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Monson CM, Fredman SJ, Fitzpatrick S, Macdonald A, Pukay-Martin ND, Shepherd-Banigan M, Dworkin ER, Luedtke B, Dekel R, Shoval-Zuckerman Y, Sautter F, Glynn SM. Impact of the revised VA/DoD Clinical Practice Guideline for Management of Posttraumatic Stress Disorder and Acute Stress Disorder for couples and families: Commentary on Lang et al. (2024). J Trauma Stress 2024; 37:344-347. [PMID: 38523433 DOI: 10.1002/jts.23039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 02/22/2024] [Indexed: 03/26/2024]
Affiliation(s)
- Candice M Monson
- Department of Psychology, Toronto Metropolitan University, Toronto, Canada
| | - Steffany J Fredman
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, Pennsylvania, USA
| | | | - Alexandra Macdonald
- The Citadel-The Military College of South Carolina, Charleston, South Carolina, USA
| | | | - Megan Shepherd-Banigan
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
- U.S. Department of Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, North Carolina, USA
- Duke University, Durham, North Carolina, USA
| | - Emily R Dworkin
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Brandi Luedtke
- Posttraumatic Stress Clinical Team, Phoenix VA Health Care System, Phoenix, Arizona, USA
| | - Rachel Dekel
- School of Social Work, Bar-Ilan University, Ramat Gan, Israel
| | | | - Fred Sautter
- Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Shirley M Glynn
- Semel Institute of Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, California, USA
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Sippel LM, Knopp KC, Wachsman T, Khalifian CE, Glynn SM, Morland LA. An examination of relationship satisfaction as a predictor of outcomes of brief couple therapy for posttraumatic stress disorder. J Trauma Stress 2023; 36:1115-1125. [PMID: 37898980 DOI: 10.1002/jts.22984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/13/2023] [Accepted: 09/13/2023] [Indexed: 10/31/2023]
Abstract
The pretreatment quality of intimate relationships can promote or interfere with couple therapy for posttraumatic stress disorder (PTSD) treatment response. We tested whether baseline relationship satisfaction predicted clinical and process outcomes in two dyadic treatments for PTSD. Using data from a randomized trial comparing brief cognitive behavioral conjoint therapy (bCBCT) for PTSD to PTSD family education (PFE) among 137 military veterans and their partners (N = 274, Mage = 42.3 years, 46.7% White, 81.0% male veteran partner), we examined whether baseline relationship satisfaction (Couples Satisfaction Index; CSI-32) predicted change in PTSD symptom severity (Clinician Administered PTSD Scale for DSM-5; CAPS-5), psychosocial functioning (Brief Inventory of Psychosocial Functioning; B-IPF), and relationship satisfaction at posttreatment and 6-month follow-up. We also explored associations with process outcomes (working alliance, treatment satisfaction, dropout). In both treatment conditions, neither partner's baseline CSI-32 score moderated change in veteran CAPS-5 or B-IPF score or any process variable. However, baseline CSI-32 scores moderated both partners' CSI-32 score change during bCBCT and PFE; participants who scored in the distressed range at baseline (n = 123) experienced significant improvements in relationship satisfaction, β = .199, whereas there was no change among those in the nondistressed range at baseline (n = 151), β = .025. Results suggest bCBCT and PFE are effective in improving PTSD symptoms and psychosocial functioning regardless of whether a couple is experiencing clinically significant relationship distress; further, these treatments improve relationship satisfaction for the most distressed individuals.
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Affiliation(s)
- Lauren M Sippel
- Department of Veterans Affairs Northeast Program Evaluation Center, West Haven, Connecticut, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
- Department of Veterans Affairs National Center for PTSD Evaluation Division, West Haven, Connecticut, USA
| | - Kayla C Knopp
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Tamara Wachsman
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - Chandra E Khalifian
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Shirley M Glynn
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California, USA
| | - Leslie A Morland
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
- Department of Veterans Affairs National Center for PTSD Women's Health Sciences Division, Boston, Massachusetts, USA
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3
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Dodge J, Sullivan K, Grau PP, Chen C, Sripada R, Pfeiffer PN. Retention in Individual Trauma-Focused Treatment Following Family-Based Treatment Among US Veterans. JAMA Netw Open 2023; 6:e2349098. [PMID: 38127345 PMCID: PMC10739069 DOI: 10.1001/jamanetworkopen.2023.49098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/09/2023] [Indexed: 12/23/2023] Open
Abstract
Importance Despite the availability of several empirically supported trauma-focused interventions, retention in posttraumatic stress disorder (PTSD) psychotherapy is poor. Preliminary efficacy data shows that brief, family-based interventions may improve treatment retention in a veteran's individual PTSD treatment, although whether this occurs in routine clinical practice is not established. Objective To characterize receipt of family therapy among veterans diagnosed with PTSD and evaluate whether participation in family therapy is associated with an increased likelihood of completing individual trauma-focused treatment. Design, Setting, and Participants This retrospective cohort study used the Veterans Health Administration (VHA) Informatics and Computing Infrastructure to extract electronic health record data of participants. All participants were US veterans diagnosed with PTSD between October 1, 2015, and December 31, 2019, who attended at least 1 individual trauma-focused treatment session. Statistical analysis was performed from May to August 2023. Exposures Receipt of any family psychotherapy and subtype of family-based psychotherapy. Main Outcomes and Measures Minimally adequate individual trauma-focused treatment completion (ie, 8 or more sessions of trauma-focused treatment in a 6-month period). Results Among a total of 1 516 887 US veterans with VHA patient data included in the study, 58 653 (3.9%) received any family therapy; 334 645 (23.5%) were Black, 1 006 168 (70.5%) were White, and 86 176 (6.0%) were other race; 1 322 592 (87.2%) were male; 1 201 902 (79.9%) lived in urban areas; and the mean (SD) age at first individual psychotherapy appointment was 52.7 (15.9) years. Among the 58 653 veterans (3.9%) who received any family therapy, 36 913 (62.9%) received undefined family therapy only, 15 528 (26.5%) received trauma-informed cognitive-behavioral conjoint therapy (CBCT) only, 5210 (8.9%) received integrative behavioral couples therapy (IBCT) only, and 282 (0.5%) received behavioral family therapy (BFT) only. Compared with receiving no family therapy, the odds of completing individual PTSD treatment were 7% higher for veterans who also received CBCT (OR, 1.07 [95% CI, 1.01-1.13]) and 68% higher for veterans received undefined family therapy (OR, 1.68 [95% CI, 1.63-1.74]). However, compared with receiving no family therapy care, veterans had 26% lower odds of completing individual PTSD treatment if they were also receiving IBCT (OR, 0.74 [95% CI, 0.66-0.82]). Conclusions and Relevance In this cohort study of US veterans, family-based psychotherapies were found to differ substantially in their associations with individual PTSD psychotherapy retention. These findings highlight potential benefits of concurrently providing family-based therapy with individual PTSD treatment but also the need for careful clinical attention to the balance between family-based therapies and individual PTSD treatment.
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Affiliation(s)
- Jessica Dodge
- Health Services Research and Development/Center for Clinical Management Research, Ann Arbor Veterans Affairs Hospital (152), Ann Arbor, Michigan
| | | | - Peter P. Grau
- Health Services Research and Development/Center for Clinical Management Research, Ann Arbor Veterans Affairs Hospital (152), Ann Arbor, Michigan
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor
| | - Charity Chen
- Health Services Research and Development/Center for Clinical Management Research, Ann Arbor Veterans Affairs Hospital (152), Ann Arbor, Michigan
| | - Rebecca Sripada
- Health Services Research and Development/Center for Clinical Management Research, Ann Arbor Veterans Affairs Hospital (152), Ann Arbor, Michigan
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor
| | - Paul N. Pfeiffer
- Health Services Research and Development/Center for Clinical Management Research, Ann Arbor Veterans Affairs Hospital (152), Ann Arbor, Michigan
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor
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Crenshaw AO, Libet J, Petty K, Teves JB, Huang A, Mitchell J. Subjective emotion trajectories in couple therapy and associations with improvement in relationship satisfaction. FAMILY PROCESS 2023; 62:1542-1554. [PMID: 36575606 DOI: 10.1111/famp.12843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 11/02/2022] [Accepted: 11/02/2022] [Indexed: 06/17/2023]
Abstract
Existing couple therapies are generally effective for reducing romantic relationship distress and divorce, but therapy outcomes remain poor for many. Outcomes can be improved through greater understanding of session-by-session therapeutic processes, particularly in real-world treatment settings. Modern couple therapy models commonly emphasize the importance of emotional experiences as key change processes, yet few empirical studies have tested the merits of this focus. The present study addresses this limitation by examining trajectories of subjective emotions and their association with change in a key relationship outcome, relationship satisfaction, among military veterans and their partners at a VA Medical Center. Partners rated their relationship satisfaction prior to couple therapy sessions and subjective emotions immediately after sessions. Consistent with hypotheses, both hard (e.g., anger) and soft (e.g., sadness) negative emotions decreased significantly over the course of therapy. Those couples with greater decreases in hard negative, but not soft negative, emotions showed significantly more improvement in relationship satisfaction. Positive emotions did not significantly change across couples in general, but those couples whose positive emotions did increase also showed more improvement in relationship satisfaction. These results suggest change in subjective emotions may be one process underlying improvement in couple therapy and lend empirical support to the emphasis on emotion-based change processes underlying acceptance-based and emotion-focused couple therapies.
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Affiliation(s)
- Alexander O Crenshaw
- Ralph H. Johnson VA Medical Center, Charleston, South Carolina, USA
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Julian Libet
- Ralph H. Johnson VA Medical Center, Charleston, South Carolina, USA
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Karen Petty
- Ralph H. Johnson VA Medical Center, Charleston, South Carolina, USA
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jenna B Teves
- Ralph H. Johnson VA Medical Center, Charleston, South Carolina, USA
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Alice Huang
- Ralph H. Johnson VA Medical Center, Charleston, South Carolina, USA
| | - Jerez Mitchell
- Ralph H. Johnson VA Medical Center, Charleston, South Carolina, USA
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Brickell TA, French LM, Varbedian NV, Sewell JM, Schiefelbein FC, Wright MM, Lange RT. Relationship satisfaction among spouse caregivers of service members and veterans with comorbid mild traumatic brain injury and post-traumatic stress disorder. FAMILY PROCESS 2022; 61:1525-1540. [PMID: 34859431 DOI: 10.1111/famp.12731] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 10/15/2021] [Accepted: 10/22/2021] [Indexed: 06/13/2023]
Abstract
This study examined relationship satisfaction and health-related quality of life (HRQOL) among spouse caregivers assisting service members and veterans (SMV) with comorbid uncomplicated mild traumatic brain injury (MTBI) and post-traumatic stress disorder (PTSD). Spouse caregivers (N = 205) completed the Couples Satisfaction Index (CSI), 12 HRQOL measures, and the Mayo-Portland Adaptability Inventory 4th Edition (MPAI-4). T-scores were classified as "clinically elevated" using a cutoff of ≥60T. The sample was also classified into "Satisfied" (≥13.5, n = 113, 55.0%) or "Dissatisfied" (<13.5, n = 92, 44.0%) relationship categories. Using stepwise regression analysis, Anxiety, Family Disruption, Vigilance, Emotional Support, Feeling Trapped, and MPAI-4 Adjustment were identified as the strongest predictors of CSI total scores (p < 0.001), accounting for 41.6% of the variance. Squared semi-partial correlations revealed that 18.1% of the variance was shared across all six measures, with 7.8% to 1.5% of unique variance accounted for by each measure separately. When comparing the number of clinically elevated measures simultaneously, the Dissatisfied group consistently had a higher number of clinically elevated scores compared to the Satisfied group (e.g., 3-or-more clinically elevated scores: Dissatisfied = 40.2%, Satisfied = 8.8%, OR = 6.93, H = 0.76). Caring for a SMV with comorbid TBI and PTSD can have a profound impact on the spouse caregiver's HRQOL, relationship satisfaction, and family functioning. The findings from the current study continue to support the need for family involvement in the SMV's treatment plan, but more effort is needed to integrate behavioral health treatment that focuses on the family member's own issues into military TBI and PTSD systems of care.
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Affiliation(s)
- Tracey A Brickell
- Traumatic Brain Injury Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- General Dynamics Information Technology, Silver Spring, Maryland, USA
- Centre of Excellence on Post-Traumatic Stress Disorder, Ottawa, ON, Canada
| | - Louis M French
- Traumatic Brain Injury Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Nicole V Varbedian
- Traumatic Brain Injury Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- General Dynamics Information Technology, Silver Spring, Maryland, USA
| | - Jessie M Sewell
- Traumatic Brain Injury Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- General Dynamics Information Technology, Silver Spring, Maryland, USA
| | - Faith C Schiefelbein
- Traumatic Brain Injury Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- General Dynamics Information Technology, Silver Spring, Maryland, USA
| | - Megan M Wright
- Traumatic Brain Injury Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- General Dynamics Information Technology, Silver Spring, Maryland, USA
| | - Rael T Lange
- Traumatic Brain Injury Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- General Dynamics Information Technology, Silver Spring, Maryland, USA
- Centre of Excellence on Post-Traumatic Stress Disorder, Ottawa, ON, Canada
- University of British Columbia, Vancouver, BC, Canada
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6
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Meis LA, Glynn SM, Spoont MR, Kehle-Forbes SM, Nelson D, Isenhart CE, Eftekhari A, Ackland PE, Linden EB, Orazem RJ, Cutting A, Hagel Campbell EM, Astin MC, Porter KE, Smith E, Chuick CD, Lamp KE, Vuper TC, Oakley TA, Khan LB, Keckeisen SK, Polusny MA. Can families help veterans get more from PTSD treatment? A randomized clinical trial examining Prolonged Exposure with and without family involvement. Trials 2022; 23:243. [PMID: 35354481 PMCID: PMC8965544 DOI: 10.1186/s13063-022-06183-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 03/17/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Posttraumatic stress disorder occurs in as many as one in five combat veterans and is associated with a host of negative, long-term consequences to the individual, their families, and society at large. Trauma-focused treatments, such as Prolonged Exposure, result in clinically significant symptom relief for many. Adherence to these treatments (i.e., session attendance and homework compliance) is vital to ensuring recovery but can be challenging for patients. Engaging families in veterans’ treatment could prove to be an effective strategy for promoting treatment adherence while also addressing long-standing calls for better family inclusion in treatment for posttraumatic stress disorder. This paper describes the methods of a pragmatic randomized controlled trial designed to evaluate if family inclusion in Prolonged Exposure can improve treatment adherence.
Methods
One hundred fifty-six veterans, with clinically significant symptoms of posttraumatic stress disorder, will be randomized to receive either standard Prolonged Exposure or Prolonged Exposure enhanced through family inclusion (Family-Supported Prolonged Exposure) across three different VA facilities. Our primary outcomes are session attendance and homework compliance. Secondary outcomes include posttraumatic stress disorder symptom severity, depression, quality of life, and relationship functioning. The study includes a concurrent process evaluation to identify potential implementation facilitators and barriers to family involvement in Prolonged Exposure within VA.
Discussion
While the importance of family involvement in posttraumatic stress disorder treatment is non-controversial, there is no evidence base supporting best practices on how to integrate families into PE or any other individually focused trauma-focused treatments for posttraumatic stress disorder. This study is an important step in addressing this gap, contributing to the literature for both retention and family involvement in trauma-focused treatments.
Trial registration
ClinicalTrials.govNCT03256227. Registered on August 21, 2017.
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Thompson-Hollands J, Lee DJ, Sloan DM. The Use of a Brief Family Intervention to Reduce Dropout Among Veterans in Individual Trauma-Focused Treatment: A Randomized Controlled Trial. J Trauma Stress 2021; 34:829-839. [PMID: 33891718 PMCID: PMC8555692 DOI: 10.1002/jts.22680] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/16/2021] [Accepted: 03/14/2021] [Indexed: 01/09/2023]
Abstract
Dropout from trauma-focused treatment for posttraumatic stress disorder (PTSD) represents a daunting challenge for the field, particularly among military and veteran samples. Family involvement may help to increase the effectiveness of PTSD treatment while also improving retention. We tested a two-session brief family intervention (BFI) protocol delivered as an adjunct to individual trauma-focused treatment among a sample of 20 veteran-family member dyads (N = 40). Willingness to participate in the family-inclusive protocol was high, with over 85% of veterans and family members who were screened agreeing to take part. All enrolled veterans were beginning a course of either cognitive processing therapy (CPT) or prolonged exposure (PE), delivered in outpatient Veterans Affairs clinics. Family members were randomized to either receive or not receive the BFI from study clinicians. In the BFI condition, 20.0% of veterans dropped out of CPT/PE before the 16-week study end; the remainder were either still attending on-protocol sessions or had completed the full protocol. In the control condition, 40.0% of veterans dropped out of CPT/PE before the end of the study. Observed significant, large-magnitude decreases in PTSD symptoms over time did not differ by condition, ESsg range = -1.12 to -2.04. Accommodation did not significantly decrease over time in either condition, ESsg range = 0.18 to -0.98. The BFI represents a promising option for veterans, family members, and clinicians who are seeking a brief, feasible, narrowly focused method for incorporating families into veterans' individual trauma-focused therapy and potentially reducing the rate of dropout.
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Affiliation(s)
- Johanna Thompson-Hollands
- National Center for PTSD at VA Boston Healthcare System, Behavioral Science Division, Boston, Massachusetts, United States
- Department of Psychiatry, Boston University School of Medicine, Boston University, Boston, Massachusetts, United States
| | - Daniel J Lee
- National Center for PTSD at VA Boston Healthcare System, Behavioral Science Division, Boston, Massachusetts, United States
- Department of Psychiatry, Boston University School of Medicine, Boston University, Boston, Massachusetts, United States
| | - Denise M Sloan
- National Center for PTSD at VA Boston Healthcare System, Behavioral Science Division, Boston, Massachusetts, United States
- Department of Psychiatry, Boston University School of Medicine, Boston University, Boston, Massachusetts, United States
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Kugler J, Andresen FJ, Bean RC, Blais RK. Couple‐based interventions for PTSD among military veterans: An empirical review. J Clin Psychol 2019; 75:1737-1755. [DOI: 10.1002/jclp.22822] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Jordan Kugler
- Department of PsychologyUtah State University Logan Utah
| | | | - Ron C. Bean
- Department of PsychologyUtah State University Logan Utah
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9
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An Intensive Outpatient Program for Veterans With Posttraumatic Stress Disorder and Traumatic Brain Injury. COGNITIVE AND BEHAVIORAL PRACTICE 2019. [DOI: 10.1016/j.cbpra.2018.07.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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10
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Wagner AC, Mithoefer MC, Mithoefer AT, Monson CM. Combining Cognitive-Behavioral Conjoint Therapy for PTSD with 3,4-Methylenedioxymethamphetamine (MDMA): A Case Example. J Psychoactive Drugs 2019; 51:166-173. [PMID: 30890035 DOI: 10.1080/02791072.2019.1589028] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Treatments for posttraumatic stress disorder (PTSD) have evolved significantly in the past 35 years. From what was historically viewed as a pervasive, intractable condition have emerged multiple evidence-based intervention options. These treatments, predominantly cognitive behavioral in orientation, provide significant symptom improvement in 50-60% of recipients. The treatment of PTSD with MDMA-assisted psychotherapy using a supportive, non-directive approach has yielded promising results. It is unknown, however, how different therapeutic modalities could impact or improve outcomes. Therefore, to capitalize on the strengths of both approaches, Cognitive Behavioral Conjoint Therapy for PTSD (CBCT) was combined with MDMA in a small pilot trial. The current article provides a case study of one couple involved in the trial, chosen to provide a demographically representative example of the study participants and a case with a severe trauma history, to offer a detailed account of the methodology and choices made to integrate CBCT and MDMA, as well as an account of their experience through the treatment and their treatment gains. This article offers a description of the combination of CBCT for PTSD and MDMA, and demonstrates that it can produce reductions in PTSD symptoms and improvements in relationship satisfaction.
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Affiliation(s)
- Anne C Wagner
- a Department of Psychology , Ryerson University , Toronto , Canada.,b Remedy , Toronto , Canada
| | | | | | - Candice M Monson
- a Department of Psychology , Ryerson University , Toronto , Canada
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11
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Malaktaris AL, Buzzella BA, Siegel ME, Myers US, Browne KC, Norman SB, Angkaw AC. OEF/OIF/OND Veterans Seeking PTSD Treatment: Perceptions of Partner Involvement in Trauma-Focused Treatment. Mil Med 2019; 184:e263-e270. [PMID: 30215768 DOI: 10.1093/milmed/usy231] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 07/03/2018] [Accepted: 08/17/2018] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Post-traumatic stress disorder (PTSD) has been linked to a variety of adverse mental and physical health outcomes including distressed relationships. Involving romantic partners in PTSD treatment appears to be a promising new avenue for PTSD treatment; however, additional research is necessary to clarify veteran preferences for inclusion of significant others in treatment and relationship characteristics that may influence such preferences. Accordingly, the present study was designed to evaluate Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) veterans' desire to include romantic partners in trauma-focused care (n = 74) and to explore psychological and relationship variables associated with preference for partner inclusion in PTSD treatment. MATERIALS AND METHODS This study surveyed male (N = 74) OEF/OIF/OND combat veterans seeking mental health services at a Veterans Health Administration PTSD treatment program. Relationships between PTSD symptoms, romantic relationship functioning, and interest in including their romantic partner in PTSD treatment were examined. RESULTS Consistent with previous research, OEF/OIF/OND veterans seeking treatment at a specialty PTSD program report low relationship satisfaction. The majority of participants reported that PTSD symptoms interfere with relationship functioning; specifically, numbing symptoms were a significant predictor of PTSD-related relationship impairment. A minority (26%) of participants reported a desire to include their romantic partner in PTSD treatment. Greater behavioral avoidance and communication difficulties were associated with increased interest in including a romantic partner in PTSD treatment. CONCLUSION We confirmed that OEF/OIF/OND veterans seeking PTSD treatment experience PTSD-related problems in romantic relationships, low-relationship satisfaction, and relationship satisfaction was positively associated with perceived communication and problem-solving skills. A minority of veterans were interested in involving significant others in their PTSD treatment; however, in the present study, veterans were not given information about the various ways that a romantic partner might be involved in treatment, and they were not presented with specific conjoint therapies (e.g., Cognitive-Behavioral Conjoint Therapy for PTSD, Strategic Approach Therapy). For veterans with PTSD, relationship distress, and communication difficulties, conjoint psychotherapies may offer a way of increasing engagement in PTSD treatment by parsimoniously addressing multiple treatment targets at once (PTSD symptoms, relationship distress, communication problems) and providing veteran-centered care.
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Affiliation(s)
- Anne L Malaktaris
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA.,Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA.,VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Drive, San Diego, CA (MC 116 A)
| | - Brian A Buzzella
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA.,Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA
| | - Maya E Siegel
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA
| | - Ursula S Myers
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA.,San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA
| | - Kendall C Browne
- Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System, 1660 South Columbian Way, Seattle, WA
| | - Sonya B Norman
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA.,San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA.,VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Drive, San Diego, CA (MC 116 A).,National Center for PTSD, 1234 VA Cutoff Rd, White River Junction, VT
| | - Abigail C Angkaw
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA.,Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA.,San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA.,National Center for PTSD, 1234 VA Cutoff Rd, White River Junction, VT
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12
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Stadtmann MP, Maercker A, Binder J, Schnepp W. Why do I have to suffer? Symptom management, views and experiences of persons with a CPTSD: a grounded theory approach. BMC Psychiatry 2018; 18:392. [PMID: 30567517 PMCID: PMC6299949 DOI: 10.1186/s12888-018-1971-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 12/03/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND For the 11th version of the International Classification of Diseases, a new stress related diagnosis has been proposed: complex post-traumatic stress disorder (CPTSD). It is described as a chronic condition with several severe and concurrent symptoms. In the literature, these symptoms are discussed as a common reason for seeking psychiatric treatment as they can influence and impair the quality of life not only for affected persons but also for their social and familial system. AIM This research studies symptom management in everyday life by exploring and reconstructing the views, perceptions, experiences, facilitators and barriers of adults with CPTSD. METHODS A theoretical sampling was used to recruit 18 to 65 years old patients diagnosed with CPTSD from an inpatient setting. The 17 semi-structured interviews were audio recorded and transcribed verbatim. The transcriptions were uploaded into MAXQDA, and a Grounded Theory method based on Corbin and Strauss was used to analyse the data. RESULTS We provide a process model with 5 interacting phases: trauma experience, emotional ignorance, overcompensation, paroxysm, and perspectives. Each phase is specified with subcategories. CONCLUSIONS The participants did not recognise their symptoms as such and were unaware of their diagnosis for many years. Nevertheless, they used various resources and were able to develop skills and techniques to deal with their symptoms and to function on a day-to-day basis. Overall, the process of symptom management was extremely exhausting for the participants and they felt left alone with it. The participants were eager to gain support from healthcare professionals and, when necessary, financial support from the government. Thus, these results indicate an essential need to develop support and tailored interventions for the symptom management of persons with a CPTSD. TRIAL REGISTRATION Ethical approval was obtained from the Swiss Cantonal Ethic Commission (Nr 201,500,096). This research was also registered at the World Health Organization Clinical Trials Search Portal through the German Clinical Trial Register, Trial DRKS00012268 .
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Affiliation(s)
- Manuel P. Stadtmann
- 0000 0000 9024 6397grid.412581.bDepartment of Health, University of Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany ,0000 0004 0570 3485grid.491855.4Centre for Trauma Disorders, Integrierte Psychiatrie Winterthur, Technikumstrasse 81, Winterthur, Switzerland
| | - Andreas Maercker
- 0000 0004 1937 0650grid.7400.3Department of Psychology, Psychopathology and Clinical Intervention, University of Zurich, Binzmühlestrasse 14/17, 8050 Zürich, Switzerland
| | - Jochen Binder
- 0000 0004 0570 3485grid.491855.4Centre for Trauma Disorders, Integrierte Psychiatrie Winterthur, Technikumstrasse 81, Winterthur, Switzerland
| | - Wilfried Schnepp
- 0000 0000 9024 6397grid.412581.bDepartment of Health, University of Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany
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Stadtmann MP, Maercker A, Binder J, Schnepp W. Mastering life together - symptom management, views, and experiences of relatives of persons with CPTSD: a grounded theory study. J Patient Rep Outcomes 2018. [PMCID: PMC6195499 DOI: 10.1186/s41687-018-0070-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Complex posttraumatic stress disorder is described as a chronic condition with several severe and concurrent symptoms. Symptoms influence and impair not only the affected individuals but also their social surroundings and their relatives. The literature describes relatives as a key factor in managing symptoms, both as a barrier and a facilitator. Aim This research aimed to explore and to reconstruct the views, perceptions, experiences, facilitations and barriers of relatives who support the symptom management of persons with CPTSD in everyday life. Methods A theoretical sampling was used to recruit for an interview 18- to 65-year-old relatives of patients with diagnosed CPTSD. The 17 semi-structured interviews were audio-recorded and transcribed verbatim. The transcriptions were uploaded into MAXQDA, and a Grounded Theory method based on that of Corbin and Strauss was used to analyse the data. Results We provide a process model with 5 interacting phases: the initial situation, state of permanence, being an anchor, recognizing limits, and potential outcomes. Each phase is further divided into subcategories. Discussion Participants experienced their condition as unpredictable. Although they mastered different strategies through own exploration and in cooperation, there is a clear need for more education, advice and support for relatives caring for those affected by CPTSD. Health care services should consider providing family support, educational services and increase the involvement of relatives in treatment. Over all, well-supported relatives can play a facilitative, key role in improving symptom management. Trial registration Ethical approval was obtained from the Swiss Cantonal Ethic Commission (Nr 201,500,096). This research was also registered at the World Health Organization Clinical Trials Search Portal through the German Clinical Trial Register, Trial DRKS00012268.
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Madsen JW, Tomfohr-Madsen LM, Doss BD. The Impact of Couple Therapy on Service Utilization among Military Veterans: The Moderating Roles of Pretreatment Service Utilization and Premature Termination. FAMILY PROCESS 2017; 56:620-635. [PMID: 27370514 DOI: 10.1111/famp.12234] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Couple therapy reduces relational and individual distress and may affect utilization of other health services, particularly among higher service utilizers. Although average decreases in service utilization are predicted among recipients of couple therapy, low utilizers of services may appropriately increase use. The relationship between couple therapy and service utilization was examined among a sample of 179 U.S. military veterans who received treatment in Veterans Affairs (VA) specialty couple therapy clinics. Consistent with hypotheses, overall mental and physical health visits decreased from the 12 months preceding couple therapy to the 12 months following treatment. Moderator analyses showed that decreases were greatest among individuals who were rated by their therapist as having completed a full course of couple therapy, suggesting that change was attributable to intervention. Pretreatment service utilization also moderated observed change-higher utilizers' use of services decreased substantially, whereas lower utilizers' slightly increased. Cost analyses revealed that the estimated per person mean cost in our sample decreased by $930.33 in the year following compared to the year prior to couple therapy, as per 2008 VA cost data. As service utilization data were only available for one partner and only for 1 year posttherapy, the true magnitude of this effect may be underestimated. Our findings are relevant to policy makers as they demonstrate that couple therapy reduces average service utilization and associated costs and addresses calls for analyses of cost effectiveness of systemic interventions.
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Affiliation(s)
- Joshua W Madsen
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Lianne M Tomfohr-Madsen
- Departments of Psychology and Pediatrics, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Brian D Doss
- Department of Psychology, University of Miami, Coral Gables, FL
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Driesenga SA, Rodriguez JL, Picard T. Evidence-based Treatments for Military-related Posttraumatic Stress Disorder in a Veterans Affairs Setting. Crit Care Nurs Clin North Am 2017; 27:247-70. [PMID: 25981727 DOI: 10.1016/j.cnc.2015.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Posttraumatic stress disorder (PTSD) can have a significant negative impact on the physical, emotional, and mental health of individuals. This article discusses the prevalence, risk factors, and diagnostic criteria for PTSD. Given the high incidence of PTSD in the Veteran population, much attention has been given to assessment and treatment issues. Treatment options for PTSD, including the 2 most effective treatments, prolonged exposure and cognitive processing therapy, are discussed. Special issues concerning the treatment of Veterans are also reviewed.
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Affiliation(s)
- Scott A Driesenga
- Psychology Service, VA Medical Center - Battle Creek, 5500 Armstrong Road, Battle Creek, MI 49037-7314, USA.
| | - Jessica L Rodriguez
- Psychology Service, VA Medical Center - Battle Creek, 5500 Armstrong Road, Battle Creek, MI 49037-7314, USA
| | - Thomas Picard
- Psychology Service, VA Medical Center - Battle Creek, 5500 Armstrong Road, Battle Creek, MI 49037-7314, USA
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Jobe-Shields L, Flanagan JC, Killeen T, Back SE. Family composition and symptom severity among Veterans with comorbid PTSD and substance use disorders. Addict Behav 2015; 50:117-23. [PMID: 26132535 DOI: 10.1016/j.addbeh.2015.06.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Revised: 03/17/2015] [Accepted: 06/04/2015] [Indexed: 11/26/2022]
Abstract
Posttraumatic stress disorder (PTSD) and substance use disorders (SUD) frequently co-occur and affect a substantial proportion of military Veterans. Although the impact of parental PTSD and SUD on child development is well-documented, little is known about the influence of family composition on PTSD/SUD symptom severity. The present study investigated children in the home as an independent risk factor for symptom severity in a sample of treatment-seeking Veterans (N = 94; 92% male) with comorbid PTSD/SUD. Twenty-seven percent of the sample had minor children (age 18 or younger) living in the home. Veterans with children in the home evidenced significantly higher PTSD symptomatology as measured by the Clinical Administered PTSD Scale (CAPS; M = 82.65 vs. M = 72.17; t = -2.18; p < .05), and reported using marijuana more frequently than Veterans without children in the home (34% vs. 13% of past 60 days; t = -2.35, p < .05). In a multivariate model, having children in the home accounted for unique variance (ΔR(2) = .07) in PTSD severity after accounting for a range of covariates; however, having children in the home did not account for unique variance in substance use. Directions for future research as well as potential clinical implications for parents seeking treatment for PTSD/SUD are discussed.
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Albritton T, Angley M, Gibson C, Sipsma H, Kershaw T. Mental Health Utilization Among Diverse Parenting Young Couples. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2015; 56:89-100. [PMID: 26163272 PMCID: PMC4753767 DOI: 10.1007/s10464-015-9738-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Mental health issues often become apparent as adolescents emerge into young adulthood. The use of mental health services is low among adolescents and young adults, and use is particularly low among minorities. In this study, we examine mental health utilization among diverse young parenting couples. The sample consisted of 296 couples. We used the social-personal framework to examine personal, family, partner relationship, and environmental predictors for using mental health services. We used the Actor-Partner Interdependence Model to assess actor and partner effects on mental health utilization. We also examined moderator effects for gender and internalizing and externalizing behaviors. We found that being female, being White, higher income, more conduct problems, and less anxious romantic attachment predicted mental health utilization. Significant moderator effects included depression × gender, depression × medical insurance, and stress × Latino. Implications for community mental health practice include conducting mental health assessments during medical visits and systematic mental health follow-up for individuals and couples with identified mental health and support needs. Future research should include married couples and the spouse's influence on mental health use and examine relevant parenting factors that may also predict mental health utilization among couples.
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Affiliation(s)
- Tashuna Albritton
- The Consultation Center, Yale University, 389 Whitney Avenue, New Haven, CT, 06511, USA,
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Hershenberg R, Mavandadi S, Klaus JR, Oslin DW, Sayers SL. Veteran preferences for romantic partner involvement in depression treatment. Gen Hosp Psychiatry 2014; 36:757-9. [PMID: 25219288 DOI: 10.1016/j.genhosppsych.2014.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Revised: 07/02/2014] [Accepted: 08/05/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The objective was to examine Veterans' preferences for romantic partner involvement in depression treatment and patient characteristics that are associated with the likelihood of preferred involvement. METHOD One hundred seventy-nine Veterans who met criteria for major or minor depression reported if they wanted their partners to give them medication reminders, accompany them to appointments, and speak with their treatment provider. RESULTS Greater depression severity and wanting a partner to be less critical and more encouraging were associated with greater preferences for involvement. CONCLUSION Veterans may view their partners' involvement in depression treatment as one opportunity for partners to decrease blame or understand more about their problems.
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Affiliation(s)
- Rachel Hershenberg
- VISN 4 Mental Illness Research, Education and Clinical Center at Philadelphia VA Medical Center, Philadelphia, PA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania
| | - Shahrzad Mavandadi
- VISN 4 Mental Illness Research, Education and Clinical Center at Philadelphia VA Medical Center, Philadelphia, PA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania
| | - Johanna R Klaus
- VISN 4 Mental Illness Research, Education and Clinical Center at Philadelphia VA Medical Center, Philadelphia, PA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania
| | - David W Oslin
- VISN 4 Mental Illness Research, Education and Clinical Center at Philadelphia VA Medical Center, Philadelphia, PA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania
| | - Steven L Sayers
- VISN 4 Mental Illness Research, Education and Clinical Center at Philadelphia VA Medical Center, Philadelphia, PA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania.
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Glynn SM. Family-Centered Care to Promote Successful Community Reintegration After War: It Takes a Nation. Clin Child Fam Psychol Rev 2013; 16:410-4. [DOI: 10.1007/s10567-013-0153-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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