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Evaluation of an internet-based intervention for service members of the German armed forces with deployment-related posttraumatic stress symptoms.

ABSTRACT: BACKGROUND:The present study was designed to evaluate the efficacy of a therapist-guided internet-based cognitive-behavioral therapy (iCBT) intervention for service members of the German Armed Forces with posttraumatic stress disorder (PTSD). The iCBT was adapted from Interapy, a trauma-focused evidence-based treatment based on prolonged exposure and cognitive restructuring. It lasted for 5 weeks and included 10 writing assignments (twice a week). The program included a reminder function if assignments were overdue, but no multimedia elements. Therapeutic written feedback was provided asynchronously within one working day. METHODS:Male active and former military service members were recruited from the German Armed Forces. Diagnoses were assessed with the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) and the Mini-International Neuropsychiatric Interview. Psychopathology was assessed at pre-treatment, post-treatment, and 3-month follow-up. Severity of PTSD was the primary outcome and anxiety was the secondary outcome. Participants were randomly allocated to a treatment group that received iCBT immediately or to a waitlist group that received iCBT after 6 weeks. Due to the overall small sample size (n?=?37), the two groups were collapsed for the statistical analyses. Change during the intervention period was investigated using latent-change score models. RESULTS:Improvements in the CAPS-5 were small and not statistically significant. For anxiety, small significant improvements were observed from pre- to follow-up assessment. The dropout rate was 32.3%. CONCLUSIONS:The low treatment utilization and the high dropout rate are in line with previous findings on treatment of service members. The interpretation of the current null results for the efficacy of iCBT is limited due to the small sample size, however for military samples effect estimates were also smaller in other recent studies. Our results demonstrate the need to identify factors influencing treatment engagement and efficacy in veterans. TRIAL REGISTRATION:Australian Clinical Trials Registry ACTRN12616000956404.

SUBMITTER: Niemeyer H

PROVIDER: S-EPMC7204035 | biostudies-literature | 2020 May

REPOSITORIES: biostudies-literature

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Evaluation of an internet-based intervention for service members of the German armed forces with deployment-related posttraumatic stress symptoms.

Niemeyer Helen H Knaevelsrud Christine C Schumacher Sarah S Engel Sinha S Kuester Annika A Burchert Sebastian S Muschalla Beate B Weiss Deborah D Spies Jan J Rau Heinrich H Willmund Gerd-Dieter GD

BMC psychiatry 20200506 1

<h4>Background</h4>The present study was designed to evaluate the efficacy of a therapist-guided internet-based cognitive-behavioral therapy (iCBT) intervention for service members of the German Armed Forces with posttraumatic stress disorder (PTSD). The iCBT was adapted from Interapy, a trauma-focused evidence-based treatment based on prolonged exposure and cognitive restructuring. It lasted for 5 weeks and included 10 writing assignments (twice a week). The program included a reminder function ...[more]

PMID: 32375754

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Project description:Study objectivesCharacterize associations between sleep impairments and posttraumatic stress disorder (PTSD) symptoms, including anger, in service members seeking treatment for PTSD.MethodsNinety-three US Army personnel recruited into a PTSD treatment study completed the baseline assessment. State-of-the-science sleep measurements included 1) retrospective, self-reported insomnia, 2) prospective sleep diaries assessing sleep patterns and nightmares, and 3) polysomnography measured sleep architecture and obstructive sleep apnea-hypopnea severity. Dependent variables included self-report measures of PTSD severity and anger severity. Pearson correlations and multiple linear regression analyses examined if sleep symptoms, not generally measured in PTSD populations, were associated with PTSD and anger severity.ResultsAll participants met PTSD, insomnia, and nightmare diagnostic criteria. Mean sleep efficiency = 70%, total sleep time = 5.5 hours, obstructive sleep apnea/hypopnea (obstructive sleep apnea-hypopnea index ≥ 5 events/h) = 53%, and clinically significant anger = 85%. PTSD severity was associated with insomnia severity (β = .58), nightmare severity (β = .24), nightmare frequency (β = .31), and time spent in Stage 1 sleep (β = .27, all P < .05). Anger severity was associated with insomnia severity (β = .37), nightmare severity (β = .28), and obstructive sleep apnea-hypopnea during rapid eye movement sleep (β = .31, all P < .05).ConclusionsInsomnia and nightmares were related to PTSD and anger severity, and obstructive sleep apnea-hypopnea was related to anger. Better assessment and evidence-based treatment of these comorbid sleep impairments in service members with PTSD and significant anger should result in better PTSD, anger, and quality-of-life outcomes.Clinical trials registrationRegistry: ClinicalTrials.gov; Name: Treatment of Comorbid Sleep Disorders and Post Traumatic Stress Disorder; Identifier: NCT02773693; URL: https://clinicaltrials.gov/ct2/show/NCT02773693.CitationMiles SR, Pruiksma KE, Slavis D, et al. Sleep disorder symptoms are associated with greater posttraumatic stress and anger symptoms in US Army service members seeking treatment for posttraumatic stress disorder. J Clin Sleep Med. 2022;18(6):1617-1627.

Project description:BackgroundMandatory deployment-related quarantining added further constraints on soldiers during the pandemic. Contrary to overwhelming research documenting an adverse impact of quarantining on mental health, no adverse short-term mental health effects of pre-deployment quarantining for German soldiers were identified. Therefore, we are interested in a potentially delayed onset, the impact of an additional post-deployment quarantine, and quarantine-associated risk and resilience factors predicting mental health post-deployment.MethodsIn a prospective research design, 928 German soldiers enrolled in the study at the in-processing of pre-deployment quarantine between February 2021 and March 2022. Every German military service member undergoing pre-deployment quarantine could participate. The soldiers were between 18 and 64 years old; 87.5% identified as male and 12.5% as female. Self-reported mental health (Mini-SCL), perceived social support (FSozU-K22), and perceived unit cohesion were assessed three to five times: at the beginning and the end of pre-deployment quarantine (Nt1 = 928, Nt2 = 907), if still mandatory-at the beginning and the end of post-deployment quarantine (Nt3 = 143 and Nt4 = 132), and 3 months post-deployment, on average 7 to 8 months later than pre-deployment quarantine (Nt5 = 308). The analyzed quarantine-associated risk and resilience factors were informedness about COVID-19, infection risk, quarantine benefit, clarity of quarantine protocol, need for intimacy/bonding, norms, stigma, practicality, financial disadvantages, boredom, and health-promoting leadership.ResultsDespite four different mental health trajectories identified, repeated measures ANOVAs revealed a significant improvement in mental health post-deployment (F[2,265] = 21.54, p < 0.001), a small decrease in social support (F[2,266] = 16.85, p < 0.001), and no significant changes in unit cohesion (F[2,264] = 0.482, p = 0.618) 3 months post-deployment. Using stepwise regression, 24% of variance in mental health symptomatology post-deployment is predicted pre-deployment by a clear quarantine protocol, unit cohesion, intimacy/bonding, and social support (F[4,263] = 22.23, p < 0.001). In total, 30% of mental health at the end of post-deployment quarantine is predicted by stigma and a clear quarantine protocol (F[2,99] = 22.22, p < 0.001).ConclusionAlthough no overall adverse impact of quarantining on mental health was found, it is recommended to address perceived stigma and clearly communicate the quarantine protocol, and to further follow up on the perceived decrease in social support.

Dataset Information

Evaluation of an internet-based intervention for service members of the German armed forces with deployment-related posttraumatic stress symptoms.

Publications

Evaluation of an internet-based intervention for service members of the German armed forces with deployment-related posttraumatic stress symptoms.

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