1
|
Burgess HJ, Rizvydeen M, Huizenga B, Prasad M, Bahl S, Duval ER, Kim HM, Phan KL, Liberzon I, Abelson J, Klumpp H, Horwitz A, Mooney A, Raglan GB, Zalta AK. A 4-week morning light treatment reduces amygdala reactivity and clinical symptoms in adults with traumatic stress. Psychiatry Res 2024; 342:116209. [PMID: 39316998 DOI: 10.1016/j.psychres.2024.116209] [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] [Received: 07/26/2024] [Revised: 09/17/2024] [Accepted: 09/17/2024] [Indexed: 09/26/2024]
Abstract
Trauma leads to mental health problems including posttraumatic stress disorder (PTSD), depression, and anxiety. New treatments are needed for traumatic stress that can overcome barriers to care while targeting underlying biological mechanisms of the pathology. Morning light treatment has potential as a novel intervention for traumatic stress. We conducted a randomized clinical trial testing 3 doses of a 4-week morning light treatment in people with traumatic stress to evaluate brain mechanisms underlying the treatment. Forty-six participants completed a baseline week followed by a 4-week morning light treatment (15, 30 or 60 mins each morning). Functional magnetic resonance imaging was conducted at pre- and post-treatment using an emotional faces task to probe the amygdala, based on prior work showing direct effects of light on the amygdala and the role of amygdala in traumatic stress. Clinician-rated symptoms and self-reported symptoms were also assessed at pre- and post-treatment. No group differences were observed in left amygdala reactivity, but right amygdala reactivity reduced only in the 30 and 60 min groups with medium effect sizes. Clinical symptoms reduced in all groups with medium to large effect sizes. Self-reported depression and anxiety scores reduced more in the 60 min than in the 15 min group (p = .02). The results suggest that 4 weeks of morning light treatment of at least 30 min per day can reduce amygdala reactivity and symptoms of traumatic stress. Morning light treatment should be further explored as a potential treatment for traumatic stress, given it is relatively safe, acceptable, accessible and scalable.
Collapse
Affiliation(s)
- Helen J Burgess
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
| | - Muneer Rizvydeen
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Brooke Huizenga
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Masumi Prasad
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Sonal Bahl
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Elizabeth R Duval
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Hyungjin Myra Kim
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - K Luan Phan
- Department of Psychiatry, Ohio State University, Columbus, OH, USA
| | - Israel Liberzon
- Department of Psychiatry, Texas A&M University, College Station, TX, USA
| | - James Abelson
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Heide Klumpp
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Adam Horwitz
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Ann Mooney
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Greta B Raglan
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Alyson K Zalta
- Department of Psychological Science, University of California Irvine, Irvine, CA, USA
| |
Collapse
|
2
|
Somohano VC, Cameron D, Lewis MM, O’Neill A, Phillips R, Kaplan J, O’Neil ME. Predictors of evidence-based psychotherapy initiation among veterans with co-occurring PTSD and substance use disorder. Front Psychiatry 2024; 15:1432361. [PMID: 39220182 PMCID: PMC11363902 DOI: 10.3389/fpsyt.2024.1432361] [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] [Received: 05/13/2024] [Accepted: 07/08/2024] [Indexed: 09/04/2024] Open
Abstract
Objective To compare initiation of PTSD evidence-based psychotherapy (EBP) between Veterans with and without a co-occurring substance use disorder (SUD), and identify factors associated with EBP initiation among Veterans with PTSD-SUD. Method A national sample of Veterans with PTSD (n = 301,872) and PTSD-SUD (n = 94,515) were identified from VA Electronic Health Record data. Treatment initiation was defined as having at least one mental health encounter associated with Cognitive Processing Therapy or Prolonged Exposure therapy. Generalized estimating equations were used to compare EBP initiation between Veterans with and without co-occurring SUD, and to identify patient- and facility characteristics associated with EBP initiation among Veterans with PTSD-SUD. Results The majority of Veterans were 30 - 44 years old, male sex, and Non-Hispanic White. No significant differences were observed in EBP initiation between Veterans with and without a co-occurring SUD (OR=1.00, p=0.985). Among Veterans with PTSD-SUD, co-occurring bipolar disorder (OR=0.83, p=.000), co-occurring psychotic disorder (OR=0.69, p=.000), service connection (OR=0.94, p=.001), female sex (OR=0.87, p=.000), and being 60 years or older (OR=0.57, p=.000) were associated with a reduced likelihood of initiating a PTSD EBP. Having a co-occurring anxiety disorder (OR=1.06, p=.020), MST history (OR=1.95, p=.000), and high risk for suicide (OR=1.15, p=.000) were associated with an increased likelihood of initiating EBP. Discussion These findings support VA provision of EBP for Veterans with PTSD regardless of the presence of co-occurring SUD. Identifying characteristics that increase or reduce the likelihood of EBP initiation may provide insight into treatment pathways and subgroups warranting augmented outreach.
Collapse
Affiliation(s)
- Vanessa C. Somohano
- Center to Improve Veteran Involvement in Care, VA Portland Healthcare System, Portland, OR, United States
| | - David Cameron
- Center to Improve Veteran Involvement in Care, VA Portland Healthcare System, Portland, OR, United States
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, United States
| | - Meaghan M. Lewis
- Center to Improve Veteran Involvement in Care, VA Portland Healthcare System, Portland, OR, United States
| | - Allison O’Neill
- Center to Improve Veteran Involvement in Care, VA Portland Healthcare System, Portland, OR, United States
| | - Rachel Phillips
- Center to Improve Veteran Involvement in Care, VA Portland Healthcare System, Portland, OR, United States
| | - Joshua Kaplan
- Integrative Neurology and Intraoperative Neuromonitoring, Oregon Health & Science University, Portland, OR, United States
| | - Maya E. O’Neil
- Center to Improve Veteran Involvement in Care, VA Portland Healthcare System, Portland, OR, United States
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, United States
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, United States
| |
Collapse
|
3
|
Hernandez-Tejada MA, Little DM, Bruce MJ, Butte S, Burnett J, Wood L, Acierno R. Building resilience: A specialty clinic tailored to older adults at risk of violence and abuse. Int J Psychiatry Med 2024:912174241272591. [PMID: 39097799 DOI: 10.1177/00912174241272591] [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] [Indexed: 08/05/2024]
Abstract
OBJECTIVE Both structural (e.g., ageism) and personal (e.g., stigma) barriers hinder older adult's access to and engagement with mental health care). These barriers are particularly problematic for those vulnerable to interpersonal violence and abuse (e.g., due to social isolation). This study presents a quality improvement program aimed at older adults who have experienced significant stress events, particularly elder mistreatment, within a larger trauma specialty clinic. Leveraging home-based telemedicine, the clinic provides evidence-based psychotherapy tailored to older adults' needs. METHODS From 2021 through 2023, the authors retrospectively examined treatment initiation, engagement, completion, and clinical outcomes among 231 older adults age 60+ who reported trauma that met DSM-5 criterion A criteria for Post-traumatic Stress Disorder (PTSD), depression and other mental health comorbid conditions related to their traumatic event. The clinic uses an automated measurement-based care approach that facilitates Quality Improvement projects, allowing us to track treatment initiation, engagement, completion, and clinical outcomes for all patients. RESULTS The results indicated high treatment completion, high engagement with telemedicine-delivered interventions, and, most importantly, significant changes in clinical outcomes. CONCLUSION These findings highlight the importance of expanding telemedicine-based mental health services for older adults, challenging ageist norms, and prioritizing older adults' mental health needs by providing tailored services to this patient population.
Collapse
Affiliation(s)
- Melba A Hernandez-Tejada
- Louis A. Faillace, MD Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Deborah M Little
- Louis A. Faillace, MD Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Madeline J Bruce
- Louis A. Faillace, MD Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Sarly Butte
- Louis A. Faillace, MD Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Jason Burnett
- Joan and Stanford Division of Geriatric and Palliative Medicine, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - Leila Wood
- Louis A. Faillace, MD Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Ron Acierno
- Louis A. Faillace, MD Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA
- Ralph H. Johnson VA Healthcare System, Charleston, SC, USA
| |
Collapse
|
4
|
Purnell L, Chiu K, Bhutani GE, Grey N, El-Leithy S, Meiser-Stedman R. Clinicians' perspectives on retraumatisation during trauma-focused interventions for post-traumatic stress disorder: A survey of UK mental health professionals. J Anxiety Disord 2024; 106:102913. [PMID: 39111232 DOI: 10.1016/j.janxdis.2024.102913] [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] [Received: 04/23/2024] [Revised: 07/18/2024] [Accepted: 07/26/2024] [Indexed: 09/07/2024]
Abstract
Concerns regarding retraumatisation have been identified as a barrier to delivering trauma-focused therapy for post-traumatic stress disorder (PTSD). We explored clinicians' understanding of what constitutes potential signs of retraumatisation (PSoR), reported incidences of witnessing retraumatisation, use of (and confidence in) therapies for PTSD, fear of retraumatisation during therapy for PTSD, and whether having witnessed retraumatisation was associated with these variables. We surveyed 348 clinicians. There was variation in what clinicians viewed as PSoR. Retraumatisation was reported by clinicians in 3.4 % of patients undergoing trauma-focused therapy for PTSD. A variety of trauma-focused and non-trauma-focused therapies were routinely used, yet 14.4 % reported not using trauma-focused therapy. There was a significant negative correlation between participants' highest reported confidence in trauma-focused therapy and endorsement of PSoR (r = -.25) and fear of retraumatisation (r = -.28). Mean fear of retraumatisation was 30.3 (SD=23.4; a score we derived from asking participants out of 100 how much they worry about trauma-focused therapy being harmful in its own right/leading to a worsening of PTSD symptoms). Participants who had witnessed retraumatisation reported significantly greater endorsement of PSoR (d=.69 [95 % CI .37, 1.02]) and fear of retraumatisation (d=.94 [95 % CI .61, 1.26]). Confidence in using therapies for PTSD was varied and related to how clinicians understood retraumatisation. Retraumatisation is uncommon, but there is variability in clinicians' interpretation of what retraumatisation is, and its utility warrants research.
Collapse
Affiliation(s)
- Lucy Purnell
- Department of Clinical Psychology and Psychological Therapies, University of East Anglia, United Kingdom
| | - Kenny Chiu
- Department of Clinical Psychology and Psychological Therapies, University of East Anglia, United Kingdom
| | - Gita E Bhutani
- Lancashire & South Cumbria NHS Foundation Trust, Preston, United Kingdom; University of Liverpool, Liverpool, United Kingdom
| | - Nick Grey
- Sussex Partnership NHS Foundation Trust, Worthing, United Kingdom; School of Psychology, University of Sussex, Brighton, United Kingdom
| | - Sharif El-Leithy
- South West London and St George's Mental Health NHS Trust, London, United Kingdom
| | - Richard Meiser-Stedman
- Department of Clinical Psychology and Psychological Therapies, University of East Anglia, United Kingdom.
| |
Collapse
|
5
|
Springer S, Whitmer P, Steinlin M, Gray L, Blankfield J. Optimizing clinical outcomes with stellate ganglion block and trauma-informed care: A review article. NeuroRehabilitation 2024:NRE230236. [PMID: 38995805 DOI: 10.3233/nre-230236] [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: 07/14/2024]
Abstract
BACKGROUND For decades, thousands of active-duty service members have sought treatment for trauma exposure. Stellate ganglion block (SGB) is a fast-acting nerve block documented in medical literature for nearly a century that has shown promise as a potentially life-altering treatment for post-traumatic stress (PTS). OBJECTIVE This review aims to answer the practical questions of those who support individuals suffering from trauma: (1) SGB's safety profile (2) efficacy data (3) potential advantages and limitations, (4) a cross-cultural application example, (5) and the use of SGB in combination with talk therapy to optimize clinical outcomes. METHODS The current body of literature, to include several large case series, meta-analyses, and a sufficiently powered randomized controlled trial, were reviewed, and presented to describe the history of SGB for emotional trauma symptoms and address the objectives of this review. RESULTS Critical consideration is given to the safety and efficacy data on SGB and the evolution in safety-related technologies. Advantages such as decreased barriers to care, rapid onset, and decreased dropout and limitations such as treatment non-response, potential adverse effects, and misconceptions about the treatment are then described. Finally, the cross-cultural application of SGB is explored based on the deployment of SGB in Israel. CONCLUSION SGB is associated with level 1B evidence and a reassuring safety profile. Evolving the model of care through the combined use of effective biological treatments like SGB with trauma informed talk therapy offers a hopeful path forward for supporting those who suffer from post-traumatic stress.
Collapse
Affiliation(s)
| | - Paul Whitmer
- School of Social Work, Illinois State University, Normal, IL, USA
| | | | | | | |
Collapse
|
6
|
Koroglu S, Durat G. The impact of mind-body therapies on the mental health of women victims of violence: A meta-analysis. Arch Womens Ment Health 2024:10.1007/s00737-024-01484-8. [PMID: 38958726 DOI: 10.1007/s00737-024-01484-8] [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: 11/11/2023] [Accepted: 06/11/2024] [Indexed: 07/04/2024]
Abstract
PURPOSE Violence against women is a common public health problem and causes negative mental health outcomes. Mind-body therapies aim to positively affect a person's mental health by focusing on the interaction between mind, body, and behavior. Therefore, this study aims to evaluate the effect of mind-body therapies on women's mental health. METHODS Randomized controlled trials published in the last 20 years comparing mind-body therapies with active control or waiting lists in women victims of violence were included. Pubmed, Cochrane, Scopus, Web of Science, and CINAHL databases were searched until August 2023. The random effects model and fixed effects model were used for data analysis. The heterogeneity of the study was assessed using the I2 index, and publication bias was assessed using Egger's test and funnel plot. RESULTS Twelve eligible studies with a sample size of 440 women victims of violence were selected. Mind-body therapies led to a statistically significant reduction in anxiety scores (SMD: 1.95, 95% CI: 1.01, 2.89), depression scores (SMD: 1.68, 95% CI: 0.83, 2.52) and posttraumatic stress scores (SMD: 0.95, 95% CI: 0.73, 1.18). There was a high level of heterogeneity in the outcome for anxiety (I2 = 85.18), a high level of heterogeneity for depression (I2 = 88.82), and a low level of heterogeneity for PTSD (I2 = 19.61). Results of subgroup analysis based on the number of sessions showed that eight or fewer sessions reduced anxiety (SMD: 3.10, 95% CI: 1.37, 4.83) and depression scores (SMD: 3.44, 95% CI: 1.21, 5.68), while PTSD scores did not change. CONCLUSION Evidence suggests that mind-body therapies may reduce anxiety, depression, and PTSD in women victims of violence.
Collapse
Affiliation(s)
- Sevgi Koroglu
- Faculty of Health Sciences, Department of Psychiatric Nursing, Sakarya University, Sakarya, Turkey.
| | - Gülgün Durat
- Faculty of Health Sciences, Department of Psychiatric Nursing, Sakarya University, Sakarya, Turkey
| |
Collapse
|
7
|
Gausemel Å, Filkuková P. Virtual realities, real recoveries: exploring the efficacy of 3MDR therapy for treatment-resistant PTSD. Front Psychol 2024; 15:1291961. [PMID: 38813557 PMCID: PMC11135474 DOI: 10.3389/fpsyg.2024.1291961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 04/16/2024] [Indexed: 05/31/2024] Open
Abstract
Exposure-based therapies have shown promise in treating post-traumatic stress disorder (PTSD), but challenges exist in maintaining patient engagement and finding appropriate stimuli for graded exposure. Virtual reality (VR) technology has been used to enhance exposure therapy, but current software lacks customization and some patients remain treatment-resistant. A novel approach called multimodular motion-assisted memory desensitization and reconsolidation (3MDR) has the potential to solve some of the current limitations of VR-assisted exposure therapy. This study examines the efficacy of 3MDR treatment for individuals with treatment-resistant PTSD through a systematic review of relevant literature and clinical studies. Preliminary findings indicate promise for 3MDR in reducing PTSD symptoms, including emotional regulation and moral injury. However, further research with larger samples and controlled studies is needed to understand underlying mechanisms and validate these results. Moreover, this study highlights the importance of health-economic evaluations to assess costs and resource utilization associated with implementing 3MDR treatment in clinical services.
Collapse
Affiliation(s)
- Åsmund Gausemel
- Department of Psychology, Inland Norway University of Applied Sciences, Lillehammer, Norway
| | - Petra Filkuková
- Department of Psychology, Inland Norway University of Applied Sciences, Lillehammer, Norway
- Department of High Performance Computing, Simula Research Laboratory, Oslo, Norway
| |
Collapse
|
8
|
Rubenstein A, Duek O, Doran J, Harpaz-Rotem I. To expose or not to expose: A comprehensive perspective on treatment for posttraumatic stress disorder. AMERICAN PSYCHOLOGIST 2024; 79:331-343. [PMID: 38635195 PMCID: PMC11034887 DOI: 10.1037/amp0001121] [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] [Indexed: 04/19/2024]
Abstract
Trauma-focused psychotherapies, in particular prolonged exposure (PE) therapy, have been recognized as the "gold standard" for the treatment of posttraumatic stress disorder (PTSD). But effectiveness and implementation data show that a large proportion of patients who undergo exposure therapy retain their PTSD diagnosis, and implementation studies have shown low engagement and high dropout rates. Meanwhile, non-trauma-focused therapies have shown promise in treating PTSD. In this review, we aim to answer the question of whether exposure is necessary to treat PTSD by integrating clinical and research literature from multiple perspectives. We review the roots of exposure therapy in both psychodynamic and behavioral paradigms and their proposed mechanisms. We then review non-trauma-focused treatments and their proposed mechanisms. We conclude that the specific form of exposure required by PE is not necessary for symptom remission. Finally, common psychotherapy factors may facilitate patient self-directed exposure outside of the therapy context. These findings should alter the direction of clinical research to identify the therapy processes that most effectively promote the processing of trauma memories. With respect to clinical practice, shared decision-making should allow for increased patient autonomy in choosing either trauma-focused or non-trauma-focused treatments. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
Collapse
Affiliation(s)
| | - Or Duek
- Department of Psychiatry, Yale University School of Medicine
| | - Jennifer Doran
- Department of Psychiatry, Yale University School of Medicine
| | | |
Collapse
|
9
|
Pebole MM, Singleton CR, Hall KS, Petruzzello SJ, Reginald A, Smith BN, Whitworth JW, Gobin RL. Sex-specific associations between self-reported physical activity and PTSD among survivors of sexual violence. J Behav Med 2024; 47:220-231. [PMID: 37698803 DOI: 10.1007/s10865-023-00434-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 06/28/2023] [Indexed: 09/13/2023]
Abstract
This study examined sex-specific associations between sexual violence (SV) type and physical activity, and identified associations between PTSD symptoms and physical activity, all among cisgender men and women survivors of SV. Cross-sectional data from men (n = 197) and women (n = 356) survivors of SV were analyzed with stratified (men; women) hierarchical logistic regressions. Additionally, fully adjusted models for the total sample included interaction terms to further assess whether associations between SV type as well as PTSD symptoms (sum, clusters) and physical activity differed significantly by sex. Sexual assault was negatively associated with physical activity in the crude model among women (ORs: 0.58; p < 0.05). Harassment was positively associated with physical activity in the crude and adjusted models (ORs:1.92-2.16; ps<0.05) among women. Among men, there were no significant relationships. Regarding PTSD symptoms among women, crude and adjusted stratified models identified significant positive relationships with intrusion (ORs: 1.18-1.22; ps<0.05). Crude and adjusted models revealed significant positive relationships between avoidance and activity (ORs:1.38-1.41; ps<0.05) among men but not women. The interaction term for this difference in the association between avoidance and physical activity by sex was significant (OR: 0.65; 95%CI: 0.48-0.88; p < 0.01). Overall, findings provide evidence for sex-specific associations between SV and physical activity.
Collapse
Affiliation(s)
- Michelle M Pebole
- The Translational Research Center for TBI and Stress Disorders (TRACTS), Veterans Affairs Boston Healthcare System, 150 S Huntington Ave, Boston, MA, 02130, USA.
- Department of Kinesiology and Community Health, University of Illinois at Urbana Champaign, 505 E Armory Ave, Champaign, IL, 61280, USA.
| | - Chelsea R Singleton
- Department of Social, Behavioral, and Population Sciences, Tulane School of Public Health & Tropical Medicine, 1440 Canal Street, New Orleans, LA, 70112, USA
| | - Katherine S Hall
- Geriatric Research, Education, and Clinical Center, Durham VA Healthcare System, 508 Fulton St, Durham, NC, 27705, USA
- Department of Medicine, Duke University, 2301 Erwin Road, Durham, NC, 27710, USA
| | - Steven J Petruzzello
- Department of Kinesiology and Community Health, University of Illinois at Urbana Champaign, 505 E Armory Ave, Champaign, IL, 61280, USA
| | - Alston Reginald
- Department of Kinesiology and Community Health, University of Illinois at Urbana Champaign, 505 E Armory Ave, Champaign, IL, 61280, USA
| | - Brian N Smith
- National Center for PTSD Women's Health Sciences Division, VA Boston Healthcare System, 150 S Huntington Ave, Boston, MA, 02130, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, 720 Harrison Avenue, Boston, MA, 02118, USA
| | - James W Whitworth
- National Center for PTSD Behavioral Science Division at VA Boston Healthcare System, 150 S Huntington Ave, Boston, MA, 02130, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, 720 Harrison Avenue, Boston, MA, 02118, USA
| | - Robyn L Gobin
- Department of Kinesiology and Community Health, University of Illinois at Urbana Champaign, 505 E Armory Ave, Champaign, IL, 61280, USA
| |
Collapse
|
10
|
Pimentel FU, Oliveira SESD. Personality functioning, positive outlook for the future, and simple and complex post-traumatic stress disorder. Acta Psychol (Amst) 2024; 244:104165. [PMID: 38335812 DOI: 10.1016/j.actpsy.2024.104165] [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: 07/17/2023] [Revised: 01/15/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
Posttraumatic Stress Disorder (PTSD) and its complex form (C-PTSD) are psychopathological conditions that are related to several personality traits. In particular, the current study aims to investigate the associations of impairment of personality functioning (IPF) and positive outlook for the future (POF) with PTSD and C-PTSD. A sample of 304 Brazilian adults responded to an online survey. IPF was measured according to the alternative model for personality disorders, POF was operationalized using optimism and hope scales, and PTSD and C-PTSD were measured using the ICD-11 model. Data analysis included correlation, structural equation models, multivariate analysis of variance, and multinomial logistic regression. The results showed that IPF and POF were moderately correlated with PTSD and C-PTSD in positive and negative directions, respectively. IPF and POF were more strongly associated with C-PTSD than PTSD. From the categorical approach to psychopathology, IPF and POF were shown to be associated only with C-PTSD. This is the first study that provides empirical data on the association of IPF and POF with both forms of PTSD. Understanding the associations between pathological and resilient personality domains and PTSD and C-PTSD symptoms can support the development of effective interventions.
Collapse
|
11
|
Armstrong SB, Xin Y, Sepeda ND, Polanco M, Averill LA, Davis AK. Prospective associations of psychedelic treatment for co-occurring alcohol misuse and posttraumatic stress symptoms among United States Special Operations Forces Veterans. MILITARY PSYCHOLOGY 2024; 36:184-191. [PMID: 38377244 PMCID: PMC10880491 DOI: 10.1080/08995605.2022.2156200] [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: 06/30/2022] [Accepted: 11/30/2022] [Indexed: 02/05/2023]
Abstract
This study evaluated prospective associations of ibogaine and 5-MeO-DMT treatment for risky alcohol use and post-traumatic stress disorder (PTSD) symptoms among United States (US) Special Operations Forces Veterans (SOFV). Data were collected during standard clinical operations at pre-treatment and 1-month (1 m), 3-months (3 m), and 6-months (6 m) post-treatment in an ibogaine and 5-MeO-DMT treatment program in Mexico. Of the 86 SOFV that completed treatment, 45 met criteria for risky alcohol use at pre-treatment (mean age = 44; male = 100%; White = 91%). There was a significant reduction in alcohol use from pre-treatment (M = 7.2, SD = 2.3) to 1 m (M = 3.6; SD = 3.5) post-treatment, which remained reduced through 6 m (M = 4.0; SD = 2.9; p < .001, partial eta squared = .617). At 1 m, 24% were abstinent, 33% were non-risky drinking, and 42% were risky drinkers. At 6 m, 16% were abstinent, 31% were non-risky drinking, and 53% were risky drinkers. There were no differences between responders (abstinent/non-risky drinkers) and non-responders (risky drinkers) in demographics/clinical characteristics. However, there were significant and very large differences between responders and non-responders in PTSD symptom (p < .01, d = -3.26) and cognitive functioning change (p < .01, d = -0.99). Given these findings, future clinical trials should determine whether psychedelic-assisted therapy holds promise for individuals with complex trauma and alcohol misuse who have not been successfully treated with traditional interventions.
Collapse
Affiliation(s)
- Stacey B. Armstrong
- Center for Psychedelic Drug Research and Education, The Ohio State University, Columbus, Ohio
| | - Yitong Xin
- Center for Psychedelic Drug Research and Education, The Ohio State University, Columbus, Ohio
| | - Nathan D. Sepeda
- Center for Psychedelic Drug Research and Education, The Ohio State University, Columbus, Ohio
- Center for Psychedelic and Consciousness Research, Johns Hopkins University, Baltimore, Maryland
| | | | - Lynnette A. Averill
- US Department of Veterans Affairs, Michael E. DeBakey Veterans Administration Medical Center, Houston, TX, USA
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Alan K. Davis
- Center for Psychedelic Drug Research and Education, The Ohio State University, Columbus, Ohio
- Center for Psychedelic and Consciousness Research, Johns Hopkins University, Baltimore, Maryland
| |
Collapse
|
12
|
Hien DA, Papini S, Saavedra LM, Bauer AG, Ruglass LM, Ebrahimi CT, Fitzpatrick S, López-Castro T, Norman SB, Killeen TK, Back SE, Morgan-López AA. Project harmony: A systematic review and network meta-analysis of psychotherapy and pharmacologic trials for comorbid posttraumatic stress, alcohol, and other drug use disorders. Psychol Bull 2024; 150:319-353. [PMID: 37971855 PMCID: PMC10939977 DOI: 10.1037/bul0000409] [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] [Indexed: 11/19/2023]
Abstract
We conducted a systematic review and network meta-analyses (NMA) of psychotherapy and pharmacologic treatments for individuals with co-occurring posttraumatic stress disorder (PTSD) and alcohol or other drug use disorder (AOD). A comprehensive search spanning 1995-2019 yielded a pool of 39 studies for systematic review, including 24 randomized controlled trials for the NMA. Study interventions were grouped by target of treatment (PTSD + AOD, PTSD-only, and AOD-only) and approach (psychotherapy or medication). Standardized mean differences (SMD) from the NMA yielded evidence that at the end of treatment, integrated, trauma-focused therapy for PTSD + AOD was more effective at reducing PTSD symptoms than integrated, non-trauma-focused therapy (SMD = -0.30), AOD-focused psychotherapy (SMD = -0.29), and other control psychotherapies (SMD = -0.43). End-of-treatment alcohol use severity was less for AOD medication compared to placebo medication (SMD = -0.36) and trauma-focused therapy for PTSD + placebo medication (SMD = -0.67), and less for trauma-focused psychotherapy + AOD medication compared to PTSD medication (SMD = -0.53), placebo medication (SMD = -0.50), and trauma-focused psychotherapy + placebo medication (SMD = -0.81). Key limitations include the small number of studies in the NMA for pharmacologic treatments and the lack of demographic diversity apparent in the existing literature. Findings suggest room for new studies that can address limitations in study sample composition, sample sizes, retention, and apply new techniques for conducting comparative effectiveness in PTSD + AOD treatment. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
Collapse
Affiliation(s)
- Denise A Hien
- Department of Clinical Psychology, Center of Alcohol and Substance Use Studies, Graduate School of Applied and Professional Psychology, Rutgers University-New Brunswick
| | | | | | - Alexandria G Bauer
- Department of Clinical Psychology, Center of Alcohol and Substance Use Studies, Graduate School of Applied and Professional Psychology, Rutgers University-New Brunswick
| | | | - Chantel T Ebrahimi
- Department of Clinical Psychology, Center of Alcohol and Substance Use Studies, Graduate School of Applied and Professional Psychology, Rutgers University-New Brunswick
| | | | | | - Sonya B Norman
- Department of Psychiatry, University of California, San Diego
| | - Therese K Killeen
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina
| | - Sudie E Back
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina
| | | |
Collapse
|
13
|
Wall EK, Teo JN, Roth A, Chan ME, Brandt J, Hibri M, Richardson R, Baker KD. Effects of social buffering on fear extinction in adolescent rats. Behav Res Ther 2024; 173:104457. [PMID: 38134498 DOI: 10.1016/j.brat.2023.104457] [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: 05/11/2023] [Revised: 10/12/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023]
Abstract
Across social species, the presence of another individual can reduce stress reactions to adverse stimuli, a phenomenon known as social buffering. The present study investigated whether social buffering influences the expression and extinction of learned fear in adolescence, a developmental period of diminished fear inhibition and increased social interaction. Quality of maternal care and degree of social investigation were examined as factors that may influence social buffering. In adolescence, male rats were fear conditioned and then given extinction training either in the presence of a same-age rat or alone. Animals were then tested alone for extinction retention. In two experiments, the presence of a conspecific robustly reduced conditioned fear responses during extinction training. Interestingly, a persistent social buffering effect was observed when the extinction and conditioning contexts had prominent differences in features (Experiment 1), but not when these contexts were relatively similar (Experiment 2). Neither quality of maternal care nor degree of social investigation predicted the effects of social buffering. These findings suggest that social buffering robustly dampens fear responses during adolescence when a peer is present and this suppression can persist, in some instances, even when the peer is absent.
Collapse
Affiliation(s)
- Emily K Wall
- School of Psychology, UNSW Sydney, NSW, 2052, Australia
| | - Jia Ni Teo
- School of Psychology, UNSW Sydney, NSW, 2052, Australia
| | | | - Mei E Chan
- School of Psychology, UNSW Sydney, NSW, 2052, Australia
| | | | - Maya Hibri
- School of Psychology, UNSW Sydney, NSW, 2052, Australia
| | | | | |
Collapse
|
14
|
Somohano VC, Cameron D, Lewis M, Denneson LM, Lovejoy TI, O'Neil ME. Characterizing and Comparing Evidence-Based Psychotherapy Utilization Among Veterans with Co-occurring PTSD and Substance Use Disorder. Subst Use Misuse 2024; 59:425-431. [PMID: 38111167 DOI: 10.1080/10826084.2023.2275566] [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: 12/20/2023]
Abstract
Objective: The current study sought to describe a nationally representative sample of Veterans diagnosed with co-occurring PTSD and substance use disorder (SUD) who initiated and completed evidence-based psychotherapy (EBP) for PTSD, and explored whether completion rates differed by SUD subtype. Methods: Using electronic health record data from the Veterans Health Administration (VHA) Corporate Data Warehouse, Veterans with a dual diagnosis of PTSD and SUD who initiated either Cognitive Processing Therapy (CPT) or Prolonged Exposure (PE) between January 01, 2019 and July 16, 2019 were identified (N = 2,996). Logistic analyses were employed to determine whether there were differences in EBP completion rates among Veterans with an alcohol use disorder (AUD; n = 1,383) versus all other SUDs (n = 1,613). Results: On average, Veterans were 45 years old, and identified as male, White, and non-Hispanic. Logistic regression analyses revealed there was not a significant difference between Veterans with AUD only and other SUDs in the probability of completing EBP treatment, OR = 1.02, 95% CI =0.87, 1.17, p = 0.79. Conclusions: No differences in EBP completion rates were observed between SUD subtypes, indicating that EBPs for PTSD are tolerated well for individuals with various types of SUDs and may be offered as treatment options.
Collapse
Affiliation(s)
- Vanessa C Somohano
- Center to Improve Veteran Involvement in Care, VA Portland Healthcare System, Portland, Oregon, USA
| | - David Cameron
- Center to Improve Veteran Involvement in Care, VA Portland Healthcare System, Portland, Oregon, USA
- School of Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Meaghan Lewis
- Center to Improve Veteran Involvement in Care, VA Portland Healthcare System, Portland, Oregon, USA
| | - Lauren M Denneson
- Center to Improve Veteran Involvement in Care, VA Portland Healthcare System, Portland, Oregon, USA
- School of Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Travis I Lovejoy
- Center to Improve Veteran Involvement in Care, VA Portland Healthcare System, Portland, Oregon, USA
- School of Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Maya E O'Neil
- Center to Improve Veteran Involvement in Care, VA Portland Healthcare System, Portland, Oregon, USA
- School of Medicine, Oregon Health and Science University, Portland, Oregon, USA
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, OR
| |
Collapse
|
15
|
Saito A, Tsuruta N, Arai Y, Okamoto K, Narisawa T, Nozaki M, Konno N, Asukai N. Effectiveness of prolonged exposure (PE) after implementation at a crime victim support centre. Eur J Psychotraumatol 2024; 15:2302703. [PMID: 38264969 PMCID: PMC10810613 DOI: 10.1080/20008066.2024.2302703] [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] [Received: 07/25/2023] [Accepted: 12/22/2023] [Indexed: 01/25/2024] Open
Abstract
Background: Recent practice guidelines strongly recommend evidence-based psychotherapies (EBPs) as the first-line treatment for post-traumatic stress disorder (PTSD). However, previous studies found barriers to the implementation of EBPs and a relatively high dropout rate in clinical settings. After proving the efficacy of prolonged exposure (PE) in Japan [Asukai, N., Saito, A., Tsuruta, N., Kishimoto, J., & Nishikawa, T. (2010). Efficacy of exposure therapy for Japanese patients with posttraumatic stress disorder due to mixed traumatic events: A randomized controlled study. Journal of Traumatic Stress, 23(6), 744-750. https://doi.org/10.1002/jts.20589], we began implementing PE in a real-world clinical setting at the Victim Support Center of Tokyo (VSCT).Objective: We aimed to investigate the effectiveness and benefit of PE for crime-induced PTSD among VSCT clients and what causes dropout from treatment.Method: Of 311 adult clients who received counselling from clinical psychologists at VSCT due to violent or physical crime victimization from April 2008 through December 2019, 100 individuals received PE and participated in this study. Their PTSD symptoms were evaluated before and after treatment using the Impact of Event Scale-Revised and the Clinician-Administered PTSD Scale for DSM-IV.Results: A total of 93 participants completed PE and seven dropped out after six sessions or less. The completers group improved in PTSD symptoms with significant score differences between pre- and post-treatment in IES-R and CAPS-IV. Participants' symptoms did not exacerbate after treatment. Forty of 49 completers who left their workplace or college/school after victimization returned to work or study shortly after treatment. Compared to the completers, all dropout participants were women and younger. The majority were rape survivors, with significantly shorter intervals between victimization and treatment. The reasons for dropout were difficulty scheduling treatment between work/study schedules and manifestation of bipolar disorder or physical illness.Conclusions: PE can be implemented with significant effectiveness and a low dropout rate in a real-world clinical setting if advantages in the system and policies, local organizational context, fidelity support and patient engagement are fortified.
Collapse
Affiliation(s)
- Azusa Saito
- Faculty of Human Sciences, Department of Psychology, Sophia University, Tokyo, Japan
- Victim Support Center of Tokyo, Tokyo, Japan
| | | | - Yoko Arai
- Victim Support Center of Tokyo, Tokyo, Japan
| | - Kaori Okamoto
- Victim Support Center of Tokyo, Tokyo, Japan
- Faculty of Human Studies, Department of Psychology, Seisen Jogakuin College, Nagano, Japan
| | - Tomomi Narisawa
- Victim Support Center of Tokyo, Tokyo, Japan
- Faculty of Human Sciences, Department of Human Sciences, Musashino University, Tokyo, Japan
| | - Mari Nozaki
- Victim Support Center of Tokyo, Tokyo, Japan
| | | | - Nozomu Asukai
- Victim Support Center of Tokyo, Tokyo, Japan
- Aoki Hospital, Tokyo
| |
Collapse
|
16
|
Kaplan J, Somohano VC, Zaccari B, O’Neil ME. Randomized controlled trials of mind-body interventions for posttraumatic stress disorder: a systematic review. Front Psychol 2024; 14:1219296. [PMID: 38327501 PMCID: PMC10847595 DOI: 10.3389/fpsyg.2023.1219296] [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: 05/08/2023] [Accepted: 12/18/2023] [Indexed: 02/09/2024] Open
Abstract
Mind-body interventions (MBIs) include mindfulness-based interventions (MiBIs), meditation- and mantra-based interventions (MMIs), and movement-based interventions (MoBIs). These approaches have demonstrated preliminary efficacy in improving posttraumatic stress disorder (PTSD) symptoms. However, previous systematic reviews and meta-analyses have noted that this area of research is limited by inadequate comparator conditions, heterogeneity of measurement, and absence of objective outcome measures. For these reasons, an updated review of the highest-quality evidence available is warranted. We used the Agency for Healthcare Research and Quality (AHRQ)-funded evidence tables for the PTSD-Repository to identify relevant studies and assess the risk of bias as follows: The search was conducted between June 2018 and June 2022, and databases included PTSDpubs (formerly PILOTS), Ovid® MEDLINE®, Cochrane CENTRAL, Embase®, the Cumulative Index to Nursing and Allied Health Literature (CINAHL®), SCOPUS, and PsycINFO®. Twenty-six randomized controlled trials met our inclusion criteria. After identifying studies and retrieving risk of bias information from the PTSD-Repository evidence tables, we extracted additional data and synthesized the evidence. The strength of evidence was rated as low for MiBIs and MMIs, largely due to contradicting results, inconsistent use of active versus passive comparators, and high risk of bias. The strength of evidence for MoBIs was rated as moderate due to individual studies consistently favoring the intervention and a relatively large number of studies and participants. Of the 26 included studies, only two included objective outcome measures. Implications for future MBI research and clinical applications for treating PTSD are discussed.
Collapse
Affiliation(s)
- Josh Kaplan
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
| | | | - Belle Zaccari
- Veterans Affairs Portland Health Care System, Portland, OR, United States
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, United States
| | - Maya E. O’Neil
- Veterans Affairs Portland Health Care System, Portland, OR, United States
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, United States
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, United States
| |
Collapse
|
17
|
Modlin NL, Creed M, Sarang M, Maggio C, Rucker JJ, Williamson V. Trauma-Informed Care in Psychedelic Therapy Research: A Qualitative Literature Review of Evidence-Based Psychotherapy Interventions in PTSD and Psychedelic Therapy Across Conditions. Neuropsychiatr Dis Treat 2024; 20:109-135. [PMID: 38268571 PMCID: PMC10807282 DOI: 10.2147/ndt.s432537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 11/10/2023] [Indexed: 01/26/2024] Open
Abstract
Introduction Post-traumatic stress disorder (PTSD) is associated with significant patient burden. While pharmacotherapies and evidence-based psychotherapy interventions (EBPI) are effective, studies consistently highlight inadequate outcomes and high treatment dropout. Psychedelic therapy (PT) has shown preliminary promise across difficult-to-treat conditions, including MDMA-assisted therapy for PTSD, however trials of classical psychedelics in PTSD are lacking. Understanding patients' experiences of EBPI could help promote safety in PT. Aim To systematically review qualitative research on patients' subjective experience of EBPI for PTSD, and of PT, and examine areas of overlap and divergence between them. Methods Systematic literature searches for studies published between 2010 and 2023 were conducted on OVID, PubMed, Web of Science, and PsycInfo. Included were original studies in English that presented qualitative data of patient experiences of EBPI in PTSD, or PT for any indication. Extracted data from included studies were analysed using thematic synthesis. Syntheses were completed separately for EBPI and PT, before similarities and differences between the therapies were identified. Results 40 research articles were included for review: 26 studies on EBPI for PTSD, and 14 studies on PT. EBPI studied were CBT, EMDR, CPT and PE. Psychedelic compounds studied were psilocybin, ibogaine, LSD, MDMA and ketamine, for treatment of substance use disorders, anxiety relating to physical illness, depression, and PTSD. Core themes from patient experiences of EBPI: 1) patient burden in PTSD treatment; 2) readiness; 3) key mechanisms of change; 4) psychological safety and trust. Themes identified in the review of PT: 1) indirect trauma processing; 2) reorganisation of self-narratives via processes of relatedness and identification; 3) key treatment characteristics. Conclusion This study suggests overlap between patients' experience of EBPI and PT in terms of key mechanisms of change, the importance of psychological safety and readiness to engage in treatment. Trauma-informed care paradigms and practices may improve safety and acceptability of PT research.
Collapse
Affiliation(s)
- Nadav Liam Modlin
- The Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AF, UK
| | - Michael Creed
- The Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, SE5 8AZ, UK
| | - Maria Sarang
- The Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AF, UK
| | - Carolina Maggio
- The Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AF, UK
| | - James J Rucker
- The Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, SE5 8AZ, UK
| | - Victoria Williamson
- King’s Centre for Military Health Research, King’s College London, London, SE5 9RJ, UK
- Department of Experimental Psychology, Anna Watts Building, University of Oxford, Oxford, OX2 6 GG, UK
| |
Collapse
|
18
|
Manfield PE, Taylor G, Dornbush E, Engel L, Greenwald R. Preliminary evidence for the acceptability, safety, and efficacy of the flash technique. Front Psychiatry 2024; 14:1273704. [PMID: 38260782 PMCID: PMC10801180 DOI: 10.3389/fpsyt.2023.1273704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/27/2023] [Indexed: 01/24/2024] Open
Abstract
Objectives This study reports on four similar studies intended to explore the acceptability, safety, and efficacy of the flash technique (FT), a method of rapidly reducing the intensity of a disturbing memory or image, with minimal subjective disturbance for subjects during the process. Of the four studies, two were conducted during FT trainings in the United States, one in Australia, and one in Uganda. Methods The studies involve pre-, post-, and follow-up repeated-measures design to determine the effectiveness of a 15-min FT intervention. A total of 654 subjects were asked to think of a disturbing memory and then participate in a structured experience of an FT. The purpose of this investigation was to determine whether a brief application of an FT would be safe and effective in significantly reducing their disturbance. In each study, subjects rated their disturbing memories on a 0-to-10 scale, with zero representing no disturbance at all and 10 representing the worst they could imagine. Then, they took part in a 15-min group practicum where they were guided in a self-administering FT with no individual supervision or support. Results In all four studies, the mean reduction in disturbance exceeded two-thirds, the results were significant (p < 0.001), and the effect size was very large. Of the 813 sessions (654 subjects) represented in these studies, only two subjects reported slight increases in disturbances, and both of these subjects reported reductions in disturbance in their second FT experiences 2 h later. At a 4-week follow-up, mean disturbance levels in all four studies indicated maintenance of benefit or slightly further reduction of mean disturbance levels. An 18-month follow-up study with a subgroup of subjects who initially reported a high level of memory-related distress found similar maintenance of gains as well as symptom reduction. Conclusion These findings provide preliminary evidence of acceptability, safety, and efficacy of FT; therefore, further study is warranted.
Collapse
Affiliation(s)
| | | | | | - Lewis Engel
- Independent Practice, San Francisco, CA, United States
| | | |
Collapse
|
19
|
Israel BS, Belcher AM, Ford JD. A Harm Reduction Framework for Integrated Treatment of Co-Occurring Opioid Use Disorder and Trauma-Related Disorders. J Dual Diagn 2024; 20:52-85. [PMID: 38165922 DOI: 10.1080/15504263.2023.2295416] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
The opioid epidemic has exposed a gulf in mental health research, treatment, and policy: Most patients with comorbid trauma-related disorder (TRD) and opioid use disorder (OUD) (TRD + OUD) remain undiagnosed or unsuccessfully treated for the combination of TRD symptoms and opioid use. TRD treatments tend to be psychotherapies that are not accessible or practical for many individuals with TRD + OUD, due to TRD treatment models not systematically incorporating principles of harm reduction (HR). HR practices prioritize flexibility and unequivocally improve outcomes and save lives in the treatment of OUD. Considering the urgent need to improve TRD + OUD treatment and outcomes, we propose that the OUD and TRD fields can be meaningfully reconciled by integrating HR principles with classic phasic treatment for TRD. Adding a "prestabilization" phase of treatment for TRD - largely analogous to the precontemplation Stage of Change - creates opportunities to advance research, clinical practice, and policies and potentially improve patient outcomes.
Collapse
Affiliation(s)
- Benjamin S Israel
- Division of Addiction Research and Treatment, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Annabelle M Belcher
- Division of Addiction Research and Treatment, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Julian D Ford
- Department of Psychiatry, University of Connecticut Health Center, Farmington, Connecticut, USA
| |
Collapse
|
20
|
Valentine SE, Godfrey LB, Gellatly R, Paul E, Clark C, Giovannini K, Saia KA, Nillni YI. Supporting the implementation of written exposure therapy for posttraumatic stress disorder in an obstetrics-substance use disorder clinic in the Northeastern United States. SSM - MENTAL HEALTH 2023; 4:100256. [PMID: 38645900 PMCID: PMC11027481 DOI: 10.1016/j.ssmmh.2023.100256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2024] Open
Abstract
Pregnant people with comorbid posttraumatic stress disorder (PTSD) and substance use disorder (SUD) constitute a highly vulnerable population. PTSD and SUD confer risks to both the pregnant person and the fetus, including a host of physical and mental health consequences. When PTSD and SUD co-occur, potential negative impacts are amplified, and the symptoms of each may exacerbate and maintain the other. Pregnancy often increases engagement in the healthcare system, presenting a unique and critical opportunity to provide PTSD and SUD treatment to birthing people motivated to mitigate risks of losing custody of their children. This paper presents implementation process outcomes of Written Exposure Therapy (WET), a brief, scalable, and sustainable evidence-based PTSD treatment delivered to pregnant persons receiving care in an integrated obstetrical-addiction recovery program at Boston Medical Center. Trial participants (N = 18) were mostly White, non-Hispanic (61.1%), not currently working (77.8%), had a high school or lower level of education (55.5%), had an annual household income less than $35,000 (94.4%), and were living in a substance use residential program (55.6%). We examined intervention feasibility, acceptability, appropriateness, adoption; barriers and facilitators to implementation; and feedback on supporting uptake and sustainability of the intervention using coded qualitative sources (consultation field notes [N = 47] and semi-structured interviews [N = 5]) from providers involved in trial planning and treatment delivery. Results reflected high acceptability, appropriateness, and adoption of WET. Participants described system-, provider-, and patient-level barriers to implementation, offered suggestions to enhance uptake, but did not raise concerns about core components of the intervention. Findings suggest that WET is an appropriate and acceptable PTSD treatment for this difficult-to-reach, complex population, and has the potential to positively impact pregnant persons and their children.
Collapse
Affiliation(s)
- Sarah E. Valentine
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA
| | - Laura B. Godfrey
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA
| | - Resham Gellatly
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA
- Immigrant and Refugee Health Center, Boston Medical Center, Boston, MA, USA
| | - Emilie Paul
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA
| | - Caitlin Clark
- Department of Obstetrics & Gynecology, Boston Medical Center, Boston, MA, USA
| | - Karissa Giovannini
- Department of Obstetrics & Gynecology, Boston Medical Center, Boston, MA, USA
| | - Kelley A. Saia
- Department of Obstetrics & Gynecology, Boston Medical Center, Boston, MA, USA
- Department of Obstetrics & Gynecology, Boston University School of Medicine, Boston, MA, USA
| | - Yael I. Nillni
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
- National Center for PTSD, Women’s Health Sciences Division at VA Boston Healthcare System, Boston, MA, USA
| |
Collapse
|
21
|
Pebole MM, Singleton CR, Hall KS, Petruzzello SJ, Alston R, Darroch FE, Gobin RL. Perceived Barriers and Benefits of Exercise Among Men with Histories of Sexual Violence: Impact of PTSD and Physical Activity Status. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:11842-11869. [PMID: 37519195 DOI: 10.1177/08862605231188058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
This study reported on perceived benefits and barriers of exercise among men with histories of sexual violence (SV) and compared these perceptions by activity level and post-traumatic stress disorder (PTSD) status. An online, cross-sectional, survey of men with histories of SV (N = 198) was completed using Amazon Mechanical Turk. Inclusion criteria were identifying sex at birth as male, age between 18 and 65 years, self-reported history of SV, and living in the United States (U.S.). A total of 1,260 men were screened for the study, of which 316 met the inclusion criteria, and 198 met all data quality requirements and were included in the study. Sociodemographic information, exercise behavior, PTSD symptoms, and perceived exercise barriers/benefits were collected. Comparisons by activity and PTSD status were analyzed. Additionally, two open-ended qualitative research questions were included to provide nuance to perceived barriers/benefits of exercise. The most salient benefits included physical performance, psychological outlook, and preventative health. Open-ended responses also noted the mental and physical benefits of exercise. The most salient barrier was physical exercise, with open-ended responses emphasizing lack of time, chronic pain and health concerns, and poor mental health and lack of motivation as impediments to exercise. Significant differences were found in benefits (psychological outlook, physical performance) and barriers (exercise environment, high time expenditure, and family discouragement) between active and insufficiently active men with histories of SV (ps < .05; Cohen's ds = 0.32-0.57). Significant differences were found by PTSD status on benefits (physical performance, social interaction, and preventative health) and barriers (exercise milieu, time expenditure, hard physical exercise, family discouragement) (ps < .05; Cohen's ds = 0.40-1.10). Findings provide new gender-specific strategies for promoting exercise among men with histories of SV: integrating exercise physiologists into trauma recovery programs, psychoeducation, engaging friends and family members, peer-support, and building self-efficacy.
Collapse
Affiliation(s)
- Michelle M Pebole
- Veterans Affairs Boston Healthcare System, Boston, MA, USA
- University of Illinois at Urbana Champaign, Champaign, IL, USA
| | | | - Katherine S Hall
- VA Durham Healthcare System, Durham, NC, USA
- Duke University, Durham, NC, USA
| | | | - Reginald Alston
- University of Illinois at Urbana Champaign, Champaign, IL, USA
| | | | - Robyn L Gobin
- University of Illinois at Urbana Champaign, Champaign, IL, USA
| |
Collapse
|
22
|
van den End A, Beekman ATF, Dekker J, Thomaes K. Self-rated personality disorder symptoms do not predict treatment outcome for posttraumatic stress disorder in routine clinical care. Clin Psychol Psychother 2023; 30:1338-1348. [PMID: 37985013 DOI: 10.1002/cpp.2933] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/28/2023] [Accepted: 10/30/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVE To test the hypothesis that self-rated personality disorder (PD) symptoms are a significant and clinically relevant predictor of treatment outcomes in a naturalistic treatment setting specialized in trauma-focused treatment using a single-group pretest-posttest design. METHOD Treatment-seeking patients reporting clinical levels of posttraumatic stress disorder (PTSD) symptoms filled out questionnaires at intake and after treatment. The primary outcome was change in PTSD severity after treatment, measured by the PTSD Checklist for DSM-5 (PCL-5). PD symptoms were measured with the Structured Clinical Interview for DSM-5 Screening Personality Questionnaire (SCID-5-SPQ). Secondary outcomes were general mental health problems, treatment response, number of sessions and dropout. RESULTS N = 1174 patients (59% female, baseline PCL-5 score M [SD] = 53.0 [10.8]) were included for the primary analysis. Regression analysis revealed that PD symptoms explained 0.4% of variance in PTSD symptom change (p = .066). After controlling for baseline PTSD symptoms, PD symptoms explained 0.0% of variance (p = .311). The fully adjusted model including baseline PTSD symptom severity, age, gender, cumulative exposure to potentially traumatic experiences, PD symptoms, and number of sessions together explained 5% of the observed variance in PTSD symptom change. Baseline PTSD severity was the only significant predictor and negatively predicted outcome. Sensitivity analyses with imputed data from N = 2694 cases yielded comparable results. Finally, secondary analyses showed that PD symptoms did not predict significant or clinically relevant changes in treatment response status, general mental health problems, dropout rates or number of sessions. CONCLUSION The findings provide no evidence that self-rated PD symptoms predict treatment outcomes for patients suffering from clinical levels of PTSD symptoms in a naturalistic treatment setting specializing in trauma-focused treatment. Self-report screening for these symptoms to inform clinicians about expected effects of PTSD treatment is not supported by the evidence.
Collapse
Affiliation(s)
- Arne van den End
- Department of Psychiatry, Amsterdam University Medical Center, Location Vrije Universiteit Medical Center, Amsterdam, The Netherlands
- Sinai Center, Amstelveen, The Netherlands
| | - Aartjan T F Beekman
- Department of Psychiatry, Amsterdam University Medical Center, Location Vrije Universiteit Medical Center, Amsterdam, The Netherlands
| | - Jack Dekker
- Department of Research, Arkin Mental Health Care, Amsterdam, The Netherlands
- Faculty of Behavioral and Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands
| | - Kathleen Thomaes
- Department of Psychiatry, Amsterdam University Medical Center, Location Vrije Universiteit Medical Center, Amsterdam, The Netherlands
- Sinai Center, Amstelveen, The Netherlands
- Department of Research, Arkin Mental Health Care, Amsterdam, The Netherlands
| |
Collapse
|
23
|
Haun JN, Venkatachalam HH, Fowler CA, Alman AC, Ballistrea LM, Schneider T, Benzinger RC, Melillo C, Alexander NB, Klanchar SA, Lapcevic W, French DD. Mobile and Web-Based Partnered Intervention to Improve Remote Access to Pain and Posttraumatic Stress Disorder Symptom Management: Recruitment and Attrition in a Randomized Controlled Trial. J Med Internet Res 2023; 25:e49678. [PMID: 37788078 PMCID: PMC10582813 DOI: 10.2196/49678] [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: 06/05/2023] [Revised: 08/22/2023] [Accepted: 08/29/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Increasing access to nonpharmacological interventions to manage pain and posttraumatic stress disorder (PTSD) is essential for veterans. Complementary and integrative health (CIH) interventions can help individuals manage symptom burden with enhanced accessibility via remotely delivered health care. Mission Reconnect (MR) is a partnered, self-directed intervention that remotely teaches CIH skills. OBJECTIVE The purpose of this paper is to describe the recruitment, onboarding phase, and attrition of a fully remote randomized controlled trial (RCT) assessing the efficacy of a self-directed mobile and web-based intervention for veterans with comorbid chronic pain and PTSD and their partners. METHODS A total of 364 veteran-partner dyads were recruited to participate in a mixed methods multisite waitlist control RCT. Qualitative attrition interviews were conducted with 10 veterans with chronic pain and PTSD, and their self-elected partners (eg, spouse) who consented but did not begin the program. RESULTS At the point of completing onboarding and being randomized to the 2 treatment arms, of the 364 recruited dyads, 97 (26.6%) failed to complete onboarding activities. Reported reasons for failure to complete onboarding include loss of self-elected partner buy-in (n=8, 8%), difficulties with using remote data collection methods and interventions (n=30, 31%), and adverse health experiences unrelated to study activities (n=23, 24%). Enrolled veterans presented at baseline with significant PTSD symptom burden and moderate-to-severe pain severity, and represented a geographically and demographically diverse population. Attrition interviews (n=10) indicated that misunderstanding MR including the intent of the intervention or mistaking the surveys as the actual intervention was a reason for not completing the MR registration process. Another barrier to MR registration was that interviewees described the mailed study information and registration packets as too confusing and excessive. Competing personal circumstances including health concerns that required attention interfered with MR registration. Common reasons for attrition following successful MR registration included partner withdrawal, adverse health issues, and technological challenges relating to the MR and electronic data collection platform (Qualtrics). Participant recommendations for reducing attrition included switching to digital forms to reduce participant burden and increasing human interaction throughout the registration and baseline data collection processes. CONCLUSIONS Challenges, solutions, and lessons learned for study recruitment and intervention delivery inform best practices of delivering remote self-directed CIH interventions when addressing the unique needs of this medically complex population. Successful recruitment and enrollment of veterans with chronic pain and PTSD, and their partners, to remote CIH programs and research studies requires future examination of demographic and symptom-associated access barriers. Accommodating the unique needs of this medically complex population is essential for improving the effectiveness of CIH programs. Disseminating lessons learned and improving access to remotely delivered research studies and CIH programs is paramount in the post-COVID-19 climate. TRIAL REGISTRATION ClinicalTrials.gov NCT03593772; https://clinicaltrials.gov/ct2/show/NCT03593772.
Collapse
Affiliation(s)
- Jolie N Haun
- James A. Haley Veterans' Hospital, Research Service, Tampa, FL, United States
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
| | | | - Christopher A Fowler
- James A. Haley Veterans' Hospital, Research Service, Tampa, FL, United States
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, United States
| | - Amy C Alman
- College of Public Health, University of South Florida, Tampa, FL, United States
| | - Lisa M Ballistrea
- James A. Haley Veterans' Hospital, Research Service, Tampa, FL, United States
| | - Tali Schneider
- James A. Haley Veterans' Hospital, Research Service, Tampa, FL, United States
| | - Rachel C Benzinger
- James A. Haley Veterans' Hospital, Research Service, Tampa, FL, United States
| | - Christine Melillo
- James A. Haley Veterans' Hospital, Research Service, Tampa, FL, United States
| | - Neil B Alexander
- VA Ann Arbor Healthcare System, Geriatric Research, Education, and Clinical Center, Ann Arbor, MI, United States
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, Ann Arbor, MI, United States
| | - S Angelina Klanchar
- James A. Haley Veterans' Hospital, Research Service, Tampa, FL, United States
| | - William Lapcevic
- James A. Haley Veterans' Hospital, Research Service, Tampa, FL, United States
| | - Dustin D French
- Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Hines, IL, United States
- Center for Health Services and Outcomes Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Departments of Ophthalmology and Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| |
Collapse
|
24
|
Yunitri N, Chu H, Kang XL, Wiratama BS, Lee TY, Chang LF, Liu D, Kustanti CY, Chiang KJ, Chen R, Tseng P, Chou KR. Comparative effectiveness of psychotherapies in adults with posttraumatic stress disorder: a network meta-analysis of randomised controlled trials. Psychol Med 2023; 53:6376-6388. [PMID: 36628572 DOI: 10.1017/s0033291722003737] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Evidence on the long-term comparative effectiveness of posttraumatic stress disorder (PTSD) psychotherapies in adults remains unknown. Therefore, we performed an extensive network meta-analysis of randomised controlled trials (RCTs) to determine the comparative effectiveness of psychotherapies for people diagnosed with PTSD. METHODS A comprehensive search was conducted in Cochrane library, Embase, Medline-OVID, PubMed, Scopus, and Psych-Info until March 2021. Studies on the effectiveness of cognitive processing therapy (CPT), cognitive therapy (CT), eye movement desensitisation reprocessing (EMDR), narrative exposure therapy (NET), prolonged exposure (PE), cognitive behavioural therapy (CBT), present-centred therapy (PCT), brief eclectic psychotherapies (BEP), psychodynamic therapy (PDT) or combination therapies compared to no treatment (NT) or treatment as usual (TAU) in adults with PTSD were included. Frequentist and Bayesian approaches were used for analysis in R-software. RESULTS We included 98 RCTs with 5567 participants from 18 897 studies. CPT, EMDR, CT, NET, PE, CBT, and PCT were significant to reduce PTSD symptoms (SMD range: -1.53 to -0.75; Certainty: very low to high) at immediate post-treatment and ranked accordingly. Longitudinal analysis found EMDR (1.02) and CPT (0.85) as the significant therapies with large effect size in short-term and long-term follow-up, respectively. NET and CPT showed higher proportion of loss of PTSD diagnosis (RR range: 5.51-3.45) while there were no significant psychotherapies for retention rate compared to NT. CONCLUSIONS Our findings provide evidence for improving current guidelines and informing clinical decision-making for PTSD management. However, the best PTSD treatment plan should be tailored to patients' needs, characteristics, and clinician expertise. REGISTRATION PROSPERO CRD42020162143.
Collapse
Affiliation(s)
- Ninik Yunitri
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Mental Health and Psychiatric Nursing Department, Faculty of Nursing, Universitas Muhammadiyah Jakarta, Indonesia
| | - Hsin Chu
- Institute of Aerospace and Undersea Medicine, School of Medicine, National Defense Medical Center, Taipei, Taiwan
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Xiao Linda Kang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- School of Nursing, University of Pennsylvania, Philadelphia, USA
| | - Bayu Satria Wiratama
- Department of Biostatistics, Epidemiology and Population Health, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Tso-Ying Lee
- Nursing Research Center, Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan
| | - Li-Fang Chang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Department of Medical Education & Emergency and Critical Care Medicine, Taipei Medical University Hospital, Taipei, Taiwan
- School of Nursing, National Defense Medical Center, Taipei, Taiwan
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Doresses Liu
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Christina Yeni Kustanti
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Sekolah Tinggi Ilmu Kesehatan Bethesda Yakkum Yogyakarta, Indonesia
| | - Kai-Jo Chiang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Department of Nursing, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- School of Nursing, National Defense Medical Center, Taipei, Taiwan
| | - Ruey Chen
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Philip Tseng
- Graduate Institute of Mind, Brain and Consciousness, Taipei Medical University, Taipei, Taiwan
- Brain and Consciousness Research Center, TMU - Shuang Ho Hospital, New Taipei, Taiwan
- Research Center for Mind, Brain & Learning, National Chengchi University, Taipei, Taiwan
| | - Kuei-Ru Chou
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan
- Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Neuroscience Research Center, Taipei Medical University, Taipei, Taiwan
| |
Collapse
|
25
|
Davis AK, Xin Y, Sepeda N, Averill LA. Open-label study of consecutive ibogaine and 5-MeO-DMT assisted-therapy for trauma-exposed male Special Operations Forces Veterans: prospective data from a clinical program in Mexico. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2023; 49:587-596. [PMID: 37734158 DOI: 10.1080/00952990.2023.2220874] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/28/2023] [Indexed: 09/23/2023]
Abstract
Background: Research in psychedelic medicine has focused primarily on civilian populations. Further study is needed to understand whether these treatments are effective for Veteran populations.Objectives: Here, we examine the effectiveness of psychedelic-assisted therapy among trauma-exposed Special Operations Forces Veterans (SOFV) seeking treatment for cognitive and mental health problems in Mexico.Methods: Data were collected from an ibogaine and 5-methoxy-N,N-dimethyltryptamine (5-MeO-DMT) clinical treatment program for SOFV with a history of trauma exposure. This clinical program collects prospective clinical program evaluation data, such as background characteristics, symptom severity, functioning (e.g., satisfaction with life, posttraumatic stress disorder symptoms, depression symptoms, anxiety symptoms, sleep disturbance, psychological flexibility, disability in functioning, cognitive functioning, neurobehavioral symptoms, anger, suicidal ideation), and substance persisting/enduring effects through online surveys at four timepoints (baseline/pre-treatment, one-, three-, and six-months after treatment).Results: The majority of the sample (n = 86; Mean Age = 42.88, SD = 7.88) were Caucasian (87.2%), non-Hispanic (89.5%), and males (100%). There were significant and large improvements in self-reported PTSD symptoms (p < .001, d = .414), depression (p < .001, d = .275), anxiety (p < .001, d = .276), insomnia severity (p < .001, d = .351), and post-concussive symptoms (p < .001, d = .389) as well as self-reported satisfaction with life (p < .001, d = .371), psychological flexibility (p < .001, d = .313) and cognitive functioning (p < .001, d = .265) from baseline to one-month follow-up.Conclusions: Data suggest combined ibogaine and 5-MeO-DMT assisted therapy has potential to provide rapid and robust changes in mental health functioning with a signal of durable therapeutic effects up to 6-months. Future research in controlled settings is warranted.
Collapse
Affiliation(s)
- Alan Kooi Davis
- Center for Psychedelic Drug Research and Education, College of Social Work, The Ohio State University, Columbus, OH, USA
- Center for Psychedelic and Consciousness Research, Johns Hopkins University, Baltimore, MD, USA
| | - Yitong Xin
- Center for Psychedelic Drug Research and Education, College of Social Work, The Ohio State University, Columbus, OH, USA
| | - Nathan Sepeda
- Center for Psychedelic Drug Research and Education, College of Social Work, The Ohio State University, Columbus, OH, USA
- Center for Psychedelic and Consciousness Research, Johns Hopkins University, Baltimore, MD, USA
| | - Lynnette A Averill
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- Michael E. DeBakey VA Medical Center, US Department of Veteran Affairs, Houston, TX, USA
| |
Collapse
|
26
|
Choi YJ, Choi EJ, Ko E. Neurofeedback Effect on Symptoms of Posttraumatic Stress Disorder: A Systematic Review and Meta-Analysis. Appl Psychophysiol Biofeedback 2023; 48:259-274. [PMID: 37314616 DOI: 10.1007/s10484-023-09593-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2023] [Indexed: 06/15/2023]
Abstract
Posttraumatic stress disorder (PTSD) encompasses various psychological symptoms and a high early dropout rate due to treatment unresponsiveness. In recent years, neurofeedback has been implemented to control PTSD's psychological symptoms through physiological brain regulation. However, a comprehensive analysis concerning its efficacy is lacking. Therefore, we conducted a systematic review and meta-analysis to determine neurofeedback's effect on reducing PTSD symptoms. We analyzed randomized and non-randomized controlled trials (RCTs) from 1990 to July 2020, evaluating neurofeedback treatments for those diagnosed with PTSD and their symptoms. In addition, we calculated the standardized mean difference (SMD)using random-effects models to estimate effect sizes. We assessed ten articles comprising 276 participants, with a - 0.74 SMD (95% confidence interval = - 0.9230, - 0.5567), 42% I2, moderate effect size, and - 1.40 to -0.08 prediction intervals (PI). Neurofeedback was more effective for complex trauma PTSD patients than single trauma. Increasing and lengthening sessions are more effective than fewer, condensed ones. Neurofeedback positively affected arousal, anxiety, depression, and intrusive, numbing, and suicidal thoughts. Therefore, neurofeedback is a promising and effective treatment for complex PTSD.
Collapse
Affiliation(s)
- Yun-Jung Choi
- Chung-Ang University, Red Cross College of Nursing, Seoul, South Korea.
| | - Eun-Joo Choi
- Department of Nursing, Kyung-In Women's University, Incheon, South Korea
| | - Eunjung Ko
- Department of Nursing, Kyungbok University, Namyangju, South Korea
| |
Collapse
|
27
|
McLean CL, Ruork AK, Ramaiya MK, Fruzzetti AE. Feasibility and initial impact of single-session internet-delivered acceptance vs change skills for emotions for stress- and trauma-related problems: a randomized controlled trial. Behav Cogn Psychother 2023; 51:443-458. [PMID: 37288653 DOI: 10.1017/s1352465823000206] [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: 06/09/2023]
Abstract
BACKGROUND Current psychological trauma-focused interventions have left a gap for individuals who may not be ready for trauma-focused treatment and/or who present with other forms of clinically significant distress, such as subthreshold post-traumatic stress disorder (PTSD). Emotion regulation is a possible transdiagnostic mechanism of change that may promote and maintain some of the varied mental health problems related to trauma exposure. AIMS This study examines the feasibility and initial impact of two brief emotion regulation skill trainings targeting different processes hypothesized to reduce trauma-related problems, compared with an active control. METHOD Subjects (n = 156) were randomized to receive one of three brief internet-based trainings: (1) skill training on accepting emotions, (2) skill training on changing emotions, or (3) stress psychoeducation (control). Participants completed measures of emotion regulation, mindfulness, and affect intensity 24 hours pre- and immediately post-training. RESULTS Results suggested that a brief internet-based skills training programme was feasible and acceptable, with 91.9% completing the training programme to which they were randomized. Results showed that participants in all conditions demonstrated significant decreases in emotion regulation problems over time; yet these improvements did not vary by condition. Participants in the Change condition with higher PTSD symptoms were significantly more likely to have greater increases in positive affect compared with those with lower PTSD symptoms. CONCLUSIONS Although the three conditions did not show different outcomes, all three brief internet-delivered trainings were feasible. Results provide direction for future studies to evaluate the delivery of emotion regulation skills in individuals with trauma-related distress.
Collapse
Affiliation(s)
- Caitlin L McLean
- University of Nevada Reno, Reno, NV89557, USA
- VA San Diego Healthcare System and University of California San Diego, San Diego, CA92161, USA
| | - Allison K Ruork
- University of Nevada Reno, Reno, NV89557, USA
- Rutgers, The State University of New Jersey, New Brunswick, NJ08901, USA
| | - Megan K Ramaiya
- University of California San Francisco, San Francisco, CA94143, USA
| | - Alan E Fruzzetti
- University of Nevada Reno, Reno, NV89557, USA
- McLean Hospital and Harvard Medical School, Belmont, MA02478, USA
| |
Collapse
|
28
|
Marchand WR. Potential Mechanisms of Action and Outcomes of Equine-Assisted Services for Veterans with a History of Trauma: A Narrative Review of the Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6377. [PMID: 37510609 PMCID: PMC10379349 DOI: 10.3390/ijerph20146377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/08/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023]
Abstract
Equine-assisted services (EASs) are being increasingly used as complementary interventions for military veterans who have experienced trauma. However, there is limited evidence of benefit for this population and almost no literature describing the desired potential outcomes and possible mechanisms of action. The aim of this article is to address these gaps by reviewing the extant literature of animal-assisted interventions in general, and equine-assisted services in particular, with the goal of providing guidance for future investigations in the field. Currently, the field is in the early stage of scientific development, but published results are promising. Interventions that enhance treatment compliance and/or outcomes could benefit this population. Preliminary results, reviewed herein, indicate that EAS interventions might benefit the military veteran population by enhancing treatment engagement and therapeutic alliance, as well as by contributing to symptom reduction and resulting in various transdiagnostic benefits. It is recommended that future studies include exploration of potential beneficial outcomes discussed herein, as well as investigate suggested mechanisms of action.
Collapse
Affiliation(s)
- William R Marchand
- VISN 19 Whole Health Flagship Site, VA Salt Lake City Health Care System, 500 Foothill, Salt Lake City, UT 84148, USA
- Department of Psychiatry, School of Medicine, University of Utah, 501 Chipeta Way, Salt Lake City, UT 84108, USA
- Animal, Dairy and Veterinary Sciences, Utah State University, 4815 Old Main Hill, Logan, UT 84322, USA
| |
Collapse
|
29
|
Moitra E, Brick LA, Cancilliere MK, Elwy AR, Erbe AM, Fenn N, Nunn AS, Salhaney P, Chan PA. A randomized trial of acceptance-based behavioral therapy to improve mental health outcomes for LGBTQ+ persons: Study protocol. Contemp Clin Trials 2023; 130:107211. [PMID: 37146874 PMCID: PMC10155421 DOI: 10.1016/j.cct.2023.107211] [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: 02/15/2023] [Revised: 04/14/2023] [Accepted: 04/27/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND During the COVID-19 pandemic, public health measures limited social interactions as an effective and protective intervention for all. For many, however, this social isolation exacerbated mental health symptoms. People who identify as lesbian, gay, bisexual, transgender, and queer (LGBTQ+) were already at elevated risk of anxiety and depression, relative to cisgender and heterosexual populations, and pandemic-related social isolation likely heightened these disparities. In our prior work with sexual and gender minorities, we developed and established feasibility and acceptability of a novel acceptance-based behavioral therapy (ABBT) intervention for HIV treatment. ABBT showed promise in improving social support and reducing mental health symptoms. In the current study, we investigate the efficacy of ABBT, compared to a treatment-as-usual control condition, in a full-scale randomized controlled trial to improve social support for LGBTQ+ persons living with anxiety and depression. METHODS Two hundred forty LGBTQ+ adults with anxiety and/or depressive symptoms will be recruited and equally randomized to receive: (a) the ABBT intervention, consisting of two 30-40 min sessions plus treatment-as-usual (TAU), or (b) TAU only. Primary outcomes are interviewer-assessed anxiety and depressive symptoms. Secondary outcomes are self-reported anxiety and depressive symptoms. Experiential avoidance and social support are hypothesized mediators and presence of an anxiety and/or depressive disorder is a hypothesized moderator. CONCLUSIONS ABBT represents a novel, identify-affirming real-world approach to promoting social support as a means of improving mental health among individuals who identify as LGBTQ+. This study will contribute actionable data establishing the impact, mediational mechanisms, and effect modifiers of ABBT. CLINICALTRIALS govregistration: NCT05540067.
Collapse
Affiliation(s)
- Ethan Moitra
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.
| | - Leslie A Brick
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Mary Kathryn Cancilliere
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA; Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
| | - A Rani Elwy
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA; Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - A Maximillian Erbe
- Open Door Health, Rhode Island Public Health Institute, Providence, RI, USA
| | - Natalie Fenn
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA; Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
| | - Amy S Nunn
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA; Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA; Open Door Health, Rhode Island Public Health Institute, Providence, RI, USA
| | - Peter Salhaney
- Open Door Health, Rhode Island Public Health Institute, Providence, RI, USA
| | - Philip A Chan
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA; Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA; Open Door Health, Rhode Island Public Health Institute, Providence, RI, USA
| |
Collapse
|
30
|
Fremont R, Brown O, Feder A, Murrough J. Ketamine for Treatment of Posttraumatic Stress Disorder: State of the Field. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:257-265. [PMID: 37404968 PMCID: PMC10316217 DOI: 10.1176/appi.focus.20230006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
Posttraumatic stress disorder (PTSD) is a chronic and debilitating condition. Although several psychotherapeutic and pharmacological treatments are recommended for PTSD, many individuals do not respond to treatment or respond only partially, highlighting a critical need for additional treatments. Ketamine has the potential to address this therapeutic need. This review discusses how ketamine emerged as a rapid-acting antidepressant and has become a potential treatment for PTSD. A single dose of intravenous (IV) ketamine has been shown to facilitate rapid reduction of PTSD symptoms. Repeated IV ketamine administration significantly improved PTSD symptoms, compared with midazolam, in a predominantly civilian sample of individuals with PTSD. However, in a veteran and military population, repeated IV ketamine did not significantly reduce PTSD symptoms. Further study of ketamine as a treatment for PTSD is necessary, including which populations benefit most from this therapy and the potential benefits of combining psychotherapy and ketamine.
Collapse
Affiliation(s)
- Rachel Fremont
- Depression and Anxiety Center for Discovery and Treatment, Department of Psychiatry (all authors), and Nash Family Department of Neuroscience (Murrough), Icahn School of Medicine at Mount Sinai, New York
| | - Oneysha Brown
- Depression and Anxiety Center for Discovery and Treatment, Department of Psychiatry (all authors), and Nash Family Department of Neuroscience (Murrough), Icahn School of Medicine at Mount Sinai, New York
| | - Adriana Feder
- Depression and Anxiety Center for Discovery and Treatment, Department of Psychiatry (all authors), and Nash Family Department of Neuroscience (Murrough), Icahn School of Medicine at Mount Sinai, New York
| | - James Murrough
- Depression and Anxiety Center for Discovery and Treatment, Department of Psychiatry (all authors), and Nash Family Department of Neuroscience (Murrough), Icahn School of Medicine at Mount Sinai, New York
| |
Collapse
|
31
|
Pebole MM, Singleton CR, Hall KS, Petruzzello SJ, Alston R, Gobin RL. Perceived Barriers and Benefits of Exercise Among Women Survivors of Sexual Violence by Physical Activity Level and Posttraumatic Stress Disorder Status. Violence Against Women 2023:10778012231182412. [PMID: 37350105 DOI: 10.1177/10778012231182412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
An online, cross-sectional survey of women survivors of sexual violence (SV; N = 355) gathered information on perceived barriers and benefits of exercise, along with exercise level and posttraumatic stress disorder (PTSD) symptoms. This study reports exercise perceptions and provides comparisons by exercise level and PTSD status. Differences by exercise level were found in life enhancement, physical performance, psychological outlook, and social interaction (ps < 0.05; rs = -0.04-0.25). Differences were found by PTSD status in physical performance, social interaction, and preventative health and exercise milieu, time expenditure, and family discouragement (ps < 0.05; rs = -0.39-0.21). Findings provide new information relevant for promoting exercise among women survivors of SV.
Collapse
Affiliation(s)
- Michelle M Pebole
- The Translational Research Center for TBI and Stress Disorders (TRACTS), Veterans Affairs Boston Healthcare System, Boston, MA, USA
- Department of Kinesiology and Community Health, University of Illinois at Urbana Champaign, Urbana, IL, USA
| | - Chelsea R Singleton
- Department of Social, Behavioral, and Population Sciences, Tulane School of Public Health & Tropical Medicine, New Orleans, LA, USA
| | - Katherine S Hall
- Department of Medicine, Duke University, Durham NC, USA
- Geriatric Research, Education, and Clinical Center, Durham VA Healthcare System, Durham, NC, USA
| | - Steven J Petruzzello
- Department of Kinesiology and Community Health, University of Illinois at Urbana Champaign, Urbana, IL, USA
| | - Reginald Alston
- Department of Kinesiology and Community Health, University of Illinois at Urbana Champaign, Urbana, IL, USA
| | - Robyn L Gobin
- Department of Kinesiology and Community Health, University of Illinois at Urbana Champaign, Urbana, IL, USA
| |
Collapse
|
32
|
Pang T, Murn L, Williams D, Lawental M, Abhayakumar A, Kip KE. Comparison of Accelerated Resolution Therapy for PTSD Between Veterans With and Without Prior PTSD Treatment. Mil Med 2023; 188:e621-e629. [PMID: 34383937 DOI: 10.1093/milmed/usab335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/06/2021] [Accepted: 08/02/2021] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Post-traumatic stress disorder (PTSD) is a psychiatric disorder commonly caused by a traumatic event(s) and prevalent among service members and veterans. Accelerated Resolution Therapy (ART) is an emerging "mind-body" psychotherapy for PTSD that is generally briefer and less expensive than current first-line treatments, such as cognitive processing therapy (CPT) and prolonged exposure (PE) therapy. This study examined the results of ART for treatment of military-related PTSD, with stratification by prior PTSD treatment types, including service members/veterans with reported residual PTSD symptoms following receipt of first-line recommended psychotherapy. MATERIALS AND METHODS Four groups were constructed and compared based on self-reported prior PTSD treatment history: treatment-naïve (n = 33), pharmacotherapy only (n = 40), first-line psychotherapy (CPT and/or PE) (n = 33), and other psychotherapy (n = 42). Participants were assessed for PTSD symptoms at baseline, post-treatment, and 6-month follow-up using the 17-item Military PTSD Checklist (PCL-M), as well as assessment of depressive, anxiety, and sleep symptoms. The study was approved by the Institutional Review Board at University of South Florida. RESULTS Among 148 veterans/service members who enrolled and started treatment with ART, 106 (71.6%) completed treatment in a mean of 3.5 treatment sessions, and 55 (51.9%) provided 6-month follow-up data. Mean age was 43.8 years, 95% were male, and 84% were of white race. Within-group standardized effect sizes for pre-to-post changes in PTSD scores (PCL-M) were large at 1.48, 1.11, 1.88, and 1.03 for the treatment-naïve, pharmacotherapy only, first-line psychotherapy, and other psychotherapy groups, respectively. Among treatment completers, the clinically significant treatment response rate (reduction of ≥10 points on the PCL-M) was highest in the treatment-naïve (83%) and first-line psychotherapy (88%) groups. Similar significant symptom reductions were observed for measures of depression and anxiety, and favorable treatment effects were generally sustained at 6-month follow-up. CONCLUSION In a brief treatment period, ART appears to result in substantial reductions in symptoms of PTSD among veterans, including those with residual PTSD symptoms after prior treatment with first-line psychotherapies endorsed by the U.S. Department of Defense and Veterans Affairs. These results suggest that ART be considered as a potential first-line treatment modality for veterans with PTSD.
Collapse
Affiliation(s)
- Tiantian Pang
- College of Public Health, University of South Florida, Tampa, FL 33612, USA
| | - Lindsay Murn
- Minnesota State University-Mankato, Mankato, MN 56001, USA
| | - Dana Williams
- College of Behavioral and Community Sciences, University of South Florida
| | - Maayan Lawental
- College of Public Health, University of South Florida, Tampa, FL 33612, USA
| | | | - Kevin E Kip
- Clinical Analytics, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| |
Collapse
|
33
|
Sciarrino NA, Myers US. If it's offered, will they come? Practical considerations when offering intensive PTSD treatment in an outpatient Veterans Affairs PTSD clinic. Bull Menninger Clin 2023; 87:46-62. [PMID: 36856477 DOI: 10.1521/bumc.2023.87.1.46] [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] [Indexed: 03/02/2023]
Abstract
Evidence-based psychotherapies (EBPs) for posttraumatic stress disorder (PTSD) are efficacious; however, treatment dropout remains high. The delivery of intensive EBPs for PTSD (i.e., sessions three times per week or more) and telemental health may address barriers impacting dropout. Current evidence for intensive EBPs comes primarily from programs specifically designed for this level of care. Therefore, the feasibility of delivering intensive EBPs for PTSD in traditional outpatient clinics remains unclear. The aim of this pilot study was to identify veteran level of interest in intensive treatment and explore the feasibility of delivering intensive treatment via telemental health in an outpatient PTSD clinic at a Veterans Affairs (VA) hospital. One provider offered intensive treatment to 14 veterans. Three of the veterans initiated intensive treatment and completed with benefit. Veteranand system-level barriers, as well as veteran preferences for initiating intensive therapy and suggestions for implementing intensive EBPs in a routine outpatient clinic, are discussed.
Collapse
Affiliation(s)
- Nicole A Sciarrino
- The Ralph H. Johnson VA Medical Center, and in the Department of Psychiatry and Behavioral Sciences, Military Sciences Division, Medical University of South Carolina, Charleston, South Carolina. Dr
| | - Ursula S Myers
- The Ralph H. Johnson VA Medical Center, and in the Department of Psychiatry and Behavioral Sciences, Military Sciences Division, Medical University of South Carolina, Charleston, South Carolina. Dr.,The Charleston Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson VA Medical Center, Charleston, South Carolina
| |
Collapse
|
34
|
Evaluation of a mindfulness and self-compassion-based psychotherapy incorporating horses for Veterans who have experienced trauma. Complement Ther Med 2023; 72:102914. [PMID: 36610554 DOI: 10.1016/j.ctim.2023.102914] [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: 10/07/2022] [Revised: 12/20/2022] [Accepted: 01/03/2023] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES The primary aim of this pilot study was to assess the safety, feasibility, acceptability, as well as preliminary outcomes of a mindfulness and self-compassion-based psychotherapy incorporating horses (PIH) intervention, Whispers with Horses, for Veterans who had experienced trauma. Whispers with Horses was developed as a structured intervention that could be easily replicated for additional studies. If shown to be effective by future rigorous research, the aim is to disseminate a manualized version of the intervention to the field. DESIGN Prospective open trial. SETTING A large Veterans Administration healthcare system and local equine facilities. INTERVENTION A six-session PIH intervention that focused on participants developing or enhancing mindfulness and self-compassion skills in the context of an emerging horse-human relationship. MAIN OUTCOME MEASURES Safety, feasibility and acceptability were assessed, and psychological instruments were administered. Instruments utilized were the PTSD Checklist for DSM 5 (PCL-V), the Patient Health Questionnaire 9 (PHQ-9), the Positive and Negative Affect Scale (PANAS), the Acceptance and Action Questionnaire II (AAQ-II), and the Physical Activity Enjoyment Scale (PACES). RESULTS Subjects were 33 Veterans who were 52% male with a mean age of 46 years-old. There were no adverse outcomes to participants indicating the intervention was safe. Participants completed an average of 3.8 sessions with 24% completing all sessions indicating the intervention is feasible to use, and acceptable to, the population studied. The mean PACES score for all sessions together was 110.4, indicating subjects generally enjoyed participation. Preliminary outcome assessments revealed pre- to post-session significant improvements in affect and psychological flexibility for some sessions (p ranging from.001 -0.015). Pre- to post-intervention outcomes indicated significant improvements in depression (p = .003) and psychological flexibility (p = .005). CONCLUSIONS The Whispers with Horses intervention shows promise as a PIH for Veterans who have experienced trauma. More rigorous studies of this intervention are warranted. Also, additional investigations aimed at better understanding mechanisms underlying changes in psychological flexibility are justified.
Collapse
|
35
|
Marchand WR, Smith J, Hoopes KH, Osborne M, Andersen SJ, Bell K, Nazarenko E, Macneill R, Joubert K. A pilot observational study of horsemanship skills training for veterans with posttraumatic stress disorder. Complement Ther Med 2023; 72:102910. [PMID: 36535458 DOI: 10.1016/j.ctim.2022.102910] [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: 09/09/2022] [Revised: 12/12/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Pilot assessment of an equine-assisted services intervention for Veterans with posttraumatic stress disorder. DESIGN Prospective cohort. SETTING A large Veterans Administration healthcare system. INTERVENTION Two sessions of instruction in horsemanship skills and two sessions of trail rides. MAIN OUTCOME MEASURES Safety and feasibility of recruitment, retention, providing the intervention, and measuring outcomes, as well as acceptability of the intervention to the population studied were the main outcome measures. RESULTS There were no injuries among the 18 participants, 6 staff, or 11 equines over the 3 months of the study. Eleven of 12 (92 %) planned intervention sessions were provided, with one being canceled due to weather. Out of approximately 1800 potential subjects, 21 were enrolled within three months and three dropped out before the first session. The mean number of sessions attended was 3 % and 52 % of participants completed all sessions. The mean PACES score for all sessions together was 109 (SD = 12), with a range of 50-126. Pre- to one-month post-intervention exploratory results indicated increased psychological flexibility (p = 0.008) and positive affect (p = 0.008) as measured by the Acceptance and Action Questionnaire II and the Positive and Negative Affect Scale, respectively as well as decreased PTSD (p = 0.001) and depressive symptoms (p = 0.017) as measured by the PTSD Checklist for DSM 5 and the Beck Depression Inventory, respectively. CONCLUSIONS Results suggest the intervention can be conducted with minimal risk. Further, it was feasible to recruit participants as well as provide the intervention and measure exploratory outcomes. Session attendance and PACES scores indicate acceptability to the Veteran population. The exploratory results will provide sample size estimates for future randomized controlled studies of this intervention Future studies should plan for missed sessions due to weather and consider compensating subjects to enhance retention. Finally, this work provides preliminary evidence that this intervention, without a mental health treatment component, might benefit the mental health of Veterans with PTSD.
Collapse
Affiliation(s)
- William R Marchand
- VISN 19 Whole Health Flagship Site, VA Salt Lake City Health Care System, 500 Foothill Drive, Salt Lake City, UT 84148, USA; Department of Psychiatry, University of Utah, 501 Chipeta Way, Salt Lake City, UT 84108, USA; Department of Animal, Dairy and Veterinary Sciences, Utah State University, 4815 Old Main Hill, Logan, UT 84322, USA.
| | - Judy Smith
- Department of Animal, Dairy and Veterinary Sciences, Utah State University, 4815 Old Main Hill, Logan, UT 84322, USA
| | - Karl H Hoopes
- Department of Animal, Dairy and Veterinary Sciences, Utah State University, 4815 Old Main Hill, Logan, UT 84322, USA
| | - Makenna Osborne
- Department of Animal, Dairy and Veterinary Sciences, Utah State University, 4815 Old Main Hill, Logan, UT 84322, USA
| | - Sarah J Andersen
- Department of Animal, Dairy and Veterinary Sciences, Utah State University, 4815 Old Main Hill, Logan, UT 84322, USA
| | - Kylie Bell
- Department of Animal, Dairy and Veterinary Sciences, Utah State University, 4815 Old Main Hill, Logan, UT 84322, USA
| | - Elena Nazarenko
- VISN 19 Whole Health Flagship Site, VA Salt Lake City Health Care System, 500 Foothill Drive, Salt Lake City, UT 84148, USA
| | - Rachel Macneill
- Mental Health Service, VA Salt Lake City Health Care System, 500 Foothill Drive, Salt Lake City, UT 84148, USA
| | - Katryna Joubert
- Mental Health Service, VA Salt Lake City Health Care System, 500 Foothill Drive, Salt Lake City, UT 84148, USA
| |
Collapse
|
36
|
Hahn CK, Kilimnik CD, Brady KT, Marx BP, Rothbaum BO, Saladin ME, Gilmore AK, Metts CL, Back SE. Early intervention using written exposure therapy for PTSD and AUD symptoms following sexual assault: Description of design and methodology. Contemp Clin Trials 2023; 125:107002. [PMID: 36436732 PMCID: PMC9989773 DOI: 10.1016/j.cct.2022.107002] [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: 06/28/2022] [Revised: 10/31/2022] [Accepted: 11/09/2022] [Indexed: 11/25/2022]
Abstract
The co-occurrence of posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) is common following sexual assault and associated with more severe symptomology and increased likelihood of sexual revictimization. Integrated interventions aimed at reducing PTSD and AUD symptoms following recent sexual assault are needed and should address barriers to care and early treatment termination. The proposed study will test a novel, brief (5 to 7 sessions) intervention that integrates Written Exposure Therapy for PTSD and Cognitive Behavioral Therapy for AUD, and is initiated within the first six weeks post-assault. In Phase 1, qualitative analysis of content gathered during focus groups with treatment providers will be conducted to inform intervention development. In Phase 2, a proof-of-concept pilot study (n = 10) of the intervention, Substance Use Skills Training and Exposure Post-Sexual Assault (STEPS), will be conducted. In Phase 3, a pilot randomized controlled trial (RCT) among 54 recent sexual assault survivors will be implemented using the updated manualized STEPS intervention to evaluate feasibility and preliminary efficacy in reducing PTSD and AUD symptoms. Ecological momentary assessments will be used to assess daily alcohol use, craving, affect, intrusions and avoidance. The effects of STEPS on commonly associated symptoms (e.g., depression, substance use) will be examined. The proposed study has the potential to make a significant public health impact by advancing knowledge on the link between sexual assault and co-occurring PTSD and AUD and informing early intervention efforts for this high-risk population.
Collapse
Affiliation(s)
- Christine K Hahn
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, 67 President St., 2nd Fl. S., MSC 861, Charleston, SC, USA.
| | - Chelsea D Kilimnik
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, 67 President St., 2nd Fl. S., MSC 861, Charleston, SC, USA.
| | - Kathleen T Brady
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, 67 President St., 2nd Fl. S., MSC 861, Charleston, SC, USA.
| | - Brian P Marx
- Department of Psychiatry, Boston University School of Medicine, 720 Harrison Avenue, Boston, MA 02118, USA.
| | - Barbara O Rothbaum
- Emory School of Medicine, Emory University, 01 Dowman Dr., Atlanta, GA 30322, USA.
| | - Michael E Saladin
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, 67 President St., 2nd Fl. S., MSC 861, Charleston, SC, USA
| | - Amanda K Gilmore
- Department of Health Policy and Behavioral Sciences, Mark Chaffin Center for Healthy Development, School of Public Health, Georgia State University, Atlanta, GA 30303, USA.
| | - Christopher L Metts
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, 67 President St., 2nd Fl. S., MSC 861, Charleston, SC, USA.
| | - Sudie E Back
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, 67 President St., 2nd Fl. S., MSC 861, Charleston, SC, USA; Ralph H. Johnson Veterans Affairs Medical Center, 109 Bee St. Charleston, SC 29401, USA.
| |
Collapse
|
37
|
Serfioti D, Murphy D, Greenberg N, Williamson V. Effectiveness of treatments for symptoms of post-trauma related guilt, shame and anger in military and civilian populations: a systematic review. BMJ Mil Health 2022:e002155. [PMID: 36442888 DOI: 10.1136/military-2022-002155] [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: 05/12/2022] [Accepted: 11/08/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Individuals who have been exposed to a traumatic event can develop profound feelings of guilt, shame and anger. Yet, studies of treatments for post-traumatic stress disorder (PTSD) have largely investigated changes in PTSD symptoms relating to a sense of ongoing fear or threat and the effectiveness of such treatments for post-trauma related guilt, shame or anger symptom reduction is comparatively not well understood. METHODS This review systematically examined the effectiveness of existing treatment approaches for three symptoms associated with exposure to traumatic events: guilt, shame and anger. Studies included had to be published after 2010 with a sample size of n=50 or greater to ensure stable treatment outcome estimates. RESULTS 15 studies were included, consisting of both civilian and (ex-) military population samples exposed to a wide range of traumatic events (eg, combat-related, sexual abuse). Findings indicated a moderate strength of evidence that both cognitive-based and exposure-based treatments are similarly effective in reducing symptoms. Cognitive-based treatments were found to effectively reduce post-trauma related guilt and anger, while exposure-based treatments appeared effective for post-trauma related guilt, shame and anger. CONCLUSIONS The findings suggest the importance of confronting and discussing the traumatic event during therapy, rather than using less directive treatments (eg, supportive counselling).Nonetheless, while these results are promising, firm conclusions regarding the comparative effectiveness and long-term impact of these treatments could not be drawn due to insufficient evidence. Further empirical research is needed to examine populations exposed to traumatic events and investigate which treatment approaches (or combination thereof) are more effective in the long-term.
Collapse
Affiliation(s)
- Danai Serfioti
- University of Derby, Derby, UK
- KCMHR, Institute of Psychiatry Psychology and Neuroscience Department of Basic and Clinical Neuroscience, London, UK
- Nottingham Trent University, Nottingham, UK
| | | | - N Greenberg
- Academic Department for Military Mental Health, King's College London, London, UK
| | - V Williamson
- KCMHR, Institute of Psychiatry Psychology and Neuroscience Department of Basic and Clinical Neuroscience, London, UK
- University of Oxford, Oxford, UK
| |
Collapse
|
38
|
Casey M, Yates K, Tulchinsky M, Zheng A, Perera D, Miller C, Nixon RDV. Posttraumatic stress disorder and service utilisation outcomes following delivery of Cognitive Processing Therapy in a community mental health setting. CLIN PSYCHOL-UK 2022. [DOI: 10.1080/13284207.2022.2128642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Melissa Casey
- Monash Health, Monash Medical Centre, Clayton, Vic, Australia
- Department of Psychiatry, Monash University, Clayton, Vic, Australia
| | - Kirsten Yates
- Monash Health, Monash Medical Centre, Clayton, Vic, Australia
| | | | - Ashley Zheng
- Monash Health, Monash Medical Centre, Clayton, Vic, Australia
| | - Dinali Perera
- Monash Health, Monash Medical Centre, Clayton, Vic, Australia
- Department of Psychiatry, Monash University, Clayton, Vic, Australia
| | | | - Reginald D. V. Nixon
- Flinders University Institute for Mental Health and Wellbeing, Adelaide, SA, Australia
- College of Education, Psychology and Social Work, Flinders University, Adelaide, SA, Australia
| |
Collapse
|
39
|
Souza RR, Powers MB, Rennaker RL, McIntyre CK, Hays SA, Kilgard MP. Timing of vagus nerve stimulation during fear extinction determines efficacy in a rat model of PTSD. Sci Rep 2022; 12:16526. [PMID: 36192564 PMCID: PMC9530175 DOI: 10.1038/s41598-022-20301-9] [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: 04/01/2022] [Accepted: 09/12/2022] [Indexed: 11/09/2022] Open
Abstract
Studies have indicated that vagus nerve stimulation (VNS) enhances extinction learning in rodent models. Here, we investigated if pairing VNS with the conditioned stimulus is required for the enhancing effects of VNS. Adult Sprague-Dawley rats were exposed to intense stress followed by fear conditioning training to produce resistant fear. Rats were then implanted with a cuff electrode around the left vagus. After recovery, rats underwent extinction training paired with VNS (0.5 s, 0.8 mA, 100 µs, and 30 Hz) or with Sham VNS (0 mA). VNS rats were randomized into the following subgroups: During VNS (delivered during presentations of the conditioned stimulus, CS), Between VNS (delivered between CS presentations), Continuous VNS (delivered during the entire extinction session), and Dispersed VNS (delivered at longer inter-stimulation intervals across the extinction session). Sham VNS rats failed to extinguish the conditioned fear response over 5 days of repeated exposure to the CS. Rats that received Between or Dispersed VNS showed modest improvement in conditioned fear at the retention test. During and Continuous VNS groups displayed the greatest reduction in conditioned fear. These findings indicate that delivering VNS paired precisely with CS presentations or continuously throughout extinction promotes the maximum enhancement in extinction learning.
Collapse
Affiliation(s)
- Rimenez R Souza
- Texas Biomedical Device Center, The University of Texas at Dallas, Richardson, TX, 75080, USA.
- School of Behavioral Brain Sciences, The University of Texas at Dallas, Bioengineering and Sciences Building, 14.506, 800 West Campbell Road, Richardson, TX, 75080, USA.
| | - Mark B Powers
- Baylor University Medical Center, Dallas, TX, 75246, USA
| | - Robert L Rennaker
- Texas Biomedical Device Center, The University of Texas at Dallas, Richardson, TX, 75080, USA
- School of Behavioral Brain Sciences, The University of Texas at Dallas, Bioengineering and Sciences Building, 14.506, 800 West Campbell Road, Richardson, TX, 75080, USA
- Erik Jonsson School of Engineering and Computer Science, The University of Texas at Dallas, Richardson, TX, 75080, USA
| | - Christa K McIntyre
- Texas Biomedical Device Center, The University of Texas at Dallas, Richardson, TX, 75080, USA
- School of Behavioral Brain Sciences, The University of Texas at Dallas, Bioengineering and Sciences Building, 14.506, 800 West Campbell Road, Richardson, TX, 75080, USA
| | - Seth A Hays
- Texas Biomedical Device Center, The University of Texas at Dallas, Richardson, TX, 75080, USA
- Erik Jonsson School of Engineering and Computer Science, The University of Texas at Dallas, Richardson, TX, 75080, USA
| | - Michael P Kilgard
- Texas Biomedical Device Center, The University of Texas at Dallas, Richardson, TX, 75080, USA
- School of Behavioral Brain Sciences, The University of Texas at Dallas, Bioengineering and Sciences Building, 14.506, 800 West Campbell Road, Richardson, TX, 75080, USA
| |
Collapse
|
40
|
Potik D. Depth Psychology Conceptualization of Trauma-Focused Treatment for Patients with Combat-Related PTSD: Joining the Therapeutic Quest and Alchemy. PSYCHOLOGICAL PERSPECTIVES-A QUARTERLY JOURNAL OF JUNGIAN THOUGHT 2022. [DOI: 10.1080/00332925.2022.2153524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
|
41
|
Israel B, Wiprovnick AE, Belcher AM, Kleinman MB, Ramprashad A, Spaderna M, Weintraub E. Practical Considerations for Treating Comorbid Posttraumatic Stress Disorder in the Addictions Clinic: Approaches to Clinical Care, Leadership, and Alleviating Shame. Psychiatr Clin North Am 2022; 45:375-414. [PMID: 36055729 DOI: 10.1016/j.psc.2022.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
A practical, common-sense framework for recognizing and addressing comorbid posttraumatic stress disorder (PTSD) in the substance use disorder (SUD) clinic is outlined. The article focuses on strategies that can help establish trauma-informed care or augment an existing approach. Interventions are organized around the task of ameliorating shame (or shame sensitivity), which represents a transdiagnostic mediator of psychopathology and, potentially, capacity for change. Countershaming strategies can guide a trauma-responsive leadership approach. Considering the striking rate of underdiagnosis of PTSD among patients with SUD, implementing routine systematic PTSD screening likely represents the single most consequential trauma-informed intervention that SUD clinics can adopt.
Collapse
Affiliation(s)
- Benjamin Israel
- Division of Consultation-Liaison Psychiatry, Department of Psychiatry, University of Maryland School of Medicine, 4801 Yellowwood Ave, Ste 2E1, Baltimore, MD 21209, USA.
| | - Alicia E Wiprovnick
- Division of Addiction Research and Treatment, Department of Psychiatry, University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201, USA
| | - Annabelle M Belcher
- Division of Addiction Research and Treatment, Department of Psychiatry, University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201, USA
| | - Mary B Kleinman
- Department of Psychology, University of Maryland at College Park, Biology/Psychology Building, 4094 Campus Drive, College Park, MD 20742, USA
| | - Avinash Ramprashad
- Division of Addiction Research and Treatment, Department of Psychiatry, University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201, USA
| | - Max Spaderna
- Division of Addiction Research and Treatment, University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201, USA
| | - Eric Weintraub
- Division of Addiction Research and Treatment, University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201, USA
| |
Collapse
|
42
|
Somohano VC, Bowen S. Trauma-Integrated Mindfulness-Based Relapse Prevention for Women with Comorbid Post-Traumatic Stress Disorder and Substance Use Disorder: A Cluster Randomized Controlled Feasibility and Acceptability Trial. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2022; 28:729-738. [PMID: 35648046 DOI: 10.1089/jicm.2021.0306] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Comorbid post-traumatic stress disorder and substance use disorder (PTSD-SUD) among women receiving substance use treatment are common. Few evidence-based interventions target PTSD-SUD, however, fewer are gender responsive. Mindfulness-based relapse prevention (MBRP) has shown effectiveness for women with SUD, although it does not explicitly target PTSD. Integration of trauma-focused and gender-responsive treatments into MBRP may address the limited availability of PTSD-SUD interventions for women. This study assessed feasibility and acceptability of trauma-integrated MBRP (TI-MBRP). Methods: A single-blind computer-generated cluster-randomized design was employed in which women with PTSD-SUD (N = 83) received either TI-MBRP (k = 5) or MBRP (k = 5). Measures of PTSD symptom severity and craving were administered at pre-, post-, 1-, 3-, 6-, 9-, and 12-month follow-up and assessed at the individual level. Results: TI-MBRP demonstrated acceptability among participants; however, attrition was high (64%) at 12-month follow-up. Reductions in PTSD were greater in the MBRP than in the TI-MBRP group at postcourse and 1-month follow-up, and there were significant reductions in PTSD severity and craving over the 12-month period in both conditions. Conclusions: Integrating trauma- and gender-focused interventions into MBRP was feasible and acceptable. MBRP alone may be effective in reducing both PTSD and SUD symptoms in women with PTSD-SUD; however, confirmatory studies are warranted. Clinical Trial Registration Number: NCT03505749.
Collapse
Affiliation(s)
| | - Sarah Bowen
- School of Graduate Psychology, Pacific University, Hillsboro, OR, USA
| |
Collapse
|
43
|
Cenkner DP, Burgess HJ, Huizenga B, Duval ER, Kim HM, Phan KL, Liberzon I, Klumpp H, Abelson J, Horwitz A, Mooney A, Raglan GB, Zalta AK. Morning light treatment for traumatic stress: The role of amygdala reactivity study protocol. PLoS One 2022; 17:e0269502. [PMID: 35675275 PMCID: PMC9176814 DOI: 10.1371/journal.pone.0269502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 05/19/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Exposure to trauma can result in various mental health disorders including anxiety, depression, and posttraumatic stress disorder (PTSD). Although psychotherapies and pharmacotherapies exist for the treatment of these disorders, many individuals fail to receive treatment and among those who do, many remain symptomatic. Therefore, it is critical to continue developing new interventions for traumatic stress that target underlying mechanisms of pathology and offer a safe and acceptable alternative to current treatments. Morning light treatment has good potential as a novel non-invasive, low risk treatment for traumatic stress. Evidence suggests that morning light may improve traumatic stress by reducing reactivity in the amygdala, a brain region implicated in the pathophysiology of PTSD and anatomically linked to circadian photoreceptors in the eye.
Methods
In this study, we aim to establish a significant dose-response relationship between duration of morning light treatment and reduction in amygdala reactivity among individuals with traumatic stress symptoms (NCT# 04117347). Using a transdiagnostic approach, sixty-six individuals with a history of a DSM-5 criterion A trauma and traumatic stress symptoms will be recruited to participate in a 5-week study. Participants will be randomized across three treatment arms based on morning light treatment duration: 15-minutes, 30-minutes, or 60-minutes of light treatment per day for four weeks. To evaluate amygdala activity, participants will undergo fMRI at pre-treatment, mid-treatment, and post-treatment. Participants will also complete clinical assessments and self-report measures of PTSD, depression, and anxiety at pre-treatment, mid-treatment, and post-treatment.
Discussion
Morning light therapy may be an acceptable, feasible, and effective treatment for individuals suffering from traumatic stress. Identifying mechanistically relevant targets, and the doses needed to impact them, are critical steps in developing this new treatment approach for the sequelae of traumatic stress.
Collapse
Affiliation(s)
- David P. Cenkner
- Department of Psychological Science, University of California, Irvine, California, United States of America
| | - Helen J. Burgess
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Brooke Huizenga
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Elizabeth R. Duval
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Hyungjin Myra Kim
- Consulting for Statistics, Computing & Analytics Research, University of Michigan, Ann Arbor, Michigan, United States of America
| | - K. Luan Phan
- Department of Psychiatry and Behavioral Health, Ohio State University, Columbus, Ohio, United States of America
| | - Israel Liberzon
- Department of Psychiatry and Behavioral Sciences, Texas A&M University, Bryan, Texas, United States of America
| | - Heide Klumpp
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - James Abelson
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Adam Horwitz
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Ann Mooney
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Greta B. Raglan
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Alyson K. Zalta
- Department of Psychological Science, University of California, Irvine, California, United States of America
- * E-mail:
| |
Collapse
|
44
|
Intensive Cognitive Processing Therapy Associated With Reduced PTSD Treatment Dropout in a Case-Controlled Study of Treatment-Seeking Veterans. COGNITIVE AND BEHAVIORAL PRACTICE 2022. [DOI: 10.1016/j.cbpra.2022.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
45
|
Rajan G, Wachtler C, Lee S, Wändell P, Philips B, Wahlström L, Svedin CG, Carlsson AC. A One-Session Treatment of PTSD After Single Sexual Assault Trauma. A Pilot Study of the WONSA MLI Project: A Randomized Controlled Trial. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP6582-NP6603. [PMID: 33084475 PMCID: PMC9092905 DOI: 10.1177/0886260520965973] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Sexual abuse is a crime with devastating health consequences. Accessible, acceptable and affordable treatment of PTSD after sexual abuse is important. In this pilot study, a one-session PTSD treatment and a modified perspective to PTSD treatment is introduced. The aim of the study was to test the efficacy of one session of Modified Lifespan Integration (MLI) on reduction of symptoms of PTSD in individuals with PTSD after one sexual assault. This was a single-center, individually randomized waitlist-controlled treatment study with 1:1 allocation, with the intervention of one 90 - 140 minutes session of MLI and with post-treatment follow-up at 3 weeks (time point two). All participants were females, mean age 24, with PTSD symptoms after one sexual assault during the past 5 years. Exclusion criteria were poor understanding of Swedish, multiple traumas, active substance abuse, active psychosis, ADHD, or autism spectrum disorder. Of 135 interested participants, 38 were finally included, 36 completed baseline measures and were included in the intent to treat analyses and 33 were analyzed per protocol. The primary outcome was the difference between the two trial arms in mean PTSD symptoms as measured by the Impact of Event Scale Revised (IES-R) at time point two. In the intervention arm, 72% no longer scored PTSD in per-protocol analysis, compared to 6% in the waiting list arm. IES-R scores were on average halved in the intervention arm (F=21.37, P<0.001), but were essentially unchanged in the waiting list arm. No adverse effects or drop-outs were seen. One session of Modified Lifespan Integration was an effective treatment with a low drop-out rate for females aged 15-65 with PTSD after one sexual assault. Provided that this result can be replicated, MLI should be offered to these patients in clinical settings. Registration number NCT03141047 was given 03/25/2016 at ClinicalTrials.gov (https://register.clinicaltrials.gov/).
Collapse
Affiliation(s)
- Gita Rajan
- Karolinska Institutet, Huddinge, Sweden
- Academic Primary Healthcare Centre, Stockholm, Sweden
| | | | - Sara Lee
- Svenska Kognitiva Institutet, Stockholm, Sweden
| | | | | | | | | | - Axel C Carlsson
- Karolinska Institutet, Huddinge, Sweden
- Academic Primary Healthcare Centre, Stockholm, Sweden
| |
Collapse
|
46
|
Feary N, Brand R, Williams A, Thomas N. 'Like jumping off a ledge into the water': A qualitative study of trauma-focussed imaginal exposure for hearing voices. Psychol Psychother 2022; 95:277-294. [PMID: 34799984 PMCID: PMC9298761 DOI: 10.1111/papt.12372] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 10/06/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVE There is growing evidence of a link between the experience of hearing voices and past traumatic events, and trauma-focussed psychological interventions are being applied to hearing voices as an emerging treatment direction. To inform the ongoing development and implementation of this application, there is a need to understand clients' therapy experiences. DESIGN Qualitative study exploring the experience of people who received an intervention for voices linked to a previous traumatic event. METHOD Ten participants experiencing voices with some connection to a previous traumatic event participated in individual semi-structured interviews following six sessions of imaginal exposure, an exposure-based trauma-focussed intervention. Participant responses were analysed using thematic analysis. RESULTS Participants reported a range of benefits from the intervention, including improved mental health, reduction of distressing voice-hearing experiences, and increased clarity of the traumatic event. The therapy was perceived as distinctly different to previous therapy experiences, and participants noted that therapy could be intense and challenging, yet helpful later. Participants also reported that outside circumstances impacted on their progress in therapy and their voice-hearing experience. CONCLUSIONS The findings suggest that exposure-based trauma-focussed therapies may be beneficial for people who hear trauma-related voices. However, this intervention can be intense and clinicians and consumers need to consider the timing of delivery, and pay attention to internal and external resources that can increase participants' sense of safety. PRACTITIONER POINTS Imaginal exposure may be an effective intervention for people who hear voices that they perceive to be associated with a past traumatic event. Positive changes associated with the intervention may be highly variable between individuals, and encompass changes in sense of self, changes to internal states, and changes to voice-hearing experience. Imaginal exposure interventions may involve some temporary discomfort and symptom exacerbation, which may affect the acceptability of the intervention. This needs to be considered in both future research and clinical delivery.
Collapse
Affiliation(s)
- Natalie Feary
- Centre for Mental HealthSwinburne University of TechnologyMelbourneVictoriaAustralia
| | - Rachel Brand
- Centre for Mental HealthSwinburne University of TechnologyMelbourneVictoriaAustralia
| | - Anne Williams
- Department of Nursing and Allied HealthSwinburne University of TechnologyMelbourneVictoriaAustralia
| | - Neil Thomas
- Centre for Mental HealthSwinburne University of TechnologyMelbourneVictoriaAustralia,Alfred HospitalMelbourneVictoriaAustralia
| |
Collapse
|
47
|
Thorarinsdottir K, Holmes EA, Hardarson J, Stephenssen ES, Jonasdottir MH, Kanstrup M, Singh L, Hauksdottir A, Halldorsdottir T, Gudmundsdottir B, Thordardottir E, Valdimarsdottir U, Bjornsson A. Using a Brief Mental Imagery Competing Task to Reduce the Number of Intrusive Memories: An Exploratory Case Series with Trauma Exposed Women in Iceland (Preprint). JMIR Form Res 2022; 6:e37382. [PMID: 35857368 PMCID: PMC9491830 DOI: 10.2196/37382] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 05/18/2022] [Accepted: 05/18/2022] [Indexed: 12/02/2022] Open
Abstract
Background Novel interventions should be developed for people who have undergone psychological trauma. In a previous case study, we found that the number of intrusive memories of trauma could be reduced with a novel intervention. The intervention included a brief memory reminder, a visuospatial task and mental rotation, and targeted trauma memory hotspots one at a time in separate sessions. Objective This case series (N=3) extended the first case study with 3 new cases to determine whether a similar pattern of beneficial results is observed. We explored whether the brief intervention would result in reduced numbers of intrusive memories and whether it would impact symptoms of posttraumatic stress, depression and anxiety, and general functioning. Acceptability of the intervention was also explored. Methods A total of 3 women completed the study: 2 with posttraumatic stress disorder and other comorbidities and 1 with subthreshold posttraumatic stress disorder. The primary outcome was the change in the number of intrusive memories from the baseline phase to the intervention phase and at the 1-month follow-up, with an assessment of the intrusion frequency at 3 months. Participants monitored the number of intrusive memories in a daily diary for 1 week at baseline, for maximum of 6 weeks during the intervention phase and for 1 week at the 1-month and 3-month follow-ups. The intervention was delivered in person or digitally, with guidance from a clinical psychologist. A repeated AB design was used (A was a preintervention baseline phase and B intervention phase). Intrusions were targeted individually, creating repetitions of an AB design. Results The total number of intrusive memories was reduced from the baseline to the intervention phase for all participants. The total number for participant 3 (P3) reduced from 38.8 per week during the baseline phase to 18.0 per week in the intervention phase. It was 13 at the 3-month follow-up. The total number for P4 reduced from 10.8 per week at baseline to 4.7 per week in the intervention phase. It was 0 at the 3-month follow-up. The total number for P5 was reduced from 33.7 at baseline to 20.7 per week in the intervention phase. It was 8 at the 3-month follow-up. All participants reported reduction in posttraumatic stress symptoms in the postintervention phase. Depression and anxiety symptoms reduced in 2 of the 3 participants in the postintervention phase. Acceptability was favorable. Conclusions We observed good compliance with the intervention and intrusive memory diary in all 3 cases. The number of intrusive memories was reduced for all participants during the intervention phase and at the 1-month follow-up, with some improvement in other symptoms and functioning. Further research should explore the remote delivery of the intervention and whether nonspecialists can deliver the intervention effectively.
Collapse
Affiliation(s)
| | - Emily A Holmes
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Johann Hardarson
- Department of Psychology, University of Iceland, Reykjavík, Iceland
| | | | | | - Marie Kanstrup
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Laura Singh
- Department of Psychology, Uppsala University, Uppsala, Sweden
- Swedish Collegium for Advanced Study, Uppsala University, Uppsala, Sweden
| | - Arna Hauksdottir
- The Center of Public Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Thorhildur Halldorsdottir
- The Center of Public Health Sciences, University of Iceland, Reykjavik, Iceland
- Department of Psychology, University of Reykjavik, Reykjavik, Iceland
| | - Berglind Gudmundsdottir
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- The National University Hospital of Iceland, University of Iceland, Reykjavik, Iceland
| | - Edda Thordardottir
- The Center of Public Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Unnur Valdimarsdottir
- The Center of Public Health Sciences, University of Iceland, Reykjavik, Iceland
- The National University Hospital of Iceland, University of Iceland, Reykjavik, Iceland
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, United States
| | - Andri Bjornsson
- Department of Psychology, University of Iceland, Reykjavík, Iceland
| |
Collapse
|
48
|
Hoppe JM, Holmes EA, Agren T. Imaginal extinction and the vividness of mental imagery: Exploring the reduction of fear within the mind's eye. Behav Brain Res 2022; 418:113632. [PMID: 34695540 DOI: 10.1016/j.bbr.2021.113632] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 10/08/2021] [Accepted: 10/13/2021] [Indexed: 01/10/2023]
Abstract
Patients are encouraged to produce vivid mental imagery during imaginal exposure, as it is assumed to promote fear reduction. Nevertheless, the link between fear reduction and imagery vividness is unclear. We investigated the impact of vividness on fear responses using an experimental analogue of imaginal exposure - imaginal extinction - in which conditioned fear, measured with skin conductance, is reduced through exposure to mental imagery of the conditioned stimulus. We examined (1) if task-specific vividness (high vs low) of the conditioned stimulus during imaginal extinction moderated the reduction of fear responses, and (2) if task-specific vividness influenced remaining fear responses 24 h later. Findings suggest that high vividness may be advantageous for fear reduction during imaginal extinction, but it may not influence fear responses in the longer term. A possible clinical implication is that high imagery vividness during imaginal exposure may not be vital for overall treatment outcome. As high vividness is associated with increased levels of distress, a future direction would be to explore whether similar fear reduction can be obtained with less vivid imaginal exposure and thereby make treatment tolerable for more patients.
Collapse
Affiliation(s)
- Johanna M Hoppe
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Emily A Holmes
- Department of Psychology, Uppsala University, Uppsala, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Thomas Agren
- Department of Psychology, Uppsala University, Uppsala, Sweden.
| |
Collapse
|
49
|
Thorarinsdottir K, Holmes EA, Hardarson J, Hedinsdottir U, Kanstrup M, Singh L, Hauksdottir A, Halldorsdottir T, Gudmundsdottir B, Valdimarsdottir U, Thordardottir EB, Gamble B, Bjornsson A. Reducing Intrusive Memories of Childhood Trauma Using a Visuospatial Intervention: Case Study in Iceland. JMIR Form Res 2021; 5:e29873. [PMID: 34734830 PMCID: PMC8603162 DOI: 10.2196/29873] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/11/2021] [Accepted: 07/05/2021] [Indexed: 01/20/2023] Open
Abstract
Background Additional interventions are needed for survivors of psychological trauma because of several barriers to and limitations of existing treatment options (eg, need to talk about the trauma in detail). Case studies are an important step in exploring the development of novel interventions, allowing detailed examination of individual responses to treatment over time. Here, we present a case study that aims to test a novel intervention designed to disrupt memory reconsolidation, taking a single-symptom approach by focusing on intrusive memories of a traumatic event. Objective This study aims to examine a novel brief cognitive intervention to reduce the number of intrusive memories of trauma in an Icelandic setting and to extend previous studies by examining long-term effects for up to 3 months. The intervention was guided by a clinical psychologist and comprised a brief memory reminder, followed by Tetris gameplay with mental rotation, targeting one memory at a time in each session. Methods This was a single case study in Iceland with a woman in her 50s (drawn from an epidemiological study of trauma) with subthreshold posttraumatic stress disorder and a diagnosis of obsessive-compulsive disorder and social anxiety disorder. The participant had four different intrusive memories from a traumatic event that happened in her childhood. The primary outcome was the change in the number of intrusive memories from baseline to intervention phase and to follow-ups. The number of intrusions was monitored in a daily diary for 4 weeks preintervention, 8 weeks during the intervention, and 1 week at 1-month and 3-month follow-ups. Intrusions were targeted one by one over six intervention sessions, creating four repetitions of an AB design (ie, length of baseline A and intervention phase B varied for each memory). We examined changes in both the total number of intrusions (summed across all four memories) and individually for each memory. In addition, we explored whether having fewer intrusive memories would have an impact on functioning, posttraumatic stress, and depression or anxiety symptoms. Results The total number of intrusions per week was 12.6 at baseline, 6.1 at the intervention phase (52% reduction from baseline), 3.0 at the 1-month follow-up (76% reduction), and 1.0 at the 3-month follow-up (92% reduction). Reductions in the symptoms of posttraumatic stress and depression were observed postintervention. Sleep, concentration, stress, and functioning improved. The participant considered the gameplay intervention acceptable and helpful in that she found that the memories disappeared while she was playing. Conclusions This guided brief cognitive intervention reduced the number of intrusive memories over the intervention phase and follow-ups. The brief memory reminder was well tolerated, removing the need to discuss trauma in detail. The next steps require an extension to more cases and exploring remote delivery of the intervention.
Collapse
Affiliation(s)
| | - Emily A Holmes
- Department of Psychology, Uppsala University, Uppsala, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Johann Hardarson
- Department of Psychology, University of Iceland, Reykjavik, Iceland
| | | | - Marie Kanstrup
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Laura Singh
- Department of Psychology, Uppsala University, Uppsala, Sweden.,Swedish Collegium for Advanced Study, Uppsala, Sweden
| | - Arna Hauksdottir
- Centre of Public Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Thorhildur Halldorsdottir
- Department of Psychology, University of Iceland, Reykjavik, Iceland.,Centre of Public Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Berglind Gudmundsdottir
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Unnur Valdimarsdottir
- Centre of Public Health Sciences, University of Iceland, Reykjavik, Iceland.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, United States
| | | | - Beau Gamble
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Andri Bjornsson
- Department of Psychology, University of Iceland, Reykjavik, Iceland
| |
Collapse
|
50
|
Somohano VC, Shank T, Manuel J, Mallik D, Rehder K, Bowen S. The Role of Pretreatment Expectancy on Substance Use Outcomes in Women Mandated to Mindfulness-Based Relapse Prevention. J Altern Complement Med 2021; 27:1147-1155. [PMID: 34516782 DOI: 10.1089/acm.2021.0123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: More than one-third of justice-involved individuals meet the criteria for substance use disorder (SUD). Many studies show that treatment expectancy predicts longitudinal SUD outcomes; however, results are inconsistent, and the role of treatment expectancy on SUD outcomes for individuals mandated to a mindfulness-based intervention (MBI) is unknown. Mindfulness-based relapse prevention (MBRP) has shown efficacy with justice-involved populations; however, enrollment in MBRP is typically voluntary. The current study assessed whether pretreatment expectancy predicted SUD- and affect-related outcomes in a sample of women (n = 54) mandated to MBRP as part of their residential SUD programming. Method: The authors employed a quasiexperimental design and administered measures at pre-, mid-, and postcourse. Results: Following mandatory participation in MBRP, significant reductions in craving and substance use were observed. However, contrary to hypotheses, higher pretreatment expectancy predicted greater substance dependence at postcourse. Conclusions: Positive treatment expectancy within the context of an MBI was not related to favorable posttreatment outcomes; in fact, it was related to higher postcourse substance dependence. This suggests that MBIs may be suitable for mandated individuals who may not have voluntarily chosen to participate in such an intervention, and thus may have lower expectancy for the treatment. This finding needs to be replicated in a larger sample to warrant a firmer conclusion.
Collapse
Affiliation(s)
| | - Taylor Shank
- School of Graduate Psychology, Pacific University, Hillsboro, OR, USA
| | - Jacob Manuel
- School of Graduate Psychology, Pacific University, Hillsboro, OR, USA
| | - Debesh Mallik
- School of Graduate Psychology, Pacific University, Hillsboro, OR, USA
| | - Kristoffer Rehder
- VA Portland Health Care System, Portland, OR, USA.,School of Graduate Psychology, Pacific University, Hillsboro, OR, USA
| | - Sarah Bowen
- School of Graduate Psychology, Pacific University, Hillsboro, OR, USA
| |
Collapse
|