Cognitive Processing Therapy for Posttraumatic Stress Disorder via Telehealth: Practical Considerations During the COVID-19 Pandemic.

The global outbreak of COVID-19 has required mental health providers to rapidly rethink and adapt how they provide care. Cognitive processing therapy (CPT) is a trauma-focused, evidence-based treatment for posttraumatic stress disorder that is effective when delivered in-person or via telehealth. Given current limitations on the provision of in-person mental health treatment during the COVID-19 pandemic, this article presents guidelines and treatment considerations when implementing CPT via telehealth. Based on lessons learned from prior studies and clinical delivery of CPT via telehealth, recommendations are made with regard to overall strategies for adapting CPT to a telehealth format, including how to conduct routine assessments and ensure treatment fidelity.

Food insecurity is associated with unhealthy dietary practices among US veterans in California.

OBJECTIVE: US veterans (hereafter, 'veterans') are at risk for being overweight or obese and associated unhealthy behaviours, including poor diet; although limited studies have examined the underlying factors associated with such outcomes. As such, the present study evaluated the association between food insecurity and dietary practices among veterans. DESIGN: A secondary analysis of cross-sectional data from the California Health Interview Survey (2009, 2011/2012) was conducted. Survey weights were applied to identify univariate means, population estimates and weighted percentages. Bivariate analyses followed by survey-weighted negative binomial regression were used to model the association between food insecurity and dietary practices of fruit, vegetable, fast food and soda intakes. SETTING: California Health Interview Survey 2009-2011/2012. SUBJECTS: The present study included a total of 11 011 veterans from California. RESULTS: Nearly 5 % of the studied veteran population reported living in poverty with food insecurity. Compared with those at or above the poverty level and those in poverty but food secure, the mean intakes of fruits and vegetables were lower, while the mean intakes of soda and fast foods (P for trend <0·05) were higher among veterans living in poverty with food insecurity. Food insecurity was associated with 24 and 142 % higher average consumption of fast foods and soda, respectively, and 24 % lower fruit intake. CONCLUSIONS: Food insecurity remains a burden among veterans and is associated with unhealthy dietary practices. Targeted interventions to improve diet quality are imperative.

How Will I Be Perceived: The Role of Trauma-Related Shame in the Relationship Between Psychological Distress and Expectations of Disclosure Among Survivors of Sexual Victimization.

Sexual assault is a serious physical and psychological concern worldwide. Various negative psychological outcomes are associated with survivor well-being, including depression, posttraumatic stress disorder (PTSD), depressive symptoms, and trauma-related shame. Opportunities for emotional expression and processing have been shown to be beneficial among survivors of trauma; however, survivors of sexual victimization may be reticent to disclose details of their traumatic experience, particularly to formal sources of support. Trauma-related shame (e.g., negative evaluations of self, feelings of worthlessness, and powerlessness) has been shown to negatively impact expectations of disclosure, as some survivors may fear being blamed or judged. Limited research exists on the impact of psychological distress on survivors' expectations of disclosure. The current study investigated whether psychological distress (i.e., depressive and PTSD symptoms) is associated with expectations of disclosure (positive vs. negative) through trauma-related shame among survivors of sexual victimization. Participants, recruited from a primarily Hispanic-serving institution, participated in the present study. Participants (N = 86) completed measures of PTSD and depression symptom severity, trauma-related shame, and expectations of disclosure. Results revealed that psychological distress severity was associated with negative expectations of disclosure through trauma-related shame (b = 0.682, p < .05, 95% confidence interval [CI] [0.197, 1.367]), but not positive expectation (b = -0.068, p = .417, 95% CI [-0.523, 0.155]). Our findings have implications for prognosis and treatment for survivors of sexual victimization, particularly among LatinX populations.

The influence of combat and interpersonal trauma on PTSD, depression, and alcohol misuse in U.S. Gulf War and OEF/OIF women veterans.

The present study evaluated the impact of combat and interpersonal trauma exposure in a sample of 115 U.S. women veterans from Gulf War I and the Iraq and Afghanistan wars on 3 postdeployment trauma-related mental health outcomes: posttraumatic stress disorder symptoms (PSS), depressive symptom severity (DSS), and alcohol misuse. Patients presenting for healthcare services at a Veterans Affairs postdeployment health specialty clinic completed screening questionnaires that assessed combat exposure, lifetime interpersonal trauma history of childhood neglect, physical, or sexual abuse, and adult sexual and physical assault. In a regression model, combat exposure was the only significant independent variable associated with PSS, DSS, and alcohol misuse (ß = .42, .27 and B = 1.58, respectively) even after adding lifetime interpersonal assault exposure to the model. Results highlight the negative effects of combat exposure on treatment-seeking women veterans' postdeployment mental health. Incorporating combat exposure into routine screening procedures for Gulf War and Iraq and Afghanistan war women veterans can aid in mental health treatment planning.

The effectiveness and feasibility of videoconferencing technology to provide evidence-based treatment to rural domestic violence and sexual assault populations.

OBJECTIVE: Although evidence-based treatments for post-traumatic stress disorder (PTSD) have been available for some time, many treatment-seeking trauma survivors are unable to access such services. This is especially the case in remote and rural areas where access to specialists is an exception rather than a rule. Advances in videoconferencing-based technologies are improving rural residents' access to specialized psychological services. However, at present, little is known about the viability and efficacy of providing psychological interventions via distal technologies to individuals who present at rural domestic violence and rape crisis centers. The present study attempts to partially address this void by evaluating, in the context of an uncontrolled trial, the effectiveness and feasibility of providing evidence-based, trauma-focused treatment via videoconferencing to rural survivors of domestic violence and sexual assault. MATERIALS AND METHODS: Participants in the present study were clients referred to the Wyoming Trauma Telehealth Treatment Clinic (WTTTC) for psychological services via videoconferencing from distal domestic violence and rape crisis centers located in the state of Wyoming. Fifteen female victims of assaultive violence who received at least four sessions of trauma-focused treatment via videoconferencing-based technology at distal rape and domestic violence crisis centers were included in the present study. Participants completed measures of PTSD and depression symptom severity and client satisfaction. RESULTS: Participants evidenced large reductions on measures of PTSD (d = 1.17) and depression (d = 1.24) symptom severity following treatment via videoconferencing. Additionally, participants reported a high degree of satisfaction with videoconferencing-administered services. CONCLUSIONS: Results provide evidence in support of videoconferencing as an effective means to provide psychological services to rural domestic violence and sexual assault populations. Clinical implications and avenues for future research are discussed.

Sleepless in school: The role of social determinants of sleep health among college students.

Sleep health is a public health concern and has been linked to an increased risk of number of deleterious health outcomes. Poor sleep health has been documented among college student populations; however, few studies have examined the social determinants of deficient sleep. The present study aims to address this gap, with emphasis on food insecurity, psychological distress, everyday discrimination, and academic performance. Participants (n = 282) completed self-report measures online assessing the variables of interest for the present study. Results revealed that the majority of college students in our sample reported feeling tired, fatigue, or daytime sleepiness and sleeping less than eight hours per night during the school week. Poor sleep health was significantly associated with being food insecurity, serious psychological distress, and poorer self-rated mental and physical health. Results have important implications for the development of targeted evidence-based interventions to improve sleep health among college populations.

Unmet Mental Healthcare Need and Suicidal Ideation Among U.S. Veterans.

INTRODUCTION: Suicide prevention remains a national priority, especially among vulnerable populations. With increasing trends in suicide among Veterans, understanding the underlying factors associated with such an outcome is imperative. In this study, the association between unmet mental healthcare need and suicidal ideation among U.S. Veterans was evaluated. METHODS: The National Survey on Drug Use and Health, 2008-2013, was used to identify those with mental illness, resulting in a total sample of 2,015 Veterans. Data were analyzed in July 2015. Survey-weighted descriptive and logistic regression analyses were conducted with p<0.05 used to establish significance. RESULTS: Sixteen percent of Veterans reported unmet mental healthcare need and 18% had past-year suicidal ideation. After adjusting for confounders, unmet mental healthcare need was associated with increased likelihood of suicidal ideation (AOR=4.11) in the study population. Other characteristics, such as participating in a governmental assistance program and alcohol dependency in the past year, demonstrated 66% and 103% increased odds of suicidal ideation, respectively. CONCLUSIONS: Unmet mental healthcare need is a critical aspect of suicidal ideation among Veterans. Improved access to care for such at-risk populations through means of integrated care is needed to ensure reduced burden of suicide among Veterans.

Sexual assault related distress and drinking: the influence of daily reports of social support and coping control.

Introduction. A history of sexual assault (SA) is often associated with increased distress and heavy drinking. One's ability to cope with the distress and seek social support has been associated with drinking more generally. However, SA-related distress, drinking, and the extent to which a woman engages in adaptive coping or seeks social support is known to vary day-to-day. The goal of the present investigation was to examine the moderating influence of perceived coping control and social support on the event-level association between SA-related distress and drinking. Methods. This study included 133 college women with a history of SA who reported recent heavy drinking. Participants provided daily reports of their SA-related distress, perceived coping control, perceived social support, and alcohol consumption every day for 30days. Results. Results of generalized estimating equation models suggest that coping control moderated the association between distress and drinking such that those with less perceived coping control drank more as their SA-related distress increased from their average. Although social support did not moderate between distress and drinking, decreases in perceived social support were associated with more drinking on that day. Conclusions. The results suggest that daily deviations in SA-related distress may influence alcohol consumption more than average levels of distress, especially among women with low coping control. Interventions for women with SA histories should help them build coping skills as well as adequate social support in order to reduce drinking.

Female Sexual Victimization Among College Students: Assault Severity, Health Risk Behaviors, and Sexual Functioning.

The purpose of the present study was to examine the relationship between college women's sexual victimization experiences, health risk behaviors, and sexual functioning. A sample of 309 college women at a mid-sized Midwestern university completed measures assessing sexual victimization, sexual risk taking, substance use behaviors, sexual desire, sexual functioning, prior sexual experiences, and social desirability. Severity of sexual victimization was measured using a multi-item, behaviorally specific, gender-neutral measure, which was divided into four categories based on severity (none, sexual contact, sexual coercion, rape). Within the sample, 72.8% (n = 225) of women reported at least one experience of sexual victimization since age 16. Results from MANCOVAs and a multinomial logistic regression, controlling for social desirability and prior sexual experience, revealed that sexual victimization among female students was related to increased drug use, problematic drinking behaviors, sexual risk taking, sexual dysfunction, and dyadic sexual desire. In addition, findings indicated that women exposed to more severe forms of sexual victimization (i.e., rape) were most likely to report these risk-taking behaviors and sexual functioning issues. Implications for sexual assault risk reduction programming and treatment are discussed.

Bodily pain and coping styles among four geriatric age groups of women.

No research is available regarding the association between coping styles and bodily pain by age-specific sub-groups in non-clinical older populations. To address this research gap, we recruited 317 older women (age 55-105, mainly from minority ethnic backgrounds) and divided our sample into sub-groups by decade. Regression analyses on the total sample and the age group of 65-74 demonstrated that denial and venting were inversely related to pain. Findings for the age groups 55-64 and 75-84 were non-significant. Among women age 85 or older, seeking emotional support was inversely associated with pain, while active coping was related to higher pain reports.

Negative social reactions to assault disclosure as a mediator between self-blame and posttraumatic stress symptoms among survivors of interpersonal assault.

The type of causal attributions offered for traumatic life events has been documented as a potential vulnerability factor for posttraumatic stress disorder (PTSD). However, few investigations have sought to identify the mechanisms by which such explanations are associated with greater posttraumatic distress. One possible factor that may account for the relationship between maladaptive attributional tendencies and PTSD symptoms is the quality of social reactions received from one's social network upon disclosure. The aim of the present study was to examine the relationship between self-blaming attributions provided for traumatic events, negative social reactions, and PTSD symptom severity. Undergraduate psychology students (N = 68), who reported previously experiencing interpersonal assault, completed measures assessing their attributions for their assault and the quality of reactions received from members of their social network upon disclosure. Results from a statistical mediational analysis suggest that a self-blame may be associated with poorer psychological adjustment by virtue of negative social reactions. Results of this study further our understanding of risk and resilience among assault survivors and may have significant implications for treatment interventions for individuals with PTSD.

Numbing and dysphoria symptoms of posttraumatic stress disorder among Iraq and Afghanistan War veterans: a review of findings and implications for treatment.

Iraq and Afghanistan war veterans experience significant rates of posttraumatic stress disorder (PTSD) and other trauma-related mental health conditions. Understanding how specific PTSD symptomatology affects physical health and psychosocial functioning may be useful in improving the conceptualization of PTSD nosology and informing treatment approaches for this population. Confirmatory factor analytic evidence supports four-factor models of PTSD symptoms that classify emotional numbing and/or dysphoria symptoms as a distinct PTSD symptom cluster, and these symptoms appear to be related to poorer psychological adjustment among returning Iraq and Afghanistan war veterans. This review briefly describes current conceptualizations of numbing/dysphoria symptoms of PTSD and summarizes research on the factor structure of PTSD symptoms. Then, the literature on the influence of numbing/dysphoria symptoms on physical and psychological health among these veterans is reviewed, and implications for treatment and directions for future research are presented.

Technological advances in the treatment of trauma: a review of promising practices.

Given the availability of empirically supported practices for addressing posttraumatic stress disorder and other forms of trauma-related distress, the development and implementation of new technology to deliver these treatments is exciting. Technological innovations in this literature aim to expand availability of empirically based intervention, increase treatment adherence and acceptability, and overcome barriers commonly encountered with conventional trauma-focused treatment. Much of the current research on these technological developments consists of brief reviews and case studies of the separate therapy modalities. Although this work serves to document the appeal and utility of these innovations, it does not provide comprehensive information about the host of options available. To that end, the three general categories of technological advances in trauma therapy (i.e., videoconferencing, e-Health, virtual reality) are reviewed here, including information regarding their empirical support and suggestions for future research and clinical practice.

Impact of emotional approach coping and hope on PTSD and depression symptoms in a trauma exposed sample of Veterans receiving outpatient VA mental health care services.

The present investigation evaluates the relationship between coping style, dispositional hope, and posttraumatic stress disorder (PTSD) and depression symptom severity in a trauma-exposed Veteran sample. Specifically, we evaluated the adaptive value of emotional avoidant and approach coping strategies and perceptions of hope in a sample of 209 trauma-exposed Veterans receiving outpatient mental health care at a VA facility. Participants completed a life events questionnaire and inventories assessing coping, dispositional hope, and PTSD and depression symptom severity. Hierarchical regression analyses were conducted controlling for relevant demographic variables. Greater levels of emotional avoidance and lower levels of emotional expression were significantly associated with increased PTSD and depression symptom severity. Dispositional hope was positively associated with depression symptoms only and perceptions of hope moderated the association between emotional avoidance coping and depression symptoms. Findings highlight the value of emotional coping strategies and perceptions of hope in posttraumatic adjustment. Specifically, employing coping techniques that encourage emotional expression may promote improved adjustment among trauma-exposed individuals, while reduced perceptions of hope and the use of avoidant coping strategies may place individuals at greater risk for depression following exposure to traumatic events.