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Trauma victims often come to remember experiencing more trauma than they initially reported. Our experiments are the first to investigate a plausible mechanism for this memory amplification, namely, that people incorporate new details contained in post-event information (PEI) into their event memory. In Experiment 1, participants viewed traumatic photographs, and completed recognition memory tests before and 24-h after PEI exposure. As predicted, PEI distorted traumatic memory. In Experiments 2 and 3, we found that encouraging source monitoring reduced PEI-related errors regardless of whether the delay period between memory tests was shorter (24 h; Experiment 2) or longer (1 week; Experiment 3). Our results suggest that evaluating the source of traumatic photos increases source monitoring, making people resistant to inaccurate PEI.

The heterogeneity of the core symptoms of posttraumatic stress disorder (PTSD), high rates of comorbid mental and physical health conditions, and substantial impact of the disorder on functioning and well‐being contribute to complex clinical presentations that can be challenging to treat. Despite these challenges, there are excellent manualized treatments for PTSD with significant empirical support. Although the success of frontline treatments for PTSD is evident, there remains room for improvement as indicated by suboptimal response and attrition rates. To address challenges to optimal therapy outcomes (COTOs), researchers have conducted numerous clinical trials designed to (a) enhance the core structure of treatment protocols to increase flexibility or (b) expand the protocols to address comorbid conditions that inhibit recovery. However, it is implausible to ever conduct the number of enhancement and expansion clinical trials necessary to test manual modifications for the universe of possible COTOs. This conceptual review describes the concept of a personalized model of therapy that leverages a case formulation approach to implementing an evidence‐based treatment for PTSD. This personalized approach provides guidance for the clinician in assessing the patient's COTOs, monitoring them throughout treatment, and relying on the patient's idiosyncratic data to inform treatment decisions, including how and when to diverge from treatment when clinically indicated and ensuring a clear path to return to trauma‐focused work when the COTO is stabilized. This personalized, case formulation approach to treating PTSD provides guidance for adopting a more flexible approach to treating clinically complex patients while ensuring fidelity to the protocol. [ABSTRACT FROM AUTHOR]

Acute stress disorder (ASD) was included as a diagnosis to the 4th edition of the "Diagnostic and Statistical Manual" (American Psychiatric Association, 1994) as a way of describing pathological reactions in the first month following a trauma. Since that time, ASD has been the focus of some controversy, particularly regarding the theoretical basis and practical utility of the disorder. Despite this controversy, ASD has demonstrated usefulness in identifying individuals experiencing a high level of distress in the acute aftermath of a trauma as well as those at risk for developing posttraumatic stress disorder (PTSD). This paper reviews the clinical application of ASD, the current controversy surrounding its conceptual basis, and then discusses the dilemmas regarding this diagnosis that might occur in clinical practice. A review of the randomized control trial treatment outcome literature for ASD is also included in an effort to assist clinicians selecting interventions for clients recently exposed to traumatic events. Throughout this paper, the relationship between research and applied clinical practice is highlighted. (Contains 1 table.)

Little is known about the cognitive mechanisms involved in the development of psychopathology following psychological maltreatment in children. This study therefore examined the role of thinking styles on children's outcomes following this subtype of maltreatment. Children who had experienced past maltreatment (n = 24) and a control group (n = 26) were assessed using self-report questionnaires. Maltreatment history, cognitive styles and psychological outcomes, such as depression, posttraumatic stress disorder (PTSD) and self-esteem were assessed. Parents/caregivers also completed a measure of child internalizing and externalizing behaviours. Psychological maltreatment made a significant contribution to children's self-reported depression and low self-esteem, and parent reported internalizing and externalizing problems, even after controlling for other abusive experiences. This was not the case for PTSD symptoms. Further, children's cognitive styles were associated with self-reported depression, self-esteem and PTSD. They did not, however, predict parent-rated emotional and behavioural problems. This study provides preliminary support for a cognitive model of adjustment following psychological maltreatment. The results indicate the need for enhanced community awareness about the impact of psychological maltreatment, and suggest a direction for therapeutic intervention.

Research of childhood psychological maltreatment has documented a range of severe and long-lasting difficulties for children who experience this type of abuse. Consequences can include but are not limited to emotional and behavioural problems, low self-esteem, and relationship difficulties. Accordingly, the development of therapy programs to assist children's recovery is imperative. Despite this, there are currently no empirically validated therapy programs designed specifically to target the effects of psychological maltreatment. There is, however, a growing literature on the effectiveness of therapies for other types of maltreatment, in particular sexual abuse. The present paper summarises the literature on treatments for childhood trauma including sexual and physical abuse. The application of these treatments to target outcomes secondary to psychological maltreatment is discussed and future research directions identified.

Three screening methods to predict posttraumatic stress disorder (PTSD) and depression symptoms in children following single-incident trauma were tested. Children and adolescents (N = 90; aged 7-17 years) were assessed within 4 weeks of an injury that led to hospital treatment and followed up 3 and 6 months later. Screening methods were adapted from existing instruments and examined (a) an Australian version of the Screening Tool for Predictors of PTSD (STEPP-AUS), (b) an abbreviated measure of initial PTSD severity, and (c) an abbreviated measure of initial maladaptive trauma-specific beliefs. The STEPP-AUS correctly identified 89% of the children who developed PTSD at 6-month follow-up and the 69% of children who were non-PTSD. Predictive performance of the others instruments was generally poor, and no instrument consistently predicted subclinical levels of depression. (Contains 6 tables.)

Ironic Process Theory and the role of thought suppression have been used in part to explain the phenomenon of intrusive memories in various disorders, including posttraumatic stress disorder. How thought suppression interacts with other cognitive processes believed to be instrumental in the development of traumatic intrusive memory is unclear. In an analogue study, thought suppression and cognitive processing was manipulated in 4 experimental groups after participants (n = 80) viewed a trauma film. The impact of suppression was examined in relation to self-reported intrusive experiences as well as via more objective methods (word stem and dot probe tasks) to assess potential preferential encoding of negative material. Cognitive load appeared to undermine thought suppression ability, with these participants experiencing more intrusions over the week relative to participants in all other conditions. This group also showed greater priming to negative film-related words, and both suppression groups demonstrated enhanced memory for film-related content on recognition testing. Thought suppression mediated the relationship between negative interpretations of initial intrusions and later intrusions experienced over the week. The findings are discussed in the context of ironic process theory and cognitive models of posttraumatic stress. (Contains 1 figure and 2 tables.)

Background: Negative trauma-related cognitions have been found to be a significant factor in the maintenance of post-traumatic stress disorder (PTSD) in adults. Initial studies of such appraisals in trauma-exposed children and adolescents suggest that this is an important line of research in youth, yet empirically validated measures for use with younger populations are lacking. A measure of negative trauma-related cognitions for use with children and adolescents, the Child Post-Traumatic Cognitions Inventory (CPTCI), is presented. The measure was devised as an age-appropriate version of the adult Post-Traumatic Cognitions Inventory (Foa et al., 1999). Methods: The CPTCI was developed and validated within a large (n = 570) sample, comprising community and trauma-exposed samples of children and adolescents aged 6-18 years. Results: Principal components analysis suggested a two-component structure. These components were labelled "permanent and disturbing change" and "fragile person in a scary world", and were each found to possess good internal consistency, test-retest reliability, convergent validity, and discriminative validity. The reliability and validity of these sub-scales was present regardless of whether the measure was completed in the acute phase or several months after a trauma. Scores on these sub-scales did not vary with age. Conclusions: The CPTCI is a reliable and valid measure that is not specific to the type of trauma exposure, and shows considerable promise as a research and clinical tool. The structure of this measure suggests that appraisals concerning the more abstract consequences of a trauma, as well as physical threat and vulnerability, are pertinent factors in trauma-exposed children and adolescents, even prepubescent children.

Previous studies have reported that adding cognitive restructuring (CR) to exposure therapy does not enhance treatment gains in posttraumatic stress disorder (PTSD). This study investigated the extent to which CR would augment treatment response when provided with exposure therapy. The authors randomly allocated 118 civilian trauma survivors with PTSD to receive 8 individually administered sessions of either (a) imaginal exposure (IE), (b) in vivo exposure (IVE), (c) IE combined with IVE (IE/IVE), or (d) IE/IVE combined with CR (IE/IVE/CR). There were fewer patients with PTSD in the IE/IVE/CR (31%) condition than the IE (75%), IVE (69%), and IE/IVE (63%) conditions at a 6-month follow-up assessment. The IE/IVE/CR condition resulted in larger effect sizes than each of the other conditions in terms of PTSD and depressive symptoms. These findings suggest that optimal treatment outcome may be achieved by combining CR with exposure therapy in treating PTSD patients. (Contains 1 figure and 4 tables.)

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The long-term effect of two parent training programs for conduct problem preschoolers is reported. Families of 54 behaviorally disturbed preschool-aged children were randomly assigned to 1 of 3 treatment conditions: standard Parent-Child Interaction Therapy (STD), an abbreviated form of PCIT (ABB), and a no-treatment waitlist control group (WL). Of the families who completed treatment (STD and ABB), data were collected on 97% and 94% of families at 1- and 2-year follow-up, respectively. Follow-up assessment of parent report and independent observations indicated that treatment gains were largely maintained for both treatment conditions with little difference between the two treatments. The findings suggest that an abbreviated form of PCIT has long-term benefits for families with young children displaying early conduct problems.

Significant proportions of participants drop out of cognitive behaviour therapy for post-traumatic stress disorder (PTSD). This study indexed the pretreatment characteristics of civilian trauma survivors who remained in (n = 95) and dropped out (n = 33) of therapy for chronic PTSD. Therapy involved either cognitive behaviour therapy or supportive counselling. Participants who dropped out of therapy had higher scores on the Impact of Event Scale-Avoidance and the Catastrophic Cognitions Questionnaire, controlling for the influence of pretreatment PTSD severity. These findings suggest that retaining participants in therapy for PTSD may be enhanced by focusing initial therapy attention on modification of catastrophic cognitive styles and avoidance tendencies. (Contains 1 table.)

We undertook a systematic review to assess the efficacy of exposure-based writing therapies (WTs) for trauma-exposed adults with subthreshold or clinical levels of posttraumatic stress disorder. Four databases (PsycINFO, Medline, Wiley Online, PILOTS) were searched for randomized controlled trials (RCTs) of exposure-based WTs. A total of 13 RCTs that reported on results from 17 WT versus control comparisons were included. The primary outcomes were posttraumatic stress symptom severity at posttreatment and/or clinical response. An overall unclear or high risk of bias was identified in 84.6% of studies. In comparison to both waitlist k = 3, Hedges' g = -0.97, 95% CI [-1.20, -0.73], and placebo writing conditions, k = 9, Hedges' g = -0.48, 95% CI [-0.87, -0.08], WTs were more beneficial to participants. There was no evidence of a difference between WTs that were longer in duration compared to other psychotherapy, k = 2; pooled OR = 1.42; 95% CI [0.83, 2.43]. These findings indicate that exposure-based WTs are effective when compared to waitlist and placebo writing control conditions. The evidence needs to be considered in the context of the modest number of studies conducted to date, the high methodological heterogeneity between the studies, and the high or unclear risk of bias across many studies. Further research is needed to increase the evidence base regarding the efficacy of WTs for posttraumatic stress. Future research should also measure the mediators and predictors of outcomes to further develop protocols and understand which variants of WTs work for different populations or individuals. [ABSTRACT FROM AUTHOR]

Trauma-related rumination is considered one cognitive process that underlies the maintenance of posttraumatic stress. However experimental findings for the effect of trauma-related rumination have been inconclusive and a moderating role of trait rumination has been speculated. Further, existing depression may also interact with traumarelated rumination to increase posttraumatic stress symptoms. The roles of trauma-related rumination, trait rumination and existing depression were therefore investigated. Healthy female participants watched an analogue trauma film and completed either film-related rumination or control inductions involving a distraction and free-thinking task in the first and second experiments, respectively. Participants' frequency of film-related intrusions and associated distress levels were assessed within the initial experimental session, over 1-week after the film and at 1-week follow-up. Induced rumination resulted in greater intrusion-related distress in the second experiment. However no consistent moderations of trait rumination and existing depression were found. Theoretical and clinical implications of findings are discussed. [ABSTRACT FROM AUTHOR]