Jessica A. Chen

Mother–infant circadian rhythm: Development of individual patterns and dyadic synchrony

BACKGROUND Mutual circadian rhythm is an early and essential component in the development of maternal-infant physiological synchrony. AIMS The aim of this to examine the longitudinal pattern of maternal-infant circadian rhythm and rhythm synchrony as measured by rhythm parameters. STUDY DESIGN In-home dyadic actigraphy monitoring at infant age 4, 8, and 12 weeks. SUBJECTS Forty-three healthy mother-infant pairs. OUTCOME MEASURES Circadian parameters derived from cosinor and non-parametric analysis including mesor, magnitude, acrophase, L5 and M10 midpoints (midpoint of lowest 5 and highest 10h of activity), amplitude, interdaily stability (IS), and intradaily variability (IV). RESULTS Mothers experienced early disruption of circadian rhythm, with re-establishment of rhythm over time. Significant time effects were noted in increasing maternal magnitude, amplitude, and IS and decreasing IV (p<.001). Infants demonstrated a developmental trajectory of circadian pattern with significant time effects for increasing mesor, magnitude, amplitude, L5, IS, and IV (p<.001). By 12 weeks, infant phase advancement was evidenced by mean acrophase and M10 midpoint occurring 60 and 43 min (respectively) earlier than at 4 weeks. While maternal acrophase remained consistent over time, infants became increasingly phase advanced relative to mother and mean infant acrophase at 12 weeks occurred 60 min before mother. Mother-infant synchrony was evidenced in increasing correspondence of acrophase at 12 weeks (r=0.704), L5 (r=0.453) and M10 (r=0.479) midpoints. CONCLUSIONS Development of mother-infant synchrony reflects shared elements of circadian rhythm.

How will it help me? Reasons underlying treatment preferences between sertraline and prolonged exposure in posttraumatic stress disorder.

AbstractIndividuals with posttraumatic stress disorder (PTSD) often wait years before seeking treatment. Improving treatment initiation and adherence requires a better understanding of patient beliefs that lead to treatment preferences. Using a treatment-seeking sample (N = 200) with chronic PTSD, qualitative reasons underlying treatment preferences for either prolonged exposure (PE) or sertraline (SER) were examined. Reasons for treatment preference primarily focused on how the treatment was perceived to reduce PTSD symptoms rather than practical ones. The patients were more positive about PE than SER. Individual differences did not reliably predict underlying preference reasons, suggesting that what makes a treatment desirable is not strongly determined by current functioning, treatment, or trauma history. Taken together, this information is critical for treatment providers, arguing for enhancing psychoeducation about how treatment works and acknowledging preexisting biases against pharmacotherapy for PTSD that should be addressed. This knowledge has the potential to optimize and better personalize PTSD patient care.

The role of context in the implementation of trauma-focused treatments: effectiveness research and implementation in higher and lower income settings

In recent years, the implementation of trauma-focused treatments has expanded across settings that vary widely in the availability of resources, infrastructure, and personnel. The present review aims to inform researchers, policy makers, trainers, and administrators about this diverse range of research. Taking a global health perspective, this review of effectiveness trials and implementation studies compares strategies used in high-income countries to those in low- and medium-income countries. A primary difference between studies in high-income and low- and medium-income countries is the relative emphasis placed on fidelity or adaptation. Adaptations used in low- and medium-income countries might offer useful ideas for increasing the portability, impact, and accessibility of evidence-based interventions in high-income countries.

Enhancing Stress Management Coping Skills Using Induced Affect and Collaborative Daily Assessment

The purpose of this paper is to highlight the use of induced affect (IA) and collaborative (therapeutic) assessment (CA) as components of Cognitive-Affective Stress Management Training (CASMT). IA is a technique for rehearsing cognitive and physical relaxationcoping skills under conditions of high affective arousal, which has been shown to result in high levels of coping self-efficacy. CA provides diary-based feedback to clients about the processes underlying theirstress experiences and helps identify affect-arousing experiences to be targeted by IA. We include descriptions of the IA technique and anonline stress and coping daily diary, as well as sample transcripts illustrating how CA is integrated into CASMT and how IA evokes high affective arousal and skills rehearsal. To illustrate idiographic assessment, we also describe threetreatment cases involving female clients between the ages of 20 and 35 with anxiety symptoms who participated in six weeks of CASMT and reported their daily stress and coping experiences (before, during, and following the intervention)for a total of ten weeks. The resulting time series data, analyzed using Simulation Modeling Analysis (SMA), revealed that all clients reported improved negative affect regulation over the course of treatment, yet they exhibited idiographic patterns of change on other outcome and coping skills variables. These results illustrate how IA and CA may be used to enhance emotional self-regulation and how time-series analyses can identify idiographic aspects of treatment response that would not be evident in group data.

Alcohol-related and mental health care for patients with unhealthy alcohol use and posttraumatic stress disorder in a National Veterans Affairs cohort

OBJECTIVE Unhealthy alcohol use and posttraumatic stress disorder (PTSD) frequently co-occur. Patients with both conditions have poorer functioning and worse treatment adherence compared to those with either condition alone. Therefore, it is possible that PTSD, when co-occurring with unhealthy alcohol use, may influence receipt of evidence-based alcohol-related care and mental health care. We evaluated receipt of interventions for unhealthy alcohol use and receipt of mental health follow-up care among patients screening positive for unhealthy alcohol use with and without PTSD in a national sample from the Veterans Health Administration (VA). METHODS National clinical and administrative data from VAs electronic medical record were used to identify all patients who screened positive for unhealthy alcohol use (AUDIT-C score≥5) between 10/1/09-5/30/13. Unadjusted and adjusted Poisson regression models were fit to estimate the relative rate and prevalence of receipt of: brief interventions (advice to reduce or abstain from drinking≤14days after positive screening), specialty addictions treatment for alcohol use disorder (AUD; documented visit≤365days after positive screening), pharmacotherapy for AUD (filled prescription≤365days after positive screening), and mental health care ≤14days after positive screening for patients with and without PTSD (documented with ICD-9 CM codes). In secondary analyses, we tested effect modification by both severity of unhealthy alcohol use and age. RESULTS Among 830,825 patients who screened positive for unhealthy alcohol use, 140,388 (16.9%) had documented PTSD. Of the full sample, 71.6% received brief interventions, 10.3% received specialty AUD treatment, 3.1% received pharmacotherapy for AUD, and 24.0% received mental health care. PTSD was associated with increased likelihood of receiving all types of care. Adjusted relative rates were 1.04 (95% CI 1.03-1.05) for brief interventions, 1.06 (1.05-1.08) for specialty AUD treatment, 1.35 (1.31-1.39) for AUD pharmacotherapy, and 1.82 (1.80-1.84) for mental health care. Alcohol use severity modified effects of PTSD for specialty AUD treatment, AUD pharmacotherapy, and mental health care such that effects were maintained at lower severity but attenuated among patients with severe unhealthy alcohol use. Age modified all effects with the strength of the association between PTSD and care outcomes being strongest for younger (18-29years) and older veterans (65+ years) and weaker or non-significant for middle-aged veterans (30-44 and 45-64years). CONCLUSIONS In this large national sample of patients with unhealthy alcohol use, PTSD was associated with increased likelihood of receiving alcohol-related and mental health care. PTSD does not appear to be a barrier to care among VA patients with unhealthy alcohol use.

A qualitative analysis of transgender veterans’ lived experiences.

Transgender veterans (trans-vets) experience high rates of discrimination, family rejection, homelessness, and suicidality, yet little is known about trans-vets’ potentially positive experiences. There has been minimal qualitative research on the subjective experiences at the intersection of transgender and veteran identity. No study to date has focused on describing resilience among trans-vets. The aims of the current study were to identify major themes related to both challenges and strengths in the lived experiences of trans-vets, as well as advice they would give to their fellow trans-vets. A national convenience sample of 201 U.S. transgender veterans provided online responses to 3 open-ended questions asking about challenges, strengths, and advice related to trans-vet identity. Qualitative data were analyzed using thematic analysis and a hybrid of inductive and deductive approaches. Several recurring themes were identified, including health care access and providers, Veterans Health Administration (VA) and military experiences, discrimination, rejection versus acceptance, concealment versus authenticity, and the importance of community. Trans-vets also discussed feelings of personal strength, growth from adversity, and advocacy as important positive experiences. Findings demonstrated the centrality of military and VA experiences as unique aspects of transgender veteran identity. The present study was limited by the restricted nature of data collected from brief, open-ended online questions. Results point to the importance of provider training for trans-affirmative health care, especially in VA and military settings. Additionally, trans-vets reported that resilience can be fostered through advocacy and community building.

How will it help me

AbstractIndividuals with posttraumatic stress disorder (PTSD) often wait years before seeking treatment. Improving treatment initiation and adherence requires a better understanding of patient beliefs that lead to treatment preferences. Using a treatment-seeking sample (N = 200) with chronic PTSD, qualitative reasons underlying treatment preferences for either prolonged exposure (PE) or sertraline (SER) were examined. Reasons for treatment preference primarily focused on how the treatment was perceived to reduce PTSD symptoms rather than practical ones. The patients were more positive about PE than SER. Individual differences did not reliably predict underlying preference reasons, suggesting that what makes a treatment desirable is not strongly determined by current functioning, treatment, or trauma history. Taken together, this information is critical for treatment providers, arguing for enhancing psychoeducation about how treatment works and acknowledging preexisting biases against pharmacotherapy for PTSD that should be addressed. This knowledge has the potential to optimize and better personalize PTSD patient care.

Do trauma type, stressful life events, and social support explain women veterans’ high prevalence of PTSD?

ObjectivesTo examine factors that account for women veterans’ higher prevalence of past-year DSM-5 posttraumatic stress disorder (PTSD) compared to women civilians and men veterans.MethodsCross-sectional analyses of the 2012–2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III). Face-to-face interviews with 379 women veterans, 20,007 women civilians, and 2740 men veterans were conducted. Trauma type (child abuse, interpersonal violence, combat or war zone, and other), number of trauma types, past-year stressful life events, current social support, and DSM-5 PTSD were assessed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-5. Generalized linear models were used that accounted for the complex survey design.ResultsWomen veterans had a higher unadjusted prevalence of past-year PTSD (11.40%) compared to their civilian (5.96%) and male (5.19%) counterparts. Individual predictor models indicated that the difference between women veterans’ and civilians’ prevalence of PTSD was attenuated when adjusting for number of trauma types, whereas the difference between men and women veterans was attenuated when adjusting for child abuse, interpersonal violence, and stressful life events. Nonetheless, while full adjustment in a multiple predictor model accounted for the difference in PTSD between women veterans and civilians, gender differences between men and women veterans remained.ConclusionsNumber of trauma types, type of trauma, and social factors may together help explain women veterans’ higher PTSD prevalence compared to women civilians, but do not fully account for differences between men and women veterans. Results highlight a need to explore additional explanatory factors and evaluate associations with longitudinal data.

Barriers to addiction treatment among formerly incarcerated adults with substance use disorders

BackgroundAddiction treatment improves substance use and criminal recidivism outcomes among justice-involved individuals with substance use disorders, but is underutilized. Although information exists regarding barriers to addiction treatment among individuals with substance use disorders more generally, less is known about barriers among individuals with previous justice involvement. The purpose of this pilot study was to describe barriers to addiction treatment in a sample of adults with a substance use disorder who participated in a pilot trial of brief interventions and were recently released from jail.MethodsIncarcerated individuals who were arrested for an alcohol- or drug-related crime and reported moderate or high alcohol use on the ASSIST (n = 28; 96.4% men) were recruited for a pilot trial of brief interventions to reduce substance use, which were delivered just prior to release from jail. After their release, participants completed the Barriers to Treatment Inventory (BTI), which included 25 numerical items and one open-ended question on additional barriers that provided qualitative data. We described frequency of quantitative responses and qualitatively coded open-ended data using seven previously identified domains of the BTI.ResultsThe most commonly reported barriers assessed quantitatively were items related to Absence of Problem: “I do not think I have a problem with drugs” (42.8%), Privacy Concerns: “I do not like to talk about my personal life with other people” (35.8%), and Admission Difficulty: “I will have to be on a waiting list for treatment” (28.6%). Items related to Negative Social Support (e.g., “Friends tell me not to go to treatment”) were rarely endorsed in this sample. Responses to the open-ended question also related to Absence of Problem, Privacy Concerns, and Admission Difficulty. Additional categories of barriers emerged from the qualitative data, including Ambivalence and Seeking Informal Assistance.ConclusionsIn this small sample of adults with a substance use disorder recently released from jail, barriers to treatment were frequently endorsed. Future research on larger samples is needed to understand barriers to treatment specific to justice-involved populations. Clinicians may consider using open-ended questions to explore and address barriers to addiction treatment among individuals with current or recent justice involvement.

“How Will It Help Me?”: Reasons Underlying Treatment Preferences Between Sertraline and Prolonged Exposure in PTSD

AbstractIndividuals with posttraumatic stress disorder (PTSD) often wait years before seeking treatment. Improving treatment initiation and adherence requires a better understanding of patient beliefs that lead to treatment preferences. Using a treatment-seeking sample (N = 200) with chronic PTSD, qualitative reasons underlying treatment preferences for either prolonged exposure (PE) or sertraline (SER) were examined. Reasons for treatment preference primarily focused on how the treatment was perceived to reduce PTSD symptoms rather than practical ones. The patients were more positive about PE than SER. Individual differences did not reliably predict underlying preference reasons, suggesting that what makes a treatment desirable is not strongly determined by current functioning, treatment, or trauma history. Taken together, this information is critical for treatment providers, arguing for enhancing psychoeducation about how treatment works and acknowledging preexisting biases against pharmacotherapy for PTSD that should be addressed. This knowledge has the potential to optimize and better personalize PTSD patient care.