Trauma-focused Psychotherapy Research Articles

Efficacy of trauma-focused therapies for post-traumatic stress disorder in disaster-affected regions: insights from Minamisoma, Japan.

This study investigated the implementation and efficacy of trauma-focused psychotherapies at a psychiatric clinic in Minamisoma City, Fukushima, after the 2011 Great East Japan Earthquake and nuclear disaster. Analyzing medical records from April 2016 to March 2021, the authors identified a significant dropout rate of 43.2% among post-traumatic stress disorder (PTSD) patients within the first 5 years. These findings highlight the challenges and effectiveness of trauma-focused treatments like prolonged exposure therapy in disaster-stricken areas, where PTSD incidence is notably high. This study emphasizes the necessity to establish robust therapeutic frameworks capable of addressing PTSD in such contexts, considering the limited coverage of comprehensive psychotherapies by Japan's healthcare system.

Life After EBPs: Characterizing Subsequent Engagement in Evidence-Based Psychotherapy After Completion of an Initial Trauma-Focused EBP in a National Sample of VA Patients.

Many Veterans who complete prolonged exposure (PE) or cognitive processing therapy (CPT) report residual symptoms, but it is unclear how to best address the mental health needs of these individuals. Examining patterns of mental health service utilization following completion of these two treatments may provide insight into how to best serve this group of individuals. In a large cohort of Veterans (N = 12,514) who sought treatment in the Veterans Health Administration during Fiscal Years 2015-2019, logistic regression models were used to assess the odds of initiating an additional course of trauma-focused (i.e., PE or CPT) or depression-focused psychotherapy in the year following completion of PE or CPT based on demographic, psychiatric, and treatment effectiveness-related variables. Approximately 9% of Veterans engaged in either trauma-(6%) or depression-(3%) related psychotherapy in the year following discharge from PE or CPT. Factors associated with increased odds of trauma-focused treatment initiation included having a sleep disorder diagnosis (OR = 1.23), a substance use disorder diagnosis (OR = 1.27), or experiencing military sexual trauma (OR = 1.64). Factors associated with increased odds of depression-focused treatment initiation included having a depression diagnosis (OR = 2.02). This study suggests that certain subgroups of Veterans who engage in PE or CPT (e.g., Veterans with comorbid sleep or substance use problems) are more likely to seek additional evidence-based treatment and may require augmentations to maximize clinical benefits, either during the initial course of treatment or subsequent to PTSD treatment.

Posttraumatic Stress Disorder and Substance Use Disorder Screening, Assessment, and Treatment.

We review prevalence, etiology, impact on treatment, and best practices for treatment of posttraumatic stress disorder (PTSD) in a substance use disorder (SUD) treatment setting. Recommendations are given related to screening, assessment, and symptom monitoring. PTSD and SUDs are highly comorbid. This comorbidity is associated with higher acuity, more difficulty completing treatment, and worse prognosis. Integrated treatment is recommended, and trauma-focused psychotherapies combined with pharmacotherapy show particular promise. PTSD is highly prevalent in substance using samples, negatively impacting treatment course and worsening prognosis. This comorbidity has been explained by a variety of models, with self-medication having garnered the most support. Trauma-focused psychotherapies combined with pharmacotherapy demonstrate the most efficacy and are recommended when treating co-occurring SUDs and PTSD. Specifically, prolonged exposure (PE), concurrent treatment of PTSD and SUDs using PE (COPE), and cognitive processing therapy (CPT) have been seen as promising trauma-focused treatments. Investigations into ways to best augment therapy are also underway, both through treatment format and neuromodulation. Several recommendations are given.

Effectiveness of telehealth-delivered massed trauma-focused psychotherapy among veterans with posttraumatic stress disorder.

Trauma-focused psychotherapies can be effectively delivered using a massed delivery format. Telehealth treatment for posttraumatic stress disorder (PTSD) using evidence-based interventions has been shown to be as effective as in-person treatment. However, the effectiveness of evidence-based treatments for PTSD over telehealth using the massed delivery format requires further examination. To examine the effectiveness of telehealth massed PTSD treatment, we report on a quality improvement study of 33 veterans (75.8% male; MAge = 42.3, SD = 11.0) who participated in a virtual 4-week massed PTSD program at a Department of Veterans Affairs (VA) medical center. Twenty-seven (81.8%) veterans completed the treatment and reported large reductions in PTSD (d = 1.48) and depressive symptoms (d = 1.08) at Week 4 and at 1-month follow-up (PTSD, d = 1.34; depression, d = 0.70). Results suggested that evidence-based treatment for PTSD can be effectively delivered in a massed format over telehealth in a VA medical setting. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Telomere length and mitochondrial DNA copy number in association with trauma-focused psychotherapy efficacy

Early life adversities (ELA) have been linked to a greater risk for major depressive disorder (MDD) and treatment-resistant depression (TRD). The molecular mechanisms underlying the link between ELA and MDD and/or TRD are yet unknown. It has been suggested that ELA induces an allostatic burden, which in turn promotes oxidative stress and an inflammatory response that are further intensified by the influence of maladaptive coping behaviour. In this study we explored the role of two markers of cellular aging and oxidative stress (telomere length (TL) and mitochondrial DNA copy number mtDNAcn) in TRD and in response to trauma-focused psychotherapies. The study comprised 30 TRD patients receiving trauma-focused psychotherapies and 65 healthy controls. TL and mtDNAcn were measured at baseline and four weeks after the end of the psychotherapy sessions. Response was defined based on reduction in the Montgomery-Åsberg Depression Rating Scale (MADRS). In the case control analysis, the logistic regression model showed that mtDNAcn but not TLT was a significant predictor of diagnosis (chi-square 92.108, p=7.72e-20; contribution of mtDNAcn, B=-9-297, p=0.00009, Table 2). In the TRD sample, LTL and mtDNAcn were inversely correlated with MADRS score at baseline (TL, Pearson’s r=-0.478, p=0.008; mtDNAcn, Pearson’s r=-0.656, p=0.00008), but there was no difference in either TL or mtDNAcn between responders and non-responders. In conclusion, our findings support an involvement of cellular aging in TRD, and suggest that TLA and mtDNAcn are not predictors or mediators of response to trauma-focused psychotherapies.

Clinical Case of Trauma-Focused Psychodynamic Psychotherapy for a Veteran With PTSD and Race-Based Trauma.

Clinical Case of Trauma-Focused Psychodynamic Psychotherapy for a Veteran With PTSD and Race-Based Trauma.

Task-shifting of prolonged exposure for primary care (PE-PC) for PTSD in a semirural setting in South Africa: A pilot implementation study.

Implementation science (IS) has received increased attention as it provides a means to bridge the know-do gap to implement evidence-based interventions in real-world settings. Against this backdrop, posttraumatic stress disorder (PTSD) is a global mental health concern (Koenen et al., 2017), especially in low- and middle-income countries characterized by limited trained health professionals, infrastructure, and limited access to evidence-based mental health care (Chen et al., 2017). Over the last 3 decades, effective trauma-focused psychotherapies (TFPs) for PTSD have been developed (Hamblen et al., 2019). Prolonged exposure therapy (PE) is a first-line TFP for PTSD (Hamblen et al., 2019), yet the dissemination and implementation of PE have been limited to specialty care settings in developed or industrialized countries (Booysen & Kagee, 2020). Implementation science provides an opportunity for disseminating and implementing TFPs like PE in low- and middle-income countries. This article describes mixed-method data from a pilot implementation study of an abbreviated version of PE, known as prolonged exposure for primary care (S. A. M. Rauch, Kim, et al., 2023), in a semirural city in the Eastern Cape of South Africa. Importantly, prolonged exposure for primary care shows a significant reduction in PTSD when provided by lay counselors and good feasibility and acceptability. In addition, we reflect on the barriers and facilitators related to implementation research within a low-resourced community, namely, (a) training lay counselors, (b) cultural diversity, and (c) mental health literacy. Mental health literacy is proposed as an essential component to consider in implementation science, especially in low-resourced communities. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A systematic review and meta-analysis of predictors of response to trauma-focused psychotherapy for posttraumatic stress disorder.

Although trauma-focused psychotherapy (T-F psychotherapy) is the treatment of choice for posttraumatic stress disorder (PTSD), up to one half of patients do not respond to this treatment. Attempts to improve response to T-F psychotherapy have focused on augmenting fear extinction-based factors. Here, a systematic and meta-analytic review of predictors of T-F psychotherapy outcome was conducted with the goal of using an aggregate data-driven approach to elucidate baseline factors associated with treatment outcome. There were 114 studies that met inclusion criteria (N = 61, 970; Mage = 40.1 years; 40.1% female). There were 237 effect sizes across 24 meta-analytic categories. Poorer treatment response is associated with lower pretreatment levels of activation of fear-related brain regions, psychophysiological reactivity to fear provocation, trauma-related cognitions, anger, depression, high-risk alleles of genes linked to fear, lower levels of executive control, and social support. A range of other factors also predicted poorer responses including being male, non-Caucasian, older in age, early trauma occurrence, more trauma experience, history of combat trauma, as well as comorbid sleep, pain, poor quality life, and alcohol abuse difficulties. This review provides one potential explanation for the limited success of T-F psychotherapy augmentation strategies that have focused only on fear circuity mechanisms at the exclusion of other factors. Here, poor response relating to predictors of early trauma onset and comorbidity are consistent with clinical presentations of complex PTSD, which may suggest T-F psychotherapy is less effective for this condition. This collective evidence suggests that clinicians should consider a tailored approach that targets potential barriers to successful treatment response. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Evidence-based psychotherapy of posttraumatic stress syndrome-An update

The aim of this article is to summarize the current state of research on the effectiveness of psychotherapeutic treatment of posttraumatic stress disorder (PTSD). The results of current meta-analyses and trend-setting individual studies are summarized and the most important forms of intervention are explained. The psychotherapeutic treatment methods for PTSD are very effective, the effect sizes are large and superior to those of pharmacotherapy. Trauma exposure and cognitive restructuring are most effective. Trauma-focused procedures are generally superior to other forms of psychotherapy. Arange of different cognitive behavioral procedures as well as eye movement desensitization and reprocessing are recommended. The most recent initial findings confirm a very good effectiveness for imagery rescripting methods as protective interventions without a formal confrontation with trauma. Individual therapy works better than group psychotherapy. In the group setting cognitive processing therapy has proven to be the best intervention. Trauma-focused treatment should also be used when comorbid conditions such as schizophrenia, bipolar disorder or addiction are present. Trauma-focused psychotherapy in an individual setting is the treatment of choice for PTSD. Alarge selection of effective methods and well-reviewed manuals are available. The German language S3 guidelines are currently being updated.

The development and the effectiveness of schema therapy on Malaysian female young adults who experienced continuous trauma and post-traumatic stress disorder

In Malaysia, most psychotherapies were introduced in the 1980s and 1990s. Unfortunately, the development and availability of new psychotherapies have been comparatively slower and neglected in Malaysia, particularly in the context of trauma-focused psychotherapy. A new therapeutic model, schema therapy, has been hypothesized as a potential alternative for trauma treatment. This study adapted schema therapy to be culturally specific for Malaysia and conducted an interventional randomized controlled trial to investigate its effectiveness. The study focused on female young adults in Malaysia who had experienced repeated and continuous trauma.The effectiveness of schema therapy was compared with Trauma-Focused Cognitive Behavioral Therapy (Tf-CBT). Each group comprised 15 participants who received 16 one-hour therapy sessions over a span of 4 months. Post-traumatic stress disorder (PTSD) symptoms were measured during the pre-test, post-test, and 3-month follow-up assessments. Additionally, semi-structured qualitative interviews were conducted with participants from both the schema therapy and Tf-CBT groups to gain a deeper understanding of the differences between the two psychotherapeutic approaches.Both quantitative and qualitative analyses demonstrated that schema therapy exhibited superior short-term and long-term effectiveness compared to Tf-CBT in reducing PTSD symptoms. These findings support the viability of schema therapy as an effective option for addressing trauma in the Malaysian context.

Sequenced Treatment Effectiveness for Posttraumatic Stress (STEPS) Trial: A protocol for a pragmatic comparative effectiveness trial with baseline results

BackgroundThere have only been two efficacy trials reporting a head-to-head comparison of medications and psychotherapy for PTSD, and neither was conducted in primary care. Therefore, this protocol paper describes a pragmatic trial that compares outcomes of primary care patients randomized to initially receive a brief trauma-focused psychotherapy or a choice of three antidepressants. In addition, because there are few trials examining the effectiveness of subsequent treatments for patients not responding to the initial treatment, this pragmatic trial also compares the outcomes of those switching or augmenting treatments. MethodPatients screening positive for PTSD (n = 700) were recruited from the primary care clinics of 7 Federally Qualified Health Centers (FQHC) and 8 Department of Veterans Affairs (VA) Medical Centers and randomized in the ratio 1:1:2 to one of three treatment sequences: 1) selective serotonin reuptake inhibitor (SSRI) followed by augmentation with Written Exposure Therapy (WET), 2) SSRI followed by a switch to serotonin-norepinephrine reuptake inhibitor (SNRI), or 3) WET followed by a switch to SSRI. Participants complete surveys at baseline, 4 months, and 8 months. The primary outcome is PTSD symptom severity as measured by the PTSD Checklist (PCL-5). ResultsAverage PCL-5 scores (M = 52.8, SD = 11.1) indicated considerable severity. The most common bothersome traumatic event for VA enrollees was combat (47.8%), and for FQHC enrollees was other (28.2%), followed by sexual assault (23.4%), and child abuse (19.8%). Only 22.4% were taking an antidepressant at baseline. ConclusionResults will help healthcare systems and clinicians make decisions about which treatments to offer to patients.

Evidence-based assessment and treatment of military/Veteran PTSD: Reflections on 15 years of practice

LAY SUMMARY This reflection following 15 years of military/Veteran clinical practice reviews special assessment and treatment considerations, with a focus on prolonged exposure therapy for posttraumatic stress disorder. It discusses common assumptions about evidence-based psychotherapy that can negatively impact treatment outcome and patient motivation and participation in treatment. The widely varying clinical presentations of the Canadian military population and unique nature of military service, as well as its impact on mental health, are reviewed. Key practice suggestions include the importance of identifying the index trauma, using outcome monitoring, and understanding the theory of each of the gold-standard trauma-focused psychotherapies, as well as the rationale for each included intervention, so that clinicians can tailor treatments to patients as clinically required. Common misunderstanding and complexities related to trauma-focused psychotherapies are discussed, including the goal of treatment and clinician hesitation to implement evidence-based psychotherapies. The intention of this reflection is to increase discussion, contribute to a greater understanding and deeper appreciation for the uniqueness of military/Veteran patients, and promote advancement and innovation in research and clinical practice.

Current Research on Matching Trauma-Focused Therapies to Veterans: A Scoping Review.

Trauma-focused (psycho)therapies (TFTs) are often used to treat post-traumatic stress disorder (PTSD) of (military) veterans, including prolonged exposure (PE), cognitive processing therapy (CPT), and eye movement desensitization and reprocessing. However, research thus far has not conclusively determined predictors of TFTs' success in this population. This scoping review's objectives are 1) to explore whether it is possible, based on currently available evidence, to match TFTs to veterans to maximize their outcomes, (2) to identify possible contraindications and adaptations of TFTs for this population, and (3) to identify gaps in the literature to guide future research. Standard scoping review methodology was used. "White" and "gray" literature searches resulted in 4963 unique items identified. Following title and abstract screening and full-text analysis, 187 sources were included in the review. After data extraction, a narrative summary was used to identify common themes, discrepancies between sources, and knowledge gaps. Included publications most often studied CPT and PE rather than eye movement desensitization and reprocessing. These TFTs were at least partly effective with mostly moderate effect sizes. Attrition rates were slightly higher for PE versus CPT. There was variance in the methodological quality of the included studies. The current literature on TFTs to treat PTSD in veterans contains several knowledge gaps, including regarding treatment matching. Future research should examine effectiveness of these treatments using multiple sources of outcomes, longer time periods, combination with other treatment, outcomes outside of PTSD symptoms (such as functioning), and resilience.

Using brief reflections to capture and evaluate end-user engagement: a case example using the COMPASS study

BackgroundUse of participatory research methods is increasing in research trials. Once partnerships are established with end-users, there is less guidance about processes research teams can use to successfully incorporate end-user feedback. The current study describes the use of a brief reflections process to systematically examine and evaluate the impact of end-user feedback on study conduct.MethodsThe Comparative Effectiveness of Trauma-Focused and Non-Trauma- Focused Treatment Strategies for PTSD among those with Co-Occurring SUD (COMPASS) study was a randomized controlled trial to determine the effectiveness of trauma-focused psychotherapy versus non-trauma-focused psychotherapy for Veterans with co-occurring posttraumatic stress disorder and substance use disorder who were entering substance use treatment within the Department of Veterans Affairs. We developed and paired a process of “brief reflections” with our end-user engagement methods as part of a supplemental evaluation of the COMPASS study engagement plan. Brief reflections were 30-minute semi-structured discussions with the COMPASS Team following meetings with three study engagement panels about feedback received regarding study issues. To evaluate the impact of panel feedback, 16 reflections were audio-recorded, transcribed, rapidly analyzed, and integrated with other study data sources.ResultsBrief reflections revealed that the engagement panels made recommended changes in eight areas: enhancing recruitment; study assessment completion; creating uniformity across Study Coordinators; building Study Coordinator connection to Veteran participants; mismatch between study procedures and clinical practice; therapist skill with patients with active substance use; therapist burnout; and dissemination of study findings. Some recommendations positively impact study conduct while others had mixed impact. Reflections were iterative and led to emergent processes that included revisiting previously discussed topics, cross-pollination of ideas across panels, and sparking solutions amongst the Team when the panels did not make any recommendations or recommendations were not feasible.ConclusionsWhen paired with end-user engagement methods, brief reflections can facilitate systematic examination of end-user input, particularly when the engagement strategy is robust. Reflections offer a forum of accountability for researchers to give careful thought to end-user recommendations and make timely improvements to the study conduct. Reflections can also facilitate evaluation of these recommendations and reveal end-user-driven strategies that can effectively improve study conduct.Trial registrationClinicalTrials.gov (NCT04581434) on October 9, 2020; https://clinicaltrials.gov/ct2/show/study/NCT04581434?term=NCT04581434&draw=2&rank=1.

Cognitive processing therapy (CPT) versus individual drug counseling (IDC) for PTSD for veterans with opioid use disorder maintained on buprenorphine.

There are high rates of comorbidity between posttraumatic stress disorder (PTSD) and opioid use disorder (OUD). Evidence-based trauma-focused psychotherapies such as Cognitive Processing Therapy (CPT) are a first-line treatment for PTSD. Veterans with OUD are treated primarily in substance use disorder (SUD) clinics where the standard of care is drug counseling; they often do not have access to first-line PTSD treatments. This study tested whether CPT can be conducted safely and effectively in veterans with comorbid OUD treated with buprenorphine. This 12-week, 2-site, randomized clinical trial (RCT) included open-label randomization to two groups: (a) CPT versus (b) Individual Drug Counselling (IDC) in veterans with PTSD and comorbid OUD who were maintained on buprenorphine (N = 38). Veterans randomized to either IDC (n = 18) or CPT (n = 20) showed a significant reduction in self-reported PTSD symptoms over time as measured by the PTSD checklist (PCL-5) but there were no treatment group differences; there was some indication that reduction in PTSD symptoms in the CPT group were sustained in contrast to the IDC group. Recruitment was significantly impacted by COVID-19 pandemic, so this study serves as a proof-of-concept pilot study. Veterans with OUD and PTSD can safely and effectively participate in evidence-based therapy for PTSD; further work should confirm that trauma-focused treatment may be more effective in leading to sustained remission of PTSD symptoms than drug counseling. This is the first study to evaluate CPT for PTSD in the context of buprenorphine treatment for OUD.

Clinician Burnout and Effectiveness of Guideline-Recommended Psychotherapies

Clinician burnout has been associated with clinician outcomes, but the association with patient outcomes remains unclear. To evaluate the association between clinician burnout and the outcomes of patients receiving of guideline-recommended trauma-focused psychotherapies for posttraumatic stress disorder (PTSD). This cohort study was set at the US Veterans Affairs Health Care System and included licensed therapists who provided trauma-focused psychotherapies and responded to an online survey between May 2 and October 8, 2019, and their patients who initiated a trauma-focused therapy during the following year. Patient data were collected through December 31, 2020. Data were analyzed from May to September 2023. Therapists completing the survey reported burnout with a 5-point validated measure taken from the Physician Worklife Study. Burnout was defined as scores of 3 or more. The primary outcome was patients' clinically meaningful improvement in PTSD symptoms according to the PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). Patient dropout, therapist adherence, and session spacing was assessed through electronic health records. Multivariable random-effects logistic regression examined the association of therapist burnout and clinically meaningful improvement, adjusted for case-mix. In this study, 165 of 180 (91.7%) therapists (89 [53.9%] female) completed the burnout measure and provided trauma-focused psychotherapies to 1268 patients (961 [75.8%] male) with outcome data. Fifty-eight (35.2%) therapists endorsed burnout. One third of patients (431 [34.0%]) met criterion for clinically meaningful improvement. Clinically meaningful improvement in PTSD symptoms was experienced by 120 (28.3%) of the 424 patients seen by therapists who reported burnout and 311 (36.8%) of the 844 patients seen by therapists without burnout. Burnout was associated with lower odds of clinically meaningful improvement (adjusted odds ratio [OR],0.63; 95% CI, 0.48-0.85). The odds of clinically meaningful improvement were reduced for patients who dropped out (OR, 0.15; 95% CI, 0.11-0.20) and had greater session spacing (OR, 0.80; 95% CI, 0.70-0.92). Therapist adherence was not associated with therapy effectiveness. Adjusting for dropout or session spacing did not meaningfully alter the magnitude of the association between burnout and clinically meaningful improvement. In this prospective cohort study, therapist burnout was associated with reduced effectiveness of trauma-focused psychotherapies. Studying when and how burnout affects patient outcomes may inform workplace interventions.

Dissociative Identity Unveiled: A Case Report of 17 Distinct Identities Emerging in a Clear Timeline Following Trauma Events

Introduction Dissociative Identity Disorder (DID) is a complex and enigmatic mental disorder in which an individual maintains two or more distinct identities or personality states. We present a rare and captivating case report of a 27-year-old female patient who exhibited a remarkable 17 distinct identities, developed in a clear and unprecedented timeline following a series of specific traumatic events. The novelty of this case lies in the comprehensive documentation and analysis of the sequential emergence of these identities, offering valuable insights into the development and progression of DID.ObjectivesOur aim in presenting this case study is to offer a unique presentation to the constantly evolving understanding of DID. This case offers insight and provokes the need for research into the traumagenic nature of DID. This case showcases the influence on the chronological evolution of the patient’s 17 identities following a multitude of traumatic events.MethodsStructured interviews, psychiatric assessments, and psychological measurements, including self-reported measures of the Dissociative Experiences Scale, were employed to assess the identities and their individual experiences of the traumatic events. The patient was diagnosed with DID and received treatment including pharmacotherapy, psychoeducation, and trauma-focused psychotherapy. As a result of the therapeutic process, the patient was able to develop a higher sense of self-awareness and thus was able to integrate their 17 fragmented identities into a single host identity, demonstrating improvement in the functioning of interpersonal relationships.ResultsThe patient’s history reveals that the onset of her DID was linked to a traumatic event that occurred during early childhood, triggering the emergence of her first alternate identity. Over time, additional identities manifested, each appearing to serve as a coping mechanism to contend with the psychological distress stemming from subsequent significant trauma episodes. This case report meticulously outlines the chronological development of these identities and explores the distinct characteristics, behaviors, and roles assumed by each personality.ConclusionsThis case report offers valuable information on the complex development and pathogenesis of DID with a trauma influence. The presentation of this patient may lead to further research and more tailored therapeutic interventions for individuals suffering from DID.Disclosure of InterestNone Declared

The impact of trauma-focused psychotherapies on anger: A systematic review and meta-analysis.

Anger is one of the most prevalent concerns among individuals with posttraumatic stress disorder (PTSD) and is often a residual symptom following PTSD treatment. The purpose of this systematic review and meta-analysis was to determine how effective trauma-focused PTSD psychotherapies are in reducing anger. The study was reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. This study conducted a systematic review of studies that reported the effect of trauma-focused treatments on anger outcomes. Additionally, a meta-analysis was conducted with a subset of studies that used randomized controlled trials (RCTs) methodologies to compare trauma-focused PTSD treatments to nontrauma-focused and control conditions. The systematic review included 16 studies with a total of 1,846 participants. In 11 of the studies, there was a significant decrease in an anger dimension following treatment. Eight studies with 417 total participants met inclusion criteria for the meta-analysis. The meta-analysis yielded a pooled effect size of PTSD treatment on anger of Hedges's g = 0.33. Overall, trauma-focused treatments for PTSD significantly improve anger, but the magnitude of change is small-to-medium. Additional research is needed to determine how best to maximize anger outcomes following trauma-focused treatment or determine if and when targeted anger treatment is needed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Supplemental Material for The Impact of Trauma-Focused Psychotherapies on Anger: A Systematic Review and Meta-Analysis

Supplemental Material for The Impact of Trauma-Focused Psychotherapies on Anger: A Systematic Review and Meta-Analysis

Brief family involvement enhances veteran homework quality during trauma-focused psychotherapy.

Homework has been shown to improve outcomes in cognitive-behavioral therapy, though less is known about the importance of homework during trauma-focused psychotherapy. Similarly, prior research suggests family context plays a key role in posttraumatic stress disorder (PTSD)-related distress and treatment engagement. One potential way that families can facilitate better treatment outcomes is by promoting homework engagement. This study examined the impact of a brief family intervention (BFI) for PTSD toward this aim. We hypothesized that veterans with PTSD whose family members (FMs) received the BFI would have better homework completion and quality than those who did not receive the BFI. This mixed-methods analysis examined 24 veteran-family dyads enrolled in a randomized clinical trial examining the BFI. All veterans were currently engaged in trauma-focused psychotherapy. Each veteran's clinician rated their homework quality and completion after each therapy session. A subset of dyads also completed semistructured interviews posttreatment. A rapid qualitative analysis approach was used to examine themes in shifting family behavior post-BFI. Quantitative analyses yielded partial support for our hypotheses: those in the BFI condition had significantly higher clinician-rated homework quality. While participants in the BFI condition had a higher homework completion rate, this difference did not reach statistical significance. Qualitative analyses suggested that the BFI prompted meaningful discussions about PTSD and increased FMs' use of supportive (rather than accommodative) behavior when responding to PTSD-related distress. Involving FMs in PTSD treatment appears to shift the family context in a manner that improves homework quality in veterans. (PsycInfo Database Record (c) 2024 APA, all rights reserved).