Psychotherapy For PTSD Appendices
Available AppendicesA. Acronyms Used in Appendix B . 2B. Research Narrative by Division . 3C. Funding . 17D. Publications . 29E. In-Press Publications and Advance Online Publications .46F. Scientifc Presentations .53G. Educational Presentations .63H. Editorial Board Activities .66N AT IO N A L C E N T E R F O R PTSD / 2019 Annual Report / www.ptsd.va.gov1
APPENDIX AAcronyms Used in Appendix BAPOEApolipoprotein EAUDAlcohol Use DisorderBDNFBrain-Derived NeurotrophicFactorCAPS-5Clinician-AdministeredPTSD Scale for DSM-5CBCTCognitive-BehavioralConjoint TherapyCBTCognitive-BehavioralTherapyCOECenter of ExcellenceCPTCognitive ProcessingTherapyDSM-5Diagnostic and StatisticalManual of Mental DisordersFifth ical MomentaryAssessmentLATRLater-Adulthood TraumaReengagementLGBTLesbian, Gay, Bisexual, andTransgenderLIGHTLongitudinal Investigationof Gender, Health, andTraumaMBCMeasurement-Based CareMVPMillion Veteran ProgramNCPSNational Center for PatientSafetyNDHSNeurocognitionDeployment Health StudyNEPECNortheast ProgramEvaluation CenterMDDMajor Depressive DisorderNHRVSNational Health andResilience in Veterans StudyENIGMAEnhancing NeuroimagingGenetics through MHSPOffice of Mental Health andSuicide PreventionfMRIFunctional MagneticResonance ImagingMEGMagnetoencephalographyPC-PTSD-5Primary Care Screen forPTSD for DSM-5FYFiscal YearmGluR5Metabotropic GlutamateReceptor Type 5CSPCooperative StudiesProgramGWASGenome-Wide AssociationStudiesMRIMagnetic ResonanceImagingDODDepartment of DefenseIPVIntimate Partner ViolenceMSTMilitary Sexual TraumaN AT IO N A L C E N T E R F O R PTSD / 2019 Annual Report / www.ptsd.va.govPCTPresent-Centered TherapyPEProlonged ExposurePETPositron EmissionTomographyPGCPsychiatric GenomicsConsortiumPTSDPosttraumatic StressDisorderREACH VETRecovery Engagementand Coordination forHealth – Veterans EnhancedTreatmentRRTPResidential RehabilitationTreatment ProgramSERVSurvey of ReturningVeteransSSRISelective SerotoninReuptake InhibitorSTAIRSkills Training in Affectiveand InterpersonalRegulationSTRONG STARSouth Texas ResearchOrganizational NetworkGuiding Studies on Traumaand ResilienceTBITraumatic Brain InjuryTMSTranscranial MagneticStimulationTRACTSTranslational ResearchCenter for Traumatic BrainInjury and Stress DisordersTSPOTranslocator ProteinVADepartment of VeteransAffairsProject VALORVeterans After-DischargeLongitudinal RegistryVHAVeterans HealthAdministrationWeb-PEWeb Version of ProlongedExposureWETWritten Exposure TherapyWoVeNWomen Veterans Network2
APPENDIX BFiscal Year 2019 Research Narrative by DivisionBehavioral Science DivisionThe Behavioral Science Division (BSD) in Boston, Massachusetts, conducts research on life adjustment aftermilitary deployment and other traumatic stressors, methods to assess trauma and posttraumatic stressdisorder (PTSD), innovative approaches to clinical intervention and treatment delivery, and the potentialneurobiological and genomic basis of PTSD and its comorbidities.BiomarkersThe Division has an active portfolio ofgenetic and neuroimaging studies involvingcollaborations with investigators in theTranslational Research Center for TraumaticBrain Injury and Stress Disorders (TRACTS), theDepartment of Veterans Affairs (VA) NationalPTSD Brain Bank, the Psychiatric GenomicsConsortium (PGC), and the PTSD Working Groupof the ENIGMA (Enhancing NeuroimagingGenetics through Meta-Analysis) Consortium.During FY 2019, Division investigators focusedon the roles of inflammation and oxidativestress in the biology of PTSD, and on the role ofPTSD and other trauma-associated symptoms inaccelerated aging.Ongoing studies that examine PTSD and blastrelated traumatic brain injury (TBI) in Veterans ofIraq and Afghanistan war zones aim to clarify therelative contribution of mild TBI and psychiatricconditions to deficits in current functioningand health outcomes. Investigators are nowexpanding this work to an older longitudinalcohort to study how stress, genetic risk, andperipheral biomarkers of inflammation areassociated with subsequent health decline andneurodegeneration.Biomarkers examined by the Division includebrain features measured by neuroimaging,peripheral markers of inflammation andmetabolic pathology, and specific genes andpolygenic risk scores. Also under investigationare epigenetic markers drawn from blood andpostmortem brain tissue, including epigenomewide DNA methylation levels and transcriptomewide mRNA (i.e., gene expression).Division researchers continued to use functionaland structural magnetic resonance imaging(MRI) to identify neural circuitry involved inPTSD. They also used magnetic resonancespectroscopy to examine neurodegeneration andneuroinflammation.N AT IO N A L C E N T E R F O R PTSD / 2019 Annual Report / www.ptsd.va.govTreatment Efficiency, Effectiveness, andEngagementThe Division’s pioneering research on treatmentsfor PTSD is focused on overcoming barriers toseeking care, reducing dropout, and increasingthe efficiency of care delivery. One example isthe internet-based treatment VetChange, whichwas originally designed for Iraq and Afghanistancombat Veterans who report both risky use ofalcohol and PTSD-related distress. The initialclinical trial produced evidence that VetChangewas effective in reducing both drinking andPTSD symptoms. VetChange was subsequentlymodified to include mobile-friendly features andwas disseminated nationally; this later version,which is applicable to Veterans of all eras, hasbeen shown to be effective as well.A VetChange mobile app that has key VetChangefeatures was developed recently, in conjunctionwith the Dissemination and Training Division,and efforts are currently underway to integratethe mobile app and web versions to increasemobile access for real-time intervention support.In addition, a major extension of the VetChangeweb intervention is underway to directlyintegrate with clinical care delivered by VAproviders and to evaluate its effectiveness in VAPTSD clinics as well as inpatient detoxification3
APPENDIX B: Fiscal Year 2019 Research Narrative(Behavioral Science Division, continued)settings.Other Division efforts include developing andtesting efficient, therapist-delivered interventionsor treatment extenders, with the goals of findingapproaches that require less professional stafftime and that are easier for patients to complete.A prime example is Written Exposure Therapy(WET), a five-session exposure-based treatmentfor PTSD that has been shown to be highlyeffective with non-Veteran patients. A currentVA-funded study is being conducted to examinethe efficacy of WET in comparison to ProlongedExposure (PE) with Veterans. An implementationstudy is also being conducted in which VA mentalhealth providers are being trained to deliver WET.Research on factors that link PTSD withaggression toward intimate partners has led tothe development and evaluation of interventionsthat reduce or prevent aggression within at-riskmilitary and Veteran families. Positive clinicaltrials have been published, and the interventionscontinue to be implemented across the VA healthcare system and on one military installation.An ongoing pilot study also is testing one ofthese programs in an underserved urban civiliansetting. Data collection is nearing completion,with preliminary analyses showing large effects inreducing intimate partner violence (IPV).Division investigators have also been studyinghow clinicians make decisions around familyinvolvement in PTSD treatment, conductingqualitative interviews with staff andadministrators to identify their decision-makingprocess and various barriers or facilitators forfamily involvement. Efforts are also underwayto examine how to harness social support fromVeterans’ family members to aid treatmenteffectiveness. A small, randomized, controlledtrial is being conducted to examine the impact ofa two-session family intervention to complementthe delivery of Cognitive Processing Therapy(CPT) or PE. The goals of the intervention areto increase family members’ support for andunderstanding of trauma-focused treatment, andalso to reduce levels of family accommodationaround PTSD symptoms.In the area of complementary interventions,a continuing five-year study is examining theimpact of two 12-week group treatments onchronic pain in Gulf War Illness. A one-year pilotstudy is examining the same interventions forolder, sedentary, trauma-exposed Veterans. Inboth studies, tai chi, a mind-body exercise thathas been associated with physical and mentalhealth benefits, is compared with a wellnesspromotion intervention that is based on anexisting VA model of care entitled Whole Health.Division investigators also are examining adevelopmental phenomenon termed lateradulthood trauma reengagement (LATR). Itinvolves efforts by older combat Veterans toactively re-engage with wartime memorieswith the aim of building coherence and findingmeaning in past experience. It is theorized thatthe LATR process has the potential to lead toeither positive outcomes such as personal growthor negative outcomes such as increased PTSDsymptoms. An ongoing study is examining theimpact of a 10-week psychosocial discussiongroup for older combat Veterans who reportexperiences consistent with the LATR process.N AT IO N A L C E N T E R F O R PTSD / 2019 Annual Report / www.ptsd.va.govDivision investigators are partnering withresearchers in the Women’s Health SciencesDivision to examine the effects of trauma andother high-impact stressors on PTSD and relatedsequalae such as substance use disordersamong lesbian, gay, bisexual, and transgender(LGBT) Veterans. This research aims to developand refine conceptual models of trauma, PTSD,and related impairments to inform research,treatment development, and treatmentplanning for LGBT Veterans.Care Delivery, Models of Care, and SystemFactorsThe main example of work related to this NationalCenter priority is a project that examines howevidence-based psychotherapy (EBP) is deliveredby clinicians affiliated with the VA BostonHealthcare System Outpatient PTSD Clinic.Findings indicate that strategic changes in clinicintake procedures, such as distributing materialsdescribing treatment options and adding asecond intake session focused on collaborativetreatment planning, were associated withincreased rates of retention in treatment for PTSD.DSM-5Data collection is complete for a study validatinga cutoff score for PTSD status according toDiagnostic and Statistical Manual of MentalDisorders–Fifth Edition (DSM-5) criteria basedon the most recent version of the Primary CareScreen for PTSD for DSM-5 (PC-PTSD-5). Thestudy is part of a larger effort to validate DSM-5versions of measures that have been developedby National Center investigators. The ongoingproject recruits Veterans from VA primary care4
APPENDIX B: Fiscal Year 2019 Research Narrative(Behavioral Science Division, continued)locations and compares the screening measureto the gold-standard interview, the ClinicianAdministered PTSD Scale for DSM-5 (CAPS-5).The study also examines the extent to whichthe optimal PC-PTSD-5 cutoff score varies acrosssubgroups of Veterans. Data analyses have beencompleted and a manuscript is being prepared tosubmit for publication. A separate study co-led bya Division investigator aims to provide validationof CAPS-5 performance with a military sample.PTSD and SuicideDivision researchers are actively contributing toknowledge about PTSD and suicide, particularlyin the domain of identifying risk factors. For oneproject, investigators used machine learning toidentify the interactions among risk factors thatpredict future suicide attempts, using data fromthe Veterans After-Discharge Longitudinal Registry(Project VALOR) partitioned by gender. Resultsrevealed that almost 8 percent of the sample madea suicide attempt over a five-year period. Machinelearning portioned by gender identified importantsimilarities and differences in risk pathways.Two other projects are testing interventionsto prevent suicide among Veterans andServicemembers who are at risk for suicide. Oneproject will examine feasibility and acceptabilityof Brief Cognitive-Behavioral Therapy for suicideprevention in a sample of Veterans hospitalizedfor suicide risk. In addition, experience samplingwill be used to explore granular fluctuationsin suicide risk and related risk factors (e.g.,hopelessness) during and after treatment.In another project that was recently launched, incollaboration with the STRONG STAR (South TexasResearch Organizational Network Guiding Studieson Trauma and Resilience) Consortium, Divisioninvestigators are testing a modified version ofWET for Suicide with a sample of Army soldiersand Veterans with PTSD symptoms who havebeen hospitalized for suicide risk. The study seeksto determine whether treating PTSD symptomsreduces the likelihood of future suicidal behavior.Other Important ResearchThe Division has a great deal of expertise inlongitudinal, observational studies that informthe understanding of the course of PTSD andassociated conditions over time. Divisionresearchers are working on two large prospectivecohort studies that collect information fromstrategically selected Veteran and Servicemembergroups. The first, Project VALOR (Veterans AfterDischarge Longitudinal Registry), is workingwith a registry of 1,649 male and female combatVeterans who became users of VA services after2002. The project collects data about healthoutcomes associated with PTSD, supplementedby clinical information from VA electronicmedical records. Data collection for the fifthsampling wave is now complete, with over 1,000participants providing saliva samples for futuregenomic analyses; examination of PTSD symptomtrajectories and predictors of those trajectoriesare now complete.The second large investigation, theNeurocognition Deployment Health Study(NDHS), began data collection at the outsetof the Iraq War in 2003. Military personnelwere assessed before deployment and atN AT IO N A L C E N T E R F O R PTSD / 2019 Annual Report / www.ptsd.va.govseveral intervals afterward, making this thefirst prospective longitudinal study to addressthe psychological impact of war zone stress.The study design allows examination of longterm emotional and neuropsychologicaloutcomes, as well as health-related quality oflife and occupational functioning. Initial papershave described PTSD outcomes; longitudinalneuropsychological outcomes; and relationshipsamong PTSD, TBI, and neuropsychologicaloutcomes. Data preparation and analysis areunderway for an associated study that examinesthe adjustment of both partners and children ofthe Servicemembers and Veterans in the cohort.Using data from the Nurses’ Health Study andVA Normative Aging Study, during which nursesand Veterans were followed for 10 and 30 yearsrespectively, researchers found that higherinitial levels of optimism were associated with11 percent -15 percent longer life span and 50percent - 70 percent greater odds of achievingexceptional longevity, defined as reaching age 85.In a related study examining psychosocialfactors which underlie the associations of earlyexperiences to longevity, investigators alsofound that greater optimism in midlife helpedto explain the benefits of higher childhoodsocioeconomic status on greater longevity,whereas greater exposure to stressful life eventsin midlife accounted for some of the negativeinfluence of childhood psychosocial stressors onreduced life span.Division assessment research includes workwith teams from the MITRE Corporation, anot-for-profit organization based in Bedford,Massachusetts, that manages federally funded5
APPENDIX B: Fiscal Year 2019 Research Narrative(Behavioral Science Division, continued)research and development centers. The currentproject is aimed at developing a nonintrusivemethod of PTSD detection based on voiceanalysis applied to interview recordings. Thiswork identifies vocal markers related to timingand coordination of speech to determine theClinical Neurosciences DivisionThe Clinical Neurosciences Division in West Haven, Connecticut, focuses on research to establish noveltreatments and uncover biomarkers of disease mechanisms related to traumatic stress, and investigatesparadigms of risk and resilience. By leveraging an interdisciplinary approach that includes genetics,neuroimaging, treatment interventions, and epidemiological studies, the Division maximizes efforts totranslate discoveries into therapeutic targets for PTSD and associated comorbid conditionsBiomarkersNeurogenomics and neuroimaging drivebiomarker development, including molecular,biochemical, structural, and functionalapproaches to investigate stress-relatedphenotypes and to better understand thesequence of pathological events associatedwith posttraumatic stress. The cross-cuttingnature of this work provides a foundation toresearch methods for the early detection ofat-risk individuals, genetic and environmentalinteractions underlying symptoms, andtreatment response.Division researchers use genome-wideassociation studies (GWAS) to screen for geneticvariations across large numbers of researchparticipants. GWAS data from 165,000 U.S.military Veterans participating in the MillionVeteran Program (MVP) provided the firstevidence of genetic vulnerability to one of thehallmark symptoms of PTSD, re-experiencingtraumatic events. A report published in NatureNeuroscience describes eight distinct geneticregions associated with PTSD and stress response:markers for genes that influence corticosteroidfunction (CRHR1 and HSD17B11), immuneand inflammatory response (RAB27B), andassociations with schizophrenia and bipolardisorder (TCF4 and MAD1L1). Genetic overlapbetween PTSD and schizophrenia may be dueto shared biochemical pathways betweenhallucinations, dissociation, nightmares, andflashbacks, and may identify which PTSD patientsare appropriate candidates for antipsychoticpharmacotherapy. Cell-type analyses revealedthat medium spiny neurons may implicate striataldysfunction in PTSD. Data further revealed thatre-experiencing symptoms share genetic riskfactors with hypertension.The VA National PTSD Brain Bank studiespostmortem brain tissue of PTSD and majordepressive disorder (MDD) donors to characterizegene expression associated with stress andsuicide, which may lead to blood-basedbiomarkers that could be used to diagnose andN AT IO N A L C E N T E R F O R PTSD / 2019 Annual Report / www.ptsd.va.govpresence and sev
APPENDIX B: Fiscal Year 2019 Research Narrative. NATIONAL CENTER FOR PTSD / 2019 Annual Report / www.ptsd.va.gov 5. locations and compares the screening measure . to the gold-standard interview, the Clinician-Administered PTSD Scale for . DSM-5 (CAPS-5). The study also examines the extent to which the optimal PC-PTSD-5 cutoff score varies across
VA » Health Care » PTSD: National Center for PTSD » » Clinician's Guide to Medications for PTSD PTSD: National Center for PTSD . Two examples include the Post-Traumatic Stress Disorder Checklist (PCL) and the Clinician-Administered PTSD Scale (CAPS). The PCL is an example of a patient self-rating form without stressor information, while .
An RCT of a Primary Care-Based PTSD Intervention: Clinician-Supported PTSD Coach Specific Aims: 1. Investigate impact of CS-PTSD Coach on PTSD severity 2. Investigate the impact of CS-PTSD Coach on engagement in specialty mental health care 3. Investigate patient and provider satisfaction with CS-PTSD Coach Exploratory Aims: Explore potential .
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Produced by the National Center for PTSD July 2010 U.S. Department of Veterans Affairs www.ptsd.va.gov . Posttraumatic stress disorder, or PTSD, can occur after someone goes through, sees, or learns about a traumatic . Only a qualified mental health care practitioner, such as a clinician or psychologist, can diagnose you with PTSD. www .
Transcranial Magnetic Stimulation (TMS) for PTSD and mTBI Study 17. Service Dog Training for PTSD 18. Clinician Administered PTSD Scale for DSM-5 (CAPS-5) and PTSD Symptom Scale Interview for DSM-5 (PSSI-5) Study 19. qEEG During Art Therapy 20. 3MDR Study to Treat PTSD after Mild TBI
PTSD Coach Online is a free, online, self-paced program that provides education and teaches . coping skills and problem solving through step-by-step tools. PTSD Coach Online was developed in . 2013 by a team at the VA's National Center for PTSD, Executive Division. PTSD Coach Online can be used independently or with a provider.
community mental health services: PTSD focused Cognitive restructuring vs. exposure-based Simple for therapists to do, easy to learn Good PTSD and psychiatric outcomes Well-tolerated by patients: 1) Relapse potential appears low (PTSD & other symptoms); 2) Most effective among those with severe PTSD
The effects of using a more efficient insulation don’t appear to be much at face value, but factor in a minimum 30-year life-cycle cost of operating
