Posttraumatic stress disorder (PTSD) is a prevalent and concerning mental health diagnosis across the globe. There are multiple evidence-based treatments that have been shown to effectively treat PTSD, including cognitive processing therapy (CPT) and exposure-based interventions. This case study depicts using CPT for treating uncomplicated PTSD in a 28-year-old woman, while integrating brief exposure exercises in the client's homework. These exercises helped target avoidance symptoms and acute distress as well as increase quality of life, such that the client was better able to engage in CPT. Follow up data indicated a significant reduction in PTSD symptoms as measured by the Posttraumatic Stress Disorder Checklist (PCL-5) such that she no longer met clinical criteria for a diagnosis of PTSD or experienced significant distress related to her trauma. This data reflects the utility of integrating other evidence-based exercises into manualized treatment to create nuanced, individualized treatment plans. Clinical and research implications regarding the utility of implementing an integrated, conceptualization-driven treatment approach are discussed.

Background: There exist substantial patient barriers to accessing medications for opioid use disorder (MOUD), including travel distance, stigma, and availability of MOUD providers. Yet, despite these barriers, there exists a subset of patients who possess the requisite motivation to seek and remain adherent to treatment. Objective: To explore patient-derived goals in MOUD treatment-adherent patients. Methods: This study used in-depth interviews with patients receiving methadone who were enrolled in opioid treatment programs (OTPs) across Tennessee. Participants were recruited from 12 different OTPs to participate in telephonic semi-structured interviews to a point of saturation. Participants had to be adherent to treatment, in treatment for 6 months or greater, and English speaking. Analysis occurred inductively using a constructivist approach to Grounded Theory. Results: In total, 17 patient interviews were conducted in the spring of 2021. Participants described goal setting across three general stages of treatment: (1) addressing acute physical and emotional needs upon treatment entry, (2) development of supportive structure and routine to develop healthy skills facilitated by treatment team, and (3) identifying and pursuing future-focused goals not directly linked to treatment. A Proximal Goals in MOUD Framework is introduced. Conclusion: In this qualitative study on patient reported goals in MOUD it was found that goals are transitory and relative to the stage of treatment. Further research is needed to better understand goal evolution over the course of treatment and its impact on treatment retention.

Community pharmacists have become increasingly exposed to opioid use disorders in recent decades. However, both pharmacist training and traditional practice environments have not been adequate to prepare the pharmacist for both the patient care needs and regulatory barriers of patients experiencing opioid use disorders (OUD). As a result, there is a need to increase pharmacists’ awareness of both the overall patient experience as they navigate their OUD and the role of the community pharmacy as a touchpoint within that experience. To this end, a Community-Centered Patient Journey in Drug Addiction Treatment journey map was developed with expert insights, clinical experience, and in-depth interviews (conducted in spring of 2021) with 16 participants enrolled in licensed opioid treatment programs in Tennessee. Patients, policymakers, clinicians, and academic researchers were involved in the map development. Lived experiences of key informants were captured via in-depth interviews. A consensus decision-making approach was used throughout the patient journey map development process. The final patient journey map illustrates a non-linear pathway, describes the central role of the patient’s community, and emphasizes three major “pain points” within the system (access, adherence, and affordability). Future research should investigate the impact of such a journey map on pharmacy personnel’s knowledge, attitudes, and behaviors.

The standard of care calls for the assessment of patients with chronic pain prior to the initiation of opioids, with one part of this assessment including assessment of the risk of misuse of medications. However, traditional opioid risk assessment tools focus almost entirely on individual factors and on the risk of misuse and addiction to opioids. Diversion of opioid medications has been found to be not uncommon, but to date, there have been no assessment tools specifically designed to assess the risk of diversion. In this study, we developed a measure designed specifically to assess the risk of an opioid medication ending up in the hands of someone other than the chronic pain patient to whom they were prescribed. A 15-item measure, the Diversion Risk Scale, was created and administered to 85 patients at a chronic pain practice. Results found that the measure had acceptable predictive validity. It was moderately correlated with traditional opioid risk assessment tools and showed improved ability to predict specific indicators of diversion. Diversion has been an understudied phenomenon, and the clinical value of an assessment tool that can help predict diversion in the chronic pain population is discussed.

Perpetration of relational aggression, which is estimated to occur in 60% to 90% of relationships, has been demonstrated to have lasting negative effects both systemically and for its victims. Relational aggression has also been demonstrated to be impacted, in part by impulsivity, stress mind-set, and mindfulness. The present study examined a path analysis model of the relation between mindfulness and relational aggression, utilizing impulsivity as the mediating variable. Furthermore, the present study incorporated an examination of the potential moderating effects of stress mind-set on the relation between impulsivity and relational aggression. Three hundred eighty-three participants were recruited from across the United States, using Facebook ads. Participants completed online questionnaires assessing key study variables. We hypothesized that the negative urgency aspect of impulsivity would mediate the relation between the five facets of mindfulness and relational aggression, and further that this relationship would be moderated by stress mind-set, such that a stress mind-set which conceptualizes stress as negative would make the relation between impulsivity and relational aggression stronger. We hypothesized that the negative urgency aspect of impulsivity would mediate the relation between mindfulness and relational aggression. Furthermore, we hypothesized that the relation between impulsivity and aggression would be moderated by stress mind-set. Results indicated that the negative urgency component of impulsivity mediated the relation between all five facets of mindfulness and perpetration of relational aggression. Furthermore, stress mind-set moderated the relation between negative urgency and relational aggression, such that a lower stress mind-set was related to a stronger association between negative urgency and aggression. Implications for clinical intervention and future research efforts are discussed.

Reservation communities are among emerging communities for gang activity, in which reports of a rise in youth and/or criminal gangs began occurring after the 1980s. Gang membership has been found to pose a public health risk, strain community resources, and risk a number of individual negative life outcomes. Perceived increases in reservation gang activity have been observed by law-enforcement and community stakeholders, but comparatively little empirical research has focused specifically on these communities. Utilizing data from an existing public dataset, analysis of variance and regression analysis were utilized to examine cross sectional trends in gang involvement among 14,457 American Indian adolescents in reservation communities between 1993-2013. Results of this study failed to establish a consistent pattern of either growth or decline in gang membership across time when examining all reservations communities, with data suggesting that consistent trends may exist only within specific communities. Gang members were found to endorse significantly more alcohol and marijuana use, anger, depressed mood, and victimization as a whole. Only alcohol and marijuana use, violent behavior, and depressed mood demonstrated a significant interaction with time and gang membership. Finally, self-reported substance use, criminal behavior/delinquency, and violence perpetration significantly increased as gang affiliation increased.

Alcohol misuse is often a chronic problem such that relapses following treatment are common. One potential protective factor for alcohol misuse is self-compassion, which includes self-kindness, feelings of common humanity, and mindfulness when faced with personal suffering and hardships. This study tested the hypothesis that self-compassion, and specifically self-compassion promoting facets including self-kindness, common humanity, and mindfulness, were longitudinally associated with reduced alcohol use among a sample of men and women in substance use disorder treatment (N = 62). Results partially supported the hypothesis, in that only the mindfulness facet of self-compassion was associated with decreased alcohol use over time. Sex and age differences as they related to the positive facets of self-compassion and alcohol use emerged. These findings suggest that positive facets of self-compassion may be beneficial factors to cultivate in alcohol treatment programs.

Aim: To investigate the 20-year relationship between anxiety, depression and pain medication use. Patients: A total of 521 individuals reporting chronic pain from the National Survey of Midlife Development in the USA (MIDUS) study. Methods: Structural equation modeling of 20-year longitudinal survey data. Results: Over 20 years, a bidirectional relationship between depression and anxiety in individuals with chronic pain was indicated. Pain medication utilization predicted later use at 10 years. Pain medication use was not strongly related to later anxiety; however, heightened anxiety was associated with later use. Conclusion: Depression and anxiety show an extensive long-term bidirectional relationship. While there was little indication of a relationship between pain medication use and later negative mood, anxiety was associated with subsequent pain medication use.

The role of the oral microbiome in maintaining health is becoming increasingly apparent (1). Oral nitrate-reducing commensal bacteria reduce nitrate to nitrite, which is then reduced to nitric oxide in the acidic environment of the stomach via the nitrate-nitrite-nitric oxide pathway. Nitric oxide has a key role in maintaining gastric mucosal blood flow and thickness, thereby protecting against bacterial infection. Gastric nitric oxide levels are nearly abolished in intubated and ventilated intensive care patients, which might be linked to the prevalence of ulcers and bacterial overgrowth (2). In addition, it has been reported that the nitrate content of both enteral and parenteral nutrition is minimal (3) thereby further reducing the activity of the nitrate-nitrite-nitric oxide pathway. Patients on intensive care may receive salivary suction, antibacterial mouthwash, low nitrate feeds and broad-spectrum antibiotics, all of which could affect the oral microbiome. Poor oral health and periodontal disease is associated with ventilator-associated pneumonia (4). As part of a wider study we investigated the effects of antibacterial mouthwash on oral nitrate-reducing capacity and salivary pH, glucose and lactate as well as salivary and plasma nitrate and nitrite concentrations.

The current study examines how different levels of past aggression combined with self-reported levels of alcohol use impacted lab-based aggressive responding. Data were collected from 160 male undergraduate college students. Participants completed online measures of drinking (Alcohol Use Disorders Identification Test) and past aggression (Buss Perry Aggression Questionnaire) prior to a lab session assessing aggressive responding [Point Subtraction Aggression Paradigm (PSAP)]. Regression analyses revealed participants with "high" levels of past alcohol use and a history of "high" aggression were more likely to respond aggressively on the PSAP, a trend primarily driven by those with a history of physical aggression. For proactively aggressive participants, the risk for aggressive responding is greater in individuals with a history of physically aggressive behavior as they report higher alcohol use, relative to those "low" in past aggression. The interaction of alcohol use and past aggression was associated with continued aggressive behavior.

The present study investigated whether bullying victimization and parental involvement were associated with internalizing distress, suicidal thoughts and behavior, and substance use in Jamaican adolescents as well as whether parental involvement moderated the relation between bullying victimization and measures of psychological and behavioral distress. Analyses were based on a sample of 1,595 adolescents who were participating in the 2010 Global School-Based Student Health Survey. Data were collected using a complex survey design. Regression models were estimated using weighted data, which allowed us to draw conclusions about the population of Jamaican adolescents. Consistent with findings from international studies, bullying victimization was uniquely and positively associated with feelings of loneliness, sleep difficulties due to worry, smoking frequency, and suicidality for both male and female adolescents as well as with alcohol use frequency for female adolescents. Our pattern of findings also suggested that parental involvement is a more robust correlate of psychological and behavioral adjustment for female adolescents. Female adolescents who reported higher levels of parental involvement were less lonely and less likely to consider or plan suicide. For boys, parental involvement was only negatively related to loneliness. Finally, we found evidence that parental involvement moderated the relation between bullying victimization and cigarette use and considering suicide, although the latter finding was at the level of a nonsignificant trend. Our findings suggest parental involvement may attenuate the relation between bullying victimization and considering suicide but may strengthen the relation between bullying victimization and smoking. We discuss our findings in the context of Jamaican cultural socialization and with an appreciation for the social challenges faced by adolescents experiencing bullying victimization.

Gender role theory argues that men are socialized to adhere to masculine norms that foment resistance to help-seeking in general and medical care in particular. We hypothesize an automatic link in memory between medical care and masculinity among men, developed through gender role socialization, such that by the time men have reached adulthood, medical-related stimuli inescapably and unintentionally activate masculinity-relevant concepts. Across two studies we employ a lexical decision task with medical and non-medical primes to demonstrate an automatic link between medicine and masculinity (in addition to other concepts) among male university students. Further, we illustrate how self-affirmation may temporarily untether the two concepts. A novel "masculine-affirmation" was also explored, which increased the medicine-masculinity link.

OBJECTIVE: The use of virtual reality (VR) for pain has numerous studies showing effectiveness. However, there has been limited study of its use for chronic pain. METHODOLGY: This pilot study (N=10) investigated the impact of repeated sessions of a VR application for chronic pain on ten subjects. Impact on pain as well as on psychological variables such as depression, anxiety, catastrophizing, and sense of control over pain was assessed. Subjects underwent three twenty minute sessions of the VR application Cool! on a weekly basis using an Oculus Rift or Vive. The impact of the sessions on pain was assessed at four intervals and psychological data captured at two intervals. RESULTS: Results indicate that the VR sessions provided significant pain relief in all treatment sessions with an average of a 66% reduction in pain during the VR session and a 45% reduction in pain immediately after the session. A decrease in pain was reported to last an average of 30 hours after the session. There appeared to be limited if any impact of the VR intervention on chronic pain levels across time. There was no significant impact found for the VR intervention on depression, anxiety, catastrophizing and sense of control over pain. CONCLUSION: Implications for the use of VR on chronic pain conditions are discussed. More frequent VR interventions for chronic pain may be needed to impact pain across time. In addition, VR applications might not be used as an interventional-type in-office treatment as done here but perhaps need to have a skill teaching component or be an application available for in-home and more frequent use.

OBJECTIVEResearch demonstrates alcohol temporally precedes and increases the odds of violence between intimate partners. However, despite an extensive theoretical literature on factors that likely moderate the relationship between alcohol and dating violence, minimal empirical research has examined such moderators.METHODThe purpose of the present study was to examine two potential moderators of this association: trait anger and partner-specific anger management. Undergraduate men (N = 67) who had consumed alcohol within the past month and were in current dating relationships completed a baseline assessment of their trait anger and partner-specific anger management skills and subsequently completed daily assessments of their alcohol use and violence perpetration (psychological, physical, and sexual) for up to 90 consecutive days.RESULTSAlcohol was significantly associated with increased odds of physical aggression among men with relatively high but not low trait anger and partner-specific anger management deficits. In contrast, alcohol was significantly associated with increased odds of sexual aggression among men with relatively low trait anger and partner-specific anger management deficits.CONCLUSIONSOur findings demonstrate important differences in the roles of acute intoxication and anger management in the risk of physical aggression and sexual dating violence. Interventions for dating violence may benefit from targeting both alcohol and adaptive anger management skills.

Many college students underestimate or ignore the side-effects associated with nonmedical use of prescription stimulants (NMUPS) and are motivated by hopes of academic enhancement. The present study measured the effect a placebo stimulant and personal expectancies have on subjective physiological changes and cognitive enhancement. Undergraduate college students participated in a two-phase study. Phase 1 (n = 305) involved completing an online survey to gather distal study variables and individual stimulant expectancy data. Phase 2 (n = 166) required students to attend an in-person session where they completed physiological and neuropsychological measures (e.g., Physical Symptom Checklist, Digit Span, Passage Comprehension). Students were randomized to receive a placebo stimulant medication (experimental) or no medication (control). Following a 30-minute absorption period, participants completed another set of physiological and neuropsychological measures. Experimental participants reported significant increases in positive symptoms resulting from the placebo stimulant. Expectancies moderated the impact of the placebo stimulant on Passage Comprehension performance; no other neuropsychological task performance was impacted. Despite subjective reports of feeling the effects of stimulants, task performance was unaffected. Moreover, expectancies may play a small role in perceptions of the effects of stimulants.

Alcohol use disorder is widespread in the United States and research suggests that significant neuropsychological damage can result from prolonged and/or excessive alcohol use. Neuropsychological and affective effects of prolonged and/or excessive alcohol use include memory deficits, limited emotional expression and recognition, and impairments in executive functioning. Research has yielded mixed results on the improvement of these deficits once alcohol use is discontinued. The aim of this study was to assess psychological changes during an approximately 28-day residential substance use treatment program among adults diagnosed with an alcohol use disorder (N=122). Patients were predominantly White (91.8%) and male (77.9%). Cognitive, psychological and affective functioning were measured utilizing WebNeuro, a computer-based assessment of four specific domains (Feeling, Self-Regulation, Emotion, and Thinking). Time 1 assessments were completed following alcohol detoxification and Time 2 assessments were conducted upon discharge from the treatment facility, approximately 28-days after Time 1. Results revealed significant increases across all four domains at Time 2, suggesting that there were significant improvements in cognitive and psychological functioning over time. The effect of Time was qualified by a significant TimexAUDIT score interaction in predicting the Feeling and Self-Regulation domains, indicating the more severe the alcohol use, the greater the psychological improvement. Continued research is needed to determine whether functioning continues to improve following treatment for an alcohol use disorder.

This study involved the development of the Stages of Change in Relationship Status (SOCRS) measure in 2 samples of college students. This scale is designed to measure how individuals progress through stages of change when terminating violent and nonviolent intimate relationships. Results indicated that the SOCRS is a reliable and valid tool to assess stages of change consistent with the guiding theory. Implications for practice are discussed.

The evidence underpinning the developmental origins of health and disease (DOHaD) is overwhelming. As the emphasis shifts more towards interventions and the translational strategies for disease prevention, it is important to capitalize on collaboration and knowledge sharing to maximize opportunities for discovery and replication. DOHaD meetings are facilitating this interaction. However, strategies to perpetuate focussed discussions and collaborations around and between conferences are more likely to facilitate the development of DOHaD research. For this reason, the DOHaD Society of Australia and New Zealand (DOHaD ANZ) has initiated themed Working Groups, which convened at the 2014-2015 conferences. This report introduces the DOHaD ANZ Working Groups and summarizes their plans and activities. One of the first Working Groups to form was the ActEarly birth cohort group, which is moving towards more translational goals. Reflecting growing emphasis on the impact of early life biodiversity - even before birth - we also have a Working Group titled Infection, inflammation and the microbiome. We have several Working Groups exploring other major non-cancerous disease outcomes over the lifespan, including Brain, behaviour and development and Obesity, cardiovascular and metabolic health. The Epigenetics and Animal Models Working Groups cut across all these areas and seeks to ensure interaction between researchers. Finally, we have a group focussed on 'Translation, policy and communication' which focusses on how we can best take the evidence we produce into the community to effect change. By coordinating and perpetuating DOHaD discussions in this way we aim to enhance DOHaD research in our region.

The treatment of chronic pain could benefit from additional non-opioid interventions. Virtual reality (VR) has been shown to be effective in decreasing pain for procedural or acute pain but to date there have been few studies on its use in chronic pain. The present study was an investigation of the impact of a virtual reality application for chronic pain. Thirty (30) participants with various chronic pain conditions were offered a five-minute session using a virtual reality application called Cool! Participants were asked about their pain using a 0-10 visual analog scale rating before the VR session, during the session and immediately after the session. They were also asked about immersion into the VR world and about possible side effects. Pain was reduced from pre-session to post-session by 33%. Pain was reduced from pre-session during the VR session by 60%. These changes were both statistically significant at the p < .001 level. Three participants (10%) reported no change between pre and post pain ratings. Ten participants (33%) reported complete pain relief while doing the virtual reality session. All participants (100%) reported a decrease in pain to some degree between pre-session pain and during-session pain. The virtual reality experience was found here to provide a significant amount of pain relief. A head mounted display (HMD) was used with all subjects and no discomfort was experienced. Only one participant noted any side effects. VR seems to have promise as a non-opioid treatment for chronic pain and further investigation is warranted.

We present ERICA (Energy Resolving Inline X-ray Camera) a photon-counting readout ASIC, with 6 energy bins. The ASIC is composed of a matrix of 8 × 20 pixels controlled by a global digital controller and biased with 7 independent digital to analog converters (DACs) and a band-gap current reference. The pixel analog front-end includes a charge sensitive amplifier with 16 mV/ke− gain and dynamic range of 45 ke−. ERICA has programmable pulse width, an adjustable constant current feedback resistor, a linear test pulse generator, and six discriminators with 6-bit local threshold adjustment. The pixel digital back-end includes the digital controller, 8 counters of 8-bit depth, half-full buffer flag for any of the 8 counters, a 74-bit shadow/shift register, a 74-bit configuration latch, and charge sharing compensation processing to perform the energy classification and counting operations of every detected photon in 1 μ s. The pixel size is 330 μm × 330 μm and its average consumption is 150 μW. Implemented in TSMC 0.25 μm CMOS process, the ASIC pixel's equivalent noise charge (ENC) is 90 e− RMS connected to a 1 mm thickness matching CdTe detector biased at −300 V with a total leakage current of 20 nA.