We Built it, But Did They Come: Veterans' Use of VA Healthcare System-Provided Complementary and Integrative Health Approaches.

BACKGROUND: Interest in complementary and integrative health (CIH) approaches, such as meditation, yoga, and acupuncture, continues to grow. The evidence of effectiveness for some CIH approaches has increased in the last decade, especially for pain, with many being recommended in varying degrees in national guidelines. To offer nonpharmacological health management options and meet patient demand, the nation's largest integrated healthcare system, the Veterans Health Administration (VA), greatly expanded their provision of CIH approaches recently. OBJECTIVE: This paper addressed the questions of how many VA patients might use CIH approaches and chiropractic care if they were available at modest to no fee, and would patients with some health conditions or characteristics be more likely than others to use these therapies. DESIGN: Using electronic medical records, we conducted a national, three-year, retrospective analysis of VA patients' use of eleven VA-covered therapies: chiropractic care, acupuncture, Battlefield Acupuncture, biofeedback, clinical hypnosis, guided imagery, massage therapy, meditation, Tai Chi/Qigong, and yoga. PARTICIPANTS: We created a national cohort of veterans using VA healthcare from October 2016-September 2019. KEY RESULTS: Veterans' use of these approaches increased 70% in three years. By 2019, use was 5.7% among all VA patients, but highest among patients with chronic musculoskeletal pain (13.9%), post-traumatic stress disorder (PTSD; 10.6%), depression (10.4%), anxiety (10.2%), or obesity (7.8%). The approach used varied by age and race/ethnicity, with women being uniformly more likely than men to use each approach. Patients having chronic musculoskeletal pain, obesity, anxiety, depression, or PTSD were more likely than others to use each of the approaches. CONCLUSIONS: Veterans' use of some approaches rapidly grew recently and was robust, especially among patients most in need. This information might help shape federal/state health policy on the provision of evidence-based CIH approaches and guide other healthcare institutions considering providing them.

Trajectories of relationship and individual functioning among waitlisted couples for an online relationship intervention.

To inform research and practice with distressed couples, the current study was designed to examine patterns of change among distressed, help-seeking couples prior to receiving an intervention. Data from this study originate from 221 couples assigned to the waitlist control condition of a randomized controlled trial for couples seeking online help for their relationship. All couples self-selected into the online program and agreed to withhold seeking additional services for their relationship during the waitlist period. In contrast with prior findings, results from the current study indicated a general pattern of mean improvement in both self-reported relationship functioning (e.g., increased relationship satisfaction, partner emotional support) and self-reported individual functioning (i.e., decreased psychological distress, anger) over the six-month waitlist period. Nonetheless, the majority of couples continued to remain relationally distressed despite these improvements. Findings from the study indicate that distressed couples can, in fact, exhibit some degree of improvement absent of intervention. At the same time, overall levels of distress remained elevated, indicating that these improvements are not sufficient to result in high levels of functioning and suggesting that many distressed couples may benefit from empirically supported programs to realize greater gains. These results also highlight and underscore the importance of including control conditions in studies examining the efficacy of relationship interventions with distressed couples to ensure that any observed improvements in relationship functioning are attributable to the intervention rather than to naturally occurring changes.

Con el fin de orientar la investigación y la práctica con parejas con distrés, se diseñó el presente estudio para analizar patrones de cambio entre parejas con distrés que buscan ayuda antes de recibir una intervención. Los datos de este estudio surgen de 221 parejas asignadas al grupo comparativo de lista de espera de un ensayo controlado aleatorizado para parejas que buscaban ayuda virtual para su relación. Todas las parejas eligieron ellas mismas estar en el programa virtual y acordaron dejar de buscar otros servicios para su relación durante el periodo de lista de espera. A diferencia de los resultados anteriores, los de este estudio indicaron un patrón general de mejoría promedio tanto en el funcionamiento relacional autoinformado (p. ej.: mayor satisfacción con la relación y apoyo emocional de la pareja) como en el funcionamiento individual autoinformado (p. ej.: menos distrés psicológico y enfado) durante el periodo de seis meses en lista de espera. Sin embargo, a pesar de estas mejorías, la mayoría de las parejas continuó teniendo distrés relacional. Los resultados del estudio indican que las parejas con distrés pueden, de hecho, mostrar algún grado de mejoría sin intervención. Al mismo tiempo, los niveles generales de distrés se mantuvieron elevados, lo cual indica que estas mejorías no son suficientes para dar como resultado niveles altos de funcionamiento, y sugiere que muchas parejas con distrés pueden beneficiarse de programas basados en la experiencia para lograr mayores avances. Estos resultados también destacan y subrayan la importancia de incluir grupos comparativos en los estudios que analizan la eficacia de las intervenciones en las relaciones de parejas con distrés a fin de garantizar que las mejorías observadas en el funcionamiento relacional sean atribuibles a la intervención en lugar de a los cambios que se producen naturalmente.

Relationship between change in in-vivo exposure distress and PTSD symptoms during exposure therapy for active duty soldiers.

OBJECTIVE: The current study sought to examine the relationship between changes in distress for items on in-vivo exposure hierarchies and posttraumatic stress disorder (PTSD) symptom change over the course of exposure therapy. METHODS: Active duty army soldiers (N = 108) were recruited from a military base in the U.S. and were enrolled in a randomized clinical trial comparing Prolonged Exposure (PE), Virtual Reality Exposure (VRE), and a wait-list control for the treatment of PTSD stemming from deployments to Iraq or Afghanistan. PTSD diagnosis followed DSM-IV-TR criteria. Outcome measures were assessed via self-report and clinician interview. The relationships between in-vivo exposure distress, imaginal exposure distress, and PTSD symptoms, were examined in a factor of curves model for participants in the treatment conditions. RESULTS: Analyses revealed that, when controlling for one another, changes in in-vivo exposure distress were significantly associated with changes in PTSD symptoms (ß = 0.75, 95% CI [0.60, 0.90]), while changes in imaginal exposure distress were not (ß = 0.03, 95% CI [-0.27, 0.33]). The model also revealed that after accounting for the shared variation in trajectories of change, symptom clusters did not have unique variation, meaning that symptom clusters did not change independently. CONCLUSION: Results suggest the possibility that in-vivo exposures are more closely tied to changes in overall PTSD symptoms than imaginal exposures during exposure therapy. Furture research should incorporate more frequent measurement of in-vivo exposure distress to better elucidate these relations over the course of treatment.

Determinants of Coach Communication About Concussion Safety in US Collegiate Sport.

BACKGROUND: Communication between coaches and athletes about concussion safety can reinforce or undermine a sport culture in which concussion under-reporting is often endemic. METHOD: This study tested a model in which self-reported coach communication about concussion safety was predicted by factors including concussion knowledge, attitudes and beliefs, sex of the coach, and sex of the team coached. Participants were 997 coaches of contact and collision sports teams competing in National Collegiate Athletic Association Division I, II, or III. RESULTS: Concussion attitudes and beliefs were the strongest predictors of communication, and the small effect of knowledge on communication was transmitted nearly entirely through its effect on attitudes and beliefs. Much of the variability in communication was attributable to the sex of the coach and the sex of the team coached. CONCLUSIONS: These results serve as a starting point for the design of coach-targeted interventions that encourage communication about health and safety with athletes.