Distress tolerance and duration of past smoking cessation attempts.

The present study tested the hypothesis that limited ability to tolerate physical and psychological distress is associated with early relapse from smoking cessation. Specifically, the authors exposed 16 current smokers who had failed to sustain any previous quit attempt for more than 24 hr (immediate relapsers) and 16 smokers with at least 1 sustained quit attempt of 3 months or longer (delayed relapsers) to psychological (mental arithmetic) and physical (carbon dioxide inhalation-breath holding) stressors. Relative to delayed relapsers, immediate relapsers were characterized by higher baseline levels of affective vulnerability, by greater levels of dysphoria and urge to smoke after 12 hr of nicotine deprivation, and by less task persistence on the stressors, suggesting that these may be risk factors for early lapse in the context of quitting smoking. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Craving and physiological reactivity to trauma and alcohol cues in posttraumatic stress disorder and alcohol dependence.

The high comorbidity of posttraumatic stress disorder (PTSD) and alcohol dependence (AD) has been firmly established. Although laboratory studies have examined self-reported craving in response to trauma and alcohol cues, no studies have reported on alcohol-related physiological responding in response to trauma cues in PTSD-AD individuals. Using a cue reactivity paradigm, this study examined the impact of personalized trauma-image cues and in vivo alcohol cues on alcohol-related responding (e.g., salivation, craving) in individuals with PTSD and AD (n = 40). Participants displayed reactivity to both trauma and alcohol cues when compared to neutral cues, including increased self-reported craving and distress, as well as greater salivation. These findings suggest that through repeated pairings of trauma memories and alcohol consumption, salivation may become classically conditioned to trauma cues. Moreover, the fact that the trauma-alcohol cue combination elicited greater alcohol craving, salivary responding, distress, and arousal than either the trauma-neutral or neutral-alcohol cue combinations suggests that effects of the trauma and alcohol cues were additive in nature. Evidence that AD individuals with PTSD report increased alcohol craving and display greater salivation in response to trauma memories, supplements prior research indicating that PTSD-related negative emotion and trauma-related alcohol craving may play an important role in the maintenance of AD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of social exclusion in trauma survivors with posttraumatic stress disorder.

Trauma survivors with posttraumatic stress disorder (PTSD) often experience or report social stigmatization and isolation. Williams (2001) provided an experimental paradigm to assess behavioral effects of social exclusion. This paradigm (face-to-face version) has been applied in a 2 × 2 group × experimental condition design. Participants in the PTSD group (N = 16) and the nontraumatized control group (N = 25) were randomly assigned to an exclusion or inclusion condition. The results showed interaction effects for main psychopathological assessments (depression, anxiety, psychoticism) and expected main effects for the majority of outcome measures (psychopathology, well-being, belonging, and meaningful existence). The research concludes that a general assumption of elevated levels of self-perceived social exclusion in PTSD patients has to be considered in terms of differentiated psychopathological effects of exclusion. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reduced autobiographical memory specificity predicts depression and posttraumatic stress disorder after recent trauma.

In this prospective longitudinal study, the authors examined the relationship between reduced specificity in autobiographical memory retrieval and the development of depression, posttraumatic stress disorder (PTSD), and specific phobia after injury in an assault. Assault survivors (N = 203) completed the Autobiographical Memory Test (J. M. G. Williams & K. Broadbent, 1986) at 2 weeks after the trauma as well as structured clinical interviews at 2 weeks and 6 months. Participants with acute stress disorder or major depression at 2 weeks, but not those with phobia, retrieved fewer specific autobiographical memories than those without the respective disorder. Reduced memory specificity at 2 weeks also predicted subsequent PTSD and major depression at 6 months over and above what could be predicted from initial diagnoses and symptom severity. Moderator analyses showed that low memory specificity predicted later depression in participants with prior episodes of major depression but not in those without prior depression. Mediation analyses suggested that rumination partly mediated and perceived permanent change fully mediated the effects of low memory specificity on posttrauma psychopathology at follow-up. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Trauma and posttraumatic stress disorder in people with schizophrenia.

This study evaluated the hypothesis that trauma and posttraumatic stress disorder (PTSD) severity would be positively associated with schizophrenia symptoms. Forty-seven clients with schizophrenia were assessed for schizophrenia severity and for lifetime trauma history and PTSD symptoms in 2 independent symptom interviews; 35 (74%) participants reported at least 1 event in which there was threat of harm or life threat and subjective distress, and 6 (13%) had current PTSD. Trauma across the life span was associated with greater severity of PTSD. Within the total sample, PTSD symptoms were associated with greater emotional distress, but not with schizophrenia-specific symptoms. Distress among clients with schizophrenia and PTSD suggests the need for routine assessment of PTSD and development of PTSD interventions in this population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Trauma exposure and posttraumatic stress disorder predictors of mental health treatment use in college students.

The authors examined trauma exposure and posttraumatic stress disorder (PTSD) associations with previous mental health (MH) treatment use in college students while statistically controlling for gender and treatment attitudes. A total of 300 students were recruited for an Internet survey and were administered a modified version of the demographic survey, the Stressful Life Events Screening Questionnaire (L. Goodman, C. Corcoran, K. Turner, N. Yuan, & B. L. Green, 1998), PTSD Symptom Scale-Self-Report (PSS; E. B. Foa, D. S. Riggs, C. V. Dancu, & B. O. Rothbaum, 1993), Attitudes Toward Seeking Professional Psychological Help Scale-Short Form (ATSPPH; E. H. Fischer & A. Farina, 1995), and a MH treatment use survey. Univariate analyses demonstrated that previous MH treatment use was associated with violent crime and noncrime trauma frequency, and treatment attitudes. Controlling for gender and MH treatment attitudes, regression analyses including violent and noncrime trauma and PTSD significantly predicted previous MH service use and recent visit counts; only noncrime trauma and treatment attitudes were significant for service use, and only treatment attitudes was significant for visit counts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Neural responses to masked fear faces: Sex differences and trauma exposure in posttraumatic stress disorder.

Although women have a greater propensity than men to develop posttraumatic stress disorder (PTSD) following trauma, sex differences in neural activations to threat have received little investigation. This study tested the prediction that trauma would heighten activity in automatic fear-processing networks to a greater extent in women than in men. Functional magnetic resonance imaging (fMRI) data were recorded in 23 participants with PTSD (13 women, 10 men), 21 trauma-exposed controls (9 women, 12 men), and 42 non-trauma-exposed controls (22 women, 20 men) while they viewed masked facial expressions of fear. Exposure to trauma was associated with enhanced brainstem activity to fear in women, regardless of the presence of PTSD, but in men, it was associated only with the development of PTSD. Men with PTSD displayed greater hippocampal activity to fear than did women. Both men and women with PTSD showed enhanced amygdala activity to fear relative to controls. The authors conclude that greater brainstem activation to threat stimuli may contribute to the greater prevalence of PTSD in women, and greater hippocampal activation in men may subserve an enhanced capacity for contextualizing fear-related stimuli. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Maladaptive self-appraisals before trauma exposure predict posttraumatic stress disorder.

This study tested the proposal that negative appraisals represent a risk factor for developing posttraumatic stress disorder (PTSD) after trauma. Trainee firefighters (N = 68) were assessed during training (before trauma exposure) for PTSD, history of traumatic events, and tendency to engage in negative appraisals. Firefighters were reassessed 4 years later (N = 52), after commencing firefighter duty (after trauma exposure), for PTSD and depression using the Posttraumatic Stress Disorder Scale (E. B. Foa, L. Cashman, L. Jaycox, & K. Perry, 1997) and the Beck Depression Inventory (Version 2; A. T. Beck, R. A. Steer, & G. K. Brown, 1996). At follow-up, 12% met criteria for PTSD. Pretrauma negative appraisals about oneself accounted for 20% of variance in PTSD severity at follow-up. These data provide the first evidence that preexisting negative appraisals are a risk factor for PTSD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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)     

Guidelines for differential diagnoses in a population with posttraumatic stress disorder.

In a large posttraumatic stress disorder (PTSD) and depression treatment outcome study, thorough diagnostic assessments of veterans at pretreatment, posttreatment, and 3 follow-up times were completed. The research team that reviewed these assessments encountered several challenges in the differential diagnosis of PTSD because of high comorbidity and symptoms shared with or resembling other disorders. For example, how do mental health professionals distinguish symptoms of agoraphobia from avoidance and hypervigilance symptoms of PTSD? When are hallucinations symptomatic of PTSD (e.g., flashbacks) versus a nonpsychotic near-death experience or an independent psychotic disorder? How do mental health professionals differentiate overlapping symptoms of PTSD and depressive disorders? To help make reliable diagnoses, the team developed clarifying questions and diagnostic guidelines, which may prove useful to other clinicians and researchers working with PTSD populations. (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)     

Predictors of posttraumatic stress disorder following cancer.

This study investigated the predictors of posttraumatic stress disorder (PTSD) following a diagnosis of cancer. Individuals who were recently diagnosed with 1st onset head and neck or lung malignancy (N = 82) were assessed within 1 month of diagnosis for acute stress disorder (ASD) and other psychological responses including depression; individuals were reassessed (N = 63) for PTSD 6 months following their cancer diagnosis. At the initial assessment ASD was diagnosed in 28% of participants, and 22% met criteria for PTSD at 6-months follow-up. Peritraumatic dissociative symptoms at the time of receiving one's cancer diagnosis was the sole predictor of PTSD severity at 6-months follow-up. Elevated dissociative symptoms and greater distress at the initial assessment were the best predictors of PTSD caseness at 6-months follow-up. This study provides evidence for identifying recently diagnosed cancer patients who may benefit from psychological assistance in order to prevent chronic psychopathology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attachment and treatment response among adults in inpatient treatment for posttraumatic stress disorder.

In this study, the authors investigated changes in attachment orientation after treatment in an inpatient program for adults with posttraumatic stress disorder. The authors also examined the association between these changes and symptom reduction. Results indicated that secure attachment increased significantly over treatment in comparison to a wait list group, and this change was maintained over the 6 months after discharge. Positive changes were also noted in the underlying attachment dimensions of anxiety and avoidance. Furthermore, positive changes in attachment were found to be associated with symptom reduction during treatment and maintenance of these reductions after discharge. These results have potential implications for the goals of psychotherapeutic intervention in general and for the utility of specialized inpatient trauma treatment specifically. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The structure of distress following trauma: Posttraumatic stress disorder, major depressive disorder, and generalized anxiety disorder.

The current report used confirmatory factor analysis to examine the latent structures of both key features and associated symptoms of three disorders that commonly develop following a traumatic event: posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and generalized anxiety disorder (GAD). Participants were 228 motor-vehicle accident survivors who sought treatment for emotional difficulties. PTSD, MDD, and GAD were assessed with a combination of self-report and interview-based measures. The results of construct level analyses suggested that PTSD, MDD, and GAD are distinguishable but highly correlated disorders following a traumatic event. Symptom level analyses supported a model where the Reexperiencing, Avoidance, and Hypervigilance factors were subsumed under the PTSD construct. However, in this model the Dysphoria factor was a higher order construct correlated with the PTSD, MDD, and GAD factors, suggesting that the Dysphoria cluster may not be unique to PTSD. Diagnostic and theoretical implications of these results are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attentional networks reveal executive function deficits in posttraumatic stress disorder.

Executive function was assessed with the Trail Making Test (Army Individual Test Battery; M. D. Lezak, 1983), the Comprehensive Trail Making Test (C. Reynolds, 2002), and a neurocognitive measure of executive control (Attentional Network Task [ANT]; J. I. Fan, B. D. McCandliss, T. Somer, A. Raz, & M. I. Posner, 2002) in 19 undergraduates with posttraumatic stress disorder (PTSD; Posttraumatic Stress Disorder Symptom Scale-Self-Report version; E. B. Foa, D. S. Riggs, C. V. Dancu, & B. O. Rothbaum, 1993), 15 high trauma participants without PTSD, and 18 low trauma control participants. Although groups did not differ on any trail making task or on the ANT measures of alerting or orienting, PTSD participants were significantly more impaired on the ANT executive network index than were high or low trauma control participants, even when level of depressive symptoms was covaried. Previous animal research identified a relationship between dopamine and the ANT measure of executive function. Elevated PTSD symptom severity and levels of hyperarousal, reexperiencing, and avoidance-numbing were associated significantly with executive function deficits indexed by the ANT. These results indicate a potentially subtle but specific deficit in executive function and a possible relationship between PTSD symptoms and irregularities in dopamine function. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nicotine withdrawal in smokers with current depressive disorders undergoing intensive smoking cessation treatment.

The authors investigated withdrawal in smokers with current threshold and subthreshold depressive disorders (N = 21) who were participating in a pilot study of intensive counseling interventions for smoking cessation. The majority of participants (67%) were taking antidepressants when they entered the trial. Withdrawal symptoms were compared in prolonged abstainers versus nonabstainers across a 12-week treatment period and at the 3-month follow-up assessment visit. Prolonged abstinence was associated with an increase in positive affect and a decrease in depressive symptoms and craving over time. Nonabstinence was associated with little overall change in these variables from treatment onset to the 3-month follow-up. At the 3-month follow-up, 44% of prolonged abstainers were in complete remission of their baseline depressive disorders, compared with 0% remission among nonabstainers. Findings suggest that within the context of an intensive smoking cessation intervention, some smokers with current depressive disorders may experience significant improvement in affective and craving symptoms. Findings also suggest that abstinence may be associated with improvement in affect. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The structure of personality disorders in individuals with posttraumatic stress disorder.

Research on the structure of personality disorders (PDs) has relied primarily on exploratory analyses to evaluate trait-based models of the factors underlying the covariation of these disorders. This study used confirmatory factor analysis to evaluate whether a model that included both PD traits and a general personality dysfunction factor would account for the comorbidity of the PDs better than a trait-only model. It also examined if the internalizing/externalizing model of psychopathology, developed previously through research on the structure of Axis I disorders, might similarly account for the covariation of the Axis II disorders in a sample of 245 veterans and nonveterans with posttraumatic stress disorder. Results indicated that the best fitting model was a modified bifactor structure composed of nine lower-order common factors. These factors indexed pathology ranging from aggression to dependency, with the correlations among them accounted for by higher-order Internalizing and Externalizing factors. Further, a general factor, reflecting a construct that we termed boundary disturbance, accounted for additional variance and covariance across nearly all the indicators. The Internalizing, Externalizing, and Boundary Disturbance factors evidenced differential associations with trauma-related covariates. These findings suggest continuity in the underlying structure of psychopathology across DSM–IV Axes I and II and provide empirical evidence of a pervasive, core disturbance in the boundary between self and other across the PDs. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Review of The trauma response: Treatment for emotional injury.

Reviews the book, The trauma response: Treatment for emotional injury by Diana S. Everstine and Louis Everstine (see record 1993-97113-000). The major premise of this book is that PTSD, as defined in the DSM-III-R, should be reconceptualized and recognized as "trauma response." This shift in focus emphasizes normalcy and a nonpathological recovery process as opposed to adherence to a disease model of psychological affliction in which a "disorder" is diagnosed and treated. The stated purpose of this book is to help clinicians identify, measure, and treat emotional trauma. This book is comprehensive and divided into four parts, covering topics such as the phenomenon of trauma, treatment for adult trauma, hidden trauma, trauma in the work place and trauma and the law. According to the reviewer, the book as a whole reflects valuable learning that has accrued from the authors' clinical experiences in working with victims of trauma. A diverse readership would benefit from this addition to the clinical literature. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-control predicts later symptoms of posttraumatic stress disorder.

Self-control, often defined as the ability to control one's thoughts and actions, is one of the most important constructs in psychology. However, the relationship of self-control to clinical disorders has rarely been directly examined. The current study sought to explore this relationship by examining whether self-control predicted posttraumatic stress disorder (PTSD) symptoms in a longitudinal study of 65 inner-city women. Results showed that baseline levels of self-control predicted PTSD symptoms at 3-month follow-up above and beyond other variables in the model. This research combines clinical and social psychological research to reveal the potential role of self-control in protecting against future symptoms of PTSD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Magnitude and duration of cardiovascular response to anger in Vietnam veterans with and without posttraumatic stress disorder.

This study investigated the cardiovascular responses to a relived anger task in 118 male Vietnam combat veterans (62 with posttraumatic stress disorder [PTSD] and 56 without PTSD). Participants completed standardized diagnostic measures, hostility measures, and a laboratory session in which they relived a self-chosen anger memory while heart rate (HR), systolic blood pressure, and diastolic blood pressure (DBP) were measured continuously using an Ohmeda Finapres monitor. Compared with veterans without PTSD, PTSD veterans took less time to feel anger, had greater mean HR and DBP response during relived anger, and reported greater anger and anxiety during the task. There was a significant relationship between covert hostility and anger response during and after the anger task only in participants with PTSD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)