Hierarchical elaboration in the conceptual structures of vietnam combat veterans

Abstract

Sixty male Vietnam combat veterans, 30 hospitalized for post-traumatic stress disorder (PTSD) and 30 with no PTSD or other psychiatric disorder, sorted and labeled their life events into numeric matrices (repertory grids). Through hierarchical-classes analysis of a subject's matrix, we could compare the hierarchical level (elaboration) of the subject's constructs of a negative combat event with the hierarchical levels of other subjects' constructs of negative combat events and with the subject's precombat life event construction. As predicted, the level of construct elaboration was virtually identical for the two groups for precombat non-trauma-related events but was reduced in the PTSD group for the negative combat event. In addition, the Pythagorean distance scores of the PTSD group indicated less conceptual distance between the negative combat event and negative life events after Vietnam compared with the non-PTSD group's scores. Patients with PTSD rated negative life events more extremely (fewer “shades of gray” ratings) than did the non-PTSD group, especially life events that occurred after Vietnam.     

PTSD青少年执行功能缺陷的情绪特异性

已有研究表明PTSD青少年存在执行功能缺陷,但尚不清楚这种缺陷是否具有情绪特异性。以2008年汶川地震重灾区汉旺中学PTSD、非PTSD以及非灾区青少年各28名为被试,探讨震后PTSD青少年执行功能缺陷是否具有情绪特异性。实验1采用经典Stroop范式,结果发现3组被试的Stroop效应量无显著差异;实验2采用情绪Stroop范式,结果发现PTSD组对地震信息的Stroop效应量显著大于非PTSD组和控制组。整个研究表明,震后PTSD青少年的执行功能缺陷具有情绪特异性。     

A meta-analytic review of cognitive processing therapy for adults with posttraumatic stress disorder

Numerous studies have demonstrated the efficacy of cognitive processing therapy (CPT) for treating posttraumatic stress disorder (PTSD). Two prior meta-analyses of studies are available but used approaches that limit conclusions that can be drawn regarding the impact of CPT on PTSD outcomes. The current meta-analysis reviewed outcomes of trials that tested the efficacy of CPT for PTSD in adults and evaluated potential moderators of outcomes. All published trials comparing CPT against an inactive control condition (i.e. psychological placebo or wait-list) or other active treatment for PTSD in adults were included, resulting in 11 studies with a total of 1130 participants. CPT outperformed inactive control conditions on PTSD outcome measures at posttreatment (mean Hedges’ g = 1.24) and follow-up (mean Hedges’ g = 0.90). The average CPT-treated participant fared better than 89% of those in inactive control conditions at posttreatment and 82% at follow-up. Results also showed that CPT outperformed inactive control conditions on non-PTSD outcome measures at posttreatment and follow-up and that CPT outperformed other active treatments at posttreatment but not at follow-up. Effect sizes of CPT on PTSD symptoms were not significantly moderated by participant age, number of treatment sessions, total sample size, length of follow-up, or group versus individual treatment; but, older studies had larger effect sizes and percent female sex moderated the effect of CPT on non-PTSD outcomes. These meta-analytic findings indicate that CPT is an effective PTSD treatment with lasting benefits across a range of outcomes.     

A Preliminary Examination of Thought Suppression,Emotion Regulation,and Coping in a Trauma-Exposed Sample

Attempts to modulate negative emotional and cognitive symptoms of posttraumatic stress disorder (PTSD) may be related to psychopathology. Trauma-exposed undergraduates, 31 reporting severe PTSD symptoms (PTSD group) and 34 without PTSD symptoms (non-PTSD group), completed measures of PTSD, depression, anxiety, thought control, emotion regulation, and coping. The PTSD group had greater psychopathology and overall modulation strategy use than the non-PTSD group. Thought suppression, emotion suppression, and avoidant coping strategies were positively related to psychopathology, whereas emotion reappraisal and approach coping strategies were either not related or weakly negatively related. Hierarchical multiple regressions with psychopathologic variables as criteria and modulation strategies as predictors indicated significant models in all cases. Generally, thought suppression was the only significant independent predictor of psychopathology.     

De novo conditioning in trauma-exposed individuals with and without posttraumatic stress disorder

Differential conditioning was assessed in 15 medication-free individuals meeting Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) criteria for chronic posttraumatic stress disorder (PTSD) and 18 trauma-exposed individuals who never developed PTSD (non-PTSD). Conditioned stimuli (CSs) were colored circles, and the unconditioned stimulus was a "highly annoying" electrical stimulus. Individuals with PTSD had higher resting heart rate (HR) and skin conductance (SC) levels and produced larger SC orienting responses. During conditioning, the PTSD group showed larger differential SC, HR, and electromyogram responses to the reinforced vs. nonreinforced stimuli (CS+ vs. CS-) compared with the non-PTSD group. Only PTSD participants continued to show differential SC responses to CS+ vs. CS- during extinction trials. Results suggest that individuals with PTSD have higher sympathetic nervous system arousal at the time of conditioning and are more conditionable than trauma-exposed individuals without PTSD.     

Posttraumatic Growth in Trauma Recollections of 9/11 Survivors: A Narrative Approach

The relationship between posttraumatic growth (PTG) and adaptation is unclear. This study is the first to examine PTG in trauma narratives of survivors of the World Trade Center (WTC) attacks. Participants recalled their experiences 7 and 18 months post 9/11, and content analysis was conducted to detect PTG. Posttraumatic stress was also measured. PTG was commonly reported. Relating to others and positivity were frequent in the PTSD and non-PTSD group, although less frequent over time in the PTSD. Greater appreciation for life was reported by the non-PTSD group but relatively absent in the PTSD group. Women but not men reported relating to others across time. It appears that there are distinct profiles of growth implicated in distress and adaptation.     

Gratitude and hedonic and eudaimonic well-being in Vietnam war veterans

Little information exists on the contribution of psychological strengths to well-being in persons with post-traumatic stress disorder (PTSD). Data from other populations suggest that gratitude, defined as the positive experience of thankfulness for being the recipient of personal benefits, may have salutary effects on everyday functioning. We investigated whether dispositional gratitude predicted daily hedonic and eudaimonic well-being in combat veterans with and without PTSD. We also examined associations between daily gratitude and daily well-being across time. Veterans with PTSD, compared to those without PTSD, exhibited significantly lower dispositional gratitude; no differences were found on daily gratitude. Dispositional gratitude predicted greater daily positive affect, percentage of pleasant days over the assessment period, daily intrinsically motivating activity, and daily self-esteem over and above effects attributable to PTSD severity and dispositional negative and positive affect in the PTSD group but not the non-PTSD group. Daily gratitude was uniquely associated with each dimension of daily well-being in both groups. Although preliminary, these results provide support for the further investigation of gratitude in trauma survivors.     

Exposure to War Trauma, War-Related PTSD, and Psychological Impact of Subsequent Hurricane

This study explored the impact of psychological outcomes to war on response to subsequent natural disaster. Participants were 312 military personnel, 66% of whom saw Gulf War duty. All were exposed to the 1992 Hurricane Andrew. Troops were compared on reported traumatic events, hurricane impact responses, and psychological symptoms in subgroups defined by war or no war exposure prior to hurricane and by presence or absence of war-related posttraumatic stress disorder (PTSD). Data were gathered in face-to-face clinical assessments. War trauma prior to hurricane was associated with more reported traumatic events, greater fears for safety during the hurricane, and heightened psychological symptoms. Troops with preexisting war-related PTSD showed more adverse psychological hurricane sequelae and reported more traumatic events, higher depression, anxiety, anger, PTSD symptoms, and physical symptoms, and lower self-esteem than those free of diagnoses. Results point to the negative influence of exposure to one traumatic event on the experience of and response to a subsequent stressor.     

Fear-potentiated startle conditioning to explicit and contextual cues in Gulf War veterans with posttraumatic stress disorder

Aversive conditioning to explicit and contextual cues was examined in Gulf War veterans with and without posttraumatic stress disorder (PTSD) by use of the startle reflex methodology. Veterans participated in a differential aversive conditioning experiment consisting of 2 sessions separated by 4 or 5 days. Each session comprised two startle habituation periods, a preconditioning phase, a conditioning phase, and a postconditioning extinction test. In contrast to the non-PTSD group, the PTSD group showed a lack of differential startle response in the presence of a conditioned stimulus with or without an unconditioned stimulus in Session 1 and an increase in the baseline startle response during Session 2. The PTSD group also exhibited normal differential conditioning following reconditioning in Session 2. These data suggest that individuals with PTSD tend to generalize fear across stimuli and are sensitized by stress.     

Event centrality prospectively predicts PTSD symptoms

Background: Recent evidence suggests that event centrality has a prominent association with post-traumatic stress disorder (PTSD) symptoms. However, evidence for this notion thus far has been mostly correlational. We report two studies that prospectively examined the relationship between event centrality and PTSD symptoms. Study 1 Methods: Participants (N?=?1438) reported their most stressful event (“prior event”), along with event centrality, PTSD symptoms, and neuroticism. At Time 2 participants reported their most stressful event since Time 1 (“critical event”), along with measures of event centrality and PTSD symptoms. Study 1 Results: Event centrality for the critical event predicted PTSD symptoms, after controlling for event centrality and PTSD symptoms of the prior event and neuroticism. Study 2 Methods: In the second study (N?=?161) we examined changes in event centrality and PTSD symptoms over a month. Study 2 Results: Using a cross-lagged panel design, results revealed event centrality at Time 1 significantly predicted PTSD symptoms at Time 2, but the reverse was not significant. Conclusions: In two studies, a prospective association between event centrality and PTSD symptoms, but not the reverse, emerged. This evidence implicates event centrality in the pathogenesis and/or maintenance of PTSD symptoms.     

Regional brain electrical activity in posttraumatic stress disorder after motor vehicle accident

This study examined whether patients with posttraumatic stress disorder (PTSD) related to motor vehicle accidents (MVAs) would show an abnormal pattern of electroencephalographic (EEG) alpha asymmetries, which has been proposed for particular types of anxiety. Patients with PTSD (n = 22) or subsyndromal PTSD (n = 21), traumatized controls without PTSD (non-PTSD with MVA; n = 21), and healthy controls without MVA (n = 23) underwent measurement of EEG activity during baseline and exposure to a neutral, a positive, a negative, and an accident-related picture. Differences in brain asymmetry between groups were observed only during exposure to trauma-related material. PTSD and subsyndromal PTSD patients showed a pattern of enhanced right anterior and posterior activation, whereas non-PTSD with MVA participants showed the opposite pattern. Furthermore, posterior asymmetry in nontraumatized healthy controls varied with gender, with female participants showing a pattern of higher right posterior activation. The results support the hypothesis that symptomatic MVA survivors are characterized by a pattern of right hemisphere activation that is associated with anxious arousal and symptoms of PTSD during processing of trauma-specific information.     

中小学教师PTSD和PTG的影响因素研究：灾难前-中-后的视角

采用事件影响量表、创伤后成长问卷、社会支持问卷、应对方式问卷等对汶川地震1年后极重灾区的106名中小学教师进行调查,考察前灾难因子、灾难当下因子和后灾难因子等对教师创伤后应激障碍（PTSD）和创伤后成长（PTG）的影响。结果发现：（1）灾后中小学教师的PTSD处于中低水平、PTG处于中上水平,其中女教师的PTSD和PTG水平高于男教师,班主任教师PTSD水平高于非班主任教师,有过被困经历的教师PTSD水平高于没有被困经历的教师,有亲朋或学生受伤的教师其PTSD和PTG水平均高于无亲朋或学生受伤的教师;（2）社会支持对PTSD没有显著的预测作用,社会支持中的信息支持可以促进PTG,而情感支持和实质性支持对PTG没有显著的影响;（3）逃避的应对方式能显著地正向预测PTSD,问题解决的应对方式能显著正向地预测PTG,而寻求帮助的应对方式对PTSD和PTG都不具有显著的影响。     

Fear and Loathing: A Meta-Analytic Review of the Specificity of Anger in PTSD

The available empirical literature suggests that anger may be characteristic of posttraumatic stress disorder (PTSD). Meta-analytic strategies were used to evaluate the extent to which the experience of anger is specific to PTSD rather than anxiety disorders in general. Thirty-four anxiety disorder patient samples (n = 2,169) from 28 separate studies were included in the analysis. Results yielded a large effect size indicating greater anger difficulties among anxiety disorder patients versus controls. Compared to control samples, a diagnosis of PTSD was associated with significantly greater difficulties with anger than was any other anxiety disorder diagnosis. Other anxiety disorder diagnoses did not differ significantly from each other. However, the specific association between PTSD and anger did vary depending on the anger domain assessed. Difficulties with anger control, anger in, and anger out significantly differentiated PTSD from non-PTSD anxiety disorder samples, whereas difficulties with anger expression, state anger, and trait anger did not. These findings are discussed in the context of future research on the role of anger in PTSD.     

False memory,attentional bias and future thinking among people living with HIV with posttraumatic stress disorder

People living with HIV can experience posttraumatic stress disorder (PTSD). Complex relationships exist between HIV, PTSD and cognitive impairments. This cross-sectional study compared three cognitive impairments (false memory, attentional bias, deficits in future thinking) among people living with HIV with and without PTSD in Iran. People living with HIV with PTSD (n = 20) and without PTSD (n = 20) completed measures of psychological symptomatology, dot-probe task, Deese Roediger McDermott paradigm and future thinking task at Razavi Khorasan Health Center. The PTSD group, when compared to the non-PTSD group, recognised a significantly greater number of false memories (p < .001; η² = .58), had an attentional bias toward threat-related words (p < .001; η² = .35) and imagined fewer specific future events (p < .001; η² = .31). People living with HIV with PTSD may have difficulties with false memory, attentional biases, and generating future events. Since psychological treatments are limited in Iran, this research highlighted some potential cognitive targets for people living with HIV.     

A Reevaluation of the Use of the MMPI in the Assessment of Combat-Related Posttraumatic Stress Disorder

This study attempts to validate previously developed, empirically based Minnesota Multiphasic Personality Inventory (MMPI) decision rules (Keane, Malloy, & Fairbank, 1984) to aid in the diagnosis of combat-related posttraumatic stress disorder (PTSD). Four groups of 21 subjects each were identified: PTSD, psychotic, depressed, and chronic pain. A decision rule based on the standard clinical scales resulted in a correct classification rate (PTSD vs. non-PTSD) of 81% across the four-group sample. An empirically derived MMPI PTSD scale resulted in a correct classification rate of 77%. However, 43% of the PTSD subjects were incorrectly classified as non-PTSD by these rules. Independent, blind sorting of the 84 MMPI profiles by two doctoral-level clinical psychologists resulted in "hit rates" similar to the MMPI decision rules. The present results suggest that the previously derived, empirically based MMPI decision rules for PTSD do scarcely better than chance on correct classification of individuals with PTSD. We suggest that the differential diagnosis of PTSD is difficult because of the wide variety of symptoms in common with other diagnostic groups, and hence the variability of PTSD subjects on psychometric measures. We also suggest that the MMPI decision rules of Keane et al. (1984) may have utility in identifying subgroup(s) of combat-related PTSDs.     

Diagnosing posttraumatic stress disorder with the MMPI clinical scales: A review of the literature

A review of the literature resulted in 21 published studies that reported mean MMPI profile patterns for PTSD patients. Of these, six (29%) reported that the mean 8-2 profile pattern significantly differentiated PTSD patients from non-PTSD patients. The majority of studies found additional PTSD profile patterns reflecting nearly all of the MMPI clinical scales. The data indicate some common group profile patterns for inpatient veterans, prisoner's of war, and inpatient veteran substance abusers. The results also support the hypothesis that there is a continuum from inpatient to outpatient and veteran to civilian populations that corresponds with both symptom and stressor severity. It is concluded that although there is some typicality in similar populations, clinicians should expect heterogeneous MMPI profiles from PTSD patients representing a diversity of clinical symptoms and styles.     

Overgeneral autobiographical memory recollection in Iranian combat veterans with posttraumatic stress disorder

This study examined the recollection of autobiographical material in memory among Iranian military veterans with and without posttraumatic stress disorder (PTSD), and healthy non-trauma-exposed control subjects. Participants completed the Autobiographical Memory Test, Autobiographical Memory Interview (counterbalanced), Impact of Event Scale-Revised, Beck Depression Inventory-II, Wechsler Memory Scale-III and Wechsler Adult Intelligence Scale-Revised. The PTSD group generated fewer specific episodic and semantic details of autobiographical memory compared to the non-PTSD and control groups. Working memory did not significantly moderate the relationship between PTSD diagnosis and reduced autobiographical memory specificity but did moderate the relationship between PTSD diagnosis and semantic recall; semantic memory recall was not significantly related to working memory ability for those with PTSD but was related to working memory ability for trauma survivors without PTSD. While the data provide some support for the expectation that higher working memory ability is associated with an increased ability to retrieve specific memories (i.e. semantic memory recall in those without PTSD), the findings are also consistent with the view that for those with PTSD the demands on working memory required for affect regulation cancel out this influence of working memory in augmenting access to specific memories.     

Control-related beliefs and sleep characteristics of posttraumatic stress disorder patients

To examine correlations among chronic Posttraumatic Stress Disorder (PTSD), control-related beliefs, and sleep difficulties 7 PTSD casualities and 7 non-PTSD matched subjects were compared in their laboratory sleep patterns as well as in their beliefs about personal control over external and internal events in general and over sleep-related events in particular. Analyses indicated that PTSD casualties had poorer sleep and reported more doubts regarding their ability to control external and internal events than control subjects. Further, we found a significant association between perceived control and sleep difficulties. Results were discussed in terms of Horowitz's conception of intrapsychic processes related to PTSD.     

Two studies of psychiatric morbidity among motor vehicle accident survivors 1 year after the crash

We assessed the psychiatric co-morbidity associated with chronic posttraumatic stress disorder (PTSD) (1-2 years) secondary to personal injury motor vehicle accidents (MVAs) in two studies. In Study 1, we compared the results of SCID assessments for 75 treatment-seeking MVA survivors (51 with PTSD and 24 with symptoms but no PTSD). In Study 2, we compared similar results among 132 MVA survivors who had been followed prospectively for 12+ months after their accidents (19 with PTSD, 32 who had PTSD but who had remitted, and 81 who never met criteria for PTSD). We found comparable levels of current co-morbid major depression (53%), any mood disorder (62-68%), generalized anxiety disorder (26%) and any anxiety disorder (42%) for both groups of participants with chronic PTSD. These rates of co-morbidity were higher than those found in non-PTSD comparison groups with similar MVA histories.     

Probable PTSD and Impairment in Witnesses of Work-Related Fatalities

According to the U.S. Bureau of Labor Statistics, steel, oil, and mining are among the nation's most dangerous industries. This study assessed probable posttraumatic stress disorder (PTSD), depressive symptoms, life functioning, and well-being in a unique sample of 89 members of the United Steelworkers who reported directly witnessing an occupational fatality. Of the sample, 25.8% reported symptoms consistent with probable PTSD, while 21.3% reported symptoms consistent with subthreshold PTSD. These two groups differed significantly from the non-PTSD group on measures of depressive symptoms, well-being, and life functioning. These findings highlight the further need for assessment and intervention for workers exposed to fatalities.