More is not always better: 2 weeks of intensive cognitive processing therapy-based treatment are noninferior to 3 weeks.

OBJECTIVE: Although there is mounting evidence that massed treatment for PTSD is both feasible and effective, many questions remain about the optimal length of intensive treatment programs (ITPs), as well as the role of adjunctive services, such as psychoeducation, mindfulness, and yoga. Our setting recently transitioned from a three-week ITP to a two-week program. Adjunctive services were reduced, but the amount of individual CPT between programs remained similar. The present study examined the effectiveness of a two-week ITP based on twice daily individual CPT sessions and evaluated the program's noninferiority to an established three-week ITP using a Bayesian analytical approach. METHOD: Bayesian linear mixed regression models were used to explore PTSD and depression changes over time, as well as predictors of change. Noninferiority of the two-week ITP to a three-week ITP was also established using a Bayes factor approach. RESULTS: Results indicate that program participants change meaningfully in both PTSD and depression severity over the course of treatment, and that changes in posttraumatic cognitions predict subsequent changes in these outcomes. Further, the two-week ITP can be considered noninferior to the three-week ITP in both clinical outcomes and overall satisfaction. CONCLUSIONS: In the context of intensive PTSD treatment, the content of the ITP appears to matter more than its overall length. Shorter programs have the potential to increase access and treatment capacity. Our findings demonstrate the importance of continuous and rigorous program evaluation. Limitations as well as future directions for research, such as identifying the most effective treatment components, are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Building strong therapeutic relationships quickly: The effect of the perceived working alliance on veterans' intensive PTSD treatment outcomes.

Intensive treatment programs (ITPs) are successful at reducing posttraumatic stress disorder (PTSD) and depression symptoms in veterans. However, the role of the working alliance in the context of ITPs is largely unexplored. The purpose of this study was to examine veteran-rated working alliance with their individual cognitive processing therapy (CPT) provider as a predictor of changes in PTSD and depression symptoms as well as negative posttrauma cognitions in two unique ITP formats. Data were collected from 128 veterans who completed a 2-week ITP, involving 2 × individual CPT/day, as well as 73 veterans who completed a 3-week ITP, involving 1 × group CPT/day and 1 × individual CPT/day. Both ITPs included adjunctive wellness, skills, and psychoeducation services in addition to CPT. Linear mixed-effects models were used to determine whether changes in working alliance predicted changes in PTSD and depression symptoms. Stronger veteran-reported working alliance with their individual CPT therapist, most notably agreement on tasks, predicted significant reductions in both the 2-week and 3-week programs in PTSD (ps = .012 and .002, respectively) and depression symptoms (ps = .009 and .007, respectively) and negative posttrauma cognitions (ps = .009 and .016, respectively). These results highlight the importance of veterans' perceived working alliance with their individual treatment therapists in ITPs. Results suggest that a strong working alliance that is meaningful for treatment outcomes can be developed quickly despite the brevity of this intensive treatment format. Future research should examine ways to facilitate the development of a strong working alliance prior to or as early as possible in ITPs. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A case series examining PTSD and depression symptom reductions over the course of a 2-week virtual intensive PTSD treatment program for veterans.

OBJECTIVE: Evidence-based treatments for posttraumatic stress disorder (PTSD) can be effectively delivered over telehealth. There are, however, no studies that examine the effectiveness of delivering evidence-based treatments for PTSD in an intensive format via telehealth. Telehealth may be well-suited as a delivery modality because it may address barriers specific to intensive treatments. METHOD: To address this gap, we report on a case series of ten consecutively enrolled veterans (60% male; mean age 42.3, SD = 6.3) who participated in a virtual 2-week, cognitive processing therapy (CPT)-based intensive program. RESULTS: All (100%) participants completed treatment and reported large reductions in PTSD and depression symptoms pre- to posttreatment (Hedge's gws = 2.83 and gws = 1.97, respectively), pre- to 3-month follow-up (Hedge's gws = .99 and gws = 1.24, respectively), as well as very high satisfaction. CONCLUSIONS: Results of this case series suggest that evidence-based treatments for PTSD can be effectively delivered in intensive formats over telehealth and lay the foundation for more rigorously designed and larger scale research comparing virtual to in-person delivered intensive PTSD treatments. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Delivering Intensive PTSD Treatment Virtually: The Development of a 2-Week Intensive Cognitive Processing Therapy-Based Program in Response to COVID-19.

Of the many vulnerable groups affected by the spread of COVID-19, veterans have been especially impacted by the pandemic. Beginning in March 2020, nationwide shelter-in-place orders rapidly led to widespread job loss and economic upheaval; disruption and breakdown of multiple support systems; and increases in family stress, all of which may exacerbate underlying PTSD symptoms. Although telehealth has proven an effective means of delivering evidence-based psychotherapies for PTSD, little is known about the delivery of these treatments in an intensive, daily format over telehealth. There is growing need for intensive treatment options to reduce treatment-interfering barriers such as high dropout rates. In order to address this gap in the literature, this paper details several design considerations as well as patient selection procedures for a 2-week virtual intensive treatment program (vITP) for veterans with posttraumatic stress disorder (PTSD), consisting of daily individual Cognitive Processing Therapy (CPT) and other adjunctive interventions. We also describe two cases of veterans who successfully completed the vITP including their clinical outcomes, therapist reflections on the process, feedback regarding the program, as well as challenges patients encountered with the telehealth platform. Intensive evidence-based psychotherapy for PTSD delivered through a virtual format seems to show promise, but more systemic research is needed.

Evaluation of a gender-affirming healthcare curriculum for second-year medical students.

BACKGROUND: Transgender medicine is an emergent subfield with clearly identified educational gaps. AIMS: This manuscript evaluates a gender-affirming healthcare curriculum for second-year medical (M2) students. METHODS: Students received a survey assessing Gender Identity Competency in terms of skills, knowledge and attitudes regarding transgender and gender non-conforming (TGNC) issues. The authors administered the survey before and after the delivery of the curriculum. The curriculum included five online modules, a quiz, a 3-hour case-based workshop and a 2-hour interactive patient-provider panel. RESULTS: Approximately 60% of M2 students (n=77) completed both preassessments and postassessments. The following showed a statistically significant improvement from preassessment to postassessment: student Gender Identity Competency, t(76) = -11.07, p<0.001; skills, t(76) = -15.22, p<0.001; and self-reported knowledge, t(76) = -4.36, p<0.001. Negative attitudes did not differ (p=0.378). Interest in TGNC issues beyond healthcare settings did not change (p=0.334). M2 students reported a significant change in experience role-playing chosen pronouns in a clinical setting, t(76) = -8.95, p<0.001. CONCLUSIONS: The curriculum improved students' gender-affirming medical competency, knowledge and skills. The development of a sustained, longitudinal curriculum is recommended in addition to the continuing education of faculty to reinforce this expanding knowledge and skills base and to address discomfort working with this population.

Racial differences in posttraumatic stress disorder symptoms among African American and Caucasian male veterans.

OBJECTIVE: Posttraumatic stress disorder (PTSD) is one of the most prevalent mental health diagnoses for veterans. Previous research as well as the minority stress model and transgenerational trauma theories, suggest that race may be associated with PTSD, particularly in veterans. The current study examined whether there were racial differences in symptomology in a sample of combat veterans with PTSD (global and symptom cluster-specific). METHODS: Data were collected from male veterans who identified as non-Hispanic Caucasian or non-Hispanic African American (N = 413). Participants completed the Posttraumatic Stress Disorder Checklist- Military version (PCL-M). The PCL-M items were split into four symptom clusters to align with the DSM-5: Re-experiencing, Avoidance, Numbing, and Hyperarousal. It was hypothesized that African American veterans would report more severe global PTSD symptoms and higher levels of hypervigilance. RESULTS: Findings indicated global PTSD symptoms and three of the four symptom clusters did not differ, although the symptom cluster of Re-experiencing was found to be higher for African Americans compared to Caucasians. CONCLUSIONS: It may be helpful for researchers to broaden their methods of assessing PTSD symptomology, such as to examine specific PTSD symptom clusters, especially when assessing differences by race.

Moderation of improvement in self-efficacy following group psychotherapy for PTSD.

Posttraumatic stress disorder (PTSD) is a primary mental health concern of veterans. In clinical settings, efforts to improve broad facets beyond symptom amelioration and consideration of moderators of treatment effectiveness in this population are needed for continued improvement in care. General self-efficacy (GSE) has been indicated as a useful treatment target because of its association with positive outcomes such as increased positive health behaviors. Both race and educational attainment represent potential moderators of treatment response that are relevant for a veteran PTSD population. This study aimed to determine whether a PTSD Recovery Group Therapy Program resulted in improvement in GSE and whether racial and educational differences moderated GSE outcomes. Archival data were examined from male veterans (N = 450) receiving mental health services at a Veterans Affairs medical center using multilevel modeling to examine change in GSE over the course of treatment as well as moderation of change in GSE as a function of race and educational attainment. After completion of group therapy, results indicated there was significant improvement in GSE, with significantly different improvement based on education. Higher levels of education were associated with greater increases in GSE after treatment. Improvement in GSE did not differ by participant race. In clinical settings, efforts to increase GSE and attending to moderators such as educational attainment may be useful for improving PTSD treatment approaches. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Examination of Racial Differences in a Posttraumatic Stress Disorder Group Therapy Program for Veterans.

Posttraumatic stress disorder (PTSD) is one of the most prevalent mental health diagnoses for veterans. Group therapy can be an effective and efficient means of treating PTSD, yet the literature exploring treatment outcomes for racial minorities is mixed and limited. The present study was an evaluation across racial groups of the PTSD Recovery Program, a manualized group therapy implemented at a Veterans Affairs hospital. Data were collected from male veterans (N = 450) who identified as non-Hispanic White or non-Hispanic African American and participated in a 10-week, combat-related, group therapy program between 2010 and 2014. Participants completed the Posttraumatic Stress Disorder Checklist-Military version (PCL-M) measure at pre-treatment and post-treatment. The Program led to a statistically significant reduction in PCL-M scores (Cohen's d = .64). Symptom reduction occurred regardless of race, with no racial differences in improvement. Racial and ethnic composition of groups was not related to outcomes. The Program was effective regardless of veteran group or provider. Results imply that the PTSD Recovery Program is an effective first-line option to treating non-Hispanic White and non-Hispanic African American veterans with PTSD. Future research should continue to explore the associations between group characteristics and treatment outcomes.

Negative Interpersonal Interactions and Dating Abuse Perpetration: The Mediating Role of Dispositional Forgivingness.

Theory and research suggest that an individual's negative interactions with his or her parents or romantic partner are associated with the perpetration of dating abuse. Research is beginning to explore the role of forgivingness within abusive romantic relationships, and these preliminary findings suggest that dispositional forgivingness might mediate the relations between negative interpersonal interactions and dating abuse. The current study assessed negative interactions with one's parents and one's romantic partner, the frequency of dating abuse perpetration, and dispositional forgivingness of others and oneself among a sample of emerging adults in college ( n = 421). Dispositional forgivingness of others was negatively associated with the perpetration of emotional/verbal dating abuse and threatening behaviors, and it mediated relations between negative interpersonal interactions and dating abuse perpetration. Our findings suggest that the tendency to forgive others may explain why some individuals who experience negative interpersonal interactions with parents or romantic partners do not escalate to perpetration of abuse within their romantic relationships. Implications for future research and application are discussed.

Effects of Aging on General and Specific Memory for Impressions.

Despite the number of documented declines in memory with age, memory for socioemotional information can be preserved into older adulthood. These studies assessed whether memory for character information could be preserved with age, and how the general versus specific nature of the information tested affected outcomes. We hypothesized that memory for general impressions would be preserved with age, but that memory for specific details would be impaired. In two experiments, younger and older adults learned character information about individuals characterized as positive, neutral, or negative. Participants then retrieved general impressions and specific information for each individual. The testing conditions in Experiment 2 discouraged deliberate recall. In Experiment 1, we found that younger performed better than older adults on both general and specific memory measures. Although age differences in memory for specific information persisted in Experiment 2, we found that younger and older adults remembered general impressions to a similar extent when testing conditions encouraged the use of "gut impressions" rather than deliberate retrieval from memory. We conclude that aging affects memory for specific character information, but memory for general impressions can be age-equivalent. Furthermore, there is no evidence for a positivity bias or differences in the effects of valence on memory across the age groups.

A multi-level modeling approach examining PTSD symptom reduction during prolonged exposure therapy: moderating effects of number of trauma types experienced, having an HIV-related index trauma, and years since HIV diagnosis among HIV-positive adults.

People living with HIV (PLWH) have extensive interpersonal trauma histories and higher rates of posttraumatic stress disorder (PTSD) than the general population. Prolonged exposure (PE) therapy is efficacious in reducing PTSD across a variety of trauma samples; however, research has not examined factors that influence how PTSD symptoms change during PE for PLWH. Using multi-level modeling, we examined the potential moderating effect of number of previous trauma types experienced, whether the index trauma was HIV-related or not, and years since HIV diagnosis on PTSD symptom reduction during a 10-session PE protocol in a sample of 51 PLWH. In general, PTSD symptoms decreased linearly throughout the PE sessions. Experiencing more previous types of traumatic events was associated with a slower rate of PTSD symptom change. In addition, LOCF analyses found that participants with a non-HIV-related versus HIV-related index trauma had a slower rate of change for PTSD symptoms over the course of PE. However, analyses of raw data decreased this finding to marginal. Years since HIV diagnosis did not impact PTSD symptom change. These results provide a better understanding of how to tailor PE to individual clients and aid clinicians in approximating the rate of symptom alleviation. Specifically, these findings underscore the importance of accounting for trauma history and index trauma type when implementing a treatment plan for PTSD in PLWH.

The moderating impact of interacting with distressed families of decedents on trauma exposure in medical examiner personnel.

OBJECTIVES: Prior research has examined the incidence of posttraumatic stress stemming from either direct or indirect trauma exposure in employees of high-risk occupations. However, few studies have examined the contribution of both direct and indirect trauma exposure in high-risk groups. One particularly salient indirect trauma often endorsed as the most stressful by many occupational groups is interacting with distressed family members of victims of crime, illness, or accidents. The present study examined the extent to which interacting with distressed families moderated the impact of cumulative potentially traumatic event (PTE) exposure on depression and posttraumatic stress disorder (PTSD) symptoms in 245 employees of medical examiner (ME) offices. METHOD: Employees from 9 ME office sites in the United States participated in an online survey investigating the frequency of work place PTE exposures (direct and indirect) and mental health outcomes. RESULTS: Results revealed that cumulative PTE exposure was associated with higher PTSD symptoms (PTSS) for employees who had higher frequency of exposure to distressed family members. After controlling for cumulative and direct PTE exposure, gender, and office site, exposure to distressed families was significantly associated with depressive symptoms, but not PTSS. CONCLUSIONS: Findings of our research underscore the need for training employees in high-risk occupations to manage their reactions to exposure to distraught family members. Employee training may buffer risk for developing PTSD and depression. (PsycINFO Database Record

Mind and body: Mental health and health related quality of life in SCI caregivers from Neiva, Colombia.

BACKGROUND: Despite the body of research on caregivers of individuals with various types of disabilities, SCI caregivers have received comparably less attention, especially in regions like Latin America. OBJECTIVE: The purpose of this study was to examine the association between HRQOL and mental health in SCI caregivers from Colombia. METHOD: A cross sectional study assessed SCI caregivers (n = 40) in Neiva, Colombia. Participants completed a measure of their HRQOL (SF-36 Health Questionnaire) and four measures of mental health (Satisfaction With Life Scale, Zarit Burden Interview, Patient Health Questionnaire-9, and State-Trait Anxiety Inventory). RESULTS: A canonical correlation between variables revealed that 64% of the variance was shared between mental health and HRQOL. The domains that loaded highest within the canonical correlation were social functioning, general health, and anxiety, indicating that SCI caregivers with higher anxiety experienced lower social functioning and lower general health. Furthermore, 15 of the 24 bivariate correlations between mental health and HRQOL were statistically significant, suggesting a strong connection between these two sets of variables. CONCLUSION: Rehabilitation professionals in Latin America should consider the development of caregiver interventions focusing on both physical and mental health, as the two constructs are closely connected through social functioning, general health, and anxiety.

Disability and assistance dog implicit association test: a novel IAT.

OBJECTIVE: Individuals with disabilities often face stigma and negative social interactions. Human-animal interaction literature suggests that an individual paired with an animal will be perceived differently than an individual alone. Although people with disabilities report increases in social interactions when with assistance dogs, the reasons for this remain unclear. One possibility is that attitudes toward people with disabilities are altered by the presence of assistance dogs, thus affecting the social behaviors of the perceiver. This study examines whether implicit attitudes toward individuals with disabilities differ in the presence of an assistance dog. METHOD: College students (N = 244) completed the Attitudes of Adults to Dogs scale, an item assessing dog ownership, and the Disabilities and Assistance Dog Implicit Association Test (IAT). RESULTS: A 1-sample t test demonstrated a significant IAT effect, t(240) = 3.62, p < .001, with a positive implicit bias observed toward an individual with a disability when paired with an assistance dog over the individual alone. White individuals were more likely than Black individuals to hold positive implicit attitudes toward an individual with a disability paired with a dog, F(2, 238) = 3.18, p = .04. There were no significant differences in IAT D scores based on gender or dog ownership. IMPLICATIONS: This study extends previous research regarding social interactions for individuals with disabilities who are paired with assistance dogs. Increases in positive implicit attitudes toward an individual with a disability paired with a dog may explain these changes in social interactions. Dogs may serve as a social lubricant, increasing positive social interactions for individuals with disabilities.

The relationship between physical and mental health variables in individuals with spinal cord injury from Latin America.

BACKGROUND: Previous research has examined the health-related quality of life (HRQOL) and mental health of persons with spinal cord injury (SCI), but the majority of the research has taken place in the United States, Western Europe, and other developed countries. Limited research has been conducted with persons with SCI in Latin America. OBJECTIVE: To examine the relationship between HRQOL and mental health in persons with SCI from Neiva, Colombia. DESIGN: Cross-sectional. SETTING: Participants were recruited from the Foundation for the Integral Development of People with Disabilities, a nonprofit community organization for persons with disabilities. PARTICIPANTS: Forty persons with SCI from Neiva, Colombia. METHODS: Caregivers completed the Spanish versions of questionnaires. MAIN OUTCOME MEASURES: Participants completed self-report measures of HRQOL (SF-36 Health Questionnaire) and mental health (Satisfaction with Life Scale, Patient Health Questionnaire-9, and State Trait Anxiety Inventory). RESULTS: The hypothesis that higher HRQOL would be related to better mental health found robust support, as the canonical correlation between these 2 sets of variables uncovered that 50.4% of the variance was shared, such that persons with lower HRQOL had reduced mental health. Within this canonical correlation, anxiety, fatigue, and general health loaded most highly, suggesting that persons with SCI who experienced lower energy and reduced general health tended to have high anxiety. Additionally, 9 out of the 18 bivariate correlations between these 2 variable sets were statistically significant. CONCLUSIONS: In Latin America, SCI rehabilitation services are extremely sparse and rarely include interventions that target postinjury mental health. The current study suggests that mental health issues in patients with reduced HRQOL warrant attention in SCI rehabilitation services, especially in this region.

Age differences in self-referencing: Evidence for common and distinct encoding strategies.

Although engagement of medial prefrontal cortex (MPFC) underlies self-referencing of information for younger and older adults, the region has not consistently been implicated across age groups for the encoding of self-referenced information. We sought to determine whether making judgments about others as well as the self influenced findings in the previous study. During an fMRI session, younger and older adults encoded adjectives using only a self-reference task. For items later remembered compared to those later forgotten, both age groups robustly recruited medial prefrontal cortex, indicating common neural regions support encoding across younger and older adults when participants make only self-reference judgments. Focal age differences emerged in regions related to emotional processing and cognitive control, though these differences are more limited than in tasks in which judgments also are made about others. We conclude that making judgments about another person differently affects the ways that younger and older adults make judgments about the self, with results of a follow-up behavioral study supporting this interpretation. This article is part of a Special Issue entitled Memory and Aging.

Comparison of mental health between individuals with spinal cord injury and able-bodied controls in Neiva, Colombia.

Although research has investigated the mental health of individuals with spinal cord injury (SCI), an overwhelming majority of this research has been conducted in the United States, Western Europe, and other developed countries. The purpose of this study was to compare the mental health of individuals with SCI with able-bodied controls in Neiva, Colombia, South America. Subjects included 40 Colombians with SCI and 42 age- and sex-matched controls (N = 82). The groups did not differ based on age, sex, years of education, or socioeconomic status. However, controls were twice as likely to be married. Four measures assessed mental health, including satisfaction with life (Satisfaction with Life Scale), depressive symptoms (Patient Health Questionnaire-9), self-esteem (Rosenberg Self-Esteem Scale), and anxiety (State-Trait Anxiety Inventory). In comparison with able-bodied controls, individuals with SCI reported significantly lower mental health on both depressive symptoms and satisfaction with life. These effect sizes were medium and large, respectively. The groups did not differ significantly on measures of self-esteem or anxiety. Mental health of individuals with SCI should be considered a central part of SCI rehabilitation interventions, particularly in Latin America.

Examining the relationship between health-related quality of life in individuals with spinal cord injury and the mental health of their caregivers in Colombia, South America.

Although considerable research has been carried out on family caregivers of individuals with various types of disabilities, spinal cord injury (SCI) caregivers have received considerably less attention in terms of research, especially in regions such as Latin America. This study examined the relationship between health-related quality of life (HRQOL) in individuals with SCI and their family caregiver's mental health in Neiva, Colombia. Thirty-four individuals with SCI and their primary caregivers (34 dyads; n=68) from the Foundation for the Integral Development of People with Disabilities in Neiva, Colombia, were included in this study. Individuals with SCI completed eight subscales of the SF-36 that assessed HRQOL. Five aspects of caregiver mental health were assessed, including burden (Zarit Burden Interview), satisfaction with life (Satisfaction with Life Scale), depression (Patient Health Questionnaire-9), self-esteem (Rosenberg Self-Esteem Scale), and anxiety (State Trait Anxiety Inventory). A series of multiple regressions uncovered strong associations among the HRQOL of individuals with SCI and various aspects of caregiver mental health. In these regressions, patient physical functioning and pain were independently related to caregiver burden; patient pain and general health were independently related to caregiver satisfaction with life; and patient pain was independently related to caregiver anxiety. HRQOL in individuals with SCI was robustly related to their caregiver's mental health, suggesting that the two sets of variables are closely linked. These findings suggest that caregiver mental health should be a central part of SCI rehabilitation interventions, especially in Latin America.