Prevalence and Factor Structure of PTSD in DSM-5 Versus DSM-IV in a National Sample of Sexual Minority Women.

The impact of changes to posttraumatic stress disorder (PTSD) diagnostic criteria from Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) to Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) within diverse communities is unclear. Young adult sexual minority women are at high risk for interpersonal violence and other forms of trauma exposure compared with heterosexual populations and sexual minority men. They are also at heightened risk of PTSD. As a result, young adult sexual minority women are a key population of interest when examining the impact of diagnostic criteria changes. The goal of the current study was to evaluate the impact of changes to PTSD diagnostic criteria in sexual minority women. Using an online survey, we administered both the original PTSD Symptom Checklist-S (based on DSM-IV criteria) and a version adapted to assess DSM-5 criteria to a national, nonclinical sample of young adult sexual minority women (N = 767). The DSM-5 symptom criteria fit the data well in confirmatory factor analysis. Current PTSD prevalence was higher under the DSM-5 diagnostic algorithm compared with DSM-IV (18.6% vs. 22.9%; d = 0.15). Compared with DSM-IV, associations between PTSD and depression were stronger using DSM-5 criteria, whereas associations between PTSD and high-risk drinking were reduced. Findings suggest that changes to PTSD diagnostic criteria do not have a major impact on prevalence of PTSD among sexual minority women but may have some impact on observed comorbidities.

Behavioral Activation as a Treatment for Posttraumatic Stress Disorder Among Returning Veterans: A Randomized Trial.

OBJECTIVE: Although evidence-based, trauma-processing treatments exist for posttraumatic stress disorder (PTSD), many individuals do not seek out, complete, or fully respond to these treatments, pointing to the need for alternative treatments. In this study, the authors evaluated the effectiveness of behavioral activation therapy modified to address PTSD among veterans. METHODS: In a randomized trial, behavioral activation was compared with treatment as usual (referral to PTSD "standard care") among a sample of 80 veterans of the wars in Iraq and Afghanistan who were enrolled at the U.S. Department of Veterans Affairs (VA) Portland Health Care System and the VA Puget Sound Health Care System. RESULTS: Levels of PTSD symptoms decreased for both groups across posttreatment and at 3-month follow-up as measured by clinical interview and self-report measures. The behavioral activation group had greater improvement on PTSD as evidenced by the self-report measure of symptom severity. Both groups also showed improvement on self-report measures of depression and overall functioning across time, with greater improvement on depression evidenced by the behavioral activation group. Ratings of treatment satisfaction were high for both groups. CONCLUSIONS: Behavioral activation is a promising alternative treatment for PTSD.

Independent Versus Co-occurring Substance Use in Relation to Gambling Outcomes in Older Adolescents and Young Adults.

PURPOSE: Gambling is prevalent among college students and can be associated with significant negative consequences. Students who report gambling also tend to report use of alcohol and cannabis, but little research has explored the associated risks of using these substances in relation to gambling episodes. This study explored associations between the independent and co-occurring use of alcohol and cannabis before/during gambling episodes and gambling outcomes. METHODS: Students (n = 1,834) completed an online survey that included measures of gambling frequency, amount lost, negative gambling consequences, gambling problem severity, and substance use. RESULTS: As hypothesized, individuals who reported using either alcohol or cannabis alone or both substances before/while gambling endorsed greater gambling quantity, frequency, negative consequences, and problem severity than individuals who used alcohol and cannabis in general but denied use of either substance before/while gambling. Use of both substances compared to use of alcohol alone was associated with greater gambling quantity, frequency, and negative consequences, although these groups did not differ on gambling problem severity. Cannabis use alone was no different on any outcome than use of both substances, and alcohol use alone was no different than cannabis use alone on any outcome. CONCLUSIONS: Use of cannabis alone before/while gambling may confer the same level of risk for negative gambling outcomes as use of both cannabis and alcohol. Prevention efforts may, therefore, benefit from targeting cannabis use in relation to gambling. Additional investigation is needed in light of recent and upcoming state legislation on the legalization of cannabis.

Electronic Feedback in College Student Drinking Prevention and Intervention.

Alcohol consumption is prevalent among college students and can be associated with serious negative consequences. Several efficacious programs using one-on-one brief intervention techniques have been developed to target high-risk drinking by individual students, such as the Brief Alcohol Screening and Intervention for College Students (BASICS) (Dimeff et al. 1999). To reach a larger population (e.g., the incoming freshman class), researchers have adapted these interventions so that students can access them via the Internet or in some other electronic format.The purpose of this review is to discuss specific alcohol intervention programs that were (1) designed to be delivered remotely (e.g., via the Web or on an electronic device) without interaction with a provider and (2) were tested among college students using a randomized controlled trial design. Specific studies were drawn from earlier reviews as well as a comprehensive literature search. Although many programs have limited research support, and some findings are mixed, components that were directly translated from in-person BASICS to remote-delivery mediums (i.e., personalized feedback interventions [PFIs], personalized normative feedback [PNF] interventions), and broader programs that incorporate PFI/ PNF, show promise in reducing alcohol use and/or negative consequences. However, more research is needed and suggestions for how the field can move these interventions forward are discussed.

Teaching Trauma-Focused Exposure Therapy for PTSD: Critical Clinical Lessons for Novice Exposure Therapists.

Over the past 10 years, our experiences delivering exposure therapy and teaching clinicians to deliver exposure therapy for PTSD have taught us some important lessons. We will focus on lessons learned as we have attended to clinicians' experiences as they begin to implement and apply the therapy. Specifically, we highlight common therapist expectations including the beliefs that the exposure therapy requires a new set of clinical skills, therapists themselves will experience a high level of distress hearing about traumatic events, and clients will become overly distressed. We then discuss common clinical challenges in the delivery of exposure therapy and illustrate them with case examples. The challenges addressed include finding the appropriate level of therapist involvement in session, handling client distress during treatment, targeting in-session covert avoidance, and helping the client shift from being trauma-focused to being more present and future oriented. Clinicians training exposure therapists and therapists new to the implementation of exposure therapy for PTSD should find this practical discussion of common expectations and initial clinical challenges reassuring and clinically useful.

Posttraumatic sequelae associated with military sexual trauma in female veterans enrolled in VA outpatient mental health clinics.

The purpose of this study was to explore the relationship between military sexual assault (MSA) and posttraumatic stress disorder (PTSD) and other symptoms associated with trauma, referred to as disorders of extreme stress not otherwise specified (DESNOS) or complex PTSD within a Veterans Affairs (VA) Medical Center outpatient mental health treatment-seeking sample. The present results focus on female Veterans only because of the low rates of endorsement of MSA among male Veterans resulting in a sample too small to use in analyses. Compared with those who did not endorse MSA, those who did reported greater frequency of other potentially traumatic events; PTSD symptoms; and symptoms characteristic of DESNOS, such as difficulties with interpersonal relationships, emotion regulation, dissociation, somatization, and self-perception. When childhood and other adulthood interpersonal trauma were both taken into account, MSA continued to contribute unique variance in predicting PTSD and DESNOS symptoms. VA patients reporting MSA may represent notably heterogeneous groups that include more complex posttraumatic reactions. Treatment interventions focused on complex PTSD may be warranted for a subset of female veterans who endorse MSA.

What you believe is what you want: modeling PTSD-related treatment preferences for sertraline or prolonged exposure.

Despite the known efficacy of various psychotherapies and pharmacotherapies for posttraumatic stress disorder (PTSD), we know little about what factors predict treatment preference. In the present study, we first developed exploratory path models of treatment preference for a psychotherapy or pharmacotherapy (n=273) and then conducted confirmatory analyses of these models in a second sample (n=324) and in a third generalization sample of trauma-exposed women (n=105). We examined demographic and psychopathology factors and treatment-related beliefs (i.e., credibility and personal reactions). Across all samples, treatment-related beliefs were the strongest predictors of treatment preference. Further, severity of depression directly reduced the likelihood of choosing psychotherapy, and severity of PTSD directly increased the likelihood of choosing pharmacotherapy. These results underscore the importance of better understanding individual's beliefs regarding treatments. With a clearer understanding of these factors, we may be able to reduce barriers to treatment and increase access to effective treatments for those with trauma-related symptoms.

Mediating and moderating effects of stress perception and situation type on coping responses in women with disordered eating.

Effects of stress perception and situation type on coping behavior were assessed in undergraduate females. Women with high (n=28) and low (n=28) Eating Attitudes Test (EAT) scores listened to audiotaped scenes representing two different situation types and two levels of stress. As predicted, the High EAT group rated scenes as more stressful and endorsed more of the maladaptive emotion-oriented coping, compared to the low EAT condition. Importantly, analyses revealed that stress perception mediated the relationship between group membership and emotion-oriented coping. Scene type appeared to moderate the effect of group on emotion-oriented coping. However, stress perception was shown to mediate, or account for, the moderating effect of situation type; a relationship termed mediated moderation. So although the two groups appeared to differ in the effect of situation type on coping, this apparent interaction effect can be attributed to differences in their perception of stress. Finally, women with High EAT scores did not exhibit a deficit in the more productive task-oriented coping behaviors, nor did they exhibit an avoidant coping style. In sum, the maladaptive coping used by women with disordered eating may represent characteristic emotional responses to exaggerated perceptions of stress and a preoccupation with issues specific to body image and food, rather than deficits in productive coping skills or an avoidant coping style.

Family Functioning, Substance Use and Related Problem Behaviors: Hispanic vs. Anglo Runaway Youths.

Runaway youths represent a neglected clinical group, and few studies have examined ethnicity differences within this population. Substance use, family functioning and related problem behaviors were examined in a sample of Hispanic and Anglo runaway youths with substance abuse diagnoses (N = 145). Youths, aged 12-17, were recruited from two urban, southwestern runaway shelters. Within single-parent families, Anglo youths reported more marijuana use, and, regardless of family constitution, reported more tobacco use than did Hispanic youths. Overall, Anglo youths reported more externalizing problems and more conflict tactics used in resolving disagreements with their primary caretaker while Hispanic youths reported higher depression and familism scores. Given the differences found between Hispanic and Anglo youths, the findings argue that culturally sensitive interventions for runaway youths and families are warranted.