Michelle P Brown, Chad E Shenk, Brian Allen, Emily D Dunning, Metzli A Lombera, Ashley M Bucher, Nancy A Dreschel
Child maltreatment is associated with respiratory sinus arrhythmia (RSA) dysregulation, a physiological indicator of emotion regulation that predicts elevated posttraumatic stress disorder (PTSD) symptoms and may be a mechanism of action for exposure-based therapies, such as trauma-focused cognitive behavioral therapy (TF-CBT). Animal-assisted therapy (AAT) has been proposed as an adjunct to TF-CBT for improving emotion regulation following maltreatment. The current study reports findings from a randomized controlled feasibility trial (N = 33; Mage = 11.79 years, SD = 3.08; 63.6% White; 66.7% female) that measured youths' resting RSA, RSA reactivity, and RSA recovery in response to a pretreatment laboratory challenge. We tested whether (a) lower pretreatment resting RSA was associated with blunted RSA during the challenge; (b) either of the pretreatment RSA dimensions predicted more severe pretreatment PTSD symptoms; and (c) either of the pretreatment RSA dimensions predicted less severe posttreatment PTSD symptoms and, as an exploratory aim, whether this was moderated by treatment group (i.e., TF-CBT vs. TF-CBT + AAT). Results from multiple linear regression indicated that, after controlling for pretreatment symptom severity, there was a large effect size for higher resting RSA predicting less severe caregiver-reported posttreatment PTSD symptoms, β = -.52, p = .058, and higher RSA during recovery predicting less severe child-reported posttreatment PTSD symptoms, β = -.70, p = .056, although these findings were not significant. These preliminary results offer important insights for future studies to investigate how the ability to regulate RSA informs which children need additional support to benefit from psychotherapeutic treatment.
{"title":"The influence of pretreatment respiratory sinus arrhythmia dimensions on trauma-focused cognitive behavioral therapy outcomes: Findings from a randomized controlled feasibility trial.","authors":"Michelle P Brown, Chad E Shenk, Brian Allen, Emily D Dunning, Metzli A Lombera, Ashley M Bucher, Nancy A Dreschel","doi":"10.1002/jts.23053","DOIUrl":"10.1002/jts.23053","url":null,"abstract":"<p><p>Child maltreatment is associated with respiratory sinus arrhythmia (RSA) dysregulation, a physiological indicator of emotion regulation that predicts elevated posttraumatic stress disorder (PTSD) symptoms and may be a mechanism of action for exposure-based therapies, such as trauma-focused cognitive behavioral therapy (TF-CBT). Animal-assisted therapy (AAT) has been proposed as an adjunct to TF-CBT for improving emotion regulation following maltreatment. The current study reports findings from a randomized controlled feasibility trial (N = 33; M<sub>age</sub> = 11.79 years, SD = 3.08; 63.6% White; 66.7% female) that measured youths' resting RSA, RSA reactivity, and RSA recovery in response to a pretreatment laboratory challenge. We tested whether (a) lower pretreatment resting RSA was associated with blunted RSA during the challenge; (b) either of the pretreatment RSA dimensions predicted more severe pretreatment PTSD symptoms; and (c) either of the pretreatment RSA dimensions predicted less severe posttreatment PTSD symptoms and, as an exploratory aim, whether this was moderated by treatment group (i.e., TF-CBT vs. TF-CBT + AAT). Results from multiple linear regression indicated that, after controlling for pretreatment symptom severity, there was a large effect size for higher resting RSA predicting less severe caregiver-reported posttreatment PTSD symptoms, β = -.52, p = .058, and higher RSA during recovery predicting less severe child-reported posttreatment PTSD symptoms, β = -.70, p = .056, although these findings were not significant. These preliminary results offer important insights for future studies to investigate how the ability to regulate RSA informs which children need additional support to benefit from psychotherapeutic treatment.</p>","PeriodicalId":17519,"journal":{"name":"Journal of traumatic stress","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140922468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shira Maguen, Brandon J. Griffin, Robert H. Pietrzak, Carmen P. McLean, Jessica L. Hamblen, Sonya B. Norman
Despite the proliferation of moral injury studies, a remaining gap is distinguishing moral injury from normative distress following exposure to potentially morally injurious events (PMIEs). Our goal was to leverage mental health and functional measures to identify clinically meaningful and functionally impairing moral injury using the Moral Injury and Distress Scale (MIDS). Participants who endorsed PMIE exposure (N = 645) were drawn from a population-based sample of military veterans, health care workers, and first responders. Using signal detection methods, we identified the optimally efficient MIDS score for detecting clinically significant posttraumatic stress and depressive symptom severity, trauma-related guilt, and functional impairment. The most efficient cut scores across outcomes converged between 24 and 27. We recommend a cut score of 27 given that roughly 70% of participants who screened positive on the MIDS at this threshold reported clinically significant mental health symptoms, and approximately 50% reported severe trauma-related guilt and/or functional impairment. Overall, 10.2% of respondents exposed to a PMIE screened positive for moral injury at this threshold, particularly those who identified as a member of a minoritized racial or ethnic group (17.9%) relative to those who identified as White, non-Hispanic (8.0%), aOR = 2.52, 95% CI [1.45, 4.42]. This is the first known study to establish a cut score indicative of clinically meaningful and impairing moral injury. Such scores may enhance clinicians’ abilities to conduct measurement-based moral injury care by enabling them to identify individuals at risk of negative outcomes and better understand risk and protective factors for moral injury.
{"title":"Using the Moral Injury and Distress Scale to identify clinically meaningful moral injury","authors":"Shira Maguen, Brandon J. Griffin, Robert H. Pietrzak, Carmen P. McLean, Jessica L. Hamblen, Sonya B. Norman","doi":"10.1002/jts.23050","DOIUrl":"10.1002/jts.23050","url":null,"abstract":"<p>Despite the proliferation of moral injury studies, a remaining gap is distinguishing moral injury from normative distress following exposure to potentially morally injurious events (PMIEs). Our goal was to leverage mental health and functional measures to identify clinically meaningful and functionally impairing moral injury using the Moral Injury and Distress Scale (MIDS). Participants who endorsed PMIE exposure (<i>N</i> = 645) were drawn from a population-based sample of military veterans, health care workers, and first responders. Using signal detection methods, we identified the optimally efficient MIDS score for detecting clinically significant posttraumatic stress and depressive symptom severity, trauma-related guilt, and functional impairment. The most efficient cut scores across outcomes converged between 24 and 27. We recommend a cut score of 27 given that roughly 70% of participants who screened positive on the MIDS at this threshold reported clinically significant mental health symptoms, and approximately 50% reported severe trauma-related guilt and/or functional impairment. Overall, 10.2% of respondents exposed to a PMIE screened positive for moral injury at this threshold, particularly those who identified as a member of a minoritized racial or ethnic group (17.9%) relative to those who identified as White, non-Hispanic (8.0%), a<i>OR</i> = 2.52, 95% CI [1.45, 4.42]. This is the first known study to establish a cut score indicative of clinically meaningful and impairing moral injury. Such scores may enhance clinicians’ abilities to conduct measurement-based moral injury care by enabling them to identify individuals at risk of negative outcomes and better understand risk and protective factors for moral injury.</p>","PeriodicalId":17519,"journal":{"name":"Journal of traumatic stress","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140660186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Prolonged exposure therapy (PE) is a well-established first-line treatment for posttraumatic stress disorder (PTSD) that is based on emotional processing theory. PE has been rigorously evaluated and tested in a large number of clinical trials in many countries covering a wide range of trauma populations. In this review, we summarize the evidence base supporting the efficacy of PE across populations, including adults with sexual assault–related PTSD and mixed trauma–related PTSD, military populations, and adolescents. We highlight important strengths and gaps in the research on PE with individuals from marginalized communities. We discuss the efficacy of PE on associated psychopathology and in the presence of the most commonly comorbid conditions, either alone or integrated with other treatments. In addition, we provide an overview of research examining strategies to augment PE. Much of this work remains preliminary, but numerous trials have tested PE in combination with other psychological or pharmacological approaches, interventions to facilitate extinction learning, and behavioral approaches, in the hopes of further increasing the efficiency and efficacy of PE. There are now several trials testing PE in novel formats that may have advantages over standard in-person PE, such as lower dropout and increased scalability. We examine this recent work on new models of delivering PE, including massed treatment, telehealth, and brief adaptations for primary care, all of which have the potential to increase access to PE. Finally, we highlight several promising areas for future research.
长期暴露疗法(PE)是治疗创伤后应激障碍(PTSD)的一种行之有效的一线疗法,它以情绪处理理论为基础。在许多国家进行的大量临床试验中,对创伤后应激障碍进行了严格的评估和测试。在这篇综述中,我们总结了支持 PE 在不同人群中疗效的证据基础,包括患有性侵犯相关创伤后应激障碍和混合创伤相关创伤后应激障碍的成年人、军人和青少年。我们强调了针对边缘化群体个人的 PE 研究的重要优势和不足之处。我们讨论了 PE 对相关精神病理学以及最常见的合并症的疗效,无论是单独使用还是与其他治疗方法结合使用。此外,我们还概述了有关 PE 增强策略的研究。这项工作的大部分内容仍处于初步阶段,但许多试验已对 PE 与其他心理或药物治疗方法、促进消退学习的干预措施以及行为治疗方法的结合进行了测试,希望能进一步提高 PE 的效率和疗效。现在有几项试验测试了新形式的 PE,与标准的面对面 PE 相比,这些新形式可能具有更多优势,如更低的辍学率和更高的可扩展性。我们研究了最近有关提供 PE 的新模式的工作,包括大规模治疗、远程保健和针对初级保健的简短调整,所有这些都有可能增加 PE 的使用机会。最后,我们强调了未来研究的几个前景广阔的领域。
{"title":"State of the Science: Prolonged exposure therapy for the treatment of posttraumatic stress disorder","authors":"Carmen P. McLean, Edna B. Foa","doi":"10.1002/jts.23046","DOIUrl":"10.1002/jts.23046","url":null,"abstract":"<p>Prolonged exposure therapy (PE) is a well-established first-line treatment for posttraumatic stress disorder (PTSD) that is based on emotional processing theory. PE has been rigorously evaluated and tested in a large number of clinical trials in many countries covering a wide range of trauma populations. In this review, we summarize the evidence base supporting the efficacy of PE across populations, including adults with sexual assault–related PTSD and mixed trauma–related PTSD, military populations, and adolescents. We highlight important strengths and gaps in the research on PE with individuals from marginalized communities. We discuss the efficacy of PE on associated psychopathology and in the presence of the most commonly comorbid conditions, either alone or integrated with other treatments. In addition, we provide an overview of research examining strategies to augment PE. Much of this work remains preliminary, but numerous trials have tested PE in combination with other psychological or pharmacological approaches, interventions to facilitate extinction learning, and behavioral approaches, in the hopes of further increasing the efficiency and efficacy of PE. There are now several trials testing PE in novel formats that may have advantages over standard in-person PE, such as lower dropout and increased scalability. We examine this recent work on new models of delivering PE, including massed treatment, telehealth, and brief adaptations for primary care, all of which have the potential to increase access to PE. Finally, we highlight several promising areas for future research.</p>","PeriodicalId":17519,"journal":{"name":"Journal of traumatic stress","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140671325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In 2009, a fire occurred in the ABC Day Care Center in Hermosillo, Mexico, that killed and injured many children who were in attendance that day. This study investigated the association between the posttraumatic stress symptoms (PTSS) of socially connected parents and caregivers whose children were affected by the fire. Parents and caregivers of the children who were in attendance the day of the fire were interviewed 8–11 months and 20–23 months postfire. Linear network autocorrelation modeling was used to test for autocorrelations of the outcome variable count of PTSS within different configurations of the network of caregivers. No significant network effects appeared in models from the first interview period, but effects did appear in the second period, specifically in the three models in which network ties consisted of “receive informational support” (.220), “give and receive emotional support” (.167), and “give and receive both informational and emotional support” (.213). The findings suggest that in these three network configurations, as relationships grew in strength from the first interview to the second, the level of one's own PTSS was more comparable to the level of PTSS of one's social connections. Two theoretical mechanisms that may explain this result are homophily and social influence.
{"title":"The contributions of social network support and reciprocity to posttraumatic stress symptoms across time among parents and caregivers impacted by the ABC Day Care Center fire in Hermosillo, Mexico","authors":"Austin Arceneaux, Eric C. Jones, Arthur D. Murphy","doi":"10.1002/jts.23041","DOIUrl":"10.1002/jts.23041","url":null,"abstract":"<p>In 2009, a fire occurred in the ABC Day Care Center in Hermosillo, Mexico, that killed and injured many children who were in attendance that day. This study investigated the association between the posttraumatic stress symptoms (PTSS) of socially connected parents and caregivers whose children were affected by the fire. Parents and caregivers of the children who were in attendance the day of the fire were interviewed 8–11 months and 20–23 months postfire. Linear network autocorrelation modeling was used to test for autocorrelations of the outcome variable count of PTSS within different configurations of the network of caregivers. No significant network effects appeared in models from the first interview period, but effects did appear in the second period, specifically in the three models in which network ties consisted of “receive informational support” (.220), “give and receive emotional support” (.167), and “give and receive both informational and emotional support” (.213). The findings suggest that in these three network configurations, as relationships grew in strength from the first interview to the second, the level of one's own PTSS was more comparable to the level of PTSS of one's social connections. Two theoretical mechanisms that may explain this result are homophily and social influence.</p>","PeriodicalId":17519,"journal":{"name":"Journal of traumatic stress","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140671096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In this commentary, I propose that a person-oriented and research-focused approach can stimulate the discussion on the definition of a traumatic stressor and help to refine Criterion A in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Particularly, I suggest that a contextual perspective focusing on the interaction between event features and person-related factors captures more adequately the individual perception of and cognitions related to extremely threatening adverse life events for a diversity of individuals exposed to trauma. In future debate, I encourage the involvement of patients and the public and urge consideration of all potential consequences for practice and research that can directly result from changes to Criterion A (e.g., the heterogenization of posttraumatic stress disorder).
在这篇评论中,我提出以人为本、注重研究的方法可以激发对创伤应激源定义的讨论,并有助于完善《精神疾病诊断与统计手册》(DSM)中的标准 A。特别是,我建议从情境的角度出发,关注事件特征与个人相关因素之间的相互作用,从而更充分地捕捉到遭受创伤的各种个体对极具威胁性的不利生活事件的感知和认知。在未来的辩论中,我鼓励患者和公众参与进来,并敦促考虑标准 A 的修改可能直接对实践和研究造成的所有潜在后果(例如,创伤后应激障碍的异质性)。
{"title":"Understanding trauma as contextualized adverse life events that threaten the individual: Commentary in response to Marx et al. (2024)","authors":"Philipp Herzog","doi":"10.1002/jts.23048","DOIUrl":"10.1002/jts.23048","url":null,"abstract":"<p>In this commentary, I propose that a person-oriented and research-focused approach can stimulate the discussion on the definition of a traumatic stressor and help to refine Criterion A in the <i>Diagnostic and Statistical Manual of Mental Disorders</i> (<i>DSM</i>). Particularly, I suggest that a contextual perspective focusing on the interaction between event features and person-related factors captures more adequately the individual perception of and cognitions related to extremely threatening adverse life events for a diversity of individuals exposed to trauma. In future debate, I encourage the involvement of patients and the public and urge consideration of all potential consequences for practice and research that can directly result from changes to Criterion A (e.g., the heterogenization of posttraumatic stress disorder).</p>","PeriodicalId":17519,"journal":{"name":"Journal of traumatic stress","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jts.23048","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140677040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lucas Torres, Timothy J. Geier, Carissa W. Tomas, Claire M. Bird, Sydney Timmer-Murillo, Christine L. Larson, Terri A. deRoon-Cassini
Traumatic, life-threatening events are experienced commonly among the general U.S. population, yet Black individuals in the United States (i.e., Black Americans) exhibit higher prevalence rates of posttraumatic stress disorder (PTSD) and more severe symptoms than other populations. Although empirical research has noted a range of symptom patterns that follow traumatic injury, minimal work has examined the role of racial discrimination in relation to PTSD symptom trajectories. The current study assessed racial discrimination and PTSD symptom trajectories at 6 months postinjury across two separate samples of traumatically injured Black Americans (i.e. emergency department (ED)–discharged and hospitalized). Identified PTSD symptom trajectories largely reflect those previously reported (i.e., ED: nonremitting, moderate, remitting, and resilient; hospitalized: nonremitting, delayed, and resilient), although the resilient trajectory was less represented than expected given past research (ED: 55.8%, n = 62; hospitalized: 46.9%, n = 38). Finally, higher racial discrimination was associated with nonremitting, ED: relative risk ratio (RR) = 1.32, hospitalized: RR = 1.23; moderate, ED: RR = 1.18; and delayed, hospitalized: RR = 1.26, PTSD symptom trajectories. Overall, the current findings not only emphasize the inimical effects of racial discrimination but also demonstrate the unique ways in which race-related negative events can impact PTSD symptom levels and recovery across time.
{"title":"Racial discrimination increases the risk for nonremitting posttraumatic stress disorder symptoms in traumatically injured Black individuals living in the United States","authors":"Lucas Torres, Timothy J. Geier, Carissa W. Tomas, Claire M. Bird, Sydney Timmer-Murillo, Christine L. Larson, Terri A. deRoon-Cassini","doi":"10.1002/jts.23051","DOIUrl":"10.1002/jts.23051","url":null,"abstract":"<p>Traumatic, life-threatening events are experienced commonly among the general U.S. population, yet Black individuals in the United States (i.e., Black Americans) exhibit higher prevalence rates of posttraumatic stress disorder (PTSD) and more severe symptoms than other populations. Although empirical research has noted a range of symptom patterns that follow traumatic injury, minimal work has examined the role of racial discrimination in relation to PTSD symptom trajectories. The current study assessed racial discrimination and PTSD symptom trajectories at 6 months postinjury across two separate samples of traumatically injured Black Americans (i.e. emergency department (ED)–discharged and hospitalized). Identified PTSD symptom trajectories largely reflect those previously reported (i.e., ED: nonremitting, moderate, remitting, and resilient; hospitalized: nonremitting, delayed, and resilient), although the resilient trajectory was less represented than expected given past research (ED: 55.8%, <i>n</i> = 62; hospitalized: 46.9%, <i>n</i> = 38). Finally, higher racial discrimination was associated with nonremitting, ED: relative risk ratio (<i>RR</i>) = 1.32, hospitalized: <i>RR</i> = 1.23; moderate, ED: <i>RR</i> = 1.18; and delayed, hospitalized: <i>RR</i> = 1.26, PTSD symptom trajectories. Overall, the current findings not only emphasize the inimical effects of racial discrimination but also demonstrate the unique ways in which race-related negative events can impact PTSD symptom levels and recovery across time.</p>","PeriodicalId":17519,"journal":{"name":"Journal of traumatic stress","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140674825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Although exposure therapies have established effects in treating posttraumatic stress disorder (PTSD), these therapies might be hindered by issues of cost, distance, time, and human resources, which are potentially alleviated by digital health. Despite the potential of digital health, there is currently no systematic review specifically evaluating digital health–based exposure therapies. We aimed to conduct a systematic literature review of randomized controlled trials (RCTs) examining the impact of digital health–based exposure therapies in treating patients with PTSD. A literature search was conducted from December 31, 2023, to February 22, 2024, using the PubMed, Web of Science, and PsycINFO databases. A total of 12 RCTs with 1,361 participants were included in the systematic review. These RCTs were conducted mainly in the United States and primarily enrolled military samples. Overall, the utility of digital health–based exposure therapies appeared plausible and comparable to that of in‐person therapies. The dropout rate was counterintuitively high, potentially due to technological issues and the absence of personal connections. The findings suggest that digital health–based exposure therapies may potentially resolve the issues of cost, distance, time, and human resources in the treatment of patients with PTSD. Future RCTs should employ larger sample sizes. Addressing technological challenges and the absence of personal connection may be important in resolving the high dropout rate.
{"title":"Digital health–based exposure therapies for patients with posttraumatic stress disorder: A systematic review of randomized controlled trials","authors":"Mayu Yoshikawa, Zui Narita, Yoshiharu Kim","doi":"10.1002/jts.23052","DOIUrl":"https://doi.org/10.1002/jts.23052","url":null,"abstract":"Although exposure therapies have established effects in treating posttraumatic stress disorder (PTSD), these therapies might be hindered by issues of cost, distance, time, and human resources, which are potentially alleviated by digital health. Despite the potential of digital health, there is currently no systematic review specifically evaluating digital health–based exposure therapies. We aimed to conduct a systematic literature review of randomized controlled trials (RCTs) examining the impact of digital health–based exposure therapies in treating patients with PTSD. A literature search was conducted from December 31, 2023, to February 22, 2024, using the PubMed, Web of Science, and PsycINFO databases. A total of 12 RCTs with 1,361 participants were included in the systematic review. These RCTs were conducted mainly in the United States and primarily enrolled military samples. Overall, the utility of digital health–based exposure therapies appeared plausible and comparable to that of in‐person therapies. The dropout rate was counterintuitively high, potentially due to technological issues and the absence of personal connections. The findings suggest that digital health–based exposure therapies may potentially resolve the issues of cost, distance, time, and human resources in the treatment of patients with PTSD. Future RCTs should employ larger sample sizes. Addressing technological challenges and the absence of personal connection may be important in resolving the high dropout rate.","PeriodicalId":17519,"journal":{"name":"Journal of traumatic stress","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140623960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sinead Day, Phillipa Hay, Christopher Basten, Susan Byrne, Amanda Dearden, Mandy Goldstein, Amy Hannigan, Gabriella Heruc, Catherine Houlihan, Marion Roberts, W. Kathy Tannous, Chris Thornton, Natalie Valentine, Deborah Mitchison
Although childhood trauma and posttraumatic stress disorder (PTSD) have been well-researched in eating disorder epidemiology, prevalence rates are unavailable for complex PTSD (CPTSD). Under recently introduced ICD-11 criteria, individuals with CPTSD have both PTSD symptoms and additional disturbances in self-organization (DSO). Using ICD-11 criteria, this study aimed to determine the prevalence of PTSD and DSO symptoms, diagnostic rates of PTSD and CPTSD, and childhood trauma exposure in eating disorder treatment-seekers. Participants (N = 217) were individuals attending residential, partial hospitalization, and outpatient services who completed measures of eating disorder– and trauma-related symptoms and childhood adverse experiences. One third of participants reported PTSD symptoms, and over half reported DSO symptoms, with probable ICD-11 diagnostic rates of 3.8% for PTSD and 28.4% for CPTSD. CPTSD was significantly more prevalent than PTSD and more common in higher levels of care. Both PTSD and DSO symptom severity were positively correlated with eating disorder symptoms and impairment, rs = .285–.642. DSO symptom severity was a significant and unique explanatory factor of eating disorder severity and impairment. The findings highlight the prevalence of CPTSD in eating disorder populations and the association between DSO symptoms and eating psychopathology independent of PTSD symptoms. Implications are discussed for adjunct treatment approaches for individuals with comorbid eating disorders and PTSD or CPTSD.
{"title":"Posttraumatic stress disorder (PTSD) and complex PTSD in eating disorder treatment-seekers: Prevalence and associations with symptom severity","authors":"Sinead Day, Phillipa Hay, Christopher Basten, Susan Byrne, Amanda Dearden, Mandy Goldstein, Amy Hannigan, Gabriella Heruc, Catherine Houlihan, Marion Roberts, W. Kathy Tannous, Chris Thornton, Natalie Valentine, Deborah Mitchison","doi":"10.1002/jts.23047","DOIUrl":"10.1002/jts.23047","url":null,"abstract":"<p>Although childhood trauma and posttraumatic stress disorder (PTSD) have been well-researched in eating disorder epidemiology, prevalence rates are unavailable for complex PTSD (CPTSD). Under recently introduced <i>ICD-11</i> criteria, individuals with CPTSD have both PTSD symptoms and additional disturbances in self-organization (DSO). Using <i>ICD-11</i> criteria, this study aimed to determine the prevalence of PTSD and DSO symptoms, diagnostic rates of PTSD and CPTSD, and childhood trauma exposure in eating disorder treatment-seekers. Participants (<i>N</i> = 217) were individuals attending residential, partial hospitalization, and outpatient services who completed measures of eating disorder– and trauma-related symptoms and childhood adverse experiences. One third of participants reported PTSD symptoms, and over half reported DSO symptoms, with probable <i>ICD-11</i> diagnostic rates of 3.8% for PTSD and 28.4% for CPTSD. CPTSD was significantly more prevalent than PTSD and more common in higher levels of care. Both PTSD and DSO symptom severity were positively correlated with eating disorder symptoms and impairment, <i>r</i>s = .285–.642. DSO symptom severity was a significant and unique explanatory factor of eating disorder severity and impairment. The findings highlight the prevalence of CPTSD in eating disorder populations and the association between DSO symptoms and eating psychopathology independent of PTSD symptoms. Implications are discussed for adjunct treatment approaches for individuals with comorbid eating disorders and PTSD or CPTSD.</p>","PeriodicalId":17519,"journal":{"name":"Journal of traumatic stress","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jts.23047","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140623956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Zeno Franco, Leslie Ruffalo, Bob Curry, Martina Gollin-Graves, Sheikh Iqbal Ahamed, Otis Winstead, Katinka Hooyer, Myah Pazdera, Lisa Rein, Jose Lizarraga Mazaba, Md Fitrat Hossain, Virginia Stoffel, Mark Flower, Praveen Madiraju, Stephen Melka, Karen Berte, Jeffrey Whittle
Peer mentorship shows promise as a strategy to support veteran mental health. A community–academic partnership involving a veteran-led nonprofit organization and institutions of higher education evaluated a collaboratively developed peer mentor intervention. We assessed posttraumatic stress disorder (PTSD), postdeployment experiences, social functioning, and psychological strengths at baseline, midpoint, and 12-week discharge using the PTSD Checklist for DSM-5 (PCL-5), Deployment Risk and Resilience Inventory–2, Social Adaptation Self-evaluation Scale, and Values in Action Survey. Brief weekly check-in surveys reinforced mentor contact and assessed retention. The sample included 307 veterans who were served by 17 veteran peer mentors. Mixed-effects linear models found a modest effect for PTSD symptom change, with a mean PCL-5 score reduction of 4.04 points, 95% CI [−6.44, −1.64], d = 0.44. More symptomatic veterans showed a larger effect, with average reductions of 9.03 points, 95% CI [-12.11, -5.95], d = 0.77. There were no significant findings for other outcome variables. Compared to younger veterans, those aged 32–57 years were less likely to drop out by 6 weeks, aORs = 0.32–0.26. Week-by-week hazard of drop-out was lower with mentors ≥ 35 years old, aHR = 0.62, 95% CI [0.37, 1.05]. Unadjusted survival differed by mentor military branch, p = .028, but the small mentor sample reduced interpretability. Like many community research efforts, this study lacked a control group, limiting the inferences that can be drawn. Continued study of veteran peer mentorship is important as this modality is often viewed as more tolerable than therapy.
同伴指导作为支持退伍军人心理健康的一种策略,显示了其前景。一个由退伍军人领导的非营利性组织和高等教育机构共同参与的社区-学术合作项目对合作开发的同伴指导干预措施进行了评估。我们使用创伤后应激障碍核对表 DSM-5(PCL-5)、部署风险和复原力量表-2、社会适应自我评估量表和行动中的价值观调查表,对创伤后应激障碍(PTSD)、部署后经历、社会功能和心理优势进行了基线、中点和 12 周出院时的评估。每周一次的简短签到调查加强了指导者的联系,并对保留情况进行了评估。样本包括 307 名退伍军人,由 17 名退伍军人同伴导师提供服务。混合效应线性模型发现,创伤后应激障碍症状变化的影响不大,PCL-5 评分平均降低了 4.04 分,95% CI [-6.44, -1.64], d = 0.44。症状较重的退伍军人受到的影响更大,平均减少了 9.03 分,95% CI [-12.11, -5.95],d = 0.77。其他结果变量没有明显发现。与较年轻的退伍军人相比,32-57 岁的退伍军人在 6 周前退出的可能性较小,aORs = 0.32-0.26。导师年龄≥ 35 岁的退学风险逐周降低,aHR = 0.62,95% CI [0.37, 1.05]。未经调整的生存率因指导员所属军种而异,p = .028,但指导员样本较少,降低了可解释性。与许多社区研究工作一样,这项研究缺乏对照组,从而限制了可以得出的推论。继续研究退伍军人同伴指导非常重要,因为这种方式通常被认为比治疗更容易忍受。
{"title":"Impact of veteran-led peer mentorship on posttraumatic stress disorder","authors":"Zeno Franco, Leslie Ruffalo, Bob Curry, Martina Gollin-Graves, Sheikh Iqbal Ahamed, Otis Winstead, Katinka Hooyer, Myah Pazdera, Lisa Rein, Jose Lizarraga Mazaba, Md Fitrat Hossain, Virginia Stoffel, Mark Flower, Praveen Madiraju, Stephen Melka, Karen Berte, Jeffrey Whittle","doi":"10.1002/jts.23038","DOIUrl":"10.1002/jts.23038","url":null,"abstract":"<p>Peer mentorship shows promise as a strategy to support veteran mental health. A community–academic partnership involving a veteran-led nonprofit organization and institutions of higher education evaluated a collaboratively developed peer mentor intervention. We assessed posttraumatic stress disorder (PTSD), postdeployment experiences, social functioning, and psychological strengths at baseline, midpoint, and 12-week discharge using the PTSD Checklist for <i>DSM-5</i> (PCL-5), Deployment Risk and Resilience Inventory–2, Social Adaptation Self-evaluation Scale, and Values in Action Survey. Brief weekly check-in surveys reinforced mentor contact and assessed retention. The sample included 307 veterans who were served by 17 veteran peer mentors. Mixed-effects linear models found a modest effect for PTSD symptom change, with a mean PCL-5 score reduction of 4.04 points, 95% CI [−6.44, −1.64], <i>d =</i> 0.44. More symptomatic veterans showed a larger effect, with average reductions of 9.03 points, 95% CI [-12.11, -5.95], <i>d</i> = 0.77. There were no significant findings for other outcome variables. Compared to younger veterans, those aged 32–57 years were less likely to drop out by 6 weeks, a<i>OR</i>s = 0.32–0.26. Week-by-week hazard of drop-out was lower with mentors ≥ 35 years old, a<i>HR</i> = 0.62, 95% CI [0.37, 1.05]. Unadjusted survival differed by mentor military branch, <i>p</i> = .028, but the small mentor sample reduced interpretability. Like many community research efforts, this study lacked a control group, limiting the inferences that can be drawn. Continued study of veteran peer mentorship is important as this modality is often viewed as more tolerable than therapy.</p>","PeriodicalId":17519,"journal":{"name":"Journal of traumatic stress","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140629518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Martin Osayande Agwogie, Wendy Kliewer, Muhammed Bashir Ibrahim
Adverse childhood experiences (ACEs) are associated with a wide range of health problems and health-compromising behaviors, including drug use, but are understudied in sub-Saharan Africa. Further, some data suggest that some types of ACEs are more strongly associated with outcomes than others. We investigated associations between different types of ACEs and recent drug use among 2,011 women living in Katsina State, Nigeria. This community-based survey included questions on ACE exposure, modifiable individual-level risk and promotive factors, and past-year drug use. Tobacco, cannabis, and the nonmedical use of cough syrup with codeine and tramadol were the most frequently used drugs. Logistic regressions revealed that across most drugs, ACEs reflecting abuse, neglect, and household dysfunction, but not community violence, increased the likelihood of drug use, odds ratios (ORs) = 1.30–3.10. Ease of access to drugs, ORs = 1.33–2.98, and personal religiosity, ORs = 1.19–2.27, also enhanced the risk of drug use, and higher depressive affect was associated with codeine, OR = 1.27, and tramadol use, ORs = 2.42. Practicing religious rites, ORs = 0.38–0.70; disapproval of drug use, ORs = 0.36–0.57; and perceived harm from drug use, ORs = 0.54–0.71, reduced the likelihood of drug use. Efforts to prevent abuse, neglect, and household dysfunction; reduce access to drugs; treat depression; and increase disapproval and harm associated with drug use may reduce drug use in the context of ACE exposure.
{"title":"Adverse childhood experiences, individual-level risk and protective factors, and recent drug use in a community sample of Nigerian women","authors":"Martin Osayande Agwogie, Wendy Kliewer, Muhammed Bashir Ibrahim","doi":"10.1002/jts.23043","DOIUrl":"10.1002/jts.23043","url":null,"abstract":"<p>Adverse childhood experiences (ACEs) are associated with a wide range of health problems and health-compromising behaviors, including drug use, but are understudied in sub-Saharan Africa. Further, some data suggest that some types of ACEs are more strongly associated with outcomes than others. We investigated associations between different types of ACEs and recent drug use among 2,011 women living in Katsina State, Nigeria. This community-based survey included questions on ACE exposure, modifiable individual-level risk and promotive factors, and past-year drug use. Tobacco, cannabis, and the nonmedical use of cough syrup with codeine and tramadol were the most frequently used drugs. Logistic regressions revealed that across most drugs, ACEs reflecting abuse, neglect, and household dysfunction, but not community violence, increased the likelihood of drug use, odds ratios (<i>OR</i>s) = 1.30–3.10. Ease of access to drugs, <i>OR</i>s = 1.33–2.98, and personal religiosity, <i>OR</i>s = 1.19–2.27, also enhanced the risk of drug use, and higher depressive affect was associated with codeine, <i>OR</i> = 1.27, and tramadol use, <i>OR</i>s = 2.42. Practicing religious rites, <i>OR</i>s = 0.38–0.70; disapproval of drug use, <i>OR</i>s = 0.36–0.57; and perceived harm from drug use, <i>OR</i>s = 0.54–0.71, reduced the likelihood of drug use. Efforts to prevent abuse, neglect, and household dysfunction; reduce access to drugs; treat depression; and increase disapproval and harm associated with drug use may reduce drug use in the context of ACE exposure.</p>","PeriodicalId":17519,"journal":{"name":"Journal of traumatic stress","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jts.23043","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140586825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}