Treating PTSD in Patients With Psychosis: A Within-Group Controlled Feasibility Study Examining the Efficacy and Safety of Evidence-Based PE and EMDR Protocols

The present study uses a within-group controlled design to examine the efficacy and safety of two psychological approaches to posttraumatic stress disorder (PTSD) in 10 patients with a concurrent psychotic disorder. Patients were randomly assigned either to prolonged exposure (PE; N = 5) or eye movement desensitization and reprocessing (EMDR; N = 5). Before, during, and after treatment, a total of 20 weekly assessments of PTSD symptoms, hallucinations, and delusions were carried out. Twelve weekly assessments of adverse events took place during the treatment phase. PTSD diagnosis, level of social functioning, psychosis-prone thinking, and general psychopathology were assessed pretreatment, posttreatment, and at three-month follow-up. Throughout the treatment, adverse events were monitored at each session. An intention-to-treat analysis of the 10 patients starting treatment showed that the PTSD treatment protocols of PE and EMDR significantly reduced PTSD symptom severity; PE and EMDR were equally effective and safe. Eight of the 10 patients completed the full intervention period. Seven of the 10 patients (70%) no longer met the diagnostic criteria for PTSD at follow-up. No serious adverse events occurred, nor did patients show any worsening of hallucinations, delusions, psychosis proneness, general psychopathology, or social functioning. The results of this feasibility trial suggest that PTSD patients with comorbid psychotic disorders benefit from trauma-focused treatment approaches such as PE and EMDR.     

Latent Profiles of Comorbid Depression as Predictors of PTSD Treatment Outcome

Posttraumatic stress disorder (PTSD) frequently co-occurs with major depressive disorder, and empirically supported PTSD treatments consistently improve depression. However, both diagnoses are heterogeneous and specific patterns of symptom overlap may be related to worse treatment outcome. Two hundred individuals with chronic PTSD participated in a doubly randomized preference trial comparing prolonged exposure and sertraline. Latent Profile Analysis was used to identify classes based on PTSD and depression symptoms prior to starting treatment. A three-class model best fit the data, with a high depression and PTSD severity class (distressed), a moderate depression and low PTSD avoidance class (depressive), and a low depression and high PTSD avoidance class (avoidant). The avoidant class showed the lowest rates of major depressive disorder diagnosis and transdiagnostic vulnerabilities to depression. Patients in the distressed class experienced more robust PTSD treatment response, with no differences between prolonged exposure and sertraline. These findings highlight the role of avoidance in nondepressed PTSD presentations while also demonstrating that co-occurring depression is not contraindicated in evidence-based PTSD treatment.     

Latinx LGBQ Young Adults’ Coming-Out Experiences

Abstract

Marriage and family therapists (MFTs) must be culturally competent and sensitive to serve the growing Latinx population in the United States (US). To understand the sexual orientation disclosure experiences of Latinx LGBQ individuals, we interviewed 10 individuals. Using Moustakas’ (1994) phenomenology, we identified six themes: disclosure impacts family closeness, family members experience disbelief, control over the disclosure influences young adults’ perception of their coming-out experience, the coming-out experience is influenced by religion, the coming-out experience is influenced by traditional gender roles, and disclosure of sexual identity is a continuous process. We discuss clinical implications and areas for future research.     

Cortisol Response Following Exposure Treatment for PTSD in Rape Victims

This study examined changes in salivary cortisol levels pre- to posttreatment in adult female rape victims diagnosed with posttraumatic stress disorder (PTSD) randomly assigned to be treated with either prolonged exposure therapy or eye movement desensitization and reprocessing. Salivary cortisol was collected at baseline, Session 3, and Session 9. A significant decrease in salivary cortisol levels was observed in individuals classified as treatment responders in both treatment conditions. Findings suggest that successful exposure-based treatments for PTSD that result in trauma-related and depressive symptom reduction may impact the action of the hypothalamic–pituitary–adrenal axis as measured by changes in level of salivary cortisol from pre- to posttreatment.     

Psychopathology Following Interpersonal Violence: A Comparison of Risk Factors in Older and Younger Adults

A randomly selected sample of 549 women age 55 years and older and 2,669 women age 18–34 years was interviewed via telephone to determine prevalences of physical and sexual assault, posttraumatic stress disorder (PTSD) symptomatology, and depression. Prevalences of sexual and physical assaults were lower in older compared to younger women. In addition, given a trauma, prevalences and proportionate risk of posttraumatic psychopathology and depression were also lower for older, relative to younger women. Specifically, multivariate analyses revealed that sexual assault predicted only PTSD avoidance in older adults, but all forms of PTSD symptomatology and depression in younger adult women. Similarly, physical assault predicted only PTSD re-experiencing symptoms in older women, but all forms of PTSD symptoms and depression in younger women. Self-reported health status was not associated with any increased risk of psychopathology, and low income predicted increased avoidance and depression only in younger women.     

Using Prolonged Exposure and Cognitive Processing Therapy to Treat Veterans With Moral Injury-Based PTSD: Two Case Examples

Moral injury refers to acts of commission or omission that violate individuals’ moral or ethical standards. Morally injurious events are often synonymous with psychological trauma, especially in combat situations—thus, morally injurious events are often implicated in the development of posttraumatic stress disorder (PTSD) for military service members and veterans. Although prolonged exposure (PE) and cognitive processing therapy (CPT) have been well established as effective treatments for veterans who are struggling with PTSD, it has been suggested that these two evidence-based therapies may not be sufficient for treating veterans whose PTSD resulted from morally injurious events. The purpose of this paper is to detail how the underlying theories of PE and CPT can account for moral injury-based PTSD and to describe two case examples of veterans with PTSD stemming from morally injurious events who were successfully treated with PE and CPT. The paper concludes with a summary of challenges that clinicians may face when treating veterans with PTSD resulting from moral injury using either PE or CPT.     

Sexual Preference,Gender, and Blame Attributions in Adolescent Sexual Assault

ABSTRACT

The study investigated the impact of victim sexual orientation, perpetrator gender, and participant gender on judgements toward a 15-year-old male victim of a depicted sexual assault. One hundred and eight-eight participants (97 male, 91 female) read a hypothetical scenario depicting the sexual assault of a 15-year-old male victim where the victim's sexual orientation and the perpetrator's gender were varied between subjects. Participants then completed a questionnaire assessing their attributions toward both the victim and the perpetrator. Results revealed that male participants blamed the victim more than female participants when the victim was both gay and attacked by a male perpetrator. All participants, regardless of gender, made more positive judgements toward the female as opposed to male perpetrator. Results are discussed in relation to gender role stereotypes and homophobia.