Treatment Of Posttraumatic Stress Disorder Research Articles

Exploring the feasibility and acceptance of huddinge online prolonged exposure therapy (HOPE) for severe and complex PTSD

ABSTRACT Background: Trauma-focused cognitive behavioural therapy such as prolonged exposure is considered firsthand choice for treatment of posttraumatic stress disorder (PTSD) but is seldom available in regular care. Digital therapy is proposed to bridge this gap, but its effectiveness for severe and complex PTSD is uncertain. The primary objective of the current study was to examine the feasibility, acceptability, and preliminary effects of digital therapist-guided prolonged exposure (Huddinge Online Prolonged Exposure; HOPE). Method: Thirty participants with moderate to severe PTSD, with the majority self-reporting complex PTSD symptoms, received HOPE over a ten-week period. Eighty percent of participants had been diagnosed with other psychiatric comorbidity by a mental health professional. Primary outcome was the feasibility and acceptability of treatment. Participants were repeatedly assessed using clinician- and self-rated outcome measures at baseline, during the treatment period, post-treatment, and at 1-month and 6-month follow-ups to estimate preliminary treatment effects. The Clinician Administered PTSD Scale version 5 (CAPS-5), administered by independent assessors, evaluated PTSD symptom severity. Results: HOPE proved feasible and effective, delivering evidence-based treatment content in a psychiatric outpatient setting with reduced therapist time. The treatment was well-tolerated, with no severe adverse events and a 17% dropout rate. Sixty-four percent completed the exposure-based portion of the treatment, and overall satisfaction measured by the Client Satisfaction Questionnaire was moderate. Furthermore, significant reductions in PTSD symptoms as assessed with the CAPS-5 (Cohen's d = 1.30 [95% CI −1.79 to −0.82]) at the primary endpoint 1 month which were sustained at the 6-month follow up. Conclusion: Altogether, this study indicate feasibility of treating severe and complex PTSD through a digital PE intervention, thereby building upon and extending previous research findings. Large-scale controlled trials are needed to further validate the specific effect and long-term benefits of HOPE. Trial registration: ClinicalTrials.gov identifier: NCT05560854.

ПСИХОЛОГІЧНА ПІДТРИМКА ВІЙСЬКОВОСЛУЖБОВЦІВ З ПОСТТРАВМАТИЧНИМ СТРЕСОВИМ РОЗЛАДОМ

The article examines the features of psychological support for military personnel who suffered from post-traumatic stress disorder (PTSD) as a result of participation in combat operations (or after experiencing other severe traumatic events). It is noted that PTSD is a serious problem for the military: this disorder negatively affects their mental, physical and emotional health, leading to disability and deterioration of social adaptation. PTSD can manifest itself in mild, moderate, or severe forms, which requires different approaches to treatment. Therefore, risk factors that increase the likelihood of developing PTSD, such as previous mental disorders, the severity of the traumatic event, and coping strategies, are also considered. The diagnostics of military personnel anxiety as a preliminary and direct sign of stress is carried out. The work emphasizes that psychological rehabilitation of military personnel is a key aspect of PTSD treatment and should be comprehensive, including medical, social and psychological care. Emphasis is placed on the need for early treatment of mental disorders and rehabilitation measures at the initial stages of trauma. Special attention is paid to the stages of psychological rehabilitation, which include normalization of the psychological state, restoration of mental functions, as well as assistance in the formation of new values and meanings in civilian life. The article also describes the main methods of psychotherapy, support and prevention of psychological deformations that are used to support military personnel during rehabilitation. An important aspect is the participation in rehabilitation processes not only of medical and psychological workers, but also of volunteers, public organizations and clergy. The study emphasizes the importance of successful psychological assistance for preventing the development of PTSD and improving the quality of life of military personnel, and also emphasizes the need to provide comprehensive support for restoring social adaptation and combat readiness.

Marketing study of selective serotonin reuptake inhibitors for the treatment of post-traumatic stress disorder in military servants and war veterans

The aim of the work: to present the results of a marketing study of medicinal products of the ATC classification group N06AB "Selective serotonin reuptake inhibitors" (SSRIs) in terms of registration and legal status, the state of the wholesale and retail market, presence in socio-economic regulatory lists of medicinal products, as well as to evaluate the results of an anonymous survey of doctors regarding the prescription of SSRIs to military personnel and war veterans with post-traumatic stress disorder (PTSD). Materials and methods. Methods such as analysis, synthesis, comparison, specification, systematization, generalization, and reliability assessment were used; an anonymous survey of 35 psychiatrists and 25 neurologists was conducted regarding the prescription of drugs for patients with PTSD. Results and discussion. It was found that SSRIs should be considered as first-line pharmacotherapy for military personnel with PTSD. At the same time, escitalopram, which, according to the literature, demonstrates the best safety and efficacy indicators, which was preferred by 97% of the surveyed doctors, the market of which showed the greatest growth in terms of assortment and which was most numerously included in the List of Drugs Subject to Reimbursement, remains absent from the updated Unified Clinical Protocol for the Treatment of PTSD. Conclusions. 100% of doctors confirmed the choice of SSRIs, among which, with a probability of type I error α = 0.05, a reliable probability of p ≥ 0.95 regarding the unanimity of responses, psychiatrists most often prescribed escitalopram and sertraline, neurologists - citalopram and escitalopram, in general - escitalopram. As of 01.10.2024, 45 trade names of SSRIs were registered in Ukraine (4 - fluoxetine, 1 - citalopram, 7 - paroxetine, 9 - sertraline, 2 - fluvoxamine, 22 - escitalopram), 80% of the drugs were of foreign origin, 20% of which were manufactured to order by domestic manufacturing companies. Imported drugs came from 15 countries, most of them - from India (28%); among 9 domestic companies, Pharma Start LLC supplies the largest number of medicines (33%). It was found that currently the lowest prices for drugs in Ukraine are offered by the drug booking service Tabletky.UA. The state reimburses the cost of PTSD treatment with the most affordable drugs paroxetine and sertraline (1 trade name each), fluoxetine (3), escitalopram (5). Therefore, given the results of the study, it is recommended to include escitalopram in the Unified Clinical Protocol of Primary and Specialized Medical Care “Acute Stress Reaction. PTSD. Adaptation Disorders”.

The effect of eye movement desensitization on neurocognitive functioning compared to retrieval-only in PTSD patients: a randomized controlled trial

BackgroundThere is robust evidence that posttraumatic stress disorder (PTSD) is associated with neurocognitive deficits, such as executive dysfunction or memory dysfunction. Eye Movement Desensitization and Reprocessing (EMDR) is an evidence-based treatment for PTSD, in which eye movements (EMs) are performed during traumatic memory retrieval. We examined whether Eye Movement Desensitization (EMD) improves neurocognitive functioning in PTSD patients, in comparison with a retrieval-only control condition without EMs.MethodsAdult patients with PTSD (N = 91) were randomized into EMD (N = 47) or retrieval-only (N = 44). Data were collected at baseline (T0), one-week post-treatment (T1), one-month follow-up (T2), and at three-month follow-up (T3). Outcome measures were the California Verbal Learning Test (CVLT), the Trail Making Test (TMT), and the Digit Span Subtest of the Wechsler Adult Intelligence Scale fourth edition (WAIS-IV). We conducted linear mixed model to analyse the main outcomes.ResultsThere was a main effect of time, indicating improvements for both the EMD and retrieval-only groups in CVLT scores, TMT A, TMT B and Digit Span score of WAIS-IV (Bonferroni-adjusted p’s < 0.001) from T0 to T3. There were no effects of group (p = .64) or group by time on CVLT total trial A (T3; p = .34), delay A (T3; p = .76), TMT A (T3; p = .61), TMT B (T3: p = .58), and Digit Span scores (T3; p = .78) of the WAIS-IV, indicating no significant differences between groups on any of the outcomes.ConclusionComparing EMD and retrieval-only did not show evidence for additive effects of EMs on the treatment of PTSD in terms of improvements in neurocognitive functioning. Thus, treatments based on retrieval of traumatic memories may be used to improve neurocognitive functioning in patients with PTSD.Clinical trial registrationThe trial was registered 19/12/2017 at ClinicalTrials.gov, identifier [ISRCTN55239132].

Acceptability and Preliminary Effects of Intensive Brief Trauma-Focused PTSD Treatment for Refugees.

Post-Traumatic Stress Disorder (PTSD) is a significant mental health concern in refugee populations exposed to trauma and displacement. Traditional treatments for PTSD often involve lengthy interventions. However, there's a growing interest in exploring more condensed, intensive treatments to improve outcomes and accessibility for refugees. This study aimed to evaluate the acceptability, and preliminary effects of an intensive brief trauma-focused PTSD treatment (ITT) program delivered to refugees at the Swedish Red Cross Treatment Center for Persons Affected by War and Torture in Uppsala, Sweden. Ten participants were enrolled in the study and received ITT over five consecutive weekdays comprising Eye Movement Desensitization and Reprocessing Therapy (EMDR), prolonged exposure (PE), and physical activity (PA). Acceptability was assessed by analyzing journal notes, and clinicians' and patients' open-ended responses to sets of questions designed to elicit the patients' experiences and potential adverse events. Baseline and follow-up data regarding PTSD (i.e., PCL-5 and CAPS-5), disability (i.e., Whodas-12), and anxiety or depression (i.e., HSCL-25) were collected and analyzed. The study demonstrated that ITT is an acceptable and viable treatment option for refugees with PTSD. No serious adverse events were reported, although some found the treatment very taxing. Overall, the ordeals were perceived as worthwhile. The statistical analyses showed substantial and significantly reduced PTSD symptoms, and anxiety levels i.e., CAPS-5 (Cohen's d 1,91; CI 95% 0.77-3.02), PCL-5 (Cohen's d 1,31; CI 95% 0.43 -2.15) Anxiety subscale of HSCL-25 (Cohen's d 1.47; CI 95% 0.49 -2.41). Reductions in depression symptoms and disability were also observed but were non-significant. The results suggest that this brief and massed treatment program for refugees with PTSD is a well-received and preliminary effective treatment option. Identifying less suitable candidates and conducting larger, controlled studies with longer follow-up periods are needed to establish ITT's efficacy in this population.

Moral injury appraisals and PTSD symptoms in treatment-seeking refugees: a latent profile analysis

ABSTRACT Objective: Refugees flee from countries due to war, violence, or persecution and are often exposed to potentially traumatic events (PTEs). Furthermore, they might encounter situations where they are compelled to act contrary to their moral codes or witness others acting morally wrong. Consequently, they are at risk to not only develop symptoms of posttraumatic stress disorder (PTSD), but also moral injury (MI). To date, MI in traumatized refugees has received limited research attention. The present study sought to identify classes of MI appraisals and PTSD symptoms among refugees exposed to PTEs and to investigate differences between these classes in terms of demographics, general psychopathology, and depression. Method: For this study, 136 treatment-seeking refugees completed questionnaires on demographics, self-directed and other-directed MI appraisals, PTSD symptoms, general psychopathology, and depression. Latent profile analysis was conducted to identify classes and regression analyses to explore differences between classes in terms of age, gender, general psychopathology, and depression. Results: The following three classes were identified: a ‘below average MI and below average PTSD class’ (39%), an ‘average MI-self, below average MI-other and low PTSD class’ (10%) and an ‘above average MI and above average PTSD class’ (50%). Classes differed in terms of general psychopathology and depression but not age and gender. Conclusions: We identified three classes, each displaying distinct manifestations of MI appraisals and PTSD symptoms. This highlights the importance of assessing and recognizing MI appraisals within treatment-seeking refugees, enabling customized treatment interventions for both MI and PTSD.

Brexpiprazole and Sertraline Combination Treatment in Posttraumatic Stress Disorder

New pharmacotherapy options are needed for posttraumatic stress disorder (PTSD). To investigate the efficacy, safety, and tolerability of brexpiprazole and sertraline combination treatment (brexpiprazole + sertraline) compared with sertraline + placebo for PTSD. This was a parallel-design, double-blind, randomized clinical trial conducted from October 2019 to August 2023. The study had a 1-week, placebo run-in period followed by an 11-week, double-blind, randomized, active-controlled, parallel-arm period (with 21-day follow-up) and took place at 86 clinical trial sites in the US. Adult outpatients with PTSD were enrolled (volunteer sample). Oral brexpiprazole 2 to 3 mg per day (flexible dose) + sertraline 150 mg per day or sertraline 150 mg per day + placebo (1:1 ratio) for 11 weeks. The primary end point was change in Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) total score (which measures the severity of 20 PTSD symptoms) from randomization (week 1) to week 10 for brexpiprazole + sertraline vs sertraline + placebo. Safety assessments included adverse events. A total of 1327 individuals were assessed for eligibility. After 878 screen failures, 416 participants (mean [SD] age, 37.4 [11.9] years; 310 female [74.5%]) were randomized. Completion rates were 137 of 214 participants (64.0%) for brexpiprazole + sertraline and 113 of 202 participants (55.9%) for sertraline + placebo. At week 10, brexpiprazole + sertraline demonstrated statistically significant greater improvement in CAPS-5 total score (mean [SD] at randomization, 38.4 [7.2]; LS mean [SE] change, -19.2 [1.2]; n = 148) than sertraline + placebo (randomization, 38.7 [7.8]; change, -13.6 [1.2]; n = 134), with LS mean difference, -5.59 (95% CI, -8.79 to -2.38; P < .001). All key secondary and other efficacy end points were also met. Treatment-emergent adverse events with incidence of 5% or greater for brexpiprazole + sertraline (and corresponding incidences for sertraline + placebo) were nausea (25 of 205 [12.2%] and 23 of 196 [11.7%]), fatigue (14 of 205 [6.8%] and 8 of 196 [4.1%]), weight increase (12 of 205 [5.9%] and 3 of 196 [1.5%]), and somnolence (11 of 205 [5.4%] and 5 of 196 [2.6%]). Discontinuation rates due to adverse events were 8 of 205 participants (3.9%) for brexpiprazole + sertraline and 20 of 196 participants (10.2%) for sertraline + placebo. Results of this randomized clinical trial show that brexpiprazole + sertraline combination treatment statistically significantly improved PTSD symptoms vs sertraline + placebo, indicating its potential as a new efficacious treatment for PTSD. Brexpiprazole + sertraline was tolerated by most participants, with a safety profile consistent with that of brexpiprazole in approved indications. ClinicalTrials.gov Identifier: NCT04124614.

The clinically relevant MEK inhibitor mirdametinib combined with D-cycloserine and prediction error disrupts fear memory in PTSD models

This study establishes mirdametinib as the first MEK inhibitor that can undergo clinical development for psychiatric indications such as post-traumatic stress disorder (PTSD). PTSD is characterized by persistent traumatic memories with limited effective treatment options. A body of evidence suggests that memory storage is dynamic and constantly updated through post-retrieval modification a process termed reconsolidation. Although ERK/MAPK signaling plays a central role in fear memory consolidation, no clinically translatable MEK inhibitor has been tested in experimental models or in clinical trials to disrupt this process. Furthermore, there is need to develop pharmacological and behavioral strategies to labilize the memory to make it susceptible for disruption. Here, we disrupted fear memory reconsolidation with the clinically relevant MEK inhibitor mirdametinib in C57BL/6 mice and tested memory destabilization strategies using an auditory fear conditioning paradigm, with drugs administered following reactivation of memory. We found prediction error effective in labilizing weak fear memory and combined D-cycloserine (DCS) and predication error effective in labilizing strong fear memory. Mirdametinib disrupted the weak fear memory and reduced ERK phosphorylation in lateral amygdala when coupled with prediction error at the time of memory reactivation but required coordinated combination of DCS, prediction error and mirdametinib to disrupt strong fear memory. Barnes maze spatial memory test and open field test revealed that mirdametinib did not affect retrieval of other forms (spatial) of long-term memory and locomotor activity. Furthermore, the effect of mirdametinib was specific to reconsolidation as it had no effect on fear memory when given without reactivation. These translational findings identify a new drug that can be adapted for the treatment of PTSD.

Implementation of a Dedicated Intake Team Reduces Time to Massed PTSD Treatment.

The Institute of Medicine (2001) describes quality health care as safe, effective, patient-centered, efficient, equitable, and timely. Although this definition highlights the necessity of continuous program evaluation to ensure that these goals are being addressed, there is a notable lack of industry-wide standards and benchmarks, and many clinical programs lack the ability to continually and rigorously evaluate their own performance with data. This might be particularly true in the case of ensuring service members and veterans with posttraumatic stress disorder (PTSD) obtain treatment, as several systemic barriers exist, such as long wait times and lack of equitable treatment for individuals with minoritized identities. The current study examines the impact of a clinic-wide intake redesign for a massed PTSD treatment program to shift the intake process to a small, dedicated team rather than a responsibility shared across all clinicians. The redesign led to significantly shorter wait times for treatment and reduced some types of pre-treatment dropout. On average, patients received an acceptance/rejection decision 1 week sooner, attended the program almost 2 months sooner, and saw a roughly 60% reduction in the odds of dropout at the point of receiving an acceptance/rejection decision. Some disparities in wait times for those who were not partnered, women, and individuals who financially supported more family members remained after the redesign. Results are discussed in light of the importance of continuous program evaluation to address IOM's holistic definition of quality health care.

The Therapeutic Power of Creativity: The Role of Art Therapy in the Treatment of Post-Traumatic Stress Disorder

Purpose: This study will explore the role of creative art therapies in the treatment of PTSD, with the view of judging their efficacy in reducing symptoms of an emotional and psychological nature associated with trauma. Creative art therapies provide a complementary approach to other traditional treatments by facilitating emotional expression and working through traumatic experiences. Methodology: A systematic review was conducted, and 11 randomized controlled trials and experimental studies published between 2014 and 2024 were included in the review. The databases used for searching include PubMed, PsycINFO, and Scopus. Study selection was performed based on specific inclusion criteria. The techniques of art therapy applied in the studies included visual arts, music, and drama. Findings: The studies hint at how art therapies may contribute to symptom reduction, particularly in managing anxiety and depression among people with PTSD. Art therapy seemed to be effective in improving emotional regulation and processing trauma in more than one population, including refugee children and war veterans. However, its effectiveness varied based on the type of therapy, its duration, the person's characteristics, and cultural factors. Unique Contribution to Theory, Practice, and Policy: This research provides evidence of the potential of art therapy as an adjunct treatment for PTSD. It also serves to accentuate the need for tailor-made therapy programs in view of individual and cultural differences. The results stress the integration of creative therapies with traditional psychotherapies to enhance outcomes. More large-scale studies will be needed to develop standardized protocols and further expand the use of art therapy across mental health disorders.

Neural Markers of Treatment Response in Pediatric Anxiety and PTSD.

Pediatric anxiety disorders and post-traumatic stress disorder (PTSD) are associated with elevated threat sensitivity and impaired emotion regulation, accompanied by dysfunction in the neural circuits involved in these processes. Despite established treatments like cognitive behavioral therapy (CBT) and selective serotonin reuptake inhibitors, many children do not achieve remission, underscoring the importance of understanding the neurobiological underpinnings of these disorders. This review synthesizes current research on the neural predictors of treatment response and the neurofunctional changes associated with treatment in pediatric anxiety and PTSD during threat and reward processing. Several key findings emerged. First, enhanced threat/safety discrimination in the amygdala predicted better outcomes of pediatric anxiety and PTSD treatments. Second, differences in pretreatment activation within the lateral prefrontal and dorsal anterior cingulate cortices predicted treatment response, likely reflecting baseline executive control differences. Third, post-CBT decreases in activation in default mode, visuo-attentional, and sensorimotor areas may support treatment-related increases in task engagement. Finally, functional connectivity between the amygdala and other limbic, prefrontal, and default mode network nodes predicts treatment response in anxiety and PTSD, highlighting its potential as a biomarker for therapeutic efficacy. Understanding these neurofunctional markers could lead to more targeted interventions, optimizing treatment planning and potentially leading to the development of "pretreatment" strategies to enhance the efficacy of existing treatments. This review highlights the necessity for future research to establish more direct links between neuroimaging findings and clinical outcomes to facilitate the translation of these findings into clinical practice.

Memantine Alleviates PTSD-like Symptoms and Improves Dendritic Arborization through Modulation of the HPA Axis and Neuroinflammation in Rats.

Post-traumatic stress disorder (PTSD) poses significant neurological and psychiatric challenges. Investigations into the glutamatergic system, particularly the N-methyl-D-aspartate (NMDA) receptor, are crucial for understanding PTSD mechanisms. This study aimed to evaluate the therapeutic potential of the non-competitive NMDA receptor antagonist memantine in mitigating PTSD symptoms and to explore its underlying cellular and molecular impacts. Male Sprague Dawley rats were subjected to inescapable foot shock stress (FS-stress) to model PTSD. Following stress exposure, memantine was administered at doses of 5mg/kg and 10mg/kg six hours post-stress. Behavioural assessments, including fear conditioning and sucrose preference tests, were conducted. Golgi-Cox staining was used to assess neuroanatomical changes related to synaptic plasticity. Western blotting was used to analyse molecular markers associated with synaptic plasticity, while immunoassays measured proinflammatory cytokines and cortisol levels. Memantine treatment improved behavioral outcomes, restoring sucrose preference and reducing freezing behavior. Morphological analysis demonstrated that memantine enhanced dendritic spine structure, particularly increasing the proportion of mature mushroom spines, which are critical for synaptic stability. Additionally, memantine normalized cortisol levels, suggesting a regulatory effect on the hypothalamic-pituitary-adrenal (HPA) axis. Additionally, memantine treatment improved the inflammatory cytokine profile, reducing IL-6 and TNF-α levels. These results suggest that memantine has potential as a therapeutic intervention for PTSD by targeting critical pathways involved in stress responses.The findings indicate that memantine, an NMDA receptor antagonist, can counteract behavioral and functional disturbances induced by FS-stress.

Does Trauma Change the Way Individuals with Post-Traumatic Stress Disorder (PTSD) Deal with Positive Stimuli?

Post-Traumatic Stress Disorder (PTSD) is a highly prevalent disorder and a highly debilitating condition. Although current theories focused on depressed mood and intrusion as critical dimensions, the mechanism through which depression increases the risk of PTSD remains unclear. Research usually concentrates on the hyperactive negative valence system (NVS) (e.g., increased fear and threat responses), but some evidence suggests a significant role for the hypoactive positive valence system (PVS) (e.g., less neural activation towards rewards). The main aim of the present research was to investigate whether probable PTSD leads to a different evaluation of the implicit processing in a refugee's sample. Ratings of arousal, dominance, and valence from 60 International Affective Picture System (IAPS) pictures (positive, neutral, and negative) were collected from 42 individuals with probable PTSD, and a group of 26 trauma-exposed individuals (Mage = 28.49 years, SD = ±7.78). ANOVA results revealed a main group effect (η2p = 0.379) on arousal, dominance, valence dimensions, and pictures' categories (η2p = 0.620), confirming evidence according to which PTSD origins a state of maladaptive hyperarousal and troubles the regulation of emotions, and not supporting the view that such difficulties arise only with negative stimuli. Participants with probable PTSD deemed negative stimuli as more threatening than they really are, reacting to unpleasant images with greater negative emotionality (i.e., enhanced arousal and lower valence ratings) compared with individuals without PTSD. Moreover, they rated positive stimuli as less pleasant. Furthermore, arousal ratings were negatively correlated with valence (r = -0.709, p < 0.01) indicating that pictures with high arousal (negative) were associated with lower valence. Our findings supported evidence according to which PTSD caused a constant state of hyperarousal and difficulties in regulating emotions facing environmental stimuli. Positive stimuli are considered less pleasant, and this inhibits from completely benefiting from them. Our study provides evidence for a differential and potentially complementary involvement of NVS and PVS in PTSD development. Intervention for PTSD may, thus, target both negative and positive valence processing.

Large-scale implementation of a brief treatment program for PTSD in persons with serious mental illness in a mental health agency: The Brief, Relaxation, Education and Trauma Healing (BREATHE) program.

We examined the feasibility and clinical outcomes of implementing a brief intervention for treating posttraumatic stress disorder (PTSD) in persons with serious mental illness receiving services at a large, urban community mental health agency. The Brief, Relaxation, Education and Trauma Healing (BREATHE) program is a standardized, three-session intervention that targets PTSD symptoms through teaching breathing retraining and personalized psychoeducation about trauma and PTSD. A total of 60 clinicians were trained in the BREATHE intervention throughout the agency, which was offered to 233 clients who screened positive for probable PTSD. Self-report assessments of PTSD and depressive symptom severity were obtained before the first session, after the third session, and at a 3-month follow-up. Participant satisfaction was assessed in a brief survey. Of the 233 clients offered the BREATHE program, 211 (91%) accepted and attended at least one session. Most participants attended all three BREATHE sessions (59%) or two sessions (32%), with completers reporting high levels of satisfaction with the program. Participants showed clinically significant improvements in PTSD and depression symptoms from pretreatment to posttreatment and the 3-month follow-up. This brief intervention for PTSD was feasible to implement in a large agency serving a diverse population of persons with serious mental illness, showed high client acceptability in terms of participation and satisfaction, and was associated with significant reductions in PTSD and depressive symptoms. Further research is needed to evaluate the impact of the BREATHE program for treating PTSD in this population. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Identifying predictors of long-term treatment outcomes using narratives from written exposure therapy and cognitive processing therapy for PTSD.

Cognitive processing therapy (CPT), a 12-session, gold-standard treatment for posttraumatic stress disorder (PTSD), and written exposure therapy (WET), a brief, five-session treatment, have similar treatment efficacy. The aim of the present study was to identify predictors of long-term treatment outcomes of WET and CPT using clients' written narratives. Narratives from both treatments were coded with the Change and Growth Experiences Scale coding system to identify predictors of long-term PTSD symptom outcomes. Participants were 113 adults with PTSD randomly assigned to receive WET (n = 60) or CPT (n = 53). In WET, higher average levels of accommodated (balanced, healthy) beliefs predicted lower PTSD symptoms at the 60-week endpoint, as well as a decrease in symptoms over the follow-up symptom slope. In CPT, higher average negative emotions and positive view of self predicted better 60-week PTSD symptom outcomes, as did lower hopelessness, which also predicted a decrease in PTSD symptoms over the follow-up period. Even without direct cognitive change techniques, adaptive processing of traumatic experiences occurred in WET and predicted PTSD long-term symptom improvement. Both emotional engagement and cognitive change might help to sustain treatment gains in CPT. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Role of Momentary Alcohol Cognitions in Event-Level Relations Between PTSD Symptoms and Alcohol Outcomes: Le rôle des cognitions momentanées liées à l'alcool au niveau de l'événement entre les symptômes du TSPT et la consommation d'alcool.

Posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) commonly co-occur. Momentary alcohol cognitions may represent in-the-moment, modifiable risk factors to target in interventions for comorbid PTSD and AUD. However, the role of such cognitions in risk for problematic drinking as it emerges in response to individuals' fluctuating PTSD symptoms across their daily lives remains unknown. The present study aimed to test whether state-level PTSD-alcohol expectancies and/or drinking motives modulate in-the-moment associations between PTSD symptoms and alcohol outcomes. Frequent drinking adults with current PTSD (n = 54) reported on their posttraumatic symptoms and alcohol cognitions, craving, and consumption during four momentary surveys each day for 14 days (3,024 observations) in an ecological momentary assessment design. Multilevel moderation analyses tested whether in-the-moment PTSD-alcohol expectancies and/or drinking motives moderated relations of PTSD symptoms with alcohol craving and consumption. Findings demonstrated a significant interaction between PTSD symptoms and coping drinking motives on in-the-moment alcohol craving. Specifically, greater experience of PTSD symptoms related more strongly to craving for alcohol during events in which drinkers endorsed higher levels of coping drinking motives. There were no additional interaction effects for drinking motives or PTSD-alcohol expectancies on either alcohol craving or consumption. Coping drinking motives appear to convey strong in-the-moment risk for PTSD-related alcohol craving yet not subsequent alcohol consumption. Future research should delineate concurrent alcohol risk and possible protective processes active in the presence of PTSD symptoms to help identify targets for interventions tailored to the unique risk processes maintaining comorbid PTSD and AUD.

Promoting Psychological Health and Overall Wellness in Female Veterans With Military Sexual Trauma Through Complementary Health Interventions: A Quality Improvement Project.

Military sexual trauma (MST) has been associated with long-term negative outcomes such as increased rates of cardiovascular disease, post-traumatic stress disorder (PTSD), and suicidal thoughts and behaviors. While evidence supports the effectiveness of psychotherapeutic approaches as treatments for MST and related PTSD symptoms, these interventions have limited impact, attributed to perceived stigma with high dropout rates in female Veterans. Complementary and integrative health (CIH) interventions provide an alternative that may be more acceptable and can help transition Veterans into mental health treatments. Although evidence supports the utility of individual CIH interventions to be both effective and acceptable treatments for MST-related PTSD amongst female Veterans, there are limited evaluations of interventions that combine multiple CIH modalities, specifically in populations of at-risk female Veterans with histories of suicidal ideation or behavior. Thus, this quality improvement (QI) project aimed to assess the impact of a multimodal CIH intervention on mental and physical health symptoms specifically in female at-risk Veterans with MST. A total of 19 female Veterans with histories of MST and suicidal ideation and/or behavior who participated in an interventional programming in an urban VA in New York City were included in a secondary analysis for QI evaluation. These female Veterans comprised a subset of participants who previously engaged in a larger QI multimodal CIH intervention delivered over 4-week long in a cohort setting during which Veterans (both males and females) engaged in meditation and mindfulness, physical exercise, nutrition, and motivational curricula. Integrated as part of this programming, mental health symptoms (i.e., depression, PTSD, and stress/anxiety) and other factors related to suicide risk were assessed before and after program participation for all participants. Improvements across these symptoms pre- vs. post-program participation were examined. For this secondary analysis, a total of 73% of females with MST who participated in the multimodal CIH interventional programming had a prior history of suicidal ideation or behavior. These participants showed elevated levels of depression and sleep disturbance symptoms at baseline prior to engagement in the multimodal CIH interventions, with medium-to-large reductions in these symptoms following completion of the multimodal CIH programming (Cohen's d > 0.61 magnitude differences in symptom reduction pre vs. post). The results of this QI evaluation add to the growing body of evidence demonstrating that CIH interventions can be effective in attenuating mental health symptom-related MST and particularly within female Veteran populations at-risk for suicide, underscoring the potential importance of investigating integration of multiple CIH interventions for treatment of at-risk populations in future clinical research studies.

Intensive Narrative Exposure Therapy for Posttraumatic Stress Disorder: A 1-Week Intervention.

Posttraumatic stress disorder (PTSD) is associated with some of the poorest mental and physical health outcomes. There is often high dropout from treatment for PTSD, especially among those who have experienced chronic or multiple traumatic events. One increasingly popular PTSD treatment delivery model targeting treatment retention is intensive treatment delivery. Narrative exposure therapy (NET) is an exposure-based PTSD treatment designed to address multiple trauma exposures, but NET has not been systematically delivered in an intensive brief format. The current study aimed to determine the feasibility, acceptability, and preliminary efficacy of intensively delivered NET to a highly traumatized sample (HI-NET). A trauma-exposed clinical sample (n = 8; range of lifetime traumatic events: 5-15; 100% endorsed history of interpersonal violence; mean age = 46; 87% White) participated in daily NET sessions for 1 week. Participants completed self-report measures assessing PTSD, depressive, and dissociation symptoms as well as trauma-related cognitions at baseline, 1 week posttreatment, and 1-, 3-, and 6-month follow-up timepoints. HI-NET was feasible, with all participants attending all sessions. Participants reported high levels of acceptability and satisfaction. Participants showed significant reductions in PTSD symptoms (≥12 points on the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders-5 [PCL-5]) from baseline (M = 49.00, SD = 16.34) through 6-month assessment (M = 24.29, SD = 16.89, g =1.88). Depressive symptoms, the frequency and intensity of dissociative symptoms, and dysfunctional trauma-related cognitions all significantly decreased alongside PTSD symptoms. This is the first investigation of an intensive delivery of NET, an evidence-based treatment for PTSD that can target multiple traumatic events. After only six sessions delivered to a highly traumatized sample, there was a significant decrease in PTSD symptoms that remained decreased over time. HI-NET is feasible, acceptable, and efficacious, yet larger clinical trials with more diverse samples are needed.

Study protocol for a randomized controlled trial to adapt a posttraumatic stress disorder intervention of patients with opioid-stimulant polysubstance use receiving methadone maintenance treatment

BackgroundThe purpose of the Treatment for Harnessing Resiliency, Improving emotional regulation, and empowering indiViduals for a brighter future (THRIVE) study is to adapt an evidence-based posttraumatic stress disorder (PTSD) treatment for use among a polysubstance population receiving methadone maintenance treatment (MMT) at an opioid treatment program. Polysubstance use of high-risk combinations, such as illicit opioids and stimulants, is a critical public health issue. Individuals who engage in these high-risk combinations are more likely to have histories of childhood trauma, multiple traumas, PTSD, and greater PTSD severity as compared to mono-substance using individuals. Trauma, co-morbid mental health disorders such as PTSD, and polysubstance use complicate treatment outcomes. This study will use eight study phases to adapt an existing evidence-based PTSD intervention, Skills Training in Affective and Interpersonal Regulation with Narrative Therapy (STAIR-NT), via a massed treatment model (i.e., condensed treatment schedule) for patients in MMT who are engaged in sustained opioid-stimulant polysubstance use.Methods and analysisThe intervention is an adapted version of the STAIR-NT protocol. The massed version created includes four 60-min sessions of skill building and two weeks of four 60-min sessions of narrative therapy. A preliminary randomized controlled trial (RCT) with 80 participants, randomized 1:1, will be conducted to assess the intervention's implementation and impact on primary short-term outcomes of polysubstance use and PTSD symptoms.Ethics and disseminationThe results of this study will inform a fully-powered effectiveness trial for individuals with PTSD and polysubstance use receiving MMT. The findings are expected to provide valuable insights into improving both PTSD and substance use outcomes, and real-world implementation insights to integrating trauma-informed care in treatment settings for vulnerable populations.RegistrationThis study is registered at ClinicalTrials.Gov as NCT06307340. Registration date 03/2024.

Posttraumatic stress disorder and metabolic syndrome: the role of some biofactors in treatment

Post-traumatic stress disorder (PTSD) and metabolic syndrome (MetS) are often comorbidities and share neurobiological and clinical features. In particular, the results of meta-analyses indicate a higher prevalence of MetS in patients with PTSD compared to the general population. At the same time, PTSD is also a known risk factor for MetS. The involvement of common pathogenetic mechanisms characteristic of both conditions partially explains this coincidence. Insufficient intake and deficiency of certain biofactors, especially micronutrients (vitamins and essential minerals), are associated with an increased risk of MetS, type 2 diabetes mellitus, and cardiovascular diseases, and maintaining their physiological content in the body reduces this risk. Taking nutritional supplements with certain biofactors may help as an adjunct to conventional therapy to prevent and treat PTSD and, more often than not, MetS at the same time. This is because both conditions are linked to deficiencies in a number of biofactors. This review aims to discuss the role of several biofactors, including α-lipoic acid, vitamin B1/benfotiamine, L-carnitine and acetyl-L-carnitine, ω-3 polyunsaturated fatty acids, quercetin, magnesium, vitamins D and E, polyphenols, in the prevention and treatment of PTSD and MetS comorbidity, as well as to analyze new trends and future research directions. We conducted the search in databases such as Scopus, Science Direct (from Elsevier), PubMed, and MEDLINE. The keywords used were “post-traumatic stress disorder”, “metabolic syndrome”, and “biofactors”. We manually searched the bibliography of publications to identify research results that were not found during the online search.