Tracy Simpson - Academia.edu (original) (raw)

Papers by Tracy Simpson

Public reporting burden for this collection of information is estimated to average 1 hour per res... more Public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing this collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0704-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ADDRESS. 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF ABSTRACT 18. NUMBER OF PAGES 19a. NAME OF RESPONSIBLE PERSON

npj Primary Care Respiratory Medicine, Apr 24, 2022

Because they provide data on responsiveness to experimental manipulation, clinical trials involvi... more Because they provide data on responsiveness to experimental manipulation, clinical trials involving mindfulness-based interventions are a source of evidence for the construct validity of self-report measures of mindfulness. Within-group and between-group changes in mindfulness were examined from randomized clinical trials comparing mindfulness interventions to other bona fide treatment comparison conditions or waitlist control conditions. We also examined changes in clinical outcomes and the magnitude of these changes relative to changes in mindfulness. We included 69 published studies representing 55 unique samples (n = 4,743). Self-report mindfulness measures showed relatively larger gains in mindfulness intervention conditions vis-à-vis waitlist comparison conditions at both post-treatment (effect size [ES] = 0.52, 95% CI [0.40, 0.64]) and follow-up (ES = 0.52 [0.20, 0.84]), although the effect at followup diminished to non-significance in a trim-and-fill analysis intended to account for publication bias (ES = 0.35 [-0.03, 0.72]). Measures of mindfulness also showed relatively larger gains in mindfulness intervention conditions vis-à-vis bona fide comparison conditions, but only at post

npj Primary Care Respiratory Medicine, Feb 15, 2022

Patients who receive earlier treatment for acute exacerbations of chronic obstructive pulmonary d... more Patients who receive earlier treatment for acute exacerbations of chronic obstructive pulmonary disease (COPD) have a better prognosis, including earlier symptom resolution and reduced risk of future emergency-department visits (ED) or hospitalizations. However, many patients delay seeking care or do not report worsening symptoms to their healthcare provider. In this study, we aimed to understand how patients perceived their breathing symptoms and identify factors that led to seeking or delaying care for an acute exacerbation of COPD. We conducted semistructured interviews with 60 individuals following a recent COPD exacerbation. Participants were identified from a larger study of outpatients with COPD by purposive sampling by exacerbation type: 15 untreated, 15 treated with prednisone and/or antibiotics in the outpatient setting, 16 treated in an urgent care or ED setting, and 14 hospitalized. Data were analyzed using inductive content analysis. Participants were primarily male (97%) with a mean age of 69.1 ± 6.9 years, mean FEV 1 1.42 (±0.63), and mean mMRC dyspnea of 2.7 (±1.1). We identified 4 primary themes: (i) access and attitudinal barriers contribute to reluctance to seek care, (ii) waiting is a typical response to new exacerbations, (iii) transitioning from waiting to care-seeking: the tipping point, and (iv) learning from and avoiding worse outcomes. Interventions to encourage earlier care-seeking for COPD exacerbations should consider individuals' existing self-management approaches, address attitudinal barriers to seeking care, and consider health-system changes to increase access to non-emergent outpatient treatment for exacerbations.

Influential psychological theories hypothesize that people consume alcohol in response to the exp... more Influential psychological theories hypothesize that people consume alcohol in response to the experience of both negative and positive emotions. Despite two decades of daily diary and ecological momentary assessment research, it remains unclear whether people consume more alcohol on days they experience higher negative and positive affect in everyday life. In this preregistered meta-analysis, we synthesized the evidence for these daily associations between affect and alcohol use. We included individual participant data from 69 studies (N = 12,394), which used daily and momentary surveys to assess affect and the number of alcoholic drinks consumed. Results indicate that people are not more likely to drink on days they experience high negative affect, but are more likely to drink and drink heavily on days high in positive affect. People self-reporting a motivational tendency to drink-to-cope and drink-to-enhance consumed more alcohol, but not on days they experienced higher negative a...

Drug and Alcohol Dependence

OBJECTIVE Proportionally more women use online alcohol interventions but also report less robust ... more OBJECTIVE Proportionally more women use online alcohol interventions but also report less robust treatment outcomes compared to men. Less is known about outcome disparities among veteran women, who are a growing demographic nationally. The current study examined gender differences among returning veteran men and women who used VetChange, a web-based intervention for hazardous drinking and posttraumatic stress symptoms (PTSS). METHOD Using data from a nationwide implementation study of returning combat veterans (n = 222), we performed hierarchical linear modeling to examine gender differences in alcohol and PTSS outcomes over six months following VetChange registration. Additional analyses examined gender differences in proportional changes in hazardous drinking and at each assessment point. RESULTS Returning veterans reported significant decreases in alcohol use and PTSS over time, yet men evidenced significantly greater reduction in average weekly drinks and drinks per drinking day compared to women. Follow up analyses indicated that women were significantly less likely than men to achieve low-risk drinking by one month post-registration. Proportional change in alcohol use yielded marginal and non-significant trends that were, nonetheless, consistent with the overall pattern of gender differences. CONCLUSION These results contribute to emerging literature suggesting that women use online alcohol use interventions at proportionately higher rates than do men, but do not reduce their drinking as much as men. There are a number of potential content changes that could improve outcomes for returning veteran women using online interventions, and data-driven adaptations based on stakeholder input are recommended.

JAMA Network Open, 2021

IMPORTANCE Additional options are needed for treatment of posttraumatic stress disorder (PTSD) am... more IMPORTANCE Additional options are needed for treatment of posttraumatic stress disorder (PTSD) among veterans. OBJECTIVE To determine whether group loving-kindness meditation is noninferior to group cognitive processing therapy for treatment of PTSD.

Military Behavioral Health, 2019

Although the 9/11 GI Bill gives veterans access to educational benefits, many return from deploym... more Although the 9/11 GI Bill gives veterans access to educational benefits, many return from deployment with physical and psychological challenges that may impede academic success. The current study assessed veteran and nonveteran students reports of alcohol misuse and psychiatric symptoms. The study sought to examine how identifying as a veteran and/or a college student might influence the relationship between veteran status and alcohol and psychiatric symptoms. Participants were 184 veteran and 201 nonveteran students, who completed measures of alcohol use and problems, posttraumatic stress disorder (PTSD), generalized anxiety, depression symptoms, and identification with college student and veteran identities. Veterans were less likely to identify with typical college students compared to nonveterans. There were no significant differences in alcohol use, consequences, or PTSD symptoms between veteran and nonveteran students. However, veteran status was associated with lower scores on measures of depression and anxiety. Interestingly, identification with typical students was associated with lower scores on all measures of mental health symptoms. Moderation analyses suggests that higher identification with typical college student identity was associated with fewer PTSD symptoms particularly among veterans. Identification with typical students may be associated with fewer mental health symptoms among college students, particularly veterans returning to college.

American Jails, 2003

, the King County North Rehabilitation Facility (NRF) cautiously opened its doors to a meditation... more , the King County North Rehabilitation Facility (NRF) cautiously opened its doors to a meditation program for inmates. NRF, located just north of Seattle, Washington, was already committed to a rich menu of offender change programs and services. Most of the 273 "long-term" inmates at NRF were recidivists characterized by significant involvement with alcohol and other drugs, and often, with one or more co-occurring mental disorder as well. Today, meditation often has esoteric or "new age" connotations, but the meditation course initiated at NRF, Vipassana meditation, is not a religious or mystical practice, not a relaxation technique or an escape from reality. Vipassana meditation, as taught by instructor S.N. Goenka and assistant teachers under his direction, is a systematic process of mental training and ethical conduct in which sustained self-observation leads to increased awareness, self-control, and inner balance (Hart, 1987). The Vipassana meditation course is offered free of charge by well-qualified volunteer teachers and course assistants in communities all over North America and throughout the world. To be successful in a correctional context, it takes a serious commitment from both the inmate and the penal institution. The Vipassana meditation course requires ten continuous days of intensive meditation training in a selfcontained area segregated from the main jail population in which inmates and volunteer teachers observe a rigorous schedule of eleven hours per day of meditation practice and a code of moral conduct, and are taught a method of mind training they can practice the rest of their lives (see American Jails Magazine article, July/August 1999). After considerable planning and preparation, Vipassana meditation courses were held at NRF every three to four months from November 1997 through August 2002 using multipurpose program space. In total, 20 courses were conducted at the facility. Total start-up costs were minimal, and the largest ongoing expense was for additional hours of security coverage for the ten-day period of the course. The Vipassana meditation courses at NRF were successfully implemented due to model collaboration between security, program, and food services personnel. A vegetarian menu for courses was developed that required no additional staffing to prepare and serve. Program classroom and office space was modified for rapid conversion to residential use by meditating inmates. Procedures for course setup (security clearing and training volunteers, notifying health services and classification units, risk management protocols, inmate orientation, etc.) became routine over time. In order to evaluate the outcome of the Vipassana program on post-release criminal behavior, the NRF Programs Manager completed the Vipassana Recidivism Study (Murphy, 2002) which included data collected from courses one through eight. The study consisted of a two-year criminal history pre-program review and a two-year recidivism post-program review. The sample size of Vipassana course completers for this study was small (n = 75), and NRF did not have the resources to review recidivism data outside King County. Nonetheless, this study provided valuable baseline information that led to the awarding of a two-year research grant from the National Institutes of Health to the University of Washington to study the effects of the Vipassana meditation program at NRF on alcohol and drug relapse and recidivism. Final outcome results from the recidivism study (Murphy, 2002) revealed that approximately half (56%) of the inmates completing a Vipassana course at NRF recidivated as measured by returning to King County Jail (KCJ) custody within two years, compared with a 75% rate of recidivism in a NRF General Population Study (Murphy, 2000; n = 437). Moreover, the average number of bookings for Vipassana course completers declined from 2.9 pre-program to 1.5 post-program. Fifty-four percent of women who completed the course returned to KCJ, as compared to 57% of men. This is remarkable given that the criminal histories and presenting problems were more severe for women than men admitted to NRF.

PLOS ONE, Nov 29, 2022

Objective To compare a Posttraumatic Stress Disorder (PTSD) treatment (Cognitive Processing Thera... more Objective To compare a Posttraumatic Stress Disorder (PTSD) treatment (Cognitive Processing Therapy; CPT), an Alcohol Use Disorder (AUD) treatment (Relapse Prevention; RP), and assessment-only (AO) for those meeting diagnostic criteria for both PTSD and AUD. Method Participants with current PTSD/AUD (N = 101; mean age = 42.10; 56% female) were initially randomized to CPT, RP, or AO and assessed post-treatment or 6-weeks post-randomization (AO). AO participants were then re-randomized to CPT or RP. Follow-ups were at immediate post-treatment, 3-, and 12-months. Mixed effects intent-to-treat models compared conditions on changes in PTSD symptom severity, drinking days, and heavy drinking days. Results At post-treatment, participants assigned to CPT showed significantly greater improvement than those in AO on PTSD symptom severity (b =-9.72, 95% CI [-16.20,-3.23], d = 1.22);

Alcohol: Clinical and Experimental Research

Journal of Racial and Ethnic Health Disparities

Objective Evaluate suicide attempt prevalence and potentially related sociodemographic and psychi... more Objective Evaluate suicide attempt prevalence and potentially related sociodemographic and psychiatric factors among racial and ethnic groups. Methods Between 2012 and 2013, the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III) conducted semi-structured interviews with 36,309 adults in the USA. We identified lifetime suicide attempt prevalence and significant predictors for each racial/ethnic group using stratified logistic regressions. Analyses were exploratory without a priori hypotheses. Results Asian/Native Hawaiian/other Pacific Islander and Black individuals had the lowest prevalence of suicide attempts while Alaska Native/American Indian and White individuals had the highest prevalence. Identifying as female and meeting criteria for psychiatric diagnoses featuring mood regulation difficulties (depression, borderline personality disorder, bipolar I disorder) were consistently related to a suicide attempt history across racial and ethnic groups, whereas substance abuse disorders and other sociodemographic factors differed between racial and ethnic groups in their associations with suicide attempt history. Conclusions Although several factors were consistently related to suicide risk across racial and ethnic groups, the prevalence of suicide attempts and overall pattern of related factors were not uniform between racial and ethnic groups. Policy Implications Study findings highlight the importance of considering suicide risk within the context of race and ethnicity both regarding the overall prevalence of risk and in determining personal factors associated with elevated risk. A failure to appreciate experiences related to race and ethnicity may adversely impact suicide risk assessment and treatment, ultimately contributing to health disparities. Results suggest that additional research is warranted.

This therapist manual was prepared in the public domain as part of a treatment development

Pharmacology Biochemistry and Behavior, 2021

BACKGROUND Regular alcohol consumption is on the rise among older adults and has the potential of... more BACKGROUND Regular alcohol consumption is on the rise among older adults and has the potential of altering the subjective experience of pain and response to pain medications. This study examined the cognitive, analgesic and side effect response to oxycodone in middle age and older adults with elevated levels of customary alcohol consumption in a human laboratory setting. METHODS After refraining from alcohol for one day, eligible participants underwent baseline assessment cognition and side effects by means of questionnaires that were repeated at three time points (90 min, 5 and 8 h) following administration of a 10 mg oral dose of oxycodone. Response to pain stimulus (Cold Pressor Test (CPT)), pupil size, and plasma oxycodone were also measured. RESULTS One hundred twenty-eight adults (age 35-85) completed the study day. Compared to those with lower customary alcohol consumption, participants with elevated alcohol consumption showed attenuated opioid-induced pupil constriction and cognitive decline on objective measures of working memory, sustained attention, inhibitory control, coordination on a simulated driving task, and subjective dysphoric effects with enhanced subjective euphoric effects. Oxycodone pharmacokinetics, pain tolerance to CPT, and Berg balance were impacted comparably between alcohol consumption groups. Women endorsed greater negative drug effects, whereas men endorsed positive drug effects. CONCLUSION Independent of subject's age, elevated customary alcohol consumption attenuates opioid central effects (i.e., pupil miosis, impaired cognition) and gender influences subjective drug effects. Clinicians should consider alcohol consumption and gender when prescribing opioid medications.

Journal of Consulting and Clinical Psychology, 2021

OBJECTIVE Scalable, efficiently delivered treatments are needed to address the needs of women Vet... more OBJECTIVE Scalable, efficiently delivered treatments are needed to address the needs of women Veterans with PTSD. This randomized clinical trial compared an online, coach-assisted cognitive behavioral intervention tailored for women Veterans with PTSD to phone monitoring only. METHOD Women Veterans who met diagnostic criteria for PTSD were randomized to an 8-week web-based intervention, called DElivery of Self TRaining and Education for Stressful Situations (DESTRESS)-Women Veterans version (WV), or to phone monitoring only (N = 102). DESTRESS-WV consisted of online sessions and 15-min weekly phone calls from a study coach. Phone monitoring included 15-min weekly phone calls from a study coach to offer general support. PTSD symptom severity (PTSD Symptom-Checklist-Version 5 [PCL-5]) was evaluated pre and posttreatment, and at 3 and 6 months posttreatment. RESULTS More participants completed phone monitoring than DESTRESS-WV (96% vs. 76%, p = 0.01), although treatment satisfaction was significantly greater in the DESTRESS-WV condition. We failed to confirm the superiority of DESTRESS-WV in intent-to-treat slope changes in PTSD symptom severity. Both treatments were associated with significant reductions in PTSD symptom severity over time. However, post hoc analyses of treatment completers and of those with baseline PCL ≥ 33 revealed that the DESTRESS-WV group had greater improvement in PTSD symptom severity relative to phone monitoring with significant differences at the 3-month follow-up assessment. CONCLUSIONS Both DESTRESS-WV and phone monitoring resulted in significant improvements in women Veterans' PTSD symptoms. DESTRESS-WV may be an appropriate care model for women Veterans who can engage in the demands of the treatment and have higher baseline symptoms. Future research should explore characteristics of and the methods of reliably identifying women Veterans who are most likely to benefit. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

American Journal of Health Promotion, 2020

Purpose: Veterans with post-traumatic stress disorder (PTSD) lose less weight in the Veterans Aff... more Purpose: Veterans with post-traumatic stress disorder (PTSD) lose less weight in the Veterans Affairs (VA) weight management program (MOVE!), so we developed MOVE!+UP. Design: Single-arm pre–post pilot to iteratively develop MOVE!+UP (2015-2018). Setting: Veterans Affairs Medical Center. Participants: Overweight Veterans with PTSD (5 cohorts of n = 5-11 [N = 44]; n = 39 received ≥1 MOVE+UP session, with cohorts 1-4 [n = 31] = “Development” and cohort 5 [n = 8] = “Final” MOVE!+UP). Intervention: MOVE!+UP weight management for Veterans with PTSD modified after each cohort. Final MOVE!+UP was coled by a licensed clinical psychologist and Veteran peer counselor in 16 two-hour in-person group sessions and 2 individual dietician visits. Sessions included general weight loss support (eg, behavioral monitoring with facilitator feedback, weekly weighing), cognitive-behavioral skills to address PTSD-specific barriers, and a 30-minute walk to a nearby park. Measures: To inform post-cohort modi...

Innovation in Aging, 2019

Chronic unhealthy levels of alcohol use, may predispose adults to use illicit substances and/or m... more Chronic unhealthy levels of alcohol use, may predispose adults to use illicit substances and/or modify their response to prescribed medications, such as pain medications. We examined the cognitive and side effect response of older adults who met criteria for healthy and unhealthy alcohol drinking patterns after exposure to 10mg of oxycodone. Using a human laboratory model, eligible participants were characterized on cognitive, side effect measures and cold-pressor pain test (CPT) at baseline and repeated 90 minutes, 3 and 5 hours post dosing (10mg oxycodone). Blood samples were taken at regular intervals to measure drug levels. One-hundred twenty-five adults completed the study day, eighty participants with heavy alcohol consumption and 45 with healthy. Middle age (MA) group had a mean age of 51 (11.2) years, older adults (OA) 72 (4.2) years. Between group (unhealthy vs healthy drinkers, middle age vs older adult) comparisons for cognitive performance indicate a significant decline ...

Preventive Medicine Reports, 2019

Posttraumatic stress disorder (PTSD) is a risk factor for cardiovascular disease (CVD) and diabet... more Posttraumatic stress disorder (PTSD) is a risk factor for cardiovascular disease (CVD) and diabetes. Dedert and colleagues hypothesized a model whereby PTSD leads to poor health behaviors, depression, and pre-clinical disease markers, and that these factors lead to CVD and diabetes (Ann Behav Med, 2010, 61-78). This study provides a preliminary test of that model. Using data from a mailed cross-sectional survey conducted 2012-2013, path analysis was conducted among N = 657 with complete demographic data. We first analyzed the hypothesized model, followed by four alternatives, to identify the best-fitting model. The alternate model that specified pathways from depression to health behaviors had the best fit. Contrary to hypotheses, higher PTSD symptoms were associated with better physical activity and diet quality. Of the specific indirect pathways from PTSD to Body Mass Index (BMI), only the path through depression was significant. Higher depression symptoms were significantly associated with less physical activity, poorer diet, and greater likelihood of smoking. In addition, the specific indirect effect from depression to BMI through physical activity was significant. Current smoking and higher BMI were associated with greater likelihood of diabetes, and hypertension was associated with greater likelihood of CVD. PTSD symptoms may increase risk for CVD and diabetes through the negative impact of depression on health behaviors and BMI. With or without PTSD, depression may be an important target in interventions targeting cardiovascular and metabolic diseases among veterans.