Low Levels Of Posttraumatic Stress Disorder Symptoms Research Articles

Narrative therapy online intervention improves post-traumatic stress disorder symptoms, perceived stress, anxiety, and depression in nurses: A randomized controlled trial.

Clinical nurses have symptoms of post-traumatic stress disorder (PTSD), anxiety and depression, which seriously affect their physical and mental health. Narrative therapy (NT), a therapy for trauma-related psychological disorders, may be an effective intervention. The aim of this study was to evaluate the effect of NT on improving PTSD symptoms, perceived stress, anxiety and depression in nurses. A total of 92 participants who were clinical nurses and had positive PTSD symptom screening results were randomly assigned (1:1) to the intervention and control groups. The intervention group received NT and a psychological stress leaflet, while the control group received only a psychological stress leaflet. PTSD, perceived stress, anxiety, and depression were measured before and after the intervention to assess the effect of NT. After the intervention, the intervention group showed significantly lower levels of PTSD symptoms (P=0.025), perceived stress (P=0.033), anxiety (P=0.004), and depression (P=0.015) compared with the control group. Regarding the dichotomous outcomes of PTSD, anxiety, and depression, there was a statistically significant decrease in the number of positive cases of PTSD (P=0.030) and anxiety (P=0.002), while there was no statistically significant change in the number of positive cases of depression (P=0.060). NT is expected to alleviate PTSD symptoms, stress, anxiety, and depression among clinical frontline nurses, and healthcare professionals should consider applying NT to improve nurses' mental health.

Everyday life experiences for evaluating post-traumatic stress disorder symptoms

ABSTRACT Background: Previous research has highlighted the importance of regularizing daily routines for maintaining mental health. Little is known about whether and how regularity of daily routines is associated with reduced post-traumatic stress disorder (PTSD) symptoms. Objective: We aimed to examine the associations between regularity of daily routines and PTSD symptoms in two studies (N = 796). Method: In Study 1, prospective data were analysed with the latent change score model to investigate the association between sustainment of regular daily routines and change in PTSD symptoms over time amid massive civil unrest in Hong Kong in 2019. Study 2 used vignette as a quasi-experimental method to assess the ability of maintaining regular daily routines in face of a major stressor, and tested its associations with PTSD symptoms. Results: In Study 1, increased regularity of diverse daily routines was inversely associated with increased PTSD symptoms amid the civil unrest in Hong Kong (β = −.427 to −.224, 95% confidence intervals [−.543 to −.359, −.310 to −.090], p values < .01). In Study 2, a greater ability to maintain regular daily routines during stress was associated with lower levels of PTSD symptoms (β = −.285 to −.096, 95% confidence intervals [−.379 to −.189, −.190 to −.003], p values < .05). Conclusions: Our findings suggest the benefit of considering diverse everyday activities in evaluating PTSD symptoms in both clinical and subclinical populations. Interventions with the direct focus on the role of daily living could promote psychological resilience during and after potentially traumatic events.

Psychometric properties of the post-traumatic stress disorder checklist for DSM-5 (PCL-5) in Chinese stroke patients

BackgroundStroke is a devastating disease and can be sufficiently traumatic to induce post-traumatic stress disorder (PTSD). Post-stroke PTSD is attracting increasing attention, but there was no study assessing the psychometric properties of the PCL-5 in stroke populations. Our study was conducted to examine the psychometric properties of the PTSD Checklist for DSM-5 (PCL-5) in Chinese stroke patients.MethodsThis was a cross-sectional observational study conducted at our hospital. Three hundred and forty-eight Chinese stroke patients came to our hospital for outpatient service were recruited. They were instructed to complete the PCL-5 scales and were interviewed for PTSD diagnosis with the Clinician Administered PTSD Scale for DSM-5 (CAPS-5). The cutoff scores, reliability and validity of the PCL-5 were analyzed.ResultsPCL-5 scores in our sample were positively skewed, suggesting low levels of PTSD symptoms. The reliability of PCL-5 was good. Exploratory and confirmatory factor analyses indicated acceptable construct validity, and confirmed the multi-dimensionality of the PCL-5. By CFA analysis, the seven-factor hybrid model demonstrated the best model fit. The PCL-5 also showed good convergent validity and discriminant validity. Receiver operating characteristic (ROC) analyses revealed a PCL-5 score of 37 achieved optimal sensitivity and specificity for detecting PTSD.ConclusionsOur findings supported the use of PCL-5 as a psychometrically adequate measure of post-stroke PTSD in the Chinese patients.

Attention Control Training for the Prevention of Posttraumatic Stress Disorder in Firefighters: A Randomized Controlled Trial

Background: Firefighters are at high risk for developing posttraumatic stress disorder (PTSD), with attention bias being a contributing factor. Attention Control Training (ACT) is a cognitive behavioral intervention for PTSD treatment and prevention, but its effectiveness for firefighters is unverified. Methods: A randomized controlled trial involving the Kunming Training Brigade of the Fire Rescue Bureau assessed the impact of four weeks of ACT exercises on PTSD symptoms, attention bias, and attention-bias variability. Results: 180 individuals were randomized into two groups. Within groups, there was a significant decrease in PTSD symptoms from pre- to post-intervention for both the intervention and control groups. Additionally, a comparison of post-intervention PTSD symptoms between the intervention and control groups showed a statistically significant difference, with the intervention group showing lower levels of PTSD symptoms than the control group (U = 4688, p = 0.048, r = -0.148). The post-intervention analysis also revealed a statistically significant difference in ABV between the intervention and control groups, with the intervention group showing a greater reduction in ABV than the control group (U = 4766, p = 0.041, r = -0.153). Conclusions: The present study provides evidence that ACT can be an effective intervention for preventing PTSD among firefighters. The study highlights the importance of addressing mental health concerns among firefighters and contributes to the development of effective interventions for the prevention of PTSD among high-risk populations. Further research is needed to determine the long-term effectiveness of the intervention and to examine its generalizability to other populations.

For there is nothing either good or bad: a study of the mediating effect of interpretation bias on the association between mindfulness and reduced post-traumatic stress vulnerability

BackgroundDespite increasing interest in the association between mindfulness and reduced trauma vulnerability, and the use of mindfulness in the latest interventions for Post-Traumatic Stress Disorder (PTSD), few studies have examined the mechanisms through which mindfulness may influence post-trauma psychopathology. The present study aimed to determine whether negative interpretation bias, the tendency to interpret ambiguous information as negative or threatening rather than positive or safe, mediates the association between higher levels of trait mindfulness and lower levels of PTSD symptoms. Negative interpretation bias was examined due to prior evidence indicating it is associated with being less mindful and post trauma psychopathology.MethodsThe study examined 133 undergraduate students who reported exposure to one or more potentially traumatic events in their lifetime. Participants completed self-report measures of trait mindfulness (Five Facet Mindfulness Questionnaire – Short Form; FFMQ-SF) and PTSD symptoms (Post-Traumatic Stress Disorder Checklist – Civilian version; PCL-C) as well an interpretation bias task that assessed the degree to which participants interpreted a range of everyday hypothetical scenarios to be threatening to their physical and/or psychological wellbeing.ResultsResults of a mediation analysis indicated a significant negative direct effect of trait mindfulness on PTSD symptomatology (p < .001). There was no evidence that negative interpretation bias mediated this relationship [BCa CI [-0.04, 0.03)], nor was it associated with trait mindfulness (p = .90) and PTSD symptomatology (p = .37).ConclusionsThe results of the current study provide further evidence of the link between trait mindfulness and reduced post-trauma psychopathology while providing no support for the role of negative interpretation bias in this relationship.

Investigating the Feasibility, Acceptability and Efficacy of Using Modified-Written Exposure Therapy in the Aftermath of a Terrorist Attack on Symptoms of Posttraumatic Stress Disorder Among Afghan Adolescent Girls.

BackgroundThe aim of this study was to assess the efficacy, acceptability and feasibility of using modified written exposure therapy (m-WET) to treat symptoms of posttraumatic stress disorder (PTSD) in Afghan adolescent girls in the aftermath of a terrorist attack.Methods120 Afghan (Hazara) adolescent girls who had been exposed to the Sayed al-Shuhada school terrorist attack were randomly assigned to the m-WET (n = 40), trauma-focused cognitive behavior therapy (TF-CBT) (n = 40), or control groups (n = 40). m-WET involved five consecutive daily group sessions where participants simply wrote about the terrorist attack including thoughts and feelings. TF-CBT was an intensive five-session group intervention. The control group had no additional contact. The trial was undertaken at a local non-government organization in Kabul. The primary analysis was comparing PTSD symptoms (Child Revised Impact of Event Scale-13) in the three groups at post-intervention and three-month follow-up.ResultsOverall, participant and facilitator satisfaction with m-WET was high. Acceptability of m-WET was relatively high, with 15% drop-out in the m-WET group and all m-WET sessions were attended. While the groups did not differ significantly in PTSD symptoms at baseline, the m-WET group had significantly lower levels of PTSD symptoms compared to the control group at post-intervention and follow-up. There was no significant difference between the m-WET and TF-CBT groups.ConclusionThe findings suggest m-WET may be promising intervention for the treatment of PTSD among adolescent girls in humanitarian settings. Further research in the area is warranted.

Attention-control training as an early intervention for veterans leaving the military: A pilot randomized controlled trial.

Transitioning out of the military can be a time of change and challenge. Research indicates that altered threat monitoring in military populations may contribute to the development of psychopathology in veterans, and interventions that adjust threat monitoring in personnel leaving the military may be beneficial. Australian Defence Force personnel (N = 59) transitioning from the military were randomized to receive four weekly sessions of either attention‐control training or a placebo attention training. The primary outcome was symptoms of posttraumatic stress disorder (PTSD), as measured using the PTSD Checklist for DSM‐5 (PCL‐5) at posttreatment. Following training, participants who received attention‐control training reported significantly lower levels of PTSD symptoms, Hedges’ g = 0.86, 95% CI [0.37, 1.36], p = .004, and significantly improved work and social functioning, Hedges’ g = 0.93, 95% CI [0.46, 1.39], p = .001, relative to those in the placebo condition. Moreover, no participants who received attention‐control training worsened with regard to PTSD symptoms, whereas 23.8% of those who received the placebo attention training experienced an increase in PTSD symptoms. The preliminary findings from this pilot study add to a small body of evidence supporting attention‐control training as a viable indicated early intervention approach for PTSD that is worthy of further research.

The influence of risk perception for COVID-19 pandemic on posttraumatic stress disorder in healthcare workers: A survey from four designated hospitals.

The aim of current study was to investigate risk perception of COVID‐19 pandemic, sleep quality and time change of leisure activity and their correlations with posttraumatic stress disorder (PTSD) in healthcare workers (HCWs) from four designated hospitals in China. Medical staffs (n = 317) from three designated hospitals in Guangdong Province and one designated hospital in Guangxi Province were surveyed on their demographic information, sleep quality and time change of leisure activity, risk perception of pandemic and PTSD symptoms (by using PTSD checklist for DSM‐5 (PCL‐5)). Hierarchical regression and structural equation model (SEM) were used to examine the correlated factors of PTSD. The prevalence of high level of PTSD symptoms (PCL‐5 > =33, a probable diagnosis of PTSD) was 10.7%. Regression analysis found that risk perception (dread: β = 0.142, p < 0.01; familiarity: β = 0.203, p < 0.01), sleep quality (β = 0.250, p < 0.001), time change of leisure activity (β = −0.179, p < 0.01), were independently correlated with PTSD severity, which was further confirmed by SEM. Locations of COVID‐19‐related hazards were significant different in cognitive map of risk perception between groups with high and low levels of PTSD symptoms. Risk perception of COVID‐19 pandemic influenced PTSD symptoms in HCWs. Adequate time for leisure activity and good sleep quality protected some HCWs against PTSD symptoms under the influence of pandemic. More researches were warranted to understand the path from pre‐factors of risk perception to its psychological consequences among HCWs.

Predeployment neurocognitive functioning predicts postdeployment posttraumatic stress in Army personnel.

The Fort Campbell Cohort study was designed to assess predeployment biological and behavioral markers and build predictive models to identify risk and resilience for posttraumatic stress disorder (PTSD) following deployment. This article addresses neurocognitive functioning variables as potential prospective predictors. In a sample of 403 soldiers, we examined whether PTSD symptom severity (using the PTSD Checklist) as well as posttraumatic stress trajectories could be prospectively predicted by measures of executive functioning (using two web-based tasks from WebNeuro) assessed predeployment. Controlling for age, gender, education, prior number of deployments, childhood trauma exposure, and PTSD symptom severity at Phase 1, linear regression models revealed that predeployment sustained attention and inhibitory control performance were significantly associated with postdeployment PTSD symptom severity. We also identified two posttraumatic stress trajectories utilizing latent growth mixture models. The "resilient" group consisted of 90.9% of the soldiers who exhibited stable low levels of PTSD symptoms from pre- to postdeployment. The "increasing" group consisted of 9.1% of the soldiers, who exhibited an increase in PTSD symptoms following deployment, crossing a threshold for diagnosis based on PTSD Checklist scores. Logistic regression models predicting trajectory revealed a similar pattern of findings as the linear regression models, in which predeployment sustained attention (95% CI of odds ratio: 1.0109, 1.0558) and inhibitory control (95% CI: 1.0011, 1.0074) performance were significantly associated with postdeployment PTSD trajectory. These findings have clinical implications for understanding the pathogenesis of PTSD and building preventative programs for military personnel. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Hope, optimism, self-efficacy, and posttraumatic stress disorder: A meta-analytic review of the protective effects of positive expectancies.

The present meta-analysis consolidated research examining how positive expectancies (e.g., hope, self-efficacy, and optimism) may protect against the development of posttraumatic stress disorder (PTSD). Articles were identified by searching PILOTS, PsycINFO, PubMed, and ProQuest Dissertations and Theses databases. Aggregated results from 154 studies indicated that positive expectancies were associated with lower levels of PTSD symptoms. This relationship was stronger for coping-specific self-efficacy (k = 38, r = -.49; -.54 to -.43) and hope (k = 20, r = -.34; -.39 to -.28) compared with general self-efficacy (k = 45, r = -.25; -.30 to -.20) and optimism (k = 59, r = -.29; -.33 to -.25) when examining cross-sectional studies, and results were consistent in prospective studies. Age and gender did not moderate the cross-sectional relationships. These findings indicate that positive expectancies predict post-trauma resilience. Future research should identify moderators and examine positive expectancies as mechanisms of change in therapy.

Interactive effects of PTSD and substance use on suicidal ideation and behavior in military personnel: Increased risk from marijuana use.

The current study examines the unique and interactive effects of posttraumatic stress disorder (PTSD) symptoms and days using alcohol, opioids, and marijuana on PTSD symptoms, suicidal ideation, and suicidal behavior up to 1 year, later in a high-risk sample of military personnel not active in mental health treatment. Current and former military personnel at risk for suicide (N = 545; M age = 31.91 years, standard deviation = 7.27; 88.2% male) completed self-report measures of PTSD symptoms, past 30 days heavy alcohol use, opioid use, marijuana use, and current suicidal ideation via telephone at baseline and 1, 3, 6, and 12 months later. PTSD symptoms and the substance use variables (and relevant covariates) were entered as predictors of changes in PTSD symptoms, the likelihood of suicidal ideation, suicidal ideation severity, and the likelihood of suicidal behavior during the 11-month follow-up period. PTSD symptoms predicted PTSD symptoms 1 month later. PTSD symptoms and marijuana use predicted the likelihood of suicidal ideation 1 month later and suicidal behavior during the 11-month follow-up period. The interaction between PTSD symptoms and marijuana use significantly predicted increased PTSD symptoms over time and suicidal behavior. At high, but not low levels of PTSD symptoms, more days using marijuana predicted increased PTSD symptoms over time and the likelihood of suicidal behavior. Results suggest marijuana, especially for military personnel experiencing elevated PTSD symptoms may negatively impact suicidal thoughts and behavior. These results are relevant to suggestions that medical marijuana could be used in treating or augmenting treatment for PTSD.

A common neural substrate for elevated PTSD symptoms and reduced pulse rate variability in combat-exposed veterans.

Previous studies have identified reduced heart rate variability (HRV) in post-traumatic stress disorder (PTSD), which may temporally precede the onset of the disorder. A separate line of functional neuroimaging research in PTSD has consistently demonstrated hypoactivation of the ventromedial prefrontal cortex (vmPFC), a key aspect of a descending neuromodulatory system that exerts inhibitory control over heart rate. No research to date, however, has simultaneously investigated whether altered vmPFC activation is associated with reduced HRV and elevated PTSD symptoms in the same individuals. Here, we collected fMRI data during alternating conditions of threat of shock and safety from shock in 51 male combat-exposed veterans with either high or low levels of PTSD symptoms. Pulse rate variability (PRV)-a HRV surrogate calculated from pulse oximetry-was assessed during a subsequent resting scan. Correlational analyses tested for hypothesized relationships between reduced vmPFC activation, lower PRV, and elevated PTSD symptomatology. We found that PTSD re-experiencing symptoms were inversely associated with high-frequency (HF)-PRV, thought to primarily reflect parasympathetic control of heart rate, in veterans with elevated PTSD symptoms. Reduced vmPFC activation for the contrast of safety-threat was associated both with lower HF-PRV and elevated PTSD re-experiencing symptoms. These results tie together previous observations of reduced HRV/PRV and impaired vmPFC function in PTSD and call for further research on reciprocal brain-body relationships in understanding PTSD pathophysiology.

The efficacy of memory specificity training in improving symptoms of post-traumatic stress disorder in bereaved Afghan adolescents

The main objective of this study was to study the effectiveness of memory specificity training (MEST) on the symptoms of post-traumatic stress disorder (PTSD) of bereaved Afghan adolescents. Participants were bereaved Afghan adolescents with PTSD and depressive symptomatology and were randomly assigned into the MEST, trauma-focused cognitive behavioural therapy (TF-CBT) and a control group. In this study, a quasi-experimental design with pretest–post-test and follow-up with experimental and control groups was used. The instruments used were the Impact of Event Scale-Revised, Persian versions of the Mood and Feelings Questionnaire, clinical interview and demographic questionnaire. Post-intervention, the MEST and TF-CBT groups had significantly lower levels of PTSD symptoms compared with the control group. There was no significant difference between the MEST and TF-CBT groups. These effects were maintained at 12 weeks. Post-intervention, the MEST and TF-CBT groups also had significantly lower levels of depression symptoms compared with the control group.The findings of this small pilot study suggest that MEST is a promising intervention for the treatment of PTSD and a larger randomized controlled trial is warranted.

Emotional distress and positive and negative memories from military deployment: the influence of PTSD symptoms and time

ABSTRACTDuring military deployment, soldiers are confronted with both negative and positive events. What is remembered and how it affects an individual is influenced by not only the perceived emotion of the event, but also the emotional state of the individual. Here we examined the most negative and most positive deployment memories from a company of 337 soldiers who were deployed together to Afghanistan. We examined how the level of emotional distress of the soldiers and the valence of the memory were related to the emotional intensity, experience of reliving, rehearsal and coherence of the memories, and how the perceived impact of these memories changed over time. We found that soldiers with higher levels of post-traumatic stress disorder (PTSD) symptoms were more affected by both their negative and positive memories, compared with soldiers with lower levels of PTSD symptoms. Emotional intensity of the most negative memory increased over time in the group with highest levels of PTSD symptoms, but dropped in the other groups. The present study adds to the literature on emotion and autobiographical memory and how this relationship interacts with an individual’s present level of emotional distress and the passage of time.

Treatment of substance use disorders: Effects on patients with higher or lower levels of PTSD symptoms

While guidelines advise integrated treatment of patients with substance use disorder (SUD) and posttraumatic stress disorder (PTSD), recent studies and reviews find no convincing evidence of different outcomes following treatment between non-trauma focused integrated programs and SUD treatment alone. In this study, we analyzed whether SUD patients with higher levels of PTSD symptoms receiving standard, non-integrated SUD treatment (N=145) differed in outcomes compared to patients with lower levels of PTSD symptoms (N=152). Patients with higher levels of PTSD symptoms showed no difference in days of substance use, but significantly more craving and psychiatric symptoms (depression, anxiety and stress) were measured at baseline. After 3 and 6months of SUD treatment, there was no difference between the groups in decreased days of substance use. After 6months of SUD treatment, depression, anxiety and stress were significantly diminished in both groups. However, those with higher levels of PTSD symptoms at the start of the SUD treatment still reported significantly higher scores on depression, anxiety and stress after 6months of SUD treatment. These findings corroborate earlier studies that SUD patients with PTSD symptoms do not necessarily have poorer addiction treatment outcomes. However, as anxiety and PTSD symptoms predict relapse, future research should note the effect of higher symptom levels on long-term SUD treatment results. Additionally, more research is needed to determine which patients need additional treatment in conjunction with or following SUD treatment.

Correlates of cognitive flexibility in veterans seeking treatment for posttraumatic stress disorder.

This study examined the association between cognitive flexibility and variables that may be associated with treatment outcome for 579 veterans seeking Veterans Health Administration treatment for posttraumatic stress disorder (PTSD) secondary to combat or sexual trauma. Factors associated with severity of PTSD (level of PTSD symptoms and guilt cognitions) and with PTSD prognosis (posttraumatic growth and optimistic expectations for the future) were examined. Regression analyses revealed that cognitive flexibility was associated with lower levels of PTSD symptoms and fewer guilt cognitions. Cognitive flexibility was positively associated with posttraumatic growth and optimistic expectations for the future, even when controlling for PTSD severity. These results suggest that interventions designed to increase cognitive flexibility in veterans may be a worthwhile adjunct to treatment for PTSD as we continue efforts to improve treatment outcomes.

The effect of deployment to a combat zone on testosterone levels and the association with the development of posttraumatic stress symptoms: A longitudinal prospective Dutch military cohort study.

There is limited evidence on the association of the activity of HPG-axis with stress and symptoms of stress-related disorders. The aim of the current study was to assess the effect of deployment to a combat zone on plasma testosterone levels, and the possible association with the development of symptoms of posttraumatic stress disorder (PTSD). A total of 918 males were included in the study before deployment to a combat zone in Afghanistan. The effect of deployment on testosterone was longitudinally assessed; starting prior to deployment and follow-up assessments were preformed at 1 and 6 months after return. Furthermore, the association with PTSD symptoms reported at 1 and 2 years post-deployment was assessed. Plasma testosterone levels were significantly increased after deployment compared with pre-deployment levels. Although no difference was found between individuals reporting high or low levels of PTSD symptoms, pre-deployment testosterone levels predicted the development of PTSD symptoms at 1 and 2 years post-deployment. This study provides evidence that not the alterations in testosterone levels shortly after deployment, but the pre-deployment testosterone levels are associated with PTSD symptoms, which is of value in the identification of biological vulnerability factors for the development of PTSD.

The Effects of Alcohol Problems, PTSD, and Combat Exposure on Nonphysical and Physical Aggression Among Iraq and Afghanistan War Veterans.

Aggression among combat veterans is of great concern. Although some studies have found an association between combat exposure and aggressive behavior following deployment, others conclude that aggression is more strongly associated with symptoms of posttraumatic stress disorder (PTSD), and that alcohol misuse may influence this association. Many of these studies have assessed aggression as a single construct, whereas the current study explored both nonphysical aggression only and physical aggression in a sample of Iraq and Afghanistan war veterans (N = 337; 91% male). We found that alcohol problems interacted with PTSD symptom severity to predict nonphysical aggression only. At low levels of PTSD symptoms, veterans with alcohol problems were more likely to perpetrate nonphysical aggression only, as compared with no aggression, than veterans without an alcohol problem. There was no difference in the likelihood of nonphysical aggression only between those with and without alcohol problems at high levels of PTSD symptoms. The likelihood of nonphysical aggression only, as compared with no aggression, was also greater among younger veterans. Greater combat exposure and PTSD symptom severity were associated with an increased likelihood of perpetrating physical aggression, as compared with no aggression. Ethnic minority status and younger age were also associated with physical aggression, as compared with no aggression. Findings suggest that a more detailed assessment of veterans' aggressive behavior, as well as their alcohol problems and PTSD symptoms, by researchers and clinicians is needed in order to determine how best to intervene.

Fear Extinction Requires Multipronged Intervention

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

Posttraumatic growth and recovery in people with first episode psychosis: an investigation into the role of self-disclosure

The study investigated the relationship of self-disclosure about a psychotic episode to posttraumatic stress symptoms, posttraumatic growth (PTG) and recovery following psychosis. Thirty-four participants who had experienced a first episode of psychosis completed the Impact of Events Scale-Revised, Disclosure of Trauma Questionnaire (a measure of need for, and resistance to, disclosure), a measure of actual self-disclosure, Posttraumatic Growth Inventory and Process of Recovery Questionnaire. The results highlighted that degree of self-disclosure about a psychotic episode was associated with lower levels of posttraumatic stress disorder (PTSD) and higher levels of PTG and recovery. Low PTSD symptoms, high recovery, high actual self-disclosure and low reluctance to talk were significantly related to high PTG. However, only low levels of PTSD symptoms significantly predicted recovery. Finally, recovery was found to mediate the relationship between self-disclosure and PTG. The findings are discussed in terms of the PTG model. Clinically, the findings suggest that people with early psychosis may benefit from disclosing their experiences of psychosis, including those aspects that were traumatic, as this may support the processes of recovery and PTG.