Regression-based statistical mediation and moderation analysis in clinical research: Observations, recommendations, and implementation.

Importance Posttraumatic stress disorder (PTSD) is a disabling psychiatric disorder common among military personnel and veterans. First-line psychotherapies most often recommended for PTSD consist mainly of “trauma-focused” psychotherapies that involve focusing on details of the trauma or associated cognitive and emotional effects. Objective To examine the effectiveness of psychotherapies for PTSD in military and veteran populations. Evidence Review PubMed, PsycINFO, and PILOTS were searched for randomized clinical trials (RCTs) of individual and group psychotherapies for PTSD in military personnel and veterans, published from January 1980 to March 1, 2015. We also searched reference lists of articles, selected reviews, and meta-analyses. Of 891 publications initially identified, 36 were included. Findings Two trauma-focused therapies, cognitive processing therapy (CPT) and prolonged exposure, have been the most frequently studied psychotherapies for military-related PTSD. Five RCTs of CPT (that included 481 patients) and 4 RCTs of prolonged exposure (that included 402 patients) met inclusion criteria. Focusing on intent-to-treat outcomes, within-group posttreatment effect sizes for CPT and prolonged exposure were large (Cohen d range, 0.78-1.10). CPT and prolonged exposure also outperformed waitlist and treatment-as-usual control conditions. Forty-nine percent to 70% of participants receiving CPT and prolonged exposure attained clinically meaningful symptom improvement (defined as a 10- to 12-point decrease in interviewer-assessed or self-reported symptoms). However, mean posttreatment scores for CPT and prolonged exposure remained at or above clinical criteria for PTSD, and approximately two-thirds of patients receiving CPT or prolonged exposure retained their PTSD diagnosis after treatment (range, 60%-72%). CPT and prolonged exposure were marginally superior compared with non–trauma-focused psychotherapy comparison conditions. Conclusions and Relevance In military and veteran populations, trials of the first-line trauma-focused interventions CPT and prolonged exposure have shown clinically meaningful improvements for many patients with PTSD. However, nonresponse rates have been high, many patients continue to have symptoms, and trauma-focused interventions show marginally superior results compared with active control conditions. There is a need for improvement in existing PTSD treatments and for development and testing of novel evidence-based treatments, both trauma-focused and non–trauma-focused.

Psychotherapy for Military-Related PTSD: A Review of Randomized Clinical Trials.

Objective:Attention allocation to threat is perturbed in patients with posttraumatic stress disorder (PTSD), with some studies indicating excess attention to threat and others indicating fluctuations between threat vigilance and threat avoidance. The authors tested the efficacy of two alternative computerized protocols, attention bias modification and attention control training, for rectifying threat attendance patterns and reducing PTSD symptoms.Method:Two randomized controlled trials compared the efficacy of attention bias modification and attention control training for PTSD: one in Israel Defense Forces veterans and one in U.S. military veterans. Both utilized variants of the dot-probe task, with attention bias modification designed to shift attention away from threat and attention control training balancing attention allocation between threat and neutral stimuli. PTSD symptoms, attention bias, and attention bias variability were measured before and after treatment.Results:Both studies indicated signif...

/pdf/effect-of-attention-training-on-attention-bias-variability-24itcuby7d.pdf

Effect of Attention Training on Attention Bias Variability and PTSD Symptoms: Randomized Controlled Trials in Israeli and U.S. Combat Veterans

https://biblio.ugent.be/publication/8687172/file/8692967.pdf

Neural correlates of emotion-attention interactions : From perception, learning, and memory to social cognition, individual differences, and training interventions

Convergence of prefrontal and parietal anatomical projections in a connectional hub in the striatum

The effectiveness of an attention bias modification program as an adjunctive treatment for Post-Traumatic Stress Disorder.

Establishing an Embedded Psychiatry Rotation with Naval Special Warfare: A Win for Both the Education of Military Psychiatry Residents and the Operational Forces.

Stigma against mental illness and its treatment has long been an issue across societies. While the stigma against seeking mental health treatment has generally decreased over time, the same may not be true when the person seeking treatment is a world leader. In this paper, we discuss historical examples of world leaders who have had mental health concerns as well as their own and others’ reactions to the idea of them seeking mental healthcare. In the first example of Ludendorff, a German leader during World War I, his staff encouraged him to seek mental health treatment, and he was able to retain power even after doing so. In the second example of Lyndon B. Johnson, despite displaying depressive symptoms, he did not seek mental health treatment. The third example is the story of Thomas Eagleton, who was briefly a vice-presidential candidate before his history of mental illness and treatment led him to step out of the race. We conclude that the timeline of these historical examples suggests that society’s acceptance of world leaders accessing mental health care has not progressed in the way it has for the public. 

/pdf/alls-not-quiet-on-the-western-front-the-stigma-against-18m27i2u.pdf

All’s Not Quiet on the Western Front? The Stigma against Mental Health Treatment for World Leaders

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The effectiveness of an attention bias modification program as an adjunctive treatment for Post-Traumatic Stress Disorder.

Establishing an Embedded Psychiatry Rotation with Naval Special Warfare: A Win for Both the Education of Military Psychiatry Residents and the Operational Forces.

All’s Not Quiet on the Western Front? The Stigma against Mental Health Treatment for World Leaders