Compassion Meditation for Distressed Older Veterans: A Feasibility Study.

OBJECTIVES: Older Veterans are at elevated risk for psychological distress and may encounter barriers to accessing mental health services. Compassion Meditation (CM) promotes positive emotions and outcomes among distressed individuals; thus, we conducted a preliminary feasibility study of CM among distressed older Veterans. METHODS: Participants included 25 Veterans aged 55+ (M = 69.0, SD = 10.6) with anxiety and/or depressive symptoms, recruited from primary care, mostly male (76.0%), and White (60.0%). CM consisted of 10 groups, which were transitioned from in-person to telehealth due to COVID-19. Feasibility indices included rates of intervention initiation and completion, and attendance. Participants completed measures of symptom severity and well-being pre- and post-intervention. RESULTS: Of 25 enrolled participants, 88.0% (n = 22) attended at least one session, and 52% (n = 13) completed the intervention (attended six or more sessions). Among intervention completers, the average number of sessions attended was 9.46. Seven Veterans withdrew from intervention due to difficulties engaging via telehealth. CONCLUSIONS: These findings support the feasibility of CM training in older Veterans with psychological distress, though dropouts highlighted potential need for additional strategies to facilitate telehealth participation. CLINICAL IMPLICATIONS: Older Veterans appear amenable to meditation-based practices, provided they are easy to access.

Measures of empathy and compassion: A scoping review.

Evidence to date indicates that compassion and empathy are health-enhancing qualities. Research points to interventions and practices involving compassion and empathy being beneficial, as well as being salient outcomes of contemplative practices such as mindfulness. Advancing the science of compassion and empathy requires that we select measures best suited to evaluating effectiveness of training and answering research questions. The objective of this scoping review was to 1) determine what instruments are currently available for measuring empathy and compassion, 2) assess how and to what extent they have been validated, and 3) provide an online tool to assist researchers and program evaluators in selecting appropriate measures for their settings and populations. A scoping review and broad evidence map were employed to systematically search and present an overview of the large and diverse body of literature pertaining to measuring compassion and empathy. A search string yielded 19,446 articles, and screening resulted in 559 measure development or validation articles reporting on 503 measures focusing on or containing subscales designed to measure empathy and/or compassion. For each measure, we identified the type of measure, construct being measured, in what context or population it was validated, response set, sample items, and how many different types of psychometrics had been assessed for that measure. We provide tables summarizing these data, as well as an open-source online interactive data visualization allowing viewers to search for measures of empathy and compassion, review their basic qualities, and access original citations containing more detail. Finally, we provide a rubric to help readers determine which measure(s) might best fit their context.

Mitigating the health effects of systemic racism: Evaluation of the Race-Based Stress and Trauma Empowerment intervention.

BACKGROUND: Disparities in physical and mental health among Black, Indigenous, and People of Color (BIPOC) are well-documented and mirrored in the Veteran population. Chronic stress due to racism and discrimination is one possible mechanism driving these negative health outcomes. The Race-Based Stress and Trauma Empowerment (RBSTE) group is a novel, manualized, health promotion intervention designed to address the direct and indirect impacts of racism among Veterans of Color. This paper describes the protocol of the first pilot randomized controlled trial (RCT) of RBSTE. This study will examine the feasibility, acceptability, and appropriateness of RBSTE compared to an active control (an adaptation of Present-Centered Therapy; PCT) in a Veterans Affairs (VA) healthcare setting. A secondary aim is to identify and optimize strategies for holistic evaluation. METHODS: Veterans of Color (N = 48) endorsing perceived discrimination and stress will be randomized to RBSTE or PCT; both groups will be delivered in 8 weekly, 90-min virtual group sessions. Outcomes will include measures of psychological distress, discrimination and ethnoracial identity, holistic wellness, and allostatic load. Measures will be administered at baseline and post-intervention. CONCLUSION: This study will inform future interventions targeting identity-based stressors and represents an important step in advancing equity for BIPOC in medicine and research. CLINICAL TRIAL REGISTRATION NUMBER: NCT05422638.

Higher frequency of mantram repetition practice is associated with enhanced clinical benefits among United States Veterans with posttraumatic stress disorder.

Background: There is increasing support for the use of meditation-based treatments for US military Veterans with posttraumatic stress disorder (PTSD). The Mantram Repetition Program (MRP), which is a portable meditative practice that features mindful repetition of a sacred phrase, is associated with significant reductions in PTSD symptom severity. Although regular practice is emphasized in meditation-based interventions, associations between frequency of practice and clinical outcomes are often not reported. Objectives: This study will examine whether the frequency of mantram repetition is associated with greater improvements in clinical outcomes. Methods: Veterans with PTSD participating in MRP (N = 160; combined experimental groups from two randomized controlled trials). Participants completed pre- and post-treatment self-report measures of anger and well-being and a clinician-administered interview of PTSD severity (CAPS-IV-TR). Veterans also reported average daily mantram repetition practice at post-treatment. We conducted a series of hierarchal multiple regression analyses. Results: When controlling for race/ethnicity and pre-treatment severity, higher frequency of mantram repetition practice was associated with significantly greater improvements (small effect sizes) in PTSD symptom severity (F(3,128) = 6.60, p < .001, ß = .21, p = .007), trait anger (F(3,128) = 31.23, p < .001, ß = .25, p < .001), state anger (F(3,110) = 17.62, p < .001, ß = .16, p = .04), mental health well-being (F(3,128) = 28.38, p < .001, ß = .14, p = .04), and spiritual well-being (F(3,127) = 13.15, p < .001, ß = .23, p = .003), but not physical health well-being. Conclusions: Higher frequency of mantram repetition practice appears to have beneficial effects on clinical outcomes for Veterans with PTSD. Strategies that promote skills practice may be an important target for improving clinical outcomes for meditation-based interventions. HIGHLIGHTS: Higher frequency of meditation practice during Mantram Repetition Program was associated with greater reductions in PTSD symptoms and anger as well as improvements in well-being.Strategies to promote at-home meditation practice may optimize the benefits of MRP.

The role of threat appraisal and coping style in psychological response to the COVID-19 pandemic among university students.

BACKGROUND: The COVID-19 pandemic has led to psychological distress among community samples and university students. Some coping behaviors and cognitive appraisals allow individuals to experience positive psychological growth amid such a crisis (Folkman et al. 1986). In the event of continuing waves of COVID-19 infection and future viral outbreaks, understanding the relationships between coping behaviors, stress appraisals, and COVID-related distress and growth can empower public health officials and university leadership to mitigate negative consequences and encourage growth. METHODS: 774 undergraduate students completed online self-report measures of coping (Brief COPE; emotion, problem, avoidant), stress appraisal (SAM; threat/centrality, challenge/self-efficacy, uncontrol, other-control), neuroticism (NEO-N), health anxiety (SHAI), and COVID-19 exposure/impact (C-PIQ; distress and growth). Hypotheses were examined via simple regressions and interactions. RESULTS: Increased utilization of avoidant coping was associated with high levels of distress regardless of whether it was perceived as threatening or not. Emotion-focused and problem-focused coping strategies were associated with more growth, whereas avoidant coping was associated with less growth. Higher emotion-focused coping and challenge appraisal together predicted the most growth. LIMITATIONS: Cross-sectional design precludes the tracking of distress and growth over time; this study relied on self-report data. CONCLUSIONS: These results underscore the impact of stress appraisals on the mental health of students navigating the COVID-19 pandemic. Findings may inform public health messaging-or have clinical implications, as successful interventions exist for improving coping strategies and stress appraisals.

Pilot Study of Compassion Meditation Training to Improve Well-being Among Older Adults.

OBJECTIVES: Compassion meditation (CM) training has demonstrated potential in improving well-being and psychosocial functioning. However, most prior studies of CM training have focused on younger adults. The generalizability of the effectiveness of CM training with older adults requires further study. This pilot study was intended to inform future randomized controlled studies of CM training in older adults. METHODS: Participants included 24 older adults who attended a 10-week group CM training. Exploratory outcome measures were administered prior to, during, and after the intervention. Participants also completed logs of mood and meditation practice, and provided descriptive comments in response to open-ended questions administered at the end of treatment. RESULTS: High treatment completion rates (87.5%) and reported adherence (85.7% of assigned meditation) were observed. Descriptive feedback from participants indicated older adults are interested in and capable of learning and applying new concepts and skills in support of their well-being. Pre- to post-intervention changes were explored with a variety of self-report measures. Weekly journals suggested increased feelings of love, closeness, or trust, and decreased feelings of stress, nervousness, or being overwhelmed. CONCLUSIONS: These findings provide preliminary support for the feasibility of CM training in community-dwelling older adults, and suggest the need for future efficacy and effectiveness clinical trials. CLINICAL IMPLICATIONS: CM training offers potential benefits for improving well-being among older adults, and, as an example of a strengths-based approach, can be tailored to the specific needs of older adults.

Are alterations in estradiol, cortisol, and inflammatory cytokines associated with depression during pregnancy and postpartum? An exploratory study.

BACKGROUND: Pregnant veterans are a subpopulation known to be at elevated risk of developing mental health symptoms, such as depression and suicidal ideation. Inflammation has been associated with depression, specifically during the perinatal period. Critical changes in estradiol, cortisol, and inflammatory cytokines are necessary for the progression of a healthy pregnancy, which are then rapidly altered in the postpartum period. We explored changes in estradiol, cortisol, and pro-inflammatory cytokines relative to depressive symptoms and suicidal thoughts across pregnancy and postpartum in this pilot and feasibility study. METHODS: We measured estradiol, cortisol, and the inflammatory cytokines IL-1ß, IL-6, IL-8, IFN-γ, and TNF-α in 18 pregnant veterans and analyzed the data using descriptive statistics, dependent t-tests, and correlation analyses. We assessed depression severity with the Edinburgh Postnatal Depression Scale and suicidality with the Columbia-Suicide Severity Rating Scale. Thirteen of the women repeated assessments in the early postpartum period at an average of 6.7 weeks after birth. RESULTS: As anticipated, estradiol (t(12) â€‹= â€‹12.47, p â€‹< â€‹.001) and cortisol (t(12) â€‹= â€‹9.43, p â€‹< â€‹.001) significantly decreased from pregnancy to postpartum. There were no differences in the means of gestational and postpartum IL-1ß, IL-6, TNF-α, or IFN-γ, but IL-8 was significantly increased from pregnancy to postpartum (t(12) â€‹= â€‹-4.60, p â€‹= â€‹.001). Estradiol during pregnancy was positively correlated with IL-6 levels both during pregnancy (r p  â€‹= â€‹.656, p â€‹= â€‹.008) and postpartum (r â€‹= â€‹0.648, p â€‹= â€‹.023). Elevated IL-1ß was associated with suicidal thoughts during pregnancy (r â€‹= â€‹0.529, p â€‹= â€‹.029). Although not statistically significant, depressive symptom severity trended towards a positive association with larger increases in IL-1ß (r â€‹= â€‹0.535, p â€‹= â€‹.09) and TNF-α (r â€‹= â€‹0.501, p â€‹= â€‹.08) from pregnancy to postpartum. CONCLUSION: This preliminary study suggests the feasibility of our approach for exploring a complex interplay between hormonal and pro-inflammatory changes from pregnancy to postpartum, and their relationship with depressive symptoms. Given our small sample and the relatively exploratory nature of our analyses, additional investigation focusing on hormonal and inflammatory changes and their potential associations with perinatal mental health is necessary to confirm and extend our preliminary findings and examine additional potential covariates.

A randomized controlled trial of yoga vs nonaerobic exercise for veterans with PTSD: Understanding efficacy, mechanisms of change, and mode of delivery.

BACKGROUND AND OBJECTIVES: Posttraumatic stress disorder (PTSD) is a chronic, disabling, and prevalent mental health disorder among Veterans. Despite the availability of empirically supported psychotherapies, many Veterans remain symptomatic after treatment and/or prefer to seek complementary and integrative health approaches, including yoga, to manage PTSD. The randomized controlled trial (RCT) described herein will evaluate the efficacy of a manualized yoga program as compared to nonaerobic exercise in reducing PTSD severity among Veterans. A secondary aim of this study is to better understand the mechanisms of change. METHODS: Veterans (N = 192) with PTSD will be randomized to hatha yoga or nonaerobic physical activity control; both groups consist of 12 weekly, 60-min group or online training sessions with 15-20 min of daily at-home practice. Outcome measures will be administered at baseline, mid-treatment, posttreatment, and 12-week follow-up. PROJECTED OUTCOMES: This study will evaluate changes in PTSD severity (primary outcome) as well as depression, anxiety, anger, sleep problems, and psychosocial disability (secondary outcomes). We will also use multiple mediation to examine two potential models of the mechanisms of clinical effect: the Attention Model (i.e., yoga increases attentional control, which reduces PTSD symptoms), the Coping Model (i.e., yoga increases distress tolerance, which improves coping, which reduces PTSD symptoms), and the combination of these models. This aspect of the study is innovative and important given the absence of an existing, comprehensive model for understanding yoga's impact on PTSD. Ultimately, we hope to develop guidelines for application of yoga to PTSD recovery.

Trauma-related guilt and pain among veterans with PTSD.

Despite the well-known co-occurrence of posttraumatic stress disorder (PTSD) and chronic pain, large gaps remain in understanding how these two conditions influence each other. The aim of the present study was to examine the association between trauma-related guilt and pain among veterans with PTSD. Participants were 140 veterans enrolling in treatment for PTSD and alcohol use disorder. Trauma-related guilt was assessed by the trauma-related guilt inventory, including the global guilt, distress, and guilt cognitions scales. Measures of pain included pain severity, pain disability, and fear of pain. Several significant bivariate associations were observed between trauma-related guilt scales and pain outcomes; however, in linear regression models, only the association between thoughts of trauma-related guilt and fear of pain remained statistically significant after controlling for confounding factors. Further, thoughts of trauma-related guilt, specifically thoughts of wrongdoing, partially mediated the association between PTSD severity and fear of pain. Our findings suggest that trauma-related guilt may play a role in the relationship between PTSD and chronic pain. Future research is encouraged to examine thoughts of trauma-related guilt as a potential therapeutic target in the treatment of persons with comorbid PTSD and chronic pain.

Compassion Meditation for Posttraumatic Stress Disorder in Veterans: A Randomized Proof of Concept Study.

There is considerable interest in developing complementary and integrative approaches for ameliorating posttraumatic stress disorder (PTSD). Compassion meditation (CM) and loving-kindness meditation appear to offer benefits to individuals with PTSD, including symptom reduction. The present study was a pilot randomized controlled trial of CM for PTSD in veterans. The CM condition, an adaptation of Cognitively-Based Compassion Training (CBCT®), consists of exercises to stabilize attention, develop present-moment awareness, and foster compassion. We compared CM to Veteran.calm (VC), which consists of psychoeducation about PTSD, rationale for relaxation, relaxation training, and sleep hygiene. Both conditions consist of 10 weekly 90-min group sessions with between-session practice assignments. A total of 28 veterans attended at least one session of the group intervention and completed pre- and posttreatment measures of PTSD severity and secondary outcomes as well as weekly measures of PTSD, depressive symptoms, and positive and negative emotions. Measures of treatment credibility, attendance, practice compliance, and satisfaction were administered to assess feasibility. A repeated measures analysis of variance revealed a more substantive reduction in PTSD symptoms in the CM condition than in the VC condition, between-group d = -0.85. Credibility, attendance, and satisfaction were similar across CM and VC conditions thus demonstrating the feasibility of CM and the appropriateness of VC as a comparison condition. The findings of this initial randomized pilot study provide rationale for future studies examining the efficacy and effectiveness of CM for veterans with PTSD.

Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Meditación de compasión para el trastorno de estrés postraumático en veteranos: un estudio aleatorio de prueba de concepto MEDITACIÓN DE COMPASIÓN PARA EL TEPT Existe un interés considerable en desarrollar enfoques complementarios e integrativos para mejorar el trastorno de estrés postraumático (TEPT). La meditación de compasión (CM en su sigla en inglés) y la meditación de bondad amorosa (LKM, en su sigla en inglés) parecen ofrecer beneficios a las personas con trastorno de estrés postraumático, incluida la reducción de síntomas. El presente estudio fue un ensayo piloto controlado aleatorizado de CM para el TEPT en veteranos. La condición de CM, una adaptación del entrenamiento de compasión de base cognitiva (CBCT® en sus siglas en inglés), consiste en ejercicios para estabilizar la atención, desarrollar la conciencia del momento presente y fomentar la compasión. Comparamos CM con Veteran.calm (VC en sus siglas en inglés), que consiste en psicoeducación sobre el TEPT y las razones para la relajación, entrenamiento de relajación e higiene del sueño. Ambas condiciones consisten en 10 sesiones de grupo semanales de 90 minutos con tareas de práctica entre sesiones. Un total de 28 veteranos asistieron al menos a una sesión de la intervención grupal y completaron las medidas previas y posteriores al tratamiento de la gravedad del TEPT y resultados secundarios, así como las medidas semanales de TEPT, síntomas depresivos y emociones positivas y negativas. Las medidas de credibilidad del tratamiento, asistencia, cumplimiento de la práctica y satisfacción se administraron para evaluar la viabilidad. Un análisis de la varianza de medidas repetidas reveló una reducción más sustancial en síntomas de TEPT en la condición de CM que en la condición de VC, d de Cohen = -0.85 entre grupos. La credibilidad, la asistencia y la satisfacción fueron similares en todas las condiciones de CM y VC y demostraron la viabilidad de CM y la idoneidad de VC como condición de comparación. Los hallazgos de este estudio piloto aleatorizado inicial proporcionan una base para futuros estudios que examinan la eficacia y la efectividad de CM para los veteranos con TEPT.

The Association Between Negative Trauma-Related Cognitions and Pain-Related Functional Status Among Veterans With Posttraumatic Stress Disorder and Alcohol Use Disorder.

Among veterans with posttraumatic stress disorder (PTSD), alcohol use disorders (AUDs) are highly prevalent. Furthermore, PTSD frequently co-occurs with chronic pain (CP), and CP is associated with an increased risk of AUD. Pain-related beliefs and appraisals are significantly associated with poorer pain-related functional status, yet few studies have examined negative trauma-related cognitions and their impact on pain-related functional disability in veterans with co-occurring PTSD and AUD. Accordingly, we examined the association between negative trauma-related cognitions and pain severity and pain disability in 137 veterans seeking treatment for PTSD and AUD. Using hierarchical multiple linear regression, we found that higher levels of negative trauma-related cognitions (e.g., "I am completely incompetent") were associated with a higher level of pain severity, after controlling for PTSD symptom severity and frequency of alcohol use, total R2 = .07, ΔR2 = .06. Additionally, as hypothesized, we found that higher levels of negative trauma-related cognitions were associated with higher levels of pain disability, after controlling for PTSD symptom severity, frequency of alcohol use, and pain severity, total R2 = .46, ΔR2 = .03. Given that negative trauma-related cognitions contributed to pain severity and pain disability, even when controlling for PTSD severity and frequency of alcohol use, future studies should explore the potential impact of interventions that address negative trauma-related cognitions (e.g., prolonged exposure or cognitive processing therapy) on pain severity and disability.

Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) La asociación entre las cogniciones negativas relacionadas con el trauma y el estado funcional relacionado con el dolor entre los veteranos con trastorno por estrés postraumático y trastorno por uso de alcohol COGNICIONES NEGATIVAS DE TRAUMA Y DOLOR Entre los veteranos con trastorno por estrés postraumático (TEPT), los trastornos por consumo de alcohol (AUD en su sigla en inglés) son altamente prevalentes. Además, el TEPT con frecuencia coexiste con el dolor crónico (DC), y el DC se asocia con un mayor riesgo de AUD. Las creencias y evaluaciones relacionadas con el dolor se asocian significativamente con un estado funcional más pobre relacionado con el dolor, sin embargo, pocos estudios han examinado las cogniciones negativas relacionadas con el trauma y su impacto en la discapacidad funcional relacionada con el dolor en veteranos con coexistencia de TEPT y AUD. En consecuencia, examinamos la asociación entre las cogniciones negativas relacionadas con el trauma y la gravedad del dolor y la discapacidad del dolor en 137 veteranos que buscaban tratamiento para TEPT y AUD. Al utilizar la regresión lineal múltiple jerárquica, encontramos que los niveles más altos de cogniciones negativas relacionadas con el trauma (por ejemplo "Soy completamente incompetente") se asociaron con un mayor nivel de severidad del dolor, después de controlar la severidad de los síntomas de TEPT y la frecuencia del consumo de alcohol, total R2 = .07, ΔR2 = .06. Además, como hipotetizamos, encontramos que los niveles más altos de cogniciones negativas relacionadas con el trauma se asociaron con niveles más altos de discapacidad del dolor, después de controlar la gravedad de los síntomas de TEPT, la frecuencia del consumo de alcohol y la gravedad del dolor, R2 total = .46, ΔR2 = . 03. Dado que las cogniciones negativas relacionadas con el trauma contribuyeron a la severidad del dolor y la discapacidad del dolor, incluso cuando se controla la gravedad y la frecuencia del consumo de alcohol, los estudios futuros deben explorar el impacto potencial de las intervenciones que abordan las cogniciones negativas relacionadas con el trauma (por ejemplo, la terapia de exposición prolongada o la terapia de procesamiento cognitivo) sobre la severidad del dolor y la discapacidad.

Acceptance and Commitment Therapy for Chronic Pain: Does Post-traumatic Stress Disorder Influence Treatment Outcomes?

OBJECTIVE: The aim of this study was to determine whether post-traumatic stress disorder (PTSD) moderates treatment outcomes in Acceptance and Commitment Therapy for chronic pain. DESIGN: Longitudinal. SETTING: Veterans Affairs San Diego Healthcare System. SUBJECTS: A total of 126 veterans with chronic pain participating in an Acceptance and Commitment Therapy intervention for chronic pain. A structured clinical interview was used at baseline to designate PTSD-positive (N = 43) and -negative groups (N = 83). METHODS: Linear mixed-effects models to determine whether PTSD moderated change in pain interference, pain severity, pain acceptance, depressive symptoms, or pain-related anxiety at post-treatment and six-month follow-up. RESULTS: Participants with co-occurring PTSD reported greater pain interference, pain severity, depressive symptoms, and pain-related anxiety at baseline. PTSD status did not moderate treatment effects post-treatment. Rather, there were significant improvements on all study measures across groups (P < 0.001). PTSD status moderated change in depressive symptoms at six-month follow-up (P < 0.05). Specifically, participants with chronic pain alone demonstrated improvement in depressive symptoms compared with pretreatment levels, whereas participants with PTSD regressed to pretreatment levels. CONCLUSIONS: PTSD status did not significantly affect treatment outcomes, with the exception of depressive symptoms at six-month follow-up. Overall, Acceptance and Commitment Therapy for chronic pain appears helpful for improving outcomes among veterans with co-occurring PTSD; however, veterans with co-occurring PTSD may experience fewer long-term gains compared with those with chronic pain alone.

OEF/OIF/OND Veterans Seeking PTSD Treatment: Perceptions of Partner Involvement in Trauma-Focused Treatment.

INTRODUCTION: Post-traumatic stress disorder (PTSD) has been linked to a variety of adverse mental and physical health outcomes including distressed relationships. Involving romantic partners in PTSD treatment appears to be a promising new avenue for PTSD treatment; however, additional research is necessary to clarify veteran preferences for inclusion of significant others in treatment and relationship characteristics that may influence such preferences. Accordingly, the present study was designed to evaluate Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) veterans' desire to include romantic partners in trauma-focused care (n = 74) and to explore psychological and relationship variables associated with preference for partner inclusion in PTSD treatment. MATERIALS AND METHODS: This study surveyed male (N = 74) OEF/OIF/OND combat veterans seeking mental health services at a Veterans Health Administration PTSD treatment program. Relationships between PTSD symptoms, romantic relationship functioning, and interest in including their romantic partner in PTSD treatment were examined. RESULTS: Consistent with previous research, OEF/OIF/OND veterans seeking treatment at a specialty PTSD program report low relationship satisfaction. The majority of participants reported that PTSD symptoms interfere with relationship functioning; specifically, numbing symptoms were a significant predictor of PTSD-related relationship impairment. A minority (26%) of participants reported a desire to include their romantic partner in PTSD treatment. Greater behavioral avoidance and communication difficulties were associated with increased interest in including a romantic partner in PTSD treatment. CONCLUSION: We confirmed that OEF/OIF/OND veterans seeking PTSD treatment experience PTSD-related problems in romantic relationships, low-relationship satisfaction, and relationship satisfaction was positively associated with perceived communication and problem-solving skills. A minority of veterans were interested in involving significant others in their PTSD treatment; however, in the present study, veterans were not given information about the various ways that a romantic partner might be involved in treatment, and they were not presented with specific conjoint therapies (e.g., Cognitive-Behavioral Conjoint Therapy for PTSD, Strategic Approach Therapy). For veterans with PTSD, relationship distress, and communication difficulties, conjoint psychotherapies may offer a way of increasing engagement in PTSD treatment by parsimoniously addressing multiple treatment targets at once (PTSD symptoms, relationship distress, communication problems) and providing veteran-centered care.

The trauma model of dissociation: inconvenient truths and stubborn fictions. Comment on Dalenberg et al. (2012).

Dalenberg et al. (2012) argued that convincing evidence (a) supports the longstanding trauma model (TM), which posits that early trauma plays a key role in the genesis of dissociation; and (b) refutes the fantasy model (FM), which posits that fantasy proneness, suggestibility, cognitive failures, and other variables foster dissociation. We review evidence bearing on Dalenberg et al.'s 8 predictions and find them largely wanting in empirical support. We contend that the authors repeat errors committed by many previous proponents of the TM, such as attributing a central etiological role to trauma in the absence of sufficient evidence. Specifically, Dalenberg et al. leap too quickly from correlational data to causal conclusions, do not adequately consider the lack of corroboration of abuse in many studies, and underestimate the relation between dissociation and false memories. Nevertheless, we identify points of agreement between the TM and FM regarding potential moderators and mediators of dissociative symptoms (e.g., family environment, biological vulnerabilities) and the hypothesis that dissociative identity disorder is a disorder of self-understanding. We acknowledge that trauma may play a causal role in dissociation but that this role is less central and specific than Dalenberg et al. contend. Finally, although a key assumption of the TM is dissociative amnesia, the notion that people can encode traumatic experiences without being able to recall them lacks strong empirical support. Accordingly, we conclude that the field should now abandon the simple trauma-dissociation model and embrace multifactorial models that accommodate the diversity of causes of dissociation and dissociative disorders.