Posttraumatic Stress Disorder Service Research Articles

Can scent-detection dogs detect the stress associated with trauma cue exposure in people with trauma histories? A proof-of-concept study.

Post-traumatic stress disorder (PTSD) is an impairing mental health condition with high prevalence among military and general populations alike. PTSD service dogs are a complementary and alternative intervention needing scientific validation. We investigated whether dogs can detect putative stress-related volatile organic compounds (VOCs) in the breath of people with trauma histories (54% with PTSD) exposed to personalized trauma cues. Breath samples were collected from 26 humans over 40 experimental sessions during a calm (control breath sample) and stressed state induced by trauma cue exposure (target breath sample). Two scent detection canines were presented with the samples in a two alternative forced choice (2AFC) discrimination and yes/no detection task. The 2AFC task assessed the dogs' ability to discriminate between the two states within the breath samples of one individual. The detection task determined their ability to generalize the target odour across different individuals and different stressful events of one individual. Signal Detection Theory was applied to assess dogs' sensitivity, specificity, precision, and response bias. The dogs performed at ∼90% accuracy across all sample sets in the discrimination experiment, and at 74% and 81% accuracy, respectively, in the detection experiment. Further analysis of dog olfactory performance in relation to human donor self-reported emotional responses to trauma cue exposure suggested the dogs may have been detecting distinct endocrine stress markers. One dog's performance correlated with the human donors' self-reported fear responses and the other dog's performance correlated with the human donors' self-reported shame responses. Based on these correlations between dog performance and donor self-report measures, we speculate that the VOCs each dog was detecting likely originated from the sympathetico-adreno-medullary axis (SAM; adrenaline, noradrenaline) in the case of the first dog and the hypothalamo-pituitary-adrenal axis (HPA; glucocorticoids) in the case of the second dog. Our proof-of-concept study is the first to demonstrate that some dogs can detect putative VOCs emitted by people with trauma histories when experiencing distress theoretically associated with the intrusion and arousal/reactivity symptoms of PTSD. Results have potential to improve the effectiveness and training protocol of PTSD service dogs with a focus on enhancing their alert function.

The cortisol awakening response in a 3 month clinical trial of service dogs for veterans with posttraumatic stress disorder

Recent literature suggests that service dogs may be a valuable complementary intervention option for posttraumatic stress disorder (PTSD) among military veterans due to the potential influence on stress response dysregulation. The aim of this short-term longitudinal study was to quantify the impact of service dogs in US military veterans with PTSD with particular attention to the cortisol awakening response. A sub aim of the study was to empirically evaluate the physiological effects of PTSD service dogs on veteran partners. We conducted a clinical trial (ID: NCT03245814) that assessed the cortisol awakening response for 245 participants at baseline and 3 months follow-up across an intervention group (service dog: veterans n = 88, partners n = 46) and control group (usual care: n = 73, partners n = 38). A total of N = 161 veterans and N = 84 partners collected whole saliva samples via a passive drool collection immediately upon waking, 30 min after waking, and 45 min after waking on three consecutive weekdays at baseline and again at follow-up. Mixed model repeated measures (MMRM) with a fixed effect of the intervention group (service dog or control) were utilized. Covariates considered for the model included time of awakening, sleep duration, sleep efficiency, prior day experiences (measured via ecological momentary assessment), traumatic brain injury, age, gender, race, ethnicity, socioeconomic status, smoking status, alcohol use, physical health, and body mass index. A total of 3951 salivary samples were collected (veterans: 2613, partners: 1338). MMRM results demonstrated that veterans with a service dog had a statistically significant higher cortisol awakening response, including the area under the curve with respect to both increase (AUCi, β = 1.46, p = 0.046) and absolute increase (AINC, β = 0.05, p = 0.035). Results were not statistically significant for partners. Findings suggest that veterans with service dogs have a higher, less blunted CAR in comparison to veterans receiving usual care alone. In veterans with a blunted morning cortisol response, service dog placement could help boost their morning cortisol response.

Experiences of Parental PTSD for Children Aged 9–17 in Military and Emergency First Responder Families

AbstractThis study is the first to examine the experiences of children aged 9–17 who have a military or emergency first responder (EFR) parent with post-traumatic stress disorder (PTSD). These experiences of children are important to understand through a lens of intergenerational trauma theory, given the high rates of PTSD in these service populations. Additionally, we need to know if they differ from the experiences of children of civilian parents with PTSD. To examine this, we conducted a total of 17 in-depth interviews in Australia with 5 service parents, 5 co-parents and 7 children aged 9–17 who have a parent who had formerly served in the military or an emergency service. Interviewees were not always from the same family. The families included single-parent, dual-parent, separated, and same-sex families. Gender and service type (military or EFR) were evenly distributed among interviewees. We used a critical humanist approach and undertook a reflexive thematic analysis of the interview data. The major themes were (1) parental emotional extremes, volatility, and unpredictability, (2) changes in home and family relations, (3) impacts on child wellbeing, and (4) PTSD awareness and help-seeking. We found evidence of specific impacts for children related to a combination of parental PTSD symptoms and service conditioning and culture. This study highlights the role of reduced parental capacity in the transmission of trauma from parent to child. It provides an evidence base to direct policy and research into targeted and culturally specific therapeutic interventions and support services for children and parents in service families living with PTSD.

Addressing Attrition from Psychotherapy for PTSD in the U.S. Department of Veterans Affairs

The United States Department of Veterans Affairs (VA) uses a systematized approach for disseminating evidence-based, trauma-focused psychotherapies for post-traumatic stress disorder (PTSD). Within this approach, veterans with PTSD must often choose between Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT), each delivered in their standard protocols. Many veterans have been greatly helped by this approach. Yet limiting trauma-focused therapy to these two options leaves the VA unable to fully address the needs of a variety of veterans. This limitation, among other factors, contributes to the suboptimal attrition rates within the VA. The present review proposes solutions to address treatment barriers that are both practical (such as time and travel constraints) and psychological (such as resistance to trauma exposure). By reducing barriers, attrition may lessen. Proposed countermeasures against practical barriers include intensive protocols, shortened sessions, telehealth, smartphone application delivery, or any combination of these methods. Countermeasures against psychological barriers include alternative evidence-based treatment programs (such as Acceptance and Commitment Therapy), intensive protocols for exposure-based treatments, and the integration of components from complementary treatments to facilitate PE and CPT (such as Motivational Interviewing or family therapy). By further tailoring treatment to veterans’ diverse needs, these additions may reduce attrition in VA services for PTSD.

Reproducing differential racialisation: social triage in migrant mental health services in England

Abstract In England, coverage for treatment of post-traumatic stress disorder (PTSD), a health condition that disproportionately affects forced migrants, is universal, in principle provided free of charge to all. Yet, multiple informal access barriers typically arise and informal systems of social triage may emerge. Using intersectional analysis, this study asks what political and moral rationalities inform social triage in the NHS. It is particularly attentive to how and why a supposedly universal service reproduces differential racialisation, in which multiple and co-existing populations are stratified and ranked as more or less belonging to a nation. Fieldwork was conducted in two waves, in 2015-2016 and in 2019-2021. It included six months of participant observation in an NGO; 21 semi-structured interviews with health professionals across 16 different NHS and NGO service providers, purposively sampled until saturation was reached; six interviews with mental health commissioners and national policymakers; and analysis of grey literature. Transcripts and fieldnotes were analysed inductively to identify themes using NvivoR1. Results were validated by interviewees. Despite being covered, undocumented migrants and asylum seekers were systematically excluded from NHS PTSD services, through social triage. People with refugee status were prioritised. Mental health care providers consciously and subconsciously reproduced differential racialisation, which generated health inequality. This was facilitated by: austerity; omitting immigration status in measurement of health inequality; securitisation of mental health services and minoritised Muslim populations; and bifurcated activism in which the forced migrant sector was disconnected from established struggles to combat racism in mental health care. Policies extending coverage to undocumented migrants and asylum seekers must be accompanied by extra monitoring, as well as financial, political and social support to service providers. Key messages • Health professionals informally, but systematically, reproduce differential racialisation in the rationing of health care through practices such as obfuscation and silencing critique. • Informal systems of social triage erode universal health coverage. This is exacerbated in contexts of austerity, where health professionals use their discretion to ration limited resources.

"It's a sign of weakness": Masculinity and help-seeking behaviors among male veterans accessing posttraumatic stress disorder care.

Male veterans delay posttraumatic stress disorder (PTSD) treatment and are less likely to engage in help-seeking behaviors or receive adequate mental health treatment. Male veterans face additional stigma seeking mental health care due to traditional masculine ideologies perpetuated by military culture. This study presents the perspectives of male veterans accessing Veterans Affairs (VA) PTSD services, focusing particularly on help-seeking behaviors and barriers to care. Semistructured interviews were conducted with 13 United States male veterans seeking treatment in VA primary care. Qualitative data analysis was coded using Atlas.ti, and thematic analysis was used to develop and refine themes. This study is part of a larger study examining veterans' initiation of PTSD treatment. Findings indicate that male veterans in this sample may be reluctant to initiate PTSD care due to stigma, distrust of the military or mental health care, and a desire to avoid reliving their trauma. Significant others may encourage help-seeking behaviors among this population. Veterans also reported a need for mental health services that address PTSD from noncombat trauma and from military sexual trauma (MST). Findings indicate that male veterans face unique challenges accessing mental health services and may benefit from increased VA services focused on MST and noncombat specific PTSD. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Characterizing veteran and PTSD service dog teams: Exploring potential mechanisms of symptom change and canine predictors of efficacy.

Psychiatric service dogs are an emerging complementary intervention for posttraumatic stress disorder (PTSD). Initial evidence suggests that partnership with a service dog may be related to less PTSD symptom severity. However, it remains unclear how or why this might occur. To address this gap, we conducted a longitudinal investigation of 82 post-9/11 military members or veterans and their PTSD service dogs to (1) evaluate service dog characteristics as potential predictors of efficacy, (2) assess dog and human characteristics as potential predictors of veteran-dog bond, and (3) explore potential mechanisms for mental health outcomes. Aim 1 results demonstrated that most service dog characteristics did not predict veterans’ mental health outcomes, but lower service dog excitability was associated with less PTSD symptom severity at follow-up. Aim 2 results showed that closer dog-veteran relationships were associated with less excitable dog temperament. Aim 3 results indicated that worse mental health at follow-up was associated with greater use of the specifically trained PTSD service dog task to initiate a social greeting (“make a friend”), whereas better mental health was related to less use of dominance-based training methods, lower perceived emotional/logistical costs of service dog partnership, and closer veteran-dog relationships. More frequent use of the trained service dog task to signal when someone approaches from behind (cover/watch back) was associated with greater anxiety, but less PTSD symptom severity. Overall, veterans spent an average of 82% of their time with service dogs (assessed via Bluetooth proximity between dog collar and veteran smartphone), and most frequently asked their service dogs to perform the trained task for calming their anxiety (calm/comfort anxiety). The present study provides subjective and objective metrics of the heterogeneity among veteran-service dog dyads while also suggesting which of the assessed metrics might be potential mechanisms involved in the intervention.

A web-based analysis of public concern about Post-Traumatic Stress Disorder (PTSD) Ukraine during the 2022 military conflict: An infodemiological study

BackgroundThe 2022 military conflict in Ukraine has led to multiple traumas, including the loss of property, income, businesses, homes, life, and loved ones of millions of individuals. Thus, there is a need to examine the trauma-related needs in Ukraine, including post-traumatic stress disorder (PTSD.) MethodThis study utilized an infodemiological design by exploring the keyword “Post-traumatic Stress Disorder (Topic)” in Google Trends from 2022 January 1 to 2022 March 16 in Ukraine. As an alternative measure for public concern, Relative Search Volume (RSV) and Interest by Region were described and compared ResultsThis study found rising public concern about PTSD in Ukraine, as manifested by an almost 50% increase in searches for PTSD between January and March 2022. The regions with the highest searches were Odessa, Zakarpats'ka, Kyiv city, Zhytomyrs'ka, Vinnyts'ka, Cherkas'ka, Kharkiv, Lviv, Kyivs'ka oblast, and Rivnens'ka. ConclusionThis study showed the possible application of infodemiological methods in military conflict zones. Given these, humanitarian efforts can include PTSD-related services in regions with the most significant concern and relative safety. Likewise, future analysis can determine where there is substantial public concern regarding PTSD. Moreover, countries receiving refugees should offer PTSD screening and services.

Posttraumatic stress disorder service dogs and the wellbeing of veteran families

ABSTRACT Background Benefits and challenges associated with service dogs for veterans with posttraumatic stress disorder (PTSD) may extend beyond veterans to their families. Objective The purpose of the current study is to evaluate the impact of veterans’ PTSD service dogs on spouses and families in a parallel-group, longitudinal design with assessments at baseline and three months follow-up. Method A total of 88 United States military veteran spouses completed a survey composed of multiple standardized measures at baseline and three months later. In the intervention group (n = 48), veterans received service dogs shortly after baseline while the waitlist control group (n = 40) did not. Results Linear regression analyses demonstrated significantly lower caregiver satisfaction, higher caregiver burden and higher participation in life activities among spouses who had service dogs in their homes compared to those on the waitlist. Though not significant, small effect sizes were present among additional measures. Conclusion Results suggest that although previous literature demonstrates service dogs may offer significant improvements for veterans, spouses and children may not experience those same benefits. Clinicians should consider how to prepare veteran spouses and families for integrating service dogs into their home. Future studies should explore family-focused approaches for service dog integration, defining an optimal strategy for the benefit of the entire family. HIGHLIGHTS Though service dogs may improve wellbeing for veterans with posttraumatic disorder, families of veterans may not experience those same benefits. Researchers and clinicians should consider how to best prepare veteran families for integrating service dogs into their homes. Though posttraumatic stress disorder (PTSD) service dogs are trained specifically for veterans, recent studies have demonstrated that their impact may go beyond veterans themselves (McCall, Rodriguez, Wadsworth, Meis, & O’Haire, 2020; Nieforth, Craig, Behmer, MacDermid Wadsworth, & O’Haire, 2021). PTSD service dogs may provide both benefits and challenges for veteran families.

Quantifying the emotional experiences of partners of veterans with PTSD service dogs using ecological momentary assessment

The objective of this study was to investigate the day-to-day experiences of positive and negative emotions among partners of veterans assigned service dogs for posttraumatic stress disorder (PTSD). As part of a larger clinical trial, a total of N = 87 partners of post-9/11 veterans with PTSD were recruited from a nonprofit service dog provider and participated in an ecological momentary assessment (EMA) protocol. The sample included partners of veterans who received a PTSD service dog after baseline (n = 48, treatment group) and partners of veterans on the waitlist for a service dog (n = 39, control group). Data were collected twice daily for two weeks at baseline and again at follow-up three months later, for approximately 56 assessments per participant (28 at baseline, 28 at follow up). Participants completed an average of 84% of questionnaires at baseline (n = 23.6) and 86% (n = 24.1) at follow-up. A total of 3780 EMA questionnaires were collected among partners for this analysis. Data were analyzed using a generalized linear mixed model. Three months following baseline, partners of veterans with service dogs reported statistically significant higher levels of positive emotions than the control partners (p = .01, d = 0.39) with small-to-medium effect sizes for each individual positive emotion. No statistically significant differences were reported for negative emotions (p = .77, d = 0.21). This study quantitatively identifies higher levels of positive emotion in partners who are cohabitating with a PTSD service dog compared to those partners who remained on the waitlist. Given the influence that positive emotions have on well-being and coping, findings suggest that the influence of service dogs may go beyond veterans to influence their cohabitating partners.

"Expectations versus experiences of veterans with posttraumatic stress disorder (PTSD) service dogs: An inductive conventional content analysis": Correction to Nieforth et al. (2022).

Reports an error in "Expectations versus experiences of veterans with posttraumatic stress disorder (PTSD) service dogs: An inductive conventional content analysis" by Leanne O. Nieforth, Kerri E. Rodriguez and Marguerite E. O'Haire (Psychological Trauma: Theory, Research, Practice, and Policy, Advanced Online Publication, Feb 25, 2021, np). In this article, the length of time in which service dogs had been paired with Veterans was reported incorrectly in the third paragraph under the "Participants" heading of the "Methods" section whereby the sentence "Participants with a service dog had received their PTSD service dog an average of 51.5 months prior to participating in the study (range = 3-121.7 months, SD = 33.3)." should have read "Participants with a service dog had received their PTSD service dog an average of 20.9 months prior to participating in the study (range = 1.2-46.23 months, SD = 13.18)." All versions of this article have been corrected. (The following abstract of the original article appeared in record 2021-21569-001.) Objective: The objective of this study was twofold: to describe the benefits and drawbacks of a posttraumatic stress disorder (PTSD) service dog from the perspective of Veterans with service dogs and to compare these reports to the expectations of Veterans who were on a waitlist for a PTSD service dog. Method: A total of 128 U.S. post-9/11 Veterans with PTSD were recruited from a nonprofit service dog provider (K9s for Warriors), including n = 69 with a PTSD service dog and n = 59 on the waitlist. Participant responses to open-ended survey questions were analyzed with conventional content analysis and classified into 214 codes across six subthemes, creating three larger themes. A subset (20%) of the data was independently coded to establish interrater reliability (Cohen's κ = .804). Frequency data were used to compare theme and subtheme prevalence between groups. Results: Veterans' experiences and expectations were centered on the effects the service dogs had on Veteran mental health, human-dog interaction, and the associated drawbacks. Although the majority of Veterans reported benefits from their service dogs, the findings revealed that Veterans on the waitlist more frequently mentioned benefits than those with a service dog. Study findings suggest that the drawbacks expected from service dogs differ from the drawbacks experienced. Conclusion: Understanding expectations versus experiences provides critical information for mental health professionals who are informing Veterans on individualized interventions for PTSD. This knowledge will enable professionals to temper expectations and educate Veterans on specific benefits and drawbacks so that they have a more rounded view of PTSD service dogs. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Expectations versus experiences of veterans with posttraumatic stress disorder (PTSD) service dogs: An inductive conventional content analysis.

[Correction Notice: An Erratum for this article was reported in Vol 14(3) of Psychological Trauma: Theory, Research, Practice, and Policy (see record 2022-33825-001). In this article, the length of time in which service dogs had been paired with Veterans was reported incorrectly in the third paragraph under the "Participants" heading of the "Methods" section whereby the sentence "Participants with a service dog had received their PTSD service dog an average of 51.5 months prior to participating in the study (range = 3-121.7 months, SD = 33.3)." should have read "Participants with a service dog had received their PTSD service dog an average of 20.9 months prior to participating in the study (range = 1.2-46.23 months, SD = 13.18)." All versions of this article have been corrected.] Objective: The objective of this study was twofold: to describe the benefits and drawbacks of a posttraumatic stress disorder (PTSD) service dog from the perspective of Veterans with service dogs and to compare these reports to the expectations of Veterans who were on a waitlist for a PTSD service dog. Method: A total of 128 U.S. post-9/11 Veterans with PTSD were recruited from a nonprofit service dog provider (K9s for Warriors), including n = 69 with a PTSD service dog and n = 59 on the waitlist. Participant responses to open-ended survey questions were analyzed with conventional content analysis and classified into 214 codes across six subthemes, creating three larger themes. A subset (20%) of the data was independently coded to establish interrater reliability (Cohen's κ = .804). Frequency data were used to compare theme and subtheme prevalence between groups. Results: Veterans' experiences and expectations were centered on the effects the service dogs had on Veteran mental health, human-dog interaction, and the associated drawbacks. Although the majority of Veterans reported benefits from their service dogs, the findings revealed that Veterans on the waitlist more frequently mentioned benefits than those with a service dog. Study findings suggest that the drawbacks expected from service dogs differ from the drawbacks experienced. Conclusion: Understanding expectations versus experiences provides critical information for mental health professionals who are informing Veterans on individualized interventions for PTSD. This knowledge will enable professionals to temper expectations and educate Veterans on specific benefits and drawbacks so that they have a more rounded view of PTSD service dogs. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Nationwide Survey of Trauma Center Screening and Intervention Practices for Posttraumatic Stress Disorder, Firearm Violence, Mental Health, and Substance Use Disorders.

Posttraumatic stress disorder (PTSD) symptoms, firearm violence events, alcohol and drug use problems, and major depression and suicidal ideation are endemic among patients admitted to US trauma centers. Despite increasing policy importance, the current availability of screening and intervention services for this constellation of conditions in US trauma centers is unknown. Trauma program staff at all Level I and Level II trauma centers in the US. (N = 627) were contacted to complete a survey describing screening and intervention procedures for alcohol and drug use problems, PTSD symptoms, depression and suicidality, and firearm violence. Additional questions asked trauma centers about the delivery of peer interventions and information technology capacity for screening and intervention procedures. Fifty-one percent of trauma centers (n = 322) responded to the survey. More than 95% of responding sites endorsed routinely screening and/or intervening for alcohol use problems. Routine services addressing PTSD were less common, with 28% of centers reporting routine screening. More than 50% of sites that screened for PTSD used previously established trauma center alcohol use services. Programmatic screening and intervention for firearm injury sequelae was occurring at 30% of sites. Alcohol screening and intervention is occurring frequently at US trauma centers and appears to be responsive to American College of Surgeons Committee on Trauma verification requirements. Routine screening and intervention services for PTSD and firearm injury were occurring less frequently. Regular national surveys may be a key element of tracking progress in national mental health and substance use screening, intervention, and referral policy.

Epidemiology of posttraumatic stress disorder: A prospective cohort study based on multiple nationwide Swedish registers of 4.6 million people.

Experiencing exceptionally threatening or horrifying traumas can lead to posttraumatic stress disorder (PTSD). Increasing political unrest/war/natural disasters worldwide could cause more traumatic events and change the population burden of PTSD. Most PTSD research is based on surveys, prone to selection/recall biases with inconsistent results. The aim was therefore, to use register-based data to identify the occurrence of PTSD and contributing factors in the Swedish general population. This register-based cohort study used survival analysis. Individuals born between 1960-1995, aged ≥15 years, registered and living in Sweden, not emigrating, anytime between 1990-2015, not receiving specialized care for PTSD before 2006 were included (N = 4,673,764), and followed from their 15th/16th birth date until first PTSD diagnosis between 2006-2016 or study endpoint (31-December-2016). PTSD cases (ICD-10: F43.1) were identified from the national patient register. Mean follow-up time was 18.8 years. Between 2006-2016, the incidence of specialized healthcare utilization for PTSD nearly doubled, and 0.7% of the study population received such care. The highest risk was observed for refugees [aHR 8.18; 95% CI:7.85-8.51] and for those with depressive disorder [aHR 4.51; 95% CI:3.95-5.14]. Higher PTSD risk was associated with female sex, older age, low education, single parenthood, low household income, urbanicity, and being born to a foreign-born parent. PTSD is more common among refugee migrants, individuals with psychiatric disorders, and the socioeconomically disadvantaged. It is important that provision of services for PTSD are made available, particularly to these higher risk, and often hard-to-reach groups.

PTSD service dogs foster resilience among veterans and military families.

Military deployment and reintegration challenges permeate the lives and relationships of Veterans, their spouses, and their families. Among these challenges, 23% of post-9/11 Veterans have been diagnosed with posttraumatic stress disorder (PTSD). Psychiatric service dogs have been found to help clinically alleviate PTSD symptoms when used as a complementary intervention. However, minimal research exists that explores the role of the service dog as a mechanism for cultivating resilience within the military family system. Researchers utilized a qualitative, constant comparative approach to analyze self-reported experiences of 101 individuals, including Veterans (n = 67) and their spouses (n = 34). Analyzed through the framework of the Theory of Resilience and Relational Load (Afifi et al., 2016), findings suggest complex communication processes that facilitate relational and family adaptation. These processes encompassed (a) the role of the service dog in building emotional reserves, (b) relational load introduced when caring for the service dog, and (c) the service dog's facilitation of relational maintenance behaviors among family members that contributed to communal orientation. Based on the results of this qualitative analysis, researchers suggest educational interventions where service dog trainers and mental health practitioners can incorporate relational maintenance strategies and family-focused approaches to integrating service dogs as military family members.

A study examining whether social cognitive abilities impact on recovery from PTSD

AimsDeficits in social cognition (the ability to recognise and understand emotions, intentions and actions in oneself and in others) have been found in people with post-traumatic stress disorder (PTSD). Few studies so far have examined whether social cognitive ability impacts on PTSD recovery. Here we present a protocol and preliminary data for a study that aims to evaluate whether pre-treatment social cognitive deficits are associated with treatment outcomes following trauma-focused therapy for PTSD.MethodThe protocol was developed after discussion with Patient and Public Involvement (PPI) groups, and a battery of social cognitive tasks was trialled on 20 participants without PTSD. The final protocol was then developed using information and feedback from these preliminary studies. We aim to recruit 60 individuals who are about to start a trauma-focused therapy for PTSD within the two tertiary PTSD services. Social cognition (measured using a variety of tasks including Reading the Mind in the Eyes Task and the Reflective Functioning Questionnaire) and potential confounders (including severity of trauma history, attachment and verbal IQ) are assessed at baseline, prior to the start of therapy. PTSD symptom severity (measured using the PCL-5) and daily functioning (measured using the WSAS) are assessed pre and post-treatment. The primary aim of the study is to examine whether baseline social cognition is associated with the degree of improvement in the PCL-5.ResultSo far 29 participants have been recruited and consented. 6 participants have completed follow-up assessments. The study has been adapted for the COVID-19 pandemic so participants can complete the tasks remotely. Preliminary results show a moderate negative correlation between baseline social cognitive abilities and baseline PTSD symptom severity (Spearman's correlation -0.30) and functional abilities (Spearman's correlation -0.42).ConclusionDevelopment of our study in collaboration with PPI and preliminary testing of measures suggests it is likely that it will be feasible for us to conduct this study in this patient group. Baseline preliminary results show/suggest a moderate correlation between PTSD symptom severity and social cognitive impairment. Our main analyses, when completed, will help to determine whether social cognitive ability is associated with recovery from 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.

Perceptions and Use of Alcohol and Medical Cannabis among Canadian Military Veterans Living with PTSD

Posttraumatic stress disorder (PTSD) is a common psychiatric diagnosis among Canadian military veterans, and alcohol and medical cannabis are commonly used by this group to cope with PTSD symptoms. This paper is part of a larger study that examined a cohort of 5 veterans, over a 1-year period, who used both medical cannabis and alcohol and were matched with a PTSD service dog. This paper compares the perceptions and use of alcohol and medical cannabis among the veterans to cope with their PTSD symptoms and outlines key implications. Semi-structured interviews offer insight into similarities and differences between the veterans’ perceptions and use of the two substances. Both substances are used by the veterans to manage their PTSD symptoms, typically worsening them if used in excess. Medical cannabis is a prescribed medication; however, it is perceived by the veterans to be associated with a negative discourse and in particular stigma. This is not the case for alcohol. The veterans identified alcohol use as more influenced by social norms and perceived it as more of a concern for addiction compared to medical cannabis. This did not, however, appear to impact the level of alcohol use. These findings offer unique insight into the military culture’s general acceptance of alcohol but not medical cannabis use. This has possible implications for veterans’ use of alcohol and/or medical cannabis to help manage their PTSD symptoms.

Reversals in initially denied Department of Veterans Affairs\u2019 PTSD disability claims after 17\xa0years: a cohort study of gender differences

BackgroundIn 2011, the Department of Veterans Affairs (VA) strengthened its disability claims processes for military sexual trauma, hoping to reduce gender differences in initial posttraumatic stress disorder (PTSD) disability awards. These process improvements should also have helped women reverse previously denied claims and, potentially, diminished gender discrepancies in appealed claims’ outcomes. Our objectives were to examine gender differences in reversals of denied PTSD claims’ outcomes after 2011, determine whether disability awards (also known as “service connection”) for other disorders offset any PTSD gender discrepancy, and identify mediating confounders that could explain any persisting discrepancy.MethodsFrom a nationally representative cohort created in 1998, we examined service connection outcomes in 253 men and 663 women whose initial PTSD claims were denied. The primary outcome was PTSD service connection as of August 24, 2016. Secondary outcomes were service connection for any disorder and total disability rating. The total disability rating determines the generosity of Veterans’ benefits.Results51.4% of men and 31.3% of women were service connected for PTSD by study’s end (p < 0.001). At inception, 54.2% of men and 63.2% of women had any service connection—i.e., service connection for disorders other than PTSD (p = 0.01) and similar total disability ratings (p = 0.50). However, by study’s end, more men than women had any service connection (88.5% versus 83.5%, p = 0.05), and men’s mean total disability rating was substantially greater than women’s (77.1 ± 26.2 versus 66.8 ± 30.7, p < 0.001). History of military sexual assault had the largest effect modification on men’s versus women’s odds of PTSD service connection.ConclusionEven after 2011, cohort men were more likely than the women to reverse initially denied PTSD claims, and military sexual assault history accounted for much of this difference. Service connection for other disorders initially offset women’s lower rate of PTSD service connection, but, ultimately, men’s total disability ratings exceeded women’s. Gender discrepancies in service connection should be monitored beyond the initial claims period.

Service Dogs for Veterans and Military Members With Posttraumatic Stress Disorder: Replication With the PTSD Checklist for DSM-5.

Psychiatric service dogs are an emerging complementary intervention for veterans and military members with posttraumatic stress disorder (PTSD). Recent cross-sectional studies have documented significant, clinically relevant effects regarding service dogs and PTSD symptom severity. However, these studies were conducted using the PTSD Checklist (PCL) for the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). The present study aimed to replicate and advance these findings using the latest version of the PCL for the fifth edition of the DSM (PCL-5). Participants included 186 military members and veterans who had received a PTSD service dog (n = 112) or who were on the waitlist to receive one in the future (n = 74). A cross-sectional design was used to investigate the association between having a service dog and PCL-5 total and symptom cluster scores. After controlling for demographic variables, there was a significant association between having a service dog and lower PTSD symptom severity both in total, B = -14.52, p < .001, d = -0.96, and with regard to each symptom cluster, ps < .001, ds = -0.78 to -0.94. The results replicated existing findings using the largest sample size to date and the most recent version of the PCL. These findings provide additional preliminary evidence for the efficacy of service dogs as a complementary intervention for military members and veterans with PTSD and add to a growing body of foundational research serving to rationalize investment in the further clinical evaluation of this emerging practice.