Twelve years after Washington and Colorado became the first states to legalize recreational marijuana, it’s safe to say that weed is here to stay. report using cannabis in the last month, and believe marijuana products are safe.����

When it comes to the safety of long-term marijuana use among the general population, the jury’s still out. But there are some groups for whom cannabis poses a serious health risk. Among the most vulnerable are young adults with psychosis, who tend to use cannabis at extremely high rates, and whose symptoms can be exacerbated by long-term marijuana use. A team of ����Ӱ�Ӵ�ý researchers is focused on this particular group.��

To effectively treat these patients’ symptoms and improve long-term outcomes, it’s critical for providers to help young adults as quickly as possible after their first psychotic episode. But that’s proven tricky. Current best practices aren’t always effective for young adults with psychosis, who tend to use cannabis for different reasons than their peers and who may feel different effects.��

That leaves mental health care providers with a difficult problem: How can they best discern why their patients use cannabis, and what’s the best way to help them stop?����

UW researchers and from the School of Social Work, and , an associate professor in department of psychiatry and behavioral sciences in the UW School of Medicine, studied and then developed a novel treatment method. A pilot study of 12 people showed the method to be effective, though final results have yet to be published. UW News sat down with the research team to discuss their intervention and why it’s so important to help young people in this group cut down their use.��

Cannabis use is increasing across the board, but the numbers are staggeringly high among young adults with psychosis – you cite statistics estimating that 60-80% have used cannabis at some point in their lifetime. What makes a person experiencing psychosis so much more likely to use cannabis?����

Denise Walker: Many people were probably using cannabis before the onset of their psychosis symptoms, because there is strong research evidence that cannabis increases the risk for developing psychosis-related disorders. For those who do develop a psychosis-related disorder like schizophrenia, continued cannabis use impedes the recovery process and makes outcomes worse. There is still a lot more to learn about the cause and effect of these relationships, but cannabis does seem to have a unique relationship with psychosis.��

Ryan Petros: In addition, there is some evidence to suggest that people with schizophrenia are more prone to feeling bored than people without schizophrenia. In general, a lot of people use cannabis because they like it, and they find the associated high to be fun. It may be that people with schizophrenia-spectrum disorders are more likely to use cannabis to have fun and feel good because they are more likely to feel bored and less likely to feel pleasure in everyday activities. But the fact of the matter is, we don’t really know. Another reason that people use cannabis, in general, is because it facilitates social interactions or provides a shared activity in social settings. Because people with schizophrenia-spectrum disorders have smaller social networks and fewer social engagements, it may be that they use cannabis to facilitate improved social interaction, but here again, we need more research to know with more certainty.��

At the heart of all this research is the different health risks of cannabis use for people with and without psychosis or other mental health challenges. What are those differences, and why is cannabis use among young adults with psychosis particularly concerning?��

RP: For people with a psychosis, cannabis use is associated with higher rates of dropping from treatment and decreased adherence to medication. It leads to increased symptoms of psychosis and higher rates of psychiatric rehospitalization. In the long –term, cannabis use increases the risk of poor psychosocial outcomes and diminished overall functioning.��

DW: Essentially, continued cannabis use makes it much harder for young adults with psychosis to take advantage of treatment, make strides in their recovery and, ultimately, get on with having the life they want.��

RP: Another major reason for concern is that not only is cannabis use on the rise, people also have progressively adopted more tolerant attitudes toward cannabis. Cannabis has recently overtaken alcohol as the drug most often used on a daily basis in the United States. While some people can use cannabis without a problem, it’s recommended that some others abstain from using at all.�� Over time, however, people have come to believe that cannabis use has health benefits, and they are less likely to perceive risks of use. This may result in a particularly challenging set of circumstances for helping someone with psychosis to learn about the real risks that cannabis use has for their health and wellness and to make the choice to reduce or abstain from use.��

DW: I agree. Perceptions surrounding cannabis are often polarized – it is often viewed as either “good” or “bad,” when in reality, it’s somewhere in the middle. There can be benefits for some to use cannabis and real risks of harm for others. These mixed messages, or at least the lack of acknowledgement of harms, contribute to continued hardship for those experiencing psychosis and their families.��

What methods are currently recommended to help people reduce their cannabis use, and why might those not be as effective for young adults with psychosis?����

DW: The gold standard treatment includes a combination of motivational enhancement therapy (MET), cognitive behavioral therapy (CBT), and contingency management. Contingency management is often not available in the community, and studies show that MET plus CBT perform almost as well. Because it is normal for motivation to wax and wane for someone contemplating changing their cannabis use, MET addresses the issue of motivation early on. CBT teaches skills to avoid drug use, cope with social situations and negative moods, and solve problems without the use of cannabis. Family therapy is another option with strong support.����

The big problem is that we don’t know if these treatments are effective for young adults with psychosis.�� MET is the most studied intervention in cannabis treatment, alone and in combination; however, it has not been tested with young adults with psychosis.�� With a few optimizations, we believe that it could perform even better than with the general population, and we have begun to test it with young adults with psychosis.��

Your team has developed an intervention for young adults with psychosis that incorporates MET. Can you describe what that intervention looks like, and why it might be more effective for this population?����

DW: MET is a person-centered, nonjudgmental approach that facilitates an honest and candid discussion about cannabis use. The techniques are intended to draw out the individuals’ personal reasons for making a change and to grow their motivation to do so. Individualized feedback is created based on a client’s responses to an assessment of their cannabis use and related experiences and summarizes information about their cannabis use patterns, how their cannabis use compares with others, and their risk factors for developing a cannabis use disorder. It also provides an opportunity for clients to think about their personal goals and how their cannabis use promotes or detracts from their ability to attain those goals.����

When we asked young adults with psychosis what they wanted in a cannabis intervention, they were clear that they wanted an individualized and nonjudgmental approach. They also said they wanted accurate and science-based information about the relationship between cannabis and psychosis. MET ticks those boxes. With a few adaptations, it is an ideal format for providing objective information, while also inviting the young adult to talk it through and consider what the information means to them personally.��

Currently, providers are giving the message to patients that cannabis is harmful for those with psychosis, which is a great start.�� But most providers don’t feel confident discussing why cannabis is harmful and what the research has found.�� My sense is that patients often take that message and defend against it with their own personal experiences of what they like about cannabis. MET offers an invitation to receive and discuss objective evidence, consider their own experiences of how cannabis affects their symptoms and what they want for their future, and do so in a supportive environment that allows for looking at their use from a variety of perspectives.������

You ran a pilot program to understand how the new intervention works. What did you learn in that pilot study?����

DW: We adapted the MET intervention to include personalized feedback on the interaction between cannabis and psychosis and included some graphics and ideas about ways to reduce those risks in addition to abstinence. Twelve young adults experiencing psychosis who used cannabis regularly enrolled in the study and were offered the intervention.��Most of the participants were not interested in changing their use of cannabis at the outset of the study, and by the end, several chose to reduce their cannabis use.��

Overall, the feedback was very positive. Participants overwhelmingly said they would recommend the intervention and would retain the psychosis specific pieces of the conversation. They appreciated the data that was included and the opportunity to discuss what it meant for them. They also said they enjoyed talking about how cannabis fits into their larger life and goals for the future. Overall, the feedback suggests this intervention has promise and should be studied in a larger trial.��

Maria Monroe-DeVita: My long-term goal would be to offer this new intervention either in addition to, or integrated within, the evidence-based package of services known to work best for individuals experiencing first episode psychosis.��

is a research professor in the UW School of Social Work, is an associate professor in the UW School of Social Work, and is an associate professor of psychiatry and behavioral sciences in the UW School of Medicine.����

For more information or to reach the researchers, contact Alden Woods at acwoods@uw.edu.��

UPDATE (Aug. 2, 2024): A previous version of this story misstated Paul Kinahan’s name.

Fifteen faculty members at the ����Ӱ�Ӵ�ý have been elected to the Washington State Academy of Sciences. They are among 36 scientists and educators from across the state . Selection recognizes the new members’ “outstanding record of scientific and technical achievement, and their willingness to work on behalf of the academy to bring the best available science to bear on issues within the state of Washington.”

Twelve UW faculty members were selected by current WSAS members. They are:

• , associate professor of epidemiology, of health systems and population health, and of child, family and population health nursing, who “possesses the rare combination of scientific rigor and courageous commitment to local community health. Identifying original ways to examine questions, and seeking out appropriate scientific methods to study those questions, allow her to translate research to collaborative community interventions with a direct impact on the health of communities.”
• , the Shauna C. Larson endowed chair in learning sciences, for “his work in the cultural basis of scientific research and learning, bringing rigor and light to multiculturalism in science and STEM education through STEM Teaching Tools and other programs.”
• , professor of psychiatry and behavioral sciences, “for her sustained commitment to community-engaged, science-driven practice and policy change related to the prevention of suicide and the promotion of mental health, with a focus on providing effective, sustainable and culturally appropriate care to people with serious mental illness.”
• , the David and Nancy Auth endowed professor in bioengineering, who has “charted new paths for 30-plus years. Her quest to deeply understand protein folding/unfolding and the link to amyloid diseases has propelled her to pioneer unique computational and experimental methods leading to the discovery and characterization of a new protein structure linked to toxicity early in amyloidogenesis.”
• , professor of environmental and occupational health sciences, of global health, and of emergency medicine, who is “a global and national leader at the intersection of climate change and health whose work has advanced our understanding of climate change health effects and has informed the design of preparedness and disaster response planning in Washington state, nationally and globally.”
• , professor of bioengineering and of radiology, who is “recognized for his contributions to the science and engineering of medical imaging systems and for leadership in national programs and professional and scientific societies advancing the capabilities of medical imaging.”
• , the Donald W. and Ruth Mary Close professor of electrical and computer engineering and faculty member in the UW Clean Energy Institute, who is “recognized for his distinguished research contributions to the design and operation of economical, reliable and environmentally sustainable power systems, and the development of influential educational materials used to train the next generation of power engineers.”
• , senior vice president and director of the Vaccine and Infectious Disease Division at the Fred Hutchinson Cancer Center, the Joel D. Meyers endowed chair of clinical research and of vaccine and infectious disease at Fred Hutch, and UW professor of medicine, who is “is recognized for her seminal contributions to developing validated laboratory methods for interrogating cellular and humoral immune responses to HIV, TB and COVID-19 vaccines, which has led to the analysis of more than 100 vaccine and monoclonal antibody trials for nearly three decades, including evidence of T-cell immune responses as a correlate of vaccine protection.”
• , professor of political science and the Walker family professor for the arts and sciences, who is a specialist “in environmental politics, international political economy, and the politics of nonprofit organizations. He is widely recognized as a leader in the field of environmental politics, best known for his path-breaking research on the role firms and nongovernmental organizations can play in promoting more stringent regulatory standards.”
• , the Ballmer endowed dean of social work, for investigations of “how inequality, in its many forms, affects health, illness and quality of life. He has developed unique conceptual frameworks to investigate how race, ethnicity and immigration are associated with health and social outcomes.”
• , professor of chemistry, who is elected “for distinguished scientific and community contributions to advancing the field of electron paramagnetic resonance spectroscopy, which have transformed how researchers worldwide analyze data.”
• , professor of bioengineering and of ophthalmology, whose “pioneering work in biomedical optics, including the invention of optical microangiography and development of novel imaging technologies, has transformed clinical practice, significantly improving patient outcomes. Through his numerous publications, patents and clinical translations, his research has helped shape the field of biomedical optics.”

Three new UW members of the academy were selected by virtue of their previous election to one of the National Academies. They are:

• , professor of atmospheric and climate science, who had been elected to the National Academy of Sciences “for contributions to research and expertise in atmospheric radiation and cloud processes, remote sensing, cloud/aerosol/radiation/climate interactions, stratospheric circulation and stratosphere-troposphere exchanges and coupling, and climate change.”
• , the Bartley Dobb professor for the study and prevention of violence in the Department of Epidemiology and a UW professor of pediatrics, who had been elected to the National Academy of Medicine “for being a national public health leader whose innovative and multidisciplinary research to integrate data across the health care system and criminal legal system has deepened our understanding of the risk and consequences of firearm-related harm and informed policies and programs to reduce its burden, especially among underserved communities and populations.”
• , division chief of general pediatrics at Seattle Children’s Hospital and a UW professor of pediatrics, who had been elected to the National Academy of Medicine “for her leadership in advancing child health equity through scholarship in community-partnered design of innovative care models in pediatric primary care. Her work has transformed our understanding of how to deliver child preventive health care during the critical early childhood period to achieve equitable health outcomes and reduce disparities.”

In addition, Dr. , president and director of the Fred Hutchinson Cancer Center and of the Cancer Consortium — a partnership between the UW, Seattle Children’s Hospital and Fred Hutch — was elected to the academy for being “part of a research effort that found mutations in the cell-surface protein epidermal growth factor receptor (EGFR), which plays an important role in helping lung cancer cells survive. Today, drugs that target EGFR can dramatically change outcomes for lung cancer patients by slowing the progression of the cancer.”

the Boeing-Egtvedt endowed professor and chair in aeronautics and astronautics, will join the board effective Sept. 30. Morgansen was elected to WSAS in 2021 “for significant advances in nonlinear methods for integrated sensing and control in engineered, bioinspired and biological flight systems,” and “for leadership in cross-disciplinary aerospace workforce development.” She is currently director of the Washington NASA Space Grant Consortium, co-director of the UW Space Policy and Research Center and chair of the AIAA Aerospace Department Chairs Association. She is also a member of the WSAS education committee.

“I am excited to serve on the WSAS board and work with WSAS members to leverage and grow WSAS’s impact by identifying new opportunities for WSAS to collaborate and partner with the state in addressing the state’s needs,” said Morgansen.

The new members to the Washington State Academy of Sciences will be formally inducted in September.

Most people who die by suicide in the year before their deaths – but only about one-third have received mental health services. This means that primary care and emergency room doctors, nurses and other specialists may be more often positioned to evaluate a person in crisis.

After Washington in 2012 became the first state to require suicide prevention training for health care professionals, the ����Ӱ�Ӵ�ý developed a program, , to help providers identify people at risk of suicide.

A , published online June 23 in the journal Psychiatric Services, finds large-scale training in this critical work is possible. The first wave of health care professionals to try All Patients Safe also report improved understanding of suicide and how to respond to people at risk.

“The results suggest that it is possible to provide high-quality training to health care professionals about suicide, which is an important but not sufficient step in the prevention of suicide,” said , associate professor of social work at the UW and the study’s lead author. “It’s also essential to look at systems and policies to ensure there is maximum support for health care professionals to implement the clinical skills they were taught in the training.”

, according to the Centers for Disease Control and Prevention. It is among the leading causes of death for teens.

Stuber, who co-founded at the UW, helped push for the Washington state legislation to train health care providers, following the death of her husband by suicide. The law is named for him. A few years after passage, the law was amended to include all licensed health care providers – not just behavioral health specialists – in the requirement for training. Behavioral health specialists must participate in training every six years, whereas other health professionals must take a course only once.

In addition to Washington, 17 other states encourage or require such training for health care providers.

All Patients Safe was developed in collaboration with a variety of experts and heath care organizations, including the UW AIMS Center, and is one of a few dozen suicide prevention trainings that have been approved by the Washington State Department of Health.

Administered online in three- and six-hour versions, All Patients Safe is structured in modules and uses case-based materials and videos that model provider-patient interactions. The aim is to educate and empower providers to identify at-risk behaviors and to discuss with their patients, among other things, limiting access to lethal means.

Between November 2018 and December 2020, more than 1,500 providers completed the six-hour course and a pre-training survey. Just over half filled out a post-training survey and were included in the new study. Participants were asked about their understanding of and confidence in addressing a number of topics with a patient, including storage of medication and firearms, and thoughts of suicide.

Results from that survey showed improved levels of confidence and understanding in all areas. For example, the number of respondents who believed they could identify warning signs of suicide increased by 60%, while confidence in asking about medication and firearms also rose.

Researchers say the results indicate at least a short-term knowledge gain, as well as the potential for delivering the training to large numbers of providers. They say more study is warranted on the longer-term efficacy of the training in specific health care settings.

Co-authors were Sarah Porter of the UW School of Social Work; Anne Massey of the UW School of Public Health; and and of the UW Department of Psychiatry and Behavioral Sciences.

For more information, contact Stuber at jstuber@uw.edu.

Now, a new meta-analysis of 38 studies finds consistent results and themes: that people engage in self-injury and/or think about suicide to alleviate some types of stress; and that the perceived stress relief that results from thoughts and behaviors indicates potential for therapy and other interventions.

Over the past 10 years, researchers have started to ask people at risk of suicide to complete surveys multiple times per day. This type of data allows for researchers to understand the thoughts, emotions and behaviors that precede self-injurious thoughts and actions. The ����Ӱ�Ӵ�ý conducted the data aggregation of these types of studies involving more than 1,600 participants around the world. It was published April 28 in .

“Many researchers have been collecting this data and testing for the same finding, but there were mixed findings across studies. We wanted to see if we saw this effect when we combined these datasets,” said , lead author of the meta-analysis and a UW doctoral student in clinical psychology.

With suicide and the role of self-harm, or non-suicidal self-injury (NSSI), as a risk factor, Kuehn and his team wanted to look collectively at separate studies of NSSI and suicidal thoughts. By analyzing data of individual participants in these studies, the UW researchers found that high levels of emotional distress precede both self-injury and suicidal thoughts, followed by reduced stress.

Researchers point to additional data on suicide — that , for example — and consistent findings from the meta-analysis that stress precedes self-injury.

They say this can inform prevention and intervention efforts, such as learning how to replace self-injury and suicidal thoughts with other means of reducing stress.

“The good news is that we have effective behavioral interventions, such as cognitive behavioral therapy and dialectical behavioral therapy, which teach skills for managing intense emotions to replace self-injurious thoughts and behaviors. Increasing access to these types of treatments is likely to reduce the prevalence of them,” Kuehn said.

One limit of the meta-analysis, researchers said, is that participants in the various studies were predominantly young white women. Further research into self-injury and related thoughts and behaviors should focus on increasing the age, gender and racial and ethnic diversity of study samples. In addition, the meta-analysis found only modest evidence that stress, while a connection to self-harm, could be used as a means for predicting when an individual might injure themselves. Future studies could try to identify more precisely when and how stress leads to self-injurious thoughts and behaviors.

The research was funded by the National Institute of Mental Health. Co-authors were Jonas Dora, Katherine Foster, Frank Song, Michele Smith and Kevin King of the UW Department of Psychology; and Melanie Harned of the UW Department of Psychiatry and Behavioral Sciences and the Veterans Affairs Puget Sound Health Care System.

For more information, contact Kuehn at kskuehn@uw.edu.

Months into the pandemic, as restrictions loosen and more people venture out, families and friends may confront differences over what’s necessary, safe or comfortable.

So many questions and choices: Attend a child’s birthday party? Host a backyard barbecue? Meet for a drink? Hug a relative?

Decline, and you risk hurt feelings; accept, and you may expose yourself and your loved ones to risk, increase the risk for your community, and feel judged by others in the process.

All are natural experiences during the pandemic, ����Ӱ�Ӵ�ý psychologists say, but there are ways to approach interactions with friends and loved ones, and to reflect on your own feelings, that can provide a positive path forward and help maintain healthy relationships.

“Effective communication skills are key to navigating conflicts around COVID-related attitudes,” said , a doctoral student in the UW Center for Anxiety & Traumatic Stress. Consider the goal for an interaction. Maybe you simply want to explain how you’re feeling, and that maintaining the friendship or relationship is the priority.

Rosencrans recommends speaking with a respectful tone and an easy manner, listening actively, with interest, and really trying to understand the other person’s point of view. Use humor when appropriate. Smile genuinely. Think of it as the “soft sell” approach, rather than the hard sell, he said.

Key to that approach is trying not to judge others for the decisions they feel are best for them, said , an associate professor of psychiatry and behavioral sciences in the UW School of Medicine.

“These things are going to differ greatly from person to person. A little empathy and understanding goes a long way,” she said.

For example, everyone has a different level of risk at which they are comfortable, said psychology professor . People take “reasonable” risks of all kinds every day, balancing a need or want with the possibility of rejection, loss or danger. Letting a newly licensed teenager drive the car, for example, can be considered a reasonable risk.

A deadly pandemic, of course, carries with it other risks. People face differing degrees of risk related to COVID-19, due to age, underlying health conditions and other factors. If someone believes they are less likely to suffer severe consequences from contracting coronavirus, then they may be more willing to take risks that expose themselves, noted Bedard-Gilligan.

The difficult conversations can arise when someone’s behavior endangers others, she added. Arguing or trying to engender fear is unlikely to work. You can attempt a rational discussion with that person, or focus instead on what you can control in your own life, and the behaviors and limits that work for you.

Following public health guidelines should be paramount, and doing whatever possible to minimize risk to the community, said , a UW research associate professor of psychology who’s leading both King County and national studies into how people are coping with the physical isolation of lockdown restrictions.

“When we experience others not following guidelines, we have choices to make, and they’re not easy,” Kanter said. “Do we feel a responsibility to speak up? Will we be effective, or just start an argument that won’t change behavior in any event? Do we have a handle on why we’re feeling what we’re feeling, and are we coming from a sense of values and purpose, or are we just reacting out of anger?”

People are feeling a responsibility to step up because of a lack of leadership, but they don’t necessarily know how to be effective, or even why other people aren’t adhering to the guidelines.

Researchers say there could be more, and perhaps better, public health messaging to educate the public. Simoni, who specializes in community and health psychology, said that in the early years of the AIDS epidemic, solely disseminating information about the risks of HIV wasn’t enough. Public health interventions needed to promote not only the knowledge of what was necessary to stay safe, but also the motivation and skills needed to effectively change behaviors. This also had to be done at many levels: individuals, health providers and systems, and communities. Today, the mitigation strategies around coronavirus – the importance of wearing masks, testing and contact tracing – require the same coordination at the individual, health provider and community levels.

Fear and a lack of control tend to guide our responses, Simoni said.

“There are a variety of reasonable reactions to the pandemic. Try to have compassion and patience with other people. We share more in common than we think,” she said.

In her own life right now, Simoni said, she feels comfortable playing tennis, but other tennis-playing friends don’t. “We all agreed not to judge each other. Everyone has to feel comfortable and supported in their choices,” she said.

What about when the situation is more adversarial? Say you’re asking someone to change their behavior, or standing your ground.

Speak matter-of-factly, and nonjudgmentally, Rosencrans said. Be clear and direct about your feelings and beliefs about the situation; don’t assume the other person knows. Explicitly ask for what you want.

“Keep the conversation focused on your goals,” he said. “But potentially be willing to negotiate, while also having a clear sense of your limits.” In the end, focus on what works, and try not to let the desire to be “right” on every point of disagreement get in the way of being effective.

In all, UW professors make up one-third of the 24 new members, who will be formally inducted in September during an annual meeting at the Museum of Flight in Seattle.

Elected by current members of the Washington State Academy of Sciences:

• , professor of environmental and occupational health sciences
• , associate dean for faculty affairs and professor in the Evans School of Public Policy & Governance
• , professor of chemistry
• , professor of electrical and computer engineering and associate vice provost of research
• , professor and chair of mechanical engineering
• , professor of physics at the UW Institute for Nuclear Theory
• , professor of pharmacology and of psychiatry and behavioral sciences

Additionally, , professor of atmospheric sciences and of applied mathematics, was elected to the state academy by virtue of his election into the National Academy of Sciences.

A multiyear clinical trial comparing medication and mental health counseling in the treatment of post-traumatic stress disorder shows that patients who chose their form of treatment — whether drugs or therapy — improved more than those who were simply prescribed one or the other regardless of the patient’s preference.

The study, led by the ����Ӱ�Ӵ�ý and Case Western Reserve University, was conducted at outpatient clinics in Seattle and Cleveland. It found that both a medication — Sertraline, marketed as Zoloft — and a specific form a therapy known as prolonged exposure were effective in reducing PTSD symptoms during the course of treatment, with improvements maintained at least two years later. But patients who received their choice between the two possible treatments showed greater reduction in symptoms, were more apt to stick to their treatment program and even lost their PTSD diagnosis over time.

The , published Oct. 19 in the American Journal of Psychiatry, is the first large-scale trial of hundreds of PTSD patients, including veterans and survivors of sexual assault, to measure whether patient preference in the course of treatment impacts the effectiveness of a type of ��cognitive behavioral therapy and use of selective serotonin reuptake inhibitors, a type of antidepressant often prescribed for PTSD.

“In any form of health care, when receiving a recommendation from a provider, patients may or may not be given a choice of approaches to address their problems,” said the study’s lead author, ��, a UW professor of psychology and director of the . “This research suggests that prolonged exposure and Sertraline are both good, evidence-based options for PTSD treatment — and that providing information to make an informed choice enhances long-term outcomes.”

The 200 subjects in the study, all adults, had been diagnosed with chronic PTSD. At the start of the study, all participants expressed a treatment preference between two options — medication or 10 weeks of therapy — at the outset of the trial. The study was doubly randomized, meaning that participants were randomly assigned to a group in which they received their preferred treatment, or to a group in which they were also randomly assigned to one treatment program or the other. All participants were evaluated by clinicians for PTSD symptoms, along with the patients’ own reports of feelings and behaviors, before, immediately after, and at three, six, 12 and 24 months later.

In this study, 61 percent of participants expressed a preference for prolonged exposure therapy. is often used to treat PTSD because it encourages patients to talk about what happened to them, learn coping strategies and explore their thoughts and feelings through repeatedly approaching the trauma memory and reminders of the trauma.

Of those participants who received prolonged exposure therapy, nearly 70 percent were determined to be free of their PTSD diagnosis two years after the therapy ended, compared with 55 percent of those who had taken and stayed on Sertraline through the follow-up.

Comparing medication to psychotherapy is rare in a clinical trial because it is time- and labor-intensive, Zoellner explained. In this case, both treatments had positive effects, though therapy demonstrated a slight edge.

“When both interventions reduce symptoms, it is often difficult to detect a difference because of patients’ varying responses — some get a lot better, some do not.�� This study showed both prolonged exposure and Sertraline provide generally large and clinically meaningful effects to reduce PTSD and related symptoms,” she said. “Prolonged exposure psychotherapy for PTSD is as good as Sertraline, if not better, for the treatment of PTSD.”

When treatment preference is taken into account, results are more dramatic. Of those who wanted and received therapy, 74 percent had lost their PTSD diagnosis two years later; of those who preferred therapy but received medication instead, only 37 percent were PTSD-free after two years.

Whether patients received their choice of treatment appeared to directly affect their commitment: Nearly 75 percent of those who were “matched” with their preferred method completed their full treatment program, while more than half of those who were “mismatched” with a treatment method did not complete that course of treatment.

Though PTSD is commonly associated with combat veterans, more than half the participants in the study were diagnosed with chronic PTSD due to a sexual assault, in either childhood or adulthood. Three-quarters of participants were women.

Not all survivors of sexual assault have PTSD or depression, Zoellner pointed out, but those who do may not know that short-term therapy or a medication can yield significant long-term benefits.

“Sexual assault often has a long-term impact on the trauma survivor, but for many it need not be in the form of chronic psychiatric problems,” she said. “Survivors should know good, short options exist and need not suffer in silence.”

, released in 2014, showed that patient choice in treatment also saved money, in the form of fewer emergency department visits, hospitalizations and other care, as well as indirect savings such as fewer lost work hours.

Overall, the trial indicates the importance of tailoring PTSD treatment to the patient, said study co-author , a psychology professor at Case Western Reserve University.

“Dr. Zoellner and our team showed that we’ve got two effective, very different interventions for chronic PTSD and associated difficulties,” Feeny said. “Given this, and the fact that getting a treatment you prefer confers significant benefit, we are now able to move toward better personalized treatment for those suffering after trauma. These findings have significant public health impact and should inform practice.”

Other authors of the study were , a UW emeritus professor of psychiatry in private practice; and , a professor of psychiatry at Case Western Reserve University.

The study was funded by the National Institute of Mental Health. Pfizer supplied the medication for the study.

###

For more information, contact Zoellner at zoellner@uw.edu or 206-685-3126.

Grant numbers: R01MH066347, R01MH066348, UL1 RR024989

Humans’ ability to notice moving objects has always been a useful skill, from avoiding an animal predator in ancient times to crossing a busy street in the modern world.

That evolutionary success attests to the importance of visual motion processing, and why there may be specialized regions of the brain specifically dedicated to this function, researchers say. ��To shed light on how neurons respond in these regions, researchers can look for small differences in motion perception among groups of people.

One of those perceptual differences may be between the sexes.

In an published Aug. 16 in Current Biology, a ����Ӱ�Ӵ�ý-led team of researchers says that on average, men pick up on visual motion significantly faster than women do.

The study, which involved more than 250 adult men and women, shows that both males and females are good at reporting whether black and white bars on a screen are moving to the left or to the right — requiring only a tenth of a second and often much less to make the right call. But, compared to men, women regularly took about 25 to 75 percent longer.

The researchers say that the faster perception of motion by males may not necessarily reflect “better” visual processing. They note that faster motion processing has been observed in individuals diagnosed with autism spectrum disorder (ASD), depression, and in older individuals. All three of these conditions have been linked to disruptions in the brain’s ability to “put the brakes” on neural activity. The authors speculate that this regulatory process may also be weaker in the male brain, allowing males to process visual motion faster than females.

“We were very surprised,” UW psychology professor said. “There is very little evidence for sex differences in low-level visual processing, especially differences as large as those we found in our study.”

Murray and co-author Duje Tadin of the University of Rochester say that the finding was “entirely serendipitous.” They were using the visual motion task to study processing differences in individuals with ASD. Because boys are about four times more likely to be diagnosed with ASD than girls, the researchers included sex as a factor in their analysis of the control group, the members of which did not have ASD. The sex difference in visual perception of motion became immediately apparent.

To confirm the findings, the researchers asked other investigators who had used the same task in their own experiments for additional data representing larger numbers of study participants. And those independent data showed the same sex difference pattern.

The researchers aren’t quite sure where these differences are coming from. So far, the difference between males and females appears to be specific to motion – there were no differences in performance in tasks that involved other types of visual information. The differences aren’t apparent in functional MRI scans of the brain, either.

Overall, according to the study, the results show how sex differences can manifest unexpectedly. The results also highlight the importance of considering sex as a potential factor in any study of perception or cognition.

These findings come as evidence that visual processing differs in males and females in ways that hadn’t been recognized, according to the researchers. The results also provide a new window into differences in neural mechanisms that process visual information, Tadin said.

In further studies, the researchers hope to discover the underlying differences in the brain that may explain this discrepancy in visual motion processing between males and females. Because brain images of the key motion-processing areas haven’t offered up any clues, the difference may originate in other portions of the brain or may be difficult to measure using current techniques. Ultimately, researchers say, this research might even yield new clues for understanding a vexing question: why ASD is more common in males.

The study was funded by the National Institutes of Health. Other co-authors were , a professor in the UW Department of Psychiatry & Behavioral Sciences; postdoctoral researcher Tamar Kolodny, former postdoctoral researcher Rachel Millin and former research assistant Alex Kale, all in the UW Department of Psychology; Michael-Paul Schallmo of the University of Minnesota; Philipp Thomas and Thomas Rammsayer of the University of Bern, in Switzerland; and Stefan Troche of the University of Witten/Herdecke, in Germany.

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For more information, contact Murray at somurray@uw.edu or Tadin at dtadin@ur.rochester.edu.

Adapted from a release by Cell Press.

As the war in Afghanistan enters its 17^th year – it’s often labeled America’s longest war – an estimated have post-traumatic stress disorder.

But PTSD symptoms of anxiety, sleeplessness and anger aren’t, of course, relegated to those who served in the Middle East, or even in combat. Veterans have a than the general population, among which an estimated 7 percent will experience symptoms at some point during their lives. Research has shown, too, that service members have a than those without military experience.

Yet many service members don’t seek help, because they think it’s unlikely to work, they fear damage to their career, or they simply don’t know where to turn.

Now the ����Ӱ�Ӵ�ý is launching a study to identify soldiers experiencing post-traumatic stress symptoms and to determine whether free, confidential, over-the-phone counseling can help them navigate resources and spur them to seek further support.

is recruiting active-duty personnel to participate in the study, which involves three counseling sessions over two months, as well as four follow-up assessments within the first six months, all by phone.

“There are a lot of barriers to seeking care in the military,” said , a research associate professor in the UW School of Social Work. “Soldiers are worried about it going on their record, losing their security clearance, or risking a promotion. But with PTSD, like substance abuse, if you seek treatment earlier, you can get your life back sooner.”

In recent years, Walker led a similar UW study involving soldiers, known as the , which used a phone-counseling intervention to address excessive alcohol use. Participants in that study cut their drinking in half by the end of six months – an example of a “self-change,” in which a person can take action to adjust his or her own behavior.

“In this trial, the target is different. The ultimate outcome is for people to seek additional resources and to resolve their ambivalence about doing that. If they could just stop having PTSD, they would have done so,” explained Walker, who is leading the study with , a UW professor of psychiatry and behavioral sciences.

“This is an opportunity for them to talk about the symptoms related to the traumatic event, how that experience has gotten in their way, or is getting in the way of relationships, work and school, in an effort to help them weigh the pros and cons of seeking help,” Walker said.

Soldiers receive up to $200 for their participation. The study is funded by the U.S. Department of Defense.

To participate, call 1-866-866-0137, email ucheckup@uw.edu or visit . For more information, contact Walker at ddwalker@uw.edu or 206-543-7511, or Kaysen at dkaysen@uw.edu or 206-221-4657.

Neighborhoods with greater poverty and disorganization may play a greater role in problem drinking than the availability of bars and stores that sell hard liquor, a ����Ӱ�Ӵ�ý-led study has found.

While there is evidence for the link between neighborhood poverty and alcohol use, the new twist — that socioeconomics are more powerful environmental factors than even access to the substance itself — suggests that improving a neighborhood’s quality of life can yield a range of benefits.

“Is there something about the neighborhood itself that can lead to problems? As we learn more about those neighborhood factors that are relevant, then this might point to population-level strategies to modify or improve the environments where people live,” said , a research assistant professor in the Department of Psychiatry & Behavioral Sciences.

A common way to think of such broader changes is the “” theory of maintaining neighborhoods to deter crime. In other words, implementing programs, services or clean-up efforts to improve a neighborhood could help attain another goal: reducing problem drinking.

The UW was published online May 8 in the Journal of Urban Health.

In examining the combination of multiple neighborhood factors on alcohol use, UW researchers turned to an ongoing research study of adults the university’s has followed for decades. They interviewed more than 500 of the adults in the study, who were first identified as fifth-graders in Seattle elementary schools and now live throughout King County. In this neighborhood study, 48 percent of participants were women; people of color made up nearly 60 percent of respondents.

Researchers determined the U.S. Census Block Group (a geographic area of roughly 1,000 people) of each participant’s residence, along with demographic data tied to that area and the number of locations that sold hard alcohol there. Participants also answered a series of questions about their alcohol consumption and their perceptions of their neighborhood.

This information allowed researchers to classify neighborhoods according to poverty level, alcohol availability (location of bars and liquor stores) and “disorganization,” which included factors such as crime, drug selling and graffiti.

The ability to consider a number of neighborhood characteristics simultaneously and to identify patterns of how these characteristics grouped together to form distinct neighborhood types made this study different from others that might focus on the impact of, say, poverty alone, Rhew said.

And while poverty and disorganization often are assumed to go hand-in-hand, that’s not always the case, added study co-author , a research scientist in the UW School of Social Work. A socioeconomically disadvantaged neighborhood might also be highly organized, with strong leaders, a sense of identity and various programs and services for residents. At the same time, a low-poverty neighborhood might be highly disorganized, with a lack of resources or sense of community, or a few streets with more trouble than others.

In this study, researchers found that residents of neighborhoods primarily characterized by high poverty and disorganization tended to drink twice as much in a typical week as those in other types of neighborhoods. Binge-drinking — generally defined as more than four drinks at a time for women, five for men — occurred in these high-poverty, highly disorganized communities about four times as frequently as in other types of neighborhoods. These findings are consistent with previous research indicating that people in lower income neighborhoods may be at greater risk for alcohol-related problems, Rhew said.

What’s different, Rhew and Kosterman agreed, is the fact that neighborhoods characterized by greater alcohol availability showed no increased alcohol use among residents — suggesting that socioeconomic factors may pose a greater risk for substance abuse.

“On its face, the connection between poverty and disorganization and alcohol use may not be all that surprising, but when you find that this connection may be even more important than the location of bars and liquor stores, then it’s those characteristics of a neighborhood that we want to pay attention to,” Kosterman said.

Researchers pointed to an important change that has occurred since their original data was collected: in 2011 privatizing liquor sales. The went from a little more than 300 state-run stores to some 1,500 pharmacies, grocery stores and warehouse clubs.

“People who utilize the outlets aren’t just people from the neighborhood. We see stronger evidence of the link between where alcohol is sold and other problems such as violence, crime, and drinking and driving, but not necessarily consumption,” he added.

The ability, thanks to recent funding, to overlay neighborhood data with the longitudinal Seattle Social Development Project — the study of 808 individuals begun in 1985 — presents opportunities for future analyses of a variety of behaviors and circumstances, the researchers said.

The other co-author was Jungeun Olivia Lee at the USC School of Social Work. This study was funded by the National Institute on Drug Abuse.

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For more information, contact Rhew at 206-221-1897 or rhew@uw.edu, or Kosterman at 206-543-4546 or rickk@uw.edu.

Grant numbers: RO1DA033956, RO1DA09679