PSY 940 Northwest Florida College Trauma Management Therapy Annotated Bibliography Do not worry about formatting, I will take care of all of that. A writt

PSY 940 Northwest Florida College Trauma Management Therapy Annotated Bibliography Do not worry about formatting, I will take care of all of that.

A written summary (synthesizing) of the key concept(s) of 12 Specific journal articles (provided). Each articles summary should be 200 to 250 words and each one should focus on the following questions:

o Why was the study conducted and/or what themes emerge from the theory/article?

o What was the population studied?

o What did the researcher(s) conclude?

o What other information about this study do you believe is unique or important to recall? (I’m looking for limitations in this element.)

The twelve (12) articles are:

Beidel, D. C., Frueh, B. C., Neer, S. M., Lejuez, C. W. (2017). The efficacy of Trauma Management Therapy: A controlled pilot investigation of a three-week intensive outpatient program for combat-related PTSD. Journal of Anxiety Disorders, 50, 23–32. doi:10.1016/j.janxdis.2017.05.001

Berke, D. S., Kline, N. K., Wachen, J. S., McLean, C. P., Yarvis, J. S., Mintz, J., Young-McCaughan, S., Peterson, A. L., Foa, E., Resick, P. A., & Litz, B. T. (2019). Predictors of attendance and dropout in three randomized controlled trials of PTSD treatment for active duty service members. Behaviour Research and Therapy, 118, 7–17. doi:10.1016/j.brat.2019.03.003

Berke, C. D. S. J. R., Rusowicz-Orazem, L., Kline, G. N. K. B., Mintz, J., Yarvis, J. S., Peterson, A. L., Young-McCaughan, S., Foa, E. B., Resick, P. A., & Litz, B. T. (2020). Parameters of Aggressive Behavior in a Treatment-Seeking Sample of Military Personnel: A Secondary Analysis of Three Randomized Controlled Trials of Evidence-Based PTSD Treatments. Behavior Therapy. doi:10.1016/j.beth.2020.03.007

Bjornsson, A. S., Hardarson, J. P., Valdimarsdottir, A. G., Gudmundsdottir, K., Tryggvadottir, A., Thorarinsdottir, K., Wessman, I., Sigurjonsdottir, O., Davidsdottir, S., & Thorisdottir, A. S. (2020). Social trauma and its association with posttraumatic stress disorder and social anxiety disorder. Journal of Anxiety Disorders, 72. doi:10.1016/j.janxdis.2020.102228

Crocker, L. D., Jurick, S. M., Thomas, K. R., Keller, A. V., Sanderson-Cimino, M., Boyd, B., Rodgers, C., Twamley, E. W., & Jak, A. J. (2018). Worse baseline executive functioning is associated with dropout and poorer response to trauma-focused treatment for veterans with PTSD and comorbid traumatic brain injury. Behaviour Research and Therapy, 108, 68–77. doi:10.1016/j.brat.2018.07.004

Dillon, K. H., Hale, W. J., LoSavio, S. T., Wachen, J. S., Pruiksma, K. E., Yarvis, J. S., Mintz, J., Litz, B. T., Peterson, A. L., Resick, P. A., & Strong Star Consortium. (2020). Weekly Changes in Blame and PTSD Among Active-Duty Military Personnel Receiving Cognitive Processing Therapy. Behavior Therapy, 51(3), 386–400. doi:10.1016/j.beth.2019.06.008

Holder N, Shiner B, Li Y, et al. Cognitive Processing Therapy for Veterans with Posttraumatic Stress Disorder: What is the Median Effective Dose? Journal of Anxiety Disorders, 273, 425-433. doi:10.1016/j.jad.2020.04.030.

Kehle-Forbes, S. M., Chen, S., Polusny, M. A., Lynch, K. G., Koffel, E., Ingram, E., Foa, E. B., Van Horn, D. H. A., Drapkin, M. L., Yusko, D. A., & Oslin, D. W. (2019). A randomized controlled trial evaluating integrated versus phased application of evidence-based psychotherapies for military veterans with comorbid PTSD and substance use disorders. Drug and Alcohol Dependence, 205, 107647. doi:10.1016/j.drugalcdep.2019.107647

Kline, A. C., Cooper, A. A., Rytwinksi, N. K., & Feeny, N. C. (2018). Long-term efficacy of psychotherapy for posttraumatic stress disorder: A meta-analysis of randomized controlled trials. Clinical Psychology Review, 59, 30–40. doi:10.1016/j.cpr.2017.10.009

Kozel, F. A., Motes, M. A., Didehbani, N., DeLaRosa, B., Bass, C., Schraufnagel, C. D., Jones, P., Morgan, C. R., Spence, J. S., Kraut, M. A., & Hart, J. J. (2018). Repetitive TMS to augment cognitive processing therapy in combat veterans of recent conflicts with PTSD: A randomized clinical trial. Journal of Affective Disorders, 229, 506–514. doi:10.1016/j.jad.2017.12.046

McLean, C. P., Rauch, S. A. M., Foa, E. B., Sripada, R. K., Tannahill, H. S., Mintz, J., Yarvis, J., Young-McCaughan, S., Dondanville, K. A., Hall-Clark, B. N., Fina, B. A., Keane, T. M., & Peterson, A. L. (2018). Design of a randomized controlled trial examining the efficacy and biological mechanisms of web-prolonged exposure and present-centered therapy for PTSD among active-duty military personnel and veterans. Contemporary Clinical Trials, 64, 41–48. doi:10.1016/j.cct.2017.11.008

Meyer, E. C., Kotte, A., Kimbrel, N. A., DeBeer, B. B., Elliott, T. R., Gulliver, S. B., & Morissette, S. B. (2019). Predictors of lower-than-expected posttraumatic symptom severity in war veterans: The influence of personality, self-reported trait resilience, and psychological flexibility. Behaviour Research and Therapy, 113, 1–8. doi:10.1016/j.brat.2018.12.005 Journal of Anxiety Disorders 50 (2017) 23–32
Contents lists available at ScienceDirect
Journal of Anxiety Disorders
journal homepage: www.elsevier.com/locate/janxdis
The efficacy of Trauma Management Therapy: A controlled pilot
investigation of a three-week intensive outpatient program for combatrelated PTSD☆
MARK
⁎
Deborah C. Beidela, , B. Christopher Fruehb, Sandra M. Neera, Carl W. Lejuezc
a
b
c
Department of Psychology, University of Central Florida, 4111 Pictor Lane, Orlando, FL 32816, United States
Department of Psychology, University of Hawaii at Hilo, 200 W. Kawili St., Hilo, HI, United States
Department of Psychology, Kansas University, Strong Hall, Room 200, Lawrence, KS 66045, United States
A R T I C L E I N F O
A B S T R A C T
Keywords:
PTSD
Combat-trauma
Exposure therapy
Skills training
Virtual reality
Despite the 8–18.5% of returning Operation Iraqi Freedom (OIF), Operation Enduring Freedom (OEF) and
Operation New Dawn (OND) veterans who are suffering from posttraumatic stress disorder (PTSD), few receive
empirically supported treatments. Among those that do, the dropout rate is high and more than 50% retain their
diagnosis after treatment. This study evaluated the efficacy of Trauma Management Therapy (TMT), delivered in
a 3-week intensive outpatient (IOP) format. TMT combines virtual-reality augmented individual exposure
therapy with a group intervention to address social isolation, anger, and depression. One hundred twelve (112)
OIF/OEF/OND veterans and active duty personnel participated. Assessment included measures of PTSD, sleep,
depression, anger, guilt, and social isolation, administered at post-treatment, 3-month, and 6-month follow-up.
The effect size for TMT delivered in an IOP format was 2.06, with 65.9% no longer meeting diagnostic criteria for
PTSD. There were similar positive effects in other domains and treatment gains were maintained at 6-month
follow-up. The results are discussed regarding the need for efficacious, multi-component interventions that can
be delivered safely and rapidly, and the potential of this approach towards that end.
1. Introduction
It is estimated that between 8% and 18.5% of veterans returning
from Operation Iraqi Freedom/Operation Enduring Freedom/Operation
New Dawn (OIF/OEF/OND) have been diagnosed with posttraumatic
stress disorder (PTSD) (Richardson, Frueh, & Acierno, 2010; Smith
et al., 2008; Tanielian & Jaycox, 2008). Given this prevalence, providing empirically supported treatments for the nation’s veterans and
active duty personnel who have served in these conflicts remains a
national imperative.
The US Department of Veterans Affairs (VA) has designated
prolonged exposure therapy (PE) and cognitive processing therapy
(CPT) as empirically supported and first-line psychological treatments
for PTSD in the VA settings. The published clinical trial literature on the
treatment of PTSD among civilians (e.g., rape victims) shows substantial treatment gains across virtually all studies, with about 50% of
patients showing full remission from the disorder; in stark contrast, the
published literature on treatment of PTSD in combat veterans shows
almost no treatment benefits, with very few in full remission (see
review by Bradley, Greene, Russ, Dutra, & Westen, 2005). A recent
meta-analysis has found this unfortunate pattern remains in effect
(Watts et al., 2013). Among randomized controlled trials for OIF/OEF
veterans with combat-related PTSD (Monson et al., 2006; Morland
et al., 2014; Rauch et al., 2015; Reger et al., 2016; Resick et al., 2015,
2017; Yehuda et al., 2014; Yuen et al., 2015), significant reductions in
symptoms occur but with few exceptions (Reger et al., 2016; Resick
et al., 2017) sample sizes were small and approximately half to two
thirds still met diagnostic criteria for PTSD (Steenkamp, 2016). In an
assessment of the status of current psychological treatments, Hoge, Lee,
and Castro (2016) describe an “ongoing crisis” in PTSD care for active
duty personnel and veterans, reiterating the challenge of high treatment
attrition (averaging 28% and up to 40% in recent RCTs) and the
substantial number who retain their PTSD diagnosis after a full course
of treatment. They conclude that there is still considerable room for
☆
This study was supported by the U.S. Army Medical Research & Materiel Command-Military Operational Medicine Research Program (USAMRMC-MOMRP; contract W81XWH-11-20038) to the first and second author. The study had both MRCM HRPO and local IRB approval and does not necessarily reflect the policy/position of the government. The funding source
had no involvement with the design, collection, analysis or interpretation of the data, or the writing of the report or the decision to submit the article for publication.
⁎
Corresponding author.
E-mail addresses: deborah.beidel@ucf.edu (D.C. Beidel), frueh@hawaii.edu (B.C. Frueh), sandra.neer@ucf.edu (S.M. Neer), clejuez@ku.edu (C.W. Lejuez).
http://dx.doi.org/10.1016/j.janxdis.2017.05.001
Received 1 January 2017; Received in revised form 25 April 2017; Accepted 3 May 2017
Available online 11 May 2017
0887-6185/ © 2017 Elsevier Ltd. All rights reserved.
Journal of Anxiety Disorders 50 (2017) 23–32
D.C. Beidel et al.
improving treatment efficacy, “particularly interventions that enhance
treatment engagement or retention” (Hoge et al., 2016, p. E2).
Surveys of returning veterans (Crawford et al., 2015), active duty
personnel (Hoge et al., 2004) and active duty personnel and National
Guard (Kim, Thomas, Wilk, Castro, & Hoge, 2010) list the barriers that
these personnel perceive with respect to accessing empirically supported treatments. These barriers include difficulties in scheduling
appointments (due to lack of services in their area or difficulty in
getting time off from work (Hoge et al., 2004; Kim et al., 2010)),
perceived stigma of requesting or receiving services (Crawford et al.,
2015; Hoge et al., 2004; Kim et al., 2010) and a disconnect between the
services desired and the services offered (Crawford et al., 2015). With
respect to the latter barrier, veterans report a preference for treatment
of mental health issues such as sleep disruption, anger and stress, which
are not often an integral part of the first-line treatments for PTSD
provided by the VA.
The concerns about stigma may be the most difficult to overcome.
Although the military has continuously provided assurance that seeking
psychological treatment will not affect career trajectories, many
individuals do not believe this to be the case. Thus, to address personnel
concerns, what may be needed is not reassurance, but an alternative
conceptualization of PTSD and how to treat it. For example, physical
injuries because of military service typically require an intensive period
of treatment and rehabilitation, after which the warfighter returns to
active duty. If PTSD were re-conceptualized as a psychological injury,
the same treatment approach could apply. That is, rather than a series
of weekly outpatient appointments, where treatment stretches over
several months (and dropout rates are high), treatment would be
delivered intensively within a shorter time frame. Within the psychiatric treatment literature, such models exist, the most common of which
is the intensive outpatient program (IOP).
An alternative to traditional outpatient therapy and less restrictive
than inpatient hospitalization, IOPs are designed to (a) deliver treatment in a more rapid fashion, (b) establish psychosocial supports for
participants, and (c) address relapse and enhance coping skills
(McCarty et al., 2014). The IOP “…allowed acute patients to be treated
in an outpatient setting and also provided clinicians the opportunity to
work intensively with patients on a daily basis for an extended period of
time” (Wise, 2005, p. 887). Furthermore, the IOP model is consistent
with the extant literature that exposure therapy is most efficacious
when delivered in “massed” versus “spaced” fashion (Foa, Jameson,
Turner, & Payne, 1980; Gutner, Suvak, Sloan, & Resick, 2016). IOPs
have been used with a variety of patient populations including
individuals
with mood
and anxiety
disorders
(Ritschel,
Cheavens, & Nelson, 2012), obsessive-compulsive disorders (Shikatani
et al., 2016), eating disorders (Schaffner & Buchanan, 2008), and
substance abuse (McCarty et al., 2014). Successfully implemented in
private practice settings to treat individuals with severe depression (see
Wise, 2005 for a review), IOPs have also been used to treat small
samples of veterans and active duty personnel with PTSD (Dretsch
et al., 2016; Humphreys, Westerink, Giarratano, & Brooks, 1999; Lande,
Williams, Francis, Gragnani, & Morin, 2017; Meyers et al., 2017), with
program length ranging from 3 to 12 weeks. The results of these
investigations suggest some decrease in PTSD symptoms but individuals
remain impaired (Lande et al., 2011). Other limitations of these
investigations include small sample sizes, lack of clarity in the samples
with respect to the triggering traumatic event (combat, sexual trauma),
outcome assessment restricted to symptoms of PTSD and depression,
and except for Humphreys et al. (1999), minimal follow-up.
IOPs hold significant promise in addressing some of the identified
treatment barriers relevant to OIF/OEF service personnel. For example,
providing empirically-supported treatments in this intensive fashion
may help address the high drop-out rates (up to 40%) of programs that
offer treatment once or twice per week (Imel, Laska,
Jakupcak, & Simpson, 2013; Steenkamp, Litz, Hoge, & Marmar, 2015).
An IOP could be particularly advantageous for active duty personnel
who may be forced to drop out of traditional outpatient treatment
programs because of orders to deploy or a change in duty station (e.g.,
Reger et al., 2016). Finally, recalling that one of the major barriers to
treatment acceptance was that offered treatments were not always
consistent with services that veterans most desired, an IOP model could
combine current efficacious interventions and include additional desired services. “Including treatment components that veterans felt
necessary could enhance treatment engagement or retention” (Hoge
et al., 2016, p. E2). In a synergistic fashion, an IOP could be a service
delivery model that has the promise to treat severe psychological
disorders (Wise, 2005). However, further research is needed to
determine the feasibility/efficacy of this treatment model.
Given the extensive limitations in the extant combat-related PTSD
treatment literature and the promising nature of IOPs for treating
severe psychological disorders, the next logical step is a well-controlled
pilot investigation of an IOP format for the treatment of combat-related
PTSD. Such an investigation should include a sufficient sample size, a
manualized intervention and a multi-component assessment battery
designed to assess not simply core PTSD symptoms but the feasibility/
acceptability of this format as well as assessment of the myriad of
behavioral and emotional symptoms that are part of this disorder.
Trauma Management Therapy (TMT; Frueh, Turner, Beidel,
Mirabella, & Jones, 1996; Turner, Beidel, & Frueh, 2005) was developed
in the mid-1990s to address what were perceived as the limitations of
standard exposure therapy for Vietnam veterans, who continued to
exhibit anger, social isolation, depression, and guilt. TMT includes
intensive individual exposure therapy plus a group intervention that
addressed these additional behaviors and emotions. An initial randomized controlled trial with Vietnam veterans (Beidel, Frueh, Uhde,
Wong, & Mentrikoski, 2011) and a recent randomized controlled trial
with OIF/OEF veterans (Beidel et al., under review) both indicate
statistically significant decreases on core PTSD symptoms as well as
significant decreases for depression, anger, and social isolation. Given
(a) the current status of treatments for combat-related PTSD, (b) the
desire to provide interventions that enhance treatment engagement and
retention (thereby reducing dropout rates), and (c) the potential of the
IOP format to provide treatment rapidly and in a manner consistent
with how physical injuries are treated, the next logical step is a
controlled pilot investigation of TMT adapted for an IOP format.
Therefore, this study had two specific aims. The first aim was to
deliver TMT using an IOP format, evaluating the acceptability and
feasibility of this intervention when delivered in this format (drop-out
rate, iatrogenic effects). The second specific aim was to examine TMT’s
efficacy in this format not only on core symptoms but also on associated
emotions/behaviors in an OIF/OEF/OND sample.
2. Method
2.1. Study overview
We conducted a controlled pilot study, adapting TMT to an IOP
format treatment in a sample of OIF/OEF/OND veterans and active
duty military personnel (n = 112). Specifically, we adapted TMT, a 29session intervention originally administered across of 17 weeks, to be
delivered in three weeks. Clinical and process outcomes representing
multiple symptom domains were assessed at pre-treatment, post-treatment, 3-month, and 6-month follow-up.
2.2. Participants
The study was approved by the US Army Medical Research and
Materiel Command (USAMRMC), Office of Research Protections (ORP),
Human Research Protection Office and from the University of Central
Florida IRB and informed consent was obtained from each participant.
Participants were recruited nationwide through Yellow Ribbon events,
presentations to (a) veteran’s support groups, (b) veteran related public
24
Journal of Anxiety Disorders 50 (2017) 23–32
D.C. Beidel et al.
2.3. Assessment
events, and (c) staff at military installations, as well as radio and
television ads, and social media. Housing in the Orlando area was
provided by the research grant; however, participants provided their
own transportation to Orlando.
This study was initiated prior to the publication of the Diagnostic
and Statistical Manual-5th Edition (APA, 2013), thus, diagnoses were
assigned using DSM-IV-TR criteria. To establish the diagnosis, participants were assessed with the Clinician—Administered PTSD Scale (see
below). Only participants who were confirmed by the CAPS assessment
to have a primary DSM-IV diagnosis of combat-related PTSD were
included in the study. Twenty percent of the interviews were audio/
videotaped and rated by a second clinician to calculate inter-rater
reliability. Following the CAPS interview, participants were interviewed with the Structured Clinical Interview for DSM-IV (SCID;
First, Gibbon, Spitzer, Williams, & Benjamin, 1997) and the Structured
Clinical
Interview
for
DSM-IV
(SCID-II;
First,
Spitzer,
Gibbon, & Williams, 1997) to assess presence/absence of other Axis I
and II disorders.
Specific inclusion and exclusion criteria were as follows:
Clinician—Administered PTSD Scale (CAPS; Blake et al., 1990;
Weathers & Litz, 1994; Weathers, Ruscio, & Keane, 1999). The CAPS is a
30-item semi-structured interview. In addition to assessing severity of
each of 17 diagnostic criteria, the CAPS quantifies the impact of
symptoms on social and occupational functioning. We used the “1, 2”
rule be used to determine a diagnosis; that is, a frequency score of 1
(scale 0 = “none of the time” to 4 = “most or all of the time”) and an
intensity score of 2 (scale 0 = “none” to 4 = “extreme”) is required for
a particular symptom to meet criterion (Weathers et al., 1999). The
diagnosis is then made according to the DSM-IV algorithm: (a) Criterion
A is met, (experienced event and response involved intense fear, horror
or helplessness); (b) At least one Criterion B symptom, (re-experiencing); (c) At least three Criterion C symptoms, (avoidance); (d) At least
2 Criterion D symptoms, (arousal); (e) Criterion E is met, (duration
greater than one month) and (f) Criterion F is met (distress or
impairment).
The CAPS was designated a priori as the primary outcome measure.
In addition, the information on the CAPS was used to determine
whether participants still met diagnostic criteria for PTSD at posttreatment and at all follow-up assessments. Licensed clinical psychologists
or doctoral students in clinical psychology conducted the interviews.
CAPS interviews were videotaped and 20% (across all assessment
points) were rated by a second clinician for the purpose of determining
inter-rater reliability. The resultant intra-class correlation was .993.
PTSD Checklist – Military Version (PCL-M; Weathers,
Huska, & Keane, 1991). The 17-item self-report military-specific version
of the PCL was used to assess PTSD symptom severity at pre and posttreatment as well as 3 and 6-month follow-up. Test-retest reliability is
high (r = .97; Weathers, Herman, Huska, & Keane, 1993) and there is
good convergent validity with other measures of trauma (r = .90;
Weathers et al., 1993). Because this investigation used an intensive
outpatient (3 week) format, participants were asked to assess the
severity of their symptoms “over the past week” rather than over the
past month. This was necessary to determine that assessment of posttreatment PTSD symptoms was not confounded by pre-treatment
clinical status. Cronbach’s alpha for this sample was 0.87.
Structured Clinical Interview for DSM-IV (SCID I and II; First,
Gibbon et al., 1997; First, Spitzer et al., 1997) was used at pretreatment to assess other Axis I and II disorders.
Quality of Life Inventory (QoLI; Frisch, 1994). The QoLI is a 192item self-report questionnaire that assesses patients’ perception of their
quality of life across 15 different domains, including dimensions of
interpersonal relationships (marital, parent-child, extended family,
extramarital, and occupational) and social activities (altruistic behavior, political behavior, creative-aesthetic behavior, sports activity, and
vacation behavior). The QoLI has good test-retest reliability (r = 0.79),
and good convergent validity (r = 0.56) with other measures of life
satisfaction (Frisch, 1994). The QoLI was administered at all 4 assessment points. Cronbach’s alpha for this sample was 0.85.
Health-Related Functioning: Medical Outcome Study Short
Form-36 Health Survey (SF-36; Ware & Sherbourne, 1992). The SF36 is a 36-item self-report questionnaire that assesses health status and
functioning along 8 dimensions covering (a) Functional Status; (b)
Well-Being; and (c) Overall Evaluation of Health. The SF-36 has good
test-retest reliability (r = 0.75) as well as sensitivity to change in health
status (Beaton, Hogg-Johnson, & Bombardier, 1997; Brazier et al.,
1992). The SF-36 was administered at all 4 assessment intervals.
Cronbach’s alpha for this sample was 0.92 for physical health and
0.90 for mental health.
The Behavior Rating Inventory of Executive Function – Adult
Version (BRIEF-A; Roth, Isquith, & Gioia, 2005) The BRIEF-A assesses
an individual’s perception of their executive functions in nine areas and
provides an overall summary score, the Global Executive Composite
(GEC). Test-retest reliability ranges from 0.82 to 0.93 over a 4-week
• Individuals who reported acute cardiac difficulties (angina, myo-
•
•
•
cardial infarction, and severe hypertension) were initially excluded
because intensive exposure therapy, which is often accompanied by
temporary increases in heart rate and blood pressure, could pose
risks of exacerbating cardiac status. They were included only after
their physician cleared their participation.
Participants with comorbid psychotic disorders or antisocial personality disorder were excluded. Participants with acute substance
abuse disorder were excluded until their substance abuse was under
control for at least two weeks.
Patients with comorbid depressive disorders, anxiety disorders, and
personality disorders other than Antisocial…
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