An intensive outpatient program with prolonged exposure for veterans with posttraumatic stress disorder: Retention, predictors, and patterns of change

High rates of drop-out from treatment of PTSD have challenged implementation. Care models that integrate PTSD focused psychotherapy and complementary interventions may provide benefit in retention and outcome. The first 80 veterans with chronic PTSD enrolled in a 2-week intensive outpatient program combining Prolonged Exposure (PE) and complementary interventions completed symptom and biological measures at baseline and posttreatment. We examined trajectories of symptom change, mediating and moderating effects of a range of patient characteristics. Of the 80 veterans, 77 completed (96.3%) treatment and pre- and posttreatment measures. Self-reported PTSD (p < .001), depression (p < .001) and neurological symptoms (p < .001) showed large reductions with treatment. For PTSD, 77% (n = 59) showed clinically significant reductions. Satisfaction with social function (p < .001) significantly increased. Black veterans and those with a primary military sexual trauma (MST) reported higher baseline severity than white or primary combat trauma veterans respectively but did not differ in their trajectories of treatment change. Greater cortisol response to the trauma potentiated startle paradigm at baseline predicted smaller reductions in PTSD over treatment while greater reductions in this response from baseline to post were associated with better outcomes. Intensive outpatient prolonged exposure combined with complementary interventions shows excellent retention and large, clinically significant reduction in PTSD and related symptoms in two weeks. This model of care is robust to complex presentations of patients with varying demographics and symptom presentations at baseline. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Targeting memory reconsolidation to prevent the return of fear in patients with fear of flying

BACKGROUND

When a memory is recalled, it may again exist in a labile state and stored information becomes amenable to change, a psychobiological process known as reconsolidation. Exposure therapy for anxiety disorders involves accessing a fear memory and modifying it with less fearful information. A preclinical study reported that providing a reminder of a fear memory 10 min prior to extinction training in humans decreased fear up to 1 year later (Schiller et al., 2010).

METHODS

For this pilot clinical study, we used virtual reality exposure therapy (VRE) for fear of flying (FoF) to determine if using a cue to reactivate the memory of the feared stimulus 10 min prior to exposure sessions leads to fewer anxiety-related behaviors and a more durable response compared to a neutral cue. FoF participants (N = 89) received four sessions of anxiety management training followed by four sessions of VRE. Participants were randomly assigned to receive an FoF cue (reactivation group) or a neutral cue (control group) prior to the VRE sessions. Heart rate (HR) and skin conductance levels (SCLs) were collected during posttreatment and 3-month follow-up assessments as objective markers of fear responding.

RESULTS

Treatment was effective and all clinical measures improved equally between groups at posttreatment with maintained gains through follow-ups. Significant differences were identified with regard to HR and SCL indices.

CONCLUSIONS

These results suggest that memory reactivation prior to exposure therapy did not have an impact on clinical measures but may enhance the effect of exposure therapy at the physiological level.

Defining Adult Experiences: Perspectives of a Diverse Sample of Young Adults

This study explored the roles and psychological experiences identified as defining adult moments using mixed methods with a racially, ethnically, and socioeconomically diverse sample of young adults both enrolled and not enrolled in college (N = 726; ages 18-35). First, we evaluated results from a single survey item that asked participants to rate how adult they feel. Consistent with previous research, the majority of participants (56.9%) reported feeling "somewhat like an adult," and older participants had significantly higher subjective adulthood, controlling for other demographic variables. Next, we analyzed responses from an open-ended question asking participants to describe instances in which they felt like an adult. Responses covered both traditional roles (e.g., marriage, childbearing; 36.1%) and nontraditional social roles and experiences (e.g., moving out of parent's home, cohabitation; 55.6%). Although we found no differences by age and college status in the likelihood of citing a traditional or nontraditional role, participants who had achieved more traditional roles were more likely to cite them in their responses. In addition, responses were coded for psychological experiences, including responsibility for self (19.0%), responsibility for others (15.3%), self-regulation (31.1%), and reflected appraisals (5.1%). Older participants were significantly more likely to include self-regulation and reflected appraisals, whereas younger participants were more likely to include responsibility for self. College students were more likely than noncollege students to include self-regulation and reflected appraisals. Implications for research and practice are discussed.

Resource loss, resource gain, and mental health among survivors of Hurricane Katrina

Prior research has shown that losses of personal, social, and material resources resulting from traumatic events significantly contribute to psychopathology. Gains of such resources have been shown to have protective effects on posttrauma mental health. Few previous studies of resource change, however, have controlled for pretrauma mental health. The current study, which included 402 survivors of Hurricane Katrina, made use of data collected prehurricane to examine patterns of loss and gain and subsequent mental health. The loss of social support, physical health, and personal property were shown to significantly affect posthurricane psychological distress over and above the effect of prehurricane psychological functioning and disaster exposure. Gains in resources showed no effect. Implications for practice and policy were discussed.

The impact of pet loss on the perceived social support and psychological distress of hurricane survivors

Associations between pet loss and posthurricane perceived social support and psychological distress were explored. Participants (N = 365) were primarily low-income African American single mothers who were initially part of an educational intervention study. All participants were exposed to Hurricane Katrina, and 47% experienced Hurricane Rita. Three waves of survey data, two from before the hurricanes, were included. Sixty-three participants (17.3%) reported losing a pet due to the hurricanes and their aftermath. Pet loss significantly predicted postdisaster distress, above and beyond demographic variables, pre- and postdisaster perceived social support, predisaster distress, hurricane-related stressors, and human bereavement, an association that was stronger for younger participants. Pet loss was not a significant predictor of postdisaster perceived social support, but the impact of pet loss on perceived social support was significantly greater for participants with low levels of predisaster support.