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Previous research with civilian populations has found strong associations between fibromyalgia (FM) and posttraumatic stress disorder (PTSD). We undertook this study to investigate the prevalence of FM in military service members with and without PTSD. Participants were active duty military personnel recruited into either an epidemiologic cohort study of service members before a military deployment or 1 of 3 PTSD treatment trials. Instruments used to document FM and PTSD included the PTSD Checklist–Stressor‐Specific Version, the PTSD Symptom Scale‐Interview, and the 2012 American College of Rheumatology FM questionnaire. Across the 4 studies, 4,376 subjects completed surveys. The prevalence of FM was 2.9% in the predeployment cohort, and the prevalence was significantly higher in individuals with PTSD (10.8%) compared with those without PTSD (0.8%). In the treatment trials, all of the participants met criteria for PTSD before starting treatment, and the prevalence of FM was 39.7%. The prevalence of FM in active duty service members preparing to deploy is similar to that reported for the general population of the US but is higher than expected for a predominantly male cohort. Furthermore, the prevalence of FM was significantly higher in service members with comorbid PTSD and was highest among those seeking treatment for PTSD. Further investigation is needed to determine the factors linking PTSD and FM.

Objective: The authors report an 8-week randomized, controlled proof-of-concept trial of a new therapist-assisted, Internet-based, self-management cognitive behavior therapy versus Internet-based supportive counseling for posttraumatic stress disorder (PTSD). Method: Service members with PTSD from the attack on the Pentagon on September 11th or the Iraq War were randomly assigned to self-management cognitive behavior therapy (N=24) or supportive counseling (N=21). Results: The dropout rate was similar to regular cognitive behavior therapy (30%) and unrelated to treatment arm. In the intent-to-treat group, self-management cognitive behavior therapy led to sharper declines in daily log-on ratings of PTSD symptoms and global depression. In the completer group, self-management cognitive behavior therapy led to greater reductions in PTSD, depression, and anxiety scores at 6 months. One-third of those who completed self-management cognitive behavior therapy achieved high-end state functioning at 6 months. Conclusions: Self-management cognitive behavior therapy may be a way of delivering effective treatment to large numbers with unmet needs and barriers to care.

Abstract: This study tested the efficacy of repeated intravenous ketamine doses to reduce symptoms of posttraumatic stress disorder (PTSD). Veterans and service members with PTSD (n= 158) who failed previous antidepressant treatment were randomized to 8 infusions administered twice weekly of intravenous placebo (n= 54), low dose (0.2 mg/kg; n= 53) or standard dose (0.5 mg/kg; n= 51) ketamine. Participants were assessed at baseline, during treatment, and for 4 weeks after their last infusion. Primary analyses used mixed effects models. The primary outcome measure was the self-report PTSD Checklist for DSM-5(PCL-5), and secondary outcome measures were the Clinician-Administered PTSD Scale for DSM-5(CAPS-5) and the Montgomery Åsberg Depression Rating Scale (MADRS). There were no significant group-by-time interactions for PTSD symptoms measured by the PCL-5 or CAPS-5. The standard ketamine dose ameliorated depression measured by the MADRS significantly more than placebo. Ketamine produced dose-related dissociative and psychotomimetic effects, which returned to baseline within 2 h and were less pronounced with repeated administration. There was no evidence of differential treatment discontinuation by ketamine dose, consistent with good tolerability. This clinical trial failed to find a significant dose-related effect of ketamine on PTSD symptoms. Secondary analyses suggested that the standard dose exerted rapid antidepressant effects. Further studies are needed to determine the role of ketamine in PTSD treatment. ClinicalTrials.gov identifier: NCT02655692.

Objective: The end of the Cold War has marked a period when the U.S. military is asked to secure peace under conditions in which peace is tenuous, yet the need for resolution of the conflict is great. Combat-trained soldiers are highly visible and are exposed to threats to their lives, yet are asked to exhibit restraint and neutrality. The psychiatric consequences of peacekeeping duty under these conflicting and volatile conditions have been underresearched. The authors examined the prevalence of posttraumatic stress disorder (PTSD) associated with exposure to peacekeeping duty in Somalia. Method: A large cohort of active duty personnel deployed to Somalia (N=3,461) were surveyed approximately 5 months after their return to the United States. A variety of military service characteristics and exposure variables and PTSD symptoms were examined. Results: Eight percent of peacekeepers were found to meet diagnostic criteria for PTSD. PTSD symptom severity was best predicted by the rewards of military service, war zone stress, and frustrations with peacekeeping (e.g., restrictive rules of engagement). Conclusions: It is likely that the mission in Somalia represents a new paradigm of dangerous military operations for the United States. These data suggest that peacekeeping may be difficult to reconcile for some combat-trained soldiers and can create a risk for PTSD.

Veterans with posttraumatic stress disorder (PTSD) report more aggression than civilians with PTSD. Because emotion regulation difficulties mediated the relationship between PTSD symptoms and impulsive aggression in veterans, we developed an intervention to increase emotion regulation skills. This pilot study tested the feasibility and acceptability of a three-session treatment, Manage Emotions to Reduce Aggression (MERA), and examined its effectiveness at reducing aggression and emotion dysregulation. Male combat veterans with PTSD and impulsive aggression completed assessments before and 4 weeks after MERA. Overt Aggression Scale measured frequency of aggression; Difficulties in Emotion Regulation Scale assessed emotion dysregulation. Most veterans (95%) who completed MERA and the posttreatment assessment (n= 20) reported MERA was helpful. Veterans in the intent-to-treat sample demonstrated a significant decrease in their frequency of aggression (Cohen's d= −0.55) and emotion dysregulation (Cohen's d= −0.55). MERA may be an innovative treatment that helps veterans reduce aggression.

Driven by the need to share data, sufficiently power studies, and allow for cross-study comparisons of medical and psychiatric diseases, the President's National Research Action Plan issued in 2013 called for the use of state-of-the-art common data elements (CDEs) for research studies. CDEs are variables measured across independent studies that facilitate methodologically sound data aggregation and study replication. Researchers in the field of military-related post-traumatic stress disorder (PTSD) have suggested applicable CDEs; however, to date, these recommendations have been conceptual and not field-tested. The Consortium to Alleviate PTSD (CAP) - an interdisciplinary and multi-institutional, military-related PTSD research consortium funded by the Departments of Defense and Veterans Affairs - generated and applied CDEs that can be used to combine data from disparate studies to improve the methodological and statistical capabilities of study findings. We provide a description and rationale for the CAP CDEs and details about administration with two main goals: (1) to encourage military-related PTSD researchers to use these measures in future studies and (2) to facilitate comparison, replication, and data aggregation.

AbstractThis study surveyed 1,129 U.S. military medical personnel deployed to a combat support hospital in Iraq regarding their attitudes and beliefs about providing healthcare to Iraqi National Guard, civilian, and security detainee patients. A significant percentage of military medical personnel reported they were comfortable treating Iraqi patients. However, a notable proportion indicated discomfort in this role, especially when interacting with security detainees. Nearly half of the medical personnel did not feel adequately prepared or trained for this role. U.S. military medical personnel may benefit from enhanced predeployment cultural education and training tailored to care for the local civilian patient population.

ABSTRACTMany service members in need of mental health treatment do not seek such treatment. This study investigated the frequency of Army soldiers’ exposure to specific types of deployment stressors and whether different event-types were associated with willingness to seek and actual receipt of treatment. Male soldiers who were married (n = 600) completed online surveys that assessed posttraumatic stress disorder (PTSD), willingness to seek treatment for PTSD, actual receipt of PTSD treatment, and the frequency of exposure to 4 types of potentially traumatizing warzone experiences: committing a moral injury, observing a moral injury, threats to life, and traumatic loss. Soldiers who reported greater exposure to moral injury experiences (committed or observed) were less likely to be willing to seek treatment, regardless of PTSD symptom severity. Although exposure to moral injury did not differentiate actual treatment receipt, soldiers who endorsed loss were more likely to have received treatment, regardless of PTSD symptom severity. These results suggest that the types of trauma experienced during deployment may be a factor in postdeployment treatment-seeking attitudes and behaviors.

Limited research has been conducted on the impact of deployment-related trauma exposure on post-traumatic stress symptoms in military medical personnel. This study evaluated the association between exposure to both combat experiences and medical duty stressors and post-traumatic stress symptoms in deployed military medical personnel.

While cognitive reappraisal represents a promising emotion regulation strategy to assist refugees with posttraumatic stress disorder (PTSD) in managing responses to trauma reminders, there has been no experimental research investigating its efficacy in reducing intrusions and negative affect in this group. In this study, 76 refugees and asylum-seekers with varying levels of PTSD received instructions in cognitive reappraisal or emotional suppression before viewing emotional images depicting trauma-related scenes. Findings indicated that cognitive reappraisal led to fewer subsequent image-related intrusions in refugees high in PTSD symptoms. Trait suppression moderated the efficacy of cognitive reappraisal such that participants high in PTSD who had low levels of trait suppression reported significantly lower levels of negative affect when using cognitive reappraisal compared to emotional suppression. These findings highlight the potential utility of cognitive reappraisal when assisting individuals with PTSD to manage responses trauma reminders and for informing the treatment of the psychological effects of the refugee experience.

To determine the prevalence, correlates, and predictors of insomnia in US Army personnel prior to deployment.

The prevalence of post-traumatic stress disorder (PTSD) among aging Vietnam-era veterans is not well characterized.

Prior research on mental health stigma in military personnel has been cross-sectional. We prospectively examined the course of perceived mental health stigma in a cohort of deployed U.S. combat Marines.

The pervasive negative impact of human rights violations (HRVs) on psychological functioning has been well documented. There is limited research, however, investigating the mechanisms that mediate the link between exposure to HRVs and various mental and behavioral health outcomes. We propose three theory‐ and evidence‐based pathways by which HRVs may lead to psychosocial impairment, namely, disruptions in interpersonal processes, decreased perceptions of control, and the denigration of individual and group identity. We also underscore how the post‐HRVenvironment moderates each of these pathways, and we describe the implications of the proposed model for clinical practice.

The authors evaluated 2 cohorts of individuals from different Israeli communities (Sderot and Otef Aza) that are repeatedly subjected to potentially lethal missile attacks. Although both communities border the Gaza Strip and face similar levels of threat, the authors hypothesized that the Sderot cohort would endorse higher rates of stress‐related symptoms because it has fewer mitigating economic and psychosocial resources. The authors further hypothesized that there would be a significant relationship between exposure to terror and psychopathology regardless of community context. To test these predictions, the authors compared the levels of exposure to terror, posttraumatic stress disorder (PTSD), and depression in representative samples of adults from the 2 communities (n= 298 and n= 152, respectively). Residents of Sderot had a much higher rate of probable PTSD(35.2% vs. 6.6%), and community context was the most important predictor of PTSDand depression. The study also revealed a significant relationship between exposure and psychopathology, but for Sderot residents only. The conclusion is that researchers, mental health workers, and policy makers should pay attention to the influence of community characteristics, such as the availability of resources, the general sense of support, and the level of solidarity, on the mental health response to exposure to terror.

Susceptibility to PTSD is determined by both genes and environment. Similarly, gene‐expression levels in peripheral blood are influenced by both genes and environment, and expression levels of many genes show good correspondence between peripheral blood and brain. Therefore, our objectives were to test the following hypotheses: (1) pre‐trauma expression levels of a gene subset (particularly immune‐system genes) in peripheral blood would differ between trauma‐exposed Marines who later developed PTSD and those who did not; (2) a predictive biomarker panel of the eventual emergence of PTSD among high‐risk individuals could be developed based on gene expression in readily assessable peripheral blood cells; and (3) a predictive panel based on expression of individual exons would surpass the accuracy of a model based on expression of full‐length gene transcripts. Gene‐expression levels were assayed in peripheral blood samples from 50 U.S. Marines (25 eventual PTSD cases and 25 non‐PTSD comparison subjects) prior to their deployment overseas to war‐zones in Iraq or Afghanistan. The panel of biomarkers dysregulated in peripheral blood cells of eventual PTSD cases prior to deployment was significantly enriched for immune genes, achieved 70% prediction accuracy in an independent sample based on the expression of 23 full‐length transcripts, and attained 80% accuracy in an independent sample based on the expression of one exon from each of five genes. If the observed profiles of pre‐deployment mRNA‐expression in eventual PTSD cases can be further refined and replicated, they could suggest avenues for early intervention and prevention among individuals at high risk for trauma exposure. © 2013 Wiley Periodicals, Inc. © 2013 Wiley Periodicals, Inc.

Literature describing the phenomenology of the stress of combat suggests that war-zone experiences may lead to adverse psychological outcomes such as post-traumatic stress disorder not only because they expose persons to life threat and loss but also because they may contradict deeply held moral and ethical beliefs and expectations. We sought to develop and validate a measure of potentially morally injurious events as a necessary step toward studying moral injury as a possible adverse consequence of combat. We administered an 11-item, self-report Moral Injury Events Scale to active duty Marines 1 week and 3 months following war-zone deployment. Two items were eliminated because of low item-total correlations. The remaining 9 items were subjected to an exploratory factor analysis, which revealed two latent factors that we labeled perceived transgressions and perceived betrayals; these were confirmed via confirmatory factor analysis on an independent sample. The overall Moral Injury Events Scale and its two subscales had favorable internal validity, and comparisons between the 1-week and 3-month data suggested good temporal stability. Initial discriminant and concurrent validity were also established. Future research directions were discussed.

The pernicious individual and societal effects of exposure to violence highlight the importance of understanding factors related to trauma perpetration. Little research has investigated the phenomenon of accidental perpetration of serious injury and death, or considered the relationship between perpetration and trauma exposure.

We tested whether a continuous measure of repressor coping style predicted lower posttraumatic stress disorder (PTSD) symptoms in 122 health care professionals serving in Operation Iraqi Freedom. Zero-order correlational analyses indicated that predeployment repressor coping scores negatively predicted postdeployment PTSD symptoms, r(s) = -0.29, p = 0.001, whereas predeployment Connor-Davidson Resilience Scale (CD-RISC) scores did not predict postdeployment PTSD symptoms, r(s) = -0.13, p = 0.14. However, predeployment trait anxiety was chiefly responsible for the association between repressor coping and PTSD symptom severity, r(s) = 0.38, p = 0.001. Four percent of the subjects qualified for a probable PTSD diagnosis. Although service members with relatively higher PTSD scores had lower repressor coping scores than did the other subjects, their level of predeployment anxiety was chiefly responsible for this relationship. Knowing someone's predeployment level of trait anxiety permits better prediction of PTSD symptoms among trauma-exposed service members than does knowing his or her level of repressive coping.

This report describes the development and initial validation of the Response to Stressful Experiences Scale (RSES), a measure of individual differences in cognitive, emotional, and behavioral responses to stressful life events. We validated this instrument with active-duty and reserve components of military and veterans samples (N = 1,014). The resulting 22-item scale demonstrated sound internal consistency (alpha = 0.91-0.93) and good test-retest reliability (r = 0.87). Factor analysis suggested 5 protective factors: (a) meaning-making and restoration, (b) active coping, (c) cognitive flexibility, (d) spirituality, and (e) self-efficacy. Associations with other measures supported convergent, discriminant, and concurrent validity. In separate military samples, the RSES accounted for unique variance in posttraumatic stress disorder symptoms above and beyond existing scales measuring resilience-related constructs, thereby demonstrating incremental validity. The RSES provides a brief, reliable, and valid measure of individual differences in cognitive, emotional, and behavioral responses to life's most stressful events.

Research suggests that military unit cohesion may protect against the development of post-traumatic stress disorder (PTSD). However, equivocal findings have led researchers to hypothesize a potential curvilinear interaction between unit cohesion and warzone stress. This hypothesis states that the protective effects of cohesion increase as warzone stress exposure intensifies from low to moderate levels, but at high levels of warzone stress exposure, cohesion loses its protective effects and is potentially detrimental. To test this theory, we conducted a test for curvilinear moderation using a sample of 705 Air Force medical personnel deployed as part of Operation Iraqi Freedom. Results did not support the curvilinear interaction hypothesis, although evidence of cohesion's protective effects was found, suggesting that unit cohesion protects against PTSD regardless of level of stress exposure.

Peacekeepers deployed to Kosovo (N = 203) were evaluated prospectively, before the mission (August 2000) and at postdeployment, on a number of mental health and functional impairment variables. We examined the association between PTSD symptom subclusters and three indicators of functional impairment using hierarchical regression analyses, controlling for PTSD symptoms before the mission, and history of prior trauma. In the first model, avoidance and hyperarousal symptoms uniquely predicted a conglomerate of functional impact outcomes (e.g., employment, family relationships, social functioning). In the second model, emotional numbing was the only significant predictor of violent behaviors. In the third model, re-experiencing symptoms were the only significant predictor of alcohol abuse problems. Overall, the four PTSD subclusters are differentially associated with varying functional impairment outcomes, which is important to note for evaluation and treatment purposes for veterans returning from overseas deployments.

Levi et al. (2021) reported posttreatment outcomes of 709 Israeli veterans seeking treatment for service-related distress and concluded that their results reveal the “limited overall effectiveness” of treatments for posttraumatic stress disorder (PTSD). In this commentary, I critically appraise the categorical/diagnostic, model-based methods Levi et al. employed to examine effectiveness and use their observational study as a point of departure to describe an approach that uses benchmarked, repeated assessments of individual and aggregated outcomes (measurement-based care) to leverage these types of observational results to improve outcomes at the point of care as a way of advancing knowledge about how to best treat PTSD.

Military medical personnel preparing for deployment to Iraq (N = 328) participated in a survey concerning predeployment risk and resilience factors. Participants reported exposure to an average of 2.5 potentially traumatic events before deployment and 76% (n = 229) reported at least two current concerns about predeployment stressors. Military personnel also endorsed a series of positive appraisals of the military, the mission, and their unit. Fairly low levels of post-traumatic stress disorder symptoms before deployment were reported and positive affect was significantly higher than reported negative affect. Post-traumatic stress disorder symptoms that were present before deployment were most strongly associated with risk factors, whereas positive affect was most strongly associated with resilience factors. Predeployment negative affect was associated with a combination of risk and resilience factors. These findings have implications for possible interventions and preparation of medical personnel before military deployment. A better understanding of the factors related to risk and resilience in military medical personnel will allow for improved screening, educational, training, and clinical programs aimed at increasing resilience before military deployments.

In this study, we assessed basic, physical, and mental health needs of peacekeepers; determined barriers to mental health treatment; and examined predictors of barriers to mental health care. Active duty peacekeepers were surveyed before and after their deployment to Kosovo (n = 203) concerning their stress symptoms and attitudes about seeking mental health care after peacekeeping. Sixty-five peacekeepers were evaluated before and after their peacekeeping deployment to Bosnia. Upon returning from their mission, between 5% and 9% of Kosovo and Bosnia peacekeepers reported needing help for anger or hostility, depression, or deployment-related stress. The most frequently endorsed barrier was concern about the personal cost of mental health care. Among Kosovo peacekeepers, pre- and postdeployment post-traumatic stress disorder symptoms were the most robust predictors of mental health treatment barriers. Peacekeepers report a number of treatment needs and barriers that could prevent them from receiving care. The soldiers most in need of services are also those who report the most barriers to care.

U.S. soldiers' appraisal and experience of the Kosovo peacekeeping mission is described. Using a prospective design, we evaluated the prevalence, severity, and predictors of several mental health outcomes at redeployment. We found that peacekeepers frequently were exposed to potentially traumatizing and other stressful events while in Kosovo, but on average, their appraisal of those events was moderate. Postdeployment psychopathology was also low--soldiers endorsed more severe mental health difficulties at predeployment, which suggests anticipatory negative affect. After controlling for the impact of predeployment stressors, we examined the contribution of potentially traumatizing events, general overseas military duty stressors, negative aspects of peacekeeping roles, and generic positive military experiences, including morale, to explain variance in four outcomes: post-traumatic stress disorder, depression, hostility and aggression problems, and problems with alcohol abuse. Findings indicate that hostility and drinking may be more chronic problems that emerge during stressful times, whereas depression and post-traumatic stress disorder symptoms may be more apt to fluctuate and are associated with potentially traumatizing experiences during peacekeeping. The implications and limitations of the study are discussed.

Using the National Vietnam Veterans Readjustment Study database, we explored predictors of current posttraumatic stress disorder (PTSD) symptom severity in 373 female Vietnam veteran health care providers. We derived war-zone stressor scales to encompass general contextual and specific occupational stressors. To assess the comparative impact of war-zone stressors, we included measures of prewar and postwar factors in a multivariate model. PTSD symptom severity was significantly related to war-zone deprivation, dilemmas for health care providers, purposelessness, and unit cohesion. In contrast, the war-zone stressors more clearly identifiable as crite-rion-A-level traumatic exposure were not directly related to outcome. Results support the clinical relevance of war-zone occupational stressors while emphasizing the predominance of postwar emotional support and life events in the expression of chronic PTSD symptoms among this population.

Although psychological debriefing (PD) represents the most common form of early intervention for recently traumatized people, there is little evidence supporting its continued use with individuals who experience severe trauma. This review identifies the core issues in early intervention that need to be addressed in resolving the debate over PD. It critiques the available evidence for PD and the early provision of cognitive‐behavioral therapy (CBT). Based on available evidence, we propose that psychological first aid is an appropriate initial intervention, but that it does not serve a therapeutic or preventive function. When feasible, initial screening is required so that preventive interventions can be used for those individuals who may have difficulty recovering on their own. Evidence‐based CBT approaches are indicated for people who are at risk of developing posttraumatic psychopathology. Guidelines for managing acutely traumatized people are suggested and standards are proposed to direct future research that may advance our understanding of the role of early intervention in facilitating adaptation to trauma.

Not unlike combat soldiers, peacekeepers are at risk for the development of significant symptoms of posttraumatic stress disorder (PTSD; Litz, Orsillo, Freidman, Ehlich, & Batres, 1997). Previous studies have demonstrated that the response of family and community members at homecoming has a significant restorative role in the adaptation of combat soldiers (e.g., Fontana & Rosenheck, 1994). This study assesses this potential effect in the postdeployment adjustment of peacekeepers. As part of a larger investigation, 1,023 U.S. military personnel who served as peacekeepers in Somalia were administered a comprehensive psychosocial questionnaire that included measures of exposure to negative and potentially traumatic peacekeeping experiences, homecoming reception, and PTSD symptom severity. Adjustment to peacekeeping was positively related to homecoming reception.

Disorders of extreme stress (DES), previously referred to as disorders of extreme stress not otherwise specified and/or complex posttraumatic stress disorder, is a proposed diagnosis designed to describe the symptom presentation of those repeatedly exposed to traumatic stressors. Little is known, however, about the applicability of DES to combat veterans. We clinically assessed combat veterans for the presence or absence of DES in order to provide descriptive clinical information about the severity and patterns of endorsement of DES symptoms among combat veterans. Results indicate that DES is relevant to veterans and the implications of these results for both diagnoses and treatment are discussed.

The present study was designed to assess whether smokers and never-smokers differ in the manner in which they process smoking-related information. Twenty-four smokers and 29 never-smokers participated in a schema reaction time task, in which judgments were made as to the applicability of a series of attributes to smoking (as well as two sets of control stimuli). One-half the subjects rated these attributes with respect to smoking in general, while the rest of the subjects did so in a condition designed to enhance self-referent processing. For all groups, an incidental recall test followed the presentation of smoking stimuli. Results indicated that while groups did not differ in their responses to control stimuli, there were reliable differences between smokers' and never-smokers' responses to smoking attributes on all dependent measures (i.e., latency, confidence ratings, and number of endorsements). Smokers responded in a manner indicative of schematic processing to positively valenced attributes, while never-smokers demonstrated facilitated processing of negatively valenced attributes. However, neversmokers demonstrated expected within-group differences, while smokers did not. In addition, no effect for the self-referencing manipulation was evident. These findings are discussed with regard to the nature of information processing in smokers.

This study investigated the comparability of the embedded and stand-alone versions of the Keane Posttraumatic Stress Disorder scale (PKscale) of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Participants were 123 Vietnam theater veterans, 68 of whom (55%) were diagnosed with war zone-related posttraumatic stress disorder (PTSD). In separate testing sessions scheduled two to three days apart, all participants first completed the full MMPI-2 followed by the 46 PKscale items administered in a stand-alone format. Sixty participants completed the stand-alone version again in a third session. In addition, all participants were administered the Structured Clinical Interview for DSM-III-R(SCID), including the PTSD module, and completed a number of other questionnaire measures of combat exposure and PTSD. Results indicated that the embedded and stand-alone versions of the MMPI-2 PKscale are quite comparable in terms of mean scores, internal consistency, convergent validity, and diagnostic utility. Use of the standalone version is indicated for assessment applications in which the full MMPI-2 cannot be administered.

Previous research has found high rates of psychiatric disorders among veterans with war zone-related posttraumatic stress disorder (PTSD). However, many studies in this area are methodologically limited in ways that preclude unambiguous interpretation of their results. The purpose of this study was to address some of these limitations to clarify the relationship between war zone-related PTSD and other disorders. Participants were 311 male Vietnam theater veterans assessed at the National Center for PTSD at the Boston Veterans Affairs Medical Center. The Clinician-Administered PTSD Scale and the Structured Clinical Interview for DSM-III-R were used to derive current and lifetime diagnoses of PTSD, other axis I disorders (mood, anxiety, substance use, psychotic, and somatoform disorders), and two axis II disorders (borderline and antisocial personality disorders only). Participants also completed several self-report measures of PTSD and general psychopathology. Relative to veterans without PTSD, veterans with PTSD had significantly higher rates of current major depression, bipolar disorder, panic disorder, and social phobia, as well as significantly higher rates of lifetime major depression, panic disorder, social phobia, and obsessive-compulsive disorder. In addition, veterans with PTSD scored significantly higher on all self-report measures of PTSD and general psychopathology. These results provide further evidence that PTSD is associated with high rates of additional psychiatric disorders, particularly mood disorders and other anxiety disorders. The implications of these findings and suggestions about the direction of future research in this area are discussed.

Several recent studies have demonstrated that posttraumatic stress disorder (PTSD) and insomnia treatments are associated with significant reductions in suicidal ideation (SI) among service members. However, few investigations have evaluated the manner in which suicide risk changes over time among military personnel receiving PTSD or insomnia treatments. This paper describes the study protocol for a project with these aims: (1) explore potential genetic, clinical, and demographic subtypes of suicide risk in a large cohort of deployed service members; (2) explore subtype change in SI as a result of evidence-based psychotherapies for PTSD and insomnia; (3) evaluate the speed of change in suicide risk; and (4) identify predictors of higher- and lower-risk for suicide.

Although there are a number of effective treatments for posttraumatic stress disorder (PTSD), there is a need to develop more efficient evidence-based PTSD treatments to address barriers to seeking and receiving treatment. Written exposure therapy (WET) is a potential alternative that is a 5-session treatment without any between-session assignments. WET has demonstrated efficacy, and low treatment dropout rates. However, prior studies with WET have primarily focused on civilian samples. Identifying efficient PTSD treatments for military service members is critical given the high prevalence of PTSD in this population. The current ongoing randomized clinical trial builds upon the existing literature by investigating whether WET is equally efficacious as Cognitive Processing Therapy (CPT) in a sample of 150 active duty military service members diagnosed with PTSD who are randomly assigned to either WET (n = 75) or CPT (n = 75). Participants are assessed at baseline and 10, 20, and 30 weeks after the first treatment session. The primary outcome measure is PTSD symptom severity assessed with the Clinician Administered PTSD Scale for DSM-5. Given the prevalence of PTSD and the aforementioned limitations of currently available first-line PTSD treatments, the identification of a brief, efficacious treatment that is associated with reduced patient dropout would represent a significant public health development.

To compare the efficacy of cognitive behavioral therapy for insomnia (CBTi) disorder and a Control condition on reducing insomnia and comorbid symptoms in a sample of active duty military personnel.

The resilience construct has received a great deal of attention as a result of the long wars in Iraq and Afghanistan. The discourse about resilience, especially the promise of promoting it and mitigating risk for serious post-traumatic negative outcomes among service members and veterans, is hopeful and encouraging. Remarkably, most service members exposed to horrific war trauma are not incapacitated by the experience. Yet, resilience is elusive and fleeting for many veterans of war. In this paper, I address some of the complexities about resilience in the context of exposure to war stressors and I offer some assumptions and heuristics that stem from my involvement in the dialogue about resilience and from experiences helping prevent post-traumatic stress disorder among active-duty service members with military trauma. My goal is to use my observations and applied experiences as an instructive context to raise critical questions for the field about resilience in the face of traumatic life-events.

Little is known about the impact of dementia on sexuality. The attendant cognitive changes that occur in the Alzheimers patient present the caregiver with many, often conflicting, challenges to a couples sexual functioning. This case study highlights these issues by describing a man who reported an erectile dysfunction directly stemming from stressful.changes that had occurred in his relationship to his wife who had Alzheimers disease. General themes and relevant hypotheses are derived and clinical practice implications are explored.