Search

This chapter outlines the known literature on the treatment of motor vehicle accident (MVA) survivors, reviews the treatment of MVA related post-traumatic stress disorder (PTSD), and concludes with a description of a piloted program conducted at the Albany MVA Treatment Project. The initial effort at treatment at the Albany MVA Treatment Project arose from our experience conducting a National Institute of Mental Health funded research project investigating the psychological effects of motor vehicle accidents. Based upon the success of a nonsystematic initial intervention, a treatment manual for MVA victims with PTSD was designed. The treatment for MVA-related PTSD is clearly an emerging area and one where it is reasonable that application of individual treatment to group process could occur. The treatment, conducted by private psychologists, two of whom were associated with the MVA research project, offered a unique opportunity to measure the change in symptoms across time.

Individuals with posttraumatic stress disorder (PTSD) related to a serious motor vehicle accident were randomly assigned to either group cognitive behavioral treatment(GCBT) or a minimum contact comparison group (MCC).Compared to the MCC participants (n=16), individuals who completed GCBT (n=17) showed significant reductions in PTSD symptoms, whether assessed using clinical interview or a self-report measure. Among treatment completers, 88.3% of GCBT participants did not satisfy criteria for PTSD at posttreatment assessment, relative to31.3% of the MCC participants. Examination of anxiety,depression, and pain measures did not show a unique advantage of GCBT. Treatment-related gains were maintained over a 3-month follow-up interval. Patients reported satisfaction with GCBT, and attrition from this treatment was comparable with individually administered CBTs.Results are discussed in light of modifications necessitated by the group treatment format, with suggestions for future study of this group intervention.

Despite the accumulation of efficacy data for cognitive-behavioral treatment of Irritable Bowel Syndrome (IBS), efforts to investigate methods for increasing access to psychological treatments are in their infancy. The current study examined the efficacy of self-administered treatment in comparison to a wait list control. Twenty-eight participants monitored gastrointestinal (GI) symptoms and completed measures of quality of life (QOL) and psychological distress prior to randomized assignment to self-help treatment or wait list. Wait listed participants later received treatment. A 3 month post-treatment follow-up was included. Seven participants completed immediate treatment; nine the wait list. The self-help treatment significantly decreased composite GI symptom scores in comparison to the wait list, but did not lead to significant improvements in QOL or distress. In the entire treated sample, including wait list crossovers, analyses showed significant improvement in abdominal pain, average GI symptoms, and perceived health and well-being. Interpretation of these results should be considered in the context of several limitations, including small sample size, brief baseline symptom monitoring, and high drop out rate. Despite these limitations, this study is an important first step in empirically validating low-cost, self-administered treatments as a first line psychological intervention for IBS.

We randomized, at two sites, 210 patients with Rome II diagnosed irritable bowel syndrome (IBS), of at least moderate severity, to one of three conditions: group-based cognitive therapy (CT; n=120), psychoeducational support groups (n=46) as an active control, or intensive symptom and daily stress monitoring (n=44). One hundred eighty-eight participants completed the initial treatment. Those in symptom monitoring were then crossed over to CT. For an intent to treat analysis on a composite GI symptom measure derived from daily symptom diaries, both CT and the psychoeducational support groups were significantly more improved than those in the intensive symptom monitoring condition, but the CT and psychoeducational support group did not differ. Among treatment completers on the same composite measure of GI symptoms, again, both CT and psychoeducational support groups were statistically superior to symptom monitoring but did not differ on the symptom composite, or on any other measure. On individual IBS symptoms, both CT and psychoeducational support were statistically superior to symptom monitoring on reductions in abdominal pain and tenderness and for flatulence. Patient global ratings at the end of treatment showed the two active conditions statistically superior to symptom monitoring on change in Bowel Regularity, with CT superior to symptom monitoring on reduction in overall pain and in improvement in sense of well-being. Three-month follow-up data on 175 patients revealed maintenance of significant improvement or continued significant improvement on all IBS symptoms, including the McGill Pain Questionnaire. Group CT and psychoeducational support groups continued not to differ on any measure. We thus conclude that group CT is not superior to an attention placebo control condition.

Motor vehicle accidents (MVAs) are a leading cause of accidental death and injury, and aggressive driving has been identified as a risk factor for MVAs. Assessing psychiatric and behavioral disturbances in aggressive drivers is germane to the development of prevention and intervention programs for this population. The present study compared the prevalence of psychiatric diagnoses and behavioral problems in young adult drivers with self-reported high driving aggression to that of drivers with low driving aggression. Aggressive drivers evidenced a significantly higher current and lifetime prevalence of Oppositional Defiant Disorder, Alcohol and Substance Use Disorders, and Cluster B Personality Disorders, and a significantly greater lifetime prevalence of Conduct Disorder, Attention-Deficit/Hyperactivity Disorder, and Intermittent Explosive Disorder. Aggressive drivers also had a significantly greater prevalence of self-reported problems with anger, as well as a greater family history of anger problems and conflict. The findings suggest that prevention and intervention programs designed to reduce aggressive driving may need to address the presence of psychiatric and behavioral problems that could potentially complicate treatment or impede responses to treatment.

Early, brief interventions for posttraumatic stress disorder (PTSD) secondary to motor vehicle accidents (MVAs) have historically been, with few exceptions, unsuccessful with single session or even very brief (3 to 6 sessions) interventions. In contrast, very intensive cognitive behavioral therapy (CBT) applied over the first 6 to 8 weeks posttrauma has been found to be very effective in treating acute stress disorder. CBT has also been found to be very effective in treating chronic PTSD from MVAs in controlled studies. Drawing from that experience, a brief CBT therapy was given to 3 individuals who had developed ASD or subsyndromal ASD following an MVA. Results support that, for at least some individuals, a brief intervention may be effective. Benefits in terms of less time for therapist and MVA survivor, use of handouts, self-directed care, and telephone intervention were discussed. Although still in continuing development, this style of intervention appears to offer promise as an effective early treatment option for some individuals with PTSD. The need for larger scale, controlled studies is noted.

This cross-sectional study investigated the relationship between dysfunctional attitudes and the emotional unpleasantness of pain (pain affect) in a large sample (N = 281) of severely affected patients with irritable bowel syndrome (IBS). Subjects completed measures of pain, dysfunctional attitudes, and psychopathology as part of baseline assessment of an NIH-funded clinical trial featuring cognitive therapy for IBS. Drawing from the cognitive model of emotion, we predicted that patients with IBS would have a propensity toward negative thinking, as measured by the Dysfunctional Attitude Scale (DAS), and as a result rate pain affect as higher than patients with healthier cognitions. Consistent with these predictions, DAS scores for a sizable proportion of IBS patients were elevated compared to those from normative samples. Further, multiple regression analyses showed that dysfunctional attitudes account for approximately 11% of the variance in pain affect when control variables (gender, age, psychopathology) were held constant. These data are discussed in light of clinical implications for treating patients from a cognitive therapy orientation. Keywords: irritable bowel syndrome; pain; emotion; cognition schema Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal (GI) disorder whose expression and course are strongly influenced by psychological factors (Drossman et al., 1999). Of these factors, cognitive processes (thought, memory, attention) play a particularly important role in presentation of IBS. Cognitive processes have, by virtue of the neural connections between the brain and gut (Mayer, Naliboff, Chang, & Coutinho, 2001), an influence on biological systems that mediate gut sensation and function (e.g., Almy, Kern, & Tulin, 1949; Naliboff et al., 2001). Health outcomes of IBS patients are also subject to the influence of cognitive processes. Drossman (1999) found that two cognitive factors (i.e., "catastrophizing," self-efficacy) measured at baseline predicted subsequent (12-month) health outcome as measured using a composite health status of six variables (current pain, bed disability days, psychological distress, daily dysfunction, number of physician visits, number of surgeries and procedures). Another measure of the influence of cognitive processes comes from outcome research showing that psychological treatments featuring a cognitive therapy component are associated with clinically significant improvement in GI symptoms (Blanchard, 2001). Interestingly, in efforts to identify change mechanisms of cognitive therapy, Blanchard and colleagues (Greene & Blanchard, 1994; Payne & Blanchard, 1995) found that total scores on the Dysfunctional Attitude Scale (DAS), a measure of maladaptive beliefs, decreased significantly from pre- to posttreatment in patients who underwent cognitive therapy but not in patients assigned to control conditions. Drawing from Beck's cognitive model of emotion (A. T. Beck, 1976; A. T. Beck, Rush, Shaw, & Emery, 1979), cognitive therapy for IBS seeks to modify or eliminate automatic thoughts and underlying assumptions (core beliefs) that underlie excessive emotional or physiological reactions associated with GI symptoms. Automatic thoughts refer to "the actual words or images that go through a person's mind" (J. S. Beck, 1995, p. 16), while core beliefs are relatively stable assumptions and beliefs about the self, the world, the future (A. T. Beck et al., 1979). These attitudes presumably "organize prior experience, guide the interpretation of new experiences, and shape expectancies and predictions" (A. T. Beck, Brown, Steer, & Weissman, 1991, p. 478). Metaphorically, automatic thoughts can be likened to a "snapshot" of a situation or image that elicits an emotional or somatic response, while core beliefs are the "lens" through which one sees the world. Foa and Rothbaum (1998) differentiate negative automatic thoughts from dysfunctional beliefs in the following manner: Dysfunctional beliefs are "general assumptions people hold about the world and about themselves that cause them to interpret specific events in an excessively negatively and dysfunctional manner," while negative thoughts are those "thoughts or images that go through a person's mind during a situation that provokes [a] response . …

Although it has been fairly well established that symptoms of anxiety are often present in patients with irritable bowel syndrome (IBS), less is known about the role of worry and intolerance of uncertainty in this population. This study investigates the relations among these variables in a sample of treatment-seeking IBS patients. Although the results are preliminary, worry does seem to predict gastrointestinal symptom severity and, when combined with a measure of current anxiety, accounts for almost 30% of the variance. Intolerance of uncertainty differentiated diarrhea-predominant IBS patients from constipation-predominant IBS patients. Earlier research has taken a psychiatric perspective on anxiety in IBS patients-the current study may provide some support for shifting our focus to the cognitive biases that may be operating in IBS patients, regardless of the presence of an anxiety disorder. Implications for a cognitive therapy approach to IBS treatment are discussed. Keywords: irritable bowel syndrome; anxiety; worry; intolerance of uncertainty; cognitive treatment Anxiety is believed to play some role in the onset and/or maintenance (see Sykes, Blanchard, Lackner, Keefer, & Krasner, 2003) of irritable bowel syndrome (IBS), a functional disorder of the lower gastrointestinal (GI) tract. Patients with IBS experience recurrent abdominal pain and/or cramping that is accompanied by altered bowel habit (diarrhea, constipation, or both); these symptoms can create marked impairment in functioning and quality of life (Drossman, Corrazziari, Taller, Thompson, & Whitehead, 2000). Although GI symptoms have a high degree of instability, physicians can often classify their patients into one of three IBS subtypes: diarrheapredominant, constipation-predominant, and mixed type. Research studies rarely examine differences among these three groups of patients, which may partially explain the marked variability seen in IBS assessment and treatment outcome research. As IBS is a GI illness that has no known organic cause (and is therefore considered functional), it has commonly been thought of as a psychosomatic disorder. In support of this hypothesis are several studies that have shown that between 33% and 94% of IBS patients have a diagnosable psychiatric disorder (Blewett et al, 1996; Jarret et al, 1998; Lydiard, Fosset, Marsh, & Ballenger, 1993; for a summary see Blanchard, 2001). Further, although depression and somatization were also commonly diagnosed conditions within IBS patients, it is likely that between 4% and 60% of IBS patients meet criteria for a current anxiety disorder (Blanchard, 1990; Lydiard et al.; Folks & Kinney, 1992; Blanchard et al, 1990). Unfortunately, although most clinicians would agree that anxiety is an important component of an IBS patient's presentation, the measurement of such anxiety has resulted in inconsistent findings. When measured categorically (i.e., through DSM-III-R or DSM-IV diagnoses), IBS patients exhibit significantly higher rates of anxiety disorders than normal controls or individuals with inflammatory bowel disease (Blanchard, Scharff, Schwatz, Suis, & Barlow, 1990). On the other hand, when measured dimensionally, IBS patients, on average, suffer from only mild to moderate anxiety when measured by the State-Trait Anxiety Inventory (STAI; Speilberger, 1983; see Blanchard & Keefer, 2003). This is somewhat surprising, given the high rate of anxiety disorders seen in IBS patients. It is possible that measurement of anxiety by the STAI excludes some of the other components of anxiety that IBS patients may manifest. The most commonly diagnosed anxiety disorder among our IBS treatment-seeking population is Generalized Anxiety Disorder (GAD). GAD, a disorder characterized by chronic, uncontrollable worry and multiple CNS-mediated complaints, was found in 37% of our population in earlier research (Blanchard et al., 1990) and between 26% and 32% of our population more recently (Blanchard & Keefer, 2003; Sykes et al. …

Research on controlled evaluations of psychological treatments for IBS is summarized with regards to methodology and outcome, with special attention to differential outcome. There is ample evidence to support the efficacy of various combinations of cognitive and behavioral therapy techniques as well as brief psychodynamic psychotherapy, and hypnotherapy. There has also recently appeared some evidence that is not supportive of each approach. Long-term follow-up, although relatively rare, generally finds the maintenance of initial improvement in IBS symptoms. There is some growing evidence on changes in the putative cognitive mechanisms targeted by the cognitive therapy techniques. More research is needed on these process variables. The field may be ripe for direct comparisons of 2 or more psychological approaches to the IBS treatment.

In the present study, we tested the effectiveness of a cognitive-behavioral group treatment (CBGT) for hot flashes in menopausal women. Treatment was administered over 8, 90 min weekly sessions and consisted of education, relaxation training and cognitive restructuring. Nineteen women meeting STRAW staging criteria for the menopause transition (stages -1 to +1) were randomly assigned to immediate or delayed treatment (wait list) and were asked to monitor their hot flashes and night sweats prospectively. They also completed questionnaires, including the Women's Health Questionnaire and the Menopause Specific Quality of Life Questionnaire to determine psychosocial benefits of treatment. Results suggested that the CBGT was moderately successful in reducing the frequency of total vasomotor symptoms [F (1, 17) = 6.16, p < .01], as measured by daily symptom diaries. While there were arithmetic improvements in psychosocial functioning in this sample, these results were not significant. Despite the limitations of small sample size and possible placebo effect, this pilot study supports the notion that cognitive-behavioral interventions aimed at reducing vasomotor symptoms may be of value for menopausal hot flashes when administered in a small-group format.

While most healthy women report that the menopausal transition is nondistressing, a subset of women does report that symptoms significantly interfere in their lives. The most common reason that women seek treatment during this time is for vasomotor symptoms, namely, hot flashes and night sweats. Research has suggested that reports of distress during flashing are only weakly related to more objective measures of the flash, including duration and frequency and that differences in treatment-seeking during the menopausal transition may be better accounted for by differences in symptom awareness mediated by a variety of personality and stress factors. This paper discusses hot flashes and night sweats from a cognitive-behavioral perspective, taking into account individual difference variables that may also affect the experience of menopausal symptoms.

Chronic headache is a significant public health problem in Western nations. Although controlled trials demonstrate the efficacy and cost-effectiveness of face-to-face behavioral therapy, most headache sufferers have limited access to these treatments. Delivery of behavioral interventions using Internet technology has the potential to reach a larger number of headache sufferers and reduce the burden of disease. This randomized controlled study evaluated an Internet-delivered behavioral regimen composed of progressive relaxation, limited biofeedback with autogenic training, and stress management versus a symptom monitoring waitlist control. Treatment led to a significantly greater decrease in headache activity than symptom monitoring alone. Thirty-nine percent of treated individuals showed clinically significant improvement on self-report measures of headache symptoms at post-treatment. At two-month follow-up, 47% of participants maintained improvement. Treatment had a significant impact on general headache symptoms and headache-related disability. There was a 35% within-group reduction of medication usage among the treated subjects. The Internet program was more time-efficient than traditional clinical treatment. Treatment and follow-up dropout rates, 38.1% and 64.8%, respectively, were typical of behavioral self-help studies. This approach to self-management of headache is promising; however, several methodological and ethical challenges need to be addressed.

The aim of the present study was to investigate startle responses in motor vehicle accident (MVA) survivors to trauma-related, startle, and neutral sounds. Participants were 17 MVA survivors, 11 of whom participated in a controlled treatment study comparing cognitive-behavioral treatment (CBT) and supportive therapy (ST) versus a waitlist condition. Though participants differed significantly in their pretreatment clinical status and symptom severity, these differences were not reflected by group differences in EMG (at orbicularis oculi) to the stimuli at the initial assessment. Some cue-specificity was found, as all participants showed larger startle responses to trauma-related sounds, compared to startle and neutral sounds. At posttreatment, a significant reduction in EMG reactivity to all stimuli was observed in participants who received active treatment (either CBT or ST), compared to waitlist controls. The use of startle responses as a PTSD treatment outcome index is discussed.

OBJECTIVE Depression has been linked to irritable bowel syndrome (IBS), but the mechanism underlying this relationship is unknown. This cross-sectional study explores the possibility that negatively skewed beliefs patients hold regarding abdominal pain (ie, catastrophizing) mediate the relationship between depression and pain severity. METHODS The sample included 244 consecutively evaluated individuals who met Rome II diagnosis for IBS without comorbid gastrointestinal disease and completed measures of pain severity, trait anxiety, catastrophizing, maladaptive beliefs, and depression as part of baseline assessment of an National Institutes of Health-funded randomized controlled trial of 2 nondrug treatments. RESULTS Using a mediational model involving a series of linear regressions, results indicated that pain catastrophizing partially mediated the link between depression and abdominal pain severity. Depression, catastrophizing, and control variables accounted for 21% of the variance in pain severity. The finding that patients with IBS with greater depression reported greater pain severity can be partially explained by their tendency to engage in more catastrophic thinking specific to pain. CONCLUSIONS The relation between depression and pain is not, as psychogenic models predict, strictly a direct and linear one but works partly through patients' beliefs regarding their pain in general and pain catastrophizing in specific. Implications of the findings for understanding and investigating the depression-IBS link from a biopsychosocial perspective are discussed.

We assessed the psychiatric co-morbidity associated with chronic posttraumatic stress disorder (PTSD) (1-2 years) secondary to personal injury motor vehicle accidents (MVAs) in two studies. In Study 1, we compared the results of SCID assessments for 75 treatment-seeking MVA survivors (51 with PTSD and 24 with symptoms but no PTSD). In Study 2, we compared similar results among 132 MVA survivors who had been followed prospectively for 12+ months after their accidents (19 with PTSD, 32 who had PTSD but who had remitted, and 81 who never met criteria for PTSD). We found comparable levels of current co-morbid major depression (53%), any mood disorder (62-68%), generalized anxiety disorder (26%) and any anxiety disorder (42%) for both groups of participants with chronic PTSD. These rates of co-morbidity were higher than those found in non-PTSD comparison groups with similar MVA histories.

Although there is currently no Axis I disorder holding anger as its hallmark feature (with the possible exception of intermittent explosive disorder, IED), the impact of anger, aggression, hostility, and related behaviors on society is enormous. Anger and aggression in the workplace, in schools, on the streets, in airplanes, and on the roadways appears to be becoming increasingly commonplace. This article reviews the expanding literature regarding aggression on the roadways given the proximity of such violence to our everyday lives. In particular, this article defines aggressive driving and reviews the history, extent, and consequences of "road rage." A review of the type of individual engaging in aggressive driving behaviors is also provided in an attempt to profile (demographically, psychologically, and psychiatrically) the "aggressive driver." Finally, a review of the three successful programs currently attempting to correct such behaviors through psychological intervention is provided.

This study assessed the relative strength of the association between abuse, negative parenting style, and somatization in irritable bowel syndrome (IBS) patients. Drawing from preclinical stress physiology and abuse research identifying the family social climate as a frequently stronger and independent determinant of long-term health effects than abuse-specific variables, we predicted that negative parenting behaviors would more strongly correlate with somatization than abuse. Subjects were 81 consecutively evaluated patients, who at baseline underwent psychological testing, measuring perceived parental style, abuse history, somatization, and pain. Although abuse correlated with maternal and paternal rejection, abuse was not associated with somatization. Higher levels of rejection and/or hostility among fathers (not mothers) were more strongly correlated with somatization than was abuse. Further, paternal parenting behaviors were more predictive of somatization than abuse, age, and gender. The lack of an association between abuse and somatization is discussed in light of limitations of biopsychosocial IBS models, whose strong focus on "pathological stressors" (e.g., abuse, trauma) as risk factors may overlook the importance of "less extreme" parenting variables in influencing somatic complaints. The relationship between parenting and somatization is discussed in the context of broader behavioral science research linking disruptions in the quality of parenting to dramatic and long-term changes in patterns of stress reactivity and brain abnormalities seen in IBS patients.

The modified or "emotional" Stroop paradigm has been frequently employed in previous evaluations of information processing models of Posttraumatic Stress Disorder (PTSD) and other anxiety disorders. These studies have frequently documented an attentional bias to trauma-specific threatening stimuli in PTSD patients. However, the response of the Stroop color-naming interference effect to psychological treatment has yet to be tested in a trauma population. The present study evaluated the effects of three treatment conditions on the Stroop interference effect in motor vehicle accident (MVA) survivors with PTSD. Following treatment, participants were classified as either treatment responders or nonresponders. Participants named the color of three types of stimuli: MVA trauma-specific words, neutral words, and nonwords. Results showed that change in selective color-naming interference for trauma cues was unrelated to treatment response or modality at either posttreatment or follow-up. Findings cast doubt on the clinical utility of the modified Stroop test as a measure of treatment outcome in this population.

The field of pathological gambling is in its infancy. In this paper, we describe cognitive and behavioral models and treatment approaches to pathological gambling. We conclude that, based on controlled outcome research, cognitive behavioral therapies are among the more promising interventions. However, these interventions seem to pay insufficient attention to motivational factors and are marred by high attrition rates. As a possible remedy, we propose a motivationally enhanced cognitive behavioral intervention to increase pathological gamblers' engagement in, and commitment to, the treatment process. We present a case report to illustrate this intervention.

Objective.—This study examined somatic, psychological, and cognitive functioning of subjects with posttraumatic headache in comparison with multiple control groups. Background.—Posttraumatic headache is not as widely studied as other forms of headache (eg, tension-type, migraine). Previous research has suggested poor psychological functioning in patients with posttraumatic headache in comparison with other groups of patients with pain; however, this group has yet to be compared with a group of persons who have experienced trauma but are headache-free. Design and Methods.—Nineteen subjects with posttraumatic headache were studied, with full assessments available for 14 participants. Comparison groups, containing 16 participants each, included another headache group, a nonheadache group, and a trauma (motor vehicle accident) survivor nonheadache group. Participants completed several measures assessing somatic, psychological, and cognitive functioning. Results.—Findings revealed that the posttraumatic headache group exhibited significantly poorer functioning than the comparison groups on several measures including the Psychosomatic Symptom Checklist, Postconcussion Syndrome Checklist, axis II psychiatric diagnoses, Minnesota Multiphasic Personality Inventory, and the Daily Hassles Scale (frequency and total). Additionally, they scored higher on the following: number of axis I psychiatric diagnoses, the Daily Hassles Scale (intensity), Beck Depression Inventory, State-Trait Anxiety Inventory, and State-Trait Anger Expression Inventory. The posttraumatic headache group was similar to the other trauma group on the Posttraumatic Stress Disorder Symptom Checklist and the Life-Trauma Checklist. Conclusions.—This study confirmed the distress seen in this understudied population of persons with headache and highlights areas of focus for proper assessment and treatment of those with headache and who have had an accident.

Six professional actors, trained by psychologists and acting coaches to feign PTSD, were covertly enrolled into a treatment outcome study for PTSD with the aim of investigating malingering. During pretreatment assessment, individuals completed an emotional Stroop task. Vocal response latencies to different classes of stimuli were examined for sensitivity to malingering. Actor response latencies were compared to those of 6 nonlitigant PTSD patients and 6 nonanxiety controls. The actor/dissimulation group was able to feign an overall slowing of response latency across stimulus types, similar to the PTSD group. However, they were unable to modulate response latency as a function of stimulus content, a pattern that characterized the PTSD group. The use of information-processing paradigms to detect dissimulation is discussed.

Previous research has established that patients with irritable bowel syndrome (IBS) frequently have comorbid psychiatric disorders. This study sought to establish if the timing of the onset of psychiatric disorders indicated that IBS was more likely to be caused by or more likely to cause psychological difficulties. Participants were 188 treatment-seeking IBS patients who were assessed for psychiatric diagnoses using a semistructured clinical interview. Timing of the onset of any lifetime psychiatric disorders was noted in an attempt to determine if psychiatric disorders were more likely to precede or follow the onset of IBS symptoms. Those participants that met criteria for an Axis I disorder sometime during their life were significantly more likely to develop an Axis I disorder before the onset of IBS symptoms. Anxiety disorders were the most likely disorder to develop before IBS. These results support the theory that psychiatric symptoms, especially anxiety, play a role in the development of IBS.

We sought to predict posttreatment PTSD symptom scores (Clinician-Administered PTSD Scale scores) among motor vehicle accident (MVA) survivors with PTSD who had received either cognitive behavioral treatment (CBT; n = 30) or supportive psychotherapy (SUPPORT; n = 27) using pretreatment variables. We could account for 43% (CBT) to 70% (SUPPORT) of variance in the measure of PTSD symptoms. The most consistent predictors were pretreatment PTSD symptom scores. Comorbid conditions, especially depression, and degree of initial impairment were also significant predictors.

Fourteen patients with posttraumatic headache (PTHA) were treated with a comprehensive treatment package targeting headache symptoms along with associated posttraumatic stress symptoms. Treatment consisted of some or all of the following depending on headache features: thermal biofeedback, electromyography biofeedback targeting the forehead and/or neck muscles, progressive muscle relaxation, education and cognitive-behavioral therapy. Mean improvement for the treatment group was 21%, whereas mean improvement for the wait-list group was--14% indicating a worsening of headache; however, the difference between groups was not statistically significant. There was a significant between groups difference on headache-free days. Within group results were modest with 29% mean improvement by the end of treatment. The reduction in headache index was significant. Minor reductions in psychopathology, most notably anxiety, were found after treatment. This study confirmed the treatment difficulties seen in this understudied population of headache sufferers, but offered hope for symptom relief.

This study tested the efficacy of a cognitive-behavioral psychological intervention (CBT) targeting aggressive driving behaviors within both a court-referred (N=20) and a self-referred community (N=8) sample as compared to a symptom monitoring (SM) only control condition. Treatment outcome was assessed through the use of daily driving diaries, standard psychological tests, and a global rating of change scale. The CBT treatment condition improved more than the SM condition as assessed through the daily driving diaries. Although the court-referred and self-referred samples showed equivalent improvement on the driving diaries, the self-referred group improved more on measures of general anger. Standardized measures of driving anger, state anxiety and measures of general anger indicated significant change in the expected direction. Aggressive drivers who met criteria for Intermittent Explosive Disorder (IED) showed a trend to improve less than non-IED aggressive drivers. Treatment gains were maintained at the 2-month follow-up point.

This study examined the impact of a co-occurring personality disorder on the development and remission of posttraumatic stress disorder (PTSD) in 158 motor vehicle accident (MVA) survivors followed prospectively for 1 year. Participants were assessed 1 to 4 months after trauma and at 6-month and 1-year follow-up evaluations during 1991 through 1993. These archival data were analyzed in the present study. The prevalence of at least one personality disorder was 13.3%, with the majority (52.4%) presenting with obsessive-compulsive personality disorder. Persons with a personality disorder were significantly more likely to be diagnosed with PTSD at 1-year follow-up evaluation. For persons diagnosed with PTSD at the initial assessment, those with a personality disorder were significantly less likely to remit by 1 year. The presence of a preexisting personality disorder may increase the risk of chronic PTSD and impede remission.

We compared two groups of aggressive drivers, those who met criteria for Intermittent Explosive Disorder (IED) (n=10) and comparable aggressive drivers who did not meet IED criteria (n=20), to a group of non-aggressive driving controls (n=20) on measures of psychological distress, anger, hostility, and Type A behavior as well as measures of aggressive driving and driving anger and their driving records. There were few differences between the aggressive drivers with IED and those without IED. The IED positive aggressive drivers endorsed more assaultiveness and resentment as well as more impatience and showed trends to have more hostility and angry temperament. When all aggressive drivers were compared to controls, differences emerged on anxiety, hostility, and anger as well as on measure specific to aggressive driving (competitiveness) and driving anger (at slow drivers and traffic obstructions).

The current study describes the successful administration of hypnotherapy with a subject suffering from refractory Irritable Bowel Syndrome (IBS) and Generalized Anxiety Disorder (GAD). The subject had suffered from IBS for 30 years and had unsuccessfully pursued multiple psychological treatments, both traditional and non-traditional. He was referred to the Center for Stress and Anxiety Disorders and commenced hypnotherapy directed primarily at the IBS symptoms. After 6 treatment sessions, his IBS symptomatology had improved 53%. He stopped treatment at that point and continued autohypnosis with the aid of treatment audiotapes provided by his therapist. Follow-up at 6 months indicated continued improvement (70%). A 2-year follow-up revealed an improvement of 38% in IBS symptomatology. Concurrent levels of depression and anxiety had also substantially decreased. Hypnotherapy is shown to be a viable, palatable, and enduring treatment option for an individual who had been refractory to many previous therapies.

Seeking to replicate earlier reports by Shalev et al. (1998) and R. A. Bryant, A. G. Harvey, R. M. Guthrie, and M. L. Moulds (2000) that elevated heart rate (HR) shortly after a trauma was predictive of later posttraumatic stress disorder (PTSD), we examined vital sign data on 74 treatment-seeking motor vehicle accident (MVA) survivors, taken in the Emergency Department (ED) following their MVAs. Contrary to expectations, we found that those with elevated HRs in the ED were significantly less likely to meet criteria for PTSD 13 months post-MVA and that those with elevated HRs had lower levels of posttraumatic stress symptoms. Likewise, those with current PTSD had lower ED values of HR and DBP than did those who did not currently meet criteria for PTSD.

In a population of 71 (57 female, 14 male) IBS patients seeking psychological treatment, we found expected levels of childhood sexual and physical abuse (57.7%) and expected levels of current Axis I psychiatric disorders (54.9%). Moreover, we found those who had been victims of early abuse had higher current Beck Depression Inventory scores. However, contrary to expectations, there were no significant associations between early abuse and current psychiatric disorder in this population, suggesting that those individuals with psychological distress are not exactly the same group with a history of abuse.

This study investigated the ability of professional actors to fool experienced clinical evaluators with symptoms of posttraumatic stress disorder (PTSD) following a motor vehicle accident. Six trained method actors were coached with criteria for PTSD. Simulators were then entered covertly into an ongoing evaluation and treatment study in which six experienced clinical psychology doctoral students unknowingly evaluated the simulators. Examination of clinical interview material, psychological test measures and psychophysiological measures was then performed in both a case-by-case and group comparison method. Results revealed that none of the simulators were initially detected in the routine evaluations. When the assessors were told that they had, in fact, seen a simulator, results revealed that initial clinical judgment resulted in identifying three of the simulators. When clinical interview material was added with psychological test data and psychophysiological measures, accuracy increased to 91%....

Despite somewhat high attrition and relapse rates, cognitive-behavioral interventions for pathological gambling seem promising. As a possible remedy to these problems, we conducted a preliminary study of gambling-specific cognitive-behavior therapy (CBT) with the addition of motivational enhancement techniques (MET) for the treatment of pathological gamblers. Data on psychophysiological arousal upon exposure to imagined gambling vignettes were collected at both pre- and posttreatment. Results indicate that participants showed decreases in degree of arousal during the vignettes from pre- to posttreatment. There was also a strong dose-response relationship between reductions in gambling symptoms and reductions in arousal. These findings are discussed, as are their implications for further study of pathological gambling.

This study evaluated 2 hypotheses derived from the theoretical work of A. T. Beck and D. A. Clark (1997). Two anxiety disorder groups, posttraumatic stress disorder (PTSD) and panic disorder (PD), and a nonanxiety control group participated in a modified-Stroop study. The study evaluated whether the diagnostic groups could be differentiated on the basis of responses to stimulus valence and content at different stages of information processing (IP). We found no support for the hypothesis that the diagnostic groups would be sensitive to stimulus valence at automatic stages of IP. Consistent with the second of our 2 hypotheses, the PD group showed delayed vocal responses when processing disorder-specific threat stimuli at strategic stages of IP. The PTSD group showed a generalized valence effect at strategic stages of IP, evincing delayed vocal responses to all stimuli with negative valence. The clinical implications of these findings are discussed, as are directions for future research.

We have conducted a randomized, controlled trial comparing a combination of cognitive and behavioral treatments (CBT), supportive psychotherapy (SUPPORT), or an assessment-only wait-list (WAITLIST) control. To study psychophysiological reactivity in PTSD we measured heart rate (HR) reactivity to idiosyncratic audiotaped descriptions of the motor vehicle accident (MVA) that the participants had survived, both before and after each of the treatments. Results showed significantly greater reduction in HR reactivity for those receiving CBT (n = 25) than for either those in SUPPORT (n = 26) or WAITLIST (n = 22). The latter two conditions did not differ. There were significant but low-level correlations between changes in CAPS scores and changes in HR reactivity collapsing across all groups.

In this study, Herbert Benson's (1975) Relaxation Response Meditation program was tested as a possible treatment for Irritable Bowel Syndrome (IBS). Participants were 16 adults who were matched into pairs based on presence of Axis I disorder, primary IBS symptoms and demographic features and randomized to either a six week meditation condition or a six week wait list symptom monitoring condition. Thirteen participants completed treatment and follow-up. All subjects assigned to the Wait List were subsequently treated. Patients in the treatment condition were taught the meditation technique and asked to practice it twice a day for 15 minutes. Composite Primary IBS Symptom Reduction (CPSR) scores were calculated for each patient from end of baseline to two weeks post-treatment (or to post wait list). One tailed independent sample t-tests revealed that Meditation was superior to the control (P=0.04). Significant within-subject improvements were noted for flatulence (P=0.03) and belching (P=0.02) by post-treatment. By three month follow-up, significant improvements in flatulence (P

The present review, which covers the literature on psychological consequences of road traffic accidents (RTAs) published since 1999, identifies three major areas of research in this field. The first area represents prospective research studies that longitudinally assess the progression of mental dis

In the United States, motor vehicle accidents are the leading cause of accidental death and injury. Aggressive driving, which has been identified as a major risk factor for motor vehicle accidents by transportation authorities, is thus an important topic of study. This study compared the physiological reactivity of self-referred aggressive and nonaggressive drivers. Heart rate, blood pressure, facial muscle activity, and skin resistance were monitored as participants listened to idiosyncratic vignettes of driving and fear-provoking scenarios, as well as during a standard stressor task (mental arithmetic). The results were that aggressive drivers exhibited significant increases in muscle tension and blood pressure during the driving vignettes, relative to controls. They also responded to the fear vignette and mental arithmetic in a qualitatively different fashion from that of controls. The aggressive drivers responded to these stimuli with less overall heart rate and electrodermal reactivity, but increased blood pressure and muscle tension. In contrast, the controls responded to the fear vignette and mental arithmetic primarily with increased heart rates and decreased skin resistance. The findings suggest that both physiological hyperarousal as well as differential responses to stressful stimuli may contribute to aggressive driving. Implications for interventions with this population are discussed.

Sixteen patients with chronic daily headache (HA) of moderate to severe intensity received 20 sessions of self-regulatory treatment including progressive muscle relaxation, thermal biofeedback, and cognitive stress coping therapy. Four stopped treatment after 12 visits (but had received all 3 treatment components). Only 2 of 12 completers (17%) showed more than 50% reduction in HA Index based on daily diaries. Chronic daily HA continues to be relatively refractory to self-regulatory treatment.

Psychophysiological assessments measuring heart rate, systolic and diastolic blood pressure, and skin resistance level were conducted on 7 male compulsive gamblers and on 7 age and gender matched controls while both groups performed mental arithmetic and listened to individualized tapes of the gamblers' preferred form of gambling and an individualized fear tape. Heart rate responses of the gamblers to the 2 gambling audiotapes were significantly greater than those found for the controls whereas the groups did not differ on mental arithmetic or the fear provoking scene, confirming some degree of cue-specific arousal in gamblers. The other physical responses did not yield such strong results. If physiological arousal provides the motivational basis for gambling and is maintained on an intermittent schedule of reinforcement, the findings may have implications for the treatment of compulsive gambling.

This article describes assessment issues in behavioral medicine and a typology of uses of self-monitoring in behavioral medicine assessment. Illustrative examples of the use of self-monitoring in behavioral medicine assessment are presented. Current issues, and methodological concerns, in self-monitoring for behavioral medicine assessment are described along with some ideas for solutions of these issues and concems.

Investigators have recently identified a two-factor structure underlying posttraumatic stress symptoms through the use of exploratory factor analysis. [Taylor et al. (1988). The structure of posttraumatic stress symptoms. Journal of Abnormal Psychology, 107, 154-160]. These two factors, which were labeled as Intrusion and Avoidance, and Hyperarousal and Numbing, are consistent with current theoretical models of posttraumatic stress disorder--PTSD [e.g. Foa et al. (1992). Uncontrollability and unpredictability in post-traumatic stress disorder: An animal model. Psychological Bulletin, 112, 218-238]. However, the authors of the Taylor et al. study issued caution in interpreting their findings because there has yet to be a systematic replication of their results. This paper presents a confirmatory factor analysis of the two-factor structure of posttraumatic stress symptoms in 217 survivors of serious motor vehicle accidents with varying degrees of PTSD symptoms. A hierarchical, confirmatory-factor analysis conducted with a structural equation modeling statistics package confirmed that the model proposed by Taylor et al. can adequately account for the presentation of PTSD symptoms in this sample of motor vehicle accident survivors. The implications for the assessment and diagnosis of PTSD are discussed.

The hypothesis that physiological responses of migraine patients are symptom-specific was evaluated in 29 children (age range 8–16 years) suffering from migraine and 10 healthy control children. The assessment included two major stress phases and a relaxation period. A standard laboratory stressor (a subtraction task) and parent–child conflict served as stressors. A total of six physiological parameters were measured: pulse amplitude at two extracranial (A. temporalis, A. supraorbitalis) and one peripheral (index finger) sites; finger temperature; heart rate; and skin-conductance level. There were no significant group differences in autonomic arousal. Moreover, extracranial and peripheral vasomotor activity was not different between groups, a finding which might be partially due to the considerable interindividual variability. The implications of the results are discussed taking into account that studying pediatric rather than adult migraine patients allows to minimize the potentially confounding impact of factors such as headache chronicity, medication, and additional nonmigraine headaches.