Search

Objective: Treatment of posttraumatic stress disorder (PTSD) is hindered by limited uptake, early drop-out and non-response. This pilot study aimed to explore the feasibility, acceptability, and usability of a mobile app as part of a blended approach to treating frontline workers experiencing PTSD. Method: A single-group pre-post study was conducted with 10 adult frontline workers (firefighters, police, correctional workers) receiving trauma-focused cognitive-behavioural therapy for PTSD. Participants used an app (Support Base) designed to consolidate session content and encourage independent skills practice. At post-treatment, feasibility was assessed via app usage data and participant feedback, usability via the mHealth App Usability Questionnaire, and acceptability via items from the Mobile Application Rating Scale: user version. Results: Usability ratings were above average and the app received an overall mean rating of 3.4/5. Despite generally positive attitudes towards using technology in therapy, participants had low levels of confidence/experience with wellbeing apps and almost half preferred using the standard treatment workbook. Clinicians highlighted a range of client barriers to app use, including difficulties in clinician/client collaboration. Overall, there was significant pre- to post-treatment improvement in clinical measures of PTSD and depression, but this change cannot be tied to app use. Conclusions: Although Support Base was viewed by participants as usable and acceptable, there were feasibility issues which must be further considered in delivering this form of care. Due to the uncontrolled study design, any additive effects of the app beyond standard clinical treatment could not be assessed. The development of a more integrated blended care model is a potential avenue for future research. Key Points: What is already known about this topic: (1) Frontline workers are at high risk of developing PTSD along with detrimental impacts to occupational and daily life functioning. (2) Effective PTSD treatments are available, yet both uptake and treatment response are sub-optimal. (3) Mobile app-based interventions are a promising way to improve access, adherence, and response to treatment while saving practitioner time. What this study adds: (1) In this pilot study, an app-based adjunct to trauma-focused cognitive-behavioural therapy was found to be usable and acceptable for frontline workers. (2) This type of blended care for PTSD is unlikely to suit all frontline workers in its current form. (3) Future research should focus on a more integrated blended care model with increased capacity for client/clinician collaboration. [ABSTRACT FROM AUTHOR]

Copyright of European Journal of Psychotraumatology is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Reliving distressing memories is a core component of treatments for post-traumatic stress disorder (PTSD) and prolonged grief disorder (PGD). There is little understanding of how reliving these memories functions in the treatment of these disorders. Objective: This study investigated whether reliving functions comparably in the treatment of PTSD and PGD, and whether it is comparably related to treatment outcome. Method: This study conducted a reanalysis of patients with either PTSD (n = 55) or PGD (n = 45) who underwent treatments that comprised at least four sessions of reliving memories of either their traumatic experience or the loss of the deceased person. Results: PTSD participants displayed greater habituation of distress across sessions during reliving than PGD participants. Between-session reduction in distress during reliving was associated with symptom remission in PTSD, but this pattern was not observed in PGD. Conclusion: This pattern of findings indicates that although reliving appears to be a useful strategy for treating both PTSD and PGD, this strategy does not function comparably in the two conditions and may involve distinct mechanisms. Reliving distressing memories is key to treatment of PTSD and prolonged grief disorder. Distress during memory reliving habituated in PTSD treatment more than in treatment of grief. Habituation of distress during treatment predicted remission of symptoms in PTSD but not grief. [ABSTRACT FROM AUTHOR]

Copyright of European Journal of Psychotraumatology is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of European Journal of Psychotraumatology is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Approximately 10% of first responders report posttraumatic stress disorder (PTSD). Although reports within first responders suggest that they have distinct symptom presentations, there is a need to understand how the clinical profiles of first responders may differ from others seeking treatment for PTSD. This study compared the PTSD symptom profiles of first responder and civilians seeking treatment for PTSD. Participants self-referred to the Traumatic Stress Clinic (University of New South Wales, Sydney) for enrolment in out-patient treatment trials for PTSD. Participants comprised people of mean age 41.72 years (SD = 10.71) who met DSM-IV criteria for PTSD. The sample was composed of 128 first responders and 182 civilians. Clinician-administered interviews of PTSD (Clinician-Administered PTSD Scale) and depression were conducted, as well as measures of self-report measures of depression, alcohol use, posttraumatic appraisals, and anger. First responders reported greater rates of dysphoric cluster of symptoms, including diminished interest, emotional numbing, and social detachment, and less psychological reactivity and avoidance of situations, than civilians with PTSD. Beyond PTSD symptoms, first responders also reported more severe levels of depression and suppressed anger. These findings indicate that treatment-seeking first responders present with a distinct clinical profile that is characterized by dysphoric symptoms. These symptoms can predict poor treatment response and require specific attention in treating PTSD in first responders. Treatment-seeking first responders report greater rates of emotional numbing, avoidance, depression and suppressed anger than civilians, suggesting that treatment of PTSD in first responders should accommodate their specific symptom profiles. [ABSTRACT FROM AUTHOR]

Copyright of European Journal of Psychotraumatology is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of European Journal of Psychotraumatology is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of European Journal of Psychotraumatology is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article highlights few principles of psychological first aid (PFA). Topics discussed include principles of PFA that are widely implemented in post-disaster interventions; ways in which COVID-19 pandemic has brought attention to new groups to consider long-term care facilities; and challenges of the pandemic to community and social values that are important targets for community caring.

Given the devastation caused by disasters and mass violence, it is critical that intervention policy be based on the most updated research findings. However, to date, no evidence–based consensus has been reached supporting a clear set of recommendations for intervention during the immediate and the mid–term post mass trauma phases. Because it is unlikely that there will be evidence in the near or mid–term future from clinical trials that cover the diversity of disaster and mass violence circumstances, we assembled a worldwide panel of experts on the study and treatment of those exposed to disaster and mass violence to extrapolate from related fields of research, and to gain consensus on intervention principles. We identified five empirically supported intervention principles that should be used to guide and inform intervention and prevention efforts at the early to mid–term stages. These are promoting: 1) a sense of safety, 2) calming, 3) a sense of self– and community efficacy, 4) connectedness, and 5) hope. [ABSTRACT FROM AUTHOR]

Many studies show that long-term poor mental health outcomes for disaster-affected people are predicted by postdisaster stressors. Despite this finding, existing recovery frameworks vary in how these stressors are conceptualised. This paper examines community members' subjective perceptions of what they found problematic and useful in their recoveries after the Australian 2009 Black Saturday bushfires, and considers them in the light of these frameworks. We report the findings from responses to semi-structured survey questions as part of the Beyond Bushfires study, 3–4 years after these bushfires (n = 811). Participants identified the biggest problems as managing rebuilding processes and managing their own mental health, memories of the Black Saturday fires, and their concerns for family members. The four most useful supports were family, friends, rebuilding resources, and their community. We found a complex interplay of the same factors operating as both stressors and supports, particularly in relation to family levels of coping. Disaster recovery efforts require the simultaneous management of physical rebuilding and human processes. Families, friends, and neighbours are underestimated resources in postdisaster recovery. Given the complex interplay of the same factors operating as both stressors and supports, interventions are needed that maximise the positive dimensions of these factors. To manage this complexity, multiple frameworks are needed to guide disaster recovery. [ABSTRACT FROM AUTHOR]

Copyright of European Journal of Psychotraumatology is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of European Journal of Psychotraumatology is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of European Journal of Psychotraumatology is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of European Journal of Psychotraumatology is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of European Journal of Psychotraumatology is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of European Journal of Psychotraumatology is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of European Journal of Psychotraumatology is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Emergency services are under enormous pressure to offer programmes that could protect their staff from the psychological impact of stressors encountered in their roles. There has been a surge in the number of pre-incident training programmes aimed at first responders to maintain their psychological wellbeing after critical incidents. These include pre-employment screening programmes, psychoeducation, operational training, line manager training and interventions aimed at improving resilience, wellbeing or stress management. Whilst developed with the best intentions, these programmes vary in efficacy. Therefore, knowing what training to offer first responders prior to exposure to critical incidents is far from clear. In this review, we critique the available evidence and make recommendations about what to offer and what to avoid offering first responders prior to exposure to critical incidents. We found no evidence of the effectiveness of pre-employment screening or psychoeducation offered as a standalone package, and little evidence for interventions aimed to improve wellbeing and resilience to stress - although current trials of empirically-driven interventions for first responders are underway and show promise in preventing stress-related psychopathology. Operational and line manager training showed the most promise but need to be evaluated in high quality trials with sufficient follow-up to draw conclusions about their preventative benefits. [ABSTRACT FROM AUTHOR]

Copyright of European Journal of Psychotraumatology is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background and Objectives: It has been proposed that self-efficacy plays a critical role in the onset and maintenance of Posttraumatic Stress Disorder (PTSD). This study aimed to test if increasing perceptions of self-efficacy using a false feedback technique about coping abilities prior to a trauma-film paradigm lead to a reduction of visual intrusions over the course of 6 days.Design and Methods: Healthy participants recruited from the community were randomized to a high self-efficacy (HSE, N = 18), low self-efficacy (LSE, N = 21), or neutral self-efficacy (NSE, N = 23) conditions.Results: Participants in the HSE condition reported higher levels of self-efficacy. In addition, individuals in the HSE conditions reported significantly fewer intrusions over 6 days. Unexpectedly, individuals in the LSE condition reported fewer intrusions on the final day of the study compared to those in the NSE condition. The LSE group was also the only group showing a significant linear decline in intrusion across the 6 days.Discussion: These findings provide further support that perceptions of self-efficacy are modifiable and may contribute to clinically-relevant processes underlying PTSD. Future prospective research with individuals exposed to trauma will help to shed light on the potential role of self-efficacy to buffer the negative impacts of traumatic stress. [ABSTRACT FROM AUTHOR]

Post-traumatic stress disorder (PTSD) is one of the common mental disorders in military and veteran populations. Considerable research and clinical opinion has been focused on understanding the relationship between PTSD and military service and the implications for prevention, treatment, and management. This paper examines factors associated with the development of PTSD in this population, considers issues relating to engagement in treatment, and discusses the empirical support for best practice evidence-based treatment. The paper goes on to explore the challenges in those areas, with particular reference to treatment engagement and barriers to care, as well as treatment non-response. The final section addresses innovative solutions to these challenges through improvements in agreed terminology and definitions, strategies to increase engagement, early identification approaches, understanding predictors of treatment outcome, and innovations in treatment. Treatment innovations include enhancing existing treatments, emerging non-trauma-focused interventions, novel pharmacotherapy, personalized medicine approaches, advancing functional outcomes, family intervention and support, and attention to physical health. [ABSTRACT FROM AUTHOR]

Copyright of European Journal of Psychotraumatology is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of European Journal of Psychotraumatology is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Although much research indicates that proximity to attachment figures confers many psychological benefits, there is little evidence pertaining to how attachment activation may impact autobiographical memory retrieval. Following a negative mood induction to elicit overgeneral autobiographical retrieval, participants (N = 70) were administered an induction in which they imagined a person who is a strong attachment figure or an acquaintance. Participants then completed an autobiographical memory task to retrieve memories in response to neutral and negative cue words. Attachment priming resulted in less distress, increased retrieval of specific memories, and reduced retrieval of categoric memories. These findings indicate that activation of mental representations of attachment figures can impact on the specificity of autobiographical memory retrieval, and extends prevailing models of autobiographical memory by integrating them with attachment theory. [ABSTRACT FROM AUTHOR]

Background: Network analysis is an emerging methodology for investigating psychopathological symptoms. Given the unprecedented number of refugees and the increased prevalence of mental disorders such as posttraumatic stress disorder (PTSD) in this population, new methodologies that help us better to understand psychopathology in refugees are crucial. Objective: The objective of this study was to explore the network structure and centrality indices of DSM-5 PTSD symptoms in a cross-sectional clinical sample of 151 severely traumatized refugees with and without a formal PTSD diagnosis. Method: The R-packages qgraph and bootnet were used to estimate the structure of a PTSD symptom network and its centrality indices. In addition, robustness and significance analyses for the edges weights and the order of centrality were performed. Results: Three pairs of symptoms showed significantly stronger connections than at least half of the other connections: hypervigilance and exaggerated startle response, intrusion and difficulties falling asleep, and irritability or outbursts of anger and self-destructive or reckless behaviour. Emotional cue reactivity had the highest centrality and trauma-related amnesia the lowest. Conclusion: Although only 51.0% of participants fulfilled criteria for a probable PTSD diagnosis, emotional cue reactivity showed the highest centrality, emphasizing the importance of emotional trauma reminders in severely traumatized refugees attending an outpatient clinic. However, due to the small sample size, the results should be interpreted with care. [ABSTRACT FROM AUTHOR]

Copyright of European Journal of Psychotraumatology is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: This paper is based on a panel discussion at the 32nd annual meeting of the International Society for Traumatic Stress Studies in Dallas, Texas, in November 2016. Objective: Paula Schnurr convened a panel of experts in the fields of public health and technology to address the topic: 'What I have changed my mind about and why.' Method: The panel included Richard Bryant, Lucy Berliner, Dean Kilpatrick, Albert ('Skip') Rizzo, and Josef Ruzek. Results: Panellists discussed innovative strategies for the dissemination of scientific knowledge and evidence-based treatment. Conclusions: Although there are effective treatments, there is a need to enhance the effectiveness of these treatments. There also is a need to develop simpler, low-cost strategies to disseminate effective treatments. However, technology approaches also offer pathways to increased dissemination. Researchers must communicate scientific findings more effectively to impact public opinion and public policy. [ABSTRACT FROM AUTHOR]

An emerging body of research on individuals exposed to trauma shows that the ability to flexibly employ different coping styles is associated with better adjustment. Specifically, individuals who use both “trauma-focused” (focusing on the experience and significance of a potentially traumatic event) and “forward-focused” (optimism, helping others, goal-oriented thinking) coping styles exhibit less psychological disturbance after trauma exposure than those with less coping flexibility. We investigated whether greater coping flexibility is associated with less Post-traumatic Stress Disorder (PTSD) and Major Depressive Disorder (MDD) in an international sample of human rights advocates. In an online, cross-sectional study, 346 international human rights advocates completed self-reported measures of PTSD, MDD, trauma exposure, and the Perceived Ability to Cope with Trauma (PACT) scale. Results showed that coping flexibility was associated with lower rates and symptom severity of PTSD and MDD. Whereas both trauma-focused and forward-focused coping were associated with lower rates of PTSD, the inverse relationship between coping flexibility and MDD was driven primarily by less forward-focused coping. These findings are the first to show that lower levels of coping flexibility may be an important factor underlying vulnerability to PTSD and MDD among human rights advocates. Longitudinal studies are needed to clarify whether coping flexibility can mitigate the potential negative mental health impact of traumatic stress over the course of one’s career in international human rights advocacy. [ABSTRACT FROM PUBLISHER]

A Romanesque double-springer and five voussoirs, decorated with foliate carving and pellet, have been reused as a door-head in the ground floor of Church House, Gloucester Cathedral. The carved stones are illustrated, together with a reconstruction of the original double arch, which may have come from an early 12th- century pulpitum screen or the arcade of the first Norman cloister. [ABSTRACT FROM AUTHOR]

For eyewitness testimony to be considered reliable, it is important to ensure memory remains accurate following the event. As many testimonies involve traumatic, as opposed to neutral, events, it is important to consider the role of distress in susceptibility to false memories. The aim of this study was to investigate whether cortisol response following a stressor would be associated with susceptibility to false memories. Psychological distress responses were also investigated, specifically, dissociation, intrusions, and avoidance. Participants were allocated to one of three conditions: those who viewed a neutral film (N = 35), those who viewed a real trauma film (N = 35), and a trauma “reappraisal” group where participants were told the film was not real (N = 35). All received misinformation about the film in the form of a narrative. Participants provided saliva samples (to assess cortisol) and completed distress and memory questionnaires. Cortisol response was a significant predictor of the misinformation effect. Dissociation and avoidance were related to confabulations. In conclusion, following a stressor an individual may differ with regard to their psychological response to the event, and also whether they experience a cortisol increase. This may affect whether they are more distressed later on, and also whether they remember the event accurately. [ABSTRACT FROM PUBLISHER]

Individuals with health anxiety report experiencing a strong sense of vulnerability to illness. Such beliefs may be driven by the biased recollection of past illness-related events. However, little research has explored the role of memory in health anxiety. In other disorders, rumination has also been identified as a process that leads individuals to recall memories dominated by the content of their concerns. This study examined the proposition that rumination might impact the content of “self-defining” autobiographical memories among 60 college students with varying health anxiety (35% with clinical-level health anxiety). Participants were randomised to experiential/ruminative self-focus conditions, and then they completed the Self-Defining Memory Task. Responses were coded for valence and illness-relatedness. Results indicated that rumination led participants to retrieve more illness-related self-defining memories, while higher health anxiety scores were associated with more negative, but not more illness-focused memories. Ruminative thinking appears to activate health concerns, and may play a role in maintaining ongoing health anxiety. [ABSTRACT FROM PUBLISHER]

Background: Although there is some evidence of the posttraumatic stress disorder (PTSD) construct's cross cultural validity, trauma-related disorders may vary across cultures, and the same may be true for treatments that address such conditions. Experienced therapists tailor psychotherapy to each patient's particular situation, to the nature of the patient's psychopathology, to the stage of therapy, and so on. In addition, culture-sensitive psychotherapists try to understand how culture enhances the meaning of their patient's life history, the cultural components of their illness and help-seeking behaviors, as well as their expectations with regard to treatment. We cannot take for granted that all treatment-seeking trauma survivors speak our language or share our cultural values. Therefore, we need to increase our cultural competencies. Methods: The authors of this article are clinicians and/or researchers from across the globe, working with trauma survivors in various settings. Each author focused on one or more specific cultural aspects of working with trauma survivors and highlighted the following aspects. Results: As a result of culture-specific individual and collective meanings linked to trauma and trauma-related disorders survivors may be exposed to (self-)stigma in the aftermath of trauma. Patients who are reluctant to talk about their traumatic experiences may instead be willing to write or use other ways of accessing the painful memories such as drawing. In other cultures, community and family cohesion are crucial elements of recovery. While awareness of culture-specific aspects is important, we also need to beware of premature cultural stereotyping. When disseminating empirically supported psychotherapies for PTSD across cultures, a number of additional challenges need to be taken into account: many low and middle income countries have very limited resources available and suffer from a poor health infrastructure. Conclusions: In summary, culture-sensitive psychotraumatology means assuming an empathic and nonjudgmental attitude, trying to understand each individual's cultural background. [ABSTRACT FROM AUTHOR]

The extent to which we engage with our social world has been central to our survival as a species and, accordingly, is relevant to how we cope with trauma and adversity. This review summarises current knowledge about the importance of social connections from an evolutionary perspective, as well as integrating this with a discussion of prevailing attachment theories. Experimental research supporting the potential benefit of attachments for managing adversity are presented, along with a review of how these benefits are moderated by individual differences in attachment style. The potential impact of trauma on attachment systems, and the manner in which this can compound trauma stress is discussed. Finally, a broader overview of social network analysis is introduced and it is proposed that a more sociocentric framework of trauma response would promote a fuller understanding of how social processes moderate trauma response. [ABSTRACT FROM AUTHOR]

Background: The construct of complex posttraumatic stress disorder (CPTSD) has attracted much research attention in previous years, however it has not been systematically evaluated in individuals exposed to persecution and displacement. Given that CPTSD has been proposed as a diagnostic category in the ICD-11, it is important that it be examined in refugee groups. Objective: In the current study, we proposed to test, for the first time, the factor structure of CPTSD proposed for the ICD-11 in a sample of resettled treatment-seeking refugees. Method: The study sample consisted of 134 traumatized refugees from a variety of countries of origin, with approximately 93% of the sample having been exposed to torture. We used confirmatory factor analysis to examine the factor structure of CPTSD in this sample and examined the sensitivity, specificity, positive predictive power and negative predictive power of individual items in relation to the CPTSD diagnosis. Results: Findings revealed that a two-factor higher-order model of CPTSD comprising PTSD and Difficulties in Self-Organization (χ² (47)=57.322, p=0.144, RMSEA=0.041, CFI=0.981, TLI=0.974) evidenced superior fit compared to a one-factor higher-order model of CPTSD (χ² (48)=65.745, p=0.045, RMSEA=0.053, CFI=0.968, TLI=0.956). Overall, items evidenced strong sensitivity and negative predictive power, moderate positive predictive power, and poor specificity. Conclusions: Findings provide preliminary evidence for the validity of the CPTSD construct with highly traumatized treatment-seeking refugees. [ABSTRACT FROM AUTHOR]

Background: Refugees have been shown to present high prevalence rates of trauma-related mental disorders. Despite their psychological impairment, they are expected to meet high functional requirements in terms of social integration into, and financial independence from, the host society. Methods: This cross-sectional study examined the relationship of mental health problems, post-migration living difficulties (PMLD), and social integration in a sample of 104 refugees seeking treatment for severe posttraumatic stress and comorbid symptoms in two outpatient clinics in Switzerland. Results: Despite an average time of residence in Switzerland of over 10 years, participants showed poor integration and a high number of PMLD. Integration difficulties were closely associated with psychological symptoms, but not with socio-demographic parameters such as education or visa status. Conclusions: Psychological impairment in treatment-seeking traumatized refugees is associated with poor integration. To foster social integration, it is crucial to better understand and address the specific needs of this highly vulnerable population. [ABSTRACT FROM AUTHOR]

The article presents the author's views on dismantling and integrating the levels of resilience. Topics discussed include the multidimensionality of resilience, the networks of social resilience, and integrating biological systems. Also being discussed are the ways to promote family and community resilience factors.

In social anxiety the psychological self is closely related to the feared stimulus. Socially anxious individuals are, by definition, concerned about how the self is perceived and evaluated by others. As autobiographical memory is strongly related to views of the self it follows that biases in autobiographical memory play an important role in social anxiety. In the present study high (n= 19) and low (n= 29) socially anxious individuals were compared on autobiographical memory bias, current goals, and self-discrepancy. Individuals high in social anxiety showed a bias towards recalling more negative and more social anxiety-related autobiographical memories, reported more current goals related to overcoming social anxiety, and showed larger self-discrepancies. The pattern of results is largely in line with earlier research in individuals with PTSD and complicated grief. This suggests that the relation between autobiographical memory bias and the self is a potentially valuable trans-diagnostic factor. [ABSTRACT FROM PUBLISHER]

Individuals with health anxiety experience catastrophic fears relating to future illness. However, little research has explored cognitive processes involved in how health anxious individuals picture the future. Ruminative thinking has been shown to impede the ability to recall specific autobiographical memories, which in turn is related to maladaptive, categoric future thinking processes. This study examined the impact of rumination on memory and future thinking among 60 undergraduate participants with varying health anxiety (35% clinical-level health anxiety). Participants were randomized to experiential/ruminative self-focus conditions, then completed an Autobiographical Memory Test and Future Imaginings Task. Responses were coded for specificity and the presence of illness concerns. Rumination led to more specific illness-concerned memories overall, yet at the same time led to more categoric illness-related future imaginings. Rumination and health anxiety together best predicted overgeneral illness-related future imaginings. Highly specific illness-related memories may be maintained due to their personal salience. However, more overgeneral illness-related future imaginings may reflect cognitive avoidance in response to the threat of future illness. This divergent pattern of results between memory and future imaginings may exacerbate health anxiety, and may also serve to maintain maladaptive responses among individuals with realistic medical concerns, such as individuals living with chronic illness. [ABSTRACT FROM PUBLISHER]

Individuals with post-traumatic stress disorder (PTSD) tend to retrieve autobiographical memories with less episodic specificity, referred to as overgeneralised autobiographical memory. In line with evidence that autobiographical memory overlaps with one's capacity to imagine the future, recent work has also shown that individuals with PTSD also imagine themselves in the future with less episodic specificity. To date most studies quantify episodic specificity by the presence of a distinct event. However, this method does not distinguish between the numbers of internal (episodic) and external (semantic) details, which can provide additional insights into remembering the past and imagining the future. This study employed the Autobiographical Interview (AI) coding scheme to the autobiographical memory and imagined future event narratives generated by combat veterans with and without PTSD. Responses were coded for the number of internal and external details. Compared to combat veterans without PTSD, those with PTSD generated more external than internal details when recalling past or imagining future events, and fewer internal details were associated with greater symptom severity. The potential mechanisms underlying these bidirectional deficits and clinical implications are discussed. [ABSTRACT FROM AUTHOR]

BACKGROUND: There has been debate regarding whether Complex Posttraumatic Stress Disorder (Complex PTSD) is distinct from Borderline Personality Disorder (BPD) when the latter is comorbid with PTSD. OBJECTIVE: To determine whether the patterns of symptoms endorsed by women seeking treatment for childhood abuse form classes that are consistent with diagnostic criteria for PTSD, Complex PTSD, and BPD. METHOD: A latent class analysis (LCA) was conducted on an archival dataset of 280 women with histories of childhood abuse assessed for enrollment in a clinical trial for PTSD. RESULTS: THE LCA REVEALED FOUR DISTINCT CLASSES OF INDIVIDUALS: a Low Symptom class characterized by low endorsements on all symptoms; a PTSD class characterized by elevated symptoms of PTSD but low endorsement of symptoms that define the Complex PTSD and BPD diagnoses; a Complex PTSD class characterized by elevated symptoms of PTSD and self-organization symptoms that defined the Complex PTSD diagnosis but low on the symptoms of BPD; and a BPD class characterized by symptoms of BPD. Four BPD symptoms were found to greatly increase the odds of being in the BPD compared to the Complex PTSD class: frantic efforts to avoid abandonment, unstable sense of self, unstable and intense interpersonal relationships, and impulsiveness. CONCLUSIONS: Findings supported the construct validity of Complex PTSD as distinguishable from BPD. Key symptoms that distinguished between the disorders were identified, which may aid in differential diagnosis and treatment planning. [ABSTRACT FROM AUTHOR]

Peritraumatic dissociation is one of the most critical acute responses to a traumatic experience, partly because it predicts subsequent posttraumatic stress disorder. Despite this, there is little understanding about the factors that influence peritraumatic dissociation. This study investigated the extent to which peritraumatic dissociation is predicted by the amount of perceived warning that participants had of the impact of the trauma. Randomized eligible admissions to four major trauma hospitals (N =243) were assessed during hospital admission with the Peritraumatic Dissociation Experiences Questionnaire (PDEQ) and the perceived warning that participants had before the trauma impact occurred. Whereas female gender predicted both Awareness and Derealization subscale scores on the PDEQ, perceived warning also predicted scores on the Derealization subscale. This finding suggests that the degree of anticipated threat may contribute to peritraumatic dissociation. [ABSTRACT FROM AUTHOR]

Predominant dissociation in posttraumatic stress disorder (PTSD) is characterized by restricted affective responses to positive stimuli. To date, no studies have examined neural responses to a range of emotional expressions in PTSD with high dissociative symptoms. This study tested the hypothesis that PTSD patients with high dissociative symptoms will display increased event-related potential (ERP) amplitudes in early components (N1, P1) to threatening faces (angry, fearful), and reduced later ERP amplitudes (Vertex Positive Potential (VPP), P3) to happy faces compared to PTSD patients with low dissociative symptoms. Thirty-nine civilians with PTSD were classified as high dissociative (n=16) or low dissociative (n=23) according to their responses on the Clinician Administered Dissociative States Scale. ERPs were recorded, whilst participants viewed emotional (happy, angry, fear) and neutral facial expressions in a passive viewing task. High dissociative PTSD patients displayed significantly increased N120 amplitude to the majority of facial expressions (neutral, happy, and angry) compared to low dissociative PTSD patients under conscious and preconscious conditions. The high dissociative PTSD group had significantly reduced VPP amplitude to happy faces in the conscious condition. High dissociative PTSD patients displayed increased early (preconscious) cortical responses to emotional stimuli, and specific reductions to happy facial expressions in later (conscious), face-specific components compared to low dissociative PTSD patients. Dissociation in PTSD may act to increase initial pre-attentive processing of affective stimuli, and specifically reduce cortical reactivity to happy faces when consciously processing these stimuli. [ABSTRACT FROM AUTHOR]

There is considerable debate concerning the diagnosis of post-traumatic stress disorder ( PTSD) in compensation claims. This study reviewed the quality of the assessment reports prepared by clinicians who evaluated 31 emergency service workers making PTSD-related compensation claims. Assessments were conducted by 4-year trained psychologists (39%), psychologists holding a masters degree (36%), and psychiatrists (19%). The assessment reports were evaluated relative to the diagnostic criteria for PTSD in the Diagnostic and Statistical Manual of Mental Disorders 4th edition (2000). In the majority of cases (81%), the assessor determined that the emergency service worker had PTSD, but only one report met the minimum standard for that diagnosis. In the majority (65%) of cases the clinician failed to address the possibility of malingering. These data suggest that clinical assessment reports for PTSD frequently fail to meet minimum assessment standards. [ABSTRACT FROM AUTHOR]

The WHO International Classification of Diseases, 11th version (ICD-11), has proposed two related diagnoses, posttraumatic stress disorder (PTSD) and complex PTSD within the spectrum of trauma and stress-related disorders. To use latent profile analysis (LPA) to determine whether there are classes of individuals that are distinguishable according to the PTSD and complex PTSD symptom profiles and to identify potential differences in the type of stressor and severity of impairment associated with each profile. An LPA and related analyses were conducted on 302 individuals who had sought treatment for interpersonal traumas ranging from chronic trauma (e.g., childhood abuse) to single-incident events (e.g., exposure to 9/11 attacks). The LPA revealed three classes of individuals: (1) a complex PTSD class defined by elevated PTSD symptoms as well as disturbances in three domains of self-organization: affective dysregulation, negative self-concept, and interpersonal problems; (2) a PTSD class defined by elevated PTSD symptoms but low scores on the three self-organization symptom domains; and (3) a low symptom class defined by low scores on all symptoms and problems. Chronic trauma was more strongly predictive of complex PTSD than PTSD and, conversely, single-event trauma was more strongly predictive of PTSD. In addition, complex PTSD was associated with greater impairment than PTSD. The LPA analysis was completed both with and without individuals with borderline personality disorder (BPD) yielding identical results, suggesting the stability of these classes regardless of BPD comorbidity. Preliminary data support the proposed ICD-11 distinction between PTSD and complex PTSD and support the value of testing the clinical utility of this distinction in field trials. Replication of results is necessary. [ABSTRACT FROM AUTHOR]

Objective: Many traumatised refugees suffer from both persistent pain and posttraumatic stress disorder (PTSD). To date, no specific guidelines exist for treatment of this group of patients. This paper presents data on a pilot treatment study conducted with 15 traumatised refugees with persistent pain and PTSD. Methods: Participants received 10 sessions of pain-focused treatment with biofeedback (BF) followed by 10 sessions of Narrative Exposure Therapy (NET). Structured interviews and standardised questionnaires were used to assess symptoms of pain intensity, pain disability, PTSD and quality of life directly before and after treatment and at 3 months follow-up. Results: Following the combined intervention, participants showed a significant reduction in both pain and PTSD symptoms, as well as improved quality of life. Additionally, biofeedback increased motivation for subsequent trauma-focused therapy, which in turn was related to larger PTSD treatment gains. Conclusion: This pilot study provides initial evidence that combining BF and NET is safe, acceptable, and feasible in patients with co-morbid persistent pain and PTSD. [ABSTRACT FROM AUTHOR]

International clinical practice guidelines for the management of psychological trauma recommend Psychological First Aid (PFA) as an early intervention for survivors of potentially traumatic events. These recommendations are consensus-based, and there is little published evidence assessing the effectiveness of PFA. This is not surprising given the nature of the intervention and the complicating factors involved in any evaluation of PFA. There is, nevertheless, an urgent need for stronger evidence evaluating its effectiveness. The current paper posits that the implementation and evaluation of PFA within high risk organizational settings is an ideal place to start. The paper provides a framework for a phasic approach to implementing PFA within such settings and presents a model for evaluating its effectiveness using a logic- or theory-based approach which considers both pre-event and post-event factors. Phases 1 and 2 of the PFA model are pre-event actions, and phases 3 and 4 are post-event actions. It is hoped that by using the Phased PFA model and evaluation method proposed in this paper, future researchers will begin to undertake the important task of building the evidence about the most effective approach to providing PFA in high risk organizational and community disaster settings. [ABSTRACT FROM AUTHOR]

Psychoeducation is increasingly used following trauma. The term covers the provision of information about the nature of stress, posttraumatic and other symptoms, and what to do about them. The provision of psychoeducation can also occur before possible exposure to stressful situations or, alternatively, after exposure. The intention of both is to ameliorate or mitigate the effects of exposure to extreme situations. Educational information can be imparted in a number of ways and can also form part of what has been termed psychological first aid. Despite its ubiquity, however, good evidence as to the value of psychoeducation is rare. Perhaps it could be assumed that psychoeducation, like education in general, is so obviously a "good thing" that it requires no evidence. In this paper we question the assumption, arguing that like any other intervention, psychoeducation needs to be backed up by empirical evidence. We will first present the case for and then the case against psychoeducation before reaching some conclusions and making some recommendations. [ABSTRACT FROM AUTHOR]