Debra Kaysen received her PhD in Clinical Psychology from the University of Missouri. She completed an internship at the University of Washington and continued there to complete an NIAAA-funded F32 to study the area of overlap between PTSD and alcohol use disorders. Dr. Kaysen joined the faculty at University of Washington in 2006 in the Department of Psychiatry and Behavioral Sciences. While there she founded a program to develop and test more accessible interventions for individuals suffering from mental health symptoms following traumatic events. Dr. Kaysen joined the Stanford faculty in 2019.
Dr. Kaysen’s area of specialty both in research and clinical work is in treatment for those who have experienced traumatic events including treatment of PTSD and related disorders. She has conducted critical studies on treatment of PTSD and/or substance use across a variety of populations (sexual minority women, Native Americans, sexual assault survivors, torture survivors, active duty military), settings (the Democratic Republic of Congo, Iraq, primary care, rural settings), and modalities (telephone based, web-based). Other research conducted by Dr. Kaysen have focused on increasing our understanding of how PTSD and substance use may influence each other. Dr. Kaysen is a Past President of the International Society for Traumatic Stress Studies (www.istss.org). Her research has been funded by the National Institute of Alcohol Abuse and Alcoholism, the National Institute of Drug Abuse, the National Institute on Minority Health and Health Disparities, the Department of Defense, PCORI, and USAID.
Dr. Kaysen is currently involved in helping develop and implement coping strategies for healthcare workers dealing with mental health concerns related to COVID-19. Dr. Kaysen's clinical work has been featured on This American Life (https://www.thisamericanlife.org/682/ten-sessions).
- Posttraumatic Stress Disorder
- Cognitive Behavioral Therapy
- Evidence based psychotherapy
- Anxiety Disorders
Professor - University Medical Line, Psychiatry and Behavioral Sciences
Chief, Division of Public Mental Health & Population Sciences, Department of Psychiatry (2022 - Present)
Honors & Awards
Fellow, Association for Behavioral and Cognitive Therapy (2015)
Boards, Advisory Committees, Professional Organizations
President, International Society for Traumatic Stress Studies (2019 - 2020)
Member, European Society for Traumatic Stress Studies (2018 - Present)
Board of Directors, International Society for Traumatic Stress Studies (2013 - 2021)
Member, Association for Behavioral and Cognitive Therapy (2005 - Present)
Member, American Psychological Association (2005 - Present)
Member, International Society for Traumatic Stress Studies (1998 - Present)
Board Certification: American Board of Professional Psychology, Psychology (2014)
Fellowship: University of Washington Psychology Postdoctoral Fellowship (2006) WA
Internship: University of Washington Psychology Internship Program (2003) WA
PhD Training: University of Missouri St Louis (2003) MO United States of America
Community and International Work
Preventing HIV among Native Americans through the Treatment PTSD & Substance Use, Washington state
PTSD, substance use
University of Washington
Opportunities for Student Involvement
Counter Gender Based Violence, Democratic Republic of Congo
IMA WorldHealth, Johns Hopkins, University of Washington
Sexual assault survivors
Opportunities for Student Involvement
Current Research and Scholarly Interests
Much of my current research focus is on the development of testing of accessible, scaleable, and effective treatments for trauma-related disorders and related comorbidities (e.g. substance use disorders, HIV, mood disorders). This work has focused on addressing trauma-related disorders especially in underserved populations and settings. This includes research in rural communities, with Native American communities, and with sexual minorities. My research has had a strong impact on building an evidence base on adaptations of psychotherapies for PTSD and substance use disorders for diverse populations both within and outside the United States. Our findings demonstrate that complex cognitive behavioral psychotherapies like Cognitive Processing Therapy can be culturally adapted and delivered in challenging settings (conflict settings, high poverty environments) with significant and lasting change in PTSD, depression, and functioning. This has led to work adapting CPT for diverse populations within the United States (rural Native Americans, urban Latinos) and outside of it (Iraq, DRC). Other research has focused on treatment for PTSD/SUD. My research has also found support for the use of brief telehealth interventions to build treatment engagement and to reduce drinking among trauma-exposed populations. In addition, my work has been critical in testing the feasibility of novel trauma-focused interventions for use by those with PTSD and SUD, thus paving the road for more rigorous research studies.
Current PI'ed research studies include: 1) developing and evaluating a brief motivational interviewing intervention designed to increase treatment-seeking among military personnel with untreated PTSD; a two-arm randomized comparative effectiveness trial to evaluate prevention of HIV/STI sexual risk behavior by addressing PTSD through Narrative Exposure Therapy or substance use through Motivational Interviewing among Native American men and women with PTSD; and 3) a comparison of outcomes among patients randomized to initially receive pharmacotherapy or Written Exposure Therapy delivered in primary care as well as comparing outcomes among patients randomized to treatment sequences (i.e., switching and augmenting) for patients who do not respond to the initial treatment.
CBT Texts for PTSD & Hazardous Drinking (Project Better)
The research study seeks to refine and test a brief, self-directed, intervention for individuals from the general public with PTSD and co-occurring HD that can be delivered via text-messaging. This application seeks to refine the intervention further by testing whether theoretically-driven, evidence-based strategies from basic cognitive psychology (message framing) and social psychology (facilitating growth mindsets) result in better outcomes for PTSD symptoms and HD by addressing pilot participant feedback related to avoidance and motivation.
Efficacy Trial of Stress Check-Up
Untreated posttraumatic stress disorder (PTSD) is associated with high societal and individual costs. Effective interventions for symptoms of posttraumatic stress (PTS) exist but are underutilized by those who could benefit, especially among active duty military. This study will develop and test a brief telephone-delivered motivational enhancement intervention (MET) for military personnel (active, reserve, or national guard) serving in the Army, Air Force, or Navy who are experiencing symptoms of PTS, but who are not currently engaged in PTS treatment. The goal of the intervention is to decrease stigma around seeking care, increase knowledge about treatment options, increase engagement in help-seeking behavior, all leading to reductions in PTS symptoms.
Personalized Integrated Alcohol and Sexual Assault Prevention Among College Students
Heavy episodic drinking and sexual assault are problematic on college campuses. This study includes a randomized controlled trial of Positive Change (+Change), an integrated alcohol and sexual assault prevention program, compared to an attention-matched control condition across two universities in reducing alcohol use, sexual assault victimization, sexual assault perpetration, and increasing sexual assault bystander intervention. This study will also test the efficacy of +Change plus Booster session, an identical version of +Change delivered 6 months after the baseline, compared to +Change alone in long-term reductions in alcohol use, sexual assault victimization, sexual assault perpetration, and increases in sexual assault bystander intervention. This research is the next step of a NIAAA-funded planning grant (R34AA025691).
Preventing HIV Among Native Americans Through the Treatment PTSD & Substance Use
Investigators will conduct a two-arm, comparative effectiveness randomized controlled trial of two culturally adapted, empirically based programs (EBP) - Narrative Exposure Therapy (NET) vs. Motivational Interviewing with Skills Training (MIST) in terms of lowering HIV sexual-risk behaviors (HSB) for American Indian / Alaska Native (AIAN) men and women. NET addresses Posttraumatic Stress Disorder (PTSD) as a pathway to preventing substance use disorders (SUD) and HSB whereas MIST addresses substance misuse as a way of preventing SUD and HSB.
Cognitive Processing Intervention for Trauma, HIV/STI Risks, and Substance Use Among Native Women
Many American Indian (AI) women never receive services for serious mental health problems resulting from traumatic events, violence exposure and maltreatment. AI women suffer higher lifetime rates of Post-traumatic Stress Disorder (PTSD) (20-23%), that often co-occur with excessive drinking and risky sexual behaviors. These factors magnify risk for human immunodeficiency virus and sexually transmitted disease (HIV/STI). In full development with tribal partners, this application, proposes a 3-year project to culturally adapt and pilot an empirically supported trauma-focused treatment, Cognitive Processing Therapy (CPT) for PTSD, substance use and HIV/STI sexual risk behavior among 50 AI women. Additionally, the investigators will assess the feasibility, acceptability and treatment fidelity of delivering CPT via AI community health workers in a resource-limited tribal reservation. This project brings a culturally responsive intervention to an understudied and highly vulnerable population. Its significance lies in its potential to advance science in the area of PTSD, substance use treatment and HIV/STI prevention among AI women. Study data would benefit tribal and rural communities and the mental health field. Finally, it is geared toward developing the research infrastructure and mental health treatment capacity serving AI women living in rural settings, a group at risk for an expanding HIV/AIDS epidemic. If successful, findings from this pilot will provide evidence for a larger effectiveness trial. The AIMS are AIM I. Adapt the evidence-based CPT intervention in full collaboration with tribal partners. This will be done in accordance with the CDC's Map of Adaptation Process and involves formative research with tribal leaders, potential consumers, providers, and health care administrators using qualitative methodology. AIM 2. Assess this intervention delivered by Native American community health workers for feasibility and acceptability in a resource-limited rural reservation setting. AIM 3. Conduct a two-group, single-site waitlist randomized controlled pilot trial of a 12-session, 6-week CPT intervention among 56 (6 pilot) sexually active and substance using AI women with PTSD or sub-threshold PTSD. Determine preliminary efficacy and estimate an effect size in terms of three primary outcomes: (a) PTSD symptomatology; (b) substance use; (c) high risk sexual behavior.
Stanford is currently not accepting patients for this trial.
Cognitive Processing Therapy (CPT) for Posttraumatic Stress Disorder and Borderline Personality Disorder (PTSD-BPD)
Posttraumatic Stress Disorder (PTSD) with co-occurring Borderline Personality Disorder (BPD) (i.e., PTSD-BPD) is common (as high as 58%), debilitating, costly, and limited treatment options available for this population. PTSD-BPD is associated with even greater functional impairment and higher healthcare burden than either disorder alone. There are surprisingly few treatments available for this clinical profile, despite its association with major negative health outcomes, cost, and morbidity. There is a pressing need to innovate treatments that can effectively and efficiently treat PTSD-BPD. The existing treatments used for PTSD-BPD are lengthy, laborious, resource-intensive, and require complete cessation of suicidal behaviors prior to treatment. Furthermore, no integrated treatment has been innovated to deliver the active ingredients to efficiently affect the mechanisms underpinning this comorbidity. The investigators propose to examine an adapted version of a first-line PTSD intervention, Cognitive Processing Therapy, augmented with a Suicide Risk Management, i.e., (CPT+SRM) as a brief (12 sessions) and more parsimonious treatment alternative that strategically targets shared mechanisms underpinning PTSD and BPD. The purpose of this pilot study is to 1) collect initial feasibility, acceptability, and safety data on this adapted treatment, 2) conduct a pilot randomized clinical trial evaluating the efficacy of CPT+SRM versus Treatment as Usual (TAU) + SRM, and 3) evaluate two targets (i.e, improvements in emotional intensity and cognitive dysfunction) as mechanisms leading to change in our primary outcomes. Both treatment conditions will be administered via telehealth. Potential benefits include reduction in participants' PTSD, BPD and other mental health symptoms. Additionally, this work could benefit the community by improving the treatment repertoire for PTSD-BPD. Potential risks include emotional distress, suicidality, and/or self-harm. Participants may experience discomfort and/or distress while discussing participants trauma(s) and mental health. These risks will be mitigated using a suicide risk management protocol which therapists in the assessment of risk and protective factors of suicide, followed by documentation for the decision-making around the management of risk.
Stanford is currently not accepting patients for this trial.
Sequence of Symptom Change During AUD or PTSD Treatment for Comorbid PTSD/AUD
The broad, long-term objective of the current research is to improve treatment outcomes for individuals with comorbid posttraumatic stress disorder (PTSD) and alcohol abuse and dependence (AUD). The purpose of which is to evaluate changes in both PTSD symptoms and alcohol use and cravings associated with Cognitive Processing Therapy (CPT) or Relapse Prevention (RP) treatment in individuals with PTSD/AUD, along with mediators and moderators of outcomes. The study will randomize 235 PTSD/AUD participants recruited from the VA and from the community to CPT, RP, or Interactive Voice Response (IVR) assessment only (AO). Those in the AO condition will be re-randomized after the treatment phase to either RP or CPT. Individuals will be assessed pretreatment, immediately post-treatment, 3-, 6-, 9-, and 12-months post-treatment and will monitor symptoms daily throughout treatment.
Stanford is currently not accepting patients for this trial.
Sequenced Treatment Effectiveness for Posttraumatic Stress
Individuals with PTSD are more likely to engage in unhealthy behaviors such as tobacco use, drug use, alcohol misuse, and have high rates of morbidity/mortality. PTSD negatively impacts marriages, educational attainment, and occupational functioning. Some patients with PTSD can be successfully referred to specialty mental health clinics, but most patients with PTSD cannot engage in specialty care because of geographical, financial and cultural barriers and must be treated in primary care. However, policy makers do not know the best way to treat PTSD in primary care clinics, especially for patients who do not respond to the initial treatment choice. There are effective treatments for PTSD that are feasible to deliver in primary care. These treatments include commonly prescribed antidepressants and brief exposure-based therapies. However, because there are no head-to-head comparisons between pharmacotherapy and psychotherapy in primary care settings, primary care providers do not know which treatments to recommend to their patients. In addition, despite high treatment non-response rates, very few studies have examined which treatment should be recommend next when patients do not respond well to the first, and no such studies have been conducted in primary care settings. This trial will be conducted in Federally Qualified Health Centers and VA Medical Centers, where the prevalence of both past trauma exposure and PTSD are particularly high. The investigators will enroll 700 primary care patients. The investigators propose to 1) compare outcomes among patients randomized to initially receive pharmacotherapy or brief psychotherapy, 2) compare outcomes among patients randomized to treatment sequences (i.e., switching and augmenting) for patients not responding to the initial treatment and 3) examine variation in treatment outcomes among different subgroups of patients. Telephone and web surveys will be used to assessed outcomes important to patients, like self-reported symptom burden, side-effects, health related quality of life, and recovery outcomes, at baseline, 4 and 8 months. Results will help patients and primary care providers choose which treatment to try first and which treatment to try second if the first is not effective.
Stanford is currently not accepting patients for this trial.
Study to Promote Innovation in Rural Integrated Telepsychiatry
Background: Community Health Centers care for over 20 million rural, low income and minority Americans every year. Patients often have complex mental health problems such as Posttraumatic Stress Disorder (PTSD) and Bipolar Disorder. However, Community Health Centers located in rural areas face substantial challenges to managing these patients due to lack of onsite mental health specialists, stigma and poor geographic access to specialty mental health services in the community. As a consequence, many rural primary care providers feel obligated, yet unprepared, to manage these disorders, and many patients receive inadequate treatment and continue to struggle with their symptoms. While integrated care models and telepsychiatry referral models are both promising approaches to managing patients with complex mental health problems in rural primary care settings, there have been no studies comparing which approach is more effective for which types of patients. Objectives: The central question examined by this study is whether it is better for offsite mental health specialists to support primary care providers' treatment of patients with PTSD and Bipolar Disorder through an integrated care model or to use telemedicine technology to facilitate referrals to offsite mental health specialists. We hypothesize that patients randomized to integrated care will have better outcomes than patients randomized to referral care. Methods: 1,000 primary care patients screening positive for PTSD or Bipolar Disorder will be recruited from Community Health Centers in three states (Arkansas, Michigan and Washington) and randomized to the integrated care model or the referral model. Patient Outcomes: Telephone surveys will be administered to patients at enrollment and at 6 and 12 month follow-ups. Telephone surveys will measure access to care, therapeutic alliance with providers, patient-centeredness, patient activation, satisfaction with care, appointment attendance, medication adherence, self-reported clinical symptoms, medication side-effects, health related quality of life, and progress towards life goals. A sub-sample of patients will be invited to participate in qualitative interviews to describe their treatment experience using their own words. Likewise, primary care providers will be invited to participate in qualitative interviews to voice their perspective.
Stanford is currently not accepting patients for this trial.
Tools for Health and Resilience Implemented After Violence Exposure (Project THRIVE)
Sexual assault victimization is a common and particularly harmful form of trauma that is associated with increased risk for high-risk drinking and other conditions of public health concern, such as PTSD. Given evidence that sexual assault survivors who have low social support or receive negative social reactions to sexual assault disclosure are more likely to experience PTSD and drinking problems, improving social support is a novel target for intervention. The proposed study will attempt to prevent the onset of high-risk drinking and PTSD in sexual assault survivors by developing and testing a web-based early intervention aimed at increasing contact with social supporters and mitigating the harm of negative social reactions; ultimately, results will contribute to advancing the field's understanding of the potential for social support to mitigate the harm of trauma.
Stanford is currently not accepting patients for this trial.
Understanding and Testing Recovery Processes for PTSD and Alcohol Use Following Sexual Assault
Sexual assault can lead to devastating consequences including the development of chronic conditions including posttraumatic stress disorder (PTSD) and alcohol use disorders (AUD). Interventions delivered soon after exposure to assault can decrease the long-term negative consequences of sexual assault but existing interventions are limited in their ability to target concurrent PTSD symptoms and alcohol use and little is known about how to make best practice treatment decisions in the early period following sexual assault. A greater emphasis on transdiagnostic processes that are related to both PTSD and alcohol use, such as fear and reward systems, can elucidate mechanisms of recovery, lead to the development of more effective intervention approaches, and guide clinical decision making for patients recently exposed to sexual assault.
Stanford is currently not accepting patients for this trial.
Adaptive Digital Mental Health Tools to Improve COVID-19 Mental Health Among Healthcare Workers, Stanford University (9/1/2020 - Present)
The unprecedented impact of COVID-19 on frontline healthcare workers has led to increased distress and mental health concerns among those most affected by workplace demands. Based on the scope of the problem, healthcare workers need more accessible approaches to improving their mental well-being, where and when healthcare workers need them. In addition, people’s needs change over time, and they need tools that adapt based on how the healthcare worker engages with the material, and whether their concerns and symptoms improve based on their use of those resources.
Through generous support from philanthropic donors, faculty from Stanford and other institutions have been able to create a digital mental health platform (Take a Moment) that uses individual goals and symptoms over time to deliver adaptive tools to address the mental health needs of frontline healthcare workers affected by the stress of the COVID-19 pandemic. This project is led by Drs. Kaysen and Wiltsey Stirman.
- Shannon Wiltsey Stirman, Associate Professor of Psychiatry and Behavioral Sciences (Public Mental Health and Population Sciences) at the Palo Alto Veterans Affairs Health Care System, Stanford
- Eric Roland Kuhn, Psychiatry and Behavioral Sciences
- Szu-chi Huang, Associate Professor of Marketing at the Graduate School of Business, Stanford University
- David Hong, Stanford University
- Inbal Nahum-Shani, Research Associate Professor, University of Michigan
- Melanie Brucks, Assistant Professor, Columbia University
Comparative Effectiveness PTSD Trial of Sequenced Pharmacotherapy and Psychotherapy in Primary Care, Stanford University (7/1/2020 - Present)
The major goals for this project are compare outcomes among patients randomized to initially receive pharmacotherapy or brief psychotherapy; compare outcomes among patients randomized to treatment sequences (i.e., switching and augmenting) for patients who do not respond to the initial treatment; and examine variation in treatment outcomes among different subgroups of patients
- Charles Engel, Senior Physician Policy Researcher, Rand
- John Fortney, Director, Division of Population Health; Professor, Psychiatry & Behavioral Sciences, University of Washington
- Brian Marx, Professor, Boston University School of Medicine
- Denise Sloan, Professor, Boston University School of Medicine
Improving Voluntary Engagement for PTSD Treatment Among Soldiers, University of Washington (11/1/2016 - Present)
The present research proposes to develop and evaluate a brief motivational interviewing intervention designed to increase treatment-seeking among military personnel with untreated PTSD.
- Denise Walker, Associate Professor, University of Washington
- Isaac Rhew, Associate Professor, University of Washington
Independent Studies (3)
- Graduate Research
PSYC 399 (Aut)
- Medical Scholars Research
PSYC 370 (Aut, Win, Spr)
- Undergraduate Research, Independent Study, or Directed Reading
PSYC 199 (Aut, Win, Spr)
- Graduate Research
- Comorbid posttraumatic stress disorder and alcohol use disorder in low- and middle-income countries: A narrative review. Global mental health (Cambridge, England) 2023; 10: e5
Cognitive Processing Therapy or Relapse Prevention for comorbid Posttraumatic Stress Disorder and Alcohol Use Disorder: A randomized clinical trial.
2022; 17 (11): e0276111
To compare a Posttraumatic Stress Disorder (PTSD) treatment (Cognitive Processing Therapy; CPT), an Alcohol Use Disorder (AUD) treatment (Relapse Prevention; RP), and assessment-only (AO) for those meeting diagnostic criteria for both PTSD and AUD.Participants with current PTSD/AUD (N = 101; mean age = 42.10; 56% female) were initially randomized to CPT, RP, or AO and assessed post-treatment or 6-weeks post-randomization (AO). AO participants were then re-randomized to CPT or RP. Follow-ups were at immediate post-treatment, 3-, and 12-months. Mixed effects intent-to-treat models compared conditions on changes in PTSD symptom severity, drinking days, and heavy drinking days.At post-treatment, participants assigned to CPT showed significantly greater improvement than those in AO on PTSD symptom severity (b = -9.72, 95% CI [-16.20, -3.23], d = 1.22); the RP and AO groups did not differ significantly on PTSD. Both active treatment conditions significantly decreased heavy drinking days relative to AO (CPT vs. AO: Count Ratio [CR] = 0.51, 95% CI [0.30, 0.88]; RP vs. AO: CR = 0.34, 95% CI [0.19, 0.59]). After re-randomization both treatment conditions showed substantial improvements in PTSD symptoms and drinking between pre-treatment and post-treatment over the 12-month follow-up period, with RP showing an advantage on heavy drinking days.Treatments targeting one or the other aspects of the PTSD/AUD comorbidity may have salutary effects on both PTSD and drinking outcomes. These preliminary results suggest that people with this comorbidity may have viable treatment options whether they present for mental health or addiction care.The trial is registered at clinicaltrials.gov (NCT01663337).
View details for DOI 10.1371/journal.pone.0276111
View details for PubMedID 36445895
Maintenance of intervention effects: long-term outcomes for participants in a group talk-therapy trial in the Democratic Republic of Congo.
Global mental health (Cambridge, England)
2022; 9: 347-354
Despite the growth of psychotherapy trials in low- and middle-income countries, there have been limited follow-up studies of more than 2 years. This study follows up female sexual violence survivors approximately 6 years after completing a 12-session group cognitive processing therapy (CPT) program in the eastern Democratic Republic of Congo.Baseline trial data were collected in December 2010 from 134 women in 7 study villages randomly allocated to CPT. Study women were over 18 years, reported personally experiencing or witnessing sexual violence, and reported elevated depression, anxiety and/or posttraumatic stress symptoms. Women were followed up (1) post-treatment (6-months after baseline); (2) 6 months later; (3) 12 months later; and (4) in March 2017 (6.3 years after baseline). At the long-term follow-up, 103 women (77%) in 6 of 7 CPT villages were re-assessed; one village was not visited due to ongoing insecurity.We found strong continued intervention effects; nearly all women maintained treatment impacts over the first two years; at long-term follow-up, approximately half continued to maintain low symptom scores. Relapse rates for probable PTSD and probable depression and anxiety were 20%.This study extends prior research to show that treatment impacts can be maintained for several years despite experiences of ongoing trauma. The women described continuing to meet with the women in their therapy group and using the skills they learned in the psychotherapy, providing evidence of the potential for these programs to provide valuable social supports and skills that people use as they continue to face adversity.
View details for DOI 10.1017/gmh.2022.39
View details for PubMedID 36618721
View details for PubMedCentralID PMC9807008
Adapting narrative exposure therapy with a tribal community: A community-based approach.
Journal of clinical psychology
OBJECTIVE: American Indian (AI) individuals are at increased risk for present-day trauma exposure and associated negative outcomes, as well as ongoing effects of intergenerational trauma exposure and adversity. However, few empirically supported treatments exist that are specifically tailored and/or tested with AI communities. This study describes the process of selecting, adapting, and implementing narrative exposure therapy (NET) with an AI community.METHODS: A community and academic partnership was formed and worked together to make culturally mindful changes to NET to best fit the needs of the community. The partnership incorporated community leaders/Elders (n=7), providers (n=11), and participants seeking treatment (n=50) to implement an iterative process of adapting and implementing the adapted form of NET.RESULTS: Key adaptions included addressing historical and intergenerational trauma, greater protections for confidentiality in a small community, and incorporation of cultural customs and traditions. Overall, the adapted form of NET was favorably received by the participants, and the implementation appeared to be feasible, with improved retention over past trials of adapted trauma-focused treatments with this community and with highly positive satisfaction ratings and feedback.CONCLUSIONS: NET was shown to be an appropriate approach for this AI community and should be considered as a treatment option for other AI communities. Future work should consider strategies outlined in this adaption as well as following a similar process for working with AI communities to implement culturally appropriate interventions for trauma-related symptoms.
View details for DOI 10.1002/jclp.23395
View details for PubMedID 35621371
Efficacy and acceptability of interventions for co-occurring PTSD and SUD: A meta-analysis.
Journal of anxiety disorders
2021; 84: 102490
Over the past 20 years, numerous treatments addressing comorbid Posttraumatic Stress Disorder (PTSD) and Substance Use Disorder (SUD) have been developed and tested. The current meta-analysis examined the efficacy and acceptability of the two central treatment types- trauma-focused and non-trauma-focused - compared with all comparators and with cognitive-behavioral manualized SUD treatments immediately post-treatment and at longest follow-up. Twenty-eight randomized clinical trials (N=3247) were included. There were small to large within-group effects for all forms of active treatment (gs=0.30-1.11). Trauma-focused but not non-trauma-focused treatments outperformed all comparators on PTSD outcomes at post-treatment. Neither trauma-focused nor non-trauma-focused treatment outperformed all comparators on SUD outcomes at post-treatment. Neither trauma- nor non-trauma-focused treatment outperformed manualized SUD treatments on PTSD outcomes at either time point. Manualized SUD treatments outperformed trauma-focused treatments on SUD outcomes at post-treatment and non-trauma-focused treatments on PTSD outcomes at follow-up. Regarding treatment retention, neither trauma-focused nor non-trauma-focused treatments significantly differed from all comparators or from manualized SUD treatments. Between-group results were largely unchanged in trim-and-fill analyses, but were not robust to fail-safe N. Few moderators were detected. Taken together, results suggest that trauma-focused, non-trauma-focused, and manualized SUD interventions are sound options for individuals with comorbid PTSD/SUD.
View details for DOI 10.1016/j.janxdis.2021.102490
View details for PubMedID 34763220
Comparison of Teleintegrated Care and Telereferral Care for Treating Complex Psychiatric Disorders in Primary Care: A Pragmatic Randomized Comparative Effectiveness Trial.
Importance: Only one-third of patients with complex psychiatric disorders engage in specialty mental health care, and only one-tenth receive adequate treatment in primary care. Scalable approaches are critically needed to improve access to effective mental health treatments in underserved primary care settings.Objective: To compare 2 clinic-to-clinic interactive video approaches to delivering evidence-based mental health treatments to patients in primary care clinics.Design, Setting, and Participants: This pragmatic comparative effectiveness trial used a sequential, multiple-assignment, randomized trial (SMART) design with patient-level randomization. Adult patients treated at 24 primary care clinics without on-site psychiatrists or psychologists from 12 federally qualified health centers in 3 states who screened positive for posttraumatic stress disorder and/or bipolar disorder and who were not already receiving pharmacotherapy from a mental health specialist were recruited from November 16, 2016, to June 30, 2019, and observed for 12 months.Interventions: Two approaches were compared: (1) telepsychiatry/telepsychology-enhanced referral (TER), where telepsychiatrists and telepsychologists assumed responsibility for treatment, and (2) telepsychiatry collaborative care (TCC), where telepsychiatrists provided consultation to the primary care team. TER included an adaptive intervention (phone-enhanced referral [PER]) for patients not engaging in treatment, which involved telephone outreach and motivational interviewing.Main Outcomes and Measures: Survey questions assessed patient-reported outcomes. The Veterans RAND 12-item Health Survey Mental Component Summary (MCS) score was the primary outcome (range, 0-100). Secondary outcomes included posttraumatic stress disorder symptoms, manic symptoms, depressive symptoms, anxiety symptoms, recovery, and adverse effects.Results: Of 1004 included participants, 701 of 1000 (70.1%) were female, 660 of 994 (66.4%) were White, and the mean (SD) age was 39.4 (12.9) years. Baseline MCS scores were 2 SDs below the US mean; the mean (SD) MCS scores were 39.7 (14.1) and 41.2 (14.2) in the TCC and TER groups, respectively. There was no significant difference in 12-month MCS score between those receiving TCC and TER (beta=1.0; 95% CI, -0.8 to 2.8; P=.28). Patients in both groups experienced large and clinically meaningful improvements from baseline to 12 months (TCC: Cohen d=0.81; 95% CI, 0.67 to 0.95; TER: Cohen d=0.90; 95% CI, 0.76 to 1.04). For patients not engaging in TER at 6 months, there was no significant difference in 12-month MCS score between those receiving PER and TER (beta=2.0; 95% CI, -1.7 to 5.7; P=.29).Conclusions and Relevance: In this comparative effectiveness trial of patients with complex psychiatric disorders randomized to receive TCC or TER, significantly and substantially improved outcomes were observed in both groups. From a health care system perspective, clinical leadership should implement whichever approach is most sustainable.Trial Registration: ClinicalTrials.gov Identifier: NCT02738944.
View details for DOI 10.1001/jamapsychiatry.2021.2318
View details for PubMedID 34431972
- Impact of setting insecurity on Cognitive Processing Therapy implementation and outcomes in eastern Democratic Republic of the Congo EUROPEAN JOURNAL OF PSYCHOTRAUMATOLOGY 2020; 11 (1)
- Flexible Applications of Cognitive Processing Therapy: Evidence-Based Treatment Methods Elsevier. 2020
Randomized Control Trial of Culturally Adapted Cognitive Processing Therapy for PTSD Substance Misuse and HIV Sexual Risk Behavior for Native American Women
AIDS AND BEHAVIOR
2019; 23 (3): 695–706
An overlooked sequela of HIV risk is trauma exposure, yet few HIV interventions address trauma exposure, mental health, and substance misuse. In a two-arm randomized controlled trial 73 Native American women were randomized to a culturally-adapted Cognitive Processing Therapy (CPT) or 6-weeks waitlist. Outcomes assessed: PTSD symptom severity, alcohol use frequency, substance abuse or dependence diagnosis, and high-risk sexual behavior defined as vaginal/anal intercourse (a) under the influence of alcohol and/or illicit substances, (b) with a partner who was concurrently sexually active with someone else, and/or (c) with more than one partner in the past 6 weeks. Among immediate intervention participants, compared to waitlist participants, there were large reductions in PTSD symptom severity, high-risk sexual behavior, and a medium-to-large reduction in the frequency of alcohol use. CPT appears to improve mental health and risk behaviors, suggesting that addressing PTSD may be one way of improving HIV-risk related outcomes.
View details for DOI 10.1007/s10461-018-02382-8
View details for Web of Science ID 000460607900016
View details for PubMedID 30607757
View details for PubMedCentralID PMC6407746
Co-Occurring Post-Traumatic Stress Disorder and Alcohol Use Disorder in US Military and Veteran Populations
ALCOHOL RESEARCH-CURRENT REVIEWS
2018; 39 (2): 161–69
Co-occurring post-traumatic stress disorder (PTSD) and alcohol use disorder (AUD) are costly and consequential public health problems that negatively affect the health and well-being of U.S. military service members and veterans. The disproportionate burden of comorbid PTSD and AUD among U.S. military service members and veterans may be due to unique factors associated with military service, such as aspects of military culture, deployment, and trauma exposure. This review addresses the prevalence of co-occurring PTSD and AUD in military and veteran populations, population-specific factors that contribute to development of the comorbid conditions, and evidence-based treatments that have promise for addressing these conditions in military and veteran populations. Future directions for research and practice relevant to military and veteran populations are discussed.
View details for Web of Science ID 000469410300006
View details for PubMedID 31198655
View details for PubMedCentralID PMC6561402
Controlled Trial of Psychotherapy for Congolese Survivors of Sexual Violence
NEW ENGLAND JOURNAL OF MEDICINE
2013; 368 (23): 2182–91
Survivors of sexual violence have high rates of depression, anxiety, and post-traumatic stress disorder (PTSD). Although treatment for symptoms related to sexual violence has been shown to be effective in high-income countries, evidence is lacking in low-income, conflict-affected countries.In this trial in the Democratic Republic of Congo, we randomly assigned 16 villages to provide cognitive processing therapy (1 individual session and 11 group sessions) or individual support to female sexual-violence survivors with high levels of PTSD symptoms and combined depression and anxiety symptoms. One village was excluded owing to concern about the competency of the psychosocial assistant, resulting in 7 villages that provided therapy (157 women) and 8 villages that provided individual support (248 women). Assessments of combined depression and anxiety symptoms (average score on the Hopkins Symptom Checklist [range, 0 to 3, with higher scores indicating worse symptoms]), PTSD symptoms (average score on the PTSD Checklist [range, 0 to 3, with higher scores indicating worse symptoms]), and functional impairment (average score across 20 tasks [range, 0 to 4, with higher scores indicating greater impairment]) were performed at baseline, at the end of treatment, and 6 months after treatment ended.A total of 65% of participants in the therapy group and 52% of participants in the individual-support group completed all three assessments. Mean scores for combined depression and anxiety improved in the individual-support group (2.2 at baseline, 1.7 at the end of treatment, and 1.5 at 6 months after treatment), but improvements were significantly greater in the therapy group (2.0 at baseline, 0.8 at the end of treatment, and 0.7 at 6 months after treatment) (P<0.001 for all comparisons). Similar patterns were observed for PTSD and functional impairment. At 6 months after treatment, 9% of participants in the therapy group and 42% of participants in the individual-support group met criteria for probable depression or anxiety (P<0.001), with similar results for PTSD.In this study of sexual-violence survivors in a low-income, conflict-affected country, group psychotherapy reduced PTSD symptoms and combined depression and anxiety symptoms and improved functioning. (Funded by the U.S. Agency for International Development Victims of Torture Fund and the World Bank; ClinicalTrials.gov number, NCT01385163.).
View details for DOI 10.1056/NEJMoa1211853
View details for Web of Science ID 000319948900006
View details for PubMedID 23738545
- Adaptation of Cognitive Processing Therapy for Treatment of Torture Victims: Experience in Kurdistan, Iraq PSYCHOLOGICAL TRAUMA-THEORY RESEARCH PRACTICE AND POLICY 2013; 5 (2): 184–92
- Teen Well Check: an e-health prevention program for substance use, sexual assault, and sexual risk behaviors for adolescents in primary care EUROPEAN JOURNAL OF PSYCHOTRAUMATOLOGY 2023; 14 (1)
Trends in Cannabis and Alcohol Use by Sexual Identity in the 2015-2019 National Survey on Drug Use and Health.
Journal of studies on alcohol and drugs
Sexual minority individuals are at substantially elevated risk for both cannabis use disorder (CUD) and alcohol use disorder (AUD). While recent increases in the legalization of cannabis have been linked to increases in cannabis use (CU) among the general population, few studies have examined if changes in CU and CUD vary by sexual identity. The purpose of the current study is to examine sexual identity differences in trends for CUD and compare them to trends for AUD.We utilized data from 2015-2019 National Survey on Drug Use and Health to examine annual prevalences and year-specific disparities in CU, CUD, heavy episodic drinking (HED), and AUD. We also examined sex-specific sexual identity differences in linear trends for these substance use outcomes over this five-year period.All groups except lesbian females experienced significant increases in CU rates from 2015 to 2019. Heterosexual males, heterosexual females, and bisexual females also experienced significant increases in CUD rates. In contrast, no group exhibited significant increases in HED or AUD rates. Bisexual women exhibited some of the largest year-specific disparities in CU, CUD as well as the largest growth in disparities across time.The few changes in HED and AUD alongside numerous changes in CU and CUD suggest that changes in CU may be due to legalization of CU in many states during this period. Given profound disparities and increasing rates of CUD affecting bisexual females, further research is needed to identify factors that may explain their disproportionate burden.
View details for DOI 10.15288/jsad.22-00410
View details for PubMedID 37449947
mHealth Early Intervention to Reduce Posttraumatic Stress and Alcohol Use After Sexual Assault (THRIVE): Feasibility and Acceptability Results From a Pilot Trial.
JMIR formative research
2023; 7: e44400
BACKGROUND: Sexual assault is associated with increased risk for both posttraumatic stress (PTS) and alcohol misuse. Mobile health interventions have shown promise in addressing PTS and substance use in trauma survivors and might be a promising strategy in extending the reach of early interventions to individuals who have recently experienced trauma.OBJECTIVE: This study assesses the feasibility and acceptability of THRIVE, a mobile health early intervention for recent survivors of sexual assault involving a cognitive behavioral app used daily over 21 days with weekly telephone coaching.METHODS: Twenty adult female survivors of past-10-week sexual assault with elevated PTS and alcohol use were randomized to receive the THRIVE intervention as part of a pilot randomized controlled trial. We sought to understand feasibility by examining rates of completion of intervention activities and testing changes in participants' self-reported knowledge of key intervention concepts from baseline to after the intervention. We assessed acceptability by collecting self-report ratings of satisfaction with the intervention and app usability in a follow-up survey. The coach took notes during coaching calls to track call content and record participant feedback; these notes were qualitatively analyzed to elaborate on the aforementioned domains.RESULTS: Feasibility was demonstrated by moderate rates of activity completion: all participants at least opened the app, 19 (95%) of the 20 participants completed at least 1 cognitive behavioral exercise, and 16 (80%) of the 20 participants attended all 4 coaching calls. Participants completed cognitive behavioral exercises on an average of 10.40 (SD 6.52) out of 21 days. The coaching call notes documented participant comments that app-generated reminders increased completion rates. Feasibility was also demonstrated by the finding that knowledge changes occurred from baseline to after the intervention; this indicated that THRIVE was successful in conveying key concepts. Acceptability was demonstrated by high participant ratings of THRIVE's usability; the ratings corresponded to a B+ usability grade. The coaching call notes documented that usability was increased by the coaching calls, the app exercises' clarity, and the app exercises' inclusion of suggestions; however, the coaching call notes also documented that some of the participants found aspects of the app exercises to be difficult or confusing. Acceptability was also demonstrated by participant ratings of satisfaction: most of the participants (15/16, 94%) rated the app as either moderately helpful or very helpful. The coaching call notes documented that the cognitive behavioral activity modules were seen as appealing and that the positive impact of the intervention contributed to participants' satisfaction.CONCLUSIONS: These findings suggest that THRIVE is feasible and acceptable to survivors of recent sexual assault and that further testing of THRIVE is warranted.TRIAL REGISTRATION: ClinicalTrials.gov NCT03703258; https://clinicaltrials.gov/ct2/show/NCT03703258.
View details for DOI 10.2196/44400
View details for PubMedID 37402144
A systematic review of patient-reported outcome measures used in maternal postpartum anxiety.
American journal of obstetrics & gynecology MFM
To perform a systematic review and evaluate the psychometric measurement properties of instruments in postpartum anxiety using Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines and identify the best available patient-reported outcome measure.We searched 4 databases (CINAHL, Embase, PubMed, and Web of Science in July 2022) including studies which evaluated at least one psychometric measurement property of a patient reported outcome measurement instrument. The protocol was registered with PROSPERO CRD42021260004 and followed the COSMIN guidelines for systematic reviews.Studies eligible for inclusion included those that assessed a patient-reported outcome measure examining postpartum anxiety. We included studies where the instruments had undergone some form of psychometric property assessment in the postpartum maternal population, consisted of at least 2 questions, and were not subscales.This systematic review used COSMIN and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines to identify the best patient reported outcome measurement instrument for postpartum anxiety. A risk of bias assessment was performed, and a modified GRADE approach used to assess the level of evidence with recommendations being made for the overall quality of each instrument.A total of 28 studies evaluating 13 instruments in 10,570 patients were included. Content validity was sufficient in 9, with 5 instruments receiving a class A recommendation (recommended for use). Postpartum Specific Anxiety Scale, Postpartum Specific Anxiety Scale Research Short Form, Postpartum Specific Anxiety Scale Research Short Form Covid, Postpartum Specific Anxiety Scale- Persian and State-Trait Anxiety Inventory demonstrated adequate content validity and sufficient internal consistency. Nine instruments received a recommendation of class B (further research required). No instrument received a class C recommendation (not recommended for use).Five instruments received a class A recommendation, all with limitations such as not being specific to the postpartum population, not assessing all domains, lacking generalizability or evaluation of cross-cultural validity. There is currently no freely available instrument assessing all domains of postpartum anxiety. Future studies are needed to determine the optimum current instrument or development and validation of a more specific measure for maternal postpartum anxiety.
View details for DOI 10.1016/j.ajogmf.2023.101076
View details for PubMedID 37402438
Sexual Assault, Posttraumatic Stress, Alcohol Use, and Suicidality Among Diverse College Students.
Journal of interpersonal violence
Suicide is the second leading cause of death among college-aged populations. This study examined the association of demographics (sexual orientation, gender identity, age, and race), sexual assault, posttraumatic stress symptoms (PTSS), and alcohol use with suicidality, current urge to self-harm, and current suicidal intent among a diverse sample of college students (n = 2,160) from two universities. Over half of participants reported any suicidality (63.5%), 12% reported current urge to harm themselves, and 5% reported current suicidal intent. A linear regression indicated that participants who identified as a sexual minority, gender minority, consumed more drinks per week, and had more severe PTSS reported higher levels of suicidality. University also was associated with suicidality. A negative binomial regression demonstrated that participants who identified as a sexual minority and had more severe PTSS had more current urge to harm themselves. Further, a negative binomial regression demonstrated that first-generation college students, students with more severe sexual assault histories, and students with more severe PTSS had higher current suicidal intent. Findings suggest that risk factors may differ for college students' general suicidality, self-harm urges, and suicidal intent, suggesting that these may be separate constructs. More comprehensive models, incorporating multiple risk factors and multiple ways of assessing suicidality, are needed to better understand the range of college student suicidal behavior and risks.
View details for DOI 10.1177/08862605231174698
View details for PubMedID 37226725
- Preliminary Efficacy of a Web-Based Alcohol and Emotion Regulation Intervention on Intimate Partner Aggression Among College Women PSYCHOLOGY OF VIOLENCE 2023; 13 (3): 258-266
Teen Well Check: an e-health prevention program for substance use, sexual assault, and sexual risk behaviors for adolescents in primary care.
European journal of psychotraumatology
2023; 14 (1): 2157933
Objective: Adolescents are at risk for substance use, sexual assault, and sexual risk behaviours; however, to date no integrated prevention programmes address all three risk behaviours. The goal of this study was to evaluate the usability and acceptability of Teen Well Check, an e-health prevention programme targeting substance use, sexual assault, and sexual risk among adolescents in primary care settings.Methods: The current study included content analysis of interviews with adolescents in primary care (aged 14-18; n = 25) in the intervention development process, followed by usability and acceptability testing with qualitative interviews among adolescents in primary care (aged 14-18; n = 10) and pediatric primary care providers (n = 11) in the intervention refinement process. All data were collected in the Southeastern U.S.Results: Feedback on Teen Well Check addressed content, engagement and interaction, language and tone, aesthetics, logistics, inclusivity, parent/guardian-related topics, and the application of personal stories. Overall, providers reported they would be likely to use this intervention (5.1 out of 7.0) and recommend it to adolescents (5.4 out of 7.0).Conclusions: These findings suggest preliminary usability and acceptability of Teen Well Check. A randomized clinical trial is needed to assess efficacy.
View details for DOI 10.1080/20008066.2022.2157933
View details for PubMedID 37052109
Pilot randomized clinical trial of an app-based early intervention to reduce PTSD and alcohol use following sexual assault.
Psychological trauma : theory, research, practice and policy
OBJECTIVE: Sexual assault is associated with high risk for posttraumatic stress disorder (PTSD), and PTSD often co-occurs with alcohol misuse. Most sexual assault survivors do not access early preventative interventions for such conditions. App-based interventions are a promising means to extend the reach of early interventions and thereby reduce risk of chronic PTSD and alcohol misuse.METHOD: This study was a pilot randomized clinical trial of an app-based early intervention with phone coaching (THRIVE) for survivors of past-10-week sexual assault (NCT#: NCT03703258). Intended active components of the THRIVE app are daily cognitive restructuring, daily activity scheduling, and as-needed relationally focused exercises, supported by coaching calls. Forty-one adult female survivors of recent sexual assault with elevated posttraumatic stress and drinking were randomized to intervention or control (symptom-monitoring app with phone coaching). Participants in both conditions were encouraged to use their respective app for 21 days and completed self-report symptom assessments at baseline, postintervention, and 3-month follow-up.RESULTS: At 3-month follow-up, the between-group effect size favored intervention for posttraumatic stress (d = -0.70), intoxication frequency (d = -0.62), and drinking hours per week (d = -0.39). More participants evidenced reliable change in intervention versus control for posttraumatic stress (OR = 2.67) and alcohol problems (OR = 3.05) at 3 months.CONCLUSIONS: The general direction of effects indicates that THRIVE, coupled with coaching, reduces risk for PTSD and alcohol outcomes beyond coached monitoring. These findings suggest that apps like THRIVE may provide an option for early intervention for sexual assault survivors. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
View details for DOI 10.1037/tra0001460
View details for PubMedID 37011153
Sexual Minority Stress and Substance Use: An Investigation of When and Under What Circumstances Minority Stress Predicts Alcohol and Cannabis Use at the Event-Level
JOURNAL OF PSYCHOPATHOLOGY AND CLINICAL SCIENCE
Sexual minority women and gender diverse (SMWGD) individuals are at elevated risk for alcohol and cannabis use disorders compared with cisgender, heterosexual women. This has been attributed to the unique stressors that SMWGD experience (i.e., sexual minority stress); however, recent studies have found mixed evidence for a link between sexual minority stress and substance use. The current manuscript introduces and tests a novel theoretical model derived from integrating minority stress theory and the multistage model of drug addiction to explain these mixed findings. We used data from a 30-day ecological momentary assessment (EMA) study of substance use among SMWGD to determine whether event-level associations between enacted stigma (bias from others) and same-/next-day alcohol and cannabis use are dependent on an individual's typical pattern of substance use (e.g., frequency, quantity, motives, and substance use disorder [SUD] symptoms). Findings indicate that enacted stigma predicted an increased likelihood of alcohol and cannabis use among those who used frequently and those who had a probable alcohol or cannabis use disorder and predicted a decreased likelihood of use among those who used less frequently. Enacted stigma also predicted cannabis (but not alcohol) use among those who reported high coping motives for use. Findings provide initial evidence in support of an integrated model of minority stress theory and the multistage model of drug addiction. Findings suggest that alcohol and cannabis use disorder interventions for SMWGD would benefit from addressing sexual minority stress and coping skill-building. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
View details for DOI 10.1037/abn0000819
View details for Web of Science ID 000952300700001
View details for PubMedID 36931822
A Community Engaged Approach in Adapting Motivational Interviewing and Skills Training for Native Americans With Experiences of Substance Misuse.
American journal of health promotion : AJHP
OBJECTIVE: American Indian and Alaskan Natives (AIAN) are regenerating cultural knowledge and practices to adapt westernized evidence-based interventions to address health concerns such as substance use. This study describes the process of selecting, adapting, and implementing motivational interviewing plus cognitive behavior therapy (motivational interviewing + Skills Training; MIST) for use in a combined substance use intervention with a rural, Northwest tribal community.METHODS: An established community and academic partnership worked together to make culturally mindful changes to MIST. The partnership incorporated community leaders/Elders (n = 7), providers (n = 9), and participants (n = 50) to implement an iterative process of adapting and implementing the adapted form of MIST.RESULTS: Key adaptations included presenting concepts grounded in tribal values, providing examples from the community perspective, and incorporating cultural customs and traditions. Overall, the MIST adaptation was favorably received by participants, and the adaptation appeared feasible.CONCLUSIONS: Adapted MIST appeared to be an acceptable intervention for this Native American community. Future research should evaluate the interventions efficacy in reducing substance use among this and other Native American communities. Future clinical research should consider strategies outlined in this adaptation as a potential process for working with Native American communities to implement culturally appropriate interventions.
View details for DOI 10.1177/08901171231161467
View details for PubMedID 36869715
Social support and treatment utilization for posttraumatic stress disorder: Examining reciprocal relations among active duty service members.
Journal of traumatic stress
Evidence-based treatments for posttraumatic stress disorder (PTSD) are underutilized by active duty service members in the United States. Social support may help service members overcome avoidance and facilitate treatment utilization. In turn, treatment utilization may improve social support. To evaluate these possibilities, the aim of the current study was to examine potential reciprocal associations between social support and treatment utilization among service members. Secondary analyses were conducted on a randomized controlled trial of 161 U.S. military service members with PTSD. Participants completed assessments of perceived social support and attendance at individual therapy sessions at baseline and 3- and 6-month follow-ups. To determine reciprocal relations between social support and treatment utilization, a Bayesian approach was used to estimate a random-intercept cross-lagged panel model with a two-part variable for treatment utilization (i.e., any therapy, and if so, dose). There were no between-person associations between average social support and treatment utilization. One prospective cross-lagged within-person association emerged as significant: social support at 3 months was negatively associated with any therapy use at 6 months; the model explained 26.1% of the variance in this observed variable. The findings revealed that low social support promoted subsequent treatment utilization, but such treatment did not lead to changes in social support. This suggests service members with PTSD may have been motivated to attend individual therapy in pursuit of social connection and support. Future research is needed to determine if reciprocal associations between various forms of social support and therapy utilization differ by treatment modality.
View details for DOI 10.1002/jts.22908
View details for PubMedID 36728194
Helping the Helpers: Adaptation and Evaluation of Stress First Aid for Healthcare Workers in the Veterans Health Administration During the COVID-19 Pandemic.
Workplace health & safety
BACKGROUND: Early interventions are needed to support the behavioral health of healthcare staff in the context of the COVID-19 pandemic. Stress First Aid (SFA) is a self-care and peer support model for reducing burnout and stress that is designed for use in high-stress occupations.METHODS: We conducted a mixed-methods evaluation of an SFA program in the Veterans Health Administration (VHA). This brief, multi-session, didactic program was adapted for hospital workgroups. Program attendees completed a survey assessing implementation outcomes, burnout, stress, mood, and SFA skills at the beginning (N = 246) and end (n = 94) of the SFA program and a subgroup (n = 11) completed qualitative feedback interviews.FINDINGS: Program acceptability, appropriateness, and feasibility were rated highly. From pre- to post-SFA, the impact of the pandemic on stress and anxiety, as well as proficiency in supporting peers increased. Qualitative findings suggest the program provided a shared language to discuss stress, normalized stress reactions, met a need for stress management tools, and helped staff feel valued, empowered, connected with each other. Staff reported being more aware of their stress, but SFA was insufficient to address many of the systemic sources of burnout and stress.CONCLUSIONS AND APPLICATIONS TO PRACTICE: While the SFA program was well received, the impact of brief programs is likely to be modest when implemented in the middle of an ongoing pandemic and when burnout arises from chiefly from systemic sources. Lessons learned during the program implementation that may guide future efforts are discussed.
View details for DOI 10.1177/21650799221148650
View details for PubMedID 36726298
Examining trauma cognition change trajectories among initial PTSD treatment non-optimal responders: a potential avenue to guide subsequent treatment selection.
European journal of psychotraumatology
2023; 14 (2): 2237361
BACKGROUND: Despite their general effectiveness, 14-50% of individuals do not fully respond to evidence-based treatments for posttraumatic stress disorder (PTSD). Although changes in negative posttrauma cognitions (NPCs) are considered a likely PTSD treatment mechanism, less is known about how NPCs change among individuals who continue to be symptomatic following treatment (non-optimal responders).OBJECTIVE: The objective of this study was to examine NPC change trajectories among individuals who were determined to be non-optimally responsive to intensive PTSD treatment.METHOD: Using a 3-week Cognitive Processing Therapy-based intensive PTSD treatment sample (ITP; N=243), the present study examined the number of distinct NPC change trajectories among non-optimal responders via Group Based Trajectory Modeling and assessed predictors of non-optimal responders' NPC change trajectory membership. Analyses were replicated in a separate 2-week ITP sample (N=215).RESULTS: In both non-optimal responder samples, two trajectories emerged; a no NPC change group which represented those with an overall lack of NPC change throughout treatment and an NPC change group which represented those with an overall reduction of NPCs occurring primarily later in treatment. Changes in PTSD symptom severity during treatment was the only consistent predictor of NPC change trajectory group membership among treatment non-optimal responders across ITPs.CONCLUSIONS: Findings suggest NPC change among non-optimal responders is nuanced and may inform subsequent intervention selection, resulting in testable hypotheses for future research.
View details for DOI 10.1080/20008066.2023.2237361
View details for PubMedID 37564032
Implementation of group cognitive processing therapy in correction centers: Anticipated determinants from formative evaluation.
Journal of traumatic stress
Nearly all people in prison have experienced trauma, and many meet the criteria for posttraumatic stress disorder (PTSD). Untreated PTSD increases the risk of substance use problems after release contributing to a well-documented cycle of trauma, addiction, and incarceration. However, evidence-based, trauma-focused therapy for PTSD is rarely offered in prisons, and there is little research that can guide implementation efforts. In preparation for an effectiveness-implementation hybrid II pilot trial examining group-delivered cognitive processing therapy (CPT) in prisons, we conducted a formative evaluation using interviews structured according to the consolidated framework for implementation research (i.e., CFIR). Participants were correction center leadership, treatment staff, health care staff, and security staff (n = 21) and incarcerated persons (n = 13; 61.5% female). We found that CPT was highly compatible with residents' needs and the centers' available resources, culture, existing programs, and current workflow. CPT was also acceptable to all stakeholders. Potential barriers were the lower relative priority for CPT compared with programs that are reinforced at the system level, limited staff time to deliver CPT, limited staff knowledge about PTSD, and center features that could distract from CPT groups and/or training or be countertherapeutic. Taken together, CPT is a promising trauma-focused therapy for corrections, but these findings underscore the importance of identifying and matching potential barriers to effective implementation strategies a priori and continuing work in the policy arena to promote sustainability. This article is protected by copyright. All rights reserved.
View details for DOI 10.1002/jts.22898
View details for PubMedID 36468175
Evaluating changes in negative posttrauma cognition as a mechanism of PTSD severity changes in two separate intensive treatment programs for veterans.
2022; 22 (1): 683
BACKGROUND: A wealth of evidence has illustrated that reductions in negative posttrauma cognitions (NPCs) predict improvement in posttraumatic stress disorder (PTSD) symptoms during treatment. Yet, the specific temporal arrangement of changes in these constructs is less well understood. This study examined the temporal association between NPC changes and PTSD symptom changes in two distinct intensive PTSD treatment samples.METHODS: Data from 502 veterans who completed a 3-week CPT-based intensive PTSD treatment program was used to test the extent to which lagged NPC measurement predicted the next occurring PTSD severity measurement using linear mixed effects regression models. PTSD severity was assessed every other day during treatment. NPCs were assessed at three treatment timepoints. A second sample of 229 veterans who completed a 2-week CPT-based intensive PTSD treatment program was used to replicate these findings.RESULTS: Across both intensive PTSD treatment programs, NPCs generally increased from intake the end of the first treatment week, which was followed by gradual decreases in NPCs throughout the rest of both programs. Change in NPCs during both the 3-week (b=.21, p<.001, R2=.38) and the 2-week programs (b=0.20, p<.001, R2=.24) were significant predictors of change in PTSD symptom severity. However, the reverse was true as well, with change in PTSD severity predicting latter change in NPCs during both the 3-week (b=1.51, p<.001, R2=.37) and 2-week (b=1.37, p<.001, R2=.33) programs, further raising questions about temporality of the association between NPCs and PTSD symptom severity during treatment.CONCLUSIONS: The present study demonstrated that changes in NPCs may not temporally precede changes in PTSD symptom severity in PTSD treatment samples. Instead, we observed earlier PTSD symptom changes and a bidirectional association between the two constructs across both samples. Clinically, the study supports the continued focus on NPCs as an important treatment target as they are an important indicator of successful PTSD treatment, even if they may not be a direct mechanism of treatment-based changes in PTSD severity. Future research should attempt to identify alternative mechanisms of change in CPT.
View details for DOI 10.1186/s12888-022-04296-1
View details for PubMedID 36333686
Does Effectiveness of a Brief Substance Use Treatment Depend on PTSD? An Evaluation of Motivational Enhancement Therapy for Active-Duty Army Personnel.
Journal of studies on alcohol and drugs
2022; 83 (6): 924-933
Posttraumatic stress disorder (PTSD) with comorbid substance use disorders (SUDs) has been associated with poorer treatment outcomes. The present study examined associations between provisional PTSD at baseline and 3 months with 6-month treatment outcomes from either a one-session motivational enhancement therapy (MET) or education intervention addressing substance use.Secondary analyses were conducted on a randomized clinical trial comparing a novel MET intervention to an educational intervention for Army personnel with SUD who were not engaged in SUD treatment (n = 242; 92.1% male). We compared three groups with complete data on baseline and 3-month provisional PTSD: individuals without provisional PTSD at baseline (n = 98), those with provisional PTSD remitted by 3 months (n = 42), and those with provisional PTSD unremitted at 3 months (n = 53) on alcohol use frequency, quantity, consequences, and related diagnoses.Individuals with unremitted provisional PTSD were at increased risk for moderate/severe alcohol use disorder at 6 months relative to those without baseline provisional PTSD (odds ratio = 4.53, p = .007). The effect of MET on drinks per week at 6 months (controlling for baseline) differed with a significant effect of MET for individuals with remitted provisional PTSD (count ratio = 0.41, p = .005).Both interventions were effective in reducing drinking even for those with provisional PTSD, although, compared with education, MET had slightly better effects on reducing drinking quantity for those with remitted PTSD. Findings suggest that PTSD remission may serve as an early prognostic indicator of long-term alcohol use changes, or alternatively, delivery of MET during heightened transitory distress may be most effective for reducing alcohol use.
View details for PubMedID 36484590
- Does Effectiveness of a Brief Substance Use Treatment Depend on PTSD? An Evaluation of Motivational Enhancement Therapy for Active-Duty Army Personnel JOURNAL OF STUDIES ON ALCOHOL AND DRUGS 2022; 83 (6): 924-933
A participant-randomized pilot hybrid II trial of group cognitive processing therapy for incarcerated persons with posttraumatic stress and substance use disorder symptoms: study protocol and rationale.
Health & justice
2022; 10 (1): 30
BACKGROUND: Trauma exposure and drug addiction go hand-in-hand for the 2.17 million people who are incarcerated in US prisons; prevalence of both exceed 80% among this population. This manuscript describes the rationale and methods for a participant-randomized effectiveness-implementation hybrid type II pilot trial designed to: 1) examine the effectiveness of Cognitive Processing Therapy group (CPT), an evidence-based psychotherapy for posttraumatic stress disorder (PTSD), for reducing post-release drug use and PTSD symptoms when adapted for and delivered in prisons; and 2) provide data on implementation outcomes associated with the use of implementation facilitation as a strategy for supporting uptake of CPT in prisons.METHOD: Participants in the effectiveness portion of the trial (N=120) will be incarcerated men and women who are randomly assigned to one of two group therapies: CPT or a control condition (PTSD coping skills group; PCS). Participants will complete assessment measures three times: pre-treatment, post-treatment, and 3months following release from incarceration. CPT groups will be led by prison counselors who are receiving implementation facilitation to support their efforts. PCS groups will be led by trained clinicians on the research team. Implementation outcomes will include acceptability, appropriateness, adoption, feasibility, fidelity, and sustainability. After enrollment ends, the research team will monitor CPT sustainment and recidivism outcomes of study participants for one year.DISCUSSION: This study will lay the groundwork for a larger study of interventions for co-occurring PTSD and SUD in prisons and, critically, inform the development of strategies (such as implementation facilitation) for supporting their uptake in routine practice.TRIAL REGISTRATION: NCT04007666 , clinicaltrials.gov, 24 June 2019, 02 September 2021.
View details for DOI 10.1186/s40352-022-00192-8
View details for PubMedID 36181587
Implicit Trauma Identity Associations in Treatment-Seeking US Military Personnel Do Not Predict or Change in Response to Cognitive Processing Therapy for PTSD
PSYCHOLOGICAL TRAUMA-THEORY RESEARCH PRACTICE AND POLICY
This study evaluated implicit associations (i.e., associations in memory that are automatically activated and difficult to control consciously) related to trauma and one's self in the context of a clinical trial for active duty service members seeking treatment for posttraumatic stress disorder (PTSD). Previous studies with nontreatment-seeking community samples found that implicit trauma identity associations were associated with PTSD symptoms even after controlling for amount of trauma exposure and self-reported negative cognitions about the self. This study extended prior work by evaluating whether trauma-related implicit associations were associated with PTSD and depressive symptoms in a clinical sample seeking treatment for PTSD, predicted PTSD treatment response, or changed over the course of treatment.This secondary analysis examined implicit trauma identity associations using data from a clinical trial evaluating a variable-length adaptation of cognitive processing therapy for military personnel. Participants were 127 active duty U.S. military personnel (13.4% women) seeking PTSD treatment. Implicit trauma identity associations were evaluated at baseline and posttreatment. Study hypotheses and data analysis plan were preregistered.Contrary to predictions, baseline implicit trauma identity associations were not significantly associated with baseline PTSD or depressive symptoms and did not predict treatment response. Implicit trauma identity associations did not change significantly in response to treatment.More tailoring of implicit trauma measures for military personnel and/or treatment-seeking patients may be needed. The measure may lack sensitivity to change in response to treatment and have reduced utility in treatment-seeking samples with high symptom burden and less variability in symptoms. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
View details for DOI 10.1037/tra0001367
View details for Web of Science ID 000860913000001
View details for PubMedID 36174156
Posttraumatic cognitions and sexual assault: Understanding the role of cognition type in posttraumatic stress symptoms and problematic alcohol use.
Journal of traumatic stress
Identifying potential mechanisms underlying the association between posttraumatic stress (PTS) and problematic alcohol use is an important target among college women who have experienced sexual assault. This study examined the role of posttraumatic cognitions in this association among college women (N = 530) who experienced either an alcohol-involved assault or non-alcohol-involved assault, using baseline assessment data from a larger study examining cognitive and emotional risk factors for problem drinking. Conditional path analysis was used to examine the indirect effects of posttraumatic cognitions on the association between PTSS and alcohol use consequences, with assault type as a moderator. The findings revealed a significant indirect path from PTS to alcohol use consequences through posttraumatic cognitions, B = 0.21, SE = 0.04, p < .001, 95% CI [0.13, 0.29], beta = .16, R2 = .32. Exploratory analyses revealed a significant conditional indirect effect through self-blame cognitions, R2 = .31, whereby the indirect effect of self-blame on the association between posttraumatic stress and alcohol consequences was present among participants who experienced alcohol-involved assault, B = 0.10, SE = 0.03, p < .001, 95% CI [0.06, 0.16], beta = .07, but not among those who experienced a non-alcohol-involved assault, B = 0.03, SE = 0.03, p = 0.32, 95% CI [-0.02, 0.08], beta = .02. Posttraumatic cognitions are a potential mechanism underlying the link between posttraumatic stress and alcohol consequences. Addressing posttraumatic cognitions, particularly those related to self-blame, may be an important target for interventions promoting healthy recovery following alcohol-involved assault.
View details for DOI 10.1002/jts.22869
View details for PubMedID 36000169
Understanding parental vaccine refusal: Implicit and explicit associations about vaccines as potential building blocks of vaccine beliefs and behavior.
Social science & medicine (1982)
2022; 310: 115275
OBJECTIVE: A movement of parents refusing vaccines for their children has contributed to increasingly large outbreaks of diseases that are preventable by vaccines. Research has identified multiple factors that relate to parents' vaccination behaviors (i.e., whether not they vaccinate their children), including their beliefs about vaccines' safety and utility and their trust in those who recommend vaccines. Here we examine the role of more fundamental psychological processes that may contribute to multiple vaccine-related beliefs and behaviors: cognitive associations.METHODS: Using a large sample of U.S. parents (pre-COVID-19), we investigated parents' associations between vaccines and helpfulness/harmfulness, as well as between the self and vaccines (vaccine identity), and their relation to parents' beliefs about vaccine safety and utility, trust in authorities' vaccine recommendations, and prior vaccination refusal for their children. To capture a more complete understanding of people's associations, we examined both explicit associations (measured via self-report) and implicit associations (measured by the Implicit Association Test).RESULTS: Both implicit and explicit associations correlated with beliefs, trust, and vaccination refusal. Results from structural equation models indicated that explicit vaccine-identity and vaccine-helpfulness associations and implicit vaccine helpfulness associations were indirectly related to vaccination refusal via their relation with vaccine beliefs.CONCLUSIONS: Collectively, study findings suggest that vaccine associations-especially those related to helpfulness/harmfulness-may serve as psychological building blocks for parental vaccine beliefs and behaviors.
View details for DOI 10.1016/j.socscimed.2022.115275
View details for PubMedID 36037608
A pilot study on the feasibility, acceptability, and preliminary efficacy of a brief text message intervention for co-occurring alcohol misuse and PTSD symptoms in a community sample.
Journal of anxiety disorders
2022; 91: 102615
Accessible, brief, and self-directed intervention are needed to improve treatment access for individuals with co-occuring PTSD and alcohol misuse. This pilot study tests the feasibility, acceptability, and preliminary efficacy of a brief text message intervention based on cognitive behavioral therapy plus message framing (CBT + Framing) compared to active control providing kind support and attention (KAM), to reduce PTSD symptoms and alcohol use. Two waves of community-based data collection (Wave 1n=50; Wave 2n=59) were completed. Participants self-reported symptoms at baseline, post-intervention, and 8-week follow-up. Engagement and retention were high, suggesting messages were feasible and acceptable. Across waves and conditions, from baseline to follow-up primary outcomes of PTSD symptoms (medium to large effects), weekly drinks (medium effects), and heavy episodic drinking (small to medium effects) decreased. Consistent with hypotheses, CBT +Framing outperformed KAM for PTSD at post in Wave 2 and for number of heavy drinking episodes at both post and follow-up in Wave 1. Contrary to hypotheses, KAM outperformed CBT +Framing for PTSD at post in Wave 1, and minimal differences were observed between conditions for weekly drinks in both waves. Future studies should continue to develop and test brief, accessible interventions.
View details for DOI 10.1016/j.janxdis.2022.102615
View details for PubMedID 35988440
- Maintenance of intervention effects: long-term outcomes for participants in a group talk-therapy trial in the Democratic Republic of Congo GLOBAL MENTAL HEALTH 2022
Web-Based Alcohol and Sexual Assault Prevention Program With Tailored Content Based on Gender and Sexual Orientation: Preliminary Outcomes and Usability Study of Positive Change (+Change).
JMIR formative research
2022; 6 (7): e23823
BACKGROUND: Alcohol use and sexual assault are common on college campuses in the United States, and the rates of occurrence differ based on gender identity and sexual orientation.OBJECTIVE: We aimed to provide an assessment of the usability and preliminary outcomes of Positive Change (+Change), a program that provides integrated personalized feedback to target alcohol use, sexual assault victimization, sexual assault perpetration, and bystander intervention among cisgender heterosexual men, cisgender heterosexual women, and sexual minority men and women.METHODS: Participants included 24 undergraduate students from a large university in the Southwestern United States aged between 18 and 25 years who engaged in heavy episodic drinking in the past month. All procedures were conducted on the web, and participants completed a baseline survey, +Change, and a follow-up survey immediately after completing +Change.RESULTS: Our findings indicated that +Change was acceptable and usable among all participants, despite gender identity or sexual orientation. Furthermore, there were preliminary outcomes indicating the benefit for efficacy testing of +Change.CONCLUSIONS: Importantly, +Change is the first program to target alcohol use, sexual assault victimization, sexual assault perpetration, and bystander intervention within the same program and to provide personalized content based on gender identity and sexual orientation.TRIAL REGISTRATION: ClinicalTrials.gov NCT04089137; https://clinicaltrials.gov/ct2/show/NCT04089137.
View details for DOI 10.2196/23823
View details for PubMedID 35867393
Disparities in Mental Health and Health Risk Behaviors for LGBT Veteran Subgroups in a National U.S. Survey.
Purpose: This study examined differences in mental health and health risk behaviors across sexual orientation and gender identity among U.S. veterans. Methods: Veterans were recruited through targeted social media advertising, community organizations, and listservs to complete an online survey (N=1062). Generalized linear regression was used to evaluate differences in outcomes between subgroups, which included cisgender heterosexual men and women, lesbian women, gay men, bisexual men and women, transgender men and women, and veterans with other gender identities. Results: Transgender men and women reported a significantly higher prevalence of lifetime suicide plans and attempts compared to all other subgroups within the respective genders. Beyond this finding, patterns of all outcomes varied by gender. Compared to other subgroups of men, transgender men reported higher prevalence of posttraumatic stress disorder, whereas cisgender gay men reported higher prevalence of lifetime cocaine use and positive human immunodeficiency virus (HIV) status. Within the women subgroups, all LGBT subgroups reported higher prevalence of lifetime smoking and past-year marijuana use compared to heterosexual women. Cisgender lesbian women also reported higher prevalence of past-month heavy episodic drinking, and cisgender bisexual women reported higher prevalence of lifetime cocaine and stimulant use compared to other groups. Conclusion: Transgender women and men reported significantly higher prevalence of lifetime suicide plans and attempts than other groups, highlighting this as an area in need of urgent public health attention. Other disparity patterns indicated the importance of examining subgroups within the LGBT veteran community.
View details for DOI 10.1089/lgbt.2022.0039
View details for PubMedID 35766966
Development of StressCheck: A telehealth motivational enhancement therapy to improve voluntary engagement for PTSD treatment among active-duty service members.
Contemporary clinical trials
BACKGROUND: Rates of PTSD in active-duty military are high relative to the general population. Although efficacious treatments exist, they are underutilized. Many service members with PTSD do not present for treatment and, of those who do, many do not receive sufficient doses of the interventions to receive full benefits. Motivational Enhancement Therapy (MET) "check-ups", are brief interventions designed to elicit treatment engagement for those who are not treatment-seeking.METHODS: StressCheck is an MET for nontreatment seeking Army and Air Force personnel. StressCheck aims to improve PTSD and increase treatment engagement, especially around evidence-based interventions, as well as to decrease stigma about seeking mental health services and improve knowledge about treatment options. This paper describes the intervention components and process of treatment development. The paper also describes next steps in testing the effectiveness of the intervention.CONCLUSION: PTSD is associated with deleterious health, occupational, and psychological effects. If effective, this innovative intervention will bridge the gap between those who are not treatment seeking and existing services, thereby enhancing reach and impact of existing services.CLINICALTRIALS: GOV IDENTIFIER: NCT03423394.
View details for DOI 10.1016/j.cct.2022.106841
View details for PubMedID 35777697
Event-level associations among minority stress, coping motives, and substance use among sexual minority women and gender diverse individuals.
2022; 134: 107397
BACKGROUND: Sexual minority women and gender diverse individuals (SMWGD) are at heightened risk for alcohol and cannabis use disorders compared to heterosexual and cisgender individuals, and their heightened risk has been attributed to minority stress. However, few longitudinal studies have examined mechanisms through which minority stress may impact substance use, and none have done so at the event-level.METHODS: We utilized data from a 30-day ecological momentary assessment study of 429 SMWGD who used alcohol or cannabis regularly to test a mechanistic process in which minority stress predicts alcohol and cannabis use via coping motives for use at the event-level.RESULTS: When individuals experienced more enacted stigma (e.g., microaggressions) than usual during one assessment, they were more likely to use cannabis to cope during the next. In turn, occasions when cannabis was used to cope were marked by more sessions of cannabis use, longer intoxication, higher subjective intoxication, and more cannabis consequences. Indirect effects of enacted stigma on cannabis use via coping motives were significant. However, only one of internalized stigma's indirect effects was significant, with internalized stigma predicting cannabis consequences via daily coping motives. No indirect effects predicting alcohol use were significant.CONCLUSIONS: Findings provide robust evidence that using to cope is a mechanism through which enacted stigma predicts cannabis use and internalized stigma predicts cannabis consequences. Results did not provide evidence for similar associations for alcohol. Our findings suggest that interventions designed to reduce cannabis use among SMWGD should attend to their minority stress experiences and cannabis use motives and teach alternative coping strategies.
View details for DOI 10.1016/j.addbeh.2022.107397
View details for PubMedID 35700652
College student alcohol use and confidence to intervene in interpersonal violence: Differences by gender and sexual orientation.
Journal of American college health : J of ACH
Objectives: The current study examined the association between alcohol use frequency (ie, days a week one consumes alcohol), sexual and gender identity, and bystander confidence to intervene in interpersonal violence (ie, bystander self-efficacy). Participants: Participants were 750 undergraduate students aged 18-25 (260 heterosexual men, 260 heterosexual women, 59 SM men [54 cisgender, 5 transgender men], and 171 SM women [169 cisgender, 2 transgender women]). Methods: Participants completed an online survey about alcohol and sexual behaviors. Results: Results indicated that (1) alcohol use frequency was positively associated with greater bystander self-efficacy, (2) heterosexual men, compared to heterosexual women, reported lower bystander self-efficacy, and (3) the association between alcohol use frequency and bystander self-efficacy was significant and positive among heterosexual, but not SM, women. Conclusions: Prevention efforts may benefit from targeting individuals who drink more frequently and ensuring that they have the skills to effectively intervene.
View details for DOI 10.1080/07448481.2022.2076099
View details for PubMedID 35658026
Initial findings on RESTORE for healthcare workers: an internet-delivered intervention for COVID-19-related mental health symptoms.
2022; 12 (1): 222
Many healthcare workers on the frontlines of the COVID-19 pandemic are experiencing clinical levels of mental health symptoms. Evidence-based interventions to address these symptoms are urgently needed. RESTORE (Recovering from Extreme Stressors Through Online Resources and E-health) is an online guided transdiagnostic intervention including cognitive-behavioral interventions. It was specifically designed to improve symptoms of anxiety, depression, and posttraumatic stress disorder (PTSD) associated with COVID-19-related traumatic and extreme stressors. The aims of the present study were to assess the feasibility, acceptability, and initial efficacy of RESTORE in healthcare workers on the frontline of the COVID-19 pandemic. We conducted an initial uncontrolled trial of RESTORE in 21 healthcare workers who were exposed to COVID-19-related traumatic or extremely stressful experiences in the context of their work and who screened positive for clinical levels of anxiety, depression, and/or PTSD symptoms. RESTORE was found to be feasible and safe, and led to statistically significant and large effect size improvements in anxiety, depression, and PTSD symptoms over the course of the intervention through follow-up. RESTORE has the potential to become a widely disseminable evidence-based intervention to address mental health symptoms associated with mass traumas.Clinical Trials Registration: This trial was registered with ClinicalTrials.gov ID: NCT04873622.
View details for DOI 10.1038/s41398-022-01965-3
View details for PubMedID 35650179
- Doomscrolling: Prospective Associations Between Daily COVID News Exposure, Internalizing Symptoms, and Substance Use Among Sexual and Gender Minority Individuals Assigned Female at Birth PSYCHOLOGY OF SEXUAL ORIENTATION AND GENDER DIVERSITY 2022
Treating posttraumatic stress disorder at home in a single week using 1-week virtual massed cognitive processing therapy.
Journal of traumatic stress
Posttraumatic stress disorder (PTSD) treatments are increasingly delivered in massed formats and have shown comparable results to standard, weekly treatment. To date, massed cognitive processing therapy (CPT), delivered daily, has been delivered primarily in combination with adjunctive services and among veteran populations, but it has not been rigorously evaluated as a standalone intervention. The present study evaluated 1-week massed CPT delivered virtually (i.e., via telehealth) to a community sample of trauma-exposed individuals (N = 24). Using a single-arm open-label design, participants received CPT twice per day for 5 days. The results indicated that most participants completed treatment (n = 23, 95.8%), and no adverse events were reported. Participants exhibited large reductions in clinician-rated, d = 2.01, and self-reported PTSD symptoms, d = 2.55, as well as self-reported depressive symptoms, d = 1.46. On average, participants reported a 5-point PTSD symptom reduction and 1-point reduction in depressive symptoms for each treatment day. Reductions in PTSD and depressive symptoms were maintained at 3-month follow-up. Overall, 1-week massed CPT delivered virtually was shown to be feasible and to result in rapid symptom reductions that were sustained over time. Virtual massed CPT has the potential to increase access to effective treatments and help trauma survivors restore aspects of their lives in short amounts of time.
View details for DOI 10.1002/jts.22831
View details for PubMedID 35338534
Examination of Sex-Related Distress and Self-Medication Drinking Model in U.S. College Women.
Journal of sex research
Adult sexual assault (ASA) in college remains a concern. Consequently, many college-aged women experience negative emotions surrounding sexual activity (sex-related distress). Consistent with self-medication theory, some drink to cope with sex-related distress, which may reduce distress, but lead to greater drinking quantity before sex and negative sexual consequences. How women with ASA histories navigate sexual situations and cope with sex-related distress is under researched. We examined ASA, sex-related distress, and drinking to cope motives to understand correlates of drinking before sex. First and second year college women (n=300) reported on a recent sexual experience in the past six weeks. In the full sample, ASA severity was associated with a greater likelihood of drinking before sex, while general sex-related distress was associated with a lower likelihood. General sex-related distress was associated with event-specific sex-related distress and sexual consequences. There were no differences in number of pre-sex drinks or subjective intoxication during sexual activity based on ASA. In a subsample of women who drank before sexual activity (n=179), drinking to cope with sex-related distress motives mediated the association between sex-related distress and sexual consequences. Interventions can draw on these findings to target self-medication drinking in consensual sexual situations.
View details for DOI 10.1080/00224499.2022.2044444
View details for PubMedID 35275036
Multiple diverse drinking trajectories among sexual minority women: Unique and joint prediction by minority stress and social influence risk factors.
2022; 129: 107273
BACKGROUND: Sexual minority populations are at heightened risk for alcohol use disorders compared to heterosexual populations, and these disparities are particularly pronounced for sexual minority women (SMW). Little research has examined the diversity of drinking trajectories among sexual minorities, despite evidence that such trajectories have high predictive utility and are useful in understanding how risk factors may be uniquely associated with specific trajectories.METHOD: We utilized four waves of data (12months between waves) from a sample of 1,057 SMW ages 18-25 at Wave 1. The goals were to (a) identify multiple distinct trajectories of alcohol use; (b) examine the predictive utility of these trajectories; and (c) test associations between minority stress (e.g., discrimination) and social influence (e.g., sexual minority community involvement) risk factors and alcohol trajectories.RESULTS: Using growth mixture modeling, we identified five classes based on drinking patterns at Wave 1 and change over time (stable low, stable high drinking, stable high HED, low increasing, and high decreasing). These classes were differentially associated with Wave 1 levels and changes in alcohol consequences. Minority stressors uniquely predicted a low increasing trajectory, while social influences uniquely predicted a stable high trajectory. Both minority stress and social risk factors predicted high decreasing and stable high HED trajectories.CONCLUSIONS: Findings indicate that some drinking trajectories among SMW appear similar to those found in the general population, while others appear unique. Results provide insight into how minority stress and social influence risk factors may uniquely and jointly contribute to disparities affecting this population.
View details for DOI 10.1016/j.addbeh.2022.107273
View details for PubMedID 35219035
Initial Efficacy of a Web-Based Alcohol and Emotion Regulation Intervention for College Women With Sexual Assault Histories
PSYCHOLOGY OF ADDICTIVE BEHAVIORS
2021; 35 (7): 852-865
College women with sexual assault histories report greater heavy drinking relative to those without histories of assault. Moreover, individuals with sexual assault histories often have difficulty regulating emotions and tolerating distress, which can lead to a problematic pattern of drinking to cope. Thus, we evaluated the initial efficacy of a web-based alcohol intervention that included strategies to reduce drinking and improve regulatory skills for heavy drinking college women with sexual assault histories.The sample comprised college women (N = 200) who were 20.9 (SD = 2.8) years old and primarily White (69%). They were randomized to an assessment-only control or intervention and completed 14 daily diary assessments, pre- and posttreatment surveys, and 1- and 6-month follow-up surveys. During daily diary, the intervention group received a brief (5-10 min) alcohol reduction or regulatory skill module each day.Reductions in drinking quantity and heavy episodic drinking were found for the intervention group at posttreatment and 1-month follow-up relative to controls. Improved regulatory skills and reduced posttraumatic stress disorder (PTSD) symptoms were reported at posttreatment for women who received the intervention compared to controls. Although gains were maintained, the intervention group no longer differed from controls by 6-month follow-up.Results suggest this web-based intervention may result in short-term reductions in drinking and PTSD symptoms as well as improvements in regulatory abilities for college women with sexual assault histories. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
View details for DOI 10.1037/adb0000762
View details for Web of Science ID 000716306700009
View details for PubMedID 34291957
View details for PubMedCentralID PMC8578151
The end of the trial: Perspectives on cognitive processing therapy from community-based providers in the Democratic Republic of Congo.
Journal of traumatic stress
Despite calls forincreased mental health programming in low-resource and humanitarian contexts and effectiveness trials of psychotherapy in these settings, little research exists on the extent to which providers and recipients continue to practice skills learned during trials of these programs. To understand if and how providers continued to use mental health intervention skills without ongoing institutional support following the completion of randomized controlled trials (RCTs), we analyzed data from semistructured interviews with six of seven providers who participated in an RCT of cognitive processing therapy (CPT) in the Democratic Republic of Congo 7 years prior. Provider interviews revealed continued knowledge of and, in some cases, the practice of core CPT skills as well as efforts to keep meeting with women in the community and a strong desire to learn new skills. Although financial limitations sometimes prohibited providers from formally convening CPT groups with women in need, participants maintained knowledge and skill use. Providers also reported feeling more valued in their communities, and they continued providing services beyond the planned intervention period despite a lack of ongoing support. In addition, participants described a strong desire to continue psychosocial interventions for trauma and learn more about this type of intervention. Reframing the evaluation of psychological interventions as program development and maintaining a strong working relationship with community partners may allow for increased sustainability of mental health services beyond the end of academic research studies in low-resource contexts.
View details for DOI 10.1002/jts.22734
View details for PubMedID 34644432
Risk factors for elevations in substance use and consequences during the COVID-19 pandemic among sexual and gender minorities assigned female at birth.
Drug and alcohol dependence
2021; 227: 109015
BACKGROUND: Problematic substance use (SU) has increased substantially during the COVID-19 pandemic. While studies have identified risk factors for problematic SU during the pandemic (e.g., anxiety, depression, using substances to cope), these studies have been predominately cross-sectional, rarely examined changes in SU contexts during the pandemic as potential risk factors, and neglected sexual and gender minorities (SGM) - a health disparity population disproportionately impacted by substance use disorders and the pandemic.METHOD: We utilized two waves of data collected one month apart from a sample of 212 SGM assigned female at birth who used alcohol and/or cannabis (18-25 years old) collected between August 2020-February 2021. We examined associations between potential risk factors (i.e., retrospectively reported changes in anxiety/depression and in using substances in different contexts since before the pandemic): and 1) retrospectively reported changes in alcohol and cannabis consumption; 2) coping motives for use and SU consequences; and 3) subsequent changes in coping motives and consequences.RESULTS: An increase in solitary SU was a robust risk factor for concurrent and prospective increases in SU, coping motives, and consequences. Increases in SU with romantic partners were associated with concurrent increases in alcohol/cannabis consumption and consequences. Increases in anxiety and depression were associated with concurrent increases in SU and higher coping motives and consequences.CONCLUSIONS: Results indicate that solitary SU and increases in SU with romantic partners are robust risk factors for increases in SU and consequences in the context of the pandemic. Further, findings provide support for the self-medication theory of substance use.
View details for DOI 10.1016/j.drugalcdep.2021.109015
View details for PubMedID 34492556
Establishing a New Measure of Alcohol-Related Sexual Consequences and Examining Its Association to Alcohol Consequences Among At-Risk Young Adults.
Journal of studies on alcohol and drugs
2021; 82 (4): 493-502
OBJECTIVE: Alcohol-related sexual consequences are common among young adults, yet there is no standard measure to comprehensively assess this construct. To fill this gap, the current study evaluated a 41-item measure of alcohol-related sexual consequences in a sample of at-risk young adults.METHOD: A subsample (n = 318; 54% female; 71% White; mean age = 22.52 years) of young adults from a larger intervention study was identified for analyses based on recent drinking and sexual behavior. Participants were asked whether each of 41 sexual consequences occurred in the past month as a result of drinking alcohol. More than half of the sample reported vaginal sex without a condom, oral sex without a condom, and having sex without discussing condom use.RESULTS: Only 1 of 41 items evidenced sex differences: men were more likely than women to report oral sex with someone they just met. Count regression models were conducted to determine unique associations among alcohol-related (e.g., alcohol use, expectancies) and sex-related variables (e.g., sexual behavior, expectancies) and alcohol-related sexual consequences and general alcohol consequences. Findings supported the alcohol-related sexual consequences measure as related to, but distinct from, general alcohol consequences, as it was more strongly related to sex-specific constructs.CONCLUSIONS: This study provides preliminary support for the Alcohol-Related Sexual Consequences Scale, a novel measure of alcohol-related sexual consequences, which may be useful for generating personalized feedback and assessing the efficacy of interventions targeting risky sexual behavior and drinking.
View details for PubMedID 34343081
Establishing a New Measure of Alcohol-Related Sexual Consequences and Examining Its Association to Alcohol Consequences Among At-Risk Young Adults
JOURNAL OF STUDIES ON ALCOHOL AND DRUGS
2021; 82 (4): 493-502
View details for Web of Science ID 000752487900007
A Prospective Study of Predictors and Consequences of Hooking Up for Sexual Minority Women.
Archives of sexual behavior
Hooking up, which refers to a sexual encounter (ranging from kissing to penetrative sex) between individuals who are not in a committed relationship, is an increasingly normative form of sexual exploration among emerging adults. Past research has focused on hookups within a heteronormative context, and some of this work has examined hookups as a way to cope with distress. Building on this work, we examined the role of hookups as a means for lesbian and bisexual women to cope with minority stress through increasing connection and engagement with the LGBTQ (lesbian/gay/bisexual/transgender/queer or questioning) community. A nationally recruited sample of 520 lesbian and bisexual women ages 18 to 25 years completed questionnaires regarding their hookup behaviors as part of a longitudinal study. Childhood sexual abuse, posttraumatic stress symptoms, alcohol use, minority stress, and involvement and connectedness with the LGBTQ community were also assessed. First, regression analyses were used to examine baseline predictors of hookup behaviors reported at a 12-month follow-up. Findings revealed that alcohol use was associated with a greater likelihood of any subsequent hookups, and individuals reporting more minority stress subsequently hooked up with more partners. Second, hookup behaviors at 12months were examined as predictors of outcomes at a 24-month follow-up, after controlling for baseline variables. Findings revealed that hookup behaviors were associated with reduced minority stress as well as increased involvement with and connectedness to the LGBTQ community, suggesting hookups may serve a protective function. Overall, findings support the notion that, for sexual minority women, hookups may operate as a means of coping and connection.
View details for DOI 10.1007/s10508-020-01896-4
View details for PubMedID 33977424
Cognitive Processing Therapy for Substance-Involved Sexual Assault: Does an Account Help or Hinder Recovery?
Journal of traumatic stress
Sexual assault (SA) often occurs in the context of substances, which can impair the trauma memory and contribute to negative cognitions like self-blame. Although these factors may affect posttraumatic stress disorder (PTSD) treatment, outcomes for substance-involved SA have not been evaluated or compared with other types of SA. As such, we conducted a secondary analysis of a dismantling trial for cognitive processing therapy (CPT), focusing on 58 women with an index trauma of SA that occurred since age 14. Women who experienced a substance-involved SA (n = 21) were compared with those who experienced a non-substance-involved SA (n = 37). Participants were randomized to CPT, CPT with written account (CPT+A), or written account only (WA). Regressions controlling for pretreatment symptom levels revealed no differences by SA type in PTSD severity at posttreatment. At 6-month follow-up, substance-involved SA was associated with more severe residual PTSD severity than non-substance-involved SA, with no significant differences by treatment condition. Among participants in the substance-involved SA group, the largest effect for reduced PTSD symptom severity from pretreatment to follow-up emerged in the CPT condition, d = -2.02, with reductions also observed in the CPT+A, d = -0.92, and WA groups, d = -1.23. Although more research in larger samples is needed, these preliminary findings suggest that following substance-involved SA, a cognitive treatment approach without a trauma account may facilitate lasting change in PTSD symptoms. We encourage replications to better understand the relative value of cognitive and exposure-based treatment for PTSD following substance-involved SAs.
View details for DOI 10.1002/jts.22674
View details for PubMedID 33821515
A formative evaluation of a web-based intervention for women with a sexual assault history and heavy alcohol use.
Psychological trauma : theory, research, practice and policy
OBJECTIVE: Sexual assault (SA) among college women is widespread and is associated with negative consequences including heavy drinking. However, women with SA histories are rarely the target of alcohol interventions, and existing alcohol interventions do not address the distal factors that contribute to heavy drinking in this group, such as emotion regulation and distress tolerance. The goal of this study was to evaluate a newly developed web-based alcohol intervention targeting college women with SA histories.METHOD: Heavy-drinking college women with SA histories (N = 21) reviewed a series of brief web-based alcohol reduction and regulatory (i.e., emotion regulation, distress tolerance) skill modules and provided feedback on each module.RESULTS: Directed content analysis of open-ended survey responses resulted in three themes: intervention content (i.e., what was said in the intervention), intervention delivery (i.e., the look and feel of the intervention), and areas for improvement (i.e., how to enhance the intervention). Quantitative ratings indicated that participants found skill modules moderately relevant and engaging, and qualitative themes and subthemes highlighted important areas for improvement.CONCLUSIONS: Incorporating user feedback early in the intervention development process provides critical information for content and delivery modifications that may enhance the target population's engagement and satisfaction with the final product. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
View details for DOI 10.1037/tra0000917
View details for PubMedID 33630636
- Prospective Predictors of Work Limitations in Young Adult Lesbian and Bisexual Women: An Examination of Minority Stress, Trauma Exposure, and Mental Health STIGMA AND HEALTH 2021
Banbury Forum Consensus Statement on the Path Forward for Digital Mental Health Treatment.
Psychiatric services (Washington, D.C.)
A major obstacle to mental health treatment for many Americans is accessibility: the United States faces a shortage of mental health providers, resulting in federally designated shortage areas. Although digital mental health treatments (DMHTs) are effective interventions for common mental disorders, they have not been widely adopted by the U.S. health care system. National and international expert stakeholders representing health care organizations, insurance companies and payers, employers, patients, researchers, policy makers, health economists, and DMHT companies and the investment community attended two Banbury Forum meetings. The Banbury Forum reviewed the evidence for DMHTs, identified the challenges to successful and sustainable implementation, investigated the factors that contributed to more successful implementation internationally, and developed the following recommendations: guided DMHTs should be offered to all patients experiencing common mental disorders, DMHT products and services should be reimbursable to support integration into the U.S. health care landscape, and an evidence standards framework should be developed to support decision makers in evaluating DMHTs.
View details for DOI 10.1176/appi.ps.202000561
View details for PubMedID 33467872
Development of RESTORE: an online intervention to improve mental health symptoms associated with COVID-19-related traumatic and extreme stressors.
European journal of psychotraumatology
2021; 12 (1): 1984049
Background: Frontline healthcare workers, recovered COVID+ patients who had severe illness, and close others of COVID+ patients who have recovered or died are at risk for clinical levels of mental health symptoms in the context of the COVID-19 pandemic. RESTORE (Recovering from Extreme Stressors Through Online Resources and E-health) was specifically designed for this context. RESTORE is a transdiagnostic guided online intervention adapted from evidence-based cognitive-behavioural therapies.Objectives: RESTORE was designed to address depression, anxiety, and posttraumatic stress disorder symptoms associated with exposure to COVID-19-related traumatic and extreme stressors, and to overcome multiple barriers to accessing psychotherapies.Method: This paper describes the intervention components and platform, as well as the principles used to develop RESTORE. Current research and future directions in developing and testing RESTORE are outlined.Results: Preliminary data from an initial uncontrolled trial evaluating RESTORE in frontline healthcare workers is highly promising.Conclusion: We believe RESTORE has great potential to provide accessible, evidence-based psychological intervention to those in great need.
View details for DOI 10.1080/20008198.2021.1984049
View details for PubMedID 34745446
Impact of hazardous alcohol use on intensive PTSD treatment outcomes among veterans
EUROPEAN JOURNAL OF PSYCHOTRAUMATOLOGY
2021; 12 (1): 1888541
Background: Intensive treatment programmes (ITPs) for posttraumatic stress disorder (PTSD) produce large symptom reductions and have generally higher completion rates compared to traditional weekly care. Although ITPs do not appear to increase substance use, it has yet to be determined whether their effectiveness differs for veterans with and without hazardous alcohol use (HAU). Objective: This study examined the effectiveness of a 3-week Cognitive Processing Therapy-based ITP for 538 veterans with PTSD (66.0% male; mean age = 41.22 years) and with (n = 193) or without HAU (n = 343) for reducing PTSD and depression symptoms. Method: Veterans' PTSD (PCL-5) and depression (PHQ-9) symptoms were assessed at pre-treatment, during treatment, and at post-treatment. HAU (AUDIT-C total score ≥4 for males; ≥3 for females) was measured at intake. Results: Treatment completion rates were high for both individuals who endorsed HAU (92.68%) and those who did not (93.37%), likely due to veterans being housed near the treatment facility. Mixed effects regression models revealed a significant time by alcohol use interaction when predicting both PCL-5 (p < .001) and PHQ-9 (p = .003), suggesting time-trends over the course of the ITP differed based on alcohol use. Veterans who endorsed HAU improved to a statistically significantly lesser extent. However, endpoint differences between groups for both outcomes were small (Cohen's ds between 0.15 and 0.20). Conclusions: Veterans with and without HAU reported significant reductions in PTSD and depression symptoms and completed the ITP at comparably high rates. Findings support the effectiveness of intensive PTSD treatment programmes for individuals with PTSD and HAU. Future studies should utilize controlled designs to evaluate whether intensive PTSD treatment can reduce HAU.
View details for DOI 10.1080/20008198.2021.1888541
View details for Web of Science ID 000661272300001
View details for PubMedID 34178292
View details for PubMedCentralID PMC8205011
Evaluation of an integrated intervention to reduce psychological distress and intimate partner violence in refugees: Results from the Nguvu cluster randomized feasibility trial.
2021; 16 (6): e0252982
INTRODUCTION: The complex relationship between intimate partner violence and psychological distress warrants an integrated intervention approach. In this study we examined the relevance, acceptability, and feasibility of evaluating a multi-sectoral integrated violence- and mental health-focused intervention (Nguvu).METHODS: We enrolled 311 Congolese refugee women from Nyarugusu refugee camp in Tanzania with past-year intimate partner violence and elevated psychological distress in a feasibility cluster randomized trial. Women were recruited from local women's groups that were randomized to the Nguvu intervention or usual care. Participants from women's groups randomized to Nguvu received 8 weekly sessions delivered by lay refugee incentive workers. Psychological distress, intimate partner violence, other wellbeing, and process indicators were assessed at baseline and 9-weeks post-enrollment to evaluate relevance, acceptability, and feasibility of implementing and evaluating Nguvu in refugee contexts.RESULTS: We found that Nguvu was relevant to the needs of refugee women affected by intimate partner violence. We found reductions in some indicators of psychological distress, but did not identify sizeable changes in partner violence over time. Overall, we found that Nguvu was acceptable and feasible. However, challenges to the research protocol included baseline imbalances between study conditions, differential intervention completion related to intimate partner violence histories, differences between Nguvu groups and facilitators, and some indication that Nguvu may be less beneficial for participants with more severe intimate partner violence profiles.CONCLUSIONS: We found evidence supporting the relevance of Nguvu to refugee women affected by partner violence and psychological distress and moderate evidence supporting the acceptability and feasibility of evaluating and implementing this intervention in a complex refugee setting. A definitive cluster randomized trial requires further adaptations for recruitment and eligibility screening, randomization, and retention.TRIAL REGISTRATION: ISRCTN65771265, June 27, 2016.
View details for DOI 10.1371/journal.pone.0252982
View details for PubMedID 34143803
Refinement and Pilot Testing of a Brief, Early Intervention for PTSD and Alcohol Use Following Sexual Assault
COGNITIVE AND BEHAVIORAL PRACTICE
2020; 27 (4): 470–86
View details for Web of Science ID 000604754200010
Refinement and Pilot Testing of a Brief, Early Intervention for PTSD and Alcohol Use Following Sexual Assault.
Cognitive and behavioral practice
2020; 27 (4): 470-486
Experiencing a sexual assault can have long-lasting negative consequences including development of posttraumatic stress disorder (PTSD) and alcohol misuse. Intervention provided in the initial weeks following assault can reduce the development of these chronic problems. This study describes the iterative treatment development process for refining a brief intervention targeting PTSD and alcohol misuse for women with recent sexual assault experiences. Experts, treatment providers, and patients provided feedback on the intervention materials and guided the refinement process. Based on principles of cognitive change, the final intervention consists of one in-person session and four coaching calls targeting beliefs about the assault and about drinking behavior. Initial feasibility and acceptability data are presented for patients enrolled in an open trial (N = 6). The intervention was rated as helpful, not distressing, and interesting by patients and all patients completed the entire treatment protocol. A large decrease in PTSD symptoms pre- to post-intervention was observed. A small effect on decreasing alcohol consequences also emerged, although drinks consumed per week showed a slight increase, not a decrease, over the course of the intervention. Applications of this intervention and next steps for testing efficacy are presented.
View details for DOI 10.1016/j.cbpra.2019.10.003
View details for PubMedID 34168421
Social interaction anxiety and perceived coping efficacy: Mechanisms of the association between minority stress and drinking consequences among sexual minority women.
Sexual minority women (SMW; individuals who identify as women and as lesbian, bisexual, or with another sexual minority identity) are at increased risk for problematic alcohol use compared to their heterosexual counterparts. This increased risk has been attributed to minority stress. However, longitudinal research examining associations between minority stress and alcohol use outcomes is extremely limited and examinations of these associations at the daily level are nearly non-existent. Further, few longitudinal studies have examined mechanisms through which minority stress may impact alcohol use. We utilized data from a 14-day daily diary study of 98 SMW to examine daily-level associations between experiences of minority stress, alcohol consumption and consequences, and two proposed mediators of these associations (perceived coping efficacy, social interaction anxiety). Results indicated that on days when participants experienced minority stress events, they experienced lower coping efficacy, higher social interaction anxiety, and more drinking consequences than usual. Minority stress was not associated with same-day alcohol consumption. Perceived coping efficacy and social interaction anxiety mediated the same-day association between minority stress and drinking consequences. No prospective associations were significant, suggesting that studies with multiple assessments per day may be necessary to detect immediate effects of minority stress. Findings highlight the potential impact of daily experiences of minority stress on alcohol consequences and provide evidence that two general psychological processes may be mechanisms through which minority stress impacts alcohol consequences. These results provide evidence of a need for interventions that teach SMW skills for coping with minority stress and its psychological consequences.
View details for DOI 10.1016/j.addbeh.2020.106718
View details for PubMedID 33131969
Discussing substance use with clients during the COVID-19 pandemic: A motivational interviewing approach.
Psychological trauma : theory, research, practice and policy
During the COVID-19 pandemic, trauma-exposed individuals may have heightened risk for substance use. Using substances to cope may contribute to the development of problematic substance use over time. It is imperative to initiate conversations about substance use with clients during this time and motivational interviewing offers an ideal framework for doing so. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
View details for DOI 10.1037/tra0000764
View details for PubMedID 32525386
Cognitive Processing Therapy for Posttraumatic Stress Disorder via Telehealth: Practical Considerations During the COVID-19 Pandemic.
Journal of traumatic stress
The global outbreak of COVID-19 has required mental health providers to rapidly rethink and how they provide care. Cognitive processing therapy (CPT) is a trauma-focused, evidence-based treatment for posttraumatic stress disorder that is effective when delivered in-person or via telehealth. Given current limitations on the provision of in-person mental health treatment during the COVID-19 pandemic, this article presents guidelines and treatment considerations when implementing CPT via telehealth. Based on lessons learned from prior studies and clinical delivery of CPT via telehealth, recommendations are made with regard to overall strategies for adapting CPT to a telehealth format, including how to conduct routine assessments and ensure treatment fidelity. This article is protected by copyright. All rights reserved.
View details for DOI 10.1002/jts.22544
View details for PubMedID 32400911
Stressors and Drinking in Sexual Minority Women: The Mediating Role of Emotion Dysregulation.
Psychology of sexual orientation and gender diversity
2020; 7 (1): 46–54
Sexual minority women are at elevated risk for exposure to stressors (both traumatic and discriminatory) and have higher rates of alcohol consumption and problems. The psychological mediation framework (Hatzenbuehler, 2009) suggests that both general (e.g., traumatic events to which minorities and nonminorities may be exposed) and minority-group-specific (e.g., discrimination) stressors contribute to psychopathology through mediators such as emotion dysregulation. Guided by this framework, the present study longitudinally examined the relationship between stressors and problematic drinking outcomes (i.e., binge drinking and alcohol-related problems), as mediated by emotion dysregulation, in sexual minority women (SMW). It addressed two research questions: (1) whether stressors longitudinally predict problematic drinking outcomes in SMW, as mediated by emotion dysregulation, and (2) for which specific forms of stressor (i.e., traumatic events and/or discrimination) this mediational relationship is present. Young adult women (N = 1057) who identified as lesbian or bisexual completed annual measures of daily heterosexism, traumas, and drinking outcomes for four years, and completed a measure of emotion dysregulation during the third year of data collection. We found an indirect relationship between discrimination and problematic drinking outcomes via emotion dysregulation. These findings are consistent with the psychological mediation framework (Hatzenbuehler, 2009) and suggest that SMW group-specific processes such as discrimination may be especially important in conferring risk for problem drinking via emotion dysregulation. Clinicians are advised to assess unique stressors faced by SMW and their potential contribution to problematic drinking outcomes, and to target emotion dysregulation in alcohol treatments.
View details for DOI 10.1037/sgd0000351
View details for PubMedID 32596411
Best Practices for Approaching Cognitive Processing Therapy and Prolonged Exposure During the COVID-19 Pandemic.
Journal of traumatic stress
The COVID-19 pandemic presents major challenges for mental health care providers. In particular, providers who treat posttraumatic stress disorder (PTSD) are now tasked with determining whether to initiate trauma-focused therapy during the pandemic and, if so, whether and how to adapt treatment. The purpose of this communication is to identify and organize key considerations for whether and how to deliver commonly used evidence-supported therapy protocols for trauma treatment-specifically, cognitive processing therapy (CPT) and prolonged exposure (PE) therapy-during the ongoing COVID-19 pandemic for adults who currently meet the criteria for PTSD. Based on relevant public health and clinical literature, we present a structured guide that can be used by treatment teams and individual providers to evaluate whether initiating CPT or PE is indicated given a particular patient-provider pair and system context amidst pandemic conditions. In addition, we suggest appropriate action steps, including problem-solving strategies, evidence-informed modifications to CPT and PE, and alternative intervention approaches.
View details for DOI 10.1002/jts.22583
View details for PubMedID 32865850
- Cognitive Processing Therapy Effective treatments for PTSD: Practice guidelines from the International Society for Traumatic Stress Studies edited by Forbes, D., Bisson, J. I., Monson, C. M., Berliner, L. Guilford. 2020; 3rd: 210–233
Daily relationships between posttraumatic stress symptoms, drinking motives, and alcohol consumption in trauma-exposed sexual minority women.
Psychology of addictive behaviors : journal of the Society of Psychologists in Addictive Behaviors
Objective: Sexual minority women (SMW) evidence elevated rates of trauma exposure, posttraumatic stress (PTS), and alcohol consumption. Self-medication models of drinking suggest that individuals may drink to cope with symptoms of PTS, but this possibility remains untested among SMW. Method: The current study used data from drinking days collected via daily diary assessments from 81 trauma-exposed SMW. Participants were mostly White (72.8%) and ranged in age from 18 to 25 (M = 23.8). Participants were followed over 2 14-consecutive-day measurement bursts (720 person-days reported). Analyses were conducted to examine whether coping drinking motives (vs. social, enhancement, and conformity drinking motives), as assessed by an adapted Drinking Motives Questionnaire, mediated the daily level relationship between PTS symptoms (assessed by the PTSD Checklist) and the number of standard drinks per drinking day. Results: Results from multilevel structural equation models indicated that day-to-day fluctuations in PTS symptoms, as well as average levels of PTS symptoms, were associated with increased coping drinking motives. Coping drinking motives, but not other drinking motives, mediated within-person associations between PTS and drinking, such that daily fluctuations in PTS symptoms were associated with stronger-than-normal coping drinking motives, which in turn predicted more drinks per drinking day. Conclusions: Results highlight the importance of coping drinking motives and suggest that alternative coping strategies may help trauma-exposed SMW to manage heightened PTS symptoms without increasing their alcohol consumption. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
View details for DOI 10.1037/adb0000680
View details for PubMedID 33030918
Prevalence and Factor Structure of PTSD in DSM-5 Versus DSM-IV in a National Sample of Sexual Minority Women.
Journal of interpersonal violence
The impact of changes to posttraumatic stress disorder (PTSD) diagnostic criteria from Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) to Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) within diverse communities is unclear. Young adult sexual minority women are at high risk for interpersonal violence and other forms of trauma exposure compared with heterosexual populations and sexual minority men. They are also at heightened risk of PTSD. As a result, young adult sexual minority women are a key population of interest when examining the impact of diagnostic criteria changes. The goal of the current study was to evaluate the impact of changes to PTSD diagnostic criteria in sexual minority women. Using an online survey, we administered both the original PTSD Symptom Checklist-S (based on DSM-IV criteria) and a version adapted to assess DSM-5 criteria to a national, nonclinical sample of young adult sexual minority women (N = 767). The DSM-5 symptom criteria fit the data well in confirmatory factor analysis. Current PTSD prevalence was higher under the DSM-5 diagnostic algorithm compared with DSM-IV (18.6% vs. 22.9%; d = 0.15). Compared with DSM-IV, associations between PTSD and depression were stronger using DSM-5 criteria, whereas associations between PTSD and high-risk drinking were reduced. Findings suggest that changes to PTSD diagnostic criteria do not have a major impact on prevalence of PTSD among sexual minority women but may have some impact on observed comorbidities.
View details for DOI 10.1177/0886260519892960
View details for PubMedID 31833796
Changes in Sexual Identity and Associations With Alcohol Use and Depression Among Young Adult Sexual Minority Women.
Journal of studies on alcohol and drugs
2019; 80 (6): 623–30
OBJECTIVE: Sexual minority women report more problematic alcohol use and depression than heterosexual women. Despite evidence that sexual identity can change over time, most studies treat it as a static construct. As a result, little is known about the extent to which changes in sexual identity influence alcohol use and depression. The current study examined (a) changes in sexual identity over 36 months, (b) the associations between the number of changes in sexual identity and measures of alcohol use (typical weekly alcohol consumption, peak drinking, and alcohol-related consequences) and depression at the final assessment, and (c) baseline sexual identity as a moderator of the associations.METHOD: The analyses used four waves of data from a national U.S. sample of sexual minority women ages 18-25 (n = 1,057).RESULTS: One third (34%) of participants reported at least one change in sexual identity over the course of the study. The number of changes in sexual identity was positively associated with typical weekly alcohol consumption and depression but was not significantly associated with peak drinking or alcohol-related consequences. None of the associations were moderated by baseline sexual identity.CONCLUSIONS: These findings provide additional evidence that sexual identity continues to change over time for a sizeable proportion of young adult sexual minority women and these changes are relevant to their health and well-being.
View details for PubMedID 31790352
Study to Promote Innovation in Rural Integrated Telepsychiatry (SPIRIT): Rationale and design of a randomized comparative effectiveness trial of managing complex psychiatric disorders in rural primary care clinics.
Contemporary clinical trials
OBJECTIVE: Managing complex psychiatric disorders like PTSD and bipolar disorder is challenging in Federally Qualified Health Centers (FQHCs) delivering care to U.S residents living in underserved rural areas. This protocol paper describes SPIRIT, a pragmatic comparative effectiveness trial designed to compare two approaches to managing PTSD and bipolar disorder in FQHCs.INTERVENTIONS: Treatment comparators are: 1) Telepsychiatry Collaborative Care, which integrates consulting telepsychiatrists into primary care teams, and 2) Telepsychiatry Enhanced Referral, where telepsychiatrists and telepsychologists treat patients directly.METHODS: Because Telepsychiatry Enhanced Referral is an adaptive intervention, a Sequential, Multiple Assignment, Randomized Trial design is used. Twenty-four FQHC clinics without on-site psychiatrists or psychologists are participating in the trial. The target sample is 1000 patients screening positive for PTSD and/or bipolar disorder who are not already engaged in pharmacotherapy with a mental health specialist. Intervention fidelity is measured but not controlled. Patient treatment engagement is measured but not required, and intent-to-treat analysis will be used. Survey questions measure treatment engagement and effectiveness. The Short-Form 12 Mental Health Component Summary (SF-12 MCS) is the primary outcome.RESULTS: To date, 34% of those enrolled (n = 924) are racial/ethnic minorities, 82% are not fully employed, 68% are Medicaid enrollees, 7% are uninsured, and 62% live in poverty. Mental health related quality of life (SF-12 MCS) is 2.5 standard deviations below the national mean.DISCUSSION: We hypothesize that patients randomized to Telepsychiatry Collaborative Care will have better outcomes than those randomized to Telepsychiatry Enhanced Referral because a higher proportion will engage in evidence-based treatment.
View details for DOI 10.1016/j.cct.2019.105873
View details for PubMedID 31678410
- Growing Up, Hooking Up, and Drinking: A Review of Uncommitted Sexual Behavior and Its Association With Alcohol Use and Related Consequences Among Adolescents and Young Adults in the United States FRONTIERS IN PSYCHOLOGY 2019; 10
Growing Up, Hooking Up, and Drinking: A Review of Uncommitted Sexual Behavior and Its Association With Alcohol Use and Related Consequences Among Adolescents and Young Adults in the United States.
Frontiers in psychology
2019; 10: 1872
Hookups are uncommitted sexual encounters that range from kissing to intercourse and occur between individuals in whom there is no current dating relationship and no expressed or acknowledged expectations of a relationship following the hookup. Research over the last decade has begun to focus on hooking up among adolescents and young adults with significant research demonstrating how alcohol is often involved in hooking up. Given alcohol's involvement with hooking up behavior, the array of health consequences associated with this relationship, as well as its increasing prevalence from adolescence to young adulthood, it is important to determine the predictors and consequences associated with alcohol-related hooking up. The current review extends prior reviews by adding more recent research, including both qualitative and experimental studies (i.e., expanding to review more diverse methods), research that focuses on the use of technology in alcohol-related hookups (i.e., emerging issues), further develops prevention and intervention potentials and directions, and also offers a broader discussion of hooking up outside of college student populations (i.e., expanding generalization). This article will review the operationalization and ambiguity of the phrase hooking up, the relationship between hooking up and alcohol use at both the global and event levels, predictors of alcohol-related hooking up, and both positive and negative consequences, including sexual victimization, associated with alcohol-related hookups. Throughout, commentary is provided on the methodological issues present in the field, as well as limitations of the existing research. Future directions for research that could significantly advance our understanding of hookups and alcohol use are provided.
View details for DOI 10.3389/fpsyg.2019.01872
View details for PubMedID 31551844
View details for PubMedCentralID PMC6736570
Are trauma memories state-dependent? Intrusive memories following alcohol-involved sexual assault.
European journal of psychotraumatology
2019; 10 (1): 1634939
Background: Sexual assault (SA) frequently occurs under the influence of alcohol, and is often followed by both drinking and posttraumatic stress symptoms, including intrusive memories. Although many theories attempt to explain the co-occurrence of alcohol use and posttraumatic stress, one possibility not yet considered is that SA memories may be more likely to occur when there is an encoding-retrieval match in alcohol intoxication state. Objective: The aim of this study was to examine the potential for intrusive memories of SA to be state-dependent, such that intrusive memories for alcohol-involved SA may be more likely to occur in the context of subsequent alcohol intoxication. Method: Participants were 100 college women (age range = 18 to 24 years; 73% White/Caucasian, 89% heterosexual) with a history of alcohol-involved SA (67%) or other, non-alcohol-involved SA (33%). Participants completed daily questionnaires for 30 days assessing past-day drinking and intrusion symptoms. Results: A random-intercept, negative binomial multilevel model revealed that, after controlling for overall frequency of drinking and perceived threat during SA, women with a history of alcohol-involved SA reported more severe intrusion symptoms on drinking days than on non-drinking days. No such difference in intrusions was observed for women who were not intoxicated at the time of the assault. Conclusions: Findings are consistent with the possibility of state-dependent intrusive memories. Additional research is needed to determine whether alcohol intoxication might serve as a discriminative cue preceding intrusive memories of alcohol-involved SA.
View details for DOI 10.1080/20008198.2019.1634939
View details for PubMedID 31448064
View details for PubMedCentralID PMC6691878
Determinants of Trauma-Related Mental Health Problems and Recovery in Refugees and Migrants
TAYLOR & FRANCIS LTD. 2019
View details for Web of Science ID 000473714500096
Trauma-Focused Therapies in the Treatment of Comorbid PTSD and Substance Use Disorders
TAYLOR & FRANCIS LTD. 2019
View details for Web of Science ID 000473714500163
Cognitive Processing Therapy and Relapse Prevention in the Treatment of PTSD and Comorbid Alcohol Use Disorders
TAYLOR & FRANCIS LTD. 2019
View details for Web of Science ID 000473714500166
Clinical presentations, social functioning, and treatment receipt among individuals with comorbid life-time PTSD and alcohol use disorders versus drug use disorders: findings from NESARC-III
2019; 114 (6): 983–93
To compare individuals with comorbid life-time post-traumatic stress disorder (PTSD) and alcohol use disorders [AUD; i.e. no drug use disorders (DUD)] with those with comorbid PTSD and DUD on past-year prevalence of these disorders, social functioning, life-time psychiatric comorbidities, and treatment receipt. The comorbid groups were also compared with their single diagnosis counterparts.Cross-sectional cohort study using data from the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC-III).The total sample size was 36 309. Six groups were established: PTSD/AUD, PTSD/DUD, AUD, DUD, PTSD, and neither PTSD nor AUD/DUD. Life-time prevalence of AUD among those with PTSD/DUD was 80.2% and among those with DUD was 73.8%.The Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-5 version assessed life-time and past-year psychiatric disorders and treatment receipt. Demographics and social stability indicators were queried. Group characteristics were summarized using weighted means. Prevalences and estimates for adjusted differences in means and adjusted odds ratios (aORs) were derived from multiple linear regression and logistic regression models, respectively. Analyses were conducted in R and accounted for the NESARC-III's complex survey design, clustering, and non-response.Compared with those with life-time PTSD/AUD, those with life-time PTSD/DUD were significantly less likely to have neither disorder in the past year (PTSD/AUD = 16.1%; PTSD/DUD = 8.5%; aOR = 0.54), and were more likely to report worse social and psychiatric functioning, and to have received both addiction and mental health treatment (PTSD/AUD = 18.4%; PTSD/DUD = 43.2%; aOR = 3.88). Compared with their single disorder counterparts, those with PTSD/DUD reported greater impairment than both groups, whereas the comorbid PTSD/AUD group differed more from the AUD than the PTSD group.People with comorbid PTSD and drug use disorder have greater social and psychiatric impairment and may require different types and intensity of intervention than people with comorbid post-traumatic stress disorder and alcohol use disorder.
View details for DOI 10.1111/add.14565
View details for Web of Science ID 000467577800004
View details for PubMedID 30694592
Provider Fidelity and Modifications to Cognitive Processing Therapy in a Diverse Community Health Clinic: Associations With Clinical Change
JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY
2019; 87 (4): 357–69
The purpose of this study is to examine associations between therapist adherence, competence, and modifications of an evidence-based protocol (EBP) delivered in routine clinical care and client outcomes.Data were derived from a NIMH-funded implementation-effectiveness hybrid study of Cognitive Processing Therapy (CPT) for PTSD in a diverse community health center. Providers (n = 19) treated clients (n = 58) as part of their routine clinical care. Clients completed the PCL-S and PHQ-9 at baseline, after each CPT session, and posttreatment. CPT sessions were rated for treatment fidelity and therapist modifications.Overall, therapist adherence was high, although it decreased across sessions suggesting potential drift. Therapist competence ratings varied widely. Therapists made on average 1.6 fidelity-consistent and 0.4 fidelity-inconsistent modifications per session. Results show that higher numbers of fidelity-consistent modifications were associated with larger reductions in posttraumatic stress and depressive symptoms. High adherence ratings were associated with greater reductions in depressive symptoms, whereas higher competence ratings were associated with greater reduction in posttraumatic stress symptoms.The results highlight the importance of differentially assessing therapist adherence, competence, and modifications to EBP in usual care settings. The findings also suggest that effective EBP delivery in routine care may require minor adaptations to meet client needs, consistent with previous studies. Greater attention to fidelity and adaptation can enhance training so providers can tailor while retaining core components of the intervention. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
View details for DOI 10.1037/ccp0000384
View details for Web of Science ID 000461486100004
View details for PubMedID 30883163
View details for PubMedCentralID PMC6430611
Evaluating Personalized Feedback Intervention Framing with a Randomized Controlled Trial to Reduce Young Adult Alcohol-Related Sexual Risk Taking
2019; 20 (3): 310–20
The purpose of this study was to evaluate personalized feedback intervention (PFI) framing with two web-delivered PFIs aimed to reduce young adult alcohol-related risky sexual behavior (RSB). Combined PFIs typically use an additive approach whereby independent components on drinking and components on RSB are presented without the discussion of the influence of alcohol on RSB. In contrast, an integrated PFI highlights the RSB-alcohol connection by presenting integrated alcohol and RSB components that focus on the role of intoxication as a barrier to risk reduction in sexual situations. In a randomized controlled trial, 402 (53.98% female) sexually active young adults aged 18-25 were randomly assigned to a combined PFI, an integrated PFI, or attention control. All assessment and intervention procedures were web-based. At the 1-month follow-up, those randomly assigned to the integrated condition had a lower likelihood of having any casual sex partners compared to those in the control group. At the 6-month follow-up, the combined condition had a lower likelihood of having any casual sex partners compared to those in the control group. When examining alcohol-related RSB, at the 1-month follow-up, both interventions showed a lower likelihood of any drinking prior to sex compared to the control group. When examining alcohol-related sexual consequences, results showed a reduction in the non-zero count of consequences in the integrated condition compared to the control at the 1-month follow-up. For typical drinks per week, those in the combined condition showed a greater reduction in the non-zero count of drinks than those in the control condition at the 1-month follow-up. While there were no significant differences between the two interventions, the current findings highlight the utility of two efficacious web-based alcohol and RSB interventions among a national sample of at-risk young adults.
View details for DOI 10.1007/s11121-018-0879-4
View details for Web of Science ID 000466220100003
View details for PubMedID 29511966
View details for PubMedCentralID PMC6127012
- Use of Prolonged Exposure and Sertraline in the Treatment of Posttraumatic Stress Disorder for Veterans JAMA PSYCHIATRY 2019; 76 (2): 109–10
Self-control, implicit alcohol associations, and the (lack of) prediction of consumption in an alcohol taste test with college student heavy episodic drinkers
2019; 14 (1): e0209940
The high levels of problematic drinking in college students make clear the need for improvement in the prediction of problematic drinking. We conducted a laboratory-based experiment that investigated whether implicit measures of alcohol-related associations, self-control, and their interaction predicted drinking. Although a few studies have evaluated self-control as a moderator of the relationship between implicit measures of alcohol-related associations and drinking, this study extended that work by using a previously-validated manipulation that included a more (vs. less) cognitively demanding task and incentive to restrain drinking and by evaluating multiple validated measures of alcohol-related associations. Experimental condition was expected to moderate the relationship between implicit measures of alcohol-related associations and drinking, with a more positive relationship between alcohol-related associations and drinking among participants who completed the more (vs. less) cognitive demanding task. Secondary aims were to evaluate how individual differences in control factors (implicit theories about willpower and working memory capacity) might further moderate those relationships. One hundred and five U.S. undergraduate heavy episodic drinkers completed baseline measures of: drinking patterns, three Implicit Association Tests (evaluating drinking identity, alcohol excite, alcohol approach associations) and their explicit measure counterparts, implicit theories about willpower, and working memory capacity. Participants were randomized to complete a task that was more (vs. less) cognitively demanding and were given an incentive to restrain their drinking. They then completed an alcohol taste test. Results were not consistent with expectations. Despite using a previously validated manipulation, there was no evidence that one condition was more demanding than the other, and none of the predicted interactions reached statistical significance. The findings raise questions about the relation between self-control, implicit measures of alcohol-related associations, and drinking, as well as the conditions under which implicit measures of alcohol-related associations predict alcohol consumption in the laboratory.
View details for DOI 10.1371/journal.pone.0209940
View details for Web of Science ID 000455359400065
View details for PubMedID 30625204
View details for PubMedCentralID PMC6326486
- Are trauma memories state-dependent? Intrusive memories following alcohol-involved sexual assault EUROPEAN JOURNAL OF PSYCHOTRAUMATOLOGY 2019; 10 (1)
Application of Evidence-Based Practices for Trauma-Related Disorders Among Sexual Minority Women
Handbook of Evidence-Based Mental Health Practice with Sexual and Gender Minorities Find at OUP.com Google Preview Handbook of Evidence-Based Mental Health Practice with Sexual and Gender Minorities
edited by Pachankis, J. E.
Oxford University Press. 2019: 244–267
View details for DOI 10.1093/med-psych/9780190669300.003.0011
- New Directions in PTSD and Substance Use Treatment: Leveraging Technology to Expand Reach. Posttraumatic Stress and Substance Use Disorders edited by Back, S., Vujanovic, A. Routledge. 2019; 1st: 326–346
Understanding PTSD and sexual assault
Handbook of Sexual Assault and Sexual Assault Prevention
edited by O'Donohue, W., Cummings, C., Schewe, P.
Springer. 2019: 293–307
View details for DOI 10.1007/978-3-030-23645-8_17
Prospective Risk for Incapacitated Rape among Sexual Minority Women: Hookups and Drinking.
Journal of sex research
Sexual minority women (SMW), including lesbian and bisexual women, are at greater risk for heavy drinking and sexual victimization than heterosexual women. Risk factors for alcohol-related sexual victimization, such as incapacitated rape (IR), include frequent heavy drinking and hookups among heterosexual women, but it is less clear whether these risk factors extend to SMW. This current study was designed to address this gap. In a national sample of SMW (N = 1,057), logistic regressions were used to test whether heavy drinking and hookups in the first year of the study were risk factors for IR during the second year. After controlling for history of prior sexual victimization, subsequent IR was predicted by an interaction between heavy drinking and the number of male hookup partners. Specifically, more frequent heavy drinking was associated with increased risk for subsequent IR, but only among SMW who reported more than one male hookup partner, indicating exposure to more potential perpetrators. When examined separately, this finding held for bisexual women, but was not significant for lesbian women, likely because they reported fewer male hookup partners. Overall, findings from this longitudinal study highlight that in combination, heavy drinking and hookups with multiple men elevate risk for IR.
View details for DOI 10.1080/00224499.2019.1661949
View details for PubMedID 31556751
Developing an integrated intervention to address intimate partner violence and psychological distress in Congolese refugee women in Tanzania.
Conflict and health
2019; 13: 38
Multi-sectoral, integrated interventions have long been recommended for addressing mental health and its social determinants (e.g., gender-based violence) in settings of ongoing adversity. We developed an integrated health and protection intervention to reduce psychological distress and intimate partner violence (IPV), and tested its delivery by lay facilitators in a low-resource refugee setting.Formative research to develop the intervention consisted of a structured desk review, consultation with experts and local stakeholders (refugee incentive workers, representatives of humanitarian agencies, and clinical experts), and qualitative interviews (40 free list interviews with refugees, 15 key informant interviews). Given existing efforts by humanitarian agencies to prevent gender-based violence in this particular refugee camp, including with (potential) perpetrators, we focused on a complementary effort to develop an integrated intervention with potential to reduce IPV and associated mental health impacts with female IPV survivors. We enrolled Congolese refugee women with elevated psychological distress and past-year histories of IPV (n = 60) who received the intervention delivered by trained and supervised lay refugee facilitators. Relevance, feasibility and acceptability of the intervention were evaluated through quantitative and qualitative interviews with participants. We assessed instrument test-retest reliability (n = 24), inter-rater reliability (n = 5 interviews), internal consistency, and construct validity (n = 60).We designed an 8-session intervention, termed Nguvu ('strength'), incorporating brief Cognitive Processing Therapy (focused on helping clients obtaining skills to overcome negative thoughts and self-perceptions and gain control over the impact these have on their lives) and Advocacy Counseling (focused on increasing autonomy, empowerment and strengthening linkages to community supports). On average, participants attended two-thirds of the sessions. In qualitative interviews, participants recommended adaptations to specific intervention components and provided recommendations regarding coordination, retention, safety concerns and intervention participation incentives. Analysis of the performance of outcome instruments overall revealed acceptable reliability and validity.We found it feasible to develop and implement an integrated, multi-sectoral mental health and IPV intervention in a refugee camp setting. Implementation challenges were identified and may be informative for future implementation and evaluation of multi-sectoral strategies for populations facing ongoing adversity.ISRCTN65771265, June 27, 2016.
View details for DOI 10.1186/s13031-019-0222-0
View details for PubMedID 31428190
View details for PubMedCentralID PMC6697920
Building a Tribal-Academic Partnership to Address PTSD, Substance Misuse, and HIV Among American Indian Women
HEALTH PROMOTION PRACTICE
2019; 20 (1): 48–56
To describe our partnership and research infrastructure development strategies and discuss steps in developing a culturally grounded framework to obtain data and identify a trauma-informed evidence-based intervention.We present funding strategies that develop and maintain the partnership and tools that guided research development. We share how a community research committee was formed and the steps taken to clarify the health concern and develop a culturally tailored framework. We present results from our needs/assets assessment that led to the selection of a trauma-informed intervention. Finally, we describe the agreements and protocols developed.We produced a strong sustainable research team that brought program and research funding to the community. We created a framework and matrix of program objectives grounded in community knowledge. We produced preliminary data and research and publication guidelines that have facilitated program and research funding to address community-driven concerns.This study highlights the importance of bidirectional collaboration with American Indian communities, as well as the time and funding needed to maintain these relationships. A long-term approach is necessary to build a sustainable research infrastructure. Developing effective and efficient ways to build culturally based community research portfolios provides a critical step toward improving individual and community health outcomes.
View details for DOI 10.1177/1524839918762122
View details for Web of Science ID 000453548800009
View details for PubMedID 29506417
View details for PubMedCentralID PMC6119529
Examining the influence of gender and sexual motivation in college hookups
JOURNAL OF AMERICAN COLLEGE HEALTH
2018; 66 (8): 739–46
Hooking up is common in college, and has been linked to heavy drinking. Hookups have positive as well as negative consequences, and thus the motivations for hooking up are complex. Yet, little research has focused on these motivations. The present study examined the role that gender and drinking patterns play in the relationship between sexual motivation and penetrative hookups.Heavy drinking college students (N = 396) completed online surveys between September/October 2009.Sexual motivation, alcohol, and hooking up were assessed.Enhancement motives and drinking frequency predicted more frequent oral and vaginal sex when hooking up, while peer and partner motives predicted anal sex. Men endorsed greater enhancement motives, peer motives, and hookup oral and vaginal sex. For men, coping motives predicted oral and vaginal sex and peer motives predicted anal sex.Results provide greater insight into the reasons why college students engage in penetrative hookups.
View details for DOI 10.1080/07448481.2018.1440571
View details for Web of Science ID 000457889700004
View details for PubMedID 29447601
View details for PubMedCentralID PMC6093797
Subgroups of Young Sexual Minority Women Based on Drinking Locations and Companions and Links With Alcohol Consequences, Drinking Motives, and LGBTQ-Related Constructs
JOURNAL OF STUDIES ON ALCOHOL AND DRUGS
2018; 79 (5): 741–50
Sexual minority women (SMW; e.g., lesbians, bisexual women) are at increased risk for alcohol use disorders and related problems compared with heterosexual women. However, little is known about the social context in which drinking occurs in this high-risk population. This study used latent class analysis to identify subgroups of SMW based on drinking locations and companions and examined whether class membership was associated with consequences, drinking motives, and LGBTQ-related constructs (e.g., outness, discrimination).A sample of 670 SMW reported on alcohol use, drinking locations and companions, and related measures as part of a larger study on women's health.Based on SMW's patterns of responding to drinking locations and companions, latent class analysis identified five classes: Infrequent Drinking Contexts (10% of sample, reference class), Private/Intimate Drinking (28%), Convivial Drinking (29%), Alone/Convivial Drinking (20%), and Multiple Drinking Contexts (13%). Greater consequences were associated with greater odds of membership in the Convivial, Alone/Convivial, and Multiple Drinking Contexts classes relative to the Infrequent Drinking Contexts Class. Drinking motives were associated with class membership, although significant group comparisons varied by motive. Higher LGBTQ community involvement was associated with greater odds of membership in the Convivial, Alone/Convivial, and Multiple Drinking Contexts classes.Drinking classes paralleled those found in the literature on heterosexual individuals (e.g., public versus private contexts). Women in the Alone/Convivial and Multiple Drinking Contexts classes may be at particular risk. The context within which SMW drink may be a useful way to identify women at highest risk for problematic drinking.
View details for DOI 10.15288/jsad.2018.79.741
View details for Web of Science ID 000454776100013
View details for PubMedID 30422788
View details for PubMedCentralID PMC6240013
Sexual Identity of Drinking Companions, Drinking Motives, and Drinking Behaviors Among Young Sexual Minority Women: An Analysis of Daily Data
PSYCHOLOGY OF ADDICTIVE BEHAVIORS
2018; 32 (5): 540–51
Research has indicated that sexual minority women (SMW) drink more than do their heterosexual counterparts. Minority stress theory postulates that this increased drinking is motivated by efforts to modulate distress related to minority status, highlighting the potential importance of coping and enhancement drinking motives. Social learning theory postulates that SMW are motivated to drink more because their social companions model drinking behavior and convey social norms regarding appropriate alcohol consumption, suggesting that socialization and conformity motives may be important. The degree to which different motives for drinking affect SMW's alcohol consumption may depend in part on whether SMW drink with other sexual minorities, but this has not been investigated. This study examined daily data across 2 separate 14-day bursts to understand associations among daily drinking motives, the sexual identity of drinking companions, and alcohol consumption among 67 young SMW who reported on 553 social drinking days. On days when SMW had higher than typical socialization and enhancement motives, they tended to drink more, and SMW who typically had higher coping motives tended to drink more on any given day. Further, higher than typical enhancement motives were associated with heavier drinking on days when SMW drank with only heterosexual companions, relative to days when they drank with only sexual minority companions or in mixed sexual-identity groups. SMW's typical conformity motives were more strongly related to drinking on days when SMW drank in mixed sexual-identity groups relative to heterosexual companions only. These results indicate that SMW's drinking motives and drinking companions may be important targets for future research and intervention. (PsycINFO Database Record
View details for DOI 10.1037/adb0000384
View details for Web of Science ID 000439908900005
View details for PubMedID 30047754
View details for PubMedCentralID PMC6063518
Evaluating Within-Person Change in Implicit Measures of Alcohol Associations: Increases in Alcohol Associations Predict Increases in Drinking Risk and Vice Versa
ALCOHOL AND ALCOHOLISM
2018; 53 (4): 386–93
Implicit measures of alcohol associations (i.e. measures designed to assess associations that are fast/reflexive/impulsive) have received substantial research attention. Alcohol associations related to the self (drinking identity), the effects of alcohol (alcohol excite) and appetitive inclinations (alcohol approach) have been found to predict drinking cross-sectionally and over time. A critical next step in this line of research and the goal of this study is to evaluate whether increases in the strength of these associations predict increases in drinking and vice versa. These hypotheses were tested in a sample of first- and second-year US university students: a sample selected because this time period is associated with initiation and escalation of drinking, peak levels of alcohol consumption and severe alcohol-related negative consequences.This study's purpose was to evaluate whether increases in the strength of alcohol associations with the self (drinking identity), excitement (alcohol excite) and approach (alcohol approach) as assessed by implicit measures predicted subsequent increases in drinking risk and vice versa using a longitudinal, university student sample. Results were consistent with hypotheses.A sample of 506 students' (57% women) alcohol associations and alcohol consumption were assessed every 3 months over a 2-year period. Participants' consumption was converted to risk categories based on NIAAA's criteria: non-drinkers, low-risk drinkers and high-risk drinkers. A series of cross-lagged panel models tested whether changes in alcohol associations predicted subsequent change in drinking risk (and vice versa).Across all three measures of alcohol associations, increases in the strength of alcohol associations were associated with subsequent increases in drinking risk and vice versa.Results from this study indicate bi-directional relationships between increases in alcohol associations (drinking identity, alcohol excite and alcohol approach) and subsequent increases in drinking risk. Intervention and prevention efforts may benefit from targeting these associations.
View details for DOI 10.1093/alcalc/agy012
View details for Web of Science ID 000439653000006
View details for PubMedID 29506082
View details for PubMedCentralID PMC6016689
Mood Selectively Moderates the Implicit Alcohol Association-Drinking Relation in College Student Heavy Episodic Drinkers
PSYCHOLOGY OF ADDICTIVE BEHAVIORS
2018; 32 (3): 338–49
Multiple studies indicate that implicit alcohol-related associations (i.e., indices of relatively fast, spontaneous processes) predict drinking. An important next step is to investigate moderators of the implicit association-drinking relationship. Mood state has been proposed as a moderator of this relationship: implicit associations have been theorized to be stronger predictors of drinking under positive mood states. From the same theoretical perspective, explicit measures (indices of relatively slow, reflective processes) have been proposed to be stronger predictors of drinking under negative mood states. The current study evaluated these hypotheses by investigating whether mood state (manipulated via exposure to a brief video clip) moderated the relations between three types of implicit alcohol-related associations (alcohol excite, alcohol approach, and drinking identity), their explicit counterparts, and drinking in a taste test that included beer and soft drinks. A sample of 152 undergraduate social drinkers (81 men; 71 women) completed baseline measures of implicit alcohol-related associations, their explicit counterparts, and typical drinking behaviors. Participants then viewed a mood-state-inducing video clip (positive, neutral, or negative), and completed the taste test. Results were mixed but generally indicated that prediction of drinking by baseline implicit alcohol excite (but not alcohol approach or drinking identity) associations was moderated by mood. Specifically, implicit alcohol excite associations were more negatively associated with drinking after viewing the sad video and more positively associated with drinking after watching the happy/neutral video. Moderation was also observed for the explicit counterpart of alcohol excite. Findings are discussed in terms of models of negative reinforcement drinking. (PsycINFO Database Record
View details for DOI 10.1037/adb0000360
View details for Web of Science ID 000432373500009
View details for PubMedID 29771561
View details for PubMedCentralID PMC5962035
Predicting PTSD Severity From Experiences of Trauma and Heterosexism in Lesbian and Bisexual Women: A Longitudinal Study of Cognitive Mediators
JOURNAL OF COUNSELING PSYCHOLOGY
2018; 65 (3): 324–33
Sexual minority women (SMW) are at high risk of trauma exposure and, subsequently, the development of posttraumatic stress disorder (PTSD). The authors extended a theoretical model explaining the higher risk of mental disorders in minority populations to the maintenance and exacerbation of PTSD symptoms among young adult SMW specifically. This study used observational longitudinal data from a sample of 348 trauma-exposed 18- to 25-year-old individuals assigned female sex at birth who identified as either bisexual (60.1%) or lesbian (39.9%) and met screening criteria for PTSD. Participants identified as White (82.8%), Hispanic/Latina (12.4%), American Indian/Alaska Native (13.5%), Black/African American (13.8%), and/or Asian/Asian American (4.9%). The authors investigated whether distal stressors (i.e., criterion A traumatic events, daily experiences of heterosexism) produced proximal stressors (i.e., trauma-related cognitions, internalized heterosexism) that maintained or exacerbated PTSD symptoms. Findings indicated that daily heterosexism longitudinally predicted trauma-related cognitions (i.e., cognitions related to the self, world, and self-blame). Internalized heterosexism and cognitions about the self longitudinally predicted PTSD symptom severity. In addition, a significant indirect effect was identified between daily heterosexism and PTSD symptoms via self-related posttraumatic cognitions. These findings suggest that exposure to minority-specific distal stressors appears to promote nonminority-specific cognitive processes that, in turn, may maintain or exacerbate PTSD among young adult SMW exposed to trauma. Clinicians should consider addressing daily heterosexism in young adult SMW presenting with PTSD and evaluate how these experiences might promote clients' global, negative views regarding themselves. (PsycINFO Database Record
View details for DOI 10.1037/cou0000287
View details for Web of Science ID 000430378900005
View details for PubMedID 29672082
View details for PubMedCentralID PMC6020062
Bringing the "Bookmobile" model to mental health: Use of mobile therapists to extend access to cognitive processing therapy in Eastern Congo
BIOMED CENTRAL LTD. 2018
View details for Web of Science ID 000428649900003
Social support predicts reductions in PTSD symptoms when substances are not used to cope: A longitudinal study of sexual assault survivors
JOURNAL OF AFFECTIVE DISORDERS
2018; 229: 135–40
After sexual assault, many college women develop symptoms of posttraumatic stress disorder (PTSD), and those who engage in substance use coping are at heightened risk for this outcome. Positively-perceived social support has been identified as an important protective factor against the development of PTSD, but received social support could involve problematic behaviors-like the encouragement of coping through use of alcohol and/or drugs-that could worsen symptoms.In the current study, 147 undergraduate women with a lifetime history of sexual assault completed two waves of self-report measures assessing their symptoms. We test main and interaction effects for social support and substance use coping at baseline on PTSD symptoms one month later.Results suggest that social support is longitudinally associated with decreases in PTSD. Although substance use coping did not evidence a direct association with PTSD, the relationship between social support and PTSD was significantly weaker as substance use coping increased. Only support from friends (but not family members or a "special person") was associated with later PTSD, and this relationship was moderated by substance use coping.Substance use coping was assessed via a brief measure, and peer encouragement of coping by using alcohol and/or drugs was not directly assessed.Clinicians should consider ways to increase access to social support from friends in patients with PTSD and evaluate ways that substance use coping may interfere with social support's benefits.
View details for DOI 10.1016/j.jad.2017.12.042
View details for Web of Science ID 000424335600017
View details for PubMedID 29310061
View details for PubMedCentralID PMC5807183
Sociocultural and structural perpetuators of domestic violence in pregnancy: A qualitative look at what South Indian women believe needs to change
HEALTH CARE FOR WOMEN INTERNATIONAL
2018; 39 (2): 243–60
In India, reported rates of domestic violence rise as high as 31%. Abuse against pregnant women in India is associated with depressive and PTSD symptoms, and poor birth outcomes, yet no evidence-based interventions have been tested on this population. In this cross-sectional qualitative study, we sought perspective on South Indian women's concerns about abuse during pregnancy and what they believed would help. Participants cited economic dependence on husbands and sociocultural structures as factors perpetuating domestic violence. Women also described resilience factors that can protect against abuse. Our participants highlighted a requisite for interventions within health and social systems.
View details for DOI 10.1080/07399332.2017.1375505
View details for Web of Science ID 000428750000008
View details for PubMedID 28956725
Proximal relationships between social support and PTSD symptom severity: A daily diary study of sexual assault survivors
DEPRESSION AND ANXIETY
2018; 35 (1): 43–49
In cross-sectional studies, social support and posttraumatic stress disorder (PTSD) symptoms appear related, in that higher severity of PTSD is associated with lower social support and vice versa. Theoretical models of the causal direction of this relationship differ. Most longitudinal studies suggest that PTSD symptoms erode social support over time, although some suggest that higher social support is prospectively associated with decrease in PTSD symptom severity. It is unclear, though, how social support and PTSD affect each other in the short term. The purpose of this study was to test day-to-day relationships between PTSD and social support to elucidate how PTSD and social support influence each other.Using 1173 daily observations from 75 college women who met screening criteria for lifetime sexual assault and past-month PTSD, this study tested same-day and next-day relationships between PTSD and social support using mixed models.Within-person analyses indicated that, when PTSD was higher than usual on a given day, social support was higher the next day. Between-person analyses suggested that people with generally higher social support tended to have lower PTSD symptoms on a given day, but average PTSD symptom severity was not associated with day-to-day fluctuations in social support.Rather than eroding in response to daily symptoms, social support might be sought out following increases in PTSD, and when received consistently, might reduce symptoms of PTSD in the short term. Interventions that increase college women's access to social support after sexual assault may thus be helpful in addressing PTSD.
View details for DOI 10.1002/da.22679
View details for Web of Science ID 000419117000005
View details for PubMedID 28960606
View details for PubMedCentralID PMC5760275
Daily-level associations between PTSD and cannabis use among young sexual minority women
2017; 74: 118–21
Sexual minority women have elevated trauma exposure and prevalence of posttraumatic stress disorder (PTSD) compared to heterosexual women and they are also more likely to use cannabis, although no research has examined relationships between PTSD and cannabis use in this population. Daily-level methodologies are necessary to examine proximal associations between PTSD and use.This study included 90 trauma-exposed young adult women who identified as sexual minorities (34.4% identified as lesbian and 48.9% identified as bisexual) and evaluated daily-level associations between their PTSD symptoms and cannabis use. Participants were assessed at two measurement waves, one year apart, each consisting of 14 consecutive daily assessments.Cannabis use occurred on 22.8% of the days. Results from generalized linear mixed effects models showed that a person's mean level of PTSD symptom severity across days was strongly associated with same-day likelihood of cannabis use (OR=2.67 for 1 SD increase in PTSD score; p<0.001). However, daily deviation from one's average PTSD score was not associated with cannabis use on the same day.Findings suggest that PTSD severity may confer general risk for cannabis use, rather than being a state-dependent risk factor.
View details for DOI 10.1016/j.addbeh.2017.06.007
View details for Web of Science ID 000407536100018
View details for PubMedID 28618391
View details for PubMedCentralID PMC5538382
Effects of Trauma and PTSD on Self-Reported Physical Functioning in Sexual Minority Women
2017; 36 (10): 947–54
Sexual minority women (lesbians, bisexual women, and women who partner with women) experience high rates of trauma exposure, are more likely to develop posttraumatic stress disorder (PTSD), and have high rates of physical health problems compared with heterosexual women. The present study tested whether PTSD may be the mechanism through which trauma exposure affects self-reported physical functioning in this population.In a sample of 857 sexual minority women, we examined the association between trauma exposure and worsening physical functioning (measured using the 12-item Short Form Health Survey) 2 years later, whether PTSD mediated this relationship, and if so, which PTSD symptom clusters best accounted for this mediation.Results showed that more Criterion A traumatic events experienced (based on DSM-IV) predicted greater decline in physical functioning 2 years later, and PTSD symptoms mediated this relationship, explaining 73% of the total effect. The arousal/reactivity symptom cluster was the only significant mediator, explaining 68% of the total effect.Results show that PTSD, and arousal/reactivity symptoms in particular, may be the mechanism through which traumatic events negatively impact self-reported physical functioning. These findings provide further evidence that, for this at risk population, treating PTSD as soon as possible after onset may improve long term physical functioning. (PsycINFO Database Record
View details for DOI 10.1037/hea0000543
View details for Web of Science ID 000413337600003
View details for PubMedID 28825499
View details for PubMedCentralID PMC5620128
Effects of Sexual Assault on Alcohol Use and Consequences Among Young Adult Sexual Minority Women
JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY
2017; 85 (5): 424–33
The purpose of this study was to examine effects of sexual assault victimization on later typical alcohol use and alcohol-related consequences among young sexual minority women (SMW).Data were collected over 4 annual assessments from a national sample of 1,057 women who identified as lesbian or bisexual and were 18- to 25-years-old at baseline. Marginal structural modeling, an analytic approach that accounts for time-varying confounding through the use of inverse probability weighting, was used to examine effects of sexual assault and its severity (none, moderate, severe) on typical weekly number of drinks consumed and number of alcohol-related consequences 1-year later as well as 2-year cumulative sexual assault severity on alcohol outcomes at 36-month follow-up.Findings showed that compared with not experiencing any sexual assault, severe sexual assault at the prior assessment was associated with a 71% higher number of typical weekly drinks (count ratio [CR] = 1.71; 95% confidence interval [CI] [1.27, 2.31]) and 63% higher number of alcohol-related consequences (CR = 1.63; 95% CI [1.21, 2.20]). Effects were attenuated when comparing moderate to no sexual assault; however, the linear trend across sexual assault categories was statistically significant for both outcomes. There were also effects of cumulative levels of sexual assault severity over 2 years on increased typical drinking and alcohol-related consequences at end of follow-up.Sexual assault may be an important cause of alcohol misuse among SMW. These findings further highlight the need for strategies to reduce the risk of sexual assault among SMW. (PsycINFO Database Record
View details for DOI 10.1037/ccp0000202
View details for Web of Science ID 000399743700002
View details for PubMedID 28287804
View details for PubMedCentralID PMC5398947
Alcohol and Binge Eating as Mediators Between Posttraumatic Stress Disorder Symptom Severity and Body Mass Index
2017; 25 (4): 801–6
Sexual-minority women are at elevated risk for obesity, as well as exposure to traumatic events. Rates of obesity are elevated in individuals with posttraumatic stress disorder (PTSD), but little is known about why this relationship exists. Behavioral mechanisms, such as eating patterns and alcohol use, are possible explanations that would be clinically useful to identify.Binge eating and alcohol use were longitudinally investigated as mediators of the relationship between PTSD symptom severity and body mass index (BMI) in a large sample of young-adult, sexual-minority women (N = 425). PTSD symptom severity was assessed at baseline, binge eating and alcohol use were assessed 12 months later, and BMI was assessed 24 months after baseline.Using a multiple mediator model, higher baseline PTSD symptom severity was found to be significantly associated with higher BMI 2 years later, operating through binge-eating behavior but not through alcohol use. Exploratory moderator analyses found that this effect was higher for those with lower baseline BMI.Results suggest that higher PTSD symptoms are longitudinally associated with increased BMI and that binge eating behavior is one factor that explains this relationship.
View details for DOI 10.1002/oby.21809
View details for Web of Science ID 000400018600023
View details for PubMedID 28276646
View details for PubMedCentralID PMC5375022
- PTSD and Alcohol Associations Among Trauma-Exposed Women: Critical Questions for the Field CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2017; 24 (1): 23–26
Randomized Trial of Motivational Interviewing Plus Feedback for Soldiers With Untreated Alcohol Abuse
JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY
2017; 85 (2): 99–110
Alcohol use disorders (AUDs) are prevalent in the military and are a major public health concern. Although efficacious AUD interventions exist, few service members seek treatment. Army-specific barriers to AUD treatment include treatment being recorded on health records, command being notified of participation, and perceptions that seeking treatment would interfere with promotion or retention in the military. This study evaluated a telephone delivered motivational interviewing plus feedback (MIF) intervention designed to attract self-referral and reduce substance use from active-duty military with untreated AUD.A randomized controlled trial enrolled 242 Army personnel who met criteria for AUD according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed.) and who were not engaged in AUD treatment. Participants were screened and assessed at baseline, 1-week, and 3- and 6-month follow-ups. Participants were randomly assigned to receive 1 session of MIF or psychoeducation (control). All participation occurred over the telephone. Primary outcomes included number of drinks per week, substance use disorder (SUD) diagnosis and consequences, and treatment-seeking behavior.Generalized linear models were used to test group differences in drinking behaviors and substance use problems. Results indicated that all participants significantly reduced their drinking over time. MIF participants reported significantly fewer drinks per week than did control participants. Similarly, alcohol dependence diagnosis was marginally lower among MIF participants than control participants at the 6-month assessment. SUD treatment seeking significantly increased for both conditions.This novel adaptation of MIF shows promise for decreasing drinking and alcohol dependence among this high-risk sample of non-treatment-seeking soldiers and may complement existing AUD services already provided by the Army. (PsycINFO Database Record
View details for DOI 10.1037/ccp0000148
View details for Web of Science ID 000394993800002
View details for PubMedID 27736113
The Role of Context in the Implementation of Trauma-Focused Treatments: Effectiveness Research and Implementation in Higher and Lower Income Settings.
Current opinion in psychology
2017; 14: 61–66
In recent years, the implementation of trauma-focused treatments has expanded across settings that vary widely in the availability of resources, infrastructure, and personnel. The present review aims to inform researchers, policy makers, trainers, and administrators about this diverse range of research. Taking a global health perspective, this review of effectiveness trials and implementation studies compares strategies used in high-income countries to those in low- and medium-income countries. A primary difference between studies in high-income and low- and medium-income countries is the relative emphasis placed on fidelity or adaptation. Adaptations used in low- and medium-income countries might offer useful ideas for increasing the portability, impact, and accessibility of evidence-based interventions in high-income countries.
View details for PubMedID 28713852
A descriptive analysis of where and with whom lesbian versus bisexual women drink
JOURNAL OF GAY & LESBIAN MENTAL HEALTH
2017; 21 (4): 316–26
Sexual minority women (SMW) are at increased risk for alcohol use disorders and related problems. Social context (e.g., where and with whom one drinks) has been identified as an important factor associated with drinking behavior, but little is known about social context among SMW. An improved understanding of social context among SMW has the potential to inform efforts to reduce problematic drinking and its consequences in this high-risk population.We examined where and with whom SMW drink in a national sample recruited via social media (N = 1,057).SMW reported more frequent drinking in private locations (compared to public locations), with friends and romantic partners (compared to family members and strangers), and in locations with both heterosexuals and sexual minorities (compared to mostly or exclusively sexual minorities). Additionally, lesbians reported more frequent drinking in bars and in locations with more sexual minorities compared to bisexual women.Interventions to reduce problematic drinking among SMW may benefit from addressing social context.
View details for DOI 10.1080/19359705.2017.1353472
View details for Web of Science ID 000423989100004
View details for PubMedID 30505375
View details for PubMedCentralID PMC6261480
In-The-Moment Dissociation, Emotional Numbing, and Sexual Risk: The Influence of Sexual Trauma History, Trauma Symptoms, and Alcohol Intoxication
PSYCHOLOGY OF VIOLENCE
2016; 6 (4): 586–95
Prior research on the effects of sexual trauma has examined dissociation but not emotional numbing during sex and has relied exclusively on retrospective surveys. The present experiment examined associations among distal factors of childhood sexual abuse (CSA), adolescent/adult sexual assault (ASA), and trauma symptoms and the proximal factor of acute alcohol intoxication on in-the-moment dissociation, emotional numbing, and sexual risk intentions.Young adult female drinkers (N = 436) at elevated sexual risk were randomized to receive alcohol (target peak breath alcohol concentration = .10%) or no alcohol. They then read an eroticized sexual scenario and reported on their dissociation and emotional numbing experiences, unprotected sex refusal self-efficacy, and unprotected sex intentions.Path analysis revealed that CSA was indirectly associated with increased unprotected sex intentions through increased ASA severity, increased trauma-related symptoms, increased emotional numbing, and decreased unprotected sex refusal self-efficacy. Further, alcohol intoxication was indirectly associated with increased unprotected sex intentions through increased emotional numbing and decreased unprotected sex refusal self-efficacy.Emotional numbing, but not dissociation, was associated with unprotected sex intentions and may be one potential target for interventions aimed at reducing HIV/STI-related risk among women with a history of sexual trauma.
View details for DOI 10.1037/a0039978
View details for Web of Science ID 000385914900010
View details for PubMedID 28239507
View details for PubMedCentralID PMC5321660
Minority stress is longitudinally associated with alcohol-related problems among sexual minority women
2016; 61: 80–83
Compared to sexual minority men and heterosexual women, sexual minority women report elevated alcohol use in young adulthood. Heavy alcohol use and alcohol use disorders disproportionately affect sexual minority women across the lifespan, yet there is limited research investigating reasons for such associations. The present study investigates longitudinal associations between minority stress and both alcohol use as well as self-rated drinking consequences. Participants (N=1057) were self-identified lesbian (40.5%) and bisexual (59.5%) women between the ages of 18 to 25 recruited from across the U.S. using online advertisements. Participants completed four annual surveys. Hurdle mixed effects models were used to assess associations between minority stress and typical weekly drinking and drinking consequences one year later. Minority stress was not significantly associated with subsequent typical drinking. However, minority stress was significantly associated with having any alcohol consequences as well as the count of alcohol consequences one year later after controlling for covariates. Consistent with extant literature, this study provides evidence for a prospective association between minority stress experienced by sexual minority women and drinking consequences. This study also provides support for the potential impact of efforts to reduce minority stress faced by sexual minority women.
View details for DOI 10.1016/j.addbeh.2016.05.017
View details for Web of Science ID 000379630700014
View details for PubMedID 27249806
View details for PubMedCentralID PMC4915988
Implicit Alcohol Associations, Especially Drinking Identity, Predict Drinking Over Time
2016; 35 (8): 908–18
There is considerable excitement about implicit alcohol associations (IAAs) as predictors of college-student hazardous drinking; however, few studies have investigated IAAs prospectively, included multiple assessments, or controlled for previous drinking. Doing so is essential for showing the utility of these associations as predictors, and ultimately, targets for screening or intervention. Therefore, 3 IAAs (i.e., drinking identity, alcohol approach, and alcohol excitement) were evaluated as prospective predictors of drinking in 1st- and 2nd-year undergraduates in the United States.A sample of 506 undergraduates completed 8 online assessments of IAAs, explicit measures of the IAA constructs, and hazardous drinking (i.e., consumption, problems, and risk of alcohol-use disorders) every 3 months over a 21-month period. Retention rates, ordered by follow-up time points, were 90%, 76%, 76%, 77%, 72%, 67%, and 66%, respectively. Half of the participants were nondrinkers at baseline; 21% were above clinical cutoffs for hazardous drinking.Drinking-identity and alcohol-excitement associations predicted future alcohol consumption and problems after controlling for previous drinking and explicit measures; drinking identity also predicted future risk of alcohol-use disorder. Relative to the other IAAs, drinking identity predicted alcohol consumption for the longest duration (i.e., 21 months). Alcohol-approach associations rarely predicted variance in drinking.IAAs vary in their utility as prospective predictors of college-student hazardous drinking. Drinking identity and, to a lesser extent, alcohol excitement, emerged as robust prospective predictors of hazardous drinking. Intervention and screening efforts could likely benefit from targeting those associations. (PsycINFO Database Record
View details for DOI 10.1037/hea0000396
View details for Web of Science ID 000383102200020
View details for PubMedID 27505215
View details for PubMedCentralID PMC4984526
Addressing gaps on risk and resilience factors for alcohol use outcomes in sexual and gender minority populations
DRUG AND ALCOHOL REVIEW
2016; 35 (4): 484–93
In 2011, the Institute of Medicine released a report that constituted the first comprehensive effort by a federal body to understand the current state of science pertinent to the health needs of sexual and gender minority populations. This mini-review summarises recent empirical, methodological and theoretical advances in alcohol-related research among to lesbian, gay, bisexual and transgender (LGBT) populations and highlights progress towards addressing gaps, with a particular interest in those identified by the Institute of Medicine report.Articles published since 2011 were identified from PsycINFO and PubMed database searches, using various combinations of keyword identifiers (alcohol, alcohol abuse, substance abuse, LGBT, lesbian, gay, bisexual, transgender). Reference sections of included articles were also examined for additional citations.Recent empirical work has contributed to a greater understanding of sub-group differences within this diverse population. Evidence has supported theorised influences that can account for alcohol-related disparities, yet important gaps remain. Studies that examine the role of gender identity and its intersection with sexual identity within transgender and gender non-conforming sub-populations are lacking. Methodological advances in this literature have begun to allow for examinations of how minority-specific and general risk factors of alcohol misuse may contribute to patterns of alcohol involvement over time and within social-relational contextsThe recommendations made in the current mini-review are meant to facilitate future collaborative efforts, scale development, thoughtful methodological design and analysis and theoretically driven nuanced hypotheses to better understand, and ultimately address, alcohol-related disparities among sexual and gender minority populations. [Talley AE, Gilbert PA, Mitchell J, Goldbach J, Marshall BDL, Kaysen D. Addressing gaps on risk and resilience factors for alcohol use outcomes in sexual and gender minority populations. Drug Alcohol Rev 2016;35:484-493].
View details for DOI 10.1111/dar.12387
View details for Web of Science ID 000379898400016
View details for PubMedID 27072658
View details for PubMedCentralID PMC4930390
College Status, Perceived Drinking Norms, and Alcohol Use among Sexual Minority Women.
Psychology of sexual orientation and gender diversity
2016; 3 (1): 104–12
Lesbian, gay, and bisexual young adults are at elevated risk for drinking compared to heterosexual young adults, and this discrepancy is particularly striking for sexual minority women (SMW). Perceived social norms are strong predictors of young adult alcohol use, especially among college students. The college environment is often one where increases in alcohol use are seen, but the impact of college status on SMW's drinking has been understudied. The present study explored patterns of alcohol use and consequences among SMW and the extent to which social norms relate to use and consequences. Participants were recruited via social networking sites for a larger national study on SMW's health behaviors. Present analyses focused on 875 SMW between 18 and 25 who were categorized as either a 2-year college student (n = 196), 4-year college student (n = 418), or non-student (n = 261). Several differences emerged between college and non-college SMW, with non-college women reporting higher alcohol use and social norms compared to 4-year college women. In terms of alcohol-related consequences, students in both 2-year and 4-year colleges reported a higher likelihood of any consequences. There was some evidence that perceived norms partially explained differences in typical drinking among the college status groups. The present findings suggest that college may play a protective role against heavy drinking for this population of young women, however, the results are not straightforward and additional research is warranted.
View details for PubMedID 27774492
The impact of domestic violence and depressive symptoms on preterm birth in South India
SOCIAL PSYCHIATRY AND PSYCHIATRIC EPIDEMIOLOGY
2016; 51 (2): 225–32
India has the highest absolute number of maternal deaths, preterm birth cases, and under-5 mortality in the world, as well as high domestic violence (DV) rates. We sought to examine the impact of DV and its psychosocial correlates on pregnancy and birth outcomes.Women seeking antenatal care in Tamil Nadu, South India (N = 150) were assessed during pregnancy, and birth outcomes were abstracted from medical records after the babies were born.We found that psychological abuse (OR 3.9; 95% CI 1.19-12.82) and mild or greater depressive symptoms (OR 3.3; 95% CI 0.99-11.17) were significantly associated with increased risk of preterm birth. Physical abuse was also associated with increased risk of preterm birth, but this was not statistically significant (OR 1.9; 95% CI 0.59-6.19). In each of the above adjusted models, low maternal education was associated with increased risk of preterm birth, in the analysis with depressive symptoms OR 0.18, CI 0.04-0.86 and in the analyses with psychological abuse OR 0.19, CI 0.04-0.91.These findings suggest that future research should focus on understanding the psychosocial antecedents to preterm birth, to better target interventions and improve maternal child health in limited resource settings.
View details for DOI 10.1007/s00127-015-1167-2
View details for Web of Science ID 000370202500007
View details for PubMedID 26747253
Delivering cognitive processing therapy in a community health setting: The influence of Latino culture and community violence on posttraumatic cognitions.
Psychological trauma : theory, research, practice and policy
2016; 8 (1): 98-106
Despite the applicability of cognitive processing therapy (CPT) for posttraumatic stress disorder (PTSD) to addressing sequelae of a range of traumatic events, few studies have evaluated whether the treatment itself is applicable across diverse populations. The present study examined differences and similarities among non-Latino, Latino Spanish-speaking, and Latino English-speaking clients in rigid beliefs-or "stuck points"-associated with PTSD symptoms in a sample of community mental health clients. We utilized the procedures of content analysis to analyze stuck point logs and impact statements of 29 participants enrolled in a larger implementation trial for CPT. Findings indicated that the content of stuck points was similar across Latino and non-Latino clients, although fewer total stuck points were identified for Latino clients compared to non-Latino clients. Given that identification of stuck points is central to implementing CPT, difficulty identifying stuck points could pose significant challenges for implementing CPT among Latino clients and warrants further examination. Thematic analysis of impact statements revealed the importance of family, religion, and the urban context (e.g., poverty, violence exposure) in understanding how clients organize beliefs and emotions associated with trauma. Clinical recommendations for implementing CPT in community settings and the identification of stuck points are provided. (PsycINFO Database Record
View details for DOI 10.1037/tra0000044
View details for PubMedID 25961865
View details for PubMedCentralID PMC4641844
Reciprocal Relationships Over Time Between Descriptive Norms and Alcohol Use in Young Adult Sexual Minority Women
PSYCHOLOGY OF ADDICTIVE BEHAVIORS
2015; 29 (4): 885–93
Young adulthood, roughly ages 18-25, is a period of great risk for excessive consumption of alcohol, especially among sexual minority women (SMW). Despite the substantial literature examining the relationships between social norms and behavior in general, little attention has been given to the role of descriptive norms on the drinking behaviors of sexual minorities. The present study had 3 aims: to compare both typical woman descriptive norms and sexual minority-specific descriptive normative perceptions among a sample of SMW, to examine reciprocal associations between sexual minority-specific descriptive norms and alcohol consumption over time, and to examine whether these reciprocal associations were moderated by sexual orientation (i.e., whether 1 identifies as lesbian or bisexual). A national sample of 1,057 lesbian and bisexual women between the ages of 18 and 25 was enrolled in this study. Participants completed an online survey at 4 time points that assessed the constructs of interest. Results indicated that SMW consistently perceived that SMW drank more than their nonsexual minority peers; that SMW-specific descriptive drinking norms and alcohol consumption influenced 1 another over time in a reciprocal, feed-forward fashion; and that these associations were not moderated by sexual orientation. These findings highlight the importance of considering SMW-specific norms as an important factor in predicting alcohol consumption in SMW. Results further support the development and testing of normative interventions for high-risk drinking among SMW.
View details for DOI 10.1037/adb0000122
View details for Web of Science ID 000367460900007
View details for PubMedID 26478944
View details for PubMedCentralID PMC4701630
Community-based mental health treatments for survivors of torture and militant attacks in Southern Iraq: a randomized control trial
2015; 15: 249
Systematic violence is a long-standing problem in Iraq. Research indicates that survivors often experience multiple mental health problems, and that there is a need for more rigorous research that targets symptoms beyond post-traumatic stress (PTS). Our objective was to test the effectiveness of two counseling therapies in Southern Iraq in addressing multiple mental health problems among survivors of systematic violence: (1) a transdiagnostic intervention (Common Elements Treatment Approach or CETA); and (2) cognitive processing therapy (CPT). The therapies were provided by non-specialized health workers since few MH professionals are available to provide therapy in Iraq.This was a randomized, parallel, two site, two-arm (1:1 allocation), single-blinded, wait-list controlled (WLC) trial of CETA in one site (99 CETA, 50 WLC), and CPT in a second site (129 CPT, 64 WLC). Eligibility criteria were elevated trauma symptoms and experience of systematic violence. The primary and secondary outcomes were trauma symptoms and dysfunction, respectively, with additional assessment of depression and anxiety symptoms. Non-specialized health workers (community mental health worker, CMHW) provided the interventions in government-run primary health centers. Treatment effects were determined using longitudinal, multilevel models with CMHW and client as random effects, and a time by group interaction with robust variance estimation, to test for the net difference in mean score for each outcome between the baseline and follow up interview. Multiple imputation techniques were used to account for missingness at the item level and the participant level. All analyses were conducted using Stata 12.The CETA intervention showed large effect sizes for all outcomes. The CPT intervention showed moderate effects sizes for trauma and depression, with small to no effect for anxiety or dysfunction, respectively.Both CETA and CPT appear to benefit survivors of systematic violence in Southern Iraq by reducing multiple mental health symptoms, with CETA providing a very large benefit across a range of symptoms. Non-specialized health workers were able to treat comorbid symptoms of trauma, depression and anxiety, and dysfunction among survivors of systematic violence who have limited access to mental health professionals. The trial further supports the use of evidence-based therapies in lower-resource settings.This trial was registered at ClinicalTrials.gov on 16 July 2010 with an identifier of NCT01177072 as the Study of Effectiveness of Mental Health Interventions among Torture Survivors in Southern Iraq. The study protocol can be downloaded from the following website: http://tinyurl.com/CETA-Iraq-Protocol . In the protocol, the CETA intervention is given a different name: components-based intervention or CBI.
View details for DOI 10.1186/s12888-015-0622-7
View details for Web of Science ID 000362815300006
View details for PubMedID 26467303
View details for PubMedCentralID PMC4605204
Blackout Drinking Predicts Sexual Revictimization in a College Sample of Binge-Drinking Women
JOURNAL OF TRAUMATIC STRESS
2015; 28 (5): 484–88
Sexual victimization is prevalent on U.S. college campuses. Some women experience multiple sexual victimizations with heightened risk among those with prior victimization histories. One risk factor for sexual revictimization is alcohol use. Most research has focused on associations between alcohol consumption and revictimization. The current study's objective was to understand potential mechanisms by which drinking confers risk for revictimization. We hypothesized that specific drinking consequences would predict risk for revictimization above and beyond the quantity of alcohol consumed. There were 162 binge-drinking female students (mean age = 20.21 years, 71.3% White, 36.9% juniors) from the University of Washington who were assessed for baseline victimization (categorized as childhood vs. adolescent victimization), quantity of alcohol consumed, and drinking consequences experienced, then assessed 30 days later for revictimization. There were 40 (24.6%) women who were revictimized in the following 30 days. Results showed that blackout drinking at baseline predicted incapacitated sexual revictimization among women previously victimized as adolescents, after accounting for quantity of alcohol consumed (OR = 1.79, 95% CI [1.07, 3.01]). Other drinking consequences were not strongly predictive of revictimization. Adolescent sexual victimization was an important predictor of sexual revictimization in college women; blackout drinking may confer unique risk for revictimization.
View details for DOI 10.1002/jts.22042
View details for Web of Science ID 000365385200016
View details for PubMedID 26401899
View details for PubMedCentralID PMC4765805
A Person-Centered Approach to Examining Heterogeneity and Subgroups Among Survivors of Sexual Assault
JOURNAL OF ABNORMAL PSYCHOLOGY
2015; 124 (3): 685–96
This study identified subgroups of female sexual assault survivors based on characteristics of their victimization experiences, validated the subgroup structure in a second cohort of women recruited identically to the first, and examined subgroups' differential associations with sexual risk/safety behavior, heavy episodic drinking (HED), psychological distress symptomatology, incarceration, transactional sex, and experiences with controlling and violent partners. The community sample consisted of 667 female survivors of adolescent or adult sexual assault who were 21 to 30 years old (M = 24.78, SD = 2.66). Eligibility criteria included having unprotected sex within the past year, other HIV/STI risk factors, and some experience with HED, but without alcohol problems or dependence. Latent class analyses (LCA) were used to identify subgroups of women with similar victimization experiences. Three groups were identified and validated across 2 cohorts of women using multiple-group LCA: contact or attempted assault (17% of the sample), incapacitated assault (52%), and forceful severe assault (31%). Groups did not differ in their sexual risk/safety behavior. Women in the forceful severe category had higher levels of anxiety, depression, and trauma symptoms; higher proportions of incarceration and transactional sex; and more experiences with controlling and violent partners than did women in the other 2 groups. Women in the forceful severe category also reported a higher frequency of HED than women in the incapacitated category. Different types of assault experiences appear to be differentially associated with negative outcomes. Understanding heterogeneity and subgroups among sexual assault survivors has implications for improving clinical care and contributing to recovery.
View details for DOI 10.1037/abn0000055
View details for Web of Science ID 000359379000019
View details for PubMedID 26052619
View details for PubMedCentralID PMC4573799
Current Intimate Relationship Status, Depression, and Alcohol Use Among Bisexual Women: The Mediating Roles of Bisexual-Specific Minority Stressors
2015; 73 (1-2): 43–57
Current intimate relationship characteristics, including gender and number of partner(s), may affect one's visibility as a bisexual individual and the minority stressors they experience, which may in turn influence their health. The current study tested four hypotheses: 1) minority stressors vary by current intimate relationship status; 2) higher minority stressors are associated with higher depressive symptoms and alcohol-related outcomes; 3) depressive symptoms and alcohol-related outcomes vary by current intimate relationship status; and 4) minority stressors will mediate differences in these outcomes. Participants included 470 self-identified bisexual women (65% Caucasian, mean age: 21) from a sample of sexual minority women recruited from different geographic regions in the United States through advertisements on social networking sites and Craigslist. Participants completed a 45 minute survey. Respondents with single partners were first grouped by partner gender (male partner: n=282; female partner: n=56). Second, women were grouped by partner gender/number (single female/male partner: n = 338; women with multiple female and male partners: n=132). Women with single male partners and women with multiple male and female partners exhibited elevated experienced bi-negativity and differences in outness (H1). Experienced and internalized bi-negativity were associated with health outcomes, but not outness (H2). Differences in outcomes emerged by partner number and partner number/gender (H3); these differences were mediated by experienced bi-negativity (H4). These results suggest that experiences of discrimination may underlie differences in health related to bisexual women's relationship structure and highlight the importance of evaluating women's relational context as well as sexual identification in understanding health risk behaviors.
View details for DOI 10.1007/s11199-015-0483-z
View details for Web of Science ID 000358172900004
View details for PubMedID 26456995
View details for PubMedCentralID PMC4594946
Racial/Ethnic Differences in Identity and Mental Health Outcomes Among Young Sexual Minority Women
CULTURAL DIVERSITY & ETHNIC MINORITY PSYCHOLOGY
2015; 21 (3): 380–90
Previous research suggests that sexual minorities are at greater risk for trauma exposure, mental health problems, and substance use. To date, few studies have examined racial/ethnic differences among sexual minorities in relation to health-related behaviors and outcomes. Furthermore, studies of racial/ethnic differences among young adult sexual minority women (SMW) are virtually nonexistent. The current study adds to the previous literature by exploring differences in trauma exposure, sexual identity, mental health, and substance use in a nonprobability national sample of young adult SMW. A total of 967 self- identified lesbian and bisexual women were recruited via the Internet using social networking sites to participate in a larger longitudinal study on young women's health behaviors. The present study included 730 (76%) White, 108 (10%) African American, 91 (9%) Latina, and 38 (4%) Asian women ages 18 to 25 years. Results revealed differences in socioeconomic variables, degree of outness to family, childhood sexual assault, and forcible rape, but not overall lifetime trauma exposure. Among mental health and health-related behavior variables, few differences between groups emerged. Our findings indicate that both researchers and clinicians should turn their attention to processes of resilience among young SMW, particularly young SMW of color.
View details for DOI 10.1037/a0038680
View details for Web of Science ID 000357814900008
View details for PubMedID 25642782
View details for PubMedCentralID PMC4512644
Habit doesn't make the predictions stronger: Implicit alcohol associations and habitualness predict drinking uniquely
2015; 45: 139–45
As research on implicit (in the sense of fast/reflexive/impulsive) alcohol associations and alcohol advances, there is increasing emphasis on understanding the circumstances under which implicit alcohol associations predict drinking. In this study, we investigated habitualness of drinking (i.e., the extent to which drinking is automatic or occurs without thinking) as a moderator of the relations between several measures of implicit alcohol associations and key drinking outcomes.A sample of 506 participants (57% female) completed web-based measures of implicit alcohol associations (drinking identity, alcohol approach, and alcohol excitement), along with indicators of habitualness, and typical alcohol consumption, alcohol problems, and risk of alcohol use disorders.As expected, implicit alcohol associations, especially drinking identity, were positively associated with, and predicted unique variance in, drinking outcomes. Further, habitualness emerged as a consistent, positive predictor of drinking outcomes. Contrary to expectations, habitualness rarely moderated the relation between implicit alcohol associations and drinking outcomes.Although moderation was rarely observed, findings indicated that even mild levels of habitualness are risky. Findings also continue to support implicit alcohol associations, particularly drinking identity, as a risk factor for hazardous drinking. Collectively, this suggests the importance of targeting both in prevention and intervention efforts.
View details for DOI 10.1016/j.addbeh.2015.01.003
View details for Web of Science ID 000352676100025
View details for PubMedID 25665917
View details for PubMedCentralID PMC4373979
Sexual Assault History and Its Association With the Use of Drinking Protective Behavioral Strategies Among College Women
JOURNAL OF STUDIES ON ALCOHOL AND DRUGS
2015; 76 (3): 459–64
The current study examined the relationship between sexual assault history and drinking protective behavioral strategies (PBS). Given the relationship between sexual assault history and alcohol use, we hypothesized that after we controlled for drinking behavior, women with a childhood sexual abuse (CSA) history would use fewer drinking PBS than those without a CSA history. We also hypothesized that a history of adolescent/adult sexual assault (ASA) involving incapacitation and force would be associated with lower use of drinking PBS after controlling for CSA history and drinking behavior.A total of 800 undergraduate college women completed a survey online.Regression analyses indicated that the only sexual assault history type that was consistently related to all three types of drinking PBS was ASA involving incapacitation. Women with a history of incapacitated ASA were less likely to use any type of drinking PBS than women without such history. A history of other types of sexual assault (CSA, physically forced ASA, and verbally coerced ASA) was associated only with lower use of serious harm-reduction drinking PBS, such as going home with a friend or knowing the location of your drink.This was the first study to examine the relationship between different sexual assault histories and drinking PBS, and it furthers our understanding of the relationship between alcohol and sexual assault. Possible reasons for this relationship between ASA and PBS use are discussed.
View details for DOI 10.15288/jsad.2015.76.459
View details for Web of Science ID 000354755100015
View details for PubMedID 25978833
View details for PubMedCentralID PMC4440303
Traumatic Revictimization of Men Who Have Sex With Men Living With HIV/AIDS
JOURNAL OF INTERPERSONAL VIOLENCE
2015; 30 (9): 1459–77
Abuse in childhood has been established as a predictor of adult abuse, with the strongest associations found between childhood sexual abuse (CSA) and adult sexual victimization. Revictimization has been demonstrated among women, and there is a growing literature on revictimization experiences among men who have sex with men (MSM). No studies have assessed revictimization among MSM living with HIV, despite strong evidence for disproportionately high rates of life span abuse among this group, along with the added vulnerability of living with HIV and sexual minority stress. In this study, we contribute to the literature by exploring associations between multiple types of childhood and adult abuse experiences (physical, sexual, and psychological; perpetrated by partners and non-partner), rather than examining sexual victimization alone. A sample of 166 HIV-positive MSM attending primary HIV health care clinics in Seattle, Washington, completed a one-time questionnaire. Results of regression analyses revealed associations between experiencing CSA and adult sexual abuse, and experiencing childhood physical abuse and adult physical and sexual abuse. Childhood psychological abuse was associated with adult physical and psychological abuse and partner psychological abuse. At higher frequencies, childhood psychological abuse was associated with all forms of adult abuse. These findings suggest that various forms of childhood abuse experiences confer broad vulnerability to adult abuse experiences and point to potentially different pathways to revictimization based on childhood abuse type.
View details for DOI 10.1177/0886260514540802
View details for Web of Science ID 000352003900001
View details for PubMedID 24989040
Modeling Cyclical Patterns in Daily College Drinking Data with Many Zeroes
MULTIVARIATE BEHAVIORAL RESEARCH
2015; 50 (2): 184–96
Daily college drinking data often have highly skewed distributions with many zeroes and a rising and falling pattern of use across the week. Alcohol researchers have typically relied on statistical models with dummy variables for either the weekend or all days of the week to handle weekly patterns of use. However, weekend versus weekday categorizations may be too simplistic and saturated dummy variable models too unwieldy, particularly when covariates of weekly patterns are included. In the present study we evaluate the feasibility of cyclical (sine and cosine) covariates in a multilevel hurdle count model for evaluating daily college alcohol use data. Results showed that the cyclical parameterization provided a more parsimonious approach than multiple dummy variables. The number of drinks when drinking had a smoothly rising and falling pattern that was reasonably approximated by cyclical terms, but a saturated set of dummy variables was a better model for the probability of any drinking. Combining cyclical terms and multilevel hurdle models is a useful addition to the data analyst toolkit when modeling longitudinal drinking with high zero counts. However, drinking patterns were not perfectly sinusoidal in the current application, highlighting the need to consider multiple models and carefully evaluate model fit.
View details for DOI 10.1080/00273171.2014.977433
View details for Web of Science ID 000353394400004
View details for PubMedID 26609877
View details for PubMedCentralID PMC4662085
A controlled examination of two coping skills for daily alcohol use and PTSD symptom severity among dually diagnosed individuals
BEHAVIOUR RESEARCH AND THERAPY
2015; 66: 8–17
Investigations of targeted coping skills could help guide initial treatment decisions for individuals with co-occurring posttraumatic stress disorder (PTSD) and alcohol dependence (AD) who often endorse worse coping skills than those with AD but not PTSD. Although improvement in coping skills is associated with enhanced alcohol use outcomes, no study has evaluated the utility of teaching specific coping skills in the context of comorbid PTSD/AD. We compared the effects of teaching two coping skills (cognitive restructuring [CR] and experiential acceptance [EA]) or an attention control condition on drinking and PTSD symptoms among 78 men and women with comorbid PTSD/AD during a 5-week daily follow-up assessment. Both CR and EA skills were associated with decreased drinking compared to control, and that change in drinking over time did not significantly differ between those who received CR and EA. Individuals who received CR skills, however, consumed less alcohol on a given day than those who received EA skills. Neither CR nor EA was associated with a decrease in PTSD symptom severity. These results provide preliminary support for clinicians to prioritize CR and EA skills during initial treatment sessions when working with individuals with PTSD/AD, and offer ideas for continued investigation and intervention refinement.
View details for DOI 10.1016/j.brat.2014.12.013
View details for Web of Science ID 000351249200002
View details for PubMedID 25617814
View details for PubMedCentralID PMC4346423
Sexual assault related distress and drinking: The influence of daily reports of social support and coping control
2015; 42: 108–13
Introduction. A history of sexual assault (SA) is often associated with increased distress and heavy drinking. One's ability to cope with the distress and seek social support has been associated with drinking more generally. However, SA-related distress, drinking, and the extent to which a woman engages in adaptive coping or seeks social support is known to vary day-to-day. The goal of the present investigation was to examine the moderating influence of perceived coping control and social support on the event-level association between SA-related distress and drinking. Methods. This study included 133 college women with a history of SA who reported recent heavy drinking. Participants provided daily reports of their SA-related distress, perceived coping control, perceived social support, and alcohol consumption every day for 30days. Results. Results of generalized estimating equation models suggest that coping control moderated the association between distress and drinking such that those with less perceived coping control drank more as their SA-related distress increased from their average. Although social support did not moderate between distress and drinking, decreases in perceived social support were associated with more drinking on that day. Conclusions. The results suggest that daily deviations in SA-related distress may influence alcohol consumption more than average levels of distress, especially among women with low coping control. Interventions for women with SA histories should help them build coping skills as well as adequate social support in order to reduce drinking.
View details for DOI 10.1016/j.addbeh.2014.11.013
View details for Web of Science ID 000348555100020
View details for PubMedID 25437266
View details for PubMedCentralID PMC4620925
Resilience in Community: A Social Ecological Development Model for Young Adult Sexual Minority Women
AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY
2015; 55 (1-2): 179–90
Family support and rejection are associated with health outcomes among sexual minority women (SMW). We examined a social ecological development model among young adult SMW, testing whether identity risk factors or outness to family interacted with family rejection to predict community connectedness and collective self-esteem. Lesbian and bisexual women (N = 843; 57% bisexual) between the ages of 18-25 (M = 21.4; SD = 2.1) completed baseline and 12-month online surveys. The sample identified as White (54.2%), multiple racial backgrounds (16.6%), African American (9.6%) and Asian/Asian American (3.1%); 10.2% endorsed a Hispanic/Latina ethnicity. Rejection ranged from 18 to 41% across family relationships. Longitudinal regression indicated that when outness to family increased, SMW in highly rejecting families demonstrated resilience by finding connections and esteem in sexual minority communities to a greater extent than did non-rejected peers. But, when stigma concerns, concealment motivation, and other identity risk factors increased over the year, high family rejection did not impact community connectedness and SMW reported lower collective self-esteem. Racial minority SMW reported lower community connectedness, but not lower collective self-esteem. Families likely buffer or exacerbate societal risks for ill health. Findings highlight the protective role of LGBTQ communities and normative resilience among SMW and their families.
View details for DOI 10.1007/s10464-015-9702-6
View details for Web of Science ID 000349023400017
View details for PubMedID 25572956
View details for PubMedCentralID PMC4381736
POST-TRAUMATIC STRESS DISORDER AND HIV RISK BEHAVIORS AMONG RURAL AMERICAN INDIAN/ALASKA NATIVE WOMEN
AMERICAN INDIAN AND ALASKA NATIVE MENTAL HEALTH RESEARCH
2015; 22 (3): 1–20
We assessed the relationship between post-traumatic stress disorder (PTSD), binge drinking, and HIV sexual risk behavior by examining number of unprotected sex acts and number of sexual partners in the past 6 months among 129 sexually active American Indian women. A total of 51 (39.5%) young women met PTSD criteria. Among women who met the PTSD criteria, binge drinking was associated with a 35% increased rate of unprotected sex (IRR 1.35, p < .05), and there was a stronger association between increased binge drinking and risk of more sexual partners (IRR 1.21, p < .001) than among women who did not meet PTSD criteria (IRR 1.08, p < .01) with a difference of 13% (p < .05). HIV intervention and prevention interventions in this population likely would benefit from the inclusion of efforts to reduce binge drinking and increase treatment of PTSD symptoms.
View details for DOI 10.5820/aian.2203.2015.1
View details for Web of Science ID 000366978800001
View details for PubMedID 26425863
View details for PubMedCentralID PMC4603289
A randomized controlled trial of mental health interventions for survivors of systematic violence in Kurdistan, Northern Iraq
2014; 14: 360
Experiencing systematic violence and trauma increases the risk of poor mental health outcomes; few interventions for these types of exposures have been evaluated in low resource contexts. The objective of this randomized controlled trial was to assess the effectiveness of two psychotherapeutic interventions, Behavioral Activation Treatment for Depression (BATD) and Cognitive Processing Therapy (CPT), in reducing depression symptoms using a locally adapted and validated version of the Hopkins Symptom Checklist and dysfunction measured with a locally developed scale. Secondary outcomes included posttraumatic stress, anxiety, and traumatic grief symptoms.Twenty community mental health workers, working in rural health clinics, were randomly assigned to training in one of the two interventions. The community mental health workers conducted baseline assessments, enrolled survivors of systematic violence based on severity of depression symptoms, and randomly assigned them to treatment or waitlist-control. Blinded community mental health workers conducted post-intervention assessments on average five months later.Adult survivors of systematic violence were screened (N = 732) with 281 enrolled in the trial; 215 randomized to an intervention (114 to BATD; 101 to CPT) and 66 to waitlist-control (33 to BATD; 33 to CPT). Nearly 70% (n = 149) of the intervention participants completed treatment and post-intervention assessments; 53 (80%) waitlist-controls completed post-intervention assessments. Estimated effect sizes for depression and dysfunction were 0.60 and 0.55 respectively, comparing BATD participants to all controls and 0.84 and 0.79 respectively, compared to BATD controls only. Estimated effect sizes for depression and dysfunction were 0.70 and 0.90 respectively comparing CPT participants to all controls and 0.44 and 0.63 respectively compared to CPT controls only. Using a permutation-based hypothesis test that is robust to the model assumptions implicit in regression models, BATD had significant effects on depression (p = .003) and dysfunction (p = .007), while CPT had a significant effect on dysfunction only (p = .004).Both interventions showed moderate to strong effects on most outcomes. This study demonstrates effectiveness of these interventions in low resource environments by mental health workers with limited prior experience.ClinicalTrials.Gov NCT00925262 . Registered June 3, 2009.
View details for DOI 10.1186/s12888-014-0360-2
View details for Web of Science ID 000348155600001
View details for PubMedID 25551436
View details for PubMedCentralID PMC4301059
COPING AS A MEDIATOR OF INTERNALIZED HOMOPHOBIA AND PSYCHOLOGICAL DISTRESS AMONG YOUNG ADULT SEXUAL MINORITY WOMEN.
Psychology of sexual orientation and gender diversity
2014; 1 (3): 225–33
Sexual minorities have higher rates of depression and anxiety than their heterosexual counterparts. This elevated risk of psychological distress has generally been hypothesized to be a result of the effects of discrimination including internalized negative beliefs about sexual minorities. However, little research has examined the role of various types of coping in mediating between internalized homophobia and mental health. We tested the direct relationship between internalized homophobia and psychological distress and evaluated general and sexual minority-specific coping strategies as potential mediators using structural equation modeling. Data are from a national sample of 1,099 young adult sexual minority women who were on average 20.86 (SD= 2.12) years old, participating in a study on mental health and substance use. The model demonstrated acceptable fit, chi2 (83) = 402.9, p <.001, CFI=.94, TLI=.92, SRMR= .07, and RMSEA=.06, accounting for 73% of variance in psychological distress. Greater use of maladaptive coping and less use of sexual minority-specific coping were associated with higher psychological distress. Although maladaptive coping mediated the relationship between internalized homophobia and psychological distress, sexual minority-specific coping did not. Our findings support previous studies that have demonstrated the impact of internalized homophobia on psychological distress as well as the role of coping as a protective/risk factor in this relationship.
View details for PubMedID 25530980
The Effect of Cognitive Therapy on Structural Social Capital: Results From a Randomized Controlled Trial Among Sexual Violence Survivors in the Democratic Republic of the Congo
AMERICAN JOURNAL OF PUBLIC HEALTH
2014; 104 (9): 1680–86
We evaluated changes in social capital following group-based cognitive processing therapy (CPT) for female survivors of sexual violence.We compared CPT with individual support in a cluster-randomized trial in villages in South Kivu province, Democratic Republic of the Congo. Local psychosocial assistants delivered the interventions from April through July 2011. We evaluated differences between CPT and individual support conditions for structural social capital (i.e., time spent with nonkin social network, group membership and participation, and the size of financial and instrumental support networks) and emotional support seeking. We analyzed intervention effects with longitudinal random effects models.We obtained small to medium effect size differences for 2 study outcomes. Women in the CPT villages increased group membership and participation at 6-month follow-up and emotional support seeking after the intervention compared with women in the individual support villages.Results support the efficacy of group CPT to increase dimensions of social capital among survivors of sexual violence in a low-income conflict-affected context.
View details for DOI 10.2105/AJPH.2014.301981
View details for Web of Science ID 000341864400034
View details for PubMedID 25033113
View details for PubMedCentralID PMC4151928
Posttraumatic Cognitions, Somatization, and PTSD Severity Among Asian American and White College Women With Sexual Trauma Histories
PSYCHOLOGICAL TRAUMA-THEORY RESEARCH PRACTICE AND POLICY
2014; 6 (4): 337–44
The need for trauma research with monoracial groups such as Asian Americans (AA) has recently been emphasized to better understand trauma experiences and inform interventions across populations. Given AA cultural contexts, posttraumatic cognitions and somatization may be key in understanding trauma experiences for this group. AA and White American (WA) trauma-exposed college women completed a survey on sexual trauma history, posttraumatic cognitions, somatic symptoms, and PTSD severity. For the overall sample, higher negative cognitions were associated with higher somatization. Asian race was associated with higher negative cognitions, which then predicted higher PTSD. Unexpectedly, WAs more strongly endorsed somatization than AAs. These findings indicate that posttraumatic cognitions may be helpful in understanding relationships between somatization and PTSD severity among those of Asian backgrounds and that the relationship between somatization and PTSD symptoms is culturally complex.
View details for DOI 10.1037/a0033830
View details for Web of Science ID 000339664100006
View details for PubMedID 25419439
View details for PubMedCentralID PMC4237214
Spicing up the military: Use and effects of synthetic cannabis in substance abusing army personnel
2014; 39 (7): 1139–44
Synthetic cannabis (SC) use has been increasing within the United States. Due to difficulties with its detection through standard testing, it may be an attractive substance of abuse for military personnel. However, few studies have examined the consequences of its use in this population, including evidence for its potential for abuse and dependence. Participants included 368 active-duty Army personnel who expressed interest in participating in a "check-up" around their alcohol or substance use, of whom 294 (80%) met DSM-IV criteria for substance abuse or dependence (including alcohol, illicit drugs, and prescription medications) and were not engaged in substance abuse treatment. Forty-one participants (11%) reported using SC in the last 90 days. Of those, 27 listed SC as their drug of choice. There were no significant differences in race, ethnicity, deployment history, or religion between SC users and others. Users of SC were generally younger and had less education and income than those who used only alcohol. Among SC users, 12% met criteria for drug abuse and 68% for dependence. Participants perceived SC use to be significantly more prevalent among military personnel than among civilians. Results suggest that SC is prevalent among substance-using soldiers and that DSM-IV criteria for abuse and dependence apply to SC. In addition, results highlight the importance of assessing and treating SC use among active-duty military personnel.
View details for DOI 10.1016/j.addbeh.2014.02.018
View details for Web of Science ID 000336772000001
View details for PubMedID 24727109
Sex on the Beach: The Influence of Social Norms and Trip Companion on Spring Break Sexual Behavior
2014; 15 (3): 408–18
Spring Break trips are associated with heavy drinking and with risky sexual behavior (e.g., unprotected sex, multiple partners, unwanted sexual contact), especially for those students who go on trips with friends. The present study adds to this growing event-specific risk literature by examining Spring Break-specific normative perceptions of sexual risk behavior and the role that these perceptions and taking a trip with a friend or with a romantic partner have on Spring Break sexual behavior. College students (N = 1,540; 53.9 % female) were asked to report descriptive normative perceptions of sex with casual partners, drinking prior to sex, number of drinks prior to sex, and condom use as well as their own Spring Break drinking and sexual behaviors. Students perceived the typical same-sex student to have engaged in more frequent sexual behavior for all outcomes than students' own self-reported sexual behavior. Furthermore, results revealed that these perceptions were positively associated with behavior. The choice of travel companion (friend(s) versus romantic partner) also differentially predicted sexual behaviors. Results suggested that intervention efforts aimed at reducing risks for Spring Break trip-takers may be strongest when they incorporate corrective normative information and target those traveling with friends.
View details for DOI 10.1007/s11121-014-0460-8
View details for Web of Science ID 000336283200015
View details for PubMedID 24464322
View details for PubMedCentralID PMC4028385
- A la Carte or Prix Fixe? Differing Approaches to Addressing the Gap in Dissemination of Evidence-Based Care in Mental Health COGNITIVE AND BEHAVIORAL PRACTICE 2014; 21 (2): 134–38
The Relationship Between Assault and Physical Health Complaints in a Sample of Female Drinkers Roles of Avoidant Coping and Alcohol Use
JOURNAL OF INTERPERSONAL VIOLENCE
2014; 29 (8): 1359–79
Trauma exposure and PTSD are associated with poorer physical health. Psychological and behavioral mechanisms may help account for this relationship. In this study, we tested avoidant coping and alcohol use as mediators of the relationship between trauma exposure, PTSD, and self-reported physical health complaints in female drinkers. In 827 college women, we compared three groups: women with no trauma history, women with a sexual assault but no PTSD, and women with a sexual assault and PTSD, on avoidant coping, alcohol use, and physical health complaints. We found that PTSD was positively associated with alcohol use and that PTSD and trauma exposure were associated with increased avoidant coping. We also found that avoidant coping mediated the relationship between trauma, PTSD, and physical health complaints. Alcohol use did not predict physical health but was associated with PTSD. These results suggest that in female college students, coping may be more critical in the PTSD/physical health relationship than alcohol and have implications for targeting coping in young trauma-exposed women to improve physical health.
View details for DOI 10.1177/0886260513507139
View details for Web of Science ID 000333382400001
View details for PubMedID 24288191
View details for PubMedCentralID PMC3969404
Randomized Controlled Trial of a Spring Break Intervention to Reduce High-Risk Drinking
JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY
2014; 82 (2): 189–201
Although recent studies have documented high-risk drinking occurring during Spring Break (SB), particularly on SB trips with friends, published intervention studies are few. In the present study, we evaluated the efficacy of event specific prevention strategies for reducing SB drinking among college students, compared to general prevention strategies and an assessment-only control group, as well as evaluated inclusion of peers in interventions and mode of intervention delivery (in-person vs. web).Participants included 783 undergraduates (56.1% women; average age = 20.5 years) intending to go on a SB trip with friends as well as to drink heavily on at least 1 day of SB. Participants completed assessments prior to SB and were randomized to 1 of 5 intervention conditions: SB in-person Brief Alcohol Screening and Intervention for College Students (BASICS; Dimeff, Baer, Kivlahan, & Marlatt, 1999), SB web BASICS, SB in-person BASICS with friend, SB web BASICS with friend, general BASICS, or an attention control condition. Follow-up assessment was completed 1 week after SB.Although the SB web BASICS (with and without friends) and general BASICS interventions were not effective at reducing SB drinking, results indicated significant intervention effects for SB in-person BASICS in reducing SB drinking, particularly on trip days. Follow-up analyses indicated that change in descriptive norms mediated treatment effect and reductions in drinking, whereas SB drinking intentions and positive expectancies did not.Overall, results suggest that an in-person SB-specific intervention is effective at reducing SB drinking, especially during trips. In contrast, interventions that contain non-SB-related content, are web-based, or seek to involve friends may be less effective at reducing SB drinking.
View details for DOI 10.1037/a0035743
View details for Web of Science ID 000333463400002
View details for PubMedID 24491072
View details for PubMedCentralID PMC4390296
Proximal Relationships Between PTSD Symptoms and Drinking Among Female College Students: Results From a Daily Monitoring Study
PSYCHOLOGY OF ADDICTIVE BEHAVIORS
2014; 28 (1): 62–73
Self-medication has been theorized to explain comorbidity between posttraumatic stress disorder (PTSD) and drinking, whereupon problem drinking develops in order to modulate negative affect and ameliorate PTSD symptoms. Daily monitoring methodologies may help refine our understanding of proximal relations between PTSD, affect, and alcohol use. One hundred thirty-six female college drinkers with a past history of sexual victimization and 38 female college drinkers with no past trauma history completed electronic monitoring of PTSD symptoms, affect, alcohol use, and alcohol cravings, daily for 4 weeks. A two-part mixed hurdle model was used to examine likelihood of drinking and amount of alcohol consumed on drinking days. We found significant relationships between daily PTSD symptoms, affect, and drinking. On days women experienced more intrusive and behavioral avoidance symptoms of PTSD, they experienced stronger urges to drink and were more likely to drink on that day. On days in which women experienced more negative affect than their average, they experienced stronger urges to drink, whereas on days in which women experienced more of the dysphoric symptoms associated with PTSD than their average, they drank less. On days with higher positive affect, women reported stronger urges to drink and were more likely to drink. Results suggest the need to examine both aspects of affect and specific PTSD symptoms as they may differentially predict drinking behavior. Differences in the ways in which PTSD symptoms and affect influence drinking suggest that interventions more specifically address the function of drinking behaviors in reducing alcohol use among college women.
View details for DOI 10.1037/a0033588
View details for Web of Science ID 000334693600007
View details for PubMedID 23915369
View details for PubMedCentralID PMC3825767
Impact of Daily Assessments on Distress and PTSD Symptoms in Trauma-Exposed Women
JOURNAL OF INTERPERSONAL VIOLENCE
2014; 29 (5): 824–45
As more advanced methodologies are developed for symptom assessment in traumatic stress studies, it is important to examine how these methodologies can exacerbate distress or contribute to symptoms among study participants. Using a sample of 202 female college students, we examined the changes in posttraumatic stress disorder (PTSD) symptoms and general psychological symptomatology among groups of trauma-exposed and non-trauma-exposed women randomly assigned to complete 30 days of daily monitoring of traumatic symptoms and substance use behaviors using personal digital assistants (PDAs). These two groups were compared with a trauma-exposed sample of women who did not complete daily monitoring assessments and only completed pre- and post-monitoring online assessments. While trauma-exposed participants in the monitoring group reported more distress from the daily assessments than those in the monitoring group with no history of trauma, this distress level was relatively low. Online surveys delivered pre- and post-monitoring showed a similar pattern. Trauma-exposed participants in monitoring and no-monitoring groups reported a decrease in general psychological symptoms over the 30 days; however, monitoring participants reported increased levels of PTSD severity over time. Closer examination revealed the observed changes were relatively moderate. Participants expressed benefits and risks regarding study participation supporting the findings that repeated assessments of traumatic symptoms using personal handheld devices may lead to small increases in distress and PTSD symptoms, but that these approaches may be generally well tolerated.
View details for DOI 10.1177/0886260513505705
View details for Web of Science ID 000330019800003
View details for PubMedID 24257591
View details for PubMedCentralID PMC3946887
Sexual assault, drinking norms, and drinking behavior among a national sample of lesbian and bisexual women
2014; 39 (3): 630–36
Childhood sexual abuse (CSA) and adolescent/adult sexual assault (ASA) are strongly associated with women's alcohol use and the rates of both alcohol use and sexual assault history are higher among lesbian and bisexual women than heterosexual women. Although descriptive drinking norms are one of the highest predictors of alcohol use in emerging adults, this is the first study to examine the relationship between sexual assault history, drinking norms, and alcohol use in lesbian and bisexual women. We found that CSA severity was associated with a higher likelihood of experiencing more severe alcohol-involved ASA, more severe physically forced ASA, and was indirectly associated with more drinking behavior and higher drinking norms. Additionally, more severe alcohol-involved ASA was associated with higher drinking norms and more drinking behavior, but physically forced ASA was not. These findings help explain previous contradictory findings and provide information for interventions.
View details for DOI 10.1016/j.addbeh.2013.11.015
View details for Web of Science ID 000331160700020
View details for PubMedID 24360780
View details for PubMedCentralID PMC4041383
Gender Differences in Relationships Among PTSD Severity, Drinking Motives, and Alcohol Use in a Comorbid Alcohol Dependence and PTSD Sample
PSYCHOLOGY OF ADDICTIVE BEHAVIORS
2014; 28 (1): 42–52
Alcohol dependence (AD) and posttraumatic stress disorder (PTSD) are highly prevalent and comorbid conditions associated with a significant level of impairment. Little systematic study has focused on gender differences specific to individuals with both AD and PTSD. The current study examined gender-specific associations between PTSD symptom severity, drinking to cope (i.e., reduce negative affect), drinking for enhancement (i.e., increase positive affect), and average alcohol use in a clinical sample of men (n = 46) and women (n = 46) with comorbid AD and PTSD. Results indicated that PTSD symptoms were highly associated with drinking-to-cope motives for both men and women, but with greater drinking for enhancement motives for men only. Enhancement motives were positively associated with average alcohol quantity for both men and women, but coping motives were significantly associated with average alcohol quantity for women only. These findings suggest that for individuals with comorbid AD and PTSD, interventions that focus on reducing PTSD symptoms are likely to lower coping motives for both genders, and targeting coping motives is likely to result in decreased drinking for women but not for men, whereas targeting enhancement motives is likely to lead to reduced drinking for both genders.
View details for DOI 10.1037/a0032266
View details for Web of Science ID 000334693600005
View details for PubMedID 23647151
View details for PubMedCentralID PMC3769473
Drinking Motives Moderate Daily Relationships Between PTSD Symptoms and Alcohol Use
JOURNAL OF ABNORMAL PSYCHOLOGY
2014; 123 (1): 237–47
Posttraumatic stress disorder (PTSD) and alcohol dependence (AD) frequently co-occur, although results of both cross-sectional and longitudinal studies evaluating the nature of their relationship have been mixed. There has been varied support for competing models explaining how these conditions influence one another. To assess both the self-medication and mutual maintenance models, as well as examine the potential moderating role of drinking motives, the current study used Generalized Estimating Equations to evaluate daily associations for an average of 7.3 days between PTSD symptoms and alcohol use in a mixed-gender sample of individuals who met criteria for both PTSD and AD. Results generally supported a self-medication model with elevated PTSD symptoms predictive of greater alcohol use on that same day and on the following day. Contrary to a mutual maintenance model prediction, drinking did not predict next-day PTSD symptoms. Results also indicated that both coping and enhancement drinking motives were significant moderators of the PTSD and drinking relationships, suggesting that these relationships may be more or less salient depending on an individual's particular drinking motivations. For example, among those higher on coping drinking motives, a 1-unit increase in PTSD symptom severity was associated with a 35% increase in amount of alcohol consumed the same day, while among those low on coping drinking motives, a 1-unit PTSD increase was associated with only a 10% increase in alcohol consumption. We discuss implications of these findings for the larger literature on the associations between PTSD and alcohol use as well as for clinical interventions. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
View details for DOI 10.1037/a0035193
View details for Web of Science ID 000333462800024
View details for PubMedID 24661174
View details for PubMedCentralID PMC4030751
Cognitive Processing Therapy for veterans with comorbid PTSD and alcohol use disorders
2014; 39 (2): 420–27
Posttraumatic stress disorder (PTSD) and alcohol-use disorders (AUD) frequently present comorbidity in veteran populations. Traditionally those with alcohol dependence have been excluded from PTSD treatment outcome studies, thus we do not know how those with alcohol dependence may tolerate or respond to PTSD-specific interventions; no studies to date have examined the extent to which cognitive PTSD interventions are tolerated or effective for those with comorbid PTSD/AUD. The present study examines the extent to which CPT is tolerated by and effective in treating PTSD symptoms for veterans with PTSD and AUD, as compared to veterans with PTSD only in an outpatient treatment setting. Data were obtained through chart review of 536 veterans diagnosed with PTSD who had received at least 1 session of CPT at a Midwestern US Veterans Affairs hospital. Nearly half (n=264, 49.3%) of the veterans in the study exhibited a current or past AUD diagnosis. Participants were grouped into the following diagnostic groups: current AUD (past 12 months), past AUD (prior to 12 months), and no AUD. Participants completed an average of 9 sessions of CPT with no significant difference between AUD diagnostic groups on the number of CPT sessions completed. Individuals with past AUD had higher initial symptoms of self-reported PTSD symptoms than those with no AUD. All groups reported significant reductions in PTSD symptoms and depression over time. Overall, the results suggest that CPT appears well tolerated among veterans with comorbid AUD and is associated with significant reductions in symptoms of PTSD and depression in an outpatient treatment setting.
View details for DOI 10.1016/j.addbeh.2013.08.016
View details for Web of Science ID 000329479400009
View details for PubMedID 24035644
View details for PubMedCentralID PMC3855895
Spring Break Versus Spring Broken: Predictive Utility of Spring Break Alcohol Intentions and Willingness at Varying Levels of Extremity
2014; 15 (1): 85–93
Within the domain of risk-related behavior, many times the decision to engage is not a product of premeditation or intention. The prototype willingness model was created to capture and explain the unintended element of risk behavior. The present study aimed to evaluate the importance of willingness versus intention, two important constructs within the prototype willingness model, in relation to spring break drinking behavior when assessed at both high and low extremities. College undergraduates (N = 275) completed questionnaires prior to spring break regarding their anticipated spring break activities. Willingness and intention were assessed for different levels of risk. Specifically, participants indicated the extent to which they intended to (a) get drunk and (b) drink enough to black out or pass out; and the extent to which they were willing to (a) get drunk and (b) drink enough to black out or pass out. When classes resumed following spring break, the students indicated the extent to which they actually (a) got drunk and (b) drank enough to black out or pass out. Results demonstrated that when the health-related risk was lower (i.e., getting drunk), intention was a stronger predictor of behavior than was willingness. However, as the level of risk increased (i.e., getting drunk enough to black out or pass out), willingness more strongly predicted behavior. The present study suggests that willingness and intentions differentially predict spring break alcohol-related behavior depending on the extremity of behavior in question. Implications regarding alcohol interventions are discussed.
View details for DOI 10.1007/s11121-012-0355-5
View details for Web of Science ID 000331000100009
View details for PubMedID 23404667
View details for PubMedCentralID PMC3686846
Proximal relationships between PTSD and drinking behavior
CO-ACTION PUBLISHING. 2014: 26518
Co-morbid PTSD and alcohol use disorders are both common and debilitating. However, many of these studies rely on cross-sectional studies that obscure more complex relationships between PTSD and drinking. Event-level studies allow for examination of proximal relationships between PTSD and drinking. Among women (n=136 with past sexual victimization, n=40 no past trauma history), a two-part mixed hurdle model was used to examine daily PTSD and drinking. On days women experienced more intrusive and behavioral avoidance symptoms, they were more likely to drink. For a 2 SD increase in symptoms, there was a 5% increased likelihood of drinking, and for a 2 SD increase in dysphoric symptoms or negative affect, women drank approximately half drink less. Daily-level coping self-efficacy moderated the association between distress and drinking (IRR=0.91, p<0.01). Women who reported less coping drank more as their distress increased on a certain day whereas women who reported more coping drank about the same regardless of distress. Overall, findings suggest that specific PTSD symptoms are associated with higher alcohol use and that these relationships are moderated by daily coping self-efficacy. Implications of these findings for informing models of PTSD/AUD comorbidity, as well as clinical implications will be discussed.
View details for DOI 10.3402/ejpt.v5.26518
View details for Web of Science ID 000346312900008
View details for PubMedID 25511723
View details for PubMedCentralID PMC4265132
Wounds that can't be seen: Implicit Trauma Associations predict posttraumatic stress disorder symptoms
JOURNAL OF BEHAVIOR THERAPY AND EXPERIMENTAL PSYCHIATRY
2013; 44 (4): 368–75
Prominent theories suggest that explicit and implicit cognitive biases are critical in the development and maintenance of posttraumatic stress disorder (PTSD). However, studies evaluating implicit PTSD-related cognitive biases are rare, and findings are mixed. We developed two adaptions of the Implicit Association Test (IAT), the "traumatized self" IAT (evaluations of the self as traumatized vs. healthy) and the "dangerous memory" IAT (evaluations of remembering as dangerous vs. safe), and investigated their psychometric properties and relations to PTSD symptoms and trauma exposure.Participants were visitors to the Project Implicit research website (Study 1: N = 347, Study 2: N = 501). They completed the IATs (Study 1: both IATs; Study 2: traumatized self IAT only), a trauma exposure measure, a PTSD symptom inventory, and explicit cognitive bias measures (Study 2 only).Both IATs had good internal consistency, but only the traumatized self IAT was correlated with PSTD symptoms and identified participants meeting clinical cutoffs for PTSD symptoms. Study 2 focused on the traumatized self IAT and included explicit cognitive bias measures. The IAT correlated with PTSD symptoms and explicit cognitions, and predicted variance in PSTD symptoms above and beyond trauma exposure and explicit cognitions.Study designs were cross-sectional; samples were unselected; and PTSD symptoms were self-reported.Despite these limitations, these studies provide preliminary validation of an implicit measure of PTSD-related cognitive bias - the traumatized self IAT - that is consistent with PTSD theories and may ultimately improve the identification and treatment of individuals with PTSD.
View details for DOI 10.1016/j.jbtep.2013.03.003
View details for Web of Science ID 000323092000003
View details for PubMedID 23624314
View details for PubMedCentralID PMC3742610
What Is Hooking Up? Examining Definitions of Hooking Up in Relation to Behavior and Normative Perceptions
JOURNAL OF SEX RESEARCH
2013; 50 (8): 757–66
Research has demonstrated ambiguity about the definition of hooking up among college students. The current research examined whether there were multiple definitions of hooking up among college students and how different definitions might be associated with the participant's own hooking up behavior and normative perceptions of peer hooking up behavior. A random sample (N = 1,468) of undergraduates (56.4% female) completed a Web-based survey composed of measures of drinking and sexual behavior. Open-ended definitions of hooking up were content-coded and analyzed using a mixture model to explore discrete definitions of hooking up among college students. Findings indicated three clusters of student definitions of hooking up: Cluster 1 had the broadest definition, referring to sex in general, not specific sexual acts, and to making out. Cluster 2 placed an emphasis on interpersonal and social aspects. Cluster 3 defined hooking up as sex with notable references to specific sexual acts. Results further indicated that hooking up behavior and normative perceptions differentiated these three groups of definitions. Clinical implications regarding the inconsistency of student definitions of hooking up and how they may impact negative consequences associated with hooking up are discussed.
View details for DOI 10.1080/00224499.2012.706333
View details for Web of Science ID 000325787300006
View details for PubMedID 23057805
View details for PubMedCentralID PMC3546226
Drinking motives for self and others predict alcohol use and consequences among college women: The moderating effects of PTSD
2013; 38 (3): 1831–39
Although drinking motives have been shown to influence drinking behavior among women with trauma histories and PTSD, no known research has examined the influence of drinking motives on alcohol use and alcohol-related consequences for women with PTSD as compared to women with a trauma history but no PTSD and women with no trauma history. Therefore, the present study sought to examine the associations between drinking motives women held for themselves as well as their perception of the drinking motives of others and their own alcohol use and consequences, and whether this was moderated by a history of trauma and/or PTSD. College women (N=827) were categorized as either having no trauma exposure (n=105), trauma exposure but no PTSD (n=580), or PTSD (n=142). Results of regression analyses revealed that women with trauma exposure and PTSD consume more alcohol and are at greatest risk of experiencing alcohol-related consequences. A diagnosis of PTSD moderated the association between one's own depression and anxiety coping and conformity drinking motives and alcohol-related consequences. PTSD also moderated the association between the perception of others' depression coping motives and one's own consequences. These findings highlight the importance of providing alternative coping strategies to women with PTSD to help reduce their alcohol use and consequences, and also suggest a possible role for the perceptions regarding the reasons other women drink alcohol and one's own drinking behavior that may have important clinical implications.
View details for DOI 10.1016/j.addbeh.2012.10.012
View details for Web of Science ID 000315369800038
View details for PubMedID 23261496
View details for PubMedCentralID PMC3558629
- Alcohol and Sexual Violence PRINCIPLES OF ADDICTION: COMPREHENSIVE ADDICTIVE BEHAVIORS AND DISORDERS, VOL 1 2013: 627–36
Protective Behavioral Strategies as a Mediator of the Generalized Anxiety and Alcohol Use Relationship Among Lesbian and Bisexual Women
JOURNAL OF STUDIES ON ALCOHOL AND DRUGS
2013; 74 (1): 168–74
Alcohol use disorders and anxiety disorders often co-occur; moreover, lesbian and bisexual women appear at higher risk for both alcohol and anxiety disorders. Although research among college student samples has found direct effects of increased use of protective behavioral strategies on decreasing alcohol use and alcohol-related negative consequences, this has yet to be demonstrated among lesbian and bisexual women. Furthermore, it is unclear whether generalized anxiety influences the use of such strategies, which in turn predict alcohol consumption and related negative consequences. The primary objective of the present study was to examine the mediating role of protective behavioral strategies on the relationships between generalized anxiety and alcohol consumption and related negative consequences among a young adult sample of lesbian and bisexual women.A national sample of 1,083 lesbian and bisexual women between the ages of 18 and 25 years completed an online survey that assessed the constructs of interest.Results showed support for mediation such that lesbian and bisexual women who reported having higher levels of generalized anxiety were less likely to use drinking protective behavioral strategies, which in turn led to higher levels of alcohol consumption as well as negative alcohol-related consequences.These findings highlight the importance of examining who is at risk for alcohol use disorders as well as why they are at risk. Results indicate that interventions for high-risk drinking among younger lesbian and bisexual women may need to specifically address factors such as affect management or coping with anxiety, at least for the proportion of women who are endorsing significant symptoms of anxiety.
View details for DOI 10.15288/jsad.2013.74.168
View details for Web of Science ID 000313026300020
View details for PubMedID 23200163
View details for PubMedCentralID PMC3517260
Reaching Soldiers with Untreated Substance Use Disorder: Lessons Learned in the Development of a Marketing Campaign for the Warrior Check-Up Study
SUBSTANCE USE & MISUSE
2013; 48 (10): 908–21
The Warrior Check-Up, a confidential telephone-delivered intervention, is designed to reach active-duty soldiers with untreated substance-use disorder at a large U.S. military base. This paper describes the development and successful implementation of the study's marketing strategies at the recruitment period's midpoint (2010-2012). Qualitative analyses of focus groups (n = 26) and survey responses (n = 278) describe the process of campaign design. Measures of demographics, media exposure, post-traumatic stress, anxiety and depression gathered from callers (n = 172) are used in quantitative analysis assessing the campaign's success in reaching this population. Implications, limitations, and suggestions for future research are discussed. Department of Defense provided study funding.
View details for DOI 10.3109/10826084.2013.797996
View details for Web of Science ID 000322025400010
View details for PubMedID 23869462
View details for PubMedCentralID PMC4942844
Symptoms of Posttraumatic Stress Predict Craving Among Alcohol Treatment Seekers: Results of a Daily Monitoring Study
PSYCHOLOGY OF ADDICTIVE BEHAVIORS
2012; 26 (4): 724–33
Alcohol use disorders (AUDs) and Posttraumatic Stress Disorder (PTSD) commonly co-occur. Craving for alcohol is a common aspect of AUD, with and without PTSD, and is one of the key predictors of continued problematic alcohol use among treatment seekers. The present study sought to investigate the self-medication hypothesis using daily Interactive Voice Response (IVR) reports to examine the relationships between PTSD symptomatology and both same-day and next-day alcohol craving. Twenty-nine individuals with an AUD (26 of whom screened positive for PTSD) entering AUD treatment provided daily IVR data for up to 28 days regarding their alcohol use, craving, and 7 symptoms of PTSD. Given the nested nature of daily data, generalized estimating equations using a negative binomial distribution and a log link function were used to test hypotheses. Results suggest that days with greater overall PTSD severity are associated with greater alcohol craving, and greater reports of startle and anger/irritability were particularly associated with same-day craving. The next-day results suggest that the combination of the 7 PTSD symptoms did not predict next-day craving. However, greater distress from nightmares the previous night, emotional numbing, and hypervigilance predicted greater next-day craving, while greater anger/irritability predicted lower next-day craving. These findings highlight the importance of assessing the relationship between specific symptoms of PTSD and alcohol cravings in order to increase our understanding of the functional interplay among them for theory building. Additionally, clinicians may be better able to refine treatment decisions to more efficiently break the cycle between PTSD-related distress and AUD symptoms.
View details for DOI 10.1037/a0027169
View details for Web of Science ID 000312682000005
View details for PubMedID 22369221
The Correspondence of Daily and Retrospective PTSD Reports Among Female Victims of Sexual Assault
2012; 24 (4): 1041–47
Research addressing the association between daily and retrospective symptom reports suggests that retrospective reports are typically inflated. The present study examined the association between daily posttraumatic stress disorder (PTSD) symptom reports over 1 month and a corresponding retrospective report (PTSD Checklist [PCL]; Weathers et al., 1993) for both total scores and symptom clusters. The authors hypothesized that greater PTSD symptom instability and greater depression would be associated with poorer agreement between daily and retrospective reports. Data were collected from 132 female college students who were sexually assaulted. Multilevel modeling indicated very strong agreement between mean daily and retrospective reports for total scores and symptom clusters, with pseudo-R2 ranging from .55 to .77. Depression symptoms did not moderate this association, but daily-retrospective agreement was lowest for the avoidance cluster, which was also the most unstable. Finally, retrospective recall for each symptom cluster showed acceptable specificity to the corresponding daily symptom clusters. Overall, these findings suggest that retrospective memories for global PTSD symptoms and symptom clusters, as assessed by the PCL, are consistent with daily reports over a 1-month period. Implications for clinical assessment methodology are discussed.
View details for DOI 10.1037/a0028518
View details for Web of Science ID 000312425000024
View details for PubMedID 22612649
View details for PubMedCentralID PMC3660399
A Randomized Controlled Trial of Event-Specific Prevention Strategies for Reducing Problematic Drinking Associated With 21st Birthday Celebrations
JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY
2012; 80 (5): 850–62
While research has documented heavy drinking practices and associated negative consequences of college students turning 21, few studies have examined prevention efforts aimed at reducing high-risk drinking during 21st birthday celebrations. The present study evaluated the comparative efficacy of a general prevention effort (i.e., Brief Alcohol Screening and Intervention for College Students, or BASICS) and event-specific prevention in reducing 21st birthday drinking and related negative consequences. Furthermore, this study evaluated inclusion of peers in interventions and mode of intervention delivery (i.e., in-person vs. via the Web).Participants included 599 college students (46% male): men who intended to consume at least 5 drinks and women who intended to consume at least 4 drinks on their 21st birthday. After completing a screening/baseline assessment approximately 1 week before turning 21, participants were randomly assigned to 1 of 6 conditions: 21st birthday in-person BASICS, 21st birthday web BASICS, 21st birthday in-person BASICS plus friend intervention, 21st birthday web BASICS plus friend intervention, BASICS, or an attention control. A follow-up assessment was completed approximately 1 week after students' birthdays.Results indicated a significant intervention effect for BASICS in reducing blood alcohol content reached and number of negative consequences experienced. All 3 in-person interventions reduced negative consequences experienced. Results for the web-based interventions varied by drinking outcome and whether a friend was included.Overall, results provide support for both general intervention and ESP approaches across modalities for reducing extreme drinking and negative consequences associated with turning 21. These results suggest there are several promising options for campuses seeking to reduce both use and negative consequences associated with 21st birthday celebrations.
View details for DOI 10.1037/a0029480
View details for Web of Science ID 000309312400014
View details for PubMedID 22823855
View details for PubMedCentralID PMC3458124
Pick your poison: Stimuli selection in alcohol-related implicit measures
2012; 37 (8): 990–93
It is common for people to report strong preferences for certain types of alcohol, often as a function of past positive or negative experiences with particular types of drinks. Despite this individual difference, implicit measures related to alcohol frequently use nomothetic approaches--i.e., use a standard set of alcohol beverage stimuli--which may not match individuals' actual drinking behavior. Moreover, this mismatch may account for some of the inconsistencies across studies using implicit measures. The present study used an idiographic variant of the Implicit Association Test (IAT) in which participants (N=300) selected alcohol images that matched their drinking behavior (non-drinkers selected what they were offered most often). Results were consistent with previous research on alcohol preference: women selected more liquor and wine images, men selected more beer images; heavy episodic drinkers selected more beer and liquor images and selected fewer wine images than lighter drinkers and non-drinkers. In addition, IAT scores were sensitive to drinking levels in the expected direction and, importantly, were robust to stimuli selected. Thus, results provide initial validation of idiographic approaches to stimuli selection.
View details for DOI 10.1016/j.addbeh.2012.03.024
View details for Web of Science ID 000305549900017
View details for PubMedID 22503165
View details for PubMedCentralID PMC3584679
Use of Protective Behavioral Strategies and Their Association to 21st Birthday Alcohol Consumption and Related Negative Consequences: A Between- and Within-Person Evaluation
PSYCHOLOGY OF ADDICTIVE BEHAVIORS
2012; 26 (2): 179–86
The purpose of the present study was to examine between- and within-person relationships among protective behavioral strategies (PBS), alcohol consumption, and related negative consequences during the 21st birthday week. Participants for the present study included undergraduate college students (n = 1,028) who turned 21 during three academic quarters at a large public northwestern university in the United States. Students completed a Web-based survey that comprised measures of 21st birthday PBS, alcohol consumption, and alcohol-related negative consequences. Between-person findings indicated that participants who used more manner of drinking PBS and fewer serious harm reduction PBS consumed fewer drinks and reached lower BACs. Results also showed that participants who used a greater number of limiting/stopping PBS and who used more manner of drinking PBS experienced fewer negative consequences. Within-person findings demonstrated that on days when participants used more limiting/stopping PBS, fewer manner of drinking PBS, and more serious harm reduction PBS than average they also consumed more drinks and reached higher BACs. When examining negative consequences, within-person results showed that on days when participants used more limiting/stopping PBS, fewer manner of drinking PBS, and more serious harm reduction PBS than usual they experienced more negative consequences. Discussion focuses on clarification of the association between PBS and drinking and implications for preventive interventions.
View details for DOI 10.1037/a0023797
View details for Web of Science ID 000305097500001
View details for PubMedID 21553945
View details for PubMedCentralID PMC3191316
Brief motivational feedback and cognitive behavioral interventions for prevention of disordered gambling: a randomized clinical trial
2012; 107 (6): 1148–58
The purpose of the current study was to evaluate feasibility and efficacy of two promising approaches to indicated prevention of disordered gambling in a college population.Randomized clinical trial with assignment to a personalized feedback intervention (PFI), cognitive-behavioral intervention (CBI) or assessment-only control (AOC). PFI was delivered individually in a single session and included feedback regarding gambling behavior, norms, consequences and risk-reduction tips, delivered in a motivational interviewing style. CBI was delivered in small groups over four to six sessions and included functional analysis and brief cognitive correction, as well as identification of and alternatives for responding to gambling triggers.College campus.At-risk or probable pathological gamblers (n = 147; 65.3% male; group assignment: PFI, n = 52; CBI, n = 44; AOC, n = 51).Self-reported gambling quantity, frequency, consequences, psychopathology, normative perceptions and beliefs.Relative to control, results at 6-month follow-up indicated reductions in both interventions for gambling consequences (PFI d = 0.48; CBI d = 0.39) and DSM-IV criteria (PFI d = 0.60; CBI d = 0.48), reductions in frequency for PFI (d = 0.48). CBI was associated with reduced illusions of control, whereas PFI was associated with reduced perceptions of gambling frequency norms. Reductions in perceived gambling frequency norms mediated effects of PFI on gambling frequency.A single-session personalized feedback intervention and a multi-session cognitive-behavioral intervention may be helpful in reducing disordered gambling in US college students.
View details for DOI 10.1111/j.1360-0443.2011.03776.x
View details for Web of Science ID 000303594900025
View details for PubMedID 22188239
View details for PubMedCentralID PMC3528181
Do drinking motives mediate the association between sexual assault and problem drinking?
2012; 37 (3): 323–26
Sexual assault and problem drinking are both prevalent in college women and are interrelated. Findings from cross-sectional research indicate that motives to drink to decrease negative affect (coping motives) or to increase positive affect (enhancement motives) are partial mediators of the sexual assault-problem drinking relation. However, no published longitudinal studies have examined these relations. The current study tests a longitudinal model and examines coping and enhancement motives as potential mediators. Participants were 131 female undergraduates who completed baseline measures of self-reported sexual assault victimization and problem drinking. Coping and enhancement motives were measured at three-month follow up; problem drinking was measured at six-month follow-up. Analyses using structural equation modeling (SEM) indicated direct and indirect paths in the sexual assault-problem drinking relation. Zero-order correlations indicated significant, positive relations among drinking motives, sexual assault, and drinking variables. Longitudinally, mediation was evident for coping but not enhancement motives. Ultimately, findings were most consistent with self-medication hypotheses about the sexual assault - problem drinking relation - i.e., drinking in order to gain relief from symptoms or problems.
View details for DOI 10.1016/j.addbeh.2011.10.009
View details for Web of Science ID 000300862100016
View details for PubMedID 22094169
View details for PubMedCentralID PMC3314710
What Should We Do When Participants Report Dangerous Drinking? The Impact of Personalized Letters Versus General Pamphlets as a Function of Sex and Controlled Orientation
ETHICS & BEHAVIOR
2012; 22 (1): 1–15
Research in which participants report potentially dangerous health-related behaviors raises ethical and professional questions about what to do with that information. Policies and laws regarding reportable behaviors vary across states and Institutional Review Boards (IRB). In alcohol research, IRBs often require researchers to respond to participants who report dangerous drinking practices. Researchers have little guidance regarding how best to respond in such cases. Personalized feedback or general nonpersonalized information may prove differentially effective as a function of gender and/or level of self-determination. This study evaluated response strategies for reducing peak blood alcohol concentration (BAC) among participants reporting dangerous BACs (≥ .35%) in the context of a two-year longitudinal intervention trial with 818 heavy drinking college students. After each assessment, participants who reported drinking to estimated BACs at or greater than .35% were sent either a personalized letter expressing concern and indicating their reported BAC or a nonpersonalized pamphlet that included general information about alcohol and other substances, referral information, and a BAC handout. Hierarchical linear modeling results revealed that both strategies were associated with reduced peak BAC when controlling for previous BAC. The personalized letter was more effective for women and for students who tend to regulate their behavior based on others' expectations and contingencies in the environment. This research provides some guidance for researchers considering appropriate responses to participants who report dangerous health behavior in the context of a research trial.
View details for DOI 10.1080/10508422.2012.638817
View details for Web of Science ID 000301799700001
View details for PubMedID 27909388
View details for PubMedCentralID PMC5127270
Event-Specific Drinking Among College Students
PSYCHOLOGY OF ADDICTIVE BEHAVIORS
2011; 25 (4): 702–7
College represents a period of risk for heavy drinking and experiencing unwanted consequences associated with drinking. Previous research has identified specific events, including holidays (e.g., New Years), school breaks (e.g., Spring Break) and personally relevant events (e.g., 21st birthdays), that are associated with elevated risk of heavy drinking and negative alcohol-related consequences. The systematic evaluation of relative risk offers insights into event-specific drinking and an empirical basis upon which to consider allocation of limited prevention resources. Thus, the purpose of the present study was to provide a comparative index of drinking across a wide range of holidays and compare holiday drinking to 21st birthday drinking. Participants were 1,124 students (55% female) who had turned 21 within the previous three weeks in 2008 and provided 90-day retrospective reports of their drinking using the Timeline Follow-back. Results based on a hurdle mixed model for blood alcohol content revealed several holidays that stand out for elevated drinking, including New Year's Eve and July 4th, whereas other holidays appear more similar to weekend drinking, such as Spring Break (approximately last week of March) and graduation (mid-June). Drinking on holidays or special days was substantially lower than drinking on 21st birthdays. Results are discussed in terms of practical applications for targeted intervention efforts on college campuses toward specific events where elevated drinking is known to occur.
View details for DOI 10.1037/a0024051
View details for Web of Science ID 000298062200014
View details for PubMedID 21639597
View details for PubMedCentralID PMC3192907
Alcohol-involved assault: Associations with posttrauma alcohol use, consequences, and expectancies
2011; 36 (11): 1076–82
Victim alcohol consumption is common prior to sexual assault, and a burgeoning literature suggests that victims who were intoxicated during assault may differ in post-assault adjustment compared to those who were not impaired. Less is known about potential relationships between experiencing an alcohol-involved assault (AIA) and later drinking behavior. In this study, we examined the relationships between sexual assault, subsequent drinking behavior and consequences, and alcohol expectancies in a sample of 306 undergraduate women who reported current alcohol use and reported either no trauma history (n=53), non-AIA (n=69), or AIA (n=184). Differences emerged for alcohol use (F(2, 298)=12.78, p<.001), peak blood alcohol content (F(2, 298)=9.66, p<.001), consequences (F(2, 296)=7.38, p<.005), and positive alcohol expectancies (F(14, 796)=1.93, p<.05). In particular, women with an AIA reported greater alcohol use and positive expectancies compared to women with no trauma history and women with a non-alcohol influenced assault. In addition, both assault groups reported greater drinking consequences than women with no trauma history. Findings suggest that it is the women who are assaulted while under the influence of alcohol who evidence more alcohol use and alcohol-related problems following assault.
View details for DOI 10.1016/j.addbeh.2011.07.001
View details for Web of Science ID 000294984300008
View details for PubMedID 21813246
View details for PubMedCentralID PMC3153602
Coping motives as a mediator of the relationship between sexual coercion and problem drinking in college students
2011; 36 (10): 1001–7
Sexually coercive experiences, heavy alcohol use, and alcohol-related problems occur at relatively high base rates in college populations. As suggested by the self-medication hypothesis, alcohol consumption may be a means by which one can reduce negative affect or stress related to experiences of sexual coercion. However, few studies have directly tested the hypothesis that coping motives for drinking mediate the relation between sexual assault and problem drinking behaviors, and no published studies have tested this in men. The current study tested this hypothesis using structural equation modeling in a sample of 780 male and female undergraduates. Results revealed that coping motives partially mediated the relation between sexual coercion and drinking and alcohol-related negative consequences. In addition, direct and indirect paths between sexual coercion and drinking were found for men whereas only indirect paths were found for women. Results provide support for self-medication models of drinking and suggest the importance of exploring gender differences in mechanisms for drinking.
View details for DOI 10.1016/j.addbeh.2011.06.001
View details for Web of Science ID 000293480400008
View details for PubMedID 21719202
View details for PubMedCentralID PMC3148088
Descriptive Drinking Norms: For Whom Does Reference Group Matter?
JOURNAL OF STUDIES ON ALCOHOL AND DRUGS
2011; 72 (5): 833–43
Perceived descriptive drinking norms often differ from actual norms and are positively related to personal consumption. However, it is not clear how normative perceptions vary with specificity of the reference group. Are drinking norms more accurate and more closely related to drinking behavior as reference group specificity increases? Do these relationships vary as a function of participant demographics? The present study examined the relationship between perceived descriptive norms and drinking behavior by ethnicity (Asian or White), sex, and fraternity/sorority status.Participants were 2,699 (58% female) White (75%) or Asian (25%) undergraduates from two universities who reported their own alcohol use and perceived descriptive norms for eight reference groups: "typical student"; same sex, ethnicity, or fraternity/sorority status; and all combinations of these three factors.Participants generally reported the highest perceived norms for the most distal reference group (typical student), with perceptions becoming more accurate as individuals' similarity to the reference group increased. Despite increased accuracy, participants perceived that all reference groups drank more than was actually the case. Across specific subgroups (fraternity/sorority members and men) different patterns emerged. Fraternity/sorority members reliably reported higher estimates of drinking for reference groups that included fraternity/ sorority status, and, to a lesser extent, men reported higher estimates for reference groups that included men.The results suggest that interventions targeting normative misperceptions may need to provide feedback based on participant demography or group membership. Although reference group-specific feedback may be important for some subgroups, typical student feedback provides the largest normative discrepancy for the majority of students.
View details for DOI 10.15288/jsad.2011.72.833
View details for Web of Science ID 000295562500015
View details for PubMedID 21906510
View details for PubMedCentralID PMC3174027
Comparing the Diagnosis of PTSD When Assessing Worst Versus Multiple Traumatic Events in a Chronically Mentally Ill Sample
JOURNAL OF TRAUMATIC STRESS
2011; 24 (3): 361–64
Despite interest in the nature of the traumatic event required to meet Criterion A for posttraumatic stress disorder (PTSD) as defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994), little attention has been paid to the diagnostic ramifications of linking PTSD symptoms to a single traumatic event in the context of multiple trauma exposures. In this study, 67 dually diagnosed clients with at least 2 potential Criterion A traumatic events completed the Posttraumatic Stress Diagnostic Scale twice, in counterbalanced order: once regarding their worst event and once regarding all events. When responding regarding their worst trauma, 53.7% met probable PTSD criteria. This rose to 67.2% when considering all traumas. Although preliminary, these results suggest that linking PTSD symptoms to a single traumatic event excludes a meaningful number of cases who are otherwise indistinguishable based on symptom profile.
View details for DOI 10.1002/jts.20647
View details for Web of Science ID 000291350300017
View details for PubMedID 21594901
Experimental and cross-sectional examinations of the relations among implicit alcohol cognitions, stress, and drinking
ELSEVIER SCIENCE INC. 2011: 276
View details for Web of Science ID 000289538300048
Alcohol Use, Problems, and the Course of Posttraumatic Stress Disorder: A Prospective Study of Female Crime Victims
JOURNAL OF DUAL DIAGNOSIS
2011; 7 (4): 262–79
This study examines whether alcohol use disorder status and consequences of drinking moderate the course of PTSD over the first 6 months following trauma exposure in a sample of female victims of interpersonal violence.Female sexual and physical assault victims (n = 64) were recruited through police, hospital, and victim service agencies. Women completed structured clinical interviews and self-report measures within the first five weeks, three months, and six months post-trauma with 73% retention across all three time points (n = 47). Analyses were conducted using Hierarchical Linear Modeling using alcohol abuse/dependence, peak alcohol use, and consequences during the 30 days prior to assault as moderators of the course of PTSD over time.Women with alcohol use disorder at baseline had lower initial PTSD symptoms but also less symptom recovery over time than women without alcohol use disorder. This pattern of results was also found for those with high negative drinking consequences during the month prior to the assault. Baseline alcohol use was not found to significantly moderate PTSD course over the 6 months.Findings suggest that negative consequences associated with alcohol use may be a risk factor for PTSD. Incorporating assessment of drinking problems for women presenting early post-trauma may be useful for identifying PTSD risk.
View details for DOI 10.1080/15504263.2011.620449
View details for Web of Science ID 000300007600006
View details for PubMedID 23538605
View details for PubMedCentralID PMC3607458
PTSD symptom clusters in relationship to alcohol misuse among Iraq and Afghanistan war veterans seeking post-deployment VA health care
2010; 35 (9): 840–43
Demographic factors, characteristics of military service, PTSD, and depression were examined as predictors of alcohol misuse in Iraq and Afghanistan War Veterans (N=287) presenting for post-deployment Veteran Affairs (VA) health care. Results indicated that alcohol misuse was more common among younger male Veterans who served in the Army or Marine Corps. Accounting for demographic factors and characteristics of service, Veterans who screened positive for PTSD or depression were two times more likely to report alcohol misuse relative to Veterans who did not screen positive for these disorders. The examination of specific PTSD symptom clusters suggested that emotional numbing symptoms were most strongly associated with alcohol misuse. The implications for interventions for alcohol misuse in returning Veterans are discussed.
View details for DOI 10.1016/j.addbeh.2010.03.023
View details for Web of Science ID 000280030000006
View details for PubMedID 20471180
Alcohol-Involved Assault and the Course of PTSD in Female Crime Victims
JOURNAL OF TRAUMATIC STRESS
2010; 23 (4): 523–27
Although alcohol use has been associated with increased risk of victimization, little is known about how victim substance use at the time of assault may affect posttraumatic stress disorder (PTSD) symptom development. The present study is a longitudinal examination of substance use on PTSD symptom severity and course. A community sample of female crime victims (n = 60) were assessed within 5 weeks of sexual or physical assault with 3 and 6 month post-assault follow-ups. Twenty-three participants had consumed alcohol or alcohol/drugs prior to the assault (38%) and 37 had consumed neither alcohol nor drugs. Analyses were conducted using hierarchical linear modeling. Participants who had consumed alcohol had lower initial intrusive symptoms, but their symptoms improved less over time.
View details for DOI 10.1002/jts.20542
View details for Web of Science ID 000281501400017
View details for PubMedID 20669240
View details for PubMedCentralID PMC3647032
Incapacitated Rape and Alcohol Use in White and Asian American College Women
VIOLENCE AGAINST WOMEN
2010; 16 (8): 919–33
This study examined the role of Asian ethnicity as a moderator of drinking outcomes associated with alcohol-related sexual assault (incapacitated rape). Participants were 5,467 Asian American and White college women. Results found the overall MANOVA for ethnicity and incapacitated rape (IR) interactions to be significant. Asian American participants with no history of IR had fewer drinking problems than White American participants with no history of IR. Asian American participants with IR histories had more drinking problems than White Americans with IR histories. Findings indicate Asian Americans who experience IR may be at increased risk for negative alcohol outcomes.
View details for DOI 10.1177/1077801210377470
View details for Web of Science ID 000280610300005
View details for PubMedID 20679187
Use of Drinking Protective Behavioral Strategies in Association to Sex-Related Alcohol Negative Consequences: The Mediating Role of Alcohol Consumption
PSYCHOLOGY OF ADDICTIVE BEHAVIORS
2010; 24 (2): 229–38
Alcohol use has been implicated as a risk factor for sexual negative consequences, such as unprotected sexual intercourse. The present research was conducted to examine the relationship between drinking protective behavioral strategies and consensual sex-related alcohol negative consequences, and whether this relationship varied by gender. Additionally, typical number of drinks during sexual behavior was evaluated as a potential mediator of this association. Heavy drinking, sexually active college students (N = 297, 50.2% women) completed self-report measures of drinking protective behavioral strategies, alcohol consumption, and sex-related alcohol negative consequences. Findings indicated that women who used drinking protective behavioral strategies more frequently were less likely to experience sex-related alcohol negative consequences whereas this relationship was not significant for men. For women, this relationship was mediated by the typical number of drinks consumed during sexual behavior. The current research demonstrates that use of drinking protective behavioral strategies is related to a reduction in women's sex-related risks when drinking. Findings are discussed in terms of alcohol myopia theory. Implications for interventions aimed to reduce higher risk sexual behavior among college students are discussed.
View details for DOI 10.1037/a0018361
View details for Web of Science ID 000279069600006
View details for PubMedID 20565149
View details for PubMedCentralID PMC2891544
The Relationship between Condom-Related Protective Behavioral Strategies and Condom Use among College Students: Global- and Event-Level Evaluations
JOURNAL OF SEX RESEARCH
2010; 47 (5): 471–78
This study evaluated the relationship between condom-related protective behavioral strategies (PBS; including those that require active behavior and mental planning) and condom use at both global and event levels. College students (N = 623; 57.8% female) completed self-report measures of condom-related PBS, as well as drinking and sexual behavior. Logistic regression findings indicated that students who reported greater use of condom-related PBS were more likely to discuss their and their partner's HIV status, sexually transmitted infection (STI) history (other than HIV), and protection against STIs (such as HIV and other STIs) the first time they had sex with their most recent vaginal sexual partner. Logistic regression findings also indicated that more frequent use of condom-related PBS was associated with being more likely to use a condom during the most recent vaginal sexual experience. Zero-inflated negative binomial regression results showed that condom-related PBS predicted condom non-users and that condom-related PBS were associated with increased use of condoms during sexual behavior in the previous three months. These results extend prior research by demonstrating that both active and mental planning condom-related PBS are associated with condom use at both the global and event levels, which suggests that condom-related PBS may be useful to incorporate in interventions targeting risky sexual behavior among young adults.
View details for DOI 10.1080/00224490903132069
View details for Web of Science ID 000283890600007
View details for PubMedID 19657943
View details for PubMedCentralID PMC2927717
Duration of Exposure and the Dose-Response Model of PTSD
JOURNAL OF INTERPERSONAL VIOLENCE
2010; 25 (1): 63–74
A dose-response model underlies posttraumatic stress disorder (PTSD) and posits a relationship between event magnitude and clinical outcome. The present study examines whether one index of event magnitude--duration of exposure--contributes to risk of PTSD among female victims of sexual assault. Findings support a small but significant contribution of event duration to clinical status in the immediate aftermath of trauma but not at 3-month follow-up. The opposite pattern is obtained for subjective appraisals of threat. These findings add to a growing literature that suggests that a simple application of the dose-response model to objective event characteristics may be insufficient to explain the risk of PTSD.
View details for DOI 10.1177/0886260508329131
View details for Web of Science ID 000272145800004
View details for PubMedID 19252066
View details for PubMedCentralID PMC2962551
Evaluating Level of Specificity of Normative Referents in Relation to Personal Drinking Behavior
JOURNAL OF STUDIES ON ALCOHOL AND DRUGS
Research has found perceived descriptive norms to be one of the strongest predictors of college student drinking, and several intervention approaches have incorporated normative feedback to correct misperceptions of peer drinking behavior. Little research has focused on the role of the reference group in normative perceptions. The current study sought to examine whether normative perceptions vary based on specificity of the reference group and whether perceived norms for more specific reference-group norms are related to individual drinking behavior.Participants were first-year undergraduates (n = 1,276, 58% female) randomly selected from a university list of incoming students. Participants reported personal drinking behavior and perceived descriptive norms for eight reference groups, including typical student; same gender, ethnicity, or residence; and combinations of those reference groups (e.g., same gender and residence).Findings indicated that participants distinguished among different reference groups in estimating descriptive drinking norms. Moreover, results indicated misperceptions in drinking norms were evident at all levels of specificity of the reference group. Additionally, findings showed perceived norms for more specific groups were uniquely related to participants' own drinking.These results suggest that providing normative feedback targeting at least one level of specificity to the participant (i.e., beyond what the "typical" student does) may be an important tool in normative feedback interventions.
View details for DOI 10.15288/jsads.2009.s16.115
View details for Web of Science ID 000267842300013
View details for PubMedID 19538919
View details for PubMedCentralID PMC2701099
Readiness to Change Drinking Behavior in Female College Students
JOURNAL OF STUDIES ON ALCOHOL AND DRUGS
Motivational interviewing (MI) therapies are effective in reducing high-risk drinking in college populations. Although research supports efficacy of MI prevention strategies in reducing alcohol use, there are little data examining readiness to change (RTC), the underlying theoretical model of MI interventions. The purpose of the present study was to explore RTC variability and drinking behavior and whether MI increases RTC in an intervention group compared with controls.Two-hundred eighty-five first-year female college students participated in the study. Present analyses focused on those students who consumed alcohol in the month before the study (n = 182). RTC was measured using the Readiness to Change Ruler.Analyses were conducted using hierarchical linear modeling. There was significant variability in RTC: 71.86% of variance in RTC was between-person differences, and 28.14% was within-person differences. Higher RTC was associated with lower intentions to drink and future drinking behavior. However, in weeks in which students drank more, they experienced a decrease in RTC. Based on the significant cross-level interaction, the intervention group had significantly higher RTC than controls.These results provided partial support for our hypotheses. The overall theoretical construct of RTC varies both across and within individuals. These results also offer support for the utility of MI-based prevention strategies in increasing RTC within individuals. However, we did not consistently find that these changes related to drinking changes. Findings provide support for both the construct of RTC and utility of MI interventions in changing these beliefs in female college students.
View details for DOI 10.15288/jsads.2009.s16.106
View details for Web of Science ID 000267842300012
View details for PubMedID 19538918
View details for PubMedCentralID PMC2701096
Identification With Mainstream Culture and Preference for Alternative Alcohol Treatment Approaches in a Community Sample
ASSOC ADV BEHAVIOR THERAPY. 2009: 72–81
Although various treatment approaches are available for alcohol problems, less than 25% of individuals with alcohol use disorders obtain treatment. The purpose of this study is to evaluate interest in attending alternative alcohol treatments, such as meditation and acupuncture, compared to Alcoholics Anonymous (AA). A community sample of 156 adult participants concerned about their drinking were recruited through flyers and newspaper advertisements to complete a Web-based survey assessing identification with mainstream culture, sexual identity, and likelihood to attend alternative alcohol treatments. Participants reported higher likelihood of attending alternative treatments as compared to AA, and lesbian, gay, and bisexual participants (28.2% of the sample) were more likely to attend alternative treatments than heterosexual participants. A series of regression analyses were conducted to test whether the relationship between sexual identity and likelihood to attend alternative treatments was mediated by identification with mainstream culture. Participants who were less strongly identified with mainstream culture, regardless of sexual identity, reported higher likelihood of attending alternative treatments. These findings highlight that, for certain subgroups of the population, alternative treatments for alcohol misuse are appealing and suggest the need for future research testing the efficacy of alternative treatments for alcohol problems.
View details for DOI 10.1016/j.beth.2008.01.002
View details for Web of Science ID 000263507700007
View details for PubMedID 19187818
The relation between interpersonal violence and substance use among a sample of university students: Examination of the role of victim and perpetrator substance use
2009; 34 (3): 316–18
To examine the relation between interpersonal violence and substance use and to describe the role of victim and perpetrator substance use within such incidents among university students.A random sample of students (N=1197) participating in this cross-sectional study completed an online survey. Logistic regression models assessed the relation between substance use and sexual and physical victimization. Victim and perpetrator substance use at the time of incident were described.Females were more likely to report sexual violence compared to males, whereas males were more likely to report physical victimization (p's<0.05). In logistic regression models, all forms of substance use were significantly associated with physical victimization among males (OR's=2.0-5.1). Among females, most forms of substance use were associated with sexual victimization (OR's=2.4-4.7). Both males and females reported high rates of perpetrator and own substance use during victimization incidents.Findings suggest that previous documentation among victimization studies of a relation between substance use and subsequent risk for victimization may also be attributable to the substance use behavior of the perpetrator.
View details for DOI 10.1016/j.addbeh.2008.10.015
View details for Web of Science ID 000263130200014
View details for PubMedID 19028021
View details for PubMedCentralID PMC4497789
Beyond fear - The role of peritraumatic responses in posttraumatic stress and depressive symptoms among female crime victims
JOURNAL OF INTERPERSONAL VIOLENCE
2008; 23 (6): 853–68
This study examines peritraumatic (and posttrauma) responses in a sample of female crime victims who had been sexually or physically assaulted within the previous 2 months. Women were interviewed about their emotional and behavioral responses during the trauma and assessed for posttraumatic stress disorder and depression symptomatology. Results indicate that women experience a wide range of behavioral and emotional responses during a traumatic event and that these responses have implications for posttrauma adjustment. Women who experienced behaviors typical of a freeze response are more likely to have a greater degree of symptomatology after the assault. Peritraumatic emotions, other than fear, such as sadness, humiliation, and anger, also appear to be related to posttrauma depression symptoms. These findings highlight the necessity of exploring the full range of possible reactions during a trauma.
View details for DOI 10.1177/0886260508314851
View details for Web of Science ID 000255512700009
View details for PubMedID 18292400
Posttraumatic stress disorder, alcohol use, and physical health concerns
JOURNAL OF BEHAVIORAL MEDICINE
2008; 31 (2): 115–25
PTSD is a risk factor for alcohol problems and both in turn have been independently associated with increased health problems. However, it is unclear whether alcohol use moderates the relationship between PTSD and health. Participants were battered women (N = 336) recruited from local domestic violence shelters and non-shelter victim-assistance agencies. A 2 (PTSD diagnosis) x 3 (abstainer, infrequent/light, regular/heavy drinking) ANCOVA was conducted, with injuries and length of abuse as covariates and health concerns as the dependent variable. Main effects for PTSD and alcohol use were significant but not the interaction. Women with PTSD reported the greatest number of health concerns. Women who abstained from drinking and those who drank regularly/heavily reported more health concerns than the infrequent/light drinkers. Health concerns associated with PTSD do not appear to be due to problem drinking. In addition, infrequent/light drinking, even for women with PTSD, may be associated with fewer health concerns.
View details for DOI 10.1007/s10865-007-9140-5
View details for Web of Science ID 000255839100003
View details for PubMedID 18095150
View details for PubMedCentralID PMC2977920
Intimate partner violence perpetration and problem drinking among college students: The roles of expectancies and subjective evaluations of alcohol aggression
JOURNAL OF STUDIES ON ALCOHOL AND DRUGS
2007; 68 (5): 706–13
The present research examined the effect of alcohol aggression expectancies and subjective evaluations of alcohol's effects on aggression in intimate partner violence (IPV) perpetration among college students. We were interested in determining the extent to which these relationships differed across gender.A total of 780 (57.3% female) incoming heavy drinking college freshmen who were between the ages of 18 and 25 years completed self-reported measures of IPV perpetration, alcohol use and problems, and alcohol aggression expectancies and subjective evaluations of those expectancies as part of the baseline assessment for a larger social norms alcohol intervention study. Analyses evaluated the effect of alcohol aggression expectancies and subjective evaluations of those expectancies on IPV perpetration.Results indicated that problem drinking was positively associated with IPV perpetration for those who were lower (beta = .32, p < .001) versus those who were higher (beta = .07, p = ns) in alcohol aggression expectancies. Among men, there was a significantly stronger relationship between problem drinking and IPV perpetration among those who evaluated alcohol's effects on aggression more favorably (beta = .41, p < .001) versus less favorably (beta = .11, p = ns). Among women, there was not a significantly stronger relationship between problem drinking and IPV perpetration at less favorable (beta = .17, p < .05) versus more favorable (beta = .11, p < .06) evaluations of alcohol's effects on aggression.Findings suggest that, in understanding IPV perpetration, it may not be sufficient to evaluate expected alcohol effects without also including whether those effects are viewed as good or bad. Findings also suggest that the relationship between alcohol problems and IPV perpetration may be stronger and more straightforward for men than for women.
View details for DOI 10.15288/jsad.2007.68.706
View details for Web of Science ID 000248891600011
View details for PubMedID 17690804
View details for PubMedCentralID PMC2459310
Domestic violence and alcohol use: Trauma-related symptoms and motives for drinking
2007; 32 (6): 1272–83
Alcohol use is frequently associated with posttraumatic stress disorder (PTSD), especially in the face of chronic traumatic experiences. However, the relationship between alcohol use and symptoms associated with chronic trauma exposure has not been evaluated. This study examined alcohol use in recently battered women (N=369). Differences were found in trauma symptoms between abstainers, moderate drinkers, and heavy drinkers, with heavy drinkers reporting more severe symptoms. Mediational analyses suggest that the relationship between drinking and trauma symptoms is mediated by drinking to cope, which has not been previously demonstrated in a battered population. Results suggest the importance of assessing trauma symptoms and motives for drinking in understanding alcohol use in recent survivors of domestic violence.
View details for DOI 10.1016/j.addbeh.2006.09.007
View details for Web of Science ID 000246097600013
View details for PubMedID 17098370
View details for PubMedCentralID PMC1902810
Incapacitated rape and alcohol use: A prospective analysis
2006; 31 (10): 1820–32
This study examined timing of alcohol-related sexual assaults (incapacitated rape) in relation to both alcohol consumption and alcohol-related negative consequences. The sample was drawn from a randomly selected pool of college students across three campuses (n=1238) followed over a three year time period. 91% of students never experienced an incapacitated rape, 2% reported an incapacitated rape prior to the first assessment point (n=30), and 6% reported one over the course of the study (n=76). Results indicated that incapacitated rape was associated with higher alcohol use and more negative consequences in the years prior to the assault. Incapacitated rape was also associated with higher alcohol use and more negative consequences during the year in which the rape took place and subsequent years, with highest rates measured for the year of the rape. These results suggest alcohol use can function as both risk factor and consequence of sexual victimization.
View details for DOI 10.1016/j.addbeh.2005.12.025
View details for Web of Science ID 000240719500008
View details for PubMedID 16446044
View details for PubMedCentralID PMC1893005
Alcohol problems and posttraumatic stress disorder in female crime victims
JOURNAL OF TRAUMATIC STRESS
2006; 19 (3): 399–403
Comorbidity between alcohol use and posttraumatic stress disorder (PTSD) has been well documented. However, there are few longitudinal studies with acute trauma samples. The present study examined symptoms of alcohol use disorders (AUDs) and PTSD longitudinally after assault. Female sexual (n = 69) and physical assault victims (n = 39) were assessed 2 to 4 weeks and 3 months post trauma. Women who had lifetime AUD had higher intrusive and avoidance symptoms than those who did not have AUD. Women who had any alcohol problems had higher PTSD symptoms. Participants who had alcohol problems had the same pattern of symptom recovery as those who did not have alcohol problems but remained more symptomatic over the 3 months. These findings suggest that early intervention strategies for women who have previous histories of alcohol problems and seek medical attention early post trauma may be indicated.
View details for DOI 10.1002/jts.20122
View details for Web of Science ID 000238773800009
View details for PubMedID 16788998
View details for PubMedCentralID PMC2958431
Peritraumatic responses and their relationship to perceptions of threat in female crime victims
VIOLENCE AGAINST WOMEN
2005; 11 (12): 1515–35
Peritraumatic responses, aside from dissociation, have been understudied in acute trauma populations. Participants were 172 female rape, 68 assault, and 80 robbery victims recruited through formal reporting agencies and assessed 1 month after the crime. Despite substantial overlap across crimes, rape victims reported more emotional responses reflecting fear, detachment, shame, and more nonactive behavioral responses. Regression analysis examining the prediction of perceived threat by peritraumatic responses and crime variables indicated that increased duration of crimes; decreased calmness; increased fear; numbing; use of begging, pleading, and crying; and attempts to reason with the perpetrator(s) were all significantly associated with increased appraisal of threat.
View details for DOI 10.1177/1077801205280931
View details for Web of Science ID 000235467500004
View details for PubMedID 16247114
View details for PubMedCentralID PMC1317308
Cognitive processing therapy for acute stress disorder resulting from an anti-gay assault
ASSOC ADV BEHAVIOR THERAPY. 2005: 278–89
This case study describes Cognitive Processing Therapy (CPT) with a 30-year-old gay man with symptoms of acute stress disorder (ASD) following a recent homophobic assault. Treatment addressed assault-related posttraumatic stress disorder symptoms and depressive symptoms. Also addressed were low self-esteem, helplessness, and high degrees of internalized homophobia. Client symptomatology was tracked using the PTSD Symptom Scale and the Beck Depression Inventory over the course of 12 sessions and for a 3-month posttermination session. Symptoms were significantly reduced by the end of the 12-week therapy and were maintained at 3-month follow-up. This case highlights the utility of this therapy in targeting both ASD symptoms and internalized homophobia relating to experiencing a hate crime-related assault. The authors elaborate on theoretical and applied issues in adapting a structured cognitive-behavioral intervention to the treatment of ASD symptoms associated with experiencing a hate crime.
View details for DOI 10.1016/S1077-7229(05)80050-1
View details for Web of Science ID 000233682900002
View details for PubMedID 17075610
View details for PubMedCentralID PMC1627447
Cognitive mediation of childhood maltreatment and adult depression in recent crime victims
ASSOC ADV BEHAVIOR THERAPY. 2005: 235–44
Childhood maltreatment has been linked to adult depressive disorders. However, few studies have examined mechanisms through which childhood maltreatment may contribute to adult depression. Thus, we examined the role of one potential mechanism of this relationship, maladaptive cognitions, in a recently traumatized sample. Participants were adult women who had been recently raped (n = 133) or physically assaulted (n = 73). We examined whether maladaptive self-and other-cognitions mediated relationships between childhood sexual, physical, and emotional abuse and current depression. Relationships between childhood sexual abuse and both current depression symptoms and diagnosis were mediated by maladaptive cognitions about self. Relationships between both childhood sexual abuse and childhood physical abuse and adult depressive symptoms were mediated by maladaptive cognitions about others.
View details for DOI 10.1016/S0005-7894(05)80072-3
View details for Web of Science ID 000231225700004
View details for PubMedID 16467922
View details for PubMedCentralID PMC1351207
Living in danger: the impact of chronic traumatization and the traumatic context on posttraumatic stress disorder.
Trauma, violence & abuse
2003; 4 (3): 247–64
In this article on the effects of chronic traumatization, research is reviewed regarding the association between chronicity of traumatization and posttraumatic stress disorder (PTSD) symptomatology. The contribution of the broader traumatic context to PTSD symptomatology is also examined. This review focuses on three populations: combat veterans, child sexual abuse survivors, and survivors of domestic violence. The challenges of defining chronicity of a traumatic event and traumatic context are addressed. Finally, suggestions for future directions are provided.
View details for DOI 10.1177/1524838003004003004
View details for PubMedID 14697125