Trauma-informed parenting intervention for veterans: A preliminary uncontrolled trial of Strength at Home-Parents.

Trauma exposure and posttraumatic stress disorder (PTSD) are highly prevalent in military and veteran populations and are associated with parenting difficulties. Unfortunately, there is a lack of accessible, trauma-informed, and evidence-based parenting support interventions within the Department of Veterans Affairs (VA). Strength at Home-Parents (SAHP) is a trauma-informed psychotherapy group that aims to improve parenting behaviors and overall parent-child and family functioning among U.S. military veterans with PTSD symptoms. SAHP was developed to maximize ease of use by VA providers and accessibility for parents. Here we report data from an uncontrolled trial of SAHP delivered using synchronous video technology in a sample of veterans using VA care (N = 53) who met the criteria for PTSD and parent-child functioning difficulties. Enrollment and retention rates met study goals and suggest feasibility and acceptability of study methods. Significant pre- to postintervention improvements were observed in measures of dysfunctional discipline, parenting stress, general family functioning, child psychosocial functioning, and parental PTSD and depression symptoms. Coupled with high satisfaction ratings, findings support further study of the intervention, including in an efficacy trial. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Pilot trial of Strength at Home Parents, a trauma-informed parenting support treatment for veterans.

PTSD is associated with compromised parenting which is not adequately addressed in available evidence-based PTSD treatments. Strength at Home - Parents (SAHP) is a trauma-informed parenting intervention which aims to improve parenting behaviors and overall parent-child functioning. Here we report pilot data obtained in a sample of veterans (N=21) with PTSD and parent-child functioning difficulties. Results support feasibility of study methods, and intervention acceptability, credibility and satisfaction. Movement on primary outcome measures suggested improved overall family functioning, a decrease in the use of dysfunctional parenting practices, an increase in positive parenting practices and a trend towards a reduction in parenting stress. Results should be interpreted with caution because of the small sample size and attrition at follow-up. Limitations withstanding, findings support further study of the intervention, which would provide insights into whether an efficacy trial is indicated.

Computerized Psychological Interventions in Veterans and Service Members: Systematic Review of Randomized Controlled Trials.

BACKGROUND: Computerized psychological interventions can overcome logistical and psychosocial barriers to the use of mental health care in the Veterans Affairs and Department of Defense settings. OBJECTIVE: In this systematic review, we aim to outline the existing literature, with the goal of describing: the scope and quality of the available literature, intervention characteristics, study methods, study efficacy, and study limitations and potential directions for future research. METHODS: Systematic searches of two databases (PsycINFO and PubMed) using PRISMA (Preferred Reporting Item for Systematic Reviews and Meta-Analyses) guidelines were conducted from inception until November 15, 2020. The following inclusion criteria were used: the study was published in an English language peer-reviewed journal, participants were randomly allocated to a computerized psychological intervention or a control group (non-computerized psychological intervention active treatment or nonactive control group), an intervention in at least one treatment arm was primarily delivered through the computer or internet with or without additional support, participants were veterans or service members, and the study used validated measures to examine the effect of treatment on psychological outcomes. RESULTS: This review included 23 studies that met the predefined inclusion criteria. Most studies were at a high risk of bias. Targeted outcomes, participant characteristics, type of support delivered, adherence, and participant satisfaction were described. Most of the examined interventions (19/24, 79%) yielded positive results. Study limitations included participant characteristics limiting study inference, high rates of attrition, and an overreliance on self-reported outcomes. CONCLUSIONS: Relatively few high-quality studies were identified, and more rigorous investigations are needed. Several recommendations for future research are discussed, including the adoption of methods that minimize attrition, optimize use, and allow for personalization of treatment.

Network analyses reveal which symptoms improve (or not) following an Internet intervention (Deprexis) for depression.

BACKGROUND: Depression is a heterogeneous collection of symptoms. Prior meta-analyses using symptom sum scores have shown the Internet intervention, Deprexis, to be an efficacious treatment for depression. However, no prior research has investigated how Deprexis (or any other Internet intervention for depression) impacts specific symptoms of depression. The current study utilizes symptom-level analyses to examine which symptoms are directly, indirectly, or minimally influenced by treatment. METHODS: Network analysis and mean-level approaches examined which symptoms, assessed by the Quick Inventory of Depression Symptoms, were affected by an 8-week course of Deprexis compared with a waitlist in a nationally recruited sample from the United States (N = 295). RESULTS: Deprexis directly improved the symptoms of sadness and indecision. Changes in these symptoms, in turn, was associated with a change in early insomnia, middle insomnia, self-dislike, fatigue, anhedonia, suicidality, slowness, and agitation. All of these symptoms (except for agitation and early insomnia) show decreases with Deprexis compared with a waitlist after correcting for multiple comparisons. Six additional symptoms, particularly the somatic symptoms, were not impacted by Deprexis compared with a waitlist. CONCLUSIONS: In this sample, the efficacy of Deprexis was due to its direct impact on sadness and indecision. Examining the treatment-related change in specific symptoms may facilitate a more nuanced understanding of how a treatment works compared with examining symptom sum scores. Symptom-level approaches may also identify symptoms that do not improve and provide important direction for future treatment development.

Childhood trauma and clinical high risk for psychosis.

As a risk factor for psychosis, childhood trauma rates are elevated in the clinical-high-risk (CHR) syndrome compared to the general population. However, it is unknown whether trauma is typically experienced in childhood or adolescence/young adulthood, whether it occurred prior to CHR syndrome onset, and how severe trauma relates to presenting symptoms. In this study, we examined the relationship of trauma history to symptoms and functioning in individuals diagnosed with the CHR syndrome on the Structured Interview for Psychosis-Risk Syndromes (N = 103). Trauma, defined as meeting the DSM-IV A1 criterion of actual or threatened death or injury, was assessed by semi-structured interview. A large proportion of CHR participants (61%) reported trauma exposure, including interpersonal trauma, trauma prior to CHR onset, and childhood trauma prior to age 12. Those with a trauma history (versus those without trauma) were rated as having more severe perceptual disturbances, general/affective symptoms and more impairment on the Global Assessment of Functioning Scale. The number of traumatic events correlated with more severe ratings in those three domains. Additionally, the number of interpersonal traumas was correlated with ratings of suspiciousness. Trauma was unrelated to specific measures of social and role functioning. A small proportion of CHR participants were diagnosed with formal PTSD (14%), which was unrelated to symptom severity or functioning. Thus, we demonstrate that trauma exposure is often early in life (before age 12), occurs prior to the onset of the CHR syndrome, and is related to both positive and affective symptoms.

A machine learning ensemble to predict treatment outcomes following an Internet intervention for depression.

BACKGROUND: Some Internet interventions are regarded as effective treatments for adult depression, but less is known about who responds to this form of treatment. METHOD: An elastic net and random forest were trained to predict depression symptoms and related disability after an 8-week course of an Internet intervention, Deprexis, involving adults (N = 283) from across the USA. Candidate predictors included psychopathology, demographics, treatment expectancies, treatment usage, and environmental context obtained from population databases. Model performance was evaluated using predictive R2$\lpar R_{{\rm pred}}^2\rpar\comma $ the expected variance explained in a new sample, estimated by 10 repetitions of 10-fold cross-validation. RESULTS: An ensemble model was created by averaging the predictions of the elastic net and random forest. Model performance was compared with a benchmark linear autoregressive model that predicted each outcome using only its baseline. The ensemble predicted more variance in post-treatment depression (8.0% gain, 95% CI 0.8-15; total $R_{{\rm pred}}^2 \; $= 0.25), disability (5.0% gain, 95% CI -0.3 to 10; total $R_{{\rm pred}}^2 \; $= 0.25), and well-being (11.6% gain, 95% CI 4.9-19; total $R_{{\rm pred}}^2 \; $= 0.29) than the benchmark model. Important predictors included comorbid psychopathology, particularly total psychopathology and dysthymia, low symptom-related disability, treatment credibility, lower access to therapists, and time spent using certain Deprexis modules. CONCLUSION: A number of variables predict symptom improvement following an Internet intervention, but each of these variables makes relatively small contributions. Machine learning ensembles may be a promising statistical approach for identifying the cumulative contribution of many weak predictors to psychosocial depression treatment response.

Acetaminophen enhances the reflective learning process.

Acetaminophen has been shown to influence cognitive and affective behavior possibly via alterations in serotonin function. This study builds upon this previous work by examining the relationship between acetaminophen and dual-learning systems, comprising reflective (rule-based) and reflexive (information-integration) processing. In a double-blind, placebo-controlled study, a sample of community-recruited adults (N = 87) were randomly administered acetaminophen (1000 mg) or placebo and then completed reflective-optimal and reflexive-optimal category learning tasks. For the reflective-optimal category learning task, acetaminophen compared to placebo was associated with enhanced accuracy prior to the first rule switch (but not overall accuracy), with needing fewer trials to reach criterion and with a faster learning rate. Acetaminophen modestly attenuated performance on the reflexive-optimal category learning task compared to placebo. These findings indirectly support two positions that have been proposed elsewhere. First, they are consistent with the view that acetaminophen has an influence on the serotonergic system. Second, the findings are consistent with a proposed link between elevated serotonin function and relative dominance of effortful, rule-based processing.

Effectiveness of an internet intervention (Deprexis) for depression in a united states adult sample: A parallel-group pragmatic randomized controlled trial.

OBJECTIVE: To examine the effectiveness of an Internet intervention for depression with a randomized, controlled trial in a large sample of adults recruited from the United States. METHOD: The current study examines the effectiveness of Deprexis, an Internet treatment for depression that was provided with relatively minimal support. There were 376 treatment-seeking adults (mean age = 32 years; 74% female; 77% Caucasian, 7% Asian, 7% multiple races, 4% African American, and 11% Hispanic/Latino) with elevated depression (Quick Inventory of Depressive Symptoms-Self-Report [QIDS-SR] > = 10) who were randomized to receive an 8-week course of treatment immediately (n = 285) or after an 8-week delay (n = 91; i.e., waitlist control). RESULTS: Intention-to-treat analyses indicated that treatment was associated with greater reduction in self-reported symptoms of depression (effect size d = .80) and 12 times greater likelihood of experiencing at least 50% symptom improvement compared with waitlist control. Similar effects were observed for several secondary outcomes, such as interviewer-rated depression symptoms, well-being, and depression-related disability. Treatment effects for symptoms of social anxiety, panic, and traumatic intrusions were relatively small. CONCLUSION: Results suggest that Deprexis can produce symptomatic improvement among depressed adults recruited from the United States. Additional research is needed that examines whether improvements are maintained over time and who is particularly likely to respond to this form of treatment. (PsycINFO Database Record

Additive genetic contribution to symptom dimensions in major depressive disorder.

Major depressive disorder (MDD) is a phenotypically heterogeneous disorder with a complex genetic architecture. In this study, genomic-relatedness-matrix restricted maximum-likelihood analysis (GREML) was used to investigate the extent to which variance in depression symptoms/symptom dimensions can be explained by variation in common single nucleotide polymorphisms (SNPs) in a sample of individuals with MDD (N = 1,558) who participated in the National Institute of Mental Health Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study. A principal components analysis of items from the Hamilton Rating Scale for Depression (HRSD) obtained prior to treatment revealed 4 depression symptom components: (a) appetite, (b) core depression symptoms (e.g., depressed mood, anhedonia), (c) insomnia, and (d) anxiety. These symptom dimensions were associated with SNP-based heritability (hSNP2) estimates of 30%, 14%, 30%, and 5%, respectively. Results indicated that the genetic contribution of common SNPs to depression symptom dimensions were not uniform. Appetite and insomnia symptoms in MDD had a relatively strong genetic contribution whereas the genetic contribution was relatively small for core depression and anxiety symptoms. While in need of replication, these results suggest that future gene discovery efforts may strongly benefit from parsing depression into its constituent parts. (PsycINFO Database Record

Serotonin promoter polymorphism (5-HTTLPR) predicts biased attention for emotion stimuli: Preliminary evidence of moderation by the social environment.

A number of studies have found an association between attentional bias for negative stimuli and variation in the serotonin transporter promoter region polymorphism (5-HTTLPR). The current project examined whether a positive social environment mitigates this association. More specifically, we examined the relationship between attentional bias on the dot-probe task, variation in the 5-HTTLPR and current social support among a community sample of adults (N=216). Consistent with prior research, the S/LG homozygotes were more likely than the other genotype groups to have a negative attention bias. However, social support moderated the association between 5-HTTLPR variation and attentional bias. The S/LG homozygote group was particularly likely to exhibit greater attentional bias towards negative stimuli at low levels of social support. However, as social support improved, negative attention bias decreased. Findings suggest that supportive environments may attenuate genetic associations with negative attention bias.

Symptom assessment in early psychosis: the use of well-established rating scales in clinical high-risk and recent-onset populations.

Symptom assessment in early psychosis research typically relies on scales validated in chronic schizophrenia samples. Our goal was to inform investigators who are selecting symptom scales for early psychosis research. We described measure characteristics, baseline scores, and scale inter-relationships in clinical-high-risk (CHR) and recent-onset psychotic disorder (RO) samples using the Positive and Negative Syndrome Scale, Brief Psychiatric Rating Scale, Scale for the Assessment of Positive Symptoms, and Scale for the Assessment of Negative Symptoms; for the CHR group only, we included the Scale of Prodromal Symptoms. For investigators selecting symptom measures in intervention or longitudinal studies, we also examined the relationship of symptom scales with psychosocial functioning. In both samples, symptom subscales in the same domain, across measures, were moderately to highly intercorrelated. Within all measures, positive symptoms were not correlated with negative symptoms, but disorganized symptoms overlapped with both positive and negative symptoms. Functioning was significantly related to negative and disorganized, but not positive, symptoms in both samples on most measures. Findings suggest strong overlap in symptom severity ratings among the most common scales. In recent-onset samples, each has strengths and weaknesses. In CHR samples, they appear to add little information above and beyond the SOPS.

Association between serotonin cumulative genetic score and the Behavioral Approach System (BAS): Moderation by early life environment.

The present study investigates if genetic variation in the serotonergic system interacts with early adversity to predict changes in the Behavioral Approach System (BAS), a system that taps into reward processing. In a sample of community adults (N= 236) the influence of single serotonergic candidate polymorphisms on BAS was analyzed, we also examined the aggregate contribution of these genetic variants by creating a Cumulative Genetic Score (CGS). A CGS quantifies an individual's cumulative risk by aggregating the number of risk alleles across the candidate polymorphisms. After individual gene analysis, three candidate genes rs7305115 (TPH2), rs6311 (HTR2A), and rs6295 (HTR1A) were combined into the CGS. There were no significant interactions between individual candidate polymorphisms and childhood adversity, but the CGS interacted with childhood adversity to explain a significant amount of variance (11.6%) in the BAS. Findings suggest that genetic variations in the serotonergic system in combination with childhood adversity contribute to individual differences in reward sensitivity.

Environmental Risk and Protective Factors and Their Influence on the Emergence of Psychosis.

Environmental risk and protective factors in schizophrenia play a significant role in the development and course of the disorder. The following article reviews the current state of evidence linking a variety of environmental factors and their impact on the emergence of psychotic disorders. The environmental factors include pre- and perinatal insults, stress and trauma, family environment, and cannabis use. The review of evidence is followed by case examples and clinical applications to facilitate the integration of the evidence into clinical practice.

Psychosis risk screening with the Prodromal Questionnaire--brief version (PQ-B).

In this study, we examined the preliminary concurrent validity of a brief version of the Prodromal Questionnaire (PQ-B), a self-report screening measure for psychosis risk syndromes. Adolescents and young adults (N=141) who presented consecutively for clinical assessment to one of two early psychosis research clinics at the University of California, San Francisco and UC Los Angeles completed the PQ-B and the Structured Interview for Prodromal Syndromes (SIPS) at intake. Endorsement of three or more positive symptoms on the PQ-B differentiated between those with prodromal syndrome and psychotic syndrome diagnoses on the SIPS versus those with no SIPS diagnoses with 89% sensitivity, 58% specificity, and a positive Likelihood Ratio of 2.12. A Distress Score measuring the distress or impairment associated with endorsed positive symptoms increased the specificity to 68%, while retaining similar sensitivity of 88%. Agreement was very similar when participants with psychotic syndromes were excluded from the analyses. These results suggest that the PQ-B may be used as an effective, efficient self-report screen for prodromal psychosis syndromes when followed by diagnostic interview, in a two-stage evaluation process in help-seeking populations.