Christi S. Ulmer

Cognitive aspects of chronic depression.

Previous research on chronic depression has focused on its link with other mood disorders and Axis II personality disorders. However, there are few data examining whether the cognitive perspective applies to this condition. In this cross-sectional study, 42 outpatients with chronic depression were compared with 27 outpatients with nonchronic major depressive disorder and 24 never psychiatrically ill controls on cognitive variables thought to be related to vulnerability to depression (e.g., dysfunctional attitudes, attributional style, a ruminative response style, and maladaptive core beliefs). Both depressed groups were more elevated than a never-ill comparison group. However, chronically depressed individuals were generally more elevated on measures of cognitive variables than those with major depressive disorders even after controlling for mood state and personality disorder symptoms.

Mindfulness Meditation in Clinical Practice.

The practice of mindfulness is increasingly being integrated into contemporary clinical psychology. Based in Buddhist philosophy and subsequently integrated into Western health care in the contexts of psychotherapy and stress management, mindfulness meditation is evolving as a systematic clinical intervention. This article describes stress-reduction applications of mindfulness meditation predominantly in medical settings, as originally conceived and developed by Kabat-Zinn and colleagues. It describes process factors associated with the time-limited, group-based formal favored by this model, and presents in tabular form results of both early and more recent outcome studies.

Improving sleep with mindfulness and acceptance: A metacognitive model of insomnia

While there is an accumulating evidence to suggest that therapies using mindfulness and acceptance-based approaches have benefits for improving the symptoms of insomnia, it is unclear how these treatments work. The goal of this paper is to present a conceptual framework for the cognitive mechanisms of insomnia based upon mindfulness and acceptance approaches. The existing cognitive and behavioral models of insomnia are first reviewed and a two-level model of cognitive (primary) and metacognitive (secondary) arousal is presented in the context of insomnia. We then focus on the role of metacognition in mindfulness and acceptance-based therapies, followed by a review of these therapies in the treatment of insomnia. A conceptual framework is presented detailing the mechanisms of metacognition in the context of insomnia treatments. This model proposes that increasing awareness of the mental and physical states that are present when experiencing insomnia symptoms and then learning how to shift mental processes can promote an adaptive stance to ones response to these symptoms. These metacognitive processes are characterized by balanced appraisals, cognitive flexibility, equanimity, and commitment to values and are posited to reduce sleep-related arousal, leading to remission from insomnia. We hope that this model will further the understanding and impact of mindfulness and acceptance-based approaches to insomnia.

Impact of combat deployment and posttraumatic stress disorder on newly reported coronary heart disease among US active duty and reserve forces.

Background— The recent conflicts in Iraq and Afghanistan have exposed thousands of service members to intense stress, and as a result, many have developed posttraumatic stress disorder (PTSD). The role of military deployment experiences and PTSD in coronary heart disease (CHD) is not well defined, especially in young US service members with recent combat exposure. Methods and Results— We conducted a prospective cohort study to investigate the relationships between wartime experiences, PTSD, and CHD. Current and former US military personnel from all service branches participating in the Millennium Cohort Study during 2001 to 2008 (n=60 025) were evaluated for newly self-reported CHD. Electronic medical record review for International Classification of Diseases, Ninth Revision, Clinical Modification codes for CHD was conducted among a subpopulation of active duty members (n=23 794). Logistic regression models examined the associations between combat experiences and PTSD with CHD with adjustment for established CHD risk factors. A total of 627 participants (1.0%) newly reported CHD over an average of 5.6 years of follow-up. Deployers with combat experiences had an increased odds of newly reporting CHD (odds ratio, 1.63; 95% confidence interval, 1.11–2.40) and having a diagnosis code for new-onset CHD (odds ratio, 1.93; 95% confidence interval, 1.31–2.84) compared with noncombat deployers. Screening positive for PTSD symptoms was associated with self-reported CHD before but not after adjustment for depression and anxiety and was not associated with a new diagnosis code for CHD. Conclusions— Combat deployments are associated with new-onset CHD among young US service members and veterans. Experiences of intense stress may increase the risk for CHD over a relatively short period among young adults.

Mindfulness and acceptance are associated with exercise maintenance in YMCA exercisers

Although most U.S. adults have initiated an exercise program at some time, only a fraction are able to maintain consistent exercise. Instead, research suggests that intermittent exercise is commonplace among U.S. adults, underscoring the importance of identifying factors associated with consistent exercise at a level that promotes health and long-term maintenance of this activity. We proposed a theoretical model in which mindfulness and acceptance may promote exercise initiation and maintenance. Mindfulness, acceptance, and suppression were examined as a function of exercise status in 266 YMCA exercisers. Those who were successful at maintaining exercise tended to score higher on measures of mindfulness and acceptance, and lower on measures of suppression. Findings are discussed in light of our proposed theoretical model in which exercisers having greater mindfulness and acceptance are less reactive; responding with more balanced appraisals to threats to their exercise regimen which in turn promotes increased exercise maintenance. Future studies should utilize longitudinal design to examine causal relationships between variables.

Ethnic Differences in Continuous Positive Airway Pressure (CPAP) Adherence in Veterans With and Without Psychiatric Disorders

Continuous positive airway pressure (CPAP) is a safe, effective treatment for sleep apnea, yet adherence is notoriously problematic. Vulnerable populations that may be at increased risk of sleep apnea include African Americans (AAs) and individuals with psychiatric disorders, yet little is known about whether such individuals are at increased risk of CPAP non-adherence. This study examined rates of CPAP adherence in a large sample of AA and Caucasian American (CA) military veterans with and without comorbid mental health disorders. AAs used CPAP less than CAs throughout the first 3 months of treatment. AAs with mental health diagnoses showed the lowest CPAP adherence; additional research is needed to identify factors that may be increasing the risk for CPAP non-adherence in these individuals.

Behavioral health mediators of the link between posttraumatic stress disorder and dyslipidemia

OBJECTIVES Posttraumatic stress disorder (PTSD) has been linked to dyslipidemia, which is a major risk factor for coronary artery disease. Although this link is thought to reflect response to heightened stress, behavioral health risks, including smoking, alcohol dependence, and poor sleep quality, may mediate the relationship between PTSD and dyslipidemia. METHODS To test this hypothesis, serum lipid levels were collected from 220 young adults (18-39 years old), 103 of whom were diagnosed with PTSD. RESULTS PTSD and associated depressive symptoms were negatively related to high-density lipoprotein cholesterol (HDL-C), p=.04, and positively related to triglyceride (TG) levels, p=.04. Both associations were mediated by cigarette consumption and poor sleep quality, the latter of which accounted for 83% and 93% of the effect of PTSD and depression on HDL-C and TG, respectively. CONCLUSIONS These results complement recent findings highlighting the prominence of health behaviors in linking PTSD with cardiovascular risk.

Nocturnal Blood Pressure Non-Dipping, Posttraumatic Stress Disorder, and Sleep Quality in Women

Women with posttraumatic stress disorder (PTSD) have poor sleep quality and increased risk of cardiovascular disease (CVD). Non-dipping of nocturnal blood pressure may be an explanatory factor for the relationship between sleep and CVD found in previous research. The current study was designed to determine if non-dipping nocturnal blood pressure was associated with trauma exposure, PTSD diagnosis, PTSD symptoms, and sleep quality in a sample of women. Participants completed 24 hours of ABPM and self-report questionnaires. Non-dipping was defined as less than 10% reduction in blood pressure during sleep. The frequency of non-dippers did not differ by diagnostic status (d = .15). However, non-dippers endorsed more traumatic event categories (d = .53), more PTSD hyperarousal symptoms (d = .53), poorer overall sleep quality (d = .59), more frequent use of sleep medication (d = .62), greater sleep-related daytime dysfunction (d = .58), and longer sleep onset latencies (d = .55) than dippers. Increased attention to nocturnal blood pressure variation may be needed to improve blood pressure control in trauma-exposed women.

Sleep disturbance and baroreceptor sensitivity in women with posttraumatic stress disorder

In a previous study, women with posttraumatic stress disorder (PTSD) had greater objective sleep disturbance than those without PTSD. In a separate previous study, women with PTSD were also found to have lower baroreceptor sensitivity (BRS), an index of blood pressure regulation. In the present study, the authors concurrently assessed BRS and objective sleep by diagnostic status. A comparison of 32 women with PTSD with 21 women without PTSD revealed an interaction between BRS and sleep efficiency, wake after sleep onset percentage, and sleep fragmentation. Lower BRS was associated with poorer sleep in women with PTSD, but not in those without. Future research should investigate causal relationships between sleep and blood pressure regulation in those with PTSD.

Associations between sleep difficulties and risk factors for cardiovascular disease in veterans and active duty military personnel of the Iraq and Afghanistan conflicts

Recent evidence suggests that sleep disturbance may play an important role in the development of cardiovascular disease (CVD). Despite the prevalence of sleep complaints among service members of recent military conflicts, few studies have examined associations between sleep and risk factors for CVD in this population. Symptom checklist items regarding distress about “trouble falling asleep” and “restless/disturbed sleep” were used as proxies for sleep onset and maintenance difficulties to examine these associations in US military service members of recent conflicts. Veterans having both sleep onset and maintenance difficulties had greater odds of being a current smoker and having psychiatric symptoms and diagnoses. Increased odds of a self-reported hypertension diagnosis and elevated systolic blood pressure were also found in certain subsets of this sample. Findings highlight the need for greater recognition of sleep difficulties as a CVD risk factor in a population known to be at increased risk for this condition.