The relationship between acute stress disorder and posttraumatic stress disorder in severely injured trauma survivors

This prospective longitudinal study was designed to investigate the relationship between acute stress disorder (ASD) and the subsequent development of posttraumatic stress disorder (PTSD) in a population of severely injured hospitalised trauma survivors. Symptoms of ASD were assessed just prior to discharge in 307 consecutive admissions to a Level 1 Trauma Centre, with PTSD assessments completed at 3 and 12 months post-injury. A well-established structured clinical interview was adopted for both assessments. Only 1% of the sample met criteria for an ASD diagnosis (at a mean of 8 days post-injury), while the incidence of PTSD was 9% at 3 months and 10% at 12 months. Although all ASD symptom clusters contributed to the prediction of subsequent PTSD severity, logistic regression indicated that only re-experiencing and arousal predicted a categorical PTSD diagnosis. The dissociative symptoms that form the core of ASD were rarely endorsed and showed high specificity but low sensitivity, resulting in a high proportion of false negative diagnoses. Reducing the number of dissociative symptoms required for a diagnosis ameliorated, but did not resolve, the problem. In this particular population, the low sensitivity of the ASD diagnosis renders it a poor screening test for use in identifying high risk individuals for early intervention and prevention strategies.     

Framing social information and generalized social phobia

Patients with generalized social phobia (GSP, N=33) and matched community controls (N=31) engaged in a social interaction that was constructed to go well, and then received feedback that framed social cues reflecting either the absence of negative outcomes or the presence of positive outcomes. Following feedback that framed positive social cues, the GSP group predicted they would experience more anxiety in a subsequent interaction than did non-phobic controls. In contrast, following feedback framing the absence of negative outcomes, the GSP group did not differ from controls in their anxiety predictions. The results demonstrated that framing paradigms and methods can be usefully applied to the study of cognitive processes in social phobia and indicated that research to examine how GSP patients process specific types of social information is needed.     

Acculturation strategies, coping process and acculturative stress

Using structural equation modeling, this study examines the influences of motivational factors (Need for Cognitive Closure--NCC--and Decisiveness), coping strategies and acculturation strategies on levels of acculturative stress. Two groups of immigrants in Rome (Croatians n= 156 and Poles n= 179) completed a questionnaire that included scales for the various factors. Although our initial hypothesized model was not confirmed, a modified model showed that the motivational factors of NCC and Decisiveness indirectly influence acculturative stress. The modified model with good fit indices indicated that the relationship between NCC and Decisiveness are mediated by coping strategies and acculturation strategies. Specifically, NCC is associated positively with avoidance coping, which in turn is negatively associated with the host group relationships and positively with the original culture maintenance. The last two dimensions predicted lower levels of acculturative stress. Decisiveness was positively associated with the problem-oriented coping and, negatively, with emotional and avoidance coping.     

Psychological reactions in Icelandic earthquake survivors

The aim of this study was to explore the psychological consequences of two earthquakes in Iceland in two probability samples of subjects--residents in the exposed area and a control group from an unexposed area. The sample was composed of 52 adults exposed to the earthquakes and 29 adults in a control group. Three months after the earthquakes, both groups were approached with questions from a survey consisting of the Harvard Trauma Questionnaire (HTQ), the Trauma Symptom Checklist (TSC), the Coping Styles Questionnaire (CSQ), the World Assumption Scale (WAS), and the Crisis Support Scale (CSS). The results revealed that 24% in the exposed group had Posttraumatic Stress Disorder (PTSD), and none in the control group had PTSD. Earthquake-related anxiety, inability to express one's thoughts and feelings, and emotional coping predicted 81% of the HTQ variance for both groups. Previous life events, low self-worth, and luck attributions, together with numbing and the feeling of being let down, predicted 56% of the symptom variance for both groups. When degree of traumatization and emotional coping were added to the model, another 30% of the variance could be explained.     

Stress priming in picture naming: an SOA study

This study investigates whether or not the representation of lexical stress information can be primed during speech production. In four experiments, we attempted to prime the stress position of bisyllabic target nouns (picture names) having initial and final stress with auditory prime words having either the same or different stress as the target (e.g., WORtel-MOtor vs. koSTUUM-MOtor; capital letters indicate stressed syllables in prime-target pairs). Furthermore, half of the prime words were semantically related, the other half unrelated. Overall, picture names were not produced faster when the prime word had the same stress as the target than when the prime had different stress, i.e., there was no stress-priming effect in any experiment. This result would not be expected if stress were stored in the lexicon. However, targets with initial stress were responded to faster than final-stress targets. The reason for this effect was neither the quality of the pictures nor frequency of occurrence or voice-key characteristics. We hypothesize here that this stress effect is a genuine encoding effect, i.e., words with stress on the second syllable take longer to be encoded because their stress pattern is irregular with respect to the lexical distribution of bisyllabic stress patterns, even though it can be regular with respect to metrical stress rules in Dutch. The results of the experiments are discussed in the framework of models of phonological encoding.     

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.     

Treatment of pharmacotherapy-refractory posttraumatic stress disorder among Cambodian refugees: a pilot study of combination treatment with cognitive-behavior therapy vs sertraline alone

Cambodian refugees with posttraumatic stress disorder (PTSD) represent a cohort in severe need of treatment, but little information is available to guide treatment choices. We selected a sample of pharmacotherapy-refractory individuals to test the efficacy of combination treatment with sertraline and cognitive-behavior therapy (CBT) for treating PTSD. Participants in this pilot study were ten Khmer-speaking women who had been at a mean age of 22-26 years during the Pol Pot period (1975-1979). These patients were randomly assigned to either sertraline alone or combined treatment. We found that combined treatment offered additional benefit in the range of medium to large effect sizes for PTSD and associated symptoms. Our findings indicate that substantial gains can be achieved by adding CBT to pharmacotherapy for PTSD, and that a program of CBT emphasizing information, exposure, and cognitive-restructuring can be successfully modified for Khmer-speaking refugees.     

Emancipatory responses to oppression: the template of land-use planning and the Old Order Amish of Ontario

In this paper I discuss the clash of values between the Old Order Amish community of Ontario and the dominant social paradigm in agriculture. Land-use and agricultural regulations, designed for an industrial style of agriculture, are experienced as a threat to the survival of the Old Order Amish agricultural social economy and community. The paper describes how I have worked with the Old Order Amish to respond to these challenges and to create public policies that will allow them to maintain their human and agricultural diversity and small-scale sustainable farm practices. Four case studies illuminating the oppressive land-use regulations along with the emancipatory responses to the oppression are examined. The social transformation themes include principles and processes for community psychologists, land-use planners, and community economic development practitioners to consider. The article has heuristic value for a practice-based approach to social change.     

Exploring dynamics of abusive lesbian relationships: preliminary analysis of a multisite,qualitative study

This paper presents preliminary results from a multisite, qualitative study on violence in lesbian relationships. A framework for conducting community-based, empowerment research that draws on theories of community psychology, feminism, and postmodernism is presented. The study was designed to understand the dynamics of abusive lesbian relationships and social service providers' responses to the abuse. Results from 80 in-depth interviews with lesbians who have experienced relationship violence are examined with a particular focus on a pattern of first relationships being abusive and a theme of shifting power dynamics. Analysis of focus group discussions with 45 feminist service providers (e.g., counselors, shelter workers, social workers, healthcare providers) reveals the difficulties in assessing the power dynamics of abusive same-sex relationships and in developing appropriate responses when relying on heterosexually gendered models developed to address men's violence against women. The preliminary results present implications both for how we theorize and research this form of violence, and for improving the practices and policies of social services that work with lesbian, gay, bisexual, and transgendered communities.     

Demographic characteristics,social competence,and behavior problems in children with gender identity disorder: a cross-national,cross-clinic comparative analysis

This study examined demographic characteristics, social competence, and behavior problems in clinic-referred children with gender identity problems in Toronto, Canada (N = 358), and Utrecht, The Netherlands (N = 130). The Toronto sample was, on average, about a year younger than the Utrecht sample at referral, had a higher percentage of boys, had a higher mean IQ, and was less likely to be living with both parents. On the Child Behavior Checklist (CBCL), both groups showed, on average, clinical range scores in both social competence and behavior problems. A CBCL-derived measure of poor peer relations showed that boys in both clinics had worse ratings than did the girls. A multiple regression analysis showed that poor peer relations were the strongest predictor of behavior problems in both samples. This study—the first cross-national, cross-clinic comparative analysis of children with gender identity disorder—found far more similarities than differences in both social competence and behavior problems. The most salient demographic difference was age at referral. Cross-national differences in factors that might influence referral patterns are discussed.