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Post-Traumatic Stress Disorders: HELP
Articles from Honolulu
Based on 83 articles published since 2010
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These are the 83 published articles about Stress Disorders, Post-Traumatic that originated from Honolulu during 2010-2020.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4
1 Editorial National prevalence of traumatic brain injury, posttraumatic stress disorder, and pain diagnoses in OIF/OEF/OND Veterans from 2009 to 2011. 2013

Lew, Henry L / Cifu, David X / Crowder, Tamara / Hinds, Sidney R. ·Department of Communication Sciences and Disorders, John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, HI. ·J Rehabil Res Dev · Pubmed #24458972.

ABSTRACT: -- No abstract --

2 Review Trauma and Aging. 2018

Cook, Joan M / Simiola, Vanessa. ·Yale School of Medicine, New Haven, CT, USA. joan.cook@yale.edu. · National Center for PTSD, Evaluation Division, West Haven, CT, USA. joan.cook@yale.edu. · Kaiser Permanente, Center for Health Research, Honolulu, HI, USA. ·Curr Psychiatry Rep · Pubmed #30194546.

ABSTRACT: PURPOSE OF REVIEW: The aim of this paper is to present a succinct summary of the major scientific findings on trauma, posttraumatic stress disorder (PTSD), and aging over the past few years. RECENT FINDINGS: There have been several reports from longitudinal investigations using representative samples of veterans regarding traumatic exposure and subsequent effects on health and functioning. There has also been further documentation of the significant association between PTSD and dementia as well as accelerated aging in late life. Several studies indicate that older adults with PTSD are at risk of not receiving timely and appropriate mental health treatment, indicating that targeted outreach could be helpful in increasing service use and improving care. The current knowledge base would benefit from more research on traumatized older adults from non-industrialized countries, as well as those in North America from diverse backgrounds, including ethnic and racial minorities, women, and those with cognitive impairments. Studies limited to adults aged 65 and over as well as those addressing disparities in the availability of mental health-related services within this population are warranted.

3 Review Mind-Body Therapy for Military Veterans with Post-Traumatic Stress Disorder: A Systematic Review. 2018

Cushing, Robin E / Braun, Kathryn L. ·Office of Public Health Studies, University of Hawai'i at Mānoa , Honolulu, HI. ·J Altern Complement Med · Pubmed #28880607.

ABSTRACT: OBJECTIVE: About one-third of service members returning from post-9/11 deployment in Afghanistan and Iraq report combat-related mental health conditions, but many do not seek conventional treatment. Mind-body therapies have been offered as alternative approaches to decreasing post-traumatic stress disorder (PTSD), but no review of studies with veterans of post-9/11 operations was found. The objective of this study was to fill that gap. DESIGN: A systematic literature review was conducted following the preferred items for systematic reviews and meta-analyses (PRISMA) guidelines. PubMed MeSH terms were used to capture articles reporting on the military population (veteran and veterans) with PTSD who received a portable mind-body intervention (e.g., mindfulness, mind-body therapy, and yoga). PubMed/MEDLINE and PsycINFO were searched. Studies were included if participants were a mixed group of war veterans, as long as some post-9/11 veterans were included. In addition, participants must have had a diagnosis of PTSD or subthreshold PTSD, and the PTSD must have been attributable to combat, rather than another event, such as sexual trauma or natural disaster. RESULTS: Of 175 records identified, 15 met inclusion criteria. Studies reported on seated or gentle yoga that included breath work, meditation, mantra repetition, or breathing exercises. For 14 of the 15 studies, study retention was 70% or higher. Overall, studies reported significant improvements in PTSD symptoms in participants in these interventions. Although each study included post-9/11 veterans, about 85% of participants were from other conflicts, predominantly Vietnam. CONCLUSION: Although findings were positive, future studies are needed to evaluate the short- and long-term impact of mind-body therapies on larger samples of post-9/11 veterans and to address research questions related to broadening service member and veteran participation in these therapies.

4 Review Violence-related mild traumatic brain injury in women: identifying a triad of postinjury disorders. 2014

Davis, Alice. ·School of Nursing, University of Hawaii at Hilo, Hilo, Hawaii. ·J Trauma Nurs · Pubmed #25397339.

ABSTRACT: Violence against women whether from domestic partner abuse, sex trafficking injuries, or sexual assault is a pervasive health problem without racial or social boundaries. Regardless of cause, violence results in a complex triad of physical, emotional, and psychological injuries. There is clear evidence that female victims of violence or "battered women" experience brain injury. What is less certain is whether the constellations of events surrounding brain injury including postconcussion syndrome, depression, and posttraumatic stress disorder are acute symptoms after the brain injury, premorbid as a result of persistent abuse, or a synergistic triad of combined disorders as a result of the injuries. The purpose of this article is to examine the relationship between physical violence-associated mild traumatic brain injury (MTBI) and postinjury cognitive, emotional, and psychological disorders. The review of the literature addresses epidemiological factors associated with domestic partners and sexual violence, abuse and health outcomes in women, physical injury, and its consequences. Along with MTBI, a triad of disorders is hypothesized that includes postconcussion syndrome, depression, and posttraumatic stress disorder. Screening for MTBI and the triad of disorders is advocated, and assessment methods are offered.

5 Review Meta-analysis of the use of narrative exposure therapy for the effects of trauma among refugee populations. 2013

Gwozdziewycz, Nicolas / Mehl-Madrona, Lewis. ·Argosy University in Honolulu, HI, USA. neg3z@yahoo.com ·Perm J · Pubmed #23596375.

ABSTRACT: BACKGROUND: Narrative therapies, especially narrative exposure therapy, are used to treat the effects of trauma in refugees and to prevent psychiatric illness. These methods involve helping the person to tell the story of what happened to them until it no longer elicits anxiety. METHODS: We reviewed all quantitative studies related to narrative exposure methods for treating trauma or posttraumatic stress disorder in refugees. We focused on studies with sufficient information to calculate effect sizes and statistical power. RESULTS: We found 7 quantitative studies for which effect size and power could be calculated. The total average effect size for all interventions was 0.63 (medium). The average effect size for studies in which interventions were administered by physicians, adequately trained graduate students, or both was 0.53. The effect size for studies in which the counselors were themselves refugees was 1.02. The 95% confidence intervals for the effect sizes of narrative exposure therapy did not reach below 0. CONCLUSION: Studies demonstrating the effectiveness of narrative methods have adequate effect sizes and statistical power. Empowering lay counselors to treat their fellow refugees in future studies is warranted.

6 Review Technology complementing military behavioral health efforts at tripler army medical center. 2011

Stetz, Melba C / Folen, Raymond A / Yamanuha, Bronson K. ·Research Psychology, Department of Psychology, Tripler Army Medical Center, Honolulu, HI 96859, USA. melba.stetz@us.army.mil ·J Clin Psychol Med Settings · Pubmed #21643963.

ABSTRACT: The purpose of this article is to provide a short narrative on the ways that behavioral health professionals and their patients are currently benefitting from the use of technology. Examples stem from applications of technology to patients/research participants at the Tripler Army Medical Center. The paper also discusses how current use of this technology has made it possible to serve individuals in their own cultural environment, providing a cost-effective means of providing mental health services.

7 Review Non-impact, blast-induced mild TBI and PTSD: concepts and caveats. 2011

Chen, Yun / Huang, Wei. ·Tripler Army Medical Center, Honolulu, HI, USA. yun.chen@us.army.mil ·Brain Inj · Pubmed #21604927.

ABSTRACT: PRIMARY OBJECTIVE: A volumetric blood surge (rapid physical movement/displacement of blood) is hypothesized to cause the non-impact, mild TBI and battlefield PTSD induced by a blast over-pressure wave. RESEARCH DESIGN: Systematic review of the literature. METHODS AND PROCEDURES: Articles relating to the fields of blast injury, brain injury and relevant disorders were searched between the years 1968-2010 for keywords such as 'brain injury', 'post-traumatic stress disorder' and 'blast pressure wave'. Articles found through journal and Internet databases were cross-referenced. MAIN OUTCOMES AND RESULTS: The blood surge, which is driven by elevated overall pressure in the ventral body cavity after exposure of the torso to blast wave, may move through blood vessels to the low-pressure cranial cavity from the high-pressure ventral body cavity. It dramatically increases cerebral perfusion pressure and causes damage to both tiny cerebral blood vessels and the BBB. CONCLUSIONS: Three factors may be critical to the induction of blast-induced brain injuries: (1) the difference in pressure between the ventral body cavity and cranial cavity; (2) blood that acts as a transmission medium to propagate a pressure wave to the brain; and (3) the vulnerability of cerebral blood vessels and the BBB to a sudden fluctuation in perfusion pressure.

8 Clinical Trial Combat-related guilt and the mechanisms of exposure therapy. 2018

Trachik, Benjamin / Bowers, Clint / Neer, Sandra M / Nguyen, Vu / Frueh, B Christopher / Beidel, Deborah C. ·UCF RESTORES and Department of Psychology, University of Central Florida, 4111 Pictor Lane, Orlando, FL 32816-1390, United States; VA Puget Sound Health Care System, Seattle, 1660 S. Columbian Way, Seattle, WA 98108-1597, United States. Electronic address: ben.trachik@knights.ucf.edu. · UCF RESTORES and Department of Psychology, University of Central Florida, 4111 Pictor Lane, Orlando, FL 32816-1390, United States. Electronic address: clint.bowers@knights.ucf.edu. · UCF RESTORES and Department of Psychology, University of Central Florida, 4111 Pictor Lane, Orlando, FL 32816-1390, United States. Electronic address: sandra.neer@ucf.edu. · UCF RESTORES and Department of Psychology, University of Central Florida, 4111 Pictor Lane, Orlando, FL 32816-1390, United States. Electronic address: vu.nguyen@ucf.edu. · Department of Psychology, University of Hawaii, Hilo, HI, United States. Electronic address: frueh@hawaii.edu. · UCF RESTORES and Department of Psychology, University of Central Florida, 4111 Pictor Lane, Orlando, FL 32816-1390, United States. Electronic address: deborah.beidel@ucf.edu. ·Behav Res Ther · Pubmed #29229376.

ABSTRACT: Exposure therapy (EXP) is one of the most widely used and empirically supported treatments for PTSD; however, some researchers have questioned its efficacy with specific populations and in targeting specific symptoms. One such symptom, guilt, has garnered increased attention in the PTSD treatment literature, as it is associated with worse symptomatology and outcomes. The current study examined cognitive changes in guilt in response to Intensive (3-week) and Standard (17-week) Trauma Management Therapy (TMT), and the potential mechanisms underlying TMT treatment. TMT is an exposure based intervention that does not include an emotional processing component after the imaginal exposure session. A portion of the sample completed measures of guilt. As a result, sample size for these analyses ranged from 39 to 102 and varied by the domain and measure. Of the 102 individuals that completed the PTSD Checklist- Military Version, 42 completed the Trauma Related Guilt Inventory, and 39 completed the Clinician Administered PTSD Scale supplemental guilt items. Participants reported significant reductions in trauma-related guilt symptoms over the course of the TMT interventions. Greater reductions in avoidance and prior session general arousal predicted the reduction of guilt symptoms. Exposure therapy may be effective in reducing trauma-related guilt even in the absence of the emotional processing component of treatment.

9 Clinical Trial Open trial of exposure therapy for PTSD among patients with severe and persistent mental illness. 2016

Grubaugh, Anouk L / Clapp, Joshua D / Frueh, B Christopher / Tuerk, Peter W / Knapp, Rebecca G / Egede, Leonard E. ·Ralph H. Johnson Veterans Affairs Medical Center & Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 109 Bee Street, Charleston, SC, 29401, USA. Electronic address: grubaugh@musc.edu. · University of Wyoming, Department of Psychology, 1000 E. University Avenue, Laramie, 82071, USA. · The Menninger Clinic, Houston, TX & Department of Psychology, University of Hawaii, 200 W. Kawili Street, Hilo, HI, 96720, USA. · Ralph H. Johnson Veterans Affairs Medical Center & Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 109 Bee Street, Charleston, SC, 29401, USA. · Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, Charleston, SC, 29403, USA. · Ralph H. Johnson Veterans Affairs Medical Center & Division of General Internal Medicine and Geriatrics, Medical University of South Carolina, 135 Rutledge Avenue, P.O. Box 250593, Charleston, SC, 29425, USA. ·Behav Res Ther · Pubmed #26797658.

ABSTRACT: OBJECTIVE: There are few empirical data regarding effective treatment of trauma-related symptoms among individuals with severe mental illness (SMI; e.g., bipolar disorder, schizophrenia). This under-examined clinical issue is significant because rates of trauma and PTSD are higher among individuals with SMI relative to the general population, and there are sufficient data to suggest that PTSD symptoms exacerbate the overall course and prognosis of SMI. METHOD: 34 veterans with SMI received prolonged exposure (PE) for PTSD using an open trial study design. RESULTS: Data suggest that PE is feasible to implement, well-tolerated, and results in clinically significant decreases in PTSD severity in patients with SMI. Mean CAPS scores improved 27.2 points from baseline to immediate post [95% CI for mean change: -44.3, - 10.1; p = 0.002, paired t-test, and treatment gains were maintained at 6 months [mean change from baseline to 6-months, -16.1; 95% CI: -31.0, -1.2; p = 0.034, paired t-test]. CONCLUSIONS: The current data support the use of exposure-based interventions for PTSD among individuals with SMI and highlight the need for rigorous randomized efficacy trials investigating frontline PTSD interventions in this patient population.

10 Article "Operator syndrome": A unique constellation of medical and behavioral health-care needs of military special operation forces. 2020

Frueh, B Christopher / Madan, Alok / Fowler, J Christopher / Stomberg, Sasha / Bradshaw, Major / Kelly, Karen / Weinstein, Benjamin / Luttrell, Morgan / Danner, Summer G / Beidel, Deborah C. ·Department of Psychology, University of Hawaii, Hilo, HI, USA. · Trauma and Resilience Center, Department of Psychiatry and Behavioral Sciences, University of Texas Health Sciences Center, Houston, TX, USA. · Department of Behavioral Health, Houston Methodist Hospital, Houston, TX, USA. · Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA. · Department of Warfighter Performance, Naval Health Research Center, San Diego, CA, USA. · Department of Psychiatry and Behavioral Sciences, University of Texas Health Sciences Center, Houston, TX, USA. · Department of Psychology, University of Central Florida, Orlando, FL, USA. ·Int J Psychiatry Med · Pubmed #32052666.

ABSTRACT: -- No abstract --

11 Article Comparisons Between Patients Diagnosed with PTSD in Primary Care Versus Mental Health Care in Five Large Civilian Health Care Systems. 2020

Cook, Joan M / Zeber, John E / Simiola, Vanessa / Rossom, Rebecca / Scherrer, Jeffrey F / Owen-Smith, Ashli A / Ahmedani, Brian K / Zolfaghari, Kiumars / Copeland, Laurel A. ·Yale School of Medicine, New Haven, CT, USA. Joan.Cook@yale.edu. · Department of Psychiatry, Yale School of Medicine, 300 George St #901, New Haven, CT, 06511, USA. Joan.Cook@yale.edu. · University of Massachusetts, Amherst, MA, USA. · Central Texas Veterans Health Care System, Tempe, TX, USA. · Kaiser Permanente, Center for Integrated Health Care Research, Honolulu, HI, USA. · Health Partners Institute, Bloomington, MN, USA. · Saint Louis University, Saint Louis, MO, USA. · Kaiser Permanente Center for Research and Evaluation, Atlanta, GA, USA. · Georgia State University School of Public Health, Atlanta, GA, USA. · Henry Ford Health System, Detroit, MI, USA. · Center for Applied Health Research, Baylor Scott & White Health, Dallas, TX, USA. · VA Central Western Massachusetts Healthcare System, Leeds, MA, USA. ·J Clin Psychol Med Settings · Pubmed #32048114.

ABSTRACT: Posttraumatic stress disorder (PTSD) is a serious mental health disorder that may not be adequately detected or treated in primary care (PC). The purpose of this study was to compare the clinical characteristics and health care utilization of PTSD patients diagnosed in PC versus in specialty mental health care (MHC) across five large, civilian, not-for-profit healthcare systems. Electronic claims and medical record data on patients treated during 2014 were analyzed. Treatment was considered in terms of initiation and dose (i.e., psychotherapy sessions; pharmacotherapy-prescription psychotropics). Of 5256 patients aged 15-88 with a diagnosis of PTSD, 84.4% were diagnosed by a MHC provider. Patients diagnosed by MHC providers had 4 times the rate of and more enduring psychotherapy than those diagnosed by PC providers. Receipt of psychotropics varied by provider type, with generally higher prescription fill levels for patients in MHC. Strategies to better align patient needs with access and treatment modality in PC settings are needed.

12 Article The Association Between Sexual Functioning and Suicide Risk in U.S. Military Veteran Couples Seeking Treatment for Post-Traumatic Stress Disorder. 2020

Khalifian, Chandra E / Knopp, Kayla / Wilks, Chelsey R / Wooldridge, Jennalee / Sohn, Min Ji / Thomas, Derek / Morland, Leslie A. ·Veterans Affairs Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA. Chandra.khalifian@va.gov. · Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA. Chandra.khalifian@va.gov. · Veterans Affairs Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA. · Department of Psychology, University of Denver, Denver, CO, USA. · Department of Psychology, Harvard University, Cambridge, MA, USA. · Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA. · National Center for PTSD -Pacific Islands Division, Honolulu, HI, USA. ·Arch Sex Behav · Pubmed #31915971.

ABSTRACT: Intimate relationship distress has been identified as one of the most common precipitants of suicidal thoughts for U.S. military populations. Sexual functioning is associated with relationship distress and has recently been identified as a predictor of suicidal ideation with female military personnel; however, no studies have examined this association among a treatment-seeking sample of male and female veterans and their partners. Couples (N = 138) completed baseline assessments of sexual functioning, relationship functioning, suicidal ideation, and mental health prior to evaluation for engagement in a couples-based PTSD treatment study. Analyses revealed that decreased sexual pleasure and decreased frequency of sexual intercourse were associated with more recent suicidal ideation for male veterans, whereas increased sexual frequency was marginally associated with increased suicidal ideation for female veterans, controlling for PTSD and depression symptoms, relationship satisfaction, and medications. These findings stress the importance of assessing sexual functioning as a risk factor for suicide and taking into consideration the possibility that sexual functioning may be protective or predictive of suicidality depending on the person and context.

13 Article Opponent Effects of Hyperarousal and Re-experiencing on Affective Habituation in Posttraumatic Stress Disorder. 2020

McCurry, Katherine L / Frueh, B Christopher / Chiu, Pearl H / King-Casas, Brooks. ·Salem Veterans Affairs Medical Center, Salem, Virginia; Fralin Biomedical Research Institute at Virginia Tech Carilion, Virginia Tech, Roanoke, Virginia; Department of Psychology, Virginia Tech, Blacksburg, Virginia. · Fralin Biomedical Research Institute at Virginia Tech Carilion, Virginia Tech, Roanoke, Virginia; Department of Psychology, University of Hawaii at Hilo, Hilo, Hawaii; Trauma and Resilience Center, Department of Psychiatry, University of Texas Health Sciences Center, Houston, Texas. · Salem Veterans Affairs Medical Center, Salem, Virginia; Fralin Biomedical Research Institute at Virginia Tech Carilion, Virginia Tech, Roanoke, Virginia; Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia; Department of Psychology, Virginia Tech, Blacksburg, Virginia. Electronic address: chiup@vtc.vt.edu. · Salem Veterans Affairs Medical Center, Salem, Virginia; Fralin Biomedical Research Institute at Virginia Tech Carilion, Virginia Tech, Roanoke, Virginia; Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia; Department of Psychology, Virginia Tech, Blacksburg, Virginia; School of Biomedical Engineering and Sciences, Virginia Tech-Wake Forest University, Blacksburg, Virginia. Electronic address: bkcasas@vtc.vt.edu. ·Biol Psychiatry Cogn Neurosci Neuroimaging · Pubmed #31759868.

ABSTRACT: BACKGROUND: Aberrant emotion processing is a hallmark of posttraumatic stress disorder (PTSD), with neurobiological models suggesting both heightened neural reactivity and diminished habituation to aversive stimuli. However, empirical work suggests that these response patterns may be specific to subsets of those with PTSD. This study investigates the unique contributions of PTSD symptom clusters (re-experiencing, avoidance and numbing, and hyperarousal) to neural reactivity and habituation to negative stimuli in combat-exposed veterans. METHODS: Ninety-five combat-exposed veterans (46 with PTSD) and 53 community volunteers underwent functional magnetic resonance imaging while viewing emotional images. This study examined the relationship between symptom cluster severity and hemodynamic responses to negative compared with neutral images (NEG>NEU). RESULTS: Veterans exhibited comparable mean and habituation-related responses for NEG>NEU, relative to civilians. However, among veterans, habituation, but not mean response, was differentially related to PTSD symptom severity. Hyperarousal symptoms were related to decreased habituation for NEG>NEU in a network of regions, including superior and inferior frontal gyri, ventromedial prefrontal cortex, superior and middle temporal gyri, and anterior insula. In contrast, re-experiencing symptoms were associated with increased habituation in a similar network. Furthermore, re-experiencing severity was positively related to amygdalar functional connectivity with the left inferior frontal gyrus and dorsal anterior cingulate cortex for NEG>NEU. CONCLUSIONS: These results indicate that hyperarousal symptoms in combat-related PTSD are associated with decreased neural habituation to aversive stimuli. These impairments are partially mitigated in the presence of re-experiencing symptoms, such that during exposure to negative stimuli, re-experiencing symptoms are positively associated with amygdalar connectivity to prefrontal regions implicated in affective suppression.

14 Article Effectiveness and harms of mental health treatments in service members and veterans with deployment-related mild traumatic brain injury. 2019

Ackland, Princess E / Greer, Nancy / Sayer, Nina A / Spoont, Michele R / Taylor, Brent C / MacDonald, Roderick / McKenzie, Lauren / Rosebush, Christina / Wilt, Timothy J. ·Center for Care Delivery and Outcomes Research (CCDOR), Minneapolis VA Health Care System, One Veterans Drive (152), Minneapolis, MN 55417, USA; Department of Medicine, University of Minnesota, Minneapolis, MN. Electronic address: Princess.Ackland@va.gov. · Center for Care Delivery and Outcomes Research (CCDOR), Minneapolis VA Health Care System, One Veterans Drive (152), Minneapolis, MN 55417, USA; Minneapolis VA Evidence-based Synthesis Program Center, Minneapolis VA Health Care System, One Veterans Drive (111-O), Minneapolis, MN 55417, USA. · Center for Care Delivery and Outcomes Research (CCDOR), Minneapolis VA Health Care System, One Veterans Drive (152), Minneapolis, MN 55417, USA; Department of Medicine, University of Minnesota, Minneapolis, MN; Department of Psychiatry, University of Minnesota, Minneapolis, MN. · Center for Care Delivery and Outcomes Research (CCDOR), Minneapolis VA Health Care System, One Veterans Drive (152), Minneapolis, MN 55417, USA; Department of Medicine, University of Minnesota, Minneapolis, MN; National Center for PTSD, Honolulu, HI. · Center for Care Delivery and Outcomes Research (CCDOR), Minneapolis VA Health Care System, One Veterans Drive (152), Minneapolis, MN 55417, USA; Department of Medicine, University of Minnesota, Minneapolis, MN; Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN. · Center for Care Delivery and Outcomes Research (CCDOR), Minneapolis VA Health Care System, One Veterans Drive (152), Minneapolis, MN 55417, USA; Department of Medicine, University of Minnesota, Minneapolis, MN; Minneapolis VA Evidence-based Synthesis Program Center, Minneapolis VA Health Care System, One Veterans Drive (111-O), Minneapolis, MN 55417, USA. ·J Affect Disord · Pubmed #31028994.

ABSTRACT: BACKGROUND: Co-morbidity of psychiatric conditions with traumatic brain injury (TBI) is common among service members and Veterans from recent deployments. Practice guidelines for mild TBI (mTBI) recommend management of co-occurring psychiatric conditions with existing treatments, but it is unclear whether the effectiveness of treatments for psychiatric conditions is impacted by mTBI. We conducted a systematic literature review to examine the effectiveness and harms of pharmacological and non-pharmacological treatments for posttraumatic stress disorder, depressive disorders, substance use disorders, suicidal ideation or attempts, and anxiety disorders in the presence of co-morbid deployment-related mTBI. METHODS: We searched bibliographic databases for peer-reviewed, English language studies published from 2000 to October 2017. Two reviewers independently completed abstract triage and full text review. RESULTS: We identified 7 studies (5 pre-post and 2 secondary analysis). Six assessed psychotherapy and one reported on hyperbaric oxygen therapy (HBO LIMITATIONS: Studies lacked usual care or wait-list control groups and no randomized trials were found, making the strength of evidence insufficient. CONCLUSIONS: Evidence is insufficient to fully assess the impact of TBI on the effectiveness of treatments for psychiatric conditions. Higher quality evidence with definitive guidance for providers treating this population is needed.

15 Article Adoption by VA Residential Programs of Two Evidence-Based Psychotherapies for PTSD: Effect on Patient Outcomes. 2019

Cook, Joan M / Schnurr, Paula P / Simiola, Vanessa / Thompson, Richard / Hoff, Rani / Harpaz-Rotem, Ilan. ·Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (Cook, Hoff, Harpaz-Rotem) · National Center for PTSD, U.S. Department of Veterans Affairs (VA) Connecticut Healthcare System, West Haven (Cook, Hoff, Harpaz-Rotem) · National Center for PTSD, White River Junction VA Medical Center, White River Junction, Vermont (Schnurr) · Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire (Schnurr) · Center for Health Research, Kaiser Permanente, Honolulu (Simiola). ·Psychiatr Serv · Pubmed #30966944.

ABSTRACT: OBJECTIVE: This observational study examined the association between patient outcomes at 39 U.S. Department of Veterans Affairs residential treatment programs for veterans with posttraumatic stress disorder (PTSD) and the degree of adoption of two evidence-based psychotherapies, prolonged exposure and cognitive processing therapy. The hypothesis was that a higher degree of adoption would be associated with better outcomes. METHODS: Providers (N=171) completed a qualitative interview and quantitative survey about their level of adoption of prolonged exposure delivered individually and cognitive processing therapy delivered in individual or group formats. On the basis of responses, programs were assigned to one of three adoption categories: little or no adoption of either therapy (N=8), some adoption, (N=9), and high adoption (N=22). A linear mixed model compared patient outcomes (e.g., PTSD and depression symptom severity, substance use, and distress) between adoption groups. RESULTS: The sample of veterans consisted of 2,834 who completed an assessment of PTSD symptoms and functioning at program intake and again at either program discharge or at 4 months postdischarge. Improvements in PTSD, distress, and alcohol use were noted over time for all programs, with decreases at follow-up. No effects of adoption group or a group × time interaction were noted for any outcome. CONCLUSIONS: Moderate to large effects were noted across all programs. However, programs that used prolonged exposure and cognitive processing therapy with most or all patients did not see greater reductions in PTSD or depression symptoms or alcohol use, compared with programs that did not use these evidence-based psychotherapies.

16 Article Changes in Post-traumatic Stress Disorder Service Connection Among Veterans Under Age 55: An 18-Year Ecological Cohort Study. 2019

Murdoch, Maureen / Kehle-Forbes, Shannon / Spoont, Michele / Sayer, Nina A / Noorbaloochi, Siamak / Arbisi, Paul. ·Section of General Internal Medicine, Minneapolis VA Health Care System, One Veterans Drive (111-0), Minneapolis, MN 55417. · Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, One Veterans Drive (152), Minneapolis, MN 55417. · Department of Internal Medicine, University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN 55455. · National Center for PTSD Women's Health Sciences Division at VA Boston Healthcare System, 150 S Huntington Ave, Boston, MA 02130. · National Centers for PTSD, Pacific Islands Division, Department of Veterans Affairs 3375 Koapaka Street, Suite I-560; Honolulu, HI 96819. · Department of Psychiatry, University of Minnesota Medical School, F282/2 A West Building, 2450 Riverside Avenue S, Minneapolis, MN 55454. · Department of Psychology, College of Liberal Arts, University of Minnesota, 75 E River Rd, Minneapolis, MN 55455. · Psychology Service, Minneapolis VA Health Care System, One Veterans Drive (116-B), Minneapolis, MN 55417. ·Mil Med · Pubmed #30938816.

ABSTRACT: INTRODUCTION: Mandatory, age-based re-evaluations for post-traumatic stress disorder (PTSD) service connection contribute substantially to the Veterans Benefits Administration's work load, accounting for almost 43% of the 168,013 assessments for PTSD disability done in Fiscal Year 2017 alone. The impact of these re-evaluations on Veterans' disability benefits has not been described. MATERIALS AND METHODS: The study is an 18-year, ecological, ambispective cohort of 620 men and 970 women receiving Department of Veterans Affairs PTSD disability benefits. Veterans were representatively sampled within gender; all were eligible for PTSD disability re-evaluations at least once because of age. Outcomes included the percentage whose PTSD service connection was discontinued, reduced, re-instated, or restored. We also examined total disability ratings among those with discontinued or reduced PTSD service connection. Subgroup analyses examined potential predictors of discontinued PTSD service connection, including service era, race/ethnicity, trauma exposure type, and chart diagnoses of PTSD or serious mental illness. Our institution's Internal Review Board reviewed and approved the study. RESULTS: Over the 18 years, 32 (5.2%) men and 180 (18.6%) women had their PTSD service connection discontinued; among them, the reinstatement rate was 50% for men and 34.3% for women. Six men (1%) and 23 (2.4%) women had their PTSD disability ratings reduced; ratings were restored for 50.0% of men and 57.1% of women. Overall, Veterans who lost their PTSD service connection tended to maintain or increase their total disability rating. Predictors of discontinued PTSD service connection for men were service after the Vietnam Conflict and not having a Veterans Health Administration chart diagnosis of PTSD; for women, predictors were African American or black race, Hispanic ethnicity, no combat or military sexual assault history, no chart diagnosis of PTSD, and persistent serious mental illness. However, compared to other women who lost their PTSD service connection, African American and Hispanic women, women with no combat or military sexual assault history, and women with persistent serious illness had higher mean total disability ratings. For both men and women who lost their PTSD service connection, those without a PTSD chart diagnosis had lower mean total disability ratings than did their counterparts. CONCLUSIONS: Particularly for men, discontinuing or reducing PTSD service connection in this cohort was rare and often reversed. Regardless of gender, most Veterans with discontinued PTSD service connection did not experience reductions in their overall, total disability rating. Cost-benefit analyses could help determine if mandated, age-based re-evaluations of PTSD service connection are cost-effective.

17 Article Anger, social support, and suicide risk in U.S. military veterans. 2019

Wilks, Chelsey R / Morland, Leslie A / Dillon, Kirsten H / Mackintosh, Margaret-Anne / Blakey, Shannon M / Wagner, H Ryan / Anonymous2850972 / Elbogen, Eric B. ·Veterans Affairs Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA. Electronic address: chelseywilks@fas.harvard.edu. · Veterans Affairs Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA; University of California, San Diego, Department of Psychiatry, 9500 Gilman Dr, La Jolla, CA, 92093, USA; National Center for PTSD, Pacific Islands Division, 3375 Koapaka Street, Honolulu, HI, 96819, USA. · Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center, 3022 Croasdaile Drive, Durham, NC, 27705, USA; Durham Veterans Affairs Healthcare System, 508 Fulton Street, Durham, NC, 27705, USA; Duke University School of Medicine, 2424 Erwin Rd, Durham, NC, 27705, USA. · National Center for PTSD, Dissemination and Training Division, Veterans Affairs Palo Alto Healthcare System, NCPTSD, 334795 Willow Road Menlo Park, CA, 94025, USA. · University of North Carolina at Chapel Hill, Dept. of Psychology and Neuroscience, Davie Hall (CB 3270), Chapel Hill, NC, 27599-3270, USA. ·J Psychiatr Res · Pubmed #30537566.

ABSTRACT: There have been considerable efforts to understand, predict, and reduce suicide among U.S. military veterans. Studies have shown that posttraumatic stress disorder (PTSD), major depression (MDD), and traumatic brain injury (TBI) increase risk of suicidal behavior in veterans. Limited research has examined anger and social support as factors linked to suicidal ideation, which if demonstrated could lead to new, effective strategies for suicide risk assessment and prevention. Iraq/Afghanistan era veterans (N = 2467) were evaluated in the ongoing Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC) multi-site Study of Post-Deployment Mental Health on demographic and psychological variables. Analyses revealed that suicidal ideation in veterans was positively associated with anger and negatively associated with social support. These results remained significant in multivariate logistic regression models controlling for relevant variables including PTSD, MDD, and TBI. Examining interrelationships among these variables, the analyses revealed that the association between PTSD and suicidal ideation was no longer statistically significant once anger was entered in the regression models. Further, it was found that TBI was associated with suicidal ideation in veterans with MDD but not in veterans without MDD. These findings provide preliminary evidence that suicide risk assessment in military veterans should include clinical consideration of the roles of anger and social support in addition to PTSD, MDD, and TBI. Further, the results suggest that suicide prevention may benefit from anger management interventions as well as interventions aimed at bolstering social and family support as treatment adjuncts to lower suicide risk in veterans.

18 Article Examining Changes in Sexual Functioning after Cognitive Processing Therapy in a Sample of Women Trauma Survivors. 2019

Wells, Stephanie Y / Glassman, Lisa H / Talkovsky, Alexander M / Chatfield, Miranda A / Sohn, Min Ji / Morland, Leslie A / Mackintosh, Margaret-Anne. ·San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California; San Diego VA Healthcare System, San Diego, California. Electronic address: sw4618@gmail.com. · Center of Excellence for Stress and Mental Health, San Diego VA Healthcare System, San Diego, California; Department of Psychiatry, University of California San Diego, San Diego, California. · Palo Alto University, Palo Alto, California. · San Diego VA Healthcare System, San Diego, California. · National Center for PTSD-Pacific Island Division, Honolulu, Hawaii; Department of Psychiatry, University of California San Diego, San Diego, California. · National Center for PTSD - Dissemination and Training Division, Palo Alto, California. ·Womens Health Issues · Pubmed #30455090.

ABSTRACT: BACKGROUND: Posttraumatic stress disorder (PTSD) and sexual dysfunction commonly co-occur. Although sexual dysfunction is more prevalent among women and the negative impact of sexual dysfunction on quality of life is stronger in women compared with men, few studies examine the impact of evidence-based PTSD treatments on sexual functioning outcomes in women with PTSD. The current study examined the relationship between PTSD and sexual functioning among women trauma survivors to examine if sexual functioning improves after cognitive processing therapy (CPT). PROCEDURES: A total of 126 civilian and veteran women were randomly assigned to receive CPT delivered via either office-based videoconferencing or traditional office-based care. PTSD outcomes were examined from before treatment to after treatment and sexual functioning outcomes were examined from before treatment to the 3-month follow-up. Multigroup structural equation modeling was used to compare changes in sexual functioning and PTSD scores over time. We also compared how sexual functioning changed after treatment among women who identified a sexual trauma as their index trauma compared with those with nonsexual index traumas. FINDINGS: Greater baseline PTSD symptoms predicted poorer sexual satisfaction at baseline. Sexual satisfaction, arousal, and desire improved after CPT; veteran status and index trauma type (i.e., sexual vs. nonsexual) did not attenuate this relationship. Women who had greater decreases in PTSD symptoms experienced greater improvements in sexual satisfaction, arousal, and desire. CONCLUSIONS: The current study provides preliminary support that CPT treatment may improve sexual functioning in women trauma survivors. Clinicians should assess sexual functioning to promote disclosure and develop a treatment plan.

19 Article BDNF Val66Met polymorphism and posttraumatic stress symptoms in U.S. military veterans: Protective effect of physical exercise. 2019

Pitts, Barbara L / Whealin, Julia M / Harpaz-Rotem, Ilan / Duman, Ronald S / Krystal, John H / Southwick, Steven M / Pietrzak, Robert H. ·U.S. Department of Veterans Affairs VA Pacific Islands Healthcare System, Honolulu, HI, USA. · U.S. Department of Veterans Affairs VA Pacific Islands Healthcare System, Honolulu, HI, USA; University of Hawaii School of Medicine, Manoa, HI, USA. · U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA. · Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Department of Neurobiology, Yale University School of Medicine, New Haven, CT, USA. · U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA. Electronic address: robert.pietrzak@yale.edu. ·Psychoneuroendocrinology · Pubmed #30388593.

ABSTRACT: The Met allele of the brain-derived neurotrophic factor (BDNF) Val66Met polymorphism is associated with reduced levels of BDNF release, heightened hypothalamic-pituitary-adrenal axis reactivity, and impaired fear extinction. As a result, Met allele carriers may be at risk for greater severity of posttraumatic stress disorder (PTSD) symptoms. In this study, we examined the relationship between the BDNF Val66Met polymorphism and PTSD symptoms in two nationally representative samples of European American U.S. military veterans (main sample, n = 1386; replication sample, n = 509). Results revealed that, relative to Val/Val homozygotes, Met allele carriers reported greater severity of lifetime and current PTSD symptoms, specifically re-experiencing symptoms. Met allele carriers with high trauma burden also reported greater severity of lifetime and past-month PTSD symptoms. Greater engagement in physical exercise moderated this gene-by-environment interaction. Specifically, among veterans with high lifetime trauma burden, Met allele carriers who exercised had significantly lower severity of PTSD symptoms compared to those who did not exercise. These findings suggest that interventions designed to bolster engagement in physical exercise may help mitigate PTSD symptoms in veterans who are Met allele carriers and highly exposed to trauma.

20 Article Heart Rate Variability and Cognitive Bias Feedback Interventions to Prevent Post-deployment PTSD: Results from a Randomized Controlled Trial. 2019

Pyne, Jeffrey M / Constans, Joseph I / Nanney, John T / Wiederhold, Mark D / Gibson, Douglas P / Kimbrell, Timothy / Kramer, Teresa L / Pitcock, Jeffery A / Han, Xiaotong / Williams, D Keith / Chartrand, Don / Gevirtz, Richard N / Spira, James / Wiederhold, Brenda K / McCraty, Rollin / McCune, Thomas R. ·Center for Mental Health Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR. · South Central Mental Illness Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR. · Division of Health Services Research, Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR. · Southeastern Louisiana Veterans Health Care System, Tulane University, Department of Psychiatry and Behavioral Sciences, New Orleans, LA. · Department of Psychological Sciences, University of Missouri-Saint Louis, One University Boulevard, 325 Stadler Hall, St. Louis, MO. · Virtual Reality Medical Centers, 9565 Waples Street, Suite 200, San Diego, CA. · Office of the State Surgeon, Virginia Army National Guard, BLDG 1310, Ft. Pickett, Blackstone, VA. · Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR. · Institute of HeartMath, 14700 West Park Ave., Boulder Creek, CA. · Alliant International University, 10455 Pomerado Road, San Diego, CA. · National Center for PTSD, US Department of Veterans Affairs, University of Hawaii School of Medicine, Department of Psychiatry, Honolulu, HI. ·Mil Med · Pubmed #30020511.

ABSTRACT: Introduction: There is a long history of pre-deployment PTSD prevention efforts in the military and effective pre-deployment strategies to prevent post-deployment PTSD are still needed. Materials and Methods: This randomized controlled trial included three arms: heart rate variability biofeedback (HRVB), cognitive bias modification for interpretation (CBM-I), and control. The hypothesis was that pre-deployment resilience training would result in lower post-deployment PTSD symptoms compared with control. Army National Guard soldiers (n = 342) were enrolled in the Warriors Achieving Resilience (WAR) study and analyzed. The outcome was PTSD symptom severity using the PTSD Checklist - Military version (PCL) measured at pre-deployment, 3- and 12-month post-deployment. Due to the repeated measures for each participant and cluster randomization at the company level, generalized linear mixed models were used for the analysis. This study was approved by the Army Human Research Protection Office, Central Arkansas Veterans Healthcare System Institutional Review Board (IRB), and Southeast Louisiana Veterans Health Care System IRB. Results: Overall, there was no significant intervention effect. However, there were significant intervention effects for subgroups of soldiers. For example, at 3-months post-deployment, the HRVB arm had significantly lower PCL scores than the control arm for soldiers with no previous combat zone exposure who were age 30 and older and for soldiers with previous combat zone exposure who were 45 and older (unadjusted effect size -0.97 and -1.03, respectively). A significant difference between the CBM-I and control arms was found for soldiers without previous combat zone exposure between ages 23 and 42 (unadjusted effect size -0.41). Similarly, at 12-months post-deployment, the HRVB arm had significantly lower PCL scores in older soldiers. Conclusion: Pre-deployment resilience training was acceptable and feasible and resulted in lower post-deployment PTSD symptom scores in subgroups of older soldiers compared with controls. Strengths of the study included cluster randomization at the company level, use of iPod device to deliver the resilience intervention throughout the deployment cycle, and minimal disruption of pre-deployment training by using self-paced resilience training. Weaknesses included self-report app use, study personnel not able to contact soldiers during deployment, and in general a low level of PTSD symptom severity throughout the study. In future studies, it would important for the study team and/or military personnel implementing the resilience training to be in frequent contact with participants to ensure proper use of the resilience training apps.

21 Article Trauma management therapy with virtual-reality augmented exposure therapy for combat-related PTSD: A randomized controlled trial. 2019

Beidel, Deborah C / Frueh, B Christopher / Neer, Sandra M / Bowers, Clint A / Trachik, Benjamin / Uhde, Thomas W / Grubaugh, Anouk. ·Department of Psychology, University of Central Florida, 4111 Pictor Lane, Orlando, FL, 32816, USA. Electronic address: deborah.beidel@ucf.edu. · Department of Psychology, University of Hawaii at Hilo, 200 W. Kawili St., Hilo, HI, 96720-4091, USA. Electronic address: frueh@hawaii.edu. · Department of Psychology, University of Central Florida, 4111 Pictor Lane, Orlando, FL, 32816, USA. Electronic address: sandra.neer@ucf.edu. · Department of Psychology, University of Central Florida, 4111 Pictor Lane, Orlando, FL, 32816, USA. Electronic address: clint.bowers@ucf.edu. · Department of Psychology, University of Central Florida, 4111 Pictor Lane, Orlando, FL, 32816, USA. Electronic address: ben.trachik@knights.ucf.edu. · Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, Charleston, SC, 29425, USA. Electronic address: uhde@musc.edu. · Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, Charleston, SC, 29425, USA. Electronic address: grubaugh@musc.edu. ·J Anxiety Disord · Pubmed #28865911.

ABSTRACT: Virtual reality exposure therapy (VRET) realistically incorporates traumatic cues into exposure therapy and holds promise in the treatment of combat-related posttraumatic stress disorder (PTSD). In a randomized controlled trial of 92 Iraq and Afghanistan veterans and active duty military personnel with combat-related PTSD, we compared the efficacy of Trauma Management Therapy (TMT; VRET plus a group treatment for anger, depression, and social isolation) to VRET plus a psychoeducation control condition. Efficacy was evaluated at mid- and post-treatment, and at 3- and 6-month follow-up. Consistent with our hypothesis, VRET resulted in significant decreases on the Clinician Administered PTSD Scale and the PTSD Checklist-Military version for both groups. Also consistent with our hypothesis, significant decreases in social isolation occurred only for those participants who received the TMT group component. There were significant decreases for depression and anger for both groups, although these occurred after VRET and before group treatment. All treatment gains were maintained six-months later. Although not part of the original hypotheses, sleep was not improved by either intervention and remained problematic. The results support the use of VRET as an efficacious treatment for combat-related PTSD, but suggest that VRET alone does not result in optimal treatment outcomes across domains associated with PTSD.

22 Article The Development of a Brief Version of the Posttraumatic Cognitions Inventory (PTCI-9). 2019

Wells, Stephanie Y / Morland, Leslie A / Torres, Elisa M / Kloezeman, Karen / Mackintosh, Margaret-Anne / Aarons, Gregory A. ·1 San Diego VA Healthcare System, San Diego, CA, USA. · 2 San Diego State University/University of California Joint Doctoral Program in Clinical Psychology. · 3 Department of Psychiatry, University of California, San Diego, CA, USA. · 4 National Center for PTSD-Pacific Islands Division, Honolulu, HI, USA. ·Assessment · Pubmed #28092974.

ABSTRACT: Negative posttraumatic cognitions lead to the development and maintenance of posttraumatic stress disorder symptoms. There is a need for a brief measure to assess these cognitions. Participants were administered the Posttraumatic Cognitions Inventory (PTCI) and measures of mental health symptomatology. These data were used to develop a brief version of the PTCI (PTCI-9) in 223 male and female veterans, which was then examined in a sample of 117 female civilians. Confirmatory factor analyses demonstrated an acceptable fit in both samples. The PTCI-9 total and subscale scores showed strong internal consistencies (Cronbach's αs = .80-.87) and strong correlations with the PTCI in veterans ( rs = .90-.96) and civilians ( rs = .91-.96). Measurement invariance testing demonstrated partial invariance between the two samples. The PTCI-9 significantly correlated with measures of PTSD, depression, and quality of life. These findings demonstrate that the PTCI-9 is a reliable and valid measure of posttraumatic cognitions that can reduce patient and provider burden.

23 Article Use of Reflective Journaling to Understand Decision Making Regarding Two Evidence-Based Psychotherapies for PTSD: Practice Implications. 2018

Cook, Joan M / Simiola, Vanessa / McCarthy, Elissa / Ellis, Amy / Wiltsey Stirman, Shannon. ·Department of Psychiatry Yale School of Medicine and National Center for PTSD, West Haven, Connecticut. · Department of Psychiatry, Yale School of Medicine and Kaiser Permanente, Honolulu, Hawaii. · National Center for PTSD, White River Junction,Vermont. · Institutional Center for Scientific Research, Albizu University, Miami, Florida. · Department of Psychiatry and Behavioral Sciences, National Center for PTSD, Palo Alto, California and Stanford University of Medicine. ·Pract Innov (Wash D C) · Pubmed #30906873.

ABSTRACT: As part of a longitudinal investigation on implementation of 2 evidence-based psychotherapies (EBPs) for posttraumatic stress disorder, psychotherapists from 38 Department of Veterans Affairs residential treatment programs across the United States were asked to complete reflective journals every 4 months for a 1-year time period in regard to their successes and challenges in using prolonged exposure and cognitive processing therapy. This paper provides content analysis on the reflective journals of 24 of these providers. Five main themes were identified: EBPs are great but not sufficient for patients in residential treatment with chronic posttraumatic stress disorder and complicated life circumstances, and thus, more treatment is necessary after discharge. Modifications were made or thought needed for optimal outcome and successful delivery of these 2 EBPs; some providers blended aspects of prolonged exposure and cognitive processing therapy; what happens when providers and patients do not agree on choice of which EBP to first implement; and provider concerns on when to discontinue an EBP. Reflective journaling appears to be a promising way for trainers and treatment developers to gather important information about the clinical application and decision-making process for front-line providers, which may offer insight into how to improve EBP implementation and sustainability. Incorporating reflective journaling and strategies for accomplishing this into training, supervision, and consultation may also be 1 strategy for increasing feedback, expanding implementation, and informing ways to increase sustainability of EBPs in populations with multiple clinical and psychosocial needs.

24 Article A Qualitative Study Exploring Yoga in Veterans with PTSD Symptoms. 2018

Cushing, Robin E / Braun, Kathryn L / Alden, Susan. ·1. Office of Public Health Studies, University of Hawai'i at Manoa, Honolulu. · 2. Executive Director, Warriors at Ease, Silver Spring, Md. ·Int J Yoga Therap · Pubmed #30117759.

ABSTRACT: Quantitative studies of yoga have reported reduced posttraumatic stress disorder (PTSD) symptoms in veterans, but little is known about how and why veterans are attracted to and stick with a yoga practice. Guided by the Health Belief Model, this study examined veterans' perceptions of the benefits, barriers, and motivations to continue practicing trauma-sensitive yoga. Interviews were conducted with nine individuals, five of whom completed a 6-week trauma-sensitive yoga intervention designed for veterans and four who did not complete the intervention. Transcripts were analyzed for themes. The benefits identified by veterans were finding mental stillness, body awareness, and social connection. The barriers were perceptions that yoga is socially unacceptable, especially for men, and physically unchallenging. Understanding these benefits and barriers can help to make yoga more attractive to service members and veterans. For example, medical personnel can refer service members and veterans to yoga not only for PTSD symptoms, but also to address back pain and to reduce isolation. Access to male yoga instructors, especially those who are themselves service members or veterans, could be expanded, and classes could be integrated into physical activity routines required of active-duty personnel. Promotional materials can feature male service members and veterans with captions related to yoga as a way to increase resiliency, self-sufficiency, and physical and mental mission readiness. Findings from this study can help the Department of Defense and the Veterans Health Administration implement yoga as an adjunct or alternative treatment for veterans with PTSD symptoms.

25 Article PHIT for Duty, a Mobile Application for Stress Reduction, Sleep Improvement, and Alcohol Moderation. 2018

Kizakevich, Paul N / Eckhoff, Randall / Brown, Janice / Tueller, Stephen J / Weimer, Belinda / Bell, Stacey / Weeks, Adam / Hourani, Laurel L / Spira, James L / King, Laurel A. ·RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC 27713. · VA Pacific Islands Health Care System, 459 Patterson Rd, Honolulu, HI 96819. · Department of Psychiatry, University of Hawaii, 356 Lusitana Street, 4th Floor, Honolulu, HI 96813. · Pacific Health Research & Education Institute, 846S Hotel St Ste 301, Honolulu, HI 96813. ·Mil Med · Pubmed #29635566.

ABSTRACT: Post-traumatic stress and other problems often occur after combat, deployment, and other military operations. Because techniques such as mindfulness meditation show efficacy in improving mental health, our team developed a mobile application (app) for individuals in the armed forces with subclinical psychological problems as secondary prevention of more significant disease. Based on the Personal Health Intervention Toolkit (PHIT), a mobile app framework for personalized health intervention studies, PHIT for Duty integrates mindfulness-based relaxation, behavioral education in sleep quality and alcohol use, and psychometric and psychophysiological data capture. We evaluated PHIT for Duty in usability and health assessment studies to establish app quality for use in health research. Participants (N = 31) rated usability on a 1 (very hard) to 5 (very easy) scale and also completed the System Usability Scale (SUS) questionnaire (N = 9). Results were (mean ± SD) overall (4.5 ± 0.6), self-report instruments (4.5 ± 0.7), pulse sensor (3.7 ± 1.2), sleep monitor (4.4 ± 0.7), sleep monitor comfort (3.7 ± 1.1), and wrist actigraphy comfort (2.7 ± 0.9). The average SUS score was 85 ± 12, indicating a rank of 95%. A comparison of PHIT-based assessments to traditional paper forms demonstrated a high overall correlation (r = 0.87). These evaluations of usability, health assessment accuracy, physiological sensing, system acceptability, and overall functionality have shown positive results and affirmation for using the PHIT framework and PHIT for Duty application in mobile health research.

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