Randomized Trial of Cognitive-Behavioral Therapy for Chronic Posttraumatic Stress Disorder in Adult Female Survivors of Childhood Sexual Abuse.

The authors conducted a randomized clinical trial of individual psychotherapy for women with posttraumatic stress disorder (PTSD) related to childhood sexual abuse (n = 74), comparing cognitive-behavioral therapy (CBT) with a problem-solving therapy (present-centered therapy; PCT) and to a wait-list (WL). The authors hypothesized that CBT would be more effective than PCT and WL in decreasing PTSD and related symptoms. CBT participants were significantly more likely than PCT participants to no longer meet criteria for a PTSD diagnosis at follow-up assessments. CBT and PCT were superior to WL in decreasing PTSD symptoms and secondary measures. CBT had a significantly greater dropout rate than PCT and WL. Both CBT and PCT were associated with sustained symptom reduction in this sample. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological effects on surviving family members of seeing the deceased person after forensic autopsy.

In medicolegal autopsy, it is essential to consider the emotions experienced by relatives of the deceased person. This study examined the psychological effects on surviving family members of seeing the deceased person’s body after forensic autopsy. Participants (n = 359) were surveyed by means of a questionnaire designed to measure posttraumatic symptoms; 62 participants had been involved in traumatic events related to the bereavement (trauma-involved group), and 297 participants had not (no-involvement group). Statistical analyses using structural equation modeling (SEM) showed that the model implying a significant difference between these groups was better fitted, than that implying no difference. The trauma-involved group showed a higher score for posttraumatic symptoms than the no-involvement group (Ms = .32 and .00, respectively). However, there was a negative correlation in the trauma-involved group between seeing the deceased person after forensic autopsy and posttraumatic symptoms (r = ?.43), but there was no correlation (r = ?.01) in the no-involvement group. Furthermore, factor structure for posttraumatic symptoms in bereaved people showed that treatment focused on avoidance behavior would be most effective Japan. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Additive Benefit of Hypnosis and Cognitive-Behavioral Therapy in Treating Acute Stress Disorder.

This research represents the first controlled treatment study of hypnosis and cognitive- behavioral therapy (CBT) of acute stress disorder (ASD). Civilian trauma survivors (N = 87) who met criteria for ASD were randomly allocated to 6 sessions of CBT, CBT combined with hypnosis (CBT-hypnosis), or supportive counseling (SC). CBT comprised exposure, cognitive restructuring, and anxiety management. CBT-hypnosis comprised the CBT components with each imaginal exposure preceded by a hypnotic induction and suggestions to engage fully in the exposure. In terms of treatment completers (n = 69), fewer participants in the CBT and CBT-hypnosis groups met criteria for posttraumatic stress disorder at posttreatment and 6-month follow-up than those in the SC group. CBT-hypnosis resulted in greater reduction in reexperiencing symptoms at posttreatment than CBT. These findings suggest that hypnosis may have use in facilitating the treatment effects of CBT for posttraumatic stress. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychometric properties of the Race-Related Events Scale.

This article describes the development and preliminary validation of the Race-Related Events Scale (RES). The RES is a brief screening measure used to assess exposure to stressful and potentially traumatizing experiences of race-related stress and was designed to be both consistent with standard diagnostic definitions of traumatic events and applicable to diverse ethnic groups. Its psychometric properties were assessed in an ethnically diverse sample of undergraduate students (N = 408). The measure showed good internal consistency (α = .86) and adequate 1-month test–retest reliability (rs = .66). Its validity was supported by findings that Whites reported significantly less race-related stress than other ethnic groups and African Americans reported significantly more race-related stress than Asian Americans. A subset of participants who reported ongoing distress following a race-related stressor (n = 91) also completed posttraumatic stress disorder measures. Close to one-third of these participants reported a race-related stressor involving exposure to threat of injury or death to self or others and almost half reported fear, helplessness, or horror during a race-related stressor. Participants who met these DSM–IV–TR criteria for trauma exposure reported significantly more race-related stressors and more severe posttraumatic stress disorder symptoms. Greater exposure to race-related stressors was associated with more severe posttraumatic stress disorder symptoms among ethnic minority but not White respondents. These findings suggest that the RES is a useful screening measure of potentially traumatizing race-related experiences across diverse ethnic groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The comparative effectiveness of cognitive processing therapy for male veterans treated in a VHA posttraumatic stress disorder residential rehabilitation program.

Objective: To examine the effectiveness of group cognitive processing therapy (CPT) relative to trauma-focused group treatment as usual (TAU) in the context of a Veterans Health Administration (VHA) posttraumatic stress disorder (PTSD) residential rehabilitation program. Method: Participants were 2 cohorts of male patients in the same program treated with either CPT (n = 104) or TAU (n = 93; prior to the implementation of CPT). Cohorts were compared on changes from pre- to posttreatment using the PTSD Checklist (PCL; Weathers, Litz, Herman, Huska, & Keane, 1993) and other measures of symptoms and functioning. Minorities represented 41% of the sample, and the mean age was 52 years (SD = 9.22). The CPT group was significantly younger and less likely to receive disability benefits for PTSD; however, these variables were not related to outcome. Results: Analyses of covariance controlling for intake symptom levels and cohort differences revealed that CPT participants evidenced more symptom improvement at discharge than TAU participants on the PCL, F(3, 193) = 15.32, p     

Mediators and moderators of a psychosocial intervention for children affected by political violence.

Objective: The authors examined moderators and mediators of a school-based psychosocial intervention for children affected by political violence, according to an ecological resilience theoretical framework. Method: The authors examined data from a cluster randomized trial, involving children aged 8–13 in Central Sulawesi, Indonesia (treatment condition n = 182, waitlist control condition n = 221). Mediators (hope, coping, peer/emotional/play social support) and moderators (gender, age, family connectedness, household size, other forms of social support, exposure to political violence, and displacement) of treatment outcome on posttraumatic stress symptoms and function impairment were examined in parallel process latent growth curve models. Results: Compared with the waitlist group, those receiving treatment showed maintained hope, increased positive coping, maintained peer social support, and increased play social support. Of these putative mediators, only play social support was found to mediate treatment effects, such that increases in play social support were associated with smaller reductions in posttraumatic stress disorder (PTSD) symptoms. Furthermore, the authors identified a number of moderators: Girls showed larger treatment benefits on PTSD symptoms; girls, children in smaller households, and children receiving social support from adults outside the household showed larger treatment benefits on function impairment. Conclusions: Findings provide limited evidence for an ecological resilience theoretical framework. On the basis of these findings, the authors recommend a stronger separation between universal prevention (e.g., resilience promotion through play) and selective/indicated prevention (e.g., interventions aimed at decreasing posttraumatic stress symptoms). Play-based interventions should be careful to exclude children with psychological distress. In addition, treatment effects may be augmented by selecting girls and socially vulnerable children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Acute stress disorder in diplomats, military, and civilian Americans living abroad following the September 11 terrorist attacks on America.

Can expatriates witnessing the attack of their country from afar develop acute and posttraumatic stress reactions? In Brussels 50 expatriate Americans were surveyed in the 10 weeks following September 11. Of the sample, 10% (n=5) showed acute stress disorder in the 1st week, and 4% (n=2) persisted with traumatic stress indications in the following weeks. All participants showed symptoms of distress, including derealization, reexperiencing the event, avoidance, heightened arousal, trouble working, and assault on world assumptions. For most, symptoms diminished over time. Increased psychological readiness in terms of assessment, prevention, and treatment methods is called for in response to mass terrorism. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Fifteen-month follow-up of eye movement desensitization and reprocessing (EMDR) treatment for posttraumatic stress disorder and psychological trauma.

The present study is a 15-month follow-up of the effects of eye movement desensitization and reprocessing (EMDR) therapy on the functioning of 66 participants, 32 of whom were diagnosed with posttraumatic stress disorder (PTSD) prior to treatment. PTSD participants improved as much as those without the diagnosis, with both groups maintaining their gains at 15 months. At 15-month follow-up, the three 90-min sessions of EMDR previously administered (S. A. Wilson, L. A. Becker, & R. H. Tinker, 1995) produced an 84% reduction in PTSD diagnosis and a 68% reduction in PTSD symptoms. The average treatment effect size was 1.59; the average reliable change index was 3.37. Implications of the maintenance of EMDR treatment effects are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Efficacy of self-examination therapy in the treatment of generalized anxiety disorder.

To determine the efficacy of self-examination therapy in the treatment of generalized anxiety disorder, 38 adults volunteered for a study in which they were randomly assigned to self-examination therapy or to a delayed-treatment group. Analyses indicated that participants in self-examination therapy had significantly fewer symptoms of anxiety than did participants in the delayed-treatment group on the outcome measures of this study, which included ratings by trained clinicians and participants. The reduction in anxiety for people receiving self-examination therapy was maintained 3 months after treatment ended. The delayed-treatment group also showed significant improvement in anxiety symptoms after receiving self-examination therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Fear of Severe Acute Respiratory Syndrome (SARS) Among Health Care Workers.

In this study, the authors examined fear related to severe acute respiratory syndrome (SARS) among 2 samples of hospital staff in Hong Kong. Sample 1 included health care workers (n = 82) and was assessed during the peak of the SARS epidemic. Sample 2 included hospital staff who recovered from SARS (n = 97). The results show that participants in both samples had equal, if not more, concern about infecting others (especially family members) than being self-infected. Sample 1 participants had stronger fear related to infection than Sample 2 participants, who seemed to be concerned more about other health problems and discrimination. Participants with lower self-efficacy tended to have higher fear related to SARS. Fear related to SARS was also correlated positively with posttraumatic stress symptoms among respondents of Sample 2 (recovered staff). Interventions based on these findings are described. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment of acute stress disorder: a comparison of cognitive-behavioral therapy and supportive counseling

Acute stress disorder (ASD) is a precursor of chronic posttraumatic stress disorder (PTSD). Twenty-four participants with ASD following civilian trauma were given 5 sessions of either cognitive-behavioral therapy (CBT) or supportive counseling (SC) within 2 weeks of their trauma. Fewer participants in CBT (8%) than in SC (83%) met criteria for PTSD at posttreatment. There were also fewer cases of PTSD in the CBT condition (17%) than in the SC condition (67%) 6 months posttrauma. There were greater statistically and clinically significant reductions in intrusive, avoidance, and depressive symptomatology among the CBT participants than among the SC participants. This study represents the 1st demonstration of successful treatment of ASD with CBT and its efficacy in preventing chronic PTSD.     

Surviving the Holocaust: A meta-analysis of the long-term sequelae of a genocide.

The current set of meta-analyses elucidates the long-term psychiatric, psychosocial, and physical consequences of the Holocaust for survivors. In 71 samples with 12,746 participants Holocaust survivors were compared with their counterparts (with no Holocaust background) on physical health, psychological well-being, posttraumatic stress symptoms, psychopathological symptomatology, cognitive functioning, and stress-related physiology. Holocaust survivors were less well adjusted, as apparent from studies on nonselected samples (trimmed combined effect size d = 0.22, 95% CI [0.13, 0.31], N = 9,803) and from studies on selected samples (d = 0.45, 95% CI [0.32, 0.59], N = 2,943). In particular, they showed substantially more posttraumatic stress symptoms (nonselect studies: d = 0.72, 95% CI [0.46, 0.98], N = 1,763). They did not lag, however, much behind their comparisons in several other domains of functioning (i.e., physical health, stress-related physical measures, and cognitive functioning) and showed remarkable resilience. The coexistence of stress-related symptoms and good adaptation in some other areas of functioning may be explained by the unique characteristics of the symptoms of Holocaust survivors, who combine resilience with the use of defensive mechanisms. In most domains of functioning no differences were found between Israeli samples and samples from other countries. The exception was psychological well-being: For this domain it was found that living in Israel rather than elsewhere can serve as a protective factor. A biopsychological stress-diathesis model is used to interpret the findings, and future directions for research and social policy are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Classification of chronic pain patients with the Brief Symptom Inventory: Patient characteristics of cluster profiles.

In this study, the psychological symptom patterns of individuals with chronic pain on the Brief Symptom Inventory (BSI) were cluster analyzed. Cluster analysis was initially performed on a sample of 1,489 people with chronic pain and then cross-validated on a smaller sample of 244 people. A 2-cluster solution was deemed most appropriate. The clusters reflected low- and high-profile elevations on all BSI subscales. As part of their clinical evaluation, participants also completed the Pain Disability Index, the adjective list from the McGill Pain Questionnaire, and a modified version of the Posttraumatic Chronic Pain Test. Among persons in the smaller sample, high-profile participants were more likely to be involved in litigation, report a higher frequency of posttraumatic stress symptoms, and display poorer psychosocial functioning. The results suggest that the BSI subgroups are associated with psychosocial characteristics that may be important in terms of treatment planning and outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Direction of influence between posttraumatic and depressive symptoms during prolonged exposure therapy among children and adolescents.

Objective: Our objective in the present study was to examine the temporal sequencing of posttraumatic and depressive symptoms during prolonged exposure therapy for posttraumatic stress disorder (PTSD) among children and adolescents. Method: Participants were 73 children and adolescents (56.2% female) between the ages of 8 and 18. Participants completed self-report measures of posttraumatic stress and depression prior to every session. Measures included the Child PTSD Symptom Scale, Beck Depression Inventory, and Children's Depression Inventory. Results: Multilevel mediational analyses indicated reciprocal relations during treatment: Changes in posttraumatic symptoms led to changes in depressive symptoms and vice versa. Posttraumatic symptoms accounted for 64.1% of the changes in depression, whereas depressive symptoms accounted for 11.0% of the changes in posttraumatic stress. Conclusions: Prolonged exposure therapy may work primarily by reducing posttraumatic stress, which in turn reduces depression. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Comparative efficacy, speed, and adverse effects of three PTSD treatments: Exposure therapy, EMDR, and relaxation training.

The authors examined the efficacy, speed, and incidence of symptom worsening for 3 treatments of posttraumatic stress disorder (PTSD): prolonged exposure, relaxation training, or eye movement desensitization and reprocessing (EMDR; N=60). Treatments did not differ in attrition, in the incidence of symptom worsening, or in their effects on numbing and hyperarousal symptoms. Compared with EMDR and relaxation training, exposure therapy (a) produced significantly larger reductions in avoidance and reexperiencing symptoms, (b) tended to be faster at reducing avoidance, and (c) tended to yield a greater proportion of participants who no longer met criteria for PTSD after treatment. EMDR and relaxation did not differ from one another in speed or efficacy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sudden gains in prolonged exposure for children and adolescents with posttraumatic stress disorder.

Objective: Our objective was to examine sudden gains during developmentally adjusted prolonged exposure for posttraumatic stress disorder (PTSD) among children and adolescents. We hypothesized that sudden gains would be detected and would be predictive of treatment outcome and follow-up. Method: Sixty-three youngsters (ages 8–17) completed a developmentally adjusted protocol for the treatment of pediatric PTSD (Foa, Chrestman, & Gilboa-Schechtman, 2008). Participants' posttraumatic and depressive symptoms were assessed before each treatment session, as well as at approximately 3 and 12 months after treatment termination. We measured posttraumatic symptoms with the Child PTSD Symptom Scale (Foa, Johnson, Feeny, & Treadwell, 2001) and measured depressive symptoms with the Beck Depression Inventory (Beck, Ward, Mendelson, Mock, & Erbaugh, 1961) and the Children's Depression Inventory (Kovacs, 1981, 1982). Results: Sudden gains were found among 49.2% of participants and constituted 48.6% of the total reduction in posttraumatic symptoms. Compared to individuals who did not experience sudden gains, individuals who experienced sudden gains reported lower levels of posttraumatic symptoms, F(1, 61) = 14.4, p     

Clinical characteristics of adults reporting repressed, recovered, or continuous memories of childhood sexual abuse.

The authors assessed women and men who either reported continuous memories of their childhood sexual abuse (CSA, n = 92), reported recovering memories of CSA (n = 38), reported believing they harbored repressed memories of CSA (n = 42), or reported never having been sexually abused (n = 36). Men and women were indistinguishable on all clinical and psychometric measures. The 3 groups that reported abuse scored similarly on measures of anxiety, depression, dissociation, and absorption. These groups also scored higher than the control group. Inconsistent with betrayal trauma theory, recovered memory participants were not more likely to report abuse by a parent or stepparent than were continuous memory participants. Rates of depression and posttraumatic stress disorder did not differ between the continuous and recovered memory groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavioral and neurochemical methods in research on new psychotropic drugs

The present study is a 15-month follow-up of the effects of eye movement desensitization and reprocessing (EMDR) therapy on the functioning of 66 participants, 32 of whom were diagnosed with posttraumatic stress disorder (PTSD) prior to treatment, PTSD participants improved as much as those without the diagnosis, with both groups maintaining their gains at 15 months. At 15-month follow-up, the three 90-min sessions of EMDR previously administered (S.A. Wilson, L.A. Becker, & R. H. Tinker, 1995) produced an 84% reduction in PTSD diagnosis and a 68% reduction in PTSD symptoms. The average treatment effect size was 1.59; the average reliable change index was 3.37. Implications of the maintenance of EMDR treatment effects are discussed.     

Incomplete adherence after pediatric heart and heart-lung transplantation

Cognitive bias was investigated in survivors of motor vehicle accidents with either acute stress disorder (ASD; n = 17) or no ASD (n = 17). Participants completed the acute stress disorder interview, the Beck depression inventory, the Beck anxiety inventory, the impact of event scale, and a probability questionnaire (PQ) and a cost questionnaire (CQ) within four weeks of their accident. ASD participants exaggerated both the probability of negative events occurring, and the adverse cost of those events more than non-ASD participants. IES-Avoidance scores were the only significant predictors of both PQ and CQ scores. Findings are discussed in terms of the role of cognitive errors in posttraumatic adjustment.     

Posttraumatic stress disorder arising after road traffic collisions: Patterns of response to cognitive–behavior therapy.

Road traffic collisions (RTCs) are common precipitants of posttraumatic stress disorder (PTSD). Two preliminary studies suggest that cognitive–behavior therapy (CBT) is, on average, effective in treating this disorder, although the major patterns of treatment outcome remain to be identified. Such outcomes might include treatment response, partial response, and response followed by relapse. To identify these patterns, 50 people with RTC-PTSD completed a 12-week course of CBT, with outcome assessment extending to 3-month follow up. Dynamic cluster analyses revealed 2 replicable patterns of outcome: one for responders (n?=?30) and one for partial responders (n?=?20). Partial responders, compared with responders, tended to have more severe pretreatment numbing symptoms and greater anger about their RTC, along with lower global levels of functioning, greater pain severity and interference, and greater depression and were more likely to be taking psychotropic medications. Responders and partial responders did not differ in homework adherence, number of sessions attended, therapist effects, or stressors occurring during therapy or in the presence or absence of RTC-related litigation. Implications for enhancing treatment outcome are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)