Impact of written emotional disclosure of trauma on laboratory induced pain

This study was undertaken to determine whether written emotional disclosure of trauma impacted capsaicin induced pain immediately after writing and at a one-month follow-up, and the extent to which a lifetime history of trauma alters pain under neutral conditions. Three experiments were conducted to answer these questions. In Experiment 1 participants were randomly assigned to write about either a neutral or a trauma topic, and they concurrently completed the capsaicin test. In Experiment 2, the capsaicin test was administered to trauma history and no trauma history participants and pain ratings and secondary hyperalgesia were recorded under neutral conditions. In Experiment 3, participants wrote for three days and completed the radiant heat test before writing on day 1 and after writing on day 3. They also completed the capsaicin test on either day 4 or at a one-month follow-up (day 30). Taken together, these studies had several important results. First, radiant heat withdrawal latencies, ratings of pain intensity and unpleasantness, and area of secondary hyperalgesia were all significantly increased when participants had a history of traumatic experiences. This is evidence that trauma history is sufficient to alter pain regulatory mechanisms, and this may be attributable to the chronic negative affective state induced by trauma history and sensitization of shared circuits involved in both pain and emotion. Furthermore, our findings suggest that written emotional disclosure may lead to long-term changes in pain modulatory pathways that regulate central sensitization, without altering systems that regulate spontaneous pain

The impact of written emotional disclosure on laboratory induced pain

Previous research has demonstrated the impact of negative emotional states on pain modulation. The direction of this modulation has been shown to correspond to the arousal level and the valence of the emotional state, whether naturally occurring or induced in the laboratory. Other research has consistently linked written emotion disclosure of trauma to better long-term health outcomes among several populations. As most of these studies have focused on long-term health outcome effects of disclosure, little research has been done on the immediate effects of the paradigm on affective or physiological states. This study investigated the short-term effects of written disclosure of trauma on laboratory-induced pain, affective state, and other physiological measures of stress and arousal. Other goals of the study included investigating preexisting differences in pain sensitivity between participants corresponding to lifetime experience of trauma, and determining the degree to which baseline pain testing alters pain sensitivity after emotion induction by creating a conditioned, contextual fear. This is the first study to apply the written emotional disclosure paradigm to laboratory-induced pain

Computerized Psychological Interventions in Veterans and Service Members: Systematic Review of Randomized Controlled Trials

BackgroundComputerized psychological interventions can overcome logistical and psychosocial barriers to the use of mental health care in the Veterans Affairs and Department of Defense settings. ObjectiveIn this systematic review, we aim to outline the existing literature, with the goal of describing: the scope and quality of the available literature, intervention characteristics, study methods, study efficacy, and study limitations and potential directions for future research. MethodsSystematic searches of two databases (PsycINFO and PubMed) using PRISMA (Preferred Reporting Item for Systematic Reviews and Meta-Analyses) guidelines were conducted from inception until November 15, 2020. The following inclusion criteria were used: the study was published in an English language peer-reviewed journal, participants were randomly allocated to a computerized psychological intervention or a control group (non–computerized psychological intervention active treatment or nonactive control group), an intervention in at least one treatment arm was primarily delivered through the computer or internet with or without additional support, participants were veterans or service members, and the study used validated measures to examine the effect of treatment on psychological outcomes. ResultsThis review included 23 studies that met the predefined inclusion criteria. Most studies were at a high risk of bias. Targeted outcomes, participant characteristics, type of support delivered, adherence, and participant satisfaction were described. Most of the examined interventions (19/24, 79%) yielded positive results. Study limitations included participant characteristics limiting study inference, high rates of attrition, and an overreliance on self-reported outcomes. ConclusionsRelatively few high-quality studies were identified, and more rigorous investigations are needed. Several recommendations for future research are discussed, including the adoption of methods that minimize attrition, optimize use, and allow for personalization of treatment

The Impact of Military Deployment and Reintegration on Children and Parenting: A Systematic Review

Hundreds of thousands of children have had at least 1 parent deploy as part of military operations in Iraq (Operation Iraqi Freedom; OIF; Operation New Dawn; OND) and Afghanistan (Operation Enduring Freedom; OEF). However, there is little knowledge of the impact of deployment on the relationship of parents and their children. This systematic review examines findings from 3 areas of relevant research: the impact of deployment separation on parenting, and children's emotional, behavioral, and health outcomes; the impact of parental mental health symptoms during and after reintegration; and current treatment approaches in veteran and military families. Several trends emerged. First, across all age groups, deployment of a parent may be related to increased emotional and behavioral difficulties for children, including higher rates of health-care visits for psychological problems during deployment. Second, symptoms of PTSD and depression may be related to increased symptomatology in children and problems with parenting during and well after reintegration. Third, although several treatments have been developed to address the needs of military families, most are untested or in the early stages of implementation and evaluation. This body of research suggests several promising avenues for future research

Moral Elevation Online Intervention for Veterans Experiencing Distress Related to PTSD and Moral Injury (MOVED): A pilot trial of a 4-week positive psychology web-based intervention

Background: Veterans suffering from posttraumatic stress disorder (PTSD) and moral injury can encounter several barriers to treatment including limited access to care and low engagement with in-person therapy. Further, most approaches focus on alleviating distress rather than cultivating positive experiences that could facilitate trauma recovery. One potential way to address these areas and enhance trauma-focused treatment is through moral elevation—a distinct, positive emotional state described as feeling uplifted and inspired by others’ virtuous actions. Objective: The purpose of this study was to examine the feasibility and acceptability of a novel, web-based moral elevation intervention for veterans with PTSD symptoms and moral injury distress (MOVED). This mixed-methods study also examined potential changes in targeted outcomes of PTSD symptoms, moral injury distress, quality of life, and prosocial behavior. Methods: In this pilot trial, 48 participants were randomized to a MOVED or control condition (24 per condition). Both conditions included 8 sessions and lasted 1 month. The MOVED intervention and all survey components across both conditions were administered online. Participants completed self-report measures that assessed PTSD symptoms, moral injury distress, quality of life, and prosocial behavior at baseline and follow-up. Veterans in the MOVED condition also completed an individual qualitative interview at follow-up. We coded qualitative response to the follow-up interview and identified emergent themes. Results: Findings suggest the MOVED intervention was largely feasible with evidence for moderate-to-high levels of participation, engagement, and retention in MOVED sessions. Both quantitative and qualitative results suggest veterans found MOVED to be acceptable and satisfactory at the overall treatment level. Further, participants reported high scores for helpfulness and engagement at the session level. Veterans who completed MOVED reported large within-person decreases in PTSD symptoms (d=1.44), nearly twice that of the control condition (d=0.78). Those in MOVED also reported medium-sized increases in physical (d=0.71) and psychological domains of quality of life (d=0.74), in contrast to no meaningful changes in the control condition. Unexpectedly, MOVED veterans reported no decreases in moral injury distress, whereas the control condition endorsed medium-sized decreases in the total score. There were no changes in prosociality for either condition. Qualitative feedback further supported high levels of perceived acceptability and satisfaction, and positive treatment outcomes across a range of domains including behaviors, cognitions, emotions, and social functioning. Veterans also recommended adaptations to enhance engagement and maximize the impact of intervention content. Conclusion: Overall, findings indicate that veterans with PTSD and moral injury distress were interested in an intervention based on exposure to and engagement with experiences of moral elevation. Following further research and refinement guided by future trials, veterans may benefit from this novel approach, which may enhance treatment outcomes and increase accessibility for those in need of additional trauma-focused care

Validity of the Personality Assessment Screener in Veterans Referred for Psychological Testing

Screening for psychopathology is desirable in many settings where routine administration of full assessment batteries is not practical or cost efficient. The Personality Assessment Screener (PAS) is a 22-item self-report subset of Personality Assessment Inventory (PAI) items that was designed to screen for respondents who would be likely to achieve a clinically significant PAI profile. In this study, the PAS demonstrated classification rates in a sample of veterans referred for psychological evaluations that were similar to those described in initial validation studies. In addition, the three-item Negative Affect element of the PAS demonstrated impressive reliability and sensitivity given its brevity. These results support the use of the PAS as a screening tool to indicate clinically significant PAI profiles among veterans

Predicting utilization of healthcare services in the veterans health administration by returning women veterans: The role of trauma exposure and symptoms of posttraumatic stress.

Combat exposure and military sexual trauma (MST) are prevalent among returning women Veterans and associated with increased alcohol use and psychological distress. However, it remains unclear the extent to which combat exposure and MST are associated with utilization of healthcare in the Veterans Health Administration (VHA). The current study explored the relationships among alcohol use and distress in women who deployed in support of Operations Enduring Freedom, Iraqi Freedom, and New Dawn (OEF/OIF/OND). It was hypothesized that increased PTSD and depression symptomatology and trauma exposure would be related greater VHA utilization, whereas alcohol misuse would predict lower VHA use. Participants (N = 133) completed an internet-based survey of deployment experiences, substance use, mental health, and utilization of VHA services. In this sample, 33% endorsed MST exposure, 64% endorsed combat exposure, and 78% indicated exposure to the aftermath of battle. Multiple regression models found combat exposure – but not MST or aftermath – to be significantly associated with alcohol use and symptoms of PTSD and depression. Only 37% of participants reported use of VHA services, and logistic regression models indicated that PTSD symptomatology was the only unique predictor of VHA use. Findings suggest potential barriers for women who endured sexually based trauma in a military setting in seeking treatment at the VHA