Digital empowerment in mental health: A meta-analysis of internet-based interventions for enhancing mental health literacy.

Background: Poor mental health literacy (MHL) in the global population significantly contributes to the treatment gap associated with mental disorders. In the digital age, leveraging Internet-based MHL interventions offers scalability and broader accessibility. This meta-analysis aimed to evaluate the effects of Internet-based interventions in improving MHL and mental health. Method: Up to Feb 2024, seven databases were searched for Internet-based interventions on MHL (knowledge, stigma, help-seeking attitudes and intentions) and mental disorders (general distress, anxiety, and depressive symptoms). The random-effects meta-analyses at post-intervention and long-term follow-up assessments were performed. Results: Twenty-nine eligible studies involving 11,582 participants were included. Significant positive effects were observed across various domains: knowledge increase (immediate: g = 0.459, 95 %CI: 0.285 to 0.634; follow-up: g = 0.487, 95 %CI: 0.348 to 0.626), immediate stigma reduction (g = -0.332, 95 %CI: -0.479 to -0.186), immediate enhancement of help-seeking attitudes (g = 0.168, 95 %CI: 0.046 to 0.3291) and help-seeking intentions (g = 0.135, 95 %CI: 0.072 to 0.198), as well as immediate mental health improvements (g = -0.074, 95 %CI: -0.115 to -0.033). Conclusion: Overall, these findings underscore the promising effects of internet-based interventions in improving MHL and mental health, while maintaining these effects over time remains challenging, particularly in reducing stigma and promoting long-term help-seeking behaviors. Addressing methodological limitations, adopting a more interactive approach, and implementing targeted interventions are crucial to maximizing the effectiveness and advancing mental health care worldwide.

Unraveling the complexity and instability of negative emotional eating: A latent transition analysis.

The manifestations of emotional eating are complicated, encompassing both over- and under-eating. However, little is understood about how emotional over- and under-eating constitute individuals' eating patterns and how these patterns change over time. Employing latent transition analysis, a longitudinal and person-centered approach, this study examined the patterns and stability of emotional eating. Over six months, 755 participants completed two waves of self-reported questionnaires. Results revealed four distinct latent profiles: Low Emotional Eaters (11.5-15.8%), Emotional Eating-Undereaters (31.1-40.5%), Emotional Eating-Overeaters (15.9-18.3%), and Combined-Emotional Eaters (29.7-37.2%). Approximately 50% of participants in each profile maintained their behavioral patterns over time, with transitions often shifting towards Combined-Emotional Eaters. Individuals in the profile of Emotional Eating-Overeaters exhibited the highest level of anxiety, depression, stress, and disordered eating. Gender, self-esteem level, and self-esteem instability were associated with profile membership and transition probabilities. These findings highlight the presence of distinct and relatively unstable patterns of negative emotional eating, indicating the potential distinction between trait and state emotional eating. Recognizing these inherent characteristics is crucial for future studies and intervention programs addressing negative emotional eating.

Anxiety is related to slower RSA oscillation during stress response and regulation.

Respiratory sinus arrhythmia (RSA), an index of the parasympathetic nervous system activity, has been considered indicative of stress response and emotion regulation. However, the relationship between RSA and anxiety remains inconclusive, partly because previous research has primarily focused on static RSA levels. In this nonclinical sample (N = 75, Mage = 20.89 ± 1.72 SD, 48 males), we used a damped oscillator model to characterize RSA dynamics across 30-s epochs while participants completed the Trier social stress test. Results showed that RSA constantly oscillated during the three periods of TSST (namely Rest, Stress, and Recovery). Importantly, slower RSA oscillation in the Stress period was related to elevated state anxiety, whereas in the Recovery period, it was related to higher trait anxiety. These findings demonstrated the dynamic nature of RSA during the whole course of stress response. Slower RSA oscillation may indicate inflexible and tardy physiological regulation which may give rise to anxiety issues.

The knowledge, attitude, and intention to use internet-based mental health services: A serial mediation model.

Objective: Internet-based mental health services (i-MHS) have been widely provided to the public during the pandemic. However, people's engagement with i-MHS remains unclear. This study aimed to examine the Chinese population's knowledge, attitudes, and use intentions regarding i-MHS and determine their relations by serial mediation models. Methods: The public's knowledge, attitudes, intention to use i-MHS and psychological impact of the pandemic were assessed. An online survey was administered to respondents from mainland China (N = 2543). Results: Of the participants, 53.9 % exhibited some familiarity with i-MHS, while 62.4 % perceived these services as somewhat or very helpful, and 53.2 % were willing or very willing to use them. Serial mediation analyses indicated that the psychological impact of the pandemic indirectly related to the intention to use i-MHS. Knowledge and attitudes toward i-MHS sequentially mediated this relation [χ 2(61) = 179.359, P < .001; χ 2 /df = 2.940; CFI = 0.996; RMSEA = 0.028]. Conclusions: This study underscores the critical role of knowledge in shaping positive attitudes and intentions to use i-MHS, emphasizing the need for robust mental healthcare promotion strategies to raise knowledge and maximize the benefits of i-MHS.

Effectiveness and mechanism of a 4-week online self-help mindfulness intervention among individuals with emotional distress during COVID-19 in China.

BACKGROUND: Many people suffered from emotional distress especially during the COVID-19 pandemic. In order to alleviate emotional distress, more accessible psychological intervention programs, such as online intervention programs, are needed. The study aimed to investigate the efficacy and the potential mechanism of a 4-week, online, self-help mindfulness-based intervention to manage emotional distress during the COVID-19 pandemic between February 3 and May 20, 2020. METHODS: A total of 302 individuals with high emotional distress completed a self-help mindfulness course, which lasted 30-60 min per day for 28 consecutive days. Participants who registered in the program later were included in the analyses as the control group (n = 315). Levels of mindfulness, perceived stress, emotional distress, anxiety and depression were assessed at baseline(T1), week 1(T2), week 2(T3), week 3(T4) and week 4(T5). RESULTS: Significant Group by Time interaction effects were found on mindfulness, perceived stress, emotional distress, anxiety and depression (p < 0.001). Compared to the control group, the intervention group had a greater increase in changes of all outcome variables (p < 0.001). Random intercept cross-lagged analyses showed that compared with control group, mindfulness at T2 and T4 negatively predicted stress at T3 and T5, and mindfulness at T2 and T4 negatively predicted depression at T3 and T5 while depression at T3 predicted mindfulness at T4 in the mindfulness group. CONCLUSIONS: The results suggest that a 4-week self-help online mindfulness intervention improved mindfulness and reduced stress, emotional distress, anxiety and depression symptoms. Compared to the control group, changes in mindfulness preceded changes in stress, and mindfulness and depression reciprocally influenced each other during the intervention. Trial registration Chinese Clinical Trial Registry: ChiCTR2000034539. Registered 9 July 2020-Retrospectively registered, http://www.chictr.org.cn/edit.aspx?pid=55721&htm=4 .

An Innovative Mobile Game for Screening of Pediatric PTSD: a Study in Primary Care Settings.

Childhood is a developmental period associated with high risk of posttraumatic stress disorder (PTSD). Available validated pencil-and-paper diagnostic tools can be difficult for younger children to engage with given format and length. This study investigated psychometric properties of a briefer, more interactive game version of the Child PTSD Symptom Scale for DSM-5 (CPSS-5). Participants (n = 49) were children attending primary care appointments between 8 to 12 years of age who were exposed to a DSM-5 Criterion A trauma. Participants completed the 6-item screening version of the CPSS-5 delivered in mobile tablet game format (the CPSS-5 Screen Team Game) and a self-report version of the full CPSS-5 (CPSS-5-SR) before their medical appointments. The mobile game showed adequate internal consistency (α = 0.79), was significantly positively correlated to the total CPSS-5-SR (r = .74, p < .001, n = 49), and with the total of the six identical items of the CPSS-5-SR (r = .79, p < .001, n = 49), demonstrating good convergent validity. Receiver operating characteristic (ROC) analyses revealed a cut-off score of 9 on the screening game as indicative of probable PTSD. Implementation of this screening game into primary care settings could be a low-burden method to greatly increase the detection of pediatric PTSD for referral to appropriate integrated care interventions.

A large-scale structural and functional connectome of social mentalizing.

Humans have a remarkable ability to infer the mind of others. This mentalizing skill relies on a distributed network of brain regions but how these regions connect and interact is not well understood. Here we leveraged large-scale multimodal neuroimaging data to elucidate the brain-wide organization and mechanisms of mentalizing processing. Key connectomic features of the mentalizing network (MTN) have been delineated in exquisite detail. We found the structural architecture of MTN is organized by two parallel subsystems and constructed redundantly by local and long-range white matter fibers. We uncovered an intrinsic functional architecture that is synchronized according to the degree of mentalizing, and its hierarchy reflects the inherent information integration order. We also examined the correspondence between the structural and functional connectivity in the network and revealed their differences in network topology, individual variance, spatial specificity, and functional specificity. Finally, we scrutinized the connectome resemblance between the default mode network and MTN and elaborated their inherent differences in dynamic patterns, laterality, and homogeneity. Overall, our study demonstrates that mentalizing processing unfolds across functionally heterogeneous regions with highly structured fiber tracts and unique hierarchical functional architecture, which make it distinguishable from the default mode network and other vicinity brain networks supporting autobiographical memory, semantic memory, self-referential, moral reasoning, and mental time travel.

Written exposure therapy and app-delivered mindfulness-based meditation for PTSD and subthreshold PTSD in China: Design of a randomized controlled trial.

BACKGROUND: Posttraumatic stress disorder (PTSD) and subthreshold PTSD are still major global concerns, especially in developing areas short of mental health resources. Written exposure therapy (WET), a brief 5-session treatment, has been found to be effective in reducing PTSD symptoms, but no studies have examined it in an Eastern context. Mindfulness-based meditation mobile application may be a promising approach to reduce insomnia comorbid with PTSD. The current study aims to: 1) examine the effectiveness of WET for Chinese PTSD and subthreshold PTSD patients, and 2) examine the effectiveness of adding a mindfulness-based application (MBA) to WET for reducing comorbid insomnia. METHODS: The randomized controlled trial will enroll 150 adults with subthreshold/full PTSD and comorbid insomnia. Participants will be randomly assigned to written exposure therapy plus mindfulness-based application condition (WET + MBA, n = 50), written exposure therapy alone (WET, n = 50), or minimal contact control (MMC, n = 50). Clinical interview of the primary outcome (PTSD symptoms) will be administrated at baseline, posttreatment, 3- and 6- month follow-up, while self-reported PTSD symptoms and secondary outcomes (insomnia severity) will be administrated at baseline, every week and all follow-ups. DISCUSSION: This is the first study applying WET in Chinese PTSD patients, as well as examining a mindfulness-based mobile application as a treatment add-on for comorbid insomnia. Study findings will contribute to the knowledge of the effectiveness of WET and a mindfulness-based mobile application, and the development of a culture-adapted treatment protocol. TRIAL REGISTRATION: ChiCTR, ChiCTR2000034119. Registered 24 June 2020, http://www.chictr.org.cn/showproj.aspx?proj=55,467.

Primary care provider evaluation and management of insomnia.

STUDY OBJECTIVES: To evaluate the type and extent of information collected from patients with insomnia during their first office encounter for insomnia and the prescribing therapies of primary care providers during this initial encounter. METHODS: This study was a retrospective chart review of randomly selected patients who had a primary care provider office visit at any clinic affiliated with a university medical system between March 1, 2013, and March 1, 2016. Demographic and clinical information was abstracted for analysis. RESULTS: Our sample (n = 200) was primarily female (63.5%), White (69%), middle-aged (ages 44.6 ± 15.1 years) adults. Most (68.5%) encounter notes did not have significant information related to insomnia risk factors and symptoms (< 50% of the notes). When examining comorbidities, we found that younger patients (<45 years old) were more likely to have anxiety linked to insomnia (P = .025), whereas older patients (≥45) were less likely to have any identified comorbidities associated with insomnia (P = .009). Only 5.0% of patients with insomnia were referred for cognitive-behavioral therapy for insomnia, whereas 51.5% of patients were prescribed sleep medications. The younger cohort was statistically more likely to receive sleep hygiene or cognitive-behavioral therapy for insomnia as a treatment option in comparison to the older cohort (P = .01 and P = .04, respectively). CONCLUSIONS: Progress notes from primary care providers tend to have a paucity of information on insomnia symptoms and related comorbidities. Medications are often prescribed as the first-line treatment for insomnia. Cognitive-behavioral therapy for insomnia remains underutilized despite robust evidence suggesting that cognitive-behavioral therapy for insomnia is a safe and effective treatment for insomnia.

The effects of a prolonged exposure workshop with and without consultation on provider and patient outcomes: a randomized implementation trial.

BACKGROUND: Prolonged exposure therapy (PE) is an evidence-based treatment for posttraumatic stress disorder (PTSD) that is underutilized in the military health system. Standard workshop training in PE may not be sufficient to alter provider behavior, but post-workshop consultation requires significant resources. Therefore, it is important to determine the incremental utility of post-workshop consultation. METHODS: This study used a hybrid type III randomized implementation trial at 3 US Army installations. Providers were randomized to receive a 4-day prolonged exposure workshop (Standard training condition, n = 60), or the prolonged exposure workshop followed by 6-8 months of post-workshop expert case consultation (Extended training condition, n = 43). The effects training condition were examined on provider attitudes (self-efficacy in delivering PE, expectations for patient improvement, and beliefs about PE), use of PE and PE components, and clinical outcomes of patients with PTSD (using the Clinician-Administered PTSD Scale (CAPS-5)). RESULTS: Extended condition providers reported greater improvements in self-efficacy, b = .83, 95% CI [.38, 1.27], t(79) = 3.71, p = .001, and d = .63. A greater proportion of patients in the Extended condition (44%) than in the Standard condition (27%) received at least 1 PE session, b = .76, t(233) = 2.53, p = .012, and OR = 2.13. Extended condition providers used more PE components (M = .9/session) than did Standard condition providers (M = .5/session), b = .54, 95% CI [.15, .93], t(68) = 2.70, p = .007, and d = .68. Finally, decrease in patients' PTSD symptoms was faster for patients of Extended condition providers than for patients of Standard condition providers, b = - 1.81, 95% CI [- 3.57, - .04], t(263) = - 2.02, p = .045, and d = .66, and their symptoms were lower at the second assessment, b = - 5.47, 95% CI [- 9.30, - 1.63], t(210) = - 2.81, p = .005, and d = .66. CONCLUSIONS: Post-workshop consultation improved self-efficacy for delivering PE, greater use of PE, faster PTSD reduction, and lower PTSD severity at the second assessment. To our knowledge, this is the first demonstration that post-workshop case consultation for PE improves patient outcomes. TRIAL REGISTRATION: Clinicaltrials.gov , NCT02982538 . Registered December 5, 2016; retrospectively registered.

Trauma-related cognitions predict treatment response in smokers with PTSD: Evidence from cross-lagged panel analyses.

OBJECTIVE: Compared to smokers without posttraumatic stress disorders (PTSD), smokers with PTSD smoke more heavily and are less successful in quitting smoking. However, limited research has examined the cognitive pathways underlying this heightened comorbidity. The current study is the first to simultaneously model the cross-sectional and lagged relationships between trauma-related cognitions and cigarette smoking, as well as between trauma-related cognitions and PTSD severity, in smokers with comorbid PTSD receiving treatment. METHOD: Participants (n = 142) were seeking treatment for smoking cessation and PTSD as part of a randomized controlled trial of varenicline and smoking cessation counseling with or without adjunctive Prolonged Exposure (varenicline + PE vs. varenicline only) (Foa et al., 2017). Data were available for both baseline and end-of-treatment assessments of trauma cognitions severity of cigarette smoking and PTSD symptoms. We conducted both cross-sectional and lagged analysis to simultaneously examine the bidirectional relationship from trauma cognitions and 1) cigarette smoking and 2) PTSD symptoms. RESULTS: Trauma cognitions (specifically, negative beliefs about the self and the world) were significantly associated with cigarette/day at the end of treatment for participants who received varenicline only. However, baseline trauma cognitions did not predict post-treatment cigarettes/day. Baseline trauma cognitions (specifically negative beliefs about the self and world) were associated with PTSD severity at both baseline and end of treatment; furthermore, these negative cognitions at baseline positively and prospectively predicted end-of-treatment PTSD severity, but not vice versa. Wald tests revealed that there were no treatment effects on these cross-lagged relationships. Conclusions These findings provide novel empirical support for the importance of addressing trauma-related cognitions in the smoking cessation treatment efforts for patients with comorbid PTSD and cigarette smoking.

Anxiety sensitivity and emotion regulation as mechanisms of successful CBT outcome for anxiety-related disorders in a naturalistic treatment setting.

BACKGROUND: Numerous randomized controlled trials (RCTs) have examined the efficacy of cognitive behavioral therapy (CBT) in reducing anxiety symptoms. However, relatively fewer studies have examined the effectiveness of CBT in naturalistic treatment settings. There is even less known about the mechanisms underlying successful outcomes in naturalistic samples receiving CBT. This study aimed to examine the absolute and relative mediation of emotion regulation (ER) difficulties and anxiety sensitivity (AS) on anxiety symptom reduction. METHODS: Participants were treatment-seeking patients (N = 247) at an outpatient anxiety clinic. Measures of difficulties in ER, AS, and disorder specific symptoms were administered at baseline, mid, and post-treatment. A composite anxiety score was calculated to measure anxiety disorder symptom severity across anxiety-related diagnoses. RESULTS: Individual mediation models revealed that both AS and ER significantly mediated the reduction in anxiety-related symptoms over the course of treatment. A multiple mediation model found that ER was the strongest mediator (indirect effect = -1.030, 95% CI = -2.172 to -0.153). Further analyses revealed that the ER subscale of impulse control difficulties (e.g., the tendency to avoid when confronted with a feared stimulus) was the strongest mediator (indirect effect = -0.849, 95% CI = -1.913 to -0.081). LIMITATIONS: This study relied solely on self-report measures of ER, AS, and anxiety pathology, and did not have a control group. CONCLUSIONS: These results suggest that improvement in the ability to control impulses may act as a mechanism of anxiety symptom reduction and may be important to target in CBT with naturalistic samples.

Effect of Weight Loss on Upper Airway Anatomy and the Apnea-Hypopnea Index. The Importance of Tongue Fat.

Rationale: Obesity is the primary risk factor for obstructive sleep apnea (OSA). Tongue fat is increased in obese persons with OSA, and may explain the relationship between obesity and OSA. Weight loss improves OSA, but the mechanism is unknown.Objectives: To determine the effect of weight loss on upper airway anatomy in subjects with obesity and OSA. We hypothesized that weight loss would decrease soft tissue volumes and tongue fat, and that these changes would correlate with reductions in apnea-hypopnea index (AHI).Methods: A total of 67 individuals with obesity and OSA (AHI ≥ 10 events/h) underwent a sleep study and upper airway and abdominal magnetic resonance imaging before and after a weight loss intervention (intensive lifestyle modification or bariatric surgery). Airway sizes and soft tissue, tongue fat, and abdominal fat volumes were quantified. Associations between weight loss and changes in these structures, and relationships to AHI changes, were examined.Measurements and Main Results: Weight loss was significantly associated with reductions in tongue fat and pterygoid and total lateral wall volumes. Reductions in tongue fat were strongly correlated with reductions in AHI (Pearson's rho = 0.62, P < 0.0001); results remained after controlling for weight loss (Pearson's rho = 0.36, P = 0.014). Reduction in tongue fat volume was the primary upper airway mediator of the relationship between weight loss and AHI improvement.Conclusions: Weight loss reduced volumes of several upper airway soft tissues in subjects with obesity and OSA. Improved AHI with weight loss was mediated by reductions in tongue fat. New treatments that reduce tongue fat should be considered for patients with OSA.

Multimodal mapping of the face connectome.

Face processing supports our ability to recognize friend from foe, form tribes and understand the emotional implications of changes in facial musculature. This skill relies on a distributed network of brain regions, but how these regions interact is poorly understood. Here we integrate anatomical and functional connectivity measurements with behavioural assays to create a global model of the face connectome. We dissect key features, such as the network topology and fibre composition. We propose a neurocognitive model with three core streams; face processing along these streams occurs in a parallel and reciprocal manner. Although long-range fibre paths are important, the face network is dominated by short-range fibres. Finally, we provide evidence that the well-known right lateralization of face processing arises from imbalanced intra- and interhemispheric connections. In summary, the face network relies on dynamic communication across highly structured fibre tracts, enabling coherent face processing that underpins behaviour and cognition.

Trauma-Related Cognitions and Cognitive Emotion Regulation as Mediators of PTSD Change Among Treatment-Seeking Active-Duty Military Personnel With PTSD.

Trauma-related cognitions about the self and the world have been identified as a mediator of posttraumatic stress disorder (PTSD) change during prolonged exposure (PE) therapy. However, the extent to which negative cognitions mediate PTSD change in other PTSD treatments is unclear. In addition, previous studies have not tested alternate mediators of PTSD change during PE. In a sample of 216 treatment-seeking active-duty military personnel with PTSD, the present study examined the specificity of the negative cognition mediation effect in both PE and present-centered therapy (PCT). In addition, we examined another possible mediator, cognitive emotion regulation. Lagged mediational analyses indicated that negative cognitions about the self and world and the unhelpful cognitive emotion regulation strategy of catastrophizing each significantly mediated change in PTSD from baseline to 6-month follow-up. In a combined model, the mediating effect of catastrophizing was greater than negative cognitions about the world, and similar to negative cognitions about the self. Moderated mediation analyses revealed that the effect of catastrophizing was greater in PE than in PCT. Findings show that trauma-related cognitions and, to a greater degree, the emotion regulation strategy catastrophizing, both mediate PTSD change. Further research is needed to determine whether these mediating variables represent mechanisms of therapeutic change.

Predictors for Excellent Versus Partial Response to Prolonged Exposure Therapy: Who Needs Additional Sessions?

In practice, the duration of psychotherapy is determined by the patient's response to treatment. Identifying predictors for treatment responses is of great clinical utility to guide clinicians in their treatment planning. Demographic characteristics, trauma history, comorbidity, and early reduction of posttraumatic stress disorder (PTSD) symptoms were examined as predictors of excellent versus partial response to prolonged exposure therapy (PE) for PTSD. Participants were 96 female assault survivors with chronic PTSD who received at least eight PE sessions with or without cognitive restructuring. Participants were classified as excellent responders (n = 27) or partial responders (n = 69) based on whether they achieved at least 70% improvement in self-reported PTSD severity on the PTSD Symptom Scale-Self-Report at the end of Session 8. Excellent responders terminated therapy after Session 9, and partial responders were offered up to three additional sessions. Logistic regression was conducted to investigate predictors of response to PE. Results showed that prior interpersonal violence and comorbid alcohol use disorder were associated with partial response. Comorbid depressive disorder and early PTSD symptom reduction were associated with excellent response. Being treated by a cognitive behavioral therapy expert predicted higher excellent response for patients with a history of prior interpersonal violence. The model accounted for 56.6% of the variance in treatment response and correctly predicted responder status for 83.3% of the sample. These findings contribute to the field's understanding of factors that predict or moderate response to PE and have implications for treatment planning.

Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Predictores de Respuesta Excelente Versus Parcial a la Terapia De Exposición Prolongada: ¿Quién Necesita Más Sesiones? RESPUESTA A LA EXPOSICIÓN PROLONGADA POR TEPT En la práctica, la duración de la psicoterapia está determinada por la respuesta del paciente al tratamiento. La identificación de predictores para las respuestas al tratamiento es de gran utilidad clínica para guiar a los clínicos en su planificación de tratamiento. Características demográficas, historia de trauma, comorbilidad y una reducción temprana de los síntomas del trastorno de estrés postraumático (TEPT) fueron examinados como predictores de respuesta excelente versus respuesta parcial a la terapia de exposición prolongada (EP) para el TEPT. Las participantes fueron 96 mujeres sobrevivientes de asalto con TEPT crónico que recibieron al menos ocho sesiones de EP con o sin reestructuración cognitiva. Las participantes fueron clasificadas como respondedores excelentes (n = 27) o respondedores parciales (n = 69) en función de si lograron al menos un 70% de mejoría en el autoinforme de severidad del TEPT en la Escala de Síntomas Auto-reportados de TEPT al final de la sesión 8. Los respondedores excelentes terminaron la terapia después de la sesión 9, y se ofreció tres sesiones adicionales a los respondedores parciales. Se realizó una regresión logística para investigar los predictores de respuesta a la EP. Los resultados mostraron violencia interpersonal previa y comorbilidad de trastorno por consumo de alcohol asociados con respuesta parcial. Comorbilidad de trastorno depresivo y reducción temprana del síntoma de TEPT se asoció con una excelente respuesta. Ser tratado por un experto en terapia de comportamiento cognitivo (TCC) predijo una respuesta excelente superior para los pacientes con antecedentes de violencia interpersonal. El modelo dio cuenta del 56.6% de la varianza en la respuesta al tratamiento y predijo correctamente el estado del respondedor para el 83.3% de la muestra. Estos hallazgos contribuyen a la esfera de comprensión de los factores que predicen o moderan la respuesta a la EP y tienen implicaciones para planificación del tratamiento.

Guilt in the Treatment of Posttraumatic Stress Disorder Among Active Duty Military Personnel.

The current study examined the role of trauma-related guilt on posttraumatic stress disorder (PTSD) symptom change during prolonged exposure therapy (PE) as well as the efficacy of PE in reducing three dimensions of guilt (responsibility, wrongdoing, and lack of justification) during treatment. Participants were 331 active duty U.S. military personnel seeking treatment for PTSD who were randomized to one of four groups: massed PE (10 sessions delivered over 2 weeks), spaced PE (10 sessions delivered over 8 weeks), present-centered therapy (PCT; 10 sessions delivered over 8 weeks), or minimal contact control (MCC; weekly therapist phone check-in for 4 weeks). The results showed that baseline guilt did not predict reductions in PTSD symptoms for spaced PE or for PCT, ps = .178-.387, ds = -0.02-0.07. Treatment condition (massed PE vs. MCC; spaced PE vs. PCT) did not moderate reductions in guilt for spaced PE versus PCT. Guilt decreased significantly over treatment in all groups, p < .001 to p = .038, ds = -0.19 to -0.42, except concerning justification in the spaced PE and PCT groups, p = .140, d = -0.10. The findings suggest that guilt may be reduced significantly following active PTSD treatment and attention control and that PTSD recovery is not impacted by baseline levels of trauma-related guilt in military personnel with PTSD, although reported levels of guilt were low to moderate in this sample.

Mediation of suicide ideation in prolonged exposure therapy for posttraumatic stress disorder.

BACKGROUND: Evidence-based treatments for posttraumatic stress disorder (PTSD) are associated with reduction in suicidal ideation (SI), yet the mechanisms underlying this reduction are unclear. The current study investigated improvements in PTSD, depression, and social support as potential mediators of the change in SI over time. METHOD: Participants (N = 200) were active duty military personnel with PTSD randomized to prolonged exposure therapy (PE) or present-centered therapy (PCT). Using parallel mediation and serial mediation models, we examined the relative influence of the mediators on suicidal ideation over time. RESULTS: Consistent with our hypotheses, lagged mediation analyses revealed that depression was the strongest mediator of improvements in SI over time in PE and PCT. Reductions in PTSD were associated with subsequent reductions in depression, which was associated with reductions in SI. Treatment condition did not moderate this relationship, and social support was not a significant mediator. CONCLUSIONS: In active duty military personnel, reduction in depression was the strongest mediator of reduction in suicidal ideation in PE and PCT for PTSD. These results were not altered by treatment condition. TRIAL REGISTRATION: Clinicaltrials. gov identifier: NCT01049516. http://www.clinicaltrials.gov/show/NCT01049516.

Does prolonged exposure increase suicide risk? Results from an active duty military sample.

The efficacy of prolonged exposure (PE) on suicide ideation (SI) as a secondary outcome among individuals with posttraumatic stress disorder (PTSD) is unclear. The purpose of this study was to compare the efficacy of PE in two formats (spaced, S-PE, 10 sessions over 8 weeks, and massed, M-PE, 10 sessions over 2 weeks) to Present Centered Therapy (PCT) and minimal contact control (MCC) on SI exacerbation among patients without suicide intent or plans. Active duty military personnel (n = 335) were randomized to: (1) S-PE vs. PCT and (2) M-PE vs. MCC. All participants completed the Beck Scale for Suicide Ideation and the Beck Depression Inventory (Suicide item) at baseline, posttreatment, and follow-ups. S-PE and PCT had significant and comparable reductions in SI during treatment. M-PE had significantly steeper reductions in SI during treatment compared to MCC. Specifically, more participants in M-PE compared to MCC had reliable improvement versus reliable exacerbation. Reduction in PTSD symptoms was significantly associated with reduction of SI. PE was associated with significant reductions in SI over time that were comparable to PCT and superior to MCC. These findings suggest that both trauma- and non-trauma-focused treatments are associated with reductions in SI, and that trauma-focused treatments improve SI relative to waitlist.

Changes in Gray Matter Density, Regional Homogeneity, and Functional Connectivity in Methamphetamine-Associated Psychosis: A Resting-State Functional Magnetic Resonance Imaging (fMRI) Study.

BACKGROUND Using regional homogeneity (ReHo) blood oxygen level-dependent functional MR (BOLD-fMRI), we investigated the structural and functional alterations of brain regions among patients with methamphetamine-associated psychosis (MAP). MATERIAL AND METHODS This retrospective study included 17 MAP patients, 16 schizophrenia (SCZ) patients, and 18 healthy controls. Informed consent was obtained from all patients before the clinical assessment, the severity of clinical symptoms was evaluated prior to the fMRI scanning, and then images were acquired and preprocessed after each participant received 6-min fRMI scanning. The participants all underwent BOLD-fMRI scanning. Voxel-based morphometry was used to measure gray matter density (GMD). Resting-state fMRI (rs-fMRI) was conducted to analyze functional MR, ReHo, and functional connectivity (FC). RESULTS GMD analysis results suggest that MAP patients, SCZ patients, and healthy volunteers show different GMDs within different brain regions. Similarly, the ReHo analysis results suggest that MAP patients, SCZ patients, and healthy volunteers have different GMDs within different brain regions. Negative correlations were found between ReHo- and the PANSS-positive scores within the left orbital interior frontal gyrus (L-orb-IFG) of MAP patients. ReHo- and PANSS-negative scores of R-SFG were negatively correlated among SCZ patients. The abnormal FC of R-MFG showed a negative correlation with the PANSS score among MAP patients. CONCLUSIONS The abnormalities in brain structure and FC were associated with the development of MAP.