Beyond stigma: Understanding the "inclined abstainers" in military behavioral health-care utilization.

Low treatment utilization in Soldiers with combat-related Posttraumatic Stress Disorder (PTSD) is an ongoing issue. The critical concern is to better understand factors which prohibit a Soldier with PTSD who wants help from seeking treatment (an "inclined abstainer"). A total of 537 Active Duty Soldiers on a US Army post completed a brief survey comprising psychometrically validated measures of stigma, behavioral health treatment beliefs, resilience, PTSD symptoms, and treatment intentions. Health-care records were prospectively tracked for 12 months to determine the relation between survey answers and treatment utilization. Sixty-three percent of those who acknowledged having a mental health-related problem did not seek help within a one-year period. Greater severity of PTSD symptoms was associated with an increased likelihood of behavioral health engagement. Soldiers that were classified as "inclined abstainers" were also more likely to endorse negative beliefs about psychotherapy and report higher levels of resilience as compared to "inclined actors." These results suggest that a treatment model of PTSD emphasizing self-efficacy and self-reliance, while addressing negative beliefs about psychotherapy, may help promote engagement of behavioral health services among Active Duty Soldiers.

Differences in hippocampal serotonergic activity in a mouse single prolonged stress paradigm impact discriminant fear acquisition and retention.

A mouse model of traumatic stress provided insight into a mechanism of individual differences in conditioned fear responding. Hippocampal serotonergic activity (metabolic turnover) was associated with increased behavioral freezing during fear acquisition in a portion of trauma-exposed subjects. These subjects later displayed enhanced fear to the neutral cue during retention. An inability to discriminate fear responses may underlie dysfunctional fear memories in a sub-population of individuals with Posttraumatic Stress Disorder, with contributions from the hippocampal serotonin system.

Emotion-related regulatory difficulties contribute to negative psychological outcomes in active-duty Iraq war soldiers with and without posttraumatic stress disorder.

Data suggest military personnel involved in U.S. military initiatives in Iraq and Afghanistan are returning from deployment with elevated rates of mental health diagnoses, including posttraumatic stress disorder (PTSD). The aim of this study was to examine difficulties with emotion regulation as a potential contributory mechanism by which soldiers have poorer psychological outcomes, such as depression, dissociation, alcohol abuse, and interpersonal difficulties. Participants were 44 active-duty male service members who comprised three groups, including those deployed with and without diagnosed PTSD and those prior to deployment. Participants in the PTSD group scored significantly higher on measures of self-reported depression, trauma-related dissociation, alcohol misuse, and social adjustment difficulties than did comparison groups. Importantly, difficulties with emotion regulation were found to partially mediate the relationship between PTSD and depression, poor social adjustment, and trauma-related depersonalization but not alcohol misuse. Emotion-regulation difficulties are important to consider in the relationship between PTSD and additional psychological outcomes in recently deployed personnel. Implications for treatment are briefly discussed.

Differential conditioned fear response predicts duloxetine treatment outcome in male veterans with PTSD: a pilot study.

This pilot study tested whether posttraumatic stress disorder (PTSD) patients with impaired conditioned fear acquisition were refractory to open-label duloxetine treatment. Patients with a differential conditioned fear response at pre-treatment subsequently demonstrated significant reductions in PTSD symptoms. These data provide initial evidence of a putative biomarker of selective treatment response in PTSD.

Decreased respiratory sinus arrhythmia in individuals with deceptive intent.

In detecting deception, the Cognitive Load hypothesis states that lying requires more cognitive resources compared to truth telling. Further, increases in cognitive load are predicted to decrease respiratory sinus arrhythmia (RSA). We evaluated the impact of cognitive tasks and the intent to deceive on RSA in 40 male, native Arabic-speaking participants quasi-randomized into truthful (n=14) or deceptive (n=26) groups. Participants donned an ambulatory physiologic recording device and completed cognitive testing after receiving translated instructions about their role in an impending mock crime. The results show that a decrease in RSA recorded during the cognitive testing was greater in individuals who were about to commit a deceptive act.

Sex-related differences in amygdala activity influences immediate memory.

Despite a well-established relationship between amygdala activation during learning and long-term memory, contributions of amygdala to immediate memory have not been studied to date. We used functional magnetic resonance imaging at 1.5-T field strength to determine whether amygdala responses to emotional pictures would predict performance on an immediate recognition memory test. Sex differences in amygdala activation were related to false-positive error rates in recognizing unpleasant pictures. Specifically, increased right amygdala activation during unpleasant picture viewing was related to lower false-positive rates for men and higher false-positive rates for women. Our results indicate that increased amygdala activation while viewing unpleasant pictures may preferentially facilitate immediate recognition memory in men relative to women.

Thought suppression failures in combat PTSD: a cognitive load hypothesis.

The present study investigated the relation between thought suppression of emotionally neutral content [i.e., Wegner's (1994) "white bear"], incidental traumatic thought intrusion, and skin conductance responses in combat-related Posttraumatic Stress Disorder (PTSD). Participants included service members who either: a) had PTSD following an Operation Iraqi Freedom deployment; b) were free of psychiatric diagnosis following deployment (Combat Equivalent), or c) were pre-deployed and without psychiatric diagnosis (Pre-Deployed). PTSD Service Members reported the greatest intrusion of combat thoughts during the suppression task and demonstrated a post-suppression rebound effect with a neutral thought. Non-specific skin conductance responses indicated that the suppression task was related to similar levels of increased sympathetic activity for both the PTSD and Pre-Deployed groups, whereas the Combat Equivalent group showed no increased activation during thought suppression. Intrusive traumatic thoughts combined with failures in neutral thought suppression may be a consequence of increased cognitive load in PTSD.

Neuroplasticity as a target for the pharmacotherapy of anxiety disorders, mood disorders, and schizophrenia.

Current treatments for psychiatric disorders were developed with the aim of providing symptomatic relief rather than reversing underlying abnormalities in neuroplasticity or neurodevelopment that might contribute to psychiatric disorders. This review considers the possibility that psychiatric treatments might be developed that target neuroplasticity deficits or that manipulate neuroplasticity in novel ways. These treatments might not provide direct symptomatic relief. However, they might complement or enhance current pharmacotherapies and psychotherapies aimed at the prevention and treatment of psychiatric disorders. In considering neuroplasticity as a target for the treatment of psychiatric disorders, we build on exciting new findings in the areas of anxiety disorders, mood disorders, and schizophrenia.

Sleep-based heart period variability in panic disorder with and without nocturnal panic attacks.

In this paper, we investigated ambulatory sleep heart period variability in panic disorder participants with nocturnal panic (NP) compared to daytime panic attacks only. A time-derived measure of heart period variability (HPV) during sleep was significantly reduced in the NP group (n=32) relative to the daytime panic (n=17) and nonanxious (n=17) control groups. Consistent with previous work, NP participants also reported greater fear of relaxation and sleep than daytime panic and control groups. Based on a neurovisceral model of attention [Thayer, J. F., & Lane, R. D. (2000). A model of neurovisceral integration in emotion regulation and dysregulation. Journal of Affective Disorders, 61, 210-216] that predicts that decreased HPV is related to disregulated behavioral adaptation, we hypothesized that HPV measured during sleep would be most reduced in NP participants. These findings indicate that HPV is related to nocturnal panic disorder insofar as it is measured during sleep.

Relation between cardiac vagal tone and performance in male military personnel exposed to high stress: three prospective studies.

Vagal tone has been proposed both as an index of emotion regulation and cognitive ability. To assess the relation between vagal tone and emotion regulation and cognitive ability, the present research prospectively measured vagal tone (measured either as high-frequency spectral power or respiratory sinus arrhythmia) in healthy participants exposed to high stress. The participants were active duty military personnel (men) enrolled in high intensity military training: Survival School (Experiments 1 and 3) and Combat Diver Qualification Course (Experiment 2). We consistently observed a significant relationship between low vagal tone and superior performance. The data suggest that vagal suppression is associated with enhanced performance under conditions of high stress and that this enhanced performance may be related to emotion regulation and cognitive functioning.