Decreases In Posttraumatic Stress Symptoms Research Articles

Efficacy of the my health too online cognitive behavioral therapy program for healthcare workers during the COVID-19 pandemic: A randomized controlled trial

BackgroundHealthcare workers' mental health has been impacted by the COVID-19 pandemic, emphasizing the need for mental health interventions in this population. Online cognitive behavioral therapy (CBT) is efficient to reduce stress and may reach numerous professionals. We developed “MyHealthToo”, an online CBT program to help reduce stress among healthcare workers during the COVID-19 pandemic. ObjectiveThe aim of our study is to investigate the efficacy of an online CBT program on stress and mental health conditions among healthcare workers during a health crisis. MethodsWe performed a multicentric randomized controlled trial among 155 participants allocated either to the experimental or active control group (bibliotherapy). The primary outcome was the decrease of perceived stress scores (PSS-10) post-treatment. Secondary outcomes included depression, insomnia and PTSD symptoms along with self-reported resilience and ruminations. Assessments were scheduled pretreatment, mid-treatment (4 weeks), post-treatment (8 weeks), and at 1-month and 4-months follow-up. ResultsFor both interventions, mean changes on the PSS-10 were significant post-therapy (W8), as at 1-month (W12) and 4-months (W24) follow-ups. The between-group comparison showed no difference at any time point (ps > 0.88). Work-related ruminations significantly decreased in the experimental group with a significant between-group difference at W8 (Δ = −1.83 [−3.57; −0.09], p = 0.04). Posttraumatic stress symptoms significantly decreased in the experimental group with a significant between-group difference at W12 (Δ = −1.41 [−2.68; −0.14], p = 0.03). The decrease in work-related ruminations at W8 mediated the decrease in posttraumatic stress symptoms at W12 (p = 0.048). ConclusionThe “MyHealthToo” online CBT intervention may help reduce ruminations about work and posttraumatic stress symptoms among healthcare workers during a major health crisis. Work-related ruminations may represent a relevant target of online interventions to improve mental health among healthcare workers.

Examining the Temporal Relation between Posttraumatic Stress Symptoms and Heavy Drinking among Veterans Receiving Mental Health Treatment in Primary Care

Objective Evidence for the use of integrated treatments targeting co-occurring posttraumatic stress disorder (PTSD) and alcohol use disorders is steadily growing. However, limited work has evaluated the temporal association between posttraumatic stress symptoms (PTSS) and alcohol misuse over the course of integrated treatment, with no studies examining such interventions in primary care (PC). The current study examined temporal changes in PTSS and heavy drinking among individuals who received a brief treatment for co-occurring PTSD and alcohol misuse in PC (Primary Care Treatment Integrating Motivation and Exposure; PC-TIME) compared with those who received PC treatment as usual (PC-TAU). Method A total of 63 veterans (33 randomized to PC-TIME and 30 randomized to PC-TAU) presenting to PC with co-occurring PTSD and alcohol misuse were included in this study. PTSS and heavy drinking were examined at each treatment session for those in PC-TIME. Veterans in both conditions provided reports of PTSS and heavy drinking at baseline, 8-weeks (post-treatment), 14-weeks, and 20-week follow-ups. Results Session-by-session findings for PC-TIME demonstrated that PTSS at Session 1 predicted a greater decrease in heavy drinking from Session 1 to Session 2. Moreover, heavy drinking at baseline predicted greater decreases in PTSS at 8-weeks for those in PC-TIME, whereas the reverse association was found for those randomized to PC-TAU. Additionally, heavy drinking at 8-weeks predicted decreased PTSS at 14-weeks for those randomized to PC-TAU. Conclusions The current study evidenced mixed support for the temporal precedence of PTSS and alcohol misuse. Relations between PTSS and heavy drinking appeared to be linked to treatment targets within PC-TIME and varied between treatment condition (PC-TIME versus PC-TAU). Notably, those with greater than average heavy drinking at the initiation of integrated treatment appeared to have greater reductions in PTSS at post-treatment. Results suggest a mutual maintenance model may best characterize the association between co-occurring PTSS and heavy drinking among treatment-seeking individuals.

A Scoping Review of Trauma-Informed Pediatric Interventions in Response to Natural and Biologic Disasters.

A scoping review was performed of trauma-informed psychological interventions to treat anxiety, depression, and posttraumatic stress symptoms in youth in response to natural/biologic disasters. The specific aims were to identify psychosocial interventions used in response to natural/biologic disasters, report the interventions' effectiveness, describe limitations, and provide treatment recommendations and future directions. Of the 45 studies extracted, 28 were on natural disasters and 17 on biologic disasters with the majority related to the COVID-19 pandemic. The most commonly implemented interventions were Cognitive Behavioral Therapy (CBT), Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), and eye movement desensitization and reprocessing (EMDR). The UCLA Posttraumatic Stress Disorder Reaction Index (UCLA PTSD-RI) and the Strengths and Difficulties Questionnaire (SDQ) were the most frequently used measures. Methodological rigor was varied, with 60% randomized, controlled trials. Overall, there was a significant decrease in posttraumatic stress symptoms, distress, anxiety, and depression regardless of whether the participant received CBT, TF-CBT, or EMDR. Generally, there was not a significant decrease in anxiety and depression with yoga, cognitive fear-reduction, emotion-based drawing, and community health education. Recommendations for future directions include larger-scale studies with group and on-line interventions that include younger children with moderation analyses by gender and race/ethnicity.

Examining the Feasibility of Telehealth Trauma-Focused Cognitive Behavioural Therapy (TF-CBT) with Young People in Foster Care.

Purpose: Despite the high rate of trauma exposure among young people with child welfare involvement, various systematic and patient barriers exist that inhibit utilization of evidence-based trauma treatments. One strategy for alleviating barriers to such treatments is using telehealth. A few studies have found that the clinical outcomes of telehealth TF-CBT are comparable to those found from clinic-based, in-person treatment administration. Studies have yet to examine the feasibility of telehealth TF-CBT with young people in care. The current study sought to address this gap by examining outcomes for patients who received telehealth TF-CBT, along with factors that may have impacted successful completion, at an integrated primary care clinic exclusively serving young people in care. Methods: Patient data were collected retrospectively from the electronic health records of 46 patients who received telehealth TF-CBT between March 2020 and April 2021, and feedback was sought via focus group from 7 of the clinic's mental health providers. A paired-sample t-test was conducted to evaluate the impact of the intervention for the 14 patients who completed treatment. Results: Responses from the Child and Adolescent Trauma Screen showed a significant decrease in posttraumatic stress symptoms when comparing pre-treatment scores (M = 25.64, SD = 7.85) to post-treatment scores (13.57, SD = 5.30), t(13) = 7.50, p < .001. The mean decrease in scores was 12.07 with a 95% confidence interval ranging from 8.60 to 15.55. Themes emerging from the focus group centered on home environment, caregiver participation, and systemic topics. Conclusions: Findings suggest that telehealth TF-CBT with young people in care is feasible but relatively low completion rates suggest that barriers to treatment completion remain.

Development and implementation of self-supportive intervention on post-traumatic stress symptoms and quality of life among battered wives of Madhya Pradesh, India: A pilot study

Background: In India, intimate partner violence against women is a major problem that leads to terrible physical, sexual, emotional, psychological and economic consequences. In 55-92% of women who have a history of being abused wives, high levels of symptoms of post-traumatic stress disorder have been discovered. Therefore, the quality of life is significantly low among them regardless of regions and countries. The purpose of the current study was to create and evaluate the effectiveness of a self-supportive intervention on the quality of life and post-traumatic stress symptoms among abused wives in Madhya Pradesh, India. Methods: The post-traumatic Symptoms Scale Interview version for DSM-5 (PSS-I-5) and WHO Quality of Life-BREF (WHOQOL) were used in this study as assessment tools. The Need assessment results showed that 51% of battered wives met the criteria of PTSD symptoms from moderate to severe and 83% experienced low quality of life. This study utilized a mixed research method and was executed in three phases, based on the main three elements of Conklin’s (1997) program development model, namely (1) planning; (2) design and implementation; and (3) evaluation of the newly created Self-Supportive Intervention program (SSI). The SSI program consisted of six modules, focused on addressing the issues that emerged through qualitative data and need assessments. Results: Excellent inter-rater reliability (.845) was found in the expert evaluation's findings, which supported the recommendation to use the SSI as it is with minor modification. The SSI was further pilot-tested for its feasibility with 10 battered wives and validated through the paired sample t-test, which showed a substantial decrease in post-traumatic stress symptoms and enhanced quality of life at 0.05 level of significance. Conclusion: This is an indication that the SSI program can be recommended as a psychological intervention in eliminating the PTSD symptoms and improving the quality of life.

Mental Health Outcomes Among Italian Health Care Workers During the COVID-19 Pandemic

Health care workers (HCWs) exposed to COVID-19 have high rates of mental health issues. However, longitudinal data on the evolution of mental health outcomes in HCWs are lacking. To evaluate the mental health outcomes among Italian HCWs 14 months after the beginning of the COVID-19 pandemic. This longitudinal cohort study collected data from March 1 to April 30, 2020 (T1) and from April 1 to May 31, 2021 (T2), from 2856 Italian HCWs aged 18 years or older who responded to an online questionnaire. Participants were also recruited via snowballing, a technique in which someone who receives the invitation to participate forwards it to his or her contacts. Frontline vs second-line position, job type, hospitalization for COVID-19, and colleagues or family members affected by COVID-19. Outcomes are depression symptoms, anxiety symptoms, insomnia symptoms, and posttraumatic stress symptoms (PTSSs). Four different trajectories are described for each condition: resilient, remittent, incident, and persistent. Of the 2856 HCWs, 997 (34.9%) responded to the follow-up assessment (mean [SD] age, 42.92 [10.66] years; 816 [82.0%] female). Depression symptoms (b = -2.88; 95% CI, -4.05 to -1.71), anxiety symptoms (b = -2.01; 95% CI, -3.13 to -0.88), and PTSSs (b = -0.77; 95% CI, -1.13 to -0.42) decreased over time; insomnia symptoms increased (b = 3.05; 95% CI, 1.63-4.47). Serving as a frontline HCW at T1 was associated with decreased symptoms of depression (b = -1.04; 95% CI, -2.01 to -0.07), and hospitalization for COVID-19 was associated with increased depression symptoms (b = 5.96; 95% CI, 2.01-9.91); younger age (b = -0.36; 95% CI, -0.70 to -0.03) and serving as a frontline HCW at T1 (b = -1.04; 95% CI, -1.98 to -0.11) were associated with decreased anxiety symptoms. Male sex was associated with increase in insomnia symptoms (b = 1.46; 95% CI, 0.39-2.53). Serving as a frontline HCW at T1 (b = -0.42; 95% CI, -0.71 to -0.13) and being a physician (b = -0.52; 95% CI, -0.81 to -0.24) were associated with a decrease in PTSSs, whereas younger age (b = 0.35; 95% CI, 0.09-0.61) and male sex (b = 0.12; 95% CI, 0.01-0.22) were associated with an increase in PTSSs. Depression trajectories were 629 resilient (65.5%), 181 remittent (18.8%), 58 incident (6.0%), and 92 persistent (9.6%). Anxiety trajectories were 701 resilient (73.3%), 149 remittent (15.6%), 45 incident (4.7%), and 61 persistent (6.4%). Insomnia trajectories were 858 resilient (88.9%), 77 remittent (8.0%), 20 incident (2.1%), and 10 persistent (1.0%). The PTSS trajectories were 363 resilient (38.5%), 267 remittent (28.3%), 86 incident (9.1%), and 226 persistent (24.0%). In this cohort study, relative to the beginning of the COVID-19 pandemic, mental health among HCWs has improved. Factors associated with change in mental health outcomes could help in the design of prevention strategies for HCWs.

The Influence of a Peer Support Camp on Mitigating Emotional Distress in Siblings of Children With Cancer.

Background: Siblings of children with cancer often experience anxiety and posttraumatic stress symptoms (PTSS), which negatively impact their self-esteem due to emotionally upsetting circumstances. The purpose of this longitudinal quantitative study was to investigate changes in anxiety, PTSS, and self-esteem of youth who participated in a peer support camp for siblings of children with cancer. Methods: A longitudinal study examined changes over time. Data were collected from 32 sibling surveys pre-, post-, and three months after camp. Siblings completed assessments to measure anxiety, PTSS, and self-esteem. A repeated measures ANOVA or Friedman Test was conducted to identify changes across the three data points for each outcome measured. Post hoc comparisons using paired sample t-tests or Wilcoxon Signed-Rank tests were conducted. Results: Significant improvements in anxiety; T1 and T2 (p < .000); T1 and T3 (p < .000). Significant decrease in PTSS; T1 and T2 (p = .001); T1 and T3 (p = .011). Significant improvement in self-esteem scores for older participants (ages 10-16); T1 and T2 (p < .000). Significant improvement in self-esteem for younger participants (ages 7-9); T1 and T3 (p = .005). Discussion: The data generated in this study expand knowledge about the influence of peer support camps on reducing the emotional distress of siblings of children with cancer. The findings warrant further research on the long-term impact of such camps, the value of repeated participation, differences between bereaved and nonbereaved siblings, the phase of the cancer experience, and elements of the camp that have the most impact.

Effects of mindfulness training on posttraumatic stress symptoms from a community-based pilot clinical trial among survivors of intimate partner violence.

Objective: Exposure to intimate partner violence (IPV) is a significant public health issue associated with deleterious mental and medical health comorbidities, including posttraumatic stress disorder (PTSD). The hallmark symptoms of posttraumatic stress (PTS), even when not meeting the threshold for a diagnosis of PTSD, appear to be underpinned by poor self-regulation in multiple domains, including emotion, cognitive control, and physiological stress. Mindfulness-based stress reduction (MBSR) holds promise for treating PTS symptoms because evidence suggests it targets these domains. The current study was a pilot randomized clinical trial designed to examine changes in emotion regulation, attentional function, and physiological stress dysregulation among women IPV survivors with elevated PTS symptoms after participation in a group-based, 8-week MBSR program. Method: In total, 29 participants were randomized to receive MBSR (n = 19) or an active control (n = 10). Assessments were conducted at study entry, as well as 8 and 12 weeks later. Results: Between-group differences on primary outcomes were nonsignificant; however, when exploring within groups, statistically significant decreases in PTS symptoms, F(1.37, 16.53) = 5.19, p < .05, and emotion dysregulation, F(1.31, 14.46) = 9.36, p < .01, were observed after MBSR but not after the control intervention. Further, decreases in PTSD and emotion dysregulation were clinically significant for MBSR participants but not control participants. Conclusions: These preliminary data signal that MBSR may improve PTS symptoms and emotion regulation and suggest further study of the effectiveness of PTSD interventions guided by integrative models of MBSR mechanisms and psychophysiological models of stress regulation. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Choosing Life in the Black Community, Achieving the Dream: A Traumatic Stress Curriculum Pilot Study.

This study measured changes in post-traumatic stress symptoms and collective-efficacy in African Americans participating in cohorts of "Choosing Life in the Black Community: Achieving the Dream", an Afrocentricity-based Cognitive Behavioral Therapy curriculum for trauma. Participants were recruited by key leaders in the black community of the Twin Cities, Minnesota Metropolitan Area and completed a 6-week group counselling curriculum led by lay health workers and supervised by professional psychologists. Twenty-six participants provided pre- and post-curriculum responses to validated measures of post-traumatic stress symptoms, collective-efficacy and adverse childhood experiences. Thirteen participants provided semi-structured interviews. Pre- to post-curriculum change score were calculated for post-traumatic stress symptoms and collective-efficacy. Interviews were analyzed using thematic analysis. Post-traumatic stress symptoms decreased and collective-efficacy increased, though neither change achieved statistical significance. Participants with more adverse childhood experiences showed significantly greater decreases in post-traumatic stress symptoms. There is evidence that this program may be particularly effective in participants that have greater past experiences of trauma.

Perceived social support and posttraumatic stress symptoms in children and youth in therapy: A parallel process latent growth curve model

Many studies show that perceived social support protects against the development of posttraumatic stress symptoms (PTSS) in the aftermath of trauma, but less is known about support in relation to PTSS in trauma therapy. This study examined associations between perceived social support and PTSS in children and adolescents during trauma therapy. Parallel process latent growth curve modeling was used to examine trajectories of perceived social support and PTSS over five measurement waves in a sample of 156 patients, aged between 10 and 18 years (M age = 15.1, SD = 2.2, 79.5% girls), randomized to receive trauma-focused cognitive behavior therapy (TF-CBT) or therapy-as-usual (TAU). Across all participants there was an average decline in PTSS and increase of perceived social support from pre-therapy to 18 months after therapy. Most of the change occurred during therapy and was maintained after therapy. Higher levels of PTSS prior to therapy were associated with lower levels of perceived social support prior to therapy, and a decrease in PTSS was associated with increase in perceived social support. This co-development may have been directed by a third underlying factor or short-term temporal effects. Studies investigating within-person associations over shorter time intervals will benefit our understanding of possible temporal effects.

Preliminary evaluation of treatment outcomes at a military intensive outpatient program.

Recent U.S. Army policy has established intensive outpatient programs at several installations as part of a comprehensive behavioral health system of care. This study presents retrospective program evaluation data from a case series without randomization or a control group at 1 recently established intensive outpatient program for active duty service members at a joint military installation. Out of 240 patients referred to the program at 1 installation, 200 enrolled in treatment. Of these, 169 completed treatment in a Skills & Resiliency Track (n = 97), Trauma Track (n = 34), or both (Combined Track; n = 38). Patients completed measures of posttraumatic stress symptoms and general distress throughout program enrollment. First year preliminary results show significant decreases in distress for those in the Skills & Resiliency and Combined groups. Trauma group patients showed significant decreases in posttraumatic stress symptoms. Patients in the Skills & Resiliency and Combined groups showed significant decreases in rates of psychiatric hospitalization. These results show potential for treating high-risk or treatment-resistant patients in a half-day intensive outpatient program. Lessons learned and recommendations for establishing intensive outpatient programming for the military are discussed. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

The Louisiana Mental and Behavioral Health Capacity Project Trauma-Informed Integrated Care Model and Improved Posttraumatic Stress Outcomes.

The Mental and Behavioral Health Capacity Project in Louisiana has been addressing health disparities by increasing accessibility and availability through integrating services into primary care clinics. Integrated health is becoming the standard of care, providing an opportunity to address the trauma-specific needs of communities, and allowing for informed and less stigmatized services. The purpose of this study is to test the efficacy of the Mental and Behavioral Health Capacity Project in Louisiana model in the primary care settings to reduce posttraumatic stress symptoms and physical health complaints. A pre-experimental time series design was used on the basis of participants self-reporting at least 1 trauma at intake and follow-up collected at 1-, 3-, and 6-month intervals. The hypotheses were that posttraumatic stress and physical health complaints would significantly decrease over the course of treatment. This study was part of a larger study to evaluate the effectiveness of the Mental and Behavioral Health Capacity Project in Louisiana-integrated health efforts. Sample parameters included (1) intake date from January 2013 through December 2015; (2) at least 18 years of age; and (3) presented at 1 of 5 primary health care clinics in Southeast Louisiana. A total of 235 patients were selected; the mean age was 44.7 years (SD = 13.6) and the majority were white (68%) and female (76%). Brief behavioral-based trauma treatment was delivered using both on-site and telemedicine therapies provided by a psychologist, psychiatrist, or through a combined treatment model. The main outcome measures were the Posttraumatic Stress Civilian Checklist (PCL-C) and the Patient Health Questionnaire (PHQ-15). The hypothesis was supported. Statistically significant decreases in posttraumatic stress symptoms and physical health complaints were shown over the course of treatment, with 63% of the group demonstrating clinically significant change. This study supports brief trauma treatment in primary care clinics as an effective method of reducing trauma and physical health symptoms in postdisaster environments.

긍정심리개입이 외상경험 대학생들의 심리적 건강 및 외상 후 성장에 미치는 효과

본 연구는 긍정심리개입이 외상경험 대학생들의 심리적 건강 및 외상 후 성장에 미치는 효과를 알아보고자 하였다. 총 63명의 대학생(긍정심리개입 집단 30명, 무처치 통제집단 33명)이 참여하였고, 긍정심리개입은 총 8회기에 걸쳐 한 회기당 120분 동안 진행 되었으며, 무처치 통제집단은 심리학 교양과목을 이수하는 학생들로 이루어졌다. 긍정심리개입 집단의 참가자들은 총 4번(개입 전, 4회기 후, 개입 직후, 1개월후) 탄력성, 외상 후 성장, 정신적 웰빙, 삶의 의미, 외상 후 스트레스증상, 우울증상 및 외상 후 인지를 측정하는 척도들을 작성하였으며, 무처치 통제집단의 참가자들은 총 3번(개입 전, 4회기 후, 개입 직후) 동일한 척도들을 작성하였다. 분석 결과, 무처치 통제집단에 비해 긍정심리개입은 탄력성, 외상 후 성장, 정신적 웰빙, 삶의 의미, 우울증상 및 외상 후 인지 수준을 변화시키는데 더 효과적이었으며, 이러한 효과는1개월 동안 유지되었다. 하지만 종결 직후 두 집단 간 비교 결과, 외상 후 스트레스증상 수준은 유의한 차이를 보이지 않았다. 이 결과들은긍정심리개입이 외상경험 대학생들의 우울증상을 완화하고, 탄력성, 외상 후 성장 및 긍정적인 정신건강을 증진시키는데 효과적일 수 있음을 시사한다. 마지막으로, 본 연구의 의의뿐만 아니라, 그 한계점에 기초하여 미래 연구방향에 관해 논의하였다.

Clinical, hemispheric, and autonomic changes associated with use of closed-loop, allostatic neurotechnology by a case series of individuals with self-reported symptoms of post-traumatic stress

BackgroundThe objective of this pilot study was to explore the use of a closed-loop, allostatic, acoustic stimulation neurotechnology for individuals with self-reported symptoms of post-traumatic stress, as a potential means to impact symptomatology, temporal lobe high frequency asymmetry, heart rate variability (HRV), and baroreflex sensitivity (BRS).MethodsFrom a cohort of individuals participating in a naturalistic study to evaluate use of allostatic neurotechnology for diverse clinical conditions, a subset was identified who reported high scores on the Posttraumatic Stress Disorder Checklist (PCL). The intervention entailed a series of sessions wherein brain electrical activity was monitored noninvasively at high spectral resolutions, with software algorithms translating selected brain frequencies into acoustic stimuli (audible tones) that were delivered back to the user in real time, to support auto-calibration of neural oscillations. Participants completed symptom inventories before and after the intervention, and a subset underwent short-term blood pressure recordings for HRV and BRS. Changes in temporal lobe high frequency asymmetry were analyzed from baseline assessment through the first four sessions, and for the last four sessions.ResultsNineteen individuals (mean age 47, 11 women) were enrolled, and the majority also reported symptom scores that exceeded inventory thresholds for depression. They undertook a median of 16 sessions over 16.5 days, and 18 completed the number of sessions recommended. After the intervention, 89% of the completers reported clinically significant decreases in post-traumatic stress symptoms, indicated by a change of at least 10 points on the PCL. At a group level, individuals with either rightward (n = 7) or leftward (n = 7) dominant baseline asymmetry in temporal lobe high frequency (23–36 Hz) activity demonstrated statistically significant reductions in their asymmetry scores over the course of their first four sessions. For 12 individuals who underwent short-term blood pressure recordings, there were statistically significant increases in HRV in the time domain and BRS (Sequence Up). There were no adverse events.ConclusionClosed-loop, allostatic neurotechnology for auto-calibration of neural oscillations appears promising as an innovative therapeutic strategy for individuals with symptoms of post-traumatic stress.Trials registrationClinicalTrials.gov #NCT02709369, retrospectively registered on March 4, 2016.

Effects of Equine-Facilitated Psychotherapy on Post-Traumatic Stress Symptoms in Youth

Equine-assisted therapy has become an increasingly popular complementary mental health treatment approach, but there is limited empirical research assessing the effectiveness of this practice. In particular, equine-facilitated psychotherapy has many potential benefits for the treatment of trauma in youth. The purpose of the proposed study was to investigate changes in levels of post-traumatic stress symptomatology and levels of the human-animal bond in children and adolescents ages 10–18 over the course of a 10-week equine-facilitated psychotherapy (EFP) intervention. Youth in the treatment group (n = 36) participated in 10 weekly two hour EFP sessions, and were compared on changes in post-traumatic stress symptoms with a control group of participants (n = 32) who continued to receive the already existing traditional therapeutic services provided by their treatment facility or outpatient therapist. Findings suggested a significant decrease in post-traumatic stress symptoms across the intervention for both the treatment and control group, but the treatment group did not decrease significantly more than the control group. These findings suggest that EFP may be an effective additional treatment modality for post-traumatic stress symptoms, but there was no evidence from this initial study that EFP was significantly more effective than traditional office-based therapy. Further research and discussion of the relative benefits of EFP compared to traditional treatment modalities is warranted.

Eficacia de un programa de intervención para mujeres maltratadas por su pareja

This study analyzed the efficacy of a psychological treatment program for battered women. The sample consisted of 107 battered women aged between 23 and 64 years-old (mean age = 39.64, SD = 9.87) and with diverse sociodemographic characteristics. A quasi-experimental design of two independent groups (intervention and control) and with repeated measures (pre-treatment, post-treatment and three and six month follow-up) has been used. Women in the intervention group experienced statistically and clinical significant decreases in posttraumatic stress symptoms of reexperienced the traumatic event, avoidance and symptoms of increased arousal. Also experienced significant and clinical decreases in depressive and anxiety symptoms and significant increases in self-esteem and social support. Gains were maintained at 3- and 6-months follow-ups.

Cognitive-behaviour therapy for post-traumatic stress in schizophrenia. A randomized controlled trial.

There is limited evidence for effective interventions in the treatment of post-traumatic stress symptoms within individuals diagnosed with schizophrenia. Clinicians have concerns about using exposure treatments with this patient group. The current trial was designed to evaluate a 16-session cognitive restructuring programme, without direct exposure, for the treatment of post-traumatic stress symptoms specifically within individuals diagnosed with schizophrenia. A multicentre randomized controlled single-blinded trial with assessments at 0 months, 6 months (post-treatment) and 12 months (follow-up) was conducted. A total of 61 participants diagnosed with schizophrenia and exhibiting post-traumatic stress symptoms were recruited. Those randomized to treatment were offered up to 16 sessions of cognitive-behaviour therapy (CBT, including psychoeducation, breathing training and cognitive restructuring) over a 6-month period, with the control group offered routine clinical services. The main outcome was blind rating of post-traumatic stress symptoms using the Clinician Administered PTSD Scale for Schizophrenia. Secondary outcomes were psychotic symptoms as measured by the Positive and Negative Symptom Scale and the Psychotic Symptom Rating Scale. Both the treatment and control groups experienced a significant decrease in post-traumatic stress symptoms over time but there was no effect of the addition of CBT on either the primary or secondary outcomes. The current trial did not demonstrate any effect in favour of CBT. Cognitive restructuring programmes may require further adaptation to promote emotional processing of traumatic memories within people diagnosed with a psychotic disorder.

Mediators and Treatment Factors in Intervention for Children Exposed to Interparental Violence

Changes in children's emotion differentiation, coping skills, parenting stress, parental psychopathology, and parent–child interaction were explored as mediators of treatment factors in two selective preventive group interventions for children exposed to interparental violence (IPV) and their parents. One hundred thirty-four IPV-exposed children (ages 6–12 years, 52% boys) and their parents were randomized to an IPV-focused or common factors community-based group intervention and completed baseline, posttest, and follow-up assessments for posttraumatic stress (PTS). A multilevel model tested mediators that included children's ability to differentiate emotions and coping skills, parenting stress, parental psychopathology, and parent–child interactions. In both conditions, exposure to nonspecific factors, specific factors unrelated to IPV and trauma-specific intervention factors was coded from videotaped child and parent sessions. Improved parental mental health mediated the link between greater exposure to nonspecific treatment factors and decreases in PTS symptoms. In addition, an increase in emotion differentiation and a decrease in parenting stress were associated with a decrease in PTS symptoms. Greater exposure to trauma-specific factors in child sessions was associated with a small decrease in emotion differentiation, an increase in coping skills, and a decrease in PTS symptoms over time. Greater exposure to nonspecific treatment factors in child and parent sessions was associated with more positive parent–child interaction. Parental mental health appears to be an important mechanism of change that can be promoted through exposure to nonspecific factors in parent intervention. For children, the effect of greater exposure to trauma-specific factors in intervention is less clear and may not have clear benefits.

The Dutch version of the Child Posttraumatic Cognitions Inventory: validation in a clinical sample and a school sample

BackgroundWith the inclusion of trauma-related cognitions in the DSM-5 criteria for posttraumatic stress disorder (PTSD), the assessment of these cognitions has become essential. Therefore, valid tools for the assessment of these cognitions are warranted.ObjectiveThe current study aimed at validating the Dutch version of the Child Posttraumatic Cognitions Inventory (CPTCI).MethodWe included children aged 8–19 years in our study and assessed the factor structure, reliability and validity of the CPTCI in a clinical sample (n=184) and a school sample (n=318).ResultsOur results supported the two-factor structure of the CPTCI and showed good internal consistency for the total scale and the two subscales. We found significant positive correlations between the CPTCI and measures of PTSD, depression, and anxiety disorder. The CPTCI correlated negatively with a measure of quality of life. Furthermore, we found significantly higher scores in the clinical sample than in the school sample. For children who received treatment, we found that a decrease in CPTCI scores was accompanied by a decrease in posttraumatic stress symptoms and comorbid problems indicating that the CPTCI is able to detect treatment effects.ConclusionOverall, our results suggest that the Dutch CPTCI is a reliable and valid instrument.

One-year follow-up study of posttraumatic stress disorder among earthquake survivors in Turkey

Earthquakes and their consequences present a major global public health problem. In 1998, a major earthquake struck Southern Turkey. The aims of this study were to describe longitudinally the severity and the course of posttraumatic stress disorder (PTSD) and depression among earthquake survivors in Turkey and to explore risk factors associated with psychiatric disorders. The sample of this study consists of 105 consecutive subjects who used our psychiatric service, via either outpatient clinic or home visit. PTSD was assessed by the Clinician-Administered PTSD Scale for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. The severity of depression was assessed using Beck Depression Inventory. The rates of earthquake-related Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition PTSD were 42% within 1 month and 23% within 13 months. The diagnosis of PTSD was significantly related to the presence of injury and to less social support in the initial assessment. In the follow-up assessment, although the mean total Clinician-Administered PTSD Scale severity score improved significantly, the mean Beck Depression Inventory score did not change significantly. The decrease in posttraumatic stress symptoms 13 months after the earthquake may be related to relatively good living conditions and adequate social and health services. Early mental health intervention may serve to prevent the chronicity of posttraumatic stress reactions among earthquake victims.