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Vignaud P, Lavallé L, Brunelin J, Prieto N. Are psychological debriefing groups after a potential traumatic event suitable to prevent the symptoms of PTSD? Psychiatry Res 2022; 311:114503. [PMID: 35287042 DOI: 10.1016/j.psychres.2022.114503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 03/02/2022] [Accepted: 03/06/2022] [Indexed: 11/18/2022]
Abstract
Psychological debriefing is a psychotherapeutic approach developed for early intervention in civilians and professionals who have to cope with a potential traumatic event (PTE). Although initial works claimed that this approach may decrease symptoms of posttraumatic stress disorder (PTSD), some studies have concluded that the clinical benefits of psychological debriefing were limited. Several methodological variations could explain the discrepancies observed among studies. Among these variations, how the approach is administered to participants should have importance, and clinical evidence suggests that debriefing groups instead of individuals could have a beneficial clinical effect. We conducted a systematic search of the literature investigating the clinical effects of psychological debriefing groups on PTSD symptoms after a PTE according to the PRISMA guidelines. Among the 790 articles found, 11 met our inclusion criteria. Most of these articles did not support any beneficial effect of psychological debriefing groups on PTSD symptoms. A large number of methodological variations that may influence the outcomes of these studies were observed. Psychological debriefing groups did not seem efficient in alleviating PTSD symptoms. Further studies of high methodological quality are needed to elucidate the effect of psychological debriefing groups on specific PTSD symptoms and on nonspecific symptoms.
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Affiliation(s)
- Philippe Vignaud
- Hospices civils de Lyon, Hôpital Edouard Herriot, Cellule d'urgences médico psychologiques, 69437 Lyon, France; Hospices civils de Lyon, Hôpital Edouard Herriot, Centre régional du Psychotraumatisme Auvergne Rhône Alpes, 69437 Lyon, France.
| | - Layla Lavallé
- INSERM U1028, CNRS UMR5292, PSYR2 Team, Centre de recherche en Neurosciences de Lyon, Université Claude Bernard Lyon 1, 69437 Lyon, France; Centre Hospitalier Le Vinatier, 69677 Bron, France
| | - Jérôme Brunelin
- INSERM U1028, CNRS UMR5292, PSYR2 Team, Centre de recherche en Neurosciences de Lyon, Université Claude Bernard Lyon 1, 69437 Lyon, France; Centre Hospitalier Le Vinatier, 69677 Bron, France
| | - Nathalie Prieto
- Hospices civils de Lyon, Hôpital Edouard Herriot, Cellule d'urgences médico psychologiques, 69437 Lyon, France; Hospices civils de Lyon, Hôpital Edouard Herriot, Centre régional du Psychotraumatisme Auvergne Rhône Alpes, 69437 Lyon, France
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Osuch E, Ursano R, Li H, Webster M, Hough C, Fullerton C, Leskin G. Brain Environment Interactions: Stress, Posttraumatic Stress Disorder, and the Need for a Postmortem Brain Collection. Psychiatry 2022; 85:113-145. [PMID: 35588486 DOI: 10.1080/00332747.2022.2068916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Stress, especially the extreme stress of traumatic events, can alter both neurobiology and behavior. Such extreme environmental situations provide a useful model for understanding environmental influences on human biology and behavior. This paper will review some of the evidence of brain alterations that occur with exposure to environmental stress. This will include recent studies using neuroimaging and will address the need for histological confirmation of imaging study results. We will review the current scientific approaches to understanding brain environment interactions, and then make the case for the collection and study of postmortem brain tissue for the advancement of our understanding of the effects of environment on the brain.Creating a brain tissue collection specifically for the investigation of the effects of extreme environmental stressors fills a gap in the current research; it will provide another of the important pieces to the puzzle that constitutes the scientific investigation of negative effects of environmental exposures. Such a resource will facilitate new discoveries related to the psychiatric illnesses of acute stress disorder and posttraumatic stress disorder, and can enable scientists to correlate structural and functional imaging findings with tissue abnormalities, which is essential to validate the results of recent imaging studies.
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Jackson JE, Do-Nguyen A, Ewbank C, Anderson C, Newton C, Schreiber M. Feasibility of PTSD risk identification in pediatric trauma patients using PsySTART: A pilot study. J Pediatr Surg 2021; 56:2348-2353. [PMID: 33836845 DOI: 10.1016/j.jpedsurg.2021.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 03/01/2021] [Accepted: 03/12/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Trauma patients undergo a standardized history and physical, however identification of mental health risk factors is not typically included. We aimed to assess the feasibility of using a modified version of Psychological Simple Triage and Rapid Treatment (PsySTART) to identify post-traumatic stress disorder (PTSD) risk factors in pediatric trauma patients. We hypothesized that PsySTART could identify risk factors and be integrated into the electronic medical record (EMR). METHODS Trauma patients 10-17 years old at a level II pediatric trauma center from 2014 to 2015 were screened. PsySTART was used on a pilot cohort to determine if risk factors were present. PsySTART was then integrated into an automated EMR workflow and completion rates were evaluated. RESULTS PsySTART was completed in a pilot cohort of 63 patients with the following findings: 33.3% (n = 21) with 1 risk factor, 22.2% (n = 14) with 2 risk factors, and 19.1% (n = 12) with ≥3 risk factors. The most commonly identified risk factor was, "felt or expressed extreme fear or panic" (n = 27, 43.0%). After EMR integration, PsySTART was successfully completed with automatic consults in 156 of 198 patients (78.8%). CONCLUSIONS PsySTART identified risk factors in pediatric trauma patients. EMR integration was feasible and led to proactive psychological management and intervention. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Jordan E Jackson
- Department of Surgery, University of California, San Francisco East Bay, Oakland, CA USA.
| | - Amy Do-Nguyen
- Department of Pediatrics, Lundquist Institute at Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | - Clifton Ewbank
- Department of Surgery, University of California, San Francisco East Bay, Oakland, CA USA
| | - Craig Anderson
- Department of Emergency Medicine, University of California Irvine, Irvine, CA USA
| | - Christopher Newton
- Department of Surgery, University of California San Francisco Benioff Children's Hospital Oakland, Oakland, CA USA
| | - Merritt Schreiber
- Department of Pediatrics, Lundquist Institute at Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA USA
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Hobfoll SE, Watson P, Bell CC, Bryant RA, Brymer MJ, Friedman MJ, Friedman M, Gersons BPR, de Jong J, Layne CM, Maguen S, Neria Y, Norwood AE, Pynoos RS, Reissman D, Ruzek JI, Shalev AY, Solomon Z, Steinberg AM, Ursano RJ. Five Essential Elements of Immediate and Mid-Term Mass Trauma Intervention: Empirical Evidence. Psychiatry 2021; 84:311-346. [PMID: 35061969 DOI: 10.1080/00332747.2021.2005387] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Given the devastation caused by disasters and mass violence, it is critical that intervention policy be based on the most updated research findings. However, to date, no evidence-based consensus has been reached supporting a clear set of recommendations for intervention during the immediate and the mid-term post mass trauma phases. Because it is unlikely that there will be evidence in the near or mid-term future from clinical trials that cover the diversity of disaster and mass violence circumstances, we assembled a worldwide panel of experts on the study and treatment of those exposed to disaster and mass violence to extrapolate from related fields of research, and to gain consensus on intervention principles. We identified five empirically supported intervention principles that should be used to guide and inform intervention and prevention efforts at the early to mid-term stages. These are promoting: 1) a sense of safety, 2) calming, 3) a sense of self- and community efficacy, 4) connectedness, and 5) hope.
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Short NA, Morabito DM, Gilmore AK. Secondary prevention for posttraumatic stress and related symptoms among women whohave experienced a recent sexual assault: A systematic review and meta-analysis. Depress Anxiety 2020; 37:1047-1059. [PMID: 32442345 PMCID: PMC7680285 DOI: 10.1002/da.23030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 03/23/2020] [Accepted: 04/19/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Women who have experienced a recent sexual assault (SA) are at high risk for posttraumatic stress disorder (PTSD) and related conditions, with approximately half of women experiencing SA meeting criteria for PTSD. There are no guidelines for the prevention of PTSD and other common mental health disorders after SA. Thus, the purpose of this systematic review and meta-analysis is to synthesize research on secondary preventions for PTSD after SA, determine efficacy whether any intervention seems promising, and ascertain when, how, and to whom interventions should be delivered. METHODS After searching electronic databases for secondary preventions for PTSD and related conditions among women who have experienced a recent SA, 17 studies were reviewed, their quality was rated on the clinical trial assessment measure, and 10 studies were meta-analyzed (7 were excluded, as they were not randomized controlled trials or due to the absence of heterogeneity). RESULTS Results suggested a small-to-moderate effect of prevention on reducing PTSD and related symptoms. There was no moderating effect of medication versus psychosocial interventions, timing, treatment modality, or targeted versus universal prevention. Half of the studies were of high quality. CONCLUSION Cognitive-behavioral secondary preventions for PTSD appear to be safe and effective among women who have experienced a recent SA. Future research should identify best practices and mechanisms of treatment, and once identified, it should move toward implementation science.
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Affiliation(s)
- Nicole A. Short
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC, USA
| | | | - Amanda K. Gilmore
- Department of Health Policy & Behavioral Sciences and Mark Chaffin Center for Healthy Development, School of Public Health, Georgia State University, Atlanta, GA
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Hameed M, O'Doherty L, Gilchrist G, Tirado-Muñoz J, Taft A, Chondros P, Feder G, Tan M, Hegarty K. Psychological therapies for women who experience intimate partner violence. Cochrane Database Syst Rev 2020; 7:CD013017. [PMID: 32608505 PMCID: PMC7390063 DOI: 10.1002/14651858.cd013017.pub2] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Intimate partner violence (IPV) against women is prevalent and strongly associated with mental health problems. Women experiencing IPV attend health services frequently for mental health problems. The World Health Organization recommends that women who have experienced IPV and have a mental health diagnosis should receive evidence-based mental health treatments. However, it is not known if psychological therapies work for women in the context of IPV and whether they cause harm. OBJECTIVES To assess the effectiveness of psychological therapies for women who experience IPV on the primary outcomes of depression, self-efficacy and an indicator of harm (dropouts) at six- to 12-months' follow-up, and on secondary outcomes of other mental health symptoms, anxiety, quality of life, re-exposure to IPV, safety planning and behaviours, use of healthcare and IPV services, and social support. SEARCH METHODS We searched the Cochrane Common Mental Disorders Controlled Trials Register (CCMDCTR), CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, and three other databases, to the end of October 2019. We also searched international trials registries to identify unpublished or ongoing trials and handsearched selected journals, reference lists of included trials and grey literature. SELECTION CRITERIA We included randomised controlled trials (RCTs), quasi-RCTs, cluster-RCTs and cross-over trials of psychological therapies with women aged 16 years and older who self-reported recent or lifetime experience of IPV. We included trials if women also experienced co-existing mental health diagnoses or substance abuse issues, or both. Psychological therapies included a wide range of interventions that targeted cognition, motivation and behaviour compared with usual care, no treatment, delayed or minimal interventions. We classified psychological therapies according to Cochrane Common Mental Disorders's psychological therapies list. DATA COLLECTION AND ANALYSIS Two review authors extracted data and undertook 'Risk of Bias' assessment. Treatment effects were compared between experimental and comparator interventions at short-term (up to six months post-baseline), medium-term (six to under 12 months, primary outcome time point), and long-term follow-up (12 months and above). We used standardised mean difference (SMD) for continuous and odds ratio (OR) for dichotomous outcomes, and used random-effects meta-analysis, due to high heterogeneity across trials. MAIN RESULTS We included 33 psychological trials involving 5517 women randomly assigned to experimental (2798 women, 51%) and comparator interventions (2719 women, 49%). Psychological therapies included 11 integrative therapies, nine humanistic therapies, six cognitive behavioural therapy, four third-wave cognitive behavioural therapies and three other psychologically-orientated interventions. There were no trials classified as psychodynamic therapies. Most trials were from high-income countries (19 in USA, three in Iran, two each in Australia and Greece, and one trial each in China, India, Kenya, Nigeria, Pakistan, Spain and UK), among women recruited from healthcare, community, shelter or refuge settings, or a combination of any or all of these. Psychological therapies were mostly delivered face-to-face (28 trials), but varied by length of treatment (two to 50 sessions) and staff delivering therapies (social workers, nurses, psychologists, community health workers, family doctors, researchers). The average sample size was 82 women (14 to 479), aged 37 years on average, and 66% were unemployed. Half of the women were married or living with a partner and just over half of the participants had experienced IPV in the last 12 months (17 trials), 6% in the past two years (two trials) and 42% during their lifetime (14 trials). Whilst 20 trials (61%) described reliable low-risk random-sampling strategies, only 12 trials (36%) described reliable procedures to conceal the allocation of participant status. While 19 trials measured women's depression, only four trials measured depression as a continuous outcome at medium-term follow-up. These showed a probable beneficial effect of psychological therapies in reducing depression (SMD -0.24, 95% CI -0.47 to -0.01; four trials, 600 women; moderate-certainty evidence). However, for self-efficacy, there may be no evidence of a difference between groups (SMD -0.12, 95% CI -0.33 to 0.09; one trial with medium-term follow-up data, 346 women; low-certainty evidence). Further, there may be no difference between the number of women who dropped out from the experimental or comparator intervention groups, an indicator of no harm (OR 1.04, 95% CI 0.75 to 1.44; five trials with medium-term follow-up data, 840 women; low-certainty evidence). Although no trials reported adverse events from psychological therapies or participation in the trial, only one trial measured harm outcomes using a validated scale. For secondary outcomes, trials measured anxiety only at short-term follow-up, showing that psychological therapies may reduce anxiety symptoms (SMD -0.96, 95% CI -1.29 to -0.63; four trials, 158 women; low-certainty evidence). However, within medium-term follow-up, low-certainty evidence revealed that there may be no evidence between groups for the outcomes safety planning (SMD 0.04, 95% CI -0.18 to 0.25; one trial, 337 women), post-traumatic stress disorder (SMD -0.24, 95% CI -0.54 to 0.06; four trials, 484 women) or re-exposure to any form of IPV (SMD 0.03, 95% CI -0.14 to 0.2; two trials, 547 women). AUTHORS' CONCLUSIONS There is evidence that for women who experience IPV, psychological therapies probably reduce depression and may reduce anxiety. However, we are uncertain whether psychological therapies improve other outcomes (self-efficacy, post-traumatic stress disorder, re-exposure to IPV, safety planning) and there are limited data on harm. Thus, while psychological therapies probably improve emotional health, it is unclear if women's ongoing needs for safety, support and holistic healing from complex trauma are addressed by this approach. There is a need for more interventions focused on trauma approaches and more rigorous trials (with consistent outcomes at similar follow-up time points), as we were unable to synthesise much of the research.
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Affiliation(s)
- Mohajer Hameed
- Department of General Practice, The University of Melbourne, Melbourne, Australia
| | - Lorna O'Doherty
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | - Gail Gilchrist
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Judit Tirado-Muñoz
- Addiction Research Group, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Angela Taft
- The Judith Lumley Centre, La Trobe University, Melbourne, Australia
| | - Patty Chondros
- Department of General Practice, The University of Melbourne, Melbourne, Australia
| | - Gene Feder
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Melissa Tan
- Department of General Practice, The University of Melbourne, Melbourne, Australia
| | - Kelsey Hegarty
- Department of General Practice, The University of Melbourne, Melbourne, Australia
- The Royal Women's Hospital, Victoria, Australia
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Silander NC, Chesire DJ, Scott KS. Psychological Prophylaxis: An Integrated Psychological Services Program in Trauma Care. J Clin Psychol Med Settings 2020; 26:291-301. [PMID: 30341469 DOI: 10.1007/s10880-018-9586-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
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.
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Affiliation(s)
- Nina C Silander
- Brooks Rehabilitation Hospital, 3599 University Blvd S., Jacksonville, FL, USA.
| | - David J Chesire
- Division of Acute Care Surgery, Department of Surgery, College of Medicine/Jacksonville, University of Florida, Jacksonville, FL, USA
| | - Kamela S Scott
- Division of Acute Care Surgery, Department of Surgery, College of Medicine/Jacksonville, University of Florida, Jacksonville, FL, USA
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Lai BS, Osborne MC, Veauuse-Brown ND, Swedo EA, Self-Brown S, Massetti GM. Violence victimization and negative health correlates of youth in post-earthquake Haiti: Findings from the cross-sectional violence against children survey. J Affect Disord 2020; 270:59-64. [PMID: 32275221 PMCID: PMC7359602 DOI: 10.1016/j.jad.2020.03.050] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 12/18/2019] [Accepted: 03/20/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND We examined the prevalence of and relationships between violence victimization and negative health correlates of Haitian youth exposed to the 2010 earthquake. METHODS Participants were randomly selected 13-24 year-old youth (1457 females; 1459 males) living in Haiti following the 2010 earthquake. Data collected via Haiti's 2012 Violence against Children Survey (VACS) were analyzed. RESULTS Participants reported violence victimization in the past 12 months (females: 49.93%; males: 41.68%), moderate-to-severe mental distress (females: 76.56%; males: 66.41%), and suicidal ideation (females: 26.79%; males: 8.05%). Compared to participants without experiences of violence, victims of violence had significantly higher mean number of sexual partners (females: 1.99, 95% CI: 1.81-2.16, p = .02; males: 4.33, 95% CI: 3.50-5.16, p = .03), mental distress (females: 80.39%, p = .01; males: 72.95%, p = .002), and suicidal ideation (females: 36.09%, p < .0001; males: 12.02%, p < .0001). Male victims of violence were more likely to have sex without a condom (26.02%, p = .01) and female victims of violence were more likely to report histories of STIs (28.04%, p = .01), when compared to participants without history of violence. LIMITATIONS Data were collected via self-report. Disaster exposure experiences were not assessed. Analysis was correlational and did not control for potential confounding variables. CONCLUSIONS Disaster-exposed youth endorsed high levels of violence victimization and negative health correlates. Earthquake survivors who experienced violence were more likely to report negative health correlates. Greater attention to downstream sequelae of natural disasters is needed.
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Affiliation(s)
- Betty S. Lai
- Lynch School of Education and Human Development, Boston College, 140 Commonwealth Ave, Chestnut Hill, MA, 02467, USA,Corresponding author. Tel.: 617.552.8026., (B.S. Lai)
| | | | | | - Elizabeth A. Swedo
- Division of Violence Prevention, Centers for Disease Control and Prevention, USA
| | | | - Greta M. Massetti
- Division of Violence Prevention, Centers for Disease Control and Prevention, USA
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Maples-Keller JL, Post LM, Price M, Goodnight JM, Burton MS, Yasinski CW, Michopoulos V, Stevens JS, Hinrichs R, Rothbaum AO, Hudak L, Houry D, Jovanovic T, Ressler K, Rothbaum BO. Investigation of optimal dose of early intervention to prevent posttraumatic stress disorder: A multiarm randomized trial of one and three sessions of modified prolonged exposure. Depress Anxiety 2020; 37:429-437. [PMID: 32248637 PMCID: PMC7347250 DOI: 10.1002/da.23015] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 12/04/2019] [Accepted: 01/03/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is linked to a specific event, providing the opportunity to intervene in the immediate aftermath of trauma to prevent the development of this disorder. A previous trial demonstrated that trauma survivors who received three sessions of modified prolonged exposure therapy demonstrated decreased PTSD and depression prospectively compared to assessment only. The present study investigated the optimal dosing of this early intervention to test one versus three sessions of exposure therapy in the immediate aftermath of trauma. METHODS Participants (n = 95) recruited from a Level 1 Trauma Center were randomly assigned in a 1.5:1.5:1 ratio in a parallel-group design to the three conditions: one-session exposure therapy, three-session exposure therapy, and assessment only. Follow-up assessments were conducted by study assessors blind to study condition. RESULTS Mixed-effects model results found no significant differences in PTSD or depression symptoms between the control condition and those who received one or three exposure therapy sessions across 1-12-month follow-up assessment. Results indicate that the intervention did not interfere with natural recovery. Receiver operating characteristic curve analyses on the screening measure used for study inclusion (Predicting PTSD Questionnaire; PPQ) in the larger sample from which the treatment sample was drawn (n = 481) found that the PPQ was a poor predictor of likely PTSD at all follow-up time points (Area under the curve's = 0.55-0.62). CONCLUSIONS This likely impacted study results as many participants demonstrated natural recovery. Recommendations for future early intervention research are reviewed, including strategies to identify more accurately those at risk for PTSD and oversampling more severe trauma types.
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Affiliation(s)
- Jessica L. Maples-Keller
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, Georgia
| | - Loren M. Post
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, Georgia
| | - Matthew Price
- Department of Psychological Science, University of Vermont, Burlington, Vermont
| | - Jessica M. Goodnight
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, Georgia
| | - Mark S. Burton
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, Georgia
| | - Carly W. Yasinski
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, Georgia
| | - Vasiliki Michopoulos
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, Georgia,Developmental and Cognitie Neuroscience, Yerkes National Primate Research Center, Atlanta, Georgia
| | - Jennifer S. Stevens
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, Georgia
| | - Rebecca Hinrichs
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, Georgia
| | - Alex O. Rothbaum
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio
| | - Lauren Hudak
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, Georgia
| | - Debra Houry
- Division of Injury Prevention, National Center for Injury Control and Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, Georgia
| | - Kerry Ressler
- Department of Psychiatry, Mclean Hospital, Harvard Medical School, Belmont, Massachusetts
| | - Barbara O. Rothbaum
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, Georgia
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10
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The role of psychological support interventions in trauma patients on mental health outcomes: A systematic review and meta-analysis. J Trauma Acute Care Surg 2019; 87:463-482. [DOI: 10.1097/ta.0000000000002371] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lewis-Schroeder NF, Kieran K, Murphy BL, Wolff JD, Robinson MA, Kaufman ML. Conceptualization, Assessment, and Treatment of Traumatic Stress in First Responders: A Review of Critical Issues. Harv Rev Psychiatry 2019; 26:216-227. [PMID: 29975339 PMCID: PMC6624844 DOI: 10.1097/hrp.0000000000000176] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
First responders are regularly confronted with exposure to traumatic events, including potentially life-threatening situations as well as the grave injuries and deaths of colleagues and civilians. Evidence indicates that the prevalence of posttraumatic stress disorder (PTSD) is substantially higher among first responders than the general population. This article provides information about the outpatient trauma services at McLean Hospital's LEADER (Law Enforcement, Active Duty, Emergency Responder) program to assist clinicians who encounter these first responders in their practices or who are specifically interested in working with this patient population. We begin by synthesizing the literature on the prevalence of PTSD in first responders following work-related exposure to traumatic stress, and by addressing the occupation-specific risk factors and the third-variable risk factors that may contribute to potentiated risk. We then discuss assessment strategies and treatment options used in our program, which is tailored for individuals who are dealing with mental health issues stemming from occupation-specific traumatic-stress exposure. We also address the unique challenges of treating traumatized first responders with more complex issues such as traumatic stress exposure across the lifespan and safety issues, including acute suicidality. We conclude by discussing notable gaps in the literature, including the need to investigate why and how women present with different PTSD symptoms than men and how these differences need to be taken into account in determining appropriate treatment for women.
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Affiliation(s)
- Nina F Lewis-Schroeder
- From Harvard Medical School (Drs. Lewis-Schroeder, Murphy, Robinson, and Kaufman) and McLean Hospital, Belmont, MA (all)
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Neukirch N, Reid S, Shires A. Yoga for PTSD and the role of interoceptive awareness: A preliminary mixed-methods case series study. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2019. [DOI: 10.1016/j.ejtd.2018.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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13
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Guay S, Sader J, Boyer R, Marchand A. Treatment of acute stress disorder for victims of violent crime. J Affect Disord 2018; 241:15-21. [PMID: 30089232 DOI: 10.1016/j.jad.2018.07.048] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 06/08/2018] [Accepted: 07/17/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Victims of violent crime are at elevated risk of developing acute stress disorder (ASD) as well as subsequent post-traumatic stress disorder (PTSD), both of which are linked to severe psychological distress. The aim of this 12-month prospective study was to evaluate the efficacy of cognitive-behavioral therapy (CBT) vs. cognitive-behavioral therapy with a significant other (CBT-SO), relative to usual care (UC), for the improvement of post-traumatic, depression and anxiety symptoms and the prevention of PTSD among victims of violent crime with ASD. METHODS A total of 166 victims of violent crime with ASD were assigned to CBT (n = 54), CBT-SO (n = 52) or UC (n = 60). Self-report assessments and diagnostic interviews were completed at pre-treatment and post-treatment as well as at 6-month and 12-month follow-ups. RESULTS CBT and CBT-SO participants had fewer depression symptoms than those in the UC group up to 12 months post-event. Significantly fewer participants in the CBT condition met criteria for PTSD than in the UC group up to 12 months post-event. The CBT group did not differ from the CBT-SO group on any variable at any assessment time. LIMITATIONS Findings must be interpreted in light of the quasi-experimental nature of the study and limitations concerning the management of missing data. CONCLUSIONS Further research is warranted in order to assess whether more extensive involvement of a significant other in therapy may lead to better outcomes for victims of violent crime with ASD.
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Affiliation(s)
- Stéphane Guay
- School of Criminology, University of Montreal, Montreal, Canada; Department of Psychiatry, University of Montreal, Montreal, Canada.
| | - Josette Sader
- School of Criminology, University of Montreal, Montreal, Canada
| | - Richard Boyer
- Department of Psychiatry, University of Montreal, Montreal, Canada
| | - André Marchand
- Department of Psychology, University of Quebec in Montreal, Montreal, Canada
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14
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Dworkin ER, Schumacher JA. Preventing Posttraumatic Stress Related to Sexual Assault Through Early Intervention: A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2018; 19:459-472. [PMID: 27681005 PMCID: PMC5373931 DOI: 10.1177/1524838016669518] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Sexual assault survivors come into contact with a variety of community responders after assault, and these interactions may play an important role in mitigating distress. Given theoretical understandings of the importance of early experiences in the development of posttraumatic stress (PTS), early contact with formal systems (e.g., health care, criminal justice, social services) and informal responders (e.g., friends, family) might be particularly important in preventing PTS. However, the effectiveness of these early interventions is unclear. Understanding the key elements of early interventions, both formal and informal, that successfully prevent the development of PTS could help to improve community responses to sexual assault and ultimately promote survivor well-being. In this systematic review, we investigate the types of experiences with responders in the early aftermath of assault that are associated with PTS, the duration of effects on PTS, and the role of the timing of these responses in the development of PTS. Findings indicate that responder contact alone is not typically associated with significant differences in PTS, and there is insufficient evidence to indicate that the timing of seeking help is associated with PTS, but the quality of services provided and perceptions of interactions with certain responders appear to be associated with PTS. Although many effects were short-lived, interventions that were perceived positively may be associated with lower PTS up to a year postassault. These findings support the importance of offering best practice interventions that are perceived positively, rather than simply encouraging survivors to seek help.
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Affiliation(s)
- Emily R Dworkin
- 1 University of Mississippi Medical Center, Jackson, MS, USA
- 2 G.V. "Sonny" Montgomery VA Medical Center, Jackson, MS, USA
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15
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Brief Cognitive Therapy Plus Treatment as Usual for Social Anxiety Disorder: a Randomized Trial of Adults in India. Int J Cogn Ther 2018. [DOI: 10.1007/s41811-018-0025-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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16
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Aronson KR, Welsh JA, Fedotova A, Morgan NR, Perkins DF, Travis W. Treating PTSD in active duty service members using cognitive processing therapy or prolonged exposure therapy: Examining everyday practice at a military outpatient clinic. MILITARY PSYCHOLOGY 2018. [DOI: 10.1080/08995605.2018.1478550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | - Janet A. Welsh
- Pennsylvania State University, University Park, Pennsylvania
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17
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Lenglet A, Lopes-Cardozo B, Shanks L, Blanton C, Feo C, Tsatsaeva Z, Idrisov K, Bolton PA, Pintaldi G. Outcomes of an individual counselling programme in Grozny, Chechnya: a randomised controlled study. BMJ Open 2018; 8:e019794. [PMID: 30139892 PMCID: PMC6112398 DOI: 10.1136/bmjopen-2017-019794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
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.
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Affiliation(s)
- Annick Lenglet
- Médecins Sans Frontières, Operational Centre Amsterdam, Amsterdam, The Netherlands
| | - Barbara Lopes-Cardozo
- Emergency Response and Recovery Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Leslie Shanks
- Médecins Sans Frontières, Operational Centre Amsterdam, Amsterdam, The Netherlands
| | - Curtis Blanton
- Emergency Response and Recovery Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | - Kyuri Idrisov
- Psychiatry Department, Chechnya State University, Grozny, Republic of Chechnya
| | - Paul A Bolton
- Departments of International Health and Mental Health,Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Giovanni Pintaldi
- Médecins Sans Frontières, Operational Centre Amsterdam, Amsterdam, The Netherlands
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18
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Abstract
Post-traumatic stress disorder (PTSD), recognised as a diagnostic entity in 1980, was originally associated with combat or war experiences. It has since been recognised that it is prevalent in any population exposed to traumatic events. Although much has been written about the management of PTSD, the concepts of resilience and vulnerability have not received the same attention. This article reviews the conceptualisation, epidemiology and comorbidities of PTSD and highlights the factors underlying vulnerability and conveying resilience.
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19
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Koenen KC, Ratanatharathorn A, Ng L, McLaughlin KA, Bromet EJ, Stein DJ, Karam EG, Ruscio AM, Benjet C, Scott K, Atwoli L, Petukhova M, Lim CC, Aguilar-Gaxiola S, Al-Hamzawi A, Alonso J, Bunting B, Ciutan M, de Girolamo G, Degenhardt L, Gureje O, Haro JM, Huang Y, Kawakami N, Lee S, Navarro-Mateu F, Pennell BE, Piazza M, Sampson N, ten Have M, Torres Y, Viana MC, Williams D, Xavier M, Kessler RC. Posttraumatic stress disorder in the World Mental Health Surveys. Psychol Med 2017; 47:2260-2274. [PMID: 28385165 PMCID: PMC6034513 DOI: 10.1017/s0033291717000708] [Citation(s) in RCA: 551] [Impact Index Per Article: 78.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Traumatic events are common globally; however, comprehensive population-based cross-national data on the epidemiology of posttraumatic stress disorder (PTSD), the paradigmatic trauma-related mental disorder, are lacking. METHODS Data were analyzed from 26 population surveys in the World Health Organization World Mental Health Surveys. A total of 71 083 respondents ages 18+ participated. The Composite International Diagnostic Interview assessed exposure to traumatic events as well as 30-day, 12-month, and lifetime PTSD. Respondents were also assessed for treatment in the 12 months preceding the survey. Age of onset distributions were examined by country income level. Associations of PTSD were examined with country income, world region, and respondent demographics. RESULTS The cross-national lifetime prevalence of PTSD was 3.9% in the total sample and 5.6% among the trauma exposed. Half of respondents with PTSD reported persistent symptoms. Treatment seeking in high-income countries (53.5%) was roughly double that in low-lower middle income (22.8%) and upper-middle income (28.7%) countries. Social disadvantage, including younger age, female sex, being unmarried, being less educated, having lower household income, and being unemployed, was associated with increased risk of lifetime PTSD among the trauma exposed. CONCLUSIONS PTSD is prevalent cross-nationally, with half of all global cases being persistent. Only half of those with severe PTSD report receiving any treatment and only a minority receive specialty mental health care. Striking disparities in PTSD treatment exist by country income level. Increasing access to effective treatment, especially in low- and middle-income countries, remains critical for reducing the population burden of PTSD.
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Affiliation(s)
- K. C. Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - A. Ratanatharathorn
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - L. Ng
- Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
| | - K. A. McLaughlin
- Department of Psychology, University of Washington, Seattle, Washington, USA
| | - E. J. Bromet
- Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, New York, USA
| | - D. J. Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Republic of South Africa
| | - E. G. Karam
- Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon
- Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
| | - A. Meron Ruscio
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - C. Benjet
- Department of Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente, Mexico City, Mexico
| | - K. Scott
- Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand
| | - L. Atwoli
- Department of Mental Health, Moi University School of Medicine, Eldoret, Kenya
| | - M. Petukhova
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - C. C.W. Lim
- Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand
- Queensland Brain Institute, University of Queensland, St Lucia
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Queensland, Australia
| | - S. Aguilar-Gaxiola
- Center for Reducing Health Disparities, UC Davis Health System, Sacramento, California, USA
| | - A. Al-Hamzawi
- College of Medicine, Al-Qadisiya University, Diwania governorate, Iraq
| | - J. Alonso
- Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Pompeu Fabra University (UPF); CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - B. Bunting
- School of Psychology, Ulster University, Londonderry, UK
| | - M. Ciutan
- National School of Public Health, Management and Professional Development, Bucharest, Romania
| | - G. de Girolamo
- IRCCS St John of God Clinical Research Centre//IRCCS Centro S. Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - L. Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - O. Gureje
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - J. M. Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Barcelona, Spain
| | - Y. Huang
- Institute of Mental Health, Peking University, Beijing, China
| | - N. Kawakami
- Department of Mental Health, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - S. Lee
- Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
| | - F. Navarro-Mateu
- UDIF-SM, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud IMIB-Arrixaca; CIBERESP-Murcia, Murcia, Spain
| | - B.-E. Pennell
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - M. Piazza
- Universidad Cayetano Heredia, Lima, Peru
- National Institute of Health, Lima, Peru
| | - N. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - M. ten Have
- Trimbos-Instituut, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Y. Torres
- Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia
| | - M. C. Viana
- Department of Social Medicine, Federal University of Espírito Santo, Vitoria, Brazil
| | - D. Williams
- Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, Massaschusetts, USA
| | - M. Xavier
- Chronic Diseases Research Center (CEDOC) and Department of Mental Health, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - R. C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
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20
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Cognitive Processing Therapy for the Treatment of Acute Stress Disorder Following Sexual Assault: A Randomised Effectiveness Study. BEHAVIOUR CHANGE 2017. [DOI: 10.1017/bec.2017.2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The effectiveness of individually administered cognitive processing therapy (CPT) when compared with treatment as usual (TAU) in a community sexual assault centre was tested. Trauma survivors with acute stress disorder (ASD) following sexual assault were randomised to either CPT (n = 25) or TAU (n = 22), and assessed at pretreatment, posttreatment, and 3-, 6- and 12-month follow-up. Both groups demonstrated large reductions in PTSD and depression symptoms following treatment, and these gains were maintained over the course of follow-ups (Cohen's ds for PTSD symptom reductions ranging between 0.76 to 1.45). Although smaller and not always consistent, between-group effect sizes typically favoured CPT. Effect sizes (d) ranged between 0.13–0.50 for posttraumatic stress and 0.13–0.41 for depression over the course of follow-ups. Independent assessment of PTSD severity indicated more CPT participants reached good end-state functioning at 12-month follow-up (50%) than TAU (31%). Although both treatments were effective, there were some indications that CPT led to better outcomes relative to therapists delivering their usual therapy. The present study demonstrates that evidence-based, trauma-focused therapy such as CPT can be effective when delivered as an early intervention in a routine mental health setting.
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21
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Birur B, Moore NC, Davis LL. An Evidence-Based Review of Early Intervention and Prevention of Posttraumatic Stress Disorder. Community Ment Health J 2017; 53:183-201. [PMID: 27470261 DOI: 10.1007/s10597-016-0047-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 07/22/2016] [Indexed: 12/13/2022]
Abstract
We present an evidence-based review of post-trauma interventions used to prevent posttraumatic stress disorder (PTSD). Literature search of PubMed from 1988 to March 2016 using keywords "Early Intervention AND Prevention of PTSD" yielded 142 articles, of which 52 intervention studies and 6 meta-analyses were included in our review. Trauma-focused cognitive behavioral therapy and modified prolonged exposure delivered within weeks of a potentially traumatic event for people showing signs of distress have the most evidence in the treatment of acute stress and early PTSD symptoms, and the prevention of PTSD. Even though several pharmacological agents have been tried, only hydrocortisone prior to high-risk surgery, severe traumatic injury, or during acute sepsis has adequate evidence for effectiveness in the reduction of acute stress symptoms and prevention of PTSD. There is an urgent need to determine the best targets for interventions after trauma to accelerate recovery and prevent PTSD.
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Affiliation(s)
- Badari Birur
- Department of Psychiatry, University of Alabama at Birmingham, 1713 6th Avenue South, Birmingham, AL, 35210, USA.
| | - Norman C Moore
- Department of Psychiatry, Quillen College of Medicine, East Tennessee State University, 70567, Johnson City, TN, 37614-1707, USA
| | - Lori L Davis
- Department of Psychiatry, University of Alabama at Birmingham, 1713 6th Avenue South, Birmingham, AL, 35210, USA.,VA Medical Center, 3701, Loop Road East, Tuscaloosa, AL, 35404, USA
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22
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McNally RJ, Bryant RA, Ehlers A. Does Early Psychological Intervention Promote Recovery From Posttraumatic Stress? Psychol Sci Public Interest 2016; 4:45-79. [DOI: 10.1111/1529-1006.01421] [Citation(s) in RCA: 357] [Impact Index Per Article: 44.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In the wake of the terrorist attacks at the World Trade Center, more than 9,000 counselors went to New York City to offer aid to rescue workers, families, and direct victims of the violence of September 11, 2001. These mental health professionals assumed that many New Yorkers were at high risk for developing posttraumatic stress disorder (PTSD), and they hoped that their interventions would mitigate psychological distress and prevent the emergence of this syndrome. Typically developing in response to horrific, life-threatening events, such as combat, rape, and earthquakes, PTSD is characterized by reexperiencing symptoms (e.g., intrusive recollections of the trauma, nightmares), emotional numbing and avoidance of reminders of the trauma, and hyperarousal (e.g., exaggerated startle, difficulty sleeping). People vary widely in their vulnerability for developing PTSD in the wake of trauma. For example, higher cognitive ability and strong social support buffer people against PTSD, whereas a family or personal history of emotional disorder heightens risk, as does negative appraisal of one's stress reactions (e.g., as a sign of personal weakness) and dissociation during the trauma (e.g., feeling unreal or experiencing time slowing down). However, the vast majority of trauma survivors recover from initial posttrauma reactions without professional help. Accordingly, the efficacy of interventions designed to mitigate acute distress and prevent long-term psychopathology, such as PTSD, needs to be evaluated against the effects of natural recovery. The need for controlled evaluations of early interventions has only recently been widely acknowledged. Psychological debriefing—the most widely used method—has undergone increasing empirical scrutiny, and the results have been disappointing. Although the majority of debriefed survivors describe the experience as helpful, there is no convincing evidence that debriefing reduces the incidence of PTSD, and some controlled studies suggest that it may impede natural recovery from trauma. Most studies show that individuals who receive debriefing fare no better than those who do not receive debriefing. Methodological limitations have complicated interpretation of the data, and an intense controversy has developed regarding how best to help people in the immediate wake of trauma. Recent published recommendations suggest that individuals providing crisis intervention in the immediate aftermath of the event should carefully assess trauma survivors' needs and offer support as necessary, without forcing survivors to disclose their personal thoughts and feelings about the event. Providing information about the trauma and its consequences is also important. However, research evaluating the efficacy of such “psychological first aid” is needed. Some researchers have developed early interventions to treat individuals who are already showing marked stress symptoms, and have tested methods of identifying those at risk for chronic PTSD. The single most important indicator of subsequent risk for chronic PTSD appears to be the severity or number of posttrauma symptoms from about 1 to 2 weeks after the event onward (provided that the event is over and that there is no ongoing threat). Cognitive-behavioral treatments differ from crisis intervention (e.g., debriefing) in that they are delivered weeks or months after the trauma, and therefore constitute a form of psychotherapy, not immediate emotional first aid. Several controlled trials suggest that certain cognitive-behavioral therapy methods may reduce the incidence of PTSD among people exposed to traumatic events. These methods are more effective than either supportive counseling or no intervention. In this monograph, we review risk factors for PTSD, research on psychological debriefing, recent recommendations for crisis intervention and the identification of individuals at risk of chronic PTSD, and research on early interventions based on cognitive-behavioral therapy. We close by placing the controversy regarding early aid for trauma survivors in its social, political, and economic context.
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Affiliation(s)
| | | | - Anke Ehlers
- Institute of Psychiatry, King's College London, London, United Kingdom
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23
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Zhou P, Zhang Y, Wei C, Liu Z, Hannak W. Acute stress disorder as a predictor of posttraumatic stress: A longitudinal study of Chinese children exposed to the Lushan earthquake. Psych J 2016; 5:206-14. [PMID: 27329012 DOI: 10.1002/pchj.136] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 04/28/2016] [Indexed: 01/02/2023]
Abstract
This study examined the prevalence of acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) in children who experienced the Lushan earthquake in Sichuan, China, and assessed the ability of ASD to predict PTSD. The Acute Stress Disorder Scale (ASDS) was used to assess acute stress reaction within weeks of the trauma. The University of California at Los Angeles Post-Traumatic Stress Disorder Reaction Index (UCLA-PTSD) for children was administered at intervals of 2, 6, and 12 months after the earthquake to 197 students who experienced the Lushan earthquake at the Longxing Middle School. The results demonstrated that 28.4% of the children suffered from ASD, but only a small percentage of the population went on to develop PTSD. Among all of the students, 35.0% of those who met the criteria for ASD were diagnosed with PTSD at the 12-month interval. The severity of ASD symptoms correlated with later PTSD symptoms.
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Affiliation(s)
- Peiling Zhou
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Graduate University of the Chinese Academy of Sciences, Beijing, China
| | - Yuqing Zhang
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.
| | - Chuguang Wei
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Graduate University of the Chinese Academy of Sciences, Beijing, China
| | - Zhengkui Liu
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Walter Hannak
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
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24
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Breathing biofeedback as an adjunct to exposure in cognitive behavioral therapy hastens the reduction of PTSD symptoms: a pilot study. Appl Psychophysiol Biofeedback 2016; 40:25-31. [PMID: 25750106 PMCID: PMC4375291 DOI: 10.1007/s10484-015-9268-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
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.
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25
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Erford BT, Gunther C, Duncan K, Bardhoshi G, Dummett B, Kraft J, Deferio K, Falco M, Ross M. Meta-Analysis of Counseling Outcomes for the Treatment of Posttraumatic Stress Disorder. JOURNAL OF COUNSELING AND DEVELOPMENT 2016. [DOI: 10.1002/jcad.12058] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | - Chelsea Gunther
- Education Specialties Department; Loyola University Maryland
| | - Kelly Duncan
- Division of Counseling and Psychology; University of South Dakota
- Now at School of Education; Northern University
| | - Gerta Bardhoshi
- Division of Counseling and Psychology; University of South Dakota
- Now at Department of Rehabilitation and Counselor Education; University of Iowa
| | - Beth Dummett
- Education Specialties Department; Loyola University Maryland
| | - Jennifer Kraft
- Education Specialties Department; Loyola University Maryland
| | - Katie Deferio
- Education Specialties Department; Loyola University Maryland
| | - Michelle Falco
- Education Specialties Department; Loyola University Maryland
| | - Margaret Ross
- Education Specialties Department; Loyola University Maryland
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26
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Lee JK, Choi HG, Kim JY, Nam J, Kang HT, Koh SB, Oh SS. Self-resilience as a protective factor against development of post-traumatic stress disorder symptoms in police officers. Ann Occup Environ Med 2016; 28:58. [PMID: 27777782 PMCID: PMC5067890 DOI: 10.1186/s40557-016-0145-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 10/03/2016] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Jong-Ku Lee
- Department of Occupational and Environmental Medicine, Wonju Severance Christian Hospital, Wonju College of Medicine, Yonsei University, 20 ilsan-ro, Wonju, Gangwon 220-701 South Korea
| | - Hyeon-Gyeong Choi
- Department of Occupational and Environmental Medicine, Wonju Severance Christian Hospital, Wonju College of Medicine, Yonsei University, 20 ilsan-ro, Wonju, Gangwon 220-701 South Korea
| | - Jae-Yeop Kim
- Department of Occupational and Environmental Medicine, Wonju Severance Christian Hospital, Wonju College of Medicine, Yonsei University, 20 ilsan-ro, Wonju, Gangwon 220-701 South Korea
| | - Juhyun Nam
- Department of Occupational and Environmental Medicine, Wonju Severance Christian Hospital, Wonju College of Medicine, Yonsei University, 20 ilsan-ro, Wonju, Gangwon 220-701 South Korea
| | - Hee-Tae Kang
- Department of Occupational and Environmental Medicine, Wonju Severance Christian Hospital, Wonju College of Medicine, Yonsei University, 20 ilsan-ro, Wonju, Gangwon 220-701 South Korea
| | - Sang-Baek Koh
- Department of Occupational and Environmental Medicine, Wonju Severance Christian Hospital, Wonju College of Medicine, Yonsei University, 20 ilsan-ro, Wonju, Gangwon 220-701 South Korea
- Department of Preventive Medicine, Wonju College of Medicine, Yonsei University, 20 ilsan-ro, Wonju, 220-701 Gangwon South Korea
| | - Sung-Soo Oh
- Department of Occupational and Environmental Medicine, Wonju Severance Christian Hospital, Wonju College of Medicine, Yonsei University, 20 ilsan-ro, Wonju, Gangwon 220-701 South Korea
- Department of Preventive Medicine, Wonju College of Medicine, Yonsei University, 20 ilsan-ro, Wonju, 220-701 Gangwon South Korea
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Foa EB, Gillihan SJ, Bryant RA. Challenges and Successes in Dissemination of Evidence-Based Treatments for Posttraumatic Stress: Lessons Learned From Prolonged Exposure Therapy for PTSD. Psychol Sci Public Interest 2015; 14:65-111. [PMID: 25722657 DOI: 10.1177/1529100612468841] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Posttraumatic stress disorder (PTSD) poses monumental public health challenges because of its contribution to mental health, physical health, and both interpersonal and social problems. Recent military engagements in Iraq and Afghanistan and the multitude of resulting cases of PTSD have highlighted the public health significance of these conditions. There are now psychological treatments that can effectively treat most individuals with PTSD, including active duty military personnel, veterans, and civilians. We begin by reviewing the effectiveness of these treatments, with a focus on prolonged exposure (PE), a cognitive-behavioral therapy (CBT) for PTSD. Many studies conducted in independent research labs have demonstrated that PE is highly efficacious in treating PTSD across a wide range of trauma types, survivor characteristics, and cultures. Furthermore, therapists without prior CBT experience can readily learn and implement the treatment successfully. Despite the existence of highly effective treatments like PE, the majority of individuals with PTSD receive treatments of unknown efficacy. Thus, it is crucial to identify the barriers and challenges that must be addressed in order to promote the widespread dissemination of effective treatments for PTSD. In this review, we first discuss some of the major challenges, such as a professional culture that often is antagonistic to evidence-based treatments (EBTs), a lack of clinician training in EBTs, limited effectiveness of commonly used dissemination techniques, and the significant cost associated with effective dissemination models. Next, we review local, national, and international efforts to disseminate PE and similar treatments and illustrate the challenges and successes involved in promoting the adoption of EBTs in mental health systems. We then consider ways in which the barriers discussed earlier can be overcome, as well as the difficulties involved in effecting sustained organizational change in mental health systems. We also present examples of efforts to disseminate PE in developing countries and the attendant challenges when mental health systems are severely underdeveloped. Finally, we present future directions for the dissemination of EBTs for PTSD, including the use of newer technologies such as web-based therapy and telemedicine. We conclude by discussing the need for concerted action among multiple interacting systems in order to overcome existing barriers to dissemination and promote widespread access to effective treatment for PTSD. These systems include graduate training programs, government agencies, health insurers, professional organizations, healthcare delivery systems, clinical researchers, and public education systems like the media. Each of these entities can play a major role in reducing the personal suffering and public health burden associated with posttraumatic stress.
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Affiliation(s)
- Edna B Foa
- Department of Psychiatry, University of Pennsylvania, Philadelphia
| | - Seth J Gillihan
- Department of Psychiatry, University of Pennsylvania, Philadelphia
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, Australia
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Abstract
In this article we present how the consultation-liaison and psychology divisions of an academic medical center's Department of Psychiatry responded in the first week after the Boston Marathon bombings, specifically in the context of disaster response guidelines and evidence-based approaches to acute trauma. Since the department had to address several complicated matters at multiple levels within the hospital system, we highlight unexpected issues unique to this particular event as they arose within the primary domains of our involvement. This article aims to (1) provide a descriptive analysis of how we enacted disaster and trauma guidelines and evidence-based care within a hospital setting, (2) shed light on the unique and unexpected administrative and systemic issues encountered in our response, and (3) discuss lessons learned, including opportunities to improve trauma-related care.
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A Brief, Early Cognitive-Behavioral Program for Cancer-Related PTSD, Anxiety, and Comorbid Depression. COGNITIVE AND BEHAVIORAL PRACTICE 2014. [DOI: 10.1016/j.cbpra.2014.05.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Abstract
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.
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Shanks L, Ariti C, Siddiqui MR, Pintaldi G, Venis S, de Jong K, Denault M. Counselling in humanitarian settings: a retrospective analysis of 18 individual-focused non-specialised counselling programmes. Confl Health 2013; 7:19. [PMID: 24041036 PMCID: PMC3849884 DOI: 10.1186/1752-1505-7-19] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 09/04/2013] [Indexed: 11/10/2022] Open
Abstract
Background Médecins Sans Frontières (MSF) provides individual counselling interventions in medical humanitarian programmes in contexts affected by conflict and violence. Although mental health and psychosocial interventions are a common part of the humanitarian response, little is known about how the profile and outcomes for individuals seeking care differs across contexts. We did a retrospective analysis of routine programme data to determine who accessed MSF counselling services and why, and the individual and programmatic risk factors for poor outcomes. Methods We analysed data from 18 mental health projects run by MSF in 2009 in eight countries. Outcome measures were client-rating scores (1–10 scale; 1 worst) for complaint severity and functioning and counsellor assessment. The effect of client and programme factors on outcomes was assessed by multiple regression analysis. Logistic regression was used to assess binary outcome variables. Results 48704 counselling sessions were held with 14963 individuals. Excluding women-focused projects, 66.8% of patients were women. Mean (SD) age was 33.3 (14.1) years. Anxiety-related complaints were the most common (35.0%), followed by family-related problems (15.7%), mood-related problems (14.1%) and physical complaints (13.7%). Only 2.0% presented with a serious mental health condition. 27.2% did not identify a traumatic precipitating event. 24.6% identified domestic discord or violence and 17.5% psychological violence as the precipitating event. 6244 (43.9%) had only one session. For 91% of 7837 who returned, the counsellor reported the problem had decreased or resolved. The mean (SD) complaint rating improved by 4.7 (2.4) points (p < 0.001) and by 4.2 (2.3, p < 0.001) for functional rating. Risk factors for poorer outcomes were few sessions, non-conflict setting (stable or societal violence settings), serious mental health condition, or attending a large, recently opened project. Conclusions The majority of clients accessing counselling services present with anxiety related complaints. Attrition rates were high. Good outcomes were recorded among those who attended for more than one visit. Lessons learned included the importance of adaptation of approach in non-conflict contexts such as societal violence or post-conflict contexts. There is a need for further research to evaluate the intervention against a control group.
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Affiliation(s)
- Leslie Shanks
- Médecins Sans Frontières (MSF), Amsterdam, The Netherlands.
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Russo J, Katon W, Zatzick D. The development of a population-based automated screening procedure for PTSD in acutely injured hospitalized trauma survivors. Gen Hosp Psychiatry 2013; 35:485-91. [PMID: 23806535 PMCID: PMC3784242 DOI: 10.1016/j.genhosppsych.2013.04.016] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Revised: 04/26/2013] [Accepted: 04/30/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This investigation aimed to advance posttraumatic stress disorder (PTSD) risk prediction among hospitalized injury survivors by developing a population-based automated screening tool derived from data elements available in the electronic medical record (EMR). METHOD Potential EMR-derived PTSD risk factors with the greatest predictive utilities were identified for 878 randomly selected injured trauma survivors. Risk factors were assessed using logistic regression, sensitivity, specificity, predictive values and receiver operator characteristic (ROC) curve analyses. RESULTS Ten EMR data elements contributed to the optimal PTSD risk prediction model including International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) PTSD diagnosis, other ICD-9-CM psychiatric diagnosis, other ICD-9-CM substance use diagnosis or positive blood alcohol on admission, tobacco use, female gender, non-White ethnicity, uninsured, public or veteran insurance status, E-code identified intentional injury, intensive care unit admission and EMR documentation of any prior trauma center visits. The 10-item automated screen demonstrated good area under the ROC curve (0.72), sensitivity (0.71) and specificity (0.66). CONCLUSIONS Automated EMR screening can be used to efficiently and accurately triage injury survivors at risk for the development of PTSD. Automated EMR procedures could be combined with stepped care protocols to optimize the sustainable implementation of PTSD screening and intervention at trauma centers nationwide.
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Affiliation(s)
- Joan Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA 98104
| | - Wayne Katon
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA 98104
| | - Douglas Zatzick
- Department of Psychiatry and Behavioral Sciences, Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, WA 98104
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McLaughlin KA, Koenen KC, Hill ED, Petukhova M, Sampson NA, Zaslavsky AM, Kessler RC. Trauma exposure and posttraumatic stress disorder in a national sample of adolescents. J Am Acad Child Adolesc Psychiatry 2013; 52:815-830.e14. [PMID: 23880492 PMCID: PMC3724231 DOI: 10.1016/j.jaac.2013.05.011] [Citation(s) in RCA: 371] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 04/09/2013] [Accepted: 05/17/2013] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Although exposure to potentially traumatic experiences (PTEs) is common among youths in the United States, information on posttraumatic stress disorder (PTSD) risk associated with PTEs is limited. We estimate lifetime prevalence of exposure to PTEs and PTSD, PTE-specific risk of PTSD, and associations of sociodemographics and temporally prior DSM-IV disorders with PTE exposure, PTSD given exposure, and PTSD recovery among U.S. adolescents. METHOD Data were drawn from 6,483 adolescent-parent pairs in the National Comorbidity Survey Replication Adolescent Supplement (NCS-A), a national survey of adolescents aged 13 through 17 years. Lifetime exposure to interpersonal violence, accidents/injuries, network/witnessing, and other PTEs was assessed along with DSM-IV PTSD and other distress, fear, behavior, and substance disorders. RESULTS A majority (61.8%) of adolescents experienced a lifetime PTE. Lifetime prevalence of DSM-IV PTSD was 4.7% and was significantly higher among females (7.3%) than among males (2.2%). Exposure to PTEs, particularly interpersonal violence, was highest among adolescents not living with both biological parents and with pre-existing behavior disorders. Conditional probability of PTSD was highest for PTEs involving interpersonal violence. Predictors of PTSD among PTE-exposed adolescents included female gender, prior PTE exposure, and pre-existing fear and distress disorders. One-third (33.0%) of adolescents with lifetime PTSD continued to meet criteria within 30 days of interview. Poverty, U.S. nativity, bipolar disorder, and PTE exposure occurring after the focal trauma predicted nonrecovery. CONCLUSIONS Interventions designed to prevent PTSD in PTE-exposed youths should be targeted at victims of interpersonal violence with pre-existing fear and distress disorders, whereas interventions designed to reduce PTSD chronicity should attempt to prevent secondary PTE exposure.
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Otis C, Marchand A, Courtois F. Risk factors for posttraumatic stress disorder in persons with spinal cord injury. Top Spinal Cord Inj Rehabil 2013; 18:253-63. [PMID: 23459174 DOI: 10.1310/sci1803-253] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
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.
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Affiliation(s)
- Catherine Otis
- Department of Psychology, Université du Québec à Montréal , Montréal, Québec, Canada
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Nixon RDV. Cognitive processing therapy versus supportive counseling for acute stress disorder following assault: a randomized pilot trial. Behav Ther 2012; 43:825-36. [PMID: 23046784 DOI: 10.1016/j.beth.2012.05.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 05/02/2012] [Accepted: 05/03/2012] [Indexed: 10/28/2022]
Abstract
The study tested the efficacy and tolerability of cognitive processing therapy (CPT) for survivors of assault with acute stress disorder. Participants (N=30) were randomly allocated to CPT or supportive counseling. Therapy comprised six individual weekly sessions of 90-min duration. Independent diagnostic assessment for PTSD was conducted at posttreatment. Participants completed self-report measures of posttraumatic stress, depression, and negative trauma-related beliefs at pre-, posttreatment, and 6-month follow-up. Results indicated that both interventions were successful in reducing symptoms at posttreatment with no statistical difference between the two; within and between-group effect sizes and the proportion of participants not meeting PTSD criteria was greater in CPT. Treatment gains were maintained for both groups at 6-month follow-up.
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Affiliation(s)
- Reginald D V Nixon
- School of Psychology, Flinders University, Adelaide, SA 5001, Australia.
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Browne AL, Appleton S, Fong K, Wood F, Coll F, de Munck S, Newnham E, Schug SA. A pilot randomized controlled trial of an early multidisciplinary model to prevent disability following traumatic injury. Disabil Rehabil 2012; 35:1149-63. [DOI: 10.3109/09638288.2012.721047] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Polak AR, Witteveen AB, Visser RS, Opmeer BC, Vulink N, Figee M, Denys D, Olff M. Comparison of the effectiveness of trauma-focused cognitive behavioral therapy and paroxetine treatment in PTSD patients: design of a randomized controlled trial. BMC Psychiatry 2012; 12:166. [PMID: 23046608 PMCID: PMC3539952 DOI: 10.1186/1471-244x-12-166] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 09/27/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The two most common interventions for Posttraumatic Stress Disorder (PTSD) are pharmacological treatment with SSRIs such as paroxetine and psychological treatment such as Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). International guidelines recommend trauma-focused psychological interventions for all PTSD patients as first-line treatment (NICE). However, no clear-cut evidence is available to support this recommendation. METHODS/DESIGN In order to compare pharmacological treatment (paroxetine) and psychological treatment (TF-CBT) in (cost-) effectiveness on the short and the long term, we will randomize 90 patients with chronic PTSD to either paroxetine (24 weeks) or TF-CBT (10-12 weeks). We will assess symptom severity and costs before and after the intervention with the Clinician Administered PTSD Scale (CAPS), the Clinical Global Impression Scale (CGI) and the Trimbos/iMTA questionnaire for Costs associated with Psychiatric Illness (TiC-P). DISCUSSION This study is unique for its direct comparison of the most commonly used psychological intervention (TF-CBT) and pharmacological intervention (paroxetine) on (cost-) effectiveness on the short and the long term. The anticipated results will provide relevant evidence concerning long-term effects and relapse rates and will be beneficial in reducing societal costs. It may also provide information on who may benefit most from which type of intervention. Some methodological issues will be discussed. TRIAL REGISTRATION Dutch Trial registration: NTR2235.
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Affiliation(s)
- A Rosaura Polak
- Academic Medical Center, Department of Anxiety Disorders, University of Amsterdam, Meibergdreef 5, Amsterdam 1105 AZ, The Netherlands.
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Koucky EM, Galovski TE, Nixon RD. Acute Stress Disorder: Conceptual Issues and Treatment Outcomes. COGNITIVE AND BEHAVIORAL PRACTICE 2012. [DOI: 10.1016/j.cbpra.2011.07.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Gray MJ, Maguen S, Litz BT. Acute Psychological Impact of Disaster and Large-Scale Trauma: Limitations of Traditional Interventions and Future Practice Recommendations. Prehosp Disaster Med 2012; 19:64-72. [PMID: 15453161 DOI: 10.1017/s1049023x00001497] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractNearly everyone will experience emotional and psychological distress in the immediate aftermath of a disaster or other large-scale traumatic event. Although extremely upsetting and disruptive, the reaction is understood best as a human response to inordinate adversity, which in the majority of cases remits over time without formal intervention. Nevertheless, some people experience sustained difficulties. To prevent chronic post-traumatic difficulties, mental health professionals provide early interventions soon after traumatic exposure. These interventions typically take the form of single-session debriefings, which have been applied routinely following disasters. The research bearing on these traditional forms of early crisis interventions has shown that, although well-received by victims, there is no empirical support for their continued use. However, promising evidence-based, early interventions have been developed, which are highlighted. Finally, traumatic bereavement and complicated grief in survivors of disasters, an area largely neglected in the field, is discussed.
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Affiliation(s)
- Matt J Gray
- Department of Psychology, University of Wyoming, Laramie, Wyoming 82071-3415, USA.
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Gurwitch RH, Kees M, Becker SM, Schreiber M, Pfefferbaum B, Diamond D. When Disaster Strikes: Responding to the Needs of Children. Prehosp Disaster Med 2012; 19:21-8. [PMID: 15453156 DOI: 10.1017/s1049023x00001448] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractWhen a disaster strikes, parents are quick to seek out the medical advice and reassurance of their primary care physician, pediatrician, or in the case of an emergency, an emergency department physician. As physicians often are the first line of responders following a disaster, it is important that they have a thorough understanding of children's responses to trauma and disaster and of recommended practices for screening and intervention. In collaboration with mental health professionals, the needs of children and families can be addressed. Policy-makers and systems of care hold great responsibility for resource allocation, and also are well-placed to understand the impact of trauma and disaster on children and children's unique needs in such situations.
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Affiliation(s)
- Robin H Gurwitch
- Department of Pediatrics, University of Oklahoma Health Sciences Center for Terrorism and Disaster Branch, Oklahoma City, Oklahoma 73117, USA.
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Walser RD, Ruzek JI, Naugle AE, Padesky C, Ronell DM, Ruggiero K. Disaster and Terrorism: Cognitive-Behavioral Interventions. Prehosp Disaster Med 2012; 19:54-63. [PMID: 15453160 DOI: 10.1017/s1049023x00001485] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractThe mental health effects of disaster and terrorism have moved to the forefront in the recent past following the events of 11 September 2001 in the United States. Although there has been a protracted history by mental health researchers and practitioners to study, understand, prevent, and treat mental health problems arising as a result of disasters and terrorism, there still is much to learn about the effects and treatment of trauma. Continued communication among disaster workers, first-response medical personnel, and mental health professionals is part of this process. This paper outlines current knowledge regarding the psychological effects of trauma and best cognitive-behavioral practices used to treat trauma reactions. More specifically, the information presented is a summary of Cognitive-Behavioral Therapy (CBT) interventions that are relevant for responding to and dealing with the aftermath of disasters.
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Affiliation(s)
- Robyn D Walser
- National Center for Post-Traumatic Stress Disorder, Veterans Administration Palo Alto Health Care System, Menlo Park, California 94025, USA.
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Emergence of delayed posttraumatic stress disorder symptoms related to sexual trauma: patient-centered and trauma-cognizant management by physical therapists. Phys Ther 2012; 92:339-51. [PMID: 22173794 DOI: 10.2522/ptj.20100344] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND PURPOSE Sexual violence has been identified as one of the most common predictors of posttraumatic stress disorder (PTSD). This case report describes the emergence of delayed PTSD symptoms, disclosure of history of sexual trauma, and the influence of re-experiencing, avoidance, and hyperarousal symptoms on physical therapy treatment. CASE DESCRIPTION A 60-year-old woman was seen for treatment of low back pain. DISCUSSION of a discord between fear of falling and no balance impairments led to disclosure of sexual assault by a physician at 19 years of age. The patient's PTSD symptoms emerged after 10 weeks of physical therapy. The physical therapists monitored somatic responses and body language closely and modified and planned treatment techniques to avoid PTSD triggers and limit hyperarousal. Collaborative communication approaches included reinforcement of cognitive-behavioral strategies introduced by her psychotherapists. OUTCOMES Trauma-cognizant approaches supported the patient's efforts to manage PTSD symptoms sufficiently to tolerate physical therapy and participate in a back care class. Nonlinear psychological healing is illustrated. DISCUSSION Symptoms of PTSD may emerge during physical therapy treatment, and patient-sensitive responses to disclosure are important. The trauma-cognizant approach (2-way communication, patient-centered management, and integration of psychological elements into clinical decision making) helped identify and respond to triggers. The physical therapists reinforced cognitive-behavioral strategies introduced by psychotherapists to manage PTSD symptoms. Patient-centered care with further refinement to a trauma-cognizant approach may play an important role in assisting patients with PTSD or a history of sexual trauma to manage symptoms while addressing rehabilitation needs.
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Ruggiero KJ, Resnick HS, Paul LA, Gros K, McCauley JL, Acierno R, Morgan M, Galea S. Randomized controlled trial of an internet-based intervention using random-digit-dial recruitment: the Disaster Recovery Web project. Contemp Clin Trials 2012; 33:237-46. [PMID: 22008248 PMCID: PMC3253875 DOI: 10.1016/j.cct.2011.10.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Accepted: 10/04/2011] [Indexed: 11/19/2022]
Abstract
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.
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Affiliation(s)
- Kenneth J Ruggiero
- National Crime Victims Research and Treatment Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St., MSC861, Charleston, SC 29425, USA.
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Kress VEW, Trippany RL, Nolan JM. Responding to Sexual Assault Victims: Considerations for College Counselors. JOURNAL OF COLLEGE COUNSELING 2011. [DOI: 10.1002/j.2161-1882.2003.tb00233.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Ivey AE, Ivey MB. ReframingDSM-IV: Positive Strategies From Developmental Counseling and Therapy. JOURNAL OF COUNSELING AND DEVELOPMENT 2011. [DOI: 10.1002/j.1556-6676.1998.tb02550.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Day KW. Violence Survivors With Posttraumatic Stress Disorder: Treatment by Integrating Existential and Narrative Therapies. ADULTSPAN JOURNAL 2011. [DOI: 10.1002/j.2161-0029.2009.tb00061.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Hensley LG. Drug-Facilitated Sexual Assault on Campus: Challenges and Interventions. JOURNAL OF COLLEGE COUNSELING 2011. [DOI: 10.1002/j.2161-1882.2002.tb00219.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Ivey AE, Ivey MB. Toward a Developmental Diagnostic and Statistical Manual: The Vitality of a Contextual Framework. JOURNAL OF COUNSELING AND DEVELOPMENT 2011. [DOI: 10.1002/j.1556-6676.1999.tb02476.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Shearing V, Lee D, Clohessy S. How do clients experience reliving as part of trauma-focused cognitive behavioural therapy for posttraumatic stress disorder? Psychol Psychother 2011; 84:458-75. [PMID: 22903886 DOI: 10.1111/j.2044-8341.2010.02012.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Reliving is an integral part of trauma-focused cognitive-behavioural therapy (CBT), a recommended treatment for post-traumatic stress disorder (PTSD) with a convincing evidence base supporting its use. However, the literature suggests that clinicians are reluctant to use reliving in therapy. The aim of this study was to explore participants' experiences of undergoing reliving as part of CBT for PTSD in order to further clinicians' understanding of client experiences of reliving. DESIGN This was a qualitative study. Semi-structured interviews were conducted and the transcripts analyzed using interpretative phenomenological analysis (IPA) (Smith, Jarman, & Osborn, 1999). METHOD Seven participants who had completed the reliving component of trauma-focused CBT in the previous month were recruited through therapists working in specialist trauma services, and semi-structured interviews were conducted using a topic guide. The transcripts were analyzed using IPA to enable the research questions to be addressed. RESULTS Three super-ordinate themes and 11 subordinate themes were developed to reflect participants' common and distinct experiences. The three super-ordinate themes were 'overcoming ambivalence', 'painful but achievable', and 'positive change'. CONCLUSIONS This study provided useful information about participants' experiences of reliving during CBT for PTSD. Clinical implications regarding the therapeutic relationship, preparing clients for reliving, and the impact of reliving were suggested. Implications for future research were identified including extending the score of the study, exploring differences in participants' experiences, and exploring unexpected findings.
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