Joan M. Cook

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Verified

Joan verified their affiliation via an institutional email.

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• Ph.D.
• Professor at Yale University

Introduction Despite expert recommendations to prioritise non-invasive and patient-centred approaches for behavioural crisis management, physical restraints are commonly used in the emergency department (ED). Patients describe the restraint process as coercive and dehumanising. The use of peer support workers, who are individuals with lived experie...

A randomized clinical trial was conducted comparing the effectiveness of motivational interviewing (MI) versus MI with trauma‐informed affirmative care (AC; i.e., MI+AC) to reduce adverse psychiatric symptoms and facilitate entry into formal mental health services for sexual and gender minority (SGM) men who experienced sexual trauma. The sample co...

Background: As the number of older adults increases worldwide, understanding their mental health is crucial, including the impact of traumatic experiences that can lead to posttraumatic stress disorder (PTSD). However, validated screening and diagnostic instruments for PTSD in older adults are limited. Objective: We sought to provide a comprehensiv...

Trauma is a global issue and public health concern. Political decisions may directly impact rates of trauma exposure, be it individual trauma or mass disaster, and guide how we deal with the consequences of trauma. In this editorial, we warn that the current U.S. administration's decisions are impacting exposure to and consequences of trauma worldw...

The Primary Care PTSD Screen for DSM‐5 (PC‐PTSD‐5) and PTSD Checklist for DSM‐5 (PCL‐5) have demonstrated high levels of diagnostic accuracy and strong psychometric properties across various samples and settings. However, the impact of age on these measures has been underinvestigated. This is problematic, as without accurate measurement, older adul...

Objectives: To examine the psychometric properties of an assessment measure for posttraumatic stress disorder (PTSD) that corresponds with the current version of the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) in older adults. Design: Cross-sectional study. Setting: Nationally representative web-based survey (Nationa...

Objective: This study provides nationally representative data on the prevalence, risk factors, and associated mental health and functional outcomes of mild traumatic brain injury (mTBI) in U.S. military veterans. Methods: Data (N = 4,069) were analyzed from the National Health and Resilience in Veterans Study (NHRVS). Analyses estimated mTBI pre...

Background: Assessment of Posttraumatic Stress Disorder (PTSD) symptoms in individuals with dementia is difficult due to diagnostic challenges like an incomplete self-report, interference of neuropsychiatric symptoms and overlapping comorbid psychiatric symptoms. Objective: These diagnostic challenges are articulated here and an in-depth evaluation...

Objectives: To examine the nature and correlates of 10-year trajectories of posttraumatic stress disorder (PTSD) symptoms in older U.S. military Veterans. Design and setting: A nationally representative web-based survey of older U.S. Veterans who participated in the National Health and Resilience in Veterans Study over 5 waves between 2011 and 2...

Background: Psychiatric comorbidity is high in adults with posttraumatic stress disorder (PTSD), with up to 90% having at least one additional condition, and two-thirds having two or more other diagnoses. With an increasing aging population in industrialized counties, knowing which psychiatric disorders frequently co-occur in older adults with PTS...

Research has demonstrated that the impact of the coronavirus 2019 (COVID-19) pandemic on the mental health of United States (U.S.) veterans was less negative than originally anticipated. However, U.S. veterans are susceptible to exacerbation of post-traumatic stress disorder (PTSD) symptomology in late life. The aims of this study were to examine t...

This paper provides a description and evaluation of training male sexual abuse survivors to deliver Motivational Interviewing (MI) and Motivational Interviewing with Trauma-Informed Affirmative Care (MI-AC) online to sexual and gender minority (SGM) men with sexual assault histories and depression. After a search and selection process, 26 men with...

Objective: This study compared sexual abuse histories and depressive symptoms between younger, middle-aged, and older sexual and gender minority (SGM) male survivors. Design: Participants completed a brief, online screener as part of a large comparative effectiveness psychotherapy trial. Setting: SGM males 18 years or older, residing in the U....

Objectives: To examine the role of subjective cognitive difficulties (SCD), posttraumatic stress disorder (PTSD), and their interaction in predicting suicidal ideation and current suicidal intent in middle-aged and older United States (US) military veterans. Design: Population-based cross-sectional study. Setting and participants: Data were an...

Numerous guidelines exist to inform decision-making regarding psychological treatment of patients with posttraumatic stress disorder (PTSD). While strides have been made in the implementation of evidence-based psychotherapies (EBPs) for PTSD in the United States. Department of Veterans Affairs (VA), a large population of veterans does not receive s...

Cognitive and behavioral aspects may mask posttraumatic stress disorder (PTSD) in people with dementia. PTSD severely lowers quality of life in people with dementia. Proper recognition of PTSD is essential to ensure adequate treatment. However, a valid diagnostic tool for PTSD in dementia is lacking. A Delphi study was conducted among 20 Dutch and...

Posttraumatic stress disorder (PTSD) affects 6.8% of adults in the United States and is associated with high rates of disability, comorbid medical and psychiatric disorders, and suicide. Recent studies report increasing prevalence rates of PTSD among older adults, and this pattern is anticipated to accelerate as the population skews older and Veter...

Objective: Community-engaged research (CEnR) is an approach to inquiry that centers scientist-community partnerships characterized by mutuality and reciprocity, and is well-aligned with trauma-informed principles, such as trustworthiness, transparency, and fostering empowerment. Method: The current paper considers definitions and applications of CE...

Sexual abuse of boys and men is a public health problem that has received relatively little attention from clinical scholars and researchers. Given unique pathways for development of and recovery from trauma-related emotional distress, sexual abuse survivors who identify as men may require distinct psychosocial interventions to engage in formal men...

Objectives To characterize the prevalence, characteristics, and comorbidities of subthreshold and full posttraumatic stress disorder (PTSD) in older U.S. military veterans. Design and Setting A nationally representative web-based survey of older U.S. military veterans who participated in the National Health and Resilience in Veterans Study (NHRVS)...

Purpose of Review Anxiety, trauma-related and obsessive-compulsive disorders are relatively common in older adults, and may go undetected, with potential negative physical, psychological, and psychosocial consequences. These mental health conditions are frequently comorbid with medical, cognitive, and other psychiatric disorders. Screening in prima...

Posttraumatic stress disorder (PTSD) is a serious mental health disorder that may not be adequately detected or treated in primary care (PC). The purpose of this study was to compare the clinical characteristics and health care utilization of PTSD patients diagnosed in PC versus in specialty mental health care (MHC) across five large, civilian, not...

At least 1 in 4 men are sexually abused or assaulted across their lifetime. Although many have significant negative mental health (MH) difficulties, relatively few seek formal MH treatment. This study sought to understand current engagement in and perceived helpfulness of MH treatment in male survivors. Eighty-eight men completed an online survey v...

The present study examined the patterns of adoption of two evidence‐based psychotherapies (EBPs)—prolonged exposure (PE) and cognitive processing therapy (CPT)—in U.S. Department of Veterans Affairs (VA) residential posttraumatic stress disorder (PTSD) treatment programs. A total of 526 providers from 39 programs nationwide completed online quantit...

To the Editor In the network and pairwise meta-analysis comparing psychotherapy with medication for treatment of posttraumatic stress disorder (PTSD), Merz et al¹ report no difference at the end of the short-term treatment period but greater benefit for psychotherapy at long-term follow-up. However, their results from the long-term pairwise meta-an...

The goal of this study was to summarize evidence from head-to-head randomized trials for treatment of posttraumatic stress disorder (PTSD) in adults comparing trauma-focused psychotherapies and selective serotonin reuptake inhibitors (SSRIs) or serotonin/norepinephrine reuptake inhibitors (SNRIs) in a systematic review and meta-analysis. We conduct...

Traumatic stress is currently not a required component of the standard curricula in graduate-level education in clinical and counseling psychology. However, due to the high prevalence of trauma and its potentially deleterious physical and mental health effects in the general and clinical populations, it is imperative that psychology graduate studen...

The current study examined the nature and correlates of seven-year posttraumatic stress disorder (PTSD) symptom courses in a nationally representative, prospective cohort of U.S. military veterans. Data were analyzed from 2,307 trauma-exposed veterans who completed at least one follow-up assessment over a 7-year period, a subsample of n = 3,157 vet...

The American Psychological Association (APA) developed a clinical practice guideline (CPG) to provide recommendations on psychological and pharmacological treatments for posttraumatic stress disorder (PTSD) in adults. This paper is a summary of the CPG, including the development process. Members of the guideline development panel (GDP) used a compr...

Study objectives: To examine the efficacy of imagery rehearsal (IR) combined with cognitive behavioral therapy for insomnia (CBT-I) compared to CBT-I alone for treating recurrent nightmares in military veterans with posttraumatic stress disorder (PTSD). Methods: In this randomized controlled study, 108 male and female United States veterans of t...

Objective: This observational study examined the association between patient outcomes at 39 U.S. Department of Veterans Affairs residential treatment programs for veterans with posttraumatic stress disorder (PTSD) and the degree of adoption of two evidence-based psychotherapies, prolonged exposure and cognitive processing therapy. The hypothesis w...

As part of a longitudinal mixed-methods investigation on implementation of 2 evidence-based psychotherapies (EBPs) for Posttraumatic Stress Disorder, 164 mental health providers from 38 Department of Veterans Affairs (VA) residential treatment programs across the United States were asked questions about their decision making for using Prolonged Exp...

Older adults have generally not been included in randomized clinical trials of psychotherapy for posttraumatic stress disorder (PTSD). Of the case reports and treatment outcome studies that have included those aged 55 and older, most did not include men with sexual abuse-related PTSD. This case report presents the successful application of Prolonge...

Objectives: We provide a review of the literature on posttraumatic stress disorder (PTSD) in older adults, focusing largely on older U.S. military veterans in two primary areas: 1) assessment and diagnosis and 2) non-pharmacological treatment of PTSD in late life. Methods: We performed a search using PubMed and Academic Search Premier (EBSCO) datab...

The United States Department of Veterans Affairs (VA) provides Cognitive Processing Therapy (CPT) and Prolonged Exposure therapy (PE) for PTSD at all of its facilities, but little is known about systematic differences between patients who do and do not initiate these treatments. VA administrative data were analyzed for 6,251 veterans receiving psyc...

This study examined the role of attitudes toward evidence-based psychotherapies (EBPs) in predicting use of prolonged exposure (PE) and cognitive processing therapy (CPT), two EBPs for posttraumatic stress disorder (PTSD) among PTSD treatment providers within the Department of Veterans Affairs. Providers' general attitudes toward EBPs, as well as t...

Purpose of Review The aim of this paper is to present a succinct summary of the major scientific findings on trauma, posttraumatic stress disorder (PTSD), and aging over the past few years. Recent Findings There have been several reports from longitudinal investigations using representative samples of veterans regarding traumatic exposure and subs...

Objective: It has been over a decade since the U.S. Department of Veterans Affairs (VA) began formal dissemination and implementation of two trauma-focused evidence-based psychotherapies (TF-EBPs). The objective of this study was to examine the sustainability of the TF-EBPs and determine whether team functioning and workload were associated with T...

As part of a longitudinal investigation on implementation of 2 evidence-based psychotherapies (EBPs) for posttraumatic stress disorder, psychotherapists from 38 Department of Veterans Affairs residential treatment programs across the United States were asked to complete reflective journals every 4 months for a 1-year time period in regard to their...

Sexual abuse is an often overlooked public health issue for boys and men. Given its prevalence and well-documented connection to mental and physical health disorders, the relevance of male survivor input and engagement in health care research is profound. Using a community-based participatory research design, an in-person focus group with male surv...

Objective Available studies on implementation of evidence-based psychotherapy (EBP) for patients attending Department of Veterans Affairs (VA) residential post-traumatic stress disorder (PTSD) programs rely on therapist self-report of EBP delivery. Patient-level data on receipt of EBP are needed both to corroborate therapist self-report and to unde...

Post traumatic stress disorder (PTSD) may first emerge, reemerge, or worsen as individuals approach end of life and may complicate the dying process. Unfortunately, lack of awareness of the occurrence and/or manifestation of PTSD at end of life can lead to PTSD going unaddressed. Even if PTSD is properly diagnosed, traditional evidence-based trauma...

Evidence-based psychotherapies for PTSD are often underused. The objective of this mixed-method study was to identify organizational and clinic factors that promote high levels of reach of evidence-based psychotherapies for PTSD 10 years into their dissemination throughout the Veterans Health Administration. We conducted 96 individual interviews wi...

Objectives Veterans from the recent conflicts in Iraq and Afghanistan are being diagnosed with posttraumatic stress disorder (PTSD) at high rates. This study examined characteristics associated with mental health service utilization, specifically psychotherapy, through the Department of Veterans Affairs (VA), in a large cohort of Iraq and Afghanist...

Directors from psychology internship programs across the United States were asked to participate in a survey regarding their sites’ provision of services to traumatized populations and didactic and supervisory training offered to interns. All totaled, 259 training directors completed the survey. Using a point system, an impact score of training sat...

Objective: The purpose of this paper was to systematically review and synthesize the empirical literature on the effects of evidence-based therapy relationship (EBR) variables in the psychological treatment for adults who experienced trauma-related distress. Method: Studies were identified using comprehensive searches of PsycINFO, Medline, Publi...

With the high prevalence of potentially traumatic events and subsequent associated mental health problems and impaired functioning, there is a need for graduate training in trauma psychology. A national survey was conducted of all North American doctoral programs in psychology to ascertain the current status of training in trauma. Training director...

Background Large-scale implementation of evidence-based psychotherapies (EBPs) such as cognitive processing therapy (CPT) for posttraumatic stress disorder can have a tremendous impact on mental and physical health, healthcare utilization, and quality of life. While many mental health systems (MHS) have invested heavily in programs to implement EBP...

Although lifetime exposure to potentially traumatic events among older adults is fairly high, rates of full-blown Posttraumatic Stress Disorder (PTSD) are estimated at about 4.5%, a rate lower than middle-aged and young adults. However, PTSD seems to be an under-recognized and under-treated condition in older adults. Assessment and treatment can be...

Objective: Despite a growing body of knowledge about the dissemination of evidence-based psychotherapies (EBPs), their actual use in clinical settings is not well understood. The purpose of the current study was to compare self-reported component use with global use for 2 EBPs for posttraumatic stress disorder (PTSD), prolonged exposure (PE), and...

Since 2006, the Veterans Health Administration (VHA) has instituted policy changes and training programs to support system-wide implementation of two evidence-based psychotherapies (EBPs) for posttraumatic stress disorder (PTSD). To assess lessons learned from this unprecedented effort, we used PubMed and the PILOTS databases and networking with re...

Although many cross-sectional studies have examined the correlates of psychological resilience in U.S. military veterans, few longitudinal studies have identified long-term predictors of resilience in this population. The current prospective cohort study utilized data from a nationally representative sample of 2157 U.S. military veterans who comple...

This review presents recent empirical developments on posttraumatic stress disorder (PTSD) in older adults, highlighting some of the most interesting lines of investigation that have taken place over the past few years. The majority of the extant literature has focused on male veterans or former prisoners of war, Caucasians, and those from the Unit...

Objective: Mental health provider perceptions of patient readiness for trauma-focused evidence-based treatments (EBTs) for posttraumatic stress disorder (PTSD) have been found to impact outpatient care in the Department of Veterans Affairs (VA). Method: One hundred and 72 mental health directors and providers from 36 VA residential PTSD treatmen...

The Perceived Characteristics of Intervention Scale (PCIS), a 20-item assessment measure, was developed to assess health care providers’ views of interventions. Two hundred and fifteen Department of Veterans Affairs’ residential treatment providers from 38 programs across the United States completed an online survey that included the PCIS as well a...

Understanding the impact of trauma on late-life functioning in older females is needed in order to provide best care. We explored the impact of trauma on late-life psychological and physical health and functioning among older women (n = 48) who served in the military, or participated in a military lifestyle. Eleven of these women were not veterans,...

The prevalence of trauma histories and related psychological problems is high in general clinical settings, but little is known about trauma patient preferences for mental health treatment. The purpose of this article is to systematically review and synthesize the literature on treatment preferences in survivors of traumatic events. Studies were id...

Older veterans are the largest cohort served by the U.S. Department of Veterans Affairs (VA). The aim of this study was to examine mental health service utilization among older veterans recently diagnosed with posttraumatic stress disorder (PTSD), with an interest in sociodemographic and clinical characteristics related to receipt and type of menta...

Despite extensive data from randomized controlled trials supporting the efficacy of evidence-based treatments (EBTs), the adoption of these interventions in the Department of Veterans Affairs (VA) and the Department of Defense has been markedly slow. Qualitative interviews were conducted with a nationally representative sample of 38 directors of sp...

This study examines the implementation of two evidence-based psychotherapies, Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT), in the Department of Veterans Affairs residential Posttraumatic Stress Disorder treatment programs. Two hundred and one providers from 38 programs completed an online survey concerning implementation of PE de...

Purpose of study: Exposure to traumatic events is a highly prevalent, although often overlooked, aspect in the lives of homeless veterans. In this study, the prevalence and correlates of potentially traumatic events, including posttraumatic stress disorder, in the homeless veteran population are presented. Findings/conclusions: Presently, there...

Although the scientific literature on traumatic stress is large and growing, most psychologists have only a cursory knowledge of this science and have no formal training in, nor apply evidence-based psychosocial treatments for, trauma-related disorders. Thus, there exists a clear need for the development and dissemination of a comprehensive model o...

Objectives: Older adults represent the fastest growing segment of the US and industrialized populations. However, older adults have generally not been included in randomized clinical trials of psychotherapy for post-traumatic stress disorder (PTSD). This review examined reports of psychological treatment for trauma-related problems, primarily PTSD...

This national investigation utilizes qualitative data to evaluate an implementation model regarding factors influencing provider use of two evidence-based treatments for posttraumatic stress disorder (PTSD). Semi-structured qualitative interviews with 198 mental health providers from 38 Department of Veterans Affairs' (VA) residential treatment pro...

There has been little investigation of the natural course of evidence-based treatments (EBTs) over time following the draw-down of initial implementation efforts. Thus, we undertook qualitative interviews with the providers at 38 U.S. Department of Veterans Affairs' residential treatment programs for posttraumatic stress disorder (PTSD) to understa...

Assessment of posttraumatic stress disorder (PTSD) in older adults has received limited investigation. The purpose of this study was to compare the severity of PTSD symptoms in treatment-seeking older and younger U.S. veterans with PTSD. Participants were 360 male and 284 female veterans enrolled in 2 separate clinical trials of psychotherapy for P...

Providers (N = 198) from 38 Department of Veterans Affairs residential posttraumatic stress disorder treatment programs across the United States completed qualitative interviews regarding implementation of 2 evidence-based treatments: prolonged exposure and cognitive processing therapy. As part of this investigation, providers were asked how they d...

Impaired sleep and nightmares are known symptoms of posttraumatic stress disorder (PTSD) in the veteran population. In order to assess prospectively the sleep disturbances in this population, sleep diaries are an effective way to obtain information over an extended period of time. In this investigation, a sample of veterans (N = 105) completed dail...

Thirty-eight U.S. Department of Veterans Affairs’s (VA) residential treatment programs for posttraumatic stress disorder took part in a formative evaluation of their programmatic services, including perceptions of effective treatment. From July 2008 through March 2011, face-to-face qualitative interviews were conducted with over 250 VA residential...

In this article, the authors provide information on key characteristics of imagery rehearsal treatment protocols and examine the quality of reporting of randomized controlled and uncontrolled trials of imagery rehearsal for treating posttraumatic nightmares. Using a reliable and valid scale, two independent psychologists rated 16 trials. Most repor...

Objectives: This study presents prevalence and characteristics of physical and sexual assaults, and their relationship to posttraumatic stress disorder (PTSD), and mood and anxiety disorders in a nationally representative sample of older women. Design and setting: Face-to-face interviews conducted with adult participants from wave 2 of the Natio...

Background: Although a large body of empirical research has examined negative psychological outcomes in older veterans, relatively little is known about the prevalence and determinants of psychological resilience in this population. Methods: A nationally representative sample of 2,025 U.S. veterans aged 60 and older (mean = 71.0, standard deviat...

A quality improvement effort was undertaken in Department of Veterans Affairs' (VA) residential treatment programs for Posttraumatic Stress Disorder (PTSD) across the United States. Qualitative interviews were conducted with over 250 directors, providers, and staff during site visits of 38 programs. The aims of this report are to describe clinical...

This study examined factors predicting treatment dropout and outcome in 124 male Vietnam War veterans with chronic, severe posttraumatic stress disorder treated in a randomized controlled trial of two cognitive–behavioral group therapies for combat-related nightmares. Though significant bivariate predictors of dropout in the imagery rehearsal condi...

Between July 2008 and March 2011, 38 U.S. Department of Veterans Affairs (VA) residential treatment programs for posttraumatic stress disorder (PTSD) participated in a formative evaluation of their programmatic services, including evidenced-based treatments (EBTs). Face-to-face qualitative interviews were conducted with over 250 staff by an indepen...

This chapter focuses on older adult trauma survivors. Information is presented on prevalence of acute stress disorder (ASD) and posttraumatic stress disorder (PTSD); course, functional impairment, suicide risk, and health care utilization in older adults with PTSD; and the impact of demographic factors such as gender, ethnicity, and race on PTSD in...

The characteristics of nightmares of 48 male U.S. Vietnam war veterans with combat-related posttraumatic stress disorder (PTSD), as well as revised dream scripts developed in the course of Imagery Rehearsal therapy, were examined in relation to pretreatment symptomatology and treatment outcome. Features, content, and themes of nightmares and rescri...

Background Greenhalgh et al. used a considerable evidence-base to develop a comprehensive model of implementation of innovations in healthcare organizations [1]. However, these authors did not fully operationalize their model, making it difficult to test formally. The present paper represents a first step in operationalizing Greenhalgh et al.’s mod...

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