Panic symptoms during trauma and acute stress disorder

This study investigated the role of panic symptoms that occur during trauma and subsequent acute stress disorder (ASD). Civilian trauma (N=51) survivors with either acute stress disorder (ASD), subclinical ASD, or no acute stress disorder (non-ASD) were administered the Acute Stress Disorder Scale, Impact of Event Scale, Beck Anxiety Inventory, Beck Depression Inventory, and the Anxiety Sensitivity Index (ASI). Participants also completed the Physical Reactions Scale to index panic symptoms that occurred during their trauma. Overall, 53% of participants reported panic attacks during their trauma. ASD and subclinical ASD participants reported more peritraumatic panic symptoms, and higher ASI scores, than non-ASD participants. These findings are consistent with the notion that peritraumatic panic may be related to subsequent posttraumatic stress, and suggest that modification of maladaptive beliefs about physical sensations should be addressed in posttraumatic therapy.     

Daily stress interacts with trait dissociation to predict sleep-related experiences in young adults

Building on the previously documented effects of stress and dissociation on sleep and dreaming, we examined their interactive role in general sleep-related experiences (GSEs; e.g., nightmares, falling dreams, hypnagogic hallucinations; see Watson, 2001). Stress, sleep quality, and GSEs were assessed daily for 14 days among young adults. Baseline assessment included life stress, sleep quality, psychopathology, dissociation, and related dimensions. Multilevel analyses indicated that daily stress brings about GSEs among highly dissociative young adults. Additionally, baseline trait dissociation predicted within-subject elevation in GSEs when daily stress was high. Flawed sleep-wake transitions, previously linked to dissociation and sleep-related experiences, might account for this effect.     

Anxiety and post-traumatic stress symptoms following wisdom tooth removal

The purpose of the present study was to determine the psychological impact of wisdom teeth removal and to identify the psychological risk factors for the development of dental anxiety and post-traumatic stress symptoms. Participants were 34 consecutive elective patients referred for surgical removal of a wisdom tooth under local anesthesia. Frequency of previous distressing dental events and general traumatic life events were assessed at baseline (t1), and emotional distress (pain, state anxiety and disturbance) immediately after treatment (t2). Post-traumatic stress responses were determined three days after treatment (t3), and at four weeks follow-up (t4), while severity of dental trait anxiety was assessed at t1 and at t4. Two patients (8%) met screening criteria for Post-Traumatic Stress Disorder (PTSD) at t4. Multivariate analysis revealed that previous exposure to distressing dental events and pre-operative anxiety level predicted anxiety level at t4, accounting for 71% of the variance. Severity of pain during treatment was a significant predictor variable of PTSD symptom severity at t4 (25% explained variance). The findings underline the importance of pain-free treatments and awareness of patients' individual predisposition to anxiety or trauma-related symptoms to reduce the risk of iatrogenic psychological harm.     

Vulnerability associations and symptoms of post-traumatic stress disorder in soldiers deployed to Iraq

The purpose of this prospective study was to examine whether explicit and implicit vulnerability associations before and after trauma exposure predict the onset and persistence of post-traumatic stress disorder (PTSD) symptoms. The implicit association test (IAT) was modified to assess associations of self with vulnerability related cues. Dutch soldiers completed the IAT 6 weeks before being deployed to Iraq, and again 5 months upon return home. They also rated an explicit vulnerability scale. PTSD symptoms were assessed 5 and 15 months after deployment with a clinical interview and questionnaire. The results showed that (1) the pre-deployment vulnerability measures did not predict PTSD symptoms at 5 months, (2) both explicit and implicit post-deployment vulnerability measures explained unique variance in concurrent PTSD symptoms, over and above pre-existing neuroticism, and (3) only the explicit post-deployment vulnerability measure predicted unique variance in later PTSD symptoms (at 15 months), after controlling for earlier symptoms. This was no longer the case after controlling for neuroticism. The results suggest that strong implicit associations between the self and vulnerability are a consequence rather than a cause of PTSD symptoms.     

Overgeneral memory and suppression of trauma memories in post-traumatic stress disorder

The study investigated the relationship between the suppression of trauma memories and overgeneral memory in 42 assault survivors with and without PTSD. Overgeneral memory (OGM) was assessed with a standard autobiographical memory test (AMT). Participants completed two further AMTs under the instructions to either suppress or not suppress assault memories, in counterbalanced order. Participants with PTSD retrieved fewer and more general memories when following the suppression instruction than participants without PTSD, but not under the control instruction. OGM correlated with PTSD symptom severity, and measures of cognitive avoidance. The results are discussed with reference to current theories of overgeneral memory and its possible relationship with PTSD.     

The centrality of event scale: a measure of integrating a trauma into one's identity and its relation to post-traumatic stress disorder symptoms

We introduce a new scale that measures how central an event is to a person's identity and life story. For the most stressful or traumatic event in a person's life, the full 20-item Centrality of Event Scale (CES) and the short 7-item scale are reliable (alpha's of .94 and .88, respectively) in a sample of 707 undergraduates. The scale correlates .38 with PTSD symptom severity and .23 with depression. The present findings are discussed in relation to previous work on individual differences related to PTSD symptoms. Possible connections between the CES and measures of maladaptive attributions and rumination are considered along with suggestions for future research.     

Basic assumptions and symptoms of post-traumatic stress among victims of bullying at work

Results from several empirical studies suggest that many victims of bullying suffer from post-traumatic stress disorder (PTSD). However, few researchers have attempted to explain why exposure to bullying may result in severe trauma. Furthermore, no studies have related these symptoms to the victims' exposure to other distressing life events. The aims of this study were therefore to assess the prevalence and intensity of PTSD analogue symptomatology among a group of 118 victims of bullying at work. Second, we investigated whether victims of bullying who report being more affected by other distressing life events than by bullying were more likely to suffer PTSD analogue symptomatology. In accordance with Janoff-Bulman's cognitive theory of PTSD, a third aim was to investigate whether victims of bullying and non-bullied controls differ in their basic assumptions of themselves, others, and the world. Based on self-report measures, 76% of the victims portrayed symptoms indicating post-traumatic stress disorder. However, although 29% were found to meet all DSM-IV-TR criteria for PTSD, another 47% only failed to fulfil the A1 criterion, i.e., they did not report serious injuries or threats to their physical integrity while being bullied. Measurements of symptom severity scores indicated that 61.7% portrayed a moderate to severe or severe level of impairment, whereas 73.6% displayed a moderate or severe impairment in functioning. Compared with victims who failed to meet all or several diagnostic criteria for PTSD, a significantly higher percentage of the victims meeting all criteria reported feeling more negatively affected by an event other than bullying, indicating that exposure to other traumatic life events may increase victims' vulnerability. Finally, significant group differences on six out of eight basic assumptions were demonstrated between victims of bullying and non-bullied controls, indicating that exposure to bullying at work may result in increased negative views on self, others, and the world.     

Serotonin transporter polymorphism interacts with childhood adversity to predict aspects of impulsivity

The serotonin transporter polymorphism has been linked--often in interaction with environmental adversity--to a variety of outcomes, including affective disorders. This polymorphism is widely viewed as relating to anxiety traits. A different view is that it relates instead to impulsivity (vs. control) in reacting to emotions. In a test of the latter view, 303 students were genotyped on this polymorphism and completed self-reports bearing on impulsive reactions to emotions (including both negative and positive emotions in separate measures), impulsive tendencies that do not stem from emotions, and childhood adversity. The impulsivity measures reflected three latent variables: pervasive influence of feelings, feelings (including positive feelings) triggering action, and failure to carry through on intentions (with no mention of emotion). Interactions between genotype and adversity emerged for both emotion-related aspects of impulsivity. Theoretical implications of the findings are discussed.     

Behaviorally inhibited temperament is associated with severity of post-traumatic stress disorder symptoms and faster eyeblink conditioning in veterans

Prior studies have sometimes demonstrated facilitated acquisition of classically conditioned responses and/or resistance to extinction in post-traumatic stress disorder (PTSD). However, it is unclear whether these behaviors are acquired as a result of PTSD or exposure to trauma, or reflect preexisting risk factors that confer vulnerability for PTSD. Here, we examined classical eyeblink conditioning and extinction in veterans self-assessed for current PTSD symptoms, exposure to combat, and the personality trait of behavioral inhibition (BI), a risk factor for PTSD. A total of 128 veterans were recruited (mean age 51.2 years; 13.3% female); 126 completed self-assessment, with 25.4% reporting a history of exposure to combat and 30.9% reporting current, severe PTSD symptoms (PTSS). The severity of PTSS was correlated with current BI (R(2) = 0.497) and PTSS status could be predicted based on current BI and combat history (80.2% correct classification). A subset of the veterans (n = 87) also completed the eyeblink conditioning study. Among veterans without PTSS, childhood BI was associated with faster acquisition; veterans with PTSS showed delayed extinction, under some conditions. These data demonstrate a relationship between current BI and PTSS, and indicate that the facilitated conditioning sometimes observed in patients with PTSD may partially reflect personality traits such as childhood BI that pre-date and contribute to vulnerability for PTSD.     

Workplace bullying and its relation with work characteristics, personality, and post-traumatic stress symptoms: an integrated model

Workplace bullying refers to prolonged exposure to frequent hostile behaviors at work, which can lead to severe stress reactions. Research in this area has not revealed a clear picture on how bullying escalates in organizations. Drawing on recent developments in work stress theory, this study tested a comprehensive model of bullying in which work environmental and personality factors were hypothesized to act as antecedents of bullying and post-traumatic stress symptoms as an outcome. Structural equation modeling on data provided by 609 public sector employees in Italy showed that job demands (workload and role conflict) and job resources (decision authority, co-worker support and salary/promotion prospects) were related to bullying over and above neuroticism, and that bullying mediated the relationship between job demands and PTSD symptoms. Evidence also emerged for a buffering effect of job resources on the job demands-bullying relationship. Overall results are compatible with a view of bullying as a strain phenomenon, initiated by both work environmental and personality factors.     

Evaluating a novel intervention to reduce trauma symptoms and sexual risk taking: qualitative exit interviews with sexual minority men with childhood sexual abuse

Childhood sexual abuse (CSA) continues to affect sexual minority men (SMM) at disproportionate levels and contributes to multiple negative health outcomes, including sexual-risk taking and HIV acquisition. This paper presents qualitative evaluative feedback from SMM (N = 9) who participated in a 10-session Cognitive Behavioral Therapy-Trauma and Sexual Health (CBT-TSH) intervention to reduce CSA-related posttraumatic stress reaction and distress. The treatment was designed to increase accurate sexual risk appraisals and to improve self-care health behaviors related to HIV/STI acquisition. The researchers identified four emerging themes: (1) motivation to participate, (2) response to cognitive therapy, (3) process of change, and (4) considerations for intervention improvement. These qualitative findings provide useful feedback on the acceptability of an innovative program that integrates CBT for trauma related to CSA with sexual risk-reduction counseling.     

Stereotypical thinking as a mediating factor in the association between exposure to terror and post-traumatic stress disorder symptoms among Israeli youth

Background and Objectives: The negative impact of exposure to terror on mental health, as well as on the perceptions of each side of the conflict toward the other, is well-documented. However, the association between stereotyping, concomitant with perceived threat, and anxiety, was rarely investigated. The current study examined information processing attributes and exposure to terror as predictors of PTSD symptoms among youth at inter-group conflict, with stereotypical thinking toward a threatening out-group as a possible mediator. Design: Cross-sectional, with exposure to terror, need for cognitive structure (NCS), efficacy at fulfilling the need for closure (EFNC) and self-esteem, predicting stereotypical thinking and PTSD symptoms. Method: Ninth graders (N?=?263) from two residential areas in Israel, varying in their degree of exposure to terror, responded to a self-report questionnaire tapping the above variables. Results: Stereotypical thinking was found to mediate the association between exposure to terror and PTSD symptoms, but not the association between the NCS and EFNC interaction and PTSD symptoms. Conclusions: The findings support terror management theory, so that a negative and rigid perception makes it difficult to construct coherent world-view, thus contributing to aggregation of existential anxiety and PTSD symptoms.     

The effect of sensitization and coping style on post-traumatic stress symptoms and quality of life: two longitudinal studies

The present study investigated the effects of multiple trauma exposure and coping style on post-traumatic stress symptoms and quality of life. It was hypothesized that sensitization would occur in subjects repeatedly exposed to life-threatening situations (study 1), and different coping styles would act as a resilience or facilitating factor in symptom development (study 2). The results showed that the single-exposure group revealed a decrease in trauma specific stress reactions from three weeks to four months, with a persistent reduction at 12-month follow-up, while the repeated-exposure group showed an increase in symptom reporting over the 12-month period. The same pattern emerged for perceived quality of life-measured by the General Health Questionnaire (GHQ-30). The second study revealed a correlation between scores on avoidant-focused coping style and the Impact of Event Scale-avoidance dimension, Post-traumatic Symptom Scale and GHQ-30. Furthermore, only subjects with a dominant coping style of emotion-focused or task-focused coping showed a reduction in trauma-specific symptom scores over time.     

From supportive-listening to a solution-focused intervention for counsellors dealing with political trauma

This article focuses on a brief 'helping the helper' intervention with school counsellors during a nation-wide political trauma, the recent Intifada in Israel. An emergency field intervention programme for Israeli school counsellors was developed that was aimed at addressing their personal as well as professional (and role-related) concerns to reduce or prevent burnout and enhance empowerment. The action research method was used to adapt the programme to the participants' needs. The resulting brief intervention programme was designed to shift processing of the perceived situation from affective processes to more structured and controlled cognitive processes. The burnout prevention programme included a short (process) debriefing to promote the affective to cognitive coping processes shift, presenting coping strategies to enhance cognitive adaptation to threatening events, and using a solution-focused guidance intervention. The rationale and the results supporting the face validity of the intervention are presented.     

Pavlovian eyeblink conditioning in combat veterans with and without post-traumatic stress disorder

Several recent studies have investigated relationships between post-traumatic stress disorder (PTSD) and learning and memory problems. These reports have found in general that not only does PTSD affect trauma-related memories, but when patients with PTSD are compared with similar trauma patients without PTSD, general memory impairments have been found. The present paper reports a study in which associative learning, using Pavlovian eyeblink conditioning, was investigated in combat veterans with and without chronic PTSD, using interstimulus intervals of 500 and 1000 msec in two separate experiments. Although several recent reports suggest that larger-magnitude autonomic conditioned responses occur in patients with PTSD during Pavlovian conditoning, the present study found evidence of impaired Pavlovian eyeblink conditioning in combat veterans with and without PTSD, compared to non-combat veterans. Although these data suggest that combat leads to an impaired associative learning process regardless of whether PTSD is apparent, a group of community-dwelling combat veterans not under medical treatment showed normal conditioning, suggesting that variables other than prior combat must also be involved.     

Regressive experiences in Vietnam veterans: Their relationship to war,post-traumatic symptoms and recovery

Regression has been commonly associated with war and postwar symptomatology. Posttraumatic symptoms have been considered regressive when manifested by chronic dependent behavior or outbursts of primitive, aggressive behavior. Recovery from regressive symptoms may in itself induce regressive experiences since recovery necessarily leads to another change in ego boundaries; rigid or fused boundaries becoming realigned, intact, and flexible. Recovery therefore requires a stable and trusting therapeutic relationship to gradually permit such changes. Psychological treatment of Vietnam veterans often has occurred in phases with immediate management of regressive symptoms occurring during early phases and induction of regressive states has often occurred during late phases to facilitate integration of split-off traumatic experiences and emotions.     

Intrusive memories and rumination in patients with post-traumatic stress disorder: a phenomenological comparison

The aim of the study was to investigate the phenomenological differences between intrusive memories and rumination in PTSD. The study population consisted of 31 patients with PTSD referred for cognitive behavioural therapy to specialist services. A semi-structured interview was used to examine the characteristics of the most prominent intrusive memory and rumination. Intrusive memories were predominantly sensory experiences of short duration, whereas rumination was predominantly a thought process of longer duration. Shame was associated more with rumination than with intrusive memories. Anxiety, helplessness, numbness, and threat were greater at the time of the trauma than when experiencing the intrusive memory. In contrast, feelings like anger and sadness were greater when experiencing intrusive memories than at the time of the event. The distinction between intrusive memories and rumination is of clinical importance as intrusive memories usually decrease with imaginal reliving of the trauma, whereas rumination may require different therapeutic strategies, such as rumination-focused or mindfulness-based cognitive therapy.     

Cognitive trait anxiety,stress and effort interact to predict inhibitory control

Few studies have focussed on the link between anxiety and inhibitory control in the absence of stimulus-driven external threat. This two-part experiment examined the interactions between (1) somatic trait anxiety, somatic situational stress (i.e. threat of electric shock), and effort, and (2) cognitive trait anxiety, cognitive situational stress (i.e. ego-threat instructions), and effort, on inhibitory processes using a Go-No-Go paradigm. Trait anxiety was operationalised using questionnaire scores and effort was operationalised using a visual analogue scale. Performance effectiveness was measured using the d′ parameter from signal detection theory and processing efficiency was indexed by the ratio of d′ to response time on correct trials. Results indicated that somatic trait anxiety and stress did not predict effectiveness or efficiency. Cognitive trait anxiety and stress were associated with both inhibitory effectiveness and efficiency deficits; however, contrary to expectations these deficits were evident at higher rather than lower mental effort. Results suggest a distinction between how somatic and cognitive anxiety manifest on tasks involving inhibitory control.     

Understanding the impact of prior depression on stress generation: Examining the roles of current depressive symptoms and interpersonal behaviours

Stress generation is a process in which individuals contribute to stressful life events. While research has supported an association between current depression and stress generation, it has been noted that individuals with prior depression tend to contribute to stressors even when they are no longer experiencing a depressive episode. The aim of the study is to elucidate the pathways through which prior major depression predicts interpersonal stress generation in women. Specifically, we examined current subsyndromal depressive symptoms and problematic interpersonal behaviours as potential mediators. Fifty‐one college women were followed prospectively for 6 weeks. Participants were interviewed to assess current and past depression as well as stressful life events they experienced over the 6‐week period. The findings suggest that prior major depression continues to have an impact even after the episode has ended, as the disorder continues to contribute to stress generation through residual depressive symptoms.     

5-HTTLPR,HTR1A,and HTR2A cumulative genetic score interacts with mood reactivity to predict mood-congruent gaze bias

Genetic variation within the serotonin system has been associated with biased attention for affective stimuli and, less consistently, with vulnerability for major depressive disorder. In particular, 5-HTTLPR, HTR1A (rs6295), and HTR2A (rs6311) polymorphisms have been linked with biased cognition. The present study developed a serotonergic cumulative genetic score (CGS) that quantified the number of risk alleles associated with these candidate polymorphisms to yield a single CGS. The CGS was then used to model genetic influence on the relationship between reactivity to a negative mood induction and negatively biased cognition. A passive-viewing eye-tracking task was administered to 170 healthy volunteers to assess sustained attention for positive, dysphoric, neutral, and threatening scenes. Participants were then induced into a sad mood and readministered the passive-viewing task. Change in gaze bias, as a function of reactivity to mood induction, was the primary measure of cognitive vulnerability. Results suggest that, although none of the individual genes interacted with mood reactivity to predict change in gaze bias, individuals with higher serotonin CGS were significantly more likely to look toward dysphoric images and away from positive images as mood reactivity increased. These findings suggest that a CGS approach may better capture genetic influences on cognitive vulnerability and reaffirm the need to examine multilocus approaches in genomic research.