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Martinez-Calderon J, Villar-Alises O, García-Muñoz C, Pineda-Escobar S, Matias-Soto J. Multimodal exercise programs may improve posttraumatic stress disorders symptoms and quality of life in adults with PTSD: An overview of systematic reviews with meta-analysis. Clin Rehabil 2024; 38:573-588. [PMID: 38258461 DOI: 10.1177/02692155231225466] [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: 01/24/2024]
Abstract
OBJECTIVE This overview of reviews aimed to summarize the effectiveness of exercise, regular physical activity or mind-body exercises on posttraumatic stress disorder (PTSD) symptoms and comorbidities associated with PTSD (e.g. depression symptoms) among individuals without age, gender, race, ethnicity or setting restrictions. DATA SOURCES The CINAHL, Embase, PubMed and SPORTDiscus databases were searched from inception to November 16, 2023. REVIEW METHODS Systematic reviews with meta-analysis of randomized clinical trials evaluating exercise, regular physical activity or mind-body exercises were considered. Control groups and outcome measures were not restricted. AMSTAR 2 assessed the methodological quality of reviews. The overlap between reviews was calculated. RESULTS A total of 14 systematic reviews were included meta-analyzing 23 distinct randomized clinical trials. There was a very high overlap between reviews (corrected covered area = 16%). PTSD symptoms, depression symptoms, anxiety symptoms, sleep quality, substance abuse and quality of life were meta-analyzed. No reviews meta-analyzed the effects of regular physical activity. Overall, the meta-analyses found multicomponent exercise programs may have positive results in reducing PTSD symptoms and improving quality of life. In addition, the results of yoga were inconsistent across the meta-analyses for PTSD symptoms, and no differences between groups were found in favor of yoga for depression symptoms. Finally, no specific conclusions could be made about anxiety symptoms, sleep quality and substance abuse. CONCLUSION A multicomponent exercise program may be effective in improving PTSD symptoms and quality of life, whereas yoga may be ineffective for depression symptoms in adults with PTSD.
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Affiliation(s)
- Javier Martinez-Calderon
- Departamento de Fisioterapia, Instituto de Biomedicina de Sevilla, IBiS, Universidad de Sevilla, Sevilla, Spain
- CTS 1110: Uncertainty, Mindfulness, Self, and Spirituality (UMSS) Research Group, Andalusia, Spain
| | - Olga Villar-Alises
- Departamento de Fisioterapia, Instituto de Biomedicina de Sevilla, IBiS, Universidad de Sevilla, Sevilla, Spain
- CTS 1110: Uncertainty, Mindfulness, Self, and Spirituality (UMSS) Research Group, Andalusia, Spain
| | - Cristina García-Muñoz
- CTS 1110: Uncertainty, Mindfulness, Self, and Spirituality (UMSS) Research Group, Andalusia, Spain
- Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain
| | - Saul Pineda-Escobar
- CTS 1110: Uncertainty, Mindfulness, Self, and Spirituality (UMSS) Research Group, Andalusia, Spain
- Departamento de Ciencias de la Salud y Biomédicas, Universidad Loyola Andalucía, Sevilla, Spain
| | - Javier Matias-Soto
- CTS 1110: Uncertainty, Mindfulness, Self, and Spirituality (UMSS) Research Group, Andalusia, Spain
- Department of Physical Therapy, Faculty of Health Sciences, Universidad de Malaga, Malaga, Spain
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Quiñones-Labernik P, Blocklinger KL, Bruce MR, Ferri SL. Excess neonatal testosterone causes male-specific social and fear memory deficits in wild-type mice. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2023.10.18.562939. [PMID: 37905064 PMCID: PMC10614869 DOI: 10.1101/2023.10.18.562939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Neurodevelopmental disorders (ND) disproportionately affect males compared to females, and Autism Spectrum Disorder (ASD) in particular exhibits a 4:1 male bias. The biological mechanisms of this female protection or male susceptibility have not been identified. There is some evidence to suggest that fetal/neonatal gonadal hormones, which play pivotal roles in many aspects of development, may contribute. Here, we investigate the role of testosterone administration during a critical period of development, and its effects on social approach and fear learning in C57BL/6J wildtype mice. Male, but not female mice treated with testosterone on the day of birth (PN0) exhibited deficits in both social behavior and contextual fear conditioning, whereas mice treated with the same dose of testosterone on postnatal day 18 (PN18) did not display such impairments. Testosterone administration did not induce anxiogenic effects or lead to changes in body weight compared to the vehicle-treated group. These impairmeants are relevant to ND and may help identify novel treatment targets.
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Affiliation(s)
| | | | | | - Sarah L Ferri
- Department of Pediatrics, University of Iowa, Iowa City, IA, United States
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3
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Andreassen M, Deahl M. What's in a memory? PTSD and working with survivors of psychological trauma. Int J Soc Psychiatry 2024; 70:237-240. [PMID: 37814962 DOI: 10.1177/00207640231196739] [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] [Indexed: 10/11/2023]
Abstract
BACKGROUND Treating the consequences of psychological trauma and PTSD is of major concern to psychiatry although outcomes are often rather poor, often giving to the fact that the diagnose of PTSD is misused and no consideration of the trauma settings and its consequences on the brain. AIMS This paper looks at the impact of false or induced memories in the trauma narrative and their potential impact on therapy with examples from the everyday world. The consequences of this in civilian therapy sessions is discussed compared to the classical debriefing for PTSD in the armed forces. METHODS We take a theoretical overview of the interaction between therapist and patient with PTSD and consider the shortfalls of any therapy that requires the patient to recount their experiences. RESULTS We argue the uncritical acceptance of trauma history fails to take account of, and even lends itself, to induced or false memories which undermine treatment. CONCLUSIONS We conclude that, this is also often leading to a wrong conception of the outcome of treatment for PTSD, which is often much more sombre than the treatment outcome of lesser conditions.
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Affiliation(s)
| | - Martin Deahl
- Centre for Affective Disorders, Kings College London, UK
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4
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Hunt C, King-Casas B, Chiu PH, Smith LJ, Priorello L, Lee K, Estey M, Newsome MR, Wright Williams M. Pretreatment characteristics associated with symptom reduction during group cognitive processing therapy versus exposure therapy for PTSD: an exploratory study of Veterans. Cogn Behav Ther 2024; 53:70-86. [PMID: 37969001 PMCID: PMC10842083 DOI: 10.1080/16506073.2023.2268277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 10/02/2023] [Indexed: 11/17/2023]
Abstract
Exposure and cognitive-based therapies are both effective for PTSD, but knowledge of which intervention is best for which patient is lacking. This lack of knowledge is particularly noticeable for group treatments, as no study has examined whether responses to different group therapies are associated with different pretreatment characteristics. Here, we explored whether pretreatment levels of three types of psychological characteristics-PTSD symptom clusters, posttraumatic cognitions, and emotion regulation difficulties-were associated with symptom reduction during group-delivered cognitive versus exposure-based PTSD treatment. Participants were Veterans with PTSD drawn from two previous clinical trials: one of group CPT (GCPT; n = 32) and the other of group-based exposure therapy (GBET; n = 21). Growth curve modeling was used to identify pretreatment variables that predicted weekly PTSD symptom changes during each therapy. Higher posttraumatic cognitions at pretreatment predicted steeper PTSD symptom reduction during GCPT but not GBET. Additionally, symptom reduction during each therapy was associated with different pretreatment emotion regulation difficulties: difficulties with goal-directed behavior for GBET and lack of emotional clarity and limited access to emotion regulation strategies for GCPT. These findings suggest that assigning Veterans to a group PTSD therapy that better matches their pretreatment psychological profile might facilitate a better therapeutic response.
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Affiliation(s)
- Christopher Hunt
- Michael E. DeBakey Veteran’s Affairs Medical Center, Houston, TX, USA
- Center for Excellence in Stress and Mental Health, San Diego Veteran’s Affairs Medical Center, San Diego, CA, USA
| | - Brooks King-Casas
- Research Service Line, Salem Veteran’s Affairs Medical Center, Salem, Virginia, USA
- Fralin Biomedical Research Institute, Virginia Tech, Roanoke, Virginia, USA
| | - Pearl H. Chiu
- Research Service Line, Salem Veteran’s Affairs Medical Center, Salem, Virginia, USA
- Fralin Biomedical Research Institute, Virginia Tech, Roanoke, Virginia, USA
| | - Lia J. Smith
- Michael E. DeBakey Veteran’s Affairs Medical Center, Houston, TX, USA
- University of Houston, Department of Psychology, Houston, TX, USA
| | - Laura Priorello
- Mayo Clinic Arizona, Division of Psychology and Psychiatry, Scottsdale, AZ, USA
| | - Kelly Lee
- Department of Educational Psychology, Texas A&M, College Station, TX, USA
| | | | - Mary R. Newsome
- Michael E. DeBakey Veteran’s Affairs Medical Center, Houston, TX, USA
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - M. Wright Williams
- Michael E. DeBakey Veteran’s Affairs Medical Center, Houston, TX, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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Antonopoulos I, Carney AE, Wiltsey Stirman S, Monson CM. Sudden gains in PTSD symptoms and social functioning in cognitive processing therapy for posttraumatic stress disorder. Psychother Res 2023:1-12. [PMID: 37847997 DOI: 10.1080/10503307.2023.2265046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 09/19/2023] [Indexed: 10/19/2023] Open
Abstract
OBJECTIVE Sudden gains (SGs) are rapid symptom improvements between two consecutive therapy sessions that predict treatment outcomes. This study investigated SGs in posttraumatic stress disorder (PTSD) symptoms, interpersonal relationship functioning, and social role functioning in Cognitive Processing Therapy (CPT). METHOD Participants were 121 patients and 81 therapists involved in a parent randomized controlled hybrid implementation-effectiveness trial of CPT. Descriptive analyses examined the frequency and timing of different forms of SGs. Multilevel modeling examined the impact of the three SGs on outcomes. RESULTS PTSD SGs occurred more often and at different sessions than SGs in facets of social functioning. Most individuals experienced only one form of SG and there were no significant clinical or demographic differences in those who had PTSD only SGs, social functioning only SGs, or both SGs. PTSD SGs and interpersonal relationship functioning SGs both predicted changes in PTSD symptoms and interpersonal difficulties over time, but not changes in social role functioning. SGs in social role functioning predicted all three forms of outcomes. CONCLUSIONS The findings suggest that there are multiple forms of SGs in CPT beyond primary symptom changes that are predictive of patient outcomes. Clinicians should highlight various SGs that patients experience to further enhance outcomes.
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Affiliation(s)
| | - Alison E Carney
- Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Shannon Wiltsey Stirman
- National Center for PTSD, Menlo Park, California, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
| | - Candice M Monson
- Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
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Levendosky AA, Turchan JE, Luo X, Good E. A re-introduction of the psychodynamic approach to the standard clinical psychology curriculum. J Clin Psychol 2023; 79:2439-2451. [PMID: 37310149 DOI: 10.1002/jclp.23551] [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] [Received: 10/09/2022] [Revised: 05/02/2023] [Accepted: 05/28/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVE There is a strong evidence-base for a psychodynamic approach, supporting primary theoretical tenets as well as the treatment effectiveness. Additionally, there are increasing calls from the field for more individualized treatment for clients, and the lack of training in multiple orientations limits the ability of students in clinical psychology Ph.D. programs in the United States to personalize their treatments. The accumulated evidence-base for contemporary relational psychodynamic theory and therapy places it in good standing to return to the standard clinical psychology curriculum, along with other evidence-based approaches. METHODS We use data from the Insider's Guide (which describes clinical Ph.D. programs in the United States) from three time points over 20 years to document the waning psychodynamic approach in clinical psychology programs. We review the scientific evidence for four primary tenets of a contemporary psychodynamic approach: three related to development-from healthy to psychopathological: (1) unconscious processes; (2) internal representations of self and other; (3) dimensional model of psychopathology, and a fourth tenet that builds on these three and is the foundation for a contemporary psychodynamic approach to psychotherapy: (4) therapeutic relationship as a primary mechanism of change. RESULTS/CONCLUSIONS Based on the review of the evidence, we make specific recommendations for clinical psychology training programs about how to include a psychodynamic approach in the curriculum.
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Affiliation(s)
- Alytia A Levendosky
- Department of Psychology, Michigan State University, East Lansing, Michigan, USA
| | - Joshua E Turchan
- Counseling and Psychiatric Services, Michigan State University, East Lansing, Michigan, USA
| | - Xiaochen Luo
- Department of Counseling Psychology, Santa Clara University, Santa Clara, California, USA
| | - Evan Good
- Austen Riggs Center, Stockbridge, Massachusetts, USA
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7
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Matthews SR, Elizabeth M, Roberts LN, Kaambwa B, Wade TD, Nixon RDV. Assessing the validity and responsiveness of a generic preference quality of life measure in the context of posttraumatic stress disorder. Qual Life Res 2023; 32:2817-2827. [PMID: 37179519 PMCID: PMC10474197 DOI: 10.1007/s11136-023-03432-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2023] [Indexed: 05/15/2023]
Abstract
PURPOSE There is limited research exploring the usefulness of generic preference-based quality of life (GPQoL) measures used to facilitate economic evaluation in the context of posttraumatic stress disorder (PTSD). The aim of the current study was to explore the validity and responsiveness of a common GPQoL measure (Assessment of Quality of Life 8 Dimension [AQoL-8D]) in relation to a PTSD condition-specific outcome measure (Posttraumatic Stress Disorder Checklist for the DSM-5 [PCL-5]). METHOD This aim was investigated in a sample of individuals (N = 147) who received trauma-focused cognitive-behavioural therapies for posttraumatic stress disorder. Convergent validity was investigated using spearman's correlations, and the level of agreement was investigated using Bland-Altman plots. Responsiveness was investigated by exploring the standardised response means (SRM) from pre-post-treatment across the two measures, which allow the comparison of the magnitude of change between the measures over time. RESULTS Correlations between the AQoL-8D (dimensions, utility and summary total scores) and the PCL-5 total score ranged from small to large and agreement between the measures was considered moderate to good. While SRMs were large for the AQoL-8D and PCL-5 total scores, the SRM for the PCL-5 was nearly double that of the AQoL-8D. CONCLUSION Our findings demonstrate that the AQoL-8D has good construct validity but present preliminary evidence that economic evaluations using only GPQoL measures may not fully capture the effectiveness of PTSD treatments.
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Affiliation(s)
- Sheradyn R. Matthews
- College of Education, Psychology and Social Work, Flinders University, P.O. Box 2100, Adelaide, SA 5001 Australia
| | - Marja Elizabeth
- College of Education, Psychology and Social Work, Flinders University, P.O. Box 2100, Adelaide, SA 5001 Australia
| | - Larissa N. Roberts
- College of Education, Psychology and Social Work, Flinders University, P.O. Box 2100, Adelaide, SA 5001 Australia
| | - Billingsley Kaambwa
- College of Medicine and Public Health, Flinders University, P.O Box 2100, Adelaide, SA 5001 Australia
| | - Tracey D. Wade
- Flinders University Institute for Mental Health and Wellbeing, P.O Box 2100, Adelaide, SA 5001 Australia
- College of Education, Psychology and Social Work, Flinders University, P.O. Box 2100, Adelaide, SA 5001 Australia
| | - Reginald D. V. Nixon
- Flinders University Institute for Mental Health and Wellbeing, P.O Box 2100, Adelaide, SA 5001 Australia
- College of Education, Psychology and Social Work, Flinders University, P.O. Box 2100, Adelaide, SA 5001 Australia
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8
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Gates JA, McNair ML, Richards JK, Lerner MD. Social Knowledge & Performance in Autism: A Critical Review & Recommendations. Clin Child Fam Psychol Rev 2023; 26:665-689. [PMID: 37544969 PMCID: PMC10613329 DOI: 10.1007/s10567-023-00449-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 08/08/2023]
Abstract
Autistic social challenges have long been assumed to arise from a lack of social knowledge ("not knowing what to do"), which has undergirded theory and practice in assessment, treatment, and education. However, emerging evidence suggests these differences may be better accounted for by difficulties with social performance ("doing what they may know"). This distinction has important implications for research, practice, policy, and community support of autistic people. This review examines the theoretical and clinical implications and empirical status of the knowledge-performance distinction in autism. Current evidence suggests that social knowledge deficits are neither definitional nor reliably related to outcomes in autism. Prioritizing social knowledge, then, may produce unanticipated, problematic consequences in terms of accuracy of assessment, intervention effectiveness, and promotion of stigma. It may also yield unrealistic expectations around the value of knowledge for autistic people and their families, yielding important ethical considerations. Conversely, recent evidence highlights performance-related factors as being especially promising for better modeling and addressing social challenges in autism. Prioritizing performance, then, may offer new directions for assessment, substantially different intervention opportunities, and novel methods of inclusion and affirmation. This review touches upon each of these domains and implications, integrates these developments with broader models of social competence in youth, and provides direction for future research and practice regarding social competence in autism.
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Affiliation(s)
| | | | | | - Matthew D Lerner
- Stony Brook University, Stony Brook, USA.
- Department of Psychology, Stony Brook University, Stony Brook, NY, 11794-2500, USA.
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9
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Swerdlow BA, Baker SN, Leifker FR, Straud CL, Rozek DC, Sippel LM. The impact of trauma-focused psychotherapy for posttraumatic stress disorder on interpersonal functioning: A systematic review and meta-analysis of randomized clinical trials. J Trauma Stress 2023. [PMID: 36628929 DOI: 10.1002/jts.22906] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 10/27/2022] [Accepted: 11/14/2022] [Indexed: 01/12/2023]
Abstract
Interpersonal functioning is a common concern for people with postttraumatic stress disorder (PTSD) but is not a key target of most trauma-focused psychotherapies (TFPs). We preregistered and undertook a systematic review and meta-analysis of randomized clinical trials (RCTs) examining the efficacy of TFPs for improving interpersonal functioning. Studies were identified through the PTSD Trials Standardized Data Repository, scholarly databases, and the solicitation of unpublished data from the PTSD research community following current PRISMA guidelines. We used random effects meta-analysis to estimate within-group change (i.e., pre- to posttreatment) in interpersonal functioning. Meta-analytic findings yielded a medium total effect of TFP on interpersonal functioning, g = 0.54, 95% CI [0.37, 0.72], with high between-study heterogeneity. Sensitivity analyses yielded substantively equivalent point estimates when outliers were excluded, g = 0.55, and when only the most well-established individual TFPs were included, g = 0.57. In contrast, allocation to a control condition was associated with little average change in interpersonal functioning, g = 0.04 [-0.12, 0.21]. Formal tests did not yield clear evidence of publication bias. Bias-corrected estimates varied but centered around a medium effect, gs = 0.41-1.11. There was a medium-to-large association between change in interpersonal functioning and change in PTSD symptoms, rs = -.35--.44. The extant literature on TFPs and interpersonal functioning is small and heterogeneous, indicating the need for more focused attention on this outcome. Results suggest that, on average, TFPs are moderately efficacious for improving interpersonal functioning; however, additional treatment may be needed to meet the desired level of improvement.
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Affiliation(s)
| | - Shelby N Baker
- Department of Psychology, University of Central Florida, Orlando, Florida, USA
| | - Feea R Leifker
- Department of Psychology, University of Utah, Salt Lake City, Utah, USA
| | - Casey L Straud
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.,Department of Psychology, University of Texas at San Antonio, San Antonio, Texas, USA.,South Texas Veterans Healthcare System, San Antonio, Texas, USA
| | - David C Rozek
- Department of Psychology, University of Central Florida, Orlando, Florida, USA.,Department of Psychology, University of Utah, Salt Lake City, Utah, USA
| | - Lauren M Sippel
- Department of Veterans Affairs Northeast Program Evaluation Center, West Haven, Connecticut, USA.,Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.,Department of Veterans Affairs National Center for PTSD, West Haven, Connecticut, USA
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10
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Campbell SB, Rau H, Fortney JC, Batten L, Simpson TL. Behavioral Activation and Social Engagement for Posttraumatic Stress Disorder: Preliminary Acceptability and Clinical Outcomes in an Open Pilot Trial. COGNITIVE AND BEHAVIORAL PRACTICE 2022. [DOI: 10.1016/j.cbpra.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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11
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Ripley AJ, Clapp JD, Wilkowski BM. Trauma and aggression: Evaluating the influence of primed hostility and survivor sex. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2022; 61:1154-1168. [PMID: 35938347 DOI: 10.1111/bjc.12386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 06/30/2022] [Accepted: 07/20/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The relation between posttrauma symptoms and aggression is an area of growing interest in the larger clinical literature. The current project looked to examine the impact of primed hostility on aggressive responding in men and women with and without a history of prior trauma. DESIGN Experimental aggression paradigm assessed in a 2 (Group) × 2 (Sex) × 2 (Prime) mixed factorial ANOVA. METHODS Trauma-naïve participants (N = 52) and survivors reporting active symptoms (N = 43) were exposed to hostile and neutral lexical primes in what was presented as a reaction time task played against an unseen 'opponent'. In actuality, 'wins' and 'losses' during the task were assigned by an automated system. The intensity of an aversive sound blast delivered by participants to the supposed opponent in trials the participant 'won' served as an index of behavioural aggression. RESULTS Repeated-measures ANOVA identified a between-by-within interaction of exposure group and lexical prime (p = .010; η p 2 $$ {\eta}_p^2 $$ = .070), with trauma-exposed participants (p = .002, Δ = .30), but not controls (p = .159, Δ = .11), demonstrating elevations in aggression subsequent to hostile priming. A sex by prime interaction (p = .001; η p 2 $$ {\eta}_p^2 $$ = .117) similarly indicated elevated aggression following hostile priming in men (p = .007, Δ = .58) as compared to women (p = .062, Δ = .10). CONCLUSIONS Results offer preliminary support for the association of situationally primed hostility and biological sex with aggressive responding in survivors reporting active symptoms.
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Affiliation(s)
- Adam J Ripley
- Department of Psychology, University of Wyoming, Laramie, Wyoming, USA.,Summa Health System's Traumatic Stress Center, Akron, Ohio, USA
| | - Joshua D Clapp
- Department of Psychology, University of Wyoming, Laramie, Wyoming, USA
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12
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Zhang D, Wei J, Li X. The mediating effect of social functioning on the relationship between social support and fatigue in middle-aged and young recipients with liver transplant in China. Front Psychol 2022; 13:895259. [PMID: 35992430 PMCID: PMC9382128 DOI: 10.3389/fpsyg.2022.895259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveThe objective of the study was to explore the relationship between social support and fatigue as well as the mediating role of social functioning on that relationship.BackgroundPsychosocial factors such as social support and social functioning may influence patients’ fatigue symptoms. There is limited evidence on the relationship between social support, social functioning, and fatigue in liver transplant recipients.MethodsA total of 210 patients with liver transplants from two tertiary hospitals were enrolled in the current study. Questionnaires used include one for general demographic data, the Perceived Social Support Scale (PSSS), Social Disability Screening Schedule (SDSS), and Fatigue Symptom Inventory (FSI).ResultsA total of 126 (60%) recipients reported fatigue. Gender, residence, BMI, and liver function were the primary factors affecting fatigue. Social support was positively correlated with social functioning and was negatively correlated with fatigue. The effect of social support on fatigue was partially mediated by social functioning (35.74%).ConclusionThe fatigue of liver transplant recipients should be attended to. The higher the social support, the lower the fatigue of liver transplant recipients. Social support may also reduce fatigue through social functioning. The liver transplant team should help the liver transplant recipient establish a social support system, restore social functioning, and reduce fatigue symptoms.
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Affiliation(s)
- Dan Zhang
- Nursing Department, The First Hospital of China Medical University, Shenyang, China
| | - Junling Wei
- Rehabilitation Department, Qingdao Hospital of Traditional Chinese Medicine, Qingdao, China
| | - Xiaofei Li
- Transplantation and Hepatobiliary Department, The First Hospital of China Medical University, Shenyang, China
- *Correspondence: Xiaofei Li,
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13
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Kovacevic M, Haney AM, Sullivan CP, Kramer LB, Chard KM. Four profiles of symptom change in residential Cognitive Processing Therapy. J Anxiety Disord 2022; 90:102585. [PMID: 35797805 DOI: 10.1016/j.janxdis.2022.102585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 02/26/2022] [Accepted: 05/09/2022] [Indexed: 11/15/2022]
Abstract
A significant portion of veterans do not respond to evidence-based treatments for PTSD. Therefore, researchers have sought to predict who will respond well to trauma-focused treatment. The present study examined pre- and posttreatment symptom profiles, session-by-session change, as well as demographic and additional diagnostic information to better understand PTSD treatment response. Participants included 332 veterans undergoing residential Cognitive Processing Therapy. Latent profile analyses were computed, and four meaningful profiles emerged: Fast Responders, Steady Responders, Partial Responders, and Minimal Responders. Each profile demonstrated symptom reduction at approximately the same rate in the first half of treatment. Two specific profiles, Steady Responders and Minimal Responders, showed key clinically important differences. Both profiles demonstrated severe pretreatment PTSD symptom severity; however, in the second half of treatment, Steady Responders saw the steepest decrease in symptoms of any of the profiles while Minimal Responders saw less symptom reduction compared to all other profiles. Via a thorough examination, membership in Steady Responders compared to Minimal Responders was not associated with demographic or health variables. Results suggest that pretreatment symptom severity does not necessarily determine a client's posttreatment symptom severity. Pretreatment symptom severity did not determine outcome, though some veterans (Minimal Responders) did not experience the same symptom change and treatment effectiveness. Further identifying the factors that lead to the separation of these groups will add important information for determining treatment selection and potential obstacles to effectiveness.
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Affiliation(s)
- Merdijana Kovacevic
- Trauma Recovery Center, Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio USA.
| | - Alison M Haney
- Trauma Recovery Center, Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio USA
| | - Connor P Sullivan
- Trauma Recovery Center, Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio USA
| | - Lindsay B Kramer
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio USA
| | - Kathleen M Chard
- Trauma Recovery Center, Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio USA; Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio USA
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14
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Zhang J, Luberto CM, Huang Q, Kuang J, Zhong J, Yeung A, Zou L. Validation of the Chinese Version of Relaxation Sensitivity Index: A Tool for Predicting Treatment Effect in Mindfulness Interventions. Front Public Health 2021; 9:809572. [PMID: 34988059 PMCID: PMC8720785 DOI: 10.3389/fpubh.2021.809572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 11/29/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The Relaxation Sensitivity Index (RSI) measures relaxation-related fears developed and validated in western samples. The RSI captures three facets of fear regarding relaxation: physical, cognitive, and social concerns. This study aimed to translate and identify the factor structure of the Chinese version of the RSI. Methods: In a preliminary study, 26 items were generated mainly by translation and modified from the original RSI. In Study 1, factor analysis and internal consistency reliability analysis were conducted on separated half samples of 597 Chinese college students. In Study 2, test-retest reliability, convergent, and predictive criterion validity were examined based on 465 Chinese college students. Results: Fourteen items were selected based on the factor loading and item prevalence in the preliminary study. Factor analysis based on Study 1 identified three factors: Social appealing, Social performance, and Physical concerns. In general, the RSI demonstrated good internal consistency (αs = 0.750-0.860), convergent validity and predictive criterion validity, while the test-retest reliability is relatively low (rs = 0.525-0.685). Notably, less related to the other two factors, Social performance concerns may be a unique factor solely predicting social anxiety (p <0.001), but not relaxation-induced anxiety (p = 0.442). Conclusion: The Chinese version of the RSI possesses a factor structure different from the western population. The robustness of factor structure and test-retest reliability was not as good as expected. Further research is warranted to explore the validity of the RSI in Chinese samples.
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Affiliation(s)
- Jieting Zhang
- Department of Psychology, Shenzhen University, Shenzhen, China
- Institution for Mental Health, Shenzhen University, Shenzhen, China
| | - Christina M. Luberto
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Qi Huang
- Department of Psychology, Shenzhen University, Shenzhen, China
| | - Jin Kuang
- Department of Psychology, Shenzhen University, Shenzhen, China
| | - Juan Zhong
- Springfield College, Springfield, MA, United States
| | - Albert Yeung
- Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Liye Zou
- Department of Psychology, Shenzhen University, Shenzhen, China
- Exercise Psychophysiology Laboratory, School of Psychology, Shenzhen University, Shenzhen, China
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15
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Bird ER, Piccirillo M, Garcia N, Blais R, Campbell S. Relationship Between Posttraumatic Stress Disorder and Sexual Difficulties: A Systematic Review of Veterans and Military Personnel. J Sex Med 2021; 18:1398-1426. [PMID: 37057456 DOI: 10.1016/j.jsxm.2021.05.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 04/26/2021] [Accepted: 05/15/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is associated with sexual difficulties but the nuances of this relationship remain elusive. Research has increased in recent years, most notably following publication of several reviews in 2015. AIM This systematic review examines the relationship between PTSD and sexual difficulties in veterans/military personnel. METHODS A systematic review was conducted using PRISMA guidelines in PsycINFO and PubMed databases for studies examining a diagnosis of PTSD or PTSD severity in relation to a range of sexual difficulties. Forty-three studies were identified that met inclusion and exclusion criteria for this review. RESULTS PTSD was associated with increased risk of experiencing at least one sexual difficulty. PTSD was most clearly associated with overall sexual function, sexual desire, sexual satisfaction, and sexual distress. Results were mixed for sexual arousal, orgasm function, erectile dysfunction, premature ejaculation, sexual pain, and frequency of sexual activity. PTSD symptom clusters of avoidance and negative alterations in cognition/mood were most commonly associated sexual difficulties. Few studies compared results by gender and trauma type. CLINICAL IMPLICATIONS Clinicians should inquire about sexual health in relation to PTSD symptoms and target avoidance and negative mood symptoms by incorporating sexual exposure assignments and sexual activation exercises when appropriate. STRENGTHS & LIMITATIONS This systematic review synthesizes an extensive literature that has grown substantially in the past 5 years and includes studies with low to moderate risk of bias. Limitations of the existing literature include challenges differentiating between PTSD and depression, inconsistent measurement of PTSD and trauma histories, inconsistent operationalization and measurement of sexual outcomes, and largely cross-sectional study designs. CONCLUSION PTSD is linked to a range of sexual outcomes. The current literature suggests that PTSD is associated with sexual difficulties related to both the sexual response cycle (ie, sexual desire) and one's emotional relationship to sexual activity (eg, sexual distress). More research is needed to increase confidence in findings. Bird ER, Piccirillo M, Garcia N, et al. Relationship Between Posttraumatic Stress Disorder and Sexual Difficulties: A Systematic Review of Veterans and Military Personnel. J Sex Med 2021;18:1398-1426.
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Affiliation(s)
- Elizabeth R Bird
- VA Puget Sound Healthcare System, Seattle Division, Seattle, WA.
| | - Marilyn Piccirillo
- VA Puget Sound Healthcare System, Seattle Division, Seattle, WA; University of Washington, Department of Psychology, Seattle, WA
| | - Natalia Garcia
- VA Puget Sound Healthcare System, Seattle Division, Seattle, WA
| | - Rebecca Blais
- Utah State University, Department of Psychology, Logan, UT
| | - Sarah Campbell
- Seattle-Denver Center of Innovation in Veteran-Centered and Value-Driven Care, Health Services Research and Development, VA Puget Sound Health Care System, Seattle, WA; Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
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16
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Macia KS, Blonigen DM, Shaffer PM, Cloitre M, Smelson DA. Trauma-related differences in socio-emotional functioning predict housing and employment outcomes in homeless veterans. Soc Sci Med 2021; 281:114096. [PMID: 34126293 DOI: 10.1016/j.socscimed.2021.114096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/29/2021] [Accepted: 05/29/2021] [Indexed: 01/10/2023]
Abstract
RATIONALE Mental health and substance use disorders are strong risk factors for homelessness. Understanding the role of transdiagnostic factors could help inform efforts to reduce homelessness among veterans with a range of disorders. Homeless veterans have high rates of trauma exposure, which can result in the depletion of social and emotional resources that may contribute to housing and employment stability. In this study, we evaluated the role of problems with emotional lability and interpersonal closeness as transdiagnostic socio-emotional factors that might interfere with efforts to achieve housing and employment stability. METHODS The sample consisted of 346 homeless veterans with co-occurring disorders that were admitted to a U.S. Department of Veterans Affairs (VA) residential treatment program between 2004 and 2009. Assessments were conducted at treatment entry (baseline) and two follow-up timepoints (6- and 12-months). Variables used in the current analyses included history of interpersonal trauma exposure, emotional lability and interpersonal closeness at baseline and 6-months, and homelessness and employment problems during follow-up. Data were analyzed using structural equation modeling and counterfactually-defined mediation effects. RESULTS Veterans exposed to more trauma types experienced more baseline impairment and less improvement during treatment in emotional lability and interpersonal closeness. Problems with interpersonal closeness mediated 73% of the relationship between exposure to multiple traumas and homelessness, and 32%-61% of the relationship between trauma exposure and employment problems. Emotional lability mediated 36% of the relationship between exposure to multiple traumas and employment problems. Decomposition of indirect pathways revealed that indirect effects were primarily transmitted through changes during treatment, and not baseline levels. CONCLUSION Findings support a cumulative effect of trauma on persistence of socio-emotional deficits across treatment, which increased risk of homelessness and employment problems during follow-up. Greater attention and more targeted efforts should be directed at helping trauma-exposed veterans build socio-emotional resources during treatment.
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Affiliation(s)
- Kathryn S Macia
- National Center for PTSD Dissemination and Training Division, VA Palo Alto Health Care System, Menlo Park, CA, 94025, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, 94304, USA.
| | - Daniel M Blonigen
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, 94304, USA; Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, 94025, USA
| | - Paige M Shaffer
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, 01655, USA
| | - Marylène Cloitre
- National Center for PTSD Dissemination and Training Division, VA Palo Alto Health Care System, Menlo Park, CA, 94025, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, 94304, USA
| | - David A Smelson
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, 01655, USA; Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, MA, 01730, USA
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17
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Salhi C, Scoglio AAJ, Ellis H, Issa O, Lincoln A. The relationship of pre- and post-resettlement violence exposure to mental health among refugees: a multi-site panel survey of somalis in the US and Canada. Soc Psychiatry Psychiatr Epidemiol 2021; 56:1015-1023. [PMID: 33398495 DOI: 10.1007/s00127-020-02010-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 12/07/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND A large body of research highlights the lasting impact of pre-resettlement violence on the mental health of refugees after resettlement. However, there is limited research on violence exposure after resettlement and its association with mental health. We examine the association of pre- and post-resettlement violence with post-resettlement mental health symptoms in a survey of Somali refugees in the US and Canada. METHODS AND FINDINGS We collected survey data from 383 Somalis across five cities in the US and Canada (Boston, MA; Minneapolis, MN; Lewiston, NC; Portland, ME; Toronto, Canada). Wave 1 data were collected between May 2013 and January 2014, while Wave 2 was collected between June 2014 and August 2015. Data from both waves were used to examine whether the association of past violence exposures persists across time and with more recent violence exposures. The War Trauma Screening Scale assessed exposure to any pre- and post-resettlement violence at Wave 1, while the My Exposure to Violence scale assessed any past-year violence exposure at Wave 2. Mental health outcomes included symptoms of depression and anxiety (Hopkins Symptom Checklist) and post-traumatic stress symptoms (Harvard Trauma Questionnaire). Separate linear regression models at Waves 1 and 2 examined the relationship of past violence exposure to standardized scores of mental health symptoms. Participants were 22 years of age, on average. Fifty-six percent of our sample had been exposed to violence after resettlement by Wave 2. At Wave 1, the associations of pre- and post-resettlement violence with mental health were comparable in magnitude across depression [β = 0.39, 95% CI (0.21 0.57) vs. β = 0.36, 95% CI (0.10 0.62)], anxiety [β = 0.33, 95% CI (0.12 0.55) vs. β = 0.38, 95% CI (0.01 0.75)], and PTSD [β = 0.55, 95% CI (0.37 0.72) vs. β = 0.47, 95% CI (0.21 0.74)]. At Wave 2, pre-resettlement violence was associated with depressive symptoms only [β = 0.23, 95% CI (0.06 0.40)], while past-year exposure to violence had the largest association with all mental health outcomes [depression: β = 0.39, 95% CI (0.17 0.62); anxiety: β = 0.46, 95% CI (0.01 0.75); PTSD: β = 0.67, 95% CI 0.46 0.88)]. CONCLUSIONS Our study is the first to examine refugees' exposure to post-resettlement violence across time, finding that Somali refugees' exposure is both persistent and prevalent after resettlement. Post-resettlement violence had a larger association with mental health than pre-resettlement exposure by Wave 2. Our study highlights the urgent need to understand the role of post-resettlement violence exposure for refugees in the US and Canada.
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Affiliation(s)
- Carmel Salhi
- Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA. .,Institute of Health Equity and Social Justice Research, Northeastern University, Boston, MA, USA.
| | | | - Heidi Ellis
- Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, Boston, USA
| | - Osob Issa
- Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, Boston, USA
| | - Alisa Lincoln
- Institute of Health Equity and Social Justice Research, Northeastern University, Boston, MA, USA
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