Using eye movement desensitization and reprocessing to treat complex PTSD in a biracial client

A biracial client's recovery from posttraumatic stress disorder (PTSD) through the use of eye movement desensitization and reprocessing (EMDR) is discussed to illustrate the interaction between ethnicity and phenotype as well as diagnosis and treatment considerations. This case explores a woman's experience of discrimination in and out of her home and her vulnerability to complex PTSD, and it documents the importance of the therapy focusing on experiences of discrimination and prejudice as well as abuse. It shows how the client structures her environment in a personally creative fashion to include representative features of various aspects of her identity, by her choice of where and who she teaches as well as how and with whom she spends her free time.     

Reappraising the link between peritraumatic dissociation and PTSD symptom severity: evidence from a longitudinal study of community violence survivors

Cross-lagged panel analysis of longitudinal data collected from young adult survivors of community violence was used to examine the relationship between recall of peritraumatic dissociation and posttraumatic stress disorder (PTSD) symptom severity. Recollections of peritraumatic dissociation assessed within days of exposure differed from recollections measured at 3- and 12-month follow-up interviews. Peritraumatic dissociation was highly correlated with PTSD symptoms within each wave of data collection. Baseline recollections of peritraumatic dissociation were not predictive of follow-up PTSD symptom severity after controlling for baseline PTSD symptom severity. This pattern of results replicates previous work demonstrating a correlation between peritraumatic dissociation and subsequent symptom severity. However, findings are not consistent with the prevailing view that peritraumatic dissociation leads to increased PTSD symptom severity.     

PTSD易感性人格特质、工作记忆能力和创伤期间认知加工对模拟创伤闪回的影响

基于模拟创伤研究范式, 采用道路交通事故影片对159名健康大学生进行模拟创伤, 考察PTSD易感性人格特质(特质焦虑、特质分离和神经质)、工作记忆能力(注意控制和工作记忆容量)和创伤期间认知加工(数据驱动加工和概念加工)对模拟创伤后不同时段闪回的影响。运用结构方程模型分析数据, 结果发现：(1)数据驱动加工正向预测不同时段闪回(即时闪回、一周闪回和触发闪回)的数量、生动性、痛苦度以及一周侵入频率; (2)神经质正向预测触发闪回痛苦度, 注意控制和工作记忆容量负向预测一周侵入频率; (3)概念加工在注意控制与即时闪回痛苦度之间起中介作用。研究结果提示：数据驱动加工是创伤后不同时段闪回的主要影响因素; 概念加工主要作用于早期急性应激反应, 注意控制是其保护因素; 神经质和工作记忆能力对闪回具有较长期的影响, 且工作记忆能力具有一定的保护作用。     

Rape-supportive attitudes and sexual victimization experiences of sorority and nonsorority women

This study explored the link between sorority membership and rape-supportive attitudes and sexual victimization experiences. Data from a random sample of primarily white college women indicated that there were statistically significant differences between sorority women and nonsorority women on two of four rape-supportive attitudes (the acceptance of rape myths and the acceptance of interpersonal violence). Sorority women were also significantly more likely than nonsorority women to have been forced to have sexual intercourse because a partner either used physical force or threatened to use physical force. There was no significant difference between sorority women and nonsorority women in victimization through social, or nonviolent, coercion. However, sorority women had a significantly higher rate of nonconsensual intercourse while under the influence of alcohol or drugs.     

Long-term effects of intensive treatment for a client with both a cluttering and stuttering disorder

This study presents data on the effects of an intensive smooth speech treatment program for stuttering on the speech and psychological status of a man, aged 21 years who stuttered and who was also diagnosed as a clutterer (S 29). Stuttering was mild to moderate (7% syllables stuttered) (%SS) and consisted mostly of rapid repetitions with an occasional block. The client had stuttered since the age of 5 years. Initial rate could not be determined with accuracy due to its irregularity and speed, but was estimated to be between 260 to 300 syllables per minute (SPM). Speech was also characterized by irregular quick bursts that were often unintelligible. There was no evidence of abnormal psychological traits. However, a higher than normal level of negative communication attitudes was evidenced. An intensive 3-week smooth speech program designed to reduce and control stuttering was initiated. It was believed the training, which involved rate control, would control the cluttering symptoms as well. After successful completion of the program, stuttering was greatly reduced, and the gains were maintained after 10 months. Speech rate was reduced to normal levels and was also maintained at the 10-month follow-up. Negative attitudes to communication, furthermore, were greatly reduced both in the short- and long-term. Consequently the cluttering symptoms after treatment were minimal. This case study suggests that an intensive treatment for stuttering, which contains rate control, can also be a successful treatment for cluttering, at least for those who also stutter.     

The accuracy and speed of repeated responses

Summary Although experimental psychologists measure the quality of performance in terms of either terminal accuracy or latency, no clear theoretical link has been recently made between these measurements. This paper reports two experiments which show that a fundamental limitation to performance, either in terms of speed or accuracy, is the delay since a previous movement was made. Under circumstances where eye-movements are controlled, the ensemble size appears not to affect response latency directly, but response-to-stimulus interval (RSI) has a highly significant effect. Furthermore, the accuracy of responses is independent of either ensemble size or entropy, but is again directly related to RSI. These results are discussed in terms of the instability and lability of the spatial information upon which the operator must act, and it is hypothesized that a major contributing factor to performance in serial tasks is the state of the subject's knowledge about the spaces he or she operates in.     

Prevalence of sexual assault victimization among heterosexual and gay/lesbian university students

The prevalence of being a victim of forced sex was examined in a sample of 412 university students. Sexual victimization was significantly more common among female than male and among gay and lesbian than heterosexual students.     

Development of a Brief Adjunctive Intervention for Family Members of Veterans in Individual PTSD Treatment

Family involvement in the treatment of posttraumatic stress disorder (PTSD) among veterans has the potential to improve treatment retention and outcomes. Current protocols that incorporate family members into treatment tend to involve at least 15 sessions, and none are designed to complement Cognitive Processing Therapy (CPT) or Prolonged Exposure (PE), the two most widely used and heavily promoted evidence-based PTSD therapies in the Veterans Affairs (VA) healthcare system. The current paper describes the development and initial feasibility and acceptability of a Brief Family Intervention (the BFI) designed to be delivered as an adjunct to veterans’ individual CPT/PE. The BFI focuses on providing psychoeducation about PTSD and treatment, building family member support for treatment, and reducing family symptom accommodation. A detailed review of the treatment structure and activities is provided, and qualitative data from four dyads (veterans and their spouses/significant others) at baseline and post-intervention are presented. Veterans and partners reported positive responses to the program and were enthusiastic about its utility. Larger randomized controlled studies will be needed to determine the protocol’s efficacy and effectiveness.     

Brief Imaginal Exposure for PTSD: Trajectories of Change in Distress

Preliminary evidence shows that brief, condensed imaginal exposure only interventions can be effective in the treatment of PTSD, but we need to understand its mechanisms of action. Consistent with extinction learning and retrieval processes, the present study examined whether a pattern of between-session distress reduction observed during standard prolonged exposure (PE) therapy would be observed and predict outcome. Sixty-three patients with PTSD were enrolled in two clinical trials using our treatment protocol consisting of six daily 50-min sessions focusing on imaginal exposure and processing only. Individual patient trajectories of distress reduction were examined over the course of the five imaginal exposure sessions (Sessions 2-6). Overall, significant linear distress reduction was observed for anticipatory (d = 1.18), peak (d = 1.83), and ending imaginal exposure distress (d = 1.21). Consistent with extinction learning, the steeper slope of peak distress (d = 1.03) and end distress (d = 0.68) across imaginal exposure sessions strongly predicted decreases in PTSD symptoms. Distress reduction across sessions was predicted by higher baseline avoidance and hyperarousal but not reexperiencing symptoms. This condensed format of daily 50-min sessions without in vivo exposure may be operating via similar extinction learning processes as longer protocols. Our clinical observations suggest that the brief daily format may offer the advantage of allowing each session to build on the previous one to promote meaningful shifts in the retrieval of the trauma memory. Brief imaginal exposure and processing may be a viable option for PTSD patients in settings where brief interventions are needed. Understanding potential change processes and baseline predictors of change brings us closer toward precision medicine in treating PTSD.     

Therapeutic response to Cognitive Processing Therapy in White and Black female veterans with military sexual trauma-related PTSD

Cognitive Processing Therapy (CPT) is an evidence-based treatment (EBT) for posttraumatic stress disorder (PTSD) which has been validated for female veterans with military-related PTSD. Existing trials have enrolled predominantly White veterans with some studies documenting higher rates of early termination from EBTs among Black females when compared to White females. Data from a previously published randomized clinical trial were used to evaluate the effectiveness of CPT for Black female veterans with military sexual trauma (MST)-related PTSD. Reductions in PTSD symptom severity, number of sessions attended, and early termination rates were compared between Black (n = 20) and White (n = 16) female veterans. A hierarchical linear modeling approach was used, with PTSD symptom severity over the course of treatment and follow-up entered as a level-1 variable and race (Black or White) entered as a level-2 predictor. Piecewise growth curves analyses revealed that both Black and White female veterans experienced significant reductions in PTSD symptom severity over the course of treatment and gains were maintained up to 6 months post-treatment. Race was not found to be a significant predictor of change in the slope of PTSD symptom severity over the course of CPT treatment. Additionally, number of sessions attended and rates of early termination did not significantly differ based on race. Results suggest that CPT was a well-tolerated and effective psychotherapeutic treatment for this sample regardless of racial self-identification.     

Factors associated with responses to sexual harassment and satisfaction with outcome

This study examined contextual and behavioral factors and types of responses to sexual harassment in relation to harassed employees' satisfaction with the outcome of sexual harassment situations. Subjects were 105 male and female faculty and staff members (89.5% Caucasian; 5.7% multiethnic/multicultural; 4.8% unspecified) employed by a midwestern university who reported experiencing unwanted sexual attention on the job. Results undicated that employees responded more strongly to unwanted sexual behavior if they perceived it as sexual harassment and if they perceived their work climate as encouraging the problem. Harassed employees' gender, power, and perceptions of the work climate were all associated with their satisfaction with the situation outcome. Although making a formal or informal complaint was not associated with greater satisfaction, talking to the harasser without using aggressive communication strategies increased the likelihood of a satisfactory outcome for the employee. Talking to family or friends, a response used by women more often than men, was associated with dissatisfaction. Suggestions for further research are discussed.This research was primarily funded by the Center for Public Affairs Research at the University of Nebraska at Omaha. The authors gratefully acknowledge the research assistance of Jami Winters, Gena Ritter, Sarah Holmes, Kim Gangwish, and Mary Lou Costanzo.     

Determinants of judgments of and responses to a complaint of sexual harassment

Judgments concerning a complaint of sexual harassment focused on the perpetrator as a cause of the complaint. However, judgments of the role of the victim's characteristics as a cause of the complaint and responses to the perpetrator were influenced by the victim's feminist orientation, when there was competition between the victim and the perpetrator for a promotion, and when decision makers were male. The findings have practical implications in that they point out factors that may affect how organizational decision makers judge and respond to complaints of sexual harassment.     

Prolonged exposure in patients with chronic PTSD: predictors of treatment outcome and dropout

The present study investigated predictors of treatment outcome and dropout in two samples of PTSD-patients with mixed traumas treated using prolonged imaginal exposure. Possible predictors were analysed in both samples separately, in order to replicate in one sample findings found in the other. The only stable finding across the two groups was that patients who showed more PTSD-symptoms at pre-treatment, showed more PTSD-symptoms at post-treatment and follow-up. Indications were found that benzodiazepine use was related to both treatment outcome and dropout, and alcohol use to dropout. Demographic variables, depression and general anxiety, personality, trauma characteristics, feelings of anger, guilt, and shame and nonspecific variables regarding therapy were not related to either treatment outcome or dropout, disconfirming generally held beliefs about these factors as contra-indications for exposure therapy. It is concluded that it is difficult to use pre-treatment variables as a powerful and reliable tool for predicting treatment outcome or dropout. Clinically seen, it is therefore argued that exclusion of PTSD-patients from prolonged exposure treatment on the basis of pre-treatment characteristics is not justified.     

Evolutionary perspective on indirect victimization in adolescence: the role of attractiveness, dating and sexual behavior

We studied indirect victimization from an evolutionary perspective by examining links between this type of victimization and several indicators of attractiveness (past sexual behavior, dating frequency and physical appearance). Two thousand three hundred and nineteen (56% female) students (ages 13-18) from a region of southern Ontario, Canada, completed self-report measures of indirect victimization, physical appearance, dating frequency, recent sexual behavior (number of partners in previous month) and past sexual behavior (number of lifetime partners minus number of partners in previous month) as well as indexes of depression, aggression and attachment security, which were used to control for psychosocial maladjustment. Consistent with an evolutionary framework, physical appearance interacted significantly with gender, wherein attractive females were at greater risk for indirect victimization, whereas for males physical attractiveness was a protective factor, reducing risk of victimization. Physical appearance also interacted with grade, being inversely related to indirect victimization for younger adolescents and having a nonsignificant association with victimization for older youth. Finally, recent sexual behavior was associated with increased risk of indirect victimization for older adolescents only, which we discussed with regard to peer perceptions of promiscuity and short-term mating strategies. These findings have important implications for the development of interventions designed to reduce peer victimization, in that victims of indirect aggression may represent a rather broad, heterogeneous group, including attractive individuals with no obvious signs of maladjustment.     

Peer victimization in adolescence has different effects on the sexual behavior of male and female college students

We studied levels of peer victimization from an evolutionary perspective by investigating self-reported victimization during adolescence in relation to sexual behavior in college students. One-hundred and twelve (47 female) undergraduates completed self-report measures of victimization during middle and high school, onset of sexual activity, and number of sexual partners. Nearly 85% of victimization during adolescence was perpetrated by members of the same sex. Furthermore, results show that this intrasexual victimization (particularly indirect forms) was negatively correlated with reproductive opportunities in males, but positively correlated in females. Males who were frequently victimized had fewer total sexual partners and partners per year on average, while females who were often victims of aggression reported having more sexual partners and an earlier onset of sexual activity. Regression analysis revealed that demeaning, diminishing and embarrassing was the most significant predictor of the rate of sexual activity in both sexes (although this relationship was inverted between them), while teasing was the best predictor of total sexual partners in females. This evidence is consistent with evolutionary interpretations regarding human aggression and competition, as well as with recent findings suggesting that indirect victimization during adolescence is a form of intrasexual competition associated with reproductive opportunities.     

Refinement and Pilot Testing of a Brief,Early Intervention for PTSD and Alcohol Use Following Sexual Assault

Experiencing a sexual assault can have long-lasting negative consequences including development of posttraumatic stress disorder (PTSD) and alcohol misuse. Intervention provided in the initial weeks following assault can reduce the development of these chronic problems. This study describes the iterative treatment development process for refining a brief intervention targeting PTSD and alcohol misuse for women with recent sexual assault experiences. Experts, treatment providers, and patients provided feedback on the intervention materials and guided the refinement process. Based on principles of cognitive change, the final intervention consists of one in-person session and four coaching calls targeting beliefs about the assault and about drinking behavior. Initial feasibility and acceptability data are presented for patients enrolled in an open trial (N = 6). The intervention was rated as helpful, not distressing, and interesting by patients and all patients completed the entire treatment protocol. A large decrease in PTSD symptoms pre- to post-intervention was observed. A small effect on decreasing alcohol consequences also emerged, although drinks consumed per week showed a slight increase, not a decrease, over the course of the intervention. Applications of this intervention and next steps for testing efficacy are presented.     

Deployment trauma and seeking treatment for PTSD in US soldiers

Many service members in need of mental health treatment do not seek such treatment. This study investigated the frequency of Army soldiers’ exposure to specific types of deployment stressors and whether different event-types were associated with willingness to seek and actual receipt of treatment. Male soldiers who were married (n = 600) completed online surveys that assessed posttraumatic stress disorder (PTSD), willingness to seek treatment for PTSD, actual receipt of PTSD treatment, and the frequency of exposure to 4 types of potentially traumatizing warzone experiences: committing a moral injury, observing a moral injury, threats to life, and traumatic loss. Soldiers who reported greater exposure to moral injury experiences (committed or observed) were less likely to be willing to seek treatment, regardless of PTSD symptom severity. Although exposure to moral injury did not differentiate actual treatment receipt, soldiers who endorsed loss were more likely to have received treatment, regardless of PTSD symptom severity. These results suggest that the types of trauma experienced during deployment may be a factor in postdeployment treatment-seeking attitudes and behaviors.     

Observer perceptions of moral obligations in groups with a history of victimization

The authors investigated when observers assign contemporary group members moral obligations based on their group's victimization history. In Experiment 1, Americans perceived Israelis as obligated to help Sudanese genocide victims and as guiltworthy for not helping if reminded of the Holocaust and its descendants were linked to this history. In Experiment 2, participants perceived Israelis as more obligated to help and guiltworthy for not helping when the Holocaust was presented as a unique victimization event compared with when genocide was presented as pervasive. Experiments 3 and 4 replicated the effects of Experiment 1 with Cambodians as the victimized group. Experiment 5 demonstrated that participants perceived Cambodians as having more obligations under high just world threat compared with low just world threat. Perceiving victimized groups as incurring obligations is one just world restoration method of providing meaning to collective injustice.