Showing papers in "Journal of Traumatic Stress in 2005"
TL;DR: Children and adults exposed to chronic interpersonal trauma consistently demonstrate psychological disturbances that are not captured in the posttraumatic stress disorder (PTSD) diagnosis, and these data invite further exploration of what constitutes effective treatment of the full spectrum of posttraumatic psychopathology.
Abstract: Children and adults exposed to chronic interpersonal trauma consistently demonstrate psychological disturbances that are not captured in the posttraumatic stress disorder (PTSD) diagnosis. The DSM-IV (American Psychiatric Association, 1994) Field Trial studied 400 treatment-seeking traumatized individuals and 128 community residents and found that victims of prolonged interpersonal trauma, particularly trauma early in the life cycle, had a high incidence of problems with (a) regulation of affect and impulses, (b) memory and attention, (c) self-perception, (d) interpersonal relations, (e) somatization, and (f) systems of meaning. This raises important issues about the categorical versus the dimensional nature of posttraumatic stress, as well as the issue of comorbidity in PTSD. These data invite further exploration of what constitutes effective treatment of the full spectrum of posttraumatic psychopathology.
1,167 citations
TL;DR: The performance of some currently available instruments is near to their maximal potential effectiveness, and that instruments with fewer items, simpler response scales, and simpler scoring methods perform as well as if not better than longer and more complex measures.
Abstract: The development of effective methods of screening for posttraumatic stress disorder (PTSD) is important in the context of mass trauma, the geographical dispersion of victims, and the restricted availability of specialists in psychological trauma. The review focused on published English-language screening instruments for civilian PTSD consisting of 30 items or fewer and validated against structured clinical interviews. Thirteen instruments were identified meeting these criteria, all consisting of symptoms of traumatic stress. The review concluded that the performance of some currently available instruments is near to their maximal potential effectiveness, and that instruments with fewer items, simpler response scales, and simpler scoring methods perform as well as if not better than longer and more complex measures.
426 citations
TL;DR: Improvement in PTSD as assessed by blind independent assessors, depression, dissociation, and state anxiety was significantly greater in both the PE and EMDR group than the WAIT group.
Abstract: This controlled study evaluated the relative efficacy of Prolonged Exposure (PE) and Eye Movement Desensitization and Reprocessing (EMDR) compared to a no-treatment waitlist control (WAIT) in the treatment of PTSD in adult female rape victims (n = 74). Improvement in PTSD as assessed by blind independent assessors, depression, dissociation, and state anxiety was significantly greater in both the PE and EMDR group than the WAIT group (n = 20 completers per group). PE and EMDR did not differ significantly for change from baseline to either posttreatment or 6-month follow-up measurement for any quantitative scale.
394 citations
TL;DR: Findings from a Web-based survey of the International Society for Traumatic Stress Studies' members regarding use of trauma exposure and posttraumatic assessment instruments suggest highest professional degree, time since degree award, and student status yielded no differences in extent of reported trauma assessment test use.
Abstract: We report findings from a Web-based survey of the International Society for Traumatic Stress Studies' members (n = 227) regarding use of trauma exposure and posttraumatic assessment instruments. Across clinical and research settings, the most widely used tests included the Posttraumatic Stress Diagnostic Scale, Trauma Symptom Inventory, Life Events Checklist, Clinician-Administered Post-traumatic Stress Disorder (PTSD) Scale, PTSD Checklist, Impact of Event Scale—Revised, and Trauma Symptom Checklist for Children. Highest professional degree, time since degree award, and student status yielded no differences in extent of reported trauma assessment test use.
381 citations
TL;DR: Relevant literature on complex trauma and attachment is integrated with contemporary trauma theory as the background for discussing relational issues that commonly arise in this treatment, highlighting common challenges such as forming a therapeutic alliance, managing frame and boundaries, and working with dissociation and reenactments.
Abstract: The self and attachment difficulties associated with chronic childhood abuse and other forms of pervasive trauma must be understood and addressed in the context of the therapeutic relationship for healingtoextendbeyondresolutionoftraditionalpsychiatricsymptomsandskilldeficits.Theauthors integrate contemporary research and theory about attachment and complex developmental trauma, including dissociation, and apply it to psychotherapy of complex trauma, especially as this research and theory inform the therapeutic relationship. Relevant literature on complex trauma and attachment is integrated with contemporary trauma theory as the background for discussing relational issues that commonly arise in this treatment, highlighting common challenges such as forming a therapeutic alliance, managing frame and boundaries, and working with dissociation and reenactments.
333 citations
TL;DR: Symptom severity was associated with high perceived life threat and low emotional support, and participants who personally knew someone who had SARS were more likely to be affected by depressive symptoms.
Abstract: This study examines the psychological impact of severe acute respiratory syndrome (SARS) in 195 adult patients in Hong Kong. The Impact of Event Scale-Revised and Hospital Anxiety and Depression Scale were administered to patients 1 month after their discharge. Of the participants 10% to 18% reported symptoms related to posttraumatic stress disorder, anxiety, and depression. Symptom severity was associated with high perceived life threat and low emotional support. Women and participants who had low education level were more likely to have symptoms of avoidance. Participants who personally knew someone who had SARS were more likely to be affected by depressive symptoms.
306 citations
TL;DR: The authors offer a framework for the assessment of psychological responses associated with exposure to early onset, multiple, or extended traumatic stressors, and specific recommendations for use of various generic and trauma-specific child and adult measures are provided.
Abstract: The authors offer a framework for the assessment of psychological responses associated with exposure to early onset, multiple, or extended traumatic stressors. Six prominent and overlapping symptoms clusters are described: altered self-capacities, cognitive symptoms, mood disturbance, overdeveloped avoidance responses, somatoform distress, and posttraumatic stress. A strategy for the structured, psychometrically valid assessment of these outcomes is introduced, and specific recommendations for use of various generic and trauma-specific child and adult measures are provided. Implications of trauma assessment for treatment planning are discussed.
296 citations
TL;DR: The therapeutic efficacy of a culturally adapted cognitive-behavior therapy for Cambodian refugees with treatment-resistant posttraumatic stress disorder (PTSD) and comordid panic attacks and the severity of (culturally related) neck-focused and orthostasis-cued panic attacks, including flashbacks associated with these subtypes, improved across treatment.
Abstract: We examined the therapeutic efficacy of a culturally adapted cognitive-behavior therapy for Cambodian refugees with treatment-resistant posttraumatic stress disorder (PTSD) and comordid panic attacks. We used a cross-over design, with 20 patients in the initial treatment (IT) condition and 20 in delayed treatment (DT). Repeated measures MANOVA, Group & times; Time ANOVAs, and planned contrasts indicated significantly greater improvement in the IT condition, with large effect sizes (Cohen's d) for all outcome measures: Anxiety Sensitivity Index (d = 3.78), Clinician-Administered PTSD Scale (d = 2.17), and Symptom Checklist 90-R subscales (d = 2.77). Likewise, the severity of (culturally related) neck-focused and orthostasis-cued panic attacks, including flashbacks associated with these subtypes, improved across treatment.
271 citations
TL;DR: An array of deployment stressors that were content valid for both female and male Gulf War I military personnel was examined to elucidate gender differences in war-zone exposure and identify gender-based differential associations between stressors and mental health outcomes.
Abstract: Findings indicate that war-zone exposure has negative implications for the postdeployment adjustment of veterans; however, most studies have relied on limited conceptualizations of war-zone exposure and focused on male samples. In this study, an array of deployment stressors that were content valid for both female and male Gulf War I military personnel was examined to elucidate gender differences in war-zone exposure and identify gender-based differential associations between stressors and mental health outcomes. While women and men were exposed to both mission-related and interpersonal stressors and both stressor categories were associated with mental health outcomes, women reported more interpersonal stressors and these stressors generally had a stronger impact on women's than on men's mental health. Exceptions are described, and implications are discussed.
254 citations
TL;DR: The authors describe a three-phase sequential integrative model for the psychotherapy of complex posttraumatic self-dysregulation: Phase 1 (alliance formation and stabilization), Phase 2 (trauma processing), and Phase 3 (functional reintegration).
Abstract: The authors describe a three-phase sequential integrative model for the psychotherapy of complex posttraumatic self-dysregulation: Phase 1 (alliance formation and stabilization), Phase 2 (trauma processing), and Phase 3 (functional reintegration). The technical precautions designed to maximize safety, trauma processing, and reintegration regardless of the specific treatment approach are discussed. Existing and emerging treatment models that address posttraumatic dysregulation of consciousness,bodilyfunctioning,emotion,andinterpersonalattachmentsarealsodescribed.Theauthors conclude with suggestions for further clinical innovation and research evaluation of therapeutic models that can enhance the treatment of PTSD by addressing complex posttraumatic self-dysregulation.
252 citations
TL;DR: Examination of self-esteem, social support, and religious coping as mediators between experiences of child maltreatment and IPV and symptoms of PTSD in a sample of low-income African American women found both variables mediated the abuse-PTSD symptom link.
Abstract: There is a dearth of research on risk/protective factors for posttraumatic stress disorder (PTSD) among low-income African American women with a history of intimate partner violence (IPV), presenting for suicidal behavior or routine medical care in a large, urban hospital. We examined self-esteem, social support, and religious coping as mediators between experiences of child maltreatment (CM) and IPV and symptoms of PTSD in a sample (N = 134) of low-income African American women. Instruments used included the Index of Spouse Abuse, the Childhood Trauma Questionnaire, the Taylor Self-Esteem Inventory, the Multidimensional Profile of Social Support, the Brief Religious Coping Activities Scale, and the Davidson Trauma Scale. Both CM and IPV related positively to PTSD symptoms. Risk and resilience individual difference factors accounted for 18% of the variance in PTSD symptoms over and above IPV and CM, with self-esteem and negative religious coping making unique contributions. Both variables mediated the abuse-PTSD symptom link. In addition, we tested an alternate model in which PTSD symptoms mediated the relationship between abuse and both self-esteem and negative religious coping.
TL;DR: It is postulated that traumatization essentially involves some degree of division or dissociation of psychobiological systems that constitute personality, and that dissociation parts manifest in negative and positive dissociative symptoms that should be distinguished from alterations of consciousness.
Abstract: The role of dissociation in (complex) posttraumatic stress disorder (PTSD) has been insufficiently recognized for at least two reasons: the view that dissociation is a peripheral, not a central feature of PTSD, and existing confusion regarding the nature of dissociation. In this conceptual article, the authors address both issues by postulating that traumatization essentially involves some degree of division or dissociation of psychobiological systems that constitute personality. One or more dissociative parts of the personality avoid traumatic memories and perform functions in daily life, while one or more other parts remain fixated in traumatic experiences and defensive actions. Dissociative parts manifest in negative and positive dissociative symptoms that should be distinguished from alterations of consciousness. Complex PTSD involves a more complex structural dissociation than simple PTSD.
TL;DR: Results indicated five factors for the Posttraumatic Growth Inventory, and moderate levels of PTG, and Trauma severity was found to significantly predict PTG in addition to a positive correlation between PTG and negative posttrauma effects.
Abstract: Recent trauma literature has supported a philosophical shift from a pathogenic to a salutogenic paradigm in which the focus is on positive, as well as negative, posttrauma changes; however, empirical knowledge exploring the different domains of positive change or posttraumatic growth (PTG) is scarce. The present study investigated the multidimensionality of PTG in Australian undergraduate students (N = 219). Results indicated five factors for the Posttraumatic Growth Inventory, and moderate levels of PTG. Trauma severity was found to significantly predict PTG in addition to a positive correlation between PTG and negative posttrauma effects. While not negating negative effects of traumatic experiences, this area of traumatology research has important implications for redefining the "victims" of trauma as individuals capable of positive change rather than merely surviving.
TL;DR: The authors review sample composition and enrollment data for 34 studies cited in the ISTSS 2000 Practice Guidelines as meeting the Level A U.S. Agency for Health Care Policy and Research (AHCPR) classification for treatment of adult posttraumatic stress disorder (PTSD), and compare data from more recent research.
Abstract: The authors review sample composition and enrollment data for 34 studies cited in the International Society for Traumatic Stress Studies (ISTSS) 2000 Practice Guidelines as meeting the Level A U.S. Agency for Health Care Policy and Research (AHCPR) classification for treatment of adult posttraumatic stress disorder (PTSD), and compare data from more recent research. Findings reveal that many published reports omitted vital data including exclusion criteria and rates, demographics, and trauma exposure history. Moreover, severe comorbid psychopathology, a common feature of treatment-seeking individuals with PTSD, emerged as the predominant reason for exclusion across studies. Subsequently published studies exhibited improved reporting of sample characteristics and demonstrated comparable outcomes despite inclusion of more diverse trauma exposure samples. Findings indicate the need for future efficacy research to adopt more comprehensive reporting requirements and to test the applicability of validated treatments to individuals suffering from as yet unstudied combinations of PTSD and prevalent comorbid disorders.
TL;DR: Results of the path analyses indicated that personal resources, earthquake experiences, CSE, and gender have direct effects on intrusion and general distress and personal resources had an indirect effect on general distress mediated by CSE.
Abstract: This study examined the predictive power of personal resources (i.e., self-esteem, optimism, and perceived control), severity of earthquake experience (i.e., material and human loss and perceived threat), and coping self-efficacy (CSE) on general distress, intrusion, and avoidance symptoms among the survivors of the 1999 Marmara earthquake in Turkey. Specifically, we expected that CSE would mediate the links between personal resources, severity of earthquake experience, and distress. Survivors (N = 336) filled out various measures of earthquake exposure, personal resources, CSE, and distress. Results of the path analyses indicated that personal resources, earthquake experiences, CSE, and gender have direct effects on intrusion and general distress. Personal resources had also an indirect effect on general distress mediated by CSE. Findings were discussed considering the implications for conservation of resources model and social cognitive theory as well as for interventions following natural disasters.
TL;DR: Two models are proposed to relate maladaptive emotion regulation strategies and alcohol-related problems for women with a history of childhood sexual assault and one suggests only one motive-drinking to cope with negative emotions-mediates the relationship between CSA and alcohol problems.
Abstract: Two models are proposed to relate maladaptive emotion regulation strategies and alcohol-related problems for women with a history of childhood sexual assault (CSA) The distress coping model suggests only one motive-drinking to cope with negative emotions-mediates the relationship between CSA and alcohol problems The emotion regulation model suggests two motives mediate the relationship between CSA and alcohol problems: drinking to cope with negative emotions and drinking to enhance positive emotions These models were tested in a random community sample of 697 women, ranging from 25 to 75 years old Both motives partially mediated the relationship between CSA and alcohol problems Effects were small, but reliable
TL;DR: Recommendations for practice include informing DMH recruits of therapist risk factors and assigning at-risk DMH workers to lower-risk assignments.
Abstract: Relationships between secondary traumatic stress (STS) symptoms and therapist characteristics and assignment variables were examined for 81 disaster mental health (DMH) workers who responded to the terrorist attacks of September 11, 2001. Higher STS was associated with therapist variables of heavier prior trauma caseload, less professional experience, youth, and therapist's discussion of his or her own trauma or trauma work in his or her own therapy. Therapist gender and personal trauma history were not significantly related to STS. Assignment variables associated with higher STS included longer length of assignment and more time spent with child clients, firefighters (who suffered great losses in the tragedy), or clients who discussed morbid material. Recommendations for practice include informing DMH recruits of therapist risk factors and assigning at-risk DMH workers to lower-risk assignments.
TL;DR: The notion of dissociation as a general trait was not supported and dissociation may represent a variety of phenomenologically distinct and only moderately related symptom clusters whose ultimate commonality is more theoretical than empirical.
Abstract: The dimensionality of dissociation was examined in a combined sample of 1,326 general population, clinical, and university participants who completed the Multiscale Dissociation Inventory (MDI). Principal components analysis identified five moderately intercorrelated factors (mean r = .39): Disengagement, Identity Dissociation, Emotional Constriction, Memory Disturbance, and Depersonalization/Derealization. Differential relationships were found between individual MDI factors and demographics, trauma history, clinical status, posttraumatic stress, and scores on other dissociation measures. Surprisingly, after controlling for sex and age, trauma exposure accounted for only 3 to 7% of the variance in MDI factors. The notion of dissociation as a general trait was not supported. Instead, dissociation may represent a variety of phenomenologically distinct and only moderately related symptom clusters whose ultimate commonality is more theoretical than empirical.
TL;DR: Seven hypothesized factor structures were evaluated using confirmatory factor analysis of the Posttraumatic Stress Disorder Checklist and different patterns of correlations with external variables were found for the avoidance and emotional numbing factors, providing further validation of the supported model.
Abstract: Posttraumatic stress disorder (PTSD) factor analytic research to date has not provided a clear consensus on the structure of posttraumatic stress symptoms. Seven hypothesized factor structures were evaluated using confirmatory factor analysis of the Posttraumatic Stress Disorder Checklist, a paper-and-pencil measure of posttraumatic stress symptom severity, in a sample of 1,218 women who experienced a broad range of workplace sexual harassment. The model specifying correlated re-experiencing, effortful avoidance, emotional numbing, and hyperarousal factors provided the best fit to the data. Virtually no support was obtained for the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV; American Psychiatric Association, 1994) three-factor model of re-experiencing, avoidance, and hyperarousal factors. Different patterns of correlations with external variables were found for the avoidance and emotional numbing factors, providing further validation of the supported model.
TL;DR: Most dropouts occurred before starting imaginal ET, although initiating ET was associated with greater likelihood of completion, and avoidance and depression as unique predictors of completion.
Abstract: This study assessed rates of imaginal exposure therapy (ET) utilization and completion of cognitive behavioral therapy (CBT) for posttraumatic stress disorder (PTSD) in a clinical setting and examined variables associated with CBT completion. Using a clinical definition, the completion rate of CBT was markedly lower than rates reported in randomized trials. CBT completion was inversely related to severity of overall pretreatment measures of PTSD, avoidance, hyperarousal, depression, impaired social functioning, and borderline personality disorder. Regression yielded avoidance and depression as unique predictors of completion. Most dropouts occurred before starting imaginal ET, although initiating ET was associated with greater likelihood of completion. Results highlight methodological differences between research and practice notions of treatment completion and the need for further study of variables influencing CBT completion in practice settings.
TL;DR: Pre- and post-treatment assessments revealed that SHTC participants decreased avoidance behavior, frequency of intrusive symptoms, state anxiety, and depressive symptoms, and increased coping skills and coping self-efficacy significantly more than WL participants.
Abstract: This study compared the efficacy of an Internet-based, 8-week self-help program for traumatic event-related consequences (SHTC) (n = 13) to a wait-list (WL) condition (n = 14). The SHTC consisted of cognitive-behavioral modules that progressed from the least anxiety-provoking component (i.e., information) to the most anxiety-provoking (i.e., exposure). Participants were those who had experienced a traumatic event and had been experiencing subclinical levels of symptoms associated with the event. Participants mastered the material in each module before proceeding to the next module. Pre- and post-treatment assessments revealed that SHTC participants decreased avoidance behavior, frequency of intrusive symptoms, state anxiety, and depressive symptoms, and increased coping skills and coping self-efficacy significantly more than WL participants. SHTC participants demonstrated more clinically significant improvement than WL individuals.
TL;DR: Brief behavioral treatment has promise as a cost-effective intervention for disaster survivors and significant treatment effects were found on all measures at posttreatment.
Abstract: In an attempt to develop a brief treatment for disaster survivors, the present study examined the effectiveness of a single session of modified behavioral treatment in earthquake-related posttraumatic stress disorder. Fifty-nine earthquake survivors in Turkey were randomized into either single-session modified behavioral treatment (SSBT) designed to enhance sense of control over earthquake-related fears or waiting list control condition (WL). The WL group received SSBT after a second baseline assessment. Follow-ups were at weeks 6, 12, 24, and at 1-2 years posttreatment. Significant treatment effects were found on all measures at posttreatment. The improvement rate was 49% at week 6; it rose to 80% by week 12, 85% by week 24, and 83% by the 1-2-year follow-up. Brief behavioral treatment has promise as a cost-effective intervention for disaster survivors.
TL;DR: The results of this investigation indicated that individuals with more extensive histories of potentially traumatic events in childhood were more likely to report the experience of trauma-related guilt after exposure to domestic violence victimization in adulthood, and the path model indicated that experiencing trauma- related guilt was associated with greater use of avoidant coping strategies.
Abstract: This investigation utilized path analyses to examine the direct and indirect effects of experiences of potentially traumatic events in childhood, trauma-related guilt, and the use of avoidant coping strategies on level of PTSD symptomatology among a sample of female survivors of domestic violence. The results of this investigation indicated that individuals with more extensive histories of potentially traumatic events in childhood were more likely to report the experience of trauma-related guilt after exposure to domestic violence victimization in adulthood. Further, the path model indicated that experiencing trauma-related guilt was associated with greater use of avoidant coping strategies. Trauma-related guilt was related to increased PTSD symptomatology both directly and indirectly through the use of avoidant coping strategies. These findings highlight the importance of attending to guilt-based affective and cognitive reactions, maladaptive coping strategies, and the association between these constructs when treating survivors of relationship violence with multiple exposures to potentially traumatic events.
TL;DR: Findings indicated that the factor structure of the SIDES across samples was not stable; thus construct equivalence was not shown and a multistep interdisciplinary method is proposed to improve the cross-cultural construct validity of a psychiatric concept.
Abstract: This study examined the cross-cultural construct equivalence of the Structured Interview for Disorders of Extreme Stress (SIDES), an instrument designed to assess symptoms of Disorders of Extreme Stress Not Otherwise Specified (DESNOS). Participants completed the SIDES as a part of an epidemiological survey conducted between 1997 and 1999 among survivors of war or mass violence in Algeria (n = 652), Ethiopia (n = 1,200), and Gaza (n = 585). Findings indicated that the factor structure of the SIDES across samples was not stable; thus construct equivalence was not shown. A multistep interdisciplinary method is proposed to improve the cross-cultural construct validity of a psychiatric concept. This method accommodates universal chronic sequelae of extreme stress and accommodates culture-specific symptoms across a variety of cultures.
TL;DR: The authors evaluated the posttraumatic stress disorder (PTSD) Checklist's (PCL) psychometric properties in 142 older adult primary care patients screened for several psychiatric disorders, finding similar convergence with the Center for Epidemiological Studies-Depression scale.
Abstract: In this article the authors evaluated the posttraumatic stress disorder (PTSD) Checklist's (PCL) psychometric properties in 142 older adult primary care patients screened for several psychiatric disorders. Several established PCL scoring rules were assessed. Receiver operating characteristic analyses revealed a PCL score of 37 achieving optimal sensitivity and specificity, when compared to the PCL's algorithm-derived PTSD diagnosis (based on whether at least one reexperiencing, three avoidance/numbing, and two hyperarousal symptoms were endorsed with a rating of 3 or higher, indicating at least moderate severity). Among depressed, anxious, and substance abusing older adults, the PCL demonstrated adequate internal consistency. It also revealed similar convergence with the Center for Epidemiological Studies-Depression scale, found in previous research. Implications for using the PTSD Checklist with community-dwelling older adults in primary care are discussed.
TL;DR: Significant differences based on sexual trauma type were observed; individuals who experienced adolescent sexual assault or revictimization were at greatest risk for psychopathology, poor social adjustment, and risky sexual behaviors.
Abstract: Studies typically demonstrate that sexual victimization is associated with negative outcomes, yet they often fail to control for other trauma exposure and rarely address the impact of developmental level at the time of exposure or the type of sexual trauma experienced. The present study addresses these confounds by identifying groups of women with unique, nonoverlapping sexual trauma histories and examines the association between type of sexual trauma exposure and mental health impairment, social adjustment, and sexual functioning. This study compared five discrete groups of college-sophomore women based on self-identified trauma histories including no trauma, childhood sexual assault, childhood sexual abuse, adolescent sexual assault, and revictimization. Significant differences based on sexual trauma type were observed; individuals who experienced adolescent sexual assault or revictimization were at greatest risk for psychopathology, poor social adjustment, and risky sexual behaviors.
TL;DR: Two hundred North Korean defectors in South Korea were studied to identify their experiences of traumatic events in North Korea and during defection, and the correlation with Posttraumatic Stress Disorder (PTSD).
Abstract: The number of North Korean defectors entering South Korea has been increasing rapidly since 1994. Two hundred North Korean defectors in South Korea were studied to identify their experiences of traumatic events in North Korea and during defection, and the correlation with Posttraumatic Stress Disorder (PTSD). Researchers conducted face-to-face interviews and assisted defectors in performing a self-report assessment of this survey. The study questionnaire consisted of demographic characteristics, the Traumatic Experiences Scale for North Korean Defectors, and the PTSD part of the Structured Clinical Interview for DSM-III-R Korean version. Prevalence rate of PTSD in defectors was 29.5%, with a higher rate for women. In factor analysis, the 25 items of traumatic events experienced in North Korea were divided into three factors: Physical Trauma, Political-Ideological Trauma, and Family-Related Trauma. In addition, the 19 items of traumatic events during defection were grouped into four factors: Physical Trauma, Detection and Capture-Related Trauma, Family-Related Trauma, and Betrayal-Related Trauma. In multifactorial logistic regression analysis, Family-Related Trauma in North Korea had a significant odds ratio.
TL;DR: The most important factors associated with treatment seeking appear to be a higher level of psychopathology, the type and level of the traumatic event, and sociodemographic characteristics, in particular female gender.
Abstract: This review aimed to identify factors associated with seeking treatment from mental health services after a traumatic event. Databases of literature were searched in a systematic manner and 24 relevant articles were found. Although many of the findings are inconsistent, the most important factors associated with treatment seeking appear to be a higher level of psychopathology, the type and level of the traumatic event, and sociodemographic characteristics, in particular female gender. Even though the evidence is insufficient to guide service development, suggestions for future research are made. The methodological quality of research should be improved to establish whether the inconsistency of findings reflects methodological artefacts or true differences between different samples and contexts.
TL;DR: The effects of administering a five-session cognitive-behavioral insomnia treatment to 5 patients who responded to CBT for PTSD yet continued to report insomnia are reported.
Abstract: Insomnia is one of the most common symptoms of posttraumatic stress disorder (PTSD). Evidence suggests that insomnia may persist for many PTSD patients after other symptoms have responded to cognitive-behavioral therapy (CBT). The present article reports the effects of administering a five-session cognitive-behavioral insomnia treatment to 5 patients who responded to CBT for PTSD yet continued to report insomnia. Insomnia treatment was associated with improvements on subjective sleep measures (Pittsburgh Sleep Quality Index, Insomnia Severity Index, and Beliefs and Attitudes about Sleep Scale) and self-monitored sleep efficiency and related measures in 4 of 5 cases. Results highlight issues specific to treating insomnia in trauma populations and future directions for examining treatment of insomnia associated with PTSD.