Relationship between change in in-vivo exposure distress and PTSD symptoms during exposure therapy for active duty soldiers
AuthorNorr, Aaron M
Bourassa, Kyle J
Stevens, Elizabeth S
Hawrilenko, Matthew J
Michael, Scott T
Reger, Greg M
MetadataShow full item record
PublisherPERGAMON-ELSEVIER SCIENCE LTD
CitationNorr, A. M., Bourassa, K. J., Stevens, E. S., Hawrilenko, M. J., Michael, S. T., & Reger, G. M. (2019). Relationship between change in in-vivo exposure distress and PTSD symptoms during exposure therapy for active duty soldiers. Journal of psychiatric research.
JournalJOURNAL OF PSYCHIATRIC RESEARCH
RightsPublished by Elsevier Ltd.
Collection InformationThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at email@example.com.
AbstractObjective: The current study sought to examine the relationship between changes in distress for items on in-vivo exposure hierarchies and posttraumatic stress disorder (PTSD) symptom change over the course of exposure therapy. Methods: Active duty army soldiers (N = 108) were recruited from a military base in the U.S. and were enrolled in a randomized clinical trial comparing Prolonged Exposure (PE), Virtual Reality Exposure (VRE), and a waitlist control for the treatment of PTSD stemming from deployments to Iraq or Afghanistan. PTSD diagnosis followed DSM-IV-TR criteria. Outcome measures were assessed via self-report and clinician interview. The relationships between in-vivo exposure distress, imaginal exposure distress, and PTSD symptoms, were examined in a factor of curves model for participants in the treatment conditions. Results: Analyses revealed that, when controlling for one another, changes in in-vivo exposure distress were significantly associated with changes in PTSD symptoms (beta = 0.75, 95% CI [0.60, 0.90]), while changes in imaginal exposure distress were not (beta = 0.03, 95% CI [-0.27, 0.33]). The model also revealed that after accounting for the shared variation in trajectories of change, symptom clusters did not have unique variation, meaning that symptom clusters did not change independently. Conclusion: Results suggest the possibility that in-vivo exposures are more closely tied to changes in overall PTSD symptoms than imaginal exposures during exposure therapy. Furture research should incorporate more frequent measurement of in-vivo exposure distress to better elucidate these relations over the course of treatment.
Note12 month embargo; published online: 18 June 2019
VersionFinal accepted manuscript
SponsorsU.S. Army Medical Research and Materiel Command Military Operational Medicine Research Program [W81XWH-08-2-0015]
- Randomized controlled trial of prolonged exposure using imaginal exposure vs. virtual reality exposure in active duty soldiers with deployment-related posttraumatic stress disorder (PTSD).
- Authors: Reger GM, Koenen-Woods P, Zetocha K, Smolenski DJ, Holloway KM, Rothbaum BO, Difede J, Rizzo AA, Edwards-Stewart A, Skopp NA, Mishkind M, Reger MA, Gahm GA
- Issue date: 2016 Nov
- Effects of prolonged exposure and virtual reality exposure on suicidal ideation in active duty soldiers: An examination of potential mechanisms.
- Authors: Norr AM, Smolenski DJ, Reger GM
- Issue date: 2018 Aug
- Virtual reality exposure versus prolonged exposure for PTSD: Which treatment for whom?
- Authors: Norr AM, Smolenski DJ, Katz AC, Rizzo AA, Rothbaum BO, Difede J, Koenen-Woods P, Reger MA, Reger GM
- Issue date: 2018 Jun
- Does virtual reality increase emotional engagement during exposure for PTSD? Subjective distress during prolonged and virtual reality exposure therapy.
- Authors: Reger GM, Smolenski D, Norr A, Katz A, Buck B, Rothbaum BO
- Issue date: 2019 Jan
- Changes in physiological reactivity in response to the trauma memory during prolonged exposure and virtual reality exposure therapy for posttraumatic stress disorder.
- Authors: Katz AC, Norr AM, Buck B, Fantelli E, Edwards-Stewart A, Koenen-Woods P, Zetocha K, Smolenski DJ, Holloway K, Rothbaum BO, Difede J, Rizzo A, Skopp N, Mishkind M, Gahm G, Reger GM, Andrasik F
- Issue date: 2020 Oct
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RECENT EXPOSURE TO CENTERFOLD IMAGES, SEXUAL EXPLICITNESS, PAST EXPOSURE TO OBJECTIFYING MEDIA, AND THE ACTIVATION OF THE CENTERFOLD SYNDROMEKunkel, Dale; Wright, Paul; Donnerstein, Edward; Mastro, Dana; Kunkel, Dale (The University of Arizona., 2011)The chief goal of the present study was to test whether exposing young adult males to female centerfold images causes them to believe more strongly in a set of beliefs clinical psychologist Gary Brooks terms "the centerfold syndrome." In addition to testing the straightforward effect of exposure to centerfold images on males' centerfold syndrome beliefs, the present study explored the moderating potential of three variables: sexual explicitness of the centerfold images, males' past exposure to objectifying media, and recency of exposure to the centerfold images.Participants were randomly assigned to either a control condition that did not feature centerfold stimuli, a "nonexplicit" condition that featured female centerfolds who did not expose their nipples or genitalia, or an "explicit" condition that featured female centerfolds exposing either their nipples, genitalia, or both. Past exposure to objectifying media was assessed by asking participants how frequently they viewed pornography in the prior year. Items indexing the five centerfold syndrome beliefs - voyeurism, sexual reductionism, masculinity validation, trophyism, nonrelational sex - were administered immediately after exposure and approximately 48 hours after exposure.Exposure to centerfold images had an immediate strengthening effect on the sexual reductionism and nonrelational sex beliefs of males who view objectifying media about once a month or less and this effect persisted approximately 48 hours after exposure. Likewise, exposure to centerfold images had an immediate strengthening effect on the masculinity validation beliefs of males who view objectifying media about once a month or less, and this effect persisted at a marginally significant level approximately 48 hours after exposure. No difference were found between males exposed to nonexplicit vs. explicit images.These findings are consistent with a growing body of literature indicating that mainstream media sex can affect the sexuality of young people. Furthermore, the findings of the present study affirm the suspicions of some that objectifying depictions of females affect the sexual beliefs of some males in ways that are likely unrelated to sexual aggression but are still antisocial.
Parents in middle adulthood: Exposure and reactivity to daily child-related experiencesAlmeida, David M.; Chandler, Amy Louise Wiles (The University of Arizona., 2001)The purpose of the present study was twofold; it examined midlife parents' exposure to daily child-related events as well as the daily emotional reactivity that parents experience in association with these events. The premise of the study is that children can influence the well-being of their parents and that both daily exposure and reactivity to child-related experiences differ with the age of child as well as parental gender. Two conceptual frameworks, generativity and stress theory are used to explain how children influence parents' development and well-being. The study variables included daily child-related stressful events of high and low severity, daily emotional support parents provided their children, and parents' negative mood. Data for these analyses are from the National Study of Daily Experiences. The sample for the present study consisted of parents of minor children, ages 1 to 21 (n = 214; 107 mothers, 107 fathers), and parents of adult children, ages 22 and above (n = 287; 107 mothers, 180 fathers). The findings indicated that there were no significant parent gender or child age differences in exposure to high severity stressors, but there were parent gender and child age differences in low severity stressors and emotional support. Mothers of children of all ages experience more frequent low severity daily stressors and provide more emotional support than do fathers. Parents of minor children also experience more frequent daily low severity stressors and provide more emotional support than do parents of adult children. However, parents of minor children do not experience more severe events than parents of adult children. For parents of adult children, the proportion of severe stressors to all stressors was much greater than for parents of minor children. In other words, when a parent of an adult child experiences a child-related stressor, it is more likely to be very serious than when a parent of a minor child experiences a child-related stressor. Last, in relation to parental well-being, this daily stressor study showed that low severity stressors are associated with parents' negative mood. Parent gender nor child age moderated the effects of stressors on negative mood. What this might indicate is that it is truly the persistent, mundane child-related stressors that wear a parent down. Implications of this study show that child-related stressors can also enhance parental development and well-being through opportunity for generativity.
In utero and early childhood exposure to arsenic decreases lung function in childrenRecio-Vega, Rogelio; Gonzalez-Cortes, Tania; Olivas-Calderon, Edgar; Lantz, R Clark; Gandolfi, A Jay; Gonzalez-De Alba, Cesar; Univ Arizona, Dept Cellular & Mol Med; Univ Arizona, Southwest Environm Hlth Sci Ctr; Univ Arizona, Dept Pharmacol & Toxicol (WILEY, 2014)The lung is a target organ for adverse health outcomes following exposure to As. Several studies have reported a high prevalence of respiratory symptoms and diseases in subjects highly exposed to As through drinking water; however, most studies to date has been performed in exposed adults, with little information on respiratory effects in children. The objective of the study was to evaluate the association between urinary levels of As and its metabolites with lung function in children exposed in utero and in early childhood to high As levels through drinking water. A total of 358 healthy children were included in our study. Individual exposure was assessed based on urinary concentration of inorganic As. Lung function was assessed by spirometry. Participants were exposed since pregnancy until early childhood to an average water As concentration of 152.13 µg l⁻¹. The mean urinary As level registered in the studied subjects was 141.2 µg l⁻¹ and only 16.7% had a urinary concentration below the national concern level. Forced vital capacity was significantly decreased in the studied population and it was negatively associated with the percentage of inorganic As. More than 57% of the subjects had a restrictive spirometric pattern. The urinary As level was higher in those children with restrictive lung patterns when compared with the levels registered in subjects with normal spirometric patterns. Exposure to As through drinking water during in utero and early life was associated with a decrease in forced vital capacity and with a restrictive spirometric pattern in the children evaluated.