/pdf/invisible-wounds-of-war-psychological-and-cognitive-injuries-30tq5543fu.pdf

Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences and Services to Assist Recovery

Background: The International Trauma Questionnaire (ITQ) is a validated measure that assesses ICD-11 posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD). An important task is to determine...

https://www.tandfonline.com/doi/pdf/10.1080/20008198.2021.1930961

The international trauma questionnaire (ITQ) measures reliable and clinically significant treatment-related change in PTSD and complex PTSD

In the context of an ongoing, highly uncertain pandemic, disaster mental health measures can increase community capacity for resilience and well-being, support formal mental health treatment, and help address the risk for mental health reactions in high-stress occupations. The purpose of this review is to summarize the literature on disaster mental health interventions that have been helpful both prior to and during the pandemic in a broad range of applications, including for use with high-stress occupations in an effort to mitigate risk for post-traumatic stress disorder (PTSD) and other mental health sequelae.Evidence-based and evidence-informed disaster mental health interventions, frameworks, and treatments have been studied in pilot studies, non-randomized trials, and randomized clinical trials prior to and in the context of the current COVID-19 pandemic. The studies have demonstrated feasibility and acceptability of these modalities and improved perceived support, as well as significant reductions in distress, and mental health symptoms such as depression, anxiety, and PTSD.A disaster mental health approach to the COVID-19 pandemic can generate opportunities for prevention and support at multiple levels with timely interventions tailored for different concerns, cultures, and available resources. 

/pdf/stress-ptsd-and-covid-19-the-utility-of-disaster-mental-42x6grki.pdf

Stress, PTSD, and COVID-19: the Utility of Disaster Mental Health Interventions During the COVID-19 Pandemic

Blended models of therapy, which incorporate elements of both internet and face-to-face methods, have been shown to be effective, but therapists and patients have expressed concerns that fewer face-to-face therapy sessions than self-guided internet sessions may be associated with lower therapeutic alliance, lower program completion rates, and poorer outcomes.A multisite quasi-experimental comparison study with a noninferiority design implemented in routine clinical care was used to assess webSTAIR, a 10-module blended therapy derived from STAIR (skills training in affective and interpersonal regulation) for trauma-exposed individuals delivered with 10 weekly therapist sessions (termed Coach10) compared to 5 biweekly sessions (Coach5). It was hypothesized that Coach5 would be as good as Coach10 in a range of outcomes.A total of 202 veterans were enrolled in the study with 101 assigned to Coach5 and 101 to Coach10. Posttraumatic stress disorder (PTSD) symptoms, depression, emotion regulation, interpersonal problems, and social functioning measures were collected pre-, mid-, and posttreatment, and at a 3-month follow-up. Noninferiority analyses were conducted on symptom outcome measures. Comparisons were made of continuous and categorical measures regarding participant and therapist activities.Participants reported moderate to severe levels of baseline PTSD, depression, or both. Significant reductions were obtained in all symptom measures posttreatment and at the 3-month follow up. Coach5 was not inferior to Coach10 in any outcome. Therapeutic alliance was at an equivalently high level across the 2 treatment conditions; completion rates and web usage were similar. Total session time was substantially less for the Coach5 therapists than the Coach10 therapists. Both programs were associated with a low, but equal number of therapist activities related to scheduling and crisis or motivational sessions.A blended model delivered with 5 sessions of therapist support was noninferior to 10 sessions in individuals with moderate to severe symptoms. Future studies identifying patient characteristics as moderators of outcomes with high versus low doses of therapist support will help create flexible, technology-based intervention programming. 

/pdf/comparing-the-ratio-of-therapist-support-to-internet-1msl4od8.pdf

Comparing the Ratio of Therapist Support to Internet Sessions in a Blended Therapy Delivered to Trauma-Exposed Veterans: Quasi-experimental Comparison Study

Background It has been identified that military veterans have distinct experiences of loneliness and social isolation and, when comparing this community to other client groups with a PTSD diagnosis, veterans respond less favorably to treatment. However, the link between PTSD and loneliness for veterans remains insufficiently researched and it is unclear if there are effective interventions tackling this distinct experience of loneliness. Aims This systematic narrative review aimed to synthesize existing evidence incorporating elements of social connection, social isolation, and loneliness within interventions for military veterans with a diagnosis of PTSD, consequently aiming to examine the impact of such interventions upon this community. Methods Six databases were searched, utilizing relevant search criteria, with no date restrictions. Articles were included if they involved intervention or treatment for military veterans with PTSD and considered elements of social connection, social isolation, and/or loneliness. The initial search returned 202 papers. After exclusions, removal of duplications, and a reference/citation search, 28 papers remained and were included in this review. Results From the 28 studies, 11 directly addressed social isolation and two studies directly addressed loneliness. Six themes were generated: (i) rethinking the diagnosis of PTSD, (ii) holistic interventions, (iii) peer support, (iv) social reintegration, (v) empowerment through purpose and community, and (vi) building trust. Conclusions A direct focus upon social reintegration and engagement, psychosocial functioning, building trust, peer support, group cohesiveness and empowerment through a sense of purpose and learning new skills may mitigate experiential loneliness and social isolation for veterans with PTSD. Future research and practice should further explore the needs of the PTSD-diagnosed veteran community, seek to explore and identify potential common routes toward the development of PTSD within this community and consider bespoke interventions for tackling loneliness.

https://www.frontiersin.org/articles/10.3389/fpsyg.2022.873885/pdf

Exploring the Role of Social Connection in Interventions With Military Veterans Diagnosed With Post-traumatic Stress Disorder: Systematic Narrative Review

Emotion regulation difficulties are common experiences for survivors of trauma, especially those who have experienced early childhood and/or interpersonal trauma. Because close relationships provide a core vehicle for early learning, childhood and/or interpersonal trauma can interrupt the normative development of skills to modulate both emotional experiencing and interpersonal relating. Skills training in affective and interpersonal regulation (STAIR) Narrative Therapy offers a two-module framework to address such challenges in a supportive, pragmatic, and client-centered way. This chapter outlines key theoretical underpinnings of STAIR Narrative Therapy, particularly theories of attachment, resource loss, and narrative therapy, before providing an overview of the therapy’s skills training and narrative components. A case example elucidates how the theory and intervention work in an applied manner. The chapter ends with a review of the most recent research supporting the effectiveness of STAIR Narrative Therapy and a preview of more recent, novel applications of the model.

Skills Training in Affective and Interpersonal Regulation (STAIR) Narrative Therapy: Making meaning while learning skills

Background: Veterans have higher rates of PTSD and depression compared to the general population and experience substantial functional impairment Impairment in social functioning has been a significant concern among Veterans, particularly rural Veterans, who have limited access to mental health care and are at risk for social isolation Objective: A mixed-method study was implemented to evaluate the feasibility and effectiveness of webSTAIR, a web-based skills training programme, paired with home-based telehealth sessions It was hypothesized that the programme would lead not only to reductions in PTSD and depression but also to improvements in social functioning Method: Participants were 80 trauma-exposed Veterans enrolled in rural-serving VHA facilities with clinically elevated symptoms of either PTSD or depression The study directed substantial outreach efforts to rural women Veterans and those who have experienced military sexual trauma (MST) Results: Significant improvements were obtained with PTSD and depression symptoms as well as in social functioning, emotion regulation, and interpersonal problems at post-treatment and 3-month follow-up Ratings of therapeutic alliance were high as were reports of overall satisfaction in the programme There were no differences by gender or MST status in symptom outcomes or satisfaction Conclusions: The results support the feasibility and effectiveness of this integrated telehealth web-based skills training programme for both male and female Veterans as well as for those with and without MST The focus on resource building and improved functioning make this programme of particular interest Further testing is warranted

https://www.tandfonline.com/doi/pdf/10.1080/20008198.2020.1860357

A Resource Building Virtual Care Programme: improving symptoms and social functioning among female and male rural veterans

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Skills Training in Affective and Interpersonal Regulation (STAIR) Narrative Therapy: Making meaning while learning skills

A Resource Building Virtual Care Programme: improving symptoms and social functioning among female and male rural veterans