Objective
Many patients dropout of treatments for Post-traumatic stress
disorder (PTSD) and some clinicians believe that ‘trauma
focused’ treatments increase dropout.
Method
We conducted a meta-analysis of dropout among active treatments in
clinical trials for PTSD (42 studies; 17 direct comparisons).
Results
The average dropout rate was 18%, but it varied significantly
across studies. Group modality and greater number of sessions, but not
trauma focus, predicted increased dropout. When the meta-analysis was
restricted to direct comparisons of active treatments, there were no
differences in dropout. Differences in trauma focus between treatments in
the same study did not predict dropout. However, trauma focused treatments
resulted in higher dropout as compared to Present Centered Therapy (PCT)
– a treatment originally designed as a control, but now listed as a
research supported intervention for PTSD.
Conclusion
Dropout varies between active interventions for PTSD across studies,
but differences are primarily driven by differences between studies. There
do not appear to be systematic differences across active interventions when
they are directly compared in the same study. The degree of clinical
attention placed on the traumatic event does not appear to be a primary
cause of dropout from active treatments. However comparisons of PCT may be
an exception to this general pattern, perhaps due to a restriction of
variability in trauma focus among comparisons of active treatments. More
research is needed comparing trauma focused interventions to trauma avoidant
treatments such as PCT.
Iraq and Afghanistan War veterans were grouped by level of posttraumatic stress disorder (PTSD) symptomatology and compared on self-report measures of trait anger, hostility, and aggression. Veterans who screened positive for PTSD reported significantly greater anger and hostility than those in the subthreshold-PTSD and non-PTSD groups. Veterans in the subthreshold-PTSD group reported significantly greater anger and hostility than those in the non-PTSD group. The PTSD and subthreshold-PTSD groups did not differ with respect to aggression, though both groups were significantly more likely to have endorsed aggression than the non-PTSD group. These findings suggest that providers should screen for anger and aggression among Iraq and Afghanistan War veterans who exhibit symptoms of PTSD and incorporate relevant anger treatments into early intervention strategies.
Posttraumatic stress disorder (PTSD) was examined as a risk factor for suicidal ideation in Iraq and Afghanistan War veterans (N = 407) referred to Veterans Affairs mental health care. The authors also examined if risk for suicidal ideation was increased by the presence of comorbid mental disorders in veterans with PTSD. Veterans who screened positive for PTSD were more than 4 times as likely to endorse suicidal ideation relative to non-PTSD veterans. Among veterans who screened positive for PTSD (n = 202), the risk for suicidal ideation was 5.7 times greater in veterans who screened positive for two or more comorbid disorders relative to veterans with PTSD only. Findings are relevant to identifying risk for suicide behaviors in Iraq and Afghanistan War veterans.
Masculine gender role stress and masculine ideology were investigated to better understand each
factor's role in men's aggressive and violent behaviors perpetrated within their romantic
relationships. Participants were 165 men attending an urban university campus. A hierarchical
regression analysis was used to analyze each factor's contribution to predicting aggression and
violence. Results indicated that masculine gender role stress accounted for a significant portion
of the variance in aggression and violence scores. In addition, the interaction effect of Ideology
× Gender Role Stress emerged as a significant predictor of aggression and violence. Results are
discussed in terms of clinical implications and future research.
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