Warriors Internet Recovery & Education (WIRED): An Online Program for PTSD
Veterans suffering from posttraumatic stress disorder (PTSD) may avoid or fail to follow through with a full course of face-to-face mental health treatment for a variety of reasons. We conducted a pilot effectiveness trial of an online intervention for veterans with current PTSD to determine the feasibility, safety, and preliminary effectiveness of an online writing intervention (i.e., Warriors Internet Recovery & EDucation [WIRED]) as an adjunct to face-to-face psychotherapy. Method: Veterans (N = 34) who had served in Iraq or Afghanistan with current PTSD subsequent to deployment-related trauma were randomized to Veterans Affairs (VA) mental health treatment as usual (TAU) or to treatment as usual plus the online intervention (TAU + WIRED). All research participants were recruited from the Trauma Services Program, VA Medical Center, Washington, DC. They completed baseline assessments as well as assessments 12 weeks and 24 weeks after the baseline assessment. The online intervention consisted of therapist-guided writing, using principles of prolonged exposure and cognitive therapy. The intervention was adapted from an evidence-based treatment used in The Netherlands and Germany for individuals who had been exposed to nonmilitary traumas. Results: In addition to showing that the online intervention was both feasible to develop and implement, as well as being safe, the results showed preliminary evidence of the effectiveness of the TAU + WIRED intervention in this patient population, with particular evidence in reducing PTSD symptoms of hyperarousal. Conclusion: With minor modifications to enhance the therapeutic alliance, this intervention should be tested in a larger clinical trial to determine whether this method of online intervention might provide another alternative to face-to-face treatment for veterans with PTSD.
Citation: Krupnick, Janice & Green, Bonnie & Amdur, Richard & Aloui, Adil & Beloui, Anas & Roberge, Erika & Cueva, David & Roberts, Miguel & Melnikoff, Elizabeth & Dutton, Mary. (2016). An Internet-Based Writing Intervention for PTSD in Veterans: A Feasibility and Pilot Effectiveness Trial. Psychological Trauma: Theory, Research, Practice, and Policy. 9. 10.1037/tra0000176.
Psychotherapy with low-income patients presents a variety of challenges for the clinician. This paper discusses some of those challenges, including the barriers that poor individuals face in obtaining treatment, as well as issues of stigma, mistrust of authority, and potential cultural differences and differing expectations between mental health providers from higher socioeconomic backgrounds and lower-income individuals in need of care. We review some of the findings reported in treatment studies with low-income, frequently minority, samples that shed light on the types of adaptations to treatment that have proven successful. Finally, we discuss some of the clinical research that has been conducted with low-income, predominantly minority women through the department of psychiatry at Georgetown University over the past several years, concluding with some of the lessons we have learned in developing and conducting psychotherapeutic treatments with this population.
Citation: Krupnick, J.L., Melnikoff, S.E. Psychotherapy with Low-Income Patients: Lessons Learned from Treatment Studies. J Contemp Psychother 42, 7–15 (2012). https://doi.org/10.1007/s10879-011-9182-4
This pilot study aimed to determine whether interpersonal psychotherapy (IPT) for posttraumatic stress disorder (PTSD) would be effective with a sample of women veterans who experienced military-related PTSD.Method: Women veterans presenting for mental health services through the Trauma Services Program at the Washington, DC, Veterans Affairs Medical Center (VAMC) were referred to the study by Veterans Affairs (VA) clinicians if they experienced trauma during their military service and scored > 35 on the PTSD Checklist–Military Version. A total of 20 women completed a baseline assessment and were referred to treatment, the first trial of this treatment method with a veteran sample. Of the 15 women veterans who started treatment, 10 completed a trial of 12 individual sessions. Assessments were conducted posttreatment and at three months posttreatment follow-up.
Citation: Janice L. Krupnick, Elizabeth Melnikoff & Matthew Reinhard (2016) A Pilot Study of Interpersonal Psychotherapy for PTSD in Women Veterans, Psychiatry, 79:1, 56-69, DOI: 10.1080/00332747.2015.1129873
The genetics of functional disability in schizophrenia and bipolar illness
Washington DC VA Medical Center
In one of the largest and most definitive studies of the genetics of psychiatric illness to date, researchers have identified 108 genetic locations where the DNA of people with schizophrenia tends to differ from those without the disease. The study, published last week in Nature was produced by the Psychiatric Genomics Consortium (PGC), a collaboration of more than 80 institutions worldwide, including the Washington DC VA Medical Center (DCVAMC).
The study is helping to unravel the complex mystery of schizophrenia. According to Dr. Ayman H. Fanous, Chief, Psychiatric Genetics Research Program, DCVAMC; Associate Professor of Psychiatry, Georgetown University School of Medicine; and one of the co-authors of the study, the results could eventually lead to more effective ways to diagnose and treat this dreaded disease.
“Because of major advances in genomics technology, we can now, for the first time, have a detailed picture of the genes and gene groups that increase the risk of schizophrenia,” Dr. Fanous explained.
Schizophrenia is a devastating mental illness that afflicts 1% of the population worldwide, including about 100,000 Veterans treated in the VA Health Care System. People suffering with schizophrenia experience such disruptive symptoms as hallucinations, delusions of persecution, disorganized thinking, and the even more disabling negative symptoms, which include loss of interest in other people as well as their own self-care.
While schizophrenia has long been known to run in families, it has only been in the last few years that scientists have reliably identified specific genetic changes thought to increase susceptibility to schizophrenia. Most of these changes in the genetic code, or mutations, have very small effects individually, but can act together to significantly increase the risk of becoming ill.
These small effects have required an extremely large sample in order to be identified with confidence. The PGC is a large international consortium of dozens of institutions which have combined their individual samples to form the largest genetic study of any psychiatric disorder ever conducted. The study involved comparing about 37,000 individuals with schizophrenia and 114,000 control individuals for the presence of several million known changes in the human genome sequence.
Significant differences were found at 108 individual areas of the genome. These included a number of genes involved in immune processes, as well as the dopamine and glutamate neurotransmitter systems, among others.
Overall, the results of the study were generally consistent with previous biological hypotheses about the causes of schizophrenia. Interestingly, for the first time, the study confirmed the role of the dopamine type 2 (DRD2) receptor, which is the only molecule consistently targeted by medications that ameliorate schizophrenia symptoms.
Furthermore, 83 genes which had not previously been known to be involved in the development of schizophrenia were identified. These could provide new targets in the development of novel and perhaps more effective treatments, which could improve the outcomes of people with schizophrenia among both veterans and the general population. They could also provide the basis for new and more powerful diagnostic and screening tools, which are very much needed.
Citation: Harvey PD, Siever, LJ, Huang, GD, Muralidhar S, Zhao, H, Miller, P, … Aslan, M (2014). The genetics of functional disability in schizophrenia and bipolar illness: Methods and initial results for VA cooperative study #572. American Journal of Medical Genetics Neuropsychiatric Genetics Part B, 165B: 381-389. (Acknowledgments- Melnikoff, SE)