Integrating tobacco cessation treatment into mental health care for patients with posttraumatic stress disorder.

The integration of tobacco cessation treatment into mental health care for posttraumatic stress disorder (PTSD), known as Integrated Care (IC), was evaluated in an uncontrolled feasibility and effectiveness study. Veterans (N = 107) in PTSD treatment at two outpatient clinics received IC delivered by mental health practitioners. Outcomes were seven-day point prevalence abstinence measured at two, four, six, and nine months post-enrollment and repeated seven-day point prevalence abstinence (RPPA) obtained across three consecutive assessment intervals (four, six, and nine months). Abstinence rates at the four assessment intervals were 28%, 23%, 25%, and 18%, respectively, and RPPA was 15%. The number of IC sessions and a previous quit history greater than six months predicted RPPA. Stopping smoking was not associated with worsening PTSD or depression.

A pilot study of behavioral activation for veterans with posttraumatic stress disorder.

A pilot study was conducted to investigate the feasibility and effectiveness of behavioral activation (BA) therapy for veterans with posttraumatic stress disorder (PTSD). Eleven veterans seeking treatment at a Veterans Administration outpatient PTSD clinic were enrolled in the study protocol, consisting of 16-weekly individual sessions of BA. Nine veterans completed the protocol, one participant completed 15 sessions, and one dropped out after one session. Clinician-rated PTSD symptom severity showed significant pre- to posttreatment improvement and was associated with a moderate effect size. A number of participants also were improved on measures of depression and quality of life, but changes did not reach statistical significance. Findings suggest that BA is a well-tolerated, potentially beneficial intervention for veterans with chronic symptoms of PTSD.

Improving the rates of quitting smoking for veterans with posttraumatic stress disorder.

OBJECTIVE: Smoking is highly prevalent and refractory among people with posttraumatic stress disorder (PTSD). This study aimed to improve the rate of quitting smoking for veterans with PTSD by integrating treatment for nicotine dependence into mental health care. METHOD: Smokers undergoing treatment for PTSD (N=66) were randomly assigned to 1) tobacco use treatment delivered by mental health providers and integrated with psychiatric care (integrated care) versus 2) cessation treatment delivered separately from PTSD care by smoking-cessation specialists (usual standard of care). Seven-day point prevalence abstinence was the primary outcome, measured at 2, 4, 6, and 9 months after random assignment. Data were analyzed by using a generalized estimating equations approach following the intent-to-treat principle. RESULTS: Subjects assigned to integrated care were five times more likely than subjects undergoing the usual standard of care to abstain from smoking across follow-up assessment intervals (odds ratio=5.23). Subjects in the integrated care condition were significantly more likely than subjects in usual standard of care to receive transdermal nicotine and nicotine gum. They also received a greater number of smoking-cessation counseling sessions. Stopping smoking was not associated with worsening symptoms of PTSD or depression. CONCLUSIONS: Smoking-cessation interventions can be safely incorporated into routine mental health care for PTSD and are more effective than treatment delivered separately by a specialized smoking-cessation clinic. Integrating cessation treatment into psychiatric care may have the potential for improving smoking quit rates in other populations of chronically mentally ill smokers.

Anger dysregulation, depressive symptoms, and health in married women and men.

BACKGROUND: Anger problems (anger dysregulation) and depressive symptoms have been linked to risk for all causes of mortality, but less is known about the association between anger dysregulation and depressive symptoms within the context of gender differences and health outcomes. OBJECTIVES: The association between anger dysregulation, depressive symptoms, and self-reports of health in married adults was evaluated using an emotion-regulation model. METHODS: Fifty-two married couples completed a series of procedures that included an interview assessing their ability to regulate anger, a questionnaire reporting depressive symptoms (Beck Depression Inventory) and self-reports indicating health. RESULTS: Results provided support for hypothesized links between the variables, but they varied by gender: (a) greater anger dysregulation in the wives, but not the husbands, was predictive of depressive symptoms; (b) anger dysregulation was predictive of the husbands' self-reports of health but was not predictive of the wives' self-reports of health; (c) depressive symptoms were not significantly associated with self-reports of health for either married women or men. DISCUSSION: These results suggest that anger dysregulation may play different roles in the depressive symptoms and self-reports of health for married women and men.

The roles of marriage and anger dysregulation in biobehavioral stress responses.

Physiological and behavioral correlates of anger dysregulation in adults were evaluated in the context of marital stress. Fifty-four married couples participated in a series of laboratory procedures that included electrocardiogram measures during a 15-min marital conflict interaction and an interview assessing their inability to regulate anger (anger dysregulation). Results from the multivariate regression analyses indicated that the nature of the couple's relationship, rather than individual levels of anger dysregulation, predicted lower parasympathetic cardiac activity (indexed by high-frequency heart period variability) and shorter cardiac interbeat intervals. Anger dysregulation, rather than the dyadic relationship, was predictive of greater displays of angry behavior during the marital conflict interaction. The importance of contextual factors in stress processes, such as stress due to marriage, are discussed in light of research linking poor marital quality to greater health risks for women than for men.

Correlates of gay and lesbian couples' relationship satisfaction and relationship dissolution.

A sample of committed gay and lesbian cohabiting couples engaged in two conversations after being apart for at least 8 hours: (a) an events of the day conversation and (b) a conflict resolution conversation. Physiological data were collected during the conversations and a videotape record was made. Couples viewed the videotapes and rated their affect during the interaction. The video records were coded with a system that categorized specific affects displayed. Models derived from physiology, from the perception of interaction, and from specific affective behavior were related to relationship satisfaction, and to the prediction of relationship dissolution over a 12-year period. Results supported previous findings that satisfaction and stability in gay and lesbian relationships are related to similar emotional qualities as in heterosexual relationships.

Observing gay, lesbian and heterosexual couples' relationships: mathematical modeling of conflict interaction.

Two samples of committed gay and lesbian cohabiting couples and two samples of married couples (couples in which the woman presented the conflict issue to the man, and couples in which the man presented the conflict issue to the woman) engaged in three conversations: (1) an events of the day conversation (after being apart for at least 8 hours), (2) a conflict resolution conversation, and (3) a pleasant topic conversation. The observational data were coded with a system that categorized specific affects displayed. Data were weighted and two time-series created, one for the husband and one of the wife. The time series were modeled with nonlinear difference equations (Cook et al., 1995), and parameters were estimated that indexed uninfluenced steady state, influenced steady state, emotional inertia, repair effectiveness and threshold, and the power of positive and negative affect of one partner to affect the other partner.