We examined the frequency of trauma types reported in a cohort of service members seeking treatment for posttraumatic stress disorder (PTSD) and compared symptom profiles between types. In this ...observational study, 999 service members (9.2% women; Mage = 32.91 years; 55.6% White) were evaluated using a standardized assessment procedure to determine eligibility for clinical trials. Participants were evaluated for DSM‐IV‐TR‐defined PTSD using the PTSD Symptom Scale–Interview; all participants reported a Criterion A event. Independent evaluators rated descriptions of Criterion A events as belonging to trauma types at a high degree of reliability, κ = 0.80. Aggregated non‐life‐threat primary trauma types were more frequently endorsed than aggregated life‐threat types, 95% CI 17.10%, 29.20%. Participants who endorsed moral injury–self traumas had a higher level of reexperiencing (d = 0.39), guilt (hindsight bias, d = 1.06; wrongdoing, d = 0.93), and self‐blame (d = 0.58) symptoms, relative to those who reported life threat–self. Participants who experienced traumatic loss had greater reexperiencing (d = 0.39), avoidance (d = 0.22), guilt (responsibility, d = 0.39), and greater peri‐ and posttraumatic sadness (d = 0.84 and d = 0.70, respectively) symptoms, relative to those who endorsed life threat–self. Relative to life threat–self, moral injury–others was associated with greater peri‐ (d = 0.36) and posttraumatic (d = 0.33) betrayal/humiliation symptoms, and endorsement of aftermath of violence was associated with greater peri‐ (d = 0.84) and posttraumatic sadness (d = 0.57) symptoms. War zone traumas were heterogeneous, and non‐life‐threat traumas were associated with distinct symptoms and problems.
Resumen
Spanish s by the Asociación Chilena de Estrés Traumático (ACET)
TIPOS DIFERENTES DE TRAUMA EN MIEMBROS DEL SERVICIO MILITAR QUE BUSCAN TRATAMIENTO POR TRASTORNO DE ESTRÉS POSTRAUMÁTICO
TIPOS DE TRAUMA EN MIEMBROS DEL SERVICIO QUE BUSCAN TRATAMIENTO
Examinamos la frecuencia de tipos de trauma reportados en una cohorte de miembros del servicio que buscaban tratamiento por trastorno de estrés Postraumático (TEPT), y comparamos el perfil de síntomas entre los tipos de trauma. En este estudio observacional, 999 miembros del servicio (9.2% mujeres; Media de edad = 32,91 años; 55,6% blancos) fueron evaluados usando un procedimiento de evaluación estandarizado para determinar la elegibilidad para los estudios clínicos. Los participantes fueron evaluados según criterios DSM‐IV‐TR para TEPT usando la Entrevista de Escala de Síntomas para TEPT; todos los participantes reportaron un evento del Criterio A. Evaluadores independientes clasificaron la descripción de los eventos del Criterio A como pertenecientes a los tipos de trauma con un alto grado de fiabilidad (ĸ = 0.80). Los tipos de trauma primarios agregados sin amenaza vital fueron endosados con mayor frecuencia que los tipos agregados con amenaza vital, IC 95% 17.10%, 29,20%. Los participantes que endosaron traumas por daño moral auto‐infringido tuvieron mayores síntomas de re‐experimentación (d = 0,39), sentimientos de culpa (sesgo retrospectivo, d = 1,06; hacerlo mal, d = 0,93), y autoinculpación (d = 0,58) en relación con aquellos que reportaron amenaza vital personal. Los participantes que experimentaron pérdidas traumáticas tuvieron mayores síntomas de re‐experimentación (d = 0,39), evitación (d = 0,22), sentimientos de culpa (responsabilidad, d = 0,39) y mayor tristeza peri y postraumática (d = 0,84 y 0,70 respectivamente), en relación con aquellos que reportaron amenaza vital personal. En relación con amenaza vital, de daño moral a otros estuvo más asociado con mayores niveles de síntomas de traición/ humillación peri (d = 0,36) y postraumáticos (d = 0,33), y el endosamiento de las consecuencias de la violencia estuvo asociado con más síntomas de tristeza peri (d = 0,84) y postraumática (d = 0,57). Los traumas de guerra fueron heterogéneos y los traumas sin amenaza de vida estuvieron asociados con problemas y síntomas distintivos.
抽象
Traditional and Simplified Chinese s by AsianSTSS
Distinct Trauma Types in Military Service Members Seeking Treatment for Posttraumatic Stress Disorder
Traditional Chinese
標題: 尋求治療創傷後壓力症的軍隊成員不同的創傷類型
撮要: 我們透過尋求治療創傷後壓力症(PTSD)的軍隊成員, 檢視創傷類型的頻率, 並比較不同創傷類型的症狀剖象。這項觀察研究的樣本為999名軍隊成員(9.2% 女性; Mage = 32.91 歲; 55.6% 白人)。我們採用標準化評估步驟, 找出樣本是否合適接受臨床試驗, 然後以「PTSD症狀量表會談版」評估樣本是否患有DSM‐IV‐TR介定的 PTSD。所有樣本都曾經歷標準A (Criterion A)事件。獨立的評估員把標準A事件歸類為有高水平倚賴性的創傷類型(κ = 0.80)。相比起整體生命威脅的創傷類型, 較多樣本有整體非生命威脅的主要創傷類型, 95% CI 17.10%, 29.20%。與有「生命威脅—個人」創傷類型的樣本相比, 有「道德創傷—個人」創傷類型的樣本, 有較高水平的再體驗(d = 0.39)、內疚 (事後聰明偏向, d = 1.06; 犯錯, d = 0.93)、和自責(d = 0.58)症狀。與有「生命威脅—個人」的樣本相比, 曾經歷創傷性損失的樣本有較高水平的再體驗(d = 0.39)、迴避(d = 0.22) 、內疚(責任, d = 0.39), 亦有較大程度的創傷當下和創傷後悲傷 (分別為d = 0.84 和d = 0.70)。與有「生命威脅—個人」的樣本相比, 有「道德創傷—他人」的創傷類型跟創傷當下(d = 0.36)和創傷後(d = 0.33)的背叛༏受辱症狀水平較高有關;受暴力影響跟有較高水平的創傷當下(d = 0.84)和創傷後(d = 0.57)悲傷有關。戰爭創傷具異質性;非生命威脅的創傷跟不同的症狀問題有關。
Simplified Chinese
标题: 寻求治疗创伤后压力症的军队成员不同的创伤类型
撮要: 我们透过寻求治疗创伤后压力症(PTSD)的军队成员, 检视创伤类型的频率, 并比较不同创伤类型的症状剖象。这项观察研究的样本为999名军队成员(9.2% 女性; Mage = 32.91 岁; 55.6% 白人)。我们采用标准化评估步骤, 找出样本是否合适接受临床试验, 然后以「PTSD症状量表会谈版」评估样本是否患有DSM‐IV‐TR介定的 PTSD。所有样本都曾经历标准A (Criterion A)事件。独立的评估员把标准A事件归类为有高水平倚赖性的创伤类型(κ = 0.80)。相比起整体生命威胁的创伤类型, 较多样本有整体非生命威胁的主要创伤类型, 95% CI 17.10%, 29.20%。与有「生命威胁—个人」创伤类型的样本相比, 有「道德创伤—个人」创伤类型的样本, 有较高水平的再体验(d = 0.39)、内疚 (事后聪明偏向, d = 1.06; 犯错, d = 0.93)、和自责(d = 0.58)症状。与有「生命威胁—个人」的样本相比, 曾经历创伤性损失的样本有较高水平的再体验(d = 0.39)、回避(d = 0.22) 、内疚(责任, d = 0.39), 亦有较大程度的创伤当下和创伤后悲伤 (分别为d = 0.84 和d = 0.70)。与有「生命威胁—个人」的样本相比, 有「道德创伤—他人」的创伤类型跟创伤当下(d = 0.36)和创伤后(d = 0.33)的背叛༏受辱症状水平较高有关;受暴力影响跟有较高水平的创伤当下(d = 0.84)和创伤后(d = 0.57)悲伤有关。战争创伤具异质性;非生命威胁的创伤跟不同的症状问题有关。
Insomnia and nightmares are common in patients with posttraumatic stress disorder (PTSD). They are associated with worse psychological and physical health and worse PTSD treatment outcomes. In ...addition, they are resistant to PTSD treatments, which do not typically address sleep disorders. Cognitive behavioral therapy for insomnia and nightmares (CBT‐I&N) and cognitive processing therapy (CPT) for PTSD are first‐line treatments, but limited evidence exists guiding the treatment of individuals with all three disorders. The current study randomized U.S. military personnel (N = 93) to one of three conditions: CBT‐I&N delivered before CPT, CBT‐I&N delivered after CPT, or CPT alone; all groups received 18 sessions. Across groups, participants demonstrated significantly improved PTSD symptoms. Because the study was terminated prematurely due to challenges with recruitment and retention, it was underpowered to answer the initially intended research questions. Nonetheless, statistical findings and relevant clinically meaningful changes were observed. Compared to participants who received CPT alone, those who received CBT‐I&N and CPT, regardless of sequencing, demonstrated larger improvements in PTSD symptoms, d = −0.36; insomnia, d = −0.77; sleep efficiency, d = 0.62; and nightmares, d = −.53. Compared to participants who received CBT‐I&N delivered before CPT, those who received CBT‐I&N delivered after CPT demonstrated larger improvements in PTSD symptoms, d = 0.48, and sleep efficiency, d = −0.44. This pilot study suggests that treating comorbid insomnia, nightmares, and PTSD symptoms results in clinically meaningful advantages in improvement for all three concerns compared to treating PTSD alone.
This study examined the impact of a history of head injury (HHI) on posttraumatic stress disorder (PTSD) and depression symptoms in active duty military personnel following group and individual ...cognitive processing therapy (CPT). Data for these secondary analyses were drawn from a clinical trial comparing group and individual CPT. Service members (N = 268, 91.0% male) were randomized to 12 sessions of group (n = 133) or individual (n = 135) CPT. Most participants (57.1%) endorsed a deployment‐related HHI, 92.8% of whom reported currently experiencing symptoms (CES) related to the head injury (i.e., HHI/CES). Patients classified as non‐HHI/CES demonstrated large, significant improvements in PTSD symptom severity in both individual and group therapy, ds = 1.1, p < .001. Patients with HHI/CES status showed similar significant improvements when randomized to individual CPT, d = 1.4, p < .001, but did not demonstrate significant improvements when randomized to group CPT, d = 0.4, p = .060. For participants classified as HHI/CES, individual CPT was significantly superior to group CPT, d = 0.98, p = .003. Symptoms of depression improved following treatment, with no significant differences by treatment delivery format or HHI/CES status. The findings of this clinical trial subgroup study demonstrate evidence that group CPT is less effective than individual CPT for service members classified as HHI/CES. The results suggest that HHI/CES status may be important to consider in selecting patients for group or individual CPT; additional research is needed to confirm the clinical implications of these findings.
Cognitive processing therapy (CPT) is an effective treatment for posttraumatic stress disorder (PTSD); however, some patients do not improve to the same extent as others. It is important to ...understand potential factors that can be modified for better patient outcomes. This clinical trial implemented a three‐arm, equipoise‐stratified randomization design to allow for the accommodation of patient preference before randomization to one of three CPT treatment modalities: in‐home, in‐office, or telehealth. This study examined whether satisfaction with the modality, perceived stigma, expectations of therapy, and credibility of the therapist differed between modalities and whether these factors impacted treatment outcomes. We hypothesized that the contributions of these variables would depend upon whether participants opted out of any treatment arms and that these factors would predict treatment outcomes. Participants who endorsed less perceived stigma demonstrated larger reductions in PTSD symptom severity than those with similar levels of perceived stigma in the telehealth and in‐office conditions, η2 = .12–.18. Participants who endorsed lower satisfaction with their treatment modality and were assigned to the in‐home condition experienced larger PTSD symptom reductions than those with similar dissatisfaction in the telehealth and in‐office conditions, η2 = .20. The results show the robustness of evidence‐based therapies for PTSD given that dissatisfaction did not impede treatment success. In addition, they demonstrate that it is important for clinicians to address stigma before initiating evidence‐based therapies for PTSD. Strategies to address these factors are discussed.
Prolonged exposure therapy (PE) is an efficacious treatment for active duty service members and veterans with posttraumatic stress disorder (PTSD). However, PE is sometimes associated with high ...dropout rates, limited tolerability, and temporary symptom exacerbation during treatment. Stellate ganglion blocks (SGBs) are an emerging treatment that has the potential to enhance outcomes for PTSD when combined with trauma‐focused psychotherapy. To date, no study of which we are aware has examined the potential additive benefits of SGB injections when administered in conjunction with trauma‐focused behavioral treatment for PTSD. Thus, we conducted a nonrandomized clinical trial to evaluate the use of an SGB combined with massed PE therapy for combat‐related PTSD. Participants (N = 12) were treated with 10 daily 90‐min PE sessions delivered over 2 weeks and received a single SGB injection between Sessions 1 and 2. PE sessions lasted 90 min each. Participants reported a mean posttreatment PTSD symptom reduction of 32 points on the PTSD Checklist for DSM‐5 (PCL‐5), Hedges’ gs = 1.28–2.80. Most participants (90.9%) demonstrated clinically significant change on the PCL‐5 (i.e., ≥10 points) by the final treatment session and 50.0% no longer met the diagnostic criteria for PTSD per the Clinician‐Administered PTSD Scale for DSM‐5 at 1‐month follow‐up. Adverse events for the combined treatment were consistent with those previously reported for standalone SGB and PE. This combined treatment approach provides promising results for improving the tolerability of trauma‐focused therapies, reducing symptom severity, and increasing PTSD remission rates.
Objective
Previous research with civilian populations has found strong associations between fibromyalgia (FM) and posttraumatic stress disorder (PTSD). We undertook this study to investigate the ...prevalence of FM in military service members with and without PTSD.
Methods
Participants were active duty military personnel recruited into either an epidemiologic cohort study of service members before a military deployment or 1 of 3 PTSD treatment trials. Instruments used to document FM and PTSD included the PTSD Checklist–Stressor‐Specific Version, the PTSD Symptom Scale‐Interview, and the 2012 American College of Rheumatology FM questionnaire.
Results
Across the 4 studies, 4,376 subjects completed surveys. The prevalence of FM was 2.9% in the predeployment cohort, and the prevalence was significantly higher in individuals with PTSD (10.8%) compared with those without PTSD (0.8%). In the treatment trials, all of the participants met criteria for PTSD before starting treatment, and the prevalence of FM was 39.7%.
Conclusion
The prevalence of FM in active duty service members preparing to deploy is similar to that reported for the general population of the US but is higher than expected for a predominantly male cohort. Furthermore, the prevalence of FM was significantly higher in service members with comorbid PTSD and was highest among those seeking treatment for PTSD. Further investigation is needed to determine the factors linking PTSD and FM.
The theoretical framework of behavioral economics, a metatheory that integrates operant learning and economic theory, has only recently been applied to posttraumatic stress disorder (PTSD). A ...behavioral economic theory of PTSD reflects an expansion of prior behavioral conceptualization of PTSD, which described PTSD in terms of respondent and operant conditioning. In the behavioral economic framework of PTSD, negatively reinforced avoidance behavior is overvalued, in part due to deficits in environmental reward, and may be conceptualized as a form of reinforcer pathology (i.e., excessive preference for and valuation of an immediate reinforcer). We investigated cross‐sectional relationships between PTSD severity and several constructs rooted in this behavioral economic framework, including future orientation, reward availability, and delay discounting in a sample of 110 military personnel/veterans (87.2% male) who had served combat deployments following September 11, 2001. Total PTSD severity was inversely related to environmental reward availability, β = −.49, ΔR2 = 0.24, p < .001; hedonic reward availability, β = −.32, ΔR2 = 0.10, p = .001; and future orientation, β = −.20, ΔR2 = 0.04, p = .032, but not delay discounting, r = −.05, p = .633. An examination of individual symptom clusters did not suggest that avoidance symptoms were uniquely associated with these behavioral economic constructs. The findings offer support for a behavioral economic model of PTSD in which there is a lack of positive reinforcement as well as a myopic focus on the present.
The Posttraumatic Stress Disorder Checklist (PCL-5; Weathers et al., 2013) was recently revised to reflect the changed diagnostic criteria for posttraumatic stress disorder (PTSD) in the fifth ...edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013). We investigated the psychometric properties of PCL-5 scores in a large cohort (N = 912) of military service members seeking PTSD treatment while stationed in garrison. We examined the internal consistency, convergent and discriminant validity, and DSM-5 factor structure of PCL-5 scores, their sensitivity to clinical change relative to PTSD Symptom Scale-Interview (PSS-I; Foa, Riggs, Dancu, & Rothbaum, 1993) scores, and their diagnostic utility for predicting a PTSD diagnosis based on various measures and scoring rules. PCL-5 scores exhibited high internal consistency. There was strong agreement between the order of hypothesized and observed correlations among PCL-5 and criterion measure scores. The best-fitting structural model was a 7-factor hybrid model (Armour et al., 2015), which demonstrated closer fit than all other models evaluated, including the DSM-5 model. The PCL-5's sensitivity to clinical change, pre- to posttreatment, was comparable with that of the PSS-I. Optimally efficient cut scores for predicting PTSD diagnosis were consistent with prior research with service members (Hoge, Riviere, Wilk, Herrell, & Weathers, 2014). The results indicate that the PCL-5 is a psychometrically sound measure of DSM-5 PTSD symptoms that is useful for identifying provisional PTSD diagnostic status, quantifying PTSD symptom severity, and detecting clinical change over time in PTSD symptoms among service members seeking treatment.
Objective
To examine whether treating posttraumatic stress disorder (PTSD) reduces anger and aggression and if changes in PTSD symptoms are associated with changes in anger and aggression.
Method
...Active duty service members (n = 374) seeking PTSD treatment in two randomized clinical trials completed a pretreatment assessment, 12 treatment sessions, and a posttreatment assessment. Outcomes included the Revised Conflict Tactics Scale and state anger subscale of the State‐Trait Anger Expression Inventory.
Results
Treatment groups were analyzed together. There were small to moderate pretreatment to posttreatment reductions in anger (standardized mean difference SMD = −0.25), psychological aggression (SMD = −0.43), and physical aggression (SMD = −0.25). The majority of participants continued to endorse anger and aggression at posttreatment. Changes in PTSD symptoms were mildly to moderately associated with changes in anger and aggression.
Conclusions
PTSD treatments reduced anger and aggression with effects similar to anger and aggression treatments; innovative psychotherapies are needed.
Abstract Between 44% and 87% of active duty service members and veterans who deployed following the September 11, 2001, terrorist attacks know someone who was killed or seriously injured in combat. ...Considering the high frequency and known impact of traumatic loss, it is important to understand if and how traumatic loss may impede posttraumatic stress disorder (PTSD) treatment progress in military personnel. Additionally, experiencing a traumatic loss elevates the risk of developing prolonged grief disorder (PGD), which is associated with higher levels of PTSD symptoms, more functional impairment, and more lifetime suicide attempts among military personnel. Given what is known about the association between PGD and PTSD in treatment‐seeking service members and veterans, it is also important to understand whether grief‐related symptom severity negatively impacts PTSD treatment response. The current study examined associations among traumatic loss, complicated grief, depressive symptoms, and PTSD treatment response among military personnel ( N = 127) who participated in variable‐length cognitive processing therapy (CPT). There was no direct, F (2, 125) = 0.77, p = .465, or indirect, β = .02, p = .677, association between a traumatic loss index event and PTSD treatment response compared with other trauma types. Prior assessments of depressive symptom severity were directly related to PTSD at later assessments across two models, p s < .001– p = .021 Participants with a traumatic loss index trauma demonstrated significant reductions in complicated grief, depressive symptoms, and PTSD following CPT, p s < .001, d s = −0.61–−0.83. Implications, study limitations, and suggestions for future research are presented.
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