A Randomized Pilot Study of Acceptance and Commitment Therapy to Improve Social Support for Veterans with PTSD

Perceived Family Support Buffers the Impact of PTSD-Depression Symptoms on Suicidal Ideation in College Students

Students reporting symptoms of posttraumatic stress disorder (PTSD) and depression are at increased risk for suicidal ideation, putting them at greater risk for suicidal behavior and attempts. Perceived social support is a robust protective factor against the impact of PTSD and depression on suicidal ideation in college students, however different forms of social support (family, friends, significant others) may have greater influence on this association. In the current study, the influence of the different types of perceived social support on the relationship between PTSD-depression symptoms and suicidal ideation in college students were examined. College students (N = 928; 71% female) were recruited in part of a cross-sectional survey study examining the role of mental health on education functioning. A hierarchical regression indicated that PTSD-depression symptoms (b = .27, p < .001) and perceived family support (b = -.04, p < .01) were significantly associated with current suicidal ideation, while perceived support from friends (b = -.02, p = .417) and significant others (b = -.01, p = .301) were not. Perceived family support interacted with PTSD-depression symptoms (b = -.03, p < .05) to weaken the positive influence of symptoms on current suicidal ideation. Perceived family support appears to be the significant component of social support that moderates the relationship between PTSD-depression symptoms and suicidal ideation. Future research should focus on strengthening family support as a potential mechanism to mitigate suicide risk among college students who may be away from their families for the first time.

Acceptance and Commitment Therapy for Posttraumatic Psychopathology: A Group-Based Telehealth Intervention

OBJECTIVE

Transdiagnostic treatments are needed to address the diverse manifestations and effects of trauma-related psychopathology. Acceptance and commitment therapy (ACT) is a promising intervention, although little is known about its application among trauma-exposed civilians. A single-arm pilot study evaluated outcomes of a virtual, group-based ACT intervention for trauma delivered through a training clinic.

METHODS

Five female clients (mean age=42.6 years) with a history of criterion A trauma completed an 11-week skills group and repeated measures assessing posttraumatic and related psychopathology symptoms (e.g., depression, anxiety, posttraumatic stress disorder [PTSD]), emotion regulation, quality of life, posttraumatic growth, and experiential avoidance. Paired-samples t tests were used to assess pre- to postintervention effects.

RESULTS

All clients completed the intervention, suggesting high acceptability. Analyses of pre- to postintervention effects demonstrated significant reductions in depression (d=1.16, p=0.03) and anxiety (d=0.95, p=0.05) symptoms but not in PTSD symptoms; effect sizes for significant changes were large. Significant and large increases in effective use of emotion regulation strategies (d=1.02, p=0.04) and posttraumatic growth (d=1.18, p=0.03) were also observed. Experiential avoidance, a hypothesized treatment mechanism in ACT, decreased from pre- to postintervention (d=1.22, p=0.03).

CONCLUSIONS

Findings provide initial evidence for acceptability and beneficial clinical outcomes of a virtual, group-based ACT intervention to address the transdiagnostic consequences of traumatic stress.

Acceptance and commitment therapy for enhancing mental health in military personnel: A comprehensive review and meta-analysis

BACKGROUND

Military personnel frequently face unique psychological challenges due to high-stress environments, which increase the risk of mental health issues like anxiety and depression. Acceptance and commitment therapy (ACT) has shown potential in addressing these issues by enhancing psychological flexibility and resilience.

AIM

To systematically evaluate the effectiveness of ACT in improving the mental health of military personnel. Through a scoping review and meta-analysis, we quantitatively assess the impact of ACT on psychological outcomes, guiding future research and clinical practice.

METHODS

Relevant literature was searched systematically from database inception to June 30, 2023, across multiple databases, including PubMed, Web of Science, Cochrane Library, and Embase. The Joanna Briggs Institute's (JBI) scoping review guidelines were used as the methodological framework. Meta-analysis was performed using a random-effects model, and publication bias was assessed through Egger's regression test and Begg's funnel plot.

RESULTS

Twenty-six studies were included, highlighting the application of ACT in addressing PTSD, chronic pain, anxiety, and depression among military personnel. The meta-analysis of eight studies demonstrated a significant positive effect of ACT on mental health, with a pooled mean difference of -4.99 (95%CI: -6.53 to -3.45). Despite high heterogeneity (I² = 63%), sensitivity analyses confirmed the robustness of the findings.

CONCLUSION

This study underscores the potential of ACT as an effective intervention for improving the mental health of military personnel. Future research should focus on large-scale, multi-center RCTs to further validate these findings, particularly within diverse military populations.

Testing the Effectiveness of a Mindfulness- and Acceptance-Based Smartphone App for Nurses Traumatized by the COVID-19 Pandemic: A Pilot Study

A significant proportion of frontline nurses developed post-traumatic stress disorder (PTSD) symptoms as a result of working during the COVID-19 pandemic. This study aimed to determine the efficacy of a mindfulness- and acceptance-based smartphone app intervention among nurses traumatized by the COVID-19 pandemic. This was a two-arm, randomized controlled trial. We randomly assigned 60 frontline nurses working in various clinical settings in the United States during the pandemic to either the intervention group (i.e. participants used the mindfulness app for 6 wk) or the wait-list control group. We assessed the app's efficacy through outcome measures of PTSD symptom severity, experiential avoidance, rumination, mindfulness, and resilience, measured at pre-, mid-, and post-intervention periods and a 1-month follow-up. Intervention satisfaction and perceived usability of the app were assessed within the intervention group. There was strong evidence of within-between interaction for PTSD, experiential avoidance, and rumination, implying significant improvement of these outcomes for the intervention group as compared to the control group. We only found a within-group interaction effect for mindfulness, indicating significant improvement of mindfulness within the intervention group only. Participants in the intervention group reported high satisfaction levels and perceived usability with the app. Findings highlight that mindfulness- and acceptance-based smartphone apps can improve PTSD symptoms of nurses traumatized by the pandemic. Healthcare organizations should provide nurses with accessible interventions (e.g. mindfulness apps) to treat and prevent secondary behavioral consequences of the pandemic, such as PTSD.

MDMA-Based Psychotherapy in Treatment-Resistant Post-Traumatic Stress Disorder (PTSD): A Brief Narrative Overview of Current Evidence

Post-traumatic stress disorder (PTSD) is a debilitating mental health disorder that causes significant dysfunction in individuals. Currently, there are many approved pharmacotherapy and psychotherapy treatment options for PTSD, but unfortunately, half of the patients do not respond to traditional therapies. In this article, we review clinical trials and research on 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy in PTSD patients, its pharmacokinetics, and current treatment guidelines for PTSD. Our findings are based on the results of the efficacy of MDMA-assisted psychotherapy from six phase II randomized controlled trials. MDMA-assisted psychotherapy for PTSD has received the "breakthrough therapy" designation from the FDA. MDMA can reduce PTSD symptoms even in treatment-resistant cases by increasing certain neurohormones, i.e., dopamine, serotonin, norepinephrine, and oxytocin. It also modulates activities in the brain regions involved in fear and anxiety. Future research is needed to show whether the advantages outweigh the disadvantages and whether its use can be integrated into available treatment options for PTSD.

A randomized trial of acceptance-based behavioral therapy to improve mental health outcomes for LGBTQ+ persons: Study protocol

BACKGROUND

During the COVID-19 pandemic, public health measures limited social interactions as an effective and protective intervention for all. For many, however, this social isolation exacerbated mental health symptoms. People who identify as lesbian, gay, bisexual, transgender, and queer (LGBTQ+) were already at elevated risk of anxiety and depression, relative to cisgender and heterosexual populations, and pandemic-related social isolation likely heightened these disparities. In our prior work with sexual and gender minorities, we developed and established feasibility and acceptability of a novel acceptance-based behavioral therapy (ABBT) intervention for HIV treatment. ABBT showed promise in improving social support and reducing mental health symptoms. In the current study, we investigate the efficacy of ABBT, compared to a treatment-as-usual control condition, in a full-scale randomized controlled trial to improve social support for LGBTQ+ persons living with anxiety and depression.

METHODS

Two hundred forty LGBTQ+ adults with anxiety and/or depressive symptoms will be recruited and equally randomized to receive: (a) the ABBT intervention, consisting of two 30-40 min sessions plus treatment-as-usual (TAU), or (b) TAU only. Primary outcomes are interviewer-assessed anxiety and depressive symptoms. Secondary outcomes are self-reported anxiety and depressive symptoms. Experiential avoidance and social support are hypothesized mediators and presence of an anxiety and/or depressive disorder is a hypothesized moderator.

CONCLUSIONS

ABBT represents a novel, identify-affirming real-world approach to promoting social support as a means of improving mental health among individuals who identify as LGBTQ+. This study will contribute actionable data establishing the impact, mediational mechanisms, and effect modifiers of ABBT.

CLINICALTRIALS

govregistration: NCT05540067.

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.

METHODS

One hundred and twelve treatment-seeking female veteran participants with PTSD completed baseline assessments and received 12-15 sessions of Prolonged Exposure. Symptom measures were completed biweekly as well as at immediate posttreatment, 3-month, and 6-month follow-ups.

RESULTS

Thirty (26.8%) participants seeking PTSD treatment also met diagnostic criteria for social anxiety disorder. Multilevel modeling was used to examine effects of social anxiety disorder diagnosis on post-intervention symptoms and revealed significantly worse outcomes for symptoms of PTSD and depression in participants with comorbid PTSD and social anxiety disorder.

CONCLUSION

Consistent with previous studies of co-occurring PTSD and depression, present findings suggest that comorbid diagnoses may adversely affect disorder-specific treatment outcomes. As such, the presence of diagnostic comorbidity may merit further consideration and potential adaptions to the traditional, disorder-specific assessment and treatment practices for PTSD.