Attitudes to emotional expression and personality in predicting post-traumatic stress disorder

Temporal Transitions in Patterns of Posttraumatic Stress Disorder and Depression Among Adolescents Following the Wenchuan Earthquake

Posttramatic stress disorder (PTSD) and depression are persistent disorders with heterogeneous comorbidity. Cross-sectional design limitations have prevented previous studies from examining symptom pattern transitions, which limits the understanding on the change of mental health over time since trauma. This study examined transition patterns of PTSD and depression comorbidity and assessed the role of personality. PTSD, depression, and personality scales were used to assess 619 adolescents 1 year after the Wenchuan earthquake and then to longitudinally assess 332 adolescents 2 years post-earthquake. Data were analyzed using latent transition analysis and logistic regression. Four PTSD and depression comorbidity patterns were identified at both times: moderate comorbidity, high comorbidity, no symptoms, and depression. Patterns of PTSD and depression changed in 23.4% of adolescents: 4.4% and 7.1% transitioned from no symptoms to depression and from depression to moderate comorbidity, respectively; 7.5% transitioned from moderate comorbidity to depression. Extraversion and conscientiousness were more likely and openness was less likely to be associated with moderate comorbidity symptoms transitioned to depression symptoms. These findings indicated that patterns of PTSD and depression in adolescents are heterogeneous and show temporal change.

Posttraumatic stress symptomatology following exposure to perceived traumatic perinatal events within the midwifery profession: The impact of trait emotional intelligence

AIMS

To explore factors associated with, and predictors of, posttraumatic stress symptoms in midwives. To explore factors associated with, and potential moderating effects of, trait emotional intelligence. Secondary analysis explored predictors of resilience.

BACKGROUND

Midwives may experience vicarious trauma responses due to exposure to certain perinatal events in their professional lives. This may have adverse psychological outcomes for midwives, and women and children in their care.

DESIGN

A cross-sectional, online and paper survey of midwives in the United Kingdom was conducted.

METHODS

Between February and October 2016, 113 midwives who met inclusion criteria provided demographic information, and completed scales measuring posttraumatic stress symptoms, trait emotional intelligence, empathy, resilience, social support, and attitudes towards emotional expression.

RESULTS

Higher resilience and trait emotional intelligence scores were associated with reduced posttraumatic stress symptoms. Higher empathy, perceived social support, and resilience were associated with higher trait emotional intelligence. Lower resilience significantly predicted posttraumatic stress symptoms. Trait emotional intelligence did not moderate relationships between resilience and posttraumatic stress symptoms, but may protect against posttraumatic stress symptoms in midwives with higher empathy. Higher trait emotional intelligence, and lower empathy and need for support, significantly predicted resilience. Notably, when trait emotional intelligence was higher, the negative relationship between empathy and resilience was reduced.

CONCLUSION

Approximately one-fifth of midwives were experiencing posttraumatic stress symptoms at clinically significant levels. Trait emotional intelligence may protect against posttraumatic stress symptoms by supporting resilience, while enabling midwives to remain empathic. The negative correlation between resilience and empathy needs careful consideration by policy makers.

Agreeableness and pregnancy: Relations with coping and psychiatric symptoms, a longitudinal study on Spanish pregnant women

Agreeableness is associated with good mental health during pregnancy. Although different studies have indicated that agreeableness is related to adaptive coping, this relation has scarcely been studied in pregnant women. The aim of this study was to analyze the possible differences between high and low agreeableness in relation to coping strategies and psychiatric symptoms in pregnant women. We conducted a longitudinal prospective study between October 2009 and January 2013. Pregnant women (n = 285) were assessed in the first trimester of pregnancy, and 122 of them were assessed during the third. Data were collected using the Coping Strategies Questionnaire, the Symptom Check List 90-R, and the agreeableness subscale of the NEO-FFI. Using the SPSS 21 statistics package, binary logistic regression, two-way mixed analysis of variance, and multiple regression analyses and a Sobel test were conducted. Higher levels of agreeableness were associated with positive reappraisal and problem-solving, and lower levels of agreeableness were associated with overt emotional expression and negative self-focused coping. Women with low agreeableness had poorer mental health, especially in the first trimester. These findings should be taken into account to improve women's experiences during pregnancy. Nevertheless, given the scarcity of data, additional studies are needed.

Acceptance and Commitment Therapy in the Treatment of Posttraumatic Stress Disorder

The current article describes the application of a behavioral psychotherapy, acceptance and commitment therapy (ACT), to the treatment of post-traumatic stress disorder (PTSD). It is argued that PTSD can be conceptualized as a disorder that is developed and maintained in traumatized individuals as a result of excessive, ineffective attempts to control unwanted thoughts, feelings, and memories, especially those related to the traumatic event(s). As ACT is a therapeutic method designed specifically to reduce experiential avoidance, it may be a treatment that is particularly suited for individuals with PTSD. The application of ACT to PTSD is described, and a case example is used to demonstrate how this therapy can be successfully used with individuals presenting for life problems related to a traumatic event.

Plasma levels of high mobility group box 1 increase in patients with posttraumatic stress disorder after severe blunt chest trauma: a prospective cohort study

BACKGROUND

High-mobility group box 1 (HMGB1), a key late mediator of systemic inflammation, is a potentially useful biomarker for predicting outcome in patients with severe blunt chest trauma. The purpose of this study was to define the relationship between plasma levels of HMGB1 and posttraumatic stress disorder (PTSD) in patients with severe blunt chest trauma.

METHODS

All patients with severe blunt chest trauma (abbreviated injury score ≥3) who were admitted to traumatic surgery department and ultimately survived to follow-up at 6 mo were eligible for the study. HMGB1 was sampled every other day from day 1-day 7 after admission, and plasma concentrations of HMGB1 were measured by a quantitative enzyme-linked immunosorbent assay test. Multivariate regression analysis was used to define the independent contribution of possible risk factors selected by univariate analysis.

RESULTS

PTSD was identified in 43 patients including acute PTSD (n = 21), chronic PTSD (n = 18), and delayed-onset PTSD (n = 4) after 6-mo follow-up, in whom significant higher plasma levels of HMGB1 on days three, five, and seven after blunt chest trauma were noted compared with those seen in patients without PTSD (n = 10). Multivariate logistic analysis showed that transfusion, injury severity score, and HMGB1 levels at day 7 were the valuable risk factors for PTSD.

CONCLUSIONS

In blunt chest trauma, plasma HMGB1 levels were significantly higher in patients with PTSD compared with patients with non-PTSD. Our data indicate that patients with high plasma levels of HMGB1 may be more prone to develop PTSD including acute and chronic PTSD.

Posttraumatic Stress and Meaning Making in Mexico City

Mexico City, established in 1524, is Mexico’s most important educational, financial and cultural centre. As is typical of large metropolitan cities, Mexico City has its share of crime, violence and poverty. It also has a history of natural disasters, particularly large-scale earthquakes. There is a lack of research on the impacts and correlates of chronic exposure to trauma in developing societies such as Mexico City. Particularly, a dearth of research that examines the relationship between exposure to trauma and posttraumatic growth in these populations exists. Recently, the Association of Trauma Outreach and Prevention (ATOP) organised a humanitarian mission to Mexico City to assess posttraumatic symptomatology and identify factors that contributed to meaning making and posttraumatic growth, including socio-demographic variables. The results demonstrated that age and marital status were associated with traumatic stress symptomatology and the ability to find meaning in trauma and purpose in one’s life. Inconsistent with previous research, there were no differential associations in symptomatology or posttraumatic growth on the basis of gender. Of note, the results suggested that individuals who had offered support to others during a traumatic event were currently experiencing lower levels of posttraumatic stress and an increased ability to find meaning in the trauma.

Relations Between Resilience, Positive and Negative Emotionality, and Symptoms of Anxiety and Depression

Although research concerning the effects of traumatic and stressful life events on an individual's mental health has been plentiful in the past several decades, research aimed at understanding the nature of resilience and its role in this process has been less plentiful. The present study examined the relationship between a commonly used measure of resilience, the Connor-Davidson Resilience Scale (CD-RISC), facets of personality, and symptoms of psychopathology-specifically, posttraumatic symptomatology-in a sample of college students. We found that the CD-RISC was most strongly linked with the personality facet of positive emotionality rather than the expected facet of negative emotionality. With regard to psychopathology, the CD-RISC displayed the largest relationship to a measure of anhedonic depression rather than a measure of posttraumatic stress. Lastly, the CD-RISC added little in predicting symptoms of posttraumatic stress above and beyond negative emotionality, a personality facet that has previously shown robust relationships with posttraumatic stress. These results suggest that the CD-RISC is most strongly predictive of positive emotionality and thus may be most useful in predicting resilience for disorders characterized by disruptions in positive affect.

Psychobiology of PTSD in the acute aftermath of trauma: Integrating research on coping, HPA function and sympathetic nervous system activity

Research on the psychobiological sequelae of trauma has typically focused on long-term alterations in individuals with chronic posttraumatic stress disorder (PTSD). Far less is known about the nature and course of psychobiological risk factors for PTSD during the acute aftermath of trauma. In this review, we summarize data from prospective studies focusing on the relationships among sympathetic nervous system activity, hypothalamic-pituitary-adrenal function, coping strategies and PTSD symptoms during the early recovery (or non-recovery) phase. Findings from pertinent studies are integrated to inform psychobiological profiles of PTSD-risk in children and adults in the context of existing models of PTSD-onset and maintenance. Data regarding bidirectional relations between coping strategies and stress hormones is reviewed. Limitations of existing literature and recommendations for future research are discussed.

Fear of emotion as a moderator between PTSD and firefighter social interactions

Despite high levels of exposure to stress, questions remain regarding how social interactions and beliefs about emotion interact to influence posttraumatic stress disorder (PTSD) in firefighters. United States urban firefighters (N = 225) completed the Interpersonal Support Evaluation List, the Unsupportive Social Interactions Inventory, the Affective Control Scale, and the Posttraumatic Stress Disorder Checklist. Each independent variable predicted PTSD beyond variance accounted for by demographic variables. Additionally, fear of emotion emerged as the strongest individual predictor of PTSD and a moderator of the relation between social interactions and PTSD symptoms. These findings emphasize the importance of beliefs about emotion both in how these beliefs might influence the expression of PTSD symptoms, and in how the social networks of trauma survivors might buffer distress.

Risk factors for psychological distress following injury

OBJECTIVES

To identify predictors of psychological morbidity among injured patients admitted to an Emergency Department (ED).

DESIGN

A prospective cohort study.

PARTICIPANTS

Participants were consecutive male ED attenders. 210 (97.7%) patients consented to participate. At one month, 128 (61.0%) responded, at six months, 114 (54.3%), at eighteen months 96 (45.7%).

MAIN OUTCOME MEASURES

Measures immediately following injury were the Hospital Anxiety and Depression Scale, the Eysenck Personality Questionnaire and the McGill pain questionnaire. Recovery at one month was recorded using the SF-36 Health Survey, COPE scale, Perceived Stress Scale and Revised Impact of Events Scale. At six and eighteen months outcome was measured using the General Health Questionnaire (28 items) and Revised Impact of Events Scale. Multivariate analysis identified pre-morbid, accident-related and recovery factors influencing outcome at six and eighteen months.

RESULTS

The strongest predictors of outcome were initial levels of anxiety and depression, prior history of mental health problems, early PTSD symptoms and involvement in litigation. These factors predicted between 40-60% of the variance at six months (p<0.001), and 50-60% of the variance in psychological distress at eighteen months (p<0.001).

CONCLUSION

Factors identifying individuals at-risk from psychological distress following injury include those related to the immediate response and the recovery phases of injury. Further development is needed to convert identified predictors into a comprehensive screening tool for clinical use.

Adverse childhood experiences (ACEs), genetic polymorphisms and neurochemical correlates in experimentation with psychotropic drugs among adolescents

Epidemiological and clinical data show frequent associations between adverse childhood experiences (ACEs) and substance abuse susceptibility particularly in adolescents. A large body of evidences suggests that the possible dysregulation of neuroendocrine responses as well as neurotransmitters function induced by childhood traumatic experiences and emotional neglect could constitute one of the essential biological changes implementing substance abuse vulnerability. Moreover, genotype variables and its environment interactions have been associated with an increased risk for early onset substance abuse. In this paper we present several data that support the hypothesis of the involvement of hypothalamus-pituitary-adrenal (HPA) axis in mediating the combined effect of early adverse experiences and gene variants affecting neurotransmission. The presented data also confirm the relationship between basal plasma levels of cortisol and ACTH, on the one hand, and retrospective measures of neglect during childhood on the other hand: the higher the mother and father neglect (CECA-Q) scores are, the higher the plasma levels of the two HPA hormones are. Furthermore, such positive relationship has been proved to be particularly effective and important when associated with the "S" promoter polymorphism of the gene encoding the 5-HTT transporter, both in homozygote and heterozygote individuals.

Emotion regulation difficulties in trauma survivors: the role of trauma type and PTSD symptom severity

Two different hypotheses regarding the relationship between emotion regulation and PTSD are described in the literature. First, it has been suggested that emotion regulation difficulties are part of the complex sequelae of early-onset chronic interpersonal trauma and less common following late-onset or single-event traumas. Second, PTSD in general has been suggested to be related to emotion regulation difficulties. Bringing these two lines of research together, the current study aimed to investigate the role of trauma type and PTSD symptom severity on emotion regulation difficulties in a large sample of trauma survivors (N=616). In line with the hypotheses, PTSD symptom severity was significantly associated with all variables assessing emotion regulation difficulties. In addition, survivors of early-onset chronic interpersonal trauma showed higher scores on these measures than survivors of single-event and/or late-onset traumas. However, when controlling for PTSD symptom severity, the group differences only remained significant for 2 out of 9 variables. The most robust findings were found for the variable "lack of clarity of emotions." Implications for future research, theoretical models of trauma-related disorders, and their treatment will be discussed.

The trauma outcome process assessment model: a structural equation model examination of adjustment

This investigation sought to operationalize a comprehensive theoretical model, the Trauma Outcome Process Assessment, and test it empirically with structural equation modeling. The Trauma Outcome Process Assessment reflects a robust body of research and incorporates known ecological factors (e.g., family dynamics, social support) to explain internalizing distress (e.g., anxiety, depression), externalizing distress (e.g., aggression), and recovery outcomes following traumatic events. Results revealed that expected relationships among the variables were significantly related in the expected direction, and the measures mapped well onto the expected latent constructs. Following optimal specification of the relationships within the Trauma Outcome Process Assessment, structural equation modeling revealed strong support for the Trauma Outcome Process Assessment as a comprehensive identification and treatment model to explain the differential outcomes of those exposed to traumatic stressors.

Severity of injury does not have any impact on posttraumatic stress symptoms in severely injured patients

BACKGROUND

Due to improved surgical techniques and more efficient decision making in treating severely injured patients, survival rates have increased over the years. This study was initiated to evaluate the incidence and identify risk factors for developing posttraumatic stress symptoms, using both extensive trauma-related data and data assessing the psychological trauma, in a population of severely injured patients.

PATIENTS AND METHODS

79 patients admitted to the Department of Multitrauma and Spinal Cord Injury at Sunnaas Rehabilitation Hospital from 2003 to 2005, prospectively completed semistructured psychological interviews and questionnaires, such as Impact of Event Scale-Revised. In addition, extensive injury-related data, such as injury severity score (ISS), new injury severity score (NISS), and probability of survival (PS) were collected.

RESULTS

39% had multiple trauma, 34% had multiple injuries including spinal cord injuries, and 27% had isolated spinal cord injuries. Mean NISS was 31.5 (S.D. 13.7). 6% met diagnostic criteria for posttraumatic stress disorder (PTSD) and 9% met the criteria for subsyndromal PTSD. Injury-related data did not influence the prevalence of posttraumatic stress symptoms, however, some psychosocial variables did have a significant impact.

CONCLUSIONS

We found a low incidence of PTSD and subsyndromal PTSD. No significant differences were found between the patients suffering from posttraumatic stress symptoms and the non-symptoms group in relation to injury-related data such as ISS/NISS, PS, or multiple trauma versus spinal cord injury. The most evident risk factors for developing posttraumatic stress symptoms were symptoms of anxiety, female gender and negative attitudes toward emotional expression.

Psychological outcomes and measurement of maternal posttraumatic stress disorder during the perinatal period

For many parents, labor, delivery, and/or the perinatal and neonatal periods present significant stressors that result in clinically significant parental feelings of psychological distress or trauma. This review article identifies known preexisting risk, and protective, factors for such distress, focusing on individual variables and familial or other social support networks. Research describing the full range of possible psychological reactions is also presented, loosely categorized as representing psychological outcomes of resiliency or growth, externalized distress, and internalized distress. These outcomes are viewed as neither linear nor mutually exclusive, and specific implications for each outcome are presented. The primary focus of this review is on the most well understood internalizing distress outcome during the perinatal period, maternal posttraumatic stress reactions. The utility of a brief, freely available measure quantifying such distress is also overviewed, including standards for its usage. Healthcare and particularly nursing staff are encouraged to attend to the range of possible psychological outcomes that may emerge during the perinatal period, identifying distressed mothers, so that they may be referred for care. The review concludes by presenting recommended future directions for research regarding the measurement of posttraumatic stress disorder in parents.

Comorbidity and personality traits in patients with different levels of posttraumatic stress disorder following myocardial infarction

More research is needed to further our understanding of posttraumatic stress responses and comorbidity following myocardial infarction (MI), and to help us identify more clearly the personality traits which indicate that a person is more prone to developing post-MI posttraumatic stress disorder (PTSD). This study aimed to 1) investigate the comorbidity of patients who suffered from different levels of posttraumatic stress disorder following myocardial infarction (i.e. post-MI PTSD), and 2) investigate to what extent patients with different levels of post-MI PTSD differed in their personality traits. One hundred and twenty MI patients from two general practices were recruited for the study. They were asked to complete the Posttraumatic Stress Diagnostic Scale (PDS), the General Health Questionnaire-28 (GHQ-28) and the NEO-Five Factor Inventory (NEO-FFI). They were divided into a no-PTSD group, a partial-PTSD group and a full-PTSD group, according to the scores of the PDS. One hundred and sixteen members of the general public were also recruited for comparison purposes. They were asked to complete the GHQ-28. The results showed that patients with full-PTSD reported significantly more somatic problems, anxiety, social dysfunction and depression than the other two patient groups and the control group. When age, bypass surgery, mental health problems before MI and angioplasty were controlled for, patients with full-PTSD also reported greater symptom severity of the four GHQ subscales than the other two patient groups. Patients with full-PTSD were significantly more neurotic than those with no-PTSD and partial-PTSD. Patients with full-PTSD were less agreeable than patients with no-PTSD. Regression analyses showed that personality did not moderate the relationship between PTSD and comorbidity. To conclude, following MI, those with full-PTSD tend to report more severe comorbidity than those who have not developed PTSD fully. The former can also be distinguished from the latter by virtue of their specific personality traits.

Facial expression and experience of emotions in psychodynamic interviews with patients with PTSD in comparison to healthy subjects

BACKGROUND

The facial affective behavior of traumatized patients and of a healthy control group was compared.

SAMPLING AND METHODS

Data of 15 videotaped clinical interviews of traumatized inpatients and of 15 healthy women (absence of mental/psychiatric disorder according to ICD-10) were ascertained. The affective facial expression of both groups was coded with the Emotional Facial Acting Coding System. Afterwards, the mimic analysis was correlated with gazing behavior and the emotional experience. The patients reported their traumatic experiences and the healthy women their main complaints.

RESULTS

The traumatized patients showed neither a reduction of overall facial expressions nor a reduced frequency of facial affects in comparison to the healthy control group. The control group, however, showed significantly more 'genuine joy'. The traumatized patients showed significantly more anger.

CONCLUSIONS

The traumatized patients did not show a significant reduction of overall facial expression. A more detailed analysis showed that on the one hand, stabilizing elements of relationships, such as genuine joy, appear significantly less on the face of traumatized patients as compared with the healthy women. On the other hand, the expression of anger was brought into the relationship significantly more often by the traumatized patients during face-to-face interaction (clinical interview). This indicates the importance of distance regulation interaction patterns of traumatized patients.

Posttraumatic stress disorder and general health problems following myocardial infarction (Post-MI PTSD) among older patients: the role of personality

OBJECTIVES

This study aimed to: (1) investigate the degree to which older MI patients experienced post-MI PTSD and general health problems, and to (2) identify the association between five personality traits, post-MI PTSD and general health problems among these older people.

METHODS

The sample comprised 96 older MI patients and were recruited from two general practices. They were interviewed using the Posttraumatic Stress Diagnostic Scale (PDS), the General Health Questionnaire-28 (GHQ-28) and the NEO-Five Factor Inventory (NEO-FFI). The control group comprised 92 older people who experienced no MI. They were assessed using the GHQ-28.

RESULTS

The older MI patients experienced hyperarousal the most, followed by avoidance and re-experiencing symptoms. PDS revealed that 30% had full PTSD. The older patients were conscientious and agreeable individuals. They were also somewhat extraverted and open to experience. They also showed traits of neuroticism. Controlling for bypass surgery, heart failure, previous mental health difficulties, angina and angioplasty, regression analyses showed that neuroticism predicted re-experiencing and avoidance symptoms and general health total. Neuroticism and less agreeableness predicted hyperarousal symptoms.

CONCLUSIONS

MI older patients could manifest PTSD symptoms and general health problems following their MI. Personality traits, particularly neuroticism and antagonism, played a role in the manifestation of these symptoms.

Solving the puzzle of deliberate self-harm: The experiential avoidance model

Despite increasing attention to the phenomenon of deliberate self-harm (DSH), the literature currently lacks a unifying, evidence-based, theoretical framework within which to understand the factors that control this behavior. The purpose of the present paper is to outline such a framework-the Experiential Avoidance Model (EAM) of DSH. The EAM poses that DSH is primarily maintained by negative reinforcement in the form of escape from, or avoidance of, unwanted emotional experiences. Literature on factors that may lead to experiential avoidance is reviewed, along with the mounting empirical evidence that DSH functions to help the individual escape from unwanted emotional experiences. The EAM integrates a variety of research on emotions, experiential avoidance, and DSH within a clinically useful framework that sparks novel research directions.

Trauma narratives and emotional processing

The present study examined the relations between indicators of emotional processing (e.g. trauma narratives), posttraumatic stress symptoms, and psychological distress in two military samples (N = 120) exposed to significant training accidents. Trauma narratives were collected at 2-3 weeks, while outcome measures (e.g. IES-15, PTSS-10, and GHQ-30) were collected at 2-3 weeks, and 4 months after the accidents. Emotional processing was indexed by the content of positive and negative emotional expressions in the trauma narratives. The results showed that positive emotional expressions were associated with lower levels of psychological distress, whereas negative emotional expressions were linked to trauma specific symptoms and psychological distress at 2-3 weeks. Negative emotional expressions explained between 6-8% of the variance in trauma specific symptoms at 2-3 weeks, and 11% of the variance in psychological distress symptoms at 4 months after the traumatic event.

Serotonin transporter promoter polymorphism genotype is associated with temperament, personality traits and illegal drugs use among adolescents

Serotonin transporter promoter polymorphism (5-HTTLPR) genotype was previously found associated with substance use disorders, particularly in the subjects with comorbid antisocial behavior, and with temperament and personality traits at risk for substance abuse. Aim of the present study was to evaluate the possible association between 5-HTTLPR genotype and the availability to experiment illegal drugs among adolescents, in relationship with psychological characteristics. 216 caucasian high school students (aged 14-19 ys), 125 abstinent subjects, who have never experimented psychotropic drugs, and 91 experimenters of illegal drugs have been genotyped. Aggressiveness levels and temperamental traits were measured in both abstinent subjects and experimenters utilizing respectively Buss-Durkee-Hostility-Inventory (BDHI) and Cloninger Three-dimensional Personality Questionnaire (TPQ). Data about school performance have been also collected. The short-short (SS) genotype frequency was significantly higher among experimenters compared with abstinent subjects (p = 0.001). The odds ratio for the SS genotype vs the long-long (LL) genotype frequency was 4.67, 95% Cl (1.97-11.04), when experimenters were compared with abstinent students. The SS genotype frequency was significantly higher among aggressive/novelty seeker (NS) experimenters with poor school achievements, compared with drugs experimenters without aggressiveness and school failure (p = 0.02). When evaluated on the entire sample, BDHI mean total scores, NS scores at TPQ and school failure frequency were significantly higher in SS individuals, in comparison with LL subjects. Our data suggest that a decreased expression of the gene encoding the 5-HTT transporter, due to "S" promoter polymorphism, may be associated with an increased availability to experiment illegal drugs among adolescents, particularly in the subjects with more consistent aggressiveness, NS temperament and learning disabilities.

A preliminary test of the role of experiential avoidance in post-event functioning

Experiential avoidance is the unwillingness to experience unwanted thoughts, emotions, or bodily sensations and an individual's attempts to alter, avoid, or escape those experiences. The aim of the current studies was to broaden previous research indicating that experiential avoidance often leads to the development and maintenance of psychological distress. Results indicated that experiential avoidance is significantly correlated with psychological distress and post-traumatic symptomatology over and above other measures of psychological functioning. Limitations and implications for treatment and prevention of psychological distress are discussed.

Content and processes of postpartum counseling after a distressing birth experience: a review

BACKGROUND

A distressing birth experience can produce debilitating symptoms of psychological trauma; however, little is known about the content and processes of counseling interventions to relieve trauma symptoms. This review identifies and examines common content and processes of postpartum counseling interventions to address trauma symptoms following childbirth.

METHOD

A search of major databases (Cinahl 1982-2003; Cochrane 2003; Embase; Proquest; Psychlit; Pubmed/Medline 1966-2003; Sociofile) was conducted, using combinations of the key words of "childbirth,""postpartum,""posttraumatic stress disorder,""anxiety,""trauma,""stress,""debriefing," and "counselling" or "counseling." Identified content and processes were clustered through a thematic analysis.

RESULTS

Nineteen publications were retrieved. Counseling strategies provided women with opportunities to talk about their birth experience, express feelings about what happened, have questions answered, address gaps in knowledge or understanding of events, connect the event with emotions and behavior, talk about future pregnancies, and explore existential issues.

CONCLUSIONS

Descriptions of postpartum counseling and debriefing are generalized and nonspecific; they provide minimal direction for postpartum counseling models, lack necessary detail for replication, may require psychotherapeutic training and therefore be unsuitable for use by caregivers, and are often based on opinion with little empirical evaluation. Few studies have tested specific counseling interventions on a range of maternal outcomes. Further research is needed to develop counseling models for use by health professionals with women who report a distressing birth experience.

An experimental study of emotional responding in women with posttraumatic stress disorder related to interpersonal violence

Although posttraumatic stress disorder (PTSD) is defined by the experience of intense negative emotions and emotional numbing (American Psychiatric Association, 1994), empirical study of emotional responding in PTSD has been limited. This study examined emotional responding among women with and without PTSD to positive and negative film stimuli across self-reported experience, facial expression, and written expression. Consistent with previous findings, no evidence for generalized numbing was found. In general, women with PTSD exhibited higher levels of negative activation and expressed more negative emotion words to both positive and negative film stimuli, whereas no group differences emerged in facial expressivity. Results are interpreted within the context of the current literature on emotional deficits associated with PTSD.

Development and validation of a modified version of the Peritraumatic Dissociative Experiences Questionnaire

This article reports results from 3 studies conducted to develop and validate a modified version of the self-administered form of the Peritraumatic Dissociative Experiences Questionnaire (PDEQ; C. R. Marmar, D. S. Weiss, & T. J. Metzler, 1997). The objective was to develop an instrument suitable for use with persons from diverse ethnic and socioeconomic backgrounds. In Study 1, the original PDEQ was administered to a small sample (N = 15) recruited from among men admitted to the hospital for physical injuries stemming from exposure to community violence. Results led to modifications aimed at improving the utility of the instrument. In Study 2, the modified PDEQ was subjected to structural equation modeling and item response theory analyses to assess its psychometric properties in a larger, primarily male, sample of community violence survivors (N = 284). In Study 3, the reliability and validity of the modified instrument were further assessed in a sample of female survivors of sexual assault (N = 90). Results attest to the psychometric properties as well as the reliability and validity of the modified 8-item PDEQ.

Analgesia, sedation, and memory of intensive care

PURPOSE

The purpose of this article was to investigate the relationship between analgesia, sedation, and memory of intensive care.

PATIENTS AND METHODS

One hundred fifty-two adult, cooperative intensive care unit (ICU) patients were interviewed 6 months after hospital discharge about their memory of intensive care. The patient was considered to be cooperative when he/she was aware of self and environment at the interview. The patients were grouped as follows: A (45 patients) substantially no sedation, B (85) morphine, and C (22) morphine and other sedatives.

RESULTS

The patients having no memory of intensive care were 38%, 34%, and 23% respectively, in the three groups. They were less ill, according to SAPS II (P <.05), and had a shorter ICU stay (P <.01). Group C patients were more seriously ill according to SAPS II, duration of mechanical ventilation, and length of stay in ICU and in hospital (P <.001). The incidence of factual, sensation, and emotional memories was not different among the three groups. Females reported at least one emotional memory more frequently than males (odds ratio 4.17; 95% CI 10.97-1.59).

CONCLUSIONS

The patients receiving sedatives in the ICU are not comparable with those receiving only opiates or nothing, due to the different clinical condition. The lack of memory of intensive care is present in one third of patients and is influenced more by length of stay in ICU than by the sedation received. Sedation does not influence the incidence of factual, sensation, and emotional memories of ICU admitted patients. Females have higher incidences of emotional memories than males.