A pilot randomized controlled trial of online written exposure therapy delivered by peer coaches to veterans with posttraumatic stress disorder.

This pilot randomized clinical trial (RCT) sought to examine the preliminary efficacy of an internet-based version of written exposure therapy delivered to veterans through an online program supported by peer coaches. Veterans (N = 124) with clinically significant posttraumatic stress disorder (PTSD) symptoms were randomly assigned to imaginal exposure either via writing (written exposure) or verbal recounting (verbal exposure). The online treatment involved four to eight sessions of imaginal exposure preceded and followed by an online chat with a peer coach. Participants completed assessments at baseline, posttreatment, and 3-month follow-up. Half of the participants never started treatment; among those who started treatment, the mean number of sessions completed was 4.92. At posttreatment, participants in both conditions reported clinically meaningful improvements in PTSD symptoms, d = 1.35; depressive symptoms, d = 1.10; and functioning, d = 0.39. Although participants in both treatment conditions demonstrated significant improvements in PTSD symptom severity, equivalence results were inconclusive, as the 95% confidence interval of the change score difference exceeded the specified margin and overlapped with 0. Estimated mean change scores demonstrated that both conditions showed significant reductions at posttreatment and follow-up. Although engagement with the online program was a significant challenge, the findings suggest that written exposure therapy is effective for improving PTSD symptoms, depressive symptoms, and functioning when adapted for internet-based delivery and facilitated by peer coaches. Using technology to deliver exposure therapy and task-shifting the role of the therapist to peer coaches are promising strategies to increase access to effective PTSD care.

A multistep mediation model examining how consultation in prolonged exposure therapy affects PTSD treatment outcomes.

Prolonged exposure therapy (PE) is an evidence-based psychotherapy (EBP) for posttraumatic stress disorder (PTSD) that is underutilized in the military health system. Previous research suggests that postworkshop consultation is important for successful implementation. However, little is known about how consultation may relate to EBP adoption or patient outcomes. The present study addressed these gaps by examining associations between consultation, provider self-efficacy, use of PE, and patient outcomes using a multistep mediation model. This study used data from Foa et al. (2020), a two-armed randomized implementation trial comparing two PE training models: standard training (workshop only) and extended training (workshop + 6-8 months of postworkshop expert consultation) at three U.S. Army sites. Participants were patients with PTSD (N = 242) receiving care from the participating providers (N = 103). Providers who received extended training reported greater PE self-efficacy compared to standard training providers, but self-efficacy was unrelated to their use of PE components or to patient outcomes. Extended training providers used more PE components and had superior patient outcomes than standard training providers, and patient outcomes were mediated by the use of PE components. To our knowledge, this is the first study to demonstrate that EBP consultation leads to improved clinical outcomes for patients through increased use of the EBP. PE adoption (i.e., use of PE components in therapy) was not explained by increases in self-efficacy among providers who received extended training. Therefore, future research should assess how other factors may influence provider behavior in implementing EBPs. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Sleep timing, chronotype, and posttraumatic stress disorder: An individual participant data meta-analysis.

Sleep disturbance is a major component of posttraumatic stress disorder (PTSD). The role of circadian disruption is largely overlooked, though many PTSD studies collect proxy markers of circadian timing. This individual participant data (IPD) meta-analysis examined the correlation between sleep timing / chronotype and PTSD severity among individuals diagnosed with PTSD, the standardized mean difference in sleep timing / chronotype for individuals with and without PTSD, and moderators of these relationships. A systematic search was conducted; authors provided IPD for 27 studies and aggregate data for 16 studies (3,011 participants with PTSD; 2,703 participants without PTSD). Two-step meta-analyses were conducted using a random-effects multivariate approach with robust variance estimation. Bedtime and wake time were not significantly associated with PTSD symptoms or diagnosis. Less total sleep time / time in bed was weakly associated with greater PTSD symptoms. Moderator analyses revealed that effect sizes were stronger in certain populations and when using wrist actigraphy to measure sleep timing; however, gap maps revealed few studies in moderator categories with the strongest effects. Only two studies measured chronotype, prohibiting strong conclusions. Our findings indicate that the relationship between sleep timing and PTSD is weak; however, key gaps in the literature warrant further study.

Sentenced to shame: Moral injury exposure in former lifers.

OBJECTIVE: A significant increase in the release of individuals who served life sentences (i.e., lifers) in California has created the opportunity to study aspects of their psychological wellness for the first time. Moral injury may be a particularly relevant factor to consider in this population but has not been previously studied. This study is the first to explore the concept of moral injury within a currently or formerly incarcerated population. METHOD: Former lifers currently in reentry in California (N = 41) completed a survey that measured their moral injury exposure (MIE), MIE-related guilt, MIE-related shame, MIE-related rumination, religiosity, attempts at making amends, and flourishing. RESULTS: As expected, a high rate of lifetime MIEs was endorsed (97.6%). Events linked to life sentence crimes (75.6%) and time in prison (56.1%) were very common. Lower levels of MIE-related shame (r = -.58, p < .01) and higher levels of religiosity (r = .35, p < .05) were significantly associated with greater flourishing. By contrast, degree of MIE exposure, MIE-related guilt, and MIE-related rumination, and making amends were all weakly associated with flourishing. CONCLUSION: Our results highlight that MIE is pervasive in this population and extends beyond life sentence crimes. Moreover, our findings suggest that it is lifers' self-concept following MIEs that appears to affect well-being upon release, rather than the extent and nature of moral injury exposure. Further research exploring moral injury in incarcerated and formerly incarcerated populations is needed to improve their well-being and chances of successful reentry. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Molecular tectonics. Selective exchange of cations in porous anionic hydrogen-bonded networks built from derivatives of tetraphenylborate.

Tetraphenylmethanes with multiple hydrogen-bonding sites are known to associate to form robust porous supramolecular networks. Analogous anionic networks can be built from the corresponding tetraphenylborates. Crystallization of the tetraphenylphosphonium salt of tetraphenylborate 2 produces an anionic network in which 74% of the volume is available for including cations and neutral guests. Other salts of anion 2 with diverse cations crystallize consistently to form the same network, whereas a neutral analogue of anion 2, tetraphenylmethane 1, produces an uncharged network that is far less open. Cations can be exchanged in single crystals of salts of tetraphenylborate 2 with retention of crystallinity and with selectivities similar to those observed in typical zeolites. Together, these observations provide new strategies for making ordered molecular materials by design, and they reveal that constructing such materials from charged subunits offers special advantages.