Active duty and ex-serving military personnel with post-traumatic stress disorder treated with psychological therapies: systematic review and meta-analysis

Background: Post-traumatic stress disorder (PTSD) is a major cause of morbidity amongst active duty and ex-serving military personnel. In recent years increasing efforts have been made to develop more effective treatments. Objective: To determine which psychological therapies are efficacious in treating active duty and ex-serving military personnel with post-traumatic stress disorder (PTSD). Method: A systematic review was undertaken according to Cochrane Collaboration Guidelines. The primary outcome measure was reduction in PTSD symptoms and the secondary outcome dropout. Results: Twenty-four studies with 2386 participants were included. Evidence demonstrated that CBT with a trauma focus (CBT-TF) was associated with the largest evidence of effect when compared to waitlist/usual care in reducing PTSD symptoms post treatment (10 studies; n = 524; SMD −1.22, −1.78 to −0.66). Group CBT-TF was less effective when compared to individual CBT-TF at reducing PTSD symptoms post treatment (1 study; n = 268; SMD −0.35, −0.11 to −0.59). Eye Movement Desensitization and Reprocessing (EMDR) therapy was not effective when compared to waitlist/usual care at reducing PTSD symptoms post treatment (4 studies; n = 92; SMD −0.83, −1.75 to 0.10). There was evidence of greater dropout from CBT-TF therapies compared to waitlist and Present Centred Therapy. Conclusions: The evidence, albeit limited, supports individual CBT-TF as the first-line psychological treatment of PTSD in active duty and ex-serving personnel. There is evidence for Group CBT-TF, but this is not as strong as for individual CBT-TF. EMDR cannot be recommended as a first line therapy at present and urgently requires further evaluation. Lower effect sizes than for other populations with PTSD and high levels of drop-out suggest that CBT-TF in its current formats is not optimally acceptable and further research is required to develop and evaluate more effective treatments for PTSD and complex PTSD in active duty and ex-serving military personnel

Mechanisms of Thermal Balance in Flying Centris Pallida (Hymenoptera: Anthophoridae)

Thermoregulation of the Thorax is Critical for Bees and Other Endothermic Insects to Achieve High Rates of Flight Muscle Power Production. However, the Mechanisms Allowing Insects to Regulate Thorax Temperatures during Flight Are Not Well Understood. to Test Whether Variations in Metabolic Heat Production, Evaporation or Heat Transfer from the Thorax to the Abdomen Contribute to the Maintenance of Stable Body Temperatures during Flight in the Bee Centris Pallida, We Measured CO2 Production, Water Vapor Loss, Wingbeat Frequency and Body Segment Temperatures during Flight at Varying Air Temperatures (T(A)). While Hovering in the Field and While Flying in the Respirometer, C. Pallida Males Maintain Extremely Stable, Elevated Thorax Temperatures (45±2°C; Mean ± S.E.M.). Measurements of Head, Thorax and Abdomen Temperatures as a Function of T(A) during Hovering Flight in the Field Indicated that C. Pallida Males Were Not Actively Increasing Heat Transfer from the Thorax to the Head or Abdomen at High T(A) Values. as T(A) Increased from 26 to 35 °C, Increases in Evaporative Water Loss Were Relatively Small Compared with the Decrease in Carbon Dioxide Emission. as T(A) Values Increased from 26 to 35°C, the Factorial Decreases in Metabolic Heat Production and the Elevation of Thorax Temperature above T(A) Were Closely Matched (35%), Suggesting that Variation in Metabolic Heat Production is the Major Mechanism of Thermoregulation in Flying C. Pallida. the Thermal Effects on Rates of Water Loss and Metabolic Water Production Resulted in a Strong Positive Water Balance at Cooler T(A) Values, but a Strong Negative Water Balance at T(A) Values above 31 °C. during the First Minute of Flight in the Respirometry Chamber, Wingbeat Frequency Was Independent of T(A). However, by the Fourth Minute, There Was a Significant Negative Relationship between T(A) and Wingbeat Frequency, Which Was Similar to the Thermal Relationship Observed for Wingbeat Frequency in the Field. These Data Suggest that, either through Homeostatic Regulation or Resulting Secondarily from Thermal Effects on Flight Motor Properties, Variation in Metabolic Heat Production May Occur Via Altered Wingbeat Kinematics

Non-pharmacological and non-psychological approaches to the treatment of PTSD: results of a systematic review and meta-analyses

ABSTRACT Background: Non-pharmacological and non-psychological approaches to the treatment of post-traumatic stress disorder (PTSD) have often been excluded from systematic reviews and meta-analyses. Consequently, we know little regarding their efficacy. Objective: To determine the effect sizes of non-pharmacological and non-psychological treatment approaches for PTSD. Method: We undertook a systematic review and meta-analyses following Cochrane Collaboration guidelines. A pre-determined definition of clinical importance was applied to the results and the quality of evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Results: 30 randomised controlled trials (RCTs) of a range of heterogeneous non- psychological and non-pharmacological interventions (28 in adults, two in children and adolescents) were included. There was emerging evidence for six different approaches (acupuncture, neurofeedback, saikokeishikankyoto (a herbal preparation), somatic experiencing, transcranial magnetic stimulation, and yoga). Conclusions: Given the level of evidence available, it would be premature to offer non- pharmacological and non-psychological interventions routinely, but those with evidence of efficacy provide alternatives for people who do not respond to, do not tolerate or do not want more conventional evidence-based interventions. This review should stimulate further research in this area

Internet-based cognitive and behavioural therapies for posttraumatic stress disorder (PTSD) in adults

Therapist-delivered trauma-focused psychological therapies are an effective treatment for post-traumatic stress disorder (PTSD). These have become the accepted first-line treatments for the disorder. Despite the established evidence-base for these therapies, they are not always widely available or accessible.Many barriers limit treatment uptake, such as the limited number of qualified therapists to deliver the interventions, cost, and compliance issues, such as time off work, childcare, and transportation, associated with the need to attend weekly appointments. Delivering cognitive behavioural therapy (CBT) on the Internet is an effective and acceptable alternative to therapist-delivered treatments for anxiety and depression. However, fewer Internet-based therapies have been developed and evaluated for PTSD, and uncertainty surrounds the efficacy of Internet-based cognitive and behavioural therapy (I-C/BT) for PTSD. Objectives To assess the effects of I-C/BT for PTSD in adults. Search methods We searched the Cochrane Common Mental Disorders Group's Specialised Register (CCMDCTR) to June 2016 and identified four studies meeting the inclusion criteria. The CCMDCTR includes relevant randomised controlled trials (RCT) from MEDLINE, Embase, and PsycINFO.We also searched online clinical trial registries and reference lists of included studies, and contacted researchers in the field to identify additional and ongoing studies. We ran an update search on 1 March 2018, and identified four additional completed studies, which we added to the analyses along with two that were previously awaiting classification. Selection criteria We searched for RCTs of I-C/BT compared to face-to-face or Internet-based psychological treatment, psychoeducation, wait list or care as usual. We included studies of adults (aged over 16 years or over), in which at least 70% of the participants met the diagnostic criteria for PTSD, according to the Diagnostic and Statistical Manual (DSM) or the International Classification of Diseases (ICD)

Fertility in relation to the risk of breast cancer.

All studies reported here, like our own, support the view that the higher risk of breast cancer in women having a late first birth is attributable to early pregnancy itself having a direct protective effect against the disease, a benefit which they have not experienced. One study, however, has directly examined breast cancer risk in two groups of infertile women - those presumed to have 'progesterone deficiency' and those presumed to have infertility of non hormonal origin. The results suggested that breast cancer risk was increased in premenopausal women (but not in postmenopausal women) with 'progesterone deficiency'. The number of cases of premenopausal breast cancer included in the analysis (11) was, however, very small. In our view, the findings in this study do not weigh heavily against our results and those of others

Early oral contraceptive use and breast cancer: results of another case-control study.

We report the results of a case-control study of oral contraceptive use and breast cancer conducted in London, Oxford and Edinburgh between 1980 and 1984. One thousand one hundred and twenty-five women aged 16-64 years with newly diagnosed breast cancer and a like number of matched controls were interviewed and asked about their past due use of oral contraceptives (OCs). Among women aged 45 years or more at diagnosis there was no evidence of an association between OC use and breast cancer. Among the 351 pairs of women aged under 45 years at diagnosis there was a significantly elevated risk associated with increasing duration of use before first full term pregnancy (relative risk for 4+ years use versus never use = 2.6, 95% confidence limits, 1.3-5.4). Since this result is at variance with the findings in some other studies we have investigated the nature of this association with particular emphasis on possible bias, pill type and a latent effect

The REconsolidaTion Using RewiNd Study (RETURN): trial protocol

Background: An increasing body of research highlights reconsolidation-based therapies as emerging treatments for post-traumatic stress disorder (PTSD). The Rewind Technique is a non-pharmacological reconsolidation-based therapy with promising early results, which now requires evaluation through an RCT. Objectives: This is a preliminary efficacy RCT to determine if the Rewind Technique is likely to be a good candidate to test against usual care in a future pragmatic efficacy RCT. Methods: 40 participants will be randomised to receive either the Rewind Technique immediately, or after an 8 week wait. The primary outcome will be PTSD symptom severity as measured by the Clinician-Administered PTSD Scale for DSM5 (CAPS-5) at 8 and 16 weeks post-randomisation. Secondary outcome measures include the PTSD Checklist (PCL-5), International Trauma Questionnaire (ITQ), Patient Health Questionnaire (PHQ-9), the General Anxiety Disorder-7 (GAD-7), Insomnia Severity Index, the Euro-Qol-5D (EQ5D-5 L), the prominence of re-experiencing specific symptoms (CAPS-5) and an intervention acceptability questionnaire to measure tolerability of the intervention. Conclusions: This study will be the first RCT to assess the Rewind Technique. Using a cross-over methodology we hope to rigorously assess the efficacy and tolerability of Rewind using pragmatic inclusion criteria. Potential challenges include participant recruitment and retention

A systematic review and meta-analysis of psychological interventions for comorbid post-traumatic stress disorder and substance use disorder

Background The psychological treatment of comorbid post-traumatic stress disorder (PTSD) and substance use disorder (SUD) is clinically challenging, and outcomes are often poor. Objective This paper describes a systematic review and meta-analysis which sought to establish the current efficacy for a number of established psychological approaches for adults and adolescents, in comparison to interventions for SUD alone, or other active approaches, following a pre-registered protocol. Method This review followed PRISMA and Cochrane Collaboration guidelines. Data extraction and risk of bias judgements using Cochrane criteria were undertaken by all authors. Primary outcomes were PTSD severity and substance use post-treatment. The quality of findings was assessed using GRADE. Following a comprehensive search, conducted to 13 September 2021, 27 studies were included. Results We found a relatively high level of dropout across studies. In our main comparisons, we found no benefits for present-focused treatment approaches aimed at improving coping skills beyond those for SUD-only interventions. We found modest benefits for trauma-focused intervention plus SUD intervention post-treatment for PTSD (standardized mean difference (SMD) = −0.36, 95% confidence interval (CI) −0.64, −0.08), and at 6–13 months for PTSD (SMD = −0.48, 95% CI −0.81, −0.15) and alcohol use (SMD = −0.23, 95% CI −0.44, −0.02). There were no benefits for cognitive restructuring interventions as a group, but we found a modest effect for integrated cognitive behavioural therapy (ICBT) for PTSD post-treatment (SMD = −0.33, 95% CI −0.62, −0.04). There was evidence of some benefit for trauma-focused intervention over present-focused intervention for PTSD from a single study and for reduction in dropout for incentivized attendance for trauma-focused intervention from another single study. Most findings were of very low quality. Conclusion There is evidence that trauma-focused therapy and ICBT can improve PTSD for some individuals, but many patients do not fully engage with treatment and average treatment effects are modest

How do people seeking asylum in the United Kingdom conceptualize and cope with the asylum journey?

People seeking asylum experience traumatic events and psychological difficulties in country-of-origin, in ‘flight’, and during re-settlement. Research with this population has focussed on using quantitative methods to examine psychopathology from exposure to traumatic events, and there is a paucity of qualitative research exploring subjective experiences of this population throughout their asylum journey. Few studies have examined ways asylum seekers might cope with such events. This study aimed to address this gap by employing Constructivist Grounded Theory to understand the ways people seeking asylum conceptualize and cope with their experiences across the asylum process. Semi-structured interviews were conducted with eleven people seeking asylum accessing a third sector mental health project and/or primary-care health service. Four main themes emerged from the data: ‘Before Asylum’, ‘Displacement’, ‘Identity in the UK’ and ‘Reflections on the Future’. The stress of the asylum system and adaptation to new environments are core aspects of the theory, along with an exploration of how people cope with these circumstances, via internal psychological strategies and external support sources. Prior experiences (including the development of ‘inner strength’) impacted upon how participants conceptualized their everyday experiences, and this shaped their considerations for the future. Service implications are discussed