Physical inactivity, cigarette smoking, and psychiatric comorbidity among veterans with posttraumatic stress disorder.

BACKGROUND: Posttraumatic stress disorder (PTSD) is associated with physical inactivity and cigarette smoking. However, little is known about the degree to which comorbid psychiatric conditions affect the odds of physical inactivity and smoking among individuals with PTSD. OBJECTIVE: To examine associations between PTSD, comorbid psychiatric conditions (depression, anxiety, or hazardous alcohol/substance use), physical inactivity and smoking among military veterans. METHOD: This was a cross-sectional analysis of data on U.S. veterans from Project VALOR (Veterans' After-discharge Longitudinal Registry; n = 1140). Logistic regressions examined associations between PTSD, comorbid psychiatric conditions, physical inactivity, and cigarette smoking. RESULTS: PTSD was associated with increased odds of being physically inactive (odds ratio [OR] = 2.08, p < .001) and a current smoker (OR = 1.39, p = .037), relative to no PTSD. PTSD with cooccurring depression was associated with increased odds for physical inactivity (OR = 2.68, p < .001) and smoking (OR = 1.78, p = .003), relative to PTSD only. PTSD with anxiety was associated with physical inactivity (OR = 2.17, p < .001), whereas cooccurring alcohol (OR = 1.60, p = .023) and substance use (OR = 2.00, p = .001) were associated with smoking. Additionally, numerous combinations of PTSD plus multiple conditions (e.g., PTSD + depression + anxiety) further increased the odds of physical inactivity and smoking (p < .05). CONCLUSIONS: Greater numbers of psychiatric comorbidities increase the odds of physical inactivity and cigarette smoking among veterans with PTSD. Physical inactivity and cigarette smoking are important predictors of cardiovascular and metabolic disease, and PTSD rarely occurs without psychiatric comorbidity. Thus, additional longitudinal research is needed to determine the impact of these associations, as they have clear physical and mental health implications. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Posttraumatic stress disorder and eating disorders: maintaining mechanisms and treatment targets.

Many individuals with lifetime histories of eating disorders (EDs) report exposure to interpersonal trauma and posttraumatic stress disorder (PTSD). However, this relationship is not well-understood, and there are no established, evidence-based therapies for the concurrent treatment of EDs and PTSD. This review focuses on studies of the mechanisms associating trauma exposure and/or PTSD with EDs. Possible mechanisms of the trauma-ED association identified from the literature include self-criticism, low self-worth, guilt, shame, depression, anxiety, emotion dysregulation, anger, and impulsivity/compulsivity. ED behaviors may be used as coping strategies to manage PTSD symptoms and negative affect. Avoidance of hyperarousal symptoms by engaging in binge eating, purging, and/or restriction may serve to maintain both the ED as well as the PTSD. Given the evidence of the bidirectional relationship between EDs and PTSD, we describe an integrated cognitive behavioral theory that may account for the persistence of comorbid PTSD and EDs. The integrated model is based on the theoretical models that underpin existing evidence-based treatments for PTSD and ED and incorporates many of the potential mechanisms highlighted to date. The primary aim of the model is to identify potential treatment targets as well as elucidate future directions for research.

Moderated mediation for exercise maintenance in pain and posttraumatic stress disorder: A randomized trial.

This study utilizes the Science of Behavior Change (SOBC) experimental medicine approach to evaluate the effects of a 3-month, individually prescribed progressive exercise training program on neurobiological, cognitive and motivational mechanisms by which our exercise-training paradigm may foster exercise maintenance. We will investigate hypothesized relationships between exercise-training associated augmentation of neuropeptide Y (NPY) system function and improvements in self-regulation and reward sensitivity-cognitive control and motivational processes posited to promote self-efficacy and intrinsic motivation, which have been shown to predict exercise maintenance. This study will recruit Veterans with chronic low back pain and posttraumatic stress disorder (PTSD). Procedures include a baseline, acute cardiopulmonary exercise challenge assessment that will inform the exercise prescription for a 12-week progressive exercise training program comprised of three 45-minute aerobic exercise sessions per week-all of which will be supervised by an exercise physiologist. Additionally, a week-7 and week-14 exercise challenge assessment will track changes in NPY system function and the variables of interest. We hypothesize that increases in the capacity to release NPY in response to acute exercise testing will be associated with improvements in self-regulation and reward sensitivity, which will in turn be associated with self-efficacy and intrinsic motivation to maintain regular exercise. Ninety participants will be randomized either to the "active exercise training condition" or to the "wait list symptom monitoring condition". The study aims to demonstrate the feasibility of procedures and elucidate mechanisms relevant to developing individually prescribed, motivationally based exercise regimens to reduce negative consequences of PTSD and low back pain over the long-term. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Adaptation to extreme stress: post-traumatic stress disorder, neuropeptide Y and metabolic syndrome.

The prevalence rates of obesity and metabolic syndrome are on the rise in the United States. Epidemiological surveys suggest that the rates of these medical conditions are especially high among persons with psychiatric disorders, including post-traumatic stress disorder (PTSD). A variety of factors are thought to contribute to the risk for metabolic syndrome, including excessive caloric intake, decreased activity and energy expenditure, use of certain medications, stress and genetic influences. Recent research demonstrates that stress, acting through the neuropeptide Y (NPY) and glucocorticoid systems, potentiates the development of obesity and other aspects of metabolic syndrome in mice fed a high caloric, fat and sugar diet. Alterations in the NPY and glucocorticoid systems also impact behavioral adaptation to stress, as indicated by studies in animals and persons exposed to severe, life-threatening or traumatic stress. The following review examines the biology of the NPY and neuroactive steroid systems as physiological links between metabolic syndrome and PTSD, a paradigmatic neuropsychiatric stress disorder. Hopefully, understanding the function of these systems from both a translational and systems biology point of view in relation to stress will enable development of more effective methods for preventing and treating the negative physical and mental health consequences of stress.

The development of an integrated treatment for veterans with comorbid chronic pain and posttraumatic stress disorder.

OBJECTIVE: The purpose of this article is to describe the development of the first integrated treatment for Veterans with comorbid chronic pain and posttraumatic stress disorder (PTSD). DESIGN: Descriptive, including pre- and posttreatment assessment results from a pilot study of six veterans with comorbid chronic pain and PTSD. SETTING: Northeastern Department of Veterans Affairs Medical Center. INTERVENTIONS: Using components of cognitive processing therapy (CPT) for PTSD and cognitive behavioral therapy (CBT) for chronic pain management, a 12-session integrated treatment for veterans with comorbid chronic pain and PTSD was developed. A therapist manual and patient workbook that included weekly readings and homework assignments were created. Participants received pre- and posttreatment evaluations using measures of pain, PTSD, physical disability, and psychological distress. The treatment development process is reviewed and the benefits and challenges of implementing this integrated treatment are presented. RESULTS: Several themes emerged over the course of implementing the treatment, including the importance of establishing participant trust, regular therapy attendance, and addressing participant avoidance. Of the six participants recruited for the pilot study, three withdrew from the study and three completed the integrated treatment. Participants reported that they generally liked the format of treatment, appreciated learning about the ways that chronic pain and PTSD share some common symptoms, and ways that the two disorders can interact with one another. The assessment results of those who completed treatment suggest that this treatment approach is feasible and may have clinical benefit. CONCLUSIONS: Participants appeared to benefit from receiving the integrated treatment for pain and PTSD. A randomized clinical trial is currently being conducted to evaluate the efficacy of this treatment approach.

Personal motivation, exercise, and smoking behaviors among young adults.

This study explored the motivational factors that influence individuals across the stages of change for exercise. The authors compared physically active nonsmokers with physically active smokers in a college student population. Half of regular exercisers identified themselves as smokers. Compared with their nonsmoking peers, young smokers have higher rates of physical and emotional distress. Those participants who exercise and do not smoke are more likely to exhibit intrinsic factors for exercise. Undergraduate psychology students (N = 614) completed an Internet survey on exercise and smoking behavior as well as motivational factors for exercise. Multivariate analyses of variance revealed that intrinsic motivational factors for exercise were significantly higher for the active nonsmokers than for the active smokers. Interventions promoting consistent exercise and smoking abstinence should continue to be directed toward young adults, focusing on fostering intrinsic motivational factors for exercise.