Posttraumatic Stress Disorder Symptoms In Veterans Research Articles

A Retrospective Pilot Study of Imagery Rehearsal Therapy Enhanced with Narrative Therapy Principles for the Treatment of Nightmares in US Military Veterans.

Introduction Chronic nightmares are a common and disabling feature of posttraumatic stress disorder (PTSD) for which broadly effective treatments are still lacking. While imagery rehearsal therapy (IRT) demonstrates benefits for patients with idiopathic nightmares and some patients with PTSD-related nightmares, research indicates it may be less beneficial for veterans. Narrative therapy (NT) is a form of psychotherapy which is client-centered and value-focused and has demonstrated benefits for PTSD patients. The application of NT principles to IRT may provide a valuable therapeutic approach for treatment in veterans. Objective To perform a retrospective chart review of veteran clients participating in a novel, brief intervention developed by the first author consisting of IRT enhanced with NT principles (N-IRT) for the treatment of nightmares. The primary outcomes were nightmare frequency and intensity, and the secondary outcome was the impact of the intervention on nightmare distress and coping, subjective sleep quality, and overall PTSD symptoms. Materials and Methods We conducted retrospective chart reviews for eight veterans referred to the first author for the treatment of nightmares, who completed N-IRT, including baseline and end-of-treatment measures. The protocol involved a single 60-minute NT-enhanced rescripting session and assigned homework to rehearse the revised dream script, and a follow-up evaluation 4 weeks later. The subjects completed a sleep and nightmare interview developed by the first author and the PTSD Checklist at baseline and after the intervention at the follow-up evaluation. Paired t -tests were conducted to test for pre-to-post differences. Results In the statistical analysis, we observed a statistically significant and clinically meaningful reduction in the frequency ( p = 0.04) and intensity of nightmares ( p = 0.001) from pretreatment to the 1-month follow-up. Measures of nightmare-associated emotional distress, the ability to cope with nightmares, sleep duration and sleep efficiency, as well as overall PTSD symptoms also demonstrated significant improvements. Conclusion These pilot data provide compelling preliminary evidence that a single-session IRT intervention modified with NT (N-IRT) is effective in reducing nightmare frequency and intensity, reducing nightmare distress, improving the act of coping with nightmares, and improving sleep quality and overall PTSD symptoms in veterans. Further investigation of this method with gold-standard clinical trial designs and larger sample sizes is indicated to confirm effectiveness and to better understand the possible mechanisms of treatment effect.

Veterans, PTSD, and Equine-Assisted Psychotherapy: Perspectives of Licensed Mental Health Therapists

Veterans returning home after deployment and active military personnel have been members of a highly vulnerable population for whom trauma, suicide, domestic issues, substance abuse, crime, and homelessness have been complicating factors. Equine-assisted psychotherapy (EAP) has gained in popularity as a treatment for post-traumatic stress disorder (PTSD) and other mental illnesses Veterans experience. It has drawn attention from federal agencies, but the literature pertaining to the best and most effective techniques and practices is unclear or nonexistent. We conducted this study to (a) analyze licensed equine-assisted mental health therapists’ (LMHT) observations regarding the relative efficacy of EAP in mitigating or eliminating PTSD symptoms in Veterans, and (b) help LMHTs adopt and implement a set of best practices with respect to EAP for U.S. Veterans who suffer from PTSD. We hoped the answers to both of those inquiries would improve understanding and practices associated with using EAP as a treatment for PTSD. The 31 LMHTs who participated reported that EAP worked best for PTSD (as a stand-alone therapy) when compared to 10 other mental health disorders. They did not think EAP worked as well for clients whose diagnosis included schizophrenia. Typically, sessions consisted of one client (although the size of the treatment group did not impact EAP’s effectiveness). The sessions typically ran from one to two hours. We recommend the establishment of a clearing house that provides information on the relative effectiveness of different practices, and that other researchers examine the long-term effects of preferred treatments on Veterans.

Mediators of improved PTSD symptoms in veterans and civilians following a yoga program.

Although yoga shows some promise as an intervention for post-traumatic stress disorder (PTSD), little is known about how yoga reduces PTSD symptoms. The current study hypothesised that aspects of interoceptive awareness would mediate the effect of a yoga intervention on PTSD symptoms. We used data from our recently completed randomised controlled trial of a 16-week holistic yoga programme for veterans and civilians diagnosed with PTSD (n = 141) that offered weekly 90-minute sessions. We conducted a mediation analysis using interoceptive awareness and other variables that were associated with PTSD symptom reduction at mid-treatment and treatment end. Although measures of anxiety, interoceptive awareness, and spirituality were identified in individual mediator models, they were no longer found to be significant mediators when examined jointly in multiple mediator models. When examining the multiple mediator models, the strongest mediator of the yoga intervention on PTSD symptoms was mental well-being at mid-treatment and stigma at the treatment end. The total effect of yoga on CAPS and PCL at the treatment end mediated by stigma was 37.1% (-1.81/-4.88) and 33.6% (-1.91/-5.68), respectively. Investigation of mental well-being and mental illness stigma as potential mediators is warranted in future studies of yoga as a treatment for PTSD as they may prove to be important foci for yoga interventions.

Reconsolidation and Consolidation Therapies for the Treatment and Prevention of Post-Traumatic Stress Disorder


 The evidence about the clinical effectiveness of reconsolidation and consolidation therapies for the treatment and prevention of post-traumatic stress disorder (PTSD) is uncertain because these therapies include a wide range of interventions and the study results varied widely.
 The results from 1 systematic review suggest there were significantly greater improvements in PTSD severity in patients treated with reconsolidation therapy versus control. However, 3 other systematic reviews reported conflicting findings with some reconsolidation therapies indicating significant improvements in PTSD symptoms or severity versus control, whereas other reconsolidation therapies had no significantly different outcomes than the control groups.
 There was limited evidence suggesting that multi-modular motion-assisted memory desensitization and reprocessing therapy reduced PTSD symptoms in veterans with treatment-resistant and combat-related PTSD; however, the significance of these results was not reported.
 There was limited evidence suggesting a significant difference in PTSD incidence in favour of adults exposed to trauma treated with hydrocortisone versus control. There were no significant differences in PTSD incidence between adults exposed to trauma treated with any 1 of propranolol, omega-3 fatty acids, gabapentin, or paroxetine versus placebo.

Effects of intranasal (S)-ketamine on Veterans with co-morbid treatment-resistant depression and PTSD: A retrospective case series

SummaryBackground(S)-ketamine is a glutamatergic drug with potent and rapid acting effects for the treatment of depression. Little is known about the effectiveness of intranasal (S)-ketamine for treating patients with comorbid depression and post-traumatic stress disorder (PTSD).MethodsWe performed a retrospective case series analysis of clinical outcomes in 35 Veterans with co-morbid depression and PTSD who were treated with intranasal (S)-ketamine treatments at the VA San Diego Neuromodulation Clinic between Jan 2020 and March 2021. Veterans were not randomized or blinded to treatment. The primary outcome measured was a change in patient health questionnaire-9 (PHQ-9) and PTSD Checklist for DSM-5 (PCL-5) scores across the first 8 treatments (induction period) using a repeated measures analysis of variance (ANOVA). In a smaller sub-group (n = 19) of Veterans who received at least 8 additional treatments, we analyzed whether intranasal (S)-ketamine continued to show treatment effects. Finally, we performed a sub-group and correlation analyses to understand how changes in PHQ-9 and PCL-5 scores were related across treatments.FindingsDuring the induction phase of treatment there was an absolute reduction of 5.1 (SEM 0.7) on the patient health questionnaire-9 (PHQ-9) rating scale for depression, from 19.8 (SEM 0.7) at treatment 1 to 14.7 (SEM 0.8) at treatment 8 (week 4) (F(7238) = 8.3, p = 1e-6, partial η2 = 0.2). Five Veterans (14%) showed a clinically meaningful response (50% reduction in PHQ-9 score) at treatment 8. There was an absolute reduction of 15.5 +/- 2.4 on the patient checklist 5 (PCL-5) rating scale for PTSD, from 54.8 (SEM 2) at treatment 1 down to 39.3 (SEM 2.5) at treatment 8 (F(7238) = 15.5, p = 2e-7, partial η2 = 0.31). Sixteen Veterans (46%) showed a clinically meaningful response (reduction in PCL-5 of > 30%) in PTSD. Change in PHQ-9 correlated with change in PCL-5 at treatment 8 (r = 0.47, p = 0.005), but a decrease in PTSD symptoms were observable in some individuals with minimal anti-depressant response.InterpretationsWhile this is an open-label retrospective analysis, our results indicate that both depression and PTSD symptoms in Veterans with dual-diagnoses may improve with repeated intranasal (S)-ketamine treatment. The effects of (S)-ketamine on PTSD symptoms were temporally and individually distinct from those on depression, suggesting potentially different modes of action on the two disorders. This work may warrant formal randomized controlled studies on the effects of intranasal (S)-ketamine for individuals with co-morbid MDD and PTSD.FundingVA Center of Excellence in Stress and Mental Health, VA ORD (Career Development Award to DSR), Burroughs-Wellcome Fund Award (DSR), NIMH (EL)

The Awareness of PTSD in Military Personnel among Clinical Social Workers and Psychologists in Health-Care Centers

The actual number of Saudi Arabian military members diagnosed with post-traumatic stress disorder (PTSD) is unknown, and sociological research on the subject is crucial. Furthermore, clinical social workers and psychologists must get a better understanding of PTSD symptoms in veterans. The most recent study sought to identify what the most important factor was in increasing PTSD awareness among clinical social workers and psychologists, and to check whether there was a disparity in awareness between individuals who completed an abroad qualification and those who had not. Clinical social workers and psychologists in the health-care field were polled to see how much they knew about PTSD. Purposive and snowball sampling approaches were used to disseminate an online survey to N = 144 participants to meet the research objectives. The findings revealed a link between education, self- development, and organizational development and the amount of PTSD awareness among the study participants. There were no statistically significant changes in awareness levels based on whether the certification was obtained inside or outside Saudi Arabia. The results of this study revealed that the level of awareness among the study sample varied significantly.

Exercise and PTSD Symptoms in Emergency Service and Frontline Medical Workers: A Systematic Review

ABSTRACT Context: Emergency service and medical frontline workers are exposed to significant occupational stressors that may confer an increased risk of poor mental health, including posttraumatic stress disorder (PTSD). Emerging evidence suggests that physical activity and its structured subset, exercise, may be effective in improving symptoms of PTSD in veterans; however, the potential efficacy for other populations at high risk of occupational trauma exposure is currently unclear. Given the potential of physical activity interventions to improve both PTSD symptoms and physical comorbidities, there has been increasing interest in the potential role in the treatment of PTSD. Objective: The purpose of this review was to investigate the associations between physical activity levels and PTSD symptoms in emergency service and frontline medical workers. Design: A systematic review was conducted by searching major electronic databases for relevant studies published from database inception until February 2021. Eligibility Criteria: Studies among traditional emergency service occupations, e.g., police officers, firefighters, paramedics, and medical frontline workers, including doctors and nurses, were included. Study Selection: Experimental and observational studies with or without control groups were eligible for inclusion. Main Outcome Measure: The primary outcome measure was symptoms of PTSD. Results: The search identified eight eligible studies (four experimental and four observational). Three of the experimental studies showed that exercise significantly reduced symptoms of PTSD in emergency service personnel, including police and nurses. Based on the results of results of three studies, physical activity may be inversely associated with PTSD symptom severity among nurses and firefighters. Conclusions: Existing research suggests that physical activity may improve symptoms of PTSD in emergency service personnel and frontline workers. Considering physical activity promotion initiatives for occupations at high risk of trauma exposure may therefore be warranted to promote mental health. The existing research has several methodological limitations, and findings should therefore be interpreted with caution until further robust studies are available.

Knowledge, Attitudes, and Screening for Obstructive Sleep Apnea and Diabetes Mellitus among War Veterans Seeking Treatment of Posttraumatic Stress Disorder.

Posttraumatic stress disorder (PTSD) is one of the most common psychiatric disorders. However, we should not neglect the somatic aspects of PTSD. Associations with cardiovascular diseases (CVD) are particularly concerning because PTSD was associated with an even 53% higher risk for CVD. This study aimed to analyze the prevalence of several CVD risk factors, especially diabetes mellitus among PTSD patients divided into three groups according to obstructive sleep apnea (OSA) risk stratification (low, intermediate, and high). This cross-sectional study included one hundred male PTSD veterans. The mean age was 53 (40–67) years. The estimated OSA risk was 95% for the whole cohort, and 53% were in the high-risk group. Median HbA1c was 5.6 (4.6–10)%. The hemoglobin A1c (HbA1c) levels showed that 34 patients were in the prediabetes group, and 20 of them fulfilled the criteria for diabetes. However, only 13 of them were aware of their previous diagnosis of diabetes mellitus. In testing knowledge about diabetes, 62% and only 23% of patients knew the correct definition of HbA1c and level of fasting plasma glucose, respectively. Diabetic patients had insufficient knowledge about diabetic complications and treatment. A higher level of PTSD symptoms in veterans was associated with a higher prevalence of OSA. The results strongly support further research and education into early detection of CVD risk factors associated with PTSD.

Hospice and palliative care clinicians’ perceptions of posttraumatic stress disorder at end-of-life in military veterans

At the end of life, individuals may re-engage with earlier life trauma as they reflect on life experiences and confront their mortality. As such, posttraumatic stress disorder (PTSD) symptoms at the end of life may worsen the quality of death experience. This is a concern for military veterans, who tend to have more trauma exposures and higher rates of PTSD, and particularly for veterans receiving care in rural areas where access to PTSD specialty services is limited. To better understand this issue, we conducted 10 focus groups with clinicians serving veterans in rural communities across five U.S. states. The aims of this project were to evaluate: (1) do hospice and palliative care providers/staff observe PTSD symptoms in veterans at the end of life? (2) if so, how are symptoms similar to and different from existing DSM-5 criteria for PTSD? We used qualitative content analysis with mixed deductive and inductive approaches to code 151 anonymized statements. Analyses found descriptions of PTSD symptoms aligned broadly with existing diagnostic nomenclature, but descriptions revealed specific presentations relevant to the end of life setting such as resistance to care, agitation, restlessness, and effects of delirium. In addition, some veterans expressed pride in service and openness to discussing military experiences. Further, clinicians noted that PTSD symptoms were relevant to family dynamics. Future research should further characterize these symptom differences through direct patient assessment and develop resources to improve quality of death experience for veterans with PTSD symptoms.

The role of positive emotion dysregulation in the relationship between childhood abuse and PTSD in a community sample of veterans

BackgroundThe co-occurrence of childhood abuse and posttraumatic stress disorder (PTSD) among United States military veterans is highly prevalent and clinically significant. Emotion dysregulation is one factor that has been found to underlie the association between childhood abuse and PTSD, yet past research has focused exclusively on dysregulation stemming from negative emotions. ObjectiveThe current study extends existing research by clarifying the role of positive emotion dysregulation in the relation between childhood abuse and PTSD in a community sample of military veterans. Participants and settingParticipants were 465 trauma-exposed military veterans in the community (Mage = 38.00, 71.6 % women, 69.5 % White). MethodUsing structural equation modeling, we tested the indirect association of childhood abuse to PTSD symptom severity through positive emotion dysregulation. ResultsThe hypothesized model showed adequate model fit, χ2 (32, n = 465) = 176.22, p < .001, CFI = .97, RMSEA = .10, 90 % CI [.08, .11], SRMR = .04. Results showed that childhood abuse was indirectly associated with PTSD symptom severity through positive emotion dysregulation. ConclusionsThis finding highlights the potential utility of targeting positive emotion dysregulation in the detection and treatment of PTSD symptoms in veterans who experienced childhood abuse.

Psychotic Disorders in the Veterans of Local Wars

Objectives. To determine the frequency of leading psychopathological syndromes, dynamics, and comorbidities of schizophrenia and other endogenous psychoses in Russian veterans of local wars receiving hospital treatment. Materials and methods. A total of 685 patients receiving treatment in the psychiatric departments of a military hospital were studied: 264 veterans of local wars (the study group), 296 servicemen (personnel and reserves) who had not taken part in military engagements (reference group 1), whose mean age differed from that of the study group, and 125 servicemen (personnel and reserves) who had not taken part in military engagements and had the same mean age and age distribution as patients of the study group (reference group 2). Results and conclusions. Among veterans (patients of the study group), the frequency of delusional (schizotypic) psychoses was somewhat lower (7.2%) than among patients who had not taken part in military engagements (14.5% and 8.8%, respectively). Patients of all three groups were mainly diagnosed with schizophrenia (ICD-10 F20): 3.8% in the study group, 4.4% in reference group 1, and 4.0% in reference group 2. Other acute and chronic psychotic disorders (F22–F23) were rarer and were seen in 0.8%, 5.4%, and 3.2% of patients, respectively. Organic delusional disorders were diagnosed in 1.5% of veterans and 3.7% of patients in reference group 1 but were not seen in patients of reference group 2. Comorbidity with post-traumatic stress disorder (PTSD) and psychotic symptoms in veterans was less than 2% but was seen in 26.3% of patients with diagnoses of schizophrenia and other disorders. The incidence of PTSD symptoms in veterans with diagnosed schizophrenia and other delusional disorders was significantly lower than the incidence among all veterans (20% and 46.9%, respectively). No link was found between hallucinatory and delusional experiences and the actions of military stress factors in the study group. In most patients of the study group, psychotic symptomatology became manifest after combat stress ended, and the subsequent development and relapse of psychotic symptomatology occurred independently of the effects of wartime factors.

The impact of social support and morally injurious events on PTSD symptoms in Veterans

ABSTRACT Potentially morally injurious events (PMIEs), including committing transgressions (Transgressions-Self) and perceiving betrayals, have been positively associated with posttraumatic stress disorder (PTSD). A proposed mechanism for the association between PMIEs and PTSD symptoms is social disconnection. However, research on PMIEs and social disconnection is limited. Secondary data analysis from a larger study examined the moderating role of different sources of perceived social support (Family, Friends, and Significant Other) on the relation between PMIEs (Transgressions-Self and Betrayal) and PTSD. The interaction of Transgressions-Self and perceived social support subscales did not predict PTSD symptoms. However, the interaction of Betrayals and perceived social support (Significant Other and Family) predicted PTSD symptoms. Results suggest that perceived social support provides a protective effect for low to mean levels of perceived betrayals; however, for Veterans reporting high levels of betrayal, perceived social support did not attenuate PTSD symptom severity. Additional research on perceived betrayals and the association with PTSD is needed, especially for Veterans who experience high levels of perceived betrayals.

Interactive Motion-Assisted Exposure Therapy for Veterans with Treatment-Resistant Posttraumatic Stress Disorder: A Randomized Controlled Trial

Background: Veterans with posttraumatic stress disorder (PTSD) tend to benefit less from evidence-based treatments than other PTSD populations. A novel virtual reality and motion-assisted exposure therapy, called 3MDR, provides treatment in an immersive, personalized and activating context. Objective: To study the efficacy of 3MDR for veterans with treatment-resistant PTSD. Method: In a randomized controlled trial (n = 43) 3MDR was compared to a non-specific treatment component control group. Primary outcome was clinician-rated PTSD symptoms at baseline, after 3MDR, and at the 12-week and 16-week follow-up (primary end point). Intention-to-treat analyses of covariance and mixed models were applied to study differences between groups at the end point and over the course of intervention, controlling for baseline scores. Results: The decrease in PTSD symptom severity from baseline to end point was significantly greater for 3MDR as compared to the control group, with a large effect size (F[1, 37] = 6.43, p = 0.016, d = 0.83). No significant between-group difference was detected in the course of PTSD symptoms during treatment when including all time points. The dropout rate was low (7%), and 45% of the patients in the 3MDR group improved clinically. The number needed to treat was 2.86. Conclusions: In this trial, 3MDR significantly decreased PTSD symptoms in veterans with, on average, a history of 4 unsuccessful treatments. The low dropout rate may be indicative of high engagement. However, a lack of significant differences on secondary outcomes limits conclusions that can be drawn on its efficacy and underlines the need for larger phase III trials. These data show emerging evidence for 3MDR and its potential to progress PTSD treatment for veterans (Dutch Trial Register Identifier: NL5126).

Latent classes of PTSD symptoms in veterans undergoing residential PTSD treatment.

Although most veterans in the Department of Veterans Affairs (VA) health system are treated for posttraumatic stress disorder (PTSD) in the outpatient setting, the VA has approximately 40 residential PTSD treatment facilities across the country for those requiring more intensive care. The symptom profiles of these veterans are poorly understood. Thus, the current study was designed to characterize classes of PTSD symptoms in a national sample of veterans undergoing residential treatment. We analyzed latent classes of PTSD symptoms among 2,452 veterans entering VA PTSD residential treatment in fiscal year 2013. The model with the best fit was a 4-class model comprising a low symptom class, moderate symptom class with high reexperiencing symptoms, a moderate symptom class with high emotional numbing, and a high symptom class. Compared to classes identified in outpatient samples, these classes were similar in type but greater in severity. Classes differed by age, race/ethnicity, trauma type, co-occurring medical conditions, co-occurring psychiatric conditions, and social functioning. Compared to the moderate class with high emotional numbing, those in the moderate class with high reexperiencing symptoms were more likely to be non-White, have greater pain severity, greater sleep problems, and were less likely to be depressed. Our findings suggest that veterans in residential treatment who have more severe PTSD symptoms also experience other medical and psychosocial stressors. A better understanding of symptom profiles may help to create more individualized treatment planning and thus potentially improve care for these veterans. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

High Behavioral Sensitivity to Carbon Dioxide Associates with Enhanced Fear Memory and Altered Forebrain Neuronal Activation

There is considerable interest in pre-trauma individual differences that may contribute to increased risk for developing post-traumatic stress disorder (PTSD). Identification of underlying vulnerability factors that predict differential responses to traumatic experiences is important. Recently, the relevance of homeostatic perturbations in shaping long-term behavior has been recognized. Sensitivity to CO2 inhalation, a homeostatic threat to survival, was shown to associate with the later development of PTSD symptoms in veterans. Here, we investigated whether behavioral sensitivity to CO2 associates with PTSD-relevant behaviors and alters forebrain fear circuitry in mice. Mice were exposed to 5% CO2 or air inhalation and tested one week later on acoustic startle and footshock contextual fear conditioning, extinction and reinstatement. CO2 inhalation evoked heterogenous freezing behaviors (high freezing CO2-H and low freezing CO2-L) that significantly associated with fear conditioning and extinction behaviors. CO2-H mice elicited potentiated conditioned fear and delayed extinction while behavioral responses in CO2-L mice were similar to the air group. Persistent neuronal activation marker ΔFosB immunostaining revealed altered regional neuronal activation within the hippocampus, amygdala and medial pre-frontal cortex that correlated with conditioned fear and extinction. Inter-regional co-activation mapping revealed disruptions in the coordinated activity of hippocampal dentate-amygdala-infralimbic regions and infralimbic-prelimbic associations in CO2-H mice that may explain their enhanced fear phenotype. In conclusion, our data support an association of behavioral sensitivity to interoceptive threats such as CO2 with altered fear responding to exteroceptive threats and suggest that “CO2-sensitive” individuals may be susceptible to developing PTSD.

Psychotic disorders in the veterans of local wars

To determine the frequency of the key psychopathological syndromes, the dynamics and comorbidity of schizophrenia and other psychoses in Russian veterans of local wars receiving hospital treatment. The study included 685 patients of a psychiatric department of a military hospital, including 264 veterans of the local wars (the main group), 296 people (career military servicemen and retirees), who do not take part in combat actions (the first comparison group) and 125 people matched for the middle age and the age distribution curve with the main group (the second comparison group). The frequency of psychoses appeared to be slightly less in veterans (7.2%) compared to patients of comparison groups (14.5% and 8.8%, respectively). In all groups, most patients were diagnosed with schizophrenia (ICD-10 F20): 3.8% in the main group, 4.4% in the first comparison group and 4.0% in the second comparison group. Other acute and chronic psychotic disorders (F22-F23) were diagnosed in 0.8, 5.4 and 3.2% patients, respectively. Organic delusion disorders were diagnosed in 1.5% patients of the main group, 3.7% patients of the first comparison group and were not detected in the second comparison group. Comorbidity of posttraumatic stress disorder (PTSD) and psychosis was about 2% in the main group in whole and 26.3% in those with schizophrenia and other delusional disorders. The degree of incidence of symptoms of PTSD in veterans diagnosed with psychosis was significantly less than their frequency among all veterans (20% and 46.9%, respectively). Military stress factors do not influence the development of hallucinations and delusions in the main group. In the majority of veterans, psychotic symptoms manifested for the first time after stopping combat stress, the subsequent development and recurrence of psychotic symptoms happened regardless of the influence of combat stress factors.

Pilot Data on Effects of Community Dance for Veterans with PTSD and their Family Members

Prior research has shown that there are several symptoms of Post-Traumatic Stress Disorder (PTSD) that are persistently hard to treat and critically important for full recovery. Community reintegration can be an especially challenging aspect of returning home from combat duty. The purpose of this study was to test the effects of a community dance program on some of these psychological symptoms. Community dance has been shown to strengthen cognitive plasticity which is often a problem for veterans with PTSD. This program also includes predictable gentle touch and family involvement, two elements that can predict stress reduction and successful community reintegration in those with PTSD. Before and after each ten-week community dance program, seventeen veterans and accompanying family members were measured on connectedness using the Interpersonal Needs Questionnaire, Revised (INQ-R) (Van Orden, Witte, Gordon, Bender, & Joiner, 2008), experience avoidance using the Acceptance and Action Questionnaire, Version 2 (AAQ-II) (Bond, et al., 2011), and hope and optimism using a modified Life Orientation Test, Revised questionnaire (LOT-r ) Scheier, Carver, & Bridges, 1994), combined into a wellness score. Each ten-week program consisted of weekly, 90-minute community dances with live music and a nationally recognized dance caller. We found improvements in wellness scores for all participants, regardless of PTSD status, partial h2 =0.52. We think this program, and programs like it, show great promise in treating some of the most persistent symptoms of PTSD in veterans and in their families.

Latent factor structure of PTSD symptoms in veterans with a history of mild traumatic brain injury and close-range blast exposure.

Confirmatory factor analysis (CFA) has previously been employed to examine the latent factor structure of posttraumatic stress disorder (PTSD) symptoms with mixed results. A limited number of studies examined PTSD factor structure among veterans of recent military conflicts. This study examined the relationship between PTSD factor structure and the hallmark conditions of these conflicts, mild traumatic brain injury (mTBI) and close-range blast exposure (CBE). The fit of previously proposed PTSD factor models was compared in a cohort of 387 combat-exposed veterans, with stratified analyses comparing factor structure models between those with a history of military-related mTBI and CBE (n = 106) and those without either of these antecedents (n = 151). CFAs were conducted using criteria from the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994). The 4-factor emotional numbing (EN) model yielded the best fit when using a clinician-administered assessment of PTSD symptoms regardless of mTBI/CBE exposure status. However, when using a self-report measure of PTSD symptom severity, the EN model yielded best fit for those with mTBI/CBE exposure history while the 5-factor dysphoric arousal (DA) model was preferable among combat-exposed veterans with no history of mTBI/CBE exposure. Factors including mTBI and blast exposure and type of assessment tools must be considered when determining preferable PTSD latent factor structure models. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Non-trauma-focused meditation versus exposure therapy in veterans with post-traumatic stress disorder: a randomised controlled trial

Post-traumatic stress disorder (PTSD) is a complex and difficult-to-treat disorder, affecting 10-20% of military veterans. Previous research has raised the question of whether a non-trauma-focused treatment can be as effective as trauma exposure therapy in reducing PTSD symptoms. This study aimed to compare the non-trauma-focused practice of Transcendental Meditation (TM) with prolonged exposure therapy (PE) in a non-inferiority clinical trial, and to compare both therapies with a control of PTSD health education (HE). We did a randomised controlled trial at the Department of Veterans Affairs San Diego Healthcare System in CA, USA. We included 203 veterans with a current diagnosis of PTSD resulting from active military service randomly assigned to a TM or PE group, or an active control group of HE, using stratified block randomisation. Each treatment provided 12 sessions over 12 weeks, with daily home practice. TM and HE were mainly given in a group setting and PE was given individually. The primary outcome was change in PTSD symptom severity over 3 months, assessed by the Clinician-Administered PTSD Scale (CAPS). Analysis was by intention to treat. We hypothesised that TM would show non-inferiority to PE in improvement of CAPS score (Δ=10), with TM and PE superior to PTSD HE. This study is registered with ClinicalTrials.gov, number NCT01865123. Between June 10, 2013, and Oct 7, 2016, 203 veterans were randomly assigned to an intervention group (68 to the TM group, 68 to the PE group, and 67 to the PTSD HE group). TM was significantly non-inferior to PE on change in CAPS score from baseline to 3-month post-test (difference between groups in mean change -5·9, 95% CI -14·3 to 2·4, p=0·0002). In standard superiority comparisons, significant reductions in CAPS scores were found for TM versus PTSD HE (-14·6 95% CI, -23·3 to -5·9, p=0·0009), and PE versus PTSD HE (-8·7 95% CI, -17·0 to -0·32, p=0·041). 61% of those receiving TM, 42% of those receiving PE, and 32% of those receiving HE showed clinically significant improvements on the CAPS score. A non-trauma-focused-therapy, TM, might be a viable option for decreasing the severity of PTSD symptoms in veterans and represents an efficacious alternative for veterans who prefer not to receive or who do not respond to traditional exposure-based treatments of PTSD. Department of Defense, US Army Medical Research.

BDNF Val66Met polymorphism and posttraumatic stress symptoms in U.S. military veterans: Protective effect of physical exercise

The Met allele of the brain-derived neurotrophic factor (BDNF) Val66Met polymorphism is associated with reduced levels of BDNF release, heightened hypothalamic-pituitary-adrenal axis reactivity, and impaired fear extinction. As a result, Met allele carriers may be at risk for greater severity of posttraumatic stress disorder (PTSD) symptoms. In this study, we examined the relationship between the BDNF Val66Met polymorphism and PTSD symptoms in two nationally representative samples of European American U.S. military veterans (main sample, n = 1386; replication sample, n = 509). Results revealed that, relative to Val/Val homozygotes, Met allele carriers reported greater severity of lifetime and current PTSD symptoms, specifically re-experiencing symptoms. Met allele carriers with high trauma burden also reported greater severity of lifetime and past-month PTSD symptoms. Greater engagement in physical exercise moderated this gene-by-environment interaction. Specifically, among veterans with high lifetime trauma burden, Met allele carriers who exercised had significantly lower severity of PTSD symptoms compared to those who did not exercise. These findings suggest that interventions designed to bolster engagement in physical exercise may help mitigate PTSD symptoms in veterans who are Met allele carriers and highly exposed to trauma.