Changes in anger and aggression after treatment for PTSD in active duty military

Miles, Shannon R.; Dillon, Kirsten H.; Jacoby, Vanessa M.; Hale, Willie J.; Dondanville, Katherine A.; Wachen, Jennifer Schuster; Yarvis, Jeffrey S.; Peterson, Alan L.; Mintz, Jim; Litz, Brett T.; Young‐McCaughan, Stacey; Resick, Patricia A.

doi:10.1002/jclp.22878

Cited by 23 publications

(10 citation statements)

References 47 publications

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“…Studies that examined individual symptoms of PTSD, rather than symptom clusters, have produced similar results. Residual sleep difficulties (Belleville et al, 2011; Galovski et al, 2009; Pruiksma et al, 2016; Taylor et al, 2020) and aggression (Miles, Dillon, et al, 2020) often remain problematic for the majority of patients after successful completion of EBP for PTSD in civilian as well as military samples. In a group of female survivors of rape who completed CPT+A or PE, both EBP led to large decreases in symptoms (Larsen et al, 2019).…”

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confidence: 99%

Hyperarousal symptoms linger after successful PTSD treatment in active duty military.

Miles¹,

Hale²,

Mintz³

et al. 2023

Psychological Trauma: Theory, Research, Practice, and

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Objective: Evidence-based psychotherapies are efficacious at reducing posttraumatic stress disorder (PTSD) symptoms, but military and veteran samples improve less than civilians. The objective of this secondary analysis of two clinical trials of cognitive processing therapy (CPT) was to determine if hyperarousal symptoms were more resistant to change compared with other PTSD symptom clusters in active duty service members. Method: Service members completed the PTSD Checklist for the DSM-5 (PCL-5) pre-and post-CPT. Symptoms were coded present if rated 2 (moderate) or higher on a 0-4 scale. Cutoffs for reliable and clinically significant change classified 21%, 18%, and 61% of participants as recovered, improved, and suboptimal responders, respectively. Data analyses focused on the posttreatment status of symptoms that were present at baseline to determine their persistence as a function of treatment outcome. Generalized linear mixed effects models with items treated as a repeated measure estimated the proportions who continued to endorse each symptom and compared hyperarousal Shannon R. Miles https://orcid.

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confidence: 99%

Hyperarousal symptoms linger after successful PTSD treatment in active duty military.

Miles¹,

Hale²,

Mintz³

et al. 2023

Psychological Trauma: Theory, Research, Practice, and

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“…Although few studies have examined how PTSD treatments impact hostility, several researchers have examined the impact of PTSD treatments on the closely related construct of anger. The findings suggest that although PTSD treatments can significantly reduce anger symptoms (Cahill et al., 2003; Ford et al., 2018; Miles et al., 2020), individuals are likely to experience residual anger following PTSD treatment, and effect sizes tend to be smaller for reductions in anger than they are for PTSD symptoms (Ford et al., 2018; Miles et al., 2020; Schnurr & Lunney, 2019). There is evidence that anger‐specific treatments, such as cognitive behavioral anger management interventions, are helpful in reducing problematic anger (Morland et al., 2010).…”

Section: Discussionmentioning

confidence: 99%

The Impact of Hostility on Quality of Life, Functioning, and Suicidal Ideation Among Male Veterans with Posttraumatic Stress Disorder

Wells

Brennan

Voorhees

et al. 2021

Journal of Traumatic Stress

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Veterans with posttraumatic stress disorder (PTSD) often experience high levels of hostility. Although studies have found that PTSD is associated with poorer quality of life (QoL), increased functional impairment, lower levels of social support, and increased suicidal ideation, it is unclear if hostility impacts these domains in veterans with PTSD above and beyond the impact from PTSD and depressive symptoms. The present study aimed to examine whether hostility is related to several indices of poorer QoL and functioning after controlling for demographic characteristics, PTSD symptoms, and depressive symptoms. Participants (N = 641) were male U.S. veterans seeking PTSD treatment through a specialty clinic in the Veterans Affairs Healthcare System. Veterans completed the Davidson Trauma Scale for DSM‐IV (DTS), Personality Assessment Inventory (PAI), Quality of Life Inventory, and the Sheehan Disability Scale. Hierarchical regressions were conducted to examine the impact of PAI measures of hostility on QoL, functioning, social support, and suicidal ideation beyond DTS, depression, race, and age. After covarying for DTS total score, depression symptoms, age, and race, higher levels of hostility were significantly associated with higher degrees of functional impairment and lower degrees of social support, ΔR2 = .01 and ΔR2 = .02, respectively. Higher levels of hostility were significantly related to diminished functioning and lower social support beyond PTSD and depressive symptoms in veterans seeking treatment for PTSD. These findings highlight the importance of assessing and treating hostility in veterans with PTSD.

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“…While many rehabilitation programs appropriately focus on the brain injury, a more holistic health perspective may be needed. PTSD symptoms are an important treatment consideration after TBI as they can negatively affect rehabilitation outcomes including being related to greater levels of irritability, anger, and aggression (Miles et al, 2020). In turn, sleep apnea interferes with the PTSD treatment process (Mesa et al, 2017).…”

Section: Discussionmentioning

confidence: 99%

Sleep apnea and posttraumatic stress after traumatic brain injury (TBI): A Veterans Affairs TBI Model Systems study.

Miles

Silva

Lang

et al. 2021

Rehabilitation Psychology

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Objective: Traumatic brain injury (TBI) is a complex health problem in military veterans and service members (V/SM) that often co-occurs with psychological and medical conditions such as posttraumatic stress disorder (PTSD) and sleep apnea. We aimed to examine if sleep apnea is associated with the presence and severity of PTSD in V/SM with TBI of all severities. Research Method: The study examined participants at varying times since their TBI (N = 602) enrolled in the Veterans Affairs TBI Model Systems database. Frequency of selfreported sleep apnea diagnosis was calculated in a cross-sectional sample. Prevalence of co-occurring sleep apnea and probable PTSD was tested with a chi-square analysis. A multivariable regression model evaluated the association between sleep apnea and PTSD symptom severity while controlling for relevant covariates. Results: Almost 32% of the sample stated they had been diagnosed with sleep apnea. In those reporting sleep apnea, 32% also had probable PTSD; 19% of those without sleep apnea had probable PTSD. The regression demonstrated sleep apnea was significantly associated with PTSD symptom severity (p , .001). Greater number of TBIs, recent mental health treatment, being deployed to a combat zone, and greater years since TBI were also significant predictors of PTSD symptom severity (all p , .05). Conclusions: TBI, PTSD, and sleep apnea are often comorbid in V/SM. We expand the literature by demonstrating that sleep apnea was associated with PTSD severity. A multipronged approach to TBI rehabilitation that addresses sleep and psychological distress is recommended for enhancing health outcomes in this population.

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Changes in anger and aggression after treatment for PTSD in active duty military

Cited by 23 publications

References 47 publications

Hyperarousal symptoms linger after successful PTSD treatment in active duty military.

Hyperarousal symptoms linger after successful PTSD treatment in active duty military.

The Impact of Hostility on Quality of Life, Functioning, and Suicidal Ideation Among Male Veterans with Posttraumatic Stress Disorder

Sleep apnea and posttraumatic stress after traumatic brain injury (TBI): A Veterans Affairs TBI Model Systems study.

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