A protocol for a randomized controlled trial of exposure and response prevention for veterans with obsessive compulsive disorder.

Background: Obsessive compulsive disorder (OCD) is effectively treated with exposure and response prevention (ERP), yet very few veterans receive ERP for OCD within the Veterans Health Administration (VHA). Veterans are a clinically complex population, and no prior research has evaluated the effectiveness of ERP in veterans with OCD or comorbid OCD and posttraumatic stress disorder (PTSD). Given the limited accessibility of ERP-trained providers within VHA, assessment of video telehealth (VTH) delivery of ERP is warranted.

Management of Chronic Pain and PTSD in Veterans With tDCS+Prolonged Exposure: A Pilot Study.

Introduction: Chronic pain and posttraumatic stress disorder (PTSD) are prevalent comorbid conditions, particularly in Veterans; however, there are few integrated treatments for chronic pain and PTSD. Instead, interventions are typically implemented separately and may involve addictive opioids. Although there are highly effective, non-pharmacological treatments for PTSD, they are plagued by high dropout, which may be exacerbated by comorbid pain, as these PTSD treatments typically require increased activity.

Predictors of symptom reduction following intensive weekend treatment for panic disorder: An exploratory study of veterans.

Background: Recent evidence implicates intensive panic control treatment (IPCT) - a full panic control treatment protocol compressed into a single weekend - as a viable alternative for Veterans with panic disorder who are unable or unwilling to commit to standard weekly cognitive behavioral therapy (CBT). However, no studies to date have examined pretreatment predictors of response to IPCT. Knowledge of such predictors may be important for understanding which Veterans are best suited for IPCT relative to standard CBT.

Enhancing Problem-Solving Therapy With Smartphone Technology: A Pilot Randomized Controlled Trial.

Objective: Development of smartphone apps for mental health care has outpaced research on their effectiveness. This pilot study tested Moving Forward an app designed to support problem-solving therapy (PST).

Methods: Thirty-three veterans seeking mental health care in U.

Intolerance of uncertainty prospectively predicts the transdiagnostic severity of emotional psychopathology: Evidence from a Veteran sample.

Intolerance of uncertainty (IU) has been conceptualized as a transdiagnostic vulnerability for emotional psychopathology, but few studies have tested whether it prospectively predicts emotional psychopathology, and none have utilized transdiagnostic and clinician-rated outcomes. To fill this gap, the present study tested whether IU prospectively predicted the clinician-rated severity of transdiagnostic emotional psychopathology six months later in a treatment-seeking Veteran sample. Participants completed the Intolerance of Uncertainty 12-item scale (IUS-12) and the Structured Clinical Interview for the DSM-5 (SCID-5) at Time 1 and again six-months later (Time 2); assessed emotional disorders included both anxiety-related disorders (i.

Merging Our Understanding of Anxiety and Exposure: Using Inhibitory Learning to Target Anxiety Sensitivity in Exposure Therapy.

Exposure-based therapies are the gold standard treatment for anxiety disorders, and recent advancements in basic and clinical research point to the need to update the implementation of exposure. Recent research has highlighted the importance of transdiagnostic factors such as anxiety sensitivity (AS), or fear of anxiety-related sensations. Elevated AS is common among all anxiety disorders and contains three dimensions, or expectancies, that can be used to guide treatment.

A Pilot Study of Transdiagnostic Group Cognitive-behavior Therapy for Anxiety: An Intensive Weekend Intervention.

Anxiety disorders are highly prevalent and can cause serious functional impairment. Cognitive-behavioral treatments are effective but they are not always readily available. One factor contributing to this problem is the large number of disorder-specific treatments that require a high level of clinician training and resources, despite the similarity in the mechanisms underlying the various anxiety disorders and their treatments.

Using acceptance and commitment therapy techniques to enhance treatment engagement in veterans with posttraumatic stress disorder.

Evidence-based treatments for posttraumatic stress disorder (PTSD) are available for veterans, but many do not benefit due to low treatment engagement. This may be partially due to avoidance behaviors characteristic of individuals with PTSD. Acceptance and Commitment Therapy () is a transdiagnostic treatment approach that aims to reduce avoidance.

The impact of social support and morally injurious events on PTSD symptoms in Veterans.

Potentially morally injurious events (PMIEs), including committing transgressions (Transgressions-Self) and perceiving betrayals, have been positively associated with posttraumatic stress disorder (PTSD). A proposed mechanism for the association between PMIEs and PTSD symptoms is social disconnection. However, research on PMIEs and social disconnection is limited.

A Systematic Review of Intensive Empirically Supported Treatments for Posttraumatic Stress Disorder.

Various clinical practice guidelines for the treatment of posttraumatic stress disorder (PTSD) have consistently identified two frontline evidence-based psychotherapies (EBPs)-prolonged exposure (PE) and cognitive processing therapy (CPT)-as well as other empirically supported treatments (EST), such as eye movement desensitization and reprocessing (EMDR) and cognitive therapy for PTSD (CT for PTSD). However, researchers and clinicians continue to be concerned with rates of symptom improvement and patient dropout within these treatments. Recent attempts to address these issues have resulted in intensive, or "massed," treatments for PTSD.

Examining the Overlap Between Moral Injury and PTSD in US Veterans and Active Duty Military.

Moral injury (MI) is a syndrome thought to be separate from posttraumatic stress disorder (PTSD), yet having some overlap. To determine the overlap, we examined the relationship between MI and the four DSM-5 PTSD symptom clusters (B, C, D, E) in US veterans and active duty military (ADM). The 45-item Moral Injury Symptom Scale (MISS-M) was administered to 591 veterans and ADM who had served in a combat theater and had PTSD symptoms.

A proposal for augmenting the measurement of index events in PTSD assessment using event centrality.

Standard practice in assessing and diagnosing posttraumatic stress disorder (PTSD) entails identifying a single "worst" index event as the basis for symptom inquiry. Determining a single event can be challenging for clinicians and clients when multiple traumas are considered equally distressing. Additionally, it can be difficult to distinguish potential index events based on distress given the cumulative effect of repeated trauma exposure.

Dimensions of Religiosity and PTSD Symptom Clusters in US Veterans and Active Duty Military.

We examined multiple dimensions of religiosity and their relationship to the four DSM-5 PTSD symptom clusters among US Veterans and Active Duty Military (ADM), hypothesizing that religiosity would be most strongly inversely related to negative cognitions/emotions (Criterion D symptoms) and less strongly to neurobiologically based symptom clusters (B, C, and E). This cross-sectional multisite study involved 591 Veterans and ADM from across the southern USA. Inclusion criteria were having served in a combat theater and the presence of PTSD symptoms.

Importance of knowledge in the behavioural treatment of panic disorder.

Background: Cognitive behavioural therapy (CBT) for panic disorder encourages patients to learn about and make changes to thoughts and behaviour patterns that maintain symptoms of the disorder. Instruments to assess whether or not patients understand therapy content do not currently exist.

Aims: The aim of this study was to examine if increases within specific knowledge domains of panic disorder were related to improvement in panic symptoms following an intensive 2-day panic treatment.

Co-Occurrence of Obsessive-Compulsive Disorder and Substance Use Disorders Among U.S. Veterans: Prevalence and Mental Health Utilization.

Obsessive-compulsive disorder (OCD) and substance-use disorders (SUDs) co-occur at high rates, which is related to poorer psychosocial outcomes. Prior work suggests that, among veterans in the Veterans Health Administration (VHA), OCD is underdiagnosed and undertreated, which can compound negative effects of OCD and SUD co-occurrence. This study identified patterns of OCD and specific SUD co-occurrence and their effect on mental health and substance-use screening measures and mental healthcare utilization.

Implications of comorbid OCD on PTSD treatment: A case study.

Given the high degree of diagnostic overlap and limited empirical literature surrounding the comorbidity between posttraumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD), appropriately conceptualizing the relationship between the comorbid symptoms and their impact on the treatment process can be challenging. This is especially true when the symptoms of the two disorders become functionally connected, with each symptom set maintaining the other. This article details the case of a veteran with comorbid PTSD and OCD who sought intensive trauma-focused treatment within the U.

Interest among veterans in spiritually-oriented therapy for inner conflict/moral injury in the setting of PTSD.

Background: We examined U.S. veterans' interest in spiritually-oriented therapy (SOT) for treating inner conflict/moral injury (ICMI); identified combat-related, demographic, religious, and psychological characteristics of those interested in this treatment modality; and determined which participants would prefer SOT therapy.

Religious Involvement, Anxiety/Depression, and PTSD Symptoms in US Veterans and Active Duty Military.

Religious involvement is associated with mental health and well-being in non-military populations. This study examines the relationship between religiosity and PTSD symptoms, and the mediating effects of anxiety and depression in Veterans and Active Duty Military (V/ADM). This was a cross-sectional multi-site study involving 585 V/ADM recruited from across the USA.

Emotion Regulation Difficulties in Relation to Anxiety, Depression, and Functional Impairment Among Treatment-Seeking Smokers.

Psychological distress is elevated among smokers and plays a key role in the maintenance of smoking behavior. Although research has implicated emotion regulation (ER) difficulties as a transdiagnostic construct for psychological distress, empirical work has not yet investigated ER difficulties among treatment-seeking smokers. The purpose of the current study was to increase understanding of ER difficulties in relation to depression, anxious arousal, and functional impairment among treatment-seeking smokers.

Obsessive-compulsive disorder in the Veterans Health Administration.

Little is known about the diagnosis and treatment of obsessive-compulsive disorder (OCD) in the Veterans Health Administration (VHA). This study examined diagnostic rates of OCD in a national sample of veterans as well as clinical comorbidities and mental health service use following an OCD diagnosis. This study used administrative data extracted from VHA medical records to identify patients with an OCD diagnosis between 2010 and 2011 (N = 20,364).

Screening for Moral Injury: The Moral Injury Symptom Scale - Military Version Short Form.

Introduction: To develop a short form (SF) of the 45-item multidimensional Moral Injury Symptom Scale - Military Version (MISS-M) to use when screening for moral injury and monitoring treatment response in veterans and active duty military with PTSD.

Methods: A total of 427 veterans and active duty military with PTSD symptoms were recruited from VA Medical Centers in Augusta, GA; Los Angeles, CA; Durham, NC; Houston, TX; and San Antonio, TX; and from Liberty University, Lynchburg, Virginia. The sample was randomly split in two.

Moral Injury and Religiosity in US Veterans With Posttraumatic Stress Disorder Symptoms.

Moral injury (MI) involves feelings of shame, grief, meaninglessness, and remorse from having violated core moral beliefs related to traumatic experiences. This multisite cross-sectional study examined the association between religious involvement (RI) and MI symptoms, mediators of the relationship, and the modifying effects of posttraumatic stress disorder (PTSD) severity in 373 US veterans with PTSD symptoms who served in a combat theater. Assessed were demographic, military, religious, physical, social, behavioral, and psychological characteristics using standard measures of RI, MI symptoms, PTSD, depression, and anxiety.

The Moral Injury Symptom Scale-Military Version.

The purpose of this study was to develop a multi-dimensional measure of moral injury symptoms that can be used as a primary outcome measure in intervention studies that target moral injury (MI) in Veterans and Active Duty Military with PTSD. This was a multi-center study of 427 Veterans and Active Duty Military with PTSD symptoms recruited from VA Medical Centers in Augusta, Los Angeles, Durham, Houston, and San Antonio, and from Liberty University in Lynchburg. Internal reliability of the Moral Injury Symptom Scale-Military Version (MISS-M) was examined along with factor analytic, discriminant, and convergent validity.