Improvement In Posttraumatic Stress Disorder Symptoms Research Articles

MDMA-assisted psychotherapy for the treatment of PTSD: A systematic review and meta-analysis of randomized controlled trials (RCTs).

Post-traumatic stress disorder (PTSD) is a mental health disorder resulting from exposure to traumatic events, manifesting in various debilitating symptoms. Despite available treatments, many individuals experience inadequate response or significant side effects. Previous reviews suggest promising outcomes with MDMA-assisted psychotherapy (MDMA-AT), but limitations prompt the need for a comprehensive evaluation. We searched various online databases and registries such as MEDLINE (via PubMed), Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov to retrieve RCTs that fit our inclusion criteria. We performed meta-analyses using Review Manager by applying a random-effects model. Dichotomous and continuous outcomes were pooled as risk ratios (RR) and standard mean difference (SMD), respectively. Nine studies with a total of 297 participants with PTSD were included in our meta-analysis. The control group consisted of inactive doses of MDMA (25-40 mg) or placebo. Our meta-analysis showed that MDMA-AT led to a significant reduction in the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) severity scores as compared to the control group (SMD -1.10, 95% CI: -1.62 to -0.59). More patients in the MDMA-AT group exhibited significant response (RR 1.59, 95% CI: 1.22, 2.08) and remission (RR 2.32, 95% CI: 1.47 to 3.66) as compared to patients in the control group. There was no significant difference regarding the incidence of ≥1 treatment-emergent adverse events (TEAE), ≥1 severe TEAE, and suicidal ideation between the two groups. MDMA-AT demonstrates significant efficacy in improving PTSD symptoms, enhancing both response and remission rates in individuals with chronic, treatment-resistant PTSD, while maintaining a favorable safety profile.

Effect of Obstructive Sleep Disorder Treatment on Posttraumatic Stress Disorder Symptoms: A Literature Review.

To explore whether continuous positive airway pressure (CPAP) adherence among adult patients with obstructive sleep apnea (OSA) and posttraumatic stress disorder (PTSD) affects the PTSD Checklist (PCL), a validated tool that measures severity of PTSD symptoms. Studies focusing on PTSD and OSA were searched in PubMed and CINAHL databases. Inclusion and exclusion criteria were applied, decreasing the article yield to nine. All articles chosen focused on the adult population and were conducted in North America. The literature review yielded eight observational cohort studies and one descriptive study. Seven studies were conducted with Veterans and all studies used the PCL tool. Three themes were identified: (a) Trauma and OSA, (b) OSA and PTSD Symptoms, and (c) CPAP Therapy and PTSD Symptoms. An area of further study is assessing how CPAP adherence might affect improvement in PTSD symptoms and how adherence can be improved. OSA is correlated with more severe PTSD symptoms, but CPAP use is associated with improvement in PTSD symptoms. The literature reviewed found PCL scores improved up to 10 points within 3 months of CPAP use. These findings highlight the importance of collaboration between mental health and sleep medicine professionals and opportunity for further study in this area. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].

Narrative therapy online intervention improves post-traumatic stress disorder symptoms, perceived stress, anxiety, and depression in nurses: A randomized controlled trial.

Clinical nurses have symptoms of post-traumatic stress disorder (PTSD), anxiety and depression, which seriously affect their physical and mental health. Narrative therapy (NT), a therapy for trauma-related psychological disorders, may be an effective intervention. The aim of this study was to evaluate the effect of NT on improving PTSD symptoms, perceived stress, anxiety and depression in nurses. A total of 92 participants who were clinical nurses and had positive PTSD symptom screening results were randomly assigned (1:1) to the intervention and control groups. The intervention group received NT and a psychological stress leaflet, while the control group received only a psychological stress leaflet. PTSD, perceived stress, anxiety, and depression were measured before and after the intervention to assess the effect of NT. After the intervention, the intervention group showed significantly lower levels of PTSD symptoms (P=0.025), perceived stress (P=0.033), anxiety (P=0.004), and depression (P=0.015) compared with the control group. Regarding the dichotomous outcomes of PTSD, anxiety, and depression, there was a statistically significant decrease in the number of positive cases of PTSD (P=0.030) and anxiety (P=0.002), while there was no statistically significant change in the number of positive cases of depression (P=0.060). NT is expected to alleviate PTSD symptoms, stress, anxiety, and depression among clinical frontline nurses, and healthcare professionals should consider applying NT to improve nurses' mental health.

Reciprocal changes in functioning and PTSD symptoms over the course of psychotherapy

Psychotherapies for posttraumatic stress disorder (PTSD) assume that PTSD symptom improvement will lead to improvements in functioning. Yet, few studies have examined the dynamic interplay between these constructs. Using a random intercepts cross-lagged panel model, we examined the association between functioning and PTSD, both modeled as a total score and as the DSM-5 subclusters, across twelve sessions of treatments that chiefly target functioning. Participants were 161 Veterans with PTSD enrolled in a randomized controlled trial comparing present centered therapy and an enhanced version of adaptive disclosure. Overall, PTSD symptoms, measured as the total PTSD score, led to changes in functioning more frequently than functioning predicting PTSD symptoms, although these effects did not appear until session 7. In terms of subclusters, functioning predicted changes in the PTSD subclusters B (intrusions), C (avoidance), and E (alterations in arousal and reactivity) at more timepoints compared to timepoints at which these subclusters predicted functioning. The dynamic relationships between PTSD and functioning in the context of functioning-focused treatments are complex, with functioning playing an important role in reduction of some of the core symptoms of PTSD.

Brief Report: Baseline HRV Time Domain Parameters Predict Trauma and Depression Symptom Change in Veterans with PTSD Undergoing Biofeedback.

Heart rate variability (HRV) is an index of cardiac autonomic function and an objective biomarker for stress and health. Improving HRV through biofeedback has proven effective in reducing symptoms of posttraumatic stress disorder (PTSD) and depression in veteran populations. Brief protocols involving fewer sessions can better maximize limited clinic resources; however, there is a dearth of knowledge on the number of clinical sessions needed to significantly reduce trauma and depression symptoms. We conducted a series of linear regression models using baseline, post-intervention, and follow-up data from intervention group participants (N = 18) who engaged in a pilot waitlist-controlled study testing the efficacy of a 3-session mobile app-adapted HRV biofeedback intervention for veterans with PTSD. Based on Nunan et al. (Pacing and Clinical Electrophysiology 33:1407-1417, 2010) short-term norms, we found that pre-intervention RMSSD in the normal range significantly predicted PTSD and depression symptom improvement. Findings suggest the utility of baseline RMSSD as a useful metric for predicting HRV biofeedback treatment outcomes for veterans with PTSD and comorbid depression. Those with below-normal baseline RMSSD may likely need additional sessions or an alternative treatment to show clinically meaningful symptom improvement.

Advances in Repetitive Transcranial Magnetic Stimulation for the Treatment of Post-traumatic Stress Disorder.

Post-traumatic stress disorder (PTSD) is a psychiatric disorder that develops and persists after an individual experiences a major traumatic or life-threatening event. While pharmacological treatment and psychological interventions can alleviate some symptoms, pharmacotherapy is time-consuming with low patient compliance, and psychological interventions are costly. Repetitive Transcranial Magnetic Stimulation (rTMS) is a safe and effective technique for treating PTSD, with advantages such as high compliance, low cost, and simplicity of implementation. It can even simultaneously improve depressive symptoms in some patients. Current research indicates that high-frequency rTMS shows better therapeutic effects compared to low-frequency rTMS, with no significant difference in the likelihood of adverse reactions between the two. Theta Burst Stimulation (TBS) exhibits similar efficacy to high-frequency rTMS, with shorter duration and significant improvement in depressive symptoms. However, it carries a slightly higher risk of adverse reactions compared to traditional high-frequency rTMS. Combining rTMS with psychological therapy appears to be more effective in improving PTSD symptoms, with early onset of effects and longer duration, albeit at higher cost and requiring individualized patient control. The most common adverse effect of treatment is headache, which can be improved by stopping treatment or using analgesics. Despite these encouraging data, several aspects remain unknown. Given the highly heterogeneous nature of PTSD, defining unique treatment methods for this patient population is quite challenging. There are also considerable differences between trials regarding stimulation parameters, therapeutic effects, and the role of combined psychological therapy, which future research needs to address.

Trait Mindfulness Moderates Treatment Outcomes in a Randomized Controlled Trial of Mantram Repetition Program for Veterans with Post-Traumatic Stress Disorder.

Objectives: This secondary analysis examined five facets of mindful awareness as potential moderators of clinical outcomes using data from a randomized controlled trial (RCT) that compared Mantram Repetition Program (MRP) with present-centered therapy (PCT) in veterans with post-traumatic stress disorder (PTSD). Methods: Data were examined from 173 veterans with military-related PTSD randomly assigned to receive eight sessions of MRP (n = 89) or PCT (n = 84). Clinician-administered and self-report measures of mindfulness (Five Facet Mindfulness Questionnaire [FFMQ]), PTSD severity, insomnia symptoms, and depression symptoms, and were obtained pre- and post-intervention. Hierarchical regressions were used to test for FFMQ moderation on clinical outcomes within the two treatment groups. Results: For those with greater ability to "describe their internal experience" (+1 standard deviation [SD]), MRP was associated with lower PTSD hyperarousal symptoms post-intervention than PCT (p < 0.001). For those with lower "nonreactivity to internal stimuli" (-1 SD), MRP was associated with greater reductions in PTSD avoidance and numbing symptoms and insomnia compared with PCT (all ps < 0.002). Conclusions: Pre-intervention mindfulness domains of "describe" and "nonreactivity to inner experience" differentially predicted improvements in PTSD and insomnia symptoms for MRP as compared with PCT subjects. The FFMQ may be an important tool for predicting patient preparedness for mindfulness-based interventions, such as MRP.

Testing the Effectiveness of a Mindfulness- and Acceptance-Based Smartphone App for Nurses Traumatized by the COVID-19 Pandemic: A Pilot Study

A significant proportion of frontline nurses developed post-traumatic stress disorder (PTSD) symptoms as a result of working during the COVID-19 pandemic. This study aimed to determine the efficacy of a mindfulness- and acceptance-based smartphone app intervention among nurses traumatized by the COVID-19 pandemic. This was a two-arm, randomized controlled trial. We randomly assigned 60 frontline nurses working in various clinical settings in the United States during the pandemic to either the intervention group (i.e. participants used the mindfulness app for 6 wk) or the wait-list control group. We assessed the app’s efficacy through outcome measures of PTSD symptom severity, experiential avoidance, rumination, mindfulness, and resilience, measured at pre-, mid-, and post-intervention periods and a 1-month follow-up. Intervention satisfaction and perceived usability of the app were assessed within the intervention group. There was strong evidence of within-between interaction for PTSD, experiential avoidance, and rumination, implying significant improvement of these outcomes for the intervention group as compared to the control group. We only found a within-group interaction effect for mindfulness, indicating significant improvement of mindfulness within the intervention group only. Participants in the intervention group reported high satisfaction levels and perceived usability with the app. Findings highlight that mindfulness- and acceptance-based smartphone apps can improve PTSD symptoms of nurses traumatized by the pandemic. Healthcare organizations should provide nurses with accessible interventions (e.g. mindfulness apps) to treat and prevent secondary behavioral consequences of the pandemic, such as PTSD.

Ketamine plus Cervical Sympathetic Blockade (CSB) Seems to be Significantly More Effective in Reducing the Symptoms of PTSD and Depression than CSB alone in a PTSD Cohort

Purpose: A significant number of Americans have symptoms of Post-Traumatic Stress Disorder (PTSD) and depression. Cervical sympathetic block (CSB) combined with sub-anesthetic ketamine infusions (KI) have been shown to reduce the symptoms of PTSD and depression via a synergistic effect. We aim to report a significant improvement of PTSD and depressive symptoms by concordant use of CSB and KI as compared to CSB alone. Methods: 26 consecutive patients were recruited to study the effects of KI and bilateral CSB vs bilateral CSB alone on sleep via a WHOOP band analysis. Patients were randomized to receive CSB alone vs KI and CSB. Patients received KI and CSB via clinic protocol. Results: Patients (n=11) that received CSB only, demonstrated a PCL reduction of 56.1% and BDI reduction of 59.5%. Patients (n=12) that received CSB and KI together, demonstrated a PCL reduction of 76.9% and a BDI reduction of 83.7%. Conclusion: Bilateral CSB combined with KI seems to be more effective in treating PTSD and depression symptoms as compared to bilateral CSB alone. Considering the size of the study, a larger scale evaluation would be necessary to confirm our findings.

Evaluation of a PTSD group intervention in a secondary care mental health service

Introduction: Secondary care mental health services in the United Kingdom are under increasing pressure to meet the demand for support for Post-Traumatic Stress Disorder (PTSD), however, there is a lack of clear guidance for treating complex cases of PTSD. Therefore, an evaluation was conducted to investigate the effectiveness of a pilot stabilisation group programme for clients with PTSD in a secondary care mental health service. Method: Attendees of the group (n = 64) were asked to complete routinely collected outcome measures of wellbeing (WEMWBS) and PTSD symptoms (PCL-5). A repeated-measures t-test analysed the pre and post group scores for statistical significance, whilst Reliable Change Indices analysed the data forreliable improvement and clinically significant change. Results: There was a significant difference between the pre and post group scores on the measures of wellbeing and PTSD symptoms. A large proportion of clients demonstrated reliable and clinically significant improvements in wellbeing. A small proportion of service users demonstrated clinically significant improvements in PTSD symptoms. Conclusion: The intervention shows promise as an initial stage of trauma treatment due to the improvements in wellbeing. However, a large proportion of clients are likely to require further intervention to reduce symptoms of PTSD.

CBT Intervention Post-2023 Southeast Türkiye Quake: A Case Study

This case study investigates the effectiveness of Cognitive Behavioral Therapy (CBT) in treating Post-Traumatic Stress Disorder (PTSD) in an individual survivor of the catastrophic 2023 Southeast Türkiye Earthquake. The study aims to provide detailed insights into the therapeutic process and outcomes of CBT applied in a post-disaster context. A 38-year-old female survivor, pseudonymously named Serpil, participated in an eight-week structured CBT program specifically tailored to address her severe PTSD symptoms following the earthquake. The therapeutic interventions included exposure therapy, cognitive restructuring, and relaxation techniques. Data collection was achieved using quantitative methods such as the Clinician-Administered PTSD Scale (CAPS) and the Beck Depression Inventory (BDI), supplemented by qualitative assessments through detailed therapy session notes and Serpil’s personal reflections. The intervention led to significant improvements in Serpil's PTSD symptoms, particularly a reduction in the frequency and severity of nightmares and flashbacks. Serpil reported enhanced coping mechanisms, which improved her overall psychological resilience and functionality. The data illustrate a notable decrease in PTSD symptomatology, corroborated by scores from CAPS and BDI, indicating an overall improvement in mental health and quality of life. This case study underscores the potential of CBT as a potent intervention for managing PTSD in survivors of natural disasters. It highlights the necessity of integrating specialized psychotherapeutic techniques in disaster response initiatives to address the psychological impacts effectively. The findings advocate for broader implementation and evaluation of similar interventions across diverse post-disaster settings to confirm these results and optimize treatment protocols. Further research with larger sample sizes and longer follow-up periods is recommended to enhance the generalizability and understanding of CBT's long-term effectiveness in disaster-stricken populations.

Changes in emotion regulation difficulties and PTSD symptom severity in an intensive treatment program for PTSD

BackgroundGreater difficulties in emotion regulation (ER) and decreased use of adaptive ER strategies have been associated with higher levels of posttraumatic stress disorder (PTSD) symptoms. To date, limited research has explored whether ER improves with PTSD treatment or whether such improvements are linked with improvements in PTSD symptoms. MethodsVeterans and service members with PTSD (N = 223) participated in a 2-week intensive treatment program (ITP) based in Cognitive Processing Therapy (CPT). ER was measured using the Difficulties in Emotion Regulation Short Form (DERS-SF) at baseline and on days 4 and 9 of treatment. PTSD symptoms were reported on the PTSD Symptom Checklist for DSM-5 (PCL-5) at baseline, on days 3, 5, 6, and 8 of treatment, and at post-treatment. ResultsDERS-SF scores decreased during treatment (Mchange = 5.12, d = 0.38). Baseline DERS-SF did not predict overall PCL-5 scores across timepoints (p = .377). However, scores on the DERS-SF over time were significantly associated with PCL-5 improvement over the course of treatment (p < .001, R2b = 0.07). Finally, improvements in all subscales of the DERS-SF across time except clarity were significantly associated with improvement in PCL-5 over time. LimitationsAdditional treatment components in the ITP beyond CPT may have contributed to ER improvements. Conclusions are also limited by the use of self-report data. ConclusionsAn intensive CPT-based treatment program for veterans and service members can lead to improved ER in two weeks. ER improvements are associated with PTSD symptom severity during the ITP.

An Integrative Review of Post-traumatic Stress Disorder Intervention for Police Officers and Firefighters: Focusing on Studies from 2006 to 2023

Objectives: This study aimed to determine the current state of Post-traumatic stress disorder (PTSD) interventions for police officers and firefighter and their effectiveness by using an integrative review. There has been a significant increase in mental health issues among police and firefighters due to exposure to traumatic life events, and an integrative review of the research evidence underpinning these programs is timely. Methods: Previous intervention studies were identified through PubMed, Web of science, Embase, PsycINFO, CINAHL, DBpia, RISS, and KISS database. Eligible studies included articles published between 2006 and 2023 in English and Korean. We excluded articles that did not include police and firefighters and did not focus on PTSD interventions. We also excluded simple systematic reviews, protocols, and editorials. Results: A total of 26 studies were selected for this an integrative review. The intervention elements of extracted 26 studies were categorized into 3 themes. The intervention elements were divided into the themes of psychosocial centered interventions to reduce PTSD symptoms, target population-oriented specific PTSD interventions, and applying individual, group and integrated interventions. Conclusions: The results show that several PTSD interventions can be effective methods to improve PTSD symptoms of police officers and firefighters suffered from PTSD. The findings emphasize the importance of implementing programs to provide coping strategies and regulate physical, emotional, and mental reactions to address crisis situations faced by police officers and firefighters. Therefore, those findings will serve as a foundation for the development of PTSD intervention for police officers and firefighters in South Korea.

Effects of mindfulness-based cognitive therapy for Chinese adults with PTSD symptoms: protocol for a randomised controlled trial

IntroductionEmerging evidence supports mindfulness as a potential psychotherapy for post-traumatic stress disorder (PTSD). Individuals with subthreshold PTSD experience significant impairment in their daily life and functioning due to PTSD symptoms, despite not meeting the full diagnostic criteria for PTSD in DSM-5. Mindfulness skills, including non-judgmental acceptance, attentional control and openness to experiences may help alleviate PTSD symptoms by targeting characteristics such as intensified memory processing, dysregulated hyperarousal, avoidance, and thought suppression. This trial aims to test the effects of mindfulness-based cognitive therapy (MBCT) when compared to an active control.Method and analysisThis 1:1 randomised controlled trial will enroll 160 participants with PTSD symptoms in 2 arms (MBCT vs. Seeking Safety), with both interventions consisting of 8 weekly sessions lasting 2 h each week and led by certified instructors. Assessments will be conducted at baseline (T0), post-intervention (T1), and 3 months post-intervention (T2), with the primary outcome being PTSD symptoms measured by the PTSD checklist for DSM-5 (PCL-5) at T1. Secondary outcomes include depression, anxiety, attention, experimental avoidance, rumination, mindfulness, and coping skills. Both intention-to-treat and per-protocol analyses will be performed. Mediation analysis will investigate whether attention, experimental avoidance, and rumination mediate the effect of mindfulness on PTSD symptoms.DiscussionThe proposed study will assess the effectiveness of MBCT in improving PTSD symptoms. The findings are anticipated to have implications for various areas of healthcare and contribute to the enhancement of existing intervention guidelines for PTSD.Trial registration numberChiCTR2200061863.

Subtypes of childhood maltreatment and posttraumatic stress disorder symptoms in an adult trauma sample: The mechanistic role of sleep.

Childhood maltreatment is indisputably linked to adverse mental health outcomes, including an increased risk to develop posttraumatic stress disorder (PTSD) in adulthood. The role of childhood maltreatment in the context of recovery from a trauma later in adulthood is not well understood. A variable related to both childhood maltreatment and PTSD symptoms, and a potential link between the two, is sleep. The current study aimed to understand how sleep disturbances may play a mechanistic role in the effect of subtypes of childhood maltreatment on PTSD symptom severity in an adult trauma sample. 160 adults (90 women; Mage = 33.73, SD = 10.86) were recruited from the emergency department at a Level-1 trauma center in southeastern Wisconsin after experiencing a traumatic injury. Experiences of childhood maltreatment and sleep were self-reported at 2-week and 3-month posttrauma, respectively. PTSD symptoms were clinically assessed 6 months later. Sleep disturbances 3-month posttrauma mediated the effect of emotional abuse, physical neglect, and emotional neglect on PTSD symptom 6 months after the traumatic injury. The effect of sexual and physical abuse on PTSD symptoms was not significantly mediated by sleep disturbances. These findings highlight the differential impact of subtypes of childhood maltreatment on PTSD symptoms, the mechanistic role of sleep, and the need to consider early life adversity when assessing adult posttrauma experiences. These results also suggest that interventions aimed at improving sleep quality might improve PTSD symptoms in those who have experienced childhood maltreatment and a subsequent traumatic injury in adulthood. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Revisiting Eye Movement Desensitization and Reprocessing Therapy for Post-traumatic Stress Disorder: A Systematic Review and Discussion of the American Psychological Association's 2017 Recommendations.

This literature review evaluates the efficacy and clinical applications of eye movement desensitization and reprocessing (EMDR) therapy for post-traumatic stress disorder (PTSD). The review highlights the effectiveness of EMDR in reducing PTSD symptoms and explores variations in treatment protocols, populations studied, and outcome measures. We conducted systematic searches of multiple databases, supplemented with manual searches and reference list exploration. The inclusion criteria focused on English-language studies published between January 2000 and June 2023, with a specific emphasis on adult psychiatric patients with PTSD receiving EMDR treatment. The review utilized Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for narrative literature reviews. Out of 867 identified studies, 16 met the eligibility criteria. Most studies found that EMDR was superior in relieving PTSD when compared to controls. Eleven of the 16 selected studies demonstrated improvement in PTSD symptoms. An additional three studies noted an improvement in PTSD symptoms when compared to their waitlist control counterparts. One study found EMDR superior in combating depressive symptoms when compared to rapid eye movement desensitization. EMDR therapy is an appropriate treatment for PTSD. Although some studies compared to waitlist controls, and others have a small number of participants, the data supports the use of EMDR for PTSD. Future studies are needed to continue to better understand the mechanism and application in different populations.

Clinician Burnout and Effectiveness of Guideline-Recommended Psychotherapies

Clinician burnout has been associated with clinician outcomes, but the association with patient outcomes remains unclear. To evaluate the association between clinician burnout and the outcomes of patients receiving of guideline-recommended trauma-focused psychotherapies for posttraumatic stress disorder (PTSD). This cohort study was set at the US Veterans Affairs Health Care System and included licensed therapists who provided trauma-focused psychotherapies and responded to an online survey between May 2 and October 8, 2019, and their patients who initiated a trauma-focused therapy during the following year. Patient data were collected through December 31, 2020. Data were analyzed from May to September 2023. Therapists completing the survey reported burnout with a 5-point validated measure taken from the Physician Worklife Study. Burnout was defined as scores of 3 or more. The primary outcome was patients' clinically meaningful improvement in PTSD symptoms according to the PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). Patient dropout, therapist adherence, and session spacing was assessed through electronic health records. Multivariable random-effects logistic regression examined the association of therapist burnout and clinically meaningful improvement, adjusted for case-mix. In this study, 165 of 180 (91.7%) therapists (89 [53.9%] female) completed the burnout measure and provided trauma-focused psychotherapies to 1268 patients (961 [75.8%] male) with outcome data. Fifty-eight (35.2%) therapists endorsed burnout. One third of patients (431 [34.0%]) met criterion for clinically meaningful improvement. Clinically meaningful improvement in PTSD symptoms was experienced by 120 (28.3%) of the 424 patients seen by therapists who reported burnout and 311 (36.8%) of the 844 patients seen by therapists without burnout. Burnout was associated with lower odds of clinically meaningful improvement (adjusted odds ratio [OR],0.63; 95% CI, 0.48-0.85). The odds of clinically meaningful improvement were reduced for patients who dropped out (OR, 0.15; 95% CI, 0.11-0.20) and had greater session spacing (OR, 0.80; 95% CI, 0.70-0.92). Therapist adherence was not associated with therapy effectiveness. Adjusting for dropout or session spacing did not meaningfully alter the magnitude of the association between burnout and clinically meaningful improvement. In this prospective cohort study, therapist burnout was associated with reduced effectiveness of trauma-focused psychotherapies. Studying when and how burnout affects patient outcomes may inform workplace interventions.

Reducing posttraumatic stress disorder symptom severity among depressed women with childhood sexual abuse histories in interpersonal psychotherapy-trauma: The role of improved social functioning.

Childhood sexual abuse (CSA) increases risk for posttraumatic stress disorder (PTSD), and both CSA and PTSD are strongly associated with impaired social functioning. Interpersonal psychotherapy (IPT) has demonstrated promise for adults with PTSD and has been shown to be effective for women with PTSD and histories of CSA, but the mechanisms by which IPT might improve PTSD are unknown. The current secondary analysis tested whether the ameliorative effect of IPT-trauma (IPT-T) on PTSD, demonstrated in a randomized effectiveness trial, was mediated by improved social function. The randomized effectiveness trial compared IPT-T to clinic psychotherapy in a publicly funded community mental health center. Women with CSA histories and major depression (n = 162; Mage = 36.3; 54% White, 38% Black, 8% other race) were randomly assigned to IPT-T or CP, and 16 free sessions of IPT-T or CP were offered within a 32-week treatment period. Eighty-eight percent of the sample met diagnostic criteria for PTSD. Mediation models confirmed hypotheses, showing that the effect of IPT-T on improved PTSD symptoms at Week 32 (end of treatment) was partially mediated by better social functioning at Week 16 (middle of treatment period; path c¹: B = 12.25, p = .04, 95% confidence interval [.44, 24.05]). Findings support that a non-exposure-based therapy can reduce PTSD symptoms via improved social functioning. Given extensive literature showing the importance of social functioning in mental health generally and PTSD specifically, integrating a focus on social functioning (e.g., building social skills, expanding support networks) into treatments, including exposure-based treatments, may enhance outcomes. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

BPD Compass: Using a dimensional model of psychopathology to treat co-occurring borderline personality disorder and posttraumatic stress symptoms.

BPD Compass is a transdiagnostic psychotherapy that includes cognitive, behavioral, and mindfulness skills targeting the personality dimensions of negative affectivity, disinhibition, and antagonism. Given considerable symptom comorbidity and overlap in etiology between borderline personality disorder (BPD) and posttraumatic stress disorder (PTSD), this study investigated whether BPD Compass holds promise as an integrated approach to simultaneously treating co-occurring BPD features and PTSD symptoms. Participants included 84 trauma-exposed adults who participated in a two-phase clinical trial (Phase 1: randomized controlled trial of BPD Compass vs. waitlist [n = 43]; Phase 2: open trial of BPD Compass [n = 41]). Compared to waitlist, BPD Compass led to medium-to-large-sized, significant improvements in BPD features, βs = -.57 -.44, and facets of neuroticism, βs < -.55--.73, as well as small, nonsignificant improvements in self-reported, β = -.20, and clinician-rated PTSD symptom severity, β = -.19. During treatment, within-person improvements in PTSD symptoms predicted subsequent improvements in BPD features, β =.13, but not vice versa, β =.07. Within-person PTSD symptom reduction also predicted subsequent improvement in all personality dimensions, whereas only within-person improvement in despondence, β =.12, affective dysregulation, β =.11, and dissociative tendencies, β =.12, predicted PTSD symptom reductions. Findings offer preliminary support for the potential of BPD Compass to target BPD features and aspects of neuroticism and agreeableness among trauma-exposed adults. Moreover, PTSD symptom change predicting subsequent improvement in BPD features runs counter to current stage-based treatment models that emphasize BPD feature stabilization before engaging in trauma-focused therapy.

Heart rate reactivity during trauma recall as a predictor of treatment outcome in cognitive processing therapy for PTSD

Emotional engagement when recollecting a trauma memory is considered a key element of effective trauma-focused therapy. Research has shown that reduced physiological reactivity during trauma recall is associated with worse treatment outcomes for posttraumatic stress disorder (PTSD), but this has yet to be examined in a cognitively oriented treatment. This study examined whether pretreatment heart rate (HR) reactivity during trauma recall predicts PTSD symptom improvement and treatment dropout during Cognitive Processing Therapy (CPT) for PTSD. Participants were 142 women with PTSD secondary to interpersonal violence enrolled in one of two clinicals trials. HR reactivity reflected the mean increase in HR after listening to two 30-s scripts of the trauma memory prior to treatment. Linear mixed-effects models showed the effect of HR reactivity on change in total PTSD symptoms was not significant, but lower HR reactivity predicted less improvement in reexperiencing and avoidance and was associated with increased dropout. Findings suggest pretreatment physiological reactivity to the trauma memory may be a prognostic indicator of some elements of treatment response in CPT. Results tentatively support the importance of emotional activation during trauma recall in cognitive treatment of PTSD, though more research is needed to clarify how low HR reactivity impacts treatment.