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Malhotra B, Jones LC, Spooner H, Levy C, Kaimal G, Williamson JB. A conceptual framework for a neurophysiological basis of art therapy for PTSD. Front Hum Neurosci 2024; 18:1351757. [PMID: 38711802 PMCID: PMC11073815 DOI: 10.3389/fnhum.2024.1351757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 03/28/2024] [Indexed: 05/08/2024] Open
Abstract
Post-traumatic stress disorder (PTSD) is a heterogeneous condition that affects many civilians and military service members. Lack of engagement, high dropout rate, and variable response to psychotherapy necessitates more compelling and accessible treatment options that are based on sound neuroscientific evidence-informed decision-making. Art therapy incorporates elements proven to be effective in psychotherapy, such as exposure, making it a potentially valuable treatment option. This conceptual paper aims to inform the neurophysiological rationale for the use of art therapy as a therapeutic approach for individuals with PTSD. A narrative synthesis was conducted using literature review of empirical research on the neurophysiological effects of art therapy, with supporting literature on neuroaesthetics and psychotherapies to identify art therapy factors most pertinent for PTSD. Findings were synthesized through a proposed framework based on the triple network model considering the network-based dysfunctions due to PTSD. Art therapy's active components, such as concretization and metaphor, active art engagement, emotion processing and regulation, perspective taking and reframing, and therapeutic alliance, may improve symptoms of PTSD and prompt adaptive brain functioning. Given the scarcity of rigorous studies on art therapy's effectiveness and mechanisms of alleviating PTSD symptoms, the suggested framework offers a neurophysiological rationale and a future research agenda to investigate the impact of art therapy as a therapeutic approach for individuals with PTSD.
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Affiliation(s)
- Bani Malhotra
- Department of Creative Arts Therapies, Drexel University, Philadelphia, PA, United States
| | - Laura C. Jones
- Brain Rehabilitation Research Center, North Florida/South Georgia Veterans Affairs Medical Center, Gainesville, FL, United States
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
| | - Heather Spooner
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. in support of Creative Forces: NEA Military Healing Arts Network, Bethesda, MD, United States
- Center of Arts in Medicine, University of Florida, Gainesville, FL, United States
| | - Charles Levy
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. in support of Creative Forces: NEA Military Healing Arts Network, Bethesda, MD, United States
| | - Girija Kaimal
- Department of Creative Arts Therapies, Drexel University, Philadelphia, PA, United States
| | - John B. Williamson
- Brain Rehabilitation Research Center, North Florida/South Georgia Veterans Affairs Medical Center, Gainesville, FL, United States
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
- Center for OCD, Anxiety and Related Disorders, Department of Psychiatry, University of Florida, Gainesville, FL, United States
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2
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Stingl M, Sammer G, Hanewald B, Zinsser F, Tucha O, Pape VR. Constant installation of present orientation and safety (CIPOS) - subjective and physiological effects of an ultrashort-term intervention combining both stabilizing and confrontational elements. Front Psychol 2022; 13:1035371. [PMID: 36389546 PMCID: PMC9665111 DOI: 10.3389/fpsyg.2022.1035371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 10/11/2022] [Indexed: 09/19/2023] Open
Abstract
Objectives Constant Installation of Present Orientation and Safety (CIPOS) is a Eye Movements Desensitization and Reprocessing (EMDR)-derived technique, which is often used to prepare for the treatment of post-traumatic stress disorder (PTSD). It differs from the latter by involving cyclically recurring exercises in reorientation to the present, interspersed between brief periods of exposure to the traumatic material.While EMDR is well established as a therapeutic method, the efficacy and mechanisms of action of CIPOS have not been investigated so far. In this pilot study, an experimental setting was used to record the subjective and physiological effects of the CIPOS intervention compared to a control condition with pure mental exposition. Methods The study was performed on 30 healthy volunteers aged from 20 to 30 years. Distress was induced using audio files of subjectively stressful situations. Subjective distress was measured via the Subjective Units of Distress Scale (SUD), while physiological indicators (noise-induced startle reflex, skin conductance level) were used as measures for objective stress. For each condition, pre- and post-intervention comparisons were calculated. Results In both groups, startle reflex potentiation and mean skin conductance level significantly decreased. In the group with CIPOS intervention, but not in the control group, a significant decrease in the SUD value was found. Conclusion and significance The results show that the CIPOS technique is as effective as pure mental exposition in reducing physiological stress. In addition, a superiority in reducing subjective distress (indicating a simplified reassessment of the stressful material) was found compared to pure mental exposition. Possible explanations of these effects are discussed.
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Affiliation(s)
- Markus Stingl
- Center for Psychiatry and Psychotherapy, Justus-Liebig-University Giessen, Giessen, Germany
| | - Gebhard Sammer
- Center for Psychiatry and Psychotherapy, Justus-Liebig-University Giessen, Giessen, Germany
| | - Bernd Hanewald
- Center for Psychiatry and Psychotherapy, Justus-Liebig-University Giessen, Giessen, Germany
| | - Franziska Zinsser
- Center for Psychiatry and Psychotherapy, Justus-Liebig-University Giessen, Giessen, Germany
| | - Oliver Tucha
- Clinic and Policlinic for Psychiatry and Psychotherapy, University of Rostock, Rostock, Germany
| | - Valeska Reichel Pape
- Center for Psychiatry and Psychotherapy, Justus-Liebig-University Giessen, Giessen, Germany
- Clinic and Policlinic for Psychiatry and Psychotherapy, University of Rostock, Rostock, Germany
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3
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Muñoz-Rivas M, Bellot A, Montorio I, Ronzón-Tirado R, Redondo N. Profiles of Emotion Regulation and Post-Traumatic Stress Severity among Female Victims of Intimate Partner Violence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136865. [PMID: 34206787 PMCID: PMC8297086 DOI: 10.3390/ijerph18136865] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 11/26/2022]
Abstract
Emotional dysregulation is a construct that has drawn substantial attention as a transdiagnostic contributing factor to the loss of health. Intimate partner violence (IPV) is a term used to describe physical, psychological, or sexual assault of a spouse or sexual partner. The aim of the study was to determine the variability of emotional dysregulation among women with different types of IPV revictimization and post-traumatic stress. The cross-sectional survey included 120 women attended by the Integrated Monitoring System of Gender Violence of Madrid, Spain, due to a gender violence complaint. The presence of post-traumatic stress disorder (DSM 5 criteria), emotional dysregulation (Emotional Processing Scale (EPS)), childhood trauma, and type of revictimization were evaluated. Cluster analysis found three profiles of emotional regulation: Emotionally Regulated, Avoidance/Non-Impoverished, and Emotional Overwhelm. The results showed that the Emotional Overwhelm group was characterized by a general dysregulation of emotional experiences and a greater intensity of post-traumatic stress symptoms. In addition, women who have suffered several episodes of IPV by different partners showed a differential pattern of emotional regulation than the rest of the victims that entailed greater psychopathology. Findings confirm that emotional dysregulation is a critical pathway to the decrease of health among IPV victims.
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Kwon A, Lee HS, Lee SH. The Mediation Effect of Hyperarousal Symptoms on the Relationship Between Childhood Physical Abuse and Suicidal Ideation of Patients With PTSD. Front Psychiatry 2021; 12:613735. [PMID: 33841200 PMCID: PMC8032896 DOI: 10.3389/fpsyt.2021.613735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 03/03/2021] [Indexed: 12/11/2022] Open
Abstract
Objective: This study examined the relationship of childhood physical abuse, posttraumatic stress disorder (PTSD), depression, and suicide in patients with PTSD through path analysis. Materials and Methods: A total of 114 patients with PTSD (36 men and 78 women) were recruited and completed psychological assessments including the Childhood Trauma Questionnaire, the scale for suicidal ideation, the clinician-administered PTSD scale for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, the PTSD checklist, and the Hospital Anxiety and Depression Scale. Structural equation modeling was used to evaluate the results. We developed a model including childhood physical abuse experience as the causal variable, suicidal ideation as a result variable, and PTSD and depression as mediation variables. PTSD symptoms were divided into four clusters [intrusion, avoidance, negative cognition and mood, and altered arousal and reactivity (hyperarousal)] to determine predictive power for suicide. Results: PTSD symptoms fully mediated the relationship between childhood physical abuse and suicidal ideation. Furthermore, PTSD symptoms fully mediated the relationship between childhood physical abuse and depression. Among the PTSD symptoms, hyperarousal was the only symptom cluster that mediated the relationship between childhood physical abuse and suicidal ideation. The symptom clusters of negative cognition and mood as well as hyperarousal mediated the relationship between childhood physical abuse and depression. Conclusions: This study presents a link between childhood physical abuse and current symptoms in patients with PTSD, and highlights specific PTSD symptom clusters (i.e., hyperarousal, negative cognition and mood) that may increase the risk for psychopathology later in life.
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Affiliation(s)
- Aeran Kwon
- Department of Social Welfare and Counseling, Chodang University, Muan, South Korea
| | - Hyun Seo Lee
- Clinical Emotion and Cognition Research Laboratory, Inje University, Goyang, South Korea
| | - Seung-Hwan Lee
- Clinical Emotion and Cognition Research Laboratory, Inje University, Goyang, South Korea.,Department of Psychiatry, Inje University, Ilsan-Paik Hospital, Goyang, South Korea
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5
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Butler N, Quigg Z, Bellis MA. Cycles of violence in England and Wales: the contribution of childhood abuse to risk of violence revictimisation in adulthood. BMC Med 2020; 18:325. [PMID: 33190642 PMCID: PMC7667802 DOI: 10.1186/s12916-020-01788-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 09/17/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Interpersonal violence is a leading cause of death and disability globally, has immediate and long-term impacts on individuals' health and wellbeing, and impacts global health care expenditures and national economies. A public health approach to violence prevention is crucial, and addressing risk factors is a key priority. Global research has demonstrated that childhood adversity increases risk of a range of poor outcomes across the lifecourse. This study examined the association between being a victim of child abuse and the risk of physical assault (PA), intimate partner violence (IPV), and sexual violence (SV) victimisation in adulthood. METHODS Data from a nationally representative survey of household residents (adults aged 16 to 59 years; n = 21,845) was analysed. Types of child abuse examined included physical, sexual, and psychological abuse and witnessing domestic violence. Logistic regressions examined the independent relationships between child abuse types, experiencing multiple types, and adulthood violence outcomes. RESULTS Most individual types of child abuse were significantly associated with each adulthood violence outcome, after controlling for sociodemographics and other abuse types. Compared to individuals who experienced no abuse in childhood, those who experienced one form of abuse were over twice as likely to experience PA in the past year and three times as likely to have experienced IPV and/or SV since age 16 years, whilst individuals who experienced multiple types were three, six, and seven times more likely to experience PA, IPV, and SV, respectively. After controlling for sociodemographics and multi-type childhood victimisation, the type or combination of types which remained significant differed by violence outcome; child psychological and physical abuse were significantly associated with IPV; psychological and sexual abuse with SV; and psychological abuse with PA. CONCLUSIONS Prevention of child abuse is an important goal, and evidence from the current study suggests such efforts will have a downstream effect on preventing interpersonal violence across the lifecourse. With adulthood victimisation likely to compound the already detrimental effects of childhood abuse, and given that many associated outcomes also represent adversities for the next generation, breaking the cycle of violence should be a public health priority.
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Affiliation(s)
- Nadia Butler
- Public Health Institute, Liverpool John Moores University, 3rd Floor Exchange Station, Tithebarn Street, Liverpool, L2 2QP, UK.
| | - Zara Quigg
- Public Health Institute, Liverpool John Moores University, 3rd Floor Exchange Station, Tithebarn Street, Liverpool, L2 2QP, UK
| | - Mark A Bellis
- College of Health and Behavioural Sciences, Bangor University, Bangor, UK
- Policy and International Health Directorate, Public Health Wales, Clwydian House, Wrexham, UK
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Lanius RA, Terpou BA, McKinnon MC. The sense of self in the aftermath of trauma: lessons from the default mode network in posttraumatic stress disorder. Eur J Psychotraumatol 2020; 11:1807703. [PMID: 33178406 PMCID: PMC7594748 DOI: 10.1080/20008198.2020.1807703] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Trauma can profoundly affect the sense of self, where both cognitive and somatic disturbances to the sense of self are reported clinically by individuals with posttraumatic stress disorder (PTSD). These disturbances are captured eloquently by clinical accounts, such as, 'I do not know myself anymore,' 'I will never be able to experience normal emotions again,' and, 'I feel dead inside.' Self-related thoughts and experiences are represented neurobiologically by a large-scale, cortical network located along the brain's mid-line and referred to as the default mode network (DMN). Recruited predominantly during rest in healthy participants, the DMN is also active during self-referential and autobiographical memory processing - processes which, collectively, are thought to provide the foundation for a stable sense of self that persists across time and may be available for conscious access. In participants with PTSD, however, the DMN shows substantially reduced resting-state functional connectivity as compared to healthy individuals, with greater reductions associated with heightened PTSD symptom severity. Critically, individuals with PTSD describe frequently that their traumatic experiences have become intimately linked to their perceived sense of self, a perception which may be mediated, in part, by alterations in the DMN. Accordingly, identification of alterations in the functional connectivity of the DMN during rest, and during subliminal, trauma-related stimulus conditions, has the potential to offer critical insight into the dynamic interplay between trauma- and self-related processing in PTSD. Here, we discuss DMN-related alterations during these conditions, pointing further towards the clinical significance of these findings in relation to past- and present-centred therapies for the treatment of PTSD.
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Affiliation(s)
- Ruth A Lanius
- Department of Neuroscience, Western University, London, Ontario, Canada.,Department of Psychiatry, Western University, London, Ontario, Canada.,Imaging Division, Lawson Health Research Institute, London, Ontario, Canada
| | - Braeden A Terpou
- Department of Neuroscience, Western University, London, Ontario, Canada
| | - Margaret C McKinnon
- Mood Disorders Program, St. Joseph's Healthcare, Hamilton, Ontario, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Homewood Research Institute, Guelph, Ontario, Canada
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7
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Terpou BA, Densmore M, Théberge J, Frewen P, McKinnon MC, Nicholson AA, Lanius RA. The hijacked self: Disrupted functional connectivity between the periaqueductal gray and the default mode network in posttraumatic stress disorder using dynamic causal modeling. NEUROIMAGE-CLINICAL 2020; 27:102345. [PMID: 32738751 PMCID: PMC7394966 DOI: 10.1016/j.nicl.2020.102345] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 12/21/2022]
Abstract
Posttraumatic stress disorder (PTSD) shows altered effective connectivity dynamics. Modeling between the periaqueductal gray (PAG) and the default mode network (DMN). In PTSD, stronger excitatory effective connectivity from the PAG towards the DMN. Trauma-related/neutral stimulus modulations to effective connectivity are compared. In PTSD, trauma-related stimulus modulations differ significantly to the controls.
Self-related processes define assorted self-relevant or social-cognitive functions that allow us to gather insight and to draw inferences related to our own mental conditions. Self-related processes are mediated by the default mode network (DMN), which, critically, shows altered functionality in individuals with posttraumatic stress disorder (PTSD). In PTSD, the midbrain periaqueductal gray (PAG) demonstrates stronger functional connectivity with the DMN [i.e., precuneus (PCN), medial prefrontal cortex (mPFC)] as compared to healthy individuals during subliminal, trauma-related stimulus processing. Here, we analyzed the directed functional connectivity between the PAG and the PCN, as well as between the PAG and the mPFC to more explicitly characterize the functional connectivity we have observed previously on the corresponding sample and paradigm. We evaluated three models varying with regard to context-dependent modulatory directions (i.e., bi-directional, bottom-up, top-down) among individuals with PTSD (n = 26) and healthy participants (n = 20), where Bayesian model selection was used to identify the most optimal model for each group. We then compared the effective connectivity strength for each parameter across the models and between our groups using Bayesian model averaging. Bi-directional models were found to be favoured across both groups. In PTSD, we revealed the PAG to show stronger excitatory effective connectivity to the PCN, as well as to the mPFC as compared to controls. In PTSD, we further demonstrated that PAG-mediated effective connectivity to the PCN, as well as to the mPFC were modulated more strongly during subliminal, trauma-related stimulus conditions as compared to controls. Clinical disturbances towards self-related processes are reported widely by participants with PTSD during trauma-related stimulus processing, where altered functional connectivity directed by the PAG to the DMN may elucidate experiential links between self- and trauma-related processing in traumatized individuals.
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Affiliation(s)
- Braeden A Terpou
- Department of Neuroscience, Western University, London, ON, Canada.
| | - Maria Densmore
- Imaging Division, Lawson Health Research Institute, London, ON, Canada; Department of Psychiatry, Western University, London, ON, Canada.
| | - Jean Théberge
- Imaging Division, Lawson Health Research Institute, London, ON, Canada; Department of Psychiatry, Western University, London, ON, Canada; Department of Medical Imaging, Western University, London, ON, Canada; Department of Medical Biophysics, Western University, London, ON, Canada; Department of Diagnostic Imaging, St. Joseph's Healthcare, London, ON, Canada.
| | - Paul Frewen
- Department of Neuroscience, Western University, London, ON, Canada; Department of Psychiatry, Western University, London, ON, Canada; Department of Psychology, Western University, London, ON, Canada.
| | - Margaret C McKinnon
- Mood Disorders Program, St. Joseph's Healthcare, Hamilton, ON, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Homewood Research Institute, Guelph, ON, Canada.
| | - Andrew A Nicholson
- Department of Cognition, Emotion, and Methods in Psychology, University of Vienna, Wien, Austria.
| | - Ruth A Lanius
- Department of Neuroscience, Western University, London, ON, Canada; Imaging Division, Lawson Health Research Institute, London, ON, Canada; Department of Psychiatry, Western University, London, ON, Canada.
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8
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Ross MC, Cisler JM. Altered large-scale functional brain organization in posttraumatic stress disorder: A comprehensive review of univariate and network-level neurocircuitry models of PTSD. Neuroimage Clin 2020; 27:102319. [PMID: 32622316 PMCID: PMC7334481 DOI: 10.1016/j.nicl.2020.102319] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 12/31/2022]
Abstract
Classical neural circuitry models of posttraumatic stress disorder (PTSD) are largely derived from univariate activation studies and implicate the fronto-limbic circuit as a main neural correlate of PTSD symptoms. Though well-supported by human neuroimaging literature, these models are limited in their ability to explain the widely distributed neural and behavioral deficits in PTSD. Emerging interest in the application of large-scale network methods to functional neuroimaging provides a new opportunity to overcome such limitations and conceptualize the neural circuitry of PTSD in the context of network patterns. This review aims to evaluate both the classical neural circuitry model and a new, network-based model of PTSD neural circuitry using a breadth of functional brain organization research in subjects with PTSD. Taken together, this literature suggests global patterns of reduced functional connectivity (FC) in PTSD groups as well as altered FC targets that reside disproportionately in canonical functional networks, especially the default mode network. This provides evidence for an integrative model that includes elements of both the classical models and network-based models to characterize the neural circuitry of PTSD.
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Affiliation(s)
- Marisa C Ross
- Neuroscience and Training Program, University of Wisconsin-Madison, United States; Neuroscience and Public Policy Program, University of Wisconsin-Madison, United States.
| | - Josh M Cisler
- Neuroscience and Training Program, University of Wisconsin-Madison, United States; Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, United States
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9
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Strøm IF, Kristian Hjemdal O, Myhre MC, Wentzel-Larsen T, Thoresen S. The Social Context of Violence: A Study of Repeated Victimization in Adolescents and Young Adults. JOURNAL OF INTERPERSONAL VIOLENCE 2020; 35:2210-2235. [PMID: 29294736 PMCID: PMC7221456 DOI: 10.1177/0886260517696867] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Multiple factors may influence the risk of exposure to childhood violence and repeated victimization, although most research has focused on individual rather than contextual factors. Moreover, it is unclear whether family background factors associated with exposure to childhood violence also are associated with revictimization in young adulthood. This article investigates individual and contextual factors associated with childhood abuse and revictimization. Data from a community telephone survey, collected at two different time points (N = 1,011, 16-33 years of age), were used. Logistic regression analysis was applied to analyze family background factors in childhood violence-exposed cases and non-exposed controls. Similar analyses were conducted for the relationship of individual and contextual variables in the revictimized and the non-revictimized groups. The adjusted analyses showed that social problems (≥2 or more social problems: odds ratio [OR] = 2.89, 95% confidence interval [CI] = [1.41, 5.94]) and frequent binge drinking (OR = 1.21, 95% CI = [1.05, 1.40]) were significantly associated with repeated victimization whereas social support decreased the odds (OR = 0.74, 95% CI = [0.55, 0.99]). Family problems and low family cohesion growing up (although measured at Wave 2) were significantly associated with childhood exposure to violence, but not with revictimization. Our findings emphasizes that it is useful to separate factors associated with childhood abuse from factors related to revictimization to identify current ecological aspects that can be addressed to prevent further abuse.
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Affiliation(s)
- Ida Frugård Strøm
- Norwegian Centre for Violence and
Traumatic Stress Studies, Oslo, Norway
| | | | - Mia C. Myhre
- Norwegian Centre for Violence and
Traumatic Stress Studies, Oslo, Norway
- Oslo University Hospital, Norway
| | - Tore Wentzel-Larsen
- Norwegian Centre for Violence and
Traumatic Stress Studies, Oslo, Norway
- Center for Child and Adolescent Mental
Health, Eastern and Southern Norway, Norway
| | - Siri Thoresen
- Norwegian Centre for Violence and
Traumatic Stress Studies, Oslo, Norway
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10
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Ghafoerkhan RS, van Heemstra HE, Scholte WF, van der Kolk JRJ, ter Heide JJF, de la Rie SM, Verhaak LM, Snippe E, Boelen PA. Feasibility and predictors of change of narrative exposure therapy for displaced populations: a repeated measures design. Pilot Feasibility Stud 2020; 6:69. [PMID: 32477587 PMCID: PMC7243314 DOI: 10.1186/s40814-020-00613-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 05/04/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Displaced victims of interpersonal violence, such as refugees, asylum seekers, and victims of sexual exploitation, are growing in numbers and are often suffering from a post-traumatic stress disorder (PTSD). At the same time, these victims are known to benefit less from trauma-focused therapy (TFT) and to be less compliant to treatment. The objective of this paper is to describe the rationale and research protocol of an ongoing trial that aims to evaluate different variables that might influence the feasibility of TFT for the study population. Specifically, perceived daily stress, emotion regulation, and mood are investigated as predictors of change in PTSD symptoms during a trauma-focused therapy (narrative exposure therapy (NET)). The feasibility of administering measures tapping these constructs repeatedly during treatment will also be evaluated. METHODS/DESIGN Using an observational treatment design, 80 displaced victims of interpersonal violence will be measured before, during, and after partaking in NET. Several questionnaires tapping PTSD plus the aforementioned possible predictors of PTSD change will be administered: Post-traumatic Stress Disorder Checklist-5, Perceived Stress Scale, Difficulties in Emotion Regulation Scale-18 (pre-test, post-test, and follow-up),subscale impulsivity of the Difficulties in Emotion Regulation Scale-18, Perceived Stress Scale short version, Primary Care Post-traumatic Stress Disorder and a single Mood item (each session). Multilevel modelling will be used to examine the relation between the possible predictors and treatment outcome. DISCUSSION The present study is the first to examine the interplay of facilitating and interfering factors possibly impacting treatment feasibility and effectiveness in displaced victims of interpersonal violence with PTSD receiving NET, using repeated measures. The current study can help to improve future treatment based on individual characteristics. TRIAL REGISTRATION Netherlands Trial Register: NTR7353, retrospectively registered. Date of registration: July 11, 2018.
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Affiliation(s)
- Rina S. Ghafoerkhan
- ARQ National Psychotrauma Centre, Nienoord 5, 1112 XE Diemen, The Netherlands
- Department of Clinical Psychology, Utrecht University, Heidelberglaan 1, 3584 CS Utrecht, The Netherlands
| | - Henriette E. van Heemstra
- ARQ National Psychotrauma Centre, Nienoord 5, 1112 XE Diemen, The Netherlands
- Department of Clinical Psychology, Utrecht University, Heidelberglaan 1, 3584 CS Utrecht, The Netherlands
| | - Willem F. Scholte
- ARQ National Psychotrauma Centre, Nienoord 5, 1112 XE Diemen, The Netherlands
- Dept. of Psychiatry, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Laguna Collective, Reigerstraat 16, 3816 AX Amersfoort, The Netherlands
| | - Joriene R. J. van der Kolk
- Laguna Collective, Reigerstraat 16, 3816 AX Amersfoort, The Netherlands
- Sinai Centrum, Arthur van Schendelstraat 800, 3511 ML Utrecht, The Netherlands
| | | | - Simone M. de la Rie
- ARQ National Psychotrauma Centre, Nienoord 5, 1112 XE Diemen, The Netherlands
| | - Linda M. Verhaak
- ARQ National Psychotrauma Centre, Nienoord 5, 1112 XE Diemen, The Netherlands
| | - Evelien Snippe
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Paul A. Boelen
- ARQ National Psychotrauma Centre, Nienoord 5, 1112 XE Diemen, The Netherlands
- Department of Clinical Psychology, Utrecht University, Heidelberglaan 1, 3584 CS Utrecht, The Netherlands
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11
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Lawson DM, Skidmore ST, Akay‐Sullivan S. The Influence of Trauma Symptoms on the Therapeutic Alliance Across Treatment. JOURNAL OF COUNSELING AND DEVELOPMENT 2020. [DOI: 10.1002/jcad.12297] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- David M. Lawson
- Department of Counselor Education, Sam Houston State University
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12
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Suomi A, Evans L, Rodgers B, Taplin S, Cowlishaw S. Couple and family therapies for post-traumatic stress disorder (PTSD). Cochrane Database Syst Rev 2019; 12:CD011257. [PMID: 31797352 PMCID: PMC6890534 DOI: 10.1002/14651858.cd011257.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) refers to an anxiety or trauma- and stressor-related disorder that is linked to personal or vicarious exposure to traumatic events. PTSD is associated with a range of adverse individual outcomes (e.g. poor health, suicidality) and significant interpersonal problems which include difficulties in intimate and family relationships. A range of couple- and family-based treatments have been suggested as appropriate interventions for families impacted by PTSD. OBJECTIVES The objectives of this review were to: (1) assess the effects of couple and family therapies for adult PTSD, relative to 'no treatment' conditions, 'standard care', and structured or non-specific individual or group psychological therapies; (2) examine the clinical characteristics of studies that influence the relative effects of these therapies; and (3) critically evaluate methodological characteristics of studies that may bias the research findings. SEARCH METHODS We searched MEDLINE (1950- ), Embase (1980- ) and PsycINFO (1967- ) via the Cochrane Common Mental Disorders Controlled Trials Register (CCMDCTR) to 2014, then directly via Ovid after this date. We also searched the Cochrane Central Register of Controlled Trials (CENTRAL) via the Cochrane Library. We conducted supplementary searches of PTSDPubs (all available years) (this database is formerly known as PILOTS (Published International Literature on Traumatic Stress)). We manually searched the early editions of key journals and screened the reference lists and bibliographies of included studies to identify other relevant research. We also contacted the authors of included trials for unpublished information. Studies have been incorporated from searches to 3 March 2018. SELECTION CRITERIA Eligible studies were randomised controlled trials (RCTs) of couple or family therapies for PTSD in adult samples. The review considered any type of therapy that was intended to treat intact couples or families where at least one adult family member met criteria for PTSD. It was required that participants were diagnosed with PTSD according to recognised classification systems. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures prescribed by Cochrane. Three review authors screened all titles and abstracts and two authors independently extracted data from each study deemed eligible and assessed the risk of bias for each study. We used odds ratios (OR) to summarise the effects of interventions for dichotomous outcomes, and standardised mean differences (SMD) to summarise post-treatment between-group differences on continuous measures. MAIN RESULTS We included four trials in the review. Two studies examined the effects of cognitive behavioural conjoint/couple's therapy (CBCT) relative to a wait list control condition, although one of these studies only reported outcomes in relation to relationship satisfaction. One study examined the effects of structural approach therapy (SAT) relative to a PTSD family education (PFE) programme; and one examined the effects of adjunct behavioural family therapy (BFT) but failed to report any outcome variables in sufficient detail - we did not include it in the meta-analysis. One trial with 40 couples (80 participants) showed that CBCT was more effective than wait list control in reducing PTSD severity (SMD -1.12, 95% CI -1.79 to -0.45; low-quality evidence), anxiety (SMD -0.93, 95% CI -1.58 to -0.27; very low-quality evidence) and depression (SMD -0.66, 95% CI -1.30 to -0.02; very low-quality evidence) at post-treatment for the primary patient with PTSD. Data from two studies indicated that treatment and control groups did not differ significantly according to relationship satisfaction (SMD 1.07, 95% CI -0.17 to 2.31; very low-quality evidence); and one study showed no significant differences regarding depression (SMD 0.28, 95% CI -0.35 to 0.90; very low-quality evidence) or anxiety symptoms (SMD 0.15, 95% CI -0.47 to 0.77; very low-quality evidence) for the partner of the patient with PTSD. One trial with 57 couples (114 participants) showed that SAT was more effective than PFE in reducing PTSD severity for the primary patient (SMD -1.32, 95% CI -1.90 to -0.74; low-quality evidence) at post-treatment. There was no evidence of differences on the other outcomes, including relationship satisfaction (SMD 0.01, 95% CI -0.51 to 0.53; very low-quality evidence), depression (SMD 0.21, 95% CI -0.31 to 0.73; very low-quality evidence) and anxiety (SMD -0.16, 95% CI -0.68 to 0.36; very low-quality evidence) for intimate partners; and depression (SMD -0.28, 95% CI -0.81 to 0.24; very low-quality evidence) or anxiety (SMD -0.34, 95% CI -0.87 to 0.18; very low-quality evidence) for the primary patient. Two studies reported on adverse events and dropout rates, and no significant differences between groups were observed. Two studies were classified as having a 'low' or 'unclear' risk of bias in most domains, except for performance bias that was rated 'high'. Two studies had significant amounts of missing information resulting in 'unclear' risk of bias. There were too few studies available to conduct subgroup analyses. AUTHORS' CONCLUSIONS There are few trials of couple-based therapies for PTSD and evidence is insufficient to determine whether these offer substantive benefits when delivered alone or in addition to psychological interventions. Preliminary RCTs suggest, however, that couple-based therapies for PTSD may be potentially beneficial for reducing PTSD symptoms, and there is a need for additional trials of both adjunctive and stand-alone interventions with couples or families which target reduced PTSD symptoms, mental health problems of family members and dyadic measures of relationship quality.
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Affiliation(s)
- Aino Suomi
- Australian Catholic UniversityInstitute of Child Protection StudiesCanberraAustralia
- The University of MelbourneMelbourne Graduate School of EducationMelbourneAustralia
| | - Lynette Evans
- La Trobe UniversitySchool of Psychological Studies, Faculty of Science, Technology and EngineeringMelbourneAustralia
| | - Bryan Rodgers
- The Australian National UniversitySchool of Demography, ANU College of Arts and Social SciencesCanberraAustralia
| | - Stephanie Taplin
- Australian Catholic UniversityInstitute of Child Protection StudiesCanberraAustralia
| | - Sean Cowlishaw
- The University of MelbournePhoenix Australia Centre for Posttraumatic Mental Health, Department of PsychiatryMelbourneAustralia
- University of BristolBristol Medical SchoolBristolUK
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Pfaltz MC, Passardi S, Auschra B, Fares-Otero NE, Schnyder U, Peyk P. Are you angry at me? Negative interpretations of neutral facial expressions are linked to child maltreatment but not to posttraumatic stress disorder. Eur J Psychotraumatol 2019; 10:1682929. [PMID: 31762947 PMCID: PMC6853207 DOI: 10.1080/20008198.2019.1682929] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 08/30/2019] [Accepted: 09/25/2019] [Indexed: 12/23/2022] Open
Abstract
Background: Individuals with a high prevalence of child maltreatment, e.g. those with borderline personality disorder, tend to see neutral facial expressions as negative. Objective: Our aim was to assess whether this bias is present in individuals with posttraumatic stress disorder (PTSD) and whether it is linked to child maltreatment. Methods: Thirty-nine PTSD participants, 44 traumatized and 35 non-traumatized healthy controls watched 300 one-second movies showing 30 neutral and 270 emotional facial expressions, and indicated whether they interpreted each as a neutral or as one of nine emotional expressions. Results: PTSD individuals did not perform differently than the two control groups in the recognition and interpretation of neutral facial expressions (p's < .300). Higher levels of childhood sexual and emotional abuse, and physical neglect were linked to more interpretations of neutral facial expressions as contempt (p's < .043), and (for sexual abuse and physical neglect) to more interpretations of neutral facial expressions as anger (p's < .014). Comparisons of statistical model fits suggested that childhood sexual abuse was the most relevant predictor of recognition accuracy in our sample. Alexithymia, state dissociation, interpersonal trauma, and number of experienced trauma types were not associated with deficits in the interpretation of neutral expressions. Conclusions: Child maltreatment, especially sexual abuse, may shape the interpretation of neutral facial expressions. Future research should explore whether the observed biases extend to real-life situations. If so, therapists might improve the therapeutic relationship with patients with a history of child maltreatment by paying more attention to their own non-verbal communication and their patients' responses to it. Furthermore, similarly to individuals with high depressive and high social anxiety symptoms, facial expression recognition training might counteract negativity bias in individuals with a history of childhood (sexual and emotional) abuse, and (physical) neglect.
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Affiliation(s)
- Monique C Pfaltz
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Sandra Passardi
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Bianca Auschra
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Natalia E Fares-Otero
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ulrich Schnyder
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Peter Peyk
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Woerner J, Schleider JL, Overstreet C, Foster DW, Amstadter AB, Sartor CE. The role of drinking motives and perceived controllability of events in the association between college women's sexual assault victimization and binge drinking. Addict Behav 2019; 90:210-216. [PMID: 30445414 PMCID: PMC6324951 DOI: 10.1016/j.addbeh.2018.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 10/02/2018] [Accepted: 11/05/2018] [Indexed: 11/16/2022]
Abstract
Women with a history of sexual assault are at elevated risk for engaging in binge drinking. The aims of the current study are to investigate two types of drinking motives (coping and social) that potentially underlie the sexual assault-binge drinking link in a sample of female college drinkers (N = 691; 37.6% sexual assault prevalence), and to determine the extent to which the relationships between sexual assault history and each type of drinking motive depend on women's assumptions about the controllability of events. Conditional process analysis results indicated that women who experienced sexual assault (vs. those who did not) were more likely to report both coping and social drinking motives, which in turn, were both positively associated with increased binge drinking. Consistent with our hypothesis, results showed the relationship between sexual assault history and coping drinking motives was moderated by perceived controllability of events. Specifically, sexual assault victims reported high coping motives regardless of controllability of events. Nonvictims only reported high coping motives when their perceived controllability of events was low - comparable to coping motives of victims. This integrative approach affords a more comprehensive understanding of the context in which college women's binge drinking occurs, and offers insight into processes that could be targeted in interventions.
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Affiliation(s)
- Jacqueline Woerner
- Yale University School of Medicine, 389 Whitney Ave, New Haven, CT, United States.
| | - Jessica L Schleider
- Stony Brook University, Psychology B Building, Stony Brook, NY, United States
| | - Cassie Overstreet
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, 800 E Leigh, Richmond, VA, United States
| | - Dawn W Foster
- Yale University School of Medicine, 34 Park St, New Haven, CT, United States
| | - Ananda B Amstadter
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, 800 E Leigh, Richmond, VA, United States
| | - Carolyn E Sartor
- Yale University School of Medicine, 389 Whitney Ave, New Haven, CT, United States
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Jaffe AE, DiLillo D, Gratz KL, Messman-Moore TL. Risk for Revictimization Following Interpersonal and Noninterpersonal Trauma: Clarifying the Role of Posttraumatic Stress Symptoms and Trauma-Related Cognitions. J Trauma Stress 2019; 32:42-55. [PMID: 30748027 PMCID: PMC6599470 DOI: 10.1002/jts.22372] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 10/22/2018] [Accepted: 11/01/2018] [Indexed: 11/09/2022]
Abstract
One victimization experience can increase the risk for subsequent victimization, which is known as revictimization. The aims of this study were to build on sexual revictimization research by (a) broadening the understanding of revictimization to interpersonal (and potentially noninterpersonal) trauma generally and (b) gaining specificity in the mechanisms that underlie revictimization. Using a prospective multisite design, an ethnically and racially diverse sample of 453 young women from the community (age range: 18-25 years, 60.7% European American) completed an initial survey and at least one follow-up survey within the subsequent year. Participants completed self-report measures of trauma history, posttraumatic stress symptoms, and maladaptive posttraumatic cognitions. Structural equation models revealed that interpersonal revictimization was observed when controlling for past noninterpersonal trauma, odds ratio (OR) = 2.27, 95% CI [1.23, 4.18], and supported the role of posttraumatic stress symptoms as a mechanism underlying such revictimization, 95% CI of indirect effect (IE) [0.08, 0.51]. Additionally, a history of noninterpersonal trauma (controlling for past interpersonal trauma) increased risk of subsequent interpersonal victimization via posttraumatic stress symptoms, 95% CI of IE [0.01, 0.38]. Notably, however, when maladaptive cognitions were included as mediators in addition to posttraumatic stress symptoms, the only unique indirect effect was for the association between interpersonal trauma and risk of revictimization specifically through perceived threat of harm, 95% CI of IE [0.05, 0.20]. These findings suggest that efforts to reduce interpersonal revictimization should target maladaptive posttraumatic cognitions, particularly perceptions of threat in the environment.
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Affiliation(s)
- Anna E. Jaffe
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - David DiLillo
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
| | - Kim L. Gratz
- Department of Psychology, University of Toledo, Toledo, Ohio, USA
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Terpou BA, Densmore M, Théberge J, Thome J, Frewen P, McKinnon MC, Lanius RA. The Threatful Self: Midbrain Functional Connectivity to Cortical Midline and Parietal Regions During Subliminal Trauma-Related Processing in PTSD. CHRONIC STRESS (THOUSAND OAKS, CALIF.) 2019; 3:2470547019871369. [PMID: 32440598 PMCID: PMC7219912 DOI: 10.1177/2470547019871369] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 07/26/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND The innate alarm system consists of a subcortical network of interconnected midbrain, lower brainstem, and thalamic nuclei, which together mediate the detection of evolutionarily-relevant stimuli. The periaqueductal gray is a midbrain structure innervated by the innate alarm system that coordinates the expression of defensive states following threat detection. In participants with post-traumatic stress disorder, the periaqueductal gray displays overactivation during the subliminal presentation of trauma-related stimuli as well as altered resting-state functional connectivity. Aberrant functional connectivity is also reported in post-traumatic stress disorder for the default-mode network, a large-scale brain network recruited during self-referential processing and autobiographical memory. Here, research lacks investigation on the extent to which functional interactions are displayed between the midbrain and the large-scale cortical networks in post-traumatic stress disorder. METHODS Using a subliminal threat presentation paradigm, we investigated psycho-physiological interactions during functional neuroimaging in participants with post-traumatic stress disorder (n = 26) and healthy control subjects (n = 20). Functional connectivity of the periaqueductal gray was investigated across the whole-brain of each participant during subliminal exposure to trauma-related and neutral word stimuli. RESULTS As compared to controls during subliminal threat presentation, the post-traumatic stress disorder group showed significantly greater periaqueductal gray functional connectivity with regions of the default-mode network (i.e., angular gyrus, precuneus, superior frontal gyrus). Moreover, multiple regression analyses revealed that the functional connectivity between the periaqueductal gray and the regions of the default-mode network correlated positively to symptoms of avoidance and state dissociation in post-traumatic stress disorder. CONCLUSION Given that the periaqueductal gray engages the expression of defensive states, stronger midbrain functional coupling with the default-mode network may have clinical implications to self-referential and trauma-related processing in participants with post-traumatic stress disorder.
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Affiliation(s)
- Braeden A Terpou
- Department of Neuroscience, Western University, London, ON, Canada
| | - Maria Densmore
- Department of Psychiatry, Western University, London, ON, Canada
- Imaging Division, Lawson Health Research Institute, London, ON, Canada
| | - Jean Théberge
- Department of Psychiatry, Western University, London, ON, Canada
- Imaging Division, Lawson Health Research Institute, London, ON, Canada
- Department of Medical Biophysics, Western University, London, ON, Canada
| | - Janine Thome
- Department of Psychiatry, Western University, London, ON, Canada
- Department of Theoretical Neuroscience, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, BW, Germany
| | - Paul Frewen
- Department of Neuroscience, Western University, London, ON, Canada
- Department of Psychiatry, Western University, London, ON, Canada
- Department of Psychology, Western University, London, ON, Canada
| | - Margaret C McKinnon
- Mood Disorders Program, St. Joseph's Healthcare, Hamilton, ON, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Homewood Research Institute, Guelph, ON, Canada
| | - Ruth A Lanius
- Department of Neuroscience, Western University, London, ON, Canada
- Department of Psychiatry, Western University, London, ON, Canada
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Gilmore AK, Hahn CK, Jaffe AE, Walsh K, Moreland AD, Ward-Ciesielski EF. Suicidal ideation among adults with a recent sexual assault: Prescription opioid use and prior sexual assault. Addict Behav 2018; 85:120-124. [PMID: 29902682 DOI: 10.1016/j.addbeh.2018.05.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 05/28/2018] [Accepted: 05/29/2018] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Sexual assault (SA) is common, and recent sexual assault is associated with suicidal ideation and prescription opioid (PO) use. PO use is also associated with increased risk of suicidal ideation. The current study examined suicidal ideation among adults seeking medical and psychological follow-up care after a SA medical forensic examination based on PO use and prior SA. METHODS Adults (n = 60) who received a SA medical forensic exam at the emergency room within 120 h of a SA were invited to receive medical and psychological follow-up care, which included a questionnaire about current mental health symptoms. RESULTS Results from a linear regression model revealed that more acute stress symptoms were associated with higher suicidal ideation. Further, there was a significant association between PO use and suicidal ideation among those with a prior SA such that those with a prior SA and who used POs reported more severe suicidal ideation than those with a prior SA who did not use POs. CONCLUSIONS Routine screening at the emergency department for PO use and prior SA may help prevention efforts for suicide among adults who recently experienced SA.
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Affiliation(s)
- Amanda K Gilmore
- College of Nursing, Medical University of South Carolina, United States; Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, United States.
| | - Christine K Hahn
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, United States
| | - Anna E Jaffe
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, United States
| | - Kate Walsh
- Ferkauf Graduate School of Psychology, Yeshiva University, United States
| | - Angela D Moreland
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, United States
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Keating L, Muller RT, Classen CC. Changes in attachment organization, emotion dysregulation, and interpersonal problems among women in treatment for abuse. J Trauma Dissociation 2018; 19:247-266. [PMID: 28548624 DOI: 10.1080/15299732.2017.1331946] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Women who have experienced childhood abuse often have interpersonal difficulties. The current study examines whether changes in emotion dysregulation mediate the relationship between changes in attachment patterns and changes in interpersonal problems among women who completed treatment for the sequelae of childhood abuse. METHOD Participants were 36 women who completed a program targeting the psychological consequences of childhood maltreatment. At pre-and posttreatment, participants completed a projective assessment of adult attachment, and self-report measures of emotion dysregulation and interpersonal problems. RESULTS Changes in emotion dysregulation mediated the relationship between shifts toward resolved attachment and changes in interpersonal problems. Compared to participants who maintained their pretreatment attachment patterns, those who shifted toward a resolved pattern became significantly more able to clarify and describe their emotions. Improvements in these abilities were associated with decreased problems with being nonassertive, overly accommodating, self-sacrificing, and socially inhibited. Additionally, improvements in emotional clarity uniquely mediated the relationship between shifts to resolved attachment and reductions in problems with being domineering and intrusive. Moreover, decreased difficulty describing feelings uniquely mediated the relationship between shifts to resolved attachment and decreases in problems with being cold. CONCLUSIONS Among women who complete treatment for the sequelae of childhood abuse, shifts to resolved attachment were indirectly related to decreases in interpersonal problems through improved emotional processing.
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Affiliation(s)
- Leah Keating
- a Department of Psychology, Faculty of Health , York University , Toronto , Ontario , Canada
| | - Robert T Muller
- a Department of Psychology, Faculty of Health , York University , Toronto , Ontario , Canada
| | - Catherine C Classen
- b Women's College Hospital , Toronto , ON , Canada.,c Women's College Research Institute , Toronto , ON , Canada.,d Department of Psychiatry , University of Toronto , Toronto , ON , Canada.,e Trauma Recovery Center , San Francisco , California , USA
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Jones AC, Badour CL, Alex Brake C, Hood CO, Feldner MT. Facets of Emotion Regulation and Posttraumatic Stress: An Indirect Effect via Peritraumatic Dissociation. COGNITIVE THERAPY AND RESEARCH 2018; 42:497-509. [PMID: 32952232 DOI: 10.1007/s10608-018-9899-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Research suggests important associations between emotion regulation difficulties and posttraumatic stress disorder (PTSD) symptomology, with prospective studies indicating that emotion regulation difficulties may lead to increased PTSD symptoms. Peritraumatic dissociation is considered an important and consistent predictor of PTSD symptoms. The present study examines whether peritraumatic dissociation accounts for associations between facets of emotion regulation difficulties and PTSD symptoms. Adult women with a history of sexual victimization participated in an interview to assess past-month PTSD symptoms and self-report questionnaires to assess peritraumatic dissociation and emotion regulation difficulties. Results showed a partial indirect effect of three facets of emotion regulation difficulties (i.e., nonacceptance of negative emotional responses, limited access to emotion regulation strategies perceived as effective in the context of distress, and impulse control difficulties when experiencing negative emotions) on PTSD symptoms through peritraumatic dissociation. Reverse indirect effects models were also explored. The present study offers preliminary evidence that peritraumatic dissociation by traumatized individuals may signal the presence of specific emotion regulation deficits, which may indicate increased risk of heightened PTSD severity.
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Holmgreen L, Oswald DL. Men's Sexual Coerciveness, Perceptions of Women's Attachment, and Dating Preferences. VIOLENCE AND VICTIMS 2017; 32:935-952. [PMID: 28810935 DOI: 10.1891/0886-6708.vv-d-12-00133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This study examined whether sexually coercive men are uniquely drawn to certain attachment styles in women. Specifically, it employed an experimental design to investigate what sorts of inferences men draw about women based on women's attachment styles and whether a woman's attachment style may serve as an indicator of vulnerability, rendering sexually coercive men more attracted to some women than to others. One-hundred thirty-six college men completed a measure of sexual coerciveness and answered questions about personal ads experimentally manipulated for portrayed attachment style. Findings suggest that sexually coercive men may be more attracted to women with characteristics associated with sexual vulnerability. Additionally, men perceive women differently based on their attachment styles, and sexually coercive men may perceive women differently than do other men.
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Tennessee AM, Bradham TS, White BM, Simpson KN. The Monetary Cost of Sexual Assault to Privately Insured US Women in 2013. Am J Public Health 2017; 107:983-988. [PMID: 28426319 PMCID: PMC5425864 DOI: 10.2105/ajph.2017.303742] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To determine whether privately insured female rape victims were billed for charges associated with a specific rape in the United States. METHODS We examined 2013 de-identified patient data from Truven Analytics Health MarketScan database for an assault that occurred by using International Classification of Diseases, Ninth Revision, code E960.1. RESULTS Analysis of insurance providers' payment patterns for 1355 incident events to female victims aged between 16 and 61 years revealed that victims remit, on average, 14% or $948 of the rape cost, whereas insurance providers pay 86% or $5789 of the total cost. CONCLUSIONS Hospital billing procedures for privately insured victims of rape across the United States are not separate from billing procedures for privately insured nonrape patients. This standardized procedure leads hospitals to bill victims directly for services not paid under the victims' insurance policy. Public Health Implications. The Violence Against Women Act (passed in 1994, reauthorized in 2000, 2005, and 2013) must be amended to mandate that all costs incurred because of rape are not passed on to the victim.
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Affiliation(s)
- Ashley M Tennessee
- Ashley M. Tennessee and Brandi M. White are with the Department of Health Professions, Medical University of South Carolina, Charleston. Tamala S. Bradham is with the Center for Quality, Safety, and Risk Prevention, Vanderbilt University Medical Center, Nashville, TN. Kit N. Simpson is with the Department of Healthcare Leadership and Management, Medical University of South Carolina
| | - Tamala S Bradham
- Ashley M. Tennessee and Brandi M. White are with the Department of Health Professions, Medical University of South Carolina, Charleston. Tamala S. Bradham is with the Center for Quality, Safety, and Risk Prevention, Vanderbilt University Medical Center, Nashville, TN. Kit N. Simpson is with the Department of Healthcare Leadership and Management, Medical University of South Carolina
| | - Brandi M White
- Ashley M. Tennessee and Brandi M. White are with the Department of Health Professions, Medical University of South Carolina, Charleston. Tamala S. Bradham is with the Center for Quality, Safety, and Risk Prevention, Vanderbilt University Medical Center, Nashville, TN. Kit N. Simpson is with the Department of Healthcare Leadership and Management, Medical University of South Carolina
| | - Kit N Simpson
- Ashley M. Tennessee and Brandi M. White are with the Department of Health Professions, Medical University of South Carolina, Charleston. Tamala S. Bradham is with the Center for Quality, Safety, and Risk Prevention, Vanderbilt University Medical Center, Nashville, TN. Kit N. Simpson is with the Department of Healthcare Leadership and Management, Medical University of South Carolina
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Brown MJ, Masho SW, Perera RA, Mezuk B, Pugsley RA, Cohen SA. Sex Disparities in Adverse Childhood Experiences and HIV/STIs: Mediation of Psychopathology and Sexual Behaviors. AIDS Behav 2017; 21:1550-1566. [PMID: 27688144 PMCID: PMC5896316 DOI: 10.1007/s10461-016-1553-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
HIV and other sexually transmitted infections (STIs) are important public health challenges in the US. Adverse childhood experiences (ACEs), including abuse (emotional, physical or sexual), witnessing violence among household members, may have an effect on sexual behaviors, which increase the risk of HIV/STIs. The aim of this study was to examine the sex differences in the role of posttraumatic stress disorder (PTSD), major depression (MD), substance use disorders (SUDs), early sexual debut, and intimate partner violence (IPV) perpetration as mediators in the association between ACEs and HIV/STIs. Data were obtained from Wave 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions. Structural equation modeling was used to determine the role of PTSD, MD, SUDs, early sexual debut, and IPV perpetration as mediators in the relationships between ACEs and HIV/STIs. Differences and similarities existed in the mediational roles of psychopathology and sexual behaviors. For example, among men, MD fully mediated physical/psychological abuse (β = 0.0002; p = 0.012) and sexual abuse (β = 0.0002; p = 0.006), and HIV/STIs while among women, MD fully mediated physical/psychological abuse (β = 0.0005; p < 0.001) and parental violence (β = -0.0002; p = 0.012). Among men, IPV perpetration fully mediated sexual abuse (β = -0.0005; p = 0.012) and HIV/STIs while among women, IPV perpetration was not a statistically significant mediator. HIV/STI prevention and intervention programs should use a life course approach by addressing adverse childhood events among men and women and consider the sex differences in the roles of psychopathology and sexual behaviors.
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Affiliation(s)
- Monique J Brown
- College of Behavioral and Community Sciences, University of South Florida, 13301 Bruce B. Downs Blvd, MHC 2503, Tampa, FL, 33612, USA.
| | - Saba W Masho
- Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Robert A Perera
- Department of Biostatistics, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Briana Mezuk
- College of Behavioral and Community Sciences, University of South Florida, 13301 Bruce B. Downs Blvd, MHC 2503, Tampa, FL, 33612, USA
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
- Research Center for Group Dynamics, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - River A Pugsley
- Office of Epidemiology, Division of Disease Prevention, Virginia Department of Health, Richmond, VA, USA
| | - Steven A Cohen
- Health Studies, University of Rhode Island, Kingston, RI, USA
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Hyland P, Murphy J, Shevlin M, Vallières F, McElroy E, Elklit A, Christoffersen M, Cloitre M. Variation in post-traumatic response: the role of trauma type in predicting ICD-11 PTSD and CPTSD symptoms. Soc Psychiatry Psychiatr Epidemiol 2017; 52:727-736. [PMID: 28194504 DOI: 10.1007/s00127-017-1350-8] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 01/22/2017] [Indexed: 12/13/2022]
Abstract
PURPOSE The World Health Organization's 11th revision to the International Classification of Diseases manual (ICD-11) will differentiate between two stress-related disorders: PTSD and Complex PTSD (CPTSD). ICD-11 proposals suggest that trauma exposure which is prolonged and/or repeated, or consists of multiple forms, that also occurs under circumstances where escape from the trauma is difficult or impossible (e.g., childhood abuse) will confer greater risk for CPTSD as compared to PTSD. The primary objective of the current study was to provide an empirical assessment of this proposal. METHODS A stratified, random probability sample of a Danish birth cohort (aged 24) was interviewed by the Danish National Centre for Social Research (N = 2980) in 2008-2009. Data from this interview were used to generate an ICD-11 symptom-based classification of PTSD and CPTSD. RESULTS The majority of the sample (87.1%) experienced at least one of eight traumatic events spanning childhood and early adulthood. There was some indication that being female increased the risk for both PTSD and CPTSD classification. Multinomial logistic regression results found that childhood sexual abuse (OR = 4.98) and unemployment status (OR = 4.20) significantly increased risk of CPTSD classification as compared to PTSD. A dose-response relationship was observed between exposure to multiple forms of childhood interpersonal trauma and risk of CPTSD classification, as compared to PTSD. CONCLUSIONS Results provide empirical support for the ICD-11 proposals that childhood interpersonal traumatic exposure increases risk of CPTSD symptom development.
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Affiliation(s)
- Philip Hyland
- School of Business, National College of Ireland, IFSC, Mayor Street, Dublin 1, Ireland. .,Centre for Global Health, School of Psychology, Trinity College Dublin, College Green, Dublin 2, Ireland.
| | - Jamie Murphy
- Psychology Research Institute, School of Psychology, Ulster University, Northland Road, Co. Londonderry, Londonderry, BT48 7JL, Ireland
| | - Mark Shevlin
- Psychology Research Institute, School of Psychology, Ulster University, Northland Road, Co. Londonderry, Londonderry, BT48 7JL, Ireland
| | - Frédérique Vallières
- Centre for Global Health, School of Psychology, Trinity College Dublin, College Green, Dublin 2, Ireland
| | - Eoin McElroy
- Psychology Research Institute, School of Psychology, Ulster University, Northland Road, Co. Londonderry, Londonderry, BT48 7JL, Ireland
| | - Ask Elklit
- National Centre for Psychotraumatology, Institute for Psychology, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
| | | | - Marylène Cloitre
- National Centre for PTSD Division of Dissemination and Training, Department of Psychiatry and Behavioural Sciences, Stanford University, Stanford, CA, USA.,Department of Psychiatry and Behavioral Science, Stanford University, Palo Alto, CA, USA
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Oh W, Muzik M, McGinnis EW, Hamilton L, Menke RA, Rosenblum KL. Comorbid trajectories of postpartum depression and PTSD among mothers with childhood trauma history: Course, predictors, processes and child adjustment. J Affect Disord 2016; 200:133-41. [PMID: 27131504 PMCID: PMC4887316 DOI: 10.1016/j.jad.2016.04.037] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 04/16/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Both postpartum depression and posttraumatic stress disorder (PTSD) have been identified as unique risk factors for poor maternal psychopathology. Little is known, however, regarding the longitudinal processes of co-occurring depression and PTSD among mothers with childhood adversity. The present study addressed this research gap by examining co-occurring postpartum depression and PTSD trajectories among mothers with childhood trauma history. METHODS 177 mothers with childhood trauma history reported depression and PTSD symptoms at 4, 6, 12, 15 and 18 months postpartum, as well as individual (shame, posttraumatic cognitions, dissociation) and contextual (social support, childhood and postpartum trauma experiences) factors. RESULTS Growth mixture modeling (GMM) identified three comorbid change patterns: The Resilient group (64%) showed the lowest levels of depression and PTSD that remained stable over time; the Vulnerable group (23%) displayed moderately high levels of comorbid depression and PTSD; and the Chronic High-Risk group (14%) showed the highest level of comorbid depression and PTSD. Further, a path model revealed that postpartum dissociation, negative posttraumatic cognitions, shame, as well as social support, and childhood and postpartum trauma experiences differentiated membership in the Chronic High-Risk and Vulnerable. Finally, we found that children of mothers in the Vulnerable group were reported as having more externalizing and total problem behaviors. LIMITATIONS Generalizability is limited, given this is a sample of mothers with childhood trauma history and demographic risk. CONCLUSIONS The results highlight the strong comorbidity of postpartum depression and PTSD among mothers with childhood trauma history, and also emphasize its aversive impact on the offspring.
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Affiliation(s)
- Wonjung Oh
- Department of Human Development and Family Studies, Texas Tech University
| | - Maria Muzik
- Department of Psychiatry, University of Michigan, Ann Arbor, United States; Center for Human Growth & Development, University of Michigan, Ann Arbor, United States.
| | | | | | - Rena A. Menke
- Department of Psychiatry, University of Michigan, Ann Arbor
| | - Katherine Lisa Rosenblum
- Department of Psychiatry, University of Michigan, Ann Arbor,Center for Human Growth & Development, University of Michigan, Ann Arbor
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Bockers E, Roepke S, Michael L, Renneberg B, Knaevelsrud C. Risk recognition, attachment anxiety, self-efficacy, and state dissociation predict revictimization. PLoS One 2014; 9:e108206. [PMID: 25238153 PMCID: PMC4169587 DOI: 10.1371/journal.pone.0108206] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 08/27/2014] [Indexed: 12/02/2022] Open
Abstract
Background Previous research has identified a number of variables that constitute potential risk factors for victimization and revictimization. However, it remains unclear which factors are associated not only with childhood or adolescent victimization, but specifically with revictimization. The aim of this study was to determine whether risk recognition ability and other variables previously associated with revictimization are specifically able to differentiate individuals with childhood victimization only from revictimized individuals, and thus to predict revictimization. Methods Participants were N = 85 women aged 21 to 64 years who were interpersonally victimized in childhood or adolescence only, interpersonally revictimized in another period of life, or not victimized. A logistic regression analysis was conducted to examine whether risk recognition ability, sensation seeking, self-efficacy, state dissociation, shame, guilt, assertiveness, and attachment anxiety predicted group membership. Results The logistic regression analysis revealed risk recognition ability, attachment anxiety, state dissociation, and self-efficacy as significant predictors of revictimization. The final model accurately classified 82.4% of revictimized, 59.1% of victimized and 93.1% of non-victimized women. The overall classification rate was 80%. Conclusions This study suggests that risk recognition ability, attachment anxiety, self-efficacy, and state dissociation play a key role in revictimization. Increased risk recognition ability after an interpersonal trauma may act as a protective factor against repeated victimization that revictimized individuals may lack. A lack of increased risk recognition ability in combination with higher attachment anxiety, lower self-efficacy, and higher state dissociation may increase the risk of revictimization.
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Affiliation(s)
- Estelle Bockers
- Department of Clinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany
- The Berlin Center for Torture Victims, Berlin, Germany
- * E-mail:
| | - Stefan Roepke
- Department of Psychiatry, Charité – Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
- Cluster of Excellence “Languages of Emotion”, Freie Universität Berlin, Berlin, Germany
| | - Lars Michael
- Medical School Hamburg, University of Applied Sciences and Medical University, Hamburg, Germany
| | - Babette Renneberg
- Department of Clinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany
| | - Christine Knaevelsrud
- Department of Clinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany
- The Berlin Center for Torture Victims, Berlin, Germany
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Jerud AB, Zoellner LA, Pruitt LD, Feeny NC. Changes in emotion regulation in adults with and without a history of childhood abuse following posttraumatic stress disorder treatment. J Consult Clin Psychol 2014; 82:721-30. [PMID: 24708349 DOI: 10.1037/a0036520] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study compared changes in emotion regulation and trait affect over the course of PTSD treatment with either prolonged exposure (PE) therapy or sertraline in adults with and without a history of childhood abuse (CA). METHOD Two hundred adults with PTSD received 10 weeks of PE or sertraline. Emotion regulation and trait affect were assessed pre- and posttreatment and at 6-month follow-up with the Emotion Regulation Questionnaire (Gross & John, 2003), the Negative Mood Regulation Scale (Catanzaro & Mearns, 1990), and the Positive and Negative Affect Schedule (Watson, Clark, & Tellegen, 1988). RESULTS Individuals with and without a history of CA did not differ from one another at pretreatment on PTSD severity, emotion regulation, or positive/negative affect. In addition, treatment was effective at improving emotion regulation and trait affect in those with and without a history of CA, and no significant differences in emotion regulation or trait affect emerged posttreatment or at 6-month follow-up between adults with and without a history of CA. Furthermore, noninferiority analyses indicated that the emotion regulation and trait affect outcomes of individuals with a history of CA were no worse than those of individuals without a history of CA. CONCLUSION These findings cast doubt on the assumption that CA is associated with worse emotion regulation following PTSD treatment, arguing against assertions that a history of CA itself is a contraindication for traditional PTSD treatment, and that there is a clear necessity for additional interventions designed to target assumed emotion regulation deficits. [Corrected]
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Affiliation(s)
| | | | | | - Norah C Feeny
- Department of Psychological Sciences, Case Western Reserve University
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Yiaslas TA, Kamen C, Arteaga A, Lee S, Briscoe-Smith A, Koopman C, Gore-Felton C. The relationship between sexual trauma, peritraumatic dissociation, posttraumatic stress disorder, and HIV-related health in HIV-positive men. J Trauma Dissociation 2014; 15:420-35. [PMID: 24354509 PMCID: PMC4119469 DOI: 10.1080/15299732.2013.873376] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study tested a novel extension of P. P. Schnurr and B. L. Green's (2004) model of the relationships between trauma symptoms and health outcomes with specific application to HIV-positive men. A diverse sample of 167 HIV-positive men recruited from San Francisco Bay Area HIV clinics completed demographic, medical, trauma history, and symptom questionnaires. Mediation analyses were conducted using the method proposed by R. Baron and D. Kenny (1986). Regression analyses found that sexual revictimization (SR) significantly mediated the relationship between child sexual abuse and peritraumatic dissociation (PD), and PD mediated the relationship between SR and current posttraumatic stress (PTS) symptom severity. PTS symptoms partially mediated the relationship between SR and current HIV symptom severity. The findings indicate that among HIV-positive men, sexually revictimized men constitute a vulnerable group that is prone to PD, which places them at risk for posttraumatic stress disorder (PTSD) and worsened HIV-related health. Furthermore, traumatic stress symptoms were associated with worse HIV-related symptoms, suggesting that PTS symptoms mediate the link between trauma and health outcomes. This study highlights the need for future research to identify the biobehavioral mediators of the PTSD-health relationship in HIV-positive individuals.
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Eichhorn S, Brähler E, Franz M, Friedrich M, Glaesmer H. Traumatic experiences, alexithymia, and posttraumatic symptomatology: a cross-sectional population-based study in Germany. Eur J Psychotraumatol 2014; 5:23870. [PMID: 25206956 PMCID: PMC4149745 DOI: 10.3402/ejpt.v5.23870] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 07/18/2014] [Accepted: 07/19/2014] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE Previous studies have established an association between number of traumatic experiences and alexithymia. The present study examines this relationship in a large-scale representative sample of the German general population (N=2,507) and explores the potential mediating effects of posttraumatic symptomatology, particularly avoidance/numbing. METHODS Alexithymia was assessed with the German version of the Toronto Alexithymia Scale (TAS-20). Posttraumatic symptomatology was operationalized by the symptom score of the modified German version of the Posttraumatic Symptom Scale, and traumatic experiences were assessed with the trauma list of the Munich Composite International Diagnostic Interview. Two mediation analyses were conducted. RESULTS Of the total sample, 24.2% (n=606) reported at least one traumatic experience, 10.6% (n=258) were classified as alexithymic, and 2.4% (n=59) fulfilled the criteria of posttraumatic stress disorder (PTSD). Participants who had survived five or more traumatic experiences had significantly higher alexithymia sum scores. The PTSD symptom cluster avoidance/numbing mediated the association between the number of traumatic experiences and alexithymia. CONCLUSIONS Our findings illustrate an association between number of traumatic experiences and alexithymia and the influence of emotional avoidance and numbing within this relationship. The significant relationship between alexithymia and number of traumatic experiences in a general population sample further supports the concept of multiple and complex traumatization as associated with alexithymia. The results suggest the importance of further investigations determining the causal impact of alexithymia both as a potential premorbid trait and as consequence of traumatization. Lastly, future investigations are needed to clarify alexithymia as a distinct trauma-relevant characteristic for better diagnostics and specialized trauma-integrative therapy.
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Affiliation(s)
- Svenja Eichhorn
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Elmar Brähler
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany ; Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Matthias Franz
- Clinical Institute for Psychosomatic Medicine and Psychotherapy, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Michael Friedrich
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Heide Glaesmer
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
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Iverson KM, McLaughlin KA, Adair KC, Monson CM. Anger-related dysregulation as a factor linking childhood physical abuse and interparental violence to intimate partner violence experiences. VIOLENCE AND VICTIMS 2014; 29:564-78. [PMID: 25199386 PMCID: PMC4219736 DOI: 10.1891/0886-6708.vv-d-12-00125] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE Childhood family violence exposure is associated with increased risk for experiencing intimate partner violence (IPV) in adulthood, but the mechanisms underlying this relationship remain inadequately understood. Difficulties with emotion regulation may be one factor that helps to explain this relationship. METHOD Childhood physical abuse and interparental violence, as well as subsequent IPV experiences, were assessed in a large sample of young adults (N = 670). Several indicators of anger-related dysregulation were also assessed. Structural equation modeling was used to create a latent variable of anger-related dysregulation, which was examined as a potential mediator of the associations between childhood family violence exposure and IPV. RESULTS Childhood physical abuse and interparental violence were associated with greater physical, sexual, and emotional IPV victimization. Childhood physical abuse and interparental violence were also associated with anger-related dysregulation, which was positively associated with all three types of IPV experiences. Anger-related dysregulation fully mediated the association between witnessing interparental violence and physical IPV. Anger-related dysregulation partially mediated the association between witnessing interparental violence and psychological IPV and the associations of childhood physical abuse with all three forms of IPV. These associations were consistent across gender. CONCLUSIONS Interventions aimed at reducing IPV risk among survivors of childhood family violence may benefit from including techniques to target anger-related emotion regulation skills.
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30
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Knefel M, Lueger-Schuster B. An evaluation of ICD-11 PTSD and complex PTSD criteria in a sample of adult survivors of childhood institutional abuse. Eur J Psychotraumatol 2013; 4:22608. [PMID: 24312721 PMCID: PMC3851534 DOI: 10.3402/ejpt.v4i0.22608] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 10/14/2013] [Accepted: 10/18/2013] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The WHO recently launched the proposal for the 11th version of the International Classification of Diseases (ICD-11) that also includes two diagnoses related to traumatic stress. In contrast to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), ICD-11 will probably, in addition to posttraumatic stress disorder (PTSD), also define a new diagnosis termed "complex posttraumatic stress disorder" (CPTSD). OBJECTIVE We aimed to apply the proposed ICD-11 criteria for PTSD and CPTSD and to compare their prevalence to the ICD-10 (International Classification of Diseases [10th revision]) PTSD prevalence. In addition, we compiled a list of symptoms for CPTSD based on subthreshold PTSD so as to include a wider group of individuals. METHODS To evaluate the appropriateness of the WHO ICD-11 proposal compared to the criteria of ICD-10, we applied the newly introduced criteria for PTSD and CPTSD deriving from the Posttraumatic Stress Disorder Checklist - Civilian Version (PCL-C) and the Brief Symptom Inventory (BSI) scales, to a sample of adult survivors (N=229) of childhood institutional abuse. We evaluated the construct validity of CPTSD using confirmatory factor analysis (CFA). RESULTS More individuals fulfilled the criteria for PTSD according to ICD-10 (52.8%) than the ICD-11 proposal (17% for PTSD only; 38.4% if combined with complex PTSD). The new version of PTSD neutralized the gender effects. The prevalence of CPTSD was 21.4%, and women had a significantly higher rate of CPTSD than men (40.4 and 15.8%, respectively). Those survivors who were diagnosed with CPTSD experienced institutional abuse for a longer time. CFA showed a strong model fit. CONCLUSION CPTSD is a highly relevant classification for individuals with complex trauma history, but surprisingly, effects of gender were apparent. Further research should thus address gender effects.
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Clum GA, Czaplicki L, Andrinopoulos K, Muessig K, Hamvas L, Ellen, and the Adolescent Medicine JM. Strategies and outcomes of HIV status disclosure in HIV-positive young women with abuse histories. AIDS Patient Care STDS 2013; 27:191-200. [PMID: 23596649 DOI: 10.1089/apc.2012.0441] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Young women with HIV and histories of physical and/or sexual abuse in childhood may be vulnerable to difficulties with disclosure to sexual partners. Abuse in childhood is highly prevalent in HIV-positive women, and has been associated with poorer communication, low assertiveness, low self worth, and increased risk for sexual and other risk behaviors that increase the risk of secondary transmission of HIV. HIV disclosure may be an important link between abuse and sexual risk behaviors. Qualitative interviews with 40 HIV-positive young women with childhood physical and/or sexual abuse were conducted; some women had also experienced adult victimization. Results suggest that HIV-positive women with abuse histories use a host of strategies to deal with disclosure of HIV status, including delaying disclosure, assessing hypothetical responses of partners, and determining appropriate stages in a relationship to disclose. Stigma was an important theme related to disclosure. We discuss how these disclosure processes impact sexual behavior and relationships and discuss intervention opportunities based on our findings.
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Affiliation(s)
- Gretchen A. Clum
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | | | | | | | - L. Hamvas
- Washington University, St. Louis, Missouri
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Walsh K, Gonsalves VM, Scalora MJ, King S, Hardyman PL. Child maltreatment histories among female inmates reporting inmate on inmate sexual victimization in prison: the mediating role of emotion dysregulation. JOURNAL OF INTERPERSONAL VIOLENCE 2012; 27:492-512. [PMID: 21987505 PMCID: PMC3405898 DOI: 10.1177/0886260511421670] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Despite data indicating that child maltreatment (CM) in various forms is associated with adult sexual victimization among community women, few studies have explicitly explored how types of CM might relate to prison sexual victimization. Because little is known about how CM might give rise to prison sexual victimization, the present study also examined emotion dysregulation emanating from early abuse experiences as a potential mediator in the link between early CM and inmate-on-inmate prison sexual victimization. Approximately 168 incarcerated women completed self-report inventories assessing various types of childhood maltreatment, emotion dysregulation, and coerced or forced sexual experiences in prison. Nearly 77% of the sample endorsed experiencing at least one form of CM, with 64% of inmates reporting that they experienced two or more forms of CM. Approximately 9% of inmates reported sexual coercion and 22% reported a forced sexual experience in prison. Each form of CM was associated with prison sexual coercion; however, fewer associations emerged between CM and forced prison sexual experiences. Emotion dysregulation was found to mediate links between CM, particularly co-occurring CM, and sexual coercion in prison, but it was unrelated to forced prison sexual experiences. Implications are discussed.
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Affiliation(s)
- Kate Walsh
- University of Nebraska-Lincoln, NE, USA.
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Murrough JW, Czermak C, Henry S, Nabulsi N, Gallezot JD, Gueorguieva R, Planeta-Wilson B, Krystal JH, Neumaier JF, Huang Y, Ding YS, Carson RE, Neumeister A. The effect of early trauma exposure on serotonin type 1B receptor expression revealed by reduced selective radioligand binding. ACTA ACUST UNITED AC 2011; 68:892-900. [PMID: 21893657 DOI: 10.1001/archgenpsychiatry.2011.91] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
CONTEXT Serotonergic dysfunction is implicated in the pathogenesis of posttraumatic stress disorder (PTSD), and recent animal models suggest that disturbances in serotonin type 1B receptor function, in particular, may contribute to chronic anxiety. However, the specific role of the serotonin type 1B receptor has not been studied in patients with PTSD. OBJECTIVE To investigate in vivo serotonin type 1B receptor expression in individuals with PTSD, trauma-exposed control participants without PTSD (TC), and healthy (non-trauma-exposed) control participants (HC) using positron emission tomography and the recently developed serotonin type 1B receptor selective radiotracer [(11)C]P943. DESIGN Cross-sectional positron emission tomography study under resting conditions. SETTING Academic and Veterans Affairs medical centers. PARTICIPANTS Ninety-six individuals in 3 study groups: PTSD (n = 49), TC (n = 20), and HC (n = 27). Main Outcome Measure Regional [(11)C]P943 binding potential (BP(ND)) values in an a priori-defined limbic corticostriatal circuit investigated using multivariate analysis of variance and multiple regression analysis. RESULTS A history of severe trauma exposure in the PTSD and TC groups was associated with marked reductions in [(11)C]P943 BP(ND) in the caudate, the amygdala, and the anterior cingulate cortex. Participant age at first trauma exposure was strongly associated with low [(11)C]P943 BP(ND). Developmentally earlier trauma exposure also was associated with greater PTSD symptom severity and major depression comorbidity. CONCLUSIONS These data suggest an enduring effect of trauma history on brain function and the phenotype of PTSD. The association of early age at first trauma and more pronounced neurobiological and behavioral alterations in PTSD suggests a developmental component in the cause of PTSD.
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Affiliation(s)
- James W Murrough
- Mood and Anxiety Disorders Program, Department of Psychiatry, Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, USA.
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Farrugia PL, Mills KL, Barrett E, Back SE, Teesson M, Baker A, Sannibale C, Hopwood S, Rosenfeld J, Merz S, Brady KT. Childhood trauma among individuals with co-morbid substance use and post traumatic stress disorder. ACTA ACUST UNITED AC 2011; 4:314-326. [PMID: 21984884 DOI: 10.1080/17523281.2011.598462] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND: Little is known about the impact of childhood trauma (CT) on the clinical profile of individuals with co-occurring substance use disorder (SUD) and post traumatic stress disorder (PTSD). AIMS: To compare the clinical characteristics of individuals with SUD+PTSD who have a history of CT with SUD+PTSD individuals who have experienced trauma during adulthood only. METHOD: Data were collected on 103 individuals as part of a randomised controlled trial examining the efficacy of an integrated psychosocial treatment for SUD+PTSD. Participants were recruited from substance use treatment services, community referrals and advertising. Data were collected on demographic characteristics, substance use and treatment histories, lifetime trauma exposure, and current physical and mental health functioning. RESULTS: The vast majority (77%) of the sample had experienced at least one trauma before the age of 16, with 55% of those endorsing childhood sexual abuse. As expected individuals with a CT history, as compared to without, evidenced significantly longer duration of PTSD. Those with a CT history also had more extensive lifetime trauma exposure, an earlier age of first intoxication, and reported more severe substance use (e.g., a greater number of drug classes used in their lifetime, higher severity of dependence scores and greater number of drug treatment episodes). CONCLUSION: Individuals with co-morbid SUD+PTSD who have experienced CT present with a more severe and chronic clinical profile in relation to a number of trauma and substance use characteristics, when compared to individuals with adulthood only trauma histories. It is therefore important for SUD+PTSD treatment planning that CT be carefully assessed.
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Iverson KM, Gradus JL, Resick PA, Suvak MK, Smith KF, Monson CM. Cognitive-behavioral therapy for PTSD and depression symptoms reduces risk for future intimate partner violence among interpersonal trauma survivors. J Consult Clin Psychol 2011; 79:193-202. [PMID: 21341889 DOI: 10.1037/a0022512] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Women who develop symptoms of posttraumatic stress disorder (PTSD) and depression subsequent to interpersonal trauma are at heightened risk for future intimate partner violence (IPV) victimization. Cognitive-behavioral therapy (CBT) is effective in reducing PTSD and depression symptoms, yet limited research has investigated the effectiveness of CBT in reducing risk for future IPV among interpersonal trauma survivors. METHOD This study examined the effect of CBT for PTSD and depressive symptoms on the risk of future IPV victimization in a sample of women survivors of interpersonal violence. The current sample included 150 women diagnosed with PTSD secondary to an array of interpersonal traumatic events; they were participating in a randomized clinical trial of different forms of cognitive processing therapy for the treatment of PTSD. Participants were assessed at 9 time points as part of the larger trial: pretreatment, 6 times during treatment, posttreatment, and 6-month follow-up. RESULTS As hypothesized, reductions in PTSD and in depressive symptoms during treatment were associated with a decreased likelihood of IPV victimization at a 6-month follow-up even after controlling for recent IPV (i.e., IPV from a current partner within the year prior to beginning the study) and prior interpersonal traumas. CONCLUSIONS These findings highlight the importance of identifying and treating PTSD and depressive symptoms among interpersonal trauma survivors as a method for reducing risk for future IPV.
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Affiliation(s)
- Katherine M Iverson
- Women's Health Sciences Division of the National Center for PTSD, VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA 02130, USA.
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Walsh K, DiLillo D, Scalora MJ. The cumulative impact of sexual revictimization on emotion regulation difficulties: an examination of female inmates. Violence Against Women 2011; 17:1103-18. [PMID: 21727155 DOI: 10.1177/1077801211414165] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The present study examined associations between child sexual abuse (CSA), adult sexual victimization, and emotion regulation difficulties in a sample of 168 incarcerated women. Approximately 50% of the participants reported CSA, 54% reported adult sexual victimization, and 38% reported sexual revictimization (i.e., CSA and adult victimization). Revictimized women reported significantly greater difficulties with several facets of emotion regulation when compared to singly victimized and nonvictimized women. Interestingly, singly victimized women did not demonstrate greater emotion regulation deficits when compared to nonvictims. Findings suggest that the negative impact of victimization experiences on adult emotion regulation abilities may be cumulative. Furthermore, they highlight the potential importance of assessing and targeting emotion regulation difficulties among child abuse and adult sexual victimization survivors.
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Affiliation(s)
- Kate Walsh
- University of Nebraska-Lincoln, Lincoln, NE 68588-0308, USA.
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37
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Daniels JK, Frewen P, McKinnon MC, Lanius RA. Default mode alterations in posttraumatic stress disorder related to early-life trauma: a developmental perspective. J Psychiatry Neurosci 2011; 36:56-9. [PMID: 20964955 PMCID: PMC3004976 DOI: 10.1503/jpn.100050] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
| | | | | | - Ruth A. Lanius
- Correspondence to: Dr. R.A. Lanius, University Campus, London Health Sciences Centre, 339 Windermere Rd., London ON N6A 5A5;
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38
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Lutz-Zois CJ, Phelps CER, Reichle AC. Affective, behavioral, and social-cognitive dysregulation as mechanisms for sexual abuse revictimization. VIOLENCE AND VICTIMS 2011; 26:159-176. [PMID: 21780532 DOI: 10.1891/0886-6708.26.2.159] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Using a sample of 1117 female college students, this study examined emotional, behavioral, and social-cognitive mechanisms of sexual abuse revictimization. It was hypothesized that numbing, alexithymia, alcohol problems, mistrust, and adult attachment dimensions would mediate the relationship between childhood sexual abuse (CSA) and adult sexual abuse (ASA). Aside from the close adult attachment dimension, the results indicated that all of the hypothesized mediators were associated with CSA. However, only alcohol problems and mistrust met the necessary conditions of mediation. The results with respect to mistrust are especially unique in that it is one of the first empirical demonstrations of a social-cognitive mechanism for sexual abuse revictimization. Thus, these results enhance our understanding of interpersonal mediators of the relationship between CSA and ASA and provide a new direction for future research.
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39
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Yehuda R, Flory JD, Pratchett LC, Buxbaum J, Ising M, Holsboer F. Putative biological mechanisms for the association between early life adversity and the subsequent development of PTSD. Psychopharmacology (Berl) 2010; 212:405-17. [PMID: 20706708 DOI: 10.1007/s00213-010-1969-6] [Citation(s) in RCA: 149] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Accepted: 07/16/2010] [Indexed: 12/18/2022]
Abstract
RATIONALE Early Life Stress (ELS) increases risk for both adult traumatization and posttraumatic stress disorder (PTSD). Adult PTSD may also reflect a continuation of a response to an earlier exposure to adversity. Given similarities between neuroendocrine aspects of PTSD and ELS, such as in reduced cortisol signaling and glucocorticoid receptor (GR) responsiveness, some aspects of the biology of PTSD may reflect biological correlates of risk. OBJECTIVES This paper will examine how empirical findings regarding the biological basis of ELS can inform our understanding of the neuroendocrinology of PTSD. This paper will also propose a hypothetical model to guide future research that integrates genetic, epigenetic, neuroendocrine, and psychological observations to understand the contribution of ELS neurobiology to PTSD. RESULTS Recent genetic findings demonstrate heritable aspects of at least some of these cortisol-related disturbances. Furthermore, ELS may produce at least some of the PTSD-associated changes in glucocorticoid responsiveness through epigenetic mechanisms such as developmental programming. These, then, may contribute to enduring changes in stress responsiveness as well as enhanced risk for adult exposure and PTSD. CONCLUSION Molecular mechanisms associated with gene x environment interactions or GR programming are essential in explaining current observations in the neuroendocrinology of PTSD that have been difficult to understand through the lens of contemporary stress theory.
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Affiliation(s)
- Rachel Yehuda
- Department of Psychiatry, James J. Peters Veterans Affairs Medical Center, 526 OOMH, 130 W. Kingsbridge Rd, Bronx, NY, USA.
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40
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Behnken MP, Le YCL, Temple JR, Berenson AB. Forced sexual intercourse, suicidality, and binge drinking among adolescent girls. Addict Behav 2010; 35:507-9. [PMID: 20074862 DOI: 10.1016/j.addbeh.2009.12.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2009] [Revised: 10/23/2009] [Accepted: 12/10/2009] [Indexed: 11/26/2022]
Abstract
Although sexual assault victimization has been shown to predict suicidality, little is known about the mechanisms linking these two factors. Using cross-sectional data (N=6364) from the 2007 Youth Risk Behavior Survey, binge drinking significantly mediated the relationship between forced sexual intercourse and suicide for Hispanic (n=1915) and Caucasian (n=2928) adolescent females, but not for African American adolescent females (n=1521). Results suggest the need for closer monitoring of adolescent victims of sexual assault who also abuse alcohol to intervene in early suicide behaviors. Treatment and intervention programs should also be culturally sensitive to account for differences in reaction to sexual trauma among race/ethnicity. Implications for suicide prevention and alcohol intervention strategies as well as suggestions to clinical providers are discussed.
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41
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Markowitz JC, Milrod B, Bleiberg K, Marshall RD. Interpersonal factors in understanding and treating posttraumatic stress disorder. J Psychiatr Pract 2009; 15:133-40. [PMID: 19339847 PMCID: PMC2852131 DOI: 10.1097/01.pra.0000348366.34419.28] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Exposure to reminders of trauma underlies the theory and practice of most treatments for post-traumatic stress disorder (PTSD), yet exposure may not be the sole important treatment mechanism. Interpersonal features of PTSD influence its onset, chronicity, and possibly its treatment. The authors review interpersonal factors in PTSD, including the critical but underrecognized role of social support as both protective posttrauma and as a mechanism of recovery. They discuss interpersonal psychotherapy (IPT) as an alternative treatment for PTSD and present encouraging findings from two initial studies. Highlighting the potential importance of attachment and interpersonal relationships, the authors propose a mechanism to explain why improving relationships may ameliorate PTSD symptoms.
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Affiliation(s)
- John C Markowitz
- New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons, 1051 Riverside Drive, New York, NY 10032, USA.
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42
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Friedman SH, Loue S. Incidence and prevalence of intimate partner violence by and against women with severe mental illness. J Womens Health (Larchmt) 2007; 16:471-80. [PMID: 17521250 DOI: 10.1089/jwh.2006.0115] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Although a significant body of research has focused on the victimization of severely mentally ill persons and their perpetration of violence against others, relatively little attention has specifically addressed partner violence inflicted against and committed by severely mentally ill women. We conducted a review of the existing research to examine these issues. The published literature suggests that severely mentally ill women are at increased risk of being victimized by their partners and that a high proportion of severely mentally ill individuals may assault their intimate partners. Directions for future research and suggestions for clinical practice are presented.
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Affiliation(s)
- Susan Hatters Friedman
- Department of Psychiatry and Biostatistics, Case Western Reserve University, School of Medicine, Cleveland, Ohio 44106-4945, USA
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43
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Riggs SA, Paulson A, Tunnell E, Sahl G, Atkison H, Ross CA. Attachment, personality, and psychopathology among adult inpatients: Self-reported romantic attachment style versus Adult Attachment Interview states of mind. Dev Psychopathol 2007; 19:263-91. [PMID: 17241494 DOI: 10.1017/s0954579407070149] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The present study examined self-reported romantic attachment style and Adult Attachment Interview (AAI) states of mind regarding early attachment relationships, personality dimensions, and psychopathology in a psychiatric sample of trauma survivors. Inpatients (N = 80) admitted to a hospital trauma treatment program were administered the Experiences in Close Relationships Scale, AAI, Millon Clinical Multiaxial Inventory-III, Dissociative Experiences Scale, and Dissociative Disorder Interview Schedule. Self-report and AAI attachment classifications were not related, and different results emerged for the two measures. Self-reported romantic attachment style was significantly associated with personality dimensions, with fearful adults showing the most maladaptive personality profiles. Findings suggested that self-report dimensions of self and other independently contribute to different forms of psychological dysfunction. AAI unresolved trauma was uniquely associated with dissociation and posttraumatic stress disorder, whereas unresolved trauma and unresolved loss jointly contributed to schizotypal and borderline personality disorder scores. The differences in findings between the two measures are discussed with a view toward the developmental and clinical implications.
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Affiliation(s)
- Shelley A Riggs
- Department of Psychology, University of North Texas, P.O. Box 311280, Denton, TX 76203-1280, USA.
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Cusack KJ, Grubaugh AL, Knapp RG, Frueh BC. Unrecognized trauma and PTSD among public mental health consumers with chronic and severe mental illness. Community Ment Health J 2006; 42:487-500. [PMID: 16868841 DOI: 10.1007/s10597-006-9049-4] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2005] [Accepted: 07/20/2005] [Indexed: 10/24/2022]
Abstract
Lifetime prevalence of traumatic events and current PTSD was assessed among 142 mental health consumers with serious mental illness served by a psychosocial rehabilitation day program. Lifetime exposure to trauma was high (87%). The rate of PTSD based on the PTSD Checklist (PCL) was also high (19-30% depending on different scoring criteria). Overall, the PCL had strong internal reliability for this sample. Documentation of trauma and PTSD was exceptionally low in medical records. Results suggest that trauma and PTSD are significantly overlooked in the public mental health system. Improved recognition of trauma and PTSD are needed in order to provide meaningful services to this highly vulnerable population.
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Affiliation(s)
- Karen J Cusack
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 Martin Luther King, Chapel Hill, NC 27599-7590, USA.
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45
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Frewen PA, Pain C, Dozois DJA, Lanius RA. Alexithymia in PTSD: psychometric and FMRI studies. Ann N Y Acad Sci 2006; 1071:397-400. [PMID: 16891585 DOI: 10.1196/annals.1364.029] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Two studies examined correlates of alexithymia in posttraumatic stress disorder (PTSD). In study 1 (n = 77 individuals with PTSD and 45 controls) Toronto alexithymia scale (TAS-20) scores were positively correlated with PTSD symptoms, dissociation, and childhood abuse and neglect. In study 2, TAS-20 scores were examined as correlates of functional magnetic resonance imaging (fMRI) blood oxygen level dependent (BOLD) response to trauma script imagery. In 16 controls, TAS-20 scores correlated positively with response in medial prefrontal cortex (mPFC), and negatively with response in anterior cingulate cortex (ACC) and thalamus. In 26 individuals with PTSD, TAS-20 scores correlated positively with response in insula, posterior cingulate cortex (PCC), and thalamus, and negatively with response in ACC.
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Affiliation(s)
- Paul A Frewen
- London Health Sciences Centre, 339 Windermere Road, PO Box 5339, London, Ontario, Canada, N6A 5A5
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46
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Stovall-McClough KC, Cloitre M. Unresolved attachment, PTSD, and dissociation in women with childhood abuse histories. J Consult Clin Psychol 2006; 74:219-228. [PMID: 16649866 DOI: 10.1037/0022-006x.74.2.219] [Citation(s) in RCA: 136] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The primary objective of this study was to examine unresolved trauma as assessed by the Adult Attachment Interview and current psychiatric symptoms, focusing on posttraumatic stress disorder (PTSD) and dissociation, in a group of adult female childhood abuse survivors. The authors examined psychiatric symptoms and attachment representations in a group with (n = 30) and without (n = 30) abuse-related PTSD. The findings revealed that unresolved trauma carried a 7.5-fold increase in the likelihood of being diagnosed with PTSD and was most strongly associated with PTSD avoidant symptoms rather than dissociative symptoms. The utility of a PTSD framework for understanding unresolved trauma and the role of intentional avoidance of trauma cues in the maintenance of traumatized states of mind are discussed.
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Affiliation(s)
| | - Marylene Cloitre
- Institute for Trauma and Stress, Child Study Center, School of Medicine, New York University
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47
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Hien D, Cohen L, Campbell A. Is traumatic stress a vulnerability factor for women with substance use disorders? Clin Psychol Rev 2005; 25:813-23. [PMID: 15967556 PMCID: PMC3679552 DOI: 10.1016/j.cpr.2005.05.006] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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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48
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Kallstrom-Fuqua AC, Weston R, Marshall LL. Childhood and Adolescent Sexual Abuse of Community Women: Mediated Effects on Psychological Distress and Social Relationships. J Consult Clin Psychol 2004; 72:980-92. [PMID: 15612845 DOI: 10.1037/0022-006x.72.6.980] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Possible mediators of sexual abuse severity were tested on the basis of D. Finkelhor and A. Browne's (1985) traumagenic dynamics model with 178 low-income African American, European American, and Mexican American community women interviewed for Project HOW Health Outcomes of Women. This subsample reported contact sexual abuse before the age of 18 years. Severity was level of force, number of perpetrators, relationship to perpetrator, and age at first assault. As expected, structural equation modeling showed powerlessness, and stigmatization largely mediated the effects of sexual abuse severity on women's psychological distress in adulthood. Powerlessness also mediated the effects of severity on maladaptive social relationships. The expected path from betrayal to relationships was nonsignificant. Overall, the results support extension of D. Finkelhor and A. Browne's model. Possible interventions are addressed.
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49
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Resnick SG, Bond GR, Mueser KT. Trauma and posttraumatic stress disorder in people with schizophrenia. JOURNAL OF ABNORMAL PSYCHOLOGY 2003; 112:415-23. [PMID: 12943020 DOI: 10.1037/0021-843x.112.3.415] [Citation(s) in RCA: 118] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study evaluated the hypothesis that trauma and posttraumatic stress disorder (PTSD) severity would be positively associated with schizophrenia symptoms. Forty-seven clients with schizophrenia were assessed for schizophrenia severity and for lifetime trauma history and PTSD symptoms in 2 independent symptom interviews; 35 (74%) participants reported at least 1 event in which there was threat of harm or life threat and subjective distress, and 6 (13%) had current PTSD. Trauma across the life span was associated with greater severity of PTSD. Within the total sample, PTSD symptoms were associated with greater emotional distress, but not with schizophrenia-specific symptoms. Distress among clients with schizophrenia and PTSD suggests the need for routine assessment of PTSD and development of PTSD interventions in this population.
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Affiliation(s)
- Sandra G Resnick
- Veterans Affairs Northeast Program Evaluation Center, West Haven, Connecticut 06516, USA.
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50
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Callahan KL, Price JL, Hilsenroth MJ. Psychological assessment of adult survivors of childhood sexual abuse within a naturalistic clinical sample. J Pers Assess 2003; 80:173-84. [PMID: 12700020 DOI: 10.1207/s15327752jpa8002_06] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
This study investigates the long-term effects of childhood sexual abuse (CSA). Differences between abused and nonabused individuals in psychiatric symptomatology, interpersonal functioning, social and occupational functioning, personality dynamics, and therapeutic alliance were examined. The relationship between abuse severity and long-term effects was also analyzed. Data were gathered from 51 patients seeking individual psychotherapy at a community outpatient clinic. Findings suggested that CSA survivors tend to experience greater psychiatric distress and poorer interpersonal functioning than nonabused clinical controls. No significant differences were found in social and occupational functioning or in alliance developed by the end of the therapeutic assessment process. Abuse severity was significantly related to increased symptomatology and poorer interpersonal functioning. Findings support and extend existing literature and are especially useful for clinicians working with abuse survivors.
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Affiliation(s)
- Kelley L Callahan
- Derner Institute of Advanced Psychological Studies, Adelphi University, Garden City, NY 11530, USA.
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