A randomised controlled trial to assess the effectiveness of providing self-help information to people with symptoms of acute stress disorder following a traumatic injury

BACKGROUND: Patients attending accident and emergency (A&E) may develop long-term psychological difficulties. Psycho-education has been suggested to reduce the risk of post-injury disorders. AIMS: We tested the efficacy of providing self-help information to a high-risk sample. METHODS: A&E attenders were screened for acute stress disorder and randomised to two groups: patients (n=116) receiving a self-help booklet and those who did not (n=111). A sample of 'low' scorers was also included (n=120); they did not receive a booklet. Psychological assessments were completed at baseline (within 1 month post-injury) and 3 and 6 months post-injury. RESULTS: Post-traumatic stress disorder (PTSD), anxiety and depression decreased (p<0.001) across time but there were no group differences in these measures or quality of life. However, subjective ratings of the usefulness of the self-help booklet were very high. CONCLUSIONS: This trial failed to support the efficacy of providing self-help information, as a preventative strategy to ameliorate PTSD.     

Post-traumatic stress symptoms in adolescents exposed to an earthquake: Association with self-efficacy,perceived magnitude,and fear

The objective of this study was to evaluate th×e relationship between the magnitude of an earthquake, the fear experienced, the self-efficacy beliefs, and post-traumatic stress symptoms in adolescents. We expected self-efficacy beliefs to predict post-traumatic stress symptoms, and this relation to be mediated by fear. We used data from a longitudinal project on adolescent normative development that was under way at the time of the 2010 earthquake in Chile. Six months before the earthquake, 218 adolescents responded to a self-efficacy beliefs scale; three months after the earthquake they reported the perceived magnitude of the event, the fear they experienced, and their post-traumatic stress symptoms. Results showed that perceived magnitude was not associated with fear or post-traumatic stress symptoms, but self-efficacy beliefs and fear were associated with post-traumatic stress symptoms. The hypothesized role of fear as a mediator in the relation between self-efficacy beliefs and post-traumatic stress symptoms was supported by the data. The results of the study, suggest that preventive interventions aimed to increase awareness of how to face a disaster may not only contribute to save lives but may also increase adolescentś sense of personal efficacy, reducing subsequent emotional reactivity associated with the event.     

Parental grief following the death of an infant—a follow-up over one year

The course of parental bereavement during the first year following an infant's death was investigated. Also, the differences in mothers' and fathers' reactions, the differences according to the mothers' occupational role, and the similarities in couples' reactions were studied. From a total sample of 59 families, 13 families answered their questionnaires at all three time points (1, 6 and 13 months), 22 families responded at two time points, and 37 families responded at some point following the loss. Measures relating to anxiety, depression, bodily discomfort, general well being and impact of event were used at the three time points. The results showed that grief, as measured by the different inventories, decreased over time. The decrease was most evident from 6 to 13 months, and most prominent in women. A considerable number of the parents were still actively dealing with the loss all through the first year of bereavement. In most couples the mother reported most distress. Mothers were significantly more depressed than fathers at all time points, and mothers also had significantly higher anxiety and lower general health at 1 and 13 months, and intrusive scores of 1 and 6 months. Women at home evidenced more grief at all three time points than women employed outside the home. A high or low score in one spouse was more strongly correlated with a similar score in the other at 1 and 13 months, than at 6 months. The implications for counselling of parents, with special emphasis on the employment situation of the mother, is emphasized.     

Cognitive behaviour therapy of acute stress disorder: a four-year follow-up

The aim of this study was to index the long-term benefits of early provision of cognitive behavior therapy to trauma survivors with acute stress disorder. Civilian trauma survivors (n = 80) with acute stress disorder were randomly allocated to either cognitive behavior therapy (CBT) or supportive counseling (SC) - 69 completed treatment, and 41 were assessed four years post-treatment for post-traumatic stress disorder (PTSD) with the Clinician Administered PTSD Scale. Two CBT patients (8%) and four SC patients (25%) met PTSD criteria at four-year follow-up. Patients who received CBT reported less intense PTSD symptoms, and particularly less frequent and less avoidance symptoms, than patients who received SC. These findings suggest that early provision of CBT in the initial month after trauma has long-term benefits for people who are at risk of developing PTSD.     

Hypnotherapy and cognitive behaviour therapy of acute stress disorder: a 3-year follow-up

The long-term benefits of cognitive behaviour therapy (CBT) for trauma survivors with acute stress disorder were investigated by assessing patients 3 years after treatment. Civilian trauma survivors (n=87) were randomly allocated to six sessions of CBT, CBT combined with hypnosis, or supportive counselling (SC), 69 completed treatment, and 53 were assessed 2 years post-treatment for post-traumatic stress disorder (PTSD) with the Clinician-Administered PTSD Scale. In terms of treatment completers, 2 CBT patients (10%), 4 CBT/hypnosis patients (22%), and 10 SC patients (63%) met PTSD criteria at 2-years follow-up. Intent-to-treat analyses indicated that 12 CBT patients (36%), 14 CBT/hypnosis patients (46%), and 16 SC patients (67%) met PTSD criteria at 2-year follow-up. Patients who received CBT and CBT/hypnosis reported less re-experiencing and less avoidance symptoms than patients who received SC. These findings point to the long-term benefits of early provision of CBT in the initial month after trauma.     

Measuring post-traumatic stress: A psychometric evaluation of symptom- and coping questionnaires based on a Norwegian sample

The purpose of this study was to evaluate the psychometric characteristics of the Norweigian versions of the Impact of Event Scale, the Post Traumatic Stress Scale-10 item version and General Coping Questionnaire-30 item version. A group of 40 male and 56 female medical students was tested one week and four months after having started dissection of cadavers for the first time. The results showed that all scales had good internal consistency and test-retest reliability. The student sample scored lower on the IES and PTSS-10 than comparable groups of traumatized subjects. A gender difference emerged, with female subjects scoring higher than male subjects. The factor analysis of the instruments indicated good construct validity for the symptom scales. The analysis of content validity related to DSM IV criteria indicated that the IES and PTSS-10 may have some limitations in their predictive validity of PTSD. Taken together, the three scales have shown good psychometric properties and could be used in future research and clinical work.     

The approach‐avoidance framework for identifying athletes’ coping style as a function of gender and race

Anshel, M.H., Kang, M. & Miesner, M. (2010). The approach‐avoidance framework for identifying athletes’ coping style as a function of gender and race. Scandinavian Journal of Psychology. The purpose of this study was to identify the coping styles of competitive athletes as a function of gender and race in response to events experienced during the contest perceived as highly stressful using the approach and avoidance coping framework. Participants (N = 218) consisted of 111 males (48 African American and 63 Caucasian) and 107 females (41 African American and 66 Caucasian), and ranged in age from 18 to 54 yrs (M ± SD; 22.29 ± 3.9 yrs). They attended a university in the southeastern US, and were considered highly skilled athletes based on their current or former participation as competitive athletes. A 12‐item inventory was completed consisting of six approach coping and six avoidance coping strategy items. Confirmatory factor analysis, composite reliability and Cronbach’s alpha indicated acceptable model‐data fit and internal scale consistency. The results suggested the athletes’ preferred coping style was avoidance, rather than approach. A 2 × 2 ANOVA showed significant main effects for gender (p = 0.003) and race (p < 0.01); males used more approach coping than females, while Caucasians applied more approach coping than African Americans. No significant interaction was found. The results indicated the need for future study on examining gender and race as moderating variables in examining athletes’ coping styles.     

Psychotic symptoms and violence toward others — a literature review of some preliminary findings: Part 2. Hallucinations

According to the clinical impressions of a number of authors and mental health professionals, an increased risk of violence is associated with the presence of hallucinations and — in particular — command hallucinations. In contrast to this, some empirical studies have reported that there is no evidence of such a relationship. The present review examines the role of hallucinations in violence toward others. Possible empirical evidence for a violence-escalating interaction between delusions and hallucinations is also analyzed. Among the main findings were: There appears to be no evidence that auditory command hallucinations are dangerous per se. However, there is some evidence that voices ordering acts of violence toward others may increase compliance and thereby be conducive to violent behavior. Finally, the evidence for or against the existence of a possible violence-escalating interaction between delusions and hallucinations is inconclusive. The findings are discussed particularly in relation to problems of measurement and other research design factors. Discrepancies between some of the findings of the present review and current clinical lore are also briefly considered.