Change in social support while participating in behavioral activation for PTSD.
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ABSTRACT: Objective
Lack of social support predicts the development, maintenance, and exacerbation of posttraumatic stress disorder (PTSD). Moreover, social dysfunction is associated with recurrent episodes of PTSD care, and detachment/estrangement from others is a strong predictor of suicidal ideation among those with PTSD. Thus, treatments to improve social functioning among those with PTSD are needed.Method
Eighty veterans of recent operations in Iraq and Afghanistan participated in a randomized controlled trial comparing treatment as usual to behavioral activation (BA) for PTSD, a treatment that focuses on reducing avoidance behaviors and increasing engagement in valued goals rather than explicitly confronting trauma memories.Results
Mixed-model regression analyses revealed that, accounting for gender, baseline PTSD, and marital status, participants who received BA experienced greater improvements in the number of social supports from baseline to posttreatment compared with those in treatment as usual (F1,96 = 6.29, p = .014). Gains were not maintained at 3-month follow-up, and significant results were not found for satisfaction with social supports.Conclusions
BA may facilitate an increase in the perceived number of social supports available to veterans with PTSD, but treatment adaptation may be necessary to maintain these gains and to increase satisfaction with social support. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
SUBMITTER: Campbell SB
PROVIDER: S-EPMC8687639 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:PurposeSupportive social networks are important to the post-traumatic response process. However, the effects of social network structure may be distinct from the perceived function of those networks. The present study examined the relative importance of role diversity and perceived strength of social support in mitigating post-traumatic stress disorder (PTSD).MethodsData were drawn from respondents who report lifetime potentially traumatic events in the National Epidemiologic Survey on Alcohol and Related Conditions (N = 31,650). The Social Network Index (SNI) was used to measure the diversity of social connections. The Interpersonal Support Evaluation List (ISEL-12) was used to measure the perceived availability of social support within the network. Odds of current PTSD were compared among individuals representing four dichotomous types of social support: high diversity/high perceived strength, high diversity/low perceived strength, low diversity/high perceived strength, and low diversity/low perceived strength to examine which type of support is more protective against PTSD.ResultsUnadjusted odds of PTSD were 1.59 (95 % CI 1.39-1.82) for those with low versus high perceived support strength, and 1.10 (0.94-1.28) among those with non-diverse versus diverse social networks. Compared to the reference group (high diversity/high perceived strength), the adjusted odds of current PTSD were higher for two groups: low diversity/low perceived strength (OR = 1.62; 1.33-1.99), and low diversity/high perceived strength (OR = 1.57; 1.3-1.91). The high diversity/low perceived strength group had no greater odds of PTSD (OR = 1.02; 0.81-1.28).ConclusionThe diversity of a social network is potentially more protective against PTSD than the perception of strong social support. This suggests that programs, which engage individuals in social groups and activities may effectively attenuate the risk of PTSD. A better understanding of how these networks operate with respect to PTSD prevention and mitigation holds promise for improving psychiatric health.
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Project description:We have shown in previous work that acute episodes of predator exposure occurring in the context of chronic social instability produced PTSD-like sequelae in rats. Our animal model of PTSD contained two components: (1) acute trauma, immobilization of rats in close proximity to a cat twice in 10 days, and (2) chronic social instability, 31 days of randomized housing of cage cohorts. Here we tested the hypothesis that daily social stimulation would block the development of the PTSD-like sequelae.Beginning 24 h after the first cat exposure, adult male rats were given our established PTSD model, alone or in conjunction with daily social stimulation, in which all rats within a group interacted in a large apparatus for 2 h each day for the final 30 days of the PTSD regimen. All behavioral, for example, anxiety, memory, startle testing, and physiological assessments, for example, body growth, organ weights, and corticosterone levels, took place following completion of the psychosocial stress period.Daily social stimulation blocked the expression of a subset of PTSD-like effects, including predator-based cued fear conditioning, enhanced startle response, heightened anxiety on the elevated plus maze and the stress-induced suppression of growth rate. We also found that social stimulation and psychosocial stress produced equivalent outcomes in some measures, including adrenal and heart hypertrophy, thymus atrophy, and a reduction in poststress corticosterone levels.Daily exposure of rats to a highly social environment blocked the development of a subset of trauma-induced sequelae, particularly fear-related outcomes. It is notable that daily social stimulation normalized a subset, but not all, of the PTSD-like effects. We discuss our findings in the context of the literature demonstrating that social stimulation can counteract the adverse effects of traumatic stress on behavioral and physiological measures, as well as to produce its own stress-like outcomes.
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Project description:To examine moderators of change during group-based intervention for Posttraumatic Stress Disorder (PTSD), multilevel models were used to assess trajectories of symptom clusters in male veterans receiving trauma focused Group Cognitive Behavioral Treatment (gCBT; N = 84) or non-trauma focused Group Present Centered Therapy (gPCT; N = 91; Sloan et al., 2018). Separate models were conducted for symptom clusters in each intervention, examining pre-treatment PTSD symptoms, pre-treatment depression severity, age, index trauma, and outcome expectancies as potential moderators. Unconditioned growth models for both gCBT and gPCT showed reductions in intrusions, avoidance, negative cognitions/mood, and arousal/reactivity (all p < .001). Distinct moderators of recovery emerged for each treatment. Reductions in avoidance during gCBT were strongest at high levels of pre-treatment PTSD symptoms (low PTSD: p = .964, d = .05; high PTSD: p < .001, d = 1.31) whereas positive outcome expectancies enhanced reductions in cognitions/mood (low Expectancy: p = .120, d = .50; high Expectancy: p < .001, d = 1.13). For gPCT, high levels of pre-treatment depression symptoms negatively impacted change in both intrusion (low depression: p < .001, d = .96; high depression: p = .376, d = .22) and arousal/reactivity (low depression: p < .001, d = .95; high depression: p = .092, d = .39) symptoms. Results support the importance of examining trajectories of change and their moderators for specific treatments, particularly when contrasting trauma focused and non-trauma focused treatments.
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Project description:Excess weight has been associated with numerous psychological problems, including depression and anxiety. This study examined the impact of intentional weight loss on the psychological well-being of adults participating in three clinical weight loss interventions.This population consisted of 588 overweight or obese individuals randomized into one of three weight loss interventions of incremental intensity for 12 months. Psychological well-being was measured at baseline and 6, and 12 months using the Psychological Well-Being Index.Mean weight loss was 5.0 pounds at 12 months. Weight change at 12 months was associated with higher overall psychological well-being (r = -.20, p < .001), lower levels of anxiety (r = -.16, p = .001) and depression (r = -.13, p = .004), and higher positive well-being (r = -.19, p < .001), self-control (r = -.13, p = .004), and vitality (r = -.22, p < .001). Vitality was found to be the best predictor of weight change at 12 months (p < .001).Weight loss was associated with positive changes in psychological well-being. Increased vitality contributed the largest percentage of variance to this change.
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Project description:Social support is one of the most robust predictors of posttraumatic stress disorder (PTSD). Yet, little is known about factors that moderate the relationship between social support and PTSD symptom severity. This meta-analysis estimated the overall effect size of the relationship between self-reported social support and PTSD severity and tested meaningful demographic, social support, and trauma characteristics that may moderate this association using both cross-sectional and longitudinal effect sizes. A comprehensive search identified 139 studies with 145 independent cross-sectional effect sizes representing 62,803 individuals and 37 studies with 38 independent longitudinal effect sizes representing 25,792 individuals. Study samples had to comprise trauma-exposed, nonclinical adult populations to be included in the analysis. Cross-sectional and longitudinal analyses revealed a near medium overall effect size (rcross = -.27; 95% CI [-.30, -.24]; rlong = -.25; 95% CI [-.28, -.21]) with a high degree of heterogeneity (cross-sectional I2 = 91.6, longitudinal I2 = 86.5). Both cross-sectional and longitudinal moderator analyses revealed that study samples exposed to natural disasters had a weaker effect size than samples exposed to other trauma types (e.g., combat, interpersonal violence), studies measuring negative social reactions had a larger effect size than studies assessing other types of social support, and veteran samples revealed larger effect sizes than civilian samples. Several other methodological and substantive moderators emerged that revealed a complex relationship between social support and PTSD severity. These findings have important clinical implications for the types of social support interventions that could mitigate PTSD severity. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Project description:Variables associated with levels of, and change in, social support were identified in a cohort of early stage breast cancer patients and age-matched controls.Telephone interviews measuring perceived social support and other demographic and psychosocial variables were conducted at 4 to 6 weeks and 6, 12, and 24 months after surgery (patients) or a normal/benign screening mammogram (controls). We modeled the intercept (starting point) and slope (changing) aspects of social support.Participants included 542 controls and 541 patients (77% White, 23% African American; mean age 57.7 years [SD = 10.6]). Most participants reported high social support. Patients reported significantly higher levels of social support at baseline than controls. For patients, social support had a significant negative slope that significantly varied between individuals; the intercept of social support also varied significantly. Predictors of lower social support intercept in patients included not being married/partnered, being White, having lower perceived general health, and having higher negative affect (a latent variable defined by anxiety and depression symptom severity). Patients who were African American (vs. White) or had mastectomy (vs. lumpectomy) had steeper social support declines, and participants with both these characteristics had lower starting points as well as steeper declines. Social support among controls did not change significantly.Clinicians might consider psychosocial interventions for patients reporting low social support around the time of diagnosis and surgical treatment, and for patients at risk for steeper declines in support, such as African Americans and women undergoing mastectomy.
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