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Kearns NT, Trachik B, Fawver B, Osgood J, Dretsch MN. Alcohol motivations associated with frequency of alcohol use, binge drinking, and alcohol problems among active duty junior enlisted soldiers and non-commissioned officers. Alcohol 2024; 115:23-31. [PMID: 37684009 DOI: 10.1016/j.alcohol.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 08/15/2023] [Accepted: 09/05/2023] [Indexed: 09/10/2023]
Abstract
Problematic alcohol use is a serious threat to the behavioral health of active-duty Service Members (ADSM), resulting in numerous calls from governmental agencies to better understand mechanistic factors contributing to alcohol misuse within the military. Alcohol use motives are reliable predictors of alcohol-related behaviors and are considered malleable targets for prevention and intervention efforts. However, empirical research indicates that drinking motives vary across contextually distinct populations. Although some research has been conducted among veteran and reservist populations, limited work has been specifically focused on ADSM and no research has evaluated motives and alcohol metrics among ADSM based on military rank. Participants for the current study included 682 ADSM recruited from a large military installation in the U.S. Structural equation modeling evaluated associations between four drinking motives (i.e., enhancement, social, conformity, coping) and three alcohol misuse metrics (i.e., alcohol frequency, binge frequency, alcohol problems). Three models were evaluated: one full (combined) model and two separate models based on military rank - junior enlisted (i.e., E1-E4) and non-commissioned officers (NCOs) (i.e., E5-E9). Results for junior enlisted ADSM indicated that coping and enhancement motives were most strongly associated with all alcohol misuse metrics. However, among NCOs, results indicated that alcohol problems were only associated with coping motives. Notably, results also indicated that alcohol use motives accounted for substantively more variance across all alcohol-related metrics among NCOs. Findings generally support extant military-related literature indicating use of alcohol for coping (e.g., with anxiety) as the motivation most consistently associated with increased alcohol misuse. However, novel findings highlight enhancement motives - using alcohol to attain some positive internal reward - as another, often stronger, motivation impacting alcohol use outcomes. Further, findings highlight notable distinctions between alcohol use motives (i.e., coping vs. enhancement) and the impact of alcohol use motives (i.e., effect size) on alcohol metrics between junior enlisted and NCOs.
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Affiliation(s)
- Nathan T Kearns
- Walter Reed Army Institute of Research - West (WRAIR-W), 9933A W. Johnson St., Joint Base Lewis-McChord, Washington, United States.
| | - Benjamin Trachik
- Walter Reed Army Institute of Research - West (WRAIR-W), 9933A W. Johnson St., Joint Base Lewis-McChord, Washington, United States
| | - Bradley Fawver
- Walter Reed Army Institute of Research - West (WRAIR-W), 9933A W. Johnson St., Joint Base Lewis-McChord, Washington, United States
| | - Jeffrey Osgood
- Walter Reed Army Institute of Research - West (WRAIR-W), 9933A W. Johnson St., Joint Base Lewis-McChord, Washington, United States
| | - Michael N Dretsch
- Walter Reed Army Institute of Research - West (WRAIR-W), 9933A W. Johnson St., Joint Base Lewis-McChord, Washington, United States
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Trachik B, Fawver B, Trapp SK, Goldberg SB, Ganulin ML, Kearns NT, McKeon AB, Dretsch MN, Sowden WJ. Measurement validity of the six-factor model of psychological well-being in a military sample: Implications for measuring well-being in service members. Psychol Assess 2023; 35:729-739. [PMID: 37470988 PMCID: PMC10524694 DOI: 10.1037/pas0001239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
Subjective well-being is a positive psychological construct that has important implications for the U.S. Military's goal to develop service members' strengths and support their overall thriving and downstream resilience. Despite this, the concept of well-being has not been well studied in military populations who have unique work demands, stressors, and autonomy/agency in daily life compared to civilians. To address this shortcoming in the literature, the present study assessed Ryff's measures of psychological well-being (PWB) in 1,333 U.S. service members prior to the deployments in the Middle East. Various methods attempting to validate the theoretical model purported by Ryff were unsuccessful, and exploratory factor analyses did not result in a novel model for this population. Future research should continue to evaluate proposed models of soldier well-being and propose novel theories, as well as measures, to assess this important construct. Implications are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Benjamin Trachik
- US Army Medical Research Directorate-West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, WA
| | - Bradly Fawver
- US Army Medical Research Directorate-West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, WA
| | | | - Simon B. Goldberg
- Department of Counseling Psychology, University of Wisconsin-Madison, WI
| | - Michelle L. Ganulin
- US Army Medical Research Directorate-West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, WA
| | - Nathan T. Kearns
- US Army Medical Research Directorate-West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, WA
| | - Ashlee B. McKeon
- Directorate of Psychological Application, U.S. Army Special Operations Command, Fort Bragg, NC
| | - Michael N. Dretsch
- US Army Medical Research Directorate-West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, WA
| | - Walter J. Sowden
- Department of Behavioral Health, Tripler Army Medical Center, HI
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Trachik B, Elliman TD, Ganulin ML, Dretsch MN, Riviere LA, Cabrera OA, Thomas JL, Hoge CW. Order effects in PTSD network analysis: important implications for diagnostic conceptualization, treatment refinement, and research. Psychol Med 2022; 52:2492-2499. [PMID: 33261701 DOI: 10.1017/s0033291720004377] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND For decades confirmatory factor analysis (CFA) has been the preeminent method to study the underlying structure of posttraumatic stress disorder (PTSD); however, methodological limitations of CFA have led to the emergence of other analytic approaches. In particular, network analysis has become a gold standard to investigate the structure and relationships between PTSD symptoms. A key methodological limitation, however, which has significant clinical implications, is the lack of data on the potential impact of item order effects on the conclusions reached through network analyses. METHODS The current study, involving a large sample (N = 5055) of active duty army soldiers following deployment to Iraq, assessed the vulnerability of network analyses and prevalence rate to item order effects. This was done by comparing symptom networks of the DSM-IV PTSD checklist items to these same items distributed in random order. Half of the participants rated their symptoms on traditionally ordered items and half the participants rated the same items, but in random order and interspersed between items from other validated scales. Differences in prevalence rate and network composition were examined. RESULTS The prevalence rate differed between the ordered and random item samples. Network analyses using the ordered survey closely replicated the conclusions reached in the existing network analyses literature. However, in the random item survey, network composition differed considerably. CONCLUSION Order effects appear to have a significant impact on conclusions reached from PTSD network analysis. Prevalence rates were also impacted by order effects. These findings have important diagnostic and clinical treatment implications.
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Affiliation(s)
- Benjamin Trachik
- US Army Medical Research Directorate-West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, WA 98433, USA
| | - Toby D Elliman
- Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Michelle L Ganulin
- US Army Medical Research Directorate-West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, WA 98433, USA
| | - Michael N Dretsch
- US Army Medical Research Directorate-West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, WA 98433, USA
| | | | - Oscar A Cabrera
- US Army Medical Research Directorate-West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, WA 98433, USA
| | | | - Charles W Hoge
- Walter Reed Army Institute of Research, Silver Spring, MD, USA
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Moscardini EH, Robinson A, Trachik B, Ganulin ML, LoPresti M, Dretsch MN, Calamia M, Tucker RP. Psychometric properties of the interpersonal needs questionnaire (INQ-15) in army soldiers: Implications and future directions. Military Psychology 2022. [DOI: 10.1080/08995605.2021.2006528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Emma H. Moscardini
- Department of Psychology, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Anthony Robinson
- Department of Psychology, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Benjamin Trachik
- US Army Medical Research Directorate-West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, Washington, USA
| | - Michelle L. Ganulin
- US Army Medical Research Directorate-West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, Washington, USA
| | - Matthew LoPresti
- US Army Medical Research Directorate-West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, Washington, USA
| | - Michael N. Dretsch
- US Army Medical Research Directorate-West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, Washington, USA
| | - Matthew Calamia
- Department of Psychology, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Raymond P. Tucker
- Department of Psychology, Louisiana State University, Baton Rouge, Louisiana, USA
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Dretsch MN, Trachik B, Taylor M, Kotov R, Krueger R. Variability in the stability of personality traits across a single combat deployment. Military Psychology 2021. [DOI: 10.1080/08995605.2021.2003147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Michael N. Dretsch
- US Army Aeromedical Research Laboratory, Fort Rucker, Alabama, USA
- US Army Medical Research Directorate-West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, Washington, USA
| | - Benjamin Trachik
- US Army Medical Research Directorate-West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, Washington, USA
| | - Maura Taylor
- US Army Medical Research Directorate-West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, Washington, USA
| | - Roman Kotov
- Department of Psychiatry, Stony Brook University, Stony Brook, New York, USA
| | - Robert Krueger
- Department of Psychology, University of Minnesota, Minneapolis, Minnesota, USA
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Trachik B, Moscardini EH, Ganulin ML, McDonald JL, McKeon AB, Dretsch MN, Tucker RP, Sowden WJ. Perceptions of purpose, cohesion, and military leadership: A path analysis of potential primary prevention targets to mitigate suicidal ideation. Military Psychology 2021. [DOI: 10.1080/08995605.2021.1962184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - Emma H. Moscardini
- Department of Psychology, Louisiana State University, Baton Rouge, Louisiana, USA
| | | | | | - Ashlee B. McKeon
- The Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | | | - Raymond P. Tucker
- Department of Psychology, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Walter J. Sowden
- The Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- Department of Behavioral Health, Tripler Army Medical Center (Tripler AMC), Honolulu, Hawaii, USA
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Oakey-Frost N, Trachik B, Ganulin ML, LoPresti ML, Dretsch MN, Tucker RP. Indirect effects of soldier healthy eating and physical activity on suicidal ideation through psychological health symptoms in active-duty military. Military Psychology 2021. [DOI: 10.1080/08995605.2021.1902180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Nicolas Oakey-Frost
- Department of Psychology, Louisiana State University, Baton Rouge, Louisiana
| | - Benjamin Trachik
- US Army Medical Research Directorate-West, Walter Reed Army Institute of Research, Washington
| | - Michelle L. Ganulin
- US Army Medical Research Directorate-West, Walter Reed Army Institute of Research, Washington
| | - Mathew L. LoPresti
- US Army Medical Research Directorate-West, Walter Reed Army Institute of Research, Washington
| | - Michael N. Dretsch
- US Army Medical Research Directorate-West, Walter Reed Army Institute of Research, Washington
| | - Raymond P. Tucker
- Department of Psychology, Louisiana State University, Baton Rouge, Louisiana
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Trachik B, Oakey-Frost N, Ganulin ML, Adler AB, Dretsch MN, Cabrera OA, Tucker RP. Military suicide prevention: The importance of leadership behaviors as an upstream suicide prevention target. Suicide Life Threat Behav 2021; 51:316-324. [PMID: 33876487 DOI: 10.1111/sltb.12707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the longitudinal relationships between unit cohesion, Army leader behaviors, and subordinate suicidal/death ideation. Recent cross-sectional research indicates that subordinates who perceive that their leaders instill a sense of purpose regarding military service demonstrate less frequent suicidal ideation. METHOD Five hundred fifty-nine soldiers completed self-report measures of perceptions of leadership behaviors, unit cohesion, and suicidal/death ideation during deployment as well as one and three months following deployment. Latent change score modeling was conducted to evaluate the course and direction of study variables as well as the relationship between them. RESULTS Although lower levels of suicidal/death ideation were related to leader-provided purpose, leader-provided meaning, and unit cohesion at baseline, only leader-provided purpose and unit cohesion prospectively predicted changes in suicidal/death ideation. CONCLUSIONS Consistent with the goal of military leadership to augment effective clinical interventions that reduce suicide risk, prevention programs that reach a broader population of personnel should be considered. Enhanced leadership training may be an important primary prevention tool to reduce suicide risk that warrants further research.
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Affiliation(s)
- Benjamin Trachik
- U.S. Army Medical Directorate-West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, WA, USA
| | | | - Michelle L Ganulin
- U.S. Army Medical Directorate-West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, WA, USA
| | - Amy B Adler
- Research Transition Office, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Michael N Dretsch
- U.S. Army Medical Directorate-West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, WA, USA
| | - Oscar A Cabrera
- U.S. Army Medical Directorate-West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, WA, USA
| | - Raymond P Tucker
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
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Trachik B, Tucker RP, Ganulin ML, Merrill JC, LoPresti ML, Cabrera OA, Dretsch MN. Leader provided purpose: Military leadership behavior and its association with suicidal ideation. Psychiatry Res 2020; 285:112722. [PMID: 31822356 DOI: 10.1016/j.psychres.2019.112722] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 11/27/2019] [Accepted: 11/28/2019] [Indexed: 11/28/2022]
Abstract
Suicide in U.S. Army Soldiers is of major concern as it is estimated that over 100 Soldiers die by suicide each year. Examining risk and protective factors is essential to develop both an understanding of Soldier suicide as well as inform systemic interventions to reduce suicide. One potential systemic approach is to embed preventive mechanisms within the structure of the military rather than the typical administration of primary intervention through mandatory training. To examine potential mechanisms of leader-based interventions, several leadership behaviors were assessed in a cross-sectional sample of n = 1,096 active duty Soldiers. Soldiers completed self-report measures of interpersonal predictors of suicide, suicidal ideation (SI), leadership behaviors, and unit cohesion. Logistic regression was used to identify leadership behaviors related to SI. Only the leader behavior attempting to foster a sense of purpose predicted SI. Leader provided purpose (LPP) was then entered into indirect effect analyses to evaluate the mechanisms of this relationship. Analyses revealed that LPP predicted SI through unit cohesion, thwarted belongingness, and perceived burdensomeness. Results demonstrate that specific aspects of military leadership such as fostering Soldier purpose may enhance resilience and reduce risk for SI.
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Affiliation(s)
- Benjamin Trachik
- U.S. Army Medical Directorate-West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, 9933 W. Johnson St., WA 98433, USA.
| | - Raymond P Tucker
- Department of Psychology, Louisiana State University, Baton Rouge, LA 70803, USA
| | - Michelle L Ganulin
- U.S. Army Medical Directorate-West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, 9933 W. Johnson St., WA 98433, USA
| | - Julie C Merrill
- U.S. Army Medical Directorate-West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, 9933 W. Johnson St., WA 98433, USA
| | - Matthew L LoPresti
- U.S. Army Medical Directorate-West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, 9933 W. Johnson St., WA 98433, USA
| | - Oscar A Cabrera
- U.S. Army Medical Directorate-West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, 9933 W. Johnson St., WA 98433, USA
| | - Michael N Dretsch
- U.S. Army Medical Directorate-West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, 9933 W. Johnson St., WA 98433, USA
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Campbell SB, Trachik B, Goldberg S, Simpson TL. Identifying PTSD symptom typologies: A latent class analysis. Psychiatry Res 2020; 285:112779. [PMID: 31983505 DOI: 10.1016/j.psychres.2020.112779] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 01/06/2020] [Accepted: 01/06/2020] [Indexed: 02/08/2023]
Abstract
Posttraumatic stress disorder (PTSD) is characterized by re-experiencing, avoidance, negative alterations in cognition and mood, and arousal symptoms per the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). While numerous symptom combinations are possible to meet diagnostic criteria, simplification of this heterogeneity of symptom presentations may have clinical utility. In a nationally representative sample of American adults with lifetime DSM-5 PTSD diagnoses from the third wave of the National Epidemiologic Survey on Alcohol and Related Conditions (n = 2,365), we used Latent Class Analysis (LCA) to identify qualitatively distinct PTSD symptom typologies. Subsequently, we used linear and logistic regressions to identify demographic, trauma-related, and psychiatric characteristics associated with membership in each class. In contrast to prior LCAs with DSM-IV-TR diagnostic criteria, fit indices for the present analyses of DSM-5 PTSD revealed a four-class solution to the data: Dysphoric (23.8%), Threat-Reactivity (26.1%), High Symptom (33.7%), and Low Symptom (16.3%). Exploratory analyses revealed distinctions between classes in socioeconomic impairment, trauma exposure, comorbid diagnoses, and demographic characteristics. Although the study is limited by its cross-sectional design (preventing analysis of temporal associations or causal pathways between covariates and latent classes), findings may support efforts to develop personalized medicine approaches to PTSD diagnosis and treatment.
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Affiliation(s)
- Sarah B Campbell
- VA Puget Sound Health Care System - Seattle Division, 1660 S. Columbian Way, Seattle WA, 98108, United States; University of Washington Department of Health Services, 1959 NE Pacific St, Magnuson Health Sciences Center, Room H-680, Box 357660, Seattle, WA, 98195-7660.
| | - Benjamin Trachik
- U.S. Army Medical Research Directorate-West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, WA, USA.
| | - Simon Goldberg
- Department of Counseling Psychology, University of Wisconsin - Madison, Madison, WI, USA; Center for Healthy Minds, University of Wisconsin - Madison, Madison, WI, USA.
| | - Tracy L Simpson
- U.S. Army Medical Research Directorate-West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, WA, USA; University of Washington Department of Psychiatry and Behavioral Sciences, 1959 NE Pacific Street, Box 356560, Room BB1644, Seattle, WA 98195-6560.
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Abstract
The purpose of this study was to evaluate a newly designed peer support training program for first responders titled Recognize, Evaluate, Advocate, Coordinate, and Track (REACT). REACT was developed in partnership with public safety agencies to address the need for promoting psychological health. This resulted in the development of a program that uses train-the-trainer methodology to address primary prevention of stress injuries. REACT was an all-day training that consisted of four modules, each featuring instruction and practice. Six public safety agencies totaling 30 individuals (76.9% from four fire departments, 23.1% from two emergency communication centers) participated in REACT. The primary outcomes were knowledge and training-related self-efficacy; secondary outcomes included general self-efficacy, resilience, and improved attitudes and expectations. A peer-support model, using a train-the-trainer methodology, is a promising approach for addressing the promotion of psychological health.
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Affiliation(s)
| | | | | | | | | | - Nicholas T James
- Department of Psychology, University of Central Florida, Orlando, Florida
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Trachik B, Bowers C, Neer SM, Nguyen V, Frueh BC, Beidel DC. Combat-related guilt and the mechanisms of exposure therapy. Behav Res Ther 2018; 102:68-77. [DOI: 10.1016/j.brat.2017.11.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 11/13/2017] [Accepted: 11/24/2017] [Indexed: 10/18/2022]
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Abstract
This clinical case describes the assessment and treatment of Roger, a 31-year-old veteran who served in Operation Iraqi Freedom. In addition to combat-related post-traumatic stress disorder (PTSD), Roger presented with a conversion disorder (globus pharyngeus) and avoidance of consuming solid food without also consuming alcohol. A multicomponent treatment program for PTSD, trauma management therapy (TMT), was provided 5 times per week over a 3-week period. TMT included daily-exposure therapy (EXP) as well as daily social and emotion regulation (SER) group therapy to target anger, social withdrawal, and depression. In addition to TMT, exposure to food consumption in the absence of alcohol was provided in the final week. PTSD symptoms were assessed via semi-structured interview and self-report measures, while food intake was assessed via behavioral observation. PTSD symptoms as measured by the Clinician-Administered PTSD Scale (CAPS) decreased from 63 at pre-treatment to 17 at post-treatment, indicating that Roger no longer met criteria for PTSD. Exposure to food intake was equally successful with Roger consuming full meals (e.g., hamburger and french fries) without consuming alcohol. This case study exemplifies the successful use of intensive exposure therapy to target comorbid anxiety-based disorders in a short period.
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