PTSD Severity and Cognitive Reactions to Trauma Among a College Sample

ABSTRACT

Two hundred twenty-one undergraduate education students were assessed to determine trauma history and cognitive responses to traumatic events. Participants completed a demographic questionnaire, the Cognitive Distortions Scale, and the PTSD Symptom Scale (for those reporting a trauma history). The most common types of traumatic events were domestic violence, natural disasters, and severe transportation accidents. Differences in cognitive distortions of individuals with and without a trauma history also were assessed. Individuals with a trauma history were significantly higher on Preoccupation with Danger and Self-Blame subscales. Number of previous traumatic events and the subscale of Preoccupation of Danger significantly predicted PTSD severity.     

Traumatic memories and pseudomemories in posttraumatic stress disorder

Intrusive imagery was investigated in survivors of motor vehicle accidents with (a) posttraumatic stress disorder (PTSD) and accurate recall of the trauma, (b) PTSD and amnesia of the trauma, (c) no PTSD, or (d) control participants who simulated PTSD. Imagery was precipitated by presentation of an audiotape of a motor vehicle accident. Whereas the traumatic imagery of participants who had accurate recall of their trauma was consistent with third party accounts of the trauma, the imagery of amnesic participants was inconsistent with these accounts. Participants were then interviewed about cognitive and emotional aspects of their responses. All participants with PTSD and simulators reported similar levels of imagery detail, involuntariness, re-experiencing, and emotional response, and reported higher levels than participants with no PTSD. Findings are discussed in terms of cognitive and contextual factors that can mediate accurate and inaccurate traumatic imagery. © 1998 John Wiley & Sons, Ltd.     

Diagnostic, demographic, memory quality, and cognitive variables associated with acute stress disorder in children and adolescents

To date, no studies have investigated factors associated with acute stress disorder (ASD) in children and adolescents. Relationships between ASD and a number of demographic, trauma, cognitive, and trauma memory variables were therefore investigated in a sample (N=93) of children and adolescents involved in assaults and motor vehicle accidents. Several cognitive variables and the quality of trauma memories, but not demographic or trauma variables, were correlated with ASD and also mediated the relationship between peritraumatic threat and ASD. Finally, nosological analyses comparing ASD with indexes of posttraumatic stress disorder in the month posttrauma revealed little support for the dissociation mandate that uniquely characterizes ASD. The results are discussed with respect to assessment and treatment for the acute traumatic stress responses of children and young people.     

Coping responses in the midst of terror: The July 22 terror attack at Utøya Island in Norway

This study examined the peri‐trauma coping responses of 325 survivors, mostly youth, after the July 22, 2011 terror attack on Utøya Island in Norway. The aim was to understand peri‐trauma coping responses and their relation to subsequent post‐traumatic stress (PTS) reactions. Respondents were interviewed face‐to‐face 4–5 months after the shooting, and most were interviewed at their homes. Peri‐trauma coping was assessed using ten selected items from the “How I Cope Under Pressure Scale” (HICUPS), covering the dimensions of problem solving, positive cognitive restructuring, avoidance, support seeking, seeking understanding, and religious coping. PTS reactions were assessed with the UCLA PTSD Reaction Index. The participants reported using a wide variety of coping strategies. Problem solving, positive cognitive restructuring, and seeking understanding strategies were reported most often. Men reported using more problem‐solving strategies, whereas women reported more emotion‐focused strategies. There were no significant associations between age and the use of coping strategies. Problem solving and positive cognitive restructuring were significantly associated with fewer PTS reactions. The results are discussed in light of previous research and may help to inform early intervention efforts for survivors of traumatic events.     

Towards a cognitive-behavioral model of PTSD in children and adolescents

Posttraumatic stress disorder in children and adolescents has been studied only for the past 15–20 years and is the subject of a burgeoning corpus of research. Much research has focused on examining whether children and adolescents have the same responses to trauma as those experienced by adults. Many of the research tools used to investigate children's responses are taken from measures designed for use with adults, and these measures have proven to be useful. However, it has not been established that children's responses to traumatic events are related to the same underlying processes as are adults' responses. The possible application of 2 recent cognitive models of PTSD in adults to understanding PTSD in children and adolescents is discussed in this paper, within the context of what is already known about children's reaction to trauma and existing theoretical accounts of childhood PTSD. Particular attention is paid toward the nature of children's memories of traumatic events and how these memories relate to the reexperiencing symptoms of PTSD, and cognitive processes that may play a role in the maintenance of PTSD. It is proposed that the adoption of a more specific cognitive–behavioral framework in the study of this disorder may be beneficial and lead to better treatment outcomes.     

Creating Supportive Environments for Children Who have had Exposure to Traumatic Events

The prevalence of trauma among young children and its impact on educational outcomes is gaining attention. It is probable that the needs of children who have experienced or been exposed to trauma have long gone unmet due to identification challenges and a lack of knowledge concerning best practices. For this study, qualitative interviews were conducted to gather perspectives of 14 community-based service providers who worked with children and families regarding trauma-related concerns. Each shared his or her perspectives on knowledge and skills early childhood education teachers need to support children who have experienced traumatic events and partner with their families. Research questions were: What should early childhood teachers know about (1) trauma experiences among young children; (2) the emotional and behavioral patterns of children who have experienced traumatic events; and (3) supporting the social and emotional well-being of children in the classroom setting, including partnering with families, who have experienced or been exposed to traumatic events? Participants indicated that teachers might not readily connect children’s behaviors and emotions to trauma. However, teachers can use approaches and strategies (e.g., being attuned and supporting positive social and emotional and communicative responses) that promote social and emotional well-being for children who experience trauma. Participants also noted that teachers can resist re-traumatization by making adaptations to social, physical, and temporal aspects of the classroom environment. Findings indicate that trauma-informed care might be viable in early childhood classroom settings. Implications for research are discussed.     

Assessment of Trauma History and Trauma-Related Problems in Ethnic Minority Child Populations: An INFORMED Approach

Youth who experience traumatic events are at risk for a range of negative outcomes, including posttraumatic stress disorder, other anxiety disorders, depression, substance use, and health risk behaviors. It is important to identify valid methods to assess individuals for exposure to traumatic events, as well as the types of problems or symptoms they may be experiencing as a result of these events.

An individual's cultural values, beliefs, and practices can affect the ways that trauma-related sequelae are manifested and presented upon evaluation. Obtaining information about a child's ethnic background, including cultural beliefs and practices, can be a useful component of a trauma assessment. In this paper, the authors will (a) review standard guidelines for assessment of trauma in the general population; (b) present an argument for modification of standard trauma assessment strategies used with culturally diverse populations; (c) describe the culturally INFORMED model, comprised of 8 empirically based recommendations for modifying trauma assessment of culturally diverse populations; and (d) provide an example of how this model has been applied to a trauma assessment protocol with a Mexican immigrant population. Implications of how culturally modified assessment can be used to inform culturally modified cognitive-behavioral treatment of trauma symptoms in children also are addressed.     

An evidence-based group coping intervention for women living with HIV and history of childhood sexual abuse

Women living with HIV/AIDS and a history of childhood sexual abuse often exhibit sexual trauma symptoms and elevated rates of HIV-risk behaviors. In this paper, we describe a coping skills group intervention that reduced traumatic stress and sexual-risk behavior in a recent randomized clinical trial. We focused on clinical issues that emerged among female participants receiving the intervention. Clinical observations showed that recognizing connections between trauma, psychological distress, and high risk behaviors was a new and powerful experience for many participants. Participants successfully applied psychoeducational material, expressing an increased sense of power and control over their relationships and behaviors as they developed more adaptive cognitive and behavioral skills. Women expressed high levels of satisfaction with the intervention. Recommendations for clinical practice are provided.     

Cognitive factors involved in the onset and maintenance of posttraumatic stress disorder (PTSD) after physical or sexual assault.

Cognitive factors hypothesised to influence the development and maintenance of PTSD were investigated. 92 assault victims completed questionnaires assessing a range of cognitive variables. Factors relating to onset of PTSD were investigated by comparing victims who did and who did not suffer PTSD. Factors relating to maintenance of PTSD were investigated by comparing victims who had recovered from PTSD with victims who had persistent PTSD. Cognitive factors associated with both onset and maintenance of PTSD were: appraisal of aspects of the assault itself (mental defeat, mental confusion, appraisal of emotions); appraisal of the sequelae of the assault (appraisal of symptoms, perceived negative responses of others, permanent change); dysfunctional strategies (avoidance/safety seeking) and global beliefs impacted by assault. Cognitive factors that were associated only with the onset of PTSD were: detachment during assault; failure to perceive positive responses from others and mental undoing. Relationships between the cognitive variables and PTSD remained significant when variations in perceived and objective assault severity were statistically controlled. The cognitive factors identified in the study may contribute to PTSD directly, by generating a sense of ongoing threat, or indirectly, by motivating cognitive and behavioural strategies that prevent recovery, or by affecting the nature of the traumatic memory.     

The psychodynamic of panic attacks: A useful integration of psychoanalysis and neuroscience1

This article tries to explain, in the light of some neuroscientific and psychoanalytical considerations, the repetitive pattern of panic attacks. Freud considered the panic attack as an ‘actual neurosis’ not involving any conflictual process. Recent neuroscientific findings indicate that psychosomatic reactions, set off by a danger situation, depend on the primitive circuit of fear (including the amygdala) characterised by its speed, but lack accurate responses and may also be activated by harmless stimuli perceived erroneously as dangerous. The traumatic terror is stored in implicit memory and may be set off by a conditioned stimulus linked to a previous danger situation. In the panic attack, the traumatic event is created by the imagination and this construction (a micro‐delusion), built in loneliness and anxiety, has the same power as the real trauma. A mutual psychosomatic short‐circuit between body and psyche, in which terror reinforces the somatic reactions and the psychic construction, is established. Therefore, it is important to highlight these constructions in order to analyse and transform them. In the second part of the article the author reviews the main psychoanalytical theories about panic attacks, stressing how, in his opinion, panic attack is a consequence of the breakdown of the defence organisation at various levels and may appear during periods of life crisis. Two patients suffering from a deficit of personal identity are presented. The various organisations and the different levels (biological, neuroscientific, associative, traumatic) of the panic attack determine different kinds of therapeutic approaches (pharmacological, cognitive and psychoanalytical). While the psychopharmacological treatment is aimed at reducing the neurovegetative reaction and the cognitive method is attempting to correct the associative and perceptive processes of fear signals, psychoanalytical therapy represents both a specific means to free patients from panic attacks as well as an indispensable route for their emotional growth.     

Perspectives on Memory for Trauma and Cognitive Processes Associated with Dissociative Tendencies

Summary

Cognitive science approaches can inform research in traumatic stress studies by articulating separate scientific issues that may be relevant to understanding alterations in memory and awareness for trauma. This article will first address general issues about disrupted memory and “knowledge isolation” for trauma, as well as introduce specific aspects of “betrayal trauma theory” (Freyd 1994, 1996) that inform our understanding of memory impairment. According to betrayal trauma theory, a potent motivation for knowledge isolation (including amnesia, dissociation, and unawareness) in the face of trauma is to preserve apparently necessary human relationships in which betrayal occurs. Results from three recent laboratory investigations of cognitive processes associated with dissociative tendencies are summarized. These laboratory investigations suggest that the attentional capacities of high dissocators are impaired under conditions of selective attention, but not divided attention. Furthermore, in our laboratory tasks high dissocators have impaired memory for emotionally charged words associated with sexual assault and abuse (e.g., “incest”) but not neutral words, as compared with low dissociators. The findings suggest that high dissociators use divided attention and multi-tasking as a way to control the flow of information. Such a view is consistent with betrayal trauma theory. Though in its infancy, this research draws on cognitive science and observations of traumatic response and offers much promise.     

Nurturing Environments for Boys and Men of Color with Trauma Exposure

Boys and men of color are exposed to traumatic experiences at significantly higher rates than are other demographic groups. To understand and address the mental and behavioral health effects of trauma, including violent incidents, on this population, we review the literature showing the context for, outcomes of, and potential responses to trauma exposure. We present the existing research about the unique challenges and associated negative outcomes for boys and men of color, as well as identify the gaps in the literature. We present the potential nurturing responses by systems such as schools, law enforcement, and communities to trauma-exposed boys and men of color, and we describe evidence-based programs and practices that directly address trauma. Finally, we argue that, rather than using a deficit model, a model of optimal development can be used to understand how to support and protect boys and men of color through nurturing environments.     

The Politics of Trauma Studies: What Can We Learn From Women Combatants' Experiences of Traumatic Events in Conflict Zones?

Wars, combat, and political developments triggered the study of trauma. Knowledge about trauma initially emerged from the experiences of men combatants in the battlefield. At a later stage, the study of trauma focused on women and children subject to violence and abuse. The current research suggests that additional aspects of trauma can be understood through the study of competent women exposed to traumatic events and not merely as victims of war or abuse. The study offers an analysis of women combatants' narratives of their exposure to traumatic events in conflict zones. Data were obtained from two focus groups and a series of 30 personal interviews of women veterans who served in the IDF. Interviewing women combat soldiers revealed a variety of narratives of their war experiences, including the intertwining of the emotional and the physical. The window to understanding the trauma was opened by analysis of the responses of the women combatants to potentially traumatic events rather than by focusing on post‐traumatic stress disorder (PTSD) per se. We emphasize the need for a critical perspective in the study of trauma and combat trauma and propose that there is value in engaging with and listening to diverse narratives of trauma.     

Making Meaning of Trauma: Trauma Exposure Doesn’t Tell the Whole Story

Although traumatic experiences are relatively common, there is wide variability in individuals’ responses to them. This study examined trauma exposure, meaning making efforts (indexed by post-traumatic cognitions), and post-traumatic stress symptoms (PTS) in a non-clinical volunteer student sample (N = 631). We further examined the moderating role of gender, the importance of trauma type (interpersonal vs. non-interpersonal), and the impact of cumulative traumatic experiences. About 75% of the sample reported past trauma (n = 475). Women reported more interpersonal trauma than did men. For both genders, trauma exposure was associated with more PTS. A dose–response relationship was found between the extent of trauma exposure and negative post-traumatic cognitions. Importantly, post-traumatic cognitions predicted PTS controlling for amount of trauma exposure. It appears that it is not merely exposure to negative events that matters, but how we construe and make sense of these experiences. This study extends our understanding of gender differences, meaning-making, and responses to trauma exposure, and suggests avenues of clinical treatment.     

青少年重复创伤暴露与创伤后应激障碍的关系:安全感与认知重评的中介作用

采用创伤暴露程度问卷、生活事件量表、安全感量表、情绪调节策略问卷和修订后的DSM-5的PTSD核查表对汶川地震8.5年后的1156名中学生进行调查,考察其重复创伤暴露、安全感和认知重评与PTSD之间的关系。结果发现,在控制初次地震暴露后,重复创伤暴露可以直接正向预测PTSD,也可以通过确定控制感和人际安全感分别间接地正向预测PTSD,还可以通过人际安全感经认知重评的多重中介作用来正向预测PTSD。不过,重复创伤暴露不能直接经过认知重评对PTSD发挥显著的预测作用,也不能通过确定控制感经认知重评来对PTSD发挥显著的多重间接预测作用。     

Psychic trauma and traumatic object loss

Psychoanalysis began with the concept of psychic trauma, which was subsequently not clearly differentiated from traumatic object loss or from unconscious conflict and fantasy. Psychic trauma is investigated in relation to unconscious conflict, with and without concurrent object loss. The syndromes of PTSD, uncomplicated by object loss, of traumatic bereavement, and of relatively nontraumatic bereavement, though often interwoven and inseparable, are all different. The significance of the loss, sociocultural factors, and group process influence individual responses to trauma and traumatic bereavement. There are specific neurobiological and psychological sequelae of traumatic experience. Clinical applications are noted.     

A longitudinal investigation of the reliability of memories for trauma and other emotional experiences

This study examined the relative consistency and characteristics of memories for trauma and other non‐traumatic emotional experiences over time. A community sample of 52 participants who reported a recent traumatic event were asked to recall both the traumatic and a positive emotional experience in two interviews separated by approximately three months (M = 105.39 days). The recollections were elicited with either a free narrative, cognitive interview, guided imagery, or written narrative approach. Results indicated that traumatic experiences were recalled more reliably over time than other emotional experiences. Traumatic memory imagery tended to persist in memory (with no apparent impairment), whereas features of positive memories were subject to considerable distortion, regardless of interview style. The findings contribute to the understanding of the impact of trauma on memory with the passage of time. Copyright © 2004 John Wiley & Sons, Ltd.     

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. Re‐experiencing 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”).     

The effect of cognitive load and hyperarousal on negative intrusive memories

Clinical theories of post-traumatic stress suggest that encoding processes at the time of a trauma are critical in determining whether intrusive memories will develop. Potential mechanisms that might influence the development of intrusive memories were studied, as was objective memory performance. In an analogue design, 65 participants were randomised to three conditions (cognitive load, hyperventilation, and control), and then watched a film of traumatic content. Intrusive memories were recorded during the experimental phase and at 1-week follow-up. Support was found for the prediction that verbal cognitive load and hyperventilation would facilitate intrusion development immediately following exposure to the trauma film; however, this was not maintained at follow-up. Consistent with cognitive models of post-traumatic stress, thought suppression and the distress associated with intrusive experiences mediated the relationship between distress caused by the film and intrusions at 1-week follow-up. Objective memory testing indicated that the three experimental groups showed similar recall and recognition performance for the content of the film; however, relative to the control group, individuals in the cognitive load condition were significantly less able to place film scenes in the correct order.     

Trauma Competency: An Active Ingredients Approach to Treating Posttraumatic Stress Disorder

Meta‐analytic studies have extracted 4 common elements among effective posttraumatic stress disorder treatments: cognitive restructuring and psychoeducation, a deliberate and continually improving therapeutic relationship, relaxation and self‐regulation, and exposure via narrative of traumatic experiences. The authors present a clinical treatment structure catalyzing these active ingredients into discrete therapeutic tasks that counselors can focus on to maximize treatment effectiveness. The 4 tasks represent an attempt to identify critical competencies and baseline standards for the field of trauma counseling.