Exacerbation Of Posttraumatic Stress Disorder Symptoms Research Articles

Predicting PTSD severity from experiences of trauma and heterosexism in lesbian and bisexual women: A longitudinal study of cognitive mediators.

Sexual minority women (SMW) are at high risk of trauma exposure and, subsequently, the development of posttraumatic stress disorder (PTSD). The authors extended a theoretical model explaining the higher risk of mental disorders in minority populations to the maintenance and exacerbation of PTSD symptoms among young adult SMW specifically. This study used observational longitudinal data from a sample of 348 trauma-exposed 18- to 25-year-old individuals assigned female sex at birth who identified as either bisexual (60.1%) or lesbian (39.9%) and met screening criteria for PTSD. Participants identified as White (82.8%), Hispanic/Latina (12.4%), American Indian/Alaska Native (13.5%), Black/African American (13.8%), and/or Asian/Asian American (4.9%). The authors investigated whether distal stressors (i.e., criterion A traumatic events, daily experiences of heterosexism) produced proximal stressors (i.e., trauma-related cognitions, internalized heterosexism) that maintained or exacerbated PTSD symptoms. Findings indicated that daily heterosexism longitudinally predicted trauma-related cognitions (i.e., cognitions related to the self, world, and self-blame). Internalized heterosexism and cognitions about the self longitudinally predicted PTSD symptom severity. In addition, a significant indirect effect was identified between daily heterosexism and PTSD symptoms via self-related posttraumatic cognitions. These findings suggest that exposure to minority-specific distal stressors appears to promote nonminority-specific cognitive processes that, in turn, may maintain or exacerbate PTSD among young adult SMW exposed to trauma. Clinicians should consider addressing daily heterosexism in young adult SMW presenting with PTSD and evaluate how these experiences might promote clients' global, negative views regarding themselves. (PsycINFO Database Record

Treatment of sleep disturbances in trauma-affected refugees: Study protocol for a randomised controlled trial

BackgroundSleep disturbances are often referred to as a hallmark and as core symptoms of post-traumatic stress disorder (PTSD). Untreated sleep disturbances can contribute to the maintenance and exacerbation of PTSD symptoms, which may diminish treatment response and constitute a risk factor for poor treatment outcome. Controlled trials on treatment of sleep disturbances in refugees suffering from PTSD are scarce. The present study aims to examine sleep-enhancing treatment in refugees with PTSD. We aim to assess if add-on treatment with mianserin and/or Imagery Rehearsal Therapy (IRT) to treatment as usual (TAU) for PTSD improves sleep disturbances. We will study the relation between sleep disturbances, PTSD symptoms, psychosocial functioning and quality of life.MethodsThe study is a randomised controlled superiority trial with a 2 × 2 factorial design. The study will include 230 trauma-affected refugees.The patients are randomised into four groups. All four groups receive TAU – an interdisciplinary treatment approach covering a period of 6–8 months with pharmacological treatment, physiotherapy, psychoeducation and manual-based cognitive behavioural therapy within a framework of weekly sessions with a physician, physiotherapist or psychologist. One group receives solely TAU, serving as a control group, while the three remaining groups are active-treatment groups receiving add-on treatment with either mianserin, IRT or a combination of both.Treatment outcome is evaluated using self-administered rating scales, observer ratings and actigraph measurements at baseline, during treatment and post treatment. The primary outcome is subjective sleep quality using the Pittsburgh Sleep Quality Index. Secondary outcome measures are objective sleep length, nightmares, PTSD severity, symptoms of depression and anxiety, pain, quality of life and psychosocial functioning.DiscussionThis trial will be the first randomised controlled trial to examine sleep-enhancing treatment in trauma-affected refugees, as well as the first trial to investigate the effect of IRT and mianserin in this population. Therefore, this trial may optimise treatment recommendations for sleep disturbances in trauma-affected refugees. Based on our findings, we expect to discuss the effect of treatment, focussing on sleep disturbances. Furthermore, the results will provide new information regarding the association between sleep disturbances, PTSD symptoms, psychosocial functioning and quality of life in trauma-affected refugees.Trial registrationEudraCT registration under the name ‘Treatment of sleep disturbances in trauma-affected refugees – a randomised controlled trial’, registration number: 2015-004153-40, registered on 13 November 2015.ClinicalTrials.gov, ID: NCT02761161. Registered on 27 April 2016.

Case Study of Acceptance Commitment Therapy for Childhood Onset Posttraumatic Stress Disorder: A Patient’s Unique Use of the Lord’s Prayer

Case Study of Acceptance Commitment Therapy for Childhood Onset Posttraumatic Stress Disorder: A Patient’s Unique Use of the Lord’s Prayer Until recently the number of young individuals who met diagnostic criteria for posttraumatic stress disorder (PTSD) represented a small percentage of those exposed to trauma because their symptoms did not meet full criteria for PTSD. Many patients with childhood onset PTSD were classified as suffering from unspecified anxiety, depression or adjustment disorders despite experiencing long lasting PTSD symptoms. With the publication of the fifth edition of the diagnostic and statistical manual of mental disorders (DSM-5), PTSD has been moved from the category of anxiety disorders and reclassified under the new category of Traumaand Stressor-Related Disorders that included a new diagnostic category of childhood onset PTSD. As a result the treatment modalities used for treating adults patients began to be introduced and used in youth with childhood onset PTSD. Acceptance and commitment therapy (ACT) has shown preliminary effectiveness in the treatment of PTSD in adults, but its effectiveness in treating PTSD in youth is still undetermined. This report describes the progression of childhood onset PTSD in a patient who at the age of 17 responded well to a course of Trauma-Focused Cognitive- Behavioral Therapy (TF-CBT) which led to a remission of the distressing feelings associated with recollections of his childhood traumatic events, and significantly decreased his symptoms of anxiety, anger, hypervigilance, and mood lability. However later on and at the age of 21 he experienced an acute exacerbation of PTSD symptoms triggered by an interaction with a person who resembled his childhood abuser. During this acute episode he developed intense homicidal intention toward that person and was admitted to an inpatient psychiatric unit. At the time he could not respond to TF-CBT and consequently received a course ACT to which he responded favorably and his intense homicidal intention subsided. Following his hospital discharge he was transferred to a residential respite care facility for ongoing stabilization and continuation of ACT. Despite the remission of the PTSD symptomatology of intrusion, avoidance, and alterations in cognition, he re-experienced alterations in arousal, with increased recurrent reactivity, along with aggressive thoughts and urges to kill a person at the respite care facility who resembled his childhood abuser. When he began to sing developed a sense of inner peace and made a conscious decision to grant forgiveness to his childhood abuser and that subsequently led to a sustained remission of his homicidal urges not only toward his childhood abuser, but for all individuals who resembled that abuser. The case study provides narrative descriptions of the implementation of the six core therapeutic processes of ACT which include ‘acceptance,’ ‘defusion,’ ‘values,’ ‘committed action,’ ‘the present moment’ and ‘self-as-context’. In addition to describing ACT beneficial effects in the treatment of a young adult patient with childhood onset PTSD, this case illustrate the unique role of singing the Lord’s Prayer on reversing rigid thought patterns, demand for revenge, and ultimately the remission of homicidal intentions. Although the effects of the Lord’s prayer on granting forgiveness and the remission of homicidal intention are interesting and significantly important findings they remain speculative and specifically tied to the patient’s personal religious interpretations and could not be generalized to other patients without the conduction of rigorous randomized double- blind placebo controlled clinical studies.

Ecological Momentary Assessment of Posttraumatic Stress Disorder Symptoms During a Smoking Quit Attempt

Smokers with posttraumatic stress disorder (PTSD) tend to lapse more quickly following a quit attempt, which might be explained by changes in PTSD symptoms during a quit attempt. The present study examines changes in PTSD symptoms, negative affect, and craving before and during a quit attempt. Participants in this study were 52 smokers with PTSD who completed random-alarm ecological momentary assessments of PTSD symptoms, negative affect, cigarette craving, and smoking behavior throughout a prequit phase of ad hoc smoking, a phase of abstinence from smoking, and a postlapse phase. Relative to the prequit phase, the abstinent phase was marked by decreases in PTSD reexperiencing, avoidance, and numbing clusters (ps ≤ .01). The odds of PTSD symptom or negative affect variability from one reading in the ecological momentary assessment (EMA)to the next reading was decreased in PTSD reexperiencing, avoidance, and numbing clusters (ps ≤ .02). Smoking cravings were also mildly decreased in the abstinent and postlapse phases (ps < .01), although some cravings in both phases were rated at the maximum intensity. Increased craving was predicted by the previous EMA reading of PTSD symptoms. Results suggested that smoking abstinence is not associated with exacerbation of PTSD symptoms, but PTSD symptoms during abstinence were related to craving levels during the quit attempt.

Mild traumatic brain injury, meaning made of trauma, and posttraumatic stress: A preliminary test of a novel hypothesis.

Research has demonstrated that a substantial number of veterans returning from Iraq and Afghanistan with mild traumatic brain injury (mTBI) also contend with symptoms of posttraumatic stress disorder (PTSD). One possible contributing factor for the development and/or exacerbation of PTSD symptoms among individuals with mTBI could involve challenges processing trauma and integrating their memories into existing global meaning systems. The goal of this study was to provide a preliminary examination of whether meaning made of trauma could account for the association between mTBI and PTSD (i.e., reexperiencing, avoidance, and hyperarousal symptoms). The sample was comprised of 162 Iraq and/or Afghanistan veterans who presented for health care services at a Department of Veterans Affairs hospital. These veterans completed a two-level evaluation for mTBI as well as a self-report questionnaire assessing demographic and military background factors, meaning made of trauma, and PTSD symptomatology. Drawing on structural equation modeling, results indicated that probable mTBI was indirectly associated with the three domains of PTSD symptomatology via veterans' meaning made of trauma. Although the cross-sectional nature of this study limits the conclusions that can be drawn, these results offer support for difficulties with meaning-making as a contributing factor for risk of PTSD among veterans with mTBI. (PsycINFO Database Record (c) 2013 APA, all rights reserved).

Exacerbation of posttraumatic stress disorder symptoms with medical illness

Chronic posttraumatic stress disorder (PTSD) may increase the risk for associated psychiatric and medical illnesses. In turn, the onset of medical illness may result in an exacerbation of PTSD symptoms leading to excessive or maladaptive psychological and physiological reactions. Five combat veterans with PTSD and medical disease are presented to illustrate this potential for worsening of PTSD with concurrent medical illness. Health care workers in general hospital settings should be aware of unique psychological vulnerabilities in PTSD patients. Prospective studies are needed to assess the impact of medical comorbidity on the course of PTSD.