创伤暴露程度对青少年物质滥用的影响：创伤后应激障碍与依恋的中介作用

为了考察汶川地震后青少年的创伤暴露程度、创伤后应激障碍（PTSD）、父母依恋和同伴依恋与物质滥用之间的关系,采用创伤暴露程度问卷、儿童创伤后应激障碍症状量表、父母与同伴依恋问卷和物质滥用问卷对汶川县和茂县的1435名中学生进行调查,选取有物质滥用的青少年354名作为本研究的对象。结果发现：创伤暴露程度可以直接正向预测作用物质滥用。不过,在创伤暴露与物质滥用直接关系之间加入PTSD、父母和同伴依恋之后,创伤暴露程度对物质滥用的直接预测作用不再显著,并且创伤暴露程度不能通过同伴依恋预测物质滥用,也不能通过PTSD经同伴依恋对物质滥用发挥多重中介作用;但创伤暴露程度能通过PTSD正向预测物质滥用,可以通过父母依恋负向预测物质滥用,并且创伤暴露程度还可以通过PTSD经过父母依恋对物质滥用发挥正向的多重中介作用。     

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 After Traumatic Brain Injury: A Review of Evidence for Clinical Heterogeneity

Depression represents a major source of disability among individuals who have suffered a traumatic brain injury (TBI), with estimates of prevalence in this population ranging over 50%. In comparison with other sequelae of TBI, depression is often poorly conceptualized and treated among acute care and rehabilitation professionals. One reason for this is the lack of clear etiological models for the development of depression following TBI. This paper argues that post-TBI depression actually represents a heterogeneous category, with multiple etiologic pathways and clinical implications. The literature in this area is reviewed, with an emphasis on an appreciation of the diversity within this clinical population. Conclusions focus on suggestions for differential diagnosis and treatment options.     

False memory,attentional bias and future thinking among people living with HIV with posttraumatic stress disorder

People living with HIV can experience posttraumatic stress disorder (PTSD). Complex relationships exist between HIV, PTSD and cognitive impairments. This cross-sectional study compared three cognitive impairments (false memory, attentional bias, deficits in future thinking) among people living with HIV with and without PTSD in Iran. People living with HIV with PTSD (n = 20) and without PTSD (n = 20) completed measures of psychological symptomatology, dot-probe task, Deese Roediger McDermott paradigm and future thinking task at Razavi Khorasan Health Center. The PTSD group, when compared to the non-PTSD group, recognised a significantly greater number of false memories (p < .001; η² = .58), had an attentional bias toward threat-related words (p < .001; η² = .35) and imagined fewer specific future events (p < .001; η² = .31). People living with HIV with PTSD may have difficulties with false memory, attentional biases, and generating future events. Since psychological treatments are limited in Iran, this research highlighted some potential cognitive targets for people living with HIV.     

Psychobiological Treatment Response to a Two-Week Posttraumatic Stress Disorder and Mild Traumatic Brain Injury Integrated Treatment Program: A Case Report

Posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) demonstrate high prevalence and comorbidity among post-9/11 veterans. Veterans with this comorbidity often present with multiple co-occurring healthcare needs and increased clinical complexity. The current case report describes the clinical presentation of a veteran with mild TBI and PTSD, both before, during, and after treatment within a multidisciplinary 2-week intensive outpatient program involving prolonged exposure, evidence-based PTSD treatment, and Cognitive Symptom Management and Rehabilitation Therapy, evidence-based treatment for postconcussive symptoms. Mr. A was a 25-year-old White, transgender male who presented with a complex mental health history. At intake, presenting complaints included anxiety, panic attacks, nightmares, and depression secondary to military sexual trauma, as well as reported cognitive difficulties secondary to a concussion. He met current criteria for PTSD as well as panic disorder with agoraphobia. Head injury history consisted of a motor vehicle collision with less than 30 seconds loss of consciousness, brief posttraumatic amnesia, and alterations of consciousness. Mr. A demonstrated habituation during individual exposure sessions as assessed via skin conductance during imaginal exposures and decreased subjective ratings during in vivo exposures, as well as a decrease in trauma-potentiated startle response to trauma cues. Posttreatment data indicates significant reduction in neurobehavioral, posttraumatic stress, and depression symptoms and significant improvement in subjective cognitive functioning. The current findings support the feasibility and efficacy of short-term integrated treatment for complex clinical presentations and the need for larger scale research investigating combined PTSD and TBI intervention.     

Temporal Associations Between Posttraumatic Stress Symptoms and Depression in Response to Online Expressive Writing Interventions in a Hispanic Sample

Some expressive writing (EW) interventions targeting posttraumatic stress symptoms (PTSS) may reduce both PTSS and comorbid depression symptoms. The temporal associations between PTSS and depression symptom levels in response to EW interventions are unknown. This study examined the directionality of PTSS and depression symptom levels from baseline to 1-week, 1-month, and 3-month follow-ups of two online EW interventions in a Hispanic sample with diverse trauma experiences. Participants (n = 70) completed either emotion-focused or fact-focused writing for 3 consecutive days online. A manifest autoregressive model with cross-lagged effects and treatment condition was analyzed. All but one first-order autoregressive path were statistically significant, with later PTSS and depression scores significantly predicted by those scores at preceding time points. The cross-lagged effects findings suggest that earlier PTSS levels influenced later depression levels, but earlier depression did not influence later PTSS, demonstrating a unidirectional temporal association. Severe PTSS may hinder EW treatment gains in depression. Superior outcomes for emotion-focused writing relative to fact-focused writing were also found.     

The Shattering of the Stimulus Barrier: The Case for an Integrative Approach in Short-Term Treatment of Psychological Trauma

The paper argues that the integrative psychotherapy approach is ideally suited to the treatment of psychological trauma. A brief term intervention model, devised by psychotherapists working with trauma in the South African context, is presented to illustrate this premise. It is asserted that posttraumatic stress represents a disorder in which dysfunction occurs both internally and externally, according to Freud at the interface of these two aspects of psychological functioning, i.e., at the ego boundary. Disturbance manifests in recognizable cognitive, behavioral, and somatic symptoms and in addition carries unconscious associations and anxieties. The ideal approach to treatment thus appears to be to draw on the relative strengths of both the psychodynamic and cognitive-behavioral schools. Existing trauma intervention models reflect the centrality of integration in many respects, although this does not seem to be explicitly recognized. The five components of the model referred to above are outlined and each component is explored in terms of its efficacy within both a cognitive-behavioral and a psychodynamic framework. Illustrative case material is provided to demonstrate the mechanisms at work in each case. The paper argues that the clinical success of the model lies in its integrative perspective and that psychotherapy integration should be recognized as the approach of choice in the treatment of traumatized individuals.