Cognitive behavior therapy for PTSD in rape survivors

Posttraumatic Stress Disorder Among Military Returnees From Afghanistan and Iraq

To examine the cross-sectional and longitudinal associations between sleep disturbance and posttraumatic stress disorder (PTSD) and depressive symptoms in a large cohort of adolescents exposed to the 2008 Wenchuan earthquake in China. Participants were 1,573 adolescents (mean age at initial survey = 15.0 years, SD = 1.3 years; 46% male) in the Wenchuan Earthquake Adolescent Health Cohort (WEAHC) in Dujiangyan, China, 20 km away from the east epicenter. The Pittsburgh Sleep Quality Index, Post-Traumatic Stress Disorder Self-Rating Scale, and Depression Self-Rating Scale for Children were used to assess participants' sleep, PTSD symptoms, and depressive symptoms, respectively, at 12 months (T12m) and 24 months (T24m) after the Wenchuan earthquake that occurred on May 12, 2008. At T12m and T24m, 38.3% and 37.5% of participants reported sleep disturbance, 22.5% and 14.0% reported PTSD symptoms, and 41.0% and 38.3% reported depressive symptoms, respectively. The prevalence rates of PTSD and depressive symptoms at T12m and T24m significantly increased with sleep disturbance and short sleep duration. After adjusting for demographics, earthquake exposure, and PTSD/depressive symptoms at T12m, sleep disturbance at T12m was significantly associated with increased risk for PTSD (odds ratio [OR] = 1.80; 95% CI, 1.17-2.75) and depressive symptoms (OR = 1.51; 95% CI, 1.14-2.02) at T24m. Furthermore, sleep disturbance predicted the persistence of PTSD (OR = 2.35; 95% CI, 1.43-3.85) and depressive symptoms (OR = 2.41; 95% CI, 1.80-3.24). Sleep disturbance, PTSD, and depressive symptoms were prevalent and persistent in adolescents at 12 and 24 months after exposure to the Wenchuan earthquake. Sleep disturbance predicts the development and persistence of PTSD and depressive symptoms. Early assessment and treatment of sleep disturbance may be an important strategy for prevention and intervention of PTSD and depression in adolescent trauma survivors.

Even after the most effective posttraumatic stress disorder (PTSD) treatments, symptoms often persist. Understanding residual symptoms is particularly relevant in military populations, who may be less responsive to PTSD interventions. The sample consisted of 282 male service members who engaged in a residential PTSD treatment program at a military treatment facility that provided evidence-based PTSD psychotherapies and adjunctive interventions. PTSD and depression symptoms were assessed before and after treatment and weekly during treatment via the PTSD Checklist-Military Version and Patient Health Questionnaire-8. Logistic regression with Hochberg's step-up procedure compared the likelihood of individual residual symptoms between service members who did (n = 92, 32.6%) and did not (n = 190, 67.4%) experience clinically significant PTSD change (≥ 10-point PTSD Checklist-Military Version reduction). Not achieving clinically significant PTSD change was associated with greater odds of nearly all residual symptoms (OR = 2.03-6.18), excluding two Patient Health Questionnaire-8 items (appetite and psychomotor changes). Among service members experiencing clinically significant PTSD change, concentration difficulties (73.3%), physical reactions to reminders (71.1%), and intrusions (70.8%) were PTSD symptoms most likely to persist. Poor sleep (56.2%), low energy (50.0%), and concentration difficulties (48.3%) were the most common for depression. To our knowledge, this study is the first to examine residual PTSD and depression symptoms following residential PTSD treatment for active duty service members. Given the low rates of clinically significant PTSD change and the high frequency of residual symptoms, strategies may be needed to improve residential PTSD treatment outcomes in the military. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Introduction Combat veterans are at high risk for the development of posttraumatic stress disorder (PTSD) and substance use disorders. Ketamine has been shown to be an effective treatment for numerous mental health disorders, although research on its efficacy in combat-related PTSD in veterans is very limited. Methods The study population consisted of 30 US military veterans with combat-related PTSD. Participants underwent a standard induction series of six 1-hour ketamine infusions with the goal of obtaining a transpersonal dissociative experience. Participants were given a series of self-report questionnaires to assess for changes in symptoms of depression, PTSD, and substance use prior to the first and sixth infusions. Results Symptoms of depression as measured by change in score on the Patient Health Questionnaire decreased significantly from an average of 18.9 to 9.5 ( P < .001). Similarly, symptoms of PTSD as measured by change in score on the PSTD Checklist for DSM-5 dropped significantly from an average of 56.2 to 31.3 ( P < .001). Self-reported levels of substance use did not significantly decrease during the study period, although the level of use trended down. Conclusions This observational study suggests that high-dose ketamine infusion therapy, which induced a transpersonal dissociative experience, could be a valuable tool in the treatment of combat-related PTSD. Further study is needed to better elucidate ketamine's mechanism of action with regards to the treatment of PTSD.

Reducing suicidal ideation through evidence-based treatment for posttraumatic stress disorder

Sustained Elevation of Serum Interleukin-6 and Relative Insensitivity to Hydrocortisone Differentiates Posttraumatic Stress Disorder with and Without Depression

While previous studies have documented that evidence-based treatments for posttraumatic stress disorder (PTSD) are efficacious, treatment completers often continue to experience residual symptoms. However, no studies to date have assessed residual symptoms following intensive treatment programs (ITPs) for PTSD, which combine evidence-based PTSD treatment along with adjunctive interventions. The present study examined residual symptoms of PTSD and depression in 482 veterans and service members who completed a 3-week Cognitive Processing Therapy-based ITP. Residual symptoms were examined at posttreatment and 3 months following ITP completion. Frequency analyses and logistic regressions were conducted to discern the presence of residual symptoms among (a) the total sample and (b) participants who did and did not experience clinically meaningful change in PTSD symptom severity over the course of treatment. Study results indicated that the majority of participants (80%-87%) reported some PTSD and depression residual symptoms at ITP completion, which commonly continued to be endorsed at 3 months following ITP completion. At both treatment completion and 3 months following treatment, participants who experienced clinically meaningful changes during the ITP exhibited statistically lower odds of PTSD and depression residual symptoms as compared to participants who did not experience clinically meaningful changes. However, regardless of whether clinically meaningful changes in PTSD symptoms were experienced, participants most commonly endorsed residual symptoms in the hyperarousal cluster of PTSD and general depression symptoms at high rates. Findings suggest the need to further examine functional impairment and coping skill use associated with these long-standing residual symptoms. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

We know little about how change unfolds in depression symptoms during posttraumatic stress disorder (PTSD) treatment or how patient characteristics predict depression symptom change. This study examined critical transition points in depression symptoms during PTSD treatment, namely, depression sudden gains, which are rapid symptom improvements and transient depression spikes, which are transient depression worsenings. Social support, one of the strongest predictors of PTSD development, was examined as a predictor of depression symptom discontinuities. At pretreatment, 200 participants (76.6% female; 64.9% Caucasian; age M = 37.1, SD = 11.3 years) completed measures of PTSD severity (PTSD Symptom Scale-Self-Report), depression severity (Beck Depression Inventory), general social support (Inventory of Socially Supportive Behaviors; Social Support Questionnaire), and trauma-related social support (Social Reactions Questionnaire). During 10 weeks of prolonged exposure (PE) or sertraline, depression was assessed weekly. Overall, 18.0% of participants experienced a depression sudden gain, and 22.5% experienced a transient depression spike. The presence of a depression sudden gain predicted better treatment outcome, β = -4.82, SE = 1.17, p = .001, 95% CI [-6.79, -2.90]. Higher perceptions of negative trauma-related reactions, albeit modestly, were associated with experiencing a transient depression spike (r = .18, p = .01). There were no differences in rates of depression sudden gains or transient depression spikes between treatments. Encouragingly, rapid improvements in depression symptoms are beneficial for PTSD treatment outcome, but transient spikes in depressive symptoms do not strongly influence outcome. Understanding symptom discontinuities may help us to personalize current PTSD treatment options.

People with dissociative symptoms are generally poly-symptomatic and require high levels of healthcare resources. Post-traumatic stress disorder (PTSD) and depressive symptoms are two major disabling comorbid symptoms in people with dissociative symptoms. While the sense of control over symptoms may be associated with PTSD and dissociative symptoms, the interplay among these factors over time remains unexplored. This study examined the predictors of PTSD and depressive symptoms in people with dissociative symptoms. Longitudinal data from 61 participants with dissociative symptoms were analyzed. Participants completed self-report measures of dissociative, depressive, and PTSD symptoms and the sense of control over symptoms two times (T1 & T2) with an interval of over one month. PTSD and depressive symptoms were not transient or time-specific, but they persisted over time in our sample. Hierarchical multiple regression analyses revealed that, after controlling for age, treatment usage and baseline symptom severity, T1 symptom management scores (β = −.264, p = .006) negatively predicted T2 PTSD symptoms, while T1 PTSD symptoms (β = .268, p = .017) positively predicted T2 depressive symptoms. T1 depressive symptoms (β = −.087, p = .339) did not predict T2 PTSD symptoms. The findings highlight the importance of improving symptom management skills and treating comorbid PTSD symptoms when working with people with dissociative symptoms.

Back to table of contents Previous article Next article Professional NewsFull AccessMajor Study Will Assess 'What Works' in PTSD CareAaron LevinAaron LevinPublished Online:1 Apr 2011https://doi.org/10.1176/pn.46.7.psychnews_46_7_4_1AbstractThe Department of Defense and the Department of Veterans Affairs have received enormous funding from Congress for treating PTSD, but we can't view that as a bottomless pit," Navy Capt. Paul Hammer, M.C., said at the first meeting of an Institute of Medicine (IOM) panel that will study the current status of research and treatment of posttraumatic stress disorder (PTSD). "We have to learn to treat PTSD at a reasonable cost," said Hammer, an APA member and the new director of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury. Doing that requires knowing more about the disorder, its causes, diagnosis, and treatment, so the Department of Defense (DoD) requested the IOM study. The panel is chaired by Sandro Galea, M.D., Dr.P.H., a professor and chair of the Department of Epidemiology in the Mailman School of Public Health at Columbia University. The request came three years after another report from the IOM noting that "significant gaps" existed in the evidence underlying nearly all treatments for PTSD (Psychiatric News, December 7, 2007). The earlier report said that only therapies that included some element of exposure to reminders of trauma—like prolonged exposure therapy, cognitive-behavioral therapy, or cognitive-processing therapy—were backed by sufficient evidence from clinical trials. "The 2007 PTSD report was simply an evaluation of the evidence on best practices for PTSD," said Galea. "Our mandate with this study is to understand what the best approach to screening, prevention, treatment, and rehabilitation for PTSD is and what DoD and the Department of Veterans Affairs [VA] should be doing about it." The panel will spend two years gathering information from the two federal departments "on programs and methods available for the prevention, screening, diagnosis, treatment, and rehabilitation of posttraumatic stress disorder," as well as study clinical trials of innovative treatments and services. The panel will then take another two years to evaluate the rates of success of each modality. The study could clarify how well current PTSD programs are working and identify gaps in assessment and treatment, said Hammer during the panel's initial meeting in late February. About 2.4 percent of the 2.2 million deployed service members have been diagnosed with PTSD, but depending on survey methodology, 10 percent to 17 percent of service members report some symptoms of PTSD, he noted. Several areas require special attention in any study of PTSD in military populations, Hammer pointed out.For example, "patterns of comorbidities are different in military populations, compared to the civilian sector," he said. Mild traumatic brain injury, pain, and substance abuse are common. In addition, combat troops less often report Category A ("horror") PTSD symptoms, because their military training and experience prepares them for battle. But they also have less access to protective factors due to their frequent re-exposure and the "tough-it-out" military culture, he said. National Guard and Reserve personnel are at even greater risk of PTSD and have less access to therapists skilled in PTSD care for military populations because they are dispersed geographically after they return from war zones. The armed forces have used several strategies to protect troops. Education and training begin at the start of military service. Increased screening and surveillance, interventions to manage combat stress in the field, and a full spectrum of available treatments in war zones and at home also serve as factors that may mitigate the likelihood or severity of PTSD. The Military Health System has increased behavioral health staffing from about 4,000 in 2007 to about 6,500 now, so fewer referrals for care go unfulfilled. Spending on PTSD care for the current cohort of veterans is likely to be high, and the true costs of treating them needed to be made clear, said Hammer. But more work needs to be done first. "Data are problematic on the effectiveness of current therapies," said Hammer. "We don't know what type of therapy is used or whether the therapist has made individual modifications. We don't have the ability to track measures over time." The executive director of the VA's National Center for PTSD (NCPTSD), Matthew Friedman, M.D., Ph.D., stressed that more should be done to monitor outcomes in clinical practice, expand the use of evidence-based therapies and clinical practice guidelines, and increase quality improvement and program evaluation efforts. The National Center for PTSD is a hub for research into the neuroscience of PTSD and its treatment, along with ways to move that research into the clinic. Basic research there now addresses mechanisms underlying the development of PTSD, as well as resilience, treatment effectiveness, and treatment resistance, Friedman told the IOM panel. The NCPTSD also provides PTSD-related assessment tools, training, treatment guides, and consultation services within the VA, he said. In addition, it provides information on PTSD and its treatment for outside clinicians and for the public via its Web site. The IOM study, when completed, will help guide future DoD and VA policies for screening, diagnosing, and treating service members and veterans. That can't come too soon, said Hammer. "We need to get it right and target well for what works," said Hammer.Information on the Institute of Medicine's "Assessment of Ongoing Efforts in the Treatment of PTSD" is posted at <www.iom.edu/Activities/Veterans/PTSDTreatment.aspx>. The Web site for the National Center for PTSD is <www.ptsd.va.gov>. ISSUES New Archived

Research on the impact of time since trauma (TST) on posttraumatic stress disorder (PTSD) treatment outcomes lacks consensus and has not been examined in cognitive processing therapy (CPT)-based intensive PTSD treatment programs (ITPs). Furthermore, little is known about how TST impacts other trauma-related outcomes, such as depressive symptoms and negative posttrauma cognitions. We examined whether TST predicted severity and changes in PTSD and depressive symptoms and negative posttrauma cognitions, controlling for trauma type (combat or military sexual trauma), age, sex, and race, in two separate samples of veterans with PTSD who completed 2-week (n = 132) or 3-week (n = 407) CPT-based ITPs. In the 3-week sample, PTSD symptom reduction differed based on TST; however, these differences lacked clinical significance, TST x Time R2 b = .002, and were not replicated in the 2-week sample, R2 b < .001. TST did not significantly predict depressive symptoms, R2 b = .005, or negative posttrauma cognition severity or changes, R2 b = .002, in the 3-week sample. In the 2-week sample, linear mixed-effects models indicated that TST also did not significantly predict PTSD or depressive symptoms, R2 b s < .001, or negative posttrauma cognition severity or changes, R2 b s = .002. These findings suggest that TST is not a clinically relevant predictor of PTSD symptoms, depressive symptoms, or negative posttrauma cognitions among individuals engaged in CPT-based ITPs. Future research should investigate the association between TST and trauma-related outcomes in more trauma type- and age-diverse samples within different intensive treatment settings.

Symptoms of depression and posttraumatic stress disorder (PTSD) were examined for their association with health status in a sample of sexual assault victims. Hypotheses were that symptoms of each disorder would account for unique variance in health status among individuals exposed to traumatic stressors. Fifty-seven sexually assaulted college women were assessed for prior victimization history, assault characteristics, and depressive and PTSD symptoms. When prior history of sexual victimization, assault severity, and physical reactions during the assault were controlled, hierarchical multiple regression models indicated that symptoms of PTSD and depression were significantly associated with global health perceptions and severity of self-reported health symptoms. Only PTSD symptoms were significantly associated with reproductive health symptoms. The results suggest that both symptoms of PTSD and depression account for the relationship between exposure and health impairment among sexual assault victims.

Individuals with post-traumatic stress disorder (PTSD) have an elevated risk of developing cardiovascular disease. Emerging research suggests that blood pressure variability (BPV) may serve as an early indicator for increased cardiovascular disease risk. However, the relationship between post-traumatic stress symptom severity and symptom clusters, and comorbid conditions such as depression, with BPV is unclear. Purpose: The primary objective of this study was to investigate the relationship between the severity of PTSD and depression symptoms, PTSD symptom clusters, and beat-to-beat blood pressure variability (BPV) in a sample of individuals diagnosed with PTSD. We hypothesized that participants with greater PTSD symptom severity would have increased BPV. Methods: Twenty participants (mean age = 46 ± 10 yr; 70% males; 75% African American) with diagnosed PTSD were enrolled. PTSD severity and symptom clusters were assessed via the PTSD Checklist (PCL-5) and depression symptoms were assessed via Beck's Depression Inventory (BDI). Beat-to-beat blood pressure was recorded via finger photoplethysmography for a five-minute duration. BPV indices were calculated as the coeffcient of variation (CV), standard deviation (SD), and average real variability (ARV) for systolic, diastolic, and mean blood pressure. Pearson correlations were conducted to evaluate the association between symptoms and BPV outcomes. Participants were also categorized into two groups based on symptom severity. Independent t-tests were used to compare those with mild to moderate symptoms (n = 7) relative to participants with severe and extreme PTSD symptoms (n = 13). Results: PTSD symptom severity was significantly correlated with depression symptoms (r = 0.83, p &lt; 0.001). However, there were no significant correlations between BPV measures and either PTSD or depression symptoms. We did observe moderate non-significant correlations between the PTSD intrusive symptom cluster and diastolic and mean blood pressure CV (r = 0.33 and r = 0.29, p &gt; 0.05). Similar moderate correlations were observed between depression symptoms and diastolic and mean blood pressure CV (r = 0.31 and r = 0.29, p &gt; 0.05). No significant differences were observed between the two symptom severity groups in terms of systolic, diastolic, and mean blood pressure for CV, SD, and ARV (systolic CV 0.61 ± 0.17 vs. 0.62 ± 0.17 %, p &gt; 0.05, diastolic CV, 0.70 ± 0.06 vs. 0.72 ± 0.16 %, p &gt; 0.05, and mean blood pressure CV 0.63 ± 0.09 vs. 0.65 ± 0.15 %, p &gt; 0.05 for mild to moderate and severe to extreme PTSD symptoms, respectively). Conclusions: Contrary to our hypothesis, those with greater PTSD symptom severity did not have significantly greater BPV. In summary, our data demonstrate that higher PTSD symptoms are not associated with beat-to-beat BPV; however, the moderate correlations suggest that larger studies are needed to determine if PTSD intrusive symptoms and depression symptoms, are related beat-to-beat BPV indices. VA Merit I01-CX001065, and DOD PR210574. M. McGranahan is supported by NIDDK training grant TL1DK129502 and U2CDK129501. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

ObjectiveThis study aimed at testing the significance of mediating and moderating roles of sense of coherence, adaptive coping styles and social support in the relationship between exposure to trauma and...

Negative cognitions about oneself, others, and the world are central to the development and maintenance of posttraumatic stress disorder (PTSD). We provide a comprehensive review of the literature examining the change in post-trauma negative cognitions in PTSD treatments. We explore the association between change in cognitions and change in PTSD symptoms and the mediational effect of negative cognitions on PTSD symptoms. A review of over 2000 manuscripts resulted in 65 PTSD treatment articles for review that included a measure of negative post-trauma cognitions and PTSD severity. Several studies found that PTSD treatments are associated with concurrent reductions in PTSD symptoms and negative post-trauma cognitions. Many studies suggest that the degree of reduction in negative post-trauma cognitions is both associated with the degree of reduction in PTSD symptoms and may mediate the change in PTSD symptoms in treatment. PTSD treatments are associated with significant improvements in negative post-trauma cognitions that often precede and predict reductions in PTSD symptoms.