Massed cognitive processing therapy for posttraumatic stress disorder in women survivors of intimate partner violence.

OBJECTIVE: Survivors of intimate partner violence (IPV) report significant trauma histories, high rates of posttraumatic stress disorder (PTSD), head injuries and comorbid disorders, and multiple barriers to treatment that often preclude the regular attendance and engagement required in typical therapy protocols. The significant challenges faced by IPV survivors needing treatment may be ameliorated by condensing effective treatments for PTSD, such as cognitive processing therapy (CPT), in an accelerated delivery timeline. METHOD: Using a multiple subject, single case design of six matched pairs of 12 female IPV survivors, we preliminarily tested the relative effectiveness of individual massed CPT delivered over 5 days (mCPT) as compared with standard CPT (sCPT) delivery in women IPV survivors. Assessments included full psychiatric diagnostic interviews, clinical interviews assessing trauma history and head injury prior to treatment, symptom monitoring during treatment, and full repeat assessments at 1 month and 3 months following treatment. RESULTS: No treatment group effect was found for PTSD severity between mCPT and sCPT among intention-to-treat, F(1, 10) = .01, p = .93. Both mCPT and sCPT were associated with significant improvement in PTSD, F(2, 20) = 45.05, p < .001, ds = 1.32-2.38). CONCLUSION: Overall, findings indicate mCPT appears effective in reducing psychological symptoms for women IPV survivors and suggest that condensed treatment is both palatable and feasible. Accelerated treatment delivery in this population may provide a necessary lifeline for women with IPV-related PTSD. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

PTSD and Attitudes Toward Guns Following Interpersonal Trauma.

Gun violence is a serious public health concern that is currently grossly understudied. Gun attitudes are a potential risk factor for gun violence; however, factors related to gun attitudes have not been identified. Mental illness such as posttraumatic stress disorder (PTSD) is commonly discussed as a key factor in gun violence, despite research lacking in this area, and it is unknown whether symptoms of PTSD and probable PTSD are associated with more positive attitudes toward guns. The aim of the current study was to investigate the relations between PTSD symptoms and gun attitudes among 265 undergraduate students who experienced at least one interpersonal traumatic event (Mage = 24.69 years, SD = 7.15 years, 75.6% female, 61.1% White). Path analysis revealed that individuals with PTSD symptoms above clinical cutoff were not more likely to have more positive gun attitudes. However, the PTSD symptom clusters evinced distinct relations with gun attitudes. Intrusion and avoidance symptoms were related to gun beliefs regarding protection, with intrusion symptoms being linked to a stronger belief that guns provide protection from crime and victimization (ß = .23), whereas avoidance symptoms were inversely associated with this belief (ß = -.22). Interestingly, neither trauma related in feelings and thoughts nor arousal and reactivity corresponded with gun attitudes. Certain PTSD symptom clusters may be relevant in understanding gun beliefs, with specific symptoms exhibiting distinct ties to gun attitudes.

Trauma Exposure, Posttraumatic Stress Disorder, and Aggression Among Civilian Females.

Trauma exposure and posttraumatic stress disorder (PTSD) have evinced ties to increased risk for aggressive behavior. However, very little information is known regarding the relations between trauma exposure, PTSD, and aggression among non-veteran women. Furthermore, research has not examined the associations between trauma exposure, PTSD symptoms, and aggression using the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) PTSD criteria. The primary aim of the current study was to investigate the relationships between trauma exposure, PTSD symptoms, and aggression among women. The secondary aim was to examine the specific PTSD symptom clusters in relation to indices of aggression. A total of 217 civilian, trauma-exposed female undergraduate students participated in the study (Mage = 24.30, SD = 6.83, 63.2% White). Higher levels of trauma exposure and PTSD symptoms corresponded with anger (b = .47, 95% CI = [0.11-0.83]; b = .11, 95% CI = [0.05-0.16], respectively) and verbal aggression (b = .50, 95% CI = [0.21-0.78]; b = .06, 95% CI = [0.01-0.10], respectively). PTSD symptoms, but not cumulative trauma exposure, was associated with hostility (b = .23, 95% CI = [0.14-0.59]), whereas physical aggression was only related to trauma exposure (b = .69, 95% CI = [0.31-1.06]). Furthermore, there was a significant indirect effect of cumulative trauma through PTSD symptoms on anger and verbal aggression (b = .15, 95% CI = [0.05-0.32]; b = .09, 95% CI = [0.02-0.20], respectively). Trauma-exposed civilian females with higher levels of PTSD symptoms may be at increased risk for several indices of aggressive behavior. Furthermore, PTSD symptoms may better account for some, but not all, aspects of aggression in trauma-exposed women.

Sexual Assault, Posttraumatic Stress Symptoms, and Indices of Aggression Among Women.

Sexual assault is associated with many adverse outcomes, including a higher risk for developing posttraumatic stress symptoms (PTSS). Although nonsexual trauma exposure has been linked to aggression, the associations between sexual assault and aggression are understudied. Further, the DSM-5 conceptualization of posttraumatic stress disorder (PTSD) includes a symptom related to aggression, and associations between symptom clusters and aggression with regard to the new criteria are underexplored. The present study aimed to (a) examine the relations between sexual assault and indices of aggression (i.e., physical/verbal aggression, anger, and hostility) after accounting for PTSS and (b) investigate PTSD symptom clusters in relation to aggression among 263 women (Mage = 29.03 years, SD = 11.71; 67.6% white). Path analysis revealed that sexual assault was unrelated to indices of aggression, ßs = .003-.08; however, PTSS was consistently linked with increased aggression, ßs = .22-.49. Results indicated specificity in the associations between the symptom clusters and aspects of aggression. Negative alterations in cognitions and mood corresponded with increased physical aggression, ß = .28, and hostility, ß = .38, and avoidance was related to verbal aggression, ß = .19. Hyperarousal was also tied to higher levels of anger, hostility, and verbal aggression, ßs = .21-.33. Nonetheless, lower levels of intrusion symptoms were associated with increased anger and hostility, ß = -.26. With regard to understanding women's risk for aggression, PTSS may be more relevant than sexual assault. Further, there may be specificity related to the type of PTSD symptoms and aspects of aggression.

Heart Rate Variability and Cognitive Bias Feedback Interventions to Prevent Post-deployment PTSD: Results from a Randomized Controlled Trial.

Introduction: There is a long history of pre-deployment PTSD prevention efforts in the military and effective pre-deployment strategies to prevent post-deployment PTSD are still needed. Materials and Methods: This randomized controlled trial included three arms: heart rate variability biofeedback (HRVB), cognitive bias modification for interpretation (CBM-I), and control. The hypothesis was that pre-deployment resilience training would result in lower post-deployment PTSD symptoms compared with control. Army National Guard soldiers (n = 342) were enrolled in the Warriors Achieving Resilience (WAR) study and analyzed. The outcome was PTSD symptom severity using the PTSD Checklist - Military version (PCL) measured at pre-deployment, 3- and 12-month post-deployment. Due to the repeated measures for each participant and cluster randomization at the company level, generalized linear mixed models were used for the analysis. This study was approved by the Army Human Research Protection Office, Central Arkansas Veterans Healthcare System Institutional Review Board (IRB), and Southeast Louisiana Veterans Health Care System IRB. Results: Overall, there was no significant intervention effect. However, there were significant intervention effects for subgroups of soldiers. For example, at 3-months post-deployment, the HRVB arm had significantly lower PCL scores than the control arm for soldiers with no previous combat zone exposure who were age 30 and older and for soldiers with previous combat zone exposure who were 45 and older (unadjusted effect size -0.97 and -1.03, respectively). A significant difference between the CBM-I and control arms was found for soldiers without previous combat zone exposure between ages 23 and 42 (unadjusted effect size -0.41). Similarly, at 12-months post-deployment, the HRVB arm had significantly lower PCL scores in older soldiers. Conclusion: Pre-deployment resilience training was acceptable and feasible and resulted in lower post-deployment PTSD symptom scores in subgroups of older soldiers compared with controls. Strengths of the study included cluster randomization at the company level, use of iPod device to deliver the resilience intervention throughout the deployment cycle, and minimal disruption of pre-deployment training by using self-paced resilience training. Weaknesses included self-report app use, study personnel not able to contact soldiers during deployment, and in general a low level of PTSD symptom severity throughout the study. In future studies, it would important for the study team and/or military personnel implementing the resilience training to be in frequent contact with participants to ensure proper use of the resilience training apps.

Childhood trauma exposure and gun violence risk factors among victims of gun violence.

OBJECTIVE: Gun violence is a serious public health concern, yet risk factors for gun violence involvement remain understudied. Childhood trauma exposure, such as domestic violence (DV) and community violence (CV), may increase the risk for aggression, although this relationship has not been examined in the context of gun violence. The aim of the current study was to investigate whether different childhood trauma ecologies are related to increased gun violence involvement and gun violence risk factors among individuals hospitalized for a gun injury. METHOD: Seventy-two gun violence victims reported on their gun violence involvement and gun violence risk factors (e.g., gun ownership, gun carrying, gun arrests, impulsivity, perceptions regarding violence) at hospital bedside. RESULTS: Childhood DV and CV exposure were both associated with increased gun violence involvement as well as numerous gun violence risk factors. Effect sizes were generally medium to large (M d = .53). CONCLUSION: Childhood traumatic events, such as DV and CV, may be important antecedent risk factors for gun violence. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Motivational Interviewing for Victims of Armed Community Violence: A Nonexperimental Pilot Feasibility Study.

OBJECTIVE: The present study aimed to develop a novel, hospital-based motivational interviewing (MI) intervention for victims of armed community violence (MI-VoV) targeting patient-specific risk factors for future violence or violent victimization. METHOD: This uncontrolled pilot feasibility study examined a sample of patients (n = 71) hospitalized due to violent injury at a Level 1 Trauma Center in [Location Redacted for Masked Review] between January 2013 and May 2014. Patients first participated in a brief assessment to identify risk factors for violence/violent injury. A single MI session then targeted risk behaviors identified for each patient. Proximal outcomes, including motivation for change and behaviors to reduce risk, were examined at 2 weeks and 6-12 weeks post-discharge. Distal outcomes, including fighting, weapon-carrying, and gun-carrying, and other violence risk factors were examined at 6-12 week follow-up. RESULTS: Ninety-five patients were offered participation, 79 (83.2%) agreed to participate, and 73 (76.8%) completed the risk assessment. Of these, 71 had at least one violence/violent injury risk factor. Behaviors to reduce risk were significantly greater at two-week and 6-12 week follow-up (ps < .05). Fighting, weapon-carrying, gun-carrying were significantly reduced at 6-12 week follow-up (p < .05). CONCLUSIONS: This intervention appears to be feasible to implement and acceptable to patients. A randomized controlled trial evaluating efficacy appears warranted.

Pretrauma Power and Control Beliefs and Posttraumatic Stress: A Longitudinal Study of Combat Soldiers.

Belief in one's ability to exert power and control over outcomes following trauma has long been understood as protective against the development of posttraumatic stress disorder (PTSD). The role of pretrauma beliefs about power and control, however, remains unclear. Though a strong pretrauma belief in power and control may similarly be protective, we predicted such a belief may actually be a diathesis for PTSD. When exposed to trauma, individuals with a strong pretrauma belief in power and control may believe they should have prevented the trauma and/or their acute reactions. Such expectations may lead to negative self-beliefs and a higher level of PTSD symptoms. Longitudinal structural equation modeling in a sample of combat soldiers (N = 305) supported our hypothesized model. Stronger predeployment power and control beliefs predicted more negative postdeployment self-beliefs, ß = .15, p = .035, 95% CI [.11, .18], and in turn, a higher level of PTSD symptoms, ß = .08, 95% CI [.01, .15]. Prior combat exposure moderated these effects in that soldiers with no prior combat experience evidenced the hypothesized associations, whereas those with moderate or high prior combat exposure did not. Resilience interventions for soldiers who are first entering combat may thus benefit from promoting acceptance of uncontrollable events in addition to agentic change skills.

Differentiating between appraisal process and product in cognitive theories of posttraumatic stress.

Biased appraisal is central to cognitive theories of posttraumatic stress, but little research has examined the potentially distinct meanings of the term. The ongoing process of appraising social information and the beliefs that emerge as products of that process can be distinguished conceptually. This study sought to examine whether these 2 meanings are empirically distinct as well, and if so, to begin exploring potential relations between these appraisal constructs and posttraumatic stress symptoms. Soldiers (N = 424) preparing for deployment to Iraq or Afghanistan were administered measures of each construct. Results of confirmatory factor analysis suggest that the appraisal process and the products of that process (i.e., beliefs) are indeed distinct. Structural equation models are consistent with cognitive bias and social information processing literatures, which posit that a biased appraisal process may contribute to the development of dysfunctional beliefs and posttraumatic stress symptoms following trauma. The potential utility of distinctly conceptualizing and measuring the appraisal process in both clinical and research settings is discussed.

Criminal Behavior and Repeat Violent Trauma: A Case-Control Study.

INTRODUCTION: Repeat violent injury is common among young urban men and is increasingly a focus of trauma center-based injury prevention efforts. Though understanding risk factors for repeat violent injury may be critical in designing such interventions, this knowledge is limited. This study aims to determine which criminal behaviors, both before and after the initial trauma, predict repeat violent trauma. Gun, violent, and drug crimes are expected to increase risk of subsequent violent injury among victims of violence. METHODS: A case-control design examined trauma registry and publicly available criminal data for all male patients aged <40 years presenting for violent trauma between April 2006 and December 2011 (N=1,142) to the sole Level 1 trauma center in a city with high rates of violence. Logistic regression was used to determine criminal behaviors predictive of repeat violent injury. Data were obtained and analyzed between January 2013 and June 2014. RESULTS: Regarding crimes committed before the first injury, only drug crime (OR=5.32) predicted repeat violent trauma. With respect to crimes committed after the initial injury, illegal gun possession (OR=2.70) predicted repeat victimization. Initiating gun (OR=3.53) or drug crime (OR=5.12) was associated with increased risk. CONCLUSIONS: Prior drug involvement may identify young male victims of violence as at high risk of repeat violent injury. Gun carrying and initiating drug involvement after the initial injury may increase risk of repeat injury and may be important targets for interventions aimed at preventing repeat violent trauma.

Over-reporting bias and the modified Stroop effect in Operation Enduring and Iraqi Freedom veterans with and without PTSD.

The current study investigated in a sample of Operation Enduring and Iraqi Freedom (OEF/OIF) veterans how a symptom overreporting response style might influence the association between PTSD diagnostic status and color-naming response latency for trauma-related stimuli during the Modified Stroop Task (i.e., the Modified Stroop Task effect, MST effect). It was hypothesized that, if an overreporting response style reflected feigning or exaggerating PTSD symptoms, an attenuated MST effect would be expected in overreporters with PTSD as compared with PTSD-diagnosed veterans without an overreporting style. If, however, overreporting stemmed from high levels of distress, the MST effect might be greater in overreporters compared with those with a neutral response style. The results showed that veterans with PTSD and an overreporting response style demonstrated an augmented MST effect in comparison with those with a more neutral style of response. Overreporters also reported greater levels of psychopathology, including markedly elevated reports of dissociative experiences. We suggest that dissociation-prone overreporters may misattribute emotional distress to combat experiences leading to the enhanced MST effect. Other possible explanations for these results are also discussed.

Multidimensional self-esteem as a mediator of the relationship between sports participation and victimization: a study of African American girls.

The purpose of this study that focused on African American high school girls was threefold. First, the relationship of sports participation and victimization was explored. Second, the impact of sports participation on self-esteem was assessed. Third, the role of self-esteem and its disaggregated components (social acceptance, competence, and self-confidence) as mediators of the relationship between sports participation and victimization was examined. In accordance with the sport protection hypothesis, it was hypothesized that sports participation would be related to enhanced self-esteem and reduce victimization. Results suggest that sports participation appears to have some relationship to lower rates of victimization. There was also support for our assertion that sports participation was related to enhanced self-esteem. Finally, overall self-esteem and, specifically, the individual component competence mediated the relationship between sports participation and victimization.