Startle Modulation During Conscious Emotion Regulation Is Arousal-Dependent.

Conscious regulation of negative emotion has been shown to affect human eyeblink startle responses, but whether these results depend on modulation of arousal- or valence-based processes is unknown. The authors presented participants with negative, neutral, and positive pictures and directed them to enhance, maintain, and suppress emotional responses. On emotional picture trials, startle responses decreased as a function of cue in the following order: enhance > maintain > suppress. Analysis of negative and positive picture trials separately revealed similar patterns of startle modulation by emotion regulation. There were no effects of emotion regulation on neutral trials. Results indicate that arousal, not valence, may be critical to startle modulation via conscious emotion regulation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Relationship Between Acute Stress Disorder and Posttraumatic Stress Disorder Following Cancer.

In this study, the authors investigated the relationship between acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) following cancer diagnosis. Patients who were recently diagnosed with 1st onset head and neck or lung malignancy (N = 82) were assessed for ASD within the initial month following their diagnosis and reassessed (n = 63) for PTSD 6 months following their cancer diagnosis. At the initial assessment, 28% of patients had ASD, and 32% displayed subsyndromal ASD. At follow-up, PTSD was diagnosed in 53% of patients who had been diagnosed with ASD and in 11% of those who had not met criteria for ASD; 36% of patients with PTSD did not initially display ASD. In this study, the authors question the use of the ASD diagnosis to identify recently diagnosed patients at risk of PTSD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attention, Heart Rate, and Startle Response During Exposure to Trauma-Relevant Pictures: A Comparison of Recent Trauma Victims and Patients With Posttraumatic Stress Disorder.

Victims of a recent trauma were compared with posttraumatic stress disorder (PTSD) patients and healthy controls to assess whether a specific anxiety response and an attentional bias were evident initially or only in chronic PTSD. Heart rate (HR) and startle response were measured, and a dot-probe task was carried out using trauma-relevant pictures. Severely affected recent trauma victims and chronic PTSD patients showed HR acceleration to trauma-related material, which was the only significant group difference. A bias away from trauma-related material was related to severity of intrusions in recent trauma victims, and the bias toward trauma-related material increased with amplitude of the HR response in PTSD patients. A specific anxiety reaction is present initially in severely affected trauma victims. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Epidemiology of Trauma and Posttraumatic Stress Disorder in Mexico.

Prevalence rates of trauma and posttraumatic stress disorder (PTSD) were estimated from a probability sample of 2,509 adults from 4 cities in Mexico. PTSD was assessed according to Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994) criteria using the Composite International Diagnostic Interview (CIDI; WHO, 1997). Lifetime prevalence of exposure and PTSD were 76% and 11.2%, respectively. Risk for PTSD was highest in Oaxaca (the poorest city), persons of lower socioeconomic status, and women. Conditional risk for PTSD was highest following sexual violence, but nonsexual violence and traumatic bereavement had greater overall impact because of their frequency. Of lifetime cases, 62% became chronic; only 42% received medical or professional care. The research demonstrates the importance of expanding the epidemiologic research base on trauma to include developing countries around the world. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A Prospective Study of Autobiographical Memory and Posttraumatic Stress Disorder Following Cancer.

In this study, the authors investigated the relationship between autobiographical memory and the onset and maintenance of distressing memories following cancer. In Study 1, participants recently diagnosed with head, neck, or lung cancer were assessed for acute stress disorder (ASD). Participants with ASD reported fewer specific memories than did participants without ASD. In Study 2, the same participants were assessed 6 months later for autobiographical memory and cancer-related posttraumatic stress disorder (PTSD). Deficits in the retrieval of specific memories in Study 1 were not predictive of subsequent PTSD. Increased hopelessness during the 6 months was associated with a decline in the retrieval of positive memories and an increase in the retrieval of negative memories. These findings accord with propositions that retrieval of distressing memories is guided by current self-image and attitude toward one's future. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment of Posttraumatic Stress Disorder in Military and Veteran Populations.

While concerns about the psychological effects of war are not new, only recently has systematic attention been paid to such problems among past and present military personnel. There is increasing recognition that mental health has serious implications for operational performance, retention, and compensation. Although little controlled research exists with this population, preliminary evidence suggests that psychological treatments for posttraumatic stress disorder may be beneficial, albeit less so than for civilian populations. This article reviews evidence for each of several psychological treatment stages: stabilization and engagement, psychoeducation, symptom management, prolonged exposure, cognitive restructuring, and relapse prevention, with particular reference to the clinical issues raised by military personnel. Possible explanations for reduced treatment effects in this population compared with civilians are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The impact of changes in spatial distance on emotional responses.

Drawing on motivational approaches to emotion, the authors propose that the perceived change in spatial distance to pictures that arouse negative emotions exerts an influence on the significance of these pictures. Two experiments induced the illusion that affective pictures approach toward the observer, recede from the observer, or remain static. To determine the motivational significance of the pictures, emotional valence and arousal ratings as well as startle responses were assessed. Approaching unpleasant pictures were found to exert an influence on both the valence and the arousal elicited by the pictures. Furthermore, movement of pleasant or neutral pictures did not influence startle responses, while the second experiment showed that approaching unpleasant pictures elicited enhanced startle responses compared to receding unpleasant pictures. These findings support the view that a change of spatial distance influences motivational significance and thereby shapes emotional responses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Validating the Primary Care Posttraumatic Stress Disorder Screen and the Posttraumatic Stress Disorder Checklist with soldiers returning from combat.

The purpose of the research was to assess the diagnostic efficiency of the Primary Care Posttraumatic Stress Disorder Screen (PC-PTSD) and the Posttraumatic Stress Disorder Checklist (PCL) as clinical screening tools for active duty soldiers recently returned from a combat deployment. A secondary goal was to examine the item-level characteristics of both the PC-PTSD and the PCL. A validation study conducted with a sample of 352 service members showed that both the PC-PTSD and PCL had good diagnostic efficiency. The overall diagnostic efficiency assessed by the area under the curve (AUC) was virtually the same for both the PC-PTSD and PCL. The most efficient cutoff values for the PC-PTSD were either 2 or 3 yes responses with the latter favoring specificity. For the PCL, the most efficient cutoff values were between 30 and 34, mirroring recommended PCL cutoff values from some studies in primary care settings. The examination of item characteristics suggested a 4-item PCL with an AUC virtually identical to that of the full PCL. Item analyses also identified that the most discriminate item in both scales pertained to symptoms of avoidance. Implications and limitations are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Posttraumatic Stress Disorder and Current Relationship Functioning Among World War II Ex-Prisoners of War.

This study examined the association of posttraumatic stress disorder (PTSD) with the quality of intimate relationships among present-day male World War II ex-prisoners of war (POWs). Ex-POWs had considerable marital stability; those with PTSD were no less likely to be in an intimate relationship. Ex-POWs in an intimate relationship who had PTSD (N=125 ) were compared with ex-POWs in a relationship who did not have PTSD (N=206). Marital functioning was within a range expected for persons without traumatic exposure. Yet, over 30% of those with PTSD reported relationship problems compared with only 11% of those without PTSD. Ex-POWs with PTSD reported poorer adjustment and communication with their partners and more difficulties with intimacy. Emotional numbing was significantly associated with relationship difficulties independent of other symptom complexes and severity of PTSD. Implications for clinical practice are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive Changes During Prolonged Exposure Versus Prolonged Exposure Plus Cognitive Restructuring in Female Assault Survivors With Posttraumatic Stress Disorder.

The authors report on changes in cognitions related to posttraumatic stress disorder (PTSD) among 54 female survivors of sexual and nonsexual assault with chronic PTSD who completed either prolonged exposure alone or in combination with cognitive restructuring. Treatment included 9-12 weekly sessions, and assessment was conducted at pretreatment, posttreatment, and a modal 12-month follow-up. As hypothesized, treatment that included prolonged exposure resulted in clinically significant, reliable, and lasting reductions in negative cognitions about self, world, and self-blame as measured by the Posttraumatic Cognitions Inventory. The hypothesis that the addition of cognitive restructuring would augment cognitive changes was not supported. Reductions in these negative cognitions were significantly related to reductions in PTSD symptoms. The addition of cognitive restructuring did not significantly augment the cognitive changes. Theoretical implications of the results are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Key Elements in Couples Therapy With Veterans With Combat-Related Posttraumatic Stress Disorder.

If a client dealing with combat-related posttraumatic stress disorder (PTSD) presents for psychotherapy, should you consider including his or her partner in treatment? How could couples therapy be beneficial? What framework do you have to conceptualize the relational issues and potential treatment? Although clinicians have long been encouraged to include families in the treatment of combat-related PTSD, few specific couple-family therapies exist, and outcome research is scarce. Because of the adverse effects of PTSD on relationships, couples therapy can be a powerful adjunct treatment; however, few receive this service. A new framework for conceptualizing couples therapy organizes treatment around the 3 PTSD symptom clusters (reexperiencing, avoidance, and arousal). Relationship consequences of each symptom cluster are summarized, followed by useful treatment interventions and a case study. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prevalence of Posttraumatic Stress Disorder in Persons With Spinal Cord Injuries: The Mediating Effect of Social Support.

Objectives: To evaluate the prevalence of posttraumatic stress disorder (PTSD) and to identify risk factors of PTSD in persons with spinal cord injury (SCI). Main Outcome Measures: PTSD and social support were assessed by using the Harvard Trauma Questionnaire (R. F. Mollica et al., 1992) and the Crisis Support Scale (S. Joseph, W. Yule, R. Williams, & B. Andrews, 1993). Participants: One hundred sixty-eight persons with SCI, who were an average of 14 years after injury, filled in the questionnaire. Results: The prevalence of PTSD was 7.1%. Risk factors for PTSD included complete injury, being single, and low level of social support. Conclusions: The prevalence of PTSD after SCI is similar to that in the general population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive Approaches to Posttraumatic Stress Disorder: The Evolution of Multirepresentational Theorizing.

The evolution of multirepresentational cognitive theorizing in psychopathology is illustrated by detailed discussion and analysis of a number of prototypical models of posttraumatic stress disorder (PTSD). Network and schema theories, which focus on a single, explicit aspect/format of mental representation, are compared with theories that focus on 2 or more explicit representational elements. The author argues that the latter theories provide a more complete account of PTSD data, though are not without their problems. Specifically, it is proposed that at least 3 separate representational elements-associative networks, verbal/propositional representations, and schemas-are required to generate a comprehensive cognitive theory of PTSD. The argument that the development of multirepresentational cognitive theory in PTSD is a paradigm case for the development of similar theories in other forms of psychopathology is elaborated, and a brief agenda is proposed promoting 2 levels of theorizing-deep, formal theory alongside more localized, applied theory. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Bridging the Gap Between Posttraumatic Stress Disorder Research and Clinical Practice: The Example of Exposure Therapy.

There are notable challenges in translating empirically supported psychosocial treatments (ESTs) into general routine clinical practice. However, there may be additional unique dissemination and implementation obstacles for ESTs for trauma-related disorders. For example, despite considerable evidence from randomized clinical trials that attests to the efficacy of exposure therapy for posttraumatic stress disorder, front-line clinicians in real-world settings rarely use this treatment. Perceived and actual barriers that interfere with adoption include clinician misconceptions about what exposure entails and complex cases to which ESTs may not be readily applicable. Specific suggestions for bridging the science-into-service gap in trauma ESTs (in general) and in exposure therapy (in particular) are proposed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A Comparison of Narrative Exposure Therapy, Supportive Counseling, and Psychoeducation for Treating Posttraumatic Stress Disorder in an African Refugee Settlement.

Little is known about the usefulness of psychotherapeutic approaches for traumatized refugees who continue to live in dangerous conditions. Narrative exposure therapy (NET) is a short-term approach based on cognitive-behavioral therapy and testimony therapy. The efficacy of narrative exposure therapy was evaluated in a randomized controlled trial. Sudanese refugees living in a Ugandan refugee settlement (N = 43) who were diagnosed as suffering from posttraumatic stress disorder (PTSD) either received 4 sessions of NET, 4 sessions of supportive counseling (SC), or psychoeducation (PE) completed in 1 session. One year after treatment, only 29% of the NET participants but 79% of the SC group and 80% of the PE group still fulfilled PTSD criteria. These results indicate that NET is a promising approach for the treatment of PTSD for refugees living in unsafe conditions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Posttraumatic Stress Disorder in Youth: A Critical Review of the Cognitive and Behavioral Treatment Outcome Literature.

What treatments work for children who have posttraumatic stress disorder (PTSD)? Perhaps more important, what else do clinicians need to learn? In this article, the authors focus on treatment research in the area of trauma and PTSD in youth, in an attempt to highlight the clinical implications of such work and to identify the areas in which additional research is needed. Overall, there is emerging evidence that a variety of cognitive and behavioral programs are effective in treating youth with PTSD. In spite of such evidence, additional research is needed to shore up the scientific base for effective clinical practice with these youth. Psychologists working with traumatized youth will find this article a useful update on the state of evidence for cognitive-behavioral interventions in the treatment of PTSD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Immediate Antecedents of Cigarette Smoking in Smokers With and Without Posttraumatic Stress Disorder: A Preliminary Study.

Using ambulatory methods for 1 day of monitoring, the authors of this study investigated the association between smoking and situational cues in 63 smokers with posttraumatic stress disorder (PTSD) and 32 smokers without PTSD. Generalized estimating equations contrasted 682 smoking and 444 nonsmoking situations by group status. Smoking was strongly related to craving, positive and negative affect, PTSD symptoms, restlessness, and several situational variables among PTSD smokers. For non-PTSD smokers, the only significant antecedent variables for smoking were craving, drinking coffee, being alone, not being with family, not working, and being around others who were smoking. These results are consistent with previous ambulatory findings regarding mood in smokers but also underscore that, in certain populations, mood and symptom variables may be significantly associated with ad lib smoking. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sequential Treatment for Child Abuse-Related Posttraumatic Stress Disorder: Methodological Comment on Cloitre, Koenen, Cohen, and Han (2002).

M. Cloitre, K. Koenen, L. R. Cohen, and H. Han (2002; see record 2002-18226-001) presented results of a randomized trial that clearly demonstrate the safety and efficacy of a treatment program delivering skills training in affective and interpersonal regulation (STAIR) prior to conducting imaginal exposure (IE) to trauma memories for adults with posttraumatic stress disorder (PTSD) related to childhood abuse. In this comment the authors review the results presented by Cloitre et al and specifically compare the impact of the STAIR and IE phases of the treatment on affect regulation and psychopathology measures. Evidence for adverse events associated with exposure therapy is reviewed. The authors emphasize that the present study should not be interpreted as evidence that pretreatment with STAIR is additively helpful or necessary prior to IE for PTSD associated with child abuse and that a between-groups comparison is necessary before such conclusions can be drawn. (PsycINFO Database Record (c) 2010 APA, all rights reserved)