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.