Papers by Matthew Jakupcak
General Hospital Psychiatry, May 1, 2022
OBJECTIVES To understand care managers' experiences treating primary care patients with bipol... more OBJECTIVES To understand care managers' experiences treating primary care patients with bipolar disorder and PTSD in a telepsychiatry collaborative care (TCC) program, as part of a large pragmatic trial. METHODS We conducted individual qualitative interviews with 12 care managers to evaluate barriers and facilitators to implementation of a previously completed TCC intervention for patients with bipolar disorder and/or PTSD. We used directed and conventional content analysis and Consolidated Framework for Implementation Research (CFIR) constructs to organize care manager experiences. RESULTS Participants described clinical and medication management support from telepsychiatrists and satisfaction with the TCC model as facilitators of success for patients with bipolar disorder and PTSD in underserved communities. Participants also described onboarding of primary care providers and clinic leadership as keys to successful team-care and credited satisfaction with providing Behavioral Activation as essential to sustained delivery of the psychotherapy component of TCC. CONCLUSIONS Participants described high satisfaction with TCC for patients with bipolar disorder and PTSD. Challenges included lack of clinic leadership and PCP engagement. Early and ongoing promotion of integrated care and prioritizing telepsychiatry consultation with patients, behavioral health professionals and PCPs, may improve patient care, provide ongoing training and improve workforce satisfaction.
Psychological Trauma: Theory, Research, Practice, and Policy, Nov 1, 2019
Objective:Lack of social support predicts the development, maintenance, and exacerbation of postt... more Objective:Lack of social support predicts the development, maintenance, and exacerbation of posttraumatic stress disorder (PTSD). Moreover, social dysfunction is associated with recurrent episodes of PTSD care, and detachment/estrangement from others is a strong predictor of suicidal ideation among those with PTSD. Thus, treatments to improve social functioning among those with PTSD are needed.Method:Eighty veterans of recent operations in Iraq and Afghanistan participated in a randomized controlled trial comparing treatment as usual to behavioral activation (BA) for PTSD, a treatment that focuses on reducing avoidance behaviors and increasing engagement in valued goals rather than explicitly confronting trauma memories.Results:Mixed-model regression analyses revealed that, accounting for gender, baseline PTSD, and marital status, participants who received BA experienced greater improvements in the number of social supports from baseline to posttreatment compared with those in treatment as usual (F1,96 = 6.29, p = .014). Gains were not maintained at 3-month follow-up, and significant results were not found for satisfaction with social supports.Conclusions:BA may facilitate an increase in the perceived number of social supports available to veterans with PTSD, but treatment adaptation may be necessary to maintain these gains and to increase satisfaction with social support.
Families, Systems, & Health, Mar 1, 2021
INTRODUCTION Health informatics-supported strategies for training and ongoing support may aid the... more INTRODUCTION Health informatics-supported strategies for training and ongoing support may aid the delivery of evidence-based psychotherapies. The objective of this study was to describe the development, implementation, and practice outcomes of a scalable health informatics-supported training program for behavioral activation for patients who screened positive for posttraumatic stress disorder and/or bipolar disorder. METHOD We trained 34 care managers in 12 rural health centers. They used a registry checklist to document the delivery of 10 behavioral activation skills for 4,632 sessions with 455 patients. Care managers received performance feedback based on registry data. Using encounter-level data reported by care managers, we described the implementation outcomes of patient reach and care manager skill adoption. We used cross-classified multilevel modeling to explore variation in skill delivery accounting for patient characteristics, provider characteristics, and change over time. RESULTS Care managers engaged 88% of patients in behavioral activation and completed a minimum course for 57%. The average patient received 5.9 skills during treatment, with substantial variation driven more by providers (63%) than patients (29%). Care managers significantly increased the range of skills offered to patients over time. DISCUSSION The registry-based checklist was a feasible training and support tool for community-based providers to deliver behavioral activation. Providers received data-driven performance feedback and demonstrated skill improvement over time, promoting sustainment. Future research will examine patient-level outcomes. Results underscore the potential public health impact of a simple registry-based skills checklist coupled with a scalable remote training program for evidence-based psychotherapy. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
The Journal of Rural Health, 2021
PurposeCompared to urban areas, rural populations are less likely to engage in mental health care... more PurposeCompared to urban areas, rural populations are less likely to engage in mental health care. Using data from the Study to Promote Innovation in Rural Integrated Telepsychiatry, we examined the effect of rurality on engagement in mental health treatment as well as the role of potential mediators.MethodsData were obtained from medical records and surveys. We defined rurality using the rural‐urban commuting area codes. Baseline mediators included the Endorsed and Anticipated Stigma Inventory and the Assessment of Perceived Access to Care. Engagement outcomes included number of psychotherapy visits and self‐reported medication use. We used path analysis to examine the relationship between rurality and engagement and the influence of mediating variables.FindingsRural participants were less likely to initiate psychotherapy (OR = 0.49; adjusted P = .036), although rurality was not associated with number of psychotherapy sessions or medication use. Rurality was associated with a small...
Psychology of Men & Masculinity, 2017
Providing a brief introduction to this special issue of the Psychology of Men and Masculinity, th... more Providing a brief introduction to this special issue of the Psychology of Men and Masculinity, the guest editors highlight the relevance of traditional male gender norms for men and women who have served in the armed forces. The editors provide specific examples of how masculinity might impact subgroups of military and veteran populations and highlight the contributions of the articles included in this special issue. The editors also discuss the need for ongoing research of male gender norms to inform treatment and institutional policies designed for military service members and veterans.
The American journal of nursing, 2016
I n June 2012, while he was stationed at Vogelweh Air Base in Germany, Trent Smith, a 19-year-old... more I n June 2012, while he was stationed at Vogelweh Air Base in Germany, Trent Smith, a 19-year-old U.S. Airman 1st Class, says he was sexually assaulted in an off-base apartment by a higher-ranking male sergeant, a "unit sponsor" who was entrusted to ease the new recruit's transition to military life. 1, 2 Three days later Smith reported the incident in accordance with protocol and received counseling. 2 In Smith's description of the events, the male sergeant touched him and coerced him into having sex 1 : "I said, 'No, I don't want to spend the night,'" he reports. But feeling powerless in the situation, he "went along with it." Ultimately, an Air Force psychologist diagnosed him with a personality disorder and the Formal Physical Evaluation Board of the U.S. Air Force deemed him unfit for continued duty. The diagnosed personality disorder was said to make it impossible to treat the posttraumatic stress disorder (PTSD) Smith developed in the aftermath of that evening. 1, 2 In the end, the unit commander determined that there was no evidence of a crime. The sergeant who had been implicated in the incident was reprimanded for having relations with a lower-ranking service member but was allowed to remain in service. 1 Military sexual trauma (MST) is defined by federal law as "psychological trauma, which in the judgment of a mental health professional employed by the Department [of Veterans Affairs (VA)], resulted from a physical assault of a sexual nature, battery of a sexual nature, or sexual harassment which occurred while the veteran was serving on active duty, active duty ABSTRACT: The experience of military sexual trauma (MST), which can result from assault, battery, or harassment of a sexual nature, may jeopardize the mental health of service members as well as that of their family members, colleagues, and community members. Although a greater proportion of female than male service members are subjected to MST, the Department of Defense estimates that the absolute numbers of affected men and women, across all ranks and branches of military service, are nearly equal because roughly 85% of military members are men. Little research has explored the effects of MST on men. This article discusses the unique ways in which men may experience MST, and examines how social stereotypes of masculinity, myths surrounding sexual assault, and military culture and structure often influence a man's interpretation of an attack and his likelihood of reporting the incident or seeking treatment. It describes current treatments for MST-related mental health conditions and addresses implications for nurses and other health care professionals.
Couple and Family Psychology: Research and Practice, 2015
Oxford Handbooks Online, 2012
American Journal of Psychiatry, 2014
Violence and Victims, 2003
Cognitive and Behavioral Practice, 2011
Iraq and Afghanistan War veterans diagnosed with psychiatric disorders commit suicide at a higher... more Iraq and Afghanistan War veterans diagnosed with psychiatric disorders commit suicide at a higher rate than the general population (Kang & Bullman, 2008). Posttraumatic stress disorder (PTSD) has been identified as a risk factor for suicide in veterans (Bullman & Kang, 1994) and is the most common mental disorder among Iraq and Afghanistan veterans presenting for treatment at Veterans Affairs (VA) facilities (Kang, 2009). Therefore, it is critical for health providers to identify veterans with PTSD who are at high risk for suicide in order to more effectively intervene to promote safety, stabilization, and reduce psychiatric symptoms. In the following paper, we discuss risk for suicide in veterans with PTSD and application of cognitive behavioral therapies to reduce suicidality in high-risk patients. We also discuss pertinent clinical issues common to treating Iraq and Afghanistan War veterans with PTSD.
Behavioural and Cognitive Psychotherapy, 2010
Background: Physical injury and psychological trauma associated with combat in the wars in Iraq a... more Background: Physical injury and psychological trauma associated with combat in the wars in Iraq and Afghanistan frequently lead to a constellation of symptoms including pain, post traumatic stress disorder (PTSD), and depression. Method: This single case study describes the application of a behaviorally-based psychotherapy known as behavioral activation for the treatment of post traumatic stress disorder (PTSD) and depressive symptoms in a recent combat veteran with multiple physical injuries sustained from a blast injury. Treatment was provided concurrently with other rehabilitation services and consisted of weekly individual sessions for 4 months, followed by monthly sessions for 4 months. Results: Clinically significant reductions in PTSD and depressive symptoms were noted between baseline and 1 year follow-up. Conclusion: Preliminary evidence from this case suggests that behavioral activation may be a promising treatment for PTSD and depression, and can be readily tailored to in...
Behavior Modification, 2012
Iraq and Afghanistan war veterans experience significant rates of posttraumatic stress disorder (... more Iraq and Afghanistan war veterans experience significant rates of posttraumatic stress disorder (PTSD) and other trauma-related mental health conditions. Understanding how specific PTSD symptomatology affects physical health and psychosocial functioning may be useful in improving the conceptualization of PTSD nosology and informing treatment approaches for this population. Confirmatory factor analytic evidence supports four-factor models of PTSD symptoms that classify emotional numbing and/or dysphoria symptoms as a distinct PTSD symptom cluster, and these symptoms appear to be related to poorer psychological adjustment among returning Iraq and Afghanistan war veterans. This review briefly describes current conceptualizations of numbing/dysphoria symptoms of PTSD and summarizes research on the factor structure of PTSD symptoms. Then, the literature on the influence of numbing/dysphoria symptoms on physical and psychological health among these veterans is reviewed, and implications f...
ABSTRACT The specific aims of this chapter are to review data that advance our understanding of t... more ABSTRACT The specific aims of this chapter are to review data that advance our understanding of the influence of gender on posttraumatic stress disorder (PTSD) differential diagnosis among women, to provide practical guidelines for clinicians involved in assessing female trauma clients, and to identify fruitful directions for future research. We specifically address the issue of gender and differential diagnosis between PTSD and other Axis I disorders by considering (1) the presence and character of a traumatic stressor, (2) the ability of clinicians to discriminate between PTSD and other Axis I disorders, (3) evidence for the conceptual independence of PTSD and frequent comorbidities, and (4) the impact of PTSD compared to other disorders on functional impairment. The differential diagnosis of PTSD and the Axis II disorders also receive significant attention, including gender differences in Axis II patterns, treatment implications related to gender and Axis II diagnoses, and the relationship of complex PTSD to both PTSD and Axis II disorders. This chapter underscores the relationship between PTSD, other Axis I disorders, and the characterological or personality disorders related to reactions to stress or trauma. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Psychiatric Services, 2019
Although evidence-based, trauma-processing treatments exist for posttraumatic stress disorder (PT... more Although evidence-based, trauma-processing treatments exist for posttraumatic stress disorder (PTSD), many individuals do not seek out, complete, or fully respond to these treatments, pointing to the need for alternative treatments. In this study, the authors evaluated the effectiveness of behavioral activation therapy modified to address PTSD among veterans. Methods: In a randomized trial, behavioral activation was compared with treatment as usual (referral to PTSD "standard care") among a sample of 80 veterans of the wars in Iraq and Afghanistan who were enrolled at the U.S. Department of Veterans Affairs (VA) Portland Health Care System and the VA Puget Sound Health Care System. Results: Levels of PTSD symptoms decreased for both groups across posttreatment and at 3-month follow-up as measured by clinical interview and self-report measures. The behavioral activation group had greater improvement on PTSD as evidenced by the self-report measure of symptom severity. Both groups also showed improvement on self-report measures of depression and overall functioning across time, with greater improvement on depression evidenced by the behavioral activation group. Ratings of treatment satisfaction were high for both groups. Conclusions: Behavioral activation is a promising alternative treatment for PTSD.
Proportionate responses to life events influence clinicians' judgments of psychological abnormality.
Journal of family psychology : JFP : journal of the Division of Family Psychology of the American Psychological Association (Division 43), Jan 26, 2016
Despite the availability of evidence-based PTSD treatments at most facilities within the VA Healt... more Despite the availability of evidence-based PTSD treatments at most facilities within the VA Healthcare System, most Iraq and Afghanistan veterans returning from deployments with posttraumatic stress symptoms do not receive an adequate dose of mental health treatment, prompting the need to identify potential barriers to or facilitators of mental health care utilization. Previous research demonstrated self-reported mental health care utilization in the prior year varies as a function of PTSD symptom severity, and the interaction of PTSD symptom severity and romantic relationship satisfaction (Meis et al., 2010). We extended these findings by objectively measuring the degree of utilization over a 1-year period (i.e., number of sessions attended) in a sample of 130 Iraq and Afghanistan veterans who presented to primary care/deployment health and completed an initial mental health evaluation. Results indicated main and interactive effects of PTSD symptom severity and relationship satisfa...
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Papers by Matthew Jakupcak