Melissa A Polusny

• PhD
• Medical Professional at U.S. Department of Veterans Affairs

Mindfulness-based interventions may be acceptable to veterans who have poor adherence to existing evidence-based treatments for posttraumatic stress disorder (PTSD). To compare mindfulness-based stress reduction with present-centered group therapy for treatment of PTSD. Randomized clinical trial of 116 veterans with PTSD recruited at the Minneapoli...

Troops deployed to Iraq and Afghanistan are at high risk for exposure to combat events resulting in mild traumatic brain injury (MTBI) or concussion and posttraumatic stress disorder (PTSD). The longer-term impact of combat-related concussion/MTBI and comorbid PTSD on troops' health and well-being is unknown. To assess longitudinal associations bet...

National Guard troops are at increased risk for post-traumatic stress disorder (PTSD); however, little is known about risk and resilience in this population. The Readiness and Resilience in National Guard Soldiers Study is a prospective, longitudinal investigation of 522 Army National Guard troops deployed to Iraq from March 2006 to July 2007. Part...

Background Despite extensive resilience research with military personnel, progress in developing effective resilience-specific interventions for military service members (MSM) has been limited. To inform the design of effective prevention and intervention strategies, a better understanding of the neurocognitive, behavioral, and social processes ass...

Posttraumatic stress disorder (PTSD) is associated with poor quality of life. Although randomized clinical trial data show improvements in quality of life following trauma‐focused therapies (TFTs), including prolonged exposure therapy (PE) and cognitive processing therapy (CPT), less is known about how these improvements are experienced from the tr...

Meditation-based interventions are novel and effective non-pharmacologic treatments for veterans with PTSD. We examined relationships between treatment response, early life trauma exposure, DNA polymorphisms, and methylation in the serotonin transporter (SLC6A4) and FK506-binding protein 5 (FKBP5) genes. DNA samples and clinical outcomes were exami...

Background: Although studies have documented higher rates of chronic pain among women Veterans compared to men Veterans, there remains a lack of comprehensive information about potential contributors to these disparities. Materials and Methods: This study examined gender differences in chronic pain and its contributors among 419 men and 392 women V...

Prolonged exposure (PE) and cognitive processing therapy (CPT) for posttraumatic stress disorder (PTSD) are effective, but some patients do not respond adequately, and dropout rates are high. Patients’ beliefs about treatment and perceptions of treatment components influence treatment outcomes and may be amenable to change through intervention. The...

This study examined the impact of ongoing substance use during posttraumatic stress disorder (PTSD) and substance use disorder (SUD) treatment on PTSD symptoms and treatment discontinuation. The study represents a secondary analysis of U.S. military veterans (N = 183) who participated in a randomized clinical trial for the treatment of both PTSD an...

BACKGROUND Military service provides a unique opportunity for studying resilience, a dynamic process of successful adaptation (i.e., doing well in terms of functioning and symptoms) in response to significant adversity. Despite tremendous interest in positive adaptation among military service members, little is known about the processes underlying...

Background Military services provide a unique opportunity for studying resilience, a dynamic process of successful adaptation (ie, doing well in terms of functioning and symptoms) in response to significant adversity. Despite the tremendous interest in positive adaptation among military service members, little is known about the processes underlyin...

Background Military service provides a unique opportunity for studying resilience, a dynamic process of successful adaptation (i.e., doing well in terms of functioning and symptoms) in response to significant adversity. Despite tremendous interest in positive adaptation among military service members, little is known about the processes underlying...

Background Multilevel, longitudinal studies are integral to resilience research; however, they are costly and present unique methodological challenges. The objective of this study was to examine the feasibility of study methods (recruitment, retention, data collection) for a large-scale prospective, longitudinal study of resilience among young Nati...

Challenges in conceptualising resilience have impeded advancements in resilience science. In response, the National Institutes of Health (NIH) developed a general framework for harmonising the conceptualisation of resilience as a dynamic process determined by multiple systems and levels of analysis. Consistent with the NIH Resilience Framework, thi...

Accurate emotion perception is an indicator of current psychosocial functioning. Past studies have reported variable relationships between impaired emotion identification, maladaptive personality traits, and psychopathology. We examined associations between discrimination performance and trait negative emotionality, positive emotionality, constrain...

Although trauma‐focused treatments (TFTs) are generally effective, not all patients improve. Symptom accommodation (i.e., altering one's behavior in response to another's symptoms) by loved ones may be particularly relevant to TFT treatment response and engagement. We examined the role of symptom accommodation by support persons (SPs) in veterans’...

Objective: Many patients who initiate prolonged exposure (PE) and cognitive processing therapy (CPT) do not complete a full course, although little is known about how providers view PE and CPT dropout among their own patients. Method: Semistructured interviews were conducted with providers (n = 29) in the Veterans Health Administration to understan...

Objectives This study evaluates the effects of treatment with mindfulness-based stress reduction (MBSR) compared to the active control, present-centered group therapy (PCGT), on morning plasma cortisol, interleukin-6 (IL-6), and C-reactive protein (CRP) in veterans diagnosed with post-traumatic stress disorder (PTSD).Methods In a post hoc explorato...

Frontal Midline Theta (FMT) is negatively associated with Negative Emotionality (NEM) as indexed by the Multidimensional Personality Questionnaire (MPQ), suggesting that FMT may be a potential neural correlate of resilience capacity.

Background Co-occurrence of posttraumatic stress disorder (PTSD) and substance use disorders (SUDs) is common and concurrent treatment is recommended. Relatively little is known about which evidence-based psychotherapies for PTSD are most effective for patients with varying substance use profiles. We aim to examine the comparative effectiveness of...

Participation in valued interpersonal and community activities is a key component of rehabilitation for Veterans with amputation. The purpose of this study was to identify specific factors that promote or inhibit participation to inform development of interventions that may facilitate participation in desired life activities. A convenience sample o...

Introduction Accurate measurement of adverse life events is critical for understanding the effects of stressors on health outcomes. However, much of this research uses cross-sectional designs and self-report years after the events take place. The reliability of this retrospective reporting and the individual difference factors associated with incon...

We developed and refined a measure of perceived sexual harassment tolerance, the Perceived Tolerance of Sexual Harassment in the Military (PTSH), that examined social norms perceived as emanating from troops’ immediate work unit, immediate supervisor, and senior officer. A 6-item version had 0.88 internal consistency and explained 55% of the varian...

Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT) are first-line treatments for posttraumatic stress disorder (PTSD) and have been disseminated throughout the U.S. Veterans Health Administration. Treatment non-completion is common and lessens clinical effectiveness; however, prior work has failed to identify factors consistently associ...

Background Posttraumatic stress disorder occurs in as many as one in five combat veterans and is associated with a host of negative, long-term consequences to the individual, their families, and society at large. Trauma-focused treatments, such as Prolonged Exposure, result in clinically significant symptom relief for many. Adherence to these treat...

Objective: Dropout rates from trauma-focused PTSD treatments (TFTs) in VA clinics are particularly high. We conducted in-depth qualitative interviews with 29 veterans and their therapists to better understand this phenomenon. Method: Participants were part of a multisite, mixed-methods study of TFT adherence in VA clinics. Veterans were eligible...

The ability of Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF; Ben-Porath & Tellegen, 2008/2011) scores to predict treatment engagement in veterans referred for empirically supported treatments for symptoms of Posttraumatic Stress Disorder (PTSD) was examined. Early withdrawal from treatment and process factors, such as...

Objective: Comorbidity between posttraumatic stress disorder (PTSD) and substance use disorders (SUD) is common, and both are associated with cognitive dysfunction. However, few studies examine the impact of cognitive deficits on treatment outcomes. Here, we leverage data from a randomized clinical trial of integrated versus phased psychotherapy f...

Psychological resilience as a longitudinal process is highly relevant for understanding the functioning outcomes of military populations. Here, we review the extant literature on resilience among military service members, focusing on National Guard Soldiers. Our specific project (Advancing Research on Mechanisms of Resilience, “ARMOR”) aims to deve...

Background Posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) are commonly reported co-occurring mental health consequences of psychological trauma exposure. The disorders have high genetic overlap. Trauma is a complex phenotype but research suggests that trauma sensitivity has a heritable basis. We investigated whether sensit...

[This corrects the article DOI: 10.3389/fpsyt.2018.00418.].

Background While military service members are at risk for pain conditions, receipt of prescribed opioids is associated with a range of serious adverse outcomes. The goal of this study is to examine the association between pre-deployment personality traits and receipt of prescription opioids after return from deployment. Method Data were drawn from...

Background Mindfulness-based interventions (MBIs) are evidence-based nonpharmacological treatments for treating chronic pain. However, the predominant MBI, mindfulness-based stress reduction, has features that pose significant implementation barriers. Objectives This study will test two approaches to delivering MBIs for improving Veterans’ chronic...

Objectives: The primary aim of this study was to examine differences in yoga practice between persons with and without chronic pain. Secondarily, we describe use of the Essential Properties of Yoga Questionnaire, Short Form (EPYQ-SF) for self-report. Design: Participants were members of an existing cohort of veterans who completed a 2015-2016 su...

Objective: Direct-to-consumer marketing has the potential to increase demand for specific treatments, but little is known about how to best market evidence-based psychotherapies to veterans with posttraumatic stress disorder (PTSD). The objective of this study was to gain an understanding of marketing messages that may impact veteran demand for pr...

Introduction Family members are important supports for veterans with Posttrauamtic Stress Disroder (PTSD), but they often struggle with their own distress and challenges. The Veterans Affairs—Community Reinforcement and Family Training (VA-CRAFT) website was designed to teach family members of veterans with PTSD effective ways to interact with thei...

Objective: Recent clinical practice guidelines recommend the delivery of evidence-based psychotherapies for both substance use disorder (SUD) and posttraumatic stress disorder (PTSD) within the same treatment episode for patients with SUD/PTSD comorbidity. This randomized clinical trial evaluated the comparative effectiveness of integrating versus...

Prolonged exposure (PE) therapy is highly effective in reducing symptoms of PTSD, but it is often difficult for veterans to engage in and adhere to all prescribed components of this therapy. This article details a preliminary, feasibility test of Peer Enhanced Exposure Therapy (PEET), a new, manualized intervention allowing specially trained peer s...

Background: Although a common neurobiological mechanism for PTSD has been proposed, contextual issues related to race/ethnicity, gender, other sociohistorical factors, and the type of trauma experienced could influence how PTSD presents in any given individual. Objective: To analyze and compare the patterns of correlations (the component structure)...

Objective: One in 3 veterans will dropout from trauma-focused treatments for posttraumatic stress disorder (PTSD). Social environments may be particularly important to influencing treatment retention. We examined the role of 2 support system factors in predicting treatment dropout: social control (direct efforts by loved ones to encourage veterans...

Mindfulness Based Stress Reduction (MBSR) is an effective non-pharmacologic treatment for veterans with PTSD. Extensive work has identified epigenetic factors related to PTSD disease risk and pathophysiology, but how these factors influence treatment response is unclear. Serotonin signaling and hypothalamic-pituitary-adrenal (HPA) axis functioning...

Adjusted means and 95% confidence intervals of methylation in FKBP5 intron 7 bin2 and CpG_35558513 before and after treatment in MBSR responders and nonresponders.

DNA methylation sequence amplicons and primers for SLC6A4 and FKBP5 genes. Coordinates are based on Human Genome Build 37 (Human GRCh37/hg19). All primers contained one of the following tagged sequences: (1) tcgtcggcagcgtcagatgtgtataagagacag- left primer, or (2) gtctcgtgggctcggagatgtgtataagagacag- right primer.

Background: Non-pharmacological therapies and practices are commonly used for both health maintenance and management of chronic disease. Patterns and reasons for use of health practices may identify clinically meaningful subgroups of users. The objectives of this study were to identify classes of self-reported use of conventional and complementary...

Objective: Transcendental Meditation (TM) is a mental technique using a mantra to facilitate meditation. TM has a potential for treating symptoms of posttraumatic stress disorder (PTSD), but its clinical efficacy remains to be clarified. This pilot study evaluated the acceptability, preliminary effectiveness, and neurophysiology of TM for veterans...

Introduction Adequate sleep plays an integral role in the physical and mental health of individuals, while simultaneously influencing their cognitive and work performance. Having recognized this, the U.S. Army has focused efforts on improving soldiers’ healthy sleep behaviors. This study examines the extent to which mental health, alcohol use, and...

There has been growing interest in utilizing mobile phone applications (apps) to enhance traditional psychotherapy. Previous research has suggested that apps may facilitate patients’ completion of cognitive behavioral therapy for insomnia (CBT-I) tasks and potentially increase adherence. This randomized clinical trial pilot study (n = 18) sought to...

Intimate partner communication has become a part of the daily routine of military couples during deployment. However, there is a scarcity of research examining the individual and relationship implications of communication during deployment, likely due in part to the lack of existing measures of deployment communication. The current study examined t...

Although the negative effects of deployment on the health of military spouses have been studied, research on sleep disruptions remains limited. This study investigates trajectories of sleep complaints over the course of deployment and predictors of these changes among a cohort of at-home partners. Data were drawn from the Readiness and Resilience i...

Posttraumatic stress disorder (PTSD) and sequelae of mild traumatic brain injury (mTBI) are presumed to contribute to reintegration difficulties in combat-exposed veterans. Yet their relative impacts on postdeployment functioning are not well understood. The current study used structural equation modeling (SEM) to clarify the extent to which sympto...

Objective: Spouse/partners of military personnel demonstrate elevated levels of distress during military deployments, yet there is insufficient information about courses of adjustment over time. The current study identified trajectories of depression and alcohol use problems and predictors of those trajectories across the deployment cycle. Method...

Dear editor, We are pleased to respond to Drs Lee and Hoge's1 commentary on our randomised controlled trial (RCT) published in JAMA (a summary of the original article can be found at https://www.ncbi.nlm.nih.gov/pubmed/26241597).2 While we readily acknowledge several limitations to the study, Drs Lee and Hoge have failed to consider or acknowledge...

Although most people experience a traumatic event at some point in their lifetime, only a minority of trauma-exposed individuals develop posttraumatic stress disorder (PTSD). Research has increasingly focused on the role of social circumstances before, during, and after trauma exposure in PTSD risk. In this article, we provide an overview of concep...

Although the U.S. Department of Veterans Affairs (VA) has prioritized care for posttraumatic stress disorder (PTSD), many patients with PTSD remain symptomatic. Patterns of PTSD symptom change are not well understood. Thus, the current study was designed to categorize and investigate potential predictors of symptom trajectories in patients with PTS...

Objective: Spouse/partners of military personnel demonstrate elevated levels of distress during military deployments, yet there is insufficient information about courses of adjustment over time. The current study identified trajectories of depression and alcohol use problems and predictors of those trajectories across the deployment cycle. Method...

While comorbidity between posttraumatic stress disorder (PTSD) and substance use disorders (SUD) is common among veterans, there is debate regarding how to best treat individuals suffering from both conditions. Despite data supporting the effectiveness of integrated treatments that simultaneously address both disorders, due to concerns that an earl...

There is limited research testing longitudinal models of how posttraumatic stress disorder (PTSD) severity leads to impaired relationship adjustment. The present study evaluated 2 potential mechanisms among a longitudinal sample of National Guard soldiers deployed to the Iraq War: (1) sensitivity to cues associated with punishment within intimate r...

Social support is a robust correlate of posttraumatic stress disorder (PTSD) symptoms and of general psychological distress (Ozer, Best, Lipsey, & Weiss, 2003). The nature of the causal relationship between support and PTSD remains the subject of debate, with 2 models, social erosion and social causation, often used to explain findings. Despite ext...

Background. Research suggests that personality traits have both direct and indirect effects on the development of psychological symptoms, with indirect effects mediated by stressful or traumatic events. This study models the direct influence of personality traits on residualized changes in internalizing and externalizing symptoms following a stress...

In Reply Ms Goulao and Mr MacLennan state that when interventions are delivered in group format by the same therapists, within-group correlation due to shared therapist effects may be introduced, violating the assumption of independence underlying commonly used statistical methods.1 This suggests that findings reported in our trial comparing mindfu...

Over the past decade, the USA has relied on unprecedented deployments of National Guard and Reserve Component service members to support sustained military operations in Afghanistan and Iraq. In this chapter, we review the empirical literature on the prevalence of PTSD among service members following deployment to Iraq and Afghanistan. Methodologic...

Over the past decade, the USA has relied on unprecedented deployments of National Guard and Reserve Component service members to support sustained military operations in Afghanistan and Iraq. In this chapter, we review the empirical literature on the prevalence of PTSD among service members following deployment to Iraq and Afghanistan. Methodologic...

Sexual trauma is an understudied but regrettably significant problem among male Veterans. As in women, sexual trauma often results in serious mental health consequences for men. Therefore, to guide potential future interventions in this important group, we investigated associations among self-efficacy, male rape myth acceptance, devaluation of emot...

This study used a longitudinal research design to examine the impact of predeployment stressors and deployment-related sexual stressors on self-reported psychiatric symptoms of U.S. National Guard soldiers returning from deployments to Iraq or Afghanistan. Prior to deployment, participants completed measures of depression and posttraumatic stress s...

Emerging data suggest that few veterans are initiating prolonged exposure (PE) and cognitive processing therapy (CPT) and dropout levels are high among those who do start the therapies. The goal of this study was to use a large sample of veterans seen in routine clinical care to 1) report the percent of eligible and referred veterans who (a) initia...

The goal of this study was to examine the bidirectional relationship of sleep and pain to determine whether changes in sleep complaints over the course of a chronic pain treatment trial predict pain outcomes and vice versa, controlling for changes in depression and anxiety. Data were analyzed from a 12-month randomized, controlled trial that tested...

There is limited understanding of the etiology and temporal relations of chronic pain, sleep complaints, and depression/anxiety. Several models have been proposed by which sleep disruption represents a common mechanism for the comorbidity of these symptoms. The goals of this study were to (a) clarify the boundaries of these domains and (b) examine...

Background Estimates of the prevalence of mild traumatic brain injury (mTBI) among military personnel and combat veterans rely almost exclusively on retrospective self-reports; however, reliability of these reports has received little attention. Aims To examine the consistency of reporting of mTBI over time and identify factors associated with inco...

Families are a key source of support for National Guard Soldiers, yet little is known about the influence of parents on Soldiers’ pre-deployment well-being. In this chapter, we examine the potential role family may play in the psychological well-being of National Guard Soldiers. We present initial findings from the Readiness and Resilience in Natio...

Mobile health (mHealth) refers to the use of mobile technology (e.g., smartphones) and software (i.e., applications) to facilitate or enhance health care. Several mHealth programs act as either stand-alone aids for Veterans with post-traumatic stress disorder (PTSD) or adjuncts to conventional psychotherapy approaches. Veterans enrolled in a Vetera...

Despite efforts to increase the availability of prolonged exposure therapy (PE) within the Department of Veterans Affairs, little is known about the acceptability of PE among veteran populations. We queried a sample of 58 U. S. National Guard Iraq War veterans previously deployed to combat who screened positive for posttraumatic stress disorder (PT...

Background Anonymous survey methods appear to promote greater disclosure of sensitive or stigmatizing information compared to non-anonymous methods. Higher disclosure rates have traditionally been interpreted as being more accurate than lower rates. We examined the impact of 3 increasingly private mailed survey conditions—ranging from potentially i...

To estimate the cumulative incidence of sexual assault during the time of Gulf War I among male Gulf War I Veterans who later applied for Department of Veterans Affairs (VA) post-traumatic stress disorder disability benefits and to identify potential risk and protective factors for sexual assault within the population. Mailed, national, cross-secti...

This study examined in a college sample and a sample of non-treatment-seeking, trauma-exposed veterans the association between the MMPI-2 Restructured Form (MMPI-2-RF) Personality Psychopathology Five (PSY-5) Scales and DSM-5 Section 2 personality disorder (PD) criteria, the same system used in DSM-IV-TR, and the proposed broad personality trait di...

Although women in the military are exposed to combat and its aftermath, little is known about whether combat as well as pre-deployment risk/protective factors differentially predict post-deployment PTSD symptoms among women compared to men. The current study assesses the influence of combat-related stressors and pre-deployment risk/protective facto...

Because post-traumatic stress disorder (PTSD) by definition can occur only after exposure to a traumatic event, military veterans who are at high risk for trauma exposure are a particularly relevant population for studying the interaction of trauma with genetic factors that may predispose for the disorder. A number of studies have implicated specif...

Reports an error in "Does Cynicism Play a Role in Failure to Obtain Needed Care? Mental Health Service Utilization Among Returning U.S. National Guard Soldiers" by Paul A. Arbisi, Laura Rusch, Melissa A. Polusny, Paul Thuras and Christopher R. Erbes (Psychological Assessment, Advanced Online Publication, Apr 1, 2013, np). In the article, the copyri...