Posttraumatic Stress Disorder In Veterans Research Articles

Оцінки рівня дистресу, депресії, тривоги та соматизації у ветеранів з ПТСР та легкою черепно-мозковою травмою після 8-тижневого комплексного втручання

Background. Understanding the complex relationships between combat injuries, physical health, and mental health symptoms is critical to meeting the healthcare needs of veterans. The relationship between head injuries, posttraumatic stress disorder (PTSD), and depression among combat-injured service members is unique to modern conflicts but understudied. Research suggests a relationship between PTSD and somatic complaints in veterans, suggesting that PTSD influences somatic complaints through underlying symptoms of depression and anxiety sensitivity. Aims. To investigate the dynamics of distress, depression, anxiety, and somatization in veterans with PTSD and mTBI after an 8-week comprehensive intervention (combining a psychotherapy program with transcranial direct current electrical stimulation (tDCS)). Methods. The data of the initial and repeated examination of 329 veterans from three clinical groups were analyzed: individuals with PTSD (n=109), with mild TBI (n = 112), and with PTSD+TBI comorbid condition (n=108). All patients received standard therapy as well as psychotherapeutic intervention and transcranial direct current electrical stimulation (tDCS). The Four-Dimensional Symptom Questionnaire (4DSQ) was used to assess distress, depression, anxiety, and somatization. The rank correlation between the primary and repeated examination data for each clinical group was also determined. Results. Patients suffering from PTSD or PTSD with mTBI had significantly more symptoms of depression, anxiety, and somatization than patients with mTBI without PTSD. After the therapy, patients from the PTSD and PTSD+mTBI groups experienced a subjective increase in the feeling of distress, which was associated with a reduction of mainly depressive and somatoform symptoms in the respondents of the PTSD+mTBI group, and in patients with PTSD with a decrease of mainly depressive and anxiety symptoms. In contrast, in the patients with TBI, there was no increase in the subjective feeling of distress, and the improvement of the mental state was accompanied by a decrease in the entire investigated spectrum of symptoms - depressive, somatoform, and anxiety. In patients with TBI, a higher level of distress at the primary examination led to a lower level of depression and distress at the repeated examination, and a high somatization score was correlated with its significant reduction under the influence of therapy. In the patients of the PTSD+mTBI group, a high index of somatization at the primary examination was correlated with a subjective increase in distress, but a decrease in somatization itself at the end of therapy. Conclusions. The presence and level of expressiveness of symptoms of distress, depression, anxiety, and somatization in persons with PTSD, TBI, and a combination of these painful conditions are closely related to the effectiveness of the complex intervention, which provides the possibility of differentiated targeted therapy of individual clinical groups of patients.

Moderating Effects of BDNF Genetic Variants and Smoking on Cognition in PTSD Veterans.

Posttraumatic stress disorder (PTSD) is frequently associated with cognitive disturbances and high prevalence of smoking. This study evaluated cognition in war veterans with PTSD and control subjects, controlled for the effect of smoking and brain derived neurotrophic factor (BDNF) rs6265 and rs56164415 genotypes/alleles. Study included 643 male war veterans with combat related PTSD and 120 healthy controls. Genotyping was done by real time PCR. Cognitive disturbances were evaluated using the Positive and Negative Syndrome Scale (PANSS) cognition subscale and the Rey-Osterrieth Complex Figure (ROCF) test scores. Diagnosis (p < 0.001), BDNF rs56164415 (p = 0.011) and smoking (p = 0.028) were significant predictors of the cognitive decline in subjects with PTSD. BDNF rs56164415 T alleles were more frequently found in subjects with PTSD, smokers and non-smokers, with impaired cognition, i.e., with the higher PANSS cognition subscale scores and with the lower ROCF immediate recall test scores. Presence of one or two BDNF rs56164415 T alleles was related to cognitive decline in PTSD. The T allele carriers with PTSD had advanced cognitive deterioration in smokers and nonsmokers with PTSD, and worse short-term visual memory function. Our findings emphasize the role of the BDNF rs56164415 T allele and smoking in cognitive dysfunction in war veterans with PTSD.

The Effect of a PTSD Service Dog on Military Veterans’ Medication Regimens: A Cross-Sectional Pilot Study

ABSTRACT Recent research suggests that service dogs may have clinically relevant benefits for military veterans with posttraumatic stress disorder (PTSD). However, the effects of PTSD service dogs on veterans’ medication use have been largely unexplored. The objective of this study was to quantify the effect of PTSD service dogs on medication use among a population of military veterans with PTSD. In a cross-sectional design (n = 96), United States post-9/11 military veterans with PTSD were recruited from a single service dog provider including veterans living with a PTSD service dog (n = 52) and veterans on the waitlist (n = 44). Both populations of veterans received treatment as usual. Participants completed an online survey of self-reported medication regimens and medication changes. Regression models quantified the effect of having a service dog on physical health, mental health, pain, and sleep medications while controlling for confounding variables (age, gender identity, relationship status, traumatic brain injuries, and physical health). Results indicated that there were no significant effects of having a service dog on overall self-reported medication use nor any specific medication category (p’s > 0.06). However, veterans with a service dog were more likely than those on the waitlist to report that their doctor had decreased dosage or removed medications since getting their service dog. The results of this preliminary cross-sectional research should be interpreted with caution, as future within-subject and pharmacy-verified research is necessary to understand the causality of these findings.

Rationale, design, and methods of a two-site randomized controlled trial: Comparative effectiveness of two treatments for posttraumatic stress disorder in veterans

PTSD is associated with serious problems in interpersonal functioning, including higher rates of marital conflict and divorce, disrupted relationships with family and friends, estrangement from others and social isolation. Cognitive behavioral and trauma focused treatments are effective for treating PTSD symptoms, but a substantial proportion of individuals, particularly veterans, with PTSD, do not engage, complete, or fully respond to these treatments, and the effects of these treatments on interpersonal functioning are unknown. There is a critical need for alternative treatments with established efficacy, and for treatments that directly address problems in relationship functioning. Interpersonal Psychotherapy for PTSD (IPT-PTSD) is a promising candidate for such a treatment. This paper describes the rationale, design, and methods of the first randomized controlled equivalence trial comparing IPT-PTSD with a first-line gold standard treatment for PTSD (Prolonged Exposure; PE) in the treatment of PTSD in veterans. Both treatments include up to 12 weekly individual sessions. Assessments were conducted at baseline, following sessions four and eight, end of treatment, and 3 and 6 months post-treatment. Primary hypotheses are that IPT-PTSD will be statistically equivalent to PE in reducing the severity of PTSD symptoms, and superior to PE in improving interpersonal functioning. Secondary hypotheses propose that IPT will be superior to PE in improving overall social adjustment and quality of life, and in reducing suicidal ideation. Findings from this study have the potential to improve treatment options for veterans struggling with PTSD and interpersonal problems.

Involuntary Memories of War-Related Scenes in Veterans With PTSD

Studies suggest that general control deficits and elevated affect intensity in posttraumatic stress disorder (PTSD) extend beyond memory for the index trauma. However, few researchers have pursued this possibility experimentally by examining memory for novel events. We used an experimental design to measure the frequency and characteristics of involuntary memories over time. Veterans with and without PTSD saw pictures of neutral and war-related scenes. Half of the participants completed an involuntary-retrieval task immediately after encoding, whereas the other half completed the retrieval task after 1 week. Veterans with PTSD had stronger emotional reactions to their involuntary memories of the scenes regardless of their original valence. The emotional impact and specificity of the memories did not diminish over time in PTSD veterans but did so in the control group. The findings are consistent with an increased emotional response to a range of memories that include—but are not limited to—memories of traumatic events.

Comparing written exposure therapy to Prolonged Exposure for the treatment of PTSD in a veteran sample: A non-inferiority randomized design

Posttraumatic stress disorder (PTSD) is highly prevalent among veterans. Although there are effective treatment approaches for PTSD, such as Prolonged Exposure (PE) and Cognitive Processing Therapy, many providers trained in these approaches do not use them, or use them without sufficient fidelity, and veterans drop out of these treatments at very high rates. The time intensive nature of these treatments is frequently cited as a barrier to receiving the treatment among veterans and delivering the treatment among providers. According, there is an urgent need to establish more efficient and effective PTSD treatment approaches in order to meet the needs of veterans seeking care. Written exposure therapy (WET) is an efficient, exposure-based treatment, and may represent a plausible alternative treatment option to address PTSD in veterans. Although WET has been found to be effective and non-inferior to more time intensive trauma-focused treatment, it has not yet been investigated with a veteran sample. In an ongoing randomized controlled trial (RCT) we are investigating whether WET is non-inferior in treating PTSD compared with the more time intensive PE. The study sample will include 150 men and women veterans diagnosed with PTSD who are randomly assigned to either WET (n = 75) or PE (n = 75). Participants are assessed prior to treatment and 10-, 20-, and 30-weeks after the first treatment session. The primary outcome is PTSD symptom severity assessed with the Clinician Administered PTSD Scale for DSM-5. Establishing that PTSD can be treated effectively with fewer treatment sessions would represent a significant advance in improving access to evidence-based care for veterans with PTSD.

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).

Integrated Trauma-Focused Cognitive Behavioral Therapy for Comorbid Combat-Related Posttraumatic Stress Disorder: A Case Study with a Military Veteran

Individual Trauma-focused CBT has been shown to be effective for treating posttraumatic stress disorder in military veterans. Treatment challenges are common including the presence of dissociation and comorbidities including depression, traumatic brain injury symptoms, substance misuse, and social transition difficulties. There are currently no standard psychological therapy guidelines for veterans with comorbid presentations. However, as recommended by the National Institute for Health and Care Excellence treatment guidelines, adapting existing treatments can improve the chances of successfully treating trauma cases. In line with these recommendations, the current case study describes how the existing individual trauma-focused CBT model was integrated to treat posttraumatic stress disorder with comorbid depression, persistent mild-traumatic brain injury migraine, and social transition difficulties in a 38-year-old male combat veteran. The client attended 16-sessions of trauma-focused CBT. This model integrated his comorbidities and involved his spouse and multidisciplinary discussions with his general practitioner, and neurorehabilitation team and the Veterans’ Transition Service. At the end of treatment, the client no longer met the diagnostic criteria for posttraumatic stress disorder. This case illustrates how trauma-focused CBT can be integrated to treat comorbid posttraumatic stress disorder in veterans.

Subthreshold post-traumatic stress disorder as a risk factor for post-traumatic stress disorder: results from a sample of USA veterans.

Subthreshold post-traumatic stress disorder (PTSD) is more prevalent than PTSD, yet its role as a potential risk factor for PTSD is unknown. To address this gap, we analysed data from a 7-year, prospective national cohort of USA veterans. Of veterans with subthreshold PTSD at wave 1, 34.3% developed PTSD compared with 7.6% of trauma-exposed veterans without subthreshold PTSD (relative risk ratio 6.4). Among veterans with subthreshold PTSD, specific PTSD symptoms, greater age, cognitive difficulties, lower dispositional optimism and new-onset traumas predicted incident PTSD. Results suggest that preventive interventions targeting subthreshold PTSD and associated factors may help mitigate risk for PTSD in USA veterans.

A Pilot Randomized Controlled Trial of Transcendental Meditation as Treatment for Posttraumatic Stress Disorder in Veterans.

Preliminary studies have demonstrated the efficacy of Transcendental Meditation (TM) for treating posttraumatic stress disorder (PTSD). The present study extended previous research with a pilot trial of TM as a treatment for PTSD via a single-blinded, randomized controlled design. veterans with PTSD (N = 40) were assigned to a TM intervention or treatment-as-usual (TAU) control group. Participants in the TM group engaged in 16 sessions over 12 weeks, primarily in a 60-min group format. Change in PTSD symptoms, measured via the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) was the primary outcome. Secondary outcomes included self-reported PTSD symptoms, depression, anxiety, sleep difficulties, anger, and quality of life (QoL). Assessments were conducted at baseline and 3-month follow-up. Mean CAPS-5 score decreases were significantly larger for participants in the TM group (M = -11.28, 95% CI [-17.35, -5.20]), compared to the TAU group (M = -1.62, 95% CI [-6.77, 3.52]), p = .012, d = -0.84. At posttest, 50.0% of veterans in the TM group no longer met PTSD diagnostic criteria as compared to 10.0% in the TAU group, p = .007. Adjusted mean changes on self-report measures of PTSD symptoms, depression, anxiety, and sleep difficulties indicated significant reductions in the TM group compared to TAU, ds = .80-1.16. There were no significant group differences regarding anger or QoL. These findings demonstrate the efficacy of TM as a treatment for veterans with PTSD and for comorbid symptoms. Combined with other research, they suggest that TM may be a tolerable, non-trauma-focused PTSD treatment.

A retrospective chart review to determine the safety and efficacy of prazosin for nightmares related to posttraumatic stress disorder in veterans.

To evaluate the efficacy of prazosin for posttraumatic stress disorder (PTSD)-related nightmares in veterans and to analyze subgroup benefit/risk to guide prescribing. Patients with a previous prescription for prazosin between 1 June 2007 and 30 June 2017 were collected from the institution's electronic records. Efficacy (including nightmare frequency, and clinical PTSD rating scales) and safety (including blood pressure) data were retrospectively analyzed. Eighty-four patients were included in the analysis. The primary outcome, item 2 of the PTSD checklist, decreased from 4.00 to 3.19 (on a scale of 1-5), which was statistically significant (p<0.05). Nightmare frequency was found to have a statistically significant decrease from four to two times per week on average (p=0.00002, 95% CI 2.36 [1.39-3.33]). Of the patients who reported the greatest response (n=23), 91% (n=21) were on an antidepressant and 61% (n=14) were receiving concurrent psychotherapy. This is compared to 90% (n=76) and 44% (n=37) of the total cohort, respectively. No significant differences were found in blood pressure or suicidal ideation (p=0.58 and p=0.22, respectively). Prazosin may be considered as an adjunct option to decrease nightmare frequency in patients already receiving first-line treatment.

The Glucocorticoid Receptor Gene (NR3C1) 9β SNP Is Associated with Posttraumatic Stress Disorder.

Posttraumatic stress disorder (PTSD) has been associated with glucocorticoid (GC) hypersensitivity. Although genetic factors account for 30–46% of the variance in PTSD, no associations have been found between single nucleotide polymorphisms (SNPs) of the GC receptor (GR) gene (NR3C1) and risk for this disorder. We studied the association of five SNPs in the GR gene (rs10052957, rs6189/rs6190, rs6195, rs41423247, and rs6198) and haplotypes with PTSD, in a group of Portuguese male war veterans (33 with lifetime PTSD, 28 without). To determine whether the 9β SNP (rs6198) was associated with chronically altered cortisol levels, we evaluated hair cortisol concentrations (HCC) in a sample of 69 veterans’ offspring. The 9β variant (G allele) was significantly associated with lifetime PTSD under a dominant model of inheritance. The 9β variant was also significantly associated with severity of current PTSD symptoms. The haplotype analysis revealed an association between a common haplotype comprising the 9β risk allele and lifetime PTSD. Carriers of the 9β risk allele had significantly lower HCC than non-carriers. We found the 9β risk allele and a haplotype comprising the 9β risk allele of the GR gene to be associated with PTSD in veterans. This 9β risk allele was also associated with lower HCC in their offspring.

Management of Post-traumatic Stress Disorder in Veterans and Military Service Members: A Review of Pharmacologic and Psychotherapeutic Interventions Since 2016.

It is vitally important that providers treating post-traumatic stress disorder continue to stay abreast of research advances in the treatment of this disorder. This article updates the reader about advances in research in PTSD treatment in the past four years as well as the evolving recommendations of clinical practice guidelines. One of the most important developments is that trauma-focused therapy (TFT) has emerged as the first-line treatment for PTSD with pharmacologic options often being noted as second-line or adjunctive. The quality and quantity of research into the treatment of PTSD continue to grow; however, the pace of research into treatment options lags behind our understanding of the development, course, and prognosis of the disorder. The development of new research-based evidence in the treatment of PTSD, both pharmacologic and psychotherapeutic, is needed and likely to necessitate frequent updates and re-evaluations of clinical practice guidelines.

Is there more public support for US Veterans who experience homelessness and posttraumatic stress disorder than other US adults?

ABSTRACT This study examined differences in public knowledge and attitudes about homelessness and posttraumatic stress disorder (PTSD) among US Veterans and other adults. A national online survey of 541 US adults from the general population was conducted in November 2016 about knowledge and attitudes about homelessness and PTSD both in reference to the general population and the Veteran population. Results found that participants reported more positive attitudes and endorsed more federal funding for homelessness and PTSD for Veterans than other adults. Participants also reported greater safety concerns about PTSD among Veterans than other adults. Among various background characteristics, only political identification with the Republican party was consistently associated with attitudes in favor of Veterans. The US public reports greater support for addressing homelessness and PTSD among Veterans than other adults, supporting various government and private programs dedicated to Veterans. It is important that publicly supported programs and policies must be evaluated.

Do morally injurious experiences and index events negatively impact intensive PTSD treatment outcomes among combat veterans?

ABSTRACT Background: It has been suggested that current frontline posttraumatic stress disorder (PTSD) treatments are not effective for the treatment of moral injury and that individuals who have experienced morally injurious events may respond differently to treatment than those who have not. However, these claims have yet to be empirically tested. Objective: This study evaluated the rates of morally injurious event exposure and morally injurious index trauma and their impact on PTSD (PCL-5) and depression symptom (PHQ-9) reductions during intensive PTSD treatment. Method: Data from 161 USA military combat service members and veterans (91.3% male; mean age = 39.94 years) who participated in a 3-week Cognitive Processing Therapy (CPT)-based intensive PTSD treatment programme (ITP) was utilized. Morally injurious event exposure was established via the Moral Injury Event Scale (MIES). Index traumas were also coded by the treating clinician. Linear mixed effects regression analyses were conducted to examine if differences in average effects or trends over the course of treatment existed between veterans with morally injurious event exposure or index trauma and those without. Results: Rates of morally injurious event exposure in this treatment sample were high (59.0%-75.2%). Morally injurious event exposure and the type of index trauma did not predict changes in symptom outcomes from the ITP and veterans reported large reductions in PTSD (d = 1.35–1.96) and depression symptoms (d = 0.95–1.24) from pre- to post-treatment. Non-inferiority analyses also demonstrated equivalence across those with and without morally injurious event exposure and index events. There were no significant gender differences. Conclusions: The present study suggests that PTSD and depression in military veterans with morally injurious event exposure histories may be successfully treated via a 3-week CPT-based ITP.

Key Clinical Interest Outcomes of Pharmaceutical Administration for Veterans With Post-Traumatic Stress Disorder Based on Pooled Evidences of 36 Randomised Controlled Trials With 2,331 Adults.

Background: The effects of drug treatment on veterans, who have a high risk of post-traumatic stress disorder (PTSD), are not clear, and the guidelines are different from the recommendations of the recent meta-analysis. Our goal was to find the efficacy and frequencies of complications of drugs that can treat PTSD in veterans. Method: We searched Ovid MEDLINE, Ovid Embase, The Cochrane Library and Web of Science until January 1, 2020. The outcomes were designed as the change of PTSD total scale, subsymptom score, response rate, frequencies of complications outcomes, and acceptability. Results: We included a total of 36 randomised controlled trials with a total of 2,331 adults. In terms of overall effect, drug treatment is more effective than placebo in change in total PTSD symptoms scale (SMD = −0.24, 95% CI [−0.42, −0.06]) and response (RR = 1.66, 95% CI [1.01, 2.72]). However, in terms of frequencies of complications, drugs generally had a higher withdrawal rate (RR = 1.02, 95% CI [0.86, 1.20]) and a higher frequencies of complications (RR = 1.72, 95% CI [1.20, 2.47]) than placebo. Risperidone showed a good curative effect in change in total PTSD symptoms scale (SMD = −0.22, 95% CI [−0.43, 0.00]) and acceptability (RR = 1.31, 95% CI [0.82, 2.59]). The drugs acting on 5−HT receptors, our results showed that symptoms of hyper−arousal (SMD = −0.54, 95% CI [−0.86, −0.21]), symptoms of re−experiencing (SMD = −0.62, 95% CI [−0.86, −0.39]) and symptoms of avoidance (SMD = −0.53, 95% CI [− 0.77,−0.3]), The drugs acting on dopamine receptors, our results showed that symptoms of re−experiencing (SMD = −0.35, 95% CI [−0.55, −0.16]) and the drugs acting on α2 receptor has a significant effect on reducing total PTSD symptoms scale (SMD = −0.34, 95% CI [−0.62, −0.06]). Conclusion: Drug therapy can effectively treat PTSD, but its frequencies of complications should be considered. Different from the guidelines for adult PTSD, this study supports atypical antipsychotics, selective serotonin reuptake inhibitors and receptors that act on 5-HT and dopamine for the treatment of PTSD in veterans. Based on evidence among these drugs, the risperidone is the most effective for veterans, otherwise, sertraline is used as an alternative.

Health Characteristics and Treatment Patterns of VHA Veterans Diagnosed With PTSD in Later Life

Older adults may exhibit symptoms of Post-Traumatic Stress Disorder (PTSD) after a traumatic event, even if they do not meet the criteria for a full diagnosis. This sub-clinical PTSD affects 7-15% of older adults and is associated with elevated depressive symptoms, suicidal ideation, and poorer physical health. Individuals with sub-clinical PTSD often experience worsening symptoms, resulting in a full diagnosis of PTSD, albeit late onset. This evaluation informs the Veterans Health Administration (VHA)’s understanding of the developmental course of PTSD in older Veterans. VHA administrative data were used to examine health characteristics and service utilization in the five years before and five years after the initial VHA documentation of PTSD. We identified a cohort of Veterans (n=27,610), alive and with at least 1 encounter in all evaluation years, with a first PTSD diagnosis documented between ages 50-59, a cohort outside of the average age of diagnosis, but before Medicare eligibility. We compared periods before and after diagnosis across different ages of first diagnosis (50-54, 55-59). Veterans diagnosed at later ages (55-59) had a greater number of mental and physical health conditions. Increasing VHA use preceded a PTSD diagnosis in both groups, but the increase was steeper among those diagnosed at 55-59. Future analyses will compare these patterns to those of Veterans diagnosed at younger ages. Findings from this work may provide a profile of persons at risk for late-life PTSD for use in targeting interventions earlier to reduce the risk of developing worsening PTSD symptoms in late life.

Subtypes in PTSD for Veterans: Do Similar Profiles Exist in Polytrauma Patients?

Previous research has suggested the presence of various subtypes in posttraumatic stress disorder (PTSD) in patient populations. The purpose of this study was to explore the presence of various subtypes in PTSD in veterans referred for traumatic brain injury evaluation. As a focus of this analysis, comorbid symptoms (i.e., anxiety, depression, and neurobehavioral) were used to divide a polytrauma sample of veterans with diagnosed PTSD into clusters. The presence of a three-cluster solution was identified and validated with two types of cluster analysis. Discussion of the nature of the three subtypes of PTSD and implications for treatment are presented.

A Randomized, Placebo-Controlled Trial of Mirtazapine for the Treatment of Posttraumatic Stress Disorder in Veterans.

The aim of this study was to determine the efficacy of mirtazapine, a tetracyclic antidepressant, as monotherapy for the treatment of posttraumatic stress disorder (PTSD). This multisite, randomized, double-blind, placebo-controlled trial was conducted between April 2006 and November 2010 at the Tuscaloosa and Birmingham Veterans Affairs Medical Centers in Alabama. US military veterans who met DSM-IV criteria for PTSD were randomly assigned to placebo (n = 39) or mirtazapine (n = 39) titrated up to 45 mg/d for an 8-week double-blind period followed by an 8-week open-label phase of mirtazapine treatment. The primary outcome efficacy measure was the Structured Interview for Posttraumatic Stress Disorder (SIP). Secondary measures included other measures of PTSD, depression, and sleep. Analyses of treatment groups involved mixed-model procedures using a random intercept to test the hypotheses that mirtazapine would be more effective than placebo in reducing symptoms of PTSD and depression and improving quality of sleep. Seventy-eight participants were randomized with 61 completing the 8-week controlled phase and 48 completing the open-label phase. No significant differences were observed between groups on the primary outcome of SIP scores during the controlled phase (P = .418). In secondary outcomes, significant improvements per the Clinical Global Impressions-Improvement scale were found for the mirtazapine group compared to the placebo group (P = .041). The 8-week open-label phase demonstrated significant symptom improvement in SIP total score (P = .0003) and in scores on the SIP re-experiencing (P = .0007), avoidance (P = .0309), and hyperarousal (P = .0014) subscales. There were no significant differences in the occurrence of adverse events between groups. This study did not show efficacy of mirtazapine monotherapy in the treatment of PTSD. Identification of more effective treatments, either as monotherapy or adjunctive, for PTSD is imperative. ClinicalTrials.gov identifier: NCT00302107.

Evaluation of Self-Compassion Focused Group Treatment for Co-Occurring PTSD and Substance Use in Veterans with Posttraumatic Guilt: A Case Study

ABSTRACT Co-occurring posttraumatic stress disorder (PTSD) and substance use disorders (SUD) following combat exposure affects a significant proportion of military veterans. Guilt and shame are common to PTSD-SUD, suggesting a possible role as a mechanism underlying both disorders. Cultivating self-compassion (SC) among veterans is a logical approach to treating guilt and shame. The purpose of this article is threefold: (a) present scientific theories of SC in the veteran population with emphasis on PTSD, substance use, and guilt and shame; (b) present a case study that highlights how self-compassion-focused treatment (SCFT) can be utilized in a group format with veterans with PTSD-SUD and posttraumatic guilt; and (c) discuss implications of our findings for refining SCFT within a group intervention setting among this population and for future research.