Posttraumatic Stress Disorder Symptoms Of Intrusion Research Articles

Remediation of intrusive symptoms of PTSD in fewer than five sessions: A 30-person pre-pilot study of the RTM Protocol

Introduction: The Reconsolidation of Traumatic Memories (RTM) Protocol is a brief non-traumatizing intervention for the intrusive symptoms of post-traumatic stress disorder (PTSD). It is supported by nearly 25 years of anecdotal and clinical reports. This study reports the first scientific evaluation of the protocol. Methods: A 30-person pilot study using male Veterans with a pre-existing diagnosis of PTSD. Intake criteria included interviews and confirmatory re-diagnosis using the PTSD Checklist–Military version (PCL-M). Of 33 people who met the inclusion criteria, 26 completed treatment using the RTM protocol. A small ( n = 5) wait-list control group was included. All participants were reassessed following treatment using the PCL-M. Results: Of 26 program completers, 25 (96%) were symptom free at 6-week follow-up. Mean PCL-M score at intake was 61 points. At the 6-week follow-up, the mean PCL-M score was 28.8, with a mean reduction in scores of 33 points. Hedges’ g was computed for 6-week follow-up and showed a 2.9 SD difference from intake to follow-up. A wait-list control analysis indicated non-significant symptom changes during the 2-week wait period. Discussion: Results suggest that RTM is a promising intervention worthy of further investigation.

Peritraumatic dissociation and posttraumatic stress symptoms: the moderating role of perceived threat.

Background: Although peritraumatic dissociation (PD) is viewed as a risk factor for posttraumatic stress disorder (PTSD), prospective studies taking into account other well-known risk factors for PTSD have been scarce, and the exploration of potential moderators within the relations between PD and PTSD has been lacking.Objective: Filling this gap, this prospective study explored the moderating role of perceived threat within the relations between PD and PTSD, above and beyond age, gender, education, and early trauma-related symptoms.Method: A convenience sample of 200 Israeli civilians filled out self-report questionnaires during the peritraumatic phase (T1) and one to two months after the posttraumatic phase (T2) of being exposed to rocket attacks.Results: The results showed that perceived threat and PD were associated with early trauma-related symptoms and PTSD symptoms. Moreover, perceived threat moderated the relationship between PD and all PTSD symptom clusters apart from avoidance.Conclusions: The present results suggest that the implications of PD are shaped by levels of perceived threat, so that detriments of PD are evident when the trauma is appraised as being highly threatening. Therefore, early interventions that aim to decrease PD may be beneficial in preventing PTSD symptoms of intrusion, hyper arousal, and negative alterations in mood and cognition, for individuals who perceive traumatic events as highly threatening.

Associations between changes in resilient coping and posttraumatic stress disorder symptoms.

The pervasive, damaging nature of posttraumatic stress disorder (PTSD) presents enormous clinical challenges. Understanding the relationship between patients' perceptions of PTSD symptoms and resilient coping strategies may prompt investigation of clinical interventions that improve adaptive, resilient coping skills. In this study, we examined whether changes in resilient coping were related to changes over time in the PTSD symptoms of intrusion and avoidance. A secondary analysis was conducted using longitudinal data from the community-based Washington State Twin Registry. Participants completed the four-item Brief Resilient Coping Scale (BRCS) and the Avoidance and Intrusion subscales of the Impact of Events Scale (IES) at two points in time that were at least 2 years apart. To limit analyses to participants reporting PTSD symptoms at baseline, an initial value of at least 1.0 on either Avoidance (n = 1,337) or Intrusion (n = 1,206) was required for inclusion in the sample. Using linear regression, we assessed associations of change in BRCS with a change in IES scores, controlling for the respective initial scores on each measure. Controlling for initial BRCS and IES-Intrusion values, we observed a small, statistically significant association between change in BRCS and change in IES-Intrusion scores (b* = -0.07; p = .003). There was no statistically significant association between change in BRCS and change in IES-Avoidance (b* < 0.01; p = .869). In this large, longitudinal sample, increases in resilient coping were related to decreases in intrusive thoughts over time. Because coping patterns can be taught, these results warrant further investigations into adaptive coping patterns associated with diminishing PTSD symptoms.

Physical, psychological and economic burden of two-wheel users after a road traffic injury: Evidence from intensive care units of three EU countries

Introduction: This study aimed to assess the physical, psychological, and economic burden shouldered by severely injured two-wheel users in three European countries as well as the cost resulting from their hospitalization. Methods: A total of seven public hospitals were involved in three countries: Greece, Italy, and Germany. Participants enrolled during a 12-month period starting in April 2013. Eligibility criteria included an injury sustained at Road Traffic Crashes (RTC) irrespective of the type of vehicle, hospitalization 1 day in the Intensive Care Unit (ICU) or sub-ICU, and age 18 years or over. Patients were interviewed at 1, 6, and 12 months upon admission. The study used widely recommended classifications for injury severity (Abbreviated Injury Severity [AIS]; Maximum Abbreviated Injury Severity [MAIS]) and standardized measures such as the Disability Assessment Schedule II (WHODAS 2.0), “Impact of Event Scale” (IES-R), Center for Epidemiological Studies Depression Scale (CES-D Scale). Health Care Expenditure was assessed through the Monash University Accident Research Centre (MUARC's) framework, which included measures of ‘Direct’ and ‘Indirect’ costs. Diagnosis-related groups (DRGs) were used to estimate hospitalization costs. Results: A total of 54 two-wheel users enrolled in the study in all the countries and 32 completed all follow-up questionnaires. Physical disability increased over 12 months following the injury. Post Traumatic Stress Disorder (PTSD) symptoms of avoidance remained at high levels over the study period. PTSD symptoms of intrusion improved significantly during the second half of the year under investigation. The total annual cost of injury for the two-wheel users who were hospitalized in the selected ICU of all the partner countries for severe injury in 2013/2014, was estimated at €714,491 made up of €123,457 direct and €591,034 indirect costs. Men, aged 50–64 years and those who sustained slight injuries primarily at the lower extremities presented higher indirect costs per person. A total of €1032.092 was spent on hospitalization payments. Women, aged 65+ and those who sustained severe injuries at the central body region presented higher direct costs per person. Women, aged 50–64 years, those with severe injuries and a major injury at the central body and the upper body region presented the highest hospitalization costs per person. Conclusions: There is a need for effective strategies to early detect and treat groups at risk of being confronted with prolonged psychosocial and economic consequences. Practical implications: A holistic understanding of the impact of injury on individuals is important in order to achieve effective treatment of psychological co-morbidities in a timely manner.

Longitudinal Linkages Between Posttraumatic Stress Disorder Symptoms and Violent Behaviors Among Chinese Adolescents Following the Wenchuan Earthquake

ABSTRACTThis study was conducted to examine the longitudinal relations between posttraumatic stress disorder (PTSD) symptoms and violent behaviors. In this study, 415 adolescent survivors of the Wenchuan earthquake in China (May 12, 2008) were assessed by using self-report questionnaires 1 year (T1), 1.5 years (T2), and 2 years (T3) after the earthquake. The findings suggested that from 1 to 1.5 years after the earthquake, only intrusive symptoms of PTSD were a risk factor for violent behaviors, whereas violent behaviors were a risk factor for all 3 PTSD symptom clusters. Furthermore, 1.5 to 2 years after the earthquake, avoidance symptoms of PTSD were a risk factor for violent behaviors and hyperarousal symptoms of PTSD had no significant relation with violent behaviors.

Remediation of intrusive symptoms of PTSD in fewer than five sessions: a 30-person pre-pilot study of the RTM Protocol

Introduction: The Reconsolidation of Traumatic Memories (RTM) Protocol is a brief non-traumatizing intervention for the intrusive symptoms of post-traumatic stress disorder (PTSD). It is supported by nearly 25 years of anecdotal and clinical reports. This study reports the first scientific evaluation of the protocol. Methods: A 30-person pilot study using male Veterans with a pre-existing diagnosis of PTSD. Intake criteria included interviews and confirmatory re-diagnosis using the PTSD Checklist–Military version (PCL-M). Of 33 people who met the inclusion criteria, 26 completed treatment using the RTM protocol. A small ( n = 5) wait-list control group was included. All participants were reassessed following treatment using the PCL-M. Results: Of 26 program completers, 25 (96%) were symptom free at 6-week follow-up. Mean PCL-M score at intake was 61 points. At the 6-week follow-up, the mean PCL-M score was 28.8, with a mean reduction in scores of 33 points. Hedges’ g was computed for 6-week follow-up and showed a 2.9 SD difference from intake to follow-up. A wait-list control analysis indicated non-significant symptom changes during the 2-week wait period. Discussion: Results suggest that RTM is a promising intervention worthy of further investigation.

Thought Control Strategies and Rumination in Youth with Acute Stress Disorder and Posttraumatic Stress Disorder Following Single-Event Trauma

Certain thought control strategies for managing the intrusive symptoms of posttraumatic stress disorder (PTSD) are thought to play a key role in its onset and maintenance. Whereas measures exist for the empirical assessment of such thought control strategies in adults, relatively few studies have explored how children and adolescents manage posttraumatic intrusive phenomena. In a prospective longitudinal study of 10-16-year-olds with PTSD, who were survivors of road traffic collisions and assaults, a variety of thought control strategies were assessed in the acute phase. These included strategies thought to be protective (reappraisal, social support) as well as maladaptive (distraction, punishment, worry). Ruminative responses to the trauma were assessed at the follow-up assessment. Posttraumatic stress symptoms (PTSS) at each assessment were associated with the use of punishment and reappraisal, whereas social support and rumination were associated with PTSS symptoms at follow-up. Distraction was unrelated to PTSS at any time point. Rumination accounted for variance in PTSS symptoms at follow-up, even when accounting for baseline PTSS, and was found to mediate the relationships between reappraisal and punishment at baseline and PTSS at the follow-up assessment. The present study found no evidence to support advocating any particular thought control strategy for managing the intrusive symptoms of PTSD in youth in the acute posttrauma phase, and raised concerns over the use of reappraisal coping strategies. The study underscores the importance of ruminative responses in the onset and maintenance of PTSD in trauma-exposed youth.

Evidence for a psychotic posttraumatic stress disorder subtype based on the National Comorbidity Survey

This study assessed the distribution of posttraumatic stress disorder (PTSD) symptoms and psychosis indicators among a large sample of individuals with a lifetime diagnosis of PTSD. The identification of a psychotic PTSD subtype was also predicted. Using data from the National Comorbidity Survey a latent class analysis was conducted on the PTSD symptoms of intrusion, avoidance, and hyperarousal and the psychosis hallucination and delusion indicators. Results indicated four latent classes, two of which had relatively high probabilities of endorsing the hallucination and delusion indicators. These classes were associated with a broad range of traumatic experiences. One particular class had high probabilities of endorsing both the psychosis indicators and the PTSD symptoms and was associated with a broad range of comorbid psychiatric disorders. There was a candidate class that met the characteristics expected to be evident in a psychotic PTSD subtype.

P03-238 Erectile dysfunction in war veterans in Bosnia-Herzegovina

Results of previous studies suggest that people with traumatic experiences frequently have sexual problems. This study aimed to assess erectile function in war veterans. One hundred and five war veterans were tested using the Harvard Trauma Questionnaire (HTQ) and the International Index of Erectile Function (IIEF). They were divided into two groups; those with symptoms of Posttraumatic Stress Disorder (PTSD) and those without, measured with the HTQ. We tested war veterans that hadn"t been using psychotropic or other medications that could cause sexual dysfunction and who did not have either a physical or psychological disease and were not alcohol or drug addicts. The average age of the group tested was 40.84±5.94 years. All participants had had a sexual partner for longer than 6 months. We found that 67.6% of all tested veterans showed below normal erectile function. Average results of erectile function in both groups were 22.10±5.73 as measured by the IIEF. Participants without PTSD symptoms had significantly better results of erectile functioning (χ2=44.62, p=0.001). There was a significant negative corrrelation (p&lt;0.01) between the intensity of PTSD symptoms of intrusion, avoidance and hyperarousal and the intensity of sexual dysfunction as measured by the IIEF. War veterans with more intensive symptoms of PTSD and a higher number of traumatic experiences have more problems with sexual functioning.

(336/934): Clinical relationship between chronic pain and chronic combat related post traumatic stress disorder

Recent research and clinical practice suggest that there is strong interdependence between chronic pain and chronic post-traumatic stress disorder (PTSD), and there are several pathways by which both disorders may be involved in the escalation of symptoms and distress following trauma. The authors analysed the relationship between chronic pain and chronic combat-related PTSD among Croatian veterans. The 150 patients with chronic combat-related PTSD and chronic pain, who were treated at the Osijek University Clinical Hospital during year 2005, were selected as the sample for this study. On the base of clinical interviews, medical records and different self reported questionnaires (Mississippi Scale for combat-related PTSD, Mc Gill Pain Questionnaire, Pain Outcomes Questionnaire, Brief Pain Inventory, Beck Depression Inventory) the authors analysed the characteristics of chronic pain and PTSD, as well as pharmacological and non-pharmacological approaches that were used in the treatment. Combat veterans with PTSD reported in descending order back pain, headache pain, limb pain and torso pain. Intrusive symptoms of PTSD were significantly related to pain intensity and pain disability. Anxiety and depression were highly correlated to pain. All patients were treated with psychotropic drugs as well as with analgetics. The high levels of pain symptoms in PTSD patients suggests that pain is an important issue that needs to be recognized and treated by multidisciplinary approach. Rational polypharmacy may be essential to achieving and maintaining the full recovery of both disorders. But, pharmacotherapy alone is no sufficient to provide complete remission, and non-pharmacological methods have also very important place in the treatment of those patients.

Memory for trauma-related information in Holocaust survivors with PTSD

The impact of trauma-related information on memory performance in aging Holocaust survivors with post-traumatic stress disorder (PTSD) was evaluated. Explicit and implicit memory for neutral and Holocaust-related words was assessed in Holocaust survivors with PTSD (PTSD +, n=31), in Holocaust survivors without PTSD (PTSD −, n=17), and in healthy Jewish adults not exposed to the Holocaust (non-exposed, n=34) using the paired associates learning and word-stem completion tests, respectively. The PTSD + group had significantly poorer paired associate recall than the PTSD − and non-exposed groups, and showed a significantly different response to the introduction of Holocaust-related words. The PTSD + group recalled significantly more words from the Holocaust-related than the neutral word pairs, whereas word type had little effect on paired associate recall in the other two groups. In contrast, there were no group differences in implicit memory performance or in the effect of Holocaust-related words on implicit memory. Among Holocaust survivors, explicit recall of Holocaust-related word pairs was associated with intrusive PTSD symptoms. These results suggest that aging Holocaust survivors with PTSD preferentially form new associations with trauma-related stimuli as compared with neutral stimuli. The presence of such a disturbance of associative learning decades after the Holocaust may underlie the persistence of psychological symptoms and, in particular, the intrusive symptoms of PTSD. This trauma-related facilitation of explicit memory, together with generally poorer explicit memory, may help to explain the bi-directional nature of the memory impairments in PTSD.

Forms of Social Support That Moderate PTSD in Childhood Sexual Abuse Survivors

Although social support has been found to attenuate psychological symptoms in victims of sexual abuse, literature does not identify the specific forms of social support that mitigate maladjustment following a sexual abuse experience. This study sought to distinguish the specific types of perceived social support that buffer the development of post-traumatic stress disorder (PTSD) in victims of childhood sexual abuse (CSA). One hundred and seventy-two adult females reporting CSA were administered the Interpersonal Support Evaluation List (ISEL) and the Impact of Events Scale (IES). The ISEL measures the perceived availability of 4 support types. The IES measures core PTSD symptoms of intrusion and avoidance. Regression analysis indicated that social support significantly buffered PTSD development. The best model was one which contained self-esteem and appraisal support. Tangible and belonging support added little to prediction. Further, self-esteem support was identified as the most important variable in preventing PTSD development.

Psychosocial treatment of posttraumatic stress disorder: a practice-friendly review of outcome research.

A review of the treatment research indicates that several forms of therapy appear to be useful in reducing the symptoms of posttraumatic stress disorder (PTSD). Strongest support is found for the treatments that combine cognitive and behavioral techniques. Hypnosis, psychodynamic, anxiety management, and group therapies also may produce short-term symptom reduction. Still unknown is whether any approach produces lasting effects. Imaginal exposure to trauma memories and hypnosis are techniques most likely to affect the intrusive symptoms of PTSD, while cognitive and psychodynamic approaches may address better the numbing and avoidance symptoms. Treatment should be tailored to the severity and type of presenting PTSD symptoms, to the type of trauma experience, and to the many likely comorbid diagnoses and adjustment problems.

Long-term mental sequelae of torture in Iran--who seeks treatment?

In this study, we investigated long-term mental sequelae of torture in Iran and explored differences between treatment seekers and nontreatment seekers. Thirty-four torture victims suffering from enduring mental sequelae and now living in Germany were examined. According to DSM-III-R, depressive, anxiety, and somatoform disorders were diagnosed with a high degree of comorbidity and with posttraumatic stress disorder (PTSD) being the most frequent diagnosis. Treatment seekers had a higher level of psychopathology, particularly the PTSD symptoms of intrusion and increased arousal, and a poorer knowledge of German. They reported different ways of coping. The differences found between the two groups may reflect more or less successful adaptation to conditions in the host country and contribute to the motivation to seek treatment.

Psychosocial treatment of posttraumatic stress disorder

A review of the psychosocial treatment research literature indicates that several forms of therapy appear to be useful in reducing the symptoms of posttraumatic stress disorder (PTSD). Strongest support is found for the treatments that combine cognitive and behavioral techniques. Hypnosis, psychodynamic, anxiety management, and group therapies may also produce short-term symptom reduction. Still unknown is whether any approach produces lasting effects. Imaginal exposure to trauma memories and hypnosis are techniques most likely to affect the intrusive symptoms of PTSD, whereas cognitive and psychodynamic approaches may better address the numbing and avoidance symptom cluster. Treatment should be tailored to the severity and type of presenting PTSD symptoms, to the type of trauma experience, and to the many likely comorbid diagnoses and adjustment problems. © 1997 John Wiley & Sons, Inc.

Fluoxetine in post‐traumatic stress disorder

AbstractFluoxetine was given to five nonveteran patients with post‐traumatic stress disorder (PTSD). The maximum doses ranged from 20 to 80 mglday, and treatment was continued for between 8 and 32 weeks. In contrast to published reports of other drugs, which were noted to improve only the intrusive symptoms of PTSD, fluoxetine was associated with marked improvement of both intrusive and avoidant symptoms. Facilitative effects of fluoxetine were noted on trauma‐focused psychotherapy in two adult victims of childhood sexual trauma. In part, these effects were related to modulating effects of the drug upon the intensity of core PTSD symptoms. Serotonergic drugs appear to hold promise for the treatment of PTSD.

Fluoxetine in post-traumatic stress disorder

Fluoxetine was given to five nonveteran patients with post-traumatic stress disorder (PTSD). The maximum doses ranged from 20 to 80 mglday, and treatment was continued for between 8 and 32 weeks. In contrast to published reports of other drugs, which were noted to improve only the intrusive symptoms of PTSD, fluoxetine was associated with marked improvement of both intrusive and avoidant symptoms. Facilitative effects of fluoxetine were noted on trauma-focused psychotherapy in two adult victims of childhood sexual trauma. In part, these effects were related to modulating effects of the drug upon the intensity of core PTSD symptoms. Serotonergic drugs appear to hold promise for the treatment of PTSD.