Relationships among age, motivation, and exercise among women Veterans.

Physical activity (PA) and exercise are central to maintaining health, however research has shown steep declines in PA and exercise among women Veterans as they age. Though motivation may be an important contributor to initiating and sustaining exercise that may change across the lifespan, little is known about exercise motivation and its relation to age and exercise behavior among women Veterans. This cross-sectional study sought to describe exercise motivations, examine relationships among exercise motivations and age, and explore the degree to which age and motivation predict self-reported exercise behavior among women Veterans. We conducted a secondary data analysis from a regional mail survey of 197 women Veterans (mean age = 51; SD = 10.5) enrolled in Veterans Health Administration primary care in a northeastern region (N = 180 in analysis). Measures included demographics (age, body mass index), self-reported exercise motivation, and an estimate of average weekly exercise. Participants endorsed multiple motivators for exercise, most prominently fitness and health management. Age was significantly negatively related to amount of exercise and with socializing as an exercise motivation. After accounting for body mass index, age was a significant predictor of exercise behavior, and exercise motivations accounted for an additional 7.3% of variance in self-reported weekly exercise. Our results suggest that although motivation is a potentially important predictor of exercise, factors beyond motivation may better predict exercise in women Veterans. Further research is needed on personal and practical facilitators and barriers to exercise in this population.

Pain and Hazardous Alcohol Use in Veterans in Primary Care: The Role of Affective Pain Interference and Alcohol Pain-Coping Perceptions.

Chronic pain and unhealthy alcohol use commonly co-occur and are associated with negative health outcomes. Veterans may be particularly vulnerable to these conditions, yet limited research has examined factors involved in their co-occurrence. This cross-sectional study aimed to examine the role of affective pain interference and alcohol pain-coping perceptions in the relationship between pain and hazardous alcohol use. As informed by the catastrophizing, anxiety, negative urgency, and expectancy model, we hypothesized that the relationship between pain and hazardous alcohol consumption is mediated by affective pain interference and stronger among those with greater perceptions that alcohol helps cope with pain. Participants were 254 VA primary care patients (87.8% male, Mage = 64.03, 76.4% White) with a history of chronic musculoskeletal pain, past-year alcohol use, and past-week pain. Veterans completed a mailed survey including measures of pain, affective pain interference, alcohol pain-coping perceptions, and hazardous alcohol use. Hypotheses were tested with regression models and PROCESS macros. As hypothesized, affective pain interference mediated the pain-hazardous alcohol use association. Contrary to hypotheses, results showed no moderating effect of alcohol pain-coping perceptions. Findings partially support relationships among theorized constructs and suggest that for Veterans with co-occurring pain and alcohol use it may be important to target pain-related affective interference and perceptions that alcohol helps cope with pain. PERSPECTIVE: This article presents a test of factors involved in the pain and alcohol relationship, as informed by the CANUE model. Findings suggest that for Veterans with co-occurring pain and past-year alcohol use, it may be important to target pain-related affective interference and perceptions that alcohol helps cope with pain.

Primary Care Treatment Integrating Motivation and Exposure for PTSD Symptoms and Hazardous Alcohol Use: A Case Series.

Symptoms of posttraumatic stress disorder (PTSD) and hazardous alcohol use are highly comorbid. Research on integrated interventions to address PTSD symptoms and hazardous alcohol use concurrently has demonstrated efficacy, yet integrated treatments are underutilized. Both patient (e.g., stigma, scheduling/logistics) and clinician (e.g., concern about symptom exacerbation and/or treatment dropout) barriers may impede utilization of integrated interventions among those with comorbid PTSD symptoms and hazardous alcohol use. Primary care behavioral health models (PCBH), in which embedded behavioral health providers deliver treatment to individuals with mild or moderate behavioral health symptoms in primary care, may help address treatment barriers by offering accessible behavioral health interventions in a destigmatizing setting. This paper presents two case examples from a randomized controlled trial testing the efficacy of an integrated intervention for PTSD symptoms and hazardous alcohol use developed for and delivered in primary care. Outcome data and session-by-session content for two participants are included, along with discussion of barriers encountered during the course of treatment. Clinician-suggested strategies for navigating barriers to facilitate utilization of integrated interventions for PTSD symptoms and hazardous alcohol use are also discussed.

Leveraging Integrated Primary Care to Enhance the Health System Response to IPV: Moving toward Primary Prevention Primary Care.

Intimate partner violence (IPV) is a prominent public health problem in the United States, with significant health impacts that are often severe and persistent. Healthcare systems have been called upon to improve both the systematic identification and treatment of IPV largely by adopting secondary and tertiary prevention efforts. Research to date demonstrates both benefits and challenges with the current strategies employed. In this paper, we summarize current knowledge about the healthcare system's response to IPV and evaluate the strengths, limitations, and opportunities. We offer recommendations to broaden the continuum of healthcare resources to address IPV, which include a population health approach to primary prevention.

Rates and Correlates of Alcohol and Substance Use Among Women Veterans During the COVID-19 Pandemic: The Moderating Role of COVID-Specific Anxiety.

INTRODUCTION: Mental health symptoms and substance use increased during the COVID-19 pandemic, and women may be disproportionately affected. Women report substantial mental health consequences, and women veterans may experience additional risks associated with military service. However, rates and correlates of substance use and consequences among women veterans are largely unknown. This study aimed to 1) report rates of substance use and consequences among women veterans; 2) identify correlates of substance use and consequences; and 3) test COVID-specific anxiety as a moderator. METHOD: Women veterans (n = 209) enrolled in Veterans Health Administration primary care completed measures of demographics, psychiatric and substance use disorder (SUD) diagnoses, current mental health symptoms, alcohol consumption, drug-related problems, and COVID-specific anxiety. Bivariate correlations evaluated demographics (age, race, employment, relationship status), psychiatric (depression/anxiety/posttraumatic stress disorder) and SUD diagnoses, and current mental health (depression/anxiety) symptoms as correlates of substance use outcomes. For any relationships between correlates and outcomes that were statistically significant, COVID-specific anxiety was tested as a moderator using the PROCESS macro in SPSS version 27. Any statistically significant moderation effects were further investigated using the PROCESS macro to estimate conditional effects. COVID-specific anxiety was mean-centered before analyses. Alpha was set to 0.05 for all statistical tests. RESULTS: Thirty-six percent screened positive for hazardous (Alcohol Use Disorder Identification Test-Consumption [AUDIT-C] ≥ 3) alcohol consumption and 26% reported drug-related problems (18% low-level, 7% moderate-level, and 2% substantial per Drug Abuse Screening Test [DAST-10] scores). Drug-related problems were positively associated with COVID-specific anxiety, psychiatric diagnosis, SUD diagnosis, and depression symptoms. Alcohol consumption was significantly associated with SUD diagnosis. COVID-specific anxiety significantly moderated relationships between SUD diagnosis and both outcomes. DISCUSSION: Results help identify women veterans with SUD diagnoses and high COVID-specific anxiety as at risk for increased substance use during COVID-19 and suggest a potential intervention target (COVID-specific anxiety).

Randomized Clinical Trial of Brief Primary Care-Based Mindfulness Training Versus a Psychoeducational Group for Veterans With Posttraumatic Stress Disorder.

Objective: Individuals with posttraumatic stress disorder (PTSD) symptoms are often reluctant to engage in traditional mental health care but do seek primary care services. Alternative strategies are needed to develop emotional regulation skills among individuals with PTSD symptoms. This study examined the feasibility and effectiveness of Primary Care Brief Mindfulness Training (PCBMT) compared to a psychoeducational group for reducing PTSD symptoms.Methods: Primary care patients (n = 55) with DSM-5 PTSD symptoms but not engaged in PTSD psychotherapies were randomized to 4-week PCBMT or a PTSD psychoeducation group (EDU). Both groups were cofacilitated by mental health providers and veteran peer specialists. Between January 2019 and March 2020, assessments were completed at baseline, post-treatment, and 16- and 24-week follow-up.Results: PCBMT participants had significantly larger decreases in PTSD symptoms from pre- to post-treatment (d = 0.57) and depression from pre-treatment to 16- and 24-week follow-ups (d = 0.67, 0.60) compared to EDU. PCBMT participants also reported significantly greater improvements in health responsibility (d = 0.79), stress management (d = 0.99), and not feeling dominated by symptoms (d = 0.71). Both interventions resulted in the majority of participants "stepping up" to a higher level of PTSD care.Conclusions: Brief mindfulness training is effective for reducing psychiatric symptoms and improving broader recovery outcomes and health promoting behaviors. For individuals who are not yet willing to engage in trauma-focused PTSD treatment, PCBMT may be preferable and more effective than psychoeducational classes as preliminary treatments. Further research is needed to confirm the effectiveness of PCBMT in a larger sample and investigate factors that will support wider implementation in primary care settings.Clinical Trials Registration: ClinicalTrials.gov identifier: NCT03352011.

Behavioral health treatment barriers and preferences of primary care patients with chronic pain and alcohol use.

Context: Although chronic pain and high-risk alcohol use are prevalent in primary care and associated with more severe pain and functional impairment, current approaches address them separately and often neglect risky alcohol use among those with chronic pain. Treatments tailored to patient preferences increase utilization, yet little is known about patient treatment preferences for chronic pain and high-risk alcohol use. Objective: Describe treatment barriers and preferences of primary care patients with chronic musculoskeletal pain and past-year alcohol use and test for differences based on alcohol use (no risk, low risk, high risk). Study Design: Chart review and patient survey. Setting: VA primary care clinics. Inclusion criteria: ≥ 18 years old, past year VA primary care visit, chronic musculoskeletal condition, past year alcohol use. Exclusion criteria: psychotic or neurocognitive disorder diagnosis. Eligible participants were identified via chart review and mailed a survey packet. Population Studied: Participants (N = 371) were primarily White (74.7%) male (88.4%) veterans. Main and Secondary Outcome Measures: Readiness to change, alcohol treatment barriers, pain-alcohol beliefs, attitudes toward behavioral health and medical treatment, and treatment preferences were assessed. Results: Chi-square tests revealed statistically significant preferences for: face-to-face (70.3% preferred), individual (68.7% preferred), VA primary care, (69.2% preferred), and chronic pain focus (38.4% preferred). Patients with high-risk alcohol use reported more readiness to change alcohol use, stronger pain-alcohol beliefs, and more favorable attitudes toward behavioral health treatment than those with low- or no-risk alcohol use. Conclusions: Primary care patients with chronic musculoskeletal pain and alcohol use showed clear preferences for individual, face-to-face behavioral health treatment focused on chronic pain in a VA primary care clinic. Those with co-occurring high-risk alcohol use may experience differences in treatment barriers that may impede treatment engagement (i.e., stronger pain-alcohol beliefs), and in other cases, may facilitate treatment engagement (i.e., more readiness to change, more favorable treatment attitudes) compared to those with low- or no-risk alcohol use. Incorporating patient perspectives may help clinicians provide optimal behavioral health treatment for chronic pain and/or hazardous alcohol use in primary care.

Development of a Novel Brief Quantitative Sensory Testing Protocol That Integrates Static and Dynamic Pain Assessments: Test-Retest Performance in Healthy Adults.

OBJECTIVE: Quantitative sensory testing is an expanding pain research domain with numerous clinical and research applications. There is a recognized need for brief reliable quantitative sensory testing protocols that enhance assessment feasibility. This study aimed to integrate static (pain threshold, tolerance, suprathreshold) and dynamic (conditioned pain modulation, offset analgesia, temporal summation) pain reactivity measures into a brief 20-minute protocol that uses a single portable device. The test-retest performance of this optimized protocol was evaluated. DESIGN: Using a test-retest design, the brief quantitative sensory testing assessment was administered to participants on two occasions separated by exactly 7 days. SETTING: A clinical psychology research laboratory at Syracuse University. SUBJECTS: Participants were 33 healthy adults recruited from Syracuse University's online research participation pool. METHODS: A portable computerized quantitative sensory testing device delivered contact-heat pain to assess static and dynamic pain measures in participants. Dynamic responses were continuously recorded using a computerized visual analog scale. RESULTS: Pain threshold, tolerance, and suprathreshold exhibited excellent reliability (intraclass correlations ranged from 0.80 to 0.83). Conditioned pain modulation, offset analgesia, temporal summation yielded reliability in the good to excellent range (intraclass correlations ranged from 0.66 to 0.71). CONCLUSIONS: Findings suggested that this brief integrated QST protocol may reliably monitor human pain reactivity over brief periods. This protocol may enhance quantitative sensory testing feasibility in clinical and research settings.

Insomnia predicts treatment engagement and symptom change: a secondary analysis of a web-based CBT intervention for veterans with PTSD symptoms and hazardous alcohol use.

Posttraumatic Stress Disorder (PTSD) and hazardous drinking are highly comorbid, and often more severe than PTSD or hazardous drinking alone. Integrated, web-based interventions for PTSD/hazardous drinking may increase access to care, but have demonstrated equivocal results in reducing PTSD and hazardous drinking. One factor that may explain treatment engagement and symptom change is the presence of insomnia symptoms. The current study conducted secondary data analysis of a randomized controlled trial of an integrated web-based intervention for PTSD symptoms and hazardous drinking to examine insomnia symptoms as predictors of PTSD symptoms, alcohol use, and treatment engagement. In the parent study, 162 veterans in primary care reporting PTSD symptoms and hazardous drinking were randomized to receive either the intervention or treatment as usual. The current study examined insomnia among veterans who received the intervention (n = 81). Regression models tested baseline insomnia symptoms as predictors of treatment engagement, follow-up PTSD symptoms, and alcohol use. Hierarchical regression models tested change in insomnia during treatment as a predictor of follow-up PTSD symptoms and alcohol use. Results showed baseline insomnia predicted treatment engagement and follow-up drinking days, but not PTSD symptoms or heavy drinking days. Although overall change in insomnia was small, it predicted follow-up PTSD and heavy drinking days, but not drinking days. Results are consistent with previous research highlighting the importance of identifying and treating insomnia in the course of integrated treatment for PTSD/hazardous drinking. Future research should investigate how to best integrate insomnia, PTSD, and/or hazardous drinking interventions to maximize treatment engagement.

Virtual integrated primary care teams: Recommendations for team-based care.

INTRODUCTION: Integrated primary care teams are increasingly relying upon virtual care, including both telehealth and team members who are teleworking, due to the COVID-19 pandemic. This shift to virtual care can present challenges for the coordination and provision of team-based care in primary care. The current report uses extant literature on teams to provide recommendations to support integrated primary care teams, including behavioral health providers, in adapting to and sustaining virtual team-based care. METHOD: We used the Seven C's framework by Salas and colleagues (2015) to organize our findings and recommendations, focusing on coordination, cooperation, cognition, and communication. RESULTS: Integrated primary care teams may benefit from tending to both implicit and explicit forms of coordination and the use of debriefs to improve team coordination. Given the potential challenge of trust in a virtual team, documentation of care coordination and reexamination of how feedback is provided to primary care providers may benefit team cooperation. Sharing team goals and crosstraining on specific aspects of team processes, such as communicating essential information to behavioral health providers for a warm handoff, may improve the cognition of the team. Teams may also benefit by findings ways to incorporate informal communication into the workflow and using closed-loop communication to decrease missed communications. DISCUSSION: This report provides initial recommendations based on extant team literature to support integrated primary care teams in adapting to virtual care. Future work should build off this report by examining virtual integrated primary care teams and providing evidence-based recommendations to optimize virtual care. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Practical Opportunities for Biopsychosocial Education Through Strategic Interprofessional Experiences in Integrated Primary Care.

Even with the expansion of primary care teams to include behavioral health and other providers from a range of disciplines, providers are regularly challenged to deliver care that adequately addresses the complex array of biopsychosocial factors underlying the patient's presenting concern. The limits of expertise, the ever-changing shifts in evidence-based practices, and the difficulties of interprofessional teamwork contribute to the challenge. In this article, we discuss the opportunity to leverage the interprofessional team-based care activities within integrated primary care settings as interactive educational opportunities to build competencies in biopsychosocial care among primary care team members. We argue that this approach to learning while providing direct patient care not only facilitates new provider knowledge and skills, but also provides a venue to enhance team processes that are key to delivering integrated biopsychosocial care to patients. We provide three case examples of how to utilize strategic planning within specific team-based care activities common in integrated primary care settings-shared medical appointments, conjoint appointments, and team huddles-to facilitate educational objectives.

Anxiety treatment preferences among veteran primary care patients: Demographic, mental health, and treatment-related correlates.

INTRODUCTION: Anxiety symptoms are common, yet undertreated, among primary care patients. Accommodating patient treatment preferences improves engagement and retention. In contrast to depression, little is known about primary care patients' preferences for anxiety treatment. METHOD: Participants were 144 veterans experiencing anxiety symptoms but not receiving psychotherapy who were recruited from primary care. Preferences for 11 anxiety treatment attributes (method; location; type; format; provider; frequency, length, and number of appointments; psychotherapy orientation; symptom focus; and topic/skill) and demographic, mental health (e.g., anxiety symptom severity), and treatment-related (e.g., psychotherapy history) variables were assessed via mailed survey. We used chi-square goodness of fit tests to identify patient preferences for each attribute and multivariate multinomial logistic regression models to explore demographic, mental health, and treatment-related correlates of treatment preferences. RESULTS: Patient preferences were largely consistent with integrated primary care models, particularly Primary Care Behavioral Health, with a few exceptions. Patients preferred longer appointments (e.g., 45-60 minutes) and a longer duration of treatment (e.g., ≥13 appointments) than is typically offered in primary care. Several variables, particularly education level, perceived need for help, anxiety symptom severity, and attitudes toward psychotherapy, were repeatedly associated with preferences for various anxiety treatment attributes. DISCUSSION: Results from this study suggest that patients tend to have distinct preferences for anxiety treatment in primary care that are largely consistent with common integrated primary care models. Results also identify several variables that may be associated with specific preferences, which may help match patients to their preferred type of care. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

A multimethod investigation of distress tolerance and problematic alcohol use.

Negative reinforcement has been cited in many prominent theories as a process by which problematic alcohol use develops. According to negative reinforcement theories, alcohol is used to alleviate aversive physical and psychological states. Distress tolerance (DT) has been suggested as a construct that may represent individual differences in ability to tolerate aversive physical and psychological states and therefore may be valuable in identifying individuals at heightened risk for developing alcohol problems via negative reinforcement. However, research on DT is limited by heterogeneity in measurement, which has resulted in equivocal findings comparing measures of DT to each other and also in their relationships to psychopathology. The aim of the current study was to clarify relationships among measures of DT in a sample of alcohol users and to evaluate their relationships to alcohol consumption and problems. Participants were 89 undergraduate alcohol users who completed measures of perceived and behavioral tolerance to physically and psychologically aversive stimuli. Results provided some support for hypotheses, because measures of perceived tolerance were correlated with each other, but, contrary to hypotheses, measures of behavioral tolerance were not correlated with each other. Pain tolerance was the only measure of DT to significantly predict alcohol consumption and problems, although the effect was in the opposite direction from the one hypothesized. Pain tolerance was also indirectly associated with alcohol problems via alcohol consumption. Results support previous assertions of the importance of domain specificity in the measurement of DT and highlight the importance of population-specific processes to the development of alcohol problems. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Moderated Mediation of Perceived Intoxication and Sexual Arousal on Determinants of Sexual Risk Behavior in Men Who Have Sex with Men.

Behavioral interventions remain the preferred strategy for reducing HIV-related risk behavior among men who have sex with men (MSM), one of the populations most affected by HIV. To improve intervention efforts, research is needed to identify cognitive-motivational factors that may play a role in sexual risk behaviors among MSM. This study sought to replicate and extend previous work from a heterosexual population that identified a serial mediation effect of perceived intoxication and subjective sexual arousal in the relationship between alcohol consumption and determinants of sexual risk in a population of MSM. Exploratory moderated mediation analyses tested subjective sexual arousal as a moderator of the indirect effect of alcohol consumption on determinants of sexual risk via perceived intoxication. Participants (N = 117 MSM, ages 21-50) were randomly assigned to one of six experimental conditions based on two manipulations: beverage condition (alcohol, placebo, or control) and sexual arousal (low or high). Dependent measures were likelihood to engage in risky sex and condom negotiation skills. Results did not support the serial mediation effect but showed some support for the moderated mediation model in the prediction of behavioral skills. Implications for alcohol and arousal myopia theories of risky behavior and HIV prevention efforts are discussed.

Alcohol treatment goal choice predicts longitudinal drinking outcomes in adolescent substance users.

Social cognitive theory suggests that when individuals select their own goals, they work harder to achieve them as compared to clinician-imposed goals. Moreover, achieving goals during the course of treatment may increase self-efficacy, which could positively predict outcome. Research in clinical samples of adults with alcohol use disorder supports the utility of treatment goal choice in predicting longitudinal outcomes; a total abstinence (TA) goal choice has been associated with better clinical outcomes (e.g. greater percentage of days abstinent, more days to relapse to heavy drinking) compared to a controlled use (CU) goal choice. Treatment of adolescents presents unique challenges, because adolescents tend to be resistant to treatment and often enter treatment in response to external pressures (e.g. parent, school system). Data from 110 adolescents aged 14 to 18 were collected upon admission to outpatient substance use disorder treatment. A series of hierarchical linear regressions was used to test the utility of the alcohol treatment goal choice variable in predicting drinking outcomes at 6-, 12-, and 24-month follow-ups. Separate models were run to examine binge drinking days, percentage of days abstinent, and drinks per drinking day at each time point. Goal choice significantly predicted drinking outcomes at the 12-month follow-up, but not at the 6- or 24-month time points, such that TA goal choice was associated with better clinical outcomes. These findings are relevant to treatment planning, as they suggest that goal choice may have clinical utility as a predictor of alcohol use disorder clinical course in adolescents.

A randomized controlled trial of the effects of working memory training in methadone maintenance patients.

OBJECTIVE: Working memory impairment in individuals with chronic opioid dependence can play a major role in cognitive and treatment outcomes. Cognitive training targeting working memory shows promise for improved function in substance use disorders. To date, cognitive training has not been incorporated as an adjunctive treatment for opioid dependence. METHODS: Methadone maintenance patients were randomly assigned to experimental (n=28) or active control (n=28) 25-session computerized training and run in parallel. Cognitive and drug use outcomes were assessed before and after training. RESULTS: Participants in the experimental condition showed performance improvements on two of four working memory measures, and both groups improved on a third measure of working memory performance. Less frequent drug use was found in the experimental group than in the control group post-training. In contrast to previous findings with stimulant users, no significant effect of working memory training on delay discounting was found using either hypothetical or real rewards. There were no group differences on working memory outcome measures that were dissimilar from the training tasks, suggesting that another mechanism (e.g., increased distress tolerance) may have driven drug use results. CONCLUSIONS: Working memory training improves performance on some measures of working memory in methadone maintenance patients, and may impact drug use outcomes. Working memory training shows promise in patients with substance use disorders; however, further research is needed to understand the mechanisms through which performance is improved and drug use outcomes are impacted.