Tag: PTSD: Post-Traumatic Stress Disorder

Evidence-Based Practices for the (Web-based) Treatment of PTSD

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Research Paper Title

Understanding How Clinicians Use a New Web-based Tool for Disseminating Evidence-Based Practices for the Treatment of PTSD: The PTSD Clinicians Exchange.

Background

Web-based interventions hold great promise for the dissemination of best practices to clinicians, and investment in these resources has grown exponentially. Yet, little research exists to understand their impact on intended objectives.

Methods

The Post-Traumatic Stress Disorder (PTSD) Clinicians Exchange is a website to support clinicians treating veterans and active duty military personnel with PTSD, evaluated in a randomised controlled trial (N = 605). This manuscript explores how a subset of clinicians, those who utilised the intervention (N = 148), engaged with it by examining detailed individual-level web analytics and qualitative feedback. Stanford University and New England Research Institutes Institutional Review Boards approved this study.

Results

Only 32.7% of clinicians randomised to the intervention ever accessed the website. The number of pages viewed was positively associated with changes from baseline to 12 months in familiarity (P = 0.03) and perceived benefit of practices (P = 0.02). Thus, engagement with the website did predict an improvement in practice familiarity and benefit outcomes despite low rates of use.

Conclusions

This study demonstrates the importance of methodologically rigorous evaluations of participant engagement with web-based interventions.

These approaches provide insight into who accesses these tools, when, how, and with what results, which can be translated into their strategic design, evaluation, and dissemination.

Reference

Coleman, J.L., Marceau, L., Zincavage, R., Magnavita, A.M., Ambrosoli, J., Shi, L., Simon, E., Ortigo, K., Clarke-Walper, K., Penix, E., Wilk, J., Ruzek, J.I. & Rosen, R.C. (2020) Understanding How Clinicians Use a New Web-based Tool for Disseminating Evidence-Based Practices for the Treatment of PTSD: The PTSD Clinicians Exchange. Military Medicine. 185(Suppl 1), pp.286-295. doi: 10.1093/milmed/usz313.

Can Internet-based Clinical Practice Guidelines aid in the Management of PTSD?

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Research Paper Title

Randomized Controlled Trial of a Web-Based Intervention to Disseminate Clinical Practice Guidelines for Posttraumatic Stress Disorder: The PTSD Clinicians Exchange.

Background

Delivery of best-practice care for Post-Traumatic Stress Disorder (PTSD) is a priority for clinicians working with active duty military personnel and veterans.

The PTSD Clinicians Exchange, an Internet-based intervention, was designed to assist in disseminating clinically relevant information and resources that support delivery of key practices endorsed in the Veterans Administration (VA)-Department of Defence (DoD) Clinical Practice Guidelines (CPG) for the Management of Posttraumatic Stress.

Methods

The researchers conducted a randomised controlled trial to examine the effectiveness of the Clinicians Exchange intervention in increasing familiarity and perceived benefits of 26 CPG-related and emerging practices.

The intervention consisted of ongoing access to an Internet resource featuring best-in-class resources for practices, self-management of burnout, and biweekly e-mail reminders highlighting selected practices.

Mental health clinicians (N = 605) were recruited from three service sectors (VA, DoD, community); 32.7% of participants assigned to the Internet intervention accessed the site to view resources.

Results

Individuals who were offered the intervention increased their practice familiarity ratings significantly more than those assigned to a newsletter-only control condition, d = 0.27, p = .005.

From baseline to 12-months, mean familiarity ratings of clinicians in the intervention group increased from 3.0 to 3.4 on scale of 1 (not at all) to 5 (extremely); mean ratings for the control group were 3.2 at both assessments.

Clinicians generally viewed the CPG practices favourably, rating them as likely to benefit their clients.

Conclusions

The results suggest that Internet-based resources may aid more comprehensive efforts to disseminate CPGs, but increasing clinician engagement will be important.

Reference

Ruzek, J.I., Wilk, J., Simon, E., Marceau, L., Trachtenberg, F.L., Magnavita, A.M., Coleman, J.L., Ortigo, K., Ambrosoli, J., Zincavage, R., Clarke-Walper, K., Penix, E. & Rosen, R.C. (2020) Randomized Controlled Trial of a Web-Based Intervention to Disseminate Clinical Practice Guidelines for Posttraumatic Stress Disorder: The PTSD Clinicians Exchange. Journal of Traumatic Stress. 33(2), pp.190-196. doi: 10.1002/jts.22483. Epub 2020 Feb 26.

What is the Role of Combat Exposure & Malevolent Environments in Mental Health?

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Research Paper Title

Do different types of war stressors have independent relations with mental health? Findings from the Korean Vietnam Veterans Study.

Background

South Korea had the second largest contingent of soldiers in the Vietnam War, but little is known about their adaptation, especially in later life.

Previous work in a different sample found very high rates of post-traumatic stress disorder (PTSD; 41%) among Korean Vietnam veterans (KVVs; Kang, Kim, & Lee, 2014), compared to 19-31% for American Vietnam veterans.

The researchers explored possible reasons for this high rate of PTSD, as well as anxiety and depressive symptoms, utilising both vulnerability factors (e.g., war stressors) and protective factors (optimism, unit cohesion, and homecoming experiences).

Method

The sample included 367 male KVVs surveyed by mail (M age = 72, SD = 2.66).

Using hierarchical regressions controlling for demographics, the researchers examined the relative contributions of different types of war stressors and then the protective factors.

Results

Combat exposure was significantly associated with the three types of negative psychological symptoms, but their associations became non-significant when “subjective” war stressors (malevolent environments, perceived threat, and moral injury) were added.

In the final models, malevolent environments were the strongest predictor for all three outcomes.

In addition, moral injury was independently associated with PTSD symptoms, while perceived threat was marginally associated with depressive and anxiety symptoms.

Among psychosocial factors, only optimism was negatively associated with the mental health outcomes.

Conclusions

KVVs had very high rates of combat exposure, but malevolent environments played a more important role in their mental health in later life.

These findings suggest the importance of considering adverse environmental factors in understanding PTSD in future studies.

Reference

Lee, H., Aldwin, C.M. & Kang, S. (2020) Do different types of war stressors have independent relations with mental health? Findings from the Korean Vietnam Veterans Study. Psychological Trauma: Theory, Research, Practice, and Policy. doi: 10.1037/tra0000557. [Epub ahead of print].

Is There a Link between Elevated Spindle Oscillatory Frequency in PTSD & Sleep Continuity?

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Research Paper Title

Increased Oscillatory Frequency of Sleep Spindles in Combat-Exposed Veteran Men with Post-Traumatic Stress Disorder.

Background

Sleep disturbances are core symptoms of post-traumatic stress disorder (PTSD), but reliable sleep markers of PTSD have yet to be identified.

Sleep spindles are important brain waves associated with sleep protection and sleep-dependent memory consolidation.

The present study tested whether sleep spindles are altered in individuals with PTSD and whether the findings are reproducible across nights and sub-samples of the study.

Methods

Seventy-eight combat-exposed veteran men with (n = 31) and without (n = 47) PTSD completed two consecutive nights of high-density EEG recordings in a laboratory.

The researchers identified slow (10-13 Hz) and fast (13-16 Hz) sleep spindles during N2 and N3 sleep stages and performed topographical analyses of spindle parameters (amplitude, duration, oscillatory frequency, and density) on both nights.

To assess reproducibility, we used the first 47 consecutive participants (18 with PTSD) for initial discovery and the remaining 31 participants (13 with PTSD) for replication assessment.

Results

In the discovery analysis, compared to non-PTSD participants, PTSD participants exhibited:

  1. Higher slow-spindle oscillatory frequency over the antero-frontal regions on both nights; and
  2. Higher fast-spindle oscillatory frequency over the centro-parietal regions on the second night.

The first finding was preserved in the replication analysis.

The researchers found no significant group differences in the amplitude, duration, or density of slow or fast spindles.

Conclusions

The elevated spindle oscillatory frequency in PTSD may indicate a deficient sensory-gating mechanism responsible for preserving sleep continuity.

The findings, if independently validated, may assist in the development of sleep-focused PTSD diagnostics and interventions.

Reference

Wang, C., Laxminarayan, S., Ramakrishnan, S., Dovzhenok, A., Cashmere, J.D., Germain, A. & Reifman, J. (2020) Increased Oscillatory Frequency of Sleep Spindles in Combat-Exposed Veteran Men with Post-Traumatic Stress Disorder. Sleep. pii: zsaa064. doi: 10.1093/sleep/zsaa064. [Epub ahead of print].

PTSD & Korean War Veterans

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Research Paper Title

Aging and Trauma: Post Traumatic Stress Disorder Among Korean War Veterans.

Background

Having experienced posttraumatic stress disorder 30 years prior to its recognition as a formal disorder, Korean War veterans are now an ageing population that requires unique clinical management.

The Korean War lasted from 25 June 1950 through 27 July 1953. Although many veterans of the Korean War experienced traumas during extremely stressful combat conditions. However, they would not have been diagnosed with post-traumatic stress disorder (PTSD) at the time because the latter did not exist as a formal diagnosis until the publication of the third edition of the Diagnostic and Statistical Manual (DSM) in 1980. Prior to 1980, psychiatric syndromes resulting from war and combat exposure where known by numerous other terms including shell shock, chronic traumatic war neurosis, and combat fatigue/combat exhaustion. Military psychiatrists attended to combat fatigue during the course of the Korean War, but as was true of World War I and II, the focus was on returning soldiers to duty. Combat fatigue was generally viewed as a transient condition.

Although now octo- and nonagenarians, in 2019 there are 1.2 million living Korean War veterans in the US, representing 6.7% of all current veterans. Understanding their war experiences and the nature of their current and past presentation of PTSD is relevant not only in formal mental health settings, but in primary care settings, including home-based primary care, as well as community living centres, skilled nursing facilities and assisted living facilities. Older adults with PTSD often present with somatic concerns rather than spontaneously reporting mental health symptoms. Beyond the short-term clinical management of Korean War veterans with PTSD, consideration of their experiences also has long-term relevance for the appropriate treatment of other veteran cohorts as they age in coming decades.

The purpose of this article is to provide a clinically focused overview of PTSD in Korean War veterans, to help promote understanding of this often-forgotten group of veterans, and to foster optimised personalised care. This overview will include a description of the Korean War veteran population and the Korean War itself, the manifestations and identification of PTSD among Korean War veterans, and treatment approaches using evidence-based psychotherapies and pharmacotherapies. Finally, the researches provide recommendations for future research to address present empirical gaps in the understanding and treatment of Korean War veterans with PTSD.

Reference

Palmer, B.W., Friend, S., Huege, S., Mulvaney, M., Badawood, A., Almaghraby, A. & Lohr, J.B. (2019) Aging and Trauma: Post Traumatic Stress Disorder Among Korean War Veterans. Federal Practitioner. 36(12), pp.554-562.

What is the Intergenerational Transmission of Risk for PTSD Symptoms & the Roles of Maternal and Child Emotion Dysregulation?

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Research Paper Title

Intergenerational transmission of risk for PTSD symptoms in African American children: The roles of maternal and child emotion dysregulation.

Background

Emotion dysregulation is a transdiagnostic risk factor for many mental health disorders and develops in the context of early trauma exposure.

Research suggests inter-generational risk associated with trauma exposure and post-traumatic stress disorder (PTSD), such that maternal trauma experiences and related symptoms can negatively impact child outcomes across development.

The goals of the present study were to examine child and mother correlates of child PTSD symptoms and the unique roles of child and maternal emotion dysregulation in understanding child PTSD symptoms.

Methods

Subjects included 105 African American mother-child dyads from an urban hospital serving primarily low-income minority individuals.

Results

Correlational results showed that child trauma exposure, child emotion dysregulation, maternal depressive symptoms, maternal emotion dysregulation, and potential for maternal child abuse all were significantly associated with child PTSD symptoms (ps < 0.05).

Hierarchical linear regression models revealed that child trauma exposure, maternal depression, and maternal abuse potential accounted for 29% of the variance in child PTSD symptoms (p < 0.001).

Both child emotion dysregulation (Rchange² = 0.14, p < .001) and maternal emotion dysregulation (Rchange² = 0.04, p < .05) were significantly associated with child PTSD symptoms independent of other risk factors and potential for maternal abuse was no longer a significant predictor.

Conclusions

These results suggest that maternal emotion dysregulation may be an important factor in influencing their child’s PTSD symptoms above and beyond child-specific variables.

Both maternal and child emotion dysregulation could be valuable treatment targets for improving maternal mental health and parenting behaviours and bolstering child health outcomes, thus reducing inter-generational transmission of risk associated with trauma.

Reference

Powers, A., Stevens, J.S., O’Banion, D., Stenson, A.F., Kaslow, N., Jovanovic, T. & Bradley, B. (2020) Intergenerational transmission of risk for PTSD symptoms in African American children: The roles of maternal and child emotion dysregulation. Psychological Trauma: Theory, Research, Practice and Policy. doi: 10.1037/tra0000543. [Epub ahead of print].

Post-Traumatic Growth & Support: Consider Quality & Quantity

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Research Paper Title

The impact of received social support on posttraumatic growth after disaster: The importance of both support quantity and quality.

Background

Few studies have investigated the relationship between received social support (actual help received) and posttraumatic growth (PTG), and these studies focused only on the quantity of support received.

This study examined the joint implications of both the quantity and quality of post-disaster received social support for PTG.

Methods

Data were collected from Lushan earthquake (China, in 2013) survivors at 7 (n = 199) and 31 (n = 161) months after the earthquake.

The main effects of quantity and quality of received support, and the interaction between support quantity and support quality, were examined using hierarchical multiple regression analyses controlling for the extent of disaster exposure, post-disaster negative life events, and sociodemographic factors.

Results

Neither quantity nor quality of received social support exerted significant main effects on PTG.

However, the influence of the amount of received social support on PTG was moderated by the quality of received social support.

Among survivors who appraised the post-disaster social support they received as higher in quality, greater amounts of received support were associated with more subsequent PTG.

Among those survivors who appraised the post-disaster social support they received as lower in quality, greater quantity of received support was associated with lower levels of reported PTG.

Conclusions

This study calls attention to the importance of enhancing the quality of help provided to disaster survivors because simply “more” support is not necessarily better.

Reference

Shang, F., Kaniasty, K., Cowlishaw, S., Wade, D., Ma, H. & Forbes, D. (2020) The impact of received social support on posttraumatic growth after disaster: The importance of both support quantity and quality. Psychological Trauma: Theory, Research, Practice, and Policy. doi: 10.1037/tra0000541. [Epub ahead of print].

Could an Elevated Spindle Oscillatory Frequency in PTSD Indicate a Deficient Sensory-gating Mechanism is Responsible For Preserving Sleep Continuity?

Published on by Andrew MarshallLeave a comment

Research Paper Title

Increased Oscillatory Frequency of Sleep Spindles in Combat-Exposed Veteran Men with Post-Traumatic Stress Disorder.

Background

Sleep disturbances are core symptoms of post-traumatic stress disorder (PTSD), but reliable sleep markers of PTSD have yet to be identified.

Sleep spindles are important brain waves associated with sleep protection and sleep-dependent memory consolidation.

The present study tested whether sleep spindles are altered in individuals with PTSD and whether the findings are reproducible across nights and sub-samples of the study.

Methods

Seventy-eight combat-exposed veteran men with (n = 31) and without (n = 47) PTSD completed two consecutive nights of high-density EEG recordings in a laboratory.

The researchers identified slow (10-13 Hz) and fast (13-16 Hz) sleep spindles during N2 and N3 sleep stages and performed topographical analyses of spindle parameters (amplitude, duration, oscillatory frequency, and density) on both nights.

To assess reproducibility, they used the first 47 consecutive participants (18 with PTSD) for initial discovery and the remaining 31 participants (13 with PTSD) for replication assessment.

Results

In the discovery analysis, compared to non-PTSD participants, PTSD participants exhibited 1) higher slow-spindle oscillatory frequency over the antero-frontal regions on both nights and 2) higher fast-spindle oscillatory frequency over the centro-parietal regions on the second night.

The first finding was preserved in the replication analysis.

The researchers found no significant group differences in the amplitude, duration, or density of slow or fast spindles.

Conclusions

The elevated spindle oscillatory frequency in PTSD may indicate a deficient sensory-gating mechanism responsible for preserving sleep continuity.

The findings, if independently validated, may assist in the development of sleep-focused PTSD diagnostics and interventions.

Reference

Wang, C., Laxminarayan, S., Ramakrishnan, S., Dovzhenok, A., Cashmere, J.D., Germain, A. & Reifman, J. (2020) Increased Oscillatory Frequency of Sleep Spindles in Combat-Exposed Veteran Men with Post-Traumatic Stress Disorder. Sleep. pii: zsaa064. doi: 10.1093/sleep/zsaa064. [Epub ahead of print].

Book: The PTSD Workbook

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Book Title:

The PTSD Workbook, 3rd Edition: Simple, Effective Techniques for Overcoming Traumatic Stress Symptoms.

Author(s): Mary Beth Williams and Soili Poijula.

Year: 2016.

Edition: Third (3rd).

Publisher: New Harbinger.

Type(s): Paperback and Kindle.

Synopsis:

Post-traumatic stress disorder (PTSD) is an extremely debilitating condition that can occur after exposure to a terrifying event.

But whether you are a veteran of war, a victim of domestic violence or sexual violence, or have been involved in a natural disaster, crime, car accident, or accident in the workplace, your symptoms may be getting in the way of you living your life.

PTSD can often cause you to relive your traumatic experience in the form of flashbacks, memories, nightmares, and frightening thoughts. This is especially true when you are exposed to events or objects that remind you of your trauma.

Left untreated, PTSD can lead to emotional numbness, insomnia, addiction, anxiety, depression, and even suicide. So, how can you start to heal and get your life back?

In The PTSD Workbook, Third Edition, psychologists and trauma experts Mary Beth Williams and Soili Poijula outline techniques and interventions used by PTSD experts from around the world to conquer distressing trauma-related symptoms.

In this fully revised and updated workbook, you will learn how to move past the trauma you have experienced and manage symptoms such as insomnia, anxiety, and flashbacks.

Based in cognitive behavioural therapy (CBT), this book is extremely accessible and easy-to-use, offering evidence-based therapy at a low cost.

This new edition features chapters focusing on veterans with PTSD, the link between cortisol and adrenaline and its role in PTSD and overall mental health, and the mind-body component of PTSD.

Clinicians will also find important updates reflecting the new DSM-V definition of PTSD.

This book is designed to give you the emotional resilience you need to get your life back together after a traumatic event.

Book: The PTSD Behavioural Activation Workbook

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Book Title:

The PTSD Behavioral Activation Workbook: Activities to Help You Rebuild Your Life from Post-Traumatic Stress Disorder (A New Harbinger Self-Help Workbook).

Author(s): Matthew Jakupcak (PhD), Amy W Wagner (PhD), Christopher R. Martell (PhD), and Matthew T Tull (PhD).

Year: 2020.

Edition: First (1st).

Publisher: New Harbinger Publications; Workbook Edition.

Type(s): Paperback and Kindle.

Synopsis:

If you suffer from post-traumatic stress disorder (PTSD), reliving the past through trauma-focused treatments may be too painful a place to start. Behavioural activation – the powerful treatment method outlined in this workbook – provides an essential foundation for recovery by shifting the focus of your trauma to the things in life that give you true fulfilment, joy, and value. This way, you can envision the kind of future you want to have, and move forward in your treatment to pursue that future.

With this breakthrough workbook, you will learn to replace unproductive coping strategies – such as avoidance – with activities that you find pleasant and meaningful. You’ll find an overview of behavioural activation: what it is, why it works, and how you can implement it into your life to begin healing the wounds of your past and paving the way for a bright future full of possibility.

If you have experienced trauma, you need real tools to help you manage your pain and jumpstart your recovery. With this compassionate and evidence-based workbook, you will find actionable solutions to help you begin healing and take that next needed step toward wellness, wholeness, and peace.