A randomized controlled trial of emotionally expressive writing for women with metastatic breast cancer.

Objective: To test the effects of emotionally expressive writing in a randomized controlled trial of metastatic breast cancer patients and to determine whether effects of the intervention varied as a function of perceived social support or time since metastatic diagnosis. Design: Women (N = 62) living with Stage IV breast cancer were randomly assigned to write about cancer-related emotions (EMO; n = 31) or the facts of their diagnosis and treatment (CTL; n = 31). Participants wrote at home for four 20-min sessions within a 3-week interval. Main Outcome Measures: Depressive symptoms, cancer-related intrusive thoughts, somatic symptoms, and sleep quality at 3 months postintervention. Results: No significant main effects of experimental condition were observed. A significant condition × social support interaction emerged on intrusive thoughts; EMO writing was associated with reduced intrusive thoughts for women reporting low emotional support (η2 = .15). Significant condition × time since metastatic diagnosis interactions were also observed for somatic symptoms and sleep disturbances. Relative to CTL, EMO participants who were more recently diagnosed had fewer somatic symptoms (η2 = .10), whereas EMO participants with longer diagnosis duration exhibited increases in sleep disturbances (η2 = .09). Conclusion: Although there was no main effect of expressive writing on health among the current metastatic breast cancer sample, expressive writing may be beneficial for a subset of metastatic patients (including women with low levels of emotional support or who have been recently diagnosed) and contraindicated for others (i.e., those who have been living with the diagnosis for years). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Trauma-focused imaginal exposure for individuals with comorbid posttraumatic stress disorder and alcohol dependence: Revealing mechanisms of alcohol craving in a cue reactivity paradigm.

With a sample (N = 43) of participants meeting current diagnostic criteria for both alcohol dependence and posttraumatic stress disorder (PTSD), the authors tested the hypothesis that alcohol craving elicited by a trauma cue might be attenuated if trauma-elicited negative emotion were reduced following trauma-focused imaginal exposure. In a laboratory-based experiment, participants were randomly assigned to either trauma-focused imaginal exposure or imagery-based relaxation. A cue reactivity paradigm was used to assess alcohol craving prior to, and after completion of, the 6 clinical sessions. Attrition was high but did not differ between experimental conditions. For study completers, PTSD symptoms decreased in the exposure condition but not in the relaxation condition. Alcohol craving and distress elicited by trauma images decreased in the exposure condition but did not change in the relaxation condition. Results support the hypothesis that negative emotion is a mechanism of alcohol craving. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Change in posttraumatic stress disorder symptoms: Do clinicians and patients agree?

This study assessed the longitudinal association between clinician and patient ratings of posttraumatic stress disorder (PTSD) symptoms over the course of 2 different randomized clinical trials of veterans with chronic PTSD. One trial, the Department of Veterans Affairs Cooperative Study 420 (CSP 420; N = 360) compared trauma-focused and present-centered group therapies, and the 2nd trial compared cognitive processing theory and a waitlist control condition (N = 60). Linear mixed effects modeling revealed significant associations between clinician ratings (Clinician-Administered PTSD Scale; CAPS; D. D. Blake et al., 1990) and patient ratings (Posttraumatic Stress Disorder Checklist; PCL; F. W. Weathers, B. T. Litz, J. A. Herman, J. A. Huska, & T. M. Keane, 1993) in total and symptom clusters of PTSD. Contrary to hypothesis, the amount of change on the CAPS ranged from .75 to .82 standard deviations for every 1 standard deviation change on the PCL. The CAPS and PCL were more closely associated in the trauma-focused vs. present-centered treatment condition in CSP 420, and especially regarding hyperarousal symptoms. When comparing categorization of clinically significant change on the CAPS and PCL, the authors found no differences in the percentages of agreement between clinicians and patients in improvement and exacerbation. The value of multimodal assessment of PTSD treatment outcomes is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Type D personality and the development of PTSD symptoms: A prospective study.

Psychological trauma and prolonged stress may cause mental disorders such as posttraumatic stress disorder (PTSD). Pretrauma personality is an important determinant of posttraumatic adjustment. Specifically, trait neuroticism has been identified as a risk factor for PTSD. Additionally, the combination of high negative affectivity or neuroticism with marked social inhibition or introversion, also called Type D personality (Denollet, 2000), may compose a risk factor for PTSD. There is no research available that examined pretrauma Type D personality in relation to PTSD. The present study examined the predictive validity of the Type D personality construct in a sample of Dutch soldiers. Data were collected prior to and 6 months after military deployment to Afghanistan. Separate multiple regression analyses were performed to examine the predictive validity of Type D personality. First, Type D personality was defined as the interaction between negative affect and social inhibition (Na × Si). In a second analysis, Type D was defined following cutoff criteria recommended by Denollet (2000). Results showed that negative affectivity was a significant predictor of PTSD symptoms. Social inhibition and the interaction Na × Si did not add to the amount of explained variance in postdeployment PTSD scores over the effects of childhood abuse, negative affectivity, and prior psychological symptoms. A second analysis showed that Type D personality (dichotomous) did not add to the amount of explained variance in postdeployment PTSD scores over the effects of childhood abuse, and prior psychological symptoms. Therefore, Type D personality appears to be of limited value to explain development of combat-related PTSD symptoms. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Posttraumatic stress disorder, depression, alcohol use disorders and quality of life in adolescents

Posttraumatic stress disorder (PTSD) is a prevalent psychiatric disorder among adolescents. While the effects of PTSD on quality of life (QOL) have been systematically studied with adults, research on the consequences of PTSD with adolescents has been limited. Among the other psychiatric disorders often associated with PTSD, major depression and alcohol use disorders are prevalent and have their own substantial morbidities. This study was designed to examine and compare the effects of PTSD, major depression, and alcohol use disorders on quality of life during adolescence. The subjects were 540 adolescents (ages 12-18 years old) recruited from clinical and community sources. Psychiatric disorders characterizing the sample included one or more of the three disorders studied (n = 275), other psychiatric disorders (n = 121), or no psychiatric disorders (n = 144). Analysis of covariance was utilized to determine the individual main effects and relative effects sizes of the three primary disorders on QOL variables. PTSD showed significant adverse effects on psychological, physical, and social functioning. Major depression showed a similar pattern. In contrast, alcohol use disorders primarily affected role functioning. While PTSD, major depression, and alcohol use disorders all adversely influenced adolescent QOL, the patterns of their effects differed. Remedial treatment interventions designed to restore QOL for adolescents with these disorders may need to focus on different areas for adolescents with PTSD or major depression than for adolescents with alcohol use disorders.     

Womanism: a methodologic framework for African American women

Socially anxious (N = 41) and non-anxious (N = 41) individuals participated in a getting acquainted situation that was based on the reciprocity self-disclosure paradigm. Subjects' appraisals of the situation were manipulated to be either positive or negative by highlighting the likelihood of positive or negative social outcomes. Subjects' social goals and use of safety behaviors were assessed, as were others' reaction to the subjects. As predicted, socially anxious individuals elicited significantly more negative responses from others in the negative appraisal condition, where they employed safety behaviors, than in the positive appraisal condition, where they did not. The results supported a cognitive model of social anxiety, rather than alternative explanations.     

Group membership in the elementary school classroom.

Investigated the relationships between the quality of a student's group membership and 4 student outcomes in elementary school classrooms. J. Jackson's (1959) model of person–group relationships was employed for describing a student's membership relations with his or her classroom peers. In addition, this study sought to determine if relationships between group membership and student outcomes varied in classrooms with different social structures. Data from 621 5th- and 6th-grade students were treated by 4?×?2 and 2?×?2?×?2 analyses of covariance. Results indicate significant main effects for group membership and social structure. It is concluded that Jackson's conceptual model is a useful framework for contributing to an understanding of student attitudes and behaviors in elementary school classrooms. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prospective predictors of posttraumatic stress disorder symptoms: Direct and mediated relations.

This study assessed the relations between pretrauma risk (neuroticism, negative affect, prior distress) and protective (self-esteem, optimism) factors and posttraumatic stress disorder (PTSD) symptoms and potential mediators (subjective event-related distress, unsupportive social interactions, perceived control) of those relations. Students (N = 1,528) at four U.S. universities completed online surveys assessing pretrauma risk and protective factors at Time 1 (T1); 84% (N = 1,281) completed a survey 2 months later (T2). PTSD symptoms and the three potential mediators were assessed among those who experienced potentially traumatic events between T1 and T2 (n = 264). PTSD symptoms related to prior traumas were controlled in all analyses. In structural equation modeling (SEM) analyses, the relation between risk factors and PTSD symptoms was mediated by unsupportive social interactions. Protective factors did not independently predict PTSD symptoms when risk factors also were included in the SEM models. Implications for research and practice are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Electroconvulsive shocks exacerbate the heightened acoustic startle response in stressed rats.

Electroconvulsive therapy (ECT) has been successfully used in the treatment of depression, particularly when the illness is refractory to pharmacological therapy. A recent study has shown that ECT is also effective in reducing both depressive and posttraumatic stress disorder (PTSD) symptoms in patients with major depression (MDD) and co-occurring PTSD. This raises the possibility that ECT might be effective in the treatment of PTSD, a disease whose prevalence has increased substantially in recent years. A characteristic symptom of PTSD is an exaggerated reactivity to startling sounds (acoustic startle response; ASR). In the present study, we investigated the effects of electroconvulsive shocks (ECS) on the ASR, in a rat model of traumatic stress. The animals were subjected to a restraint/tailshock paradigm and then administered ECS. ASR measurements were obtained at several time points following ECS administration. Although ECS had no effect in control rats, it significantly exacerbated the already potentiated ASR in the stressed group. While ECT may prove to be an effective treatment for certain symptoms of co-occurring MDD/PTSD or PTSD alone, it may exacerbate heightened arousal associated with PTSD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessing posttraumatic stress disorder with or without reference to a single, worst traumatic event: Examining differences in factor structure.

The authors examined the effects of a methodological manipulation on the Posttraumatic Stress Disorder (PTSD) Checklist’s factor structure: specifically, whether respondents were instructed to reference a single worst traumatic event when rating PTSD symptoms. Nonclinical, trauma-exposed participants were randomly assigned to 1 of 2 PTSD assessment conditions: referencing PTSD symptoms to their worst trauma (trauma-specific group, n = 218) or to their overall trauma history in general (trauma-general group, n = 234). A 3rd group of non-trauma-exposed participants (n = 464) rated PTSD symptoms globally from any stressful event. Using confirmatory factor analysis, the authors show that the 4-factor PTSD model proposed by D. W. King, G. A. Leskin, L. A. King, and F. W. Weathers (1998; separating effortful avoidance and emotional numbing) demonstrated the best model fit for trauma-general and non-trauma-exposed participants. The 4-factor PTSD model proposed by L. J. Simms, D. Watson, and B. N. Doebbeling (2002; emphasizing a general dysphoria factor) demonstrated the best model fit for trauma-specific participants. Measurement invariance testing revealed that non-trauma-exposed participants were different from both trauma-exposed groups on factor structure parameters, but trauma groups were not substantially different from each other. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Randomized trial of prolonged exposure for posttraumatic stress disorder with and without cognitive restructuring: Outcome at academic and community clinics.

Female assault survivors (N = 171) with chronic posttraumatic stress disorder (PTSD) were randomly assigned to prolonged exposure (PE) alone, PE plus cognitive restructuring (PE/CR), or wait-list (WL). Treatment, which consisted of 9-12 sessions, was conducted at an academic treatment center or at a community clinic for rape survivors. Evaluations were conducted before and after therapy and at 3-, 6-, and 12-month follow-ups. Both treatments reduced PTSD and depression in intent-to-treat and completer samples compared with the WL condition; social functioning improved in the completer sample. The addition of CR did not enhance treatment outcome. No site differences were found: Treatment in the hands of counselors with minimal cognitive- behavioral therapy (CBT) experience was as efficacious as that of CBT experts. Treatment gains were maintained at follow-up, although a minority of patients received additional treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Working Models of Attachment Shape Perceptions of Social Support: Evidence From Experimental and Observational Studies.

Two studies examined the association between attachment style and perceptions of social support. Study 1 (N = 95 couples) used an experimental paradigm to manipulate social support in the context of a stressful task. Insecure participants (anxious and avoidant) who received low-support messages appraised these messages more negatively, rated a prior behavioral interaction with their partner as having been less supportive, and performed significantly worse at their task compared with secure participants. Study 2 (N = 153 couples) used a similar paradigm except that partners were allowed to send genuine support messages. Insecure participants (especially fearful) perceived their partners' messages as less supportive, even after controlling for independent ratings of the messages and relationship-specific expectations. These studies provide evidence that individuals are predisposed to appraise their support experiences in ways that are consistent with their chronic working models of attachment, especially when the support message is ambiguous. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adolescents' reasoning about exclusion from social groups.

Ninth- and 11th-grade students (N=379) were surveyed regarding their evaluations of excluding someone from a social group solely on the basis of his or her social reference group membership. Individuals evaluated exclusion in ambiguous and nonambiguous situations. Judgments and reasoning about exclusion were compared with judgments and reasoning about a more prototypically moral situation (denial of resources). Overall, participants evaluated exclusion as less wrong than denial of resources and used fewer moral and more conventional reasons to justify their judgments. Participants relied more on their group knowledge or stereotypes in evaluating ambiguous situations and more on their personal knowledge in evaluating nonambiguous situations. Age- and gender-related differences in evaluations, reasoning, and use of stereotypes were also found. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Play and associative fluency: Experimenter effects may be responsible for previous positive findings.

Previous studies linking play experience and associative fluency failed to control for possible experimenter effects. Preschool children (N = 64) were assigned to one of three conditions with common objects—fantasy play, play, or imitation—or to an alternative-materials control group. They were tested for associative fluency for familiar and for novel objects, both immediately and after 1 week's delay. Precautions were taken against experimenter bias in testing and scoring. Significant differences between objects were found, and delayed test results were usually poorer than immediate test results. No significant main effects for condition were obtained. It is hypothesized that the significant effects for condition found in many previous studies were due to unconscious experimenter effects in administering the conditions and the tests. Failure to find significant condition effects in the present study is ascribed to either the lack of ecological validity of small-scale experimental studies of play and/or the lack of a major impact of play on creative and problem-solving abilities. (24 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationships between posttraumatic stress symptom clusters and marital intimacy among war veterans.

This study examined (a) the relationships between posttraumatic stress disorder (PTSD) symptom clusters and marital intimacy among Israeli war veterans and (b) the role of self-disclosure and verbal violence in mediating the effects of PTSD avoidance and hyperarousal symptoms on marital intimacy. The sample consisted of 219 participants divided into 2 groups: ex-prisoners of war (ex-POWs; N = 125) and a comparison group of veterans who fought in the same war but were not held in captivity (N = 94). Ex-POWs displayed higher levels of PTSD symptoms and verbal violence and lower levels of self-disclosure than did controls. Although ex-POWs and controls did not differ in level of marital intimacy, they did, however, present a different pattern of relationships between PTSD clusters and intimacy. In ex-POWs, self-disclosure mediated the relations between PTSD avoidance and marital intimacy. Verbal aggression was also found via indirect effect of hyperarousal on marital intimacy. The results point to the importance of self-disclosure and verbal violence as interpersonal mechanisms for the relations between posttraumatic symptoms on marital intimacy of ex-POWs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

MMPI scores for field-dependent and field-independent psychiatric outpatients.

Investigated the relationship of field dependency to personality traits and styles of psychopathological adjustment. 3 shortcomings of previous research were avoided by using a larger sample (N = 414), a nonprojective measure of personality, and a clinical population. Validity scales, clinical scales, and 13 experimental Minnesota Multiphasic Personality Inventory (MMPI) scales were compared for field-dependent and field-independent psychiatric outpatients. Separate analyses were made for males and females. As predicted, field-dependent males scored higher on social desirability and acquiescence but lower on social introversion. Field-dependent females scored higher on hysteria, repression, and hypochondriasis but lower on ego strength and control. Overall results partially support the proposed relationship of field dependency to personality traits and modes of psychopathological adjustment. The sex of the S is an important variable in predicting specific relationships. Correlational data indicate that the strength of the relationship between field dependency and MMPI scales should not be overestimated. (16 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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)     

Food, mood, and attitude: Reducing risk for eating disorders in college women.

Food, Mood, and Attitude (FMA) is a CD-ROM prevention program developed to decrease risk for eating disorders in college women. Female 1st-year students (N = 240) were randomly assigned to the intervention (FMA) or control group. Equal numbers of students at risk and of low risk for developing an eating disorder were assigned to each condition. Participants in the FMA condition improved on all measures relative to controls. Significant 3-way interactions (Time × Condition × Risk Status) were found on measures of internalization of sociocultural attitudes about thinness, shape concerns, and weight concerns, indicating that at-risk participants in the intervention group improved to a greater extent than did low-risk participants. At follow-up, significantly fewer women in the FMA group reported overeating and excessive exercise relative to controls. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Conceptual and perceptual priming and dissociation in chronic posttraumatic stress disorder.

Cognitive models of posttraumatic stress disorder (PTSD) assert that memory processes play a significant role in PTSD (see e.g., Ehlers & Clark, 2000). Intrusive reexperiencing in PTSD has been linked to perceptual processing of trauma-related material with a corresponding hypothesized lack of conceptual processing. In an experimental study that included clinical participants with and without PTSD (N = 50), perceptual priming and conceptual priming for trauma-related, general threat, and neutral words were investigated in a population with chronic trauma-induced complaints as a result of the Troubles in Northern Ireland. The study used a new version of the word-stem completion task (Michael, Ehlers, & Halligan, 2005) and a word-cue association task. It also assessed the role of dissociation in threat processing. Further evidence of enhanced perceptual priming in PTSD for trauma stimuli was found, along with evidence of lack of conceptual priming for such stimuli. Furthermore, this pattern of priming for trauma-related words was associated with PTSD severity, and state dissociation and PTSD group made significant contributions to predicting perceptual priming for trauma words. The findings shed light on the importance of state dissociation in trauma-related information processing and posttraumatic symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The influence of another's perspective on children's recall of previously misconstrued events.

Children's abilities to reframe their memories of events after hearing another child's perspective of the same events were examined, and links between memory reframing, cognitive ability, and social competence were explored. Nine- to 11-year-olds (N = 79) were told to imagine that the events in a narrated story happened to them. Next, they heard another story that described either the same events (experimental condition) or unrelated events (control condition) from another child's perspective. The children in the experimental group reframed their memories in light of the alternative perspective, whereas the children in the control condition did not. Children with higher cognitive scores had higher memory reframing scores and received higher social competence ratings than children with lower cognitive scores. (PsycINFO Database Record (c) 2010 APA, all rights reserved)