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Kilpatrick LA, Gupta A, Tillisch K, Labus JS, Naliboff BD, Mayer EA, Chang L. Neural correlates of perceived and relative resilience in male and female patients with irritable bowel syndrome. Neurogastroenterol Motil 2024; 36:e14710. [PMID: 38031358 PMCID: PMC11014739 DOI: 10.1111/nmo.14710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 09/22/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Patients with irritable bowel syndrome (IBS) show lower resilience than healthy controls (HCs), associated with greater symptom severity and worse quality of life. However, little is known about affected markers of resilience or the influence of sex. Furthermore, as resilience is complex, a comprehensive assessment, with multiple resilience measures, is needed. Therefore, we aimed to evaluate perceived and relative resilience and their neural correlates in men and women with IBS. METHODS In 402 individuals (232 IBS [73.3% women] and 170 HCs [61.2% women]), perceived resilience was assessed by the Connor-Davidson Resilience Scale (CDRISC) and Brief Resilience Scale (BRS); relative resilience was assessed by the standardized residual of the Short Form-12 mental component summary score predicted by the Adverse Childhood Experiences score. Non-rotated partial least squares analysis of region-to-region resting-state connectivity data was used to define resilience-related signatures in HCs. Disease and sex-related differences within these signatures were investigated. KEY RESULTS Scores on all resilience measures were lower in IBS than in HCs (p's < 0.05). In all three resilience-related signatures, patients with IBS showed reduced connectivity largely involving the central autonomic network (p's < 0.001). Men with IBS showed lower CDRISC scores than women with IBS, and greater reductions in CDRISC-related connectivity, associated with worse symptom severity (p < 0.05). CONCLUSIONS AND INFERENCES Individuals with IBS show reduced perceived and relative resilience, with reduced connectivity suggesting impaired homeostasis maintenance. Men with IBS may show additional impairment in specific aspects of resilience. Treatments aimed at improving resilience may benefit patients with IBS, especially men with IBS.
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Affiliation(s)
- Lisa A Kilpatrick
- Goodman-Luskin Microbiome Center, David Geffen School of Medicine, University of California, Los Angeles, USA
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California, Los Angeles, USA
| | - Arpana Gupta
- Goodman-Luskin Microbiome Center, David Geffen School of Medicine, University of California, Los Angeles, USA
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California, Los Angeles, USA
| | - Kirsten Tillisch
- Goodman-Luskin Microbiome Center, David Geffen School of Medicine, University of California, Los Angeles, USA
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California, Los Angeles, USA
| | - Jennifer S Labus
- Goodman-Luskin Microbiome Center, David Geffen School of Medicine, University of California, Los Angeles, USA
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California, Los Angeles, USA
- Brain Research Institute, University of California, Los Angeles, California, USA
- Gonda (Goldschmied) Neuroscience Research Center, Los Angeles, California, USA
| | - Bruce D Naliboff
- Goodman-Luskin Microbiome Center, David Geffen School of Medicine, University of California, Los Angeles, USA
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California, Los Angeles, USA
| | - Emeran A Mayer
- Goodman-Luskin Microbiome Center, David Geffen School of Medicine, University of California, Los Angeles, USA
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California, Los Angeles, USA
| | - Lin Chang
- Goodman-Luskin Microbiome Center, David Geffen School of Medicine, University of California, Los Angeles, USA
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California, Los Angeles, USA
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Reed-Fitzke K, Ferraro AJ, Duncan JM, Wojciak AS, Hamilton A, Pippert HD. Resilience in Army STARRS: Evaluating psychometrics of a multi-dimensional resilience measure. Mil Psychol 2023; 35:521-528. [PMID: 37903165 PMCID: PMC10617280 DOI: 10.1080/08995605.2022.2131187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 09/23/2022] [Indexed: 10/24/2022]
Abstract
As policymakers and the U.S. military continue to place an emphasis on the resilience of servicemembers, it is critical to utilize psychometrically sound and valid scales to measure resilience. Using two independent samples of Army soldiers-in-training, this study explored the measurement of resilience in the Army Study to Assess Risk and Resilience among Servicemembers (Army STARRS) New Soldier Study Component (NSS). Exploratory factor analysis (EFA) was used to identify the factor structure of a measure of resilience within the Army STARRS NSS. Confirmatory factor analysis (CFA) was then used to confirm the factor structure, then internal reliability was assessed. Convergent validity of the identified resilience factors was examined using two-tailed bivariate correlations. The EFA identified a three-factor structure of a measure of resilience. The CFA confirm the first-order three-factor structure of stress tolerance, positive orientation, and social resources. Each factor was uniquely distinct from measures of the likelihood of generalized anxiety disorder and major depressive disorder, lifetime stressful events, and social network. Findings highlights the utility of a three-factor aggregate measure of resilience in the Army STARRS NSS and provide practitioners with a more nuanced picture of the role of resilience among soldiers-in-training.
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Affiliation(s)
- Kayla Reed-Fitzke
- Department of Psychological and Quantitative Foundations, University of Iowa, Iowa City, Iowa
| | - Anthony J. Ferraro
- Department of Applied Human Sciences, Kansas State University, Manhattan, Kansas
| | - James M. Duncan
- School of Human Environmental Sciences, University of Arkansas, Fayetteville
| | - Armeda S. Wojciak
- Department of Psychological and Quantitative Foundations, University of Iowa, Iowa City, Iowa
| | - Alexus Hamilton
- Department of Psychological and Quantitative Foundations, University of Iowa, Iowa City, Iowa
| | - Hilary D. Pippert
- Department of Applied Human Sciences, Kansas State University, Manhattan, Kansas
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Roomaney AA, Womersley JS, Swart PC, Spies G, Seedat S, Hemmings SMJ. Childhood trauma and genetic variation in the DAT 40-bp VNTR contribute to HIV-associated neurocognitive disorders. IBRO Neurosci Rep 2022; 12:45-54. [PMID: 35746967 PMCID: PMC9210473 DOI: 10.1016/j.ibneur.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 11/20/2021] [Accepted: 12/06/2021] [Indexed: 12/03/2022] Open
Abstract
HIV/AIDS is a major public health burden in South Africa, currently affecting an estimated 13.5% of the population. Despite improved access to antiretroviral therapies, HIV-associated neurocognitive disorders (HAND), characterised by a spectrum of neurocognitive impairment, emotional disturbances and motor abnormalities, continue to persist. Gene-environment interactions contribute to HAND pathophysiology and previous research has identified childhood trauma as an environmental risk factor. Dopaminergic signalling in the prefrontal cortex plays a key role in cognitive function. Thus, variants in genes encoding the dopamine transporter (DAT) and catechol-O-methyltransferase (COMT), which are responsible for dopamine transport and metabolism, could represent genetic risk factors for HAND. This study investigated whether the DAT variable number of tandem repeats (VNTR) and COMT Val158Met (rs4680) polymorphisms are associated with longitudinal change in cognitive function in the context of childhood trauma and HIV. Participants (n = 49 HIV-negative and n = 64 HIV-positive women) completed the Childhood Trauma Questionnaire - Short Form (CTQ-SF) and provided blood for genetic analyses. Global cognitive scores were generated from baseline and one-year follow-up assessments. Following polymerase chain reaction, genotypes were determined using gel electrophoresis and confirmed by Sanger sequencing. Baseline global cognitive scores, genotype, HIV status and CTQ-SF scores were regressed on one-year global cognitive scores in regression models. Analysis of variance was used to examine the effect of including predictor variable interactions on model fit. HIV seropositivity was associated with poorer cognitive performance at one-year follow-up (p = 2.46 ×10-4). The combination of HIV and DAT 10-repeat homozygosity (DAT 10/10) was associated with reduced global cognitive scores in longitudinal models (p = 0.010). Including the interaction between DAT 10/10, childhood trauma, and HIV explained significantly more of the variance in longitudinal cognitive scores (p = 0.008). There were no significant associations with the COMT genotype. Our research indicates that childhood trauma and genetic variation in DAT contribute toward the aetiology of HAND. Future studies in larger cohorts are warranted to verify these results.
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Affiliation(s)
- Aqeedah Abbas Roomaney
- Division of Molecular and Human Genetics, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- South African Medical Research Council / Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Jacqueline Samantha Womersley
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- South African Medical Research Council / Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Patricia Cathryn Swart
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- South African Medical Research Council / Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Georgina Spies
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- South African Medical Research Council / Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- South African Medical Research Council / Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
- South African Research Chair in PTSD, Department of Psychiatry, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Sian Megan Joanna Hemmings
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- South African Medical Research Council / Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
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Turner J, Miller WC, Reid H, Moecke DMP, Crosbie S, Kamurasi I, Girt M, Peter M, Petlitsyna P, Friesen M, Towle J, Knox A, Winter A, Camp P. How is resilience conceptualized and operationalized in occupational therapy and occupational science literature? Protocol for a scoping review. Cad Bras Ter Ocup 2022. [DOI: 10.1590/2526-8910.ctoar23833105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Introduction Resilience is a commonly discussed term describing the ability to overcome, adapt to, or cope with stressful/disruptive events. Although researchers and practitioners define resilience in diverse ways – e.g., psychological or disaster resilience – the concept fundamentally encompasses perseverance through adversity. As experts in the interplay between individuals, environments, and occupations, occupational therapists and occupational scientists have great potential to understand and enable resilience, with some similar concepts appearing in occupational theories (e.g., occupational adaptation). However, there are no published reviews of resilience in the occupation-focused literature. Objective We will explore how resilience is conceptualized and operationalized in the occupational therapy and occupational science research literature. Method Guided by the Joanna Briggs Institute scoping review methodology, we will search library databases and other sources for relevant records. Two team members will screen records for inclusion, with discrepancies settled by a third person. We will include English-language literature (including research papers, editorials, dissertations, etc.) published since 1990 which 1) contains the word root ‘resilien*’ and 2) is occupation focused, according to our criteria (occupational therapist/occupational scientist co-authors or research participants; and/or published in occupation-focused periodical). We will report key information of included literature, such as methodology and resilience theories discussed. Results Our study is ongoing at the time of publication; this manuscript reports its protocol without results. Conclusion Findings will be useful for clinicians and researchers looking for occupational conceptualizations of resilience. From a social justice perspective, our review may highlight evidence that occupational engagement can foster resilience among marginalized communities.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Pat Camp
- University of British Columbia, Canada
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Abstract
BACKGROUND Psychological resilience - positive psychological adaptation in the context of adversity - is defined and measured in multiple ways across disciplines. However, little is known about whether definitions capture the same underlying construct and/or share similar correlates. This study examined the congruence of different resilience measures and associations with sociodemographic factors and body mass index (BMI), a key health indicator. METHODS In a cross-sectional sample of 1429 African American adults exposed to child maltreatment, we derived four resilience measures: a self-report scale assessing resiliency (perceived trait resilience); a binary variable defining resilience as low depression and posttraumatic stress (absence of distress); a binary variable defining resilience as low distress and high positive affect (absence of distress plus positive functioning); and a continuous variable reflecting individuals' deviation from distress levels predicted by maltreatment severity (relative resilience). Associations between resilience measures, sociodemographic factors, and BMI were assessed using correlations and regressions. RESULTS Resilience measures were weakly-to-moderately correlated (0.27-0.69), though similarly patterned across sociodemographic factors. Women showed higher relative resilience, but lower perceived trait resilience than men. Only measures incorporating positive affect or resiliency perceptions were associated with BMI: individuals classified as resilient by absence of distress plus positive functioning had lower BMI than non-resilient (β = -2.10, p = 0.026), as did those with higher perceived trait resilience (β = -0.63, p = 0.046). CONCLUSION Relatively low congruence between resilience measures suggests studies will yield divergent findings about predictors, prevalence, and consequences of resilience. Efforts to clearly define resilience are needed to better understand resilience and inform intervention and prevention efforts.
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Affiliation(s)
- Kristen Nishimi
- Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, MA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Karmel W. Choi
- Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, MA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
- Stanley Center for Psychiatric Research, The Broad Institute of Harvard and MIT, Cambridge, MA
| | - Janine Cerutti
- Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, MA
| | - Abigail Powers
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - Bekh Bradley
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
- Atlanta VA Medical Center, Atlanta, GA
| | - Erin C. Dunn
- Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
- Stanley Center for Psychiatric Research, The Broad Institute of Harvard and MIT, Cambridge, MA
- Center on the Developing Child at Harvard University, Cambridge, MA
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Denckla CA, Cicchetti D, Kubzansky LD, Seedat S, Teicher MH, Williams DR, Koenen KC. Psychological resilience: an update on definitions, a critical appraisal, and research recommendations. Eur J Psychotraumatol 2020; 11:1822064. [PMID: 33244362 PMCID: PMC7678676 DOI: 10.1080/20008198.2020.1822064] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 08/19/2020] [Indexed: 10/25/2022] Open
Abstract
Background: The ability to resist adverse outcomes, or demonstrate resilience after exposure to trauma is a thriving field of study. Yet ongoing debate persists regarding definitions of resilience, generalizability of the extant literature, neurobiological correlates, and a consensus research agenda. Objectives: To address these pressing questions, Drs. Christy Denckla and Karestan Koenen (co-chairs) convened a multidisciplinary panel including Drs. Dante Cicchetti, Laura Kubzansky, Soraya Seedat, Martin Teicher, and David Williams at the 2019 annual meeting of the International Society for Traumatic Stress Studies (ISTSS). Questions included (1) how have definitions of resilience evolved, (2) what are the best approaches to capture the complexity of resilience processes, and (3) what are the most important areas for future research? Methods: The proceedings of this panel are summarized in this report, and prominent themes are synthesized and integrated. Results: While different definitions emerged, all shared a focus on conceptualizing resilience at multiple levels, from the biological to the social structural level, a focus on the dynamic nature of resilience, and a move away from conceptualizing resilience as only an individual trait. Critical areas for future research included 1) focused efforts to improve assessment that has international and cross-cultural validity, 2) developing within-study designs that employ more intensive phenotyping strategies, 3) examining outcomes across multiple levels and domains, and 4) integrating conceptualizations of resilience from the individual-level to the larger social context at the population health level. Conclusion: Increasingly sophisticated and nuanced conceptual frameworks, coupled with research leveraging advances in genetics, molecular biology, increased computational capacity, and larger, more diverse datasets suggest that the next decade of research could bring significant breakthroughs.
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Affiliation(s)
- Christy A. Denckla
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Dante Cicchetti
- Institute of Child Development, University of Minnesota, Minneapolis, USA
| | - Laura D. Kubzansky
- Department of Social and Behavioral Sciences, Lee Kum Sheung Center for Health and Happiness, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Soraya Seedat
- Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | | | - David R. Williams
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Sociology, Harvard University, Cambridge, MA, USA
| | - Karestan C. Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Mall S, Platt JM, Temmingh H, Musenge E, Campbell M, Susser E, Stein DJ. The relationship between childhood trauma and schizophrenia in the Genomics of Schizophrenia in the Xhosa people (SAX) study in South Africa. Psychol Med 2020; 50:1570-1577. [PMID: 31387660 PMCID: PMC7053504 DOI: 10.1017/s0033291719001703] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Evidence from high-income countries suggests that childhood trauma is associated with schizophrenia. Studies of childhood trauma and schizophrenia in low and middle income (LMIC) countries are limited. This study examined the prevalence of childhood traumatic experiences among cases and controls and the relationship between specific and cumulative childhood traumatic experiences and schizophrenia in a sample in South Africa. METHODS Data were from the Genomics of Schizophrenia in the South African Xhosa people study. Cases with schizophrenia and matched controls were recruited from provincial hospitals and clinics in the Western and Eastern Cape regions in South Africa. Childhood traumatic experiences were measured using the Childhood Trauma Questionnaire (CTQ). Adjusted logistic regression models estimated associations between individual and cumulative childhood traumatic experiences and schizophrenia. RESULTS Traumatic experiences were more prevalent among cases than controls. The odds of schizophrenia were 2.44 times higher among those who experienced any trauma than those who reported no traumatic experiences (95% CI 1.77-3.37). The odds of schizophrenia were elevated among those who experienced physical/emotional abuse (OR 1.59, CI 1.28-1.97), neglect (OR 1.39, CI 1.16-1.68), and sexual abuse (OR 1.22, CI 1.03-1.45) compared to those who did not. Cumulative physical/emotional abuse and neglect experiences increased the odds of schizophrenia as a dose-response relationship. CONCLUSION Childhood trauma is common in this population. Among many other benefits, interventions to prevent childhood trauma may contribute to a decreasing occurrence of schizophrenia.
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Affiliation(s)
- Sumaya Mall
- Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jonathan M. Platt
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - Henk Temmingh
- Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Eustasius Musenge
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Megan Campbell
- Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Ezra Susser
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
- New York State Psychiatric Institute, New York, USA
| | - Dan J. Stein
- Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- SU/UCT Medical Research Council Unit on Risk & Resilience in Mental Disorders, South Africa
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Lanesman TH, Gouse H, Bantjes J, Stein DJ, Lochner C. Correlates and predictors of impulsivity in adults with methamphetamine use disorder. Journal of Substance Use 2019. [DOI: 10.1080/14659891.2019.1572803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Tali H. Lanesman
- Department of Psychology, Stellenbosch University, Cape Town, South Africa
| | - Hetta Gouse
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- HIV Mental Health Research Unit, University of Cape Town, Cape Town, South Africa
| | - Jason Bantjes
- Department of Psychology, Stellenbosch University, Cape Town, South Africa
| | - Dan J. Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- MRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Christine Lochner
- MRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
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Nijdam MJ, Martens IJM, Reitsma JB, Gersons BPR, Olff M. Neurocognitive functioning over the course of trauma-focused psychotherapy for PTSD: Changes in verbal memory and executive functioning. Br J Clin Psychol 2018; 57:436-452. [PMID: 29717483 DOI: 10.1111/bjc.12183] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 03/28/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Individuals with post-traumatic stress disorder (PTSD) have neurocognitive deficits in verbal memory and executive functioning. In this study, we examined whether memory and executive functioning changed over the course of treatment and which clinical variables were associated with change. DESIGN Neuropsychological assessments were administered at baseline and endpoint of a randomized controlled trial as secondary outcome. METHODS Trauma survivors (n = 88) diagnosed with PTSD received trauma-focused psychotherapy within a 17-week randomized controlled trial. Neuropsychological tests were the California Verbal Learning Test, Rivermead Behavioural Memory Test, Stroop Color Word Test, and Trail Making Test. RESULTS Significant, small- to medium-sized improvements in verbal memory, information processing speed, and executive functioning were found after trauma-focused psychotherapy (Cohen's d 0.16-0.68). Greater PTSD symptom decrease was significantly related to better post-treatment neurocognitive performance (all p < .005). Patients with comorbid depression improved more than patients with PTSD alone on interference tasks (p < .01). No differences emerged between treatment conditions and between patients on serotonergic antidepressants and those who were not. CONCLUSIONS This study suggests that neurocognitive deficits in PTSD can improve over the course of trauma-focused psychotherapy and are therefore at least partly reversible. Improvements over treatment are in line with previous neuropsychological and neuroimaging studies and effect sizes exceed those of practice effects. Future research should determine whether these changes translate into improved functioning in the daily lives of the patients. PRACTITIONER POINTS Patients with PTSD have difficulties performing verbal memory tasks (e.g., remembering a grocery list, recall of a story) and executive functioning tasks (e.g., shifting attention between two tasks, ignoring irrelevant information to complete a task). Verbal memory, information processing speed, and executive functioning significantly improved in patients with post-traumatic stress disorder over the course of trauma-focused psychotherapy. Improvements were equal in size for two different trauma-focused psychotherapies (Eye movement desensitization and reprocessing therapy and brief eclectic psychotherapy for PTSD). Medium-sized effects were found for recall of a story, whereas effects in other aspects of verbal memory, information processing speed, and executive functioning were small-sized. No causal attributions can be made because we could not include a control group without treatment for ethical reasons. Findings may be more reflective of patients who completed treatment than patients who prematurely dropped out as completers were overrepresented in our sample.
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Affiliation(s)
- Mirjam J Nijdam
- Department of Psychiatry, Academic Medical Centre at the University of Amsterdam, The Netherlands.,Arq Psychotrauma Expert Group, Diemen, The Netherlands
| | | | - Johannes B Reitsma
- Department of Epidemiology, University Medical Centre Utrecht, The Netherlands
| | - Berthold P R Gersons
- Department of Psychiatry, Academic Medical Centre at the University of Amsterdam, The Netherlands.,Arq Psychotrauma Expert Group, Diemen, The Netherlands
| | - Miranda Olff
- Department of Psychiatry, Academic Medical Centre at the University of Amsterdam, The Netherlands.,Arq Psychotrauma Expert Group, Diemen, The Netherlands
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