BACKGROUND Exposures to “traumatic” events are widespread and can cause posttraumatic stress diso... more BACKGROUND Exposures to “traumatic” events are widespread and can cause posttraumatic stress disorder (PTSD). Cognitive behavioral therapy and eye movement desensitization and reprocessing (EMDR) are frequently used and validated behavioral PTSD treatments. Despite demonstrated effectiveness, highly upsetting memory reactions can be evoked, resulting in extensive distress and, sometimes, treatment dropout. In recent years, multiple treatment approaches have aimed at reducing such upsetting memory reactions to traumatic memories while therapeutic progress proceeds. One of these methods, the flash technique (FT), a modification of standard EMDR (S-EMDR), appears effective in distressing memory reduction. This study will examine FT-EMDR and S-EMDR efficacies when both methods are delivered via web-based video. OBJECTIVE This study aims to assess the relative efficacy of (web-based) FT-EMDR versus S-EMDR in reducing the PTSD symptoms, anxieties, and depression associated with traumatic memories at postintervention and 1-month follow-up. METHODS This double-blinded, web-based, 2-arm randomized controlled trial will employ self-report outcomes. A total of 90 participants will be identified from the web-based CloudResearch platform and randomly allocated to the experimental or comparison group. Inclusion criteria are as follows: (1) approved for engagement by the CloudResearch platform; (2) 25-60 years of age; (3) residing in Canada or the United States; (4) a recalled disturbing memory of an event >2 years ago that has not repeated and was moderately or more upsetting during occurrence; (5) memory moderately or more upsetting at baseline and not linked to an earlier memory that is equally or more than equally disturbing. Exclusion criteria are bipolar disorder, borderline personality disorder, obsessive-compulsive disorder, schizophrenia, substance abuse or addiction in the past 3 months, suicidal ideation, and suicide attempt in the past 6 months. Interventions include guided video instruction of full FT or guided video of EMDR. Outcome measures are as follows: Primary outcome is PTSD symptoms that are measured by the PTSD Checklist for DSM-5 (Diagnostic and Statistical Manual of Mental Disorders-5) at 1-month follow-up. Secondary outcomes are State Anxiety subscale of State-Trait Anxiety Inventory at baseline, postintervention, and 1-month follow-up; Trait Anxiety subscale of State-Trait Anxiety Inventory; depression (Patient Health Questionnaire-9); and Positive and Negative Affect Schedule measured at 1-month follow-up. RESULTS If, at 1-month follow-up, the web-based FT-EMDR intervention is more effective in reducing PTSD symptoms (as measured by the PTSD Checklist for DSM-5) than EMDR, it may help reduce traumatic memory distress in multiple contexts. CONCLUSIONS This randomized controlled trial will advance current understandings of PTSD symptoms and interventions that target traumatic memory–related distress. CLINICALTRIAL ClinicalTrials.gov NCT05262127; https://clinicaltrials.gov/ct2/show/NCT05262127
Post-traumatic stress disorder is a major public health concern with a lifetime prevalence rate o... more Post-traumatic stress disorder is a major public health concern with a lifetime prevalence rate of 6.1-9.2% in North America. PTSD is known to alter the autonomic nervous system leading to chronic sympathetic arousal including heightened anxiety and hypervigilance. Pupillometry offers a quick and accessible measure of autonomic nervous system imbalances characteristic of PTSD. This study investigates the utility of pupillometry as a biomarker to detect PTSD in a sample of 39 adults with (n = 22) and without (n = 17) PTSD. Participants viewed a 25-minute computer protocol consisting of 5-minute rest phase, 10-minute negative emotionally valent images, and 10-minute guided meditation. We relied on a time-frequency analysis to represent the pupillary responses of two different groups (PTSD-affected individuals and healthy-control subjects). These data were then employed with a CNN network to learn a prediction model. Individuals with PTSD demonstrated increased pupil dilation across the entire protocol. The final outcome revealed an accuracy of 81.09% which indicates the feasibility of using this approach to detecting participants with PTSD in an automated way. Findings from this research have important implications for clinical mental health assessment, diagnostics and treatment.
Colorectal cancer (CRC) is the third most common cancer in the United States. A reduction in cumu... more Colorectal cancer (CRC) is the third most common cancer in the United States. A reduction in cumulative mortality occurs when patients are routinely screened by fecal occult blood tests (FOBT) and early lesions are removed. These point-of-care tests detect minute amounts of blood released from precancerous and cancerous colon lesions. Positive test results should be followed up with complete diagnostic testing to treat precancerous lesions and diagnose patients at earlier stages of cancer, thereby increasing overall survival. More complex assays are designed to detect genetic changes in cells released from malignant and even premalignant lesions. This article provides information on the screening and diagnostic tests available for CRC detection as well as the advantages and disadvantages of each.
Cognitive-behavioral group therapy: For specific problems and populations.
This chapter describes the Risk Adaptation Model (RAM), an orienting model in cognitive-behaviora... more This chapter describes the Risk Adaptation Model (RAM), an orienting model in cognitive-behavioral group therapy that provides medical patients a collaborative–empirical method of mapping health pathways defined by individual and group values. By providing patients a foundation in mindfulness practice, a healing environment, and an integrative field in which group exchanges yield new insights and changes in behavior, the model enables individual members and the group, as a whole, to function in a more integrated manner. Lastly, the RAM provides the medical patients of the group a structure for managing personal and group expectancies as important tools in deriving sound decision making and successful personal change. (PsycINFO Database Record (c) 2015 APA, all rights reserved)
75 Background: Recruitment for most exercise trials is challenging and often hindered by particip... more 75 Background: Recruitment for most exercise trials is challenging and often hindered by participants’ inability to travel to the study centre and/or unwillingness to be randomized. Thus, patients in exercise randomized controlled trials (RCTs) are highly selected and may not reflect real-world experiences. Our objectives were to compare baseline characteristics and outcomes of men who agreed to participate in a preference-based trial (PREF) compared to a RCT of the same exercise interventions. Methods: A 2-arm multicentre PREF trial was conducted concurrently with a 2-arm RCT. Participants were men on ADT who were treated at 2 academic and 2 community hospitals in Canada and selected to engage in a group-based in-centre exercise intervention (GROUP) or a home-based exercise program (HOME). All participants underwent aerobic and resistance training 4-5 days per week for 6 months. Co-primary outcomes included fatigue (FACT-F) and the 6-minute walk test (6MWT). Differences at baseline between the two trials were compared using ANOVA. Analysis of covariance with adjustment for baseline value was used to assess differences in the study outcomes between the two trials and between exercise arms. Results: 56 participants (mean age 70 y) consented and selected to participate in GROUP (n = 18) or HOME (n = 38). Recruitment rate was 21.5%. Retention at 6 months in the PREF and RCT was 72.7% and 50%, respectively. No significant differences were observed in baseline characteristics between participants of the two trials. Adherence was met by 60% of participants in PREF. Participants in PREF exhibited a 28.7-metre increase (better) in the 6MWT at 6 months compared to RCT participants ( p = 0.20). Additionally, participants in PREF demonstrated less time (better) to complete 5 chair stands (mean change: -1.24s) at 6 months relative to participants in the RCT irrespective of exercise mode ( p = 0.06). HOME participants in the PREF completed the 5 chair stands faster (mean change: -2.19s) compared to HOME participants in the RCT (p = 0.01). Similarly, GROUP participants in the RCT required less time (mean change: -2.11s) for 5 chair stands compared to GROUP participants in the PREF (p = 0.04). Hip circumference was higher (worse) at 6 months in PREF participants (mean change: +2.95cm) compared to their RCT counterparts (p = 0.02). Although fatigue was not significantly different between participants in the two studies at 6 months, GROUP participants in the RCT experienced worse fatigue (mean change: -6.93) compared to those who selected GROUP (p = 0.03). Conclusions: Allowing participants to select the exercise intervention of their preference may improve retention and ameliorate functional declines as a result of ADT. Further studies that assess the effects of preference-based trials on clinical outcomes are warranted. Clinical trial information: NCT03335631.
BACKGROUND Exposures to “traumatic” events are widespread and can cause posttraumatic stress diso... more BACKGROUND Exposures to “traumatic” events are widespread and can cause posttraumatic stress disorder (PTSD). Cognitive behavioral therapy and eye movement desensitization and reprocessing (EMDR) are frequently used and validated behavioral PTSD treatments. Despite demonstrated effectiveness, highly upsetting memory reactions can be evoked, resulting in extensive distress and, sometimes, treatment dropout. In recent years, multiple treatment approaches have aimed at reducing such upsetting memory reactions to traumatic memories while therapeutic progress proceeds. One of these methods, the flash technique (FT), a modification of standard EMDR (S-EMDR), appears effective in distressing memory reduction. This study will examine FT-EMDR and S-EMDR efficacies when both methods are delivered via web-based video. OBJECTIVE This study aims to assess the relative efficacy of (web-based) FT-EMDR versus S-EMDR in reducing the PTSD symptoms, anxieties, and depression associated with traumatic memories at postintervention and 1-month follow-up. METHODS This double-blinded, web-based, 2-arm randomized controlled trial will employ self-report outcomes. A total of 90 participants will be identified from the web-based CloudResearch platform and randomly allocated to the experimental or comparison group. Inclusion criteria are as follows: (1) approved for engagement by the CloudResearch platform; (2) 25-60 years of age; (3) residing in Canada or the United States; (4) a recalled disturbing memory of an event >2 years ago that has not repeated and was moderately or more upsetting during occurrence; (5) memory moderately or more upsetting at baseline and not linked to an earlier memory that is equally or more than equally disturbing. Exclusion criteria are bipolar disorder, borderline personality disorder, obsessive-compulsive disorder, schizophrenia, substance abuse or addiction in the past 3 months, suicidal ideation, and suicide attempt in the past 6 months. Interventions include guided video instruction of full FT or guided video of EMDR. Outcome measures are as follows: Primary outcome is PTSD symptoms that are measured by the PTSD Checklist for DSM-5 (Diagnostic and Statistical Manual of Mental Disorders-5) at 1-month follow-up. Secondary outcomes are State Anxiety subscale of State-Trait Anxiety Inventory at baseline, postintervention, and 1-month follow-up; Trait Anxiety subscale of State-Trait Anxiety Inventory; depression (Patient Health Questionnaire-9); and Positive and Negative Affect Schedule measured at 1-month follow-up. RESULTS If, at 1-month follow-up, the web-based FT-EMDR intervention is more effective in reducing PTSD symptoms (as measured by the PTSD Checklist for DSM-5) than EMDR, it may help reduce traumatic memory distress in multiple contexts. CONCLUSIONS This randomized controlled trial will advance current understandings of PTSD symptoms and interventions that target traumatic memory–related distress. CLINICALTRIAL ClinicalTrials.gov NCT05262127; https://clinicaltrials.gov/ct2/show/NCT05262127
Post-traumatic stress disorder is a major public health concern with a lifetime prevalence rate o... more Post-traumatic stress disorder is a major public health concern with a lifetime prevalence rate of 6.1-9.2% in North America. PTSD is known to alter the autonomic nervous system leading to chronic sympathetic arousal including heightened anxiety and hypervigilance. Pupillometry offers a quick and accessible measure of autonomic nervous system imbalances characteristic of PTSD. This study investigates the utility of pupillometry as a biomarker to detect PTSD in a sample of 39 adults with (n = 22) and without (n = 17) PTSD. Participants viewed a 25-minute computer protocol consisting of 5-minute rest phase, 10-minute negative emotionally valent images, and 10-minute guided meditation. We relied on a time-frequency analysis to represent the pupillary responses of two different groups (PTSD-affected individuals and healthy-control subjects). These data were then employed with a CNN network to learn a prediction model. Individuals with PTSD demonstrated increased pupil dilation across the entire protocol. The final outcome revealed an accuracy of 81.09% which indicates the feasibility of using this approach to detecting participants with PTSD in an automated way. Findings from this research have important implications for clinical mental health assessment, diagnostics and treatment.
Colorectal cancer (CRC) is the third most common cancer in the United States. A reduction in cumu... more Colorectal cancer (CRC) is the third most common cancer in the United States. A reduction in cumulative mortality occurs when patients are routinely screened by fecal occult blood tests (FOBT) and early lesions are removed. These point-of-care tests detect minute amounts of blood released from precancerous and cancerous colon lesions. Positive test results should be followed up with complete diagnostic testing to treat precancerous lesions and diagnose patients at earlier stages of cancer, thereby increasing overall survival. More complex assays are designed to detect genetic changes in cells released from malignant and even premalignant lesions. This article provides information on the screening and diagnostic tests available for CRC detection as well as the advantages and disadvantages of each.
Cognitive-behavioral group therapy: For specific problems and populations.
This chapter describes the Risk Adaptation Model (RAM), an orienting model in cognitive-behaviora... more This chapter describes the Risk Adaptation Model (RAM), an orienting model in cognitive-behavioral group therapy that provides medical patients a collaborative–empirical method of mapping health pathways defined by individual and group values. By providing patients a foundation in mindfulness practice, a healing environment, and an integrative field in which group exchanges yield new insights and changes in behavior, the model enables individual members and the group, as a whole, to function in a more integrated manner. Lastly, the RAM provides the medical patients of the group a structure for managing personal and group expectancies as important tools in deriving sound decision making and successful personal change. (PsycINFO Database Record (c) 2015 APA, all rights reserved)
75 Background: Recruitment for most exercise trials is challenging and often hindered by particip... more 75 Background: Recruitment for most exercise trials is challenging and often hindered by participants’ inability to travel to the study centre and/or unwillingness to be randomized. Thus, patients in exercise randomized controlled trials (RCTs) are highly selected and may not reflect real-world experiences. Our objectives were to compare baseline characteristics and outcomes of men who agreed to participate in a preference-based trial (PREF) compared to a RCT of the same exercise interventions. Methods: A 2-arm multicentre PREF trial was conducted concurrently with a 2-arm RCT. Participants were men on ADT who were treated at 2 academic and 2 community hospitals in Canada and selected to engage in a group-based in-centre exercise intervention (GROUP) or a home-based exercise program (HOME). All participants underwent aerobic and resistance training 4-5 days per week for 6 months. Co-primary outcomes included fatigue (FACT-F) and the 6-minute walk test (6MWT). Differences at baseline between the two trials were compared using ANOVA. Analysis of covariance with adjustment for baseline value was used to assess differences in the study outcomes between the two trials and between exercise arms. Results: 56 participants (mean age 70 y) consented and selected to participate in GROUP (n = 18) or HOME (n = 38). Recruitment rate was 21.5%. Retention at 6 months in the PREF and RCT was 72.7% and 50%, respectively. No significant differences were observed in baseline characteristics between participants of the two trials. Adherence was met by 60% of participants in PREF. Participants in PREF exhibited a 28.7-metre increase (better) in the 6MWT at 6 months compared to RCT participants ( p = 0.20). Additionally, participants in PREF demonstrated less time (better) to complete 5 chair stands (mean change: -1.24s) at 6 months relative to participants in the RCT irrespective of exercise mode ( p = 0.06). HOME participants in the PREF completed the 5 chair stands faster (mean change: -2.19s) compared to HOME participants in the RCT (p = 0.01). Similarly, GROUP participants in the RCT required less time (mean change: -2.11s) for 5 chair stands compared to GROUP participants in the PREF (p = 0.04). Hip circumference was higher (worse) at 6 months in PREF participants (mean change: +2.95cm) compared to their RCT counterparts (p = 0.02). Although fatigue was not significantly different between participants in the two studies at 6 months, GROUP participants in the RCT experienced worse fatigue (mean change: -6.93) compared to those who selected GROUP (p = 0.03). Conclusions: Allowing participants to select the exercise intervention of their preference may improve retention and ameliorate functional declines as a result of ADT. Further studies that assess the effects of preference-based trials on clinical outcomes are warranted. Clinical trial information: NCT03335631.
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