Treatment for Children With Posttraumatic Stress Disorder: Current Status and Future Directions

Although the treatment-efficacy literature for adults with posttraumatic stress disorder (PTSD) has advanced considerably with the publication of several methodologically rigorous contributions during the past decade, the child-focused PTSD literature has yet to extend beyond case illustrations and open trials. Central to this article is a review of the treatment-outcome literature for children with PTSD. Because few treatment studies have targeted trauma-exposed children relative to their adult counterparts, results of some methodologically rigorous investigations with adults are also cited in this review. From these investigations and from the available treatment-outcome data with children, we derive suggestions for future research.     

Eye Movement Desensitization and Reprocessing Treatment for Posttraumatic Stress Disorder

A qualitative review of experimental and quasi-experimental outcome studies of eye movement desensitization and reprocessing (EMDR) treatment for persons with posttraumatic stress disorder (PTSD) suggests that the treatment is effective for civilian but not combat PTSD. The current data indicate that additional research into EMDR's efficacy for PTSD is warranted. Further studies should include comparisons to placebo control procedures and existing validated treatments for PTSD, an adequate treatment dose, systematic efforts to establish and assess treatment integrity and quality, and long-term follow-up data. The therapeutic mechanisms underlying EMDR's observed benefits remain elusive. Whether the eye movement or some other type of stimulation is essential to EMDR's effects cannot be determined from the current data.     

Acupuncture for the Treatment of Adults with Posttraumatic Stress Disorder: A Systematic Review and Meta-Analysis

Acupuncture has been suggested as a treatment for posttraumatic stress disorder (PTSD), yet its clinical effects are unclear. This review aims to estimate effects of acupuncture on PTSD symptoms, depressive symptoms, anxiety symptoms, and sleep quality for adults with PTSD. We searched 10 databases in January 2016 to identify eligible randomized controlled trials (RCTs). We performed random effects meta-analyses and examined quality of the body of evidence (QoE) using the GRADE approach to rate confidence in meta-analytic effect estimates. Seven RCTs with 709 participants met inclusion criteria. We identified very low QoE indicating significant differences favoring acupuncture (versus any comparator) at post-intervention on PTSD symptoms (standardized mean difference [SMD] = ?0.80, 95% confidence interval [CI] [?1.59, ?0.01], 6 RCTs), and low QoE at longer follow-up on PTSD (SMD = ?0.46, 95% CI [?0.85, ?0.06], 4 RCTs) and depressive symptoms (SMD = ?0.56; 95% CI [?0.88, ?0.23], 4 RCTs). No significant differences were observed between acupuncture and comparators at post-intervention for depressive symptoms (SMD = ?0.58, 95% CI [?1.18, 0.01], 6 RCTs, very low QoE), anxiety symptoms (SMD = ?0.82, 95% CI [?2.16, 0.53], 4 RCTs, very low QoE), and sleep quality (SMD = ?0.46, 95% CI [?3.95, 3.03], 2 RCTs, low QoE). Safety data (7 RCTs) suggest little risk of serious adverse events, though some participants experienced minor/moderate pain, superficial bleeding, and hematoma at needle insertion sites. To increase confidence in findings, sufficiently powered replication trials are needed that measure all relevant clinical outcomes and dedicate study resources to minimizing participant attrition.     

Trauma-Informed Treatment Decreases Posttraumatic Stress Disorder Among Women Offenders

Traumatic experiences among women offenders can impact their psychological well-being and patterns of substance use and offending. However, rigorous research in this area for women offenders with a history of trauma is sparse. This study combined data from 2 previous studies of women offenders in order to provide greater statistical power in examining the psychological trends found in the individual studies. Specifically, women in gender-responsive treatment (GRT; n = 135) were compared to women in non-GRT (n = 142) in regard to their change in posttraumatic stress disorder (PTSD) and related symptomatology from baseline to follow-up. The pooled sample of women were predominantly White (58%) or Hispanic (22%), and many had never been married (47%); their mean age was 36 years (SD = 8.9), and, on average, they had 12 years (SD = 1.8) of education. Methamphetamine was their primary drug (71%). Moreover, 55% of the women reported histories of sexual abuse and 37% physical abuse. Finally, 31% had a diagnosis of PTSD. Using generalized estimation equations, we detected significant Group?×?Time interactions in PTSD (odds ratio [OR] = 0.17) and some related symptomatology (reexperiencing: OR = 0.42; and avoidance: OR = 0.24). Given the aggregate impact of trauma in the lives of women offenders, these women, their families, and their communities could benefit from research on how trauma influences their lives and on services that mitigate the negative impact of such histories.     

Posttraumatic Stress Disorder: A Social‐Cognitive Perspective

This study offers a developmentally sensitive conceptual understanding of trauma by viewing posttraumatic stress disorder (PTSD) through the lens of social cognition. First, we justify our focus on social cognition by examining the literature on problematic interpersonal relationships associated with PTSD. Next, we link impaired social cognition to the developmental compromise of mentalizing capacity in attachment relationships. We then integrate the diverse research literature into a social‐cognitive model of the development of PTSD. We finally conclude by suggesting directions for future research, as it might be shaped by trends in social‐cognitive neuroscience.     

Understanding and Treating Complicated Grief: What Can We Learn from Posttraumatic Stress Disorder?

The article outlines possible parallels between the phenomenology and treatment of complicated grief (CG) and posttraumatic stress disorder (PTSD). In particular, it explores how treatment procedures used in Cognitive Therapy for PTSD ( Ehlers & Clark, 2000 ) may be adapted for the treatment of CG. Stimulus Discrimination may be helpful in breaking the link between everyday triggers and "felt presence" memories of the deceased. Memory Updating procedures may help the patient accept that the deceased is no longer alive and no longer suffering. Reclaiming your Life procedures may help the patient access autobiographical memories that are not linked to the deceased and counteract beliefs about the value of life without the deceased. The article further addresses the necessity of specifying the idiosyncratic beliefs that prevent coming to terms with the death, of understanding the relationship between beliefs and coping strategies, and of distinguishing memories from rumination.     

Posttraumatic Stress Disorder and Co‐Occurring Substance Use Disorders: Advances in Assessment and Treatment

Posttraumatic stress disorder (PTSD) and substance use disorders (SUDs) are prevalent and frequently co‐occur. Comorbid PTSD/SUD is associated with a more complex and costly clinical course when compared with either disorder alone, including increased chronic physical health problems, poorer social functioning, higher rates of suicide attempts, more legal problems, increased risk of violence, worse treatment adherence, and less improvement during treatment. In response, psychosocial treatment options have increased substantially over the past decade and integrated approaches—treatments that address symptoms of both PTSD and SUD concurrently—are fast becoming the preferred model for treatment. This article reviews the prevalence, etiology, and assessment practices as well as advances in the behavioral and pharmacologic treatment of comorbid PTSD and SUDs.     

急性应激障碍认知暴露疗法的临床应用

目的：探讨认知暴露疗法对急性应激障碍患者的治疗效果，并比较门诊和住院患者的疗效差别。方法：连续病例33名，分成门诊治疗组和住院治疗组，采用结构化的认知暴露疗法。疗效评定采用SCL-90、BDI、HAMD、STAI和HAMA。结果：在认知暴露治疗前所有患者SCL-90总分及其各因子分、BDI、HAMD、STAI、HAMA总分均显著高于治疗后得分：在治疗次数上，住院组显著高于门诊组，而量表评定总分和各分量表得分在治疗前后差值上门诊组和住院组均无显著性差异。结论：结构化认知行为疗法对ASD患者有效，不脱离住院前生活环境和家人支持的门诊治疗可能更适用于ASD患者。     

Interpersonal Relationships in Panic Disorder With Agoraphobia: A Review of Empirical Evidence

Recently there has been considerable research exploring the interpersonal relationships of patients diagnosed with panic disorder with agoraphobia. In general, recent empirical investigations support the notion that agoraphobics' interpersonal relationships are problematic and can decrease treatment efficacy. In addition, it appears that involving the partner of the agoraphobic in treatment may be more effective than treating the client alone. However, these conclusions are limited by several methodological and conceptual shortcomings, including narrow and/or biased sample selection, lack of adequate measures, and insufficient use of suitable control groups.     

Internet-Based Early Intervention to Prevent Posttraumatic Stress Disorder in Injury Patients: Randomized Controlled Trial

Background

Posttraumatic stress disorder (PTSD) develops in 10-20% of injury patients. We developed a novel, self-guided Internet-based intervention (called Trauma TIPS) based on techniques from cognitive behavioral therapy (CBT) to prevent the onset of PTSD symptoms.

Objective

To determine whether Trauma TIPS is effective in preventing the onset of PTSD symptoms in injury patients.

Methods

Adult, level 1 trauma center patients were randomly assigned to receive the fully automated Trauma TIPS Internet intervention (n=151) or to receive no early intervention (n=149). Trauma TIPS consisted of psychoeducation, in vivo exposure, and stress management techniques. Both groups were free to use care as usual (nonprotocolized talks with hospital staff). PTSD symptom severity was assessed at 1, 3, 6, and 12 months post injury with a clinical interview (Clinician-Administered PTSD Scale) by blinded trained interviewers and self-report instrument (Impact of Event Scale—Revised). Secondary outcomes were acute anxiety and arousal (assessed online), self-reported depressive and anxiety symptoms (Hospital Anxiety and Depression Scale), and mental health care utilization. Intervention usage was documented.

Results

The mean number of intervention logins was 1.7, SD 2.5, median 1, interquartile range (IQR) 1-2. Thirty-four patients in the intervention group did not log in (22.5%), 63 (41.7%) logged in once, and 54 (35.8%) logged in multiple times (mean 3.6, SD 3.5, median 3, IQR 2-4). On clinician-assessed and self-reported PTSD symptoms, both the intervention and control group showed a significant decrease over time (P<.001) without significant differences in trend. PTSD at 12 months was diagnosed in 4.7% of controls and 4.4% of intervention group patients. There were no group differences on anxiety or depressive symptoms over time. Post hoc analyses using latent growth mixture modeling showed a significant decrease in PTSD symptoms in a subgroup of patients with severe initial symptoms (n=20) (P<.001).

Conclusions

Our results do not support the efficacy of the Trauma TIPS Internet-based early intervention in the prevention of PTSD symptoms for an unselected population of injury patients. Moreover, uptake was relatively low since one-fifth of individuals did not log in to the intervention. Future research should therefore focus on innovative strategies to increase intervention usage, for example, adding gameplay, embedding it in a blended care context, and targeting high-risk individuals who are more likely to benefit from the intervention.

Trial Registration

International Standard Randomized Controlled Trial Number (ISRCTN): 57754429; http://www.controlled-trials.com/ISRCTN57754429 (Archived by WebCite at http://webcitation.org/6FeJtJJyD).     

Prevention of Anxiety Psychopathology: A Critical Review of the Empirical Literature

The empirical literature on prevention programs for anxiety psychopathology is reviewed. Programs targeting the prevention of nonspecific anxiety psychopathology as well as specific anxiety disorders are critically evaluated in the context of the Institute of Medicine's conceptualization of universal, selected, and indicated prevention. General conclusions embedded within contemporary models of prevention are discussed in order to outline future directions for the area in terms of methodological and conceptual issues.     

Culturally Competent Treatment of Posttraumatic Stress Disorder in Clinical Practice: An Ideographic, Transcultural Approach

Cultural context is a relevant factor in understanding the development, maintenance, and treatment of posttraumatic stress disorder (PTSD). Evidence suggests that the reexperiencing and arousal symptoms of PTSD represent a universal response to trauma observable across many ethnocultural groups. Variation in the expression of this response may be related to the influence of culture on the avoidance and numbing reactions to trauma. Thus, a central challenge for culturally competent treatment of PTSD does not appear to be whether to utilize empirically supported treatments for PTSD, but rather how to effectively engage individuals of various cultures in these interventions and how to address ethnocultural sources of avoidance in the maintenance of PTSD. The enormity of cultural diversity, however, presents a challenge to the task of adapting and empirically testing empirically supported treatments. An ideographic transcultural approach to cultural competency is proposed.     

Factors Associated with Treatment Outcomes in Mindfulness-Based Cognitive Therapy for Panic Disorder

Purpose

Although the effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) for panic disorder (PD) has been studied previously, data on the predictors of treatment outcomes in MBCT for PD are scarce.

Materials and Methods

Eighty patients with PD were screened to analyze treatment outcomes such as MBCT completion, treatment response, and remission after undergoing MBCT for PD. Sociodemographic characteristics, comorbid personality disorders, and baseline medication doses were examined. The study administered the Panic Disorder Severity Scale, Hamilton Anxiety Rating Scale, Hamilton Depression Rating Scale and Anxiety Sensitivity Inventory-Revised to patients at baseline and at eight weeks.

Results

Sixty-five participants were enrolled in the present study. Comorbid personality disorder was significantly associated with MBCT non-completion. We found that anxiety sensitivity (AS) improvement after an eight week MBCT program was a statistically significant factor associated with treatment response. Using logistic regression analysis, AS improvement after MBCT showed significant association with PD remission after MBCT.

Conclusion

Comorbid personality disorders of participants could be a potential predictor of MBCT non-completion. Furthermore, AS improvement after MBCT may predict treatment response and remission after MBCT for PD. However, better designed studies with a larger number of patients are needed to confirm our findings.