Examining Insomnia During Intensive Treatment for Veterans with Posttraumatic Stress Disorder: Does it Improve and Does it Predict Treatment Outcomes?

Previous research has demonstrated that sleep disturbances show little improvement with evidence-based psychotherapy for posttraumatic stress disorder (PTSD); however, sleep improvements are associated with PTSD treatment outcomes. The goal of the current study was to evaluate changes in self-reported insomnia symptoms and the association between insomnia symptoms and treatment outcome during a 3-week intensive treatment program (ITP) for veterans with PTSD that integrated cognitive processing therapy (CPT), mindfulness, yoga, and other ancillary services. As part of standard clinical procedures, veterans (N = 165) completed self-report assessments of insomnia symptoms at pre- and posttreatment as well as self-report assessments of PTSD and depression symptoms approximately every other day during treatment. Most veterans reported at least moderate difficulties with insomnia at both pretreatment (83.0%-95.1%) and posttreatment (69.1-71.3%). Statistically significant reductions in self-reported insomnia severity occurred from pretreatment to posttreatment; however, the effect size was small, d = 0.33. Longitudinal mixed-effects models showed a significant interactive effect of Changes in Insomnia × Time in predicting PTSD and depression symptoms, indicating that patients with more improvements in insomnia had more positive treatment outcomes. These findings suggest that many veterans continued to struggle with sleep disruption after a 3-week ITP, and successful efforts to improve sleep could lead to better PTSD treatment outcomes. Further research is needed to establish how adjunctive sleep interventions can be used to maximize both sleep and PTSD outcomes.

A placebo-controlled pilot study of a wearable morning bright light treatment for probable PTSD.

BACKGROUND: Evidence-based treatments for post-traumatic stress disorder (PTSD) have poor uptake and remission rates, suggesting that alternative treatments are needed. Morning bright light may be an effective treatment for PTSD given its established effects on mood and sleep, however, there are no published trials. METHODS: We conducted a placebo-controlled pilot trial of a wearable light device, the Re-timer®, for individuals with probable PTSD. Individuals were randomly assigned to the active Re-timer® (n = 9) or a placebo Re-timer® dimmed with neutral density filters (n = 6). Participants self-administered the treatment at home 1 hr each morning over 4 weeks. PTSD and depression symptoms were assessed at pre- and post-treatment. RESULTS: The Re-timer® was well tolerated and the perceived benefit was high, though treatment adherence was only moderate. Those in the active group were more likely to achieve a minimal clinically important change in PTSD and depression symptoms and had larger symptom reductions than those in the placebo group CONCLUSIONS: A wearable morning light treatment was acceptable and feasible for patients with probable PTSD. This study provides initial proof-of-concept that light treatment can improve PTSD. A larger trial is warranted to establish treatment efficacy. NCT#: 03513848.

Changes in emotion regulation difficulties and PTSD symptom severity in an intensive treatment program for PTSD.

BACKGROUND: Greater difficulties in emotion regulation (ER) and decreased use of adaptive ER strategies have been associated with higher levels of posttraumatic stress disorder (PTSD) symptoms. To date, limited research has explored whether ER improves with PTSD treatment or whether such improvements are linked with improvements in PTSD symptoms. METHODS: Veterans and service members with PTSD (N = 223) participated in a 2-week intensive treatment program (ITP) based in Cognitive Processing Therapy (CPT). ER was measured using the Difficulties in Emotion Regulation Short Form (DERS-SF) at baseline and on days 4 and 9 of treatment. PTSD symptoms were reported on the PTSD Symptom Checklist for DSM-5 (PCL-5) at baseline, on days 3, 5, 6, and 8 of treatment, and at post-treatment. RESULTS: DERS-SF scores decreased during treatment (Mchange = 5.12, d = 0.38). Baseline DERS-SF did not predict overall PCL-5 scores across timepoints (p = .377). However, scores on the DERS-SF over time were significantly associated with PCL-5 improvement over the course of treatment (p < .001, R2b = 0.07). Finally, improvements in all subscales of the DERS-SF across time except clarity were significantly associated with improvement in PCL-5 over time. LIMITATIONS: Additional treatment components in the ITP beyond CPT may have contributed to ER improvements. Conclusions are also limited by the use of self-report data. CONCLUSIONS: An intensive CPT-based treatment program for veterans and service members can lead to improved ER in two weeks. ER improvements are associated with PTSD symptom severity during the ITP.

The influence of neuropeptide Y (NPY) on the relationship between emotion regulation and mood-related pathology in survivors of childhood interpersonal trauma.

Neuropeptide Y (NPY) is a 36-amino acid peptide that is widely expressed throughout the limbic system. Recent evidence has highlighted NPY as a marker of resilience to posttraumatic psychopathology, which may be due to its association with neural regions involved with emotion regulation. This study examined whether plasma NPY levels moderated the relationship between emotion regulation and psychopathology in a sample of adult survivors of childhood interpersonal trauma, a population known to be at high risk for psychopathology. Adults exposed to an interpersonal criterion A trauma during childhood (N = 54) were recruited from an urban population at a midwestern medical center and completed a baseline study visit as part of a larger clinical trial. Participants gave a blood sample in order to assess circulating levels of NPY and answered questions related to emotion regulation and mood-related pathology. Results of a moderated multiple regression showed that the overall model was significant R2 = 0.26, F (5, 48) = 3.46, p < .01. Difficulties in emotion regulation was significantly predictive of psychopathology (unstandardized B = 0.032, p < .01), and this relationship was significantly moderated by levels of NPY (unstandardized B = -0.001, p < .05) such that the relationship between emotion regulation and psychopathology was weaker for those with higher levels of NPY. Results suggest that higher levels of NPY may lessen the association between emotion regulation and posttraumatic psychopathology in survivors of childhood interpersonal trauma. Further investigation of the contribution of NPY to psychopathology in this population is warranted. NCT: 02279290.

Rape Myth Acceptance Buffers the Association Between Sexual Assault and Posttraumatic Stress Disorder Symptoms Among College Students.

Rape myths are cultural beliefs that invalidate, blame, and stigmatize rape survivors, thereby perpetuating sexual violence. Few studies have explored associations between rape myth acceptance (RMA) and mental health outcomes, but evidence suggests that RMA can buffer the mental health impact of some forms of sexual assault. The current study examined the buffering effect of RMA on depression and posttraumatic stress disorder (PTSD) symptoms using self-report data from an online survey of 500 female college students. Findings provided support for the buffering effect of RMA on the association between any sexual assault and PTSD symptoms. Experiencing any sexual assault was significantly associated with greater PTSD symptoms among participants with low RMA, whereas this association was only marginally significant among those with high RMA. Findings demonstrate that there are some contexts in which high RMA might lessen the mental health impact of sexual assault. Thus, it is possible that as progress is made to dismantle rape myths in society, mental health symptoms amongst some survivors may exacerbate, thereby increasing the demand for mental health services.

Double-blind randomized controlled study of the efficacy, safety and tolerability of eszopiclone vs placebo for the treatment of patients with post-traumatic stress disorder and insomnia.

BACKGROUND: Sleep disturbance is a core feature of post-traumatic stress disorder (PTSD). Given the relationship between sleep disturbance and PTSD, there has been a relative paucity of studies examining the potential therapeutic impact of using pharmacotherapy to target sleep disturbance in patients with PTSD. Eszopiclone (ESZ) is a non-benzodiazepine y-aminobutyric acid-A receptor agonist indicated for the treatment of sleep and may affect sleep in patients with PTSD. AIM: To evaluate the efficacy of ESZ vs placebo (PBO) for patients with PTSD and insomnia. METHODS: The study was a 12-wk, double blind, randomized controlled trial with 3 mg of ESZ (n = 13) or PBO (n = 12). RESULTS: Patients in both arms experienced significant improvement in PTSD symptoms as assessed by the Clinician-Administered PTSD Scale for DSM-IV (CAPS): ESZ (t11 = -3.12, P = 0.005) and PBO (t11 = -3.5, P = 0.002) and by self-report with the Short PTSD Rating Interview (ESZ t11 = -3.38, P = 0.003 and PBO t11 = -4.48, P = 0.0005). There were no significant differences between treatments on the CAPS (t22 = -0.13, P = 0.70) or the Short PTSD Rating Interview (t22 = -0.58, P = 0.56). Similarly, both treated groups improved on sleep measures as assessed by the Pittsburgh Sleep Quality Index with PTSD Addendum (PSQI) and on total sleep time (TST) and sleep latency assessed by actigraphy with no significant differences between groups (PSQI t22 = -0.24, P = 0.81; total sleep time t10 = 0.13, P = 0.90 and sleep latency t10 = 0.68, P = 0.50). There was a significant correlation between improvement in sleep and overall improvement in PTSD as measured by change scores on the PSQI and CAPS, r(8) = 0.79, P = 0.01 for ESZ treated subjects, but not for those treated with PBO r(9) = 0.16, P = 0.69. Adverse events of ESZ were consistent with the known profile of the medication including dysgeusia (30%, mild), sedation (20%, mild) and headache (20%, moderate to severe). CONCLUSION: Results do not support the hypothesis of a specific positive effect of ESZ compared to PBO for measures of PTSD and associated sleep disturbance.

Dual Measures of Sexual Consent: A Confirmatory Factor Analysis of the Internal Consent Scale and External Consent Scale.

Sexual assault, often defined as nonconsensual sex, is a problem among college students. Universities have made efforts to increase student awareness about sexual consent, which varies along two dimensions: internal feelings of wantedness and external expressions of consent. However, interventions focus on increasing knowledge of the external expression of consent despite the importance of both dimensions for effective sexual communication. A validated research tool that captures students' ecological experiences along both dimensions is critical. The current study aimed to replicate and validate the factor structure of the Internal Consent Scale (ICS) and External Consent Scale (ECS) in a sample of 610 undergraduate students and to expand on prior work by examining associations with relationship to partner and sexual orientation. Confirmatory factor analyses (CFA) provided support for the ICS in its current form (i.e., model fit and factor loadings for the ICS were good). Although model fit for the ECS was good, one subscale, no response signals, had poor factor loadings (.16, .38); thus, suggestions are offered to improve its psychometric properties. Despite limitations of the ECS, these dual measures fill a gap in the consent literature by providing a tool to quantify internal and external aspects of sexual consent.

Posttraumatic Stress and Depression in the Aftermath of Environmental Disasters: A Review of Quantitative Studies Published in 2018.

PURPOSE OF REVIEW: As interest in the mental health consequences of environmental disasters increases, this review aimed to summarize peer-reviewed studies published in 2018 on posttraumatic stress disorder (PTSD) and depression symptoms after such events. RECENT FINDINGS: Notable trends in the past year of research included studies focusing on vulnerable populations (e.g., persons with preexisting physical health conditions), assessing the cumulative impact of exposure to multiple disasters, exploring pathway leading to PTSD and depression symptoms, and evaluating the effectiveness of post-disaster interventions. Over 100 articles were identified, focused on 40 disasters that occurred between 1982 and 2017. Prevalence estimates ranged from 0 to 70.51% for PTSD and 1.9 to 59.5% for depression. Consistent predictors of adverse outcomes included female gender, socioeconomic disadvantage, high disaster exposure, and low psychosocial resources. Further research that expands upon recent advances in the literature is critical given the large proportion of the world's population exposed to disasters and the increasing incidence of such events.

Poor Encoding and Weak Early Consolidation Underlie Memory Acquisition Deficits in Multiple Sclerosis: Retroactive Interference, Processing Speed, or Working Memory?

OBJECTIVE: Learning and memory impairments are common in multiple sclerosis (MS) and may be related to difficulty acquiring (encoding or consolidating) new information. We evaluate the role of retroactive interference and investigate whether minimizing interference immediately following encoding (early during consolidation) will improve MS participants' ability to remember new verbal information. Additionally, we investigate processing speed differences between memory-impaired and unimpaired participants and present an exploratory analysis of how the dual-components of working memory (capacity vs. processing) relate to memory impairment. METHOD: MS memory-unimpaired (N = 12) and MS memory-impaired participants (N = 12) were compared to healthy controls (N = 15). Interference onset following encoding (early, mid, late, no interference) was manipulated over the retention interval of a verbal learning and memory task. Response times (RT) were recorded during interference trials. RESULTS: MS memory-impaired participants encoded less information and lost proportionally more information over the retention interval (weak consolidation). Lengthening the onset of interference did not benefit memory performance in this sample. Memory performance was unrelated to RT but was related to performance on the Symbol Digit Modalities Test. Primary capacity of working memory did not differ across groups; however, secondary memory processing was reduced for MS memory-impaired participants. CONCLUSION: Minimizing interference following encoding did not improve memory in this sample. Both initial encoding and early consolidation were reduced for memory-impaired MS participants. Evidence for a relationship between processing speed and memory was mixed and depended on the processing speed assessment used. Memory impairment in MS may be partially due to inefficient processing within working memory.

Do the Morningness-Eveningness Questionnaire and Munich ChronoType Questionnaire Change After Morning Light Treatment?

The Morningness-Eveningness Questionnaire (MEQ) and Munich ChronoType Questionnaire (MCTQ) are sometimes used to estimate circadian timing. However, it remains unclear if they can reflect a change in circadian timing after a light treatment. In this study, 31 participants (25-68 years) completed both questionnaires before and after a 13-28 day morning light treatment. The dim light melatonin onset (DLMO), a physiological marker of circadian timing, was also assessed in a subsample of 16 participants. The DLMO phase advanced on average by 47 minutes (p<0.001). The MEQ score increased by 1.8 points (p=0.046). The MSFsc measure derived from the MCTQ advanced by 8.7 minutes (p=0.17). The shift towards morningness observed in both questionnaires correlated with the phase advance observed in the DLMO (MEQ r=-0.46, p=0.036; MSFsc r=0.81, p<0.001). Results suggest that these circadian questionnaires can change in response to a light treatment, indicating they can reflect underlying changes in circadian timing.