Relationships between self‐consistency,trauma‐centred identity,and post‐traumatic adjustment

Background: Post‐traumatic stress disorder (PTSD) models suggest that trauma‐centred self‐change is motivated by self‐consistency. Aim: The objective of this study was to investigate the relationships between self‐consistency, trauma‐centred identity, and PTSD symptoms. Method: University students (n = 134) completed measures of trauma‐centred identity (Centrality of Events Scale), self‐consistency, and post‐traumatic stress symptoms (Impact of Events Scale—Revised, Centre for Epidemiological Studies—Depression Scale). Results: A significant positive correlation was found between trauma‐centred identity and post‐traumatic symptoms. However, self‐consistency was not related to post‐traumatic symptoms or trauma‐centred identity. Given the relationship between depressive symptoms and self‐consistency, the correlations were also conducted controlling for depression. When the effects of depressive symptoms were partialled out, both self‐consistency and trauma‐centred identity were positively correlated with intrusion symptoms. Discussion and Conclusion: The implications for PTSD models, which suggest self‐change is motivated by self‐consistency, are discussed and implications for clinical treatments are considered.     

Insomnia symptoms predict the development of post‐traumatic stress symptoms following an experimental trauma

Insomnia symptoms prior to traumatic event exposure predict the development of post‐traumatic stress symptoms. However, potential mechanisms underlying the association between insomnia and risk for post‐traumatic stress disorder symptoms have not been prospectively tested. The current study used the trauma film paradigm to test whether insomnia symptoms prior to analogue trauma exposure predict subsequent analogue post‐traumatic stress disorder symptoms, and potential mediators of this relationship, among an at‐risk sample of 108 participants. Results indicated that, after covarying for negative affectivity, insomnia symptoms in the 2 weeks prior to analogue trauma exposure significantly predicted increased post‐traumatic stress disorder symptoms 3 days and 1 week post‐exposure. Moreover, distress immediately after exposure and post‐traumatic avoidance mediated the association between insomnia symptoms and post‐traumatic stress disorder symptoms 1 week after exposure. Effect sizes were small. The current study uses an analogue trauma and analogue post‐traumatic stress disorder symptoms to model clinical symptoms, includes an additional intervention prior to analogue trauma, and lacks a control film. Findings suggest increased reactivity to trauma exposure and subsequent reminders, and attempts to suppress trauma memories may be mechanisms in the association between insomnia symptoms and risk for post‐traumatic stress disorder symptoms.     

Derealization and self‐harm strategies are used to regulate disgust,fear, and sadness in adult survivors of childhood sexual abuse

Emotion regulation (ER) difficulties have been identified as an important target for clinical intervention in the treatment of post‐traumatic stress disorder (PTSD) symptoms in survivors of childhood sexual abuse (CSA). However, there is limited research regarding the use of specific strategies to regulate specific emotions following exposure to traumatic events. The aim of the current study was to investigate the indirect effects of four trauma‐related emotions (anger, sadness, disgust, and fear) on PTSD severity via two mediators: derealization and self‐harm. In particular, we tested that if the two hypothetical mediators operate sequentially, derealization precedes self‐harm and/or self‐harm precedes derealization. A predominate female clinical sample (N = 109) of CSA survivors completed measures of experience of emotions, ER, and post‐traumatic stress. Bivariate and serial mediation analyses were conducted to test the direct and indirect effects of trauma‐related emotions on PTSD severity. Serial mediation analyses indicated that there were significant total effects of all trauma‐related emotions on PTSD severity. Three trauma‐related emotions (sadness, disgust, and fear) were indirectly associated to PTSD severity via derealization and self‐harm and via self‐harm and derealization. Results indicate that difficulties in regulating the emotions of sadness, disgust, and fear may result in more severe derealization and self‐harm as coping strategies, which in turn lead to greater PTSD severity. The sequence of mediators does not hold great importance in these pathways. Overall, our findings suggest that therapeutically targeting derealization and self‐harm might enable the reduction of PTSD among CSA survivors.     

PTSD after traumatic injury: an investigation of the impact of injury severity and peritraumatic moderators

Presence of injury is often examined as a risk factor for posttraumatic stress disorder (PTSD); however, results have been mixed regarding the relationship between injury severity and PTSD symptoms (PTSS). The present study examined subjective and objective injury severity ratings in traumatic injury victims to determine if they differentially predict PTSS. Results demonstrated that subjective, not objective, injury severity predicted PTSS at six weeks and three months post-trauma. The moderating impact of peritraumatic factors was also examined. Peritraumatic dissociation moderated the impact of subjective injury severity on PTSS. Findings indicate that subjective injury severity should be incorporated into early screeners for PTSD risk.     

The relationship of sociotropy and autonomy to posttraumatic cognitions and PTSD symptomatology in trauma survivors

The current study examined relationships between sociotropic and autonomous personality styles and posttraumatic stress disorder (PTSD) symptomatology following trauma as well as specific posttraumatic cognitions that have been shown to characterize individuals with PTSD. Self-report data were collected in a sample of 156 college students indicating a history of traumatic experience. Significant relationships were found between symptoms of PTSD and depression and measures of sociotropy, autonomy, and negative posttraumatic beliefs about self and world. Additionally, measures of autonomy and negative posttraumatic thoughts improved prediction of PTSD symptom level after controlling for depressive symptoms.     

Expressive writing and post‐traumatic stress disorder: Effects on trauma symptoms,mood states,and cortisol reactivity

Objectives. This study investigates the boundary conditions (feasibility, safety, and efficacy) of an expressive writing intervention for individuals with post‐traumatic stress disorder [PTSD]. Design. Randomized trial with baseline and 3‐month follow‐up measures of PTSD severity and symptoms, mood states, post‐traumatic growth, and (post‐only) cortisol reactivity to trauma‐related stress. Methods. Volunteers with a verified diagnosis of PTSD (N = 25) were randomly assigned to an experimental group (writing about their traumatic experience) or control group (writing about time management). Results. Expressive writing was acceptable to patients with PTSD and appeared safe to utilize. No changes in PTSD diagnosis or symptoms were observed, but significant improvements in mood and post‐traumatic growth were observed in the expressive writing group. Finally, expressive writing greatly attenuated neuroendocrine (cortisol) responses to trauma‐related memories. Conclusions. The present study provides insight into several boundary conditions of expressive writing. Writing did not decrease PTSD‐related symptom severity. Although patients continue to exhibit the core features of PTSD, their capacity to regulate those responses appears improved following expressive writing. Dysphoric mood decreased after writing and when exposed to traumatic memories, participants' physiological response is reduced and their recovery enhanced.     

Memory performance and dysfunctional cognitions in recent trauma victims and patients with post‐traumatic stress disorder

In order to investigate whether cognitive dysregulation contributed to memory impairment in trauma patients, recent trauma victims, post‐traumatic stress disorder (PTSD) patients and healthy controls were compared with regard to verbal memory and dysfunctional cognitions. There were no significant group differences with regard to verbal memory. Concerning dysfunctional cognitions, recent trauma victims hardly differed from controls, unlike PTSD patients, who showed more negative appraisal, more dysfunctional thought control strategies and externality than controls. None of them were related to memory performance in the recent trauma group, and there was a negative correlation with distraction strategy in PTSD patients. In recent trauma victims, negative appraisal increased with time since the trauma. Copyright © 2007 John Wiley & Sons, Ltd.     

Predictors of insomnia symptoms and nightmares among individuals with post‐traumatic stress disorder: an ecological momentary assessment study

Despite the high levels of comorbidity between post‐traumatic stress disorder (PTSD) and sleep disturbance, little research has examined the predictors of insomnia and nightmares in this population. The current study tested both PTSD‐specific (i.e. PTSD symptoms, comorbid anxiety and depression, nightmares and fear of sleep) and insomnia‐specific (i.e. dysfunctional beliefs about sleep, insomnia‐related safety behaviours and daily stressors) predictors of sleep quality, efficiency and nightmares in a sample of 30 individuals with PTSD. Participants participated in ecological momentary assessment to determine how daily changes in PTSD‐ and insomnia‐related factors lead to changes in sleep. Multi‐level modelling analyses indicated that, after accounting for baseline PTSD symptom severity, PTSD‐specific factors were associated with insomnia symptoms, but insomnia‐specific factors were not. Only daytime PTSD symptoms and fear of sleep predicted nightmares. Both sleep‐ and PTSD‐related factors play a role in maintaining insomnia among those with PTSD, while nightmares seem to be linked more closely with only PTSD‐related factors.     

Sex dependent influence of a functional polymorphism in steroid 5‐α‐reductase type 2 (SRD5A2) on post‐traumatic stress symptoms

A non‐synonymous, single nucleotide polymorphism (SNP) in the gene coding for steroid 5‐α‐reductase type 2 (SRD5A2) is associated with reduced conversion of testosterone to dihydrotestosterone (DHT). Because SRD5A2 participates in the regulation of testosterone and cortisol metabolism, hormones shown to be dysregulated in patients with PTSD, we examined whether the V89L variant (rs523349) influences risk for post‐traumatic stress disorder (PTSD). Study participants (N = 1,443) were traumatized African‐American patients of low socioeconomic status with high rates of lifetime trauma exposure recruited from the primary care clinics of a large, urban hospital. PTSD symptoms were measured with the post‐traumatic stress symptom scale (PSS). Subjects were genotyped for the V89L variant (rs523349) of SRD5A2. We initially found a significant sex‐dependent effect of genotype in male but not female subjects on symptoms. Associations with PTSD symptoms were confirmed using a separate internal replication sample with identical methods of data analysis, followed by pooled analysis of the combined samples (N = 1,443, sex × genotype interaction P < 0.002; males: n = 536, P < 0.001). These data support the hypothesis that functional variation within SRD5A2 influences, in a sex‐specific way, the severity of post‐traumatic stress symptoms and risk for diagnosis of PTSD. © 2013 Wiley Periodicals, Inc.     

Driving cognitions,rumination, and posttraumatic stress disorder in road traffic accidents survivors

This study evaluated the relationships between driving cognitions (i.e., panic‐related cognitions, accident‐related cognitions, and social‐related cognitions), rumination, and posttraumatic stress disorder (PTSD) symptoms in a sample of road traffic accidents (RTAs) survivors. We also investigated the indirect effect of driving cognitions on PTSD symptoms through rumination. The sample included 633 drivers (62% were men; Mage = 36.09; standard deviation [SD] = 11.42 years). The participants completed scales measuring driving cognitions, rumination, and PTSD symptoms, as well as providing their demographic information. The results showed that all three types of driving cognitions assessed in the present study and rumination were significantly positively associated with PTSD symptoms. Furthermore, rumination mediated the relation between social‐related cognitions and PTSD symptoms. The implications for PTSD treatment and future research are discussed.     

Pain in the aftermath of trauma is a risk factor for post-traumatic stress disorder

BACKGROUND: Identifying risk factors for the development of post-traumatic stress disorder (PTSD) is important for understanding and ultimately preventing the disorder. This study assessed pain shortly after traumatic injury (i.e. peritraumatic pain) as a risk factor for PTSD.METHOD: Participants (n=115) were patients admitted to a Level 1 Surgical Trauma Center. Admission to this service reflected a severe physical injury requiring specialized, emergent trauma care. Participants completed a pain questionnaire within 48 h of traumatic injury and a PTSD diagnostic module 4 and 8 months later. RESULTS: Peritraumatic pain was associated with an increased risk of PTSD, even after controlling for a number of other significant risk factors other than acute stress disorder symptoms. An increase of 0.5 s.d. from the mean in a 0-10 pain rating scale 24-48 h after injury was associated with an increased odds of PTSD at 4 months by more than fivefold, and at 8 months by almost sevenfold. A single item regarding amount of pain at the time of hospital admission correctly classified 65% of participants. CONCLUSIONS: If these findings are replicated in other samples, high levels of peritraumatic pain could be used to identify individuals at elevated risk for PTSD following traumatic injury.     

Assessing the existence of dissociative PTSD in sub-acute patients of whiplash

Numerous studies investigating dissociative posttraumatic stress disorder (D-PTSD) have emerged. However, there is a lack of studies investigating D-PTSD following a wider range of traumatic exposure. Thus, the present study investigates D-PTSD using latent class analysis (LCA) in sub-acute patients of whiplash and associated risk factors. The results of LCA showed a three-class solution primarily distributed according to posttraumatic stress disorder (PTSD) symptom severity and thus no indication of D-PTSD. Dissociative symptoms, psychological distress (i.e. anxiety/depression), and pain severity significantly predicted PTSD severity. Combined, the results support the component model of dissociation and PTSD, while still stressing the importance of dissociative symptoms when planning treatment for PTSD.     

A preliminary study of negative appraisals and dysfunctional coping associated with post‐traumatic stress disorder symptoms following myocardial infarction

Objectives . To investigate associations between post‐traumatic stress disorder (PTSD) symptoms following myocardial infarction (MI) and subjective experience of MI, negative perception of consequences, negative appraisals of symptoms, and use of dysfunctional coping strategies, as described by Ehlers and Clark's (2000) model of PTSD. Design . Cross‐sectional questionnaire study of people who experienced a MI within the previous 12 weeks (N = 74; 51% response rate). Methods . Participants completed questionnaires assessing PTSD symptoms, subjective experience of MI, perception of consequences, appraisal of symptoms, and dysfunctional coping strategies. Results . Of the participants, 16% met DSM‐IV criteria for PTSD and a further 18% reported moderate to severe PTSD symptoms. People with PTSD symptoms also had more somatic symptoms, anxiety, depression, and social dysfunction. PTSD symptoms were associated with perceived severity and danger of MI, a history of psychological problems, previous trauma, negative appraisal of symptoms, perceived severe consequences, and dysfunctional coping strategies. These variables were entered into a regression with MI and past history variables on Step 1, and appraisal and coping variables on Step 2. This showed that perceived consequences and dysfunctional coping were strongly associated with PTSD symptoms after controlling for MI and past history variables. Conclusion . The results of this preliminary study suggest perception of consequences and dysfunctional coping may be important in PTSD symptoms following MI.     

The role of shame and self‐critical thinking in the development and maintenance of current threat in post‐traumatic stress disorder

There is increasing recognition of emotions other than fear in post‐traumatic stress disorder (PTSD), and recent research has looked at the role of shame. Cognitive theory suggests that PTSD is caused by traumatic experiences being processed in a way that causes ongoing current threat. In this paper we suggest that shame might contribute to the creation/maintenance of ongoing current threat as it attacks an individual's psychological integrity. A correlational design was used to investigate some of the factors that might contribute to a shame response within a PTSD sample. It was hypothesized that individuals with PTSD who report higher levels of shame would be more prone to engage in self‐critical thinking and less prone to engage in self‐reassuring thinking than individuals with PTSD who report lower levels of shame. Data were gathered using self‐report questionnaires, and results supported the hypotheses. It is suggested therapy for shame‐based PTSD needs to incorporate strategies to help individuals develop inner caring, compassion and self‐reassurance. Copyright © 2009 John Wiley & Sons, Ltd. Key Practitioner Message: ? Some individuals with PTSD report high levels of shame. ? High levels of shame are associated with high levels of self‐critical thinking and low levels of self‐reassuring thinking. ? Therapy for shame‐based PTSD needs to incorporate strategies that help individuals develop inner caring, compassion and self‐reassurance.     

Application of a chronic illness model as a means of understanding pre‐operative psychological adjustment in coronary artery bypass graft patients

Objectives. To increase understanding of the factors associated with pre‐operative psychological adjustment in coronary artery bypass graft (CABG) patients by assessing the utility of a chronic illness model developed by Scharloo, Kaptein, Weinman, Willems, and Rooijmans (2000) . Design. A cross‐sectional design was employed. Method. Elective CABG patients (N = 119) completed self‐report measures of illness representation, self‐rated health, social support, coping methods, and pre‐operative adjustment (depression and post‐traumatic stress disorder (PTSD) symptomatology) an average of 30 days prior to surgery. Hierarchical multiple regression was used to assess the mediational relationships proposed by the chronic illness model. Results. Five 3‐variable mediational chains were assessed. In all instances, the results conformed to the relationships suggested by the chronic illness model where the strength of the relationship between the independent and dependent variables was reduced when the mediator variable was controlled. However, a significant reduction of this relationship was found in three of the five chains examined. The most rigorous support for the model occurred, where increased use of avoidance coping mediated the relationship between poorer self‐rated health and increased PTSD symptomatology, and also where increased use of avoidance coping partially mediated the relationship between a more negative illness representation and increased PTSD symptomatology, and poorer self‐rated health and increased depression. Conclusions. The chronic illness model of Scharloo and colleagues shows potential in explaining pre‐operative adjustment in CABG patients. Longitudinal examination of the model is recommended.     

Late-onset PTSD in unaccompanied refugee minors: exploring the predictive utility of depression and anxiety symptoms

Following resettlement in Western countries, unaccompanied refugee minors (URM) are at risk of developing posttraumatic stress disorder (PTSD). It is unclear to what extent PTSD in this group may become manifest at later stages following resettlement and which factors are associated with late onset. We examined data from URM collected 1 (T1) and 2 years (T2) following resettlement for differences between groups with no PTSD, PTSD at T1, and late-onset PTSD (at T2 only) using multinomial regression and path analysis. Of the children and adolescents (ages 12-18) completing both assessments (N = 554), 223 (40%) met criteria for PTSD at T1, and 88 (16%) endorsed late-onset PTSD. Late-onset PTSD was associated with traumatic event exposure, older age, and low education. In the late-onset PTSD group, the predictive effects of traumatic event exposure on symptom severity at T2 were fully mediated by depression and anxiety symptoms at T1. These results suggest that late-onset PTSD is a clinically relevant problem among URM that may be heralded by early depression and anxiety symptoms.     

Treatment of post‐traumatic stress disorder in children using cognitive behavioural writing therapy

Objectives: This study evaluated the effectiveness of Cognitive Behavioral Writing Therapy (CBWT) in 23 children (age 8–18 years) in the Netherlands, who experienced a range of single and recurrent traumatic experiences. CBWT uses exposure, cognitive restructuring and social sharing. Methods: At pre‐test, post‐test and follow‐up, post‐traumatic stress disorder (PTSD) symptoms, depressive symptoms, trauma‐related cognitions and general behavioural problems were assessed. Results: At post‐test there was a significant reduction of all symptoms, and this effect was maintained at 6 months follow‐up. The mean amount of treatment sessions needed was 5.5. Conclusions: This study shows that short‐term CBWT is a potentially effective intervention for clinically referred traumatized children. There is now a clear need of establishing the effectiveness of CBWT in a randomized, controlled trial. Practice implication: This first study indicates CBWT is a promising treatment, which can easily be used in clinical practice. Copyright © 2009 John Wiley & Sons, Ltd. Key practitioner massage:

• CWBT can easily be implemented in clinical practice.
• CWBT is suitable for a clinically representative group of children and adolescents with PTSD, who have experienced a wide range of single and recurrent traumatic experiences.
• CWBT is a short‐term potentially effective treatment.

     

Cognitive changes during prolonged exposure versus prolonged exposure plus cognitive restructuring in female assault survivors with posttraumatic stress disorder

The authors report on changes in cognitions related to posttraumatic stress disorder (PTSD) among 54 female survivors of sexual and nonsexual assault with chronic PTSD who completed either prolonged exposure alone or in combination with cognitive restructuring. Treatment included 9-12 weekly sessions, and assessment was conducted at pretreatment, posttreatment, and a modal 12-month follow-up. As hypothesized, treatment that included prolonged exposure resulted in clinically significant, reliable, and lasting reductions in negative cognitions about self, world, and self-blame as measured by the Posttraumatic Cognitions Inventory. The hypothesis that the addition of cognitive restructuring would augment cognitive changes was not supported. Reductions in these negative cognitions were significantly related to reductions in PTSD symptoms. The addition of cognitive restructuring did not significantly augment the cognitive changes. Theoretical implications of the results are discussed.     

Associations of pre-trauma attributes and trauma exposure with screening positive for PTSD: analysis of a community-based study of 2,085 young adults

BACKGROUND: While pre-trauma personality and mental health measures are risk factors for post-traumatic stress disorder (PTSD), such information is usually obtained following the trauma and can be influenced by post-trauma distress. We used data collected from a community-based survey of young adults before and after a major natural disaster to examine the extent to which participants' traumatic experiences, demographic and pre-trauma risk factors were associated with their screening positive for PTSD when re-interviewed. METHOD: A representative selection of 2,085 young adults from the Australian Capital Territory and environs, interviewed in 1999 as part of a longitudinal community-based survey, were re-interviewed 3-18 months after a major bushfire had occurred in the region. When re-interviewed, they were asked about their experiences of trauma threat, uncontrollable and controllable traumatic experiences and their reaction to the fire. They were also screened for symptoms of fire-related PTSD experienced in the week prior to interview. RESULTS: Four-fifths of participants were exposed to the trauma with around 50% reporting having experienced uncontrollable traumatic events. Reporting PTSD symptoms was associated with being female, having less education, poorer mental health and higher levels of neuroticism prior to the trauma. Particular fire experiences, including being evacuated and feeling very distressed during the disaster, were more strongly associated with PTSD symptoms compared with pre-trauma measures. CONCLUSIONS: While demographic and pre-trauma mental health increased the likelihood of reporting PTSD symptoms, exposure to trauma threat and reaction to the trauma made greater contributions in explaining such symptoms as a result of this disaster.     

Baseline resting heart rate variability predicts post‐traumatic stress disorder treatment outcomes in adults with co‐occurring substance use disorders and post‐traumatic stress

Post‐traumatic stress disorder (PTSD) symptoms are highly prevalent among individuals with substance use disorders (SUD), presenting a difficult‐to‐treat, complex comorbidity. Prognostic factors for treatment outcomes may characterize heterogeneity of the treated population and/or implicate mechanisms of action that are salient for improving treatments. High frequency heart rate variability (HF‐HRV) is a suggested biomarker for emotion regulation—the ability to generate appropriate emotional responses via the influence of the parasympathetic nervous system on the heart. This initial study investigated the utility of baseline resting HF‐HRV for predicting PTSD symptoms and substance use outcomes following treatment of 37 SUD participants with comorbid PTSD symptoms. Participants completed either standard cognitive‐ behavioral therapy (CBT) for SUD or a novel treatment of integrated post‐traumatic stress and substance use that combined CBT for SUD with cognitive processing therapy for PTSD. Analyses demonstrated that higher HF‐HRV predicted greater reduction in PTSD symptoms following both types of treatment. This suggests prognostic value of HF‐HRV as a predictor of PTSD treatment outcomes; those with poorer autonomic emotional regulation may not respond as well to psychotherapy in general. This hypothesis‐generating analysis identifies a putative biomarker that might have utility in treatment prediction.