The impact of trauma-focused psychotherapies on anger: A systematic review and meta-analysis.

OBJECTIVE: Anger is one of the most prevalent concerns among individuals with posttraumatic stress disorder (PTSD) and is often a residual symptom following PTSD treatment. The purpose of this systematic review and meta-analysis was to determine how effective trauma-focused PTSD psychotherapies are in reducing anger. METHOD: The study was reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. This study conducted a systematic review of studies that reported the effect of trauma-focused treatments on anger outcomes. Additionally, a meta-analysis was conducted with a subset of studies that used randomized controlled trials (RCTs) methodologies to compare trauma-focused PTSD treatments to nontrauma-focused and control conditions. RESULTS: The systematic review included 16 studies with a total of 1,846 participants. In 11 of the studies, there was a significant decrease in an anger dimension following treatment. Eight studies with 417 total participants met inclusion criteria for the meta-analysis. The meta-analysis yielded a pooled effect size of PTSD treatment on anger of Hedges's g = 0.33. CONCLUSION: Overall, trauma-focused treatments for PTSD significantly improve anger, but the magnitude of change is small-to-medium. Additional research is needed to determine how best to maximize anger outcomes following trauma-focused treatment or determine if and when targeted anger treatment is needed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Examining veterans' preferences for how to deliver couples-based treatments for posttraumatic stress disorder: Home-based telehealth or in-person?

Understanding the modality by which veterans prefer to receive couples-based posttraumatic stress disorder (PTSD) treatment (i.e., home-based telehealth, in-person) may increase engagement in PTSD psychotherapy. This study aimed to understand veterans' preferred modality for couples-based PTSD treatments, individual factors associated with preference, and reasons for their preference. One hundred sixty-six veterans completed a baseline assessment as part of a clinical trial. Measures included a closed- and open-ended treatment preference questionnaire, as well as demographics, clinical symptoms, functioning, and relational measures, such as relationship satisfaction. Descriptive statistics and correlations examined factors associated with preference. An open-ended question querying veterans' reasons for their preferred modality was coded to identify themes. Though veterans as a group had no clear modality preference (51% preferring home-based telehealth and 49% preferring in-person treatment), veterans consistently expressed high levels of preference strength in the modality they chose. The presence of children in the home was associated with stronger preference for home-based telehealth. Veterans who preferred in-person care found it to be more credible and had more positive treatment expectancies. Veterans who preferred home-based telehealth believed it was flexible and increased access to care. For both preference groups, veterans' preferred modality was viewed as facilitating interpersonal relations and being more comfortable than the alternative modality. Veterans expressed strong preference for receiving their desired treatment modality for couples-based PTSD treatment. Results suggest that it is important to offer multiple treatment delivery options in couples-based PTSD treatment and matching couples to their preferred modality supports individualized, patient-centered care. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A protocol for a randomized controlled trial of exposure and response prevention for veterans with obsessive compulsive disorder.

BACKGROUND: Obsessive compulsive disorder (OCD) is effectively treated with exposure and response prevention (ERP), yet very few veterans receive ERP for OCD within the Veterans Health Administration (VHA). Veterans are a clinically complex population, and no prior research has evaluated the effectiveness of ERP in veterans with OCD or comorbid OCD and posttraumatic stress disorder (PTSD). Given the limited accessibility of ERP-trained providers within VHA, assessment of video telehealth (VTH) delivery of ERP is warranted. METHODS: A sample of 160 veterans with OCD (80 diagnosed with comorbid PTSD) will be randomly assigned to receive up to 16 sessions of ERP or a stress management training control delivered via VTH. Assessments will occur at baseline, posttreatment, and 6-month follow-up. The primary outcome will evaluate the impact of ERP on participants' functioning, and secondary outcomes will include quality of life and OCD symptoms. At posttreatment, qualitative interviews with veterans, clinicians, and administrators will explore barriers and facilitators to treatment delivery, and the implementation potential of ERP. CONCLUSIONS: Results will provide direction for the treatment of OCD and comorbid PTSD in veterans, as well as guidance for future implementation efforts for ERP within VHA. CLINICALTRIALS: gov Identifier:NCT05240924.

Addressing Uncertainty in Informal Familial Caregivers of Stroke Survivors: A Systematic Meta-Ethnography.

Background: Informal familial caregivers of stroke survivors experience uncertainty that begins at the time of the stroke event and continues into home-based care. The uncertainty faced by caregivers contributes to poor mental and physical health outcomes. Objective: This review details the factors associated with, impacts of, and coping skills used to manage uncertainty across the caregiving trajectory. By defining uncertainty reduction and tolerance recommendations, this review also builds upon the Stroke Caregiver Readiness Model to improve preparedness following the stroke event. Methods: A meta-ethnographic review was systematically conducted on thirteen qualitative studies with 218 participants from four countries. The Critical Appraisal Skills Programme (CASP) was used to assess study quality. Results: Following the stroke event, caregivers reported a lack of knowing (e.g., about the cause of the stroke event and survivor prognoses) as contributing to post-stroke uncertainty. As a result of this uncertainty, caregivers expressed concerns about their abilities to navigate caregiving responsibilities and how to plan for the future. Longer-term concerns (e.g., managing finances) and feelings of hopelessness occurred after discharge. Still, caregivers identified strategies to manage uncertainty. Caregiver coping skills included present-focused thinking, gratitude, faith, humor, and social support. Conclusions: The uncertainty faced by informal familial caregivers of stroke survivors is pervasive and changes across time. Uncertainty reduction and tolerance interventions can be used to build upon caregiver strengths and promote preparedness across the caregiving trajectory.

Women's Knowledge of Postpartum Anxiety Disorders, Depression, and Cognitive Behavioral Therapy.

ABSTRACT: Although awareness of postpartum depression (PPD) has increased, postpartum anxiety disorders (PPA) remain overlooked. Understanding women's knowledge of PPA and their effective treatments is needed given the underutilization of treatment and associated negative health outcomes. Two internet-based studies (OSF [https://osf.io/3fjvr] preregistered follow-up) were conducted to identify women's knowledge and familiarity with PPD and PPA and knowledge of cognitive behavioral therapy (CBT). Study 1 revealed that women who were planning to become pregnant, pregnant, or recently postpartum (N = 218) were less familiar with PPA than PPD and had limited familiarity with CBT. Women also reported low screening rates for PPA and low perceived treatment seeking for women with PPA and PPD. Study 2 (N = 290) revealed that recently postpartum women recognized fewer symptoms and recommended treatment less often for PPA than PPD and had limited CBT knowledge. Overall, results indicate limited knowledge of PPA compared with PPD, indicating a need for targeted information to perinatal women.

The Skidmore Anxiety Stigma Scale (SASS): A covert and brief self-report measure.

Shame and concerns about stigma are salient barriers to treatment for people with anxiety disorders, and yet very little stigma research has focused on this class of disorders. One explanation for this research gap is the absence of a brief, psychometrically sound measure for assessing public stigma for the anxiety disorders as a class. This (three-study) paper presents the psychometric properties of a 7-item scale that covertly assesses anxiety stigma by presenting as a test of knowledge. Items for the measure were derived from a mixed-methods project (Study 1) which assessed patient (N = 47) experiences with stigma. Subsequently, exploratory factor analysis (N = 270) demonstrated that the scale fit a one-factor solution (Study 2). Study 3 comprehensively evaluated the measure's psychometric properties, including confirming the one-factor solution. Results further demonstrated test-retest reliability, convergent and discriminant validity, and internal consistency. This brief measure fills an important gap by providing means for covertly assessing public stigma encountered by individuals with anxiety disorders and thus subverts social desirability concerns that plague self-report measures of stigma. Thus, the SASS increases the feasibility of work capturing the nature and impact of anxiety stigma - a highly relevant barrier to treatment.

Mnemonic discrimination and social anxiety: the role of state anxiety.

The Mnemonic Similarity Task (MST) measures mnemonic discrimination, or the ability to correctly identify new stimuli from highly similar, old stimuli. Poor mnemonic discrimination is a potential risk or maintenance factor for anxiety, and recent studies suggest state affect may moderate relations between mnemonic discrimination and trait anxiety. No studies have evaluated mnemonic discrimination in specific subtypes of anxiety or with clinically relevant stressors. This preregistered study evaluated the role of social anxiety and the anticipation of a future speech on MST performance. Participants with high (n = 66) and low (n = 64) levels of social anxiety were randomly assigned to a stressor condition or a control condition prior to the MST. State anxiety was measured throughout the study. Results did not indicate significant effects of trait (high vs. low social anxiety) or state anxiety (stressor condition vs. control condition) on mnemonic discrimination. Results are compared with previous research and implications and future directions are discussed.

Evaluating approaches to marketing cognitive behavioral therapy: does evidence matter to consumers?

Direct-to-consumer marketing initiatives may improve utilization of evidence-based therapy.  An important decision in such marketing efforts is how to effectively present scientific evidence supporting these treatments to potential consumers (if at all). This OSF preregistered study experimentally tested whether the language used to describe research evidence supporting cognitive behavioral therapy (CBT) for anxiety disorders affected consumer treatment attitudes and intentions. Adult participants (N = 303) recruited via mTurk were first assessed for their understanding of the term "evidence-based." They were then randomized to read a description of CBT employing either: formal research language (e.g., "large-scale clinical trials have demonstrated…"), informal language about research support derived from prior qualitative work (e.g., "people have better results…"), or no information about research. Perceptions of CBT (including credibility and expectancy) and likelihood of pursuing CBT (pull demand) were assessed. Results indicated that only half the sample understood the meaning of the term "evidence-based." The conditions that discussed research support outperformed the control condition on CBT perceptions, credibility, general expectancies, and perceived effectiveness. Post-hoc comparisons provided some evidence that qualitatively-derived language was more effective than formal research language for promoting positive perceptions of CBT. Implications for marketing content are discussed.