Comparing effectiveness of residential versus intensive virtual treatment for veterans with posttraumatic stress disorder.

OBJECTIVE: During the COVID-19 pandemic, restrictions imposed on residential treatment programs necessitated rapid implementation of virtual treatment delivery. Posttraumatic stress disorder (PTSD) Residential Rehabilitation Treatment Programs (P-RRTP) are a key mental health treatment for Veterans with PTSD who require more intensive interventions than outpatient care. During the pandemic, the W. G. (Bill) Hefner VA Healthcare System developed and implemented a Virtual Intensive Outpatient Program for PTSD (VIOPP) to meet the needs of the Veteran population. The purpose of this analysis was to compare the effectiveness of VIOPP to P-RRTP. METHOD: Analyses included N = 370 Veterans, n = 193 who completed P-RRTP between January 2018 to April 2020 and n = 177 who completed VIOPP between June 2020 and November 2022 and provided pre- and posttreatment scores. Pre- and posttreatment scores of the PTSD Checklist for DSM-5 (PCL-5) were available for all patients. Pre- and posttreatment depressive symptom scores from the Nine-item Patient Health Questionnaire (PHQ-9) were available for n = 254 Veterans. Paired and independent samples t tests evaluated differences in change scores overall and by treatment modality (residential vs. virtual). RESULTS: Results indicated a significant decrease in PCL-5 scores regardless of treatment modality, p < .001. Despite beginning VIOPP with significantly higher PCL-5 scores than P-RRTP, there were no significant differences in PCL-5 change scores between virtual (M = -16.94) and residential treatment (M = -17.10), p = .910. PHQ-9 scores also decreased significantly for both treatment groups. CONCLUSION: These analyses suggest that intensive virtual treatment has similar effectiveness to residential treatment for PTSD. This supports the development of intensive virtual interventions as viable alternatives to residential treatments and a valuable component within the continuum of PTSD care. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Self-discrepancy: Long-term test-retest reliability and test-criterion predictive validity.

Long-term test-retest reliability and predictive test-criterion evidence of validity of scores on measures of the real-ideal self-discrepancy and of the real-ought self-discrepancy were tested over periods of 1 year and 3 years. A sample of 184 undergraduates completed at 2 time points 1 year apart 3 instruments that each measure the 2 self-discrepancies: the idiographic Self-Concept Questionnaire-Personal Constructs, the nonidiographic Self-Concept Questionnaire-Conventional Constructs, and the content-free Abstract Measures. A separate sample of 141 undergraduates completed the instruments 3 years apart. Both samples completed 3 depression instruments and 3 anxiety instruments at the second time point. Results of analyses using latent variables modeled with 3 observed variables showed substantial statistically significant test-retest reliabilities and significant test-criterion prediction of anxiety and depression on the real-ideal and real-ought discrepancy measures over both time periods. Results for the observed variables showed significant 1-year and 3-year reliabilities for scores on all self-discrepancy measures, as well as significant 1-year and 3-year predictive validity for scores on all self-discrepancy measures, except the abstract measure of real-ought discrepancy in predicting scores on all depression measures and on at least 1 anxiety measure. The findings support very strong long-term stabilities of the self-discrepancy personality constructs and their long-term associations with anxiety and depression.

Examining the factor structure of the Connor-Davidson Resilience Scale (CD-RISC) in a post-9/11 U.S. military veteran sample.

The present study examined the structural validity of the 25-item Connor-Davidson Resilience Scale (CD-RISC) in a large sample of U.S. veterans with military service since September 11, 2001. Participants (N = 1,981) completed the 25-item CD-RISC, a structured clinical interview and a self-report questionnaire assessing psychiatric symptoms. The study sample was randomly divided into two subsamples: an initial sample (Sample 1: n = 990) and a replication sample (Sample 2: n = 991). Findings derived from exploratory factor analysis (EFA) did not support the five-factor analytic structure as initially suggested in Connor and Davidson's instrument validation study. Although parallel analyses indicated a two-factor structural model, we tested one to six factor solutions for best model fit using confirmatory factor analysis. Results supported a two-factor model of resilience, composed of adaptability- (8 items) and self-efficacy-themed (6 items) items; however, only the adaptability-themed factor was found to be consistent with our view of resilience-a factor of protection against the development of psychopathology following trauma exposure. The adaptability-themed factor may be a useful measure of resilience for post-9/11 U.S. military veterans.

Change in self-discrepancy, anxiety, and depression in individual therapy.

This study tested hypotheses of change in the real-ideal (RI) and real-ought (RO) self-discrepancies over the course of therapy, based on Rogers's (1959) theory of personality change in therapy. Before and after therapy with 20 therapists of diverse theoretical orientations at a university counseling center, 99 undergraduate and graduate students completed three instruments that measure both self-discrepancies: the Self-Concept Questionnaire--Personal Constructs, the Self-Concept Questionnaire--Conventional Constructs, and the Abstract Measures. Participants also completed the Beck Depression Inventory-II, State-Trait Anxiety Inventory Trait scale, and the Symptom Checklist-90-R Anxiety and Depression scales. Therapy outcome showed substantial decreases on all measures. Changes in the RI and RO self-discrepancies were associated with changes in anxiety and depression. Change in the RI self-discrepancy was associated with change in the RO self-discrepancy. Decreases in self-discrepancy comprised increases in real self and decreases in ideal self and ought self. Findings were independent of therapist theoretical orientation. The findings support the use of the self-discrepancy instruments in future research on therapy process and outcome. The findings also provide a basis for incorporating the self-discrepancy constructs into theory and research on mechanisms of therapeutic change.

Self-discrepancy: comparisons of the psychometric properties of three instruments.

In 2 studies, the psychometric properties of 3 methods for measuring real-ideal and real-ought self-discrepancies were compared: the idiographic Self-Concept Questionnaire-Personal Constructs, the nonidiographic Self-Concept Questionnaire-Conventional Constructs, and the content-free Abstract Measures. In the 1st study, 125 students at a university clinic completed the 3 instruments and measures of anxiety and depression before individual therapy. In the 2nd study, 278 undergraduates completed the 3 instruments at 2 time points 4 weeks apart and completed multiple measures of anxiety and depression at the 2nd time point. Internal consistency alphas were consistently strong for the personal construct measures (.90 to .92) and moderate to strong for the conventional construct measures (.82 to .90). Test-retest reliability coefficients were above .70 for the personal construct and conventional construct measures, but the coefficients for the latter were inflated by the stability of their error terms. The 2 discrepancies were found to be factorially distinct even though they were highly correlated. Convergent and discriminant evidence of validity was found in both studies for all measures except the abstract real-ought discrepancy. Convergence was as strong or stronger for the personal construct measures in comparison to the other measures. Test-criterion evidence of validity, with multiple measures of anxiety and depression as criteria, was found in both studies for all measures except for the abstract real-ought discrepancy in relation to anxiety. Overall, the findings support the idiographic personal construct instrument most strongly for clinical assessment and for clinical, translational, and personality research.