Cognitive therapy for post-traumatic stress disorder: development and evaluation

The paper describes the development of a cognitive therapy (CT) program for post-traumatic stress disorder (PTSD) that is based on a recent cognitive model (Behav. Res. Therapy 38 (2000) 319). In a consecutive case series, 20 PTSD patients treated with CT showed highly significant improvement in symptoms of PTSD, depression and anxiety. A subsequent randomized controlled trial compared CT (N = 14) and a 3-month waitlist condition (WL, N = 14). CT led to large reductions in PTSD symptoms, disability, depression and anxiety, whereas the waitlist group did not improve. In both studies, treatment gains were well maintained at 6-month follow-up. CT was highly acceptable, with an overall dropout rate of only 3%. The intent-to-treat effect sizes for the degree of change in PTSD symptoms from pre to post-treatment were 2.70-2.82 (self-report), and 2.07 (assessor-rated). The controlled effect sizes for CT versus WL post-treatment scores were 2.25 (self-report) and 2.18 (assessor-rated). As predicted by the cognitive model, good treatment outcome was related to greater changes in dysfunctional post-traumatic cognitions. Patient characteristics such as comorbidity, type of trauma, history of previous trauma, or time since the traumatic event did not predict treatment response, however, low educational attainment and low socioeconomic status were related to better outcome.     

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.     

Implicit and explicit memory bias for threat in post-traumatic stress disorder.

We investigated explicit (cued recall) and implicit (word completion) memory in Vietnam combat veterans with (n = 24) and without (n = 24) post-traumatic stress disorder (PTSD). Half of the subjects in each group encoded combat, social threat, positive, and neutral words elaboratively, whereas the others encoded these words nonelaboratively. On the cued recall test, under both encoding conditions, both groups recalled more combat words than other words. However, difference scores obtained by subtracting the mean recall for neutral words from the mean recall scores for the other words revealed that PTSD patients exhibited a relative explicit memory bias for combat words. That is, PTSD patients tended to exhibit poor memory for everything but combat words. On the word completion test, only PTSD subjects exhibited an implicit memory bias for combat words. This bias was greater for primed than for unprimed words, thereby ruling out a response bias. Such memory bias may underlie the 'reexperiencing' symptoms characteristic of PTSD (e.g. intrusive thoughts, nightmares).     

Interidentity memory transfer in dissociative identity disorder

Controversy surrounding dissociative identity disorder (DID) has focused on conflicting findings regarding the validity and nature of interidentity amnesia, illustrating the need for objective methods of examining amnesia that can discriminate between explicit and implicit memory transfer. In the present study, the authors used a cross-modal manipulation designed to mitigate implicit memory effects. Explicit memory transfer between identities was examined in 7 DID participants and 34 matched control participants. After words were presented to one identity auditorily, the authors tested another identity for memory of those words in the visual modality using an exclusion paradigm. Despite self-reported interidentity amnesia, memory for experimental stimuli transferred between identities. DID patients showed no superior ability to compartmentalize information, as would be expected with interidentity amnesia. The cross-modal nature of the test makes it unlikely that memory transfer was implicit. These findings demonstrate that subjective reports of interidentity amnesia are not necessarily corroborated by objective tests of explicit memory transfer.     

Research digest: post-traumatic stress disorder

The onset of weaning is often described as an important early milestone, but it creates considerable emotional turbulence in the motherinfant relationship. The interruption of the breast-feeding relationship, whether gradual or sudden, creates a very special kind of agony for both the mother and baby, especially when a good trusting relationship with the breast has been found. This paper explores some of the hurts and sacrifices made on both sides during weaning, and looks at some of the subtle reactions to mutual feelings of rejection at this time. It also describes some of the difficulties that arise when the work of weaning is compromised by certain anxieties in the feeding relationship. Extracts from several psychoanalytical infant observations are used both to illustrate and to discuss these themes.     

Uncontrollability and unpredictability in post-traumatic stress disorder: an animal model.

The disturbances observed in animals subjected to unpredictable and uncontrollable aversive events resemble post-traumatic stress disorder (PTSD) symptoms and thus may constitute an animal model of this disorder. It is argued that the similarity between animals' symptoms and those of trauma victims may reflect common etiological factors. Relevant experiments in which animals exhibit generalized fear and arousal, discrete fear of a conditioned stimulus (CS), analgesia, and avoidance are reviewed with the view that these manifestations may be analogous to the PTSD symptom clusters of persistent arousal, reexperiencing, numbing, and avoidance, respectively. Finally, animal paradigms are suggested to test the validity of the model and specific hypotheses are derived from the animal literature regarding trauma variables that are predictive of particular PTSD symptom clusters.     

Cognitive abnormalities in post-traumatic stress disorder

Characteristically arising in response to overwhelmingly terrifying events, post-traumatic stress disorder (PTSD) is a disorder of memory: sufferers seemingly relive their trauma in the form of involuntary recollection. Prominent cognitive abnormalities, especially in memory functioning, have motivated research designed to elucidate the mediating mechanisms that produce PTSD symptoms, especially those involving involuntary recollection. Recent developments suggest a pathophysiological model of PTSD which includes hyporesponsive prefrontal cortical regions and/or a hyper-responsive amygdala. Other work has also identified above-average cognitive ability as a protective factor and below-average hippocampal volume as a vulnerability factor for PTSD among the trauma-exposed. These attempts to elucidate the mediating mechanisms of PTSD have been both cognitive and, more recently, cognitive-neuroscientific in emphasis.     

Possible role of posttraumatic stress disorder in suicide terrorists: an hypothesis

Recent reports by journalists of suicidal terrorists suggest that exposure to recent violence in traumatic situations, combined with childhood exposure to violence, may lead to posttraumatic stress disorder, which in turn may result in suicidal violence.     

Dissociation and memory fragmentation: experimental effects on meta-memory but not on actual memory performance

The relation between state dissociation and fragmentary memory was investigated by assessing both actual memory performance and meta-memory. From a sample of 330 normal subjects, two subsamples were selected on basis of trait dissociation, as measured by the Dissociative Experience Scale. Twenty subjects scoring above 30 and 20 subjects scoring below 10 were selected. Subjects watched an extremely aversive film, after which state dissociation was measured by the Peri-traumatic Dissociative Experience Scale. Four hours later memory fragmentation was assessed in two ways. Actual fragmentation was measured by a sequential memory task, and perceived fragmentation (meta-memory) was measured using a visual analogue scale. Subjects who tended to dissociate during the film judged their recollections of the film as more fragmentary. Although this finding is in line with clinical reports given by trauma victims, it was not sustained by objective evidence. That is, no effect was observed of state dissociation on the sequential memory task. The present findings suggest that the claim that dissociation induces memory fragmentation may have to be confined to meta-memory. Implications of this divergence between actual memory and meta-memory are discussed.     

Incidental retrieval of emotional contexts in post-traumatic stress disorder and depression: an fMRI study

In the present study, we used fMRI to assess patients suffering from post-traumatic stress disorder (PTSD) or depression, and trauma-exposed controls, during an episodic memory retrieval task that included non-trauma-related emotional information. In the study phase of the task neutral pictures were presented in emotional or neutral contexts. Participants were scanned during the test phase, when they were presented with old and new neutral images in a yes/no recognition memory task. fMRI results for the contrast between old and new items revealed activation in a predominantly left-sided network of cortical regions including the left middle temporal, bilateral posterior cingulate, and left prefrontal cortices. Activity common to all three groups when correctly judging pictures encoded in emotional contexts was much more limited. Relative to the control and depressed groups the PTSD group exhibited greater sensitivity to correctly recognised stimuli in the left amygdala/ventral striatum and right occipital cortex, and more specific sensitivity to items encoded in emotional contexts in the right precuneus, left superior frontal gyrus, and bilateral insula. These results are consistent with a substantially intact neural system supporting episodic retrieval in patients suffering from PTSD. Moreover, there was little indication that PTSD is associated with a marked change in the way negatively valenced information, not of personal significance, is processed.     

Sexually abused children and post-traumatic stress disorder

Sexually abused children often develop post-traumatic stress disorder, a distressing and debilitating condition that is typically unresponsive to non-directive counselling. Empirically supported abuse-confronting, structured interventions are urgently required for use by counselling psychologists responsible for the management of this challenging clinical population. Given the success of cognitive-behavioural interventions with adult trauma victims, it has been suggested that this treatment approach be applied to sexually abused children. This paper presents a cognitive-behavioural treatment framework comprising two levels of intervention: child therapy and parent training. We selectively review emerging empirical support for the efficacy and acceptability of this treatment approach.     

HIV infection associated post-traumatic stress disorder and post-traumatic growth--a systematic review

The phenomenon of post-traumatic stress has been well documented in the literature as a lasting mental health condition associated with exposure to traumatic life events. The diagnosis and experience of human immunodeficiency virus (HIV) disease may be such a trauma. On the other hand, the phenomenon of post-traumatic growth (PTG) has been described, whereby people show positive mental health growth in the face of such trauma. This systematic review was set out to explore post-traumatic stress disorder (PTSD) and PTG in people with HIV to monitor prevalence, measurement and efficacy of interventions to reduce stress and/or promote growth. Standardised review techniques were used to track reports on both PTSD and PTG. A total of 206 papers were retrieved from the PTSD and HIV searches, and 13 from the PTG and HIV searches. After reviewing the papers for inclusion according to adequacy and relevance criteria and to remove duplicates, 33 PTSD papers and three PTG were available for full coding. Prevalence of PTSD in HIV ranged from 5% to 74%, which were much greater than the 7-10% in the general population. Seven studies showed a relation between trauma and PTSD, while six showed a link between PTSD diagnosis and reduced antiretroviral treatment adherence. Women were more likely to be diagnosed with PTSD. Only three intervention reports were identified that fitted our inclusion criteria. All of these reported on psychological interventions for HIV+?individuals with trauma. The interventions utilised HIV education, training in coping techniques and support groups. Only coping interventions were shown to be effective. PTG was under researched but showed a promising avenue of study. There needs to be harmonised measurement and the evidence base would need strengthening in order to build on the understanding of the impact of PTSD and PTG over the course of HIV disease. There is good evidence to associate HIV diagnosis and experiences during the course of illness as traumatic. PTSD has been shown to be prevalent and there seems to be good evidence to incorporate standardised measures to track the course of the disorder. There is extremely limited evidence that interventions may affect the course of symptom experience. The evidence and insight into PTG show promise but is currently inadequate.     

Group treatment of combat nightmares in post-traumatic stress disorder

This paper outlines a method for detoxifying combat nightmares in a group treatment setting and illustrates the method in a three dream sequence. Aside from the initial trauma, there is no symptom of post-traumatic stress disorder (PTSD) more vivid, painful, humbling, and ego-shattering than the combat nightmare, which forces a reliving of horrifying events. When viewed as a direct road back to the trauma, the nightmare can be transformed into a powerful therapeutic tool if deciphered empathically in the company of combat veterans who, like the dreamer, have survived similar catastrophic events. Successful depotentiation of nightmares gives PTSD patients increased control and confidence in working through the aftereffects of trauma.     

Intrusive re-experiencing in post-traumatic stress disorder: phenomenology, theory, and therapy

The article describes features of trauma memories in post-traumatic stress disorder (PTSD), including characteristics of unintentional re-experiencing symptoms and intentional recall of trauma narratives. Reexperiencing symptoms are usually sensory impressions and emotional responses from the trauma that appear to lack a time perspective and a context. The vast majority of intrusive memories can be interpreted as re-experiencing of warning signals, i.e., stimuli that signalled the onset of the trauma or of moments when the meaning of the event changed for the worse. Triggers of re-experiencing symptoms include stimuli that have perceptual similarity to cues accompanying the traumatic event. Intentional recall of the trauma in PTSD may be characterised by confusion about temporal order, and difficulty in accessing important details, both of which contribute to problematic appraisals. Recall tends to be disjointed. When patients with PTSD deliberately recall the worst moments of the trauma, they often do not access other relevant (usually subsequent) information that would correct impressions/predictions made at the time. A theoretical analysis of re-experiencing symptoms and their triggers is offered, and implications for treatment are discussed. These include the need to actively incorporate updating information ("I know now ...") into the worst moments of the trauma memory, and to train patients to discriminate between the stimuli that were present during the trauma ("then") and the innocuous triggers of re-experiencing symptoms ("now").     

From prematurity to parenting stress: The mediating role of perinatal post-traumatic stress disorder

Preterm delivery may lead to the emergence of symptoms of Post-Traumatic Stress disorder (PTSD), which may, in turn, affect the quality of the mother-child relationship. The aim of this study is to shed light on the development of parenting stress in mothers of preterm and full-term children. It is hypothesized that PTSD symptoms mediate the relationship between preterm/full-term birth and the levels of parenting stress. Perinatal PTSD, parenting stress and social support were assessed in 156 mothers of full-term children and 87 mothers of preterm children. Mothers of preterm children experienced more post-traumatic stress and parenting stress than mothers of full-term children. However, the relationship between preterm delivery and subsequent levels of parenting stress was mediated by PTSD symptoms. These findings suggest that the maternal perception of childbirth as a traumatic experience and the subsequent development of PTSD symptoms are pivotal in the emergence of parenting stress.     

Hippocampus function predicts severity of post-traumatic stress disorder.

Post-traumatic stress disorder (PTSD) is often accompanied by memory problems and abnormal brain structure, particularly within the hippocampus. We implemented a cross-species, hippocampal-dependent task--the virtual Morris Water task--to assess hippocampal function in people with PTSD and age-matched controls during functional magnetic resonance imaging (fMRI). Performance on the task was equivalent between the groups. However, when correlating fMRI-derived hippocampal activity during this task with PTSD severity, we observe a -0.84 correlation, indicating that those with reduced hippocampal activity show more severe PTSD symptoms. This correlation is not explained by differences in task performance, IQ, duration since trauma, nor time with PTSD. Hence, PTSD severity is predicted by functionally assessing the hippocampus using the virtual Morris water task, suggesting that this task may be used to identify those at risk for developing PTSD following a trauma.     

Autobiographical memory for stressful events: the role of autobiographical memory in posttraumatic stress disorder

To provide the three-way comparisons needed to test existing theories, we compared (1) most-stressful memories to other memories and (2) involuntary to voluntary memories (3) in 75 community dwelling adults with and 42 without a current diagnosis of posttraumatic stress disorder (PTSD). Each rated their three most-stressful, three most-positive, seven most-important and 15 word-cued autobiographical memories, and completed tests of personality and mood. Involuntary memories were then recorded and rated as they occurred for 2 weeks. Standard mechanisms of cognition and affect applied to extreme events accounted for the properties of stressful memories. Involuntary memories had greater emotional intensity than voluntary memories, but were not more frequently related to traumatic events. The emotional intensity, rehearsal, and centrality to the life story of both voluntary and involuntary memories, rather than incoherence of voluntary traumatic memories and enhanced availability of involuntary traumatic memories, were the properties of autobiographical memories associated with PTSD.     

A randomized, controlled trial of virtual reality-graded exposure therapy for post-traumatic stress disorder in active duty service members with combat-related post-traumatic stress disorder

Abstract Virtual reality (VR)-based therapy has emerged as a potentially useful means to treat post-traumatic stress disorder (PTSD), but randomized studies have been lacking for Service Members from Iraq or Afghanistan. This study documents a small, randomized, controlled trial of VR-graded exposure therapy (VR-GET) versus treatment as usual (TAU) for PTSD in Active Duty military personnel with combat-related PTSD. Success was gauged according to whether treatment resulted in a 30 percent or greater improvement in the PTSD symptom severity as assessed by the Clinician Administered PTSD Scale (CAPS) after 10 weeks of treatment. Seven of 10 participants improved by 30 percent or greater while in VR-GET, whereas only 1 of the 9 returning participants in TAU showed similar improvement. This is a clinically and statistically significant result (χ(2)?=?6.74, p?相似文献