purpose of this communication is to identify and organize key considerations for whether and how to deliver commonly used evidence-supported therapy protocols for trauma treatment-specifically, cognitive processing therapy (CPT) and prolonged exposure (PE) therapy-during the ongoing COVID-19 pandemic for adults who currently meet the criteria for PTSD. Based on relevant public health and clinical literature, we present a structured guide that can be used by treatment teams and individual providers to evaluate whether initiating CPT or PE is indicated given a particular patient-provider pair and system context amidst pandemic conditions. In addition, we suggest appropriate action steps, including problem-solving strategies, evidence-informed modifications to CPT and PE, and alternative intervention approaches.
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Affiliation(s)
- Sarah L Hagerty
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA.,Sierra Pacific Mental Illness Research Education and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Joseph Wielgosz
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA.,Sierra Pacific Mental Illness Research Education and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Jaclyn Kraemer
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Hong V Nguyen
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Dorene Loew
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Debra Kaysen
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA.,National Center for PTSD, VA Palo Alto Health Care System, Palo Alto, California, USA
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Shiner B, Leonard Westgate C, Simiola V, Thompson R, Schnurr PP, Cook JM. Measuring Use of Evidence-Based Psychotherapy for PTSD in VA Residential Treatment Settings with Clinician Survey and Electronic Medical Record Templates. Mil Med 2018; 183:e539-e546. [PMID: 29547909 PMCID: PMC6115864 DOI: 10.1093/milmed/usy008] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 12/22/2017] [Accepted: 01/12/2018] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Available studies on implementation of evidence-based psychotherapy (EBP) for patients attending Department of Veterans Affairs (VA) residential post-traumatic stress disorder (PTSD) programs rely on therapist self-report of EBP delivery. Patient-level data on receipt of EBP are needed both to corroborate therapist self-report and to understand patient factors that predict receipt of EBPs for PTSD. MATERIALS AND METHODS We identified 159 therapists from 38 VA residential PTSD programs who responded to a survey about EBP implementation during the 2015 fiscal year (FY15). Therapists self-reported their use of two EBPs, including prolonged exposure delivered in an individual format (PE-I) and cognitive processing therapy delivered in individual and group formats (CPT-I and CPT-G). Using electronic medical record (EMR) templates mandated for EBP documentation in FY15, we measured contemporaneous patient-level receipt of EBPs for PTSD. We assessed the degree of correlation between therapist self-reported EBP delivery and patient receipt of EBT as measured by EMR templates using polychoric correlation coefficients. We determined patient and therapist factors that predicted the receipt of EBPs with multivariable logistic regression, using random effects and robust standard error estimation, and controlling for site. The Veterans IRB of Northern New England provided a waiver of informed consent; as this was a retrospective review, no patients or therapists were contacted, and all data were stored, transmitted, and analyzed on secure VA servers. The VA Connecticut Health Care System Human Research Protection Program approved secondary use of therapist survey data for this project. RESULTS When EMR template use became mandated in FY15, the proportion of patients in residential PTSD programs who received at least one EBP session that was recorded with an EMR template increased dramatically from 8.8% to 33.9%. There was adequate correlation and between survey-based and EMR-based measures of EBP receipt, with polychoric correlation values of 0.77 for PE-I, 0.69 for CPT-I, and 0.82 for CPT-G. Multiple patient factors were positive (e.g., female gender) and negative (e.g., depressive disorders) predictors of receipt of EBPs, even after controlling for site. Among therapist factors, only EBP consultant or trainer status was a positive predictor of EBP provision and only therapist race was a negative predictor of EBT provision after controlling for site. CONCLUSION Following a FY15 mandate, EMR templates documenting EBP delivery were widely used by therapists working in VA residential PTSD programs. EBP receipt measured using EMR templates was consistent with therapist self-report of EBT delivery. There were several patient-level predictors of EBP receipt and therapist-level predictors of EBP delivery. However, therapists most likely to deliver EBPs were clustered at a limited number of sites.
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Affiliation(s)
- Brian Shiner
- VA Medical Center, 215 North Main Street, White River Junction, VT
- Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, NH
- National Center for PTSD, Executive Division, 215 North Main Street, White River Junction, VT
| | | | | | | | - Paula P Schnurr
- Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, NH
- National Center for PTSD, Executive Division, 215 North Main Street, White River Junction, VT
| | - Joan M Cook
- Yale School of Medicine, 333 Cedar Street, New Haven, CT
- National Center for PTSD, Evaluation Division, 950 Campbell Avenue, West Haven, CT
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Schacht RL, Brooner RK, King VL, Kidorf MS, Peirce JM. Incentivizing attendance to prolonged exposure for PTSD with opioid use disorder patients: A randomized controlled trial. J Consult Clin Psychol 2017; 85:689-701. [PMID: 28414485 DOI: 10.1037/ccp0000208] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine whether contingent monetary incentives increase opioid use disorder patients' attendance to Prolonged Exposure (PE) therapy and whether attendance is associated with improvement in posttraumatic stress disorder (PTSD) and substance use disorder (SUD) outcomes. METHOD Patients (N = 58) with PTSD were offered PE or PE with incentives (PE + I; max $480) to attend PE sessions. Participants were assessed at baseline and weeks 6, 12, and 24 postrandomization. RESULTS Participants were mostly women (79%) and Caucasian (71%); mean age 37.43 years (SD = 11.33). PE + I participants attended a median of 9 (of 12) sessions compared to 1 session for PE participants (p < .001), which included more exposure sessions (PE + I mdn = 6; PE mdn = 0; p < .001). A Time × treatment condition interaction indicated that PE + I participants exhibited a greater decrease in PTSD severity over time than PE participants (OR = 3.1; 95% CI = 0.4-5.7; p = .024). PE + I participants remained in substance use treatment longer than PE participants (mdn days = 262 vs. 192; p = .039). There were no group differences in drug use. CONCLUSIONS Monetary incentives increased SUD patients' attendance to an otherwise poorly attended treatment for PTSD. Better attendance in the incentivized group was associated with greater PTSD improvement, better SUD treatment retention, and no increased drug use. Incentives are well supported for improving adherence to substance use treatment goals and promising as a means to improve therapy attendance, which may improve the effectiveness of existing psychotherapies in difficult-to-treat populations. (PsycINFO Database Record
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Affiliation(s)
| | - Robert K Brooner
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - Van L King
- Department of Psychiatry, University of Texas Health Science Center at San Antonio
| | - Michael S Kidorf
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - Jessica M Peirce
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
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Norman SB, Hamblen JL. Promising Directions for Treating Comorbid PTSD and Substance Use Disorder. Alcohol Clin Exp Res 2017; 41:708-710. [PMID: 28181264 DOI: 10.1111/acer.13349] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 02/03/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Sonya B Norman
- National Center for PTSD, White River Junction, Vermont.,Center of Excellence for Stress and Mental Health and VA San Diego Healthcare System, San Diego, California.,Department of Psychiatry, University of California, San Diego, San Diego, California
| | - Jessica L Hamblen
- National Center for PTSD, White River Junction, Vermont.,Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
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Goldstein B, Bradley B, Ressler KJ, Powers A. Associations Between Posttraumatic Stress Disorder, Emotion Dysregulation, and Alcohol Dependence Symptoms Among Inner City Females. J Clin Psychol 2016; 73:319-330. [PMID: 27467499 PMCID: PMC5324595 DOI: 10.1002/jclp.22332] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 12/16/2015] [Accepted: 04/25/2016] [Indexed: 12/01/2022]
Abstract
Objective The purpose of this study was to examine how emotion dysregulation (ED) might help explain the relationship between posttraumatic stress disorder (PTSD) and alcohol dependence (AD) symptoms in females. Method Participants included 260 women from primary, diabetes, and gynecological clinics of an urban public hospital. This is a primarily African American sample (96.9%), including individuals reporting exposure to at least 1 traumatic event. We examined the associations and predictability patterns between severity of PTSD symptoms, ED, and AD symptoms. Results Using linear regression analyses, PTSD avoidance and numbing symptoms and ED were significant predictors of AD symptoms. When looking at specific dimensions of ED, one's inability to engage in goal‐directed behavior under strong emotional influences showed a full indirect effect on the relationship between PTSD avoidance and numbing symptoms and AD symptoms. Conclusion Our findings suggest that having poor emotion regulation skills may help explain why females with PTSD become dependent on alcohol.
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Affiliation(s)
| | - Bekh Bradley
- Emory University School of Medicine.,Atlanta VA Medical Center
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Prolonged Exposure With Veterans in a Residential Substance Use Treatment Program. COGNITIVE AND BEHAVIORAL PRACTICE 2016. [DOI: 10.1016/j.cbpra.2015.08.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Weiss NH, Tull MT, Borne MER, Gratz KL. Posttraumatic stress disorder symptom severity and HIV-risk behaviors among substance-dependent inpatients. AIDS Care 2013; 25:1219-26. [PMID: 23356590 DOI: 10.1080/09540121.2013.764381] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Despite findings that the co-occurrence of posttraumatic stress disorder (PTSD) and substance use disorders (SUD) is associated with heightened risk for a variety of risky behaviors, few studies have examined behaviors linked to heightened risk for HIV infection and transmission in particular, or explored the unique associations between specific PTSD symptom clusters and these HIV-risk behaviors. Therefore, the goal of this study was to examine the associations between PTSD symptom severity and HIV-risk behaviors (i.e., risky sexual behavior [RSB] and injection drug use [INJ]) within an ethnically diverse sample of 85 SUD patients in residential SUD treatment. Participants completed a battery of questionnaires assessing PTSD symptom severity and HIV-risk behaviors, including RSB and INJ. Results demonstrated significant positive associations between PTSD symptom severity and RSB; however, no significant relationship between PTSD symptom severity and INJ was found. Furthermore, the severity of hyperarousal symptoms in particular was found to significantly predict RSB above and beyond age and all other PTSD symptom clusters. Results of this study suggest that PTSD symptoms (and, more specifically, the hyperarousal symptoms of PTSD) may heighten the risk for some forms of HIV-risk behaviors (RSB) but not others (INJ). Results highlight the importance of identifying and targeting hyperarousal symptoms in the treatment of SUD patients experiencing symptoms of PTSD in order to reduce HIV infection or transmission risk.
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Affiliation(s)
- Nicole H Weiss
- a Department of Psychiatry and Human Behavior , University of Mississippi Medical Center , Jackson , MS , USA
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McCauley JL, Killeen T, Gros DF, Brady KT, Back SE. Posttraumatic Stress Disorder and Co-Occurring Substance Use Disorders: Advances in Assessment and Treatment. ACTA ACUST UNITED AC 2012; 19. [PMID: 24179316 DOI: 10.1111/cpsp.12006] [Citation(s) in RCA: 170] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Posttraumatic stress disorder (PTSD) and substance use disorders (SUDs) are prevalent and frequently co-occur. Comorbid PTSD/SUD is associated with a more complex and costly clinical course when compared with either disorder alone, including increased chronic physical health problems, poorer social functioning, higher rates of suicide attempts, more legal problems, increased risk of violence, worse treatment adherence, and less improvement during treatment. In response, psychosocial treatment options have increased substantially over the past decade and integrated approaches - treatments that address symptoms of both PTSD and SUD concurrently -are fast becoming the preferred model for treatment. This paper reviews the prevalence, etiology and assessment practices as well as advances in the behavioral and pharmacologic treatment of comorbid PTSD and SUDs.
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Aversa LH, Stoddard JA, Doran NM, Au S, Chow B, McFall M, Saxon A, Baker DG. PTSD and depression as predictors of physical health-related quality of life in tobacco-dependent veterans. J Psychosom Res 2012; 73:185-90. [PMID: 22850258 DOI: 10.1016/j.jpsychores.2012.06.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Revised: 06/25/2012] [Accepted: 06/25/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Smoking, depression and PTSD are related to poor physical health outcomes and health-related quality of life (HRQoL). Previous studies examining the effects of quitting smoking on HRQoL have been mixed. This study aimed to examine the effects of PTSD, depressive symptoms and smoking cessation on HRQoL in a sample receiving treatment for PTSD. METHOD This study utilized archival interview and self-report data from a clinical trial (VA Cooperative Study 519) that recruited tobacco dependent veterans with chronic PTSD (N=943). RESULTS Analyses were conducted using hierarchical linear modeling and indicated that PTSD and depressive symptoms differentially affected the various physical health status domains. Additionally, quitting smoking was associated with better self-perceived health status and social functioning. CONCLUSION Our findings further explain the interrelationships of PTSD, depression, and smoking in the prediction of physical HRQoL and advocate the importance of integrated care.
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Affiliation(s)
- Laura H Aversa
- Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Dr.151, San Diego, CA 92161, USA
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