Massed written exposure therapy delivered to veterans with posttraumatic stress symptoms on an acute inpatient mental health unit.

Written exposure therapy (WET) is a brief, manualized trauma-focused treatment typically delivered in five individual weekly sessions. Given the brevity and effectiveness of WET, researchers have begun to focus on its delivery in a massed format. However, only one case study examining massed delivery has been published to date. As such, the objective of the current study was to examine the acceptability, feasibility, and preliminary effectiveness of massed WET among veterans with a trauma- and stressor-related disorder receiving care on an acute inpatient mental health unit. Veterans (N = 26) were assessed prior to, immediately after, and 1 month following massed WET. Most veterans found massed WET to be useful and acceptable. Recruitment and retention rates suggested that the treatment was feasible. Notably, the results revealed statistically significant reductions in overall posttraumatic stress symptoms, ηp 2 = .81, p < .001; depressive symptoms, ηp 2 = .71, p < .001; and functional impairment, ηp 2 = .42, p = .002. These findings add to a growing body of literature highlighting the preliminary effectiveness of WET across various settings, populations, and delivery formats. Limitations include the small sample size and uncontrolled design.

Examining the unique and interactive associations of gender and race on PTSD symptom severity among military sexual trauma survivors.

OBJECTIVE: Despite a robust association between military sexual trauma (MST) and posttraumatic stress disorder (PTSD), few studies have examined factors that are associated with increased symptom severity. To this end, the current study was designed to examine the unique and interactive effects of gender and race on PTSD symptoms using a sample of MST survivors. METHOD: The sample included 126 veterans (71% Women, 29% Men; 70% Black/African American and 30% White/Caucasian) presenting for psychological services to a MST specialty clinic at a large Southeastern Veterans Affairs (VA) hospital. As part of their intake evaluation, veterans completed a diagnostic interview and battery of self-report questionnaires. RESULTS: Results revealed a main effect of gender and race such that veteran men and Black/African American veterans were found to have increased PTSD symptom severity. However, there was not a significant gender by race interaction. CONCLUSION: Findings are discussed with regard to previous research and treatment implications. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A comparative study of suicidal and nonsuicidal self-injury characteristics in heterosexual versus sexual minority females.

Sexual minorities are at heightened risk for nonsuicidal self-injury (NSSI), suicidal ideation and attempts. We tested whether sexual minority and heterosexual females differ on these characteristics. Sexual minority females (n = 45) had higher lifetime frequency of NSSI and higher thwarted belonginess compared to heterosexual females (n = 47). These specific factors may contribute to the higher rates of suicide attempts among sexual minorities than heterosexual individuals.

An initial investigation of the association between DSM-5 posttraumatic stress disorder symptoms and nonsuicidal self-injury functions.

OBJECTIVE: Despite the well-established link between posttraumatic stress disorder (PTSD) and nonsuicidal self-injury (NSSI), little is known about factors that may lead to self-injury among trauma-exposed individuals. Moreover, no research to date has examined these relations in the context of the newly revised Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) PTSD criteria. Thus, the purpose of the current study was to explore the associations between DSM-5 PTSD symptom clusters (i.e., intrusion, avoidance, negative alterations in cognitions and mood, alterations in arousal and reactivity) and self-injury functions using a small sample of college students. METHOD: Participants (N = 81) were recruited for a lifetime history of NSSI and trauma exposure. RESULTS: Findings revealed a statistically significant path from PTSD avoidance symptoms to NSSI social functions and from PTSD negative alterations in cognitions and mood symptoms to NSSI intrapersonal functions, even after controlling for relevant covariates. CONCLUSIONS: Results of the current study highlight the importance of assessing for NSSI among trauma-exposed individuals. Considering that NSSI is a risk factor for suicidal behavior and potentially a clinically distinct diagnosis, future research should continue to explore these associations using larger, more diverse clinical samples. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Anxiety sensitivity and substance use: Differential levels across individuals primarily using opioids, cannabis, or stimulants.

BACKGROUND: The purpose of the current study was to compare levels of anxiety sensitivity (AS) across a treatment-seeking sample of individuals primarily using opioids, stimulants, or cannabis. Consistent with the idea that individuals high in AS may be motivated to use substances with real or perceived anxiolytic properties, it was hypothesized that individuals primarily using opioids or cannabis would evidence higher levels of AS compared to individuals primarily using stimulants. METHODS: The sample consisted of 110 veterans (including 29 individuals primarily using opioids, 42 primarily using cannabis, and 39 primarily using stimulants) presenting for psychological services to a Posttraumatic Stress Disorder (PTSD) and Substance Use Disorder (SUD) specialty clinic at a large southeastern Veteran Affairs (VA) hospital. RESULTS: AS levels varied by group with individuals primarily using stimulants evidencing the highest levels followed by those primarily using opioids and then those primarily using cannabis. Individuals primarily using stimulants had statistically significantly higher levels of AS physical concerns compared to individuals primarily using cannabis but not those primarily using opioids. Further, individuals who primarily use opioids did not differ from those primarily using cannabis. CONCLUSIONS: Taken together, these findings call into question the notion that AS may be negatively related to the use of substances that have anxiogenic properties.

Correlates of death among SARS-CoV-2 positive veterans: The contribution of lifetime tobacco use.

Despite a growing body of research examining correlates and consequences of COVID-19, few findings have been published among military veterans. This limitation is particularly concerning as preliminary data indicate that veterans may experience a higher rate of mortality compared to their civilian counterparts. One factor that may contribute to increased rates of death among veterans with COVID-19 is tobacco use. Indeed, findings from a recent meta-analysis highlight the association between lifetime smoking status and COVID-19 progression to more severe or critical conditions including death. Notably, prevalence rates of tobacco use are higher among veterans than civilians. Thus, the purpose of the current study was to examine demographic and medical variables that may contribute to likelihood of death among veterans testing positive for SARS-CoV-2. Additionally, we examined the unique influence of lifetime tobacco use on veteran mortality when added to the complete model. Retrospective chart reviews were conducted on 440 veterans (80.5% African American/Black) who tested positive for SARS-CoV-2 (7.3% deceased) at a large, southeastern Veterans Affairs (VA) hospital between March 11, 2020 and April 23, 2020, with data analysis occurring from May 26, 2020 to June 5, 2020. Older age, male gender, immunodeficiency, endocrine, and pulmonary diseases were positively related to the relative risk of death among SARS-CoV-2 positive veterans, with lifetime tobacco use predicting veteran mortality above and beyond these variables. Findings highlight the importance of assessing for lifetime tobacco use among SARS-CoV-2 positive patients and the relative importance of lifetime tobacco use as a risk factor for increased mortality.

Anxiety sensitivity and posttraumatic stress symptoms: Associations among female Veterans with a history of military sexual trauma.

Anxiety sensitivity (AS), the degree to which individuals fear bodily sensations associated with anxious arousal, has been implicated in the development and maintenance of posttraumatic stress disorder (PTSD). Despite this well-established link, AS has yet to be examined among women who experience military sexual trauma (MST). This is particularly important as research has shown that rates of AS and PTSD are higher among females compared to males. Thus, the purpose of the current investigation was to examine the association between AS and overall PTSD symptom and cluster severity using a sample of female Veterans with a history of MST. The sample included 50 women Veterans presenting for psychological services to a MST specialty clinic at a large southeastern Veterans Affairs hospital. Results revealed a significant positive association between AS and overall PTSD symptom severity, even after controlling for levels of depression, which appeared to be driven by the relationship between AS and negative alterations in cognitions and mood and arousal and reactivity clusters. These findings provide initial support for the association between AS and PTSD symptoms among female Veterans with a history of MST. Given the malleable nature of AS, future research should examine the extent to which targeting this cognitive-behavioral construct reduces PTSD symptoms among such samples.

An initial investigation of the association between distress intolerance and posttraumatic stress within military sexual trauma survivors.

OBJECTIVE: Researchers have recently found several links between distress intolerance (DI), the perceived inability to withstand aversive emotional and somatic states, and posttraumatic stress disorder (PTSD) symptoms. Despite this well-established relationship, DI has yet to be examined among victims of military sexual trauma (MST), a population known to have increased rates of PTSD. Thus, the purpose of the current study was to examine overall rates of DI, as well as the relationship between DI and PTSD symptom and cluster severity using an outpatient sample of MST survivors. METHOD: The sample included 103 veterans presenting for psychological services to an MST specialty clinic at a large southeastern Veterans Affairs hospital. As part of their intake evaluation, veterans completed a brief battery of self-report questionnaires to assist with diagnostic clarification and treatment planning. RESULTS: Results revealed that DI was significantly associated with PTSD symptom severity above and beyond depression symptoms. Further, DI was significantly associated with the PTSD intrusion, negative alterations in cognitions and mood, and arousal and reactivity clusters. DISCUSSION: These findings provide initial evidence for a relationship between DI and PTSD symptoms within MST patients. Pending further research, investigators should determine the extent to which targeting this cognitive-behavioral construct reduces PTSD symptoms among MST samples. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Home Environmental and Behavioral Risk Indices for Reading Achievement.

The goal of this study was to identify home environmental and temperament/behavior variables that best predict standardized reading comprehension scores among school-aged children. Data from 269 children aged 9-16 (M = 12.08; SD = 1.62) were used in discriminant function analyses to create the Home and Behavior indices. Family income was controlled in each index. The final Home and Behavior models each classified around 75% of cases correctly (reading comprehension at grade level vs. not). Each index was then used to predict other outcomes related to reading. Results showed that Home and/or Behavior accounted for 4-7% of the variance in reading fluency and spelling and 20-35% of the variance in parent-rated problems in math, social anxiety, and other dimensions. These metrics show promise as environmental and temperament/behavior risk scores that could be used to predict and potentially screen for further assessment of reading related problems.

Nightmares and nonsuicidal self-injury: The mediating role of emotional dysregulation.

INTRODUCTION: Nonsuicidal self-injury (NSSI) is a transdiagnostic behavior associated with significant psychopathology. Research has shown a positive association between sleep disturbances, (e.g., nightmares and insomnia), and suicidal behavior, however, the relation between NSSI and sleep disturbances has yet to be examined. Sleep disturbances have been found to have a causal role in problems with emotional dysfunction. Specifically, sleep disturbances inhibit the emotion processing function of sleep. Importantly, a majority of individuals engage in NSSI to regulate intense emotions, and it is possible that sleep disturbances increase propensity for NSSI by contributing to dysregulated emotions. METHODS: In two cross-sectional studies, the present research examined whether insomnia symptoms and nightmares were related to NSSI in a clinical sample (Study 1, N = 313) and in a university sample (Study 2, N = 152). Furthermore, the hypothesis that emotional dysregulation would atemporally mediate the relationship between sleep disturbances and NSSI was tested in Study 2. RESULTS: Findings showed that nightmares, but not insomnia symptoms, were associated with NSSI while controlling for depressive symptoms. This pattern of findings was consistent across both clinical and university samples, which underscores the robustness of the finding. Further, the relationship between nightmares and NSSI was fully mediated by emotional dysregulation. CONCLUSION: The present research provides initial evidence that nightmares are atemporally associated with an increased propensity for NSSI by contributing to emotional dysregulation, and provides support for the emotion regulation function of dreams.

The mediating role of sleep disturbances in the relationship between posttraumatic stress disorder and self-injurious behavior.

Although posttraumatic stress disorder (PTSD) is associated with self-injurious behavior, it is currently unclear what mechanisms may account for this relationship. Sleep disturbances may be relevant as they are common among those with PTSD and are associated with emotion regulation difficulties, which may increase vulnerability to self-injurious behavior. As such, we investigated the relationship between PTSD and self-injurious behaviors, and the mediating roles of nightmares and insomnia. Hypotheses were tested cross-sectionally in a sample of psychology clinic outpatients (N=255). Participants completed a structured clinical interview assessing PTSD and self-report questionnaires measuring insomnia, nightmares, and self-injurious behaviors (i.e., Have you ever cut, burned, or scratched yourself on purpose?). PTSD was associated with self-injurious behavior after covarying for depression, and nightmare severity mediated the relationship between PTSD and self-injurious behavior. Findings are consistent with research indicating that sleep disturbances, specifically nightmares, are important predictors of poor outcomes among those with PTSD, and extend this research to suggest their role in self-injurious behaviors as well.