An intensive outpatient program with prolonged exposure for veterans with posttraumatic stress disorder: Retention, predictors, and patterns of change.

High rates of drop-out from treatment of PTSD have challenged implementation. Care models that integrate PTSD focused psychotherapy and complementary interventions may provide benefit in retention and outcome. The first 80 veterans with chronic PTSD enrolled in a 2-week intensive outpatient program combining Prolonged Exposure (PE) and complementary interventions completed symptom and biological measures at baseline and posttreatment. We examined trajectories of symptom change, mediating and moderating effects of a range of patient characteristics. Of the 80 veterans, 77 completed (96.3%) treatment and pre- and posttreatment measures. Self-reported PTSD (p < .001), depression (p < .001) and neurological symptoms (p < .001) showed large reductions with treatment. For PTSD, 77% (n = 59) showed clinically significant reductions. Satisfaction with social function (p < .001) significantly increased. Black veterans and those with a primary military sexual trauma (MST) reported higher baseline severity than white or primary combat trauma veterans respectively but did not differ in their trajectories of treatment change. Greater cortisol response to the trauma potentiated startle paradigm at baseline predicted smaller reductions in PTSD over treatment while greater reductions in this response from baseline to post were associated with better outcomes. Intensive outpatient prolonged exposure combined with complementary interventions shows excellent retention and large, clinically significant reduction in PTSD and related symptoms in two weeks. This model of care is robust to complex presentations of patients with varying demographics and symptom presentations at baseline. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Interpersonal Style and Posttraumatic Stress Disorder Symptoms in Female Victims of Dating Violence.

Symptoms of posttraumatic stress disorder (PTSD) are some of the most common mental health symptoms women experience following exposure to dating violence (DV). However, not all women who experience DV exhibit PTSD symptoms. One factor that may influence whether or not women exhibit PTSD symptoms in the aftermath of DV exposure is interpersonal style, often operationalized in terms of two orthogonal dimensions, warmth and dominance. In this study, we examined the main and moderating effects of warmth and dominance on the association between DV and PTSD symptoms using latent moderating structural equation modeling in a sample of 303 female college students who reported DV exposure in the past year. Results indicated that warmth exerted a main effect predicting fewer PTSD symptoms. In addition, dominance moderated the association between DV and PTSD symptoms such that at high levels of DV, women who were high on dominance reported fewer PTSD symptoms than did women who were low on dominance. These findings suggest that aspects of interpersonal style may promote resilience to symptoms of posttraumatic stress following DV exposure. Directions for future research are also discussed.

Traumatogenic Processes and Pathways to Mental Health Outcomes for Sexual Minorities Exposed to Bias Crime Information.

Vicarious traumatization of nonvictim members of communities targeted by bias crimes has been suggested by previous qualitative studies and often dominates public discussion following bias events, but proximal and distal responses of community members have yet to be comprehensively modeled, and quantitative research on vicarious responses is scarce. This comprehensive review integrates theoretical and empirical literatures in social, clinical, and physiological psychology in the development of a model of affective, cognitive, and physiological responses of lesbian, gay, and bisexual individuals upon exposure to information about bias crimes. Extant qualitative research in vicarious response to bias crimes is reviewed in light of theoretical implications and methodological limitations. Potential pathways to mental health outcomes are outlined, including accumulative effects of anticipatory defensive responding, multiplicative effects of minority stress, and putative traumatogenic physiological and cognitive processes of threat. Methodological considerations, future research directions, and clinical implications are also discussed.

Relational trauma in the context of intimate partner violence.

The relational model of trauma (Scheeringa & Zeanah, 2001) proposes that infants' trauma symptoms may be influenced by their mothers' trauma symptoms and disruptions in caregiving behavior, although the mechanisms by which this occurs are less well understood. In this research, we examined the direct and indirect effects of a traumatic event (maternal intimate partner violence [IPV]), maternal trauma symptoms, and impaired (harsh and neglectful) parenting on infant trauma symptoms in a sample of mother-infant dyads (N=182) using structural equation modeling. Mothers completed questionnaires on IPV experienced during pregnancy and the child's first year of life, their past-month trauma symptoms, their child's past-month trauma symptoms, and their parenting behaviors. Results indicated that the effects of prenatal IPV on infant trauma symptoms were partially mediated by maternal trauma symptoms, and the relationship between maternal and infant trauma symptoms was fully mediated by neglectful parenting. Postnatal IPV did not affect maternal or infant trauma symptoms. Findings support the application of the relational model to IPV-exposed mother-infant dyads, with regard to IPV experienced during pregnancy, and help identify potential foci of intervention for professionals working with mothers and children.

Interpersonal style moderates the effect of dating violence on symptoms of anxiety and depression.

Over a quarter of young women have experienced some form of violence within a dating relationship. The experience of dating violence is associated with problems in psychological functioning, including symptoms of anxiety and depression. However, not all women who experience dating violence exhibit anxious or depressive symptoms. One factor that may influence symptom expression is interpersonal style. In this study, we examined the main and moderating effects of dimensions of interpersonal style (dominance and warmth) on the association between dating violence and symptoms of anxiety and depression. Warmth exhibited a main effect on anxious and depressive symptoms over and above the effects of dating violence and other life stressors. Dominance moderated the association between dating violence and anxious and depressive symptoms. When levels of dating violence were high, women with higher levels of dominance reported fewer symptoms of anxiety and depression than women with lower dominance. These results indicated that whereas high warmth was associated with fewer symptoms of psychopathology generally, high dominance was a buffer against the effect of dating violence on symptoms more specifically. Directions for future research are discussed.

The effects of intimate partner violence on women and child survivors: an attachment perspective.

Approximately 25% of women in the United States report having experienced intimate partner violence (IPV) in an adult relationship with a male partner. For affected women, IPV has been shown to increase the risk of psychopathology such as depression, anxiety, and symptoms of posttraumatic stress. Further, studies suggest that the risk of IPV (victimization or perpetration) may be carried intergenerationally, and children exposed to IPV are at a greater risk of both attachment insecurity and internalizing/externalizing problems. The authors employ an attachment perspective to describe how insecure/non-balanced working models of the relational self and others may be evoked by, elicit, or exacerbate maladaptive outcomes following experiences of IPV for mothers and their children. This article draws on both rich theory and empirical evidence in a discussion of attachment patterns in violent relationships, psychopathological outcomes for exposed women, disruptions in the caregiving relationship that may confer risk to children of exposed mothers, and the biological, social, and attachment risk factors for children exposed to IPV. A clinical case example is presented and discussed in the context of attachment theory.