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Murphy JG, Dennhardt AA, Tempchin J, Colgonis HE, McDevitt-Murphy ME, Borsari B, Berlin KS. Behavioral economic and wellness-based approaches for reducing alcohol use and consequences among diverse non-student emerging adults: study protocol for Project BLUE, a randomized controlled trial. Trials 2024; 25:173. [PMID: 38459579 PMCID: PMC10924404 DOI: 10.1186/s13063-024-08009-9] [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] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 02/22/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Emerging adults (EAs) who are not 4-year college students nor graduates are at elevated risk for lifetime alcohol use disorder, comorbid drug use, and mental health symptoms, compared to college graduates. There is a need for tailored brief alcohol intervention (BAI) approaches to reduce alcohol risk and to facilitate healthy development in this high-risk population. Most BAIs include a single session focused on discussing risks associated with drinking and correcting normative beliefs about drinking rates. EAs may benefit from additional elements that enhance general wellness. The substance-free activity session (SFAS) aims to clarify life goals and values and increase goal-directed activities that provide alternatives to alcohol use, and the relaxation training (RT) session teaches relaxation and stress reduction skills. METHODS The present study is a randomized 3-group (BAI + SFAS vs. RT + SFAS vs. education control) trial with 525 EAs (175 per group; estimated 50% women and 50% African American) who report recent risky drinking and who are not students or graduates of 4-year colleges. Participants will have the option of completing the intervention sessions in person or via a secure video teleconference. Levels of drinking and alcohol-related problems will be evaluated at baseline and 1, 3, 6, and 12 months post-intervention. The primary hypothesis is that both BAI + SFAS and RT + SFAS participants will report significantly greater reductions in alcohol use and problems relative to education control participants, with no differences in outcomes between the two active treatment conditions. DISCUSSION The results of this study will inform alcohol prevention efforts for high-risk community dwelling emerging adults. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04776278.
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Affiliation(s)
- James G Murphy
- Department of Psychology, The University of Memphis, 400 Innovation Dr, Memphis, TN, 38152, USA.
| | - Ashley A Dennhardt
- Department of Psychology, The University of Memphis, 400 Innovation Dr, Memphis, TN, 38152, USA
| | - Jacob Tempchin
- Department of Psychology, The University of Memphis, 400 Innovation Dr, Memphis, TN, 38152, USA
| | - Hannah E Colgonis
- Department of Psychology, The University of Memphis, 400 Innovation Dr, Memphis, TN, 38152, USA
| | | | - Brian Borsari
- Mental Health Service (116B), San Francisco VAHCS, San Francisco, CA, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Kristoffer S Berlin
- Department of Psychology, The University of Memphis, 400 Innovation Dr, Memphis, TN, 38152, USA
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Bird BM, Levitt EE, Stewart SH, Wanklyn SG, Meyer EC, Murphy JG, McDevitt-Murphy ME, MacKillop J. Posttraumatic stress and delay discounting: a meta-analytic review. Psychol Med 2024; 54:437-446. [PMID: 37947238 DOI: 10.1017/s0033291723003069] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Delay discounting-the extent to which individuals show a preference for smaller immediate rewards over larger delayed rewards-has been proposed as a transdiagnostic neurocognitive process across mental health conditions, but its examination in relation to posttraumatic stress disorder (PTSD) is comparatively recent. To assess the aggregated evidence for elevated delay discounting in relation to posttraumatic stress, we conducted a meta-analysis on existing empirical literature. Bibliographic searches identified 209 candidate articles, of which 13 articles with 14 independent effect sizes were eligible for meta-analysis, reflecting a combined sample size of N = 6897. Individual study designs included case-control (e.g. examination of differences in delay discounting between individuals with and without PTSD) and continuous association studies (e.g. relationship between posttraumatic stress symptom severity and delay discounting). In a combined analysis of all studies, the overall relationship was a small but statistically significant positive association between posttraumatic stress and delay discounting (r = .135, p < .0001). The same relationship was statistically significant for continuous association studies (r = .092, p = .027) and case-control designs (r = .179, p < .001). Evidence of publication bias was minimal. The included studies were limited in that many did not concurrently incorporate other psychiatric conditions in the analyses, leaving the specificity of the relationship to posttraumatic stress less clear. Nonetheless, these findings are broadly consistent with previous meta-analyses of delayed reward discounting in relation to other mental health conditions and provide further evidence for the transdiagnostic utility of this construct.
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Affiliation(s)
- Brian M Bird
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton and McMaster University, Hamilton, ON, Canada
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Emily E Levitt
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton and McMaster University, Hamilton, ON, Canada
- Department of Psychology, Neuroscience, & Behaviour, McMaster University, Hamilton, ON, Canada
| | - Sherry H Stewart
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Sonya G Wanklyn
- MacDonald Franklin OSI Research Centre, Lawson Health Research Institute, London, ON, Canada
| | - Eric C Meyer
- Department of Counseling and Behavioral Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - James G Murphy
- Department of Psychology, University of Memphis, Memphis, TN, USA
| | | | - James MacKillop
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton and McMaster University, Hamilton, ON, Canada
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
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Stanley IH, Marx BP, Fina BA, Young-McCaughan S, Tyler HC, Sloan DM, Blankenship AE, Dondanville KA, Walker JL, Boffa JW, Bryan CJ, Brown LA, Straud CL, Mintz J, Abdallah CG, Back SE, Blount TH, DeBeer BB, Flanagan J, Foa EB, Fox PT, Fredman SJ, Krystal J, McDevitt-Murphy ME, McGeary DD, Pruiksma KE, Resick PA, Roache JD, Shiroma P, Taylor DJ, Wachen JS, Kaplan AM, López-Roca AL, Nicholson KL, Schobitz RP, Schrader CC, Sharrieff AFM, Yarvis JS, Litz BT, Keane TM, Peterson AL. Psychometric Properties of the Self-Injurious Thoughts and Behaviors Interview-Short Form Among U.S. Active Duty Military Service Members and Veterans. Assessment 2023; 30:2332-2346. [PMID: 36644835 DOI: 10.1177/10731911221143979] [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] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
We assessed the interrater reliability, convergent validity, and discriminant validity of the Self-Injurious Thoughts and Behaviors Interview-Short Form (SITBI-SF) in a sample of 1,944 active duty service members and veterans seeking services for posttraumatic stress disorder (PTSD) and related conditions. The SITBI-SF demonstrated high interrater reliability and good convergent and discriminant validity. The measurement properties of the SITBI-SF were comparable across service members and veterans. Approximately 8% of participants who denied a history of suicidal ideation on the SITBI-SF reported suicidal ideation on a separate self-report questionnaire (i.e., discordant responders). Discordant responders reported significantly higher levels of PTSD symptoms than those who denied suicidal ideation on both response formats. Findings suggest that the SITBI-SF is a reliable and valid interview-based measure of suicide-related thoughts and behaviors for use with military service members and veterans. Suicide risk assessment might be optimized if the SITBI-SF interview is combined with a self-report measure of related constructs.
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Affiliation(s)
- Ian H Stanley
- VA Boston Healthcare System, MA, USA
- Boston University, School of Medicine, MA, USA
- University of Colorado, School of Medicine, Aurora, USA
| | - Brian P Marx
- VA Boston Healthcare System, MA, USA
- Boston University, School of Medicine, MA, USA
| | - Brooke A Fina
- University of Texas Health Science Center at San Antonio, USA
| | - Stacey Young-McCaughan
- University of Texas Health Science Center at San Antonio, USA
- South Texas Veterans Health Care System, San Antonio, USA
| | - Hannah C Tyler
- University of Texas Health Science Center at San Antonio, USA
- South Texas Veterans Health Care System, San Antonio, USA
| | - Denise M Sloan
- VA Boston Healthcare System, MA, USA
- Boston University, School of Medicine, MA, USA
| | | | | | - James L Walker
- University of Texas Health Science Center at San Antonio, USA
| | - Joseph W Boffa
- Southeast Louisiana Veterans Health Care System, New Orleans, USA
- South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA
- Tulane University School of Medicine, New Orleans, LA, USA
| | - Craig J Bryan
- The Ohio State University Wexner Medical Center, Columbus, USA
| | | | - Casey L Straud
- University of Texas Health Science Center at San Antonio, USA
- South Texas Veterans Health Care System, San Antonio, USA
- University of Texas at San Antonio, USA
| | - Jim Mintz
- University of Texas Health Science Center at San Antonio, USA
- South Texas Veterans Health Care System, San Antonio, USA
| | - Chadi G Abdallah
- Baylor College of Medicine, Houston, TX, USA
- Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Sudie E Back
- Medical University of South Carolina, Charleston, USA
- Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | | | - Bryann B DeBeer
- University of Colorado, School of Medicine, Aurora, USA
- Rocky Mountain Regional VA Medical Center, Aurora, CO, USA
| | - Julianne Flanagan
- Medical University of South Carolina, Charleston, USA
- Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | - Edna B Foa
- University of Pennsylvania, Philadelphia, USA
| | - Peter T Fox
- University of Texas Health Science Center at San Antonio, USA
- South Texas Veterans Health Care System, San Antonio, USA
| | | | - John Krystal
- VA Connecticut Healthcare System, West Haven, USA
- Yale University, New Haven, CT, USA
| | | | - Donald D McGeary
- University of Texas Health Science Center at San Antonio, USA
- South Texas Veterans Health Care System, San Antonio, USA
- University of Texas at San Antonio, USA
| | - Kristi E Pruiksma
- University of Texas Health Science Center at San Antonio, USA
- South Texas Veterans Health Care System, San Antonio, USA
| | | | - John D Roache
- University of Texas Health Science Center at San Antonio, USA
| | - Paulo Shiroma
- Minneapolis VA Medical Center, MN, USA
- University of Minnesota, Minneapolis, USA
| | | | | | | | | | - Karin L Nicholson
- Carl R. Darnall Army Medical Center, Fort Hood, TX, USA
- Kaiser Permanente Woodland Hills Medical Center, Woodland Hills, CA, USA
| | | | | | - Allah-Fard M Sharrieff
- Carl R. Darnall Army Medical Center, Fort Hood, TX, USA
- U.S. Department of Homeland Security, Miami, FL, USA
| | - Jeffrey S Yarvis
- Tulane University School of Medicine, New Orleans, LA, USA
- Carl R. Darnall Army Medical Center, Fort Hood, TX, USA
| | - Brett T Litz
- VA Boston Healthcare System, MA, USA
- Boston University, School of Medicine, MA, USA
- Boston University, MA, USA
| | - Terence M Keane
- VA Boston Healthcare System, MA, USA
- Boston University, School of Medicine, MA, USA
| | - Alan L Peterson
- University of Texas Health Science Center at San Antonio, USA
- South Texas Veterans Health Care System, San Antonio, USA
- University of Texas at San Antonio, USA
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Gex KS, Mun EY, Barnett NP, McDevitt-Murphy ME, Ruggiero KJ, Thurston IB, Olin CC, Voss AT, Withers AJ, Murphy JG. A randomized pilot trial of a mobile delivered brief motivational interviewing and behavioral economic alcohol intervention for emerging adults. Psychol Addict Behav 2023; 37:462-474. [PMID: 35482647 PMCID: PMC9614412 DOI: 10.1037/adb0000838] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Mobile health (mHealth) interventions show potential to broaden the reach of efficacious alcohol brief motivational interventions (BMIs). However, efficacy is mixed and may be limited by low participant attention and engagement. The present study examined the feasibility, acceptability, and preliminary efficacy of a live text-message delivered BMI in a pilot randomized clinical trial. METHOD Participants were 66 college students (63.6% women; 61.9% White; Mage = 19.95, SD = 1.66) reporting an average of 11.88 (SD = 8.74) drinks per week, 4.42 (SD = 3.59) heavy drinking episodes (HDEs), and 8.44 (SD = 5.62) alcohol-related problems in the past month. Participants were randomized to receive either (a) education or (b) an alcohol BMI plus behavioral economic substance-free activity session (SFAS), each followed by 4 weeks of mini sessions. All sessions were administered via live text-message. Participants completed assessments postintervention (after the 4th mini session) and at 3-month follow-up. RESULTS 90.9% completed both initial full-length sessions and at least two of the four mini sessions with 87.9% retention at 3-month follow-up. Participants found the interventions useful, interesting, relevant, and effective, with no between-group differences. There were no statistically significant group differences in drinks per week or alcohol-related problems at follow-up, but BMI + SFAS participants reported fewer past-month HDEs than those who received education. CONCLUSIONS Live text-messaging to deliver the BMI + SFAS is feasible and well-received. The preliminary efficacy results should be interpreted cautiously due to the small sample size but support further investigation. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Kathryn S. Gex
- Department of Psychiatry and Behavioral Sciences, Medical
University of South Carolina, Charleston, SC 29425
| | - Eun-Young Mun
- Department of Health Behavior and Health Systems,
University of North Texas Health Science Center, Fort Worth, TX 76107
| | - Nancy P. Barnett
- Department of Behavioral and Social Sciences and Center for
Alcohol and Addiction Studies, Brown University, Providence, RI 02912
| | | | - Kenneth J. Ruggiero
- Department of Psychiatry and Behavioral Sciences, Medical
University of South Carolina, Charleston, SC 29425
- Department of Nursing, Medical University of South
Carolina, Charleston, SC 29425
| | - Idia B. Thurston
- Department of Psychological & Brain Sciences, Texas A
& M University, College Station, TX 77843
- Department of Health Promotion & Community Health
Sciences, Texas A&M Health, College Station, TX 77843
| | - Cecilia C. Olin
- Department of Psychology, University of Memphis, 400
Innovation Drive, Memphis, TN 38152
| | - Andrew T. Voss
- Department of Psychology, University of Memphis, 400
Innovation Drive, Memphis, TN 38152
| | - Alton J. Withers
- Department of Psychology, University of Memphis, 400
Innovation Drive, Memphis, TN 38152
| | - James G. Murphy
- Department of Psychology, University of Memphis, 400
Innovation Drive, Memphis, TN 38152
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5
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Bowen ME, McDevitt-Murphy ME, Olin CC, Buckley BE. The Utility of Assessing Alexithymia, in Addition to Coping, in the Context of Posttraumatic Stress. J Nerv Ment Dis 2023; 211:17-22. [PMID: 35944258 DOI: 10.1097/nmd.0000000000001561] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
ABSTRACT The distinction between alexithymia and coping in relation to posttraumatic stress has not been fully explored. The present study examined the extent to which alexithymia explained unique variance in posttraumatic stress, beyond the variance explained by coping, in a sample of trauma-exposed adults ( N = 706; M age = 19.41 years, SD = 1.5; 77.1% female). Then, we explored the effect of race on these associations, comparing participants who identified as Black ( n = 275) to those who identified as White ( n = 337). Avoidant-emotional coping showed stronger correlations (compared with problem-focused and active-emotional coping) with total alexithymia, difficulty identifying feelings, and difficulty describing feelings. In regression analyses, we found alexithymia explained unique variance in posttraumatic stress severity beyond the effect of coping. Results did not differ by racial identity. These findings suggest that despite some overlap between alexithymia and coping, each shows unique relations with posttraumatic stress.
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Affiliation(s)
- Mya E Bowen
- Department of Psychology, The University of Memphis, Memphis, Tennessee
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6
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Olin CC, McDevitt-Murphy ME, Murphy JG, Zakarian RJ, Roache JD, Young-McCaughan S, Litz BT, Keane TM, Peterson AL. The associations between posttraumatic stress disorder and delay discounting, future orientation, and reward availability: A behavioral economic model. J Trauma Stress 2022; 35:1252-1262. [PMID: 35437823 DOI: 10.1002/jts.22820] [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] [Received: 05/02/2021] [Revised: 01/17/2022] [Accepted: 01/18/2022] [Indexed: 11/06/2022]
Abstract
The theoretical framework of behavioral economics, a metatheory that integrates operant learning and economic theory, has only recently been applied to posttraumatic stress disorder (PTSD). A behavioral economic theory of PTSD reflects an expansion of prior behavioral conceptualization of PTSD, which described PTSD in terms of respondent and operant conditioning. In the behavioral economic framework of PTSD, negatively reinforced avoidance behavior is overvalued, in part due to deficits in environmental reward, and may be conceptualized as a form of reinforcer pathology (i.e., excessive preference for and valuation of an immediate reinforcer). We investigated cross-sectional relationships between PTSD severity and several constructs rooted in this behavioral economic framework, including future orientation, reward availability, and delay discounting in a sample of 110 military personnel/veterans (87.2% male) who had served combat deployments following September 11, 2001. Total PTSD severity was inversely related to environmental reward availability, β = -.49, ΔR2 = 0.24, p < .001; hedonic reward availability, β = -.32, ΔR2 = 0.10, p = .001; and future orientation, β = -.20, ΔR2 = 0.04, p = .032, but not delay discounting, r = -.05, p = .633. An examination of individual symptom clusters did not suggest that avoidance symptoms were uniquely associated with these behavioral economic constructs. The findings offer support for a behavioral economic model of PTSD in which there is a lack of positive reinforcement as well as a myopic focus on the present.
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Affiliation(s)
- Cecilia C Olin
- Department of Psychology, The University of Memphis, Memphis, Tennessee, USA
| | | | - James G Murphy
- Department of Psychology, The University of Memphis, Memphis, Tennessee, USA
| | - Rebecca J Zakarian
- Department of Psychology, The University of Memphis, Memphis, Tennessee, USA
| | - John D Roache
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.,Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - Stacey Young-McCaughan
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.,Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - Brett T Litz
- Massachusetts Veterans Epidemiological Research and Information Center, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA.,Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - Terence M Keane
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA.,Behavioral Science Division, National Center for PTSD at VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Alan L Peterson
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.,Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas, USA.,Department of Psychology, University of Texas at San Antonio, San Antonio, Texas, USA
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Luciano MT, Acuff SF, Olin CC, Lewin RK, Strickland JC, McDevitt-Murphy ME, Murphy JG. Posttraumatic stress disorder, drinking to cope, and harmful alcohol use: A multivariate meta-analysis of the self-medication hypothesis. J Psychopathol Clin Sci 2022; 131:447-456. [PMID: 35587413 PMCID: PMC9233097 DOI: 10.1037/abn0000764] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 06/15/2023]
Abstract
The association between posttraumatic stress disorder (PTSD) and harmful alcohol use has often been explained through the self-medication hypothesis via coping-related drinking motives. However, the magnitude of the indirect effect of PTSD on harmful alcohol use through coping motives is unclear. This study aggregated this indirect effect using a meta-analytic structural equation modeling approach and explored moderators that influenced the indirect effect. We identified articles from PsycINFO, PubMed/MEDLINE, and PROQUEST (through June 22, 2021) containing measures of (a) PTSD symptoms, (b) coping-related drinking, and (c) harmful alcohol use. Thirty-four studies yielding 69 effect sizes were included (mean N = 387.26 participants; median N = 303.5; range = 42-1,896; aggregate sample n = 15,128). Coping motives mediated the relation between PTSD and harmful alcohol use, accounting for 80% of the variance in the total effect. Moderating variables and evidence of publication bias were also found. Findings suggest that coping-related drinking is a strong mediator in the relation between PTSD and harmful alcohol use and that the strength of the indirect effect is meaningfully influenced by measurement approach, sample characteristics, and study design. Additional longitudinal and multivariate studies are needed to establish directionality and account for additional variance. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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8
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Olin CC, McDevitt-Murphy ME, Leonard SJ, Acuff SF. Wanting, Liking, and Missing Out: Exploring the Role of Reward Functioning in the Overlap Between PTSD and Depression. J Nerv Ment Dis 2022; 210:497-503. [PMID: 35766543 DOI: 10.1097/nmd.0000000000001456] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Diminished reward functioning (anhedonia) is an aspect of multiple psychiatric diagnoses and is a critical component of depression, yet it has rarely been examined in the context of posttraumatic stress disorder (PTSD). Deficits in reward function may be a transdiagnostic factor contributing to the high rate of comorbidity between PTSD and depression. The present study examined the commonality and distinction between PTSD and depression and their relationship to reward functioning using a bifactor model in a sample of 106 trauma-exposed undergraduates. Results indicated a strong commonality factor between PTSD and depression. Of three indices of reward functioning (i.e., hedonic pleasure, reward motivation, and environmental reward availability), environmental reward availability alone was related to unique latent factors for PTSD and depression, and their commonality. Findings suggest that environmental context may be the key to understanding the role of reward in PTSD, depression, and psychopathology broadly.
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Affiliation(s)
- Cecilia C Olin
- Department of Psychology, University of Memphis, Memphis, Tennessee
| | | | | | - Samuel F Acuff
- Department of Psychology, University of Memphis, Memphis, Tennessee
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9
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Luciano MT, McDevitt-Murphy ME, Murphy JG, Zakarian RJ, Olin CC. Open trial of a personalized feedback intervention and substance-free activity supplement for veterans with PTSD and hazardous drinking. J Behav Cogn Ther 2022; 32:136-144. [PMID: 35872748 PMCID: PMC9307063 DOI: 10.1016/j.jbct.2022.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This study reports findings from an open trial of a two-session intervention for veterans with symptoms of PTSD and hazardous drinking. Rooted in behavioral economic theory, this intervention aimed to decrease alcohol use and increase alcohol-free activities through personalized and normative feedback. This trial assessed the feasibility and acceptability of the intervention in a sample of 15 veterans. Participants completed assessments at baseline and post-intervention (1-month and 3-months). Thirteen participants (86.6%) were retained between the baseline assessment and second intervention session. Acceptability data indicated that veterans overwhelmingly viewed the intervention positively with little dropout between the two sessions. Further, participants in our study reduced alcohol consumption from 37.30 (SD = 17.30) drinks per week at baseline to 22.50 (SD = 27.75) drinks per week at the 1-month assessment and then to 14.60 (SD = 18.64) at the 3-months assessment, representing medium to large effects. PTSD severity also decreased from 57.20 (SD = 16.72) at baseline to 48.90 (SD = 18.99) at the 1-month assessment, representing a small effect. Though effect sizes from pilot trials should be interpreted with caution, findings suggest that this intervention was well-received, feasible to deliver, and may have resulted in improvements in intervention targets.
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Affiliation(s)
- Matthew T. Luciano
- The University of Memphis, Memphis, TN 38152, United States
- San Diego State University, San Diego, CA 92104, United States
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10
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Pebley K, Murphy JG, Wang XQ, Talcott GW, Klesges RC, McDevitt-Murphy ME, McMurry TL, Little MA. Validity of the alcohol purchase task with United States military personnel. Exp Clin Psychopharmacol 2022; 30:141-150. [PMID: 33119385 DOI: 10.1037/pha0000392] [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: 11/08/2022]
Abstract
Alcohol use is common among military personnel. However, alcohol use and problems are challenging to measure because military personnel do not have similar levels of confidentiality as civilians and can face sanctions for reporting illegal behavior (e.g., underage drinking) or for drinking during prohibited times (e.g., during basic training). The current study aimed to determine if the use of the alcohol purchase task (APT), which has previously been associated with alcohol use and alcohol-related problems in civilian populations, is a valid measure of alcohol-related risk in the military when asking about alcohol consumption is less feasible. Participants were 26,231 Air Force airmen who completed surveys including questions about sensation seeking, alcohol expectancies, perception of peer drinking, intent to drink, and family history of alcohol misuse, which are known predictors of alcohol use, and the APT, from which demand indices of intensity and Omax were derived. Individuals who were single, male, White, and had a high school diploma/GED had higher intensity and Omax scores, and non-Hispanic individuals had higher intensity scores. Age was negatively correlated with intensity and Omax. Regressions were used to determine if intensity and Omax were associated with known predictors of alcohol use and risk. Intensity and Omax showed significant but small associations with all included predictors of alcohol consumption and alcohol risk. Effect sizes were larger for individuals ages 21+ compared to individuals under 21. Thus, this study provides initial support for the validity of the APT as an index of alcohol-related risk among military personnel. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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11
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Zakarian RJ, McDevitt-Murphy ME. Posttraumatic Stress Disorder and Aggression Among Post-9/11 Veterans: The Role of Shame. Pers Individ Dif 2022; 185:111267. [PMID: 34840375 PMCID: PMC8612125 DOI: 10.1016/j.paid.2021.111267] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Posttraumatic stress disorder (PTSD) is often accompanied by elevated aggression. PTSD and combat exposure alone do not fully explain the reliable finding of heightened aggression among trauma-exposed veterans. Shame may be an important affective feature in this relationship. The present study examined the role of shame from a social hierarchy theoretical perspective in a sample of 52 combat veterans from the post-9/11 era. Correlational analyses indicated moderately strong positive relationships among PTSD, shame, and aggression. Trait shame was found to significantly mediate the relationship between total PTSD severity and physical aggression, but not other forms of aggression. For veterans within the context of a hierarchical military culture, separation from the military and PTSD diagnosis may be very salient markers of social loss and social exclusion. Aggression may operate to reduce the negative affective experience associated with shame and to regain social standing. Findings implicate shame as an important emotional component in the relationship between PTSD and aggression.
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Peterson AL, Young-McCaughan S, Roache JD, Mintz J, Litz BT, Williamson DE, Resick PA, Foa EB, McGeary DD, Dondanville KA, Taylor DJ, Wachen JS, Fox PT, Bryan CJ, McLean CP, Pruiksma KE, Yarvis JS, Niles BL, Abdallah CG, Averill LA, Back SE, Baker MT, Blount TH, Borah AM, Borah EV, Brock MS, Brown LA, Burg MM, Cigrang JA, DeBeer BB, DeVoe ER, Fina BA, Flanagan JC, Fredman SJ, Gardner CL, Gatchel RR, Goodie JL, Gueorguieva R, Higgs JB, Jacoby VM, Kelly KM, Krystal JH, Lapiz-Bluhm MD, López-Roca AL, Marx BP, Maurer DM, McDevitt-Murphy ME, McGeary CA, Meyer EC, Miles SR, Monson CM, Morilak DA, Moring JC, Mysliwiec V, Nicholson KL, Rauch SAM, Riggs DS, Rosen CS, Rudd MD, Schobitz RP, Schrader CC, Shinn AM, Shiroma PR, Sloan DM, Stern SL, Strong R, Vannoy SD, Young KA, Keane TM. STRONG STAR and the Consortium to Alleviate PTSD: Shaping the future of combat PTSD and related conditions in military and veteran populations. Contemp Clin Trials 2021; 110:106583. [PMID: 34600107 DOI: 10.1016/j.cct.2021.106583] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 06/25/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 10/20/2022]
Abstract
The STRONG STAR Consortium (South Texas Research Organizational Network Guiding Studies on Trauma and Resilience) and the Consortium to Alleviate PTSD are interdisciplinary and multi-institutional research consortia focused on the detection, diagnosis, prevention, and treatment of combat-related posttraumatic stress disorder (PTSD) and comorbid conditions in military personnel and veterans. This manuscript outlines the consortia's state-of-the-science collaborative research model and how this can be used as a roadmap for future trauma-related research. STRONG STAR was initially funded for 5 years in 2008 by the U.S. Department of Defense's (DoD) Psychological Health and Traumatic Brain Injury Research Program. Since the initial funding of STRONG STAR, almost 50 additional peer-reviewed STRONG STAR-affiliated projects have been funded through the DoD, the U.S. Department of Veterans Affairs (VA), the National Institutes of Health, and private organizations. In 2013, STRONG STAR investigators partnered with the VA's National Center for PTSD and were selected for joint DoD/VA funding to establish the Consortium to Alleviate PTSD. STRONG STAR and the Consortium to Alleviate PTSD have assembled a critical mass of investigators and institutions with the synergy required to make major scientific and public health advances in the prevention and treatment of combat PTSD and related conditions. This manuscript provides an overview of the establishment of these two research consortia, including their history, vision, mission, goals, and accomplishments. Comprehensive tables provide descriptions of over 70 projects supported by the consortia. Examples are provided of collaborations among over 50 worldwide academic research institutions and over 150 investigators.
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Affiliation(s)
- Alan L Peterson
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; South Texas Veterans Health Care System, San Antonio, TX, USA; University of Texas at San Antonio, San Antonio, TX, USA.
| | - Stacey Young-McCaughan
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; South Texas Veterans Health Care System, San Antonio, TX, USA.
| | - John D Roache
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; South Texas Veterans Health Care System, San Antonio, TX, USA.
| | - Jim Mintz
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; South Texas Veterans Health Care System, San Antonio, TX, USA.
| | - Brett T Litz
- VA Boston Healthcare System, Boston, MA, USA; Boston University School of Medicine, Boston, MA, USA; Boston University, Boston, MA, USA.
| | - Douglas E Williamson
- Duke University, Durham, NC, USA; Durham VA Health Care System, Durham, NC, USA.
| | | | - Edna B Foa
- University of Pennsylvania, Philadelphia, PA, USA.
| | - Donald D McGeary
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; South Texas Veterans Health Care System, San Antonio, TX, USA; University of Texas at San Antonio, San Antonio, TX, USA.
| | | | | | - Jennifer Schuster Wachen
- VA Boston Healthcare System, Boston, MA, USA; Boston University School of Medicine, Boston, MA, USA; National Center for PTSD, Women's Health Sciences Division, Boston, MA, USA.
| | - Peter T Fox
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; South Texas Veterans Health Care System, San Antonio, TX, USA.
| | - Craig J Bryan
- Ohio State University College of Medicine, Columbus, OH, USA.
| | - Carmen P McLean
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, Menlo Park, CA, USA; Stanford University, Stanford, CA, USA.
| | - Kristi E Pruiksma
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; South Texas Veterans Health Care System, San Antonio, TX, USA.
| | | | - Barbara L Niles
- VA Boston Healthcare System, Boston, MA, USA; Boston University School of Medicine, Boston, MA, USA; National Center for PTSD, Behavioral Science Division, Boston, MA, USA.
| | - Chadi G Abdallah
- National Center for PTSD, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, USA; Yale University School of Medicine, New Haven, CT, USA.
| | - Lynnette A Averill
- National Center for PTSD, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, USA; Yale University School of Medicine, New Haven, CT, USA.
| | - Sudie E Back
- Medical University of South Carolina, Charleston, SC, USA; Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA.
| | - Monty T Baker
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; 59th Medical Wing, Joint Base San Antonio-Lackland, San Antonio, TX, USA
| | - Tabatha H Blount
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
| | - Adam M Borah
- Carl R Darnall Army Medical Center, Fort Hood, TX, USA.
| | - Elisa V Borah
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
| | - Matthew S Brock
- 59th Medical Wing, Joint Base San Antonio-Lackland, San Antonio, TX, USA.
| | - Lily A Brown
- University of Pennsylvania, Philadelphia, PA, USA.
| | | | | | - Bryann B DeBeer
- VA VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX, USA; Central Texas Veterans Health Care System, Temple, TX, USA.
| | | | - Brooke A Fina
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
| | - Julianne C Flanagan
- Medical University of South Carolina, Charleston, SC, USA; Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA.
| | | | - Cubby L Gardner
- 59th Medical Wing, Joint Base San Antonio-Lackland, San Antonio, TX, USA.
| | | | - Jeffrey L Goodie
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
| | | | - Jay B Higgs
- Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, TX, USA
| | - Vanessa M Jacoby
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
| | - Kevin M Kelly
- Carl R Darnall Army Medical Center, Fort Hood, TX, USA.
| | - John H Krystal
- National Center for PTSD, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, USA; Yale University School of Medicine, New Haven, CT, USA.
| | - M Danet Lapiz-Bluhm
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
| | | | - Brian P Marx
- VA Boston Healthcare System, Boston, MA, USA; Boston University School of Medicine, Boston, MA, USA; National Center for PTSD, Behavioral Science Division, Boston, MA, USA.
| | | | | | - Cindy A McGeary
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; South Texas Veterans Health Care System, San Antonio, TX, USA.
| | - Eric C Meyer
- VA VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX, USA; Central Texas Veterans Health Care System, Temple, TX, USA.
| | - Shannon R Miles
- James A. Haley Veterans' Affairs Hospital, Tampa, FL, USA; University of South Florida, Tampa, FL, USA.
| | | | - David A Morilak
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; South Texas Veterans Health Care System, San Antonio, TX, USA.
| | - John C Moring
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
| | - Vincent Mysliwiec
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
| | | | - Sheila A M Rauch
- Emory University School of Medicine, Atlanta, GA, USA; Atlanta VA Healthcare System, Atlanta, GA, USA.
| | - David S Riggs
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
| | - Craig S Rosen
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, Menlo Park, CA, USA; Stanford University, Stanford, CA, USA.
| | | | - Richard P Schobitz
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, TX, USA.
| | | | - Antoinette M Shinn
- 59th Medical Wing, Joint Base San Antonio-Lackland, San Antonio, TX, USA.
| | - Paulo R Shiroma
- Minneapolis VA Health Care System, Minneapolis, MN, USA; University of Minnesota, Minneapolis, MN, USA.
| | - Denise M Sloan
- VA Boston Healthcare System, Boston, MA, USA; Boston University School of Medicine, Boston, MA, USA; National Center for PTSD, Behavioral Science Division, Boston, MA, USA.
| | - Stephen L Stern
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; South Texas Veterans Health Care System, San Antonio, TX, USA.
| | - Randy Strong
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; South Texas Veterans Health Care System, San Antonio, TX, USA.
| | | | - Keith A Young
- VA VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX, USA; Central Texas Veterans Health Care System, Temple, TX, USA; Texas A&M University College of Medicine, Bryan, TX, USA.
| | - Terence M Keane
- VA Boston Healthcare System, Boston, MA, USA; Boston University School of Medicine, Boston, MA, USA; National Center for PTSD, Behavioral Science Division, Boston, MA, USA.
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Luciano MT, Acuff SF, McDevitt-Murphy ME, Murphy JG. Behavioral economics and coping-related drinking motives in trauma exposed drinkers: Implications for the self-medication hypothesis. Exp Clin Psychopharmacol 2020; 28:265-270. [PMID: 31380693 PMCID: PMC7000292 DOI: 10.1037/pha0000318] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Behavioral economic theory can help researchers understand complex behavior by considering the availability and economic value associated with an individual's choices. This study explored how behavioral economic constructs relate to alcohol consumption and alcohol problems in a sample of trauma-exposed young adults. We further explored whether these behavioral economic constructs explained unique variance in alcohol outcomes beyond coping-related drinking motives. Participants were 91 trauma-exposed young adults who reported recent alcohol consumption (Mage = 26.53, female = 36.26%, non-White = 41.75%). Participants were recruited through Amazon Mechanical Turk. Questionnaires measured alcohol consumption, problems, and motives for use, as well as alcohol demand, delay discounting, future orientation, and access to environmental reward. Future orientation (ΔR2 = .05, p = .03) and delay discounting (ΔR2 = .04, p = .05) explained unique variance in alcohol problems after controlling for coping-related drinking motives. Further, alcohol demand indices (ΔR2s = .04-.10, ps = .00-.05) explained unique variance in alcohol consumption after controlling for coping-related drinking. Both coping motives and behavioral economic variables contribute to alcohol consumption and alcohol-related consequences among trauma-exposed young adults. Findings suggest that, beyond coping motives, behavioral economics may play a meaningful role in understanding alcohol misuse. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Matthew T. Luciano
- The University of Memphis, Department of Psychology, 202 Psychology Building, Memphis, TN 38152, United States
| | - Samuel F. Acuff
- The University of Memphis, Department of Psychology, 202 Psychology Building, Memphis, TN 38152, United States
| | - Meghan E. McDevitt-Murphy
- The University of Memphis, Department of Psychology, 202 Psychology Building, Memphis, TN 38152, United States
| | - James G. Murphy
- The University of Memphis, Department of Psychology, 202 Psychology Building, Memphis, TN 38152, United States,Corresponding author: Current Address: 202 Psychology Building, Memphis, TN 38152, United States, (James G. Murphy, PhD)., Phone Number: (901) 678-2630, Fax Number: (901) 678-2579
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Derefinko KJ, Salgado García FI, Talley KM, Bursac Z, Johnson KC, Murphy JG, McDevitt-Murphy ME, Andrasik F, Sumrok DD. Adverse childhood experiences predict opioid relapse during treatment among rural adults. Addict Behav 2019; 96:171-174. [PMID: 31102882 DOI: 10.1016/j.addbeh.2019.05.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [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: 10/17/2018] [Revised: 05/06/2019] [Accepted: 05/06/2019] [Indexed: 11/19/2022]
Abstract
Adverse childhood experiences (ACE) are a public health concern and strong predictor of substance abuse, but no studies to date have explored the association between ACE and opioid relapse during medication-assisted treatment. Using an observational design, we examined this relationship using archived medical records of 87 patients who attended opioid use disorder treatment (buprenorphine-naloxone and group counseling) at a rural medical clinic. All variables were collected from medical files. ACE scores were derived from a 10-item screening questionnaire administered at intake, a regular procedure for this clinic. The primary outcome was opioid relapse observed at each visit, as indicated by self-reported opioid use, positive urine drug screen for opioids, or prescription drug database results for opioid acquisition. The sample was 100% Caucasian and 75% male. A total of 2052 visit observations from the 87 patients were extracted from the medical records. Patients had an average of 23.6 (SD = 22) treatment visits. Opioid relapse occurred in 54% of patients. Results indicated that for every unit increase in ACE score, there was an increase of 17% in the odds of relapse (95% CI: 1.05-1.30, p = .005). Additionally, each treatment visit was associated with a 2% reduction in the odds of opioid relapse (95% CI: 0.97-0.99, p = .008). We conclude that ACE may increase the risk for poor response to buprenorphine-naloxone treatment due to high rates of opioid relapse during the first treatment visits. However, consistent adherence to treatment is likely to reduce the odds of opioid relapse.
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Affiliation(s)
- Karen J Derefinko
- University of Tennessee Health Science Center, 66 North Pauline St., Room 649, Memphis, TN 38163-2181, USA.
| | - Francisco I Salgado García
- University of Tennessee Health Science Center, 66 North Pauline St., Room 649, Memphis, TN 38163-2181, USA
| | - Kevin M Talley
- University of Tennessee Health Science Center, 66 North Pauline St., Room 649, Memphis, TN 38163-2181, USA
| | - Zoran Bursac
- University of Tennessee Health Science Center, 66 North Pauline St., Room 649, Memphis, TN 38163-2181, USA
| | - Karen C Johnson
- University of Tennessee Health Science Center, 66 North Pauline St., Room 649, Memphis, TN 38163-2181, USA
| | - James G Murphy
- University of Memphis, Psychology Building, 400 Innovation Dr., Memphis, TN 38111, USA
| | | | - Frank Andrasik
- University of Memphis, Psychology Building, 400 Innovation Dr., Memphis, TN 38111, USA
| | - Daniel D Sumrok
- University of Tennessee Health Science Center, 66 North Pauline St., Room 649, Memphis, TN 38163-2181, USA
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McDevitt-Murphy ME, Luciano MT, Zakarian RJ. Use of Ecological Momentary Assessment and Intervention in Treatment With Adults. Focus (Am Psychiatr Publ) 2019; 16:370-375. [PMID: 31191181 DOI: 10.1176/appi.focus.20180017] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This article reviews the use of ecological momentary assessment (EMA) and ecological momentary intervention (EMI) in clinical research applications. EMA refers to a method of data collection that attempts to capture respondents' activities, emotions, and thoughts in the moment, in their natural environment. It typically uses prompts administered through a personal electronic device, such as a smartphone or tablet. EMI extends this technique and includes the use of microlevel interventions administered through personal electronic devices. These technological developments hold promise for enhancing psychological treatments by prompting the patient outside of therapy sessions in his or her day-to-day environment. Research suggests that EMI may be beneficial to participants and that this effect is amplified when EMI is delivered in the context of ongoing psychotherapy. EMI may reflect a cost-effective mechanism to enhance therapeutic outcomes.
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Avery ML, McDevitt-Murphy ME, Zakarian RJ. Using Latent Variable Mixture Modeling to Understand Trauma-Related Outcomes in Undergraduate Women. J Sex Marital Ther 2019; 45:673-687. [PMID: 31027470 DOI: 10.1080/0092623x.2019.1610120] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Posttraumatic stress disorder (PTSD) and sexual functioning problems often co-occur after trauma. Researchers have linked certain factors (e.g., depression, relationship satisfaction) to PTSD and sexual functioning, but it is unclear how these variables interact. Adult undergraduate female trauma survivors (N = 280) completed self-report measures via an online survey. Latent variable mixture modeling generated four groups that differed in terms of their PTSD symptom severity, sexual functioning, sexual pain, relationship status, and relationship functioning. ANOVAs explored group differences. Classes were not differentiated by trauma, relationship satisfaction, or drug use. Results highlight the complex relations between sexual functioning and post-trauma symptomology.
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Affiliation(s)
- Megan L Avery
- Department of Psychology, University of Memphis , Memphis , TN , USA
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McDevitt-Murphy ME, Zakarian RJ, Luciano MT, Olin CC, Mazzulo NN, Neimeyer RA. Alcohol use and coping in a cross-sectional study of African American homicide survivors. J Ethn Subst Abuse 2019; 20:135-150. [PMID: 31044649 DOI: 10.1080/15332640.2019.1598905] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The loss of a loved one to homicide is associated with considerable distress, often in the form of posttraumatic stress disorder (PTSD) and complicated grief (CG), and alcohol misuse. Yet alcohol-related problems and loss from a homicide are issues that disproportionally affect African Americans. The present study investigated alcohol use in a sample of 54 African American homicide survivors. Although there was a low prevalence of hazardous drinking, alcohol use was associated with higher levels of PTSD, complicated grief, and depression severity. In addition, scores on the Alcohol Use Disorders Identification Test (AUDIT) were correlated with active emotional coping and avoidant emotional coping. In analyses of PTSD symptom clusters, emotional numbing and hyperarousal symptoms were significantly correlated with AUDIT total score.
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Derefinko KJ, Hallsell TA, Isaacs MB, Salgado Garcia FI, Colvin LW, Bursac Z, McDevitt-Murphy ME, Murphy JG, Little MA, Talcott GW, Klesges RC. Substance Use and Psychological Distress Before and After the Military to Civilian Transition. Mil Med 2019; 183:e258-e265. [PMID: 29420791 DOI: 10.1093/milmed/usx082] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 10/30/2017] [Indexed: 11/13/2022] Open
Abstract
Background Those currently serving in the military constitute a vulnerable population given their high-risk status for substance use, and population data suggest that veterans continue to engage in significant substance use long after their military service ends. Recent research suggests that the separation transition from active duty to civilian life may be critical in terms of the future functioning of the veteran. Methods We sought to explore substance use prevalence, as well as potential emotional distress among veterans by retrospectively assessing substance use during active duty and following separation to examine possible changes in use over this period. This study assessed substance use and emotional distress in veterans (N = 80; 90% male) across the military to civilian transition. Findings Repeated measures tests indicated that endorsement of alcohol use, cigarette use, and prescription drug misuse was similar during active duty and post-separation, and marijuana and hard drug use endorsement increased significantly in the 6-mo period post-separation. Further, comorbid use of different substances was common. Active duty levels of anxiety/depression and aggressive feelings were maintained from active duty to post-separation, and feeling alone and military-based trauma symptoms increased significantly. Finally, participants indicated that only a minority of the veterans they knew were doing emotionally well or did not have alcohol/substance use issues. Discussion These findings indicate a clear need for substance use and psychological intervention availability before and after transition to enable veterans to transition to civilian life effectively. Based on the many issues at work during the transition process, programs may do well to focus more specifically on identification of problems and raising awareness, rather than awaiting more severe issues in the future. Validation of the difficulties of the separation transition, veterans' feelings of isolation, and the importance of veteran community support may help newly transitioning veterans find advocates who may help them navigate existing assistance programs.
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Affiliation(s)
- Karen J Derefinko
- Department of Preventive Medicine, University of Tennessee Health Sciences Center, 66 N. Pauline St., Memphis, TN 38163-2181
| | - Troy A Hallsell
- Department of History, The University of Memphis, Memphis, TN 38152-3450
| | - Matthew B Isaacs
- Department of History, The University of Memphis, Memphis, TN 38152-3450
| | - Francisco I Salgado Garcia
- Department of Preventive Medicine, University of Tennessee Health Sciences Center, 66 N. Pauline St., Memphis, TN 38163-2181
| | - Lauren W Colvin
- Research Informatics for the Cancer Center, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105
| | - Zoran Bursac
- Department of Preventive Medicine, University of Tennessee Health Sciences Center, 66 N. Pauline St., Memphis, TN 38163-2181
| | | | - James G Murphy
- Department of Psychology, University of Memphis, 400 Innovation Drive, Memphis, TN 38152
| | - Melissa A Little
- Department of Public Health Sciences, University of Virginia School of Medicine, 560 Ray Hunt Drive, Room 2120, Charlottesville, VA 22911
| | - Gerald W Talcott
- Department of Public Health Sciences, University of Virginia School of Medicine, 560 Ray Hunt Drive, Room 2120, Charlottesville, VA 22911
| | - Robert C Klesges
- Department of Public Health Sciences, University of Virginia School of Medicine, 560 Ray Hunt Drive, Room 2120, Charlottesville, VA 22911
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Zakarian RJ, McDevitt-Murphy ME, Bellet BW, Neimeyer RA, Burke LA. Relations Among Meaning Making, PTSD, and Complicated Grief Following Homicide Loss. Journal of Loss and Trauma 2019. [DOI: 10.1080/15325024.2019.1565111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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)
- Rebecca J. Zakarian
- aDepartment of Psychology, The University of Memphis, Memphis, Tennessee, USA
| | | | - Benjamin W. Bellet
- Department of Psychology, Harvard University, Cambridge, Massachusetts, USA
| | - Robert A. Neimeyer
- aDepartment of Psychology, The University of Memphis, Memphis, Tennessee, USA
- Portland Institute for Loss and Transition, Portland, Oregon, USA
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Luciano MT, McDevitt-Murphy ME, Acuff SF, Bellet BW, Tripp JC, Murphy JG. Posttraumatic stress disorder symptoms improve after an integrated brief alcohol intervention for OEF/OIF/OND veterans. Psychol Trauma 2018; 11:459-465. [PMID: 29939060 DOI: 10.1037/tra0000378] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Although brief alcohol interventions (BAIs) that incorporate personalized feedback demonstrate efficacy for reducing the frequency and quantity of alcohol consumption in veteran samples, little research has explored the influence of BAIs in reducing symptoms of posttraumatic stress disorder (PTSD). The goal of this investigation was to understand whether PTSD symptom severity and diagnostic status changed after exposure to an intervention that targeted alcohol misuse and integrated feedback on PTSD. METHOD Sixty-eight combat veterans (8.8% female; 27.9% African American) who screened positive for hazardous drinking were recruited from a Veterans Affairs Medical Center. Participants received a 1-session brief intervention that primarily targeted alcohol misuse but also included personalized feedback and psychoeducation on PTSD symptoms and coping. Participants were randomized to receive personalized written feedback either with or without a motivational interview. RESULTS A mixed-model repeated measures analysis revealed that PTSD symptom severity was significantly lower at the 6-week (M = 41.47, SD = 28.94) and 6-month (M = 35.56 SD = 26.99) follow-up appointments relative to baseline (M = 51.22, SD = 26.67), F(2, 127.24) = 38.32, p < .001. Regression analyses demonstrate that the percent change in alcohol use was related to the change in PTSD severity. Further, results indicated that a motivational-interviewing-style counseling session accompanying the feedback was not significantly more efficacious than receiving feedback only. CONCLUSION A brief alcohol intervention that integrates information on PTSD has the potential to reduce PTSD severity. Personalized alcohol and PTSD feedback may be useful as an opportunistic intervention for OEF/OIF veterans. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Williams JL, McDevitt-Murphy ME, Murphy JG, Crouse EM. Postconcussive Symptoms, PTSD, and Medical Disease Burden in Treatment-Seeking OEF/OIF/OND Veterans. Mil Med 2018; 182:e1645-e1650. [PMID: 28290938 DOI: 10.7205/milmed-d-16-00221] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION The most common psychological and cognitive sequelae associated with deployments to Afghanistan (Operation Enduring Freedom) and Iraq (Operation Iraqi Freedom) are mild traumatic brain injury (mTBI) and post-traumatic stress disorder (PTSD). High rates of PTSD are often observed among Veterans with a history of mTBI, and persistent postconcussive symptoms commonly endorsed after mTBI are known to be associated with PTSD. Therefore, this study examined whether PTSD mediates relations between postconcussive symptoms and 2 indices of medical disease burden: 1) the number of disease categories positive for a diagnosis, or system disease burden, and 2) total number of physical diagnoses, or cumulative disease burden. MATERIALS AND METHODS Participants were 91 Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn Veterans seeking treatment at a Veterans Affairs Medical Center who screened positive for mTBI and later attended a follow-up Polytrauma clinic evaluation for neuropsychiatric assessment. Medical records were reviewed for a history of mTBI, postconcussive symptoms, and physician diagnoses, which were used to derive system and cumulative disease burden variables. Mediation was tested using bootstrapping procedures. Participants provided written informed consent and all study procedures were approved by both the VA and university institutional review boards. RESULTS Postconcussive symptoms (r = 0.53) and PTSD symptoms (r = 0.32) were both associated with cumulative disease burden. Only postconcussive symptoms were associated with system disease burden (r = 0.32). Results of our follow-up mediation analysis suggest that PTSD did not mediate relations between postconcussive symptoms and cumulative disease burden (bootstrap coefficient = -0.02, 95% confidence interval [-0.05 to 0.01]). CONCLUSION These findings join an emerging body of literature suggesting that postconcussive symptoms have a direct impact on Veterans' health above and beyond the effects of PTSD. Strengths of this study include the use of objective, clinician-diagnosed medical conditions as an indicator of health, whereas limitations include the use of self-report measures to assess postconcussive and PTSD symptoms. This study underscores the need for more original research on the impact of mTBI on the long-term health and readjustment of returning Veterans. Furthermore, this study highlights the need for additional research on the psychosocial and pathophysiological mechanisms underlying the link between mTBI and poor health.
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Affiliation(s)
- Joah L Williams
- Department of Psychology, University of Missouri-Kansas City, 5030 Cherry Street, Room 310, Kansas City, MO 64110
| | | | - James G Murphy
- Department of Psychology, University of Memphis, 202 Psychology Building, Memphis, TN 38152
| | - Ellen M Crouse
- Memphis Veterans Affairs Medical Center, 1030 Jefferson Avenue, Memphis, TN 38104
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Derefinko KJ, Linde BD, Klesges RC, Boothe T, Colvin L, Leroy K, Little MA, Pasker C, Murphy JG, McDevitt-Murphy ME, Bursac Z, Ebbert JO, Waters TM, Brooks I, Talcott GW. Dissemination of the Brief Alcohol Intervention in the United States Air Force: Study Rationale, Design, and Methods. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/21635781.2017.1397569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Karen J. Derefinko
- Department of Preventive Medicine, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Brittany D. Linde
- Organizational Wellness & Learning Systems (OWLS), Fort Worth, Texas
| | - Robert C. Klesges
- Department of Preventive Medicine, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Tina Boothe
- Department of Preventive Medicine, University of Tennessee Health Sciences Center, San Antonio, Texas
| | - Lauren Colvin
- Department of Preventive Medicine, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Karen Leroy
- Department of Preventive Medicine, University of Tennessee Health Sciences Center, San Antonio, Texas
| | - Melissa A. Little
- Department of Preventive Medicine, University of Tennessee Health Sciences Center, San Antonio, Texas
| | - Christin Pasker
- Department of Preventive Medicine, University of Tennessee Health Sciences Center, San Antonio, Texas
| | - James G. Murphy
- Department of Psychology, The University of Memphis, Memphis, Tennessee
| | - Meghan E. McDevitt-Murphy
- Department of Preventive Medicine, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Zoran Bursac
- Department of Preventive Medicine, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Jon O. Ebbert
- Nicotine Dependence Center, Mayo Clinic, Rochester, Minnesota
| | - Teresa M. Waters
- Department of Preventive Medicine, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Ian Brooks
- Department of Preventive Medicine, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - G. Wayne Talcott
- Department of Preventive Medicine, University of Tennessee Health Sciences Center, San Antonio, Texas
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Dennhardt AA, Murphy JG, McDevitt-Murphy ME, Williams JL. Drinking motives mediate the relationship between alcohol reward value and alcohol problems in military veterans. Psychol Addict Behav 2017; 30:819-826. [PMID: 28068111 DOI: 10.1037/adb0000197] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Elevated alcohol reward value (RV) has been linked to higher levels of drinking and alcohol-related consequences, and there is evidence that specific drinking motives may mediate the relationship between demand and problematic alcohol use in college students, making these variables potentially important indicators of risk for high RV and alcohol problems. The present study evaluated these relationships in a high-risk sample of military veterans. Heavy-drinking (N = 68) veterans of Operations Enduring Freedom or Iraqi Freedom (OEF/OIF) completed the alcohol purchase task (APT) measure of alcohol demand (RV), and standard assessments of alcohol consumption, alcohol-related problems, and drinking motives. RV was associated with overall alcohol consequences, interpersonal alcohol consequences, social responsibility consequences and impulse control consequences. Mediation analyses indicated significant mediation of the relationships between RV and a number of problem subscales by social motives, coping-anxiety motives, coping-depression motives and enhancement motives. This suggests that individuals who have a high valuation of alcohol may have increased motivation to drink in social, mood-enhancement, and coping situations, resulting in increased alcohol-related consequences. Demand and drinking motives should be examined as potential indicators of need for intervention services and as treatment targets in veterans. (PsycINFO Database Record
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Soltis KE, McDevitt-Murphy ME, Murphy JG. Alcohol Demand, Future Orientation, and Craving Mediate the Relation Between Depressive and Stress Symptoms and Alcohol Problems. Alcohol Clin Exp Res 2017; 41:1191-1200. [PMID: 28401985 DOI: 10.1111/acer.13395] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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: 12/08/2016] [Accepted: 04/04/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Elevated depression and stress have been linked to greater levels of alcohol problems among young adults even after taking into account drinking level. This study attempts to elucidate variables that might mediate the relation between symptoms of depression and stress and alcohol problems, including alcohol demand, future time orientation, and craving. METHODS Participants were 393 undergraduates (60.8% female, 78.9% White/Caucasian) who reported at least 2 binge-drinking episodes (4/5+ drinks for women/men, respectively) in the previous month. Participants completed self-report measures of stress and depression, alcohol demand, future time orientation, craving, and alcohol problems. RESULTS In separate mediation models that accounted for gender, race, and weekly alcohol consumption, future orientation and craving significantly mediated the relation between depressive symptoms and alcohol problems. Alcohol demand, future orientation, and craving significantly mediated the relation between stress symptoms and alcohol problems. CONCLUSIONS Heavy-drinking young adults who experience stress or depression are likely to experience alcohol problems, and this is due in part to elevations in craving and alcohol demand, and less sensitivity to future outcomes. Interventions targeting alcohol misuse in young adults with elevated levels of depression and stress should attempt to increase future orientation and decrease craving and alcohol reward value.
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Affiliation(s)
- Kathryn E Soltis
- Department of Psychology, University of Memphis, Memphis, Tennessee
| | | | - James G Murphy
- Department of Psychology, University of Memphis, Memphis, Tennessee
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Tripp JC, McDevitt-Murphy ME. Trauma-Related Guilt Mediates the Relationship between Posttraumatic Stress Disorder and Suicidal Ideation in OEF/OIF/OND Veterans. Suicide Life Threat Behav 2017; 47:78-85. [PMID: 27273459 DOI: 10.1111/sltb.12266] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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] [Received: 10/08/2015] [Accepted: 01/26/2016] [Indexed: 11/29/2022]
Abstract
Posttraumatic stress disorder (PTSD) and trauma-related guilt are risk factors for suicidal ideation (SI) in veterans. Components of trauma-related guilt were examined as serial mediators of the relationship between PTSD and SI. In a sample of 53 OEF/OIF/OND combat veterans, PTSD had an indirect effect on SI through a serial mediation chain of guilt cognitions, distress, and global guilt, suggesting that trauma-related guilt via cognitions, distress, and global guilt is a pathway from PTSD to SI. Attention should be given to assessing and addressing trauma-related guilt in veterans experiencing PTSD to prevent SI.
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Affiliation(s)
- Jessica C Tripp
- Department of Psychology, The University of Memphis and Memphis Veterans Affairs Medical Center, Memphis, TN, USA
| | - Meghan E McDevitt-Murphy
- Department of Psychology, The University of Memphis and Memphis Veterans Affairs Medical Center, Memphis, TN, USA
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Bellet BW, McDevitt-Murphy ME, Thomas DH, Luciano MT. The Utility of the Personality Assessment Inventory in the Assessment of Posttraumatic Stress Disorder in OEF/OIF/OND Veterans. Assessment 2017; 25:1074-1083. [DOI: 10.1177/1073191116681627] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We examined the use of the Personality Assessment Inventory (PAI) in a small sample of 47 U.S. military veterans of the conflicts in Iraq and Afghanistan. Approximately half of the sample met criteria for posttraumatic stress disorder (PTSD) based on the Clinician-Administered PTSD Scale. PAI profiles were compared between the PTSD and non-PTSD groups. The PTSD group had clinically significant scores (≥ 70 T) on the PAI for 5 clinical scales (anxiety, anxiety-related disorders, depression, paranoia, and schizophrenia) and 10 clinical subscales consistent with the typical symptom picture for PTSD. Effect size correlations ( r) between scales and diagnosis group membership were large ( r ≥ .5) for several scales that reflect PTSD symptoms and for the PTSD LOGIT function. In a receiver operating characteristics curve analysis, the PTSD LOGIT function and the Traumatic Stress Subscale both demonstrated good diagnostic utility (areas under the curve > .80).
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Affiliation(s)
- Benjamin W. Bellet
- The University of Memphis, Memphis, TN, USA
- Memphis Veterans Affairs Medical Center, Memphis, TN, USA
| | - Meghan E. McDevitt-Murphy
- The University of Memphis, Memphis, TN, USA
- Memphis Veterans Affairs Medical Center, Memphis, TN, USA
| | | | - Matthew T. Luciano
- The University of Memphis, Memphis, TN, USA
- Memphis Veterans Affairs Medical Center, Memphis, TN, USA
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Borsari B, Yurasek A, Miller MB, Murphy JG, McDevitt-Murphy ME, Martens MP, Darcy MG, Carey KB. Student service members/veterans on campus: Challenges for reintegration. Am J Orthopsychiatry 2017; 87:166-175. [PMID: 28206804 PMCID: PMC5319708 DOI: 10.1037/ort0000199] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [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: 11/08/2022]
Abstract
Many returning OIF/OEF/OND Veterans are seeking higher education in an effort to develop a meaningful career and financial stability. Evidence suggests that student service members/veterans (SSM/Vs) are experiencing less academic success than other students. The purpose of this review is to identify the unique challenges of SSM/Vs and evaluate current campus efforts to facilitate their retention and academic performance. With a focus on SSM/Vs attending colleges and universities, we obtained 57 peer-reviewed and 73 gray literature records published between 2001 and 2015. The current SSM/V literature contains an abundance of gray literature, and the empirical research tends to be limited by cross-sectional design and small sample sizes. SSM/Vs encounter significant personal and environmental challenges when transitioning from the military to college campuses. A variety of services have been developed to address the needs of the SSM/V population, but the efficacy of these services remains largely unknown. In conclusion, there is a clear need to provide education to faculty, students, and staff regarding the experiences of SSM/Vs. Efforts to enhance screening for, availability of, and SSM/V engagement in mental health services would also be beneficial, as would improved availability of and SSM/V access to academic support. All future programs designed to address the unique challenges of SSM/Vs in the academic environment should also be systematically implemented and evaluated. (PsycINFO Database Record
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Affiliation(s)
- Brian Borsari
- San Francisco Veteran Affairs Medical Center, Department of Psychiatry, University of California-San Francisco
| | - Ali Yurasek
- Center for Alcohol and Addiction Studies, Brown University
| | | | | | | | | | - Monica G Darcy
- Feinstein School of Education and Human Development, Rhode Island College
| | - Kate B Carey
- Center for Alcohol and Addiction Studies, Brown University
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McDevitt-Murphy ME, Luciano MT, Tripp JC, Eddinger JE. Drinking motives and PTSD-related alcohol expectancies among combat veterans. Addict Behav 2017; 64:217-222. [PMID: 27664565 DOI: 10.1016/j.addbeh.2016.08.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 08/12/2016] [Accepted: 08/23/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Combat veterans are at increased risk for PTSD and alcohol misuse, and expectancies and motives for drinking may help explain the link between these comorbid issues. This investigation explored the relationships between PTSD symptoms, PTSD-related alcohol expectancies, motives for drinking, and alcohol consumption/misuse. METHOD 67 veterans of Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) participated in this project. We examined correlations between PTSD severity, alcohol misuse, drinking motives, PTSD alcohol expectancies, and tested models of mediation and moderation. RESULTS Coping-anxiety drinking motives and positive PTSD-related alcohol expectancies were associated with alcohol misuse and alcohol-related consequences, but not with consumption. Each PTSD symptom cluster was associated with positive and negative PTSD alcohol expectancies, and coping-anxiety was specifically related to reexperiencing and avoidance. Drinking to cope mediated the relationship between PTSD symptoms and hazardous drinking. Moderation analyses showed that a positive relationship between PTSD severity and hazardous drinking existed among those with moderate and higher levels of positive PTSD-alcohol expectancies. DISCUSSION Our findings point to surprising, and in some cases complex, relationships between PTSD and alcohol use. Although related, PTSD alcohol expectancies and drinking motives seem to function differently in the relationship between PTSD and alcohol misuse.
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McDevitt-Murphy ME, Weathers FW, Flood AM, Eakin DE, Benson TA. The Utility of the PAI and the MMPI-2 for Discriminating PTSD, Depression, and Social Phobia in Trauma-Exposed College Students. Assessment 2016; 14:181-95. [PMID: 17504890 DOI: 10.1177/1073191106295914] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study investigated the Minnesota Multiphasic Personality Inventory—Revised (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) and the Personality Assessment Inventory (PAI; Morey, 1991) with regard to each instrument's utility for discriminating post-traumatic stress disorder (PTSD) from depression and social phobia in a sample of college students with mixed civilian trauma exposure. Participants were 90 trauma-exposed undergraduates (16 male, 74 female) classified into one of four groups: PTSD, depressive disorders, social phobia, and well-adjusted. For both the PAI and the MMPI-2, profile analysis revealed that the groups differed in the elevation and shape of their profiles. The PAI Traumatic Stress subscale demonstrated good discriminant validity.
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Alexander AC, Ali J, McDevitt-Murphy ME, Forde DR, Stockton M, Read M, Ward KD. Racial Differences in Posttraumatic Stress Disorder Vulnerability Following Hurricane Katrina Among a Sample of Adult Cigarette Smokers from New Orleans. J Racial Ethn Health Disparities 2016; 4:94-103. [PMID: 26823065 DOI: 10.1007/s40615-015-0206-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 10/26/2015] [Revised: 12/03/2015] [Accepted: 12/29/2015] [Indexed: 01/22/2023]
Abstract
Although blacks are more likely than whites to experience posttraumatic stress disorder (PTSD) after a natural disaster, the reasons for this disparity are unclear. This study explores whether race is associated with PTSD after adjusting for differences in preexisting vulnerabilities, exposure to stressors, and loss of social support due to Hurricane Katrina using a representative sample of 279 black and white adult current and past smokers who were present when Hurricane Katrina struck, and identified it as the most traumatic event in their lifetime. Multiple logistic regression models evaluated whether differential vulnerability (pre-hurricane physical and mental health functioning, and education level), differential exposure to hurricane-related stressors, and loss of social support deterioration reduced the association of race with PTSD. Blacks were more likely than whites to screen positive for PTSD (49 vs. 39 %, respectively, p = 0.030). Although blacks reported greater pre-hurricane vulnerability (worse mental health functioning and lower educational attainment) and hurricane-related stressor exposure and had less social support after the hurricane, only pre-hurricane mental health functioning attenuated the association of race with screening positive for PTSD. Thus, racial differences in pre-hurricane functioning, particularly poorer mental health, may partially explain racial disparities in PTSD after natural disasters, such as Hurricane Katrina. Future studies should examine these associations prospectively using representative cohorts of black and whites and include measures of residential segregation and discrimination, which may further our understanding of racial disparities in PTSD after a natural disaster.
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Affiliation(s)
- Adam C Alexander
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, TN, 38152-3450, USA
| | - Jeanelle Ali
- Department of Psychology, University of Memphis, 400 Innovation Drive, Memphis, TN, 38152-3450, USA
| | - Meghan E McDevitt-Murphy
- Department of Psychology, University of Memphis, 400 Innovation Drive, Memphis, TN, 38152-3450, USA
| | - David R Forde
- Department of Criminology & Criminal Justice, University of North Florida, 1 UNF Drive, Jacksonville, FL, 32224, USA
| | - Michelle Stockton
- School of Health Studies, University of Memphis, 106 Fieldhouse, Memphis, TN, 38152-3450, USA
| | - Mary Read
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, TN, 38152-3450, USA
| | - Kenneth D Ward
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, TN, 38152-3450, USA.
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Henschel AV, McDevitt-Murphy ME. How Do Aftermath of Battle Experiences Affect Returning OEF/OIF Veterans? ACTA ACUST UNITED AC 2016; 4:345-350. [PMID: 30505629 DOI: 10.1080/21635781.2016.1181583] [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] [Indexed: 10/21/2022]
Abstract
Aftermath of battle experiences (ABE) may contribute to adverse mental and physical health outcomes. This study examined ABE and their effect on health functioning and posttraumatic stress disorder (PTSD) in 66 OEF/OIF/OND Veterans. Bivariate correlations were conducted to investigate the contribution of ABE to PTSD and health functioning, after controlling for combat experiences. Additionally, a mediation analyses was conducted on Role Limitations due to Emotional Problems. Results suggested that the association between ABE and Role Limitations due to Emotional Problems was mediated by PTSD. These initials findings suggest the need for more research on differences in deployment experiences.
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Affiliation(s)
| | - Meghan E McDevitt-Murphy
- Department of Psychology, The University of Memphis, Memphis, Tennessee.,Memphis Veterans' Affairs Medical Center, Memphis, Tennessee
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Tripp JC, McDevitt-Murphy ME, Henschel AV. Firing a weapon and killing in combat are associated with suicidal ideation in OEF/OIF veterans. Psychol Trauma 2015; 8:626-633. [PMID: 26460495 DOI: 10.1037/tra0000085] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Combat veterans are at risk for several adverse outcomes such as posttraumatic stress disorder (PTSD), depression, hazardous alcohol use, and most critically, suicidal behaviors. The high rate of suicide in veterans has been understood as a correlate of PTSD and depression, but it is possible that certain specific types of combat experiences may lead to suicidal behaviors. Acts committed by veterans in the context of war such as killing may evoke a "moral injury," which leads to thoughts of ending one's life. METHOD The present exploratory research examined relationships between combat experiences and suicidal ideation (SI) and PTSD in a sample of 68 Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) veterans (91% male, mean age = 32.31 years) who had screened positive for alcohol misuse. We examined firing a weapon/killing in combat (Firing/Killing) and killing in combat (Killing) alone as predictors of SI and PTSD severity in both the full sample and men only. RESULTS Firing/Killing were associated with SI for the full sample and men only, and Killing showed a trend toward significance in predicting SI. Hierarchical regression analyses suggested that Firing/Killing did not predict PTSD for the full sample or men only, but Killing was predictive of PTSD for both samples. CONCLUSIONS These results indicate that there may be differences in Firing/Killing and Killing alone in OEF/OIF veterans who screened positive for alcohol misuse. Thorough screening of combat experiences and addressing moral injury in returning combat veterans may help reduce high rates of suicide and PTSD. (PsycINFO Database Record
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Tripp JC, Meshesha LZ, Teeters JB, Pickover AM, McDevitt-Murphy ME, Murphy JG. Alcohol craving and demand mediate the relation between posttraumatic stress symptoms and alcohol-related consequences. Exp Clin Psychopharmacol 2015; 23:324-31. [PMID: 26375513 PMCID: PMC4573546 DOI: 10.1037/pha0000040] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [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: 01/23/2023]
Abstract
Posttraumatic stress (PTS) symptoms are associated with alcohol-related consequences, but there is a need to understand mediators that may help explain the reasons for this relationship. Individuals with PTS may experience elevated craving and alcohol reward value (demand), which may contribute to risk for alcohol-related consequences. We examined relationships between PTS status, craving, alcohol demand, and alcohol-related consequences in PTS-positive (n = 64) and PTS-negative (n = 200) college students (M age = 21.7; 77% women; 54% Caucasian; 34% African American) who endorsed past-month alcohol use. We tested craving and alcohol demand as mediators of the relation between PTS status and alcohol-related consequences. Craving (B = .04, SE = .02, 95% CI [.01, .10]), demand intensity (B = .02, SE = .02, 95% CI [.001, .07]), and demand elasticity (B = .05, SE = .03, 95% CI [.006, .12]) significantly mediated the association between PTS symptoms and alcohol-related consequences. Craving remained a significant mediator in a multiple mediators model (B = .08, SE = .04, 95% CI [.03, .19]). Craving and alcohol demand may partially explain the relation between PTS status and alcohol-related consequences. Craving may be especially salient for individuals with PTS symptoms, as it may lead to more severe alcohol-related consequences even in the absence of elevated alcohol consumption.
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Tripp JC, McDevitt-Murphy ME. Emotion dysregulation facets as mediators of the relationship between PTSD and alcohol misuse. Addict Behav 2015; 47:55-60. [PMID: 25864136 DOI: 10.1016/j.addbeh.2015.03.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 03/04/2015] [Accepted: 03/12/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Posttraumatic stress disorder (PTSD) and alcohol misuse, which frequently co-occur among combat veterans, have been linked to emotion dysregulation. Emotion dysregulation may explain the link between PTSD and alcohol misuse, and this investigation tested emotion dysregulation as a mediator of that relationship. METHOD Correlations between PTSD symptoms and cluster symptoms, emotion dysregulation full and subscales, and alcohol misuse were examined in a sample of 139 combat Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn veterans (45% African American; 89% men). Emotion dysregulation full scale and subscales were examined as mediators of the relationship between PTSD symptoms and alcohol misuse for the full sample and men only. RESULTS PTSD symptoms and symptom clusters, emotion dysregulation, and alcohol misuse showed positive correlations for the full sample and men only. Neither the full scale of emotion dysregulation nor the facets of emotion dysregulation mediated the relationship between PTSD symptoms and alcohol misuse for the full sample; among men, the Impulse Control Difficulties when Upset and Lack of Emotional Clarity subscales were mediators of that relationship. CONCLUSIONS Impulse control difficulties and lack of emotional clarity may play an important role in the link between PTSD and alcohol misuse for male veterans and should be an important target in treatment for individuals with both disorders. Addressing impulse control difficulties and lack of emotional clarity in those with PTSD and alcohol misuse may improve outcomes by helping individuals identify and describe upsetting emotions and develop healthy coping alternatives to alcohol misuse.
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Murphy JG, Dennhardt AA, Yurasek AM, Skidmore JR, Martens MP, MacKillop J, McDevitt-Murphy ME. Behavioral economic predictors of brief alcohol intervention outcomes. J Consult Clin Psychol 2015; 83:1033-43. [PMID: 26167945 DOI: 10.1037/ccp0000032] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The present study attempted to determine whether behavioral economic indices of elevated alcohol reward value, measured before and immediately after a brief alcohol intervention, predict treatment response. METHOD Participants were 133 heavy drinking college students (49.6% female, 51.4% male; 64.3% Caucasian, 29.5% African American) who were randomized to 1 of 3 conditions: motivational interviewing plus personalized feedback (brief motivational interventions; BMI), computerized personalized feedback intervention (electronic check-up to go; e-CHUG), and assessment only. RESULTS Baseline level of alcohol demand intensity (maximum consumption) significantly predicted drinks per week and alcohol problems at 1-month follow-up and baseline relative discretionary expenditures on alcohol significantly predicted drinks per week and alcohol problems at 6-month follow-up. BMI and e-CHUG were associated with an immediate postsession reduction in alcohol demand (p < .001, ηp2 = .29) that persisted at the 1-month follow-up, with greater postsession reductions in the BMI condition (p = .02, ηp2 = .06). Reductions in demand intensity and Omax (maximum expenditure) immediately postintervention significantly predicted drinking reductions at 1-month follow up (p = .04, ΔR2 = .02, and p = .01, ΔR2 = .03, respectively). Reductions in relative discretionary expenditures on alcohol at 1-month significantly predicted drinking (p = .002, ΔR2 = .06,) and alcohol problem (p < .001, ΔR2 = .13) reductions at the 6-month follow-up. CONCLUSIONS These results suggest that behavioral economic reward value indices may function as risk factors for poor intervention response and as clinically relevant markers of change in heavy drinkers.
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Affiliation(s)
| | | | | | | | - Matthew P Martens
- Department of Educational, School, and Counseling Psychology, University of Missouri
| | - James MacKillop
- Department of Psychiatry and Behavioural Neurosciences, DeGroote School of Medicine, MacMaster University
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Piazza-Bonin E, Neimeyer RA, Burke LA, McDevitt-Murphy ME, Young A. Disenfranchised grief following African American Homicide loss: an inductive case study. Omega (Westport) 2015; 70:404-27. [PMID: 26036061 DOI: 10.1177/0030222815573727] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Disenfranchised grief is experienced when a mourner's grief response is socially invalidated, unacknowledged, or discouraged. When the circumstances of death or the emotional reactions of the griever violate social norms, empathic failures can occur within the bereaved individual's support systems. This study used conventional content analysis, an intensive and inductive qualitative research method, to analyze the experience of one African American woman who lost her only son to homicide, a particularly distressing and marginalized form of loss. Results elucidate both the empathic failings and resiliencies within the social systems of this griever and emerged from the perspectives offered by the bereaved mother and her primary supporter. Clinical implications and suggestions for future research are discussed.
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McDevitt-Murphy ME, Murphy JG, Williams JL, Monahan CJ, Bracken-Minor KL. Brief Intervention to Reduce Hazardous Drinking and Enhance Coping among OEF/OIF/OND Veterans. ACTA ACUST UNITED AC 2015; 46:83-89. [PMID: 26170531 DOI: 10.1037/a0036771] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Hazardous drinking among US Military combat veterans is an important public health issue. Because recent combat veterans are difficult to engage in specialty mental health and substance abuse care, there is a need for opportunistic interventions administered in settings visited by recent combat veterans such as primary care. This paper describes a brief (single-session) intervention that was recently developed and tested in a sample of veterans of Operations Enduring Freedom, Iraqi Freedom and New Dawn (OEF/OIF/OND). The intervention consists of a counseling session delivered in a Motivational Interviewing style using a packet of personalized feedback about alcohol misuse, symptoms of PTSD and depression, as well as coping skills. The treatment is described and data from a single case treated with this intervention are presented.
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Affiliation(s)
- Meghan E McDevitt-Murphy
- Department of Psychology, The University of Memphis, Memphis, TN, USA, and, Memphis Veterans' Affairs Medical Center, Memphis, TN, USA
| | - James G Murphy
- Department of Psychology, The University of Memphis, Memphis, TN, USA, and, Memphis Veterans' Affairs Medical Center, Memphis, TN, USA
| | - Joah L Williams
- Department of Psychology, The University of Memphis, Memphis, TN, USA, and, Memphis Veterans' Affairs Medical Center, Memphis, TN, USA
| | - Christopher J Monahan
- Department of Psychology, The University of Memphis, Memphis, TN, USA, and, Memphis Veterans' Affairs Medical Center, Memphis, TN, USA
| | - Katherine L Bracken-Minor
- Department of Psychology, The University of Memphis, Memphis, TN, USA, and, Memphis Veterans' Affairs Medical Center, Memphis, TN, USA
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Tripp JC, McDevitt-Murphy ME, Avery ML, Bracken KL. PTSD Symptoms, Emotion Dysregulation, and Alcohol-Related Consequences Among College Students With a Trauma History. J Dual Diagn 2015; 11:107-17. [PMID: 25793550 PMCID: PMC4437848 DOI: 10.1080/15504263.2015.1025013] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Posttraumatic stress disorder (PTSD), alcohol use, and alcohol-related consequences have been linked to emotion dysregulation. Sex differences exist in both emotion regulation dimensions and alcohol use patterns. This investigation examined facets of emotion dysregulation as potential mediators of the relationship between PTSD symptoms and alcohol-related consequences and whether differences may exist across sexes. METHODS Participants were 240 college students with a trauma history who reported using alcohol within the past three months and completed measures of PTSD symptoms, emotion dysregulation, alcohol consumption, alcohol-related consequences, and negative affect. The six facets of emotion dysregulation were examined as mediators of the relationship between PTSD symptoms and alcohol-related consequences in the full sample and by sex. RESULTS There were differences in sexes on several variables, with women reporting higher PTSD scores and lack of emotional awareness. Men reported significantly more drinks per week in a typical week and a heavy week. There were significant associations between the variables for the full sample, with PTSD showing associations with five facets of emotion dysregulation subscales: impulse control difficulties when upset, difficulties engaging in goal-directed behavior, nonacceptance of emotional responses, lack of emotional clarity, and limited access to emotion regulation strategies. Alcohol-related consequences were associated with four aspects of emotion dysregulation: impulse control difficulties when upset, difficulties engaging in goal-directed behavior, nonacceptance of emotional responses, and limited access to emotion regulation strategies. Two aspects of emotion regulation, impulse control difficulties and difficulties engaging in goal directed behavior, mediated the relationship between PTSD symptoms and alcohol-related consequences in the full sample, even after adjusting for the effects of negative affect. When examined separately by gender, impulse control difficulties remained a mediator for men and difficulties engaging in goal directed behavior for women. CONCLUSIONS These analyses shed light on processes that may underlie "self-medication" of PTSD symptoms. Gender-specific interventions targeting emotion dysregulation may be effective in reducing alcohol-related consequences in individuals with PTSD. Women may possibly benefit from interventions that focus on difficulties engaging in goal-directed behavior, while men may benefit from interventions that target impulse control difficulties when upset.
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McDevitt-Murphy ME, Fields JA, Monahan CJ, Bracken KL. Drinking motives among heavy-drinking veterans with and without posttraumatic stress disorder. Addict Res Theory 2014; 23:148-155. [PMID: 27812315 PMCID: PMC5089373 DOI: 10.3109/16066359.2014.949696] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE This study examined patterns of drinking motives endorsed by heavy drinking veterans who either did or did not meet criteria for posttraumatic stress disorder (PTSD). METHOD Data were collected from 69 veterans of Operations Enduring Freedom or Iraqi Freedom (OEF/OIF) who had screened positive for hazardous drinking. The sample was 91.3% male and 65.2% Caucasian. Based on a structured interview, 58% of the sample met criteria for PTSD. RESULTS The PTSD group scored higher than the non-PTSD group on scales measuring drinking to cope with anxiety and depression and similarly to the non-PTSD group on scales measuring social, enhancement and conformity motives. Coping and social motives were significantly correlated with adverse alcohol consequences. Overall, the PTSD group showed stronger relations between coping scales and aspects of alcohol misuse, relative to the non- PTSD group. CONCLUSION These findings suggest first, that among heavy drinking OEF/OIF veterans there is a high base rate of PTSD. Second, coping motives are frequently reported in this population, and they seem to be related to a more severe pattern of alcohol-related consequences. These findings underscore the importance of assessing the interplay between PTSD and substance abuse in trauma-exposed samples.
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Affiliation(s)
| | - Jordan A Fields
- Department of Psychology, University of Memphis, Memphis, TN, USA
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McDevitt-Murphy ME, Murphy JG, Williams JL, Monahan CJ, Bracken-Minor KL, Fields JA. Randomized controlled trial of two brief alcohol interventions for OEF/OIF veterans. J Consult Clin Psychol 2014; 82:562-8. [PMID: 24773573 DOI: 10.1037/a0036714] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The purpose of this study was to test the efficacy of 2 brief interventions for alcohol misuse in a sample of combat veterans of the wars in Iraq and Afghanistan. METHOD Participants were 68 combat veterans (91.2% male; 64.7% White, 27.9% Black) with a mean age of 32.31 years (SD = 8.84) who screened positive for hazardous drinking in a Veterans Affairs Medical Center primary care clinic using the Alcohol Use Disorders Identification Test (Babor, Higgins-Biddle, Saunders, & Monteiro, 2001). More than half of the sample (57.4%) met criteria for posttraumatic stress disorder (PTSD; based on the Clinician-Administered PTSD Scale; Blake et al., 1995). Eligible veterans who elected to participate completed a baseline assessment and were randomized to receive 1 of 2 interventions (personalized feedback delivered with or without a motivational interviewing counseling session). Both interventions included information on hazardous drinking, PTSD symptoms, depression, and coping. Follow-up assessments were conducted at 6 weeks and 6 months post-intervention. RESULTS Both conditions resulted in statistically significant reductions in quantity and frequency of alcohol use as well as frequency of binge drinking and alcohol-related consequences. Within-group effect sizes (ds) were in the small to medium range (.21-.55) for quantity and frequency of alcohol use. There were no statistically significant Condition × Time interactions, suggesting that both interventions were similarly effective. PTSD and non-PTSD veterans responded equally well to both interventions, but veterans with PTSD assigned to feedback plus motivational interviewing reported greater reductions in weekly drinking at the 6-week follow-up. CONCLUSIONS These findings suggest that brief interventions for alcohol misuse may be effective for reducing drinking, even in an Operation Enduring Freedom/Operation Iraqi Freedom veteran population with a high degree of PTSD.
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Klesges RC, Talcott W, Ebbert JO, Murphy JG, McDevitt-Murphy ME, Thomas F, Reese GJ, Nicholas RA. Effect of the Alcohol Misconduct Prevention Program (AMPP) in air force technical training. Mil Med 2014; 178:445-51. [PMID: 23707832 DOI: 10.7205/milmed-d-12-00400] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES Alcohol use in the U.S. military is prevalent and associated with alcohol-related incidents (ARIs), an official U.S. Air Force sanction. Military ARIs incur substantial personal and financial costs. We evaluated the impact of the Alcohol Misconduct Prevention Program (AMPP) consisting of a group-based brief alcohol intervention (BAI) conducted jointly with random alcohol breathalyzer testing on ARIs in the U.S. Air Force. METHODS A 1-hour, group-based, interactive BAI was conducted, and random alcohol breathalyzer testing was performed among 10,087 Air Force Technical Trainees at Lackland Air Force Base in San Antonio, Texas, in fiscal years 2010 and 2011. RESULTS The AMPP was associated with a significant reduction in the odds of an ARI over the year of the intervention compared to the previous year (odds ratio 0.555; 95% confidence interval 0.380-0.811; p = 0.0023). Significant reductions in the number of ARIs were observed within all quarters except for the third. The average rate of ARIs per 1,000 trainees per quarter was 7.30 before implementation of the interventions and 4.06 after implementation. CONCLUSION An AMPP consisting of an interactive BAI and random alcohol breathalyzer testing may decrease ARIs among military trainees.
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Affiliation(s)
- Robert C Klesges
- University of Tennessee Health Science Center, 66 North Pauline Street, Memphis, TN 38163, USA
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Possemato K, McKenzie S, McDevitt-Murphy ME, Williams J, Ouimette P. The Relationship Between Post-Deployment Factors and PTSD Severity in Recent Combat Veterans. Mil Psychol 2014; 26:15-22. [PMID: 25892847 PMCID: PMC4397563 DOI: 10.1037/mil0000027] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [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: 11/08/2022]
Abstract
Combat traumas precipitate PTSD, however non-traumatic deployment and post-deployment factors may also contribute to PTSD severity. The Deployment Risk and Resilience Inventory was used to investigate pre, peri and post-deployment factors associated with current PTSD severity in 150 recent combat veterans with PTSD and hazardous alcohol use. Hierarchal linear regression analyzed what factors independently predicted PTSD severity when controlling for socio-demographic characteristics and combat specific variables. Four post-deployment factors independently predicted PTSD severity: unemployment, alcohol use, social support, stressful (non-traumatic) life events. The centrality of trauma in the maintenance of PTSD and clinical implications for treatment providers are discussed.
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Affiliation(s)
- Kyle Possemato
- Center for Integrated Healthcare, VA Healthcare Network Upstate New York
| | - Shannon McKenzie
- Center for Integrated Healthcare, VA Healthcare Network Upstate New York
| | | | | | - Paige Ouimette
- Center for Integrated Healthcare, VA Healthcare Network Upstate New York
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Bracken-Minor KL, McDevitt-Murphy ME. Differences in features of non-suicidal self-injury according to borderline personality disorder screening status. Arch Suicide Res 2014; 18:88-103. [PMID: 24354453 DOI: 10.1080/13811118.2013.809040] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Given that non-suicidal self-injury (NSSI) disorder is being considered for the upcoming Diagnostic and Statistical Manual of Mental Disorders (DSM-5), it is important to consider how NSSI occurs with and without borderline personality disorder (BPD). Participants were 480 undergraduates who completed online questionnaires and were assigned to 4 groups based on NSSI and BPD status. Analyses revealed BPD-positive self-injurers had higher self-punishment, anti-suicide, and anti-dissociation functions of NSSI and higher rates of cutting and burning than BPD-negative self-injurers. Furthermore, difficulty in emotion regulation, not distress tolerance, was most critical in distinguishing between groups. Differences between BPD-positive and BPD-negative self-injurers provide preliminary support for NSSI as a distinct disorder. However, more research in this area is needed.
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Thomas KM, Hopwood CJ, Donnellan MB, Wright AGC, Sanislow CA, McDevitt-Murphy ME, Ansell EB, Grilo CM, McGlashan TH, Shea MT, Markowitz JC, Skodol AE, Zanarini MC, Morey LC. Personality heterogeneity in PTSD: distinct temperament and interpersonal typologies. Psychol Assess 2013; 26:23-34. [PMID: 24015858 DOI: 10.1037/a0034318] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Researchers examining personality typologies of posttraumatic stress disorder (PTSD) have consistently identified 3 groups: low pathology, internalizing, and externalizing. These groups have been found to predict functional severity and psychiatric comorbidity. In this study, we employed Latent Profile Analysis to compare this previously established typology, grounded in temperament traits (negative emotionality; positive emotionality; constraint), to a novel typology rooted in interpersonal traits (dominance; warmth) in a sample of individuals with PTSD (n = 155). Using Schedule for Nonadaptive and Adaptive Personality (SNAP) traits to create latent profiles, the 3-group temperament model was replicated. Using Interpersonal Circumplex (IPC) traits to create latent profiles, we identified a 4-group solution with groups varying in interpersonal style. These models were nonredundant, indicating that the depiction of personality variability in PTSD depends on how personality is assessed. Whereas the temperament model was more effective for distinguishing individuals based on distress and comorbid disorders, the interpersonal model was more effective for predicting the chronicity of PTSD over the 10 year course of the study. We discuss the potential for integrating these complementary temperament and interpersonal typologies in the clinical assessment of PTSD.
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Affiliation(s)
| | | | | | | | | | | | - Emily B Ansell
- Department of Psychiatry, Yale University School of Medicine
| | - Carlos M Grilo
- Department of Psychiatry, Yale University School of Medicine
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Monahan CJ, McDevitt-Murphy ME, Dennhardt AA, Skidmore JR, Martens MP, Murphy JG. The impact of elevated posttraumatic stress on the efficacy of brief alcohol interventions for heavy drinking college students. Addict Behav 2013; 38:1719-25. [PMID: 23261489 DOI: 10.1016/j.addbeh.2012.09.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Revised: 08/27/2012] [Accepted: 09/05/2012] [Indexed: 11/17/2022]
Abstract
Brief alcohol interventions (BAIs) have been widely adopted for use with college students and are associated with significant reductions in drinking and problems. However, many students do not respond to these approaches and little is known about risk factors for poor response. The current study investigated one possible risk factor by examining the impact of posttraumatic stress (PTS) symptoms on BAI efficacy. This study presents pooled data from two randomized clinical trials that examined the efficacy of counselor-administered BAIs compared with computerized interventions. Participants were 207 college students (53.1% women, 68.1% White/Caucasian, 16.9% with elevated post-traumatic stress) who reported past-month heavy episodic drinking. Follow-up assessments were completed six months post-intervention. Analyses testing differences in frequency of past-month heavy episodic drinking revealed a significant post-traumatic stress by time interaction (F(1,165)=8.27, p=.005) such that individuals screening positive for PTS showed larger reductions in heavy episodic drinking at follow-up. A significant three-way interaction between time, PTS, and intervention condition (F(2,167)=5.76, p=.004) was found for alcohol related consequences. Specifically, among individuals screening positive for PTS, only those that received the counselor-administered BAI showed a significant reduction in consequences at follow-up. These results suggest that overall college students with PTS may respond well to BAIs and that counselor-delivered BAIs may be more efficacious than computer-delivered interventions for reducing alcohol problems for these high-risk students.
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Affiliation(s)
- Christopher J Monahan
- Department of Psychology, The University of Memphis, 202 Psychology Building, Memphis, TN 38152, USA
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Murphy JG, Yurasek AM, Dennhardt AA, Skidmore JR, McDevitt-Murphy ME, MacKillop J, Martens MP. Symptoms of depression and PTSD are associated with elevated alcohol demand. Drug Alcohol Depend 2013; 127:129-36. [PMID: 22809894 PMCID: PMC3775331 DOI: 10.1016/j.drugalcdep.2012.06.022] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 06/20/2012] [Accepted: 06/21/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Behavioral economic demand curves measure individual differences in motivation for alcohol and have been associated with problematic patterns of alcohol use, but little is known about the variables that may contribute to elevated demand. Negative visceral states have been theorized to increase demand for alcohol and to contribute to excessive drinking patterns, but little empirical research has evaluated this possibility. The present study tested the hypothesis that symptoms of depression and PTSD would be uniquely associated with elevated alcohol demand even after taking into account differences in typical drinking levels. METHOD An Alcohol Purchase Task (APT) was used to generate a demand curve measure of alcohol reinforcement in a sample of 133 college students (50.4% male, 64.4% Caucasian, 29.5% African-American) who reported at least one heavy drinking episode (5/4 or more drinks in one occasion for a man/woman) in the past month. Participants also completed standard measures of alcohol consumption and symptoms of depression and PTSD. RESULTS Regression analyses indicated that symptoms of depression were associated with higher demand intensity (alcohol consumption when price=0; ΔR(2)=.05, p=.002) and lower elasticity (ΔR(2)=.04, p=.03), and that PTSD symptoms were associated with all five demand curve metrics (ΔR(2)=.04-.07, ps<.05). CONCLUSIONS These findings provide support for behavioral economic models of addiction that highlight the role of aversive visceral states in increasing the reward value of alcohol and provide an additional theoretical model to explain the association between negative affect and problematic drinking patterns.
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Affiliation(s)
- James G. Murphy
- Department of Psychology, University of Memphis, Memphis, TN 38152,Department of Psychology, University of Memphis, 202 Psychology Building, Memphis TN, 38152. Tel.: +901 678-2630; fax: +901 678-2579,
| | - Ali M. Yurasek
- Department of Psychology, University of Memphis, Memphis, TN 38152
| | | | | | | | - James MacKillop
- Department of Psychology, University of Georgia, Athens, GA 30602-3013
| | - Matthew P. Martens
- Department of Educational, School, and Counseling Psychology, University of Missouri, Columbia, MO 65211
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Williams JL, McDevitt-Murphy ME, Murphy JG, Crouse EM. Deployment risk factors and postdeployment health profiles associated with traumatic brain injury in heavy drinking veterans. Mil Med 2012; 177:789-96. [PMID: 22808885 DOI: 10.7205/milmed-d-12-00019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Along with post-traumatic stress disorder (PTSD), mild traumatic brain injury (mTBI) is considered one of the "signature wounds" of combat operations in Iraq (Operation Iraqi Freedom [OIF]) and Afghanistan (Operation Enduring Freedom [OEF]), but the role of mTBI in the clinical profiles of Veterans with other comorbid forms of post-deployment psychopathology is poorly understood. The current study explored the deployment risk and postdeployment health profiles of heavy drinking OIF and OEF Veterans as a function of mTBI. Sixty-nine heavy-drinking OIF/OEF Veterans were recruited through a Veterans' Affairs Medical Center and completed questionnaires and structured interviews assessing war-zone experiences, postdeployment drinking patterns, and PTSD symptoms. Veterans with positive mTBI screens and confirmed mTBI diagnoses endorsed higher rates of combat experiences, including direct and indirect killing, and met criteria for PTSD at a higher rate than Veterans without a history of mTBI. Both PTSD and combat experiences independently predicted screening positive for mTBI, whereas only combat experiences predicted receiving a confirmed mTBI diagnosis. mTBI was not associated with any dimension of alcohol use. These results support a growing body of literature linking mTBI with PTSD.
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Affiliation(s)
- Joah L Williams
- Department of Psychology, 202 Psychology Building, University of Memphis, Memphis, TN 38152, USA
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Williams JL, Burke LA, McDevitt-Murphy ME, Neimeyer RA. Responses to Loss and Health Functioning Among Homicidally Bereaved African Americans. Journal of Loss and Trauma 2012. [DOI: 10.1080/15325024.2011.635583] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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McDevitt-Murphy ME, Shea MT, Yen S, Grilo CM, Sanislow CA, Markowitz JC, Skodol AE. Prospective investigation of a PTSD personality typology among individuals with personality disorders. Compr Psychiatry 2012; 53:441-50. [PMID: 21864834 PMCID: PMC4050668 DOI: 10.1016/j.comppsych.2011.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Revised: 06/18/2011] [Accepted: 07/06/2011] [Indexed: 11/29/2022] Open
Abstract
This study investigated the replicability of a previously proposed personality typology of posttraumatic stress disorder (PTSD, and explored stability of cluster membership over a 6-month period. Participants with current PTSD (n = 156) were drawn from the Collaborative Longitudinal Personality Disorders Study (CLPS). The CLPS project tracked a large sample of individuals who met criteria for 1 of 4 target diagnoses (borderline, schizotypal, avoidant, and obsessive-compulsive) and a contrast group of individuals who met criteria for depression but no personality disorder. A cluster analysis using scales from the Schedule of Nonadaptive and Adaptive Personality yielded 3 clusters: "internalizing," "externalizing," and "low pathology." Using K-means cluster analysis, the results did not replicate previous work. Using Ward's method, the hypothesized 3-cluster structure was confirmed at baseline but did not demonstrate temporal stability at 6 months.
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Affiliation(s)
| | - M. Tracie Shea
- Providence Veterans’ Affairs Medical Center and Brown University
| | | | | | | | | | - Andrew E. Skodol
- Sunbelt Collaborative and the University of Arizona College of Medicine
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Williams JL, Burke LA, McDevitt-Murphy ME, Neimeyer RA. Responses to Loss and Health Functioning Among Homicidally Bereaved African Americans. Journal of Loss and Trauma 2012. [DOI: 10.1080/15325024.2011.616826] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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