RESUMEN
To test whether a modified version of prolonged exposure (mPE) can effectively treat posttraumatic stress disorder (PTSD) in individuals with co-occurring PTSD and substance dependence, an efficacy trial was conducted in which substance dependent treatment-seekers with PTSD (N = 126, male = 54.0%, White = 79.4%) were randomly assigned to mPE, mPE + trauma-focused motivational enhancement session (mPE + MET-PTSD), or a health information-based control condition (HLS). All participants were multiply traumatized; the median number of reported traumas that satisfied DSM-IV Criterion A for PTSD was 8. Treatment consisted of 9-12 60-min individual therapy sessions plus substance abuse treatment-as-usual. Participants were assessed at baseline, end-of-treatment, and at 3- and 6-months posttreatment. Both the mPE and mPE + MET-PTSD conditions achieved significantly better PTSD outcome than the control condition. The mPE + MET-PTSD and mPE conditions did not differ from one another on PTSD symptoms at end of treatment, 3-, or 6-month follow-up. Substance use outcomes did not differ between groups with all groups achieving 85.7%-97.9% days abstinent at follow-up. In regard to clinically significant improvement in trauma symptoms, 75.8% of the mPE participants, 60.0% of the mPE + MET-PTSD participants, and 44.4% of the HLS participants experienced clinically significant improvement at the end-of-treatment. Results indicate mPE, with or without an MET-PTSD session, can effectively treat PTSD in patients with co-occurring PTSD and substance dependence. In addition, mPE session lengths may better suit standard clinical practice and are associated with medium effect sizes. (PsycINFO Database Record
Asunto(s)
Terapia Implosiva , Trastornos por Estrés Postraumático/terapia , Trastornos Relacionados con Sustancias/terapia , Adulto , Diagnóstico Dual (Psiquiatría) , Femenino , Humanos , Masculino , Trastornos por Estrés Postraumático/complicaciones , Trastornos por Estrés Postraumático/psicología , Trastornos Relacionados con Sustancias/complicaciones , Trastornos Relacionados con Sustancias/psicología , Resultado del TratamientoRESUMEN
Laboratory studies have shown that exposure to trauma memories increases both craving and salivation responses to alcohol cues among individual with co-occurring posttraumatic stress disorder (PTSD) and alcohol dependence (AD). The purpose of the present study was to examine 1) whether this cue reactivity is dampened following exposure-based treatment for PTSD and 2) how changes in reactivity to trauma cues correspond to changes in alcohol cue-reactivity. Adults with current PTSD and AD (N = 120) were randomly assigned to 9-12 sessions of either Trauma-focused Exposure Therapy (EXP) for PTSD or Health & Lifestyles (HLS, a non-trauma focused comparison treatment), concurrent with 6-week residential AD treatment-as-usual. Participants completed trauma and alcohol cue-reactivity laboratory sessions before and after treatment. Compared to HLS, individuals receiving EXP showed significantly greater reductions in negative affect elicited by trauma cues following treatment. Both treatments demonstrated similar, moderate to large reductions in craving and salivary reactivity over time. Interestingly, latent change in trauma cue-elicited distress over the course of treatment predicted latent change in both trauma cue-elicited alcohol craving and salivation. Overall, findings highlight the utility of integrating trauma-focused therapies like EXP into substance use treatment in the interests of reducing PTSD symptoms and distress associated with trauma cues.
Asunto(s)
Alcoholismo/terapia , Señales (Psicología) , Terapia Implosiva , Psicoterapia , Trastornos por Estrés Postraumático/terapia , Adulto , Alcoholismo/complicaciones , Alcoholismo/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trastornos por Estrés Postraumático/complicaciones , Trastornos por Estrés Postraumático/psicología , Resultado del Tratamiento , Adulto JovenRESUMEN
Metacognitive models theorize that more negative appraisals of craving-related thoughts and feelings, and greater efforts to avoid or control these experiences, exacerbate suffering and increase chances the person will use substances to obtain relief. Thus far, little research has examined how attempts to quit smoking influence the way people perceive and respond to cravings. As part of a larger study, 176 adult smokers interested in quitting participated in two lab sessions, four days apart. Half the sample began a quit attempt the day after the first session; craving-related beliefs, metacognitive strategies, and negative affect were assessed at the second session. Participants who failed to abstain from smoking more strongly endorsed appraisals of craving-related thoughts as negative and personally relevant. Negative appraisals correlated strongly with distress and withdrawal symptoms. Attempting to quit smoking increased use of distraction, thought suppression and re-appraisal techniques, with no difference between successful and unsuccessful quitters. Negative beliefs about cravings and rumination predicted less change in smoking one month later. Results suggest that smoking cessation outcomes and metacognitive beliefs likely have a bidirectional relationship that is strongly related to negative affect. Greater consideration of the impact of cessation experiences on mood and craving beliefs is warranted.
Asunto(s)
Afecto , Actitud , Ansia , Psicoterapia , Cese del Hábito de Fumar/psicología , Adulto , Pruebas Respiratorias , Cognición , Femenino , Humanos , Masculino , Autoevaluación (Psicología) , Síndrome de Abstinencia a Sustancias/psicología , Adulto JovenRESUMEN
The current study examined demographic and psychosocial factors that predict major depressive disorder (MDD) and comorbid MDD/posttraumatic stress disorder (MDD/PTSD) diagnostic status after Hurricane Katrina, one of the deadliest and costliest hurricanes in the history of the United States. This study expanded on the findings published in the article by Galea, Tracy, Norris, and Coffey (J Trauma Stress 21:357-368, 2008), which examined the same predictors for PTSD, to better understand related and unique predictors of MDD, PTSD, and MDD/PTSD comorbidity. A total of 810 individuals representative of adult residents living in the 23 southernmost counties of Mississippi before Hurricane Katrina were interviewed. Ongoing hurricane-related stressors, low social support, and hurricane-related financial loss were common predictors of MDD, PTSD, and MDD/PTSD, whereas educational and marital status emerged as unique predictors of MDD. Implications for postdisaster relief efforts that address the risk for both MDD and PTSD are discussed.
Asunto(s)
Trastorno Depresivo Mayor/epidemiología , Trastornos por Estrés Postraumático/epidemiología , Adolescente , Adulto , Anciano , Comorbilidad , Tormentas Ciclónicas/estadística & datos numéricos , Trastorno Depresivo Mayor/etiología , Trastorno Depresivo Mayor/psicología , Desastres/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mississippi/epidemiología , Valor Predictivo de las Pruebas , Trastornos por Estrés Postraumático/etiología , Trastornos por Estrés Postraumático/psicología , Encuestas y Cuestionarios , Adulto JovenRESUMEN
Sleep disturbance and emotion dysregulation have been identified as etiologic and maintaining factors for a range of psychopathology and separate literatures support their relationships to anxiety, depression, PTSD, and alcohol dependence (AD) symptom severity. Previous studies have examined these relationships in isolation, failing to account for the high rates of comorbidity among disorders. It is not yet known whether these processes uniquely predict symptom severity in each of these domains. Participants were 220 patients in residential substance abuse treatment, who had experienced a potentially traumatic event and exceeded screening cutoffs for probable PTSD and problematic alcohol use. Controlling for emotion dysregulation and the interrelationships among the outcome variables, insomnia was uniquely associated with anxiety (B = .27, p < .001), depression (B = .25, p < .001), PTSD (B = .22, p < .001), and AD (B = .17, p = .01) symptom severity. Similarly, controlling for insomnia, emotion dysregulation was uniquely associated with anxiety (B = .40, p < .001), depression (B = .47, p < .001), PTSD (B = .38, p < .001), and AD (B = .26, p < .001) symptom severity. Insomnia and emotion dysregulation appear to be transdiagnostic processes uniquely associated with symptom severity across a number of different domains and might be important treatment targets for individuals with PTSD and AD.
Asunto(s)
Síntomas Afectivos/epidemiología , Alcoholismo/epidemiología , Ansiedad/epidemiología , Depresión/epidemiología , Trastornos del Inicio y del Mantenimiento del Sueño/epidemiología , Trastornos por Estrés Postraumático/epidemiología , Adulto , Síntomas Afectivos/psicología , Comorbilidad , Inteligencia Emocional , Femenino , Humanos , Masculino , Modelos Psicológicos , Escalas de Valoración Psiquiátrica/estadística & datos numéricos , Psicometría , Índice de Severidad de la Enfermedad , Trastornos del Inicio y del Mantenimiento del Sueño/psicología , Centros de Tratamiento de Abuso de Sustancias , Encuestas y CuestionariosRESUMEN
BACKGROUND: Nicotine cravings are a key target of smoking cessation interventions. Cravings demonstrate circadian variation during abstinence, often peaking during the morning and evening hours. Although some research has also shown diurnal variation in the efficacy of nicotine replacement medications, little research has examined how brief psychosocial interventions affect temporal patterns of craving during abstinence. The present study examined the impact of two brief psycho-education interventions on circadian variations in cravings during a 24-h period. METHOD: 176 adult smokers interested in quitting participated in two lab sessions. During the first session, participants received (a) mindfulness psycho-education that encouraged acceptance of cravings as a normal, tolerable part of quitting that people should not expect to perfectly control, (b) standard cessation psycho-education, or (c) no psycho-education. Half the sample initiated a cessation attempt the following day. Dependent variables were assessed using ecological momentary assessment (24-h of monitoring, immediately after first lab session) and questionnaires four days later. RESULTS: Partially consistent with hypotheses, both forms of psycho-education were associated with differential diurnal variation in cravings during cessation. Relative to those receiving no psycho-education, standard smoking cessation psycho-education decreased morning cravings. Psycho-education encouraging acceptance of cravings was associated with lower craving in both the morning and evening, albeit only among successfully abstinent smokers. CONCLUSIONS: Results demonstrate that brief non-pharmacological interventions can affect circadian craving patterns during smoking cessation. Further investigation of mechanisms of change and of the impact of psycho-education on cessation outcomes is warranted.
Asunto(s)
Ritmo Circadiano/fisiología , Educación del Paciente como Asunto , Cese del Hábito de Fumar/métodos , Cese del Hábito de Fumar/psicología , Adulto , Monóxido de Carbono/metabolismo , Cotinina/orina , Femenino , Humanos , Masculino , Atención Plena , Fumar/psicología , Resultado del TratamientoRESUMEN
INTRODUCTION: Thought suppression can produce a paradoxical rebound in unwanted cognition. Although interest in the role of suppression in nicotine dependence is growing quickly, a validated measure specifically assessing suppression of smoking-related thoughts does not exist. The present study describes the development of the White Bear Suppression Inventory-Smoking Version (WBSI-S). METHOD: The WBSI-S, in vivo monitoring of avoidance, and several other measures were completed as a part of a larger study on smoking cessation. Participants (N = 172) completed measures either during (n = 83) or preceding a smoking cessation attempt. RESULTS: Factor analysis revealed a two-factor structure for the WBSI-S, which was consistent across experimental groups. Both the Intrusive Smoking-related Thoughts and Thought Suppression subscales showed strong internal consistency. The Suppression subscale showed good convergent and discriminant validity; the Intrusion subscale demonstrated equivocal discrimination from other constructs. Participants completing the measure during a quit attempt reported higher self-reported suppression of thoughts about smoking than did continuing smokers. CONCLUSIONS: Overall, results support the construct validity of the suppression subscale and emphasize the importance of assessing suppression independently from intrusion.
Asunto(s)
Inventario de Personalidad , Psicometría/métodos , Represión Psicológica , Cese del Hábito de Fumar/psicología , Fumar/psicología , Tabaquismo/psicología , Adulto , Análisis de Varianza , Análisis Factorial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Autoinforme , PensamientoRESUMEN
Posttraumatic stress disorder (PTSD) commonly co-occurs with alcohol dependence (AD) and negatively affects treatment outcomes. Trauma-related negative affect enhances substance craving in laboratory cue-reactivity studies of AD individuals, but the role of positive affect has not been established. In this study, 108 AD treatment-seeking adults with current PTSD and AD were presented with four counterbalanced trials consisting of an audio cue (personalized trauma or neutral script) followed by a beverage cue (alcohol or water). Results revealed alcohol cues increased positive and negative affect, and positive affective responses explained significant incremental variance in self-reported craving and salivation, but only when cues were accompanied by neutral not trauma imagery. Ambivalent (high negative and positive) responses were associated with strongest craving. Findings advance the conceptualization of craving in individuals with PTSD-AD and highlight the importance of independently assessing positive and negative affective responses to cues in individuals with co-occurring PTSD-AD.