Journal articles on the topic 'Psychological trauma and related clinical interventions'
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Arancibia, Marcelo, Fanny Leyton, Javier Morán, Andrea Muga, Ulises Ríos, Elisa Sepúlveda, and Valentina Vallejo-Correa. "Phycological debriefing in acute traumatic events: Evidence synthesis." Medwave 22, no. 01 (February 23, 2022): e002538-e002538. http://dx.doi.org/10.5867/medwave.2022.01.002538.
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Stressful life situations can generate chronic symptomatology, so it is of great concern to analyze preventive strategies. Psychological debriefing is an intervention for acute trauma, which verbalizes perceptions, thoughts, and emotions experienced during a recent traumatic event. The evidence surrounding its efficacy is controversial. This article discusses the efficacy of psychological debriefing based on systematic reviews and clinical practice guidelines. In all, nine systematic reviews were included. Only one of them found that psychological debriefing effectively decreased psychological stress, while the remaining eight found no significant effects for outcomes such stress, depressive and anxious symptoms, or development and severity of post-traumatic stress disorder. Moreover, two clinical trials found that the intervention had a significantly deleterious effect. Another study found a worsening in the symptomatology associated with the event. Of the eight clinical practice guidelines incorporated, none recommended psychological debriefing as an intervention for acute trauma. Some phenomena could explain the lack of success of the intervention in the scientific evidence. The bioethical conditions related to the traumatic scenario hinder its research, and its lack of standardization makes its evaluation in clinical trials problematic. Other variables such as ethnicity, personality, culture, gender, and history of traumatic experiences have been little considered in research. Nevertheless, the intervention may hinder the adequate processing of traumatic memory and emotions. Current evidence is consistent in not recommending psychological debriefing as an intervention for acute trauma, so its management should avoid it. It is suggested to promote research on preventive interventions to develop chronic traumatic symptomatology.
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Clements, Wendy, Larry D. Williams, Tyrone David, and S. Lavi Wilson. "Childhood Trauma and Effective Empirically Based Interventions." Journal of Psychology & Behavior Research 1, no. 1 (May 17, 2019): p45. http://dx.doi.org/10.22158/jpbr.v1n1p45.
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Trauma affects many children in various ways globally. According to SAMHSA (2017), the “occurrence of child trauma is very prevalent, and 75% of children reported experiencing at least one traumatic event by age 16”. Traumatic events consist of “psychological, physical, or sexual abuse; community or school violence; witnessing or experiencing domestic violence; national disasters or terrorism; commercial sexual exploitation; sudden or violent loss of a loved one; refugee or war experiences; military family-related stressors; physical or sexual assault; neglect; and serious accidents or life-threatening illness” (SAMHSA, 2017). This literature review evaluates three different attachment-based, trauma-informed interventions for young children 0-7 years of age which are: Attachment and Bio-Behavioral Catchup (ABC), Child-Parent Psychotherapy (CPP), and Parent-Child Interaction Therapy (PCIT). Throughout this review, childhood trauma will be defined, and the current occurrence rates will be discussed. Furthermore, the descriptions of the above therapies, clinical trials, and research findings will be examined, and a discussion of the literature review findings will follow.
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Wilson, Shanika Lavi. "Childhood trauma and Effective Empirically Based Interventions." Matters of Behaviour 10, no. 11 (July 20, 2019): 17–22. http://dx.doi.org/10.26455/mob.v10i11.70.
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Trauma affects many children in various ways globally. According to SAMHSA (2017), the “occurrence of child trauma is very prevalent, and 75% of children reported experiencing at least one traumatic event by age 16”. Traumatic events consist of “psychological, physical, or sexual abuse; community or school violence; witnessing or experiencing domestic violence; national disasters or terrorism; commercial sexual exploitation; sudden or violent loss of a loved one; refugee or war experiences; military family-related stressors; physical or sexual assault; neglect; and serious accidents or life-threatening illness” (SAMHSA, 2017). This literature review evaluates three different attachment-based, trauma-informed interventions for young children 0 - 7 years of age which are: Attachment and BioBehavioural Catchup (ABC), Child-Parent Psychotherapy (CPP), and Parent-Child Interaction Therapy (PCIT). Throughout this review, childhood trauma will be defined, and the current occurrence rates will be discussed. Furthermore, the descriptions of the above therapies, clinical trials, and research findings will be examined, and a discussion of the literature review findings will follow.
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Lebois, Lauren A. M., Antonia V. Seligowski, Jonathan D. Wolff, Sarah B. Hill, and Kerry J. Ressler. "Augmentation of Extinction and Inhibitory Learning in Anxiety and Trauma-Related Disorders." Annual Review of Clinical Psychology 15, no. 1 (May 7, 2019): 257–84. http://dx.doi.org/10.1146/annurev-clinpsy-050718-095634.
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Although the fear response is an adaptive response to threatening situations, a number of psychiatric disorders feature prominent fear-related symptoms caused, in part, by failures of extinction and inhibitory learning. The translational nature of fear conditioning paradigms has enabled us to develop a nuanced understanding of extinction and inhibitory learning based on the molecular substrates to systems neural circuitry and psychological mechanisms. This knowledge has facilitated the development of novel interventions that may augment extinction and inhibitory learning. These interventions include nonpharmacological techniques, such as behavioral methods to implement during psychotherapy, as well as device-based stimulation techniques that enhance or reduce activity in different regions of the brain. There is also emerging support for a number of psychopharmacological interventions that may augment extinction and inhibitory learning specifically if administered in conjunction with exposure-based psychotherapy. This growing body of research may offer promising novel techniques to address debilitating transdiagnostic fear-related symptoms.
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Sturgeon-Clegg, Imogen, and M. McCauley. "Military psychologists and cultural competence: exploring implications for the manifestation and treatment of psychological trauma in the British armed forces." Journal of the Royal Army Medical Corps 165, no. 2 (March 17, 2019): 80–86. http://dx.doi.org/10.1136/jramc-2018-001133.
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This paper considers the manifestation and treatment of psychological trauma in the military. The article describes how military psychologists conceptualise psychological trauma within the culture of the Armed Forces (AF), which is reflected in the process of acquiring what has been referred to as cultural competency. Psychologists in this context acquire an understanding of the manner in which the psychological and organisational systems and culture of the military affect the presentation of psychological trauma, including post-traumatic stress disorder (PTSD). The paper outlines core psychological features of military life, including some of the ways in which the AF functions effectively as an adaptable fighting force. This highlights, for example, the potential for stigma within and between military personnel who experience mental health difficulties. The article proceeds to examine aspects of help-seeking in military mental healthcare, how symptoms can present at different stages in a deployment process, and the consequences that such problems can cause for military conduct and performance. Psychological care in the military is structured within an occupational mental health ethos, in which psychologists fulfil a range of clinical, organisational and leadership roles. These dynamics are explored with examples of care pathways and clarity on evidence-based interventions for trauma and PTSD in those experiencing military-related psychological injuries. Two vignettes are then offered to illustrate how some of these interventions can be used psychotherapeutically in addressing symptoms pertaining to hyperarousal, hypervigilance, guilt and shame.
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Master, Lindsay, Julie Wagner, Richard Feinn, Mary Scully, Theanvy Kuoch, Sengly Kong, S. Berthold, Thomas Buckley, and Orfeu Buxton. "0239 A Latent Profile Analysis of actigraphic sleep and physical activity measures among Cambodian-Americans: Relationship with specific trauma symptoms." Sleep 45, Supplement_1 (May 25, 2022): A108. http://dx.doi.org/10.1093/sleep/zsac079.237.
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Abstract Introduction Sleep and physical activity are related to psychological trauma. Less is known about how individuals with distinct sleep and activity profiles differ on specific clusters of trauma symptoms. Cambodian-Americans who survived the Pol Pot genocide experienced severe collective trauma. This analysis explored group differences between sleep/activity profiles on specific trauma symptoms among Cambodian-Americans. Methods Participants in a diabetes prevention trial for Cambodian-Americans (NCT02502929) met inclusion criteria for depression and high diabetes risk (but did not have diabetes). They wore wrist actigraphy (sleep) and hip actigraphy (physical activity) for 7 days (≥3 days to be included) and completed the 16-item trauma symptom scale of the Harvard Trauma Questionnaire (HTQ; N=166). Latent Profile Analyses identified profiles using 3 mean actigraphic sleep and activity variables: total nightly sleep time, sleep maintenance efficiency, and minutes in moderate-vigorous physical activity. ANOVAs explored differences between sleep/activity profiles on the HTQ, specifically total scores and the “Avoidance/Numbing” and “Re-experiencing/Hyperarousal” subscales. Models were adjusted for psychotropic medication use. Results Participants were predominantly women (79%), mean age 55.3, with elevated trauma symptoms (17% were higher than 2.5 cutpoint; mean±SD= 1.90±0.61). Sleep and physical activity patterns yielded a BIC best fit with 3 sleep/activity profiles: Inactive Poor Sleepers (n=30, 18%), Highly Active Short Sleepers (n=35, 21%), and Moderately Active Good Sleepers (n=101, 61%). Differences were observed between profiles on the HTQ total score (p=0.03). Tukey’s post hoc test revealed that Inactive Poor Sleepers exhibited greater HTQ scores than Highly Active Short Sleepers (p<0.05), but did not differ from Moderately Active Good Sleepers. There was also a significant difference between profiles in the Avoidance/Numbing subscale (p=0.01); Inactive Poor Sleepers had higher Avoidance/Numbing than Highly Active Short Sleepers (p<0.05, Cohen’s d: 0.47). There were no differences between profiles on the Re-experiencing/Hyperarousal subscale (p=.09). Conclusion Individuals with contrasting actigraphic sleep/activity profiles differed on trauma symptoms. Inactive Poor Sleepers may benefit from specific interventions for Avoidance/Numbing symptoms. Future analyses will evaluate how changes in sleep/activity profiles are longitudinally related to psychological health and diabetes risk following interventions. Support (If Any) 5R01DK103663
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Miodus, Stephanie, Maureen A. Allwood, and Nana Amoh. "Childhood ADHD Symptoms in Relation to Trauma Exposure and PTSD Symptoms Among College Students: Attending to and Accommodating Trauma." Journal of Emotional and Behavioral Disorders 29, no. 3 (January 5, 2021): 187–96. http://dx.doi.org/10.1177/1063426620982624.
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Attention-deficit/hyperactivity disorder (ADHD) and posttraumatic stress disorder (PTSD) are highly comorbid among children and adolescents with a history of maltreatment and trauma. This comorbidity is linked to increased symptom severity and poor academic and social outcomes. Such negative outcomes are shown to have further negative outcomes during the college years. However, research has yet to directly examine the associations between ADHD, trauma exposure, and PTSD among college students. To address this gap, the current study examined the relations between childhood ADHD symptoms, lifetime trauma exposure, and current PTSD symptoms among a racially and ethnically diverse group of college students ( N = 454). Analyses controlled for symptoms of depression and anxiety and examined demographic differences. Findings indicated that college students with a childhood history of elevated ADHD symptoms reported significantly higher numbers of trauma exposure and PTSD symptoms. Findings also indicated that trauma-related arousal symptoms and more general depressive symptoms were the strongest mediators in the association between ADHD symptoms and trauma exposure. These results have implications for child and adolescent clinical interventions, as well as for college counseling and accessibility services related to psychological well-being and academic accommodations.
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Ross, Allen, and Trotter Emily. "Investigation into the effectiveness of a ‘moving on from trauma’ group within a primary care setting." Clinical Psychology Forum 1, no. 339 (March 2021): 44–50. http://dx.doi.org/10.53841/bpscpf.2021.1.339.44.
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The aim of this service evaluation was to assess the effectiveness of a Cognitive Behavioural Therapy (CBT) group intervention for clients presenting with trauma-related difficulties within a part primary care, part ‘Improving Access to Psychological Therapies’ (IAPT) community service (Howells, 2004). Self-report measures were used to assess low mood, anxiety and trauma symptoms. This evaluation found that clients experienced a reduction in symptoms of anxiety and low mood; however, the difference in scores did not equate to a reliable change or improvement according to the IAPT reliable improvement index. Notwithstanding this, clients did report a change and improvement in trauma ‘symptoms’ by the end of this part of the intervention.
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Nenova, Maria, Loretta Morris, Laurie Paul, Yuelin Li, Allison Applebaum, and Katherine DuHamel. "Psychosocial Interventions With Cognitive-Behavioral Components for the Treatment of Cancer-Related Traumatic Stress Symptoms: A Review of Randomized Controlled Trials." Journal of Cognitive Psychotherapy 27, no. 3 (2013): 258–84. http://dx.doi.org/10.1891/0889-8391.27.3.258.
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Background: Cancer-related traumatic stress symptoms, including posttraumatic stress disorder (PTSD), can significantly impact the quality of life and psychological adjustment of patients and survivors with cancer. Cognitive behavioral therapy (CBT) is an effective intervention previously shown to ameliorate non-cancer-related PTSD. Because of some of the unique aspects of cancer-related traumatic stress, such as the internal and ongoing nature of the traumatic stressor, it is important to review the overall efficacy of CBT interventions in populations with cancer. Objective: To review the findings of randomized clinical trials (RCTs) testing the efficacy of interventions with CBT components for cancer-related traumatic stress symptoms, including intrusion and avoidance, in adults with cancer. Methods: Eligible RCTs were identified via search of OVID, PubMed, EMBASE, and Scopus. Bayesian random effects analysis of treatment effect sizes (ES) was conducted in a portion of the studies for which data were available. Results: Nineteen RCTs met search criteria. Six trials reported reductions in traumatic stress symptoms as a result of the intervention and 13 studies reported null findings. Bayesian modeling based on 13 studies showed no overall discernible effect of interventions with CBT components on intrusion and avoidance symptoms. Conclusions: Most of the studies were not designed to target traumatic stress symptoms in highly distressed patients with cancer and did not include previously validated CBT components, such as cognitive restructuring and exposure. Thus, there was insufficient evidence from which to draw definitive conclusions about the efficacy of CBT interventions for the treatment of cancer-related traumatic stress symptoms, including PTSD. However, interventions with CBT components may have potential for the reduction of PTSD symptoms in highly distressed patients. Future research should focus on testing trauma-focused interventions in demographically and clinically diverse samples.
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Maina, Cecilia, Stefano Piero Bernardo Cioffi, Michele Altomare, Andrea Spota, Francesco Virdis, Roberto Bini, Roberta Ragozzino, et al. "Increasing Trend in Violence-Related Trauma and Suicide Attempts among Pediatric Trauma Patients: A 6-Year Analysis of Trauma Mechanisms and the Effects of the COVID-19 Pandemic." Journal of Personalized Medicine 13, no. 1 (January 9, 2023): 128. http://dx.doi.org/10.3390/jpm13010128.
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Background: Trauma is the leading cause of morbidity and mortality in the pediatric population. During the COVID-19 pandemic (COVID-19), different trends for pediatric trauma (PT) were described. This study aims to explore the trend over time of PT in our center, also considering the effects of COVID-19, focusing on trauma mechanisms, violence-related trauma (VRT) and intentionality, especially suicide attempts (SAs). Methods: All PT patients accepted at Niguarda Trauma Center (NTC) in Milan from January 2015 to December 2020 were retrospectively analyzed. We considered demographics and clinical variables and performed descriptive and year comparison analyses. Results: There were 684 cases of PT accepted at NTC: 84 in 2015, 98 in 2016, 125 in 2017, 119 in 2018, 114 in 2019 and 144 in 2020 (p < 0.001), 66.2% male, mean age 9.88 (±5.17). We observed a higher number of traffic-related, fall-related injuries and an increasing trend for VRT and SAs, peaking in 2020. We report an increasing trend over time for head trauma (p = 0.002). The Injury Severity Score did not significantly change. During COVID-19 we recorded a higher number of self-presenting patients with low priority codes. Conclusions: NTC is the adult level I referral trauma center for the Milan urban area with pediatric commitment. During COVID-19, every traumatic emergency was centralized to NCT. In 2020, we observed an increasing trend in SAs and VRT among PT patients. The psychological impact of the COVID-19 restriction could explain this evidence. The long-term effects of COVID-19 on the mental health of the pediatric population should not be underestimated. Focused interventions on psychological support and prevention of SAs and VRT should be implemented, especially during socio-demographic storms such as the last pandemic.
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Franz, Molly R., Rebecca L. Brock, and David DiLillo. "Trauma symptoms contribute to daily experiential avoidance: Does partner support mitigate risk?" Journal of Social and Personal Relationships 38, no. 1 (October 5, 2020): 322–41. http://dx.doi.org/10.1177/0265407520963186.
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Objective: The present study examined the protective role of partner support in reducing daily experiential avoidance (EA) associated with trauma symptoms in a sample of 154 couples during pregnancy. Background: Although psychological distress during pregnancy may hinder the developing bond between parents and infants after birth, high quality intimate partner support has the potential to enhance psychological wellbeing during pregnancy, particularly in the context of trauma. Specifically, partner support might mitigate the impact of trauma symptoms on maladaptive coping strategies such as EA by enabling individuals to safely encounter their distress. Method: Participants completed a semi-structured clinical interview of support and a PTSD symptom inventory, followed by home surveys of EA over 14 days. We examined growth trajectories of EA over 14 days using latent trajectory modeling within a dyadic framework. Results: Trauma symptom severity was associated with higher levels of EA across the 2 weeks; however, among women, the impact of trauma symptoms on EA was no longer significant when support from a partner was above average quality or higher. Findings also revealed partner effects; to the extent that women reported higher levels of trauma symptoms, their partners had higher levels of EA. Conclusion: Findings highlight the protective role of high quality support from intimate partners and suggest that trauma-related interventions targeting partner support processes, especially those implemented during pregnancy, might enhance recovery and prevent further distress and dysfunction among pregnant women experiencing trauma symptoms.
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Black, Melissa, Caitlin Hitchcock, Anna Bevan, Cliodhna O Leary, James Clarke, Rachel Elliott, Peter Watson, et al. "The HARMONIC trial: study protocol for a randomised controlled feasibility trial of Shaping Healthy Minds—a modular transdiagnostic intervention for mood, stressor-related and anxiety disorders in adults." BMJ Open 8, no. 8 (August 2018): e024546. http://dx.doi.org/10.1136/bmjopen-2018-024546.
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IntroductionAnxiety, mood and trauma-related disorders are common, affecting up to 20% of adults. Many of these individuals will experience symptoms of more than one disorder as diagnostically defined. However, most psychological treatments focus on individual disorders and are less effective for those who experience comorbid disorders. The Healthy and Resilient Mind Programme: Building Blocks for Mental Wellbeing (HARMONIC) trial introduces a novel transdiagnostic intervention (Shaping Healthy Minds (SHM)), which synthesises several evidence-based treatment techniques to address the gap in effective interventions for people with complex and comorbid difficulties. This early phase trial aims to estimate the efficacy and feasibility of the transdiagnostic intervention in preparation for a later-phase randomised controlled trial, and to explore mechanisms of change.Methods/analysisWe outline a patient-level two-arm randomised controlled trial (HARMONIC) that comparesSHMto treatment-as-usual for individuals aged >18 years (n=50) with comorbid mood, anxiety, obsessive-compulsive or trauma/stressor disorders diagnoses, recruited from outpatient psychological services within the UK National Health Service (NHS). The co-primary outcomes will be 3-month follow-up scores on self-report measures of depressive symptoms, anxiety symptoms, and disability and functional impairment. Secondary outcomes include changes in symptoms linked to individual disorders. We will assess the feasibility and acceptability ofSHM, the utility of proposed outcome measures, and refine the treatment manuals in preparation for a later-phase trial.Ethics and disseminationThis trial protocol has been approved by the Health Research Authority of the NHS of the UK (East of England, Reference: 16/EE/0095). We anticipate that trial findings will inform future revisions of clinical guidelines for numerous forms of mood, anxiety and stressor-related disorders. Findings will be disseminated broadly via peer-reviewed empirical journal articles, conference presentations, clinical workshops and a trial website.Trial registrationNCT03143634; Pre-results.
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Hensler, Ida, Josefin Sveen, Martin Cernvall, and Filip K. Arnberg. "Efficacy, Benefits, and Harms of a Self-management App in a Swedish Trauma-Exposed Community Sample (PTSD Coach): Randomized Controlled Trial." Journal of Medical Internet Research 24, no. 3 (March 30, 2022): e31419. http://dx.doi.org/10.2196/31419.
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Background Self-guided interventions may complement and overcome obstacles to in-person treatment options. The efficacy of app interventions targeting posttraumatic stress disorder (PTSD) is unclear, and results from previous studies on PTSD Coach—an app for managing trauma-related distress—are inconsistent. Objective This study investigates whether access to the Swedish version of the PTSD Coach affects posttraumatic stress, depressive, and somatic symptoms. In addition, we aim to assess the perceived helpfulness, satisfaction, negative effects, response, and remission related to PTSD Coach. Methods Adults who had experienced potentially traumatic events in the past 2 years were randomized (1:1) to have access to PTSD Coach (n=89) or be on the waitlist (n=90). We assessed clinical characteristics at baseline (semistructured interviews and self-rating scales) and after 3 months (self-rating scales). We analyzed the data in R software using linear mixed effects models, chi-square tests, and Fisher exact test. Results Intention-to-treat analyses indicated that access to PTSD Coach decreased posttraumatic stress and depressive symptoms but not somatic symptoms. More participants who had access to PTSD Coach responded with clinically significant improvement and fewer instances of probable PTSD after 3 months compared with waitlist controls. Overall, participants found that PTSD Coach was slightly to moderately helpful and moderately satisfactory. Half of the intervention group (36/71, 51%) reported at least one negative reaction related to using PTSD Coach (eg, disappointment with the app or its results, arousal of stress, or distressing memories). Conclusions Using PTSD Coach may trigger symptoms among a few users; however, most of them perceived PTSD Coach as helpful and satisfactory. This study showed that having access to PTSD Coach helped improve psychological trauma-related symptoms. In addition, we have discussed implications for future research and clinical practice. Trial Registration ClinicalTrials.gov NCT04094922; https://clinicaltrials.gov/ct2/show/NCT04094922
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Lynch, James H., Peter D. Muench, John C. Okiishi, Gary E. Means, and Sean W. Mulvaney. "Behavioral health clinicians endorse stellate ganglion block as a valuable intervention in the treatment of trauma-related disorders." Journal of Investigative Medicine 69, no. 5 (March 16, 2021): 989–93. http://dx.doi.org/10.1136/jim-2020-001693.
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The stellate ganglion block (SGB) procedure has been used successfully for over 10 years to treat post-traumatic stress symptoms in thousands of US military service members, civilians, and veterans in select hospitals in Europe and North America. Primarily through targeting the autonomic nervous system, the SGB procedure serves as an invaluable adjunct to trauma-focused psychotherapy. Without published best practices for emerging therapies, clinicians are left on their own to determine how best to apply new treatments to their patient populations. The aim of this qualitative research was to compile attitudes and recommendations from therapists with expertise in using SGB for treating symptoms of post-traumatic stress disorder, so that their experiences could be disseminated widely to clinicians without SGB expertise. An 18-item survey was developed and distributed electronically to a group of behavioral health professionals of various specialties between May and June 2020. Of surveyed behavioral health clinicians with personal experience incorporating SGB into their trauma-focused psychotherapy, 95% of respondents would recommend SGB to a colleague as a useful tool for the treatment of trauma-related disorders. SGB was rated at least as useful as the most valuable interventions listed in the American Psychological Association Clinical Practice Guideline for the Treatment of Post-traumatic Stress Disorder with 100% of respondents characterizing SGB as ‘Very Beneficial’ or ‘Somewhat Beneficial’, and 0 respondents characterizing SGB as ‘Not Helpful’ or ‘Harmful’. Given the feedback from this study, behavioral health providers should consider using SGB in conjunction with standard trauma-focused care.
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Taub, Chloe J., John A. Sturgeon, Mandeep K. Chahal, Ming-Chih Kao, Sean C. Mackey, and Beth D. Darnall. "Self-reported traumatic etiology of pain and psychological function in tertiary care pain clinic patients: a collaborative health outcomes information registry (CHOIR) study." Scandinavian Journal of Pain 20, no. 3 (July 28, 2020): 499–509. http://dx.doi.org/10.1515/sjpain-2019-0154.
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AbstractBackground and aimsA sizable body of research has elucidated the significant role of psychological reactions to trauma on pain coping and outcomes. In order to best inform intervention development and clinical care for patients with both trauma and pain at the tertiary care level, greater clarity is needed regarding the magnitude of these effects and the specific pathways through which they may or may not function at the time of first presentation to such a treatment setting. To achieve this, the current study examined the cross-sectional relationships between traumatic etiology of pain, psychological distress (anger, depressive symptoms, and PTSD symptoms), and pain outcomes (pain catastrophizing, physical function, disability status).MethodsUsing a structural path modeling approach, analyses were conducted using a large sample of individuals with chronic pain (n = 637) seeking new medical evaluation at a tertiary pain management center, using the Collaborative Health Outcomes Information Registry (CHOIR). We hypothesized that the relationships between traumatic etiology of pain and poorer pain outcomes would be mediated by higher levels of psychological distress.ResultsOur analyses revealed modest relationships between self-reported traumatic etiology of pain and pain catastrophizing, physical function, and disability status. In comparison, there were stronger relationships between indices of psychological distress and pain catastrophizing, but a weaker pattern of associations between psychological distress and physical function and disability measures.ConclusionsTo the relatively small extent that self-reported traumatic etiology of pain correlates with pain-related outcomes, these relationships appear to be due primarily to the presence of psychiatric symptoms and manifest most notably in the context of psychological responses to pain (i.e. catastrophizing about pain).ImplicationsFindings from this study highlight the need for early intervention for patients with traumatic onset of pain and for clinicians at tertiary pain centers to include more detailed assessments of psychological distress and trauma as a component of comprehensive chronic pain treatment.
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Paquet, C., and J. Davis. "1070 An Examination of the Relationship Between Language Use in Post-Trauma Nightmares and Psychological Sequelae in a Treatment Seeking Population." Sleep 43, Supplement_1 (April 2020): A407—A408. http://dx.doi.org/10.1093/sleep/zsaa056.1066.
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Abstract Introduction Studying language use in dreams and nightmares has become an increasingly used tool to understand underlying emotional and cognitive processes. Specifically, in regards to post-trauma nightmares (PTNMs), nightmare transcriptions can offer a lens to understand a survivor’s interpretation of their trauma. The current study will utilize a method of quantitative text analysis to analyze the relationship between specific psychological constructs and symptoms of posttraumatic stress disorder (PTSD) and nightmare qualities. It is hypothesized that there will be a positive correlation between words related to perceptual processes and negative emotions in nightmares and PTSD symptom and nightmare severity. There will be a negative correlation between cognitive processes and positive emotion words, and PTSD symptom and nightmare severity. Methods Fifty-three nightmares were collected from participants that were recruited from the community in a Midwestern city as part of an ongoing investigation of the effectiveness of a brief cognitive-behavioral intervention for PTNM, Exposure, Relaxation, and Rescripting Therapy (ERRT). All participants were over the age of 18, have experienced a criterion A trauma, and have nightmares at least once weekly. Linguistic Inquiry and Word Count (LIWC) was utilized to analyze the nightmare transcriptions. The Posttraumatic Stress Disorder Checklist for the DSM-5 (PCL-5) and the Trauma-related Nightmare Survey (TRNS) were used to measure symptom severity. A Pearson’s correlation analysis was used for this exploratory study. Results Words related to perceptual processes were significantly positively correlated with PTSD symptom and nightmare severity (p<.05) Neither negative nor positive emotion words were significantly related to PTSD and nightmare symptoms (p>.05). Cognitive processing words were significantly negatively correlated with PTSD and nightmare symptoms (p<.05). Conclusion The results of this study support the hypothesis that language use in nightmares reveals important information about underlying cognitive and emotional functioning. The results of this study may have an important impact on treatment considerations for those who have experienced trauma. Analyzing language use in PTNM may help to understand the etiology and maintenance of PTSD symptoms. Support Support for this study comes from the University of Tulsa Institute of Trauma, Adversity, and Injustice.
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Gallo, Fred. "Mindful Energy Psychology: History, Theory, Research, and Practice." Energy Psychology 8, no. 1 (May 1, 2016): 40–54. http://dx.doi.org/10.9769/epj.2016.8.1.fg.
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Abstract: The dialectic between acceptance and the desire for change reflects a core paradox within psychology. Two clinical methodologies that at first glance appear to be diametrically opposed have been incorporated into an approach that harnesses a reciprocal synergy, seamlessly integrating a focus on acceptance with a focus on change. Mindfulness practices, which involve purposeful, nonjudgmental awareness and acceptance of the present moment, have been shown to promote general well-being as well as to alleviate many psychological and stress-related symptoms. Energy psychology, which utilizes both somatic and cognitive interventions, is believed to rapidly and with precision change the energetic and neurological underpinnings of a range of psychological disorders. Combining the two approaches into a “mindful energy psychology” resolves the acceptance/change paradox with an interplay that yields immediate, potent therapeutic benefits. This paper examines each approach and shows how they may be integrated into clinical practice. Keywords: mindful, mindfulness, mindfulnessbased therapies, energy psychology, mindful energy psychology, tapping, energy tapping, meridian tapping, Thought Field Therapy, TFT, Emotional Freedom Techniques, EFT, Midline Energy Technique, MET, Tonglen, trauma, posttraumatic stress disorder, PTSD
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Collins, Kathryn S., Pamela A. Clarkson Freeman, George Jay Unick, Melissa H. Bellin, Polly Reinicker, and Frederick H. Strieder. "Child Attributions Mediate Relationships Between Violence Exposure and Trauma Symptomology." Advances in Social Work 18, no. 1 (September 24, 2017): 284–99. http://dx.doi.org/10.18060/21283.
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Violence and trauma exposure have been increasingly investigated as contributing to a range of negative outcomes in child physical, cognitive, emotional, social, and psychological functioning, particularly among youth who are racial/ethnic minorities. This study presents findings related to children's attributions of their violence and trauma exposure. Attributions are inferences made about the cause of an event, situation, or action, with internal, stable, and global attributions most likely to lead to negative psychological outcomes. Data were drawn from an on-going clinical intervention study with families at risk for child maltreatment and/or neglect residing in a large metropolitan city on the East Coast. Mediation models provide evidence for a mediated relationship between violence exposure and PTSD through child attribution. Children develop their definitions of violence, formulate reasons why the violence occurs, and react to violence based on interpreting and developing cognitive attributions and schema about their experiences with violence in order to adaptively cope.
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Jones, N., N. T. Fear, S. Wessely, G. Thandi, and N. Greenberg. "Forward psychiatry – early intervention for mental health problems among UK armed forces in Afghanistan." European Psychiatry 39 (January 2017): 66–72. http://dx.doi.org/10.1016/j.eurpsy.2016.05.009.
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AbstractBackgroundThis observational study examined return to duty (RTD) rates following receipt of early mental health interventions delivered by deployed mental health practitioners.MethodIn-depth clinical interviews were conducted among 975 UK military personnel referred for mental health assessment whilst deployed in Afghanistan. Socio-demographic, military, operational, clinical and therapy outcomes were recorded in an electronic health record database. Rates and predictors of EVAC were the main outcomes examined using adjusted binary logistic regression analyses.ResultsOverall 74.8% (n = 729) of personnel RTD on completion of care. Of those that underwent evacuation home (n = 246), 69.1% (n = 170) returned by aeromedical evacuation; the remainder returned home using routine air transport. Predictors of evacuation included; inability to adjust to the operational environment, family psychiatric history, previously experiencing trauma and thinking about or carrying out acts of deliberate self-harm.ConclusionDeployed mental health practitioners helped to facilitate RTD for three quarters of mental health casualties who consulted with them during deployment; psychological rather than combat-related factors predicted evacuation home.
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Kovler, Jessica Diller, and Daniel Prevedello. "Trauma Symptomatology in Patients Successfully Treated for Pituitary Adenoma." Journal of the Endocrine Society 5, Supplement_1 (May 1, 2021): A637. http://dx.doi.org/10.1210/jendso/bvab048.1297.
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Abstract The emotional symptomatology accompanying pituitary adenomas has long been recognized, though research has been scant, varied, and more focused on studies related to quality of life. The present study sought to better codify the psychological presentation of pituitary adenoma patients through the lens of trauma and PTSD symptomatology. 128 patients who were successfully treated for pituitary adenoma were recruited from the Wexner School of Medicine at Ohio State University. Ranging in age from 23 to 74, the participants’ mental health functioning was assessed by the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5), the Brief Symptom Inventory (BSI), and the Dissociative Experiences Scale (DES). The findings of this pilot study showed that the rate of traumatization (PTSD) for pituitary adenoma patients was significantly higher than that of the general population. With regard to comorbid trauma-related mental health impairment, our results demonstrated that when moderated by sex, pituitary adenoma patients had significantly higher psychopathology than the non-clinical population. Replicating the existing research, there was a significant positive correlation between trauma symptoms and trauma-related psychopathology in patients successfully treated for pituitary adenoma. Overall, the results of this study demonstrate the traumatic nature of this disease and the need for applied clinical intervention. Further research is needed to replicate these findings, in light of potential selection bias and sample size.
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Reiter, Helen, and Leanne Humphreys. "Exposure, Relaxation, and Rescripting Therapy for Trauma-Related Nightmares With Psychiatric Inpatients: A Case Series." Clinical Case Studies 20, no. 1 (September 10, 2020): 3–21. http://dx.doi.org/10.1177/1534650120953614.
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Research has shown that posttraumatic stress disorder (PTSD) is a highly prevalent diagnosis for psychiatric patients, yet individualized care and treatment is limited in the inpatient acute care sector. Two case studies are presented which examine the use of Exposure, Relaxation, and Rescripting Therapy (ERRT) for chronic trauma-related nightmares, within a private acute care inpatient psychiatric hospital setting. ERRT is empirically supported with efficacy for veteran and civilian populations, however no research to date has been conducted with psychiatric inpatients. Two participants diagnosed with PTSD, suffering distressing trauma-related nightmares, completed ERRT over three sessions during their psychiatric hospital admission, with the aim of reducing the frequency and severity of nightmares and related psychological symptoms. PTSD, depression, sleep quality and quantity, and nightmare frequency and related distress, were measured pre-treatment, during treatment, and follow-up at one, 3 and 6 months. Only one participant reported ongoing nightmares by the third week of the intervention, with both participants reporting an absence of nightmares at the one and 3-month follow-ups, but mixed results by the 6-month follow-up. One participant also reported a reduction in PTSD symptoms and a mild improvement in depression. The results offer some preliminary support for the provision of ERRT for the treatment of trauma-related nightmares for psychiatric inpatients.
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Hocking, Elise, Nicholas A. Livingston, Suzannah K. Creech, and Casey Taft. "The Moderating Effect of Alcohol Use Disorder on Intimate Partner Violence Intervention Outcomes in Veterans." Partner Abuse 12, no. 2 (January 14, 2021): 205–20. http://dx.doi.org/10.1891/pa-2020-0004.
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BackgroundVeterans report relatively high rates of intimate partner violence (IPV) due to high trauma exposure. Alcohol use disorder (AUD), which is more prevalent among veterans, is a risk factor for IPV use and recidivism following IPV intervention. Using data from a prior randomized control trial of a trauma-informed IPV intervention, we examined the moderating effect of AUD on treatment outcomes among veterans.MethodsParticipants were 61 male veterans (M age = 37.18, SD = 13.23; 82% White; 18% met criteria for AUD) who participated in the Strength at Home (SAH) IPV intervention. Generalized mixed modelling was used to examine the effects of AUD and treatment attendance on posttreatment reductions in IPV.ResultsA significant three-way interaction between time, AUD, and session attendance was observed with respect to reductions in psychological IPV. Specifically, psychological IPV decreased significantly over time, but to a lesser extent among individuals with AUD, regardless of treatment attendance.DiscussionResults indicate that participants with AUD receive less benefit from treatment with regard to coercive and controlling abusive behaviors. Findings speak to the need for adapting IPV intervention in order to address problematic alcohol use and related externalizing psychopathology.
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Wright, Simonne Lesley, Eirini Karyotaki, Jonathan I. Bisson, Pim Cuijpers, Davide Papola, Anke B. Witteveen, Soraya Seedat, and Marit Sijbrandij. "Protocol for individual participant data meta-analysis of interventions for post-traumatic stress." BMJ Open 12, no. 2 (February 2022): e054830. http://dx.doi.org/10.1136/bmjopen-2021-054830.
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IntroductionSeveral evidence-based treatments are effective for post-traumatic stress disorder (PTSD), yet a substantial proportion of patients do not respond or dropout of treatment. We describe the protocol for a systematic review and individual participant data meta-analysis (IPD-MA) aimed at assessing the effectiveness and adverse effects of psychotherapy and pharmacotherapy interventions for treating PTSD. Additionally, we seek to examine moderators and predictors of treatment outcomes.Method and analysisThis IPD-MA includes randomised controlled trials comparing psychotherapy and pharmacotherapy interventions for PTSD. PubMed, Embase, PsycINFO, PTSDpubs and CENTRAL will be screened up till the 11th of January 2021. The target population is adults with above-threshold baseline PTSD symptoms on any standardised self-report measure. Trials will only be eligible if at least 70% of the study sample have been diagnosed with PTSD by means of a structured clinical interview. The primary outcomes of this IPD-MA are PTSD symptom severity, and response rate. Secondary outcomes include treatment dropout and adverse effects. Two independent reviewers will screen major bibliographic databases and past reviews. Authors will be contacted to contribute their participant-level datasets. Datasets will be merged into a master dataset. A one-stage IPD-MA will be conducted focusing on the effects of psychological and pharmacological interventions on PTSD symptom severity, response rate, treatment dropout and adverse effects. Subsequent analyses will focus on examining the effect of moderators and predictors of treatment outcomes. These will include sociodemographic, treatment-related, symptom-related, resilience, intervention, trauma and combat-related characteristics. By determining the individual factors that influence the effectiveness of specific PTSD treatments, we will gain insight into personalised treatment options for PTSD.Ethics and disseminationSpecific ethics approval for an IPD-MA is not required as this study entails secondary analysis of existing anonymised data. The results of this study will be published in peer-reviewed scientific journals and presentations.
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Miralles, Ignacio, Carlos Granell, Laura Díaz-Sanahuja, William Van Woensel, Juana Bretón-López, Adriana Mira, Diana Castilla, and Sven Casteleyn. "Smartphone Apps for the Treatment of Mental Disorders: Systematic Review." JMIR mHealth and uHealth 8, no. 4 (April 2, 2020): e14897. http://dx.doi.org/10.2196/14897.
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Background Smartphone apps are an increasingly popular means for delivering psychological interventions to patients suffering from a mental disorder. In line with this popularity, there is a need to analyze and summarize the state of the art, both from a psychological and technical perspective. Objective This study aimed to systematically review the literature on the use of smartphones for psychological interventions. Our systematic review has the following objectives: (1) analyze the coverage of mental disorders in research articles per year; (2) study the types of assessment in research articles per mental disorder per year; (3) map the use of advanced technical features, such as sensors, and novel software features, such as personalization and social media, per mental disorder; (4) provide an overview of smartphone apps per mental disorder; and (5) provide an overview of the key characteristics of empirical assessments with rigorous designs (ie, randomized controlled trials [RCTs]). Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews were followed. We performed searches in Scopus, Web of Science, American Psychological Association PsycNET, and Medical Literature Analysis and Retrieval System Online, covering a period of 6 years (2013-2018). We included papers that described the use of smartphone apps to deliver psychological interventions for known mental disorders. We formed multidisciplinary teams, comprising experts in psychology and computer science, to select and classify articles based on psychological and technical features. Results We found 158 articles that met the inclusion criteria. We observed an increasing interest in smartphone-based interventions over time. Most research targeted disorders with high prevalence, that is, depressive (31/158,19.6%) and anxiety disorders (18/158, 11.4%). Of the total, 72.7% (115/158) of the papers focused on six mental disorders: depression, anxiety, trauma and stressor-related, substance-related and addiction, schizophrenia spectrum, and other psychotic disorders, or a combination of disorders. More than half of known mental disorders were not or very scarcely (<3%) represented. An increasing number of studies were dedicated to assessing clinical effects, but RCTs were still a minority (25/158, 15.8%). From a technical viewpoint, interventions were leveraging the improved modalities (screen and sound) and interactivity of smartphones but only sparingly leveraged their truly novel capabilities, such as sensors, alternative delivery paradigms, and analytical methods. Conclusions There is a need for designing interventions for the full breadth of mental disorders, rather than primarily focusing on most prevalent disorders. We further contend that an increasingly systematic focus, that is, involving RCTs, is needed to improve the robustness and trustworthiness of assessments. Regarding technical aspects, we argue that further exploration and innovative use of the novel capabilities of smartphones are needed to fully realize their potential for the treatment of mental health disorders.
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Almeida, Isamar, Danica Slavish, Hanan Rafiuddin, and Ateka Contractor. "0042 COVID-19 related distress and sleep among trauma-exposed South Asians: Does generational status matter?" Sleep 45, Supplement_1 (May 25, 2022): A19—A20. http://dx.doi.org/10.1093/sleep/zsac079.040.
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Abstract Introduction The COVID-19 pandemic has resulted in substantial changes in social interactions, work schedules, and socioeconomic factors that may negatively impact sleep onset, maintenance, and quality. The ongoing stress of the pandemic also may exacerbate existing racial/ethnic disparities in sleep health. In this study, we examined the effects of COVID-19 related distress on sleep-related impairment and sleep disturbances among trauma-exposed South Asian adults. Since a health advantage among foreign-born individuals has been previously noted in the literature (the “immigrant paradox”), we also assessed whether generational status (i.e., being born in the U.S. or not) moderated associations between COVID-19 related distress and sleep outcomes. Methods Participants were recruited through Amazon’s Mechanical Turk and completed online surveys on demographic information, the COVID-19 Stress Scale, The Life Events Checklist for DSM-5 (LEC-5), and PROMIS™ Sleep-Related Impairment and Sleep Disturbances Scale. The final sample included 316 South Asian adults residing in the U.S, who had been exposed to a traumatic event at some point in their lifetime. Most participants were male (55%) and U.S.-born citizens (64%), with an average age of 35.32 (SD = 9.52) years. Results Examination of t-scores for PROMIS™ sleep-related and sleep disturbances revealed that our sample endorsed slightly higher values than the general U.S. population. Greater COVID-19 distress was associated with more sleep disturbances (b = 0.09, p < .001, sr2 = .04) and sleep-related impairment (b = 0.20, p < .001, sr2 = .12). Generational status was not associated with sleep, nor did it modify associations between COVID-19 distress and sleep. Conclusion In our sample, we found that psychological distress triggered by the pandemic (e.g., fear of contamination, fear of the dangerousness of the virus, socioeconomic worries) was associated with greater sleep difficulties. Our findings highlight the importance of developing targeted interventions to cope with stress and sleep disturbances during the pandemic, particularly among vulnerable populations, such as those exposed to trauma. Our results did not support the immigration paradox: stress and sleep associations were similar regardless of generational status. Future studies are needed to better understand the role of generational status on sleep across different immigrant subgroups. Support (If Any)
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Robles, Rebeca, Marcela Palacios, Nancy Rangel, Tania Real, Benjamín Becerra, Ana Fresán, Hamid Vega, Evelyn Rodríguez, Sol Durand, and Eduardo Madrigal. "A qualitative assessment of psycho-educational videos for frontline COVID-19 healthcare workers in Mexico." Salud mental 43, no. 6 (December 1, 2020): 311–18. http://dx.doi.org/10.17711/sm.0185-3325.2020.042.
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Introduction. Frontline COVID-19 healthcare workers (FLHCWs) are at a high-risk of suffering occupational stress- and trauma-related mental health problems, including burnout and compassion fatigue (B&CF). Given the time limitations (due to their heavy workloads) and need to minimize face-to-face interventions (in order to avoid contagions), psychological interventions for FHCWs should be as brief and remote as possible. Objective. To evaluate the usability and clarity of evidence-based psycho-educational videos to prevent B&CF, to deal with uncooperative, hostile, and anxious patients and relatives, and to use personal protective equipment (PPE), from the perspective of Mexican FLHCWs. Method. Based on a convenience sampling by intensity approach, videos were distributed requesting feedback based on specific questions through WhatsApp to FLHCWs. Field notes were used to triangulate the information. Results. Content analysis of feedback from a final sample of 24 participants ‒75% women, 42 ± 8.4 years old‒ yielded three general thematic categories and seven subthemes: 1. content evaluation, which included three subthemes: utility, pertinence, and practicality; 2. dissemination and other needs, with two subcategories: willingness to share and receive more videos (other needs); and 3. format aspects, also comprising two subthemes: attractiveness and duration. All participants found the videos content very beneficial, relevant, and applicable to the workplace and even in their everyday personal and family life, and were willing to share them and to receive more videos on other issues, including strategies to manage problems related to isolation. Discussion and conclusion. Escalation of this remote preventive intervention to other COVID-19 centers and future similar epidemics is recommended.
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Borges, L. "Trauma and sexual risk behaviors in an adolescent victim of sexual abuse: A case report." European Psychiatry 64, S1 (April 2021): S754. http://dx.doi.org/10.1192/j.eurpsy.2021.1998.
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IntroductionChildhood and adolescence sexual abuse (CSA) is a risk factor for psychological trauma and a strong predictor of lifetime psychopathology, including depression, anxiety, inappropriate sexual behavior, anger, guilt, shame and other emotional and relationship problems.ObjectivesDescribe a clinical case of a sexually abused adolescent admitted in a psychiatric unit for young adults and to correlate sexual abuse with trauma and sexual risk behaviors.MethodsThe data was collected through clinical and family interviews. The revision was made with the search terms “trauma”, “child and adolescence sexual abuse”, “sexual risk behaviors” in scientific databases.Results16 year-old girl, high-school student, living with her nuclear family, was admitted in a psychiatric hospital with feelings of sadness and anxiety since the previous month, that lead to a voluntary medicine ingestion. She has been continuously sexually abused from the age of 12 to 16 by an older man, and once by her cousin and his friends. Since than, she refers feelings of anger, sadness, dissociative symptoms and intrusive images and nightmares related to the abuses, and continues to seek attention from older men. With medication and individual and family psychotherapeutic interventions, depressive, anxiety and dissociative symptoms have improved.ConclusionsLiterature concludes that there’s a strong correlation between CSA, trauma and sexual risk behaviors throughout adulthood. In fact, our patient met criteria for Pos-traumatic Stress Disorder and has sexual risk behaviors that must be worked through therapy. Due to it’s complexity, treatment of the adolescent and familial system after sexual abuse is multifaceted and requires a biopsychosocial approach.DisclosureNo significant relationships.
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Penney, Danielle, Ghassan El-Baalbaki, and Martin Lepage. "T1. CLINICAL PROFILE AND PREVALENCE OF POSTTRAUMATIC STRESS SYMPTOMS AMONG SERVICE-USERS REFERRED FOR PSYCHOLOGICAL FOLLOW-UP: UTILITY OF ASSESSING SYMPTOMS SEVERITY RANGE." Schizophrenia Bulletin 46, Supplement_1 (April 2020): S231. http://dx.doi.org/10.1093/schbul/sbaa029.561.
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Abstract Background Individuals with psychosis and comorbid posttraumatic stress disorder (PTSD) typically present with more severe forms of illness. Subthreshold posttraumatic stress symptoms (PTSS) are also likely to cause significant distress. There is a need to enhance screening processes for distressing PTSS to encourage appropriate referral to specialized services. The PTSD checklist for DSM-5 (PCL-5) is a widely used self-report to assess PTSS, though there is concern regarding its validity for use in psychosis. If people scoring in the severe PTSS range on the PCL-5 also present with clinical profiles similar to those typically meeting diagnosis for PTSD, it will justify considering a broader range of PTSS and support the use of the PCL-5 as a brief screener. A severe range will arguably capture a wider array of individuals, including those with subthreshold PTSS who also likely require trauma-focused intervention. Methods One hundred and two individuals with psychosis completed the PCL-5 and a battery of clinical scales as part of an intake evaluation following referral for psychological follow-up at a clinic specializing in psychosocial interventions for psychosis. Prevalence and type of DSM-5 criterion A event were explored in conjunction with PTSS severity and referral-type. Pearson correlations identified clinical variables associated with PCL-5 total scores and were subsequently entered into a multivariate analysis of variance (MANOVA) with dichotomized PTSS severity categories (low, moderate, severe). Post hoc analyses explored significant interactions. Results Of the 102 participants, 21.6% reported no prior trauma and 14.7% reported non-valid events. Sixty-five participants were included in the analysis; 6.2% of which were referred for trauma. 81.5% reported criterion A events, 10.8% reported psychosis-related events, and 7.7% did not disclose an event. PCL-5 scores were dichotomized using the 33rd and 66th percentiles, translating into low (≤ 24), moderate (25–47), and severe (≥48) groups. Delusion severity and subjective stress, anxiety, depression, social anxiety, quality of life (QoL), and wellbeing were entered into a one-way MANOVA with PTSS severity groups. Significant main effects surviving Bonferroni correction emerged for all variables except delusion severity (F(2,40) = 3.06, p = .058) and wellbeing (F(2,56) = 1.50, p =.233). Stress (F(2,62) = 7.37, p = .001) was higher in the severe (M = 13.13, SD = 5.18) versus low group (M = 7.05, SD = 4.40, p = .001). Anxiety (F(2,62) = 8.02, p = .001) was also higher in the severe (M = 12.30, SD = 5.07) compared to low group (M = 5.85, SD = 5.06, p = .000), and depression (F(2,62) = 5.37, p = .007) was additionally higher in the severe (M = 12.61, SD = 5.73) compared to low group (M = 7.20, SD = 4.97, p = .005). Finally, social anxiety (F(2,58) = 4.25, p = .026.) was higher in the severe (M = 7.76, SD = 3.58) versus low group (M = 4.68, SD = 3.68, p = .029), while QoL (F(2,58) = 3.47, p = .038) was lower in the severe (M = 49.95, SD = 10.99) compared to low group (M = 58.95, SD = 13.76, p = .037). Discussion Due to a relatively high number of invalid questionnaires (14.7%), service users should likely complete the PCL-5 in the presence of a health-care practitioner. Findings suggest inadequate referral rates for specialized services when they may indeed benefit the service-user. Severe PTSS was associated with increased symptoms of subjective anxiety, depression, stress, social anxiety, and decreased QoL, regardless of whether diagnostic criteria for PTSD was met. A severe PTSS category likely captures a broader range of individuals requiring specialized intervention and speaks to an important need to both facilitate and increase referral rate for trauma-focused therapy.
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Huang, Hsin-hsin, and Mark Pfuetze. "Using EMDR to Address Social Anxiety With Clients Who Stutter: Treatment Considerations." Journal of EMDR Practice and Research 15, no. 1 (February 1, 2021): 60–72. http://dx.doi.org/10.1891/emdr-d-20-00035.
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This article describes the treatment considerations when providing eye movement desensitization and reprocessing (EMDR) therapy to treat clients who stutter. Since stuttering is often developed in childhood and persists into adulthood, it has long-term impacts on the educational, social, psychological, and professional development of those who stutter. While stuttering can present with physiological impairments not amendable to psychological interventions, EMDR therapy may effectively decrease the psychological stressors (such as social anxiety and shame) that can intensify stuttering. The authors present an extensive literature review on the traumatic experiences and adverse effects of stuttering. They also discuss essential treatment guidelines when using EMDR to work with people who stutter (PWS), including processing developmental trauma when stuttering, experiences of being bullied because of stuttering, shame and internalized negative self-statements, distrust of one's body due to inability to control one's speaking, and the social anxiety and avoidance in dealing with triggering situations. The clinical instructions are illustrated with a case example of a 40-year-old college professor who experienced anxiety and shame related to persistent developmental stuttering, and who sought treatment due to difficulties speaking in front of his classes. After completing 20 sessions of EMDR therapy, the client reported decreased social anxiety and shame and was able to teach courses comfortably. Further research considerations using EMDR treatment with PWS are recommended.
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Assonov, Dmytro. "Efficacy of two-step resilience-oriented intervention for veterans with a remote traumatic brain injury." Ukrainian Scientific Medical Youth Journal 131, no. 2 (June 23, 2022): 32–43. http://dx.doi.org/10.32345/usmyj.2(131).2022.32-43.
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Researchers argue that rehabilitation interventions which cultivate resilience may potentiate the effect of standard treatment and promote the readaptation of veterans with traumatic brain injury. At the same there is a lack of such interventions. The objective of the article was to investigate the efficacy of two-step resilience-oriented intervention for veterans with traumatic brain injury in remote period. We hypothesized that, compared with patients who received standardized treatment and rehabilitation in inpatient setting, those who received standardized treatment plus TROI would report increase in resilience effectiveness and positive outcomes, as well as reduced clinical symptoms. A total of 146 veterans with traumatic brain injury were enrolled into a randomized controlled trial either into intervention group, which received two-step resilience-oriented intervention and standard treatment and rehabilitation or to control group, which received only standard treatment and rehabilitation. Psychometric measures were administered at baseline, post-treatment, and 3 months follow-up. Connor-Davidson Resilience Scale (CD-RISC), Neurobehavioral Symptom Inventory (NSI), Montreal Cognitive Assessment Scale (MoCA), Hospital Anxiety and Depression Scale (HADS), Positive and Negative Affect Scale (PANAS), Posttraumatic Stress Disorder Checklist 5 (PCL-5), Chaban Quality of Life Scale (CQLS) were used to assess the treatment effectiveness. A linear mixed effect modelling was used to model each outcome. Improvements in all outcomes at post-treatment were observed in both intervention and TAU groups. After adjusting for the baseline cognitive performance, gender, brain injury clinical type and time since last trauma, the intervention group demonstrated more favorable score on CD-RISC, MoCA, PCL-5, PANAS while demonstrating no clinically significant improvement in NSI, HADS and CQLS at both post-treatment and follow-up. Difference between groups in resilience-related outcomes like positive affect and quality of life only increased throughout time, making a good follow-up prognosis. In summary, targeting cognitive and emotional factors in a single psychological intervention improves the resilience in veterans with traumatic brain injury, making veterans more adaptable and more effective in managing both persistent clinical symptoms and comorbid post-traumatic stress. Adding such resilience-oriented program to the standard inpatient treatment and rehabilitation provides improvement in clinical outcomes and better prognoses than just following usual treatment strategies.
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Boelen, Paul A., Maarten C. Eisma, Jos de Keijser, and Lonneke I. M. Lenferink. "Traumatic stress, depression, and non-bereavement grief following non-fatal traffic accidents: Symptom patterns and correlates." PLOS ONE 17, no. 2 (February 28, 2022): e0264497. http://dx.doi.org/10.1371/journal.pone.0264497.
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Non-fatal traffic accidents may give rise to mental health problems, including posttraumatic stress (PTS) and depression. Clinical evidence suggests that victims may also experience grief reactions associated with the sudden changes and losses caused by such accidents. The aim of this study was to examine whether there are unique patterns of symptoms of PTS, depression, and grief among victims of non-fatal traffic accidents. We also investigated associations of emerging symptom patterns with sociodemographic variables and characteristics of the accident, and with transdiagnostic variables, including self-efficacy, difficulties in emotion regulation, and trauma rumination. Participants (N = 328, Mage = 32.6, SDage = 17.5 years, 66% female) completed self-report measures tapping the study variables. Using latent class analysis (including symptoms of PTS, depression, and grief), three classes were identified: a no symptoms class (Class 1; 59.1%), a moderate PTS and grief class (Class 2; 23.1%), and a severe symptoms class (Class 3; 17.7%). Summed symptom scores and functional impairment were lowest in Class 1, higher in Class 2, and highest in Class 3. Psychological variables were similarly ordered with the healthiest scores in Class 1, poorer scores in Class 2, and the worst scores in Class 3. Different sociodemographic and accident related variables differentiated between classes, including age, education, and time since the accident. In a regression including all significant univariate predictors, trauma rumination differentiated Class 2 from Class 1, all three psychological variables differentiated Class 3 from Class 1, and difficulties with emotion regulation and trauma rumination differentiated Class 3 from Class 2. This study demonstrates that most people respond resiliently to non-fatal traffic accident. Yet, approximately one in three victims experiences moderate to severe mental health symptoms. Increasing PTS coincided with similarly increasing grief, indicating that grief may be considered in interventions for victims of traffic accidents. Trauma rumination strongly predicted class membership and appears a critical treatment target to alleviate distress.
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Calvano, Claudia, Elena Murray, Lea Bentz, Sascha Bos, Kathrin Reiter, Loretta Ihme, and Sibylle M. Winter. "Evaluation of an Early Intervention Model for Child and Adolescent Victims of Interpersonal Violence." Children 8, no. 10 (October 19, 2021): 941. http://dx.doi.org/10.3390/children8100941.
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Only the minority of youth exposed to traumatic events receive mental health care, as trauma-informed clinical services are lacking or are poorly accessible. In order to bridge this gap, the Outpatient Trauma Clinic (OTC) was founded, an easily accessible early, short-time intervention, with onward referral to follow-up treatment. This report presents the OTC’s interventional approach and first outcome data. Using a retrospective naturalistic design, we analyzed trauma- and intervention-related data of the sample (n = 377, 55.4% female, mean age 10.95, SD = 4.69). Following drop-out analyses, predictors for treatment outcome were identified by logistic regression. The majority (81.9%) was suffering from posttraumatic stress disorder (PTSD) or adjustment disorders. Around one forth dropped out of treatment; these cases showed higher avoidance symptoms at presentation. In 91%, psychological symptoms improved. Experience of multiple traumatic events was the strongest predictor for poor treatment outcome (B = −0.823, SE = 0.313, OR = 0.439, 95% CI 0.238–0.811). Around two thirds were connected to follow-up treatment. The OTC realized a high retention rate, initial improvement of symptoms and referral to subsequent longer-term psychotherapeutic treatment in the majority. Further dissemination of comparable early intervention models is needed, in order to improve mental health care for this vulnerable group.
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Amris, Stine. "CHRONIC PAIN IN SURVIVORS OF TORTURE – Psyche or Soma?" Psyke & Logos 25, no. 1 (July 31, 2004): 30. http://dx.doi.org/10.7146/pl.v25i1.8663.
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Persistent pain related to the musculo-skeletal system is the most frequent reported physical complaint in survivors of torture. In spite of a long-standing tradition of multidisciplinary rehabilitation, however, there is no consensus on how chronic pain and pain-related disability are best addressed within this clinical practice. Are pain problems in torture survivors to be viewed as a somatic problem and intensively investigated and managed as such, or assumed to be the presentation/concomitant of psychological disturbance such as depression, anxiety, posttraumatic stress disorder, or other trauma-related problem? The current paper is intended as an overview of chronic pain in torture survivors viewed from the perspectives offered by the interactive and multivariate theoretical models of pain. According to these models pain should be viewed not as the result of either solely physical or solely psychological causes, but rather as a set of bio-physiological, psychosocial and behavioural factors contributing to the total experience of pain. Consequently, appropriate assessment of chronic pain requires assessment of more than just the direct components of pain. Given the complexity inherent in the construct of subjective pain, there is a need to obtain a diversity of assessment information that must then be integrated to understand the individuals’ pain and to contribute to treatment decision-making. Overemphasising the importance of psychological aspects, however, may result in insufficient somatic pain diagnoses and reduced treatment efficacy. Basic knowledge of the physiology of pain is therefore a prerequisite when assessing, diagnosing, and managing individuals suffering from chronic pain conditions. A brief introduction to the physiology of pain has therefore been enclosed in this paper, focusing on chronic, persistent pain and the pain signalling system under abnormal conditions. Possible pain generating mechanisms in chronic post-torture pain are highlighted and how to use clinical information and an understanding of pain classification to identify these mechanisms. Clinically, a failure to appreciate the intricacies of the relation and co-occurrence of trauma-related problems and chronic pain carries a risk of poor clinical decision-making, selection for treatment, and design of therapeutic intervention. It is advocated that chronic post-torture pain should be viewed from the perspectives offered by the interactive and multivariate models of pain and stress, and that knowledge-based clinical guidelines for the assessment and interdisciplinary management emphasising biomedical, behavioural, and cognitive aspects of chronic pain and pain-associated disability in torture survivors should be developed based on these models.
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Baker, Monty T., John C. Moring, Willie J. Hale, Jim Mintz, Stacey Young-McCaughan, Richard A. Bryant, Donna K. Broshek, et al. "Acute Assessment of Traumatic Brain Injury and Post-Traumatic Stress After Exposure to a Deployment-Related Explosive Blast." Military Medicine 183, no. 11-12 (May 18, 2018): e555-e563. http://dx.doi.org/10.1093/milmed/usy100.
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Abstract Introduction Traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) are two of the signature injuries in military service members who have been exposed to explosive blasts during deployments to Iraq and Afghanistan. Acute stress disorder (ASD), which occurs within 2–30 d after trauma exposure, is a more immediate psychological reaction predictive of the later development of PTSD. Most previous studies have evaluated service members after their return from deployment, which is often months or years after the initial blast exposure. The current study is the first large study to collect psychological and neuropsychological data from active duty service members within a few days after blast exposure. Materials and Methods Recruitment for blast-injured TBI patients occurred at the Air Force Theater Hospital, 332nd Air Expeditionary Wing, Joint Base Balad, Iraq. Patients were referred from across the combat theater and evaluated as part of routine clinical assessment of psychiatric and neuropsychological symptoms after exposure to an explosive blast. Four measures of neuropsychological functioning were used: the Military Acute Concussion Evaluation (MACE); the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS); the Headminder Cognitive Stability Index (CSI); and the Automated Neuropsychological Assessment Metrics, Version 4.0 (ANAM4). Three measures of combat exposure and psychological functioning were used: the Combat Experiences Scale (CES); the PTSD Checklist-Military Version (PCL-M); and the Acute Stress Disorder Scale (ASDS). Assessments were completed by a deployed clinical psychologist, clinical social worker, or mental health technician. Results A total of 894 patients were evaluated. Data from 93 patients were removed from the data set for analysis because they experienced a head injury due to an event that was not an explosive blast (n = 84) or they were only assessed for psychiatric symptoms (n = 9). This resulted in a total of 801 blast-exposed patients for data analysis. Because data were collected in-theater for the initial purpose of clinical evaluation, sample size varied widely between measures, from 565 patients who completed the MACE to 154 who completed the CES. Bivariate correlations revealed that the majority of psychological measures were significantly correlated with each other (ps ≤ 0.01), neuropsychological measures were correlated with each other (ps ≤ 0.05), and psychological and neuropsychological measures were also correlated with each other (ps ≤ 0.05). Conclusions This paper provides one of the first descriptions of psychological and neuropsychological functioning (and their inter-correlation) within days after blast exposure in a large sample of military personnel. Furthermore, this report describes the methodology used to gather data for the acute assessment of TBI, PTSD, and ASD after exposure to an explosive blast in the combat theater. Future analyses will examine the common and unique symptoms of TBI and PTSD, which will be instrumental in developing new assessment approaches and intervention strategies.
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Duff, A., A. De Petrillo, D. Reynolds, E. Bangura, P. Pavilidis, and J. Mawdsley. "P332 Group-based Acceptance and Commitment Therapy (ACT) is acceptable and effective at reducing psychological distress in patients with Inflammatory Bowel Disease (IBD)." Journal of Crohn's and Colitis 16, Supplement_1 (January 1, 2022): i350. http://dx.doi.org/10.1093/ecco-jcc/jjab232.459.
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Abstract Background ACT is a psychological therapy designed to increase psychological flexibility and improve how people relate to difficulties. It has been found to be efficacious with a range of difficulties (Gloster et al, 2020) but is increasingly used to support patients with long term health difficulties due to its unique perspective on the disease related and realistic ideas that patients hold about their conditions (Graham et al, 2016). Initial studies using ACT with patients with IBD, have shown positive but varying effects on outcomes (Hou et al, 2017; Wynne et al, 2019). Feedback from these patients suggests that ACT is an acceptable approach (Dober et al, 2020), however, one trial had a significant drop out rate (Wynne et al, 2019). No real world evidence of the use of ACT with IBD patients has been reported and little is known about the practicality and efficacy as part of routine clinical practice Methods Those referred to a specialist IBD psychology service, 2019 to, 2021, were assessed as being suitable for an ACT based ‘managing symptoms group’. Those struggling with low mood, anxiety, chronic or functional symptoms and struggles with adjustment were included. Exclusion criteria were; trauma symptoms, interpersonal difficulties or individual issues such as surgery or adherence. Patients attended, 8 weekly sessions of, 90 minutes. Data was captured on demographics and attendance. The primary outcome was adherence to the group, with completion defined as attending, 5 or more sessions. Secondary outcomes of psychological distress, flexibility and functioning, were measured with patient-reported questionnaires pre and post intervention. Descriptive statistics, t-tests and Wilcoxon rank tests were performed Results 78 were assessed as suitable and enrolled for the group, 15 (19%) did not attend the first session and were discharged. Of the remaining, 63, 10 (16%) dropped out during the group, partial data is available for, 41 of those who completed the group and complete data for, 18 of these. Conclusion This is the first analysis of this type of intervention, performed in a clinical setting. Unlike a previous trial, the relatively low dropout and high number of sessions attended indicates that it is acceptable to the majority. Additionally, the significant change in psychological distress suggests that this group intervention is practical, effective and acceptable in settings where we are all under pressure for resources. The results are from a small sample and suffered from typical challenges in obtaining patient-reported responses. However, there were no obvious differences between those who completed all measures and those who didn’t. The results provide evidence to support the continued use of ACT based interventions for those with IBD.
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Alameda, Luis, Victoria Rodriguez, Monica Aas, Ewan carrr, Giulia Trotta, Paolo Marino, Natasha Vorontsova, et al. "M116. A SYSTEMATIC REVIEW OF THE PSYCHOLOGICAL AND BIOLOGICAL MEDIATORS BETWEEN ADVERSITY AND PSYCHOSIS: POTENTIAL TARGETS FOR TREATMENT." Schizophrenia Bulletin 46, Supplement_1 (April 2020): S179. http://dx.doi.org/10.1093/schbul/sbaa030.428.
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Abstract Background Various psychological and biological pathways have been proposed as mediators between childhood adverse events (CA) and psychosis. A systematic review of the evidence in this domain is needed; open new venues for treatment interventions in traumatized patients with psychosis. The aim of the current work is to systematically review the evidence on clinical and biological mediators between CA and psychosis across the psychosis spectrum. Methods This systematic review followed PRISMA guidelines. Articles published between 1979 and July 2019 were identified through a literature search in OVID (PsychINFO; Medline and Embase). The direction of the evidence by each analysis and each study was presented by group of mediator categories found in the review; the percentage of total effect mediated was calculated and whether the mediation was partial, total or null (if it was absent) was reported. Results 47 studies were included, with a total of 72286 GP subjects and 2800 from clinical samples. The quality of studies was judges as “fair”. We found (i) solid evidence of mediation between CA and psychosis by negative cognitive schemas about the self, the world and others (NS); by dissociation and other PTSD symptoms; (ii) evidence of a partial mediation through an affective pathway (affective dysregulation, anxiety and depression) in GP; (iii) that feeling of loneliness appeared as an important mediator that should be further explored; (iv) lack of studies exploring biological mediators; (v) little evidence supporting the mediating role of dysfunctional attachment between CA and psychosis. Discussion Experiences of adversity, alongside with all relevant mediators such as PTSD and mood related symptoms and NS should be routinely assessed in patients with psychosis. Targeting such mediators through cognitive behavioural approaches such as trauma-focused therapy and/or pharmacological means could be a beneficial add on to the traditional treatment of positive symptoms.
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Zheng, Dandan, Wentao Cheng, Heyu Wu, Haichao Wu, and Yuqi Cao. "Research Progress of Nursing Care for Elderly Patients With Complicating Postoperative Hip Fracture Deep Vein Thrombosis in China." International Journal of Studies in Nursing 6, no. 4 (December 30, 2021): 81. http://dx.doi.org/10.20849/ijsn.v6i4.948.
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Introduction: The aging of China's population has further deepened, and according to the results of the seventh national census, the population aged 60 years and above in China was 264.02 million, accounting for 18.70% (China.2021).The rapid growth of the elderly population has led to an increase a geriatric orthopedic morbidity. The hip fracture is one of the common orthopedic diseases, which has posed a severe threat to the elderly's life and health (Yu, 2019).Purpose: In this study, we investigated the domestic and international literature, focusing on the analysis of DVT nursing prevention programs for elderly patients after hip arthroplasty, and proposed the current nursing research progress in preventing DVT to help elderly patients actively cope with DVT, improve the quality of life in later life, and make DVT a truly preventable disease.Method: Electronic searches using scholarly databases were employed and only significant articles that met the review objective were utilized.Findings: Currently, the main treatment option for hip fracture patients in clinical practice is surgery, and how to prevent Deep Vein Thrombosis (DVT) is an important task in the postoperative care of elderly orthopedic patients (Li, 2016). Research studies have shown that all elderly patients are at a very high risk of DVT during hospitalization, but the current trend is that 50% of patients at high risk of thrombosis are still not actively and effectively prevented from developing thrombosis for various reasons.Conclusion: This disease, which has a high incidence, a high mortality rate, and is difficult to prevent, requires increased attention and necessitates exploration to derive effective nursing intervention programs and related nursing measures to prevent reduce the formation of DVT and alleviate suffering for patient (Xu, 2016).In this review, we summarized the main nursing methods for preventing deep vein thrombosis of the lower extremities after hip fracture surgery in the elderly. Elderly patients are a special group of people, both physically and psychologically in a relatively fragile state, especially after the operation, so they need to be more careful in nursing work. In addition to general physical care, the care of their psychological state is also extremely important. This article describes in detail the physiological and psychological nursing interventions for patients, which can effectively guide and help medical staff to cope with the clinical care of such patients, and enable patients to better recover from surgery and trauma, and obtain a good prognosis.
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Yehuda, Rachel, Laura C. Pratchett, Matthew W. Elmes, Amy Lehrner, Nikolaos P. Daskalakis, Erin Koch, Iouri Makotkine, Janine D. Flory, and Linda M. Bierer. "Glucocorticoid-related predictors and correlates of post-traumatic stress disorder treatment response in combat veterans." Interface Focus 4, no. 5 (October 6, 2014): 20140048. http://dx.doi.org/10.1098/rsfs.2014.0048.
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The identification of biomarkers for post-traumatic stress disorder (PTSD) and resilience/recovery is critical for advancing knowledge about pathophysiology and treatment in trauma-exposed persons. This study examined a series of glucocorticoid-related biomarkers prior to and in response to psychotherapy. Fifty-two male and female veterans with PTSD were randomized 2 : 1 to receive either prolonged exposure (PE) therapy or a weekly minimal attention (MA) intervention for 12 consecutive weeks. Psychological and biological assessments were obtained prior to and following treatment and after a 12-week naturalistic follow-up. Response was defined dichotomously as no longer meeting criteria for PTSD at post-treatment based on the Clinician Administered PTSD Scale for DSM-IV (CAPS). Clinical improvement on the CAPS was apparent for both PE and MA, with no significant difference according to treatment condition. Biomarkers predictive of treatment gains included the BCLI polymorphism of the glucocorticoid receptor gene. Additional predictors of treatment response were higher bedtime salivary cortisol and 24 h urinary cortisol excretion. Pre-treatment plasma dehydroepiandrosterone/cortisol ratio and neuropetide Y (NPY) levels were predictors of reductions in PTSD symptoms, and, for NPY only, of other secondary outcomes as well, including anxiety and depression ratings. Glucocorticoid sensitivity changed in association with symptom change, reflecting clinical state. It is possible to distinguish prognostic and state biomarkers of PTSD using a longitudinal approach in the context of treatment. Identified markers may also be relevant to understanding mechanisms of action of symptom reduction.
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Einerson, Brett D., Melissa H. Watt, Brittney Sartori, Robert Silver, and Erin Rothwell. "Lived experiences of patients with placenta accreta spectrum in Utah: a qualitative study of semi-structured interviews." BMJ Open 11, no. 11 (November 2021): e052766. http://dx.doi.org/10.1136/bmjopen-2021-052766.
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ObjectiveTo describe the lived experience of patients undergoing diagnosis and treatment of placenta accreta spectrum (PAS).DesignQualitative study of semi-structured interviews. A content analysis was used to analyse interview data using a consistent set of codes to designate data segments that contain similar material. Codes were analysed and grouped based on thematic similarities. Thematic results were systematically reviewed, verified and audited to address trustworthiness and rigour of the data and analysis.SettingA single PAS programme in Utah, USA, from 2017 to 2020.ParticipantsPatients with PAS during the study period were eligible. Those experiencing fetal demise or termination were excluded. Of 25 patients contacted at random, 17 agreed to participate in interviews. Those included were predominantly non-Hispanic white, highly parous, with average age of 34.7 years.ResultsThe lived experiences of patients with PAS emerged across the time continuum from diagnosis, pregnancy, birth, to postpartum care and recovery. Themes common across the care continuum were: the emotional burden of diagnosis and management; fear and uncertainty related to health outcomes; and lack of autonomy and medical helplessness related to medical decision-making. Many patients experienced birth-related trauma, mourned the loss of future fertility and were dissatisfied with the lack of options for treatment for this serious pregnancy complication.ConclusionsPatients undergoing diagnosis and treatment for PAS often experienced care that conflicted with their goals for pregnancy and birth. Clinical care for PAS would benefit from interventions aiming to engage patients and providers in shared decision-making and systems designed to address the social, psychological and emotional needs of patients with PAS.
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Stensland, Synne Øien, John-Anker Zwart, Tore Wentzel-Larsen, and Grete Dyb. "The headache of terror." Neurology 90, no. 2 (December 13, 2017): e111-e118. http://dx.doi.org/10.1212/wnl.0000000000004805.
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ObjectiveTo elaborate the risk of headache among adolescent survivors exposed to terror.MethodsOn July 22, 2011, a lone man opened gunfire, killing 69 people at a summer camp for adolescents on the Utøya islet in Norway. All 358 adolescent survivors 13 to 20 years of age were invited to participate in the Utøya interview study. Among the 213 (59%) respondents, half (49%) were male, the mean age was 17.7 years, and 13 (6%) were severely injured. For each survivor, 8 matched controls were drawn from the population-based Young-HUNT3 Study, conducted between 2006 and 2008, with a participation rate of 73%. Recurrent migraine and tension-type headache (TTH) over the past 3 months served as main outcomes and were measured 4 to 5 months after the mass shooting with a validated headache interview, in accordance with the International Classification of Headache Disorders.ResultsAfter exposure to terror, the odds ratio for migraine was 4.27 (95% confidence interval 2.54–7.17) and for TTH was 3.39 (95% confidence interval 2.22–5.18), as estimated in multivariable logistic regression models adjusted for injury, sex, age, family structure and economy, prior exposure to physical or sexual violence, and psychological distress. The observed increased risk of headache in survivors was related largely to an increase in weekly and daily headaches.ConclusionsExposure to terror increases risk of persistent weekly and daily migraine and TTH in adolescent survivors, above expected levels. The terrors of other violence may similarly increase the risk of frequent headaches. After severe psychological traumas, interventions may need to address survivors' pain to hinder chronification.
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Gindis, Boris. "Psychological characteristics of internationally adopted post-institutionalized children with Fetal Alcohol Spectrum Disorders." International Journal of Alcohol and Drug Research 3, no. 1 (March 19, 2014): 35–42. http://dx.doi.org/10.7895/ijadr.v3i1.133.
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Gindis, B. (2014). Psychological characteristics of internationally adopted post-institutionalized children with Fetal Alcohol Spectrum Disorders. The International Journal Of Alcohol And Drug Research, 3(1), 35-42. doi:10.7895/ijadr.v3i1.133Aims: Fetal Alcohol Syndrome Disorder (FASD) is widely observed in internationally adopted (IA) post-institutionalized children. The specificity of FASD in IA children has significant practical implications and necessitates a modified methodology for identification and remediation.Design methods, and participants: Clinical case study with statistical analysis (simple frequency recorded in an Excel spreadsheet); quantitative and qualitative data was obtained through individual medical, neuropsychological, and educational assessments of 63 children, ages five to sixteen, adopted from Eastern Europe to the United States.Findings: FASD in international adoptees presents amplified characteristics typical for this condition, with the following specificities revealed in our research: rapid first-language loss and a particular pattern of English language learning; profound complex childhood trauma related to extreme deprivation and institutional upbringing; “mixed maturity” evident in impaired executive functions; low predictive accuracy during a pre-adoption screening for FASD conditions; general cognitive ability (IQ) being in the Low Average to Borderline range, with processing speed, attention, and working memory as the weakest cognitive skills; and academic achievements being higher than could be predicted based on cognitive abilities.Conclusions: FASD must be recognized as an educational handicap in our school system in order to change the outcomes for afflicted children. Educational remediation and cognitive-behavioral therapeutic intervention are the most effective remedial methods for IA children with FASD. Practical recommendations for adoptive parents include early identification and specialized remediation of “secondary” disabilities through concerted efforts of the school and family.
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Laddis, Andreas. "Sources for Psychotherapy’s Improvement and Criteria for Psychotherapy’s Efficacy." Frontiers in the Psychotherapy of Trauma and Dissociation 1, no. 1 (2017): 6–17. http://dx.doi.org/10.46716/ftpd.2017.0003.
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The publication of the first issue of Frontiers is a happy occasion. In this editorial, I take the opportunity to share my vision of it becoming the forum for clinicians to test their insights and interventions with colleagues of various theoretical views, by means of thoughtful articles and follow-up commentaries. I also share how I use the principles of the journal’s mission statement in my clinical practice and writings. Among other expectations and suggestions, that statement encourages authors to (a) demonstrate how related disciplines help us improve psychotherapy for persons with complex trauma-related disorders related disciplines; (b) report the psychological, behavioral and/or social outcomes that they use as criteria for success. Here, I share my gratification with using concepts and findings from social psychology and anthropology, how they helped me understand the interpersonal operations of power abuse. I learned about the function of intimacy in good caretaking. When a child fears reasons like selfishness or neglect for the caretaker’s failure to fulfill the child’s expectations, caretakers ordinarily relinquish their power to deceive the child. Instead, they disclose such reasons and promise to prove their intention to remedy them, as the child understands proof of that intention. I learned how untrustworthy caretakers abuse that principle of intimacy. That, in turn, helped me discern my patients’ specific fixation from such childhood experience, a flawed working model about the interpersonal operations of intimacy. I have treated it as their fundamental impairment while they suffer disorder during crises of trust in later relationships. Therefore, I measure my psychotherapy’s efficacy in degrees of correcting that impairment. I measure it in my patients’ competence to cultivate intimacy for restoration of trust in their troubled relationships.
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Botzet, Katrin, Hannan Dalyanoglu, Ralf Schäfer, Artur Lichtenberg, Jochen Schipke, and Bernhard Korbmacher. "Anxiety and Depression in Patients Undergoing Mitral Valve Surgery: A Prospective Clinical Study." Thoracic and Cardiovascular Surgeon 66, no. 07 (August 6, 2017): 530–36. http://dx.doi.org/10.1055/s-0037-1604461.
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Background Impending cardiac surgery presents an existential experience that may induce psychological trauma. Moreover, quality of life long after successful coronary artery bypass graft surgery (CABG) can be impaired. Aim The aim of this study was to describe the time course of anxiety and depression in patients undergoing mitral valve surgery and compare it with our earlier results of patients undergoing CABG, a disease that is likely to be related to psychosomatic disorders. We hypothesized that patients undergoing mitral valve surgery can better manage stresses of cardiac surgery than patients undergoing CABG. Patients and Methods Of 117 patients undergoing mitral valve surgery, 100 patients (22 to 87 years; 53 females) completed the study and were interviewed before (pre), 1 week after (early), and 6 months after (late) surgery. The Hospital Anxiety and Depression Scale (HADS) was employed. Results The proportion of patients with elevated anxiety scores (AS ≥ 8) was higher than normal (19.8%): pre, 33.0%; early, 28.0%; and was normalized late (18.0%). Similarly, depression scores (DS ≥ 8) were increased: pre, 15.0%; early, 20.0%; and late 14.0%, respectively (normal: 3.2%). Conclusion Coronary heart disease of CABG patients is presented as a systemic disorder, associated with both higher and postoperatively increased distress levels than in mitral valve patients. Anxiety and depression should be recognized as possible symptoms of psychosomatic disorders necessitating psychotherapeutic intervention to prevent postoperative depression and warrant patient-perceived surgical outcome that is additionally affected by expectations with respect to treatment and individual coping capacities. HADS is recommended to screen for vulnerable patients in the clinical routine, and psychosomatic support should be provided.
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Fistonic, Ivan. "Novel Non-Invasive Laser and Radio-Frequency (RF) Procedures for Vaginal Dystension and Vulvar Laxity Syndroma to Enhance Sexual Gratificaton." Klinička psihologija 9, no. 1 (June 13, 2016): 84. http://dx.doi.org/10.21465/2016-kp-op-0064.
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Childbirth vaginal trauma and process of ageing are fundamental in developing stress urinary incontinence (SUI) and sexual dysfunction related to vaginal and vulvar relaxation. Unpleasant aesthetic appearance of vulva is additional factor that deepens negative psychological response, embarrassment, anxiety and lack of confidence while postmenopausal vaginal dryness additionally deteriorates sexual gratification when estrogen is avoided. Thus far, experimental and clinical studies have reported significant success in the treatment of various disorders and conditions based on collagen damage. Most references arise from the fields of dermatology and aesthetic medicine. Facial ptosis, uvular and soft-palate relaxation in snoring disorders, and ligament trauma in orthopedics may be successfully treated with laser-generated thermal energy. The precise mechanisms underlining the normalization of some vaginal properties is not yet completely clear but collagen remodeling and increased vascularization have been documented by histology following laser application. The onset and mild disorder in SUI and vaginal relaxation syndrome (VRS) still remain underreported and problem remains hidden until severe symptomatology often results in surgery treatment. However, there is a risk of serious adverse effects resulting from surgery procedures. Complications such as bleeding, infection, poor wound healing and overcorrection may require de novo medical intervention, resulting in global rising trend of non-invasive procedures. There is a rising evidence for the effectiveness of non-invasive laser procedures in the treatment of SUI, VRS and vaginal atrophy, while novel RF procedure might play a significant role in vulvar laxity treatment.
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Onigu-Otite, Edore, Miju Kurtzweil, Veronica Tucci, and Nidal Moukaddam. "Substance Use in Adolescents Presenting to the Emergency Department." Adolescent Psychiatry 9, no. 2 (January 10, 2020): 142–58. http://dx.doi.org/10.2174/2210676608666181015114220.
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Background: Adolescent substance use is a dynamic public health problem. Adolescence is a unique developmental period involving overlapping biological, psychological, and social factors which increase the rates of initiation of substance use. The developing adolescent brain is particularly susceptible to the effects of substances and most adults with substance use disorders began to have symptoms and problems in their adolescent years. Yet, for various reasons, most adolescents who use, misuse, abuse, or are addicted to substances do not perceive the need for treatment. Objective: Drug and alcohol use among adolescents is a common presentation in hospital Emergency Departments (EDs) and presents in different forms including in association with intoxication, withdrawal states, or trauma associated with drug-related events. For many adolescents with substance use, the Emergency Department (ED) is the first point of contact with medical personnel and thus also serves as a potential entry point into treatment. Methods: This article reviews the common ways drug and alcohol problems present in the ED, clinical assessment of the patient and family, screening, laboratory testing, brief interventions in the ED, and referral to treatment beyond the ED. Conclusion: Guidelines on how to manage the shifting terrain of adolescent substance use presenting in EDs across the nation continue to evolve. We highlight that considerable further research is needed to inform effective ED protocols to address this important individual and public health safety concern. Systems of care models which include collaborative teams of diverse stake holders are needed to effectively manage adolescents with substance use disorders..
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Tabaie, Azade, Amy Zeidan, Dabney Evans, Randi Smith, and Rishikesan Kamaleswaran. "A Novel Technique to Identify Intimate Partner Violence in a Hospital Setting." Western Journal of Emergency Medicine 23, no. 5 (September 12, 2022): 781–88. http://dx.doi.org/10.5811/westjem.2022.7.56726.
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Introduction: Intimate partner violence (IPV) is defined as sexual, physical, psychological, or economic violence that occurs between current or former intimate partners. Victims of IPV may seek care for violence-related injuries in healthcare settings, which makes recognition and intervention in these facilities critical. In this study our goal was to develop an algorithm using natural language processing (NLP) to identify cases of IPV within emergency department (ED) settings. Methods: In this observational cohort study, we extracted unstructured physician and advanced practice provider, nursing, and social worker notes from hospital electronic health records (EHR). The recorded clinical notes and patient narratives were screened for a set of 23 situational terms, derived from the literature on IPV (ie, assault by spouse), along with an additional set of 49 extended situational terms, extracted from known IPV cases (ie, attack by spouse). We compared the effectiveness of the proposed model with detection of IPV-related International Classification of Diseases, 10th Revision, codes. Results: We included in the analysis a total of 1,064,735 patient encounters (405,303 patients who visited the ED of a Level I trauma center) from January 2012–August 2020. The outcome was identification of an IPV-related encounter. In this study we used information embedded in unstructured EHR data to develop a NLP algorithm that employs clinical notes to identify IPV visits to the ED. Using a set of 23 situational terms along with 49 extended situational terms, the algorithm successfully identified 7,399 IPV-related encounters representing 5,975 patients; the algorithm achieved 99.5% precision in detecting positive cases in our sample of 1,064,735 ED encounters. Conclusion: Using a set of pre-defined IPV-related terms, we successfully developed a novel natural language processing algorithm capable of identifying intimate partner violence.
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Cribbet, Matthew R., Paula G. Williams, Ruben Tinajero, and Holly K. Rau. "0264 Childhood Adversity And Adult Sleep: The Role Of Deprivation And Threat." Sleep 42, Supplement_1 (April 2019): A108. http://dx.doi.org/10.1093/sleep/zsz067.263.
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Abstract Introduction There are robust associations between childhood adversity (CA) and poor physical health in adulthood. Sleep is a possible mechanism linking CA to adult health. The prevailing approach for testing associations between CA and adult sleep offers little insight into which aspects of CA are related to specific sleep outcomes. To better understand associations between CA and adult sleep outcomes, we tested a conceptual model that distinguishes between threat (e.g. physical, emotional and sexual abuse), and deprivation (e.g. emotional and physical neglect). Methods Participants (N= 79; Mage = 27.48(SD=6.53); 68% Female) were screened for insomnia disorder, mental health conditions and physical illnesses. Participants completed demographic and depressive symptom measures, along with the Childhood Trauma Questionnaire, a self-report retrospective measure that captures dimensions of threat and deprivation. Sleep duration, latency, efficiency, wake after sleep onset (WASO), and secondary sleep onset latency (SSOL) were averaged across 3 consecutive days of wrist actigraphy and sleep diaries. Daily ratings of sleep-quality, non-restorative sleep, alcohol use and current stress were averaged across 3 days. Structural equation modeling (SEM) was used to account for missing data. All SEM models included correlated measures of deprivation and threat along with age, sex, BMI, alcohol use, daily stress, and depressive symptoms. Results In SEM models, threat was significantly positively associated with non-restorative sleep (b = .046, p <.001) and sleep quality (b=.025, p=.008), but unrelated to all other diary-based and actigraphy-based sleep measures (ps > .05). Deprivation was significantly negatively associated with diary-based WASO (b = -.076, p = .003) and SSOL, but unrelated to all other diary-based and actigraphy-based sleep measures (ps > .05). Conclusion These results begin to clarify associations between related, but distinct forms of CA and specific adult sleep outcomes. Identifying specific pathways linking CA and adult health is critical for developing interventions and mitigating future health risk. Support (If Any) This study was funded by a Funding Incentive Seed Grant from the University of Utah, the Mind and Life Institute, and Division 38 of the American Psychological Association.
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Miguel Pontillo, Humberto, Jhorbet C. Rodríguez Castillo, and Tolentino Dos Santos. "Posoncological Cutaneous Reconstruction of Penis with Scrotum Flaps about a Case." Journal of Advanced Plastic Surgery Research 5, no. 2 (December 24, 2019): 4–8. http://dx.doi.org/10.31907/2414-2093.2019.05.02.
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!Objective: The penile cancer is a rare entity in the developed countries and its incidence increases in the developing countries, achieving up to 10% of the malignancies in men. There is a crucial association with the HPV, in the same way it relates to inadequate hygiene habits and the phimosis. The objective of the surgical treatment is resection with adequate margins, and the inguinal lymph node dissection when indicated. The restore skin coverage in these lesions is a challenge for the surgeon, as it seeks to achieve a phallus almost normal appearance, and restore the patient's tactile and the erogenous function, with the fewest possible interventions, trying to minimize the psychological trauma. Previously, many of these patients were considered inoperable and were recommended to radiation therapy to cure the injury. The evolution of the plastic surgical techniques using skin or the myocutaneous flaps, have provided the surgeon another option to keep the local oncological control with acceptable morbidity. Clinical Case: The aim of this paper is to present the case of a 56 years old male patient with diagnostic of squamous cell cancer of the penis stage II, who underwent the penile stripping, with bilateral inguinal lymphadenectomy; and rotation flap reconstruction of the scrotal skin. We found no published paper about the skin reconstruction of penile skin flap from scrotum for cancer patients, hence the importance of this work. Keywords: Cancer, Penile, HPV, Reconstruction, Faloplastia.
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Pruiksma, Kristi, Daniel Taylor, Jennifer Schuster Wachen, Casey Straud, Willie Hale, Jim Mintz, Stacey Young-McCaughan, et al. "730 Prevalence and impact of sleep problems in active duty military personnel receiving Cognitive Processing Therapy for PTSD." Sleep 44, Supplement_2 (May 1, 2021): A285. http://dx.doi.org/10.1093/sleep/zsab072.727.
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Abstract Introduction Sleep disturbances are common in active duty military personnel and play a key role in the development and maintenance of posttraumatic stress disorder (PTSD). Research indicates that although insomnia and nightmares improve with successful PTSD treatment, they may remain clinically significant. Few previous PTSD studies have assessed sleep disorder constructs using validated instruments. The objectives of this study were to examine the proportion of active duty military personnel seeking treatment for PTSD who reported clinically significant insomnia, nightmares, sleep duration, and excessive daytime sleepiness and to examine the impact PTSD treatment had on these sleep constructs using validated self-report questionnaires. Methods Sleep was evaluated in 223 active duty service members participating in a randomized clinical trial comparing group and individual Cognitive Processing Therapy (CPT) for PTSD. Sleep constructs were assessed using the Insomnia Severity Index (ISI), Trauma-Related Nightmare Survey (TRNS), Self-Assessment of Sleep (SAS), and Epworth Sleepiness Scale (ESS) at baseline and 2 weeks posttreatment. Results At baseline, 82% of participants reported clinically significant insomnia and 75% reported at least 1 moderately severe nightmare per week. Participants reported averaging 4.76 hours of sleep per night, and 65% reported excessive daytime sleepiness. Over the course of PTSD treatment, there were statistically significant improvements in insomnia, nightmares, and excessive daytime sleepiness, but scores remained in clinically significant ranges. Minimal increases were seen in sleep duration. Of the participants who no longer met criteria for PTSD at posttreatment, 50% continued to report clinically significant insomnia, 52% continued to report clinically significant nightmares, and 44% continued to report excessive daytime sleepiness. Conclusion Consistent with previous research, sleep problems persisted for a significant number of service members who completed treatment for PTSD. Insomnia, nightmare, and sleep extension interventions are likely an important part of comprehensive PTSD treatment plans. Support (if any) Funding for this work was made possible by the U.S. Department of Defense through the U.S. Army Medical Research and Materiel Command, Congressionally Directed Medical Research Programs, Psychological Health and Traumatic Brain Injury Research Program awards W81XWH-08-02-109 (Alan Peterson), W81XWH-08-02-0116 (Patricia Resick), W81XWH-10-1-0828 (Daniel Taylor), and W81XWH-08-02-0114 (Brett Litz).
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Gupta, Poonam, Shiny Shiju, Gracy Chacko, Mincy Thomas, Asma Abas, Indirani Savarimuthu, Emad Omari, et al. "A quality improvement programme to reduce hospital-acquired pressure injuries." BMJ Open Quality 9, no. 3 (July 2020): e000905. http://dx.doi.org/10.1136/bmjoq-2019-000905.
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BackgroundAt Heart Hospital in Doha, Qatar (HH), 127 pressure injuries (PI) were identified in 2014, corresponding to an incidence of 6.1/1000 patient-days in first 4 months of 2014. Hospital-acquired pressure injury (HAPI) is one of the most common preventable complications of hospitalisation. HAPI significantly increases healthcare costs, including use of resources (dressings, support surfaces, nursing care time and medications). They also have a significant impact on patients in terms of pain, worsened quality of life, psychological trauma and increased length of stay. Working with the Institute for Healthcare Improvement (IHI), we implemented evidence-based practices in all In patient Units at HH with the aim of reducing the number of HAPIs by 60% within 2 years.MethodsIn collaboration with IHI, our multidisciplinary clinical and risk assessment teams tested several changes and implemented a successful programme. The Surface, Skin inspection, Keep moving, Incontinence and Nutrition bundle was implemented. Signs, turning clocks and PI incidence ‘calendars’ were used in the units as reminders. Attention was paid to endotracheal tube ties in order to address device-related pressure injuries. Counts of HAPI (incidence) and number of PIs per 100 patients surveyed (prevalence) were prominently displayed. Changes were tested using the Plan-Do-Study-Act methodology. Statistical analysis using the independent t-test was applied to detect the significance of any difference in the incidence of HAPI before and after implementation of the changes.ResultsThe incidence of HAPI dropped from 6.1/1000 patient-days to 1.1/1000 patient-days, an 83.5% reduction. The prevalence, based on quarterly survey fell from 9.7/100 patients surveyed to 2.0/100 patients surveyed, a 73.4% decline.ConclusionsThe interventions proved to be successful, reducing the incidence of PI by >80%. The outcomes were sustained over a 4-year period.