Arousal, numbing, and intrusion: symptom structure of PTSD following assault

OBJECTIVE: This study investigated hypotheses concerning the importance of symptoms of numbing in posttraumatic stress disorder (PTSD). METHODS: Symptoms of PTSD were assessed in 72 female rape victims and 86 female victims of nonsexual assault approximately 3 months after the crimes occurred. A principal-components factor analysis of subjects' symptoms was then undertaken. RESULTS: The analysis yielded three factors: arousal/avoidance, numbing, and intrusion. These were somewhat different from the symptom clusters in DSM-III-R, since effortful avoidance and numbing symptoms did not load on the same factor. Numbing symptoms appeared to be particularly important in identifying individuals with PTSD. CONCLUSIONS: The results imply that there are two patterns of posttrauma symptoms, one characterizing PTSD and the second characterizing a phobic reaction.     

The use of homework in behavior therapy for anxiety disorders.

In this article, the authors discuss the role of homework in behavior therapy for the anxiety disorders. First, the authors describe the essential components of behavior therapy that include exposure to feared consequences and cessation of all avoidance behaviors. Then, the authors briefly review the literature on the relationship between homework compliance and treatment outcome. Next, the authors discuss the way that homework is used in terms of self-monitoring and exposure exercises during the course of treatment. Finally, the authors discuss the practicalities of encouraging homework compliance and managing noncompliance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Worries and obsessions in individuals with obsessive-compulsive disorder with and without comorbid generalized anxiety disorder

Participants from the DSM-IV field trial for OCD (N = 381) were divided into two groups based on the SCID interview: those who met current criteria for obsessive-compulsive disorder (OCD) but not generalized anxiety disorder (GAD) and those who met current diagnostic criteria for both. The groups were compared on their severity of obsessive and compulsive symptoms, as well as on the percent of individuals who reported excessive worry concerning everyday issues (e.g. health, finances). The comorbidity rate was 20%. While the presence of GAD did not elevate OCD symptoms per se, it was associated with more pathological responsibility and indecisiveness. Excessive worries were significantly more common in those with comorbid OCD and GAD. The relationship between obsessions and worries is discussed.     

Report to the membership for the year 1989 by the Secretary of the Universal Union of Meteorologists.

Reports on the direction of the field of meteorology in the years since The Atomic War of 1986. The author reports that two major theories emerged to dominate the field of meteorology: the wind theory and the sky theory, and an overview of these theories is presented. The author also discusses the concept of precipitation, the quantitative and qualitative differences in distinguishing between wind and breeze, and the history and organizational growth of the field. The crisis of meteorology that threatened the viability of our discipline just after The Atomic War is over. Nevertheless, one should not forget for a single moment that so much is owed to meteorology's mother-science, psychology, which has provided us with the paradigms over which the discipline could be built. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patient adherence predicts outcome from cognitive behavioral therapy in obsessive-compulsive disorder.

Objective: To examine the effects of patient adherence on outcome from exposure and response prevention (EX/RP) therapy in adults with obsessive-compulsive disorder (OCD). Method: Thirty adults with OCD were randomized to EX/RP (n = 15) or EX/RP augmented by motivational interviewing strategies (n = 15). Both treatments included 3 introductory sessions and 15 exposure sessions. Because there were no significant group differences in adherence or outcome, the groups were combined to examine the effects of patient adherence on outcome. Independent evaluators assessed OCD severity using the Yale–Brown Obsessive Compulsive Scale. Therapists assessed patient adherence to between-session EX/RP assignments at each session using the Patient EX/RP Adherence Scale (PEAS). Linear regression models were used to examine the effects of PEAS scores on outcome, adjusting for baseline severity. The relationship between patient adherence and other predictors of outcome was explored using structural equation modeling. Results: Higher average PEAS ratings significantly predicted lower posttreatment OCD severity in intent-to-treat and completer samples. PEAS ratings in early sessions (5–9) also significantly predicted posttreatment OCD severity. The effects of other significant predictors of outcome in this sample (baseline OCD severity, hoarding subtype, and working alliance) were fully mediated by patient adherence. Conclusions: Patient adherence to between-session EX/RP assignments significantly predicted treatment outcome, as did early patient adherence and change in early adherence. Patient adherence mediated the effects of other predictors of outcome. Future research should develop interventions that increase adherence and then test whether increasing adherence improves outcome. If effective, these interventions could then be used to personalize care. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Are trauma victims susceptible to "false memories?"

Laboratory studies using word-list paradigms have provided evidence that nontraumatized individuals falsely recall or recognize events that never occurred. In the present study, H. L. Roediger and K. B. McDermott's false-memory paradigm (1995) was utilized to examine possible source monitoring deficits in individuals with PTSD. Traumatized individuals with PTSD were compared with traumatized individuals without PTSD and with nontraumatized control participants. Participants heard lists of related words (e.g., bed, night) that were associates of a critical nonpresented word (e.g., sleep) and were given immediate free recall and later recognition tests. Traumatized participants with and without PTSD generated more false recalls of critical nonpresented words than did nontraumatized participants. False recall was related to trait anxiety and PTSD severity. The results are consistent with a general source-monitoring deficit in trauma-exposed individuals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluation of a brief cognitive-behavioral program for the prevention of chronic PTSD in recent assault victims.

The efficacy of a brief prevention program (BP) aimed at arresting the development of chronic posttraumatic stress disorder (PTSD) was examined with 10 recent female victims of sexual and nonsexual assault who received 4 sessions of a cognitive-behavioral program shortly after the assault. Their PTSD and depression severity was compared with that of 10 matched recent female assault victims who received repeated assessments of their trauma-related psychopathology (assessment control; AC). The BP program consisted of education about common reactions to assault and cognitive-behavioral procedures. Two months postassault, victims who received the BP program had significantly less severe PTSD symptoms than victims in the control condition; 10% of the former group met criteria for PTSD versus 70% of the latter group. Five and a half months postassault, victims in the BP group were significantly less depressed than victims in the AC group and had significantly less severe reexperiencing symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Steric stabilization and cell adhesion

We present theoretical and experimental arguments supporting the hypothesis that the cell surface glycocalyx may negatively regulate adhesive phenomena. First, it is recalled that a repulsive interaction of several thousands of piconewtons may be generated on a contact area of about 1/100 m² by a combination of electrostatic and entropic forces (steric stabilization). Second, electron microscopical data are reported to provide an estimate of the thickness of the cell coats of murine macrophages and sheep erythrocytes made phagocytable by exposure to glutaraldehyde or specific antibodies. Using conventional carbohydrate staining procedures, it is shown that the total thickness of the electron-dark regions in areas of intercellular contact is lower than the sum of the thicknesses of electron-dark regions on free cell areas. Further, removing negative charges with neuraminidase or neutralizing these charges with polylysine may reduce intermembrane distance in contact areas. Third, it is shown that a decrease of erythrocyte surface charges with neuraminidase increases their adhesion to murine phagocytes under dynamic, not static conditions. It is concluded that a major determinant of steric stabilization is the relative length of adhesion molecules and surface repeller elements, and that repulsion is particularly important under dynamic conditions. Thus, dynamic effects must be included in models of steric stabilization.     

Anger and posttraumatic stress disorder symptoms in crime victims: A longitudinal analysis.

Among trauma-exposed individuals, severity of posttraumatic stress disorder (PTSD) symptoms is strongly correlated with anger. The authors used 2 longitudinal data sets with 282 and 218 crime victims, respectively, to investigate the temporal sequence of anger and PTSD symptoms following the assault. Cross-lagged regression analyses indicated that PTSD symptoms predicted subsequent level of anger, but that anger did not predict subsequent PTSD symptoms. Testing alternative models (common factor model, unmeasured 3rd variable model) that might account for spuriousness of the relation strengthened confidence in the results of the cross-lagged analyses. Further analyses suggested that rumination mediates the effect of PTSD symptoms on anger. (PsycINFO Database Record (c) 2010 APA, all rights reserved)