Trauma-focused Therapy Research Articles

Online group-based internal family systems treatment for posttraumatic stress disorder: Feasibility and acceptability of the program for alleviating and resolving trauma and stress.

Demand for trauma-focused therapy continues to increase, especially in community mental health care settings where group treatment models can be cost-effective and increase access to care. The Internal Family Systems (IFS) model for posttraumatic stress disorder (PTSD) may offer an effective therapeutic approach. The purpose of this proof-of-concept study was to evaluate the feasibility and acceptability of a novel, trauma-focused, group-based treatment approach and investigate potential mechanisms of action. Study participants completed the Program for Alleviating and Resolving Trauma and Stress (PARTS), an online-delivered program including 16 weeks of 90-min IFS-based groups with eight 50-min individual IFS counseling sessions. Participants completed assessments including clinician-administered and self-report measures of PTSD, common comorbid conditions (e.g., complex PTSD [disturbances in self-organization], depression, anxiety, and suicidality), and potential mechanisms (e.g., decentering, self-compassion, and emotion regulation). Most participants (n = 11/15; 73%) attended 12+ group sessions, with 92% (12/13 responders) reporting they would recommend PARTS to a friend. All respondents reported the program was helpful (13/13; 100%). PTSD symptom severity was reduced from baseline to Weeks 16 (d = -0.7, p = .005) and 24 (d = -0.9, p < .001). A clinically meaningful response (i.e., 10+ point reduction on the Clinician-Administered PTSD Scale for Diagnostic and Statistical Manual of Mental Disorders [5th ed.]) was demonstrated in 53% of participants (8/15) by Week 24. Decentering, self-compassion, and emotion regulation all improved (p < .05). PARTS was feasible and acceptable as a group-based, online intervention in an urban, public community health care system. While PARTS showed promise in reducing overall PTSD symptom severity, well-controlled efficacy research is needed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Effect of Trauma-Focused Cognitive-Behavioral Therapy on Post Traumatic Stress Disorder (PTSD) Symptoms in Children and Adolescents

Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) has been shown to be an effective treatment for reducing PTSD symptoms in children and adolescents. Research has consistently demonstrated that TF-CBT leads to significant decreases in symptom severity, improved emotion regulation, and enhanced emotional well-being. Additionally, TF-CBT has been found to decrease depressive and anxiety symptoms in youth with co-occurring mental health conditions. The approach's effectiveness is influenced by factors such as age, trauma severity, and presence of additional mental health conditions. Furthermore, resilience plays a crucial role in mitigating the impact of adverse childhood experiences on mental health. By fostering effective coping strategies and promoting protective factors, TF-CBT can help children and adolescents develop resilience and improve their overall well-being Keywords: Fake News, Long Short-Term Memory (LSTM), Support Vector Machine, Dependencies Machine Learning, Journal Reference Format: Longe, Bankole-Phillips. A. (2024): The Effect of Trauma-Focused Cognitive-Behavioral Therapy on Post Traumatic Stress Disorder (PTSD) Symptoms in Children and Adolescents. Journal of Behavioural Informatics, Digital Humanities and Development Rese Vol. 10 No. 1. Pp 75-78. https://www.isteams.net/behavioralinformaticsjournal dx.doi.org/10.22624/AIMS/BHI/V10N1P7

Trauma-focused treatments for victims of interpersonal violence: A comparison of treatment interventions and outcomes

Background: Interpersonal violence represents a critical public health issue globally, with profound psychological impacts on victims. Objective: The main objective of this study was to analyze the effectiveness of different trauma-focused therapies on mental health outcomes of victims of interpersonal violence, at a community mental health clinic. Methods: Employing a secondary data methodology, the research involves 601 participants who reported being victims of sexual assault (49.1%), domestic violence (44.3%) or sexual trafficking (6.7%). The average age of the participants was 35.54 years, with a majority being female (89.8%). Results: Initial assessments revealed distinct symptomatology among the groups; however, by the ninth therapy session, symptom severity converged across the board, surpassing threshold levels for clinical concern. No significant interaction was observed between the type of trauma-focused therapy and the specific trauma encountered, suggesting a beneficial effect of trauma-focused therapies investigated. This uniformity in therapeutic outcomes underscores the potential of trauma-focused therapies to foster psychological healing in victims of diverse forms of interpersonal violence. Conclusions: The findings advocate for the widespread adoption of trauma-focused therapeutic interventions in community settings, emphasizing their role in the recovery of victims, independent of the nature of the trauma or the specific trauma-focused therapeutic model employed.

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.

Group-Based Acceptance and Commitment Therapy for PTSD in a HMO Psychiatry Clinic: An Open Trial

Mindfulness and acceptance-based approaches have shown promise as alternative interventions to trauma-focused therapies for PTSD. This open trial examined the potential effectiveness of an 8-session Acceptance and Commitment Therapy (ACT) group in reducing psychiatric symptoms and improving quality of life in outpatient adults (N = 86, 79% female) receiving treatment for PTSD in a health maintenance organization (HMO) psychiatry clinic. The group therapy was an adjunct to usual care and utilized the six core processes of ACT: acceptance, cognitive defusion, mindfulness, self-as-context, values, and committed action. Participants completed self-report measures of PTSD symptoms, depression, anxiety and quality of life; and self-report ACT-specific process measures of acceptance, cognitive defusion and mindfulness at pretreatment, posttreatment and 3-month follow-up. Repeated measures analyses of variance conducted with a completer sample (n = 55) demonstrated significant improvements on all variables with medium to large effect sizes at posttreatment and follow-up. The study findings support further investigation in a randomized controlled trial.

Personal and work-related factors associated with post-traumatic growth in nurses: A mixed studies systematic review.

Nurses, assuming a wide range of clinical and patient care responsibilities in a healthcare team, are highly susceptible to direct and indirect exposure to traumatic experiences. However, literature has shown that nurses with certain traits developed a new sense of personal strength in the face of adversity, known as post-traumatic growth (PTG). This review aimed to synthesize the best available evidence to evaluate personal and work-related factors associated with PTG among nurses. Mixed studies systematic review. Studies examining factors influencing PTG on certified nurses from all healthcare facilities were included. Published and unpublished studies were identified by searching 12 databases from their inception until 4th February 2023. Two reviewers independently screened, appraised, piloted a data collection form, and extracted relevant data. Meta-summary, meta-synthesis, meta-analysis, as well as subgroup and sensitivity analyses were performed. Integration of results followed result-based convergent design. A total of 98 studies with 29,706 nurses from 18 countries were included. These included 49 quantitative, 42 qualitative, and seven mixed-methods studies. Forty-six influencing factors were meta-analyzed, whereas nine facilitating factors were meta-summarized. A PTG conceptual map was created. Four constructs emerged from the integration synthesis: (a) personal system, (b) work-related system, (c) event-related factors, and (d) cognitive transformation. The review findings highlighted areas healthcare organizations could do to facilitate PTG in nurses. Practical implications include developing intervention programs based on PTG facilitators. Further research should examine the trend of PTG and its dynamic response to different nursing factors. Research on trauma-focused therapies targeting nurses' mental health is lacking. Therefore, findings from this review could inform healthcare organizations on the PTG phenomenon and developing support measures for nurses through healthcare policies and clinical practice.

Eye-movement desensitisation and reprocessing therapy (EMDR) to prevent transition to psychosis in people with an at-risk mental state (ARMS): mixed method feasibility study.

Trauma plays an important role in the development of psychosis, but no studies have investigated whether a trauma-focused therapy could prevent psychosis. This study aimed to establish whether it would be feasible to conduct a multicentre randomised controlled trial (RCT) to prevent psychosis in people with an at-risk mental state (ARMS), using eye-movement desensitisation and reprocessing therapy (EMDR). This started as a mixed-method randomised study comparing EMDR to treatment as usual but, as a result of low participant recruitment, was changed to a single-arm feasibility study. The proposed primary outcome for an RCT was transition to psychosis at 12-month follow-up. Data on secondary outcomes were also collected. Qualitative interviews were conducted with patients and therapists. Fourteen participants were recruited from the Early Intervention teams. Most people who expressed an interest in taking part attended an assessment to determine eligibility. All those eligible consented to take part. A total of 64% (7 of 11) of participants who were offered EMDR were followed up at 12 months. Of the 11 participants offered EMDR, one (11%, 95% CI: 0.2%, 48%) transitioned to psychosis. Nine patients and three therapists were interviewed. Participants who completed therapy (n = 4; mean 10.5 sessions) found EMDR helpful, but those who discontinued (n = 6; mean 5.2 sessions) said it had not benefitted them overall. Therapists said EMDR could be effective, although not for all patients. Future studies recruiting people with an ARMS to an RCT may need to extend recruitment beyond Early Intervention teams. Although some individuals found EMDR helpful, reasons for discontinuing need to be addressed in future studies.

The Effectiveness and Tolerability of an Intensive Outpatient Trauma Treatment Program for Adolescents With PTSD

Following the promising effects of an intensive trauma treatment for adults, the question arises whether adolescents suffering from posttraumatic stress disorder (PTSD) can also benefit from a similar treatment program. The objective of this study was to assess the effectiveness and tolerability of an intensive trauma treatment program combining two evidence-based, trauma-focused therapies—prolonged exposure (PE) and eye movement desensitization and reprocessing (EMDR)—with psychoeducation and physical activity for adolescents suffering from PTSD in an outpatient clinic. We used a multiple-baseline study design. Fifteen adolescents aged 12–18 years old with aDiagnostic and Statistical Manual of Mental Disorders(5th ed.) diagnosis of PTSD were included. Participants were randomized to wait 2, 3, or 4 weeks between the start of baseline and the start of the intervention. In the 2-week intervention period, participants received daily PE, EMDR, and physical activity. The social network of adolescents was involved for support. PTSD symptoms and treatment tolerability were assessed daily. PTSD diagnosis was assessed at baseline and at 1 month and 3 months after completion of treatment. In addition, semistructured interviews were conducted after treatment to determine the tolerability. After treatment, we found a diagnostic PTSD remission of 58%–62% and a decrease in PTSD severity compared with baseline. The effects were maintained at 1-month and 3-month follow-ups. The dropout rate was 13%. Participants reported good treatment tolerability. This study provides initial evidence that an intensive outpatient trauma treatment including PE, EMDR therapy, psychoeducation, and physical activity is effective and tolerable for adolescents with PTSD and is associated with low dropout rates.

Subjective distress, self-harm, and suicidal ideation or behavior throughout trauma-focused cognitive-behavioral therapy in transitional age youth.

Elevations in distress, self-harm, and suicidal ideation or behavior are of significant concern in clinical practice. We examined these in a pilot trial of Trauma Focused-Cognitive Behavioral Therapy (TF-CBT) for transitional age youth (aged 15-25 years) with histories of interpersonal trauma and symptoms of posttraumatic stress disorder. Participants were 20 young people (13 females, M = 19.5 years) from a pilot study of TF-CBT. Frequencies of elevated distress, self-harm, and suicidal ideation or behavior were measured throughout treatment sessions and across the treatment phases of TF-CBT. Across the 279 sessions of TF-CBT (m = 15.5 sessions), there were 16 incidents of elevated distress in seven participants (i.e., six in Phase I and five each in Phases II and III); 15 incidents of self-harming behavior in seven participants (five incidents in each of the three phases) and one incident of both elevated distress and suicide ideation (Phase I). Findings indicate that there may be a relationship between the experience of in session distress and self-harming behaviors. The importance of safety planning and coping skills (acquired in Phase 1) is stressed to ensure the effective implementation of TF-CBT. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

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.

Large-Scale Evaluation of Satisfaction, Intent to Use, and Confidence with an Online Learning Course for a Well-Established, Evidence-Based Trauma Treatment: TFCBTWeb2.0

ABSTRACT Web-courses for learning evidence-based treatments (EBTs) are increasingly being used to improve the dissemination and implementation of evidence-based practices in psychology. Most research on web-courses has focused on engagement and knowledge acquisition, and limited research has evaluated learner satisfaction with training and intent to use EBTs. Further, even when aspects of satisfaction and learner intentions are examined, factors that may contribute to these variables are often overlooked. The current study sought to address these limitations by examining individual, training, and system level factors related to web-course satisfaction, intent to use EBTs, and confidence working with trauma-exposed families following completion of TFCBTWeb2.0, a publicly available web-course for trauma-focused cognitive-behavioral therapy (TF-CBT). Data from 80,749 learners who completed TFCBTWeb2.0 and who represented a wide range of professionals were examined. Most learners (>90%) were satisfied with the course, intended to use the material, and had high confidence about working with trauma-exposed families. Moreover, those learners who completed the course more slowly (vs. faster completion time) and had more knowledge gain, as well as those who enrolled during the COVID-19 pandemic (vs. pre-pandemic), reported higher satisfaction with the course. Collectively, these results highlight the need to examine both individual and system level factors when considering web-course satisfaction, intent to use EBTs, and confidence working with client populations. Suggestions for TF-CBT trainers and supervisors are provided for how to improve training and learners’ willingness to use TF-CBT.

BPD Compass: Using a dimensional model of psychopathology to treat co-occurring borderline personality disorder and posttraumatic stress symptoms.

BPD Compass is a transdiagnostic psychotherapy that includes cognitive, behavioral, and mindfulness skills targeting the personality dimensions of negative affectivity, disinhibition, and antagonism. Given considerable symptom comorbidity and overlap in etiology between borderline personality disorder (BPD) and posttraumatic stress disorder (PTSD), this study investigated whether BPD Compass holds promise as an integrated approach to simultaneously treating co-occurring BPD features and PTSD symptoms. Participants included 84 trauma-exposed adults who participated in a two-phase clinical trial (Phase 1: randomized controlled trial of BPD Compass vs. waitlist [n = 43]; Phase 2: open trial of BPD Compass [n = 41]). Compared to waitlist, BPD Compass led to medium-to-large-sized, significant improvements in BPD features, βs = -.57 -.44, and facets of neuroticism, βs < -.55--.73, as well as small, nonsignificant improvements in self-reported, β = -.20, and clinician-rated PTSD symptom severity, β = -.19. During treatment, within-person improvements in PTSD symptoms predicted subsequent improvements in BPD features, β =.13, but not vice versa, β =.07. Within-person PTSD symptom reduction also predicted subsequent improvement in all personality dimensions, whereas only within-person improvement in despondence, β =.12, affective dysregulation, β =.11, and dissociative tendencies, β =.12, predicted PTSD symptom reductions. Findings offer preliminary support for the potential of BPD Compass to target BPD features and aspects of neuroticism and agreeableness among trauma-exposed adults. Moreover, PTSD symptom change predicting subsequent improvement in BPD features runs counter to current stage-based treatment models that emphasize BPD feature stabilization before engaging in trauma-focused therapy.

Facing posttraumatic stress disorder in Brazil: a survey of therapist practices

This study examines the treatment of PTSD in Brazil, a diverse country with limited research on the topic. It surveyed 208 psychologists and physicians who had treated PTSD cases, focusing on their approaches. The study found that 48.1% used screening instruments, with Cognitive Behavioral Therapy (CBT) being the most commonly adopted theoretical model (49%). Over 20 different theoretical affiliations were mentioned, and 41.3% of clinicians adhered to multiple theories. Criteria like individual case analysis, scientific evidence, and treatment acceptance guided treatment selection. Surprisingly, widely accepted trauma-focused therapies were not extensively used. Lack of PTSD education in undergraduate programs (38.5%) was identified as a significant barrier. These findings can inform mental health policies and highlight the need for evidence-based therapy training in educational institutions.

A pilot study of stellate ganglion block paired with exposure therapy: Feasibility and acceptability in combat veterans with posttraumatic stress disorder.

There is growing evidence that stellate ganglion block (SGB) combined with trauma-focused therapy may help veterans with posttraumatic stress disorder (PTSD) whose symptoms have not responded to traditional treatments. By combining SGB with in vivo exposure, veterans may be more able to fully engage in treatment and see improvement in their overall functioning. The primary aim of this project was to conduct a nonrandomized pilot trial on the feasibility and acceptability of delivering SGB paired with individual psychotherapy to veterans with combat-related PTSD. Eligible veterans (N = 14) constructed a hierarchy of in vivo exposure exercises, received the SGB procedure, and attended four additional weekly psychotherapy sessions with a focus on exposure exercises. Participants completed measures at baseline, weekly during treatment, and follow-up assessments immediately posttreatment and 1-month later. The recruitment target was easily met, session attendance was strong, and dropout was relatively low (21.4%). SGB was well tolerated with only mild, transient side effects. Participants reported satisfaction with the treatment they received as measured by the Client Satisfaction Questionnaire (M = 28.8). Paired t test analyses revealed a significant decrease in PTSD symptoms as measured by the PTSD Checklist for DSM-5. We also observed a significant reduction in PTSD symptoms as measured by the Clinician-Administered PTSD Scale for DSM-5 in mixed models, F(2, 13) = 8.68, p = .004. There were no significant improvements in psychosocial functioning or quality of life. SGB paired with psychotherapy is feasible and acceptable to veterans and holds promise for symptom reduction among veterans with combat-related PTSD. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Heart rate reactivity during trauma recall as a predictor of treatment outcome in cognitive processing therapy for PTSD

Emotional engagement when recollecting a trauma memory is considered a key element of effective trauma-focused therapy. Research has shown that reduced physiological reactivity during trauma recall is associated with worse treatment outcomes for posttraumatic stress disorder (PTSD), but this has yet to be examined in a cognitively oriented treatment. This study examined whether pretreatment heart rate (HR) reactivity during trauma recall predicts PTSD symptom improvement and treatment dropout during Cognitive Processing Therapy (CPT) for PTSD. Participants were 142 women with PTSD secondary to interpersonal violence enrolled in one of two clinicals trials. HR reactivity reflected the mean increase in HR after listening to two 30-s scripts of the trauma memory prior to treatment. Linear mixed-effects models showed the effect of HR reactivity on change in total PTSD symptoms was not significant, but lower HR reactivity predicted less improvement in reexperiencing and avoidance and was associated with increased dropout. Findings suggest pretreatment physiological reactivity to the trauma memory may be a prognostic indicator of some elements of treatment response in CPT. Results tentatively support the importance of emotional activation during trauma recall in cognitive treatment of PTSD, though more research is needed to clarify how low HR reactivity impacts treatment.

How is trauma-focused therapy experienced by adults with PTSD? A systematic review of qualitative studies

BackgroundTrauma-focused therapies (TFTs) are first-line treatments for posttraumatic stress disorder (PTSD). However, TFTs are under-utilised, partly due to clinicians’ and patients' fear that TFT is too challenging or harmful. We review the qualitative studies on how adults with PTSD experience TFTs to enhance the understanding of user perspectives, therapeutic processes, and outcomes.MethodsPubMed, PsychINFO and PTSDPubs were searched between October 1st and November 30th, 2021. Study quality assessments were undertaken, and studies were analysed using a descriptive-interpretative approach. Nine studies were included.ResultsThe analysis resulted in the identification of four key domains, representing a temporal sequence of TFT stages: Overcoming ambivalence towards TFT, Experience of treatment elements, Motivation for dropout/retention, and Perceived changes post-treatment.ConclusionAlthough many participants reported high levels of distress and considered dropping out, only a minority did eventually drop out and most patients expressed that the hardships in therapy were necessary for PTSD improvement. Establishing a safe therapeutic environment and working with the ambivalence towards treatment was essential for retention. This review serves a dual purpose, to shed light on diverse TFT experiences found to be important for treatment satisfaction, and to elucidate common treatment patterns. The results can be used in preparing patients for therapy and in training TFT therapists. Studies had moderate to high quality, and more studies of experiences of TFT non-responders and dropouts in a non-veteran population are needed to further our understanding of the utility and limitations of TFTs.

Project harmony: A systematic review and network meta-analysis of psychotherapy and pharmacologic trials for comorbid posttraumatic stress, alcohol, and other drug use disorders.

We conducted a systematic review and network meta-analyses (NMA) of psychotherapy and pharmacologic treatments for individuals with co-occurring posttraumatic stress disorder (PTSD) and alcohol or other drug use disorder (AOD). A comprehensive search spanning 1995-2019 yielded a pool of 39 studies for systematic review, including 24 randomized controlled trials for the NMA. Study interventions were grouped by target of treatment (PTSD + AOD, PTSD-only, and AOD-only) and approach (psychotherapy or medication). Standardized mean differences (SMD) from the NMA yielded evidence that at the end of treatment, integrated, trauma-focused therapy for PTSD + AOD was more effective at reducing PTSD symptoms than integrated, non-trauma-focused therapy (SMD = -0.30), AOD-focused psychotherapy (SMD = -0.29), and other control psychotherapies (SMD = -0.43). End-of-treatment alcohol use severity was less for AOD medication compared to placebo medication (SMD = -0.36) and trauma-focused therapy for PTSD + placebo medication (SMD = -0.67), and less for trauma-focused psychotherapy + AOD medication compared to PTSD medication (SMD = -0.53), placebo medication (SMD = -0.50), and trauma-focused psychotherapy + placebo medication (SMD = -0.81). Key limitations include the small number of studies in the NMA for pharmacologic treatments and the lack of demographic diversity apparent in the existing literature. Findings suggest room for new studies that can address limitations in study sample composition, sample sizes, retention, and apply new techniques for conducting comparative effectiveness in PTSD + AOD treatment. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Emotion regulation and heart rate variability may identify the optimal posttraumatic stress disorder treatment: analyses from a randomized controlled trial.

High variability in response and retention rates for posttraumatic stress disorder (PTSD) treatment highlights the need to identify "personalized" or "precision" medicine factors that can inform optimal intervention selection before an individual commences treatment. In secondary analyses from a non-inferiority randomized controlled trial, behavioral and physiological emotion regulation were examined as non-specific predictors (that identify which individuals are more likely to respond to treatment, regardless of treatment type) and treatment moderators (that identify which treatment works best for whom) of PTSD outcome. There were 85 US Veterans with clinically significant PTSD symptoms randomized to 6 weeks of either cognitive processing therapy (CPT; n = 44) or a breathing-based yoga practice (Sudarshan kriya yoga; SKY; n = 41). Baseline self-reported emotion regulation (Difficulties in Emotion Regulation Scale) and heart rate variability (HRV) were assessed prior to treatment, and self-reported PTSD symptoms were assessed at baseline, end-of-treatment, 1-month follow-up, and 1-year follow-up. Greater baseline deficit in self-reported emotional awareness (similar to alexithymia) predicted better overall PTSD improvement in both the short- and long-term, following either CPT or SKY. High self-reported levels of emotional response non-acceptance were associated with better PTSD treatment response with CPT than with SKY. However, all significant HRV indices were stronger moderators than all self-reported emotion regulation scales, both in the short- and long-term. Veterans with lower baseline HRV had better PTSD treatment response with SKY, whereas Veterans with higher or average-to-high baseline HRV had better PTSD treatment response with CPT. To our knowledge, this is the first study to examine both self-reported emotion regulation and HRV, within the same study, as both non-specific predictors and moderators of PTSD treatment outcome. Veterans with poorer autonomic regulation prior to treatment had better PTSD outcome with a yoga-based intervention, whereas those with better autonomic regulation did better with a trauma-focused psychological therapy. Findings show potential for the use of HRV in clinical practice to personalize PTSD treatment. ClinicalTrials.gov identifier, NCT02366403.

Trauma-focused therapy retention among military sexual trauma survivors: relationship with veterans’ sexual or gender minority identification

ABSTRACT Military servicemembers identifying as sexual and gender minorities (SGM) are at increased risk for military sexual trauma (MST) exposure and Post-traumatic Stress Disorder (PTSD). Although evidence-based treatments can reduce symptoms of PTSD, treatment attrition is concerning. Unfortunately, evaluations of such approaches with veterans identifying as SGM are currently restricted to case studies offering limited information regarding treatment completion. Both historic and current contextual factors related to military and mental health practices may uniquely influence minority veterans’ treatment engagement in veteran healthcare settings. We explored associations between SGM identification and treatment of MST-focused therapy completion patterns (finishing the full protocol [FP] or receiving minimally adequate care [MAC; defined as attending eight or more sessions]). Veterans (N = 271, 12.5% SGM) enrolled in individual Prolonged Exposure or Cognitive Processing Therapies at a Midwestern veterans hospital system. Those identifying as SGM were more likely than non-identifying peers to complete FP treatment and, even when attrition occurred, they were retained longer. For MAC, the SGM group was as likely as non-SGM peers to be retained. This research suggests SGM veterans represent a notable minority of those seeking treatment in association with MST and do not appear at greater risk for discontinuation from trauma-focused treatment.

Psychologically based interventions for adults with chronic neuropathic pain: a scoping review.

As psychologically based interventions have been shown to have clinical utility for adults with chronic pain generally, a similar benefit might be expected in the management of chronic neuropathic pain (NeuP). However, to date, this has not been established, with existing systematic reviews on this topic being hampered by the scarcity of randomized controlled trials (RCTs). This review aimed to identify the type of psychologically based interventions studied for adults with chronic NeuP. It also aimed to assess whether there are enough RCTs to justify undertaking an updated systematic review. Seven databases and 2 clinical trial registries were searched for NeuP and psychologically based interventions from database inception to December 2021, and the search was updated in February 2023. The search was broadened by reviewing the reference list of included studies and contacting field experts. Predetermined study characteristics were extracted. Of 4682 records screened, 33 articles (less than 1%) met the eligibility criteria. Four broad intervention approaches were observed, including cognitive-behavioral approaches (n = 16), mindfulness/meditation (n = 10), trauma-focused therapy (n = 4), and hypnosis (n = 3). Thirteen RCTs were identified, and of these, 9 retained 20 participants in each arm after treatment. Cognitive-behavioral therapy was the most common therapeutic approach identified, whereas mindfulness/meditation was the most frequently used technique. Almost half to two-thirds of the studies reported significant improvements in pain, disability, or distress, which suggests that psychologically based interventions are potentially beneficial for adults with chronic NeuP. An updated systematic review seems warranted. Open Science Framework (https://osf.io) (December 6, 2021; DOI: 10.17605/OSF.IO/WNSTM).