A pilot study investigating the efficacy of brief, phone-based, behavioral interventions for burnout in graduate students.

OBJECTIVE: This pilot study tested the efficacy of two brief, phone-administered, behavioral interventions derived from behavioral activation in reducing burnout among doctoral students. METHODS: Sixty-six doctoral students demonstrating current high burnout were randomly assigned to one of three intervention conditions: (1) Reward: increasing pleasant, rewarding behaviors, (2) Approach: approaching important goals that they have been avoiding, or (3) Control: monitoring only. RESULTS: Results indicated that doctoral students treated with the approach intervention reported significantly lower burnout compared to participants in the control condition immediately after the intervention and at a 1-week follow-up. Results also suggested that students in the approach intervention also reported higher well-being compared to students in the control condition. CONCLUSION: These findings suggest that this approach intervention is an effective treatment for school burnout for doctoral students that can be delivered remotely through phone and web technology.

Vicarious Fear Learning Depends on Empathic Appraisals and Trait Empathy.

Empathy and vicarious learning of fear are increasingly understood as separate phenomena, but the interaction between the two remains poorly understood. We investigated how social (vicarious) fear learning is affected by empathic appraisals by asking participants to either enhance or decrease their empathic responses to another individual (the demonstrator), who received electric shocks paired with a predictive conditioned stimulus. A third group of participants received no appraisal instructions and responded naturally to the demonstrator. During a later test, participants who had enhanced their empathy evinced the strongest vicarious fear learning as measured by skin conductance responses to the conditioned stimulus in the absence of the demonstrator. Moreover, this effect was augmented in observers high in trait empathy. Our results suggest that a demonstrator's expression can serve as a "social" unconditioned stimulus (US), similar to a personally experienced US in Pavlovian fear conditioning, and that learning from a social US depends on both empathic appraisals and the observers' stable traits.

Latent class analysis of the feared situations of social anxiety disorder: A population-based study.

BACKGROUND: Little is known about differences in mental health comorbidity and quality of life in individuals with social anxiety disorder (SAD) according to the number and the types of feared situations. METHODS: Using a US nationally representative sample, the National Epidemiologic Survey on Alcohol and Related Conditions, we performed latent class analysis to compare the prevalence rates of mental disorders and quality of life measures across classes defined by the number and the types of feared social situations among individuals with SAD. RESULTS: Among the 2,448 participants with a lifetime diagnosis of SAD, we identified three classes of individuals who feared most social situations but differed in the number of feared social situations (generalized severe [N = 378], generalized moderate [N = 1,049] and generalized low [N = 443]) and a class of subjects who feared only performance situations [N = 578]. The magnitude of associations between each class and a wide range of mental disorders and quality of life measures were consistent with a continuum model, supporting that the deleterious effects of SAD on mental health may increase with the number of social situations feared. However, we found that individuals with the "performance only" specifier may constitute an exception to this model because these participants had significantly better mental health than other participants with SAD. CONCLUSIONS: Our findings give additional support to the recent changes made in the DSM-5, including the introduction of the "performance only" specifier and the removal of the "generalized" specifier to promote the dimensional approach of the number of social fears.

The unified protocol for transdiagnostic treatment of emotional disorders for misophonia: a pilot trial exploring acceptability and efficacy.

Introduction: Misophonia is a recently defined disorder characterized by distressing responses to everyday sounds, such as chewing or sniffling. Individuals with misophonia experience significant functional impairment but have limited options for evidenced-based behavioral treatment. To address this gap in the literature, the current pilot trial explored the acceptability and efficacy of a transdiagnostic cognitive-behavioral approach to treating symptoms of misophonia. Methods: This trial was conducted in two studies: In Study 1, the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) was delivered to eight patients in order to receive feedback to guide revisions to the treatment to suit this population. In Study 2, ten patients received the revised UP treatment to explore its acceptability and preliminary efficacy. This study used a single-case experimental design with multiple baselines, randomizing patients to either a 2-week baseline or 4-week baseline prior to the 16 weeks of treatment, followed by four weeks of follow-up. Results: The findings from these studies suggested that patients found both the original and adapted versions of the UP to be acceptable and taught them skills for how to manage their misophonia symptoms. Importantly, the findings also suggested that the UP can help remediate symptoms of misophonia, particularly the emotional and behavioral responses. Discussion: These findings provide preliminary evidence that this transdiagnostic treatment for emotional disorders can improve symptoms of misophonia in adults.

Phenotyping misophonia: Psychiatric disorders and medical health correlates.

Misophonia is characterized by decreased tolerance to specific sounds and associated stimuli that causes significant psychological distress and impairment in daily functioning (Swedo et al., 2022). Aversive stimuli (often called "triggers") are commonly repetitive facial (e.g., nose whistling, sniffling, and throat clearing) or oral (e.g., eating, drinking, and mouth breathing) sounds produced by other humans. Few empirical studies examining the nature and features of misophonia have used clinician-rated structured diagnostic interviews, and none have examined the relationship between misophonia and psychiatric disorders in the Diagnostic and Statistical Manual-5th version (DSM-5; American Psychiatric Association, 2013). In addition, little is known about whether there are any medical health problems associated with misophonia. Accordingly, the purpose of the present study was to improve the phenotypic characterization of misophonia by investigating the psychiatric and medical health correlates of this newly defined disorder. Structured diagnostic interviews were used to assess rates of lifetime and current DSM-5 psychiatric disorders in a community sample of 207 adults. The three most commonly diagnosed current psychiatric disorders were: (1) social anxiety disorder, (2) generalized anxiety disorder, and (3) specific phobia. The three most common lifetime psychiatric disorders were major depressive disorder, social anxiety disorder, and generalized anxiety disorder. A series of multiple regression analyses indicated that, among psychiatric disorders that were correlated with misophonia, those that remained significant predictors of misophonia severity after controlling for age and sex were borderline personality disorder, obsessive compulsive disorder, and panic disorder. No medical health problems were significantly positively correlated with misophonia severity.

Long-term care utilization within older adults with schizophrenia: Associated factors in a multicenter study.

OBJECTIVE: Data are scarce regarding the clinical factors associated with utilization of long-term care facilities among older adults with schizophrenia. In this multicenter study, we sought to examine potential clinical differences between older adults with schizophrenia who are living in a long-term care facility and their community-dwelling counterparts. METHOD: We used data from the French Cohort of individuals with Schizophrenia Aged 55-years or more (CSA) study, a large multicenter sample of older adults with schizophrenia (N = 353). RESULTS: The prevalence of long-term care utilization was 35.1% of older patients with schizophrenia. Living in a long term care facility was significantly and independently associated with higher level of depression (Adjusted odds ratio (AOR) [95%CI]=1.97 [1.06-3.64]), lower cognitive (AOR [95%CI]=0.94 [0.88-0.99]) and global functioning (AOR [95%CI]=0.97 [0.95-0.99]), greater lifetime number of hospitalizations in a psychiatric department (AOR [95%CI]=2.30 [1.18-4.50]), not having consulted a general practitioner in the past year (AOR [95%CI]=0.28 [0.0.14-0.56]), urbanicity (AOR [95%CI]=2.81 [1.37-5.80]), and older age (AOR [95%CI]=1.08 [1.03-1.13]). DISCUSSION: Older patients with schizophrenia who live in long-term care facilities appear to belong to a distinct group, marked by a more severe course of illness with higher level of depression and more severe cognitive deficits than older patients with schizophrenia living in other settings. Our study highlights the need of early assessment and management of depression and cognitive deficits in this population and the importance of monitoring closely this vulnerable population.

A Preliminary Investigation of the Association Between Misophonia and Symptoms of Psychopathology and Personality Disorders.

Misophonia is a condition characterized by defensive motivational system emotional responding to repetitive and personally relevant sounds (e.g., eating, sniffing). Preliminary research suggests misophonia may be associated with a range of psychiatric disorders, including personality disorders. However, very little research has used clinician-rated psychometrically validated diagnostic interviews when assessing the relationship between misophonia and psychopathology. The purpose of this study was to extend the early research in this area by examining the relationship between symptoms of misophonia and psychiatric diagnoses in a sample of community adults, using semi-structured diagnostic interviews. Results indicated higher misophonia symptoms were associated with more clinician-rated symptoms of personality disorders, but not other disorders. Anxiety partially mediated the relationship between personality disorder symptoms and misophonia. These results suggest misophonia may be associated with a range of psychiatric symptoms and highlight the role of anxiety in this poorly understood condition.

The Mediating Role of Emotion Regulation Within the Relationship Between Neuroticism and Misophonia: A Preliminary Investigation.

Misophonia is a newly described condition characterized by heightened emotional reactivity (e.g., anger, anxiety, and disgust) to common repetitive sounds (e.g., oral or nasal sounds made by others), accompanied by difficulties responding to these sounds (e.g., intolerance, avoidance, and escape) and associated impairment in functioning. Although research indicates that problematic emotional responses are a key characteristic of misophonia, it is unknown whether individual differences in experiencing and regulating emotional responses influence severity of misophonia symptoms. Examination of individual differences in emotional functioning will help to guide treatment development for misophonia. Accordingly, the present study examined the associations among trait neuroticism, difficulties with emotion regulation, and symptoms of misophonia. For this study, a sample of 49 adults completed the Difficulties with Emotion Regulation Scale, the Misophonia Questionnaire, and the neuroticism subscale of the NEO-Personality inventory. Findings indicated that difficulties with emotion regulation and neuroticism were significantly positively correlated with symptoms of misophonia. Bootstrapped mediation analyses suggested that difficulties controlling impulsive behavior while experiencing intense negative emotions fully mediated the relationship between neuroticism and symptoms of misophonia. Results from this study suggest that neuroticism and difficulties with emotion regulation may be important risk factors and treatment targets for adults with misophonia, and difficulties controlling impulsive behavior when distressed may be an important individual difference accounting for the relationship between neuroticism and misophonia.

A Path From Childhood Sensory Processing Disorder to Anxiety Disorders: The Mediating Role of Emotion Dysregulation and Adult Sensory Processing Disorder Symptoms.

Although maladaptive sensory processing has been observed among individuals with persistent heightened anxiety, it is unclear if difficulties processing sensory input early in life lead to anxiety disorders in adulthood and what mechanisms would drive this progression. In a transdiagnostic clinical sample of 231 adults characterized by heightened difficulties with emotion regulation, the present study sought to examine whether: (a) childhood sensory processing disorder (SPD) symptoms predict an increased probability of an anxiety disorder diagnosis in adulthood; and (b) difficulties with emotion regulation and adult SPD symptoms mediate this relationship. Participants were administered the Structured Clinical Interview for Axis-I disorders and self-reported symptoms of SPD experienced in childhood and adulthood. Results suggested that childhood SPD symptoms were significantly associated with a higher likelihood of a lifetime anxiety disorder diagnosis. Difficulties with emotion regulation fully mediated the relationship between childhood SPD and (a) any anxiety disorder in adulthood and, specifically (b) current generalized anxiety disorder (GAD). Further, we found evidence for a candidate model accounting for the relationship among childhood SPD, adulthood SPD, difficulties with emotion regulation, and anxiety disorders in adulthood. Specifically, our data indicated that high symptoms of SPD in childhood may lead to high SPD symptoms in adulthood, which then lead to high emotion dysregulation, ultimately conferring vulnerability for an anxiety disorder diagnosis. Taken together, these findings provide preliminary evidence for how sensory processing impairments in childhood may relate to anxiety through difficulties regulating emotion regulation.

Psychiatric and physical outcomes of long-term use of lithium in older adults with bipolar disorder and major depressive disorder: A cross-sectional multicenter study.

OBJECTIVE: Although lithium is widely used in current practice to treat bipolar disorder (BD) and treatment-resistant major depressive disorder (MDD) among older adults, little is known about its efficacy and tolerability in this population, which is generally excluded from randomized clinical trials. The objective of this study was to evaluate the efficacy and tolerability of long-term use of lithium among older adults with BD and MDD. METHOD: Data from the Cohort of individuals with Schizophrenia and mood disorders Aged 55 years or more (CSA) were used. Two groups of patients with BD and MDD were compared: those who were currently receiving lithium versus those who were not. The effects of lithium on psychiatric (i.e., depressive symptoms severity, perceived clinical severity, rates of psychiatric admissions in the past-year), geriatric (overall and cognitive functioning) and physical outcomes (i.e., rates of non-psychiatric medical comorbidities and general hospital admissions in the past-year) were evaluated. All analyses were adjusted for age, sex, duration of disorder, diagnosis, smoking status, alcohol use, and use of antipsychotics, antiepileptics or antidepressants. RESULTS: Among the 281 older participants with BD or MDD, 15.7% were taking lithium for a mean duration of 12.5(SD = 11.6) years. Lithium use was associated with lower intensity of depressive symptoms, reduced perceived clinical global severity and lower benzodiazepine use (all p < 0.05), without being linked to greater rates of medical comorbidities, except for hypothyroidism. LIMITATIONS: Data were cross-sectional and data on lifetime history of psychotropic medications was not assessed. CONCLUSION: Our results suggest that long-term lithium use may be efficient and relatively well-tolerated in older adults with BD or treatment-resistant MDD.

Age differences in DSM-IV borderline personality disorder symptom expression: Results from a national study using item response theory (IRT).

Limited literature suggests that there may be age-related differences in borderline personality disorder (BPD) symptom expression. The present study used item response theory (IRT) methods to examine whether there are age differences in the likelihood of endorsing DSM-IV symptoms of BPD, when equating for levels of BPD symptom severity. Data were drawn from a nationally representative survey of adults in the US (n = 34,653), the second wave of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). We found that 7 out of the 9 DSM-IV symptoms of BPD were age invariant. However, there were statistically and clinically significant differences between the oldest and youngest age groups in two BPD symptoms: oldest adult women were less likely to report suicidal/self-harm behavior than the youngest adult women across levels of BPD severity and unstable/intense interpersonal relationships discriminated BPD severity better in the youngest age group compared to the oldest age group in both genders. Overall, our findings indicate substantial age-related differences in BPD symptom expression. Mental health care providers should be alert to these two age-related differences in BPD symptom expression when making assessment and treatment decisions across adult age groups.

Subsyndromal and syndromal depressive symptoms among older adults with schizophrenia spectrum disorder: Prevalence and associated factors in a multicenter study.

BACKGROUND: Few studies have examined the prevalence and correlates of subsyndromal and syndromal depressive symptoms (SSSD) among older adults with schizophrenia spectrum disorder. In this report, we examined the prevalence of SSSD and their associations with sociodemographic characteristics, clinical characteristics of schizophrenia, comorbidity, psychotropic medications, quality of life, functioning and mental health care utilization in a large, multicenter sample of older adults with schizophrenia spectrum disorder. METHODS: Data from the Cohort of individuals with Schizophrenia Aged 55 years or more (CSA) were used to examine the prevalence of SSSD, defined using the Center of Epidemiologic Studies Depression (CESD) scale. Clinical characteristics associated with SSSD were explored. RESULTS: Among 343 older adults with schizophrenia spectrum disorder, 78.1% had either subsyndromal (30.6%) or syndromal (47.5%) depressive symptoms. SSSD were independently associated with positive and negative symptoms, lower quality of life, non-late-onset psychosis, benzodiazepine use and urbanicity. There were no significant associations of SSSD with other sociodemographic characteristics and psychotropic medications, or with general medical conditions. We found no significant differences in the proportion of participants who were treated with antidepressants between those with syndromal depressive symptoms and those without depression (22.1% vs. 20.0%, p = 0.89). SSSD were not associated with higher mental health care utilization. LIMITATIONS: Data were cross-sectional and depression was not evaluated with a semi-structured interview. CONCLUSION: SSSD may be highly prevalent and under-assessed and/or undertreated among older adults with schizophrenia spectrum disorder. Our findings should alert clinicians about the need to assess systematically and regularly depression in this vulnerable population.

Metabolic syndrome among older adults with schizophrenia spectrum disorder: Prevalence and associated factors in a multicenter study.

Metabolic syndrome and its associated morbidity and mortality have been well documented in adults with schizophrenia. However, data is lacking for their geriatric counterparts. We sought to investigate the frequency of screening and the prevalence of metabolic syndrome in older adults with schizophrenia, as well as its possible correlates, using the Cohort of individuals with schizophrenia Aged 55 years or more study (n = 353). We found that 42.2% (n = 149) of our sample was screened for metabolic syndrome. Almost half of those (n = 77; 51.7%) screened positive according to ATPIII criteria. Hypertension and abdominal obesity were the two most prevalent metabolic abnormalities. Screening was positively associated with male gender and urbanicity, and metabolic syndrome diagnosis was positively associated with cardiovascular disorders and consultation with a general practitioner (all p < 0.05). However, there were no significant associations of metabolic syndrome with socio-demographic or clinical characteristics, psychotropic medications, other medical conditions and other indicators of mental health care utilization. Our findings support that the prevalence of metabolic syndrome among older adults with schizophrenia spectrum disorder is high and screening is crucial mainly in those patients with hypertension and/or abdominal obesity. Factors at play might be different than those in the younger population.

Changes in Problematic Anger, Shame, and Disgust in Anxious and Depressed Adults Undergoing Treatment for Emotion Dysregulation.

Emotion dysregulation, the pervasive difficulty managing negative emotions, is a core problem across mood and anxiety disorders. Anger, shame, and disgust are particularly problematic emotions, impacting both disorder severity and treatment outcome. We previously found that a 16-week dialectical behavior therapy skills training group (DBT-ST) was superior to an activities-based support group (ASG) in decreasing emotion dysregulation in 44 adults with high emotion dysregulation who met diagnostic criteria for an anxiety or depressive disorder. We presently examine these participants' changes in anger, shame, disgust, and distress using self-reports collected over 6 months during and after treatment. Hierarchical linear modeling analyses show that DBT-ST was superior to ASG in decreasing anger suppression (d = 0.93) and distress (d = 1.04). Both conditions significantly reduced shame, disgust propensity, and disgust sensitivity, but neither was superior for these outcomes. The treatments did not significantly reduce anger expression. Mediation analyses suggest that condition indirectly influenced 4-month anger suppression, shame, and distress through its effect on 2-month emotion dysregulation. These findings suggest that DBT-ST is efficacious for certain problematic emotions and distress in depressed and anxious adults and that common factors may account for some, but not all, of its benefits.

Childhood maltreatment and impulsivity as predictors of interpersonal violence, self-injury and suicide attempts: A national study.

Prior research indicates that childhood maltreatment and impulsivity increase the risk for different types of violence, including violent behaviors directed toward the self and others. However, it is not known whether childhood maltreatment and impulsivity have independent effects on different violent behaviors. Therefore, this study examined the differential effects of childhood maltreatment and impulsivity on interpersonal violence, suicide attempts, and self-injury. Data were drawn from a nationally representative survey of 34,653 US adults, the 2004-2005 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Structural equation modeling was used to simultaneously examine the shared and specific effects of five types of childhood maltreatment and impulsivity on the risk of different violent behaviors (i.e. interpersonal violence, suicide attempts, and self-injury). Analyses were stratified by gender and adjusted for age and ethnicity. Impulsivity and childhood maltreatment independently increased the risk of suicide attempt, self-injury, and interpersonal violence. Childhood maltreatment had stronger effects on violence directed towards the self than on interpersonal violence in both genders, while impulsivity had a stronger effect on self-injury than on suicide attempt or interpersonal violence in men. These findings indicate that childhood maltreatment and impulsivity relate differently to the risk of different types of violence.

Contributing Factors and Mental Health Outcomes of First Suicide Attempt During Childhood and Adolescence: Results From a Nationally Representative Study.

OBJECTIVE: To investigate whether risk factors for suicide attempts differ in children and adolescents and to categorize adulthood mental health outcomes of child and adolescent suicide attempters in the general population. METHODS: Using a large (N = 34,653), nationally representative US adult sample, the 2004-2005 National Epidemiologic Survey on Alcohol and Related Conditions, we examined whether individuals who first attempted suicide during childhood (under the age of 13 years) differ from those who first attempted suicide during adolescence (13 through 17 years) in (1) contributing factors for first suicide attempt, including mental disorders and traumatic experiences that occurred before the first suicide attempt, parental history of mental disorders, and family poverty and (2) adulthood mental health outcomes, including lifetime and current prevalence of DSM-IV psychiatric disorders and quality of life measures. RESULTS: Suicide attempts during childhood (n = 104) were more strongly related to childhood maltreatment, while suicide attempts during adolescence (n = 415) were more strongly associated with major depressive episode. Compared to first suicide attempts during adolescence, first attempts during childhood were associated with increased risk for multiple suicide attempts (61.3% vs 32.6%), several psychiatric disorders (mania, hypomania, and panic disorder), and poorer social functioning during adulthood (all P values < .05). CONCLUSIONS: Suicide attempts in children and adolescents substantially differ in contributing factors and adulthood mental health outcomes. Preventing childhood maltreatment and early intervention for psychiatric disorders may have broad benefits to reduce not only the suffering of these children and adolescents, but also the burden of suicide.

Cross-sectional Study of Glutamate in the Anterior Cingulate and Hippocampus in Schizophrenia.

BACKGROUND: There has been growing support for dysfunctions of the excitatory glutamatergic system and its implications for the psychophysiology of schizophrenia. However, previous studies reported mixed results regarding glutamate concentrations in schizophrenia with varying deviations across brain regions. METHODS: We used an optimized proton magnetic resonance spectroscopy procedure to measure absolute glutamate concentrations in the left hippocampal region and the anterior cingulate cortex (ACC) in 29 medicated patients with schizophrenia and in 29 control participants without mental disorder. RESULTS: The glutamate concentrations were significantly lower in the ACC but higher in the hippocampus of patients compared to controls. ACC and hippocampal glutamate concentrations correlated positively in patients but not in controls. ACC glutamate was weakly associated with Clinical Global Impression score and duration of illness in patients. CONCLUSION: Glutamate concentrations in schizophrenia deviate from controls and show associations with disease severity. A higher concentration of hippocampal glutamate in schizophrenia compared to controls is shown. The association between ACC and hippocampus glutamate concentrations in patients with schizophrenia suggests an abnormal coupling of excitatory systems compared to controls as predicted by previous glutamate models of schizophrenia.

Psychotherapeutic Treatment of Bipolar Depression.

The gold standard for treating bipolar depression is based on the combination of mood stabilizers and psychotherapy. Therefore, the authors present evidence-based models and promising approaches for psychotherapy for bipolar depression. Cognitive-behavioral therapy, family focused therapy, interpersonal and social rhythm therapy, mindfulness-based cognitive therapy, and dialectical behavior therapy are discussed. Behavioral activation, the cognitive behavioral analysis system of psychotherapy, and the unified protocol as promising future directions are presented. This review informs medical providers of the most appropriate referral guidelines for psychotherapy for bipolar depression. The authors conclude with a decision tree delineating optimal referrals to each psychotherapy approach.

Differences in symptom expression between unipolar and bipolar spectrum depression: Results from a nationally representative sample using item response theory (IRT).

BACKGROUND: The inclusion of subsyndromal forms of bipolarity in the fifth edition of the DSM has major implications for the way in which we approach the diagnosis of individuals with depressive symptoms. The aim of the present study was to use methods based on item response theory (IRT) to examine whether, when equating for levels of depression severity, there are differences in the likelihood of reporting DSM-IV symptoms of major depressive episode (MDE) between subjects with and without a lifetime history of manic symptoms. METHODS: We conducted these analyses using a large, nationally representative sample from the USA (n=34,653), the second wave of the National Epidemiologic Survey on Alcohol and Related Conditions. RESULTS: The items sadness, appetite disturbance and psychomotor symptoms were better indicators of depression severity in participants without a lifetime history of manic symptoms, in a clinically meaningful way. DSM-IV symptoms of MDE were substantially less informative in participants with a lifetime history of manic symptoms than in those without such history. LIMITATIONS: Clinical information on DSM-IV depressive and manic symptoms was based on retrospective self-report CONCLUSIONS: The clinical presentation of depressive symptoms may substantially differ in individuals with and without a lifetime history of manic symptoms. These findings alert to the possibility of atypical symptomatic presentations among individuals with co-occurring symptoms or disorders and highlight the importance of continued research into specific pathophysiology differentiating unipolar and bipolar depression.

Generalizability of Pharmacologic and Psychotherapy Clinical Trial Results for Posttraumatic Stress Disorder to Community Samples.

OBJECTIVE: The present study sought to quantify the generalizability of pharmacologic and psychotherapy clinical trial results in individuals with a DSM-IV diagnosis of posttraumatic stress disorder (PTSD) to a large representative community sample. METHODS: Data were derived from the 2004-2005 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a large nationally representative sample of the adult US population. We applied a standard set of exclusion criteria representative of pharmacologic and psychotherapy clinical trials to all adults with a DSM-IV diagnosis of PTSD in the previous 12 months (n = 1,715) and then to a subsample of participants seeking treatment (n = 366). Our aim was to assess how many participants with PTSD would fulfill typical eligibility criteria. RESULTS: We found that more than 6 of 10 respondents from the overall PTSD sample and more than 7 of 10 respondents seeking treatment for PTSD would have been excluded by 1 exclusion criterion or more in a typical pharmacologic trial. In contrast, about 2 of 10 participants in the full sample and about 3 of 10 participants seeking treatment for PTSD would have been excluded in a typical psychotherapy efficacy trial. CONCLUSIONS: We found that psychotherapy trial results may be applied to most patients with PTSD in routine clinical practice. The designers of pharmacologic clinical trials should carefully consider the trade-offs between the application of each exclusion criterion and its impact on representativeness. Specification a priori of the goals of the study, better justification for each exclusion criterion, and estimation of the proportion of individuals ineligible for the trial would assist study design. Developing integrated forms of pharmacotherapy and psychotherapy that simultaneously target commonly overlapping psychiatric disorders may yield more informative results for mental health care providers and research funding agencies.