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Zaccari B, Sherman ADF, Higgins M, Ann Kelly U. Trauma Center Trauma-Sensitive Yoga Versus Cognitive Processing Therapy for Women Veterans With PTSD Who Experienced Military Sexual Trauma: A Feasibility Study. J Am Psychiatr Nurses Assoc 2024; 30:343-354. [PMID: 35833676 PMCID: PMC9839891 DOI: 10.1177/10783903221108765] [Citation(s) in RCA: 4] [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: 01/17/2023]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is a common sequela to military sexual trauma (MST) among women veterans. Yoga has shown promise in research examining its benefit for symptoms and sequela of PTSD. AIMS The objective of this study was to evaluate the feasibility of a randomized controlled trial (RCT) of Trauma Center Trauma-Sensitive Yoga (TCTSY) for women veterans with PTSD related to MST. METHOD In this feasibility study, the final sample included women veterans (n = 41) with PTSD related to MST accessing health care in a Veterans Affairs Health Care System in the southeast United States; the majority were African American (n = 33; 80.5%). Interventions used established protocols of 10 weekly sessions of group TCTSY versus 12 weekly sessions of group Cognitive Processing Therapy (CPT). PTSD was assessed via clinical interview and participant report. Additional data collection included multiple participant-reported outcomes commonly associated with PTSD and psychophysiological measures. We also collected data regarding participant satisfaction and feasibility-related feedback from participants and providers. RESULTS Feasibility and acceptability were evaluated via demand, practicality, fidelity, and acceptability. This was measured by expressed interest, attendance, program completion, barriers to care and satisfaction with treatment, and satisfaction with interventions and data collection. CONCLUSIONS Results indicate the RCT design and TCTSY implementation were feasible; a full-scale RCT was subsequently conducted to determine efficacy of the experimental intervention. Recommendations for successful research strategies are provided.
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Affiliation(s)
- Belle Zaccari
- Belle Zaccari, PsyD, Veterans Affairs Portland Health Care System, Portland, OR, USA
- Belle Zaccari, PsyD, Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Athena D F Sherman
- Athena D. F. Sherman, PhD, PHN, RN, CNE, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Melinda Higgins
- Melinda Higgins, PhD, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Ursula Ann Kelly
- Ursula Ann Kelly, PhD, APRN, ANP-BC, PMHNP-BC, FAANP, FAAN, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
- Ursula Ann Kelly, PhD, APRN, ANP-BC, PMHNP-BC, FAANP, FAAN, Atlanta VA Health Care System, Atlanta, GA, USA
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Kaplan J, Somohano VC, Zaccari B, O’Neil ME. Randomized controlled trials of mind-body interventions for posttraumatic stress disorder: a systematic review. Front Psychol 2024; 14:1219296. [PMID: 38327501 PMCID: PMC10847595 DOI: 10.3389/fpsyg.2023.1219296] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 12/18/2023] [Indexed: 02/09/2024] Open
Abstract
Mind-body interventions (MBIs) include mindfulness-based interventions (MiBIs), meditation- and mantra-based interventions (MMIs), and movement-based interventions (MoBIs). These approaches have demonstrated preliminary efficacy in improving posttraumatic stress disorder (PTSD) symptoms. However, previous systematic reviews and meta-analyses have noted that this area of research is limited by inadequate comparator conditions, heterogeneity of measurement, and absence of objective outcome measures. For these reasons, an updated review of the highest-quality evidence available is warranted. We used the Agency for Healthcare Research and Quality (AHRQ)-funded evidence tables for the PTSD-Repository to identify relevant studies and assess the risk of bias as follows: The search was conducted between June 2018 and June 2022, and databases included PTSDpubs (formerly PILOTS), Ovid® MEDLINE®, Cochrane CENTRAL, Embase®, the Cumulative Index to Nursing and Allied Health Literature (CINAHL®), SCOPUS, and PsycINFO®. Twenty-six randomized controlled trials met our inclusion criteria. After identifying studies and retrieving risk of bias information from the PTSD-Repository evidence tables, we extracted additional data and synthesized the evidence. The strength of evidence was rated as low for MiBIs and MMIs, largely due to contradicting results, inconsistent use of active versus passive comparators, and high risk of bias. The strength of evidence for MoBIs was rated as moderate due to individual studies consistently favoring the intervention and a relatively large number of studies and participants. Of the 26 included studies, only two included objective outcome measures. Implications for future MBI research and clinical applications for treating PTSD are discussed.
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Affiliation(s)
- Josh Kaplan
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
| | | | - Belle Zaccari
- Veterans Affairs Portland Health Care System, Portland, OR, United States
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, United States
| | - Maya E. O’Neil
- Veterans Affairs Portland Health Care System, Portland, OR, United States
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, United States
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, United States
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Zaccari B, Higgins M, Haywood TN, Patel M, Emerson D, Hubbard K, Loftis JM, Kelly UA. Yoga vs Cognitive Processing Therapy for Military Sexual Trauma-Related Posttraumatic Stress Disorder: A Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2344862. [PMID: 38064219 PMCID: PMC10709771 DOI: 10.1001/jamanetworkopen.2023.44862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/14/2023] [Indexed: 12/18/2023] Open
Abstract
Importance First-line treatment for posttraumatic stress disorder (PTSD) in the US Department of Veterans Affairs (VA), ie, trauma-focused therapy, while effective, is limited by low treatment initiation, high dropout, and high treatment refraction. Objective To evaluate the effectiveness of Trauma Center Trauma-Sensitive Yoga (TCTSY) vs first-line cognitive processing therapy (CPT) in women veterans with PTSD related to military sexual trauma (MST) and the hypothesis that PTSD outcomes would differ between the interventions. Design, Setting, and Participants This multisite randomized clinical trial was conducted from December 1, 2015, to April 30, 2022, within 2 VA health care systems located in the southeast and northwest. Women veterans aged 22 to 71 years with MST-related PTSD were enrolled and randomized to TCTSY or CPT. Interventions The TCTSY intervention (Hatha-style yoga focusing on interoception and empowerment) consisted of 10 weekly, 60-minute group sessions, and the CPT intervention (cognitive-based therapy targeting modification of negative posttraumatic thoughts) consisted of 12 weekly, 90-minute group sessions. Main Outcome and Measures Sociodemographic data were collected via self-report survey. The primary outcome, PTSD symptom severity, was assessed using the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) and PTSD Checklist for DSM-5 (PCL-5). Assessments were conducted at baseline, midintervention, 2 weeks post intervention, and 3 months post intervention. Results Of 200 women veterans who consented to participate, the intent-to-treat sample comprised 131 participants (mean [SD] age, 48.2 [11.2] years), with 72 randomized to TCTSY and 59 randomized to CPT. Treatment was completed by 47 participants (65.3%) in the TCTSY group and 27 (45.8%) in the CPT group, a 42.6% higher treatment completion rate in the TCTSY group (P = .03). Both treatment groups improved over time on the CAPS-5 (mean [SD] scores at baseline: 36.73 [8.79] for TCTSY and 35.52 [7.49] for CPT; mean [SD] scores at 3 months: 24.03 [11.55] for TCTSY and 22.15 [13.56]) and the PCL-5 (mean [SD] scores at baseline: 49.62 [12.19] for TCTSY and 48.69 [13.62] for CPT; mean [SD] scores at 3 months: 36.97 [17.74] for TCTSY and 31.76 [12.47]) (P < .001 for time effects). None of the group effects or group-by-time effects were significant. Equivalence analyses of change scores were not significantly different between the TCTSY and CPT groups, and the two one-sided test intervals fell within the equivalence bounds of plus or minus 10 for CAPS-5 for all follow-up time points. Conclusions and Relevance In this comparative effectiveness randomized clinical trial, TCTSY was equivalent to CPT in reducing PTSD symptom severity, with both groups improving significantly. The higher treatment completion rate for TCTSY indicates its higher acceptability as an effective and acceptable PTSD treatment for women veterans with PTSD related to MST that could address current VA PTSD treatment limitations. Trial Registration ClinicalTrials.gov Identifier: NCT02640690.
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Affiliation(s)
- Belle Zaccari
- Research and Development Service, Veterans Affairs Portland Health Care System, Portland, Oregon
- Department of Mental Health and Clinical Neurosciences, Veterans Affairs Portland Health Care System, Portland, Oregon
- Department of Psychiatry, Oregon Health & Science University, Portland
| | - Melinda Higgins
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | | | - Meghna Patel
- Mental Health Service Line, Joseph Maxwell Cleland Atlanta VA Medical Center, Atlanta, Georgia
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - David Emerson
- The Center for Trauma and Embodiment at Justice Resource Institute, Needham, Massachusetts
| | - Kimberly Hubbard
- Research and Development Service, Veterans Affairs Portland Health Care System, Portland, Oregon
| | - Jennifer M. Loftis
- Research and Development Service, Veterans Affairs Portland Health Care System, Portland, Oregon
- Department of Psychiatry, Oregon Health & Science University, Portland
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland
| | - Ursula A. Kelly
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
- Nursing and Patient Care Services, Joseph Maxwell Cleland Atlanta VA Medical Center, Atlanta, Georgia
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Somohano VC, Smith CL, Saha S, McPherson S, Morasco BJ, Ono SS, Zaccari B, Lovejoy J, Lovejoy T. Patient-Provider Shared Decision-Making, Trust, and Opioid Misuse Among US Veterans Prescribed Long-Term Opioid Therapy for Chronic Pain. J Gen Intern Med 2023; 38:2755-2760. [PMID: 37118560 PMCID: PMC10506962 DOI: 10.1007/s11606-023-08212-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 12/14/2022] [Accepted: 04/12/2023] [Indexed: 04/30/2023]
Abstract
BACKGROUND Patient-provider shared decision-making is associated with better treatment adherence and pain outcomes in opioid-specific pain management. One possible mechanism through which shared decision-making may impact pain management outcomes is trust in one's prescribing provider. Elucidating relationships between factors that enhance the patient-provider relationship, such as shared decision-making and trust, may reduce risks associated with opioid treatment, such as opioid misuse. OBJECTIVE The purpose of this study was to investigate the mediating effect of trust in one's prescribing provider on the relationship between shared decision-making and current opioid misuse. DESIGN A secondary analysis of data from a prospective cohort study of US Veterans (N = 1273) prescribed long-term opioid therapy (LTOT) for chronic non-cancer pain. PARTICIPANTS Eligibility criteria included being prescribed LTOT, ability to speak and read English, and access to a telephone. Veterans were excluded if they had a cancer diagnosis, received opioid agonist therapy for opioid use disorder, or evidence of pending discontinuation of LTOT. Stratified random sampling was employed to oversample racial and ethnic minorities and women veterans. MAIN MEASURES Physician Participatory Decision-Making assessed level of patient involvement in medical decision-making, the Trust in Provider Scale assessed interpersonal trust in patient-provider relationships, and the Current Opioid Misuse Measure assessed opioid misuse. KEY RESULTS Patient-provider shared decision-making had a total significant effect on opioid misuse, in the absence of the mediator (c = - 0.243, p < 0.001), such that higher levels of shared decision-making were associated with lower levels of reported opioid misuse. When trust in provider was added to the mediation model, the indirect effect of shared decision-making on opioid misuse through trust in provider remained significant (c' = - 0.147, p = 0.007). CONCLUSIONS Shared decision-making is associated with less prescription opioid misuse through the trust that is fostered between patients and providers.
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Affiliation(s)
- Vanessa C Somohano
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
| | - Crystal L Smith
- Elson S. Floyd College of Medicine and the Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
| | - Somnath Saha
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
| | - Sterling McPherson
- Elson S. Floyd College of Medicine and the Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
| | - Benjamin J Morasco
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
- Department of Psychiatry, Oregon Health and Science University, Portland, OR, USA
| | - Sarah S Ono
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
- Department of Psychiatry, Oregon Health and Science University, Portland, OR, USA
| | - Belle Zaccari
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
- Department of Psychiatry, Oregon Health and Science University, Portland, OR, USA
| | - Jennette Lovejoy
- Department of Communication Studies, University of Portland, Portland, OR, USA
| | - Travis Lovejoy
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA.
- Department of Psychiatry, Oregon Health and Science University, Portland, OR, USA.
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Zaccari B, Lovejoy TI, O’Neil ME. Skills Training in Affective and Interpersonal Regulation Narrative Therapy Delivered via Synchronous Telehealth: A Case Study of a Rural Woman Veteran With Complex Posttraumatic Stress Disorder. Clin Case Stud 2023. [DOI: 10.1177/15346501231158400] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
The International Classification of Diseases– 11 th Revision (ICD-11) includes the diagnosis of complex posttraumatic stress disorder (CPTSD). Clinical practice guidelines support the use of phased care for individuals with CPTSD. This case study illustrates the use of synchronous telehealth to deliver phased treatment to a rural woman veteran with CPTSD. Mrs. A experienced sexual, physical, and emotional abuse throughout her life, perpetrated by family members, intimate partners, and military authority figures. She sought treatment for posttraumatic nightmares and body image issues; she also had pain related to fibromyalgia and chronic migraine headaches. Mrs. A participated in 19 sessions of Skills Training in Affective and Interpersonal Regulation (STAIR) Narrative therapy via synchronous telehealth. Trauma and eating disorder symptoms were assessed before and after treatment and the patient demonstrated clinically significant improvement on measures of these disorders. Patient-provider working alliance and quality of life were assessed post-treatment. Synchronous telehealth use drastically increased with the onset of COVID-19; however, little information on treating CPTSD via synchronous video teleconferencing is available. This case study illustrates an evidence-based, phased therapy for CPTSD while highlighting the feasibility and value of in-home delivery of psychotherapy for CPTSD via synchronous telehealth.
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Affiliation(s)
- Belle Zaccari
- Veterans Affairs Portland Health Care System, Portland, OR, USA
- Oregon Health & Science University, Portland, OR, USA
| | - Travis I. Lovejoy
- Veterans Affairs Portland Health Care System, Portland, OR, USA
- Oregon Health & Science University, Portland, OR, USA
| | - Maya E. O’Neil
- Veterans Affairs Portland Health Care System, Portland, OR, USA
- Oregon Health & Science University, Portland, OR, USA
- Oregon Health & Science University, Portland, OR, USA
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Zaccari B, Sherman ADF, Febres-Cordero S, Higgins M, Kelly U. Findings from a pilot study of Trauma Center Trauma-Sensitive Yoga versus cognitive processing therapy for PTSD related to military sexual trauma among women Veterans. Complement Ther Med 2022; 70:102850. [PMID: 35820575 PMCID: PMC9704511 DOI: 10.1016/j.ctim.2022.102850] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/03/2022] [Accepted: 07/07/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The study objective was to explore the preliminary efficacy of trauma-sensitive yoga compared to cognitive processing therapy (CPT) for women Veterans with posttraumatic stress disorder (PTSD) related to military sexual trauma (MST) in a pilot randomized control trial (RCT). We then compared these results to published interim results for the subsequent full-scale RCT. METHOD The analytic sample included women Veterans (N = 41) with PTSD related to MST accessing healthcare in a southeastern Veterans Affairs Health Care System. The majority were African American, non-Hispanic (80.5 %). The protocol-driven group interventions, Trauma Center Trauma-Sensitive Yoga (TCTSY; n = 17) and the evidence-based control condition, CPT (n = 24), were delivered weekly for 10 and 12 sessions, respectively. Multilevel linear models (MLM) were used to compare changes over time between the two groups. RESULTS The primary outcomes presented here are PTSD symptom severity and diagnosis, assessed using the Clinician Administered PTSD Scale (CAPS) and the PTSD Symptom Checklist (PCL) total scores. PTSD symptom severity on both clinician-administered (CAPS) and self-reported (PCL) measures, improved significantly (p < .005) over time, with large within group effect sizes (0.90-0.99) consistent with the subsequent RCT. Participants in the TCTSY group showed clinically meaningful improvements earlier than the CPT group participants from baseline on the CAPS and PCL Total scores. CONCLUSIONS Results support published findings of the effectiveness of TCTSY in the treatment for PTSD related to MST among women Veterans, particularly African American women. TCTSY warrants consideration as an adjunctive, precursor, or concurrent treatment to evidence-based psychotherapies. Future research should include patient preference, men with sexual trauma, and civilian populations.
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Affiliation(s)
- Belle Zaccari
- Veterans Affairs Portland Health Care System, 3710 SW US Veterans Hospital Rd, Portland, OR 97239, USA; Department of Psychiatry, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.
| | - Athena D F Sherman
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd, Atlanta, GA, USA.
| | - Sarah Febres-Cordero
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd, Atlanta, GA, USA.
| | - Melinda Higgins
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd, Atlanta, GA, USA.
| | - Ursula Kelly
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd, Atlanta, GA, USA; Atlanta VA Health Care System, Decatur, GA, USA.
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Zaccari B, Loftis JM, Haywood T, Hubbard K, Clark J, Kelly UA. Synchronous Telehealth Yoga and Cognitive Processing Group Therapies for Women Veterans with Posttraumatic Stress Disorder: A Multisite Randomized Controlled Trial Adapted for COVID-19. Telemed J E Health 2022; 28:10.1089/tmj.2021.0612. [PMID: 35357957 PMCID: PMC9519809 DOI: 10.1089/tmj.2021.0612] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Providing care over telehealth grew slowly until the COVID-19 pandemic. Since the onset of the COVID-19 pandemic, providing mental health care was readily adapted to virtual means; however, clinical trial research is nascent in adapting methods and procedures to the virtual world. Methods: We present protocol modifications to pivot a multisite randomized controlled trial study, conducted at Southeastern and Pacific Northwestern Veterans Affairs Health Care Systems, from being conducted in-person to virtually, following the onset of the COVID-19 pandemic. We measured outcomes of posttraumatic stress disorder (PTSD) symptoms and psychophysiological markers of stress among female Veterans with PTSD secondary to military sexual trauma. We collected qualitative data about provider and participant experiences with telehealth. Results: Across sites, 200 participants were consented (48 virtually), 132 were randomized (28 to virtual groups), and 117 completed data collection and treatment (69 completed all or some data collection or treatment virtually). Conclusions: The pivots made for this study were in response to the COVID-19 pandemic and offer innovative procedures leveraging technology and contributing to the broader landscape of conducting research virtually. Clinical Trials Number: NCT02640690.
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Affiliation(s)
- Belle Zaccari
- Department of Mental Health and Clinical Neurosciences, Veterans Affairs Portland Health Care System, Portland, Oregon, USA
- Department of Research and Development, Veterans Affairs Portland Health Care System, Portland, Oregon, USA
- Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA
| | - Jennifer M. Loftis
- Department of Research and Development, Veterans Affairs Portland Health Care System, Portland, Oregon, USA
- Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, Oregon, USA
| | - Terri Haywood
- Departments of Research and Development, Atlanta VA Health Care System, Decatur, Georgia, USA
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, Georgia, USA
| | | | - Jennifer Clark
- Primary Care; Veterans Affairs Portland Health Care System, Portland, Oregon, USA
| | - Ursula Ann Kelly
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, Georgia, USA
- Nursing and Patient Care Services; Atlanta VA Health Care System, Decatur, Georgia, USA
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Zaccari B, Callahan ML, Storzbach D, McFarlane N, Hudson R, Loftis JM. Yoga for veterans with PTSD: Cognitive functioning, mental health, and salivary cortisol. Psychol Trauma 2020; 12:913-917. [PMID: 32772534 PMCID: PMC7880235 DOI: 10.1037/tra0000909] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objective: Research indicates that cognitive functioning is negatively impacted by exposure to chronic stress due to overactivation of the stress response. Yoga has demonstrated benefits when practiced by individuals diagnosed with posttraumatic stress disorder (PTSD). This quasi-experimental pilot study examined the impact of a yoga intervention on cognitive functioning, symptoms of PTSD, and the biological stress response in Veterans diagnosed with PTSD. Method: Cognitive functioning, self-report measures of mental health symptoms, and salivary cortisol were measured within two weeks prior to beginning and following completion of a 10-week yoga protocol. Veterans with PTSD participated in gender-specific groups of the yoga intervention. Paired t tests and correlational analyses were used to analyze quantitative data. Results: Statistically significant improvements were observed between baseline and postintervention scores on measures of response inhibition, PTSD, depression, sleep, quality of life, and subjective neurocognitive complaints. Positive correlations were found between baseline and postintervention changes in sleep and depression, and between change in cortisol output and a measure of life satisfaction. Statistically significant differences (baseline to postintervention) for other objective measures of cognitive performance and cortisol were not detected. Conclusions: Results provide preliminary support for the practice of yoga to improve cognitive functioning (response inhibition) related to symptoms of PTSD while also improving mental health symptoms, sleep, and quality of life. Positive correlations affirm the role of sleep in mood symptoms and indicate the need for further examination of the role of cortisol in life satisfaction. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | - Rebekah Hudson
- Department of Psychiatry, Oregon Health & Science University
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Tadrous-Furnanz S, Clark J, Zaccari B, Storzbach D. A-66 Wechsler Test of Adult Reading is a More Useful Indicator of Premorbid Cognitive Functioning than the Reynolds Intellectual Screening Test in Blast Exposed Veterans. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz034.66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objective
The primary objective of this study was to compare the utility of the Wechsler Test of Adult Reading (WTAR) with the Reynolds Intellectual Screening Test (RIST) as a measure of premorbid cognitive functioning among blast-exposed Veterans.
Method
Sixty-nine Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) Veterans enrolled at the VA Portland Health Center who passed the Test of Memory Malingering (TOMM) were given the WTAR, RIST, and the Neuropsychological Assessment Battery (NAB). Data was analyzed using bi-variate correlational analyses and linear regressions.
Results
Scores on the WTAR were correlated significantly ( p < .05) with RIST, academic achievement, executive functioning (phonemic fluency), and multiple measures of attention, verbal learning and memory, and visuospatial skills. The WTAR was more consistently and strongly associated with those cognitive outcomes than the RIST. A stepwise linear regression was conducted to examine which of these cognitive domains loaded the highest on the WTAR. The overall attention index was the single most significant contributor to WTAR score, F(1,67) = 23.23, p < .001. Phonemic fluency added a significant proportion to the variance in WTAR scores Δr2 = .10, F (2, 66) = 18.30, p < .001.
Conclusions
The utility of word reading measures as indicators of premorbid functioning across multiple domains has been recently questioned. The current data suggests that for blast-exposed Veterans, the WTAR is indeed associated with cognitive functioning in attention, learning/memory, and executive functioning, even more so than the RIST. In particular, the WTAR appears related to attention.
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Clark J, Zaccari B, Tadrous-Furnanz S, Storzbach D. A-70 Beyond Validity: The Utility of the Test of Memory Malingering in Assessing Cognitive Functioning in Veterans. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz034.70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objective
The objective of the present analyses was to replicate analyses from an interim sample which found that scores on the Test of Memory Malingering (TOMM) predicted objective cognitive outcomes in the domains of attention and verbal learning even when invalid TOMM scores were excluded.
Methods
Participants consisted of 92 United States Veterans from Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) enrolled at the VA Portland Health Care System and recruited for a larger study on the role of blast exposure. Veterans were included if they had a valid performance on the TOMM (Trial 2 score > 47) were not currently substance dependent. Data was analyzed through linear regressions examining raw TOMM Trial 1 scores to predict objective cognitive performance on measures of memory and attention from the Neuropsychological Assessment Battery (NAB).
Results
In performance on the tasks of Driving Scenes (Beta = .328, p < .01), Initial Story Learning (Beta = .209, p < .05), and Attention Index Percentile (Beta = .208, p < .05) of the NAB, TOMM Trial 1 was a significant predictor. TOMM scores were also predictive of years of education (Beta = .303, p < .01).
Conclusion
These findings replicate results derived from interim data. TOMM Trial 1 significantly predicted objective cognitive performance in OEF/OIF Veterans even when invalid performance was excluded. This suggests that TOMM has a utility in assessing cognitive functioning and not just valid performance. Similarly, results also suggest that the TOMM may be sensitive to education as well.
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Zaccari B, Layne W, Loftis J, Penn P. The Participant’s Voice: A Mixed-Method Evaluation of a Mixed-Gender Seeking Safety Group. Alcoholism Treatment Quarterly 2017. [DOI: 10.1080/07347324.2017.1322416] [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: 10/19/2022]
Affiliation(s)
- Belle Zaccari
- Northwest Mental Illness Research, Education and Clinical Center, Veterans Affairs Portland Health Care System, Portland, Oregon, USA
- Research & Development Service, Veterans Affairs Portland Health Care System, Portland, Oregon, USA
- Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA
| | - Wendy Layne
- Research and Evaluation, La Frontera Center, Inc., Tucson, Arizona, USA
| | - Jennifer Loftis
- Research & Development Service, Veterans Affairs Portland Health Care System, Portland, Oregon, USA
- Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA
- Methamphetamine Abuse Research Center, Oregon Health & Science University, Portland, Oregon, USA
| | - Patricia Penn
- Research and Evaluation, La Frontera Center, Inc., Tucson, Arizona, USA
- Biobehavioral and Social Sciences Research Program, University of Arizona Cancer Center, Tucson, Arizona, USA
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Callahan ML, Binder LM, O'Neil ME, Zaccari B, Roost MS, Golshan S, Huckans M, Fann JR, Storzbach D. Sensory sensitivity in operation enduring freedom/operation Iraqi freedom veterans with and without blast exposure and mild traumatic brain injury. Appl Neuropsychol Adult 2016; 25:126-136. [PMID: 27929660 DOI: 10.1080/23279095.2016.1261867] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
To examine factors associated with noise and light sensitivity among returning Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans with a self-reported history of mild traumatic brain injury (mTBI) due to blast exposure, we compared the self-report of noise and light sensitivity of 42 OEF/OIF Veterans diagnosed with mTBI resulting from combat blast-exposure to that of 36 blast-exposed OEF/OIF Veterans without a history of mTBI. Results suggest a statistically significant difference between Veterans with and without a history of mTBI in the experience of noise and light sensitivity, with sensory symptoms reported most frequently in the mTBI group. The difference remains significant even after controlling for symptoms of PTSD, depression, and somatization. These data suggest that while psychological distress is significantly associated with the complaints of noise and light sensitivity, it may not fully account for the experience of sensory sensitivity in a population with mTBI history.
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Affiliation(s)
| | - Laurence M Binder
- b Department of Psychiatry , Oregon Health & Science University , Portland , Oregon , USA.,c Department of Neurology , Oregon Health & Science University , Portland , Oregon , USA.,d Independent Practice , Beaverton , Oregon , USA
| | - Maya E O'Neil
- a VA Portland Health Care System , Portland , Oregon , USA.,b Department of Psychiatry , Oregon Health & Science University , Portland , Oregon , USA.,e Department of Medical Informatics & Clinical Epidemiology , Oregon Health & Science University , Portland , Oregon , USA
| | - Belle Zaccari
- a VA Portland Health Care System , Portland , Oregon , USA.,b Department of Psychiatry , Oregon Health & Science University , Portland , Oregon , USA.,f Northwest Mental Illness Research, Education, and Clinical Center (MIRECC) , VA Portland Health Care System , Portland , Oregon , USA
| | - Mai S Roost
- a VA Portland Health Care System , Portland , Oregon , USA
| | - Shahrokh Golshan
- g Department of Psychiatry , University of California at San Diego , La Jolla , California , USA
| | - Marilyn Huckans
- a VA Portland Health Care System , Portland , Oregon , USA.,b Department of Psychiatry , Oregon Health & Science University , Portland , Oregon , USA
| | - Jesse R Fann
- h Department of Psychiatry and Behavioral Sciences , University of Washington , Seattle , WA , USA.,i Department of Rehabilitation Medicine , University of Washington , Seattle , WA , USA
| | - Daniel Storzbach
- a VA Portland Health Care System , Portland , Oregon , USA.,b Department of Psychiatry , Oregon Health & Science University , Portland , Oregon , USA.,c Department of Neurology , Oregon Health & Science University , Portland , Oregon , USA
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Hutson L, Callahan M, Zaccari B, Demadura T, Clark J, Golshan S, Storzbach D. C-32The Impact of PTSD on Compensatory Cognitive Training (CCT) for OEF/OIF/OND Veterans with mTBI. Arch Clin Neuropsychol 2016. [DOI: 10.1093/arclin/acw043.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Clark J, Demadura T, Hutson L, Callahan M, Zaccari B, Storzbach D. B-43Subjective and Objective Cognitive Functioning in Blast-Exposed Operation Enduring Freedom/Operation Iraqi Freedom Veterans: The Role of Posttraumatic Stress Disorder and Major Depression in an Updated Sample. Arch Clin Neuropsychol 2016. [DOI: 10.1093/arclin/acw043.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Demdura T, Clark J, Callahan M, Lee H, Zaccari B, Storzbach D. B-26Blast Exposure, Objective Cognitive Functioning, and Subjective Cognitive Complaints Predict Employment Status of Blast-Exposed Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans: An Updated Sample. Arch Clin Neuropsychol 2016. [DOI: 10.1093/arclin/acw043.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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