Key Elements in Couples Therapy With Veterans With Combat-Related Posttraumatic Stress Disorder.

If a client dealing with combat-related posttraumatic stress disorder (PTSD) presents for psychotherapy, should you consider including his or her partner in treatment? How could couples therapy be beneficial? What framework do you have to conceptualize the relational issues and potential treatment? Although clinicians have long been encouraged to include families in the treatment of combat-related PTSD, few specific couple-family therapies exist, and outcome research is scarce. Because of the adverse effects of PTSD on relationships, couples therapy can be a powerful adjunct treatment; however, few receive this service. A new framework for conceptualizing couples therapy organizes treatment around the 3 PTSD symptom clusters (reexperiencing, avoidance, and arousal). Relationship consequences of each symptom cluster are summarized, followed by useful treatment interventions and a case study. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Risk Factors for Partner Violence Among a National Sample of Combat Veterans.

In this study, the authors identified potential risk factors for partner violence perpetration among a subsample (n=109) of men who participated in a national study of Vietnam veterans. Partner violent (PV) men with posttraumatic stress disorder (PTSD) were compared with PV men without PTSD and nonviolent men with PTSD on family-of-origin variables, psychiatric problems, relationship problems, and war-zone factors. PV men with PTSD were the highest of the 3 groups on every risk factor other than childhood abuse. Group contrasts and a classification tree analysis suggest some potential markers and mechanisms for the association between PTSD and partner violence among military veterans and highlight the need for theory development in this area of inquiry. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Externalizing and Internalizing Subtypes of Combat-Related PTSD: A Replication and Extension Using the PSY-5 Scales.

This study replicated and extended prior findings of internalizing and externalizing subtypes of posttraumatic response (M. W. Miller, J. L. Greif, & A. A. Smith, 2003). Cluster analyses of the Minnesota Multiphasic Personality Inventory-2 Personality Psychopathology-Five (MMPI-2 PSY-5; A. R. Harkness, J. L. McNulty, Y. S. Ben-Porath, 1995) profiles obtained from 736 veterans with posttraumatic stress disorder (PTSD) partitioned the sample into a low pathology cluster defined by personality scores in the normal range, an externalizing cluster characterized by low constraint and high negative emotionality, and an internalizing cluster with high negative emotionality and low positive emotionality. Externalizers showed the highest rates of alcohol-related and antisocial personality disorders; internalizers, the highest rates of panic and major depressive disorder. These findings support the development of a personality-based typology of posttraumatic response designed to account for heterogeneity in the expression of PTSD and associated psychopathology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A clinician's guide to PTSD treatments for returning veterans.

What options are available to mental health providers helping clients with posttraumatic stress disorder (PTSD)? In this paper we review many of the current pharmacological and psychological interventions available to help prevent and treat PTSD with an emphasis on combat-related traumas and veteran populations. There is strong evidence supporting the use of several therapies including prolonged exposure (PE), eye movement desensitization and reprocessing (EMDR), and cognitive processing therapies (CPT), with PE possessing the most empirical evidence in favor of its efficacy. There have been relatively fewer studies of nonexposure based modalities (e.g., psychodynamic, interpersonal, and dialectical behavior therapy perspectives), but there is no evidence that these treatments are less effective. Pharmacotherapy is promising (especially paroxetine, sertraline, and venlafaxine), but more research comparing the relative merits of medication vs. psychotherapy and the efficacy of combined treatments is needed. Given the recent influx of combat-related traumas due to ongoing conflicts in Iraq and Afghanistan, there is clearly an urgent need to conduct more randomized clinical trials research and effectiveness studies in military and Department of Veterans Affairs PTSD samples. Finally, we provide references to a number of PTSD treatment manuals and propose several recommendations to help guide clinicians' treatment selections. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

A Longitudinal Study of the Relationship Between Depressive Symptoms and Cigarette Use Among African American Adolescents.

The relationship between depressive symptoms and cigarette use was examined in a sample of 623 African Americans during adolescence and transition to adulthood by using hierarchical linear modeling. Participants in the study were interviewed across 6 occasions over 8 years. Results indicate that depressive symptoms tend to decrease over time, whereas cigarette use tends to increase for both female and male adolescents. The results also suggest that depressive symptoms predict later cigarette use. Male adolescents who reported more depressive symptoms were more likely than female adolescents to use cigarettes as a way to cope with their mood. These results suggest that depressive symptoms may be important to consider when developing smoking cessation interventions for African American youth. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

PTSD treatment and 5-year remission among patients with substance use and posttraumatic stress disorders.

Given the high prevalence of comorbid substance use and posttraumatic stress disorders (SUD-PTSD), how to best treat these patients is a pressing concern for SUD providers. PTSD treatment may play an important role in patients' recovery. One hundred male SUD-PTSD patients who attended SUD treatment completed 1-, 2-, and 5-year follow-ups. Outpatient treatment information was gathered from Veterans Affairs databases. PTSD treatment and 12-Step group attendance in the 1st year predicted 5-year SUD remission. Patients who received PTSD treatment in the first 3 months following discharge and those who received treatment for a longer duration in Year 1 were more likely to be remitted in Year 5. The receipt of PTSD-focused treatment immediately after SUD treatment may enhance long-term remission. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A Longitudinal Analysis of PTSD Symptom Course: Delayed-Onset PTSD in Somalia Peacekeepers.

Posttraumatic stress disorder (PTSD) typically follows an acute to chronic course. However, some trauma victims do not report significant symptoms until a period of time has elapsed after the event. Although originally dismissed as an artifact of retrospective methodologies, recent prospective studies document apparent instances of delayed-onset PTSD. Little is known currently about factors associated with the delayed onset of PTSD. This study was designed to examine the course of PTSD in a sample of 1,040 U.S. military peacekeepers who served in Somalia. A small but nontrivial subset of participants endorsed clinically significant levels of PTSD after a period of minimal distress, the magnitude of which cannot be ascribed to minor waxing and waning of symptoms. War-zone exposure and perceived meaningfulness of the mission, as rated by soldiers after returning to the United States, predicted symptom course over the next 18 months. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Risk Factors for Course of Posttraumatic Stress Disorder Among Vietnam Veterans: A 14-Year Follow-Up of American Legionnaires.

Risk factors affecting the course of posttraumatic stress disorder (PTSD) are poorly understood. As part of a larger study on characterizing exposure to herbicides in Vietnam, the authors investigated this issue in a random sample of 1,377 American Legionnaires who had served in Southeast Asia during the Vietnam War and were followed over a 14-year period. High combat exposure, perceived negative community attitudes at homecoming, minority race, depression symptoms at Time 1, and more anger at Time 1 predicted a more chronic course. Community involvement at Time 1 was protective and associated with decreased risk at Time 2. Discomfort in disclosing Vietnam experiences was associated with an increased risk for developing PTSD but did not predict its course. Combat exposure predicted PTSD course more strongly than any other risk factor. Findings suggest recovery from PTSD is significantly influenced by perceived social support. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

PTSD and substance-related problems: The mediating roles of disconstraint and negative emotionality.

The authors examined competing hypotheses regarding the role of 2 personality dimensions, disconstraint and negative emotionality, in mediating the relationship between posttraumatic stress disorder (PTSD) severity and substance-related problems. Data were drawn from a large sample of male Vietnam veterans. The best-fitting structural model included significant indirect paths from PTSD to both alcohol- and drug-related outcomes through disconstraint, and a significant indirect path from PTSD to alcohol-related problems through negative emotionality. There were no direct effects of PTSD on either substance-related outcome. These findings indicate distinct pathways to different forms of substance-related problems in PTSD and underscore the role of personality in mediating these relationships. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A Meta-Analytic Review of Racial-Ethnic Matching for African American and Caucasian American Clients and Clinicians.

A meta-analysis was conducted to evaluate the effectiveness of client-clinician matching on the basis of race-ethnicity on overall functioning, service retention, and total number of sessions attended for African American and Caucasian American adult populations in mental health services. The analysis included 10 published and unpublished studies between 1991 and 2001. A random effects meta-analysis model showed no significant differences between client-clinician dyads matched racially-ethnically and those dyads not matched with respect to overall functioning, service retention, and total number of sessions attended. The finding was consistent for both African American and Caucasian American clients. Further implications of the findings are discussed. The authors also encourage more complete reporting of data suitable for quantitative research synthesis. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pre- and Postinjury Substance Misuse Among Veterans With Spinal Cord Injury.

Objective: To identify rates of substance misuse with onset before and after spinal cord injury (SCI) and to investigate whether patients with a history of substance misuse are more likely to report being intoxicated at the time of injury. Participants: One hundred twenty-four veterans with traumatic SCIs. Measures: Alcohol and nonalcohol psychoactive substance use disorder (PSUD) sections of the Structured Clinical Interview for DSM-III-R. Results: Forty (32%) had a lifetime PSUD. Of those, 55% recalled the onset of their PSUD occurring preinjury, 27.5% recalled the onset occurring postinjury, and 17.5% could not recall their age at onset. Compared with participants who reported postinjury onset of PSUD, those with reported preinjury onset were more likely to report intoxication at time of injury. No significant relation was found between intoxication at injury and presence of a lifetime PSUD. Conclusion: Intoxication at injury does not necessarily substantiate the existence of an underlying substance misuse problem. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Risk and Protective Factors for Substance Use Among African American High School Dropouts.

Risk and protective factors that predict substance use were investigated with 318 African American high school dropout youths who completed the 1992 follow-up of the National Educational Longitudinal Study of 1988. A conceptual model linking positive family relationships and religious involvement to youths' substance use and conventional peer affiliations through a positive life orientation was examined with structural equation modeling. Positive life orientation, which included optimism and conventional goals for the future, fully mediated the influence of family relationships on conventional peer affiliations. Religious involvement directly predicted conventional peer affiliations and positive life orientation. Conventional peer affiliations mediated the other variables' influence on substance use. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health Service Use Predictors Among Trauma Survivors: A Critical Review.

This article had 2 aims: (a) to comprehensively review and synthesize the literature on predictors of health service utilization in survivors of traumatic events and posttraumatic stress disorder (PTSD) patients and (b) to discuss methodological issues in examining service utilization in this population. PsycINFO was searched for relevant articles published through April 2004. Included studies had to primarily sample trauma survivors or PTSD patients and statistically explore health service use determinants. Although some findings conflicted across studies, increased mental health service use was generally related to being female, having a previous trauma history, and having a PTSD diagnosis. Increased medical service use was found among those with a PTSD diagnosis. Methodological recommendations are made for future health service use studies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluating a Cognitive-Behavioral Group Treatment Program for Veterans With Posttraumatic Stress Disorder.

The need to develop and further refine efficient and effective treatments for individuals with posttraumatic stress disorder (PTSD) in a climate of reduced mental health resources is critical. This study examined the impact of a series of cognitive-behavioral groups administered in an urban VA setting. The participants were veterans with chronic and severe PTSD, many of them struggling with additional physical and mental health problems. The data indicate modest improvements in the distress level of the veterans. Additional research is needed to further isolate the key elements of treatment that are most effective, palatable for patients, and cost-effective for the providers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

MMPI-2 Validity and Award of Service Connection for PTSD During the VA Compensation and Pension Evaluation.

From an initial pool of 699 Minnesota Multiphasic Personality Inventory-2s (MMPI-2s) obtained as part of the Department of Veterans Affairs (VA) Compensation and Pension (C & P) examinations for posttraumatic stress disorder (PTSD), the authors selected individuals with raw scores above 7 on the Frequency Psychpathology (F[p]) scale. The high F(p) group was matched to individuals with scores of 2 or less on the F(p) scale, and MMPI-2 interpretations, rates of disability awards for PTSD, and subsequent health care utilization were compared. The majority of psychological reports in the high F(p) group failed to indicate that the claimant's MMPI-2 appeared invalid. Moreover, there was no significant difference in rates of disability awards for PTSD or health care utilization across groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Strong African American Families Program: A cluster-randomized prevention trial of long-term effects and a mediational model.

The Strong African American Families Program, a universal preventive intervention to deter alcohol use among rural African American adolescents, was evaluated in a cluster-randomized prevention trial. This 7-week family skills training program is based on a contextual model in which intervention effects on youth protective factors lead to changes in alcohol use. African American 11-year-olds and their primary caregivers from 9 rural communities (N = 332 families) were randomly selected for study participation. Communities were randomized to prevention and control conditions. Intent-to-treat analyses indicated that fewer prevention than control adolescents initiated alcohol use; those who did evinced slower increases in use over time. Intervention-induced changes in youth protective factors mediated the effect of group assignment on long-term changes in use. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The structure of PTSD among two cohorts of returning soldiers: Before, during, and following deployment to Iraq.

Evidence suggests either a four-factor emotional numbing or dysphoria model likely reflects the underlying structure of posttraumatic stress disorder (PTSD). Questions remain as to which of these structures best represents PTSD, how the structure changes with time, the applicability of models to returning veterans, and the validity of the symptom clusters. The present study addresses these questions among two longitudinal samples of National Guard soldiers assessed prior to, during, and following a combat deployment to Iraq. Findings support a four-factor intercorrelated dysphoria model of PTSD that remains stable across samples and time points. Differential associations were observed among PTSD symptom clusters over time and between symptom clusters and both depression and combat exposure, supporting important distinctions between symptom clusters. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Interpretation of Genetic Risk Feedback Among African American Smokers With Low Socioeconomic Status.

The authors report on factors related to interpretation of feedback on genetic susceptibility to lung cancer among 371 African American smokers receiving care in a community health clinic, with a focus on whether smokers were interpreting feedback consistent with a defensive processing or an accuracy orientation. Smokers were given feedback on the absence (indicating increased risk) or presence (indicating average risk) of the gene for the mu isoform of glutathione S-transferase . Smokers who were told they were at higher risk were more likely to inaccurately recall the result than those deemed at average risk. Smokers who inaccurately recalled the result, regardless of risk status, were most likely to misinterpret the meaning of the result. Perceived lung cancer risks and worries were not associated with comprehension of the test result. The authors suggest additional research is needed to develop more effective strategies for communicating genetic risk feedback to motivate smoking cessation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reappraising the link between peritraumatic dissociation and PTSD symptom severity: Evidence from a longitudinal study of community violence survivors.

Cross-lagged panel analysis of longitudinal data collected from young adult survivors of community violence was used to examine the relationship between recall of peritraumatic dissociation and posttraumatic stress disorder (PTSD) symptom severity. Recollections of peritraumatic dissociation assessed within days of exposure differed from recollections measured at 3- and 12-month follow-up interviews. Peritraumatic dissociation was highly correlated with PTSD symptoms within each wave of data collection. Baseline recollections of peritraumatic dissociation were not predictive of follow-up PTSD symptom severity after controlling for baseline PTSD symptom severity. This pattern of results replicates previous work demonstrating a correlation between peritraumatic dissociation and subsequent symptom severity. However, findings are not consistent with the prevailing view that peritraumatic dissociation leads to increased PTSD symptom severity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)