Intensive Cognitive Processing Therapy Associated With Reduced PTSD Treatment Dropout in a Case-Controlled Study of Treatment-Seeking Veterans

Cognitive Processing Therapy (CPT) is an empirically supported psychotherapy for posttraumatic stress disorder (PTSD). The complex issue of treatment attrition is a frequently cited concern regarding CPT and other evidence-based psychotherapies for PTSD. The current study investigated the feasibility and effectiveness of “intensive” CPT, a treatment-consistent modification of CPT in which sessions are conducted more frequently than standard protocol. Fifty-four military veterans (20% female; M_age = 46; 80% Caucasian) seeking outpatient treatment for PTSD were included in this study. Patients who elected to receive intensive CPT (n = 27) were matched with archival records of individuals who received standard CPT (n = 27). Patients across treatment conditions were matched based on baseline symptom severity as measured by the PTSD Checklist for DSM-5 (PCL-5; M_PCL-5 = 52.61). Treatment outcomes were compared and longitudinal multilevel modeling was used to compare rate of symptom change over time. Patients who elected to engage in intensive CPT were twice as likely to complete treatment (88.9%) as those who received standard CPT (44.4%), X²(1, N = 54) = 12.00, p = .001. On average, intensive CPT patients completed treatment in about 25% of the time as standard CPT patients (33.8 days vs. 125.7 days). Patients in intensive CPT also demonstrated greater benefit: 81.4% reported a clinically significant improvement in PCL-5 scores compared to 51.8% of those in standard CPT, X²(1, N = 54) = 5.33, p = .020, φ = −0.314. Intensive and standard CPT performed comparably in regard to final PCL-5 score, change over time, and screening cutoff. In addition, there were no differences in treatment outcomes based on licensure status of the provider nor whether treatment was delivered in person or virtually. Intensive CPT represents a novel, treatment-consistent adaptation that was utilized to treat a group of veterans with PTSD with minimal treatment dropout. Patients who elected to engage in more frequent treatment were more likely to complete treatment, did so in one quarter of the time, and reported similar to better treatment outcomes. Providers may consider encouraging their patients to participate in treatment as frequently as they are able. However, preliminary findings are based on a nonrandom sample and design limitations temper conclusions.     

Sleep disturbance and emotion dysregulation as transdiagnostic processes in a comorbid sample

Sleep disturbance and emotion dysregulation have been identified as etiologic and maintaining factors for a range of psychopathology and separate literatures support their relationships to anxiety, depression, PTSD, and alcohol dependence (AD) symptom severity. Previous studies have examined these relationships in isolation, failing to account for the high rates of comorbidity among disorders. It is not yet known whether these processes uniquely predict symptom severity in each of these domains. Participants were 220 patients in residential substance abuse treatment, who had experienced a potentially traumatic event and exceeded screening cutoffs for probable PTSD and problematic alcohol use. Controlling for emotion dysregulation and the interrelationships among the outcome variables, insomnia was uniquely associated with anxiety (B = .27, p < .001), depression (B = .25, p < .001), PTSD (B = .22, p < .001), and AD (B = .17, p = .01) symptom severity. Similarly, controlling for insomnia, emotion dysregulation was uniquely associated with anxiety (B = .40, p < .001), depression (B = .47, p < .001), PTSD (B = .38, p < .001), and AD (B = .26, p < .001) symptom severity. Insomnia and emotion dysregulation appear to be transdiagnostic processes uniquely associated with symptom severity across a number of different domains and might be important treatment targets for individuals with PTSD and AD.     

Pilot Cases of Combined Cognitive Processing Therapy and Smoking Cessation for Smokers With Posttraumatic Stress Disorder

Posttraumatic stress disorder (PTSD) and smoking are often comorbid, and both problems are in need of improved access to evidence-based treatment. The combined approach could address two high-priority problems and increase patient access to both treatments, but research is needed to determine whether this is feasible and has promise for addressing both PTSD and smoking.We collected data from 15 test cases that received a treatment combining two evidence-based treatments: cognitive processing therapy–cognitive version (CPT-C) for PTSD and integrated care for smoking cessation (ICSC). We explored two combined treatment protocols including a brief (six-session) CPT-C with five follow-up in-person sessions focused on smoking cessation (n = 9) and a full 12-session CPT-C protocol with ICSC (n = 6). The combined interventions were feasible and acceptable to patients with PTSD making a quit attempt. Initial positive benefits of the combined treatments were observed. The six-session dose of CPT-C and smoking cessation resulted in 6-month bioverified smoking abstinence in two of nine participants, with clinically meaningful PTSD symptom reduction in three of nine participants. In the second cohort (full CPT-C and smoking treatment), both smoking and PTSD symptoms were improved, with three of six participants abstinent from smoking and four of six participants reporting clinically meaningful reduction in PTSD symptoms. Results suggested that individuals with PTSD who smoke are willing to engage in concurrent treatment of these problems and that combined treatment is feasible.     

Individuals high in neuroticism are not more reactive to adverse events

Numerous studies have related neuroticism to negative emotional outcomes of adverse life events, including post-traumatic stress disorder (PTSD) symptoms. However, the nature of the relationship between neuroticism and post-trauma symptoms is unclear. The purpose of this study was to prospectively examine whether individuals high in neuroticism, relative to low neuroticism individuals, show a larger increase in symptoms after an adverse event. A sample of infantry troops completed questionnaires before deployment to Iraq (n = 214) and about five months (n = 170; 76%) thereafter. The findings showed that, after controlling for an indicator of trauma severity, (a) higher neuroticism individuals reported more PTSD symptoms, depression symptoms, and somatic problems after negative events, and (b) these relationships disappeared after controlling for pre-trauma symptoms. There were no significant differences between individuals high and low in neuroticism in the increase in symptoms from pre to post-trauma. This suggests that individuals high in neuroticism are not more reactive to adverse events.     

Group Cognitive Behavior Therapy for Chronic Posttraumatic Stress Disorder: An Initial Randomized Pilot Study

Individuals with posttraumatic stress disorder (PTSD) related to a serious motor vehicle accident were randomly assigned to either group cognitive behavioral treatment (GCBT) or a minimum contact comparison group (MCC). Compared to the MCC participants (n = 16), individuals who completed GCBT (n = 17) showed significant reductions in PTSD symptoms, whether assessed using clinical interview or a self-report measure. Among treatment completers, 88.3% of GCBT participants did not satisfy criteria for PTSD at posttreatment assessment, relative to 31.3% of the MCC participants. Examination of anxiety, depression, and pain measures did not show a unique advantage of GCBT. Treatment-related gains were maintained over a 3-month follow-up interval. Patients reported satisfaction with GCBT, and attrition from this treatment was comparable with individually administered CBTs. Results are discussed in light of modifications necessitated by the group treatment format, with suggestions for future study of this group intervention.     

Experiences with social support among older adult women participating in gay square dancing

LGBTQI2S+ (lesbian, gay, bisexual, transgender, questioning, intersex, and two-spirit, etc.) individuals face unique challenges to physical activity participation, such as discrimination and exclusion. Square dance is a form of collaborative group dancing and while traditionally a heteronormative form of dance, gay square dance is typically open to everyone, regardless of sexual orientation. Square dancing offers opportunities to belong to a community of others engaged in the same activity, which older adults often find satisfying. The aim of this research was to understand how older adults who identify as women experience social support in the context of participating in gay square dance and the role previous experiences of social exclusion play in influencing these experiences. Fourteen self-identified women (age range 55–79 years; n = 11 White, n = 1 Black, n = 2 Jewish) belonging to a gay square dance club participated. Participants self-identified as heterosexual (n = 7), lesbian (n = 3), pansexual (n = 1), bisexual (n = 1), or did not identify with existing terminology (n = 2). Interviews were conducted during a gay square-dancing festival and thematically analyzed. Findings highlighted that participants experienced acceptance which affirmed their sense of self and enabled their authentic selves. To foster a sense of belonging and close relationships, specific actions (e.g., demonstrative welcoming of newcomers, mutual support) were taken by other participants in the group. Physical touch is an inherent part of square dancing, which took on different meanings for participants and was overall perceived as safe. Inclusive groups like gay square dance clubs are an important and consistent means where older adult women can experience meaningful social relationships and interactions.     

The Driving Behavior Survey as a Measure of Behavioral Stress Responses to MVA-Related PTSD

Numerous treatments are available that address the core symptoms of posttraumatic stress disorder (PTSD). However, there are a number of related behavioral stress responses that are not assessed with PTSD measures, yet these behavioral stress responses affect quality of life. The goal of the current study was to investigate whether a recently developed measure of behavioral stress response, the Driving Behavior Survey (DBS), was sensitive to change associated with treatment among a group of participants diagnosed with PTSD. The DBS indexes anxious driving behavior, which is frequently observed among individuals with motor vehicle accident-related PTSD. Participants (n = 40) were racially diverse adults (M age = 40.78, 63% women) who met diagnostic criteria for motor vehicle accident-related PTSD. Hierarchical linear modeling analyses indicated that participants who were assigned to a brief, exposure-based intervention displayed significant reductions on the DBS subscales relative to participants assigned to the wait-list control condition (r = .41–.43). Moreover, mediational analyses indicated that the observed reductions on the DBS subscales were not better accounted for by reductions in PTSD. Taken together, these findings suggest that the DBS subscales are sensitive to changes associated with PTSD treatment and can be used to augment outcome assessment in PTSD treatment trials.     

Evolution of match performance parameters for various playing positions in the English Premier League

This study aimed to investigate position-specific evolution of physical and technical performance parameters in the English Premier League (EPL). Match performance observations (n = 14700) were collected using a multiple-camera computerized tracking system across seven seasons (2006–07 to 2012–13). Data were analyzed relative to five playing positions: central defenders (n = 3792), full backs (n = 3420), central midfielders (n = 3200), wide midfielders (n = 2136) and attackers (n = 2152). High-intensity running distance increased in the final season versus the first season in all playing positions (p < .05, ES: 0.9–1.3) with full backs displaying the greatest increase (∼36% higher in 2012–13). Similar trends were observed for sprint distance with full backs demonstrating the most pronounced increase across the seven seasons (36–63%, p < .001, ES: 0.8–1.3). Central players (central defenders and midfielders) illustrated the most pronounced increases in total passes and pass success rate (p < .05, ES: 0.7–0.9) whilst wide players (full backs and wide midfielders) demonstrated only small-moderate increases in total passes and pass success rate (p < .05, ES: 0.6–0.8). The data demonstrates that evolving tactics in the EPL have impacted on the physical demands of wide players and the technical requirements of central players. These findings could be used for talent identification or position-specific physical and technical training.     

Joint trajectories of adolescent narcissism and self-esteem predict interpersonal features in young adulthood

The joint developmental trajectories of narcissism and self-esteem were examined across ages 13 to 19 in the prediction of interpersonal features at age 20 (indirect aggression, jealousy, hypercompetitiveness, mate value). In 617 individuals (54.5% girls/women; 76.2% White), the five expected groups of interest were found: (1) high increasing narcissism/high stable self-esteem (i.e., grandiose narcissism; 13.1%, n = 81), (2) high increasing narcissism/moderate-to-low decreasing self-esteem (i.e., vulnerable narcissism; 1.1%, n = 7), (3) low decreasing narcissism/high stable self-esteem (9.9%, n = 61), (4) low decreasing narcissism/moderate-to-low decreasing self-esteem (6.5%, n = 40), and (5) moderate stable narcissism/high stable self-esteem (35.2%, n = 217). The grandiose and vulnerable narcissism groups significantly predicted indirect aggression but differed in the other interpersonal features.     

Suicide Ideation in Female Survivors of Military Sexual Trauma: The Trauma Source Matters

Female veterans who have experienced military sexual trauma (MST) are at elevated suicide risk, yet knowledge is limited regarding correlates of suicide ideation (SI) in this population. MST is associated with a higher risk of posttraumatic stress disorder (PTSD) relative to other trauma types; however, no studies have examined whether experiencing SI differs based on the source of PTSD symptoms (MST‐related, non–MST‐related). Female service members/veterans (SM/Vs; n = 311) who screened positive for MST and reported exposure to a Criterion A event completed an online survey assessing self‐reported demographics, PTSD, depression, the source of their PTSD symptoms, and SI. Ninety‐one (29.3%) reported experiencing current SI, and 223 (71.7%) identified MST as the source of their current PTSD symptoms. Participants who identified MST as the source of their PTSD symptoms were over two times more likely to report SI, compared to those who described non–MST‐related events as the source of their PTSD symptoms. Compared to those who reported the source of their PTSD symptoms as combat‐/deployment‐related, those who identified MST as the source were at least three times as likely to report current SI. Results underscore the importance of efforts to address MST‐related PTSD symptoms when working with female SM/Vs.     

Association of physical activity and fitness with executive function among preschoolers

It is well-documented in the literature that high levels of regular physical activity (PA), low levels of sedentary behavior (SB), and high levels of cardiorespiratory fitness (CRF) are associated with superior cognitive functioning, especially with regard to older populations. However, concerning other age groups (e.g., preschoolers) the available evidence documenting such a positive relationship is relatively scarce. Thus, this study aimed to investigate the association of time spent in different PA intensity zones and CRF with executive functions (EFs) in preschool-age children. To this end, preschoolers (n = 127) aged 3 to 6 years were recruited from 9 kindergarten classes in 2 districts of Shenzhen, China. The amount and the intensity of PA were assessed via accelerometry, and the CRF level was quantified by the 20-meter shuttle run test. EFs including inhibitory control and working memory were assessed using the one-on-one iPad-based Early Year Toolbox. Results suggested that children who had a higher CRF level (“impulse control” scores: β = 0.34, p < .001; “Go” accuracy: β = 0.31, p < .001; “No-Go” accuracy: β =0.28, < .001) and spentmore time in moderate-to-vigorous physical activity (MVPA) (“impulse control” scores: β = 0.50, p < .001; No-Go” accuracy: β = 0.52, p < .001) had higher scores on inhibitory control tasks, and those who had a higher CRF level had higher scores on a working memory task (β = 0.24, p < .05). The findings are discussed in light of the positive roles of MVPA and CRF for promoting EFs, but also consider the disproportionate association of PA and CRF with working memory relative to inhibition.     

False memory,attentional bias and future thinking among people living with HIV with posttraumatic stress disorder

People living with HIV can experience posttraumatic stress disorder (PTSD). Complex relationships exist between HIV, PTSD and cognitive impairments. This cross-sectional study compared three cognitive impairments (false memory, attentional bias, deficits in future thinking) among people living with HIV with and without PTSD in Iran. People living with HIV with PTSD (n = 20) and without PTSD (n = 20) completed measures of psychological symptomatology, dot-probe task, Deese Roediger McDermott paradigm and future thinking task at Razavi Khorasan Health Center. The PTSD group, when compared to the non-PTSD group, recognised a significantly greater number of false memories (p < .001; η² = .58), had an attentional bias toward threat-related words (p < .001; η² = .35) and imagined fewer specific future events (p < .001; η² = .31). People living with HIV with PTSD may have difficulties with false memory, attentional biases, and generating future events. Since psychological treatments are limited in Iran, this research highlighted some potential cognitive targets for people living with HIV.     

Assaultive violence and the risk of posttraumatic stress disorder following a subsequent trauma

Breslau, Peterson, and Shultz (2008) reported that prior trauma alone, in the absence of PTSD, did not predict an increased PTSD risk, relative to no prior trauma. Only prior trauma that resulted in PTSD predicted an increased PTSD risk following a subsequent trauma. Recently, Cougle, Resnick, and Kilpatrick (2009) proposed that the effect of prior trauma might vary by type of prior trauma, a possibility not considered in Breslau et al. They report that childhood sexual or physical assault, in the absence of PTSD, increased the PTSD risk following a subsequent trauma. This report examines the PTSD effects of prior assaultive violence, using data from Breslau et al. (1998). The study assessed PTSD in relation to up to three events. Analysis was performed on the subset with PTSD assessment for two distinct events, the earliest trauma and a subsequent trauma (n = 967), using as reference persons with no prior trauma (n = 972). Neither prior assaultive violence nor other prior traumas, in the absence of PTSD, influenced the subsequent risk of PTSD. In contrast, prior PTSD increased considerably the PTSD risk of a subsequent trauma. The limitations in Cougle et al. (2009) and in this study and future research directions are discussed.     

Teachers' perceptions of children's sport learning capacity predicts their fundamental movement skill proficiency

The intrapersonal mechanism that drives and explains individual differences in motor development is still a relatively underexplored area of research. In this study, we set out to determine whether in teachers' perceptions, higher sport-learning capacity (SLC) is associated with the level of fundamental movement skills, and the changes therein over 24 weeks in 7-year-olds. We assessed 170 children from eight primary schools in the Netherlands twice (T1, T2) in 24 weeks, using a tool to assess their FMS in applied settings (Platvoet, Elferink-Gemser, & Visscher, 2018). The schools' eight PE teachers used a digital questionnaire to score their perceptions of children's SLC (Platvoet, Elferink-Gemser, Baker, & Visscher, 2015). Based on their SLC, each child was then placed in the low (n = 33), average (n = 107), or high SLC-group (n = 30). We used a MANOVA to examine group differences, with the four subtests as dependent variables. The results revealed that regardless of SLC-group, children improved their FMS over 24 weeks (F(4,163) = 10.22, p < .05, Wilks Lamba = 0.800). An interaction effect was found for FMS assessment and SLC-group (F(8,326) = 2.23, p < 0,05, Wilks Lamba = 0.899). The children in the average and high groups improved more on the moving sideways subtest than those in the low group (p < .05). The MANOVA showed a main effect for SLC-group (F(4,163) = 4.69, p < .05, Wilks Lamba = 0.804). The average and high groups outperformed the low group on the measurements for walking backwards and moving sideways (p < .05). The high group also outperformed the low group on jumping sideways at both measurements, while the average group only achieved this at T1. The high group scored better on jumping sideways than the average group at T1 (p < .05). No differences in proficiency were found between the three groups on the hand-eye coordination assessment (p > .05). In sum, we found an association between children's SLC and level of FMS and changes therein; this was especially pronounced in children with a lower SLC, who had a lower proficiency and improved less on the subtest moving sideways.     

Parental Coping in the Neonatal Intensive Care Unit

Fifty-six mothers of premature infants who participated in a study to reduce symptoms of posttraumatic stress disorder (PTSD) completed the Brief COPE, a self-report inventory of coping mechanisms, the Stanford Acute Stress Reaction Questionnaire to assess acute stress disorder (ASD) and the Davidson Trauma Scale to assess PTSD. 18 % of mothers had baseline ASD while 30 % of mothers met the criteria for PTSD at the 1-month follow-up. Dysfunctional coping as measured by the Brief COPE was positively associated with elevated risk of PTSD in these mothers (RR = 1.09, 95 % CI 1.02–1.15; p = .008). Maternal education was positively associated with PTSD; each year increase in education was associated with a 17 % increase in the relative risk of PTSD at 1 month follow-up (RR = 1.17, 95 % CI 1.02–1.35; p = .03). Results suggest that dysfunctional coping is an important issue to consider in the development of PTSD in parents of premature infants.     

Factor structure of the Eating Disorder Examination Questionnaire (EDE-Q) in male and female college athletes

The study explored the psychometric properties of the Eating Disorder Examination Questionnaire (EDE-Q) among 1637 university students. Participants were divided into male (n = 432) and female (n = 544) competitive athletes, and male (n = 229) and female (n = 429) comparison groups comprised of individuals who had not engaged in competitive sports for at least one year. All groups were subjected to confirmatory factor analysis (CFA) to test the fit of the published factor structure in this population, and then exploratory FA (EFA). A three-factor solution was the best fit for three out of four groups, with a two-factor solution providing best fit for the male comparison group. The first factor for all groups resembled a combined Shape and Weight Concern subscale. The factor structure among male and female competitive athletes was remarkably similar; however, non-competitive athletic/low activity males appear qualitatively different from other groups.     

Match performance and physical capacity of players in the top three competitive standards of English professional soccer

The aim of this study was to compare the match performance and physical capacity of players in the top three competitive standards of English soccer. Match performance data were collected from players in the FA Premier League (n = 190), Championship (n = 155) and League 1 (n = 366) using a multiple-camera system. In addition, a selection of players from the Premier League (n = 56), Championship (n = 61) and League 1 (n = 32) performed the Yo-Yo intermittent endurance test level 2 (Yo-Yo IE2) to determine physical capacity. Players in League 1 and the Championship performed more (p < .01) high-intensity running than those in the Premier League (Effect Size [ES]: 0.4–1.0). Technical indicators such as pass completion, frequency of forward and total passes, balls received and average touches per possession were 4–39% higher (p < .01) in the Premier League compared to lower standards (ES: 0.3–0.6). Players also covered more (p < .05) high-intensity running when moving down (n = 20) from the Premier League to the Championship (ES: 0.4) but not when players moved up (n = 18) standards (ES: 0.2). Similar Yo-Yo IE2 test performances were observed in Premier League, Championship and League 1 players (ES: 0.2–0.3). Large magnitude relationships (p < .05) were observed between Yo-Yo IE2 test performances and the total and high-intensity running distance covered in both Championship (r = .56 and .64) and Premier League matches (r = .61 and .54). The data demonstrate that high-intensity running distance was greater in players at lower compared to higher competitive standards despite a similar physical capacity in a subsample of players in each standard. These findings could be associated with technical characteristics inherent to lower standards that require players to tax their physical capacity to a greater extent but additional research is still required to confirm these findings.     

Preventing road crashes: Do infringements for traffic offences have a deterrent effect amongst drivers aged 40+? An examination of administrative data from Victoria,Australia

This study aimed to determine whether receiving a traffic infringement has a deterring influence on subsequent risky driving, measured through risk of crash involvement.Licensing, infringements and crash data for drivers aged 40+ from the Australian state of Victoria were analysed. A case-case-time-control study design was used. Overall, the odds of receiving an infringement in the month prior to a crash were 35 per cent higher than receiving an infringement in the same month the year prior, for the case group, adjusted for the change over time in the control group (Odds Ratio = 1.35, 95% CI 1.17–1.57, p < 0.001). Rather than infringements preceding a period of reduced crash involvement, and thus potentially indicating a deterrent effect, the odds of receiving an infringement in the one-month period just prior to a crash occurring was greater. Infringements for traffic offences may not be deterring further risky driving behaviours.     

The effects of goal types on psychological outcomes in active and insufficiently active adults in a walking task: Further evidence for open goals

ObjectivesThis study aimed to extend recent work on the effects of goal types in physical activity (PA; Swann, Hooper et al., 2020) by comparing the effects of SMART, open, and do-your-best (DYB) goals on performance and psychological responses in active and insufficiently active adults in a walking task.Design4 (goal condition) x 3 (attempt) x 2 (group) mixed design.MethodsActive (n = 18) and insufficiently active (n = 18) participants completed baseline and two experimental attempts of a 6-minute walking test in four conditions: SMART goal; open goal; DYB goal; and control. A range of measures were taken during and following each attempt, and after each session. A series of mixed ANOVA’s were conducted for all measures assessed between groups.ResultsInsufficiently active participants achieved greater distances in the open condition compared to the SMART condition (p < .001), whereas active participants achieved greater distances in the SMART condition compared to the open condition (p < .001). Additionally, exploratory analyses revealed that insufficiently active participants reported greater pleasure and enjoyment (p < .05) in the open condition compared to active participants, who conversely reported more pleasure and enjoyment (p < .05) in the SMART condition than insufficiently active participants.ConclusionsFindings provide initial evidence that PA and psychological responses differ between active and insufficiently active individuals depending on goal type. This work has potential implications for goal setting strategies in PA promotion and raises further questions about current practices of setting SMART goals for insufficiently active participants.