Beyond Fear Emotional Memory Mechanisms in the Human Brain

ABSTRACT— Neurobiological accounts of emotional memory have been derived largely from animal models investigating the encoding and retention of memories for events that signal threat. This literature has implicated the amygdala, a structure in the brain's temporal lobe, in the learning and consolidation of fear memories. Its role in fear conditioning has been confirmed, but the human amygdala also interacts with cortical regions to mediate other aspects of emotional memory. These include the encoding and consolidation of pleasant and unpleasant arousing events into long-term memory, the narrowing of focus on central emotional information, the retrieval of prior emotional events and contexts, and the subjective experience of recollection and emotional intensity during retrieval. Along with other mechanisms that do not involve the amygdala, these functions ensure that significant life events leave a lasting impression in memory.     

Heart rate during group flooding therapy for PTSD

The objective of this study was to assess, via heart rate, the arousal levels of participants in group trauma reexposure therapy for posttraumatic stress disorder, and so to better understand this common mode of treatment, particularly in regards to its presumed curative factor, extinction. Six Vietnam combat-related PTSD inpatients participated twice weekly in group trauma reexposure therapy during which their electrocardiograms were recorded. Heart rate was quantified continuously off-line. Heart rates of participantsnot directly engaged in imaginal reexposure to their personal combat traumas consistently exhibited mild linear declines from the beginnings to the ends of the approximately 2.5 hour sessions. Participants actively engaged in personal combat trauma reexposure exhibited higher whole-session heart rates. Most also exhibited more specific elevation extending over the later portions of therapy sessions during which intensive reexposure usually occurred. Surprisingly, no patients exhibitedfocal increases in heart rate concurrent with periods of most intensive traumatic incident review as judged from videotape. Administering imaginal reexposure in a group context does not preclude substantial physiological (sympathetic) arousal, as is preconditional for extinction. Under conditions in which the actively engaged reexposure patient is reliably identified, group trauma reexposure therapy may not provide an opportunity for “vicarious” flooding in nonengaged participants.     

Adapting Cognitive Processing Therapy to Treat Co-Occurring Posttraumatic Stress Disorder and Mild Traumatic Brain Injury: A Case Study

This case study aims to provide evidence for the effectiveness of adapting a particular manualized cognitive behavioral therapy intervention to treat co-occurring posttraumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI). This study presents the treatment of a woman who experienced co-occurring mTBI and PTSD following a motor vehicle accident, a dual diagnosis that was established through a flexible assessment approach involving interviews as well as standardized psychological, neuropsychological, and neurobehavioral testing. Treatment planning led to a-priori adaptation of Cognitive Processing Therapy (CPT) to treat both her PTSD symptoms and the sequelae associated with her mTBI. The therapist maintained fidelity to the manualized structure and content of CPT protocol, adapting portions of the treatment to add specific emphasis on issues of identity confusion and role loss in service of addressing these common functional impairments that can accompany mTBI. Discussion focuses on application of CPT for future treatment of comorbid PTSD and TBI amidst complicating factors, including role losses and medical and safety issues. This case study is especially relevant due to the prevalence of co-occurring PTSD and TBI across a variety of populations.     

Exposure to Traumatic Events and PTSD in a Postconflict and Disaster-Prone Area

The present study examines lifetime exposure to traumatic events and the rate of PTSD among university students living in a postconflict and disaster-prone area. Two self-report questionnaires, namely the Life Events Checklist and a PTSD screening tool, were used in the study. PTSD was found in 21% of respondents. Approximately 96% of the respondents have been exposed to traumatic events during their lifetime. Both genders have the same rate of PTSD (p?=?0.9) and exposure to traumatic events (p?=?0.327). Findings suggest that lifetime exposures to traumatic events are high among students living in this region.     

A review of social disinhibition after traumatic brain injury

Acquired social disinhibition refers to a debilitating behavioural syndrome commonly reported after a severe traumatic brain injury (TBI) and is characterized by inappropriate social behaviour, often described as immaturity and insensitivity towards others. These behaviours can have enduring effects on the social capability of the individual and their relationships with others. However, research into socially disinhibited behaviour after TBI has been thwarted by a lack of consensus in the literature on definition and measurement. This review provides an overview of our current understanding of the definition, measurement, prevalence, associated outcomes, neuropathology, and underlying mechanisms of social disinhibition after TBI. In addition, suggestions are made for future research to further our understanding of this syndrome with the eventual aim of rehabilitating problematic behaviours. It is concluded that an improved understanding of what causes disinhibited behaviour after TBI will be necessary for the development of effective treatment strategies aimed at the rehabilitation of underlying impairments.     

震后一年半灾区小学生的创伤症状调查研究——以“八一帐篷学校”为例

本研究对总装备部·绵阳八一帐篷学校的小学生进行创伤症状调查研究,了解震后一年半小学生的心理健康状况。方法:使用儿童创伤症状量表简版(TSCC-A)对八一帐篷学校3～6年级小学生进行评估。结果:(1)八一帐篷学校的小学生震后一年半最为突出的创伤症状是焦虑,其次为抑郁和分离症状;(2)在创伤症状得分上不存在性别差异性,但是存在年级差异性,三年级学生创伤症状得分均低于其他年级学生;(3)震后一年半学生创伤症状比震后半年学生创伤症状有所减轻。结论:灾区小学生心理健康状况仍存在一些问题,焦虑、抑郁等症状仍比较明显,还应进行持续的心理危机干预。     

Depression Following Traumatic Brain Injury: The Validity of the CES-D as a Brief Screening Device

The validity, reliability, and factor structure of the Center for Epidemiological Studies-Depression Scale (CES-D) was examined with 253 patients seen for neuropsychological evaluation following traumatic brain injury (TBI). All patients completed the CES-D; 31 also completed the Beck Depression Inventory (BDI) and 17 completed the Minnesota Multiphasic Personality Inventory-II (MMPI-II). The CES-D demonstrated good concurrent, construct validity, significantly correlating with the BDI (r = .673, p < .0001) and the MMPI-II (Depression Scale T score r = .536, p = .027). The CES-D also demonstrated good internal consistency (coefficient alpha = .8195) and split-half reliability (Spearman–Brown r = .8284). Principal components factor analysis with varimax rotation resulted in a four-factor solution that accounted for 56.01% of the variance. The factor structure differed from the originally reported factor structure, and indicated that somatic difficulties were strongly associated with dysphoric affect in TBI patients. The CES-D is a valid and reliable screening instrument for use with TBI patients.     

Secondary traumatic stress and adjustment in therapists who work with sexual violence survivors: the moderating role of posttraumatic growth

ABSTRACT

Due to their secondary exposure to the traumatic events disclosed by clients, therapists who work with sexual violence survivors are at risk of experiencing secondary traumatic stress. We examined whether the negative effects of secondary traumatic stress on therapist adjustment would be buffered by posttraumatic growth. Sixty-one therapists who work with sexual violence survivors completed measures of secondary traumatic stress, posttraumatic growth and a range of adjustment indicators. Hierarchical multiple regression analyses demonstrated that posttraumatic growth moderated the negative impact of secondary traumatic stress on therapist depression, anxiety, personal meaning and satisfaction with life. Posttraumatic growth sustained positive affect through a direct effects model only. This study provides support for the protective role of posttraumatic growth in adjustment to secondary traumatic stress.