Posttraumatic Stress Disorder Research Research Articles

Cognitive-behavioral therapy for posttraumatic stress disorder: applications to injured trauma survivors.

This article discusses the applicability of cognitive-behavioral therapy (CBT) to the treatment of injured trauma survivors, with special consideration of treatment delivery within the trauma care system. The theoretical underpinnings and major treatment components of CBT for posttraumatic stress disorder (PTSD) are presented, followed by a review of the treatment outcome research to date. As few studies have evaluated CBT for injured trauma survivors, specifically, circumstances and comorbidities of this population, that might impact treatment delivery and outcome are discussed within a cognitive-behavioral framework. The article concludes with recommendations for research and treatment of PTSD among injured trauma survivors that draw from cognitive-behavioral theory and empirically supported principles of change.

Psychophysiological reactivity in female sexual abuse survivors.

This study examined psychophysiological reactivity in 37 female childhood sexual abuse (CSA) survivors. After assessment of posttraumatic stress disorder (PTSD), psychiatric comorbidity, and trauma history, we conducted a psychophysiological assessment of forehead muscle tension, electrodermal activity, and heart rate during a mental arithmetic task and4 script-driven imagery tasks (neutral, consensual sex, pleasant, and trauma). PTSD symptom severity correlated positively with psychophysiologic changes and negative emotions during the trauma imagery task. During mental arithmetic, PTSD symptom severity correlated negatively with autonomic changes and positively with negative emotions. These results extend earlier PTSD research showing trauma-specific increased psychophysiological reactivity related to CSA in women with PTSD. They further suggest a negative association between PTSD severity and autonomic reactions to mental arithmetic.

Posttraumatic Stress Disorder: Acute and Long-Term Responses to Trauma and Disaster

Back to table of contents Previous article Next article Book Forum: StressFull AccessPosttraumatic Stress Disorder: Acute and Long-Term Responses to Trauma and DisasterSTEPHEN A. YOUNG, M.D., STEPHEN A. YOUNGSearch for more papers by this author, M.D., Columbia, S.C.Published Online:1 Jul 2001https://doi.org/10.1176/appi.ajp.158.7.1178AboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail This book is a contribution to the Progress in Psychiatry series of the American Psychiatric Press. The goal of these books is to compile the latest in clinical and research information regarding specific topics in the field.Drs. Fullerton and Ursano have established international reputations in the area of trauma research. Indeed, Dr. Ursano has developed a unique site for research and teaching in posttraumatic stress disorder (PTSD) at the Uniformed Services University of the Health Sciences. Although the author selection includes contributors with ties to the Uniformed Services University and the U.S. military experience, it is nicely complemented by chapters from a worldwide collection of interesting voices. In addition, the chapters describe a number of clinical populations that are nonmilitary in nature.As titled, the book consists of two divisions, acute and long-term responses to trauma and disaster. The Acute section contains six chapters that describe various research efforts examining “on the ground” techniques of assessing patients in the immediate aftermath of trauma. This section contains some fascinating geopolitical contexts. For example, the team leader of the World Health Organization group that entered Kuwait in late 1991 writes a compelling description of the immediate postwar situation in that country. Fullerton’s paper discussing acute psychological effects on the spouses and significant others of rescue workers is an excellent illustration of just how difficult studying this population can be. Karam’s chapter on comorbid depression and PTSD raises an issue emphasized throughout the book, namely, that individuals exposed to trauma are vulnerable to a number of other problems, including depressive, anxiety, and substance abuse disorders.The Long-Term section contains six chapters examining some of the chronic issues that clinicians treating PTSD patients will likely encounter. The chapter on comorbid alcohol dependence presents some interesting incidence data but gets bogged down with general information about substance abuse. Given the crucial importance of substance abuse to those treating traumatized patients in the field, more treatment information would have been helpful. The chapters on traumatic death and homelessness in Vietnam veteran populations present interesting perspectives, as well as some unexpected findings. Finally, the last two chapters in this section address models of etiology and treatment. Shalev’s comprehensive review of pharmacological and psychotherapeutic published reports is excellent. Unfortunately, the section is somewhat dated in that it does not discuss sertraline, recently given a Food and Drug Administration label indication for treatment of PTSD.The editors have successfully collated recent findings in PTSD research into one place, allowing the busy clinician to review a variety of papers that address clinical, experiential, and research initiatives. Because the book is really a series of papers, it does not have the continuity of a textbook or a more comprehensive review. It will serve the reader well to review these papers, which bring life to the difficult work of studying and treating trauma survivors, while at the same time respecting the importance of rational thought and scientific method in furthering knowledge in the field.Edited by Carol S. Fullerton, Ph.D., and Robert J. Ursano, M.D. Washington, D.C., American Psychiatric Press, 1997, 309 pp., $42.50. FiguresReferencesCited byDetailsCited ByNone Volume 158Issue 7 July 2001Pages 1178-1178 Metrics History Published online 1 July 2001 Published in print 1 July 2001

Neurobiological findings in posttraumatic stress disorder: a review

Since posttraumatic stress disorder (PTSD) was first recognized as a psychiatric disorder, it has generated a great deal of scientific interest. Recent studies on the neurobiology of PTSD provide evidence that PTSD is biologically distinct from other types of traumatic and nontraumatic stress responses. This paper reviews three important directions of neurobiological research in PTSD: noradrenergic axis changes and associated alterations in autonomic responsivity neuroendocrine changes involving the hypothalamic-pituitary-adrenocortical (HPA) axis, and neuroanatomy changes involving the hippocampus. Each section reviews the salient aspects of preclinical research on the biology of stress and their bearing on the understanding of PTSD, and summarizes prominent findings from clinical biological studies of PTSD, Tentative models that integrate current findings from the clinical study of PTSD are reviewed. To conclude, the important methodological and empirical issues that need to be addressed by future studies are indicated.

Stability and change in posttraumatic stress disorder symptoms following breast cancer treatment: a 1-year follow-up.

While some recent research has examined the prevalence and severity of posttraumatic stress disorder (PTSD)-like symptoms following cancer treatment, no research has examined temporal change or stability in these symptoms in cancer survivors. Female breast cancer survivors (n=46) participated in an initial telephone interview and a follow-up interview 12 months later. PTSD symptoms associated with breast cancer were assessed using the PTSD Checklist-Civilian version (PCLC). In general, PTSD symptoms in this population did not diminish over time. While group analyses indicated that PCLC-total and subscale scores were stable across the two assessments, analyses of PCLC scores indicated that many patients exhibited fairly large (>0.5 S.D.) increases and/or decreases in PCLC-total or subscale scores. Some evidence suggested that decreases in PCLC scores between the two study assessments were associated with greater social support and experience of fewer traumatic stressors prior to breast cancer diagnosis. Most significantly, the research suggested that women with greater PTSD symptoms at the initial interview were less likely to participate in the follow-up interview. Implications of this for research and clinical management of PTSD in this population are discussed.

Posttraumatic Stress Disorder

Posttraumatic Stress Disorder (PTSD) is unique in that diagnosis must include a precipitating traumatic event. Although many different traumatic events can lead to PTSD, a great amount of research has been generated on war veterans. An examination of the literature on PTSD reveals that women and minority veterans have been recipients of prejudice and exclusion in clinical research, diagnoses and treatment of PTSD. Pre- and post-trauma variables may account for differences in incidence and severity of PTSD. Clinical assessment and treatment of PTSD for women and minorities is inadequate, often not considering gender or ethnoculturally diverse research and data.

Head injury and combat-related posttraumatic stress disorder.

Given the association of injury and posttraumatic stress disorder (PTSD), we examined whether head injury might be associated with increased frequency and severity of PTSD. Using a mail survey, we queried 143 male combat veterans with and without PTSD, who had previously participated in PTSD research in our laboratory, about their history of head injury. Respondents with a PTSD diagnosis were significantly more likely to report a history of head injury than those without. Patients with a history of head injury also reported more severe symptoms of PTSD compared with PTSD patients without head injury. The association of head injury and PTSD was not due to greater combat exposure in the head-injured group. Head injury is associated with a greater likelihood of developing combat-related PTSD and with more severe PTSD symptoms. This retrospective study did not address mechanisms that could account for this finding. The results indicate head injury should be systematically assessed by both nonpsychiatric and psychiatric physicians concerned with the psychological sequelae of exposure to victimizing experiences.

A Consensus Meeting on Effective Research Practice in PTSD

AbstractThe aim of this meeting was to obtain a consensus on what constitutes good research practice in posttraumatic stress disorder (PTSD). Objectives were to review relevant parameters of trials, such as the patients recruited, the means of assessing PTSD at baseline, and the change in symptomatology in response to treatment, and to reach a consensus on the most appropriate parameters to use in future research. The bases for the discussion were the 1995 National Institute of Mental Health (NIMH) and the National Center for PTSD consensus on the assessment of PTSD, results of drug treatment trials, and information on the assessment scales used in PTSD research.

Differential responses to trauma: Migration-related discriminants of post-traumatic stress disorder among Southeast Asian refugees

This study examined possible differentiating experiences between Post-Traumatic Stress Disorder (PTSD) and non-PTSD refugees, after matching them on certain demographic characteristics and exposure to trauma. Previous research on predictors of PTSD usually has not controlled for differences in trauma exposure between the comparison groups. By examining individuals who have had similar traumatic histories, this study more clearly identified some factors implicated in the development of PTSD among Southeast Asians. To increase comparability with previous PTSD research, all events were assessed with reference to three time frames involving premigration, migration, and postmigration periods. The role of anger reactions was also examined in view of previous findings from the veteranbased PTSD research. Finally, this study ascertained the influence of acculturation and cultural identity orientation because these variables often have been implicated in the adjustment of Asian Americans. Results from the present study indicate that respondents with PTSD appeared to experience and express much more anger and were more dependent on public assistance. They were also less engaged in maintaining their cultural traditions and ties. However, more life changes and a trend toward more separations and reunifications with family members were evidenced for those without PTSD. The implications of these findings in developing community intervention strategies for Southeast Asian refugees who have experienced trauma are discussed.

Three forms of stress in Cambodian adolescent refugees

Sixty-nine Cambodian adolescents and young adults were interviewed to determine their experience as children surviving the Pol Pot regime (1975-1979); their first-year experience of resettlement in this country; and their experience of stressful events during the past year. Current DSM-III-R diagnostic status was also determined. A strong relationship between earlier war trauma, resettlement strain, and symptoms of posttraumatic stress disorder (PTSD) was found. In contrast, the strongest relationship with depressive symptoms was found for recent stressful events. These results are discussed in light of current findings from stress and PTSD research.

Sexually Abused Children at High Risk for Post-traumatic Stress Disorder

Abstract Ninety-two sexually abused children were studied using structured interviews and standardized instruments to determine the frequency of post-traumatic stress disorder (PTSD) and associated symptoms. Of these sexually abused children, 43.9% met DSM-III-R PTSD criteria; 53.8% of children abused by fathers, 42.4% abused by trusted adults, and 10% of those abused by strangers met criteria as opposed to none of the children abused by an older child. No relationship was observed between the time lapsed since last abusive episode and the presence of PTSD. Many children not meeting full criteria exhibited partial PTSD symptoms. Only one standardized instrument (Child Behavior Checklist) detected group differences with PTSD children exhibiting more symptoms. This study replicates an earlier pilot study and underscores the need for further PTSD research.

Post‐Traumatic Stress Disorder in Children: Its Identification and Treatment in a Residential Setting for Emotionally Disturbed Youth

AbstractIn the past 5 years residential programs for emotionally disturbed youth have encountered increasingly difficult‐to‐treat youngsters. These children who frequently are products of physical/sexual/emotional abuse, neglect and multiple out‐of‐home placements, often presented with severe human trauma responses, but post‐traumatic stress disorder (PTSD) was not diagnosed. This paper describes how one residential treatment center correctly identified those children referred having PTSD, developed effective treatment modalities for this syndrome in children and networked with other agencies involved in research and treatment of PTSD. Multiple out‐of‐home placements are highlighted as a heretofore unrecognized contributor to PTSD in children.

Diagnostic and psychopharmacological treatment characteristics of 536 inpatients with posttraumatic stress disorder.

Descriptive information (demographic variables, DSM-III diagnoses, and medications prescribed) was obtained from the discharge summaries of 536 male veteran inpatients who received a diagnosis of posttraumatic stress disorder (PTSD) over a 4-year period. Data comparisons were also made between two types of inpatient programs (specialized PTSD vs. psychiatric ward) to control for program selection biases. Consistent with previous studies, alcohol and substance abuse and/or depression diagnoses occurred concurrently with PTSD. Diagnoses of schizophrenia were more prevalent in the psychiatric wards. Nearly one third of the total sample received an axis II diagnosis, with borderline features most common. Half of all patients received psychopharmacological treatment in addition to psychotherapy. Antidepressants, neuroleptics, and beta-blockers were prescribed most frequently. Directions for future inpatient PTSD research are offered based on the findings.