Residential Treatment Program Research Articles

Spouses of First Responders: Support for Living With Posttraumatic Stress

Emergency first responders (police, fire, paramedic, dispatch) engage in work that includes multiple traumas, sometimes leading to posttraumatic stress. Due to work spillover at home, spouses are susceptible to vicarious and secondary trauma. While there are debriefings for traumatic calls for first responders, no such thing exists for the spouses who are the first to provide support at home. There is a lack of availability of resources supporting first responder spouses, particularly those whose first responders are diagnosed with posttraumatic stress disorder. Stepping into this gap is a unique 6-day residential treatment program provided in a secluded location in Northern California, where a small number of clients engage in a program directed by peers who have been through the program themselves, culturally competent clinicians, and chaplains. The therapeutic milieu is supported by psychoeducation, group processing, nutritious meals, daily activity, and an optional daily chapel program. Based on a dissertation, and using Gass’ wheel of change as a framework, this article shares the results of a qualitative study of eight participants' experiences of the program gleaned from in-depth interviews, a review of program agendas, and self-assessment scores pre- and postprogram. Inductive analysis resulted in common themes including a reduction in isolation, anxiety, and depression symptoms, normalization of experiences, and community. Like the insider-researcher author, individuals finding that they have “lost themselves” in the role of first responder spouse identify this residential treatment experience as a “back to myself” program. Further research on program effectiveness via program evaluation is recommended.

PTSD, depression, and treatment outcomes: A latent profile analysis among active duty personnel in a residential PTSD program

Depression frequently co-occurs with posttraumatic stress disorder (PTSD), including among active duty service members. However, symptom heterogeneity of this comorbidity is complex and its association with treatment outcomes is poorly understood, particularly among active duty service members in residential treatment. This study used latent profile analysis (LPA) to identify symptom-based subgroups of PTSD and depression among 282 male service members in a 10-week, residential PTSD treatment program with evidence-based PTSD psychotherapies and adjunctive interventions. The PTSD Checklist–Military Version and Patient Health Questionnaire-8 were completed by service members at pre- and posttreatment and weekly during treatment. Multilevel models compared subgroups on PTSD and depression symptom change across treatment. LPA indicated four subgroups provided optimal fit: Depressive (high depression severity, low PTSD avoidance; n = 33, 11.7%), Avoidant (high PTSD avoidance, moderate depression severity; n = 89, 31.6%), Moderate (moderate PTSD and depression severity; n = 27, 9.6%), and Distressed (high PTSD and depression severity; n = 133, 47.2%). Treatment response differed across classes for both PTSD and depression outcomes (time × LPA class interaction ps < 0.001). In PTSD models, post-hoc comparisons indicated the Moderate class was associated with less PTSD symptom improvement relative to the other classes (ps < 0.006). In depression models, symptom reduction was greatest for the Distressed and Depressive subgroups relative to the other two classes (ps < 0.009). Study results provide an initial model for two prevalent, impairing disorders among service members and show how these symptom-based subgroups may differentially respond to residential PTSD treatment.

Reducing tobacco and nicotine use among women in treatment for substance use disorder: evaluation of the knit to quit program

ABSTRACT Introduction Tobacco and nicotine use are prevalent in residential substance use disorder (SUD) treatment programs that serve pregnant and parenting women. This study evaluated a group intervention that integrates knitting instruction, psychoeducation, and social support to improve readiness to quit and reduce tobacco and nicotine use among this population. Methods Clients and staff in four residential SUD treatment programs were assigned to a six-week group intervention or a wait-list control group. Intervention implementation and preliminary effectiveness were assessed using surveys, interviews, and observational measures. Results From pre- to post-test, knowledge related to tobacco and nicotine use increased and number of cigarettes smoked per day and nicotine dependence decreased, on average. Additionally, the intervention group reported lower levels of nicotine dependence relative to the control group. Participants described knitting as an enjoyable replacement for smoking and a strategy to regulate stress and emotions. Conclusions Smoking cessation interventions that include knitting are promising and warrant further testing.

Transcending Self Therapy-Virtual Reality (TST-VR) and Substance Use Disorder (SUD) Treatment Completion in Veterans.

Transcending Self Therapy (TST) is an integrative Cognitive Behavioral Therapy (CBT) for substance use disorders (SUD). Virtual reality (VR)-based enhancement of treatment for mental health disorders holds potential as an innovative and immersive adjunct to standards of care. However, outside of cue-conditioning applications, how VR may assist SUD treatment is not well understood. The aim of this study was to examine the association between engagement with a VR version of TST and residential SUD treatment completion. In a program evaluation, 51 consecutive military veterans admitted to a residential SUD treatment program were afforded access to VR equipment programmed to enable ad libitum exploration of a virtual wooded retreat with stations that reinforced psychoeducation concepts of TST, meditation, and other therapeutic activities. Administrative records were reviewed, and treatment completion data were collected for veterans who opted to receive a TST-VR headset (n = 36) and those who did not (n = 15). Engagement with the VR gear and program was related to treatment completion. Veterans who opted to accept the VR program and related training in its use were significantly more likely to complete treatment than those who did not (86.1% vs 60.0%; p = 0.039). These data suggest that either VR-based reinforcement of TST concepts improved the treatment experience or motivation for change, and/or that individuals with poor general treatment motivation are unlikely to choose VR-enhancement of SUD treatment and complete treatment in general. Both possibilities have important implications for VR SUD treatment research.

Age moderates the association of optimism on craving during substance use disorder treatment

BackgroundOptimism, characterized by a positive expectancy toward future outcomes, has garnered attention for its potential role in influencing well-being and may be a protective factor in substance use disorder (SUD) treatment. This study evaluated the relationship of optimism and craving among those in substance use disorder SUD treatment. MethodsDrawing from a cohort of 4201 individuals in residential SUD treatment programs, this study used both cross-sectional and longitudinal assessment to examine tonic (steady-state) and cue-induced (phasic) cravings across individuals primarily using eight classes of substances. Previous research established that optimism increases during adulthood and peaks during an individual's 50s. This study sought to establish if the association between optimism and craving is moderated by age during the first week of treatment and if that relationship changes over the course of treatment both within and between-person. ResultsThis study found a negative correlation between optimism and craving intensity. Elevated optimism scores correlated with substantially reduced levels of both tonic (β = −0.31, p < 0.001) and cue-induced (β = −0.29, p < 0.001) cravings. Age was a significant moderator of the relationship between optimism and craving such that as individuals age, the potency of optimism in mitigating cravings gradually attenuates (interaction for tonic craving: β = 0.06, p < 0.001; interaction for cue-induced craving: β = 0.05, p < 0.001). Reflected in the fact that in older individuals' cravings tended to converge toward lower or moderate levels, regardless of their optimism scores. ConclusionsBy delineating the contemporaneous association between high optimism and lower cravings, the study suggests that interventions aimed at fostering optimism may represent an avenue to improve the effectiveness of SUD treatment, especially in emerging adults.

Outcomes and associated clinical features of people with eating disorders participating in residential treatment facilities: a scoping review

ABSTRACT Residential treatment programs for eating disorders (EDs) have gained popularity in recent years, expanding beyond the United States to countries such as Canada, Italy, and the United Kingdom. These programs offer a “home-like” environment where individuals reside for several weeks or months, emphasising both physical restoration and psychological recovery. This scoping review aimed to provide an update since the most recent reviews on the literature regarding outcomes of residential treatment programs for EDs and to explore clinical features that were associated with these outcomes. Methods used followed the Joanna Briggs Institute guidelines for scoping reviews. A systematic search of electronic databases was conducted, and 12 studies met the inclusion criteria. All studies reported improvements in various outcomes from admission to discharge, including changes in eating psychopathology, weight restoration, depression, anxiety, and quality of life. Additionally, three studies reported positive outcomes at intervals after discharge and three predictive factors (self-compassion, personality organisation, and resistance to emotional vulnerability) were reported in a small number of studies. While residential treatment facilities consistently showed positive outcomes, the review highlights the need for randomised controlled studies to establish the efficacy of these programs for EDs. Future research should include controlled studies comparing residential facilities to other treatment settings and incorporate long-term follow-up outcomes and further studies of emergent predictive factors identified in this review.

Dialectical Behavior Therapy for Adolescents with Borderline Personality Disorder: Emotion Dysregulation, Abuse, and Treatment Outcomes

ABSTRACT Objective Borderline Personality Disorder (BPD) is characterized by extreme emotional dysregulation. Dialectical Behavioral Therapy (DBT) is an empirically supported and effective treatment for BPD in adolescents and adults. However, the extent to which exposure to childhood abuse (i.e. physical and sexual abuse) impacts treatment outcomes is not well understood. This open trial investigated the effectiveness of an intensive residential DBT program in reducing emotion dysregulation in adolescents with BPD symptoms, as well as the impact that severity and type of childhood abuse had on treatment outcomes. Method Participants (N = 46) were female-identifying adolescents 13–20 years of age enrolled in an intensive residential DBT treatment program. Severity of abuse exposure and abuse subtype (Childhood Trauma Questionnaire, Short Form, CTQ-SF) and difficulties with emotional dysregulation (DERS) were assessed at admission and DERS again after 1 month of treatment. Results Bivariate correlation between DERS Total Score and Abuse Exposure Total Score indicated that severity of abuse exposure had a medium positive association with emotion dysregulation at admission. Mixed model ANOVA results showed significant reductions in emotional dysregulation following 1 month of treatment, with a large effect size. Exploratory analysis testing exposure to different subtypes of childhood abuse as a moderator of treatment effects was non-significant. Conclusions Emotion dysregulation showed significant reductions following intensive residential DBT interventions. Reductions were consistent across subtypes of abuse exposure. Implications for the treatment of adolescents with abuse histories and current BPD-related problems, and the relationship between child abuse exposure and emotional dysregulation overall, are discussed.

Residual posttraumatic stress disorder and depression symptoms following a residential posttraumatic stress disorder treatment program for U.S. active duty service members.

Even after the most effective posttraumatic stress disorder (PTSD) treatments, symptoms often persist. Understanding residual symptoms is particularly relevant in military populations, who may be less responsive to PTSD interventions. The sample consisted of 282 male service members who engaged in a residential PTSD treatment program at a military treatment facility that provided evidence-based PTSD psychotherapies and adjunctive interventions. PTSD and depression symptoms were assessed before and after treatment and weekly during treatment via the PTSD Checklist-Military Version and Patient Health Questionnaire-8. Logistic regression with Hochberg's step-up procedure compared the likelihood of individual residual symptoms between service members who did (n = 92, 32.6%) and did not (n = 190, 67.4%) experience clinically significant PTSD change (≥ 10-point PTSD Checklist-Military Version reduction). Not achieving clinically significant PTSD change was associated with greater odds of nearly all residual symptoms (OR = 2.03-6.18), excluding two Patient Health Questionnaire-8 items (appetite and psychomotor changes). Among service members experiencing clinically significant PTSD change, concentration difficulties (73.3%), physical reactions to reminders (71.1%), and intrusions (70.8%) were PTSD symptoms most likely to persist. Poor sleep (56.2%), low energy (50.0%), and concentration difficulties (48.3%) were the most common for depression. To our knowledge, this study is the first to examine residual PTSD and depression symptoms following residential PTSD treatment for active duty service members. Given the low rates of clinically significant PTSD change and the high frequency of residual symptoms, strategies may be needed to improve residential PTSD treatment outcomes in the military. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Supplemental Material for Residual Posttraumatic Stress Disorder and Depression Symptoms Following a Residential Posttraumatic Stress Disorder Treatment Program for U.S. Active Duty Service Members

Supplemental Material for Residual Posttraumatic Stress Disorder and Depression Symptoms Following a Residential Posttraumatic Stress Disorder Treatment Program for U.S. Active Duty Service Members

A Comprehensive Descriptive Analysis of Out-of-Session Meditation in a Residential Treatment Setting: Duration, Frequency, and Type of Practice

ObjectivesA nuanced examination of human behavior can yield valuable insights into whether a mindfulness-based intervention (MBI) promotes meditation practices and to what degree in various populations. This study aimed to offer a comprehensive analysis of meditation behaviors exhibited by individuals in response to a MBI in the context of an intensive residential treatment program for addiction recovery.MethodA total of 100 participants enrolled in a residential treatment program participated in an added MBI component to their routine care. We quantified the type, frequency, and duration of meditation practices outside of scheduled MBI sessions and conducted a descriptive analysis to investigate how these practices during the intervention predicted meditation behaviors 7 months later.ResultsAll seven common types of mindfulness meditation assessed, except the body scan, were performed an average of once per day during the MBI. The longest average duration of meditation practice was observed in the case of walking meditation, during both the MBI (M=20.30, SD=16.66 min) and 7-month follow-up (M=25.43, SD=20.85 min). Out-of-session meditation frequency (unstandardized beta, B=0.56, p<0.001) and duration (B=0.45, p=0.02) during the MBI significantly predicted subsequent meditation behaviors 7 months later, even after adjusting for treatment site discharge status and other clinical variables.ConclusionsMost participants in this addiction recovery sample consistently engaged in a variety of meditation practices outside of formal MBI class sessions while in residential living, performing them approximately once a day, with a particularly robust response to walking meditation. The persistence of meditation practice 7 months later suggests that the learned behaviors endure throughout addiction recovery.PreregistrationThis original trial is registered with clinicaltrials.gov (NCT02977988)

Virtual Hybrid Versus In-Person Administration of Transcending Self Therapy for Veterans with Substance Use Disorders.

Veterans with substance use disorder (SUD) can show high severity and are at high risk of relapse due to trauma histories and other comorbid conditions. However, evidence-based SUD therapies may not be available to many veterans due to geographic or transportation constraints. Telehealth approaches have shown promise to improve access to different SUD therapy formats but have not been well-studied in open (rolling-admission) group therapy of in-person patients as administered by a single on-screen therapist. Social distancing required by the COVID-19 pandemic forced the transition of delivery of Transcending Self Therapy (TST) from an in-person therapist to a single remote (on-screen) therapist. In this virtual model, veterans continued to receive TST but the therapist was off site and provided therapy to veterans who were together in the same room during a 28 day residential Veterans Affairs treatment program. In a program evaluation, we compared their changes in quality of life (QoL), treatment satisfaction ratings and group therapy treatment outcomes with those of Veterans who received TST from an in-person therapist. In both groups, there was a significant increase in QoL Inventory scores from baseline to post-treatment, with no difference in improvement between treatment modalities (i.e., in-person group vs telehealth-delivered group). Veterans professed knowledge of therapy-driven skills at the end of treatment in both groups and overwhelmingly rated TST as helpful and understandable. These data extend previous findings of patient acceptability of remotely-delivered SUD treatment, here with a remote therapist administering open group therapy, as evidenced by improvement in QoL and positive patient feedback about the remote intervention.

Medications For Opioid Use Disorder Increased Among Louisiana Medicaid Enrollees During Policy Reforms, 2018-21.

Increasing access to medications for opioid use disorder (MOUD) is a key strategy in addressing the opioid crisis. To increase MOUD access, state governments have pursued a combination of increased funding for MOUD and requirements that providers offer treatment. Louisiana has pursued multiple strategies, including a requirement that residential treatment programs offer MOUD as part of their licensure. Using Louisiana Medicaid claims data for enrollees with diagnosed OUD from the period 2018-21, we analyzed trends in MOUD between enrollees treated in residential and nonresidential settings and across demographic subgroups, and we compared trends by MOUD type. MOUD use more than tripled from 2018 to 2021 among Louisiana Medicaid enrollees diagnosed with OUD. Most of the increase in MOUD was attributable to buprenorphine use. Methadone uptake also contributed to greater MOUD use but was almost exclusively used by enrollees treated in nonresidential settings, whereas naltrexone was consistently more common in residential treatment. By 2021, differences persisted across demographic groups: MOUD use was highest among enrollees who were White, were older, had comorbidities, and lived in a metropolitan area. Policies that promote MOUD in substance use treatment programs, particularly residential programs, are critical tools for policy makers confronting a complex and unprecedented national overdose crisis.

Impact of Equine Interaction during Psychotherapy on Anxiety and Depression for Residential Treatment Program Patients Experiencing Substance Withdrawal

Impact of Equine Interaction during Psychotherapy on Anxiety and Depression for Residential Treatment Program Patients Experiencing Substance Withdrawal

Criminogenic Needs andLegal Problem Severity Among Legal System Involved Veterans.

Many veterans seeking behavioral health services have history of criminal-legal involvement. Research on criminogenic needs of legal system involved veterans is burgeoning. However, most research has relied on cross-sectional examinations and the vast majority of prior work has focused assessment on just one criminogenic need per study. The present study evaluated seven key criminogenic needs of legal system involved veterans (N = 341) enrolled in one of three U.S. Veterans Health Administration residential behavioral health treatment programs. Criminogenic needs and legal problem severity were assessed at baseline, and at 6 months and 12 months post-baseline. Directionality of associations between participants' criminogenic needs and legal problem severity was examined using latent change score models. Results revealed having more antisocial associates at a previous timepoint was associated with greater subsequent improvements in legal problem severity ($\beta $=-0.01, P < 0.02) and greater improvements in legal problem severity predicted greater subsequent improvements in alcohol problem severity ($\beta $=0.13, P < 0.01). In one of the most comprehensive single-study assessments of criminogenic needs among a sample of legal system involved veterans, results highlight links between antisocial associates and alcohol problem severity with legal problem severity.

An environmental scan of residential treatment service provision in Ontario

BackgroundOntario has one of the highest rates of substance-related harms in Canada. Residential treatment programs in the province provide a variety of in-house treatment services to support the needs of individuals with substance use disorders (SUD). However, these programs are not standardized, often varying in the type, quality, and availability of services offered, including evidence-based interventions such as Opioid Agonist Treatment (OAT). Local treatment systems are also rather fragmented and complex to navigate, creating barriers for potential services users to identify and make informed choices on available treatment options.MethodsBetween May to August 2023, we conducted an environmental scan to capture available information on all publicly-funded residential treatment programs in Ontario using the ConnexOntario service portal, a government-funded, health services information platform. Data were captured on organization name, geographical location, program description, program type (residential addictions treatment or supportive recovery programs), eligibility criteria, target population, the program’s OAT policies, number of available beds, minimum and maximum length of stay, projected wait times, funding source, and associated fees for program admission. Data were extracted and organized by geographic region, and findings were presented descriptively.ResultsA total of 102 residential addiction treatment programs and 36 residential supportive recovery programs in Ontario were identified. The scan noted substantial regional variations in program availability and wait times, along with a lack of programs tailored to unique populations such as women, youth, and Indigenous peoples. There is also a paucity of publicly-available information on program offerings, including detailed specifics on OAT policies within residential treatment programs that are crucial to ensuring that the services being offered are safe and grounded in evidence-based practice.ConclusionsFindings from the scan highlight notable gaps in program types, offerings, and availability among residential treatment programs in the province, including a lack of standardization on OAT policies across programs. Efforts should be made to ensure access to treatment-specific program information relevant to potential service users and to enhance coordinated access to residential treatment services in the province.

An open trial for adults in a residential program for binge eating spectrum disorders

ABSTRACT The current study assessed treatment outcome for 99 adult admissions to a residential program specifically designed for binge eating spectrum disorders (BESD). Participants completed self-report measures at admission, discharge, and 12-month follow-up and were asked to complete blood draws at admission and follow-up. Primary outcomes were eating behaviors; secondary outcomes included comorbid symptoms and physiological variables. Eating behaviors improved significantly from admission to follow-up, as did most comorbid symptoms and quality of life, despite no change in body mass index. Some variables displayed a curvilinear relationship, with some worsening of symptoms from discharge to follow-up, although scores at follow-up remained well below admission values. Participation in the treatment program was associated with reduced problematic eating and comorbid symptoms and increased quality of life up to one year after discharge. Findings from this study may encourage the development of similar residential treatment programs for BESD for those who have not responded to outpatient care or mixed milieu settings, and may prompt randomized studies testing similar treatments versus usual care.

Bedtime regularity predicts positive affect among veterans with posttraumatic stress disorder: an ecological momentary assessment study

BackgroundRegularizing bedtime and out-of-bed times is a core component of behavioral treatments for sleep disturbances common among patients with posttraumatic stress disorder (PTSD). Although improvements in subjective sleep complaints often accompany improvements in PTSD symptoms, the underlying mechanism for this relationship remains unclear. Given that night-to-night sleep variability is a predictor of physical and mental well-being, the present study sought to evaluate the effects of bedtime and out-of-bed time variability on daytime affect and explore the optimal window lengths of over which variability is calculated.MethodsFor about 30 days, male U.S. military veterans with PTSD (N = 64) in a residential treatment program provided ecological momentary assessment data on their affect and slept on beds equipped with mattress actigraphy. We computed bedtime and out-of-bed time variability indices with varying windows of days. We then constructed multilevel models to account for the nested structure of our data and evaluate the impact of bedtime and out-of-bed time variability on daytime affect.ResultsMore regular bedtime across 6–9 days was associated with greater subsequent positive affect. No similar effects were observed between out-of-bed time variability and affect.ConclusionsMultiple facets of sleep have been shown to differently predict daily affect, and bedtime regularity might represent one of such indices associated with positive, but not negative, affect. A better understanding of such differential effects of facets of sleep on affect will help further elucidate the complex and intertwined relationship between sleep and psychopathology.Trial registrationThe trial retrospectively was registered on the Defense Technical Information Center website: Award # W81XWH-15–2-0005.

Adjudicated Adolescents Located on a State Sex Offender Registry Website as Adults: Common Denominators

ABSTRACT This is a landmark study, the first to use a listing on a state sex offender registry website as a predictive variable for tracking adult recidivism of male adolescents adjudicated for sex offenses, and the longest to follow a cohort of these youth after discharge from a secure residential treatment program. Upon admission, the sample (N = 145) were assessed by JSORRAT-II and MEGA ♪ , two contemporary standardized, validated risk assessment tools for assessing youth who have engaged in sexually abusive behavior. They were then followed once discharged for 17.08 years into adulthood (mean follow-up = 14.0 years, SD = 1.71). Recidivism rate was 6.2% (defined as a listing for the subject on the California Megan’s Law Sex Offender Registry Website). The study offers a baseline for future studies that use a state sex offender registry website as a predictive variable for recidivism. Shared common denominators of recidivists and non-recidivists were risk level (i.e. most were High Risk or Very High Risk on MEGA ♪ ); and having a history of adverse childhood experiences other than sexual abuse (i.e. child neglect/emotional abuse and exposure to domestic violence). A history of sexual abuse, experienced by twice as many non-recidivists as recidivists, differentiated the sample. Recidivists also had fewer protective factors than non-recidivists, as assessed by the MEGA ♪ upon admission to the facility. The mean age of recidivists was younger than non-recidivists, suggesting they may have been removed from their home at an early age, and/or had an early onset of persistent coarse sexual improprieties and/or sexually abusive behaviors that persisted into adulthood. The results highlight the importance of integrating trauma-informed interventions in treatment programs for those individuals who are sexually abusive that have a history of multiple adverse childhood experiences.

3 Neuropsychiatric Change and Childhood Adversity Levels in an Opioid Treatment Population

Objective:Early life adversity is strongly correlated with a number of negative health outcomes, with some of the highest risks are related to later illicit drug use and substance use disorders (SUDs). Specifically, it has been found that an ACEs score of &gt;4 confers a 7-10-fold risk of substance abuse. Subsequent research has identified a number of neurobiological effects of childhood trauma, including structural and functional disruptions of the LHPA axis, the brain's primary stress-response system. It has been hypothesized that various trauma-induced neurobiological changes may lead to later physical health, mental health, and psychosocial problems in persons with early life adversity. One area that such changes might affect is a person's ability to stop abusing substances, with factors such as trauma-related mood, self-efficacy, or cognitive functioning as considerations in early treatment success. This study followed a group of participants in a residential substance abuse treatment program across their first month of abstinence, to assess natural change in cognitive performance as well as potential effect of early life adversity on changes in neuropsychiatric outcomes.Participants and Methods:Participants were 37 adults (mean age=33.9 years, SD=6.7) who had completed detoxification and were first assessed during their first week of residential treatment. Follow-up assessment was completed 4 weeks later. Participants were primarily male (62%) and white (62%). They were all in treatment for opioid abuse, with a majority of participants reporting a history of polysubstance abuse. To measure adverse and protective factors, participants completed the Adverse Childhood Experiences scale and Protective And Compensatory Experiences Scale at baseline. Participants also completed the NIH Toolbox cognition battery and a set of self-report measures of cognitive functioning, mood, anxiety, and self-efficacy at baseline and follow up.Results:Results of paired samples t-test comparison between baseline and follow-up testing found a significant improvement in self-reported depression symptoms, anxiety symptoms, and self-efficacy (all p&lt;.001). Interestingly, participants overall reported an increase in cognitive problems between baseline and retest, even though on objective cognitive testing (NIH Toolbox cognition battery) there was significant improvement in cognitive performance. Participants generally had a high level of childhood adversity (mean ACE score of 4.5), with an average level of childhood compensatory experiences. Considering the specific effect for childhood adversity, ACE score was found to be predictive in amount of anxiety and self-reported cognitive change but not for objective cognitive performance or change in other factors.Conclusions:Consistent with previous research, these patients had a high level of past trauma, which interacted with a number of other neuropsychiatric measures and support the importance of assessing for trauma history and integrating trauma-focused treatment into substance abuse treatment programs.

"I wish people could come together like we have," patient and provider perspectives on VA residential PTSD treatment.

Although most posttraumatic stress disorder (PTSD) care in the Veterans health administration (VHA) is provided on an outpatient basis, the VHA has 40 residential rehabilitation treatment programs (RRTPs) designed to treat Veterans who require more intensive and closely monitored care. Unfortunately, the clinical outcomes of these programs are modest, and previous attempts to identify key drivers of outcomes have uncovered few modifiable factors. The present study, informed by the model of resources, life events and changes in psychological state, was designed to identify factors associated with treatment response among RRTP patients and providers. Semistructured interviews were conducted with 24 patients and 12 providers at three regional RRTPs, using interview guides based on the theoretical model. Data were analyzed using rapid analysis. Results showed that patients and providers agreed on several factors critical to RRTP success. These factors included the provision of evidence-based psychotherapy (EBP), support and understanding from fellow patients, and skill and support from providers. Patients and providers also noted the importance of psychological flexibility, openness, and willingness to change. Patients who experienced less symptom improvement over the course of treatment were more likely to report poor therapeutic alliance. These findings underscore the importance of continued emphasis on EBP delivery but also suggest that RRTPs might find additional ways to capitalize on the residential milieu to encourage engagement in treatment and a focus on therapeutic change. (PsycInfo Database Record (c) 2023 APA, all rights reserved).