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Post-Traumatic Stress Disorders: HELP
Articles by Brett T. Litz
Based on 87 articles published since 2010
(Why 87 articles?)
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Between 2010 and 2020, B. Litz wrote the following 87 articles about Stress Disorders, Post-Traumatic.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4
1 Review Psychotherapy for Military-Related PTSD: A Review of Randomized Clinical Trials. 2015

Steenkamp, Maria M / Litz, Brett T / Hoge, Charles W / Marmar, Charles R. ·Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, New York. · VA Boston Healthcare System, Massachusetts Veterans Epidemiological Research and Information Center (MAVERIC), Boston University School of Medicine, Boston. · Walter Reed Army Institute of Research, Silver Spring, Maryland. ·JAMA · Pubmed #26241600.

ABSTRACT: IMPORTANCE: Posttraumatic stress disorder (PTSD) is a disabling psychiatric disorder common among military personnel and veterans. First-line psychotherapies most often recommended for PTSD consist mainly of "trauma-focused" psychotherapies that involve focusing on details of the trauma or associated cognitive and emotional effects. OBJECTIVE: To examine the effectiveness of psychotherapies for PTSD in military and veteran populations. EVIDENCE REVIEW: PubMed, PsycINFO, and PILOTS were searched for randomized clinical trials (RCTs) of individual and group psychotherapies for PTSD in military personnel and veterans, published from January 1980 to March 1, 2015. We also searched reference lists of articles, selected reviews, and meta-analyses. Of 891 publications initially identified, 36 were included. FINDINGS: Two trauma-focused therapies, cognitive processing therapy (CPT) and prolonged exposure, have been the most frequently studied psychotherapies for military-related PTSD. Five RCTs of CPT (that included 481 patients) and 4 RCTs of prolonged exposure (that included 402 patients) met inclusion criteria. Focusing on intent-to-treat outcomes, within-group posttreatment effect sizes for CPT and prolonged exposure were large (Cohen d range, 0.78-1.10). CPT and prolonged exposure also outperformed waitlist and treatment-as-usual control conditions. Forty-nine percent to 70% of participants receiving CPT and prolonged exposure attained clinically meaningful symptom improvement (defined as a 10- to 12-point decrease in interviewer-assessed or self-reported symptoms). However, mean posttreatment scores for CPT and prolonged exposure remained at or above clinical criteria for PTSD, and approximately two-thirds of patients receiving CPT or prolonged exposure retained their PTSD diagnosis after treatment (range, 60%-72%). CPT and prolonged exposure were marginally superior compared with non-trauma-focused psychotherapy comparison conditions. CONCLUSIONS AND RELEVANCE: In military and veteran populations, trials of the first-line trauma-focused interventions CPT and prolonged exposure have shown clinically meaningful improvements for many patients with PTSD. However, nonresponse rates have been high, many patients continue to have symptoms, and trauma-focused interventions show marginally superior results compared with active control conditions. There is a need for improvement in existing PTSD treatments and for development and testing of novel evidence-based treatments, both trauma-focused and non-trauma-focused.

2 Review Resilience in the aftermath of war trauma: a critical review and commentary. 2014

Litz, Brett T. ·Massachusetts Veterans Epidemiological Research and Information Center , VA Boston Healthcare System , Boston, MA , USA ; Departments of Psychology and Psychiatry , Boston University , Boston, MA , USA. ·Interface Focus · Pubmed #25285196.

ABSTRACT: The resilience construct has received a great deal of attention as a result of the long wars in Iraq and Afghanistan. The discourse about resilience, especially the promise of promoting it and mitigating risk for serious post-traumatic negative outcomes among service members and veterans, is hopeful and encouraging. Remarkably, most service members exposed to horrific war trauma are not incapacitated by the experience. Yet, resilience is elusive and fleeting for many veterans of war. In this paper, I address some of the complexities about resilience in the context of exposure to war stressors and I offer some assumptions and heuristics that stem from my involvement in the dialogue about resilience and from experiences helping prevent post-traumatic stress disorder among active-duty service members with military trauma. My goal is to use my observations and applied experiences as an instructive context to raise critical questions for the field about resilience in the face of traumatic life-events.

3 Review Moral injury: a mechanism for war-related psychological trauma in military family members. 2013

Nash, William P / Litz, Brett T. ·Boston VA Research Institute, 150 S. Huntington Ave., Boston, MA, 02130, USA, william.nash@opstress.net. ·Clin Child Fam Psychol Rev · Pubmed #23852334.

ABSTRACT: Recent research has provided compelling evidence of mental health problems in military spouses and children, including post-traumatic stress disorder (PTSD), related to the war-zone deployments, combat exposures, and post-deployment mental health symptoms experienced by military service members in the family. One obstacle to further research and federal programs targeting the psychological health of military family members has been the lack of a clear, compelling, and testable model to explain how war-zone events can result in psychological trauma in military spouses and children. In this article, we propose a possible mechanism for deployment-related psychological trauma in military spouses and children based on the concept of moral injury, a model that has been developed to better understand how service members and veterans may develop PTSD and other serious mental and behavioral problems in the wake of war-zone events that inflict damage to moral belief systems rather by threatening personal life and safety. After describing means of adapting the moral injury model to family systems, we discuss the clinical implications of moral injury, and describe a model for its psychological treatment.

4 Review Psychotherapy for military-related posttraumatic stress disorder: review of the evidence. 2013

Steenkamp, Maria M / Litz, Brett T. ·VA Boston Healthcare System, Boston, MA 02130, USA. maria.steenkamp2@va.gov ·Clin Psychol Rev · Pubmed #23123570.

ABSTRACT: Approximately 20% of the two million troops who have deployed to Iraq and Afghanistan may require treatment for posttraumatic stress disorder (PTSD). We review treatment outcome studies on individual outpatient therapy for military-related PTSD, and consider the extent to which veterans initiate and complete available PTSD treatments. We conclude with considerations for future research.

5 Clinical Trial Doxazosin for the treatment of co-occurring PTSD and alcohol use disorder: Design and methodology of a randomized controlled trial in military veterans. 2018

Back, Sudie E / Flanagan, Julianne C / Jones, Jennifer L / Augur, Isabel / Peterson, Alan L / Young-McCaughan, Stacey / Shirley, David W / Henschel, Aisling / Joseph, Jane E / Litz, Brett T / Hancock, Allison K / Roache, John D / Mintz, Jim / Wachen, Jennifer S / Keane, Terence M / Brady, Kathleen T / Anonymous5560959. ·Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA; Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA. Electronic address: backs@musc.edu. · Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA. Electronic address: hellmuth@musc.edu. · Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA. Electronic address: jonjen@musc.edu. · Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA. Electronic address: augur@musc.edu. · Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; Research and Development Service, South Texas Veterans Health Care System, South Texas Veterans Health Care System, San Antonio, TX, USA; Department of Psychology, University of Texas at San Antonio, San Antonio, TX, USA. Electronic address: petersona3@uthscsa.edu. · Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA. Electronic address: youngs1@uthscsa.edu. · Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy, Medical University of South Carolina, Charleston, SC, USA. · Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA. · Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA. Electronic address: josep@musc.edu. · Massachusetts Veterans Epidemiological Research and Information Center, VA Boston Healthcare System, Boston, MA, USA; Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA; Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA. Electronic address: brett.litz@va.gov. · Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA. Electronic address: hancocka@uthscsa.edu. · Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA. Electronic address: roache@uthscsa.edu. · Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; Department of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA. Electronic address: mintz@uthscsa.edu. · Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA; National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA. Electronic address: jennifer.wachen@va.gov. · Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA; National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA. Electronic address: terence.keane@va.gov. · Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA; Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA. Electronic address: bradyk@musc.edu. ·Contemp Clin Trials · Pubmed #30145268.

ABSTRACT: Posttraumatic stress disorder (PTSD) and alcohol use disorders (AUD) are two of the most common mental health disorders affecting civilians as well as military populations. If left untreated, individuals with co-occurring PTSD/AUD are at increased risk for developing other mental health problems (e.g., depression, anxiety), physical health problems, reduced resiliency and military readiness, and vocational and social impairment. Substantial gaps in the treatment of co-occurring PTSD/AUD exist and there is a critical need to develop more effective pharmacological treatments. The current study addresses this gap in the literature by testing the efficacy and safety of doxazosin, a long-acting and selective alpha-1 adrenergic antagonist, as compared to placebo in reducing PTSD and AUD severity among U.S. military veterans. Noradrenergic dysregulation has been implicated in the development and maintenance of PTSD and AUD, and pilot studies examining doxazosin in PTSD-only or AUD-only samples have shown promise. This is the first study, however, to evaluate doxazosin in a comorbid PTSD/AUD sample. This paper describes the rationale, design and methodology of a randomized, double-blind, placebo-controlled trial of doxazosin (16 mg/day) delivered over 12 weeks among military veterans with current PTSD and AUD. In addition, functional magnetic resonance imaging (fMRI) is applied at pre- and post-treatment to investigate the underlying pathophysiology of comorbid PTSD/AUD and identify prognostic indicators of treatment outcome. This study is designed to accelerate research on co-occurring PTSD/AUD and provide empirical evidence to inform clinical practice.

6 Clinical Trial Ethnoracial differences in PTSD symptoms and trauma-related cognitions in treatment-seeking active duty military personnel for PTSD. 2017

Hall-Clark, Brittany N / Kaczkurkin, Antonia N / Asnaani, Anu / Zhong, Jody / Peterson, Alan L / Yarvis, Jeffrey S / Borah, Elisa V / Dondanville, Katherine A / Hembree, Elizabeth A / Litz, Brett T / Mintz, Jim / Young-McCaughan, Stacey / Foa, Edna B. ·Department of Psychiatry, University of Texas Health Science Center at San Antonio. · Department of Psychiatry, University of Pennsylvania. · Headquarters, Carl R. Darnall Army Medical Center. · School of Social Work, University of Texas at Austin. · Massachusetts Veterans Epidemiological Research and Information Center, VA Boston Healthcare System. · Departments of Psychiatry and of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio. ·Psychol Trauma · Pubmed #28068141.

ABSTRACT: OBJECTIVE: It is uncertain whether ethnoracial factors should be considered by clinicians assessing and treating posttraumatic stress disorder (PTSD) among service members. The purpose of this study was to shed light on ethnoracial variation in the presentation of PTSD symptoms, trauma-related cognitions, and emotions among treatment-seeking active duty military personnel. METHOD: Participants were 303 male active duty military members with PTSD participating in a clinical trial (60% were self-identified as White, 19% as African American, and 21% as Hispanic/Latino). In the parent study, participants completed a baseline assessment that included clinician-administered and self-report measures of PTSD, trauma-related cognitions, and emotions. RESULTS: Multivariate hierarchical regression models were used to examine ethnoracial differences in these variables, covarying age, education, military grade, combat exposure, and exposure to other potentially traumatic events. Hispanic/Latino and African American participants reported more reexperiencing symptoms, more fear, and more guilt and numbing than White participants. All effect sizes were in the small to medium range. CONCLUSIONS: These findings suggest ethnoracial variation in PTSD symptom burden and posttraumatic cognitions among treatment-seeking service members with PTSD. Attending to cultural factors related to differences in PTSD presentation and cognitive coping strategies during the assessment and treatment process could increase rapport and lead to more comprehensive trauma processing. (PsycINFO Database Record

7 Article Study design comparing written exposure therapy to cognitive processing therapy for PTSD among military service members: A noninferiority trial. 2020

Sloan, Denise M / Marx, Brian P / Resick, Patricia A / Young-McCaughan, Stacey / Dondanville, Katherine A / Mintz, Jim / Litz, Brett T / Peterson, Alan L / Anonymous2031036. ·National Center for PTSD at VA Boston Healthcare System, 150 S. Huntington Avenue (116B-4), Boston, MA, 02130, USA. · Boston University School of Medicine, Department of Psychiatry, 72 East Concord St., Boston, MA, 02118, USA. · Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Durham, NC, 27701, USA. · University of Texas Health Science Center at San Antonio, Department of Psychiatry, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA. · University of Texas Health Science Center at San Antonio, Department of Epidemiology and Biostatistics, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA. · Massachusetts Veterans Epidemiological Research and Information Center, VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA, 02130, USA. · Boston University, Department of Psychological and Brain Sciences, 64 Cummington Mall, Boston, MA, 02215, USA. · South Texas Veterans Health Care System, Research and Development Service, San Antonio, 7400 Merton Minter Boulevard, San Antonio, TX, 78229, USA. · University of Texas at San Antonio, Department of Psychology, San Antonio, One UTSA Circle, San Antonio, TX, 78249, USA. ·Contemp Clin Trials Commun · Pubmed #31890987.

ABSTRACT: Although there are a number of effective treatments for posttraumatic stress disorder (PTSD), there is a need to develop more efficient evidence-based PTSD treatments to address barriers to seeking and receiving treatment. Written exposure therapy (WET) is a potential alternative that is a 5-session treatment without any between-session assignments. WET has demonstrated efficacy, and low treatment dropout rates. However, prior studies with WET have primarily focused on civilian samples. Identifying efficient PTSD treatments for military service members is critical given the high prevalence of PTSD in this population. The current ongoing randomized clinical trial builds upon the existing literature by investigating whether WET is equally efficacious as Cognitive Processing Therapy (CPT) in a sample of 150 active duty military service members diagnosed with PTSD who are randomly assigned to either WET (

8 Article Changes in anger and aggression after treatment for PTSD in active duty military. 2020

Miles, Shannon R / Dillon, Kirsten H / Jacoby, Vanessa M / Hale, Willie J / Dondanville, Katherine A / Wachen, Jennifer Schuster / Yarvis, Jeffrey S / Peterson, Alan L / Mintz, Jim / Litz, Brett T / Young-McCaughan, Stacey / Resick, Patricia A / Anonymous781120. ·James A. Haley Veterans' Hospital, Tampa, Florida. · Department of Psychiatry & Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, Florida. · Research and Development, Durham VA Medical Center, Durham, North Carolina. · Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina. · Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas. · Department of Psychology, University of Texas at San Antonio, San Antonio, Texas. · National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts. · Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts. · Department of Behavioral Health, Carl R. Darnall Army Medical Center, Fort Hood, Texas. · Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas. · Department of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio, San Antonio, Texas. · Massachusetts Veterans Epidemiological Research and Information Center, VA Boston Healthcare System, Boston, Massachusetts. ·J Clin Psychol · Pubmed #31733126.

ABSTRACT: OBJECTIVE: To examine whether treating posttraumatic stress disorder (PTSD) reduces anger and aggression and if changes in PTSD symptoms are associated with changes in anger and aggression. METHOD: Active duty service members (n = 374) seeking PTSD treatment in two randomized clinical trials completed a pretreatment assessment, 12 treatment sessions, and a posttreatment assessment. Outcomes included the Revised Conflict Tactics Scale and state anger subscale of the State-Trait Anger Expression Inventory. RESULTS: Treatment groups were analyzed together. There were small to moderate pretreatment to posttreatment reductions in anger (standardized mean difference [SMD] = -0.25), psychological aggression (SMD = -0.43), and physical aggression (SMD = -0.25). The majority of participants continued to endorse anger and aggression at posttreatment. Changes in PTSD symptoms were mildly to moderately associated with changes in anger and aggression. CONCLUSIONS: PTSD treatments reduced anger and aggression with effects similar to anger and aggression treatments; innovative psychotherapies are needed.

9 Article Trauma-Related Cognitions and Cognitive Emotion Regulation as Mediators of PTSD Change Among Treatment-Seeking Active-Duty Military Personnel With PTSD. 2019

McLean, Carmen P / Zang, Yinyin / Gallagher, Thea / Suzuki, Noah / Yarvis, Jeffrey S / Litz, Brett T / Mintz, Jim / Young-McCaughan, Stacey / Peterson, Alan L / Foa, Edna B / Anonymous4011083. ·National Center for PTSD, VA Palo Alto Health Care System; Stanford University. Electronic address: Carmen.McLean4@va.gov. · University of Pennsylvania School of Medicine. Electronic address: yinyinz@pennmedicine.upenn.edu. · University of Pennsylvania School of Medicine. · Carl R. Darnall Army Medical Center, Fort Hood, TX. · Massachusetts Veterans Epidemiological Research and Information Center, VA Boston Healthcare System; Boston University School of Medicine. · University of Texas Health Science Center at San Antonio. · University of Texas Health Science Center at San Antonio; South Texas Veterans Health Care System; University of Texas at San Antonio. ·Behav Ther · Pubmed #31735241.

ABSTRACT: Trauma-related cognitions about the self and the world have been identified as a mediator of posttraumatic stress disorder (PTSD) change during prolonged exposure (PE) therapy. However, the extent to which negative cognitions mediate PTSD change in other PTSD treatments is unclear. In addition, previous studies have not tested alternate mediators of PTSD change during PE. In a sample of 216 treatment-seeking active-duty military personnel with PTSD, the present study examined the specificity of the negative cognition mediation effect in both PE and present-centered therapy (PCT). In addition, we examined another possible mediator, cognitive emotion regulation. Lagged mediational analyses indicated that negative cognitions about the self and world and the unhelpful cognitive emotion regulation strategy of catastrophizing each significantly mediated change in PTSD from baseline to 6-month follow-up. In a combined model, the mediating effect of catastrophizing was greater than negative cognitions about the world, and similar to negative cognitions about the self. Moderated mediation analyses revealed that the effect of catastrophizing was greater in PE than in PCT. Findings show that trauma-related cognitions and, to a greater degree, the emotion regulation strategy catastrophizing, both mediate PTSD change. Further research is needed to determine whether these mediating variables represent mechanisms of therapeutic change.

10 Article A resting-state network comparison of combat-related PTSD with combat-exposed and civilian controls. 2019

Vanasse, Thomas J / Franklin, Crystal / Salinas, Felipe S / Ramage, Amy E / Calhoun, Vince D / Robinson, Paul C / Kok, Mitchell / Peterson, Alan L / Mintz, Jim / Litz, Brett T / Young-McCaughan, Stacey / Resick, Patricia A / Fox, Peter T / Anonymous2961067. ·Research Imaging Institute, University of Texas Health Science Center, San Antonio, TX 78229, USA. · Department of Radiology, University of Texas Health Science Center, San Antonio, TX 78229, USA. · Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX 78229, USA. · Department of Communication Sciences and Disorders, College of Health and Human Services, University of New Hampshire, Durham, NH 03824, USA. · The Mind Research Network, Albuquerque, NM 87106, USA. · Department of Electrical and Computer Engineering, University of New Mexico, Albuquerque, NM 87131, USA. · Tri-institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University 30302, Georgia Institute of Technology, Emory University 30322, Atlanta, GA, USA. · Carl R. Darnall Army Medical Center, Fort Hood, TX 76544, USA. · Department of Psychiatry, University of Texas Health Science Center, San Antonio, TX 78229, USA. · Department of Psychology, University of Texas, San Antonio, TX 78249, USA. · Department of Epidemiology and Biostatistics, University of Texas Health Science Center, San Antonio, TX 78229, USA. · Massachusetts Veterans Epidemiological Research and Information Center, VA Boston Healthcare System, Boston, MA 02130, USA. · Department of Psychiatry, Boston University School of Medicine, Boston, MA 02118, USA. · Department of Psychological and Brain Sciences, Boston University, Boston, MA 02215, USA. · Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27707, USA. ·Soc Cogn Affect Neurosci · Pubmed #31588508.

ABSTRACT: Resting-state functional connectivity (rsFC) is an emerging means of understanding the neurobiology of combat-related post-traumatic stress disorder (PTSD). However, most rsFC studies to date have limited focus to cognitively related intrinsic connectivity networks (ICNs), have not applied data-driven methodologies or have disregarded the effect of combat exposure. In this study, we predicted that group independent component analysis (GICA) would reveal group-wise differences in rsFC across 50 active duty service members with PTSD, 28 combat-exposed controls (CEC), and 25 civilian controls without trauma exposure (CC). Intranetwork connectivity differences were identified across 11 ICNs, yet combat-exposed groups were indistinguishable in PTSD vs CEC contrasts. Both PTSD and CEC demonstrated anatomically diffuse differences in the Auditory Vigilance and Sensorimotor networks compared to CC. However, intranetwork connectivity in a subset of three regions was associated with PTSD symptom severity among executive (left insula; ventral anterior cingulate) and right Fronto-Parietal (perigenual cingulate) networks. Furthermore, we found that increased temporal synchronization among visuospatial and sensorimotor networks was associated with worse avoidance symptoms in PTSD. Longitudinal neuroimaging studies in combat-exposed cohorts can further parse PTSD-related, combat stress-related or adaptive rsFC changes ensuing from combat.

11 Article Patterns and predictors of change in trauma-focused treatments for war-related posttraumatic stress disorder. 2019

Litz, Brett T / Berke, Danielle S / Kline, Nora K / Grimm, Kevin / Rusowicz-Orazem, Luke / Resick, Patricia A / Foa, Edna B / Wachen, Jennifer S / McLean, Carmen P / Dondanville, Katherine A / Borah, Adam M / Roache, John D / Young-McCaughan, Stacey / Yarvis, Jeffrey S / Mintz, Jim / Peterson, Alan L. ·VA Boston Healthcare System. · Arizona State University. · Boston University School of Public Health. · Duke University Medical Center. · University of Pennsylvania. · VA Palo Alto Health Care System. · University of Texas Health Science Center at San Antonio. · Carl R. Darnall Army Medical Center. ·J Consult Clin Psychol · Pubmed #31556650.

ABSTRACT: OBJECTIVE: We evaluated patterns and predictors of change from three efficacy trials of trauma-focused cognitive-behavioral treatments (TF-CBT) among service members (N = 702; mean age = 32.88; 89.4% male; 79.8% non-Hispanic/Latino). Rates of clinically significant change were also compared with other trials. METHOD: The trials were conducted in the same setting with identical measures. The primary outcome was symptom severity scores on the PTSD Symptom Scale-Interview Version (PSS-I; Foa, Riggs, Dancu, & Rothbaum, 1993). RESULTS: Symptom change was best explained by baseline scores and individual slopes. TF-CBT was not associated with better slope change relative to Present-Centered Therapy, a comparison arm in 2 trials. Lower baseline scores (β = .33, p < .01) and higher ratings of treatment credibility (β = -.22, p < .01) and expectancy for change (β = -.16, p < .01) were associated with greater symptom change. Older service members also responded less well to treatment (β = .09, p < .05). Based on the Jacobson and Truax (1991) metric for clinically significant change, 31% of trial participants either recovered or improved. CONCLUSIONS: Clinicians should individually tailor treatment for service members with high baseline symptoms, older patients, and those with low levels of credibility and expectancy for change. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

12 Article Conceptualizing comorbid PTSD and depression among treatment-seeking, active duty military service members. 2019

Moring, John C / Nason, Erica / Hale, Willie J / Wachen, Jennifer Schuster / Dondanville, Katherine A / Straud, Casey / Moore, Brian A / Mintz, Jim / Litz, Brett T / Yarvis, Jeffrey S / Young-McCaughan, Stacey / Peterson, Alan L / Resick, Patricia A / Anonymous6980996. ·Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA. Electronic address: moringj@uthscsa.edu. · School of Social Work, Texas State University, San Marcos, TX, USA. · Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; Department of Psychology, University of Texas at San Antonio, San Antonio, TX, USA. · National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA; Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA. · Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA. · Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; Department of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA. · Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA; Massachusetts Veterans Epidemiological Research and Information Center, VA Boston Healthcare System, Boston, MA, USA; Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA. · Department of Behavioral Health, Carl R. Darnall Army Medical Center, Fort Hood, TX, USA. · Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; Department of Psychology, University of Texas at San Antonio, San Antonio, TX, USA; Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX, USA. · Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA. ·J Affect Disord · Pubmed #31280079.

ABSTRACT: BACKGROUND: Among active duty service members and veterans with PTSD, depression is the most commonly diagnosed comorbid psychiatric condition. More research is warranted to investigate the relationship between PTSD and depression to improve treatment approaches. Byllesby et al. (2017) used confirmatory factor analyses in a sample of trauma-exposed combat veterans with PTSD and found that only the general distress factor, and not any specific symptom cluster of PTSD, predicted depression. This study seeks to replicate Byllesby et al. (2017) in a sample of treatment-seeking active duty soldiers. METHODS: Confirmatory factor analyses, bifactor modeling, and structural equation modeling (SEM) were used with data gathered at pretreatment and posttreatment as part of a large randomized clinical trial. RESULTS: Confirmatory factor analyses and bifactor modeling demonstrated that PTSD symptom clusters, Negative Alterations in Cognition and Mood (NACM) and Alterations in Arousal and Reactivity (AAR), as well as the general distress factor significantly predicted depression at pretreatment and posttreatment. LIMITATIONS: The current study was predominantly male, limiting the generalizability to female service members with PTSD. Also, self-report measures were used, which may introduce response-bias. CONCLUSIONS: The current study did not replicate Byllesby et al. (2017). Results demonstrated that the relationship between PTSD and depression among active duty service members can be explained by both transdiagnostic factors and disorder-specific symptoms.

13 Article Mediation of suicide ideation in prolonged exposure therapy for posttraumatic stress disorder. 2019

Brown, Lily A / Zang, Yinyin / Benhamou, Kathy / Taylor, Daniel J / Bryan, Craig J / Yarvis, Jeffrey S / Dondanville, Katherine A / Litz, Brett T / Mintz, Jim / Roache, John D / Pruiksma, Kristi E / Fina, Brooke A / Young-McCaughan, Stacey / Peterson, Alan L / Foa, Edna B / Anonymous1991060. ·Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States. Electronic address: lilybr@upenn.edu. · Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States. Electronic address: yinyinz@upenn.edu. · Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States. Electronic address: ksb91@case.edu. · Department of Psychology, University of North Texas, Denton, TX, United States. Electronic address: Daniel.Taylor@unt.edu. · National Center for Veterans Studies, University of Utah, Salt Lake City, UT, United States; Department of Psychology, University of Utah, Salt Lake City, UT, United States. Electronic address: craig.bryan@utah.edu. · Department of Behavioral Medicine, Carl R. Darnall Army Medical Center, Fort Hood, TX, United States. Electronic address: jeffrey.s.yarvis.mil@mail.mil. · Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States. Electronic address: Dondanville@uthscsa.edu. · Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA, United States; Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States; Department of Psychological and Brain Sciences, Boston University, Boston, MA, United States. Electronic address: Brett.Litz@va.gov. · Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States; Department of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States. Electronic address: mintz@uthscsa.edu. · Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States. Electronic address: roache@uthscsa.edu. · Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States. Electronic address: Pruiksma@uthscsa.edu. · Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States. Electronic address: Fina@uthscsa.edu. · Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States. Electronic address: youngs1@uthscsa.edu. · Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States; Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX, United States; Department of Psychology, University of Texas at San Antonio, San Antonio, TX, United States. Electronic address: petersona3@uthscsa.edu. · Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States. Electronic address: foa@pennmedicine.upenn.edu. ·Behav Res Ther · Pubmed #31176888.

ABSTRACT: BACKGROUND: Evidence-based treatments for posttraumatic stress disorder (PTSD) are associated with reduction in suicidal ideation (SI), yet the mechanisms underlying this reduction are unclear. The current study investigated improvements in PTSD, depression, and social support as potential mediators of the change in SI over time. METHOD: Participants (N = 200) were active duty military personnel with PTSD randomized to prolonged exposure therapy (PE) or present-centered therapy (PCT). Using parallel mediation and serial mediation models, we examined the relative influence of the mediators on suicidal ideation over time. RESULTS: Consistent with our hypotheses, lagged mediation analyses revealed that depression was the strongest mediator of improvements in SI over time in PE and PCT. Reductions in PTSD were associated with subsequent reductions in depression, which was associated with reductions in SI. Treatment condition did not moderate this relationship, and social support was not a significant mediator. CONCLUSIONS: In active duty military personnel, reduction in depression was the strongest mediator of reduction in suicidal ideation in PE and PCT for PTSD. These results were not altered by treatment condition. TRIAL REGISTRATION: Clinicaltrials. gov identifier: NCT01049516. http://www.clinicaltrials.gov/show/NCT01049516.

14 Article Does prolonged exposure increase suicide risk? Results from an active duty military sample. 2019

Brown, Lily A / McLean, Carmen P / Zang, Yinyin / Zandberg, Laurie / Mintz, Jim / Yarvis, Jeffrey S / Litz, Brett T / Peterson, Alan L / Bryan, Craig J / Fina, Brooke / Petersen, Julie / Dondanville, Katherine A / Roache, John D / Young-McCaughan, Stacey / Foa, Edna B / Anonymous1801060. ·Department of Psychiatry, University of Pennsylvania, 3535 Market St., Suite 600 North, Philadelphia, PA, USA. Electronic address: lilybr@upenn.edu. · Department of Psychiatry, University of Pennsylvania, 3535 Market St., Suite 600 North, Philadelphia, PA, USA; (b)National Center for PTSD, VA Palo Alto Health Care System, 795 Willow Rd., Menlo Park, CA, USA. · Department of Psychiatry, University of Pennsylvania, 3535 Market St., Suite 600 North, Philadelphia, PA, USA. · Department of Psychiatry, University of Texas Health Science Center at San Antonio, 8300 Floyd Curl Dr., San Antonio, TX, USA; Department of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., San Antonio, TX, USA. · Headquarters, Carl R. Darnall Army Medical Center, 36065 Santa Fe Avenue, Fort Hood, TX, USA. · Massachusetts Veterans Epidemiological Research Center, VA Boston Health Care System, 150 S Huntington Ave, Boston, MA, USA; Department of Psychiatry, Boston University School of Medicine, 720 Harrison Ave., Boston, MA, USA; Department of Psychological and Brain Sciences, Boston University, 64 Cummington Mall, Boston, MA, USA. · Department of Psychiatry, University of Texas Health Science Center at San Antonio, 8300 Floyd Curl Dr., San Antonio, TX, USA; Research and Development Service, South Texas Veterans Health Care System, 7400 Merton Minter, San Antonio, TX, USA; Department of Psychology, University of Texas at San Antonio, One UTSA Circle, San Antonio, TX, USA. · National Center for Veterans Studies, 332 S 1400 E, Building 73, Salt Lake City, UT, USA; Department of Psychology, The University of Utah, 1721 Campus Center Drive Saec, 3220 S, Salt Lake City, UT, USA. · Department of Psychiatry, University of Texas Health Science Center at San Antonio, 8300 Floyd Curl Dr., San Antonio, TX, USA. ·Behav Res Ther · Pubmed #31022593.

ABSTRACT: The efficacy of prolonged exposure (PE) on suicide ideation (SI) as a secondary outcome among individuals with posttraumatic stress disorder (PTSD) is unclear. The purpose of this study was to compare the efficacy of PE in two formats (spaced, S-PE, 10 sessions over 8 weeks, and massed, M-PE, 10 sessions over 2 weeks) to Present Centered Therapy (PCT) and minimal contact control (MCC) on SI exacerbation among patients without suicide intent or plans. Active duty military personnel (n = 335) were randomized to: (1) S-PE vs. PCT and (2) M-PE vs. MCC. All participants completed the Beck Scale for Suicide Ideation and the Beck Depression Inventory (Suicide item) at baseline, posttreatment, and follow-ups. S-PE and PCT had significant and comparable reductions in SI during treatment. M-PE had significantly steeper reductions in SI during treatment compared to MCC. Specifically, more participants in M-PE compared to MCC had reliable improvement versus reliable exacerbation. Reduction in PTSD symptoms was significantly associated with reduction of SI. PE was associated with significant reductions in SI over time that were comparable to PCT and superior to MCC. These findings suggest that both trauma- and non-trauma-focused treatments are associated with reductions in SI, and that trauma-focused treatments improve SI relative to waitlist.

15 Article Repeated ketamine infusions for antidepressant-resistant PTSD: Methods of a multicenter, randomized, placebo-controlled clinical trial. 2019

Abdallah, Chadi G / Roache, John D / Averill, Lynnette A / Young-McCaughan, Stacey / Martini, Brenda / Gueorguieva, Ralitza / Amoroso, Timothy / Southwick, Steven M / Guthmiller, Kevin / López-Roca, Argelio L / Lautenschlager, Karl / Mintz, Jim / Litz, Brett T / Williamson, Douglas E / Keane, Terence M / Peterson, Alan L / Krystal, John H / Anonymous1071099. ·National Center for PTSD, Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA. Electronic address: chadi.abdallah@yale.edu. · Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA. Electronic address: roache@uthscsa.edu. · National Center for PTSD, Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA. Electronic address: lynnette.averill@yale.edu. · Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA. Electronic address: youngs1@uthscsa.edu. · National Center for PTSD, Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA. Electronic address: Brenda.Martini@va.gov. · Department of Biostatistics, School of Public Health, Yale University School of Medicine, New Haven, CT, USA. Electronic address: ralitza.gueorguieva@yale.edu. · National Center for PTSD, Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA. Electronic address: timothy.amoroso@yale.edu. · National Center for PTSD, Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA. Electronic address: steven.southwick@yale.edu. · Department of Pain Management, Brooke Army Medical Center, Joint Base San Antonio - Fort Sam Houston, TX, USA. Electronic address: kevin.guthmiller@med.usc.edu. · Department of Behavioral Health, Brooke Army Medical Center, Joint Base San Antonio - Fort Sam Houston, TX, USA. Electronic address: argelio.l.lopezroca.civ@mail.mil. · Department of Pain Management, Brooke Army Medical Center, Joint Base San Antonio - Fort Sam Houston, TX, USA. Electronic address: karl.a.lautenschlager.mil@mail.mil. · Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; Department of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA. Electronic address: mintz@uthscsa.edu. · Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA, USA; Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA. Electronic address: brett.litz@va.gov. · Duke University School of Medicine, Durham, NC, USA; Durham Veterans Affairs Medical Center, Durham, NC, USA. Electronic address: douglas.williamson@duke.edu. · National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, MA, USA; Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA. Electronic address: terry.keane@va.gov. · Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX, USA; Department of Psychology, University of Texas at San Antonio, San Antonio, TX, USA. Electronic address: petersona3@uthscsa.edu. · National Center for PTSD, Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA. Electronic address: john.krystal@yale.edu. ·Contemp Clin Trials · Pubmed #30999057.

ABSTRACT: Posttraumatic stress disorder (PTSD) is a debilitating disorder with limited medication treatment options. Recent reports have described the dearth of research on new drug development as a crisis in the pharmacotherapy of PTSD. There are only two PTSD medications approved by the U.S. Food and Drug Administration, and both are serotonergic antidepressants. Therefore, there is a tremendous need to identify more effective and more rapidly acting pharmacotherapies for PTSD that work through novel neural mechanisms. Pilot evidence and case reports provided preliminary evidence supporting the safety and utility of investigating the therapeutic effects of ketamine in PTSD. However, the efficacy of this drug for PTSD has not yet been tested in active duty military or veteran populations. Here, we report the design and methods of a study funded under the Consortium to Alleviate PTSD. The study is a multisite, placebo-controlled, double-blind, randomized clinical trial to examine the dose-related efficacy of ketamine, as compared to placebo, in producing a rapid and sustained reduction in PTSD symptomatology in veterans and active duty military populations with antidepressant-resistant PTSD. Approximately 198 eligible participants who meet criteria for PTSD will be randomized to the study drug (i.e., ketamine 0.5 mg/kg, ketamine 0.2 mg/kg, or placebo). The study drug will be administered intravenously twice per week for 4 weeks, followed by a 4-week follow-up period. This ongoing study is the only trial of therapeutic effects of ketamine for PTSD and the first placebo-controlled trial to determine the dose-related effects of repeated ketamine on PTSD.

16 Article Predictors of attendance and dropout in three randomized controlled trials of PTSD treatment for active duty service members. 2019

Berke, Danielle S / Kline, Nora K / Wachen, Jennifer Schuster / McLean, Carmen P / Yarvis, Jeffrey S / Mintz, Jim / Young-McCaughan, Stacey / Peterson, Alan L / Foa, Edna / Resick, Patricia A / Litz, Brett T / Anonymous1621060. ·Massachusetts Veterans Epidemiological Research and Information Center, VA Boston Healthcare System, Boston, MA, USA; Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA. Electronic address: db2800@hunter.cuny.edu. · Massachusetts Veterans Epidemiological Research and Information Center, VA Boston Healthcare System, Boston, MA, USA. Electronic address: nkline@clarku.edu. · Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA; National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA. Electronic address: jennifer.wachen@va.gov. · National Center for PTSD, VA Palo Alto Healthcare System, Menlo Park, CA, USA; Stanford University School of Medicine, Stanford, CA, USA. Electronic address: carmen.mclean4@va.gov. · Carl R. Darnall Army Medical Center, Fort Hood, TX, USA. Electronic address: jeffrey.s.yarvis.mil@mail.mil. · Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; Department of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA. Electronic address: mintz@uthscsa.edu. · Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA. Electronic address: youngs1@uthscsa.edu. · Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX, USA; Department of Psychology, University of Texas at San Antonio, San Antonio, TX, USA. Electronic address: petersona3@uthscsa.edu. · Department of Psychiatry, University of Pennsylvania, USA. Electronic address: foa@pennmedicine.upenn.edu. · Duke University Medical Center, USA. Electronic address: patricia.resick@duke.edu. · Massachusetts Veterans Epidemiological Research and Information Center, VA Boston Healthcare System, Boston, MA, USA; Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA; Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA. Electronic address: brett.litz@va.gov. ·Behav Res Ther · Pubmed #30933748.

ABSTRACT: Dropout from first-line posttraumatic stress disorder (PTSD) treatments is a significant problem. We reported rates and predictors of attendance and dropout in three clinical trials of evidence-based PTSD treatments in military service members (N = 557). Service members attended 81.0% of treatment sessions and 30.7% dropped out. Individually delivered treatment was associated with greater attendance rates (β = 0.23, p < .001) than group therapy; trauma-focused treatments were associated with higher dropout (β = 0.19, p < .001) than Present-Centered Therapy. Age was a significant predictor of session attendance (β = 0.17, p < .001) and drop out (β = -0.23, p < .001). History of traumatic brain injury (TBI) predicted lower attendance rates (β = -0.26, p < .001) and greater dropout (β = 0.19, p < .001). Regardless of treatment type or format, patients who did not drop out were more likely to experience clinically significant gains (d = 0.49, p < .001). Results demonstrate that dropout from PTSD treatments in these trials was significantly associated with treatment outcome and suggest that strategies are needed to mitigate dropout, particularly in group and trauma-focused therapies, and among younger service members and those with TBI.

17 Article Dynamic changes in marines' reports of PTSD symptoms and problem alcohol use across the deployment cycle. 2019

Berke, Danielle S / Yeterian, Julie / Presseau, Candice / Rusowicz-Orazem, Luke / Kline, Nora K / Nash, William P / Litz, Brett T. ·Massachusetts Veterans Epidemiological Research and Information Center, Veterans Affairs Boston Healthcare System. · Headquarters, United States Marine Corps, The Pentagon. ·Psychol Addict Behav · Pubmed #30570268.

ABSTRACT: Posttraumatic stress disorder (PTSD) and alcohol misuse are commonly co-occurring problems in active-duty service members (SMs) and veterans. Unfortunately, relatively little is known about the temporal associations between these problems in the acute period following exposure to combat stressors. Discerning the temporal associations between these problems across the deployment cycle could inform prevention and treatment efforts. In this study, we examined the association between PTSD symptom severity and problem alcohol use in a large cohort of United States Marines (n = 758) evaluated prior to deployment and approximately 1, 5, and 8 months postdeployment. Results indicate that problem alcohol use was associated with a subsequent exacerbation of PTSD symptoms between the 1st and 2nd and 2nd and 3rd postdeployment assessments. PTSD symptom severity was associated with increased problem alcohol use between the 1st and 2nd postdeployment assessments. These findings suggest that problem drinking may lead to new onset or worsening of PTSD symptoms over time and that SMs with greater PTSD symptom severity upon returning from deployment may increase alcohol use in the weeks immediately following homecoming. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

18 Article Common Data Elements in the Assessment of Military-Related PTSD Research Applied in the Consortium to Alleviate PTSD. 2019

Ben Barnes, J / Presseau, Candice / Jordan, Alexander H / Kline, Nora K / Young-McCaughan, Stacey / Keane, Terence M / Peterson, Alan L / Litz, Brett T / Anonymous921095. ·Massachusetts Veterans Epidemiology Research and Information Center, MAVERIC, VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA. · Department of Psychiatry, Boston University School of Medicine, 72 East Concord Street, Boston, MA. · Department of Psychiatry, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX. · Behavioral Science Division, National Center for PTSD, VA Boston Healthcare System, 150 South Huntington Ave, Boston, MA. · Research and Development Service, South Texas Veterans Health Care System, 7400 Merton Minter, San Antonio, TX. · Department of Psychology, University of Texas at San Antonio, One UTSA Circle, San Antonio, TX. · Department of Psychological and Brain Sciences, Boston University, 64 Cummington Mall, Boston, MA. ·Mil Med · Pubmed #30252077.

ABSTRACT: INTRODUCTION: Driven by the need to share data, sufficiently power studies, and allow for cross-study comparisons of medical and psychiatric diseases, the President's National Research Action Plan issued in 2013 called for the use of state-of-the-art common data elements (CDEs) for research studies. CDEs are variables measured across independent studies that facilitate methodologically sound data aggregation and study replication. Researchers in the field of military-related post-traumatic stress disorder (PTSD) have suggested applicable CDEs; however, to date, these recommendations have been conceptual and not field-tested. The Consortium to Alleviate PTSD (CAP) - an interdisciplinary and multi-institutional, military-related PTSD research consortium funded by the Departments of Defense and Veterans Affairs - generated and applied CDEs that can be used to combine data from disparate studies to improve the methodological and statistical capabilities of study findings. We provide a description and rationale for the CAP CDEs and details about administration with two main goals: (1) to encourage military-related PTSD researchers to use these measures in future studies and (2) to facilitate comparison, replication, and data aggregation. MATERIALS AND METHODS: The CAP compiled mandated (core) and optional CDEs based on the following criteria: (1) construct applicability to military-related PTSD; (2) precedence (use) in prior, related research; (3) published and strong psychometric evidence; (4) no cost (public domain); and (5) brevity, to limit participant burden. We provided descriptive statistics and internal consistency reliabilities for mandated measures from an initial cohort of around 400 participants enrolled in CAP studies. RESULTS: Mandated CDEs in the CAP were found to have very good internal consistency reliability. CONCLUSION: Although further research is needed to determine the incremental validity of these CDEs, preliminary analyses indicated that each mandated measure has very good internal consistency reliability. Investigators designing military-related PTSD research should consider using these field-tested CDEs to facilitate future data aggregation. Feedback based on empirical evidence or practical concerns to improve these CDEs is welcome.

19 Article The pattern of symptom change during prolonged exposure therapy and present-centered therapy for PTSD in active duty military personnel. 2019

Brown, Lily A / Clapp, Joshua D / Kemp, Joshua J / Yarvis, Jeffrey S / Dondanville, Katherine A / Litz, Brett T / Mintz, Jim / Roache, John D / Young-McCaughan, Stacey / Peterson, Alan L / Foa, Edna B / Anonymous421043. ·Department of Psychiatry, University of Pennsylvania, 3535 Market Street Suite 600 N, Philadelphia, PA 19104,USA. · University of Wyoming, Laramie, WY, USA. · Warren Alpert Medical School, Providence, RI, USA. · Carl R. Darnall Army Medical Center, Fort Hood, Texas,USA. · University of Texas Health Science Center at San Antonio, San Antonio, TX,USA. · VA Boston Healthcare System and Boston University School of Medicine, Boston, MA,USA. · University of Texas Health Science Center at San Antonio and South Texas Veterans Health Care System, San Antonio, TX,USA. · University of Pennsylvania, Philadelphia, PA,USA. ·Psychol Med · Pubmed #30220261.

ABSTRACT: BACKGROUND: Few studies have investigated the patterns of posttraumatic stress disorder (PTSD) symptom change in prolonged exposure (PE) therapy. In this study, we aimed to understand the patterns of PTSD symptom change in both PE and present-centered therapy (PCT). METHODS: Participants were active duty military personnel (N = 326, 89.3% male, 61.2% white, 32.5 years old) randomized to spaced-PE (S-PE; 10 sessions over 8 weeks), PCT (10 sessions over 8 weeks), or massed-PE (M-PE; 10 sessions over 2 weeks). Using latent profile analysis, we determined the optimal number of PTSD symptom change classes over time and analyzed whether baseline and follow-up variables were associated with class membership. RESULTS: Five classes, namely rapid responder (7-17%), steep linear responder (14-22%), gradual responder (30-34%), non-responder (27-33%), and symptom exacerbation (7-13%) classes, characterized each treatment. No baseline clinical characteristics predicted class membership for S-PE and M-PE; in PCT, more negative baseline trauma cognitions predicted membership in the non-responder v. gradual responder class. Class membership was robustly associated with PTSD, trauma cognitions, and depression up to 6 months after treatment for both S-PE and M-PE but not for PCT. CONCLUSIONS: Distinct profiles of treatment response emerged that were similar across interventions. By and large, no baseline variables predicted responder class. Responder status was a strong predictor of future symptom severity for PE, whereas response to PCT was not as strongly associated with future symptoms.

20 Article Factor Structure and Psychometric Properties of the Peritraumatic and Posttraumatic Emotions Questionnaires Among Active Duty Military Personnel With Posttraumatic Stress Disorder. 2018

Zang, Yinying / Gay, Natalie G / Kaczkurkin, Antonia N / McLean, Carmen P / Wachen, Jennifer Schuster / Yarvis, Jeffrey S / Litz, Brett T / Yadin, Elna / Mintz, Jim / Roache, John D / Young-McCaughan, Stacey / Peterson, Alan L / Foa, Edna B / Resick, Patricia A / Anonymous431073. ·Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA. · National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA. · Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA. · Department of Behavioral Health, Carl R. Darnall Army Medical Center, Fort Hood, Texas, USA. · Massachusetts Veterans Epidemiological Research Center, VA Boston Healthcare System, Boston, Massachusetts. · Department of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA. · Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA. · Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas, USA. · Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA. ·J Trauma Stress · Pubmed #30548330.

ABSTRACT: The Peritraumatic Emotions Questionnaire (Peri-TEQ) and Posttraumatic Emotions Questionnaire (Post-TEQ) are self-report measures of emotions experienced during and after a traumatic event, respectively. The factor structure and psychometric properties of the Peri- and Post-TEQ were investigated among 474 military personnel with posttraumatic stress disorder (PTSD) following deployment. Exploratory factor analysis and confirmatory factor analysis were conducted to test the factor structure of the scales. Internal consistency, composite reliability, convergent validity, and discriminant validity were also assessed. Four factors were identified for the Peri-TEQ (Fear, Humiliation, Anger, and Sadness), and three factors were identified for the Post-TEQ (Fear, Anger-Hurt, and Humiliation). The full scales and all subscales demonstrated adequate-to-good internal consistency, Cronbach's αs = .722-.893. The subscales demonstrated adequate-to-good composite reliability, Cronbach's αs = .763-.861. The Peri- and Post-TEQ demonstrated good convergent validity with measures of PTSD symptoms, rs = .229-.601, ps < .001, and depressive symptoms, rs = .284-.470, ps < .001, and good discriminate validity with measures of resilience, ps = .116-.940, and unit cohesion, Peri-TEQ, p = .304 and Post-TEQ, r = -.123, p = .008. The Humiliation subscales demonstrated good convergent validity with guilt cognitions, rs = .315-.341, ps < .001, and the Anger subscales demonstrated good convergent validity with state anger, rs = .260-.347, ps < .001. The Peri- and Post-TEQ are reliable, valid self-report measures of emotions during and in response to remembering a trauma. The results support the use of these measures in research investigating trauma-related emotions.

21 Article Intensive prolonged exposure therapy for combat-related posttraumatic stress disorder: Design and methodology of a randomized clinical trial. 2018

Peterson, Alan L / Foa, Edna B / Blount, Tabatha H / McLean, Carmen P / Shah, Dhiya V / Young-McCaughan, Stacey / Litz, Brett T / Schobitz, Richard P / Castillo, Diane T / Rentz, Timothy O / Yarvis, Jeffrey S / Dondanville, Katherine A / Fina, Brooke A / Hall-Clark, Brittany N / Brown, Lily A / DeBeer, Bryann R / Jacoby, Vanessa M / Hancock, Allison K / Williamson, Douglas E / Evans, Wyatt R / Synett, Samantha / Straud, Casey / Hansen, Hunter R / Meyer, Eric C / Javors, Martin A / Sharrieff, Allah-Fard M / Lara-Ruiz, Jose / Koch, Lauren M / Roache, John D / Mintz, Jim / Keane, Terence M / Anonymous4750956. ·University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; South Texas Veterans Health Care System, San Antonio, TX, USA; University of Texas at San Antonio, San Antonio, TX, USA. Electronic address: petersona3@uthscsa.edu. · University of Pennsylvania, Philadelphia, PA, USA. Electronic address: foa@pennmedicine.upenn.edu. · University of Texas Health Science Center at San Antonio, San Antonio, TX, USA. Electronic address: blountt@uthscsa.edu. · VA Palo Alto Health Care System, Menlo Park, CA, USA; Stanford University School of Medicine, Stanford, CA, USA. Electronic address: carmen.mclean4@va.gov. · University of Texas Health Science Center at San Antonio, San Antonio, TX, USA. Electronic address: shahdv@uthscsa.edu. · University of Texas Health Science Center at San Antonio, San Antonio, TX, USA. Electronic address: youngs1@uthscsa.edu. · VA Boston Healthcare System, Boston, MA, USA; Boston University, Boston, MA, USA. Electronic address: brett.litz@va.gov. · Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, TX, USA. Electronic address: richard.p.schobitz.mil@mail.mil. · VA VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX, USA. Electronic address: diane.castillo@va.gov. · South Texas Veterans Health Care System, San Antonio, TX, USA. Electronic address: timothy.rentz@va.gov. · Carl R Darnall Army Medical Center, Fort Hood, TX, USA. Electronic address: jeffrey.s.yarvis.mil@mail.mil. · University of Texas Health Science Center at San Antonio, San Antonio, TX, USA. Electronic address: dondanville@uthscsa.edu. · University of Texas Health Science Center at San Antonio, San Antonio, TX, USA. Electronic address: fina@uthscsa.edu. · University of Texas Health Science Center at San Antonio, San Antonio, TX, USA. Electronic address: hallclark@uthscsa.edu. · University of Pennsylvania, Philadelphia, PA, USA. Electronic address: lilybr@pennmedicine.upenn.edu. · VA VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX, USA. Electronic address: bryann.debeer@va.gov. · University of Texas Health Science Center at San Antonio, San Antonio, TX, USA. Electronic address: jacobyv@uthscsa.edu. · University of Texas Health Science Center at San Antonio, San Antonio, TX, USA. Electronic address: hancocka@uthscsa.edu. · Duke University, Durham, NC, USA; Durham VA Health Care System, Durham, NC, USA. Electronic address: douglas.williamson@duke.edu. · University of Texas Health Science Center at San Antonio, San Antonio, TX, USA. Electronic address: evanswr@uthscsa.edu. · VA VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX, USA. Electronic address: synett@uthscsa.edu. · University of Texas Health Science Center at San Antonio, San Antonio, TX, USA. Electronic address: straud@uthscsa.edu. · University of Texas Health Science Center at San Antonio, San Antonio, TX, USA. Electronic address: hansenhr@uthscsa.edu. · VA VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX, USA. Electronic address: eric.meyer2@va.gov. · University of Texas Health Science Center at San Antonio, San Antonio, TX, USA. Electronic address: javors@uthscsa.edu. · Carl R Darnall Army Medical Center, Fort Hood, TX, USA. Electronic address: allah-fard.m.sharrieff.mil@mail.mil. · University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; University of Texas at San Antonio, San Antonio, TX, USA. Electronic address: lararuiz@uthscsa.edu. · University of Texas Health Science Center at San Antonio, San Antonio, TX, USA. Electronic address: kochl@uthscsa.edu. · University of Texas Health Science Center at San Antonio, San Antonio, TX, USA. Electronic address: roache@uthscsa.edu. · University of Texas Health Science Center at San Antonio, San Antonio, TX, USA. Electronic address: mintz@uthscsa.edu. · VA Boston Healthcare System, Boston, MA, USA; Boston University, Boston, MA, USA. Electronic address: terence.keane@va.gov. ·Contemp Clin Trials · Pubmed #30055335.

ABSTRACT: Combat-related posttraumatic stress disorder (PTSD) is the most common psychological health condition in military service members and veterans who have deployed to the combat theater since September 11, 2001. One of the highest research priorities for the Department of Defense and the Department of Veterans Affairs is to develop and evaluate the most efficient and efficacious treatments possible for combat-related PTSD. However, the treatment of combat-related PTSD in military service members and veterans has been significantly more challenging than the treatment of PTSD in civilians. Randomized clinical trials have demonstrated large posttreatment effect sizes for PTSD in civilian populations. However, recent randomized clinical trials of service members and veterans have achieved lesser reductions in PTSD symptoms. These results suggest that combat-related PTSD is unique. Innovative approaches are needed to augment established evidence-based treatments with targeted interventions that address the distinctive elements of combat-related traumas. This paper describes the design, methodology, and protocol of a randomized clinical trial to compare two intensive prolonged exposure therapy treatments for combat-related PTSD in active duty military service members and veterans and that can be administered in an acceptable, efficient manner in this population. Both interventions include intensive daily treatment over a 3-week period and a number of treatment enhancements hypothesized to result in greater reductions in combat-related PTSD symptoms. The study is designed to advance the delivery of care for combat-related PTSD by developing and evaluating the most potent treatments possible to reduce PTSD symptomatology and improve psychological, social, and occupational functioning.

22 Article Sources of moral injury among war veterans: A qualitative evaluation. 2018

Schorr, Yonit / Stein, Nathan R / Maguen, Shira / Barnes, J Ben / Bosch, Jeane / Litz, Brett T. ·Massachusetts Veterans Epidemiological Research and Information Center, VA Boston Healthcare System, Boston, Massachusetts. · Providence VA Medical Center, Providence, Rhode Island. · San Francisco VA Medical Center, San Francisco, California. · San Francisco School of Medicine, University of California, San Francisco, California. · School of Medicine, Boston University, Boston, Massachusetts. ·J Clin Psychol · Pubmed #29984839.

ABSTRACT: OBJECTIVE: Service members deployed to war are at risk for moral injury, but the potential sources of moral injury are poorly understood. The aim of this qualitative study was to explore the types of events that veterans perceive as morally injurious and to use those events to develop a categorization scheme for combat-related morally injurious events. METHOD: Six focus groups with US war veterans were conducted. RESULTS: Analysis based on Grounded Theory yielded two categories (and eight subcategories) of events that putatively cause moral injury. The two categories were defined by the focal attribution of responsibility for the event: Personal Responsibility (veteran's reported distress is related to his own behavior) versus Responsibility of Others (veteran's distress is related to actions taken by others). Examples of each type of morally injurious event are provided. CONCLUSIONS: Implications for the further development of the moral injury construct and treatment are discussed.

23 Article Self-Blame and PTSD Following Sexual Assault: A Longitudinal Analysis. 2018

Kline, Nora K / Berke, Danielle S / Rhodes, Charla A / Steenkamp, Maria M / Litz, Brett T. ·1 VA Boston Healthcare System, MA, USA. · 2 Boston University School of Medicine, MA, USA. · 3 NYU Langone Medical Center, NY, USA. ·J Interpers Violence · Pubmed #29683081.

ABSTRACT: Sexual assault is a prevalent trauma associated with high rates of posttraumatic stress disorder (PTSD). Social cognitive theories posit that behavioral self-blame (i.e., attributing the cause of the assault to personal peri-event behavior) contributes to the etiology and maintenance of PTSD symptoms. Yet the direction of the association between self-blame and PTSD symptoms in the acute aftermath of sexual assault is unknown. This study evaluated temporal pathways between behavioral self-blame and PTSD symptom severity in an epidemiological sample of sexual assault survivors ( n = 126) assessed at four time points in the months immediately following the assault. Results of cross-lagged panel modeling revealed that reports of behavioral self-blame at the first assessment following sexual assault predicted PTSD symptom severity at Time 2. However, there was no association between behavioral self-blame at Time 2 and PTSD symptom severity at Time 3, nor was there an association between behavioral self-blame at Time 3 and PTSD symptom severity at Time 4. Instead, PTSD symptom severity predicted behavioral self-blame at Times 3 and 4. Findings suggest that behavioral self-blame following sexual assault may be particularly relevant to the onset of PTSD symptoms, while PTSD symptoms themselves appear to intensify subsequent perceptions of behavioral self-blame. Clinical implications and limitations are discussed.

24 Article Distinct Trauma Types in Military Service Members Seeking Treatment for Posttraumatic Stress Disorder. 2018

Litz, Brett T / Contractor, Ateka A / Rhodes, Charla / Dondanville, Katherine A / Jordan, Alexander H / Resick, Patricia A / Foa, Edna B / Young-McCaughan, Stacey / Mintz, Jim / Yarvis, Jeffrey S / Peterson, Alan L / Anonymous30944. ·Massachusetts Veterans Epidemiological Research and Information Center, VA Boston Healthcare System, Boston, Massachusetts, USA. · Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA. · Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA. · Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA. · Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA. · Department of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA. · Department of Behavioral Health, Carl R. Darnall Army Medical Center, Fort Hood, Texas, USA. · Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas, USA. ·J Trauma Stress · Pubmed #29669185.

ABSTRACT: We examined the frequency of trauma types reported in a cohort of service members seeking treatment for posttraumatic stress disorder (PTSD) and compared symptom profiles between types. In this observational study, 999 service members (9.2% women; M

25 Article The Influence of Posttraumatic Stress Disorder on Health Functioning in Active-Duty Military Service Members. 2018

Asnaani, Anu / Kaczkurkin, Antonia N / Benhamou, Kathy / Yarvis, Jeffrey S / Peterson, Alan L / Young-McCaughan, Stacey / Borah, Elisa V / Dondanville, Katherine A / Hembree, Elizabeth A / Litz, Brett T / Mintz, Jim / Foa, Edna B / Anonymous20944. ·Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA. · Department of Behavioral Health, Carl R. Darnall Army Medical Center, Fort Hood, Texas, USA. · Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA. · Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas, USA. · Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, Massachusetts, USA. · Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA. · Department of Epidemiology & Biostatistics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA. ·J Trauma Stress · Pubmed #29669183.

ABSTRACT: Researchers have suggested that posttraumatic stress disorder (PTSD) is associated with significant healthcare burden and utilization of medical services. The purpose of this study was to examine the impact of PTSD symptoms on health functioning among active-duty military personnel. Participants in the study were 366 treatment-seeking service members who had returned from deployment and were participating in a larger PTSD treatment study. Assessments included measures of PTSD symptom severity, combat experiences, life stress, health functioning, alcohol use, and depression. We hypothesized that at baseline, PTSD severity and its symptom clusters would be significantly associated with poorer physical and mental health functioning. We conducted separate hierarchical multiple regressions to examine the predictive contribution the hypothesized factors would have on the variance in physical and mental health scores. Consistent with previous literature, we found that PTSD severity was significantly associated with poorer mental health functioning, B = -0.25, SE = 0.08, β = -0.15, t(342) = -3.07, R

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