Article

Gray matter volume alterations related to trait dissociation in PTSD and traumatized controls

Authors: Nardo, D. Hogberg, G, Lamius, R.A. et al

Acta Psychiatrica Scandinavica Vol 128 (3) September 2013 p222-233

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Dorsolateral Prefrontal Cortex Activation During Emotional Anticipation and Neuropsychological Performance in Posttraumatic Stress Disorder

Dorsolateral Prefrontal Cortex Activation During Emotional Anticipation and Neuropsychological Performance in Posttraumatic Stress Disorder

 Archives of General Psychiatry 2012 69 (4) pp, 360-371.

Robin L. Aupperle; Carolyn B. Allard; Erin M. Grimes; Alan N. Simmons; Taru Flagan; Michelle Behrooznia; Shadha H. Cissell; Elizabeth W. Twamley; Steven R. Thorp; Sonya B. Norman; Martin P. Paulus; Murray B. Stein.

Abstract 

Context Posttraumatic stress disorder (PTSD) has been associated with executive or attentional dysfunction and problems in emotion processing. However, it is unclear whether these two domains of dysfunction are related to common or distinct neurophysiological substrates.

Objective To examine the hypothesis that greater neuropsychological impairment in PTSD relates to greater disruption in prefrontal-subcortical networks during emotional anticipation.

Design Case-control, cross-sectional study.

Setting General community and hospital and community psychiatric clinics.

Participants Volunteer sample of 37 women with PTSD related to intimate partner violence and 34 age-comparable healthy control women.

Main Outcome Measures We used functional magnetic resonance imaging (fMRI) to examine neural responses during anticipation of negative and positive emotional images. The Clinician-Administered PTSD Scale was used to characterize PTSD symptom severity. The Wechsler Adult Intelligence Scale, Third Edition, Digit Symbol Test, Delis-Kaplan Executive Function System Color-Word Interference Test, and Wisconsin Card Sorting Test were used to characterize neuropsychological performance.

Results Women with PTSD performed worse on complex visuomotor processing speed (Digit Symbol Test) and executive function (Color-Word Interference Inhibition/Switching subtest) measures compared with control subjects. Posttraumatic stress disorder was associated with greater anterior insula and attenuated lateral prefrontal cortex (PFC) activation during emotional anticipation. Greater dorsolateral PFC activation (anticipation of negative images minus anticipation of positive images) was associated with lower PTSD symptom severity and better visuomotor processing speed and executive functioning. Greater medial PFC and amygdala activation related to slower visuomotor processing speed.

Conclusions During emotional anticipation, women with PTSD show exaggerated activation in the anterior insula, a region important for monitoring internal bodily state. Greater dorsolateral PFC response in PTSD patients during emotional anticipation may reflect engagement of cognitive control networks that are beneficial for emotional and cognitive functioning. Novel treatments could be aimed at strengthening the balance between cognitive control (dorsolateral PFC) and affective processing (medial PFC and amygdala) networks to improve overall functioning for PTSD patients.

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Innovations in Practice: Preliminary evidence for effective family engagement in treatment for child traumatic stress–trauma systems therapy approach to preventing dropout

Innovations in Practice: Preliminary evidence for effective family engagement in treatment for child traumatic stress–trauma systems therapy approach to preventing dropout, Child and Adolescent Mental Health, 2012, 17 (1) pp. 58–61

Saxe, G. N., Heidi Ellis, B., Fogler, J. and Navalta, C. P.

Abstract:

Background:  This study aimed to obtain preliminary evidence for the extent to which a novel intervention embedded within a systems-oriented treatment model [trauma systems therapy (TST)] engages and retains traumatized children and their families in treatment.

Method:  Twenty youth who had prominent symptoms of posttraumatic stress were randomly assigned to receive TST or care as usual (CAU).

Results:  At the 3-month assessment, 90% of TST participants were still in treatment, whereas only 10% of CAU participants remained. Within-group analyses of TST participants demonstrated significant reductions in posttraumatic stress and aggression as well as a slight improvement in home safety.

Conclusions:  These preliminary findings point to the need to utilize effective engagement approaches to retain traumatized children and their families in treatment.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Veterans – Combat stressors and post-traumatic stress in deployed military healthcare professionals: an integrative review

Combat stressors and post-traumatic stress in deployed military healthcare professionals: an integrative review , Journal of Advanced Nursing, 2012, 68(1), pp. 3–21

Susanne W. Gibbons et al.

Abstract:

 

Background.  While there has been a growing body of literature on the impact of combat stressors and post-traumatic stress on military service members involved in current conflicts, there has been little available information that directly examines the impact of these on healthcare providers.

 

Aims.  Aims for this integrative review included: (1) identifying exposures, experiences and other factors influencing stress responses in military healthcare providers previously engaged in a war effort and (2) describing the incidence of post-traumatic stress and related mental health problems in this population.

 

Review Methods.  Using Cooper’s integrative review method, relevant documents were collected and analysed using content categories and a coding scheme to assist with identifying and recording data for units of analysis.

 

Data Sources.  Literature searches (including all years to present) were conducted using keywords for stress reaction, for healthcare provider and for military war effort involvement. Literature was obtained using the Cumulative Index to Nursing and Allied Health Literature, the National Library of Medicine and the American Psychological Association databases.

 

Results.  Evidence suggests that similar to military combatants, military healthcare provider exposure to life-threatening situations will increase the probability of adverse psychological disorders following these traumatic experiences. The presence of a strong sense of meaning and purpose, within a supportive environment appear to help mediate the impact of these dangerous and stressful events.

 

Conclusion.  Results of this review and other supporting literature indicate the need for a systematic approach to studying combat stress and post-traumatic stress in deployed healthcare providers.

 

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Veterans – The stigma of mental health problems and other barriers to care in the UK Armed Forces

The stigma of mental health problems and other barriers to care in the UK Armed Forces, BMC Health Services Research, 2011, 11:31, pp. 1-10

Iversen AC, van Staden L, Hughes JH, Greenberg N, Hotopf M, Rona RJ, Thornicroft G, Wessely S, Fear

King’s Centre for Military Health Research, King’s College London, Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK

Abstract:

BACKGROUND:

As with the general population, a proportion of military personnel with mental health problems do not seek help. As the military is a profession at high risk of occupational psychiatric injury, understanding barriers to help-seeking is a priority.

METHOD:

Participants were drawn from a large UK military health study. Participants undertook a telephone interview including the Patient Health Questionnaire (PHQ); a short measure of PTSD (Primary Care PTSD, PC-PTSD); a series of questions about service utilisation; and barriers to care. The response rate was 76% (821 participants).

RESULTS:

The most common barriers to care reported are those relating to the anticipated public stigma associated with consulting for a mental health problem. In addition, participants reported barriers in the practicalities of consulting such as scheduling an appointment and having time off for treatment. Barriers to care did not appear to be diminished after people leave the Armed Forces. Veterans report additional barriers to care of not knowing where to find help and a concern that their employer would blame them for their problems. Those with mental health problems, such as PTSD, report significantly more barriers to care than those who do not have a diagnosis of a mental disorder.

CONCLUSIONS:

Despite recent efforts to de-stigmatise mental disorders in the military, anticipated stigma and practical barriers to consulting stand in the way of access to care for some Service personnel. Further interventions to reduce stigma and ensuring that Service personnel have access to high quality confidential assessment and treatment remain priorities for the UK Armed Forces.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Veterans – Stigma, help-seeking attitudes, and use of psychotherapy in veterans with diagnoses of posttraumatic stress disorder

Stigma, help-seeking attitudes, and use of psychotherapy in veterans with diagnoses of posttraumatic stress disorder, Journal of Nervous and Mental Disorder, 2011, 199(11)pp. 879-85

Rosen CS, Greenbaum MA, Fitt JE, Laffaye C, Norris VA, Kimerling R

National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, CA 94025, USA

Abstract:

 

Survey and medical record data from 482 Veterans Affairs (VA) patients who recently received diagnoses of posttraumatic stress disorder (PTSD) were examined to determine need and predisposing factors associated with utilization of psychotherapy and counseling. More than half (58%) of participants initiated VA psychotherapy for PTSD within a year of diagnosis. Of those, one third completed eight or more sessions. Roughly two thirds of participants initiated counseling at a Vet Center. Initiating PTSD psychotherapy was associated with greater impairment but not with stigma, concerns about fitting in, or satisfaction with care. The use of Vet Center counseling was associated with desire for help, concerns about fitting in, and satisfaction with care. Unexpectedly, veterans with greater stigma concerns completed more psychotherapy visits and Vet Center counseling. Negative attitudes about mental health treatment did not seem to be substantial barriers to engaging in psychotherapy among these VA patients. Future research should consider enabling treatment system factors in addition to predisposing patient characteristics.

 

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

 

Unique Patterns of Substance Misuse Associated With PTSD, Depression, and Social Phobia

Unique Patterns of Substance Misuse Associated With PTSD, Depression, and Social Phobia,  Journal of Dual Diagnosis, Volume 6, Issue 2, 2010, pgs 94-110

Meghan E. McDevitt-Murphy

Most Read Article

Abstract:

 

This study investigated the relations between post-trauma psychopathology and substance abuse in a sample of trauma-exposed college students (N = 136) assigned to four groups based on primary diagnosis: post-traumatic stress disorder (PTSD), depression, social phobia, or well-adjusted (participants who had low levels of distress). Groups were compared on a series of dimensions of substance use/abuse. Participants in the PTSD group evidenced greater substance use and abuse than those in the social phobia and well-adjusted groups on several dimensions and greater alcohol consumption than the depressed group. Correlation analyses suggested that most dimensions of substance abuse were related more strongly to avoidance and numbing (cluster C) symptoms than to re-experiencing and hyperarousal. The present findings suggest that trauma-related psychopathology may be associated with a more hazardous pattern of substance use than depression and social phobia.

 

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Veterans – An Evolving Integrative Treatment Program for Military Sexual Trauma (MST) and One Veteran’s Experience.

An Evolving Integrative Treatment Program for Military Sexual Trauma (MST) and One Veteran’s Experience, Issues in Mental Health Nursing, 2011 Sep; 32 (9): 552-9

Ferdinand, Lisa G et al.

Abstract:

Military sexual trauma (MST) increases the risk for Posttraumatic Stress Disorder (PTSD) and multiple other comorbidities, presenting substantial challenges for nurses and psychiatric and medical clinicians. A specialized VA Medical Center outpatient program is patterned after Herman’s three-phased, empirically-supported, recovery treatments. We use a case example of a female veteran MST survivor to illustrate our treatment model. She presented to our program meeting diagnostic criteria for PTSD, Major Depressive Disorder, and a history of substance abuse. Post-treatment she demonstrated improved scores on measures of PTSD, quality of life, and socialization. This model shows promise for treatment of MST survivors with PTSD.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Trauma and post-traumatic stress disorder in a drug treatment community service

Trauma and post-traumatic stress disorder in a drug treatment community service, The Psychiatrist, July 2011 35:pp. 256-260

 

Martina Reynolds, Kate Hinchliffe, Victor Asamoah, and Christos Kouimtsidis

 

Abstract:

 

Aims and method A cross-sectional study aiming to assess the prevalence of trauma and post-traumatic stress disorder (PTSD) in a community substitution treatment sample, and to assess and compare the characteristics of traumatic experience, substance use, and psychological and social factors in those with and without PTSD. All assessments were completed during the interview which took approximately 1.5 h.

 

Results The prevalence for current PTSD was 26.2% and for lifetime PTSD 42.9%. Traumatic experiences were extremely common, with two or more reported by 92.9% of the sample. The two groups differed significantly on the majority of psychological functioning and social variables, with women experiencing higher rates of PTSD and the non-PTSD group having lower rates of psychological impairment.

 

Clinical implications The research supported findings from previous studies. The very high incidence of traumatic experiences has not been reported before. Training and information about trauma and PTSD for substance misuse workers are therefore necessary so that PTSD can be more easily detected and treated.

 

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Methodology of a randomized double-blind clinical trial for comorbid posttraumatic stress disorder and alcohol dependence

Methodology of a randomized double-blind clinical trial for comorbid posttraumatic stress disorder and alcohol dependence, Mental Health and Substance Use, 2010,Vol.3 (2) pp.131-147

Edna B. Foa; Monnica T. Williams

Abstract:

Alcohol dependence (AD) and posttraumatic stress disorder (PTSD) are each associated with profound disruptions in psychological, social, and physical functioning, and these disruptions are compounded in individuals with both disorders. Comorbidity between the two disorders is high, with the risk for AD increasing substantially among individuals with PTSD and, conversely, PTSD is highly prevalent among people experiencing AD.

Given the increased impairment associated with this comorbidity, it is imperative to develop effective treatments for individuals who experience both disorders.

This paper describes the methodology of a study that examines the efficacy of prolonged exposure therapy alone, naltrexone alone, and their combination compared to pill placebo in reducing the severity of PTSD and alcohol use in individuals with comorbid AD and PTSD.

Issues related to design, assessment, treatment choice, and challenges posed by the study population are discussed.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Intensive Cognitive Therapy for PTSD: A Feasibility Study

Intensive Cognitive Therapy for PTSD: A Feasibility Study, Behavioural and Cognitive Psychotherapy (2010), 38: 383-398

Anke Ehlers, David M. Clark, Ann Hackmann, Nick Grey, Sheena Liness, Jennifer Wild, John Manley, Louise Waddington and Freda McManus

NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Trust and King’s College London, UK

Abstract:

Background: Cognitive Behaviour Therapy (CBT) of anxiety disorders is usually delivered in weekly or biweekly sessions. There is evidence that intensive CBT can be effective in phobias and obsessive compulsive disorder. Studies of intensive CBT for posttraumatic stress disorder (PTSD) are lacking. Method: A feasibility study tested the acceptability and efficacy of an intensive version of Cognitive Therapy for PTSD (CT-PTSD) in 14 patients drawn from consecutive referrals. Patients received up to 18 hours of therapy over a period of 5 to 7 working days, followed by 1 session a week later and up to 3 follow-up sessions. Results: Intensive CT-PTSD was well tolerated and 85.7 % of patients no longer had PTSD at the end of treatment. Patients treated with intensive CT-PTSD achieved similar overall outcomes as a comparable group of patients treated with weekly CT-PTSD in an earlier study, but the intensive treatment improved PTSD symptoms over a shorter period of time and led to greater reductions in depression. Conclusions: The results suggest that intensive CT-PTSD is a feasible and promising alternative to weekly treatment that warrants further evaluation in randomized trials.

Lancashire care staff can request the a copy of this paper, email: susan.jennings@lancashirecare.nhs.uk

Impact of Traumatic and Violent Victimization Experiences in Individuals With Schizophrenia and Schizoaffective Disorder

Impact of Traumatic and Violent Victimization Experiences in Individuals With Schizophrenia and Schizoaffective Disorder, Journal of Nervous & Mental Disease. 198(10):708-714, October 2010

Newman, Jennifer M.; Turnbull, Ayme; Berman, Brady A.; Rodrigues, Stephanie; Serper, Mark R.

Abstract:

Individuals with schizophrenia or schizoaffective disorder (SZ) experience more violent victimization and noninterpersonal traumatic experiences than the general population. Earlier studies, however, have generally excluded one or grouped together victimization and trauma experiences into single outcome variables, which may obscure their contributory role to SZ symptoms. This issue is important because there is some evidence that intentionally induced violence produces higher rates of psychopathology than nonintentional traumatic experiences. We examined the independent contribution of both types of victimization experiences on SZ patients’ symptomatology. We were also interested in determining whether SZ patients’ pattern of acute symptom presentation could discriminate between SZ patients with and without posttraumatic stress disorder (PTSD) comorbidity. SZ inpatients (n = 70) were assessed for the presence of comorbid PTSD diagnosis, violent victimization, and noninterpersonal traumatic experiences. Patients were also rated on SZ symptom severity and general psychopathology measures. Past violent victimization experiences predicted severity of dysphoria and anxiety in SZ. Past traumatic experiences, however, predicted severity of psychosis. Victimization predicted severity of patients’ autistic/cognitive symptoms. SZ patients with comorbid PTSD presented with significantly more anxiety and dysphoria symptoms and SZ illness chronicity than their non-PTSD counterparts. Discriminant function analysis revealed that the severity of positive, dysphoric, autistic/cognitive, and anxiety symptoms differentiated comorbid PTSD patients from their non-PTSD counterparts, with an overall 72.9% classification rate. Past traumatic and victimization experiences are significantly associated with SZ patients’ symptom severity and illness course in partially overlapping domains. Use of common assessment strategies may be employed to increase detection of PTSD in SZ patients presenting for acute treatment.

 

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Traumatic Events, Posttraumatic Stress Disorder, Attachment Style, and Working Alliance in a Sample of People With Psychosis

Traumatic Events, Posttraumatic Stress Disorder, Attachment Style, and Working Alliance in a Sample of People With Psychosis, Journal of Nervous & Mental Disease. 198(10):775-778, October 2010

Picken, Alicia L.; Berry, Katherine; Tarrier, Nicholas; Barrowclough, Christine

Abstract:

There is a high incidence of trauma and posttraumatic stress disorder (PTSD) in people with a diagnosis of psychosis. Sequelae of trauma may affect the ability to engage in both attachment and therapeutic relationships. This study investigated associations between trauma histories, PTSD, attachment styles, and working alliance in a sample of 110 individuals with psychosis and substance misuse. Anxious attachment was associated with number of interpersonal traumas and PTSD reported, but there were no associations between trauma and alliance. There were discrepancies in number of traumatic events reported by care coordinators and patients. The findings of this study highlight the potential use of attachment theory in working with trauma and PTSD in psychosis.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Cochrane – Combined pharmacotherapy and psychological therapies for post traumatic stress disorder

Combined pharmacotherapy and psychological therapies for post traumatic stress disorder, 7th July 2010, Cochrane Review

Hetrick Sarah E,Purcell Rosemary,Garner Belinda,Parslow Ruth

Click on the title above to access the full-text of this Cochrane

Abstract:

Background

PTSD is an anxiety disorder related to exposure to a severe psychological trauma. Symptoms include re-experiencing the event, avoidance and arousal as well as distress and impairment resulting from these symptoms.

Guidelines suggest a combination of both psychological therapy and pharmacotherapy may enhance treatment response, especially in those with more severe PTSD or in those who have not responded to either intervention alone.

Objectives

To assess whether the combination of psychological therapy and pharmacotherapy provides a more efficacious treatment for PTSD than either of these interventions delivered separately.

Search strategy

Searches were conducted on the trial registers kept by the CCDAN group (CCDANCTR-Studies and CCDANCTR-References) to June 2010. The reference sections of included studies and several conference abstracts were also scanned.

Selection criteria

Patients of any age or gender, with chronic or recent onset PTSD arising from any type of event relevant to the diagnostic criteria were included. A combination of any psychological therapy and pharmacotherapy was included and compared to wait list, placebo, standard treatment or either intervention alone. The primary outcome was change in total PTSD symptom severity. Other outcomes included changes in functioning, depression and anxiety symptoms, suicide attempts, substance use, withdrawal and cost.

Data collection and analysis

Two or three review authors independently selected trials, assessed their ‘risk of bias’ and extracted trial and outcome data. We used a fixed-effect model for meta-analysis. The relative risk was used to summarise dichotomous outcomes and the mean difference and standardised mean difference were used to summarise continuous measures.

Main results

Four trials were eligible for inclusion, one of these trials (n =24) was on children and adolescents. All used an SSRI and prolonged exposure or a cognitive behavioural intervention. Two trials compared combination treatment with pharmacological treatment and two compared combination treatment with psychological treatment. Only two trials reported a total PTSD symptom score and these data could not be combined. There was no strong evidence to show if there were differences between the group receiving combined interventions compared to the group receiving psychological therapy (mean difference 2.44, 95% CI -2.87, 7.35 one study, n=65) or pharmacotherapy (mean difference -4.70, 95% CI -10.84 to 1.44; one study, n = 25). Trialists reported no significant differences between combination and single intervention groups in the other two studies. There were very little data reported for other outcomes, and in no case were significant differences reported.

Authors’ conclusions

There is not enough evidence available to support or refute the effectiveness of combined psychological therapy and pharmacotherapy compared to either of these interventions alone. Further large randomised controlled trials are urgently required.

Lancashire Care staff can either click on the full-text link above or email: susan.jennings@lancashirecare.nhs.uk

Behavioral Activation for Treatment of PTSD and Depression in an Iraqi Combat Veteran with Multiple Physical Injuries

Behavioral Activation for Treatment of PTSD and Depression in an Iraqi Combat Veteran with Multiple Physical Injuries, Behavioural and Cognitive Psychotherapy, Volume 38, Issue 03, May 2010, pp 355-361ie

Brief Clinical Report

Aaron P. Turner and Matthew Jakupcak

Abstract:

Background: Physical injury and psychological trauma associated with combat in the wars in Iraq and Afghanistan frequently lead to a constellation of symptoms including pain, post traumatic stress disorder (PTSD), and depression. Method: This single case study describes the application of a behaviorally-based psychotherapy known as behavioral activation for the treatment of post traumatic stress disorder (PTSD) and depressive symptoms in a recent combat veteran with multiple physical injuries sustained from a blast injury. Treatment was provided concurrently with other rehabilitation services and consisted of weekly individual sessions for 4 months, followed by monthly sessions for 4 months. Results: Clinically significant reductions in PTSD and depressive symptoms were noted between baseline and 1 year follow-up. Conclusion: Preliminary evidence from this case suggests that behavioral activation may be a promising treatment for PTSD and depression, and can be readily tailored to individuals with physical limitations such as pain and mobility restriction. Treatment can be provided in the context of concurrent interdisciplinary medical and rehabilitation care.

Lancashire Care staff can request the full-text of this paper,email: susan.jennings@lancashirecare.nhs.uk

CBT for Chronic Nightmares in Trauma-Exposed Persons

Cognitive-behavioral treatment for chronic nightmares in trauma-exposed persons: assessing physiological reactions to nightmare-related fear , Journal of Clinical Psychology, 2010, Volume 66 Issue 4, Pages 365 – 382

Jamie L. Rhudy et al.

Abstract:

Cognitive-behavioral treatments (CBTs) that target nightmares are efficacious for ameliorating self-reported sleep problems and psychological distress. However, it is important to determine whether these treatments influence objective markers of nightmare-related fear, because fear and concomitant physiological responses could promote nightmare chronicity and sleep disturbance. This randomized, controlled study (N=40) assessed physiological (skin conductance, heart rate, facial electromyogram) and subjective (displeasure, fear, anger, sadness, arousal) reactions to personally relevant nightmare imagery intended to evoke nightmare-related fear. Physiological assessments were conducted at pretreatment as well as 1-week, 3-months, and 6-months posttreatment. Results of mixed effects analysis of variance models suggested treatment reduced physiological and subjective reactions to nightmare imagery, gains that were generally maintained at the 6-month follow-up. Potential implications are discussed.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Art Therapy & CBI – Trauma and acute stress disorder: A comparison between cognitive behavioral intervention and art therapy

Trauma and acute stress disorder: A comparison between cognitive behavioral intervention and art therapy, The Arts in Psychotherapy, Volume 37, Issue 1,  February 2010, Pages 8-12

Orly Sarid, Ephrat Huss

Abstract:

The aim of this paper is to initiate a comparative and theoretical study between the mechanisms of cognitive behavioral intervention (CBI) versus art therapy, in relation to the acute stress disorder (ASD) stage of trauma. The literature on CBI, art therapy, and ASD will be briefly reviewed. Similarities between these two theoretically disparate interventions will be outlined, pointing to the relevance of CBI and art therapy to alter maladaptive and traumatic sensory processing, affect excitatory reactions, modulate and challenge explicit traumatic memories and stimulate a subsequent cognitive process. Implications for mental health professionals intervening in the relatively flexible ASD period are discussed.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

The impact of dissociation and depression on the efficacy of prolonged exposure treatment for PTSD

The impact of dissociation and depression on the efficacy of prolonged exposure treatment for PTSD,  Behaviour Research and Therapy, Volume 48, Issue 1, January 2010, Pages 19-27

Muriel A. Hagenaars, Agnes van Minnen, Kees A.L. Hoogduin

Abstract:

This study investigates the impact of dissociative phenomena and depression on the efficacy of prolonged exposure treatment in 71 patients with posttraumatic stress disorder (PTSD). Diagnoses, comorbidity, pretreatment depressive symptoms, PTSD symptom severity, and dissociative phenomena (trait dissociation, numbing, and depersonalization) were assessed at pretreatment using semi-structured interviews and questionnaires. In a pretreatment behavioral exposure test, patients were imaginally exposed to (part of) their trauma memory for 9 min, during which subjective fear was assessed. At posttreatment and 6 months follow-up PTSD, depressive and dissociative symptoms were again assessed in the completers (n = 60). Pretreatment levels of dissociative and depressive symptoms were similar in dropouts and completers and none of the dissociative phenomena nor depression predicted improvement. Against expectations, dissociative phenomena and depression were associated with enhanced rather than impeded fear activation during the behavioral exposure test. However, these effects disappeared after controlling for initial PTSD severity. Hence, rather than supporting contraindication, the current results imply that patients presenting with even severe dissociative or depressive symptoms may profit similarly from exposure treatment as do patients with minimal dissociative or depressive symptoms.

 

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Combat Stress – is the leading charity specialising in the care of British Veterans who have been profoundly traumatised by harrowing experiences during their Service career

Combat Stress   New Website, Partnership between the NHS and Combat Stress

Click on the title above to access the website

Combat Stress is the leading charity specialising in the care of British Veterans who have been profoundly traumatised by harrowing experiences during their Service career.

Many Veterans leave the Armed Forces with highly debilitating conditions such as Post Traumatic Stress Disorder (PTSD), depression and anxiety disorders. Their problems can remain masked for years, and they and their families may be struggling to deal with matters at home. Combat Stress is able to provide two integrated services to meet Veterans’ needs:

  • Dedicated, short-stay clinical treatment
  • Community outreach

Last year alone, we received 1,257 new referrals – bringing the number of ex-Service men and women in our care to approximately 4,200.   

We look after Veterans of every campaign that British Forces have been involved in since the Second World War.  This includes over 300 of recent operations in Iraq and Afghanistan. 

Empirically supported psychological treatments for adult acute stress disorder and posttraumatic stress disorder: a review

Empirically supported psychological treatments for adult acute stress disorder and posttraumatic stress disorder: a review, Depression and Anxiety, Volume 26, Issue 12, Date: December 2009, Pages: 1086-1109

Kathryn Ponniah, Steven D. Hollon

Abstract:

Background: Acute stress disorder (ASD) predicts the development of posttraumatic stress disorder (PTSD), which in some sufferers can persist for years and lead to significant disability. We carried out a review of randomized controlled trials to give an update on which psychological treatments are empirically supported for these disorders, and used the criteria set out by Chambless and Hollon [1998: J Consult Clin Psychol 66:7-18] to draw conclusions about efficacy, first irrespective of trauma type and second with regard to particular populations. Methods: The PsycINFO and PubMed databases were searched electronically to identify suitable articles published up to the end of 2008. Fifty-seven studies satisfied our inclusion criteria. Results: Looking at the literature undifferentiated by trauma type, there was evidence that trauma-focused cognitive behavioral therapy (CBT) and eye movement desensitization and reprocessing (EMDR) are efficacious and specific for PTSD, stress inoculation training, hypnotherapy, interpersonal psychotherapy, and psychodynamic therapy are possibly efficacious for PTSD and trauma-focused CBT is possibly efficacious for ASD. Not one of these treatments has been tested with the full range of trauma groups, though there is evidence that trauma-focused CBT is established in efficacy for assault- and road traffic accident-related PTSD. Conclusions: Trauma-focused CBT and to a lesser extent EMDR (due to fewer studies having been conducted and many having had a mixed trauma sample) are the psychological treatments of choice for PTSD, but further research of these and other therapies with different populations is needed.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Treatment of PTSD using Writing Therapy

Treatment of adult post-traumatic stress disorder using a future-oriented writing therapy approach, The Cognitive Behaviour Therapist, 2009

Reginald D. V. Nixona1 c1 and Leonard W. Klinga1

School of Psychology, Flinders University, Adelaide, SA, Australia


Abstract:

The aim of this pilot study was to test whether a future-oriented expressive writing intervention is able to reduce post-traumatic stress disorder (PTSD) severity and associated symptoms such as depression and unhelpful trauma-related beliefs. In an uncontrolled pre-/ post-design participants attended 8 weeks of manualized therapy. Assessment was undertaken pre- and post-treatment, and participants also completed a 3-month follow-up assessment. Of the 17 participants who began therapy, 13 were treatment completers. Results indicated a significant decrease in PTSD severity, depression and unhelpful trauma-related cognitions from pre- to post-treatment and at 3-month follow-up. Clinically meaningful change was more modest; however, three participants reported PTSD remission at 3-month follow-up. It is concluded that expressive writing with a focus on achieving future goals and personal change may have some utility in reducing post-traumatic stress but future research will need to investigate this with greater methodological rigour before firm conclusions can be made.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

 

Mindfulness-based acceptance and posttraumatic stress symptoms among trauma-exposed adults without axis I psychopathology

Mindfulness-based acceptance and posttraumatic stress symptoms among trauma-exposed adults without axis I psychopathology, Journal of Anxiety Disorders, Volume 23, Issue 2, March 2009, Pages 297-303

Anka A. Vujanovic et al…

Abstract:

The present investigation examined the incremental predictive validity of mindfulness-based processes, indexed by the Kentucky Inventory of Mindfulness Skills, in relation to posttraumatic stress symptom severity among individuals without any axis I psychopathology. Participants included 239 adults who endorsed exposure to traumatic life events. Results indicated that the Accepting without Judgment subscale was significantly incrementally associated with posttraumatic stress symptoms; effects were above and beyond the variance accounted for by negative affectivity and number of trauma types experienced. The Acting with Awareness subscale was incrementally associated with only posttraumatic stress-relevant re-experiencing symptoms; and no other mindfulness factors were related to the dependent measures. Findings are discussed in relation to extant empirical and theoretical work relevant to mindfulness and posttraumatic stress.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Comorbid Panic Attacks among Individuals with PTSD: Associations with Traumatic Event Exposure History, Symptoms, and Impairment

Comorbid Panic Attacks among Individuals with Posttraumatic Stress Disorder: Associations with Traumatic Event Exposure History, Symptoms, and Impairment, Journal of Anxiety Disorders, 2009

Jesse R. Cougle et al..

Abstract:

Little is known about the prevalence of panic attacks in PTSD and their influence on symptom severity and disability. Utilizing the National Comorbidity Survey-Replication data, respondents meeting DSM-IV criteria for past year PTSD (n = 203) with and without comorbid panic attacks were compared across various dimensions. Past year panic attacks were found among 35% of the sample and were associated with greater PTSD-related disability and less time spent at work. Panic attacks were also associated with greater prevalence of comorbid depression, substance abuse/dependence, medically unexplained chronic pain, number of anxiety disorders and lifetime traumatic events, PTSD reexperiencing and avoidance/numbing symptoms, and treatment-seeking related to traumatic stress reactions. Multivariate analyses revealed that panic attacks were one of the only unique predictors of severe PTSD-related disability. Overall, findings suggest that panic attacks are common among individuals with PTSD; therapeutic strategies targeting panic in this population may be of significant benefit.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Multisite Randomized Trial of Behavioral Interventions for Women With Co-Occurring PTSD and Substance Use Disorders.

Multisite Randomized Trial of Behavioral Interventions for Women With Co-Occurring PTSD and Substance Use Disorders. Journal of Consulting & Clinical Psychology. 77(4):607-619, August 2009

Hien, Denise et al..

Abstract:

The authors compared the effectiveness of the Seeking Safety group, cognitive-behavioral treatment for substance use disorder and posttraumatic stress disorder (PTSD), to an active comparison health education group (Women’s Health Education [WHE]) within the National Institute on Drug Abuse’s Clinical Trials Network. The authors randomized 353 women to receive 12 sessions of Seeking Safety (M = 6.2 sessions) or WHE (M = 6.0 sessions) with follow-up assessment 1 week and 3, 6, and 12 months posttreatment. Primary outcomes were the Clinician Administered PTSD Scale (CAPS), the PTSD Symptom Scale-Self Report (PSS-SR), and a substance use inventory (self-reported abstinence and percentage of days of use over 7 days). Intention-to-treat analysis showed large, clinically significant reductions in CAPS and PSS-SR symptoms (d = 1.94 and 1.12, respectively) but no reliable difference between conditions. Substance use outcomes were not significantly different over time between the two treatments and at follow-up showed no significant change from baseline. Study results do not favor Seeking Safety over WHE as an adjunct to substance use disorder treatment for women with PTSD and reflect considerable opportunity to improve clinical outcomes in community-based treatments for these co-occurring conditions.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

The relationship between childhood trauma history and the psychotic subtype of major depression

The relationship between childhood trauma history and the psychotic subtype of major depression , Acta Psychiatrica Scandinavica, 2009

B. A. Gaudiano 1,2 , M. Zimmerman

 Abstract:

Objective: Increasing evidence exists linking childhood trauma and primary psychotic disorders, but there is little research on patients with primary affective disorders with psychotic features.

Method: The sample consisted of adult out-patients diagnosed with major depressive disorder (MDD) at clinic intake using a structured clinical interview. Patients with MDD with (n = 32) vs. without psychotic features (n = 591) were compared as to their rates of different types of childhood trauma.

Results: Psychotic MDD patients were significantly more likely to report histories of physical (OR = 2.81) or sexual abuse (OR = 2.75) compared with non-psychotic MDD patients. These relationships remained after controlling for baseline differences. Within the subsample with comorbid post-traumatic stress disorder, patients with psychotic MDD were significantly more likely to report childhood physical abuse (OR = 3.20).

Conclusion: Results support and extend previous research by demonstrating that the relationship between childhood trauma and psychosis is found across diagnostic groups.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Emerging treatments for PTSD

Emerging treatments for PTSD, Clinical Psychology Review, 2009

Judith Cukor et al ..

Abstract:

Recent innovations in posttraumatic stress disorder (PTSD) research have identified new treatments with significant potential, as well as novel enhancements to empirically-validated treatments. This paper reviews emerging psychotherapeutic and pharmacologic interventions for the treatment of PTSD. It examines the evidence for a range of interventions, from social and family-based treatments to technological-based treatments. It describes recent findings regarding novel pharmacologic approaches including propranolol, ketamine, prazosin, and methylenedioxymethamphetamine. Special emphasis is given to the description of virtual reality and D-Cycloserine as enhancements to prolonged exposure therapy.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Reconciling the differences between the King et al. (1998) and Simms et al. (2002) factor models of PTSD

Reconciling the differences between the King et al. (1998) and Simms et al. (2002) factor models of PTSD,  Journal of Anxiety Disorders, Volume 23, Issue 7, October 2009, Pages 995-1001

Mark Shevlin,    McBride, , , Cherie Armour and Gary Adamson

aSchool of Psychology, University of Ulster Magee Campus, Northland Road, Co. Londonderry, BT48 7JL, Northern Ireland

 

Abstract:

Much of the debate surrounding the dimensionality of PTSD relates to three specific Hyperarousal symptoms (D1–D3) and whether they are appropriate indicators of one of two broad constructs that constitute PTSD: Dysphoria or Hyperarousal. This study addressed this issue by testing a series of confirmatory factor models to determine which factor, or factors, these symptoms measured the strongest. Data from individuals who satisfied the conditions for Criterion A of the diagnostic criteria for a DSM-IV diagnosis of PTSD (n = 12,467) in the 2004–2005 NESARC were used in the analysis. The results revealed that the D1–D3 symptoms were not clear indicators of either factor, but measured both Dysphoria and Hyperarousal. Two symptoms, however, loaded more highly on the Dysphoria, rather than Hyperarousal, factor. The present findings lend support to the factor model proposed by Simms et al. [Simms, L. J., Watson, D., & Doebbeling, B. N. (2002). Confirmatory factor analyses of posttraumatic stress symptoms in deployed and non-deployed veterans of the Gulf War. Journal of Abnormal Psychology, 111, 637–647] but also question the use of symptoms that are not unique indicators of specific factors.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Cochrane – Psychological Interventions for the Prevention of PTSD

Multiple session early psychological interventions for the prevention of post-traumatic stress disorder Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD006869

Click on the title above for direct access to the full-text

Neil P Roberts1, Neil J Kitchiner1, Justin Kenardy2, Jonathan Bisson3

1Traumatic Stress Service, Cardiff and Vale NHS Trust, Cardiff, UK. 2Department of Psychology, University of Queensland, Brisbane, Australia. 3Department of Psychological Medicine, Cardiff University, Cardiff, UK

Abstract:

The prevention of long-term psychological distress following traumatic events is a major concern. Systematic reviews have suggested that individual Psychological Debriefing is not an effective intervention at preventing post traumatic stress disorder (PTSD). Recently other forms of intervention have been developed with the aim of preventing PTSD.

Objectives

To examine the efficacy of multiple session early psychological interventions commenced within three months of a traumatic event aimed at preventing PTSD. Single session individual/group psychological interventions were excluded.

Search strategy

Computerised databases were searched systematically, the most recent search was conducted in August 2008. The Journal of Traumatic Stress and the Journal of Consulting and Clinical Psychology were handsearched for the last two years. Personal communication was undertaken with key experts in the field.

Selection criteria

Randomised controlled trials of any multiple session early psychological intervention or treatment (two or more sessions) designed to prevent symptoms of PTSD.

Data collection and analysis

Data were entered using Review Manager software. The methodological quality of included studies was assessed individually by two review authors. Data were analysed for summary effects using Review Manager 4.2. Mean difference was used for meta-analysis of continuous outcomes and relative risk for dichotomous outcomes.

Main results

Eleven studies with a total of 941 participants were found to have evaluated brief psychological interventions aimed at preventing PTSD in individuals exposed to a specific traumatic event, examining a heterogeneous range of interventions. Eight studies were entered into meta-analysis. There was no observable difference between treatment and control conditions on primary outcome measures for these interventions at initial outcome (k=5, n=479; RR 0.84; 95% CI 0.60 to 1.17). There was a trend for increased self-report of PTSD symptoms at 3 to 6 month follow-up in those who received an intervention (k=4, n=292; SMD 0.23; 95% CI 0.00 to 0.46). Two studies compared a memory structuring intervention against supportive listening. There was no evidence supporting the efficacy of this intervention.

Authors’ conclusions

The results suggest that no psychological intervention can be recommended for routine use following traumatic events and that multiple session interventions, like single session interventions, may have an adverse effect on some individuals. The clear practice implication of this is that, at present, multiple session interventions aimed at all individuals exposed to traumatic events should not be used. Further, better designed studies that explore new approaches to early intervention are now required.

 

Any problems for Lancashire Care staff accessing the full-text, contact: susan.jennings@lancashirecare.nhs.uk

Impact of Sleep Disturbances on PTSD Symptoms and Perceived Health

Impact of Sleep Disturbances on PTSD Symptoms and Perceived Health, Journal of Nervous & Mental Disease. 197(2):126-132, February 2009.

Belleville, Genevieve PhD *; Guay, Stephane PhD; Marchand, Andre PhD

Abstract:

More than two-thirds of individuals with PTSD report significant sleep difficulties that correlate positively with PTSD symptom severity. The aim of the study was to assess the impact of sleep disturbances on PTSD symptom severity and perceived health. Ninety-two volunteer treatment-seeking adults with PTSD were administered a Structured Clinical Interview for DSM-IV (SCID; First, Spitzer, Gibbon and William, 1996), and a series of questionnaires assessing PTSD symptom severity, perceived health, sleep, and alcohol use. Results from regression analyses revealed that sleep quality has an impact on PTSD symptom severity and perceived mental health, even when the effect of other potential confounding variables (sociodemographic data, trauma-related characteristics, psychiatric comorbidities, alcohol, and psychotropic medication use) is controlled for. The present study highlights the important influence sleep has on the severity of PTSD symptoms. Future studies could explore whether the addition of interventions focusing on sleep help optimize PTSD treatment.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

PTSD – A therpist assisted internet based CBT intervention

A Therapist-Assisted Internet-Based CBT Intervention for Posttraumatic Stress Disorder: Preliminary Results, Cognitive Behaviour Therapy, Volume 38,  Issue 2 June 2009 , pages 121 – 131

Authors: Britt Klein a;  Joanna Mitchell b;  Kathryn Gilson b;  Kerrie Shandley a;  David Austin a;  Litza Kiropoulos b;  Jo Abbott a; Gwenda Cannard c

Affiliations:   a National eTherapy Centre, Faculty of Life and Social Sciences, Swinburne University, Victoria, Australia
  b Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
  c Reconnexion Inc, Victoria, Australia

Abstract:

Posttraumatic stress disorder (PTSD) is a debilitating mental health condition frequently associated with psychiatric comorbidity and diminished quality of life, and it typically follows a chronic, often lifelong, course. Previous research has shown that trauma-related psychopathology (but not necessarily clinical PTSD) can be effectively treated via the Internet. This study is the first of its kind to report on the online treatment of patients with a Diagnostic and Statistical Manual of Mental Disorders (fourth edition) clinical diagnosis of PTSD with therapist support by e-mail only. Preliminary findings are presented of an open trial involving a 10-week Internet-based therapist-assisted cognitive behavioural treatment for PTSD (PTSD Online). Pre and posttreatment measures of PTSD and related symptomatology were compared for 16 participants with a variety of trauma experiences. Participants showed clinically significant reductions in PTSD severity and symptomatology, moderate tolerance of the program content, and high therapeutic alliance ratings. No significant change was found on measures of more general psychological symptoms. The results suggest that PTSD Online appears to be an effective and accessible clinical treatment for people with a confirmed PTSD diagnosis.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

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