Evaluation of a brief cognitive-behavioral program for the prevention of chronic PTSD in recent assault victims

Psychological Prophylaxis: An Integrated Psychological Services Program in Trauma Care

The primary medical goals of acute care are restoration of physical health and return to physical function. However, in response to traumatic events and injuries, psychological factors are critical to one's overall recovery. Both pre-morbid psychiatric comorbidities and post-injury psychological compromise affect physical and psychological recovery in inpatient trauma populations. The Psychological Services Program (PSP), a model trauma/acute care program, addresses these critical factors in a Level 1 Trauma Center. The program routinely treats over one-quarter of the trauma patients at any given time. The incorporation of the PSP into treatment team care ensures that patients in need of mental health support can be identified and treated during their recovery. This unique model is recommended as a potential injury prevention and recovery intervention strategy for the myriad mental health comorbidities that may function as risk factors for poor post-injury adaptation and also as risk factors for possible future traumatic injury.

Outcomes of an individual counselling programme in Grozny, Chechnya: a randomised controlled study

OBJECTIVES

To evaluate the effectiveness of individual counselling on functioning of clients participating in a mental health intervention in a humanitarian setting.

DESIGN

Randomised controlled trial.

SETTING

Mental health programme implemented by Médecins Sans Frontières in Grozny, Republic of Chechnya.

PARTICIPANTS

168 eligible clients were randomly assigned to the intervention and waitlisted (2 months) arms between November 2014 and February 2015.

INTERVENTION

Individual counselling sessions.

MAIN OUTCOME MEASURES

Change in functioning was measured using the Short Form 6 (SF6) and gender-specific locally adapted Chechen functioning instruments in the intervention group at the end of counselling and the waitlisted group after their waitlisted period. Unadjusted differences in gain scores (DGSs) between intervention and waitlisted groups were calculated with effect size (Cohen's d) for both tools. Linear regression compared the mean DGS in both groups.

RESULTS

The intervention group (n=78) improved compared with waitlisted controls (n=80) on the SF6 measures with moderate to large effect sizes: general health (DGS 12.14, d=0.52), body pain (DGS 10.26, d=0.35), social support (DGS 16.07, d=0.69) and emotional functioning (DGS 16.87, d=0.91). Similar improvement was seen using the Chechen functioning instrument score (female DGS -0.33, d=0.55; male DGS -0.40, d=0.99). Adjusted analysis showed significant improvement (p<0.05) in the intervention group for all SF6 measures and for the Chechen functioning instrument score in women but not men (p=0.07).

CONCLUSIONS

Individual counselling significantly improved participants' ability to function in the intervention group compared with the waitlisted group. Further research is needed to determine whether similar positive results can be shown in other settings and further exploring the impact in male clients' population.

TRIAL REGISTRATION NUMBER

NTR4689.

Breathing biofeedback as an adjunct to exposure in cognitive behavioral therapy hastens the reduction of PTSD symptoms: a pilot study

Although trauma-focused cognitive behavioral therapy (TF-CBT) with exposure is an effective treatment for posttraumatic stress disorder (PTSD), not all patients recover. Addition of breathing biofeedback to exposure in TF-CBT is suggested as a promising complementary technique to improve recovery of PTSD symptoms. Patients (n = 8) with chronic PTSD were randomized to regular TF-CBT or TF-CBT with complementary breathing biofeedback to exposure. PTSD symptoms were measured before, during and after TF-CBT with the Impact of Event Scale-Revised. The results show that breathing biofeedback is feasible and can easily be complemented to TF-CBT. Although PTSD symptoms significantly decreased from pre to post treatment in both conditions, there was a clear trend towards a significantly faster (p = .051) symptom reduction in biofeedback compared to regular TF-CBT. The most important limitation was the small sample size. The hastened clinical improvement in the biofeedback condition supports the idea that breathing biofeedback may be an effective complementary component to exposure in PTSD patients. The mechanism of action of breathing biofeedback may relate to competing working memory resources decreasing vividness and emotionality, similar to eye movement desensitization and reprocessing. Future research is needed to examine this.

Self-resilience as a protective factor against development of post-traumatic stress disorder symptoms in police officers

BACKGROUND

This study was conducted to check whether self-resilience, one of the characteristics known to affect the occurrence of post-traumatic stress disorder (PTSD) symptoms after experiencing traumatic events, could serve as a protective factor for police officers whose occupational factors are corrected.

METHODS

We conducted a cross-sectional study in which 112 male police officers in Gangwon Province participated. They visited the Wonju Severance Christian Hospital Occupational Environment Center for medical check-ups from June to December 2015. Their general characteristics were identified using structured questionnaires, and they were asked to fill in the Korean Occupational Stress Scale-Short Form (KOSS-SF). Further, the Center for Epidemiologic Studies-Depression Scale (CES-D), Connor-Davidson Resilience Scale-Korean (CD-RI-K), and Impact of Event Scale-Revised-Korean version (IES-R-K) were used to evaluate their job stress, depression, self-resilience, and PTSD symptoms. Logistic regression analysis was conducted to correct their personal, occupational, and psychological factors to analyze the relationship between self-resilience and PTSD symptoms.

RESULTS

Among 112 respondents who experienced a traumatic event, those with low self-resilience had significantly higher rate of PTSD symptoms than those with high self-resilience even after correcting for the covariate of general, occupational, and psychological characteristics (odds ratio [OR] 3.51; 95 % CI: 1.06-19.23).

CONCLUSIONS

Despite several limitations, these results suggest that a high degree of self-resilience may protect police officers from critical incident-related PTSD symptoms.

Brief cognitive behavior therapy in patients with social anxiety disorder: a preliminary investigation

CONTEXT

Cognitive behavior therapy (CBT) is the treatment of choice in anxiety disorders. However, there is little evidence for the effectiveness brief CBT in social anxiety.

AIMS

We examined the effectiveness of a brief CBT of six sessions in patients with social anxiety disorder.

SETTINGS AND DESIGN

A single case design study baseline; post and 1 month follow-up was adopted.

MATERIALS AND METHODS

Seven patients with a DSM IV diagnosis of social anxiety underwent 6 weekly sessions of brief CBT. Their diagnosis was confirmed using structured diagnostic interviews. They were assessed at baseline, post and 1-month follow-up on CGI- Severity, Leibowitz Social Anxiety Scale (LSAS), Social Phobia Rating Scale, Brief Fear of Negative Evaluation, and Beck's Depression Inventory.

STATISTICAL ANALYSIS

Data were analyzed using the method of clinical significance.

RESULTS

Results indicated that brief CBT was effective in reducing social anxiety in all patients. Brief CBT was also effective in reducing social avoidance and self consciousness. However, brief CBT was not effective in reducing fear of negative evaluation in all patients, suggesting the need for longer duration for cognitive changes in some dysfunctional beliefs.

CONCLUSIONS

This preliminary case series indicates that brief CBT may be a promising and a cost and time effective approach to managing for social anxiety.

Parental coping in the neonatal intensive care unit

Fifty-six mothers of premature infants who participated in a study to reduce symptoms of posttraumatic stress disorder (PTSD) completed the Brief COPE, a self-report inventory of coping mechanisms, the Stanford Acute Stress Reaction Questionnaire to assess acute stress disorder (ASD) and the Davidson Trauma Scale to assess PTSD. 18 % of mothers had baseline ASD while 30 % of mothers met the criteria for PTSD at the 1-month follow-up. Dysfunctional coping as measured by the Brief COPE was positively associated with elevated risk of PTSD in these mothers (RR = 1.09, 95 % CI 1.02-1.15; p = .008). Maternal education was positively associated with PTSD; each year increase in education was associated with a 17 % increase in the relative risk of PTSD at 1 month follow-up (RR = 1.17, 95 % CI 1.02-1.35; p = .03). Results suggest that dysfunctional coping is an important issue to consider in the development of PTSD in parents of premature infants.

Assessment of Cognitive Behavioral Therapy on Quality of Life of Patients with Chronic War-related Post-traumatic Stress Disorder

BACKGROUND

Post-traumatic stress disorder (PTSD) is the one of the most commonly observed psychiatric disorder in veterans. The condition can lead to considerable social, occupational, and interpersonal dysfunction. PTSD occurring after combat injury appears to be strongly correlated with the extent of injury, and develops over several months. Present study was designed for assessing the cognitive behavioral therapy in the quality of life (QOL) of war-related PTSD in veterans compared to control group and compare applied treatments with each other.

MATERIALS AND METHODS

In the present study, we assessment effects of cognitive behavioral therapy such as problem solving, exposure therapy and their combination on QOL in 120 Iranian PTSD patients veterans after Iran-Iraq war. They were randomly allocated to one of four equal interventional groups: (a) Problem solving therapy (b) exposure therapy (c) combined therapy (exposure therapy plus problem solving) (d) control group. Before and after study intervention, patients were evaluated by short form-36 (SF-36) questionnaire.

RESULTS

Post-test and follow-up SF-36 scores were 55.6±4 and 55.1±3.6 in exposure therapy, 50±4.4 and 56.1±3.8 in problem solving, and 48.73±3.8 and 50.9±4.2 in combined therapy. In comparing to control group, all intervention showed significant improvement in QOL in PTSD patients.

CONCLUSION

According to the results of the present study, behavioral therapy can improve QOL in PTSD patients.

Risk factors for posttraumatic stress disorder in persons with spinal cord injury

PURPOSE

Many of the events that cause spinal cord injury (SCI) are traumatic events that can result in posttraumatic stress disorder (PTSD). It therefore appears that most persons with SCI are at risk for developing PTSD. This study retrospectively examined risk factors for PTSD symptoms in a sample of 71 persons with SCI.

METHOD

The Structured Clinical Interview for DSM-IV was used to assess full and partial PTSD diagnoses. Self-administered questionnaires were used to measure potential risk factors.

RESULTS

Results indicated that 11% of the participants met the criteria for full PTSD, and an additional 20% met the criteria for partial PTSD at some point after their SCI. Hierarchical linear regression analyses revealed that trauma history, peritraumatic reactions, and intolerance of uncertainty predicted the number of PTSD symptoms.

CONCLUSION

This study highlights the importance of trauma history, peritraumatic reactions, and intolerance of uncertainty in the development of PTSD symptoms. Patients at risk for PTSD should be identified early in the rehabilitation process and could benefit from psychological interventions with the aim of preventing PTSD development.

The Child PTSD Symptom Scale: psychometric properties in female adolescent sexual assault survivors

Traumatic experiences are common among youths and can lead to posttraumatic stress disorder (PTSD). In order to identify traumatized children who need PTSD treatment, instruments that can accurately and efficiently evaluate pediatric PTSD are needed. One such measure is the Child PTSD Symptom Scale (CPSS), which has been found to be a reliable and valid measure of PTSD symptom severity in school-age children exposed to natural disasters (Foa, Johnson, Feeny, & Treadwell, 2001). However, the psychometric properties of the CPSS are not known in youths who have experienced other types of trauma. The current study aims to fill this gap by examining the psychometric properties of the interview (CPSS-I) and self-report (CPSS-SR) administrations of the CPSS in a sample of 91 female youths with sexual abuse-related PTSD, a population that is targeted in many treatment studies. Scores on both the CPSS-I and CPSS-SR demonstrated good to excellent internal consistency. One-week test-retest reliability assessed for CPSS-SR scores was excellent (r=.86); interrater reliability of CPSS-I scores was also excellent (r=.87). Symptom-based diagnostic agreement between the CPSS-SR and CPSS-I was excellent at 85.5%; scores on both the CPSS-SR and CPSS-I also demonstrated good convergent validity (74.5-76.5% agreement) with the PTSD module of The Schedule of Affective Disorders and Schizophrenia for School-Age Children--Revised for DSM--IV (K-SADS; Kaufman, Birmaher, Brent, & Rao, 1997). The strong psychometric properties of the CPSS render it a valuable instrument for PTSD screening as well as for assessing symptom severity.

Randomized controlled trial of an internet-based intervention using random-digit-dial recruitment: the Disaster Recovery Web project

Disasters occur with high frequency throughout the world and increase risk for development of mental health problems in affected populations. Research focused on the development and evaluation of secondary prevention interventions addressing post-disaster mental health has high potential public-health impact. Toward this end, internet-based interventions (IBIs) are particularly attractive in that they: (1) offer a low-cost means of delivering standardized, targeted, personalized intervention content to a broad audience; and (2) are easily integrated within a stepped care approach to screening and service delivery. We describe a unique study design intended to evaluate an IBI with a disaster-affected population-based sample. Description and rationale are provided for sampling selection and procedures, selection of assessment measures and methods, design of the intervention, and statistical evaluation of critical outcomes. Unique features of this intervention include the use of a population-based sample, telephone and internet-based assessments, and development of a highly individualized web-based intervention. Challenges related to the development and large-scale evaluation of IBIs targeting post-disaster mental health problems, as well as implications for future research and practice are discussed.

Psychosocial interventions for the prevention of disability following traumatic physical injury

BACKGROUND

Traumatic physical injury can result in many disabling sequelae including physical and mental health problems and impaired social functioning.

OBJECTIVES

To assess the effectiveness of psychosocial interventions in the prevention of physical, mental and social disability following traumatic physical injury.

SEARCH STRATEGY

The search was not restricted by date, language or publication status. We searched the following electronic databases; Cochrane Injuries Group Specialised Register, CENTRAL (The Cochrane Library 2009, Issue 1), MEDLINE (Ovid SP), EMBASE (Ovid SP), PsycINFO (Ovid SP), Controlled Trials metaRegister (www.controlled-trials.com), AMED (Allied & Complementary Medicine), ISI Web of Science: Social Sciences Citation Index (SSCI), PubMed. We also screened the reference lists of all selected papers and contacted authors of relevant studies. The latest search for trials was in February 2008.

SELECTION CRITERIA

Randomised controlled trials that consider one or more defined psychosocial interventions for the prevention of physical disability, mental health problems or reduced social functioning as a result of traumatic physical injury. We excluded studies that included patients with traumatic brain injury (TBI).

DATA COLLECTION AND ANALYSIS

Two authors independently screened the titles and abstracts of search results, reviewed the full text of potentially relevant studies, independently assessed the risk of bias and extracted data.

MAIN RESULTS

We included five studies, involving 756 participants. Three studies assessed the effect of brief psychological therapies, one assessed the impact of a self-help booklet, and one the effect of collaborative care. The disparate nature of the trials covering different patient populations, interventions and outcomes meant that it was not possible to pool data meaningfully across studies. There was no evidence of a protective effect of brief psychological therapy or educational booklets on preventing disability. There was evidence from one trial of a reduction in both post-traumatic stress disorder (PTSD) and depressive symptoms one month after injury in those who received a collaborative care intervention combined with a brief psycho-educational intervention, however this was not retained at follow up. Overall mental health status was the only disability outcome affected by any intervention. In three trials the psychosocial intervention had a detrimental effect on the mental health status of patients.

AUTHORS' CONCLUSIONS

This review provides no convincing evidence of the effectiveness of psychosocial interventions for the prevention of disability following traumatic physical injury. Taken together, our findings cannot be considered as supporting the provision of psychosocial interventions to prevent aspects of disability arising from physical injury. However, these conclusions are based on a small number of disparate trials with small to moderate sample sizes and are therefore necessarily cautious. More research, using larger sample sizes, and similar interventions and patient populations to enable pooling of results, is needed before these findings can be confirmed.

A memory-based model of posttraumatic stress disorder: evaluating basic assumptions underlying the PTSD diagnosis

In the mnemonic model of posttraumatic stress disorder (PTSD), the current memory of a negative event, not the event itself, determines symptoms. The model is an alternative to the current event-based etiology of PTSD represented in the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; American Psychiatric Association, 2000). The model accounts for important and reliable findings that are often inconsistent with the current diagnostic view and that have been neglected by theoretical accounts of the disorder, including the following observations. The diagnosis needs objective information about the trauma and peritraumatic emotions but uses retrospective memory reports that can have substantial biases. Negative events and emotions that do not satisfy the current diagnostic criteria for a trauma can be followed by symptoms that would otherwise qualify for PTSD. Predisposing factors that affect the current memory have large effects on symptoms. The inability-to-recall-an-important-aspect-of-the-trauma symptom does not correlate with other symptoms. Loss or enhancement of the trauma memory affects PTSD symptoms in predictable ways. Special mechanisms that apply only to traumatic memories are not needed, increasing parsimony and the knowledge that can be applied to understanding PTSD.

An acute post-sexual assault intervention to prevent drug abuse: updated findings

Sexual assault and rape routinely produce extreme distress and negative psychological reactions in victims. Further, past research suggests that victims are at increased risk of developing substance use or abuse post-rape. The post-rape forensic medical exam may itself exacerbate peritraumatic distress because it includes cues that may serve as reminders of the assault, thereby potentiating post-assault negative sequelae. To address these problems, a two-part video intervention was developed to take advantage of the existing sexual assault forensic exam infrastructure, and to specifically (a) minimize anxiety/discomfort during forensic examinations, thereby reducing risk of future emotional problems, and (b) prevent increased substance use and abuse following sexual assault. Updated findings with a sample of 268 sexual assault victims participating in the forensic medical exam and completing one or more follow-up assessments at: (1)<3 months post-assault; (2) 3 to 6 months post-assault; or (3) 6 months or longer post-assault indicated that the video was associated with significantly lower frequency of marijuana use at each time point, among women who reported use prior to the assault.

Posttraumatic stress disorder: etiology, epidemiology, and treatment outcome

Posttraumatic stress disorder (PTSD) results from exposure to a traumatic event that poses actual or threatened death or injury and produces intense fear, helplessness, or horror. U.S. population surveys reveal lifetime PTSD prevalence rates of 7% to 8%. Potential reasons for varying prevalence rates across gender, cultures, and samples exposed to different traumas are discussed. Drawing upon a conditioning model of PTSD, we review risk factors for PTSD, including pre-existing individual-based factors, features of the traumatic event, and posttrauma social support. Characteristics of the trauma, particularly peritraumatic response and related cognitions, and posttrauma social support appear to confer the greatest risk for PTSD. Further work is needed to disentangle the interrelationships among these factors and elucidate the underlying mechanisms. Based upon existing treatment outcome studies, we recommend use of exposure therapies and anxiety management training as first-line treatment for PTSD. Among psychopharmacological treatments, selective serotonin reuptake inhibitors evidence the strongest treatment effects, yet these effects are modest compared with psychological treatments.

Randomized controlled evaluation of an early intervention to prevent post-rape psychopathology

A randomized between-group design was used to evaluate the efficacy of a video intervention to reduce post-traumatic stress disorder (PTSD) and other mental health problems, implemented prior to the forensic medical examination conducted within 72 h post-sexual assault. Participants were 140 female victims of sexual assault (68 video/72 nonvideo) aged 15 years or older. Assessments were targeted for 6 weeks (Time 1) and 6 months (Time 2) post-assault. At Time 1, the intervention was associated with lower scores on measures of PTSD and depression among women with a prior rape history relative to scores among women with a prior rape history in the standard care condition. At Time 2, depression scores were also lower among those with a prior rape history who were in the video relative to the standard care condition. Small effects indicating higher PTSD and Beck Anxiety Inventory (BAI) scores among women without a prior rape history in the video condition were observed at Time 1. Accelerated longitudinal growth curve analysis indicated a videoxprior rape history interaction for PTSD, yielding four patterns of symptom trajectory over time. Women with a prior rape history in the video condition generally maintained the lowest level of symptoms.

PTSD and the Social Support of the Interpersonal Environment: The Development of Social Cognitive Behavior Therapy

We will argue that, although the evidence for the effectiveness of cognitive-behavioral treatment, of PTSD is compelling, not all patients engage or respond to treatment and in those who do, residual symptomatology is not uncommon. We then briefly examine the literature on the influence of the interpersonal and emotional aspects of social support on the development, maintenance, and treatment of post-traumatic stress disorder (PTSD). Two areas of social support are suggested as potentially important to the study of PTSD: (1) the literature on expressed emotion (EE) and the underlying beliefs held by significant others which influence their negative coping behaviors and interactions with the patient, and (2) examination of the concept of reciprocity, the ability to receive and provide social support. Finally, we suggest a range of possible treatment options suggested by this review as possible adjuncts to conventional CBT. These include formal family interventions, re-engagement with social networks, and modification of perceptions of social interactions.