In-office, in-home, and telehealth cognitive processing therapy for posttraumatic stress disorder in veterans: a randomized clinical trial.

BACKGROUND: Trauma-focused psychotherapies for combat-related posttraumatic stress disorder (PTSD) in military veterans are efficacious, but there are many barriers to receiving treatment. The objective of this study was to determine if cognitive processing therapy (CPT) for PTSD among active duty military personnel and veterans would result in increased acceptability, fewer dropouts, and better outcomes when delivered In-Home or by Telehealth as compared to In-Office treatment. METHODS: The trial used an equipoise-stratified randomization design in which participants (N = 120) could decline none or any 1 arm of the study and were then randomized equally to 1 of the remaining arms. Therapists delivered CPT in 12 sessions lasting 60-min each. Self-reported PTSD symptoms on the PTSD Checklist for DSM-5 (PCL-5) served as the primary outcome. RESULTS: Over half of the participants (57%) declined 1 treatment arm. Telehealth was the most acceptable and least often refused delivery format (17%), followed by In-Office (29%), and In-Home (54%); these differences were significant (p = 0.0008). Significant reductions in PTSD symptoms occurred with all treatment formats (p < .0001). Improvement on the PCL-5 was about twice as large in the In-Home (d = 2.1) and Telehealth (d = 2.0) formats than In-Office (d = 1.3); those differences were statistically large and significant (d = 0.8, 0.7 and p = 0.009, 0.014, respectively). There were no significant differences between In-Home and Telehealth outcomes (p = 0.77, d = -.08). Dropout from treatment was numerically lowest when therapy was delivered In-Home (25%) compared to Telehealth (34%) and In-Office (43%), but these differences were not statistically significant. CONCLUSIONS: CPT delivered by telehealth is an efficient and effective treatment modality for PTSD, especially considering in-person restrictions resulting from COVID-19. TRIAL REGISTRATION: ClinicalTrials.gov ID NCT02290847 (Registered 13/08/2014; First Posted Date 14/11/2014).

The Emotional and Functional Impact of the Type of Tinnitus Sensation.

One to three percent of individuals with tinnitus experience significant reduction in quality of life. Factors that contribute to distress include personality variables, intolerance to loud noises, external locus of control, and pre-existing anxiety. Characteristics of tinnitus itself, such as perceived loudness, can also cause functional impairment. It is unknown whether different tinnitus sensations have various effects on either emotional or functional impairment, which can reduce quality of life. While audiological tests can determine pitch and loudness of tinnitus, questionnaires also can be easily used to assess subjective characteristics of tinnitus. In this study, 370 participants, recruited via email from a national tinnitus organization, completed online surveys that assessed tinnitus-related distress and provided qualitative descriptions of their tinnitus sensation. Self-reports of tinnitus sensation were rated by five independent coders, with excellent agreement. Individuals who reported a combination of tinnitus sensations were found to experience significantly more functional impairment and avoidant behavior. Future research should utilize more sophisticated approaches to categorize individuals' tinnitus sensation and to examine associated emotional and functional differences. Providers should appropriately refer patients for tinnitus management and empirically-supported therapies aimed at reducing tinnitus related distress and functional impairment.

Cognitive Behavioral Therapy for Veterans With Comorbid Posttraumatic Headache and Posttraumatic Stress Disorder Symptoms: A Randomized Clinical Trial.

Importance: Posttraumatic headache is the most disabling complication of mild traumatic brain injury. Posttraumatic stress disorder (PTSD) symptoms are often comorbid with posttraumatic headache, and there are no established treatments for this comorbidity. Objective: To compare cognitive behavioral therapies (CBTs) for headache and PTSD with treatment per usual (TPU) for posttraumatic headache attributable to mild traumatic brain injury. Design, Setting, and Participants: This was a single-site, 3-parallel group, randomized clinical trial with outcomes at posttreatment, 3-month follow-up, and 6-month follow-up. Participants were enrolled from May 1, 2015, through May 30, 2019; data collection ended on October 10, 2019. Post-9/11 US combat veterans from multiple trauma centers were included in the study. Veterans had comorbid posttraumatic headache and PTSD symptoms. Data were analyzed from January 20, 2020, to February 2, 2022. Interventions: Patients were randomly assigned to 8 sessions of CBT for headache, 12 sessions of cognitive processing therapy for PTSD, or treatment per usual for headache. Main Outcomes and Measures: Co-primary outcomes were headache-related disability on the 6-Item Headache Impact Test (HIT-6) and PTSD symptom severity on the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (PCL-5) assessed from treatment completion to 6 months posttreatment. Results: A total of 193 post-9/11 combat veterans (mean [SD] age, 39.7 [8.4] years; 167 male veterans [87%]) were included in the study and reported severe baseline headache-related disability (mean [SD] HIT-6 score, 65.8 [5.6] points) and severe PTSD symptoms (mean [SD] PCL-5 score, 48.4 [14.2] points). For the HIT-6, compared with usual care, patients receiving CBT for headache reported -3.4 (95% CI, -5.4 to -1.4; P < .01) points lower, and patients receiving cognitive processing therapy reported -1.4 (95% CI, -3.7 to 0.8; P = .21) points lower across aggregated posttreatment measurements. For the PCL-5, compared with usual care, patients receiving CBT for headache reported -6.5 (95% CI, -12.7 to -0.3; P = .04) points lower, and patients receiving cognitive processing therapy reported -8.9 (95% CI, -15.9 to -1.9; P = .01) points lower across aggregated posttreatment measurements. Adverse events were minimal and similar across treatment groups. Conclusions and Relevance: This randomized clinical trial demonstrated that CBT for headache was efficacious for disability associated with posttraumatic headache in veterans and provided clinically significant improvement in PTSD symptom severity. Cognitive processing therapy was efficacious for PTSD symptoms but not for headache disability. Trial Registration: ClinicalTrials.gov Identifier: NCT02419131.

Effectiveness of three brief treatments for recent traumatic events in a low-SES community setting.

OBJECTIVE: To determine whether brief treatments provide psychological relief after traumatic events in low-resource communities. METHOD: Participants (n = 105) who had experienced a traumatic event within the past 6 months were randomly assigned to 1 of 3 4-session treatments: individual eye movement desensitization and reprocessing (EMDR), group-administered stress management with a trauma focus (SMT), or group-administered psychological first aid (PFA). Measures administered pretreatment and at 1-, 3-, and 6-month posttreatment included posttraumatic stress disorder (PTSD) symptoms, posttraumatic cognitions (PTCI), and depressive symptoms (BDI). RESULTS: The 3 treatment groups all showed significant declines in PTSD, PTCI, and BDI symptoms over time with large prepost effect sizes (median 1-month: 0.96, 3-month: 1.38, 6-month: 1.10). However, the treatment groups showed significantly different rates of decline, with the EMDR group showing the fastest declines-interaction PTCI: F(1, 237) = 5.85, p = .016; depression:, F(1, 239) = 4.90, p = .028-followed by the SMT and then PFA group. While there were significant differences between the EMDR and PFA groups at the 1- and 3-month follow-ups, there were no significant differences in any of the 3 outcome measures at the 6-month follow-up, nor were there significant differences between groups on PTSD symptoms, F(1, 239) = 2.30, p = .131. CONCLUSION: This study provides preliminary evidence that any of these 3 approaches may be useful in low-resource community settings. Because it gives the quickest relief, EMDR is the preferred approach, followed by SMT, due its ease of administration. PFA provides a reasonable alternative. Where possible, booster sessions should be planned. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Positive and negative emotional expression measured from a single written essay about trauma predicts survival 17 years later in people living with HIV.

OBJECTIVE: To determine whether expression of positive and negative emotions measured within a single written trauma essay predicts survival over 17 years in people living with HIV. METHODS: This is a longitudinal, observational study of a volunteer sample of HIV-seropositive individuals at the mid-range of disease (150-500 CD4-cells/mm3 with no prior AIDS-defining symptoms). Exclusion criteria included substance dependence, dementia, and/or psychosis. Baseline assessments occurred between 1997 and 1999 and survival data was collected in 2014 (17 year follow up). At baseline, participants wrote an essay about the most traumatic event in their life. Emotional expression was measured by the number of positive and negative emotional words in the essay. The primary study outcome measure was survival from baseline. Biomedical covariates included CD4 count, viral load, age, and antiretroviral medications. Sociodemographic covariates included gender, race, and education. RESULTS: The sample was diverse in terms of age (M [SD] 37.60 [9.07]), sex (70.7% male), sexual orientation (55.5% gay or bisexual), and race/ethnicity (37.2% African American, 30.5% white, 28.0% Hispanic, and 4.3% other). Positive, negative, and total emotional expression predicted greater survival (ps < 0.015). Those in the top third of total emotional expression had 3.83 times the survival rate (95% CI: 1.62, 9.02) of those in the bottom third. Odds ratios were 1.85 for positive emotion expression and 2.18 for negative emotion expression. CONCLUSIONS: Both positive and negative emotions expressed in a written trauma essay predict survival over 17 years in people living with HIV. Expressing emotions may have benefits for health.

Publisher Correction: Reply to 'A lack of evidence for six times more anxiety and depression in US graduate students than in the general population'.

In the version of this article initially published, the Editor's Note indicating that the article has been peer-reviewed was missing. The error has been corrected in the HTML and PDF versions of the article.

Use and effectiveness of the Individual Development Plan among postdoctoral researchers: findings from a cross-sectional study.

The individual development plan (IDP) is a career planning tool that aims to assist PhD trainees in self-assessing skills, exploring career paths, developing short- and long-term career goals, and creating action plans to achieve those goals. The National Institutes of Health and many academic institutions have created policies that mandate completion of the IDP by both graduate students and postdoctoral researchers. Despite these policies, little information exists regarding how widely the tool is used and whether it is useful to the career development of PhD trainees. Herein, we present data from a multi-institutional, online survey on the use and effectiveness of the IDP among a group of 183 postdoctoral researchers. The overall IDP completion rate was 54% and 38% of IDP users reported that the tool was helpful to their career development. Positive relationships with one's advisor, confidence regarding completing training, trainees' confidence about their post-training career, and a positive experience with institutional career development resources are associated with respondents' perception that the IDP is useful for their career development. We suggest that there is a need to further understand the nuanced use and effectiveness of the IDP in order to determine how to execute the use of the tool to maximize trainees' career development.

A cross-sectional study of the use and effectiveness of the Individual Development Plan among doctoral students.

Background: The Individual Development Plan (IDP) was introduced as a tool to aid in career planning for doctoral trainees. Despite the National Institutes of Health and academic institutions creating policies that mandate the use of IDPs, little information exists regarding the actual use and effectiveness of the career planning tool. Methods: We conducted a multi-institutional, online survey to measure IDP use and effectiveness. The survey was distributed to potential respondents via social media and direct email. IDP survey questions were formatted using a five-point Likert scale (strongly agree, agree, neutral, disagree and strongly disagree). For data analysis purposes, responses were grouped into two categories (agree versus does not agree/disagree). The data were summarized as one-way frequencies and the Pearson Chi-square test was used to determine statistical significance. Results: Usage of the IDP among doctoral students was low and the tool produces minimal effectiveness with regard to the perception of whether it is helpful to one's career development. Further, our data suggests that the IDP is most effective when doctoral students complete the tool with faculty mentors with whom they have a positive relationship. Respondents who are confident about completing their doctoral training and their post-training career plans, and who take advantage of career development resources at their institution are also more likely to perceive that the IDP is useful for their career development. Conclusion: Given the nuanced use and effectiveness of the IDP, we call for more research to determine why IDP use and effectiveness is low, exactly how IDPs are being used, and whether there are unintended negative consequences created through the use of the tool. Furthermore, we recommend an enhancement of career development infrastructure that would include mentorship training for faculty in order to provide substantially more career planning support to doctoral trainees.

Design of a clinical effectiveness trial of in-home cognitive processing therapy for combat-related PTSD.

Approximately 14% of military personnel and veterans who have deployed to the combat theater are at risk for combat-related posttraumatic stress disorder (PTSD). The treatment of combat-related PTSD in active duty service members and veterans is challenging. Combat trauma may involve multiple high levels of exposure to different types of traumatic events (e.g., human carnage after explosive blasts, life threat/injuries to self/others, etc.). Many service members and veterans are unable or unwilling to receive treatment in government facilities due to avoidance, scheduling difficulties, transportation or parking problems, concerns about career advancement, or stigma associated with seeking treatment. Innovative treatment-delivery approaches are needed to help overcome these barriers. The present study is a randomized clinical trial to evaluate three versions of Cognitive Processing Therapy (CPT; [54]) for the treatment of combat-related PTSD in active duty military service members and veterans: (1) standard In-Office CPT, (2) In-Home Telebehavioral Health CPT from the provider's office to the participant's home, and (3) In-Home CPT in which the provider delivers treatment in the participant's home. Use of an equipoise-stratified randomization design allows participants to decline one of the treatment arms. This research design partly overcomes the problems active duty military and veterans face when receiving PTSD treatment by allowing them to opt out of one inappropriate or unacceptable treatment modality and still permitting randomization to the two remaining treatment modalities. This manuscript provides an overview of the research design and methods for the study.