A comparison of the CAPS-5 and PCL-5 to assess PTSD in military and veteran treatment-seeking samples

Cognitive processing therapy (CPT) versus individual drug counseling (IDC) for PTSD for veterans with opioid use disorder maintained on buprenorphine

BACKGROUND AND OBJECTIVES

There are high rates of comorbidity between posttraumatic stress disorder (PTSD) and opioid use disorder (OUD). Evidence-based trauma-focused psychotherapies such as Cognitive Processing Therapy (CPT) are a first-line treatment for PTSD. Veterans with OUD are treated primarily in substance use disorder (SUD) clinics where the standard of care is drug counseling; they often do not have access to first-line PTSD treatments. This study tested whether CPT can be conducted safely and effectively in veterans with comorbid OUD treated with buprenorphine.

METHODS

This 12-week, 2-site, randomized clinical trial (RCT) included open-label randomization to two groups: (a) CPT versus (b) Individual Drug Counselling (IDC) in veterans with PTSD and comorbid OUD who were maintained on buprenorphine (N = 38).

RESULTS

Veterans randomized to either IDC (n = 18) or CPT (n = 20) showed a significant reduction in self-reported PTSD symptoms over time as measured by the PTSD checklist (PCL-5) but there were no treatment group differences; there was some indication that reduction in PTSD symptoms in the CPT group were sustained in contrast to the IDC group. Recruitment was significantly impacted by COVID-19 pandemic, so this study serves as a proof-of-concept pilot study.

DISCUSSION AND CONCLUSIONS

Veterans with OUD and PTSD can safely and effectively participate in evidence-based therapy for PTSD; further work should confirm that trauma-focused treatment may be more effective in leading to sustained remission of PTSD symptoms than drug counseling.

SCIENTIFIC SIGNIFICANCE

This is the first study to evaluate CPT for PTSD in the context of buprenorphine treatment for OUD.

The revised Clinician-Administered PTSD scale for DSM-5 (CAPS-5-R): Initial psychometric evaluation in a trauma-exposed community sample

The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) is a widely used, well-validated structured interview for posttraumatic stress disorder (PTSD). It was recently revised to improve various aspects of administration and scoring. We conducted a psychometric evaluation of the revised version, known as the CAPS-5-R. Participants were 73 community residents with mixed trauma exposure (e.g., sexual assault, physical assault, transportation accident, the unnatural death of a loved one). CAPS-5-R PTSD diagnosis demonstrated good test-retest reliability, кs = .73-.79; excellent interrater reliability, кs = .86-.93; and good-to-excellent alternate forms reliability with the CAPS-5, кs = .79-.93. In addition, the CAPS-5-R total PTSD severity score demonstrated excellent test-retest reliability, intraclass correlation coefficient (ICC) = .86; interrater reliability, ICC = .98; and alternate forms reliability with the CAPS-5, r = .95. Further, the CAPS-5-R demonstrated good convergent validity with other measures of PTSD and good discriminant validity with measures of other constructs (e.g., depression, anxiety, alcohol problems, somatic concerns, mania). Given its strong psychometric performance in this study, as well as its improvements in administration and scoring, the CAPS-5-R appears to be a valuable update of the current CAPS-5.

The assessment of reliability generalisation of clinician-administered PTSD scale for DSM-5 (CAPS-5): a meta-analysis

Background

The CAPS-5 is a reliable instrument for assessing PTSD symptoms, demonstrating strong consistency, validity, and reliability after a traumatic event. However, further research is warranted to explore the divergent validity of the CAPS-5 and its adaptation to diverse cultural contexts.

Objective

In this meta-analysis, we endeavoured to comprehensively evaluate the reliability generalization of the CAPS-5 across diverse populations and clinical contexts.

Methods

A reliability generalization meta-analysis on the psychometric properties of CAPS-5 was conducted, encompassing 15 studies. The original versions' psychometric properties were systematically retrieved from databases including PubMed, PsychNet, Medline, CHAHL, ScienceDirect, Scopus, Web of Science, and Google Scholar, with a focus on studies published between 2013 and 2023. Two independent investigators evaluated study quality using QUADAS-2 and COSMIN RB, pre-registering the protocol in the Prospero database for transparency and minimizing bias risk.

Results

Meta-analysis reveals CAPS-5 global reliability (α = 0.92, 95% CI [0.90, 0.94]), z = 99.44, p < 0.05 across 15 studies, supporting consistent internal consistency. Subscale analysis shows variability in Reexperiencing (α = 0.82), Avoidance (α = 0.68), Cognition and Mood (α = 0.82), and Hyperarousal (α = 0.74), with an overall estimate of 0.77 (95% CI [0.70;0.83]). Language-dependent analysis highlights reliability variations (α range: 0.83 to 0.92) across Brazilian-Portuguese, Dutch, English, French, German, Korean, and Portuguese. Test-retest reliability demonstrates stability (r = 0.82, 95% CI [0.79; 0.85]), with overall convergent validity (r = 0.59, 95% CI [0.50;0.68]).

Conclusion

The meta-analysis affirms CAPS-5's robust global and subscale reliability across studies and languages, with stable test-retest results. Moderator analysis finds no significant impact, yet substantial residual heterogeneity remains unexplained. Our findings contribute intricate insights into the psychometric properties of this instrument, offering a more complete understanding of its utility in PTSD assessment.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023483748.

A Four-Country Study of Strangulation-Related Alterations in Consciousness in Women Who Have Experienced Intimate Partner Violence: Co-Occurrence with Traumatic Brain Injuries and Measures of Psychological Distress

At least one in three women experience intimate partner violence (IPV) in their lifetime. The most commonly sustained IPV-related brain injuries include strangulation-related alterations in consciousness (S-AICs) and traumatic brain injuries (TBIs). Moreover, survivors of IPV-related S-AICs and/or TBIs often demonstrate psychological distress such as depression, anxiety, and post-traumatic stress. However, the co-occurrence of S-AICs and TBIs, and whether such TBIs may be moderate to severe, has not been systematically examined, and most data have been collected from women in North America. The purpose of this study was to examine the co-occurrence of IPV-related S-AICs and TBIs across a range of geographical locations and to determine the extent to which these S-AICs are related to psychological distress. Women who had experienced physical IPV (n = 213) were included in this secondary analysis of retrospectively collected data across four countries (Canada, the United States, Spain, and Colombia). The Brain Injury Severity Assessment (BISA) was used to assess IPV-related BI across all sites. Because various questionnaires were employed to assess levels of depression, anxiety, and post-traumatic stress disorder at each site, we created a standardized composite score by converting raw scores into Z-scores for analysis. Mann-Whitney U tests and chi-square tests were conducted to examine differences between women with and without experience of S-AICs and to discover if there was a relationship between the occurrence of S-AICs and TBIs. Analysis of variance and analysis of covariance (to control for the potential confounding effects of age, education, and non IPV-related TBI) were used to compare levels of psychological distress in women who had or had not experienced S-AICs. Approximately, 67% of women sustained at least one IPV-related BI (i.e., TBI and/or S-AIC). In a subsample of women who sustained at least one IPV-related BI, approximately 37% sustained both S-AICs and TBIs, 2% sustained only S-AICs (with no TBIs), and 61% sustained TBIs exclusively (with no S-AICs). Furthermore, women who had sustained S-AICs (with or without a TBI) were more likely to have experienced a moderate-to-severe BI than those who had not sustained an S-AIC (BISA severity subscale: U = 3939, p = 0.006). In addition, women who experienced S-AICs (with or without a TBI) reported higher levels of psychological distress compared with women who never experienced S-AICs, irrespective of whether they occurred once or multiple times. These data underscore the importance of assessing for S-AIC in women who have experienced IPV and when present, to also assess for TBIs and the presence of psychological distress. Unfortunately, there were methodological differences across sites precluding cross-site comparisons. Nonetheless, data were collected across four culturally and geographically diverse countries and, therefore, highlight IPV-related BIs as a global issue that needs to be aggressively studied with policies established and then implemented to address findings.

Understanding trauma as contextualized adverse life events that threaten the individual: Commentary in response to Marx et al. (2024)

In this commentary, I propose that a person-oriented and research-focused approach can stimulate the discussion on the definition of a traumatic stressor and help to refine Criterion A in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Particularly, I suggest that a contextual perspective focusing on the interaction between event features and person-related factors captures more adequately the individual perception of and cognitions related to extremely threatening adverse life events for a diversity of individuals exposed to trauma. In future debate, I encourage the involvement of patients and the public and urge consideration of all potential consequences for practice and research that can directly result from changes to Criterion A (e.g., the heterogenization of posttraumatic stress disorder).

A counsellor-supported 'PTSD Coach' intervention versus enhanced Treatment-as-Usual in a resource-constrained setting: A randomised controlled trial

To widen treatment access for posttraumatic stress disorder (PTSD) in resource-constrained South Africa, we evaluated the feasibility and effectiveness of a counsellor-supported PTSD Coach mobile application (app) (PTSD Coach-CS) intervention on PTSD and associated sequelae in a community sample. Participants (female = 89%; black = 77%; aged 19-61) with PTSD were randomised to PTSD Coach-CS (n = 32) or enhanced Treatment-as-Usual (n = 30), and assessed with the Clinician-Administered PTSD Scale (CAPS-5), PTSD Checklist (PCL-5) and Depression, Anxiety and Stress Scale-21 items, at pre- to post-treatment and follow-up (1 and 3 months). We also collected data on user experiences of the PTSD Coach app with self-administered surveys. We conducted an intent-to-treat analysis and linear mixed models. A significant (group × time) effect for the CAPS-5 (F3.136 = 3.33, p = 0.02) indicated a greater reduction in PTSD symptom severity over time for the intervention group with a significant between-group effect size detected at 3-month follow-up. Significant between-group effect sizes were detected in self-reported stress symptom reduction in the intervention group at post-treatment and 3-month follow-up. Participants perceived the app as helpful and were satisfied with the app. Findings suggest PTSD Coach-CS as a suitable low-cost intervention and potential treatment alternative for adults with PTSD in a resource-constrained country. Replication in larger samples is needed to fully support effectiveness. Pan African Trial Registry: PACTR202108755066871.