Trauma history and increased exposure to combat and sexual trauma may account for heightened rates of PTSD among military populations. This study assessed trauma type and exposure history, diagnostic ...impressions, and PTSD severity in a large clinical dataset (n = 2463) of veterans presenting for PTSD evaluation at a Midwestern VA Medical Center between the years 2006 and 2013. The degree of lifetime trauma exposure was pronounced, with approximately 76% of the sample reporting exposure to at least four traumatic events. Higher numbers of lifetime trauma and higher levels of combat exposure were associated with more severe PTSD symptoms. Sexual trauma and combat trauma were more predictive of PTSD than other trauma types. Sexual trauma was associated with more severe PTSD than combat and other trauma.
Prolonged exposure (PE) is a first-line treatment for posttraumatic stress disorder (PTSD) available in specialty mental health. PE for primary care (PE-PC) is a brief version of PE adapted for ...primary care mental health integration, composed of four-eight, 30-min sessions. Using retrospective data of PE-PC training cases from 155 Veterans Health Administration (VHA) providers in 99 VHA clinics who participated in a 4- to 6-month PE-PC training and consultation program, we examined patients' PTSD and depression severity across sessions via mixed effects multilevel linear modeling. Additionally, hierarchical logistic regression analysis was conducted to assess predictors of treatment dropout. Among 737 veterans, medium-to-large reductions in PTSD (intent-to-treat, Cohen's d = 0.63; completers, Cohen's d = 0.79) and small-to-medium reductions in depression (intent-to-treat, Cohen's d = 0.40; completers, Cohen's d = 0.51) were observed. The modal number of PE-PC sessions was five (SD = 1.98). Providers previously trained in both PE and cognitive processing therapy (CPT) were more likely than providers who were not trained in either PE or CPT to have veterans complete PE-PC (OR = 1.54). Veterans with military sexual trauma were less likely to complete PE-PC than veterans with combat trauma (OR = 0.42). Asian American and Pacific Islander veterans were more likely than White veterans to complete treatment (OR = 2.93). Older veterans were more likely than younger veterans to complete treatment (OR = 1.11).
Impact Statement
Veterans who received PE-PC in primary care from newly trained providers experienced reductions in PTSD and depression symptoms. Providers with training in multiple effective PTSD treatments had higher retention of patients when compared to providers who had no specific PTSD treatment training prior to PE-PC training. In addition, veterans with military sexual trauma as the focus of PE-PC were less likely to complete PE-PC compared to veterans with combat as target trauma.
Posttraumatic stress disorder occurs in as many as one in five combat veterans and is associated with a host of negative, long-term consequences to the individual, their families, and society at ...large. Trauma-focused treatments, such as Prolonged Exposure, result in clinically significant symptom relief for many. Adherence to these treatments (i.e., session attendance and homework compliance) is vital to ensuring recovery but can be challenging for patients. Engaging families in veterans' treatment could prove to be an effective strategy for promoting treatment adherence while also addressing long-standing calls for better family inclusion in treatment for posttraumatic stress disorder. This paper describes the methods of a pragmatic randomized controlled trial designed to evaluate if family inclusion in Prolonged Exposure can improve treatment adherence.
One hundred fifty-six veterans, with clinically significant symptoms of posttraumatic stress disorder, will be randomized to receive either standard Prolonged Exposure or Prolonged Exposure enhanced through family inclusion (Family-Supported Prolonged Exposure) across three different VA facilities. Our primary outcomes are session attendance and homework compliance. Secondary outcomes include posttraumatic stress disorder symptom severity, depression, quality of life, and relationship functioning. The study includes a concurrent process evaluation to identify potential implementation facilitators and barriers to family involvement in Prolonged Exposure within VA.
While the importance of family involvement in posttraumatic stress disorder treatment is non-controversial, there is no evidence base supporting best practices on how to integrate families into PE or any other individually focused trauma-focused treatments for posttraumatic stress disorder. This study is an important step in addressing this gap, contributing to the literature for both retention and family involvement in trauma-focused treatments.
ClinicalTrials.gov NCT03256227 . Registered on August 21, 2017.
Low social support is associated with greater prevalence and severity of posttraumatic stress disorder (PTSD). However, the factors that explain the association between social support and PTSD are ...not well understood. In the current study, 741 VA patients who presented to a PTSD clinic between 2005 and 2013 completed assessments of symptom severity and social support. Analysis of variance and linear regression tested the associations between social support, sociodemographic characteristics, and PTSD symptom severity. In adjusted analyses, social support was robustly associated with PTSD severity (β = -0.30, p < 0.001). After stratification by combat era, this association remained significant for all era veterans except veterans of the post-Vietnam/Desert Storm era. Other sociodemographic characteristics did not affect the association between social support and PTSD. Our findings suggest that the detrimental effects of poor social support pervade across sociodemographic groups and that efforts to improve social support in veterans with PTSD are needed.
Objective: In accordance with Veterans Affairs (VA) policy, VA posttraumatic stress disorder (PTSD) clinics offer evidence-based treatments including cognitive processing therapy (CPT). To facilitate ...access to care, CPT is offered in both group and individual formats in many VA PTSD clinics. Group and individual delivery of CPT have been directly compared in active duty samples, but these findings have not been extended to VA populations. The present article directly compares the effectiveness of group and individual CPT with a written trauma account (CPT+A) across two VA PTSD clinics. Method: Veterans (N = 465) completed initial evaluations and enrolled in either group CPT+A (N = 146) or individual CPT+A (N = 319). Self-report measures of PTSD and depression symptoms were collected at pre-, mid-, and posttreatment; combined across treatment sites; and analyzed using hierarchical linear modeling. Results: PTSD and depression symptoms reduced significantly over the course of group and individual CPT+A. Medium treatment effects were found for group CPT+A (d = .66 for PTSD, d = .68 for depression), and large treatment effects were found for individual CPT+A (d = .96 for PTSD, d = .79 for depression). Conclusion: Individual CPT+A led to significantly greater PTSD and depression symptom reduction than group CPT+A, indicating that in VA outpatient PTSD clinic settings, individual CPT+A may be a more effective approach than group CPT-A. In addition, PTSD symptoms reduced significantly more for Caucasian veterans than for African American veterans during CPT+A, indicating the importance of providing culturally competent trauma-focused care.
Clinical Impact Statement
Cognitive processing therapy (CPT) is an effective treatment for posttraumatic stress disorder (PTSD). CPT is provided either in an individual or group format, though few studies have examined which of these two formats is more effective. This study compared individual and group CPT in a sample of 465 veterans from two Veterans Affairs PTSD clinics. Results showed that both individual and group CPT improved PTSD and depression symptoms. Individual CPT led to more improvement than group CPT. Caucasian veterans had more improvement than African American veterans. Therefore, veterans would likely benefit the most from individual, culturally competent CPT.
The present study explored interest in treatment and treatment initiation patterns among veterans presenting at a VA posttraumatic stress disorder (PTSD) clinic. U.S. veterans who were referred for ...treatment of posttraumatic stress symptoms (N = 476) attended a 2‐session psychoeducation and orientation class where they completed measures of demographic variables, PTSD and depression symptom severity, and interest in treatment. Consistent with previous literature and our hypotheses, Vietnam (OR = 1.78) and Persian Gulf veterans (OR = 2.05) were more likely than Iraq and Afghanistan veterans to initiate treatment. Veterans reporting more severe PTSD and depression symptoms were more likely to initiate treatment than not (OR for PTSD = 1.02, OR for depression = 1.02). Interest in treatment emerged as a strong predictor of treatment initiation. Specifically, interest in trauma‐focused treatment showed a significant independent predictive effect on initiation such that veterans who expressed interest in trauma‐focused treatment were significantly more likely to initiate treatment than those who did not express interest (OR = 2.13). Building interest in trauma‐focused treatment may be a vital component for engaging veterans in evidence‐based trauma‐focused therapy.
Resumen
Spanish s by the Asociación Chilena de Estrés Traumático (ACET)
El presente estudio exploró los patrones de interés en el tratamiento e iniciación del mismo entre vetarnos que se presentaron en una clínica de Trastorno por Estrés Post Traumático (TEPT). Los veteranos norteamericanos que fueron referidos para tratamiento de síntomas de estrés postraumático (N = 476) asistieron a 2 sesiones de psicoeducación y orientación donde completaron medidas de variables demográficas, severidad de los síntomas de TEPT y depresión, e interés en el tratamiento. Consistente con literatura previa y nuestras hipótesis, los veteranos de Vietnam (OR = 1.78) y del Golfo Pérsico (OR = 2.05) iniciaron tratamiento con mayor probabilidad que los veteranos de Iraq y Afganistán. Los veteranos que reportaron síntomas más severos de TEPT y depresión tuvieron mayor probabilidad de iniciar tratamiento que los que no (OR para TEPT = 1.02, OR para depresión = 1.02). El interés en el tratamiento surgió como un predictor importante para el inicio de tratamiento. Específicamente, el interés en el tratamiento enfocado al trauma mostró un efecto predictor independiente significativo en su inicio de tal forma que los veteranos que expresaron interés en el tratamiento lo iniciaron con una significativa mayor probabilidad que aquellos que no expresaron interés (OR = 2.13). El trabajar en el interés por el tratamiento enfocado al trauma puede ser un componente vital o enganche para incorporar veteranos a una terapia enfocada al trauma basada en la evidencia.
摘要
Traditional and Simplified Chinese s by AsianSTSS
標題: 在有提供實證護理的退伍軍人事務門診病人創傷服務計劃中，治療興趣和開始治療的預測變量
撮要: 本研究探索在一所退伍軍人事務的創傷後壓力症(PTSD)診所中，退伍軍人對治療的興趣和開始治療的模式。經轉介去接受創傷後壓力症症狀治療的美國退伍軍人(N = 476)，上了心理教育和取向兩節課堂，完成人口統計變量、PTSD和抑鬱症嚴重程度、及接受治療興趣的評估。跟以往的文獻和我們的假設相符，越南(OR = 1.78)和波斯灣退伍軍人(OR = 2.05)比起伊拉克和阿富汗退伍軍人更有可能開始治療。PTSD和抑鬱症症狀較嚴重的退伍軍人，比起沒那麼嚴重的(創傷後壓力症OR = 1.02, 抑鬱症OR = 1.02)更有可能開始治療。患者對接受治療的興趣成為其開始治療的有力預測。具體來說，患者對於對準創傷治療的興趣，對其開始治療反映出顯著的獨立預測效果：對治療表示興趣的退伍軍人比對治療沒表示興趣的退伍軍人(OR = 2.13)，顯著地有更大機會開始治療。建立退伍軍人對於對準創傷治療的興趣，可能是一個重要的部分，令他們接受以實證為本、對準創傷的治療。
标题: 在有提供循证护理的退伍军人事务门诊病人创伤服务计划中，治疗兴趣和开始治疗的预测变量
撮要: 本研究探索在一所退伍军人事务的创伤后压力症(PTSD)诊所中，退伍军人对治疗的兴趣和开始治疗的模式。经转介去接受创伤后压力症症状治疗的美国退伍军人(N = 476)，上了心理教育和取向两节课堂，完成人口统计变量、PTSD和抑郁症严重程度、及接受治疗兴趣的评估。跟以往的文献和我们的假设相符，越南(OR = 1.78)和波斯湾退伍军人(OR = 2.05)比起伊拉克和阿富汗退伍军人更有可能开始治疗。PTSD和抑郁症症状较严重的退伍军人，比起没那么严重的(创伤后压力症OR = 1.02, 抑郁症OR = 1.02)更有可能开始治疗。患者对接受治疗的兴趣成为其开始治疗的有力预测。具体来说，患者对于对准创伤治疗的兴趣，对其开始治疗反映出显著的独立预测效果：对治疗表示兴趣的退伍军人比对治疗没表示兴趣的退伍军人(OR = 2.13)，显著地有更大机会开始治疗。建立退伍军人对于对准创伤治疗的兴趣，可能是一个重要的部分，令他们接受以实证为本、对准创伤的治疗。
This study compared adults (
Homo sapiens
), young children (
Homo sapiens
), and adult tamarins (
Saguinus oedipus
) while they discriminated global and local properties of stimuli. Subjects were ...trained to discriminate a circle made of circle elements from a square made of square elements and were tested with circles made of squares and squares made of circles. Adult humans showed a global bias in testing that was unaffected by the density of the elements in the stimuli. Children showed a global bias with dense displays but discriminated by both local and global properties with sparse displays. Adult tamarins' biases matched those of the children. The striking similarity between the perceptual processing of adult monkeys and humans diagnosed with autism and the difference between this and normatively developing human perception is discussed.
•Written Exposure Therapy can be used in a wide range of settings.•Treatment-congruent adaptations were helpful in expanding reach.•The effectiveness of WET varied across settings.•Clinics ...implementing WET should attend to provider training and consultation needs.
Written Exposure Therapy (WET) is a promising evidence-based psychotherapy (EBP) for posttraumatic stress disorder (PTSD), in part because it is less time-intensive (i.e., five sessions with no between-session assignments) and has lower dropout than other first-line PTSD psychotherapies. As such, WET has the potential to improve access to quality care and reduce attrition, particularly among difficult-to-reach populations (e.g., veterans, military service members, and minoritized groups). The process of effectively translating WET to diverse practice settings is likely to require the development of customized treatment-congruent adaptations to facilitate access to care and the uptake of the intervention.
This article outlines several recent efforts to implement WET in novel ways, while maintaining an emphasis on fidelity to the core mechanisms of the treatment. Implementation efforts include a cultural center with Spanish-speaking immigrants, active-duty military behavioral health, technology-based approaches, and group format in residential and outpatient Veterans Affairs (VA) settings. We will review lessons learned and program evaluation data from the included sites and will offer suggestions for clinic administrators and providers hoping to implement WET.
Interest in the roles of environmental supports and barriers in career and educational development has increased steadily over the past few decades, enough to warrant a meta-analysis of this vast and ...still growing literature. The current study presents the results of a meta-analytic investigation, employing 276 samples drawn from 249 published articles (N = 104,440), on the relationships of supports and barriers to nine different career and educational outcomes. Employing a random effects meta-analytic model and sampling and measurement error-corrected effect size estimates, the study found that supports tended to account for more variance (M = 10%) across all outcomes than did barriers (M = 3%). Several moderators were also found, suggesting that (a) men’s self-efficacy beliefs and outcome expectations are more strongly related to supports than women’s, (b) Latino(a) students’ levels of school engagement and performance are more weakly related to supports than White students, and (c) supports (and perhaps barriers) seem to be more highly related to elementary school students’ levels school engagement than high school students. The implications of the results are discussed as well as potential avenues for future investigation suggested by some gaps in the literature uncovered in this meta-analysis.
Two studies were designed to explore whether a meta-analytically derived four-factor model of career indecision (Brown & Rector, 2008) could be replicated at the primary and secondary data levels. In ...the first study, an initial pool of 167 items was written based on 35 different instruments whose scores had loaded saliently on at least one factor in the Brown and Rector meta-analysis. These items were then administered to a sample of undergraduate college students and the resultant inter-item correlation matrix was subjected to principal axis factoring with oblique rotations. A four-factor solution was uncovered that resembled the four-factor meta-analytically derived solution but with a few theoretically and practically interesting exceptions. A second study used two existing correlation matrices derived from Gati and colleagues’ cognitive and personality/emotional models of career indecision. Exploratory factor analyses of these matrices revealed that the current four-factor model could, in part, be uncovered from these matrices as well. The theoretical and counseling implications of the results are discussed and future research directions are articulated.
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