Acute and chronic distress and posstraumatic stress disorder as a function of responsibility for serious motor vehicle accidents.

In this study on the effects of attributions of responsibility for traumatic events, stress, coping, and symptoms of posttraumatic stress disorder (PTSD) were measured, including intrusive thoughts among 130 victims of serious motor vehicle accidents (MVAs) 14-21 days and 3, 6, and 12 months after their accident. MVA victims and 43 control participants were categorized by accident and attribution of responsibility for their accidents (self-responsible, other-responsible, and control). Although initially all MVA victims reported higher levels of intrusive thoughts and were more likely to meet criteria for PTSD diagnoses, only other-responsible participants continued to demonstrate increased distress 6 and 12 months postaccident. Self-responsible participants used more self-blame coping than other-responsible participants, although within the self-responsible group, use of self-blame was associated with more distress. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Maladaptive cognitive appraisals mediate the evolution of posttraumatic stress reactions: A 6-month follow-up of child and adolescent assault and motor vehicle accident survivors.

A prospective longitudinal follow-up study (n = 59) of child and adolescent survivors of physical assaults and motor vehicle accidents assessed whether cognitive processes predicted posttraumatic stress symptomatology (PTSS) at 6 months posttrauma in this age group. In particular, the study assessed whether maladaptive posttraumatic appraisals mediated the relationship between initial and later posttraumatic stress. Self-report measures of PTSS, maladaptive appraisals, and other cognitive processes, as well as structured interviews assessing for acute stress disorder and posttraumatic stress disorder (PTSD), were completed at 2–4 weeks and 6 months posttrauma. PTSS and PTSD at 6 months were associated with maladaptive appraisals and other cognitive processes but not demographic or objective trauma severity variables. Only maladaptive appraisals were found to associate with PTSS/PTSD after partialing out initial symptoms/diagnosis and to mediate between initial and later PTSS. It was argued that, on this basis, maladaptive appraisals are involved in the development and maintenance of PTSS over time, whereas other cognitive processes (e.g., subjective threat, memory processes) may have an effect only in the acute phase. The implications of this study for the treatment of PTSS in youths are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Do cognitive models help in predicting the severity of posttraumatic stress disorder, phobia, and depression after motor vehicle accidents? A prospective longitudinal study.

The study investigated the power of theoretically derived cognitive variables to predict posttraumatic stress disorder (PTSD), travel phobia, and depression following injury in a motor vehicle accident (MVA). MVA survivors (N = 147) were assessed at the emergency department on the day of their accident and 2 weeks, 1 month, 3 months, and 6 months later. Diagnoses were established with the Structured Clinical Interview for DSM-IV. Predictors included initial symptom severities; variables established as predictors of PTSD in E. J. Ozer, S. R. Best, T. L. Lipsey, and D. S. Weiss's (2003) meta-analysis; and variables derived from cognitive models of PTSD, phobia, and depression. Results of nonparametric multiple regression analyses showed that the cognitive variables predicted subsequent PTSD and depression severities over and above what could be predicted from initial symptom levels. They also showed greater predictive power than the established predictors, although the latter showed similar effect sizes as in the meta-analysis. In addition, the predictors derived from cognitive models of PTSD and depression were disorder-specific. The results support the role of cognitive factors in the maintenance of emotional disorders following trauma. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessment and treatment of posttraumatic stress disorder after a motor vehicle collision: Empirical findings and clinical observations.

Individuals who experience a serious motor vehicle accident (MVA) are at increased risk for psychological problems, particularly posttraumatic stress disorder (PTSD). In this article, we review the literature on PTSD among MVA survivors, with particular attention to available instruments to screen for and assess symptomatology of the disorder. Approaches to the treatment of PTSD in this population are reviewed, separated into interventions designed to prevent PTSD in unselected samples, treatment targeting individuals with acute stress disorder that is designed to prevent subsequent development of PTSD, and therapy for individuals with chronic PTSD. Treatment process issues are discussed in an effort to integrate empirical findings with clinical observations. The empirical literature suggests several approaches to treatment that have good potential outcomes, although continued work is needed to identify factors that predict treatment response as well as augment individual-based treatment formats. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coping strategies and posttraumatic stress disorder in female victims of sexual and nonsexual assault.

The coping behaviors and (posttraumatic stress disorder [PTSD]) symptoms of 215 female assault victims (103 rape victims and 112 nonsexual assault victims) were assessed within 2 weeks following the assault (Time I), and 133 of them (62%) were followed up 3 mo later (Time 2). Posttrauma symptom severity significantly decreased during the 3-mo study period, but PTSD severity levels at Times I and 2 were highly correlated. Three coping scales were constructed on the basis of exploratory factor analyses: Mobilizing Support, Positive Distancing, and Wishful Thinking. Three mo postassault, rape victims showed higher levels of wishful thinking and PTSD than nonsexual assault victims. Wishful thinking showed a positive association and positive distancing a negative association with PTSD severity, controlling for assault type, initial levels of PTSD severity, and other coping strategies. The clinical relevance of these findings is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coping mediates the relationship between posttraumatic stress disorder (PTSD) symptoms and alcohol use in homeless, ethnically diverse women: A preliminary study.

Homeless women are at increased risk for problematic alcohol use and posttraumatic stress disorder (PTSD). While coping motives have been shown to mediate the relationship between PTSD symptoms and alcohol problems in victims of sexual assault and domestic violence, it is unknown whether this relationship is evident in other trauma-exposed populations. The focus of this study was to examine whether drinking to cope mediated the relationship between PTSD symptoms and current alcohol use in a group of homeless, ethnically diverse women. Twenty-three women were recruited from local shelters in a southwestern community and asked to complete measures assessing their current alcohol use, drinking motives, and PTSD symptoms. Results revealed that drinking to cope mediated the relationship between PTSD symptoms and current alcohol use. This finding supports the theory that homeless women may benefit from treatment interventions that address both their substance use and trauma issues. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Neuropsychological functioning in posttraumatic stress disorder and alcohol abuse.

Studies have shown differences in neuropsychological functioning between groups with posttraumatic stress disorder (PTSD) and control participants. Because individuals with PTSD often have a history of comorbid alcohol abuse, the extent to which an alcohol confound is responsible for these differences remains a concern. The current study compares neuropsychological testing scores in 4 groups of veterans with and without PTSD (PTSD+ and PTSD-, respectively) and with and without a history of alcohol abuse (ETOH+ and ETOH-, respectively): n for PTSD+/ETOH- = 30, n for PTSD+/ETOH- = 37, n for PTSD-/ETOH+ = 30, and n for PTSD-/ETOH- = 31. Results showed that PTSD, when alcohol, educational level, vocabulary, and depression are controlled for, was associated with decreased verbal memory, attention, and processing speed performance. Alcohol abuse history was associated with decreased visual memory performance. By controlling for alcohol and depression, the authors can more conclusively demonstrate that verbal memory and attention differences are associated with PTSD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A prospective examination of delayed onset PTSD secondary to motor vehicle accidents.

Seven participants who did not meet the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; American Psychiatric Association, 1987) criteria for posttraumatic stress disorder (PTSD) 1-4 months post-motor vehicle accident (MVA) and developed delayed onset PTSD during a 1-year follow-up interval were compared with 38 MVA controls who did not develop PTSD, as well as to 62 MVA participants who met criteria for acute onset PTSD on variables related to demographics, pre-MVA functioning, post-MVA functioning, and follow-up. The delayed onset participants were more symptomatic at the time of the initial interview than the controls. The delayed onset participants had poorer social support than the controls prior to and after the MVA. For the month prior to the MVA, the delayed onset participants had lower Global Assessment of Functioning scores than the controls. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Processing threatening information in posttraumatic stress disorder.

The authors used a modified Stroop task to study how people with posttraumatic stress disorder (PTSD) process threatening information. Participants were motor vehicle accident (MVA) survivors with either PTSD (n?=?15), simple phobia of driving (n?=?15), or low anxiety (n?=?15). Participants named colors of 4 types of words: strong threat words (MVA related), mild threat words (MVA related), positive words, and neutral words. Participants with PTSD demonstrated greater interference on strong threat words than those with simple phobia or low anxiety. Contrary to expectation, participants with simple phobia did not display an interference effect. Findings suggest that individuals with PTSD and simple phobia may process threatening information differently. The nature of attentional bias in different anxiety conditions following trauma is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Introduction to the special section on substance use disorder and posttraumatic stress disorder comorbidity.

A body of 2 complementary, albeit independent, research literatures has emerged that documents a strong relationship between substance use disorders (SUDs) and posttraumatic stress disorder (PTSD) in both community and clinical samples. Research on the concomitants and consequences of PTSD has found that substance abuse is a frequent comorbid problem among individuals diagnosed with PTSD. Researchers from the substance abuse field are now investigating the interrelationship between PTSD and SUDs and finding that PTSD has a notable effect on SUD course and treatment response. Here, a brief summary of the prevalence of SUD-PTSD comorbidity is provided and the 5 articles of the special section are introduced. (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)     

Regional brain electrical activity in posttraumatic stress disorder after motor vehicle accident.

This study examined whether patients with posttraumatic stress disorder (PTSD) related to motor vehicle accidents (MVAs) would show an abnormal pattern of electroencephalographic (EEG) alpha asymmetries, which has been proposed for particular types of anxiety. Patients with PTSD (n = 22) or subsyndromal PTSD (n = 21), traumatized controls without PTSD (non-PTSD with MVA; n = 21), and healthy controls without MVA (n = 23) underwent measurement of EEG activity during baseline and exposure to a neutral, a positive, a negative, and an accident-related picture. Differences in brain asymmetry between groups were observed only during exposure to trauma-related material. PTSD and subsyndromal PTSD patients showed a pattern of enhanced right anterior and posterior activation, whereas non-PTSD with MVA participants showed the opposite pattern. Furthermore, posterior asymmetry in nontraumatized healthy controls varied with gender, with female participants showing a pattern of higher right posterior activation. The results support the hypothesis that symptomatic MVA survivors are characterized by a pattern of right hemisphere activation that is associated with anxious arousal and symptoms of PTSD during processing of trauma-specific information. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-evaluative appraisals of coping capability and posttraumatic distress following motor vehicle accidents.

This study tested the importance of coping self-efficacy (CSE) perceptions and change in perceptions of CSE for recovery from motor vehicle accident (MVA) trauma. Data were collected 7 days following the accident (Time 1; n = 163), 1 month after the accident (Time 2; n = 91), and 3 months after the accident (Time 3; n = 70). Early changes in CSE (i.e., from Time 1 to Time 2) predicted posttraumatic distress at 3 months after MVA trauma, even after controlling for Time 1 or Time 2 posttraumatic distress and other trauma-related variables (i.e., accident responsibility, litigation involvement, and peritraumatic dissociation). Early changes in CSE perceptions, however, neither moderated nor mediated the effects of early posttraumatic distress (Time 1) on 3-month posttraumatic distress. Time 2 CSE levels, however, did mediate the relationship between acute posttraumatic distress (Time 1) and 3-month posttraumatic distress (Time 3). These findings highlight the importance of early interventions aimed at strengthening self-efficacy after MVA trauma. (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)     

Psychometric properties of the Accident Fear Questionnaire: An analysis based on motor vehicle accident survivors in a rehabilitation setting.

ABSTRACT. Objective: To evaluate the reliability and validity of the Accident Fear Questionnaire (AFQ; K. Kuch, B. J. Cox, & D. M. Direnfeld, 1995), a self-rated instrument developed for efficient screening of posttraumatic stress disorder (PTSD) and phobic avoidance after involvement in a motor vehicle accident (MVA). Participants: One hundred thirteen individuals receiving rehabilitation after an MVA. Setting: Tertiary rehabilitation center. Main Measures: The AFQ, comprising a 10-item accident profile and a 10-item phobic avoidance (PA) subscale; a structured clinical interview; and other self-report measures of psychopathology, personality and pain. Results: Correlations between the AFQ-PA total score and measures of psychopathology and personality indicated adequate convergent and discriminant validity. Patients diagnosed with PTSD or accident phobia scored higher on the AFQ-PA subscale and 6 of its 10 items than did those with neither diagnosis. An AFQ-PA cutoff score of 15 appears suitable for screening of patients in a rehabilitation setting. Hierarchical logistic regression indicated that the AFQ-PA was the only self-report measure that possessed incremental power over and above general negative affectivity in predicting group membership… (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Screening for trauma histories, posttraumatic stress disorders (PTSD) and subthreshold PTSD in psychiatric outpatients.

The ability of the Structured Clinical Interview for DSM-IV (SCID) posttraumatic stress disorder (PTSD) module's screening question to identify individuals with PTSD or subthreshold PTSD was examined. First, the screen's sensitivity for detecting a trauma history was determined. Second, the incremental validity of a more thorough trauma assessment was examined by determining how many individuals responded negatively to the screen but then were diagnosed with PTSD or subthreshold PTSD. Last, the optimal SCID termination point for assessing subthreshold PTSD was determined. Using a trauma list increased the number of participants reporting a trauma; however, the SCID screen captured almost all individuals who had PTSD or subthreshold PTSD. When one screens for subthreshold PTSD, the SCID can be terminated on failure to meet Criterion B. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Trajectories of PTSD and substance use disorders in a longitudinal study of personality disorders.

This study investigated the co-occurrence of posttraumatic stress disorder (PTSD) and substance use disorders (SUDs) in a sample (N = 668) recruited for personality disorders and followed longitudinally as part of the Collaborative Longitudinal Personality Disorders Study. The study both examined rates of co-occurring disorders at baseline and temporal relationships between PTSD and substance use disorders over 4 years. Subjects with a lifetime history of PTSD at baseline had significantly higher rates of SUDs (both alcohol and drug) than subjects without PTSD. Latent class growth analysis, a relatively novel approach used to analyze trajectories and identify homogeneous subgroups of participant on the basis of probabilities of PTSD and SUD over time, identified 6 classes, which were compared with respect to a set of functioning and personality variables. The most consistent differences were observed between the group that displayed low probabilities of both SUD and PTSD and the group that displayed high probabilities of both. (PsycINFO Database Record (c) 2010 APA, all rights reserved)