A Systematic Review of Intensive Empirically Supported Treatments for Posttraumatic Stress Disorder.

Various clinical practice guidelines for the treatment of posttraumatic stress disorder (PTSD) have consistently identified two frontline evidence-based psychotherapies (EBPs)-prolonged exposure (PE) and cognitive processing therapy (CPT)-as well as other empirically supported treatments (EST), such as eye movement desensitization and reprocessing (EMDR) and cognitive therapy for PTSD (CT for PTSD). However, researchers and clinicians continue to be concerned with rates of symptom improvement and patient dropout within these treatments. Recent attempts to address these issues have resulted in intensive, or "massed," treatments for PTSD. Due to variability among intensive treatments, including treatment delivery format, fidelity to the EST, and the population studied, we conducted a systematic review to summarize and integrate the literature on the impact of intensive treatments on PTSD symptoms. A review of four major databases, with no restrictions regarding publication date, yielded 11 studies that met all inclusion criteria. The individual study findings denoted a large impact of treatment on reduction of PTSD symptoms, ds = 1.15-2.93, and random-effects modeling revealed a large weighted mean effect of treatment, d = 1.57, 95% CI [1.24, 1.91]. Results from intensive treatments also noted high rates of treatment completion (i.e., 0%-13.6% dropout; 5.51% pooled dropout rate across studies). The findings suggest that intensive delivery of these treatments can be an effective alternative to standard delivery and contribute to improved treatment response and reduced treatment dropout.

Measurement-Based Care in the Veteran's Health Administration: A Critique and Recommendations for Future Use in Mental Health Practice.

Measurement-based care (MBC), a mechanism through which feedback is given to providers and patients, is increasingly being used in mental health care and has a number of benefits. These include providing information about treatment progress, encouraging a discussion around these topics, providing a method for shared decision-making and personalized treatment, and improving treatment outcomes. Although there are many benefits to using MBC, it is still not being used regularly. Barriers include time to administer measures and uncertainty regarding which measures to administer. This paper will briefly describe MBC and its use in mental health care and then will focus on the use and implementation of MBC within the Veteran's Health Administration (VHA). The VHA is a large healthcare system in which there have been ongoing efforts to implement MBC. Suggestions for successful implementation will be discussed.

Rumination and posttraumatic stress symptoms in trauma-exposed adults: a systematic review and meta-analysis.

BACKGROUND AND OBJECTIVES: Rumination is a correlate of increased posttraumatic stress (PTS) symptoms. This study quantitatively reviewed the literature on rumination and PTS symptoms in trauma-exposed adults, extending prior research by using an inclusive definition of trauma, addressing PTS symptom clusters, and conducting moderator analyses. METHOD: Searches were conducted in PsycINFO, PubMed, PILOTS, EBSCO Psychology and Behavioral Sciences Collection, Google Scholar, and Dissertation Abstracts. Sixty-four unique samples from 59 articles were included. RESULTS: Results showed a moderate, positive relationship between rumination and PTS symptoms (r = .50, p < .001). This was not moderated by time since trauma, gender, prior trauma history, Criterion A congruence of events, type of rumination or PTS symptom measure, or sample setting. However, trauma-focused rumination yielded smaller effect sizes than trait rumination. The association between rumination and intrusive re-experiencing was stronger than that between rumination and avoidance (t (13) = 9.18, p < .001), or rumination and hyperarousal (t (9) = 2.70, p = .022). CONCLUSIONS: Results confirm that rumination is associated with increased PTS symptoms. Future research should identify mechanisms underlying this association and their potential specificity by symptoms cluster, as well as further examine the potential moderating roles of gender and prior trauma history.

Salivary cytokine response in the aftermath of stress: An emotion regulation perspective.

Elevated inflammation in the context of stress has been implicated in mental and physical health. Approaching this from an emotion regulation perspective, we tested whether the salivary cytokine response to stress is dampened by using distraction to minimize opportunity for poststressor rumination. Healthy young adults were randomized to an acute stressor: modified Trier Social Stress Test (TSST, Study 1) or angry memory retrieval (Study 2). Within each study, participants were randomized to poststressor condition-rest or distraction-at a 3:1 ratio. Saliva, collected before and 40 min after the end of each stressor, was assayed for proinflammatory cytokines (PICs): interleukin-1ß (IL-1ß), TNF-α, and IL-6. Both stressors increased all PICs, and both provoked negative emotion. At 40 min post-TSST, salivary PIC increases did not differ between distraction and rest, but correlated positively with emotional reactivity to stress. At 40 min after memory retrieval, IL-1ß increases and intrusive rumination were lower during distraction than rest, but did not correlate with emotional reactivity. Trait rumination and interference control mechanisms, also measured, played little role in PIC increases. Overall, after some stressors, some salivary cytokine responses are lower during distraction than rest. The roles of specific emotions, emotional intensity, and poststressor timing of saliva collection in this finding require clarification. Furthermore, the possibility of two affective paths to inflammation in the context of stress-one sensitive to opportunities for early occurring emotion regulation (as reflected in emotional reactivity), and one sensitive to late-occurring emotion regulation (as reflected in distraction after stress)-deserves attention. (PsycINFO Database Record

Sheltering for Safety in Community Women With Divorce Histories.

This cross-sectional study compared the prevalence of formal and informal sheltering (i.e., staying in an agency shelter, or with friends/family, respectively) and evaluated associations with abuse severity. Community women ( N = 197) with divorce histories reported on lifetime intimate partner abuse, including sheltering for safety. Prevalence of informal sheltering (43%) exceeded that of formal sheltering (11%). Rates/levels of coercive control, severe violence, injury, and police involvement were comparable for women who sheltered formally or informally, and exceeded those of women who never sheltered. Sheltering histories can be identified in community samples of women with divorce histories. Informal sheltering is prevalent, and comparable to formal sheltering in terms of correlations with abuse severity.

Pre-learning stress that is temporally removed from acquisition exerts sex-specific effects on long-term memory.

We have examined the influence of sex and the perceived emotional nature of learned information on pre-learning stress-induced alterations of long-term memory. Participants submerged their dominant hand in ice cold (stress) or warm (no stress) water for 3 min. Thirty minutes later, they studied 30 words, rated the words for their levels of emotional valence and arousal and were then given an immediate free recall test. Twenty-four hours later, participants' memory for the word list was assessed via delayed free recall and recognition assessments. The resulting memory data were analyzed after categorizing the studied words (i.e., distributing them to "positive-arousing", "positive-non-arousing", "negative-arousing", etc. categories) according to participants' valence and arousal ratings of the words. The results revealed that participants exhibiting a robust cortisol response to stress exhibited significantly impaired recognition memory for neutral words. More interestingly, however, males displaying a robust cortisol response to stress demonstrated significantly impaired recall, overall, and a marginally significant impairment of overall recognition memory, while females exhibiting a blunted cortisol response to stress demonstrated a marginally significant impairment of overall recognition memory. These findings support the notion that a brief stressor that is temporally separated from learning can exert deleterious effects on long-term memory. However, they also suggest that such effects depend on the sex of the organism, the emotional salience of the learned information and the degree to which stress increases corticosteroid levels.