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Psychological
and
Physiological
Trauma
Research
Seize Your Journeys
_______________________
Traumatic stress is found in many competent, healthy, strong, good people.
No one can completely protect themselves from traumatic experiences.
Many people have long-lasting problems following exposure to trauma.
Up to 8% of persons will have PTSD at some time in their lives. People who
react to traumas are not going crazy. What is happening to them is
part of a set of common symptoms and problems that are connected with being
in a traumatic situation, and thus, is a normal reaction to abnormal events
and experiences. Having symptoms after a traumatic event is
NOT a sign of personal weakness. Given exposure to a trauma that is
bad enough, probably all people would develop PTSD.
By understanding trauma
symptoms better, a person can become less fearful of them and better able to
manage them. By recognizing the effects of trauma and knowing more about
symptoms, a person will be better able to decide about getting treatment.
_______________________
DID-PTSD-EMDR
Dissociative Identity Disorder (DID)
"The essential feature of Dissociative identity Disorder is the
presence of two or more distinct identities or personality
states (Criterion A) that recurrently take control of behavior
(Criterion B). There is an inability to recall important
personal information, the extent of which is too great to be
explained by ordinary forgetfulness (Criterion C). The
disturbance is not due tot eh direct physiological effects of a
substance or a general medical condition (Condition D.). In
children, the symptoms cannot be attributed to imaginary
playmates or other fantasy play.
Dissociative Identity Disorder reflects a failure to integrate
various aspects of identity, memory, and consciousness. Each
personality state may be experienced as if it has a distinct
personal history, self-image, and identity, including a separate
name. Usually there is a primary identity that carries the
individual's given name and is passive, dependent, guilty, and
depressed. The alternate identities frequently have different
names and characteristics that contrast with the primary
identity (e.g., are hostile, controlling, and
self-destructive). Particular identities may emerge in specific
circumstances and may differ in reported age and gender,
vocabulary, general knowledge, or predominant affect. Alternate
identities are experienced as taking control in sequence, ore at
the expense of the other, and may deny knowledge of one another,
be critical of one another, or appear to be in open conflict.
Occasionally, one or more powerful identities allocate time to
the others. Aggressive or hostile identities may at times
interrupt activities or place the others in uncomfortable
situations.
Individuals with this disorder experience frequent gaps in
memory for personal history, both remote and recent. The
amnesia is frequently asymmetrical. The more passive identities
tend to have more constricted memories, whereas the more
hostile, controlling, or "protector" identities have more
complete memories. An identity that is not in control may
nonetheless gain access to consciousness by producing auditory
or visual hallucinations (e.g., a voice giving instructions).
Evidence of amnesia may be uncovered by reports from others who
have witnessed behavior that is disavowed by the individual or
by the individual's own discoveries (e.g., finding items of
clothing at home that the individual cannot remember having
bought). There may be loss of memory not only for recurrent
periods of time, but also an overall loss of biographical memory
for some extended period of childhood, adolescence, or even
adulthood. Transitions among identities are often triggered by
psychosocial stress. The time required to switch from one
identity to another is usually a matter of seconds, but, less
frequently, may b gradual. Behavior that may be frequently
associated with identity switches include rapid blinking, facial
changes, changes in voice or demeanor, or disruption in the
individual's train of thoughts. The number of identities
reported ranges from 2 to more than 100. Half of reported cases
include the individuals with 10 or fewer identities."
Diagnostic and Statistical Manual of Mental Disorders.
2000. 4th ed. Washington, D.C.: American Psychiatric
Association.
PTSD, DID, and EMDR
Posttraumatic Stress Disorder
"The essential feature of Posttraumatic Stress Disorder us the
development of characteristic symptoms following exposure to an
extreme traumatic stressor involving direct personal experience
of an event that involves actual or threatened death or serious
injury, or other threat to one's physical integrity; or
witnessing an event that involves death, injury, or a threat to
the physical integrity of another person; or learning about
unexpected or violent death, serious harm, or threat of death or
injury experienced by a family member or other close associate
(Criteria A1). The person's response to the event must involve
intense fear, helplessness, or horror (or in children, the
response must involve disorganized or agitated behavior)
(Criterion A2). The characteristic symptoms resulting from the
exposure to the extreme trauma include persistent reexperiencing
of the traumatic event (Criterion E), and the disturbance must
cause clinically significant distress or impairment in social,
occupational, or other important areas of functioning (Criterion
F).
Traumatic events that are experienced directly include, but are
not limited to, military combat, violent personal assault
(sexual assault, physical attack, robbery, mugging), being
kidnapped, being taken hostage, terrorist attack, torture,
incarceration as a prisoner of war or in a concentration camp,
natural or manmade disasters, severe automobile accidents, or
being diagnosed with a life-threatening illness. For children,
sexually traumatic events may include developmentally
inappropriate sexual experiences without threatened or actual
violence or injury. Witnessed events include, but are not
limited to, observing the serious injury or unnatural death of
another person due to violent assault, accident, war, or
disaster or unexpectedly witnessing a dead body or body parts.
Events experienced by others that are learned about include, but
are not limited to, violent personal assault, serious accident,
or serious injury experienced y a family member or a close
friend; learning about the sudden, unexpected death of a family
member or a close friend; or learning that one's child has a
life threatening disease. The disorder may be especially sever
or long lasting when the stressor is of human design (e.g.,
torture, rape). the likelihood of developing this disorder may
increase as the intensity of and physical proximity to the
stressor increase.
The traumatic event can be reexperienced in various ways.
Commonly the person has recurrent and intrusive recollections of
the event (Criterion B1) or recurrent distressing dreams during
which the event can be replayed or otherwise represented
(Criterion B2). In rare instances, the person experiences
dissociative states that last from a few seconds to several
hours, or even days, during which components of the event are
relived and the person behaves as though experiencing the event
at that moment (Criterion B3). These episodes, often referred
to as "flashbacks," are typically brief but can be associated
with prolonged distress and heightened arousal. Intense
psychological distress (Criterion B4) or physiological
reactivity (Criterion B5) often occurs when the person is
exposed to triggering events that resemble or symbolize an
aspect of the traumatic event (e.g., anniversaries of the
traumatic event; cold, snowy weather or uniformed guards for
survivors of death camps in cold climates; hot, humid weather
for combat veterans of the South Pacific; entering any elevator
for an woman who was reaped in an elevator).
Stimuli associated with the trauma are persistently avoided.
The person commonly makes deliberate efforts to avoid thoughts,
feelings, or conversations about the traumatic event (Criterion
C1) and to avoid activities, situations, or people who around
recollections of it (Criterion C2). This avoidance of reminders
may include amnesia for an important aspect of the traumatic
event (Criterion C3). Diminished responsiveness to the external
work, referred to as "psychic numbing" or "emotional
anesthesia," usually begins soon after the traumatic event. The
individual may complain of having markedly diminished interest
or participation in previously enjoyed activities (Criterion
C4), of feeling detached or estranged from other people
(Criterion C5), or of having markedly reduced ability to feel
emotions (especially those associated with intimacy, tenderness
and sexuality) (Criterion C6). The individual may have a sense
of a foreshortened future (e.g., not expecting to have a career,
marriage, children, or a normal life span) (Criterion C7).
The individual has persistent symptoms of anxiety or increased
arousal that were not present before the trauma. these symptoms
may include difficulty falling or staying asleep that may be to
recurrent nightmares during which the traumatic event is relived
(Criterion D1), hypervigilance (Criterion D4), and exaggerated
startle response (Criterion D5). Some individuals report
irritability or outburst of anger (Criterion D2) or difficulty
concentrating or completing tasks (Criterion D3)."
EMDR
Eye Movement Desensitization and Reprocessing
"Eye Movement Desensitization and Reprocessing (EMDR)1
integrates elements of many effective psychotherapies in
structured protocols that are designed to maximize treatment
effects. These include psychodynamic, cognitive behavioral,
interpersonal, experiential, and body-centered therapies2.
EMDR is an
information processing therapy
and uses an eight phase approach.
During EMDR1 the client attends to past and present
experiences in brief sequential doses while simultaneously
focusing on an external stimulus. Then the client is instructed
to let new material become the focus of the next set of
dual attention. This
sequence of dual attention and personal association is repeated
many times in the session.
Eight Phases of Treatment
The first phase is a history taking session during which the
therapist assesses the client's readiness for EMDR and develops
a treatment plan. Client and therapist identify possible targets
for EMDR processing. These include recent distressing events,
current situations that elicit emotional disturbance, related
historical incidents, and the development of specific skills and
behaviors that will be needed by the client in future
situations.
During the second phase of treatment, the therapist ensures that
the client has adequate methods of handling emotional distress
and good coping skills, and that the client is in a relatively
stable state. If further stabilization is required, or if
additional skills are needed, therapy focuses on providing
these. The client is then able to use stress reducing techniques
whenever necessary, during or between sessions. However, one
goal is not to need these techniques once therapy is complete.
In phase three through six, a target is identified and processed
using EMDR procedures. These involve the client identifying the
most vivid visual image related to the memory (if available), a
negative belief about self, related emotions and body
sensations. The client also identifies a preferred positive
belief. The validity of the positive belief is rated, as is the
intensity of the negative emotions.
After this, the client is instructed to focus on the image,
negative thought, and body sensations while simultaneously
moving his/her eyes back and forth following the therapist's
fingers as they move across his/her field of vision for 20-30
seconds or more, depending upon the need of the client. Athough
eye movements are the most commonly used external stimulus, therapists often use
auditory tones, tapping, or other types of tactile stimulation.
The kind of dual attention and the length of each set is
customized to the need of the client. The client is instructed
to just notice whatever happens. After this, the clinician
instructs the client to let his/her mind go blank and to notice
whatever thought, feeling, image, memory, or sensation comes to
mind. Depending upon the client's report the clinician will
facilitate the next focus of attention. In most cases a
client-directed association process is encouraged. This is
repeated numerous times throughout the session. If the client
becomes distressed or has difficulty with the process, the
therapist follows established procedures to help the client
resume processing. When the client reports no distress related
to the targeted memory, the clinician asks him/her to think of
the preferred positive belief that was identified at the
beginning of the session, or a better one if it has emerged, and
to focus on the incident, while simultaneously engaging in the
eye movements. After several sets, clients generally report
increased confidence in this positive belief. The therapist
checks with the client regarding body sensations. If there are
negative sensations, these are processed as above. If there are
positive sensations, they are further enhanced.
In phase seven, closure, the therapist asks the client to keep a
journal during the week to document any related material that
may arise and reminds the client of the self-calming activities
that were mastered in phase two.
The next session begins with phase eight, re-evaluation of the
previous work, and of progress since the previous session. EMDR
treatment ensures processing of all related historical events,
current incidents that elicit distress, and future scenarios
that will require different responses. The overall goal is
produce the most comprehensive and profound treatment effects in
the shortest period of time, while simultaneously maintaining a
stable client within a balanced system.
After EMDR processing, clients generally report that the
emotional distress related to the memory has been eliminated, or
greatly decreased, and that they have gained important cognitive
insights. Importantly, these emotional and cognitive changes
usually result in spontaneous behavioral and personal change,
which are further enhanced with standard EMDR procedures."
www.emdr.com
1Shapiro,
F. (2001). Eye Movement Desensitization and Reprocessing: Basic Principles,
Protocols and Procedures (2nd ed.). New York: Guilford Press.
2Shapiro, F. (2002).
EMDR as an Integrative Psychotherapy Approach: Experts
of Diverse Orientations Explore the Paradigm Prism. Washington,
DC: American Psychological Association Books.
|
|
EMDR PTSD Dissociation
Exposure
Therapy and PTSD
|
Title: |
Trauma
and substance abuse: Causes, consequences, and treatment
of comorbid disorders. |
|
Author(s): |
Ouimette, Paige, (Ed), Washington State U, Pullman, WA,
US
Brown, Pamela J., (Ed),
Private Practice, New Bedford, MA, US |
|
Source: |
Washington, DC, US: American Psychological Association,
2003. xiii, 315 pp.
Publisher URL:
http://www.apa.org/books |
|
Abstract: |
(from
the publicity materials) This book explores the
underdiagnosed connection between drug use and
posttraumatic stress disorder (PTSD). Patients with
trauma-related distress such as PTSD often use alcohol
and drugs in a problematic manner classifiable as
substance use disorder (SUD). By not recognizing the
connection between symptoms, providers frequently
misdiagnose or do not fully attend to SUD-PTSD
comorbidity. This book presents research on how often
the two disorders co-occur and why. Authors describe the
self-medication model and explore how specific PTSD and
substance use symptoms are functionally related to each
other. In addition, they suggest assessment approaches
and practice guidelines to facilitate proper diagnosis
and treatment. Particularly valuable are descriptions of
several new treatment approaches that have been
developed specifically for SUD-PTSD, including
cognitive-behavioral and exposure therapy |
|
Title: |
Virtual
reality exposure therapy for World Trade Center
post-traumatic stress disorder: A case report. |
|
Author(s): |
Difede,
Joann, Cornell U, Weill Medical Coll, New York, NY, US,
jidefede@med.cornell.edu
Hoffman, Hunter G., U
Washington, Human Interface Technology Lab, Seattle, WA,
US |
|
Address: |
Difede,
Joann, Helmsley Medical Tower, 1320 York Ave., Ste. 610,
New York, NY, US,
jidefede@med.cornell.edu |
|
Source: |
CyberPsychology & Behavior, Vol 5(6), Dec 2002. pp.
529-535. |
|
Publisher: |
US:
Mary Ann Liebert Publishers |
|
Abstract: |
Describes the treatment of a survivor (aged 26 yrs) of
the World Trade Center (WTC) attack of 9-11-01 who had
developed acute Post-traumatic Stress Disorder (PTSD).
After she failed to improve with traditional imaginal
exposure therapy, the authors sought to increase
emotional engagement and treatment success using virtual
reality (VR) exposure therapy. Over the course of 6 1-hr
VR exposure therapy sessions, they gradually and
systematically exposed the PTSD patient to virtual
planes flying over the WTC, jets crashing into the WTC
with animated explosions and sound effects, virtual
people jumping to their deaths from the burning
buildings, towers collapsing, and dust clouds. VR graded
exposure therapy was successful for reducing acute PTSD
symptoms. Depression and PTSD symptoms as measured by
the Beck Depression Inventory and the Clinician
Administered PTSD Scale indicated a large (83%)
reduction in depression, and large (90%) reduction in
PTSD symptoms after completing VR exposure therapy.
Although case reports are scientifically inconclusive by
nature, these strong preliminary results suggest that VR
exposure therapy is a promising new medium for treating
acute PTSD. |
|
Title: |
EMDR
for women who experience traumatic events. |
|
Author(s): |
Peterson, Gary, Southeast Inst for Group & Family
Therapy, Chapel Hill, NC, US |
|
Source: |
Journal
of Clinical Psychiatry, Vol 63(11), Nov 2002. pp.
1047-1048. |
|
Publisher: |
US:
Physicians Postgraduate Press |
|
Abstract: |
Comments on an article by E. B. Foa and G. P. Street
(see record 2001-11162-005) regarding psychotherapeutic
interventions for women with PTSD. It is noted that Foa
and Street describe other psychotherapy procedures, but
do not mention eye movement desensitization and
reprocessing (EMDR). Peterson cites that in Effective
Treatments for PTSD: Practice Guidelines from the
International Society for Traumatic Stress Studies
[ISTSS] , 2 psychotherapy treatments for PTSD are listed
as having been shown to be effective: exposure therapy
and EMDR. SIT is reported to have had 2 well-controlled
studies published on the treatment of PTSD. Both SIT
studies were with female sexual assault victims. It is
concluded that given that EMDR has been established as
effective in the ISTSS guidelines, it may be important
for the reader to know that this form of therapy may be
applied when confronting the issues addressed in this
article. A comment by Foa follows. |
|
Title: |
Diagnosen akutt stresslidelse og forebygging av
posttraumatisk stresslidelse. |
|
Translated Title: |
Acute
stress disorder and prevention of posttraumatic stress
disorder. |
|
Author(s): |
Eid,
Jarle, U Bergen, Sjokrigsskolen, Bergen, Norway,
jeid@sksk.mil.no
Johnsen, Bjorn Helge, U
Bergen, Sjokrigsskolen, Bergen, Norway |
|
Source: |
Tidsskrift for Norsk Psykologforening, Vol 39(11), Nov
2002. pp. 987-995. |
|
Publisher: |
Norway:
Norsk Psykologforening |
|
Abstract: |
The
diagnosis of acute stress disorder (ASD) was introduced
in DSM-IV in 1994 in order to identify trauma victims
with a high potential for later posttraumatic stress
disorder (PTSD). This article reviews current diagnostic
criteria and available assessment instruments for ASD.
Recent studies have suggested that ASD is highly
predictive of later PTSD. Theoretical models and
randomized controlled clinical trials have indicated
that early exposure and emotional processing of
traumatic memories could be an effective early
intervention following trauma. However, evidence
indicates that some survivors seem to gain less from
exposure treatment. A casuistic presentation of early
interventions after a naval shipwreck is used to discuss
benefits and limitations of early exposure as a
preventive intervention. |
|
Title: |
Skills
training in affective and interpersonal regulation
followed by exposure: A phase-based treatment for PTSD
related to childhood abuse. |
|
Author(s): |
Cloitre, Marylene, New York Presbyterian Hosp, Anxiety &
Traumatic Stress Program, New York, NY, US,
mcloitre@med.cornell.edu
Koenen, Karestan C.,
Columbia U, Dept of Public Health, New York, NY, US
Cohen, Lisa R., St.
Luke's-Roosevelt Hosp, Dept of Psychiatry, New York, NY,
US
Han, Hyemee, Weill Medical
Coll of Cornell U, Dept of Psychiatry, New York, NY, US |
|
Address: |
Cloitre, Marylene, 418 East 59th Street, Apartment 25B,
New York, NY, US,
mcloitre@med.cornell.edu |
|
Source: |
Journal
of Consulting and Clinical Psychology, Vol 70(5), Oct
2002. pp. 1067-1074. |
|
Publisher: |
US:
American Psychological Assn |
|
Abstract: |
Fifty-eight women with posttraumatic stress disorder
(PTSD) related to childhood abuse were randomly assigned
to a 2-phase cognitive-behavioral treatment or a minimal
attention wait list. Phase 1 of treatment included 8
weekly sessions of skills training in affect and
interpersonal regulation; Phase 2 included 8 sessions of
modified prolonged exposure. Compared with those on wait
list, participants in active treatment showed
significant improvement in affect regulation problems,
interpersonal skills deficits, and PTSD symptoms. Gains
were maintained at 3- and 9-month follow-up. Phase 1
therapeutic alliance and negative mood regulation skills
predicted Phase 2 exposure success in reducing PTSD,
suggesting the value of establishing a strong
therapeutic relationship and emotion regulation skills
before exposure work among chronic PTSD populations.
|
|
Title: |
Fear
activation and habituation patterns as early process
predictors of response to prolonged exposure treatment
in PTSD. |
|
Author(s): |
van
Minnen, Agnes, U Nijmegen, Dept of Clinical Psychology &
Personality, Nijmegen, Netherlands,
minnen@psych.kun.nl
Hagenaars, Muriel, U
Nijmegen, Dept of Clinical Psychology & Personality,
Nijmegen, Netherlands |
|
Address: |
van
Minnen, Agnes, U Nijmegen, Dept of Clinical Psychology,
PO Box 9104, 6500 HE, Nijmegen, Netherlands,
minnen@psych.kun.nl |
|
Source: |
Journal
of Traumatic Stress, Vol 15(5), Oct 2002. pp. 359-367. |
|
Publisher: |
US:
John Wiley & Sons |
|
Abstract: |
Improved (n=21) and nonimproved (n=13) posttraumatic
stress disorder (PTSD) patients (a mixed trauma
population) were compared for fear activation and
habituation patterns during and between the 1st and 2nd
prolonged exposure sessions. Drop-outs (n=11) were also
evaluated. Nonimproved patients had significantly higher
ratings of anxiety at the start of the first exposure
session. Improved patients showed more within-session
habituation during the self-exposures at home and more
between-session habituation. Even after controlling for
initial PTSD and depression symptom severity,
habituation between the first and second exposure
sessions was significantly related to treatment outcome.
Patients who dropped out of the treatment were found not
to differ from completers on fear activation and
within-session habituation during the first exposure
session. |
|
Title: |
Effectiveness of exposure therapy: A case study of
posttraumatic stress disorder and mental retardation. |
|
Author(s): |
Lemmon,
Valerie A., Riverside Associates, P.C., Harrisburg, PA,
US,
vlemmon@messiah.edu
Mizes, J. Scott, West
Virginia University, Morgantown, WV, US |
|
Address: |
Lemmon,
Valerie A., Riverside Associates, P.C., 2818 Green
Street, Harrisburg, PA, US,
vlemmon@messiah.edu |
|
Source: |
Cognitive and Behavioral Practice, Vol 9(4), Fal 2002.
pp. 317-323. |
|
Publisher: |
US:
Assn for the Advancement of Behavior Therapy |
|
Abstract: |
Posttraumatic stress disorder (PTSD) is a common
disorder following sexual assault. There is significant
empirical evidence that cognitive-behavioral
interventions are efficacious in the treatment of PTSD.
People with mental retardation (MR) often are victims of
sexual assaults, but the presence of comorbid PTSD and
MR was not found in the current literature. In addition,
there is no evidence showing that any specific
short-term intervention is effective in treating PTSD
with comorbid MR. The present article describes a case
study in which short-term exposure therapy following
numerous sexual assaults was effective in reducing the
symptoms of PTSD in a woman with comorbid MR. |
|
Title: |
Treatment of PTSD: Stress Inoculation Training with
Prolonged Exposure compared to EMDR. |
|
Author(s): |
Lee,
Christopher, Sir Charles Gairdner Hosp, QEII Medical
Ctr, Perth, Australia,
chlee@central.murdoch.edu.au
Gavriel, Helen, HMAS
Stirling, Royal Australian Navy, Australia
Drummond, Peter, Murdoch U,
School of Psychology, Perth, Australia
Richards, Jeff, U Ballarat,
Ballarat, Australia
Greenwald, Ricky, Mount
Sinai School of Medicine, New York, NY, US |
|
Address: |
Lee,
Christopher, 88 Palmerston St., Mosman Park, WAU,
Australia,
chlee@central.murdoch.edu.au |
|
Source: |
Journal
of Clinical Psychology, Vol 58(9), Sep 2002. pp.
1071-1089. |
|
Publisher: |
US:
John Wiley & Sons |
|
Abstract: |
The
effectiveness of Stress Inoculation Training with
Prolonged Exposure (SITPE) was compared to Eye Movement
Desensitization and Reprocessing (EMDR). 24 participants
(mean age 35.3 yrs) who had a diagnosis of Post
Traumatic Stress Disorder (PTSD) were randomly assigned
to one of the treatment conditions. Participants were
also their own wait-list control. Outcome measures
included self-report and observer-rated measures of
PTSD, and self-report measures of depression. On global
PTSD measures, there were no significant differences
between the treatments at the end of therapy. However on
the subscale measures of the degree of intrusion
symptoms, EMDR did significantly better than SITPE. At
follow-up EMDR was found to lead to greater gains on all
measures. |
Record: 9
|
Title: |
Innovative use of virtual reality technology in the
treatment of PTSD in the aftermath of September 11. |
|
Author(s): |
Difede,
JoAnn, Cornell U, Weill Medical Coll, Dept of
Psychiatry, New York, NY, US,
jdifede@med.cornell.edu
Hoffman, Hunter, U
Washington, Human Interface Technology Lab, Seattle, WA,
US
Jaysinghe, Nimale, Cornell
U, Weill Medical Coll, Dept of Psychiatry, New York, NY,
US |
|
Address: |
Difede,
JoAnn,
jdifede@med.cornell.edu |
|
Source: |
Psychiatric Services, Vol 53(9), Sep 2002. pp.
1083-1085. |
|
Publisher: |
US:
American Psychiatric Assn |
|
Abstract: |
Highlights developing research on and clinical
applications of virtual reality technology to
established psychotherapeutic principles and techniques
for the treatment of anxiety disorders. In particular,
the application of virtual reality technology in the
treatment of posttraumatic stress disorder related to
September 11th is addressed. Until now, psychotherapy in
general and imaginal exposure in particular have relied
on the capacities of a patient's imagination and memory.
However, virtual environments afford opportunities not
only to capitalize on a patient's capacities, but also
to augment them with visual, auditory, and even haptic
computer-generated experiences. |
|
Title: |
Cognitive-behavior therapy for PTSD in rape survivors. |
|
Author(s): |
Jaycox,
Lisa H., RAND, Arlington, VA, US,
Jaycox@rand.org
Zoellner, Lori, U
Washington, WA, US
Foa, Edna B., U
Pennsylvania, PA, US |
|
Address: |
Jaycox,
Lisa H., RAND, 1200 South Hayes Street, Arlington, VA,
US,
Jaycox@rand.org |
|
Source: |
Journal
of Clinical Psychology, Vol 58(8), Aug 2002. pp.
891-906. |
|
Publisher: |
US:
John Wiley & Sons |
|
Abstract: |
Notes
that in recent years, new data have appeared, further
suggesting the utility of cognitive-behavioral
interventions for posttraumatic stress disorder (PTSD)
subsequent to sexual assault. In this article, the
authors present a model of cognitive-behavioral
treatment (CBT) for PTSD in rape survivors.
Emotional-processing theory, which proposes mechanisms
that underlie the development of disturbances following
rape, is reviewed. A CBT-based therapy (Prolonged
Exposure) is presented that entails education about
common reactions to trauma, relaxation training,
imaginal reliving of the rape memory, exposure to trauma
reminders, and cognitive restructuring. Current research
regarding the use of prolonged exposure is discussed.
The case example of a young female rape survivor (aged
25 yrs) is described in detail, and her prior substance
dependence and intense shame are highlighted. The
therapy was successful in reducing the client's symptoms
of PTSD, as well as her depressive symptoms, and these
gains were maintained at a 1-yr follow-up assessment. |
|
Title: |
Trauma
focus group therapy for combat-related PTSD: An update. |
|
Author(s): |
Foy,
David W., Pepperdine U, Graduate School of Education &
Psychology, Encino, CA, US,
dfoy@pepperdine.edu
Ruzek, Josef I., National
Ctr for PTSD, Palo Alto, CA, US
Glynn, Shirley M., West Los
Angeles Veterans Medical Ctr, Los Angeles, CA, US
Riney, Sherry J., National
Ctr for PTSD, Palo Alto, CA, US
Gusman, Fred D., National
Ctr for PTSD, Palo Alto, CA, US |
|
Address: |
Foy,
David W., Pepperdine U, Graduate School of Education &
Psychology, 16830 Ventura Boulevard, Suite #200, Encino,
CA, US,
dfoy@pepperdine.edu |
|
Source: |
Journal
of Clinical Psychology, Vol 58(8), Aug 2002. pp.
907-918. |
|
Publisher: |
US:
John Wiley & Sons |
|
Abstract: |
Individual cognitive-behavioral therapy involving
directed exposure to memories of traumatic events has
been found to be effective in treating posttraumatic
stress disorder. In this article, the authors present
updated information on an alternative group form of
exposure therapy: manualized trauma-focus group therapy
(TFGT), designed as an efficient means of conducting
directed exposure. The cognitive-behavioral and
developmental models from which the approach was derived
are described, and an overview of session topics and a
case illustration are presented. The authors also
provide guidelines for referring individuals to TFGT,
and offer suggestions for future research. (PsycINFO
Database Record (c) 2005 APA, all rights reserved) |
|
Title: |
A
comparison of cognitive-processing therapy with
prolonged exposure and a waiting condition for the
treatment of chronic posttraumatic stress disorder in
female rape victims. |
|
Author(s): |
Resick,
Patricia A., U Missouri, Dept of Psychology, Ctr for
Trauma Recovery, St Louis, MO, US,
resick@umsl.edu
Nishith, Pallavi, U
Missouri, Dept of Psychology, Ctr for Trauma Recovery,
St Louis, MO, US
Weaver, Terri L., U
Missouri, Dept of Psychology, Ctr for Trauma Recovery,
St Louis, MO, US
Astin, Millie C., U
Missouri, Dept of Psychology, Ctr for Trauma Recovery,
St Louis, MO, US
Feuer, Catherine A., U
Missouri, Dept of Psychology, Ctr for Trauma Recovery,
St Louis, MO, US |
|
Address: |
Resick,
Patricia A., U Missouri, Dept of Psychology, Ctr for
Trauma Recovery, Weinman Bldg, 8001 Natural Bridge Road,
St Louis, MO, US,
resick@umsl.edu |
|
Source: |
Journal
of Consulting and Clinical Psychology, Vol 70(4), Aug
2002. pp. 867-879. |
|
Publisher: |
US:
American Psychological Assn |
|
Abstract: |
The
purpose of this study was to compare
cognitive-processing therapy (CPT) with prolonged
exposure and a minimal attention condition (MA) for the
treatment of posttraumatic stress disorder (PTSD) and
depression. One hundred seventy-one female rape victims
were randomized into 1 of the 3 conditions, and 121
completed treatment. Participants were assessed with the
Clinician-Administered PTSD Scale, the PTSD Symptom
Scale, the Structured Clinical Interview for DSM-IV, the
Beck Depression Inventory, and the Trauma-Related Guilt
Inventory. Independent assessments were made at
pretreatment, posttreatment, and 3 and 9 months
posttreatment. Analyses indicated that both treatments
were highly efficacious and superior to MA. The 2
therapies had similar results except that CPT produced
better scores on 2 of 4 guilt subscales. (PsycINFO
Database Record (c) 2005 APA, all rights
reserved)(journal abstract) |
Record: 13
|
Title: |
Pattern
of change in prolonged exposure and cognitive-processing
therapy for female rape victims with posttraumatic
stress disorder. |
|
Author(s): |
Nishith, Pallavi, U Missouri, Dept of Psychology, Ctr
for Trauma Recovery, St Louis, MO, US,
pnishith@umsl.edu
Resick, Patricia A., U
Missouri, Dept of Psychology, Ctr for Trauma Recovery,
St Louis, MO, US
Griffin, Michael G., U
Missouri, Dept of Psychology, Ctr for Trauma Recovery,
St Louis, MO, US |
|
Address: |
Nishith, Pallavi, U Missouri, Dept of Psychology, Ctr
for Trauma Recovery, Weinman Bldg, 8001 Natural Bridge
Rd, St Louis, MO, US,
pnishith@umsl.edu |
|
Source: |
Journal
of Consulting and Clinical Psychology, Vol 70(4), Aug
2002. pp. 880-886. |
|
Publisher: |
US:
American Psychological Assn |
|
Abstract: |
Curve
estimation techniques were used to identify the pattern
of therapeutic change in female rape victims with
posttraumatic stress disorder (PTSD). Within-session
data on the Posttraumatic Stres Disorder Symptom Scale
were obtained, in alternate therapy sessions, on 171
women. The final sample of treatment completers included
54 prolonged exposure (PE) and 54 cognitive-processing
therapy (CPT) completers. For both PE and CPT, a
quadratic function provided the best fit for the total
PTSD, reexperiencing, and arousal scores. However, a
difference in the line of best fit was observed for the
avoidance symptoms. Although a quadratic function still
provided a better fit for the PE avoidance, a linear
function was more parsimonious in explaining the CPT
avoidance variance. Implications of the findings are
discussed. |
|
Title: |
Does
imaginal exposure exacerbate PTSD symptoms? |
|
Author(s): |
Foa,
Edna B., U Pennsylvania, Dept of Psychiatry, Ctr for the
Treatment & Study of Anxiety, Philadelphia, PA, US,
foa@mail.med.upenn.edu
Zoellner, Lori A., U
Pennsylvania, Dept of Psychiatry, Ctr for the Treatment
& Study of Anxiety, Philadelphia, PA, US
Feeny, Norah C., U
Pennsylvania, Dept of Psychiatry, Ctr for the Treatment
& Study of Anxiety, Philadelphia, PA, US
Hembree, Elizabeth A., U
Pennsylvania, Dept of Psychiatry, Ctr for the Treatment
& Study of Anxiety, Philadelphia, PA, US
Alvarez-Conrad, Jennifer, U
Pennsylvania, Dept of Psychiatry, Ctr for the Treatment
& Study of Anxiety, Philadelphia, PA, US |
|
Address: |
Foa,
Edna B., U Pennsylvania, Ctr for the Treatment & Study
of Anxiety, 3535 Market St, Philadelphia, PA, US,
foa@mail.med.upenn.edu |
|
Source: |
Journal
of Consulting and Clinical Psychology, Vol 70(4), Aug
2002. pp. 1022-1028. |
|
Publisher: |
US:
American Psychological Assn |
|
Abstract: |
Symptom
exacerbation (i.e., treatment side effects) has often
been neglected in the psychotherapy literature. Although
prolonged exposure has gained empirical support for the
treatment of chronic posttraumatic stress disorder
(PTSD), some have expressed concern that imaginal
exposure, a component of this therapy, may cause symptom
exacerbation, leading to inferior outcome or dropout. In
the present study, symptom exacerbation was examined in
76 women with chronic PTSD. To define a "reliable"
exacerbation, we used a method of incorporating the
standard deviation and test-retest reliability of each
outcome measure. Only a minority of participants
exhibited reliable symptoms exacerbation. Individuals
who reported symptom exacerbation benefited comparably
from treatment. Further, symptom exacerbation was
unrelated to dropout. Thus, although a minority of
individuals experienced a temporary symptom
exacerbation, this exacerbation was unrelated to
outcome. |
Record: 15
|
Title: |
Changes
in PTSD patients' narratives during prolonged exposure
therapy: A replication and extension. |
|
Author(s): |
van
Minnen, Agnes, U Nijmegen, Dept of Clinical Psychology &
Personality, Nijmegen, Netherlands,
minnen@psych.kun.nl
Wessel, Ineke, Maastricht U,
Dept of Psychology, Maastricht, Netherlands
Dijkstra, Ton, U Nijmegen,
Nijmegen Inst for Cognition & Information, Nijmegen,
Netherlands
Roelofs, Karin, U Nijmegen,
Dept of Clinical Psychology & Personality, Nijmegen,
Netherlands |
|
Address: |
van
Minnen, Agnes, U Nijmegen, Dept of Clinical Psychology &
Personality, PO Box 9104, 6500 HE, Nijmegen,
Netherlands,
minnen@psych.kun.nl |
|
Source: |
Journal
of Traumatic Stress, Vol 15(3), Jul 2002. pp. 255-258. |
|
Publisher: |
US:
John Wiley & Sons |
|
Abstract: |
Replicated and extended the findings of E. B. Foa et al
(1995), who explored the process of narrative
organization during posttraumatic stress disorder (PTSD)
treatment. Narrative changes from the first to the last
exposure session were compared for improved and
nonimproved PTSD patients (mean age 38.4 yrs) on
fragmentation, organization, internal, and external
events. The 8 improved and 12 nonimproved patients did
not differ regarding changes in fragmentation or
organized thoughts. However, improved patients showed a
greater decrease in disorganized thoughts during
treatment. Furthermore, all patients, independent of
improvement, showed significant changes in the same
direction; a decrease in disorganized thoughts and
external events and an increase in internal events.
Although previous results were partly replicated, it is
concluded that narrative changes may be due to exposure
treatment itself rather than to changes in memory
representation. |
|
Title: |
Intrusive thoughts in posttraumatic stress disorder. |
|
Author(s): |
Falsetti, Sherry A., Medical U of South Carolina,
Charleston, SC, US
Monnier, Jeannine, Medical U
of South Carolina, Charleston, SC, US
Davis, Joanne L., Medical U
of South Carolina, Charleston, SC, US
Resnick, Heidi S., Medical U
of South Carolina, Charleston, SC, US |
|
Address: |
Falsetti, Sherry A., Medical U of South Carolina, Dept
of Psychiatry & Behavioral Sciences, 165 Cannon Street,
P.O. Box 250852, Charleston, SC, US |
|
Source: |
Journal
of Cognitive Psychotherapy, Vol 16(2), Sum 2002. Special
issue: Special Issue on Intrusions in Cognitive
Behavioral Therapy. pp. 127-143. |
|
Publisher: |
US:
Springer Publishing |
|
Abstract: |
Reviews
the literature on prevalence, associated features,
assessment, and treatment of intrusive symptoms
associated with posttraumatic stress disorder (PTSD).
Research indicates that among trauma survivors,
intrusive thoughts and imagery are quite common and
distressing. It appears that early intrusions may be
predictive of long-term distress and that avoidance and
suppression can maintain intrusions. The treatment
outcome literature for PTSD indicates that current
cognitive behavioral treatments are effective in
reducing intrusions. New data from a recent treatment
outcome study for PTSD with comorbid panic attacks,
using Multiple Channel Exposure Therapy, also suggest
that this treatment is effective in significantly
reducing intrusions. (PsycINFO Database Record (c) 2005
APA, all rights reserved) |
|
Title: |
Prolonged exposure in patients with chronic PTSD:
Predictors of treatment outcome and dropout. |
|
Author(s): |
van
Minnen, A., U Nijmegen, Dept of Clinical Psychology,
Nijmegen, Netherlands,
minnen@psych.kun.nl
Arntz, A., U Maastricht,
Dept of Medical, Clinical & Experimental Psychology,
Maastricht, Netherlands
Keijsers, G. P. J., U
Nijmegen, Dept of Clinical Psychology, Nijmegen,
Netherlands |
|
Address: |
van
Minnen, A., U Nijmegen, Dept of Clinical Psychology, PO
Box 9104, 6500, Nijmegen, Netherlands,
minnen@psych.kun.nl |
|
Source: |
Behaviour Research and Therapy, Vol 40(4), Apr 2002. pp.
439-457. |
|
Publisher: |
Netherlands: Elsevier Science |
|
Abstract: |
Investigated predictors of treatment outcome and dropout
in 2 samples (N=59 and 63) of posttraumatic stress
disorder (PTSD) patients with mixed traumas treated
using prolonged imaginal exposure. Possible predictors
were analysed in both samples separately, in order to
replicate in one sample findings found in the other. The
only stable finding across the two groups was that
patients who showed more PTSD-symptoms at pre-treatment,
showed more PTSD-symptoms at post-treatment and
follow-up. Indications were found that benzodiazepine
use was related to both treatment outcome and dropout,
and alcohol use to dropout. Demographic variables,
depression and general anxiety, personality, trauma
characteristics, feelings of anger, guilt, and shame and
nonspecific variables regarding therapy were not related
to either treatment outcome or dropout, disconfirming
generally held beliefs about these factors as
contra-indications for exposure therapy. It is concluded
that it is difficult to use pre-treatment variables as a
powerful and reliable tool for predicting treatment
outcome or dropout. Clinically seen, it is therefore
argued that exclusion of PTSD-patients from prolonged
exposure treatment on the basis of pre-treatment
characteristics is not justified. |
|
Title: |
A
narrative exposure treatment as intervention in a
refugee camp: A case report. |
|
Author(s): |
Neuner,
Frank, U Konstanz, Konstanz, Germany,
frank.neuner@uni-konstanz.de
Schauer, Margarete, U
Konstanz, Konstanz, Germany
Roth, Walton T., Stanford U,
Stanford, CA, US
Elbert, Thomas, U Konstanz,
Konstanz, Germany |
|
Address: |
Neuner,
Frank, U Konstanz, Dept of Psychology, Fach D25,
D-78457, Konstanz, Germany, frank.neuner@uni-konstanz.de |
|
Source: |
Behavioural and Cognitive Psychotherapy, Vol 30(2), Apr
2002. pp. 205-210. |
|
Publisher: |
US:
Cambridge Univ Press |
|
Abstract: |
The
authors applied Narrative Exposure Treatment (NET) to a
severely traumatized Kosovar refugee (aged 24 yrs)
living in a Macedonian refugee camp during the Balkan
War. NET is a pragmatic short-term approach that
integrates effective therapeutic components deriving
from Cognitive Behavior Therapy and Testimony Therapy.
Outcome was evaluated by clinical examination and the
Posttraumatic Stress Diagnostic Scale. Three sessions of
NET were enough to afford considerable relief, although
some posttraumatic stress disorder (PTSD) symptoms
remained. The authors' experience indicates that
Narrative Exposure is a promising and realistic approach
for the treatment of even severely traumatized refugees
living in camps. In addition, it can prove valid
testimonies about human fights violations without
humiliating the witness. |
|
Title: |
Prolonged exposure counterconditioning (PEC) as a
treatment for chronic post-traumatic stress disorder and
major depression in an adult survivor of repeated child
sexual and physical abuse. |
|
Author(s): |
Paunovic, Nenad, Stockholm U, Stockholm, Sweden |
|
Source: |
Clinical Case Studies, Vol 1(2), Apr 2002. pp. 148-169. |
|
Publisher: |
US:
Sage Publications |
|
Abstract: |
Prolonged exposure counterconditioning (PEC) was tested
as a treatment for chronic post-traumatic stress
disorder (PTSD) in an adult male survivor (aged 42
years) of repeated child sexual and physical abuse. PEC
utilizes imaginal reliving of very pleasurable life
moments in order to weaken traumatic conditioned
emotional responses (CERs). A higher-order conditioned
stimuli (CS) is used as a traumatic CER elicitor.
Prolonged imaginal reliving of pleasurable CSs is used
as a counterconditioner to the traumatic CERs. A
statistical technique for analyzing single-case subject
designs based on classical test theory was used to
evaluate the client's progress in treatment. Results
showed that PEC effectively decreased the client's PTSD
symptoms, depression, and anxiety. In addition, the
client's negative cognitions became considerably more
positive. Also, the client lost his comorbid conditions
of chronic major depressive disorder and social phobia.
Finally, other clinically observed symptoms, which are
described in the article, improved markedly. All results
were maintained at a 3-month follow-up. (PsycINFO
Database Record (c) 2005 APA, all rights reserved) |
|
Title: |
Integrated behavioral treatment of comorbid OCD, PTSD,
and borderline personality disorder: A case report. |
|
Author(s): |
Becker,
Carolyn Black, Trinity U, San Antonio, TX, US,
carolyn.becker@trinity.edu |
|
Address: |
Becker,
Carolyn Black, Trinity U, Dept of Psychology, 715
Stadium Dr, San Antonio, TX, US,
carolyn.becker@trinity.edu |
|
Source: |
Cognitive and Behavioral Practice, Vol 9(2), Spr 2002.
pp. 100-110. |
|
Publisher: |
US:
Assn for the Advancement of Behavior Therapy |
|
Abstract: |
According to critics of empirically supported
treatments, comorbidity represents a significant barrier
to the implementation of such interventions in standard
clinical practice. Advocates of empirically supported
treatment have noted that comorbid disorders can be
addressed concurrently. There is, however, little
guidance in the literature regarding implementation of
concurrently delivered protocols. The present case
report describes the successful treatment of a
43-year-old woman diagnosed with comorbid
obsessive-compulsive disorder (OCD), posttraumatic
stress disorder (PTSD), and borderline personality
disorder. Treatment utilized a concurrent approach that
integrated exposure and response prevention for OCD,
exposure therapy for PTSD, and components of dialectical
behavior therapy for borderline personality disorder.
Both 12-month formal and 18-month informal follow-up
assessment indicated that improvement was maintained
after termination. Results suggest that integrated
delivery of empirically supported interventions can be
utilized to successfully treat complex, comorbid cases.
|
|
Title: |
Marked
lability in urinary cortisol levels in subgroups of
combat veterans with posttraumatic stress disorder
during an intensive exposure treatment program. |
|
Author(s): |
Mason,
John W., Yale U School of Medicine, Dept of Psychiatry,
New Haven, CT, US, jwmason@pol.net
Wang, Sheila, Yale U School
of Medicine, Dept of Psychiatry, New Haven, CT, US
Yehuda, Rachel, Mount Sinai
Medical School, Dept of Psychiatry, New York, NY, US
Lubin, Hadar, Yale U School
of Medicine, Dept of Psychiatry, New Haven, CT, US
Johnson, David, Yale U
School of Medicine, Dept of Psychiatry, New Haven, CT,
US
Bremner, J. Douglas, Yale U
School of Medicine, Dept of Psychiatry, New Haven, CT,
US
Charney, Dennis, Yale U
School of Medicine, Dept of Psychiatry, New Haven, CT,
US
Southwick, Steven, Yale U
School of Medicine, Dept of Psychiatry, New Haven, CT,
US |
|
Address: |
Mason,
John W., 32 Maple Vale Drive, Woodbridge, CT, US,
jwmason@pol.net |
|
Source: |
Psychosomatic Medicine, Vol 64(2), Mar-Apr 2002. pp.
238-246. |
|
Publisher: |
US:
Lippincott Williams & Wilkins |
|
Abstract: |
Examined longitudinal data on lability of cortisol
levels in posttraumatic stress disorder (PTSD) because
previous studies have largely been based on sampling at
a single time point and have yielded varying results.
This study measured urinary cortisol levels at
admission, midcourse, and discharge during a 90-day
hospitalization period in 51 male Vietnam combat
veterans (mean age 42.7 yrs) with PTSD. Although there
were no significant differences in the mean urinary
cortisol levels between the admission, midcourse, and
discharge values, marked lability of cortisol levels in
individual patients was observed over time. In addition,
this hormonal lability defined discrete subgroups of
patients on the basis of the longitudinal pattern of
cortisol change during exposure treatment, and there
were significant psychometric differences in the level
of social functioning between these subgroups. The
findings suggest a psychogenic basis for cortisol
alterations in PTSD in relation to psychosocial stress
and indicate a central regulatory dysfunction of the
hypothalamic-pituitary-adrenal axis characterized by a
dynamic tendency to overreact in both upward and
downward directions. |
|
Title: |
Exposure therapy for posttraumatic stress disorder. |
|
Author(s): |
Rothbaum, Barbara Olasov, Emory U School of Medicine,
Trauma & Anxiety Recovery Program, Atlanta, GA, US,
brothba@emory.edu
Schwartz, Ann C., Emory U
School of Medicine, Atlanta, GA, US |
|
Address: |
Rothbaum, Barbara Olasov, The Emory Clinic, 1365 Clifton
Road, Atlanta, GA, US, brothba@emory.edu |
|
Source: |
American Journal of Psychotherapy, Vol 56(1), 2002. pp.
59-75. |
|
Publisher: |
US:
Assn for the Advancement of Psychotherapy |
|
Abstract: |
Exposure therapy is a well-established treatment for
posttraumatic stress disorder (PTSD) that requires the
patient to focus on and describe the details of a
traumatic experience. Exposure methods include
confrontation with frightening, yet realistically safe,
stimuli that continues until anxiety is reduced. A
review of the literature on exposure therapy indicates
strong support from well-controlled studies applied
across trauma populations. However, there are many
misconceptions about exposure therapy that may interfere
with its widespread use. These myths and clinical
guidelines are addressed. It is concluded that exposure
therapy is a safe and effective treatment for PTSD when
applied as directed by experienced therapists. |
|
Title: |
Trastorno de estrés postraumáitico en víctimas de
maltrato doméstico: Evaluación de un programa de
intervención. |
|
Translated Title: |
Posttraumatic stress disorder in battered women:
evaluation of an intervention program. |
|
Author(s): |
Labrador, Francisco Javier, Universidad Complutense de
Madrid, Madrid, Spain
Rincón, Paulina Paz,
Universidad Complutense de Madrid, Departamento de
Psicología Clínica, Madrid, Spain, psper30@sis.ucm.es |
|
Address: |
Rincón,
Paulina Paz, Departamento de Psicologia Clinica,
Universidad Complutense de Madrid, Campus de Somosaguas
s/n, 28223, Madrid, Spain, psper30@sis.ucm.es |
|
Source: |
Análisis y Modificación de Conducta, Vol 28(122), 2002.
pp. 905-932. |
|
Publisher: |
Spain:
Editorial Promolibro |
|
Abstract: |
This
study was directed to develop and prove an effective,
short length, treatment programme for posttraumatic
stress disorder (PTSD) among battered women. The
treatment program was applied to nine female PTSD
patients, according to the DSM-IV criteria, grouped in 3
member groups. The treatment program included 8 sessions
(2 months), whose main components were psychoeducation,
training relaxation, cognitive therapy and exposure
therapy. The results on the posttreatment and on the
first and third month follow-up sessions, show that the
programme was effective to reduce the TEPT on the 100%
of the patients. The results also point out an
improvement in variables such as depression,
self-esteem, social inadaptation, and posttraumatic
cognitions. The implications of this study for clinical
practice and future research in PTSD are discussed.
|
|
Title: |
Cognitive restructuring within reliving: A treatment for
peritraumatic emotional 'hotspots' in posttraumatic
stress disorder. |
|
Author(s): |
Grey,
Nick, Ctr for Anxiety Disorders & Trauma, London, United
Kingdom, n.grey@iop.kcl.ac.uk
Young, Kerry, Traumatic
Stress Clinic, London, United Kingdom
Holmes, Emily, Traumatic
Stress Clinic, London, United Kingdom |
|
Address: |
Grey,
Nick, Inst of Psychiatry, Ctr for Anxiety Disorders &
Trauma, 99 Denmark Hill, London, United Kingdom, SE5
8AF, n.grey@iop.kcl.ac.uk |
|
Source: |
Behavioural and Cognitive Psychotherapy, Vol 30(1), Jan
2002. pp. 37-56. |
|
Publisher: |
US:
Cambridge Univ Press |
|
Abstract: |
This
paper describes a distinct clinical approach to the
treatment of Posttraumatic Stress Disorder (PTSD). It is
theoretically guided by recent cognitive models of PTSD
and explicitly combines cognitive therapy techniques
within exposure/reliving procedures. A clinically
pertinent distinction is made between the cognitions and
emotions experienced at the time of the trauma and,
subsequently, in flashback experiences, and secondary
negative appraisals. The term peritraumatic emotional
"hotspot" is used to describe moments of peak distress
during trauma. It is argued that a focus on cognitively
restructuring these peritraumatic emotional hotspots
within reliving can significantly improve the
effectiveness of the treatment of PTSD and help explain
some treatment failures with traditional prolonged
exposure. An approach to the identification and
treatment of these hotspots is detailed for a range of
cognitions and emotions not limited to fear. |
|
Title: |
Behavioral/cognitive approaches to post-traumatic
stress: Theory-driven, empirically based therapy. |
|
Series
Title: |
Contributions in psychology; no. 39 |
|
Author(s): |
Roemer,
Lizabeth, U Massachusetts, Dept of Psychology, Boston,
MA, US
Harrington, Nicole T.,
Mental Health & Substance Abuse Services of the
Berkshires, Family Ctr of the Berkshires, US
Riggs, David S., State U New
York at Stony Brook, Stony Brook, NY, US |
|
Source: |
Brief
treatments for the traumatized: A project of the Green
Cross Foundation. Figley, Charles R. (Ed); pp. 59-80.
Westport, CT, US: Greenwood
Press/Greenwood Publishing Group, Inc, 2002. xxiv, 337
pp. |
|
Abstract: |
(from
the chapter) Provides an overview of the authors'
behavioral/cognitive approach to the treatment of
trauma-related psychological difficulties. This chapter
is meant to be read with the chapter in this volume
about behavioral/cognitive theories (see record
2003-04267-002), which provides the conceptual basis for
the therapeutic approach outlined here. This chapter is
divided into a section on the initial phase of
treatment, including assessment, monitoring,
psychoeducation, and establishing a therapeutic
relationships, followed by separate sections for
exposure-based, cognitive, and skills-training
interventions as well as relapse prevention. These
treatments have been designated as active ingredients in
the treatment of posttraumatic stress disorder (PTSD)
and studies have supported their efficacy. |
|
Title: |
Posttraumatic stress disorder. |
|
Author(s): |
Scotti,
Joseph R., West Virginia U, Dept of Psychology,
Morgantown, WV, US
Morris, Tracy L., West
Virginia U, Dept of Psychology, Morgantown, WV, US
Ruggiero, Kenneth J., West
Virginia U, Dept of Psychology, Morgantown, WV, US
Wolfgang, Julie, West
Virginia U, Dept of Psychology, Morgantown, WV, US |
|
Source: |
Clinical behavior therapy: Adults and children. Hersen,
Michel; pp. 361-382.
Hoboken, NJ, US: John Wiley
& Sons, Inc, 2002. xiv, 513 pp. |
|
Abstract: |
(from
the create) Two children were passengers in a car
accident in which the children were in extreme distress
when their mothers injuries appeared serious and the
threesome had to wait an inordinate amount of time until
help arrived. This chapter describes the use of a
complex therapy for posttraumatic stress disorder (PTSD)
in these children, aged 3 and 9 yrs. A treatment choice
was made for the use of behavior therapy (BT), involving
anxiety management, exposure-based procedures, and
contingency management procedures. A general description
of the disorder and a specific case history and accident
description are provided. Results of a clinical
assessment and a medical consultation are then followed
by a case conceptualization and finally the rationale
for treatment choice and planning. A detailed course of
treatment is then related, including therapist-client
factors, course of termination, follow-up, and a
commentary on managed care considerations. The overall
effectiveness of BT in this case is then discussed.
|
|
Title: |
Cortisol and imaginal exposure in posstraumatic stress
disorder: A case report. |
|
Author(s): |
Otte,
Christian, University Hosp Hamburg-Eppendorf, Dept of
Psychiatry & Psychotherapy, Hamburg, Germany,
otte@uke.uni-hamburg.de
Arlt, Josef, University Hosp
Hamburg-Eppendorf, Dept of Psychiatry & Psychotherapy,
Hamburg, Germany
Wiedemann, Klaus, University
Hosp Hamburg-Eppendorf, Dept of Psychiatry &
Psychotherapy, Hamburg, Germany
Kellner, Michael, University
Hosp Hamburg-Eppendorf, Dept of Psychiatry &
Psychotherapy, Hamburg, Germany |
|
Address: |
Otte,
Christian, Dept of Psychiatry & Psychotherapy, U of
Hamburg, Martinistrasse 52, 20246, Hamburg, Germany,
otte@uke.uni-hamburg.de |
|
Source: |
German
Journal of Psychiatry, Vol 5(3), 2002. pp. 75-77. |
|
Publisher: |
Germany: German Journal of Psychiatry |
|
Abstract: |
Imaginal exposure is closely associated with hippocampal
processing of traumatic memory. The hippocampus is a
target for glucocorticoids which influence memory
retrieval and stress response. Glucocorticoid secretion
in response to imaginal exposure has not been
investigated. We measured subjective distress and
salivary cortisol during the 1st and the 20th exposure
session in a female patient (aged 45 yrs) with PTSD.
Despite considerable arousal and anxiety, cortisol did
not increase during the first exposure. During the 20th
exposure there was a marked reduction of distress,
although cortisol values did not differ from exposure 1.
The response of glucocorticoids to imaginal exposure and
mechanisms of the lacking cortisol response need further
research. |
|
Tests &
Measures: |
Posttraumatic Stress Diagnostic Scale |
|
Title: |
Managing obstacles to the utilization of exposure
therapy With PTSD patients. |
|
Author(s): |
Zayfert, Claudia, Dept of Psychiatry, Dartmouth Medical
School, Lebanon, NH, US, claudia.zayfert@dartmouth.edu
Becker, Carolyn B., Trinity
U, San Antonio, TX, US, cbecker@trinity.edu
Gillock, Karen L., Dartmouth
Medical School, Lebanon, NH, US,
Karen.l.gillock@dartmouth.edu |
|
Address: |
Zayfert, Claudia, Dept of Psychiatry, Dartmouth Medical
School, One Medical Center Dr., Lebanon, NH, US,
claudia.zayfert@dartmouth.edu |
|
Source: |
Innovations in clinical practice: A source book (Vol.
20). VandeCreek, Leon (Ed); Jackson, Thomas L. (Ed); pp.
201-222.
Sarasota, FL, US:
Professional Resource Press/Professional Resource
Exchange, Inc, 2002. x, 501 pp. |
|
Abstract: |
(from
the chapter) This chapter relies heavily on the authors'
experiences implementing exposure therapy (ET) in the
anxiety disorders clinic of a rural tertiary care
medical center. The authors explore factors pertinent to
the utilization of ET in a clinical context. They begin
with an overview of ET for posttraumatic stress disorder
(PTSD), and assert that, despite the limitations of
existing data and problems in the implementation of ET,
the goal of increasing its clinical use is justifiable.
Next, they offer a framework for conceptualizing
difficulties in ET implementation that incorporates
recent theoretical explanations of ET process and draws
upon empirical work on motivation and process in
behavior therapy. Within this framework, the remainder
of the chapter elaborates on specific methods to
facilitate implementation and completion of ET.
|
|
Title: |
Is EMDR
an exposure therapy? A review of trauma protocols. |
|
Author(s): |
Rogers,
Susan, VA Medical Ctr, Coatsville, PA, US,
rogers.susan@coatsville.va.gov
Silver, Steven M. |
|
Address: |
Rogers,
Susan, DVA Medical Ctr, PTSD Program 116P, Coatsville,
PA, US, rogers.susan@coatsville.va.gov |
|
Source: |
Journal
of Clinical Psychology, Vol 58(1), Jan 2002. pp. 43-59. |
|
Publisher: |
US:
John Wiley & Sons |
|
Abstract: |
Presents the well established theoretical base and
clinical practice of exposure therapy for trauma.
Necessary requirements for positive treatment results
and contraindicated procedures are reviewed. Eye
Movement Desensitization and Reprocessing (EMDR) is
contrasted with these requirements and procedures. By
the definitions and clinical practice of exposure
therapy, the classification of EMDR poses some problems.
As seen from the exposure therapy paradigm, its lack of
physiological habituation and use of spontaneous
association should result in negligible or negative
effects rather than the well researched positive
outcomes. Possible reasons for the effectiveness of EMDR
are discussed, ranging from the fundamental nature of
trauma reactions to the nonexposure mechanisms utilized
in information processing models. |
|
Title: |
Comparison for two treatments for traumatic stress: A
community-based study of EMDR and prolonged exposure. |
|
Author(s): |
Ironson, Gail, U Miami, Cable Gables, FL, US,
gironson@aol.com
Freud, B.
Strauss, J. L.
Williams, J. |
|
Address: |
Ironson, Gail, U Miami, Behavioral Medicine Program,
P.O. Box 248185, Coral Gables, FL, gironson@aol.com |
|
Source: |
Journal
of Clinical Psychology, Vol 58(1), Jan 2002. pp.
113-128. |
|
Publisher: |
US:
John Wiley & Sons |
|
Abstract: |
This
pilot study compared the efficacy of 2 treatments for
postraumatic stress disorder (PTSD): Eye Movement
Desensitization and Reprocessing (EMDR) and Prolonged
Exposure (PE). Data were analyzed for 22 patients (aged
16-62 yrs) from a university based clinic serving the
outside community (predominantly rape and crime victims)
who completed at least 1 active session of treatment
after 3 preparatory sessions. Results showed both
approaches produced a significant reduction in PTSD and
depression symptoms, which were maintained at 3-month
follow-up. Successful treatment was faster with EMDR as
a larger number of people (7 of 10) had a 70% reduction
in PTSD symptoms after 3 active sessions compared to 2
of 12 with PE. EMDR appeared to be better tolerated as
the dropout rate was significantly lower in those
randomized to EMDR versus PE (0 of 10 vs 3 of 10).
However all patients who remained in treatment with PE
had a reduction in PTSD scores. Finally, Subjective
Units of Distress (SUDS) ratings decreased significantly
during the initial session of EMDR, but changed little
during PE. Postsession SUDS were significantly lower for
EMDR than for PE. Suggestions for future research are
discussed. |
|
Title: |
Post-traumatic stress disorder. |
|
Author(s): |
Yehuda,
Rachel, Mount Sinai School of Medicine, Dept of
Psychiatry, NY, US, rachel.yehuda@med.va.gov |
|
Address: |
Yehuda,
Rachel, Bronx Veterans Affairs Medical Ctr, 130
Kingsbridge Road, Bronx, NY, US,
rachel.yehuda@med.va.gov |
|
Source: |
New
England Journal of Medicine, Vol 346(2), Jan 2002. pp.
108-114. |
|
Publisher: |
US:
Massachusetts Medical Society |
|
Abstract: |
Although most people will gradually recover from the
psychological effects of a traumatic event,
posttraumatic stress disorder (PTSD) will develop in a
substantial proportion. PTSD appears to represent a
failure to recover from a nearly universal set of
emotions and reactions and is typically manifested as
distressing memories or nightmares related to the
traumatic event, attempts to avoid reminders of the
trauma, and a heightened state of physiological arousal.
The treatment of PTSD involves educating the patient
about the nature of the disorder, providing a safe and
supportive environment for discussing traumatic events
and their impact, and relieving the distress associated
with memories and reminders of the event. A variety of
approaches, such as exposure therapy, cognitive therapy,
and pharmacotherapy, have been found to be effective in
the treatment of PTSD. |
|
Title: |
Beliefs, sense of control and treatment outcome in
post-traumatic stress disorder. |
|
Author(s): |
Livanou, Maria, U London, Inst of Psychiatry, Div of
Psychological Medicine, Section of Trauma Studies,
London, England
Basoglu, M., U London, Inst
of Psychiatry, Div of Psychological Medicine, Section of
Trauma Studies, London, England
Marks, I. M., U London, Inst
of Psychiatry, Div of Psychological Medicine, Section of
Trauma Studies, London, England
De Silva, P., U London, Inst
of Psychiatry, Div of Psychological Medicine, Section of
Trauma Studies, London, England
Noshirvani, H., U London,
Inst of Psychiatry, Div of Psychological Medicine,
Section of Trauma Studies, London, England
Lovell, K., U London, Inst
of Psychiatry, Div of Psychological Medicine, Section of
Trauma Studies, London, England
Thrasher, S., U London, Inst
of Psychiatry, Div of Psychological Medicine, Section of
Trauma Studies, London, England |
|
Address: |
Livanou, Maria, Inst of Psychiatry, Dept of Psychiatry,
Section of Trauma Studies, 38 Carver Road, London,
England, SE24 9LT |
|
Source: |
Psychological Medicine, Vol 32(1), Jan 2002. pp.
157-165. |
|
Publisher: |
US:
Cambridge Univ Press |
|
Abstract: |
Few
studies have shown that maladaptive beliefs relate to
treatment outcome. In a randomized controlled study, 87
outpatients (aged 16-65 yrs) with posttraumatic stress
disorder (PTSD) had exposure therapy alone or cognitive
restructuring alone, or both combined, or relaxation.
Independent blind assessors assessed patients at pre-,
mid-, and post-treatment and at follow-up; at those
times patients rated cognitive, behavioral, and
emotional aspects of their disorder. Baseline beliefs
about mistrust, helplessness, meaninglessness, and
unjustness of the world related to baseline PTSD
symptoms but did not predict treatment outcome, though
improvement in certain beliefs correlated with more
symptom improvement. Several "key" beliefs changed
after, and none before, symptoms improved. At
posttreatment, sense of control and attribution of gains
to personal efforts predicted maintenance of gains at
follow-up. Baseline beliefs and improvement in beliefs
did not predict outcome. Post-treatment sense of
control/internal attribution predicted maintenance of
gains at follow-up. |
|
Title: |
Cognitive-behavioral treatment of PTSD. |
|
Author(s): |
Zoellner, Lori A., Hahnemann U, Medical Coll of
Philadelphia, Ctr for the Treatment & Study of Anxiety,
Philadelphia, PA, US
Foa, Edna B., Hahnemann U,
Medical Coll of Philadelphia, Ctr for the Treatment &
Study of Anxiety, Philadelphia, PA, US
Fitzgibbons, Lee A.,
Hahnemann U, Medical Coll of Philadelphia, Ctr for the
Treatment & Study of Anxiety, Philadelphia, PA, US |
|
Source: |
Simple
and complex post-traumatic stress disorder: Strategies
for comprehensive treatment in clinical practice.
Williams, Mary Beth (Ed); Sommer, John F. Jr. (Ed); pp.
75-98.
Binghamton, NY, US: Haworth
Maltreatment and Trauma Press/The Haworth Press, Inc,
2002. xxiii, 408 pp. |
|
Abstract: |
(from
the chapter) The most studied psychosocial treatment
programs for posttraumatic stress disorder (PTSD) have
utilized cognitive-behavioral techniques. These consist
of a variety of treatment programs including exposure
procedures, cognitive restructuring, and anxiety
management. Treatment is conceived as promoting
emotional processing of the traumatic event. Two
conditions are necessary for emotional processing to
take place during treatment. First, fear-relevant
information must be made available so that the fear
memory can be activated. Second, information made
available must contain elements that are incompatible
with some of those that exist so that a new memory can
be formed. This new information must then be integrated
into the evoked memory structure in order for emotional
change to occur. Accordingly, therapy for PTSD aims at
modifying the victims' exaggerated perception of the
world as entirely dangerous and of themselves as
entirely incompetent and worthless. |
|
Title: |
Cognitive Processing Therapy for PTSD in a Survivor of
the World Trade Center Bombing: A Case Study. |
|
Author(s): |
Difede,
JoAnn, The New York Presbyterian Hospital-Weill Cornell
Medical Center, New York, NY, US,
jdifede@mail.med.cornell
Eskra, David, The New York
Presbyterian Hospital-Weill Cornell Medical Center, New
York, NY, US |
|
Address: |
Difede,
JoAnn, The New York Hospital-Cornell Medical Center, 525
East 68th Street, Box 200, New York, NY, US,
jdifede@mail.med.cornell |
|
Source: |
Trauma
Practice in the Wake of September 11, 2001. Gold, Steven
N. (Ed); Faust, Jan (Ed); pp. 155-165.
New York, NY, US: Haworth
Press, 2002. 170 pp. |
|
Abstract: |
(from
the chapter) The present case study describes the
successful treatment, including long-term follow-up of a
survivor of the first World Trade Center (WTC) bombing
who developed posttraumatic stress disorder (PTSD). The
literature indicates that behavioral, particularly
exposure based techniques, and cognitive applications
have shown promising results in reducing symptoms of
PTSD, in adults exposed to combat and rape. To our
knowledge, no treatment protocol has been developed for
PTSD following a terrorist incident. This paper
presented the application of a PTSD treatment protocol
based on Cognitive Processing Therapy (CPT) (Resick &
Schnicke, 1992, 1993) in the treatment of an adult
female exposed to such terrorist trauma. |
|
Tests &
Measures: |
Structured Clinical Interview for the DSM III-R
PTSD Symptoms Scale
Brief Symptom Inventory
Clinician-Administered PTSD
Scale |
|
Title: |
Innovations in clinical practice: A source book (Vol.
20). |
|
Author(s): |
VandeCreek, Leon, (Ed), School of Professional
Psychology, Wright State U, Dayton, OH, US,
leon.vandecreek@wright.edu
Jackson, Thomas L., (Ed),
Aggression & Violence Prevention Consultants, US,
AvertViolence@aol.com |
|
Address: |
VandeCreek, Leon, School of Professional Psychology,
3640 Colonel Glenn Hwy, Wright State U, Dayton, OH, US,
leon.vandecreek@wright.edu |
|
Source: |
Sarasota, FL, US: Professional Resource
Press/Professional Resource Exchange, Inc, 2002. x, 501
pp. |
|
Abstract: |
(from
the introduction) As in previous volumes, Innovations in
Clinical Practice: A Source Book (Volume 20) is
organized into five sections that reflect the diversity
of contributions to the series. The first section,
"Clinical Issues and Applications", deals primarily with
therapeutic concerns. The second section addresses
"Practice Management and Professional Development" and
is included because of the increasing number of
clinicians who work independently. The third section
includes "Assessment Instruments and Office Forms". The
instruments are primarily informal and designed to
assist clinicians in collecting information about
clients. "Community Interventions" and "Selected Topics"
cover the fourth and fifth sections, respectively.
|
|
Title: |
Linguistic predictors of trauma pathology and physical
health. |
|
Author(s): |
Alvarez-Conrad, Jennifer, U Pennsylvania School of
Medicine, PA, US
Zoellner, Lori A., U
Pennsylvania School of Medicine, PA, US,
zoellner@u.washington.edu
Foa, Edna B., U Pennsylvania
School of Medicine, PA, US |
|
Address: |
Zoellner, Lori A., U Washington, Dept of Psychology, Box
351525, Seattle, WA, US, zoellner@u.washington.edu |
|
Source: |
Applied
Cognitive Psychology, Vol 15(7), Dec 2001. Special
issue: Trauma, stress, and autobiographical memory. pp.
S159-S170. |
|
Publisher: |
US:
John Wiley & Sons |
|
Abstract: |
The
present study examined how specific linguistic elements
in trauma narratives were associated with post-treatment
psychopathology and physical symptoms. The authors
analyzed the narratives of 28 female assault victims
(mean age 31 yrs) being treated for chronic
posttraumatic stress disorder (PTSD). During exposure
therapy, participants were asked to recount their
assault 'as if it was happening now.' These trauma
narratives were videotaped, transcribed, and analyzed
using a linguistic coding program. In particular,
narratives containing words about death and dying were
associated with worse post-treatment functioning. This
relationship could not be accounted for by
assault-related characteristics. The focus on death and
dying in the trauma narrative may reflect the concept of
mental defeat, suggesting a possible target for
intervention in cognitive-behavioral treatment of PTSD.
|
|
Title: |
Treatment of posttraumatic stress disorder with comorbid
panic attacks: Combining cognitive processing therapy
with panic control treatment techniques. |
|
Author(s): |
Falsetti, Sherry A., Medical U of South Carolina, Dept
of Psychiatry & Behavioral Sciences, National Crime
Victims Research & Treatment Ctr, Charleston, SC, US
Resnick, Heidi S.
Davis, Joanne
Gallagher, Natalie G. |
|
Address: |
Falsetti, Sherry A., Medical U of South Carolina,
National Crime Victims Research & Treatment Ctr, 165
Cannon Street, P. O. Box 250852, Charleston, SC, US |
|
Source: |
Group
Dynamics: Theory, Research, and Practice, Vol 5(4), Dec
2001. Special issue: Group-based interventions for
trauma survivors. pp. 252-260. |
|
Publisher: |
US:
Educational Publishing Foundation |
|
Abstract: |
A large
proportion of patients who present for treatment of
posttraumatic stress disorder (PTSD) experience comorbid
panic attacks, yet currently available PTSD treatment
programs do not address this problem. This report
provides an initial evaluation of a newly developed
treatment, multiple channel exposure therapy (M-CET),
for comorbid PTSD and panic attacks. The treatment uses
elements of cognitive processing therapy treatment for
PTSD and elements of panic control treatment to target
physiological, cognitive, and behavioral symptoms.
Results suggest that M-CET may be a promising treatment
program for a subset of PTSD patients who experience
panic attacks. Preliminary guidelines for conducting
M-CET in a group format with participants exposed to
diverse traumatic events are provided. |
|
Title: |
Cognitive therapy for posttraumatic stress disorder. |
|
Author(s): |
Resick,
Patricia A., U Missouri, St Louis, MO, US |
|
Address: |
Resick,
Patricia A., Ctr for Trauma Recovery, Weinman Building,
U Missouri-St. Louis, 8001 Natural Bridge Road, St.
Louis, MO, US |
|
Source: |
Journal
of Cognitive Psychotherapy, Vol 15(4), Win 2001. Special
issue: Review of cognitive behavioral therapy. pp.
321-329. |
|
Publisher: |
US:
Springer Publishing |
|
Abstract: |
Examines 7 controlled studies that included at least a
component of cognitive therapy for posttraumatic stress
disorder (PTSD). Two studies specifically focused on
early intervention to treat PTSD and included both
cognitive therapy and exposure therapy. Three studies
examined cognitive processing therapy, which is
predominantly cognitive therapy. Two other studies
compared pure cognitive therapy with exposure therapy.
The author maintains that overall, cognitive therapy for
PTSD appears to be highly effective compared to
no-treatment, relaxation, or supportive counseling, and
similar to exposure treatments. Treatment effects appear
to continue through follow-up periods of up to 1 yr.
However, little is known about who benefits best with
cognitive therapy or predictors of treatment outcome.
|
|
Title: |
Cognitive-behavior therapy vs exposure therapy in the
treatment of PTSD in refugees. |
|
Author(s): |
Paunovic, Nenad, Stockholm U, Dept of Psychology,
Stockholm, Sweden
Öst, Lars-Göran |
|
Address: |
Paunovic, Nenad, Stockholm U, Dept of Psychology, 106
91, Stockholm, Sweden, npc@psychology.su.se |
|
Source: |
Behaviour Research and Therapy, Vol 39(10), Oct 2001.
pp. 1183-1197. |
|
Publisher: |
Netherlands: Elsevier Science |
|
Abstract: |
Investigated the efficacy of cognitive-behavior therapy
(CBT) and exposure therapy (E) in the treatment of
post-traumatic stress disorder (PTSD) in refugees. 16
outpatients (aged 22-48 yrs) fulfilling the Diagnostic
and Statistical Manual of Mental Disorders-IV (DSM-IV)
criteria for PTSD were randomized to one of the two
treatments. Assessor and self-report measures of
PTSD-symptoms, generalized anxiety, depression, quality
of life and cognitive schemas were administered before
and after treatment, and at a 6-mo follow-up. The
patients were treated individually for 16-20 weekly
sessions. The results showed that both treatments
resulted in large improvements on all the measures,
which were maintained at the follow-up. There was no
difference between E and CBT on any measure. E and CBT
led to a 48 and 53% reduction on PTSD-symptoms,
respectively, a 49 and 50% reduction on generalized
anxiety, and a 54 and 57% reduction on depression. The
results were maintained at the 6-mo follow-up. The
conclusion that can be drawn is that both E and CBT can
be effective treatments for PTSD in refugees. |
|
Title: |
Virtual
reality exposure therapy for Vietnam veterans with
posttraumatic stress disorder. |
|
Author(s): |
Rothbaum, Barbara O., Emory Clinic, Dept of Psychiatry,
Atlanta, GA, US, brothba@emory.edu
Hodges, Larry F.
Ready, David
Graap, Ken
Alarcon, Renato D. |
|
Source: |
Journal
of Clinical Psychiatry, Vol 62(8), Aug 2001. pp.
617-622. |
|
Publisher: |
US:
Physicians Postgraduate Press |
|
Abstract: |
Virtual
reality (VR) integrates real-time computer graphics,
body-tracking devices, visual displays, and other
sensory input devices to immerse a participant in a
computer-generated virtual environment that changes in a
natural way with head and body motion. This report
presents the results of an open clinical trial using VR
exposure to treat Vietnam combat veterans who have
posttraumatic stress disorder (PTSD). In 8-16 sessions,
10 male patients (mean age 51 yrs) were exposed to 2
virtual environments: a virtual Huey helicopter flying
over a virtual Vietnam and a clearing surrounded by
jungle. Clinician-rated PTSD symptoms as measured by the
Clinician Administered PTSD Scale, the primary outcome
measure, at 6-month follow-up indicated an overall
statistically significant reduction from baseline in
symptoms associated with specific reported traumatic
experiences. All 8 Ss interviewed at the 6-month
follow-up reported reductions in PTSD symptoms ranging
from 15-67%. Significant decreases were seen in all 3
symptom clusters. Patient self-reported intrusion
symptoms as measured by the Impact of Event Scale were
significantly lower at 3 mo than at baseline but not at
6 mo, although there was a clear trend toward fewer
intrusive thoughts and somewhat less avoidance.
|
|
Title: |
Tratamientos psicológicos eficaces para el estrés
post-traumático. |
|
Translated Title: |
Efficacious psychological treatments for post-traumatic
stress disorder. |
|
Author(s): |
Báguena
Puigcerver, María José, U Valencia, Facultad de
Psicología, Valencia, Spain, maria.j.baguena@uv.es |
|
Source: |
Psicothema, Vol 13(3), Aug 2001. pp. 479-492. |
|
Publisher: |
Spain:
Colegio Oficial de Psicólogos del Principado de Asturias |
|
Abstract: |
Reviews
the most effective psychological and pharmacological
therapies for the treatment of posttraumatic stress
disorder (PTSD). The empirical findings on
cognitive-behavioral approaches (exposure therapy,
cognitive restructuring, and anxiety management
training), hypnotherapy, and pharmacotherapy
(antidepressants, valproic acid, lithium, carbamazepine,
and other substances) are examined. The recent emphasis
on designing treatment programs that integrate several
therapies is discussed. |
|
Title: |
Exposure therapy in the treatment of PTSD among
cocaine-dependent individuals: Description of
procedures. |
|
Author(s): |
Back,
Sudie E., U Georgia, Dept of Psychology, Athens, GA, US,
sback@arches.uga.edu
Dansky, Bonnie S.
Carroll, Kathleen M.
Foa, Edna B.
Brady, Kathleen T. |
|
Source: |
Journal
of Substance Abuse Treatment, Vol 21(1), Jul 2001. pp.
35-45. |
|
Publisher: |
Netherlands: Elsevier Science |
|
Abstract: |
An
estimated 30% to 50% of cocaine-dependent individuals
meet criteria for lifetime posttraumatic stress disorder
(PTSD). Cocaine dependence is associated with increased
rates of exposure to trauma, more severe symptoms,
higher rates of treatment attrition and
retraumatization, and greater vulnerability to PTSD when
compared to other substance use disorders. These
associations underscore the need for effective
treatments that address issues particular to PTSD in a
manner tolerable to cocaine-dependent individuals. This
article describes a manualized psychotherapy developed
specifically for individuals with PTSD and cocaine
dependence. Concurrent Treatment of PTSD and Cocaine
Dependence (CTPCD) provides coping skills training,
cognitive restructuring techniques, and relapse
prevention strategies to reduce cocaine use. In-vivo and
imaginal exposure therapy techniques are incorporated to
reduce PTSD symptom severity. Primary treatment goals
include psychoeducation specific to the
interrelationship between PTSD and cocaine dependence,
and clinically meaningful reductions in cocaine use and
PTSD symptomatology. Secondary goals include a reduction
in HIV high-risk behaviors and improved functioning in
associated areas, such as anger and negative affect
management. |
|
Title: |
Exposure therapy in the treatment of PTSD among
cocaine-dependent individuals: Preliminary findings. |
|
Author(s): |
Brady,
Kathleen T., Medical U South Carolina, Ctr for Drug &
Alcohol Programs, Dept of Psychiatry & Behavioral
Sciences, Charleston, SC, US
Dansky, Bonnie S.
Back, Sudie E.,
sback@arches.uga.edu
Foa, Edna B.
Carroll, Kathleen M. |
|
Source: |
Journal
of Substance Abuse Treatment, Vol 21(1), Jul 2001. pp.
47-54. |
|
Publisher: |
Netherlands: Elsevier Science |
|
Abstract: |
39 Ss
participated in an outpatient, 16-session individual,
manual-guided psychotherapy designed to treat concurrent
posttraumatic stress disorder (PTSD) and cocaine
dependence. Therapy consisted of a combination of
imaginal and in-vivo exposure therapy techniques to
treat PTSD symptoms and cognitive-behavioral techniques
to treat cocaine dependence. The dropout rate was high,
but treatment completers demonstrated significant
reductions in all PTSD symptom clusters and cocaine use
from baseline to end of treatment. Significant
reductions in depressive symptomatology, as measured by
the Beck Depression Inventory, and psychiatric and
cocaine use severity, as measured by the Addiction
Severity Index, were also observed. These improvements
in PTSD symptoms and cocaine use were maintained over a
6-month follow-up period among completers. Baseline
comparisons between treatment completers and
noncompleters revealed significantly higher avoidance
symptoms, as measured by the Impact of Events Scale, and
fewer years of education among treatment noncompleters
as compared to completers. This study provides
preliminary evidence to suggest that exposure therapy
can be used safely and may be effective in the treatment
of PTSD in some individuals with cocaine dependence.
|
|
Title: |
Dreams
and exposure therapy in PTSD. |
|
Author(s): |
Rothbaum, Barbara Olasov, Emory U, School of Medicine,
Dept of Psychiatry & Behavioral Sciences, Atlanta, GA,
US, brothba@emory.edu
Mellman, Thomas Alan |
|
Address: |
Rothbaum, Barbara Olasov, Emory Clinic, Dept of
Psychiatry & Behavioral Sciences, 1365 Clifton Road,
Atlanta, GA, US, brothba@emory.edu |
|
Source: |
Journal
of Traumatic Stress, Vol 14(3), Jul 2001. pp. 481-490. |
|
Publisher: |
US:
John Wiley & Sons |
|
Abstract: |
Exposure therapy is a well-established treatment for
posttraumatic stress disorder (PTSD) that requires the
patient to focus on and describe the details of a
traumatic experience. Nightmares that refer to or
replicate traumatic experiences are prominent and
distressing symptoms of PTSD and appear to exacerbate
the disorder. With this apparent paradox in mind,
exposure therapy and the literature on sleep and PTSD
are reviewed in the context of the relationship between
therapeutic exposure and exposure to trauma-related
stimuli that occurs in dreams. It is concluded that
nightmares that replay the trauma and disrupt sleep do
not meet requirements for therapeutic exposure, whereas
other dreaming may aid in the recovery from trauma. |
|
Title: |
Treatment of a 50-year-old African American woman whose
chronic posttraumatic stress disorder went undiagnosed
for over 20 years. |
|
Author(s): |
Cooke,
Alice L., U Pittsburgh, Western Psychiatric Inst &
Clinic, Dept of Psychiatry, Pittsburgh, PA, US
Shear, M. Katherine,
shearmk@msc.umpx.edu |
|
Source: |
American Journal of Psychiatry, Vol 158(6), Jun 2001.
pp. 866-870. |
|
Publisher: |
US:
American Psychiatric Assn |
|
Abstract: |
Presents the case of an African-American woman who met
Diagnostic and Statistical Manual of Mental Disorders-IV
(DSM-IV) criteria for posttraumatic stress disorder
(PTSD) and was treated at a mental health clinic serving
low-income African Americans. The diagnosis of PTSD was
first made 22 yrs after the initial presentation, and
only then did she reveal her experience of having been
held hostage, bound, beaten, and repeatedly raped,
narrowly escaping with her life. The PTSD diagnosis was
made only after the patient underwent a structured
diagnostic interview and a targeted treatment was
provided under the auspices of a research project. The S
was originally treated for panic disorder with
agoraphobia, and then obsessive-compulsive disorder,
before the accurate diagnosis of PTSD was given and the
S was able to discuss her traumatic experience. The PTSD
treatment course included in-session re-experiencing
exposure to the traumatic event and between-session in
vivo exposure to feared situations. |
|
Tests &
Measures: |
Geriatric Depression Scale |
|
Title: |
Family
and past history of mental illness as predisposing
factors in post-traumatic stress disorder. |
|
Author(s): |
McKenzie, Nigel, U London, Inst of Psychiatry, Dept of
Experimental Psychopathology, London, England
Marks, Isaac
Liness, Sheena |
|
Source: |
Psychotherapy and Psychosomatics, Vol 70(3), May-Jun
2001. pp. 163-165. |
|
Publisher: |
Switzerland: Karger |
|
Abstract: |
Family
studies of posttraumatic stress disorder (PTSD) have
given inconsistent results to date. Identifying
predisposing factors in PTSD compared to anxiety
disorders may help to clarify the classification of PTSD
as a diagnostic entity. The present study used a
retrospective case note study of 87 PTSD patients (mean
age 37 yrs) who participated in exposure or cognitive
restructuring therapy, and 51 PTSD patients (mean age 38
yrs) and 87 patients with agoraphobia (mean age 39 yrs)
treated routinely as outpatients. Compared to those with
agoraphobia, PTSD patients had significantly less family
history of anxiety disorder but not mental illness in
general. They also had significantly less personal
history of mental illness prior to the index episode.
Trauma precipitated PTSD in Ss who had significantly
fewer premorbid predisposing factors than did Ss with
agoraphobia. Such factors may predispose agoraphobia Ss
to become psychiatrically ill after more minor trauma.
Research is needed to systematically compare the events
which precipitate PTSD as opposed to agoraphobia and
other anxiety disorders. |
|
Title: |
Integrating DBT-based techniques and concepts to
facilitate exposure treatment for PTSD. |
|
Author(s): |
Becker,
Carolyn Black, Trinity U, San Antiono, TX, US,
carolyn.becker@trinity.edu
Zayfert, Claudia, Dartmouth
Medical School, NH, US |
|
Address: |
Becker,
Carolyn Black, Trinity U, Dept of Psychology, 715
Stadium Drive, San Antonio, TX, US,
carolyn.becker@trinity.edu |
|
Source: |
Cognitive and Behavioral Practice, Vol 8(2), Spr 2001.
pp. 107-122. |
|
Publisher: |
US:
Assn for the Advancement of Behavior Therapy |
|
Abstract: |
While
considerable evidence supports the use of exposure-based
treatment for posttraumatic stress disorder (PTSD), its
utilization in clinical practice remains limited. This
article presents a systematic and empirically grounded
approach to the flexible application of PTSD treatment
research in a "true" clinical setting. High rates of
attrition, suicidality, dissociation, destructive
impulsivity, and chaotic life problems are reasons cited
by clinicians for abandoning empirically supported
exposure treatment. M. M. Linehan's (1993) dialectical
behavior therapy (DBT), designed to address many of
these issues, offers useful strategies for addressing
the needs of patients considered poor candidates for
exposure therapy. This article offers a model for
integrating DBT-based theory, concepts, and skills with
manualized exposure-based cognitive-behavior therapy for
PTSD in order to improve patient (and therapist)
tolerance of this treatment. |
|
Title: |
The
investigation of exposure and cognitive therapy: Comment
on Tarrier et al. (1999). |
|
Author(s): |
Devilly, Grant J., U Melbourne, Dept of Criminology,
Parkville, VIC, Australia
Foa, Edna B. |
|
Source: |
Journal
of Consulting and Clinical Psychology, Vol 69(1), Feb
2001. pp. 114-116. |
|
Publisher: |
US:
American Psychological Assn |
|
Abstract: |
This
article outlines concerns relating to the N. Tarrier et
al. (1999) investigation (see record 1999-00242-002)
comparing imaginal exposure and cognitive therapy.
Specifically, the authors offer N. Tarrier et al. the
opportunity to operationally define and clarify the
claim that more patients treated by imaginal exposure
"worsened" during treatment. Equally, in light of N.
Tarrier et al.'s low effect sizes in relation to past
research the authors also highlight the need to utilize
accountable treatment integrity checks. |
|
Title: |
What
can be learned from clinical trials? Reply to Devilly
and Foa (2001). |
|
Author(s): |
Tarrier, Nicholas, U Manchester, Withington Hosp, Dept
of Clinical Psychology, Manchester, England |
|
Source: |
Journal
of Consulting and Clinical Psychology, Vol 69(1), Feb
2001. pp. 117-118. |
|
Publisher: |
US:
American Psychological Assn |
|
Abstract: |
G.
Devilly and E. B. Foa (see record 2001-14541-013)
claimed that the results of the Manchester posttraumatic
stress disorder (PTSD) trial (Tarrier, Pilgrim, et al.,
see record 1999-00242-002) "significantly differ" from
the results of other groups. This claim does not survive
scrutiny. G. Devilly and E. B. Foa are unhappy with our
report of treatment failures being overrepresented by
patients receiving exposure. However, the failure of
some patients to respond to exposure is in agreement
with the literature, including E. B. Foa's own writing
(A. Ehlers et al., 1998). Possible reasons the magnitude
of change may differ from other studies are discussed,
including differences in sample populations, methods of
recruitment, and participant attrition. Attention is
drawn to unique characteristics of the Manchester PTSD
study, including the use of a baseline
symptom-monitoring phase to exclude patients who would
respond to minimal intervention and measurement of the
psychosocial environment (expressed emotion). |
|
Title: |
Treatment of reactivated post-traumatic stress disorder:
Imaginal exposure in an older adult with multiple
traumas. |
|
Author(s): |
Russo,
Stephen A., Nova Southeastern U, Ft Lauderdale, FL, US
Hersen, Michel
Van Hasselt, Vincent B. |
|
Source: |
Behavior Modification, Vol 25(1), Jan 2001. pp. 94-115. |
|
Publisher: |
US:
Sage Publications |
|
Abstract: |
A
single-case analysis was used to assess the effects of
imaginal exposure in a 57-yr-old female suffering from
current and reactivated posttraumatic stress disorder
(PTSD) following a transient ischemic attack. The
client's responses to self-reported depression, anxiety,
and PTSD symptoms were repeatedly recorded during 4
phases: (1) initial psychotherapy, (2) imaginal
exposure, (3) skill generalization, and (4) fading of
treatment. In addition to dramatic reduction in levels
of depression and anxiety, results showed a significant
improvement in PTSD symptoms relating to recent and
remote traumatic experiences. Improvements were
maintained approximately 16 mo after imaginal exposure
ended, |
|
Title: |
Designing a virtual environment for post-traumatic
stress disorder in Israel: A protocol. |
|
Author(s): |
Josman,
Naomi, Department of Occupational Therapy, University of
Haifa, Haifa, Israel,
naomij@research.haifa.ac.il
Somer, Eli, School of Social
Work University of Haifa, Haifa, Israel
Reisberg, Ayelet, Department
of Occupational Therapy, University of Haifa, Haifa,
Israel
Weiss, Patrice L. (Tamar),
Department of Occupational Therapy, University of Haifa,
Haifa, Israel
Garcia-Palacios, Azucena,
Jaume I University, Castellon, Israel
Hoffman, Hunter, HIT Lab,
University of Washington, Seattle, WA, US |
|
Address: |
Josman,
Naomi, Department of Occupational Therapy, University of
Haifa, Mount Carmel, Haifa, Israel, 31905,
naomij@research.haifa.ac.il |
|
Source: |
CyberPsychology & Behavior, Vol 9(2), Apr 2006. Special
issue: Virtual and physical toys: Open-ended features
for non-formal learning. pp. 241-244. |
|
Publisher: |
US:
Mary Ann Liebert Publishers |
|
Abstract: |
A
number of carefully controlled studies have documented
the effectiveness of traditional imaginal exposure for
the treatment of post-traumatic stress disorder (PTSD).
Virtual reality (VR) exposure therapy is based on a
similar logic but rather than self-generating imagery,
patients wear a VR helmet and go into a
three-dimensional (3-D) computer generated virtual world
to help them gain access to their memory of the
traumatic event. Recent preliminary research has shown
that some patients who fail to respond to traditional
therapy benefit from virtual reality exposure therapy,
presumably because VR helps the patient become
emotionally engaged while
recollecting/recounting/re-interpreting/emotionally
processing what happened during the traumatic event. The
present paper presents a brief overview of a new VR
World we developed to provide virtual reality therapy
for terrorist bus bombing victims in Israel, and a brief
description of our research protocol and measures (for
details, see
www.vrpain.com). |
|
Title: |
Simulation and virtual reality in medical education and
therapy: A protocol. |
|
Author(s): |
Roy,
Michael J., Department of Medicine, Uniformed Services
University, Bethesda, MD, US,
mroy@usuhs.mil
Sticha, Deborah l.,
SIMmersion LLC, Columbia, MD, US
Kraus, Patricia L.,
Department of Medicine, Uniformed Services University,
Bethesda, MD, US
Olsen, Dale E., SIMmersion
LLC, Columbia, MD, US |
|
Address: |
Roy,
Michael J., Department of Medicine, Uniformed Services
University, Rm. A3062, 4301 Jones Bridge Rd., Bethesda,
MD, US,
mroy@usuhs.mil |
|
Source: |
CyberPsychology & Behavior, Vol 9(2), Apr 2006. Special
issue: Virtual and physical toys: Open-ended features
for non-formal learning. pp. 245-247. |
|
Publisher: |
US:
Mary Ann Liebert Publishers |
|
Abstract: |
Continuing medical education has historically been
provided primarily by didactic lectures, though adult
learners prefer experiential or self-directed learning.
Young physicians have extensive experience with
computer-based or "video" games, priming them for
medical education--and treating their patients--via new
technologies. We report our use of standardized patients
(SPs) to educate physicians on the diagnosis and
treatment of biological and chemical warfare agent
exposure. We trained professional actors to serve as SPs
representing exposure to biological agents such as
anthrax and smallpox. We rotated workshop participants
through teaching stations to interview, examine,
diagnose and treat SPs. We also trained SPs to simulate
a chemical mass casualty (MASCAL) incident. Workshop
participants worked together to treat MASCAL victims,
followed by discussion of key teaching points. More
recently, we developed computer-based simulation (CBS)
modules of patients exposed to biological agents. We
compare the strengths and weaknesses of CBS vs. live SPs.
Finally, we detail plans for a randomized controlled
trial to assess the efficacy of virtual reality (VR)
exposure therapy compared to pharmacotherapy for
post-traumatic stress disorder (PTSD). PTSD is
associated with significant disability and healthcare
costs, which may be ameliorated by the identification of
more effective therapy. |
|
Title: |
Taking
Charge: A Pilot Curriculum of Self-Defense and Personal
Safety Training for Female Veterans With PTSD Because of
Military Sexual Trauma. |
|
Author(s): |
David,
Wendy S., University of Washington, Seattle, Seattle,
WA, US,
wendy.david@med.va.gov
Simpson, Tracy L.,
University of Washington, Seattle, Seattle, WA, US
Cotton, Ann J., University
of Washington, Seattle, Seattle, WA, US |
|
Address: |
David,
Wendy S., VA Puget Sound Health Care System, (116-MHC)
1660 S. Columbian Way, Seattle, WA, US,
wendy.david@med.va.gov |
|
Source: |
Journal
of Interpersonal Violence, Vol 21(4), Apr 2006. pp.
555-565. |
|
Publisher: |
US:
Sage Publications |
|
Abstract: |
The
authors describe an overview of the pilot project Taking
Charge, a 36-hour comprehensive behavioral intervention
involving psychoeducation, personal safety, and
self-defense training for 12 female veterans with
posttraumatic stress disorder (PTSD) from military
sexual trauma. Self-defense training can incorporate the
benefits of repeated exposure while teaching proactive
cognitive and behavioral responses to the feared
stimuli, and thus facilitate emotional and physical
rescripting of and mastery over the trauma. Results up
to 6 months follow-up indicate significant reductions in
behavioral avoidance, PTSD hyperarousal, and depression,
with significant increases in interpersonal, activity,
and self-defense self-efficacy. The authors propose that
this therapeutic self-defense curriculum provides an
enhanced exposure therapy paradigm that may be a potent
therapeutic tool in the treatment of PTSD. |
|
Tests &
Measures: |
PTSD
Checklist-Civilian version (PCL-C)
Self-Defense Scale
General Self-Efficacy Scale
Beck Depression Inventory
Aggression Questionnaire |
|
Title: |
The
Active Ingredient in EMDR: Is It Traditional Exposure or
Dual Focus of Attention? |
|
Author(s): |
Lee,
Christopher W., School of Psychology, Murdoch
University, Perth, WAU, Australia,
chlee@murdoch.edu.au
Taylor, Graham, Private
Practice, Australia
Drummond, Peter D., School
of Psychology, Murdoch University, Perth, WAU, Australia |
|
Address: |
Lee,
Christopher W., School of Psychology, Murdoch
University, South Street, Murdoch, WAU, Australia, 6150,
chlee@murdoch.edu.au |
|
Source: |
Clinical Psychology & Psychotherapy, Vol 13(2), Mar-Apr
2006. pp. 97-107. |
|
Publisher: |
US:
John Wiley & Sons |
|
Abstract: |
Very
little is known about the mechanisms that underlie the
therapeutic effectiveness of eye movement
desensitization and reprocessing (EMDR). This study
tested whether the content of participants' responses
during EMDR is similar to that thought to be effective
for traditional exposure treatments (reliving), or is
more consistent with distancing, which would be expected
given Shapiro's proposal of dual process of attention.
The responses made by 44 participants with
post-traumatic stress disorder (PTSD) were examined
during their first EMDR treatment session. An
independent rater coded these responses according to
whether they were consistent with reliving, distancing
or focusing on material other than the primary trauma.
The coding system was found to have satisfactory
inter-rater reliability. Greatest improvement on a
measure of PTSD symptoms occurred when the participant
processed the trauma in a more detached manner.
Cross-lagged panel correlations suggest that processing
in a more detached manner was a consequence of the EMDR
procedure rather than a measure that covaried with
improvement. |
|
Tests &
Measures: |
Structured Interview for PTSD
Impact of Event Scale |
|
Title: |
Virtual
reality and other experiential therapies for
combat-related posttraumatic stress disorder. |
|
Author(s): |
Spira,
James L., Department of Psychiatry, University of
California, San Diego, CA, US,
JimSpira@aol.com
Pyne, Jeffrey M., Central
Arkansas Veterans Healthcare System, North Little Rock,
AR, US
Wiederhold, Brenda, Virtual
Reality Medical Center, San Diego, CA, US
Wiederhold, Mark, Virtual
Reality Medical Center, San Diego, CA, US
Graap, Ken, Virtually
Better, Inc., Decatur, GA, US
Rizzo, Albert, University of
Southern California, Los Angeles, CA, US |
|
Address: |
Spira,
James L., 817 Mola Vista Way, Solana Beach, CA, US,
JimSpira@aol.com |
|
Source: |
Primary
Psychiatry, Vol 13(3), Mar 2006. pp. 58-64. |
|
Publisher: |
US: MBL
Communications, Inc |
|
Abstract: |
Numerous experiences can lead to acute stress disorder
or posttraumatic stress disorder (PTSD) in military
personnel. Unfortunately, PTSD is a relatively common
outcome of combat exposure. The primary focus of this
article is the role of experiential psychotherapy
treatments which teach skill development to better cope
with combat-related PTSD. The article focuses largely on
virtual-reality-assisted exposure therapies. |
|
Title: |
Posttraumatic stress disorder: Etiology, Epidemiology,
and Treatment Outcome. |
|
Author(s): |
Keane,
Terence M., VA Boston Healthcare System, Boston
University School of Medicine, Boston, MA, US,
Terry.Keane@va.gov
Marshall, Amy D., VA Boston
Healthcare System, Boston University School of Medicine,
Boston, MA, US,
Amy.Marshall2@va.gov
Taft, Casey T., VA Boston
Healthcare System, Boston University School of Medicine,
Boston, MA, US,
Casey.Taft@va.gov |
|
Address: |
Keane,
Terence M., VA Boston Healthcare System, Boston
University School of Medicine, Boston, MA, US,
Terry.Keane@va.gov |
|
Source: |
Annual
Review of Clinical Psychology, Vol 2, 2006. pp. 161-197. |
|
Publisher: |
US:
Annual Reviews |
|
Abstract: |
Posttraumatic stress disorder (PTSD) results from
exposure to a traumatic event that poses actual or
threatened death or injury and produces intense fear,
helplessness, or horror. U.S. population surveys reveal
lifetime PTSD prevalence rates of 7% to 8%. Potential
reasons for varying prevalence rates across gender,
cultures, and samples exposed to different traumas are
discussed. Drawing upon a conditioning model of PTSD, we
review risk factors for PTSD, including pre-existing
individual-based factors, features of the traumatic
event, and posttrauma social support. Characteristics of
the trauma, particularly peritraumatic response and
related cognitions, and posttrauma social support appear
to confer the greatest risk for PTSD. Further work is
needed to disentangle the interrelationships among these
factors and elucidate the underlying mechanisms. Based
upon existing treatment outcome studies, we recommend
use of exposure therapies and anxiety management
training as first-line treatment for PTSD. Among
psychopharmacological treatments, selective serotonin
reuptake inhibitors evidence the strongest treatment
effects, yet these effects are modest compared with
psychological treatments. |
|
Title: |
Prolonged Exposure Treatment of Posttraumatic Stress
Disorder. |
|
Author(s): |
Riggs,
David S., Center for the Treatment and Study of Anxiety,
Department of Psychiatry, University of Pennsylvania,
Philadelphia, PA, US
Cahill, Shawn P., Center for
the Treatment and Study of Anxiety, Department of
Psychiatry, University of Pennsylvania, Philadelphia,
PA, US
Foa, Edna B., Center for the
Treatment and Study of Anxiety, Department of
Psychiatry, University of Pennsylvania, Philadelphia,
PA, US |
|
Source: |
Cognitive-behavioral therapies for trauma. Follette,
Victoria M. (Ed); Ruzek, Josef I. (Ed); pp. 65-95.
New York, NY, US: Guilford
Press, 2006. xxiv, 472 pp. |
|
Abstract: |
(from
the chapter) In the present chapter we examine the
theoretical underpinnings of prolonged exposure (PE) for
postraumatic stress disorder as well as the empirical
support for its efficacy in treating trauma survivors.
We then discuss concerns that have been raised about
exposure therapy and summarize research findings
relevant to these concerns. Finally, we describe recent
attempts to disseminate PE to clinicians who regularly
provide mental health services to trauma survivors.
|
|
Title: |
Non-visual flashbacks: In vivo versus imaginal exposure. |
|
Author(s): |
Salyards, Carolyn J., Marquette U., US |
|
Source: |
Dissertation Abstracts International: Section B: The
Sciences and Engineering, Vol 66(8-B), 2006. pp. 4500. |
|
Publisher: |
US:
ProQuest Information & Learning |
|
Abstract: |
More
than 3 million persons are injured in work-related
accidents in the U.S. annually and posttraumatic stress
disorder (PTSD) is a frequent psychological consequence
of accidental injuries. While many patients suffering
from PTSD respond positively to in vivo or imaginal
exposure therapy, patients who experience non-visual
flashbacks are particularly difficult to treat. This
dissertation analyzed data collected in a prospective
study of 80 individuals diagnosed with PTSD after
work-related accidental injuries who experienced
non-visual flashbacks. Injuries sustained by the
participants in this study occurred on the job from
industrial machinery, environmental exposure, or motor
vehicle accidents. A single licensed psychologist
treated all of the participants at the Medical College
of Wisconsin. Participants were assessed before
treatment, at the end of treatment, at 6-month follow
up, and at 12-month follow up. Of the 80 participants,
40 were treated with in vivo exposure and 40 were
treated with imaginal exposure. The purpose of this
study was to (1) delineate the characteristics of
non-visual flashbacks in victims of work-related
injuries, and (2) compare the course of treatment and
outcomes for in vivo exposure versus imaginal exposure
treatment for this unique patient population. Types of
non-visual flashbacks experienced by participants
included auditory, kinesthetic, olfactory,
auditory/kinesthetic, auditory/olfactory, and
olfactory/kinesthetic. The results of this study
supported the use of imaginal exposure for the treatment
of PTSD in individuals with non-visual flashbacks
following work-related traumatic injury. Participants
treated with both in vivo and imaginal exposure
experienced a decrease in symptoms over time. However,
participants treated with imaginal exposure experienced
more reduction of symptoms than participants treated
with in vivo exposure at all assessment times. Positive
treatment effects occurred at a greater rate with
imaginal exposure than with in vivo exposure treatment.
Effects were maintained and continued to improve for
many participants at 12-month follow-up. In addition to
symptom reduction, clinical improvement measured by
return-to-work outcomes occurred at a greater rate for
participants treated with imaginal exposure. In addition
to statistical findings, three case studies were
presented to illustrate unique patterns of change and
treatment outcomes. |
|
Title: |
Posttraumatic Stress Disorder. |
|
Series
Title: |
Dissociation, trauma, memory, and hypnosis book series |
|
Author(s): |
Lynn,
Steven Jay, State University of New York at Binghamton,
Binghamton, NY, US
Kirsch, Irving, University
of Plymouth, United Kingdom |
|
Source: |
Essentials of clinical hypnosis: An evidence-based
approach. Lynn, Steven Jay; Kirsch, Irving; pp. 159-173.
Washington, DC, US: American
Psychological Association, 2006. viii, 271 pp.
|
|
Abstract: |
(from
the create) In this chapter the authors illustrate how
exposure-based techniques can be combined with hypnosis
and cognitive interventions to ameliorate PTSD symptoms.
For a diagnosis of PTSD to be made, the traumatic event
must be life endangering and the person's response must
involve intense fear, helplessness, or horror (American
Psychiatric Association, 1994). It is also necessary for
the symptoms to persist for at least 1 month; otherwise
the condition is diagnosed as acute stress disorder. The
symptoms of PTSD include stress and hyperarousal (e.g.,
sleep difficulties, exaggerated and distressing startle
response), emotional numbing of responsiveness (e.g.,
restricted range of emotional experiences, feelings of
detachment and alienation from others), and persistent
avoidance of situations or reminders of trauma (e.g.,
efforts to avoid activities, places, or people
associated with the event). |
|
Title: |
Virtual
reality exposure for veterans with posttraumatic stress
disorder. |
|
Author(s): |
Ready,
David J., Atlanta VA Medical Center, Atlanta, GA, US,
David.Ready@med.va.gov
Pollack, Stacey, PTSD
Program, Washington DC VA Medical Center, Washington,
DC, US
Rothbaum, Barbara Olasov,
Emory School of Medicine, Department of Psychiatry and
Behavioral Sciences, Atlanta, GA, US
Alarcon, Renato D., Mayo
Medical School, Rochester, MN, US |
|
Address: |
Ready,
David J., Atlanta VA Medical Center, (116A-4), 1670
Clarimont Road, Decatur, GA, US,
David.Ready@med.va.gov |
|
Source: |
Journal
of Aggression, Maltreatment & Trauma, Vol 12(1-2), 2006.
pp. 199-220. |
|
Publisher: |
US:
Haworth Press |
|
Abstract: |
Two
open trials of Virtual Reality based exposure therapy
(VRE) to desensitize Vietnam veterans with Posttraumatic
Stress Disorder (PTSD) to some of their traumatic
memories are described. A total of 21 patients were
exposed to one of two virtual Vietnam computer-generated
environments in which their individual traumatic
experiences were simulated in response to their
recounting these events. Although two patients
experienced significant increases in symptoms during
VRE, all patients' PTSD symptoms were below baseline by
the 3-month posttreatment assessment. When the data from
the two open trials was combined, clinically meaningful
and statistically significant reductions in PTSD
symptoms were found. These changes were long lasting as
evidenced by the 6-month follow-up assessments. Two case
examples are provided and future applications of this
treatment are discussed. |
|
Tests &
Measures: |
Subjective Units of Discomfort Scale
Beck Depression Inventory
Clinician-Administered PTSD
Scale
Impact of Event Scale |
|
Title: |
Posttraumatic stress disorder: A state-of-the-science
review. |
|
Author(s): |
Nemeroff, Charles B., Department of Psychiatry and
Behavioral Sciences, Emory University School of
Medicine, Atlanta, GA, US,
cnemero@emory.edu
Bremner, J. Douglas,
Department of Psychiatry and Radiology, Emory University
School of Medicine, Atlanta, GA, US
Foa, Edna B., Department of
Psychiatry, University of Pennsylvania School of
Medicine, Philadelphia, PA, US
Mayberg, Helen S.,
Department of Psychiatry and Neurology, Emory University
School of Medicine, Atlanta, GA, US
North, Carol S., Department
of Psychiatry, Washington University School of Medicine,
St. Louis, MO, US
Stein, Murray B., Department
of Psychiatry and Family & Preventive Medicine,
University of California San Diego, La Jolla, CA, US |
|
Address: |
Nemeroff, Charles B., Department of Psychiatry and
Behavioral Sciences, Emory University School of
Medicine, 1639 Pierce Drive, Atlanta, GA, US,
cnemero@emory.edu |
|
Source: |
Journal
of Psychiatric Research, Vol 40(1), Jan 2006. pp. 1-21. |
|
Publisher: |
Netherlands: Elsevier Science |
|
Abstract: |
This
article reviews the state-of-the-art research in
posttraumatic stress disorder (PTSD) from several
perspectives: (1) Sex differences: PTSD is more frequent
among women, who tend to have different types of
precipitating traumas and higher rates of comorbid panic
disorder and agoraphobia than do men. (2) Risk and
resilience: The presence of Group C symptoms after
exposure to a disaster or act of terrorism may predict
the development of PTSD as well as comorbid diagnoses.
(3) Impact of trauma in early life: Persistent increases
in CRF concentration are associated with early life
trauma and PTSD, and may be reversed with paroxetine
treatment. (4) Imaging studies: Intriguing findings in
treated and untreated depressed patients may serve as a
paradigm of failed brain adaptation to chronic emotional
stress and anxiety disorders. (5) Neural circuits and
memory: Hippocampal volume appears to be selectively
decreased and hippocampal function impaired among PTSD
patients. (6) Cognitive behavioral approaches: Prolonged
exposure therapy, a readily disseminated treatment
modality, is effective in modifying the negative
cognitions that are frequent among PTSD patients. In the
future, it would be useful to assess the validity of the
PTSD construct, elucidate genetic and experiential
contributing factors (and their complex
interrelationships), clarify the mechanisms of action
for different treatments used in PTSD, discover ways to
predict which treatments (or treatment combinations)
will be successful for a given individual, develop an
operational definition of remission in PTSD, and explore
ways to disseminate effective evidence-based treatments
for this condition. |
|
Title: |
Cognitive-Behavioral Perspectives on Theory and
Treatment of Posttraumatic Stress Disorder. |
|
Author(s): |
Hembree, Elizabeth A., Department of Psychiatry,
University of Pennsylvania School of Medicine,
Philadelphia, PA, US
Feeny, Norah C., Departments
of Psychiatry & Psychology, Case Western Reserve
University, Cleveland, OH, US |
|
Source: |
Pathological anxiety: Emotional processing in etiology
and treatment. Rothbaum, Barbara Olasov (Ed); pp.
197-211.
New York, NY, US: Guilford
Press, 2006. xvi, 272 pp. |
|
Abstract: |
(from
the chapter) In this chapter, we review the diagnostic
criteria for and prevalence of posttraumatic stress
disorder (PTSD). Next, we discuss conceptualizations of
the development and maintenance of PTSD, with emphasis
on emotional processing theory as presented by Foa and
colleagues. We then describe several
cognitive-behavioral approaches to the treatment of PTSD
and provide a brief summary of current empirical support
for these. Finally, we describe a specific treatment for
PTSD that has received extensive empirical
support--prolonged exposure therapy--and present a case
example that illustrates this effective and efficient
treatment. |
|
Title: |
Adapting Imaginal Exposure to the Treatment of
Complicated Grief. |
|
Author(s): |
Shear,
Katherine, Bereavement & Grief Profram, Western
Psychiatric Institute & Clinic, Pittsburgh, PA, US |
|
Source: |
Pathological anxiety: Emotional processing in etiology
and treatment. Rothbaum, Barbara Olasov (Ed); pp.
215-226.
New York, NY, US: Guilford
Press, 2006. xvi, 272 pp. |
|
Abstract: |
(from
the chapter) Complicated grief (CG) is a newly
recognized, chronic, debilitating psychiatric condition.
CG comprises symptoms of separation distress, along with
prominent symptoms of traumatic stress. We recently
undertook the task of devising a treatment for CG. CG
shares features of both mood and anxiety disorders.
Given the amalgam of depressive and trauma-like
symptoms, we decided to develop a treatment that
integrates techniques found helpful for depression with
those used for PTSD. Edna Foa's PTSD treatment was
highly effective and carefully studied. We consulted
with her to develop the trauma-focused component of CG
treatment. In the remainder of this chapter, we (1)
describe the syndrome of CG and review treatments for
bereavement- related distress, (2) explain the process
we used to develop CG treatment (CGT), (3) present
techniques we use to train therapists, and (4) give an
overview of data from our studies of this condition.
|
|
Title: |
Virtual
Reality Exposure Therapy. |
|
Author(s): |
Rothbaum, Barbara Olasov, Department of Psychiatry and
Trauma and Anxiety Recovery Program, Emory University
School of Medicine, Atlanta, GA, US |
|
Source: |
Pathological anxiety: Emotional processing in etiology
and treatment. Rothbaum, Barbara Olasov (Ed); pp.
227-244.
New York, NY, US: Guilford
Press, 2006. xvi, 272 pp. |
|
Abstract: |
(from
the chapter) This chapter provides an overview of
research supporting the use of virtual reality (VR) to
help treat anxiety disorders, the rationale for its use,
and future directions for the field. In this chapter, I
will present data on the use of VR exposure therapy in
the treatment of the fear of heights, the fear of
flying, social phobia, and posttraumatic stress disorder
(PTSD). In general, these data support propositions
about emotional processing and therapy. |
|
Title: |
Combining Cognitive Processing Therapy with Panic
Exposure and Management Techniques. |
|
Author(s): |
Falsetti, Sherry A., Family Health Center, Department of
Family and Community Medicine, College of Medicine,
University of Illinois, Rockford, IL, US
Resnick, Heidi S.,
Department of Psychiatry and Behavioral Sciences,
Medical University of South Carolina, Charleston, SC, US
Lawyer, Steven R., National
Crime Victims Research and Treatment Center, Medical
University of South Carolina, Charleston, SC, US |
|
Source: |
Psychological effects of catastrophic disasters: Group
approaches to treatment. Schein, Leon A. (Ed); Spitz,
Henry I. (Ed); Burlingame, Gary M. (Ed); Muskin, Philip
R. (Ed); Vargo, Shannon (Col); pp. 629-668.
New York, NY, US: Haworth
Press, 2006. xxiv, 940 pp. |
|
Abstract: |
(from
the chapter) In this chapter we describe multiple
channel exposure therapy (M-CET), a group treatment, and
its application to post-traumatic stress disorder (PTSD)
and comorbid panic attacks. This treatment was developed
to meet the needs of clients who had difficulty doing
trauma-focused therapy because high levels of emotional
arousal would often trigger panic attacks, which were
very fearful to these clients. The treatment approach is
designed to include exposure in all three major response
channels: cognitive, behavioral, and physiological.
M-CET integrates components of cognitive processing
therapy (CPT) that address changes in cognitive schema
following traumatic events. These include cognitive
restructuring and writing about the memory of the
traumatic event to reduce symptoms of PTSD and altered
belief systems that result from the aftermath of
traumatic events. In addition, M-CET includes adapted
components of Barlow and Craske's Mastery of Your
Anxiety and Panic (MAP) treatment package, a highly
effective treatment for panic disorder. The MAP
treatment includes in-depth psychoeducation about the
physiology of panic, cognitive restructuring related to
overestimation, and catastrophizing panic attacks; and
provides exercises that allow for exposure to the
physical sensations of panic. As adapted within M-CET,
the theoretical rationale posits that panic attacks may
have been initially experienced during the traumatic
event but are currently experienced with or without
identified event-related cues which elicit fear.
Finally, M-CET incorporates in vivo exposure exercises
to promote habituation to PTSD and panic-related
situational cues. |
|
Title: |
A
Clinician's Guide to STAIR/MPE: Treatment for PTSD
Related to Childhood Abuse. |
|
Author(s): |
Levitt,
Jill T., New York University School of Medicine, NY, US,
jilllevitt@yahoo.com
Cloitre, Marylene, New York
University School of Medicine, NY, US,
mcloitre@med.nyu.edu |
|
Address: |
Levitt,
Jill T., 425 East 86th St., New York, NY, US,
jilllevitt@yahoo.com |
|
Source: |
Cognitive and Behavioral Practice, Vol 12(1), Win 2005.
pp. 40-52. |
|
Publisher: |
US:
Assn for the Advancement of Behavior Therapy |
|
Abstract: |
Women
who have PTSD related to childhood abuse have
significant deficits in the areas of emotion regulation
and interpersonal skills. These problems are associated
with impaired functioning in social, work, and home
life. In addition, there is substantial clinical concern
that limited emotion-regulation skills puts this
population at risk for early dropout and symptom
exacerbation in treatment focusing on emotional
processing of traumatic memories. Skills Training in
Affective and Interpersonal Regulation plus Modified
Prolonged Exposure (STAIR/MPE) is an evidence-based,
2-phase cognitive behavioral treatment designed to
address these concerns. Specifically, this treatment
targets PTSD symptoms, emotion-regulation deficits, and
interpersonal difficulties. The purpose of this article
is to describe the rationale for and clinical
application of STAIR/MPE, detailing the essential
clinical components and presenting relevant case
examples. (PsycINFO Database Record (c) 2005 APA, all
rights reserved)(journal abstract) |
|
Title: |
Review
of assessment and treatment of PTSD among elderly
American armed forces veterans. |
|
Author(s): |
Owens,
Gina P., University of Kentucky, Lexington, KY, US,
ginaowens@juno.com
Baker, Dewleen G., San Diego
VA Medical Center, CA, US
Kasckow, John, Cincinnati VA
Medical Center, OH, US
Ciesla, Jeffrey A.,
Vanderbilt University, Nashville, TN, US
Mohamed, Somaia, Cincinnati
VA Medical Center, OH, US |
|
Address: |
Owens,
Gina P., University of Kentucky, 251-D Dickey Hall,
Lexington, KY, US,
ginaowens@juno.com |
|
Source: |
International Journal of Geriatric Psychiatry, Vol
20(12), Dec 2005. pp. 1118-1130. |
|
Publisher: |
US:
John Wiley & Sons |
|
Abstract: |
Background: The number of elderly combat veterans is
steadily increasing in the US and estimates project that
a notable percentage of these veterans experience
symptoms of posttraumatic stress disorder (PTSD).
Limited data exist specifically related to prevalence,
assessment, and treatment of PTSD among the elderly
veteran population. Objective: This review summarizes
the available research related to difficulties in
assessment with the elderly American Armed Forces
veteran population. In addition, both psychotherapeutic
and pharmacological treatment interventions for PTSD are
discussed. Methods: A literature search was conducted
using PsycINFO, Medline, and the National Center for
PTSD's PILOTS database. Results: Evidence suggests that
elderly veterans generally present more somatic symptoms
of PTSD. Medical and psychological comorbidities, such
as depression, substance abuse, or cognitive deficits
can further complicate the assessment process.
Cut-scores for existing instruments need to be further
established with elderly veterans. Use of exposure
therapies with the elderly has not been adequately
researched and mixed results have been obtained for
supportive therapy for treatment of PTSD. Controlled
research investigating pharmacological interventions for
PTSD with the elderly is also limited. Conclusion:
Evidence suggests that some psychotherapeutic and
pharmacological interventions already utilized with
younger individuals may be useful with the elderly
veteran population. However, research indicates that
modifications may be required for working with the
elderly population and further research in the areas of
assessment and treatment are necessary. |
|
Title: |
Seeking
safety plus exposure therapy: An outcome study on dual
diagnosis men. |
|
Author(s): |
Najavits, Lisa M., Harvard Medical School, Boston, MA,
US, lisa_najavits@hms.harvard.edu
Schmitz, Martha, Harvard
Medical School, Boston, MA, US
Gotthardt, Silke, McLean
Hospital, Belmont, MA, US
Weiss, Roger D., Harvard
Medical School, Boston, MA, US |
|
Address: |
Najavits, Lisa M., McLean Hospital, 115 Mill Street,
Belmont, MA, US, lisa_najavits@hms.harvard.edu |
|
Source: |
Journal
of Psychoactive Drugs, Vol 37(4), Dec 2005. pp. 425-435. |
|
Publisher: |
US:
Haight-Ashbury Publications |
|
Abstract: |
This
study arose out of a prominent clinical need: effective
treatment for comorbid posttraumatic stress disorder
(PTSD) and substance use disorder (SUD) in civilian men.
This dual diagnosis is estimated to occur in up to 38%
of men in substance abuse treatment, and generally
portends a more severe clinical course than SUD alone.
Clinical issues include self-harm, suicidality,
perpetration of violence against others, and HIV risk
behaviors. This study appears to be the first outcome
trial to address a sample of civilian men with PTSD and
SUD using manualized psychosocial treatment. It
evaluates a novel combination treatment, Seeking Safety
plus Exposure Therapy-Revised. The former is a coping
skills treatment designed for PTSD and SUD; the latter
is an adaptation of Foa's exposure therapy, modified for
PTSD and SUD. In this small sample (n = 5) outpatient
pilot trial, patients with current PTSD and current SUD
were offered 30 sessions over five months, with the
option to select how much of each type of treatment they
preferred. Outcome results showed significant
improvements in drug use; family/social functioning;
trauma symptoms; anxiety; dissociation; sexuality;
hostility; overall functioning; meaningfulness; and
feelings and thoughts related to safety. Trends
indicating improvement on 11 other outcome variables
were also found. Treatment attendance, satisfaction, and
alliance were extremely high. The need for further
evaluation using more rigorous methodology is discussed.
|
|
Tests &
Measures: |
Mini-International Neuropsychiatric Interview
Timeline Interview
Trauma History Questionnaire
Suicidal Behaviors
Questionnaire
Trauma Symptom Checklist-40
Treatment Services Review
World Assumptions Scale
Patient Preferences
Questionnaire
Core Components
Questionnaire
Helping Alliance
Questionnaire-II
Seeking Safety Feedback
Questionnaire
Exposure Therapy-Revised
Feedback Questionnaire
Addiction Severity Index
Brief Symptom Inventory
Social Adjustment Scale
Client Satisfaction
Questionnaire
Clinical Global Impression
Scale
Global Assessment of
Functioning Scale
Structured Clinical
Interview for DSM-IV |
|
Title: |
Stress-induced enhancement of fear learning: An animal
model of posttraumatic stress disorder. |
|
Author(s): |
Rau,
Vinuta, Department of Psychology, University of
California, Los Angeles, Los Angeles, CA, US,
vrau@ucla.edu
DeCola, Joseph P.,
Department of Psychology, Ohio State University,
Columbus, OH, US
Fanselow, Michael S.,
Department of Psychology, University of California, Los
Angeles, Los Angeles, CA, US |
|
Address: |
Rau,
Vinuta, Department of Psychology, University of
California, Los Angeles, 415 Hilgard Ave, Los Angeles,
CA, US, vrau@ucla.edu |
|
Source: |
Neuroscience & Biobehavioral Reviews, Vol 29(8), Dec
2005. Special issue: Defensive Behavior. pp. 1207-1223. |
|
Publisher: |
Netherlands: Elsevier Science |
|
Abstract: |
Fear is
an adaptive response that initiates defensive behavior
to protect animals and humans from danger. However,
anxiety disorders, such as Posttraumatic Stress Disorder
(PTSD), can occur when fear is inappropriately
regulated. Fear conditioning can be used to study
aspects of PTSD, and we have developed a model in which
pre-exposure to a stressor of repeated footshock
enhances conditional fear responding to a single
context-shock pairing. The experiments in this chapter
address interpretations of this effect including
generalization and summation or fear, inflation, and
altered pain sensitivity. The results of these
experiments lead to the conclusion that pre-exposure to
shock sensitizes conditional fear responding to similar
less intense stressors. This sensitization effect
resists exposure therapy (extinction) and amnestic (NMDA
antagonist) treatment. The pattern predicts why in PTSD
patients, mild stressors cause reactions more
appropriate for the original traumatic stressor and why
new fears are so readily formed in these patients. This
model can facilitate the study of neurobiological
mechanisms underlying sensitization of responses
observed in PTSD. (PsycINFO Database Record (c) 2006
APA, all rights reserved)(journal abstract) |
|
Title: |
Treating traumatic stress: Conducting imaginal exposure
in PTSD. |
|
Author(s): |
Bryant,
Richard A.
Mastrodomenico, Julie A. |
|
Source: |
Clinical Psychologist, Vol 9(2), Nov 2005. pp. 83. |
|
Publisher: |
United
Kingdom: Taylor & Francis |
|
Reviewed
Item: |
Mark
Creamer, David Forbes, Andrea Phelps and Leanne
Humphreys (No Year Specified). Treating traumatic
stress: Conducting imaginal exposure in PTSD |
|
Abstract: |
Reviews
the video, Treating Traumatic Stress: Conducting
Imaginal Exposure in PTSD by Mark Creamer et al. This
treatment manual commences with introductory information
about exposure, reviews the evidence for exposure
therapy, and guides for assessing the PTSD patient. The
next section provides a clear overview of treating PTSD,
including a sequential narrative of the range of
treatment strategies that can be provided. The third
section addresses exposure in detail. It discusses the
rationale for exposure therapy, and usefully spells out
when it should and should not be used. The fourth
section practically spells out how to commence a
hierarchy for conducting exposure, identifying the
targets for exposure, and preparing the client for
exposure therapy. The fifth section is really the heart
of the training package. The video scenarios are
exceptionally well-conducted and provide the clinician
with insights into the specific clinical skills required
to conduct exposure and, importantly, how to overcome
difficulties that can frequently arise during exposure
sessions. Overall, this training package is a very
welcome resource for clinicians and clinical
supervisors. The feedback is that psychiatrists,
psychologists, and social workers are benefiting
enormously from this brief training. |
|
Title: |
Simultaneous Treatment of Substance Abuse and
Post-Traumatic Stress Disorder: A Case Study. |
|
Author(s): |
Davis,
Joanne L., University of Tulsa, Tulsa, OK, US,
joanne-davis@utulsa.edu
Davies, Stephenie, Private
Practice, Ottawa, ON, Canada
Wright, David C., University
of Tulsa, Tulsa, OK, US
Falsetti, Sherry, Medical
University of South Carolina, Charleston, SC, US
Roitzsch, John C., Medical
University of South Carolina, Charleston, SC, US |
|
Address: |
Davis,
Joanne L., University of Tulsa, 600 South College
Avenue, 308C Lorton Hall, Tulsa, OK, US,
joanne-davis@utulsa.edu |
|
Source: |
Clinical Case Studies, Vol 4(4), Oct 2005. pp. 347-362. |
|
Publisher: |
US:
Sage Publications |
|
Abstract: |
The
type and timing of treatment for comorbid substance
abuse and victimization has been debated in the past
decade. Arguments have been made for simultaneous
treatment and consecutive treatment of each difficulty.
Current issues and a case study in which both problems
are treated simultaneously are presented. The patient
received inpatient detoxification, inpatient and
outpatient group counseling following the 12-step
program, and a cognitive-behavioral-oriented outpatient
group in the substance treatment component. Multiple
Channel Exposure Therapy (MCET), a 12-week manualized
treatment developed to treat individuals suffering from
both post-traumatic stress disorder and panic disorder,
was implemented in the victimization component. At
postassessment and at follow-up, the patient no longer
met criteria for any pretreatment diagnoses, and her
alcohol dependence was in remission. Clinical
implications and recommendations for the treatment of
substance abuse and victimization are discussed.
|
|
Tests &
Measures: |
Risk in
Intimacy Inventory
Trauma Assessment for Adults
Symptom Checklist-90-Revised
Trauma Symptom Inventory
Beck Depression Inventory
PTSD Checklist
Impact of Event Scale
Structured Clinical
Interview for DSM-IV |
|
Title: |
Randomized trial of prolonged exposure for posttraumatic
stress disorder with and without cognitive
restructuring: Outcome at academic and community
clinics. |
|
Author(s): |
Foa,
Edna B., Department of Psychiatry, University of
Pennsylvania, US, foa@mail.med.upenn.edu
Hembree, Elizabeth A.,
Department of Psychiatry, University of Pennsylvania, US
Cahill, Shawn P., Department
of Psychiatry, University of Pennsylvania, US
Rauch, Sheila A. M.,
Department of Psychiatry, University of Pennsylvania, US
Riggs, David S., Department
of Psychiatry, University of Pennsylvania, US
Feeny, Norah C., Department
of Psychiatry, Case Western Reserve University,
Cleveland, OH, US
Yadin, Elna, Department of
Psychiatry, University of Pennsylvania, US |
|
Address: |
Foa,
Edna B., Center for the Treatment and Study of Anxiety,
Department of Psychiatry, University of Pennsylvania,
3535 Market Street, Suite 600N, Philadelphia, PA, US,
foa@mail.med.upenn.edu |
|
Source: |
Journal
of Consulting and Clinical Psychology, Vol 73(5), Oct
2005. pp. 953-964. |
|
Publisher: |
US:
American Psychological Assn |
|
Abstract: |
Female
assault survivors (N = 171) with chronic posttraumatic
stress disorder (PTSD) were randomly assigned to
prolonged exposure (PE) alone, PE plus cognitive
restructuring (PE/CR), or wait-list (WL). Treatment,
which consisted of 9-12 sessions, was conducted at an
academic treatment center or at a community clinic for
rape survivors. Evaluations were conducted before and
after therapy and at 3-, 6-, and 12-month follow-ups.
Both treatments reduced PTSD and depression in
intent-to-treat and completer samples compared with the
WL condition; social functioning improved in the
completer sample. The addition of CR did not enhance
treatment outcome. No site differences were found:
Treatment in the hands of counselors with minimal
cognitive- behavioral therapy (CBT) experience was as
efficacious as that of CBT experts. Treatment gains were
maintained at follow-up, although a minority of patients
received additional treatment. |
|
Tests &
Measures: |
The
PTSD Symptom Scale-Interview
The PTSD Symptom Scale-Self
Report
Beck Depression Inventory
Social Adjustment Scale
Structured Clinical
Interview for DSM-IV Axis I Disorders |
|
Title: |
Advances in the Treatment of Posttraumatic Stress
Disorder: Cognitive-behavioral Perspectives. |
|
Author(s): |
Wetmore, Ann, Private Practice, Halifax, NS, Canada |
|
Source: |
Canadian Psychology, Vol 46(3), Aug 2005. pp. 172-173. |
|
Publisher: |
Canada:
Canadian Psychological Assn |
|
Reviewed
Item: |
Steven
Taylor (Ed.) (2004). Advances in the Treatment of
Posttraumatic Stress Disorder: Cognitive-behavioral
Perspectives; New York: Springer, 2004, 336 pages |
|
Abstract: |
Reviews
the book Advances in the Treatment of Posttraumatic
Stress Disorder: Cognitive-behavioral Perspectives,
edited by Steven Taylor (see record 2004-18734-000).
This collection of articles on posttraumatic stress
disorder (PTSD) intends to present reader-practitioners
with a stand-alone source of descriptions of the state
of the art in PTSD research and treatment. While this
edited volume covers many state of the art Cognitive
Behavior Therapy (CBT) approaches in Part I and Part II,
ranging from Exposure Therapy and Eye Movement
Desensitization Therapy (EMDR) to Cognitive
Restructuring and Social Support, its unique and
outstanding contribution is in Part III, which is
dedicated to "Special Populations" with PTSD,
specifically, Military Populations, those with
predominant Anger, Chronic Pain, Dissociation, and
Children and Adolescents. Overall, it is likely that
this volume will serve as a stimulus for further
research in treatment applications for PTSD,
particularly with "special populations," as it raises
many more questions than it answers, and presents many
avenues for future research in a variety of PTSD-related
areas. |
|
Title: |
Facilitation of Extinction of Conditioned Fear by
D-Cycloserine: Implications for Psychotherapy. |
|
Author(s): |
Davis,
Michael, Department of Psychology, Emory University,
Atlanta, GA, US, mdavis4@emory.edu
Myers, Karyn M., Department
of Psychiatry & Behavioral Sciences, Emory University,
Atlanta, GA, US
Ressler, Kerry J.,
Department of Psychiatry & Behavioral Sciences, Emory
University, Atlanta, GA, US
Rothbaum, Barbara O.,
Department of Psychiatry & Behavioral Sciences, Emory
University, Atlanta, GA, US |
|
Address: |
Davis,
Michael, Yerkes National Primate Research Center, Emory
University, 954 Gatewood Rd NE, Atlanta, GA, US,
mdavis4@emory.edu |
|
Source: |
Current
Directions in Psychological Science, Vol 14(4), Aug
2005. pp. 214-219. |
|
Publisher: |
United
Kingdom: Blackwell Publishing |
|
Abstract: |
Excessive fear and anxiety are characteristic of
disorders such as post-traumatic stress disorder (PTSD)
and phobias and are believed to reflect abnormalities in
neural systems governing the development and reduction
of conditioned fear. Conditioned fear can be suppressed
through a process known as extinction, in which repeated
exposure to a feared stimulus in the absence of an
aversive event leads to a gradual reduction in the fear
response to that stimulus. Like conditioned fear
learning, extinction is dependent on a particular
protein (the N-methyl-D-aspartate or NMDA receptor) in
apart of the brain called the amygdala. Blockade of this
receptor blocks extinction and improving the activity of
this receptor with a drug called D-cycloserine speeds up
extinction in rats. Because exposure-based psychotherapy
for fear disorders in humans resembles extinction in
several respects, we investigated whether D-cycloserine
might facilitate the loss of fear in human patients.
Consistent with findings from the animal laboratory,
patients receiving D-cycloserine benefited more from
exposure-based psychotherapy than did placebo-treated
controls. Although very preliminary, these data provide
initial support for the use of cognitive enhancers in
psychotherapy and demonstrate that preclinical studies
in rodents can have direct benefits to humans. |
|
Tests &
Measures: |
Clinical Global Improvement Scale |
|
Title: |
Alternatives to Debriefing and Modifications to
Cognitive Behavior Therapy for Posttraumatic Stress
Disorder. |
|
Author(s): |
Belaise, Carlotta, Laboratory of Experimental
Psychotherapy, Department of Psychology, University of
Bologna, Bologna, Italy
Fava, Giovanni A.,
Laboratory of Experimental Psychotherapy, Department of
Psychology, University of Bologna, Bologna, Italy,
giovanniandrea.fava@unibo.it
Marks, Isaac M., Department
of Psychiatry, Imperial College School of Medicine,
United Kingdom |
|
Address: |
Fava,
Giovanni A., Dipartimento di Psicologia, Universita di
Bologna, Viale Berti Pichat, 5, IT-40127, Bologna,
Italy, giovanniandrea.fava@unibo.it |
|
Source: |
Psychotherapy and Psychosomatics, Vol 74(4), Jun 2005.
pp. 212-217. |
|
Publisher: |
Switzerland: Karger |
|
Abstract: |
Background: Psychological debriefing uses brief
unsystematic exposure, and is ineffective for
posttraumatic stress symptoms and disorder. Systematic
exposure alone and cognitive restructuring alone are
each effective. Other approaches too may be useful.
Methods: The treatment of 3 posttraumatic stress
disorder (PTSD) patients is detailed in which there was
no exposure to the main traumatic event. There was
exposure to related cues in case 1, exposure to related
and other cues followed by well-being therapy (WBT) in
case 2 and WBT in case 3. Results: The 3 patients
improved enduringly, confirming earlier findings that
exposure to the main trauma is not essential for PTSD to
improve. Conclusions: A study is needed of therapeutic
mechanisms in PTSD and of the value of WBT in a
randomized controlled trial. |
|
Title: |
Differential Time Courses and Specificity of Amygdala
Activity in Posttraumatic Stress Disorder Subjects and
Normal Control Subjects. |
|
Author(s): |
Protopopescu, Xenia, Functional Neuroimaging Laboratory,
Weill Medical College, Cornell University, New York, NY,
US
Pan, Hong, Functional
Neuroimaging Laboratory, Weill Medical College, Cornell
University, New York, NY, US
Tuescher, Oliver, Functional
Neuroimaging Laboratory, Weill Medical College, Cornell
University, New York, NY, US
Cloitre, Marylene, New York
University School of Medicine, New York, NY, US
Goldstein, Martin,
Functional Neuroimaging Laboratory, Weill Medical
College, Cornell University, New York, NY, US
Engelien, Wolfgang,
Functional Neuroimaging Laboratory, Weill Medical
College, Cornell University, New York, NY, US
Epstein, Jane, Functional
Neuroimaging Laboratory, Weill Medical College, Cornell
University, New York, NY, US
Yang, Yihong, Functional
Neuroimaging Laboratory, Weill Medical College, Cornell
University, New York, NY, US
Gorman, Jack, Mount Sinai
School of Medicine, NY, US
LeDoux, Joseph, New York
University, New York, NY, US
Silbersweig, David,
Functional Neuroimaging Laboratory, Weill Medical
College, Cornell University, New York, NY, US
Stern, Emily, Functional
Neuroimaging Laboratory, Weill Medical College, Cornell
University, New York, NY, US, estern@med.cornell.edu |
|
Address: |
Stern,
Emily, Functional Neuroimaging Laboratory, Department of
Psychiatry, Weill Medical College, Cornell University,
Box 140, Room 1302, 1300 York Avenue, New York, NY, US,
estern@med.cornell.edu |
|
Source: |
Biological Psychiatry, Vol 57(5), Mar 2005. pp. 464-473. |
|
Publisher: |
Netherlands: Elsevier Science |
|
Abstract: |
Background: Previous neuroimaging studies have
demonstrated exaggerated amygdala responses to negative
stimuli in posttraumatic stress disorder (PTSD). The
time course of this amygdala response is largely
unstudied and is relevant to questions of habituation
and sensitization in PTSD exposure therapy. Methods: We
applied blood oxygen level dependent functional magnetic
resonance imaging and statistical parametric mapping to
study amygdala responses to trauma-related and
nontrauma-related emotional words in sexual/physical
abuse PTSD and normal control subjects. We examined the
time course of this response by separate analysis of
early and late epochs. Results: PTSD versus normal
control subjects have a relatively increased initial
amygdala response to trauma-related negative, but not
nontrauma-related negative, versus neutral stimuli.
Patients also fail to show the normal patterns of
sensitization and habituation to different categories of
negative stimuli. These findings correlate with measured
PTSD symptom seventy, Conclusions: Our results
demonstrate differential time courses and specificity of
amygdala response to emotional and control stimuli in
PTSD and normal control subjects. This has implications
for path ophysiologic models of PTSD and treatment
response. The results also extend previous neuroimaging
studies demonstrating relatively increased amygdala
response in PTSD and expand these results to a largely
female patient population probed with emotionally
valenced words. |
|
Tests &
Measures: |
State
Trait Anger Expression Inventory
PTSD Symptom Scale-Self
Report
Anxiety Sensitivity Index
Adult Non-Interpersonal
Violence scales
Clinician Administered PTSD
Scale
Sexual Assault and Adult
Interpersonal violence
Childhood Interpersonal
Violence Before Age 18
Dissociative Experiences
Scale
State Trait Anxiety
Inventory
Structured Clinical
Interview for DSM-IV Axis II Personality Disorders
Beck Depression Inventory
Structured Clinical
Interview for DSM-IV Axis I Disorders |
|
Title: |
Interoceptive Exposure Therapy Combined with
Trauma-related Exposure Therapy for Post-traumatic
Stress Disorder: A Case Report. |
|
Author(s): |
Wald,
Jaye, University of British Columbia, Vancouver, BC,
Canada, jwald@interchange.ubc.ca
Taylor, Steven, University
of British Columbia, Vancouver, BC, Canada |
|
Address: |
Wald,
Jaye, Department of Psychiatry, University of British
Columbia, 2255 Wesbrook Mall, Vancouver, BC, Canada, V6T
2A1, jwald@interchange.ubc.ca |
|
Source: |
Cognitive Behaviour Therapy, Vol 34(1), Mar 2005. pp.
34-40. |
|
Publisher: |
United
Kingdom: Taylor & Francis |
|
Abstract: |
Trauma-related exposure therapy is a useful but not
universally effective treatment for post-traumatic
stress disorder. Anxiety sensitivity may play an
important role in this disorder, as it does in panic
disorder. Studies have shown that interoceptive exposure
therapy reduces anxiety sensitivity in panic disorder.
The present case study was a preliminary investigation
of the merits of including interoceptive exposure
therapy in the treatment of post-traumatic stress
disorder, in order to improve treatment outcome for a
patient who had no history of panic disorder or panic
attacks. Interoceptive exposure therapy (4 sessions) was
one component of treatment, combined with trauma-related
exposure therapy (4 sessions of imaginal exposure
followed by 4 sessions of in vivo exposure). Treatment
outcome was assessed with the Clinician-Administered
Post-traumatic Stress Disorder Scale, a self-report
measure of post-traumatic stress disorder symptoms, and
measures of symptoms and cognitions commonly associated
with post-traumatic stress disorder. Scores on all
outcome measures decreased over the course of treatment,
with gains maintained at 1- and 3-month follow-up.
Symptoms of anxiety sensitivity and post-traumatic
stress disorder decreased during interoceptive exposure
therapy. The results indicate that interoceptive
exposure therapy is a promising adjunctive intervention
for post-traumatic stress disorder. Further research is
needed into the merits of combining interoceptive
exposure therapy and trauma-related exposure therapy as
a means of boosting treatment efficacy. |
|
Tests &
Measures: |
PTSD
Symptom Severity Scale
Anxiety Sensitivity Index
Beck Anxiety Index
State-Trait Anger Expression
Inventory - Trait Form
Post-traumatic Cognitions
Inventory
Reactions to Treatment
Questionnaire
Beck Depression Inventory
Clinician-Administered PTSD
Scale
Structured Clinical
Interview for DSM-IV Axis I Disorders |
|
Title: |
Traumaexposition in der
körpertherapeutisch-energetischen Psychotherapie. |
|
Translated Title: |
Trauma
exposure in body oriented, energetic psychotherapy. |
|
Author(s): |
Fuckert, Dorothea, Wilhelm-Reich-Institut für
Interdisziplinäre Therapie u. Beratung, Waldbrunn,
Germany, praxis@fuckert.de |
|
Address: |
Fuckert, Dorothea, Wilhelm-Reich-Institut fur
Interdisziplinare Therapie u. Beratung, Im Braunlesrot
20, 69429, Waldbrunn, Germany, praxis@fuckert.de |
|
Source: |
PTT:
Persönlichkeitsstörungen Theorie und Therapie, Vol 9(1),
Mar 2005. pp. 36-40. |
|
Publisher: |
Germany: Schattauer |
|
Abstract: |
Is
neurosis replaced by trauma-disorder? Does its alarm
effect mean a chance for change? Specifically disturbed
life energy functions in PTSD are described. Basics,
therapy goals, typical errors and advantage of body
oriented, energetic psychotherapy are discussed, as well
as the use of an individually adapted, multimodal
traumatherapy, and the evaluation of results, finally
followed by a case-description. |
|
Title: |
Acceptance and Mindfulness-Based Approaches to the
Treatment of Posttraumatic Stress Disorder. |
|
Series
Title: |
Series
in anxiety and related disorders |
|
Author(s): |
Batten,
Sonja V., VA Maryland Health Care System, Baltimore, MD,
US
Orsillo, Susan M., Suffolk
University, Boston, MA, US
Walser, Robyn D., VA Palo
Alto Health Care System, National Center for PTSD, Palo
Alto, CA, US |
|
Source: |
Acceptance and mindfulness-based approaches to anxiety:
Conceptualization and treatment. Orsillo, Susan M.
(Ed); Roemer, Lizabeth (Ed); pp. 241-269.
New York, NY, US: Springer
Science + Business Media, 2005. xvii, 375 pp.
|
|
Abstract: |
(from
the chapter) Posttraumatic stress disorder (PTSD) is the
only anxiety disorder for which a specific event is seen
as responsible for the etiology of the symptoms. Because
of its diagnostic categorization within the anxiety
disorders, most of the treatments developed for PTSD
have been based upon an understanding of posttraumatic
symptoms as they relate to problems with fear and
anxiety responses. Although this original
conceptualization of PTSD as an anxiety disorder has led
to several effective treatments (most notably exposure
therapy), it has recently been argued that PTSD can be
more thoroughly understood as a disorder of experiential
avoidance. We believe that acceptance-based behavioral
therapies that follow from this model of experiential
avoidance have the potential to add significantly to the
effectiveness and comprehensiveness of the current PTSD
treatment armamentarium. The integration of
acceptance-based approaches with traditional behavioral
methods may be an important next step in the treatment
of PTSD. Although preliminary findings are encouraging,
more systematic evaluation of the potential efficacy and
effectiveness of these approaches is clearly needed.
|
|
Title: |
Beyond
Exposure for Posttraumatic Stress Disorder (PTSD)
Symptoms: Broad-Spectrum PTSD Treatment Strategies. |
|
Author(s): |
Lombardo, Thomas W., University of Mississippi,
University, MS, US, pytwl@olemiss.edu
Gray, Matt J., Boston
Veterans Health Care System, US |
|
Address: |
Lombardo, Thomas W., Psychology Department, University
of Mississippi, P.O. Box 1848, University, MS, US,
pytwl@olemiss.edu |
|
Source: |
Behavior Modification, Vol 29(1), Jan 2005. Special
issue: Beyond Exposure for Posttraumatic Stress Disorder
Symptoms: Broad-Spectrum PTSD Treatment Strategies. pp.
3-9. |
|
Publisher: |
US:
Sage Publications |
|
Abstract: |
Although cases of posttraumatic stress disorder (PTSD)
with comorbid disorders are common, the first generation
of PTSD treatment approaches, including exposure and
cognitive-behavioral therapy, generally ignore symptoms
beyond those specific to PTSD. Optimum PTSD treatment
outcome requires more comprehensive strategies, and the
development and empirical testing of broader approaches
is the focus of the articles that follow in this special
issue. After providing some background on PTSD and PTSD
treatment, this paper gives an overview of these
treatment and prevention papers, which represent
second-generation strategies to help trauma-exposed
individuals. |
|
Title: |
Exposure Therapy for Substance Abusers with PTSD:
Translating Research to Practice. |
|
Author(s): |
Coffey,
Scott F., Department of Psychiatry and Human Behavior,
University of Missippi Medical Center, Jackson, MS, US,
scoffey@psychiatry.umsmed.edu
Schumacher, Julie A.,
Department of Psychiatry and Human Behavior, University
of Missippi Medical Center, Jackson, MS, US
Brimo, Marcella L., State
University of New York, Buffalo, NY, US
Brady, Kathleen T., General
Clinical Research Center, Medical University of South
Carolina, Charleston, SC, US |
|
Address: |
Coffey,
Scott F., Department of Psychiatry and Human Behavior,
University of Missippi Medical Center, Clinical Sciences
Building, 2500 North State Street, Jackson, MS, US,
scoffey@psychiatry.umsmed.edu |
|
Source: |
Behavior Modification, Vol 29(1), Jan 2005. Special
issue: Beyond Exposure for Posttraumatic Stress Disorder
Symptoms: Broad-Spectrum PTSD Treatment Strategies. pp.
10-38. |
|
Publisher: |
US:
Sage Publications |
|
Abstract: |
Epidemiological research indicates that there is
substantial cornorbidity between posttraumatic stress
disorder (PTSD) and substance use disorder (SUD).
Moreover, there is growing evidence that having a
comorbid PTSD diagnosis is associated with greater
substance use problem severity and poorer outcomes from
SUD treatment. In an attempt to improve the treatment
outcome for individuals with PTSD-SUD, recently
developed treatments combine exposure therapy for PTSD
with an empirically supported treatment for SUD. This
article describes one of the treatments and discusses
treatment modifications that have been incorporated when
translating this research-based therapy to practice in
an inner-city community mental health center. |
|
Title: |
Multicomponent Behavioral Treatment for Chronic
Combat-Related Posttraumatic Stress Disorder: Trauma
Management Therapy. |
|
Author(s): |
Turner,
Samuel M., University of Maryland, College Park, MD, US,
Turner@psyc.umd.edu
Beidel, Deborah C.,
University of Maryland, College Park, MD, US
Frueh, B. Christopher,
Division of Public Psychiatry and Behavioral Science,
Medical University of South Carolina, Charleston, SC, US |
|
Address: |
Turner,
Samuel M., Maryland Center for Anxiety Disorders,
Department of Psychology, University of Maryland,
College Park, MD, US, Turner@psyc.umd.edu |
|
Source: |
Behavior Modification, Vol 29(1), Jan 2005. Special
issue: Beyond Exposure for Posttraumatic Stress Disorder
Symptoms: Broad-Spectrum PTSD Treatment Strategies. pp.
39-69. |
|
Publisher: |
US:
Sage Publications |
|
Abstract: |
Posttraumatic stress disorder (PTSD) is a severe and
chronic menial disorder that is highly prevalent within
Veterans: Affairs (VA) Medical Centers. A severe
psychiatric disorder, combat-related PTSD is typically
accompanied by multiple comorbid psychiatric disorders,
symptom chronicity, and extreme social maladjustment.
Thus, PTSD is a complex psychiatric disorder resulting
in considerable emotional distress and impaired social
functioning and often constitutes a significant
treatment challenge. Although a range of
psychotherapeutic strategies for chronic PTSD have been
advanced, behavioral treatments emphasizing various
methods of exposure therapy have been the most carefully
studied and show the most promise. However, chronic PTSD
exposure alone does not appear to have a significant
effect on the negative symptoms of PTSD (e.g.,
avoidance, interpersonal difficulties) or anger control.
This may be because exposure is more focused on anxiety
and fear reduction and does not address basic skill
deficits, help reestablish impaired relationships, or
teach anger control. Therefore, we developed a
multicomponent treatment program to complement exposure
by targeting those areas of the clinical syndrome (e.g.,
social skills) not found to be helped by exposure alone.
This treatment program, trauma management therapy (TMT),
has showed good preliminary results in an open trial. In
this article, we describe the treatment program,
including elements of education, individually
administered exposure therapy, programmed practice
(i.e., homework), and group-administered social and
emotional skills training. The appendix includes a
detailed description of how to implement the social and
emotional skills training components on a
session-by-session basis; the full TMT treatment manual
is available on request. |
|
Tests &
Measures: |
Clinical Global Impressions Scale
Spielberger Anger Expression
Inventory
Social Phobia and Anxiety
Inventory
Beck Depression Inventory
Clinician-Administered PTSD
Scale
Hamilton Anxiety Rating
Scale |
|
Title: |
Multiple Channel Exposure Therapy: Combining
Cognitive-Behavioral Therapies for the Treatment of
Posttraumatic Stress Disorder with Panic Attacks. |
|
Author(s): |
Falsetti, Sherry A., Family Health Center, Department of
Family and Community Medicine, University of Illinois
College of Medicine, Rockford, IL, US
Resnick, Heidi S.,
Department of Psychiatry and Behavioral Sciences,
Medical University of South Carolina, Charleston, SC, US
Davis, Joanne, University of
Tulsa, Tulsa, OK, US |
|
Source: |
Behavior Modification, Vol 29(1), Jan 2005. Special
issue: Beyond Exposure for Posttraumatic Stress Disorder
Symptoms: Broad-Spectrum PTSD Treatment Strategies. pp.
70-94. |
|
Publisher: |
US:
Sage Publications |
|
Abstract: |
A large
proportion of patients who present for treatment of
posttraumatic stress disorder (PTSD) experience comorbid
panic attacks, yet it is unclear to what extent
currently available PTSD treatment programs address this
problem. Here we describe a newly developed treatment,
multiple-channel exposure therapy (M-CET), for comorbid
PTSD and panic attacks. The treatment utilizes elements
of cognitive processing therapy treatment for PTSD and
elements of panic control treatment to target
physiological, cognitive, and behavioral symptoms.
Preliminary results suggest that M-CET may provide a
promising treatment program for a subset of patients
with PTSD who experience panic attacks. In addition,
guidelines for conducting M-CET with clients who have
been exposed to diverse traumatic events are provided.
(PsycINFO Database Record (c) 2005 APA, all rights
reserved)(journal abstract) |
|
Title: |
On
'Converting' Hand Pain Into Psychological Pain: Treating
Hand Pain Vicariously Through Exposure-Based Therapy for
PTSD. |
|
Author(s): |
Ciano-Federoff, Lynda M., Indiana University of
Pennsylvania, Indiana, PA, US
Sperry, Jeannie A., Oasis
Occupational Rehabilitation, US |
|
Address: |
Ciano-Federoff, Lynda M., Department of Psychology,
Indiana University of Pennsylvania, Indiana, PA, US |
|
Source: |
Clinical Case Studies, Vol 4(1), Jan 2005. pp. 57-71. |
|
Publisher: |
US:
Sage Publications |
|
Abstract: |
A
36-year-old woman with a history of teenage trauma
presented to a pain clinic with unexplained hand pain
and numbness. The patient was ultimately diagnosed with
post-traumatic stress disorder with a conversion
reaction. Because the trauma was taken to be significant
in her symptomatology, she was referred for
exposure-based therapy. Although psychological distress
increased over treatment, her reported physical symptoms
and an objectively measured index of symptoms both
improved dramatically. Because many patients with
unconventional presentations are overutilizers of
medical resources, addressing the "cause" of the
distress (e.g., trauma) can be advantageous for both
patient and medical personnel. |
|
Tests &
Measures: |
Fear of
Pain Questionnaire-Ill
McGill Pain
Questionnaire-short form
West Haven-Yale
Multidimensional Pain Inventory
Pain Disability Index
Minnesota Multiphasic
Personality Inventory-2
Beck Depression Inventory |
|
Title: |
Implications for Psychological Intervention. |
|
Author(s): |
Brewin,
Chris R., Sub-Department of Clinical Health Psychology,
University College London, London, United Kingdom |
|
Source: |
Neuropsychology of PTSD: Biological, cognitive, and
clinical perspectives. Vasterling, Jennifer J.
(Ed); Brewin, Chris R. (Ed); pp. 271-291.
New York, NY, US: Guilford
Press, 2005. xiv, 337 pp. |
|
Abstract: |
(from
the create) Posttraumatic stress disorder (PTSD) is a
complex disorder involving a variety of quite distinct
biological and psychological disturbances.
Psychologically, changes can be observed in attention,
memory, behavior, emotion, conscious appraisals, and
sense of identity. It is important to note that it is
not a disorder characterized exclusively, or even
mainly, by fear. Models of PTSD based on the study of
fear in animals, while of great interest, are unlikely
on their own to provide a sufficiently comprehensive
account of the disorder. Two separate processes are
involved in recovery from traumatic experiences (Brewin,
2003). One is bringing under control the vivid
reexperiencing of the trauma through flashbacks and
nightmares, a reaction that seems to be mainly reported
in the context of extreme fear, helplessness, or horror.
The second is the conscious reappraisal of the event and
its impact. Corresponding to these two processes are
contrasting types of therapy for PTSD. One type, which
includes prolonged exposure, focuses primarily on the
relief of flashbacks and nightmares whereas the other
type, which includes cognitive therapy, places greater
emphasis on issues of belief, interpretation, and
identity. This chapter examines the implications of
neuropsychological and cognitive research on PTSD for
understanding posttrauma reactions and the psychological
treatment of PTSD. |
|
Title: |
Bringing home the psychological immediacy of the Iraqi
battlefield. |
|
Author(s): |
Nathan,
Peter E., Department of Psychology, University of Iowa,
Iowa City, IA, US, peter-nathan@uiowa.edu |
|
Address: |
Nathan,
Peter E., Department of Psychology, College of Liberal
Arts and Sciences, University of Iowa, E119 Seashore
Hall, Iowa City, IA, US, peter-nathan@uiowa.edu |
|
Source: |
Pragmatic Case Studies in Psychotherapy, Vol 1(2), 2005.
pp. 1-3. |
|
Publisher: |
US:
Rutgers University Libraries |
|
Abstract: |
The
case report by J. A. Cigrang et al (see record
2006-04748-001) serves two functions. It describes
serious combat-induced psychopathology in a sample of
three veterans of the Iraq war, and it tests the
efficacy of a method for preventing chronic PTSD that
might be more efficient than current methods. Thus,
exposure therapy in these three cases appears to have
alleviated the intense early symptoms of PTSD, perhaps
thereby heading off a chronic debilitating condition.
While the Cigrang et al report does not constitute a
definitive demonstration of the efficacy of exposure to
abort chronic PTSD, it does convey with great immediacy
the Iraq battlefield context as well as the demanding
decisions front-line mental health professionals must
make about combat-induced psychopathology. Of course,
additional research is needed to establish the efficacy
and effectiveness of this approach to psychopathology
generated by battlefield conditions. |
|
Title: |
The
scientist-practitioner on the front line: Development
and formalization of evidenced-based interventions on
the battlefield. |
|
Author(s): |
Peterson, Alan L., Wilford Hall Medical Center, San
Antonio, TX, US, alan.peterson@lackland.af.mil
Cigrang, Jeffrey A.,
Wright-Patterson Medical Center, Dayton, OH, US
Schobitz, Richard P.,
Tripler Army Medical Center, Honolulu, HI, US |
|
Address: |
Peterson, Alan L., Department of Psychology, Wilford
Hall Medical Center, 2200 Bergquist Drive, Suite 1, San
Antonio, TX, US, alan.peterson@lackland.af.mil |
|
Source: |
Pragmatic Case Studies in Psychotherapy, Vol 1(2), 2005.
pp. 1-5. |
|
Publisher: |
US:
Rutgers University Libraries |
|
Abstract: |
P. E.
Nathan (see record 2006-04748-002) and M. R. Petronko
(see record 2006-04748-003) provide excellent
commentaries on our three case studies (J. A. Cigrang,
et al, see record 2006-04748-001) describing the use of
prolonged imaginal exposure for the secondary prevention
of Post-Traumatic Stress Disorder (PTSD). In this
response, we note that future research should build upon
the lessons and experiences of these cases and include
larger sample sizes, additional measures (anxiety,
depression, grief, quality of life, subjective units of
distress ratings), the development of a flexible
treatment manual, and formal measures of Acute Stress
Disorder (ASD). Future research should also target
process measures such as patient acceptability of the
treatment and willingness to engage in the exposure
sessions. Deployed military psychologists, in
collaboration with civilian researchers, have the
potential to further advance the scientific knowledge
base on the assessment and treatment of combat-stress
disorders through the use of innovative case studies.
The potential importance of research and formalized
treatments for individuals exposed to the significant
psychological trauma related to terrorist attacks and
bombings is highlighted. |
|
Title: |
Three
american troops in Iraq: Evaluation of a brief exposure
therapy treatment for the secondary prevention of
combat-related PTSD. |
|
Author(s): |
Cigrang, Jeffrey A., Wright-Patterson Medical Center,
Dayton, OH, US, jeff.cigrang@wpafb.af.mil
Peterson, Alan L., Wilford
Hall Medical Center, San Antonio, TX, US
Schobitz, Richard P.,
Tripler Army Medical Center, Honolulu, HI, US |
|
Address: |
Cigrang, Jeffrey A., 88th Medical Operations
Squadron/SGOH, 4881 Sugar Maple Drive, Wright-Patterson
Air Force Base, OH, US, jeff.cigrang@wpafb.af.mil |
|
Source: |
Pragmatic Case Studies in Psychotherapy, Vol 1(2), 2005.
pp. 1-25. |
|
Publisher: |
US:
Rutgers University Libraries |
|
Abstract: |
Relatively little research has been devoted to
developing empirically-supported interventions for the
secondary prevention of chronic post-traumatic stress
disorder (i.e., for individuals who have developed PTSD
symptoms but not the full PTSD disorder). One-session
psychological debriefing has been routinely used as a
primary preventive intervention for individuals exposed
to trauma, but the appropriateness of this practice has
been questioned. The authors describe an alternative,
secondary prevention model of brief exposure-based
treatment using three cases of military members seeking
help at a forward-deployed medical clinic in Iraq for
PTSD symptoms following combat-related traumas.
Treatment involved repeated imaginal exposure and in
vivo exposure conducted in four therapy sessions over a
five-week period. Baseline measures on the PTSD
Checklist were at a level that is considered to be in
the range of PTSD. The results indicated that after four
treatment sessions, PTSD symptoms were reduced by an
average of 56%, and the final PTSD Checklist scores were
within normal limits. The results suggest that prolonged
exposure therapy may be a rapid individual treatment for
the secondary prevention of combat-related PTSD. |
|
Title: |
Towards
formalizing a very promising treatment. |
|
Author(s): |
Petronko, Michael R., PTSD Clinic, Rutgers-State
University of New Jersey, Piscataway, NJ, US,
mpetronk@rci.rutgers.edu |
|
Address: |
Petronko, Michael R., PTSD Clinic, Rutgers University,
Graduate School of Applied and Professional Psychology,
797 Hoes Lane West, Piscataway, NJ, US,
mpetronk@rci.rutgers.edu |
|
Source: |
Pragmatic Case Studies in Psychotherapy, Vol 1(2), 2005.
pp. 1-6. |
|
Publisher: |
US:
Rutgers University Libraries |
|
Abstract: |
J. A.
Cigrang et al (see record 2006-04748-001) present three
case studies of a cognitive-behaviorally based approach
to treat early symptoms of PTSD in American soldiers
fighting in Iraq. Their clinical model is very promising
in its capacity not only to address the needs of these
soldiers in the combat theater, but also to proactively
mitigate more pernicious symptom development subsequent
to their return home. As one direction for extending
their work, I suggest that they consider further
formalizing and standardizing it so as to (a) facilitate
groupbased research using a model that complements the
case studies; (b) enhance its use in training; and (c)
increase its capacity for dissemination. I further
discuss the role of case studies in developing
manualized therapy, together with the issue of degree of
structure in manualization. |
|
Title: |
Tell Me
Your Story: A Brief Exposure Treatment for Civilian War
Victims. |
|
Author(s): |
Brown,
Seth A.
Collins, Amanda L. |
|
Source: |
PsycCRITIQUES, Vol 50 (24), 2005. pp. No Pagination
Specified. |
|
Publisher: |
US:
American Psychological Assn |
|
Reviewed
Item: |
Maggie
Schauer, Frank Neuner, and Thomas Elbert (2005).
Narrative Exposure Therapy: A Short-Term Intervention
for Traumatic Stress Disorders After War, Terror, or
Torture; Cambridge, MA: Hogrefe & Huber, 2005. 80 pp. |
|
Abstract: |
This
article reviews Narrative Exposure Therapy: A Short-Term
Intervention for Traumatic Stress Disorders After War,
Terror, or Torture, by Maggie Schauer, Frank Neuner, and
Thomas Elbert (see record 2005-02626-000). This book
aims to provide one option for clinicians working in
war-torn countries in need of brief and easily
implemented therapeutic interventions for posttraumatic
stress disorder (PTSD). In narrative exposure therapy
(NET), the therapist and patient collaboratively develop
a chronological narrative of the patient's life starting
from birth with an emphasis on traumatic periods.
Developing and continually revising an autobiographical
narrative allows the patient to speak about and
reexperience his or her buried traumatic experiences in
a safe environment, which allows for a modification of
his or her fear network, resulting in decreased
symptoms. NET, being a newly developed treatment, has
limited empirical support at this time. An additional
concern is whether the narrative component of NET has
incremental treatment value beyond the exposure
component. This book makes a notable contribution toward
fulfilling the treatment void for civilian war victims.
|
|
Title: |
Associative Functional Analysis Model of Posttraumatic
Stress Disorder. |
|
Author(s): |
Paunovic, Nenad, Department of Psychology, Stockholm
University, Stockholm, Sweden |
|
Source: |
Trends
in posttraumatic stress disorder research. Corales,
Thomas A. (Ed); pp. 45-66.
Hauppauge, NY, US: Nova
Science Publishers, Inc, 2005. xii, 291 pp. |
|
Abstract: |
(from
the chapter) A revised associative functional analysis (AFA)
model of posttraumatic stress disorder (PTSD) is
outlined. In terms of the AFA model currently elicited
respondent mechanisms, and dysfunctional cognitive and
behavioral responses reciprocally influence each other,
and interact with a representational memory network of
corresponding factors in determining the development and
maintenance of PTSD. The present AFA model combines
cognitive, behavioral and network models into a unified
framework. In the present AFA model a special emphasis
is put on the influence of pleasurable and mastery
respondent learning mechanisms incompatible to the
respondent trauma-related learning. It is proposed that
in order to achieve recovery the former should be
elicited in the context of fully elicited trauma-related
respondent mechanisms. Prolonged exposure
counterconditioning (PEC), a new treatment for PTSD,
aims at reinforcing an individuals incompatible
respondent learning mechanisms and utilizing them in
order to counter the numbing symptoms, increase the
trauma exposure tolerance and weaken respondently
learned trauma-related emotions. Important theoretical
and methodological issues related to the PEC treatment
are reviewed. In the discussion section additional
issues related to the present AFA model and the PEC
treatment for PTSD are outlined. |
|
Title: |
Posttraumatic Stress Disorder. |
|
Author(s): |
Wiederhold, Brenda K., Virtual Reality Medical Center,
CA, US
Wiederhold, Mark D., Virtual
Reality Medical Center, CA, US |
|
Source: |
Virtual
reality therapy for anxiety disorders: Advances in
evaluation and treatment. Wiederhold, Brenda
K.; Wiederhold, Mark D.; pp. 117-124.
Washington, DC, US: American
Psychological Association, 2005. viii, 225 pp. |
|
Abstract: |
(from
the chapter) Posttraumatic stress disorder (PTSD) is a
heterogeneous disorder that may occur following a
traumatic event such as serious injury or threat of
injury or death to self or others. Symptoms can include
increased anxiety or arousal, dissociation, and
flashbacks of the event. Duration of these symptoms must
be at least once a month (American Psychiatric
Association, 2000). Anxiety-reducing medications,
antidepressants, support from friends and family, and
cognitive-behavioral therapy (CBT; with some exposure
involved) can help with recovery (Barlow, 1988). In
treating those with PTSD following a motor vehicle
accident, it is important to carefully assess whether
the person is experiencing "accident phobia," which
would be a specific phobia, or PTSD. Reports of treating
accident phobias can be found as far back as 1962
(Wolpe) and have traditionally included some sort of
exposure therapy. In the treatment of PTSD, exposure
also seems to be included in most all treatment
regimens. In fact, a panel of experts recently published
a consensus opinion that exposure therapy is the most
appropriate therapy for PTSD; the possibility of
"retraumatizing" the individual was not considered cause
for concern (Ballenger et al., 2001). Topics discussed
in this chapter include the prevalence of and risk
factors for PTSD; PTSD in Vietnam Veterans; PTSD in
motor vehicle accident survivors; and virtual reality
applications for these and other types of PTSD.
|
|
Title: |
Fear of
Driving. |
|
Author(s): |
Wiederhold, Brenda K., Virtual Reality Medical Center,
CA, US
Wiederhold, Mark D., Virtual
Reality Medical Center, CA, US |
|
Source: |
Virtual
reality therapy for anxiety disorders: Advances in
evaluation and treatment. Wiederhold, Brenda
K.; Wiederhold, Mark D.; pp. 147-155.
Washington, DC, US: American
Psychological Association, 2005. viii, 225 pp. |
|
Abstract: |
(from
the chapter) Virtual driving systems have three main
clinical applications in psychotherapy: (a) the
treatment of posttraumatic stress disorder (PTSD)
associated with individuals recovering from motor
vehicle accidents who require, as part of treatment,
exposure to driving scenarios; (b) the treatment of
specific driving phobias; and (c) as part of a general
treatment for agoraphobia, one manifestation of which is
the inability to drive long distances from home. In the
privacy of the therapist's office, driving exposure is
achieved systematically and safely for both the patient
and therapist. Tasks of increasing difficulty can be
assigned to the patient, and the patient's reactions can
be measured and observed. Another clinical application
in the health psychology field is to provide treatment
for individuals who have had a traumatic brain injury,
stroke, or other physical trauma who need to relearn
driving skills. Nonclinical applications are various and
include training new drivers and assessing and
retraining older drivers; this approach could also be
used as a disciplinary treatment for drivers charged
with road rage infractions. The research on clinical
applications of virtual reality (VR) for the treatment
of accident-related PTSD, specific driving phobias, and
agoraphobia is not as well developed as research on many
other specific phobias, but some studies indicate that
virtual reality graded exposure therapy (VRGET) can be a
successful therapeutic option. The importance of these
studies derives from the observation that the
physiological responses at work in driving anxiety are
similar to those in other phobias that respond
positively to VRGET. The breadth of these studies
provides a sense of the potential for this application
of VR treatment. |
|
Title: |
Claustrophobia. |
|
Author(s): |
Wiederhold, Brenda K., Virtual Reality Medical Center,
CA, US
Wiederhold, Mark D., Virtual
Reality Medical Center, CA, US |
|
Source: |
Virtual
reality therapy for anxiety disorders: Advances in
evaluation and treatment. Wiederhold, Brenda
K.; Wiederhold, Mark D.; pp. 165-171.
Washington, DC, US: American
Psychological Association, 2005. viii, 225 pp. |
|
Abstract: |
(from
the chapter) Whereas agoraphobia is usually associated
with the fear of being trapped alone in an open space,
claustrophobia is the fear of being trapped in an
enclosed place. There is often a strong association
between the two phobias; many of those who are fearful
of large, open spaces also seem frightened of small,
enclosed spaces. One hypothesis posits that both phobias
are vestiges of primitive fears--the danger of being
attacked was great while in either a large, unsheltered
place or in a small, enclosed space. About 10% of the
population have a mild to marked form of claustrophobia,
and about 2% have severe claustrophobia. In about 33% of
individuals with claustrophobia, the fear begins in
childhood; more women appear to experience this disorder
than men (Rachman, 1978). Claustrophobia can be a
concomitant of agoraphobia, aviophobia, or posttraumatic
stress disorder (PTSD). One of the most common
manifestations of claustrophobia is a refusal to ride in
an enclosed elevator. Other common precipitators of
claustrophobia include closets, tunnels, airplanes, and
certain medical testing machinery and procedures, such
as magnetic resonance imaging, hyperbaric oxygen
treatment, and computed tomography (CT) scan (Beck,
Emery, & Greenberg, 1985; Botella, Quero, et al., 1998).
This chapter explores the use of virtual reality therapy
in claustrophobia studies, particularly virtual reality
graded exposure therapy. |
|
Title: |
Interview with Albert ('Skip') Rizzo. |
|
Author(s): |
Thies,
Yvonne, International University Bremen, Bremen,
Germany, y.thies@iu-bremen.de |
|
Source: |
Zeitschrift für Medienpsychologie, Vol 17(4), 2005. pp.
168-170. |
|
Publisher: |
Germany: Hogrefe & Huber |
|
Abstract: |
Presents an interview with Albert Rizzo on Virtual
Reality. Albert "Skip" Rizzo is a clinical psychologist
and professor at the University of Southern California's
Integrated Media Systems Center and School of
Gerontology. His current clinical and research interests
involve neuropsychological assessment, cognitive
rehabilitation, and the use of advanced computer
interface technology (i. e., Virtual Reality) for mental
health treatment. Here he conducts research on the
design, development and evaluation of virtual reality
systems targeting the assessment and
training/rehabilitation of spatial abilities, attention,
memory, executive function and motor abilities. His
research also includes virtual reality applications that
use 360° panoramic video for exposure therapy and he is
developing a graphics-based VR environment for treating
PTSD in returning military personnel from the Iraq War.
|
|
Title: |
Narrative exposure therapy: A short-term intervention
for traumatic stress disorders after war, terror, or
torture. |
|
Author(s): |
Schauer, Maggie
Neuner, Frank
Elbert, Thomas |
|
Source: |
Ashland, OH, US: Hogrefe & Huber Publishers, 2005. viii,
68 pp. |
|
Abstract: |
(from
the jacket) This book is the first practical manual
describing a new and successful short-term treatment for
traumatic stress and PTSD called Narrative Exposure
Therapy (NET). The manual provides both experienced
clinicians and trainees with all the knowledge and
skills needed to treat trauma survivors using this
approach, which is especially useful in crisis regions
where longer- term interventions are not possible. NET
has been field tested in postwar societies such as
Kosovo, Sri Lanka, Uganda, and Somalia. Its
effectiveness was demonstrated in controlled trials in
Uganda and Germany. Single case studies have also been
reported for adults and children. Three to six sessions
can be sufficient to afford considerable relief. Part I
of this manual describes the theoretical background.
Part II covers the therapeutic approach in detail, with
practical advice and tools. Part III then focuses on
special issues such as dealing with challenging moments
during therapy, defense mechanisms for the therapist,
and ethical issues. |
Record: 47
|
Title: |
Imagery
vividness and perceived anxious arousal in prolonged
exposure treatment for PTSD. |
|
Author(s): |
Rauch,
Sheila A. M., University of Pennsylvania, Department of
Psychiatry, Center for the Treatment and Study of
Anxiety, Philadelphia, PA, US,
srauch@mail.med.upenn.edu.
Foa, Edna B., University of
Pennsylvania, Department of Psychiatry, Center for the
Treatment and Study of Anxiety, Philadelphia, PA, US
Furr, Jami M., Temple
University, Department of Psychology, Philadelphia, PA,
US
Filip, Jennifer C.,
University of Pennsylvania, Department of Psychiatry,
Center for the Treatment and Study of Anxiety,
Philadelphia, PA, US |
|
Address: |
Rauch,
Sheila A. M., Center for the Treatment and Study of
Anxiety, University of Pennsylvania, 3535 Market Street,
Suite 600N, Philadelphia, PA, US,
srauch@mail.med.upenn.edu. |
|
Source: |
Journal
of Traumatic Stress, Vol 17(6), Dec 2004. pp. 461-465.
Journal URL:
http://www.wkap.nl/journalhome.htm/0894-9867 |
|
Publisher: |
US:
John Wiley & Sons
Publisher URL:
http://www.wiley.com/WileyCDA/ |
|
ISSN: |
0894-9867 (Print)
1573-6598 (Electronic) |
|
Digital
Object Identifier: |
10.1007/s10960-004-5794-8 |
|
Language: |
English |
|
Keywords: |
imagery
vividness; prolonged exposure treatment; perceived
anxious arousal; subjective distress; female survivors;
chronic PTSD; sexual assault; nonsexual assault;
cognitive restructuring |
|
Abstract: |
The
present paper examines imagery vividness and anxiety
during Prolonged Exposure (PE) for chronic PTSD among 69
female survivors of sexual or nonsexual assault. All
participants received between 9 and 12 individual
sessions of either PE alone or in combination with
cognitive restructuring. As hypothesized, vividness and
anxiety ratings from early imaginal exposure sessions
were moderately to highly correlated, but these
correlations decreased in later sessions. Both
subjective distress and vividness decreased
significantly with exposure. Greater reductions in
subjective distress between the first and last exposure
session were related to better outcome. However,
contrary to hypothesis, vividness was not related to
outcome. Theoretical implications of the results are
discussed. (PsycINFO Database Record (c) 2005 APA, all
rights reserved)(journal abstract) |
|
Tests &
Measures: |
PTSD
Symptom Scale - Interview (PSS-I)
Subjective Units of Distress
Ratings |
Record: 48
|
Title: |
Bridging the Gap Between Posttraumatic Stress Disorder
Research and Clinical Practice: The Example of Exposure
Therapy. |
|
Author(s): |
Cook,
Joan M., Department of Psychiatry, University of
Pennsylvania, Philadelphia, PA, US,
cook_j@mail.trc.upenn.edu
Schnurr, Paula P., Executive
Division, VA National Center for PTSD, White River
Junction, VT, US
Foa, Edna B., Department of
Psychiatry, University of Pennsylvania, Philadelphia,
PA, US |
|
Address: |
Cook,
Joan M., University of Pennsylvania, Treatment Research
Center, 3900 Chestnut Street, Philadelphia, PA, US,
cook_j@mail.trc.upenn.edu |
|
Source: |
Psychotherapy: Theory, Research, Practice, Training, Vol
41(4), Win 2004. Special issue: The Psychological Impact
of Trauma: Theory, Research, Assessment, and
Intervention. pp. 374-387. |
|
Publisher: |
US:
Educational Publishing Foundation
Publisher URL:
http://www.apa.org |
|
ISSN: |
0033-3204 (Print) |
|
Digital
Object Identifier: |
10.1037/0033-3204.41.4.374 |
|
Language: |
English |
|
Keywords: |
exposure therapy; posttraumatic stress disorder;
research; clinical practice; empirically supported
psychosocial treatments |
|
Abstract: |
There
are notable challenges in translating empirically
supported psychosocial treatments (ESTs) into general
routine clinical practice. However, there may be
additional unique dissemination and implementation
obstacles for ESTs for trauma-related disorders. For
example, despite considerable evidence from randomized
clinical trials that attests to the efficacy of exposure
therapy for posttraumatic stress disorder, front-line
clinicians in real-world settings rarely use this
treatment. Perceived and actual barriers that interfere
with adoption include clinician misconceptions about
what exposure entails and complex cases to which ESTs
may not be readily applicable. Specific suggestions for
bridging the science-into-service gap in trauma ESTs (in
general) and in exposure therapy (in particular) are
proposed. (PsycINFO Database Record (c) 2005 APA, all
rights reserved)(journal abstract) |
Record: 49
|
Title: |
The
experience of mental death: The core feature of complex
posttraumatic stress disorder. |
|
Author(s): |
Ebert,
Angela, School of Psychology, Curtin University of
Technology, Perth, WAU, Australia,
a.ebert@exchange.curtin.edu.au
Dyck, Murray J., School of
Psychology, Curtin University of Technology, Perth, WAU,
Australia |
|
Address: |
Ebert,
Angela, School of Psychology, Curtin University of
Technology, GPO Box U1987, Perth, WAU, Australia, 6845,
a.ebert@exchange.curtin.edu.au |
|
Source: |
Clinical Psychology Review, Vol 24(6), Oct 2004. pp.
617-635.
Journal URL:
http://www.elsevier.com/wps/find/journaldescription.cws_home/652/description#description |
|
Publisher: |
Netherlands: Elsevier Science
Publisher URL:
http://elsevier.com |
|
ISSN: |
0272-7358 (Print) |
|
Digital
Object Identifier: |
10.1016/j.cpr.2004.06.002 |
|
Language: |
English |
|
Keywords: |
mental
death; posttraumatic stress disorder; interpersonal
stress; torture; cognitive mechanisms |
|
Abstract: |
Exposure to extreme interpersonal stress, exemplified by
the experience of torture, represents a threat to the
psychological integrity of the victim. The experience is
likely to result in mental death, in the loss of the
victim's pretrauma identity. Mental death is
characterized by loss of core beliefs and values,
distrust, and alienation from others, shame and guilt,
and a sense of being permanently damaged. Mental death
is a primary feature of a distinct posttrauma syndrome,
complex posttraumatic stress disorder (PTSD), which is
refractory to standard exposure therapies. We identify
cognitive mechanisms that mediate the symptoms of
complex PTSD, and suggest how current treatments need to
be modified to obtain enhanced treatment outcomes.
(PsycINFO Database Record (c) 2005 APA, all rights
reserved)(journal abstract) |
Record: 50
|
Title: |
Hjelper
terapi for traumatiserte mennesker? |
|
Translated Title: |
Does
trauma therapy help? |
|
Author(s): |
Dyregrov, Atle, Senter for Krisepsykologi, Bergen,
Norway, atle@uib.no |
|
Address: |
Dyregrov, Atle, Senter for Krisepsykologi, Fabrikkgt. 5,
5059, Bergen, Norway, atle@uib.no |
|
Source: |
Tidsskrift for Norsk Psykologforening, Vol 41(10), Oct
2004. pp. 787-793. |
|
Publisher: |
Norway:
Norsk Psykologforening
Publisher URL:
http://www.psykol.no/ |
|
ISSN: |
0332-6470 (Print) |
|
Language: |
Norwegian |
|
Keywords: |
trauma
therapy; therapeutic interventions; posttraumatic stress
disorder; psychological consequences; physical
consequences |
|
Abstract: |
This
article describes the psychological and physical
consequences of trauma. It then reviews different
therapeutic interventions for Posttraumatic Stress
Disorder (PTSD). Methods based on behavioural and
cognitive strategies seem most effective in the
treatment of trauma. Studies have shown that a large
majority of persons with an existing PTSD diagnosis do
not have PTSD after termination of treatment.
Furthermore, positive treatment outcome is clearly
demonstrated long after treatment closure. Effective
methods of treatment include exposure therapy, cognitive
therapy, Eye Movement Desensitisation and Reprocessing
(EMDR), and cognitive behavioural therapy. New treatment
methods will no doubt broaden the number of ways in
which PTSD may be treated, allowing for programmes
better suited to the needs of each particular patient.
(PsycINFO Database Record (c) 2006 APA, all rights
reserved)(journal abstract) |
|
Title: |
A
Comparison of Narrative Exposure Therapy, Supportive
Counseling, and Psychoeducation for Treating
Posttraumatic Stress Disorder in an African Refugee
Settlement. |
|
Author(s): |
Neuner,
Frank, Department of Clinical Psychology, University of
Konstanz, Konstanz, Germany,
frank.neuner@uni-konstanz.de
Schauer, Margarete,
Department of Clinical Psychology, University of
Konstanz, Konstanz, Germany
Klaschik, Christine,
Department of Clinical Psychology, University of
Konstanz, Konstanz, Germany
Karunakara, Unni, Johns
Hopkins University School of Public Health and Vivo,
Baltimore, MD, US
Elbert, Thomas, Department
of Clinical Psychology, University of Konstanz,
Konstanz, Germany |
|
Address: |
Neuner,
Frank, Department of Clinical Psychology, University of
Konstanz, D-78457, Konstanz, Germany,
frank.neuner@uni-konstanz.de |
|
Source: |
Journal
of Consulting and Clinical Psychology, Vol 72(4), Aug
2004. pp. 579-587.
Journal URL:
http://www.apa.org/journals/ccp.html |
|
Publisher: |
US:
American Psychological Assn
Publisher URL:
http://www.apa.org |
|
ISSN: |
0022-006X (Print) |
|
Digital
Object Identifier: |
10.1037/0022-006X.72.4.579 |
|
Language: |
English |
|
Keywords: |
narrative exposure therapy; supportive counseling;
psychoeducation; posttraumatic stress disorder; African
refugee settlement; emotional trauma; refugees |
|
Abstract: |
Little
is known about the usefulness of psychotherapeutic
approaches for traumatized refugees who continue to live
in dangerous conditions. Narrative exposure therapy
(NET) is a short-term approach based on
cognitive-behavioral therapy and testimony therapy. The
efficacy of narrative exposure therapy was evaluated in
a randomized controlled trial. Sudanese refugees living
in a Ugandan refugee settlement (N = 43) who were
diagnosed as suffering from posttraumatic stress
disorder (PTSD) either received 4 sessions of NET, 4
sessions of supportive counseling (SC), or
psychoeducation (PE) completed in 1 session. One year
after treatment, only 29% of the NET participants but
79% of the SC group and 80% of the PE group still
fulfilled PTSD criteria. These results indicate that NET
is a promising approach for the treatment of PTSD for
refugees living in unsafe conditions. (PsycINFO Database
Record (c) 2005 APA, all rights reserved)(journal
abstract) |
|
Tests &
Measures: |
Composite International Diagnostic Interview
Demography of Forced
Migration Questionnaire |
|
Title: |
Brief
Exposure Therapy for the Relief of Posttraumatic Stress
Disorder: A Single Case Experimental Design. |
|
Author(s): |
Sharp,
John, University of Glasgow, Glasgow, Scotland
Espie, Colin A., University
of Glasgow, Glasgow, Scotland,
c.espie@clinmed.gla.ac.uk |
|
Address: |
Espie,
Colin A., Psychological Medicine, Division of Community
Based Sciences, University of Glasgow, Gartnavel Royal
Hospital, 1055 Great Western Road, Glasgow, Scotland,
G12 0XH,
c.espie@clinmed.gla.ac.uk |
|
Source: |
Behavioural and Cognitive Psychotherapy, Vol 32(3), Jul
2004. pp. 365-369. |
|
Publisher: |
US:
Cambridge Univ Press |
|
Abstract: |
The
present study tested the effectiveness of Vaughan and
Tarrier's (1992) Image Habituation Training (IHT) in the
treatment of posttraumatic stress disorder (PTSD) using
a single case experimental design. The intervention was
a brief exposure treatment involving one therapist-led
training session and 12 self-directed homework sessions.
Assessment measures were taken at pre-treatment,
post-treatment, and 3-month follow-up. Decreases
demonstrated in direct standardized measures of PTSD,
anxiety, and depression were consistent with previous
research. The mechanisms underlying the treatment effect
were also investigated. Measures of image intensity,
image-related anxiety, and belief in a dysfunctional
cognition were taken at session-start, mid-session, and
session-end. Decreases in between and within homework
sessions using these three measures suggested that the
processes responsible for change are complex and
interactive. The findings from this study demonstrate
the effectiveness of IHT as a brief exposure therapy for
PTSD and highlight the need for further research aimed
at eliciting the mechanisms of change. |
|
Tests &
Measures: |
PTSD
Diagnostic Scale
Revised Impact of Events
Scale
Beck Anxiety Inventory
Beck Depression Inventory |
|
Title: |
The
Nakivale Camp Mental Health Project: Building local
competency for psychological assistance to traumatised
refugees. |
|
Author(s): |
Onyut,
Lamaro P., Vivo, Mbarara, Uganda,
Patience.Onyut@vivo.org
Neuner, Frank, Vivo,
Mbarara, Uganda
Schauer, Elisabeth, Vivo,
Mbarara, Uganda
Ertl, Verena, University of
Konstanz, Germany
Odenwald, Michael, Vivo,
Mbarara, Uganda
Schauer, Maggie, Vivo,
Mbarara, Uganda
Elbert, Thomas, Vivo,
Mbarara, Uganda |
|
Address: |
Onyut,
Lamaro P.,
Patience.Onyut@vivo.org |
|
Source: |
Intervention: International Journal of Mental Health,
Psychosocial Work & Counselling in Areas of Armed
Conflict, Vol 2(2), Jun 2004. pp. 90-107. |
|
Publisher: |
Netherlands: War Trauma Foundation |
|
Abstract: |
Little
is known about the usefulness of psychiatric concepts
and psychotherapeutic approaches for refugees who have
experienced severe traumatic events and continue to live
in stressful and potentially dangerous conditions in
refugee settlements. The central goal of the Nakivale
Camp Mental Health Project is to establish the
usefulness of short-term treatment approaches when
applied by local paramedical personnel in a disaster
region. In a randomized controlled clinical trial, the
efficacy of Narrative Exposure Therapy (NET) vis-à-vis
Supportive Counselling has been tested, when applied by
trained paramedical personnel from within the same
refugee community. Here we demonstrate the feasibility
of such an approach and detail the methods and strategy
for it. The project also included an epidemiological
survey to ascertain the prevalence of PTSD among refugee
adolescents and adults alike. Consistent with other
investigations, the demographic survey revealed a high
prevalence of chronic PTSD ranging from 31.1% in the
Rwandan to 47% in the Somali population; even though
traumatic events had on average taken place more than 9
and 11 years earlier in each case respectively.
Diagnostic validity was assured using expert clinical
interviews. The significant social and work-related
dysfunction, a disabling consequence of PTSD, does not
only impact on the life of the affected individual.
Communities where a significant percentage of members,
are psychologically affected by past human rights
violations, atrocities and war, are held back in their
recovery process at many levels. Therefore mental health
programmes with workable guidelines on how to treat
posttraumatic symptoms, based on solid scientific
research with proven effectiveness and feasibility, in
particular cultural settings, must become a humanitarian
priority. |
|
Tests &
Measures: |
Posttraumatic Diagnostic Survey
Composite International
Diagnostic Interview
Hopkins Symptom Checklist 25 |
|
Title: |
Therapeutic Alliance, Negative Mood Regulation, and
Treatment Outcome in Child Abuse-Related Posttraumatic
Stress Disorder. |
|
Author(s): |
Cloitre, Marylene, Institute for Trauma and Stress, New
York University, New York, NY, US,
marylene.cloitre@med.nyu.edu
Chase Stovall-McClough, K.,
Institute for Trauma and Stress, New York University,
New York, NY, US
Miranda, Regina, School of
Medicine, New York University, New York, NY, US
Chemtob, Claude M.,
Department of Psychiatry, Mount Sinai School of
Medicine, New York, NY, US |
|
Address: |
Cloitre, Marylene, Institute for Trauma and Stress,
Child Study Center, New York University, 215 Lexington
Avenue, 16th Floor, New York, NY, US,
marylene.cloitre@med.nyu.edu |
|
Source: |
Journal
of Consulting and Clinical Psychology, Vol 72(3), Jun
2004. pp. 411-416. |
|
Publisher: |
US:
American Psychological Assn |
|
Abstract: |
This
study examined the related contributions of the
therapeutic alliance and negative mood regulation to the
outcome of a 2-phase treatment for childhood
abuse-related posttraumatic stress disorder (PTSD).
Phase 1 focused on stabilization and preparatory skills
building, whereas Phase 2 was comprised primarily of
imaginal exposure to traumatic memories. Hierarchical
regression analyses indicated the strength of the
therapeutic alliance established early in treatment
reliably predicted improvement in PTSD symptoms at
posttreatment. Furthermore, this relationship was
mediated by participants' improved capacity to regulate
negative mood states in the context of Phase 2 exposure
therapy. In the treatment of childhood abuse-related
PTSD, the therapeutic alliance and the mediating
influence of emotion regulation capacity appear to have
significant roles in successful outcome. |
|
Tests &
Measures: |
Working
Alliance Inventory
General Expectancy for
Negative Mood Regulation scale
Modified PTSD Symptom
Scale-Self Report (MPSS-SR) |
|
Title: |
Sequential Treatment for Child Abuse-Related
Posttraumatic Stress Disorder: Methodological Comment on
Cloitre, Koenen, Cohen, and Han (2002). |
|
Author(s): |
Cahill,
Shawn P., Center for the Treatment and Study of Anxiety,
University of Pennsylvania, Philadelphia, PA, US,
scahill@mail.med.upenn.edu
Zoellner, Lori A.,
Department of Psychology, University of Washington,
Seattle, WA, US
Feeny, Norah C., Department
of Psychiatry, Case Western Reserve University,
Cleveland, OH, US
Riggs, David S., Center for
the Treatment and Study of Anxiety, University of
Pennsylvania, Philadelphia, PA, US |
|
Address: |
Cahill,
Shawn P., Center for the Treatment and Study of Anxiety,
University of Pennsylvania, 3535 Market Street, 6th
Floor, Philadelphia, PA, US,
scahill@mail.med.upenn.edu |
|
Source: |
Journal
of Consulting and Clinical Psychology, Vol 72(3), Jun
2004. pp. 543-548. |
|
Publisher: |
US:
American Psychological Assn |
|
Abstract: |
M.
Cloitre, K. Koenen, L. R. Cohen, and H. Han (2002; see
record 2002-18226-001) presented results of a randomized
trial that clearly demonstrate the safety and efficacy
of a treatment program delivering skills training in
affective and interpersonal regulation (STAIR) prior to
conducting imaginal exposure (IE) to trauma memories for
adults with posttraumatic stress disorder (PTSD) related
to childhood abuse. In this comment the authors review
the results presented by Cloitre et al and specifically
compare the impact of the STAIR and IE phases of the
treatment on affect regulation and psychopathology
measures. Evidence for adverse events associated with
exposure therapy is reviewed. The authors emphasize that
the present study should not be interpreted as evidence
that pretreatment with STAIR is additively helpful or
necessary prior to IE for PTSD associated with child
abuse and that a between-groups comparison is necessary
before such conclusions can be drawn. |
|
Title: |
Treating Life-Impairing Problems Beyond PTSD: Reply to
Cahill, Zoellner, Feeny, and Riggs (2004). |
|
Author(s): |
Cloitre, Marylene, Child Study Center, New York
University School of Medicine, New York, NY, US,
marylene.cloitre@med.nyu.edu
Stovall-McClough, K. Chase,
Child Study Center, New York University School of
Medicine, New York, NY, US
Levitt, Jill T., Child Study
Center, New York University School of Medicine, New
York, NY, US |
|
Address: |
Cloitre, Marylene, Institute for Trauma and Stress, New
York University Child Study Center, 215 Lexington
Avenue, 16th Floor, New York, NY, US,
marylene.cloitre@med.nyu.edu |
|
Source: |
Journal
of Consulting and Clinical Psychology, Vol 72(3), Jun
2004. pp. 549-551. |
|
Publisher: |
US:
American Psychological Assn |
|
Abstract: |
This
reply to the comment by Cahill, Riggs, Zoellner, and
Feeny (2004; see record 2004-95166-018) on the article
by Cloitre, Koenen, Cohen, and Han (2002; see record
2002-18226-001) reiterates that an important goal of
treatment research among chronically traumatized
populations is to address problems that impair life
functioning, including not only posttraumatic stress
disorder but also emotion regulation difficulties and
interpersonal problems. The need for further research on
symptom exacerbation and drop-out rates in
exposure-based treatment for child abuse survivors is
discussed. An ongoing follow-up study is described,
which is designed to assess the relative utility of
STAIR and modified PE individually versus their
combination in meeting "good outcome" standards as
defined above. (PsycINFO Database Record (c) 2005 APA,
all rights reserved)(journal abstract) |
|
Title: |
VA
practice patterns and practice guidelines for treating
posttraumatic stress disorder. |
|
Author(s): |
Rosen,
Craig S., National Center for PTSD, Veterans Affairs
Palo Alto Health Care System, Palo Alto, CA, US,
crosen@stanford.edu
Chow, Helen C., VA VISN 21
Mental Illness Research, Education, and Clinical Center,
Palo Alto, CA, US
Finney, John F., VA VISN 21
Mental Illness Research, Education, and Clinical Center,
Palo Alto, CA, US
Greenbaum, Mark A., VA VISN
21 Mental Illness Research, Education, and Clinical
Center, Palo Alto, CA, US
Moos, Rudolf H., VA VISN 21
Mental Illness Research, Education, and Clinical Center,
Palo Alto, CA, US
Sheikh, Javaid I., National
Center for PTSD, Veterans Affairs Palo Alto Health Care
System, Palo Alto, CA, US
Yesavage, Jerome A., VA VISN
21 Mental Illness Research, Education, and Clinical
Center, Palo Alto, CA, US |
|
Address: |
Rosen,
Craig S., National Center for PTSD, (152-MPD), 795
Willow Road, Menlo Park, CA, US,
crosen@stanford.edu |
|
Source: |
Journal
of Traumatic Stress, Vol 17(3), Jun 2004. pp. 213-222. |
|
Publisher: |
US:
John Wiley & Sons |
|
Abstract: |
Little
is known about how recent ISTSS practice guidelines (E.
B. Foa, T. M. Keane, & M. J. Friedman, 2000) compare
with prevailing PTSD treatment practices for veterans.
Prior to guideline dissemination, clinicians in 6 VA
medical centers were surveyed in 1999 (n = 321) and in
2001 (n = 271) regarding their use of various assessment
and treatment procedures. Practices most consistent with
guideline recommendations included psychoeducation,
coping skills training, attention to trust issues,
depression and substance use screening, and prescribing
of SSRIs, anticonvulsants, and trazodone. PTSD and
trauma assessment, anger management, and sleep hygiene
practices were provided less consistently. Exposure
therapy was rarely used. Additional research is needed
on training, clinical resources, and organizational
factors that may influence VA implementation of
guideline recommendations. |
|
Title: |
Fallacies and Deflections in Debating the Empirical
Support for EMDR in the Treatment of PTSD: A Reply to
Maxfield, Lake, & Hyer. |
|
Author(s): |
Rubin,
Allen, University of Texas, School of Social Work,
Austin, TX, US,
arubin@mail.utexas.edu |
|
Address: |
Rubin,
Allen, University of Texas, School of Social Work,
Austin, TX, US,
arubin@mail.utexas.edu |
|
Source: |
Traumatology, Vol 10(2), Jun 2004. pp. 91-105. |
|
Publisher: |
US:
Academy of Traumatology |
|
Abstract: |
The
Maxfield, Lake, and Hyer acerbic attack (see record
2005-01404-002) on my review (2003) is filled with
fallacies and inaccurate and unwarranted accusations
that deflect attention away from the main issue
pertaining to the insufficient evidence base for current
claims that EMDR is more effective than exposure
therapies and is an empirically-supported treatment for
children, combat PTSD, and multiple trauma PTSD. More
research is needed before such claims can be called
evidence-based. (PsycINFO Database Record (c) 2005 APA,
all rights reserved)(journal abstract) |
|
Title: |
Posttraumatic Stress Disorder: Acquisition, Recognition,
Course, and Treatment. |
|
Author(s): |
Davidson, Jonathan R. T., Department of Psychiatry and
Behavioral Sciences, Duke University Medical Center,
Durham, NC, US,
tolme@acpub.duke.edu
Stein, Dan J.
Shalev, Arieh Y.
Yehuda, Rachel |
|
Address: |
Davidson, Jonathan R. T., Department of Psychiatry and
Behavioral Sciences, Duke University Medical Center,
Durham, NC, US,
tolme@acpub.duke.edu |
|
Source: |
Journal
of Neuropsychiatry & Clinical Neurosciences, Vol 16(2),
May 2004. pp. 135-147. |
|
Publisher: |
US:
American Psychiatric Assn |
|
Abstract: |
Following exposure to trauma, a large number of
survivors will develop acute symptoms of posttraumatic
stress disorder (PTSD), which mostly dissipate within a
short time. In a minority, however, these symptoms will
evolve into chronic and persistent PTSD. A number of
factors increase the likelihood of this occurring,
including characteristic autonomic and
hypothalamic-pituitary-adrenal axis responses. PTSD
often presents with comorbid depression, or in the form
of somatization, both of which significantly reduce the
possibilities of a correct diagnosis and appropriate
treatment. Mainstay treatments include exposure-based
psychosocial therapy and selective serotonin reuptake
inhibitors, such as paroxetine and sertraline, both of
which have been found to be effective in PTSD. This
paper looks at the course of PTSD, its disabling effect,
its recognition and treatment, and considers possible
new research directions. |
|
Title: |
A
survey of psychologists' attitudes towards and
utilization of exposure therapy for PTSD. |
|
Author(s): |
Becker,
Carolyn Black, Department of Psychology, Trinity
University, San Antonio, TX, US,
carolyn.becker@trinity.edu
Zayfert, Claudia, Dartmouth
Medical School, Lebanon, NH, US
Anderson, Emily, Department
of Psychology, Trinity University, San Antonio, TX, US |
|
Address: |
Becker,
Carolyn Black, Department of Psychology, Trinity
University, 715 Stadium Drive, San Antonio, TX, US,
carolyn.becker@trinity.edu |
|
Source: |
Behaviour Research and Therapy, Vol 42(3), Mar 2004. pp.
277-292. |
|
Publisher: |
Netherlands: Elsevier Science |
|
Abstract: |
Although research supports the efficacy of exposure
therapy for PTSD, some evidence suggests that exposure
is under-utilized in general clinical practice. The
purpose of this study was to assess licensed
psychologists' use of imaginal exposure for PTSD and to
investigate perceived barriers to its implementation. A
total of 852 psychologists from three states were
randomly selected and surveyed. An additional 50 members
of a trauma special interest group of a national
behavior therapy organization were also surveyed. The
main survey results indicate that a large majority of
licensed doctoral level psychologists do not report use
of exposure therapy to treat patients with PTSD.
Although approximately half of the main study sample
reported that they were at least somewhat familiar with
exposure for PTSD, only a small minority used it to
treat PTSD in their clinical practice. Even among
psychologists with strong interest and training in
behavioral treatment for PTSD, exposure therapy is not
completely accepted or widely used. Clinicians also
appear to perceive a significant number of barriers to
implementing exposure. |
|
Title: |
Combat-related PTSD and logotherapy. |
|
Author(s): |
Gilmartin, Robin M., PTSD Residential Rehabilitation
Program, CT Veterans Hospital, Newington, CT, US
Southwick, Steven, Yale
University Medical School, New Haven, CT, US |
|
Address: |
Gilmartin, Robin M., VA Connecticut Healthcare, 555
Willard Ave., Newington, CT, US |
|
Source: |
International Forum for Logotherapy, Vol 27(1), Spr
2004. pp. 34-38. |
|
Publisher: |
US:
Viktor Frankl Inst of Logotherapy |
|
Abstract: |
In
accordance with DSM-IV, Posttraumatic Stress Disorder
(PTSD) follows from traumatic events that have been
experienced, witnessed, or confronted and which involve
actual or threatened death or serious injury, or threat
to the physical integrity of self or others. Chronic
combat-related PTSD is difficult to treat. In this
report we describe the use of logotherapy for the
treatment of a combat veteran suffering with chronic
PTSD. Jim, a 54-year-old Vietnam veteran who served as a
medic in the Marines, struggled with chronic war-related
PTSD. He joined a weekly meaning-focused Community
Service (CS) group after completing a combination of
treatments for PTSD - cognitive behavioral therapy
(CBT), pharmacotherapy, skills training, followed by
exposure therapy. These treatments were moderately
effective in reducing some symptoms while improving
Jim's coping with other, persistent symptoms. We have
identified four core existential issues that veterans
with combatrelated PTSD often face and which
conventional therapies alone do not adequately address.
These include a severely skewed external locus of
control, a foreshortened sense of future, guilt and
survivor guilt, and loss of meaning. |
|
Title: |
Efficacy and Outcome Predictors for Three PTSD
Treatments: Exposure Therapy, EMDR, and Relaxation
Training. |
|
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