Male Military Veterans Research Articles

Occupational rehabilitation of Israel Defense Forces veterans with PTSD: A 5-year follow-up.

The MOD Rehabilitation Department (RD) offers three types of rehabilitation tracks (RTs): (a) education, (b) work placement, (c) economic independence. This study aimed to examine which of the offered RTs predicted a better integration into the workforce. This is an observational, prospective, case-controlled study. Data were collected from administrative files. The data pertained to soldiers injured in military service, under RD care and recognised as posttraumatic stress disorder (PTSD) patients between 2001 and 2006. As rehabilitation takes 5-6 years, we examined two points in time: 2015 and 5 years later, in 2020. The studied population comprised 462 male military veterans injured during military service and diagnosed with PTSD (mean age at the time of injury was 24.60 [SD 5.70]; median = 22). Of the participants, 87.9% (n = 406) also sustained physical injury, and 12.1% were not injured physically (n = 56; 12.1%). A regression analysis indicated that the educational RT (OR = 19.509; p = .001) predicted integration into the workforce. The whole model explained 49.0% of the variance. Of the three RT types examined, education is the most important. The more years of study, the better the ability to integrate into the workforce.

Research Letter: Characterizing Lifetime Mild TBI Exposure Among Female and Male Military Service Members and Veterans in the LIMBIC-CENC Study.

To (1) characterize lifetime mild traumatic brain injury (TBI) exposures among male and female US military service members and Veterans (SMVs) and (2) evaluate sex-related differences in mild TBI exposures. Clinical research laboratory. Participants were enrolled in the ongoing Long-term Impact of Military-relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium (LIMBIC-CENC) Prospective Longitudinal Study. Cross-sectional. Lifetime history of mild TBI was measured via structured interview. All mild TBI characteristics were collected as part of this interview, including total lifetime number; environment (deployment vs. non-deployment); timing of injury (relative to military service and age); and mechanism of injury (blast-related vs. non-blast). Most participants (n =2323; 87.5% male; 79.6% Veteran) reported ≥1 lifetime mild TBI (n =1912; 82%), among whom, many reported ≥2 lifetime mild TBIs. Female SMVs reported fewer total lifetime mild TBIs than male participants (P <0.001), including fewer deployment-related (P <0.001) and non-deployment (P <0.001) mild TBIs. There were significant sex differences for total number of mild TBIs sustained before (P =0.005) and during (P <0.001) military service but not after separation from military service (P =0.99). Among participants with a lifetime history of mild TBI, female SMVs were less likely to report ≥2 mTBIs (P =0.003); however, male SMVs were more likely to report a mild TBI during military service (P =0.03), including combat-related mild TBI (P <0.001) and mild TBI involving blast (P <0.001). These findings inform clinical and research efforts related to mild TBI in US military SMVs. It may not be sufficient to simply measure the total number of mild TBIs when seeking to compare clinical outcomes related to mild TBI between sexes; rather, it is important to measure and account for the timing, environment, and mechanisms associated with mild TBIs sustained by female and male SMVs.

Combat-Genital Injury in UK Male Military Veterans: A Pilot and Feasibility Study Exploring Long-Term Psychosocial and Sexual Experiences and Support Needs

During the most recent conflicts in Iraq and Afghanistan, genital injuries were reported among male personnel at rates higher than previous conflicts. To date, research has focused predominantly on immediate medical management with limited published research exploring the long-term psychosocial and sexual impacts of combat-genital injury. This pilot study, therefore, aimed to explore the psychosocial and sexual health outcomes, experiences and support needs of military veterans who sustained combat-genital injuries and to assess the feasibility of conducting further research on this topic. A cross-sectional online survey design was used, comprising open and closed questions. Recruited through opportunity and snowball sampling, 11 eligible male UK veterans who had sustained a combat-genital injury completed the survey between March and July 2021. The results indicate that participants experienced long-term challenges related to their genital injury including low self-esteem, sexual function difficulties, and fertility concerns. The findings provide preliminary evidence of unmet long-term psychosocial, sexual, and fertility support needs among UK veterans with combat-genital injury. Further research is required to better understand the psychosexual wellbeing of combat veterans who have sustained physical injuries more broadly and to determine how best to provide psychosexual support to those who may benefit.

Relationships of DSM-5 PTSD symptom clusters to suicidal ideation and death ideation in outpatient military veterans

Veterans with PTSD are at higher risk for suicide. This study examined the specific associations of PTSD symptom clusters with suicidal ideation (SI) and death ideation (DI), independently from depressive symptom clusters. Participants included 695 Israeli male outpatient military veterans (M = 25.35 years, SD = 5.65), divided into subsamples of probable PTSD (PTSD Checklist for DSM-5 [PCL-5] ≥ 33) and subthreshold PTSD scores (PCL-5 < 33). Data were extracted from medical chartsand self-report questionnaires. The main analyses included logistic regression to evaluate the associations between SI and DI (Brief Symptom Inventory, items 9 and 39) and PTSD symptom clusters (PCL-5), controlling for depressive symptom clusters (Beck Depression Inventory; cognitive-affective and somatization) in each subsample. The results showed that, for veterans with probable PTSD, the negative alterations in cognition and mood symptom cluster was positively correlated with SI and DI, while avoidance was negatively correlated with SI, independently from depressive symptoms clusters. In those with sub-syndromal PTSD, the re-experiencing cluster was positively correlated with DI, independently from the depressive symptom clusters. These findings highlight the importance of targeting PTSD components, such as negative alterations in cognition and mood symptoms experienced by veterans with PTSD, as part of suicide prevention efforts.

AGING IN THE RIGHT PLACE: TEMPORARY SUPPORTIVE HOUSING FOR OLDER MALE VETERANS IN CALGARY, CANADA

Abstract In 2019 an estimated 1.6% of emergency shelter users in Canada were veterans (1,905 individuals), which is consistent with the proportion of veterans in the general population (1.7%). However, veterans tend to be older, male, and cite an illness or medical condition as a contributing factor to their homelessness, than their non-veteran counterparts. As part of the Aging in the Right Place (AIRP) study, we sought to understand the housing and support needs of older male military veterans (age 50+) living in a congregate temporary supportive housing in Calgary, Alberta. This exploratory, multi-methods study used: (1) de-identified document review, (2) environmental audit, (3) in-depth qualitative key informant interviews with service providers and (4) in-depth qualitative and Photovoice interviews with older shelter residents to understand the shelter needs of older homeless veterans. The data was collected between February and June 2023. Interviews were transcribed, managed with NVivo 1.6.1, and team-based flexible coding was employed on the key informant (n=5) and shelter resident (n=5) interviews to determine older male veterans’ shelter needs. In this presentation we share the findings of the study and offer recommendations for shelter and services designed to assist older housing insecure veterans to age in the right place.

Drivers of dropout and enhancers of engagement for male military veterans in therapy: practitioner perspectives

ABSTRACT Male veterans are vastly over-represented in suicide rates relative to non-veterans. A critical avenue for improving male veterans’ mental health outcomes is improving their engagement with mental health services. This study presents a qualitative investigation of mental health practitioners’ perspectives on enhancers of engagement in, and drivers of dropout from therapy among male veterans. Participants were 138 mental health practitioners across Australia, the USA, Canada, New Zealand and the UK (44.9% male; age M = 47.5 years, SD = 12 years). Participants responded to qualitative survey items inquiring about their perspectives on what works to engage male veterans in therapy, alongside common drivers of therapy dropout. Under an overarching theme contextualising the therapeutic alliance between veterans and mental health practitioners, interpretive description analyses led to eight distinct subthemes. Results highlight the range of areas in which mental health practitioners can thoughtfully adapt their practice to engage male veterans and align with military masculinities. In addition, findings underscore the range of barriers facing veterans when they seek help, which can precipitate dropout if not overcome by the right balance between practitioner engagement and veteran persistence.

Erectile Dysfunction in a U.S. National Sample of Male Military Veterans.

Erectile dysfunction (ED) is one of the most prevalent sexual dysfunctions in men and often co-occurs with physical and mental health issues. Military veterans are at elevated risk for many comorbid physical and mental health issues, including ED, although little research has examined the prevalence and health burden of ED in the general U.S. veteran population. The present study calculated the weighted lifetime prevalence of ED and its association with physical and mental health conditions in a nationally representative sample of U.S. veterans. Using data from a nationally representative sample of 921 male U.S. veterans, self-report assessments assessed major depressive disorder (MDD), generalized anxiety disorder, probable post-traumatic stress disorder (PTSD), at-risk/problem gambling, and past two-week suicidal ideation and attempts, as well as 22 physical health conditions. The weighted lifetime prevalence of ED among veterans was 14.2% (95% CI = 12.0%-16.0%). Veterans with ED were more likely to be older than 60, unemployed, to have served less than four years in the military, and to have served in combat roles and in the Vietnam War. Relative to veterans without ED, veterans with ED had higher rates of sleep disorders (adjusted odds ratio [aOR] = 3.23), arthritis (aOR = 2.60), high cholesterol (aOR = 2.30), diabetes (aOR = 2.29), high blood pressure (aOR = 2.14), obesity (aOR = 2.12), heart disease (aOR = 2.10), cancer (aOR = 2.07), respiratory illness (aOR = 2.02), and chronic pain (aOR = 1.86). After adjusting for sociodemographic characteristics and physical health conditions, ED was associated with increased odds of MDD (aOR = 2.88), at-risk/problem gambling (aOR = 2.45), and suicidal ideation (aOR = 1.91) but not for generalized anxiety disorder (aOR = 1.69) or probable PTSD (aOR = 1.63). When considered in the context of all mental health variables, MDD was independently associated with ED (aOR = 3.39). This study examined both mental and physical health conditions associated with ED in a U.S. nationally representative sample of veterans. ED is prevalent in veterans and associated with elevated physical and mental health burden. Results highlight the importance of considering ED in disease prevention and treatment efforts in this population. These findings may help inform prevention approaches as well as clinical targets for early screening and treatment in vulnerable subgroups of this population. Notably, data collected relied on self-report assessments; data on race and socioeconomic status were not collected.

Reliable and clinically significant change in the clinician-administered PTSD Scale for DSM-5 and PTSD Checklist for DSM-5 among male veterans.

We calculated the reliable change index (RCI) and clinically significant change (CSC) values for two widely used measures of posttraumatic stress disorder (PTSD): The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) and the PTSD Checklist for DSM-5 (PCL-5) and examined how symptom changes at these thresholds related to improvements in psychosocial functioning. We used data from three independent samples of male military veterans, including two randomized controlled trials for PTSD (N = 198 for Sample 1 and N = 102 for Sample 2) and a cross-sectional study of primary care patients (N = 228). For Sample 1, within-person change in CAPS-5 and PCL-5 scores of ≥ 13 and 15, respectively, was indicative of reliable change. For Sample 2, within-person change in CAPS-5 and PCL-5 scores of ≥ 12 and 18, respectively, was indicative of reliable change. Scores of ≤ 8 and 28 on the CAPS-5 and PCL-5, respectively, indicated a participant is more likely to belong to the non-PTSD population than the PTSD population (i.e., clinically significant change) in both Samples 1 and 2. Participants who exhibited reliable or CSC reported significantly better psychosocial functioning at all posttreatment assessments than those who did not. Results provide thresholds for identifying clinically meaningful PTSD symptom change using these measures. Care should be taken to interpret these values appropriately and relative to numerous other definitions for meaningful symptom change. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Extreme sport as an intervention for physically injured military veterans: the example of competitive motorsport

Purpose Physically or psychologically injured military veterans are motivated and benefited by physical activity or sport that may involve high levels of achievement. The aim of this study was to provide an in-depth insight into the impact of Competitive Motorsport (CM) on physically injured/disabled veterans’ subjective well-being and in turn determine if it improves the quality of their lives. Methods This is a qualitative study. Two sets of semi-structured interviews were conducted with 14 male British military veterans including a 6-month follow-up. All participants were subjected to a permanent, moderate or severe, physical injury/disability. Data were analysed in accordance with the principles of Thematic Analysis. Results/Conclusions Five key elements (familiar environment, team spirit, adrenaline rush, competition and equality) made CM a unique experience for physically injured/disabled veterans. Various psychological and physical benefits were found, including an increased sense of accomplishment, opportunity to socialise in a non-clinical environment, embracement of body image and adoption of a healthier lifestyle. Since physical activity and sport are among growing research on alternative interventions for military veterans, they deserve serious consideration as part of the treatment regimens and rehabilitation programmes to improve physically inured/disabled veterans’ physical and mental health. Implications for Rehabilitation Competitive Motorsport is an effective means of improving physical health and subjective well-being of physically injured/disabled military veterans. Multiple perceived psychological and physical benefits were identified over time, including motivation for living, embracement of body image and adoption of a healthier lifestyle. Competitive Motorsport deserves consideration as part of the treatment regimens and rehabilitation programmes to improve physically injured/disabled veterans’ physical and mental health while facilitating transition to civilian life.

PTSD in veterans, couple behavior, and cardiovascular response during marital conflict.

Posttraumatic stress disorder (PTSD) is associated with strain in marriage and similar intimate relationships, and such difficulties could contribute to associations of PTSD with risk of cardiovascular disease (CVD). Heightened cardiovascular reactivity (CVR) during stressful marital interactions may be an important mechanism in this regard. This study examined dysfunctional behavior during marital conflict as a mediator of the association of PTSD with heightened CVR during these interactions. In 64 couples comprising male military veterans and female partners, participants underwent a 17-min video-recorded conflict discussion, with assessment of blood pressure and cardiac sympathetic activation (i.e. preejection period). In half of the couples, veterans met interview and questionnaire criteria for PTSD. Behavior was coded for aspects of affiliation (e.g., warmth vs. hostility) and control (e.g., dominance vs. deference), as well as blends of these broader dimensions. Extending previous reports from this study, actor-partner mediational analyses indicated that PTSD contributed to larger increases in veterans' and spouses' systolic blood pressure during the interaction through effects of the individual's own expressions of low warmth. PTSD contributed to veterans' and spouses' greater cardiac sympathetic activation through effects of the individual's own expressions of hostile control (e.g., blame, criticism). Hence, expressions of low warmth and high hostile control contribute to effects of PTSD on veterans' and spouses' heightened CVR during marital conflict discussions, suggesting a mechanism linking PTSD with CVD risk and potential targets for risk-reducing behavioral interventions. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

What Little We Know: Peer-Reviewed Articles on the Impact of United States Military Culture on Male Victims of Military Sexual Trauma

Conduct a narrative review study to identify, evaluate, and summarize pertinent published literature on the influence of U.S. military culture on male victims of military sexual assault (MSA) and military sexual trauma (MST). Various aspects of military culture have been shown to contribute significantly to barriers of reporting, prevention, and social support for male service members who have experienced MST and MSA in the U.S. military forces. A variety of U.S. military cultural factors associated with barriers to reporting MST/MSA among male military service members and veterans were assessed and identified in this narrative review. Overall study findings suggest that increasing research on the impact of military culture and male MST and MSA is imperative in the effort to reduce and prevent sexual violence within the U.S. military armed forces. Various aspects of the U.S. military culture play a significant role in the influence of sexual assault occurrences that take place within U.S. military service units. Supporting evidence suggests that the U.S. military culture impacts the overall severity of barriers to reporting sexual assault and/or trauma among male military service members and veterans.

The psychophysiological response during post-traumatic stress disorder treatment with modular motion-assisted memory desensitisation and reconsolidation (3MDR)

ABSTRACT Background: Psychophysiological changes are part of post-traumatic stress disorder (PTSD) symptomatology and can signal emotional engagement during psychological treatment. Objectives: The aim of this study was to explore psychophysiological responses during multi‐modular motion‐assisted memory desensitization and reconsolidation (3MDR) therapy. Increased self-reported distress, substantially increased heart rate (HR) and breathing rate (BR) were expected at the start of therapy and predicted to improve over time. Since physical exercise demands during therapy were low, any large HR or BR responses were considered part of the psychophysiological response. Methods: This study used pooled data collected during a randomized controlled trial of 3MDR, which demonstrated significant improvement as measured by the Clinician Administered PTSD Scale. Whilst attending therapy, HR and BR data, subjective units of distress (SUD) score and phrases to describe feelings whilst exposed to trauma-related images were collected continuously from 37 UK male military veterans with PTSD. Results: HR and BR were significantly increased throughout all sessions (p < .01 for both). Whilst HR was raised slightly remaining on average below 100 beats/minute, BR was increased substantially with average values between 40 and 50 breaths/minute. SUD scores were very high during therapy which concurred with the many negative feelings experienced during therapy sessions. Across the course of the treatment, SUD scores (p < .01) and negative feelings were reduced (p < .001), and positive feelings have increased (p < .01) significantly, reflecting improvements in clinicians assessed PTSD symptoms. Across therapy sessions, HR (p = .888) and BR (p = .466) responses did not change. Conclusions: The strong psychophysiological response alongside high levels of self-reported distress and negative feelings is interpreted as high emotional engagement during therapy. A novel finding was the very significant BR increase throughout recorded sessions. Future PTSD research should include BR response to therapy and explore breathing control as a treatment target.

Living with mesothelioma: A qualitative study of the experiences of male military veterans in the UK.

The UK has the highest incidence of mesothelioma in the world. Evidence in the United States suggests that mesothelioma may disproportionately affect military veterans. However, there has been no investigation of the experience of UK veterans living with mesothelioma. The Military Mesothelioma Experience Study (MiMES) aimed to understand the experience and health/support needs of British Armed Forces personnel/veterans with mesothelioma. Semi-structured interviews were conducted with 13 veterans living with mesothelioma, and nine family members of veterans living with mesothelioma. Participants were recruited via charities and asbestos support groups. Data were analysed using thematic analysis. Participants' experiences are presented using three themes, i) exposure to asbestos and awareness of asbestos related diseases, ii) using military strategies to cope with mesothelioma and iii) preferences for information and support. MiMES indicates that the nature and range of UK military veterans' asbestos exposure is varied and not limited to high risk occupations. Participants' knowledge of asbestos and experience of mesothelioma influenced their experiences of diagnosis. Participants had coping strategies influenced by their military experiences. Assistance in navigating health and military systems was considered beneficial, especially if support was provided by professionals with knowledge or experience of the military. Attributes which may inhibit veterans from seeking professional support are discussed. MiMES provides insight into how UK military veterans experience and cope with mesothelioma. Key implications focus on the role that Mesothelioma Nurse Specialists, Asbestos Support Groups and veterans groups play in providing acceptable support for UK veterans.

The Contribution of Empathy to the Adjustment of Military Veterans and Their Female Partners

ObjectiveEmpathy plays an important role in romantic relationships; and thus, this study examined the contribution of both Israeli male military veterans' and their female partners' cognitive and emotional empathy to both partners' adjustment defined as posttraumatic stress symptoms (PTSS) and functioning, comparing veterans who asked for mental health help and a comparison group of veterans who did not.MethodParticipants were 300 Israeli male veterans of the 2006 Israel–Lebanon War and their female partners, all of whom completed self‐report questionnaires.ResultsResults demonstrated significant differences between the models in the groups. Among the male veterans in the research group, higher levels of veterans' own emotional and cognitive empathy were associated with higher levels of their PTSS and lower levels of functioning. In the comparison group, females' Personal Distress and Fantasy subscales of the Interpersonal Reactivity Index were positively associated with their own PTSS, whereas the Empathic Concern subscale was negatively associated. Females' Perspective‐Taking served as a protective factor only for those in the research group and was negatively associated with females' PTSS. In each of the models, the cross effects (from one partner to the other) were limited.ConclusionThe various facets of empathy and its dyadic nature appear to play a different role in the adjustment of each partner in military couples. The associations among the research group were stronger than in the comparison group.

Interrelationship of emotional stability, hassles, uplifts, coping and stress-related symptoms in Swedish female and male military veterans.

Drawing on previous research, two hypotheses were tested: (1) the higher the frequency of daily uplifts and use of functional coping strategies, and the lower the frequency of daily hassles and use of dysfunctional coping strategies, the lower the prevalence of stress-related symptoms will be, and vice versa; and (2) the direct relationship between the personality dimension emotional stability and stress-related symptoms, will be moderated by daily hassles, daily uplifts and coping processes. A quantitative test of a qualitatively developed model was performed. A questionnaire was sent to all Swedish military veterans who had served in the period 2011-2015 and 1859 individuals (1,614 men and 199 women, 46 individuals did not mark gender) responded (40.5% total response rate). All analyses were made separately for men and women. Comparisons between theoretically favorable and unfavorable profiles across the model variables, daily uplifts, daily hassles, functional coping and dysfunctional coping (based on a cluster analysis), showed considerable differences regarding the prevalence of stress-related symptoms as predicted by the model and supporting the first hypothesis. Regression and moderation analyses yielded limited support for the second hypothesis. As predicted, female veterans reported a higher frequency of physical, emotional and cognitive stress-related symptoms than male veterans. The main conclusion is that the theoretical model stood up well when empirically tested and offers a promising approach to future studies on everyday stress and health. The results contribute with new knowledge of military veterans compared to the main stream PTSD, depression and drug abuse-oriented studies.

Elevated White Blood Cell Count Resultant Atherogenesis is Associated With Panoramic-Imaged Carotid Plaque

Atherosclerotic plaques develop as a result of a low-grade, chronic, systemic inflammatory response to the injury of endothelial cells arising from lipid deposition within the intima. Increased white blood cell count (WBCC) is both a validated "biologic marker" of the extent of this inflammatory process and a key participant in the development of subsequent atherosclerotic ischemic heart disease manifesting as myocardial infarction. We sought to determine if calcified carotid artery plaque (CCAP) on a panoramic image (PI), also a validated risk indicator of future myocardial infarction, is associated with increased WBCC. We retrospectively evaluated the PI and medical records of White male military veterans aged 55years and older treated by a VA dental service. Established were 2 cohorts of patients, 50 having plaques (CCAP+) and 50 without plaques (CCAP-). Predictor variable was CCAP+; outcome variable was WBCC. Bootstrapping analysis determined the differences in mean WBCCs between groups. Statistical significance set at ≤ 0.05. The study group, (mean age 74; range 59 to 91years) demonstrated a mean WBCC of 8,062 permm3. The control group, (mean age 72 range; 57 to 94) evidenced a mean WBCC of 7,058 permm3. Bootstrapping analysis of WBCC values demonstrated a significant (P=.012) difference (95% confidence interval of difference of mean, -806, 742; observed effect size, 1004) between groups. The presence of CCAP demonstrated on PIs of older Caucasian men is associated with elevated WBCC. Concomitant presence of CCAP on PI and increased WBCC (≥7,800 per mm3) amplifies need for medical consultation before intravenous anesthesia and maxillofacial surgical procedures.

Predicting problematic pornography use among male returning US veterans

Problematic Pornography Use (PPU) is the most common problem behavior among individuals with compulsive sexual behavior (CSB). Previous research suggests US veterans are at a greater risk of engaging in PPU. The present study sought to investigate further PPU among male military veterans. Data from 172 male veterans who endorsed ever watching pornography and completed the Problematic Pornography Use Scale (PPUS) were included in the study. Participants completed self-report questionnaires, including demographic information, psychiatric co-morbidities, impulsivity, as measured by the UPPS-P, pornography-related behaviors, and pornography craving as measured by Pornography Craving Questionnaire (PCQ). Younger age and lower educational attainment were associated with higher PPUS scores. Depression, anxiety, post-traumatic stress disorder (PTSD), insomnia, and impulsivity were positively associated with higher PPUS scores. There was no statistically significant association between PPU with suicidal ideation or alcohol use disorder. In the multivariable hierarchical regression, depression, frequency of use, and higher PCQ scores were associated with higher PPUS scores, although only the latter two remained significant in the final model. Understanding the risk factors via more frequent screening for PPU will help with the development of treatment protocols for this problematic behavior.

Randomized controlled trial of multi‐modular motion‐assisted memory desensitization and reconsolidation (3MDR) for male military veterans with treatment‐resistant post‐traumatic stress disorder

To explore the potential efficacy of multi-modular motion-assisted memory desensitization and reprocessing (3MDR) in British military veterans with treatment-resistant service-related PTSD. Exploratory single-blind, randomized, parallel arm, cross-over controlled trial with nested process evaluation to assess fidelity, adherence and factors that influence outcome. A total of 42 participants (all male) were randomized with 83% retention at 12weeks and 86% at 26weeks. The difference in mean Clinician-Administered PTSD Scale for DSM-5 scores between the immediate and delayed 3MDR arms was -9.38 (95% CI -17.33 to -1.44, P=0.021) at 12weeks and -3.59 (-14.39 to 7.20, P=0.513) at 26weeks when both groups had received 3MDR. The likely effect size of 3MDR was found to be 0.65. Improvements were maintained at 26-week follow-up. 3MDR was found to be acceptable to most, but not all, participants. Several factors that may impact efficacy and acceptability of 3MDR were identified. 3MDR is a promising new intervention for treatment-resistant PTSD with emerging evidence of effect.

The Role of Impulsivity in the Association Between Posttraumatic Stress Disorder Symptom Severity and Substance Use in Male Military Veterans.

High rates of posttraumatic stress disorder (PTSD) and comorbid substance use disorder (SUD) are prevalent in military veterans. However, few studies have investigated impulsivity as a risk factor for engaging in substance use behavior for individuals who are experiencing PTSD symptoms. The present study evaluated impulsivity as a moderator of the association between PTSD symptoms and alcohol/drug use. Male military veterans (N = 106) completed self-report measures of alcohol use behavior, drug use behavior, and impulsivity. Participants also completed a structured diagnostic interview to assess for PTSD. The findings indicated that impulsivity moderated the relation between total PTSD symptoms and alcohol use, B = 0.01, p = .035, along with associations between alcohol use and two of the symptom clusters: PTSD reexperiencing symptoms, B = 0.01, p = .016; and PTSD avoidance/numbing symptoms, B = 0.01, p = .029. Veterans with high levels of impulsivity were at significantly higher risk of engaging in alcohol use than veterans with low-to-average levels. Impulsivity did not potentiate the relation between PTSD hyperarousal symptoms and alcohol use nor did it moderate the association between any of the PTSD variables and drug use. Impulsivity appears to serve as a significant risk factor for alcohol use, but not drug use, for male veterans experiencing PTSD symptoms. Future studies are necessary to replicate and expand upon these findings, particularly to facilitate the development of integrated evidence-based treatments that target both alcohol use and impulsivity within the context of PTSD.

Advances in PTSD Treatment Delivery: the Role of Digital Technology in PTSD Treatment

Post-traumatic stress disorder (PTSD) is a common mental health disorder affecting about 7% of the general population during their lifetime. PTSD typically has a chronic course, is often comorbid with other psychiatric disorders, and negatively impacts functioning and quality of life. This review examines the evidence for several digital technology–based applications being used to deliver PTSD interventions, including video telehealth, Internet-based interventions, virtual reality exposure therapy, and mobile apps. A number of randomized controlled trials (RCTs) have examined the use of video telehealth, Internet-based interventions, and virtual reality exposure therapy for PTSD. Relatively few RCTs have investigated mobile apps for PTSD. Evidence reviewed shows that PTSD therapy delivered by video telehealth is as good as that delivered in person, but samples were almost exclusively comprised of military veterans. Internet-based interventions as well evidence strong support for their use. There is strong evidence for virtual reality exposure therapy as well, but it is limited by small samples mostly of male military service members and veterans. Lastly, the evidence for mobile apps is promising but inconclusive given the lack of published full-scale RCTs. The implications of these findings for future research directions and clinical practice are discussed.