Augmenting Virtual Reality Exposure Therapy for Social and Intergroup Anxiety With Transcranial Direct Current Stimulation.

Objectives: Exposure therapy is a cornerstone of social anxiety treatment, yet not all patients respond. Symptoms in certain social situations, including intergroup (ie, out-group) contexts, may be particularly resistant to treatment. Exposure therapy outcomes may be improved by stimulating neural areas associated with safety learning, such as the medial prefrontal cortex (mPFC).

Longitudinal associations between moral injury perceptions and mental health among healthcare workers during the pandemic.

Objective: The COVID-19 pandemic strained the healthcare system and resulted in higher rates of potentially morally injurious events. These events are perceived as violating one's own moral code, so a more precise construct label could be moral injury perceptions (MIPs). MIPs may exacerbate stress-related symptoms.

Relationships Between Burnout, Secondary Traumatic Stress, Mindfulness, and Self-Compassion in Victim Advocates.

Victim advocates experience burnout and secondary traumatic stress (STS) in response to their exposure to trauma at work. Mindful awareness may serve as a protective factor against these negative outcomes. The current study examined a sample of 133 victim advocates from across the country to better understand and predict STS and burnout.

The association of distress tolerance and mindful awareness with mental health in first responders.

Mindful awareness (MA) and distress tolerance are emerging as robust predictors of mental health in populations with high levels of stress and trauma exposure, such as first responders. The combination of both protective factors may have potentiating benefits for mental health. First responders might especially benefit from high levels of MA if they are able to tolerate distressing present-moment experiences as needed.

Patterns of acute stress disorder in a sample of blast-injured military service members: A latent profile analysis.

Objective: The primary aims of this study were to identify latent profiles of acute stress disorder (ASD) symptoms and to evaluate postconcussive symptom differences across the identified profiles as measured by the Acute Stress Disorder Scale and the Military Acute Concussion Evaluation, respectively.

Method: Participants (N = 315) in the current study were predominantly active-duty (75.0%), enlisted (97.

The protective effects of perceived cohesion on the mental health of first responders.

First responders are repeatedly exposed to traumatic and stressful situations. Perceived cohesion can mitigate the potentially harmful psychological impact of these stressors. While the positive effects of cohesion have been established in other trauma-exposed populations such as the military, these effects have not been examined in first responders.

Compassion for Oneself and Others Protects the Mental Health of First Responders.

Objectives: First responders are at elevated risk for psychological distress from frequent exposure to potentially traumatic events. Self-compassion may buffer against the negative impact of these stressors, and the potential emotional challenges of having high levels of compassion for others. However, little is known about the psychological impact of compassion in first responders.

Augmenting exposure therapy with pre-extinction fear memory reactivation and deepened extinction: A randomized controlled trial.

Background: Pre-extinction fear memory reactivation (PE-FMR) and deepened extinction (DE) enhance long-term extinction of shock-conditioned fear, and may also enhance long-term extinction of naturally acquired fear. Preliminary data suggest that PE-FMR may additionally boost the speed of fear reduction during exposure therapy.

Design: Randomized controlled trial, factorial design.

Distress Tolerance and Emotion Regulation as Potential Mediators Between Secondary Traumatic Stress and Maladaptive Coping.

The extant literature has illustrated that protective service workers experience negative repercussions associated with their job (including the development of secondary traumatic stress; STS) and may utilize maladaptive coping mechanisms. Developing an improved understanding of factors that might explain the relationship between STS and the utilization of maladaptive coping mechanisms is warranted. This study sought to examine emotion regulation and distress tolerance as potential mediators between STS and the utilization of maladaptive coping mechanisms.

Association between physical activity and mental health among first responders with different service roles.

Studies suggest that physical activity (PA) improves psychological recovery in trauma-exposed populations like first responders. However, trauma exposure varies among first responders in relation to their unique service roles and duties. The purpose of this study was to examine the interaction effect of service role (traditional vs.

Air Force Medical Personnel: Perspectives Across Deployment.

Introduction: Contingency operations during the past 18 years have exposed millions of U.S. military service members to numerous combat and operational stressors.

Residual Insomnia and Nightmares Postintervention Symptom Reduction Among Veterans Receiving Treatment for Comorbid PTSD and Depressive Symptoms.

While evidence-based interventions can help the substantial number of veterans diagnosed with comorbid PTSD and depression, an emerging literature has identified sleep disturbances as predictors of treatment nonresponse. More specifically, predicting effects of residual insomnia and nightmares on postintervention PTSD and depressive symptoms among veterans with comorbid PTSD and depression has remained unclear. The present study used data from a clinical trial of Behavioral Activation and Therapeutic Exposure (BA-TE), a combined approach to address comorbid PTSD and depression, administered to veterans (N = 232) to evaluate whether residual insomnia and nightmare symptoms remained after treatment completion and, if so, whether these residual insomnia and nightmare symptoms were associated with higher levels of comorbid PTSD and depression at the end of treatment.

Does trauma-focused exposure therapy exacerbate symptoms among patients with comorbid PTSD and substance use disorders?

Background: Although exposure-based therapy is a well-established, effective treatment for post-traumatic stress disorder (PTSD), some practitioners report reluctance to implement it due to concerns that it may exacerbate symptoms of PTSD and commonly comorbid disorders, such as substance use disorders (SUD).

Aim: This study compared the exacerbation of psychological symptoms among participants with comorbid PTSD and SUD who received either SUD treatment alone or SUD treatment integrated with exposure therapy for PTSD.

Method: Participants (N = 71) were treatment-seeking, military Veterans with comorbid PTSD and SUD who were randomized to 12 individual sessions of either (1) an integrated, exposure-based treatment (Concurrent Treatment of PTSD and Substance Use Disorders using Prolonged Exposure; COPE); or (2) a non-exposure-based, SUD-only treatment (Relapse Prevention; RP).

An Examination of Social Support and PTSD Treatment Response During Prolonged Exposure.

Objective: Posttraumatic stress disorder (PTSD) results from exposure to traumatic events. Social support is negatively related to PTSD symptoms in cross-sectional and longitudinal studies. It is unclear, however, if social support is associated with treatment response for PTSD.

Deployed Military Medical Personnel: Impact of Combat and Healthcare Trauma Exposure.

Introduction: Limited research has been conducted on the impact of deployment-related trauma exposure on post-traumatic stress symptoms in military medical personnel. This study evaluated the association between exposure to both combat experiences and medical duty stressors and post-traumatic stress symptoms in deployed military medical personnel.

Materials And Methods: U.

Acute Assessment of Traumatic Brain Injury and Post-Traumatic Stress After Exposure to a Deployment-Related Explosive Blast.

Introduction: Traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) are two of the signature injuries in military service members who have been exposed to explosive blasts during deployments to Iraq and Afghanistan. Acute stress disorder (ASD), which occurs within 2-30 d after trauma exposure, is a more immediate psychological reaction predictive of the later development of PTSD. Most previous studies have evaluated service members after their return from deployment, which is often months or years after the initial blast exposure.

Cortisol, Testosterone, and Prospective Risk for War-zone Stress-Evoked Depression.

Introduction: The major challenges of efforts to reveal biological risk factors and biomarkers of depression include the complexity of underlying systems, interactions with other systems, and contextual factors governing their expression. Altered endocrine function is believed to be a central contributor to depressive illness, but across studies, evidence for a link between endocrine markers and depression has been mixed, inconclusive, or conditional in nature. In the present study, we evaluated basal testosterone (T), cortisol (C), and CO2 inhalation-stress-reactivity measures of these hormones (TR, CR) as pre-deployment moderators of the later impact of war-zone stressors on depression symptoms in-theater.

Residual Sleep Problems Predict Reduced Response to Prolonged Exposure among Veterans with PTSD.

Objectives: While evidence-based treatments exist for posttraumatic stress disorder (PTSD), a significant sub-set of veterans continue to meet criteria for PTSD after treatment. Sleep problems may affect treatment retention and predict efficacy for PTSD treatments.

Methods: The present study used data from a clinical trial of Prolonged Exposure therapy (PE) administered to veterans (N=154) to evaluate whether residual sleep symptoms remained after treatment completion, and if so, whether these residual sleep symptoms were associated with higher levels of PTSD and comorbid depression at the end of treatment.

Substance use disorders in military veterans: prevalence and treatment challenges.

Substance use disorders (SUDs) are a significant problem among our nation's military veterans. In the following overview, we provide information on the prevalence of SUDs among military veterans, clinical characteristics of SUDs, options for screening and evidence-based treatment, as well as relevant treatment challenges. Among psychotherapeutic approaches, behavioral interventions for the management of SUDs typically involve short-term, cognitive-behavioral therapy interventions.

The influence of traumatic brain injury on treatment outcomes of Concurrent Treatment for PTSD and Substance Use Disorders Using Prolonged Exposure (COPE) in veterans.

Background: The co-occurrence of posttraumatic stress disorder (PTSD), substance use disorders (SUD), and traumatic brain injury (TBI) in veterans of Operations Enduring/Iraqi Freedom and New Dawn has received much attention in the literature. Although hypotheses have been presented and disseminated that TBI history will negatively influence treatment response, little data exist to support these claims. The present study investigates the influence of TBI history on response to COPE (Concurrent Treatment of PTSD and SUD Using Prolonged Exposure), a 12-session, integrated psychotherapy designed to address co-occurring PTSD and SUD.

Predictors of Treatment Discontinuation During Prolonged Exposure for PTSD.

Background: Post-traumatic stress disorder (PTSD) is a highly prevalent and impairing condition for which there are several evidence-based psychotherapies. However, a significant proportion of patients fail to complete a 'sufficient dose' of psychotherapy, potentially limiting treatment gains.

Aims: The present study investigated predictors of premature treatment discontinuation during a trial of prolonged exposure (PE) therapy for PTSD.

Dual-hormone stress reactivity predicts downstream war-zone stress-evoked PTSD.

Background: The crucial role of the hypothalamic-pituitary-adrenal axis (HPA) in stress-related homeostasis suggests dysregulated HPA involvement in the pathogenesis of post-traumatic stress disorder (PTSD), yet most studies examining linkages between HPA axis measures and PTSD have yielded null findings. One untested explanation for this inconsistency is a failure to account for simultaneous adrenal and gonadal influence. Here we tested the singular and interactive effects of cortisol (C) and testosterone (T) reactivity as moderators of war-zone stress evoked PTSD emergence in the war-zone.

Posttraumatic Stress Disorder: Overview of Evidence-Based Assessment and Treatment.

Posttraumatic stress disorder (PTSD) is a chronic psychological disorder that can develop after exposure to a traumatic event. This review summarizes the literature on the epidemiology, assessment, and treatment of PTSD. We provide a review of the characteristics of PTSD along with associated risk factors, and describe brief, evidence-based measures that can be used to screen for PTSD and monitor symptom changes over time.