Addressing dropout from prolonged exposure : feasibility of involving peers during exposure trials

Posttraumatic stress disorder (PTSD) is a significant problem for combat veterans. Fortunately, effective treatments, such as Prolonged Exposure (PE), are available and widely disseminated in the Veterans Affairs (VA) health-care system. Nonetheless, despite well-documented effectiveness, attrition remains high at approximately 30% across evidence-based interventions. Early studies indicated that dropout was largely related to stigma and logistical barriers (e.g., travel time and cost). However, research demonstrates that eliminating these logistical and stigmabased barriers (e.g., through home-based telemedicine) has little effect on dropout. We surveyed 82 veterans who dropped out of PE treatment regarding reasons for leaving treatment. Approximately half indicated that in vivo homework assignments caused significant problems, and when asked to consider the possibility of peer support during in vivo exposure assignments, 52% indicated that they would consider returning to treatment with such assistance. In response to this feedback, we constructed an in vivo therapy peer support program wherein peers are directly involved with in vivo exposure exercises. The following brief report presents the rationale for, outline of, and initial feasibility data supporting this program to enhance both return to, and completion of, exposure therapy treatment for PTS

Risk and protective factors for psychopathology among older versus younger adults after the 2004 Florida hurricanes

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/48790/1/acierno_risk and protective factors for psychopathology_2006.pd

A preliminary examination of sexual and physical victimization 6 months after recent rape

One in four US women will experience a completed or attempted rape in their lifetime, and more than 50% of survivors will experience two or more rapes. Rape and physical violence also co-occur. Multiple experiences of sexual and physical violence are associated with elevated mental and physical health problems. This secondary analysis examined the prevalence and correlates of experiencing sexual or physical violence within 6 months of a sexual assault medical forensic exam (SAMFE). Between May 2009 and December 2013, 233 female rape survivors aged 15 and older were enrolled in a randomized controlled trial during a SAMFE in the emergency department (ED). Demographics, rape characteristics, distress at the ED, and pre-rape history of sexual or physical victimization were assessed. New sexual and physical victimization was assessed 6 months after the SAMFE via telephone interview. Six months after the exam, 21.7% reported a new sexual or physical victimization. Predictors of revictimization during follow-up included sexual or physical victimization prior to the index rape, making less than $10,000 annually, remembering the rape well, life threat during the rape, and higher distress at the ED. In adjusted models, only pre-rape victimization and making less than$10,000 annually were associated with revictimization. Factors assessed at the ED can inform subsequent victimization risk. More research is needed to prevent revictimization among recent rape victims. Policies to provide financial support to recent rape victims and/or targeted prevention for those with pre-rape victimization at the SAMFE could reduce revictimization risk

How should we screen for depression following a natural disaster? An ROC approach to post-disaster screening in adolescents and adults

The present study’s aim was to provide the foundation for an efficient, empirically based protocol for depression screening following a natural disaster. Utilizing a Receiver Operating Characteristic (ROC) analytic approach, the study tested a) what specific disaster-related stressors (i.e., property damage, loss of basic services) and individual-related constructs (i.e., PTSD symptoms, trauma history, social support) conveyed the greatest risk for post-natural disaster depression, b) specific cutoff scores across these measures, and c) whether the significance or cutoff scores for each construct varied between adolescents and adults

Social context and the psychobiology of posttraumatic stress

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/41211/1/galea_social context and psychobiology_2006.pd

Understanding the impact of complicated grief on combat related posttraumatic stress disorder, guilt, suicide, and functional impairment in a clinical trial of post‐9/11 service members and veterans

BackgroundComplicated grief (CG) is a bereavement‐specific syndrome distinct from but commonly comorbid with posttraumatic stress disorder (PTSD). While bereavement is common among military personnel (Simon et al., 2018), there is little research on the impact of CG comorbidity on PTSD treatment outcomes.MethodsTo evaluate the impact of comorbid CG on PTSD treatment outcomes we analyzed data from a randomized trial comparing prolonged exposure, sertraline, and their combination in veterans with a primary diagnosis of combat‐related PTSD (n = 194). Assessment of PTSD, trauma‐related guilt, functional impairment, and suicidal ideation and behavior occurred at baseline and weeks 6, 12, and 24 during the 24‐week trial.ResultsCG was associated with lower PTSD treatment response (odds ratio (OR) = 0.29, 95% confidence interval (CI) [0.12, 0.69], p = 0.005) and remission (OR = 0.28, 95% CI [0.11, 0.71], p = 0.007). Those with CG had greater severity of PTSD (p = 0.005) and trauma‐related guilt (<0.001) at baseline and endpoint. In addition, those with CG were more likely to experience suicidal ideation during the study (CG: 35%, 14/40 vs. no CG 15%, 20/130; OR = 3.01, 95% CI [1.29, 7.02], p = 0.011).ConclusionsComorbid CG is associated with elevated PTSD severity and independently associated with poorer endpoint treatment outcomes in veterans with combat‐related PTSD, suggesting that screening and additional intervention for CG may be needed.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/153078/1/da22911_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/153078/2/da22911.pd

Participant Reactions to Survey Research in the General Population After Terrorist Attacks

There remains concern that survey research after a disaster can precipitate or exacerbate distress among study participants. The authors surveyed 5,774 persons in three random-digit-dial telephone surveys of the general population of New York City conducted 1–2 months, 4–5 months, and 6–9 months after the terrorist attack on September 11, 2001. Overall, 746 (12.9%) people who finished the surveys said that the survey questions were upsetting but only 57 (1.0% overall) were still upset at the end of the interview, and 19 (0.3%) wanted assistance from a counselor. Ten persons who did not finish the survey also received counselor assistance. Persons with mental health symptoms were more likely to find the survey questions emotionally upsetting as were participants who lacked salutary resources, including health insurance and a regular health care provider. Although relatively few of those interviewed found the survey assessment disturbing, the presence of a small number of respondents who wanted mental health assistance suggests the need for a mental health backup system for research conducted soon after exposure to large-scale traumatic events.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/40338/2/Galea_Participant Reactions to Survey Research_2005.pd

Re-engaging dropouts of prolonged exposure for PTSD delivered via home-based telemedicine or in person : satisfaction with veteran-to-veteran support

Funding for the parent studies from which dropouts were recruited and for whom baseline data were provided included: the Department of Veterans Affairs HSR&D MERIT Award HX00152 and the Department of Defense Grants W81XWH-14-1-0264 and W81XWH-08-2-0047.This paper describes feasibility of and patient and peer satisfaction with a Veteran-to-Veteran peer support program purposefully integrated into prolonged exposure (PE) for post-traumatic stress disorder (PTSD) to address barriers contributing to dropout from both in person and telemedicine delivered PE. Specifically, patients who had dropped out of PE were offered the opportunity to return to treatment, this time with a peer who themselves had completed PE, who would join them during a limited number of PE in vivo exposure homework trials. About half of the Veterans who dropped out indicated willingness to return to treatment, noting the peer as central to this decision, and about a third actually returned to treatment. Participants reported high satisfaction with the program, as did peers. Peers reported that their own symptoms were not exacerbated by engaging in exposure homework with the patients. While in the military, service members are trained to leverage the power of the group toward mission-specific tasks; and this training appears relevant to PTSD treatment in the present context

Psychological Interventions for Drug Abuse: A Critique and Summation of Controlled Studies

Empirical evaluations of treatments for abuse of substances other than alcohol are reviewed and critiqued. Methodological strengths and deficits of treatment-outcome studies are delineated, and interpretation of reported results is considered in light of these factors. In large part, intervention strategies for which controlled outcome evaluations exist can be divided into those conceptualized along classical conditioning lines (e.g., extinction and stimulus avoidance) and those derived from operant learning principles (e.g., contingency contracting and community reinforcement). Whereas stimulus-avoidance techniques appear to be relatively more effective than pure extinction trials in reducing drug use, the efficacy of operant methods has been most strongly supported. Moreover, componential treatment packages in which contingent reinforcement is applied to both reductions in drug use and increases in stimulus-avoidance behaviors evince the most dramatic effects. Additional research that addresses the methodological shortcomings of contemporary studies is needed

Relationship of Depression with Measures of Social Functioning in Adult Drug Abusers

The present study describes the relationship between depression and several measures of social functioning--including employment, criminal activity, incarceration, marital functioning, and alcohol and drug use--in a population of adult drug abusers. Our investigation extends past work in this area by specifically investigating the effects of depression (as opposed to simple substance use) on social and interpersonal functioning. Predictably, elevated levels of depression were associated with increased use of hard drugs and alcohol, greater levels of institutionalization, reduced attendance at work or school, and lower overall rates of marital satisfaction. Consistent with previous reports, level of marijuana use was not related to severity of depression. It appears that depressed substance abusers experience significantly more social, vocational, and interpersonal dysfunction than their nondepressed counterparts. It is proposed that the efficacy of existing treatment programs for adult drug abusers will be enhanced through the addition of strategies to assess and ameliorate depression