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The article describes features of trauma memories in post-traumatic stress disorder (PTSD), including characteristics of unintentional re-experiencing symptoms and intentional recall of trauma narratives. Reexperiencing symptoms are usually sensory impressions and emotional responses from the trauma that appear to lack a time perspective and a context. The vast majority of intrusive memories can be interpreted as re-experiencing of warning signals, i.e., stimuli that signalled the onset of the trauma or of moments when the meaning of the event changed for the worse. Triggers of re-experiencing symptoms include stimuli that have perceptual similarity to cues accompanying the traumatic event. Intentional recall of the trauma in PTSD may be characterised by confusion about temporal order, and difficulty in accessing important details, both of which contribute to problematic appraisals. Recall tends to be disjointed. When patients with PTSD deliberately recall the worst moments of the trauma, they often do not access other relevant (usually subsequent) information that would correct impressions/predictions made at the time. A theoretical analysis of re-experiencing symptoms and their triggers is offered, and implications for treatment are discussed. These include the need to actively incorporate updating information ("I know now ...") into the worst moments of the trauma memory, and to train patients to discriminate between the stimuli that were present during the trauma ("then") and the innocuous triggers of re-experiencing symptoms ("now").

Despite the high rates of trauma exposure in people with schizophrenia spectrum disorders or bipolar disorders, there has been a lack of empirically validated treatment options for symptoms of post...

Background. Little is known about the psychological and behavioural consequences of road traffic accidents for children. The study aimed to determine the outcome of road traffic accidents on children and their mothers.Method. A 1-year cohort study of consecutive child attenders aged 5–16 years at an Accident and Emergency Department. Data were extracted from medical notes and from interview and self-report at baseline, 3 months and 6 months.Results. The children had an excellent physical outcome. Fifteen per cent suffered acute stress disorder; 25% suffered post-traumatic stress disorder at 3 months and 18% at 6 months. Travel anxiety was frequent. Post-traumatic consequences for mothers were common.Conclusion. Psychological outcome was poor for a minority of children and associated with disability, especially for travel. There were significant family consequences. There is a need for changes in clinical care to prevent, identify and treat distressing and disabling problems.

Human major histocompatibility (human leucocyte antigen (HLA)) complex-linked odorant receptor (OR) genes are among the best characterized OR genes in the human genome. In addition to their functions as odorant receptors in olfactory epithelium, they have been suggested to play a role in the fertilization process. Here, we report the first in-depth analysis of their expression and regulation within testicular tissue. Sixteen HLA-linked OR and three non-HLA-linked OR were analyzed. One OR gene (hs6M1-16, in positive transcriptional orientation) exhibited six different transcriptional start sites combined with extensive alternative splicing within the 5'-untranslated region, the coding exon, and the 3'-untranslated region. Long distance splicing, exon sharing, and premature polyadenylation were features of another three OR loci (hs6M1-18, -21, and -27, all upstream of hs6M1-16, but in negative transcriptional orientation). Determination of the transcriptional start sites of these OR genes identified a region of 81 bp with potential bi-directional transcriptional activity. The results demonstrate that HLA-linked OR genes are subject to unusually complex transcriptional regulatory mechanisms.

This article describes the development of a questionnaire that assesses problems in adapting to chronic skin disorders, the Adjustment to Chronic Skin Diseases Questionnaire. Patients (N = 442) with different skin disorders completed the original item pool. Principal-components analysis suggested a 6-factor solution that was largely replicated with 2 additional samples of 192 patients with psoriasis or atopic dermatitis and 165 patients with atopic dermatitis. Four of the subscales showed very good internal consistencies, retest reliabilities, and sufficient correlations with expert ratings: Social Anxiety/Avoidance, Itch-Scratch Cycle, Helplessness, and Anxious-Depressive Mood. Two short additional subscales, Impact on Quality of Life and Deficit in Active Coping, showed moderate internal consistencies, but good retest reliabilities. Correlations of the subscales with measures of depression, anxiety, and coping, and meaningful differences between dermatological subgroups support their construct validity. A treatment study showed that changes in some of the subscales correlated with changes in the severity of the skin condition.

Background: Research has demonstrated that Cognitive Therapy for PTSD (CT-PTSD), a version of traumafocused cognitive-behavioural therapy developed by Ehlers and Clark’s group (2000), is effective and feasible when offered in weekly and intensive daily formats. It is unknown whether patients with post-traumatic stress disorder (PTSD) could engage in and benefit from self-study assisted cognitive therapy, which would reduce therapist contact time. Objectives: This case report aims to illustrate this possibility. Design: A patient with PTSD and comorbid major depression, who developed these problems following a road traffic accident, was treated in six sessions of cognitive therapy with six self-study modules completed inbetween sessions. The patient made a complete recovery on measures of PTSD, anxiety, and depression as assessed by self-report and independent assessment. Conclusion: Self-study assisted cognitive CT-PTSD reduced the therapist contact time to half of that normally required in standard CT-PTSD. This highlights the potential feasibility and therapeutic benefits of self-study modules in the brief treatment of PTSD. Further research is required to systematically evaluate the acceptability and efficacy of brief self-study assisted CT-PTSD. Keywords: PTSD; self-study assisted treatment; cognitive therapy; road traffic accident; cognitive behavioural therapy; self-help (Published: 6 December 2010) Citation: European Journal of Psychotraumatology 2010, 1 : 5599 - DOI: 10.3402/ejpt.v1i0.5599 For the abstract or full text in other languages, please see Supplementary files in the column to the right (under Reading Tools).

Individuals who had experienced a range of different traumas were asked to describe the quality and content of their intrusive memories. Visual intrusions were the most common, and thoughts were uncommon. Intrusion quality varied little with type of trauma. Intrusive memories commonly consisted of stimuli that were present immediately before the traumatic event happened or shortly before the moments that had the largest emotional impact (i.e., when the meaning of the event became more traumatic). It is suggested that intrusive memories are about stimuli that through temporal association with the trauma acquired the status of warning signals, i.e., stimuli that if encountered again would indicate impending danger. This explains why intrusive memories are accompanied by a sense of serious current threat. The warning signal hypothesis may be useful in guiding therapists in identifying the moments with the largest emotional impact that will need reprocessing in treatment, and in educating patients about the nature of reexperiencing symptoms.

Scope Breakdown products of certain glucosinolates induce detoxifying enzymes and demonstrate preventive activities against chemically induced tumourigenesis in animal models. However, other breakdown products are genotoxic. 1-Methoxy-3-indolylmethyl alcohol (1-MIM-OH) is mutagenic in bacterial and mammalian cells upon activation by sulphotransferases and forms DNA adducts in mouse tissues. This effect is enhanced in mice transgenic for human sulphotransferases 1A1/2 (FVB/N-hSULT1A1/2). Therefore, we explored gene expression changes induced by 1-MIM-OH in mouse liver. Methods and results FVB/N-hSULT1A1/2 mice were orally treated with 1-MIM-OH for 21 or 90 days, leading to high levels of hepatic 1-MIM-DNA adducts. Genome-wide expression analyses demonstrated no influence on detoxifying enzymes, but up-regulation of many mediators of the tumour suppressor p53 and down-regulation of Fhit and other long genes. While this p53 response might indicate protection, it was unable to prevent the accumulation of DNA adducts. However, various epidemiological studies reported inverse associations between the intake of cruciferous vegetables and cancer. This association may be due to the presence of other glucosinolates with tumour-preventing influences possibly outweighing adverse effects of some metabolites. Conclusion 1-MIM-OH is a genotoxic substance inducing a gene expression profile similar to the expression signature caused by known genotoxic hepatocarcinogens.

Presentation of social situations via immersive virtual reality (VR) has the potential to be an ecologically valid way of assessing psychiatric symptoms. In this study we assess the occurrence of paranoid thinking and of symptoms of posttraumatic stress disorder (PTSD) in response to a single neutral VR social environment as predictors of later psychiatric symptoms assessed by standard methods. One hundred six people entered an immersive VR social environment (a train ride), presented via a head-mounted display, 4 weeks after having attended hospital because of a physical assault. Paranoid thinking about the neutral computer-generated characters and the occurrence of PTSD symptoms in VR were assessed. Reactions in VR were then used to predict the occurrence 6 months later of symptoms of paranoia and PTSD, as assessed by standard interviewer and self-report methods. Responses to VR predicted the severity of paranoia and PTSD symptoms as assessed by standard measures 6 months later. The VR assessments also added predictive value to the baseline interviewer methods, especially for paranoia. Brief exposure to environments presented via virtual reality provides a symptom assessment with predictive ability over many months. VR assessment may be of particular benefit for difficult to assess problems, such as paranoia, that have no gold standard assessment method. In the future, VR environments may be used in the clinic to complement standard self-report and clinical interview methods.

OBJECTIVE: Psychological treatments for posttraumatic stress disorder (PTSD) are usually delivered once or twice a week over several months. It is unclear whether they can be successfully delivered over a shorter period of time. This clinical trial had two goals: to investigate the acceptability and efficacy of a 7-day intensive version of cognitive therapy for PTSD and to investigate whether cognitive therapy has specific treatment effects by comparing intensive and standard weekly cognitive therapy with an equally credible alternative treatment. METHOD: Patients with chronic PTSD (N=121) were randomly allocated to 7-day intensive cognitive therapy for PTSD, 3 months of standard weekly cognitive therapy, 3 months of weekly emotion-focused supportive therapy, or a 14-week waiting list condition. The primary outcomes were change in PTSD symptoms and diagnosis as measured by independent assessor ratings and self-report. The secondary outcomes were change in disability, anxiety, depression, and quality of life. Evaluations were conducted at the baseline assessment and at 6 and 14 weeks (the posttreatment/wait assessment). For groups receiving treatment, evaluations were also conducted at 3 weeks and follow-up assessments at 27 and 40 weeks after randomization. All analyses were intent-to-treat. RESULTS: At the posttreatment/wait assessment, 73% of the intensive cognitive therapy group, 77% of the standard cognitive therapy group, 43% of the supportive therapy group, and 7% of the waiting list group had recovered from PTSD. All treatments were well tolerated and were superior to waiting list on nearly all outcome measures; no difference was observed between supportive therapy and waiting list on quality of life. For primary outcomes, disability, and general anxiety, intensive and standard cognitive therapy were superior to supportive therapy. Intensive cognitive therapy achieved faster symptom reduction and comparable overall outcomes to standard cognitive therapy. CONCLUSIONS: Cognitive therapy for PTSD delivered intensively over little more than a week was as effective as cognitive therapy delivered over 3 months. Both had specific effects and were superior to supportive therapy. Intensive cognitive therapy for PTSD is a feasible and promising alternative to traditional weekly treatment.

Olfactory receptor (OR) loci frequently cluster and are present on most human chromosomes. They are members of the seven transmembrane receptor (7-TM) superfamily and, as such, are part of one of the largest mammalian multigene families, with an estimated copy number of up to 1000 ORs per haploid genome. As their name implies, ORs are known to be involved in the perception of odors and possibly also in other, nonolfaction-related, functions. Here, we report the characterization of ORs that are part of the MHC-linked OR clusters in human and mouse (partial sequence only). These clusters are of particular interest because of their possible involvement in olfaction-driven mate selection. In total, we describe 50 novel OR loci (36 human, 14 murine), making the human MHC-linked cluster the largest sequenced OR cluster in any organism so far. Comparative and phylogenetic analyses confirm the cluster to be MHC-linked but divergent in both species and allow the identification of at least one ortholog that will be useful for future regulatory and functional studies. Quantitative feature analysis shows clear evidence of duplications of blocks of OR genes and reveals the entire cluster to have a genomic environment that is very different from its neighboring regions. Based on in silico transcript analysis, we also present evidence of extensive long-distance splicing in the 5′-untranslated regions and, for the first time, of alternative splicing within the single coding exon of ORs. Taken together with our previous finding that ORs are also polymorphic, the presented data indicate that the expression, function, and evolution of these interesting genes might be more complex than previously thought.[The sequence data described in this paper have been submitted to the EMBL nucleotide data library under accession nos.Z84475, Z98744, Z98745, AL021807, AL021808, AL022723, AL022727,AL031893, AL035402, AL035542, AL050328, AL050339, AL078630, AL096770,AL121944, AL133160, and AL133267.]

Negative and distorted images of the observable self are important in the development and maintenance of social phobia. Previous research has shown that video feedback has potential to correct the distorted self-perception [Rapee, R. M. and Hayman, K. (1996). The effects of video feedback on the self-evaluation of performance in socially anxious subjects. Behaviour Research and Therapy, 34, 315-322]. The present experiment investigated whether the construction of a self-image prior to viewing the video may enhance the therapeutic effects of video feedback. High and low socially anxious individuals gave a speech and then viewed the video of their performance. Half of the sample were given cognitive preparation prior to viewing the video. Cognitive preparation involved asking participants to (1) predict in detail what they will see in the video, (2) form an image of themselves giving the speech and (3) watch the video as though they were watching a stranger. Participants who received cognitive preparation prior to the video feedback made higher ratings of their overall performance and of specific aspects of their performance compared to those who were not given cognitive preparation and compared to the same ratings made prior to the video feedback. These results suggest that the therapeutic effects of video feedback can be enhanced by careful cognitive preparation which maximises the perceived discrepancy between self and video images.

The hundreds of human olfactory receptor (OR) genes are organized into clusters occurring on nearly every chromosome. Although their sequences are not always closely related, they share stretches of considerable similarity, both at the amino acid and nucleotide levels. We demonstrate here that an HLA complex-linked OR sequence, FAT11, for which recently a number of alleles have been claimed within the Hutterites, contains sequences derived from two closely related, linked OR genes, hs6M1-12 and hs6M1-16. Instead of indicating a difference between alleles of a given locus, two of the polymorphisms described for FAT11 (at amino acids 48 and 220 of the deduced protein sequence, respectively) may in fact reflect distinct sequences of hs6M1-12 and a further, closely related HLA-linked OR locus, hs6M1-13P. As a consequence, recombination rates in Hutterites in the region telomeric of HLA-G may have to be reconsidered.

BackgroundPsychological debriefing is widely used for trauma victims but there is uncertainty about its efficacy. We have previously reported a randomised controlled trial which concluded that at 4 months it was ineffective.AimsTo evaluate the 3-year outcome in a randomised controlled trial of debriefing for consecutive subjects admitted to hospital following a road traffic accident.MethodPatients were assessed in hospital by the Impact of Event Scale (IES), Brief Symptom Inventory (BSI) and questionnaire and re-assessed at 3 months and 3 years. The intervention was psychological debriefing as recommended and described in the literature.ResultsThe intervention group had a significantly worse outcome at 3 years in terms of general psychiatric symptoms (BSI), travel anxiety when being a passenger, pain, physical problems, overall level of functioning, and financial problems. Patients who initially had high intrusion and avoidance symptoms (IES) remained symptomatic if they had received the intervention, but recovered if they did not receive the intervention.ConclusionsPsychological debriefing is ineffective and has adverse long-term effects. It is not an appropriate treatment for trauma victims.

This article describes the development and validation of a new measure of trauma-related thoughts and beliefs, the Posttraumatic Cognitions Inventory (PTCI), whose items were derived from clinical observations and current theories of post-trauma psychopathology. The PTCI was administered to 601 volunteers, 392 of whom had experienced a traumatic event and 170 of whom had moderate to severe posttraumatic stress disorder (PTSD). Principal-components analysis yielded 3 factors: Negative Cognitions About Self. Negative Cognitions About the World, and Self-Blame. The 3 factors showed excellent internal consistency and good test-retest reliability; correlated moderately to strongly with measures of PTSD severity, depression, and general anxiety: and discriminated well between traumatized individuals with and without PTSD. The PTCI compared favorably with other measures of trauma-related cognitions, especially in its superior ability to discriminate between traumatized individuals with and without PTSD.

SummaryA German version of the ‘Rheumatology Attitudes Index’ – the ‘Rheuma-Kontroll-Skala’ (RKS) – to assess perceived control in rheumatic disease is presented, and first norms are repo

Cognitive models have linked individual differences in the appraisal of traumatic events and their sequelae to the persistence of post-traumatic stress disorder (PTSD). A pilot study investigated this proposal with victims of assault. Eleven assault victims suffering from persistent PTSD and 9 victims who had recovered from PTSD were interviewed retrospectively and compared on potentially relevant cognitive factors. Groups were comparable in terms of characteristics of the assault, gender, age, and initial PTSD severity. Participants with persistent PTSD were less likely than those who had recovered to have engaged in mental planning during the assault and more likely to have experienced mental defeat, and to indicate negative appraisals of their actions during the assault, of others' reactions after the assault, and of their initial PTSD symptoms. They were also more likely to indicate global negative beliefs concerning their perception of themselves, their world or their future. These cognitive factors may maintain PTSD symptoms either directly or by motivating the individual to engage in behaviour that prevents change.

Intrusive memories are common following traumatic events and among the hallmark symptoms of posttraumatic stress disorder (PTSD). Most studies assess summarized accounts of intrusions retrospectively. We used an ecological momentary approach and index intrusive memories in trauma survivors with and without PTSD using electronic diaries. Forty-six trauma survivors completed daily diaries for 7 consecutive days recording a total of 294 intrusions. Participants with PTSD experienced only marginally more intrusions than those without PTSD, but experienced them with more “here and now quality,” and responded with more fear, helplessness, anger, and shame than those without PTSD. Most frequent intrusion triggers were stimuli that were perceptually similar to stimuli from the trauma. Individuals with PTSD experienced diary-prompted voluntary trauma memories with the same sense of nowness and vividness as involuntary intrusive trauma memories. The findings contribute to a better understanding of everyday experiences of intrusive reexperiencing in trauma survivors with PTSD and offer clinical treatment implications.

Background: The main aims of the study were to assess psychological morbidity among adults nine months after a car bomb explosion in the town of Omagh, Northern Ireland and to identify predictors of chronic posttraumatic stress disorder symptoms.Method: A questionnaire was sent to all adults in households in The Omagh District Council area. The questionnaire comprised established predictors of PTSD (such as pre-trauma personal characteristics, type of exposure, initial emotional response and long-term adverse physical or financial problems), predictors derived from the Ehlers and Clark (2000) cognitive model, a measure of PTSD symptoms and the General Health Questionnaire.Results: Among respondents (n = 3131) the highest rates of PTSD symptoms and probable casesness (58.5%) were observed among people who were present in the street when the bomb exploded but elevated rates were also observed in people who subsequently attended the scene (21.8% probable caseness) and among people for whom someone close died (11.9%). People with a near miss (left the scene before the explosion) did not show elevated rates. Exposure to the bombing increased PTSD symptoms to a greater extent than general psychiatric symptoms. Previously established predictors accounted for 42% of the variance in PTSD symptoms among people directly exposed to the bombing. Predictors derived from the cognitive model accounted for 63%.Conclusions: High rates of chronic PTSD were observed in individuals exposed to the bombing. Psychological variables that are in principle amenable to treatment were the best predictors of PTSD symptoms. Teams planning treatment interventions for victims of future bombings and other traumas may wish to take these results into account.

The consumption of okadaic acid (OA) contaminated shellfish can induce acute toxic symptoms in humans such as diarrhea, nausea, vomiting and abdominal pain; carcinogenic and embryotoxic effects have also been described. Toxicokinetic studies with mice have shown that high cytotoxic doses of OA can pass the gastrointestinal barrier presumably by paracellular passage. However, in vitro studies using human intestinal Caco-2 cell monolayers to represent the intestinal barrier have shown that at low-dose exposure OA is transported against a concentration gradient suggesting an active efflux mechanism. Since P-glycoprotein (P-gp) transports a wide variety of substrates, we investigated its possible influence on the observed elimination of OA. We used two different cellular transwell models: (i) Caco-2 cell monolayer endogenously expressing human P-gp and simulating the intestinal barrier and (ii) MDCK-II cell monolayer stably over-expressing P-gp. Our study demonstrates clearly that OA at non-cytotoxic concentrations passes the monolayer barrier only to a low degree, and that it is actively eliminated by P-gp over the apical membrane. Therefore, our in vitro data indicate that humans appear to have efficient defense mechanisms to protect themselves against low-dose contaminated shellfish by exhibiting a low bioavailability as a result of active elimination of OA by P-gp.

Background The main objective of this study was to assess psychiatric morbidity among adolescents following the Omagh car bombing in Northern Ireland in 1998. Methods Data was collected within schools from adolescents aged between 14 and 18 years via a self-completion booklet comprised of established predictors of PTSD; type of exposure, initial emotional response, long-term adverse physical problems, predictors derived from Ehlers and Clark’s (2000) cognitive model, a PTSD symptoms measure (PDS) and the General Health Questionnaire (GHQ). Results Those with more direct physical exposure were significantly more likely to meet caseness on the GHQ and the PDS. The combined pre and peri trauma risk factors highlighted in previous meta-analyses accounted for 20% of the variance in PDS scores but the amount of variance accounted for increased to 56% when the variables highlighted in Ehlers and Clark’s cognitive model for PTSD were added. Conclusions High rates of chronic PTSD were observed in adolescents exposed to the bombing. Whilst increased exposure was associated with increased psychiatric morbidity, the best predictors of PTSD were specific aspects of the trauma (‘seeing someone you think is dying’), what you are thinking during the event (‘think you are going to die’) and the cognitive mechanisms employed after the trauma. As these variables are in principle amenable to treatment the results have implications for teams planning treatment interventions after future traumas.

Objective: There is a growing body of evidence for the effectiveness of trauma focused cognitive behavior therapy (TF CBT) for posttraumatic stress disorder (PTSD) but few studies to date have investigated the mechanisms by which TF CBT leads to therapeutic change. Models of PTSD suggest that a core treatment mechanism is the change in dysfunctional appraisals of the trauma and its aftermath. If this is the case then changes in appraisals should predict a change in symptoms. The present study investigated whether cognitive change precedes symptom change in Cognitive Therapy for PTSD a version of TF CBT. Method: The study analyzed weekly cognitive and symptom measures from 268 PTSD patients who received a course of Cognitive Therapy for PTSD using bivariate latent growth modeling. Results: Results showed that (a) dysfunctional trauma related appraisals and PTSD symptoms both decreased significantly over the course of treatment (b) changes in appraisals and symptoms were correlated and (c) weekly change in appraisals significantly predicted subsequent reduction in symptom scores (both corrected for the general decrease over the course of therapy). Changes in PTSD symptom severity did not predict subsequent changes in appraisals. Conclusions: The study provided preliminary evidence for the temporal precedence of a reduction in negative trauma related appraisals in symptom reduction during trauma focused CBT for PTSD. This supports the role of change in appraisals as an active therapeutic mechanism. (PsycINFO Database Record (c) 2012 APA all rights reserved).

Trans fatty acids (TFA) are hypothesized to have an impact not only on coronary heart diseases but also on the development of colon cancer. To analyze if TFA exhibit cellular and molecular effects which could be involved in colon tumor progression, cells of the human colorectal adenocarcinoma-derived cell line Caco-2 were treated with various TFA isomers differing in the number and position of trans double bonds. The TFA tested in this study did not increase cellular proliferation but displayed growth-inhibitory effects at concentrations higher than 500 μM. In case of the TFA isomer C18:3 t9, t11, t13, an IC50 value of 23 μM was estimated for cytotoxicity indicating a high cytotoxic potential of this compound. In addition to the cytotoxicity studies, the TFA isomers were tested for their ability to activate peroxisome proliferator-activated receptors (PPAR) by taking advantage of a PPAR-dependent reporter gene assay. In contrast to PPARγ that was not activated by the TFA isomers tested in this study, the substances were shown to moderately activate PPARα, and strong activation was observed for PPARδ. The putative impact of TFA on colon cancer development with respect to PPARδ activation is being discussed.

Nach einem traumatischen Erlebnis entwickeln die meisten Personen fur einige Zeit Symptome der posttraumatischen Belastungsstorung (PTBS), jedoch gesunden viele im Laufe der nachsten Monate auch ohne professionelle Hilfe. Bei einer Untergruppe kommt es zu einem chronischen Verlauf. In diesem Kapitel soll ein kognitives Modell der Aufrechterhaltung posttraumatischer Symptome beschrieben werden, das als Grundlage kognitiver Interventionen dienen soll.

Depressed individuals tend to assign internal, stable, and global causes to negative events. The present study investigated the specificity of this effect to depression and compared depressive attributional styles of individuals with major depression (MD), post-traumatic stress disorder (PTSD), and healthy controls. We indexed attributional style using the depressive attributions questionnaire in 164 participants. Additionally, we assessed appraisals characteristic of PTSD using the post-traumatic cognitions inventory (PTCI), depressive rumination, trauma history, and depression and PTSD symptom severity. Individuals with MD endorsed a depressive attributional style to a greater extent than both individuals with PTSD, who were not depressed, and healthy controls. Depressive attributional style was associated with the severity of depressive and PTSD symptoms, number and distress of traumatic experiences, frequency of rumination, and post-traumatic cognitions. Depressive attributions and PTCI appraisals independently predicted MD and PTSD symptom severity. They may thus be useful in predictingMDand PTSD, and should be targeted in psychological treatments of these conditions. © Springer Science+Business Media, LLC 2011.

Individuals meeting criteria of the revised third edition of Diagnostic and Statistical Manual for Mental Disorders (American Psychiatric Association, 1987) for social phobia with a fear of speaking in front of people were subdivided into those with (n = 16) and without (n = 14) avoidant personality disorder (APD). These individuals and nonanxious controls (n = 22) spoke in front of a small audience while speaking time, subjective anxiety, fearful thoughts, and electrocardiographic and respiratory measures were recorded. Controls spoke for longer than either social phobia group. Those with social phobia and APD reported more subjective anxiety and more fear cognitions than the other two groups; phobic individuals without APD showed greater heart rates in the phobic situation than either social phobics with APD or controls. The latter two groups did not differ in heart rate. These results indicate incongruent subjective and heart rate responses to the feared situation. A similar pattern of results was found when participants were divided into generalized and specific social phobia groups.

That patients with panic disorder exhibit an attentional bias towards physical threat has been inferred from their responses to such words in modified Stroop paradigms. The present study investigated selective attention to physical cues directly. Subjects were given a mild electrical shock to one ring finger followed by a target stimulus (vibration of one index finger) applied to either the same or the other hand. An attentional bias index was calculated by subtracting mean reaction times in trials in which the neutral target and the electrical stimulus were applied to the same hand from those trials in which both stimuli were applied to different hands. Sixty-one patients with panic disorder, 45 subjects with infrequent spontaneous panic attacks, 24 patients with specific phobias, and 40 normal controls participated in the study. Consistent with our hypothesis, subjects with spontaneous panic attacks, but not normal controls, shifted their attention toward the threatening stimulus. There was no difference between panic disorder patients and infrequent panickers. Selective attention to physical threat could increase the probability that anxiety is triggered or that it escalates during panic attacks. Patients with simple phobias showed the same response pattern as panickers. Lack of specificity in our paradigm may be related to the importance of “fear of fear” for all anxiety disorders or to the relevance of tactile stimuli for the fear structures of animal phobics.

Clinicians have long noted that traumatic events can lead to severe psychological disturbance. At the end of the nineteenth and the beginning of the twentieth centuries, railway disasters, the World Wars, and the Holocaust prompted systematic descriptions of the symptoms associated with traumatic stress reactions. These include the spontaneous re-experiencing of aspects of the traumatic events, startle responses, irritability, impairment in concentration and memory, disturbed sleep, distressing dreams, depression, phobias, guilt, psychic numbing, and multiple somatic symptoms. A variety of labels were used to describe these reactions including ‘fright neurosis’, ‘combat/war neurosis’, ‘shell shock’, ‘survivor syndrome’, and ‘nuclearism’. This chapter covers clinical features of post-traumatic stress disorder, classification, diagnosis and differential diagnosis, epidemiology, prevalence, comorbidity of PTSD with other disorders, aetiology, course and prognosis, treatment, and finally advice on management.

The chapter reviews the contribution of information processing models to understanding the development and maintenance of posttraumatic stress disorder. Individual differences in cognitive processing during the trauma and basic memory mechanism, such as priming and associative learning, may help explain why people with PTSD involuntarily re-experience parts of the trauma in a wide range of situations. Individual differences in how people remember traumatic events may influence the likelihood of developing PTSD. Attentional bias to trauma-related cues and threatening interpretations of the trauma or its aftermath help explain why people with PTSD have many symptoms of anxiety even though the trauma is over. Cognitive strategies people use to deal with memories of the trauma, such as effortful suppression of trauma memories and rumination, help explain why some develop chronic PTSD whereas many recover from trauma. Finally, there may be cognitive vulnerability factors that increase the probability of developing PTSD in response to trauma. Directions for future research are outlined.

Clinical reports have related stressful social interactions to the course of atopic dermatitis (AD). Controlled behavioral observations of interaction patterns of AD patients and their significant others, however, were lacking. In two studies, adult AD patients and their mothers (N1 = 26) or partners (N2 = 67) engaged in a discussion of a mutual problem. Their verbal and nonverbal communication behavior was analyzed with a reliable standardized interactional coding system and compared to that of control dyads (N1 = 18, N2 = 28). Although AD patients and their significant others did not differ from controls in their self-reported satisfaction with the relationship, the behavioral observations showed less positive and more negative communication patterns compared to the control dyads. Negative interactions with significant others may prevent the solution of everyday problems and may add to the patients' stress level.

The objective of this study was to examine the psychometric properties of the Autobiographical Memory Test (AMT), which is widely used to measure overgeneral autobiographical memory in individuals with depression and a trauma history. Its factor structure and internal consistency have not been explored in a clinical sample. This study examined the psychometric properties of the AMT in a sample of recent trauma survivors (N = 194), who completed the AMT 2 weeks after a trauma. Participants were also assessed with structured clinical interviews for current acute stress disorder and current and past major depressive disorder. Confirmatory factor analysis and item response theory were used to analyze the AMT in the whole sample. The factor structure of the AMT was also compared for (a) individuals with and without lifetime major depressive disorder and (b) individuals with current (posttrauma) major depressive disorder and/or acute stress disorder versus those with neither disorder. In all of these analyses, the AMT with cues of positive and negative valence had a 1-factor structure, which replicates work in nonclinical samples. Based on analyses of the whole sample, scores from the AMT had a reliability estimate of .72, and standard error of measurement was lowest for people who scored low on memory specificity. In conclusion, the AMT measures 1 factor of memory specificity in a clinical sample and can yield reliable scores for memory specificity. More psychometric studies of the AMT are needed to replicate these results with similar and other clinical populations.

Research into cognitive mechanisms in posttraumatic stress disorder (PTSD) typically comprises two types of studies. The first group of studies is conducted with survivors of traumatic events and assesses the association between PTSD and cognitive variables with questionnaires and/or information processing paradigms. In the second group of studies, healthy nontraumatized individuals are exposed to an analogue stressor (e.g., a stressful film) and cognitive variables of interest are usually experimentally manipulated to investigate their effects on analogue PTSD symptoms. This review illustrates how studies of trauma survivors and analogue studies with nontraumatized populations can be usefully combined. Two examples for this approach are presented: (1) research into the role of perceptual priming for trauma-related stimuli and (2) research into trauma-related rumination. The advantages and limitations of both types of studies are discussed and it is argued that a combination of both approaches is needed to investigate cognitive mechanisms in PTSD. © 2011 International Association for Cognitive Psychotherapy.

Background Epigenetic changes are involved in the extinction of the B-cell gene expression program of classical Hodgkin’s lymphoma. However, little is known regarding epigenetic similarities between cells of classical Hodgkin’s lymphoma and plasma cell myeloma, both of which share extinction of the gene expression program of mature B cells. Design and Methods Global histone H3 acetylation patterns were determined in cell lines derived from classical Hodgkin’s lymphoma, plasma cell myeloma and B-cell lymphoma by chromatin immunoprecipitation and subsequent hybridization onto promoter tiling arrays. H3K27 trimethylation was analyzed by chromatin immunoprecipitation and real-time DNA polymerase chain reaction for selected genes. Epigenetic modifications were compared to gene expression data. Results Characteristic B-cell genes were hypoacetylated in classical Hodgkin’s lymphoma and plasma cell myeloma cell lines as demonstrated by comparison of their histone H3 acetylation patterns to those of B-cell lines. However, the number of genes jointly hyperacetylated and expressed in classical Hodgkin’ lymphoma and plasma cell myeloma cell lines, such as IRF4/MUM1 and RYBP , is limited. Moreover, H3K27 trimethylation for selected characteristic B-cell genes revealed that this additional epigenetic silencing is much more prevalent in classical Hodgkin’s lymphoma than in plasma cell myeloma. Conclusions Our epigenetic data support the view that classical Hodgkin’s lymphoma is characterized by abortive plasma cell differentiation with a down-regulation of characteristic B-cell genes but without activation of most genes typical of plasma cells.

Item does not contain fulltext It is essential that outcome research permit clear conclusions to be drawn about the efficacy of interventions. The common practice of nesting therapists within conditions can pose important methodological challenges that affect interpretation, particularly if the study is not powered to account for the nested design. An obstacle to the optimal design of these studies is the lack of data about the intraclass correlation coefficient (ICC), which measures the statistical dependencies introduced by nesting. To begin the development of a public database of ICC estimates, the authors investigated ICCs for a variety outcomes reported in 20 psychotherapy outcome studies. The magnitude of the 495 ICC estimates varied widely across measures and studies. The authors provide recommendations regarding how to select and aggregate ICC estimates for power calculations and show how researchers can use ICC estimates to choose the number of patients and therapists that will optimize power. Attention to these recommendations will strengthen the validity of inferences drawn from psychotherapy studies that nest therapists within conditions. 19 p.

A depressogenic attributional style, i.e.; internal, stable and global causal interpretations of negative events, is a stable vulnerability factor for depression. Current measures of pessimistic attributional style can be time-consuming to complete, and some are designed for specific use with student populations. We developed and validated a new short questionnaire suitable for the measurement of depressogenic attributions in clinical settings, the Depressive Attributions Questionnaire (DAQ). The 16-item DAQ, and measures of depression and related cognitive concepts were completed by three samples of depressed patients and matched controls, or depressed and non-depressed participants who had been exposed to a recent uncontrollable stressful life event (total N=375). The DAQ had high (i) internal reliability, (ii) test-retest reliability, (iii) convergent, discriminant and construct validity. It predicted a diagnosis of major depression at 6 months after an uncontrollable stressor, over and above what could be predicted from initial depression severity. Depressed patients rated the scale as acceptable. The DAQ may be a useful short measure of depressogenic attributions, which is easy to administer, and predicts concurrent and future depression. It has possible applications as a screening measure for risk of depression, or as a treatment process measure. © 2011 The Author(s).

Juckreiz stellt ein Hauptsymptom dermatologischer Krankheiten wie der atopischen Dermatitis dar und ist fur die Betroffenen sehr belastend. Der von uns entwickelte Juckreiz-Kognitions-Fragebogen miβt zum einen fur die Bewaltigung von Juckreiz gunstige Kognitionen (Skala Bewaltigung) und zum anderen solche Kognitionen, die einer Bewaltigung im Wege stehen (Skala Katastrophisieren/Hilflosigkeit). Die Skalen weisen eine hohe interne Konsistenz auf. Der Fragebogen, insbesondere die Skala Katastrophisieren, klarte einen Teil der Varianz des durch die Krankheit und den Juckreiz verursachten Leidensdrucks und des Kratzverhaltens auf, der unabhangig vom Schweregrad der Hauterscheinungen war. In einer vergleichenden Therapiestudie zeigten sich positive Veranderungen in der Skala Bewaltigung nur bei psychologischer Behandlung (Verhaltenstherapie, kombinierte verhaltenstherapeutische und dermatologische Schulung, Autogenes Training), nicht jedoch bei einem dermatologischen Schulungsprogramm. In alien Behandlungsbedingungen fanden sich Verbesserungen in der Skala Katastrophisieren. Die Werte in der Skala Katastrophisieren am Ende der Therapie sagten den Schweregrad der Hauterscheinungen und die Beeintrachtigung durch die Krankheit und den Juckreiz bei der 1-Jahres-Katamnese vorher.

Bei der Diagnostik von Angststorungen finden in der jungsten Zeit interne Angstausloser, wie korperliche Symptome und katastrophisierende Gedanken, verstarkt Beachtung. Diese wurden zunachst vor allem zur Erklarung agoraphobischen Vermeidungsverhaltens und «spontaner» Panikanfalle herangezogen, sind jedoch aufgrund neuerer Befunde von allgemeiner Bedeutung fur die Diagnostik von Angststorungen. Patienten mit Angststorungen, insbesondere mit Paniksyndrom oder Agoraphobien, zeigen Angst vor den korperlichen Begleiterscheinungen der Angst (z.B. Herzklopfen, Atemnot) und bewerten diese Symptome als gefahrlich; auβerdem befurchten solche Patienten negative soziale oder gesundheitliche Konsequenzen der Angst und der korperlichen Symptome («Angst vor der Angst»). Als reliable Meβinstrumente zur Erfassung der «Angst vor der Angst» wurden der Fragebogen zur Angst vor korperlichen Symptomen (BSQ), der Fragebogen zu angstbezogenen Kognitionen (ACQ) sowie der Angst-Sensitivitats-Index (ASI) entwickelt. Wir berichten Untersuchungen zu den deutschen Versionen dieser Fragebogen. Die «Angst vor der Angst»-Skalen sagen einen Anteil der Varianz der phobischen Angst und Vermeidung vorher, der unabhangig von der habituellen Angstlichkeit (Trait-Angst) ist. Patienten mit Angststorungen erreichen auf diesen Skalen hohere Werte als Patienten ohne Angststorungen und Kontrollpersonen. Patienten mit Paniksyndrom konnen von Patienten mit anderen Angststorungen vor allem durch hohere Werte im ACQ-Faktor «Gedanken an korperliche Krisen» unterschieden werden. Insgesamt bestatigen unsere Studien die Bedeutung des Konzepts der «Angst vor der Angst» fur die Erklarung des phobischen Vermeidungsverhaltens und fur die Diagnostik der Angststorungen.

BackgroundLittle is known about how to remedy the unmet mental health needs associated with major terrorist attacks, or what outcomes are achievable with evidence-based treatment. This article reports the usage, diagnoses and outcomes associated with the 2-year Trauma Response Programme (TRP) for those affected by the 2005 London bombings.MethodFollowing a systematic and coordinated programme of outreach, the contact details of 910 people were obtained by the TRP. Of these, 596 completed a screening instrument that included the Trauma Screening Questionnaire (TSQ) and items assessing other negative responses. Those scoring ⩾6 on the TSQ, or endorsing other negative responses, received a detailed clinical assessment. Individuals judged to need treatment (n=217) received trauma-focused cognitive-behaviour therapy (TF-CBT) or eye movement desensitization and reprocessing (EMDR). Symptom levels were assessed pre- and post-treatment with validated self-report measures of post-traumatic stress disorder (PTSD) and depression, and 66 were followed up at 1 year.ResultsCase finding relied primarily on outreach rather than standard referral pathways such as primary care. The effect sizes achieved for treatment of DSM-IV PTSD exceeded those usually found in randomized controlled trials (RCTs) and gains were well maintained an average of 1 year later.ConclusionsOutreach with screening, linked to the provision of evidence-based treatment, seems to be a viable method of identifying and meeting mental health needs following a terrorist attack. Given the failure of normal care pathways, it is a potentially important approach that merits further evaluation.

There is preliminary evidence that enhanced priming for trauma-related cues plays a role in posttraumatic stress disorder (PTSD). A prospective study of 119 motor vehicle accident survivors investigated whether priming for trauma-related stimuli predicts PTSD. Participants completed a modified word-stem completion test comprising accident-related, traffic-related, general threat, and neutral words at 2 weeks post-trauma. Priming for accident-related words predicted PTSD at 6 months follow-up, even when initial symptom levels of PTSD and depression and priming for other words were controlled. The results are in line with the hypothesis that enhanced priming for traumatic material contributes to the development of chronic PTSD.

Objective: To investigate in trauma survivors the predictive validity of heightened physiological responsivity to script-driven imagery for the development of posttraumatic stress disorder (PTSD) and to evaluate the interactive effect of survivors' sex. Physiological responses to idiosyncratic trauma reminders may be predictive of later PTSD. The majority of previous studies have been cross sectional and have produced mixed findings. Sex differences may contribute to this heterogeneity. Methods: Heart rate (HR) and respiratory sinus arrhythmia were measured at 2 weeks post trauma in 158 assault survivors during baseline and as they listened to an idiosyncratic trauma script. At 6 months, 15.2% of male and 28.1% of female participants met the diagnostic criteria for PTSD. Results: Generalized linear model and logistic regression analyses showed that HR response to script-driven imagery and sex interacted in predicting PTSD symptom severity at 6 months. Women had greater PTSD symptom severities overall. Female HR responders to script-driven imagery showed the highest PTSD symptom severities and were almost three times more likely to develop PTSD at 6 months compared with men and female nonresponders (odds ratio, 2.72; 95% confidence interval, 1.13-6.57). Respiratory sinus arrhythmia responder type did not predict PTSD (odds ratio, 0.64; 95% confidence interval, 0.30-1.33). Conclusion: Female trauma survivors who respond to trauma reminders with increased HR may be at particular risk of developing PTSD. Physiological reactivity to trauma cues may be a useful index for screening and prevention of PTSD. Language: en

Background: The present study investigated cognitive mediation of clinical improvement in patients with agoraphobia (N5427) or social phobia (N598) receiving high-density exposure therapy in a naturalistic clinical treatment setting. Methods: Patients were assessed before therapy, 6 weeks after the end of therapy, and 1 year thereafter, using a self-report assessment battery. Lower level mediation analyses provided support for the notion that cognitive changes partially mediate clinical improvement after exposure therapy. Results: Changes in cognitions relating to physical catastrophes mediated treatment outcome only for patients with agoraphobia, whereas changes in cognitions about loss of control mediated outcome for both agoraphobia and social phobia patients. Changes in relationship satisfaction did not mediate symptomatic improvement. Conclusions: The results extend previous findings by demonstrating mediation in an unselected clinical sample and by providing evidence for the specificity of mediation effects. They further support the importance of cognitive changes in cognitive‐behavior therapy. Depression and Anxiety 0:1‐8, 2009. r2009

Die Geschichte der kognitiven Verhaltenstherapie (KVT) ist besonders eng mit der Psychologie des Lernens verknupft. Experimentelle Befunde zur klassischen und operanten Konditionierung sind eine wichtige Grundlage von gangigen Modellen zur Entstehung psychischer Storungen sowie von Interventionsmethoden. Zusatzlich finden die Prinzipien des Modelllernens und die Wissensvermittlung Berucksichtigung. Aus heutiger Sicht lassen sich alle Formen des Lernens unter dem Begriff der Informationsverarbeitung zusammenfassen. Lernen findet dann statt, wenn das Individuum bedeutsame Informationen uber das Auftreten von externen oder internen Bedingungen oder deren Valenz erhalt, die sein zukunftiges Befinden, Denken, Verhalten und/oder seine physiologischen Reaktionen beeinflussen.

Empirically supported psychological treatments have been developed for a range of psychiatric disorders but there is evidence that patients are not receiving them in routine clinical care. Furthermore, even when patients do receive these treatments there is evidence that they are often not well delivered. The aim of this paper is to identify the barriers to the dissemination of evidence-based psychological treatments and then propose ways of overcoming them, hence potentially bridging the gap between research findings and clinical practice.

Post-traumatic stress disorder (PTSD) is a common and disabling disorder that develops as a consequence of traumatic events and is characterised by distressing re-experiencing of parts of the trauma, avoidance of reminders, emotional numbing and hyperarousal. The NICE guidelines for PTSD (2005)recommend trauma-focused psychological therapy as the first-line treatment. A survey of 129 GPs in south London investigated the recognition and treatment of PTSD in primary care. The majority of GPs underestimated the prevalence of PTSD. Most PTSD patients seen in GP surgeries currently do not receive or are not referred for NICE recommended psychological treatments. Medications, especially SSRIs, appear to be more commonly prescribed than recommended by NICE. Efforts to disseminate information about PTSD and effective treatments to both patients and GPs are needed to increase recognition rates and prompter access to treatment. The Improving Access to Psychological Therapies (IAPT) programme will make the NICE recommended treatments more widely available and will allow self-referral by adults with PTSD to trauma-focused psychological therapy. (Less)