The generality of cognitive bias in acute stress disorder

Cognitive bias was investigated in acutely traumatised civilians with either acute stress disorder (ASD; n = 26) or no ASD (n = 24). Participants completed the Acute Stress Disorder Interview, the Beck Depression Inventory, the Beck Anxiety Inventory (BAI), the Impact of Event Scale (IES), and an Event Probability Questionnaire and an Event Cost Questionnaire that comprised items pertaining to (a) external harm, (b) somatic sensations and (c) social events. ASD participants exaggerated both the probability of negative external harm, somatic and social events occurring, and the adverse cost of those events more than non-ASD participants. Elevated probability and cost estimates were predicted by BAI and IES-Avoidance scores, respectively. These findings are discussed in the context of different patterns observed in other anxiety disorders, and interpreted in terms of network theories of posttraumatic stress.     

Thought control strategies in acute stress disorder

Intrusive trauma-related thoughts and the means to manage them are a central dynamic in posttraumatic stress. Thought control strategies were investigated in survivors of motor vehicle accidents with either acute stress disorder (ASD; n=20) or no ASD (n=20). Participants completed the Acute Stress Disorder Interview, the Beck Depression Inventory, the Beck Anxiety Inventory, the Impact of Event Scale, and the Thought Control Questionnaire (TCQ) within four weeks of their accident. Although distraction, social control, and reappraisal were the most common strategies in both groups, ASD participants engaged in punishment and worry more than non-ASD participants. Worry and punishment were also strongly associated with severity of intrusive, avoidance, arousal, and depressive symptoms. Findings are discussed in terms of the role of cognitive strategies in resolving posttraumatic stress.     

Panic symptoms during trauma and acute stress disorder

This study investigated the role of panic symptoms that occur during trauma and subsequent acute stress disorder (ASD). Civilian trauma (N=51) survivors with either acute stress disorder (ASD), subclinical ASD, or no acute stress disorder (non-ASD) were administered the Acute Stress Disorder Scale, Impact of Event Scale, Beck Anxiety Inventory, Beck Depression Inventory, and the Anxiety Sensitivity Index (ASI). Participants also completed the Physical Reactions Scale to index panic symptoms that occurred during their trauma. Overall, 53% of participants reported panic attacks during their trauma. ASD and subclinical ASD participants reported more peritraumatic panic symptoms, and higher ASI scores, than non-ASD participants. These findings are consistent with the notion that peritraumatic panic may be related to subsequent posttraumatic stress, and suggest that modification of maladaptive beliefs about physical sensations should be addressed in posttraumatic therapy.     

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.     

Acute Stress Disorder Scale: a self-report measure of acute stress disorder

The Acute Stress Disorder Scale (ASDS) is a self-report inventory that (a) indexes acute stress disorder (ASD) and (b) predicts posttraumatic stress disorder (PTSD). The ASDS is a 19-item inventory that is based on Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV, American Psychiatric Association, 1994) criteria. The ASDS possessed good sensitivity (95%) and specificity (83%) for identifying ASD against the ASD Interview on 99 civilian trauma survivors. Test-retest reliability of the ASDS scores between 2 and 7 days was strong (r = .94). The ASDS predicted 91% of bushfire survivors who developed PTSD and 93% of those who did not; one third of those identified by the ASDS as being at risk did not develop PTSD, however. The ASDS shows promise as a screening instrument to identify acutely traumatized individuals who warrant more thorough assessment for risk of PTSD.     

Directed forgetting in acute stress disorder

The rationale underpinning the diagnosis of acute stress disorder is that cognitive mechanisms result in avoidant processing of aversive experiences. This study investigated acutely traumatized participants with either acute stress disorder (ASD; n = 15) or no ASD (n = 14) and nontraumatized comparison participants (n = 16). Participants were administered intermixed presentations on a computer screen of positive, neutral, and trauma-related words that were followed by instructions to either remember or forget each word. On a subsequent recall test, ASD participants displayed poorer recall of to-be-forgotten trauma-related words than did non-ASD participants. Severity of psychopathology was negatively correlated with to-be-remembered positive words. These findings are consistent with the proposal that people who develop ASD display an aptitude for superior forgetting of aversive material.     

Attribution style and post-traumatic stress severity in the Central Region of Kenya: Influences of dwelling location

This study investigated the influence of attribution styles as predictors of post-traumatic stress severity (PTSS) by dwelling in Kenya. A non-clinical convenience sample of 354 rural (n = 178) and urban (n = 176) Kenyans from the Central Region of Kenya were participants. They responded to a post-traumatic stress screener, attribution style questionnaire and post-traumatic disorder (PTSD) checklist. A regression analysis showed that the urban dweller (UD) sample was significantly more likely to attribute negative events to internal, specific causes than the rural dweller (RD) sample. Findings suggest social support protections in RD to buffer them from negative self-attributions for PTSS among this Kenyan sample.     

Follow-up of victims of one terrorist attack in Israel: ASD, PTSD and the perceived threat of Iraqi missile attacks

The first aim of the study was to examine the relationships between acute stress reactions and post-traumatic reactions following exposure to a terrorist attack. The second was to examine whether exposure to a terrorist attack increases the perceived threat and fear of renewed Iraqi missile attacks. Data were collected at two points in time: during the first month after the exposure to a terrorist attack (N = 54), and four months later (N = 44). Twenty-four percent of the exposed group had acute stress disorder (ASD), and a similar percentage had PTSD. Among participants who had ASD, the chances of developing PTSD were three times greater than among those who had never experienced ASD. Among participants who had been exposed to a terrorist attack and developed PTSD, the perceived threat of an Iraqi missile attack was greater than among those who had been exposed to a terrorist attack but did not develop PTSD, or among the participants in the control group. The discussion deals with the findings in light of the current controversy regarding ASD and the current situation in Israel.     

Sluggish cognitive tempo in children and adolescents with higher functioning autism spectrum disorders: Social impairments and internalizing symptoms

Sluggish cognitive tempo (SCT) was introduced in 1980s in the field of attention deficit hyperactivity disorder (ADHD). Studies indicate that symptoms of SCT are separate from symptoms of ADHD and independently associated with multiple domains of functioning in clinical groups and in typical development. We assessed whether similar pattern would apply to higher functioning autism spectrum disorders (ASD). Children with higher functioning ASD (N = 55; 5?15 years) were divided into the ASD+High SCT (n = 17), the ASD+Medium SCT (n = 18) and the ASD+Low SCT (n = 20) groups based on parent‐rated daydreaming and slowness on the Five to Fifteen questionnaire (FTF). The groups were compared on SCT‐related impairments found in previous studies: social skills, academic functioning, psychiatric symptoms, and processing speed. Assessment methods were the FTF, the Development and Well‐Being Assessment, and the Coding subtest of the WISC‐III. The ADHD symptoms were statistically controlled due to the overlap between SCT and ADHD. The ASD+High SCT and ASD+Medium SCT groups were significantly more likely to have the most pronounced social impairments, and the ASD+High SCT group had significantly higher rate of internalizing disorders compared to the ASD+Low SCT group. Our results suggest that children with higher functioning ASD and high or medium levels of SCT symptoms could be at higher risk for psychosocial impairments than children with higher functioning ASD with low levels of SCT symptoms. Co‐occurring ADHD symptoms do not explain the finding. Recognizing SCT symptoms in higher functioning ASD would be important to targeting preventive support.     

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.     

Cognitive Processing Therapy for Acute Stress Disorder Resulting From an Anti-Gay Assault

This case study describes Cognitive Processing Therapy (CPT) with a 30-year-old gay man with symptoms of acute stress disorder (ASD) following a recent homophobic assault. Treatment addressed assault-related posttraumatic stress disorder symptoms and depressive symptoms. Also addressed were low self-esteem, helplessness, and high degrees of internalized homophobia. Client symptomatology was tracked using the PTSD Symptom Scale and the Beck Depression Inventory over the course of 12 sessions and for a 3-month posttermination session. Symptoms were significantly reduced by the end of the 12-week therapy and were maintained at 3-month follow-up. This case highlights the utility of this therapy in targeting both ASD symptoms and internalized homophobia relating to experiencing a hate crime-related assault. The authors elaborate on theoretical and applied issues in adapting a structured cognitive-behavioral intervention to the treatment of ASD symptoms associated with experiencing a hate crime.     

Hot and cool executive function in children and adolescents with autism spectrum disorder: Cross-sectional developmental trajectories

The development of executive function (EF) in autism spectrum disorder (ASD) has only been investigated using “cool”-cognitive-EF tasks. Little is known about the development of “hot”-affective-EF and whether it follows a similar developmental pathway. This study employed a cross-sectional developmental trajectories approach to examine the developmental changes in cool (working memory, inhibition, and planning) and hot EF (delay discounting and affective decision-making) of ASD participants (n = 79) and controls (n = 91) relative to age and IQ, shedding more light on the hot–cool EF organization. The developmental trajectories of some aspects of cool EF (working memory and planning) differed significantly as a function of age in ASD participants relative to controls. For both hot EFs, no significant age-related changes were found in either group. These findings extend our understanding regarding the maturation of EF from childhood through adolescence in ASD.     

Parental Coping in the Neonatal Intensive Care Unit

Fifty-six mothers of premature infants who participated in a study to reduce symptoms of posttraumatic stress disorder (PTSD) completed the Brief COPE, a self-report inventory of coping mechanisms, the Stanford Acute Stress Reaction Questionnaire to assess acute stress disorder (ASD) and the Davidson Trauma Scale to assess PTSD. 18 % of mothers had baseline ASD while 30 % of mothers met the criteria for PTSD at the 1-month follow-up. Dysfunctional coping as measured by the Brief COPE was positively associated with elevated risk of PTSD in these mothers (RR = 1.09, 95 % CI 1.02–1.15; p = .008). Maternal education was positively associated with PTSD; each year increase in education was associated with a 17 % increase in the relative risk of PTSD at 1 month follow-up (RR = 1.17, 95 % CI 1.02–1.35; p = .03). Results suggest that dysfunctional coping is an important issue to consider in the development of PTSD in parents of premature infants.     

Acute Stress Disorder: Conceptual Issues and Treatment Outcomes

Acute stress disorder (ASD) was included as a diagnosis to the 4th edition of the Diagnostic and Statistical Manual (American Psychiatric Association, 1994) as a way of describing pathological reactions in the first month following a trauma. Since that time, ASD has been the focus of some controversy, particularly regarding the theoretical basis and practical utility of the disorder. Despite this controversy, ASD has demonstrated usefulness in identifying individuals experiencing a high level of distress in the acute aftermath of a trauma as well as those at risk for developing posttraumatic stress disorder (PTSD). This paper reviews the clinical application of ASD, the current controversy surrounding its conceptual basis, and then discusses the dilemmas regarding this diagnosis that might occur in clinical practice. A review of the randomized control trial treatment outcome literature for ASD is also included in an effort to assist clinicians selecting interventions for clients recently exposed to traumatic events. Throughout this paper, the relationship between research and applied clinical practice is highlighted.     

Attachment security differs by later autism spectrum disorder: A prospective study

Although difficulties with social relationships are key to autism spectrum disorder (ASD), no previous study has examined infant attachment security prior to ASD diagnosis. We prospectively assessed attachment security at 15 months in high‐risk infants with later ASD (high‐risk/ASD, n = 16), high‐risk infants without later ASD (high‐risk/no‐ASD, n = 40), and low‐risk infants without later ASD (low‐risk/no‐ASD, n = 39) using the Strange Situation Procedure. High‐risk/ASD infants were disproportionately more likely to be classified as insecure (versus secure) and more likely to be classified as insecure‐resistant (versus secure or avoidant) than high‐risk/no‐ASD and low‐risk/no‐ASD infants. High‐risk infants with insecure‐resistant attachments were over nine times more likely to receive an ASD diagnosis than high‐risk infants with secure attachments. Insecure‐resistant attachment in high‐risk infants suggests a propensity toward negative affect with the parent in conditions of stress. Insecure‐resistant attachment may prove useful as a potential early index of propensity toward ASD diagnosis in high‐risk siblings, while insecure‐resistant attachment in the context of emergent autism may contribute to difficulties experienced by children with ASD and their families.     

Does ‘Wanting the Best’ create more stress? The link between baby sign classes and maternal anxiety

This study investigated whether gesturing classes (baby sign) affected parental frustration and stress, as advertised by many commercial products. The participants were 178 mother–infant dyads, divided into a gesture group (n=89) and a non‐gesture group (n=89), based on whether they had attended baby sign classes or not. Mothers completed a background demographics questionnaire and the Parenting Stress Index. Gesturing mothers had higher total stress scores, with higher scores on the child domain, despite having similar backgrounds to non‐gesturing mothers. There was no relationship between the frequency or duration of gesture use and stress scores. It is suggested that gesturing mothers had higher pre‐existing stress and were attracted to gesture classes because of the promoted benefits, which include stress reduction, although class attendance did not alleviate their stress. The possibility that attending gesturing classes made mothers view their infant in a more negative way, due to their heightened expectations not being met, is also discussed. Copyright © 2010 John Wiley & Sons, Ltd.     

The structure of acute stress disorder among Chinese adults exposed to an earthquake: Is dysphoric arousal a unique construct of acute posttraumatic responses?

Wang, R., Wang, L., Zhang, J., Liu, Z. & Wu, K. (2012). The structure of acute stress disorder among Chinese adults exposed to an earthquake: Is dysphoric arousal a unique construct of acute posttraumatic responses? Scandinavian Journal of Psychology 53, 430–436. As a diagnosis organized mainly on the basis of theoretical conceptualization, acute stress disorder (ASD) has been widely criticized for lack of empirical support since it was introduced into the DSM system. To address this issue, the present study investigated the latent structure of ASD symptoms measured by the Acute Stress Disorder Scale (ASDS). A total of 350 adults with a mean age of 32.9 years (SD = 14.0, range: 16–85) took part in this study 12 to 15 days after an earthquake. The results of confirmatory factor analyses showed that a five‐factor intercorrelated model (dissociation, reexperiencing, avoidance, dysphoric arousal, and anxious arousal) demonstrated the best data fit. The findings provide preliminary empirical evidence in favor of a new reconceptualization of ASD symptoms, and are informative for the impending DSM‐5.     

A Pilot Study of Acute Stress Symptoms in Parents and Youth Following Diagnosis of Type I Diabetes

The primary aims of this exploratory study were to determine the rate of occurrence of acute stress disorder (ASD) in children newly diagnosed with Type 1 diabetes and their parents, to examine relationships with demographic and psychosocial factors, and to examine the relationships between ASD symptom clusters and early adherence behavior (clinic attendance). The sample consisted of 102 parents of children ages 0–17 years and 40 youth ages 11–17 who were evaluated within three days of diabetes diagnosis. Eighteen percent of parents and 17% of youth reported subthreshold symptoms of ASD. Acute stress symptoms and demographic variables predicted clinic attendance, with a differential pattern evident in the responses of youth and their parents. These findings reinforce the importance of screening symptoms of ASD in youth with newly diagnosed diabetes and their parents to assist in identifying families who may be in need of additional support.     

Depression and Openness to Experience

The relation between depression and Openness to Experience was examined. Self-report measures of personality traits (Revised NEO Personality inventory; Costa & McCrae, 1992a) and depression (Beck Depression Inventory; Beck, Rush, Shaw, & Emery, 1979; and Inventory to Diagnose Depression; Zimmerman, 1994) were administered to 143 undergraduate participants from the following 3 groups: current depression (n = 46), past depression (n = 50), and never-depressed controls (n = 47). Depressed participants exhibited significantly higher scores than nondepressed controls on two facets of Openness (Aesthetics and Feelings). Openness to Experience was also found to account for a significant proportion of the variance in depression scores, beyond the variance accounted for by Neuroticism and Extraversion. The facet of Openness to Aesthetics appeared to be most strongly related to depression scores, and the facet of Openness to Fantasy was implicated as a moderator of the relation between Extraversion and depression.     

Long-Term stress reactions in new immigrants to israel exposed to the chernobyl accident

Abstract

This comparison study examined the relation between presumed level of exposure to the accident at Chernobyl in 1986 to symptoms of post-traumatic stress disorder (PTSD) and other psychological symptoms (depression, somatization, anxiety, obsessive-compulsive style and interpersonal sensitivity), life events and the negative appraisal of the events surrounding the accident. The sample (N = 708) included new immigrants from the former Soviet Union (Confederation of Independent States) who arrived in Israel since 1989 from more exposed areas (n = 137), less exposed (n = 240) and a comparison sample (n = 331) who immigrated from other republics. The exposed groups had higher mean scores on all psychological outcome measures than the comparison group, particularly symptoms of PTSD. Both subsequent stressful life events and a negative, cognitive assessment of events contributed to present psychological distress, independent of exposure.