Emotional Processing Therapy for post traumatic stress disorder

While prolonged exposure is considered one of the “gold standard” and recommended treatments for post traumatic stress disorder (PTSD), it has been poorly utilised in clinical practice. Individuals with PTSD often find it too distressing to confront memories, and therapists may be uncomfortable using the therapy. A new Emotional Processing Therapy is described in which an emotional approach to prolonged exposure provides individuals with a new insight into how trauma is processed. A conceptual analysis of exposure suggests that it is exposure to distressing emotional experiences which is a key element. Viewing it as an emotion-based therapy, allows the creative addition of new emotional elements. Through exploring the individual’s emotional processing style, previously learned and unhelpful patterns can be addressed, and the addition of an “emotional preparation” phase helps them understand why it is important to face emotionally distressing memories before exposure sessions begin. Emotional Processing Therapy is intuitive and makes sense to those affected by PTSD. It is framed in an emotional context and is presented as part of a lifestyle change that may reduce the likelihood of psychological problems developing in the future.     

Clinical research on behavioral activation as treatment for post‐traumatic stress disorder: A brief review and meta‐analysis

Behavioral activation (BA), an effective treatment for depression, has recently been receiving attention as a possible intervention for PTSD. BA interventions could be particularly useful in treating underserved populations (i.e., individuals with lower socioeconomic status). A literature search was conducted, which identified seven outcome studies that examined the effectiveness of stand‐alone BA treatment for individuals with PTSD. All studies identified for this brief review demonstrated clinically significant reductions in PTSD symptoms using BA as an intervention. A meta‐analysis of these few studies revealed a nonsignificant effect (Cohen's d = 0.713, p = .512) despite reporting an average symptom reduction of 25.8%. Other studies utilizing BA treatment for PTSD do so in tandem with other interventions and were excluded from analysis. This brief review summarizes the literature on the use of BA as a stand‐alone treatment for PTSD and suggests that future research seek to confirm the usefulness of BA as a potential treatment modality for mental health‐care providers treating individuals with PTSD.     

The power of rituals in dealing with traumatic stress symptoms: cleansing rituals for former child soldiers in Northern Uganda

International guidelines for emergency response note the importance of cultural adaptions and facilitation of local spiritual and religious healing practices when appropriate. Deciding whether traditional medicine is safe, effective and appropriate is a complex matter. This study explores the therapeutic factors of a local cleansing ritual in Northern Uganda aimed at healing former child soldiers. The components of the ritual are analysed and compared with research-based therapy for post-traumatic stress disorder. Participant observation was used during the ritual, followed by qualitative in-depth interviews and follow-up interviews over three years. The key informant is a former child soldier participating in the ritual. He was abducted and forced to commit several killings during a three-year period. The collective mobilisation of social support, the collective forgiveness and the strength of the psycho-education appear central for the effect of the ritual. In addition, the ritual draws on common therapeutic factors. The findings indicate that such a ritual involves elements that safely and effectively deal with symptoms in accordance with modern research on trauma therapy, perhaps more powerfully than Western-style therapy. Implications for collaboration with local healers in emergency settings are indicated.     

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.     

Analysis of long-term stress reactions in emergency room patients: An initial study

The psychological stress reactions of 44 family medicine patients who were treated in the emergency room were examined approximately a year after the event. Patients were assessed on several psychological measures, including one for posttraumatic stress disorder (PTSD), and on their perception of how stressful the event was initially and now. Results show continuing stress reactions related to the emergency room event. Three patients endorsed symptoms indicating full PTSD and 13 appeared to have at least partial PTSD. Age appeared to be a factor in the presence of stress symptoms and in degree of perceived communication with the physician.     

Effects of traumatic stress and perceived stress on everyday cognitive functioning

Stressful or traumatic events have been shown to impair cognitive functioning on laboratory-based tasks due to stress-related intrusive thoughts and avoidance. However, research on the effects of stress on everyday cognitive functioning has been lacking. A sample of 909 undergraduates completed measures of perceived stress, PTSD symptoms, and everyday cognitive failures. The results revealed that both perceived stress and PTSD symptoms uniquely predicted cognitive failures, even after controlling for a number of potentially confounding variables. Additionally, there was a significant interaction. Participants with low scores on both measures of stress reported the fewest occurrences of everyday cognitive failures. In contrast, participants with elevated scores on either measure of stress reported higher levels of cognitive failures. These results suggest that there are unique negative effects of perceived stress and PTSD symptoms on everyday cognitive functioning and sharpen our understanding of the relationship between stress and cognition.     

Secondary traumatic stress and adjustment in therapists who work with sexual violence survivors: the moderating role of posttraumatic growth

ABSTRACT

Due to their secondary exposure to the traumatic events disclosed by clients, therapists who work with sexual violence survivors are at risk of experiencing secondary traumatic stress. We examined whether the negative effects of secondary traumatic stress on therapist adjustment would be buffered by posttraumatic growth. Sixty-one therapists who work with sexual violence survivors completed measures of secondary traumatic stress, posttraumatic growth and a range of adjustment indicators. Hierarchical multiple regression analyses demonstrated that posttraumatic growth moderated the negative impact of secondary traumatic stress on therapist depression, anxiety, personal meaning and satisfaction with life. Posttraumatic growth sustained positive affect through a direct effects model only. This study provides support for the protective role of posttraumatic growth in adjustment to secondary traumatic stress.     

Systemic psychotherapy as an intervention for post‐traumatic stress responses: an introduction,theoretical rationale and overview of developments in an emerging field of interest

The purpose of this article is to critically examine the literature to provide a rationale for including systemic family therapy (SFT) in the psycho‐social treatment of people suffering the impact of post‐traumatic stress (PTS). Attention is drawn to the relatively underdeveloped academic literature on PTS and the family. The impact of PTS is conceptualized within a psycho‐social framework and the current evidence base for psycho‐social interventions for PTS responses is described, highlighting the opportunity and need to undergird this area of daily practice. The impact of PTS on the family at multiple levels is identified, emphasizing its recursive nature. The case for SFT is articulated and a range of models of family intervention for PTS briefly reviewed, concluding with an emphasis on Walsh's key processes in family resilience as a framework for practice.     

Life‐events and post‐traumatic stress in a sample of English adolescents

The aim of the present study was to investigate the lifetime prevalence of negative life‐events and their association with post‐traumatic stress in English adolescents. Of the 427 adolescents surveyed, 360 (84%) endorsed at least one negative event. Respondents were asked to complete the Impact of Event Scale (IES: Horowitz, Wilner and Alvarez, 1979) for each event that they endorsed. For boys, highest levels of post‐traumatic stress were found in those who had experience of a ‘family member with a drink or drugs problem’, followed by ‘parental separation or divorce’, ‘life threat to family member’, and ‘life‐threat to self ’. For girls, highest levels of post‐traumatic stress were found in those who had experienced ‘attack or physical assault to self ’, followed by ‘family member with drink or drugs problem’, ‘parental separation or divorce’, and ‘life threat to family member’. These data suggest that moderate levels of post‐traumatic stress are present in around one fifth of adolescents who have experienced one of these events and that community levels of post‐traumatic stress in adolescents may be higher than previously thought. Copyright © 2000 John Wiley & Sons, Ltd.     

Posttraumatic Stress Disorder Symptom Severity and Emotion Regulation in Acute-Care Psychiatric Inpatients: Associations With Suicidality

Posttraumatic stress disorder (PTSD) symptomatology has been positively associated with suicidality (suicidal ideation and attempts), but less is known about factors that might exacerbate that association. The present study examined the main and interactive effects of PTSD symptom severity and difficulties in emotion regulation in association with four suicidality outcomes. Participants included 128 adults in an acute-care psychiatric inpatient setting. Results revealed that PTSD symptom severity was significantly incrementally associated with self-reported suicidal ideation (ß = .30, p = .02). Difficulties in emotion regulation were significantly associated with suicide as the reason for current admission (p = .01). The interactive effect of PTSD symptom severity and difficulties in emotion regulation was significant only for self-reported suicidal ideation (ß = .24, p < .001). Participants with high levels of PTSD symptom severity and difficulties in emotion regulation exhibited the highest level of suicidal ideation. Clinical implications and future directions are discussed.     

Exploring the relationship between secondary traumatic stress,professional identity and career factors for counsellors

This study used a correlational research design to explore the relationship between secondary traumatic stress, counsellor professional identity and career factors, including work setting and amount of counselling experience, among counsellor practitioners. A sample of 1,218 counsellors completed an online survey including the Secondary Traumatic Stress Scale (STSS), Professional Identity Scale in Counseling and career factors. Career factors included context of work environments including years of experience, licence status, type of practice and work setting. Multiple regression analysis with forward selection demonstrated that, out of all the variables, professional identity emerged as the best predictor of secondary traumatic stress. One-way ANOVA showed significant group differences in the level of counsellors' secondary traumatic stress based on work setting, level of experience, type of practice and gender. Discussion explores how career and personal factors impact counsellor experiences of professional identity and secondary trauma in mental health settings.     

Trauma as an objective or subjective experience: The association between types of traumatic events,personality traits,subjective experience of the event,and posttraumatic symptoms

The study aimed to examine the discrete effect of objective (type of trauma and demographic characteristics) and subjective (proximity to the trauma, subjective experience of the trauma as a threat, the Big Five personality traits, and dissociative symptoms) factors on the risk for PTSD among 1,210 undergraduate students. The findings indicate that survivors of physical/sexual assault scored the highest on proximity to the trauma, subjective experience of the trauma as a threat, neuroticism, dissociation, and PTSD symptoms. In addition, subjective experience of the trauma, proximity to it, type of trauma, dissociation, and neuroticism were associated with the risk for PTSD symptoms. The findings point to the significance of both subjective and objective variables in the risk for PTSD symptoms.     

Recovery from post‐traumatic stress disorder in children following road traffic accidents: the role of talking and feeling understood

Forty children were assessed 6 weeks and 8 months after involvement in a road traffic accident (RTA). Ten of the 21 children suffering post‐traumatic stress disorder (PTSD) at 6 weeks continued to fulfil diagnostic criteria at 8 months. There was no evidence of delayed onset of PTSD in children who had not developed this condition at 6 weeks. Talking about the accident and feeling understood were associated with recovery. Providing children with opportunities to talk about their accident may be helpful in preventing or reducing psychological distress. Copyright © 2001 John Wiley & Sons, Ltd.     

Amnesia, traumatic brain injury, and posttraumatic stress disorder: a methodological inquiry

This study explored the relationship between mild traumatic brain injury (MTBI), amnesia, and posttraumatic stress disorder (PTSD). MTBI status and amnesia for the event were assessed in 307 consecutive admissions to a Level 1 Trauma Center. Amnesia did not always occur concurrently with MTBI: 18% of those with MTBI had full recall and over half had partial recall of the event. Just over 10% of participants developed PTSD by 12 months post-injury, with prevalence comparable across MTBI and non-MTBI groups. Non-significant differences in incidence of PTSD were apparent between those with full recall (9%), partial recall (14%) and no recall (7%). These data highlight the fact that PTSD may develop following trauma despite amnesia for the event, and illustrate the importance in both clinical and research settings of carefully examining the extent of amnesia.     

Technologies to Lessen the Distress of Autism

Abstract

This article explores aspects of autism that make it a potential traumatic stressor for family members, and may put them at risk for Posttraumatic Stress Disorder (PTSD) and/or its sub-syndromal variants. It also surveys current trends in autism, including the growing number of families affected by autism. Because PTSD and its sub-syndromes can benefit from prevention or at least bolstering the resources of the person and their social support system, this article will then focus on relevant technology trends being used to mediate or ameliorate aspects of living with autism. This technology includes telehealth, distance education, information technology, video-conferencing, and computer software.     

Potential traumatic events in early childhood and behavioural resilience: a longitudinal case control study

Abstract

Resilience can be evidenced when an exposure to potentially traumatic event (PTE) has no negative impact on behavior. This study explored the effects of exposure to PTE applying a longitudinal design with 592 children (mean age 4 years) followed across three years. Children who had experienced a PTE and those who had not, were compared over time. Behavioral difficulties and prosocial behaviour for children experiencing PTE did not differ from those who had not experienced a PTE suggesting resilience among the exposed children. PTE in itself seems to carry minimal risk for symptoms of behaviour difficulties among preschool children.     

Post–traumatic stress disorder in patients with coronary artery disease: A review and evaluation of the risk

Psychosocial factors are known to impact on the prognosis of patients with coronary artery disease independently of disease severity. However, few studies have looked at whether these patients are at risk of developing post-traumatic stress disorder, and the potential implications for morbidity and mortality. Through a review of the empirical literature, the objectives were to investigate whether patients with coronary artery disease are at risk of developing this disorder, to look at relations between post-traumatic stress disorder and heart disease, and to stimulate further research. The review indicated that some patients with coronary artery disease are at risk of developing post-traumatic stress disorder, although the prevalence varied considerably. Methodological issues together with recommendations for future research are discussed. Although only some cardiac patients may develop post-traumatic stress, this disorder should not be overlooked due to its potential role in reinfarctions and mortality.