Social functioning mediates the relationship between psychiatric symptoms and recovery among veteran and community service users with serious mental illness.

OBJECTIVE: Previous research has established the impact of psychiatric symptoms on social functioning, while there is a paucity of research examining how social functioning relates to personal recovery, an individual's self-assessment of their mental health recovery. This study examined the mediating effect of social engagement, interpersonal communication, and satisfaction with support in the relationship between distinct psychiatric symptom clusters and perceived mental health recovery. METHODS: In a cross-sectional study, both patient self-report and provider assessment data were collected for 250 patients with serious mental illness (SMI) across four mental health service sites. Parallel mediation analytic models were used. RESULTS: Interpersonal communication partially mediated the relationship between positive and negative symptom clusters and personal recovery. Satisfaction with social supports partially mediated the relationship between excited symptoms and personal recovery. Both interpersonal communication and satisfaction with social supports partially mediated the relationship between general psychological distress and depressive symptoms and personal recovery. Collectively, social functioning mediators explained nearly half of the relationship between general psychological distress and excited symptoms and personal recovery and nearly all of the relationship between positive symptoms and personal recovery. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Clinical providers working with persons with SMI should regularly assess social functioning in addition to assessing psychiatric symptoms and personal recovery factors and should incorporate social skills education into SMI group and individual treatments. Social functioning as a target of treatment may be especially beneficial for patients who are dissatisfied with other interventions or feel they have experienced the maximum benefit from treatment and are seeking additional methods to support personal recovery. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Self-Stigma and PTSD: Conceptualization and Implications for Research and Treatment.

Preliminary empirical evidence suggests that self-stigma may be a significant problem for those with posttraumatic stress disorder (PTSD). Although research on self-stigma for persons with PTSD is limited, some PTSD symptoms, such as negative thoughts about oneself, feelings of shame, and avoidance-particularly of social interactions-may be conceptually related to self-stigma, potentially explaining the co-occurrence and relevance of self-stigma in PTSD. This Open Forum reviews how the social cognitive model may explain the co-occurrence of self-stigma and PTSD, considers how this model may inform treatment approaches for self-stigma in PTSD, and identifies next steps to empirically test the proposed theory.

Blocking the orexin system following therapeutic exposure promoted between session habituation, but not PTSD symptom reduction.

There is a need to identify strategies to increase the effectiveness of treatments for posttraumatic stress disorder (PTSD). Sleep is often disturbed in PTSD and has been implicated in learning processes that underlie recovery from PTSD, including extinction of conditioned fear. Our prior study suggested that diminished arousal during sleep may enhance benefits of therapeutic exposure for PTSD. The orexin system regulates arousal, and blocking the system diminishes arousal and promotes sleep. We, therefore, examined whether a dual orexin receptor antagonist, suvorexant, administered following evening exposure sessions, would enhance their therapeutic effectiveness for PTSD. In this randomized double-blind placebo-controlled trial, adults with PTSD completed four written narrative exposure (WNE) sessions, two of which took place in the evening, and two the next morning. Participants received either suvorexant or placebo after each evening WNE. We found that suvorexant increased N3 sleep and decreased N2 sleep and rapid-eye-movement latency measured by polysomnography. Between session habituation indexed by subjective distress ratings was greater with suvorexant, but there was no group difference in the reduction of PTSD severity from baseline to 1-week follow-up. No safety concerns emerged. The present findings provide preliminary support for enhancement of an effect of therapeutic exposure for PTSD by suvorexant. Further studies with larger samples are needed to translate the present findings into clinical applications, including studies to develop optimal suvorexant administration and exposure session schedules to achieve persistent benefits to sleep and possibly greater treatment augmentation.

Impact of Traumatic Stress on Sleep and Management Options in Women.

After exposure to traumatic stress, women are at greater risk than men for developing symptoms of some psychiatric disorders, including insomnia and nightmares. Sleep disturbance is one of the most refractory symptoms of posttraumatic stress disorder. Women were included in a few studies that examined efficacy of psychological or pharmacologic interventions for trauma-related sleep disturbances. Studies demonstrated preliminary evidence for efficacy of cognitive behavioral therapy for insomnia, imagery rehearsal therapy, and combinations of these techniques in treating insomnia and nightmares in trauma-exposed women. Prazosin as an adjunct to ongoing treatment is a potentially efficacious strategy for treating trauma-related nightmares in women.

Sleep and Processing of Trauma Memories.

Sleep has been implicated in learning processes that appear to underlie recovery from posttraumatic stress disorder (PTSD). The importance of quality and timing of sleep following exposure-based therapies has been suggested. The present study evaluated relationships between sleep and adaptive emotional processing following written narrative exposure (WNE) to memories of traumatic events experienced by participants with clinically significant PTSD symptoms. Participants included 21 urban-residing nontreatment-seeking adults with full or subthreshold symptoms of PTSD who completed 4 sessions of 30-min WNE with the first session either in the evening or the morning. There was a significant reduction of PTSD symptom severity after WNE sessions (partial η = .65), but there was no interaction between group assignment based on the initial session's proximity to sleep and initial reduction of PTSD symptom severity (partial η = .01). Polysomnography following evening WNE revealed increased duration of total sleep and N2%, reduced N3%, and increased eye movement density during REM sleep compared with baseline recordings (dz = 0.65 to 1.15). Reduced N3% and increased REM density were associated with less improvement of PTSD symptoms (r = .58 & -.63). These findings suggest a relationship between preservation of diminished arousal during sleep and adaptive trauma memory processing.