Treating a common comorbidity: Pain outcomes following a 3-week cognitive processing therapy-based intensive treatment for posttraumatic stress disorder address.

Posttraumatic stress disorder (PTSD) commonly co-occurs with pain and has been implicated in the maintenance of chronic pain. However, limited research has examined whether intervening for PTSD can hinder or optimize treatment outcomes for co-occurring pain and PTSD. In the present study, we examined changes in pain, PTSD, and depressive symptoms among 125 veterans completing a 3-week cognitive processing therapy (CPT)-based intensive treatment program (ITP) for PTSD. We also explored whether pretreatment pain interference predicted changes in PTSD and depressive symptom severity and whether larger changes in pain interference over the course of treatment were associated with larger changes in PTSD and depressive symptom severity. Linear mixed models revealed that participants' pain interference decreased throughout treatment, d = 0.15, p = .039. Higher levels of pretreatment pain interference were associated with higher PTSD, p = .001, and depressive symptom severity, p = .014, over time. Larger reductions in pain interference corresponded to more improvement in PTSD symptoms, ß = -.03; p < .001, but not depressive symptoms. These findings indicate that ITPs for PTSD can reduce pain interferences, albeit to a small degree, and that reductions in pain interference can contribute to reductions in PTSD symptom severity. Future studies should examine which treatment components contribute to larger changes in symptom severity for veterans with co-occurring pain and PTSD.

The association between social support and posttraumatic stress symptoms among survivors of betrayal trauma: a meta-analysis.

Background: Betrayal traumas have a particularly deleterious effect on mental health. Although social support is a robust predictor of posttraumatic stress disorder (PTSD) symptom severity, it is not clear what factors may impact this relationship among betrayal trauma survivors. Objective: This study sought to describe the association between social support and PTSD symptom severity among survivors of betrayal trauma and examine whether methodological, sample, trauma, and social support characteristics moderated this association. Method: A comprehensive search identified 29 studies that assessed the cross-sectional association between PTSD symptom severity and social support among 6,510 adult betrayal trauma survivors. Results: The average effect size (r = -.25; 95% CI: -.30, -.20) was small to medium, with significant heterogeneity between studies (I2 = 71.86). The association between PTSD and social support was stronger when the trauma was perpetrated by a romantic partner compared to mixed perpetrators, even after accounting for covariates. There was also a significant effect of support type depending on whether the support was provided in the context of trauma disclosure. Specifically, positive reactions to trauma disclosure were not associated with PTSD symptoms whereas general positive social support (not disclosure focused) was associated with fewer PTSD symptoms. Negative reactions to trauma disclosure were associated with more PTSD symptoms. None of the included studies measured general negative social support outside of trauma disclosure. Conclusions: Our findings suggest that social support may be a particularly important buffer against PTSD symptoms when experiencing traumatic betrayal by an intimate partner. Additionally, our results suggest that social support interventions for those experiencing betrayal trauma should focus on reducing negative responses to disclosure and bolstering general satisfaction with social support.

Antecedentes: Los traumas de traición tienen un efecto particularmente perjudicial sobre la salud mental. Aunque el apoyo social es un fuerte predictor de la severidad de los síntomas del trastorno de estrés postraumático (TEPT), no está claro qué factores pueden afectar esta relación entre los sobrevivientes de traumas de traición.Objetivo: Este estudio buscó describir la asociación entre el apoyo social y la severidad de los síntomas del TEPT entre los sobrevivientes de trauma de traición y examinar si las características metodológicas, muestrales, de trauma y de apoyo social moderaron esta asociación.Método: Una búsqueda exhaustiva identificó 29 estudios que evaluaron la asociación transversal entre la gravedad de los síntomas de TEPT y el apoyo social entre 6.510 adultos sobrevivientes de trauma de traición.Resultados: El tamaño del efecto promedio (r = −.25; IC del 95%: −.30, −.20) fue de pequeño a mediano, con heterogeneidad significativa entre los estudios (I2 = 71.86). La asociación entre el TEPT y el apoyo social fue más fuerte cuando el trauma fue perpetrado por una pareja romántica en comparación con perpetradores mixtos, incluso después de tener en cuenta las covariables. También hubo un efecto significativo del tipo de apoyo dependiendo de si el apoyo se proporcionó en el contexto de la revelación del trauma. Específicamente, las reacciones positivas a la revelación del trauma no se asociaron con síntomas de TEPT, mientras que el apoyo social positivo general (no enfocado en la revelación) se asoció con menos síntomas de TEPT. Las reacciones negativas a la revelación del trauma se asociaron con más síntomas de TEPT. Ninguno de los estudios incluidos midió el apoyo social negativo general fuera de la revelación del trauma.Conclusiones: Nuestros hallazgos sugieren que el apoyo social puede ser un amortiguador particularmente importante contra los síntomas del TEPT cuando se experimenta una traición traumática por un compañero íntimo. Además, nuestros resultados sugieren que las intervenciones de apoyo social para quienes experimentan el trauma de traición deben centrarse en reducir las respuestas negativas a la revelación y reforzar la satisfacción general con el apoyo social.

Self-reported PTSD symptoms and social support in U.S. military service members and veterans: a meta-analysis.

Background: The mental health burden of posttraumatic stress disorder (PTSD) is high in U.S. military samples. Social support is one of the most robust protective factors against PTSD and a recent meta-analysis indicates that this relationship is even stronger in military samples compared to civilian samples. Yet no meta-analyses have explored factors impacting this association in veterans and military service members (VSMs). Objective: The current meta-analysis examined demographic, social support, and military characteristics that may moderate the relationship of PTSD severity and social support among U.S. VSMs. Method: A search identified 37 cross-sectional studies, representing 38 unique samples with a total of 18,766 individuals. Results: The overall random effects estimate was -.33 (95% CI: -.38, -.27, Z = -10.19, p <.001), indicating that lower levels of social support were associated with more severe PTSD symptoms. PTSD measures based on the Diagnostic and Statistical Manual (DSM)-III had a larger effect size than measures based on DSM-IV or DSM-5. The social support source was a significant moderator such that support perceived from non-military sources was associated with a larger effect size than support perceived from military sources. This finding held after accounting for covariates. Deployment-era, timing of social support, and age were also significant moderators, but were no longer significantly associated with effect size after adjusting for covariates. Although previous meta-analyses have shown social negativity to be more impactful than positive forms of social support, there were too few studies conducted to evaluate social negativity in moderator analyses. Conclusion: Results suggest that social support received from civilians and in the home environment may play a greater protective role than social support received from military sources on long-term PTSD symptom severity. The literature on social support and PTSD in U.S. VSMs would be strengthened by studies examining the association of social negativity and PTSD symptoms.

Antecedentes: La carga en salud mental del trastorno de estrés post-traumático (TEPT) es alta en muestras militares estadounidenses. El apoyo social es uno de los factores protectores más robustos contra el TEPT, y un meta-análisis reciente indica que esta relación es incluso más fuerte en muestras militares comparada con muestras de civiles. Aunque, ningún meta-análisis ha explorado los factores que impactan esta asociación en veteranos y miembros militares en servicio (VMS).Objetivo: El presente meta-análisis examinó características demográficas, de apoyo social, y militares que puedan moderar la relación de severidad de TEPT y apoyo social en VMS estadounidenses.Método: Una búsqueda identificó 37 estudios transversales, representando 38 muestras únicas con un total de 18.766 individuos.Resultados: La estimación general de efectos aleatorios fue −.33 (95% CI: −.38, −.27, Z=−10.19, p<.001), indicando que niveles más bajos de apoyo social estaban asociados a mayor severidad de síntomas TEPT. Los instrumentos de TEPT basados en el Manual diagnóstico y estadístico de los trastornos mentales (DSM) ­III obtuvieron un tamaño de efecto mayor que los instrumentos basados en DSM-IV o DSM-5. La fuente de apoyo social fue un moderador significativo, de tal forma que el apoyo percibido de fuentes no militares estuvo asociado a un tamaño de efecto más grande que el percibido de fuentes militares. Este efecto se mantuvo luego de controlar covariables. La era de despliegue militar, temporalidad del apoyo social, y edad también fueron moderadores significativos, pero no se mantuvieron significativamente asociados al tamaño de efecto luego de controlar covariables. Aunque meta-análisis previos han demostrado que la negatividad social ha tenido más impacto que las formas positivas de apoyo social, existían muy pocos estudios como para evaluar negatividad social en un análisis de moderación.Conclusión: Los resultados sugieren que el apoyo social recibido de civiles y en el ambiente familiar puede tener un rol protector más relevante que el recibido de fuentes militares en la severidad de síntomas TEPT en el largo plazo. La literatura sobre apoyo social y TEPT en VMS estadounidenses se vería enriquecida por estudios que examinen la asociación de la negatividad social y síntomas TEPT.

Examining the Impact of Sexual Revictimization in a Sample of Veterans Undergoing Intensive PTSD Treatment.

Sexual revictimization refers to exposure to more than one incident of rape and is a known risk factor for poor mental health among civilians. This construct has been understudied among veterans. In addition, although individuals who have experienced revictimization generally have greater symptom severity than those who have experienced one rape, it is unclear whether these differences persist following treatment. This study examined differences between veterans who reported histories of revictimization (n =111) or a single rape (n = 45), over the course of a 3-week intensive cognitive processing therapy (CPT)-based treatment program for veterans with posttraumatic stress disorder (PTSD). The sample consisted of predominately female (70.5%) post-9/11 veterans (82.7%). Self-reported PTSD and depression symptom severity were assessed regularly throughout the course of treatment. Controlling for non-interpersonal trauma exposure and whether veterans were seeking treatment for combat or military sexual trauma, sexual revictimization was generally associated with greater pretreatment distress and impairment. However, sexual revictimization did not impact rates of PTSD or depression symptom change over the course of intensive treatment, or overall improvement in these symptoms posttreatment. Our findings suggest that the rates of sexual revictimization are high among treatment-seeking veterans with PTSD. Although veteran survivors of sexual revictimization tend to enter treatment with higher levels of distress and impairment than their singly victimized peers, they are equally as likely to benefit from treatment.

Examining moderators of the relationship between social support and self-reported PTSD symptoms: A meta-analysis.

Social support is one of the most robust predictors of posttraumatic stress disorder (PTSD). Yet, little is known about factors that moderate the relationship between social support and PTSD symptom severity. This meta-analysis estimated the overall effect size of the relationship between self-reported social support and PTSD severity and tested meaningful demographic, social support, and trauma characteristics that may moderate this association using both cross-sectional and longitudinal effect sizes. A comprehensive search identified 139 studies with 145 independent cross-sectional effect sizes representing 62,803 individuals and 37 studies with 38 independent longitudinal effect sizes representing 25,792 individuals. Study samples had to comprise trauma-exposed, nonclinical adult populations to be included in the analysis. Cross-sectional and longitudinal analyses revealed a near medium overall effect size (rcross = -.27; 95% CI [-.30, -.24]; rlong = -.25; 95% CI [-.28, -.21]) with a high degree of heterogeneity (cross-sectional I2 = 91.6, longitudinal I2 = 86.5). Both cross-sectional and longitudinal moderator analyses revealed that study samples exposed to natural disasters had a weaker effect size than samples exposed to other trauma types (e.g., combat, interpersonal violence), studies measuring negative social reactions had a larger effect size than studies assessing other types of social support, and veteran samples revealed larger effect sizes than civilian samples. Several other methodological and substantive moderators emerged that revealed a complex relationship between social support and PTSD severity. These findings have important clinical implications for the types of social support interventions that could mitigate PTSD severity. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Improving outcomes for a 3-week intensive treatment program for posttraumatic stress disorder in survivors of military sexual trauma.

BACKGROUND: The experience of Military Sexual Trauma (MST) in the form of sexual assault and sexual harassment is common during service in the U.S. Armed Forces and often leads to adverse health outcomes including posttraumatic stress disorder (PTSD). Improving treatment of MST-related PTSD across settings is important to optimize treatment for survivors. The delivery of Cognitive Processing Therapy (CPT) in an intensive treatment program (ITP) shows promise for rapid reduction of PTSD symptoms for veterans and service members (veterans). However, a recent outcome study suggested that this modality is significantly less effective in reducing symptoms of PTSD for survivors of MST compared to veterans recovering from combat trauma. METHODS: -The current study examines the utility of modifications made to a CPT-based ITP designed to treat PTSD secondary to MST in a mixedgender sample (N = 285). Treatment modifications included the introduction of skills-based groups in emotion regulation and interpersonal domains. Individual skills-consultation sessions were also offered to participants on an as-needed basis. Further, training was provided to both clinical and non-clinical staff to increase understanding of the unique experiences and needs of MST survivors. RESULTS: Program changes proved beneficial, resulting in PTSD treatment outcomes that were comparable for survivors of MST and combat traumas. LIMITATIONS: Further research is needed to determine which of these specific program changes were most impactful in improving symptom outcomes. CONCLUSIONS: Our findings suggest that short-term, intensive PTSD treatment for MST survivors may be improved by integrating present-focused, skills-based therapies and staff sensitivity training.

Sleep Disturbance and Depression Symptoms Mediate Relationship Between Pain and Cognitive Dysfunction in Lupus.

OBJECTIVE: To determine whether sleep disturbance and symptoms of depression mediate the relationship between pain and cognitive dysfunction (CD) in a sample of 115 patients with systemic lupus erythematosus (SLE). METHODS: A total of 115 patients with SLE completed questionnaires regarding pain, perceived stress, depression, sleep, and CD. Relationships among pain, sleep, depression, and CD were assessed using bootstrap mediation models, controlling for race/ethnicity, fibromyalgia diagnosis, current corticosteroid use, disease activity and damage, and perceived stress. RESULTS: Mediation analyses indicated that the effect of pain on CD was mediated by sleep disturbance (ß = 0.30) and depression symptoms (ß = 0.33). These effects were maintained even after controlling for the aforementioned covariates, of which only disease activity (ß = 0.20) and stress (ß = 0.22) remained significantly linked to CD (overall model R2 = 0.53; all P < 0.05). CONCLUSION: After controlling for disease activity and perceived stress, the relationship between pain and CD was explained by sleep disturbance and depression symptoms. Although these relationships need validation in longitudinal studies with additional measurement modalities, our findings may indicate promising, nonpharmacologic intervention avenues for SLE patients with pain and CD. Specifically, cognitive behavioral therapies for depression and sleep are known to reduce distress and enhance functioning across various psychosocial domains. Given the symptom burden of SLE, interventions that maximize potential benefits without the use of additional pharmacologic treatments may be of particular utility.

Examining the effectiveness of a coordinated perinatal mental health care model using an intersectional-feminist perspective.

Untreated perinatal depression and anxiety are significant public health problems that disproportionately affect ethno-racial minorities. The purpose of this study was to examine the effectiveness of a coordinated perinatal mental health care model, focusing on socially-disadvantaged, ethno-racial minority women, with an intersectional-feminist perspective. The treatment model was grounded in intersectionality theory with the aim of addressing complex social vulnerability factors in the context of perinatal mental health treatment. Participants were 67 perinatal women (64% African American or Hispanic/Latina) referred by medical providers at an urban teaching hospital. Results demonstrated high treatment engagement and effectiveness, with 65.9% of participants demonstrating reliable improvement in symptoms. Moreover, African American and Hispanic/Latina patients had similar treatment outcomes compared to White patients, despite facing greater socio-economic disadvantages. Findings indicate that the treatment model may be a promising approach to reducing perinatal mental health disparities. Strengths and limitations of the study are discussed within the intersectionality framework.

Posttraumatic stress and depression may undermine abuse survivors' self-efficacy in the obstetric care setting.

INTRODUCTION: Posttraumatic stress symptoms (PTS) are associated with increased risk of obstetric complications among pregnant survivors of trauma, abuse and interpersonal violence, but little is known about how PTS affects women's actual experiences of obstetric care. This study investigated the rate at which abuse history was detected by obstetricians, whether abuse survivors experienced more invasive exams than is typically indicated for routine obstetric care, and whether psychological distress was associated with abuse survivors' sense of self-efficacy when communicating their obstetric care needs. METHODS: Forty-one pregnant abuse survivors completed questionnaires about abuse history, current psychological distress and self-efficacy for communicating obstetric care needs and preferences. Electronic medical records (EMRs) were reviewed to examine frequency of invasive prenatal obstetric procedures (e.g. removal of clothing for external genital examination, pelvic exams and procedures) and to examine the detection rate of abuse histories during the initial obstetric visit. RESULTS: The majority of participants (83%) reported at least one past incident of violent physical or sexual assault. Obstetricians detected abuse histories in less than one quarter of cases. Nearly half of participants (46%) received invasive exams for non-routine reasons. PTS and depression symptoms were associated with lower self-efficacy in communicating obstetric care preferences. DISCUSSION: Women most at risk for experiencing distress during their obstetric visits and/or undergoing potentially distressing procedures may also be the least likely to communicate their distress to obstetricians. Results are discussed with implications for improving screening for abuse screening and distress symptoms as well as need for trauma-sensitive obstetric practices.

A Pilot Study of Tailored Cognitive-Behavioral Resilience Training for Trauma Survivors With Subthreshold Distress.

This pilot study evaluated the feasibility, acceptability, and preliminary effectiveness of tailored cognitive-behavioral resilience training (TCBRT) for trauma-exposed individuals with a variety of subsyndromal psychological symptoms. TCBRT is a brief, flexible intervention that allows individuals to select the areas they wish to target using common cognitive-behavioral change principles. There were 14 individuals (78.6% female) who were recruited from a major medical center and enrolled in the 5-session intervention. There were 12 (85.7%) who completed all TCBRT sessions, and 2 (14.3%) who dropped out after 3 sessions. All participants reported that they received benefit from, were engaged in, and were satisfied with the intervention. Of the 12 with postintervention data, 5 of the participants demonstrated reliable increases in resilience and 6 demonstrated reliable decreases in anxiety. These improvements appeared to be maintained at 2-month follow-up; of the 11 participants with follow-up data, 5 demonstrated reliable increases in resilience and 6 demonstrated reliable decreases in anxiety. Our findings suggested that TCRBT was acceptable to trauma-exposed individuals with varying types of subthreshold distress.

Coordinated Community Response Components for Victims of Intimate Partner Violence: A Review of the Literature.

Intimate partner violence (IPV) against women is a serious problem throughout the world. Each year a substantial number of women experience psychological, physical, and sexual aggression from an intimate partner, with many women experiencing serious mental and physical health outcomes as a result of their victimization. A number of services are available to women who sustain IPV (e.g., shelters, advocacy, legal protection), and the combination of these services has been termed a Coordinated Community Response (CCR) to IPV. The purpose of the present manuscript is to review the individual components of CCRs for IPV victims, examine the extant literature on a number of the individual CCR components, and suggest directions for future research on CCRs for IPV victims. Our review demonstrates that there is a significant lack of research on various CCR components, that research on the integration of CCR services is limited, and that theoretical guidance for CCR programs is almost non-existent. Directions for improving research on CCR components are suggested.

A preliminary investigation of the influence of subjective norms and relationship commitment on stages of change in female intimate partner violence victims.

Intimate partner violence (IPV) against women is a prevalent and serious problem throughout the world, causing devastating mental and physical health problems for victims. Recent research has begun to focus on factors that may influence women's decisions to stay or leave their abusive partners, as interventions for batterers has only resulted in minimal success in reducing IPV. Therefore, this study preliminarily examined the influence of women's perceptions of their social network members' subjective norms and their relationship commitment on stages of change to end an abusive relationship among a community sample of female IPV victims (N = 84). Results showed that subjective norms and women's relationship commitment were associated with women's stages of change. Relationship commitment did not mediate the relation between subjective norms and stages of change. These findings indicate that a number of factors contribute to women's stay/leave decision-making process, and close social network members could be included in interventions designed to keep women safe.

Breaking up is hard to do: psychological entrapment and women's commitment to violent dating relationships.

Psychological entrapment occurs when people continue investing in unfavorable situations after already devoting too much to lose. We predicted that women who already invested more time and resources into their relationships would exert effort to improve their relationships following partner violence. In turn, these efforts were expected to increase women's subjective investment in, and thus, commitment to violent relationships. Undergraduate women (N = 98) in heterosexual relationships reported on partner violence and relationship duration at Time 1 and relationship sacrifices, subjective investment, and commitment at Times 1 and 2. As expected, women with violent partners who were in longer term relationships sacrificed more 6 weeks later. Unexpectedly, in multivariate analyses, Time 2 sacrifices were not significantly associated with Time 2 subjective investment, although subjective investment was positively associated with concurrent commitment. These results provide preliminary evidence for women's entrapment in violent relationships.

The Prevalence of Mental Health Disorders in a Community Sample of Female Victims of Intimate Partner Violence.

Intimate partner violence (IPV) is a serious, devastating, and prevalent problem. IPV places women at risk for negative health consequences, including increased mental health disorders. The majority of research to date has focused on mental health disorders among women in domestic violence shelters, and research is needed that examines mental health disorders among a broader range of women experiencing IPV. Therefore, the present study examined the prevalence of posttraumatic stress disorder (PTSD), depression, and substance abuse disorders in a community sample of IPV victims (N = 94) using diagnostic interviews. Results showed that the majority of women met diagnostic criteria for a mental health disorder, with PTSD being the most common mental health disorder. Furthermore, psychological abuse was a significant predictor of both PTSD and depression, whereas physical aggression did not predict these outcomes. Implications of these findings for treatment and intervention work with battered women are discussed.

Going along with it: sexually coercive partner behavior predicts dating women's compliance with unwanted sex.

Sexual compliance involves willing consent to unwanted sex despite a lack of sexual desire.The authors hypothesized that compliance would be significantly more common among women with sexually coercive partners because compliance allows women to bypass possible coercion. Undergraduate women in heterosexual relationships ( N = 76) responded to self-report measures of partner sexually coercive behavior at baseline and sexual compliance 6 weeks later. As expected, reports of partner coercive behavior at Time 1 predicted women's willing consent to unwanted sex at Time 2. Most compliant women consented to unwanted sex after learning their partners may coerce them if they refuse.

Modeling associations between posttraumatic stress symptoms and substance use.

Comorbid substance use and posttraumatic stress disorders (SUD-PTSD) predict poorer treatment outcomes. Self-medication has been forwarded as a symptom-level explanatory model. However, research has yet to be conducted that can provide detailed examination of SUD and PTSD symptom fluctuations over time as posited by such a process. This pilot study examined associations between PTSD and substance dependence (SD) symptoms/substance use using two established methodologies that assess week-by-week symptom and substance use/dependence status. Outpatients (N=35) in SUD treatment completed the Longitudinal Follow-Up Evaluation and the Time Lime Follow-Back Interview, retrospectively reporting weekly PTSD and SD symptoms, and substance use over the previous 6-months. Results indicated that weekly PTSD symptom fluctuations were concurrently associated with the presence of alcohol and cocaine dependence symptoms and were associated with the presence of opiate dependence symptoms in the following week. These findings support a self-medication conceptualization, underscore the utility of using a more detailed process analysis of PTSD and SD symptoms, and suggest that PTSD fluctuations are associated with substance problems, rather than with substance use per se.