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In This Issue of JAMA |

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JAMA. 2015;314(5):427-429. doi:10.1001/jama.2014.11893.
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Experiential avoidance is a key factor in the development and maintenance of posttraumatic stress disorder (PTSD). Mindfulness-based interventions encourage nonjudgmental acceptance of thoughts, feelings, and experiences without avoidance. In a randomized trial that enrolled 116 veterans with PTSD, Polusny and colleagues compared mindfulness-based stress reduction with present-centered group therapy for treatment of PTSD. The authors report that compared with present-centered group therapy, mindfulness-based stress reduction resulted in a greater decrease in self-reported PTSD symptom severity during treatment and at 2-month follow-up, with the magnitude of symptom improvement suggesting a modest therapeutic effect. In an Editorial, Kearney and Simpson discuss treatment of PTSD.

Co-occurrence of heavy drinking and intimate partner violence (IPV) is common and often bi-directional. In a randomized trial that was conducted in 2 academic urban emergency departments and enrolled 592 IPV-involved women who exceeded gender-specific safe drinking limits, Rhodes and colleagues assessed whether a brief, 20-30 minute manual-guided motivational intervention for co-occurring IPV and heavy drinking would reduce incidents of either or both events. The authors report that compared with 2 control conditions—either a baseline interview and 12 weekly interactive voice response system assessments; or a no-contact control group—the brief motivational intervention did not significantly reduce days of heavy drinking or incidents of verbal, physical, or sexual IPV.


Sumner and colleagues analyzed data from multiple health and law enforcement surveillance systems to assess the burden of interpersonal violence in the United States, explore major challenges facing violence prevention efforts, and identify opportunities for prevention. The authors highlight the often hidden nature of non-lethal violence; consequences of undetected maltreatment and exposure to violence—particularly among children; health consequences of violence; and evidence-based prevention strategies.

In a systematic review that identified 36 randomized trials assessing the effectiveness of psychotherapies for posttraumatic stress disorder (PTSD) in military populations, Steenkamp and colleagues found that 2 trauma-focused interventions—cognitive processing therapy and prolonged exposure therapy—can achieve clinically meaningful improvement, but a substantial number of patients remain symptomatic. The authors’ findings support use of either trauma-focused or structured non-trauma-focused therapies, with patient preference an important factor in therapeutic approach.

Editorial and Related Article

Mr L was involved in a motor vehicle accident and sustained mild head trauma and a pneumothorax. He returned to work, but reports difficulty concentrating, sleep disturbance, and irritability. His physician wonders if he might have posttraumatic stress disorder (PTSD). Spoont and colleagues discuss primary care screening for PTSD, and report results of a systematic review of 23 studies that assessed the utility of screening instruments for PTSD.

Editorial, Related Article, and JAMA Patient Page

An article in JAMA Pediatrics reported that lay counselor–provided trauma-focused cognitive behavioral therapy decreased trauma and stress-related symptoms and improved social function among orphans and vulnerable children in Zambia. In this From The JAMA Network article, Ventevogel and Spiegel discuss treatment of psychological and social consequences of childhood trauma and chronic adversity.




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