Examining MEmory Training for Recovery-Adolescent among Afghan adolescent boys: a pilot randomised controlled trial

Objectives: To examine the relationships between self-reported posttraumatic stress disorder (PTSD) symptoms, perceived positive relations with others, self-regulation strategy use, and academic motivation among student service members/veterans (SSM/V) enrolled in postsecondary education. Participants: SSM/V (N = 214), defined as veterans, active duty, or National Guard/Reservists of the US military, enrolled at 5 different institutions in Fall 2012. Methods: Data were collected using an online questionnaire that included standardized measures of PTSD symptoms, perceived quality of personal relations, academic self-regulation strategy use, and academic motivation. Results: PTSD symptoms were associated with lower self-efficacy for learning and maladaptive academic goal orientation. Additionally, PTSD symptoms were associated with lower effort regulation (ie, persistence) during academic work. Endorsement of more positive relations moderated the deleterious relationship between PTSD symptoms and maladaptive goal orientation. Conclusion: The results suggest that postsecondary personnel adopt a social-cognitive framework to develop social, mental health, and academic supports for SSM/V with PTSD.

Research has demonstrated that veterans with a history of traumatic brain injury (TBI) may experience persistent symptoms following injury. These symptoms are frequently maintained or exacerbated by psychiatric symptoms, including posttraumatic stress disorder (PTSD). Studies suggest that decreasing PTSD symptoms may also reduce postconcussive symptoms. This study examined whether (a) PTSD and postconcussive symptoms decreased over the course of residential PTSD/TBI treatment and (b) a reduction in PTSD symptoms was associated with a reduction in postconcussive symptoms. Twenty-eight veterans who met diagnostic criteria for PTSD and had a history of TBI were included in the study. Veterans received 8 weeks of treatment in a residential PTSD/TBI program and completed self-report measures of PTSD and postconcussive symptoms at pre- and posttreatment. Results indicated that PTSD and postconcussive symptoms significantly decreased over the course of treatment. Furthermore, the decreases in PTSD and postconcussive symptoms were significantly positively related. The reduction in PTSD symptoms is positively associated with a reduction in postconcussive symptoms following residential treatment in a PTSD/TBI program. These findings suggest that PTSD and postconcussive symptoms are interdependent and mutually influence one another.

BackgroundIn this randomised clinical trial, we investigated the efficacy of MEmory Training for Recovery-Adolescent (METRA) in improving psychiatric symptoms among adolescents in Iraq.MethodsIn the study, we included adolescents aged 10–19 years with heightened psychiatric distress living in Kirkuk. It was a parallel-group trial comparing METRA with treatment as usual (TAU), with a three-month follow-up. The study occurred between July 2023 and January 2024. Participants assigned to METRA received a 10-session group-intervention comprised of memory specificity training and writing for recovery. Assessments occurred at baseline, post-intervention, and three months after treatment. Primary outcome measures were self-reported posttraumatic stress disorder (PTSD) and depression symptoms post-intervention. Secondary outcomes were measures of anxiety and psychiatric difficulties. We also examined the costs and affordability of METRA in a humanitarian context. The sample size for primary analyses included 67 adolescents in the METRA group and 65 adolescents in TAU.ResultsFollowing the intention-to-treat principle, linear mixed effects models found at post-intervention the METRA group had a 10.96-point decrease (95% confidence interval (CI) = –13.82, –8.09) in PTSD symptoms and a 3.27-point decrease (95% CI = –4.67, –1.87) in depression symptoms. Improvements were maintained at the three-month follow-up. While the time main effects were significant (P < 0.001), the group × time interactions were not significant (P = 0.61 for PTSD and P = 0.71 for depression); thus, there was no evidence that these improvements were superior to the symptom improvements observed in TAU.ConclusionsIn this study, we found that while METRA was not more effective than TAU, it was less costly, offering an option for replacing current practice. The findings highlight a need for further research in this area of global mental health.RegistrationAustralian New Zealand Clinical Trials Registry (ACTRN12622001413718).

Prospective network of post-traumatic stress disorder (PTSD) symptoms across adolescent survivors with distinct trajectories of PTSD: A cohort study of the Wenchuan earthquake

Adolescents who experience conflict in humanitarian contexts often have high levels of psychiatric distress but rarely have access to evidence-based interventions. To investigate the efficacy of Memory Training for Recovery-Adolescent (METRA) intervention in improving psychiatric symptoms among adolescent girls in Afghanistan. This randomized clinical trial included girls and young women aged 11 to 19 years with heightened psychiatric distress living in Kabul, Afghanistan, and was conducted as a parallel-group trial comparing METRA with treatment as usual (TAU), with a 3-month follow-up. Participants were randomized 2:1 to receive either METRA or TAU. The study occurred between November 2021 and March 2022 in Kabul. An intention-to-treat approach was used. Participants assigned to METRA received a 10-session group-intervention comprised of 2 modules (module 1: memory specificity; module 2: trauma writing). The TAU group received 10 group adolescent health sessions. Interventions were delivered over 2 weeks. Primary outcome measures were self-reported posttraumatic stress disorder (PTSD) and depression symptoms after the intervention. Secondary outcomes were self-reported measures of anxiety, Afghan-cultural distress symptoms, and psychiatric difficulties. Assessments occurred at baseline, after modules 1 and 2, and at 3 months after treatment. The 125 participants had a mean (SD) age of 15.96 (1.97) years. Overall sample size for primary analyses included 80 adolescents in the METRA group and 45 adolescents in TAU. Following the intention-to-treat principle, generalized estimating equations found that the METRA group had a 17.64-point decrease (95% CI, -20.38 to -14.91 points) in PTSD symptoms and a 6.73-point decrease (95% CI, -8.50 to -4.95 points) in depression symptoms, while the TAU group had a 3.34-point decrease (95% CI, -6.05 to -0.62 points) in PTSD symptoms and a 0.66-point increase (95% CI, -0.70 to 2.01 points) in depression symptoms, with the group × time interactions being significant (all P < .001). METRA participants had significantly greater reductions in anxiety, Afghan-cultural distress symptoms, and psychiatric difficulties than TAU participants. All improvements were maintained at 3-month follow-up. Dropout in the METRA group was 22.5% (18 participants) vs 8.9% for TAU (4 participants). In this randomized clinical trial, those in the METRA group had significantly greater improvements in psychiatric symptoms relative to those in the TAU group. METRA appeared to be a feasible and effective intervention for adolescents in humanitarian contexts. anzctr.org.au Identifier: ACTRN12621001160820.

Background Little is known about the efficacy of eye movement desensitization and reprocessing (EMDR) therapy for post-traumatic stress disorder (PTSD) symptoms in people with mild intellectual disability or borderline intellectual functioning (MID-BIF). Aims To explore the safety, feasibility, and efficacy of EMDR therapy in adults with MID-BIF, PTSD, and comorbid mental health and psycho-social problems. Methods and procedures Data were collected from nine participants using a non-concurrent multiple baseline design. PTSD symptoms, level of daily life impairment, and possible adverse effect were measured weekly during baseline, treatment, post-treatment, and at three-month follow-up. Depressive symptoms, general psychopathology, and mental health problems were assessed once in every phase. Outcomes and results Participants displayed a significant reduction of PTSD symptoms, and the majority of participants no longer met criteria for DSM-5 PTSD diagnosis after therapy. EMDR therapy appeared to be safe, as no adverse events were reported during the study time frame. Further, participants showed a decrease in depressive symptoms as well as less severe general psychopathology and mental health problems following therapy. Conclusion EMDR therapy was found to be safe, feasible, and (potentially) efficacious in decreasing PTSD symptoms, loss of PTSD diagnoses, reduction of level of daily life impairment, and general psychopathology for adults with MID-BIF, suffering from both severe mental health and psycho-social problems.

Posttraumatic Stress Disorder Symptoms During the First Six Months After Traumatic Brain Injury

A randomized controlled trial of prolonged exposure therapy versus relaxation training for older veterans with military-related PTSD

Background: Posttraumatic stress disorder (PTSD) is a serious and debilitating condition among military veterans. Exposure to potentially traumatic events (PTEs) may lead to PTSD and PTE sensitivity may be influenced by the personality trait neuroticism. Objective: The current investigation aims to test whether exposure to PTEs during deployment is associated with changes in PTSD symptoms, and whether individual levels of neuroticism are related to resilience or sensitivity to such exposures. Methods: The study sample included 701 Danish soldiers deployed to Afghanistan in 2009. PTSD symptoms were measured pre-, peri- and post-deployment (T1-T3) with the PTSD Checklist-Civilian Version. PTSD symptom load was modelled in a mixed linear model along with an extensive list of covariates. Interactions between time, exposure, and neuroticism were tested in order to assess whether neuroticism moderated the effect of PTEs upon PTSD symptoms. Results: On average, PTSD symptoms decreased from T1 through T3. Factors associated with higher PTSD symptom levels included number of past trauma, neuroticism, and low age at deployment. Interaction analyses showed that individuals with low and medium neuroticism levels displayed no significant change in PTSD symptoms, and individuals with high neuroticism displayed a significant decrease in PTSD symptoms. These changes were consistent across levels of perceived exposure to danger and combat and witnessing the consequences of war. Conclusions: Results indicate that low levels of neuroticism appear to be related to resilience. Individuals with high levels of neuroticism displayed elevated PTSD symptoms across all time points, but contrary to expectations, they reported a significant decrease in PTSD symptoms from pre- to post-deployment.

BackgroundPosttraumatic stress disorder (PTSD) develops in 10-20% of injury patients. We developed a novel, self-guided Internet-based intervention (called Trauma TIPS) based on techniques from cognitive behavioral therapy (CBT) to prevent the onset of PTSD symptoms.ObjectiveTo determine whether Trauma TIPS is effective in preventing the onset of PTSD symptoms in injury patients.MethodsAdult, level 1 trauma center patients were randomly assigned to receive the fully automated Trauma TIPS Internet intervention (n=151) or to receive no early intervention (n=149). Trauma TIPS consisted of psychoeducation, in vivo exposure, and stress management techniques. Both groups were free to use care as usual (nonprotocolized talks with hospital staff). PTSD symptom severity was assessed at 1, 3, 6, and 12 months post injury with a clinical interview (Clinician-Administered PTSD Scale) by blinded trained interviewers and self-report instrument (Impact of Event Scale—Revised). Secondary outcomes were acute anxiety and arousal (assessed online), self-reported depressive and anxiety symptoms (Hospital Anxiety and Depression Scale), and mental health care utilization. Intervention usage was documented.ResultsThe mean number of intervention logins was 1.7, SD 2.5, median 1, interquartile range (IQR) 1-2. Thirty-four patients in the intervention group did not log in (22.5%), 63 (41.7%) logged in once, and 54 (35.8%) logged in multiple times (mean 3.6, SD 3.5, median 3, IQR 2-4). On clinician-assessed and self-reported PTSD symptoms, both the intervention and control group showed a significant decrease over time (P<.001) without significant differences in trend. PTSD at 12 months was diagnosed in 4.7% of controls and 4.4% of intervention group patients. There were no group differences on anxiety or depressive symptoms over time. Post hoc analyses using latent growth mixture modeling showed a significant decrease in PTSD symptoms in a subgroup of patients with severe initial symptoms (n=20) (P<.001).ConclusionsOur results do not support the efficacy of the Trauma TIPS Internet-based early intervention in the prevention of PTSD symptoms for an unselected population of injury patients. Moreover, uptake was relatively low since one-fifth of individuals did not log in to the intervention. Future research should therefore focus on innovative strategies to increase intervention usage, for example, adding gameplay, embedding it in a blended care context, and targeting high-risk individuals who are more likely to benefit from the intervention.Trial RegistrationInternational Standard Randomized Controlled Trial Number (ISRCTN): 57754429; http://www.controlled-trials.com/ISRCTN57754429 (Archived by WebCite at http://webcitation.org/6FeJtJJyD).

Military sexual trauma (MST) affects approximately 2% and 36% of male and female veterans, respectively, (e.g., Allard, Gregory, Klest, & Platt, 2011). Although the deleterious consequences of MST have been clearly established, few studies have explored treatment effectiveness for this population. Using archival data from a residential treatment program, the current study explored the effectiveness of cognitive processing therapy (CPT) in treating full or subthreshold posttraumatic stress disorder (PTSD) to compare U.S. veterans reporting an MST index trauma (MST-IT) to those without MST-IT. Of the 481 participants, 40.7% endorsed MST-IT. Multiway frequency analyses were utilized to compare men and women with and without MST on baseline demographic variables. Hierarchical linear models were constructed to investigate treatment outcome by MST status and sex. Results showed that 44.8%, 23.8%, and 19.6% of the variation in clinician- and self-reported PTSD and depression symptoms were explained by three models. Scores on all outcome measures significantly decreased over time for both groups. Additionally, women demonstrated a sharper decrease in PTSD symptoms over time than men. Lastly, men who reported MST-IT had higher PTSD symptoms than men without MST-IT on average. With no control group or random assignment, preliminary findings suggest residential treatment including CPT may be effective for MST-IT regardless of sex.

Objective: Incarcerated individuals have high rates of trauma exposure. IPT reduces posttraumatic stress disorder (PTSD) symptoms in non-incarcerated adults, but has not been examined in prison populations. Moreover, little is known about the mechanisms through which IPT reduces PTSD symptoms. The current study investigated the direct and indirect effects of IPT on PTSD symptoms. We hypothesized that IPT would decrease PTSD symptoms by enhancing social support and decreasing loneliness (theorized IPT mechanisms). Method: A sub-sample of trauma-exposed participants (n = 168) were drawn from a larger randomized trial (n = 181) of IPT for major depressive disorder among prisoners. We examined a series of mediation models using non-parametric bootstrapping procedures to evaluate the indirect effect of IPT on PTSD symptoms. Results: Contrary to hypotheses, the relation between IPT and PTSD symptoms was significantly mediated through improvements in hopelessness and depressive symptoms (mechanisms of cognitive behavioral interventions), rather than through social support and loneliness. Increased social support and decreased loneliness were associated with decreased PTSD symptoms, but IPT did not predict changes in social support or loneliness. Conclusions: IPT may reduce PTSD symptoms in depressed prisoners by reducing hopelessness and depression. (ClinicalTrials.gov number NCT01685294)

Moderate-quality evidence indicates that PCT is more effective in reducing PTSD severity compared to control conditions. Low quality of evidence did not support PCT as a non-inferior treatment compared to TF-CBT on clinician-rated post-treatment PTSD severity. The treatment effect differences between PCT and TF-CBT may attenuate over time. PCT participants drop out of treatment at lower rates relative to TF-CBT participants. Of note, all of the included studies were primarily designed to test the effectiveness of TF-CBT which may bias results away from PCT non-inferiority.The current systematic review provides the most rigorous evaluation to date to determine whether PCT is comparably as effective as TF-CBT. Findings are generally consistent with current clinical practice guidelines that suggest that PCT may be offered as a treatment for PTSD when TF-CBT is not available.

Posttraumatic stress disorder (PTSD) symptoms are robustly associated with intimate relationship dysfunction among veterans, but most existing research has focused on male veterans and their female partners. Links between PTSD and relationship functioning may differ between female-veteran couples and male-veteran couples. The current study used actor-partner interdependence models (APIMs) to test the associations between PTSD symptoms (i.e., veteran self-report or significant others' collateral-report) and each partner's reports of six domains of relationship functioning, as well as whether these links were moderated by the gender composition of the couple. Data were from 197 mixed-gender couples (N = 394 individuals) who completed baseline assessments for a larger randomized controlled trial of a couple-based PTSD treatment. Significant others' collateral PTSD reports were associated with their own ratings of relationship satisfaction, negotiation, psychological aggression, sexual pleasure, and sexual desire frequency, |β|s = .19-.67, and with veterans' ratings of negotiation and sexual desire frequency, |β|s = .20-.48. In contrast, veterans' self-reported PTSD symptoms were only associated with their own ratings of psychological aggression, β = .16. Gender moderated the associations between significant others' collateral PTSD reports and five of the six outcome variables; findings from exploratory subgroup analyses suggested links between reported PTSD symptoms and relationship functioning were generally more maladaptive for male-veteran couples, whereas female veterans showed more neutral or even helpful impacts of higher partner-perceived PTSD symptoms. These findings have implications for clinicians treating relational impacts of PTSD and emphasize the need for further research with female-veteran couples.

The purpose of this study was to identify how physical injury, perceived threat, forgiveness of others, and problem-focused coping influence the change of posttraumatic stress disorder (PTSD) symptoms. One hundred twenty patients who had experienced a traumatic vehicle accident participated in 1 to 2 months after the accident; 70 of these people involved at 6 months after the accident. We used a hierarchical linear model analysis to verify the impacts of predictors on change of PTSD symptoms as time passed. The results showed that PTSD symptoms decreased over time, and greater perceived threat would worsen PTSD symptoms and more forgiveness would decrease PTSD symptoms. On the other hand problem-focused coping and physical injury severity were not significantly related to the PTSD symptoms. Specifically, greater perceived threat was found to be related with a deceleration of the decrease in PTSD symptoms, whereas greater forgiveness of others was associated with an acceleration of this decrease. However, problem-focused coping and physical injury severity had no influence on the change rate of PTSD symptoms. Cognitive variable could be more important than physical injury to understand PTSD. In addition, forgiveness of other in a traumatic situation needs to be considered as one of coping strategies.