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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
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PTSD Dissociation
PTSD and Mass Trauma
Record: 1
Title: Posttraumatic Stress Disorder as a result of mass trauma. Author(s): Shalev, Arieh Y. , ashalev@cc.huji.ac.il, Center for Traumatic Stress, Kiryat Hadassah, Israel
Tuval-Mashiach, Rivka , Center for Traumatic Stress, Kiryat Hadassah, Israel
Hadar, Hilit , Center for Traumatic Stress, Kiryat Hadassah, Israel Address: Shalev, Arieh Y., Center for Traumatic Stress, Kiryat Hadassah, P.O. Box 12000, IL 91120, Jerusalem, Israel, ashalev@cc.huji.ac.il Source: Journal of Clinical Psychiatry , Vol 65(Suppl1), 2004. Special Issue: Update on posttraumatic stress disorder. pp. 4-10. Publisher: US: Physicians Postgraduate Press. Publisher URL: ISSN: 0160-6689 (Print) Language: English Key Concepts: posttraumatic stress disorder; mass trauma; trauma severity; victimized communities; psychological treatment; acute stress reactions; social support systems; functional impairment; at risk population Abstract: There are few studies of the acute and long-term effects of mass trauma on victimized communities. Acute stress reactions are expected, and overall resilience in the aftermath of major disasters is the rule rather than the exception. However, the available literature on mass trauma suggests that certain factors may provide clues to identifying persons at greater risk for posttraumatic stress disorder (PTSD). The severity of the trauma and the accessibility of support systems may affect longterm outcome. In industrialized countries, mass violence caused by malicious human intent may be a more virulent precursor to PTSD than other types of mass trauma, such as natural disasters. School-aged children, women, persons with existing psychiatric illness, those who experienced significant losses or threat to life, those who have insufficient psychological and social support systems, and persons who exhibit symptoms of functional impairment may be at greater risk for PTSD. The findings of a population study of 2 traumatized communities are discussed. Early intervention in communities suffering mass trauma should consist of general support and bolstering of the recovery environment rather than psychological treatment; some forms of early psychological interventions may worsen outcome. _____
Record: 2
Title: Risk and resilience in posttraumatic stress disorder. Author(s): Yehuda, Rachel , rachel.yehuda@med.va.gov, Bronx VA Medical Center, Mt. Sinai School of Medicine, Bronx, NY, US Address: Yehuda, Rachel, Bronx VA Medical Center, 130 West Kingsbridge Rd., Building 107, Psychiatry 116A OOMH, Room 125A, Bronx, NY, US, 10468, rachel.yehuda@med.va.gov Source: Journal of Clinical Psychiatry , Vol 65(Suppl1), 2004. Special Issue: Update on posttraumatic stress disorder. pp. 29-36. Publisher: US: Physicians Postgraduate Press. Publisher URL: ISSN: 0160-6689 (Print) Language: English Key Concepts: posttraumatic stress disorder; life threatening trauma; cortisol levels; terrorist activity; traumatic memories; PTSD patients; symptoms; at risk populations; neuroendocrine changes Abstract: Posttraumatic stress disorder (PTSD) is a common psychiatric disorder. In light of recent war and terrorist activity worldwide, it is likely that increased numbers of individuals will be exposed to severe or life-threatening trauma, and the incidence of PTSD may be even higher. PTSD may develop after exposure to a traumatic event where the individual experienced, witnessed, or was confronted by either actual or threatened loss of life or serious injury. Patients may reexperience intrusive recollections of the event in ways that are highly distressing and may be described as reliving the memory. Symptoms of avoidance are noted because patients wish to escape recollections (thoughts, feelings, conversations, places) related to the trauma. They also experience symptoms of hyperarousal and difficulty concentrating or exaggerated startle response. PTSD patients represent only a subset of those exposed to trauma. It is of interest why certain individuals are at risk for development of PTSD. Studies suggest that previous exposure to trauma and intensity of the response to acute trauma may affect the development of PTSD. Neuroendocrine changes, such as lower cortisol levels, also may influence formation and processing of traumatic memories and may be associated with PTSD. _____
Record: 3
Title: The psychological effects of parental mental health on children experiencing disaster: The experience of Bolu earthquake in Turkey. Author(s): Kilic, Emine Zinnur , Ankara University, School of Medicine, Department of Child Psychiatry, Ankara, Turkey
Ozguven, Halise Devrimci , Ankara University, School of Medicine, Department of Psychiatry, Ankara, Turkey
Sayil, Iaik , Ankara University School of Medicine, Department of Psychiatry, Ankara, Turkey Source: Family Process , Vol 42(4), Win 2003. pp. 485-495. Journal URL: http://www.familyprocess.org/ Publisher: US: Family Process. Publisher URL: ISSN: 0014-7370 (Print) Language: English Key Concepts: posttraumatic stress disorder; disaster experience; children; general family functioning; parental psychopathology; parental mental health; psychopathology; earthquake Abstract: Disasters affect families as a whole, and symptoms displayed by a family member may lead to secondary traumatizations for other members of the family, especially the children. This study examines the effects of parental psychopathology and family functioning on children's psychological problems six months after the earthquake in Bolu, Turkey. Forty-nine children aged between 7 and 14 and their parents were assessed by trained psychiatrists and psychologists using self-report measures for posttraumatic stress disorder (PTSD), depression, and anxiety symptoms six months after the earthquake. Severity of PTSD in children was mainly affected by the presence of PTSD and the severity of depression in the father. State and trait anxiety scores of children were related to general family functioning. The constellation of PTSD symptomatology was different in fathers than in mothers: the most common type of symptoms was "externalizing" in fathers with PTSD. This study supports the notion that the mere presence of PTSD in parents may not be enough to explain the relational process in families experiencing trauma. Our findings with earthquake survivors suggest that when fathers become more irritable and detached because of PTSD symptoms, their symptoms may affect children more significantly. _____
Record: 4
Title: Rates and Symptoms of PTSD among Cocaine-Dependent Patients. Author(s): Najavits, Lisa M. , Lnajavits@hms.harvard.edu, McLean Hospital, Belmont, MA, US
Runkel, Ragna , Department of Psychology, University of Heidelberg, Heidelberg, Germany
Neuner, Christina , Boston College, Boston, MA, US
Frank, Arlene F. , Brookside Hospital, Nashua, NH, US
Thase, Michael E. , Western Psychiatric Institute and Clinic, University of Pittsburgh, Pittsburgh, PA, US
Crits-Christoph, Paul , Department of Psychiatry, University of Pennsylvania Medical School, University of Pennsylvania, Philadelphia, PA, US
Elaine, Jack , National Institute on Drug Abuse, Rockville, MD, US Address: Najavits, Lisa M., McLean Hospital, 115 Mill St., Belmont, MA, US, 02478, Lnajavits@hms.harvard.edu Source: Journal of Studies on Alcohol , Vol 64(5), Sep 2003. pp. 601-606. Publisher: US: Alcohol Research Documentation. Publisher URL: http://rci.rutgers.edu/~cas2/structure/publicat ISSN: 0096-882X (Print) Language: English Key Concepts: posttraumatic stress disorder; symptoms; lifetime traumatic events; substance abuse; cocaine dependency Abstract: This study evaluated lifetime traumatic events and current posttraumatic stress disorder (PTSD) symptoms in a substance abuse sample. Ss consisted of 558 (75.1% male) cocaine-dependent Ss who completed self-report measures of trauma and PTSD symptoms prior to treatment entry. Results showed a high number of lifetime traumatic events, even among those without PTSD. General disaster was the most prevalent. Current PTSD was found in 10.9% of Ss, with a significantly higher rate among women (21.6%) than among men (7.2%). For Ss with PTSD, the most prominent PTSD symptom cluster was arousal, and the most common symptoms were restricted affect, detachment and irritability. Ss with PTSD endorsed a large number of symptoms; however, neither number of traumas nor type of trauma was associated with the level of PTSD symptoms. Even among those not meeting PTSD criteria, subthreshold symptoms were found, with avoidance the most prominent cluster. Sociodemographic and recent cocaine use variables did not differentiate PTSD from non-PTSD Ss. It is concluded that PTSD is present in a sizeable percentage of cocaine-dependent treatment-seeking Ss, particularly women. Clinicians might address arousal symptoms, since this was the most prominent symptom cluster and may be exacerbated by cocaine use. _____
Record: 5
Title: Posttraumatic Symptoms and the Complexity of Responses to Trauma. Author(s): Kroll, Jerome , kroll001@umn.edu, Department of Psychiatry and Community-University Health Care Clinic, University of Minnesota Medical School, Minneapolis, MN, US Address: Kroll, Jerome, Dept of Psychiatry, Medical School, F282/2A West Bldg, 2450 Riverside Ave, Minneapolis, MN, US, 55454-1495, kroll001@umn.edu Source: JAMA: Journal of the American Medical Association , Vol 290(5), Aug 2003. pp. 667-670. Journal URL: http://jama.ama-assn.org/ Publisher: US: American Medical Assn. Publisher URL: http://www.amapublications.com ISSN: 0098-7484 (Print) Digital Object Identifier: http://dx.doi.org/10.1001/jama.290.5.667
Language: English Key Concepts: posttraumatic stress symptoms; trauma responses; public health Abstract: Discusses the articles in the current issue of the Journal of the American Medical Association that highlight the increasing appreciation of the complexity, ubiquity, and inescapability of both personal and indirect exposure to trauma and violence. Posttraumatic stress responses resist easy formulation and categorization. Although final common pathways are inevitably mediated biologically and psychologically, the long-term consequences of trauma are far-reaching. The context in which the trauma occurs, the age and stage of life of the traumatized person, the associated losses of family and cultural coherence, characteristics of the person prior to the trauma, the conditions of life after the traumatic encounter, and the meanings attached to the traumatic events all affect the expression and experience of posttraumatic stress responses. The challenge for the health care professional is to approach the study and treatment of PTSD in a scientifically sound, targeted, and systematic manner, providing the basis for incorporating social and cultural components as well as traditional medical interventions into comprehensive programs. The 5 articles in this issue provide examples of research designed to increase the understanding and treatment of PTSD as a public health problem. _____
Record: 6
Title: Sensitivity and specificity of the PTSD checklist in detecting PTSD in female veterans in primary care. Author(s): Lang, Ariel J. , ajlang@ucsd.edu, VA San Diego Healthcare System, Psychology Service, San Diego, CA, US
Laffaye, Charlene , U California - San Diego, Dept of Psychiatry, San Diego, CA, US
Satz, Leslie E. , VA San Diego Healthcare System, Nursing Service, San Diego, CA, US
Dresselhaus, Timothy R. , VA San Diego Healthcare System, Medicine Service, San Diego, CA, US
Stein, Murray B. , U California - San Diego, Dept of Psychiatry, San Diego, CA, US Address: Lang, Ariel J., VA Outpatient Clinic (MC116A4Z), 8810 Rio San Diego Dr., San Diego, CA, US, 92108, ajlang@ucsd.edu Source: Journal of Traumatic Stress , Vol 16(3), Jun 2003. pp. 257-264. Journal URL: http://www.wkap.nl/journalhome.htm/0894-9867 Publisher: Netherlands: Kluwer Academic Publishers. Publisher URL: ISSN: 0894-9867 (Print) Digital Object Identifier: http://dx.doi.org/10.1023/A:1023796007788 Language: English Key Concepts: distress; psychiatric diagnoses; primary care; Post traumatic stress disorder; veterans; psychometrics Abstract: PTSD affects a substantial number of women in medical settings and is associated with significant distress and impairment. There are effective methods of treating trauma-related distress, but a minority seek such care. Thus, primary care is an important setting in which to identify individuals with PTSD. We sent questionnaires, including the PTSD Checklist-Civilian Version (PCL-C), to 419 female veterans who were seen in our primary care clinic in 1998; 56% (N=221) returned the measures. A random subset (n = 49) was interviewed to establish psychiatric diagnoses. The results provide qualified support for the use of the PCL-C total score with a lowered cutoff score as a screening measure for PTSD in female veterans in primary care. _____
Record: 7
Title: Using trauma theory and S.A.G.E. in outpatient psychiatric practice. Author(s): Bills, Lyndra J. , Private Practice, US Address: Bills, Lyndra J., PMB 138, 12 West Willow Grove Avenue, Philadelphia, PA, US, 19118, ljbshrink@msn.com Source: Psychiatric Quarterly , Vol 74(2), Sum 2003. pp. 191-203. Journal URL: http://www.wkap.nl/journalhome.htm/0033-2720 Publisher: US: Kluwer Academic/Plenum Publishers. ISSN: 0033-2720 (Print) Language: English Key Concepts: Sanctuary model; trauma; recovery; S.A.G.E.; posttraumatic stress disorder; milieu therapy; PTSD Abstract: In this paper the author reviews case examples of how a thorough understanding of trauma and recovery combined with a coherent, nonlinear, phased approach to treatment called S.A.G.E. (Safety, Affect Management, Grieving, and Emancipation), helps to provide a conceptual framework that is easily understood by clients and their families and allows the clinician to organize and measure treatment success, regardless of the complexity of the cases involved. _____
Record: 8
Title: Transtorno de estresse pos-traumatico e transtorno de humor bipolar. Translated Title: Posttraumatic stress disorder and bipolar mood disorder. Author(s): Vieira, Rodrigo Machado , rvieira@usp.br, Programa de Transtorno de Humor Bipolar do Hospital de Clinicas de Porto Alegre-UFRGS, Porto Alegre, Brazil
Gauer, Gabriel J. C. , Departamento de Psiquiatria e Medicina Legal e do Programa de Mestrado em Ciencias Criminais da PUCRS, Brazil Address: Vieira, Rodrigo Machado, Centro de Pesquisas, Laboratorio de Psiquiatria Experimental, Rua Ramiro Barcellos, 2350, RS, 90035-003, Porto Alegre, Brazil, rvieira@usp.br Source: Revista Brasileira de Psiquiatria , Vol 25(Suppl1), Jun 2003. pp. 55-61. Publisher: Brazil: Associacao Brasileira de Psiquiatria. ISSN: 1516-4446 (Print) Language: Portuguese Key Concepts: posttraumatic stress disorder; bipolar mood disorder; comorbidity; intrusive memories; traumatic memories; behavioral sensitivity; psychotic patients; epidemiology; etiology; pharmocological treatment Abstract: Bipolar disorder (BD) is not only an endogenous condition. Severe negative life events have been shown to influence the development of the first episode and lifetime course of BD. Posttraumatic stress disorder (PTSD) is a severe and incapacitating mental condition that affects a significant proportion of the general population at some time in their lives. The concomitant presence of BD and PTSD has been shown to be more frequent than previously suggested and psychotic patients with trauma histories have a tendency to present more severe symptoms and are more prone to present substance use disorders. Trauma-related intrusive memories and nightmares of PTSD have been associated with mood changes. Also, kindling and behavioral sensitization have been proposed to explain the etiology and course of both disorders. Pharmacological approaches for this comorbidity are still based on empirical or not controlled approaches. In this article, we critically review the current literature regarding this comorbid condition, and highlight some aspects related to epidemiology, etiology, course and pharmacological treatment of both disorders. Overall, our review emphasizes the importance of systematically evaluating trauma histories in patients with BD. _____
Record: 9
Title: Screening for post-traumatic stress disorder among refugees in Stockholm. Author(s): Soendergaard, Hans Peter , hans.peter.sondergaard@phs.ki.se, Ctr for Torture & Trauma Survivors (CTD), Stockholm, Sweden
Ekblad, S. , National Swedish Inst for Psychosocial Factors & Health, Stockholm, Sweden
Theorell, T. , National Swedish Inst for Psychosocial Factors & Health, Stockholm, Sweden Address: Soendergaard, Hans Peter, National Swedish Institute for Psychosocial Factors and Health, PO Box 230, SE-171 77, Stockholm, Sweden, hans.peter.sondergaard@phs.ki.se Source: Nordic Journal of Psychiatry , Vol 57(3), May 2003. pp. 185-189. Publisher: Norway: Scandinavian Univ Press. ISSN: 0803-9488 (Print) Language: English Key Concepts: post-traumatic stress disorder; refugees; screening procedures Abstract: A screening procedure (The Health Leaflet; HL) to assist social workers in finding subjects with possible post-traumatic stress disorder (PTSD) in recently resettled refugees is presented. It is compared with two established self-rating instruments, the Harvard Trauma Questionnaire (HTQ) and Impact of Event Scale-22 (IES-22), as well as structured clinical interview. Aim: To validate the screening interview and the rating scales in comparison to a clinical assessment for PTSD, and examine the feasibility of lay screening for PTSD. Findings: The Health Screening Interview with a cut-off value of 10 points identified cases with fully developed PTSD with both sensitivity and specificity about 0.7. Only two items--difficulties concentrating and having been exposed to torture--contributed to the discriminatory performance of the HL interview. In the HTQ symptom subscale, emotional detachment and a feeling of going mad contributed to the discriminatory performance. In the IES-22, recurring strong affects about the events, as well as intrusive memories, were the items with the highest canonical correlation coefficients. In the HL, the single screening question about difficulties concentrating identified 31/32 individuals diagnosed with PTSD in this group, with a relative risk of 24... _____
Record: 10
Title: Olfaction as a traumatic reminder in posttraumatic stress disorder: Case reports and review. Author(s): Vermetten, Eric , e.vermetten@azu.nl, Emory U School of Medicine, Dept of Psychiatry & Behavioral Sciences, Atlanta, GA, US
Bremner, J. Douglas , Emory U School of Medicine, Dept of Psychiatry & Behavioral Sciences, Atlanta, GA, US Address: Vermetten, Eric, Dept of Psychiatry, U Medical Ctr/Central Military Hosp-T2, Heidelberglaan 100, 3584 CX, Utrecht, Netherlands, e.vermetten@azu.nl Source: Journal of Clinical Psychiatry , Vol 64(2), Feb 2003. pp. 202-207. Publisher: US: Physicians Postgraduate Press. Publisher URL: ISSN: 0160-6689 (Print) Language: English Key Concepts: odors; olfaction; traumatic memory; emotional triggers; flashbacks; posttraumatic stress disorder Abstract: Memory for odors that are associated with intense emotional experiences is often strongly engraved. Odors may be more closely connected to affect than other sensory experiences. They can serve as potent contextual cues for memory formation and emotional conditioning and can also serve as cues for olfactory flashbacks. Though trauma-related smells have long been noted by clinicians to be precipitants of traumatic memories in patients with posttraumatic stress disorder (PTSD), very few reports have been published that document this. The authors review olfactory memories and olfactory flashbacks by presenting 3 cases that illustrate the role of olfaction in PTSD. In these cases olfaction is either a precipitant of PTSD symptoms or an important component of reexperiencing. In PTSD, seemingly nonspecific cues have the potential to precipitate traumatic memories with strong emotional components. These conditioned responses in PTSD are hypothesized to be mediated by specific brain areas, i.e., amygdala, hippocampus, and orbitofrontal cortex. Questions about smells as a traumatic reminder should be part of the routine assessment of intrusive memories in PTSD. Smells may also have the potential to provide cues to exposure situations in therapy or to facilitate de novo conditioning. _____
Record: 11
Title: Building somatic resources: The theory and practice of sensorimotor psychotherapy in the treatment of trauma. Author(s): Ogden, Pat , Union Inst And U., US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering , Vol 64(2-B), 2003. pp. 972. Publisher: US: Univ Microfilms International. ISSN: 0419-4217 (Print) Language: English Key Concepts: sensorimotor psychotherapy; therapeutic interventions; traditional psychotherapy; sensorimotor processing; emotional reactivity; Posttraumatic Stress Disorder Abstract: Traditional psychotherapy addresses the cognitive and emotional elements of trauma, but lacks techniques that work directly with somatic elements, despite the fact that trauma profoundly affects the body and many symptoms of traumatized individuals are somatically based. Sensorimotor Psychotherapy is a method that integrates sensorimotor processing with cognitive and emotional processing in the treatment of trauma. Unassimilated somatic responses evoked in trauma involving both arousal and defensive responses are shown to contribute to many PTSD symptoms and to be critical elements in the practice of Sensorimotor Psychotherapy. By using the body (rather than cognition or emotion) as a primary entry point in processing trauma, Sensorimotor Psychotherapy directly treats the effects of trauma on the body, which in turn facilitates emotional and cognitive processing. The somatically based approaches described by Pierre Janet (1859-1947) provide a historical foundation for Sensorimotor Psychotherapy. These century-old methods of education about and practice of integrated physical action and body awareness as interventions that might help alleviate the movement disorders and other somatic symptoms of traumatized individuals are integrated with contemporary trauma theory, methodology and interventions. Sensorimotor Psychotherapy interventions that promote somatic resources, including somatic awareness, the practice of mindfulness, contacting and tracking the body, completing actions evoked in trauma, economical movement, containment, and specific movement exercises, are described and illustrated through case examples. Emphasis is placed on keeping patients' arousal levels within a "window of tolerance" and expanding integrative capacity. The therapist's ability to interactively regulate clients' dysregulated states and the synthesis of somatic 'bottom-up' techniques with cognitive 'top-down' interventions is underscored as being a beneficial combination of therapeutic interventions in the treatment of PTSD. This method is shown as especially beneficial for clinicians working with structural dissociation of the personality, emotional reactivity or flat affect, frozen states, hypoarousal, hyperarousal and other PTSD symptoms. Somatic resourcing interventions are illustrated which can be integrated with traditional approaches that treat these symptoms. _____
Record: 12
Title: Emotional arousal during therapy for posttraumatic stress disorder with childhood sexual abuse survivors. Author(s): Gleiser, Kari A. , Boston U., US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering , Vol 64(3-B), 2003. pp. 1491. Publisher: US: Univ Microfilms International. ISSN: 0419-4217 (Print) Language: English Key Concepts: emotional arousal; postraumatic stress disorder; childhood sexual abuse; habituation Abstract: This process-outcome psychotherapy study examined the influence of emotional arousal and habituation on symptom reduction in two brief therapies for adult female survivors of childhood sexual abuse (CSA) with Posttraumatic Stress Disorder (PTSD). Although affect regulation and emotional processing have been long regarded as essential markers of therapeutic progress in healing from trauma, there is a paucity of rigorous empirical investigation of affective process variables contributing to good therapeutic outcome. This study explored the relationship of observer-rated emotional arousal and habituation to PTSD symptom reduction in 46 adult female survivors of CSA: 21 in a 14-session cognitive-behavioral exposure therapy (CBT), and 25 in a 14-session supportive present-centered therapy (PCT). Researchers rated from videotapes clients' peak and modal negative affective arousal, and the presence/absence of eight categorical emotions (e.g. fear, sadness, anger, shame) across an early and late session. Six hypotheses investigated whether extremes of overly restricted or unmodulated emotional arousal and reduced rates of between-session habituation were significantly related to poorer treatment outcome, and whether this relationship changed depending on the type of treatment. Participants who experienced more habituation of negative affect arousal (expressions of distress manifest in facial expressions, voice intonation, and body language) exhibited more PTSD symptom (e.g. nightmares, intrusive memories, avoidance of triggers) improvement. Higher peak arousal and lower modal arousal at the beginning of therapy were related to more symptom reduction. Although overall negative affect arousal was higher among CBT clients than PCT clients, this interaction did not relate to improvement on PTSD symptomatology. The data did not show support for any correlations between observer-rated negative affect arousal and clients' subjective report of distress, or for any relationship between expression of categorical emotions and symptom improvement. Finally, no association was found for the therapy group by habituation interaction in predicting PTSD symptom reduction. These findings provide support for the centrality of emotional engagement and habituation in treating PTSD, and highlight the need to develop more empirically supported ways of assessing constructs related to emotional processing and regulation. For clinicians, monitoring and helping regulate clients' emotional arousal in PTSD therapies is crucial for achieving good outcome. _____
Record: 13
Title: Life events and mental health service utilization in vietnam veterans with posttraumatic stress disorder. Author(s): Inman, Gregory Lynn , Georgia State U., US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering , Vol 63(12-B), 2003. pp. 6096. Publisher: US: Univ Microfilms International. ISSN: 0419-4217 (Print) Language: English Key Concepts: posttraumatic stress disorder; life events; mental health service; retirement; education Abstract: An estimated half a million Vietnam veterans currently meet criteria posttraumatic stress disorder (PTSD). Yet, most have never been treated by a mental health provider. Previous case studies of Korean and World War II veterans indicated that normal life cycle changes in later adulthood (e.g., retirement, health problems) and/or other trauma lead to an exacerbation, reactivation or delayed onset of PTSD symptoms. Vietnam veterans are entering middle to late adulthood and may warrant special considerations in the assessment and treatment of PTSD. Examining precipitating events that prompt service seeking in Vietnam veterans may contribute to an understanding of how the aging process affects PTSD assessment, treatment, and theory. This study examined the reported life stressors and traumatic events in the year prior to treatment seeking for PTSD in Vietnam veterans at the Atlanta VA Hospital. The purpose of this study was to examine the relationships between recent stressful life events and traumatic events in a PTSD treatment-seeking sample of Vietnam veterans. Seventy veterans with PTSD were compared to 79 Vietnam veterans at a Primary Care clinic and 61 age matched participants from the community. Participants completed a life events measure (LOPES), the Traumatic Stress Schedule to report events that they had experienced in the last year. It was hypothesized that after adjusting for marital status, race and SES, the mean number of negative life events and event frequencies in the PTSD treatment-seeking group would significantly exceed that of the other two groups. Results indicated that the PTSD sample experienced more stressful events compared to the control groups. Both Vietnam veteran samples reported more recent life stressors than the community sample. The implications of the findings are discussed in terms of education, assessment and treatment. _____
Record: 14
Title: PTSD in children and adolescents: An overview with guidelines for forensic assessment. Author(s): Schetky, Diane H. , University of Vermont, College of Medicine, Maine Medical Center, Portland, ME, US Source: Simon, Robert I. (Ed); 2003. Posttraumatic stress disorder in litigation: Guidelines for forensic assessment (2nd ed.). Washington, DC, US: American Psychiatric Publishing, Inc.. pp. 91-118 ISBN: 1-58562-066-1 (hardcover) Language: English Key Concepts: forensic assessment; parental response; PTSD in children; risk factors; victim's response Abstract: The forensic assessment of the impact of trauma in children is more complex than that in adults, for whom risk factors and damages relate primarily to the dimensions of the traumatic event and factors within the victims that affect response to the trauma. Added dimensions in children's responses to trauma include parental response to the trauma, the impact of the trauma on the child's development, and the possibility of delayed-onset PTSD symptoms. In addition, PTSD in children may not look like PTSD in adults. _____
Record: 15
Title: Assessment of comorbid substance use disorder and posttraumatic stress disorder. Author(s): Read, Jennifer P. , Brown U, Ctr for Alcohol & Addiction Studies, Providence, RI, US
Bollinger, Andreas R. , VA Boston Healthcare System, Boston, MA, US
Sharkansky, Erica , National Ctr for Post-Traumatic Stress Disorder, Boston VA Medical Ctr & Women's Health Sciences Div, Boston, MA, US Source: Ouimette, Paige (Ed); Brown, Pamela J. (Ed); 2003. Trauma and substance abuse: Causes, consequences, and treatment of comorbid disorders. Washington, DC, US: American Psychological Association. pp. 111-125 ISBN: 1-55798-938-9 (hardcover) Language: English Key Concepts: comprehensive assessment; posttraumatic stress disorder; substance use disorder; comorbidity Abstract: This chapter is designed to review theoretical and procedural approaches to the comprehensive assessment of comorbid substance use disorder-posttraumatic stress disorder (SUD-PTSD). The authors outline several widely used assessment measures as well as methods to enhance accurate assessment of PTSD and SUD symptoms, discuss the importance of assessing other comorbidities and present procedural and provider issues that may affect assessment. _____
Record: 16
Title: Comorbid posttraumatic stress disorder and substance use disorders: Treatment outcomes and the role of coping. Author(s): Brown, Pamela J. , Private Practice, Providence, RI, US
Read, Jennifer P. , Brown U, Ctr for Alcohol & Addiction Studies, Providence, RI, US
Kahler, Christopher W. , Brown U, Ctr for Alcohol & Addiction Studies, Providence, RI, US Source: Ouimette, Paige (Ed); Brown, Pamela J. (Ed); 2003. Trauma and substance abuse: Causes, consequences, and treatment of comorbid disorders. Washington, DC, US: American Psychological Association. pp. 171-188 ISBN: 1-55798-938-9 (hardcover) Language: English Key Concepts: posttraumatic stress disorder; PTSD; comorbidity; substance use disorder; gender differences; treatment outcomes; coping skills Abstract: In this chapter the authors describe a study that examines the prospective relationship between posttraumatic stress disorder (PTSD) and substance use disorders (SUDs) among inpatients (aged 18-55 yrs) recently treated for substance abuse or dependence. To provide a context for this study, the authors survey the relevant prospective literature on SUD-PTSD comorbidity and review factors suggested by this literature on affect symptom presentation, treatment, and remission of these two disorders. Specifically, the authors discuss the role of gender and coping skills in the relationship between SUDs and PTSD. _____
Record: 17
Title: Posttraumatic stress disorder: Malady or myth? Series Title: Current perspectives in psychology. Author(s): Brewin, Chris R. , University Coll London, London, United Kingdom Source: 2003. New Haven, CT, US: Yale University Press. xii, 271 pp. ISBN: 0-300-09984-3 (hardcover) Language: English Key Concepts: posttraumatic stress disorder; characteristics; diagnosis; treatment; research; memory; survivors Abstract: As more individuals bear witness to terrorist attacks, school shootings, or assaults, there has been an increase in posttraumatic stress disorder (PTSD), a controversial diagnosis since the Vietnam War. Is PTSD real or is it a modern myth? Is counseling for it valuable or harmful? Are uncovered memories of childhood trauma valid or unwitting fabrications? In this book, C. Brewin presents recent research on PTSD, memory, and neuroscience and offers a theory to explain conflicting findings about the nature and treatment of traumatic stress. At the core of the book is an analysis of how the impact of trauma affects memory and identity. Brewin suggests that there are 2 forms of memory for trauma, one based in words and one in images. Overwhelming stress on different areas of the brain can leave survivors at a loss for words to describe what has happened to them, but they still experience vivid, detailed, and inescapable images. Trauma can also bring about profound changes in identity and block normal mechanisms for correcting abnormal memory. Building on this analysis, Brewin provides information on who will be vulnerable to traumatic stress, how to tell whether someone is likely to be suffering from PTSD, why only some interventions work, and what should be done to help survivors. Table of Contents: Series foreword
Acknowledgments
..Saviors and skeptics
..Posttraumatic stress disorder: Discovery or invention?
..Is posttraumatic stress disorder caused by trauma?
..A crisis of identity
..The puzzle of emotional memory
..Trauma, memory, and the brain
..Myths, memory wars, and witch-hunts
..The return of repression?
..More battlegrounds: Preventing and treating PTSD
..Ancient malady or modern myth?
Notes
References
Index _____
Record: 18
Title: Coping strategies and the development of posttraumatic stress symptoms in sexually abused children. Author(s): Kaplow, Julie B. , Duke U., US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering , Vol 63(2-B), Aug 2002. pp. 1032. Publisher: : Transaction Periodicals Consortium, Rutgers University. ISSN: 0419-4217 (Print) Order Number: AAI3041594 Language: English Key Concepts: coping strategies; PTSD; symptoms; sexual abuse; children Abstract: This research examined the concurrent and prospective relations between abuse-related factors, various coping strategies, and posttraumatic stress symptoms in sexually abused children. Participants of Study 1 included 156 children, aged 8 to 13 years, who were allegedly sexually abused and referred for an evaluation at a local treatment facility. Various abuse-related factors were extracted from written reports. A global coding system was used to analyze children's coping strategies (expression, avoidance, and affective responses) through observations of videotaped interviews. Finally, children were administered the Trauma Symptom Checklist for Children (TSCC) in order to assess their PTSD symptomatology. Regression models indicated that children who had higher levels of parental support and displayed higher levels of expressiveness during their investigative interviews were more likely to demonstrate higher concurrent levels of PTSD symptomatology. In Study 2, 56 of these children were re-administered the TSCC approximately 8 to 32 months later in order to examine the prospective relations between abuse-related factors, coping strategies, and growth in PTSD symptomatology. Regression models demonstrated a marginally significant relation between (a) higher levels of avoidance and positive affect measured at the first time point and (b) higher levels of PTSD symptoms measured at the second time point. These findings have critical implications for those involved with the assessment and referral of sexually abused children as well as prevention and intervention efforts aimed at reducing children's risk for growth in posttraumatic stress reactions following sexual abuse. _____
Record: 19
Title: Adolescents' exposure to community violence: Living as if there is no tomorrow. Author(s): Wynne, Robert Louis , California Inst Integral Studies, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering , Vol 63(2-B), Aug 2002. pp. 1056. Publisher: : Transaction Periodicals Consortium, Rutgers University. ISSN: 0419-4217 (Print) Order Number: AAI3042883 Language: English Key Concepts: community violence; trauma symptoms; future time perspective; homeless; adolescents Abstract: This study investigated the pervasive influence of community violence upon homeless adolescents. It was premised that this population suffers exceptionally high risk for physical assault, sexual abuse, poverty, sexually transmitted diseases, and psychiatric problems. The focus of the study was to determine whether exposure to violence and symptoms of trauma impact future time perspective. Developmental vicissitudes of adolescence were considered as an important context for understanding these concerns. Relationships between community violence exposure, symptoms of posttraumatic stress disorder, and indications of foreshortened future were examined. Associations between demographic variables and foreshortened future were also assessed. Respondents included eighty homeless youth, ages 17-20, that lived in San Francisco homeless shelters. The subjects completed self-report measures for community violence (Survey of Exposure to Community Violence), PTSD (Child Posttraumatic Stress Disorder Reaction Index), foreshortened future (Future Events Test) and demographic variables. A sub-sample was also administered five cards from the Thematic Apperception Test (TAT), which generated narratives illustrating various components of time orientation. Results indicated high levels of direct and secondary victimization from community violence. Nearly 40% endorsed PTSD symptoms within the clinical range. Findings confirmed a significant and positive relationship between community violence and PTSD. Higher exposure corresponded with more severe PTSD. Regression analyses indicated that violence exposure was a predictor (albeit not strong) of foreshortened future. Higher endorsement of violence corresponded with foreshortened future scores. Findings did not show PTSD as a predictor of foreshortened future. However, this outcome may suggest that the avoidant functions of foreshortened future effectively defend against trauma related affects. No significant associations were found between an adapted version of FET scores and the T.A.T. But both measures showed substantial indications of foreshortened and 'idealized' perspectives of the future. The results suggest that foreshortened and idealized fantasies function as defensive strategies, which ward off the press of environmental and intrapsychic conflicts. It was suggested that assessing an individual's future orientation can provide diagnostic information for determining defensive structures. Implications for future research were discussed. _____
Record: 20
Title: Psychosocial treatment of posttraumatic stress disorder: A practice-friendly review of outcome research. Author(s): Solomon, Susan D. , National Inst of Health, Bethesda, MD, US
Johnson, Dawn M. , Brown U, US Address: Solomon, Susan D., National Inst of Health, Office of Behavioral & Social Science Research, One Center Drive, Room 256, Bethesda, MD, US, 20892 Source: Journal of Clinical Psychology , Vol 58(8), Aug 2002. pp. 947-959. Journal URL: http://www.interscience.wiley.com/jpages/0021-9762/ Publisher: US: John Wiley & Sons. Publisher URL: ISSN: 0021-9762 (Print)
1097-4679 (Electronic) Language: English Key Concepts: PTSD; psychodynamic approaches; psychosocial treatment; behavioral techniques; adjustment problems; intrusive symptoms; anxiety management; comorbid diagnoses Abstract: A review of the treatment research indicates that several forms of therapy appear to be useful in reducing the symptoms of posttraumatic stress disorder (PTSD). Strongest support is found for the treatments that combine cognitive and behavioral techniques. Hypnosis, psychodynamic, anxiety management, and group therapies also may produce short-term symptom reduction. Still unknown is whether any approach produces lasting effects. Imaginal exposure to trauma memories and hypnosis are techniques most likely to affect the intrusive symptoms of PTSD, while cognitive and psychodynamic approaches may address better the numbing and avoidance symptoms. Treatment should be tailored to the severity and type of presenting PTSD symptoms, to the type of trauma experience, and to the many likely comorbid diagnoses and adjustment problems. _____
Record: 21
Title: Screening for posttraumatic stress disorder in a general psychiatric outpatient setting. Author(s): Sheeran, Thomas , Brown Medical School/Rhode Island Hosp, Dept of Psychiatry & Human Behavior, Providence, RI, US
Zimmerman, Mark , Brown Medical School/Rhode Island Hosp, Dept of Psychiatry & Human Behavior, Providence, RI, US Address: Zimmerman, Mark, Brown Medical School/Rhode Island Hosp, Dept of Psychiatry & Human Behavior, 235 Plain St, Suite 501, Providence, RI, US, 02905, mzimmerman@lifespan.org Source: Journal of Consulting & Clinical Psychology , Vol 70(4), Aug 2002. pp. 961-966. Journal URL: http://www.apa.org/journals/ccp.html
Publisher: US: American Psychological Assn. Publisher URL: ISSN: 0022-006X (Print) Digital Object Identifier: http://dx.doi.org/10.1037//0022-006X.70.4.961 Language: English Key Concepts: posttraumatic stress disorder; PTSD; Posttraumatic Diagnostic Scale; psychiatric patients; screening tool; diagnosis Abstract: Posttraumatic stress disorder (PTSD) may affect survivors of a number of accidents and illnesses, in addition to violence victims and combat veterans. Prior research suggests that PTSD may be underdiagnosed when trauma is not the presenting problem. Thus, a PTSD screening scale might have utility in routine clinical settings. The authors evaluated the screening performance of the Posttraumatic Diagnostic Scale (PDS) in a general psychiatric setting. Results indicated that the PDS performed as well in this setting as it did in the original trauma-focused validation studies, independent of PTSD status as a primary, versus secondary, reason for presenting. A simple cutoff score was adequate for case identification. There were no gender effects, and the scale performed equally well among patients with, versus without, a depressive diagnosis. _____
Record: 22
Title: Dissociation status and attentional allocation in male Vietnam combat veterans with posttraumatic stress disorder. Author(s): Kaufman, Milissa Lynn , Boston U., US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering , Vol 63(1-B), Jul 2002. pp. 110. Publisher: US: Univ Microfilms International. ISSN: 0419-4217 (Print) Order Number: AAI3040708 Language: English Key Concepts: dissociation; attentional allocation; PTSD; Vietnam combat veterans Abstract: Previous studies using event-related potential (ERP) indices of stimulus information processing have shown that individuals with posttraumatic stress disorder (PTSD) display attentional deficits during presentations of auditory stimuli. However, there have been no studies investigating the potential contribution of co-occurring dissociative symptoms in this disorder with respect to such deficits. Nor have there been studies investigating the extent to which the specific context in which stimulus processing occurs may affect the allocation of attentional resources. The present study utilized an auditory Novelty P300 ERP paradigm to assess patterns of attentional resource allocation in Vietnam veterans with combat-related PTSD (N = 25). Participants were exposed to three affective induction conditions (neutral, generally stressful, and trauma-relevant). Immediately following each condition, they completed a novelty P300 task, which included target tones (10%) and non-repeating distractor sounds (10%). Using a cutoff score of 20 on the Dissociative Experiences Scale (DES), participants were categorized into 'low-DES' (N = 11) and 'high-DES' (N = 14) groups. The extent to which participants in each group reported having dissociative experiences during each condition was also assessed. Findings revealed that individuals in the high-DES group showed significantly smaller P300 amplitudes to distracting novel sounds and delayed responses to distracting and target stimuli. Such findings remained significant following an adjustment for the level of depression. However, findings were not sensitive to context, as P300 amplitude and latency differences were present across conditions. Participants in the high-DES group also reported more acute dissociative symptoms across conditions, although between-group differences were statistically significant during the neutral and generally stressful conditions only, due to a sharp increase in reported dissociative symptoms in the low-DES group during the trauma-relevant condition. Findings indicate that attentional functioning in combat-veterans with PTSD may be less influenced by their PTSD status than by the presence or absence of a concurrent dissociative trait. Individuals in the high-DES group exhibited P300 responses consistent with relatively delayed information processing and a propensity to screen out peripheral environmental stimuli. Replication of this study with a trauma-exposed group without PTSD and dissociative disordered groups will allow for more definitive conclusions with respect to potential clinical relevance. _____
Record: 23
Title: An examination of suppressing thoughts following motor vehicle accidents: Implications for the PTSD diagnosis. Author(s): Shipherd, Jillian Carroll , State U New York At Buffalo, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering , Vol 63(1-B), Jul 2002. pp. 550. Publisher: US: Univ Microfilms International. ISSN: 0419-4217 (Print) Order Number: AAI3039940 Language: English Key Concepts: thought suppression; motor vehicle accidents: PTSD Abstract: The aim of this study was to document the effects of two thought suppression tasks (baseline, suppression, and expression phases) in trauma survivors with and without Posttraumatic Stress Disorder (PTSD). Fifty-five motor vehicle accident (MVA) survivors were classified as having PTSD or No PTSD, and were asked to complete two thought suppression tasks (trauma and neutral). Ratings of mood, subjective distress, control over thoughts, and degree of thought suppression were collected at each phase. Based on previous work in this area (Shipherd & Beck, 1999), it was hypothesized that an increase in thoughts following suppression (rebound effect) would be replicated for trauma-related thoughts in the PTSD participants. In contrast, it was hypothesized that there would not be a rebound effect with the No PTSD survivors. Results from this investigation demonstrated that the rebound effect replicated in the PTSD group for trauma-related thoughts. Specifically, PTSD participants were able to suppress thoughts about their MVA, and then experienced an increase in the frequency of these thoughts. In contrast, the No PTSD MVA survivors suppressed thoughts successfully, with no rebound effect. Overall, the PTSD group reported less positive affect, more subjective distress, and more attempts to suppress their thoughts than the No PTSD participants; during the MVA thought suppression task. However, ratings of control over thoughts, mood, and distress did not vary across the phases. The generalizability of the rebound effect was examined by including personally relevant, neutral thought suppression task (daily activities). During this task, both the PTSD and No PTSD participants reported high levels of thought suppression during all phases, regardless of the experimental instructions. Thus, due to an absence of compliance with the experimental instructions, no conclusions were drawn from the neutral thought suppression data. Implications of the data from the MVA suppression task are discussed in relationship to the diagnosis and treatment of PTSD. _____
Record: 24
Title: Occupational effects of stalking. Author(s): Abrams, Karen M. , karen.abrams@utoronto.ca, U Toronto, Toronto, ON, Canada
Robinson, Gail Erlick , U Toronto, Toronto, ON, Canada Source: Canadian Journal of Psychiatry , Vol 47(5), Jun 2002. pp. 468-472. Journal URL: http://www.cpa-apc.org/Publications/cjpHome.asp Publisher: Canada: Canadian Psychiatric Assn. Publisher URL: ISSN: 0706-7437 (Print) Language: English Key Concepts: stalking; victimization; psychiatric consequences; social consequences; occupation Abstract: This case report and discussion describe the psychiatric and social consequences of being a stalking victim, with particular focus on its impact on the victim's occupation. Data were gathered from the assessment and arbitration hearing of a 37-yr-old female airline employee who lost her job while being stalked. Computerized literature searches were used to identify relevant papers from psychiatric and legal journals. This case illustrates many of the common features of stalking. The female victim was harassed by a male after a failed intimate relationship. The victim suffered from depression, anxiety, guilt, shame, helplessness, humiliation, and posttraumatic stress disorder (PTSD). The stalking affected her psychological, interpersonal, and occupational functioning. Consequently, she was fired for poor work performance and poor attendance. Results show that stalking may affect a victim's ability to work in several ways. The criminal behaviors often interfere directly with work attendance or productivity and result in the workplace becoming an unsafe location. Further, stalking may indirectly affect a person's ability to work through the many adverse emotional consequences suffered. _____
Record: 25
Title: Are the neural substrates of memory the final common pathway in posttraumatic stress disorder (PTSD)? Author(s): Elzinga, B. M. , U Amsterdam, Dept of Clinical Psychology, Amsterdam, Netherlands
Bremner, J. D. , Emory U School of Medicine, Dept of Psychiatry, Emory Ctr for Positron Emission Tomography, Atlanta, GA, US Address: Elzinga, B. M., U Amsterdam, Dept of Clinical Psychology, Roetersstraat 15, 1018 WB, Amsterdam, Netherlands, kp_elzinga@macmail.psy.uva.nl Source: Journal of Affective Disorders , Vol 70(1), Jun 2002. pp. 1-17. Journal URL: http://www.elsevier.com/inca/publications/store/5/0/6/0/7/7/ Publisher: Netherlands: Elsevier Science Publishers BV. Publisher ISSN: 0165-0327 (Print) Language: English Key Concepts: PTSD; memory; hippocampus; amygdala; prefrontal cortex; models; stress reactions; recall; emotional responses; traumatic information Abstract: A model for PTSD as a disorder of memory is presented drawing both on psychological and neurobiological data. Evidence on intrusive memories and deficits in declarative memory function in PTSD patients is reviewed in relation to 3 brain areas that are involved in memory functioning and the stress response: the hippocampus, amygdala, and the prefrontal cortex. Neurobiological studies have shown that the noradrenergic stress-system is involved in enhanced encoding of emotional memories, sensitization, and fear conditioning, by way of its effects on the amygdala. Chronic stress also affects the hippocampus, a brain area involved in declarative memories, suggesting that hippocampal dysfunction may partly account for the deficits in declarative memory in PTSD-patients. Deficits in the medial prefrontal cortex, a structure that normally inhibits the amygdala, may further enhance the effects of the amygdala, thereby increasing the frequency and intensity of the traumatic memories. Thus, exposure to severe stress may simultaneously result in strong emotional reactions and in difficulties to recall the emotional event. This model is also relevant for understanding the distinction between declarative and non-declarative memory-functions in processing trauma-related information in PTSD. _____
Record: 26
Title: Characterizing the effects of sertraline in post-traumatic stress disorder. Author(s): Davidson, Jonathan R. T. , Duke U, Medical Ctr, Dept of Psychiatry & Behavioral Sciences, Durham, NC, US
Landerman, L. R. , Duke U, Medical Ctr, Dept of Psychiatry & Behavioral Sciences, Durham, NC, US
Farfel, G. M. , Duke U, Medical Ctr, Dept of Psychiatry & Behavioral Sciences, Durham, NC, US
Clary, C. M. , Duke U, Medical Ctr, Dept of Psychiatry & Behavioral Sciences, Durham, NC, US Address: Davidson, Jonathan R. T., Duke U Medical Ctr, Box 3812, Durham, NC, US, 27710 Source: Psychological Medicine , Vol 32(4), May 2002. pp. 661-670. Journal URL: http://uk.cambridge.org/journals/psm/ Publisher: US: Cambridge Univ Press. ISSN: 0033-2917 (Print) Language: English Key Concepts: efficacy of sertraline; individual symptoms; changes in anger; posttraumatic stress disorder; PTSD Abstract: Sertraline has a proved efficacy in post-traumatic stress disorder (PTSD), but it is unknown which symptoms respond or in what sequence this occurs. The study examined the effects of sertraline on the 17 individual symptoms of PTSD. It also examined whether early changes in anger explained drug-induced change in other symptoms over time. Mixed models analysis was applied to datasets from 2 12-wk placebo-controlled trials of sertraline. Treatment efficacy was assessed with the validated self-rated Davidson Trauma Scale (Davidson et al, 1997). Sertraline was superior to placebo on 15 of 17 symptoms, especially in the numbing and hyperarousal clusters. A strong effect was found on anger from wk 1, which partly explained the subsequent effects of sertraline on other symptoms, some of which began to show significantly greater response to drug than to placebo at wk 6 (emotional upset at reminders, anhedonia, detachment, numbness, hypervigilance) and wk 10 (avoidance of activities, foreshortened future). Sertraline exercises a broad spectrum effect in PTSD. Effects are more apparent on the psychological rather than somatic symptoms of PTSD, with an early modulation of anger and, perhaps, other affects, preceding improvement in other symptoms. _____
Record: 27
Title: Effects of posttraumatic stress disorder and child sexual abuse on self-efficacy development. Author(s): Diehl, Amy S. , Assessment & Treatment Alternatives, Philadelphia, PA, US
Prout, Maurice F. , Widener U, Inst of Graduate Clinical Psychology, School of Human Service Professions, Chester, PA, US Address: Prout, Maurice F., Widener U, Inst of Graduate Clinical Psychology, School of Human Service Professions, One University Place, Chester, PA, US, 19013-5792 Source: American Journal of Orthopsychiatry , Vol 72(2), Apr 2002. pp. 262-265. Publisher: US: American Psychological Assn/Educational Publishing Foundation. Publisher URL: http://www.apa.org ISSN: 0002-9432 (Print) Digital Object Identifier: http://dx.doi.org/10.1037//0002-9432.72.2.262 Language: English Key Concepts: posttraumatic stress disorder; child sexual abuse; coping skills; self-efficacy; treatment effects Abstract: Discusses how the symptoms of child sexual abuse and posttraumatic stress disorder (PTSD) affect a child's self-efficacy. A child's self-efficacy beliefs impact the course and treatment of PTSD, because perceived self-efficacy plays a mediating role in children's ability to cope with trauma. Self-efficacy research indicates that emotional competence can be learned and may provide treatment for PTSD that provides symptom reduction as well as a means of substituting problem-solving coping skills for emotion-focused coping skills. _____
Record: 28
Title: Evaluating the effectiveness of a group treatment program: Integrating neurobiology, post-traumatic stress disorder, and childhood trauma literature. Author(s): Fujimoto, Kevin Lee , Pepperdine U., US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering , Vol 62(8-B), Mar 2002. pp. 3799. Publisher: US: Univ Microfilms International. ISSN: 0419-4217 (Print) Order Number: AAI3024464 Language: English Key Concepts: effectiveness; group treatment; psychoeducation; PTSD; catharsis Abstract: Research has demonstrated that childhood abuse may negatively alter cognition, affect, and behavior throughout the lifespan (Briere, 1992; van der Kolk, 1988). PTSD related to childhood abuse has been increasingly associated with impaired memory functioning and neurobiological alterations (Briggs & Joyce, 1997; van der Kolk & Fisler, 1995). A review of the trauma and child abuse literature incorporates recent research from various theoretical perspectives. In addition, the effectiveness of a treatment program is evaluated based on the literature review. Specifically, an inpatient program that utilized cathartic interventions within a supportive psycho-educational group context was examined. Catharsis was considered a critical treatment component because it is hypothesized to provide access to the implicit memory system (subcortical neural-networks) and allow traumatic experiences to reemerge (Levitt & Pinnell, 1995). Additional higher-order processing and subsequent development of explicit memory may increase impulse control, diminish PTSD symptoms, and decrease depression (Squire, 1992; Zola-Morgan & Squire, 1990). The group modality was utilized to address common issues faced by abuse victims and provide interpersonal support and validation during the expression of powerful affect. Archival data collected from treatment seeking individuals suffering from the effects of negative childhood experiences including abuse and neglect was analyzed. An experimental group (N = 68) that completed the treatment program was compared to a non-treatment group (N = 15) to determine treatment effectiveness. Specified symptoms, PTSD symptomatology (Los Angeles Symptom Checklist), anxiety (Minnesota Multiphasic Personality Inventory (MMPI) Scale 7 and A Scale), and depression (MMPI Scale 2 and the Beck Depression Inventory) were assessed. It was hypothesized that treatment subjects would report decreased levels of symptoms when contrasted with the comparison group following treatment. A MANOVA revealed no significant differences between groups for PTSD symptoms, anxiety, or depression. A clinical significance analysis also revealed that experimental subjects and no-treatment comparison subjects improved over time on all variables at the nine-month follow-up period. Possible reasons for the lack of statistical findings are given and suggestions for future research are presented. _____
Record: 29
Title: Post-traumatic stress disorder symptomatology among american indian vietnam veterans: Mediators and moderators of the stress-illness relationship. Author(s): Dempsey, Catherine Lisle , U Colorado At Denver, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering , Vol 62(7-B), Feb 2002. pp. 3153. Publisher: US: Univ Microfilms International. ISSN: 0419-4217 (Print) Order Number: AAI3021498 Language: English Key Concepts: stress illness relationship; PTSD; American Indians; veterans Abstract: Results from the National Vietnam Veterans Readjustment Study (NVSRS) reported high rates of Post-traumatic Stress Disorder (PTSD) among Vietnam Theater veterans compared to rates in the Vietnam Era and others of the veterans' generation. Prevalence rates were even higher among minority groups, specifically Blacks and Hispanics. Results from the American Indian Vietnam Veterans Project (AIVVP) suggested that American Indian Vietnam veterans were also at increased risk for PTSD. However, not all American Indian veterans with high levels of trauma exposure developed PTSD, which suggests that other contributing factors specific to American Indian populations may also affect their vulnerability to PTSD outcomes. The objective of this study was to identify potential predictors of PTSD symptomatology across three military timeframes and to examine the relationships among personal resources, trauma, and PTSD symptomatology in American Indian Vietnam veterans. It was hypothesized that high levels of social support and ethnic identity may enhance one's psychosocial resilience to stress, resulting in positive health outcomes. This study was based on AIVVP data collected by the National Center for American Indian and Alaska Native Mental Health Research (NCAIANMHR) at the University of Colorado Health Sciences Center. Interviews with 621 American Indian Vietnam veterans living on or near their reservations assessed predisposing factors, characteristics of military service, military and nonmilitary trauma, personal resources, and PTSD symptomatology. The results of hierarchical linear regression analyses showed a strong relationship between social support and PTSD symptomatology across all time flames. Although results did not support the stress-buffering hypothesis, combat trauma and social support during the military interacted significantly. In addition, post-military social support appeared to mediate the relationship between trauma and PTSD symptomatology. Identifying a relationship between social support and PTSD has implications for the development of interventions used to treat PTSD in ethnic minorities. The impact of personal resources on PTSD symptomatology may be important for traumatic survivors and long-term strategies for victims of PTSD. _____
Record: 30
Title: Posttraumatic stress disorder: The perspectives of object relations and self psychology in individual and group psychodynamic psychotherapy with Vietnam militar combat veterans. Author(s): Kost, Linda S. , Rutgers The State U New Jersey, Graduate School Of Applied And Professional Psychology, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering , Vol 62(7-B), Feb 2002. pp. 3381. Publisher: US: Univ Microfilms International. ISSN: 0419-4217 (Print) Order Number: AAI3018848 Language: English Key Concepts: object relations; PTSD; self psychology; psychodynamic psychotherapy; Vietnam combat veterans Abstract: This dissertation comprises an exploration and integration of the psychodynamic literature about posttraumatic stress disorder (PTSD) in Vietnam combat veterans, illustrated with case material from two individual psychotherapy cases and two PTSD groups conducted at a Veterans Affairs Medical Center. Object relations and self psychology theories were used to explore questions about how to formulate the nature of PTSD symptoms and the effects of symptoms on an individual's life, to elucidate the individual and societal meaning of Vietnam-related trauma, and to treat combat-related PTSD. The dissertation reviews selected works of psychodynamic clinicians since Freud that relate to war veterans, including authors who address the complex PTSD that affects Vietnam veterans. The theories of Klein, Fairbairn, Winnicott, Balint, Bion, Kernberg, Kohut, and Wolf are reviewed, as are authors who apply these theories to individual and group treatment of Vietnam-related PTSD. Object relations and self psychology theories applied to the case material include Fairbairn's notions of internal splitting and repression of bad objects, the moral defense, and the tripartite ego, and Winnicott's concepts of a good-enough holding environment, transitional phenomena, false self, and true self. The self psychology concepts of self-cohesion, selfobject transferences, and central organizing narcissistic fantasies are also applied. Unique aspects of the Vietnam War that contributed to developmental disturbances are presented. The wartime disruption of Erikson's chief adolescent developmental tasks, establishment of identity and capacity for intimacy, resulted in PTSD symptoms-loss of basic trust, alienation, lack of values and goals, identity diffusion, a sense of being 'split' into an omnipotent killer and an ashamed victim, chronic unmet needs for mirroring and idealizing, and vulnerability to self-fragmentation experiences-that are especially aptly addressed by object relations and self psychology. The purpose of this integrative and qualitative study was to explore the phenomenology of PTSD and recurrent clinical themes. _____
Record: 31
Title: Preventing traumatic stress: Public health approaches. Author(s): Sorenson, Susan B. , U California, School of Public Health, Los Angeles, CA, US Source: Journal of Traumatic Stress , Vol 15(1), Feb 2002. pp. 3-7. Journal URL: http://www.wkap.nl/journalhome.htm/0894-9867 Publisher: US: Kluwer Academic/Plenum Publishers. Publisher URL: ISSN: 0894-9867 (Print) Language: English Key Concepts: public health; policy; prevention; PTSD; stressors; trauma Abstract: Population-based approaches to the primary prevention of posttraumatic stress disorder (PTSD) focus on the prevention of the stressor itself. Policy decisions also consider ways to allocate resources to best reduce potential damage from traumatic stressors and to ameliorate any resulting harm. A balance between broad risk prevention approaches and narrower treatment and recovery strategies can redistribute the risk of exposure and lead to fewer cases. Understanding that PTSD and its costs affect not only individuals who seek care, but also many others whose lives overlap with these individuals as well as society as a whole, further informs and shapes prevention decisions. _____
Record: 32
Title: Facial affect recognition in post-traumatic stress disorder. Author(s): Sta.Maria, Nelly Lorenzo , St. John'S U., NY, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering , Vol 63(6-B), Jan 2002. pp. 3026. Publisher: US: Univ Microfilms International. ISSN: 0419-4217 (Print) Order Number: AAI3058274 Language: English Key Concepts: facial affect recognition; PTSD Abstract: Three groups of adults were compared on their ability to recognize emotions. One group consisted of 18 subjects diagnosed with Post Traumatic Stress Disorder (PTSD), another consisted of 18 subjects with no psychiatric diagnoses (Normal Controls), and another consisted of 18 trauma-exposed subjects without PTSD (Trauma Controls). The emotional expressions tested were fear, anger, disgust, sadness, surprise, and happiness. Participants labeled and rated the intensity of photographs of facial expressions from the Ekman and Friesen series of photographs. An analysis of the error rates suggested that PTSD patients made more errors in emotion recognition than Normal Controls. The analysis also indicated that the PTSD group made significantly more errors in recognizing fear than any other emotion. All three groups made the fewest errors to the happy stimuli. There were no group differences in intensity ratings. Implications of these findings and suggestions for future research were discussed. _____
Record: 33
Title: Ueberlebende von folter. Eine studie zu komplexen postraumatischen belastungsstoerungen. Translated Title: Survivors of torture: A study of complex posttraumatic stress disorders. Author(s): Teegen, Frauke , U Hamburg, Psychologisches Inst III, Hamburg, Germany
Vogt, Silke , U Hamburg, Psychologisches Inst III, Hamburg, Germany Source: Verhaltenstherapie & Verhaltensmedizin , Vol 23(1), 2002. pp. 91-106. Publisher: Germany: Pabst Science Publishers. Publisher URL: http://www.pabst-publishers.de ISSN: 1013-1973 (Print) Language: German Key Concepts: torture; PTSD; survivors; screening instrument; symptoms
Abstract: The objective of this study was to question survivors of torture about the context and kind of the sustained torture and to administer a screening of lasting physical sequelae and symptoms of PTSD. Assuming that the experience of torture leads to very comprehensive trauma related syndromes, the construct of complex PTSD was additionally included. As item version was constructed on the basis of the Structured Interview of Disorders for Extreme Stress, which captures changes in affect regulation, self-perception, relationship capability, systems of meaning as well as somatic disorders. 33 survivors participated (male and female; mean age 41 yrs old). When experiencing torture for the first time, 21% were younger than 16 yrs old. 83% sustained lasting physical damage. PTSD was diagnosed in 94%. In addition to the syndrome of PTSD, two thirds exhibited the entire syndrome of a complex PTSD. _____
Record: 34
Title: Approaches to the treatment of PTSD. Author(s): van der Kolk, Bessel A. , Trauma Clinic, Brookline, MA, US
van der Hart, Onno , Mental Health Ctr, Amsterdam, Netherlands
Burbridge, Jennifer , Washington U, St Louis, MO, US Source: Williams, Mary Beth (Ed); Sommer, John F. JR (Ed); 2002. Simple and complex post-traumatic stress disorder: Strategies for comprehensive treatment in clinical practice. Binghamton, NY, US: Haworth Maltreatment and Trauma Press/The Haworth Press, Inc. pp. 23-45 ISBN: 0-7890-0297-3 (hardcover)
0-7890-0298-1 (paperback) Language: English Key Concepts: posttraumatic stress disorder; therapeutic relationship; treatment Abstract: Lack of predictability and controllability are the central issues for the development and maintenance of posttraumatic stress disorder (PTSD). The combination of intrusive and numbing symptoms have been consistently noted over the past century and forms the basis of understanding of the nature of PTSD. The therapeutic relationship with PTSD patients tends to be extraordinarily complex, confronting all participants with intense emotional experiences. The effects of trauma affect modulation, attention, perception, and the giving and taking of pleasure. Because the core problem in PTSD consists of a failure to integrate an upsetting experience into autobiographical memory, the goal of treatment is to find a way in which people can acknowledge the reality of what has happened without having to reexperience the trauma all over again. The treatment of PTSD has 3 principal components: (1) processing and coming to terms with the horrifying, overwhelming experience; (2) controlling and mastering physiological and biological stress reactions; and (3) reestablishing secure social connections and interpersonal efficacy. _____
Record: 35
Title: Imagery rescripting: A new treatment for survivors of childhood sexual abuse suffering from posttraumatic stress. Author(s): Smucker, Mervin R. , Medical Coll of Wisconsin, Milwaukee, WI, US
Dancu, Constance , Ctr for Cognitive & Behavioral Therapy, Wilmington, DE, US
Foa, Edna B , Medical Coll of Philadelphia, Dept of Psychiatry, Philadelphia, PA, US
Niederee, Jan L. Source: Leahy, Robert L. (Ed); Dowd, E. Thomas (Ed); 2002. Clinical advances in cognitive psychotherapy: Theory and Application. New York, NY, US: Springer Publishing Co. pp. 294-310 ISBN: 0-8261-2306-6 (hardcover) Language: English Key Concepts: imagery rescripting; childhood sexual abuse survivors; PTSD; cognitive restructuring; personal empowerment Abstract: Imagery rescripting is presented as a new treatment of posttraumatic stress disorder (PTSD) for adult survivors of childhood sexual abuse. A theoretical discussion illustrates the model's consistency with schema theory and information processing models of PTSD, and suggests that the rescripting process may affect change in pathological schemas associated with interpretation of the traumatic event(s). It is proposed that this combination of imaginal exposure, mastery imagery, and cognitive restructuring goes beyond extinction models to alter recurring images of the trauma and create more adaptive schemas. Hypothesized mechanisms for PTSD symptom reduction are presented, implications for cognitive restructuring are noted, and the model's potential for facilitating personal empowerment and self-nurturance are discussed. Preliminary outcome research data are summarized that support the efficacy of imagery rescripting in significantly reducing PTSD symptomatology with this population. _____
Record: 36
Title: Journalists, war and post traumatic stress disorder. Author(s): Feinstein, Anthony , U Toronto, Sunnybrook & Women's Health Science Ctr, Neuropsychiatry Program, Toronto, Canada
Owen, John Source: Danieli, Yael (Ed); 2002. Sharing the front line and the back hills: International protectors and providers: Peacekeepers, humanitarian aid workers and the media in the midst of crisis. Amityville, NY, US: Baywood Publishing Co, Inc. pp. 305-315 ISBN: 0-89503-263-5 (hardcover) Language: English Key Concepts: journalists; war; posttraumatic stress disorder (PTSD); trauma; war; psychological distress; stress; treatment; psychological difficulties Abstract: In this study of how war journalists deal with the stresses and physical dangers of their work, approximately one in five journalists was found to have "probable" Post Traumatic Stress Disorder (PTSD) while one in three showed evidence of psychological distress. Some of the large news organizations have belatedly discovered that war journalists are at risk for disorders such as PTSD. While confidential psychiatric help is now offered to war journalists within these organizations, the same does not apply to freelance journalists. The latter also lack the logistical back-up provided by the large organizations to their journalists in the field. Thus, the freelancer is potentially at greater risk for developing more frequent and enduring psychological difficulties. PTSD is potentially a chronic disorder. It also impacts on the quality of life and is known to affect the lives of family members too. For all these reasons, it behoves the news organizations to provide speedy access to therapy for their staff and any freelance journalists whom they may employ on a contract basis. It is equally important that no stigma be attached to those journalists requiring therapy. _____
Record: 37
Title: Gender issues in couple and family therapy following traumatic stress. Author(s): Byrne, Christina A. , Western Washington U, Dept of Psychology, Bellingham, WA, US
Riggs, David S. , U Pennsylvania School of Medicine, Ctr for the Treatment & Study of Anxiety, Philadelphia, PA, US Source: Kimerling, Rachel (Ed); Ouimette, Paige (Ed); et al; 2002. Gender and PTSD. New York, NY, US: Guilford Press. pp. 382-399 ISBN: 1-57230-783-8 (hardcover) Language: English Key Concepts: posttraumatic stress disorder; gender differences; couples therapy; family therapy; treatment outcomes Abstract: The potential for psychological trauma to result in negative consequences for individuals who directly experience traumatic events is well documented. Traumatic events and their consequences may also affect family members, intimate partners, and others close to the traumatized individual. Clinicians and researchers have emphasized the potential value of incorporating couple and/or family therapy in treatment programs for individuals suffering from posttraumatic stress disorder (PTSD) and other difficulties following psychological trauma. When utilizing family and couple approaches in the treatment of trauma survivors, it is important to consider how gender may influence the process. Gender may also be linked to individuals' perceptions of relationship dynamics, such as social support, that may impact the efficacy of family and couple-based interventions. Furthermore, there are gender differences in the types of traumas individuals are most likely to experience. Thus, in this chapter, as we review findings related to inclusion of intimate partners and family members in treatment for psychological sequelae of trauma, we draw attention to gender-related issues essential in understanding and applying these findings. _____
Record: 38
Title: Tools for transforming trauma. Author(s): Schwarz, Robert Source: 2002. New York, NY, US: Brunner-Routledge. xii, 260 pp. ISBN: 1-583-91341-6 (paperback) Language: English Key Concepts: trauma; abuse; treatment; dissociative disorder; psychotherapeutic techniques Abstract: Among the many challenges faced by therapists is the treatment of trauma and abuse. Based upon a framework that integrates a wide range of therapeutic theories of PTSD and techniques, including Ericksonian, solution-oriented, and hypnotherapeutic approaches, this book provides clinicians with specific skills for treating traumatized individuals. Detailed, how-to instructions for the implementation of over 30 "tools" throughout the different phases of treatment make this book a resource for anyone working with trauma, abuse, and dissociative disorders. The book provides the reader with tools for transforming trauma in diverse areas such as affect dysregulation, ego strengthening, transforming negative memories, the false memory controversy, working with beliefs, cultivating a positive life, energy work, spirituality, and managing the therapeutic relationship during the process of healing. Table of Contents: Acknowledgments
Introduction
..Understanding how trauma leads to PTSD
..A Neo-Eriksonian framework for treating trauma
..The tools framework
..Tools for safety, ego support, and ego growth
..Tools for transforming traumatic memory
..The use of thought field therapy in treating trauma
..Tools for the holistic self
..If you meet the "tool" on the road, leave it! Person-of-the-therapist issues
Integration and summary: Beyond tools and trauma
Epilogue: Tools for transforming terrorism
References
Index _____
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Title: Trauma, Reizschutz und traumatische Neurose Versuch einer Klaerung der Konzepte Freuds. Translated Title: Trauma, stimulus barrier and traumatic neurosis. An attempted clarification of Freud's concepts. Author(s): Zepf, Siegfried Address: Zepf, Siegfried, Inst fuer Psychoanalyse, Psychotherapie und Psychosomatische Medizin, Haus 2, Universitaetskliniken des Saarlandes, 66421, Homburg/Saar, Germany Source: Forum der Psychoanalyse: Zeitschrift fuer klinische Theorie & Praxis , Vol 17(4), Dec 2001. pp. 332-349. Journal URL: http://link.springer.de/link/service/journals/00451/index.htm Publisher: Germany: Springer-Verlag. ISSN: 0178-7667 (Print)
1437-0751 (Electronic) Language: German Key Concepts: traumatic neurosis; stimulus barrier; Freudian theory; emotional trauma; PTSD Abstract: Examines Freud's concepts of trauma, stimulus barrier and traumatic neurosis in the light of recent findings and gives a systematic presentation in terms of Freudian theory. Stimulus barrier is regarded as a biological concept. In mental life it appears as the striving to avoid unpleasant affects. Trauma is a twofold concept, in that it relates to mental experience and links an external event with the ensuing specific effects on a subject's psychic reality. A distinction must be made between destroying and affective trauma. A destroying trauma does not damage the stimulus barrier but does breach the pleasure-unpleasure principle, thus destroying mental life, so that in the course of later mastery a traumatic neurosis results. An affective trauma can be warded off by means of defense mechanisms under the rule of the pleasure-unpleasure principle and thus results in a psychoneurosis. _____
Record: 40
Title: Substance abuse as a symptom of childhood sexual abuse. Author(s): Teusch, Rita , Boston University School of Medicine, Dept of Psychiatry, MA, US Address: Teusch, Rita, 129 Mt. Auburn Street, Cambridge, MA, US, 02138 Source: Psychiatric Services , Vol 52(11), Nov 2001. pp. 1530-1532. Journal URL: http://psychservices.psychiatryonline.org/ Publisher: US: American Psychiatric Assn. Publisher URL: ISSN: 1075-2730 (Print) Document Link URL: http://ps.psychiatryonline.org/content/vol52/issue11/index.shtml Digital Object Identifier: http://dx.doi.org/10.1176/appi.ps.52.11.1530 Language: English Key Concepts: adult onset PTSD; childhood sexual abuse; substance abuse as symptom; recovery process Abstract: The recovery process of a 37-yr-old woman with adult onset posttraumatic stress disorder (PTSD) is presented. The patient had suffered childhood sexual abuse and had self-medicated for many years with drugs and alcohol to maintain the dissociation of memories of abuse and to facilitate interpersonal functioning. Upon onset of PTSD, the patient's substance abuse became a full-blown addiction that was highly resistant to treatment. It became evident that her substance abuse symbolically repeated her traumatization. In reexperiencing the affects associated with her earlier trauma (despair, denial, shame, and helplessness) as part of her substance abuse and in the transference, the patient was able to gain mastery over these affects and, subsequently, was able to achieve a stable recovery from both illnesses. _____
Record: 41
Title: "Affect without recollection" in post-traumatic stress disorder where head injury causes organic amnesia for the event. Author(s): King, Nigel S. , Warneford Hosp, Headington, Isis Education Ctr, Oxford, United Kingdom Address: King, Nigel S., Oxford Doctoral Course in Clinical Psychology, Isis Education Centre, Warneford Hospital, Headington, Oxford, United Kingdom, OX3 7JX, nigel.king@oxmhc-tr.anglox.nhs.uk Source: Behavioural & Cognitive Psychotherapy , Vol 29(4), Oct 2001. pp. 501-504. Journal URL: http://uk.cambridge.org/journals/bcp/ Publisher: US: Cambridge Univ Press. Publisher URL: ISSN: 1352-4658 (Print) Language: English Key Concepts: posttraumatic stress disorder; PTSD; head injury; affect without recollection; organic amnesia Abstract: A. Ehlers and D. L. Clark (2000) recently published a rigorous cognitive behavioral model of posttraumatic stress disorder (PTSD). Part of the model explains how the phenomenon of "affect without recollection" can emerge in posttraumatic stress disorder (PTSD). This happens when the re-experiencing phenomena occur without explicit or conscious recall of the parts of the traumatic event from whence the phenomena originated. The following paper presents a case study of a man (aged 32 yrs) with posttraumatic stress disorder (PTSD) and head injury in which there was complete organic amnesia for the trauma but where re-experiencing of the event occurred via implicit conditioned responses to reminders of the event. It provides elegant supportive evidence for the phenomenon of "affect without recollection" where both posttraumatic stress disorder (PTSD) and severe head injury are present. _____
Record: 42
Title: Bilingual code-switching (CS) as a mediator in the processing posttraumatic stress disorder (PTSD) traumatic memories (TM): A manual for therapists. Author(s): Madrid, Paula Andrea , U Hartford, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering , Vol 62(4-B), Oct 2001. pp. 2067. Publisher: US: Univ Microfilms International. ISSN: 0419-4217 (Print) Language: English Key Concepts: bilingual code switching; PTSD; traumatic memories Abstract: This dissertation explores the notion that a bilingual's ability to code-switch (CS), a bilingual's tendency when speaking with other bilinguals to switch from one language to another during a conversation, can be a mediating tool in processing bilinguals posttraumatic stress disorder (PTSD) traumatic memories (TM). One of the phases of PTSD treatment involves extensive work on TM. A literature review including relevant concepts, theories, and ideas on posttraumatic stress disorder-traumatic memories, psycholinguistic aspects of bilinguals and bilingualism is presented in the introductory section. The later sections focus on a discussion and conceptualization of material into an explanation of the hypothesis that bilinguals can and often use their two languages in a way that serves as defense mechanisms that allow them to cope with anxiety or overwhelming affect. Similarly, bilinguals may use their more affect-laden language to increase the degree of affective closeness with what they are saying. This dissertation elaborates and substantiates the idea that manipulating and directing a patient's CS is likely to lead to increased emotional distance, thus controlling the patient's affect with the purpose of maintaining feelings of safety, or to increased access and processing of the traumatic memory, both of which are necessary aspects of trauma work. A therapist's manual is included which consists of an assessment component and instructions for the appropriate usage of CS to process TM. It also includes a review of five phases of TM treatment as well as the role of CS in each of them. _____
Record: 43
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
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. Journal URL: http://www.elsevier.com/inca/publications/store/5/2/5/4/7/5/ Publisher: US: Elsevier Science. ISSN: 0740-5472 (Print) Digital Object Identifier: http://dx.doi.org/10.1016/S0740-5472(01)00181-7 Language: English Key Concepts: cocaine dependence; posttraumatic stress disorder; psychotherapy; Concurrent Treatment of PTSD & Cocaine Dependence; coping skills; cognitive restructuring; relapse prevention; exposure therapy 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. _____
Record: 44
Title: Treating low-income and African American women with posttraumatic stress disorder: A case series. Author(s): Feske, Ulrike , U Pittsburgh School of Medicine, Pittsburgh, PA, US Address: Feske, Ulrike, Western Psychiatric Inst & Clinic, 3811 O'Hara Street, Pittsburgh, PA, US, 15213, FeskeU@msx.upmc.edu Source: Behavior Therapy , Vol 32(3), Sum 2001. pp. 585-601. Publisher: US: Assn for Advancement of Behavior Therapy. ISSN: 0005-7894 (Print) Language: English Key Concepts: prolonged exposure; PTSD; low-income; African-American; women; general anxiety; depression Abstract: The present uncontrolled case series was designed to examine the feasibility of prolonged exposure (PE) for posttraumatic stress disorder (PTSD) with low-income and African-American women. Five of 10 eligible women completed PE and showed significant improvements in symptoms of PTSD, general anxiety, and depression. Clinical observations suggest that the addition of interventions aimed at improving interpersonal problems might lead to a more complete recovery in this population of women with complex trauma and psychiatric histories and that a priming intervention focused on teaching affect-regulation skills might enhance the effectiveness of PE. The removal of structural barriers (e.g., lack of transportation and child care) appears to be necessary in order to boost the benefits of traditional treatment interventions in disadvantaged women. _____
Record: 45
Translated Title: Prevalence and correlated factors of posttraumatic stress disorder in adolescents 17 months after earthquake.
Author(s): Zhao, Chengzhi , Hebei Normal U, Zhangjiakou, China
Li, Junfu
Wang, Mingshan
Fan, Qiliang
Zhang, Fu
Zhang, Huabiao
Wang, Xiangdong Source: Chinese Mental Health Journal , Vol 15(3), May 2001. pp. 145-147. Publisher: China: Chinese Mental Health. ISSN: 1000-6729 (Print) Language: Chinese Key Concepts: PTSD; traumatic events; disasters; adolescents Abstract: Examined the prevalence and related factors of posttraumatic stress disorder (PTSD) in adolescents 17 mo after an earthquake. Ss were 192 middle school students (aged 14-18 yrs) (8th-9th graders) (107 males and 84 females, 1 sex not indicated) who experienced an earthquake in Dahe village, Zhangbei county, Hebei province, China. Ss were assessed with a demographic information questionnaire, a traumatic event exposure questionnaire, the SCL-90, and a PTSD diagnostic scale which was based on the WHO's Computer International Diagnostic Interview (CIDI)-PTSD module. Multiple linear regression analysis and logistic regression analysis were conducted for studying PTSD-related factors. The results show that 18 Ss (9.4% (18/192)) met diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV); and that the prevalence of PTSD in females (15.5%, (13/84)) was higher than that in male (4.7% (5/107)). The results reveal the most frequently occurring symptom: acting or feeling as if the traumatic event were recurring (74.5%), the least frequently occurring symptom: restricted range of affect (10.4%), and the related factors of PTSD: level of sadness, degree of fear of loss of life, severity of injury, and gender (female). _____
Record: 46
Title: Eye movement desensitization and reprocessing in the psychological treatment of combat-related guilt: A study of the effects of eye movements. Author(s): Cerone, Melanie R. , Temple U., US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering , Vol 61(10-B), May 2001. pp. 5555. Publisher: US: Univ Microfilms International. ISSN: 0419-4217 (Print) Language: English Key Concepts: combat related guilt; Eye Movement Desensitization and Reprocessing; psychological treatment Abstract: The purpose of this study was to investigate the role of eye movements in Eye Movement Desensitization and Reprocessing (EMDR), and to test the efficacy of EMDR in the treatment of guilt associated with combat trauma. EMDR was compared to a non-eye movement (NEM) analog, which entailed the full EMDR procedure minus the eye movements. A single-case multiple component cross-over design across seven participants was utilized. Participants were combat veterans who were receiving inpatient treatment for Posttraumatic Stress Disorder (PTSD) at the Coatesville Veterans Administration Medical Center. Four participants were introduced first to the EMDR condition and three participants were introduced first to the NEM analog condition. Each participant was exposed to both conditions. Dependent measures included: (1) pre- and post-treatment scores on the Clinician Administered PTSD Scale for DSM-IV - One Week Symptom Status Version (CAPS-SX), Beck Depression Inventory (BDI), Impact of Event Scale (IES), and Trauma Related Guilt Inventory (TRGI), (2) self-monitoring data on the frequency and intensity of intrusive thoughts, disturbing dreams, and guilt, and (3) measures of participants' subjective level of distress within sessions and pre- and post-treatment using the Subjective Units of Distress Scale (SUDS). As measured by SUDS ratings, EMDR resulted in a greater decrease in dyphoric affect within-session than the NEM analog. EMDR also resulted in a significant decrease in mean SUDS ratings from pre- to post-treatment. EMDR resulted in significant decreases in combat-related PTSD symptomatology, as measured by pre- and post-treatment scores on the CAPS-SX, BDI, and IES. EMDR also resulted in significant decreases in mean pre- and post-treatment frequency of self-reported intrusive thoughts and mean pre- and post-treatment intensity of intrusive thoughts, disturbing dreams, and guilt. Additionally, EMDR resulted in a significant decrease in pre- and post-treatment scores on one scale and two subscales of the TRGI. No differences in the mean frequency and intensity of self-reported intrusive thoughts, disturbing dreams, and guilt were detected between EMDR and the NEM analog. Results of the present study support the role of eye movements in attaining treatment gains with EMDR. Additionally, this study supports the efficacy of EMDR in the treatment of combat-related guilt. _____
Record: 47
Title: Assessment of self-reported symptom validity among sexually abused children. Author(s): Fricker, Adrienne Elizabeth , U Arkansas, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering , Vol 61(9-B), Apr 2001. pp. 4981. Publisher: US: Univ Microfilms International. ISSN: 0419-4217 (Print) Language: English Key Concepts: child sexual abuse; distress; disclosure; self reported symptoms Abstract: Research suggests several factors may affect children's decisions of whether to disclose, recant, or deny child sexual abuse (CSA) (Sorenson & Snow, 1991). These same factors may affect children's presentation on assessment measures. Elliott and Briere (1994) provided an empirical demonstration of the impact of disclosure status on children's self-reported symptoms on the Trauma Symptom Checklist for Children (TSCC) which suggested that multiple factors should be taken into consideration when assessing sexually abused children's level of distress. Most current measures used to assess CSA effects are not abuse-specific and do not include validity scales to measure response set. The TSCC is both abuse-specific and has validity scales; however, the validity scales were created after the normative sample was completed. In the present study, 41 CSA victims between 8 and 17 years completed the TSCC and a generic measure of functioning, the Personality Inventory for Youth (PIY). This study compared the TSCC's and PIY's validity scales, and assessed whether the TSCC was more sensitive to abuse-specific sequelae than the PIY. Abuse characteristics and disclosure were examined as to their relation to response set and level of distress on the TSCC. Results suggested that the TSCC's validity scales, while similar to the PIY's scales, were more conservative in altered response detection. Further, results supported the hypothesis that the TSCC was more sensitive to PTSD diagnosis than the PIY. This study failed to replicate Elliott and Briere's (1994) findings that disclosure was related to symptoms. However, several relations were detected among abuse characteristics, level of symptoms, and altered responding. The findings of this study suggest that the TSCC, or other abuse specific measures, may be a critical addition in assessment of CSA victims, as more generic measures are less sensitive in detection of distress level. This study also provides some support for the position that certain abuse characteristics are associated with children's altered responding and level of symptoms. Further, this study suggests that denial of symptoms may not represent lack of distress, and thus, an evaluation of response set must be included in an assessment protocol for CSA victims. _____
Record: 48
Title: Clinical features of survivors of sexual abuse with major depression. Author(s): Zlotnick, Caron , Butler Hosp, Providence, RI, US
Mattia, Jill
Zimmerman, Mark Source: Child Abuse & Neglect , Vol 25(3), Mar 2001. pp. 357-367. Journal URL: http://www.elsevier.com/inca/publications/store/5/8/6/ Publisher: US: Elsevier Science Inc. ISSN: 0145-2134 (Print) Language: English Key Concepts: childhood sexual abuse; suicidal attempts; affect dysregulation; PTSD; borderline personality disorder; outpatients with major depression; psychiatric comorbidity Abstract: Examined differences in rates of trauma-related disorders between patients with histories of childhood sexual abuse (CSA) and those without such histories in a sample of depressed outpatients. Another aim of this study was to determine whether CSA is associated with recent suicidal attempts, affect dysregulation and duration of index depressive episode, independent of posttraumatic stress disorder (PTSD) and borderline personality disorder (BPD). Ss were 235 treatment-seeking outpatients with major depression. Structured interviews were administered to assess for Axis I and Axis II disorders, CSA, and various clinical features. Patients with sexual abuse compared to those without sexual abuse histories had higher rates of comorbidity, primarily BPD, PTSD and multiple Axis I diagnoses. CSA status was linked to a longer duration of the index depressive episode, independent of BPD and/or PTSD. However, CSA status was not independently related to affect dysregulation and suicidal attempts. The findings suggest that patients with histories of sexual abuse represent a subgroup of depressed patients who are at especially high risk for psychiatric morbidity and a prolonged episode of depression. _____
Record: 49
Title: Affect management in group therapy for women with posttraumatic stress disorder and histories of childhood sexual abuse. Author(s): Wolfsdorf, Barbara A. , Boston VA Outpatient Clinic, Psychology Service, Boston, MA, US
Zlotnick, Caron Source: Journal of Clinical Psychology , Vol 57(2), Feb 2001. Special Issue: Treating emotion regulation problems in psychotherapy. pp. 169-181. Journal URL: http://www.interscience.wiley.com/jpages/0021-9762/ Publisher: US: John Wiley & Sons. Publisher URL: ISSN: 0021-9762 (Print)
1097-4679 (Electronic) Digital Object Identifier: http://dx.doi.org/10.1002/1097-4679(200102)57:2<169::AID-JCLP4>3.0.CO;2- 0 Language: English Key Concepts: affect management group based on stage approach to treatment of trauma, female adult survivors of childhood sexual abuse with PTSD Abstract: Affect dysregulation is pervasive among women with histories of childhood sexual abuse. It is an important aspect of the clinical presentation of posttraumatic stress disorder (PTSD), a disorder that frequently characterizes survivors of childhood abuse. Based on distinctions between approach and avoidance orientations to coping, there is controversy regarding whether initial treatment for trauma survivors should employ an exposure-based approach to increase affect or an affect-management approach to reduce it. In this article, the authors review theoretical and empirical literature regarding affect dysregulation and its relations with childhood sexual abuse and PTSD. A new affect-management group for adult survivors of childhood sexual abuse is described that is based on a stage approach to the treatment of trauma. This group emphasizes skill acquisition, symptom reduction, and patient stabilization. Affect-management strategies such as mindfulness, crisis planning, and challenging distorted thinking are presented to patients. Preliminary research findings support the use of this treatment. _____
Record: 50
Title: ECEM (Eye Closure Eye Movements): Integrating aspects of EMDR with hypnosis for treatment of trauma. Author(s): Hollander, Harriet E.
Bender, Sheila S. Source: American Journal of Clinical Hypnosis , Vol 43(3-4), Jan-Apr 2001. pp. 187-202. Publisher: US: American Society of Clinical Hypnosis. Publisher URL: http://www.asch.net/journal.htm ISSN: 0002-9157 (Print) Language: English Key Concepts: hypnotic interventions vs eye movement desensitizing & reprocessing, patients with PTSD Abstract: Addresses distinctions between hypnotic interventions and Eye Movement Desensitizing and Reprocessing (EMDR) and discusses their effect on persons who have symptoms of posttraumatic stress disorder (PTSD). Eye movements in hypnosis and EMDR are considered in terms of the different ways they may affect responses in treatment. A treatment intervention within hypnosis called ECEM (Eye Closure, Eye Movements) is described. ECEM can be used for patients with histories of trauma who did not benefit adequately from either interventions in hypnosis or the EMDR treatment protocol used separately. In ECEM the eye movement variable of EMDR is integrated within a hypnosis protocol to enhance benefits of hypnosis and reduce certain risks of EMDR.
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