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)     

Cognitive processing therapy for posttraumatic stress disorder in a residential treatment setting.

Cognitive processing therapy (CPT) is an exposure-based protocol designed to reduce posttraumatic stress disorder (PTSD) symptoms and challenge faulty beliefs and interpretations that prevent trauma survivors from coming to terms with their traumatic experiences. This article provides a brief summary of this treatment and the related literature and describes how the CPT protocol was modified to implement this treatment in this study's setting. Also provided is a discussion of various institutional and intrapatient barriers that existed before the introduction of CPT and how these difficulties were ultimately resolved. Patients' responses to treatment, as indicated by both qualitative and quantitative data, are also reviewed. A total of 18 patients participated and completed treatment with CPT (50% Caucasian, 22.2% African American, 16.7% biracial, 5.6% Native American, and 5.6% Hispanic). Overall, the women participating in the protocol benefited greatly, and 15 of the 18 women had a statistically significant reduction in scores measuring PTSD symptoms. The article concludes with recommendations to other programs and providers interested in providing CPT to similar treatment populations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A randomized clinical trial to dismantle components of cognitive processing therapy for posttraumatic stress disorder in female victims of interpersonal violence.

The purpose of this experiment was to conduct a dismantling study of cognitive processing therapy in which the full protocol was compared with its constituent components--cognitive therapy only (CPT-C) and written accounts (WA)--for the treatment of posttraumatic stress disorder (PTSD) and comorbid symptoms. The intent-to-treat (ITT) sample included 150 adult women with PTSD who were randomized into 1 of the 3 conditions. Each condition consisted of 2 hr of therapy per week for 6 weeks; blind assessments were conducted before treatment, 2 weeks following the last session, and 6 months following treatment. Measures of PTSD and depression were collected weekly to examine the course of recovery during treatment as well as before and after treatment. Secondary measures assessed anxiety, anger, shame, guilt, and dysfunctional cognitions. Independent ratings of adherence and competence were also conducted. Analyses with the ITT sample and with study completers indicate that patients in all 3 treatments improved substantially on PTSD and depression, the primary measures, and improved on other indices of adjustment. However, there were significant group differences in symptom reduction during the course of treatment whereby the CPT-C condition reported greater improvement in PTSD than the WA condition. (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)     

The effects of forgiveness therapy on depression, anxiety, and posttraumatic stress for women after spousal emotional abuse.

Emotionally abused women experience negative psychological outcomes long after the abusive spousal relationship has ended. This study compares forgiveness therapy (FT) with an alternative treatment (AT; anger validation, assertiveness, interpersonal skill building) for emotionally abused women who had been permanently separated for 2 or more years (M = 5.00 years, SD = 2.61; n = 10 per group). Participants, who were matched, yoked, and randomized to treatment group, met individually with the intervener. Mean intervention time was 7.95 months (SD = 2.61). The relative efficacy of FT and AT was assessed at p     

Cognitive processing therapy for veterans with military-related posttraumatic stress disorder.

Sixty veterans (54 men, 6 women) with chronic military-related posttraumatic stress disorder (PTSD) participated in a wait-list controlled trial of cognitive processing therapy (CPT). The overall dropout rate was 16.6% (20% from CPT, 13% from waiting list). Random regression analyses of the intention-to-treat sample revealed significant improvements in PTSD and comorbid symptoms in the CPT condition compared with the wait-list condition. Forty percent of the intention-to-treat sample receiving CPT did not meet criteria for a PTSD diagnosis, and 50% had a reliable change in their PTSD symptoms at posttreatment assessment. There was no relationship between PTSD disability status and outcomes. This trial provides some of the most encouraging results of PTSD treatment for veterans with chronic PTSD and supports increased use of cognitive- behavioral treatments in this population. (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)     

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)     

An evaluation of cognitive processing therapy for the treatment of posttraumatic stress disorder related to childhood sexual abuse.

This study compared the effectiveness of cognitive processing therapy for sexual abuse survivors (CPT-SA) with that of the minimal attention (MA) given to a wait-listed control group. Seventy-one women were randomly assigned to 1 of the 2 groups. Participants were assessed at pretreatment and 3 times during posttreatment: immediately after treatment and at 3-month and 1-year follow-up, using the Clinician-Administered Posttraumatic Stress Disorder (PTSD) Scale (D. Blake et al., 1995), the Beck Depression Inventory (A. T. Beck, R. A. Steer, & G. K. Brown, 1996), the Structured Clinical Interview for the DSM-IV (R. L. Spitzer, J. B. W. Williams, & M. Gibbon, 1995; M. B. First et al., 1995), the Dissociative Experiences Scale-II (E. M. Bernstein & F. W. Putnam, 1986), and the Modified PTSD Symptom Scale (S. A. Falsetti, H. S. Resnick, P. A. Resick, & D. G. Kilpatrick, 1993). Analyses suggested that CPT-SA is more effective for reducing trauma-related symptoms than is MA, and the results were maintained for at least 1 year. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Meaning making and psychological adjustment following cancer: The mediating roles of growth, life meaning, and restored just-world beliefs.

Cancer survivors' efforts at meaning making may influence the extent to which they successfully make meaning from their experience (i.e., experience posttraumatic growth, find life meaningful, and restore beliefs in a just world), which may, in turn, influence their psychological adjustment. Previous research regarding both meaning making processes and meanings made as determinants of adjustment has shown inconsistent effects, partly because of the lack of clearly articulated theoretical frameworks and problematic research strategies. In a 1-year longitudinal study, the authors distinguished the meaning making process from the outcomes of that process (meanings made), employing specific measures of both. The authors tested pathways through which meaning making efforts led to 3 different meanings made (growth, life meaning, and restored just-world belief) in a sample of 172 young to middle-age adult cancer survivors, and they explored whether those meanings made mediated the effect of meaning making efforts on psychological adjustment. Cross-sectional and longitudinal path models of the meaning making process indicate that meaning making efforts are related to better adjustment through the successful creation of adaptive meanings made from the cancer experience. The authors conclude with clinical implications and suggestions for future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The importance of cognitive processing to adjustment in the 1st year following amputation.

Objective: To describe depressive symptoms, posttraumatic stress disorder (PTSD), and posttraumatic growth at 6 and 12 months following amputation and to explore differences by demographic variables and cognitive processing of trauma. Participants: 83 adults with newly acquired limb loss. Setting: Two large metropolitan hospitals. Main Outcome Measures: The Patient Health Questionnaire depression module, PTSD Checklist, and Posttraumatic Growth Inventory. Results: Significant depressive and PTSD symptoms were reported by 15%-25% of participants. Relatively low levels of posttraumatic growth were reported. Negative cognitive processing predicted depressive and PTSD symptoms at 6 months. Positive cognitive processing predicted posttraumatic growth at 12 months. Conclusion: Cognitive processing appears to be integral to positive and negative psychosocial outcomes following amputation and should be targeted by clinical interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predisaster trait anxiety and negative affect predict posttraumatic stress in youths after Hurricane Katrina.

On the basis of theory and previous research, it was hypothesized that predisaster child trait anxiety would predict disaster-related posttraumatic stress symptoms and generalized anxiety disorder symptoms, even after controlling for the number of hurricane exposure events. Results support this hypothesis and further indicate that predisaster negative affect predicted disaster-related posttraumatic stress symptoms and generalized anxiety disorder symptoms. Also, Katrina-related posttraumatic stress disorder symptoms were predicted by the number of hurricane exposure events and sex (being female). Predisaster generalized anxiety disorder symptoms predicted postdisaster generalized anxiety disorder symptoms, and predisaster trait anxiety predicted postdisaster depressive symptoms. Findings are discussed in terms of their relevance for developing interventions to mitigate the impact of disasters in youths. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Posttraumatic growth following breast cancer: A controlled comparison study.

Cancer may be viewed as a psychosocial transition with the potential for positive and negative outcomes. This cross-sectional study (a) compared breast cancer (BC) survivors' (n?=?70) self-reports of depression, well-being, and posttraumatic growth with those of age- and education-matched healthy comparison women (n?=?70) and (b) identified correlates of posttraumatic growth among BC survivors. Groups did not differ in depression or well-being, but the BC group showed a pattern of greater posttraumatic growth, particularly in relating to others, appreciation of life, and spiritual change. BC participants' posttraumatic growth was unrelated to distress or well-being but was positively associated with perceived life-threat, prior talking about breast cancer, income, and time since diagnosis. Research that has focused solely on detection of distress and its correlates may paint an incomplete and potentially misleading picture of adjustment to cancer. (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)     

Pathways to posttraumatic growth: The contributions of forgiveness and importance of religion and spirituality.

Posttraumatic growth may follow the experience of being significantly hurt by another person. This study examines the roles of forgiveness and the importance of religion and spirituality in posttraumatic growth after a significant interpersonal transgression among a diverse sample of 146 adults. Results demonstrated that transgression severity was negatively related to forgiveness: the more distressing the event, the more revenge and avoidance were endorsed in response to the offender. Regression analyses revealed that benevolence toward the offender predicted growth in the area of relating to others. The positive relationship between forgiveness and posttraumatic growth was mediated by importance of religion and spirituality; however, the relationship between unforgiveness and lack of growth was not similarly mediated. Results suggest that religious and spiritual variables influence how individuals respond to significant interpersonal transgressions through positive processes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Well-being and posttraumatic growth in unrelated donor marrow transplant survivors: A nine-year longitudinal study.

Objective: To study posttraumatic growth and psychological and physical well-being among 25 cancer survivors (12 men, 13 women) 9 years after receiving a hematopoietic stem cell transplant from an unrelated donor. Measures: Participants completed measures of well-being (e.g., depression, physical function) and posttraumatic growth at the 9-year follow-up. Prior to treatment, optimism, social support, and well-being had been assessed. Results: Findings reveal high levels of physical and psychological well-being. Survivors reported posttraumatic growth in several domains, including increased personal strengths and enhanced interpersonal relationships. Higher levels of growth were significantly related to gender and age: Women reported more total posttraumatic growth, and older survivors reported more enhanced spirituality, one domain of growth. Posttraumatic growth and well-being after treatment were predicted by 2 psychosocial variables assessed prior to treatment: dispositional optimism and social support. Implications: Although long-term survivors report ongoing physical limitations, they also experience well-being in both physical and psychological domains. Posttraumatic growth is an area of well-being deserving of additional research and clinical attention. In particular, there may be reason to assist survivors to articulate growth as part of ongoing care. (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     

A prospective study of risk and resilience factors associated with posttraumatic stress symptoms and depression symptoms among Jews and Arabs exposed to repeated acts of terrorism in Israel.

In the first prospective study, to our knowledge, of the impact of ongoing terrorism and political violence, we analyzed nationally representative data from 560 Jews and 182 Arabs in Israel over a 6-month period. Based on Conservation of Resources (COR) theory (Hobfoll, 1989, 1998), we predicted that exposure to terrorism and political violence would result in psychosocial and economic resource loss and resource lack, which in turn, would be primary predictors of increases in symptoms of posttraumatic stress (PTS) and depression. We also predicted that trauma exposure and PTS symptoms, in particular, would be related to ethnocentrism and support for political violence. Furthermore, based on theory and prior research, we predicted that posttraumatic growth (PTG) would be related to a worsening of symptoms of distress and that distress would be related to increased ethnocentrism and support for extreme political violence for their “cause.” Women, older individuals, and Arabs (compared with Jews) were more likely to have continued psychological distress over time. In addition, using simultaneous equation modeling, we found good fit for a structural model that partially supported our hypotheses. Psychosocial resource loss, PTG, and social support had direct and indirect effects on psychological distress. Political attitudes tended to harden over time but were not prospectively related to PTS or depressive symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Urban teens: Trauma, posttraumatic growth, and emotional distress among female adolescents.

Urban teens face many traumas, with implications for potential growth and distress. This study examined traumatic events, posttraumatic growth, and emotional distress over 18 months among urban adolescent girls (N = 328). Objectives were to (a) describe types of traumatic events, (b) determine how type and timing of events relate to profiles of posttraumatic growth, and (c) prospectively examine effects of event type and posttraumatic growth on short- and long-term emotional distress with controls for pre-event distress. Results indicate that type of event was related to profiles of posttraumatic growth, but not with subsequent emotional distress. When baseline emotional distress was controlled, posttraumatic growth was associated with subsequent reductions in short- and long-term emotional distress. Implications for future research and clinical practice with adolescents are addressed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The posttraumatic growth path: An emerging model for prevention and treatment of trauma-related behavioral health conditions.

The aim of this study is threefold. First, the current evidence-based treatments for posttraumatic stress disorder (PTSD) are reviewed. Treatments reviewed for efficacy include prolonged exposure therapy, cognitive processing therapy, and eye movement desensitization and reprocessing. Next, concepts identified as protective measures against chronic PTSD are explored, with particular emphasis on resiliency and posttraumatic growth (PTG). Third, based on the abovementioned systematic review, a new treatment model for trauma-related behavioral health conditions, the posttraumatic growth path (PTGP), is proposed. This research will demonstrate how this new model integrates a variety of therapeutic approaches and protective measures to treat and mitigate the development of chronic PTSD and other concomitant mental health concerns. Implications for practice are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)