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1.
Psychol Trauma ; 2021 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-34582229

RESUMO

INTRODUCTION: Among trauma-exposed, forcibly displaced Muslims, very little is known about how social connectedness, or perceived interpersonal connection and belonging, may alter the relationship between discrimination and negative posttraumatic cognitions. Discrimination may aggravate trauma psychopathology (Helms et al., 2010); however, social connectedness may buffer its negative effects (Juang & Alvarez, 2010). OBJECTIVE: We examined whether higher religious and racial/ethnic discrimination would be associated with stronger negative posttraumatic cognitions and whether stronger social connectedness may adaptively buffer this relationship. METHOD: Trauma exposed individuals (N = 99) who identified as Muslim and as a refugee, asylum seeker, or internally displaced person participated in the study. Measures of discrimination, social connection, and posttraumatic cognitions were completed. RESULTS: Higher discrimination was moderately associated with stronger negative trauma-related cognitions (r = .40, p < .001) and with lower social connectedness (r = -.32, p = .001). Social connectedness moderated the relationship between discrimination and posttraumatic cognitions, such that at lower levels of social connectedness there was a stronger relationship between discrimination and posttraumatic cognitions (-2SD: b = .32, -1SD: b = .23, M: b = .14), this was not present at higher levels of social connectedness. CONCLUSIONS: Connectedness to one's minority group may be an important protective factor by modulating the effects of discrimination on posttrauma adjustment. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

2.
Depress Anxiety ; 38(9): 882-885, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34469042

RESUMO

INTRODUCTION: The ongoing coronavirus disease 2019 (COVID-19) pandemic is a globally significant crisis with a rapid spread worldwide, high rates of illness and mortality, a high degree of uncertainty, and a disruption of daily life across the sociodemographic spectrum. The clinically relevant psychological consequences of this catastrophe will be long-lasting and far-reaching. There is an emerging body of empirical literature related to the mental health aspects of this pandemic and this body will likely expand exponentially. The COVID-19 pandemic is an example of a historic catastrophe from which we can learn much and from which the field will need to archive, interpret, and synthesize a multitude of clinical and research observations. METHODS: In this commentary, we discuss situations and contexts in which a diagnosis of posttraumatic stress disorder (PTSD) may or may not apply within the context of diagnostic and statistical manual of mental disorders, fifth edition (DSM-5) criteria. RESULTS: Our consensus is that a COVID-related event cannot be considered traumatic unless key aspects of DSM-5's PTSD Criterion A have been established for a specific type of COVID-19 event (e.g., acute, life-threatening, and catastrophic). CONCLUSION: The application of a more liberal interpretation of Criterion A will dilute the PTSD diagnosis, increase heterogeneity, confound case-control research, and create an overall sample pool with varying degrees of risk and vulnerability factors.


Assuntos
COVID-19 , Transtornos de Estresse Pós-Traumáticos , Manual Diagnóstico e Estatístico de Transtornos Mentais , Humanos , Pandemias , SARS-CoV-2 , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/epidemiologia
3.
Behav Ther ; 52(4): 970-981, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34134835

RESUMO

Posttraumatic stress disorder (PTSD) frequently co-occurs with major depressive disorder, and empirically supported PTSD treatments consistently improve depression. However, both diagnoses are heterogeneous and specific patterns of symptom overlap may be related to worse treatment outcome. Two hundred individuals with chronic PTSD participated in a doubly randomized preference trial comparing prolonged exposure and sertraline. Latent Profile Analysis was used to identify classes based on PTSD and depression symptoms prior to starting treatment. A three-class model best fit the data, with a high depression and PTSD severity class (distressed), a moderate depression and low PTSD avoidance class (depressive), and a low depression and high PTSD avoidance class (avoidant). The avoidant class showed the lowest rates of major depressive disorder diagnosis and transdiagnostic vulnerabilities to depression. Patients in the distressed class experienced more robust PTSD treatment response, with no differences between prolonged exposure and sertraline. These findings highlight the role of avoidance in nondepressed PTSD presentations while also demonstrating that co-occurring depression is not contraindicated in evidence-based PTSD treatment.


Assuntos
Transtorno Depressivo Maior , Transtornos de Estresse Pós-Traumáticos , Depressão , Transtorno Depressivo Maior/complicações , Transtorno Depressivo Maior/tratamento farmacológico , Transtorno Depressivo Maior/epidemiologia , Humanos , Transtornos de Estresse Pós-Traumáticos/complicações , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/terapia , Resultado do Tratamento
4.
J Anxiety Disord ; 78: 102367, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33592520

RESUMO

BACKGROUND: Posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) co-occur at high rates and greater disorder severity. Studies examining the contributions of specific emotion regulation (ER) processes and negative affect (NA) to PTSD and MDD co-occurrence are scarce. This study investigated a transdiagnostic understanding of the nature of PTSD and MDD co-occurrence by examining the roles of NA, ER processes, and negative mood regulation (NMR) expectancies in PTSD and MDD in relation to trauma. METHODS: Structural equation modeling was used to examine the roles of emotionality, PTSD, and MDD constructs in 200 individuals with primary PTSD. RESULTS: ER processes fully mediated the relationships between NA and PTSD (ß = .40, p < .001) and MDD (ß = .48, p < .001), and NMR expectancies and PTSD (ß = -.31, p < .001) and MDD (ß = -.37, p < .001). CONCLUSIONS: NA and NMR expectancies exert their effects on PTSD and MDD almost entirely through ER processes. ER appears to be a transdiagnostic process, partly accounting for the co-occurrence between PTSD and MDD. Co-occurrence models could benefit by incorporating ER processes to inform diagnostic classification and criteria and clinical intervention improved by specifically targeting ER processes.


Assuntos
Transtorno Depressivo Maior , Regulação Emocional , Transtornos de Estresse Pós-Traumáticos , Comorbidade , Transtorno Depressivo Maior/epidemiologia , Emoções , Humanos , Transtornos de Estresse Pós-Traumáticos/epidemiologia
5.
J Nerv Ment Dis ; 209(1): 28-34, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33093357

RESUMO

Refugees, asylum seekers, and internally displaced persons differ in their experiences, potentially affecting posttraumatic outcomes such as posttraumatic stress disorder (PTSD) symptoms, posttraumatic cognitions, and posttraumatic growth (PTG), as well as psychosocial outcomes such as social connection, discrimination, and well-being. We explored these differences in a sample of N = 112 Muslim displaced persons. Results from planned contrasts indicated that refugees reported more PTSD symptoms (t[46.63] = 3.04, p = 0.004, d = 0.77) and more PTG (t[94] = 2.71, p = 0.008, d = 0.61) than asylum seekers. Higher posttraumatic cognitions predicted less social connections across displacement immigration category. The strength of this relationship was more pronounced for asylum seekers than refugees (b = -0.43, p = 0.014). Refugees may focus more on direct threats from others, resulting in more PTSD symptoms, whereas asylum seekers' uncertainty may pose a greater threat, exacerbating posttraumatic beliefs that drive social disconnection.


Assuntos
Islamismo/psicologia , Refugiados , Discriminação Social , Transtornos de Estresse Pós-Traumáticos/psicologia , Adulto , Emigração e Imigração , Feminino , Humanos , Masculino , Refugiados/psicologia , Refugiados/estatística & dados numéricos , Apoio Social , Inquéritos e Questionários
6.
Behav Res Ther ; 135: 103750, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33035741

RESUMO

Despite effective interventions for posttraumatic stress disorder (PTSD), many patients prematurely drop out. Differentiating "types" of dropout at various stages of treatment may improve our ability to predict and prevent attrition. Using data from a doubly randomized preference trial, this study examined patient dropout prior to treatment and compared these "nonstarters" with treatment starters and in-treatment dropouts. Patients (N = 200) with chronic PTSD were randomized to "choice" (prolonged exposure [PE] or sertraline) or "no choice" (re-randomized to PE or sertraline) and received up to 10 weeks of treatment. Overall dropout rate was 33.0% (n = 66). A substantial minority were nonstarters (n = 19; 28.8%). Relative to patients who began treatment, nonstarters reported less severe PTSD symptomatology (p = .03, d = 0.57) and were less likely to have received their preferred treatment (p < .001). These differences remained even when comparing nonstarters to patients that began treatment but eventually dropped out. Differences in beliefs (i.e., perceived credibility) toward one treatment versus the other were also linked to pretreatment dropout. Reasons underlying dropout likely differ during various treatment stages. Better understanding risk factors for types of dropout may inform strategies to boost engagement and retention, ultimately improving patient outcomes.

7.
Behav Res Ther ; 135: 103747, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33049550

RESUMO

OBJECTIVE: This study examines whether imaginal exposure leads to symptom exacerbation, systematically comparing individuals who received prolonged exposure (PE) to those who received pharmacotherapy. The study also examined whether common clinical features increase the likelihood of symptom exacerbation. METHOD: In 151 men and women with PTSD, we examined rates of reliable exacerbation of PTSD and depression symptoms after initiation of imaginal exposure and compared it to those receiving sertraline. We also examined relationships between exacerbation, treatment outcome, dropout, imaginal distress, and specific clinical features, including co-occurring MDD, multiple co-occurring disorders, childhood sexual abuse as target trauma, and a history of childhood physical or sexual abuse. RESULTS: Symptom exacerbation was not more common in PE compared to sertraline, not associated with higher dropout, or predictive of worse outcome. Those with co-occurring depression or multiple disorders, a target trauma of child sexual abuse, or a history of child abuse reported functionally equivalent peak distress at onset of imaginal as those without these characteristics. These factors did not lead to more exacerbation or worse adherence. CONCLUSION: Exacerbation was not specific to PE and patients with and without symptom worsening showed comparable treatment gains, suggesting symptom exacerbation may reflect a common clinical process.

8.
Behav Res Ther ; 132: 103690, 2020 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-32650231

RESUMO

The efficacy of treatments for posttraumatic stress disorder (PTSD) among African Americans is less clear given underrepresentation in clinical research. Additionally, intervention research examining race has typically not considered within-group heterogeneity, such as acculturation, ethnic identity, and cultural attitudes. In a randomized controlled trial, African American (n = 43) and Caucasian (n = 130) individuals received prolonged exposure (PE) or sertraline for PTSD, comparing: treatment response, retention, and treatment beliefs and preferences. Indirect effects of cultural variables were also examined. African Americans reported stronger ethnic identity (d = 0.71), less positive attitudes toward other groups (d = 0.36), and less acculturation (d = 0.51) than Caucasians. Noninferiority analyses indicated clinically equivalent PTSD outcomes for African Americans and Caucasians in both treatments. Groups showed comparable improvements in depression and functioning, and similar treatment preferences and beliefs. African Americans attended fewer sessions in PE (d = 0.87) and sertraline (d = 0.53) than Caucasians. Indirect effects analyses indicated positive cultural attitudes toward other ethnoracial groups were consistently associated with better treatment outcome and retention. Despite no differential effectiveness, findings may highlight the need to target retention among African Americans. Within-group cultural aspects of race may be an informative complement to basic, categorical conceptualizations.

9.
J Trauma Stress ; 33(4): 488-499, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32662191

RESUMO

Trauma survivors with posttraumatic stress disorder (PTSD) frequently also suffer from difficulties in social functioning that range across emotional, cognitive, and environmental domains. A detailed evaluation of the differential impacts of effective PTSD treatments on social functioning is needed. Men and women (N = 200) with chronic PTSD received 10 weeks of prolonged exposure (PE) or sertraline in a randomized clinical trial and were followed for 24 months. A secondary data analysis examined changes in social functioning with regard to fear of intimacy; receipt of social support; and distress, avoidance, and negative cognitions in social situations. Effects were examined between treatments over time, controlling for baseline functioning. There were large, durable improvements across all indices. Compared to sertraline, PE was more efficient at reducing fear of intimacy and distress from negative social cognitions by posttreatment, ds = 0.94-1.14. Patients who received sertraline continued to improve over the course of follow-up, ds = 0.54-1.17. The differential speed of therapeutic effects may argue for more direct mechanisms in cognitive behavioral interventions versus cascade effects in serotonin reuptake inhibitors. Notably, both treatments produced substantial social benefits for trauma survivors with social functioning difficulties, and effect sizes were comparable to typical reductions in PTSD, depression, and anxiety.

10.
Psychol Trauma ; 12(S1): S47-S48, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32496106

RESUMO

The COVID-19 global pandemic is in many ways unchartered mental health territory, but history would suggest that long-term resilience will be the most common outcome, even for those most directly impacted by the outbreak. We address 4 common myths about resilience and discuss ways to systematically build individual and community resiliency. Actively cultivating social support, adaptive meaning, and direct prosocial behaviors to reach the most vulnerable can have powerful resilience promoting effects. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Assuntos
Adaptação Psicológica , Infecções por Coronavirus/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Pandemias , Pneumonia Viral/psicologia , Trauma Psicológico/psicologia , Resiliência Psicológica , Comportamento Social , Apoio Social , Adulto , COVID-19 , Humanos , Saúde Mental
11.
Am J Psychiatry ; 176(4): 287-296, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30336702

RESUMO

OBJECTIVE: The authors examined the effect of patient treatment preference on the differential effectiveness of prolonged exposure and sertraline for the treatment of posttraumatic stress disorder (PTSD). METHOD: In a doubly randomized preference trial, 200 patients with PTSD viewed standardized treatment rationales prior to randomization. Patients were first randomized to choice of treatment or no choice. Those assigned to no choice were then randomized to prolonged exposure or sertraline. Acute treatment was 10 weeks, with 24-month follow-up. Interviewer-rated PTSD symptom severity was the main outcome measure, and depression, anxiety, and functioning were assessed as additional outcomes. RESULTS: Patients preferred prolonged exposure over sertraline (number needed to benefit [NNTB]=4.5). Using intent-to-treat analyses (N=200), both prolonged exposure and sertraline showed large gains that were maintained over 24 months. Although no differential effect was observed on interviewer-rated PTSD severity, there was a significant benefit of prolonged exposure over sertraline on interview-rated loss of PTSD diagnosis (NNTB=7.0), responder status (NNTB=5.7), and self-reported PTSD, depression, and anxiety symptoms and functioning (effect sizes, 0.35-0.44). Patients who received their preferred treatment were more likely to be adherent, lose their PTSD diagnosis (NNTB=3.4), achieve responder status (NNTB=3.4), and have lower self-reported PTSD, depression, and anxiety symptoms (effect sizes, 0.40-0.72). CONCLUSIONS: Prolonged exposure and sertraline confer significant benefits for PTSD, with some evidence of an advantage for prolonged exposure. Giving patients with PTSD their preferred treatment also confers important benefits, including enhancing adherence.


Assuntos
Terapia Implosiva/métodos , Inibidores de Captação de Serotonina/uso terapêutico , Sertralina/uso terapêutico , Transtornos de Estresse Pós-Traumáticos/terapia , Adulto , Feminino , Humanos , Masculino , Transtornos de Estresse Pós-Traumáticos/tratamento farmacológico
12.
Br J Psychiatry ; 213(6): 704-708, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30355364

RESUMO

BACKGROUND: Better indicators of prognosis are needed to personalise post-traumatic stress disorder (PTSD) treatments.AimsWe aimed to evaluate early symptom reduction as a predictor of better outcome and examine predictors of early response. METHOD: Patients with PTSD (N = 134) received sertraline or prolonged exposure in a randomised trial. Early response was defined as 20% PTSD symptom reduction by session two and good end-state functioning defined as non-clinical levels of PTSD, depression and anxiety. RESULTS: Early response rates were similar in prolonged exposure and sertraline (40 and 42%), but in sertraline only, early responders were four times more likely to achieve good end-state functioning at post-treatment (Number Needed to Treat = 1.8, 95% CI 1.28-3.00) and final follow-up (Number Needed to Treat = 3.1, 95% CI 1.68-16.71). Better outcome expectations of sertraline also predicted higher likelihood of early response. CONCLUSIONS: Higher expectancy of sertraline coupled with early response may produce a cascade-like effect for optimal conditions for long-term symptom reduction. Therefore, assessing expectations and providing clear treatment rationales may optimise sertraline effects. DECLARATION OF INTEREST: None.


Assuntos
Antidepressivos/uso terapêutico , Sertralina/uso terapêutico , Transtornos de Estresse Pós-Traumáticos/tratamento farmacológico , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Autorrelato , Resultado do Tratamento , Estados Unidos
13.
Clin Psychol Rev ; 66: 80-96, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-29945741

RESUMO

Women are disproportionately affected by posttraumatic stress disorder (PTSD), and gonadal hormones are implicated in fear learning processes associated with PTSD. In rodents, lower estradiol, particularly during metestrus when progesterone is also low, is associated with impaired extinction. Based on theories that extinction deficits underlie PTSD, individuals with lower estradiol and progesterone may exhibit fear learning deficits and higher PTSD symptomatology. A systematic review was conducted in PsycInfo, PubMed, and Medline databases for studies examining estradiol, progesterone, or menstrual phase in relation to fear learning or PTSD symptoms. Twenty-three studies are organized into fear learning (k = 17) and PTSD symptom (k = 12) studies. Across fear learning studies, higher estradiol was consistently associated with enhanced fear extinction recall and inconsistently and weakly associated with better extinction learning and fear acquisition, respectively. Extending to PTSD symptoms, the association with hormonal status was reversed, such that luteal phase, associated with higher estradiol and progesterone, was generally associated with higher re-experiencing symptoms. Overall, human fear learning studies were consistent with rodent studies. Despite strong experimental links between fear learning processes and PTSD, the clinical translation was inconsistent and may reflect varying methods, imprecise measurement, and greater complexity of hormonal effects on symptomatology.


Assuntos
Estrogênios/metabolismo , Medo/fisiologia , Aprendizagem/fisiologia , Ciclo Menstrual/metabolismo , Progesterona/metabolismo , Transtornos de Estresse Pós-Traumáticos/metabolismo , Animais , Feminino , Humanos
14.
J Consult Clin Psychol ; 86(5): 439-451, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29683701

RESUMO

OBJECTIVE: With the inclusion of a dissociative subtype, recent changes to the DSM-5 diagnosis of posttraumatic stress disorder (PTSD) have emphasized the role of dissociation in the experience and treatment of the disorder. However, there is a lack of research exploring the clinical impact for highly dissociative groups receiving treatment for PTSD. The current study examined the presence and clinical impact of a dissociative subtype in a sample of individuals receiving treatment for chronic PTSD. METHOD: This study used latent transition analyses (LTA), an expanded form of latent profile analyses (LPA), to examine latent profiles of PTSD and dissociation symptoms before and after treatment for individuals (N = 200) receiving prolonged exposure (PE) or sertraline treatment for chronic PTSD. RESULTS: The best fitting LTA model was one with a 4-class solution at both pretreatment and posttreatment. There was a latent class at pretreatment with higher levels of dissociative symptoms. However, this class was also marked by higher reexperiencing symptoms, and membership was not predicted by chronic child abuse. Further, although those in the class were less likely to transition to the responder class overall, this was not the case for exposure-based treatment specifically. CONCLUSION: These findings are not in line with the dissociative-subtype theoretical literature that proposes those who dissociate represent a clinically distinct group that may respond worse to exposure-based treatments for PTSD. (PsycINFO Database Record


Assuntos
Transtornos Dissociativos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Adulto , Ansiolíticos/uso terapêutico , Manual Diagnóstico e Estatístico de Transtornos Mentais , Transtornos Dissociativos/psicologia , Transtornos Dissociativos/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psicoterapia , Autorrelato , Sertralina/uso terapêutico , Transtornos de Estresse Pós-Traumáticos/psicologia , Transtornos de Estresse Pós-Traumáticos/terapia , Resultado do Tratamento
15.
Qual Life Res ; 27(6): 1555-1562, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29541927

RESUMO

PURPOSE: Health outcomes may depend on which treatment is received, whether choice of treatment is given, and whether a received treatment is the preferred therapy. We examined the effects of these key factors on the EuroQol-5D (EQ-5D-3L) in patients with PTSD. METHODS: Two hundred patients aged 18-65 years with PTSD diagnosis enrolled in a doubly randomized preference trial (DRPT) examining treatment, choice of treatment, and treatment-preference effects of prolonged exposure therapy (PE) and pharmacotherapy with sertraline (SER) (clinicaltrials.gov Identifier: NCT00127673). We performed difference-in-difference analysis to estimate the treatment effects of prolonged exposure therapy (PE) as compared to pharmacotherapy with sertraline (SER), receipt of choice versus no-choice of treatment, and receipt of preferred versus non-preferred treatment on health-related quality-of-life (HRQOL) outcome using the EQ-5D-3L completed at baseline and 10-week post-treatment. RESULTS: The treatment effects of PE on the EQ-5D scores in overall patients and subgroup of patients who preferred PE were 0.150 (p = 0.025) and 0.223 (p < 0.001), respectively. The effects of treatment choice were 0.088 (p = 0.050) and 0.156 (p = 0.043) in overall patients and subgroup of patients received SER, respectively. The effects of treatment preference were 0.101 (p = 0.038) and 0.249 (p = 0.004) in overall patients and subgroup of patients SER, respectively. CONCLUSIONS: Overall, PE is associated with better improved HRQOL, especially in patients who prefer it. Independently, allowing patients to choose their preferred treatment resulted in better HRQOL than either assigning them a treatment or giving them a treatment that is not preferred.


Assuntos
Qualidade de Vida/psicologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos de Estresse Pós-Traumáticos/terapia , Adulto Jovem
16.
Psychol Bull ; 144(6): 584-640, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29553763

RESUMO

Intrusive memories, when persistent and distressing, are theorized to underlie a range of transdiagnostic psychological symptoms and associated impairment. However, little is known about factors predicting the development and persistence of intrusive memories. The aim of this systematic review is to evaluate the literature on pre-event, event-based, and post-event predictors of intrusive memories. A systematic review was conducted, searching for studies that examined intrusive, event-based memories. One hundred and six articles were identified from PsycInfo, PubMed, and Medline databases. Experimental and prospective studies with clinical (N = 14) and nonclinical (N = 92) samples were critically reviewed, provided the inclusion of an analogue stressor with nonclinical samples, and that intrusive memories frequency and/or distress were assessed as primary dependent variables. Pre-existing psychopathology and pre-event appraisal style appear to predict intrusive memories (small to medium effects), whereas trait dissociation did not predict intrusive memories. Of studies examining event-based predictors, higher data-driven processing appears to predict intrusive memories with generally large effects. Post-event negative appraisals consistently predicted intrusive memories (medium to large effects), and preliminary evidence suggests higher post-event conceptual processing predicting fewer intrusive memories. This review synthesizes findings regarding a broad range of pre-event, event-based, and post-event factors that may influence the development of intrusive memories. Methodological issues of current paradigms and the lack of emphasis on memory retrieval processes limit our understanding of what predicts intrusive memory persistence. These limitations are particularly important given that individuals typically seek treatment for distressing intrusive memories once a memory has been fully consolidated, where retrieval processes are of utmost importance. (PsycINFO Database Record


Assuntos
Cognição/fisiologia , Rememoração Mental/fisiologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Adulto , Ansiedade/psicologia , Feminino , Humanos , Memória/fisiologia , Valor Preditivo dos Testes , Estudos Prospectivos , Estresse Psicológico/psicologia , Violência/psicologia
17.
Psychol Addict Behav ; 32(3): 277-288, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29595297

RESUMO

The co-occurrence of posttraumatic stress disorder (PTSD) and substance use is related to poorer outcome and increased dropout from trauma-focused treatment. Investigating PTSD and substance use can inform the intervention approaches. Exploring cannabis use in particular is especially important because rates of cannabis use have been increasing with recent legalization trends. A better understanding of how substance use is associated with treatment processes and outcome for individuals with PTSD is needed to enhance care. In this study, both lifetime diagnoses of alcohol and drug use disorders and current alcohol and drug use severity were examined in 200 men and women with chronic PTSD who received either prolonged exposure (PE) or sertraline. No lifetime or current alcohol use variables predicted dropout, adherence, or poorer outcome. However, lifetime diagnosis of both an alcohol and drug disorder (OR = 3.42) and recent cannabis use (OR = 3.38) strongly predicted higher dropout. Recent cannabis use and drug use severity predicted poorer adherence to PE (ß = -.22 to -.29) but not to sertraline. Drug use severity (ß = -.22) also predicted worse treatment outcome, as did lifetime diagnosis of an alcohol and drug disorder (ß = -.48). Overall, patients with drug use improved with treatment but had less treatment retention, adherence, and symptom reduction. Strategies to increase engagement and retention may be indicated for these patients. Individuals who are using cannabis or other drugs may be at higher risk for not completing PTSD treatment, potentially prolonging the cycle of PTSD and substance use. (PsycINFO Database Record


Assuntos
Consumo de Bebidas Alcoólicas/psicologia , Fumar Maconha/psicologia , Transtornos de Estresse Pós-Traumáticos/terapia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adulto , Terapia Combinada , Feminino , Humanos , Terapia Implosiva , Masculino , Inibidores de Captação de Serotonina , Sertralina/uso terapêutico , Transtornos de Estresse Pós-Traumáticos/complicações , Transtornos de Estresse Pós-Traumáticos/psicologia , Transtornos Relacionados ao Uso de Substâncias/complicações , Resultado do Tratamento
18.
J Clin Psychiatry ; 78(7): e782-e789, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28686823

RESUMO

OBJECTIVE: The memory-enhancing drug methylene blue (MB) administered after extinction training improves fear extinction retention in rats and humans with claustrophobia. Robust findings from animal research, in combination with established safety and data showing MB-enhanced extinction in humans, provide a foundation to extend this work to extinction-based therapies for posttraumatic stress disorder (PTSD) such as prolonged exposure (PE). METHODS: Patients with chronic PTSD (DSM-IV-TR; N = 42) were randomly assigned to imaginal exposure plus MB (IE + MB), imaginal exposure plus placebo (IE + PBO), or waitlist (WL/standard PE) from September 2011 to April 2013. Following 5 daily, 50-minute imaginal exposure sessions, 260 mg of MB or PBO was administered. Waitlist controls received PE following 1-month follow-up. Patients were assessed using the independent evaluator-rated PTSD Symptom Scale-Interview version (primary outcome), patient-rated PTSD, trauma-related psychopathology, and functioning through 3-month follow-up. RESULTS: Both IE + MB and IE + PBO showed strong clinical gains that did not differ from standard PE at 3-month follow-up. MB-augmented exposure specifically enhanced independent evaluator-rated treatment response (number needed to treat = 7.5) and quality of life compared to placebo (effect size d = 0.58). Rate of change for IE + MB showed a delayed initial response followed by accelerated recovery, which differed from the linear pattern seen in IE + PBO. MB effects were facilitated by better working memory but not by changes in beliefs. CONCLUSIONS: The findings provide preliminary efficacy for a brief IE treatment for PTSD and point to the potential utility of MB for enhancing outcome. Brief interventions and better tailoring of MB augmentation strategies, adjusting for observed patterns, may have the potential to reduce dropout, accelerate change, and improve outcomes. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01188694.


Assuntos
Extinção Psicológica/efeitos dos fármacos , Terapia Implosiva/métodos , Azul de Metileno/uso terapêutico , Psicoterapia Breve/métodos , Transtornos de Estresse Pós-Traumáticos/psicologia , Transtornos de Estresse Pós-Traumáticos/terapia , Adulto , Doença Crônica , Terapia Combinada , Feminino , Seguimentos , Humanos , Entrevista Psicológica , Masculino , Pessoa de Meia-Idade , Pacientes Desistentes do Tratamento/psicologia , Qualidade de Vida/psicologia , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Resultado do Tratamento
19.
Clin Psychol Sci ; 5(2): 212-225, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28503366

RESUMO

Seminal theories posit that fragmented trauma memories are critical to posttraumatic stress disorder (PTSD; van der Kolk & Fisler, 1995; Brewin, 2014) and that elaboration of the trauma narrative is necessary for recovery (e.g., Foa, Huppert, & Cahill, 2006). According to fragmentation theories, trauma narrative changes, particularly for those receiving trauma-focused treatment, should accompany symptom reduction. Trauma and control narratives in 77 men and women with chronic PTSD were examined pre- and post-treatment, comparing prolonged exposure (PE) and sertraline. Utilizing self-report, rater coding, and objective coding of narrative content, fragmentation was compared across narrative types (trauma, negative, positive) by treatment modality and response, controlling for potential confounds. Although sensory components increased with PE (d = 0.23 - 0.44), there were no consistent differences in fragmentation from pre- to post-treatment between PE and sertraline or treatment responders and non-responders. Contrary to theories, changes in fragmentation may not be a crucial mechanism underlying PTSD therapeutic recovery.

20.
J Consult Clin Psychol ; 85(9): 873-882, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28504542

RESUMO

OBJECTIVE: Negative trauma-related belief change has been found to predict subsequent improvement in symptoms of posttraumatic stress disorder (PTSD) in prolonged exposure (PE) and other therapies, consistent with several psychological theories of treatment change (e.g., Foa & Kozak, 1986). However, belief change has not been examined in selective serotonin reuptake inhibitors such as sertraline. We examined processes associated with symptom improvement in 2 treatments for PTSD, hypothesizing that belief change would robustly predict PTSD improvement in patients treated with PE but not those treated with sertraline, reflecting moderation by treatment. METHOD: Patients with chronic PTSD (N = 134; 78% women, 71.6% Caucasian, M = 38.1 years, SD = 11.8) received 10 weeks of PE or sertraline in a randomized, controlled trial. Patients reported PTSD and depression symptoms, and trauma-related beliefs (Post-Traumatic Cognitions Inventory; Foa, Ehlers, Clark, D Tolin, & Orsillo, 1999) at pretreatment, every treatment session, and posttreatment. RESULTS: Using time-lagged mixed regression models, change in trauma-related beliefs predicted subsequent PTSD symptom improvement, an effect moderated by treatment and particularly strong in PE (d = 0.93) compared with sertraline (d = 0.35). Belief change also predicted depressive symptom improvement but more modestly and bidirectionally, with no difference by treatment modality. CONCLUSIONS: Trauma-related belief change precedes PTSD improvement more robustly in PE than in sertraline and with greater specificity compared with depressive symptoms. These findings highlight potentially divergent processes contributing to symptom change in these PTSD treatments, with belief change as a key mechanism of PE. (PsycINFO Database Record


Assuntos
Depressão/terapia , Terapia Implosiva/métodos , Avaliação de Resultados em Cuidados de Saúde , Inibidores de Captação de Serotonina/farmacologia , Sertralina/farmacologia , Transtornos de Estresse Pós-Traumáticos/terapia , Pensamento/fisiologia , Adulto , Depressão/tratamento farmacológico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inibidores de Captação de Serotonina/administração & dosagem , Sertralina/administração & dosagem , Transtornos de Estresse Pós-Traumáticos/tratamento farmacológico , Resultado do Tratamento
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