Hopelessness as a Risk Factor for Post‐traumatic Stress Disorder Symptoms Among Interpersonal Violence Survivors

Post‐traumatic stress disorder often co‐occurs with depression, and they may share common risk factors. One possible common cognitive risk factor is hopelessness. Thus, we examined whether hopelessness was related to symptoms of post‐traumatic stress disorder. Participants were 202 female survivors of interpersonal violence. Relationships between self‐reported and interviewer‐rated measures of hopelessness gathered at 2 weeks post‐trauma and self‐reported and interviewer‐rated symptoms of post‐traumatic stress disorder gathered at 2 weeks and 3 months post‐trauma were examined. Hierarchical, simultaneous regression analyses that co‐varied trauma type revealed that hopelessness was related to self‐reported symptoms of post‐traumatic stress disorder, both concurrently and prospectively. Follow‐up analyses revealed that relationships between hopelessness and symptoms of post‐traumatic stress disorder were due almost entirely to shared variance with depression. No relationships were found between hopelessness and interviewer‐rated symptoms of post‐traumatic stress disorder.     

Interoceptive Exposure Therapy Combined with Trauma‐related Exposure Therapy for Post‐traumatic Stress Disorder: a Case Report

Trauma‐related exposure therapy is a useful but not universally effective treatment for post‐traumatic stress disorder. Anxiety sensitivity may play an important role in this disorder, as it does in panic disorder. Studies have shown that interoceptive exposure therapy reduces anxiety sensitivity in panic disorder. The present case study was a preliminary investigation of the merits of including interoceptive exposure therapy in the treatment of post‐traumatic stress disorder, in order to improve treatment outcome for a patient who had no history of panic disorder or panic attacks. Interoceptive exposure therapy (4 sessions) was one component of treatment, combined with trauma‐related exposure therapy (4 sessions of imaginal exposure followed by 4 sessions of in vivo exposure). Treatment outcome was assessed with the Clinician‐Administered Post‐traumatic Stress Disorder Scale, a self‐report measure of post‐traumatic stress disorder symptoms, and measures of symptoms and cognitions commonly associated with post‐traumatic stress disorder. Scores on all outcome measures decreased over the course of treatment, with gains maintained at 1‐ and 3‐month follow‐up. Symptoms of anxiety sensitivity and post‐traumatic stress disorder decreased during interoceptive exposure therapy. The results indicate that interoceptive exposure therapy is a promising adjunctive intervention for post‐traumatic stress disorder. Further research is needed into the merits of combining interoceptive exposure therapy and trauma‐related exposure therapy as a means of boosting treatment efficacy.     

A case study of traumatic stress disorder in a 5‐month‐old infant following surgery

This case study of a 5‐month‐old infant describes the symptoms of trauma following a surgical procedure (cranial remodeling) with short‐term hospital stay. The infant showed a symptomatology similar to that found in other studies of hospitalization during the preverbal period, and fit the diagnosis of traumatic stress disorder according to the DC:0‐3. The therapy was implemented by the parents in consultation with the author. The approach was based on an exposure therapy model (flooding) using a somatic trauma trigger that occurred spontaneously in the context of a normal caretaking routine. The infant was allowed to have a full‐blown emotional response during several treatment sessions. The outcome was positive, with the disappearance of some symptoms of traumatic stress disorder after the first week, and no remaining symptoms after two months. Periodic follow‐up evaluations for one year revealed normal development with no return of symptoms. The symptoms, treatment, and outcomes are discussed in the context of behavioral learning theory and emotional processing theory. The role of crying during flooding therapy is discussed, and an emotional release theory emphasizing the therapeutic value of crying is proposed. Six cautionary guidelines are offered for the use of intense exposure therapy with infants.     

Predicting post‐traumatic growth and post‐traumatic stress in firefighters

Emergency service workers (e.g., firefighters, police, and paramedics) are exposed to elevated levels of potentially traumatising events through the course of their work. Such exposure can have lasting negative consequences (e.g., post‐traumatic stress disorder (PTSD)) and/or positive outcomes (e.g., post‐traumatic growth (PTG)). Research had implicated trauma, occupational and personal variables that account for variance in post‐trauma outcomes yet at this stage no research has investigated these factors and their relative influence on both PTSD and PTG in a single study. Based in Calhoun and Tedeschi's model of PTG and previous research, in this study regression models of PTG and PTSD symptoms among 218 firefighters were tested. Results indicated organisational factors predicted symptoms of PTSD, while there was partial support for the hypothesis that coping and social support would be predictors of PTG. Experiencing multiple sources of trauma, higher levels of organisational and operational stress, and utilising cognitive reappraisal coping were all significant predictors of PTSD symptoms. Increases in PTG were predicted by experiencing trauma from multiple sources and the use of self‐care coping. Results highlight the importance of organisational factors in the development of PTSD symptoms, and of individual factors for promoting PTG.     

Linguistic Predictors of Post‐Traumatic Stress Disorder Symptoms Following 11 September 2001

Prior research has linked content analysis drawn from text narratives to psychopathology in trauma survivors. This study used a longitudinal design to determine whether linguistic elements of narrative memories of first hearing about the events of 11 September 2001 predict later post‐traumatic stress disorder (PTSD). Narratives and self‐report PTSD symptoms were collected within 1 week and again 5 months after 9/11 in 40 undergraduates. People who used more “we” words at Time 1 had fewer acute PTSD symptoms. Use of more cognitive mechanism words, more religion words, more first‐person singular pronouns, and fewer anxiety words at Time 1 were related to more chronic PTSD symptoms. Linguistic characteristics accounted for variance in chronic PTSD symptoms above and beyond acute PTSD symptoms. This study provides evidence that lasting PTSD symptoms can be predicted through language in the immediate aftermath of the trauma. Copyright © 2011 John Wiley & Sons, Ltd.     

The effects of torture‐related stressors on long‐term complex post‐traumatic symptoms in South Korean torture survivors

This study explored whether perceived distress from specific stressors during and after torture explain long‐term complex post‐traumatic symptoms of South Korean torture survivors. We conducted a cross‐sectional survey of survivors who had been tortured by the homeland regime from the 1970s to the 2000s. Data from 206 survivors were gathered by key informants using target sampling and snowballing techniques. Project staff designed scales to encompass the specific types of stressors related to torture techniques used in Korea. Frequencies and distress ratings of exposure to torture, post‐torture psychosocial stressors and physical damage related to torture were gathered. Psychological symptoms were assessed by the Impact of Event Scale‐Revised‐Korean version and subscales of the Symptom Checklist 90‐Revised‐Korean version. Perceived distress from torture stressors was mainly divided into factors representing physical, psychological and deprivation torture by adapting a principal axis factor analysis. Hierarchical regression analyses showed that distress from psychological torture explained post‐traumatic stress disorder (PTSD) and that distress from deprivation explained PTSD and anxiety after controlling for demographic variables, psychological preparedness, time span since torture and distress from trauma other than torture. Among post‐torture stressors, distress from physical damage related to torture and social exclusion were strong indicators of complex symptoms.     

Centrality of Event and Symptoms of Posttraumatic Stress Disorder After the 2011 Oslo Bombing Attack

It has been proposed that a highly integrated trauma leads to more accessible and vivid memories of the traumatic event, in turn heightening symptoms of posttraumatic stress disorder. The relationship between the centrality of a traumatic event and symptoms of posttraumatic stress disorder after the 2011 Oslo bombing attack was investigated in the present study. A high degree of perceived centrality was associated with higher symptom levels of posttraumatic stress as shown in the results. This association was found after controlling for gender, age and educational background. The relationship between types and level of trauma exposure, peritraumatic reactions and centrality of event was also investigated in the present study. Higher levels of trauma exposure and peritraumatic reactions were associated with higher levels of centrality of event as shown in the results. When a traumatic event becomes a reference point in the individual's life story and central to their identity, this is associated with an increased risk of symptomatology as suggested in the findings. Copyright © 2013 John Wiley & Sons, Ltd.     

Does Overgeneralized Autobiographical Memory Facilitate or Inhibit Intrusive Images? Its Relation to Depressive Symptoms

People with high levels of depressive symptoms experience overgeneralized autobiographical memory (OGM) in voluntary recall and intrusive images in involuntary recall. The present study examined the relationship between OGM and intrusive images and the influence of depressive symptoms on this relationship over 1 week. Fifty‐three students completed self‐report questionnaires, autobiographical memory test, and the trauma film paradigm. Subsequently, they reported intrusive images from the trauma film in a diary for 1 week. Hierarchical multiple regression showed that individuals with higher levels of depressive symptoms experienced more intrusive images than did individuals with low depressive symptoms. An interaction effect between negative memory specificity and depressive symptoms revealed that number of intrusive images was related to high negative memory specificity (i.e. low OGM) in individuals with higher levels of depressive symptoms. These results support the functional avoidance strategy of OGM in analogue trauma stimuli, especially in individuals with higher depressive symptoms.Copyright © 2017 John Wiley & Sons, Ltd.     

Post‐traumatic stress disorder and anxiety symptoms in children exposed to the 1999 Greek earthquake

Five months after the Athens earthquake of September 1999, 178 children from three districts of Athens at increasing distances from the epicenter were administered questionnaires to identify symptoms of post‐traumatic stress disorder (PTSD), anxiety and the extent of personal threat experienced. It was found that PTSD and anxiety symptoms were significantly related to proximity to the epicenter, exposure to threat and female gender. Age did not have a significant main effect on either anxiety or PTSD symptoms, but there were significant interactions between age and the other main variables. In the region closest to the epicenter, the youngest children reported the highest PTSD and anxiety symptom scores, but in the group furthest from the epicenter the older children reported the highest PTSD and anxiety symptom scores. These findings were discussed in relation to direct and media‐imparted exposure to the earthquake.     

Impact of average household income and damage exposure on post‐earthquake distress and functioning: A community study following the February 2011 Christchurch earthquake

Post‐traumatic stress, depression and anxiety symptoms are common outcomes following earthquakes, and may persist for months and years. This study systematically examined the impact of neighbourhood damage exposure and average household income on psychological distress and functioning in 600 residents of Christchurch, New Zealand, 4–6 months after the fatal February, 2011 earthquake. Participants were from highly affected and relatively unaffected suburbs in low, medium and high average household income areas. The assessment battery included the Acute Stress Disorder Scale, the depression module of the Patient Health Questionnaire (PHQ‐9), and the Generalized Anxiety Disorder Scale (GAD‐7), along with single item measures of substance use, earthquake damage and impact, and disruptions in daily life and relationship functioning. Controlling for age, gender and social isolation, participants from low income areas were more likely to meet diagnostic cut‐offs for depression and anxiety, and have more severe anxiety symptoms. Higher probabilities of acute stress, depression and anxiety diagnoses were evident in affected versus unaffected areas, and those in affected areas had more severe acute stress, depression and anxiety symptoms. An interaction between income and earthquake effect was found for depression, with those from the low and medium income affected suburbs more depressed. Those from low income areas were more likely, post‐earthquake, to start psychiatric medication and increase smoking. There was a uniform increase in alcohol use across participants. Those from the low income affected suburb had greater general and relationship disruption post‐quake. Average household income and damage exposure made unique contributions to earthquake‐related distress and dysfunction.     

Unemployment in Iraqi refugees: The interaction of pre and post‐displacement trauma

Previous refugee research has been unable to link pre‐displacement trauma with unemployment in the host country. The current study assessed the role of pre‐displacement trauma, post‐displacement trauma, and the interaction of both trauma types to prospectively examine unemployment in a random sample of newly‐arrived Iraqi refugees. Participants (N = 286) were interviewed three times over the first two years post‐arrival. Refugees were assessed for pre‐displacement trauma exposure, post‐displacement trauma exposure, a history of unemployment in the country of origin and host country, and symptoms of posttraumatic stress disorder (PTSD) and depression. Analyses found that neither pre‐displacement nor post‐displacement trauma independently predicted unemployment 2 years post‐arrival; however, the interaction of pre and post‐displacement trauma predicted 2‐year unemployment. Refugees with high levels of both pre and post‐displacement trauma had a 91% predicted probability of unemployment, whereas those with low levels of both traumas had a 20% predicted probability. This interaction remained significant after controlling for sociodemographic variables and mental health upon arrival to the US. Resettlement agencies and community organizations should consider the interactive effect of encountering additional trauma after escaping the hardships of the refugee's country of origin.     

Childhood trauma and psychosis: Review of the evidence and directions for psychological interventions

There is controversy over whether childhood trauma (CT) is a causal risk factor for psychosis. The aim of this study was to provide psychologists with a brief overview of the research into relationship between childhood trauma and psychosis and directions for psychological interventions. It details six of the highest quality studies in the area and tentatively concludes from these that there is evidence for a relationship between CT and psychosis. Hallucinations and delusions have been implicated as important factors in the relationship between CT and psychotic disorder and these are discussed, along with post‐traumatic intrusions and schemas, which have been conceptualised as part of the psychological mechanisms whereby CT confers a risk for psychosis. The development of psychological interventions for people with psychosis who have experienced CT is in its infancy but has been based on evidence‐based cognitive behavioural interventions in psychosis and post‐traumatic stress disorder. A formulation‐based approach is described in this paper, along with a case study.     

Grief and trauma intervention for children after disaster: exploring coping skills versus trauma narration

This study evaluated the differential effects of the Grief and Trauma Intervention (GTI) with coping skills and trauma narrative processing (CN) and coping skills only (C). Seventy African American children (6-12 years old) were randomly assigned to GTI-CN or GTI-C. Both treatments consisted of a manualized 11-session intervention and a parent meeting. Measures of trauma exposure, posttraumatic stress symptoms, depression, traumatic grief, global distress, social support, and parent reported behavioral problems were administered at pre, post, 3 and 12 months post intervention. In general, children in both treatment groups demonstrated significant improvements in distress related symptoms and social support, which, with the exception of externalizing symptoms for GTI-C, were maintained up to 12 months post intervention. Results suggest that building coping skills without the structured trauma narrative may be a viable intervention to achieve symptom relief in children experiencing trauma-related distress. However, it may be that highly distressed children experience more symptom relief with coping skills plus narrative processing than with coping skills alone. More research on the differential effects of coping skills and trauma narration on child distress and adaptive functioning outcomes is needed.     

Why did adolescents have sleep problems after earthquakes? Understanding the role of traumatic exposure,fear, and PTSD

To examine the relationships between trauma exposure, fear, post‐traumatic stress disorder, and sleep problems in adolescents, 746 adolescent survivors of the 2008 Wenchuan earthquake in China were assessed at 1 year (T1) and 1.5 years (T2) after the earthquake using a trauma exposure questionnaire, a fear questionnaire, a child posttraumatic stress disorder symptom scale, and a subscale on child sleep problems. The results showed that T1 trauma exposure were not directly associated with sleep problems at T1 and T2, but played a positive role in sleep problems at both T1 and T2 indirectly through T1 posttraumatic stress disorder and T1 fear. T1 trauma exposure was also positively and indirectly associated with T2 sleep problems through T1 posttraumatic stress disorder via T1 sleep problems, or through T1 fear via the path from T1 posttraumatic stress disorder to T1 sleep problems. These findings indicated that fear and posttraumatic stress disorder 1 year after the earthquake played a mediating role in the relationship between trauma exposure at 1 year after the earthquake, and sleep problems at both 1 year and 1.5 years after the earthquake, respectively. In particular, posttraumatic stress disorder also had a multiple mediating effect in the path from trauma exposure to sleep problems via fear. Furthermore, the findings indicated that sleep problems were relatively stable between 1 and 1.5 years after an earthquake.     

MATERNAL TRAUMA AFFECTS PRENATAL MENTAL HEALTH AND INFANT STRESS REGULATION AMONG PALESTINIAN DYADS

We examined how diverse and cumulated traumatic experiences predicted maternal prenatal mental health and infant stress regulation in war conditions and whether maternal mental health mediated the association between trauma and infant stress regulation. Participants were 511 Palestinian mothers from the Gaza Strip who reported exposure to current war trauma (WT), past childhood emotional (CEA) and physical abuse, socioeconomic status (SES), prenatal mental health problems (posttraumatic stress disorder and depression symptoms), and perceived stress during their secondtrimester of pregnancy as well as infant stress regulation at 4 months. While all trauma types were associated with high levels of prenatal symptoms, CEA had the most wide‐ranging effects and was uniquely associated with depression symptoms. Concerning infant stress regulation, mothers’ CEA predicted negative affectivity, but only among mothers with low WT. Against hypothesis, the effects of maternal trauma on infant stress regulation were not mediated by mental health symptoms. Mothers’ higher SES was associated with better infant stress regulation whereas infant prematurity and male sex predisposed for difficulties. Our findings suggest that maternal childhood abuse, especially CEA, should be a central treatment target among war‐exposed families. Cumulated psychosocial stressors might increase the risk for transgenerational problems.     

Characteristics of memories for traumatic and nontraumatic birth

Evidence for memory characteristic differences between trauma and other memories in non‐clinical samples is inconsistent. However, trauma is frequently confounded with the event recalled. This study compares trauma and nontrauma memories for the same event, childbirth, in a non‐clinical sample of 285 women 4–6 weeks after birth. None of the women met diagnostic criteria for post‐traumatic stress disorder. Traumatic birth, defined by the DSM‐5 event criterion, was reported by 100 women. The ratings of some memory characteristics did not differ between memories for traumatic and nontraumatic birth: All were rated highly coherent and central to women's lives, with moderate sensory memory. However, women who experienced traumatic births reported more involuntary recall, reliving, and negative/mixed emotions. Thus, trauma memories differed from nontrauma memories. In this non‐clinical sample, this is likely to be due to encoding during trauma rather than the distinctive memory profile for memories retrieved by those experiencing trauma symptoms.     

Thinking About What Might Have Happened: Counterfactual Thinking and Post‐traumatic Stress in Individuals Directly and Indirectly Exposed to the 2011 Oslo Bombing

Counterfactual thinking (CFT), that is thinking about what might have happened, is linked to post‐traumatic stress. We studied the relationship between type and frequency of CFT and post‐traumatic stress in a sample of directly (n = 50) and indirectly exposed (n = 50) ministerial employees 4 years after the 2011 Oslo bombing. The results showed that frequency of CFT was associated with levels of post‐traumatic stress, among both directly and indirectly exposed participants. In the directly exposed group, self‐reported frequencies of downward counterfactuals were associated with post‐traumatic stress. A similar trend was found for upward counterfactuals. In the indirectly exposed group, self‐reported frequencies of both upward and downward counterfactuals were associated with higher levels of post‐traumatic stress. These results point to the intriguing possibility that people may not only develop post‐traumatic stress disorder as a result of actual experiences, but also via mental simulations of traumatic events that could have happened. Copyright © 2016 John Wiley & Sons, Ltd.     

Overgeneral memory extends to pictorial retrieval cues and correlates with cognitive features in posttraumatic stress disorder

Individuals with posttraumatic stress disorder (PTSD) show overgeneral memory (OGM) when retrieving autobiographical memories to word cues. We investigated whether OGM extends to picture cues and whether it is related to PTSD symptoms and cognitions. Trauma survivors with (n = 29) and without (n = 26) PTSD completed the standard Autobiographical Memory Test (AMT) and a novel picture version. Compared to the no-PTSD group, the PTSD group showed OGM in both test versions. Pictures facilitated specific memory retrieval, but this effect was no longer significant when verbal intelligence or depressive symptoms were controlled. OGM correlated with PTSD symptoms and perceived self-change; with intrusive memories, their perceived "nowness," responses to intrusions (thought suppression, rumination, dissociation), and negative interpretations of symptoms.     

Duty-Related Posttraumatic Stress Symptoms in 911 Telecommunicators: The Roles of Childhood Trauma Exposure and Emotion-Focused Coping

A history of childhood trauma exposure has been linked to the development of posttraumatic stress symptoms in adulthood following new exposure. Unhealthy coping behaviors that could develop or be utilized in response to early trauma could lend themselves to psychological issues in adulthood. Emotion-focused and problem-focused coping strategies in relation to stressful duty-related situations are examined as indirect pathways through which childhood trauma exposure could be associated with duty-related posttraumatic stress symptoms in 911 telecommunicators (N = 808). Multiple mediation models revealed that 3 of the 4 emotion-focused coping strategies, but not the problem-focused strategies, functioned as significant mediators in the association between childhood exposure and duty-related posttraumatic stress symptoms. Pairwise comparisons showed that self-controlling and escape-avoidance strategies were the strongest pathways of the indirect childhood trauma exposure–posttraumatic stress symptoms association. Implications of results regarding coping in response to new traumatic events in adulthood and potential research and intervention directions are discussed.     

Coping strategies of Ethiopian immigrants in Israel: Association with PTSD and dissociation

Finklestein, M., Laufer, A. & Solomon, Z. (2012). Coping strategies of Ethiopian immigrants in Israel: Association with PTSD and dissociation. Scandinavian Journal of Psychology 53, 490–498. The aim of this study was to examine the relations between coping strategies, posttraumatic stress disorder (PTSD), and dissociation among Jewish Ethiopian refugees in Israel (following exposure to pre‐, peri‐ and post‐migration stressful events). Method: A random sample (N = 478) of three waves of refugees took part in the research (N = 165; N = 169; N = 144). Religiosity, coping strategies, stressful and traumatic events, pre‐ and peri‐ migration, post‐migration difficulties, posttraumatic symptoms, and dissociation were assessed. Results: A significant relationship was found between PTSD symptoms and avoidance coping over and above immigration wave and traumatic events. Dissociation was positively associated with passivity and antisocial coping and negatively associated with social joining and level of religiosity, over and above immigration wave and traumatic events. The findings are discussed in the light of the coping strategies employed by Ethiopian refugees.