Patterns of recovery from trauma: The use of intraindividual analysis.

Patterns of recovery from sexual and nonsexual assault were examined. Two studies containing data from female victims of these assaults were analyzed. In Study 1, victims (N?=?101) underwent 12 weekly assessments with measures of posttraumatic stress disorder (PTSD), depression, and state anxiety. In Study 2, victims (N?=?108) underwent monthly assessments on the same measures. The authors examined the effects of type of trauma and time of peak reaction on long-term recovery using intraindividual analysis of change. In both studies, initial and peak reactions of rape victims were more severe than were those of nonsexual assault victims on all measures of psychopathology. Victims with delayed peak reaction exhibited more severe pathology at the final assessment than did victims with early peak reaction. Results of Study 2 indicated a slower recovery rate from sexual than nonsexual assault; in Study 1 a similar pattern of recovery emerged. The advantages of an individual-focused, longitudinal approach to recovery from a trauma are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluation of a brief cognitive-behavioral program for the prevention of chronic PTSD in recent assault victims.

The efficacy of a brief prevention program (BP) aimed at arresting the development of chronic posttraumatic stress disorder (PTSD) was examined with 10 recent female victims of sexual and nonsexual assault who received 4 sessions of a cognitive-behavioral program shortly after the assault. Their PTSD and depression severity was compared with that of 10 matched recent female assault victims who received repeated assessments of their trauma-related psychopathology (assessment control; AC). The BP program consisted of education about common reactions to assault and cognitive-behavioral procedures. Two months postassault, victims who received the BP program had significantly less severe PTSD symptoms than victims in the control condition; 10% of the former group met criteria for PTSD versus 70% of the latter group. Five and a half months postassault, victims in the BP group were significantly less depressed than victims in the AC group and had significantly less severe reexperiencing symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Trauma reactivity, avoidant coping, and PTSD symptoms: A moderating relationship?

In the immediate aftermath of a traumatic event, many individuals experience physiological reactivity in response to reminders of the traumatic event that typically lessens over time. However, an overreliance on avoidant coping strategies may interfere with the natural recovery process, particularly for those who are highly reactive to trauma reminders. In the current investigation, we examined avoidant coping as a moderator of the association between heart rate reactivity to a trauma monologue measured shortly after a traumatic event and severity of posttraumatic stress disorder (PTSD) symptoms measured several months later. Fifty-five female survivors of assault completed PTSD diagnostic interviews and a self-report coping measure and participated in a trauma monologue procedure that included continuous heart rate measurement. These procedures were completed within 1 month of the assault and again 3 months postassault. After we controlled for the effect of initial symptom levels, the interaction of heart rate reactivity to the trauma monologue and avoidant coping measured at Time 1 was associated with PTSD symptom severity at Time 2. Individuals who are relatively highly reliant on avoidant coping strategies and relatively highly reactive to trauma reminders may be at greatest risk of maintaining or potentially increasing their PTSD symptoms within the first few months following the trauma. These findings may help inform early intervention efforts for survivors of traumatic events. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Arousal, numbing, and intrusion: symptom structure of PTSD following assault

OBJECTIVE: This study investigated hypotheses concerning the importance of symptoms of numbing in posttraumatic stress disorder (PTSD). METHODS: Symptoms of PTSD were assessed in 72 female rape victims and 86 female victims of nonsexual assault approximately 3 months after the crimes occurred. A principal-components factor analysis of subjects' symptoms was then undertaken. RESULTS: The analysis yielded three factors: arousal/avoidance, numbing, and intrusion. These were somewhat different from the symptom clusters in DSM-III-R, since effortful avoidance and numbing symptoms did not load on the same factor. Numbing symptoms appeared to be particularly important in identifying individuals with PTSD. CONCLUSIONS: The results imply that there are two patterns of posttrauma symptoms, one characterizing PTSD and the second characterizing a phobic reaction.     

Predictors of cortisol and 3-methoxy-4-hydroxyphenylglycol responses in the acute aftermath of rape

BACKGROUND: Prospective studies of trauma survivors can provide information about the relationship between rape characteristics and the development of subsequent symptoms. METHODS: The present study examined the relationship of prior assault, rape severity, posttraumatic stress disorder (PTSD) symptoms following rape, and subsequent PTSD diagnosis, to the acute cortisol and 3-methoxy-4-hydroxyphenylglycol (MHPG) response to this traumatic event in 20 women. RESULTS: Women with a history of prior physical or sexual assault showed a significantly attenuated cortisol response to the acute stress of rape compared to women without such a history. MHPG appeared to be associated with injury-related rape characteristics, and symptoms of active avoidance, but not prior history. PTSD status at the 3-month follow-up was predicted by both a prior history of assault and high injury rape, but was not directly predicted by either cortisol or MHPG levels. MHPG and cortisol were not correlated in the sample as a whole, but were correlated among individuals who did not subsequently develop PTSD (p = .04) CONCLUSIONS: The results suggest that different neuroendocrine systems may mediate different components of the response to traumatic stress.     

Sex differences in trauma and posttraumatic stress disorder: A quantitative review of 25 years of research.

Meta-analyses of studies yielding sex-specific risk of potentially traumatic events (PTEs) and posttraumatic stress disorder (PTSD) indicated that female participants were more likely than male participants to meet criteria for PTSD, although they were less likely to experience PTEs. Female participants were more likely than male participants to experience sexual assault and child sexual abuse, but less likely to experience accidents, nonsexual assaults, witnessing death or injury, disaster or fire, and combat or war. Among victims of specific PTEs (excluding sexual assault or abuse), female participants exhibited greater PTSD. Thus, sex differences in risk of exposure to particular types of PTE can only partially account for the differential PTSD risk in male and female participants. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Do Assault-Related Variables Predict Response to Cognitive Behavioral Treatment for PTSD?

This study examined the hypothesis that variables such as history of prior trauma, assault severity, and type of assault, previously found to be associated with natural recovery, would also predict treatment outcome. Trauma-related variables were examined as predictors of posttreatment posttraumatic stress disorder (PTSD) severity in a sample of 73 female assault victims with chronic PTSD who completed treatment in a comparative outcome study (E. B. Foa et al., 1999). Results indicated that after controlling for initial severity of PTSD symptoms, the experience of trauma in childhood and sustaining physical injury during the adult assault were predictive of greater PTSD severity following treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Victims of rape: Repeated assessment of depressive symptoms.

115 rape victims (aged 15–71 yrs) were examined at 2 wks and at 1, 2, 4, 8, and 12 mo after the assault. A matched control group of 87 nonvictims was seen at the same intervals. To control for the effects of repeated testing, 3 additional groups of 22–26 victims were assessed only once at 2, 4, or 8 mo postrape. All Ss completed the Beck Depression Inventory and the Hamilton Psychiatric Rating Scale for Depression. Depressive symptoms were significantly higher in victims of rape than in nonvictim controls following the assault. By 4 mo postrape, depressive symptoms in the victim group had diminished to the level shown by the nonvictim control group. Results from the single-testing victim groups indicated that repeated assessment affected the self-report measure, but not the interviewer-rated measure. Variables reflecting pre-rape functioning were more predictive of continued problems with depressive symptoms than were demographic variables or variables associated with the rape and its aftermath. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A longitudinal examination of fear reactions in victims of rape.

Investigated fear reactions in rape victims for 1 yr following their assaults. 150 female victims, over 15 yrs of age, seen approximately 2 wks after the assault and at 1, 2, 4, 8, and 12 mo postrape, were compared with a matched control group of nonvictims seen at the same intervals. To control for the effects of repeated testing, 3 additional groups of victims were assessed only once at either 2, 4, or 8 mo postrape. All participants completed the Modified Fear Survey Schedule (MFS), which yielded a total fearfulness index as well as 6 subscale scores: rape fears, animal fears, classical fears, social–interpersonal fears, tissue-damage fears, and miscellaneous fears. Following the assault, victims were significantly more fearful than nonvictim controls as indicated by their overall MFS score and most of the subscale scores. Although their overall fearfulness declined somewhat and stabilized by 2 mo postassault, victims remained significantly more fearful than nonvictim controls at 12 mo postassault. The rape fears and classical fears subscales seemed to contribute most to this elevation. Results from the single-testing victim groups indicated that repeated assessment had no effect on participants' scores. (23 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive processing therapy for sexual assault victims.

Cognitive processing therapy (CPT) was developed to treat the symptoms of posttraumatic stress disorder (PTSD) in rape victims. CPT is based on an information processing theory of PTSD and includes education, exposure, and cognitive components. 19 sexual assault survivors received CPT, which consists of 12 weekly sessions in a group format. They were assessed at pretreatment, posttreatment, and 3- and 6-mo follow-up. CPT Ss were compared with a 20-S comparison sample, drawn from the same pool who waited for group therapy for at least 12 wks. CPT Ss improved significantly from pre- to posttreatment on both PTSD and depression measures and maintained their improvement for 6 mo. The comparison sample did not change from the pre- to the posttreatment assessment sessions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Risk recognition and trauma-related symptoms among sexually revictimized women.

This study used experimental methodology to investigate the differential impact of various levels of sexual victimization on women's perceptions of risk and evaluative judgments of sexual assault within a dating interaction. Single- and multiple-incident victims were compared with nonvictims. Results supported the hypothesis that revictimized women would exhibit longer latencies than either single incident victims or nonvictims in signaling that an audiotaped date rape should be halted. Revictimized women with greater posttraumatic stress disorder (PTSD) symptoms, arousal symptoms in particular, exhibited latencies similar to those of nonvictims, whereas revictimized women with lower levels of PTSD symptoms had significantly longer latencies. Dissociative symptoms were not related to latency These findings suggest that PTSD-related arousal symptoms may serve a buffering effect, increasing sensitivity to threat cues that portend a sexually coercive interaction. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessing the impact of rape and its significance in psychotherapy.

Explores the impact of rape as a precipitant of an emotional crisis. Guidelines are offered for assisting the therapist in determining whether a crisis-oriented vs intensive psychotherapy model is more appropriate for rape victims seeking treatment. Consideration is given to chief complaint, symptom duration and onset, developmental status, ability to discuss assault, meanings ascribed to assault, social system response, coping style, and life changes since assault. The cases of 4 females and 1 male who were sexually assaulted are included. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social adjustment in victims of sexual assault.

93 rape victims (aged 15–71 yrs) were seen approximately 2 wks after the assault and at 1, 2, 4, 8, and 12 mo postrape. A matched control group of nonvictims was seen at the same intervals. To control for the effects of repeated testing, 3 additional groups with 72 victims were assessed only once at either 2, 4, or 8 mo postrape. All Ss completed the Social Adjustment Scale–Self Report, which yielded a total adjustment score as well as subscale scores for 5 areas of adjustment: Work; Economic; Social and Leisure; Marital, Parental, and Family Unit; and Extended Family. Ss exhibited disruption in overall social adjustment and most of the subscale roles for the first few months following their assaults. By 4 mo postrape, most of the subscales had stabilized at levels similar to the nonvictims'. Work adjustment continued to be affected through 8 mo postrape. Single-testing control victims appeared to have more problems in social adjustment, particularly with regard to relationships with relatives. (14 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coping with Gulf War combat stress: Mediating and moderating effects.

The authors examined relationships between method of coping with combat-related stress and psychological symptoms among Gulf War Army personnel (N?=?1,058). Participants were surveyed on return from the Gulf region (Time 1) with the Coping Responses Inventory (R. Moos, 1990) and a measure of combat exposure. Outcomes were symptom measures of posttraumatic stress disorder (PTSD) and depression. At Time 2 (18–24 months) participants completed the same symptom measures and an index of postwar stress. Higher proportions of approach-based coping in the war zone were related to lower levels of psychological symptoms. Combat exposure moderated the effects of coping on Time 1 PTSD. Coping predicted changes in symptoms of depression but not PTSD. Combat exposure affected changes in depression through postwar stress but had a direct negative effect on PTSD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Posttraumatic stress disorder and retrospectively reported stressor exposure: A longitudinal prediction model.

There has been recent concern about the degree to which posttraumatic stress disorder (PTSD) symptomatology influences reports of prior exposure to highly stressful life events. In this longitudinal study of 2,942 male and female Gulf War veterans, the authors documented change in stressor reporting across 2 occasions and the association between change and PTSD symptom severity. A regression-based cross-lagged analysis was used to examine the relationship between PTSD symptom severity and later reported stressor exposure. Shifts in reporting over time were modestly associated with PTSD symptom severity. The cross-lagged analysis revealed a marginal association between Time 1 PTSD symptom severity and Time 2 reported stressor exposure for men and suggested that later reports of stressor exposure are primarily accounted for by earlier reports and less so by earlier PTSD symptomatology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Anger and posttraumatic stress disorder symptoms in crime victims: A longitudinal analysis.

Among trauma-exposed individuals, severity of posttraumatic stress disorder (PTSD) symptoms is strongly correlated with anger. The authors used 2 longitudinal data sets with 282 and 218 crime victims, respectively, to investigate the temporal sequence of anger and PTSD symptoms following the assault. Cross-lagged regression analyses indicated that PTSD symptoms predicted subsequent level of anger, but that anger did not predict subsequent PTSD symptoms. Testing alternative models (common factor model, unmeasured 3rd variable model) that might account for spuriousness of the relation strengthened confidence in the results of the cross-lagged analyses. Further analyses suggested that rumination mediates the effect of PTSD symptoms on anger. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prevalence of civilian trauma and posttraumatic stress disorder in a representative national sample of women.

Prevalence of crime and noncrime civilian traumatic events, lifetime posttraumatic stress disorder (PTSD), and PTSD in the past 6 mo were assessed in a sample of 4,008 US adult women. Random digit-dial telephone methods were used to identify study participants. Structured telephone interviews for assessment of specific crime or other traumatic event history and PTSD were conducted by trained female interviewers. Lifetime exposure to any type of traumatic event was 69%, whereas exposure to crimes that included sexual or aggravated assault or homicide of a close relative or friend occurred among 36%. Overall sample prevalence of PTSD was 12.3% lifetime and 4.6% within the past 6 mo. The rate of PTSD was significantly higher among crime vs noncrime victims (25.8% vs 9.4%). History of incidents that included direct threat to life or receipt of injury was a risk factor for PTSD. Findings are compared with data from other epidemiological studies. Results are discussed as they relate to PTSD etiology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reactions to rape victims: Effects of rape circumstances, victim's emotional response, and sex of helper.

Case reports purported to have come from the records of a sexual abuse care center were presented to 98 female and 107 male undergraduates who then judged the impact of the rape experience on the victims' psychological adjustment and indicated their likely counseling goals for her. Three types of rape circumstances (home blitz, outside blitz, acquaintance) were varied with 3 types of postrape manifest emotional reactions (upset–anger, upset–guilt, calm) and S sex. Upset victims were seen as having more serious and more long-lasting problems, were more likely to be encouraged to try and forget the incident, and were less likely to be encouraged to accept personal responsibility for the assault than were calm victims. Ss, especially men, evaluated victims' degree of emotional upset as a function of rape circumstances, with blitz-type assaults perceived as most upsetting. Consistent sex differences indicated that women were more sympathetic with and more willing to talk with rape victims than were men. Results are discussed in terms of popular assumptions about rape victims and sex differences in identification with and empathy for female rape victims. Implications for training of professional and paraprofessional counselors are noted. (33 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)