Treatment Of Posttraumatic Stress Disorder Research Articles

Unreal that feels real: artificial intelligence-enhanced augmented reality for treating social and occupational dysfunction in post-traumatic stress disorder and anxiety disorders

ABSTRACT Background: Fear- and trauma-related conditions, such as post-traumatic stress disorder (PTSD) and social phobia, often manifest as socially avoidant behaviours, which commonly contribute to social and occupational disability transdiagnostically. While gold-standard treatments (i.e. exposure therapy, psychotropic medications) are effective, they are hindered by high dropout rates and limited impact on real-world functioning. Furthermore, most existing interventions only target symptom reduction, with few addressing avoidance-related deficits in social and occupational functioning. Objectives: This methods paper introduces an innovative augmented reality exposure therapy (ARET) technology designed to address the limitations of traditional interventions for anxiety disorders and PTSD, by directly targeting social and occupational dysfunction through exposure to real-life social contexts. Method: We introduce an ARET system, using artificial intelligence (AI)-driven, augmented reality (AR) technology, that enables exposure to realistic scenarios within the patient's real-world environment, fostering contextual generalization and functional improvement. Featuring holographic three-dimensional humans, precise surface mapping, wireless mobility, and telemedicine capabilities, the software provides customizable exposure scenarios to transform an environment into various spaces (e.g. grocery store, house party) with diverse human characters, as well as flexible AI-driven human interactions tailored to individual needs. Results: We share observations and feedback from the treatment of first responders with PTSD. Patients found the technology easy to use, with immersive realism, active engagement, and strong emotional responses needed for effective exposure therapy. Advances in AI-driven character development and AR hardware accessibility support the wider adoption of ARET by clinicians. Conclusion: By bridging the gap between clinical interventions and real-world functioning, ARET offers a transformative approach to addressing the pervasive impact of psychiatric disorders on social and occupational outcomes.

The conceptual framework for the therapeutic approach used in phase 3 trials of MDMA-assisted therapy for PTSD

Results from multiple recent studies support further evaluation of 3,4-methylenedioxymethamphetamine (MDMA) in conjunction with psychotherapy (i.e., MDMA-Assisted Therapy) in the treatment of post-traumatic stress disorder (PTSD). In two Phase 3 trials, MDMA-Assisted Therapy comprised a short-term, intensive psychotherapy that included three sessions directly facilitated by MDMA (referred to as “experimental sessions”), as well as a number of non-drug psychotherapy sessions. This treatment model aimed to harness the potential of MDMA to facilitate recall and processing of traumatic memories, and to increase learning in a social context, integrating “top-down” and “bottom-up” approaches to trauma-focused care. To date, the conceptual framework for this treatment has not been described in the scientific literature. This omission has contributed to misunderstandings about both the theoretical underpinnings of this modality and the therapeutic approach that emerges from it. This paper delineates the psychotherapeutic concepts, theories, and historical antecedents underlying the inner-directed approach to MDMA-Assisted Therapy for PTSD. Broadly speaking, this therapeutic framework centered the concept of the participant’s inner healing intelligence as the primary agent of change, with the therapeutic relationship being the core facilitative condition fostering the participant’s self-directed movement toward recovery and growth. Corollaries to this holistic, self-directed, relational, and trauma-informed framework include a non-pathologizing approach to the participant’s embodied experience (including the possibility of intense emotional and somatic expression, experiences of multiplicity, suicidal ideation, and multigenerational and transpersonal experiences), as well as the therapists’ own psychodynamic, somatic, and transpersonal awareness, empathic attunement, relational skillfulness, and cultural humility. The use of MDMA in conjunction with this psychotherapy platform outperformed the use of placebo with psychotherapy in Phase 2 and 3 trials, as measured by symptom reduction in participants with PTSD. However, within-group comparisons also identified significant symptom reduction in participants who did not receive MDMA, lending empirical support to the psychotherapy model itself. In addition to comparative efficacy trials, future research should investigate which elements of the conceptual framework and therapeutic approach underlie the clinical benefit in individuals with PTSD.

Personalizing Cognitive Processing Therapy with a Case Formulation Approach to Intentionally Target Impairment in Psychosocial Functioning Associated with PTSD

Posttraumatic stress disorder (PTSD) is a debilitating condition often accompanied by significant functional impairments affecting quality of life and well-being. While Cognitive Processing Therapy (CPT) is a leading, evidence-based psychotherapy for PTSD, demonstrating substantial efficacy in core symptom reduction, its impact on psychosocial functioning is less well-established. The Personalizing Cognitive Processing Therapy with a Case Formulation Approach (Personalizing Approaches to Therapy: PATh) study aims to enhance CPT by explicitly targeting functional impairments and idiosyncratic challenges to optimal therapy outcomes (COTOs), comparing its efficacy against standard CPT in improving psychosocial functioning, quality of life, well-being, and core PTSD and depression symptoms. This randomized controlled trial involves 200 Veterans across eight Veterans Health Administration clinical sites, assigned to either Case Formulation CPT (CF-CPT) or standard CPT. Providers will deliver up to 20 sessions per patient, with assessments at baseline, mid-treatment, post-treatment, and three months follow-up. It is hypothesized that Veterans receiving CF-CPT will show greater improvements in functioning, quality of life, well-being, and symptom reduction, alongside higher treatment completion rates compared to standard CPT. Secondary outcomes will examine specific clinical challenges and their influence on treatment outcomes. This study investigates whether a personalized, flexible CPT protocol can enhance functional recovery in PTSD treatment without compromising the efficacy of the traditional approach, potentially impacting clinical practices and patient outcomes by promoting holistic recovery for veterans with PTSD.

Web-Based Intervention (SunnysideFlex) to Promote Resilience to Posttraumatic Stress Disorder Symptoms During Pregnancy: Development and Pilot Study.

Approximately 4% to 8% of pregnant individuals meet the criteria for current posttraumatic stress disorder (PTSD), a known risk factor for a multitude of adverse maternal and child health outcomes. However, PTSD is rarely detected or treated in obstetric settings. Moreover, available prenatal PTSD treatments require in-person services that are often inaccessible due to barriers to care. Thus, web-based interventions offer great potential in extending PTSD treatment to high-risk pregnant individuals by providing affordable, accessible care. However, there are currently no web-based interventions designed specifically for the treatment of PTSD symptoms during pregnancy. This study aims to develop and pilot a 6-week, web-based, cognitive behavioral therapy intervention for PTSD, SunnysideFlex, in a sample of 10 pregnant women with current probable PTSD. Consistent with established guidelines for developing and testing novel interventions, the focus of this pilot study was to evaluate the initial feasibility and acceptability of the SunnysideFlex intervention and preintervention to postintervention changes in PTSD and depression symptoms. This approach will allow for early refinement and optimization of the SunnysideFlex intervention to increase the odds of success in a larger-scale clinical trial. The SunnysideFlex intervention adapted an existing web-based platform for postpartum depression, Sunnyside for Moms, to include revised, trauma-focused content. A total of 10 pregnant women in weeks 16 to 28 of their pregnancy who reported lifetime interpersonal trauma exposure (ie, sexual or physical assault) and with current probable PTSD (scores ≥33 per the PTSD checklist for DSM-5) were enrolled in the SunnysideFlex intervention. Assessments took place at baseline and 6 weeks (postintervention). All participants were retained through the postintervention assessment period. Engagement was high; participants on average accessed 90% of their lessons, logged on to the platform at least weekly, and reported a generally positive user experience. Moreover, 80% (8/10) of participants demonstrated clinically meaningful reductions in PTSD symptoms from baseline to postintervention, and 50% (5/10) of participants no longer screened positive for probable PTSD at postintervention. Most (6/10, 60%) of the participants maintained subclinical depression symptoms from baseline to postintervention. Findings from this small pilot study indicate that SunnysideFlex may be a feasible and acceptable mechanism for delivering PTSD intervention to high-risk, trauma-exposed pregnant women who might otherwise not have opportunities for services. Larger-scale trials of the intervention are necessary to better understand the impact of SunnysideFlex on PTSD symptoms during pregnancy and the postpartum period.

Sporun Fiziksel Aktivite Boyutunun Psiko-Eğitimle Desteklenmesinin Sonuçlarının İncelenmesi

Today, especially after the pandemic, the importance of physical activity, in which individuals remember its value once again, stands out even more. During this period, it has become indisputable to what extent physical activity provides benefits to the social, emotional, physical and psychological development of individuals. So much so that physical activity applications have also found a place among the contents added to the distance education activities. Dec. However, the problem of overweight and obesity, which is rapidly becoming one of the most important health problems in the world, is also effective in spreading physical activity practices Decently. Considering the benefits of regular physical activity in general, it contributes to healthy growth and development, helps to protect against unwanted habits, prevents socialization and the formation of certain long-term diseases that may be encountered during adulthood, as well as treating and supporting the treatment of disorders that may occur, ensuring that they last an active old age, in other words, it can make important contributions to improving the quality of life throughout life. In this context, psycho-education as a complementary element of physical activity is also defined as empowering education aimed at promoting individual's awareness and entrepreneurship. Psycho-education is not only to inform the individual and his family about the problematic situation or to offer them solutions, but also the process of providing education and training about the factors that cause this situation. In this way, the person understands the situation better and develops a sense of control, so that the problem can gradually decrease. The human body, which was created in order to be able to do physical activity, can encounter various problems every day due to inactivity. Besides the well-known health benefits of physical activity, it should not be overlooked that along with its cognitive effects, it may also contribute to increasing academic achievement in the sense of its positive role on mental processes at different age levels depending on these effects, and ultimately as a result of these processes. At the same time, it is known in past and recent studies that physical activity has a direct or indirect effect on many topics, from the use of individuals experiencing mental or mental problems in treatment processes, to coping with stress, anxiety, and post-traumatic stress disorder treatments, in addition to conditions such as self-confidence, self-esteem, and well-being. Key Words: Special Ability, Special Ability Students, Physical Activity

Identifying transdiagnostic and multidimensional prognostic indicators among veterans with PTSD symptoms in brief integrated care settings.

Brief integrated care settings hold promise for accessible and effective trauma-informed interventions. However, clinicians often have difficulty efficiently forecasting who is most appropriate for interventions in such settings and how to target individualized care. Multidimensional and transdiagnostic evaluations may provide valuable information to improve stepped-care and treatment practices for veterans. A middle-out approach was used to concurrently evaluate self-reported posttraumatic stress disorder (PTSD) symptoms, depressive symptoms, and physical health problems using cross-sectional (latent profile analysis) and longitudinal (latent growth mixture modeling) analyses that identified unique symptom profiles, trajectories of traumatic stress reactions, and correlates of these health outcomes. Data from 234 veterans who participated in a randomized controlled trial of primary care PTSD intervention were analyzed at 0, 8, 16, and 24 weeks. Latent profile analysis identified two homogenous baseline profiles: global symptoms (33.8%); low dysphoria-lower negative cognitions, mood, and depressive symptoms (66.2%). Low dysphoria participants reported more social relationships (OR = 1.32) and fewer environmental (OR = 0.89) and financial (OR = 0.23-0.35) stressors. Latent growth mixture modeling identified three trajectories: (a) reducing symptoms ("responders"; 21.3%) and chronic symptoms of (b) moderate (59.6%) and (c) high (19.1%) severity. Low dysphoria participants were 4.35 times more likely to be responders over time compared to participants with moderate severity symptoms. Findings indicated that veterans with moderate PTSD symptoms and physical health problems but low dysphoria may respond best to trauma-informed intervention in brief integrated care settings, while others may require further individualized stepped care. Findings demonstrate unique traumatic stress reactions that support individualized stepped care and may offer greater treatment utilization, retention, and efficacy. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Massed treatment of posttraumatic stress disorder, traumatic brain injury, and co-occurring conditions: the Home Base intensive outpatient program for military veterans and service members

The two-week Home Base Intensive Clinical Program (ICP) provides treatment to veterans and active duty service members suffering from primary diagnoses of posttraumatic stress disorder (PTSD), traumatic brain injury (TBI), anxiety, or depression. First launched in 2015, this paper provides a programmatic update, including new treatment components implemented since inception, and examines outcomes for all participants who entered the program from September 2015 to July 2024 (n = 2561). The Home Base ICP provides a massed care approach through daily individual Prolonged Exposure, Cognitive Processing Therapy, Unified Protocol, or cognitive rehabilitation, along with groups targeting coping skills. Participants entering the program are provided with core group programming, as well as individualized therapy sessions tailored to their unique needs and symptom presentation. Supplemental dual recovery support is also available for all participants with co-occurring substance use or behavioral addiction concerns. Participants' support people receive education, support, and case management services. Participants have a multidisciplinary team comprising therapists, psychopharmacology providers, case managers, nurses, and wellness providers. Results demonstrate that program participants exhibited statistically significant reductions in PTSD symptoms (Cohen's d = 0.80), depression (d = 0.68), post-concussion symptoms (d = 0.71), and increased satisfaction in social roles (d = -0.65). Completion rate was 94.60% (n = 2422), suggesting that the Home Base ICP is a well-received and effective model of care for veterans and service members.

Treatment patterns and characteristics of patients with Post-Traumatic Stress Disorder (PTSD): A retrospective claims analysis among commercially insured population.

This retrospective claims analysis explored the treatment utilization and characteristics among patients with post-traumatic stress disorder (PTSD) of different severity. The index date was the first PTSD claim. The analysis observed 12 months pre- and 24 months post-index. Adults with insurance gaps, cancer, or acute PTSD during the observation were excluded. Patients were categorized into three severity cohorts based on treatment and healthcare services utilization for PTSD: 1. Baseline PTSD (BP) (no PTSD visits post-index, no FDA-approved medications/ psychotherapy, and no severe mental health comorbidities); 2. PTSD without Comorbidities (PwoC) (≥1 PTSD visits post-index and no severe mental health conditions); 3. PTSD with Comorbidities (PwC) (≥1 PTSD visits post-index and severe mental health comorbidities present). For the primary analysis, cohorts were propensity-score matched. A sub-analysis examined patients with PTSD and Substance or Alcohol Use Disorder (SUD/AUD). The primary analysis observed 1714 BP, 1681 PwoC, and 1681 PwC patients. Treatment utilization rates were highest among PwC vs. other cohorts (84.5% psychotherapy, 76.1% off-label medications, and 26.1% FDA-approved medications [p<0.001]). PwC cohort also had the highest number of psychotherapy sessions and medication prescriptions per patient (20.1 sessions, 12.6 off-label prescriptions, and 2.0 FDA-approved prescriptions [p<0.001]). The proportion of days covered (PDC) indicated low medication adherence (0.25-0.40) with adherent patient rates (PDC ≥0.80) between 8.0-17.5%. The SUD/AUD sub-analysis identified 85 BP, 537 PwoC, and 3154 PwC patients. Conclusions were similar, with PwC cohort having highest treatment utilization rates (87.1% psychotherapy, 85.0% off-label medications, 28.2% FDA-approved medications [p≤0.013] with 24.4 sessions, 16.1 off-label prescriptions, and 2.0 FDA-approved prescriptions per patient [p≤0.002]). Only 4.7-11.4% of patients were adherent. PwC patients received psychotherapy and pharmacotherapy more frequently than PwoC and BP patients. Medication adherence among treated patients was low. Patients with SUD/AUD had numerically higher treatment utilization and lower medication adherence.

Cannabidiol Modulates Neuroinflammatory Markers in a PTSD Model Conducted on Female Rats

Post-traumatic stress disorder (PTSD) is a debilitating neuropsychiatric condition closely linked to neuroinflammation, with a higher prevalence in women. Cannabidiol (CBD), a non-psychoactive cannabinoid, has shown promise as a potential treatment for PTSD. In this study, we used a PTSD model in which female rats were subjected to a severe foot shock followed by contextual situational reminders (SRs). Testing was conducted one month after exposure. The rats received daily CBD injections for three weeks during the SRs, from days 7 to 28. Two days after the final SR, the rats underwent five extinction trials, followed by the forced swim test (FST). After a five-day rest period, the rats were sacrificed, and brain tissues from the medial prefrontal cortex (mPFC) and ventral subiculum (vSUB) were analyzed for inflammatory markers. Chronic CBD treatment reversed impairments in fear extinction caused by shock and SR. It also reduced learned helplessness in the FST and decreased the upregulation of mPFC-il1β induced by shock and SRs. Additionally, exposure to shock and SRs downregulated mPFC-il6 while upregulating vSUB-il6. CBD treatment further downregulated il6 expression in the vSUB compared to the vehicle groups. Our findings show that CBD effectively inhibited the development of PTSD-like behaviors and suppressed neuroinflammation in the mPFC.

Protocol for remote Tai Chi and wellness for PTSD and pain in veterans

ABSTRACT Background: Posttraumatic stress disorder (PTSD) is a debilitating psychological disorder that is associated with a host of psychosocial and health ailments, including chronic pain. Although evidence-based psychological therapies are recommended as first-line PTSD treatments, a large proportion of individuals either drop out and/or do not achieve a therapeutic response. PTSD is increasingly recognized as a systemic disorder that impacts both physical and mental health, and mind-body approaches, such as Tai Chi, have shown promise. However, to date there have been no randomized clinical trials examining Tai Chi as a treatment for PTSD. Objective: To conduct a fully remote two-phased study designed to adapt, refine, and standardize two group treatments, Tai Chi and a Wellness comparison, for Veterans diagnosed with PTSD and chronic pain. Method: We deploy the project in two phases. In Phase One, we adapt both interventions for delivery via a videoconferencing platform. We then pilot the interventions in a ‘dry run’ with non-random assignment of 12 participants to Tai Chi or a Wellness comparison group. In Phase Two, we randomize 36 participants to one of the two group interventions. The feasibility and acceptability of the two remotely delivered interventions and assessment protocols are evaluated. Conclusions: This is the first study to our knowledge to evaluate the feasibility, acceptability, adherence, and participant burden of the Tai Chi and Wellness comparison interventions for PTSD and chronic pain in Veterans. This information will facilitate the development of a future large, randomized control trial to evaluate the efficacy of Tai Chi to address PTSD and chronic pain in Veterans.

How Psychedelics Modulate Multiple Memory Mechanisms in Posttraumatic Stress Disorder.

Posttraumatic stress disorder (PTSD) is a psychiatric disorder with defining abnormalities in memory, and psychedelics may be promising candidates for the treatment of PTSD given their effects on multiple memory systems. Most PTSD and psychedelic research has investigated memory with fear conditioning and extinction. While fruitful, conditioning and extinction provide a limited model of the complexity of PTSD and phenomenology of psychedelics, thereby limiting the refinement of therapies. In this review, we discuss abnormalities in fear conditioning and extinction in PTSD and review 25 studies testing psychedelics on these forms of memory. Perhaps the most reliable effect is that the acute effects of psychedelics can enhance extinction learning, which is impaired in PTSD. However, the post-acute effects may also enhance extinction learning, and the acute effects can also enhance fear conditioning. We then discuss abnormalities in episodic and semantic memory in PTSD and review current knowledge on how psychedelics impact these memory systems. Although PTSD and psychedelics acutely impair the formation of hippocampal-dependent episodic memories, psychedelics may acutely enhance cortical-dependent learning of semantic memories that could facilitate the integration of trauma memories and disrupt maladaptive beliefs. More research is needed on the acute effects of psychedelics on episodic memory consolidation, retrieval, and reconsolidation and post-acute effects of psychedelics on all phases of episodic memory. We conclude by discussing how targeting multiple memory mechanisms could improve upon the current psychedelic therapy paradigm for PTSD, thereby necessitating a greater emphasis on assessing diverse measures of memory in translational PTSD and psychedelic research.

(Why?) Evidence-Based Treatments for War-Related Posttraumatic Stress Disorder

Any war increases at least twice the prevalence of post-traumatic stress disorder (PTSD) in its victims. Post-traumatic stress disorder (PTSD) affects about 10% of car accident victims, half of the people who have experienced rape or war, and victims of violence. PTSD negatively affects the quality of life. It is associated with direct and indirect health costs. Any effort to treat and prevent PTSD with evidence-based methods is our obligation toward trauma victims and to professionals at an increased risk of job-related traumatization. In the paper, we will focus on three aspects. First – a rationale of decision making – the role of evidence in elaborating the intervention guidelines will be described. Second, an overview of evidence-based guidelines for the psychological help and for the diagnosis and treatment of PTSD will be presented, according to current NICE (National Institute of Care Excellence) and APA (American Psychological Association) and meta-analyses focusing on war-related trauma. The third part of the paper will be devoted to the prevention of PTSD in people who are exposed to professional, duty-related trauma – the data on the efficacy of preventive interventions together with a short description of the programs (on the example of “Effective performance under stress” program designed to prevent PTSD in firefighters and other professions).

What's in a treatment name? How people with posttraumatic stress disorder (PTSD) symptoms interpret and react to PTSD treatment names.

Prior research has rarely examined how people understand or react to the names of psychological treatments. In the case of evidence-based psychotherapies for posttraumatic stress disorder (PTSD), such reactions may be relevant to the low rates of uptake of such treatments. Participants who screened positive for PTSD (n = 887) completed questions assessing their initial reactions to PTSD treatment names as well as how a different name would affect their openness to treatment. In addition, they gave brief responses to open-ended questions about the reason for their initial reactions, and content analysis was used to better understand these reasons. The results indicated that among the treatment name options, cognitive processing therapy (CPT) and present-centered therapy (PCT) were viewed most positively. Approximately 40% of the sample preferred plain language alternatives for treatment names. Content analyses focused on descriptions of the treatments-which could be accurate or inaccurate-as well as whether respondents evaluated a treatment name itself as positive or negative. Some names conveyed treatments more accurately (e.g., CPT and written exposure therapy) than others (e.g., eye movement desensitization and reprocessing and prolonged exposure [PE]). Some names were also evaluated more positively (e.g., PCT) than others (e.g., PE). The general term "trauma-focused therapy" was seen as positive and clear. Addressing the ways patients react to psychological terms and treatment names could help clarify misperceptions about evidence-based psychotherapies and promote more widespread uptake of effective treatments for PTSD.

Traumatic brain injury rehabilitation for warfighters with post-traumatic stress.

While there is extensive empirical support and clinical guidance for the treatment of mild traumatic brain injury (mTBI) and post-traumatic stress disorder (PTSD) individually, less is known about treating the comorbid presentation of both conditions. The purpose of this review article is to provide information on the mental health treatment needs of service members (SMs) engaged in traumatic brain injury (TBI) rehabilitation. It also aims to offer a framework for an integrated treatment approach to address the cognitive and psychological health needs of warfighters. We review the prevalence and outcomes associated with comorbid TBI and PTSD and present relevant access to care considerations. Additionally, we identify an integrated approach to TBI treatment which takes psychological trauma into consideration. We introduce a trauma-informed care (TIC) model with specified diagnostic and treatment considerations for the service member and veteran (SM/V) communities. TIC is a strengths-based framework that raises the system-wide awareness of treatment facilities to the impact of psychological trauma on behavioral health. A comprehensive diagnostic approach is recommended with considerations for symptom etiology. Clinical considerations derived from available guidelines are identified to meet critical treatment needs for SM/Vs presenting for TBI treatment with a remote history of mTBI and psychological trauma or known PTSD. Clinical practice guidelines are used to inform an integrated TBI treatment model and maximize rehabilitation efforts for warfighters. Given the prevalence of comorbid TBI and PTSD among SM/Vs and its impact on outcomes, this review presents the integration of appropriate diagnostics and treatment practices, including the incorporation of CPGs into TBI rehabilitation.

Transcranial electrical stimulation in post-traumatic stress disorder and brain injury: possibilities of tuning neuronal networks

Transcranial direct current stimulation (tDCS) in the treatment of post-traumatic stress disorder (PTSD) is used to strengthen the inhibitory control of amygdala activity. However, there are still limited meta-analytic studies examining different tDCS protocols on core PTSD symptoms and the relationship between stimulation parameters and effect size. The objective is to investigate the effectiveness of such an intervention, which is a complex combination of a psychotherapy program with tDCS in the treatment of patients with PTSD and mild traumatic brain injury (mTBI) by assessing their level of functioning. 329 veterans (PTSD (n=109), mTBI (n=112), PTSD + mTBI (n=108) were examined using WHODAS 2.0. Standardized treatment was provided as well as psy­chotherapeutic intervention - a combination of psychoeducation with motivational interviewing and acceptance and commitment therapy for PTSD and tDCS. Clinical targets of therapy in the PTSD group were symptoms of intrusion, avoidance, hyperactivation and protocol of tDCS was dorsolateral prefrontal cortex arousing stimulation. In PTSD + TBI group clinical targets were neurocognitive symptoms, intrusion symptoms, avoidance, hyperactivation and tDCT protocol was motor cortex-supraorbital area inhibitory stimulation. The targest for TBI group was neurocognitive symptoms and tDCS protocol was occipital region exciting stimulation. The long-term effectiveness and the impact on neuroplasticity processes allow considering transcranial direct current stimulation as a promising method of neurorehabilitation of patients with a combination of posttraumatic stress disorder and mild traumatic brain injury.

Posttraumatic Stress Disorder and Substance Use Disorder Screening, Assessment, and Treatment.

We review prevalence, etiology, impact on treatment, and best practices for treatment of posttraumatic stress disorder (PTSD) in a substance use disorder (SUD) treatment setting. Recommendations are given related to screening, assessment, and symptom monitoring. PTSD and SUDs are highly comorbid. This comorbidity is associated with higher acuity, more difficulty completing treatment, and worse prognosis. Integrated treatment is recommended, and trauma-focused psychotherapies combined with pharmacotherapy show particular promise. PTSD is highly prevalent in substance using samples, negatively impacting treatment course and worsening prognosis. This comorbidity has been explained by a variety of models, with self-medication having garnered the most support. Trauma-focused psychotherapies combined with pharmacotherapy demonstrate the most efficacy and are recommended when treating co-occurring SUDs and PTSD. Specifically, prolonged exposure (PE), concurrent treatment of PTSD and SUDs using PE (COPE), and cognitive processing therapy (CPT) have been seen as promising trauma-focused treatments. Investigations into ways to best augment therapy are also underway, both through treatment format and neuromodulation. Several recommendations are given.

A Pilot Study Exploring the Feasibility of Virtual Written Exposure Therapy with Underserved Black Perinatal Women.

In the USA, Black pregnant women are at the highest risk for maternal morbidity. They also experience the highest rates of trauma exposure and posttraumatic stress disorder (PTSD). PTSD takes a toll on Black women's mental and physical health, placing them at risk for maternal morbidity. It increases several mental health symptoms such as suicidality, anxiety, re-living the trauma, and numbness. These mental health conditions adversely affect health behaviors, including those essential for maternal health, such as attending prenatal and postpartum appointments. Furthermore, untreated PTSD is associated with higher blood pressure, increasing Black mothers' risk of pre-eclampsia. For a variety of reasons including cultural mistrust, stigma, transportation, time constraints, and access to care, PTSD is frequently underassessed and undertreated among Black perinatal women. Written exposure therapy (WET) is a state-of-the-art brief treatment for PTSD. In this study, we explored the initial feasibility of the virtual delivery of WET to reduce PTSD symptoms among Black perinatal women. Results found the virtual delivery of WET to be feasible. Symptom reduction for PTSD in participants was 50-100% during follow-up, suggesting potential effectiveness of the intervention. Implications for virtual delivery of WET in reducing risk for Black maternal morbidity are discussed.

Rapid and sustained reduction of treatment-resistant PTSD symptoms after intravenous ketamine in a real-world, psychedelic paradigm.

Traditional treatments for post-traumatic stress disorder (PTSD) often show limited success with high dropout. Ketamine, an N-methyl-D-aspartate antagonist known for rapid antidepressant effects, has decreased PTSD symptoms in some studies but not in others. Administering ketamine in ways that parallel psychedelic-assisted treatments-including preparatory, integration, sensory immersion, and psychotherapy sessions-could decrease PTSD symptoms meaningfully. A retrospective sample of 117 screened outpatients with elevated PTSD Checklist for DSM-5 (PCL-5) scores received intravenous ketamine in supportive environments. The protocol included preparation, intention-setting, and integration sessions accompanying at least six administrations. Administration sessions included eye shades and evocative music paralleling typical psychedelic therapy trials. Mean PCL scores decreased from 52.54 (SD = 12.01) to 28.78 (SD = 16.61), d = 1.64. Patients tolerated treatment well, with no serious adverse events. Covariates, including age, gender, days between PCL assessments, number of psychiatric medications, and suicidal ideation were not significant moderators; concomitant psychotherapy did reach significance, d = 0.51. Of the 117 patients' final PCL scores, 88 (75.21%) measures suggested clinically meaningful improvement and 72 (61.54%) suggested remission of PTSD symptoms. Intravenous ketamine in supportive environments, with hallmarks of psychedelic therapy, preceded large reductions in PTSD symptoms. These results highlight ketamine's potential when delivered in this manner, suggesting environmental factors might account for some variation seen in previous work. Given the molecule's cost, minimal interaction with other psychiatric medications, and legal status, intravenous ketamine in a psychedelic paradigm may be a promising option for PTSD unresponsive to other treatments.

Digital transformation of mental health therapy by integrating digitalized cognitive behavioral therapy and eye movement desensitization and reprocessing.

Digital therapy has gained popularity in the mental health field because of its convenience and accessibility. One major benefit of digital therapy is its ability to address therapist shortages. Posttraumatic stress disorder (PTSD) is a debilitating mental health condition that can develop after an individual experiences or witnesses a traumatic event. Digital therapy is an important resource for individuals with PTSD who may not have access to traditional in-person therapy. Cognitive behavioral therapy (CBT) and eye movement desensitization and reprocessing (EMDR) are two evidence-based psychotherapies that have shown efficacy in treating PTSD. This paper examines the mechanisms and clinical symptoms of PTSD as well as the principles and applications of CBT and EMDR. Additionally, the potential of digital therapy, including internet-based CBT, video conferencing-based therapy, and exposure therapy using augmented and virtual reality, is explored. This paper also discusses the engineering techniques employed in digital psychotherapy, such as emotion detection models and text analysis, for assessing patients' emotional states. Furthermore, it addresses the challenges faced in digital therapy, including regulatory issues, hardware limitations, privacy and security concerns, and effectiveness considerations. Overall, this paper provides a comprehensive overview of the current state of digital psychotherapy for PTSD treatment and highlights the opportunities and challenges in this rapidly evolving field.

Effectiveness of telehealth-delivered massed trauma-focused psychotherapy among veterans with posttraumatic stress disorder.

Trauma-focused psychotherapies can be effectively delivered using a massed delivery format. Telehealth treatment for posttraumatic stress disorder (PTSD) using evidence-based interventions has been shown to be as effective as in-person treatment. However, the effectiveness of evidence-based treatments for PTSD over telehealth using the massed delivery format requires further examination. To examine the effectiveness of telehealth massed PTSD treatment, we report on a quality improvement study of 33 veterans (75.8% male; MAge = 42.3, SD = 11.0) who participated in a virtual 4-week massed PTSD program at a Department of Veterans Affairs (VA) medical center. Twenty-seven (81.8%) veterans completed the treatment and reported large reductions in PTSD (d = 1.48) and depressive symptoms (d = 1.08) at Week 4 and at 1-month follow-up (PTSD, d = 1.34; depression, d = 0.70). Results suggested that evidence-based treatment for PTSD can be effectively delivered in a massed format over telehealth in a VA medical setting. (PsycInfo Database Record (c) 2024 APA, all rights reserved).