Mental health treatment for first responders: An assessment of mental health provider needs.

First responders experience mental health conditions at a higher rate than the general population. To improve treatment and enhance quality of care, it is important to understand the needs of those who provide mental health treatment to this population. The purpose of this study was to explore the needs of mental health providers with experience working with first responders to better understand how first responders differ from community patients, and what training and supports providers need to enhance treatment. Semistructured qualitative interviews were conducted via videocalls with 12 mental health providers who provide mental health care to Australian first responders. The interviews were transcribed verbatim and interpretative phenomenological analysis was performed. The findings highlighted the importance of identity and culture among first responders, and the need for cultural awareness and understanding among mental health providers working with this population. Various training opportunities which could enhance treatment capacities were identified, including training in accurate assessment and differential diagnosis, evidence-based trauma-focused treatments, transdiagnostic treatments, and working with specific first responder treatment characteristics (e.g., emotional detachment, rigid cognitive styles, and preferences toward structure and order). Ways in which mental health providers can be supported included facilitating professional networks between providers and connection with first responder organizations. The insights gathered from this study provide a foundation from which to consider training and support development for mental health providers working with first responders. Service level implications and directions are outlined to assist future decision making on this topic. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Alexithymia and treatment response for prolonged exposure therapy: An evaluation of outcomes and mechanisms.

Alexithymia is the inability to identify and recognize emotions. The present study examined the impact of alexithymia on prolonged exposure (PE) therapy. Participants (n = 68) with PTSD underwent 10 PE sessions. Alexithymia was assessed via the Toronto Alexithymia Scale (TAS-20) and the emotional clarity and awareness subscales of the Difficulties in Emotion Regulation Scale. Treatment outcomes were assessed via the PTSD checklist and Clinician-Administered PTSD Scale for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition at posttreatment and 6-month follow-up. Those with high alexithymia were more likely to endorse experiencing a full PTSD diagnosis immediately posttreatment, χ²(1) = 12.53, p = .002, and at 6-month follow-up, χ²(1) = 11.21, p = .004. Alexithymia was associated with delayed treatment effects on avoidance, with a significant reduction in symptomology observed from pre- to follow-up, t(51) = 4.52, p < .001, and not from pre- to posttreatment. Although both the low and high alexithymia groups showed significant changes in negative changes in thinking and mood, F(2, 14) = 9.18, p = .001, d = 1.57 and F(2, 50) = 13.86, p = .001, d = 1.49, respectively, the high alexithymia group exhibited a marginally lesser magnitude of treatment effect. Although those with significantly greater difficulties with emotional clarity were more likely to drop out of PE treatment, emotional clarity and awareness did not moderate treatment response. Our results confirm the efficacy of PE but also highlight that those with alexithymia show a delayed treatment response and may be at greater risk of pathology after treatment. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Interactive relationship between alexithymia, psychological distress and posttraumatic stress disorder symptomology across time.

Alexithymia, psychological distress, and posttraumatic stress disorder (PTSD) are highly related constructs. The ongoing debate about the nature and relationship between these constructs is perpetuated by an overreliance on cross-sectional research. We examined the longitudinal interactive relationship between alexithymia, psychological distress, and PTSD. We hypothesised that there is an interactive relationship between the three constructs. Military personnel (N = 1871) completed the Toronto Alexithymia Scale, the Kessler 10 and a PTSD Checklist (PCL-C) at pre-deployment, post-deployment, and at 3-4 years following the post-deployment assessment. We initially tested whether psychological distress is either a moderator or mediator in the relationship between alexithymia and PTSD across the time points. General psychological distress was a partial mediator of total PTSD severity and hyperarousal symptomology at all three time points. Psychological distress fully mediated re-experiencing and avoidance symptomology at all three time points. Our results suggest that those with alexithymia are at longitudinal risk of developing more severe PTSD symptomology and experiencing hyperarousal irrespective of temporal proximity to traumatic exposure. Further, vulnerability to the emergence of re-experiencing and avoidance symptomology for those with alexithymia is increased when one experiences greater distress. Our results show that alexithymia is a persistent risk factor for PTSD symptomology.

Posttraumatic Stress and Alexithymia: Symptom Associations.

ABSTRACT: There is a demonstrated association between alexithymia and posttraumatic stress disorder (PTSD). However, work has largely focused on male-dominant, high-risk occupation populations. We aimed to explore the relationship between posttraumatic stress (PTS) and alexithymia among 100 trauma-exposed female university students. Participants completed a Life Events Checklist, the PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (PCL-5), and the Toronto Alexithymia Scale (TAS-20). Multiple regressions were run to examine whether alexithymia was associated with each of the PCL-5 subscales. The TAS-20 total scores were associated with total PTS scores, ß = 0.47, t(99) = 5.22, p < 0.001. On a subscale level, Difficulty in Identifying Feelings (DIF) was positively associated (ß = 0.50 to 0.41) with all PCL-5 subscales except for Avoidance. Our results align with research showing that for women, the DIF subscale is most strongly associated with PTS, in contrast with the literature on male samples, showing strongest associations with the Difficulties in Describing Feelings subscale, suggesting sex differences in associations between PTS and alexithymia. Our study supports the universality of the associations between alexithymia and PTS.

Emotion response disconcordance among trauma-exposed adults: the impact of alexithymia.

BACKGROUND: Emotion processing deficits have been identified as a critical transdiagnostic factor that facilitates distress after trauma exposure. Limited skills in identifying and labelling emotional states (i.e. alexithymia) may present on the more automated (less conscious) end of the spectrum of emotional awareness and clarity. Individuals with alexithymia tend to exhibit a disconcordance between subjective experience and autonomic activity (e.g. where high levels of subjective emotional intensity are associated with low physiological arousal), which may exacerbate distress. Although there is a robust link between alexithymia and trauma exposure, no work to date has explored whether alexithymia is associated with emotional response disconcordance among trauma-exposed adults. METHOD: Using a validated trauma script paradigm, the present study explored the impact of alexithymia on emotion response concordance [skin conductance (Galvanic Skin Response, GSR) and Total Mood Disturbance (TMD)] among 74 trauma-exposed adults recruited via a posttraumatic stress disorder (PTSD) treatment clinic and student research programme. RESULTS: Unlike posttraumatic symptom severity, age, sex, participant type and mood (which showed no effect on emotion response concordance), alexithymia was associated with heightened emotion response disconcordance between GSR and TMD [F(1, 37) = 8.93, p = 0.006], with low GSR being associated with high TMD. Observed effects of the trauma script were entirely accounted for by the interaction with alexithymia, such that those with alexithymia showed a negligible association between subjective and physiological states. CONCLUSION: This finding is paramount as it shows that a large proportion of trauma-exposed adults have a divergent emotion engagement profile.

A predictive coding account of value-based learning in PTSD: Implications for precision treatments.

While there are a number of recommended first-line interventions for posttraumatic stress disorder (PTSD), treatment efficacy has been less than ideal. Generally, PTSD treatment models explain symptom manifestation via associative learning, treating the individual as a passive organism - acted upon - rather than self as agent. At their core, predictive coding (PC) models introduce the fundamental role of self-conceptualisation and hierarchical processing of one's sensory context in safety learning. This theoretical article outlines how predictive coding models of emotion offer a parsimonious framework to explain PTSD treatment response within a value-based decision-making framework. Our model integrates the predictive coding elements of the perceived: self, world and self-in the world and how they impact upon one or more discrete stages of value-based decision-making: (1) mental representation; (2) emotional valuation; (3) action selection and (4) outcome valuation. We discuss treatment and research implications stemming from our hypotheses.

A Pilot Study of the Efficacy of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Treating Posttraumatic Psychopathology: A Randomized Controlled Trial.

The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) is an intervention that targets common mechanisms that maintain symptoms across multiple disorders. The UP has been shown to be effective across many disorders, including generalized anxiety disorder, major depressive episode (MDE), and panic disorder, that commonly codevelop following trauma exposure. The present study represented the first randomized controlled trial of the UP in the treatment of trauma-related psychopathology, including posttraumatic stress disorder (PTSD), depression, and anxiety symptoms. Adults (N = 43) who developed posttraumatic psychopathology that included PTSD, MDE, or an anxiety disorder after sustaining a severe injury were randomly assigned to receive 10-14 weekly, 60-min sessions of UP (n = 22) or usual care (n = 21). The primary treatment outcome was PTSD symptom severity, with secondary outcomes of depression and anxiety symptom severity and loss of diagnosis for any trauma-related psychiatric disorder. Assessments were conducted at intake, posttreatment, and 6-month follow-up. Posttreatment, participants who received the UP showed significantly larger reductions in PTSD, Hedges' g = 1.27; anxiety, Hedges' g = 1.20; and depression symptom severity, Hedges' g = 1.40, compared to those receiving usual care. These treatment effects were maintained at 6-month follow-up for PTSD, anxiety, and depressive symptom severity. Statistically significant posttreatment loss of PTSD, MDE, and agoraphobia diagnoses was observed for participants who received the UP but not usual care. This study provides preliminary evidence that the UP may be an effective non-trauma-focused treatment for PTSD and other trauma-related psychopathology.

Training plus intensive consultation improves uptake and outcome expectations of prolonged exposure therapy among practitioners treating emergency service personnel with post-traumatic stress disorder.

OBJECTIVE: Prolonged exposure (PE) therapy is an evidence-based psychological treatment of post-traumatic stress disorder (PTSD), yet uptake amongst practitioners is less than desirable. The aim of this study was to evaluate the efficacy of a PE training workshop plus intensive consultation programme to improve practitioners' self-efficacy and outcome expectations as well as uptake of PE for emergency service patients with PTSD. METHOD: Forty-five psychologists attended a PE training workshop in Sydney. Participants completed questionnaires at pre- and post-workshop and six-month follow-up. RESULTS: The findings suggest that participation in the programme was associated with improvements in practitioners' beliefs in their ability to deliver PE to patients, an increase in their use of a range of PE components and an increase in their use of in vivo exposure with a greater proportion of patients. CONCLUSION: Effective training approaches for evidence-based treatments of PTSD should incorporate intensive consultation following training. Future studies should consider additional strategies to encourage practitioners to deliver PE to more patients with PTSD.