Cognitive behavioural and neuropsychiatric treatment of post‐traumatic conversion disorder: a case study

Conversion disorder consists of involuntary sensory or motor symptoms and deficits that cannot be explained by a general medical condition. There are several treatment options, although none has emerged as the treatment of choice. The present case study examined the effects of adding cognitive behaviour therapy to neuropsychiatric management of conversion disorder (motor subtype). The patient, a retired emergency services worker, presented with a history of intermittent episodes of speech disruption (inability to speak or difficulty speaking properly). Although episodes of speech disturbance sometimes occurred unexpectedly, they were more likely to occur under conditions of stress and fatigue, and were triggered by reminders of work‐related traumatic events. The patient was treated with pharmacotherapy and psychoeducation from a neuropsychiatrist. With the aim of improving treatment outcome, cognitive behaviour therapy was added, involving imaginal exposure to trauma memories, along with cognitive restructuring. The frequency of between‐ and within‐session speech disturbance episodes declined over the course of cognitive behaviour therapy to the point that the patient was essentially symptom‐free. Within‐session distress ratings also decreased, which suggested habituation to trauma‐related memories. This case study demonstrates how particular cognitive behaviour therapy interventions can be usefully applied to one form of conversion disorder.     

Hopelessness as a Risk Factor for Post‐traumatic Stress Disorder Symptoms Among Interpersonal Violence Survivors

Post‐traumatic stress disorder often co‐occurs with depression, and they may share common risk factors. One possible common cognitive risk factor is hopelessness. Thus, we examined whether hopelessness was related to symptoms of post‐traumatic stress disorder. Participants were 202 female survivors of interpersonal violence. Relationships between self‐reported and interviewer‐rated measures of hopelessness gathered at 2 weeks post‐trauma and self‐reported and interviewer‐rated symptoms of post‐traumatic stress disorder gathered at 2 weeks and 3 months post‐trauma were examined. Hierarchical, simultaneous regression analyses that co‐varied trauma type revealed that hopelessness was related to self‐reported symptoms of post‐traumatic stress disorder, both concurrently and prospectively. Follow‐up analyses revealed that relationships between hopelessness and symptoms of post‐traumatic stress disorder were due almost entirely to shared variance with depression. No relationships were found between hopelessness and interviewer‐rated symptoms of post‐traumatic stress disorder.     

The relationship between interpersonal perception and post‐traumatic stress disorder‐related functional impairment: a social relations model analysis

This study used Kenny's social relations model to examine the relationship between Post‐Traumatic Stress Disorder‐related impairment and interpersonal perceptions. Participants were 124 students who had previously completed the Post‐traumatic Stress Diagnostic Scale as part of a larger study. After engaging in brief dyadic conversations with 3 other students, participants recorded perceptions of personality traits for themselves, their interaction partners and how they believed their partners saw them (metaperceptions). Results indicated that those with more severe post‐traumatic stress disorder‐related impairment saw themselves negatively and believed their interaction partners also viewed them negatively. However, these individuals were not seen differently by others, except that they were rated as less dependable. Our findings suggest that post‐traumatic stress disorder is associated with negative beliefs about the self that may influence self‐esteem and interpersonal relationships.     

Trauma and traumatic neurosis: Freud's concepts revisited

The authors examine Freud 's concepts of 'trauma', 'protective shield against stimuli ' and 'traumatic neurosis' in the light of recent findings. 'Protective shield against stimuli' is regarded as a biological concept which appears in mental life as the striving to avoid unpleasant affects. 'Trauma' is a twofold concept in that it relates to mental experience and links an external event with the specific after-effects on an individual 's psychic reality. A distinction needs to be made between mentally destructive trauma and affective trauma. A destructive trauma does not break through the protective shield but does breach the pleasure-unpleasure principle, so that in the course of its subsequent mastery it leads to a traumatic neurosis. An affective trauma can be warded off under the rule of the pleasure-unpleasure principle and leads to a psychoneurosis.     

SUPPORT FOR A NEUROPSYCHOLOGICAL MODEL OF SPIRITUALITY IN PERSONS WITH TRAUMATIC BRAIN INJURY

Recent research suggests that spiritual experiences are related to increased physiological activity of the frontal and temporal lobes and decreased activity of the right parietal lobe. The current study determined if similar relationships exist between self‐reported spirituality and neuropsychological abilities associated with those cerebral structures for persons with traumatic brain injury (TBI). Participants included 26 adults with TBI referred for neuropsychological assessment. Measures included the Core Index of Spirituality (INSPIRIT); neuropsychological indices of cerebral structures: temporal lobes (Wechsler Memory Scale‐III), right parietal lobe (Judgment of Line Orientation), and frontal lobes (Trail Making Test, Controlled Oral Word Association Test). As hypothesized, spirituality was significantly negatively correlated with a measure of right parietal lobe functioning and positively correlated (nonsignificantly) with measures of left temporal lobe functioning. Contrary to hypotheses, correlations between spirituality and measures of frontal lobe functioning were zero or negative (and nonsignificant). The data support a neuropsychological model that proposes that spiritual experiences are related to decreased activity of the right parietal lobe, which may be associated with decreased awareness of the self (transcendence) and increased activity of the left temporal lobe, which may be associated with the experience of specific religious archetypes (religious figures and symbols).     

The effects of torture‐related stressors on long‐term complex post‐traumatic symptoms in South Korean torture survivors

This study explored whether perceived distress from specific stressors during and after torture explain long‐term complex post‐traumatic symptoms of South Korean torture survivors. We conducted a cross‐sectional survey of survivors who had been tortured by the homeland regime from the 1970s to the 2000s. Data from 206 survivors were gathered by key informants using target sampling and snowballing techniques. Project staff designed scales to encompass the specific types of stressors related to torture techniques used in Korea. Frequencies and distress ratings of exposure to torture, post‐torture psychosocial stressors and physical damage related to torture were gathered. Psychological symptoms were assessed by the Impact of Event Scale‐Revised‐Korean version and subscales of the Symptom Checklist 90‐Revised‐Korean version. Perceived distress from torture stressors was mainly divided into factors representing physical, psychological and deprivation torture by adapting a principal axis factor analysis. Hierarchical regression analyses showed that distress from psychological torture explained post‐traumatic stress disorder (PTSD) and that distress from deprivation explained PTSD and anxiety after controlling for demographic variables, psychological preparedness, time span since torture and distress from trauma other than torture. Among post‐torture stressors, distress from physical damage related to torture and social exclusion were strong indicators of complex symptoms.     

Assessment and treatment of automatically reinforced self‐induced emesis

Frequent emesis can cause substantial deleterious effects to a child's health and environment. We conducted a functional analysis of a 3‐year‐old girl's self‐induced emesis and confirmed that emesis was maintained by automatic reinforcement. In a reversal design, we evaluated the efficacy of implementing response blocking at 100% and 50% treatment integrity levels on both attempts and successful production of emesis. One hundred percent blocking, but not 50% blocking, was successful in reducing attempts and emesis below baseline levels.     

Inconsistencies in the Reporting of Perceived Trauma Severity Among Acute Physical Injury Survivors

This study aimed to identify and predict inconsistency in perceived trauma severity reports over time among trauma survivors. Hospitalized adult survivors of a traumatic injury completed trauma exposure assessments within 40 days post-injury and 6 weeks later (n = 77). The following trauma severity characteristics were examined: (1) threat of loss of life, (2) threat of loss of a body part, (3) threat of serious injury, and (4) peritraumatic emotionality. Potential predictors of inconsistency were also examined. About half of the reports regarding perceived trauma severity characteristics were inconsistent between the baseline to 6-week assessment. The inconsistent reports were mostly small and equally likely to be either more or less severe over time. Increases in posttraumatic stress disorder (PTSD; especially avoidance) predicted increases in severity of life threat and threat of loss of a body part. Thus, acute reports of perceived trauma severity vary and are influenced by PTSD symptoms.     

Posttraumatic Stress Disorder Symptom Severity and Emotion Regulation in Acute-Care Psychiatric Inpatients: Associations With Suicidality

Posttraumatic stress disorder (PTSD) symptomatology has been positively associated with suicidality (suicidal ideation and attempts), but less is known about factors that might exacerbate that association. The present study examined the main and interactive effects of PTSD symptom severity and difficulties in emotion regulation in association with four suicidality outcomes. Participants included 128 adults in an acute-care psychiatric inpatient setting. Results revealed that PTSD symptom severity was significantly incrementally associated with self-reported suicidal ideation (ß = .30, p = .02). Difficulties in emotion regulation were significantly associated with suicide as the reason for current admission (p = .01). The interactive effect of PTSD symptom severity and difficulties in emotion regulation was significant only for self-reported suicidal ideation (ß = .24, p < .001). Participants with high levels of PTSD symptom severity and difficulties in emotion regulation exhibited the highest level of suicidal ideation. Clinical implications and future directions are discussed.