25 results on '"Niles BL"'
Search Results
2. A Double-Blind Randomized Controlled Trial of Doxazosin for Co-Occurring PTSD and Alcohol Use Disorder in Veterans.
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Back SE, Flanagan JC, Mintz J, Brady KT, Jones J, Jarnecke AM, Joseph JE, Shirley DW, Malcolm RJ, Hamner M, Litz BT, Niles BL, Young-McCaughan S, Keane TM, and Peterson AL
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- Humans, Doxazosin therapeutic use, Treatment Outcome, Adrenergic alpha-1 Receptor Antagonists adverse effects, Double-Blind Method, Veterans, Stress Disorders, Post-Traumatic complications, Stress Disorders, Post-Traumatic diagnosis, Stress Disorders, Post-Traumatic drug therapy, Alcoholism diagnosis, Alcoholism drug therapy, Alcoholism epidemiology
- Abstract
Objective: The aim of this study was to determine the efficacy of doxazosin, an α
1 -adrenergic antagonist, for the treatment of co-occurring posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD)., Methods: This 12-week, double-blind, randomized controlled trial of doxazosin (16 mg/d) was conducted between June 2016 and December 2019 at the Ralph H. Johnson VA Medical Center in Charleston, South Carolina. Participants were military veterans (N = 141) who met DSM-5 criteria for current PTSD and AUD and were randomly assigned to receive doxazosin (n = 70) or placebo (n = 71). Primary outcome measures were the Clinician Administered PTSD Scale (CAPS-5), the PTSD Checklist for DSM-5 (PCL-5), and the Timeline Follow-Back (TLFB)., Results: Findings from the intent-to-treat analyses revealed that participants in both groups demonstrated statistically significant reductions in CAPS-5 and PCL-5 scores ( P < .0001), but, contrary to hypotheses, no significant differences were observed between groups. Percent drinking days and percent heavy drinking days also decreased significantly during treatment, but there were no differences between groups ( P < .0001). Abstinence during treatment was significantly higher in the doxazosin versus the placebo group (22% vs 7%, P = .017); however, participants in the doxazosin group consumed a greater number of drinks on drinking days (6.15 vs 4.56, P = .0096). A total of 74.5% of the sample completed the treatment phase, and there were no group differences in retention or adverse events., Conclusions: Doxazosin was safe and tolerable but was not more effective than placebo in reducing PTSD or AUD severity in this dually diagnosed sample. Clinical considerations such as heterogeneity of PTSD and AUD presentation and potential moderators are discussed in the context of future research directions., Trial Registration: ClinicalTrials.gov Identifier: NCT02500602., (© Copyright 2023 Physicians Postgraduate Press, Inc.)- Published
- 2023
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3. Study protocol for a revised randomized trial: Remotely delivered Tai Chi and wellness for Gulf War illness.
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Niles BL, Grossman S, McQuade M, Grossman D, Kaiser AP, Muccio B, Warner B, Wang C, and Mori DL
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- Humans, Quality of Life, Randomized Controlled Trials as Topic, Persian Gulf Syndrome therapy, Tai Ji, Veterans, Musculoskeletal Pain therapy
- Abstract
Background: Many of the 700,000 American military personnel deployed to the Persian Gulf region in 1990 and 1991 have since reported health symptoms of unknown etiology. This cluster of symptoms has been labeled Gulf War Illness and include chronic musculoskeletal pain, fatigue, headaches, memory and attention difficulties, gastrointestinal complaints, skin abnormalities, breathing problems, and mood and sleep problems [1,2]. There have been few high-quality intervention trials and no strong evidence to support available treatments [3]. Tai Chi is an ancient Chinese martial art with benefits that include enhancing physical and mental health and improving quality of life for those with chronic conditions., Proposed Methods: In this randomized controlled trial, GW Veterans are randomly assigned to either Tai Chi or a Wellness control condition, with both remotely delivered intervention groups meeting twice a week for 12 weeks. The primary aim is to examine if Tai Chi is associated with greater improvements in GWI symptoms in Veterans with GWI compared to a Wellness intervention. Participants will receive assessments at baseline, 12 weeks (post-intervention), and follow-up assessments 3- and 9-months post-intervention. The primary outcome measure is the Brief Pain Inventory that examines pain intensity and pain interference., Conclusion: This trial will produce valuable results that can have a meaningful impact on healthcare practices for GWI. If proven as a helpful treatment for individuals with GWI, it would support the implementation of remotely delivered Tai Chi classes that Veterans can access from their own homes., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Published by Elsevier Inc.)
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- 2023
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4. Massed vs Intensive Outpatient Prolonged Exposure for Combat-Related Posttraumatic Stress Disorder: A Randomized Clinical Trial.
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Peterson AL, Blount TH, Foa EB, Brown LA, McLean CP, Mintz J, Schobitz RP, DeBeer BR, Mignogna J, Fina BA, Evans WR, Synett S, Hall-Clark BN, Rentz TO, Schrader C, Yarvis JS, Dondanville KA, Hansen H, Jacoby VM, Lara-Ruiz J, Straud CL, Hale WJ, Shah D, Koch LM, Gerwell KM, Young-McCaughan S, Litz BT, Meyer EC, Blankenship AE, Williamson DE, Roache JD, Javors MA, Sharrieff AM, Niles BL, and Keane TM
- Subjects
- Humans, Male, Adult, Female, Outpatients, Treatment Outcome, Stress Disorders, Post-Traumatic therapy, Military Personnel, Veterans
- Abstract
Importance: Improved, efficient, and acceptable treatments are needed for combat-related posttraumatic stress disorder (PTSD)., Objective: To determine the efficacy of 2 compressed prolonged exposure (PE) therapy outpatient treatments for combat-related PTSD., Design, Setting, and Participants: This randomized clinical trial was conducted among military personnel and veterans at 4 sites in Texas from 2017 to 2019. Assessors were blinded to conditions. Data were analyzed from November 2020 to October 2022., Interventions: The interventions were massed-PE, which included 15 therapy sessions of 90 minutes each over 3 weeks, vs intensive outpatient program PE (IOP-PE), which included 15 full-day therapy sessions over 3 weeks with 8 treatment augmentations. The IOP-PE intervention was hypothesized to be superior to massed-PE., Main Outcomes and Measures: Coprimary outcomes included the Clinician-Administered PTSD Scale for Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) (CAPS-5) and the PTSD Checklist for DSM-5 (PCL-5) administered at baseline and posttreatment follow-ups. Measures ranged from 0 to 80, with higher scores indicating greater severity. Diagnostic remission and reliable change were secondary outcomes., Results: Among 319 military personnel and veterans screened, 234 were randomized (mean [SD] age, 39.20 [7.72] years; 182 [78%] male participants), with 117 participants randomized to IOP-PE and 117 participants randomized to massed-PE. A total of 61 participants (26%) were African American, 58 participants (25%) were Hispanic, and 102 participants (44%) were White; 151 participants (65%) were married. Linear mixed-effects models found that CAPS-5 scores decreased in both treatment groups at the 1-month follow-up (IOP-PE: mean difference, -13.85 [95% CI, -16.47 to -11.23]; P < .001; massed-PE: mean difference, -14.13 [95% CI, -16.63 to -11.62]; P < .001). CAPS-5 change scores differed from 1- to 6-month follow-ups (mean difference, 4.44 [95% CI, 0.89 to 8.01]; P = .02). PTSD symptoms increased in massed-PE participants during follow-up (mean difference, 3.21 [95% CI, 0.65 to 5.77]; P = .01), whereas IOP-PE participants maintained treatment gains (mean difference, 1.23 [95% CI, -3.72 to 1.27]; P = .33). PCL-5 scores decreased in both groups from baseline to 1-month follow-up (IOP-PE: mean difference, -21.81 [95% CI, -25.57 to -18.04]; P < .001; massed-PE: mean difference, -19.96 [95% CI, -23.56 to -16.35]; P < .001) and were maintained at 6 months (IOP-PE: mean change, -0.21 [95% CI, -3.47 to 3.06]; P = .90; massed-PE: mean change, 3.02 [95% CI, -0.36 to 6.40]; P = .08). Both groups had notable PTSD diagnostic remission at posttreatment (IOP-PE: 48% [95% CI, 36% to 61%] of participants; massed-PE: 62% [95% CI, 51% to 73%] of participants), which was maintained at 6 months (IOP-PE: 53% [95% CI, 40% to 66%] of participants; massed-PE: 52% [95% CI, 38% to 66%] of participants). Most participants demonstrated reliable change on the CAPS-5 (61% [95% CI, 52% to 69%] of participants) and the PCL-5 (74% [95% CI, 66% to 81%] of participants) at the 1-month follow-up., Conclusions and Relevance: These findings suggest that PE can be adapted into compressed treatment formats that effectively reduce PTSD symptoms., Trial Registration: ClinicalTrials.gov Identifier: NCT03529435.
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- 2023
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5. A pilot randomized effectiveness trial of the unified protocol in trauma-exposed veterans.
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Gutner CA, Song J, Canale CA, Suvak MK, Litwack SD, Niles BL, and Stirman SW
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- Male, Female, Humans, Pilot Projects, Anxiety psychology, Comorbidity, Treatment Outcome, Veterans psychology, Stress Disorders, Post-Traumatic epidemiology
- Abstract
Background: The unified protocol (UP) is a promising transdisgnostic treatment for emotional disorders; limited data exists with trauma-exposed populations. This study compared effectiveness of the UP, presented centered therapy (PCT), and treatment as usual (TAU) in trauma-exposed veterans presenting to routine care., Method: Trauma-exposed veterans with one or more emotional disorder diagnoses participated in a pilot hybrid-1 effectiveness/preimplementation study. Thirty-seven male and female veterans were randomized to one of three conditions., Results: Multilevel growth curve modeling demonstrated improvement over time across conditions with large effect sizes (range: -2.15 to -3.32), with the UP demonstrating the greatest change. The between group effect sizes for reductions in number of comorbid diagnoses were medium to small and statistically significant (TAU and UP, d = 0.49, p = .056; TAU and PCT d = 0.18, p = .166, UP and PCT d = 0.31, p = .229). Only the UP led to a decrease in the number of comorbid diagnoses (d = -0.71). Psychosocial functioning varied by group, with slight increases in impairment in PCT and TAU, and medium effect size reduction in the UP. Only the UP exhibited significant decreases in self-reported anxiety and depression. Between group differences for UP and PCT were medium to large and statistically significant for depression across two measures (d = -0.72 to d = -1.40)., Conclusions: This represents the first trial examining effectiveness of the UP, PCT, and TAU in trauma-exposed veterans. Despite a small sample, large effect size differences demonstrated promising advantages for the UP. Trial Registration Number: NCT02944994., (© 2022 Wiley Periodicals LLC.)
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- 2022
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6. Randomised controlled trial evaluating the effects of screening and referral for social determinants of health on Veterans' outcomes: protocol.
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Gurewich D, Kressin N, Bokhour BG, Linsky AM, Dichter ME, Hunt KJ, Fix GM, and Niles BL
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- Humans, Multicenter Studies as Topic, Randomized Controlled Trials as Topic, Referral and Consultation, Social Determinants of Health, Social Factors, United States, Cardiovascular Diseases diagnosis, Veterans
- Abstract
Introduction: Health policy leaders recommend screening and referral (S&R) for unmet social needs (eg, food) in clinical settings, and the American Heart Association recently concluded that the most significant opportunities for reducing cardiovascular disease (CVD) death and disability lie with addressing the social determinants of CVD outcomes. A limited but promising evidence base supports these recommendations, but more rigorous research is needed to guide health care-based S&R efforts. Funded by the Veteran Health Administration (VA), the study described in this paper will assess the efficacy of S&R on Veterans' connections to new resources to address social needs, reduction of unmet needs and health-related outcomes (adherence, utilisation and clinical outcomes)., Methods and Analysis: We will conduct a 1-year mixed-methods randomised controlled trial at three VA sites, enrolling Veterans with CVD and CVD-risk. 880 Veterans experiencing one or more social needs will be randomised within each site (n=293 per site) to one of three study arms representing referral mechanisms of varying intensity (screening only, screening and provision of resource sheet(s), screening and provision of resource sheet(s) plus social work assistance). For each Veteran, we will examine associations of unmet social needs with health-related outcomes at baseline, and longitudinally compare the impact of each approach on connection to new resources (primary outcome) and follow-up outcomes over a 12-month period. We will additionally conduct qualitative interviews with key stakeholders, including Veterans to identify potential explanatory factors related to the relative success of the interventions., Ethics and Dissemination: Ethics approval was obtained from the VA Central Internal Review Board on 13 July 2021 (reference #: 20-07-Amendment No. 02). Findings will be disseminated through reports, lay summaries, policy briefs, academic publications, and conference presentations., Trial Registration Number: NCT04977583., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2022
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7. Tai Chi and Qigong for trauma exposed populations: A systematic review.
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Niles BL, Reid KF, Whitworth JW, Alligood E, Williston SK, Grossman DH, McQuade MM, and Mori DL
- Abstract
Background: Trauma exposure and posttraumatic stress are highly prevalent and comorbid with health problems. Despite the apparent systemic nature of post-traumatic stress, recommended treatments neglect trauma's deleterious effects on health. Integrative mind-body treatments for posttraumatic stress, such as Tai Chi and Qigong (TCQ), may offer a promising adjunct to first-line treatments., Method: A systematic search was conducted to identify trials that examined Tai Chi and/or Qigong as treatments for trauma-exposed populations. Studies were examined for rigor; design, sample and intervention characteristics, dropout, attendance, satisfaction, acceptability, and key findings were systematically extracted., Results: The 6 studies included are all pilot or feasibility trials with descriptive or mixed-methods outcomes. No randomized trials or rigorous studies were identified. Dropout rates ranged widely, and adverse reactions were not evident. Reported satisfaction was high and benefits of relaxation, reductions in mental health symptoms, and improvements in pain and physical and cognitive functioning were noted., Limitations: All the studies were non-rigorous and relatively small, with no comparison groups, or follow-up assessments; in many cases, posttraumatic stress symptoms were not formally assessed., Conclusions: The paucity and lack of rigor of the studies identified for this review highlights the need for larger, methodologically sound clinical trials. The reviewed studies suggest that TCQ practices have the potential to reduce symptoms and improve functioning for individuals exposed to trauma and provide evidence that TCQ is feasible, acceptable, and low risk in these populations. Possible mechanistic pathways supporting TCQ as a treatment for posttraumatic stress are considered., Competing Interests: Declaration of competing interest None.
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- 2022
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8. STRONG STAR and the Consortium to Alleviate PTSD: Shaping the future of combat PTSD and related conditions in military and veteran populations.
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Peterson AL, Young-McCaughan S, Roache JD, Mintz J, Litz BT, Williamson DE, Resick PA, Foa EB, McGeary DD, Dondanville KA, Taylor DJ, Wachen JS, Fox PT, Bryan CJ, McLean CP, Pruiksma KE, Yarvis JS, Niles BL, Abdallah CG, Averill LA, Back SE, Baker MT, Blount TH, Borah AM, Borah EV, Brock MS, Brown LA, Burg MM, Cigrang JA, DeBeer BB, DeVoe ER, Fina BA, Flanagan JC, Fredman SJ, Gardner CL, Gatchel RR, Goodie JL, Gueorguieva R, Higgs JB, Jacoby VM, Kelly KM, Krystal JH, Lapiz-Bluhm MD, López-Roca AL, Marx BP, Maurer DM, McDevitt-Murphy ME, McGeary CA, Meyer EC, Miles SR, Monson CM, Morilak DA, Moring JC, Mysliwiec V, Nicholson KL, Rauch SAM, Riggs DS, Rosen CS, Rudd MD, Schobitz RP, Schrader CC, Shinn AM, Shiroma PR, Sloan DM, Stern SL, Strong R, Vannoy SD, Young KA, and Keane TM
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- Humans, Texas, Combat Disorders, Military Personnel, Stress Disorders, Post-Traumatic therapy, Veterans
- Abstract
The STRONG STAR Consortium (South Texas Research Organizational Network Guiding Studies on Trauma and Resilience) and the Consortium to Alleviate PTSD are interdisciplinary and multi-institutional research consortia focused on the detection, diagnosis, prevention, and treatment of combat-related posttraumatic stress disorder (PTSD) and comorbid conditions in military personnel and veterans. This manuscript outlines the consortia's state-of-the-science collaborative research model and how this can be used as a roadmap for future trauma-related research. STRONG STAR was initially funded for 5 years in 2008 by the U.S. Department of Defense's (DoD) Psychological Health and Traumatic Brain Injury Research Program. Since the initial funding of STRONG STAR, almost 50 additional peer-reviewed STRONG STAR-affiliated projects have been funded through the DoD, the U.S. Department of Veterans Affairs (VA), the National Institutes of Health, and private organizations. In 2013, STRONG STAR investigators partnered with the VA's National Center for PTSD and were selected for joint DoD/VA funding to establish the Consortium to Alleviate PTSD. STRONG STAR and the Consortium to Alleviate PTSD have assembled a critical mass of investigators and institutions with the synergy required to make major scientific and public health advances in the prevention and treatment of combat PTSD and related conditions. This manuscript provides an overview of the establishment of these two research consortia, including their history, vision, mission, goals, and accomplishments. Comprehensive tables provide descriptions of over 70 projects supported by the consortia. Examples are provided of collaborations among over 50 worldwide academic research institutions and over 150 investigators., (Published by Elsevier Inc.)
- Published
- 2021
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9. Manage Emotions to Reduce Aggression: A Pilot Study of a Brief Treatment to Help Veterans Reduce Impulsive Aggression.
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Miles SR, Kent TA, Stanley M, Thompson KE, Sharp C, Niles BL, Young-McCaughan S, Mintz J, Roache JD, Litz BT, Hale WJ, Stanford MS, Keane TM, and Peterson AL
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- Adult, Humans, Impulsive Behavior, Male, Middle Aged, Pilot Projects, Stress Disorders, Post-Traumatic psychology, Aggression, Emotional Regulation, Stress Disorders, Post-Traumatic therapy, Veterans psychology
- Abstract
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.
- Published
- 2020
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10. Intensive, Multi-Couple Group Therapy for PTSD: A Nonrandomized Pilot Study With Military and Veteran Dyads.
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Fredman SJ, Macdonald A, Monson CM, Dondanville KA, Blount TH, Hall-Clark BN, Fina BA, Mintz J, Litz BT, Young-McCaughan S, Hancock AK, Rhoades GK, Yarvis JS, Resick PA, Roache JD, Le Y, Wachen JS, Niles BL, McGeary CA, Keane TM, and Peterson AL
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- Female, Humans, Male, Pilot Projects, Treatment Outcome, Couples Therapy, Military Personnel, Psychotherapy, Group, Stress Disorders, Post-Traumatic therapy, Veterans
- Abstract
Cognitive-behavioral conjoint therapy for posttraumatic stress disorder (CBCT for PTSD; Monson & Fredman, 2012) is efficacious in improving PTSD symptoms and relationship adjustment among couples with PTSD. However, there is a need for more efficient delivery formats to maximize engagement and retention and to achieve faster outcomes in multiple domains. This nonrandomized trial was designed to pilot an abbreviated, intensive, multi-couple group version of CBCT for PTSD (AIM-CBCT for PTSD) delivered over a single weekend for 24 couples that included an active-duty service member or veteran with PTSD who had deployed in support of combat operations following September 11, 2001. All couples completed treatment. Assessments conducted by clinical evaluators 1 and 3 months after the intervention revealed significant reductions in clinician-rated PTSD symptoms (ds = -0.77 and -0.98, respectively) and in patients' self-reported symptoms of PTSD (ds = -0.73 and -1.17, respectively), depression (ds = -0.60 and -0.75, respectively), anxiety (ds = -0.63 and -0.73, respectively), and anger (ds = -0.45 and -0.60, respectively), relative to baseline. By 3-month follow-up, partners reported significant reductions in patients' PTSD symptoms (d = -0.56), as well as significant improvements in their own depressive symptoms (d = -0.47), anxiety (d = -0.60), and relationship satisfaction (d = 0.53), relative to baseline. Delivering CBCT for PTSD through an abbreviated, intensive multi-couple group format may be an efficient strategy for improving patient, partner, and relational well-being in military and veteran couples with PTSD., (Copyright © 2020. Published by Elsevier Ltd.)
- Published
- 2020
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11. The Effects of Tai Chi Mind-Body Approach on the Mechanisms of Gulf War Illness: an Umbrella Review.
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Reid KF, Bannuru RR, Wang C, Mori DL, and Niles BL
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Gulf War illness (GWI) is a chronic and multisymptom disorder affecting military veterans deployed to the 1991 Persian Gulf War. It is characterized by a range of acute and chronic symptoms, including but not limited to, fatigue, sleep disturbances, psychological problems, cognitive deficits, widespread pain, and respiratory and gastrointestinal difficulties. The prevalence of many of these chronic symptoms affecting Gulf War veterans occur at markedly elevated rates compared to nondeployed contemporary veterans. To date, no effective treatments for GWI have been identified. The overarching goal of this umbrella review was to critically evaluate the evidence for the potential of Tai Chi mind-body exercise to benefit and alleviate GWI symptomology. Based on the most prevalent GWI chronic symptoms and case definitions established by the Centers for Disease Control and Prevention and the Kansas Gulf War Veterans Health Initiative Program, we reviewed and summarized the evidence from 7 published systematic reviews and meta-analyses. Our findings suggest that Tai Chi may have the potential for distinct therapeutic benefits on the major prevalent symptoms of GWI. Future clinical trials are warranted to examine the feasibility, efficacy, durability and potential mechanisms of Tai Chi for improving health outcomes and relieving symptomology in GWI.
- Published
- 2019
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12. Acceptability of a Wellness Group Program for Veterans With Symptoms of Posttraumatic Stress Disorder.
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Mori DL, Smidt K, Brown L, Pless Kaiser A, Weinstein ES, and Niles BL
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Background: Although there are effective evidence-based treatments for posttraumatic stress disorder (PTSD), many individuals drop out or do not benefit from treatment. There is a need for new treatments, including approaches that are nontrauma focused., Objective: The purpose of this program evaluation was to investigate the acceptability of a Wellness Group designed to promote healthy behaviors and adaptive coping when offered to veterans with PTSD., Methods: Nine veterans in a PTSD outpatient clinic enrolled in a 12-week, 24-session Wellness Group. Acceptability of the intervention was evaluated with attendance data, questionnaires, and interviews., Results: Group attendance rates were high and no participants dropped out of treatment. Treatment satisfaction was high and all veterans reported gains in at least 3 of the 8 Wellness domains covered. Interview data supported the findings that veterans had positive reactions to the group., Conclusion: A Wellness approach may offer a low-cost alternative or supplementary treatment for veterans with PTSD that is highly acceptable and may improve health behaviors, quality of life, and coping skills.
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- 2019
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13. Initiation, dropout, and outcome from evidence-based psychotherapies in a VA PTSD outpatient clinic.
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Niles BL, Polizzi CP, Voelkel E, Weinstein ES, Smidt K, and Fisher LM
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- Adult, Aged, Aged, 80 and over, Humans, Male, Middle Aged, Program Evaluation, United States, United States Department of Veterans Affairs, Young Adult, Ambulatory Care Facilities statistics & numerical data, Evidence-Based Practice methods, Mental Health Services statistics & numerical data, Outcome Assessment, Health Care statistics & numerical data, Patient Dropouts statistics & numerical data, Psychotherapy methods, Stress Disorders, Post-Traumatic therapy
- Abstract
Trauma-focused, evidence-based psychotherapies (TF-EBPs) for posttraumatic stress disorder (PTSD) have been widely promoted in the Veterans Health Administration to provide access to state-of-the-art treatments, but dropout rates may affect the impact of TF-EBPs. The current study summarizes findings from a program evaluation of 67 veterans assigned to trauma-focused treatment in a Veterans Affairs outpatient PTSD clinic. Outcomes of interest include attendance rates, dropout rates and patterns, treatment paths, changes in self-reported symptoms, and clinician ratings. Nine veterans (13.4%) did not attend a first session and 15 (22.4%) dropped out before session 4. Twenty-three (33.8%) received either a modified version of the TF-EBP or switched to a different treatment. Only 11 (16.4%) completed the assigned TF-EBP, but 10 of those 11 (90.9%) were rated by their therapist as improved. These results align with previous research documenting high dropout rates from PTSD treatment in veterans and substantial improvements for those who complete TF-EBPs. Future study of methods to enhance retention in TF-EBP treatments is needed. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
- Published
- 2018
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14. A systematic review of randomized trials of mind-body interventions for PTSD.
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Niles BL, Mori DL, Polizzi C, Pless Kaiser A, Weinstein ES, Gershkovich M, and Wang C
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- Adult, Female, Humans, Male, Meditation, Middle Aged, Yoga, Mindfulness, Psychotherapy methods, Randomized Controlled Trials as Topic, Stress Disorders, Post-Traumatic therapy
- Abstract
Objective: To systematically review outcomes from randomized controlled trials (RCTs) of mind-body treatments for PTSD., Methods: Inclusion criteria based on guidelines for assessing risk of bias were used to evaluate articles identified through electronic literature searches., Results: Twenty-two RCTs met inclusion standards. In most of the nine mindfulness and six yoga studies, significant between-group effects were found indicating moderate to large effect size advantages for these treatments. In all seven relaxation RCT's, relaxation was used as a control condition and five studies reported significant between-group differences on relevant PTSD outcomes in favor of the target treatments. However, there were large within-group symptom improvements in the relaxation condition for the majority of studies., Conclusions: Although many studies are limited by methodologic weaknesses, recent studies have increased rigor and, in aggregate, the results for mindfulness, yoga, and relaxation are promising. Recommendations for design of future mind-body trials are offered., (© 2018 Wiley Periodicals, Inc.)
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- 2018
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15. Alliance across group treatment for veterans with posttraumatic stress disorder: The role of interpersonal trauma and treatment type.
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Thompson-Hollands J, Litwack SD, Ryabchenko KA, Niles BL, Beck JG, Unger W, and Sloan DM
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Objective: Examine initial levels and pattern of change of alliance in group treatment for posttraumatic stress disorder (PTSD) for veterans., Method: One hundred and seventy-eight male veterans with PTSD were recruited for this study. Participants were randomly assigned to either group cognitive behavioral therapy (GCBT) or to group present-centered therapy (GPCT). Alliance with fellow group members was assessed every other session throughout the group (total of seven assessments). Hierarchical linear modeling was used to determine whether treatment condition or index trauma type (interpersonal or non-interpersonal) impacted initial levels of alliance or change in alliance over time., Results: Alliance increased significantly throughout treatment in both conditions. The presence of an interpersonal index event, compared to a non-interpersonal index event, did not significantly impact either initial levels of alliance or change in alliance over time. Participants in the GCBT condition experienced significantly greater growth in alliance over time compared to those in the GPCT condition ( p > .05), but did not have significantly different initial alliance ratings., Conclusions: The components and focus of the GCBT treatment may have facilitated more rapid bonding among members. Interpersonal traumatic experience did not negatively impact group alliance., Competing Interests: Disclosure: The authors report no conflicts of interest.
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- 2018
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16. Explication and Definition of Mental Health Recovery: A Systematic Review.
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Ellison ML, Belanger LK, Niles BL, Evans LC, and Bauer MS
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- Hope, Humans, Patient-Centered Care, Power, Psychological, United States, United States Substance Abuse and Mental Health Services Administration, Mental Disorders rehabilitation, Mental Health Recovery, Psychiatric Rehabilitation
- Abstract
This review assessed the concordance of the literature on recovery with the definition and components of recovery developed by the Substance Abuse and Mental Health Services Administration (SAMHSA). Each SAMHSA identified recovery component was first explicated with synonyms and keywords and made mutually exclusive by authors. Inter-rater reliability was established on the coding of the presence of 17 recovery components and dimensions in 67 literature reviews on the recovery concept in mental health. The review indicated that concordance varied across SAMHSA components. The components of recovery with greatest concordance were: individualized/person centered, empowerment, purpose, and hope.
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- 2018
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17. Feasibility, qualitative findings and satisfaction of a brief Tai Chi mind-body programme for veterans with post-traumatic stress symptoms.
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Niles BL, Mori DL, Polizzi CP, Pless Kaiser A, Ledoux AM, and Wang C
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- Adult, Aged, Feasibility Studies, Female, Humans, Male, Middle Aged, Patient Compliance, Patient Satisfaction, Quality of Life, Self Report, Treatment Outcome, United States, Stress Disorders, Post-Traumatic therapy, Tai Ji methods, Veterans psychology
- Abstract
Objective: To examine feasibility, qualitative feedback and satisfaction associated with a 4-session introduction to Tai Chi for veterans with post-traumatic stress symptoms., Design: We observed and reported recruitment and retention rates, participant characteristics, adherence, and satisfaction across 2 cohorts. We also examined qualitative feedback provided by questionnaires, focus groups and individual interviews., Main Outcome Measures: Rates of recruitment and retention, focus group and individual feedback interviews, self-reported satisfaction., Participants: 17 veterans with post-traumatic stress symptoms., Results: Almost 90% (17/19) of those eligible following the telephone screen enrolled in the programme. Three-quarters (76.4%) of the participants attended at least 3 of the 4 Tai Chi sessions. Qualitative data analysis revealed themes indicating favourable impressions of the Tai Chi sessions. In addition, participants reported feeling very engaged during the sessions, and found Tai Chi to be helpful for managing distressing symptoms (ie, intrusive thoughts, concentration difficulties, physiological arousal). Participants also reported high satisfaction: 93.8% endorsed being very or mostly satisfied with the programme. All participants (100%) indicated that they would like to participate in future Tai Chi programmes and would recommend it to a friend., Conclusions: Tai Chi appears to be feasible and safe for veterans with symptoms of post-traumatic stress disorder (PTSD), is perceived to be beneficial and is associated with high rates of satisfaction. This study highlights the need for future investigation of Tai Chi as a novel intervention to address symptoms of PTSD., Competing Interests: Conflicts of Interest: None declared., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)
- Published
- 2016
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18. Temporal Associations Among Chronic PTSD Symptoms in U.S. Combat Veterans.
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Doron-LaMarca S, Niles BL, King DW, King LA, Pless Kaiser A, and Lyons MJ
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- Boston, Chronic Disease, Humans, Male, Prospective Studies, Severity of Illness Index, Sickness Impact Profile, Stress Disorders, Post-Traumatic diagnosis, Stress Disorders, Post-Traumatic etiology, Time Factors, United States, Veterans statistics & numerical data, Arousal, Stress Disorders, Post-Traumatic psychology, Veterans psychology, Vietnam Conflict
- Abstract
The present study examined fluctuation over time in symptoms of posttraumatic stress disorder (PTSD) among 34 combat veterans (28 with diagnosed PTSD, 6 with subclinical symptoms) assessed every 2 weeks for up to 2 years (range of assessments = 13-52). Temporal relationships were examined among four PTSD symptom clusters (reexperiencing, avoidance, emotional numbing, and hyperarousal) with particular attention to the influence of hyperarousal. Multilevel cross-lagged random coefficients autoregression for intensive time series data analyses were used to model symptom fluctuation decades after combat experiences. As anticipated, hyperarousal predicted subsequent fluctuations in the 3 other PTSD symptom clusters (reexperiencing, avoidance, emotional numbing) at subsequent 2-week intervals (rs = .45, .36, and .40, respectively). Additionally, emotional numbing influenced later reexperiencing and avoidance, and reexperiencing influenced later hyperarousal (rs = .44, .40, and .34, respectively). These findings underscore the important influence of hyperarousal. Furthermore, results indicate a bidirectional relationship between hyperarousal and reexperiencing as well as a possible chaining of symptoms (hyperarousal → emotional numbing → reexperiencing → hyperarousal) and establish potential internal, intrapersonal mechanisms for the maintenance of persistent PTSD symptoms. Results suggested that clinical interventions targeting hyperarousal and emotional numbing symptoms may hold promise for PTSD of long duration., (Published 2015. This article is a US Government work and is in the public domain in the USA. View this article online at wileyonlinelibrary.com.)
- Published
- 2015
- Full Text
- View/download PDF
19. Targeted recruitment of adults with type 2 diabetes for a physical activity intervention.
- Author
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Johnson EJ, Niles BL, and Mori DL
- Abstract
Recruiting sufficient numbers of participants for physical activity trials for individuals with diabetes can be difficult because there are often many behavioral demands for participants, and inclusion and exclusion criteria can be extensive. This study examined the recruitment strategies used for a randomized, controlled trial designed to investigate the efficacy of an automated telephone intervention to promote physical activity in adults with type 2 diabetes in an urban Veterans Administration health care system. Traditional recruitment approaches of posting flyers and obtaining referrals from clinicians did not yield sufficient numbers of interested patients. Using the electronic medical record system to identify patients with uncontrolled diabetes allowed staff to send targeted mailings to participants, and 77% of participants were recruited using this method. The targeted mailing approach elicited a positive response rate of 12% (328 of 2,764 potential participants identified) and appeared to produce a more representative and appropriate sample than other recruitment methods used. Lessons learned in this study may be helpful to researchers in future trials who attempt to recruit participants with diabetes for physical activity protocols.
- Published
- 2015
- Full Text
- View/download PDF
20. Examining mechanisms of change in a yoga intervention for women: the influence of mindfulness, psychological flexibility, and emotion regulation on PTSD symptoms.
- Author
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Dick AM, Niles BL, Street AE, DiMartino DM, and Mitchell KS
- Subjects
- Adolescent, Adult, Aged, Emotions, Female, Humans, Linear Models, Middle Aged, Stress Disorders, Post-Traumatic psychology, Surveys and Questionnaires, United States, United States Department of Veterans Affairs, Women's Health, Young Adult, Adaptation, Psychological, Mindfulness, Stress Disorders, Post-Traumatic therapy, Yoga psychology
- Abstract
Objective: This study explored possible mechanisms through which symptoms of posttraumatic stress disorder (PTSD) were reduced in a randomized controlled trial comparing the effect of a yoga intervention with an assessment control., Method: We examined whether changes in psychological flexibility, mindfulness, and emotion regulation strategies (expressive suppression and reappraisal) were associated with posttreatment PTSD symptoms for 38 women with Diagnostic and Statistical Manual of Mental Disorders Fourth Edition full or subthreshold PTSD., Results: Hierarchical linear regression models revealed that expressive suppression significantly decreased for the yoga group relative to the assessment control. Psychological flexibility increased significantly for the control but not yoga group. However, increases in psychological flexibility were associated with decreases in PTSD symptoms for the yoga but not control group., Conclusion: Preliminary findings suggest that yoga may reduce expressive suppression and may improve PTSD symptoms by increasing psychological flexibility. More research is needed to replicate and extend these findings., (Published 2014. This article is a U.S. Government work and is in the public domain in the USA.)
- Published
- 2014
- Full Text
- View/download PDF
21. Sleep quality as a potential mediator between psychological distress and diabetes quality of life in veterans with type 2 diabetes.
- Author
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Seligowski AV, Pless Kaiser AP, Niles BL, Mori DL, King LA, and King DW
- Subjects
- Adult, Aged, Aged, 80 and over, Anxiety epidemiology, Anxiety psychology, Comorbidity, Depression epidemiology, Depression psychology, Diabetes Mellitus, Type 2 epidemiology, Female, Humans, Male, Middle Aged, Obesity epidemiology, Sleep Wake Disorders epidemiology, Sleep Wake Disorders psychology, Stress, Psychological epidemiology, United States, Diabetes Mellitus, Type 2 psychology, Quality of Life psychology, Sleep physiology, Stress, Psychological psychology, Veterans psychology
- Abstract
Objective: The goal of this study was to explore sleep quality as a potential mediator between depression symptoms and diabetes quality of life (DQOL), and anxiety symptoms and DQOL., Method: Participants were 83 male and 3 female veterans with type 2 diabetes (Mage = 62.4). Self-report measures were completed during the baseline assessment of a larger intervention study conducted at the VA Boston Healthcare System., Results: Depression symptoms, anxiety symptoms, and sleep quality were all associated with DQOL. Additionally, sleep quality had a partial indirect effect on the relationships between depression symptoms and DQOL, and between anxiety symptoms and DQOL., Conclusions: These findings suggest that sleep quality may have an important role in the way that psychological distress affects diabetes quality of life., (© 2012 Wiley Periodicals, Inc.)
- Published
- 2013
- Full Text
- View/download PDF
22. Aggression among combat veterans: relationships with combat exposure and symptoms of posttraumatic stress disorder, dysphoria, and anxiety.
- Author
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Taft CT, Vogt DS, Marshall AD, Panuzio J, and Niles BL
- Subjects
- Affect, Anxiety psychology, Boston, Humans, Male, Middle Aged, Models, Psychological, Stress Disorders, Post-Traumatic psychology, Aggression, Combat Disorders psychology, Veterans psychology
- Abstract
Prior research has revealed heightened aggressive behavior among veterans with PTSD. This study tested a model examining the interrelationships among combat exposure, posttraumatic stress disorder (PTSD) symptoms, dysphoric symptoms, and anxiety symptoms in predicting aggressive behavior in a sample of 265 male combat veterans seeking diagnostic assessment of PTSD. Combat exposure was indirectly associated with aggression primarily through its relationship with PTSD symptoms. Symptoms of PTSD were directly related to aggression, and indirectly related to aggression through dysphoric symptoms. Results highlight the role of PTSD symptoms and dysphoric symptoms with respect to aggressive behavior among this population, and suggest the relevance of aggression theory to the study of combat veterans.
- Published
- 2007
- Full Text
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23. Posttraumatic stress disorder symptomatology in Vietnam veterans before and after September 11.
- Author
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Niles BL, Wolf EJ, and Kutter CJ
- Subjects
- Aged, Humans, Longitudinal Studies, Male, Middle Aged, Terrorism statistics & numerical data, Veterans statistics & numerical data, Vietnam, Stress Disorders, Post-Traumatic epidemiology, Stress Disorders, Post-Traumatic psychology, Terrorism psychology, Veterans psychology
- Published
- 2003
- Full Text
- View/download PDF
24. Clinical presentation of disorders of extreme stress in combat veterans.
- Author
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Newman E, Orsillo SM, Herman DS, Niles BL, and Litz BT
- Subjects
- Combat Disorders classification, Combat Disorders psychology, Factor Analysis, Statistical, Humans, Male, Middle Aged, Psychiatric Status Rating Scales statistics & numerical data, Psychometrics, Severity of Illness Index, Terminology as Topic, Combat Disorders diagnosis, Veterans psychology
- Abstract
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.
- Published
- 1995
- Full Text
- View/download PDF
25. Detection of alcohol problems in a hospital setting.
- Author
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Niles BL and McCrady BS
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Alcohol Drinking psychology, Alcoholism psychology, Alcoholism rehabilitation, Female, Health Behavior, Humans, Liver Function Tests, Male, Middle Aged, Personality Inventory statistics & numerical data, Truth Disclosure, Alcoholism diagnosis, Hospitalization
- Abstract
Three hundred and six adult medical and family practice inpatients at a university-affiliated teaching hospital were assessed for problem drinking using: (1) a short questionnaire containing the CAGE (a 4-question, self-report screening measure), and (2) a standardized review of medical records (an examination of specific blood chemistries and the physicians' and nurses' notes). Each patient completed one of two randomly assigned questionnaires containing the CAGE within the first 48 h of admission: a "Health Habits Questionnaire" or an "Alcohol Questionnaire." No significant differences were found between the two questionnaires with regard to the number of CAGE items endorsed. Overall, 16.9% of the subjects endorsed two or more CAGE items. Using the chart screening method, 11.4% of the total subjects were considered "probable" or "definite" problem drinkers. The screener's reading of the physicians' notes was the variable most important in determining overall chart screening assessment. The correlation between the two screening measures was relatively low (r = .38, p less than .001), suggesting that the two measures identify different populations of problem drinkers.
- Published
- 1991
- Full Text
- View/download PDF
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