创伤后应激障碍患者创伤后应激症状与自传体记忆过度概括化的相关

目的:探讨伤后应激障碍患者的创伤后应激障碍症状与过度概括化自传体记忆的相互关系。方法:选取符合入组条件的创伤后应激障碍患者30人,正常对照组30人,所有被试均接受自传体记忆(AMT)、创伤后应激障碍症状自评量表(PTSD-SS)测验。结果:1与正常对照组比较,PTSD患者PTSD症状量表各症状及过度概括化自传体记忆总分上存在显著性的统计学意义(P0.05);2相关分析表明,创伤后应激障碍患者PTSD症状的重复体验、回避功能、社会功能与过度概括化自传体记忆呈高度的正相关性,分别为(r=0.59,0.53,0.71,0.59;P0.05)。结论:创伤后应激障碍患者PTSD症状及过度概括化的自传体记忆明显,且过度概括化的自传体记忆水平越高,PTSD患者的重复体验、回避功能、社会功能问题就越明显。     

不同羞耻倾向个体情绪性自传体记忆的定向遗忘

目的:探讨不同羞耻倾向个体对不同情绪自传体记忆的定向遗忘特点。方法:以高、低羞耻倾向大学生各30名为被试,使用正性、负性和中性线索词诱发被试的自传体记忆,采用项目法定向遗忘范式,从自传体记忆的具体性这一角度探讨高低羞耻倾向个体自传体记忆定向遗忘特点。结果:1高、低羞耻倾向个体在遗忘条件下对概括和具体的自传体记忆的回忆率都显著低于记住条件下;2高、低羞耻倾向个体对负性词诱发的自传体记忆的回忆率要显著低于中性和正性词;3高羞耻倾向个体对负性词引发的具体的自传体记忆的回忆率低于低羞耻倾向个体,而高、低羞耻倾向个体对概括的自传体记忆的回忆率差异不显著。结论:高、低羞耻倾向个体不论在具体和概括的自传体记忆上都表现出了定向遗忘,个体的羞耻倾向和自传体记忆的情绪性会影响具体的自传体记忆的定向遗忘。     

创伤的自传体记忆模型

自传体记忆是人类独有的记忆系统,是自我将所经验到的事件与其观点、解释、评价整合而形成的对个人史的内在表征。它服从于个人目标,以此来定义"我"是谁,是自我记忆系统的核心部分。基于自传体记忆层级模型认为,创伤致使个体自传体记忆缺损,其语义记忆、情节记忆、感觉信息和情感无法整合到自传体记忆库中。当创伤威胁到语义记忆时,个体可能会产生许多与自我认同相关的问题;对情境化情节记忆的编码和整合失败会导致创伤性事件记忆的不完整和混乱;当感觉信息和情感未能与情节记忆和语义记忆进行整合时,创伤患者的记忆将以闯入性的意象为主要表征形式。此外,记忆评估也能在一定程度上影响个体对创伤的遗忘。     

汶川地震后青少年PTSD症状及其相关因素研究

目的:对两个受灾严重程度不同地区青少年遭受的创伤暴露情况以及创伤后应激障碍(PTSD)症状进行调查,探讨影响灾后青少年PTSD症状的因素。方法:采用《儿童事件冲击量表》和自编背景资料对极重灾区四川绵竹和重灾区陕西宝鸡地区共1267名中小学生进行测查。结果:四川绵竹的青少年遭受的创伤暴露严重程度显著高于陕西宝鸡地区,但在PTSD症状严重程度(t=0.181,df=1265,P=0.857)上差异并不显著,只在PTSD症状检出率(χ2=8.766,df=1,P=0.003)上差异显著,绵竹地区的PTSD症状检出率显著高于宝鸡地区。结论:极重灾区PTSD的检出率更高。性别、年龄、被困、亲友受伤和目睹死亡是PTSD症状的有力预测因素。     

舟曲泥石流灾区居民创伤后应激障碍症状调查

目的调查舟曲泥石流灾区居民创伤后应激障碍症状(PTSD)的发生率,为灾区居民进行心理干预和心理健康教育提供科学依据。方法按随机抽样的原则,采用创伤后应激障碍检查量表平民版(PCL-C),对293名灾区居民进行自填式调查问卷调查,按照有无PTSD分为PTSD组和正常组,比较两组在社会人口学资料和受灾程度方面的心理健康状况。用logistic回归分析筛选PTSD的危险因素。结果 1灾区居民PTSD症状群筛查总阳性率为34.47%,创伤经历反复重现组阳性率最高(86.35%);2两组在性别、婚姻状况、受教育程度、职业、有无亲人死亡、房屋是否倒塌、有无伤残等方面存在显著性差异(P=0.000,0.016,0.000,0.000,0.000,0.017,0.026);3Logistic回归分析筛选出5个PTSD的预测因素,分别为女性、未婚、亲人死亡、受教育程度相对低和有房屋倒塌者(OR=2.34,0.34,0.45,0.77,0.71)。结论舟曲泥石流灾区居民PTSD症状发生率较高,不同特征的受灾居民创伤后应激障碍症状表现及严重程度不同,应采取有针对性的心理干预措施。     

条件性恐惧记忆再巩固的神经分子机制研究

<正>创伤后应激障碍(post-traumatic stress disorder,PTSD)是经历强烈创伤性事件的个体再次暴露在相似创伤情境时出现以恐惧记忆重复体验为核心症状的反应性精神障碍~([1])。正常的恐惧记忆和恐惧反应是人和动物重要的生存活动,可以帮助机体启动防御机制。然而对于PTSD患者来说,这种恐惧记忆引起的恐惧反应被某些神经生理机制扩大并长期巩固,对患者造成了严重的身心伤害。近年来随着恐     

歧视知觉与男同性恋艾滋病感染者创伤后应激障碍的关系:应对方式的中介作用

目的:探讨应对方式在歧视知觉与男同性恋艾滋病感染者的创伤后应激障碍(PTSD)关系中的中介作用。方法:采用问卷调查法测量145名男同性恋艾滋病感染者的歧视知觉、应对方式和创伤后应激障碍。结果:1歧视知觉与情感中心应对方式、PTSD均呈显著正相关,但与问题中心应对方式无显著相关。2情感中心应对方式在男同性恋艾滋病感染者群体的歧视知觉与创伤后应激障碍之间起部分中介作用。结论:歧视知觉既直接预测男同性恋艾滋病感染者PTSD的症状严重程度,也可以通过情感中心应对方式间接预测其PTSD严重程度。     

205名癌症病人创伤后应激障碍症状分析

目的:调查和分析癌症病人创伤后应激障碍症状的特点。方法:采用事件冲击问卷等测查工具对205名癌症病人进行调查。结果:①事件冲击量表的3个分量表平均分都在2.5以下,有15%的被试3个分量表和IES均分大于3。②不同性别和年龄的被试PTSD症状没有显著差异,未离退组PTSD症状显著高于离退组,文化程度越低者PTSD症状越高。③有过癌症复发和转移经历的癌症病人PTSD症状显著高于没有复发和转移经历的病人。结论:癌症病人的创伤后应激障碍症状处在“少许”到“中度”之间,有15%的病人各类症状达到“中度”以上的水平。未离退休的,文化程度更低的,有过复发、转移的癌症病人创伤后应激障碍症状更严重。     

汶川地震灾区1960名中学生创伤后应激障碍症状调查

目的:了解汶川大地震灾区中学生创伤后应激障碍症状(Post-Traumatic Stress Disorder,PTSD)的发生率。方法:采用方便取样。以汶川地震灾区3所中学1960名中学生为研究对象,用创伤后应激障碍(PTSD)症状清单平民版(PTSD Checklist-Civilian version,PCL-C)(分B、C、D三组症状群),进行自填式调查。结果:(1)PTSD症状群筛查总阳性率为78.3%,B组阳性率最高(68.9%)。(2)女性、高年级、少数民族、来自农村、地震中受伤、家庭财产受损学生PTSD症状总体阳性率及三组症状群阳性率均分别高于男性、低年级、汉族、来自城镇、地震中未受伤、家庭财产未受损失学生[如,PTSD总体阳性率:女82.2%,男73.9%,P0.05]。(3)女生和农村学生重度PTSD症状发生率高于男生和城镇学生(27.9%vs.19.9%,26.7%vs.21.4%,均P0.05)。结论:创伤后应激障碍症状是地震重灾区中学生主要心理问题,不同特征的中学生创伤后应激障碍症状表现及严重程度不同,应采取有针对性的干预措施。     

创伤后应激障碍的临床研究新进展(DSM-5新标准)

创伤后应激障碍(PTSD)是一种严重的心理障碍。PTSD常在一个人暴露于一个或多个创伤性事件后产生,如重大的刺激、性侵犯、恐怖事件或对一个人生活其他严重威胁。主要症状包括令人不安重复闪回,对事件的回避或记忆麻木,警觉性增高等。PTSD的诊断是在创伤性事件发生后持续1个月以上。美国精神病学会在2013年5月出版了《精神疾病诊断与统计手册》第5版(DSM-5)。DSM-5将PTSD的核心症状修改为4组:1在创伤事件发生后,存在1种(或多种)与创伤事件有关的重新体验症状;2创伤事件后开始持续地回避与创伤事件有关的刺激;3与创伤性事件有关的认知和心境方面的消极改变,在创伤事件发生后开始出现或加重;4与创伤事件有关的警觉性或反应性有显著的改变,在创伤事件发生后开始或加重。近年来,对PTSD的临床研究成为精神病学、心身医学和临床心理学的热点。根据DSM-5的标准和新的临床研究成果,本文对PTSD的病因和发病机制、临床表现、诊断标准、诊断和鉴别诊断、治疗、预防和预后进行了分析。     

Dissociative subtype of posttraumatic stress disorder in women in partial and residential levels of psychiatric care

ABSTRACT

The dissociative subtype of posttraumatic stress disorder (PTSD) is estimated to characterize about 12-30% of those with PTSD. Some research links this subtype with increased severity of PTSD symptoms compared to samples with “classic” PTSD. However, prevalence and severity rates reported in the literature have varied. One possible explanation for these discrepancies could be related to where the populations were sampled. Therefore, we investigated whether these differences are still observed when holding level of care constant. We collected data from 104 women at a partial and residential psychiatric hospital program focused on trauma-related disorders. Participants completed self-report questionnaires assessing trauma exposure, symptoms and provisional diagnosis of PTSD, trauma-related thoughts and beliefs, and feelings of shame. All participants reported a history of childhood and/or adulthood trauma exposure. Eighty-eight (85%) met criteria for PTSD, and of those, seventy-three (83%) met criteria for the dissociative subtype as assessed by the Dissociative Subtype of PTSD Scale. A series of independent t-tests revealed no significant differences between the “classic” and dissociative PTSD groups with respect to lifetime or childhood trauma exposure, posttraumatic cognitions, shame, or overall PTSD severity. Our results suggest that samples with classic PTSD and the dissociative subtype may not differ in some types of symptom severity when holding level of care constant. Importantly, however, we found at partial/residential level of care the majority of patients with PTSD were dissociative. Given the elevated prevalence rate in this sample, these findings support the need to assess dissociative symptoms, particularly in more acute psychiatric settings.     

Information processing and PTSD: a review of the empirical literature

This article reviews a series of studies that have utilized information-processing paradigms with posttraumatic stress disorder (PTSD) populations. The review suggests that pretrauma measures of intelligence (IQ) are predictive of the development of PTSD symptoms following trauma. There is also evidence of impaired performance on standardized tests of memory (independent of IQ) in PTSD populations. PTSD populations are found to exhibit deficits in memory function that may be due to hippocampus damage secondary to excessive neuroendocrine responses to conditioned stimuli. In addition, individuals with PTSD evince an attentional bias towards trauma-related stimuli at postrecognition stages of information processing. The review also includes that there is insufficient evidence to either support, or reject, the theoretical proposition that PTSD patients are sensitive to global valence effects at the earliest stages of information processing relative to traumatized non-PTSD populations. Finally, there is some evidence to suggest that the processes associated with autobiographical memory in PTSD populations are similar to those seen in depression. The implications of these findings for the behavioral and cognitive treatment of PTSD are discussed. Directions for future research with such paradigms are also discussed in light of contemporary information processing theories of PTSD.     

Cognitive-behavior therapy for PTSD in rape survivors

In recent years, new data have appeared, further suggesting the utility of cognitive-behavioral interventions for posttraumatic stress disorder (PTSD) subsequent to sexual assault. In this article, we present a model of cognitive-behavioral treatment (CBT) for PTSD in rape survivors. Emotional-processing theory, which proposes mechanisms that underlie the development of disturbances following rape, is reviewed. A CBT-based therapy (Prolonged Exposure) is presented that entails education about common reactions to trauma, relaxation training, imaginal reliving of the rape memory, exposure to trauma reminders, and cognitive restructuring. Current research regarding the use of prolonged exposure is discussed. The case example of a young female rape survivor is described in detail, and her prior substance dependence and intense shame are highlighted. The therapy was successful in reducing the client's symptoms of PTSD, as well as her depressive symptoms, and these gains were maintained at a one-year follow-up assessment.     

PTSD symptoms associated with the experiences of psychosis and hospitalisation: A review of the literature

There is evidence of high rates of PTSD in people with psychosis, but the influence that symptoms or hospitalisation have on PTSD in individuals with psychosis is less clear. This paper reviewed studies investigating the prevalence of PTSD induced as a result of the experience of psychosis and hospitalisation and factors that might influence its development. The review included 24 studies, published between 1980 and 2011. Studies showed high levels of PTSD resulting from the trauma of symptoms and/or hospitalisation, with prevalence rates for actual PTSD resulting from these traumas varying from 11% to 67%. In line with studies of PTSD related to other traumatic events, there were inconsistent associations between PTSD and severity of positive and negative symptoms, but there were consistent associations between affective symptoms and PTSD. There were also inconsistent associations between hospital experiences and PTSD. Consistent with the general PTSD literature, there was some evidence that psychosis-related PTSD was associated with trauma history. There was also some emerging evidence that psychological variables, such as appraisals and coping style may influence psychosis-related PTSD. The review highlights the need for further research into psychological mechanisms that could increase vulnerability to psychosis-related PTSD and treatment approaches.     

Shame as a traumatic memory

Background: This study explores the premise that shame episodes can have the properties of traumatic memories, involving intrusions, flashbacks, strong emotional avoidance, hyper arousal, fragmented states of mind and dissociation. Method: A battery of self‐report questionnaires was used to assess shame, shame traumatic memory and depression in 811 participants from general population (481 undergraduate students and 330 subjects from normal population). Results: Results show that early shame experiences do indeed reveal traumatic memory characteristics. Moreover, these experiences are associated with current feelings of internal and external shame in adulthood. We also found that current shame and depression are significantly related. Key to our findings is that those individuals whose shame memories display more traumatic characteristics show more depressive symptoms. A moderator analysis suggested an effect of shame traumatic memory on the relationship between shame and depression. Limitations: The transversal nature of our study design, the use of self‐reports questionnaires, the possibility of selective memories in participants' retrospective reports and the use of a general community sample, are some methodological limitations that should be considered in our investigation. Conclusion: Our study presents novel perspectives on the nature of shame and its relation to psychopathology, empirically supporting the proposal that shame memories have traumatic memory characteristics, that not only affect shame in adulthood but also seem to moderate the impact of shame on depression. Therefore, these considerations emphasize the importance of assessing and intervening on shame memories in a therapeutic context. Copyright © 2009 John Wiley & Sons, Ltd. Key Practitioner Message:

• Early shame experiences reveal traumatic memory characteristics and are related to current shame and to psychopathology.
• Individuals whose shame memories have more traumatic characteristics are those who show more depressive symptoms.
• Shame traumatic memories moderate the relationship between shame and depression, hence to the same shame, individuals who experienced shame as more traumatic are the ones who show more depressive symptoms.
• Therapy for shame‐based problems needs to incorporate strategies to assess and address individuals shame traumatic memories.

     

Combat guilt and its relationship to PTSD symptoms

Guilt regarding combat experiences is often considered an associated symptom of PTSD in military veterans. Little is known, however, about the role combat guilt plays in the development and maintenance of PTSD. Inadequate measurement of combat-related guilt may be one reason for this deficiency in the literature. In the present study, 40 veterans with PTSD completed a novel measure of combat guilt. Items on the scale assessed various types of guilt and shame concerning combat experiences (i.e., survival guilt, guilt over acts of omission and acts of commission, guilt about thoughts/feelings). Guilt was quite prevalent within this sample, and severity of guilt regarding combat was positively correlated with the reexperiencing and avoidance symptoms of PTSD and a general measure of PTSD severity. Implications of these findings and recommendations for the development of measures for combat-related guilt are discussed. © 1997 John Wiley & Sons, Inc. J Clin Psychol 53: 801–808, 1997     

Posttraumatic stress disorder in children. The influence of developmental factors.

Despite the prevalence of childhood trauma, there are currently no developmentally oriented cognitive theories of posttraumatic stress disorder (PTSD). This paper outlines the definitional issues of PTSD in children, reviews the incidence of PTSD in children, and compares PTSD profiles in children and adults. We propose that a cognitive theory of childhood PTSD needs to accommodate developmental factors, including knowledge, language development, memory, emotion regulation, and social cognition, in addition to contextual factors such as family interactions. Implications of these developmental factors for assessment and treatment of traumatized children are discussed.     

Impaired memory and general intelligence related to severity and duration of patients' disease in Type A posttraumatic stress disorder

Studies of short-term memory and general intelligence associated with duration and severity of posttraumatic stress disorder (PTSD) on observed Type A scores are rare. The authors' aim was to assess Type A behavior and identify subgroups of patients who performed most poorly on memory and intelligence tests and Type A scores related to the severity and duration of their disease. They administered nonverbal memory and intelligence tests to 30 men with PTSD and 20 men without PTSD who responded. During their initial contact with the participants, 2 experts assessed 3 major coronary-prone characteristics (hyperalertness, tight facial musculature, and explosive speech). They found significant differences between the PTSD and control groups in total Type A scores. Those with the most severe PTSD performed most poorly on visual retention tests and showed the highest scores on self-reported and subjective diastolic blood pressure reactivity during magnetic resonance imaging. In the PTSD group, high error scores on the visual retention test predicted Type A behavior and low scores on the picture memory block design tests predicted high Type A scores. A significant positive correlation was found between Type A and clinician-assessed subjective distress, whereas the correlations were significantly negative between picture memory and Type A behavior Suppressed fear is commonly associated with PTSD; decades of research on Type A behavior have isolated fear as a crucial factor in cardiovascular disease.     

The relationship of theory of mind and executive functions to symptom type and severity in children with autism

Although neurocognitive impairments in theory of mind and in executive functions have both been hypothesized to play a causal role in autism, there has been little research investigating the explanatory power of these impairments with regard to autistic symptomatology. The present study examined the degree to which individual differences in theory of mind and executive functions could explain variations in the severity of autism symptoms. Participants included 31 verbal, school-aged children with autism who were administered a battery of tests assessing the understanding of mental states (knowledge and false belief) and executive control skills (working memory, combined working memory and inhibitory control, and planning) and who were behaviorally evaluated for autism severity in the three core symptom domains. Whereas theory of mind and executive control abilities explained the significant variance beyond that accounted for by language level in communication symptoms, neither explained the significant variance in reciprocal social interaction or repetitive behaviors symptoms. These findings are discussed in terms of a proposed distinction between higher level, cognitive-linguistic aspects of theory of mind and related executive control skills, and more fundamental social-perceptual processes involved in the apprehension of mental state information conveyed through eyes, faces, and voices, which may be more closely linked to autistic deficits in social reciprocity.     

A Pilot Prospective Study of the Relationship among Cognitive Factors,Shame, and Guilt Proneness on Posttraumatic Stress Disorder Symptoms in Female Victims of Sexual Violence

This study prospectively examined the relationships among cognitive factors and severity of Posttraumatic stress disorder (PTSD) symptoms in female victims of sexual violence. Thirty-eight victims of sexual violence recruited from Center for Women Victims of Sexual and Domestic Violence at Ajou University Hospital. Cognitive factors and PTSD symptom were assessed within 4 months of sexual violence and 25 victims were followed-up 1 month after initial assessment. Repeated-measured ANOVA revealed that PTSD incidence and severity decreased over the month (F [1, 21]=6.61). Particularly, avoidant symptoms might decrease earlier than other PTSD symptoms (F [1, 21]=5.92). This study also showed the significant relationship between early negative trauma-related thoughts and subsequent PTSD severity. Shame and guilt proneness had significant cross-sectional correlations with PTSD severity, but did not show associations when depression severity is controlled. Our results suggest that avoidant symptoms might decrease earlier than other PTSD symptoms during the acute phase and that cognitive appraisals concerning the dangerousness of the world seem to play an important role in the maintenance of PTSD (r=0.499, P<0.05).

Graphical Abstract

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