Alan L. Peterson's research while affiliated with University of Texas Health Science Center at San Antonio and other places

Publications (65)

Article
Objective: This study evaluated implicit associations (i.e., associations in memory that are automatically activated and difficult to control consciously) related to trauma and one's self in the context of a clinical trial for active duty service members seeking treatment for posttraumatic stress disorder (PTSD). Previous studies with nontreatment...
Article
Full-text available
Prolonged exposure therapy (PE) is an efficacious treatment for active duty service members and veterans with posttraumatic stress disorder (PTSD). However, PE is sometimes associated with high dropout rates, limited tolerability, and temporary symptom exacerbation during treatment. Stellate ganglion blocks (SGBs) are an emerging treatment that has...
Article
This study examined the impact of a history of head injury (HHI) on posttraumatic stress disorder (PTSD) and depression symptoms in active duty military personnel following group and individual cognitive processing therapy (CPT). Data for these secondary analyses were drawn from a clinical trial comparing group and individual CPT. Service members (...
Article
Study Objectives The aim of this study was to characterize the sleep disorders of insomnia, obstructive sleep apnea (OSA), and comorbid insomnia and OSA (COMISA) in active duty military personnel. Methods Prospective observational study of 309 military personnel with a mean age of 37.17 years (SD = 7.27). Participants served in 4 branches of the U...
Article
Purpose Military service personnel are at increased risk for developing tinnitus due to heightened exposure to acoustic trauma. The auditory disorder is the leading service-connected disability among veterans and is highly comorbidly diagnosed with posttraumatic stress disorder (PTSD). The biopsychosocial model illustrates that chronic health condi...
Article
Introduction Prolonged exposure therapy is an effective treatment for posttraumatic stress disorder that is underutilized in health systems, including the military health system. Organizational barriers to prolonged exposure implementation have been hypothesized but not systematically examined. This multisite project sought to identify barriers to...
Article
Objective To evaluate the effects of interdisciplinary pain management on pain-related disability and opioid reduction in polymorbid pain patients with two or more comorbid psychiatric conditions. Design Two-arm randomized clinical trial testing a three-week intervention with assessments at pre-treatment, post-treatment, 6-month and 12-month follo...
Article
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 cha...
Article
There is acknowledgment that deployments can be stressful for military spouses; however, less is known about their experiences post-deployment. This qualitative study examined the post-deployment experiences of 16 female spouses, whose active duty Army husband had returned from deployment within the previous 2 years and who had a young child during...
Article
Tics peak in late childhood and decline during adolescence. Yet, for some with Tourette’s disorder (TD), tics persist into adulthood. We evaluated childhood predictors of adult tic severity and tic impairment, and change over time. Eighty adolescents/adults were evaluated 11 years following a randomized-controlled trial of behavior therapy. An inde...
Article
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Importance: Posttraumatic headache is the most disabling complication of mild traumatic brain injury. Posttraumatic stress disorder (PTSD) symptoms are often comorbid with posttraumatic headache, and there are no established treatments for this comorbidity. Objective: To compare cognitive behavioral therapies (CBTs) for headache and PTSD with tr...
Article
Objective: A common concern is whether individuals with posttraumatic stress disorder (PTSD) and hazardous drinking will respond to PTSD treatment or need a higher dose. In a sample of active-duty military, we examined the impact of hazardous drinking on cognitive processing therapy (CPT) outcomes and whether number of sessions to reach good end-s...
Article
Objective: Prolonged exposure (PE) therapy is a first-line posttraumatic stress disorder (PTSD) treatment, but the manualized 90-min session format constitutes a barrier to adopting PE in most settings because they use 60-min sessions for scheduling and billing. We examined whether 60-min PE sessions were as effective and efficient as 90-min PE se...
Article
Despite significant treatment advances, many military veterans continue to suffer from posttraumatic stress disorder ( PTSD ) and associated symptoms, suggesting a need for new interventions. This pilot trial examined the change in psychological symptoms of 19 veterans in treatment for PTSD who were randomized either to adopt a dog immediately from...
Article
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Despite established efficacy, there is low engagement in prolonged exposure (PE) therapy for PTSD among combat veterans. In preparation for a full-scale randomized trial, we sought to evaluate the feasibility, safety, and preliminary efficacy of quetiapine to enhance patient engagement in PE therapy. Open-label, randomized pilot trial of quetiapine...
Article
Background Posttraumatic stress disorder (PTSD) is heritable and a potential consequence of exposure to traumatic stress. Evidence suggests that a quantitative approach to PTSD phenotype measurement and incorporation of lifetime trauma exposure (LTE) information could enhance the discovery power of PTSD genome-wide association studies (GWAS). Meth...
Article
The theoretical framework of behavioral economics, a metatheory that integrates operant learning and economic theory, has only recently been applied to posttraumatic stress disorder (PTSD). A behavioral economic theory of PTSD reflects an expansion of prior behavioral conceptualization of PTSD, which described PTSD in terms of respondent and operan...
Article
Reports an error in "The effects of web-prolonged exposure among military personnel and veterans with posttraumatic stress disorder" by Carmen P. McLean, Edna B. Foa, Katherine A. Dondanville, Christopher K. Haddock, Madeleine L. Miller, Sheila A. M. Rauch, Jeffery S. Yarvis, Edward C. Wright, Brittany N. Hall-Clark, Brooke A. Fina, Brett T. Litz,...
Article
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Pragmatic trials testing the effectiveness of interventions under “real world” conditions help bridge the research-to-practice gap. Such trial designs are optimal for studying the impact of implementation efforts, such as the effectiveness of integrated behavioral health clinicians in primary care settings. Formal pragmatic trials conducted in inte...
Article
Objective: Tinnitus and posttraumatic stress disorder (PTSD) are among the top service-connected disabilities within the Veterans Health Administration. Extant research shows that there is considerable overlap between tinnitus-related distress and PTSD, including sleep difficulty, irritability, hyperarousal, and concentration problems. However, no...
Article
Study objectives: Characterize associations between sleep impairments and posttraumatic stress disorder (PTSD) symptoms, including anger, in service members seeking treatment for PTSD. Methods: Ninety-three US Army personnel recruited into a PTSD treatment study completed the baseline assessment. State of the science sleep measurements included...
Article
The aims of this study were to identify self-reported point-prevalence rates of concerns about relationship mistreatment, emotional abuse, and physical abuse among military medical personnel and to evaluate demographic and military risk factors associated with these concerns. Participants (N = 721) were U.S. Air Force military medical personnel (61...
Article
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Irritability, angry outbursts, and aggression are common among individuals with posttraumatic stress disorder (PTSD). Although aggression can be a problem among many individuals with PTSD, research suggests that the relationship between PTSD and aggression might be particularly relevant among military/veteran populations as compared to civilians. T...
Article
Objective: Web-based prolonged exposure therapy (Web-PE) has potential to increase the reach of effective posttraumatic stress disorder (PTSD) treatment. While there is initial support for the efficacy of Web-PE, no studies have examined the perceptions and experiences of participants receiving PE in this novel, Web based format. Method: We used...
Article
This study tested the efficacy of repeated intravenous ketamine doses to reduce symptoms of posttraumatic stress disorder (PTSD). Veterans and service members with PTSD (n = 158) who failed previous antidepressant treatment were randomized to 8 infusions administered twice weekly of intravenous placebo (n = 54), low dose (0.2 mg/kg; n = 53) or stan...
Article
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Abstract Background Trauma-focused psychotherapies for combat-related posttraumatic stress disorder (PTSD) in military veterans are efficacious, but there are many barriers to receiving treatment. The objective of this study was to determine if cognitive processing therapy (CPT) for PTSD among active duty military personnel and veterans would resul...
Article
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Importance Posttraumatic stress disorder (PTSD) occurs more commonly among military service members than among civilians; however, despite the availability of several evidence-based treatments, there is a need for more efficient evidence-based PTSD treatments to better address the needs of service members. Written exposure therapy is a brief PTSD i...
Article
The purpose of this pilot study was to determine if the efficacy of imaginal exposure for symptoms of posttraumatic stress disorder (PTSD) could be improved by adding aerobic exercise. We hypothesized that aerobic exercise would enhance the efficacy of exposure therapy. Active duty service members with clinically significant symptoms of posttraumat...
Article
It has been 20 years since the September 11, 2001 terrorist attacks on America. The ongoing military conflicts in this region are the longest sustained conflicts in U.S. history. Almost 3 million military personnel have deployed, with over 7,000 fatalities and more than 53,000 wounded in action. The most common psychological health condition associ...
Article
Cognitive-behavioral conjoint therapy (CBCT) for posttraumatic stress disorder (PTSD) has demonstrated efficacy for improving PTSD and comorbid symptoms and relationship adjustment. To enhance treatment efficiency and scalability, we developed a 2-day, abbreviated, intensive, multicouple group version of CBCT for PTSD (AIM-CBCT for PTSD). Prior wor...
Article
Soumoff et al. (2021) reported on a sample of 2,217 injured military service members and found that somatic symptom severity was more predictive of the development of probable posttraumatic stress disorder (PTSD) symptoms than injury severity. PTSD has been described as one of the invisible wounds of war, suggesting that many military service membe...
Article
Objective: The primary aims of this study were to identify latent profiles of acute stress disorder (ASD) symptoms and to evaluate postconcussive symptom differences across the identified profiles as measured by the Acute Stress Disorder Scale and the Military Acute Concussion Evaluation, respectively. Method: Participants (N = 315) in the curre...
Article
Objective: Previous research with civilian populations has found strong associations between fibromyalgia (FM) and posttraumatic stress disorder (PTSD). This study is the first large-scale investigation of the prevalence of FM in military service members with and without PTSD. Methods: Participants were active duty military recruited into either...
Article
Objective: Failing to account for temporal dynamics can hinder our understanding of suicidal ideation and the potential mechanisms underlying increased risk for suicide death and suicide attempts associated with posttraumatic stress disorder (PTSD). To address these limitations, this study used an analytic approach based on Dynamical Systems Theor...
Article
Psychiatric aeromedical evacuations are one of the leading causes of medical related evacuations of US military personnel from combat. Currently, no studies have examined gender and marital status of individuals who were evacuated from combat for a psychiatric diagnosis. Psychiatric aeromedical evacuation data from 5,957 United States military pers...
Article
The STRONG STAR Consortium (South Texas Research Organizational Network Guiding Studies on Trauma and Resilience) and the Consortium to Alleviate PTSD are interdisciplinary and multi-institutional research consortia focused on the detection, diagnosis, prevention, and treatment of combat-related posttraumatic stress disorder (PTSD) and comorbid con...
Article
Background and objectives: Behavioral therapies such as the Comprehensive Behavioral Intervention for Tics (CBIT) are recommended as the first-line treatment for Tourette's Disorder. This treatment approach is comprised of three central components: habit reversal training, functional assessment/intervention, and relaxation training. Despite its co...
Article
Studies of active duty service members have shown that military personnel who screen positive for posttraumatic stress disorder (PTSD) are more than twice as likely to make a suicide attempt. Evidence-based PTSD treatments can reduce suicidal ideation; however, it can be challenging to provide evidence-based, trauma-focused, PTSD treatment to high-...
Article
Objective To determine the long-term durability of behavior therapy for tics among youth with Tourette’s disorder and persistent (chronic) motor or vocal tic disorders. Method Eighty of the 126 youth who participated in a randomized controlled trial of behavior therapy 11 years prior were recruited for this longitudinal follow-up. Consenting parti...
Article
Patients with posttraumatic stress disorder (PTSD) are at an elevated risk of suicide. For patients hospitalized for suicide risk, psychosocial treatment and stabilization are routinely offered; however, the availability of evidence-based, manualized therapeutic interventions for PTSD is sparse. Typically, the short duration of hospitalization make...
Article
Objective: To characterize the relationship between head trauma types (blast injury, blunt injury, combined blast+blunt injury) with subsequent headache presentations and functioning. Background: Posttraumatic headaches (PTHs), the most common sequelae of traumatic brain injury (TBI), are painful and disabling. More than 400,000 veterans report...
Preprint
Full-text available
Background The limited efficacy of first-line treatment of posttraumatic stress disorder (PTSD) with selective serotonergic reuptake inhibitors commonly leads to the use of multiple medications that still fail to achieve symptomatic remission. VA/DOD guidelines identify trauma-focused psychotherapies as the evidence-based treatment for PTSD, but ov...
Article
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Background Although there has been research connecting PTSD and social support, there has been little research on effects of treatment, especially in military samples. The current study examined the relationship between these variables over the course of PTSD treatment and assessed differences based on treatment modality (i.e. group versus individu...
Article
Full-text available
Although prolonged exposure (PE) has been identified as a first-line treatment for posttraumatic stress disorder (PTSD), research has found that military service members and veterans have smaller reductions in symptom severity compared to civilians. The nature of trauma in a deployed combat setting and the unique complexities of military culture ha...
Article
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Little research regarding the influence of parental knowledge and attitudes about child development on parenting practices includes fathers. The wartime military provides a specific context for fathering with frequent separations, which may impact soldiers’ knowledge and attitudes about their young children’s development. The purpose of the current...
Article
Objective: Many clinicians question whether patients with a history of childhood trauma will benefit from trauma-focused treatment. In this secondary analysis, we examined whether reports of childhood abuse moderated the efficacy of cognitive processing therapy (CPT) for active-duty military with posttraumatic stress disorder (PTSD). Methods: Serv...
Article
Military service members and first responders experience significant trauma exposure in the line of duty. Service members who transition to first-responder positions may be at an increased risk for developing PTSD due to the cumulative effects of trauma exposure. A common criticism of the standard delivery methods for most evidence-based treatments...
Poster
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This poster examined various health and psychological disorders among military firefighters. To our knowledge, this is the first study to do so. Results indicated that incidence rates of Insomnia, Obstructive Sleep Apnea, PTSD, and Tinnitus drastically increased. Concurrently, moderate increases in incidence rates were seen in Adjustment Reactions,...
Article
Cognitive-behavioral conjoint therapy for posttraumatic stress disorder (CBCT for PTSD) is associated with improvements in patients' PTSD symptoms, partners' psychological distress, and relationship satisfaction. However, little is known about whether CBCT for PTSD is associated with changes in other relationship domains that have theoretical and c...
Article
Study objectives: Military personnel frequently experience sleep difficulties, but little is known regarding which military or life events most impact their sleep. The Military Service Sleep Assessment (MSSA) was developed to assess the impact of initial military training, first duty assignment, permanent change of station, deployments, redeployme...
Article
Behavior therapy is a first-line intervention for Tourette's Disorder (TD), and a key component is the practice of therapeutic skills between treatment visits (i.e., homework). This study examined the relationship between homework adherence during behavior therapy for TD and therapeutic outcomes, and explored baseline predictors of homework adheren...
Article
Cognitive Processing Therapy (CPT) is an evidence-based therapy recommended for posttraumatic stress disorder (PTSD). However, rates of improvement and remission are lower in veterans and active duty military compared to civilians. Although CPT was developed as a 12-session therapy, varying the number of sessions based on patient response has impro...
Chapter
Full-text available
Extensive research has been conducted since 11 September 2001 to develop and evaluate evidence-based treatments for combat-related posttraumatic stress disorder (PTSD) in active duty United States military personnel treated in the combat theater and in garrison. This chapter reviews the results of 20 PTSD clinical trials funded by the United States...
Article
Study objectives: Epidemiologic studies of obstructive sleep apnea (OSA) and insomnia in the U.S. military are limited. The primary aim of this study was to report and compare OSA and insomnia diagnoses in active duty United States military service members. Method: Data and service branch densities used to derive the expected rates of diagnoses...
Article
Full-text available
Objectives Several recent studies have demonstrated that posttraumatic stress disorder (PTSD) and insomnia treatments are associated with significant reductions in suicidal ideation (SI) among service members. However, few investigations have evaluated the manner in which suicide risk changes over time among military personnel receiving PTSD or ins...
Article
Full-text available
Posttraumatic headache (PTH) is a common debilitating condition arising from head injury and is highly prevalent among military service members and veterans with traumatic brain injury (TBI). Diagnosis and treatment for PTH is still evolving, and surprisingly little is known about the putative mechanisms that drive these headaches. This manuscript...
Article
Objective Treatment guidelines for Tourette's Disorder (TD) are based on patients' degree of tic severity and impairment. However, clear benchmarks for determining tic severity and impairment have not been established. This study examined benchmarks of tic severity and tic impairment using the Yale Global Tic Severity Scale (YGTSS) and the Clinical...
Article
Background Manualized cognitive and behavioral therapies are increasingly used in primary care environments to improve nonpharmacological pain management. The Brief Cognitive Behavioral Therapy for Chronic Pain (BCBT-CP) intervention, recently implemented by the Defense Health Agency for use across the military health system, is a modular, primary...
Article
Many individuals with posttraumatic stress disorder (PTSD) also suffer from insomnia and nightmares, which may be symptoms of PTSD or constitute partially independent comorbid disorders. Sleep disturbances are resistant to current treatments for PTSD, and those suffering from PTSD, insomnia, and nightmares have worse PTSD treatment outcomes. In add...
Article
Objective: Web-based treatments address many of the logistical and stigma-related barriers to in-person behavioral health care. Prior studies of web-based treatments for posttraumatic stress disorder (PTSD) did not employ gold-standard treatments and have not compared to in-person therapy. Method: We compared a web version of Prolonged Exposure...
Article
There is a strong comorbidity between Posttraumatic Stress Disorder (PTSD) and bipolar disorder. Unfortunately, there is lack of dissemination regarding modifications of evidence-based therapies for PTSD among individuals with comorbid bipolar I disorder. Cognitive Processing Therapy (CPT) is one such evidence-based, gold-standard psychotherapy for...
Chapter
This chapter discusses the symptoms, epidemiology, assessment, and treatment of combat-related post-traumatic stress disorder (PTSD) in active duty service members and veterans. Two treatment protocols for PTSD—prolonged exposure (PE) therapy and cognitive processing therapy (CPT)—have been identified as the treatments with the strongest scientific...

Citations

... Significant reductions in PTSD symptoms were seen in quetiapine group compared to TAU and 7 of the 9 quetiapine participants achieved PTSD remission. (Baig et al., 2021) These results suggest that it is possible to use quetiapine as an adjunct to help patients with PTSD to engage in trauma-focused therapy, even though they were initially resistant to such treatment and had several failed trials of standard psychopharmacologic treatment. Overall, this work suggests that psychosedation per se may not be necessary effect, but that medication enhancement of engagement and retention is. ...
... 24 This time action of d-methadone and the 6-h time boundary for obtaining the sustained positive therapeutic effect of its combination with MRUT suggests another interesting mechanism for the retrieval extinction that may depend on the NMDAR antagonism from d-methadone. Considering that NMDAR antagonists have certainly proven productive in depression and post-traumatic stress disorder, 25 it is interesting to develop more rapid and sustained extinction processes by combining other NMDAR antagonists with MRUP. ...
... of PTSD is another strategy that has recently been explored as an approach to overcome barriers related to material hardships or logistical barriers [64], yet may have other limitations (e.g., patient or clinician discomfort with the setting). Results of a randomized clinical trial showed that in-home treatment and telehealth treatment were more effective than treatment delivered in clinic [64]. ...
... Over the last two decades, significant advancements have been made in the treatment of posttraumatic stress disorder (PTSD) in active duty military personnel using trauma-focused psychotherapies (Peterson, 2021;. Prolonged exposure (PE) therapy is widely accepted as an evidence-based treatment for PTSD in active duty service members, often achieving 50%-70% symptom reduction . ...
... 25 Conversely, there are also reports suggesting that natural recovery from PTSD is more likely to occur in service members with physical wounds, as compared to the invisible wounds of war, because of the repeated conversations with friends, family, fellow service members, and healthcare providers that often occur after visible, physical injuries. 26 Fortunately, similar to the improvements in the case fatality rate for those physically injured in combat, there have also been advancements in the treatment of the psychological wounds of war such as combat-related PTSD. STRONG STAR has now supported over 25 PTSD clinical trials. ...
... The last several decades have witnessed a sharp, positive trajectory in suicide-related research, much of it with direct and important implications for day-to-day clinical practice (1). In particular, five identifiable domains of research are of importance for practicing clinicians, including recent work demonstrating: (a) the limited predictive value of traditional suicide risk scales (e.g., the Columbia Suicide Severity Rating Scale, C-SSRS) in real-world healthcare settings (2,3), (b) the temporal dynamics and natural variability of suicidal ideation and motivation to die across clinical and non-clinical populations [e.g., (4)(5)(6)(7)], (c) the importance of assessing constructs other than suicidal ideation that are convincingly linked to enduring risk or chronic vulnerability for suicide [e.g., (8)(9)(10)], (d) the importance of understanding and assessing the potential for poor individual adherence and cooperation with clinical care (8), and (e) the elegant utility of patients' expressed wish to live and wish to die, coupled with reasons for living and reasons for dying (11)(12)(13). Regardless of the clinician's preferred theoretical perspective or approach, findings across all five of these domains can easily and efficiently be integrated into the suicide risk assessment interview, with straightforward questions that carry very little time-burden for the clinician and/or patient, while potentially capturing data essential to efforts to accurately understand, assess and respond to suicide risk. ...
... STRONG STAR has now supported over 25 PTSD clinical trials. 1,2 The initial results of these trials documented that combatrelated PTSD could be successfully treated in about 50% of service members with trauma-focused, cognitive-behavioral therapies. Subsequent clinical trials by STRONG STAR have found even greater improvement and recovery rates in PTSD using cognitive behavioral therapies specifically tailored for the unique need of post-9/11 service members and veterans. ...
... Similar to the analyses conducted using the UKB-CARDIoGRAMplusC4D GWAS, there was evidence of significant heterogeneity in these associations (Supplementary Table 11), but the estimates were confirmed after the removal of the variant outliers (Supplementary Table 12). With regard to PTSD severity, there are two GWAS datasets not including MVP: a PCL-6 GWAS conducted in the UKB cohort and a PGC GWAS of a PTSD quantitative phenotype combining UKB PCL-6 with PTSD severity information from other cohorts [61]. To avoid sample overlap bias, the MR analyses were conducted testing CARDIoGRAMplusC4D CAD → UKB PCL-6 and ii) MVP CAD → PGC PTSD quantitative phenotype. ...
... Among 1,771 Army families that experienced child abuse and deployment between 2001 and 2004, instances of child maltreatment and neglect were higher during deployment (Gibbs et al., 2007). Although deployments stress relationships, they do not always lead to negative outcomes (see Moore et al., 2021). Rather, PTSD negatively contributes to how well couples adapt to the challenges of deployment (Allen et al., 2010). ...
... Crisis Response Planning was added to the standard WET protocol to address the suicidal ideations. Recruitment is ongoing for this study, but preliminary results appear quite promising [64]. ...