Optimizing Allocation to Telehealth and In-Person Prolonged Exposure for Women Veterans with Military Sexual Trauma: A Precision Medicine Approach.

Military sexual trauma-related post-traumatic stress disorder (PTSD) is highly prevalent and costly among women veterans, making the need for effective and accessible treatment of critical importance. Access to care is a key mechanism of mental health disparities and might affect differential response to treatment. The goal of this study was to estimate an individualized treatment rule based on readily available individual characteristics related to access to care to optimize allocation to in-person vs.

The Transition to Adulthood: A Qualitative Study of Autism Spectrum Disorder From Military and Veteran Parents and Military-Dependent Young Adults.

Introduction: Given the unique experiences of military service members and their families, military-dependent young adults (18-25 years old) with autism spectrum disorder (ASD) and their military or veteran families experience unique barriers to accessing quality mental health care during the transition to adulthood. In fact, developing services to address ASD challenges for military families is a burgeoning area of interest for the department of defense. However, there is a limited knowledge on the specific needs of military families as the young adult's transition outside of high school and lose supports.

Grief on pain and quality of life in combat veterans with PTSD.

Persistent Complex Bereavement Disorder (PCBD) comprises a set of grief symptoms that are often linked to other psychological conditions such as PTSD and depression, may be prevalent in Veterans with combat experience, and may also impact general health. This study investigated the association between grief and sleep, pain, PTSD, and depression, among Veterans participating in a clinical trial for PCBD treatment. Data from 155 Veterans receiving treatments for PCBD were analysed to explore the association between PCBD and symptoms of sleep pain, PTSD, and depression.

Building resilience: A specialty clinic tailored to older adults at risk for violence and abuse.

Objective: Both structural (e.g., ageism) and personal (e.

State of the Science: Evidence-based treatments for posttraumatic stress disorder delivered via telehealth.

Psychotherapy delivered via telehealth technology is not an artifact of the COVID-19 pandemic. Indeed, widespread, telehealth-delivered, evidence-based psychotherapy preceded the pandemic, as did randomized controlled noninferiority trials supporting this modality. It is, thus, not difficult to predict that telehealth will be an integral part of daily clinical life moving forward.

Sequenced Treatment Effectiveness for Posttraumatic Stress (STEPS) Trial: A protocol for a pragmatic comparative effectiveness trial with baseline results.

Background: There have only been two efficacy trials reporting a head-to-head comparison of medications and psychotherapy for PTSD, and neither was conducted in primary care. Therefore, this protocol paper describes a pragmatic trial that compares outcomes of primary care patients randomized to initially receive a brief trauma-focused psychotherapy or a choice of three antidepressants. In addition, because there are few trials examining the effectiveness of subsequent treatments for patients not responding to the initial treatment, this pragmatic trial also compares the outcomes of those switching or augmenting treatments.

Peer support during in vivo exposure homework increases likelihood of prolonged exposure therapy completion.

Exposure-based treatments such as prolonged exposure therapy (PE) are effective for veterans with PTSD. However, dropout rates as high as 50% are common. The Department of Veterans Affairs employs peers to increase mental health treatment engagement, however peers are not routinely used to help patients complete PE homework assignments.

Differential relations between breathing retraining, in vivo exposure, and imaginal exposure homework completion and treatment outcomes in veterans receiving prolonged exposure for PTSD.

Objectives: Limited research exists that outlines the predictive relevance of the treatment components of prolonged exposure (PE) for post-traumatic stress disorder (PTSD) on PTSD and depression symptom outcomes. The goal of the present study was to investigate relations between participant completion of breathing retraining, in vivo exposure, and imaginal exposure exercises and symptom outcomes.

Methods: A total of 58 participants completed a trial of PE as part of a larger trial on peer involvement and treatment adherence.

Clinician perspectives on technology-enhanced in vivo exposures during prolonged exposure therapy for PTSD.

Objective: To investigate clinicians' perceptions regarding the use of mobile technology tools during prolonged exposure (PE) therapy to allow for monitoring and enhancing in-vivo exposures (IVEs).

Methods: Clinicians with training in PE therapy (N = 32; average of 9 years of practice) completed surveys asking about their perspectives on the utility of virtually attending IVEs with patients while simultaneously having access to real-time subjective and physiological data (i.e.

Improving function through primary care treatment of posttraumatic stress disorder study outcomes: A randomized controlled trial of prolonged exposure for primary care in veterans.

Introduction: Despite high cost and wide prevalence of posttraumatic stress disorder (PTSD) in veteran populations, and Veterans Health Administration (VA)-wide mental health provider training in evidence-based treatments for PTSD, most veterans with PTSD do not receive best practices interventions. This may be because virtually all evidence-based PTSD treatment is offered through specialty clinics, which require multiple steps and referrals to access. One solution is to offer PTSD treatment in VA primary care settings, which are often the first and only contact point for veterans.

Written Exposure Therapy vs Prolonged Exposure Therapy in the Treatment of Posttraumatic Stress Disorder: A Randomized Clinical Trial.

Importance: Evidence-based treatments for posttraumatic stress disorder (PTSD) exist, but all require 8 to 15 sessions and thus are less likely to be completed than brief treatments. Written exposure therapy (WET) is a brief and efficacious treatment that has not been directly compared with prolonged exposure therapy (PE), a more time-intensive, exposure-based treatment.

Objective: To determine whether WET is noninferior to PE in treating PTSD among veterans.

Patient-facing, Semi-automated, solutions to enhance patient participation in measurement-based care practice standards in a tele-mental health specialty clinic for populations at higher risk for self-harm.

Purpose: Collecting validated surveys that describe symptom severity (measurement based care) during evidence-based psychotherapy is crucial to allow a therapist to tailor the speed and intensity of treatment. COVID clinic closures mandated we create a flexible, remote system to conduct measurement-based care, which was accomplished via RedCap.

Methods: RedCap was used to create a semi-automated workflow allowing all clinically-indicated evidence-based surveys (including the PHQ-9) to be delivered via email to patients; with results automatically sent to their provider.

Impact and efficiency of treatment across two PTSD clinical trials comparing in-person and telehealth service delivery formats.

The intent of this study is to examine treatment impact and efficiency observed when cognitive behavioral treatments for posttraumatic stress disorder (PTSD) are delivered in-person or using telehealth. This study pooled data from 268 veterans enrolled in two PTSD clinical trials. In both trials, treatment was delivered using in-home telehealth ( arm), in-home in-person ( arm), and in-office care, where patients traveled to the Department of Veterans Affairs for either office-based telehealth or office-based in-person care ( arm).

A preliminary examination of sexual and physical victimization 6 months after recent rape.

One in four US women will experience a completed or attempted rape in their lifetime, and more than 50% of survivors will experience two or more rapes. Rape and physical violence also co-occur. Multiple experiences of sexual and physical violence are associated with elevated mental and physical health problems.

Home-based tDCS for apathy in Alzheimer's disease: a protocol for a randomized double-blinded controlled pilot study.

Background: Apathy is among the most common behavioral symptoms in dementia and is consistently associated with negative outcomes in Alzheimer's disease (AD). Despite its prevalence and clinical relevance, available pharmacological and non-pharmacological strategies to treat apathy in AD have been marked, respectively, by potentially severe side effects and/or limited efficacy. Transcranial direct current stimulation (tDCS) is a relatively novel non-pharmacological method of neuromodulation with promising results.

The influence of posttraumatic stress disorder treatment on anxiety sensitivity: Impact of prolonged exposure, sertraline, and their combination.

Trauma-informed beliefs often decrease during posttraumatic stress disorder (PTSD) treatment. This may also extend to anxiety sensitivity (AS), defined as a fear of anxiety-related sensations and beliefs that anxiety is dangerous and/or intolerable. However, little is known about how AS changes during exposure-based and psychopharmacological PTSD treatments.

Medical board transparency regarding physician sexual misconduct: Two years post-policy updates.

Recent years have seen increased attention to and motivation for addressing sexual violence. Physician sexual misconduct (PSM) represents a significant violation and abuse of power, with consequences for both patients and public trust in medicine. In the United States, the Federation of State Medical Boards released updated policies in 2020 imploring increased transparency and stronger punishments for PSM cases.

Influence of comorbid social anxiety disorder in PTSD treatment outcomes for Prolonged Exposure in female military sexual trauma survivors with PTSD.

Objective: Posttraumatic stress disorder (PTSD) is a common psychiatric disorder that frequently presents alongside other comorbid diagnoses. Although several evidence-based psychotherapies have been well-studied for PTSD, limited research has focused on the influence of diagnostic comorbidity on their outcomes. The present study sought to investigate the influence of comorbid social anxiety disorder on treatment outcomes in patients with PTSD.

Technology-enhanced in vivo exposures in Prolonged Exposure for PTSD: A pilot randomized controlled trial.

In vivo exposures (IVEs) are a key component of exposure-based treatments, during which patients approach fear-provoking, yet safe, situations in "real life." This pilot study assessed the use of a wearable technology (Bio Ware) during IVEs to enhance Prolonged Exposure (PE) therapy for PTSD. Bio Ware provides a clinician dashboard with real-time physiological and subjective data for clinicians to use for virtually guided IVEs.

Improving function through primary care treatment of PTSD: The IMPACT study protocol.

Despite the availability of effective psychological interventions for PTSD, access to and retention in these interventions remains problematic. Of note, the Veterans Health Administration (VHA) developed and implemented post-deployment health surveys that screen for PTSD in primary care (PC), but effective PC-based, psychological intervention treatment options have yet to be established. To address the literal physical gap between where the patients first present for care (i.

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.

The efficacy of 90-min versus 60-min sessions of prolonged exposure for PTSD: A randomized controlled trial in active-duty military personnel.

Objective: Prolonged exposure (PE) therapy is a first-line posttraumatic stress disorder (PTSD) treatment, but the manualized 90-min session format constitutes a barrier to adopting PE in most settings because they use 60-min sessions for scheduling and billing. We examined whether 60-min PE sessions were as effective and efficient as 90-min PE sessions.

Method: In total, 160 active-duty military personnel with PTSD were randomized to 8-15 sessions of 60- or 90-min PE sessions and assessed pre- and posttreatment, and 3- and 6-month posttreatment, using the Clinician Administered PTSD Scale for Diagnostic and Statistical Manual for Mental Disorders, 5th edition [DSM-5] (CAPS-5).

Enhancing Prolonged Exposure therapy for PTSD using physiological biomarker-driven technology.

Prolonged Exposure (PE) therapy is one of the most efficacious, evidence-based treatments for posttraumatic stress disorder (PTSD). A key component of PE involves in vivo exposures (IVEs) during which patients approach situations or activities in "real life" that are safe but avoided because they elicit a fear response. Despite their critical role in treatment, little research has focused on IVEs.

A randomized trial of brief couple therapy for PTSD and relationship satisfaction.

Objective: This three-arm randomized trial tested a brief version of cognitive-behavioral conjoint therapy (bCBCT) delivered in two modalities compared to couples' psychoeducation in a sample of U.S. veterans with posttraumatic stress disorder (PTSD) and their intimate partners.

Individual symptom reduction and post-treatment severity: Varying levels of symptom amelioration in response to prolonged exposure for post-traumatic stress disorder.

Many patients evince significant post-traumatic stress disorder (PTSD) symptoms after a dose of an evidence-based treatment (EBT) for PTSD. Little research systematically addresses if individual PTSD symptoms are more or less resistant to change through an EBT for PTSD or have greater or lesser post-treatment severity levels. Two studies within VA medical centers provided data.