Testing Posttraumatic Stress as a Mediator of Childhood Trauma and Adult Intimate Partner Violence Victimization

This study examined whether potential posttraumatic stress disorder (PTSD) mediated the relationships between different forms of childhood trauma (sexual abuse, physical abuse, violence between caregivers) and intimate partner violence (IPV) victimization (psychological, physical, sexual). Participants were 1,150 female nurses and nursing personnel. Path analytic findings revealed potential PTSD partially mediated the relationships between childhood sexual abuse and psychological IPV and childhood sexual abuse and sexual IPV. Potential PTSD did not mediate the relationship between other types of childhood trauma and IPV. This study adds to the literature indicating PTSD as a risk factor for revictimization in the form of adult IPV among women. Screening for and treatment of PTSD among female child sexual abuse survivors could prevent future IPV victimization.     

Co-Occurring Traumatic Brain Injury,PTSD Symptoms,and Alcohol Use in Veterans

Traumatic brain injury (TBI) has been identified as a significant health problem among veterans. Recent research demonstrates the potential interaction and magnification of symptoms of posttraumatic stress disorder (PTSD) and substance use disorders (SUD) in veterans with a history of TBI; however, there is very limited research on the co-occurrence of the three conditions. Veterans (N = 115) with comorbid PTSD and SUD completed a baseline assessment for enrollment into a larger treatment study. As part of that assessment, participants completed a TBI screener as well as self-report measures for pain and physical health, affective symptoms, and substance use. Almost half of the sample (48 %) endorsed a history of a previous head trauma with loss of consciousness (LOC). Participants with and without head trauma with LOC were compared across various measures of functioning. Increased severity of physical health complaints and affective symptoms were reported by the TBI group compared to controls. However, the increases in affective symptoms were relatively small. No group differences were observed for alcohol use. Together, the findings suggest that treatment-seeking veterans with a history of head trauma with LOC may present with roughly equivalent symptoms of PTSD and SUD to those without said history.     

Trauma Exposure in Anxious Primary Care Patients

The present study examined rates of trauma exposure, clinical characteristics associated with trauma exposure, and the effect of trauma exposure on treatment outcome in a large sample of primary care patients without posttraumatic stress disorder (PTSD). Individuals without PTSD (N?=?1,263) treated as part of the CALM program (Roy-Byrne et al., Journal of the American Medical Association 303(19)1921–1928, 2010) were assessed for presence of trauma exposure. Those with and without trauma exposure were compared on baseline demographic and diagnostic information, symptom severity, and responder status six months after beginning treatment. Trauma-exposed individuals (N?=?662, 53 %) were more likely to meet diagnostic criteria for Obsessive Compulsive Disorder and had higher levels of somatic symptoms at baseline. Individuals with and without trauma exposure did not differ significantly on severity of anxiety, depression, or mental health functioning at baseline. Trauma exposure did not significantly impact treatment response. Findings suggest that adverse effects of trauma exposure in those without PTSD may include OCD and somatic anxiety symptoms. Treatment did not appear to be adversely impacted by trauma exposure. Thus, although trauma exposure is prevalent in primary care samples, results suggest that treatment of the presenting anxiety disorder is effective irrespective of trauma history.     

Do PTSD symptoms and course predict continued substance use for homeless individuals in contingency management for cocaine dependence?

Homeless individuals (n = 187) entering contingency management (CM) for cocaine dependence were assessed for PTSD diagnosis, and a subset of 102 participants reporting traumatic exposure also periodically completed a self-report measure of PTSD symptoms. Patients with PTSD in full remission at 6 months (end of active treatment) and 12 months (end of aftercare) used substances much less frequently during aftercare than those with no PTSD diagnosis. Those whose PTSD diagnosis improved to full remission status during active treatment, and remained in full remission at 12 months, also had superior substance use outcomes. Severity of PTSD symptoms at 6 months, but not baseline or 2 months, was associated with substance use across treatment phases. Substance use during aftercare, however, was better predicted by changes in PTSD symptom severity. Patients whose PTSD symptoms improved more during active treatment fared better during aftercare than those with less improvement. Findings suggest homeless individuals with comorbid PTSD entering CM for cocaine dependence are not necessarily at increased risk for substance use compared to those without the comorbidity. However, course of PTSD does predict substance use, with the potential for CM to be unusually effective for those who respond with substantial, lasting improvements in PTSD.     

Addiction in Maternity: Prevalence of Mental Illness,Substance Use,and Trauma

Women living in vulnerable neighborhoods experience higher rates of poverty, homelessness, psychiatric issues, illicit substance use, rates of HIV, and a lowered life expectancy. The aim of the study was to further explore the history of mental illness and trauma in a sample of women (N?=?31) who had recently given birth and had a substance use problem while pregnant. We investigated sociodemographic characteristics, history of trauma and post-traumatic stress disorder (PTSD), rates of substance use and dependence, and psychiatric symptoms. Childhood and adult traumatic experiences were found in the majority of the sample, and one-third presented with suspected PTSD diagnosis at the time of the interview. Women-centered services are in great demand, as well as trauma informed care, and further research on appropriate treatment for substance using, traumatized, women with a mental illness.     

Peritraumatic dissociation and experiential avoidance as predictors of posttraumatic stress symptomatology

This study examined whether peritraumatic dissociation serves as a proxy risk factor for experiential avoidance in its relationship with posttraumatic stress disorder (PTSD) symptomatology. One hundred eighty-five trauma survivors completed measures that assessed for peritraumatic dissociation, experiential avoidance, and PTSD symptom severity. The results indicated that peritraumatic dissociation and experiential avoidance were significantly related to PTSD symptomatology at baseline. However, after initial levels of PTSD symptomatology were taken into account, only experiential avoidance was related to PTSD symptoms both 4- and 8-weeks later. These results indicate that peritraumatic dissociation is not a proxy risk factor for experiential avoidance and contributes to the growing body of literature indicating that experiential avoidance is an important factor related to the psychological symptoms experienced by trauma survivors.     

Childhood Sexual Assault,Quality of Life,and Psychiatric Comorbidity in Veterans With Military and Civilian Sexual Trauma

Veterans with military sexual trauma (MST) are at risk for a variety of psychiatric conditions, including posttraumatic stress disorder (PTSD) and depression. Survivors of MST are also likely to experience diminished quality of life (QoL). Individuals with higher lifetime incidence of sexual trauma may also be at increased risk for poorer outcomes in QoL and psychiatric symptomatology. The differences in psychological sequelae among those who have experienced sexual trauma as children, and those whose sexual trauma exposure is limited to adulthood are relatively understudied. The majority of sexual trauma literature has focused primarily on civilian trauma, and comparatively few studies have specifically examined psychosocial sequelae (e.g., QoL) in veterans with MST. This study examined how childhood sexual abuse (CSA) affects overall QoL as well as severity of PTSD and depressive symptoms. Veterans who reported CSA had significantly greater depression symptom severity than veterans who did not. No significant differences in PTSD symptom severity or QoL were found between veterans who did and did not report CSA. Results highlight the need for further examination of the relationship between CSA and depression in veterans with MST-related PTSD who also report CSA.     

Trauma-Related Negative Cognitions Mediate the Relationship Between Avoidant Personality Beliefs and Impeded Response to Psychotherapy for PTSD

There is strong research evidence for the association of personality pathology and posttraumatic stress disorder (PTSD), as well as trauma-related negative cognitions (TRNC) and PTSD symptoms. However, the relationship between personality pathology and TRNC in the context of PTSD is mostly unknown. In the present study, we aimed to examine whether avoidant and borderline personality beliefs (PB, indicator of personality pathology) could predict therapy outcome in PTSD, and whether the relationship between PB and therapy outcome could be mediated by TRNC. Sixty patients with PTSD were assessed for PB, TRNC and PTSD symptoms at baseline, and for PTSD symptoms at the termination of Prolonged Exposure Therapy. Baseline avoidant PB predicted significant variance in PTSD symptoms at termination over and above baseline PTSD symptoms (16% reduction in treatment effect per SD on avoidant PB). Moreover, TRNC at baseline fully mediated the relationships between baseline avoidant PB and PTSD symptoms at termination. This is the first study to show that avoidant PB predicts treatment response in PTSD, and that patients with avoidant beliefs are more vulnerable to have TRNC, which are associated with impeded therapy response. Our results highlight the importance of targeting both dysfunctional PB and TRNC in PTSD interventions.     

Parenting stress and competence among mothers of young children with substance use disorders: The roles of trauma and reflective functioning

Posttraumatic stress symptoms are prominent in the lives of parents of young children with substance use disorders (SUD). Parenting experiences, particularly stress and competence, impact parenting behaviors and concomitant child growth and development. Factors that promote positive experiences of parenting, such as parental reflective functioning (PRF), and protect the mother and child from negative outcomes are crucial to understand to develop effective therapeutic interventions. The current US study analyzed baseline data from a parenting intervention evaluation to examine how length of substance misuse, PRF, and trauma symptoms were associated with parenting stress and parenting sense of competence among mothers in treatment for SUDs. Measures included the Addiction Severity Index, PTSD Symptom Scale-Self Report, Parental Reflective Functioning Questionnaire, Parenting Stress Index/Short Form, and Parenting Sense of Competence Scale. The sample included 54 predominantly White mothers with SUDs who had young children. Two multivariate regression analyses found that (1) lower parental reflective functioning and higher posttraumatic stress symptoms were associated with higher parenting stress, and (2) only higher posttraumatic stress symptoms were associated with lower levels of parenting sense of competence. Findings underscore the importance of addressing trauma symptoms and PRF when aiming to improve parenting experiences for women with an SUD.     

The Effectiveness of Emotionally Focused Couples Therapy With Veterans With PTSD: A Pilot Study

The current study is a pilot project conducted at Baltimore VA Medical Center investigating the use of emotionally focused couples therapy (EFT) for couples in which one partner is a veteran who has been diagnosed with posttraumatic stress disorder (PTSD). Fifteen couples enrolled in the study and seven of these couples completed treatment (26 to 36 weekly sessions of EFT). Both partners were assessed on measures of relationship satisfaction, psychological distress, depression, and quality of life, and veterans were assessed on measures of PTSD symptoms at baseline and 2 weeks after the intervention. Paired t-tests were used to compare scores before and after EFT. In terms of results, the veterans' partners reported significant improvements in relationship and life satisfaction and in decreased depression and a decrease in psychological distress. Veterans demonstrated a significant decrease in self-reported symptoms of PTSD. These results provide preliminary evidence for the usefulness of EFT to help foster improved relationship satisfaction, and psychological well-being for veterans with PTSD and their partners who completed treatment.     

A school-based assessment of secondary stressors and adolescent mental health 18 months post-Katrina

The goals of the current study were to examine the prevalence of secondary stressors related to Hurricane Katrina and to determine their impact on posttraumatic stress disorder (PTSD) symptoms among a sample of high school students. In addition, the moderating role of problem substance use was examined to determine whether it increased the risk of PTSD symptoms in the face of secondary stressors. A total of 271 ethnically and socioeconomically diverse adolescents completed an anonymous survey. Results indicated that problem substance use potentiated the positive relation between secondary stressors and PTSD symptoms, specifically symptoms of re-experiencing. The findings highlight the need for school-based assessment of and interventions for the long-term psychological effects of disasters.     

Emotion Dysregulation in Comorbid Posttraumatic Stress Disorder and Substance Use Disorders: A Narrative Review

Co-occurrence of substance use disorders (SUDs) and posttraumatic stress disorder (PTSD) is extremely common and is associated with elevated dropout and relapse rates. Given that PTSD/SUD co-occurrence rates among veterans have been found to be as high as 55?75%, it is important to identify mechanisms that may affect the interplay of both disorders. Emotion dysregulation (ED) presents a candidate mechanism that may underlie poor treatment response in co-occurring PTSD/SUD. This article proposes a transdiagnostic emotion regulation framework that considers ED conceptualized as a combination of low ability to tolerate emotional distress (low distress tolerance) and difficulties in the goal-directed use of emotion regulation strategies as a key risk factor in co-occurring PTSD/SUD. The authors review empirical findings from self-report and laboratory-based studies of ED in PTSD. They describe psychological explanations of the emotion-substance relationship and review studies documenting ED in SUDs and in co-occurring PTSD/SUD. The literature on ED in PTSD/SUD suggests that (a) patients with PTSD may resort to substances to cope with trauma-related symptoms due to ED, and (b) ED may maintain SUD symptoms and interfere with psychological treatment. Longitudinal studies on bidirectional relationships between ED and substance use in PTSD are needed, particularly research examining the course of ED in PTSD patients who use substances versus those who do not.     

Psychological Treatments for Symptoms of Posttraumatic Stress Disorder in Children,Adolescents, and Young Adults: A Meta-Analysis

Meta-analyses of the treatment of posttraumatic stress disorder (PTSD) in childhood and adolescence are restricted to specific trauma, selected interventions, and methodologically rigorous studies. This large meta-analysis quantifies the effects of psychological treatments for PTSD symptoms in children and adolescents. An extensive literature search yielded a total of 13,040 articles; 135 studies with 150 treatment conditions (N = 9562 participants) met the inclusion criteria (psychological interventions with children and/or adolescents with PTSD symptoms that report quantitative measures of symptom change). The mean effect sizes (ESs) for PTSD symptoms ranged from large to small, depending on the control condition. Cognitive behavioral therapy (CBT) yielded the highest ESs. Age and caretaker involvement were identified as moderators. CBT, especially when conducted in individual treatment with the inclusion of parents, is a highly effective treatment for trauma symptoms. Psychological treatments need to be modified to address younger patients’ specific needs.     

Prospective associations between changes in mental health symptoms and health-related quality of life in veterans seeking posttraumatic stress disorder residential treatment

Background and Objectives: This study examined prospective associations between changes in mental health symptoms (posttraumatic stress disorder [PTSD], depression) and health-related quality of life (physical health, psychological well-being) for veterans with PTSD. Design: This study focused on 139 patients who completed a residential treatment program for PTSD in the Veterans Health Administration. Methods: Patients completed the veteran-specific, 12-item Medical Outcomes Study Short Form, PTSD Checklist – Military version, and Beck Depression Inventory at pre-treatment, discharge, and a four-month follow-up. When accounting for demographic factors, combat exposure, and baseline scores on the respective outcome variables (e.g. mental health, physical health, PTSD, and depressive symptoms), a series of multivariate analyses were conducted for treatment-related changes in mental and physical health on the outcome measures. Results: Reductions in PTSD symptomatology during the treatment period were prospectively linked with better health-related outcomes at the four-month follow-up. In addition, improved physical health and psychological well-being during treatment were each similarly associated with better PTSD and depression outcomes in the months following treatment. Conclusions: Addressing concerns in mental and physical health might have synergistic effects across both domains, supporting the need for holistic models and integrated health care strategies for treating veterans with PTSD.     

Risk and Protective Factors for Comorbid Posttraumatic Stress Disorder among Homeless Individuals in Treatment for Substance-Related Problems

Homeless individuals undergoing treatment for substance use disorders (SUD) can pose clinical challenges. Posttraumatic stress disorder (PTSD) symptoms have been observed in the most difficult clients. The study sample consisted of 51 homeless individuals, 9 women and 42 men, undergoing consultation for SUD in Montreal. The mean age was 46 years (SD = 7.19). Of the sample, 49% had a potential PTSD diagnosis. Most participants had the following characteristics: an alcoholic parent, a history of an early trauma, and little social support. The participants with a potential PTSD diagnosis were significantly more likely to have had an alcoholic parent, to have experienced an early trauma, and to use more maladaptive coping strategies. The study results and limits are discussed.     

Recognizing Trauma and Posttraumatic Stress Disorder Symptoms in Individuals With Psychotic Disorders

The majority of individuals diagnosed with a psychotic episode also meet symptom criteria for posttraumatic stress disorder (PTSD; Mueser, Lu, Rosenberg, & Wolfe, 2010 ). Unfortunately, trauma from both previous life events and the experiences of a psychotic episode as well as PTSD symptoms are rarely recognized in this population. Steps to assessing trauma history and PTSD symptoms and initiating treatment in a client diagnosed with a psychotic disorder are highlighted.     

Posttraumatic symptoms and growth of Kosovar war refugees: The influence of hope and cognitive coping

Research on war trauma has been dominated by a pathological focus for decades. Researchers have now counterbalanced studies of trauma with a new focus, positive changes following crisis. This prospective study examines how specific psychological factors might influence post-war adaptive outcomes (the coexistence of posttraumatic growth [PTG] and posttraumatic stress disorder [PTSD] symptoms) in a sample of 50 Kosovar war refugees. Individual differences in positive attitude and coping strategies were explored. Hope assessed during resettlement, and cognitive coping strategies, employed between resettlement and follow-up, were associated with PTG, controlling for war-related trauma and baseline symptoms. PTG and symptoms were unrelated. No predictors for present symptoms were identified. Future mental health practice with refugees should address both positive and negative aspects.     

Posttraumatic Stress Symptoms,Aggression, and Substance Use Coping among Young Adults

This study examined how the symptom clusters of posttraumatic stress disorder (PTSD) were related to substance use and self-reported aggression in a college sample. There were 358 participants (ages 18–24) who completed surveys to assess PTSD symptoms, substance use as coping, and aggression. Hierarchical regressions tested for the effects of PTSD symptoms (total symptoms as well as cluster symptoms) on self-reported aggression, along with the main and interaction effects of substance use coping on these relationships. The hyperarousal cluster of PTSD was the only group of symptoms significantly related to aggression. There was an interaction between avoidance symptoms and substance use coping on aggression such that under conditions of high substance use coping, aggression increased regardless of avoidance symptoms; however, the relationship between avoidance and aggression was stronger under conditions of low substance use coping, with greater aggression as avoidance symptoms and low substance use coping increased.     

创伤暴露程度对青少年物质滥用的影响：创伤后应激障碍与依恋的中介作用

为了考察汶川地震后青少年的创伤暴露程度、创伤后应激障碍（PTSD）、父母依恋和同伴依恋与物质滥用之间的关系,采用创伤暴露程度问卷、儿童创伤后应激障碍症状量表、父母与同伴依恋问卷和物质滥用问卷对汶川县和茂县的1435名中学生进行调查,选取有物质滥用的青少年354名作为本研究的对象。结果发现：创伤暴露程度可以直接正向预测作用物质滥用。不过,在创伤暴露与物质滥用直接关系之间加入PTSD、父母和同伴依恋之后,创伤暴露程度对物质滥用的直接预测作用不再显著,并且创伤暴露程度不能通过同伴依恋预测物质滥用,也不能通过PTSD经同伴依恋对物质滥用发挥多重中介作用;但创伤暴露程度能通过PTSD正向预测物质滥用,可以通过父母依恋负向预测物质滥用,并且创伤暴露程度还可以通过PTSD经过父母依恋对物质滥用发挥正向的多重中介作用。     

Posttraumatic stress disorder and physical health symptoms among women seeking help for relationship aggression.

This study examined associations between intimate partner aggression and physical health symptoms among a sample of help-seeking women experiencing relationship aggression (N = 388). Using a structural equation modeling framework, the authors found posttraumatic stress disorder (PTSD) symptoms to fully mediate the associations of both physical and psychological aggression with physical health symptoms. The influence of PTSD symptoms on physical health symptoms was partially mediated by anger/irritability. Results were consistent with studies from other trauma groups suggesting that PTSD is pivotal with respect to explaining the effects of trauma on health.