Dynamics of diurnal cortisol and alpha-amylase secretion and their associations with PTSD onset in recent interpersonal trauma survivors.

BACKGROUND: Dysfunction in major stress response systems during the acute aftermath of trauma may contribute to risk for developing posttraumatic stress disorder (PTSD). The current study investigated how PTSD diagnosis and symptom severity, depressive symptoms, and childhood trauma uniquely relate to diurnal neuroendocrine secretion (cortisol and alpha-amylase rhythms) in women who recently experienced interpersonal trauma compared to non-traumatized controls (NTCs). METHOD: Using a longitudinal design, we examined diurnal cortisol and alpha-amylase rhythms in 98 young women (n = 57 exposed to recent interpersonal trauma, n = 41 NTCs). Participants provided saliva samples and completed symptom measures at baseline and 1-, 3-, and 6-month follow-up. RESULTS: Multilevel models (MLMs) revealed lower waking cortisol predicted the development of PTSD in trauma survivors and distinguished at-risk women from NTCs. Women with greater childhood trauma exposure exhibited flatter diurnal cortisol slopes. Among trauma-exposed individuals, lower waking cortisol levels were associated with higher concurrent PTSD symptom severity. Regarding alpha-amylase, MLMs revealed women with greater childhood trauma exposure exhibited higher waking alpha-amylase and slower diurnal alpha-amylase increase. CONCLUSIONS: Results suggest lower waking cortisol in the acute aftermath of trauma may be implicated in PTSD onset and maintenance. Findings also suggest childhood trauma may predict a different pattern of dysfunction in stress response systems following subsequent trauma exposure than the stress system dynamics associated with PTSD risk; childhood trauma appears to be associated with flattened diurnal cortisol and alpha-amylase slopes, as well as higher waking alpha-amylase.

Multidimensional Evaluation of Screening Brief Intervention and Referral to Treatment Training for Medical Students.

OBJECTIVE: Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based approach to identifying and addressing alcohol use in non-specialty settings. Many medical schools teach SBIRT, but most published evaluations of these efforts exclude rigorous skill assessments and teaching methods. METHODS: During the 2017-2018 academic year, 146 third-year medical students received classroom-based learning on SBIRT and motivational interviewing (MI) and at least two SBIRT practices with feedback as part of a 4-week psychiatry clerkship. The objective of this curriculum was to improve SBIRT knowledge, attitudes, and confidence and enable learners to skillfully deliver SBIRT. Outcomes evaluated included satisfaction, knowledge, attitudes and confidence, and clinical skill in delivering SBIRT to a standardized patient (rated by the actor, as well as an expert). RESULTS: Results indicated acceptable satisfaction at post-curriculum and significant improvements in attitudes and knowledge from pre- to post-curriculum. On the clinical skills exam, all students were rated as having mastered at least 80% of SBIRT elements by standardized patients and 91.8% were rated at this level by a faculty expert. Student attitudes and knowledge were unrelated to expert ratings, and standardized patient ratings had limited associations with expert ratings. CONCLUSIONS: These results suggest curriculum objectives were achieved and provide unique contributions to the SBIRT curricular outcome research for healthcare trainees. Other findings included that trainee knowledge and confidence may not relate to skill, and standardized patient feedback provides different information on SBIRT and MI skill than expert ratings.

Users of cannabis-only are less likely to accept brief interventions than other substance use profiles in a sample of people living with HIV/AIDS.

BACKGROUND AND OBJECTIVES: Research has shown that people living with HIV/AIDS (PLWHA) engage in increased rates of substance use, which has a number of potential negative health outcomes. Increased legalization of cannabis is likely to further increase the availability and use of cannabis in this population. Efforts have been made to integrate screening and intervention resources as part of an individual's routine healthcare visits. Though brief approaches such as Screening and Brief Intervention (SBIRT) have shown promise in addressing alcohol use, results are mixed in addressing cannabis use. The present study investigated how individuals reporting cannabis use responded to an invitation to engage in a brief negotiated intervention (BNI). METHODS: PLWHA participated in a self-administered tablet computer-based version of SBIRT. Patients screened as having at-risk, high-risk, or dependent substance use (N = 331) were eligible to receive the BNI. Of these patients, 101 reported cannabis-only use, with or without alcohol. RESULTS: Binary logistic regressions controlling for Alcohol Use Disorders Identification Test and Drug Abuse Screening Test score and demographics, found that cannabis-only use was significantly related to declining the BNI. DISCUSSION AND CONCLUSIONS: Cannabis-only engagement predicts lower BNI acceptance rates than other substance use profiles; inappropriate screening tools may be one reason for this discrepancy. Implications and directions for future research are discussed. SCIENTIFIC SIGNIFICANCE: Findings are relevant in modifying SBIRT for cannabis use. To our knowledge, this is the first work to evaluate acceptance of brief interventions for cannabis as compared to other substances and brief intervention acceptance in a sample of PLWHA.

Challenges to Conducting Contingency Management Treatment for Substance Use Disorders: Practice Recommendations for Clinicians.

A growing empirical literature supports contingency management (CM) as an efficacious treatment for substance use disorders, especially when reinforcers are immediate, frequent, and of sufficient magnitude on escalating schedules. However, in real world-practice, CM is often conducted in ways that are inconsistent with research protocols. One reason for these inconsistencies may be due to pragmatic challenges inherent in conducting CM. In this article, we described an outpatient CM treatment program for drug use disorders and several specific challenges associated with adherence to CM parameters from research protocols. Finally, we propose possible solutions for these challenges and discuss implications for practice.

College student mental health, treatment utilization, and reduced enrollment: Findings across a state university system during the COVID-19 pandemic.

Objective: This study measured the rate of college student mental health concerns and mental health service utilization. The roles of mental health and seeking treatment regarding anticipated enrollment were explored. Methods: One thousand eight hundred thirty-one randomly selected students participated in this online survey. Results: Most students reported clinically significant symptoms (88.3%), and many sought treatment in the past year (28.8%). Most students had favorable attitudes toward telemental health. Barriers to seeking care included a preference for self-management of symptoms (68.8%) and limited time (43.3%). Mental health was the most commonly reported reason for anticipating reduced enrollment (ps < .001), and these individuals were more likely to seek treatment. Conclusions: Past and anticipated use of mental health treatment likely exceeds on-campus capacity. Student mental health and retention are linked, and treatment may support retention. Nontraditional services, including telemental health, could help address increasing symptom severity and demand for services.

Effect of cognitive-behavioral techniques for problem gambling and gambling disorder: A systematic review and meta-analysis.

AIMS: To measure the effect of cognitive-behavioral techniques (CBTs) on gambling disorder severity and gambling behavior at post-treatment and follow-up. METHOD: Seven databases and two clinical trial registries were searched to identify peer-reviewed studies and unpublished studies of randomized controlled trials. The Cochrane Risk of Bias tool assessed risk of bias in the included studies. A random effect meta-analysis with robust variance estimation was conducted to measure the effect of CBTs relative to minimally treated or no treatment control groups. RESULTS: Twenty-nine studies representing 3991 participants were identified. CBTs significantly reduced gambling disorder severity (g = -1.14, 95% CI = -1.68, -0.60, 95% prediction interval [PI] = -2.97, 0.69), gambling frequency (g = -0.54, 95% CI = -0.80, -0.27, 95% PI = -1.48, 0.40) and gambling intensity (g = -0.32, 95% CI = -0.51, -0.13, 95% PI = -0.76, 0.12) at post-treatment relative to control. CBTs had no significant effect on follow-up outcomes. Analyses supported the presence of publication bias and high heterogeneity in effect size estimates. CONCLUSIONS: Cognitive-behavioral techniques are a promising treatment for reducing gambling disorder and gambling behavior; however, the effect of cognitive-behavioral techniques on gambling disorder severity and gambling frequency and intensity at post-treatment is overestimated, and cognitive-behavioral techniques may not be reliably efficacious for all individuals seeking treatment for problem gambling and gambling disorder.

Effects of cognitive behavioral techniques for gambling on recovery defined by gambling, psychological functioning, and quality of life: A systematic review and meta-analysis.

OBJECTIVE: Individuals who experience gambling harms report that sustained recovery involves changing both gambling behaviors and psychological symptoms, as well as building a meaningful life. However, there is limited understanding about the effect of cognitive behavioral (CB) techniques on psychological symptoms and quality of life. The purpose of the present study was to examine the effect of CB techniques for gambling-related harms on broader recovery outcomes such as psychological symptoms and quality of life. METHOD: A systematic article search was conducted to identify randomized controlled trials of CB techniques with nonactive and minimal treatment control groups that assessed psychological symptoms or quality of life as outcomes. Random-effects meta-analysis was used to examine the effect of CB techniques relative to nonactive and minimal treatment control groups. RESULTS: A total of nine studies representing 658 participants were included. Eight studies reported outcomes on depression and anxiety, three on substance use, and six on quality of life. CB techniques significantly reduced anxiety (g = -0.44) and depression (g = -0.35) at posttreatment, but not substance use. CB techniques also significantly increased quality of life at posttreatment (g = 0.40). There was a large amount of heterogeneity suggesting the magnitude of effects could vary significantly in future randomized trials. CONCLUSIONS: Future studies should examine the longitudinal associations between gambling harms, psychological symptoms, and quality of life and to assess whether changes in gambling harms throughout treatment precede or are a consequence of changes in psychological symptoms and quality of life. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The Status of SBIRT Training in Health Professions Education: A Cross-Discipline Review and Evaluation of SBIRT Curricula and Educational Research.

PURPOSE: To assess the quality of curricular research on the Screening Brief Intervention and Referral to Treatment (SBIRT) approach and determine the presence of useful training modalities, particularly motivational interviewing (MI) training, across health care training curricula. METHOD: The authors conducted a systematic review of published, peer-reviewed studies in PubMed, ERIC, CINAHL, Ovid HealthSTAR, and PsycINFO databases through March 2021 for English-language studies describing SBIRT, a curriculum for health care trainees, and curricular intervention outcomes. After the records were independently assessed, data were extracted and 20% of the studies were double-coded for interrater reliability. RESULTS: Of 1,856 studies, 95 were included in the review; 22 had overlapping samples and were consolidated into 10 nested studies, leaving 83 total. Interrater reliability ranged from moderate (κ = .74, P < .001) to strong (κ = .91, P < .001) agreement. SBIRT training was delivered to trainees across many professions, including nursing (n = 34, 41%), medical residency (n = 28, 34%), and social work (n = 24, 29%). Nearly every study described SBIRT training methods (n = 80, 96%), and most reported training in MI (n = 54, 65%). On average, studies reported 4.06 (SD = 1.64) different SBIRT training methods and 3.31 (SD = 1.59) MI training methods. Their mean design score was 1.92 (SD = 0.84) and mean measurement score was 1.89 (SD = 1.05). A minority of studies measured SBIRT/MI skill (n = 23, 28%), and 4 studies (5%) set a priori benchmarks for their curricula. CONCLUSIONS: SBIRT training has been delivered to a wide range of health care trainees and often includes MI. Rigor scores for the studies were generally low due to limited research designs and infrequent use of objective skill measurement. Future work should include predefined training benchmarks and validated skills measurement.

Dropout from face-to-face, multi-session psychological treatments for problem and disordered gambling: A systematic review and meta-analysis.

OBJECTIVE: The aims of this systematic review and meta-analysis were to examine the overall prevalence of dropout from psychological treatments for problem gambling and gambling disorder and to examine how study, client, and treatment variables influenced dropout rates. METHOD: A systematic search was conducted to identify studies of cognitive and/or behavioral therapies and motivational interventions for problem gambling and gambling disorder. Meta-analysis was used to calculate an overall weighted dropout rate. Random effect meta-regressions were used to examine covariates of dropout rates. Mixed-effect subgroup analyses were used to examine moderators of dropout rates. RESULTS: The systematic search identified 24 studies (31 dropout rates) comprising 2,791 participants. Using a random-effects model, the overall weighted dropout rate was 39.1%, 95% CI [33.0%, 45.6%]. Increases in the percentage of married participants were significantly associated with lower dropout rates. Dropout rates were significantly higher when dropout was defined as attending all sessions of a treatment protocol compared to when defined as attending a prespecified number of sessions different from the total in the protocol and when defined as study therapists judging participants to be dropouts. Insufficient reporting of some gambling-related variables and other psychological symptom variables prevented a thorough examination of covariates and moderators. CONCLUSIONS: A large proportion of individuals drop out of treatment for problem gambling and gambling disorder. Future research should examine the reasons for dropout across marital statuses and should adopt dropout definitions that consider session-by-session symptom change. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Practice and Dissemination of Motivational Interviewing: A Psychology Internship Curriculum.

Sufficient training in substance use issues has been identified as a common gap in professional psychology graduate training. Satisfactory training in evidence-based practices has also been identified as a common gap for providers who care for individuals with substance use problems. The "practice and dissemination" curriculum we developed seeks to address both of these gaps during the predoctoral internship training year by first training psychology interns to competently deliver motivational interviewing (MI) to individuals with substance use problems and then train community providers and volunteers to do so. From 2012-2013, a total of 55 community providers and volunteers from a homeless shelter, a substance use treatment facility, and a community mental health facility received training in MI through this curriculum by attending continuing education events delivered by 17 psychology interns. Evaluation of the dissemination portion of the curriculum as part of an exempt educational research project revealed that community providers were able to achieve significant increases in MI knowledge, readiness to implement MI, and MI skill as assessed with a video analogue measure by the end of the workshop. They also reported satisfaction with the workshop. These evaluation findings provide preliminary support for the curriculum as a novel and efficacious way to disseminate MI to community providers. Research is necessary to determine long-term outcomes of such training and to identify strategies to overcome potential barriers such as the substantial faculty effort necessary to implement the intensive curriculum.

Utility of the Athlete Drinking Scale for assessing drinking motives among high school athletes.

Research suggests that high school athletes are at greater risk for heavy alcohol use and alcohol-related problems than their non-athlete peers. Drinking motives unique to the athletic experience may contribute to elevated use. The Athlete Drinking Scale (ADS) was designed to assess sport-related motives for alcohol use, but has not yet been validated among high school athletes. The purpose of this study was to examine the psychometric properties of the ADS among a sample of high school athletes. Participants were 216 high school student-athlete drinkers who completed anonymous self-report surveys. A confirmatory factor analysis resulted in a revised three-factor solution with a satisfactory overall model fit. Path analyses indicated that the Positive Reinforcement motives subscale was the only ADS subscale that was significantly associated with alcohol use and alcohol-related problems when controlling for the effects of the other factors (i.e., age and gender) in this population. The ADS may be a valuable assessment tool for researchers and clinicians involved in alcohol prevention efforts for high school athletes.

A confirmatory factor analysis of the Protective Behavioral Strategies Scale among OEF/OIF veterans.

INTRODUCTION: Military veterans of the wars in Afghanistan and Iraq (OEF/OIF/OND) are at-risk for increased alcohol consumption and alcohol-related consequences. The Protective Behavioral Strategies Scale (PBSS) has been shown to be a reliable and valid measure of assessing strategies to facilitate more responsible drinking and to reduce alcohol-related harm among college student populations. The purpose of this study was to examine the psychometric properties of the PBSS among the OEF/OIF veteran population. METHOD: Participants were 251 veterans (94% male; 83% White; M age=31.77years) who were participating in a larger alcohol intervention trial and reported consuming alcohol within the past 30days. RESULTS: Confirmatory Factor Analyses indicated the model fit of the PBSS was similar to college student samples. Although a confirmatory three-factor model best fits the data, model fit indices were slightly below commonly accepted guidelines. All PBSS subscales were negatively correlated with alcohol outcomes. Greater use of Manner of Drinking (MOD) and Stopping/Limiting Drinking (SLD) strategies were associated with less alcohol consumption and lower peak BAC. Greater use of MOD strategies was associated with less alcohol-related problems. CONCLUSIONS: Findings provide initial support for use of the PBSS among OEF/OIF veterans. Strategies aimed at Stopping/Limiting Drinking and the Manner of Drinking may be more effective with a veteran sample. Additional studies examining the external validity of this measure are encouraged.