Kathleen Chard | University of Cincinnati (original) (raw)

Papers by Kathleen Chard

Research paper thumbnail of Hope as a change mechanism in the treatment of posttraumatic stress disorder

Psychological Trauma: Theory, Research, Practice, and Policy, 2012

Research exploring nonspecific mechanisms of change is necessary to understand processes that con... more Research exploring nonspecific mechanisms of change is necessary to understand processes that contribute to psychotherapy outcomes. Many veterans diagnosed with posttraumatic stress disorder (PTSD) report a profound sense of hopelessness prior to receiving treatment, and thus one possible nontargeted change mechanism is the enhancement of hope. In this study, 164 veterans diagnosed with PTSD and admitted to a Veteran's Administration residential treatment program received 6 weeks of cognitive processing therapy. Measures of PTSD symptoms, depression and hope were gathered across the course of treatment. Results revealed that higher levels of hope midway through treatment affected reductions in PTSD and depression from mid-to posttreatment (and not the other way around), thus supporting that hope is one nonspecific change mechanism toward symptom reduction. Implications of these findings as they extend to cognitive-behavior therapies as a whole, and to the understanding of how psychological strengths serve as nonspecific change mechanisms in the treatment of PTSD, conclude the article.

Research paper thumbnail of What Role Do Evidenced Based Treatments Play in Improving Quality of Life?

Research paper thumbnail of Effectiveness of Cognitive Processing Therapy for Male and Female U.S. Veterans With and Without Military Sexual Trauma

Journal of Traumatic Stress, 2015

Military sexual trauma (MST) affects approximately 2% and 36% of male and female veterans, respec... more Military sexual trauma (MST) affects approximately 2% and 36% of male and female veterans, respectively, (e.g., . Although the deleterious consequences of MST have been clearly established, few studies have explored treatment effectiveness for this population. Using archival data from a residential treatment program, the current study explored the effectiveness of cognitive processing therapy (CPT) in treating full or subthreshold posttraumatic stress disorder (PTSD) to compare U.S. veterans reporting an MST index trauma (MST-IT) to those without MST-IT. Of the 481 participants, 40.7% endorsed MST-IT. Multiway frequency analyses were utilized to compare men and women with and without MST on baseline demographic variables. Hierarchical linear models were constructed to investigate treatment outcome by MST status and sex. Results showed that 44.8%, 23.8%, and 19.6% of the variation in clinician-and self-reported PTSD and depression symptoms were explained by three models. Scores on all outcome measures significantly decreased over time for both groups. Additionally, women demonstrated a sharper decrease in PTSD symptoms over time than men. Lastly, men who reported MST-IT had higher PTSD symptoms than men without MST-IT on average. With no control group or random assignment, preliminary findings suggest residential treatment including CPT may be effective for MST-IT regardless of sex.

Research paper thumbnail of Couple Treatment for Alcohol Use Disorder and Posttraumatic Stress Disorder: Pilot Results From U.S. Military Veterans and Their Partners

Journal of Traumatic Stress, 2015

We studied 13 U.S. male military veterans and their female partners who consented to participate ... more We studied 13 U.S. male military veterans and their female partners who consented to participate in an uncontrolled trial of couple treatment for alcohol use disorder and posttraumatic stress disorder (CTAP). CTAP is a 15-session, manualized therapy, integrating behavioral couples therapy for alcohol use disorder (AUD) with cognitive-behavioral conjoint therapy for posttraumatic stress disorder (PTSD). Due to ineligibility (n = 1) and attrition (n = 3), 9 couples completed the study, and 7 completed 12 or more sessions. There were 8 veterans who showed clinically reliable pre- to posttreatment reduction of PTSD outcomes. There were also significant group-level reductions in clinician-, veteran-, and partner-rated PTSD symptoms (d = 0.94 to 1.71). Most veterans showed clinically reliable reductions in percentage days of heavy drinking. Group-level reduction in veterans' percentage days of heavy drinking was significant (d = 1.01). There were 4 veterans and 3 partners with clinically reliable reductions in depression, and group-level change was significant for veterans (d = 0.93) and partners (d = 1.06). On relationship satisfaction, 3 veterans and 4 partners had reliable improvements, and 2 veterans and 1 partner had reliable deterioration. Group-level findings were nonsignificant for veteran relationship satisfaction (d = 0.26) and for partners (d = 0.52). These findings indicate that CTAP may be a promising intervention for individuals with comorbid PTSD and AUD who have relationship partners.

Research paper thumbnail of Veteran satisfaction and treatment preferences in response to a posttraumatic stress disorder specialty clinic orientation group

Behaviour research and therapy, Jan 16, 2015

To maximize accessibility to evidence-based treatments for posttraumatic stress disorder (PTSD), ... more To maximize accessibility to evidence-based treatments for posttraumatic stress disorder (PTSD), the United States Department of Veterans Affairs (VA) has widely disseminated cognitive processing therapy (CPT) and prolonged exposure (PE) therapy to VA clinicians. However, there is a lack of research on veteran preferences when presented with a range of psychotherapy and medication options. This study uses a mixed-method approach to explore veteran satisfaction with a VA PTSD specialty clinic pre-treatment orientation group, which provides education about available PTSD treatment options. This study also tested differences in treatment preference in response to the group. Participants were 183 US veterans. Most were White, male, and referred to the clinic by a VA provider. Results indicated high satisfaction with the group in providing an overview of services and helping to inform treatment choice. Most preferred psychotherapy plus medications (63.4%) or psychotherapy only (30.1%). P...

Research paper thumbnail of Residual injury, appearance-related concerns, symptoms of post-traumatic stress disorder, and depression within a treatment-seeking veteran sample

Military medicine, 2014

This study explored the associations among injury-related appearance changes experienced during d... more This study explored the associations among injury-related appearance changes experienced during deployment/combat, symptom severity of post-traumatic stress disorder and depression, and body image distress within a treatment-seeking veteran population (n = 91). Thirty-three percent of the sample reported having an appearance-related residual injury experienced during combat or deployment (n = 30). A subsample, who completed the body image distress measure (n = 69), was divided into two groups: those with an appearance-related residual injury (n = 22) and those without an appearance-related residual injury (n = 47). Correlational analyses revealed significant, positive correlations between body image distress and depression symptom severity. Results also showed a trend relationship between body image distress and post-traumatic stress disorder symptom severity for those with an appearance-related residual injury although correlations were nonsignificant among these constructs for tho...

Research paper thumbnail of Trauma-Related Cognitions and Distress: Empirical Considerations for Intervention and Prevention

Research paper thumbnail of Telemental Health and CPT Groups for Rural Combat Veterans With PTSD: Preliminary Findings

Research paper thumbnail of Changes in mindfulness skills and treatment response among veterans in residential PTSD treatment

Psychological Trauma: Theory, Research, Practice, and Policy, 2012

Research paper thumbnail of Design of VA Cooperative Study #591: CERV-PTSD, Comparative Effectiveness Research in Veterans with PTSD

Contemporary clinical trials, Jan 29, 2014

CERV-PTSD is a randomized controlled trial of two of the most effective treatments for PTSD, Prol... more CERV-PTSD is a randomized controlled trial of two of the most effective treatments for PTSD, Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT). Despite solid evidence that both treatments are effective, there is limited evidence about their effectiveness relative to one another. The primary objective is to compare the effectiveness of PE and CPT for reducing PTSD symptom severity in a healthcare system that offers both treatments. The secondary objective is to compare the effectiveness of PE and CPT for reducing the severity of comorbid mental health problems and service utilization as well as improving functioning and quality of life. The tertiary objective is to examine whether discrepancy between patient preferences and treatment assignment reduces the effectiveness of each treatment. Exploratory analyses will examine whether demographic and clinical characteristics predict differential response to PE and CPT. The study is designed to randomize 900 male and female ve...

Research paper thumbnail of Does a history of mild traumatic brain injury increase suicide risk in veterans with PTSD?

Rehabilitation Psychology, 2012

Objective: Research shows that posttraumatic stress disorder (PTSD) and mild traumatic brain inju... more Objective: Research shows that posttraumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI) independently increase suicide risk; however, scant research has investigated whether mTBI increases suicide risk above and beyond the risk associated with PTSD alone. Design: The current research compared suicide risk factors among a matched sample of Operation Enduring Freedom and Operation Iraqi Freedom (OEF/ OIF) military personnel and veterans with PTSD alone or PTSD and a history of an mTBI. Results: Differences in the assessed risk factors were small and suggest that if PTSD and mTBI are associated with elevations in suicide risk relative to PTSD alone, the added risk is likely mediated or confounded by PTSD symptom severity. Conclusion: This finding highlights the importance of screening and treating military personnel and veterans for PTSD. Future explication of the impact of TBI-related impairments on suicide risk will be critical as we strive to ensure safety and optimize care for our military personnel and veterans.

Research paper thumbnail of Relationship between posttraumatic stress disorder and postconcussive symptom improvement after completion of a posttraumatic stress disorder/traumatic brain injury residential treatment program

Rehabilitation Psychology, 2012

Research has demonstrated that veterans with a history of traumatic brain injury (TBI) may experi... more Research has demonstrated that veterans with a history of traumatic brain injury (TBI) may experience persistent symptoms following injury. These symptoms are frequently maintained or exacerbated by psychiatric symptoms, including posttraumatic stress disorder (PTSD). Studies suggest that decreasing PTSD symptoms may also reduce postconcussive symptoms. This study examined whether (a) PTSD and postconcussive symptoms decreased over the course of residential PTSD/TBI treatment and (b) a reduction in PTSD symptoms was associated with a reduction in postconcussive symptoms. Twenty-eight veterans who met diagnostic criteria for PTSD and had a history of TBI were included in the study. Veterans received 8 weeks of treatment in a residential PTSD/TBI program and completed self-report measures of PTSD and postconcussive symptoms at pre- and posttreatment. Results indicated that PTSD and postconcussive symptoms significantly decreased over the course of treatment. Furthermore, the decreases in PTSD and postconcussive symptoms were significantly positively related. The reduction in PTSD symptoms is positively associated with a reduction in postconcussive symptoms following residential treatment in a PTSD/TBI program. These findings suggest that PTSD and postconcussive symptoms are interdependent and mutually influence one another.

Research paper thumbnail of The relationship between childhood trauma, combat exposure, and posttraumatic stress disorder in male veterans

Military Psychology, 2009

... Ohio Kathleen M. Chard Cincinnati VA Medical Center, Cincinnati, Ohio SomaiaMohamed Central T... more ... Ohio Kathleen M. Chard Cincinnati VA Medical Center, Cincinnati, Ohio SomaiaMohamed Central Texas Veterans Healthcare System, Temple, Texas Uzair Haji VA San Diego Healthcare System, San Diego, California Pia ...

Research paper thumbnail of Group cognitive processing therapy delivered to veterans via telehealth: A pilot cohort

Journal of Traumatic Stress, 2011

The authors report clinical findings from the pilot cohort of the first prospective, noninferiori... more The authors report clinical findings from the pilot cohort of the first prospective, noninferiority-designed randomized clinical trial evaluating the clinical outcomes of delivering a cognitive-behavioral group intervention for posttraumatic stress disorder (PTSD), cognitive processing therapy (CPT), via video teleconferencing (VT) compared to the in-person modality. The treatment was delivered to 13 veterans with PTSD residing on the Hawaiian Islands. Results support the general feasibility and safety of using VT. Both groups showed clinically meaningful reductions in PTSD symptoms and no significant between-group differences on clinical or process outcome variables. In keeping with treatment manual recommendations, a few changes were made to the CPT protocol to accommodate this population. Novel aspects of this trial and lessons learned are discussed.

Research paper thumbnail of A comparison of OEF and OIF veterans and Vietnam veterans receiving cognitive processing therapy

Journal of Traumatic Stress, 2010

The current wars in Iraq and Afghanistan are producing large numbers of veterans who have experie... more The current wars in Iraq and Afghanistan are producing large numbers of veterans who have experienced a variety of combat stressors. The potential impact of combat exposure has been established, including significant rates of posttraumatic stress disorder (PTSD). Limited research has examined potential differences between veteran groups and one study to date has examined differences between eras in terms of treatment response. The present study seeks to examine cohort differences between Operation Enduring Freedom and Operation Iraqi Freedom veterans and Vietnam veterans (N = 101) before and after completing treatment for PTSD using cognitive processing therapy. Findings suggest that veterans from these eras responded differently to treatment and there are multiple variables that should be considered in future cohort studies.

Research paper thumbnail of Disengagement coping as a mediator between trauma-related guilt and PTSD severity

Journal of Traumatic Stress, 2011

This study examined disengagement coping as a partial mediator between trauma-related guilt and s... more This study examined disengagement coping as a partial mediator between trauma-related guilt and severity of posttraumatic stress disorder (PTSD) in a sample of veterans (N = 175) entering residential PTSD treatment with either PTSD or subthreshold PTSD. Disengagement coping partially mediated the relationship between guilt and self-reported PTSD severity (b = .07; 95% CI = [−.003, .13]; p = .06), but did not mediate the relationship when PTSD severity was based on clinicians' ratings. These findings bolster contention that higher guilt-related cognitions are related to increases in the use of disengagement coping strategies, which can interfere with PTSD recovery. The findings support the importance of PTSD treatments that target reductions in guilt-related cognitions and disengagement coping strategies.

Research paper thumbnail of Dissemination and experience with cognitive processing therapy

The Journal of Rehabilitation Research and Development, 2012

Clinical practice guidelines suggest that cognitive behavioral therapies are recommended for the ... more Clinical practice guidelines suggest that cognitive behavioral therapies are recommended for the treatment of posttraumatic stress disorder (PTSD). One of these treatments, cognitive processing therapy (CPT), is an evidence-based treatment that has been shown to be effective at treating combat, assault, and interpersonal violence trauma in randomized controlled trials. The Department of Veterans Affairs (VA) Office of Mental Health Services has implemented an initiative to disseminate CPT as part of a broad effort to make evidence-based psychotherapies widely available throughout the VA healthcare system. This article provides an overview of CPT and reviews the efficacy and program evaluation data supporting its use in a variety of settings. In addition, we report on survey data from individuals who have participated in the VA initiative and on outcome data from patients treated by rollout-trained therapists. Our data suggest that many clinicians trained in the rollout show good adoption of the CPT model and demonstrate solid improvements in their patients' PTSD and depressive symptomotology. Finally, we offer recommendations for using CPT in clinical settings.

Research paper thumbnail of Points of Contention and Convergence

Journal of Psychotherapy Integration, 2005

ABSTRACT In this portion of the clinical exchange, Drs. Kathleen Chard and Thomas Widiger, Joel P... more ABSTRACT In this portion of the clinical exchange, Drs. Kathleen Chard and Thomas Widiger, Joel Paris, Kenneth Silk, Amy Wagner, and Jeffrey Young discuss areas of agreement and disagreement about their concepts of the case, as described in their separate articles (see records 2005-02680-006; 2005-02680-007; 2005-02680-008; 2005-02680-009; 2005-02680-010) in this issue of the journal, of the patient with traits of borderline personality disorder described in "Restitution 101" (see record 2005-02680-005). Issues of diagnosis, phenomenology, case formulation, and treatment models and techniques are compared with an eye toward integrating the various viewpoints. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

Research paper thumbnail of Abuse, Coping, and Treatment

Journal of Psychotherapy Integration, 2005

... at the very highest possible levels of psycho-logical vulnerability, anxiousness, depressiven... more ... at the very highest possible levels of psycho-logical vulnerability, anxiousness, depressiveness, angry hostility, self-con-sciousness, and impulsivity; such a person would be diagnosed with bor-derline personality disorder (Widiger, Trull, Clarkin, Sanderson, & Costa ... glum ...

Research paper thumbnail of Musculoskeletal CPD revision: Cases from the New Zealand bone and soft tissue tumour registry

Journal of Medical Imaging and Radiation Oncology, 2012

The following case report was selected from the New Zealand Bone and Soft Tissue Tumour Registry ... more The following case report was selected from the New Zealand Bone and Soft Tissue Tumour Registry to highlight some key concepts and findings in musculoskeletal imaging with radiological-pathological correlation. The presentation follows a question and answer format followed by clinical information, selected images, diagnosis, discussion and teaching points.

Research paper thumbnail of Hope as a change mechanism in the treatment of posttraumatic stress disorder

Psychological Trauma: Theory, Research, Practice, and Policy, 2012

Research exploring nonspecific mechanisms of change is necessary to understand processes that con... more Research exploring nonspecific mechanisms of change is necessary to understand processes that contribute to psychotherapy outcomes. Many veterans diagnosed with posttraumatic stress disorder (PTSD) report a profound sense of hopelessness prior to receiving treatment, and thus one possible nontargeted change mechanism is the enhancement of hope. In this study, 164 veterans diagnosed with PTSD and admitted to a Veteran's Administration residential treatment program received 6 weeks of cognitive processing therapy. Measures of PTSD symptoms, depression and hope were gathered across the course of treatment. Results revealed that higher levels of hope midway through treatment affected reductions in PTSD and depression from mid-to posttreatment (and not the other way around), thus supporting that hope is one nonspecific change mechanism toward symptom reduction. Implications of these findings as they extend to cognitive-behavior therapies as a whole, and to the understanding of how psychological strengths serve as nonspecific change mechanisms in the treatment of PTSD, conclude the article.

Research paper thumbnail of What Role Do Evidenced Based Treatments Play in Improving Quality of Life?

Research paper thumbnail of Effectiveness of Cognitive Processing Therapy for Male and Female U.S. Veterans With and Without Military Sexual Trauma

Journal of Traumatic Stress, 2015

Military sexual trauma (MST) affects approximately 2% and 36% of male and female veterans, respec... more Military sexual trauma (MST) affects approximately 2% and 36% of male and female veterans, respectively, (e.g., . Although the deleterious consequences of MST have been clearly established, few studies have explored treatment effectiveness for this population. Using archival data from a residential treatment program, the current study explored the effectiveness of cognitive processing therapy (CPT) in treating full or subthreshold posttraumatic stress disorder (PTSD) to compare U.S. veterans reporting an MST index trauma (MST-IT) to those without MST-IT. Of the 481 participants, 40.7% endorsed MST-IT. Multiway frequency analyses were utilized to compare men and women with and without MST on baseline demographic variables. Hierarchical linear models were constructed to investigate treatment outcome by MST status and sex. Results showed that 44.8%, 23.8%, and 19.6% of the variation in clinician-and self-reported PTSD and depression symptoms were explained by three models. Scores on all outcome measures significantly decreased over time for both groups. Additionally, women demonstrated a sharper decrease in PTSD symptoms over time than men. Lastly, men who reported MST-IT had higher PTSD symptoms than men without MST-IT on average. With no control group or random assignment, preliminary findings suggest residential treatment including CPT may be effective for MST-IT regardless of sex.

Research paper thumbnail of Couple Treatment for Alcohol Use Disorder and Posttraumatic Stress Disorder: Pilot Results From U.S. Military Veterans and Their Partners

Journal of Traumatic Stress, 2015

We studied 13 U.S. male military veterans and their female partners who consented to participate ... more We studied 13 U.S. male military veterans and their female partners who consented to participate in an uncontrolled trial of couple treatment for alcohol use disorder and posttraumatic stress disorder (CTAP). CTAP is a 15-session, manualized therapy, integrating behavioral couples therapy for alcohol use disorder (AUD) with cognitive-behavioral conjoint therapy for posttraumatic stress disorder (PTSD). Due to ineligibility (n = 1) and attrition (n = 3), 9 couples completed the study, and 7 completed 12 or more sessions. There were 8 veterans who showed clinically reliable pre- to posttreatment reduction of PTSD outcomes. There were also significant group-level reductions in clinician-, veteran-, and partner-rated PTSD symptoms (d = 0.94 to 1.71). Most veterans showed clinically reliable reductions in percentage days of heavy drinking. Group-level reduction in veterans' percentage days of heavy drinking was significant (d = 1.01). There were 4 veterans and 3 partners with clinically reliable reductions in depression, and group-level change was significant for veterans (d = 0.93) and partners (d = 1.06). On relationship satisfaction, 3 veterans and 4 partners had reliable improvements, and 2 veterans and 1 partner had reliable deterioration. Group-level findings were nonsignificant for veteran relationship satisfaction (d = 0.26) and for partners (d = 0.52). These findings indicate that CTAP may be a promising intervention for individuals with comorbid PTSD and AUD who have relationship partners.

Research paper thumbnail of Veteran satisfaction and treatment preferences in response to a posttraumatic stress disorder specialty clinic orientation group

Behaviour research and therapy, Jan 16, 2015

To maximize accessibility to evidence-based treatments for posttraumatic stress disorder (PTSD), ... more To maximize accessibility to evidence-based treatments for posttraumatic stress disorder (PTSD), the United States Department of Veterans Affairs (VA) has widely disseminated cognitive processing therapy (CPT) and prolonged exposure (PE) therapy to VA clinicians. However, there is a lack of research on veteran preferences when presented with a range of psychotherapy and medication options. This study uses a mixed-method approach to explore veteran satisfaction with a VA PTSD specialty clinic pre-treatment orientation group, which provides education about available PTSD treatment options. This study also tested differences in treatment preference in response to the group. Participants were 183 US veterans. Most were White, male, and referred to the clinic by a VA provider. Results indicated high satisfaction with the group in providing an overview of services and helping to inform treatment choice. Most preferred psychotherapy plus medications (63.4%) or psychotherapy only (30.1%). P...

Research paper thumbnail of Residual injury, appearance-related concerns, symptoms of post-traumatic stress disorder, and depression within a treatment-seeking veteran sample

Military medicine, 2014

This study explored the associations among injury-related appearance changes experienced during d... more This study explored the associations among injury-related appearance changes experienced during deployment/combat, symptom severity of post-traumatic stress disorder and depression, and body image distress within a treatment-seeking veteran population (n = 91). Thirty-three percent of the sample reported having an appearance-related residual injury experienced during combat or deployment (n = 30). A subsample, who completed the body image distress measure (n = 69), was divided into two groups: those with an appearance-related residual injury (n = 22) and those without an appearance-related residual injury (n = 47). Correlational analyses revealed significant, positive correlations between body image distress and depression symptom severity. Results also showed a trend relationship between body image distress and post-traumatic stress disorder symptom severity for those with an appearance-related residual injury although correlations were nonsignificant among these constructs for tho...

Research paper thumbnail of Trauma-Related Cognitions and Distress: Empirical Considerations for Intervention and Prevention

Research paper thumbnail of Telemental Health and CPT Groups for Rural Combat Veterans With PTSD: Preliminary Findings

Research paper thumbnail of Changes in mindfulness skills and treatment response among veterans in residential PTSD treatment

Psychological Trauma: Theory, Research, Practice, and Policy, 2012

Research paper thumbnail of Design of VA Cooperative Study #591: CERV-PTSD, Comparative Effectiveness Research in Veterans with PTSD

Contemporary clinical trials, Jan 29, 2014

CERV-PTSD is a randomized controlled trial of two of the most effective treatments for PTSD, Prol... more CERV-PTSD is a randomized controlled trial of two of the most effective treatments for PTSD, Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT). Despite solid evidence that both treatments are effective, there is limited evidence about their effectiveness relative to one another. The primary objective is to compare the effectiveness of PE and CPT for reducing PTSD symptom severity in a healthcare system that offers both treatments. The secondary objective is to compare the effectiveness of PE and CPT for reducing the severity of comorbid mental health problems and service utilization as well as improving functioning and quality of life. The tertiary objective is to examine whether discrepancy between patient preferences and treatment assignment reduces the effectiveness of each treatment. Exploratory analyses will examine whether demographic and clinical characteristics predict differential response to PE and CPT. The study is designed to randomize 900 male and female ve...

Research paper thumbnail of Does a history of mild traumatic brain injury increase suicide risk in veterans with PTSD?

Rehabilitation Psychology, 2012

Objective: Research shows that posttraumatic stress disorder (PTSD) and mild traumatic brain inju... more Objective: Research shows that posttraumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI) independently increase suicide risk; however, scant research has investigated whether mTBI increases suicide risk above and beyond the risk associated with PTSD alone. Design: The current research compared suicide risk factors among a matched sample of Operation Enduring Freedom and Operation Iraqi Freedom (OEF/ OIF) military personnel and veterans with PTSD alone or PTSD and a history of an mTBI. Results: Differences in the assessed risk factors were small and suggest that if PTSD and mTBI are associated with elevations in suicide risk relative to PTSD alone, the added risk is likely mediated or confounded by PTSD symptom severity. Conclusion: This finding highlights the importance of screening and treating military personnel and veterans for PTSD. Future explication of the impact of TBI-related impairments on suicide risk will be critical as we strive to ensure safety and optimize care for our military personnel and veterans.

Research paper thumbnail of Relationship between posttraumatic stress disorder and postconcussive symptom improvement after completion of a posttraumatic stress disorder/traumatic brain injury residential treatment program

Rehabilitation Psychology, 2012

Research has demonstrated that veterans with a history of traumatic brain injury (TBI) may experi... more Research has demonstrated that veterans with a history of traumatic brain injury (TBI) may experience persistent symptoms following injury. These symptoms are frequently maintained or exacerbated by psychiatric symptoms, including posttraumatic stress disorder (PTSD). Studies suggest that decreasing PTSD symptoms may also reduce postconcussive symptoms. This study examined whether (a) PTSD and postconcussive symptoms decreased over the course of residential PTSD/TBI treatment and (b) a reduction in PTSD symptoms was associated with a reduction in postconcussive symptoms. Twenty-eight veterans who met diagnostic criteria for PTSD and had a history of TBI were included in the study. Veterans received 8 weeks of treatment in a residential PTSD/TBI program and completed self-report measures of PTSD and postconcussive symptoms at pre- and posttreatment. Results indicated that PTSD and postconcussive symptoms significantly decreased over the course of treatment. Furthermore, the decreases in PTSD and postconcussive symptoms were significantly positively related. The reduction in PTSD symptoms is positively associated with a reduction in postconcussive symptoms following residential treatment in a PTSD/TBI program. These findings suggest that PTSD and postconcussive symptoms are interdependent and mutually influence one another.

Research paper thumbnail of The relationship between childhood trauma, combat exposure, and posttraumatic stress disorder in male veterans

Military Psychology, 2009

... Ohio Kathleen M. Chard Cincinnati VA Medical Center, Cincinnati, Ohio SomaiaMohamed Central T... more ... Ohio Kathleen M. Chard Cincinnati VA Medical Center, Cincinnati, Ohio SomaiaMohamed Central Texas Veterans Healthcare System, Temple, Texas Uzair Haji VA San Diego Healthcare System, San Diego, California Pia ...

Research paper thumbnail of Group cognitive processing therapy delivered to veterans via telehealth: A pilot cohort

Journal of Traumatic Stress, 2011

The authors report clinical findings from the pilot cohort of the first prospective, noninferiori... more The authors report clinical findings from the pilot cohort of the first prospective, noninferiority-designed randomized clinical trial evaluating the clinical outcomes of delivering a cognitive-behavioral group intervention for posttraumatic stress disorder (PTSD), cognitive processing therapy (CPT), via video teleconferencing (VT) compared to the in-person modality. The treatment was delivered to 13 veterans with PTSD residing on the Hawaiian Islands. Results support the general feasibility and safety of using VT. Both groups showed clinically meaningful reductions in PTSD symptoms and no significant between-group differences on clinical or process outcome variables. In keeping with treatment manual recommendations, a few changes were made to the CPT protocol to accommodate this population. Novel aspects of this trial and lessons learned are discussed.

Research paper thumbnail of A comparison of OEF and OIF veterans and Vietnam veterans receiving cognitive processing therapy

Journal of Traumatic Stress, 2010

The current wars in Iraq and Afghanistan are producing large numbers of veterans who have experie... more The current wars in Iraq and Afghanistan are producing large numbers of veterans who have experienced a variety of combat stressors. The potential impact of combat exposure has been established, including significant rates of posttraumatic stress disorder (PTSD). Limited research has examined potential differences between veteran groups and one study to date has examined differences between eras in terms of treatment response. The present study seeks to examine cohort differences between Operation Enduring Freedom and Operation Iraqi Freedom veterans and Vietnam veterans (N = 101) before and after completing treatment for PTSD using cognitive processing therapy. Findings suggest that veterans from these eras responded differently to treatment and there are multiple variables that should be considered in future cohort studies.

Research paper thumbnail of Disengagement coping as a mediator between trauma-related guilt and PTSD severity

Journal of Traumatic Stress, 2011

This study examined disengagement coping as a partial mediator between trauma-related guilt and s... more This study examined disengagement coping as a partial mediator between trauma-related guilt and severity of posttraumatic stress disorder (PTSD) in a sample of veterans (N = 175) entering residential PTSD treatment with either PTSD or subthreshold PTSD. Disengagement coping partially mediated the relationship between guilt and self-reported PTSD severity (b = .07; 95% CI = [−.003, .13]; p = .06), but did not mediate the relationship when PTSD severity was based on clinicians' ratings. These findings bolster contention that higher guilt-related cognitions are related to increases in the use of disengagement coping strategies, which can interfere with PTSD recovery. The findings support the importance of PTSD treatments that target reductions in guilt-related cognitions and disengagement coping strategies.

Research paper thumbnail of Dissemination and experience with cognitive processing therapy

The Journal of Rehabilitation Research and Development, 2012

Clinical practice guidelines suggest that cognitive behavioral therapies are recommended for the ... more Clinical practice guidelines suggest that cognitive behavioral therapies are recommended for the treatment of posttraumatic stress disorder (PTSD). One of these treatments, cognitive processing therapy (CPT), is an evidence-based treatment that has been shown to be effective at treating combat, assault, and interpersonal violence trauma in randomized controlled trials. The Department of Veterans Affairs (VA) Office of Mental Health Services has implemented an initiative to disseminate CPT as part of a broad effort to make evidence-based psychotherapies widely available throughout the VA healthcare system. This article provides an overview of CPT and reviews the efficacy and program evaluation data supporting its use in a variety of settings. In addition, we report on survey data from individuals who have participated in the VA initiative and on outcome data from patients treated by rollout-trained therapists. Our data suggest that many clinicians trained in the rollout show good adoption of the CPT model and demonstrate solid improvements in their patients' PTSD and depressive symptomotology. Finally, we offer recommendations for using CPT in clinical settings.

Research paper thumbnail of Points of Contention and Convergence

Journal of Psychotherapy Integration, 2005

ABSTRACT In this portion of the clinical exchange, Drs. Kathleen Chard and Thomas Widiger, Joel P... more ABSTRACT In this portion of the clinical exchange, Drs. Kathleen Chard and Thomas Widiger, Joel Paris, Kenneth Silk, Amy Wagner, and Jeffrey Young discuss areas of agreement and disagreement about their concepts of the case, as described in their separate articles (see records 2005-02680-006; 2005-02680-007; 2005-02680-008; 2005-02680-009; 2005-02680-010) in this issue of the journal, of the patient with traits of borderline personality disorder described in "Restitution 101" (see record 2005-02680-005). Issues of diagnosis, phenomenology, case formulation, and treatment models and techniques are compared with an eye toward integrating the various viewpoints. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

Research paper thumbnail of Abuse, Coping, and Treatment

Journal of Psychotherapy Integration, 2005

... at the very highest possible levels of psycho-logical vulnerability, anxiousness, depressiven... more ... at the very highest possible levels of psycho-logical vulnerability, anxiousness, depressiveness, angry hostility, self-con-sciousness, and impulsivity; such a person would be diagnosed with bor-derline personality disorder (Widiger, Trull, Clarkin, Sanderson, & Costa ... glum ...

Research paper thumbnail of Musculoskeletal CPD revision: Cases from the New Zealand bone and soft tissue tumour registry

Journal of Medical Imaging and Radiation Oncology, 2012

The following case report was selected from the New Zealand Bone and Soft Tissue Tumour Registry ... more The following case report was selected from the New Zealand Bone and Soft Tissue Tumour Registry to highlight some key concepts and findings in musculoskeletal imaging with radiological-pathological correlation. The presentation follows a question and answer format followed by clinical information, selected images, diagnosis, discussion and teaching points.