Nicole D. Pukay-Martin
University of North Carolina at Chapel Hill
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Publication
Featured researches published by Nicole D. Pukay-Martin.
Behavior Therapy | 2013
Jonathan S. Abramowitz; Donald H. Baucom; Sara E. Boeding; Michael G. Wheaton; Nicole D. Pukay-Martin; Laura E. Fabricant; Christine Paprocki; Melanie S. Fischer
Although cognitive-behavioral therapy (CBT) involving exposure and response prevention (ERP) is an established treatment for obsessive-compulsive disorder (OCD), not all patients respond optimally, and some show relapse upon discontinuation. Research suggests that for OCD patients in close relationships, targeting relationship dynamics enhances the effects of CBT. In the present study, we developed and pilot tested a 16-session couple-based CBT program for patients with OCD and their romantic partners. This program included (a) partner-assisted ERP, (b) techniques targeting maladaptive relationship patterns focal to OCD (e.g., symptom accommodation), and (c) techniques targeting non OCD-related relationship stressors. OCD, related symptoms, and relationship functioning were assessed at baseline, immediately following treatment (posttest), and at 6- and 12-month follow-up. At posttest, substantial improvements in OCD symptoms, relationship functioning, and depression were observed. Improvements in OCD symptoms were maintained up to 1year. Results are compared to findings from studies of individual CBT for OCD and discussed in terms of the importance of addressing interpersonal processes that maintain OCD symptoms.
Journal of Traumatic Stress | 2015
Emily Voelkel; Nicole D. Pukay-Martin; Kristen H. Walter; Kathleen M. Chard
Military sexual trauma (MST) affects approximately 2% and 36% of male and female veterans, respectively, (e.g., Allard, Gregory, Klest, & Platt, 2011). Although the deleterious consequences of MST have been clearly established, few studies have explored treatment effectiveness for this population. Using archival data from a residential treatment program, the current study explored the effectiveness of cognitive processing therapy (CPT) in treating full or subthreshold posttraumatic stress disorder (PTSD) to compare U.S. veterans reporting an MST index trauma (MST-IT) to those without MST-IT. Of the 481 participants, 40.7% endorsed MST-IT. Multiway frequency analyses were utilized to compare men and women with and without MST on baseline demographic variables. Hierarchical linear models were constructed to investigate treatment outcome by MST status and sex. Results showed that 44.8%, 23.8%, and 19.6% of the variation in clinician- and self-reported PTSD and depression symptoms were explained by three models. Scores on all outcome measures significantly decreased over time for both groups. Additionally, women demonstrated a sharper decrease in PTSD symptoms over time than men. Lastly, men who reported MST-IT had higher PTSD symptoms than men without MST-IT on average. With no control group or random assignment, preliminary findings suggest residential treatment including CPT may be effective for MST-IT regardless of sex.
Journal of Family Psychology | 2016
Alexandra Macdonald; Nicole D. Pukay-Martin; Anne C. Wagner; Steffany J. Fredman; Candice M. Monson
Numerous studies document an association between posttraumatic stress disorder (PTSD) and impairments in intimate relationship functioning, and there is evidence that PTSD symptoms and associated impairments are improved by cognitive-behavioral conjoint therapy for PTSD (CBCT for PTSD; Monson & Fredman, 2012). The present study investigated changes across treatment in clinician-rated PTSD symptom clusters and patient-rated trauma-related cognitions in a randomized controlled trial comparing CBCT for PTSD with waitlist in a sample of 40 individuals with PTSD and their partners (N = 40; Monson et al., 2012). Compared with waitlist, patients who received CBCT for PTSD immediately demonstrated greater improvements in all PTSD symptom clusters, trauma-related beliefs, and guilt cognitions (Hedges gs -.33 to -1.51). Results suggest that CBCT for PTSD improves all PTSD symptom clusters and trauma-related cognitions among individuals with PTSD and further supports the value of utilizing a couple-based approach to the treatment of PTSD.
Behavior Therapy | 2017
Steffany J. Fredman; J. Gayle Beck; Philippe Shnaider; Yunying Le; Nicole D. Pukay-Martin; Kimberly Z. Pentel; Candice M. Monson; Naomi M. Simon; Luana Marques
There are well-documented associations between posttraumatic stress disorder (PTSD) symptoms and intimate relationship impairments, including dysfunctional communication at times of relationship conflict. To date, the extant research on the associations between PTSD symptom severity and conflict communication has been cross-sectional and focused on military and veteran couples. No published work has evaluated the extent to which PTSD symptom severity and communication at times of relationship conflict influence each other over time or in civilian samples. The current study examined the prospective bidirectional associations between PTSD symptom severity and dyadic conflict communication in a sample of 114 severe motor vehicle accident (MVA) survivors in a committed intimate relationship at the time of the accident. PTSD symptom severity and dyadic conflict communication were assessed at 4 and 16weeks post-MVA, and prospective associations were examined using path analysis. Total PTSD symptom severity at 4weeks prospectively predicted greater dysfunctional communication at 16weeks post-MVA but not vice versa. Examination at the level of PTSD symptom clusters revealed that effortful avoidance at 4weeks prospectively predicted greater dysfunctional communication at 16weeks, whereas dysfunctional communication 4weeks after the MVA predicted more severe emotional numbing at 16weeks. Findings highlight the role of PTSD symptoms in contributing to dysfunctional communication and the importance of considering PTSD symptom clusters separately when investigating the dynamic interplay between PTSD symptoms and relationship functioning over time, particularly during the early posttrauma period. Clinical implications for the prevention of chronic PTSD and associated relationship problems are discussed.
Journal of Marital and Family Therapy | 2012
Donald H. Baucom; Jennifer S. Kirby; Nicole D. Pukay-Martin; Laura S. Porter; Steffany J. Fredman; Tina M. Gremore; Francis J. Keefe; David C. Atkins
Previous research indicates that men are affected when their female partners have breast cancer. However, little is known about what predicts mens psychological well-being in this context. The current investigation involved couples in which the woman had early stage breast cancer and explored the degree to which mens positive and negative well-being was related to womens well-being, womens physical symptoms, relationship functioning, and relationship duration. The findings indicate that all of these factors play a role and interact in predicting mens well-being. In particular, when women have a high level of physical symptoms, the typical associations between mens well-being with womens well-being and relationship adjustment no longer persist. Implications for working with couples addressing health problems are provided.
Neurobiology of Learning and Memory | 2016
Ronak Patel; Todd A. Girard; Nicole D. Pukay-Martin; Candice M. Monson
BACKGROUND The vast majority of functional neuroimaging studies in posttraumatic stress disorder (PTSD) have examined the amygdala as a unitary structure. However, an emerging body of studies indicates that separable functions are subserved by discrete amygdala subregions. The basolateral subdivision (BLA), as compared with the centromedial amygdala (CMA), plays a unique role in learning and memory-based processes for threatening events, and alterations to the BLA have been implicated in the pathogenesis of PTSD. We assessed whether PTSD is associated with differential involvement of the BLA versus the CMA during successful encoding of emotionally charged events. METHODS Participants with PTSD (n=11) and a trauma-exposed comparison (TEC) group (n=11) viewed a series of photos that varied in valence (negative versus positive) and arousal (high versus low) while undergoing functional magnetic resonance imaging (fMRI). Subsequently, participants completed an old/new recognition memory test. RESULTS Using analytic methods based on probabilistic cytoarchitectonic mapping, PTSD was associated with greater activation of the BLA, as compared to the CMA, during successful encoding of negative scenes, a finding which was not observed in the TEC group. Moreover, this memory-related activity in the BLA independently predicted PTSD status. Contrary to hypotheses, there was no evidence of altered BLA activity during memory encoding of high arousing relative to low arousing scenes. CONCLUSIONS Task-related brain activation in PTSD does not appear to be consistent across the entire amygdala. Importantly, memory-related processing of negative information in PTSD is associated with preferential recruitment of the BLA.
Psychological Services | 2016
Jena L. Wierwille; Nicole D. Pukay-Martin; Kathleen M. Chard; Meredith C. Klump
Over the past decade, the Veterans Health Administration has supported multiple national rollouts of evidence-based treatments for mental health disorders. Recent studies have shown, however, that the majority of veterans with mental health diagnoses are not utilizing psychotherapy services. In this article, we attempt to address one of the more commonly known barriers to treatment, distance to care. We do this by comparing the effectiveness of outpatient and telehealth cognitive processing therapy (CPT) and prolonged exposure (PE) Therapy for posttraumatic stress disorder (PTSD) in a Veteran clinical sample. Multilevel modeling analyses revealed statistically significant differences between the outpatient and telehealth treatments once baseline demographic and symptom severity differences were taken into account. Given that a number of randomized control studies have not found similar outcome differences, future research would benefit from examining whether the outcomes differences in the present study are because of treatment delivery method or sample differences. Veterans completing treatment via outpatient and telehealth delivery methods achieved clinically significant change in PTSD from pre- to posttreatment. These results suggest that delivering evidence-based treatment for PTSD via telehealth may be a viable treatment option for veterans who cannot easily access care because of geographic distance. (PsycINFO Database Record
Journal of Clinical Psychology | 2015
Nicole D. Pukay-Martin; Lindsey Torbit; Meredith S. H. Landy; Sonya G. Wanklyn; Philippe Shnaider; Jeanine Lane; Candice M. Monson
OBJECTIVE The efficacy of a present-focused version of cognitive-behavioral conjoint therapy for posttraumatic stress disorder (CBCT for PTSD) was examined in a community sample. METHOD Seven couples completed pretreatment assessments, including measures of clinician-, self- and partner-rated PTSD symptoms and relationship satisfaction. Six couples completed present-focused CBCT for PTSD and all posttreatment assessments. A seventh couple terminated their relationship prior to completing treatment; therefore, they completed posttreatment symptom measures, but not ratings of relationship satisfaction. RESULTS Results revealed significant decreases in PTSD symptoms that were associated with medium-to-large effect sizes. Medium effect sizes for changes in relationship satisfaction were found, though were only significant for partners. CONCLUSION Results from this pilot study suggest that present-focused CBCT for PTSD may be a promising alternative for individuals who are unwilling to engage in a trauma-focused treatment.
Current Treatment Options in Psychiatry | 2016
Nicole D. Pukay-Martin; Alexandra Macdonald; Steffany J. Fredman; Candice M. Monson
Opinion statementResearch has consistently documented a bidirectional association between posttraumatic stress disorder (PTSD) symptoms and intimate relationship functioning. PTSD symptoms are associated with greater relationship distress, higher likelihood of divorce, decreased emotional intimacy, and increased sexual dysfunction. Conversely, specific relational factors and interaction patterns (e.g., hostility, partner accommodation of PTSD symptoms) can serve to maintain or exacerbate PTSD symptoms. Given this reciprocal relationship, several couple therapies for PTSD have been created and empirically examined. Therapies that have been empirically studied include behavioral family therapy, emotionally focused couple therapy, strategic approach therapy, and cognitive-behavioral conjoint therapy for PTSD (CBCT for PTSD). To date, CBCT for PTSD has accumulated the most supporting evidence in the most diverse samples. Collectively, these empirical studies suggest that CBCT for PTSD is associated with improvements in PTSD, comorbid mental health symptoms, some partners’ mental health symptoms, and relationship satisfaction. CBCT for PTSD is a 15-session, trauma-focused PTSD treatment that occurs within a conjoint context. The therapy includes three phases: (1) psychoeducation and safety building, (2) communication skills and dyadic approach tasks to undermine avoidance, and (3) cognitive change regarding historical trauma appraisals and here-and-now maladaptive cognitions that maintain PTSD symptoms and/or relationship problems. Given the evidence supporting conjoint therapies for PTSD, clinicians should consider systematically involving partners in PTSD treatments to facilitate treatment by targeting both individual and relationship factors maintaining PTSD symptoms, as well as cultivate the strength within the couple’s relationship to encourage them to confront PTSD as a team.
Partner abuse | 2014
Jennifer M. Belus; Sonya G. Wanklyn; Katherine M. Iverson; Nicole D. Pukay-Martin; Jennifer Langhinrichsen-Rohling; Candice M. Monson
Objective: The purpose of this study was to determine whether anger and jealousy mediate the relationship between adult attachment styles (i.e., dismissive, fearful, preoccupied, secure) and physical intimate partner violence (IPV) perpetration for both men and women. Method: Undergraduate students (n = 431) were sampled from a large Midwestern U.S. university. Results: Mediational analyses revealed that anger mediated the associations between each of the four attachment styles and violence perpetration for women. However, neither anger nor jealousy mediated the association between attachment and violence perpetration for men. Conclusions: Young women’s IPV perpetration appears more closely related to their emotional responses, in particular anger, but violence perpetration in young men does not necessarily seem to follow this pattern. These findings suggest specific strategies which may be useful for preventive efforts of violence perpetration in young adult women, such as anger-related emotion regulation skills training.