Trauma Informed Guilt Reduction Therapy With Combat Veterans.

Guilt related to combat trauma is highly prevalent among veterans returning from Iraq and Afghanistan. Trauma-related guilt has been associated with increased risk for posttraumatic psychopathology and poorer response to treatment. Trauma Informed Guilt Reduction (TrIGR) therapy is a 4-module cognitive-behavioral psychotherapy designed to reduce guilt related to combat trauma. The goals of this study were to describe the key elements of TrIGR and report results of a pilot study with 10 recently deployed combat veterans. Ten combat veterans referred from a VA Posttraumatic Stress Disorder (PTSD) or mental health clinic completed TrIGR over 4 to 7 sessions. Nine veterans completed the posttreatment assessment. This initial pilot suggests that TrIGR may help to reduce trauma-related guilt severity and associated distress. Changes in trauma-related guilt were highly correlated with reductions in PTSD and depression symptoms over the course of treatment, suggesting a possible mechanistic link with severity of posttraumatic psychopathology. TrIGR warrants further evaluation as an intervention for reducing guilt related to traumatic experiences in combat.

Synthesis of the psychometric properties of the PTSD checklist (PCL) military, civilian, and specific versions.

The posttraumatic stress disorder checklist is a commonly used measure, with military (PCL-M), civilian (PCL-C), and specific trauma (PCL-S) versions. This synthesis of the psychometric properties of all three versions found the PCL to be a well-validated measure. The PCL shows good temporal stability, internal consistency, test-retest reliability, and convergent validity. The majority of structural validity studies support four factor models. Little is available on discriminant validity and sensitivity to change. Strengths, limitations, and future research directions are discussed. Understanding the PCL's psychometric properties, strengths (e.g., items map on to DSM-IV diagnostic criteria), and limitations (e.g., may overestimate PTSD prevalence) will help clinicians and researchers make educated decisions regarding the appropriate use of this measure in their particular setting.

A pilot study of seeking safety therapy with OEF/OIF veterans.

PTSD and substance use disorder (SUD) are highly prevalent among veterans returning from Iraq and Afghanistan (Operation Enduring Freedom/Operation Iraqi Freedom; OEF/OIF). Seeking Safety (SS) is a cognitive-behavioral psychotherapy for co-occurring PTSD/SUD. This pilot study with fourteen male OEF/OIF veterans suggests that SS may help to reduce alcohol use, PTSD, and depression in some participants at clinically significant levels, even when providing less than half of the full model. We emphasize several SS features as especially helpful: the case management component to help engage clients in further mental health and SUD care, offering PTSD as an entry point, and emphasis on community resources. Issues particular to veterans include reintegration to civilian life and supporting their connection with other veterans.

Parent-child agreement in the assessment of obsessive-compulsive disorder.

The purpose of the current study was to extend research regarding parent-child agreement in the assessment of anxiety disorders to include youth with obsessive-compulsive disorder (OCD). Ninety-three children and adolescents with OCD (50 female, 43 male), ages 6 to 17 years, and their parents were administered the Anxiety Disorders Interview Schedule for Children. Data were obtained from a review of records of children and their parents seeking services from a university-based research and treatment clinic. Consistent with previous research on the assessment of anxiety disorders in youth, results indicated that parent-child agreement in the assessment of OCD is relatively poor at both the diagnostic and symptom levels. Our findings highlight the importance of multiple informant diagnostic systems in assessing childhood OCD.

Review of biological mechanisms and pharmacological treatments of comorbid PTSD and substance use disorder.

Posttraumatic stress disorder (PTSD) and alcohol/substance use disorder (A/SUD) are frequently comorbid. Comorbidity is associated with poorer psychological, functional, and treatment outcomes than either disorder alone. This review outlines biological mechanisms that are potentially involved in the development and maintenance of comorbid PTSD and A/SUD including neurotransmitter and hypothalamic-pituitary-adrenal dysregulation, structural differences in the brain, and shared genetic risk factors. The literature regarding pharmacological treatments that have been investigated for comorbid PTSD and A/SUD is also reviewed. Empirical data for each proposed mechanism and pharmacological approach is reviewed with the goal of making recommendations for future research. This article is part of a Special Issue entitled 'Post-Traumatic Stress Disorder'.

Psychometrics of a brief measure of anxiety to detect severity and impairment: the Overall Anxiety Severity and Impairment Scale (OASIS).

Brief measures of anxiety-related severity and impairment that can be used across anxiety disorders and with subsyndromal anxiety are lacking. The Overall Anxiety Severity and Impairment Scale (OASIS) have shown strong psychometric properties with college students and primary care patients. This study examines sensitivity, specificity, and efficiency of an abbreviated version of the OASIS that takes only 2-3 min to complete using a non-clinical (college student) sample. 48 participants completed the OASIS and SCID for anxiety disorders, 21 had a diagnosis of ≥1 anxiety disorder, and 4 additional participants had a subthreshold diagnosis. A cut-score of 8 best discriminated those with anxiety disorders from those without, successfully classifying 78% of the sample with 69% sensitivity and 74% specificity. Results from a larger sample (n = 171) showed a single factor structure and excellent convergent and divergent validity. The availability of cut-scores for a non-clinical sample furthers the utility of this measure for settings where screening or brief assessment of anxiety is needed.

Posttraumatic stress disorder's role in integrated substance dependence and depression treatment outcomes.

Posttraumatic stress disorder (PTSD) frequently co-occurs with depression and substance use disorder (SUD). This study investigates the impact of PTSD diagnosis on treatment outcomes of 178 veterans treated for depression and SUD, with Integrated Cognitive-Behavioral Therapy (ICBT) or 12-Step Facilitation Therapy (TSF). Percentage days abstinent (PDA) and Hamilton Depression Rating Scale total score (HDRS total) trajectories were created. PDA was similar through initial follow-up; however, by 18 months, ICBT participants without PTSD had better PDA (M = 91%) than those without PTSD in TSF (M = 76%) and those with PTSD in either group (M = 75%-77%). Across time, participants with PTSD had higher depression levels than those without PTSD but benefited similarly from treatment (main effect, p < .004). Both conditions demonstrated reductions in average HDRS at 18 months (M = 17%-29%). Findings highlight the need to assess for PTSD and to investigate how to treat concomitant SUD, depression, and PTSD.