Experiential Avoidance, Post-Traumatic Stress Symptoms, and Academic Impairment.

The ways in which Posttraumatic Stress Disorder (PTSD) symptoms lead to impairments in functioning, including academic performance, are not well understood. The present study sought to examine the role of a common maladaptive coping strategy, experiential avoidance, as a moderator of the relationship between posttraumatic stress symptoms (PTSS) and academic achievement. Participants (N = 326) were undergraduate students enrolled in introductory psychology courses at a large university in the Midwestern United States who reported at least one event potentially meeting Criterion A for PTSD. The prospective association of PTSS with current and subsequent semester GPAs, and with experiential avoidance as the moderator, were examined. The interaction between PTSS and experiential avoidance significantly predicted both current semester GPA and subsequent semester GPA, with stronger associations between PTSS and GPA being observed at higher levels of experiential avoidance. These results were not fully explained by control variables of high school performance, standardized test scores, and general negative affect. This study found that experiential avoidance significantly moderates the relationship between PTSS and academic performance. These results suggest that interventions that target PTSS and/or experiential avoidance may increase GPA. Limitations and future directions are discussed.

Symptom attribution to a medically unexplained syndrome is associated with greater perceived severity and bothersomeness of symptoms in US military veterans.

OBJECTIVE: Medically unexplained symptoms (MUS) are prevalent among veteran and non-veteran populations. Current biopsychosocial theory implicates a multitude of factors in MUS development and perpetuation. The current study tests whether physical symptom attribution to MUS is associated with perceived symptom severity and bothersomeness and thereby might function to perpetuate MUS, as suggested by existing theory. DESIGN AND MAIN OUTCOME MEASURES: Military combat veterans (n = 243) answered postal-mail questions about their physical symptoms, severity of experienced symptoms, and attributions of these symptoms to MUS (e.g. Gulf War Illness) versus non-MUS conditions. RESULTS: Independent t-tests showed support for the first hypothesis-that those who experience the symptom and attribute it to MUS will perceive it to be more severe and bothersome than those who experience the symptom but do not attribute it to MUS. Paired-sample t-tests showed support for the second hypothesis-that experienced symptoms attributed to MUS by an individual will be perceived as more severe and bothersome than experienced symptoms the individual does not attribute to MUS. CONCLUSIONS: Results highlight a potential role of symptom attribution in MUS perpetuation, through greater perceived severity and bothersomeness of MUS-attributed symptoms. Possible intervention targets may include behavior ramifications, such as coping strategies; more research is needed.

Objective cognitive impairment and subjective cognitive problems in veterans initiating psychotherapy for posttraumatic stress disorder: An exploratory study.

The prevalence of cognitive impairment in Veterans initiating an evidence-based psychotherapy (EBP) for posttraumatic stress disorder (PTSD) is not yet established and has implications for service delivery. Our objectives were to (1) describe the type, severity, and prevalence of objective cognitive impairment and subjective cognitive problems experienced by Veterans at the time they began an EBP for PTSD and (2) determine whether assessments of objective cognitive impairment and subjective cognitive problems agree. We conducted objective and subjective (self-report) cognitive assessments in a sample of 38 Veterans initiating EBP for PTSD at one Veterans Affairs Medical Center. Thirty Veterans produced valid assessments. Almost half (14/30) of the participants demonstrated objective impairment in one or more cognitive domains, primarily in the areas of learning, memory, and processing speed. Almost all (29/30) participants endorsed moderate or greater cognitive problems on at least one self-report measure. After adjustment for multiple comparisons, there were no significant correlations between objective and subjective assessments. Objective cognitive impairment and subjective cognitive problems are common in Veterans beginning an EBP for PTSD. Longitudinal research on a larger sample is warranted to better understand relationships among subjective cognitive problems, objective cognitive impairment, and PTSD treatment participation and outcomes.

Mental Health Does Not Moderate Compensatory Cognitive Training Efficacy for Veterans With a History of Mild Traumatic Brain Injury.

OBJECTIVE: To examine the potential moderating effects of mental health symptoms on the efficacy of compensatory cognitive training (CCT) for Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn veterans with a history of mild traumatic brain injury (mTBI). DESIGN: Secondary analysis of a randomized controlled trial of CCT. Posttraumatic stress disorder, depression, and substance dependence symptom severity were examined as potential moderators of CCT efficacy for subjective cognitive complaints, use of cognitive strategies, and objective neurocognitive performance. SETTING: Three Veterans Affairs medical centers. PARTICIPANTS: Participants included veterans with history of mTBI (N=119): 50 participated in CCT and 69 received usual care (UC). INTERVENTION: CCT is a 10-week group-based (90 minutes per session) manualized cognitive rehabilitation intervention. MAIN OUTCOME MEASURES: Objective (neuropsychological functioning) and subjective (self-report) cognitive functioning and use of cognitive strategies. RESULTS: Baseline mental health symptoms did not moderate CCT efficacy: veterans who received CCT reported significantly greater improvement in cognitive difficulties and use of cognitive strategies compared with the UC group, regardless of baseline mental health symptom severity. The CCT group also demonstrated significant improvements on neuropsychological measures of attention, learning, and executive functioning compared with the UC group, regardless of baseline mental health symptom severity. CONCLUSIONS: CCT is efficacious for improving objective cognitive functioning and compensatory strategy use for veterans with a history of mTBI, regardless of the severity of comorbid psychiatric symptoms.

Evaluating challenges for improving medically unexplained symptoms in US military veterans via provider communication.

OBJECTIVES: Medically unexplained symptoms (MUS) are common, with particularly high rates observed in military veterans. Effective patient-provider-communication is thought to be a key aspect of care; however there have been few empirical studies on the association between communication and outcomes for patients with MUS. We evaluate whether discussing veterans' MUS-illness representations and good interpersonal skills have the potential to promote MUS-treatment adherence and improvement. METHODS: Veterans experiencing MUS (n=204) reported on their primary care providers' communication about illness representations and interpersonal skills; correlation, regression, and bootstrap-mediation analyses were conducted to test hypotheses regarding veteran-reported outcomes. Main outcomes included satisfaction with the provider, MUS-treatment adherence, intentions to adhere, and expectations for MUS improvement. RESULTS: Veterans reported infrequent discussion of MUS illness representations but high degrees of provider interpersonal skills. Communication regarding patients' illness representations and treatment expectations was significantly related to treatment adherence and adherence intentions; provider interpersonal skills were not. Both were related to veteran satisfaction. CONCLUSIONS AND PRACTICE IMPLICATIONS: Providers' interpersonal skills may be important in chronic illness contexts, such as MUS, by contributing to satisfaction with the provider. The current study suggests that providers may better promote MUS-treatment adherence through discussing MUS illness representations and treatment expectations.

Postconcussion symptoms reported by Operation Enduring Freedom/Operation Iraqi Freedom veterans with and without blast exposure, mild traumatic brain injury, and posttraumatic stress disorder.

OBJECTIVE: This study examined symptom reporting related to the 10th Edition of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) criteria for postconcussional syndrome (PCS) in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) Veterans. Our aims were to: (a) examine relationships among PCS symptoms by identifying potential subscales of the British Columbia Postconcussion Symptom Inventory (BC-PSI); and (b) examine group differences in BC-PSI items and subscales in Veterans with and without blast exposure, mild traumatic brain injury (mTBI), and posttraumatic stress disorder (PTSD). METHOD: Our sample included Veterans with blast-related mTBI history (n = 47), with blast exposure but no mTBI history (n = 20), and without blast exposure (n = 23). Overall, 37 Veterans had PTSD, and 53 did not. We conducted an exploratory factor analysis (EFA) of the BC-PSI followed by multivariate analysis of variance to examine differences in BC-PSI subscale scores by blast exposure, mTBI history, and PTSD. RESULTS: BC-PSI factors were interpreted as cognitive, vestibular, affective, anger, and somatic. Items and factor scores were highest for Veterans with blast exposure plus mTBI, and lowest for controls. Vestibular, affective, and somatic factors were significantly higher for Veterans with blast exposure plus mTBI than for controls, but not significantly different for those with blast exposure but no mTBI. These results remained significant when PTSD symptom severity was included as a covariate. Cognitive, anger, and somatic subscales were significantly higher for Veterans with PTSD, though there was no interaction effect of PTSD and mTBI or blast history. CONCLUSIONS: EFA-derived subscales of the BC-PSI differentiated Veterans based on blast exposure, mTBI history, and PTSD.