An integrative-sequential treatment model for posttraumatic stress disorder: A case study of the Japanese American internment and redress

Prolonged Exposure Counterconditioning (PEC) as a Treatment for Chronic Post-Traumatic Stress Disorder and Major Depression in an Adult Survivor of Repeated Child Sexual and Physical Abuse

Prolonged exposure counterconditioning (PEC) was tested as a treatment for chronic post-traumatic stress disorder (PTSD) in an adult survivor of repeated child sexual and physical abuse. PEC utilizes imaginal reliving of very pleasurable life moments in order to weaken traumatic conditioned emotional responses (CERs). A higher-order conditioned stimuli (CS) is used as a traumatic CER elicitor. Prolonged imaginal reliving of pleasurable CSs is used as a counterconditioner to the traumatic CERs. A statistical technique for analyzing single-case subject designs based on classical test theory was used to evaluate the client's progress in treatment. Results showed that PEC effectively decreased the client's PTSD symptoms, depression, and anxiety. In addition, the client's negative cognitions became considerably more positive. Also, the client lost his comorbid conditions of chronic major depressive disorder and social phobia. Finally, other clinically observed symptoms, which are described in the article, improved markedly. All results were maintained at a 3-month follow-up.

Adverse race-related events as a risk factor for posttraumatic stress disorder in Asian American Vietnam veterans

Few studies have explored the relationship between exposure to adverse race-related events and posttraumatic stress disorder (PTSD). This study examined whether adverse race-related events can give rise to symptoms that meet the criteria for a PTSD diagnosis as specified in the DSM-IV. Three hundred Asian American Vietnam veterans were administered a Mississippi Scale and a questionnaire that assessed exposure to adverse race-related events in the military and associated PTSD symptoms. A subsample was administered the Clinician-Administered PTSD Scale. A majority of the participants (77%) reported exposure to adverse race-related events. Depending on the number of events to which they were exposed, between 13% and 36% reported symptoms consistent with meeting full criteria for PTSD. Mississippi Scale scores increased significantly as a function of frequency of exposure to adverse race-related events. These results converge with the Clinician-Administered PTSD Scale findings to demonstrate that adverse race-related events can be traumatic and associated with PTSD. These findings support the construct and convergent validity of race-related PTSD.

Intergenerational communication of race-related trauma by Japanese American former internees

The present study investigated the intergenerational communications between Japanese Americans who were unjustly ordered into U.S. concentration camps during World War II and their offspring born after the war. Survey data were collected from 450 2nd-generation (Nisei) Japanese American former internees to assess patterns of communication with their children about the internment. The study and its results are discussed in relation to racial socialization and the influence of ethnicity on reactions to traumatic stress.

Coping with the stress of a painful medical procedure

To evaluate its effect on procedure-related distress, the focus of attention was manipulated by providing training to hospitalized acute burn patients (n=42). Participants were randomly assigned to attention focusing (i.e. attending to procedural sensations) or music distraction (i.e. attention diverting) coping interventions, or to usual care during the target dressing change. Coping behavior (i.e. distraction, focusing, and three confounding methods, ignoring, catastrophizing, reinterpreting), tension and intrusiveness were evaluated 24 h retrospectively (i.e. for the prior procedure), during the targeted procedure, and 30 min after the target procedure. When coping during the target procedure by ignoring, reinterpreting, and catastrophizing were covaried, the music distraction group experienced significantly fewer intrusions, and the attention focus group had more intrusions. Additionally, secondary analyses revealed that coping by ignoring during the prior day's procedure significantly predicted higher procedural tension during, and more intrusions following, the targeted procedure. Suppression-based forms of emotion-focused coping may be enhanced by training in the use of an explicit distractor.

Regulating acute posttrauma distress

The influence of emotion-approach and emotion-avoidance methods of coping on the development (cohort 1) and persistence (cohort 2) of posttraumatic stress symptoms was examined. The two coping methods and the frequency and intensity of intrusive, avoidant, and hyperarousal symptoms were assessed in separate series of 71 and 94 hospitalized acute burn-injured patients. In both samples, subjects who frequently used both mental distancing (emotion-avoidance) and venting emotions (emotion-approach), relative to subjects who used only one or neither of the two coping methods, had higher levels of posttraumatic stress disorder symptoms even when controlling for baseline symptoms. Higgins' (1997) motivational framework, incorporating the needs for controllability and predictability, and Wegner's (1994) theory of mental control are used to interpret the findings.

World war II veterans, social support, and veterans' associations

People use many different coping strategies to deal with their traumatic recollections. Twenty-five British World War II veterans were interviewed regarding the ways they used social support both during the war and in the years afterwards. The findings demonstrate that social support is used in fundamentally different ways. During the war comradeship was particularly important and even fifty years after the war comrades are still a valuable resource for discussing war experiences, and dealing with the emotional content of traumatic recollections. Veterans rely on wives and families to help deal with the more physical and practical elements of coping, but tend not to discuss their traumatic memories with them. The findings show that social support is an important lifelong coping strategy for World War II veterans.

Racial differences in combat-related PTSD: empirical findings and conceptual issues

We critically review the empirical literature on racial differences in epidemiology, psychopathology, and treatment outcome in combat veterans with posttraumatic stress disorder (PTSD). Although there is a body of literature pertaining to various aspects of race and combat-related PTSD, much of the writing is conceptual in nature and based on single case or anecdotal reports, and there is a striking paucity of rigorous empirical findings. Furthermore, despite the prevailing zeitgeist and clinical lore, the limited extant empirical evidence suggests that veterans of different races are more similar to each other than they are different when it comes to the clinical manifestation and response to treatment of combat-related PTSD and associated features. The one area where clear differences exist is in epidemiological rates of PTSD, where minority combat veterans (i.e., Blacks and Hispanics) have been shown to have higher absolute rates of the disorder. However, secondary analyses within the existing epidemiological studies suggest that differential rates of PTSD between racial groups may be a function of differential rates of traumatic stressors and other pre-existing conditions. This finding, in combination with the general paucity of empirical data and certain methodological limitations, significantly moderates the conclusions that should be reached from this body of literature. Further research is needed before we can consider our knowledge in this area complete. A number of conceptual and methodological issues are discussed in order to highlight future research directions.

Care of a patient with post-traumatic stress disorder

Amanda, a single 22-year-old woman, was involved in a road traffic accident One passenger died and another received a number of serious injuries. Amanda received injuries that required hospitalization and reconstructive surgery; from which she made a full recovery. Following discharge from hospital, Amanda developed a number of symptoms consistent with post-traumatic stress disorder. One month after the accident Amanda was referred to the community psychiatric nursing service by her district nurse. After treatment which comprised debriefing, relaxation and desensitization Amanda reported a significant improvement in her symptoms and was able to return to work. Amanda had no previous history of mental health problems.

Early avoidance of traumatic stimuli predicts chronicity of intrusive thoughts following burn injury

The role of avoidance behavior in perpetuating the experience of intrusive thoughts among burn survivors was investigated. The Impact of Events Scale (IES), which has subscales that measure the frequency of intrusive thoughts and avoidance behavior, was administered to burn survivors (n = 23) upon discharge and four months later. Both avoidance behavior and intrusive thoughts at discharge were significantly related to experiencing intrusive thoughts at four months (r = 0.59, P < 0.003, r = 0.45, P < 0.03, respectively). In a hierarchical regression analysis controlling for intrusive thoughts at discharge, avoidance behavior continued to significantly predict intrusive thoughts at four months [B = 0.43, t(20) = 2.9, P < 0.009]. Limitations of the study and implications for treatment are discussed.

Human rights and mental health among Latin American women in situations of state-sponsored violence. Bibliographic resources

A Task Force of the American Psychological Association Division 35, Psychology of Women, has been collecting resources that address issues of human rights and mental health among Latin American women living in situations of war and/or state-sponsored violence. This work is being conducted primarily by women's groups, progressive organizations, and individual women in these contexts of institutionalized political violence. This paper describes our reflections on themes that emerged from our reading of this work. We discuss the false dichotomy between public and private violence, the silencing of women as an inevitable consequence of state-imposed violence, and the collective efforts of women to resist violence and heal its effects. These themes suggest that extreme violence against women can be most adequately understood and responded to within a psychosocial and cultural framework. We examined three issues that emerge from the material gathered by the Task Force that suggest how some Latin American psychologists and activists have begun to articulate such a framework: (a) exile within and outside of one's country of origin; (b) torture, the most extreme form of state-sponsored violence; and (c) nontraditional, culturally appropriate interventions that are alternatives to Anglo-Saxon theory and practice. The work of Latin American individuals is described here as a resource for all who are engaged in the struggle to achieve justice for women.

A proposal for a conditioning model of eye movement desensitization treatment for posttraumatic stress disorder

Although eye movement desensitization (EMD) was introduced as a specific treatment for traumatic memories, a satisfactory explanation of the therapeutic mechanism underlying the method has not been offered. This article describes a model of traumatic memories and EMD based primarily on principles of respondent conditioning, emotional interference with learning, and operant conditioning. A method for evaluating the conditioning model is briefly described.