Couple and family therapies for post-traumatic stress disorder (PTSD)

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: The objectives of this review will be to: assess the efficacy of couple and family therapies for adult PTSD, relative to 'no treatment' conditions, 'standard care', and structured or non‐specific individual psychological therapies; examine the clinical characteristics of studies that influence the relative efficacy of these therapies; and critically evaluate methodological features of studies that bias research findings

Older adults’ spirituality and life satisfaction: a longitudinal test of social support and sense of coherence as mediating mechanisms

Spirituality is proposed to be a component of successful ageing and has been shown to predict wellbeing in old age. There has been conceptual discussion of possible mechanisms that link spirituality with positive psychological functioning in older adults, but few empirical examinations of these linking mechanisms over time. The current study examined the role of Antonovsky's Sense of Coherence (SOC) and social support in mediating the effects of spirituality on life satisfaction in older participants over a four-year period. The study used a cross-lagged panel analysis to evaluate longitudinal mediation within a path analysis framework. Results showed that the meaningfulness dimension of SOC mediated the influence of spirituality on life satisfaction over time, suggesting that spirituality may influence older adults' experience and perception of life events, leading to a more positive appraisal of these events as meaningful. Social support was not found to mediate the pathway between spirituality and life satisfaction. This study may be the first to examine the link between spirituality, sense of coherence, social support and wellbeing, as measured by life satisfaction, using longitudinal data from a community sample of older adults. The study provides evidence for the positive role of spirituality in the lives of older people. This is an area that requires further examination in models of successful ageing

Implications of gambling problems for family and interpersonal adjustment:Results from the Quinte Longitudinal Study

AIMS: To evaluate (1) whether gambling problems predict overall trajectories of change in family or interpersonal adjustment and (2) whether annual measures of gambling problems predict time-specific decreases in family or interpersonal adjustment, concurrently and prospectively. DESIGN: The Quinte Longitudinal Study (QLS) involved random-digit dialling of telephone numbers around the city of Belleville, Canada to recruit 'general population' and 'at-risk' groups (the latter oversampling people likely to develop problems). Five waves of assessment were conducted (2006-10). Latent Trajectory Modelling (LTM) estimated overall trajectories of family and interpersonal adjustment, which were predicted by gambling problems, and also estimated how time-specific problems predicted deviations from these trajectories. SETTING: Southeast Ontario, Canada. PARTICIPANTS: Community sample of Canadian adults (n = 4121). MEASUREMENTS: The Problem Gambling Severity Index (PGSI) defined at-risk gambling (ARG: PGSI 1-2) and moderate-risk/problem gambling (MR/PG: PGSI 3+). Outcomes included: (1) family functioning, assessed using a seven-point rating of overall functioning; (2) social support, assessed using items from the Non-support subscale of the Personality Assessment Inventory; and (3) relationship satisfaction, measured by the Kansas Marital Satisfaction Scale. FINDINGS: Baseline measures of ARG and MR/PG did not predict rates of change in trajectories of family or interpersonal adjustment. Rather, the annual measures of MR/PG predicted time-specific decreases in family functioning (estimate: -0.11, P < 0.01), social support (estimate: -0.28, P < 0.01) and relationship satisfaction (estimate: -0.53, P < 0.01). ARG predicted concurrent levels of family functioning (estimate: -0.07, P < 0.01). There were time-lagged effects of MR/PG on subsequent levels of family functioning (estimate: -0.12, P < 0.01) and social support (estimate: -0.24, P < 0.01). CONCLUSIONS: In a longitudinal study of Canadian adults, moderate-risk/problem gambling did not predict overall trajectories of family or interpersonal adjustment. Rather, the annual measures of moderate-risk/problem gambling predicted time-specific and concurrent decreases in all outcomes, and lower family functioning and social support across adjacent waves

Gambling problems in treatment for affective disorders:Results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)

BACKGROUND: Gambling problems co-occur frequently with other psychiatric difficulties and may complicate treatment for affective disorders. This study evaluated the prevalence and correlates of gambling problems in a U. S. representative sample reporting treatment for mood problems or anxiety.METHODS:&nbsp;n=3007 respondents indicating past-year treatment for affective disorders were derived from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Weighted prevalence estimates were produced and regression analyses examined correlates of gambling problems.RESULTS: Rates of lifetime and past-year problem gambling (3+DSM-IV symptoms) were 3.1% (95% CI=2.4-4.0%) and 1.4% (95% CI=0.9-2.1%), respectively, in treatment for any disorder. Rates of lifetime problem gambling ranged from 3.1% (95% CI=2.3-4.3%) for depression to 5.4% (95% CI=3.2-9.0%) for social phobia. Past-year conditions ranged from 0.9% (95% CI=0.4-2.1%) in dysthymia to 2.4% (95% CI=1.1-5.3%) in social phobia. Higher levels were observed when considering a spectrum of severity (including \u27at-risk\u27 gambling), with 8.9% (95% CI=7.7-10.2%) of respondents indicating a history of any gambling problems (1+ DSM-IV symptoms). Lifetime gambling problems predicted interpersonal problems and financial difficulties, and marijuana use, but not alcohol use, mental or physical health, and healthcare utilisation.LIMITATIONS: Data were collected in 2001-02 and were cross-sectional. CONCLUSIONS: Gambling problems occur at non-trivial rates in treatment for affective disorders and have mainly psychosocial implications. The findings indicate scope for initiatives to identify and respond to gambling problems across a continuum of severity in treatment for affective disorders

Gambling problems among patients in primary care : a cross-sectional study of general practices

BACKGROUND: Primary care is an important context for addressing health-related behaviours, and may provide a setting for identification of gambling problems. AIM: To indicate the extent of gambling problems among patients attending general practices, and explore settings or patient groups that experience heightened vulnerability. DESIGN AND SETTING: Cross-sectional study of patients attending 11 general practices in Bristol, South West England. METHOD: Adult patients (n = 1058) were recruited from waiting rooms of practices that were sampled on the basis of population characteristics. Patients completed anonymous questionnaires comprising measures of mental health problems (for example, depression) and addictive behaviours (for example, risky alcohol use). The Problem Gambling Severity Index (PGSI) measured gambling problems, along with a single-item measure of gambling problems among family members. Estimates of extent and variability according to practice and patient characteristics were produced. RESULTS: There were 0.9% of all patients exhibiting problem gambling (PGSI ≥5), and 4.3% reporting problems that were low to moderate in severity (PGSI 1-4). Around 7% of patients reported gambling problems among family members. Further analyses indicated that rates of any gambling problems (PGSI ≥1) were higher among males and young adults, and more tentatively, within a student healthcare setting. They were also elevated among patients exhibiting drug use, risky alcohol use, and depression. CONCLUSION: There is need for improved understanding of the burden of, and responses to, patients with gambling problems in general practices, and new strategies to increase identification to facilitate improved care and early intervention

Couple and family therapies for post-traumatic stress disorder (PTSD)

Background Post-traumatic stress disorder (PTSD) refers to an anxiety or trauma- and stressor-related disorder that is linked to personal or vicarious exposure to traumatic events. PTSD is associated with a range of adverse individual outcomes (e.g. poor health, suicidality) and significant interpersonal problems which include diGiculties in intimate and family relationships. A range of couple- and family-based treatments have been suggested as appropriate interventions for families impacted by PTSD. Objectives The objectives of this review were to: (1) assess the eGects of couple and family therapies for adult PTSD, relative to 'no treatment' conditions, 'standard care', and structured or non-specific individual or group psychological therapies; (2) examine the clinical characteristics of studies that influence the relative eGects of these therapies; and (3) critically evaluate methodological characteristics of studies that may bias the research findings. Search methods We searchedMEDLINE (1950-), Embase (1980-) andPsycINFO(1967-) via theCochraneCommonMentalDisordersControlledTrialsRegister (CCMDCTR) to 2014, then directly via Ovid aIer this date. We also searched the Cochrane Central Register of Controlled Trials (CENTRAL) via the Cochrane Library. We conducted supplementary searches of PTSDPubs (all available years) (this database is formerly known as PILOTS (Published International Literature on Traumatic Stress)). We manually searched the early editions of key journals and screened the reference lists and bibliographies of included studies to identify other relevant research. We also contacted the authors of included trials for unpublished information. Studies have been incorporated from searches to 3 March 2018. Selection criteria Eligible studies were randomised controlled trials (RCTs) of couple or family therapies for PTSD in adult samples. The review considered any type of therapy that was intended to treat intact couples or families where at least one adult family member met criteria for PTSD. It was required that participants were diagnosed with PTSD according to recognised classification systems. Data collection and analysis We used the standard methodological procedures prescribed by Cochrane. Three review authors screened all titles and abstracts and two authors independently extracted data from each study deemed eligible and assessed the risk of bias for each study. We used odds ratios (OR) to summarise the eGects of interventions for dichotomous outcomes, and standardised mean diGerences (SMD) to summarise posttreatment between-group diGerences on continuous measures. Main results We included four trials in the review. Two studies examined the eGects of cognitive behavioural conjoint/couple's therapy (CBCT) relative to a wait list control condition, although one of these studies only reported outcomes in relation to relationship satisfaction. One study examined the eGects of structural approach therapy (SAT) relative to a PTSD family education (PFE) programme; and one examined the eGects of adjunct behavioural family therapy (BFT) but failed to report any outcome variables in suGicient detail — we did not include it in the meta-analysis. One trial with 40 couples (80 participants) showed that CBCT was more eGective than wait list control in reducing PTSD severity (SMD −1.12, 95% CI −1.79 to −0.45; low-quality evidence), anxiety (SMD −0.93, 95% CI −1.58 to −0.27; very low-quality evidence) and depression (SMD −0.66, 95% CI −1.30 to −0.02; very low-quality evidence) at post-treatment for the primary patient with PTSD. Data from two studies indicated that treatment and control groups did not diGer significantly according to relationship satisfaction (SMD 1.07, 95% CI −0.17 to 2.31; very low-quality evidence); and one study showed no significant diGerences regarding depression (SMD 0.28, 95% CI −0.35 to 0.90; very low-quality evidence) or anxiety symptoms (SMD 0.15, 95% CI −0.47 to 0.77; very low-quality evidence) for the partner of the patient with PTSD. One trial with 57 couples (114 participants) showed that SAT was more eGective than PFE in reducing PTSD severity for the primary patient (SMD −1.32, 95% CI −1.90 to −0.74; low-quality evidence) at post-treatment. There was no evidence of diGerences on the other outcomes, including relationship satisfaction (SMD 0.01, 95% CI −0.51 to 0.53; very low-quality evidence), depression (SMD 0.21, 95% CI −0.31 to 0.73; very low-quality evidence) and anxiety (SMD −0.16, 95% CI −0.68 to 0.36; very low-quality evidence) for intimate partners; and depression (SMD −0.28, 95% CI −0.81 to 0.24; very low-quality evidence) or anxiety (SMD −0.34, 95% CI −0.87 to 0.18; very low-quality evidence) for the primary patient. Two studies reported on adverse events and dropout rates, and no significant diGerences between groups were observed. Two studies were classified as having a 'low' or 'unclear' risk of bias in most domains, except for performance bias that was rated ‘high’. Two studies had significant amounts of missing information resulting in 'unclear'risk of bias. There were too few studies available to conduct subgroup analyses. Authors' conclusions There are few trials of couple-based therapies for PTSD and evidence is insuGicient to determine whether these oGer substantive benefits when delivered alone or in addition to psychological interventions. Preliminary RCTs suggest, however, that couple-based therapies for PTSD may be potentially beneficial for reducing PTSD symptoms, and there is a need for additional trials of both adjunctive and standalone interventions with couples orfamilies which targetreduced PTSD symptoms, mental health problems of family members and dyadic measures of relationship quality

The emergence of leaders and followers in foraging pairs when the qualities of individuals differ.

BACKGROUND: Foraging in groups offers animals a number of advantages, such as increasing their likelihood of finding food or detecting and avoiding predators. In order for a group to remain together, there has to be some degree of coordination of behaviour and movement between its members (which may in some cases be initiated by a decision-making leader, and in other cases may emerge as an underlying property of the group). For example, behavioural synchronisation is a phenomenon where animals within a group initiate and then continue to conduct identical behaviours, and has been characterised for a wide range of species. We examine how a pair of animals should behave using a state-dependent approach, and ask what conditions are likely to lead to behavioural synchronisation occurring, and whether one of the individuals is more likely to act as a leader. RESULTS: The model we describe considers how the energetic gain, metabolic requirements and predation risks faced by the individuals affect measures of their energetic state and behaviour (such as the degree of behavioural synchronisation seen within the pair, and the value to an individual of knowing the energetic state of its colleague). We explore how predictable changes in these measures are in response to changes in physiological requirements and predation risk. We also consider how these measures should change when the members of the pair are not identical in their metabolic requirements or their susceptibility to predation. We find that many of the changes seen in these measures are complex, especially when asymmetries exist between the members of the pair. CONCLUSION: Analyses are presented that demonstrate that, although these general patterns are robust, care needs to be taken when considering the effects of individual differences, as the relationship between individual differences and the resulting qualitative changes in behaviour may be complex. We discuss how these results are related to experimental observations, and how the model and its predictions could be extended.RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are

Prevalence of psychiatric co-morbidity in treatment-seeking problem gamblers:A systematic review and meta-analysis

Objective: The aim of this paper was to systematically review and meta-analyse the prevalence of co-morbid psychiatric disorders (DSM-IV Axis I disorders) among treatment-seeking problem gamblers. Methods: A systematic search was conducted for peer-reviewed studies that provided prevalence estimates of Axis I psychiatric disorders in individuals seeking psychological or pharmacological treatment for problem gambling (including pathological gambling). Meta-analytic techniques were performed to estimate the weighted mean effect size and heterogeneity across studies. Results: Results from 36 studies identified high rates of co-morbid current (74.8%, 95% CI 36.5–93.9) and lifetime (75.5%, 95% CI 46.5–91.8) Axis I disorders. There were high rates of current mood disorders (23.1%, 95% CI 14.9–34.0), alcohol use disorders (21.2%, 95% CI 15.6–28.1), anxiety disorders (17.6%, 95% CI 10.8–27.3) and substance (non-alcohol) use disorders (7.0%, 95% CI 1.7–24.9). Specifically, the highest mean prevalence of current psychiatric disorders was for nicotine dependence (56.4%, 95% CI 35.7–75.2) and major depressive disorder (29.9%, 95% CI 20.5–41.3), with smaller estimates for alcohol abuse (18.2%, 95% CI 13.4–24.2), alcohol dependence (15.2%, 95% CI 10.2–22.0), social phobia (14.9%, 95% CI 2.0–59.8), generalised anxiety disorder (14.4%, 95% CI 3.9–40.8), panic disorder (13.7%, 95% CI 6.7–26.0), post-traumatic stress disorder (12.3%, 95% CI 3.4–35.7), cannabis use disorder (11.5%, 95% CI 4.8–25.0), attention-deficit hyperactivity disorder (9.3%, 95% CI 4.1–19.6), adjustment disorder (9.2%, 95% CI 4.8–17.2), bipolar disorder (8.8%, 95% CI 4.4–17.1) and obsessive-compulsive disorder (8.2%, 95% CI 3.4–18.6). There were no consistent patterns according to gambling problem severity, type of treatment facility and study jurisdiction. Although these estimates were robust to the inclusion of studies with non-representative sampling biases, they should be interpreted with caution as they were highly variable across studies. Conclusions: The findings highlight the need for gambling treatment services to undertake routine screening and assessment of psychiatric co-morbidity and provide treatment approaches that adequately manage these co-morbid disorders. Further research is required to explore the reasons for the variability observed in the prevalence estimates