Faculty Bibliography

BACKGROUND AND OBJECTIVES:Avoidance, inherent to posttraumatic stress disorder (PTSD) symptomatology, is theoretically and empirically linked to the maintenance of PTSD symptom severity. While research indicates traumatized individuals avoid positive and trauma memories, several PTSD treatments focus exclusively on traumatic memories. We examined the mediating role of PTSD's avoidance in the relationship between processing positive memories and PTSD cluster severity (intrusion, mood/cognitions, arousal). METHODS: = 22.52; 86.10% female) were randomly assigned to 3 conditions: narrating/processing, writing/processing, or control (same task across baseline [T0] and follow-up [T1]). RESULTS:Half-longitudinal mediation models indicated participation in the narrating vs. writing and control conditions predicted decreases in T1 intrusion severity via reduction in T1 avoidance severity. Similarly, participation in the narrating vs. writing and control conditions predicted decreases in T1 mood/cognitions' severity via reduction in T1 avoidance severity. Participation in the narrating vs. writing condition predicted decreases in T1 arousal severity via reduction in T1 avoidance severity. LIMITATIONS:Data was obtained from an analogue small-size sample of university students. In addition, sessions were only 6-8 days apart, with the processing component of each session lasting ∼30 min. CONCLUSIONS:Processing positive memories may relate to lower PTSD severity via a reduction in PTSD's avoidance, paralleling effects of processing trauma memories. Our findings support future investigations of the mechanisms underlying impacts of positive memory processing in the context of PTSD treatments.

Achieving the 95-95-95 UNAIDS targets requires meeting the needs of adolescents, however we lack evidenced-based approaches to improving adolescent adherence to antiretroviral therapy (ART), increasing viral suppression, and supporting general wellbeing. We developed Family Connections as a group intervention for adolescents and their adult caregivers and conducted a randomized controlled trial in Ndola, Zambia to test feasibility and acceptability. Fifty pairs (n = 100) of adolescents (15-19 years and on ART ≥ 6 months) and their caregivers were randomly assigned either to the intervention consisting of 10 group sessions over 6 months, or to a comparison group, which received the usual care. Each pair completed baseline and endline surveys, with adolescents also undergoing viral load testing. Of the 24-intervention adolescent/caregiver pairs, 88% attended at least eight group sessions. Most adolescents (96%) and all caregivers would recommend Family Connections to peers. Adolescent viral failure decreased but did not significantly differ by study group. Adolescents in the intervention group showed a greater reduction in HIV-related feelings of worthlessness and shame than the comparison group. The feasibility, acceptability, and the positive trend toward significantly reducing internalized stigma, generated by this Family Connections pilot study, contributes valuable data to support adolescent/caregiver approaches that use peer groups.

To examine the existing knowledge base on trauma experiences and positive memories, we conducted a scoping review of trauma and post-trauma factors related to positive memory count. In July 2019, we searched PubMed, Medline, PsycINFO, Web of Science, Cumulative Index of Nursing and Allied Health Literature, Embase, and PTSDpubs for a combination of words related to "positive memories/experiences," "trauma/posttraumatic stress disorder (PTSD)," and "number/retrieval." Twenty-one articles met inclusion criteria (adult samples, original articles in English, peer-reviewed, included trauma-exposed group or variable of trauma exposure, trauma exposure examined with a trauma measure/methodology, assessed positive memory count, empirical experimental/non-experimental study designs). Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines, two authors reviewed abstracts, completed a secondary search, and independently extracted data. Our review indicated (1) that depression and PTSD were most researched; (2) no conclusive relationships of positive memory count with several psychopathology (depression, acute stress disorder, eating disorder, and anxiety), cognitive/affective, neurobiological, and demographic factors; (3) trends of potential relationships of positive memory count with PTSD and childhood interpersonal traumas (e.g., sexual and physical abuse); and (4) lower positive memory specificity as a potential counterpart to greater overgeneral positive memory bias. Given variations in sample characteristics and methodology as well as the limited longitudinal research, conclusions are tentative and worthy of further investigations.

Single-case experimental designs (SCEDs) involve obtaining repeated measures from one or a few participants before, during, and, sometimes, after treatment implementation. Because they are cost-, time-, and resource-efficient and can provide robust causal evidence for more large-scale research, SCEDs are gaining popularity in trauma treatment research. However, sophisticated techniques to analyze SCED data remain underutilized. Herein, we discuss the utility of SCED data for trauma research, provide recommendations for addressing challenges specific to SCED approaches, and introduce a tutorial for two Bayesian models-the Bayesian interrupted time-series (BITS) model and the Bayesian unknown change-point (BUCP) model-that can be used to analyze the typically small sample, autocorrelated, SCED data. Software codes are provided for the ease of guiding readers in estimating these models. Analyses of a dataset from a published article as well as a trauma-specific simulated dataset are used to illustrate the models and demonstrate the interpretation of the results. We further discuss the implications of using such small-sample data-analytic techniques for SCEDs specific to trauma research.

Posttraumatic stress disorder (PTSD) treatments primarily address traumatic memories, despite PTSD's association with both traumatic and positive memory difficulties. Addressing this gap, we explored the perspectives of trauma-exposed individuals with mental health treatment experience on therapeutically addressing positive memories. A treatment-seeking sample from a community mental health center (n1 = 60) and a community sample from Amazon's Mechanical Turk (n2 = 123) were queried on the acceptability, feasibility, and delivery/components of a pilot positive memory technique. Results indicated interest or willingness in therapeutically discussing positive memories; most endorsed benefits were improved mood, positive thoughts, and self-esteem. Few barriers were identified (e.g., lack of evidence) compared with feasibility factors (ease/usefulness, improved satisfaction/tolerability, and engagement in PTSD treatment). Preferred treatment components included identifying/discussing positive memories, eliciting associated positive affect, and writing about the positive memory as homework. Results provide formative support for the development and integration of a positive memory technique into PTSD treatments.

Native Americans (NAs) experience a high burden of obesity and diabetes, yet previous research has not holistically described the unique food environments of NA communities. The objective of this paper is to describe the subgroups and demographic characteristics related to NA household food environments. Surveys collected food getting, food assistance, and sociodemographic variables from randomly selected adults from three NA communities (n = 300) in the Midwest and Southwest. Exploratory latent class analysis (LCA) identified the appropriate number of subgroups based on indicator responses. After assigning participants to classes, demographic differences were examined using bivariate analyses. NA household food environments could be described using two subgroups ("lower" and "higher access household food environments"). The "lower access" group had significantly higher age, smaller household size, and fewer children per household than the "higher access" group, while body mass index (BMI) did not significantly vary. This is the first LCA of NA household food environments and highlights the need for approaches that characterize the complexity of these environments. Findings demonstrate that NA household food environments can be described by developing subgroups based on patterns of market and traditional food getting, and food assistance utilization. Understanding NA household food environments could identify tailored individual and community-level approaches to promoting healthy eating for NA Nations.