Abstract Recent research has focused on the effectiveness of evidence-based psychotherapy delivered via telehealth services. Unfortunately to date, the majority of studies employ very small samples ...and limited predictor and moderator variables. To address these concerns and further replicate and extend the literature on telehealth, the present study investigated the effectiveness of 12-session exposure therapy delivered either via telehealth ( n = 62) or in person ( n = 27) in veterans with posttraumatic stress disorder (PTSD). Findings demonstrated that although older veterans and Vietnam veterans were more likely to complete the telehealth treatment, telehealth findings were not influenced by patient age, sex, race, combat theater, or disability status. Exposure therapy delivered via telehealth was effective in reducing the symptoms of PTSD, anxiety, depression, stress, and general impairment with large effect sizes. Interestingly, exposure therapy via telehealth was less effective than exposure therapy delivered in person; however, lack of random assignment to condition limits conclusions of differential effectiveness. Overall, these findings support the utility of telehealth services to provide effective, evidence-based psychotherapies.
Research on mechanisms of change in prolonged exposure therapy (PE), an evidence‐based treatment for posttraumatic stress disorder (PTSD), is ongoing. Two putative mechanisms of change are engagement ...during imaginal exposure and trauma‐related belief change. The PE Therapist Questionnaire (PETQ), a novel measure based on the emotional processing theory underlying PE, was developed as a practical tool for therapists to use to assess (a) patient engagement during imaginal exposures and (b) perspective shifts during postimaginal processing. Patients (N = 151) at a U.S. Veterans Affairs medical center PTSD specialty clinic completed self‐report measures of PTSD and depression symptoms prior to sessions. Study therapists (n = 17) completed the PETQ postsession. Rational construction and psychometric analyses suggested a two‐component solution for the PETQ: imaginal and processing. The imaginal factor did not relate to PTSD and depression symptoms. The processing factor correlated with current and next‐session PTSD and depression symptoms, with medium effect sizes, rs = −.41 to −.45, ps < .001. Controlling for current‐session PTSD and depression, a higher level of processing predicted lower next‐session PTSD severity, with a small effect size, β = −.38, p < .04. Postexposure emotional processing, which supports positive changes in maladaptive trauma‐related beliefs and tolerance of emotional distress, predicted future symptom improvement, highlighting the importance of processing components in PE. Further, the use of therapist observations may offer ancillary methods less influenced by correlation of within‐patient subjective ratings and concomitant risk of construct overlap in mechanisms research.
IntroductionThis study will test the effectiveness of FIT Families (FIT), a multicomponent family-based behavioural intervention, against a credible attention control condition, Home-Based Family ...Support (HBFS). This protocol paper describes the design of a randomised clinical trial testing the efficacy of the FIT intervention. The protocol will assess the efficacy of FIT to improve health status in African American adolescents with obesity (AAAO) and their primary caregivers on primary (percent body fat) and secondary (physical activity, metabolic control, weight loss) outcomes and its cost-effectiveness.Methods180 youth/caregiver dyads are randomised into FIT or HBFS, stratified by age, gender and baseline per cent overweight. The proposed study follows a two condition (FIT, HBFS) by four assessment time points. Tests will be conducted to identify potential relationship of baseline demographic and clinical variables to our dependent variables and see whether they are balanced between groups. It is hypothesised that youth/caregiver dyads randomised to FIT will show significantly greater reductions in percent body fat over a 12-month follow-up period compared with AAAO receiving HBFS. Preliminary findings are expected by November 2023.EthicsThis protocol received IRB approval from the Medical University of South Carolina (Pro00106021; see ‘MUSC IRB 106021 Main Approval.doxc’ in online supplemental materials).DisseminationDissemination activities will include summary documents designed for distribution to the broader medical community/family audience and submission of manuscripts, based on study results, to relevant peer-reviewed scientific high-impact journals.Trial registration numberNCT04974554.
Background and Objectives
Previous research demonstrates the utility of goals in attaining improved drinking outcomes. Considerably less is known about the association between substance use goals and ...outcomes among persons with comorbid substance use disorder (SUD) and posttraumatic stress disorder (PTSD). This secondary analysis examined the association between alcohol use outcomes and participants’ treatment entry substance use goals to either abstain or reduce substance use in the context of treatment for comorbid SUD/PTSD.
Methods
Participants (N = 39) were treatment‐seeking veterans with current alcohol dependence and PTSD. Participants completed self‐report and clinician‐rated measures of substance use and PTSD as part of a larger randomized controlled trial.
Results
Participants in both goal groups (abstain; reduce) achieved significant reductions in the likelihood of drinking and the likelihood of exceeding low‐risk drinking levels. The primary analysis did not identify significant differences in outcome between goal groups; however, the exploratory analysis revealed that participants with reduced use goals were more likely to drink and more likely to exceed low‐risk drinking levels.
Conclusion and Scientific Significance
The findings suggest a moderately strong association between substance use goal and drinking outcome in the current study. Although the findings did not unequivocally support abstinence as a superior treatment goal, they offer a preliminary indication that abstinence may be an overall lower‐risk option. These findings expand consideration of the utility of substance use goals and suggest that clinicians should invite consideration of abstinence but may need not limit integrated treatment for SUD/PTSD based on strict adherence to abstinence, particularly if low‐risk use goals are targeted. (Am J Addict 2021;30:131–137)
Posttraumatic stress disorder (PTSD) rarely remits over time, and if left untreated, leads to significant distress, functional impairment, and increased health care costs. Fortunately, effective ...evidence-based treatments (EBTs) for PTSD, such as Prolonged Exposure (PE), exist. Despite their availability and efficacy, a significant number of individuals with PTSD do not initiate treatment when offered or dropout prematurely. One proposed theory suggests that the emotional-numbing symptoms of PTSD (e.g., blunted affect, apathy) can serve as a barrier to engaging in, and successfully completing, treatment; and the broad human-animal interaction (HAI) literature available suggests that HAI can potentially reduce emotional numbing related to PTSD. Accordingly, this manuscript describes an ongoing, federally funded, randomized controlled trial testing the efficacy of RESCUE, an HAI intervention, as a viable adjunctive treatment component for PE.
The study will include 70 veterans with PTSD treated at a Southeastern Veterans Affairs Medical Center (VAMC). All participants in the trial receive up to 12 sessions of PE. Participants are randomly assigned 1:1 to (1) volunteer at a local animal shelter or (2) volunteer at a community agency of their choice as part of their in-vivo exposure exercises for PE. Outcomes will be examined via standard clinical interviews, self-report questionnaires, and thematic interviews.
It is hypothesized that participants in the HAI condition will report greater decreases in emotional-numbing symptoms and increased treatment compliance and completion rates relative to those in the community volunteer condition. If successful, RESCUE, could be easily incorporated into standard PE and broadly disseminated.
ClinicalTrials.gov. ID: NCT03504722. Retrospectively registered on 2 May 2017.
ABSTRACT
Aims The purpose of this study was to examine the influence of personal goals (abstinence or moderation) on treatment outcomes for marijuana use. Hypotheses regarding self‐efficacy for goal ...attainment were tested.
Design Adult marijuana users seeking treatment were assigned randomly to three treatment conditions: (1) cognitive‐behavioral relapse prevention support group; (2) individualized brief motivational enhancement; and (3) delayed treatment control group. Follow‐up assessments were conducted at 4, 7, 13 and 16 months.
Setting University research offices.
Participants Participants were 291 adult marijuana users.
Measurements Marijuana use, personal treatment goals and self‐efficacy for achieving one’s goal were assessed across the 16‐month follow‐up.
Findings Greater marijuana related problems and dependence symptoms were associated with an initial goal of abstinence. Participants were more likely to achieve outcomes consistent with their personal goals. Participants with abstinence goals reported greater self‐efficacy for goal achievement than those with moderation goals after participating in the abstinence oriented treatment; self‐efficacy for goal success predicted goal achievement for both moderate use and abstinence goals.
Conclusions Marijuana users approaching an abstinence‐oriented treatment varied in the extent to which they were actively seeking abstinence as the outcome. Differences in goals were predictable from severity of problems related to use. Goal preference and self‐efficacy for achieving goals predicted outcomes. Future research should incorporate personal goals into treatment and assess their effects on outcomes.
The effects of setting goals on goal commitment, self-efficacy for goal achievement, and goal achievement in the context of an alcohol use intervention were examined using an experimental design in ...which participants were randomized to participatively set goals, assigned goals, and no goal conditions. One hundred and twenty-six heavy-drinking college students received a single cognitive-behavioral assessment/intervention session and completed measures of goal commitment, self-efficacy for goal achievement, and alcohol use. Results were consistent with, and expanded upon, previous research by demonstrating that having a goal for limiting alcohol consumption was predictive of lower quantity and frequency of alcohol use relative to not having a goal. Participation in goal setting yielded greater goal commitment and self-efficacy for goal achievement than assigned goals, but did not result in significantly greater reductions in alcohol use relative to assigned goals. Goal commitment and self-efficacy explained unique variance in the prediction of alcohol use at follow-up. Findings support the importance of goal setting in alcohol interventions and suggest areas for further research.
Background
Posttraumatic stress disorder (PTSD) and substance use disorders (SUD) frequently co‐occur. Previous research demonstrates the utility of goals in attaining improved SUD outcomes, however, ...no previous studies have examined goal choices in the context of integrated treatment for comorbid PTSD and SUD.
Objectives
The present study investigated correlates of treatment entry goals to either reduce or abstain from substance use.
Methods
Participants (N = 60) were treatment‐seeking veterans with current PTSD and SUD. Participants completed self‐report and clinician‐rated measures of substance use, PTSD, and affective symptoms as part of a larger randomized controlled trial.
Results
Half (30/60) of participants endorsed a treatment entry goal to reduce substance use (reducers). Compared to participants who endorsed a treatment entry goal of abstinence (abstainers), reducers were significantly younger, more likely to be employed, more likely to have served in recent military conflicts (Operations Enduring/Iraqi Freedom), and endorsed significantly fewer symptoms of alcohol dependence.
Conclusions and Scientific Significance
The findings demonstrate clinically relevant differences based on treatment entry goals, suggesting that individuals are often able to choose conceivably appropriate treatment goals based, most notably, on the severity of their SUD. Collaboratively engaging patients in establishing treatment goals that are consistent with their beliefs and desires in conjunction with empirical findings is particularly relevant in the context of treatment for SUD and PTSD where many patients are ambivalent about treatment and attrition is common. (Am J Addict 2015;XX:XX–XX)
Background: There has been limited research investigating personality traits as predictors of manic and depressive symptoms in bipolar individuals. The present study investigated the relation between ...personality traits and the course of bipolar disorder. The purpose of this study was to identify specific personality traits that predict the course of manic and depressive symptoms experienced by bipolar individuals.
Methods: The sample consisted of 39 participants with bipolar I disorder assessed by the Structured Clinical Interview for DSM-IV. Personality was assessed using the NEO Five-Factor Inventory. The Modified Hamilton Rating Scale for Depression and the Bech–Rafaelsen Mania Rating Scale were used to assess symptom severity on a monthly basis.
Results: Consistent with previous research on unipolar depression, high Neuroticism predicted increases in depressive symptoms across time while controlling for baseline symptoms. Additionally, high Conscientiousness, particularly the Achievement Striving facet, predicted increases in manic symptoms across time.
Limitations: The current study was limited by the small number of participants, the reliance on a shortened version of a self-report personality measure, and the potential state-dependency of the personality measures.
Conclusions: Specific personality traits may assist in predicting bipolar symptoms across time. Further studies are needed to tease apart the state-dependency of personality.
PDF
