Post traumatic stress disorders

A clinical overview of the Post-Traumatic Stress Disorders (PTSD) is presented emphasizing altered qualities of experience and behavior. A schema of human psychological responses to stressful life events is reviewed as an introduction to the extensive development of concepts of pathological stress response syndromes: Post-Traumatic Stress Disorders; post-traumatic stress disorder, chronic type; delayed Post-Traumatic Stress Disorder. An illustrative case history is presented. The potential development of PTSD in individuals experiencing less than overwhelming stressors is conceptualized.     

Psychopathy and traumatic stress

This study examined the relationship between psychopathy and traumatic stress. First, a sample of 48 male patients in a security hospital was assessed using the Psychopathy Checklist (Hare, 2003) and the Stanford Acute Stress Reactions Questionnaire (SASRQ; Cardena, Classen, Koopman, & Spiegel, 1996). Linear regression analyses suggested that the affect deficit component of psychopathy was the best negative predictor of avoidance, dissociation, and re-experiencing symptoms. The 13 highest-scoring psychopathy participants were then compared to the 13 lowest-scoring participants. Psychopaths differed from controls in terms of number but not type of traumatic events. They obtained significantly lower SASRQ total score, reflecting a lower level of traumatic symptomatology. The results are discussed in connection with the emotional deficit component of psychopathy.     

The spiritual dynamics of chronic post traumatic stress disorder

Although there have been numerous articles and books written about Post Traumatic Stress Disorder (PTSD), relatively little has been written about the spiritual dynamics of this disorder. The authors of this article suggest that the spiritual components of PTSD should be addressed in treatment because they may have profound impact on chronic PTSD patients. A framework for treatment involving eight Rs—Risking and Revealing, Responding and Releasing, Reflecting and Reconciling, and Resurrecting and Rebuilding—is described.J. LeBron McBride, Ph.D. is Coordinator of Behavioral Science and a licensed Marriage and Family Therapist at the Georgia Baptist Family Practice Residency Program in Morrow, Georgia. Gloria Armstrong, M.Div., M.A. is licensed as a Marriage and Family Therapist and Professional Counselor and works at the Pastoral Institute in Columbus, Georgia.     

The importance of the peritraumatic experience in defining traumatic stress

In the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev., DSM-IV-TR; American Psychiatric Association, 2000), posttraumatic stress disorder (PTSD) Criterion A2 stipulates that an individual must experience intense fear, helplessness, or horror during an event that threatened the life or physical integrity of oneself or others to be eligible for the PTSD diagnosis. In considering this criterion, we describe its origins, review studies that have examined its predictive validity, and reflect on the intended purpose of the criterion and how it complements the mission of the DSM. We then assert that the predictive validity of Criterion A2 may not be an appropriate metric for evaluating its worth. We also note that the current Criterion A2 may not fully capture all the salient aspects of the traumatic stress response. To support this claim, we review empirical research showing that individuals adapt to extreme environmental events by responding in a complex and coordinated manner. This complex response set involves an individual's appraisal regarding the degree to which the event taxes his or her resources, as well as a range of other cognitions (e.g., dissociation), felt emotions (e.g., fear), physiological reactions (e.g., heart rate increase), and behaviors (e.g., tonic immobility). We provide evidence that these response components may be associated with the subsequent development of PTSD. We then describe the challenges associated with accurately assessing an individual's traumatic stress response. We conclude with a discussion of the need to consider the individual's immediate response when defining a traumatic stressor.     

Predicting traumatic stress using emotional intelligence

The study investigated whether emotional intelligence (EI) can predict how individuals respond to traumatic experiences. A random sample of 414 participants (181 male, 233 female) were administered a measure of EI along with the Impact of Event Scale--revised [IES-R; Weiss, D. S. & Marmar, C. R. (1997). The Impact of Events Scale--revised. In J.P. Wilson & T.M. Keane (Eds.), Assessing psychological trauma and PTSD (pp. 399-411). New York: Guilford Press], and the monitoring and blunting questionnaire [MBQ, Anxiety Stress Coping 7 (1994) 53]. The results showed that participants with higher NEIS scores report fewer psychological symptoms relating to their traumatic experiences, that monitors are more likely to have higher NEIS scores than blunters. Traumatic events had a greater impact on females than males, and males had higher EI than females. The implications of these findings for using EI as a predictor for individuals who may experience traumatic stress are discussed.     

Secondary traumatic stress in emergency medicine clinicians

Previously called Secondary Traumatic Stress (STS), secondary exposure to trauma is now considered a valid DSM-5 Criterion A stressor for posttraumatic stress disorder (PTSD). Previous studies have found high rates of STS in clinicians who treat traumatically injured patients. However, little research has examined STS among Emergency Medicine (EM) physicians and advanced practice providers (APPs). The current study enrolled EM providers (N = 118) working in one of 10 hospitals to examine risk factors, protective factors, and the prevalence of STS in this understudied population. Most of the participants were physicians (72.9%), Caucasian (85.6%), and male (70.3%) with mean age of 39.7 (SD = 8.9). Overall, 12.7% of the sample screened positive for STS with clinical levels of intrusion, arousal, and avoidance symptom clusters, and 33.9% had at least one symptom cluster at clinical levels. Low resilience and a history of personal trauma were positively associated with positive STS screens and STS severity scores. Borderline significance suggested that female gender and spending ≥10% of one’s time with trauma patients could be additional risk factors. Findings suggest that resilience-building interventions may be beneficial.     

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.     

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.     

War-related stress. Addressing the stress of war and other traumatic events

A task force on war-related stress was convened to develop strategies for prevention and treatment of psychological, psychosocial, and psychosomatic disorders associated with the Persian Gulf War and other extreme stressors facing communities in general. The task force focused on the return home, reunion, and reintegration of service personnel with their families and work. Although the Persian Gulf War was won with relative ease, negative psychological sequelae may develop in some individuals because of the stress of war, family disruption, financial difficulty, and changes in family routines. Typical stress reactions and modes of coping that are usually unsuccessful or destructive were outlined, and suggestions were made for monitoring these. In addition, guidelines for successful coping were developed. Special attention was given to children's reactions and needs. Recommendations were made for outreach and intervention on the policy, systems (e.g., schools, businesses, governmental agencies), family, and individual levels.     

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.     

Assessment and treatment of adult acute responses to traumatic stress following mass traumatic events

Assessment and treatment of acute responses to traumatic stress has received much attention since September 11, 2001. This article elucidates principles of early intervention with adults in the immediate (within 48 hours) and early recovery phase (within the first week). The principles have been drawn from research on risk and recover factors, stress and traumatic stress theory, and expert consensus recommendations. The debriefing model is discussed, and principle interventions of psychological first aid, pharmacology, and mass trauma systems are described. This article concludes with brief guidelines for longer-term interventions and recommendations for future research.     

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.     

Family satisfaction with medical care after traumatic brain injury

Ratings during acute and follow-up care by 35 families having members with traumatic brain injury showed none of the medical facilities met families' needs though some aspects of patients' care were rated higher in hospitals. Findings suggest comprehensive surveys are needed.     

Anxiety sensitivity and posttraumatic stress among traumatic event-exposed youth

Total and factor scores of the Childhood Anxiety Sensitivity Index (CASI) were examined in relation to posttraumatic stress symptom levels within a community-based sample of 68 (43 females) traumatic event-exposed youth between the ages of 10 and 17 years (M_age=14.74 years). Findings were consistent with hypotheses; global anxiety sensitivity (AS) levels, as well as disease, unsteady, and mental incapacitation concerns, related positively to posttraumatic stress levels, whereas social concerns were unrelated to symptom levels. These results suggest that fears of the physical and mental consequences of anxiety are associated with relatively higher levels of posttraumatic stress subsequent to traumatic event exposure. Findings are discussed in terms of potential implications for the role of AS in developmentally sensitive etiological models of posttraumatic stress disorder (PTSD).     

Workers' compensation for law enforcement related post traumatic stress disorder

The questions of how Post Traumatic Stress Disorder (PTSD) manifests itself among police officers and their eligibility to receive workers' compensation for PTSD are explored. The nature of the police officer's occupation, the prevalence of stress-related disorders among police personnel, and the relationship of the police personality to the dynamics of the way stress is manifested are considered. The extent to which workers' compensation statutes in various states cover mental injuries is also examined, and the variables that may affect the outcome of an officer's receiving compensation for PTSD are discussed. Finally, implications for mental health professionals who testify as expert witnesses in cases dealing with police stress, as well as those who work in the assessment and treatment ofpolice personnel, are explored.     

Bullying: a source of chronic post traumatic stress?

This study surveyed 165 care professionals on their experience of workplace bullying. The results showed that in a 2-year period 40% had been bullied and 68% had observed bullying taking place. Of the 67 care professionals that had been bullied 44% were experiencing high levels of PTSD symptoms based on the general factor of the IES-E. However, when these results were examined further it was found that the symptoms clustered rather differently to those of victims of other forms of trauma. In victims of bullying, the symptoms of arousal and re-experience formed a single cluster of symptoms with avoidance remaining as a separate cluster. These results are challenging in both the classification of Post Traumatic Stress Disorder and for the treatment of victims of bullying.