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Brewin CR, Atwoli L, Bisson JI, Galea S, Koenen K, Lewis-Fernández R. Post-traumatic stress disorder: evolving conceptualization and evidence, and future research directions. World Psychiatry 2025; 24:52-80. [PMID: 39810662 PMCID: PMC11733483 DOI: 10.1002/wps.21269] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2025] Open
Abstract
The understanding of responses to traumatic events has been greatly influenced by the introduction of the diagnosis of post-traumatic stress disorder (PTSD). In this paper we review the initial versions of the diagnostic criteria for this condition and the associated epidemiological findings, including sociocultural differences. We consider evidence for post-traumatic reactions occurring in multiple contexts not previously defined as traumatic, and the implications that these observations have for the diagnosis. More recent developments such as the DSM-5 dissociative subtype and the ICD-11 diagnosis of complex PTSD are reviewed, adding to evidence that there are several distinct PTSD phenotypes. We describe the psychological foundations of PTSD, involving disturbances to memory as well as to identity. A broader focus on identity may be able to accommodate group and communal influences on the experience of trauma and PTSD, as well as the impact of resource loss. We then summarize current evidence concerning the biological foundations of PTSD, with a particular focus on genetic and neuroimaging studies. Whereas progress in prevention has been disappointing, there is now an extensive evidence supporting the efficacy of a variety of psychological treatments for established PTSD, including trauma-focused interventions - such as trauma-focused cognitive behavior therapy (TF-CBT) and eye movement desensitization and reprocessing (EMDR) - and non-trauma-focused therapies, which also include some emerging identity-based approaches such as present-centered and compassion-focused therapies. Additionally, there are promising interventions that are neither psychological nor pharmacological, or that combine a pharmacological and a psychological approach, such as 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy. We review advances in the priority areas of adapting interventions in resource-limited settings and across cultural contexts, and of community-based approaches. We conclude by identifying future directions for work on trauma and mental health.
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Affiliation(s)
- Chris R Brewin
- Clinical, Educational & Health Psychology, University College London, London, UK
| | - Lukoye Atwoli
- Department of Medicine, Medical College East Africa, and Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
| | - Jonathan I Bisson
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Sandro Galea
- School of Public Health, Washington University, St. Louis, MO, USA
| | - Karestan Koenen
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
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Kivimäki V, Liski V, Taskinen I. Predisposed vulnerabilities and survival among the Finnish soldiers of World War II: historical life course approach. FRONTIERS IN SOCIOLOGY 2025; 9:1495009. [PMID: 39830692 PMCID: PMC11739069 DOI: 10.3389/fsoc.2024.1495009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2024] [Accepted: 12/13/2024] [Indexed: 01/22/2025]
Abstract
In this methodological paper we propose a historical life course approach to analyze soldiers' predispositions to experience war-related violence and stress and to respond to it. We argue that a closer quantitative inspection of pre-war and wartime factors will help to understand the various causes leading to different exposures to stress and violence during the war, which have consequently had different outcomes for the war survivors' later lives. Our methodology is designed for a rich data source, the Finnish Army in World War II Database (FA2W, N = 4,253), but is generally also applicable to other case studies. We will demonstrate in practice how we apply the historical life course approach to the study of soldiers' pre-war background variables, wartime service paths, and measurable war stress exposures. In the final discussion, as one potential follow-up to our proposal, we will point to an advanced historical analysis of community-building and meaning-making linked to different war experience profiles combining the quantitative social historical methodology with a qualitative cultural history approach.
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Affiliation(s)
- Ville Kivimäki
- Research Department of the Finnish Literature Society, Helsinki, Finland
- Faculty of Social Sciences, Finnish Research Council Centre of Excellence in the History of Experiences (HEX), Tampere University, Tampere, Finland
| | - Virva Liski
- Faculty of Social Sciences, Finnish Research Council Centre of Excellence in the History of Experiences (HEX), Tampere University, Tampere, Finland
| | - Ilari Taskinen
- Faculty of Social Sciences, Finnish Research Council Centre of Excellence in the History of Experiences (HEX), Tampere University, Tampere, Finland
- Tampere Institute for Advanced Study, Tampere University, Tampere, Finland
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Bosscher II, de la Rie SM, van der Aa N, Boelen PA. Profiles of posttraumatic stress disorder and negative world assumptions in treatment-seeking refugees. Eur J Psychotraumatol 2024; 15:2314915. [PMID: 38353932 PMCID: PMC10868437 DOI: 10.1080/20008066.2024.2314915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 01/23/2024] [Indexed: 02/16/2024] Open
Abstract
Background: Refugees often suffer from trauma-related psychopathology, specifically posttraumatic stress disorder (PTSD). Negative world assumptions are strongly correlated with the development, course, and severity of PTSD.Objective: This study aimed to investigate whether there are distinct profiles of PTSD and negative world assumptions (NWA) and examine whether trauma load, torture, and gender differentially predict such symptom profiles.Method: In a sample of 225 treatment-seeking refugees who had resettled in the Netherlands, latent profile analysis was used to identify subgroups of patients sharing the same profile of PTSD and NWA symptoms. Predictors of profile membership were analyzed via multinomial logistic regression.Results: A three-profile solution yielded the best model fit: a low PTSD/low NWA profile (23.6%), a high PTSD/high NWA profile (41.8%), and a high PTSD/low NWA profile (34.7%). Participants who reported a higher trauma load, were more likely to be part of the high PTSD/high NWA profile or the high PTSD/low NWA profile in comparison to low PTSD/low NWA profile. Participants who reported having experienced torture were more likely to be part of the high PTSD/high NWA profile in comparison to low PTSD/low NWA profile. Gender did not differentiate between the profiles.Conclusions: This study reveals that among treatment-seeking refugees resettled in the Netherlands, there are distinct profiles of PTSD and NWA. These profiles indicate that PTSD and NWA are not uniformly experienced among refugees, emphasizing the diversity in their psychological responses to trauma. Among individuals experiencing severe PTSD symptoms, a subgroup was identified of individuals who additionally exhibited negative assumptions about themselves, others, and the world. Recognizing this heterogeneity is crucial in both research and clinical practice, particularly in the context of refugee mental health. Directions for future research are discussed.
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Affiliation(s)
- Iris I. Bosscher
- ARQ Centrum’45, Diemen, the Netherlands
- ARQ Nationaal Psychotrauma Centrum, the Netherlands
- Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands
| | - Simone M. de la Rie
- ARQ Centrum’45, Diemen, the Netherlands
- ARQ Nationaal Psychotrauma Centrum, the Netherlands
- Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands
| | - Niels van der Aa
- ARQ Centrum’45, Diemen, the Netherlands
- ARQ Nationaal Psychotrauma Centrum, the Netherlands
| | - Paul A. Boelen
- ARQ Centrum’45, Diemen, the Netherlands
- ARQ Nationaal Psychotrauma Centrum, the Netherlands
- Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands
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van der Kolk BA, Wang JB, Yehuda R, Bedrosian L, Coker AR, Harrison C, Mithoefer M, Yazar-Klosinki B, Emerson A, Doblin R. Effects of MDMA-assisted therapy for PTSD on self-experience. PLoS One 2024; 19:e0295926. [PMID: 38198456 PMCID: PMC10781106 DOI: 10.1371/journal.pone.0295926] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 11/28/2023] [Indexed: 01/12/2024] Open
Abstract
INTRODUCTION There is a resurgence of interest in the therapeutic potential of psychedelic substances such as 3,4-methylenedioxymethamphetamine (MDMA). Primary findings from our randomized, double-blind, placebo-controlled, multi-site Phase 3 clinical trial of participants with severe PTSD (NCT03537014) showed that MDMA-assisted therapy induced significant attenuation in the Clinician-Administered PTSD Scale for DSM-5 compared to Therapy with placebo. Deficits in emotional coping skills and altered self-capacities constitute major obstacles to successful completion of available treatments. The current analysis evaluated the differential effects of MDMA-assisted therapy and Therapy with placebo on 3 transdiagnostic outcome measures and explored the contribution of changes in self-experience to improvement in PTSD scores. METHODS Participants were randomized to receive manualized therapy with either MDMA or placebo during 3 experimental sessions in combination with 3 preparation and 9 integration therapy visits. Symptoms were measured at baseline and 2 months after the last experimental session using the 20-item Toronto Alexithymia Scale (TAS-20), the 26-item Self Compassion Scale (SCS), and the 63-item Inventory of Altered Self-Capacities (IASC). RESULTS 90 participants were randomized and dosed (MDMA-assisted therapy, n = 46; Therapy with placebo, n = 44); 84.4% (76/90) had histories of developmental trauma, and 87.8% (79/90) had suffered multiple traumas. MDMA-assisted therapy facilitated statistically significant greater improvement on the TAS-20, the SCS, and most IASC factors of interpersonal conflicts; idealization disillusionment; abandonment concerns; identity impairment; self-awareness; susceptibility to influence; affect dysregulation; affect instability; affect skill deficit; tension reduction activities; the only exception was identity diffusion. CONCLUSION Compared with Therapy with placebo, MDMA-assisted therapy had significant positive effects on transdiagnostic mental processes of self-experience which are often associated with poor treatment outcome. This provides a possible window into understanding the psychological capacities facilitated by psychedelic agents that may result in significant improvements in PTSD symptomatology.
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Affiliation(s)
| | - Julie B. Wang
- MAPS Public Benefit Corporation (MAPS PBC), San Jose, CA, United States of America
| | - Rachel Yehuda
- James J. Peters Veterans Affairs Medical Center, Bronx, NY, United States of America
- Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Leah Bedrosian
- MAPS Public Benefit Corporation (MAPS PBC), San Jose, CA, United States of America
| | - Allison R. Coker
- University of California, San Francisco, San Francisco, CA, United States of America
- Multidisciplinary Association for Psychedelic Studies (MAPS), San Jose, CA, United States of America
| | - Charlotte Harrison
- MAPS Public Benefit Corporation (MAPS PBC), San Jose, CA, United States of America
| | - Michael Mithoefer
- MAPS Public Benefit Corporation (MAPS PBC), San Jose, CA, United States of America
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States of America
| | - Berra Yazar-Klosinki
- MAPS Public Benefit Corporation (MAPS PBC), San Jose, CA, United States of America
| | - Amy Emerson
- MAPS Public Benefit Corporation (MAPS PBC), San Jose, CA, United States of America
| | - Rick Doblin
- Multidisciplinary Association for Psychedelic Studies (MAPS), San Jose, CA, United States of America
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Themelis K, Tang NKY. The Management of Chronic Pain: Re-Centring Person-Centred Care. J Clin Med 2023; 12:6957. [PMID: 38002572 PMCID: PMC10672376 DOI: 10.3390/jcm12226957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/03/2023] [Accepted: 11/05/2023] [Indexed: 11/26/2023] Open
Abstract
The drive for a more person-centred approach in the broader field of clinical medicine is also gaining traction in chronic pain treatment. Despite current advances, a further departure from 'business as usual' is required to ensure that the care offered or received is not only effective but also considers personal values, goals, abilities, and day-to-day realities. Existing work typically focuses on explaining pain symptoms and the development of standardised interventions, at the risk of overlooking the broader consequences of pain in individuals' lives and individual differences in pain responses. This review underscores the importance of considering additional factors, such as the influence of chronic pain on an individual's sense of self. It explores innovative approaches to chronic pain management that have the potential to optimise effectiveness and offer person-centred care. Furthermore, it delves into research applying hybrid and individual formulations, along with self-monitoring technologies, to enhance pain assessment and the tailoring of management strategies. In conclusion, this review advocates for chronic pain management approaches that align with an individual's priorities and realities while fostering their active involvement in self-monitoring and self-management.
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Affiliation(s)
- Kristy Themelis
- Department of Psychology, University of Warwick, Coventry CV4 7AL, UK
| | - Nicole K. Y. Tang
- Department of Psychology, University of Warwick, Coventry CV4 7AL, UK
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Themelis K, Gillett JL, Karadag P, Cheatle MD, Giordano NA, Balasubramanian S, Singh SP, Tang NK. Mental Defeat and Suicidality in Chronic Pain: A Prospective Analysis. THE JOURNAL OF PAIN 2023; 24:2079-2092. [PMID: 37392929 DOI: 10.1016/j.jpain.2023.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 06/12/2023] [Accepted: 06/25/2023] [Indexed: 07/03/2023]
Abstract
Living with chronic pain has been identified as a significant risk factor for suicide. Qualitative and cross-sectional studies have reported an association between mental defeat and suicidal thoughts and behavior in patients with chronic pain. In this prospective cohort study, we hypothesized that higher levels of mental defeat would be associated with increased suicide risk at a 6-month follow-up. A total of 524 patients with chronic pain completed online questionnaires measuring variables related to suicide risk, mental defeat, sociodemographic, psychological, pain, activity, and health variables. At 6 months, 70.8% (n = 371) of respondents completed the questionnaires again. Weighted univariate and multivariable regression models were run to predict suicide risk at 6 months. The clinical suicide risk cutoff was met by 38.55% of the participants at baseline and 36.66% at 6 months. Multivariable modeling revealed that mental defeat, depression, perceived stress, head pain, and active smoking status significantly increased the odds of reporting higher suicide risk, while older age reduced the odds. Receiver operating characteristic (ROC) analysis showed that assessment of mental defeat, perceived stress, and depression is effective in discriminating between 'low' and 'high' suicide risk. Awareness of the prospective links from mental defeat, depression, perceived stress, head pain, and active smoking status to increased suicide risk in patients with chronic pain may offer a novel avenue for assessment and preventative intervention. PERSPECTIVE: Results from this prospective cohort study suggest that mental defeat is a significant predictor of increased suicide risk among patients with chronic pain, along with depression, perceived stress, head pain, and active smoking status. These findings offer a novel avenue for assessment and preventative intervention before risk escalates.
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Affiliation(s)
- Kristy Themelis
- Department of Psychology, University of Warwick, Coventry, United Kingdom
| | - Jenna L Gillett
- Department of Psychology, University of Warwick, Coventry, United Kingdom
| | - Paige Karadag
- Department of Psychology, University of Warwick, Coventry, United Kingdom
| | - Martin D Cheatle
- Department of Psychiatry and Anaesthesiology and Critical Care, Perelman School of Medicine University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nicholas A Giordano
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, United States
| | | | - Swaran P Singh
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Mental Health and Wellbeing, University of Warwick, Warwick Medical School, Coventry, United Kingdom
| | - Nicole Ky Tang
- Department of Psychology, University of Warwick, Coventry, United Kingdom
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Milewski A, Weinstein E, Lurie J, Lee A, Taki F, Pilato T, Jedlicka C, Kaur G. Reported Methods, Distributions, and Frequencies of Torture Globally: A Systematic Review and Meta-Analysis. JAMA Netw Open 2023; 6:e2336629. [PMID: 37787994 PMCID: PMC10548313 DOI: 10.1001/jamanetworkopen.2023.36629] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/24/2023] [Indexed: 10/04/2023] Open
Abstract
Importance Despite its prohibition by the United Nations Convention against Torture and other international treaties, torture has been perpetrated against countless individuals worldwide, and health care practitioners globally are increasingly encountering refugee torture survivors in their clinical practices. The methods, geographic distribution, and frequency of torture globally are not well described, which limits health care practitioners' ability to adequately diagnose and treat the sequelae of torture. Objective To rank the commonness of torture methods and identify the regions of the world with which they are associated. Data Sources For this systematic review and meta-analysis, Ovid MEDLINE, Ovid Embase, Web of Science, and The Cochrane Library were searched from inception to July 2021. Study Selection Included studies were peer-reviewed articles in English, contained an independent sample population of individuals who experienced torture, and outlined the type(s) of torture experienced. Excluded studies were not peer reviewed, lacked an independent sample population, or did not specify torture methods. Articles were chosen for inclusion by 2 independent and blinded reviewers, and a third, independent reviewer resolved discrepancies. Overall, 266 articles-15.3% of the 1739 studies initially identified for full review-met the inclusion criteria. Data Extraction and Synthesis Data abstraction and quality assessment followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data were extracted by 2 independent and blinded reviewers into predefined templates, and a third, independent reviewer resolved discrepancies. The risk of bias was evaluated using the Downs and Black Checklist. Main Outcomes and Measures Torture methods were ranked by their average frequencies, numbers of reporting studies, and numbers of countries wherein the methods occurred. Results A total of 9937 titles and abstracts were screened, and 266 studies encompassing 103 604 individuals (13 350 men, 5610 women, and 84 644 unspecified) were analyzed. Torture was reported for 105 countries; 21 methods accounted for 84% of all reported methods and 10 methods accounted for 78% of all physical tortures. The top 3 methods were beating or blunt-force trauma (reported in 208 studies and 59 countries; average frequency, 62.4%; 95% CI, 57.7%-67.1%), electrical torture (reported in 114 studies and 28 countries; average frequency, 17.2%; 95% CI, 15.0%-19.4%), and starvation or dehydration (reported in 65 studies in 26 countries; average frequency, 12.7%; 95% CI, 10.2%-15.2%). According to the Downs and Black appraisal tool, 50 studies were rated as good or excellent and 216 as fair or poor. Conclusions and Relevance The findings of this study suggest that torture remains widespread. Although innumerable torture methods exist, a limited number account for the vast majority of reported tortures. So that targeted therapies may be developed, additional investigation is needed to better elucidate the sequelae associated with the most common torture methods, described here.
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Affiliation(s)
- Andrew Milewski
- Department of Anesthesiology, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York
| | - Eliana Weinstein
- Department of Anesthesiology, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York
| | - Jacob Lurie
- Department of Anesthesiology, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York
| | - Annabel Lee
- Weill Cornell Medicine Medical College, New York, New York
| | - Faten Taki
- Department of Anesthesiology, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York
| | - Tara Pilato
- Samuel J. Wood Library, Weill Cornell Medicine, New York, New York
| | - Caroline Jedlicka
- Kingsborough Community College, City University of New York, Brooklyn
| | - Gunisha Kaur
- Department of Anesthesiology, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York
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Castiglioni M, Caldiroli CL, Negri A, Manzoni GM, Procaccia R. Linguistic Predictors of Psychological Adjustment in Healthcare Workers during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4482. [PMID: 36901490 PMCID: PMC10002307 DOI: 10.3390/ijerph20054482] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/25/2023] [Accepted: 02/26/2023] [Indexed: 06/18/2023]
Abstract
COVID-19 broke out in China in December 2019 and rapidly became a worldwide pandemic that demanded an extraordinary response from healthcare workers (HCWs). Studies conducted during the pandemic observed severe depression and PTSD in HCWs. Identifying early predictors of mental health disorders in this population is key to informing effective treatment and prevention. The aim of this study was to investigate the power of language-based variables to predict PTSD and depression symptoms in HCWs. One hundred thirty-five HCWs (mean age = 46.34; SD = 10.96) were randomly assigned to one of two writing conditions: expressive writing (EW n = 73) or neutral writing (NW n = 62) and completed three writing sessions. PTSD and depression symptoms were assessed both pre- and post-writing. LIWC was used to analyze linguistic markers of four trauma-related variables (cognitive elaboration, emotional elaboration, perceived threat to life, and self-immersed processing). Changes in PTSD and depression were regressed onto the linguistic markers in hierarchical multiple regression models. The EW group displayed greater changes on the psychological measures and in terms of narrative categories deployed than the NW group. Changes in PTSD symptoms were predicted by cognitive elaboration, emotional elaboration, and perceived threat to life; changes in depression symptoms were predicted by self-immersed processing and cognitive elaboration. Linguistic markers can facilitate the early identification of vulnerability to mental disorders in HCWs involved in public health emergencies. We discuss the clinical implications of these findings.
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Affiliation(s)
- Marco Castiglioni
- Department of Human Sciences “R. Massa”, University of Milano-Bicocca, 20126 Milan, Italy
| | | | - Attà Negri
- Department of Human and Social Sciences, University of Bergamo, 24129 Bergamo, Italy
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Brewin CR. Identity - A critical but neglected construct in cognitive-behaviour therapy. J Behav Ther Exp Psychiatry 2023; 78:101808. [PMID: 36435550 DOI: 10.1016/j.jbtep.2022.101808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 10/26/2022] [Accepted: 11/12/2022] [Indexed: 11/24/2022]
Abstract
In cognitive-behaviour therapy attention paid to the self and identity has primarily involved self-representations (the Me-Self) rather than how the self is experienced (the I-Self). Within the I-Self experiences vary on a continuum from pre-reflective consciousness (raw experienced perceptions and states of being) to self-awareness (permitting reflection on and evaluation of subjective experience). There is considerable evidence that the I-Self is affected in many if not all disorders, and I review illustrative studies of OCD, eating disorders, body dysmorphic disorder, PTSD, and personality disorder. These indicate that patients often experience themselves as being defective in various ways, or as having an unstable or contradictory I-Self. Recognition of this neglected aspect of patients' experience has major implications for assessment and treatment. For example, acknowledgment that their sense of self may fluctuate dramatically from moment to moment, may be fragmented, or may consist of a sense of emptiness, may help to build a more empathic therapeutic relationship. If frightening or distressing pre-reflective experiences are the cause of avoidance or other maladaptive coping strategies, conscious attention paid to them in therapy may help to better integrate the I-Self and Me-Self, restoring a sense of predictability and control.
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Albano GD, Guadagnino D, Midiri M, La Spina C, Tullio V, Argo A, Zerbo S. Torture and Maltreatment in Prison: A Medico-Legal Perspective. Healthcare (Basel) 2023; 11:healthcare11040576. [PMID: 36833110 PMCID: PMC9956078 DOI: 10.3390/healthcare11040576] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/03/2023] [Accepted: 02/12/2023] [Indexed: 02/17/2023] Open
Abstract
The maltreatment and torture of prisoners constitute a global problem. Methods of maltreatment are classified as the psychological and the physical, and physical methods inevitably lead to psychological sequelae. Our review offers an analysis from the medico-legal perspective of the literature on the torture and physical and sexual abuse experienced by prisoners and their psychological sequelae and aims to investigate the medico-legal issues of investigating maltreatment in prison so as to suggest methodologies and updated approaches for dealing with such cases in a forensic context. We performed a comprehensive literature search of peer-reviewed publications (articles and reviews), research reports, case studies, books, service models, protocols, and institutional documents available online using key electronic databases (Scopus, PubMed) and search engines (Google Scholar) with the following keywords: physical violence, psychological violence, torture, maltreatment, physical abuse, psychological abuse AND prison OR prisoner OR jail OR custody. In the medical literature, most of the publications on torture are based on retrospective studies of torture among survivors and often refer to asylum seekers. Forensic evaluation is crucial for assessing the determinant elements of torture and maltreatment. A multidisciplinary approach and standardized and updated methodologies are needed to support policymakers, national institutions, and public health system initiatives in this field.
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Affiliation(s)
- Giuseppe Davide Albano
- Section of Legal Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90129 Palermo, Italy
- Correspondence:
| | - Daniela Guadagnino
- Section of Legal Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90129 Palermo, Italy
| | - Mauro Midiri
- Section of Legal Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90129 Palermo, Italy
| | - Corinne La Spina
- Section of Legal Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90129 Palermo, Italy
| | - Valeria Tullio
- Section of Legal Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90129 Palermo, Italy
- Interdepartmental Center of Research (CIR) “Migrare” on Migration, University of Palermo, 90129 Palermo, Italy
| | - Antonina Argo
- Section of Legal Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90129 Palermo, Italy
- Interdepartmental Center of Research (CIR) “Migrare” on Migration, University of Palermo, 90129 Palermo, Italy
| | - Stefania Zerbo
- Section of Legal Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90129 Palermo, Italy
- Interdepartmental Center of Research (CIR) “Migrare” on Migration, University of Palermo, 90129 Palermo, Italy
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Gillett JL, Karadag P, Themelis K, Li YM, Lemola S, Balasubramanian S, Singh SP, Tang NKY. Investigating mental defeat in individuals with chronic pain: Protocol for a longitudinal experience sampling study. BMJ Open 2023; 13:e066577. [PMID: 36746544 PMCID: PMC9906405 DOI: 10.1136/bmjopen-2022-066577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Previous qualitative and cross-sectional research has identified a strong sense of mental defeat in people with chronic pain who also experience the greatest levels of distress and disability. This study will adopt a longitudinal experience sampling design to examine the within-person link between the sense of mental defeat and distress and disability associated with chronic pain. METHODS AND ANALYSIS We aim to recruit 198 participants (aged 18-65 years) with chronic pain, to complete two waves of experience sampling over 1 week, 6 months apart (time 1 and time 2). During each wave of experience sampling, the participants are asked to complete three short online surveys per day, to provide in-the-moment ratings of mental defeat, pain, medication usage, physical and social activity, stress, mood, self-compassion, and attention using visual analogue scales. Sleep and physical activity will be measured using a daily diary as well as with wrist actigraphy worn continuously by participants throughout each wave. Linear mixed models and Gaussian graphical models will be fit to the data to: (1) examine the within-person, day-to-day association of mental defeat with outcomes (ie, pain, physical/social activity, medication use and sleep), (2) examine the dynamic temporal and contemporaneous networks of mental defeat with all outcomes and the hypothesised mechanisms of outcomes (ie, perceived stress, mood, attention and self-compassion). ETHICS AND DISSEMINATION The current protocol has been approved by the Health Research Authority and West Midlands-Solihull Research Ethics Committee (Reference Number: 17/WM0053). The study is being conducted in adherence with the Declaration of Helsinki, Warwick Standard Operating Procedures and applicable UK legislation.
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Affiliation(s)
- Jenna L Gillett
- Department of Psychology, University of Warwick, Coventry, UK
| | - Paige Karadag
- Department of Psychology, University of Warwick, Coventry, UK
| | - Kristy Themelis
- Department of Psychology, University of Warwick, Coventry, UK
| | - Yu-Mei Li
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Sakari Lemola
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | | | - Swaran Preet Singh
- Mental Health and Wellbeing, University of Warwick, Warwick Medical School, Coventry, UK
| | - Nicole K Y Tang
- Department of Psychology, University of Warwick, Coventry, UK
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12
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Zinbarg RE, Williams AL, Mineka S. A Current Learning Theory Approach to the Etiology and Course of Anxiety and Related Disorders. Annu Rev Clin Psychol 2022; 18:233-258. [PMID: 35134320 DOI: 10.1146/annurev-clinpsy-072220-021010] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The authors describe how contemporary learning theory and research provide the basis for models of the etiology and maintenance of anxiety and related disorders. They argue that contemporary learning theory accounts for much of the complexity associated with individual differences in the development and course of these disorders. These insights from modern research on learning overcome the limitations of earlier behavioral approaches, which were overly simplistic and have been justifiably criticized. The authors show how considerations of early learning histories and temperamental vulnerabilities affect the short- and long-term likelihood that experiences with stressful events will lead to the development of anxiety disorders. They also discuss how contextual variables during and after stressful learning experiences influence the maintenance of anxiety disorder symptoms. Thus, contemporary learning models provide a rich and nuanced understanding of the etiology and course of anxiety and related disorders. Expected final online publication date for the Annual Review of Clinical Psychology, Volume 18 is May 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Richard E Zinbarg
- Department of Psychology, Northwestern University, Evanston, Illinois, USA; .,The Family Institute at Northwestern University, Evanston, Illinois, USA
| | | | - Susan Mineka
- Department of Psychology, Northwestern University, Evanston, Illinois, USA;
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13
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Maslahati T, Voß AL, Donth S, Heuser-Collier I, Röpke S. [Physical and Psychological Consequences of Political Imprisonment in the Soviet Zone of Occupation and the German Democratic Republic]. Psychother Psychosom Med Psychol 2022; 72:283-291. [PMID: 35081659 DOI: 10.1055/a-1704-8486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
About 180 000 to 300 000 people were imprisoned for political reasons in the Soviet Zone of Occupation (SBZ) and the German Democratic Republic (GDR). Traumatic stress, like political imprisonment, can lead to long-term health impairments. Furthermore, research on political imprisonment suggests a transgenerational transfer of health impairments. The current article aims at providing an overview of physical and psychological consequences of political imprisonment in the SBZ and GDR and underlining the relevance of the study currently conducted at Charité - Universitätsmedizin Berlin. Previous studies indicate increased prevalence rates for psychiatric syndromes and physical symptoms in the population of former political prisoners in the SBZ and GDR. There still is a need for a systematic assessment of possible health-related effects of political imprisonment in the SBZ/GDR on former prisoners and their offspring.
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Affiliation(s)
- Tolou Maslahati
- Klinik für Psychiatrie und Psychotherapie, Charité - Universitätsmedizin Berlin, Deutschland
| | - Aline Lea Voß
- Klinik für Psychiatrie und Psychotherapie, Charité - Universitätsmedizin Berlin, Deutschland
| | - Stefan Donth
- Stiftung Gedenkstätte Berlin-Hohenschönhausen, Berlin, Deutschland
| | - Isabella Heuser-Collier
- Klinik für Psychiatrie und Psychotherapie, Charité - Universitätsmedizin Berlin, Deutschland
| | - Stephan Röpke
- Klinik für Psychiatrie und Psychotherapie, Charité - Universitätsmedizin Berlin, Deutschland
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14
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Blackwell SE, Ehring T, Gladwin TE, Margraf J, Woud ML. The relationship between self-traumatized and self-vulnerable automatic associations and posttraumatic stress symptoms among adults who have experienced a distressing life event. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-02441-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AbstractConvergent evidence supports a crucial role for dysfunctional appraisals in the development and maintenance of post-traumatic stress disorder (PTSD). However, most research in this area has used self-report measures, assessing only explicit forms of such negative cognitions; the relevance of their more automatically-activated counterparts, as assumed by cognitive models, remains relatively unexplored. The current study aimed to further our understanding of the potential utility of measuring automatic dysfunctional associations in the context of posttraumatic stress. The relationship between scores on two different implicit association tests (IATs) and posttraumatic stress symptoms was investigated in a sample of adults (N = 279) who reported having experienced a potentially traumatic negative life event. Participants completed the two IATs (one assessing self-traumatized associations, the other self-vulnerable associations), a self-report measure of dysfunctional appraisals, and measures of posttraumatic stress symptoms and other aspects of psychopathology online. Scores indicating higher levels of dysfunctional associations on both IATs were associated with higher levels of posttraumatic stress symptoms. Only scores on the IAT measuring self-vulnerable associations, and not the IAT measuring self-traumatized associations, continued to show an association with posttraumatic stress symptoms after controlling for explicit dysfunctional appraisals. Overall, the results indicate the value of investigating PTSD-relevant automatic associations to further develop our understanding of cognitive processes implicated in posttraumatic stress.
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15
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Tyra AT, Griffin SM, Fergus TA, Ginty AT. Individual differences in emotion regulation prospectively predict early COVID-19 related acute stress. J Anxiety Disord 2021; 81:102411. [PMID: 33962141 PMCID: PMC9759661 DOI: 10.1016/j.janxdis.2021.102411] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/17/2021] [Accepted: 04/27/2021] [Indexed: 12/18/2022]
Abstract
Preliminary prospective research suggests emotion dysregulation may confer vulnerability to poor stress responses. The present prospective study extends this research by examining both specific emotion regulation strategies and global emotion regulation difficulties in the context of acute stress following onset of the COVID-19 global pandemic in 119 young adults. As part of a larger study, emotion regulation was assessed prior to pandemic onset (January 2019 - February 2020) using two standard measures (Emotion Regulation Questionnaire, ERQ, Gross & John, 2003; Difficulties in Emotion Regulation Scale, DERS, Gratz & Roemer, 2004). A self-report assessment of acute stress was conducted 2-3½ weeks after the COVID-19 pandemic declaration. Results demonstrated cognitive reappraisal and expressive suppression (i.e., ERQ) were not individually predictive of acute stress; however, there was a significant interaction of suppression by reappraisal. Simple effects indicated suppression was negatively associated with acute stress only when reappraisal levels were high. Greater global emotion regulation difficulties (i.e., DERS), particularly nonacceptance of emotions and limited access to emotion regulation strategies, significantly predicted greater acute stress. These results provide further evidence of the temporal relationship between emotion dysregulation and stress reactions, and also suggest the expected effects of emotion regulation strategies may differ across contexts.
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Affiliation(s)
- Alexandra T. Tyra
- Department of Psychology and Neuroscience, Baylor University, One Bear Place 97334, Waco, TX, 76798, USA,Corresponding author
| | - Siobhán M. Griffin
- SASHLab, Centre for Social Issues in Research, Department of Psychology, University of Limerick, V94T9PX, Ireland,Health Research Institute, University of Limerick, V94T9PX, Ireland
| | - Thomas A. Fergus
- Department of Psychology and Neuroscience, Baylor University, One Bear Place 97334, Waco, TX, 76798, USA
| | - Annie T. Ginty
- Department of Psychology and Neuroscience, Baylor University, One Bear Place 97334, Waco, TX, 76798, USA
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16
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An exploratory investigation into the effects of mental defeat on pain threshold, pain rating, pain anticipation, and mood. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01548-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AbstractIn chronic pain, mental defeat is considered as a disabling type of self-evaluation triggered by repeated episodes of debilitating pain. This exploratory study experimentally tested the effect of an activated sense of defeat, as well as its interaction with pain catastrophizing, on pain and mood. Participants (N = 71) were allocated to either high or low pain catastrophizing groups and then randomly assigned to receive either defeat or neutral manipulations. A cold pressor task administered before and after the thought manipulation measured pain threshold, alongside visual analogue scales for mental defeat, attention, pain intensity, pain anticipation as well as mood. Thought manipulation checks supported successful defeat activation. Defeat activation was associated with increased negative mood and attentional disengagement from the nociceptive stimuli, irrespective of pain catastrophizing tendency. There were no changes in pain threshold, pain or pain anticipation ratings. The results suggest that mental defeat can be experimentally activated using an autobiographical memory task and that an activated sense of defeat appears to operate independently from pain catastrophizing in influencing mood and attentional disengagement from the nociceptive stimuli. Future research can utilize our experimental approach to evaluate the effect of an activated sense of mental defeat in people with chronic pain, for whom the magnitude of pain, mood and attentional responses may be stronger and broader.
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17
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Murray H, Ehlers A. Cognitive therapy for moral injury in post-traumatic stress disorder. COGNITIVE BEHAVIOUR THERAPIST 2021; 14:e8. [PMID: 34191944 PMCID: PMC7853755 DOI: 10.1017/s1754470x21000040] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 12/22/2020] [Accepted: 01/04/2021] [Indexed: 11/21/2022]
Abstract
Moral injury is the profound psychological distress that can arise following participating in, or witnessing, events that transgress an individual's morals and include harming, betraying, or failure to help others, or being subjected to such events, e.g. being betrayed by leaders. It has been primarily researched in the military, but it also found in other professionals such as healthcare workers coping with the COVID-19 pandemic and civilians following a wide range of traumas. In this article, we describe how to use cognitive therapy for post-traumatic stress disorder (CT-PTSD) to treat patients presenting with moral injury-related PTSD. We outline the key techniques involved in CT-PTSD and describe their application to treating patients with moral injury-related PTSD. A case study of a healthcare worker is presented to illustrate the treatment interventions. KEY LEARNING AIMS (1)To recognise moral injury where it arises alongside PTSD.(2)To understand how Ehlers and Clark's cognitive model of PTSD can be applied to moral injury.(3)To be able to apply cognitive therapy for PTSD to patients with moral injury-related PTSD.
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Affiliation(s)
- Hannah Murray
- Department of Experimental Psychology, University of Oxford, Oxford, UK and Oxford Health NHS Foundation Trust, Oxford, UK
| | - Anke Ehlers
- Department of Experimental Psychology, University of Oxford, Oxford, UK and Oxford Health NHS Foundation Trust, Oxford, UK
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18
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Bernardi J, Engelbrecht A, Jobson L. The impact of culture on cognitive appraisals: Implications for the development, maintenance, and treatment of posttraumatic stress disorder. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12161] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Jessica Bernardi
- Monash Institute of Cognitive and Clinical Neuroscience, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia,
| | - Alberta Engelbrecht
- Monash Institute of Cognitive and Clinical Neuroscience, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia,
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK,
| | - Laura Jobson
- Monash Institute of Cognitive and Clinical Neuroscience, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia,
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19
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Uzer T. Validity and reliability testing of the transitional impact scale. Stress Health 2020; 36:478-486. [PMID: 32281242 DOI: 10.1002/smi.2944] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 03/18/2020] [Accepted: 03/24/2020] [Indexed: 11/06/2022]
Abstract
The transitional impact scale (TIS) was developed to measure the quality and quantity of changes brought about by transitional events. The aim of the present study was to investigate the psychometric properties of the TIS. Study 1 investigated the validity and internal consistency of the TIS among 445 participants (aged 18-73 years) who completed the TIS, beck anxiety inventory (BAI), centrality of event scale (CES), impact of event scale-revised (IES-R), and post-traumatic growth inventory. Study 2 investigated the test-retest reliability of the TIS among 140 university students (70 female; 70 male) who completed a retest of the TIS after a 2-week interval. The two-factor structure (i.e., material change and psychological change) of the TIS proposed by Svob et al. (2014) was confirmed in different age and socioeconomic status groups of a Turkish sample. The TIS was significantly correlated with the BAI, CES, and IES-R. Finally, the TIS had a high test-retest reliability.
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Affiliation(s)
- Tugba Uzer
- Department of Psychology, TED University, Ankara, Turkey
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20
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Boykin DM, Dunn QT, Orcutt HK. Cumulative Trauma and Adjustment in Women Exposed to a Campus Shooting: Examining the Role of Appraisals and Social Support. JOURNAL OF INTERPERSONAL VIOLENCE 2020; 35:3601-3621. [PMID: 29294766 DOI: 10.1177/0886260517710483] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Experiencing repeated trauma can have increasingly detrimental effects on psychosocial functioning after subsequent stressors. These effects may be intensified for victims of interpersonal traumas given that these events are often associated with heightened risk for adverse outcomes. To better understand this relationship, the present study prospectively examined the effect of pre-shooting trauma exposure (i.e., interpersonal vs. non-interpersonal trauma) on psychological functioning (i.e., posttraumatic stress symptoms, depression) following a mass campus shooting. Based on previous research, it was expected that negative appraisals and social support would mediate this relationship. A sample of 515 college women reporting prior trauma exposure was assessed at four time points following the shooting (i.e., pre-shooting, 1-month, 6-months, and 12-months post-shooting). Bootstrap analyses with bias-corrected confidence intervals were conducted. Contrary to expectation, pre-shooting trauma exposure was unrelated to 12-month post-shooting outcomes and neither negative appraisals nor social support at 6-months post-shooting emerged as mediators. Interestingly, a history of non-interpersonal trauma was associated with greater post-shooting family and friend support than a history of interpersonal trauma. Ad hoc analyses showed that pre-shooting symptom severity and level of exposure to the shooting had indirect effects on post-shooting outcomes via post-shooting negative appraisals. These findings support that cumulative trauma, regardless of type, may not have an additive effect unless individuals develop clinically significant symptoms following previous trauma. Trauma severity also appears to play a meaningful role.
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21
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Maffly-Kipp J, Flanagan P, Kim J, Schlegel RJ, Vess M, Hicks JA. The Role of Perceived Authenticity in Psychological Recovery from Collective Trauma. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2020. [DOI: 10.1521/jscp.2020.39.5.419] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction: Previous research demonstrates that perceived authenticity is positively associated with psychological health and security in the face of threats. The current research extends this work by testing whether perceived authenticity promotes recovery from the negative mental health consequences of collective trauma (e.g., a natural disaster). Methods: We recruited a sample of undergraduates (N = 570), many of whom reported direct or indirect exposure to Hurricane Harvey, to complete surveys at two time points. We assessed exposure to the disaster, acute stress, post-traumatic stress, coping, and authenticity twice, once approximately 1 month after Hurricane Harvey (Time 1) and again approximately 9 weeks after Hurricane Harvey (Time 2). Results: We employed multilevel modelling to explore whether authenticity would aid in recovery from collective trauma. Results showed that perceived authentic living at Time 1 predicted a variety of indicators of stress related to the hurricane at Time 2. Specifically, those participants who reported low authentic living at Time 1 reported greater levels of stress at Time 2, compared to individuals who reported higher levels of authentic living. Importantly, these effects remained even when controlling for known predictors of stress (e.g., levels of stress at Time 1 and coping strategies). Discussion: Findings provide preliminary insight into authenticity as a part of a likely larger network of interrelated psychosocial qualities that have the potential to help one navigate recovery from trauma.
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22
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Uzer T, Beşiroğlu L, Karakılıç M. Event centrality, transitional impact and symptoms of posttraumatic stress in a clinical sample. ANXIETY STRESS AND COPING 2019; 33:75-88. [PMID: 31752534 DOI: 10.1080/10615806.2019.1695252] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background and Objectives: There is growing research indicating that event centrality strongly predicts posttraumatic stress disorder (PTSD). However, there is not much research on what makes a traumatic event central to one's life story. One reason a traumatic memory becomes a reference point for one's life story is that it brings about significant changes in one's life. This study investigated the relationships between transitional impact of an event, event centrality, and PTSD symptoms. Specifically, it tested whether higher negative changes were associated with higher levels of event centrality and PTSD symptoms. It also investigated whether event centrality mediated the relationship between transitional impact and PTSD severity.Methods: 101 individuals diagnosed with PTSD completed the Transitional Impact Scale (TIS), Centrality of Event Scale, and Impact of Event Scale-Revised regarding their traumatic experiences. Furthermore, they responded to the Posttraumatic Stress Disorder Symptom Scale-Self Report (PSS-SR), Traumatic Events Checklist (TELC), and Beck Anxiety Inventory (BAI).Results and Conclusions: Results indicate that (a) the TIS had valid and reliable psychometric properties in a PTSD sample, (b) most of the traumatic events received high negative psychological and material change scores, and (c) event centrality mediated the relationship between transitional impact and PTSD severity.
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Affiliation(s)
- Tugba Uzer
- Department of Psychology, TED University, Ankara, Turkey
| | | | - Merve Karakılıç
- Department of Medicine, İzmir Katip Çelebi University, Izmir, Turkey
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23
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Single aggressive and non-aggressive social interactions elicit distinct behavioral patterns to the context in mice. Behav Processes 2018; 157:601-609. [DOI: 10.1016/j.beproc.2018.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 03/06/2018] [Accepted: 04/13/2018] [Indexed: 01/13/2023]
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24
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McCann KE, Sinkiewicz DM, Rosenhauer AM, Beach LQ, Huhman KL. Transcriptomic Analysis Reveals Sex-Dependent Expression Patterns in the Basolateral Amygdala of Dominant and Subordinate Animals After Acute Social Conflict. Mol Neurobiol 2018; 56:3768-3779. [PMID: 30196395 DOI: 10.1007/s12035-018-1339-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 08/30/2018] [Indexed: 12/27/2022]
Abstract
The basolateral amygdala (BLA) is a critical nucleus mediating behavioral responses after exposure to acute social conflict. Male and female Syrian hamsters both readily establish a stable dominant-subordinate relationship among same-sex conspecifics, and the goal of the current study was to determine potential underlying genetic mechanisms in the BLA facilitating the establishment of social hierarchy. We sequenced the BLA transcriptomes of dominant, subordinate, and socially neutral males and females, and using de novo assembly techniques and gene network analyses, we compared these transcriptomes across social status within each sex. Our results revealed 499 transcripts that were differentially expressed in the BLA across both males and females and 138 distinct gene networks. Surprisingly, we found that there was virtually no overlap in the transcript changes or in gene network patterns in males and females of the same social status. These results suggest that, although males and females reliably engage in similar social behaviors to establish social dominance, the molecular mechanisms in the BLA by which these statuses are obtained and maintained are distinct.
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Affiliation(s)
- Katharine E McCann
- Neuroscience Institute, Georgia State University, 161 Jesse Hill Jr. Drive, Atlanta, GA, 30303, USA
| | - David M Sinkiewicz
- Neuroscience Institute, Georgia State University, 161 Jesse Hill Jr. Drive, Atlanta, GA, 30303, USA
| | - Anna M Rosenhauer
- Neuroscience Institute, Georgia State University, 161 Jesse Hill Jr. Drive, Atlanta, GA, 30303, USA
| | - Linda Q Beach
- Neuroscience Institute, Georgia State University, 161 Jesse Hill Jr. Drive, Atlanta, GA, 30303, USA
| | - Kim L Huhman
- Neuroscience Institute, Georgia State University, 161 Jesse Hill Jr. Drive, Atlanta, GA, 30303, USA.
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25
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Le L, Morina N, Schnyder U, Schick M, Bryant RA, Nickerson A. The effects of perceived torture controllability on symptom severity of posttraumatic stress, depression and anger in refugees and asylum seekers: A path analysis. Psychiatry Res 2018; 264:143-150. [PMID: 29631246 DOI: 10.1016/j.psychres.2018.03.055] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 03/14/2018] [Accepted: 03/22/2018] [Indexed: 10/17/2022]
Abstract
Torture is associated with greater psychopathology, however, the specific mechanisms underlying the effects of torture remain unclear. Research suggests that the perceived uncontrollable nature of, rather than the exposure to, torture, influences the development of psychological disorders. Perceived distress during torture has also been shown to influence psychological outcomes. This cross-sectional study explored the relationship between perceived torture controllability, emotions (i.e., anger and fear) during torture, and current posttraumatic stress (PTS), depression and anger symptoms, controlling for the effects of post-migration living difficulties. Data were collected from 108 refugees and asylum seekers in treatment at two psychiatric clinics in Zurich, Switzerland. Path analyses revealed negative correlations between PTS, depression and anger symptoms, and perceived torture controllability, and positive correlations with anger and fear during torture. Furthermore, the effects of perceived torture controllability on PTS and depression symptoms were mediated by fear during torture, and on anger symptoms via anger during torture. This was over and above the effects of post-migration living difficulties on psychological symptoms. The study provides preliminary evidence that perceived uncontrollability and distress during torture might be significant risk factors for current mental health of torture survivors. These findings may have implications for informing interventions for torture survivors.
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Affiliation(s)
- Lillian Le
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Naser Morina
- Department of Psychiatry and Psychotherapy, Zurich University Hospital, University of Zurich, Zurich, Switzerland
| | - Ulrich Schnyder
- Department of Psychiatry and Psychotherapy, Zurich University Hospital, University of Zurich, Zurich, Switzerland
| | - Matthis Schick
- Department of Psychiatry and Psychotherapy, Zurich University Hospital, University of Zurich, Zurich, Switzerland
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Angela Nickerson
- School of Psychology, University of New South Wales, Sydney, Australia.
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26
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Investigating the Impact of Past Trauma and Defense Styles on Posttraumatic Stress Following Homicide and Psychiatric Co-morbidity. Psychiatr Q 2018; 89:439-449. [PMID: 29086239 DOI: 10.1007/s11126-017-9546-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
To examine the prevalence of PTSD following homicide and investigate the relationship between PTSD from past traumas, defense styles and PTSD following homicide and psychiatric co-morbidity. 167 male homicide perpetrators participated in the study and completed the Posttraumatic Stress Diagnostic Scale, the General Health Questionnaire-28 and the Defense Styles Questionnaire. 45% met the criteria for PTSD following homicide and 55% for no-PTSD. With the number of times for imprisonment adjusted, regression analyses showed that immature defense style was associated with PTSD following homicide with the severity of PTSD from past traumas as a moderator. Neurotic and immature defense styles and PTSD from past trauma were significantly and independently associated with psychiatric co-morbidity. Homicide perpetrators could develop PTSD following homicide. The severity of PTSD from past traumas could affect PTSD following homicide and other psychological problems, and influence the effect of using immature defense against PTSD from homicide. Past trauma, immature and neurotic defense styles had a unique and specific pattern of influence on psychological symptoms, other than trauma symptoms.
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27
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Giourou E, Skokou M, Andrew SP, Alexopoulou K, Gourzis P, Jelastopulu E. Complex posttraumatic stress disorder: The need to consolidate a distinct clinical syndrome or to reevaluate features of psychiatric disorders following interpersonal trauma? World J Psychiatry 2018; 8:12-19. [PMID: 29568727 PMCID: PMC5862650 DOI: 10.5498/wjp.v8.i1.12] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 12/29/2017] [Accepted: 02/05/2018] [Indexed: 02/05/2023] Open
Abstract
Complex posttraumatic stress disorder (Complex PTSD) has been recently proposed as a distinct clinical entity in the WHO International Classification of Diseases, 11th version, due to be published, two decades after its first initiation. It is described as an enhanced version of the current definition of PTSD, with clinical features of PTSD plus three additional clusters of symptoms namely emotional dysregulation, negative self-cognitions and interpersonal hardship, thus resembling the clinical features commonly encountered in borderline personality disorder (BPD). Complex PTSD is related to complex trauma which is defined by its threatening and entrapping context, generally interpersonal in nature. In this manuscript, we review the current findings related to traumatic events predisposing the above-mentioned disorders as well as the biological correlates surrounding them, along with their clinical features. Furthermore, we suggest that besides the present distinct clinical diagnoses (PTSD; Complex PTSD; BPD), there is a cluster of these comorbid disorders, that follow a continuum of trauma and biological severity on a spectrum of common or similar clinical features and should be treated as such. More studies are needed to confirm or reject this hypothesis, particularly in clinical terms and how they correlate to clinical entities’ biological background, endorsing a shift from the phenomenologically only classification of psychiatric disorders towards a more biologically validated classification.
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Affiliation(s)
- Evangelia Giourou
- Department of Psychiatry, School of Medicine, University of Patras, Rio Patras 26500, Greece
- Department of Public Health, School of Medicine, University of Patras, Rio Patras 26500, Greece
| | - Maria Skokou
- Department of Psychiatry, School of Medicine, University of Patras, Rio Patras 26500, Greece
| | - Stuart P Andrew
- Specialist Care Team Limited, Lancashire LA4 4AY, United Kingdom
| | | | - Philippos Gourzis
- Department of Psychiatry, School of Medicine, University of Patras, Rio Patras 26500, Greece
| | - Eleni Jelastopulu
- Department of Public Health, School of Medicine, University of Patras, Rio Patras 26500, Greece
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28
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Gieseler F, Gaertner L, Thaden E, Theobald W. Cancer Diagnosis: A Trauma for Patients and Doctors Alike. Oncologist 2018; 23:752-754. [PMID: 29472311 DOI: 10.1634/theoncologist.2017-0478] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 01/03/2018] [Indexed: 11/17/2022] Open
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29
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Kleim B, Horn AB, Kraehenmann R, Mehl MR, Ehlers A. Early Linguistic Markers of Trauma-Specific Processing Predict Post-trauma Adjustment. Front Psychiatry 2018; 9:645. [PMID: 30568607 PMCID: PMC6290715 DOI: 10.3389/fpsyt.2018.00645] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 11/15/2018] [Indexed: 11/26/2022] Open
Abstract
Identifying early predictors for psychiatric disorders, such as post-traumatic stress disorder (PTSD), is crucial for effective treatment and prevention efforts. Obtaining such predictors is challenging and methodologically limited, for example by individuals' distress, arousal, and reduced introspective ability. We investigated the predictive power of language-based, implicit markers of psychological processes (N = 163) derived from computerized text-analysis of trauma and control narratives provided within 18 days post-trauma. Trauma narratives with fewer cognitive processing words (indicating less cognitive elaboration), more death-related words (indicating perceived threat to life), and more first-person singular pronouns (indicating self-immersed processing) predicted greater PTSD symptoms at 6 months. These effects were specific to trauma narratives and held after controlling for early PTSD symptom severity and verbal intelligence. When self-report questionnaires of related processes were considered together with the trauma narrative linguistic predictors, use of more first-person singular pronouns remained a significant predictor alongside self-reported mental defeat. Language-based processing markers may complement questionnaire measures in early forecasting of post-trauma adjustment.
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Affiliation(s)
- Birgit Kleim
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Department of Psychology, University of Zurich, Zurich, Switzerland.,Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Andrea B Horn
- University Research Priority Program "Dynamics of Healthy Aging", University of Zurich, Zurich, Switzerland
| | - Rainer Kraehenmann
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Matthias R Mehl
- Department of Psychology, University of Arizona, Tucson, AZ, United States
| | - Anke Ehlers
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Department of Experimental Psychology, Oxford University, Oxford, United Kingdom
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Cuevas KM, Balbo J, Duval K, Beverly EA. Neurobiology of Sexual Assault and Osteopathic Considerations for Trauma-Informed Care and Practice. J Osteopath Med 2017; 118:e2-e10. [DOI: 10.7556/jaoa.2018.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Abstract
Sexual assault is a traumatic event with potentially devastating lifelong effects on physical and emotional health. Sexual assault is associated with gastrointestinal, neurologic, and reproductive symptoms, as well as obesity, diabetes, and chronic pain. With 1 in 3 women and 1 in 6 men experiencing some form of unwanted sexual violence in their lifetime, sexual assault is a significant public health problem that necessitates attention in the medical community. This review discusses relevant literature on the neurobiologic changes that occur as a consequence of sexual assault, such as how the brain responds during a traumatic experience and the impact of trauma on memory. Osteopathic considerations for trauma-informed care and practice and how all physicians can better serve patients with a history of sexual assault are also discussed.
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Pickover AM, Lipinski AJ, Dodson TS, Tran HN, Woodward MJ, Beck JG. Demand/withdraw communication in the context of intimate partner violence: Implications for psychological outcomes. J Anxiety Disord 2017; 52:95-102. [PMID: 28803688 DOI: 10.1016/j.janxdis.2017.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 05/26/2017] [Accepted: 07/18/2017] [Indexed: 10/19/2022]
Abstract
Intimate partner violence (IPV) is associated with symptoms of posttraumatic stress disorder (PTSD) and generalized anxiety disorder (GAD). To clarify the influence of a dyadic conflict pattern that has previously been shown to accompany violence in romantic relationships (partner demand/self withdraw) on these mental health outcomes, we examined the associations between three forms of IPV (physical, emotional-verbal, dominance-isolation), partner demand/self withdraw, and PTSD and GAD symptoms, in a sample of 284 IPV-exposed women. Using structural equation modeling, we found significant associations between dominance-isolation IPV, partner demand/self withdraw, and clinician-assessed GAD symptoms. Associations between emotional-verbal IPV and partner demand/self withdraw were also significant. Associations for physical IPV, partner demand/self withdraw, and clinician-assessed PTSD symptoms were not statistically significant. These results underscore the need for research on the mental health outcomes associated with specific forms of IPV and the long-term psychological consequences of the conflict patterns that uniquely characterize violent relationships.
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Affiliation(s)
- Alison M Pickover
- Department of Psychology, University at Memphis, 400 Innovation Drive, Memphis, TN, 38152, USA.
| | - Alexandra J Lipinski
- Department of Psychology, University at Memphis, 400 Innovation Drive, Memphis, TN, 38152, USA.
| | - Thomas S Dodson
- Department of Psychology, University at Memphis, 400 Innovation Drive, Memphis, TN, 38152, USA.
| | - Han N Tran
- Department of Psychology, University at Memphis, 400 Innovation Drive, Memphis, TN, 38152, USA.
| | - Matthew J Woodward
- Department of Psychology, University at Memphis, 400 Innovation Drive, Memphis, TN, 38152, USA.
| | - J Gayle Beck
- Department of Psychology, University at Memphis, 400 Innovation Drive, Memphis, TN, 38152, USA.
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Abstract
This article aims to review the concept of emotion dysregulation, focusing on issues related to its definition, meanings and role in psychiatric disorders. Articles on emotion dysregulation published until May 2016 were identified through electronic database searches. Although there is no agreement about the definition of emotion dysregulation, the following five overlapping, not mutually exclusive dimensions of emotion dysregulation were identified: decreased emotional awareness, inadequate emotional reactivity, intense experience and expression of emotions, emotional rigidity and cognitive reappraisal difficulty. These dimensions characterise a number of psychiatric disorders in various proportions, with borderline personality disorder and eating disorders seemingly more affected than other conditions. The present review contributes to the literature by identifying the key components of emotion dysregulation and by showing how these permeate various forms of psychopathology. It also makes suggestions for improving research endeavours. Better understanding of the various dimensions of emotion dysregulation will have implications for clinical practice. Future research needs to address emotion dysregulation in all its multifaceted complexity so that it becomes clearer what the concept encompasses.
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Self-Complexity and Perceived Self-Aspect Control in Post-Traumatic Stress Disorder. Behav Cogn Psychother 2017; 46:50-65. [PMID: 28756781 DOI: 10.1017/s1352465817000431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Post-traumatic stress disorder often brings about profound, lasting, structural changes to one's sense of self. AIMS This study investigated self-complexity and self-aspect control in post-traumatic stress disorder (PTSD). METHOD Trauma survivors with (n = 103) and without (n = 102) PTSD completed an online questionnaire which involved the completion of a self-complexity task and measures of PTSD. RESULTS It was found that those with PTSD had significantly greater overall self-complexity than those without PTSD. Furthermore, when considering self-description valence, it was found that those with PTSD had significantly greater negative self-complexity than those without PTSD, but the groups did not differ in terms of positive self-complexity. Second, those with PTSD reported significantly less control over their self-aspects. Third, for those with PTSD, lower levels of self-aspect control were significantly correlated with greater negative self-complexity and lower positive self-complexity. Finally, self-aspect control mediated the relationship between self-complexity and PTSD symptoms. CONCLUSION The theoretical implications for PTSD models and the clinical implications for the treatment of those with PTSD are explored.
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Schönfeld S, Ehlers A. Posttraumatic Stress Disorder and Autobiographical Memories in Everyday Life. Clin Psychol Sci 2017; 5:325-340. [PMID: 28781928 PMCID: PMC5528199 DOI: 10.1177/2167702616688878] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 12/09/2016] [Indexed: 01/01/2023]
Abstract
Evidence from self-reports and laboratory studies suggests that recall of nontrauma autobiographical memories may be disturbed in posttraumatic stress disorder (PTSD), but investigations in everyday life are sparse. This study investigated unintentional nontrauma and trauma memories in trauma survivors with and without PTSD (N = 52), who kept an autobiographical memory diary for a week. We investigated whether unintentional nontrauma memories show an overgeneral memory bias and further memory abnormalities in people with PTSD, and whether unintentional trauma memories show distinct features. Compared to the no-PTSD group, the PTSD group recorded fewer nontrauma memories, which were more overgeneral, more often from before the trauma or related to the trauma, were perceived as distant, and led to greater dwelling. Trauma memories were more vivid, recurrent, and present and led to greater suppression and dwelling. Within the PTSD group, the same features distinguished trauma and nontrauma memories. Results are discussed regarding theories of autobiographical memory and PTSD.
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Affiliation(s)
| | - Anke Ehlers
- King’s College London
- Department of Experimental Psychology, University of Oxford
- Oxford NIHR Cognitive Health Clinical Research Facility
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Matheson C. A new diagnosis of complex Post-traumatic Stress Disorder, PTSD – a window of opportunity for the treatment of patients in the NHS? PSYCHOANALYTIC PSYCHOTHERAPY 2016. [DOI: 10.1080/02668734.2016.1252943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Catherine Matheson
- Integrated Psychological Therapies Team, IPTT, Lewisham, South London and Maudsley NHS Foundation Trust, London, UK
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Barber BK, McNeely CA, El Sarraj E, Daher M, Giacaman R, Arafat C, Barnes W, Abu Mallouh M. Mental Suffering in Protracted Political Conflict: Feeling Broken or Destroyed. PLoS One 2016; 11:e0156216. [PMID: 27232335 PMCID: PMC4883798 DOI: 10.1371/journal.pone.0156216] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Accepted: 05/11/2016] [Indexed: 11/18/2022] Open
Abstract
PURPOSE This mixed-methods exploratory study identified and then developed and validated a quantitative measure of a new construct of mental suffering in the occupied Palestinian territory: feeling broken or destroyed. METHODS Group interviews were conducted in 2011 with 68 Palestinians, most aged 30-40, in the West Bank, East Jerusalem, and the Gaza Strip to discern local definitions of functioning. Interview participants articulated of a type of suffering not captured in existing mental health instruments used in regions of political conflict. In contrast to the specific difficulties measured by depression and PTSD (sleep, appetite, energy, flashbacks, avoidance, etc.), participants elaborated a more existential form of mental suffering: feeling that one's spirit, morale and/or future was broken or destroyed, and emotional and psychological exhaustion. Participants articulated these feelings when describing the rigors of the political and economic contexts in which they live. We wrote survey items to capture these sentiments and administered these items-along with standard survey measures of mental health-to a representative sample of 1,778 32-43 year olds in the occupied Palestinian territory. The same survey questions also were administered to a representative subsample (n = 508) six months earlier, providing repeated measures of the construct. RESULTS Across samples and time, the feeling broken or destroyed scale: 1) comprised a separate factor in exploratory factor analyses, 2) had high inter-item consistency, 3) was reported by both genders and in all regions, 4) showed discriminate validity via moderate correlations with measures of feelings of depression and trauma-related stress, and 5) was more commonly experienced than either feelings of depression or trauma-related stress. CONCLUSIONS Feeling broken or destroyed can be reliably measured and distinguished from conventional measures of mental health. Such locally grounded and contextualized measures should be identified and included in assessments of the full impact of protracted political conflict on functioning.
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Affiliation(s)
- Brian K. Barber
- University of Tennessee, Knoxville, Tennessee, United States of America
- New America, Washington, DC, United States of America
| | - Clea A. McNeely
- University of Tennessee, Knoxville, Tennessee, United States of America
| | - Eyad El Sarraj
- Gaza Community Mental Health Programme, Gaza Strip, Palestine
| | | | | | - Cairo Arafat
- Save the Children Foundation, Ramallah, West Bank, Palestine
| | - William Barnes
- Georgetown University, Washington, DC, United States of America
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Sloman L, Taylor P. Impact of Child Maltreatment on Attachment and Social Rank Systems: Introducing an Integrated Theory. TRAUMA, VIOLENCE & ABUSE 2016; 17:172-185. [PMID: 25948552 DOI: 10.1177/1524838015584354] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Child maltreatment is a prevalent societal problem that has been linked to a wide range of social, psychological, and emotional difficulties. Maltreatment impacts on two putative evolved psychobiological systems in particular, the attachment system and the social rank system. The maltreatment may disrupt the child's ability to form trusting and reassuring relationships and also creates a power imbalance where the child may feel powerless and ashamed. The aim of the current article is to outline an evolutionary theory for understanding the impact of child maltreatment, focusing on the interaction between the attachment and the social rank system. We provide a narrative review of the relevant literature relating to child maltreatment and these two theories. This research highlights how, in instances of maltreatment, these ordinarily adaptive systems may become maladaptive and contribute to psychopathology. We identify a number of novel hypotheses that can be drawn from this theory, providing a guide for future research. We finally explore how this theory provides a guide for the treatment of victims of child maltreatment. In conclusion, the integrated theory provides a framework for understanding and predicting the consequences of maltreatment, but further research is required to test several hypotheses made by this theory.
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Affiliation(s)
- Leon Sloman
- Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada
| | - Peter Taylor
- Institute of Psychology, Health and Society, University of Liverpool, England
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Schiller M, Hammen CC, Shahar G. Links among the Self, Stress, and Psychological Distress during Emerging Adulthood: Comparing Three Theoretical Models. SELF AND IDENTITY 2016. [DOI: 10.1080/15298868.2015.1131736] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Srinivas T, DePrince AP, Chu AT. Links between posttrauma appraisals and trauma-related distress in adolescent females from the child welfare system. CHILD ABUSE & NEGLECT 2015; 47:14-23. [PMID: 26074467 DOI: 10.1016/j.chiabu.2015.05.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 05/06/2015] [Accepted: 05/16/2015] [Indexed: 05/26/2023]
Abstract
Research on predictors of trauma-related distress in youth has tended to focus on trauma exposure and individual difference characteristics. This study extends previous research by examining the role of posttrauma appraisals in predicting trauma-related distress in a sample of female adolescents with current or prior involvement in the child welfare system and a history of maltreatment. Participants' posttrauma appraisals accounted for unique variance in trauma-related distress, above and beyond key trauma exposure and individual difference variables. Further, posttrauma appraisals of alienation accounted for unique variance in posttraumatic stress, dissociation, and depression symptom severity, and posttrauma appraisals of shame accounted for unique variance in posttraumatic stress symptom severity. These results suggest that posttrauma appraisals may represent an important predictor of trauma-related distress for youth with current or prior involvement in the child welfare system. They also replicate findings in youth and adult literature on interpersonal trauma, lending further support to the existence of specific pathways between certain appraisals and various forms of trauma-related distress. We discuss the implications of our study for trauma-informed practice within the child welfare system.
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Smith AJ, Donlon K, Anderson SR, Hughes M, Jones RT. When seeking influences believing and promotes posttraumatic adaptation. ANXIETY STRESS AND COPING 2014; 28:340-56. [DOI: 10.1080/10615806.2014.969719] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Munjiza J, Law V, Crawford MJ. Lasting personality pathology following exposure to catastrophic trauma in adults: systematic review. Personal Ment Health 2014; 8:320-36. [PMID: 25123294 DOI: 10.1002/pmh.1271] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 06/13/2014] [Accepted: 07/05/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND By definition, personality disorders (PDs) are evident in late childhood and adolescence, but evidence for personality pathology occurring after adolescence is unclear. AIM We aimed to review extant literature on personality change following exposure to catastrophic trauma in adults in order to identify the prevalence and clinical features of any long-term personality pathology. METHOD Relevant studies were identified by searching three bibliographic databases (MEDLINE, EMBASE and PsychINFO) from inception to November 2011 using terms related to personality and trauma. RESULTS No prospective studies that investigated long-term personality change following exposure to trauma in adults were found. Two retrospective studies reported the prevalence of enduring personality change of 2.6% and 6% (weighted prevalence 4.6%, 95% confidence interval 3.4-6.3%), and one study reported 20% increase in adult-onset antisocial behaviour following exposure to trauma. Findings from cross-sectional studies that examined the prevalence of PDs in people exposed to catastrophic trauma reported that Cluster C and Cluster A were the most common with avoidant, paranoid and obsessive-compulsive PDs among those most frequently reported. CONCLUSION A minority of adults who are exposed to severe trauma appear to go on to develop significant personality pathology. The observed personality disturbance is multifarious and more extensive than the prototype described in ICD-10.
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Affiliation(s)
- Jasna Munjiza
- Centre for Mental Health, Faculty of Medicine, Imperial College London, UK
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Abstract
OBJECTIVES The concept of mental defeat (MD) has been applied to describe the deeper impact of pain on the person's sense of self. It describes an intense psychological reaction to pain, whereby people feel that pain has taken away their autonomy and identity. Although MD has been found to characterize Western individuals who are most distressed and disabled by CP, it is debatable whether the concept can be generalized to the experience of CP patients in other cultures. The present study examined whether MD contributed to the prediction of distress and disability among Hong Kong (HK) Chinese reporting CP. METHODS Using questionnaires, the present study assessed MD, pain, distress, and disability in a sample of HK Chinese, comprising CP patients seeking specialist treatment and community volunteers with chronic or acute pain but not seeking specialist treatment. RESULTS MD was found to be elevated in CP patients seeking specialist treatment but not in nontreatment-seeking volunteers with pain of comparable duration and severity. Hierarchical regression indicated that MD was a significant predictor of functioning and distress, over and above the effects of pain severity and other potential demographic confounds. DISCUSSION These findings provide further evidence that MD is a factor that differentiates treatment-seeking from nontreatment-seeking individuals with CP. They also highlight the potential value of applying this psychological concept to the understanding and treatment of CP in HK Chinese.
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Engelbrecht A, Jobson L. An investigation of trauma-associated appraisals and posttraumatic stress disorder in British and Asian trauma survivors: the development of the Public and Communal Self Appraisals Measure (PCSAM). SPRINGERPLUS 2014; 3:44. [PMID: 24516784 PMCID: PMC3913797 DOI: 10.1186/2193-1801-3-44] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 01/15/2014] [Indexed: 12/04/2022]
Abstract
Two studies examined the role of culture on cognitive appraisals of trauma and associated implications for posttraumatic psychological adjustment. Study 2 also investigated the reliability and validity of a new measure assessing public and communal aspects of trauma-associated appraisals (Public and Communal Self Appraisals Measure; PCSAM). Study 1′s non-clinical sample (N = 75) and Study 2′s sample of British and Asian trauma survivors with and without PTSD (N = 95) provided an everyday and trauma memory, completed an Appraisal Inventory, the Posttraumatic Cognitions Inventory and measures of PTSD. Study 2 participants also completed the PCSAM. Conjoined, there were cultural differences in appraisals of everyday and trauma experiences. Nonetheless, there appeared to be cultural similarities in the dysfunctional appraisals of those with PTSD. The PSCAM had good internal consistency, test-retest reliability, convergent validity, and discriminative validity. Findings are discussed in terms of combining cultural models of self with current PTSD models.
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Affiliation(s)
| | - Laura Jobson
- University of East Anglia, Norwich, UK ; Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK
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Taylor B, Carswell K, Williams ACDC. The interaction of persistent pain and post-traumatic re-experiencing: a qualitative study in torture survivors. J Pain Symptom Manage 2013; 46:546-55. [PMID: 23507129 DOI: 10.1016/j.jpainsymman.2012.10.281] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Revised: 10/22/2012] [Accepted: 10/25/2012] [Indexed: 11/29/2022]
Abstract
CONTEXT There are limited studies and few theoretical models addressing the interaction between pain and symptoms of post-traumatic stress disorder, with none concerning this interaction in survivors of torture, who frequently report persistent pain. OBJECTIVES We aimed to explore the relationship between persistent pain and re-experiencing of traumatic events in survivors of torture. METHODS Nine torture survivors were interviewed about their experiences of pain and re-experiencing, and the results analyzed using interpretative phenomenological analysis. Levels of pain and post-traumatic stress were assessed. RESULTS Four superordinate themes emerged, namely "pain is the enemy," "pain and intrusive memories are connected," "changed identity," and "resilience and resources." These themes showed a complex relationship between torture, pain, re-experiencing, and other aspects of individual experience, such as the multiple losses experienced by torture survivors. Both pain and post-traumatic stress disorder symptoms were shown to have profound impacts on the everyday lives of participants. CONCLUSION The results suggest that the relationship between pain and re-experiencing requires a broad model that considers the impact of a range of individual, social, and environmental factors on the interaction between pain and traumatic stress symptoms in survivors of torture. The study has clinical implications, most notably the need to attempt more integrated treatment of pain and traumatic symptoms where they occur together, and to consider the meaning and impact of pain when treating survivors of torture. Further investigation of the relationship between pain and traumatic stress symptoms in torture survivors is needed, as are studies of combined treatment for pain and trauma.
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Affiliation(s)
- Bethany Taylor
- Department of Rehabilitation Psychology, Camden & Islington NHS Foundation Trust, London, United Kingdom.
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Troop NA, Hiskey S. Social defeat and PTSD symptoms following trauma. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2013; 52:365-79. [PMID: 24117910 DOI: 10.1111/bjc.12022] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2012] [Revised: 01/05/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Research indicates that constructs relevant to social rank predict a diagnosis of post-traumatic stress disorder (PTSD), including mental defeat, alienation, and shame. However, no studies have yet explored a social rank view explicitly. DESIGN This was a community-based study carried out online. Analyses were both cross-sectional and longitudinal over 6 months. METHODS Participants were recruited online for a cross-sectional study (Study 1, n = 194) and a 6-month longitudinal study (Study 2, n = 81). Measures included self-report measures of PTSD symptoms (the Post-Traumatic Diagnostic Scale) and social rank (including measures of unfavourable social comparison, social defeat, and internal/external entrapment). RESULTS Cross-sectional analysis showed that social defeat, but not other aspects of social rank, was independently predictive of a diagnosis of PTSD. Longitudinal analysis showed that greater social defeat at baseline predicted less improvement in PTSD symptoms, whereas greater reduction in social defeat over the 6-month follow-up predicted greater improvement in PTSD symptoms. CONCLUSIONS In addition to the implications for understanding the role of social (rather than individual mental) defeat in the aetiology of PTSD, interventions could usefully incorporate methods that either increase social status or else minimize the impact of low status (e.g., through the use of compassion-focused approaches).
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Baldwin DV. Primitive mechanisms of trauma response: an evolutionary perspective on trauma-related disorders. Neurosci Biobehav Rev 2013; 37:1549-66. [PMID: 23792048 DOI: 10.1016/j.neubiorev.2013.06.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 05/23/2013] [Accepted: 06/03/2013] [Indexed: 01/09/2023]
Abstract
The symptoms we identify and the behaviors we recognize as defenses define which symptoms we see as trauma-related. Early conceptions of trauma-related disorders focused on physical signs of distress while current ones emphasize mental symptoms, but traumatizing experiences evoke psychobiological reactions. An evolutionary perspective presumes that psychophysical reactions to traumatizing events evolved to ensure survival. This theoretical review examines several primitive mechanisms (e.g., sensitization and dissolution) associated with responses to diverse stressors, from danger to life-threat. Some rapidly acquired symptoms form without conscious awareness because severe stresses can dysregulate mental and physical components within systems ensuring survival. Varied defensive options engage specialized and enduring psychophysical reactions; this allows for more adaptive responses to diverse threats. Thus, parasympathetically mediated defense states such as freeze or collapse increase trauma-related symptom variability. Comorbidity and symptom variability confuse those expecting mental rather than psychophysical responses to trauma, and active (sympathetically mediated flight and fight) rather than immobility defenses. Healthcare implications for stress research, clinical practice and diagnostic nosology stem from the broader evolutionary view.
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Leask P. Losing trust in the world: Humiliation and its consequences. PSYCHODYNAMIC PRACTICE 2013; 19:129-142. [PMID: 26425115 PMCID: PMC4560131 DOI: 10.1080/14753634.2013.778485] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Revised: 01/17/2013] [Indexed: 10/27/2022]
Abstract
The author identifies acts of humiliation as a specific and often traumatic way of exercising power, with a set of consistently occurring elements and predictable consequences, including a loss of the ability to trust others. It is argued that these consequences are serious and long-lasting. The article makes a distinction between 'shame' as a state of mind and 'humiliation' as an act perpetrated against a person or group. The interplay between humiliation and shame after a humiliating act is discussed. It is argued that the patient's recovery of the capacity to resume a relatively normal life is made more likely if the therapist acknowledges the specificity of humiliation, the impossibility of reversing a humiliating act and the importance of focussing on the consequences of humiliation.
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Affiliation(s)
- Phil Leask
- Department of German, University College London, London, UK
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Abstract
BACKGROUND The majority of pain sufferers experience images when in pain. The most distressing of these images (the Index image) provokes intense emotional reactions, appraisal shifts, and increases in pain. The ability of pain sufferers to rescript their Index images, and the consequences of doing so, remain to be determined. AIMS To assess the effects upon emotions, appraisals and pain experience of rescripting Index images in pain sufferers. METHOD The Index images of a group of 55 pain sufferers were assessed using a voluntary image induction procedure (VIE) to obtain basal levels of pain, appraisal and emotion. Participants were than randomly allocated to one of two groups: Rescripted Image repetition or Index Image repetition. The two groups were compared on their responses to their Index and Rescripted images respectively. RESULTS The participants found it easy to rescript their distressing Index images. During rescripting, they reported dramatic reductions in emotion, negative appraisals, and pain. The clinically and statistically significant decrements in pain were found independent of reductions in emotion. The pain levels during rescripting were significantly below their basal levels, with 49% reporting no pain at all while viewing a rescripted image. These changes were not a function of image repetition. CONCLUSION Index images of pain sufferers can be easily elicited and rescripted. Rescripting leads to remarkable reductions in emotion, cognitions and pain levels that are not attributable to image repetition. The significant reductions in pain were independent of reductions in emotion. The implications of these results for CBT approaches to pain management are considered.
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Ardino V, Milani L, Di Blasio P. PTSD and re-offending risk: the mediating role of worry and a negative perception of other people's support. Eur J Psychotraumatol 2013; 4:21382. [PMID: 24371516 PMCID: PMC3873119 DOI: 10.3402/ejpt.v4i0.21382] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2013] [Revised: 11/29/2013] [Accepted: 12/03/2013] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Studies of posttraumatic stress disorder (PTSD) are mainly focused on victims of trauma. Very few studies explored the links between PTSD symptoms and re-offending risk in perpetrators of violence. OBJECTIVE The aim of the study was to assess the effect of PTSD symptoms on re-offending risk in prisoner populations with a focus on indirect effects of worry and a negative perception of other people's support on the relationship between PTSD and re-offending risk. METHODS 75 prisoners (25 females, mean age: 44.36 years; 50 males, mean age: 34.7 years) were assessed for exposure to child abuse and neglect, PTSD symptoms, worry, a negative perception of other people's support and re-offending risk. Mediation analyses tested the indirect effects of worry and a negative perception of other people's support on the relationship between PTSD and re-offending risk. RESULTS 72% participants presented PTSD symptoms and 30.7% were at risk of re-offending. Mediation analyses supported the hypothesis of a mediation pathway from PTSD to worry and a negative perception of other people's support to an increased risk of re-offending. CONCLUSIONS The results indicate that prisoners report high rates of PTSD symptoms; furthermore, they highlight an important relationship between PTSD and re-offending risk. Findings suggest that future research should test further the indirect effects of negative cognitive and emotional states on the relationship of PTSD and re-offending risk and explore more in depth the role of PTSD to assess and treat prisoners.
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Affiliation(s)
- Vittoria Ardino
- PSSRU Unit, Department of Social Policy, London School of Economics and Political Science, London, UK
| | - Luca Milani
- C.R i.d.e.e , Department of Psychology, Catholic University of Milan, Italy
| | - Paola Di Blasio
- C.R i.d.e.e , Department of Psychology, Catholic University of Milan, Italy
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