Laissez-Faire Leadership and the Trauma-PTSD Relationship: How Do Followers Fare?

Toward the Predeployment Detection of Risk for PTSD

Animal and human research suggests that the development of posttraumatic stress disorder (PTSD) may involve the overconsolidation of memories of a traumatic experience. Previous studies have attempted to use pharmaceutical agents, especially the β-adrenergic blocker propranolol, to reduce this overconsolidation. In this randomized, placebo-controlled study of the efficacy of propranolol in reducing the development of PTSD, we optimized dosages and conducted both psychophysiological and clinical assessments 1 and 3 months after the traumatic event. Forty-one emergency department patients who had experienced a qualifying acute psychological trauma were randomized to receive up to 240 mg/day of propranolol or placebo for 19 days. At 4 and 12 weeks post-trauma, PTSD symptoms were assessed. One week later, participants engaged in script-driven imagery of their traumatic event while psychophysiological responses were measured. Physiological reactivity during script-driven traumatic imagery, severity of PTSD symptoms, and the rate of the PTSD diagnostic outcome were not significantly different between the two groups. However, post hoc subgroup analyses showed that in participants with high drug adherence, at the 5-week posttrauma assessment, physiological reactivity was significantly lower during script-driven imagery in the propranolol than in the placebo subjects. The physiological results provide some limited support for a model of PTSD in which a traumatic conditioned response is reduced by posttrauma propranolol. However, the clinical results from this study do not support the preventive use of propranolol in the acute aftermath of a traumatic event.

Police officers are frequently exposed to two different types of potentially traumatic events: one dealing with physical threats to self and the other involving the witnessing of harm to others. These different types of traumatic experiences are thought to produce various posttraumatic reactions. Furthermore, sleep problems are also reported as a hallmark of posttraumatic stress disorder. There is evidence, however, that sleep problems may mediate the relationship between posttraumatic stress disorder symptoms and health outcomes, especially physical health and depression. Previous research has shown this to be the case among officers from large urban agencies. The purpose of the present study was to test a model involving a pathway from trauma type and posttraumatic stress disorder symptoms to physical health and depression that is mediated by sleep quality in officers (N = 193) using data from small- to mid-size police agencies. Results revealed that sleep problems served as a mediator between posttraumatic stress disorder hyperarousal and avoidance symptoms and health outcomes, that the trauma types are related to different posttraumatic stress disorder symptoms, and that complicated relationships exist between the study variables. In addition, the results indicated that approximately 25% of our sample displayed probable partial posttraumatic stress disorder or probable full posttraumatic stress disorder, causing substantial functional impairment. Suggestions for improving officer health and performance in the field are provided. Specifically, it appears that interventions designed to address posttraumatic stress disorder hyperarousal symptoms related to personal life threat and the posttraumatic stress disorder avoidance symptoms related to the witnessing of human suffering may maximize officer sleep quality and ultimately overall wellness. In particular, mindfulness-based interventions are well suited for addressing these symptom clusters.

Background The results of the previous research imply that persons with post-traumatic stress disorder (PTSD) are at an increased suicide risk. Suicidality is more probable when PTSD occurs in comorbidity with other psychological disorders. The studying of potential differences and the fundamental social and physiological characteristics of suicidal and non-suicidal persons with PTSD has so far failed to produce consistent results. The objective of this article is to examine whether suicidal and non-suicidal persons with PTSD differ by demographic characteristics, the presence and the type of comorbidity with other psychological disorders and the type of traumatic experience. Subjects and methods The study included 147 participants from Bosnia and Herzegovina, 91 men and 56 women, who have been diagnosed with PTSD under the 10th revision of the International Classification of Diseases (ICD-10). Based on the suicidality status (suicidal/non-suicidal), the sample was divided into two sub-samples. For the purpose of data collection, a clinical interview and a socio-demographic questionnaire was applied during psychological clinical assessment at a psychiatric ward. Results It has been established that suicidal and non-suicidal persons with PTSD differ by demographic characteristics, such as the educational and employment status, the presence of a history of suicide in the family, the presence and type of comorbidity with other psychiatric disorders, and the type of traumatic experience. In terms of age, gender, marital status and psychiatric heredity, no significant differences have been found relative to the suicidality status. Conclusions Suicidal persons with PTSD more frequently have low education, they are unemployed and have a history of suicide in the family, and they are diagnosed with comorbid psychiatric disorders, dominated by mood disorders and personality disorders, with multiple comorbid disorders combined, and with war, civilian and mixed trauma being equally present in these persons. Based on the established demographic and clinical characteristics of suicidal patients with PTSD, it is possible to improve the psychological and psychiatric assessment of suicidality in persons with PTSD, which enables adequate and timely identification of the suicide risk in this population.

The relationship between offense-specific forgiveness and post-traumatic stress disorder (PTSD) symptoms was examined in a cross-sectional survey of 178 college students reporting interpersonal trauma exposure, that is, a trauma exposure in which they identified a specific perpetrator. Higher levels of offense-specific forgiveness were significantly related to lower levels of PTSD symptoms. In path analyses, however, when gender and offense severity were allowed to directly predict both forgiveness and PTSD symptoms, the relationship was reduced to marginal significance. Exploratory analyses revealed that within the five most-commonly endorsed trauma subtypes, the relationship between forgiveness and PTSD symptoms may differ in strength and direction as a function of trauma type. Implications for research and treatment are discussed.

In addition to combat trauma, childhood and adult non-military, interpersonal trauma exposures have been linked to a range of psychiatric symptoms (e.g., alcohol use problems, posttraumatic stress disorder [PTSD], depression symptoms) in veterans. However, few studies simultaneously explore the associations between these civilian and combat trauma types and mental health outcomes. Using a sample of combat-exposed veterans who were previously deployed to Iraq and Afghanistan (N = 302), this study sought to (a) understand the independent associations of civilian interpersonal trauma (i.e., childhood trauma and non-military adult trauma) and combat-related trauma with post-deployment alcohol use, PTSD symptoms, and depressive symptoms, respectively and (b) to examine the interactive effects of trauma type to test whether childhood and non-military adult trauma moderate the association of combat trauma with these outcomes. A path analytic framework was used to allow for the simultaneous prediction of these associations. In the final model non-military adult trauma and combat trauma were found to be significantly associated with PTSD symptoms and depression symptoms, but not average amount of drinks consumed per drinking day. Childhood trauma was not associated with any outcomes (i.e., PTSD symptoms, depression symptoms, average amount of drinks consumed per day). Only combat trauma was significantly associated with average amount of drinks consumed per day. Results underscore the importance of assessing multiple trauma types and considering trauma as a non-specific risk factor, as different trauma types may differentially predict various mental health outcomes other than PTSD. Further, results highlight the noteworthiness of considering co-occurring outcomes within the veteran community. Limitations, future directions, and implications of diversity are discussed.

Back to table of contents Previous article Next article Clinical and Research NewsFull AccessFear Extinction Requires Multipronged InterventionAaron LevinAaron LevinSearch for more papers by this authorPublished Online:7 Jun 2013https://doi.org/10.1176/appi.pn.2013.6a22AbstractExtinction of conditioned fear in both civilian and military populations requires genetic, neuroendocrine, and psychophysiological components.A pile of trash burning in a field off an interstate highway in Georgia might seem unremarkable, but to a veteran traumatized by a roadside bomb blast, it’s another stimulus that brings back the fear he felt in Iraq, said Seth Norrholm, Ph.D., at the Eighth Annual Conference on the Amygdala, Stress, and PTSD, held April 23 at the Uniformed Services University of the Health Sciences in Bethesda, Md.An overload of fear can inhibit or delay fear extinction in patients with PTSD, said Emory University’s Seth Norrholm, Ph.D.Aaron LevinNorrholm, an assistant professor of psychiatry and behavioral sciences at Emory University School of Medicine, uses classical Pavlovian fear conditioning paradigms to study the physiological, neuroendocrine, and genetic factors that influence fear acquisition and extinction in both rodents and humans.To model these symptoms, he focuses on fear-potentiated startle, the exaggerated startle reaction to a stimulus that occurs when the subject (whether animal or human) is afraid.The model can also serve as a way of observing the effects of exposure-based extinction on how training reduces or eliminates the conditioned fear response.Norrholm, Kerry Ressler, Ph.D., and colleagues at Emory have been studying a cohort of more than 6,000 civilians who have been treated at Atlanta’s Grady Memorial Hospital. Most of them are low-income African Americans who have experienced severe trauma. The researchers have accumulated startle data on a subsample of 500 of those patients, comparing the patients with and without posttraumatic stress disorder (PTSD).Traumatized individuals with PTSD showed more fear-potentiated startle in fear-acquisition training.“There was no difference in cognitive awareness of fear and safety cues, but there was a difference at the level of the amygdala in fear acquisition,” he said. In the extinction phase, those with PTSD again had a much greater fear-potentiated startle than those without the disorder.Norrholm calls this difference “fear load,” a term that represents the much greater level of fear at the beginning of the extinction phase, which must be overcome in order to extinguish the fear-potentiated startle. It is the deficit the patient has to make up before achieving extinction.“Civilian PTSD patients show greater fear load at the time of extinction,” said Norrholm. He also found that among combat veterans of conflicts beginning with the Vietnam War, individuals with high re-experiencing symptoms had a higher fear load but were still able to extinguish fear.He divided a cohort of 168 veterans of the wars in Iraq and Afghanistan into those with high and low levels of PTSD symptoms. He found no difference in the acquisition of fear-potentiated startle. However, those with less-severe symptoms had a clear reduction in fear-potentiated startle, while those with higher symptom levels showed no reduction, indicating impairment.“Veteran PTSD patients displayed impaired within-session extinction of fear, an effect that is strongly associated with PTSD symptom severity,” he said.Epigenetic mechanisms also come into play in Norrholm’s research. DNA methylation silences genes, reducing protein expression and leading to behavioral effects. With the well-studied COMT gene, for example, the met/met allele renders individuals more susceptible to anxiety disorders, he said.“But the genotype alone is not significant, it’s the gene-by-environment interaction,” he said. The presence of the met/met allele in PTSD patients increases their fear load.His group also analyzed blood levels of the ADCYAP1 gene, which encodes the pituitary adenylate cyclase-activating polypeptide (PACAP) protein. In women with PTSD, but not in men, higher levels of the PACAP predict fear-potentiated startle response.Finally, pilot data from neuroendocrine studies of traumatized women indicate a role for estrogen as well. Women with PTSD and low estrogen levels appear to have lower levels of fear-potentiated startle than those with high estrogen levels.There may be initial clinical implications of Norrholm’s research, even at this early stage. “Fear-loaded patients may require a greater degree of intervention to overcome initial elevated levels of fear,” he said. ■More information on Seth Norrholm’s research is posted at http://www.frontiersin.org/Behavioral_Neuroscience/10.3389/fnbeh.2013.00030/abstract. ISSUES NewArchived

Cancer patients are at risk of post-traumatic stress disorder (PTSD) throughout their treatment journey due to serious challenges (e.g., complex surgical interventions, severe pain, and side effects from chemotherapy or radiation therapy). This may worsen patients' health and negatively impact their overall treatment journey and well-being. However, this area remains understudied in Algeria. Therefore, there is a need to understand the levels of PTSD symptoms and the associated factors among Algerian patients. To ensure accurate assessment and diagnosis, a validation study was conductedto confirm that the PTSD measurement instrument used was culturally appropriate for the Algerian context. The study's main objectives were to (i) determine the prevalence of PTSD among cancer patients in Algeria, (ii) validate the Arabic DSM-5 PTSD Checklist (PCL-5) among Algerian cancer patients, and (iii) explore the associations between demographic and clinical factors and PTSD among this population. The present study was cross-sectional and comprised 370 cancer patients. All participants were patients receiving treatment in oncology wards across various hospitals. All participants completed the PCL-5. Confirmatory factor analysis (CFA) was used to examine the factor structure of the PCL-5. The PCL-5 was found to have a four-factor structure. Out of the 370 participants, 154 (41.6%) had PCL-5 scores below the cutoff of 31, indicating lower levels of PTSD symptoms; 216 participants (58.4%) had scores above this threshold, suggesting a likelihood of PTSD. Moreover, PTSD was significantly associated with patients' low educational attainment and more advanced stages of their disease. The findings indicated moderate to high PTSD symptoms among cancer patients in Algeria. Moreover, the Arabic PCL-5 demonstrated good psychometric properties confirming that it is a reliable and valid tool for assessing PTSD symptoms among Algerian cancer patients.

Background: A significant proportion of patients with posttraumatic stress disorder (PTSD) do not respond sufficiently to trauma treatment. To date, it has not been clearly demonstrated which patients respond well and which do not. Objective: This study examined whether lifetime direct and interpersonal trauma exposure as well as the four distinct symptom clusters of PTSD were associated with treatment outcome. Method: Participants were 262 veterans and police officers with PTSD (measured by the Clinician-Administered PTSD Scale for DSM-5, CAPS-5). Linear Mixed Model Analysis was performed to identify whether direct and interpersonal traumatization and the distinct symptom clusters of PTSD were associated with pre- to post-treatment changes in PTSD and general psychopathology according to the PTSD Checklist for DSM-5 (PCL-5) and Brief Symptom Inventory (BSI), respectively. Predictors were mean-centred to reduce multicollinearity in models with interaction terms. Results: 51% Of participants reported clinically significant improvement for PTSD symptoms and 45% for symptoms of general psychopathology. Trauma characteristics and the severity of four PTSD symptom clusters pre-treatment were not associated with changes in total PTSD scores. Time showed consistent significant PTSD improvement across models. Higher pre-treatment symptom severity of cluster D of PTSD was associated with greater improvement in general psychopathology from pre- to post-treatment. There were two non-significant trends: higher severity of cluster C symptoms before treatment tended to be associated with smaller improvement in cluster E, and higher severity on cluster D with greater improvement of the same cluster D. Conclusions: Direct and interpersonal trauma exposure as well as pretreatment PTSD symptom cluster scores were not robustly related to overall PTSD treatment outcome. However, across all models, a significant reduction in PTSD symptoms over time was observed. To improve treatment efficacy, future research is recommended to explore individual symptoms and psychosocial contexts to achieve more personalized treatment approaches.

The purpose of this study was to determine whether anterior limbic and paralimbic regions of the brain are differentially activated during the recollection and imagery of traumatic events in trauma-exposed individuals with and without posttraumatic stress disorder (PTSD). Positron emission tomography (PET) was used to measure normalized regional cerebral blood flow (CBF) in 16 women with histories of childhood sexual abuse: eight with current PTSD and eight without current PTSD. In separate script-driven imagery conditions, participants recalled and imagined traumatic and neutral autobiographical events. Psychophysiologic responses and subjective ratings of emotional state were measured for each condition. In the traumatic condition versus the neutral control conditions, both groups exhibited regional CBF increases in orbitofrontal cortex and anterior temporal poles; however, these increases were greater in the PTSD group than in the comparison group. The comparison group exhibited regional CBF increases in insular cortex and anterior cingulate gyrus; increases in anterior cingulate gyrus were greater in the comparison group than in the PTSD group. Regional CBF decreases in bilateral anterior frontal regions were greater in the PTSD group than in the comparison group, and only the PTSD group exhibited regional CBF decreases in left inferior frontal gyrus. The recollection and imagery of traumatic events versus neutral events was accompanied by regional CBF increases in anterior paralimbic regions of the brain in trauma-exposed individuals with and without PTSD. However, the PTSD group had greater increases in orbitofrontal cortex and anterior temporal pole, whereas the comparison group had greater increases in anterior cingulate gyrus.

Previous research has documented significant variation in the prevalence of posttraumatic stress disorder (PTSD) depending on the type of traumatic experience (TE) and history of TE exposure, but the relatively small sample sizes in these studies resulted in a number of unresolved basic questions. To examine disaggregated associations of type of TE history with PTSD in a large cross-national community epidemiologic data set. The World Health Organization World Mental Health surveys assessed 29 TE types (lifetime exposure, age at first exposure) with DSM-IV PTSD that was associated with 1 randomly selected TE exposure (the random TE) for each respondent. Surveys were administered in 20 countries (n = 34 676 respondents) from 2001 to 2012. Data were analyzed from October 1, 2015, to September 1, 2016. Prevalence of PTSD assessed with the Composite International Diagnostic Interview. Among the 34 676 respondents (55.4% [SE, 0.6%] men and 44.6% [SE, 0.6%] women; mean [SE] age, 43.7 [0.2] years), lifetime TE exposure was reported by a weighted 70.3% of respondents (mean [SE] number of exposures, 4.5 [0.04] among respondents with any TE). Weighted (by TE frequency) prevalence of PTSD associated with random TEs was 4.0%. Odds ratios (ORs) of PTSD were elevated for TEs involving sexual violence (2.7; 95% CI, 2.0-3.8) and witnessing atrocities (4.2; 95% CI, 1.0-17.8). Prior exposure to some, but not all, same-type TEs was associated with increased vulnerability (eg, physical assault; OR, 3.2; 95% CI, 1.3-7.9) or resilience (eg, participation in sectarian violence; OR, 0.3; 95% CI, 0.1-0.9) to PTSD after the random TE. The finding of earlier studies that more general history of TE exposure was associated with increased vulnerability to PTSD across the full range of random TE types was replicated, but this generalized vulnerability was limited to prior TEs involving violence, including participation in organized violence (OR, 1.3; 95% CI, 1.0-1.6), experience of physical violence (OR, 1.4; 95% CI, 1.2-1.7), rape (OR, 2.5; 95% CI, 1.7-3.8), and other sexual assault (OR, 1.6; 95% CI, 1.1-2.3). The World Mental Health survey findings advance understanding of the extent to which PTSD risk varies with the type of TE and history of TE exposure. Previous findings about the elevated PTSD risk associated with TEs involving assaultive violence was refined by showing agreement only for repeated occurrences. Some types of prior TE exposures are associated with increased resilience rather than increased vulnerability, connecting the literature on TE history with the literature on resilience after adversity. These results are valuable in providing an empirical rationale for more focused investigations of these specifications in future studies.

Objective:The current study focuses on the frequency and severity of post-traumatic stress disorder (PTSD) in caregivers of children with cancer and the relationship between PTSD symptoms and the caregivers' level of gratitude in Pakistan. Methodology: This Cross-sectional design research was carried out between January 2023 and March 2023 at the Department of Oncology in Shaukat Khanum Memorial Cancer Hospital & Research Centre, Peshawar, Northwest General Hospital & Research Centre, Peshawar in Khyber Pakhtunkhwa (KPK), and Pakistan Institute of Medical Sciences, Quaid-e-Azam International Hospital in Islamabad, Pakistan.The research included 153 individuals who provided care for children with cancer between the ages of 0 and 12. The selection of these subjects was done using purposive convenience sampling. The PTSD Checklist-Civilian Version (PCL-C) was employed to evaluate the presence of PTSD, while gratitude was quantified using the Gratitude Questionnaire-Six-Item Form (GQ-6). The data were examined using the statistical software SPSS V28, utilizing descriptive statistics, independent t-tests, and Pearson's correlation coefficient. Results:The findings showed that 52.94% of caregivers had high levels of PTSD and that severe PTSD symptoms were more common among female caregivers and caregivers with lower educational attainment. Mostly, caregivers expressed moderate (40.52%) or low (30.71%) levels of gratitude. Higher degrees of gratitude were linked to lower levels of PTSD symptoms, according to a statistically significant negative correlation (r = -0.433, p < 0.001) between the two variables. Conclusion:The study emphasizes the possibility of gratitude to shield caregivers of pediatric cancer patients from experiencing or lessening the occurrence and intensity of PTSD symptoms. The results underscore the importance of implementing interventions that focus on the mental well-being of caregivers. Additionally, it is crucial to develop gratitude-based therapies that are specifically tailored for this group in order to enhance their ability to cope with challenges and reduce the overall burden of caregiving.

To determine conditional risk of posttraumatic stress disorder (PTSD) in two culturally distinct American Indian reservation communities. Data derived from the American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project, a cross-sectional population-based survey that was completed between 1997 and 2000. This study focused on 1,967 participants meeting the DSM-IV criteria for trauma exposure. Traumas were grouped into interpersonal, non-interpersonal, witnessed, and "trauma to close others" categories. Analyses examined distribution of worst traumas, conditional rates of PTSD following exposure, and distributions of PTSD cases deriving from these events. Bivariate and multivariate logistic regressions estimated associations of lifetime PTSD with trauma type. Overall, 15.9% of those exposed to DSM-IV trauma qualified for lifetime PTSD, a rate comparable to similar US studies. Women were more likely to develop PTSD than were men. The majority (60%) of cases of PTSD among women derived from interpersonal trauma exposure (in particular, sexual and physical abuse); among men, cases were more evenly distributed across trauma categories. Previous research has demonstrated higher rates of both trauma exposure and PTSD in American Indian samples compared to other Americans. This study shows that conditional rates of PTSD are similar to those reported elsewhere, suggesting that the elevated prevalence of this disorder in American Indian populations is largely due to higher rates of trauma exposure.

Asylum-seeking immigrants from Central America experience high prevalence rates of traumatic experiences and posttraumatic stress (PTS). Nonetheless, it is unknown how each type of trauma correlates uniquely to PTS variance and how cultural values may uniquely lower PTS. The present study hypothesized that, after controlling for demographics, (1) general trauma/natural disasters would be the strongest trauma-type correlates to PTS, and (2) religiosity, familismo-support, and self-efficacy would be negatively correlated to PTS. As part of a larger international study, n = 103 participants were sampled at the Texas-Mexico border. Participants were administered a series of mental health and cultural-values screeners in Spanish. A multiple hierarchical regression analysis revealed a significant model predicting PTS, with general exposure to natural disasters as the strongest correlate to PTS. Moreover, familismo-support, but not self-efficacy, significantly correlated with lower PTS scores. Finally, contrary to the hypothesized direction, religiosity was positively correlated to PTS. In this sample of Central American asylum-seekers, religiosity was correlated with higher PTS, aligning with negative religious coping models. Familismo-support was the only association to lower PTS scores. Clinical implications and future directions relevant to culturally responsive interventions and psychological assessments are discussed.

This study investigated the association between mindfulness attention awareness, age, and specific trauma types among individuals with Post-Traumatic Stress Disorder (PTSD). A cross-sectional, correlational design was employed with a sample of 200 adults (aged 19 years and older) diagnosed PTSD patients. Mindfulness was assessed using the Mindfulness Attention Awareness Scale. Independent samples t-tests and One-Way Analysis of Variance (ANOVA) were used for data analysis. Results indicated a statistically significant difference in mindfulness attention awareness according to age, with older adults (M = 28.18, SD = 8.39, n = 94) reporting significantly higher levels than younger adults (M = 25.26, SD = 9.20, n = 106), t(197.83) = -2.03, p = .043. Furthermore, a statistically significant overall effect of trauma type on mindfulness was found, F(3, 196) = 4.76, p = .003, with a medium effect size (ηp2​ = 0.068). Physical violence was at highest in trauma followed by death of loved ones. These findings suggest that both age and the type of traumatic experience are associated with mindfulness attention awareness in PTSD patients, highlighting the need for age- and trauma-informed approaches in intervention development.