Showing papers in "European Journal of Psychotraumatology in 2012"
TL;DR: Trauma informed care demonstrates promise in increasing offender responsivity to evidence-based cognitive behavioral programming that reduces criminal risk factors and supporting integrated programming for offenders with substance abuse and co-occurring disorders.
Abstract: Background: Rates of posttraumatic stress disorder and exposure to violence among incarcerated males and females in the US are exponentially higher than rates among the general population; yet, abrupt detoxification from substances, the pervasive authoritative presence and sensory and environmental trauma triggers can pose a threat to individual and institutional stability during incarceration. Objective: The authors explore the unique challenges and promises of trauma-informed correctional care and suggest strategies for administrative support, staff development, programming, and relevant clinical approaches. Method: A review of literature includes a comparison of gendered responses, implications for men’s facilities, and the compatibility of trauma recovery goals and forensic programming goals. Results: Trauma-informed care demonstrates promise in increasing offender responsivity to evidence-based cognitive behavioral programming that reduces criminal risk factors and in supporting integrated programming for offenders with substance abuse and co-occurring disorders. Conclusions: Incorporating trauma recovery principles into correctional environments requires an understanding of criminal justice priorities, workforce development, and specific approaches to screening, assessment, and programming that unify the goals of clinical and security staff. Keywords: trauma; incarceration; criminal justice; PTSD; substance abuse; treatment (Published: 30 March 2012) Citation: European Journal of Psychotraumatology 2012, 3 : 17246 - DOI: 10.3402/ejpt.v3i0.17246 For the abstract or full text in other languages, please see Supplementary files in the column to the right (under Article Tools).
230 citations
TL;DR: Examination of the evidence for or against the use of PE with patients with problems that often co-occur with PTSD, including dissociation, borderline personality disorder, psychosis, suicidal behavior and non-suicidal self-injury, substance use disorders, and major depression concludes that PE can be safely and effectively used.
Abstract: Although prolonged exposure (PE) has received the most empirical support of any treatment for posttraumatic stress disorder (PTSD), clinicians are often hesitant to use PE due to beliefs that it is contraindicated for many patients with PTSD. This is especially true for PTSD patients with comorbid problems. Because PTSD has high rates of comorbidity, it is important to consider whether PE is indeed contraindicated for patients with various comorbid problems. Therefore, in this study, we examine the evidence for or against the use of PE with patients with problems that often co-occur with PTSD, including dissociation, borderline personality disorder, psychosis, suicidal behavior and non-suicidal self-injury, substance use disorders, and major depression. It is concluded that PE can be safely and effectively used with patients with these comorbidities, and is often associated with a decrease in PTSD as well as the comorbid problem. In cases with severe comorbidity, however, it is recommended to treat PTSD with PE while providing integrated or concurrent treatment to monitor and address the comorbid problems. Keywords: PTSD; comorbidity; prolonged exposure; (contra)indications For the abstract or full text in other languages, please see Supplementary files under Reading Tools online (Published: 25 July 2012) Citation: European Journal of Psychotraumatology 2012, 3 : 18805 - http://dx.doi.org/10.3402/ejpt.v3i0.18805
181 citations
TL;DR: The focus is on the role of social support and bonding in coming to grips with psychological trauma, about the oxytocin system as a basis for reducing the stress response and creating a feeling of bonding.
Abstract: This paper outlines the state of affairs in psychobiological research on psychotrauma and PTSD with a focus on the role of the oxytocin system in traumatic stress. With a high prevalence of trauma and PTSD in the Netherlands, new preventive and therapeutic interventions are needed. The focus is on the role of social support and bonding in coming to grips with psychological trauma, about the oxytocin system as a basis for reducing the stress response and creating a feeling of bonding, about binding words to painful emotions in psychotherapy, and about the bonds between researchers and clinicians.
116 citations
TL;DR: It is concluded that patients with SUD/PTSD are a substantial and vulnerable subgroup in addiction treatment facilities and that a systematic screening for PTSD is required.
Abstract: Objectives: This study had three objectives. Firstly, the prevalence of post-traumatic stress disorder (PTSD) and trauma exposure was compared between individuals with and without substance use disorder (SUD). Secondly, we compared self-rating of PTSD and clinical judgement. Thirdly, an analysis of the characteristics of SUD/PTSD patients was performed. Methods: The sample consisted of 423 patients with SUD and 206 healthy controls. All individuals were screened on PTSD using the self-rating inventory for PTSD. Results: Significantly higher numbers of PTSD and trauma exposure were found in the SUD group (resp. 36.6 and 97.4%). PTSD went frequently unnoticed when relying on clinical judgement alone. Patients with SUD/ PTSD were significantly more often unemployed and had a lower educational level. Axis I comorbidity and especially depressive disorders were more common in the SUD/PTSD group. Conclusion: It is concluded that patients with SUD/PTSD are a substantial and vulnerable subgroup in addiction treatment facilities and that a systematic screening for PTSD is required. Keywords: prevalence; trauma exposure; post-traumatic stress disorder; substance use disorder; clinical judgment For the abstract or full text in other languages, please see Supplementary files in the column to the right (under Article Tools). (Published: 8 August 2012) Citation: European Journal of Psychotraumatology 2012, 3 : 17734 - http://dx.doi.org/10.3402/ejpt.v3i0.17734
94 citations
TL;DR: This thematic cluster of articles ‘‘Offending behaviour: the role of trauma and PTSD’’ aims to explore such trajectories and post-traumatic mechanisms in offenders.
Abstract: Research indicates an interlink between traumatic experiences and criminal behaviour (Ardino, 2011; Foy, Furrow & McManus, 2011; Weeks & Widom, 1998, 1989) revealing that offenders present a higher prevalence of Post-traumatic Stress Disorder (PTSD; APA, 1994) and associated symptoms when compared with the general population (Wright, Borrill, Teers & Cassidy, 2006). Available studies, however, rarely present data about specific trajectories that connect trauma and PTSD to criminal behaviour. This thematic cluster of articles ‘‘Offending behaviour: the role of trauma and PTSD’’ aims to explore such trajectories and post-traumatic mechanisms in offenders. (Published: 20 July 2012) Citation: European Journal of Psychotraumatology 2012, 3 : 18968 - http://dx.doi.org/10.3402/ejpt.v3i0.18968
88 citations
TL;DR: A review of findings from 33 recent studies showing consistently high rates of trauma exposure, PTSD, and common comorbidities among female adolescent offenders finds that there was some early representation of trauma and PTSD as important variables to be considered in etiology and treatment.
Abstract: Background: While males constitute the majority, female adolescent offenders are a sizeable minority of the overall delinquent population. Further, those females who become involved in delinquent activities appear to be doing so at a younger age, and they are involved in a wide range of criminal activities, including violent offenses. Objective: The goal of this article is to consolidate an empirical base for our current knowledge about female juvenile offenders’ trauma-related mental health and rehabilitation issues. Method: We searched for studies using PILOTS, PsycLIT, PsycINFO, and EBSCOhost electronic databases. Results: Accordingly, we present a review of findings from 33 recent studies showing consistently high rates of trauma exposure, PTSD, and common comorbidities among female adolescent offenders. We also examined recent literature on risk and protective factors for female delinquency, as well as treatments for offenders, and found that there was some early representation of trauma and PTSD as important variables to be considered in etiology and treatment. Conclusion: Future plans for addressing the mental health needs of female offenders should be better informed by these recent findings about widespread trauma exposure and related psychological consequences. Keywords: delinquency; PTSD; female juvenile offenders; risk and protective factors; violence exposure (Published: 31 May 2012) Citation: European Journal of Psychotraumatology 2012, 3 : 17247 - http://dx.doi.org/10.3402/ejpt.v3i0.17247 For the abstract or full text in other languages, please see Supplementary files in the column to the right (under Reading Tools)
72 citations
TL;DR: The results indicate that psychological proximity is more strongly associated with post-traumatic stress reactions than geographical proximity, and underline the importance of differentiated measurements of various aspects of early distress.
Abstract: Background: Terrorism may create fear and stress reactions not only in the direct victims, but also in the general population. Objective: This study investigated emotional responses in the Norwegian population following the 22nd July 2011 terrorist attacks. We hypothesized that Oslo residents would report a higher level of fear responses compared with people living outside Oslo and that proximity would be associated with early distress and later post-traumatic stress reactions. Method: Representative samples were drawn from the Norwegian Population Registry. Telephone interviews were conducted 4-5 months after the attacks. The response rate for the Oslo sample (N=465) was 24% of the total sample, and 43% of those who were actually reached by phone and asked to participate. Corresponding figures for the sample living outside Oslo (N=716) were 19% and 30%. Results: Our results show strong immediate emotional responses, particularly sadness and a feeling of unreality, in both samples. Jumpiness and other fear responses were significantly higher among Oslo residents. Current level of risk perception was low 4-5 months after the attacks; however, a significant minority reported to feel less safe than before. Geographical and psychological proximity were associated with early emotional responses. Psychological proximity was significantly associated with post-traumatic stress reactions, while measures of geographical proximity were not. Immediate emotional responses, firstweek reactions, and first-week jumpiness were uniquely and significantly associated with post-traumatic stress reactions. Post-traumatic stress reactions were elevated in ethnic minorities. Conclusions: The terrorist attacks seem to have had a significant effect on the Norwegian population, creating sadness and insecurity, at least in the short term. Proximity to the terrorist attacks was strongly associated with distress in the population, and early distress was strongly related to later post-traumatic stress reactions. Our results indicate that psychological proximity is more strongly associated with post-traumatic stress reactions than geographical proximity, and underline the importance of differentiated measurements of various aspects of early distress. Keywords: terrorism; PTSD; emotions; safety; epidemiology (Published: 7 December 2012) For the abstract or full text in other languages, please see Supplementary files in the column to the right (under Article Tools) Citation: European Journal of Psychotraumatology 2012, 3 : 19709 - http://dx.doi.org/10.3402/ejpt.v3i0.19709
69 citations
TL;DR: Kahn et al. as mentioned in this paper showed that disturbed sleep is a precipitating and perpetuating factor in PTSD symptomatology, creating a perpetual circle, leading to increased sleep fragmentation, decreased GH secretion, and frequent nightmares.
Abstract: Background: Sleep facilitates the consolidation of fear extinction memory. Nightmares and insomnia are hallmark symptoms of posttraumatic stress disorder (PTSD), possibly interfering with fear extinction and compromising recovery. A perpetual circle may develop when sleep disturbances increase the risk for PTSD and vice versa. To date, therapeutic options for alleviating sleep disturbances in PTSD are limited. Methods: We conducted three studies to examine the relationship between sleep and posttraumatic symptoms: (1) a prospective longitudinal cohort study examining the impact of pre-deployment insomnia symptoms and nightmares on the development of PTSD; (2) a cross-sectional study examining subjective sleep measures, polysomnography, endocrinological parameters, and memory in veterans with PTSD, veterans without PTSD, and healthy controls (HCs); (3) a randomized controlled trial (RCT) (n14) comparing the effect of prazosin and placebo on sleep disturbances in veterans with PTSD. In addition to these studies, we systematically reviewed the literature on treatment options for sleep disturbances in PTSD. Results: Pre-deployment nightmares predicted PTSD symptoms at 6 months post-deployment; however, insomnia symptoms did not. Furthermore, in patients with PTSD, a correlation between the apnea index and PTSD severity was observed, while obstructive sleep apnea syndrome was not more prevalent. We observed a significant increase in awakenings during sleep in patients with PTSD, which were positively correlated with adrenocorticotropic hormone (ACTH) levels, negatively correlated with growth hormone (GH) secretion, and the subjective perception of sleep depth. Also, heart rate was significantly increased in PTSD patients. Interestingly, plasma levels of GH during the night were decreased in PTSD. Furthermore, GH secretion and awakenings were independent predictors for delayed recall, which was lower in PTSD. In our RCT, prazosin was not associated with improvement of any subjective and objective sleep parameters. Only a few RCTs have been published. They show promising results for atypical antipsychotics and prazosin, the latter especially on nightmare reduction. Conclusions: Disturbed sleep due to nightmares increases the risk for PTSD. PTSD in turn leads to increased sleep fragmentation, decreased GH secretion, and frequent nightmares, which may again compromise fear extinction, synaptic plasticity, and recovery. This suggests that disturbed sleep is a precipitating and perpetuating factor in PTSD symptomatology, creating a perpetual circle. This dissertation suggests that activity of the hypothalamicpituitaryadrenal axis and the sympathetic nervous system (SNS) is involved in disturbed sleep in patients with PTSD. Keywords: PTSD; sleep; nightmares; polysomnography; cortisol; growth hormone; memory; noradrenalin (Published: 3 October 2012) Theses defended in Utrecht, June 21, 2012.Mentors: Prof. Dr. R.S. Kahn (University Medical Centre, Department of Psychiatry, the Netherlands), Prof. Dr. J.B.A.M. Arends (Technical University Eindhoven, the Netherlands) and Dr. E. Vermetten (Military Mental Health, the Netherlands). For the abstract or full text in other languages, please see Supplementary files in the column to the right (under Article Tools). Citation: European Journal of Psychotraumatology 2012, 3 : 19142 - http://dx.doi.org/10.3402/ejpt.v3i0.19142
65 citations
TL;DR: The results showed that conscientiousness, agreeableness, and openness to experience significantly related to the total PTG and most of the domains, and the effects of extraversion, neuroticism and Openness to experience were moderated by the PTS severity for some domains.
Abstract: Background: Posttraumatic growth (PTG) is conceptualized as a positive transformation resulting from coping with and processing traumatic life events. This study examined the contributory roles of personality traits, posttraumatic stress (PTS) severity and their interactions on PTG and its domains, as assessed with the Posttraumatic Growth Inventory Turkish form (PTGI-T). The study also examined the differences in PTG domains between survivors of accidents, natural disasters and unexpected loss of a loved one. Methods: The Basic Personality Traits Inventory, Posttraumatic Diagnostic Scale, and PTGI-T were administered to a large stratified cluster community sample of 969 Turkish adults in their home settings. Results: The results showed that conscientiousness, agreeableness, and openness to experience significantly related to the total PTG and most of the domains. The effects of extraversion, neuroticism and openness to experience were moderated by the PTS severity for some domains. PTG in relating to others and appreciation of life domains was lower for the bereaved group. Conclusion: Further research should examine the mediating role of coping between personality and PTG using a longitudinal design. Keywords: Domains of posttraumatic growth; personality traits; posttraumatic stress; traumatic event types (Published: 5 June 2012) Citation: European Journal of Psychotraumatology 2012, 3 : 17303 - http://dx.doi.org/10.3402/ejpt.v3i0.17303 For the abstract or full text in other languages, please see Supplementary files in the column to the right (under Article Tools).
64 citations
TL;DR: Results support the reliability and validity of the French version of the Harvard Trauma Questionnaire, and show high sensitivity and specificity at the original cut-off score of 2.5.
Abstract: Background: To date no validated instrument in the French language exists to screen for posttraumatic stress disorder (PTSD) in survivors of torture and organized violence. Objective: The aim of this study is to adapt and validate the Harvard Trauma Questionnaire (HTQ) to this population. Method: The adapted version was administered to 52 French-speaking torture survivors, originally from sub- Saharan African countries, receiving psychological treatment in specialized treatment centers. A structured clinical interview for DSM was also conducted in order to assess if they met criteria for PTSD. Results: Cronbach’s alpha coefficient for the HTQ Part 4 was adequate (0.95). Criterion validity was evaluated using receiver operating characteristic curve analysis that generated good classification accuracy for PTSD (0.83). At the original cut-off score of 2.5, the HTQ demonstrated high sensitivity and specificity (0.87 and 0.73, respectively). Conclusion: Results support the reliability and validity of the French version of the HTQ. Keywords: Refugees; ethnic/cultural minorities; torture; cross-cultural assessment; questionnaire For the abstract or full text in other languages, please see Supplementary files in the column to the right (under Article Tools) (Published: 6 December 2012) Citation: European Journal of Psychotraumatology 2012, 3 : 19225 - http://dx.doi.org/10.3402/ejpt.v3i0.19225
63 citations
TL;DR: Young adults completed a Hedonic Deficit & Interference Scale (HDIS), a self-report measure developed for this study, as well as a modified version of the Fawcette-Clarke Pleasure Capacity Scale that assessed not only positive but also negative affective responses to positive events.
Abstract: Symptoms of anhedonia, or deficits in the ability to experience positive affect, are increasingly recognized as an outcome of traumatic stress. Herein we demonstrate a phenomenon of ‘‘negative affective interference’’, specifically, negative affective responses to positive events, in association with childhood trauma history. Young adults ( n =99) completed a Hedonic Deficit & Interference Scale (HDIS), a self-report measure developed for this study, as well as a modified version of the Fawcette-Clarke Pleasure Capacity Scale that assessed not only positive but also negative affective responses to positive events. The two assessment approaches demonstrated convergent validity and predicted concurrent individual differences in trait positive and negative affect, and extraversion and neuroticism. Histories of childhood emotional and sexual abuse were differentially associated with negative affective responses to positive events. Future research and clinical directions are discussed. Keywords: anhedonia; deficit; negative affective interference; PTSD; depression (Published: 11 January 2012) Citation: European Journal of Psychotraumatology 2012, 3 : 8585 - DOI: 10.3402/ejpt.v3i0.8585
TL;DR: It is demonstrated not only self-reported decreased positive affect but also increased negative affect in response to positive events in 55 women with PTSD, in comparison with 35 women without PTSD, via their response to a Hedonic Deficit & Interference Scale (HDIS).
Abstract: Symptoms of anhedonia, or deficits in the ability to experience positive affect, are increasingly recognized as an outcome of traumatic stress including in individuals with PTSD. However, little research has investigated negative affective responses to what would normally be considered pleasant events (e.g., receiving a compliment or gift, physical affection) in traumatized persons. We demonstrate not only self-reported decreased positive affect but also increased negative affect in response to positive events in 55 women with PTSD, in comparison with 35 women without PTSD, via their response to a Hedonic Deficit & Interference Scale (HDIS). The HDIS demonstrated strong internal validity, convergent and incremental validity relative to other measures of anhedonia, and discriminant validity in relation to depression versus anxiety symptoms in this sample. In addition, in response to imagery of social versus non-social positive events, HDIS scores predicted self-report positive and negative affective responses. In a sub-sample of participants completing the imagery task while undergoing fMRI ( n =12), HDIS scores also predicted BOLD response within the left orbitofrontal cortex, ventromedial prefrontal cortex, amygdala, and cerebellum. Future research and clinical directions are discussed. Keywords: anhedonia; positive affect; negative affect; negative affective interference; PTSD; depression (Published: 11 January 2012) Citation: European Journal of Psychotraumatology 2012, 3 : 8587 - DOI: 10.3402/ejpt.v3i0.8587
TL;DR: There was evidence for the use of trauma-focused therapies for post-traumatic stress disorder (PTSD) and some evidence for psychological interventions in the treatment of borderline personality disorder, depression, insomnia, and panic disorder co-morbid to PTSD, however, methodological quality of many of the studies was less than optimal.
Abstract: Background: The efficacy of psychosocial therapies for common mental health disorders in veterans is unclear and requires further examination. Method: Systematic review and meta-analyses of randomised controlled trials (RCTs). Twenty databases were searched. Studies were included if they reported a psychosocial intervention designed to treat or reduce common mental health symptoms in veterans identified as being symptomatic at the time they entered the study. Studies of substance dependency disorders and psychosis were excluded. Eligible studies were assessed against methodological quality criteria and data were extracted and analysed. Results: Twenty-nine RCTs were identified. There was evidence for the use of trauma-focused therapies for post-traumatic stress disorder (PTSD) and some evidence for psychological interventions in the treatment of borderline personality disorder, depression, insomnia, and panic disorder co-morbid to PTSD. However, methodological quality of many of the studies was less than optimal. Conclusions: Trauma-focused psychological therapies are likely to be effective for combat-related PTSD but there is a need for more research to determine the efficacy of psychological treatments for other mental health disorders in veterans. Keywords: Veterans; common mental disorders; randomised controlled trials (Published: 5 December 2012) For the abstract or full text in other languages, please see Supplementary files to the column to the right (under Article Tools) Citation: European Journal of Psychotraumatology 2012, 3 : 19267 - http://dx.doi.org/10.3402/ejpt.v3i0.19267
TL;DR: A treatment combining propranolol with a brief reactivation session subsequently reduced posttraumatic stress disorder (PTSD) symptom severity and diagnosis, as well as reducing psychophysiological responses during trauma-related script-driven imagery.
Abstract: Background: In two recent studies conducted by our group, a treatment combining propranolol with a brief reactivation session subsequently reduced posttraumatic stress disorder (PTSD) symptom severity and diagnosis, as well as reducing psychophysiological responses during trauma-related script-driven imagery. One likely explanation for those results is that memory reconsolidation was blocked by propranolol. Objective: We explored the influence of various predictors on treatment outcome (i.e., PTSD severity), and whether the treated individuals improved in other important domains of functioning associated with PTSD. Method: Thirty-three patients with longstanding PTSD participated in a 6-week open-label trial consisting of actively recalling one’s trauma under the influence of propranolol, once a week. Results: Treated patients reported a better quality of life, less comorbid depressive symptoms, less negative emotions in their daily life and during trauma recollections. Women were also found to improve more than men. Type of trauma (childhood vs. adulthood), time elapsed since trauma, borderline personality traits, depressive symptoms severity, Axis I comorbidity, and age did not influence treatment outcome. Conclusion: These results must await publication of a randomized-controlled trial to further delineate effectiveness with this novel treatment approach. Keywords: reconsolidation; memory; beta-blockers; traumatic stress; PTSD; treatment outcome; gender differences (Published: 14 February 2012) Citation: European Journal of Psychotraumatology 2012, 3 : 15470 - DOI: 10.3402/ejpt.v3i0.15470 For the abstract or full text in other languages, please see Supplementary files in the column to the right (under Article Tools).
TL;DR: Compared potentially traumatic exposure during work assignments at a crisis scene and in personal life as predictors of the development of post-traumatic stress disorder (PTSD) in news journalists, depression had a significant indirect effect on the relationship between PTAs at the scene and symptoms of PTSD.
Abstract: Background: News journalists are an occupational group with a unique task at the scene of an unfolding crisis*to collect information and inform the public about the event. By being on location, journalists put themselves at risk for being exposed to the potentially traumatic event. Objective: To compare potentially traumatic exposure during work assignments at a crisis scene and in personal life as predictors of the development of post-traumatic stress disorder (PTSD) in news journalists. Further, to investigate the mediating effect of depression between the predictor and predicted variables. Method: With a web-based questionnaire, information from a sample of Finnish news journalists (n=407) was collected. The data collected included details on the range of potentially traumatic assignments (PTAs) at the crisis scene during the past 12 months, lifetime potentially traumatic events (PTEs) in personal life, PTSD symptoms, and level of depression. Results: Approximately 50% of the participants had worked with a PTA during the past 12 months. Depression had a significant indirect effect on the relationship between PTAs at the scene and symptoms of PTSD. A similar result was found regarding the relationship between personal life PTEs and PTSD. Depression had a complete indirect effect in the case of PTAs and a partial indirect effect in regard to PTE exposure in personal life. Conclusions: Exposure to PTAs is common within journalistic work. The results reflect the importance of understanding the underlying mechanisms of the measured symptoms (PTSD, depression) in relation to trauma history. The main limitations of the study include the cross-sectional design and the nature of the instruments used for the collection of work-related trauma history. Keywords: Trauma history; reporter; traumatic stress; media; journalism (Published: 16 August 2012) For the abstract or full text in other languages, please see Supplementary files in the column to the right (under Reading Tools). Citation: European Journal of Psychotraumatology 2012, 3 : 18388 - http://dx.doi.org/10.3402/ejpt.v3i0.18388
TL;DR: The hypothesis that there are differences in perceived post- and peritraumatic emotional and cognitive reactions after experiencing different types of disasters is supported.
Abstract: Background: Examination of existing research on posttraumatic adjustment after disasters suggests that survivors’ posttraumatic stress levels might be better understood by investigating the influence of the characteristics of the event experienced on how people thought and felt, during the event as well as afterwards Objective: To compare survivors’ perceived post- and peritraumatic emotional and cognitive reactions across different types of disasters Additionally, to investigate individual and event characteristics Design: In a European multi-centre study, 102 survivors of different disasters terror attack, flood, fire and collapse of a building were interviewed about their responses during the event Survivors’ perceived posttraumatic stress levels were assessed with the Impact of Event Scale-Revised (IES-R) Peritraumatic emotional stress and risk perception were rated retrospectively Influences of individual characteristics, such as socio-demographic data, and event characteristics, such as time and exposure factors, on post- and peritraumatic outcomes were analyzed Results: Levels of reported post- and peritraumatic outcomes differed significantly between types of disasters Type of disaster was a significant predictor of all three outcome variables but the factors gender, education, time since event, injuries and fatalities were only significant for certain outcomes Conclusion: Results support the hypothesis that there are differences in perceived post- and peritraumatic emotional and cognitive reactions after experiencing different types of disasters However, it should be noted that these findings were not only explained by the type of disaster itself but also by individual and event characteristics As the study followed an explorative approach, further research paths are discussed to better understand the relationships between variables Keywords: Emergency psychology; impact of event scale-revised; disaster; hazard; peritraumatic emotion; risk perception; posttraumatic stress (Published: 28 May 2012) Citation: European Journal of Psychotraumatology 2012, 3 : 7382 - http://dxdoiorg/103402/ejptv3i07382 For the abstract or full text in other languages, please see Supplementary files in the column to the right (under Article Tools)
TL;DR: There is a lack of research investigating motivational factors as outcome variables following traumatic experiences, and the strongest relationships were reported for self-efficacy, followed by locus of control and self-esteem and, lastly, impulsivity/self-control.
Abstract: How does traumatic stress change the ability to motivate oneself to achieve certain goals? How do motivational abilities influence the development and course of trauma sequelae? Few studies have focused on motivational constructs within posttraumatic stress research. From a trauma research perspective, it can be hypothesized that traumatic stress may contribute to motivational dysfunction. The main goal of the present article is to fill this gap in research by reviewing and discussing the existing trauma literature in terms of motivation-related concepts, such as self-efficacy, locus of control, self-esteem, and self-control/impulsivity. Fifty-four studies were reviewed, 10 of which were longitudinal studies. Approximately 20% of the reviews assessed whether motivational concepts predict posttraumatic stress, whereas only 8% examined the reverse relationship. With the exception of a few studies, motivational constructs seem to predict posttraumatic stress over the life span. The strongest relationships were reported for self-efficacy, followed by locus of control and self-esteem and, lastly, impulsivity/self-control. Overall, the findings of this review indicate that there is a lack of research investigating motivational factors as outcome variables following traumatic experiences. Furthermore, the need for longitudinal studies and studies with older adults is noted.
TL;DR: In this article, the authors examined associations between acute adverse events at seven time points prior to age 8 and inflammation at ages 10 and 15 using the Avon Longitudinal Study of Parents and Children (ALSPAC).
Abstract: Acute stress; Stressful life events; Prospective cohort; Avon Longitudinal Study of Parents and Children (ALSPAC) Summary Background: Retrospective studies show that childhood adversity is associated with systemic inflammation in adulthood. Few prospective studies have examined whether childhood adversity influences inflammation in an observable manner during childhood or adolescence and if these effects are sustained over time. Methods: Using longitudinal data from the Avon Longitudinal Study of Parents and Children, we examined associations between acute adverse events at seven time points prior to age 8 and inflammation at ages 10 and 15. Inflammatory markers at age 10 included interleukin-6 (IL-6; N = 4655) and C-reactive protein (CRP; N = 4647), and CRP was measured again at age 15 (N = 3286). We further evaluated whether body mass index (BMI), depression, or cigarette smoking mediated associations between adverse events and inflammation. Results: Adverse events in middle childhood (occurring between ages 6 to 8), as well as cumulative adversity from birth to 8 years, were associated with higher levels of IL-6 and CRP at age 10. Adverse events reported in early childhood (1.5 years) or middle childhood, and cumulative adversity from birth through 8 years predicted increased levels of CRP at age 15, and these associations persisted after adjustment for CRP at age 10. Some, but not all, of these associations were mediated by BMI.
TL;DR: It is suggested that future research on psychophysiological stress reactions in traumatized samples should routinely assess for acute dissociative symptoms, as the high dissociators exhibited significantly lower heart rate during trauma script and a significantly smaller script-induced decrease in parasympathetic cardiac activity.
Abstract: Background: Potential acute protective functions of dissociation include modulation of stress-induced psychophysiological arousal. This study was designed to explore whether acute dissociative reactions during a stress experiment would override the effects of reexperiencing. Methods: Psychophysiological reactions during exposure to script-driven trauma imagery were studied in relation to acute responses of reexperiencing and dissociative symptoms in 61 patients with histories of exposure to a variety of traumas. Acute symptomatic responses were assessed with the Responses to Script- Driven Imagery Scale (RSDI), and participants were divided into four groups by median splits of RSDI reexperiencing and dissociation subscale scores. Results: In a comparison of the high RSDI reexperiencing groups with low versus high acute dissociative symptoms, the high dissociators exhibited significantly lower heart rate (HR) during trauma script and a significantly smaller script-induced decrease in parasympathetic cardiac activity. HR reactivity to the trauma script was negatively correlated with acute dissociative symptom severity. Conclusions: Acute dissociative reactions are a potential moderator of response to experimental paradigms investigating psychologically traumatized populations. We therefore suggest that future research on psychophysiological stress reactions in traumatized samples should routinely assess for acute dissociative symptoms. Keywords: Dissociative disorders; PTSD psychophysiology; stress reactivity; script-driven imagery (Published: 27 November 2012) For the abstract or full text in other languages, please see Supplementary files under Reading Tools online. Citation: European Journal of Psychotraumatology 2012, 3: 17419 - http://dx.doi.org/10.3402/ejpt.v3i0.17419
TL;DR: The results of the present study suggest that the dimensionality of ASD may be best characterized as a five factor structure which separates dysphoric and anxious arousal items into two separate factors, akin to recent research on PTSD's latent structure.
Abstract: Background: Since the introduction of Acute Stress Disorder (ASD) into the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) research has focused on the ability of ASD to predict PTSD rather than focusing on addressing ASD’s underlying latent structure. The few existing confirmatory factor analytic (CFA) studies of ASD have failed to reach a clear consensus regarding ASD’s underlying dimensionality. Although, the discrepancy in the results may be due to varying ASD prevalence rates, it remains possible that the model capturing the latent structure of ASD has not yet been put forward. One such model may be a replication of a new five-factor model of PTSD, which separates the arousal symptom cluster into Dysphoric and Anxious Arousal. Given the pending DSM-5, uncovering ASD’s latent structure is more pertinent than ever. Objective: Using CFA, four different models of the latent structure of ASD were specified and tested: the proposed DSM-5 model, the DSM-IV model, a three factor model, and a five factor model separating the arousal symptom cluster. Method: The analyses were based on a combined sample of rape and bank robbery victims, who all met the diagnostic criteria for ASD ( N =404) using the Acute Stress Disorder Scale. Results: The results showed that the five factor model provided the best fit to the data. Conclusions: The results of the present study suggest that the dimensionality of ASD may be best characterized as a five factor structure which separates dysphoric and anxious arousal items into two separate factors, akin to recent research on PTSD’s latent structure. Thus, the current study adds to the debate about how ASD should be conceptualized in the pending DSM-5. Keywords: Acute stress disorder; Acute Stress Disorder Scale; confirmatory factor analysis; bank robbery; rape; dysphoric arousal; anxious arousal; DSM-5 (Published: 12 June 2012) Citation: European Journal of Psychotraumatology 2012, 3 : 18201 - http://dx.doi.org/10.3402/ejpt.v3i0.18201 For the abstract or full text in other languages, please see Supplementary files under Reading Tools online.
TL;DR: PTSD symptomatology and childhood abuse were significantly associated with both underweight and overweight/obesity, whereas sexual abuse and overall abuse were particularly associated with overweight/Obesity.
Abstract: Background: Studies of specific groups such as military veterans have found that posttraumatic stress disorder (PTSD) is linked to adverse health outcomes including unhealthy weight. The aim of this study was to examine the relationship between PTSD symptoms, experiences of childhood trauma and weight in a community sample. Methods: A stratified random probability survey was conducted in Denmark by the Danish National Centre for Social Research between 2008 and 2009 with 2,981 participants born in 1984, achieving a response rate of 67%. The participants were interviewed with a structured interview with questions pertaining PTSD symptomatology, exposure to childhood abuse, exposure to potentially traumatizing events, height, and weight. Underweight was defined by a body mass index (BMI)<18.5, overweight was defined by a BMI≥25 and <30 and obesity was defined by a BMI≥30. Results: PTSD symptomatology and childhood abuse were significantly associated with both underweight and overweight/obesity. Childhood emotional abuse was especially associated with underweight, whereas sexual abuse and overall abuse were particularly associated with overweight/obesity. Conclusion: These findings indicate that health care professionals may benefit from assessing PTSD and childhood abuse in the treatment of both overweight and underweight individuals. Keywords: PTSD; childhood abuse; eating disorders; weight (Published: 18 June 2012) Citation: European Journal of Psychotraumatology 2012, 3 : 17188 - http://dx.doi.org/10.3402/ejpt.v3i0.17188 For the abstract or full text in other languages, please see Supplementary files in the column to the right (under Article Tools).
TL;DR: Findings corroborate findings from other European countries that PTSD is a common disorder in the elderly due to WWII experience and that PTSD and trauma affect mental health even across long periods of time.
Abstract: Background: While in recent years epidemiological studies onWorldWar (WW) II-related traumatization and prevalence of posttraumatic stress disorder (PTSD) in elderly persons have been conducted for various European countries, for Austria, these numbers are unknown. Objective: The focus of this epidemiologic study was to picture the current mental health status and prevalence of PTSD and lifetime traumatic events in Austria’s elderly with respect to WWII and subsequent occupation. Method: In an interdisciplinary approach of psychologists and historians, 316 elderly Austrians (born before 1946) were interviewed for symptoms of PTSD and lifetime traumatization (Traumatic Life Events Questionnaire, PTSD Checklist-Civilian Version), current mental health (Brief Symptom Inventory), wartime-related trauma, and traumatic experiences with occupational forces. These factors were also compared regarding the zone of occupation (Allied vs. Soviet). Data were collected between March and September 2010. Results: 97.5% of the sample reported at least one lifetime trauma. War-related traumata were reported by 92.7% and non-war-related traumata by 82.3%; 40.2% experienced traumatic events with occupational forces. PTSD was present in 1.9% of the sample and up to 13.9% taking subthreshold PTSD into account. Both, the presence of symptoms indicative of PTSD and subthreshold PTSD implied weaker current mental health (regarding General Distress: odds ratios up to 25.51; 95% CI=9.82 to 66.27). Independent of PTSD diagnosis persons from the Soviet occupied zone showed higher levels of Interpersonal Sensitivity, Global Distress, and Phobic Anxiety. Prevalence of PTSD was independent of gender. Conclusions: Our results corroborate findings from other European countries that PTSD is a common disorder in the elderly due to WWII experience and that PTSD and trauma affect mental health even across long periods of time. Postwar distressing conditions also pose a further risk factor for symptomatology and distress in later years. Keywords: World War 2; epidemiology; subthreshold PTSD; elderly; general population (Published: 23 July 2012) Citation: European Journal of Psychotraumatology 2012, 3 : 17263 - http://dx.doi.org/10.3402/ejpt.v3i0.17263
TL;DR: The results show generally good psychometric properties of the Polish version of PDS, which showed high internal consistency and test–retest reliability, good diagnostic agreement with SCID, good sensitivity but relatively low specificity.
Abstract: Background: Posttraumatic Diagnostic Scale (PDS) is a self-descriptive measure developed to provide information regarding posttraumatic stress disorder (PTSD) diagnosis and symptom severity. Objectives: The aim of this article is to report on the validation of the Polish version of PDS and to test its factor structure with reference to two models: an original three-factor model (Reexperiencing, Avoidance, and Arousal) and alternative five-factor model (Reexperiencing, Avoidance, Numbing, Dysphoric Arousal, and Anxious Arousal). Method: The validation procedure included three studies conducted on samples of separate populations: university-level students ( n =507), individuals who had experienced various traumas ( n =320), and treatmentseeking survivors of motor vehicle accidents (MVA) ( n =302). Various other measures of trauma-related psychopathology were administered to participants, as well as the PTSD module of the Structured Clinical Interview (SCID) in the case of MVA patients. Results: PDS showed high internal consistency and test–retest reliability, good diagnostic agreement with SCID, good sensitivity but relatively low specificity. The satisfactory convergent validity was supported by a large number of significant correlations with other measures of trauma-related psychopathology. Confirmatory factor analysis (CFA) generally confirmed both the three-factor structure and the alternative five-factor structure of the questionnaire. Conclusions: The results show generally good psychometric properties of the Polish version of PDS. Keywords: posttraumatic stress disorder; PDS; questionnaire; validity; reliability; factor analysis For the abstract or full text in other languages, please see Supplementary files in the column to the right (under Article Tools). (Published: 9 August 2012) Citation: European Journal of Psychotraumatology 2012, 3 : 18479 - http://dx.doi.org/10.3402/ejpt.v3i0.18479
TL;DR: Altered thyroid activity, especially FT3/FT4, levels was associated with exposure to violence in childhood in women with BPD, and severe childhood trauma-related stress may promote lasting altered thyroid levels and/or contribute to the development of psychopathology associated with B PD traits or PTSD.
Abstract: Background : A relationship between exposure to sexual violence and thyroid hormone alterations has been observed among women with posttraumatic stress disorder (PTSD). Women with borderline personality disorder (BPD) report a high estimate of childhood trauma. Objective : The aim of the present study was to assess relationships between thyroid hormone measures and exposure to violence in childhood in women with BPD. Method : A total of 92 clinically euthyroid women with BPD (53% with comorbid PTSD) diagnosis and at least two prior suicide attempts were assessed with the Karolinska Interpersonal Violence Scales (KIVS). The KIVS contains four subscales with concrete examples of exposure to violence and expressed violent behavior in childhood (aged 6–14 years) and during adult life (15 years or older). Baseline thyroid function was evaluated by measuring plasma free and bound triiodothyronine (FT3 and T3), thyroxine (FT4 and T4), and thyroid-stimulating hormone (TSH) with immunoassays. The FT3/FT4 ratio was used to estimate peripheral deiodination. Plasma cortisol was also assessed. Results : Sixty-seven percent of patients reported medium high or high level of exposure to interpersonal violence as a child. The FT3/FT4 ratio showed a significant negative correlation with exposure to violence as a child. Patients with PTSD had significantly higher plasma cortisol levels. An ad hoc analysis revealed that the correlation between KIVS exposure to interpersonal violence as a child and FT3/FT4 ratio was significant only in patients with comorbid PTSD. Altered thyroid activity, especially FT3/FT4, levels was associated with exposure to violence in childhood in women with BPD. Conclusion : Severe childhood trauma-related stress may promote lasting altered thyroid levels and/or contribute to the development of psychopathology associated with BPD traits or PTSD. Keywords: HPT axis; thyroid hormones; borderline personality disorder; interpersonal violence; childhood adverse events; childhood maltreatment; trauma; stress (Published: 16 May 2014) Citation: European Journal of Psychotraumatology 2014, 5 : 23911 - http://dx.doi.org/10.3402/ejpt.v5.23911
TL;DR: The decision making of immigration lawyers are examined, who are an example of a group of nonclinicians who decide when and whether to refer asylum-seekers for psychiatric assessment, to examine how non-clinically qualified personnel perform assessments of mental health issues.
Abstract: Background: Procedures for determining refugee status across Europe are being speeded up, despite the high prevalence of mental health difficulties among asylum seekers. An assurance given is that ‘‘vulnerable applicants’’ will be identified and excluded from accelerated procedures. Although experts have recommended assessments to be undertaken by experienced clinicians, this is unlikely to happen for political and financial reasons. Understanding how non-clinically qualified personnel perform assessments of mental health issues is timely and crucial. Misrecognition of refugees due to the inappropriate use of accelerated procedures involves the risk of returning the very people who have the right to protection from further persecution. Objective: To examine the decision making of immigration lawyers, who are an example of a group of nonclinicians who decide when and whether to refer asylum-seekers for psychiatric assessment. Method: Semi-structured interviews were conducted with 12 legal representatives working with people seeking refugee or human rights protection in the United Kingdom. The resultant material was analysed using Framework Analysis. Results: Themes clustered around the legal case, the client, the representative and the systems, all with subthemes. A mapping exercise integrated these themes to show how representatives brought together questions of (1) evidential reasons for a report, influenced by their legal, psychological and case law knowledge, and (2) perceived evidence of mental distress, influenced by professional and personal experiences and expectations. Conclusions: The legal representatives interviewed were well-informed and trained in psychological issues as well as clearly dedicated to their clients. This helped them to attempt quasi-diagnoses of common mental health problems. They nonetheless demonstrated stereotypical understanding of post-traumatic stress disorder and other possible diagnoses and the role of subjectivity. The study has implications for other groups particularly those less trained and compassionate who are required to make clinical judgments without the necessary expertise. Keywords: Refugees; asylum; decision-making; psychological assessment; vulnerability assessment (Published: 16 October 2012) For the abstract or full text in other languages, please see Supplementary files in the column to the right (under Article Tools). Citation: European Journal of Psychotraumatology 2012, 3 : 18406 - http://dx.doi.org/10.3402/ejpt.v3i0.18406
TL;DR: This pilot study provides initial evidence that combining BF and NET is safe, acceptable, and feasible in patients with co-morbid persistent pain and PTSD.
Abstract: Objective: Many traumatised refugees suffer from both persistent pain and posttraumatic stress disorder (PTSD). To date, no specific guidelines exist for treatment of this group of patients. This paper presents data on a pilot treatment study conducted with 15 traumatised refugees with persistent pain and PTSD. Methods: Participants received 10 sessions of pain-focused treatment with biofeedback (BF) followed by 10 sessions of Narrative Exposure Therapy (NET). Structured interviews and standardised questionnaires were used to assess symptoms of pain intensity, pain disability, PTSD and quality of life directly before and after treatment and at 3 months follow-up. Results: Following the combined intervention, participants showed a significant reduction in both pain and PTSD symptoms, as well as improved quality of life. Additionally, biofeedback increased motivation for subsequent trauma-focused therapy, which in turn was related to larger PTSD treatment gains. Conclusion: This pilot study provides initial evidence that combining BF and NET is safe, acceptable, and feasible in patients with co-morbid persistent pain and PTSD. Keywords: Refugees; persistent pain; PTSD; treatment; biofeedback; Narrative Exposure Therapy (Published: 25 June 2012) Citation: European Journal of Psychotraumatology 2012, 3 : 17660 - http://dx.doi.org/10.3402/ejpt.v3i0.17660 For the abstract or full text in other languages, please see Supplementary files in the column to the right (under Article Tools). NB! This article has been retracted. Please find Retraction note at http://dx.doi.org/10.3402/ejpt.v4i0.21913
TL;DR: Empirical support is provided for a conceptualization of PTSD that includes a higher-order PTSD factor that encompasses re-experiencing, arousal, and effortful avoidance sub-factors and a dysphoria factor.
Abstract: Background: As of yet, no collective agreement has been reached regarding the precise factor structure of posttraumatic stress disorder (PTSD). Several alternative factor-models have been proposed in the last decades. Objective: The current study examined the fit of a hierarchical adaptation of the Simms et al. (2002) dysphoria model and compared it to the fit of the PTSD model as depicted in the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM-IV), a correlated four-factor emotional numbing, and a correlated four-factor dysphoria model. Methods: Data were collected using the Clinician-Administered PTSD Scale in a mixed-trauma sample of treatment-seeking PTSD patients (N276). Results: All examined models provided superior fit to the three-factor model of DSM-IV. The hierarchical four-factor solution provided a better fit than competing models. Conclusion: The present study provides empirical support for a conceptualization of PTSD that includes a higher-order PTSD factor that encompasses re-experiencing, arousal, and effortful avoidance sub-factors and a dysphoria factor.
TL;DR: Research employing animal models has demonstrated that chronic stress impairs innate and adaptive immunity and can yield enhanced tumor growth or increased simian immunodeficiency virus–associated mortality.
Abstract: INTRODUCTION Environmental stress is a pervasive dimension of life that results in complex biological changes. Evidence suggests that chronic stress can exert negative effects on general health, disease susceptibility, and progression of existing illness (1). Networks that are stimulated by stress include: the hypothalamic– pituitary–adrenal (HPA) axis, the sympathetic adrenal medullary axis and sympathetic and parasympathetic nerve projections that directly innervate secondary lymphoid organs (2–4). Repeated or prolonged exposure to stress-related neuroendocrine factors, such as glucocorticoids and catecholamines, can potently influence immune function and is believed to underlie the adverse health outcomes associated with chronic stress (2,3). For example, human studies have shown that chronically stressed individuals exhibit poorer influenza vaccine responses (5,6), enhanced susceptibility to experimental rhinovirus infection (7) and accelerated human immunodeficiency virus disease progression (8). Research employing animal models has demonstrated that chronic stress impairs innate and adaptive immunity (9–11) and can yield enhanced tumor growth (12,13) or increased simian immunodeficiency virus–associated mortality (14). Other work has also linked stress and glucocorticoid production with hippocampal atrophy and memory dysfunction in both humans and animals (15–17). To mitigate the negative physiologic effects of stress, stress management approaches are often advocated by health professionals. Stress reduction techThe Calm Mouse: An Animal Model of Stress Reduction