Re-experiencing Symptoms Research Articles

Internet-delivered computerized cognitive & affective remediation training for the treatment of acute and chronic posttraumatic stress disorder: Two randomized clinical trials

Treatment of posttraumatic stress disorder (PTSD) is time and cost-intensive. New, readily implementable interventions are needed. Two parallel randomized clinical trials tested if cognitive/affective computerized training improves cognitive/affective functions and PTSD symptoms in acute (N = 80) and chronic PTSD (N = 84). Adults age 18–65 were recruited from an Israeli hospital emergency room (acute) or from across the United States (chronic). Individuals were randomized to an active intervention (acute N = 50, chronic N = 48) that adaptively trains cognition and an affective positivity bias, or a control intervention (acute N = 30, chronic N = 36) of engaging computer games. Participants, blind to assignment, completed exercises at home for 30 min/day over 30 days (acute) or 45 min/day over 45 days (chronic). Primary outcomes were computerized cognitive/affective function metrics. Secondary outcomes were Clinician-Administered PTSD Scale (CAPS) total scores. In chronic PTSD, the active arm demonstrated facilitated speed of fearful face identification (F = 20.96, q < 0.001; d = 1.21) and a trend towards improvement in total PTSD symptoms (F = 2.91, p = 0.09, d = 0.47), which was due to improvement in re-experiencing symptoms (F = 6.14, p = 0.015; d = 0.73). Better cognitive performance at baseline moderated the training effect and was associated with more favorable improvements on both metrics. Cognitive and affective training does not have widespread benefit on symptoms and cognitive/affective functions in PTSD. Future studies targeting re-experiencing a priori, stratifying on cognitive capacity, and with modified methods to infer on mechanisms and optimized training parameters may be warranted. ClinicalTrials.gov Identifiers: NCT01694316 &NCT02085512.

Acute Stress Symptoms After Forcible and Substance-Involved Rapes.

In the early aftermath of a sexual assault, survivors often experience symptoms of distress including reexperiencing, avoidance, and hyperarousal symptoms. However, less is known about associations between rape characteristics and the nature of early reactions. We designed the current study to examine the unique and combined associations between force and substances during rape on acute stress symptoms. Participants were 56 women (ages 18 to 58) who completed a sexual assault medical forensic exam in the emergency department within 120 hours of the rape and then completed a follow-up clinical phone screening within 30 days of the forensic exam. Follow-up assessments included characteristics of the recent rape (force, substances), history of prior sexual assault, demographics, and symptoms of acute stress. Multivariate regression analyses revealed that, after controlling for prior sexual assault, sexual orientation, and race/ethnicity, there were no significant differences on any symptom cluster by rape type. However, this study involved a small, difficult-to-reach sample and, therefore, was only powered to detect large effect sizes. We encourage more research examining potentially unique, early symptom presentations for substance-involved rapes.

PTSD coach mobile application with brief telephone support: A pilot study.

The number of health care mobile applications (MAs) has increased drastically in recent years, but research on efficacy and approaches to provide MA intervention is lacking. The PTSD Coach was designed to help individuals with posttraumatic stress disorder (PTSD) symptoms to understand and manage symptoms. Use of MA tends to drop off quickly; this pilot study tested the use of the PTSD Coach with brief telephone support by paraprofessionals. A total of 29 participants with elevated PTSD symptoms recruited from Veterans Affairs primary care clinics completed baseline and 4-month follow-up surveys including the PTSD Checklist, Patient Health Questionnaire for depressive symptoms, and Quality of Life Enjoyment and Satisfaction Questionnaire. Participants received PTSD Coach MA intervention plus paraprofessional brief telephone support reported the phone support was helpful and greater than 70% of participants maintained use of the MA throughout the 3-month intervention period. Results indicated that participants showed significant improvement on PTSD reexperiencing symptoms, depressive symptoms, and quality of life after intervention. The PTSD Coach MA plus brief telephone support is a promising approach for primary care patients managing psychiatric symptoms. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Characterizing emotional Stroop interference in posttraumatic stress disorder, major depression and anxiety disorders: A systematic review and meta-analysis.

BackgroundPosttraumatic stress disorder is a debilitating psychiatric disorder characterized by symptoms of intrusive re-experiencing of trauma, avoidance and hyper-arousal. Diagnosis and treatment of PTSD is further complicated by concurrently occurring disorders, the most frequent being major depressive disorder and anxiety disorders. Previous research highlights that attentional processing in posttraumatic stress disorder is associated with substantial interference by emotional stimuli, a phenomenon also observed in these concurrently occurring psychiatric disorders. However, the diagnosis-relevance of this interference remains elusive. Here, we investigated the emotional Stroop interference for diagnosis-related stimuli, generally negative stimuli, and generally positive stimuli in posttraumatic stress disorder, major depressive disorder and anxiety disorders.MethodsWe performed a systematic database search in PubMed (Medline), Cochrane Library and PsycINFO on emotional Stroop performance in individuals with a diagnosis of posttraumatic stress disorder, major depressive disorder or anxiety disorders separately. Mean effect sizes, standard errors and confidence intervals were estimated for each clinical group and healthy control group comparison using random effect models.ResultsAs compared to healthy control group, the posttraumatic stress disorder group displayed greater interference by diagnosis-related stimuli and positive stimuli but not for generally negative stimuli. The major depressive disorder and anxiety disorders groups showed greater interference by diagnosis-related and negative stimuli, but not by positive stimuli. The age and sex had no significant impact on interference.ConclusionsThese findings highlight the importance of diagnosis-relevant information on attentional processing in all three clinical populations, posttraumatic stress disorder, major depressive disorder and anxiety disorders. Further, the impact of generally negative stimuli but not generally positive stimuli in major depressive disorder and anxiety disorders indicate impaired attentional bias for mood-congruent stimuli but not for general stimuli. Finally, it remains to be studied whether the influence of generally positive stimuli in posttraumatic stress disorder indicate that positive stimuli are perceived as PTSD related.

"Violence is Everywhere": Childhood Polyvictimization, Perceptions of the Prevalence of Victimization, and Posttraumatic Stress Symptoms.

Childhood polyvictimization is related to a heightened risk for mental health and functional problems in young adulthood, including posttraumatic stress symptoms, but little research has examined how perceptions of the prevalence of victimization may contribute to specific symptoms of posttraumatic stress. The primary aims of the current study were to (a) evaluate the accuracy of young adults' beliefs about the prevalence of multiple types of childhood victimization and (b) determine how inaccurate appraisals of victimization prevalence are associated with posttraumatic stress symptoms. College students (n = 369) drawn from two geographic regions of the United States responded to an online survey assessing their experiences of childhood victimization, perceptions about the prevalence of victimization, emotion regulation skills, and mental health. Childhood polyvictimization was significantly and positively related to distorted appraisals of the prevalence of victimization overall (r = .26, p < .001), and emotion regulation was associated with symptoms of posttraumatic stress in all domains. Distorted perceptions of the prevalence of victimization were linked to higher symptoms of hyperarousal, but not to higher symptoms of reexperiencing, avoidance, or negative mood/cognition. Results suggest that emotion regulation skills training is likely to be beneficial for many individuals experiencing posttraumatic stress, and intervention around perceptions of the prevalence of victimization may be useful for addressing symptoms of hyperarousal.

Handgrip Strength of World Trade Center (WTC) Responders: The Role of Re-Experiencing Posttraumatic Stress Disorder (PTSD) Symptoms.

Background: This study sought to examine whether handgrip strength (HGS), a measure of muscle strength and a biomarker of aging, was associated with post-traumatic stress disorder (PTSD) in a cohort of World Trade Center (WTC) responders at midlife. Methods: HGS was assessed utilizing a computer-assisted hand dynamometer administered to a consecutive sample of men and women (n = 2016) who participated in rescue and recovery efforts following the World Trade Center (WTC) attacks and subsequently attended monitoring appointments in Long Island, NY. PTSD symptom severity and depressive symptoms were assessed using the PTSD specific-trauma checklist (PCL-S) and the Patient Health Questionnaire (PHQ-9). General linear models were used to examine the association of WTC-related PTSD with HGS after adjusting for confounders. Results: The sample was at midlife (mean age = 53.3) when assessed, and 91.3% were men. Nearly 10% of the sample had probable PTSD (PCL ≥ 44) with concomitant depression (PHQ ≥ 10), while 5.1% had probable PTSD without depression. Average HGS was 57.4 lbs. (95% confidence interval (95% CI): 56.6–58.1) among men and 36.1 lbs. (95% CI = 33.8–38.5) among women. Mean HGS of those with probable PTSD with concomitant depression was lower (45.9 lbs., 95% CI = 43.6–48.2) than responders with only PTSD (49.1 lbs., 95% CI = 46.0–52.4) and those without PTSD or depression (57.5 lbs., 95% CI = 56.2–57.8). Subdomain analyses of PTSD symptoms revealed that re-experiencing symptoms at enrollment (p = 0.003) was associated with lower HGS after adjusting for depressive symptoms and other confounders. Discussion: Results suggested that higher WTC-related PTSD symptom severity was associated with lower HGS. Results support ongoing work suggesting that PTSD may be associated with more rapid physical aging. The potential for developing interventions that might simultaneously improve physical and mental health in the aftermath of trauma may be considered.

Changes in the dynamic network structure of PTSD symptoms pre-to-post combat.

Combat exposure is associated with elevated risk for post-traumatic stress disorder (PTSD). Despite considerable research on PTSD symptom clustering, it remains unknown how symptoms of PTSD re-organize following combat. Network analysis provides a powerful tool to examine such changes. A network analysis approach was taken to examine how symptom networks change from pre- to post-combat using longitudinal prospective data from a cohort of infantry male soldiers (Mage = 18.8 years). PTSD symptoms measured using the PTSD Checklist (PCL) were assessed after 6 months of combat training but before deployment and again after 6 months of combat (Ns = 910 and 725 at pre-deployment and post-combat, respectively). Stronger connectivity between PTSD symptoms was observed post-combat relative to pre-deployment (global strength values of the networks were 7.54 pre v. 7.92 post; S = .38, p < 0.05). Both the re-experiencing symptoms cluster (1.92 v. 2.12; S = .20, p < 0.03) and the avoidance symptoms cluster (2.61 v. 2.96; S = .35, p < 0.005) became more strongly inter-correlated post-combat. Centrality estimation analyses revealed that psychological reaction to triggers was central and linked the intrusion and avoidance sub-clusters at post-combat. The strength of associations between the arousal and reactivity symptoms cluster remained stable over time (1.85 v. 1.83; S = .02, p = .92). Following combat, PTSD symptoms and particularly the re-experiencing and avoidance clusters become more strongly inter-correlated, indicating high centrality of trigger-reactivity symptoms.

Patterns and temporal precedence of symptom change during cognitive processing therapy for military sexual trauma-related posttraumatic stress disorder.

Cognitive processing therapy (CPT) is an effective treatment for posttraumatic stress disorder (PTSD), including for veterans with military sexual trauma (MST)-related PTSD. Most CPT research to date has focused on pre- to post-treatment change in total PTSD symptoms; however, PTSD symptom criteria may not change equivalently over the course of treatment. For example, changes in re-experiencing symptoms have been shown to precede changes in other PTSD criteria during other PTSD treatments (i.e. virtual reality exposure therapy, venlafaxine ER). An improved understanding of the mechanism of change in PTSD symptoms during CPT may assist in optimizing treatment. The purpose of this study was to identify the pattern and temporal precedence of change in PTSD symptom criteria during and after CPT using cross-lagged panel analyses. Data from veterans (n = 32) enrolled in a randomized clinical trial investigating the effectiveness of CPT for MST-related PTSD were utilized for this secondary analysis. Using hierarchical linear modelling, each symptom criterion was entered as a predictor of subsequent change in the other PTSD symptom criteria. All symptom criteria followed a logarithmic pattern of change. Hyperarousal symptoms were found to both predict and temporally precede change in avoidance symptoms, but not re-experiencing symptoms. Re-experiencing and avoidance symptoms did not predict change in other PTSD symptom criteria. These findings provide initial support that targeting and reducing hyperarousal symptoms may be a key component of PTSD intervention with CPT. Additional research is needed to identify factors that predict change in PTSD-related re-experiencing symptoms.

Post-Traumatic Stress Symptoms after Pediatric Injury: Relation to Pre-Frontal Limbic Circuitry.

Pre-frontal limbic circuitry is vulnerable to effects of stress and injury. We examined microstructure of pre-frontal limbic circuitry after traumatic brain injury (TBI) or extracranial injury (EI) and its relation to post-traumatic stress symptoms (PTSS). Participants aged 8 to 15 years who sustained mild to severe TBI (n = 53) or EI (n = 26) in motor vehicle incidents were compared with healthy children (n = 38) in a prospective longitudinal study. At the seven-week follow-up, diffusion tensor imaging was obtained in all groups; injured children completed PTSS ratings using a validated scale. Using probabilistic diffusion tensor tractography, pathways were seeded from bilateral amygdalae and hippocampi to estimate the trajectory of white matter connecting them to each other and to targeted pre-frontal cortical (PFC) regions. Microstructure was estimated using fractional anisotropy (FA) in white matter and mean diffusivity (MD) in gray matter. Pre-frontal limbic microstructure was similar across groups, except for reduced FA in the right hippocampus to orbital PFC pathway in the injured versus healthy group. We examined microstructure of components of pre-frontal limbic circuitry with concurrently obtained PTSS cluster scores in the injured children. Neither microstructure nor PTSS scores differed significantly in the TBI and EI groups. Across PTSS factors, specific symptom clusters were related positively to higher FA and MD. Higher hyperarousal, avoidance, and re-experiencing symptoms were associated with higher FA in amygdala to pre-frontal and hippocampus to amygdala pathways. Higher hippocampal MD had a central role in hyperarousal and emotional numbing symptoms. Age moderated the relation of white and gray matter microstructure with hyperarousal scores. Our findings are consistent with models of traumatic stress that implicate disrupted top-down PFC and hippocampal moderation of overreactive subcortical threat arousal systems. Alterations in limbic pre-frontal circuitry and PTSS place children with either brain or body injuries at elevated risk for both current and future psychological health problems.

Gender moderates diurnal cortisol in relation to trauma and PTSD symptoms: A study in Sri Lankan adolescents

Trauma exposure and posttraumatic stress disorder (PTSD) have been linked to aspects of diurnal cortisol secretion in adolescents, but little is known about gender differences in these associations. A school-based sample of Sri Lankan adolescents aged 13–16 years took part in this study 4.5 years after the 2004 tsunami had impacted many of their lives to varying degrees. Saliva samples were obtained 4 times a day for 3 days in 84 participants, who also completed measures of lifetime trauma, current stressors, and posttraumatic stress symptoms (PTSS). We used multilevel regression to estimate effects of trauma exposure and symptoms on cortisol level, diurnal slope, and awakening response (CAR). Results indicated higher cortisol in girls and older adolescents. Although trauma, PTSS, and recent PTSD had non-significant main effects, these three variables interacted with gender, with higher cortisol in girls than in similarly traumatized or symptomatic boys. Co-occurrence of internalizing symptoms and PTSS was also associated with higher cortisol. The 28 adolescents with recent PTSD displayed flatter diurnal slopes, reflecting relatively low morning cortisol. Among the 56 trauma-exposed participants, negative trauma appraisals were associated with higher cortisol. Girls were more likely than boys to display elevated cortisol in relation to re-experiencing and hyperarousal symptoms. In contrast to significant findings for cortisol level and diurnal slope, the CAR showed no association with either trauma or PTSS, irrespective of gender. Findings, viewed in light of normative gender differences in HPA activity during adolescence, can contribute to understanding heightened female vulnerability to posttraumatic stress disorder.

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.

Attention bias toward threatening faces in women with PTSD: eye tracking correlates by symptom cluster

ABSTRACT Maladaptive patterns of attention to emotional stimuli are a common feature of posttraumatic stress disorder (PTSD), with growing evidence supporting sustained attention to threatening stimuli across trauma samples. However, it remains unclear how different PTSD symptom clusters are associated with attentional bias patterns, particularly in urban civilian settings with high rates of trauma exposure and PTSD. The present study examined associations among these variables in 70 traumatized primarily African American women. PTSD was measured using the Clinician Administered PTSD Scale, and eye tracking was used to measure patterns of attention as participants engaged in an attention bias (dot probe) task to emotional faces; average initial fixation (1 s) and dwell duration (overall time spent looking at emotional face versus neutral face across the 5 s task) were used to assess attention bias patterns toward emotional faces. Women with PTSD showed significantly longer dwell duration toward angry faces than women without PTSD (F = 5.16, p < .05). Bivariate correlation analyses with the PTSD symptom clusters showed a significant association between average initial fixation toward angry faces and higher levels of avoidance symptoms (r = 0.29, p < .05) as well as sustained attention to angry faces and higher levels of re-experiencing symptoms (r = 0.24, p < .05). Using separate linear regression models based on initial significant correlations, we found that PTSD avoidance symptoms were significantly related to average initial fixation toward angry faces (R 2 ∆ = 0.09, p < .05) and PTSD re-experiencing symptoms were significantly related to dwell duration toward angry faces (R 2 ∆ = 0.06, p < .05). These findings contribute to evidence that PTSD is related to both initial vigilance and sustained attention to threat and that certain symptom clusters may either drive or be more impacted by attentional biases, highlighting the benefits of addressing attentional biases within treatment.

Effects of Psychoeducation and Stress Coping Techniques on Posttraumatic Stress Disorder Symptoms.

This study examined the effects of psychoeducation and stress management techniques on Posttraumatic Stress Disorder (PTSD) symptoms in Libya. The 41 Libyan patients who volunteered to take part in the study were first assessed using the PTSD Checklist. They attended workshops on PTSD symptoms, stress management techniques, and communication skills on three successive days after which they were asked to answer the Coping Inventory for Stressful Situations two weeks after they completed the workshops. Among the 39% of the participants who were diagnosed with PTSD prior to the intervention, 15% met the diagnostic criteria for PTSD after the intervention. The preintervention scores were consistently higher than the postintervention scores, and there were significant differences in the PTSD Checklist total score and the re-experiencing, avoidance, and hyperarousal symptom scores. This study concluded that in mass-trauma events such as war and natural disasters, PTSD education can reduce the PTSD symptoms of those affected. Whether the benefits of psychoeducation on the participants are long term or short term is recommended for further study due to the limitations imposed by the willingness of the participants to participate, the amount of time they are willing to stay with the program, and the duration of the psychoeducation program itself.

A pilot randomized trial of a dual n-back emotional working memory training program for veterans with elevated PTSD symptoms

Anxiety is characterized by excessive attention to threatening information, leading to impaired working memory (WM) performance and elevated anxious thoughts. Preliminary research indicates that individuals with PTSD show particular difficulty with WM in emotional contexts (Schweizer et al., 2011). Although several studies show that computerized training can improve WM capacity for anxious individuals (Owens et al., 2013; Schweizer et al., 2011; 2013), there has been very little research on WM training for PTSD or with Veterans (Saunders et al., 2015). In a pilot randomized trial, we assigned Veterans with elevated PTSD symptoms to an online emotional WM training, either adaptive (n-back; n = 11) or a less potent training (1-back; n = 10). Overall, both groups showed significant decreases in PTSD symptoms. The n-back group showed a trend of outperforming the 1-back group in improving reexperiencing symptoms (which are likely to be associated with impaired WM functioning). This population anecdotally found the intervention quite challenging, which may be why even the less potent 1-back was still helpful. These preliminary findings justify the effort for developing new WM-focused PTSD intervention for complex, vulnerable populations, particularly as online training can improve accessibility.

Diagnostics of posttraumatic stress disorder according to DSM-5 and ICD-11

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the International Statistical Classification of Diseases and Related Health Problems (ICD-11, Version 2018) differ with respect to the diagnostic criteria of posttraumatic stress disorder (PTSD). The present study investigated the implications of these differences for the classification of PTSD within asample of German survivors of various traumatic events. A total of 341 trauma survivors who participated in amulticenter study were classified according to DSM-5 and ICD-11 and the results were compared. The PTSD checklist for DSM-5 (PCL-5) was used to diagnose PTSD. The ICD-11 PTSD cases were identified using a"restrictive" and a"wide" operationalization of re-experiencing symptoms (i. e. with and without intrusive memories). Depression and the level of trauma-related impairment were also assessed. The diagnosis rate using ICD-11 was significantly lower than under DSM-5 (DSM-5 64.5%, ICD-11 54.0%, p < 0.001) using arestrictive operationalization of re-experiencing symptoms but differences disappeared when using awide operationalization. Rates of comorbidity with depression were reduced under ICD-11. Individuals with high and low levels of trauma-related impairment were equally likely to receive a PTSD diagnosis under ICD-11. Differences in the diagnosis rates between ICD-11 and DSM-5 depend on the operationalization of the specific ICD-11 re-experiencing requirements. Precise diagnostic guidelines are necessary to avoid inconsistent diagnoses.

Re-experiencing trajectories of posttraumatic stress disorder among older adults exposed to an exile

One of the main symptoms in Posttraumatic Stress Disorder (PTSD) is re-experiencing the trauma (APA, American Psychiatric Association, DSM-5 Task Force, 2013), and studies have mentioned the effects of re-experiencing symptoms immediately after traumatic instances. Also, adverse psychological reactions of a traumatic event that occurred many years ago have not been extensively examined in the literature. In this respect, whether the content or frame of reexperiencing trauma symptom groups have differed from others during long years is questioned. The aim of this study is to determine the nature of the re-experiencing symptoms among individuals experienced by a shaky traumatic event many years ago. The interviews were conducted with 61 Ahıska Turkish older adults, who had the experience of deportation and forced migration. The participants’ feelings, thoughts and experiences related to those events were recorded by a video. A total of 2204 re-experiencing memos were recorded by qualitative analysis of video recordings in MAXQDA12 (VERBI, 2015). Principal codes of these memos were re-experiencing events directly by self or witnessing others pain, showing physical reactions (heath breathing, sweating) when reexperiencing, shaking emotionally, reporting flashbacks, recollections of nightmares, and having intrusive memories often. Findings demonstrated that re-experiencing the trauma even long-time after the event are not different from other immediate reactions. Re-experiencing symptoms are discussed in the frame of PTSD theories with clinical implications for deported and forced-migrated individuals. Results reveal that deportation/forced migration experiences during childhood and adolescence have life-long trajectories among older adults.

Opportunities for nurses to support recovery after pediatric injury: Relationships among posttraumatic stress, hope, and quality of life.

Nurses are at the forefront of children's postinjury recovery; this unique role provides an opportunity for nurses to recognize and screen for symptoms that may interfere with children's quality of life (QOL). As such, aims of the present investigation were to explore selected variables (e.g., posttraumatic stress symptoms [PTSS], hope) that have the potential to impact QOL after pediatric injury, with a larger goal of contributing to recommendations for nursing practice to support children's full (physical and emotional) recovery during the peritrauma period following injury. Sixty children (aged 7-13) completed measures of PTSS, hope, and QOL while receiving injury treatment. PTSS significantly predicted concurrent QOL, β = -0.42, p = 0.001. Exploratory results demonstrated that specific PTSS clusters (re-experiencing [ β = -0.39; p = 0.003), avoidance [ β = -0.35; p = 0.009], arousal [ β = -0.34; p = .012]) all significantly predicted QOL. Specific PTSS were explored. Hope (overall, domains of pathways, general agency, goal setting) did not significantly predict concurrent QOL. While this study is exploratory and more research is needed, current results suggest that nurses' awareness of PTSS (including symptoms of re-experiencing, avoidance, arousal) may help medical teams in identifying children that are at risk for impaired functional recovery (e.g., QOL) during the peritrauma period. Nurses may want to consider advocating for the integration of PTSS screeners into standard medical care. In addition, nurses have the opportunity to serve as key medical professionals in the delivery of trauma-informed medical care (which aims to minimize further trauma or re-traumatization). Nursing leadership may want to consider offering training in how nurses can identify and respond to children who have experienced an injury (such as trauma-informed care).

Relationships between cerebrospinal fluid GABAergic neurosteroid levels and symptom severity in men with PTSD

Allopregnanolone and pregnanolone (together termed allo + pregnan) are neurosteroid metabolites of progesterone that equipotently facilitate the action of gamma-amino-butyric acid (GABA) at GABAA receptors. The adrenal steroid dehydroepiandrosterone (DHEA) allosterically antagonizes GABAA receptors and facilitates N-methyl-D-aspartate (NMDA) receptor function. In prior research, premenopausal women with posttraumatic stress disorder (PTSD) displayed low cerebrospinal fluid (CSF) levels of allo + pregnan [undifferentiated by the gas chromatography-mass spectrometry (GC–MS) method used] that correlated strongly and negatively with PTSD reexperiencing and negative mood symptoms. A PTSD-related decrease in the ratio of allo + pregnan to 5α-dihydroprogesterone (5α-DHP: immediate precursor for allopregnanolone) suggested a block in synthesis of these neurosteroids at 3α-hydroxysteroid dehydrogenase (3α-HSD). In the current study, CSF was collected from unmedicated, tobacco-free men with PTSD (n = 13) and trauma-exposed healthy controls (n = 17) after an overnight fast. Individual CSF steroids were quantified separately by GC–MS. In the men with PTSD, allo + pregnan correlated negatively with Clinician-Administered PTSD Scale (CAPS-IV) total (ρ=-0.74, p = 0.006) and CAPS-IV derived Simms dysphoria cluster (ρ=-0.71, p = 0.01) scores. The allo+pregnan to DHEA ratio also was negatively correlated with total CAPS (ρ=-0.74, p = 0.006) and dysphoria cluster (ρ=-0.79, p = 0.002) scores. A PTSD-related decrease in the 5α-DHP to progesterone ratio indicated a block in allopregnanolone synthesis at 5α-reductase. This study suggests that CSF allo + pregnan levels correlate negatively with PTSD and negative mood symptoms in both men and women, but that the enzyme blocks in synthesis of these neurosteroids may be sex-specific. Consideration of sex, PTSD severity, and function of 5α-reductase and 3α-HSD thus may enable better targeting of neurosteroid-based PTSD treatments.

REM theta activity predicts re-experiencing symptoms after exposure to a traumatic film

BackgroundExtensive empirical evidence indicates that sleep plays an active role in memory consolidation. Moreover, sleep has been found to preferentially enhance emotional memories and may modulate affective reactions to previously encountered stimuli. Notably, recent findings suggest that disruptions of sleep-related memory processing could be involved in posttraumatic symptom development such that sleep disturbances may accelerate symptoms of intrusive re-experiencing. MethodsBased on this emerging evidence, we investigated whether an analogue traumatic event would result in immediate impairments of sleep quality in a group of healthy, robust sleepers. In addition, we examined associations between a specific oscillatory correlate of emotional memory consolidation processes (REM theta activity) and subsequent analogue PTSD symptoms. Thirty-three healthy participants entered the study and were exposed to either “traumatic” or neutral films. Thereafter, participants were subjected to an 8.5-hour-long nocturnal sleep opportunity under standardized laboratory conditions including full-night polysomnographic recordings. Ambulatory intrusive memories and subjective symptom ratings were assessed during a period of three consecutive days. Results and conclusionsOur results provide partial support for impaired sleep quality after exposure to a traumatic film. Correlation analyses further reveal that a longer REM sleep duration after “traumatic” exposure predicts reduced analogue PTSD symptoms. Critically, REM theta activity selectively predicts lower re-experiencing symptoms. As previous findings suggest that REM theta activity is reduced in patients with posttraumatic stress disorder, our findings provide a new perspective on the functional role of REM sleep in trauma memory processing.

The Phenomenology and Correlates of Flashbacks in Individuals With Posttraumatic Stress Symptoms

Reexperiencing symptoms are a hallmark of posttraumatic stress disorder (PTSD). Relatively little research has examined flashbacks in individuals with PTSD, and theoretical attempts to define and conceptualize flashbacks continue to be marked by considerable controversy. We compared individuals with PTSD or subthreshold PTSD symptoms (PTSS) with ( n = 45) and without flashbacks ( n = 32) to trauma-exposed controls ( n = 33) and control participants without trauma exposure ( n = 33). We compared the qualities of flashbacks of individuals with PTSS to those simulated by individuals without flashbacks. As predicted, individuals with PTSS reported significantly greater sleep disturbances, experiential avoidance, and lower trait mindfulness than those without PTSS. Individuals without PTSS underestimated the vividness, emotional intensity, distress, and functional impact associated with flashbacks. Consistent with basic-mechanisms theory, we did not find evidence of fragmentation of flashbacks in individuals with PTSS. Additional implications and future directions are discussed.