Quantitative electroencephalogram (qEEG) in combat veterans with post-traumatic stress disorder (PTSD)

BackgroundPosttraumatic stress disorder (PTSD) has a great impact on a patient’s quality of life (QoL). People in long-term contact with a person suffering from PTSD, such as family members, may also consequently develop various emotional problems.MethodsWe investigated whether chronic combat PTSD is related to lower QoL of veterans’ wives. The study included 164 veterans with PTSD, 281 PTSD veterans’ wives, 115 healthy non-veterans’ wives and 223 men without PTSD. All participants were assessed for psychiatric morbidity (Mini International Neuropsychiatric Interview) and measures of QoL (World Health Organization Quality of Life Questionnaire – short form). In veterans, the symptoms were evaluated using Clinician Administered PTSD Scale (CAPS).ResultsThe pattern of differences between the study groups was similar across all QoL domains. Men without PTSD had the highest scores, followed by women who were not married to PTSD patients (significantly different across all four QoL domains). PTSD veterans’ wives tended to had lower scores than either of these groups. Significant differences between PTSD veterans’ wives and women who were not married to PTSD patients were observed in three (out of four) QoL domains: psychological health, Z = 2.907, P = 0.022; social relationships, Z = 3.285, P = 0.006; and environmental domain, Z = 5.317, P < 0.001. The lowest scores were recorded in PTSD veterans (significantly lower than PTSD veterans’ wives in every domain except environmental). The wives who reported to be ill at the time tended to have lower scores across all four domains (P < 0.05) (low to moderate correlation; physical health, ρ = −0.56; psychological health, ρ = −0.42; social relationships, ρ = −0.30; environmental, ρ = −0.33), as well as those who sometimes in their lives they sought professional help due to having problems with their husband (P < 0.05) (very low to low correlation; physical health, ρ = −0.37; psychological health, ρ = −0.38; social relationships, ρ = −0.30; environmental, ρ = −0.15).ConclusionOur results indicate the negative impact of husband’s chronic PTSD on overall QoL, psychological health, social relations, and environmental area of QoL of veteran’s wives. Assessment of QoL may be important during the intervention and planning of specific treatment and rehabilitation programs for the families of war veterans.

Living with post-traumatic stress disorder (PTSD) veterans imposes severe stress on relatives especially their wives. Despite of these difficulties these stratum of women suffer insufficient support and less attention. This study aimed to explore the experiences of wives of veterans with PTSD. This study was conducted in 2021 using qualitative content analysis approach. Participants were selected purposely from PTSD veterans' wives. Data were collected using semi-structured interviews with 18 wives of veteran men with PTSD. All the interviews were transcribed verbatim. Data were collected using in-depth and semi-structured interviews, up to the point of data saturation, and were analyzed by Graneheim and Lundman's content analysis method with the support of MAXQDA software. Through analysis of transcribed interviews, one theme and 4 categories and 13 sub categories were emerged : The theme called "abandoned in miserable life stream" and categories consist of "living in the cage of grief and regret"; "insufficient support resources"; "marital burnout"; and "self-sacrifice to maintain family cohesion". The results of this study provide a broad range of context-specific challenges faced by wives of veterans with PTSD. In confronting with full of tensions life and lack of support, wives of veteran with PTSD are neglected and need more attention and support. It is essential for healthcare providers to be aware of the complex psychological and social conditions of wives of veterans with PTSD.

Emotive aspects of stimuli have been shown to modulate perceptual thresholds. Lately, studies using functional Magnetic Resonance Imaging (fMRI) showed that emotive aspects of visual stimuli activated not only canonical limbic regions, but also sensory areas in the cerebral cortex. However, it is still arguable to what extent such emotive, related activation in sensory areas of the cortex are affected by physical characteristic or attribute difference of stimuli. To manipulate valence of stimuli while keeping visual features largely unchanged, we took advantage of the Expressional Transfiguration (ET) of faces. In addition, to explore the sensitivity of high level visual regions, we compared repeated with unrepeated (i.e. different) stimuli presentations (fMR adaptation). Thus, the dynamics of brain responses was determined according to the relative signal reduction during "repeated" relative to "different" presentations ("adaptation ratio"). Our results showed, for the first time, that emotional valence produced significant differences in fMR adaptation, but not in overall levels of activation of lateral occipital complex (LOC). We then asked whether this emotion modulation on sensory cortex could be related to previous personal experience that attached negative attributes of stimuli. To clarify this, we investigated Posttraumatic Stress Disorder (PTSD) and non-PTSD veterans. PTSD is characterized by recurrent revival of trauma-related sensations. Such phenomena have been attributed to a disturbed processing of trauma-related stimuli, either at the perceptual level or at the cognitive level. We assumed that PTSD veterans would differ from non-PTSD veterans (who have similar combat experience) in their high order visual cortex responses to combat-related visual stimuli that are associated with their traumatic experience. An fMRI study measured the cerebral activation of subjects while viewing pictures with and without combat content, in "repeated" or "different" presentation conditions. The emotive effect on the visual cortex was found, again, only in the fMR-adaptation paradigm. Visual cortical regions showed significant differences between PTSD and non-PTSD veterans only in "repeated" presentations of trauma-related stimuli (i.e. combat). In these regions, PTSD veterans showed less decrease in signal with repeated presentations of the same combat-related stimuli. This finding points to the possibility that traumatic experience modulates brain activity at the level of sensory cortex itself.

Background and Aims: The barriers to accessing mental health services for UK members of the Armed Forces (MAF) and veterans experiencing post-traumatic stress disorder (PTSD), have been well documented (Iversen, Van &amp; Hughes, 2011; Murphy, Hunt, Luzon &amp; Greenburg, 2013). However less is known about their recovery following treatment and this study sought to explore veterans’ perspectives on what they felt had aided or impeded their recovery. Methodology: Semi-structured interviews were undertaken with nine male veterans who had recently completed treatment for PTSD at Combat Stress. The interview transcripts were analysed using Interpretive Phenomenological Analysis. Results: Four master themes emerged from this analysis and are discussed within a narrative account: “Relief of receiving a PTSD diagnosis”, “From layman’s knowledge to the technical ins and outs”, “Recovery: A changing relationship with self, the world and others” and “The road to more recovery and less suffering”. Implications and conclusion: Most participants reported the concept of recovery felt inappropriate and preferred to consider their life post-treatment as a continual journey of coping with their PTSD. Nearly all participants found their diagnosis of PTSD useful, as it gave them a long sought for answer as to why they had been struggling and offered hope for treatment. All veterans identified meeting other veterans as integral to their coping with their problems, along with psychological techniques they learned to help manage their symptoms. The proactive approach taken by many participants suggests hegemonic masculinities could be a resource for coping even if they may make initially seeking help more challenging. This research echoes other literature by arguing for the complex nature of PTSD in veterans, due to stigma surrounding mental health difficulties within the armed forces and society as well as the identity shifts they have to navigate from MAF to veteran status.

Memory function was studied in combat veterans with posttraumatic stress disorder (PTSD), combat veterans without PTSD, and noncombat veterans. The Vocabulary and Digit Span subtests of the WAIS and Logical Memory (LMS) and Verbal Paired Associates (VPAS) subtests of the Wechsler Memory Scale III were administered. Combat veterans with PTSD showed impaired memory on the LMS and VPAS compared to combat veterans without PTSD or noncombat veterans. Veterans with PTSD also showed lower WAIS Vocabulary subtest scores--but not digit span subtest scores--than combat veterans without PTSD or noncombat veterans. Medication status, co-morbid diagnosis, and age all failed to account for these memory differences, but when self-assessed depression--as measured by the Zung Self-Rating Depression Scale--or anxiety--as measured by the Spielberger State-Trait Anxiety Scale--was statistically removed, group differences on these memory measures were no longer significant. However, using a stepwise regression procedure, in which both anxiety and depression were employed to predict the LMS and VPAS scores, only the Zung scale reliably predicated performance. The present results, showing that PTSD is associated with general learning and memory impairments, is an important finding, but the specific effects of depression as a mediator of these deficits should be further studied.

The role of early maladaptive schemas in understanding and treating post-traumatic stress disorder (PTSD) was investigated. The first study examined the role of perceived adverse parenting and early maladaptive schemas in the development of PTSD in Australian and New Zealand Vietnam war veterans (n = 220). Veterans diagnosed with PTSD scored higher on the Young Schema Questionnaire (L3) and had higher scores on the Measure of Parental Style than veterans not diagnosed with PTSD. The results suggest that early maladaptive schemas have an important role in the development or maintenance of PTSD in Vietnam veterans. The second study measured at baseline, termination and 3 months the early maladaptive schemas, PTSD, anxiety and depression of war veterans (n = 54) participating in a PTSD group treatment programme that included schema-focused therapy. Scores on the PTSD Checklist, the Hospital Anxiety and Depression Scale, and 17 schemas decreased significantly after treatment. Change scores for the schema treatment were compared with change scores of war veterans (n = 127) who had completed a manualized cognitive-behavioural therapy programme without schema-focused therapy. Pre-treatment measures were similar in both groups. Nevertheless, PTSD and anxiety improved more significantly for the schema-focused therapy group. Together, these findings support the feasibility of schema-focused therapy to assist veterans with PTSD.

With the move toward dissemination of empirically supported treatments in the Veterans Health Administration (VHA), dissemination of additional data concerning the effectiveness of prolonged exposure (PE) among veterans is important. The authors present clinical treatment data from veterans with chronic posttraumatic stress disorder (PTSD) treated in a VHA PTSD clinic (N = 10). Veterans demonstrated significant reductions in total PTSD symptoms from pre- to posttreatment. Returning veterans from the conflicts in Afghanistan and Iraq and other era veterans (Vietnam Veterans and military sexual trauma veterans) demonstrated significant reductions in PTSD. In addition, veterans demonstrated significant reductions in depression from pre- to posttreatment. In conclusion, PE is effective in reducing the symptoms of PTSD in veterans.

BackgroundEquine-assisted services (EAS) involves the use of horses within therapy, learning or horsemanship sessions and has been used with military veterans suffering from post-traumatic stress disorder (PTSD). This study systematically reviewed existing research on the use of EAS in the treatment of PTSD in military veterans and evaluated its effectiveness.MethodsA systematic review was performed, in May 2023, with searches and data extraction carried out from three separate databases (PubMed, JSTOR and Science Direct) related to testing the effect of EAS on PTSD outcomes in veterans. A risk of bias assessment of included studies was conducted and meta-analysis of outcomes performed when two or more studies reported the same outcomes. Other effects of EAS on veterans’ health were also discussed.ResultsA total of 13 studies were identified based on our inclusion and exclusion criteria with 11 originating from the US and the remaining two from Australia and Israel. There were 344 participants amongst all of the studies with a mean age of 47 years and a male:female ratio of 19:6. Eight out of the 13 studies reported PTSD scores, as measured by either PTSD Checklist for DSM-5 (PCL-5) or PCL-Veteran/-Military versions (PCL-V/-M), and results suggested a reduction in PTSD score after EAS treatment of 22.6%. A meta-analysis confirmed that EAS favored a significantly lower PTSD score after treatment, with a mean difference of 12.46, 95% CI [9.03,15.88], p < 0.00001. However, only one study had low risk of bias whilst all the rest of the studies had some concerns to high risk of bias.ConclusionsEAS appeared to have a positive influence on PTSD symptoms in military veterans, significantly reducing PTSD severity scores. Other benefits of EAS may be peer support, social integration, learning new skills and bonding. However, the results of this systematic review must be interpreted with caution as almost all of the studies were of low quality. Therefore, further rigorous research is required with larger participants to be able to draw conclusions about the benefits of EAS on PTSD severity.

BackgroundA short, effective therapy for posttraumatic stress disorder (PTSD) could decrease barriers to implementation and uptake, reduce dropout, and ameliorate distressing symptoms in military personnel and veterans. This non-inferiority RCT evaluated the efficacy of 2-week massed prolonged exposure (MPE) therapy compared to standard 10-week prolonged exposure (SPE), the current gold standard treatment, in reducing PTSD severity in both active serving and veterans in a real-world health service system.MethodsThis single-blinded multi-site non-inferiority RCT took place in 12 health clinics across Australia. The primary outcome was PTSD symptom severity measured by the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) at 12 weeks. 138 military personnel and veterans with PTSD were randomised. 71 participants were allocated to SPE, with 63 allocated to MPE.ResultsThe intention-to-treat sample included 138 participants, data were analysed for 134 participants (88.1% male, M = 46 years). The difference between the mean MPE and SPE group PTSD scores from baseline to 12 weeks-post therapy was 0.94 [95% confidence interval (CI) −4.19 to +6.07]. The upper endpoint of the 95% CI was below +7, indicating MPE was non-inferior to SPE. Significant rates of loss of PTSD diagnosis were found for both groups (MPE 53.8%, SPE 54.1%). Dropout rates were 4.8% (MPE) and 16.9% (SPE).ConclusionsMPE was non-inferior to SPE in significantly reducing symptoms of PTSD. Significant reductions in symptom severity, low dropout rates, and loss of diagnosis indicate MPE is a feasible, accessible, and effective treatment. Findings demonstrate novel methods to deliver gold-standard treatments for PTSD should be routinely considered.

Substance use disorders (SUDs) and Posttraumatic Stress Disorder (PTSD) are two clinically significant and commonly co-occurring psychopathologies among military Veterans (Back, et al., 2014; Erbes, Westermeyer, Engdahl, &amp; Johnsen, 2007; Hoge, Auchterlonie, &amp; Milliken, 2006; Hoge et al., 2004). More specifically, the prevalence rates for PTSD and SUDs in Veterans are at approximately 29% and 18%, respectively, and at rates of approximately three and five times that of the general population (Bagalman, 2013; APA, 2013; SAMHSA, 2007). It is largely recognized that among many such Veterans, substances are used as coping mechanisms for posttraumatic stress disorder symptoms due to a lack of adaptive coping mechanisms. One particular study examined coping skills in male Veterans with PTSD and SUD symptoms through a variety of different coping models, generally finding avoidance to be a primary coping mechanism among substance users (Boden et al., 2014). Due to the fact that this study investigated only males, and other such studies on the psychological coping styles associated with the relationship between PTSD and SUD symptoms are sparse, additional exploration as to how existent or non-existent, adaptive or maladaptive coping skills affect the relationship between PTSD and SUD symptomology need be conducted. The primary aim of this study is to assess whether or not social problem-solving, a cognitive-behavioral construct of problem-solving and stress management, moderates the prediction of substance abuse from posttraumatic stress symptoms. One hundred and sixty individuals who have completed service in the United States Military were in a survey- based study. Assessment measures included (a) a comprehensive demographic questionnaire assessing psychological and medical health, socioeconomic status, family system, occupational history, and military history, (b) the Social Problem-Solving Inventory - Revised: Short Form (SPSI-R:SF), (c) a DSM-5 Alcohol Checklist, (d) the Alcohol Use Disorders Identification Test (AUDIT), (e) the Drug Use Disorders Identification Test (DUDIT), and (f) the PTSD Checklist for DSM-5 (PCL-5). Results suggested that rational, impulsive-careless, and avoidant problem-solving styles significantly moderate the prediction of alcohol use from PTSD symptoms, while, SPS did not moderate PTSD on drug use.

Lower Methylation of Glucocorticoid Receptor Gene Promoter 1F in Peripheral Blood of Veterans with Posttraumatic Stress Disorder

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 &lt; .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 &lt; .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.

Functional network topology associated with posttraumatic stress disorder in veterans.

Collaborative care has been shown to improve outcomes for depression and various anxiety disorders (see JW Psychiatry Jun 7 2010 and JW Gen Med Nov 10 2009) but has infrequently been studied for post-traumatic stress disorder (PTSD). In a 6-month, randomized, controlled trial, researchers compared the effects of …

Sleep disturbances are a hallmark feature of post-traumatic stress disorder (PTSD), and associated with poor clinical outcomes. Few studies have examined sleep quantitative electroencephalography (qEEG), a technique able to detect subtle differences that polysomnography does not capture. We hypothesized that greater high-frequency qEEG would reflect 'hyperarousal' in combat veterans with PTSD (n = 16) compared to veterans without PTSD (n = 13). EEG power in traditional EEG frequency bands was computed for artifact-free sleep epochs across an entire night. Correlations were performed between qEEG and ratings of PTSD symptoms and combat exposure. The groups did not differ significantly in whole-night qEEG measures for either rapid eye movement (REM) or non-REM (NREM) sleep. Non-significant medium effect sizes suggest less REM beta (opposite to our hypothesis), less REM and NREM sigma and more NREM gamma in combat veterans with PTSD. Positive correlations were found between combat exposure and NREM beta (PTSD group only), and REM and NREM sigma (non-PTSD group only). Results did not support global hyperarousal in PTSD as indexed by increased beta qEEG activity. The correlation of sigma activity with combat exposure in those without PTSD and the non-significant trend towards less sigma activity during both REM and NREM sleep in combat veterans with PTSD suggests that differential information processing during sleep may characterize combat-exposed military veterans with and without PTSD.