Primary Diagnosis Of Posttraumatic Stress Disorder Research Articles

Findings of PTSD-specific deficits in default mode network strength following a mild experimental stressor

Reductions in default mode (DMN) connectivity strength have been reported in posttraumatic stress disorder (PTSD). However, the specificity of DMN connectivity deficits in PTSD compared to major depressive disorder (MDD), and the sensitivity of these alterations to acute stressors are not yet known. 52 participants with a primary diagnosis of PTSD (n = 28) or MDD (n = 24) completed resting-state functional magnetic resonance imaging immediately before and after a mild affective stressor. A 2 × 2 design was conducted to determine the effects of group, stress, and group*stress on DMN connectivity strength. Exploratory analyses were completed to identify the brain region(s) underlying the DMN alterations. There was significant group*stress interaction (p = 0.03), reflecting stress-induced reduction in DMN strength in PTSD (p = 0.02), but not MDD (p = 0.50). Nodal exploration of connectivity strength in the DMN identified regions of the ventromedial prefrontal cortex and the precuneus potentially contributing to DMN connectivity deficits. The findings indicate the possibility of distinct, disease-specific, patterns of connectivity strength reduction in the DMN in PTSD, especially following an experimental stressor. The identified dynamic shift in functional connectivity, which was perhaps induced by the stressor task, underscores the potential utility of the DMN connectivity and raises the question whether these disruptions may be inversely affected by antidepressants known to treat both MDD and PTSD psychopathology.

Body-and movement-oriented interventions for posttraumatic stress disorder: An updated systematic review and meta-analysis.

This study is an update of the meta-analysis we published in 2019 on the effectiveness of body- and movement-oriented interventions (BMOIs) for adults with posttraumatic stress disorder (PTSD) in decreasing PTSD symptoms and secondary outcomes of depressive symptoms, sleep disturbance, and interoceptive awareness. Search terms for BMOIs and PTSD were combined to identify eligible studies in four bibliographical databases. Articles were selected if they included adult participants with a primary diagnosis of PTSD, included BMOI as one of the investigated therapies, were designed as a comparative outcome trial with any control condition, and involved a standardized outcome measure for PTSD symptom severity. This resulted in the addition of 14 new studies compared to the 2019 study. The meta-analysis, which included 29 studies in total, resulted in a mean Hedges' g effect size of 0.50, 95% CI [0.22, 0.79], in decreasing PTSD symptoms, with very high heterogeneity, I2 = 89%. Meta-analyses of secondary outcomes resulted in Hedges' g effect sizes of 0.37, 95% CI [0.08, 0.66] for depressive symptoms; 0.62, 95% CI [0.42, 0.81] for sleep quality; and -0.10, 95% CI [-0.23, 0.43] for interoceptive awareness. The risk of bias analysis resulted in some concerns or high risk of bias in almost all included studies; only one study had a low risk of bias. We conclude that BMOIs may be valuable for patients with PTSD. There is, however, still a lack of high-quality studies with proper control conditions and long-term follow-up periods from which to draw conclusions.

Comparing trauma-focused cognitive-behavioral therapy to commonly used treatments in usual care for children with posttraumatic stress disorder.

Trauma-focused cognitive-behavioral therapy (TF-CBT) is an evidence-based treatment; however, few studies have examined the use of TF-CBT as part of routine clinical care, outside of research trials. This study used administrative data from a statewide system of care to examine differences in pretreatment characteristics and outcomes between children with posttraumatic stress disorder (PTSD) who received TF-CBT and those who received non-TF-CBT treatments. The sample consisted of 1,861 children (59% female, 43% Hispanic, 35% White, and 14% Black) ages 3-17 with a primary diagnosis of PTSD who received outpatient psychotherapy at 25 clinics in Connecticut. Data were collected as part of routine care, including child demographic characteristics, diagnosis, treatment type, and problem severity and functioning using the Ohio Scales. Approximately one-third of children received TF-CBT. There were some differences at intake between children who received TF-CBT and those who received another type of usual care treatment; children who experienced sexual victimization and more types of trauma as well as non-Hispanic White children were more likely to receive TF-CBT. Propensity score matching was used to balance intake differences between treatment groups, and results indicated that children who received TF-CBT had significantly greater improvements in problem severity and functioning than children who received other types of usual care treatments (effect size = 0.21-0.24), including generic cognitive-behavioral therapy (CBT). These findings reinforce the evidence for providing TF-CBT to children with PTSD in outpatient settings and suggest that supporting clinicians in implementing TF-CBT can result in greater improvements than usual care treatments. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Psychiatric Comorbidities and Risk of Somatic Symptom Disorders in Posttraumatic Stress Disorder: A Cross-Sectional Inpatient Study.

Nearly 90% of Americans are exposed to a traumatic event at some point in their lives, and over 8% of those individuals will develop posttraumatic stress disorder (PTSD). Our study examined the demographic differences and psychiatric comorbidities in inpatients with PTSD with and without somatic symptom disorders (SSDs), using data from the Nationwide Inpatient Sample for 2018 and 2019. Our sample included 12,760 adult patients with a primary diagnosis of PTSD, which was further subdivided based on a codiagnosis of SSD. We used a logistic regression model to determine the odds ratio (OR) of association for SSD and identify demographic predictors and comorbid risk factors in inpatients with PTSD. The prevalence of SSD in inpatients with PTSD was 0.43%, and it was more commonly seen in women and Caucasians. Personality disorders (OR, 5.55; p < 0.001) and anxiety disorders (OR, 1.93; p = 0.018) were found to increase the likelihood of codiagnoses of SSD in inpatients with PTSD. These findings support the need for a systematic, modular approach that includes evidence-based interventions to treat at-risk populations.

The treatment of PTSD in refugees and asylum seekers using imagery rescripting within an NHS setting.

Refugees and asylum seekers present with high levels of post-traumatic stress disorder (PTSD), whilst little research has been conducted to assess the effectiveness or acceptability of psychological interventions for this group. Imagery rescripting is effective in reducing distressing intrusive memories within a range of conditions. The current study evaluates this approach for the treatment of PTSD in refugees and asylum seekers within a UK NHS service. To evaluate the clinical outcomes of using imagery rescripting for the treatment of PTSD in UK-based refugees and asylum seekers. Ten adult service-users from an NHS specialist service with a primary diagnosis of PTSD were recruited as part of routine service delivery. A multiple baseline design was used with participants randomly allocated to a baseline varying from 5 to 9 weeks. A baseline wait-period was followed by up to five sessions of psychoeducation and treatment preparation, in turn followed by up to 10 sessions of imagery rescripting. The Post-traumatic Symptom Scale (PSS) and Physical Health Questionnaire-9 (PHQ-9) were collected every week during baseline, at end of treatment and weekly for 5 weeks after treatment, and again at 12-week follow-up. Data were analysed with mixed regression. Results indicate a significant improvement both in PTSD symptoms and mood, and that this was attributable to the imagery rescripting phase of the intervention, and not the passage of time or non-specific therapy factors. Evidence indicates imagery rescripting to be a safe and effective treatment choice for PTSD in refugees and asylum seekers.

Nature videos for PTSD: protocol for a mixed-methods feasibility study

ABSTRACT Background: Given the prevalence of post-traumatic stress disorder (PTSD), particularly among military personnel, new treatment approaches are needed. One may be virtual relaxation interventions, especially 360-degree nature videos, since studies have demonstrated their relaxation effects for healthy participants. If these relaxation effects can be reproduced in patients with PTSD, they may offer a viable tool to reduce distress and hyperarousal. Objective: This research protocol describes a planned study that will examine the relaxation effects of 360-degree nature videos for patients with PTSD. It will also investigate whether these relaxation effects differ depending on the hardware immersion level (head-mounted display [HMD] vs. PC screen) in comparison to a control condition in which patients only listen to natural sounds and do not view a video. Finally, the effect of each intervention’s dose duration (five vs. ten minutes) will be explored. Method: A counterbalanced, randomised, controlled, within-subject experiment will be conducted (sample size N = 36). Only soldiers aged 18 years or older with a primary diagnosis of PTSD will be included. Those with psychosis, substance dependence, a change in psychiatric medication within the last month, suicidal intent, and motion sickness will be excluded. All patients will experience the HMD, PC, and control conditions once for five or ten minutes. Self-reported relaxation measures will be collected before and after, and patients’ skin conductance level, heart rate, and heart rate variability will be assessed during each condition. Semi-structured interviews will be conducted to examine the patients’ experiences in detail. Conclusions: This feasibility study will provide initial evidence of whether viewing 360-degree nature videos via HMD or PC screen is relaxing for patients with PTSD and whether the effects are greater compared with the control condition. The study will also validate the dose duration and thereby informing a subsequent confirmatory interventional trial. Trial registration: DRKS00020277. HIGHLIGHTS This randomised controlled feasibility study will examine whether 360-degree nature videos are a suitable relaxation intervention for military personnel with post-traumatic stress disorder.

0647 DSM-V Diagnosed Post-traumatic Stress Disorder (PTSD) is Associated with Reported Dream Enactment Independently from Gender, Race or Education in a Psychiatric Outpatient Population

Abstract Introduction PTSD has been associated with PSG-derived measurements of REM without atonia suggestive of RBD (Elliott et al, Sleep 2020 Mar 12;43(3):zsz237). Those findings have been reported in men in their mid-50’s. In a relatively younger, diverse, help-seeking, psychiatric outpatient population enriched with PTSD, we examined the impact of demographics (self-reported gender, race, education) on the association between primary diagnosis of PTSD and probable RBD assessed with a validated questionnaire. Methods Patients (n = 1,658) were enrolled in a non-VA based treatment program for veterans. Patients underwent detailed diagnostic interviews and psychometrics. About 48% (549 men, 251 women; mean age 40.0 [SD = 9.6] years; 381 non-white) met criteria for PTSD. Typical other diagnoses included Axis I defined major depression and various anxiety disorders (without re-experiencing). Dream enactment was assessed with the previously validated University of Michigan RBD Questionnaire (UMRBDQ), completed either by patient or bedpartner. Mean (SD) and 50th% UMRBDQ scores were 0.52 (SD = 0.26) and 0.50. We defined likelihood of RBD by the 90th% of UMRBDQ score (&amp;gt; .80), based on previously published psychometrics, and used multiple logistic regression to define predictors of high vs low UMRBDQ scores. Predictors were diagnosis, self-reported gender (male), race (non-white [vs white]) and education (at least partial college). Results PTSD diagnosis was strongly associated with positive UMRBDQ (31.5% vs 22.0%; OR = 1.77; 95% CI 1.40-2.23). Significant predictors were male gender (OR = 1.93, 95% CI 1.45-2.58) and non-white race (OR = 1.81; 95% CI 1.03-1.65) but not education (OR = 0.86; 95% CI 0.68-1.09). Models of 2-way interactions were all non-significant. Linear models employing UMRBDQ as continuous scores yielded similar results. Conclusion These results confirmed that PTSD may be associated with higher likelihood of reported dream enactment and that these results were not dependent on self-reported gender, race or education. Support (If Any) Wounded Warrior Project

Mental imagery in adolescent PTSD patients after child abuse: a comparison with matched healthy controls

BackgroundIntrusive mental imagery (MI) plays a crucial role in the maintenance of posttraumatic stress disorder (PTSD) in adults. Evidence on the characteristics of MI in adolescents suffering from PTSD is sparse. The aim of this study was to thoroughly assess MI in an adolescent sample suffering from PTSD after the experience of childhood sexual abuse and/or childhood physical abuse (CA).MethodsThirty-two adolescents with a primary diagnosis of PTSD after CA and 32 adolescents without any mental disorder and without a history of CA, matched for age and gender, completed questionnaires assessing the characteristics of negative and positive MI, as well as images of injury and death that lead to positive emotions (ID-images).ResultsThe PTSD group reported significantly more frequent, more vivid, more distressing and more strongly autobiographically linked negative MI compared to the control group. Although positive MI was highly present in both groups (PTSD: 65.6%; controls: 71.9%), no significant differences emerged between the two groups regarding the distinct characteristics of positive MI. The frequency of the ID-images did not significantly differ between the two groups (PTSD: 21.9%; controls: 9.4%), although the ID-images were more vivid in the PTSD group.DiscussionNegative MI appears to be crucial in adolescent PTSD, whilst positive MI are unexpectedly common in both the PTSD and the control group. The role of positive MI as well as that of ID-images remain unclear. Specific interventions for changing negative MI that are tailored to the developmental challenges in adolescents with PTSD should be developed.Trial registrationSome of the PTSD patients in this study were also part of a randomized controlled trial on Developmentally adapted Cognitive Processing Therapy (D-CPT). This trial was registered at the German Clinical Trial Registry (GCTR), DRKS00004787, 18 March 2013.

Pharmacotherapy of 1,044 inpatients with posttraumatic stress disorder: current status and trends in German-speaking countries

Posttraumatic stress disorder (PTSD) is a debilitating psychiatric disorder with limited approved pharmacological treatment options and high symptom burden. Therefore, real-life prescription patterns may differ from guideline recommendations, especially in psychiatric inpatient settings. The European Drug Safety Program in Psychiatry (“Arzneimittelsicherheit in der Psychiatrie”, AMSP) collects inpatients’ prescription rates cross-sectionally twice a year in German-speaking psychiatric hospitals. For this study, the AMSP database was screened for psychiatric inpatients with a primary diagnosis of PTSD between 2001 and 2017. N = 1,044 patients with a primary diagnosis of PTSD were identified with 89.9% taking psychotropics. The average prescription rate was 2.4 (standard deviation: 1.5) psychotropics per patient with high rates of antidepressant drugs (72.0%), antipsychotics drugs (58.4%) and tranquilizing drugs (29.3%). The presence of psychiatric comorbidities was associated with higher rates of psychotropic drug use. The most often prescribed substances were quetiapine (24.1% of all patients), lorazepam (18.1%) and mirtazapine (15.0%). The use of drugs approved for PTSD was low (sertraline 11.1%; paroxetine 3.7%). Prescription rates of second-generation antipsychotic drugs increased, while the use of tranquilizing drugs declined over the years. High prescription rates and extensive use of sedative medication suggest a symptom-driven prescription (e.g., hyperarousal, insomnia) that can only be explained to a minor extent by existing comorbidities. The observed discrepancy with existing guidelines underlines the need for effective pharmacological and psychological treatment options in psychiatric inpatient settings.

Amygdala and Insula Connectivity Changes Following Psychotherapy for Posttraumatic Stress Disorder: A Randomized Clinical Trial

BackgroundExposure-based psychotherapy is a first-line treatment for posttraumatic stress disorder (PTSD), but its mechanisms are poorly understood. Functional brain connectivity is a promising metric for identifying treatment mechanisms and biosignatures of therapeutic response. To this end, we assessed amygdala and insula treatment–related connectivity changes and their relationship to PTSD symptom improvements. MethodsIndividuals with a primary PTSD diagnosis (N = 66) participated in a randomized clinical trial of prolonged exposure therapy (n = 36) versus treatment waiting list (n = 30). Task-free functional magnetic resonance imaging was completed prior to randomization and 1 month following cessation of treatment/waiting list. Whole-brain blood oxygenation level–dependent responses were acquired. Intrinsic connectivity was assessed by subregion in the amygdala and insula, limbic structures key to the disorder pathophysiology. Dynamic causal modeling assessed evidence for effective connectivity changes in select nodes informed by intrinsic connectivity findings. ResultsThe amygdala and insula displayed widespread patterns of primarily subregion-uniform intrinsic connectivity change, including increased connectivity between the amygdala and insula; increased connectivity of both regions with the ventral prefrontal cortex and frontopolar and sensory cortices; and decreased connectivity of both regions with the left frontoparietal nodes of the executive control network. Larger decreases in amygdala–frontal connectivity and insula–parietal connectivity were associated with larger PTSD symptom reductions. Dynamic causal modeling evidence suggested that treatment decreased left frontal inhibition of the left amygdala, and larger decreases were associated with larger symptom reductions. ConclusionsPTSD psychotherapy adaptively attenuates functional interactions between frontoparietal and limbic brain circuitry at rest, which may reflect a potential mechanism or biosignature of recovery.

Predictors of Dropout in Cognitive Processing Therapy for PTSD: An Examination of Trauma Narrative Content

Dropout rates in trauma-focused treatments for adult posttraumatic stress disorder (PTSD) are high. Most research has focused on demographic and pretreatment predictors of dropout, but findings have been inconsistent. We examined predictors of dropout in cognitive processing therapy (CPT) by coding the content of trauma narratives written in early sessions of CPT. Data are from a randomized controlled noninferiority trial of CPT and written exposure therapy (WET) in which CPT showed significantly higher dropout rates than WET (39.7% CPT vs. 6.4% WET). Participants were 51 adults with a primary diagnosis of PTSD who were receiving CPT and completed at least one of three narratives in the early sessions of CPT. Sixteen (31%) in this subsample were classified as dropouts and 35 as completers. An additional 9 participants dropped out but could not be included because they did not complete any narratives. Of the 11 participants who provided a reason for dropout, 82% reported that CPT was too distressing. The CHANGE coding system was used to code narratives for pathological trauma responses (cognitions, emotions, physiological responses) and maladaptive modes of processing (avoidance, ruminative processing, overgeneralization), each on a scale from 0 (absent) to 3 (high). Binary logistic regressions showed that, averaging across all available narratives, more negative emotions described during or around the time of the trauma predicted less dropout. More ruminative processing in the present time frame predicted lower rates of dropout, whereas more overgeneralized beliefs predicted higher rates. In the first impact statement alone, more negative emotions in the present time frame predicted lower dropout rates, but when emotional reactions had a physiological impact, dropout was higher. These findings suggest clinicians might attend to clients’ written trauma narratives in CPT in order to identify indicators of dropout risk and to help increase engagement.

A pilot study of interpersonal process group therapy for PTSD in Canadian Veterans

Introduction: The present pilot study was designed to explore interpersonal process (IP) group therapy for post-traumatic stress disorder (PTSD); a novel and relatively untested treatment approach for PTSD. IP groups seek to normalize patients’ symptoms and enhance functioning by creating a safe environment wherein participants can engage with others who share similar experiences and symptoms. Methods: Present IP groups met weekly for 12 weeks. Participants included 20 Canadian male Veterans and RCMP officers (10 per treatment group) with a primary diagnosis of PTSD. All participants had previously received first-line treatments for PTSD but continued to experience serious limitations in functioning. Key measures of interest (i.e., PTSD, negative affect, moral injury) were administered immediately pre- and post-intervention. Qualitative data was collected from a subset of participants ( n = 6). Results: Baseline scores revealed significantly elevated symptom levels compared to normative and clinical samples. Retention rate over the course of therapy was 100%, a rare and important finding in clinical research generally, and in the PTSD population more specifically. Qualitative feedback was consistently positive; feedback also suggested future potential improvements for the therapeutic intervention. There was a significant reduction in anxiety (specifically, physiological hyperarousal) pre- to post-intervention, with a partial eta squared ( n2 p) value of 0.26, indicating a large effect size. Discussion: Examination of individual scores showed that fully one-third of participants demonstrated a reliable improvement in both physiological anxiety and anxiety sensitivity (AS), both of which have been implicated in the exacerbation and maintenance of other PTSD symptoms. Results support a randomized controlled trial of group IP for PTSD.

A Brief Exposure-Based Treatment vs Cognitive Processing Therapy for Posttraumatic Stress Disorder: A Randomized Noninferiority Clinical Trial

ImportanceWritten exposure therapy (WET), a 5-session intervention, has been shown to efficaciously treat posttraumatic stress disorder (PTSD). However, this treatment has not yet been directly compared with a first-line PTSD treatment such as cognitive processing therapy (CPT).ObjectiveTo determine if WET is noninferior to CPT in patients with PTSD.Design, Setting, and ParticipantsIn this randomized clinical trial conducted at a Veterans Affairs medical facility between February 28, 2013, and November 6, 2016, 126 veteran and nonveteran adults were randomized to either WET or CPT. Inclusion criteria were a primary diagnosis of PTSD and stable medication therapy. Exclusion criteria included current psychotherapy for PTSD, high risk of suicide, diagnosis of psychosis, and unstable bipolar illness. Analysis was performed on an intent-to-treat basis.InterventionsParticipants assigned to CPT (n = 63) received 12 sessions and participants assigned to WET (n = 63) received 5 sessions. The CPT protocol that includes written accounts was delivered individually in 60-minute weekly sessions. The first WET session requires 60 minutes while the remaining 4 sessions require 40 minutes.Main Outcomes and MeasuresThe primary outcome was the total score on the Clinician-Administered PTSD Scale for DSM-5; noninferiority was defined by a score of 10 points. Blinded evaluations were conducted at baseline and 6, 12, 24, and 36 weeks after the first treatment session. Treatment dropout was also examined.ResultsFor the 126 participants (66 men and 60 women; mean [SD] age, 43.9 [14.6] years), improvements in PTSD symptoms in the WET condition were noninferior to improvements in the CPT condition at each of the assessment periods. The largest difference between treatments was observed at the 24-week assessment (mean difference, 4.31 points; 95% CI, –1.37 to 9.99). There were significantly fewer dropouts in the WET vs CPT condition (4 [6.4%] vs 25 [39.7%]; χ21 = 12.84, Cramer V = 0.40).Conclusions and RelevanceAlthough WET involves fewer sessions, it was noninferior to CPT in reducing symptoms of PTSD. The findings suggest that WET is an efficacious and efficient PTSD treatment that may reduce attrition and transcend previously observed barriers to PTSD treatment for both patients and providers.Trial Registrationclinicaltrials.gov Identifier: NCT01800773

Usual Course of Treatment and Predictors of Treatment Utilization for Patients With Posttraumatic Stress Disorder.

Posttraumatic stress disorder (PTSD) is a debilitating psychiatric illness that frequently remains undiagnosed and untreated. While extensive research has been conducted among veterans, little research has evaluated course of treatment for PTSD in a general hospital setting. We utilized data from the Partners HealthCare Research Patient Data Registry to evaluate mental health treatment utilization, including psychotherapy and pharmacotherapy, by patients with recently diagnosed primary PTSD following DSM-IV criteria between January 1, 2002, and June 30, 2011. We additionally evaluated predictors of treatment utilization 6 months postdiagnosis. Among 2,475 patients with recently diagnosed primary PTSD, approximately half (55.7%) had any therapy visit and 10% had at least 12 therapy visits in the 6 months following diagnosis. Approximately half (47.0%) received a psychiatric prescription, with 29.3% receiving a selective serotonin reuptake inhibitor (SSRI), 11.8% receiving an atypical antipsychotic, and 24.4% receiving a benzodiazepine. Latinos were 25% (95% CL = 1.09, 1.43) more likely to have an SSRI prescription, 35% (95% CL = 1.05, 1.75) more likely to have an atypical antipsychotic prescription, and 28% (95% CL = 1.19, 1.38) more likely to receive any psychotherapy. Women were 49% (95% CL = 0.42, 0.63) less likely to have an atypical antipsychotic prescription. Patients with Medicare were 23% (95% CL = 0.67, 0.88) less likely to have any psychotherapy, and patients with Medicaid were 35% (95% CL = 0.46, 0.92) less likely to have 12 or more therapy visits. Many patients with a primary diagnosis of PTSD do not receive psychotherapy, and psychiatric prescriptions, including atypical antipsychotics and benzodiazepines, are common. Future research is needed to determine the quality of care received and explore subpopulation-specific barriers limiting access to care.

Degrading traumatic memories with eye movements: a pilot functional MRI study in PTSD

BackgroundEye movement desensitization and reprocessing (EMDR) is an effective treatment for posttraumatic stress disorder (PTSD). During EMDR, the patient recalls traumatic memories while making eye movements (EMs). Making EMs during recall is associated with decreased vividness and emotionality of traumatic memories, but the underlying mechanism has been unclear. Recent studies support a “working-memory” (WM) theory, which states that the two tasks (recall and EMs) compete for limited capacity of WM resources. However, prior research has mainly relied on self-report measures.MethodsUsing functional magnetic resonance imaging, we tested whether “recall with EMs,” relative to a “recall-only” control condition, was associated with reduced activity of primary visual and emotional processing brain regions, associated with vividness and emotionality respectively, and increased activity of the dorsolateral prefrontal cortex (DLPFC), associated with working memory. We used a randomized, controlled, crossover experimental design in eight adult patients with a primary diagnosis of PTSD. A script-driven imagery (SDI) procedure was used to measure responsiveness to an audio-script depicting the participant's traumatic memory before and after conditions.ResultsSDI activated mainly emotional processing-related brain regions (anterior insula, rostral anterior cingulate cortex (ACC), and dorsomedial prefrontal cortex), WM-related (DLPFC), and visual (association) brain regions before both conditions. Although predicted pre- to post-test decrease in amygdala activation after “recall with EMs” was not significant, SDI activated less right amygdala and rostral ACC activity after “recall with EMs” compared to post-“recall-only.” Furthermore, functional connectivity from the right amygdala to the rostral ACC was decreased after “recall with EMs” compared with after “recall-only.”ConclusionsThese preliminary results in a small sample suggest that making EMs during recall, which is part of the regular EMDR treatment protocol, might reduce activity and connectivity in emotional processing-related areas. This study warrants replication in a larger sample.Highlights of the articleScript driven imagery (SDI) before and after recall of traumatic memories is feasible to investigate working mechanisms of degrading of traumatic memories with eye movements (EMs) in PTSD.Right amygdala and rostral ACC activity was significantly lower after “recall with EMs” than after “recall-only”.Functional connectivity from amygdala to rostral ACC was decreased after “recall with EMs” vs. “recall-only”.This study warrants replication in a larger sample.

The Combined Treatment of PTSD with Borderline Personality Disorder

Psychotherapies are currently the front-line approach to treating individuals with comorbid post-traumatic stress disorder (PTSD) and borderline personality disorder (BPD). Of the available psychotherapeutic treatment options, those that have been evaluated in randomized controlled trials (RCTs) and shown to be efficacious in reducing PTSD among individuals with BPD include: Prolonged Exposure (PE), Cognitive Processing Therapy (CPT), Dialectical Behavior Therapy (DBT), DBT for PTSD (DBT-PTSD), and DBT with the DBT Prolonged Exposure protocol (DBT + DBT PE). In addition, Narrative Exposure Therapy (NET) has shown preliminary evidence of effectiveness in an open trial. The available research indicates that individuals with a primary diagnosis of PTSD and mild or sub-threshold BPD (e.g., without suicidal or serious self-injurious behavior or other severe comorbidities) can be effectively treated via brief (9–14 session), single-diagnosis treatments such as PE and CPT that focus solely on treating PTSD. PE and CPT appear to be comparably efficacious for individuals with PTSD and mild BPD. Individuals with PTSD and a moderate level of BPD (e.g., active non-suicidal self-injury [NSSI] without recent life-threatening behavior, some significant comorbidities) have shown good outcomes in DBT-PTSD, a 12-week, residential, phase-based treatment that targets comorbid problems (e.g., emotion dysregulation, psychosocial impairment) before and after addressing PTSD. Finally, individuals with PTSD and a severe level of BPD (e.g., with recent and/or acute suicidal behavior, serious NSSI and multiple severe comorbidities) have been effectively treated in longer-term (one year), integrated treatments such as DBT and DBT + DBT PE that concurrently target BPD, PTSD, and other related problems. Of these integrated treatments, DBT + DBT PE appears to be more efficacious than DBT alone in improving PTSD, suicidal and self-injurious behavior, and other trauma-related outcomes among severe BPD patients.

Effect of direct eye contact in PTSD related to interpersonal trauma: an fMRI study of activation of an innate alarm system

In healthy individuals, direct eye contact initially leads to activation of a fast subcortical pathway, which then modulates a cortical route eliciting social cognitive processes. The aim of this study was to gain insight into the neurobiological effects of direct eye-to-eye contact using a virtual reality paradigm in individuals with posttraumatic stress disorder (PTSD) related to prolonged childhood abuse. We examined 16 healthy comparison subjects and 16 patients with a primary diagnosis of PTSD using a virtual reality functional magnetic resonance imaging paradigm involving direct vs averted gaze (happy, sad, neutral) as developed by Schrammel et al. in 2009. Irrespective of the displayed emotion, controls exhibited an increased blood oxygenation level-dependent response during direct vs averted gaze within the dorsomedial prefrontal cortex, left temporoparietal junction and right temporal pole. Under the same conditions, individuals with PTSD showed increased activation within the superior colliculus (SC)/periaqueductal gray (PAG) and locus coeruleus. Our findings suggest that healthy controls react to the exposure of direct gaze with an activation of a cortical route that enhances evaluative 'top-down' processes underlying social interactions. In individuals with PTSD, however, direct gaze leads to sustained activation of a subcortical route of eye-contact processing, an innate alarm system involving the SC and the underlying circuits of the PAG.

A New Engagement Strategy in a VA-Based Family Psychoeducation Program

This brief report describes the engagement strategy used in the Reaching out to Educate and Assist Caring, Healthy Families (REACH) program, a nine-month family psychoeducation program for veterans with serious mental illness or posttraumatic stress disorder (PTSD). A motivational interviewing-based strategy was created and implemented in a Veterans Affairs hospital to engage providers and veterans and their families into the intervention. Of the 1,539 veterans told about the program, 41% had a family member living nearby and were willing to meet with a provider to learn more. REACH providers met with 505 veterans for a motivational-interviewing session to explore family participation. Of the 436 veterans who were eligible to participate in REACH, 28% of veterans with PTSD, 34% of veterans with an affective disorder, and 25% of veterans with a schizophrenia spectrum disorder went on to participate in at least one session of the REACH program with a family member; these rates compare favorably with those for programs requiring a much shorter commitment. This engagement strategy shows promise as an effective tool in recruiting veterans and their families into family psychoeducation.

Differentiating Overreporting and Extreme Distress: MMPI-2 Use With Compensation-Seeking Veterans With PTSD

This purpose of this study was to examine overreporting on the Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) in compensation-seeking veterans with posttraumatic stress disorder (PTSD). A sample of veterans tested during a V.A. hospital compensation and pension exam were given the MMPI-2 and measures of PTSD, depression, and combat exposure. Veteran's MMPI-2s were only included in the analyses if their profile was extremely exaggerated, as measured by an F scale T score above 80, did not elevate the MMPI-2 VRIN and TRIN scales, and had a primary diagnosis of PTSD (n = 127). Using the Infrequency-Psychopathology, F(p), scale to distinguish overreporting from distress, it was found that 98 veterans elevated profiles due to distress, whereas 29 elevated due to overreporting, F(p) below and above 7, respectively. Differences between groups on MMPI-2 clinical scales and the other measures were assessed. Implications of these findings for assessing veteran response style and using the MMPI-2 with a PTSD population are discussed.