Cognitive behaviour therapy of acute stress disorder: a four-year follow-up

The aim of this study was to index the long-term benefits of early provision of cognitive behavior therapy to trauma survivors with acute stress disorder. Civilian trauma survivors (n = 80) with acute stress disorder were randomly allocated to either cognitive behavior therapy (CBT) or supportive counseling (SC) - 69 completed treatment, and 41 were assessed four years post-treatment for post-traumatic stress disorder (PTSD) with the Clinician Administered PTSD Scale. Two CBT patients (8%) and four SC patients (25%) met PTSD criteria at four-year follow-up. Patients who received CBT reported less intense PTSD symptoms, and particularly less frequent and less avoidance symptoms, than patients who received SC. These findings suggest that early provision of CBT in the initial month after trauma has long-term benefits for people who are at risk of developing PTSD.     

Vicarious trauma: The psychological impact of working with survivors of trauma for South African psychologists

Traumatic events are highly prevalent in South African society and psychologists who work with survivors of trauma have been identified as particularly at risk of being adversely affected by their work, and experiencing vicarious trauma. This study aimed to explore the experiences of a group of South African psychologists who work predominantly with trauma survivors. Individual semi-structured interviews were conducted with six psychologists (females = 67%). The predominant type of trauma encountered by participants in clinical practice was interpersonal trauma in the form of physical and sexual abuse (83%). Data were analysed using thematic analysis. All participants reported symptoms of vicarious trauma including disruption in cognitive schemas, symptoms characteristic of post-traumatic stress disorder, and somatic symptoms. Participants also reported vicarious post-traumatic growth including an enhanced sense of interpersonal connectedness and positive changes in their philosophy of life and self-perceptions. The findings serve to sensitise psychologists to the impact of working with trauma survivors so as to enhance the efficiency of psychological service delivery to traumatised populations.     

Collective trauma and post-traumatic symptoms in the biblical narrative of ancient Israel

According to the biblical books of Exodus and Numbers, the early Israelites suffered recurrent plagues and other events which comprise significant collective trauma coinciding with their physical and spiritual birth as a people. These ancient narratives reflect a fledgling people's coping with high levels of transitional stress, multiple crises, and significant losses attendant upon slavery and genocide. Inspection of the text also reveals signs of collective post-traumatic reactions among the Israelites. Relevant psychological perspectives on stress, loss, and trauma can therefore usefully illuminate specific biblical events. Trauma may well be implicated in the etiology of certain stringent biblical commandments, including “the ban” and related severe restrictions against Israelite intermarriage. The Bible may also contain insights bearing upon social action aimed at preventing or coping with epidemics and for overcoming psychological trauma, of relevance to a modern positive community psychology.     

Peritraumatic and persistent panic attacks in acute stress disorder

This study examined the prevalence of peritraumatic and persistent panic symptoms following trauma. Survivors of civilian trauma (n=30) with either acute stress disorder (ASD) or no acute stress disorder (non-ASD) were administered the Panic Module of the Structured Clinical Interview for DSM-IV (SCID). Participants also completed the Impact of Event Scale, Acute Stress Disorder Scale, Beck Depression Inventory, Beck Anxiety Inventory, and the Anxiety Sensitivity Index. Panic attacks were experienced by 77% of participants during their trauma, and 47% reported recurrent panic attacks post-trauma. ASD participants demonstrated more panic symptoms during and after their trauma than non-ASD participants. Posttraumatic panic was most strongly associated with anxiety sensitivity. These findings are discussed in terms of cognitive factors that may mediate posttrauma panic and treatment implications for managing posttraumatic anxiety.There is increasing evidence that panic attacks play a role in psychopathological response to trauma. A significant proportion of people with panic disorder report a history of trauma (). Moreover, two-thirds of trauma survivors report panic attacks within the previous 2 weeks (). There is also evidence that people with posttraumatic stress disorder (PTSD) display elevated levels of anxiety sensitivity (). Recent attention has focused on acute panic reactions because of proposals that panic during trauma may condition trauma-related cues to subsequent panic (). There is evidence that panic attacks occur in 53-90% of trauma survivors during the traumatic experience (). Further, people with acute stress disorder (ASD) are more likely to report peritraumatic panic attacks than non-ASD individuals. ASD is a useful framework in which to investigate the role of panic in posttraumatic stress because ASD describes acute responses to trauma that are strongly predictive of chronic PTSD ().This study investigated the relationship between peritraumatic panic and ongoing panic attacks following trauma. Specifically, we indexed panic attacks during trauma and subsequent to trauma in trauma survivors with and without ASD. We also indexed the extent to which distorted interpretations about somatic sensations may be associated with panic attacks following trauma. We considered that the strong evidence that maladaptive appraisals of somatic sensations mediate panic () is directly relevant to posttraumatic panic. We hypothesized that ASD participants would report more peritraumatic and persistent panic than non-ASD participants, and that this panic would be associated with dysfunctional interpretations about somatic stimuli.     

Sudden Gains in Two Trauma-Focused Treatments for Posttraumatic Stress Disorder

In the current study, we examined the degree to which sudden gains (large, rapid, and stable symptom reduction in a one-session interval) predicted treatment outcome in adults randomized to two different trauma-focused treatments. Adults diagnosed with PTSD were randomized to either written exposure therapy (WET; n = 63), a brief, exposure-based treatment for posttraumatic stress disorder (PTSD), or the more time-intensive Cognitive Processing Therapy (CPT; n = 63). Findings showed that 20.6% of participants who received WET and 17.5% of participants who received CPT experienced sudden gains. Sudden gains occurred earlier in WET (M session = 2.69, SD = 0.75) than in CPT (M session = 5.64, SD = 3.01). However, there were no treatment condition differences in the magnitude of the sudden gains. Treatment outcomes were significantly better for those who experienced sudden gains compared with those who did not, regardless of treatment assignment. Exploratory analyses of participants’ trauma narratives revealed that expressing more negative emotion predicted the occurrence of sudden gains in both treatment conditions. Negative beliefs about the self and others did not predict sudden gains. The findings are discussed in terms of how they may help identify individual early response patterns that predict outcomes in trauma-focused treatments.     

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.     

Expectations and attributions in social anxiety disorder: diagnostic distinctions and relationship to general anxiety and depression

Contemporary cognitive models suggest that social anxiety disorder arises from a number of cognitive factors, including tendencies to form pessimistic (rather than optimistic) attributions and expectations for socially-related events. These models also assume that the strengths of such attributions and expectations are more closely linked with social anxiety than with general anxiety or depression. To test these assumptions, a battery of self-report measures was completed by participants with a primary diagnosis of generalized social anxiety disorder (n = 75), panic disorder with agoraphobia (n = 44), or post-traumatic stress disorder (n = 59). To examine differences on these cognitive variables, group comparisons were performed controlling for general anxiety, depression and medication status. Social anxiety disorder, compared with panic disorder with agoraphobia and post-traumatic stress disorder, was characterized by lower expectations for positive social events and higher expectations for negative social events. There was no difference among the groups on expectations for non-social positive or negative events. Stable and global attributions for social negative events were more closely associated with social anxiety disorder than with panic disorder with agoraphobia and post-traumatic stress disorder. Correlational analyses also revealed specific relationships among social-cognitive measures and social anxiety, even after controlling for general anxiety and depression. The results are consistent with cognitive models of social anxiety disorder.     

A Controlled Comparison of Eye Movement Desensitization & Reprocessing and Progressive Counting

Ten therapists who were already trained and experienced in eye movement desensitization and reprocessing (EMDR) received training in progressive counting (PC), a newer trauma resolution method. Nineteen volunteers with single-incident trauma or loss were assigned to a therapist and then randomized to treatment condition; 15 completed treatment to termination criteria or until the 4th session. Participants in both conditions experienced significant reductions in post-traumatic stress disorder (PTSD) symptoms, memory-related distress, and presenting problems at one week posttreatment, and maintained at 12-week follow-up, with no significant differences in outcomes, treatment efficiency, or dropout rate. The preliminary findings of this pilot study suggest that PC is an efficient, well-tolerated, and effective trauma treatment that is relatively easy for therapists to master.     

Effects of Equine-Facilitated Psychotherapy on Post-Traumatic Stress Symptoms in Youth

Equine-assisted therapy has become an increasingly popular complementary mental health treatment approach, but there is limited empirical research assessing the effectiveness of this practice. In particular, equine-facilitated psychotherapy has many potential benefits for the treatment of trauma in youth. The purpose of the proposed study was to investigate changes in levels of post-traumatic stress symptomatology and levels of the human-animal bond in children and adolescents ages 10–18 over the course of a 10-week equine-facilitated psychotherapy (EFP) intervention. Youth in the treatment group (n?=?36) participated in 10 weekly two hour EFP sessions, and were compared on changes in post-traumatic stress symptoms with a control group of participants (n?=?32) who continued to receive the already existing traditional therapeutic services provided by their treatment facility or outpatient therapist. Findings suggested a significant decrease in post-traumatic stress symptoms across the intervention for both the treatment and control group, but the treatment group did not decrease significantly more than the control group. These findings suggest that EFP may be an effective additional treatment modality for post-traumatic stress symptoms, but there was no evidence from this initial study that EFP was significantly more effective than traditional office-based therapy. Further research and discussion of the relative benefits of EFP compared to traditional treatment modalities is warranted.     

Narrative exposure therapy for political imprisonment-related chronic posttraumatic stress disorder and depression

The psychological consequences of traumatic stress may last even into old age. In persons in their 60s and 70s who had been victims of political detention and torture four decades ago, we compared the outcome of narrative exposure therapy (NET) to that of psychoeducation (PED) only. From a group of 59 former political detainees, 18 who fulfilled the full PTSD criteria according to the Composite International Diagnostic Interview (CIDI) were offered and accepted participation in the treatment study. The participants were randomly assigned to either one session of PED (n=9) or five sessions of NET (n=9). Symptoms of PTSD (CIDI) and depression (Beck Depression Inventory, BDI) were assessed prior to treatment and after a 6-month follow-up. NET but not PED produced a significant reduction in post-traumatic symptoms and depression scores. Four out of 9 of those who completed NET, compared to 8/9 of those within the PED group, still had PTSD 6 months after the treatment had ended. These results indicate that NET may lead to the alleviation of post-traumatic and depression symptoms even when the conditions persist for excessive time periods.     

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.     

Interoceptive exposure therapy combined with trauma-related exposure therapy for post-traumatic stress disorder: a case report

Trauma-related exposure therapy is a useful but not universally effective treatment for post-traumatic stress disorder. Anxiety sensitivity may play an important role in this disorder, as it does in panic disorder. Studies have shown that interoceptive exposure therapy reduces anxiety sensitivity in panic disorder. The present case study was a preliminary investigation of the merits of including interoceptive exposure therapy in the treatment of post-traumatic stress disorder, in order to improve treatment outcome for a patient who had no history of panic disorder or panic attacks. Interoceptive exposure therapy (4 sessions) was one component of treatment, combined with trauma-related exposure therapy (4 sessions of imaginal exposure followed by 4 sessions of in vivo exposure). Treatment outcome was assessed with the Clinician-Administered Post-traumatic Stress Disorder Scale, a self-report measure of post-traumatic stress disorder symptoms, and measures of symptoms and cognitions commonly associated with post-traumatic stress disorder. Scores on all outcome measures decreased over the course of treatment, with gains maintained at 1- and 3-month follow-up. Symptoms of anxiety sensitivity and post-traumatic stress disorder decreased during interoceptive exposure therapy. The results indicate that interoceptive exposure therapy is a promising adjunctive intervention for post-traumatic stress disorder. Further research is needed into the merits of combining interoceptive exposure therapy and trauma-related exposure therapy as a means of boosting treatment efficacy.     

E-mailed standardized cognitive behavioural treatment of work-related stress: a randomized controlled trial

The aim of this study was to assess the effects of a 7-week standardized cognitive behavioural treatment of work-related stress conducted via e-mail. A total of 342 people applied for treatment in reaction to a newspaper article. Initial screening reduced the sample to a heterogeneous (sub)clinical group of 239 participants. Participants were assigned randomly to a waiting list condition (n = 62), or to immediate treatment (n = 177). A follow-up was conducted 3 years after inception of the treatment. The outcome measures used were the Depression Anxiety Stress Scales (DASS-42) and the Emotional Exhaustion scale of the Maslach Burnout Inventory - General Survey (MBI-GS). Fifty participants (21%) dropped out. Both groups showed statistically significant improvements. Intention-to-treat analysis of covariance (ANCOVAs) revealed that participants in the treatment condition improved significantly more than those in the waiting control condition (0.001

or = d > or = 0.5 (anxiety)). The between-group effects ranged from d = 0.6 (stress) to d = 0.1 (anxiety). At follow-up, the effects were more pronounced, but this result requires replication in view of high attrition at follow-up. The results warrant further research on Internet-driven standardized cognitive behavioural therapy for work-related stress. Such research should include the direct comparison of this treatment with face-to-face treatment, and should address the optimal level of therapist contact in Internet-driven treatment.     

Hypnotherapy and cognitive behaviour therapy of acute stress disorder: a 3-year follow-up

The long-term benefits of cognitive behaviour therapy (CBT) for trauma survivors with acute stress disorder were investigated by assessing patients 3 years after treatment. Civilian trauma survivors (n=87) were randomly allocated to six sessions of CBT, CBT combined with hypnosis, or supportive counselling (SC), 69 completed treatment, and 53 were assessed 2 years post-treatment for post-traumatic stress disorder (PTSD) with the Clinician-Administered PTSD Scale. In terms of treatment completers, 2 CBT patients (10%), 4 CBT/hypnosis patients (22%), and 10 SC patients (63%) met PTSD criteria at 2-years follow-up. Intent-to-treat analyses indicated that 12 CBT patients (36%), 14 CBT/hypnosis patients (46%), and 16 SC patients (67%) met PTSD criteria at 2-year follow-up. Patients who received CBT and CBT/hypnosis reported less re-experiencing and less avoidance symptoms than patients who received SC. These findings point to the long-term benefits of early provision of CBT in the initial month after trauma.     

Post-traumatic stress disorder: A congnitive-contextural approach

Most people are psychologically effected by an extreme trauma and for a significant minority the debility is long term, often expressed as post-traumatic stress disorder (PTSD). A cognitive-contextual approach is described in which the prime focus is upon teaching the client how to interact adaptively with the memory of the trauma by: a) facilitating a switch from a primarily perceptual to a more conceptual level of processing the trauma itself; and b) placing the trauma in the context of past life experiences and determining its relevance for the future. The approach is illustrated by the treatment of a PTSD diagnosed motor vehicle accident victim.     

Renew: An Integrative Psychotherapy Program for Women Veterans with Sexual Trauma

Renew is an integrative treatment consisting of 210 hours of programming for women Veterans to address sexual trauma, including military sexual trauma. The curriculum consists of a holistic approach to healing and is based on the principles of Holographic Reprocessing. Of the 119 women Veterans enrolled in an uncontrolled outcome study (e.g., completed pre- and post-treatment questionnaires), 80 of the participants reported multiple traumas across their lifespan and 95 experienced military sexual trauma. Of the 112 who started treatment, 97 graduated (13 % dropout rate). Graduates showed a significant reduction in posttraumatic stress disorder (PTSD), psychiatric symptoms, and posttraumatic negative cognitions (up to 60 % had reliable clinical change at the 95 % confidence interval), and significant increases in self-esteem, optimism, and satisfaction with life with large to moderate effect sizes. These initial data are promising and further research is warranted to test if Renew is effective to treat women Veterans with complex issues including sexual trauma, PTSD, medical problems, chronic pain, and histories of homelessness and substance abuse.     

Therapeutic Alliance,Interpersonal Relations,and Trauma Symptoms: Examining a Mediation Model of Women With Childhood Abuse Histories

The current study explored the dimensions of the early therapeutic alliance (tasks, goals, bonds, and other-therapist [people important to clients who support their involvement in therapy]) as mediators between clients’ interpersonal relations problems and outcome measures of trauma symptoms (dissociation and total trauma symptoms). Seventy-six female participants who were receiving treatment for posttraumatic stress due to child abuse (CA), were recruited from a university training clinic. The bond and other subscales mediated the association between interpersonal relations problems and dissociation. The element of client trust associated with the alliance bond, as well as clients’ sense that people who are important to them support their involvement in therapy, should be focal in treating CA survivors. Clinical implications revolve around developing, maintaining, and repairing the therapeutic relationship, especially the bond, within the context of dissociation, as well as exploring clients’ views of important others and its impact on their therapy.     

Evidence that process simulations reduce anxiety in patients receiving dental treatment: randomized exploratory trial

Process simulations--mental simulations that ask people to imagine the process of completing a task--have been shown to decrease anxiety in students facing hypothetical or psychological threats in the short term. The aim of the present study was to see whether process simulations could reduce anxiety in a sample of the general population attending a dental practice, and whether these effects could be sustained throughout treatment. Participants (N=75) were randomized to an experimental condition where they were asked to simulate mentally the process of seeing the dentist, or to a control condition where they were asked to simulate mentally the outcome of seeing the dentist. Findings showed that participants in the experimental condition were significantly less anxious both before and after their consultations. Self-efficacy and self-esteem remained unchanged. This study suggests that process simulation is one active ingredient in anxiety treatment programs and further research is required to enhance its effects.     

Survivor Insight: A Study of Family,Friend, and Community Response to Interpersonal Violence

The purpose of this study was to examine the perspectives of survivors of trauma concerning their family, friend, and community responses to their trauma. Using a community-based, participatory action framework, a measure was developed and distributed to 351 randomly drawn survivors of interpersonal violence. The majority of participants indicated that they were never or rarely helped or protected at the time they first experienced the trauma. Several significant correlations were found between participants’ perceptions of their own healing and the responses of people in their lives. Many respondents also indicated that people do not know how to help survivors heal and that the general public does not understand how trauma affects people. The results are discussed within the framework of developing supports for trauma survivors that include trauma-informed family, friends, and community. Questions for further research and implications for professional practice and trauma-informed communities are discussed.     

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.