HRI tests cognitive training program to improve symptoms of PTSD

People diagnosed with Post-Traumatic Stress Disorder (PTSD) often experience changes in cognitive functioning, such as difficulty with memory, attention, concentration, planning and organization.

Despite the fact that these challenges can severely disrupt functioning at work, school, home, or in social settings, few studies have investigated treatments aimed specifically at improving thinking skills among individuals with PTSD.

A new study led by Homewood Research Institute (HRI) and McMaster University is examining the utility of cognitive skills training in reducing symptoms of PTSD, particularly among veterans, military members and first responders. In this study, a cognitive training program called Goal Management Training (GMT) is being offered to people with PTSD for the first time.

GMT has been used successfully in other populations, including people with brain injuries, to improve concentration, memory, and organization. GMT aims to teach individuals how to stop automatic responding, monitor progress on tasks and goals, and achieve those goals.

Early research among inpatients being treated for PTSD at Homewood Health Centre suggested that GMT helps to improve thinking speed, memory and the pursuit of personal goals. GMT also led to reductions in depression and self-reported cognitive difficulties.

The next phase of research is underway. GMT is now being tested among individuals in the community with a history of military-related trauma and those who have worked as public safety personnel, such as firefighters, paramedics or police officers. Researchers predict similar results among this outpatient population. Based on studies to date, GMT holds great promise for improving quality of life and cognitive function for individuals with PTSD.

This work is generously supported by the Cowan Foundation, the Military Casualty Support Foundation, Schlegel Healthcare and the Bickell Foundation.

Do you know someone who could benefit from GMT?

HRI has announced a call for participants in Guelph and the Greater Toronto Area. An experimental trial of GMT will begin in April 2018 at the Homewood Clinic in Mississauga, Ontario.

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New research explores subconscious effects of trauma triggers

Post-traumatic Stress Disorder (PTSD) can occur after a person experiences a traumatic event. Symptoms of PTSD can be debilitating and are often brought on by trauma triggers, or experiences in daily life that cause an individual to recall or re-live a traumatic memory.

Current therapies for trauma-related disorders are designed to treat people who respond to trauma triggers on a conscious level. But what if an individual isn’t aware of his or her trauma triggers? And how does the body respond when trauma triggers or threats are perceived on a subconscious level?

New research led by Dr. Daniela Rabellino, a postdoctoral fellow working alongside Dr. Ruth Lanius, Associate Clinical Scientist at Homewood Research Institute, has uncovered some answers to these important questions. And the findings may have significant implications for the field of trauma treatment.

Dr. Rabellino’s study, Neural and Autonomic Correlates of Post-Traumatic Stress Disorder During Processing of Trauma-Related Stimuli, explores the effects of trauma triggers that are presented to people with PTSD for only a few milliseconds and are thus perceived below the threshold of conscious awareness.

The subconscious processing of trauma triggers had a striking effect on both heart rate – an important measure of emotion regulation – and on the activation of midbrain structures that have been proposed to form the body’s innate “alarm system”. In other words, individuals react reflexively to trauma triggers, even when they are not consciously aware of those triggers.
Dr. Rabellino’s study has important implications for the future of trauma treatment; specifically, treatment must incorporate interventions that directly address the effects of trauma triggers that are not consciously perceived.

Body-oriented interventions, such as mindfulness practices and neurofeedback training – which can target the subconscious processing of trauma – are now being explored as adjunctive treatments for PTSD and other trauma-related disorders.

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HRI research findings featured at national addiction conference

HRI research findings were featured in three presentations at a national conference hosted in Calgary, Alberta by the Canadian Centre on Substance Use and Addiction (CCSA) in November. The Issues of Substance Conference brings together addiction experts, policy makers and researchers to mobilize knowledge in the addiction field to address substance use in Canada. HRI was pleased to share updates and findings from three major projects currently underway.

Recovery Monitoring

Dr. Jean Costello, Research and Evaluation Scientist, and Courtney Ropp, Research Associate, were selected to speak about HRI’s Recovery Monitoring System. Launched as a pilot project at Homewood Health Centre in 2015, Recovery Monitoring involves the routine collection of data from patients discharged from Homewood’s Addiction Medicine Service for up to one year post-discharge to measure and assess outcomes and better understand the process of recovery.

The Recovery Monitoring System is unique in Canada and provides a thorough, ongoing and quantifiable understanding of what happens once patients are discharged from residential care. Data can be used to evaluate program effectiveness, inform quality improvements and enhance mental health and addiction policies in Canada and beyond.

HRI’s presentation focused on key findings at one year post-discharge, including changes in quality of life, social engagement, occupational performance and life satisfaction.

View the Presentation     View Infographic with Key Findings

Patients’ Perceptions of Care

In collaboration with Homewood Health Centre and well-known mental health and addiction scientist, Dr. Brian Rush, HRI is conducting research that examines how a patient’s experience or perception of care during addiction treatment impacts recovery-oriented outcomes after discharge.

Currently there is little evidence within the Canadian addiction service field about the link between a patient’s experience and their outcomes, but HRI is working to change this.

As part of the Recovery Monitoring System implemented in the Addiction Medicine Service at Homewood Health Centre, HRI collects information about a patient’s experience during treatment. Using a standardized evidence-based tool, data is collected at the time of discharge, and again at one month post-discharge, to shed light on the relationship between perceptions of care and post-discharge outcomes in residential care.

A poster presentation at the CCSA conference outlined early findings from HRI’s research, which show that a more positive perception of care at discharge predicts greater adherence to treatment recommendations after discharge, as well as improvements in recovery outcomes such as motivation and quality of life. These findings suggest that the patient experience may have a significant impact on recovery and should be monitored regularly.

Universal Screening

HRI Senior Scientist, Dr. James MacKillop, shared findings from a project that involved screening patients who have been diagnosed with addiction for a secondary – or comorbid – diagnosis of trauma. The study focused on individuals receiving care in an inpatient treatment setting and involved more 500 participants in the Addiction Medicine Service (AMS) at Homewood Health Centre.

Dr. MacKillop’s study provided important insights into the prevalence and severity of comorbid addiction and trauma within the AMS patient population. Specifically, half of the participants reported a significant history of trauma, and a higher number of females (56%) met the threshold for Post-Traumatic Stress Disorder (PTSD) as compared to males (48%).

These findings reveal the importance of screening for comorbid disorders to better inform each patient’s care plan during inpatient treatment.

Dr. MacKillop’s presentation also highlighted the potential for improved care that can result when academic researchers and treatment providers work together more closely.

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HRI Releases Annual Report and Announces New Look

We have released our first Annual Report describing milestones and accomplishments achieved during the 2016-2017 fiscal year.

As we reflect on the past year, we are reminded that we have many reasons to celebrate. To name a few:

  • Our scientists received national funding to support vital research projects aimed at improving treatment for people diagnosed with addiction and PTSD.
  • HRI has established partnerships that will enable us to help military members and veterans suffering from Post-Traumatic Stress Disorder (PTSD) using an innovative cognitive training program. Research will be expanded to include police and first responders.
  • HRI’s Post-Discharge Outcome Monitoring System (PDO) enrolled nearly 1000 participants. The PDO project, which collect evaluates the long-term impacts of addiction treatment, has gained national attention and will be used to inform care across Canada.
  • HRI established a new Strategic Plan to guide our growth over the next five years as we work to build a national enterprise with a more robust research program.

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A New Look for HRI

As HRI embarks on a new and ambitious phase of growth, we are pleased to launch a new brand identity that reflects our sharpened focus on building collaborative networks to bridge research and practice. You will notice that the 2016-2017 Annual Report incorporates our updated branding.

Our new logo signifies our unwavering commitment to making connections and finding solutions. Our icon uses an upward trend line, symbolizing improvement and transformation. Other visual elements, such as brand colours and imagery, represent calmness, hope, strength and impact.  The logo places emphasis on the word research, because research is the foundation on which our organization is built.

Infographic: A Closer Look at the Recovery Journey

HRI has created an infographic summarizing early findings from the Post-Discharge Outcomes Monitoring System (PDO), also known to Homewood patients as the Recovery Journey Project.

The infographic outlines changes in various indicators of recovery between the time of admission and 12-months post-discharge for patients who receive treatment in the Addiction Medicine Service at Homewood Health Centre. It also provides an overview of participant demographics, abstinence trends, and changes in occupational performance, social roles, and overall life satisfaction.

Unique in Canada, HRI’s PDO system supports the comprehensive evaluation of the long-term impacts of treatment interventions. Future directions for this initiative include the expansion and tailoring of the system to measure outcomes among those treated for post-traumatic stress disorder (PTSD) and other mental health conditions. The PDO system provides a thorough and quantifiable understanding of what happens once patients leave residential care and holds great promise for evaluating and informing evidence-based care across Canada.

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Examining the Utility of Mindfulness-based Treatments for PTSD

Post-traumatic Stress Disorder (PTSD) can occur after exposure to a traumatic event, such as witnessing death, serious injury or violence. It causes intrusive symptoms that interfere with daily function and quality of life.

Common treatments for PTSD, including Prolonged Exposure Therapy (PE) and Cognitive Processing Therapy (CPT), have proven effective in reducing symptoms of PTSD. But a substantial number of patients do not fully recover following PE and CPT interventions.

Recent emerging studies indicate that mindfulness-based treatments may prove promising as complementary or alternative approaches to further assist people suffering from PTSD.

PhD Student, Jenna Boyd, in collaboration with HRI scientists Dr. Ruth Lanius and Dr. Margaret McKinnon (Boyd, Lanius, McKinnon, 2017) reviewed treatment literature and neurological evidence regarding mindfulness-based interventions for PTSD. The paper investigates the theoretical basis for the utility of mindfulness-based approaches in the treatment of PTSD, explores the overlap between neurobiological models of PTSD and the neurobiology of mindfulness, and discusses limitations and future directions for the potential efficacy of these approaches in treating PTSD.

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HRI Announces New Strategic Plan

We are pleased to announce that the HRI Board has approved a new Strategic Plan, identifying the strategic priorities that will move us closer to achieving our mission to improve outcomes of mental health and addiction treatments. Over the next five years, HRI will focus on building the foundation for a national enterprise that will help to guide mental health care in Canada into the next decade and beyond.

In preparation for this new phase of growth, HRI has attracted a small core group of international leaders in mental health and addiction research and evaluation. We are now set to build networks around these leaders, establish a national profile, build training programs, and bring researchers and clinical leaders together to co-create programs to improve practice. HRI will serve as a hub for the enabling of both innovative research and enhanced patient care.

“As we build out these networks and programs, we look forward to joining forces with like-minded individuals and organizations, pooling resources to maximize our collective impact in addressing Canada’s mental health and addiction crisis,” says Roy Cameron, Executive Director of HRI.

Strat Plan Summary 11-2017

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Moving Toward a Systematic Understanding of Addiction Care

In 2016, the Canadian Centre on Substance Use and Addiction (CCSA) partnered with the National Recovery Advisory Committee to conduct the first Canadian survey of people in recovery from addiction to drugs and alcohol. Modeled after Life in Recovery (LIR) surveys previously conducted in Australia, the United States and the United Kingdom, CCSA’s LIR study engaged 855 individuals recovering from addiction, and asked them about stigma, barriers to care, the recovery journey, and life in recovery.

CCSA’s Technical Report, released in May 2017, details the results of the Life in Recovery survey. General findings revealed that:

  • Recovery leads to positive citizenship and life outcomes, such as improvements in work, finances, family life and overall health
  • Individuals use a variety of recovery resources, including informal supports (e.g., family and friends, religion and spirituality) and formal recovery programs (e.g., 12-Step support, detoxification programs, residential treatment), and
  • Individuals experience a range of challenges – including financial barriers, stigma, treatment delays, lack of services, and lack of service quality – when seeking treatment.

This survey sheds light on the cost of addiction and the complexity of recovery. Importantly, CCSA notes that recovery from addiction is achievable when people have access to quality, evidence-informed services and supports.

That’s where HRI comes in.

We work to integrate emerging data from studies such as CCSA’s, and from our own research projects, into clinical practice. But we also extend research into the post-discharge phase of treatment, picking up where other studies leave off, to build the data-driven care that benefits individuals struggling with addiction.

HRI’s Post-Discharge Outcomes Monitoring System is unique in Canada and generates data to evaluate the long-term impacts of treatment interventions. This data system will also allow for the development and testing of innovations to improve the treatment experience of patients, generate better outcomes, and offer better value for money – which, according to CCSA’s study – is exactly what Canada needs to advance addiction treatment.

The Life in Recovery survey is an important step toward a systematic understanding of addiction care in Canada. Emerging data gives hope to individuals in recovery and highlights the importance of applied mental health and addictions research in Canada, which is what we do every day at HRI.

Here are a few ways you can get involved and help us move mental health and addiction care forward in Canada: