Treatment Of Posttraumatic Stress Research Articles

Development of a stepped care intervention model of evidence-based interventions for the management of posttraumatic stress in the Belgian Police

ABSTRACT Background: Police officers are frequently exposed to a wide variety of potentially traumatic events (PTE) and are therefore at a considerable risk of developing posttraumatic stress disorder (PTSD). Previous research estimated the point prevalence of PTSD in Belgian police officers at 7.4%, significantly higher than in the general population. An effective organisational strategy to manage posttraumatic stress is essential. Objective: We aimed to develop a novel organisational approach regarding traumatic stress for Belgian police, combining evidence-based strategies for the prevention and treatment of posttraumatic stress in a stepped care intervention model. Method: In a broad development process, we combined scientific literature, case studies of best practices from other police organisations with insights gathered from a number of expert panels, thematic working groups and feedback groups. Results: A comprehensive stepped care intervention model was developed, consisting of evidence-based interventions for the prevention and treatment of posttraumatic stress. Conclusions: The intervention model is a promising organisational strategy for the management of posttraumatic stress in police organisations based on evidence-based interventions. Its effectiveness will be studied in the coming years.

Comparing the effectiveness of narrative therapy and EMDR-GTEP protocols in the treatment of post-traumatic stress in children exposed to humanitarian crises

BackgroundThe mental health of children living in humanitarian crisis situations is a major issue. Post-traumatic stress disorder (PTSD) causes great psychological suffering and has negative consequences on children's development. The aim of the study was to analyze retrospective data collected in a mental health and psychosocial support program for children in the Central African Republic, and to compare results of two trauma-focused treatment interventions: the narrative protocol Action contre la Faim (ACF)/KONO; and the EMDR-based Group Trauma Episode Protocol (G-TEP). Both protocols are proposed in a group setting and led by paraprofessionals.MethodsIn the program, 884 children attended a psychoeducation session and after that, 661 children (290 for ACF/KONO and 371 for G-TEP) benefited from all treatment sessions. PTSD was measured by the Children's Revised Impact of Event Scale (CRIES-8). General distress was measured by the Child Psychosocial Distress Screener (CPDS). Data were collected before and after treatment, and measured 5 months after the end of treatment for 185 children.ResultsParticipants in the ACF/KONO group show a significant reduction on CRIES-8 (t = 44.8; p < 0.001, effect size = 2.63) and CPDS (t = 38.2; p < 0.001, effect size = 2.24). Participants to the G-TEP protocol show a significant effect with reduced scores on the CRIES-8 (t = 49.2; p < 0.001, effect size = 2.55) and CPDS (t = 57.2; p < 0.001, effect size = 2.97). A Student's t-test comparing the ACF/KONO and G-TEP groups shows no significant difference between the two types of treatment between pre- and post-treatment CRIES-8 scores (t = 1.744; p = 0.514, effect size = 0.040) and CPDS scores (t = 1.688; p = 0.092, effect size = 0.323). An analysis of the follow-up data for the 185 children shows that the effects of both protocols are maintained over time with mean scores after treatment and follow-up below the clinical cut-off for both CPDS (<8) and CRIES-8 (<17).ConclusionsBoth protocols have been shown to be effective in reducing traumatic symptoms in children exposed to conflict; they can be conducted by paraprofessionals and used in humanitarian crisis situations.

Parental post-traumatic stress and psychiatric care utilisation among refugee adolescents

Parental psychiatric morbidity related to experiences of war and trauma has been associated with adverse psychological outcomes for children. The aim of this study was to investigate parental post-traumatic stress in relation to psychiatric care utilization among children of refugees with particular attention on the child’s own refugee status, sex of both child and parents, and specific psychiatric diagnoses. This was a register study in a population of 16 143 adolescents from refugee families in Stockholm County born 1995–2000 and followed between 2011 and 2017 (11–18 years old). Parental post-traumatic stress, identified in three levels of care, was analysed in relation to child and adolescent psychiatric care use. Cox regression analysis was used to estimate hazard ratios (HR) and 95% confidence intervals (CI), adjusted for duration of residence and demographic and socioeconomic variables. Having a mother with post-traumatic stress was associated with higher psychiatric care utilization, with adjusted HR 2.44 (95% CI 1.90–3.14) among foreign-born refugee children and HR 1.77 (1.33–2.36) among Swedish-born children with refugee parents, with particularly high risks for children with less than five years of residence (HR 4.03; 2.29–7.10) and for diagnoses of anxiety and depression (HR 2.71; 2.11–3.48). Having a father with post-traumatic stress was not associated with increased HRs of psychiatric care utilization. Similar results were seen for boys and girls. Treatment for post-traumatic stress should be made available in refugee reception programmes. These programmes should use a family approach that targets both parents and children.

Intimate Partner Violence and Posttraumatic Stress Symptoms: Indirect Effects Through Negative and Positive Emotion Dysregulation.

Women who experience intimate partner violence (IPV) are at heightened risk for developing posttraumatic stress (PTS). Emotion dysregulation has been linked to both IPV and PTS, separately, however, unknown is the role of emotion dysregulation in the relation of IPV to PTS among women who experience IPV. Moreover, existing investigations in this area have been limited in their focus on negative emotion dysregulation. Extending prior research, this study investigated whether physical, sexual, and psychological IPV were indirectly associated with PTS symptom severity through negative and positive emotion dysregulation. Participants were 354 women who reported a history of IPV recruited from Amazon's MTurk platform (Mage = 36.52, 79.9% white). Participants completed self-report measures assessing physical (Conflict Tactics Scale), sexual (Sexual Experiences Scale), and psychological (Psychological Maltreatment of Women) IPV; negative (Difficulties in Emotion Regulation Scale) and positive (Difficulties in Emotion Regulation Scale-Positive) emotion dysregulation; and PTS symptom severity (PTSD Checklist for DSM-5) via an online survey. Pearson's correlation coefficients examined intercorrelations among the primary study variables. Indirect effect analyses were conducted to determine if negative and positive emotion dysregulation explained the relations between physical, sexual, and psychological IPV and PTS symptom severity. Physical, sexual, and psychological IPV were significantly positively associated with both negative and positive emotion dysregulation as well as PTS symptom severity, with the exception that psychological IPV was not significantly associated with positive emotion dysregulation. Moreover, negative and positive emotion dysregulation accounted for the relationships between all three IPV types and PTS symptom severity, with the exception of positive emotion dysregulation and psychological IPV. Our findings provide support for the potential underlying role of both negative and positive emotion dysregulation in the associations of IPV types to PTS symptom severity. Negative and positive emotion dysregulation may be important factors to integrate into interventions for PTS among women who experience IPV.

Mindfulness interventions in the treatment of posttraumatic stress disorder.

Mindfulness interventions in the treatment of posttraumatic stress disorder.

EFFECT OF NURSE-LED HEALTH EDUCATION ON POST TRAUMATIC STRESS SYMPTOMS AMONG INTERNALLY DISPLACED PERSONS IN JOS, NORTHERN NIGERIA

Introduction: Internal displacement occurred due to armed conflict or other forms of disasters; it was associated with the development of Post-Traumatic Stress (PTS) symptoms. The available interventions for PTS might be costly or not affordable for people in distress in low resource settings; hence, the need to explore alternative options. This study investigates the effect of a nurse-led health education intervention package on PTS symptoms among Internally Displaced Persons (IDPs). We hypothesised that ‘there is no statistically significant difference in PTS symptoms scores among IDPs before and after intervention with nurse-led health education. Methods: A quasi-experimental design was employed for the study. Post-Traumatic Stress short-form scale (PTS-8) was used as an instrument for data collection. Data were analysed using SPSS version 23. The socio-demographics are presented in simple percentages and tables. Unpaired student t-test was used to determine the significant differences among variables of interest in the hypothesis generated. Results: Most common PTS symptoms identified among the IDPs included recurrent memories with means and standard deviations (M 2.92, S.D 0.778); nightmare/sleep disturbance (M 2.26, SD 0.853) and feeling jumpy, easily startled and fearful (M 2.20, SD 0.969). Nurse-led health education caused a reduction in PTS symptoms severity. There was a significant difference in the PTS symptom scores before (2.3±1.7) and after (1.7±0.7) the intervention with a score of 2.37, p=0 .020. Conclusion: The nurse-led health education practised in undeveloped nature modified environment reduced PTS symptoms severity among the IDPs. It should be used as a tool for reducing the symptoms of PTS among IDPs, especially in contexts that are deficient in already developed recreational and traumatic stress healing facilities. KEYWORDS: Posttraumatic stress, Nurse-led health education, internally displaced persons.

Dampening of positive affect is associated with posttraumatic stress following stressful life events

ABSTRACT Background: Treatments for posttraumatic stress (PTS) are effective for many but not all people. There is a continued need to further our understanding of psychological mechanisms involved in the development and maintenance of PTS. Research has examined dysregulation of negative affect (NA) in PTS but relatively little attention has been paid to the role of dysregulation of positive affect (PA) in PTS. Objective: The current study sought to examine the incremental role of PA dysregulation – specifically self-focused and emotion-focused rumination (strategies to upregulate PA) and dampening (a strategy downregulating PA) in explaining variance in PTS, while taking into account neuroticism, plus more often-researched processes of NA regulation (i.e. brooding and reflection) and experiential acceptance and mindfulness – broader regulatory styles involved in PTS. Method: Data were available from 473 students who completed measures about stressful life events experienced, PTS, and measures of PA dysregulation and all other variables of interest. Results: Zero order correlations showed that dampening of PA but not self-focused and emotion-focused regulation of PA were associated with PTS total scores and PTS clusters of re-experiencing, avoidance, and hyperarousal. Multiple regression analyses revealed, among other things, that dampening of PA, neuroticism, brooding, and mindfulness (but not emotion-focused and self-focused rumination about PA, reflection, and experiential acceptance) explained unique proportions of variance in PTS when taking into account the shared variance between these variables. Conclusions: Future research may continue addressing difficulties in regulating PA alongside difficulties regulating NA to improve the understanding of mechanisms maintaining PTS and to examine the usefulness of interventions improving PA regulation in the treatment of PTS.

Meditating in virtual reality: Proof-of-concept intervention for posttraumatic stress.

Objective: We investigate the potential therapeutic application of virtual reality (VR) technology as an aid to meditation practice among persons varying in posttraumatic stress disorder (PTSD) symptoms. Method: In this within-group mixed-methods study, 96 young adults practiced both VR- and non-VR-guided meditations and reported on their experience of positive affect (PA), negative affect (NA), other meditative experiences and perceived satisfaction-credibility of each meditation. Results: Participants reported more PA and greater perceived satisfaction-credibility following the VR as compared to non-VR-guided meditations primarily when the VR meditation was practiced first, before the non-VR meditation, as opposed to vice versa. The experience of NA during meditation practice was infrequent, although persons with increased PTSD symptoms reported increased distress during both VR and non-VR meditation. Conclusions: Further study of therapeutic applications of VR as an aid to meditation practice among people with PTSD symptoms is warranted. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

26 Brief Psychological Intervention for Distress Reduction in Inpatient Burn Survivors: A Pilot Study

Abstract Introduction It is estimated that 19–45% of hospitalized burns patients exhibit symptoms of posttraumatic stress (PTS) during hospitalization, and inpatient distress is linked with poorer functional, psychosocial, and medical prognosis. Despite this, research on psychological intervention for PTS during inpatient treatment for burns remains nascent. The current study developed and pilot-tested a six-session cognitive-behavioral therapy (CBT) for adult inpatients with acute burns. Methods After IRB approval, patients were enrolled in a single verified ABA burn center. Interventions consisted of 6, 50-minute CBT sessions over two weeks. Therapeutic techniques included mindfulness-focused relaxation training, titrated exposure, psychoeducation, and cognitive restructuring. Depression (Beck Depression Inventory II; [BDI]), anxiety (Beck Anxiety Inventory [BAI]), and PTS (Detailed Assessment of Posttraumatic Stress- PTS-T subscale) were assessed at baseline, 2 weeks, and 6 weeks post-intervention. All data were analyzed in SPSS using Student’s univariate t-tests and Last Observation Carried Forward analysis for missing data at T1. No missing data were imputed for T2 given the high drop-out rate. Results Seventeen adult participants were enrolled (13 female; Mage = 31.7 years, SD = 8.7, range 21–53 years; 35% Hispanic/Latinx; MTBSA = 21.6%, SD = 20.2). Analyses indicated no relation between demographic or study variables and drop-out. Average number of sessions was 4.8 (SD = 1.4). At baseline, participants reported moderate anxiety (M = 23, SD = 12.32), mild depression (M = 14.18, SD = 8.46), and clinically significant posttraumatic stress (M = 72.18, T score = 75, 99th percentile). Comparing baseline to post-intervention, BAI scores decreased, t(16) = 3.76, p = .002, Cohen’s d = .61, whereas BDI scores, t(16) = 1.06, ns, Cohen’s d = .19, and PTS scores, t(16) = 1.03, ns, Cohen’s d = .12, did not change. There were no changes from post-intervention to follow-up in BAI, t(5) = 1.48, ns, Cohen’s d = .43, BDI, t(5) = 1.06, ns, Cohen’s d = .54, or PTS scores (t(5) = .55, ns, Cohen’s d = .12) for the six participants who completed follow-up assessment. TBSA burn was not associated with anxiety, depression, or PTS symptoms at any timepoint. Conclusions Participants reported significant reductions in anxiety, but not PTS or depression symptoms, following a CBT distress-reduction intervention. More generally, the findings of this study point to the potential utility of implementing an early intervention of empirically-based treatment components to help burn survivors manage emotional symptoms following trauma. Applicability of Research to Practice Patients experiencing anxiety may benefit from short-term mindfulness or exposure interventions and more research is needed to understand the trajectory and heterogeneity of PTS symptom relief following acute burns.

Supplemental Material for Meditating in Virtual Reality: Proof-of-Concept Intervention for Posttraumatic Stress

Supplemental Material for Meditating in Virtual Reality: Proof-of-Concept Intervention for Posttraumatic Stress

The Connectedness of Mental Health Providers Referring Patients to a Treatment Study for Post-Traumatic Stress: A Social Network Study.

We conducted a process evaluation in the context of a Hybrid Type 1 randomized controlled trial testing two treatments for post-traumatic stress, using a web-based social network survey and semi-structured interviews to illustrate the relationship between providers' influence and likelihood of referring patients to the RCT. Providers with high indegree centrality (designated by other providers as someone they seek information from) were significantly more likely to refer patients to the RCT, and serve as an influence to others' referral behavior. Interviews provided additional data to consider for future studies aimed at increasing the uptake of evidence-based practices.

Intersecting modes of aesthetic distance and mimetic induction in therapeutic process: Examining a drama-based treatment for military-related traumatic stress

Abstract Can Shakespeare be a treatment for posttraumatic stress in military veterans? This is the question that our research team has been examining through the empirical investigation of the DE-CRUIT program. DE-CRUIT uses Shakespeare’s verse to help veterans with the articulation, sharing and processing of trauma. In this article, we focus specifically on the therapeutic process of the program that involves various modes of aesthetic distance in combination with mimetic induction, a treatment technique in which fictionalized narrative reflects the real-life experience of trauma. After describing that process, we illustrate these various intersecting therapeutic components through the case of ‘D.’, a military veteran who took part in DE-CRUIT after many years of living with a secret, non-disclosed trauma.

Introduction.

Special Issue: Recent Advances in Understanding and Treatment of Posttraumatic Stress and Trauma-Related Disorders

Making connections: exploring the centrality of posttraumatic stress symptoms and covariates after a terrorist attack

ABSTRACTBackground: Posttraumatic stress symptoms are interconnected. Knowledge about which symptoms of posttraumatic stress are more strongly interconnected or central than others may have implications for the targeting of clinical interventions. Exploring whether symptoms of posttraumatic stress may be differentially related to covariates can contribute to our knowledge on how posttraumatic stress symptoms arise and are maintained.Objective: This study aimed to identify the most central symptoms of posttraumatic stress and their interconnections, and to explore how covariates such as exposure, sex, neuroticism, and social support are related to the network of symptoms of posttraumatic stress.Method: This study used survey data from ministerial employees collected approximately 10 months after the 2011 Oslo bombing that targeted the governmental quarters (n = 190). We conducted network analyses using Gaussian graphical models and the lasso regularization.Results: The network analysis revealed reliably strong connections between intrusive thoughts and nightmares, feeling easily startled and overly alert, and between feeling detached and emotionally numb. The most central symptom in the symptom network was feeling emotionally numb. The covariates were generally not found to have high centrality in the symptom network. An exception was that being female was connected to a high physiological reactivity to reminders of the trauma.Conclusions: Ten months after a workplace terror attack emotional numbness appears to be of high centrality in the symptom network of posttraumatic stress. Fear circuitry and dysphoric symptoms may constitute two functional entities in chronic posttraumatic stress. Clinical interventions targeting numbness may be beneficial in the treatment of posttraumatic stress, at least after workplace terrorism.

Dance/movement therapy in the treatment of post traumatic stress: A reference model

Given the debilitating effects of psychological trauma, the development of effective treatments is critical. Current treatment trends are increasingly inclusive of body-centered and alternative techniques. Nevertheless, the creative arts therapies (CATs) continue to be underrepresented in the literature in their work with this population. In this paper I focus on the phenomenon of interoception in the recovery process from trauma and present a dance/movement therapy (DMT) application model that is grounded in empirical findings. In three steps, safety, regulating hyperarousal, and attending to interoception, I offer practical suggestions and guidelines for the treatment of trauma survivors in the beginning stage of their recovery. This model is not meant to be exhaustive. Instead, it is hoped that, as it hones in on the basic issues of physical disconnection and lack of interoception in trauma survivors, it might function as an initial building block for a more complete treatment model in the future.

How do people cope with post traumatic distress after an accident? The role of psychological, social and spiritual coping in Malaysian Muslim patients

Introduction: Post traumatic distress, acute stress disorder and even post traumatic stress disorder may occur following traumatic events such as a motor vehicle accident (MVA). Instead of presenting to mental health service, many turn to psychosocial and spiritual strategies to cope with symptoms. The objective of this study is to explore the psychosocial and spiritual coping strategies utilised by MVA victims to deal with the distressing post traumatic symptoms.Methods: An exploratory qualitative study using individual in-depth interview was conducted from May to September 2015. Purposive sampling was done to optimise wide exploration. Only Muslim participants were included. The interviews were recorded, transcribed verbatim and analysed using thematic approach.Results: All participants interviewed employed psychological, social and spiritual coping strategies to help manage their post traumatic stress symptoms. Positive thinking and rationalisation are examples of psychological coping mechanisms used. Many have supportive families. Common spiritual coping strategies practised include the use of different Quranic verses and prayers.Conclusion: Psychosocial and spiritual coping strategies are popular, highly tolerable and useful for post traumatic distress. Psycho-socio-spiritual therapy may be an effective treatment for post traumatic stress in Muslim Malaysian patients. Further research is needed in this area.

Theatre as a treatment for posttraumatic stress in military veterans: Exploring the psychotherapeutic potential of mimetic induction

Current mainstream treatments for traumatic stress in military veterans are largely inadequate in meeting the needs of veterans who are reluctant to conform to conventional illness-based approaches, including medication. These approaches have been criticized for using rigid techniques that emphasize strict symptom-reduction without considering social and relational factors in veterans’ lives. There is thus a need for innovative treatment models for traumatic stress that acknowledge potential sources of resilience and healing in veterans’ existing communities. In particular, there is growing evidence that the arts can play an important role in supporting veterans’ recovery from trauma. Accordingly, this paper describes a strengths-based group psychotherapy model that uses theatre and specific techniques from classical actor training in combination with empirically-established trauma treatment techniques from cognitive processing therapy and narrative therapy to address posttraumatic stress in veterans. Three case examples of veterans are presented with a focus on the veterans’ experiences of mimetic induction, a process through which the narrative representation of fictional encounters simulates real-world encounters at a safe aesthetic distance and thereby fosters self-awareness and positive psychological transformation.

Interventions for Posttraumatic Stress With Children Exposed to Violence: Factors Associated With Treatment Success.

In the past 15 years, there have been a substantial number of rigorous studies examining the effectiveness of various treatments for child trauma and posttraumatic stress disorder (PTSD). Although a number of review articles exist, many have focused on randomized controlled trials or specific treatment methodologies, both of which limit the ability to draw conclusions across studies and the statistical power to test the effect of particular treatment characteristics on treatment outcomes. The current study is a review and meta-analysis of 74 studies examining treatments for children exposed to violence. After reviewing the literature, we examined the relationship of a variety of treatment characteristics (e.g., group or individual treatments) and sample characteristics (e.g., average age) on treatment effect sizes. Results indicated that individual therapies and those with exposure paradigms within a cognitive-behavioral therapy or skills-building framework show the most promise, but treatment is somewhat less effective for those with more severe symptomology and for younger children. Future treatments should consider the developmental and social contexts that may impede treatment progress for young children and consider how best to develop the effectiveness of group interventions that can be readily delivered in settings of mass trauma.

Supplemental Material for Disgust and Imaginal Exposure to Memories of Sexual Trauma: Implications for the Treatment of Posttraumatic Stress

Supplemental Material for Disgust and Imaginal Exposure to Memories of Sexual Trauma: Implications for the Treatment of Posttraumatic Stress

Civilian Clinicians Gain Competence in Military Culture via Online Course

Back to table of contents Previous article Next article Community NewsFull AccessCivilian Clinicians Gain Competence in Military Culture via Online CourseAaron LevinAaron LevinSearch for more papers by this authorPublished Online:20 Nov 2014https://doi.org/10.1176/appi.pn.2014.11b22AbstractCultural competency is as important in understanding military service members as it is for any population group.Engagement improves treatment. Now, a new online course seeks to educate civilian clinicians about military culture to help them better connect with military service members and veterans.The free, four-module course was jointly developed by the departments of Veterans Affairs and Defense and is available at the latter’s Center for Deployment Psychology website. The course was announced as part of President Obama’s executive actions in late August (Psychiatric News, September 19).Even simple miscommunication can disrupt or destroy attempts at a therapeutic relationship, say veterans. “Service members, veterans, and their families cite lack of respect and understanding of their experiences as a major reason for not seeking mental health treatment or for leaving therapy,” noted the course developers. “The ability to understand and appreciate the military culture and to tailor clinical practices based on that understanding and appreciation is imperative for clinicians working with service members.”To overcome that hurdle, the course, called “Military Culture: Core Competencies for Healthcare Professionals,” asks clinicians first to evaluate their own beliefs and understandings of military culture. It then offers information on military ethos, organization, and roles; identifies the stressors unique to military experience and their effects on the patient’s health; and offers resources and tools for culturally competent assessment and clinical treatment.The course’s four modules can be taken individually, or the full program can be completed in a single day. The modules include video clips of service members and veterans talking about their experiences, along with assessment and treatment-planning tools.The course also includes detailed, printable reference materials on everything from military insignias and basic training to information on the children of military personnel and treatment for posttraumatic stress disorder.Continuing education credits are available with the course. ■The “Military Culture: Core Competencies for Healthcare Professionals” course can be accessed here. ISSUES NewArchived