Dissociation in a developmental psychopathology framework: Predictors and outcomes among a clinical sample of trauma-impacted adolescents.

OBJECTIVE: A confirmatory factor analysis (CFA) of the Adolescent Dissociative Experiences Scale (A-DES) that found a best-fitting three-factor model for a trauma-exposed sample was recently replicated; however, a post hoc bifactor CFA model fit the data better and identified a strong general factor. Only the general factor was associated with cumulative trauma exposure, but this association was small. METHOD: Structural equation modeling (SEM) and regression analyses were applied to the best-fitting three-factor bifactor model of dissociation found in the same sample of 1,157 treatment-seeking adolescents, most with high levels of trauma exposure, to further elucidate dissociation's construct validity and dimensionality. RESULTS: The general factor was positively yet differentially associated with psychosocial outcomes. A dissociation by age interaction emerged for internalizing problems, demonstrating that the positive association was stronger for older participants. Also, an age of trauma exposure onset by dissociation interaction emerged predicting depression, such that later trauma onset produced a stronger association between dissociation and depression. CONCLUSIONS: Traumas occurring in later adolescence may confer greater risk of dissociation. Differential psychosocial outcomes also reinforce why approaching dissociation from a developmental psychopathology lens is important, enhancing the model's generalizability. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Predictors of symptom severity and change among youth in trauma-informed residential care.

BACKGROUND: Trauma-informed residential care is an intensive intervention setting for youth, but research on its effectiveness is limited and yields mixed findings. OBJECTIVES: The study aims were to; 1) evaluate change over time of mental health (MH) symptoms over 21 months of trauma-informed residential care, and 2) examine the influence of demographic and risk factor variables (e.g. age, gender, trauma and placement history) on baseline symptoms and treatment response. PARTICIPANTS: A sample of 547 youth ages 12 to18 in trauma-informed residential care (M age = 15.84 (SD = 1.56), 43.2 % male) were examined, with notable attrition over the study period. METHOD: Latent curve analysis (LCA) was used to estimate MH symptom severity at intake and change during 21 months (8 assessments total, intake and every 3 months) of care. RESULTS: Trauma-informed residential care was associated with significant reductions in symptoms of PTSD (d = -0.76), depression (d = -0.59), dissociation (d = -0.60), psychological dysregulation (d = -0.94), and externalizing (d = -0.31), but not internalizing (d = 0.01) problems. Females had greater symptoms at intake across multiple indicators and showed equivalent or greater treatment response than males, although both groups improved. Neither cumulative trauma nor previous placement were associated with attenuated treatment response, but trauma history was positively associated with severity of multiple clinical measures at intake. CONCLUSIONS: Trauma-informed residential treatment can lead to reductions in clinical symptoms, even among multiply trauma-impacted youth. The extent of youth's trauma history did not negatively influence treatment response.

Temporal Relationships between PTSD Symptoms and Social Functioning among Adolescents in Residential Care.

OBJECTIVE: Theoretical and conceptual models of posttraumatic stress disorder (PTSD) symptom progression in youth have identified social functioning as having a central influence. Yet a dearth of research has examined the bidirectional temporal associations between PTSD symptoms and social functioning. METHOD: This study is the first to investigate these temporal dynamics in a sample of adolescents in trauma-informed residential treatment (N= 453; M age = 15.77 [range = 12.12-18.95], SD = 1.55; 57.2% female). The UCLA PTSD Reaction Index for DSM-5 was analyzed as a measure of youth-reported PTSD symptoms and the Interpersonal Problems subscale of the Children's Depression Inventory, 2nd edition was analyzed as a measure of youth-reported social functioning issues. The Social Problems subscale from the Child Behavior Checklist was analyzed as a measure of clinician-reported social functioning difficulties. Measures were completed at baseline and then approximately every three months for the duration of treatment. Multivariate lagged analyses were used to examine the temporal, bidirectional associations between PTSD symptoms and social functioning. RESULTS: Results indicated that while controlling for length of stay, trauma exposure, age, and gender, reductions in PTSD symptoms predicted subsequent reductions in social functioning problems across both measures (prs = .12-.16), and that improvement in interpersonal relationships predicted subsequent decreases in PTSD symptoms (pr = .12). CONCLUSIONS: Taken together, these findings highlight the importance of healthy social relationships for decreasing adolescent's psychological distress. Treatments that include components that target social functioning in addition to symptom reduction may maximally benefit youth with trauma-related psychopathology.

Dissociation: Factor structure and the role of trauma among treatment-seeking adolescents.

OBJECTIVE: Research examining the factor structure of the Adolescent Dissociative Experiences Scale (A-DES) has yielded mixed findings. This study sought to further clarify the factor structure of the A-DES among youth with histories of exposure to multiple traumas and adversities. METHOD: We conducted a factor analysis of the A-DES using data from 1,157 treatment-seeking adolescents with histories of trauma exposure in order to expand understanding of dissociation's construct validity and provide the first attempt at post hoc analysis of trauma-impacted adolescents. RESULTS: A bifactor CFA model fit the data best and identified a strong general factor, supporting a unidimensional latent structure. Only the general dissociation factor was associated with cumulative trauma exposure, operationalized as the number of different types of exposure endorsed on the Trauma History Profile (THP), but this association was small. CONCLUSIONS: The study findings point toward a unidimensional conceptualization of dissociation. A developmental psychopathology framework is recommended for future research, allowing a nuanced and integrated approach to understanding dissociation and increasing generalizability across adolescents. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A pilot randomized effectiveness trial of the unified protocol in trauma-exposed veterans.

BACKGROUND: The unified protocol (UP) is a promising transdisgnostic treatment for emotional disorders; limited data exists with trauma-exposed populations. This study compared effectiveness of the UP, presented centered therapy (PCT), and treatment as usual (TAU) in trauma-exposed veterans presenting to routine care. METHOD: Trauma-exposed veterans with one or more emotional disorder diagnoses participated in a pilot hybrid-1 effectiveness/preimplementation study. Thirty-seven male and female veterans were randomized to one of three conditions. RESULTS: Multilevel growth curve modeling demonstrated improvement over time across conditions with large effect sizes (range: -2.15 to -3.32), with the UP demonstrating the greatest change. The between group effect sizes for reductions in number of comorbid diagnoses were medium to small and statistically significant (TAU and UP, d = 0.49, p = .056; TAU and PCT d = 0.18, p = .166, UP and PCT d = 0.31, p = .229). Only the UP led to a decrease in the number of comorbid diagnoses (d = -0.71). Psychosocial functioning varied by group, with slight increases in impairment in PCT and TAU, and medium effect size reduction in the UP. Only the UP exhibited significant decreases in self-reported anxiety and depression. Between group differences for UP and PCT were medium to large and statistically significant for depression across two measures (d = -0.72 to d = -1.40). CONCLUSIONS: This represents the first trial examining effectiveness of the UP, PCT, and TAU in trauma-exposed veterans. Despite a small sample, large effect size differences demonstrated promising advantages for the UP. Trial Registration Number: NCT02944994.

An evaluation of the construct validity of the Adult Rejection Sensitivity Questionnaire.

Rejection sensitivity (RS), the predisposition to defensively expect, readily perceive, and react strongly to interpersonal rejection (Downey & Feldman, 1996; Feldman & Downey, 1994), may be a transdiagnostic trait associated with a range of psychiatric symptoms and psychosocial dysfunction. Valid and reliable assessment of vulnerability factors is essential for individualized treatment and improving clinical outcomes. Limited research has examined the factor structure of the predominantly used self-report measure of RS, the Adult Rejection Sensitivity Questionnaire (A-RSQ; Berenson et al., 2009). Across two studies (Study 1: N = 346, 57.2% female, 76.6% White; 16.8% Hispanic/Latinx; Study 2: N = 540; 43.7% female, 80.2% White; 16.7% Hispanic/Latinx), we examined the factor structure of the A-RSQ in samples of adult U.S. residents and investigated associations with mental health correlates, including neuroticism, social anxiety, anxiety, depression, anhedonia, somatic arousal, and psychological distress. Study 2 also evaluated relations with interpersonal correlates, including introversion, submissiveness, and anxious and avoidant attachment. A two-factor solution with rejection expectancy and rejection concern representing separate factors consistently fit the data best. Distinct patterns of associations emerged suggesting that concern was more strongly associated with indicators of negative affect while expectancy was uniquely associated with diminished positive affect. Both concern and expectancy were associated with indicators of interpersonal dysfunction. Findings suggest that the current operationalization, and perhaps conceptualization, of RS as measured by the A-RSQ requires revision. Additionally, RS may be a clinically relevant transdiagnostic phenotype that influences symptom manifestation and psychosocial functioning. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

"Recovering from intimate partner violence through Strengths and Empowerment (RISE): Development, pilot testing, and refinement of a patient-centered brief counseling intervention for women": Correction.

Reports an error in "Recovering from intimate partner violence through Strengths and Empowerment (RISE): Development, pilot testing, and refinement of a patient-centered brief counseling intervention for women" by Katherine M. Iverson, Sara B. Danitz, Mary Driscoll, Dawne Vogt, Alison B. Hamilton, Megan R. Gerber, Shannon Wiltsey Stirman, Danielle R. Shayani, Michael K. Suvak and Melissa E. Dichter (Psychological Services, Advanced Online Publication, Jun 10, 2021, np). In the original article, the columns in Table 3 were misaligned such that the data presented in the columns did not correspond with the correct variable. Additionally, for clarity, the table should have presented a separate column "n" for sample size and displayed total scores for the Personal Progress Scale (PPS) as opposed to mean scores. None of these errors impacted the results or conclusions. All versions of this article have been corrected. (The following abstract of the original article appeared in record 2021-53476-001). This article describes the rationale, development, and preliminary examination of a brief, variable-length (up to six sessions), modular-based counseling intervention for women who experience intimate partner violence (IPV). Recovering from IPV through Strengths and Empowerment (RISE) is an empowerment and skills-focused treatment that incorporates Motivational Interviewing. RISE was developed to fill the gap in interventions for women who disclose IPV within integrated healthcare settings such as the Veterans Health Administration (VHA). Fifteen women Veterans with past-year IPV participated in an open trial at two VHA hospitals to evaluate the potential helpfulness, feasibility, and acceptability of RISE using a mixed-methods approach to assessment. Qualitative feedback from women Veterans and five RISE clinicians (psychologists and social workers) was collected posttreatment. Descriptive analyses of quantitative psychosocial outcomes before and after the intervention provide evidence of support for RISE as potentially helpful in improving psychosocial well-being. High retention and high satisfaction ratings, along with positive qualitative feedback from both IPV survivor participants and clinicians, supported intervention feasibility and acceptability. Overall, this pilot study offers feasibility and acceptability data for RISE as a potentially helpful intervention for women experiencing past-year IPV. Refinements to RISE based on the open trial and subsequent testing of the clinical effectiveness of the intervention are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Relationships Among Sleep Disturbance, Reward System Functioning, Anhedonia, and Depressive Symptoms.

Recent models propose reward system dysfunction as a key mediator of the relationship between sleep and depression and anhedonia. This study explored interrelationships among sleep disturbance, depressive symptoms, anhedonia, and reward responsiveness. Two-hundred and sixty undergraduate students completed questionnaires and a daily diary paradigm assessing sleep, reward responsiveness, depression, anhedonia, and positive affect over 1 week. Baseline sleep disturbance was associated with depressive symptoms, anhedonia, and reward responsiveness. Daily diary sleep parameters showed differential associations with anticipatory versus consummatory reward responsiveness and positive affect. Poorer sleep quality, shorter sleep duration, and longer awakening after sleep onset predicted blunted anticipatory and consummatory reward responsiveness, while increased sleep onset latency and lower sleep efficiency predicted only decreased consummatory reward responsiveness. All sleep indices, except sleep onset latency, were associated with positive affect. Findings demonstrate unique associations between disparate sleep disturbance and reward responsiveness elements, highlighting new treatment mechanisms for anhedonia and depression.

Temporary PTSD symptom increases among individuals receiving CPT in a hybrid effectiveness-implementation trial: Potential predictors and association with overall symptom change trajectory.

OBJECTIVE: Concern about symptom worsening with trauma-focused treatment may be one factor hindering the implementation of evidence-based treatments for PTSD, like cognitive processing therapy (CPT), despite evidence for their efficacy. Previous studies have examined the frequency and effect of symptom exacerbation, or temporary symptom increases, on outcomes, but primarily in randomized clinical trials. METHOD: We examined this issue in a community sample of participants receiving CPT from front-line clinicians learning to deliver CPT in a randomized controlled implementation trial of training strategies. Patient participants (n = 183) completed self-report measures of PTSD symptoms at each session. RESULTS: Most participants (67.3%) experienced at least one temporary symptom increase during CPT (only 1.6% continued to have higher symptoms by the end of treatment). Demographic variables, comorbid conditions (i.e., depression, anxiety, substance use), and baseline PTSD symptom levels did not predict symptom increases. Importantly, symptom increases did not predict treatment noncompletion, posttreatment PTSD symptom levels, or loss of probable PTSD diagnosis. Moreover, growth curve modeling revealed that temporary symptom increases did not predict the trajectory of PTSD symptoms over the course of treatment. CONCLUSIONS: The rates of symptom increases, which were higher than in previous studies, may be attributed to a routine care sample or to the differences in session timing and measurement. These results add to a nascent literature documenting that symptom increases may be a normal, transient part of treatment that do not impact a patient's ability to have symptom improvement during a course of CPT. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Recovering from intimate partner violence through Strengths and Empowerment (RISE): Development, pilot testing, and refinement of a patient-centered brief counseling intervention for women.

[Correction Notice: An Erratum for this article was reported online in Psychological Services on May 12 2022 (see record 2022-63047-001). In the original article, the columns in Table 3 were misaligned such that the data presented in the columns did not correspond with the correct variable. Additionally, for clarity, the table should have presented a separate column "n" for sample size and displayed total scores for the Personal Progress Scale (PPS) as opposed to mean scores. None of these errors impacted the results or conclusions. All versions of this article have been corrected.] This article describes the rationale, development, and preliminary examination of a brief, variable-length (up to six sessions), modular-based counseling intervention for women who experience intimate partner violence (IPV). Recovering from IPV through Strengths and Empowerment (RISE) is an empowerment and skills-focused treatment that incorporates Motivational Interviewing. RISE was developed to fill the gap in interventions for women who disclose IPV within integrated healthcare settings such as the Veterans Health Administration (VHA). Fifteen women Veterans with past-year IPV participated in an open trial at two VHA hospitals to evaluate the potential helpfulness, feasibility, and acceptability of RISE using a mixed-methods approach to assessment. Qualitative feedback from women Veterans and five RISE clinicians (psychologists and social workers) was collected posttreatment. Descriptive analyses of quantitative psychosocial outcomes before and after the intervention provide evidence of support for RISE as potentially helpful in improving psychosocial well-being. High retention and high satisfaction ratings, along with positive qualitative feedback from both IPV survivor participants and clinicians, supported intervention feasibility and acceptability. Overall, this pilot study offers feasibility and acceptability data for RISE as a potentially helpful intervention for women experiencing past-year IPV. Refinements to RISE based on the open trial and subsequent testing of the clinical effectiveness of the intervention are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Social anxiety, rejection sensitivity, and theory of mind decoding ability.

OBJECTIVES: Recent initiatives have highlighted the importance of investigating clinically relevant variations in social processes that contribute to mental illness. Surprisingly little research has examined the associations between socially and clinically relevant transdiagnostic factors, such as social anxity (SA) and rejection sensitvity (RS), on theory of mind (ToM) decoding ability. METHODS: The Reading the Mind in the Eyes Task and self-report measures of SA and RS were completed by 199 adult participants. RESULTS: Linear regression analyses suggest a specific difficulty decoding positive emotion associated with SA and global decrements in ToM associated with RS that may reflect a negative interpretation bias. CONCLUSIONS: These findings may have important implications for understanding how those with SA and RS perceive and navigate social interactions, which may contribute to the maintenance of symptoms and decreased psychosocial functioning.

A Novel Approach to the Assessment of Fidelity to a Cognitive Behavioral Therapy for PTSD Using Clinical Worksheets: A Proof of Concept With Cognitive Processing Therapy.

Fidelity monitoring is a critical indicator of psychotherapy quality and is central to successful implementation. A major barrier to fidelity in routine care is the lack of feasible, scalable, and valid measurement strategies. A reliable, low-burden fidelity assessment would promote sustained implementation of cognitive behavioral therapies (CBTs). The current study examined fidelity measurement for cognitive processing therapy (CPT) for posttraumatic stress disorder (PTSD) using clinical worksheets. External raters evaluated patient worksheets done as a part of treatment, both guided by the therapist and completed independently as homework. Results demonstrated that fidelity ratings from CPT session worksheets were feasible and efficient. Notably, they were strongly correlated with observer ratings of the fidelity of CPT strategies that were present on the worksheets. Agreement among ratings conducted by individuals with a range of experience with CPT was acceptable to high. There was not a main effect of therapist-guided, in-session worksheet ratings on PTSD symptom change. However, patient competence in completing worksheets independently was associated with greater PTSD symptom decline and in-session, therapist-guided worksheet completion was associated with larger symptom decreases among patients with high levels of competence. With further research and refinement, rating of worksheets may be an efficient way to examine therapist and patient skill in key CPT elements, and their interactions, compared to the gold standard of observer ratings of therapy video-recordings. Additional research is needed to determine if worksheets are an accurate and scalable alternative to gold standard observer ratings in settings in which time and resources are limited.

The Effect of PTSD Symptom Change on Suicidal Ideation in a Combined Military and Civilian Sample Engaged in Cognitive Processing Therapy.

In light of the well-established relationship between posttraumatic stress disorder (PTSD) and suicidal ideation (SI), there has been a push for treatments that simultaneously improve symptoms of PTSD and decrease SI. Using data from a randomized controlled hybrid implementation-effectiveness trial, the current study investigated the effectiveness of Cognitive Processing Therapy (CPT; Resick, Monson, & Chard, 2016) on PTSD and SI. The patient sample (N = 188) was diverse in military and veteran status, gender, and comorbidity, and 73% of the sample endorsed SI at one or more points during CPT. Participants demonstrated significant improvement in SI over the course of CPT. Multilevel growth curve modeling revealed a significant association between PTSD symptom change and change in SI. Results from cross-lagged multilevel regressions indicated that PTSD symptoms predicted SI in the next session, yet SI in a given session did not predict PTSD symptoms in the next session. Potentially relevant clinical factors (i.e., military status, gender, depression diagnosis, baseline SI, study consultation condition) were not associated with the relationship between PTSD symptoms and SI. These results add to the burgeoning literature suggesting that evidence-based treatments for PTSD, like CPT, reduce suicidality in a range of individuals with PTSD, and that this reduction is predicted by improvements in PTSD symptoms.

A Glimpse into the "Black Box": Which Elements of Consultation in an EBP are Associated with Client Symptom Change and Therapist Fidelity?

Background: Consultation is an implementation strategy that improves delivery and clinical outcomes for Cognitive Processing Therapy (CPT), an evidence-based practice (EBP) for posttraumatic stress disorder (PTSD). However, little is known about the specific components of consultation that influence the fidelity of treatment delivery or clinical outcomes. Methods: The current study examined whether specific activities performed during CPT consultation meetings were associated with better fidelity to the CPT protocol among 60 newly trained therapists or improved clinical outcomes among 135 clients treated by these therapists. Consultation activities that fall under three broad categories (discussion of the application of CPT to individual cases, review/feedback on fidelity, and technical difficulties) were measured by consultant checklists for each consultation session. Treatment fidelity (adherence to the protocol and competence of delivery) was rated by trained observers for a random sample of therapists' CPT sessions following consultation. The self-reported PTSD Checklist-IV assessed PTSD symptom change. Results: Multilevel regression analyses indicated that higher therapist consultation attendance predicted a greater decrease in their clients' PTSD symptoms and that attendance was not associated with observer-rated treatment fidelity. Discussion of the application of specific CPT strategies was the only consultation activity that was significantly associated with greater improvement in PTSD symptoms. Lastly, no consultation activities were significantly associated with treatment fidelity. Conclusions: Our findings suggest that specific consultation strategies such as emphasizing the discussion of the application of specific CPT strategies to individual cases during consultation meetings may be effective in improving the clinical outcomes of CPT.

Patterns of change in physical functioning and posttraumatic stress disorder with cognitive processing therapy in a randomized controlled implementation trial.

Background: Physical health concerns (e.g. chronic pain, fatigue) are common among clients with posttraumatic stress disorder (PTSD). Prior research has indicated that clients report improved physical functioning and fewer physical health symptoms after receiving Cognitive Processing Therapy (CPT) for PTSD. However, less is known about the impact of physical functioning on the clients' PTSD symptom improvement in CPT. Objective: The current study examined the patterns of change of and between physical functioning and PTSD symptoms over the course of CPT among a diverse military, veteran, and community sample. Method: We collected clients' (N = 188) physical functioning and PTSD symptom severity prior to and during CPT using the 12-Item Short Form Health Survey and the PTSD Checklist. We used multilevel modelling to 1) evaluate the impact of baseline physical functioning on the PTSD symptom trajectory, 2) examine the trajectory of physical functioning, and 3) assess the dynamics between physical functioning and PTSD symptoms over the course of CPT. Results: Our multilevel analyses indicated that 1) physical functioning significantly improved for those with low levels of functioning prior to treatment, 2) poorer baseline physical functioning predicted slower improvements in PTSD symptoms, and 3) poorer physical functioning in one session predicted less PTSD symptom improvement by the next session. Conclusions: Our findings demonstrate that while physical functioning can interfere with PTSD symptom improvement, physical functioning can also improve over the course of CPT. In light of the interconnected nature of physical health and PTSD symptoms, clinicians may need to attend to lower levels of physical functioning when providing CPT or other trauma-focused therapies. Future research to determine whether specific treatment adaptations may benefit such clients is needed.

Antecedentes: Los problemas de salud física (ej. dolor crónico, fatiga) son comunes entre los clientes con trastorno de estrés postraumático (TEPT). La investigación previa ha indicado que los clientes reportan una mejoría en el funcionamiento físico y menos síntomas de salud física después de recibir Terapia de Procesamiento Cognitivo (CPT, por su sigla en inglés) para TEPT. Sin embargo, se sabe menos sobre el impacto del funcionamiento físico sobre la mejoría de los síntomas de TEPT de los clientes en la CPT.Objetivo: El presente estudio examinó los patrones de cambio del funcionamiento físico y los síntomas de TEPT, por separado y entre sí, en el curso de la CPT en una muestra diversa de militares, veteranos y personas de la comunidad.Método: Recolectamos el funcionamiento físico y la severidad de los síntomas de TEPT de los clientes (N=188) antes y durante la CPT, utilizando el Cuestionario Corto de Salud de 12 items y la Lista de chequeo de TEPT. Utilizamos un modelo multinivel para 1) evaluar el impacto del funcionamiento físico basal sobre la trayectoria de los síntomas de TEPT, 2) examinar la trayectoria del funcionamiento físico, y 3) evaluar la dinámica entre el funcionamiento físico y los síntomas de TEPT en el curso de la CPT.Resultados: Nuestros análisis multinivel indicaron que 1) el funcionamiento físico mejoró en forma significativa en quienes tenían bajos niveles de funcionamiento antes del tratamiento, 2) un peor funcionamiento físico basal predijo una mejoría más lenta de los síntomas de TEPT, y 3) un peor funcionamiento físico en una sesión predijo una menor mejoría sintomática en la siguiente sesión.Conclusiones: Nuestros hallazgos demuestran que mientras que el funcionamiento físico puede interferir con la mejoría de los síntomas de TEPT, el mismo también puede mejorar en el curso de la CPT. A la luz de la naturaleza interconectada de la salud física y lossíntomas de TEPT, los clínicos pueden necesitar poner atención a niveles más bajos de funcionamiento físico cuando proveen CPT u otras terapias centradas en el trauma. Se requiere futura investigación para determinar si estos clientes se pueden beneficiar de adaptaciones de tratamiento específicas.

Bidirectional Relationships Between Posttraumatic Stress Disorder and Social Functioning During Cognitive Processing Therapy.

This study investigated temporal relationships between posttraumatic stress symptoms and two indicators of social functioning during cognitive processing therapy. Participants were 176 patients (51.5% female, M age = 39.46 [SD = 11.51], 89.1% White, 42.6% active duty military/veteran) who participated in at least two assessment time points during a trial of cognitive processing therapy. Posttraumatic stress disorder (PTSD) symptoms (PTSD Checklist for DSM-IV) and interpersonal relationship and social role functioning problems (Outcome Questionnaire-45) were assessed prior to each of 12 sessions. Multivariate multilevel lagged analyses indicated that interpersonal relationship problems predicted subsequent PTSD symptoms (b = .22, SE = 0.09, cr = 2.53, p = .01, pr = .46) and vice versa (b = .05, SE = 0.02, cr = 2.11, p = .04, pr = .16); and social role functioning problems predicted subsequent PTSD symptoms (b = .21, SE = 0.10, cr = 2.18, p = .03, pr = .16) and vice versa (b = .06, SE = 0.02, cr = 3.08, p < .001, pr = .23). Military status moderated the cross-lag from social role functioning problems to PTSD symptoms (b = -.35, t = -2.00, p = .045, pr = .16). Results suggest a robust association between PTSD symptoms and social functioning during cognitive processing therapy with a reciprocal relationship between PTSD symptoms and social functioning over time. Additionally, higher social role functioning problems for patients with military status indicate smaller reductions in PTSD symptoms from session to session.

Social criticism moderates the relationship between anxiety and depression 10 years later.

BACKGROUND: Research has consistently documented anxiety and depression as bidirectional risk factors for one another. However, little research investigates the sequential comorbidity of anxiety and depression over lengthy durations, and the influence of contextual variables on this relationship have not been fully empirically investigated. METHOD: The current study examined perceived social criticism as a moderator of the relationship between a history of anxiety and a past 12-month depressive episode at least 10 years later (and vice versa) utilizing the National Comorbidity Survey Baseline (N = 8,098) and Re-interview data (N = 5,001). History of anxiety and depressive diagnoses were assigned at Wave 1, past year diagnosis at Wave 2, and perceived social criticism was assessed at Wave 1. RESULTS: Structural equation modeling indicated that when controlling for a Wave 1 latent depression factor, a positive relationship between Wave 1 latent anxiety and a Wave 2 latent depression emerged for those endorsing higher perceived social criticism from friends and relatives, respectively. Unexpectedly, when controlling for Wave 1 latent anxiety, a negative relationship between Wave 1 latent depression and Wave 2 latent anxiety emerged for those endorsing higher perceived social criticism from friends, but no relationship when moderated by perceived social criticism from relatives. LIMITATIONS: Perceived social criticism was self-reported, which may introduce self-perception bias. CONCLUSIONS: Results identified perceived social criticism as an important moderator in the sequential comorbidity of anxiety and depression over a long period of time.

Sluggish cognitive tempo and exposure to interpersonal trauma in children.

Background: Childhood adversity has been suggested, but not yet empirically examined, as a factor in sluggish cognitive tempo (SCT) in childhood.Objective: This study was an examination of SCT in relation to childhood adversity, and its association with exposure to non-interpersonal and interpersonal trauma.Method: Caregivers (N = 161) and a sub-sample of children, 8-17 years old, were recruited from mental health and pediatric practices/programs and interviewed.Results: SCT was positively associated with interpersonal trauma but not non-interpersonal trauma. Two hierarchical regression analyses revealed that interpersonal trauma exposure was associated with SCT score over and above symptoms of other psychopathologies.Conclusion: Results suggest that SCT is associated with interpersonal trauma exposure in children. Further research is needed to examine the association between SCT and interpersonal trauma exposure, and trauma-related biopsychosocial impairments.

Examining patterns of dose response for clients who do and do not complete cognitive processing therapy.

Trauma-focused therapies, including Cognitive Processing Therapy (CPT; Resick et al., 2016), are effective at reducing clients' PTSD symptoms. A limitation to these treatments, however, is client completion of them. The current study examined temporal patterns of treatment non-completion and the relationships among non-completion, PTSD, and overall mental health functioning outcomes, among clients in a randomized controlled CPT implementation trial. Two models of symptom change were tested: 1) dose-effect model (i.e., clients uniformly improve with additional sessions at a negatively accelerating rate); and 2) the good-enough level model (i.e., clients remain in therapy until they have achieved sufficient improvement, thus clients who attend fewer sessions improve at quicker rates). Results indicated that 42% of clients did not complete treatment, with most discontinuing between sessions two and five. Data did not fit the dose-effect or good-enough level model. Rather, clients who improved at a greater rate in their PTSD symptoms and overall mental health functioning attended more sessions. The average client had the best outcomes when they completed all 12 sessions. Identifying clients who may be at risk for discontinuing treatment, and making a concerted effort toward retaining them, is imperative to reduce non-completion rates and ultimately improve client outcomes.

Effects of Rumination and Worry on Sleep.

Recent research suggests that the stress-sleep relationship is mediated by pre-sleep arousal (PSA) and that cognitive arousal has a stronger mediating effect than somatic arousal; however, this has not been directly tested. Using multilevel moderated mediation, we compared the effects of cognitive arousal and somatic arousal within the stress-sleep relationship. We also assessed whether two forms of repetitive negative thought-rumination and worry-are similarly involved in the stress-sleep relationship. Data was collected from 178 participants across the United States via an online platform. Participants completed baseline self-report surveys examining rumination tendencies and worry tendencies. Over the course of 2 weeks, participants completed daily questionnaires assessing daily stress, PSA, and sleep quality. Results indicated that indirect effects from stress to sleep quality via PSA were statistically significant at low and high levels of rumination and worry, and people at high levels of rumination and worry had stronger relationships between stress and PSA. Across all models, cognitive arousal consistently accounted for more of the variance in the stress-sleep relationship as compared to somatic arousal. Implications for the cognitive behavioral treatment of insomnia are discussed.