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)     

Changes in coping style and treatment outcome following motor vehicle accident.

Background: Motor vehicle accidents (MVAs) are highly prevalent and can result in a complex interplay of physical injury, disability, and emotional distress. It has been suggested that the manner in which individuals cope with pain experienced after injury may determine how much recovery of function can be achieved. Only a limited number of studies have examined this process in the context of a rehabilitation program, and to date few studies have examined both functional and quality of life outcomes in MVA recovery in a tertiary level program as a function of coping style. Methods: A sample of 96 consecutive referrals to a tertiary-level multidisciplinary functional restoration program completed physical performance measures pre- and post-treatment, as well as a standardized self-report measure of quality of life (QOL) at the same time points and 6-month follow-up. Results: Findings suggested that improvements from pre- to post-treatment were evident on the 6-minute walk test, left and right grip strength, and most QOL measures. Increases in active coping during treatment were associated with pre- to post-treatment increases in QOL across most domains, and improvements in performance on the 6-minute walk test. Likewise, decreases in passive coping during the course of treatment were associated with improved performance on the 6-minute walk test, right-handed standing reach test, and most QOL indicators. Conclusion: Findings suggest that those who adopt an active approach (and avoid taking a passive approach) to rehabilitation following complex musculoskeletal injury benefit along both QOL and functional dimensions relative to those who do not. (PsycINFO Database Record (c) 2011 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)     

Neural correlates of posttraumatic growth after severe motor vehicle accidents.

Frontal brain asymmetry has been associated with emotion- and motivation-related constructs. The authors examined the relationship between frontal brain asymmetry and subjective perception of posttraumatic growth (PTG) after severe motor vehicle accidents (MVAs). Eighty-two survivors of MVAs completed self-report measures of PTG, trait and state affect, and diagnostic interviews assessing clinical status, and underwent measurement of resting electroencephalographic activity. As predicted, increased relative left frontal activation was significantly related to PTG, even when statistically controlling for dispositional positive affect. The authors assume that approach-related motivational tendencies associated with higher relative left frontal brain activity may be involved in the process and outcome of PTG. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alcohol use disorder history moderates the relationship between avoidance coping and posttraumatic stress symptoms.

Avoidance coping (AVC) is common in individuals with posttraumatic stress disorder (PTSD) and in individuals with alcohol use disorder (AUD). Given that PTSD and AUD commonly co-occur, AVC may represent a risk factor for the development of comorbid posttraumatic stress and alcohol use. In this study, the relationship between AVC and PTSD symptoms (PTSS) was examined in individuals with versus without AUDs. Motor vehicle accident (MVA) victims were assessed 6 weeks postaccident for AUD history (i.e. diagnoses of current or past alcohol abuse or dependence) and AVC. PTSS were assessed 6 weeks and 6 months post-MVA. All analyses were conducted on the full sample of MVA victims as well as on the subset of participants who were legally intoxicated (blood alcohol concentration ≥ 0.08) during the accident. It was hypothesized that the relationship between AVC and PTSS would be stronger in those individuals with an AUD history and especially strong in the subset of individuals who were legally intoxicated during the MVA. Results were largely supportive of this hypothesis, even after controlling for in-hospital PTSS, gender, and current major depression. Early assessment of AUD history and avoidance coping may aid in detecting those at elevated risk for PTSD, and intervening to reduce AVC soon after trauma may help buffer the development of PTSD + AUD comorbidity. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The role of hyperarousal in the manifestation of posttraumatic psychological distress following injury.

The authors examined the temporal relation among posttraumatic stress disorder symptom clusters, using data derived from a longitudinal study of survivors of orofacial injury (N = 264). They conducted cross-lagged panel analyses, with self-reported symptom data collected at 1, 6, and 12 months postinjury. Results demonstrate that hyperarousal was a potent predictor of subsequent symptoms of reexperiencing and avoidance as well as hyperarousal. By contrast, neither reexperiencing nor avoidance was significantly related to other symptom clusters other than themselves over time. These findings underscore the distinctive nature of hyperarousal in the manifestation of posttraumatic psychological distress over time. Implications for theory, clinical intervention, and future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive appraisals and posttraumatic stress disorder symptoms in informal caregivers of stroke survivors.

Objective: To examine associations between cognitive appraisals (i.e., negative appraisals about the self, negative appraisals about the world, and self-blame) and the severity of posttraumatic stress disorder (PTSD) symptoms in informal caregivers (i.e., family relatives or close associates) of stroke survivors. Method: A cross-sectional study was conducted in which informal caregivers (N = 51) of recent stroke survivors completed the Posttraumatic Diagnostic Scale and the Posttraumatic Cognitions Inventory. Results: PTSD symptom severity correlated significantly with the Posttraumatic Cognitions Inventory Self, World, and Self-Blame subscales and with time since stroke and age (negative relationship). Cognitive appraisals explained 58% of the variance in PTSD symptom severity. Conclusion: The associations found between negative cognitive appraisals and the severity of PTSD symptoms are consistent with current cognitive models of PTSD and the recommended use of trauma-related cognitive–behavioral therapy for individuals with PTSD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gender differences in posttraumatic stress disorder.

One of the most consistent findings in the epidemiology of posttraumatic stress disorder (PTSD) is the higher risk of this disorder in women. Explanations reviewed within a psychobiological model of PTSD suggest that women's higher PTSD risk may be due to the type of trauma they experience, their younger age at the time of trauma exposure, their stronger perceptions of threat and loss of control, higher levels of peritraumatic dissociation, insufficient social support resources, and greater use of alcohol to manage trauma-related symptoms like intrusive memories and dissociation, as well as gender-specific acute psychobiological reactions to trauma. This review demonstrates the need for additional research of the gender differences in posttraumatic stress. Recommendations are made for clinical practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictors of posttraumatic stress disorder symptomatology following bone marrow transplantation for cancer.

This study examined the prevalence and predictors of posttraumatic stress disorder (PTSD) symptoms in 70 men and women treated with bone marrow transplantation for cancer. Findings indicated that number of symptoms present ranged from 0 to a possible high of 17 (M = 3.0, SD = 3.9). As predicted lower social support and higher avoidance coping I month pretransplant predicted greater PTS symptom severity an average of 7 months posttransplant. These variables remained significant predictors of symptom severity even after accounting for pretransplant levels of psychological distress. Addition analyses indicated the presence of a significant interaction between social support and avoidance coping with patients high in avoidance coping and low in social support reporting the most severe symptoms. These findings identify patients at risk for psychological disturbance posttransplant and can serve guide future intervention efforts. (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)     

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)     

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)     

The mediating role of coping: A cross-sectional analysis of the relationship between coping self-efficacy and coping effectiveness among athletes.

This study examines the relationship among global coping self-efficacy, coping, and coping effectiveness within athletes. We hypothesized that there would be a positive association between coping self-efficacy and coping effectiveness, which would be mediated by coping. It was also predicted that coping strategies within the task-oriented coping dimension would be positively associated with coping effectiveness, whereas strategies from the disengagement- and distraction-oriented coping dimensions would be negatively associated with coping effectiveness. Participants were 353 athletes between the ages of 18 and 29 years, who completed a measure of coping self-efficacy the night before they competed, in addition to a measure of the athletes' use of coping strategies and their perceived coping effectiveness, which was completed immediately after the competitive event. Results revealed that higher global coping self-efficacy scores were significantly (r = .33, p     

A predictive screening index for posttraumatic stress disorder and depression following traumatic injury.

Posttraumatic stress disorder (PTSD) and major depressive episode (MDE) are frequent and disabling consequences of surviving severe injury. The majority of those who develop these problems are not identified or treated. The aim of this study was to develop and validate a screening instrument that identifies, during hospitalization, adults at high risk for developing PTSD and/or MDE. Hospitalized injury patients (n = 527) completed a pool of questions that represented 13 constructs of vulnerability. They were followed up at 12 months and assessed for PTSD and MDE. The resulting database was split into 2 subsamples. A principal-axis factor analysis and then a confirmatory factor analysis were conducted on the 1st subsample, resulting in a 5-factor solution. Two questions were selected from each factor, resulting in a 10-item scale. The final model was cross-validated with the 2nd subsample. Receiver-operating characteristic curves were then created. The resulting Posttraumatic Adjustment Scale had a sensitivity of .82 and a specificity of .84 when predicting PTSD and a sensitivity of .72 and a specificity of .75 in predicting posttraumatic MDE. This 10-item screening index represents a clinically useful instrument to identify trauma survivors at risk for the later development of PTSD and/or MDE. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictors of posttraumatic distress 1 year after exposure to community violence: The importance of acute symptom severity.

In this longitudinal study of 333 primarily male, Hispanic survivors of community violence, the authors investigated the effects of 4 categories of risk factors on posttraumatic stress disorder (PTSD) symptom severity: demographic characteristics, pretraumatic psychological factors, characteristics of the trauma, and reactions to the trauma. Replicating past research, exemplars from all 4 categories predicted PTSD symptom severity at 12-month follow-up. Acute symptom severity, measured approximately 5 days posttrauma, accounted for the largest proportion of variance among all the predictors included. No other predictors remained significant after 5-day distress was included in the model. These findings suggest that the effects of several purported risk factors for chronic posttraumatic distress may already be reflected in acute distress following trauma exposure. These results bear on current conceptions of the fundamental nature of PTSD and suggest that initial distress during the immediate aftermath of the trauma may be an important target for intervention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Moderators of the relation between perceived and actual posttraumatic growth.

Although numerous studies suggest that most people report posttraumatic growth (PTG) following traumatic events, the relations between measures of self-reported PTG and actual pre- to posttrauma growth are small (Frazier et al., 2009). The purpose of the current study was to investigate moderators of the relation between perceived and actual growth. Participants were undergraduates who had experienced a traumatic event between Time 1 and Time 2 (2 months later; n = 122) and a matched no-trauma comparison group (n = 122). Participants completed self-report measures of perceived growth (Posttraumatic Growth Inventory; Tedeschi & Calhoun, 1996) at Time 2, actual growth from Time 1 to Time 2 (Frazier et al., 2009), and 4 potential moderators (i.e., distress and life satisfaction at Time 2 and neuroticism and self-esteem at Time 1 pre-event). The moderator analyses suggested that, in the trauma group, perceived growth was more strongly related to actual growth for individuals who reported less distress and more life satisfaction posttrauma. None of the 4 variables were significant moderators for the no-trauma group. Clinical and research implications are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Psychological distress in workers with traumatic upper or lower limb amputations following industrial injuries.

Objective: To determine whether individuals with traumatic upper limb amputations would report more symptoms of posttraumatic stress disorder (PTSD) and depression than individuals with traumatic lower limb amputations. Study Design: Retrospective file review. Setting: CARF-accredited outpatient rehabilitation center. Participants: Thirty workers with unilateral upper limb amputations and 25 workers with unilateral lower limb amputations. Main Outcome Measures: Presence or absence of depression, symptoms of PTSD, and pain. Results: The upper limb group had a higher frequency of depression and symptoms of PTSD than the lower limb group. The 2 groups did not differ with respect to pain complaints. Conclusion: More so than injuries to the lower limbs, upper limb injuries may render individuals vulnerable to PTSD and depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Directed forgetting following mood induction in chronic posttraumatic stress disorder patients.

Current research of posttrauma sequelae suggests that intrusive rather than avoidant-dissociative models more accurately represent the encoding processes of trauma cues. However, posttraumatic stress disorder (PTSD) is often conceptualized as a phasic phenomenon, altering between arousal and avoidance states. The failure to support a relationship between avoidant encoding style and PTSD may reflect this alteration. To explore this hypothesis, participants with PTSD and controls (no PTSD) completed an item-cued directed-forgetting task, following either a dissociative or a serenity (control) mood induction. Results suggested that, following the serenity induction, a standard directed-forgetting effect was observed. However, following the dissociation induction, this effect was not observed. The role of dissociation in impairing encoding via lack of selective rehearsal or source discrimination is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Community violence exposure, adverse childhood experiences, and posttraumatic distress among urban development workers.

The current study examines community violence exposure among 284 urban community development workers located in five U.S. cities. Adulthood exposure to community violence, history of adverse childhood experiences (ACEs), and current symptoms of posttraumatic distress (PTSD) were assessed to test the hypothesis that a personal history of ACEs moderates the relationship between community violence exposure and PTSD symptom severity. Seventy-five percent of urban development workers reported direct community violence victimization, 71% reported a history of at least one ACE, and 14% of the sample met probable diagnostic criteria for PTSD. A multiple regression analysis confirmed that ACEs and indirect adulthood community violence exposure were significantly positively related to the severity of PTSD symptoms. These variables accounted for a small amount of variance in PTSD. Direct exposure to community violence and the interaction between ACEs and community violence did not contribute significant variance to the model. The implications and limitations are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)