Neuroscience Informed Prolonged Exposure Practice: Increasing Efficiency and Efficacy Through Mechanisms

Prolonged exposure (PE) is an empirically supported efficacious treatment for posttraumatic stress disorder (PTSD). In this focused review, we briefly review the neurobiological networks in PTSD relevant to PE, discuss the theoretical basis of PE, review the neurobiological mechanisms underlying the effectiveness of PE and identify the enhancements that can be applied to increase treatment response and retention. Based on the reviewed studies, it is clear that PTSD results in disrupted network of interconnected regions, and PE has been shown to increase the connectivity within and between these regions. Successful extinction recall in PE is related to increased functional coherence between the ventromedial prefrontal cortex (vmPFC), amygdala and the hippocampus. Increased connectivity within the dorsolateral PFC (dlPFC) following PE is associated with more effective downregulation of emotional responses in stressful situations. Pre-existing neural connectivity also in some cases predicts response to exposure treatment. We consider various enhancements that have been used with PE, including serotonin reuptake inhibitors (SSRIs), D-cycloserine (DCS), allopregnanolone (ALLO) and propranolol, repetitive transcranial magnetic stimulation (rTMS), oxytocin and MDMA. Given that neural connectivity appears to be crucial in mechanisms of action of PE, rTMS is a logical target for further research as an enhancement of PE. Additionally, exploring the effectiveness and mechanisms of action of oxytocin and MDMA in conjunction with PE may lead to improvement in treatment engagement and retention

PTSD and Pain: Exploring the Impact of Posttraumatic Cognitions in Veterans Seeking Treatment for PTSD

Objective Previous research has demonstrated a significant relationship between posttraumatic stress disorder ( PTSD ) and pain. While several models attempt to explain this relationship, significant questions remain regarding factors that may play a role in this interaction. The purpose of this study was to determine whether posttraumatic cognitions mediate the relationship between PTSD and pain. Design The sample comprised 136 veterans who presented to the VA A nn A rbor H ealth C are System seeking evaluation and treatment in the PTSD clinic. Participants completed the Clinician‐Administered PTSD Scale, the Posttraumatic Cognitions Inventory, and Brief Pain Inventory‐Short Form, along with other assessments as part of their evaluation. Results This study showed that the majority of patients (86.8%) reported some problems with pain. Further, the findings indicate that there is a significant relationship between PTSD severity and pain severity. Posttraumatic cognitions were not related to the level of pain experienced, but they were related to pain interference in this population. Conclusions In particular, negative cognitions regarding the self were associated with the level of pain‐related interference, and partially mediated the relationship between PTSD and pain. The clinical implications of these findings are discussed.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/101855/1/pme12260.pd

Predictors of PTSD Symptom Change Among Outpatients in the U.S. Department of Veterans Affairs Health Care System

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/136244/1/jts22156.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/136244/2/jts22156_am.pd

Mild Traumatic Brain Injury and Treatment Response in Prolonged Exposure for PTSD

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/98185/1/jts21813.pd

Primum Non Nocere (First Do No Harm): Symptom Worsening And Improvement In Female Assault Victims After Prolonged Exposure For Ptsd

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/106816/1/da22225.pd

Individual differences in cognitive reappraisal use and emotion regulatory brain function in combat‐exposed veterans with and without PTSD

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135971/1/da22551.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/135971/2/da22551_am.pd

A Latent Profile Analysis of Aggression and Victimization across Relationship Types Among Veterans Who Use Substances

Objective: This study examined patterns of violence victimization and aggression in both intimate partner and non-partner relationships among veterans, and used latent profile analysis to identify subtypes of violence involvement. Methods: Participants were 841 substance use treatment-seeking veterans (94% male) from a large VA Medical Center who completed screening measures for a randomized controlled trial. Self-report measures were: substance use, legal problems, depression, and violence involvement. Results: Past year violence involvement, including both intimate partner (IPV) and non-partner (NPV) were common in the sample; although NPV occurred at somewhat higher rates. When including either IPV or NPV aggression or victimization, over 48% reported involvement with physical violence, 31% with violence involving injury and 86% with psychological aggression. Latent profile analysis including both aggression and victimization in partner and non-partner relationships indicated a four profile solution: no-low violence (NLV, n = 701), predominantly IPV (n = 35), predominantly NPV (n = 83), and high general violence (HGV, n = 22). Multinomial logistic regression analyses revealed that compared to the no-low violence group, the remaining three groups differed in demographics, depressive symptoms, alcohol and other drug use, and legal involvement. Individuals within each profile had different patterns of substance use and legal involvement with the participants with an HGV profile reporting the most legal problems. Conclusions: IPV and NPV are relatively common among veterans seeking substance use treatment. Characteristics of violence and associated substance use, mental health, and legal difficulties may be useful in considering how to tailor substance use and mental health services

Preparing Women In Academic Psychology for Their First Compensation Negotiation: A Panel Perspective of Challenges & Future Recommendations

Successfully landing and then negotiating for your first position is an exciting and challenging task. In this paper, we use a narrative review to present the literature on gender and negotiation with a focus on academic psychology work contexts. We highlight important differences between factors that are within the individual’s control vs. factors at the institutional or societal level. Drawing directly from the research literature, we make several recommendations for women trying to manage negotiation in contexts that are likely biased against them at the institutional and cultural level. For example, we recommend that women take steps to reduce situational ambiguity, use niceness and assertion strategically, and cognitive re-framing to improve performance. We also make parallel recommendations for institutions, to create a more equal playing field in employment negotiations in academia. We conclude with expert advice on how to manage the important task of negotiation throughout the career from successful psychologists to contextualize the research findings at the personal level

Combat‐Related Posttraumatic Stress Disorder and Comorbid Major Depression in U.S. Veterans: The Role of Deployment Cycle Adversity and Social Support

Posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) commonly co‐occur in combat veterans, and this comorbidity has been associated with higher levels of distress and more social and economic costs compared to one disorder alone. In a secondary analysis of a multisite randomized controlled trial of a sample of veterans with combat‐related PTSD, we examined the associations among pre‐, peri‐, and postdeployment adversity, social support, and clinician‐diagnosed comorbid MDD. Participants completed the Deployment Risk and Resilience Inventory and the Beck Depression Inventory–II as well as structured clinical interviews for diagnostic status. Among 223 U.S. veterans of the military operations in Iraq and Afghanistan (86.9% male) with primary combat‐related PTSD, 69.5% had current comorbid MDD. After adjustment for sex, a linear regression model indicated that more concerns about family disruptions during deployment, f2 = 0.065; more harassment during deployment, f2 = 0.020; and lower ratings of postdeployment social support, f2 = 0.154, were associated with more severe self‐reported depression symptoms. Interventions that enhance social support as well as societal efforts to foster successful postdeployment reintegration are critical for reducing the mental health burden associated with this highly prevalent comorbidity in veterans with combat‐related PTSD.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/155948/1/jts22496_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/155948/2/jts22496.pd

Biological And Symptom Changes In Posttraumatic Stress Disorder Treatment: A Randomized Clinical Trial

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/110764/1/da22331.pd