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In this study, we combined the results of two controlled trials and examined the relationships between working alliance, telepresence, cognitive change, and treatment outcome. Sixty-five participants with a primary diagnosis of generalized anxiety disorder (GAD) or panic disorder with agoraphobia (PDA) received cognitive behavior therapy delivered via videoconference. Participants completed measures of working alliance and telepresence after three psychotherapy sessions. They also completed measures of treatment outcome and dysfunctional beliefs (cognitive change) specific to PDA and GAD at pretreatment and posttreatment. Results revealed that telepresence at the fifth session moderated the relationship between the working alliance at the first and fifth sessions. As telepresence increased, its impact on the working alliance diminished. Cognitive change mediated the relationship between the working alliance at the fifth session and treatment outcome.

Objectives Anxiety and depression are the most prevalent disorders observed in health care services and are frequently comorbid with other disorders. Although Cognitive-Behavioral Therapy (CBT) has widely been shown efficacious to treat anxiety and mood disorders, studies that have focused on its effectiveness in the presence of comorbidity have been few and show conflicting results. Thus, the implications of the presence of comorbid disorders for treatment are still unknown. In an attempt to answer these questions, this study explores the impact of comorbidity on CBT for anxiety and mood disorders in a university-based clinic. Methods A total of 293 clients consulting for anxiety and/or mood disorders at the Service de Consultation de l'École de Psychologie de l'Université Laval (SCEP) between 2007 and 2018 took part in the study. Clients were excluded if they presented uncontrolled psychotic, manic or substance abuse symptoms as their principal complaint. Clients without comorbid disorders where compared to clients who had comorbid disorders on different measures before and after receiving therapy to examine if comorbidity had an impact on CBT effectiveness to treat the principal disorder. The impact of treatment on comorbid disorders was also investigated. Effectiveness was assessed on several measures before and after treatment including the severity of diagnoses (measured with a structured interview), anxiety and mood symptoms as well as quality of life. Repeated measures ANOVAs and t-tests were used. Results Before initiating therapy, clients with comorbid disorders had significantly more severe symptoms than clients without comorbid disorders. However, following therapy, both groups had significantly less severe principal disorders and reached a clinically significant change in equivalent proportions. Furthermore, the number and severity of comorbid disorders significantly decreased following therapy. Conclusion These findings suggest that although the presence of comorbid disorders leads to more severe symptoms, it does not affect the effectiveness of CBT for the principal disorder. Furthermore, comorbid disorders improved even though they were not specifically targeted by treatment. In concordance with the literature, it is thus suggested to keep focusing treatment on the principal disorder, whether comorbid disorders are present or not.

Background: Based on the most common psychological difficulties of the evacuees from the 2016 Fort McMurray wildfires in Alberta, Canada, a therapist-guided cognitive behavioral self-treatment was developed. This study aimed to explore how gender influences the usage and subjective appreciation of the RESILIENT online treatment. Methods: Our study included 81 English-speaking evacuees with significant posttraumatic symptoms, or with some posttraumatic symptoms accompanied by at least mild depression symptoms or subclinical insomnia, and who logged into the platform at least once. Various usage and subjective appreciation variables were analyzed, including number of completed sessions, number of logins, number of words per session, perceived efforts, perception of usefulness and intention to continue using the different strategies. Results: No difference was detected in most objective usage indicators. The number of words written in sessions 7 and 10 was significantly greater for women than for men. Regarding subjective appreciation, men had a greater perception of having put strong efforts in the cognitive restructuring strategy, while women reported in a greater proportion that they wanted to continue using physical exercise as a behavioral activation strategy. Conclusions: Our study offers a first look into how women and men use online treatments, and what their preferences are.

Peu d’études ont cherché à identifier les symptômes du trouble de stress post-traumatique (TSPT) du DSM-5 étant plus rapportés en fonction du genre. Il importe de caractériser ces différences pour mieux cibler les besoins selon ce facteur. La présente étude vise à évaluer les différences de genre dans la symptomatologie du TSPT chez 1510 évacués (838 femmes, 672 hommes) des feux de forêt de Fort McMurray un an après l’événement. Les données ont été récoltées via un sondage téléphonique. Les symptômes post-traumatiques ont été évalués par le PTSD Checklist for DSM-5. La sévérité totale et celle des quatre catégories de symptômes (intrusion, évitement, humeur/cognitions et éveil/réactivité) étaient significativement plus élevées chez les femmes de même que la fréquence d’endossement pour 12 symptômes. Les hommes présentaient une fréquence d’endossement significativement plus élevée pour un symptôme (comportements irréfléchis/autodestructeurs). Les résultats ont montré que le profil clinique du TSPT chez les évacués différait selon le genre, ce qui permet de mettre en évidence les particularités liées au genre dans le TSPT. Cela pourrait ultimement aider les cliniciens à planifier un plan de traitement plus approprié en fonction des symptômes qui ont davantage tendance à être exhibés selon le genre.

The objective of this study was to evaluate the impact of integrating insomnia management strategies into CBT for GAD on insomnia and anxiety. Forty-nine participants with GAD (84% females; mean age = 32.0) were randomized to 12-weeks of CBT for GAD that included or excluded insomnia management strategies. Participants completed the Anxiety Disorders Interview Schedule for DSM-IV (ADIS-IV) before and after treatment, as well as the Insomnia Severity Index (ISI) and the Worry and Anxiety Questionnaire (WAQ) before and after treatment and at 3- and 6-month follow-ups. There was no condition effect and no condition × time interaction effect on the primary outcomes (ISI and WAQ). Both conditions produced large decreases in insomnia, F(3, 46.03) = 25.75, P

Telepsychotherapy represents a promising solution to problems pertaining to specialized mental health services accessibility, including when delivering psychotherapy to people who do not have access to care due to the COVID-19 pandemic. The quality of the working alliance established in such a therapeutic context remains often questioned. Moreover, no study has comparatively examined the evolution of the alliance over telepsychotherapy and conventional, face-to-face, psychotherapy. This study assesses the impact of cognitive- behavioral therapy administered via telepsychotherapy or face-to-face on the quality of the working alliance. One hundred and 15 participants suffering from generalized anxiety disorder (GAD) took part in this randomized controlled trial, 50 of whom were assigned to telepsychotherapy in videoconference and 65 of whom were assigned to conventional psychotherapy. Each client and their psychotherapist completed the Working Alliance Inventory every 2 sessions. In the current sample, telepsychotherapy did not interfere with the establishment of the working alliance over the course of the treatment for GAD. On the contrary, clients showed a stronger working alliance in telepsychotherapy delivered in videoconference than in conventional psychotherapy. Clients seemed to be more comfortable with telepsychotherapy than psychotherapists. The clinical implications of these findings are discussed.

Background: Natural disasters happen in an increased frequency, and telemental health interventions could offer easily accessible help to reduce mental health symptoms experienced by survivors. However, there are very few programs offered to natural disaster survivors, and no research exists on therapists’ experiences with providing blended interventions for natural disaster survivors. Aims: Our qualitative case study aims to describe psychologists’ experiences with an online, therapist-assisted blended intervention for survivors of the Fort McMurray wildfires in Alberta, Canada. Method: The RESILIENT intervention was developed in the frames of a randomized controlled trial to promote resilience after the Fort McMurray wildfires by providing survivors free access to a 12-module, therapist-assisted intervention, aiming to improve post-traumatic stress, insomnia, and depression symptoms. A focus group design was used to collect data from the therapists, and emerging common themes were identified by thematic analysis. Results: Therapists felt they could build strong alliances and communicate emotions and empathy effectively, although the lack of nonverbal cues posed some challenges. The intervention, according to participating therapists, was less suitable for participants in high-stress situations and in case of discrepancy between client expectations and the intervention content. Moreover, the therapists perceived specific interventions as easy-to-use or as more challenging based on their complexity and on the therapist support needed for executing them. Client engagement in the program emerged as an underlying theme that had fundamental impact on alliance, communication, and ultimately, treatment efficiency. Therapist training and supervision was perceived as crucial for the success of the program delivery. Conclusions: Our findings provided several implications for the optimalization of blended interventions for natural disaster survivors from our therapists’ perspective.

Purpose/objective The goals of the present study were (a) to document the prevalence of anxiety-related disorders and anxiety symptoms at 4, 8, and 12 months postinjury in individuals with mild traumatic brain injury (mTBI) while considering preinjury history of anxiety disorders and (b) to verify whether the presence of anxiety in the first months after mTBI was associated with more symptoms present 1 year after the injury. Research Method/Design: One hundred and twenty participants hospitalized after an accident and having sustained mTBI were assessed at 4, 8, and 12 months postaccident with the Mini-International Neuropsychiatric Interview, the Hospital Anxiety and Depression Scale, and questionnaires assessing fatigue, irritability, perceived stress, cognitive difficulties, depression, insomnia, and pain. Results At 4 months, 23.8% of participants presented with at least one anxiety-related disorder compared with 15.2% at 8 months and 11.2% at 12 months. Overall, 32.5% presented with at least one anxiety disorder over the first 12 months post-mTBI. Participants with a history of anxiety (20.5%) were significantly more anxious after their accident. Individuals who were anxious 4 months after the accident presented with more symptoms in different areas 12 months postinjury compared with nonanxious individuals. Conclusions/implications The present results highlight that anxiety should be evaluated and managed carefully as it appears to be a key factor in the persistence of other mTBI-related symptoms. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Few studies have examined the scope of the subjective experience during and after a natural disaster. This qualitative study explored the perceptions of persons affected by the wildfires and evacuation of Fort McMurray in 2016. The objectives were to document (1) the experience of the evacuation, and (2) the biopsychosocial consequences of the wildfires as perceived by evacuees from Fort McMurray 3 months and 3 years after evacuation. This study included two data collections, one from 393 evacuees 3 months after evacuation using an online questionnaire, and the other from 31 participants (among those who participated in the 3-month evaluation) interviewed by telephone 3 years after evacuation. Eight themes describing the evacuation experience emerged from the qualitative analysis: the preparation for evacuation, the perceived traumatic nature of the evacuation, problems encountered while on the move, assistance received and provided, vulnerability conditions, presence of physical discomfort, relocation and no problem/no response. Seven categories of negative consequences emerged: material and financial loss, emotional/mental health disorders, cognitive impairments, behavioral changes, spiritual/existential reflections, social alterations, and physical conditions. Four categories of positive consequences emerged: posttraumatic growth, resilience/absence of consequences, altruism and community cohesion. This study showed a wide range of perceived consequences of fires and evacuations by Fort McMurray residents. The results highlight the importance of tailoring responses to the needs of evacuees and providing assistance to victims over a long period of time.

Objectives Despite the existence of several online treatments for people with posttraumatic stress disorder (PTSD), few studies have examined usage data for such interventions. Given the potential of the online modality to alleviate barriers limiting access to psychological help, it is important to document users' interactions with these tools in relation to the improvement of targeted symptoms. The objective of this study is to document usage data of the online treatment platform RESILIENT by people evacuated from the Fort McMurray, Alberta (Canada) fires, and to examine their association with the effectiveness of treatment on symptoms of posttraumatic stress disorder (PTSD), insomnia and depression, and adherence to treatment, as measured by the number of modules accessed by participants. Methods Ninety-seven people evacuated from the Fort McMurray fires with symptoms of PTSD, insomnia and depression were included in this study. Participants were invited to use the RESILIENT platform, an online therapist-assisted self-help treatment program that targets PTSD symptoms, sleep and mood, and includes 12 modules offering evidence-based cognitive-behavioural therapy (CBT) strategies. Both objective (e.g., number of modules accessed) and subjective (e.g., level of effort invested) usage data were collected. Results In order to predict the reduction in PTSD, depression and insomnia symptoms, as well as the number of modules accessed by participants, sequential regression models were conducted, with statistical control for pretreatment symptoms, age and gender. The final models revealed that a reduction in PTSD, depression and insomnia symptoms was significantly predicted by the number of modules accessed (β = -.41; -.53; -.49 respectively, all p.001) as well as the mean self-reported level of effort at module 7 (midway) (β = -.43; p.001; β = -.38; p = .005 and β = -.36; p = .007 respectively). The number of modules accessed, on the other hand, was significantly predicted by the number of words in the 4th module (β = .34; p.001) and 7th module (β = .44; p.001) and the number of sleep diary entries (β = .28; p.001). Conclusion These results confirmed that increased interaction with the platform positively influences treatment effectiveness and that increased use at the beginning of treatment appears to be a good predictor of treatment completion. This study confirms the importance of sustaining participants' commitment to online treatment in order to optimize its effectiveness.

OBJECTIVES To determine whether persons with traumatic brain injury (TBI) are at greater risk of developing posttraumatic stress disorder (PTSD) than other trauma-exposed populations without TBI, and whether this risk is even greater in military/veteran settings than in civilian settings. DESIGN A systematic review and meta-analysis was conducted in 7 databases. Reference lists from the 33 identified studies and other relevant reviews were also searched. RESULTS The pooled PTSD proportion reached 27% (95% confidence interval = 21.8-33.1) in groups with TBI, which was 2.68 times greater than the observed 11% (95% confidence interval = 8.0-15.0) in groups without TBI. PTSD after TBI was more frequently observed in military samples than in civilians (37% vs 16%). Military and civilian samples were respectively 4.18 and 1.26 times more inclined to have a diagnosis of PTSD after TBI than when there was no TBI. The proportion of PTSD after TBI was concurrently attributable to the methods of the included studies (objectives focused on PTSD diagnosis, type of comparison group) and to characteristics specific to the military setting (country, sex, blast injuries). CONCLUSIONS TBI diagnosis and military setting represent greater risks for PTSD. The dual diagnosis of TBI and PTSD requires interdisciplinary collaboration, as physical and psychological traumas are closely intertwined.

La thérapie cognitive-comportementale (TCC) pour le trouble de stress post-traumatique (TSPT) est validée empiriquement (Forman-Hoffman et al., 2018). Toutefois, à notre connaissance, aucune revue de la littérature ne s’intéresse précisément à l’efficacité à long terme de la TCC du TSPT. Il importe pourtant de s’assurer avec une vision d’ensemble de la durabilité des gains thérapeutiques afin de vérifier si la TCC du TSPT permet d’éviter un retour des symptômes après la thérapie. Des études ont observé que les gains thérapeutiques se maintiendraient entre 6 et 20 mois après la TCC (voir, p. ex., Hembree & Foa, 2000; Kline, Cooper, Rytwinksi, & Feeny, 2018) et qu’ils pourraient même s’améliorer (Hembree & Foa, 2000). La présente revue de littérature identifie des études de traitement, des revues de littérature et des méta-analyses abordant l’efficacité à long terme d’une TCC du TSPT. Ce projet répertorie également les facteurs influençant l’efficacité à long terme d’une TCC individuelle, de groupe et par vidéoconférence. Des articles publiés entre 2010 et 2018 ont été cherchés dans les bases de données MEDLINE et PsycINFO. Deux constats se dégagent de cette revue, soit que la TCC permettrait de traiter le TSPT de façon durable et que certaines variables comme la dépression ou l’anxiété comorbide, un âge avancé, des difficultés de sommeil persistantes et le fait de tarder à aller chercher de l’aide sont associées à une moins bonne efficacité à long terme de la TCC du TSPT. Il est possible que le développement d’habiletés d’adaptation en thérapie soit un facteur de maintien et même d’amélioration des gains après la TCC.

Psychiatric service dogs compensate in terms of social and physical cognition for people who suffer from chronic post-traumatic stress, reassuring them with their canine behavior in public places, at home and in relationships interpersonal skills with strangers. There are no certification and standards for schools that train service dogs in Canada and the United States. Does the fact that training is different from one school to another have an impact on the effectiveness of the assistance dog for his master? To identify all aspects that closely reflect tertiary prevention, this exploratory case study documents the processes and services supporting the assignment of service dogs to veterans with PTSD and the subsequent follow-up conducted at various dog training schools; and it evaluates and compares the processes and services in place. The case study included four data collection methods involving 31 veterans, 7 school delegates, 7 trainers and 23 dogs. Qualitative content analysis and all the information collected was rated according to the Theoretical Domains Framework (TDF) and Assistance Dogs International (ADI) criteria. Results indicated a TDF-scoring across 12 domains ranged from 6/24 to 16/24. The schools moderately reflected ADI-standards. Tertiary prevention recommendations were proposed for dog trainers to better address the domains that needed improving at the time of the study (knowledge about PTSD, beliefs about capabilities, behavioral regulation, environmental context and resources, beliefs about consequences, nature of behaviors).

Background Previous meta-analyses have shown a significant relationship between working alliance and treatment outcome in general. Some studies have examined the relationship between working alliance and treatment outcome during telepsychotherapy, but to the best of our knowledge, no study has examined the mediating role of individual components of the working alliance. Objective As part of a clinical trial of cognitive behavioral therapy (CBT) for generalized anxiety disorder (GAD) delivered by videoconference (VC), the aim of this study is to examine the mediating role of intolerance of uncertainty on the relationship between the components of the working alliance and treatment outcome. Methods A sample of 46 adults with primary GAD received 15 sessions of CBT for GAD delivered over VC. Participants completed the measure of working alliance immediately after the fifth therapy session. The degree of change in intolerance of uncertainty (a key psychological process) was assessed from pre- to posttreatment. Treatment outcome was assessed via changes in GAD symptoms from pretreatment to the 6-month follow-up. Results The results revealed that the therapeutic bond did not predict treatment outcome (r=−0.23; P=.12). However, agreement on therapeutic goals and tasks did predict treatment outcome (r=−0.42; P=.004 and r=−0.37; P=.01, respectively). In addition, the relationship between consensus on therapeutic tasks and treatment outcome was completely mediated by changes in intolerance of uncertainty (unstandardized β=−0.03; r2=0.12), whereas consensus relative to treatment goals had a direct impact on treatment outcome. Conclusions These results provide a better understanding of the differential role of the components of the working alliance in telepsychotherapy as a facilitative factor for changes in key cognitive processes, leading to therapeutic change. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN): 12662027; http://www.isrctn.com/ISRCTN12662027.

BACKGROUND Previous meta-analyses have shown a significant relationship between working alliance and treatment outcome in general. Some studies have examined the relationship between working alliance and treatment outcome during telepsychotherapy, but to the best of our knowledge, no study has examined the mediating role of individual components of the working alliance. OBJECTIVE As part of a clinical trial of cognitive behavioral therapy (CBT) for generalized anxiety disorder (GAD) delivered by videoconference (VC), the aim of this study is to examine the mediating role of intolerance of uncertainty on the relationship between the components of the working alliance and treatment outcome. METHODS A sample of 46 adults with primary GAD received 15 sessions of CBT for GAD delivered over VC. Participants completed the measure of working alliance immediately after the fifth therapy session. The degree of change in intolerance of uncertainty (a key psychological process) was assessed from pre- to posttreatment. Treatment outcome was assessed via changes in GAD symptoms from pretreatment to the 6-month follow-up. RESULTS The results revealed that the therapeutic bond did not predict treatment outcome (r=−0.23; P=.12). However, agreement on therapeutic goals and tasks did predict treatment outcome (r=−0.42; P=.004 and r=−0.37; P=.01, respectively). In addition, the relationship between consensus on therapeutic tasks and treatment outcome was completely mediated by changes in intolerance of uncertainty (unstandardized β=−0.03; r2=0.12), whereas consensus relative to treatment goals had a direct impact on treatment outcome. CONCLUSIONS These results provide a better understanding of the differential role of the components of the working alliance in telepsychotherapy as a facilitative factor for changes in key cognitive processes, leading to therapeutic change. CLINICALTRIAL International Standard Randomized Controlled Trial Number (ISRCTN): 12662027; http://www.isrctn.com/ISRCTN12662027.

Resume Introduction La combinaison des modeles de l’intolerance a l’incertitude (II) et de la regulation emotionnelle dysfonctionnelle (RED) pourrait ameliorer l’efficacite du traitement cognitif-comportemental (TCC) du trouble d’anxiete generalisee (TAG). Cette etude preliminaire compare un TCC du TAG base sur le modele de l’II (TCC II) a un TCC du TAG base sur la combinaison des modeles (TCC II + RED). Methode Vingt participants ont complete le traitement. Des entretiens semi-structures ont eu lieu deux semaines pre- et post-traitement. Des questionnaires ont ete postes 3 et 6 mois post-traitement. Resultats Les analyses par modeles mixtes revelent que les deux therapies traitent efficacement le TAG (inquietudes [F(3, 19,031) = 20,667, p Discussion Un traitement du TAG integrant la regulation emotionnelle pourrait entrainer une meilleure tolerance aux emotions.

Imagery rehearsal therapy (IRT) is an empirically validated therapy targeting recurring nightmares, for which the mechanisms of action remain poorly understood. The objective of this study was to investigate how an exploratory measure of self-efficacy could mediate IRT's effectiveness. Thirty-five victims of sexual assault with recurring nightmares were randomly assigned to either IRT or a control condition. Participants completed questionnaires about self-efficacy and nocturnal symptoms at pre- and posttreatment. Regression analyses showed that IRT predicted greater self-efficacy about dreams (β = .578) and that self-efficacy about dreams predicted improvement in insomnia (β = -.378). IRT also predicted greater self-efficacy about nightmares (β = .366), which in turn predicts sleep quality (β = -.412). However, self-efficacy was not a significant mediator of IRT's effectiveness on insomnia and sleep quality. Although IRT did increase patients' self-efficacy over dreams and nightmares, self-efficacy may not be a primary mechanism of action explaining IRT's effectiveness.

There is strong research evidence for the association of personality pathology and posttraumatic stress disorder (PTSD), as well as trauma-related negative cognitions (TRNC) and PTSD sympto...

Sleep disturbances are common among sexual assault victims with posttraumatic stress disorder (PTSD), but cognitive behavioral therapy (CBT) for PTSD does not directly address sleep-related symptoms. Trauma-related sleep disturbances are associated with more impairment and contribute to the maintenance of PTSD. In this study, we evaluated the efficacy of a combination of CBT and nightmare therapy (imagery rehearsal therapy; IRT) compared to CBT alone for the treatment of PTSD. We recruited 42 adult victims of sexual assault who were suffering from PTSD and randomly assigned them to either the experimental (IRT + CBT) or control condition (waiting period followed by CBT). After CBT, both groups demonstrated significant decreases in nighttime symptoms (except nightmare frequency) and PTSD symptoms and showed improvements in functional impairment and mental health, ds = 0.13-0.83, ps = .005-.008. Outcomes between the two groups did not differ significantly after CBT; however, we observed medium to medium-large differences between the control group and experimental group in terms of nighttime symptoms, ds = 0.45-0.63. Although results did not clearly establish the superiority of IRT + CBT over CBT alone, they demonstrated that IRT yielded greater improvement in nighttime symptoms than the waiting period, ds = 0.72-1.13, ps = .006-.047 for all interaction effects. Findings suggest that targeting nightmares at the beginning of treatment for PTSD may yield rapid improvement in nighttime symptoms. This strategy could be useful for patients with time or resource constraints or those for whom nightmares are the primary complaint.

Objective To document the usability of psychiatric service dogs (PsySDs) as a tertiary prevention modality from the perspective of veterans who have been using a PsySD 2 to 4 years as an assistive aid for post-traumatic stress disorder symptom (PTSD) management. Method A case series study with PsySD primary users was carried out with 10 Canadian veterans recruited from 4 different dog training schools. Researchers conducted semi-structured telephone interviews and asked questions pertaining to four domains addressing the PsySD’s ‘usability’. A content and thematic analysis were realized using an inductive and deductive approach. Results Our conceptual framework proposes four main themes with their associated subthemes:: 1-Service dog’s roles and tasks (8 subthemes, e.g. acting as a socializing agent, maintaining an appropriate free space around the veteran), 2-Personal advantages and Environmental impacts (8 subthemes, e.g. alleviating symptoms; increasing outings and physical activities, enabling social interactions and relationship building), 3-Obstacles (4 subthemes, e.g. high costs of dog maintenance, dog’s presence attracted unwanted public attention, prompting intrusive questions), and 4-Recommendations for PsySD programs (16 subthemes, e.g. creating a national registry for PsySD, encouraging mental health practitioners’ involvement). Conclusions and Implications for Practice Themes 1 and 2 are positive perceptions, and theme 4 suggests relevant potential improvements. The current study offers insights into how PsySDs concretely assist primary users and can help addressing PTSD chronicity. It presents the roles professionals may play when dealing with patients using PsySDs for PTSD. The proposed conceptual framework can be useful to policy makers, dog trainers and caregivers.

Studies of psychotherapeutic treatments for nightmares have yielded support for their effectiveness. However, no consensus exists to explain how they work. This study combines a systematic review with a qualitative thematic analysis to identify and categorize the existing proposed mechanisms of action (MAs) of nightmare treatments. The systematic review allowed for a great number of scholarly publications on supported psychological treatments for nightmares to be identified. Characteristics of the study and citations regarding potential MAs were extracted using a standardized coding grid. Then, thematic analysis allowed citations to be grouped under six different categories of possible MAs according to their similarities and differences. Results reveal that an increased sense of mastery was the most often cited hypothesis to explain the efficacy of nightmare psychotherapies. Other mechanisms included emotional processing leading to modification of the fear structure, modification of beliefs, restoration of sleep functions, decreased arousal, and prevention of avoidance. An illustration of the different variables involved in the treatment of nightmares is proposed. Different avenues for operationalization of these MAs are put forth to enable future research on nightmare treatments to measure and link them to efficacy measures, and test the implications of the illustration.

La thérapie cognitive-comportementale (TCC) est efficace pour traiter le trouble de stress post-traumatique (TSPT) et l’ajout d’une composante de répétition et révision par imagerie mentale (RRIM) diminue les cauchemars persistants, mais les essais cliniques effectuent rarement un suivi à long terme. La présente étude vise à évaluer l’amélioration des gains thérapeutiques jusqu’à 12 mois suivant une TCC du TSPT (avec ou sans RRIM) sur les symptômes de TSPT et le sommeil. Elle vise aussi à explorer si ces gains s’étendent à la qualité de vie et au fonctionnement quotidien et si les conditions TCC du TSPT seule ou avec RRIM diffèrent. Quarante-deux victimes d’agression sexuelle ayant un TSPT ont été assignées aléatoirement aux conditions et ont été évaluées au post-traitement et aux suivis effectués 3, 6 et 12 mois après le traitement. Aucun changement significatif n’a été observé sur les symptômes de TSPT et le sommeil dans les 12 mois après le traitement (tous les p > 0.05). Les conditions ne différaient pas significativement sur toutes les variables, sauf la santé physique perçue. Combinés aux améliorations observées pendant la thérapie (Belleville et al., 2018), les résultats suggèrent que les gains se maintiennent jusqu'à 12 mois après une TCC du TSPT (avec ou sans RRIM).

Introduction Studies have shown that, following psychotherapy for posttraumatic stress disorder (PTSD), symptoms and quality of life (QoL) may improve in many patients, but not always to the same extent. Dysfunctional core beliefs, such as personality beliefs (PB), are associated to psychopathology, including PTSD, and could be associated with the types of coping strategies deployed by an individual. Beliefs and coping strategies were also linked to psychotherapeutic outcomes. Objectives (1) To examine the associations between baseline PB as well as pre- and post-treatment coping strategies; (2) To investigate the mediation effects between PB and the changes in QoL, through changes in coping strategies in a cognitive-behavioral psychotherapy (CBT). Method Seventy-one adults with PTSD participating in a correlational/observational CBT study were assessed for PB before a CBT, as well as for coping strategies and QoL, before and after a CBT. Results PB were generally associated with post-treatment distancing coping. Moreover, changes in distancing coping mediated the relationships between avoidant or dependent PB and psychological QoL improvements. Conclusion This is the first study to show the relationships between PB and coping strategies in PTSD patients, and that higher avoidant or dependent PB predicts a lower reduction in the use of distancing coping through psychotherapy, which is associated with less improvement in psychological QoL. Future studies are needed to further define the role of these variables and target more precisely factors that may hamper the treatment effects of CBT for PTSD.

Traumatic events at work can have debilitating effects on employees. This pilot study aims to describe the trauma exposure, posttraumatic stress disorder (PTSD) severity, functioning level, and general and work-related quality of life of employees who experienced a workplace trauma and consequently developed PTSD. Forty-four participants with current PTSD were recruited and assessed using semistructured interviews and questionnaires. ANOVAs were performed to assess differences in outcomes between employees from different work settings. Specific types of traumatic events appear to occur in particular types of occupations. Participants manifested severe PTSD, low levels of current functioning, and poor general and work-related quality of life. Overall, these results did not significantly differ between employees in different occupations. Unemployed participants showed poorer outcomes than those who were still working despite their current difficulties. PTSD severity and the presence of comorbid majo...

Background: Sexual abuse victims often experience symptoms of post-traumatic stress disorder (PTSD), including sleep disturbances. Objective: To investigate whether or not characteristics of sexual abuse are associated with sleep disturbance, and to explore whether correlates of sleep disturbance are distinguishable from those of PTSD symptom severity. Method: Forty-four adult sexual abuse victims seeking treatment for PTSD and sleep disturbances completed validated self-report questionnaires assessing sleep, nightmares, and PTSD symptoms. Results: Age at time of sexual abuse contributed to the severity of distress associated with nightmares, whereas the number of perpetrators contributed to the frequency of nightmares. Sleep disturbances had different correlates compared to those of overall PTSD symptoms. Conclusions: The present study highlighted that age at time of abuse and number of offenders may account for variability in sleep disturbances. Exploration of characteristics of sexual abuse could help clinicians to quickly identify who could benefit the most from targeting nightmares and other sleep disturbances in treatment.

This study documents post-traumatic stress symptoms after the May 2016 wildfires in Fort McMurray (Alberta, Canada). A sample of 379 evacuees completed an online questionnaire from July to September 2016, and a subsample of 55 completed a psychiatric/psychological diagnostic interview. According to a self-report questionnaire, 62.5% of respondents had a provisional post-traumatic stress disorder (PTSD). The interview confirmed that 29.1% met criteria for PTSD, 25.5% for depression, and 43.6% for insomnia, in most cases, insomnia was definitely or probably related to the fires. Traumatic exposure may elicit or exacerbate sleep problems, which are closely associated with PTSD after a disaster.

Objective This paper presents a systematic review and meta-analysis of available evidence on remission rates for substance use disorders (SUDs), providing weighted mean estimates of SUD remission rates. The review also explores study-level characteristics that may explain variations in remission rates across studies. Methods A comprehensive search strategy identified studies published between 2000 and 2015 with follow-up periods of at least three years or reported lifetime remission outcomes for potential inclusion in the review. Remission was defined as not meeting diagnostic criteria for abuse or dependence for a minimum period of six months, as of final follow-up. A single-group summary meta-analysis was performed. Pooled estimated annual remission rates (PEARRs) were calculated. Meta-regression techniques and subgroup analyses were used to explore the association between study remission rates and key selected variables. Results Of 8855 studies identified, 21 met the eligibility criteria. The results suggested that 35.0% to 54.4% of individuals with SUDs achieved remission, and this occurred after a mean follow-up period of 17 years. The PEARRs projected few cases of SUD remission, between 6.8% and 9.1% in any given year. Studies that reported higher remission rates had longer follow-up periods, and lower sample retention rates. Conclusions Results support the contention that SUDs are more likely to be “chronic” or long term disorders than acute disorders for a substantial number of individuals. However, more longitudinal research is required. Treatment geared to chronicity, such as assertive community treatment and intensive case management, needs to be more readily available for SUD populations.

OBJECTIVE This study aimed to examine possible gender differences in therapy gain in patients with posttraumatic stress disorder (PTSD). It also aimed to examine whether the gender effect could be explained by gender differences in dropout rates, trauma type (interpersonal/noninterpersonal), or context of the event (work-related/not work-related). METHOD Seventy-one participants received 20-session cognitive-behavior therapy for PTSD. They were assessed pre- and posttreatment on primary and secondary outcome measures: PTSD symptoms, quality of life, avoidance, social support and positive reappraisal copings, and supportive and countersupportive interactions. RESULTS Regression analysis showed that gender explained 6%-9% significant variance in the outcome: Women statistically benefited more from the treatment than men on quality of life (p < .05), avoidance (p < .01), and support seeking (p < .05) copings, supportive (p < .05), and countersupportive (p < .05) interactions. However, there was no statistically significant gender difference on PTSD symptoms and positive reappraisal coping. Dropout rate, trauma type, and context of trauma could not explain the gender differences. CONCLUSION The results might explain ambiguous previous results on gender differences in therapy efficacy for PTSD, and highlight the importance of using multiple measurements in the evaluation of treatment outcome in PTSD. Further research is needed to explain the exact mechanisms behind women's getting more of therapy's secondary benefits. (PsycINFO Database Record

Objective To explore the efficacy of cognitive-behavior therapy (CBT) for patients with comorbid generalized anxiety disorder (GAD) and insomnia using 2 sequential treatments. Method Using a single-case methodology, 10 women (mean age = 45) with chronic insomnia and GAD were randomly assigned to CBT for GAD followed by CBT for insomnia, or to CBT for insomnia followed by CBT for GAD. Sleep and anxiety were measured via diagnostic interviews, daily diaries, and self-report questionnaires. Results Time series analyses, group effect sizes, and indications of clinically significant change revealed improvements on anxiety, worry, and sleep after CBT for GAD. Following CBT for insomnia, positive changes were observed on sleep and, to a lesser extent, anxiety and worry. Conclusions In the presence of comorbid GAD and insomnia, initiating treatment for GAD first produced superior clinical benefits in anxiety and sleep. The addition of insomnia-specific treatment led to additional improvements in worry and sleep quality.

Limited scientific evidence on the effectiveness of psychiatric service dogs used by Veterans with post-traumatic stress disorder (PTSD) is available. This study investigated their short-term effectiveness among 15 Canadian veterans who received a first psychiatric service dog. Preliminary results suggest potential beneficial effects at 3 months on the psychiatric symptoms.