Posttraumatic Stress Symptom Severity Research Articles

Posttraumatic stress symptom severity predicts marijuana use coping motives among traumatic event‐exposed marijuana users

The present study examines the relation between posttraumatic stress symptom severity and motives for marijuana use among 103 (55 women) young adult marijuana users (current) who reported experiencing at least one traumatic event in their lifetime. As expected, after covarying for the theoretically relevant variables of frequency of past 30-day marijuana use, number of cigarettes smoked per day, and volume of alcohol consumed, posttraumatic stress symptom severity was significantly related to marijuana use coping motives, but no other motives for marijuana use. Results are discussed in relation to better understanding the role of coping-motivated marijuana use among young adults experiencing posttraumatic stress.

Trauma Exposure and Stress Response: Exploration of Mechanisms of Cause and Effect

People differ markedly in their risk for developing posttraumatic stress symptoms (PTSS) after exposure to traumatic events. Twin studies suggest that the trauma-PTSS relationship is moderated by genetic and environmental influences. The present study tested for specific types of genetic and environmental interaction effects on PTSS. A sample of 222 monozygotic and 184 dizygotic twin pairs reported on lifetime frequency of assaultive and nonassaultive trauma and associated PTSS. Biometric analyses indicated that in the case of nonassaultive trauma, PTSS were directly affected by environmental factors that also influence exposure to nonassaultive trauma. For assaultive trauma both genetic and non-shared environmental influences jointly affected PTSS, and the number of traumatic events moderated the severity of PTSS. Genetic factors were found to become less important beyond some threshold (e.g., 3 or 4 types of serious trauma) suggesting that genetic factors - which may confer either risk or resilience to PTSS - modify these symptoms within a range of human experience, beyond which environmental effects supervene.

The Role of Negative Affect Intensity and the Fear of Emotions in Posttraumatic Stress Symptom Severity Among Victims of Childhood Interpersonal Violence

Heightened negative affect (NA) intensity and the tendency to negatively evaluate emotions may be associated with the development and maintenance of posttraumatic stress symptoms. However, the specific role of these vulnerabilities has yet to be explored. Thus, this study was conducted to examine the influence of NA intensity and the fear of emotions in posttraumatic symptom severity among 102 childhood interpersonal violence victims. Fear of emotions significantly predicted posttraumatic symptom severity above and beyond NA intensity and NA. Findings suggest that posttraumatic outcomes may not be influenced by an underlying vulnerability of heightened NA intensity, but instead, are affected by the extent to which emotional responses are negatively evaluated. Results are discussed in terms of their implications for interventions and future research on posttraumatic responding.

Coping style use predicts posttraumatic stress and complicated grief symptom severity among college students reporting a traumatic loss.

Problem-focused coping, and active and avoidant emotional coping were examined as correlates of grief and posttraumatic stress disorder (PTSD) severity among 123 college students reporting the unexpected death of an immediate family member, romantic partner, or very close friend. The authors administered to participants, via the Internet, 5 survey instruments that measured demographic characteristics, traumatic event exposure (Stressful Life Events Screening Questionnaire; L. Goodman, C. Corcoran, K. Turner, N. Yuan, & B. L. Green, 1998), complicated grief (CG) severity (Inventory of Complicated Grief-Revised-Short Form; A. E. Latham & H. G. Prigerson, 2004; H. G. Prigerson & S. C. Jacobs, 2001), PTSD severity (PTSD Checklist; F. W. Weathers, B. T. Litz, D. S. Herman, J. A. Huska, & T. M. Keane, 1993), and coping style use (Brief COPE; C. S. Carver, 1997). Results demonstrated that CG and PTSD severity were both significantly positively correlated with problem-focused, and active and avoidant emotional coping styles. The authors used path analysis to control for time since the loss and trauma frequency and found that only avoidant emotional coping remained significant in predicting CG and PTSD severity. Results are discussed in terms of their clinical implications for treating individuals with traumatic losses.

A Preliminary Investigation of the Relationship Between Emotion Regulation Difficulties and Posttraumatic Stress Symptoms

This study examined the relationship between posttraumatic stress (PTS) symptoms and particular aspects of emotion regulation difficulties among trauma-exposed individuals. Participants were an ethnically diverse sample of 108 undergraduates from an urban university. PTS symptom severity was found to be associated with lack of emotional acceptance, difficulty engaging in goal-directed behavior when upset, impulse-control difficulties, limited access to effective emotion regulation strategies, and lack of emotional clarity. Further, overall difficulties in emotion regulation were associated with PTS symptom severity, controlling for negative affect. Finally, individuals exhibiting PTS symptoms indicative of a PTSD diagnosis reported greater difficulties with emotion regulation than those reporting PTS symptoms at a subthreshold level. The implications of these findings for research and treatment are discussed.

Imagery Rehearsal Therapy for Acute Posttraumatic Nightmares Among Combat Soldiers in Iraq

Back to table of contents Previous article Next article Letters to the EditorFull AccessImagery Rehearsal Therapy for Acute Posttraumatic Nightmares Among Combat Soldiers in IraqBRET A. MOORE Psy.D.,BARRY KRAKOW M.D.,BRET A. MOORE Psy.D.Search for more papers by this author,BARRY KRAKOW M.D.Search for more papers by this author,Published Online:1 Apr 2007https://doi.org/10.1176/ajp.2007.164.4.683AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: Imagery rehearsal therapy is an efficacious treatment for chronic nightmares. In one controlled study using this therapy, chronic posttraumatic stress symptoms decreased as well (1) . However, imagery rehearsal therapy has not been tested on acute nightmares or acute posttraumatic stress symptoms. The following case series describes the use of imagery rehearsal therapy with U.S. Army combat soldiers deployed to Iraq. Only soldiers with a primary complaint of acute nightmares received treatment. Eleven soldiers with a primary complaint of acute nightmares received imagery rehearsal therapy, and each had experienced a traumatic event within 30 days prior to presentation. Each soldier reported the development of nightmares and related sleep complaints subsequent to the event. Imagery rehearsal therapy treatment was provided in four weekly one hour sessions by Dr. Moore, who learned the technique while in Iraq through a comprehensive user’s manual (2) and supplemental coaching by e-mail exchange with Dr. Krakow. As part of clinical care, the number of nightmares (3) , posttraumatic stress symptom severity (4) , and insomnia severity (5) were assessed at intake, posttreatment, and 1-month follow-up. Repeated-measures analysis of variance tested each variable across three time points; Hedge’s g effect sizes (for small cohorts) were calculated for changes between intake and 1-month follow-up. Each outcome showed steady reductions from the three time points ( Figure 1 ). The mean number of nightmares decreased 44% at the 1-month follow-up compared with the mean at intake (F=8.026, df=2, 9, p=0.01, Hedge’s g=1.04), and 7 out of 11 soldiers reported marked relief, with an average decrease of 61% in nightmare counts. The mean posttraumatic stress symptom scores decreased 41% at the 1-month follow-up compared with the mean at intake (F=5.999, df=2, 9, p=0.02, Hedge’s g=1.37), and these same seven soldiers reported marked improvements with an average decrease of 58% in symptoms. Insomnia showed a 34% decrease in severity (F=3.946, df=2, 9, p=0.06, Hedge’s g=1.23), with the same seven soldiers reporting the largest improvements. Among the four soldiers who completed the treatment but did not experience fewer nightmares, one showed a slight increase in nightmares, and three reported no changes. Two soldiers showed slight worsening in posttraumatic stress symptoms, and two showed slight improvement. Figure 1. Outcome Using Imagery Rehearsal TherapyIn this case series, imagery rehearsal therapy was associated with large clinical improvements in acute nightmares, posttraumatic stress symptoms, and insomnia severity. All soldiers with clear-cut decreases in nightmares (N=7 [64%]) reported improvements in posttraumatic stress and insomnia. However, these data from an uncontrolled design and small cohort must be interpreted cautiously because nightmares, insomnia, and other posttraumatic symptoms are known to dissipate spontaneously in a large proportion of trauma survivors in the early aftermath of traumatic exposure. Definitive assessment of imagery rehearsal therapy efficacy in the treatment of acute nightmares demands a randomized controlled study, and future studies in the operational environment offer a unique setting for research investigation.Ft. Hood, Tex.Albuquerque, N.M. Dr. Krakow reports the following for-profit interests: www.nightmaretreatment.com, www.sleeptreatment.com , Insomnia Cures , Turning Nightmares into Dreams, and Maimonides Sleep Arts & Sciences, Ltd. Dr. Moore reports no competing interests. The views of these authors are their own and do not purport to reflect the position of the Army Medical Department, Department of the Army, or the Department of Defense.

Belonging and Connection to School in Resettlement: Young Refugees, School Belonging, and Psychosocial Adjustment

Schools are one of the first and most influential service systems for young refugees. There is a burgeoning interest in developing school-based refugee mental health services, in part to reduce stigma and increase treatment access for this population. Despite the relevance of gaining a better understanding of how refugee students experience schools in resettlement and how this relates to psychosocial adjustment, belonging and connection to school have not been previously investigated among a population of resettled refugees. This study examines school belonging and psychosocial adjustment among a sample of 76 Somali adolescents resettled in the United States. A greater sense of school belonging was associated with lower depression and higher self-efficacy, regardless of the level of past exposure to adversities. Notably, more than one-quarter of the variation in self-efficacy was explained uniquely by a sense of school belonging. School belonging was not significantly associated with posttraumatic stress symptom severity and did not moderate the effect of exposure to adversities on psychological adjustment. These results suggest that investigating ways of improving school experiences would be particularly useful in the effort towards continued development of school-based mental health programs for young refugees.

A Randomized Controlled Trial of an Adapted Form of Individual Critical Incident Stress Debriefing for Victims of an Armed Robbery

Victims of an armed robbery are at great risk of psychological distress. This research is a prospective randomized controlled clinical trial of an adapted form of Critical Incident Stress Debriefing (CISD-A) with victims of an armed robbery. The specific goals are to examine whether the CISD-A is superior to the control group in both preventing the development of a posttraumatic stress disorder (PTSD) and attenuating the frequency and severity of posttraumatic stress symptoms. Following pretest, 75 participants were randomly assigned to individual debriefing or to a control group. Results revealed no differences between the CISD-A and the control group in preventing PTSD or attenuating posttraumatic symptoms 1 and 3 months later.

Effects of peritraumatic ketamine medication on early and sustained posttraumatic stress symptoms in moderately injured accident victims

Ketamine, an N-methyl-D: -aspartate receptor antagonist, produces transient dissociative and psychotic states in healthy humans that resemble symptoms shown by subjects with acute and chronic posttraumatic stress disorder (PTSD). Since ketamine is widely used as an analgesic and sedative in emergency care, it might be one factor triggering, modulating, or exacerbating PTSD in accident victims when given in the acute trauma phase. The purpose of the present study was to determine whether the peritraumatic administration of ketamine affects acute and sustained PTSD symptoms in accident victims. A sample of 56 moderately injured accident victims was screened retrospectively for acute (Peritraumatic Dissociative Experiences Questionnaire; Acute Stress Disorder Scale) and for current PTSD symptoms (Impact of Event Scale) approximately 1 year postaccident. All subjects had received a single or fractionated dose of either racemic ketamine (n = 17), (S)-ketamine (n = 12), or opioids (n = 27) during emergency ambulance transportation. Retrospectively assessed acute symptomatology was strongly increased in (S)-ketamine subjects in terms of dissociation, reexperiencing, and avoidance, and slightly heightened in racemic ketamines. Current PTSD symptoms were substantially elevated in (S)-ketamine subjects, while there was no difference observed between opioids and racemic ketamines. Medication groups did not differ in regard to demographic variables, previous or postaccidental traumatic events, time between accident and investigation, and injury severity. The data provide first evidence for a modulating effect of a single-dose ketamine on the severity and duration of posttraumatic stress symptoms in accident victims.

Psychological aftermath of the Lviv air show disaster: a prospective controlled study

To investigate the psychological aftermath of an air show disaster using prospectively obtained epidemiologic data. Participants in a recently completed epidemiologic mental health survey in Lviv (disaster site) and controls from western Ukraine were interviewed shortly before and 6 months after a gruesome air show disaster. The Lviv group reported more psychopathology and post-traumatic stress symptom severity, but less anomie than controls. Somatization symptoms were similar in the two groups. Predisaster mental health and postdisaster threat were the strongest risk factors while demographic characteristics, emotional support, and repeated television viewing of the event were only weakly associated with postdisaster mental health. This is the first prospective study to find a significantly higher rate of disorder as well as post-traumatic stress disorder symptomatology after a disaster. The risk factor findings suggest avenues for targeting postdisaster interventions.

School-based Cognitive-Behavioural Therapy Group Intervention for Refugee Children who have Experienced War-related Trauma

This study evaluated the effectiveness of a school-based group intervention designed for children who have experienced trauma. Twenty-six children (aged 11-15 years) who were refugees or asylum-seekers from war-affected countries participated. The manual-based intervention consisted of cognitive-behavioural therapy (CBT) techniques and was implemented within secondary schools. The treatment group ( n = 15) received six sessions of group CBT over a 6-week period, while the control group ( n = 11) were placed on a waiting list for 6 weeks and then invited to enter treatment. Children in the CBT group showed statistically significant, but clinically modest improvements following the intervention, with decreases in overall severity of post-traumatic stress symptoms. Significant improvements were also found in overall behavioural difficulties and emotional symptoms. Children in the waiting list control group did not show any improvements over the same period. However, follow-up data, which were only available for a small subset of eight children, suggest that gains in the CBT group were not maintained at 2-month follow-up.

Confirmatory factor analysis of posttraumatic stress symptoms in sexually harassed women

Posttraumatic stress disorder (PTSD) factor analytic research to date has not provided a clear consensus on the structure of posttraumatic stress symptoms. Seven hypothesized factor structures were evaluated using confirmatory factor analysis of the Posttraumatic Stress Disorder Checklist, a paper-and-pencil measure of posttraumatic stress symptom severity, in a sample of 1,218 women who experienced a broad range of workplace sexual harassment. The model specifying correlated re-experiencing, effortful avoidance, emotional numbing, and hyperarousal factors provided the best fit to the data. Virtually no support was obtained for the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV; American Psychiatric Association, 1994) three-factor model of re-experiencing, avoidance, and hyperarousal factors. Different patterns of correlations with external variables were found for the avoidance and emotional numbing factors, providing further validation of the supported model.

Psychobiological dysregulation in violence-exposed mothers: Salivary cortisol of mothers with very young children pre- and post-separation stress

To understand the determinants of frightening/frightened and other atypical maternal behavior, the authors studied a sample of 41 inner-city mothers of very young children (ages 8-50 months), the mothers of whom had lifetime histories of interpersonal violent trauma (i.e., physical or sexual abuse, and domestic violence) and related posttraumatic stress. The authors measured (1) maternal salivary cortisol levels before and 30 minutes after a videotaped play paradigm with their children, involving two separations and reunions; and (2) cortisol reactivity 30 minutes after separation stress. Data were analyzed using Pearson bivariate correlations, ANOVA, and multiple linear regressions. Salivary cortisol "baseline" values were significantly negatively correlated with childhood interpersonal violent trauma severity (i.e., trauma severity prior to age 16). However, cortisol reactivity was not significantly correlated with interpersonal violent trauma severity at this level of analysis. Although baseline salivary cortisol values were not significantly correlated with current overall psychiatric or depressive symptoms, they were negatively correlated with severity of current posttraumatic stress symptoms (PTSS) and with dissociative symptoms. Neither dimensions of negativity nor distortion of maternal attributions showed any significant association with prestress or poststress salivary cortisol levels. Salivary cortisol baseline was negatively correlated with atypical maternal behavior via measurement of the level of disrupted communication, at a trend-level of significance. Violent trauma-associated dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis may be a marker for increased risk for intergenerational transmission via parenting behavior with young children. Low salivary cortisol prior to separation stress and blunted cortisol reactivity to separation may also be markers for posttraumatic stress.

The Role of Experiential Avoidance in Posttraumatic Stress Symptoms and Symptoms of Depression, Anxiety, and Somatization

This study examined the relationships between experiential avoidance in general (and thought suppression in particular), posttraumatic stress symptom severity, and symptoms of depression, anxiety, and somatization among a sample of individuals exposed to multiple potentially traumatic events. Although experiential avoidance was not associated with severity of posttraumatic stress symptoms beyond their shared relationship with general psychiatric symptom severity, it was associated with symptoms of depression, anxiety, and somatization when controlling for posttraumatic stress symptom severity. Thought suppression, on the other hand, was associated with severity of posttraumatic stress symptoms when controlling for their shared relationship with general psychiatric symptom severity. No significant relationships were found between thought suppression and the presence of depression, anxiety, and somatization symptoms when controlling for posttraumatic stress symptom severity. Results suggest the importance of separately examining the influence of different forms of experiential avoidance on posttraumatic psychopathology.

Nightmares, insomnia, and sleep-disordered breathing in fire evacuees seeking treatment for posttraumatic sleep disturbance.

Eight months after the Cerro Grande Fire, 78 evacuees seeking treatment for posttraumatic sleep disturbances were assessed for chronic nightmares, psychophysiological insomnia, and sleep-disordered breathing symptoms. Within this sample, 50% of participants were tested objectively for sleep-disordered breathing; 95% of those tested screened positive for sleep-disordered breathing. Multiple regression analyses demonstrated that these three sleep disorders accounted for 37% of the variance in posttraumatic stress symptoms, and each sleep disorder was significantly and independently associated with posttraumatic stress symptoms severity. The only systematic variable associated with posttraumatic stress symptoms of avoidance was sleep-disordered breathing. The findings suggest that three common sleep disorders relate to posttraumatic stress symptoms in a more complex manner than explained by the prevailing psychiatric paradigm, which conceptualizes sleep disturbances in PTSD merely as secondary symptoms of psychiatric distress.

Full and partial PTSD among earthquake survivors in rural Taiwan

In 1999, a major earthquake struck central Taiwan. Ten months after the earthquake, survivors were surveyed to examine the background factors of demographics and exposure that are associated with posttraumatic stress disorder (PTSD) and subthreshold posttraumatic stress disorder (PTSS) and to investigate the relationships between other psychiatric problems and PTSD and PTSS following the earthquake. Subjects ( n=252) randomly selected from two rural communities near the epicenter of the earthquake were interviewed to obtain the following information: demographic characteristics; extent of earthquake exposure; severity of posttraumatic stress symptoms; other psychiatric morbidity; and other morbidity-related factors, including general mental health, disability, stress vulnerability, social support, and wellbeing. Three diagnostic groups were identified with regard to trauma-related symptoms: full PTSD, partial PTSD (PTSS), and non-PTSD. Prevalence rates were calculated and bivariate and multivariate comparisons adjusted for age, sex and education were performed. The prevalence rates for PTSD ( n=26) and PTSS ( n=48) were 10.3% and 19.0%, respectively. The PTSD and PTSS groups differed significantly from non-PTSD on most variables, with greater likelihood of the following: female gender; total trauma exposure; generalized anxiety disorder; suicidality; any other axis I disorder; general psychopathology, disability; and impaired wellbeing. Few differences were observed between the PTSD and PTSS groups, although greater likelihood for major depression, trauma-related loss of life, and impaired stress vulnerability were noted in the PTSD group. In conclusion, PTSD and PTSS are commonly observed following earthquake exposure and are associated with similarly high levels of psychosocial impairment.

Trauma Related Critical Incident Debriefing for Adolescents

Events like the tragedy at Columbine High School and the terrorists attacks on New York City in 2001 have highlighted the need for mental health practitioners to become familiar with interventions that are designed to assist young people who have survived extremely stressful events. Mental health professionals often see people who have experienced car accidents, severe abuse, rape, or other victimization, as well as survivors of natural and man-made disasters during the first critical stages of the recovery period. This article describes the process of critical incident de-briefing and provides a step-by-step primer for its application. The process is short-term (four sessions or less) and provides an intervention designed to reduce the frequency and severity of post-traumatic stress symptoms. Adolescents are particularly at risk because of issues surrounding identity formation, self- esteem, and developmental differences in coping mechanisms. Therefore, those who work with an adolescent cohort should be familiar with debriefing methods and how to apply them to the teenager.

Daily charting of posttraumatic stress symptoms: a pilot study.

This pilot study describes a prospective life-charting method for posttraumatic stress (PTS) symptoms. This method summarizes daily symptoms, functional impairment, life events, substance use, and treatment. Findings include experience with 17 cases over periods lasting from 3 to 25 months, with a description of 4 case examples that are characteristic of the pilot sample. People with posttraumatic stress disorder (PTSD) can complete day charting of their symptoms over an extended period of time. Some people reported that day charting distressed them mildly as they analyzed daily thoughts or feelings that they ordinarily avoided or pushed from awareness. Nonetheless, most people reported that they learned and benefited from daily symptom charting. In addition to enhancing patient self-understanding (or "insight"), the method may prove useful in assessing treatments for PTSD. Finally, these preliminary findings have suggested hypotheses regarding the clinical phenomenology and course of PTSD. For example, PTS symptom cluster exacerbation, severity, and duration appear to be highly consistent within any given patient, but highly variable across patients. Daily charting of PTS symptoms over prolonged periods is feasible. This prospective PTSD symptom charting method may have therapeutic, clinical, and research potential for understanding individual and group patterns in PTSD over time.

Persistence of posttraumatic stress in violently injured youth seen in the emergency department.

To determine if symptoms of posttraumatic stress, initially evaluated in the emergency department (ED) setting, persist over time. Prospective cohort study. Two urban, academic medical center EDs. Sixty-nine injured patients, aged 12 to 24 years, were assessed for acute posttraumatic stress symptoms at the time of their enrollment in an ongoing ED-based study of intentional youth violence, and assessed for posttraumatic stress symptoms up to 5 months later. The Immediate Stress Reaction Checklist, administered during the ED visit, and the Symptom Checklist of the Child and Adolescent Trauma Survey, administered during routine telephone follow-up. Patients in the emergency department reported a range of acute stress symptoms on the Immediate Stress Reaction Checklist, with 25% reporting clinically significant distress. On follow-up assessment, 15% reported significant posttraumatic stress symptoms. The severity of acute stress symptoms was strongly associated with the severity of posttraumatic stress symptoms at follow-up (r = 0.55, P<.005). Age, sex, injury type, and time from injury to follow-up were not associated with the degree of acute stress or posttraumatic stress symptom severity at initial or follow-up assessment. This study provides preliminary evidence that acute stress symptoms, assessed in the ED in the immediate aftermath of a traumatic injury, are useful indicators of risk for later posttraumatic stress.

The relationship among personality variables, exposure to traumatic events, and severity of posttraumatic stress symptoms

AbstractIn examining predictors of posttraumatic stress, researchers have focused on trauma intensity and devoted less attention to other variables. This study examined how personality and demographic variables are related to the likelihood of experiencing a trauma, and to the severity of posttraumatic symptoms in a sample of 402 college students reporting a wide range of trauma. Elevations in antisocial and borderline traits were significant predictors of retraumatization, accounting for 12% of the variance. Personality variables and trauma intensity were significant predictors of PTSD severity, accounting for 43% of the variance. Neuroticism interacted with trauma intensity in predicting Posttraumatic Stress Disorder (PTSD) severity. Among persons low in Neuroticism, there was a modest trauma intensity—PTSD relationship, whereas among persons high in neuroticism there was a strong relationship.