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Foschiera LN, de Freitas CPP, Luft CZ, Godoi AR, Dupont MF, Habigzang LF. Evidence of Effectiveness of a Psychotherapy Protocol for Women with a History of Intimate Partner Violence: Follow-up Study. Trends in Psychol 2022. [PMCID: PMC9294837 DOI: 10.1007/s43076-022-00213-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Laura Nichele Foschiera
- Escola de Ciências da Saúde E da Vida/Programa de Pós-Graduação Em Psicologia, Pontifícia Universidade Católica Do Rio Grande Do Sul, Porto Alegre, Brazil
| | - Clarissa Pinto Pizarro de Freitas
- Departamento de Psicologia/Programa de Pós-Graduação Em Psicologia Clínica, Pontifícia Universidade Católica Do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Caroline Zilli Luft
- Escola de Ciências da Saúde E da Vida/Programa de Pós-Graduação Em Psicologia, Pontifícia Universidade Católica Do Rio Grande Do Sul, Porto Alegre, Brazil
| | - Aline Ruoso Godoi
- Escola de Ciências da Saúde E da Vida/Programa de Pós-Graduação Em Psicologia, Pontifícia Universidade Católica Do Rio Grande Do Sul, Porto Alegre, Brazil
| | - Melina Friedrich Dupont
- Escola de Ciências da Saúde E da Vida/Programa de Pós-Graduação Em Psicologia, Pontifícia Universidade Católica Do Rio Grande Do Sul, Porto Alegre, Brazil
| | - Luísa Fernanda Habigzang
- Escola de Ciências da Saúde E da Vida/Programa de Pós-Graduação Em Psicologia, Pontifícia Universidade Católica Do Rio Grande Do Sul, Porto Alegre, Brazil
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Kratzer L, Knefel M, Haselgruber A, Heinz P, Schennach R, Karatzias T. Co-occurrence of severe PTSD, somatic symptoms and dissociation in a large sample of childhood trauma inpatients: a network analysis. Eur Arch Psychiatry Clin Neurosci 2022; 272:897-908. [PMID: 34635928 PMCID: PMC9279203 DOI: 10.1007/s00406-021-01342-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 10/04/2021] [Indexed: 12/11/2022]
Abstract
Co-occurrence of mental disorders including severe PTSD, somatic symptoms, and dissociation in the aftermath of trauma is common and sometimes associated with poor treatment outcomes. However, the interrelationships between these conditions at symptom level are not well understood. In the present study, we aimed to explore direct connections between PTSD, somatic symptoms, and dissociation to gain a deeper insight into the pathological processes underlying their comorbidity that can inform future treatment plans. In a sample of 655 adult inpatients with a diagnosis of severe PTSD following childhood abuse (85.6% female; mean age = 47.57), we assessed symptoms of PTSD, somatization, and dissociation. We analyzed the comorbidity structure using a partial correlation network with regularization. Mostly positive associations between symptoms characterized the network structure. Muscle or joint pain was among the most central symptoms. Physiological reactivation was central in the full network and together with concentrations problems acted as bridge between symptoms of PTSD and somatic symptoms. Headaches connected somatic symptoms with others and derealization connected dissociative symptoms with others in the network. Exposure to traumatic events has a severe and detrimental effect on mental and physical health and these consequences worsen each other trans-diagnostically on a symptom level. Strong connections between physiological reactivation and pain with other symptoms could inform treatment target prioritization. We recommend a dynamic, modular approach to treatment that should combine evidence-based interventions for PTSD and comorbid conditions which is informed by symptom prominence, readiness to address these symptoms and preference.
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Affiliation(s)
- Leonhard Kratzer
- Department of Psychotraumatology, Clinic St. Irmingard, Prien am Chiemsee, Germany
| | - Matthias Knefel
- Faculty of Psychology, University of Vienna, Wächtergasse 1, 1010, Vienna, Austria.
| | | | - Peter Heinz
- Department of Psychotraumatology, Clinic St. Irmingard, Prien am Chiemsee, Germany
| | - Rebecca Schennach
- Schoen Clinic Roseneck, Prien am Chiemsee, Germany
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Thanos Karatzias
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
- Rivers Centre for Traumatic Stress, NHS Lothian, Edinburgh, UK
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de Silva U, Glover N, Katona C. Prevalence of complex post-traumatic stress disorder in refugees and asylum seekers: systematic review. BJPsych Open 2021; 7:e194. [PMID: 34649634 PMCID: PMC8570104 DOI: 10.1192/bjo.2021.1013] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 07/15/2021] [Accepted: 08/26/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Refugees and asylum seekers often report having experienced numerous complex traumas. It is important to understand the prevalence of complex post-traumatic stress disorder (CPTSD), which can follow complex traumas. AIMS This systematic review aims to summarise the available literature reporting the prevalence in refugees and asylum seekers of three operationalised definitions of CPTSD: the ICD-11 diagnostic criteria, the ICD-10 criteria (for enduring personality change after catastrophic experience) and the DSM-IV criteria (for disorders of extreme stress not otherwise specified). METHOD Six electronic databases were searched for studies reporting the prevalence of CPTSD in adult refugee and/or asylum-seeking samples. Owing to heterogeneity between the studies, a narrative synthesis approach was used to summarise studies. Methodological quality was assessed using the Joanna Briggs Critical Appraisal Checklist for Prevalence Studies. This systematic review has been registered with PROSPERO (registration number CRD42020188422, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=188422). RESULTS Systematic searches identified 15 eligible studies, with 10 examining treatment-seeking samples and five using population samples. CPTSD prevalence in treatment-seeking samples was between 16 and 38%. Prevalence in population samples ranged from 2.2 to 9.3% in four studies, with the fifth reporting a much higher estimate (50.9%). CONCLUSIONS This review highlights both the high prevalence of CPTSD in treatment samples and the lack of research aiming to establish prevalence of CPTSD in refugee and asylum-seeking populations. Understanding the prevalence of these disabling disorders has implications for policy and healthcare services for the appropriate promotion, planning and provision of suitable treatment and interventions for this highly traumatised population.
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Affiliation(s)
| | - Naomi Glover
- Division of Psychiatry, University College London, UK
| | - Cornelius Katona
- Division of Psychiatry, University College London, and Helen Bamber Foundation, UK
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Lewis SJ, Koenen KC, Ambler A, Arseneault L, Caspi A, Fisher HL, Moffitt TE, Danese A. Unravelling the contribution of complex trauma to psychopathology and cognitive deficits: a cohort study. Br J Psychiatry 2021; 219:448-455. [PMID: 34538875 PMCID: PMC7611677 DOI: 10.1192/bjp.2021.57] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Complex traumas are traumatic experiences that involve multiple interpersonal threats during childhood or adolescence, such as repeated abuse. Complex traumas are hypothesized to lead to more severe psychopathology and poorer cognitive function than other non-complex traumas. However, empirical testing of this hypothesis has been limited to clinical/convenience samples and cross-sectional designs. AIMS To investigate psychopathology and cognitive function in young people exposed to complex, non-complex, or no trauma from a population-representative longitudinal cohort, and to consider the role of pre-existing vulnerabilities. METHOD Participants were from the Environmental Risk (E-Risk) Longitudinal Twin Study, a population-representative birth-cohort of 2,232 British children. At age 18 years (93% participation), we assessed lifetime exposure to complex and non-complex trauma, past-year psychopathology, and current cognitive function. We also prospectively assessed early childhood vulnerabilities: internalizing and externalizing symptoms at age 5, IQ at age 5, family history of mental illness, family socioeconomic status, and sex. RESULTS Participants exposed to complex trauma had more severe psychopathology and poorer cognitive function at age 18 compared to both trauma-unexposed participants and those exposed to non-complex trauma. Early childhood vulnerabilities predicted risk of later complex trauma exposure, and largely explained associations of complex trauma with cognitive deficits, but not with psychopathology. CONCLUSIONS By conflating complex and non-complex traumas, current research and clinical practice under-estimate the severity of psychopathology, cognitive deficits, and pre-existing vulnerabilities linked with complex trauma. A better understanding of the mental health needs of people exposed to complex trauma could inform the development of new effective interventions.
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Affiliation(s)
- Stephanie J Lewis
- King’s College London, Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, UK
| | - Karestan C Koenen
- Harvard T.H. Chan School of Public Health, Department of Epidemiology, USA
| | - Antony Ambler
- King’s College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, UK
| | - Louise Arseneault
- King’s College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, UK
| | - Avshalom Caspi
- King’s College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, UK; Duke University, Department of Psychology and Neuroscience, USA; Duke University, Department of Psychiatry and Behavioral Sciences, USA; Duke University, Center for Genomic and Computational Biology, USA
| | - Helen L Fisher
- King’s College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, UK; King’s College London, ESRC Centre for Society & Mental Health, UK
| | - Terrie E Moffitt
- King’s College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, UK; Duke University, Department of Psychology and Neuroscience, USA; Duke University, Department of Psychiatry and Behavioral Sciences, USA; Duke University, Center for Genomic and Computational Biology, USA
| | - Andrea Danese
- King’s College London, Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, UK; King’s College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, UK; South London and Maudsley NHS Foundation Trust, National and Specialist CAMHS Clinic for Trauma, Anxiety, and Depression, UK
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Voith LA, Lee H, Russell KN, Korsch-Williams AE. Understanding How Relational Health Effects Intimate Partner Violence Perpetration among Low-Income, Black, Indigenous, Men of Color Exposed to Adverse Childhood Experiences: An Exploratory Study. Int J Environ Res Public Health 2021; 18:ijerph18083890. [PMID: 33917658 PMCID: PMC8067994 DOI: 10.3390/ijerph18083890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/02/2021] [Accepted: 04/05/2021] [Indexed: 11/25/2022]
Abstract
Relational health has emerged as a consistent factor that can mitigate the effects of trauma among children; however, less is known about relational health with adults, particularly related to intimate partner violence (IPV) perpetration among racially and socioeconomically marginalized men. The Exploratory Sequential Design, Taxonomy Development Model was used. Semi-structured interviews (N = 11) and narrative analysis were conducted in Phase I. In Phase II, variables approximating the key themes that emerged in Phase I were selected from an existing dataset (N = 67), and relationships were examined using bivariate associations. The sample consisted of low-income Black, Indigenous, men of color (BIMOC) in a batterer intervention program (BIP). Adverse life experiences shaped participants’ world view via mistrust in others, stifling emotions and vulnerability, and a sense of personal guilt and shame. These orientations were then carried into adult relationships where men coped using social isolation to manage challenges, negatively affecting intimate relationships. For some men, mental health exacerbated these circumstances. Significant bivariate and multivariate associations supported this narrative. This study lays the foundation for future research to examine the potential effects of social support on IPV perpetration. BIPs should consider augmenting programming to enhance men’s social networks to support their use of nonviolence after program completion.
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Abstract
Background: Patients with PTSD related to childhood-abuse often experience additional problems such as emotional dysregulation and interpersonal difficulties. Psychotherapy focused on stabilization of symptoms, emotion-regulation, and skills training has been suggested as a treatment for this patient population, either as preparation for further treatment or as a stand-alone intervention. Objective: The present study tests the efficacy of treatment using a group-protocol for stabilizing treatment delivered adjunct with conventional individual therapy. Methods: In a delayed-treatment design with switching replication, a clinically representative sample of 89 patients with PTSD and histories of childhood abuse were randomly assigned to either 20-week stabilizing group treatment or a corresponding waiting-period, both adjunct with conventional individual therapy. After the waiting-period, patients in the control condition were offered group treatment. The primary outcome was psychosocial functioning, measured with interview - assessed Global Assessment of Functioning (GAF), while secondary outcome was self-reported PTSD symptoms. These were measured before treatment, after treatment and at 6 months follow up. The trial was preregistered at Clinical Trials (NCT02450617). Results: We found large within-group effect sizes in both conditions on GAF and moderate effects on PTSD symptoms. Linear mixed-models did not indicate significant differences in treatment trajectories between conditions. Conclusion: Stabilizing group treatment focused on emotional-regulation and skills-training does not improve outcomes beyond individual-treatment alone, and should not be recommended as first-line treatment for this patient-group.
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Affiliation(s)
- Harald Bækkelund
- Research Institute, Modum Bad, Vikersund, Norway.,Norwegian Center for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Ida Karlsrud
- Research Institute, Modum Bad, Vikersund, Norway
| | - Asle Hoffart
- Research Institute, Modum Bad, Vikersund, Norway
| | - Espen Ajo Arnevik
- Department of Addiction Treatment, Oslo University Hospital, Oslo, Norway
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Cloitre M, Brewin CR, Bisson JI, Hyland P, Karatzias T, Lueger-Schuster B, Maercker A, Roberts NP, Shevlin M. Evidence for the coherence and integrity of the complex PTSD (CPTSD) diagnosis: response to Achterhof et al., (2019) and Ford (2020). Eur J Psychotraumatol 2020; 11:1739873. [PMID: 32341764 PMCID: PMC7170304 DOI: 10.1080/20008198.2020.1739873] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 02/21/2020] [Accepted: 02/21/2020] [Indexed: 12/14/2022] Open
Abstract
This letter to the editor responds to a recent EJPT editorial and following commentary which express concerns about the validity of the ICD-11 complex PTSD (CPTSD) diagnosis. Achterhof and colleagues caution that latent profile analyses and latent class analyses, which have been frequently used to demonstrate the discriminative validity of the ICD-11 PTSD and CPTSD constructs, have limitations and cannot be relied on to definitively determine the validity of the diagnosis. Ford takes a broader perspective and introduces the concept of 'cPTSD' which describes a wide ranging set of symptoms identified from studies related to DSM-IV, DSM-V and ICD-11 and proposes that the validity of the ICD-11 CPTSD is in question as it does not address the multiple symptoms identified from previous trauma-related disorders. We argue that ICD-11 CPTSD is a theory-driven, empirically supported construct that has internal consistency and conceptual coherence and that it need not explain nor resolve the inconsistencies of past formulations to demonstrate its validity. We do agree with Ford and with Achterhof and colleagues that no one single statistical process can definitively answer the question of whether CPTSD is a valid construct. We reference several studies utilizing many different statistical approaches implemented across several countries, the overwhelming majority of which have supported the validity of ICD-11 as a unique construct. We conclude with our own cautions about ICD-11 CPTSD research to date and identify important next steps.
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Affiliation(s)
- Marylène Cloitre
- National Center for PTSD Dissemination and Training Division, VA Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Psychiatry and Behavioural Sciences, Stanford University, Stanford, CA, USA
| | - Chris R. Brewin
- Clinical Educational & Health Psychology, University College London, London, UK
| | | | - Philip Hyland
- Department of Psychology, Maynooth University, Kildare, Ireland
- Centre for Global Health, Trinity College Dublin, Dublin, Ireland
| | - Thanos Karatzias
- NHS Lothian, Rivers Centre for Traumatic Stress, Edinburgh, UK
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
| | | | - Andreas Maercker
- Division of Psychopathology and Clinical Intervention Zurich, University of Zurich, Switzerland
| | - Neil P. Roberts
- Psychology and Psychological Therapies Directorate, Cardiff & Vale University Health Board, Cardiff, UK
- Division of Psychological Medicine & Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Mark Shevlin
- School of Psychology, Ulster University, Derry, Northern Ireland
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Letica-Crepulja M, Stevanović A, Protuđer M, Grahovac Juretić T, Rebić J, Frančišković T. Complex PTSD among treatment-seeking veterans with PTSD. Eur J Psychotraumatol 2020; 11:1716593. [PMID: 32166005 PMCID: PMC7054953 DOI: 10.1080/20008198.2020.1716593] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 12/27/2019] [Accepted: 12/31/2019] [Indexed: 01/14/2023] Open
Abstract
Background: In the ICD-11 hierarchical classification structure, posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) are separate and distinct but also 'sibling' disorders, meaning that the diagnoses follow from the parent category of traumatic stress disorders. Objective: The aim of this study was to examine the prevalence of CPTSD in treatment-seeking war veterans with PTSD more than 20 years after the exposure to cumulative war-related trauma(s). The second aim was to examine if there was an association between demographic and psychosocial variables and CPTSD or PTSD. Method: A sample of 160 male war veterans with PTSD referred to the outpatient service of the PTSD Referral Centre at the Clinical Hospital Centre (CHC) Rijeka participated in a cross-sectional study. Psychiatric comorbidity was assessed using the Mini-International Neuropsychiatric Interview (MINI) and participants completed validated self-report measures: The Life Events Checklist for DSM-5 (LEC-5), International Trauma Questionnaire (ITQ). Results: In total, 80.63% of the sample met criteria for a probable diagnosis of CPTSD. The study revealed that there was no significant difference in the length of deployment, in the intensity of the PTSD symptoms, types of trauma exposure and pharmacotherapeutic treatment between PTSD and CPTSD group. It was found that veterans with PTSD were more likely to be divorced and to participate in PTSD clubs. On the other hand, veterans with CPTSD were significantly more likely to have higher levels of functional impairment and comorbidity with general anxiety disorder (GAD) compared to the PTSD group. Conclusions: This study supports the proposition that a prolonged trauma of severe interpersonal intensity such as war is related to high rates of CPTSD among treatment-seeking veterans, years after the war. The distinction between PTSD and complex PTSD may help the selection of person-centred treatment interventions that would target specific mental health and functional problems in patients.
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Affiliation(s)
- Marina Letica-Crepulja
- Department for Psychiatry and Psychological Medicine, Faculty of Medicine, University of Rijeka, Rijeka, Croatia.,Department of Psychiatry, Clinical Hospital Center Rijeka, Referral Center for Posttraumatic Stress Disorder of the Ministry of Health of the Republic of Croatia, Rijeka, Croatia
| | - Aleksandra Stevanović
- Department for Psychiatry and Psychological Medicine, Faculty of Medicine, University of Rijeka, Rijeka, Croatia.,Department of Psychiatry, Clinical Hospital Center Rijeka, Referral Center for Posttraumatic Stress Disorder of the Ministry of Health of the Republic of Croatia, Rijeka, Croatia
| | - Marina Protuđer
- Department of Addiction Prevention and Treatment, Teaching Institute of Public Health of Primorsko-Goranska County, Rijeka, Croatia
| | - Tanja Grahovac Juretić
- Department for Psychiatry and Psychological Medicine, Faculty of Medicine, University of Rijeka, Rijeka, Croatia.,Department of Psychiatry, Clinical Hospital Center Rijeka, Referral Center for Posttraumatic Stress Disorder of the Ministry of Health of the Republic of Croatia, Rijeka, Croatia
| | - Jelena Rebić
- Department for Psychiatry and Psychological Medicine, Faculty of Medicine, University of Rijeka, Rijeka, Croatia.,Department of Psychiatry, Clinical Hospital Center Rijeka, Referral Center for Posttraumatic Stress Disorder of the Ministry of Health of the Republic of Croatia, Rijeka, Croatia
| | - Tanja Frančišković
- Department for Psychiatry and Psychological Medicine, Faculty of Medicine, University of Rijeka, Rijeka, Croatia.,Department of Psychiatry, Clinical Hospital Center Rijeka, Referral Center for Posttraumatic Stress Disorder of the Ministry of Health of the Republic of Croatia, Rijeka, Croatia
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Claudino FCDA, Gonçalves L, Schuch FB, Martins HRS, da Rocha NS. The Effects of Individual Psychotherapy in BDNF Levels of Patients With Mental Disorders: A Systematic Review. Front Psychiatry 2020; 11:445. [PMID: 32508690 PMCID: PMC7249851 DOI: 10.3389/fpsyt.2020.00445] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 05/01/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Brain-derived Neurotrophic Factor (BDNF) is considered the main cerebral neurotrophin and is produced in the central neural system and peripherals. Its levels are reduced in patients with several psychiatric disorders, but it is unclear if the response to psychotherapy can alter its concentration. OBJECTIVE To carry out a systematic review evaluating the effects of individual psychotherapy in BDNF levels in patients with mental disorders. METHODS The databases PubMed, EMBASE, PsycArticles, SciELO, Web of Science, and CENTRAL; the last search was performed on October 2019 for trials evaluating the effects of individual psychotherapy in BDNF levels in adults with mental disorders. PROSPERO registration: CRD42018108144. RESULTS Eight of 293 studies were included. A rise in BDNF levels was observed in depressive patients when psychotherapy was combined with medication. Patients with post-traumatic stress disorder (PTSD) who responded to therapy presented a raise in BDNF levels mostly when combined with physical activity. There was a rise in BDNF levels in those who responded to psychotherapy in patients with bulimia, in borderline patients, and in insomniacs. CONCLUSIONS The BDNF seems to present variations after psychotherapy especially in patients with bulimia, PTSD, insomnia, and borderline. These subjects also have symptom reduction. Thereby, BDNF could be a supplemental tool to analyze the success to psychotherapy. BDNF levels in patients with major depression after therapy are still controversial and the short follow-up of most studies is a limiting factor.
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Affiliation(s)
- Felipe Cesar de Almeida Claudino
- Center of Clinical Research and Center of Experiamental Research, Hospital de Clínicas de Porto Alegre (HCPA), Post-Graduation Program in Psychiatry and Behavioral Sciences, Federal University of Rio Grande do SUl (UFRGS), Porto Alegre, Brazil
| | - Leonardo Gonçalves
- Center of Clinical Research and Center of Experiamental Research, Hospital de Clínicas de Porto Alegre (HCPA), Post-Graduation Program in Psychiatry and Behavioral Sciences, Federal University of Rio Grande do SUl (UFRGS), Porto Alegre, Brazil
| | - Felipe Barreto Schuch
- Department of Sports Methods and Techniques, Federal University of Santa Maria (UFSM), Santa Maria, Brazil
| | - Hugo Roberto Sampaio Martins
- Department of Internal Medicine, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Neusa Sica da Rocha
- Center of Clinical Research and Center of Experiamental Research, Hospital de Clínicas de Porto Alegre (HCPA), Post-Graduation Program in Psychiatry and Behavioral Sciences, Federal University of Rio Grande do SUl (UFRGS), Porto Alegre, Brazil
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10
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Swart S, Wildschut M, Draijer N, Langeland W, Hoogendoorn AW, Smit JH. The course of (comorbid) trauma-related, dissociative and personality disorders: two year follow up of the Friesland study cohort. Eur J Psychotraumatol 2020; 11:1750171. [PMID: 32489522 PMCID: PMC7241467 DOI: 10.1080/20008198.2020.1750171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 03/20/2020] [Accepted: 03/23/2020] [Indexed: 11/25/2022] Open
Abstract
Background: There is substantial comorbidity between trauma-related disorders (TRDs), dissociative disorders (DDs) and personality disorders (PDs), especially in patients who report childhood trauma and emotional neglect. However, little is known about the course of these comorbid disorders, despite the fact that this could be of great clinical importance in guiding treatment. Objective: This study describes the two-year course of a cohort of patients with (comorbid) TRDs, DDs and PDs and aims to identify possible predictors of course. Possible gender differences will be described, as well as features of non-respondents. Method: Patients (N = 150) referred to either a trauma treatment program or a PD treatment program were assessed using five structured clinical interviews for diagnosing TRDs, DDs, PDs and trauma histories. Three self-report questionnaires were used to assess general psychopathology, dissociative symptoms and personality pathology in a more dimensional way. Data on demographics and received treatment were obtained using psychiatric records. We described the cohort after a two-year follow-up and used t-tests or chi-square to test possible differences between respondents and non-respondents and between women and men. We used regression analysis to identify possible course predictors. Results: A total of 85 (56.7%) of the original 150 patients participated in the follow-up measurement. Female respondents reported more sexual abuse than female non-respondents. Six patients (4.0%; all women) died because of suicide. Levels of psychopathology significantly declined during the follow-up period, but only among women. Gender was the only significant predictor of change. Conclusions: Comorbidity between TRDs, DDs and PDs was more the rule than the exception, pleading for a more dimensional and integrative view on pathology following childhood trauma and emotional neglect. Courses significantly differed between men and women, advocating more attention to gender in treatment and future research.
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Affiliation(s)
- Sanne Swart
- FACT, GGZ Friesland, Drachten, The Netherlands
| | | | - Nel Draijer
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Willemien Langeland
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Adriaan W Hoogendoorn
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Jan H Smit
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health, Amsterdam, The Netherlands
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Abstract
Background: Justice-involved youth are at risk to become cigarette smokers as they age, leading to a variety of poor health outcomes. However, little is known about cigarette use among justice-involved youth, especially youth supervised in the community where there is ample opportunity to smoke. Objective: This study investigates the prevalence of cigarette smoking and the associations between cigarette smoking, emotional and behavioral functioning, and other substance use among a sample of first-time offending court-involved, non-incarcerated (FTO-CINI) youth. Methods: Youth were recruited from a family court in the Northeast (N = 423). Substance use was self-reported using the Adolescent Risk Behavior Assessment (ARBA). Emotional and behavioral functioning was measured using the Behavior Assessment Schedule for Children-Second Edition (BASC-2), the Affect Dysregulation Scale (ADS), National Stressful Events Survey PTSD Short Scale (NSESSS), and the National Survey of Self-Reported Delinquency (NYS-SRD). Results: About 9.9% of FTO-CINI youth had smoked cigarettes in the past 30 days. Compared with FTO-CINI youth who had not smoked recently, recent smokers endorsed more emotional and behavioral symptoms, such as school problems (p < .001), internalizing problems (p = .012), inattention/hyperactivity (p = .020), affect dysregulation (p = .044), PTSD symptoms (p = .006), and delinquent behavior (p < .001). Recent smokers were also more likely to use alcohol (OR = 5.61, p < .001), marijuana (OR = 11.27, p < .001), and other drugs (OR = 5.00, p < .001). Conclusions: Recent smoking was higher among FTO-CINI youth than youth in the general population. Findings underscore the need to incorporate nicotine into existing substance use prevention interventions for this population, who are at high risk to initiate cigarette use as they age.
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Affiliation(s)
- Anna Harrison
- Department of Psychiatry and Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California, USA.,Division of Infant, Child, and Adolescent Psychiatry, Zuckerberg San Francisco General Hospital, San Francisco, California, USA.,Mental Health Service, San Francisco VA Medical Center, San Francisco, California, USA
| | - Danielle Ramo
- Department of Psychiatry and Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California, USA.,Hopelab, San Francisco, California, USA
| | - Sharon M Hall
- Department of Psychiatry and Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California, USA
| | - Vanessa Estrada-Gonzalez
- Department of Psychiatry and Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California, USA.,Division of Infant, Child, and Adolescent Psychiatry, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Marina Tolou-Shams
- Department of Psychiatry and Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California, USA.,Division of Infant, Child, and Adolescent Psychiatry, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
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12
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Loyd AB, Hotton AL, Walden AL, Kendall AD, Emerson E, Donenberg GR. Associations of ethnic/racial discrimination with internalizing symptoms and externalizing behaviors among juvenile justice-involved youth of color. J Adolesc 2019; 75:138-150. [PMID: 31398475 PMCID: PMC6745193 DOI: 10.1016/j.adolescence.2019.07.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 07/23/2019] [Accepted: 07/27/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Youth of color (e.g., Black/African American and Latinx/Hispanic) are overrepresented in the juvenile justice system and experience greater health disparities compared to non-Hispanic White youth. Ethnic/racial discrimination (ERD) is a risk marker for poor mental health and behavioral outcomes among youth of color, and traumatic stress and emotion dysregulation have been implicated in these pathways. Despite the relevance of these factors for justice-involved youth of color, understanding of their interrelations within this demographic is lacking. METHODS Participants were 173 recently arrested adolescents (86% African American; 45% girls; ages 13-18) on probation in a large Midwest city in the United States. Participants completed surveys assessing ERD, traumatic stress, emotion dysregulation, internalizing symptoms, and externalizing behaviors. Using linear regression and path analysis, this study tested the cross-sectional links among two types of ERD (i.e., interpersonal experiences and perceptions of group experiences), traumatic stress symptoms, emotion dysregulation, and internalizing symptoms and externalizing behaviors. RESULTS Interpersonal ERD (e.g., hearing racial insults) was associated with increased internalizing symptoms and externalizing behaviors; for internalizing symptoms, the relation was stronger for girls than boys. Gender differences were partially accounted for by traumatic stress symptoms and emotion dysregulation. CONCLUSIONS This study offers new insights into ERD experiences among juvenile justice-involved youth of color, gender differences in ethnic/racial discrimination experiences, and the potential value of gender-sensitive and culturally responsive programming in strengthening youths' ability to cope with ERD.
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Affiliation(s)
- Aerika Brittian Loyd
- Department of Educational Psychology, University of Illinois at Chicago, 1040 W. Harrison St., Chicago, IL, 60607, USA.
| | - Anna L Hotton
- Chicago Center for HIV Elimination, The University of Chicago Medicine, 5837 S. Maryland Ave., Chicago, IL, 60637, USA.
| | - Angela L Walden
- Center for Dissemination and Implementation Science, Department of Medicine, University of Illinois at Chicago, 818 S. Wolcott Ave., SRH - 3rd floor, Room 332 (M/C 579), Chicago, IL, 60612, USA.
| | - Ashley D Kendall
- Center for Dissemination and Implementation Science, Department of Medicine, University of Illinois at Chicago, 818 S. Wolcott Ave., SRH - 3rd floor, Room 332 (M/C 579), Chicago, IL, 60612, USA.
| | - Erin Emerson
- Center for Dissemination and Implementation Science, Department of Medicine, University of Illinois at Chicago, 818 S. Wolcott Ave., SRH - 3rd floor, Room 332 (M/C 579), Chicago, IL, 60612, USA.
| | - Geri R Donenberg
- Center for Dissemination and Implementation Science, Department of Medicine, University of Illinois at Chicago, 818 S. Wolcott Ave., SRH - 3rd floor, Room 332 (M/C 579), Chicago, IL, 60612, USA.
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13
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Farina B, Liotti M, Imperatori C. The Role of Attachment Trauma and Disintegrative Pathogenic Processes in the Traumatic-Dissociative Dimension. Front Psychol 2019; 10:933. [PMID: 31080430 PMCID: PMC6497769 DOI: 10.3389/fpsyg.2019.00933] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 04/08/2019] [Indexed: 12/13/2022] Open
Abstract
Epidemiological, clinical, and neurobiological studies of the last 30 years suggest that traumatic attachments during the early years of life are associated to specific psychopathological vulnerabilities based on dissociative pathogenic processes. It has been observed that the dissociative pathogenic processes caused by these traumatic attachments either may contribute to the genesis of well-defined mental disorders (e.g., dissociative disorders) or may variably occur in many other diagnostic categories, complicating their clinical pictures and worsening their prognosis. For this reason, we proposed to define the dimension of psychopathological outcomes linked to traumatic attachments and dissociative pathogenic processes as the “traumatic-dissociative” dimension (TDD). The clinical complexity of the TDD requires specific training to enable mental health professionals to recognize the signs of traumatic developments and to implement specific treatment strategies. The present article aims to review some crucial points about the clinical meaning and treatment strategies of the TDD, the dissociative pathogenic processes characterizing the TDD, as well as of the role of attachment trauma in the TDD. We also focused on the clinical and theoretical evidence suggesting that dissociation and dis-integration may be considered two different processes but highly correlated. The usefulness of clinical reasoning in terms of psychopathological dimensions, instead of distinct diagnostic categories, as well as several therapeutic implications of these issues was finally discussed.
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Affiliation(s)
- Benedetto Farina
- Department of Human Sciences, European University of Rome, Rome, Italy.,Traumatic Treatment Unit, Centro Clinico De Sanctis, Rome, Italy
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14
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Schlumpf YR, Nijenhuis ERS, Klein C, Jäncke L, Bachmann S. Functional reorganization of neural networks involved in emotion regulation following trauma therapy for complex trauma disorders. Neuroimage Clin 2019; 23:101807. [PMID: 30986752 DOI: 10.1016/j.nicl.2019.101807] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 03/13/2019] [Accepted: 03/30/2019] [Indexed: 12/14/2022]
Abstract
Objectives We investigated whether patients with complex interpersonal trauma engage neural networks that are commonly activated during cognitive reappraisal and responding naturally to affect-laden images. In this naturalistic study, we examined whether trauma treatment not only reduces symptoms but also changes neural networks involved in emotional control. Methods Before and after eight weeks of phase-oriented inpatient trauma treatment, patients (n = 28) with complex posttraumatic stress disorder (cPTSD) and complex dissociative disorders (CDD) performed a cognitive reappraisal task while electroencephalography (EEG) was registered. Patients were measured as a prototypical dissociative part that aims to fulfill daily life goals while avoiding traumatic memories and associated dissociative parts. Matched healthy controls (n = 38) were measured twice as well. We examined task-related functional connectivity and assessed self-reports of clinical symptoms and emotion regulation skills. Results Prior to treatment and compared to controls, patients showed hypoconnectivity within neural networks involved in emotional downregulation while reappraising affect-eliciting pictures as well as viewing neutral and affect-eliciting pictures. Following treatment, connectivity became normalized in these networks comprising regions associated with cognitive control and memory. Additionally, patients showed a treatment-related reduction of negative but not of positive dissociative symptoms. Conclusions This is the first study demonstrating that trauma-focused treatment was associated with favorable changes in neural networks involved in emotional control. Emotional overregulation manifesting as negative dissociative symptoms was reduced but not emotional underregulation, manifesting as positive dissociative symptoms. Trauma-focused treatment normalized networks involved in emotion regulation. Post-treatment patients showed a reduction in clinical symptoms. Negative but not positive dissociative symptoms declined across treatment. Extensive therapy is warranted to overcome complex interpersonal traumatization.
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15
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Swart S, Wildschut M, Draijer N, Langeland W, Smit JH. The clinical course of trauma-related disorders and personality disorders: study protocol of two-year follow-up based on structured interviews. BMC Psychiatry 2017; 17:173. [PMID: 28486966 PMCID: PMC5424424 DOI: 10.1186/s12888-017-1339-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 04/30/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Trauma-related disorders and personality disorders are prevalent in survivors of chronic childhood trauma and neglect. Both conditions have serious consequences for patients, their families, society and public health and a high risk of development of chronicity. However, information on the long term course trajectories is lacking and predictors of course outcome in survivors of chronic childhood traumatization are unknown. The first aim of the current study is to identify two-year course trajectories of pathology in patients with trauma-related disorders and personality disorders. The second aim is to examine predictors of the course, including demographics, clinical characteristics and comorbidities. METHODS/DESIGN The study is a naturalistic two-year follow-up of 150 patients consecutively admitted to the trauma treatment program and the personality disorder treatment program respectively at GGZ Friesland, a regular Dutch mental health care center. The only exclusion criterion is insufficient mastery of the Dutch language. Participants will be assessed after 2 years of treatment through measures that have been completed at baseline, including structured clinical interviews to measure childhood histories of trauma and neglect, (symptoms of) trauma-related disorders and personality disorders, and psychological questionnaire measures (e.g., general psychopathology, depressive symptoms and personality features). In addition, participants will complete an evaluation questionnaire to assess medication prescribed and treatment (s) received outside GGZ Friesland between baseline and follow-up. Information about (psychological and pharmacological) treatment received at GGZ Friesland during the follow-up period will be collected from patient files. DISCUSSION This study provides insight in the two-year course of (comorbid) trauma-related disorders and personality disorders. Identifying predictors of the course of trauma-related and personality disorders will allow to differentiate clinical profiles and will offer indicators for treatment.
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Affiliation(s)
- Sanne Swart
- GGZ Friesland, Borniastraat 34b, Leeuwarden, 8934 AD the Netherlands
| | - Marleen Wildschut
- GGZ Friesland, Borniastraat 34b, Leeuwarden, 8934 AD the Netherlands
| | - Nel Draijer
- Department of Psychiatry and EMGO Institute, Vrije University Medical Center/GGZinGeest, Amsterdam, the Netherlands
- Department of Research, GGZinGeest, Amsterdam, the Netherlands
| | | | - Jan H. Smit
- Department of Psychiatry and EMGO Institute, Vrije University Medical Center/GGZinGeest, Amsterdam, the Netherlands
- Department of Research, GGZinGeest, Amsterdam, the Netherlands
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16
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Khan MS, Misra SK, Wang Z, Daza E, Schwartz-Duval AS, Kus JM, Pan D, Pan D. Paper-Based Analytical Biosensor Chip Designed from Graphene-Nanoplatelet-Amphiphilic-diblock-co-Polymer Composite for Cortisol Detection in Human Saliva. Anal Chem 2017; 89:2107-2115. [DOI: 10.1021/acs.analchem.6b04769] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Muhammad S. Khan
- Biomedical
Research Center, Carle Foundation Hospital, Urbana, Illinois United States
| | - Santosh K. Misra
- Biomedical
Research Center, Carle Foundation Hospital, Urbana, Illinois United States
| | - Zhen Wang
- Biomedical
Research Center, Carle Foundation Hospital, Urbana, Illinois United States
| | - Enrique Daza
- Biomedical
Research Center, Carle Foundation Hospital, Urbana, Illinois United States
| | | | - Joseph M. Kus
- Biomedical
Research Center, Carle Foundation Hospital, Urbana, Illinois United States
| | | | - Dipanjan Pan
- Biomedical
Research Center, Carle Foundation Hospital, Urbana, Illinois United States
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17
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Parra F, George C, Kalalou K, Januel D. Ideal Parent Figure method in the treatment of complex posttraumatic stress disorder related to childhood trauma: a pilot study. Eur J Psychotraumatol 2017; 8:1400879. [PMID: 29201286 PMCID: PMC5700488 DOI: 10.1080/20008198.2017.1400879] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 10/22/2017] [Indexed: 11/25/2022] Open
Abstract
Background: There is a consensus within the trauma field for the necessity of a three-phase treatment programme for complex posttraumatic stress disorder (CPTSD). This pilot study focuses on the stabilisation phase, the goal of which is the development of psychological resources and the reduction of disabling symptoms. Objective: To test the efficacy of the Ideal Parent Figure (IPF) method as a stabilization treatment for CPTSD patients with a history of childhood trauma. Method: The sample was comprised of 17 adults with a history of childhood trauma concomitant with CPTSD symptoms consulting at a clinic in France. Participants enrolled in a 5-week psychotherapy programme based on the IPF method, a semi-structured visualization programme designed to treat attachment disturbances. Measures of DESNOS symptoms, psychological symptoms, quality of life, and adult attachment were administered pre- and posttreatment as well as at 8-month follow-up. Results: A significant decrease in symptom severity and attachment traumatization and a significant increase in quality of life were found, both with medium-to-large effect sizes. The 8-month follow-up assessment showed outcome stability. Conclusions: These results suggest that treating attachment disturbances directly with an approach akin to the Ideal Parent Figure method may lead to fast and stable improvement for individuals with CPTSD.
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Affiliation(s)
- Federico Parra
- Ville Evrard Clinical Research Unit, Nuilly-sur-Marne, France.,Psychology Department, Paris VIII University, Saint-Denis, France.,Ville Evrard Center of Psychotherapy and Psychotraumatology, Saint-Denis, France
| | - Carol George
- Psychology Department, Mills College, Oakland, CA, USA
| | - Khalid Kalalou
- Ville Evrard Clinical Research Unit, Nuilly-sur-Marne, France.,Ville Evrard Center of Psychotherapy and Psychotraumatology, Saint-Denis, France
| | - Dominique Januel
- Ville Evrard Clinical Research Unit, Nuilly-sur-Marne, France.,Ville Evrard Center of Psychotherapy and Psychotraumatology, Saint-Denis, France
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18
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Ter Heide FJJ, Mooren TM, Kleber RJ. Complex PTSD and phased treatment in refugees: a debate piece. Eur J Psychotraumatol 2016; 7:28687. [PMID: 26886486 PMCID: PMC4756628 DOI: 10.3402/ejpt.v7.28687] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 10/03/2015] [Accepted: 12/08/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Asylum seekers and refugees have been claimed to be at increased risk of developing complex posttraumatic stress disorder (complex PTSD). Consequently, it has been recommended that refugees be treated with present-centred or phased treatment rather than stand-alone trauma-focused treatment. This recommendation has contributed to a clinical practice of delaying or waiving trauma-focused treatment in refugees with PTSD. OBJECTIVE The aim of this debate piece is to defend two theses: (1) that complex trauma leads to complex PTSD in a minority of refugees only and (2) that trauma-focused treatment should be offered to all refugees who seek treatment for PTSD. METHODS The first thesis is defended by comparing data on the prevalence of complex PTSD in refugees to those in other trauma-exposed populations, using studies derived from a systematic review. The second thesis is defended using conclusions of systematic reviews and a meta-analysis of the efficacy of psychotherapeutic treatment in refugees. RESULTS Research shows that refugees are more likely to meet a regular PTSD diagnosis or no diagnosis than a complex PTSD diagnosis and that prevalence of complex PTSD in refugees is relatively low compared to that in survivors of childhood trauma. Effect sizes for trauma-focused treatment in refugees, especially narrative exposure therapy (NET) and culturally adapted cognitive-behaviour therapy (CA-CBT), have consistently been found to be high. CONCLUSIONS Complex PTSD in refugees should not be assumed to be present on the basis of complex traumatic experiences but should be carefully diagnosed using a validated interview. In line with treatment guidelines for PTSD, a course of trauma-focused treatment should be offered to all refugees seeking treatment for PTSD, including asylum seekers.
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Affiliation(s)
- F Jackie June Ter Heide
- Foundation Centrum'45, Oegstgeest/Diemen, The Netherlands | Partner in Arq Psychotrauma Expert Group;
| | - Trudy M Mooren
- Foundation Centrum'45, Oegstgeest/Diemen, The Netherlands | Partner in Arq Psychotrauma Expert Group
| | - Rolf J Kleber
- Foundation Centrum'45, Oegstgeest/Diemen, The Netherlands | Partner in Arq Psychotrauma Expert Group
- Department of Clinical & Health Psychology, Utrecht University, The Netherlands
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19
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Ford JD, Mendelsohn M, Opler LA, Opler MG, Kallivayalil D, Levitan J, Pratts M, Muenzenmaier K, Shelley AM, Grennan MS, Lewis Herman J. The Symptoms of Trauma Scale (SOTS): An Initial Psychometric Study. J Psychiatr Pract 2015; 21:474-83. [PMID: 26554331 DOI: 10.1097/PRA.0000000000000107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The Symptoms of Trauma Scale (SOTS) is a 12-item, interview-based, clinician-rated measure that assesses the severity of a range of trauma-related symptoms. This pilot study evaluated its use and psychometric properties in an outpatient setting that provides treatment to survivors of chronic interpersonal trauma. Thirty participants completed self-report measures of posttraumatic stress symptoms, depression, dissociation, self-esteem, and affect dysregulation; the participants also participated separately in a semistructured interview based on the SOTS conducted by 2 trained interviewers. SOTS composite severity scores for DSM-IV posttraumatic stress disorder (PTSD) and complex PTSD (cPTSD), DSM-5 PTSD, and PTSD dissociative subtype, and total traumatic stress symptoms generally had acceptable internal consistency and interrater reliability. Evidence of convergent, discriminant, criterion, and construct validity was found for the SOTS composite PTSD scores, although potential limitations to validity that require further research and refinement of the measure were identified for the SOTS total and DSM-IV cPTSD scores and the hyperarousal, affect dysregulation, and dissociation items. Interviewers and interviewees described the interview as efficient, informative, and well tolerated. Implications for clinical practice and research to refine the SOTS are discussed.
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20
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Teodorescu DS, Heir T, Siqveland J, Hauff E, Wentzel-Larsen T, Lien L. Chronic pain in multi-traumatized outpatients with a refugee background resettled in Norway: a cross-sectional study. BMC Psychol 2015; 3:7. [PMID: 25815196 PMCID: PMC4369066 DOI: 10.1186/s40359-015-0064-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 03/03/2015] [Indexed: 01/09/2023] Open
Abstract
Background Traumatized refugees often report significant levels of chronic pain in addition to posttraumatic stress disorder symptoms, and more information is needed to understand pain in refugees exposed to traumatic events. This study aimed to assess the frequency of chronic pain among refugee psychiatric outpatients, and to compare outpatients with and without chronic pain on trauma exposure, psychiatric morbidity, and psychiatric symptom severity. Methods We conducted a cross-sectional study of sixty-one psychiatric outpatients with a refugee background using structured clinical diagnostic interviews to assess for traumatic events [Life Events Checklist (LEC)], PTSD (Posttraumatic Stress Disorder) and complex PTSD [Structured Clinical Interview for DSM-IV PTSD Module (SCID-PTSD) and Structured Interview for Disorders of Extreme Stress (SIDES)], chronic pain (SIDES Scale VI) and psychiatric symptoms [M.I.N.I. International Neuropsychiatric Interview (M.I.N.I.)]. Self-report measures were used to assess symptoms of posttraumatic stress [Impact of Event Scale-revised (IES-R)], depression and anxiety [Hopkins Symptom Checklist (HSCL-25)] and several markers of acculturation in Norway. Results Of the 61 outpatients included, all but one reported at least one chronic pain location, with a mean of 4.6 locations per patient. Chronic pain at clinical levels was present in 66% of the whole sample of outpatients, and in 88% of the outpatients with current PTSD diagnosis. The most prevalent chronic pain locations were head (80%), chest (74%), arms/legs (66%) and back (62%). Women had significantly more chronic pain locations than men. Comorbid PTSD and chronic pain were found in 57% of the outpatients. Significant differences were found between outpatients with and without chronic pain on posttraumatic stress, psychological distress, and DESNOS severity. Conclusions Chronic pains are common in multi-traumatized refugees in outpatient clinics in Norway, and are positively related to symptomatology and severity of psychiatric morbidity. The presence of chronic pain, as well as comorbid chronic pain and PTSD, in psychiatric outpatients with a refugee background call for an integrated assessment and treatment for both conditions.
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Affiliation(s)
- Dinu-Stefan Teodorescu
- Department of Public Health, Hedmark University College, Elverum, Norway ; Innlandet Hospital Trust, PO Box 104, N-2381 Brumunddal, Norway
| | - Trond Heir
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway ; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Johan Siqveland
- R & D Department, Mental Health Services, Akershus University Hospital, Oslo, Norway ; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Edvard Hauff
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway ; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Tore Wentzel-Larsen
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway ; Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Lars Lien
- Department of Public Health, Hedmark University College, Elverum, Norway ; Innlandet Hospital Trust, PO Box 104, N-2381 Brumunddal, Norway
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21
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Marinova Z, Maercker A. Biological correlates of complex posttraumatic stress disorder-state of research and future directions. Eur J Psychotraumatol 2015; 6:25913. [PMID: 25887894 PMCID: PMC4401823 DOI: 10.3402/ejpt.v6.25913] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 03/07/2015] [Accepted: 03/15/2015] [Indexed: 12/15/2022] Open
Abstract
Complex posttraumatic stress disorder (PTSD) presents with clinical features of full or partial PTSD (re-experiencing a traumatic event, avoiding reminders of the event, and a state of hyperarousal) together with symptoms from three additional clusters (problems in emotional regulation, negative self-concept, and problems in interpersonal relations). Complex PTSD is proposed as a new diagnostic entity in ICD-11 and typically occurs after prolonged and complex trauma. Here we shortly review current knowledge regarding the biological correlates of complex PTSD and compare it to the relevant findings in PTSD. Recent studies provide support to the validity of complex PTSD as a separate diagnostic entity; however, data regarding the biological basis of the disorder are still very limited at this time. Further studies focused on complex PTSD biological correlates and replication of the initial findings are needed, including neuroimaging, neurobiochemical, genetic, and epigenetic investigations. Identification of altered biological pathways in complex PTSD may be critical to further understand the pathophysiology and optimize treatment strategies.
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Affiliation(s)
- Zoya Marinova
- Department of Psychology, Division of Psychopathology and Clinical Intervention, University of Zürich, Zürich, Switzerland.,University Clinics for Child and Adolescent Psychiatry, University of Zürich, Zürich, Switzerland;
| | - Andreas Maercker
- Department of Psychology, Division of Psychopathology and Clinical Intervention, University of Zürich, Zürich, Switzerland
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22
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Abstract
The redefinition of posttraumatic stress disorder (PTSD) in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, has highlighted a range of posttraumatic affects beyond fear and anxiety. For survivors of interpersonal violence, shame has been shown to be an important contributor of self-reported symptomatology. Although biological models of PTSD emphasize physiological arousal secondary to fear and anxiety, evidence suggests that shame might be related to increased arousal as well. This study tested the contributions of anxiety, fear, and shame to autonomic arousal in a sample of female victims (N = 27) of interpersonal violence with PTSD. Shame proneness was the only significant correlate of autonomic arousal during a trauma reminder paradigm. These findings indicate that shame corresponds to important indicators of changes to the autonomic nervous system that have previously been assumed to be fear related.
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Affiliation(s)
- Steven Freed
- a The New School for Social Research , New York , New York , USA
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23
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Sack M, Sachsse U, Overkamp B, Dulz B. [Trauma-related disorders in patients with borderline personality disorders. Results of a multicenter study]. Nervenarzt 2014; 84:608-14. [PMID: 22743835 DOI: 10.1007/s00115-012-3489-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There is current controversy about the diagnostic overlap between personality disorders and trauma-related disorders. PATIENTS AND METHODS Applying a multicenter study design, trauma-related disorders were investigated via interview assessment in 136 patients with borderline personality disorder (BPD) in 5 specialized treatment centers. Additionally a spectrum of psychological symptoms and prevalence of lifetime traumatic experiences were assessed by questionnaire measures. RESULTS Diagnostic overlap between BPD and PTSD was found to be high (79%) as well as the overlap of BPD with complex PTSD (55%) and severe dissociative disorders (41%). Including neglect and emotional violence as trauma categories, an extremely high prevalence of lifetime traumatic experiences was reported (96%). Experiences of sexual violence were reported by 48% of all female and 28% of all male patients. Severe forms of physical violence were reported by 65% of all patients. CONCLUSIONS BPD patients with severe psychopathology show a high comorbidity with trauma-related disorders including dissociative disorders. This association has to be taken into account when planning psychological treatment.
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Affiliation(s)
- M Sack
- Klinik für Psychosomatische Medizin und Psychotherapie, Klinikum rechts der Isar, Technische Universität München, Langerstrasse 3, Munich, Germany.
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Abstract
BACKGROUND Although there are no established biomarkers for posttraumatic stress disorder (PTSD) as yet, biological investigations of PTSD have made progress identifying the pathophysiology of PTSD. Given the biological and clinical complexity of PTSD, it is increasingly unlikely that a single biomarker of disease will be identified. Rather, investigations will more likely identify different biomarkers that indicate the presence of clinically significant PTSD symptoms, associate with risk for PTSD following trauma exposure, and predict or identify recovery. While there has been much interest in PTSD biomarkers, there has been less discussion of their potential clinical applications, and of the social, legal, and ethical implications of such biomarkers. OBJECTIVE This article will discuss possible applications of PTSD biomarkers, including the social, legal, and ethical implications of such biomarkers, with an emphasis on military applications. METHOD Literature on applications of PTSD biomarkers and on potential ethical and legal implications will be reviewed. RESULTS Biologically informed research findings hold promise for prevention, assessment, treatment planning, and the development of prophylactic and treatment interventions. As with any biological indicator of disorder, there are potentially positive and negative clinical, social, legal, and ethical consequences of using such biomarkers. CONCLUSIONS Potential clinical applications of PTSD biomarkers hold promise for clinicians, patients, and employers. The search for biomarkers of PTSD should occur in tandem with an interdisciplinary discussion regarding the potential implications of applying biological findings in clinical and employment settings.
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Affiliation(s)
- Amy Lehrner
- James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - Rachel Yehuda
- James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA ; Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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25
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Cloitre M, Garvert DW, Weiss B, Carlson EB, Bryant RA. Distinguishing PTSD, Complex PTSD, and Borderline Personality Disorder: A latent class analysis. Eur J Psychotraumatol 2014; 5:25097. [PMID: 25279111 PMCID: PMC4165723 DOI: 10.3402/ejpt.v5.25097] [Citation(s) in RCA: 180] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 07/22/2014] [Accepted: 08/18/2014] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND There has been debate regarding whether Complex Posttraumatic Stress Disorder (Complex PTSD) is distinct from Borderline Personality Disorder (BPD) when the latter is comorbid with PTSD. OBJECTIVE To determine whether the patterns of symptoms endorsed by women seeking treatment for childhood abuse form classes that are consistent with diagnostic criteria for PTSD, Complex PTSD, and BPD. METHOD A latent class analysis (LCA) was conducted on an archival dataset of 280 women with histories of childhood abuse assessed for enrollment in a clinical trial for PTSD. RESULTS THE LCA REVEALED FOUR DISTINCT CLASSES OF INDIVIDUALS: a Low Symptom class characterized by low endorsements on all symptoms; a PTSD class characterized by elevated symptoms of PTSD but low endorsement of symptoms that define the Complex PTSD and BPD diagnoses; a Complex PTSD class characterized by elevated symptoms of PTSD and self-organization symptoms that defined the Complex PTSD diagnosis but low on the symptoms of BPD; and a BPD class characterized by symptoms of BPD. Four BPD symptoms were found to greatly increase the odds of being in the BPD compared to the Complex PTSD class: frantic efforts to avoid abandonment, unstable sense of self, unstable and intense interpersonal relationships, and impulsiveness. CONCLUSIONS Findings supported the construct validity of Complex PTSD as distinguishable from BPD. Key symptoms that distinguished between the disorders were identified, which may aid in differential diagnosis and treatment planning.
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Affiliation(s)
- Marylène Cloitre
- National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA ; Department of Psychiatry and Child & Adolescent Psychiatry, New York University Medical Center, New York, USA
| | - Donn W Garvert
- National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Brandon Weiss
- National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA ; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Eve B Carlson
- National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
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Abstract
Complex trauma events have been defined as chronic, interpersonal traumas that begin early in life (Cook, Blaustein, Spinazzola, & van der Kolk, 2003). The complex trauma definition has been examined in adults, as indicated by the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) field trial; however, this research was lacking in child populations. The symptom presentations of complexly traumatized children were contrasted with those exposed to other, less severe trauma ecologies that met 1 or 2 features of the complex trauma definition. Included in this study were 346 treatment-seeking children and adolescents (ages 3–18 years) who had experienced atraumatic event. Results indicated that child survivors of complex trauma presented with higher levels of generalized behavior problems and trauma-related symptoms than those who experienced (a) acute noninterpersonal trauma, (b) chronic interpersonal trauma that begins later in life, and (c) acute interpersonal trauma. Greater levels of behavioral problems were observed in children exposed to complex trauma as compared to those who experienced a traumatic event that begins early in life. These results provide support for the complex trauma event definition and suggest the need for a complex trauma diagnostic construct for children and adolescents.
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Affiliation(s)
- Rachel Wamser-Nanney
- Department of Psychology; University of Missouri- St. Louis; St. Louis Missouri USA
| | - Brian R. Vandenberg
- Department of Psychology; University of Missouri- St. Louis; St. Louis Missouri USA
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Mauritz MW, Goossens PJJ, Draijer N, van Achterberg T. Prevalence of interpersonal trauma exposure and trauma-related disorders in severe mental illness. Eur J Psychotraumatol 2013; 4:19985. [PMID: 23577228 PMCID: PMC3621904 DOI: 10.3402/ejpt.v4i0.19985] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Revised: 02/13/2013] [Accepted: 03/04/2013] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Interpersonal trauma exposure and trauma-related disorders in people with severe mental illness (SMI) are often not recognized in clinical practice. OBJECTIVE To substantiate the prevalence of interpersonal trauma exposure and trauma-related disorders in people with SMI. METHODS We conducted a systematic review of four databases (1980-2010) and then described and analysed 33 studies in terms of primary diagnosis and instruments used to measure trauma exposure and trauma-related disorders. RESULTS Population-weighted mean prevalence rates in SMI were physical abuse 47% (range 25-72%), sexual abuse 37% (range 24-49%), and posttraumatic stress disorder (PTSD) 30% (range 20-47%). Compared to men, women showed a higher prevalence of sexual abuse in schizophrenia spectrum disorder, bipolar disorder, and mixed diagnosis groups labelled as having SMI. CONCLUSIONS Prevalence rates of interpersonal trauma and trauma-related disorders were significantly higher in SMI than in the general population. Emotional abuse and neglect, physical neglect, complex PTSD, and dissociative disorders have been scarcely examined in SMI.
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Affiliation(s)
- Maria W. Mauritz
- Community Mental Health Care Unit/Long Treatment, GGNet, Warnsveld, The Netherlands
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Peter J. J. Goossens
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
- Saxion University of Applied Sciences, Expertise Centre of Health, Social Work & Technology, Deventer, The Netherlands
- Specialist Centre for Bipolar Disorders, Dimence, Deventer, The Netherlands
| | - Nel Draijer
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | - Theo van Achterberg
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Thomaes K, Dorrepaal E, Draijer N, de Ruiter MB, Elzinga BM, Sjoerds Z, van Balkom AJ, Smit JH, Veltman DJ. Increased anterior cingulate cortex and hippocampus activation in Complex PTSD during encoding of negative words. Soc Cogn Affect Neurosci 2013; 8:190-200. [PMID: 22156722 PMCID: PMC3575721 DOI: 10.1093/scan/nsr084] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Accepted: 11/01/2011] [Indexed: 12/15/2022] Open
Abstract
Post-traumatic stress disorder (PTSD) is associated with impaired memory performance coupled with functional changes in brain areas involved in declarative memory and emotion regulation. It is not yet clear how symptom severity and comorbidity affect neurocognitive functioning in PTSD. We performed a functional magnetic resonance imaging (fMRI) study with an emotional declarative memory task in 28 Complex PTSD patients with comorbid depressive and personality disorders, and 21 healthy non-trauma-exposed controls. In Complex PTSD patients--compared to controls--encoding of later remembered negative words vs baseline was associated with increased blood oxygenation level dependent (BOLD) response in the left ventral anterior cingulate cortex (ACC) and dorsal ACC extending to the dorsomedial prefrontal cortex (dmPFC) together with a trend for increased left hippocampus activation. Patients tended to commit more False Alarms to negative words compared to controls, which was associated with enhanced left ventrolateral prefrontal and orbitofrontal cortex (vlPFC/OFC) responses. Severity of child abuse was positively correlated with left ventral ACC activity and severity of depression with (para) hippocampal and ventral ACC activity. Presented results demonstrate functional abnormalities in Complex PTSD in the frontolimbic brain circuit also implicated in fear conditioning models, but generally in the opposite direction, which may be explained by severity of the trauma and severity of comorbid depression in Complex PTSD.
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Affiliation(s)
- Kathleen Thomaes
- Department of Psychiatry, GGZ InGeest/VU University Medical Center, Amsterdam, The Netherlands.
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Dorrepaal E, Thomaes K, Smit JH, Veltman DJ, Hoogendoorn AW, van Balkom AJLM, Draijer N. Treatment compliance and effectiveness in complex PTSD patients with co-morbid personality disorder undergoing stabilizing cognitive behavioral group treatment: a preliminary study. Eur J Psychotraumatol 2013; 4:21171. [PMID: 24224077 PMCID: PMC3820917 DOI: 10.3402/ejpt.v4i0.21171] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 09/05/2013] [Accepted: 09/14/2013] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In the empirical and clinical literature, complex posttraumatic stress disorder (PTSD) and personality disorders (PDs) are suggested to be predictive of drop-out or reduced treatment effectiveness in trauma-focused PTSD treatment. OBJECTIVE In this study, we aimed to investigate if personality characteristics would predict treatment compliance and effectiveness in stabilizing complex PTSD treatment. METHOD In a randomized controlled trial on a 20-week stabilizing group cognitive behavioral treatment (CBT) for child-abuse-related complex PTSD, we included 71 patients of whom 38 were randomized to a psycho-educational and cognitive behavioral stabilizing group treatment. We compared the patients with few PD symptoms (adaptive) (N=14) with the non-adaptive patients (N=24) as revealed by a cluster analysis. RESULTS We found that non-adaptive patients compared to the adaptive patients showed very low drop-out rates. Both non-adaptive patients, classified with highly different personality profiles "withdrawn" and "aggressive," were equally compliant. With regard to symptom reduction, we found no significant differences between subtypes. Post-hoc, patients with a PD showed lower drop-out rates and higher effect sizes in terms of complex PTSD severity, especially on domains that affect regulation and interpersonal problems. CONCLUSIONS Contrary to our expectations, these preliminary findings indicate that this treatment is well tolerated by patients with a variety of personality pathology. Larger sample sizes are needed to study effectiveness for subgroups of complex PTSD patients.
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Affiliation(s)
- Ethy Dorrepaal
- GGZ inGeest, Amsterdam, The Netherlands ; Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands ; EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands ; PsyQ, Parnassiagroep, The Hague, The Netherlands
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Abstract
The acquisition of affect regulation skills is often impaired or delayed in youth with mental health problems but the relationship between affect dysregulation and risk behaviors has not been well studied. Baseline data from adolescents (N = 417; ages 13-19) recruited from therapeutic school settings examined the relationship between affect dysregulation, substance use, self-cutting, and sexual risk behavior. Analyses of covariance demonstrated that adolescents who did not use condoms at last sex, ever self-cut, attempted suicide, used alcohol and other drugs and reported less condom use self-efficacy when emotionally aroused were significantly more likely (p < .01) to report greater difficulty with affect regulation than peers who did not exhibit these behaviors. General patterns of difficulty with affect regulation may be linked to HIV risk behavior, including condom use at last sex. HIV prevention strategies for youth in mental health treatment should target affect regulation in relation to multiple risk behaviors.
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Affiliation(s)
- Larry K Brown
- Bradley Hasbro Children's Research Center, Rhode Island Hospital, Warren Alpert Medical School of Brown University, One Hoppin Street, Suite 204, Providence, RI, 02903, USA.
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Abstract
The role of psychological trauma (eg, rape, physical assaults, torture, motor vehicle accidents) as an etiological factor in mental disorders, anticipated as early as the 19th century by Janet, Freud, and Breuer, and more specifically during World War I and II by Kardiner, was “rediscovered” some 20 years ago in the wake of the psychological traumas inflicted by the Vietnam war and the discussion “in the open ” of sexual abuse and rape by the women's liberation movement, 1980 marked a major turning point, with the incorporation of the diagnostic construct of posttraumatic stress disorder (PTSD) into the 3rd edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) and the definition of its main diagnostic criteria (reexperiencing of the traumatic event, avoidance of stimuli associated with the trauma, and symptoms of increased arousal). Initially described as resulting from a onetime severe traumatic incident, PTSD has now been shown to be triggered by chronic multiple traumas as well. This “state-of-the-art” article discusses past and current understanding of the disorder, with particular emphasis on the recent explosive developments in neuroimaging and other fields of the neurosciences that have highlighted the complex interrelationships between the psychological, psychiatric, biological, and neuroanatomical components of the disorder, and opened up entirely new therapeutic perspectives on how to help the victims of trauma overcome their past.
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Affiliation(s)
- B van der Kolk
- Professor of Psychiatry, Boston University School of Medicine, Boston, Mass, USA
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Nemcić-Moro I, Francisković T, Britvić D, Klarić M, Zecević I. Disorder of extreme stress not otherwise specified (DESNOS) in Croatian war veterans with posttraumatic stress disorder: case-control study. Croat Med J 2012; 52:505-12. [PMID: 21853545 PMCID: PMC3160697 DOI: 10.3325/cmj.2011.52.505] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Aim To determine the presence of disorder of extreme stress not otherwise specified (DESNOS) in Croatian war veterans who suffer from combat-related posttraumatic stress disorder (PTSD). Methods The research included 247 veterans of the 1991-1995 war in Croatia who suffered from PTSD and were psychiatrically examined at four clinical centers in Croatia during a month in 2008. It was based on the following self-assessment instruments: The Harvard Trauma Questionnaire (HTQ): Croatian Version, the Structured Interview for Disorder of Extreme Stress (SIDES-SR), and the Mini International Neuropsychiatric Interview (MINI) Results Based on the SIDES-SR results, we formed two groups of participants: the group with PTSD (N = 140) and the group with both PTSD and DESNOS (N = 107). Forty three percent of participants met the criteria for DESNOS. There was a significant difference in the intensity of posttraumatic symptoms between the group with both PTSD and DESNOS and the group with PTSD only (U = 3733.5, P = 0.001). Respondents who suffered from both PTSD and DESNOS also reported a significantly larger number of comorbid mental disorders (U = 1123.5, P = 0.049) and twice more frequently reported comorbid depression with melancholic features (OR = 2.109, P = 0.043), social phobia (OR = 2.137, P = 0.036), or panic disorder (OR = 2.208, P = 0.015). Conclusion Our results demonstrate that PTSD and DESNOS can occur in comorbidity, which is in contrast with the ICD-10 criteria. A greater intensity of symptoms and a more frequent comorbidity with other psychiatric disorders, especially depression, panic disorder, and social phobia require additional therapy interventions in the treatment processes.
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Affiliation(s)
- Iva Nemcić-Moro
- Department of Psychological Medicine, University Hospital Center Zagreb, Kispatićeva 12, 10 000 Zagreb, Croatia.
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Abstract
This article, condensed from Chapter 14 of A Guide to the Standard EMDR Protocols for Clinicians, Supervisors, and Consultants (Leeds, 2009), examines applying eye movement desensitization and reprocessing (EMDR) to treating individuals with panic disorder (PD) and PD with agoraphobia (PDA). The literature on effective treatments for PD and PDA is reviewed focusing on cognitive and behavioral therapies, pharmacotherapy, and EMDR. Case reports and controlled studies of EMDR treatment of PD and PDA are examined for lessons to guide EMDR clinicians. Two model EMDR treatment plans are presented: one for cases of simple PD without agoraphobia or other co-occurring disorders and the other for cases of PDA or PD with co-occurring anxiety or Axis II disorders. A more extensive literature discussion, detailed treatment guidelines, and client education resources can be found in the original chapter.
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Abstract
BACKGROUND Although affect dysregulation is considered a core component of borderline personality disorder (BPD) and somatoform disorders (SoD), remarkably little research has focused on the prevalence and nature of affect dysregulation in these disorders. Also, despite apparent similarities, little is known about how dysfunctional under- and overregulation of affect and positive and negative somatoform and psychoform dissociative experiences inter-relate. Prior studies suggest a clear relationship between early childhood psychological trauma and affect dysregulation, especially when the caretaker is emotionally, sexually, or physically abusing the child, but how these relate to under- and overregulation while differentiating for developmental epochs is not clear. Although an elevated risk of childhood trauma exposure or complex posttraumatic stress disorder (CPTSD) symptoms has been reported in BPD and SoD, trauma histories, dysfunctional affect regulation, dissociation, PTSD, and CPTSD were never assessed in unison in BPD and/or SoD. METHOD BPD and/or SoD diagnoses were confirmed or ruled out in 472 psychiatric inpatients using clinical interviews. Dysfunctional under- and overregulation of affect and somatoform and psychoform dissociation, childhood trauma-by-primary-caretaker (TPC), PTSD, and CPTSD were all measured using self reports. RESULTS No disorder-specific form of dysfunctional affect regulation was found. Although both BPD and SoD can involve affect dysregulation and dissociation, there is a wide range of intensity of dysfunctional regulation phenomena in patients with these diagnoses. Evidence was found for the existence of three qualitatively different forms of experiencing states: inhibitory experiencing states (overregulation of affect and negative psychoform dissociation) most commonly found in SoD, excitatory experiencing states (underregulation of affect and positive psychoform dissociation) most commonly found in BPD, and combination of inhibitory and excitatory experiencing states commonly occurring in comorbid BPD+SoD. Almost two-thirds of participants reported having experienced childhood TPC. Underregulation of affect was associated with emotional TPC and TPC occurring in developmental epoch, 0-6 years of age. Overregulation of affect was associated with physical TPC. Almost a quarter of all participants met the criteria for CPTSD. BPD+SoD patients had the most extensive childhood trauma histories and were most likely to meet CPTSD criteria, followed by BPD, psychiatric comparison (PC), and SoD. The BPD+SoD and BPD reported significantly higher levels of CPTSD than the SoD or PC groups but did not differ from each other except for greater severity of CPTSD somatic symptoms by the BPD+SoD group. CONCLUSION THREE QUALITATIVELY DIFFERENT FORMS OF DYSFUNCTIONAL REGULATION WERE IDENTIFIED: inhibitory, excitatory, and combined inhibitory and excitatory states. Distinguishing inhibitory versus excitatory states of experiencing may help to clarify differences in dissociation and affect dysregulation between and within BPD and SoD patients. Specific interventions addressing overregulation in BPD, or underregulation in SoD, should be added to disorder-specific evidence-based treatments. CPT is particularly prevalent in BPD and BPD+SoD and is differentially associated with under- and overregulation of affect depending on the type of traumatic exposure. CPTSD warrants further investigation as a potential independent syndrome or as a marker identifying a sub-group of affectively, or both affectively and somatically, dysregulated patients diagnosed with BPD who have childhood trauma histories.
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Abstract
This article provides a summary of all the studies that have investigated eye movement desensitization and reprocessing (EMDR) treatment of traumatized children and adolescents. The effectiveness of the treatment is revealed in more than 15 studies. This article considers the differences between Type I and Type II traumas and specifically examines the effects of EMDR on traumatic stress experienced by children and youth following Type I and Type II traumas. There is a considerable body of research evaluating EMDR treatment of Type I traumas, showing strong evidence for its efficacy, but there are few studies that have specifically investigated EMDR treatment of Type II traumas. The effect of EMDR on various symptoms and problem areas is also examined. Recommendations are made for the clinical application of EMDR and for further research.
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van Dijke A, Ford JD, van der Hart O, Van Son MJM, Van der Heijden PGM, Bühring M. Childhood traumatization by primary caretaker and affect dysregulation in patients with borderline personality disorder and somatoform disorder. Eur J Psychotraumatol 2011; 2:EJPT-2-5628. [PMID: 22893813 PMCID: PMC3402130 DOI: 10.3402/ejpt.v2i0.5628] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Revised: 11/26/2010] [Accepted: 01/27/2011] [Indexed: 11/14/2022] Open
Abstract
Affect regulation is often compromised as a result of early life interpersonal traumatization and disruption in caregiving relationships like in situations where the caretaker is emotionally, sexually or physically abusing the child. Prior studies suggest a clear relationship between early childhood attachment-related psychological trauma and affect dysregulation. We evaluated the relationship of retrospectively recalled childhood traumatization by primary caretaker(s) (TPC) and affect dysregulation in 472 adult psychiatric patients diagnosed with borderline personality disorder (BPD), somatoform disorder (SoD), both BPD and SoD, or disorders other than BPD or SoD, using the Bermond-Vorst Alexithymia Questionnaire, the self-report version of the Structured Interview for Disorders of Extreme Stress, the Self-rating Inventory for Posttraumatic Stress Disorder (SRIP) and the Traumatic Experiences Checklist. Almost two-thirds of participants reported having experienced childhood TPC, ranging from approximately 50% of patients with SoD or other psychiatric disorders to more than 75% of patients with comorbid BPD+SoD. Underregulation of affect was associated with emotional TPC and TPC occurring in developmental epoch 0-6 years. Over-regulation of affect was associated with physical TPC. Childhood trauma by a primary caretaker is prevalent among psychiatric patients, particularly those with BPD, and differentially associated with underand over-regulation of affect depending on the type of traumatic exposure.
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Moore SA, Zoellner LA, Mollenholt N. Are expressive suppression and cognitive reappraisal associated with stress-related symptoms? Behav Res Ther 2008; 46:993-1000. [PMID: 18687419 PMCID: PMC2629793 DOI: 10.1016/j.brat.2008.05.001] [Citation(s) in RCA: 269] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2007] [Revised: 04/10/2008] [Accepted: 05/01/2008] [Indexed: 11/22/2022]
Abstract
Emotion dysregulation is thought to be critical to the development of negative psychological outcomes. Gross (1998b) conceptualized the timing of regulation strategies as key to this relationship, with response-focused strategies, such as expressive suppression, as less effective and more detrimental compared to antecedent-focused ones, such as cognitive reappraisal. In the current study, we examined the relationship between reappraisal and expressive suppression and measures of psychopathology, particularly for stress-related reactions, in both undergraduate and trauma-exposed community samples of women. Generally, expressive suppression was associated with higher, and reappraisal with lower, self-reported stress-related symptoms. In particular, expressive suppression was associated with PTSD, anxiety, and depression symptoms in the trauma-exposed community sample, with rumination partially mediating this association. Finally, based on factor analysis, expressive suppression and cognitive reappraisal appear to be independent constructs. Overall, expressive suppression, much more so than cognitive reappraisal, may play an important role in the experience of stress-related symptoms. Further, given their independence, there are potentially relevant clinical implications, as interventions that shift one of these emotion regulation strategies may not lead to changes in the other.
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Affiliation(s)
- Sally A Moore
- University of Washington, Department of Psychology, Seattle, WA, USA.
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Abstract
Youth who experience difficulty in school are at risk for suicide, yet there is little published information specific to risk and protective factors among this group. The purpose of this study was to conduct an in-depth examination of risk and protective factors associated with suicidal behaviour among youth who were experiencing problems in school and to compare these factors between suicide risk and non-suicide risk subgroups. Participants were 730 high school students in the Northwest and Southwest regions of the United States, aged 14-21 years. All participants were known to be experiencing difficulty with grades and/or attendance. Students completed a paper-and-pencil questionnaire and a one-on-one interview, which assessed suicidal behaviours as well as risk factors (e.g. drug involvement, emotional distress, stress), and protective factors (e.g. self-esteem, coping, support). Analysis of covariance tests, controlling for age and sex, were conducted to examine differences between the suicide risk and non-suicide risk groups on each risk and protective factor. The suicide risk subgroup reported higher levels of all risk factors, except alcohol and marijuana use, and lower levels of protective factors. While the groups did not differ on frequency of alcohol or marijuana use, they did differ on other illicit drug use and consequences of alcohol and other illicit drug use. Recommendations for nurses practising in school settings are discussed.
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Affiliation(s)
- Elaine Walsh
- Reconnecting Youth Prevention Research Program, University of Washington School of Nursing, Seattle, Washington 98195, USA.
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Abstract
The primary goal of this paper is to review existing findings from trauma, addictions and developmental research in order to delineate salient and outstanding questions for future research in this field. Toward this aim, our manuscript will provide an overview of the extant body of knowledge of trauma/PTSD comorbidity with substance use disorders and draw attention to converging developmental and neurobiological literature on the consequences of trauma on self-regulation. We conclude with suggestions for future research in these areas.
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Affiliation(s)
- Denise Hien
- Columbia University, Social Intervention Group, New York, NY, USA.
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40
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Abstract
Individuals with sexual assault or abuse histories are likely to engage in risky sexual and other self-destructive behaviors. Studies of these behaviors, however, have focused on target traumatic events without accounting for other events in the participant's history, recency of the events, and/or developmental level at time of occurrence. The present study addressed some of these confounds by creating groups with unique and non-overlapping trauma histories among adolescent participants whose first trauma occurred at age 12 or older. Sophomore women from six regional campuses were screened in a two-stage procedure, and 209 of 363 final interviewees were included in the present report. These were assigned to a no trauma group, or to one of five groups with a unique trauma history: a single traumatic loss, a single physical assault, a single sexual assault, ongoing sexual or physical abuse, or multiple single traumas. Risky sexual behavior, suicidal ideation, and elevated perpetration of violence were most prominent among those with ongoing abuse exposure, although a single exposure to interpersonal violence during adolescence was sufficient for some risky behaviors. Major depression (MDD) and posttraumatic stress disorder (PTSD) were associated with many of the behaviors, and may serve to heighten risk.
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Affiliation(s)
- Bonnie L Green
- Department of Psychiatry, Georgetown University Medical School, Washington, DC, USA.
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41
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Abstract
The symptomatology of patients suffering in the aftermath of severe and prolonged traumatization is not entirely covered by the diagnostic criteria of post-traumatic stress disorder (PTSD). Consequently, the concept of complex PTSD was proposed, including symptoms of affective dysregulation, dissociation and somatization, alterations in self-perception, altered relationships with others, and altered systems of meaning. Thereby, a variety of symptoms usually classified as co-morbid disorders are combined in a single etiological model. The whole symptomatology is considered as more or less effective adaptation strategies and not primarily as deficits. This understand-ing of the underlying etiology in subjects with complex traumatization opens perspectives for new psychotherapeutic treatment strategies which have already shown effectiveness in daily practice.
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Affiliation(s)
- M Sack
- Abteilung Psychosomatik und Psychotherapie, Medizinische Hochschule Hannover.
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Abstract
Community mental health clinicians are likely to find their case loads composed of women who have complicated trauma histories. In response to the absence of comprehensive treatment for trauma survivors within the community mental health system, an alternative model, Overcoming Pain and Adversity in Life (OPAL) is offered. As an intensive treatment program, OPAL is structured in a triphase format to accommodate the individual needs of each woman and to promote symptom reduction and/or resolution.
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Affiliation(s)
- Nicole D Chaikin
- Institute for Graduate Clinical Psychology, Widener University, Chester, PA, USA
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Spirito A, Valeri S, Boergers J, Donaldson D. Predictors of continued suicidal behavior in adolescents following a suicide attempt. J Clin Child Adolesc Psychol 2003; 32:284-9. [PMID: 12679287 DOI: 10.1207/s15374424jccp3202_14] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Describes adolescents who attempt suicide and their risk for ongoing suicidal behavior. Fifty-eight adolescents (53 female) who attempted suicide received a baseline evaluation that was analyzed to identify factors that were associated with continued suicidal ideation and reattempt. At a 3-month follow-up assessment, 45% reported continued suicidal ideation and 12% reported a repeat attempt. Baseline measures of family functioning, feelings of hopelessness, and abilities to regulate affect were associated with suicidal ideation at follow-up but not as strongly as depressed mood. After controlling for depressive symptoms, the association between family functioning and continued suicidal behavior was no longer significant. Depressed mood at baseline was most strongly associated with both continued suicidal ideation and reattempt.
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Affiliation(s)
- Anthony Spirito
- Brown Medical School and Rhode Island Hospital, Providence, Rhode Island, USA.
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