Trauma and posttraumatic stress disorder in people with schizophrenia.

This study evaluated the hypothesis that trauma and posttraumatic stress disorder (PTSD) severity would be positively associated with schizophrenia symptoms. Forty-seven clients with schizophrenia were assessed for schizophrenia severity and for lifetime trauma history and PTSD symptoms in 2 independent symptom interviews; 35 (74%) participants reported at least 1 event in which there was threat of harm or life threat and subjective distress, and 6 (13%) had current PTSD. Trauma across the life span was associated with greater severity of PTSD. Within the total sample, PTSD symptoms were associated with greater emotional distress, but not with schizophrenia-specific symptoms. Distress among clients with schizophrenia and PTSD suggests the need for routine assessment of PTSD and development of PTSD interventions in this population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A different kind of comorbidity: Understanding posttraumatic stress disorder and chronic pain.

Many traumatic events leave lingering physical injuries and chronic pain in their wake, in addition to trauma-related psychopathology. In this review, we provide an overview of developments in the recent literature on comorbid posttraumatic stress disorder (PTSD) and chronic pain. Starting with the conceptual models presented by Sharp and Harvey (2001) and Asmundson, Coons, Taylor, and Klatz (2002), this review summarizes newer studies that examine prevalence of these comorbid conditions. Additionally, we present an updated synthesis of research on factors that may maintain both chronic physical pain and PTSD in trauma survivors. Consideration of the impact of this comorbidity on psychosocial assessment and treatment also is discussed, with particular attention to issues that warrant additional research. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Introduction to the special section on substance use disorder and posttraumatic stress disorder comorbidity.

A body of 2 complementary, albeit independent, research literatures has emerged that documents a strong relationship between substance use disorders (SUDs) and posttraumatic stress disorder (PTSD) in both community and clinical samples. Research on the concomitants and consequences of PTSD has found that substance abuse is a frequent comorbid problem among individuals diagnosed with PTSD. Researchers from the substance abuse field are now investigating the interrelationship between PTSD and SUDs and finding that PTSD has a notable effect on SUD course and treatment response. Here, a brief summary of the prevalence of SUD-PTSD comorbidity is provided and the 5 articles of the special section are introduced. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attachment and treatment response among adults in inpatient treatment for posttraumatic stress disorder.

In this study, the authors investigated changes in attachment orientation after treatment in an inpatient program for adults with posttraumatic stress disorder. The authors also examined the association between these changes and symptom reduction. Results indicated that secure attachment increased significantly over treatment in comparison to a wait list group, and this change was maintained over the 6 months after discharge. Positive changes were also noted in the underlying attachment dimensions of anxiety and avoidance. Furthermore, positive changes in attachment were found to be associated with symptom reduction during treatment and maintenance of these reductions after discharge. These results have potential implications for the goals of psychotherapeutic intervention in general and for the utility of specialized inpatient trauma treatment specifically. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of social exclusion in trauma survivors with posttraumatic stress disorder.

Trauma survivors with posttraumatic stress disorder (PTSD) often experience or report social stigmatization and isolation. Williams (2001) provided an experimental paradigm to assess behavioral effects of social exclusion. This paradigm (face-to-face version) has been applied in a 2 × 2 group × experimental condition design. Participants in the PTSD group (N = 16) and the nontraumatized control group (N = 25) were randomly assigned to an exclusion or inclusion condition. The results showed interaction effects for main psychopathological assessments (depression, anxiety, psychoticism) and expected main effects for the majority of outcome measures (psychopathology, well-being, belonging, and meaningful existence). The research concludes that a general assumption of elevated levels of self-perceived social exclusion in PTSD patients has to be considered in terms of differentiated psychopathological effects of exclusion. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The developmental mental-disorder histories of adults with posttraumatic stress disorder: A prospective longitudinal birth cohort study.

Clinical and epidemiologic studies have established that posttraumatic stress disorder (PTSD) is highly comorbid with other mental disorders. However, such studies have largely relied on adults' retrospective reports to ascertain comorbidity. The authors examined the developmental mental health histories of adults with PTSD using data on mental disorders assessed across the first 3 decades of life among members of the longitudinal Dunedin Multidisciplinary Health and Development Study; 100% of those diagnosed with past-year PTSD and 93.5% of those with lifetime PTSD at age 26 had met criteria for another mental disorder between ages 11 and 21. Most other mental disorders had first onsets by age 15. Of new cases of PTSD arising between ages 26 and 32, 96% had a prior mental disorder and 77% had been diagnosed by age 15. These data suggest PTSD almost always develops in the context of other mental disorders. Research on the etiology of PTSD may benefit from taking lifetime developmental patterns of comorbidity into consideration. Juvenile mental-disorder histories may help indicate which individuals are most likely to develop PTSD in populations at high risk of trauma exposure. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Family functioning predicts outcomes for veterans in treatment for chronic posttraumatic stress disorder.

A longitudinal framework was used to examine the competing hypotheses of (a) whether family functioning predicts changes in posttraumatic stress disorder (PTSD) symptoms or (b) whether PTSD symptoms predict changes in family functioning. Veterans (N = 311) admitted to a treatment program completed a series of questionnaires at 3 time points: at intake, from intake to completion of a treatment program, and at the 6-month follow-up. Alcohol use and general mental health symptoms were also measured at intake. A cross-lagged panel model using structural equation modeling analyses indicated that family functioning was a moderate predictor of PTSD symptoms at posttreatment and at the 6-month follow-up. PTSD was not a significant predictor of family functioning across time and alcohol use, and general mental health symptoms did not affect the overall findings. Further analyses of PTSD symptom clusters indicated that the avoidance symptom cluster was most strongly related to family functioning. Targeting family relationships for treatment may be important in the future for veterans with PTSD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cannabis use among military veterans after residential treatment for posttraumatic stress disorder.

The present investigation prospectively evaluated whether treatment changes in PTSD symptom severity, among military Veterans in residential PTSD treatment, were related to cannabis use 4 months after discharge from residential rehabilitation. The sample was comprised of 432 male military Veteran patients (Mage = 51.06 years, SD = 4.17), who had a primary diagnosis of PTSD and were admitted to a VA residential rehabilitation program for PTSD. Results demonstrated that lower levels of change in PCL-M scores between treatment intake and discharge were significantly predictive of greater frequency of cannabis use at 4-month follow-up (p     

Impact of race on early treatment termination and outcomes in posttraumatic stress disorder treatment.

Objective:The present study investigated the influence of race on posttraumatic stress disorder (PTSD) treatment among 94 African American and 214 Caucasian female victims of interpersonal violence participating in 2 studies of cognitive–behavioral treatment for PTSD that were conducted sequentially and continuously. Method:In each study, participants were randomized into 1of 3 conditions. The first study compared cognitive processing therapy with prolonged exposure and a delayed treatment condition. In the second study, cognitive processing therapy was compared with its constituent components: cognitive therapy only and written accounts. Participants were assessed with the Clinician Administered PTSD Scale and the Structured Clinical Interview for DSM–IV, as well as through self-report measures of PTSD. Results:Analyses revealed that African Americans were significantly less likely to complete treatment compared with Caucasians (45% vs. 73%, respectively, p     

Cognitive processing therapy for veterans with military-related posttraumatic stress disorder.

Sixty veterans (54 men, 6 women) with chronic military-related posttraumatic stress disorder (PTSD) participated in a wait-list controlled trial of cognitive processing therapy (CPT). The overall dropout rate was 16.6% (20% from CPT, 13% from waiting list). Random regression analyses of the intention-to-treat sample revealed significant improvements in PTSD and comorbid symptoms in the CPT condition compared with the wait-list condition. Forty percent of the intention-to-treat sample receiving CPT did not meet criteria for a PTSD diagnosis, and 50% had a reliable change in their PTSD symptoms at posttreatment assessment. There was no relationship between PTSD disability status and outcomes. This trial provides some of the most encouraging results of PTSD treatment for veterans with chronic PTSD and supports increased use of cognitive- behavioral treatments in this population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sudden gains in prolonged exposure for children and adolescents with posttraumatic stress disorder.

Objective: Our objective was to examine sudden gains during developmentally adjusted prolonged exposure for posttraumatic stress disorder (PTSD) among children and adolescents. We hypothesized that sudden gains would be detected and would be predictive of treatment outcome and follow-up. Method: Sixty-three youngsters (ages 8–17) completed a developmentally adjusted protocol for the treatment of pediatric PTSD (Foa, Chrestman, & Gilboa-Schechtman, 2008). Participants' posttraumatic and depressive symptoms were assessed before each treatment session, as well as at approximately 3 and 12 months after treatment termination. We measured posttraumatic symptoms with the Child PTSD Symptom Scale (Foa, Johnson, Feeny, & Treadwell, 2001) and measured depressive symptoms with the Beck Depression Inventory (Beck, Ward, Mendelson, Mock, & Erbaugh, 1961) and the Children's Depression Inventory (Kovacs, 1981, 1982). Results: Sudden gains were found among 49.2% of participants and constituted 48.6% of the total reduction in posttraumatic symptoms. Compared to individuals who did not experience sudden gains, individuals who experienced sudden gains reported lower levels of posttraumatic symptoms, F(1, 61) = 14.4, p     

The structure of distress following trauma: Posttraumatic stress disorder, major depressive disorder, and generalized anxiety disorder.

The current report used confirmatory factor analysis to examine the latent structures of both key features and associated symptoms of three disorders that commonly develop following a traumatic event: posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and generalized anxiety disorder (GAD). Participants were 228 motor-vehicle accident survivors who sought treatment for emotional difficulties. PTSD, MDD, and GAD were assessed with a combination of self-report and interview-based measures. The results of construct level analyses suggested that PTSD, MDD, and GAD are distinguishable but highly correlated disorders following a traumatic event. Symptom level analyses supported a model where the Reexperiencing, Avoidance, and Hypervigilance factors were subsumed under the PTSD construct. However, in this model the Dysphoria factor was a higher order construct correlated with the PTSD, MDD, and GAD factors, suggesting that the Dysphoria cluster may not be unique to PTSD. Diagnostic and theoretical implications of these results are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mindfulness in the treatment of posttraumatic stress disorder among military veterans.

How might a practice that has its roots in contemplative traditions, seeking heightened awareness through meditation, apply to trauma-related mental health struggles among military veterans? In recent years, clinicians and researchers have observed the increasing presence of mindfulness in Western mental health treatment programs. Mindfulness is about bringing an attitude of curiosity and compassion to present experience. This review addresses the above question in a detailed manner with an emphasis on the treatment of military veterans suffering from posttraumatic stress disorder (PTSD) and related psychopathology. In addition, the integration of mindfulness with current empirically supported treatments for PTSD is discussed with specific attention to directions for future research in this area. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Trauma-focused imaginal exposure for individuals with comorbid posttraumatic stress disorder and alcohol dependence: Revealing mechanisms of alcohol craving in a cue reactivity paradigm.

With a sample (N = 43) of participants meeting current diagnostic criteria for both alcohol dependence and posttraumatic stress disorder (PTSD), the authors tested the hypothesis that alcohol craving elicited by a trauma cue might be attenuated if trauma-elicited negative emotion were reduced following trauma-focused imaginal exposure. In a laboratory-based experiment, participants were randomly assigned to either trauma-focused imaginal exposure or imagery-based relaxation. A cue reactivity paradigm was used to assess alcohol craving prior to, and after completion of, the 6 clinical sessions. Attrition was high but did not differ between experimental conditions. For study completers, PTSD symptoms decreased in the exposure condition but not in the relaxation condition. Alcohol craving and distress elicited by trauma images decreased in the exposure condition but did not change in the relaxation condition. Results support the hypothesis that negative emotion is a mechanism of alcohol craving. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Screening for posttraumatic stress disorder in a general psychiatric outpatient setting.

Posttraumatic stress disorder (PTSD) may affect survivors of a number of accidents and illnesses, in addition to violence victims and combat veterans. Prior research suggests that PTSD may be underdiagnosed when trauma is not the presenting problem. Thus, a PTSD screening scale might have utility in routine clinical settings. The authors evaluated the screening performance of the Posttraumatic Diagnostic Scale (PDS) in a general psychiatric setting. Results indicated that the PDS performed as well in this setting as it did in the original trauma-focused validation studies, independent of PTSD status as a primary, versus secondary, reason for presenting. A simple cutoff score was adequate for case identification. There were no gender effects, and the scale performed equally well among patients with, versus without, a depressive diagnosis. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attentional networks reveal executive function deficits in posttraumatic stress disorder.

Executive function was assessed with the Trail Making Test (Army Individual Test Battery; M. D. Lezak, 1983), the Comprehensive Trail Making Test (C. Reynolds, 2002), and a neurocognitive measure of executive control (Attentional Network Task [ANT]; J. I. Fan, B. D. McCandliss, T. Somer, A. Raz, & M. I. Posner, 2002) in 19 undergraduates with posttraumatic stress disorder (PTSD; Posttraumatic Stress Disorder Symptom Scale-Self-Report version; E. B. Foa, D. S. Riggs, C. V. Dancu, & B. O. Rothbaum, 1993), 15 high trauma participants without PTSD, and 18 low trauma control participants. Although groups did not differ on any trail making task or on the ANT measures of alerting or orienting, PTSD participants were significantly more impaired on the ANT executive network index than were high or low trauma control participants, even when level of depressive symptoms was covaried. Previous animal research identified a relationship between dopamine and the ANT measure of executive function. Elevated PTSD symptom severity and levels of hyperarousal, reexperiencing, and avoidance-numbing were associated significantly with executive function deficits indexed by the ANT. These results indicate a potentially subtle but specific deficit in executive function and a possible relationship between PTSD symptoms and irregularities in dopamine function. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Exposure therapy for posttraumatic stress disorder in a residential substance use treatment facility.

Clinical lore abounds when discussing the issue of treating trauma-related symptoms in substance-dependent clients. Historically, clinicians have wondered whether they should wait until the client has gained substantial abstinence from abused substances before initiating trauma treatment or if trauma treatment should be conducted during substance use treatment. Furthermore, questions arise with regard to exactly how trauma-related symptoms should be addressed and how trauma treatment should be incorporated into the recovery process. In this article, the growing literature suggesting that posttraumatic stress disorder (PTSD) can be treated concurrently with substance use disorders is reviewed. In addition, the unique challenges of implementing treatment for PTSD with substance-dependent clients seeking treatment in a residential treatment facility are discussed. Specifically, we provide concrete suggestions about how to utilize prolonged exposure, a very effective treatment for PTSD, with clients in a residential substance use treatment facility, including use of the internet to facilitate exposure therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictors of posttraumatic stress disorder following cancer.

This study investigated the predictors of posttraumatic stress disorder (PTSD) following a diagnosis of cancer. Individuals who were recently diagnosed with 1st onset head and neck or lung malignancy (N = 82) were assessed within 1 month of diagnosis for acute stress disorder (ASD) and other psychological responses including depression; individuals were reassessed (N = 63) for PTSD 6 months following their cancer diagnosis. At the initial assessment ASD was diagnosed in 28% of participants, and 22% met criteria for PTSD at 6-months follow-up. Peritraumatic dissociative symptoms at the time of receiving one's cancer diagnosis was the sole predictor of PTSD severity at 6-months follow-up. Elevated dissociative symptoms and greater distress at the initial assessment were the best predictors of PTSD caseness at 6-months follow-up. This study provides evidence for identifying recently diagnosed cancer patients who may benefit from psychological assistance in order to prevent chronic psychopathology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Underdiagnosing and nontreatment of posttraumatic stress disorder in community mental health: A case study.

Research indicates that trauma is extremely prevalent among populations seeking community-based services. However, underdiagnosis and nontreatment of trauma-related disorders is widespread. This study explored how one urban community mental health center (CMHC), serving a severely mentally ill (SMI) population, assessed, diagnosed, and treated reported trauma histories. Results indicate that of the 72 consumers in this sample who reported trauma histories (51%), only 2 were diagnosed with posttraumatic stress disorder (PTSD). Instead, those with a reported trauma history were likely to be diagnosed with affective disorders and were almost seven times as likely to be recommended therapy as were those without a trauma history. However, even those recommended therapy were not likely to receive it. Findings indicate significant barriers to PTSD diagnoses and the receipt of therapy services. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The structure of personality disorders in individuals with posttraumatic stress disorder.

Research on the structure of personality disorders (PDs) has relied primarily on exploratory analyses to evaluate trait-based models of the factors underlying the covariation of these disorders. This study used confirmatory factor analysis to evaluate whether a model that included both PD traits and a general personality dysfunction factor would account for the comorbidity of the PDs better than a trait-only model. It also examined if the internalizing/externalizing model of psychopathology, developed previously through research on the structure of Axis I disorders, might similarly account for the covariation of the Axis II disorders in a sample of 245 veterans and nonveterans with posttraumatic stress disorder. Results indicated that the best fitting model was a modified bifactor structure composed of nine lower-order common factors. These factors indexed pathology ranging from aggression to dependency, with the correlations among them accounted for by higher-order Internalizing and Externalizing factors. Further, a general factor, reflecting a construct that we termed boundary disturbance, accounted for additional variance and covariance across nearly all the indicators. The Internalizing, Externalizing, and Boundary Disturbance factors evidenced differential associations with trauma-related covariates. These findings suggest continuity in the underlying structure of psychopathology across DSM–IV Axes I and II and provide empirical evidence of a pervasive, core disturbance in the boundary between self and other across the PDs. (PsycINFO Database Record (c) 2011 APA, all rights reserved)