State of the Science: Evidence-based treatments for posttraumatic stress disorder delivered via telehealth.

Psychotherapy delivered via telehealth technology is not an artifact of the COVID-19 pandemic. Indeed, widespread, telehealth-delivered, evidence-based psychotherapy preceded the pandemic, as did randomized controlled noninferiority trials supporting this modality. It is, thus, not difficult to predict that telehealth will be an integral part of daily clinical life moving forward. With respect to posttraumatic stress disorder (PTSD) specifically, there is a substantial number of studies on the feasibility, acceptability, and effectiveness of evidence-based treatments provided via videoconferencing. In this review, we delineate the literature establishing strong support for remote delivery of prolonged exposure (PE) and cognitive processing therapy (CPT); there is also promising support for written exposure therapy (WET) and trauma-focused cognitive behavioral therapy (TF-CBT). We also mention adjunctive and integrative modifications to better serve patients with PTSD. One such intervention, behavioral activation and therapeutic exposure (BATE), has several studies supporting telehealth delivery, whereas concurrent treatment of PTSD and substance use disorders using the PE protocol (COPE) and cognitive behavioral therapy for insomnia (CBT-I) would benefit from further research. Integrating instrumental peer support into telehealth-delivered PE shows promise in retaining patients in treatment. Finally, we provide ideas to maximize telehealth delivery effectiveness, explore future research directions, and discuss ways to advocate for the expansion of telehealth services from an equity perspective.

Peer support during in vivo exposure homework increases likelihood of prolonged exposure therapy completion.

Exposure-based treatments such as prolonged exposure therapy (PE) are effective for veterans with PTSD. However, dropout rates as high as 50% are common. The Department of Veterans Affairs employs peers to increase mental health treatment engagement, however peers are not routinely used to help patients complete PE homework assignments. The present study included 109 veterans who decided to drop out from exposure-based treatment after completing seven or fewer sessions and used a randomized controlled design to compare PE treatment completion rates in response to 2 forms of peer support: (1) standard weekly telephone-based peer support vs. (2) peer-assisted in vivo exposure, wherein peers accompanied veterans (virtually or in person) during a limited number of in vivo exposure assignments. There were no differences between instrumental vs general peer support conditions as randomized. However, post hoc analyses indicated that 87% of those who completed at least one peer-assisted in vivo exposure completed treatment, compared to 56% of those not completing any peer-assisted in vivo exposure. The dose effect of peer-assisted in vivo exposure increased to 93% with 2 or more peer-assisted exposures, and 97% with 3 or more peer-assisted exposures. The present study suggests that augmenting PE with instrumental peer support during in vivo exposure homework may reduce dropout if completed. Future research should test whether the impact of peer-assisted in vivo exposure is enhanced when offered at the beginning of treatment as opposed to waiting until the point of dropout.

Revisiting the Factor Structure of the Centrality of Event Scale.

Traumatic experiences that become self-defining impact posttraumatic outcomes, yet exact mechanisms are currently being studied. Recent research has used the Centrality of Event Scale (CES). However, the factor structure of the CES has been in question. We analyzed archival data (N = 318) split into homogenous groups of participants to examine whether the factor structure of the CES differed based on event type (bereavement vs. sexual assault) or by levels of PTSD (meeting clinical cut off score vs. group of lowest scorers). Exploratory factor analyses with subsequent confirmatory analyses revealed a single factor model in the bereavement group, sexual assault group, and the low PTSD group. A three-factor model emerged in the high PTSD group, with the factors' themes matching previous findings. Event centrality appears to be a universal theme when people endure and process a diversity of adverse events. These distinct factors may illuminate pathways in the clinical syndrome.

Medical board transparency regarding physician sexual misconduct: Two years post-policy updates.

Recent years have seen increased attention to and motivation for addressing sexual violence. Physician sexual misconduct (PSM) represents a significant violation and abuse of power, with consequences for both patients and public trust in medicine. In the United States, the Federation of State Medical Boards released updated policies in 2020 imploring increased transparency and stronger punishments for PSM cases. This brief report presents an assessment of how transparent medical board websites are in disclosing PSM now 2 years after this policy paper. We reviewed the websites for all 50 states and Washington, DC, to examine how easily a consumer could find a list of board orders, profiles of licensees, and PSM case summaries. In total, 24 states provided a list of orders, and 21 states provided case summaries. Many barriers to finding clearly discussed PSM-related information remain, including many outdated licensee profiles. Ideas for continued efforts to document and discuss PSM to help foster evidence-based policy recommendations are presented.

Relationship of Conflict, Conflict Avoidance, and Conflict Resolution to Psychological Adjustment.

Background: Conflict has deleterious effects on the adjustment of children, adolescence, and emerging adults. The literature is less robust on the adverse effects of conflict avoidance on adjustment as well as the beneficial effect of resolution in these age groups. The literature is markedly sparser on these relationships in adults. Method: We recruited N = 1471 US adults between 18 and 86 years old (M = 33.94, SD = 11.67). They primarily identified as White with 51% holding at least a bachelor's degree. Participants responded to the Perceived Family Conflict Subscale, Avoidant Conflict Scale, the Family Conflict Resolution Scale, and the Langner Symptom Survey. Results: A MANOVA modeling the four variables demonstrated a significant difference based on sex for the measure of distress and need for treatment (Mwomen = 5.31, Mmen = 3.93, p < .001). Separate analyses for men and women yielded the same pattern for each sex. Specifically, low conflict groups, as well as low conflict avoidance groups, scored significantly lower on a measure of distress than the high conflict and conflict avoidance group. For conflict resolution, the high groups scored significantly lower on distress than did the low resolution group. Discussion: The deleterious effect of conflict and conflict avoidance were found in both adult men and women, thereby extending results found in children, teens, and young adults. Similarly, the beneficial effect of conflict resolution manifest in adult men and women, which had been found in young adults. Interventions aimed at reducing conflict avoidance and increasing conflict resolution skills should theoretically reduce stress.

Constructivist Correlates to Anniversary Reactions Across Bereavement and Sexual Violence.

Anniversary reactions are an accepted part of bereavement, but recent research demonstrates that ARs can be seen across many traumatic events. The present study explores how constructivist theories could characterize ARs caused by the death of a loved one or sexual violence. N = 234 women answered questionnaires regarding their posttraumatic adjustment, meaning made of the trauma, trauma centrality, and social validation or invalidation of their trauma. Our data demonstrate that ARs are marked by statistically and clinically significant increases posttraumatic stress disorder symptoms. Participants in this study did not endorse significant posttraumatic growth during their AR. The women in the sexual violence group endorsed more social validation and invalidation as well as less meaning made of their trauma compared to the bereavement group. There were no group differences regarding trauma centrality. Results of this study provide empirical support for an understudied yet significant phenomenon and directions of future study.

Testing Cognitive Models to Characterize Trauma Anniversary Reactions Marked by Stress and Growth.

OBJECTIVE: Contemporary theories conceptualize the anniversary of a traumatic event as a trauma reminder capable of activating posttraumatic stress disorder (PTSD) symptoms. The current study uses the cognitive stress and growth model to examine this model's usefulness in characterizing anniversary reactions. METHOD: Participants (N = 197) were MTurk workers who endorsed an "emotionally charged reaction on or near the anniversary of a tragic event." They completed assessments of PTSD, posttraumatic growth (PTG), sense of control, rumination, and trauma centrality. RESULTS: Multiple regression analyses found both anniversary-related stress and PTSD symptoms were associated with similar factors with similar magnitude across both outcomes. Trauma centrality was uniquely associated with anniversary-related PTG. CONCLUSIONS: Anniversaries marked by stress are characterized by factors similar to PTSD generally, but growth-related reactions have different correlates compared to PTG outside the reaction. These findings suggest the anniversary period may be a time of self-reflection about the event and its impact.