The impact of aversive context on early threat detection in trauma exposed individuals and associations with post-traumatic stress symptoms.

IntroductionProlonged attentional bias to threat (AB) is associated with posttraumatic stress symptoms (PTSS). However, it is unclear whether this relationship extends to early threat detection (elicited by masked stimuli) and/or varies if AB is measured during an aversive context.MethodsTwo trauma-exposed samples of either intervention-seekers (N = 50) or community members (N = 98) completed a masked dot-probe task to measure early AB to angry faces in safe vs. aversive contexts (i.e., during threat of aversive noises).ResultsLinear mixed effects models showed that an aversive context increased the orienting responses in both samples; however, PTSS did not moderate these effects in either sample.LimitationsSample size and heterogeneity of trauma-type may have impacted effect of PTSS on AB.ConclusionThese results highlight the importance of assessing AB in varying contexts and examining generalizability across populations. Given prior research, the results also suggest that increased AB in PTSS may only be present for later attentional processes rather than early threat detection, at least with behavioral methods

Characteristics of veterans and military service members who endorse causing harm, injury, or death to others in the military.

ObjectiveThe purpose of the present research was to examine the demographic and mental health characteristics of veterans and service members who endorsed having caused harm, injury, or death to another person on deployment, while taking these individuals' total number of other lifetime traumas into account.MethodData for the present study were collected as part of the standard clinical evaluation for 228 treatment-seeking veterans and service members.ResultsThose who reported having caused harm, injury, or death to another person on deployment (22.4%) were more likely to be male, to have served in the Marines, to have served post 9/11, and to endorse other traumas commonly reported on deployment than those who did not endorse causing harm, injury, or death. Those who endorsed causing harm on deployment were less likely to have served in the Air Force, and to have experienced sexual assault than those who did not cause harm. Causing harm, injury, or death was associated with higher levels of posttraumatic stress disorder (PTSD), drug use, and expressive anger at the bivariate level, but was no longer associated with mental health problems after accounting for the number of other lifetime traumas.ConclusionsExamining the role of causing harm in isolation may lead to false conclusions. Clinicians and researchers should assess for veterans' and service members' entire trauma histories. (PsycINFO Database Recor

Exploring the potential of technology-based mental health services for homeless youth: A qualitative study.

Homelessness has serious consequences for youth that heighten the need for mental health services; however, these individuals face significant barriers to access. New models of intervention delivery are required to improve the dissemination of mental health interventions that tailor these services to the unique challenges faced by homeless youth. The purpose of this study was to better understand homeless youths' use of technology, mental health experiences and needs, and willingness to engage with technology-supported mental health interventions to help guide the development of future youth-facing technology-supported interventions. Five focus groups were conducted with 24 homeless youth (62.5% female) in an urban shelter. Youth were 18- to 20-years-old with current periods of homelessness ranging from 6 days to 4 years. Transcripts of these focus groups were coded to identify themes. Homeless youth reported using mobile phones frequently for communication, music, and social media. They indicated a lack of trust and a history of poor relationships with mental health providers despite recognizing the need for general support as well as help for specific mental health problems. Although initial feelings toward technology that share information with a provider were mixed, they reported an acceptance of tracking and sharing information under certain circumstances. Based on these results, we provide recommendations for the development of mental health interventions for this population focusing on technology-based treatment options. (PsycINFO Database Recor

Exploring the potential of technology-based mental health services for homeless youth: A qualitative study.

Homelessness has serious consequences for youth that heighten the need for mental health services; however, these individuals face significant barriers to access. New models of intervention delivery are required to improve the dissemination of mental health interventions that tailor these services to the unique challenges faced by homeless youth. The purpose of this study was to better understand homeless youths' use of technology, mental health experiences and needs, and willingness to engage with technology-supported mental health interventions to help guide the development of future youth-facing technology-supported interventions. Five focus groups were conducted with 24 homeless youth (62.5% female) in an urban shelter. Youth were 18- to 20-years-old with current periods of homelessness ranging from 6 days to 4 years. Transcripts of these focus groups were coded to identify themes. Homeless youth reported using mobile phones frequently for communication, music, and social media. They indicated a lack of trust and a history of poor relationships with mental health providers despite recognizing the need for general support as well as help for specific mental health problems. Although initial feelings toward technology that share information with a provider were mixed, they reported an acceptance of tracking and sharing information under certain circumstances. Based on these results, we provide recommendations for the development of mental health interventions for this population focusing on technology-based treatment options. (PsycINFO Database Recor

Expanding Access to Medications for Opioid Use Disorder Treatment Through Incentivized Continuing Education

INTRODUCTION: Buprenorphine treatment for opioid use disorder (OUD) has positive outcomes including reducing opioid-related morbidity and mortality. In March 2018, 58 of 102 counties in Illinois lacked access to medication for OUD. METHODS: Rush University created a fellowship training program with financial incentives to help expand buprenorphine treatment in Illinois. Fellows first completed an online waiver course, then attended an in-person intensive training weekend, and finally participated in a 9-month webinar series. Demographic and prescribing data were collected from fellows, as well as a comparison group of providers outside the fellowship who only completed a waiver training. RESULTS: At the fellowship's end, 31 of 37 fellows (84%) reported they were actively prescribing buprenorphine. Of the 23 fellows who were not prescribing at the fellowship's beginning, 17 (74%) initiated prescribing by the end. Among the 16 nonfellowship subjects who only completed a waiver training, just two (13%) reported they were prescribing buprenorphine at the study period's end. DISCUSSION: Our study indicates that providers need more training beyond the waiver to initiate buprenorphine prescribing. When resources are available to address a health crisis such as OUD, this model offers an innovative mechanism for delivering continuing medical education that produces outcomes quickly

Examining Insomnia During Intensive Treatment for Veterans with Posttraumatic Stress Disorder: Does it Improve and Does it Predict Treatment Outcomes?

Previous research has demonstrated that sleep disturbances show little improvement with evidence-based psychotherapy for posttraumatic stress disorder (PTSD); however, sleep improvements are associated with PTSD treatment outcomes. The goal of the current study was to evaluate changes in self-reported insomnia symptoms and the association between insomnia symptoms and treatment outcome during a 3-week intensive treatment program (ITP) for veterans with PTSD that integrated cognitive processing therapy (CPT), mindfulness, yoga, and other ancillary services. As part of standard clinical procedures, veterans (N = 165) completed self-report assessments of insomnia symptoms at pre- and posttreatment as well as self-report assessments of PTSD and depression symptoms approximately every other day during treatment. Most veterans reported at least moderate difficulties with insomnia at both pretreatment (83.0%-95.1%) and posttreatment (69.1-71.3%). Statistically significant reductions in self-reported insomnia severity occurred from pretreatment to posttreatment; however, the effect size was small, d = 0.33. Longitudinal mixed-effects models showed a significant interactive effect of Changes in Insomnia × Time in predicting PTSD and depression symptoms, indicating that patients with more improvements in insomnia had more positive treatment outcomes. These findings suggest that many veterans continued to struggle with sleep disruption after a 3-week ITP, and successful efforts to improve sleep could lead to better PTSD treatment outcomes. Further research is needed to establish how adjunctive sleep interventions can be used to maximize both sleep and PTSD outcomes

Maintenance of treatment gains up to 12-months following a three-week cognitive processing therapy-based intensive PTSD treatment programme for veterans

Background Intensive treatment programmes (ITPs) have shown promise for reducing PTSD and depression symptoms. It is still unknown whether treatment gains are maintained following completion. Objective This study examined whether veterans were able to maintain treatment gains for up to 12 months after an ITP for PTSD and whether reductions in negative posttrauma cognitions predicted treatment gain maintenance. Methods 209 veterans (62.7% male, mean age = 40.86 years) completed a 3-week, CPT-based ITP for PTSD. Participants’ PTSD (PCL-5) and depression (PHQ-9) symptoms were assessed at pre-treatment, post-treatment, and at 3-, 6-, and 12-month follow-up timepoints. Results Despite small symptom increases from post-treatment to 3-month follow-up, significant and clinically meaningful reductions in PTSD and depression symptoms were reported from intake to 12 months follow-up (averaging >18 points on the PCL-5 and >6 points on the PHQ-9; d = 1.28, and d = 1.18, respectively). Greater reductions in negative posttrauma cognitions during treatment were associated with lower PTSD (p <.001) and depression (p =.005) severity at follow-up. Most veterans who completed the aftercare survey followed treatment recommendations and reported seeing a mental health provider at 3-, 6-, and 12-months post-treatment. Aftercare treatment did not significantly predict whether veterans maintained treatment gains at follow-up. Conclusions Overall maintenance of treatment gains long-term suggests veterans may be able to apply skills acquired during the ITP following treatment. These findings further support the feasibility and effectiveness of intensive, trauma-focused, evidence-based therapy delivery