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Danböck SK, Franke LK, Miedl SF, Liedlgruber M, Bürkner PC, Wilhelm FH. Experimental induction of peritraumatic dissociation: The role of negative affect and pain and their psychophysiological and neural correlates. Behav Res Ther 2023; 164:104289. [PMID: 36934622 DOI: 10.1016/j.brat.2023.104289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 02/21/2023] [Accepted: 03/05/2023] [Indexed: 03/12/2023]
Abstract
While research has elucidated processes underlying dissociative symptoms in patients with posttraumatic stress disorder, little is known about the circumstances under which trauma-related dissociation initially arises. To experimentally investigate causes and concomitants of peritraumatic dissociation, we subjected sixty-nine healthy women to aversive-audiovisual and painful-electrical stimulation in a 2(aversive/neutral film) x 2(pain/no pain) within-subject design while recording psychophysiological and fMRI-BOLD responses. Afterwards, participants rated negative-affect, pain, and dissociation for each condition. Using Bayesian multilevel regression models, we examined (1) whether aversive-audiovisual and painful-electrical stimulation elicit higher dissociation-levels than control conditions and (2) whether stronger negative-affect and pain responses (operationalized via self-report, psychophysiological, and neural markers) correlate with higher dissociation-levels. Several key findings emerged: Both aversive-audiovisual and painful-electrical stimulation elicited dissociation. Dissociation was linked to higher self-reported negative-affect, but we did not find enough evidence linking it to psychophysiological and neural negative-affect markers. However, dissociation was associated with higher levels of self-reported pain, a skin-conductance-response-based pain marker, and the fMRI-BOLD-based Neurologic-Pain-Signature. Results indicate that both aversive-audiovisual and painful stimuli can independently cause dissociation. Critically, pain responses captured via self-report, psychophysiological, and neural markers were consistently linked to higher dissociation-levels suggesting a specific, evolutionary meaningful, contribution of pain to the rise of dissociation.
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Affiliation(s)
- Sarah K Danböck
- Division of Clinical Psychology and Psychopathology, Department of Psychology, Paris Lodron University of Salzburg, Hellbrunner Straße 34, 5020, Salzburg, Austria.
| | - Laila K Franke
- Division of Clinical Psychology and Psychopathology, Department of Psychology, Paris Lodron University of Salzburg, Hellbrunner Straße 34, 5020, Salzburg, Austria
| | - Stephan F Miedl
- Division of Clinical Psychology and Psychopathology, Department of Psychology, Paris Lodron University of Salzburg, Hellbrunner Straße 34, 5020, Salzburg, Austria
| | - Michael Liedlgruber
- Division of Clinical Psychology and Psychopathology, Department of Psychology, Paris Lodron University of Salzburg, Hellbrunner Straße 34, 5020, Salzburg, Austria
| | - Paul-Christian Bürkner
- Cluster of Excellence SimTech, University of Stuttgart, Universitätsstraße 32, 70569, Stuttgart, Germany
| | - Frank H Wilhelm
- Division of Clinical Psychology and Psychopathology, Department of Psychology, Paris Lodron University of Salzburg, Hellbrunner Straße 34, 5020, Salzburg, Austria
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2
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Valladares-Garrido MJ, Zapata-Castro LE, Peralta CI, García-Vicente A, Astudillo-Rueda D, León-Figueroa DA, Díaz-Vélez C. Post-Traumatic Stress Disorder after the 6.1 Magnitude Earthquake in Piura, Peru: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11035. [PMID: 36078753 PMCID: PMC9518033 DOI: 10.3390/ijerph191711035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 08/02/2022] [Accepted: 08/09/2022] [Indexed: 06/15/2023]
Abstract
In Peru, major disasters like the 2007 Pisco earthquake have produced high rates of post-traumatic stress. However, evidence is still needed to strengthen interventions. In 2021, a major earthquake struck Piura, in northern Peru. In this context, we aimed to assess the prevalence of PTSD and its associated factors. A cross-sectional study was conducted during August-September 2021 in people who experienced the 6.1 Piura earthquake on 30 July 2021. The questionnaire included the PCL-C, CD-RISC, ISI, HFIAS, and additional demographic data. Generalized linear models were used. The prevalence of PTSD was 20.3%. Household income was between PEN 2001 and 3000 (PR = 4.26, 95% CI: 1.08-16.75), smoking (PR = 2.49, 95% CI: 1.03-6.01), experience of a nervous breakdown (PR = 1.83, 95% CI: 1.09-3.09), moderate food insecurity (PR = 2.91, 95% CI: 1.10-7.73), and severe insomnia (PR = 8.25, 95% CI: 2.22-30.71) increased the prevalence of PTSD. One out of five individuals experienced post-traumatic stress symptoms after the 2021 earthquake in Piura, which varies depending on socioeconomic, psychosocial, and individual factors. Further research should strengthen these findings to ensure a fair and early mental health intervention against new seismic events in this and other Peruvian regions.
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Affiliation(s)
- Mario J. Valladares-Garrido
- South American Center for Education and Research in Public Health, Universidad Norbert Wiener, Lima 15046, Peru
- Hospital Regional Lambayeque, Chiclayo 14012, Peru
| | - Luis E. Zapata-Castro
- Faculty of Medicine, Universidad Nacional de Piura, Piura 20002, Peru
- Sociedad Científica de Estudiantes de Medicina de la Universidad Nacional de Piura (SOCIEMUNP), Piura 20002, Peru
| | - C. Ichiro Peralta
- Faculty of Medicine, Universidad Nacional Federico Villarreal, Lima 15088, Peru
| | - Abigaíl García-Vicente
- Faculty of Medicine, Universidad Nacional de Piura, Piura 20002, Peru
- Sociedad Científica de Estudiantes de Medicina de la Universidad Nacional de Piura (SOCIEMUNP), Piura 20002, Peru
| | | | - Darwin A. León-Figueroa
- Emerge, Emerging Diseases and Climate Change Research Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima 15013, Peru
- Faculty of Medicine, Universidad de San Martín de Porres, Chiclayo 14012, Peru
| | - Cristian Díaz-Vélez
- School of Medicine, Universidad Privada Antenor Orrego, Trujillo 13008, Peru
- Instituto de Evaluación de Tecnologías en Salud e Investigación-IETSI, EsSalud, Lima 15072, Peru
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3
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Magalhaes AA, Gama CMF, Gonçalves RM, Portugal LCL, David IA, Serpeloni F, Wernersbach Pinto L, Assis SG, Avanci JQ, Volchan E, Figueira I, Vilete LMP, Luz MP, Berger W, Erthal FS, Mendlowicz MV, Mocaiber I, Pereira MG, de Oliveira L. Tonic Immobility is Associated with PTSD Symptoms in Traumatized Adolescents. Psychol Res Behav Manag 2021; 14:1359-1369. [PMID: 34512046 PMCID: PMC8420784 DOI: 10.2147/prbm.s317343] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 08/11/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Growing evidence suggests that peritraumatic tonic immobility, an involuntary defensive response that involves extreme physical immobility and the perceived inability to escape, is a significant predictor of post-traumatic stress disorder (PTSD) symptomatology. However, this issue has not been specifically addressed in adolescents. Here, we investigated whether tonic immobility response experienced during the worst childhood or adolescent trauma is associated with PTSD symptom severity in a non-clinical student sample. Methods The sample was composed of students in 9th grade who were attending public and private schools. Symptoms of post-traumatic stress and tonic immobility were assessed using questionnaires. We performed bivariate and multivariate negative binomial regressions to examine whether tonic immobility was associated with PTSD symptomatology after controlling for confounders (peritraumatic dissociation, peritraumatic panic reactions, gender, age and time since trauma). Results We found an association between tonic immobility and PTSD symptom severity, even after controlling for confounders. Therefore, tonic immobility is associated with PTSD symptoms in trauma-exposed adolescents. Conclusion These findings highlight tonic immobility as a possible risk factor that could be used to provide direction for more targeted trauma interventions for individuals, particularly those at risk for developing PTSD. Therefore, it contributes to preventing and reducing the psychiatric burden in adolescence and later in life.
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Affiliation(s)
- Andressa A Magalhaes
- Biomedical Institute, Fluminense Federal University, Niterói, RJ, 24210-130, Brazil
| | - Camila M F Gama
- Biomedical Institute, Fluminense Federal University, Niterói, RJ, 24210-130, Brazil
| | - Raquel M Gonçalves
- Biomedical Institute, Fluminense Federal University, Niterói, RJ, 24210-130, Brazil
| | - Liana C L Portugal
- Department of Physiological Sciences, State University of Rio de Janeiro, Rio de Janeiro, RJ, 20550-170, Brazil
| | - Isabel A David
- Biomedical Institute, Fluminense Federal University, Niterói, RJ, 24210-130, Brazil
| | - Fernanda Serpeloni
- Department of Violence and Health Studies, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, 21040-900, Brazil
| | - Liana Wernersbach Pinto
- Department of Violence and Health Studies, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, 21040-900, Brazil
| | - Simone G Assis
- Department of Violence and Health Studies, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, 21040-900, Brazil.,The Neurology Postgraduate Program, Hospital Gaffrée and Guinle, Unirio, RJ, 20270-901, Brazil
| | - Joviana Q Avanci
- Department of Violence and Health Studies, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, 21040-900, Brazil
| | - Eliane Volchan
- Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, 21941-902, Brazil
| | - Ivan Figueira
- Psychiatry Institute, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, 22290-140, Brazil
| | - Liliane M P Vilete
- Psychiatry Institute, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, 22290-140, Brazil
| | - Mariana P Luz
- Psychiatry Institute, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, 22290-140, Brazil
| | - William Berger
- Psychiatry Institute, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, 22290-140, Brazil
| | - Fatima S Erthal
- Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, 21941-902, Brazil
| | - Mauro V Mendlowicz
- Department of Psychiatry and Mental Health, Fluminense Federal University, Niterói, RJ, 24030-215, Brazil
| | - Izabela Mocaiber
- Institute of Humanities and Health, Federal Fluminense University, Rio das Ostras, RJ, 28890-000, Brazil
| | - Mirtes G Pereira
- Biomedical Institute, Fluminense Federal University, Niterói, RJ, 24210-130, Brazil
| | - Leticia de Oliveira
- Biomedical Institute, Fluminense Federal University, Niterói, RJ, 24210-130, Brazil
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4
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Bryant RA. A critical review of mechanisms of adaptation to trauma: Implications for early interventions for posttraumatic stress disorder. Clin Psychol Rev 2021; 85:101981. [PMID: 33588312 DOI: 10.1016/j.cpr.2021.101981] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 11/23/2020] [Accepted: 01/19/2021] [Indexed: 10/22/2022]
Abstract
Although many attempts have been made to limit development of posttraumatic stress disorder (PTSD) by early intervention after trauma exposure, these attempts have achieved only modest success. This review critiques the biological and cognitive strategies used for early intervention and outlines the extent to which they have prevented PTSD. The major predictors of PTSD are reviewed, with an emphasis on potential mechanisms that may underpin the transition from acute stress reaction to development of PTSD. This review highlights that there is a wide range of biological and cognitive factors that have been shown to predict PTSD. Despite this, the major attempts at early intervention have focused on strategies that attempt to augment extinction processes or alter appraisals in the acute period. The documented predictors of PTSD indicate that a broader range of potential strategies could be explored to limit PTSD. The evidence that people follow different trajectories of stress response following trauma and there is a wide array of acute predictors of PTSD indicates that a flexible and tailored approach needs to be investigated to evaluate more effective early intervention strategies.
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5
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Hoge EA, Bui E, Mete M, Philip SR, Gabriel C, Ward MJ, Suzuki R, Dutton MA, Simon NM. Treatment for anxiety: Mindfulness meditation versus escitalopram (TAME): Design of a randomized, controlled non-inferiority trial. Contemp Clin Trials 2020; 91:105965. [PMID: 32087339 DOI: 10.1016/j.cct.2020.105965] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 01/29/2020] [Accepted: 02/17/2020] [Indexed: 11/30/2022]
Abstract
Anxiety disorders (generalized anxiety disorder, social anxiety disorder, panic disorder, and agoraphobia) are common, distressing, and impairing. While pharmacotherapy and psychotherapy are first-line treatment strategies for anxiety disorders, many patients are reluctant to take psychiatric medication, and many prefer to avoid any kind of mental health treatment due to stigma or distrust of traditional medical care. We present the trial protocol for the first study comparing first-line medication treatment with Mindfulness-Based Stress Reduction (MBSR), a popular mindfulness meditation training program, for the treatment of anxiety disorders. We will use a non-inferiority, comparative effectiveness trial design, in which individuals with diagnosed anxiety disorders will be randomized to either pharmacotherapy with escitalopram or MBSR for 8 weeks of treatment. Treatment outcome will be based on gold standard symptom severity measures assessed by trained independent evaluators blind to treatment allocation. Secondary outcomes will include key symptom and function measures, as well as tolerability and satisfaction with treatment. Findings will provide crucial information to inform decision making about the relative benefits of MBSR versus a first line medication for anxiety disorders by patients, medical care providers, healthcare insurers and other stakeholders.
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Affiliation(s)
- Elizabeth A Hoge
- Department of Psychiatry, Georgetown University Medical Center, Washington D.C, USA.
| | - Eric Bui
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Mihriye Mete
- Department of Psychiatry, Georgetown University Medical Center, Washington D.C, USA; MedStar Health Research Institute, Hyattsville, MD, USA
| | - Samantha R Philip
- Department of Psychiatry, Georgetown University Medical Center, Washington D.C, USA
| | - Caroline Gabriel
- Department of Psychiatry, Georgetown University Medical Center, Washington D.C, USA
| | - Meredith J Ward
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Rebecca Suzuki
- Department of Psychiatry, NYU Langone Health, New York University School of Medicine, New York, NY, USA
| | - Mary Ann Dutton
- Department of Psychiatry, Georgetown University Medical Center, Washington D.C, USA
| | - Naomi M Simon
- Department of Psychiatry, NYU Langone Health, New York University School of Medicine, New York, NY, USA
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6
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Molosh AI, Dustrude ET, Lukkes JL, Fitz SD, Caliman IF, Abreu ARR, Dietrich AD, Truitt WA, Ver Donck L, Ceusters M, Kent JM, Johnson PL, Shekhar A. Panic results in unique molecular and network changes in the amygdala that facilitate fear responses. Mol Psychiatry 2020; 25:442-460. [PMID: 30108314 PMCID: PMC6410355 DOI: 10.1038/s41380-018-0119-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 04/03/2018] [Accepted: 05/25/2018] [Indexed: 11/12/2022]
Abstract
Recurrent panic attacks (PAs) are a common feature of panic disorder (PD) and post-traumatic stress disorder (PTSD). Several distinct brain regions are involved in the regulation of panic responses, such as perifornical hypothalamus (PeF), periaqueductal gray, amygdala and frontal cortex. We have previously shown that inhibition of GABA synthesis in the PeF produces panic-vulnerable rats. Here, we investigate the mechanisms by which a panic-vulnerable state could lead to persistent fear. We first show that optogenetic activation of glutamatergic terminals from the PeF to the basolateral amygdala (BLA) enhanced the acquisition, delayed the extinction and induced the persistence of fear responses 3 weeks later, confirming a functional PeF-amygdala pathway involved in fear learning. Similar to optogenetic activation of PeF, panic-prone rats also exhibited delayed extinction. Next, we demonstrate that panic-prone rats had altered inhibitory and enhanced excitatory synaptic transmission of the principal neurons, and reduced protein levels of metabotropic glutamate type 2 receptor (mGluR2) in the BLA. Application of an mGluR2-positive allosteric modulator (PAM) reduced glutamate neurotransmission in the BLA slices from panic-prone rats. Treating panic-prone rats with mGluR2 PAM blocked sodium lactate (NaLac)-induced panic responses and normalized fear extinction deficits. Finally, in a subset of patients with comorbid PD, treatment with mGluR2 PAM resulted in complete remission of panic symptoms. These data demonstrate that a panic-prone state leads to specific reduction in mGluR2 function within the amygdala network and facilitates fear, and mGluR2 PAMs could be a targeted treatment for panic symptoms in PD and PTSD patients.
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Affiliation(s)
- A I Molosh
- Department of Psychiatry, Institute of Psychiatric Research, Indiana University School of Medicine, Indianapolis, IN, USA
- Paul and Carol Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, USA
| | - E T Dustrude
- Department of Psychiatry, Institute of Psychiatric Research, Indiana University School of Medicine, Indianapolis, IN, USA
| | - J L Lukkes
- Department of Psychiatry, Institute of Psychiatric Research, Indiana University School of Medicine, Indianapolis, IN, USA
| | - S D Fitz
- Department of Psychiatry, Institute of Psychiatric Research, Indiana University School of Medicine, Indianapolis, IN, USA
| | - I F Caliman
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - A R R Abreu
- Department of Psychiatry, Institute of Psychiatric Research, Indiana University School of Medicine, Indianapolis, IN, USA
| | - A D Dietrich
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - W A Truitt
- Paul and Carol Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - L Ver Donck
- Janssen Research & Development, Beerse, Belgium
| | - M Ceusters
- Janssen Research & Development, Beerse, Belgium
| | - J M Kent
- Janssen Research & Development, LLC, Titusville, NJ, USA
| | - P L Johnson
- Paul and Carol Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - A Shekhar
- Department of Psychiatry, Institute of Psychiatric Research, Indiana University School of Medicine, Indianapolis, IN, USA.
- Paul and Carol Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, USA.
- Indiana Clinical and Translational Sciences Institute, Indiana University School of Medicine, Indianapolis, IN, USA.
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7
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Terpou BA, Harricharan S, McKinnon MC, Frewen P, Jetly R, Lanius RA. The effects of trauma on brain and body: A unifying role for the midbrain periaqueductal gray. J Neurosci Res 2019; 97:1110-1140. [PMID: 31254294 DOI: 10.1002/jnr.24447] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/09/2019] [Accepted: 05/06/2019] [Indexed: 12/18/2022]
Abstract
Post-traumatic stress disorder (PTSD), a diagnosis that may follow the experience of trauma, has multiple symptomatic phenotypes. Generally, individuals with PTSD display symptoms of hyperarousal and of hyperemotionality in the presence of fearful stimuli. A subset of individuals with PTSD; however, elicit dissociative symptomatology (i.e., depersonalization, derealization) in the wake of a perceived threat. This pattern of response characterizes the dissociative subtype of the disorder, which is often associated with emotional numbing and hypoarousal. Both symptomatic phenotypes exhibit attentional threat biases, where threat stimuli are processed preferentially leading to a hypervigilant state that is thought to promote defensive behaviors during threat processing. Accordingly, PTSD and its dissociative subtype are thought to differ in their proclivity to elicit active (i.e., fight, flight) versus passive (i.e., tonic immobility, emotional shutdown) defensive responses, which are characterized by the increased and the decreased expression of the sympathetic nervous system, respectively. Moreover, active and passive defenses are accompanied by primarily endocannabinoid- and opioid-mediated analgesics, respectively. Through critical review of the literature, we apply the defense cascade model to better understand the pathological presentation of defensive responses in PTSD with a focus on the functioning of lower-level midbrain and extended brainstem systems.
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Affiliation(s)
- Braeden A Terpou
- Department of Neuroscience, Western University, London, Ontario, Canada
| | | | - Margaret C McKinnon
- Mood Disorders Program, St. Joseph's Healthcare, Hamilton, Ontario, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Homewood Research Institute, Guelph, Ontario, Canada
| | - Paul Frewen
- Department of Psychology, Western University, London, Ontario, Canada
| | - Rakesh Jetly
- Canadian Forces, Health Services, Ottawa, Canada
| | - Ruth A Lanius
- Department of Neuroscience, Western University, London, Ontario, Canada.,Department of Psychiatry, Western University, London, Ontario, Canada
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8
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Bryant RA. Acute stress disorder. Curr Opin Psychol 2017; 14:127-131. [PMID: 28813311 DOI: 10.1016/j.copsyc.2017.01.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 12/30/2016] [Accepted: 01/11/2017] [Indexed: 12/28/2022]
Abstract
Acute stress disorder (ASD) was introduced in DSM-IV to describe posttraumatic stress disorder (PTSD) symptoms that (a) occur in the initial month after trauma and (b) predict subsequent PTSD. Longitudinal studies have shown that most people who develop PTSD do not initially meet ASD criteria, which led to the decision in DSM-5 to limit the ASD diagnosis to describing acute stress reactions without any predictive function. Controlled trials have shown that trauma-focused cognitive behavior therapy is the treatment of choice for ASD, and is superior to pharmacological interventions. Recent longitudinal studies have challenged previous conceptualizations of the course of posttraumatic stress, and highlighted that people follow different trajectories of adaptation that are influenced by events that occur after the acute posttraumatic period.
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Affiliation(s)
- Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, NSW 2052, Australia.
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9
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Murphy S, Elklit A, Murphy J, Hyland P, Shevlin M. A Cross-Lagged Panel Study of Dissociation and Posttraumatic Stress in a Treatment-Seeking Sample of Survivors of Childhood Sexual Abuse. J Clin Psychol 2017; 73:1370-1381. [DOI: 10.1002/jclp.22439] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 11/07/2016] [Accepted: 12/04/2016] [Indexed: 11/10/2022]
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10
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Aho N, Proczkowska Björklund M, Svedin CG. Peritraumatic reactions in relation to trauma exposure and symptoms of posttraumatic stress in high school students. Eur J Psychotraumatol 2017; 8:1380998. [PMID: 29163861 PMCID: PMC5687802 DOI: 10.1080/20008198.2017.1380998] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 09/09/2017] [Indexed: 11/08/2022] Open
Abstract
Background: Exposure to traumatic events is clearly associated with a diversity of subsequent mental health problems, with posttraumatic stress disorder (PTSD) as the most prevalent disorder. Epidemiologically, trauma exposure rates are more prevalent than PTSD, indicating that most trauma victims do not develop PTSD. More knowledge is needed to understand the development of the different posttraumatic pathways including the significance of pretraumatic, peritraumatic and posttraumatic risk factors. Objective: To study peritraumatic reactions in relation to trauma exposure and symptoms of posttraumatic stress and to enhance our understanding of peritraumatic reactions as mediators between trauma and later symptomatology. Method: The study was composed of a representative community sample of 5332 second year high school students (mean age 17.3 years) who completed the Juvenile Victimization Questionnaire (SAQ/JVQ), Trauma Symptom Checklist for Children (TSCC) and answered questions about peritraumatic reactions. Mediation effects of peritraumatic reactions on the trauma exposure relationship to symptoms was tested using the PROCESS macro for SPSS. Results: Traumatic events are common (84.1%) and are accompanied in three-quarters of the students with at least one form of peritraumatic reaction. Peritraumatic reactions, especially peritraumatic dissociative reactions, mediate the relationship between trauma exposure and symptoms, and gender moderates the effect of peritraumatic dissociation. This moderating effect was found to be larger for boys than for girls, indicating gender differences in response to trauma. Conclusions: The results indicate the need to screen for peritraumatic reactions as early as possible after a traumatic event in order to identify those at risk for PTSD.
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Affiliation(s)
- Nikolas Aho
- Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry, Linköping, Sweden
| | - Marie Proczkowska Björklund
- Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry, Linköping, Sweden
| | - Carl Göran Svedin
- Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry, Linköping, Sweden
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11
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Tay AK, Rees S, Chen J, Kareth M, Silove D. Pathways from conflict-related trauma and ongoing adversity to posttraumatic stress disorder symptoms amongst West Papuan refugees: The mediating role of anxiety and panic-like symptoms. Compr Psychiatry 2015; 63:36-45. [PMID: 26555490 DOI: 10.1016/j.comppsych.2015.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 08/06/2015] [Accepted: 08/09/2015] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Although the relationship involving exposure to traumatic events (TEs), conditions of adversity, and posttraumatic stress disorder (PTSD) is well established in the refugee field, the psychological factors mediating the relevant pathways are not as clearly delineated. In the present path analysis, we examined a model in which anxiety and panic-like symptoms mediated the path between conflict-related TEs, ongoing adversity, and PTS symptoms amongst 230 refugees from West Papua. METHODS Culturally adapted measures were applied to assess TE exposure, ongoing adversity, anxiety, panic-like, PTS, and depressive symptoms. RESULTS Our model identified two pathways leading from conflict-related exposure to PTS symptoms, one a direct path, the other mediated by a sequence of ongoing adversity, anxiety and panic-like symptoms. Older refugees from West Papua had higher levels of anxiety and panic-like symptoms than the younger adult generation born in PNG. CONCLUSIONS Our findings suggest that a focus on reducing anxiety and panic together with addressing social deprivations and threats may improve anxiety and panic amongst refugees, ultimately improving outcomes for PTS symptoms.
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Affiliation(s)
- Alvin Kuowei Tay
- Psychiatry Research and Teaching Unit, School of Psychiatry, University of NSW, NSW, Australia.
| | - Susan Rees
- Psychiatry Research and Teaching Unit, School of Psychiatry, University of NSW, NSW, Australia
| | - Jack Chen
- Simpson Centre for Health Services Research, University of New South Wales
| | - Moses Kareth
- Psychiatry Research and Teaching Unit, School of Psychiatry, University of NSW, NSW, Australia
| | - Derrick Silove
- Psychiatry Research and Teaching Unit, School of Psychiatry, University of NSW, NSW, Australia
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12
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Examining the Latent Structure of Acute Stress Disorder Symptoms in Filipino-Victims of a Flashflood Disaster. Community Ment Health J 2015; 51:613-20. [PMID: 25575912 DOI: 10.1007/s10597-015-9826-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Accepted: 01/02/2015] [Indexed: 10/24/2022]
Abstract
Although Acute Stress Disorder (ASD) was introduced in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition for a number of years already, only few studies have examined ASD in its latent level. Utilizing 998 respondents who experienced a deadly flashflood, the results revealed that of the 7 models, Dysphoric arousal model fitted best whereas the new DSM-5 single factor model received the lowest fit. The findings of the study are pertinent in the current changes of ASD in DSM-5 and would elucidate further ASD's latent structure that best represent Asian sample, particularly Filipinos.
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Mordeno IG, Nalipay MJN, Alfonso MKS, Cue MP. Examining the Latent Structure of Posttraumatic Growth Between Male and Female Survivors in the Immediate Aftermath of a Flash Flood Disaster. CURRENT PSYCHOLOGY 2015. [DOI: 10.1007/s12144-015-9325-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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The Role of Functionality in the Latent Structure of Posttraumatic Growth among Survivors of a Flash Flood Disaster. PSYCHOLOGICAL STUDIES 2015. [DOI: 10.1007/s12646-015-0303-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Christiansen DM, Hansen M. Accounting for sex differences in PTSD: A multi-variable mediation model. Eur J Psychotraumatol 2015; 6:26068. [PMID: 25604705 PMCID: PMC4300366 DOI: 10.3402/ejpt.v6.26068] [Citation(s) in RCA: 148] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 12/04/2014] [Accepted: 12/13/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Approximately twice as many females as males are diagnosed with posttraumatic stress disorder (PTSD). However, little is known about why females report more PTSD symptoms than males. Prior studies have generally focused on few potential mediators at a time and have often used methods that were not ideally suited to test for mediation effects. Prior research has identified a number of individual risk factors that may contribute to sex differences in PTSD severity, although these cannot fully account for the increased symptom levels in females when examined individually. OBJECTIVE The present study is the first to systematically test the hypothesis that a combination of pre-, peri-, and posttraumatic risk factors more prevalent in females can account for sex differences in PTSD severity. METHOD The study was a quasi-prospective questionnaire survey assessing PTSD and related variables in 73.3% of all Danish bank employees exposed to bank robbery during the period from April 2010 to April 2011. Participants filled out questionnaires 1 week (T1, N=450) and 6 months after the robbery (T2, N=368; 61.1% females). Mediation was examined using an analysis designed specifically to test a multiple mediator model. RESULTS Females reported more PTSD symptoms than males and higher levels of neuroticism, depression, physical anxiety sensitivity, peritraumatic fear, horror, and helplessness (the A2 criterion), tonic immobility, panic, dissociation, negative posttraumatic cognitions about self and the world, and feeling let down. These variables were included in the model as potential mediators. The combination of risk factors significantly mediated the association between sex and PTSD severity, accounting for 83% of the association. CONCLUSION The findings suggest that females report more PTSD symptoms because they experience higher levels of associated risk factors. The results are relevant to other trauma populations and to other trauma-related psychiatric disorders more prevalent in females, such as depression and anxiety.
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Affiliation(s)
- Dorte M Christiansen
- Department of Psychology, University of Aarhus, Aarhus C, Demark; National Centre for Psychotraumatology, University of Southern Denmark, Odense M, Denmark;
| | - Maj Hansen
- Institute of Psychology, University of Southern Denmark, Odense M, Denmark
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Hansen M, Armour C, Wittmann L, Elklit A, Shevlin M. Is there a common pathway to developing ASD and PTSD symptoms? J Anxiety Disord 2014; 28:865-72. [PMID: 25445076 DOI: 10.1016/j.janxdis.2014.09.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 09/09/2014] [Accepted: 09/10/2014] [Indexed: 10/24/2022]
Abstract
Numerous studies have identified risk factors for acute and long-term posttraumatic stress symptoms following traumatic exposure. However, little is known about whether there are common pathways to the development of acute stress disorder (ASD) and posttraumatic stress disorder (PTSD). Research suggests that a common path to ASD and PTSD may lie in peritraumatic responses and cognitions. The results of structural equation modeling in a national sample of Danish bank robbery victims (N=450) show that peritraumatic panic, anxiety sensitivity, and negative cognitions about self were significant common risk factors for both ASD severity and PTSD severity when controlled for the effect of the other risk factors. The strongest common risk factor was negative cognitions about self. Future research should focus on replicating these results as they point to possible areas of preventive and treatment actions against the development of traumatic stress symptoms.
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Affiliation(s)
- Maj Hansen
- National Centre for Psychotraumatology, Institute for Psychology, University of Southern Denmark, Denmark.
| | - Cherie Armour
- School of Psychology and Psychology Research Institute, University of Ulster, Northern Ireland, UK
| | - Lutz Wittmann
- International Psychoanalytic University, Berlin, Germany
| | - Ask Elklit
- National Centre for Psychotraumatology, Institute for Psychology, University of Southern Denmark, Denmark
| | - Mark Shevlin
- School of Psychology and Psychology Research Institute, University of Ulster, Northern Ireland, UK
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Examining posttraumatic stress disorder's latent structure between treatment-seeking and non-treatment-seeking Filipinos. Asian J Psychiatr 2014; 11:28-34. [PMID: 25453693 DOI: 10.1016/j.ajp.2014.05.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 05/12/2014] [Accepted: 05/25/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND The discourse of latent structure of posttraumatic stress disorder (PTSD) has been extensive in trauma literature. Although findings have been consistent in rejecting DSM-IV-TR's three-factor model, alternative models are still fervently argued. This study contributes to the discussion by examining and comparing PTSD factor structure of the three most validated models—numbing model (King et al., 1998), dysphoria model (Simms et al., 2002), and dysphoric arousal model (Elhai et al., 2011b)—and determining if these are generalizable across treatment-seeking and non-treatment-seeking Filipinos with exposure to trauma events. METHODS Filipino-Tagalog version of Harvard Trauma Questionnaire (HTQ; Mollica et al., 1992) was administered to a sample of 737 treatment-seeking (n=526) and non-treatment-seeking (n=211) Filipinos who experienced and witnessed varied trauma events. Confirmatory factor analysis (CFA) was conducted involving the three models in order to determine the best-fitting model and generalizability across samples. RESULTS Results showed that all three models achieved excellent fit, with dysphoric arousal model slightly fitting better than numbing and dysphoria models in both treatment-seeking and non-treatment-seeking samples. Series of invariance testing, however, indicated that although dysphoric arousal model fits significantly better than dysphoria model, it did not significantly differ from numbing model. Results revealed that aside from the factor loadings, the two groups are noninvariant in all parameters. Treatment-seeking sample had larger intercepts, factor variances and covariances and factor means than non-treatment-seeking group. DISCUSSION The findings strongly contribute to the literature by showing how the type of groupings (treatment-seeking vs. non-treatment-seeking) moderates PTSD latent structure. It affirms the suggestion of Biehn et al. (2012) to be cautious in concluding the generalizability of PTSD models in the context that type of participants moderates PTSD's factor structure.
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Taylor MK, Larson GE, Hiller Lauby MD, Padilla GA, Wilson IE, Schmied EA, Highfill-McRoy RM, Morgan CA. Sex differences in cardiovascular and subjective stress reactions: prospective evidence in a realistic military setting. Stress 2014; 17:70-8. [PMID: 24320603 DOI: 10.3109/10253890.2013.869208] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Evidence points to heightened physiological arousal in response to acute stress exposure as both a prospective indicator and a core characteristic of posttraumatic stress disorder (PTSD). Because females may be at higher risk for PTSD development, it is important to evaluate sex differences in acute stress reactions. This study characterized sex differences in cardiovascular and subjective stress reactions among military survival trainees. One hundred and eighty-five military members (78% males) were studied before, during, and 24 h after stressful mock captivity. Cardiovascular (heart rate [HR], systolic blood pressure [SBP], diastolic blood pressure [DBP]) and dissociative states were measured at all three time points. Psychological impact of mock captivity was assessed during recovery. General linear modeling with repeated measures evaluated sex differences for each cardiovascular endpoint, and causal steps modeling was used to explore interrelationships among sex, cardiovascular reactions and psychological impact of mock captivity. Although females had lower SBP than males at all three time points, the difference was most pronounced at baseline and during stress. Accordingly, females showed greater residual elevation in SBP during recovery. Females had lower DBP at all three time points. In addition, females reported greater psychological impact of mock captivity than males. Exploratory causal steps modeling suggested that stress-induced HR may partially mediate the effect of sex on psychological impact of mock captivity. In conclusion, this study demonstrated sex-specific cardiovascular stress reactions in military personnel, along with greater psychological impact of stress exposure in females. This research may elucidate sex differences in PTSD development.
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Affiliation(s)
- Marcus K Taylor
- Behavioral Sciences Laboratory, Behavioral Sciences and Epidemiology Department, Naval Health Research Center , San Diego, CA , USA
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Zoladz PR, Diamond DM. Current status on behavioral and biological markers of PTSD: a search for clarity in a conflicting literature. Neurosci Biobehav Rev 2013; 37:860-95. [PMID: 23567521 DOI: 10.1016/j.neubiorev.2013.03.024] [Citation(s) in RCA: 188] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 03/23/2013] [Accepted: 03/27/2013] [Indexed: 12/24/2022]
Abstract
Extensive research has identified stereotypic behavioral and biological abnormalities in post-traumatic stress disorder (PTSD), such as heightened autonomic activity, an exaggerated startle response, reduced basal cortisol levels and cognitive impairments. We have reviewed primary research in this area, noting that factors involved in the susceptibility and expression of PTSD symptoms are more complex and heterogeneous than is commonly stated, with extensive findings which are inconsistent with the stereotypic behavioral and biological profile of the PTSD patient. A thorough assessment of the literature indicates that interactions among myriad susceptibility factors, including social support, early life stress, sex, age, peri- and post-traumatic dissociation, cognitive appraisal of trauma, neuroendocrine abnormalities and gene polymorphisms, in conjunction with the inconsistent expression of the disorder across studies, confounds attempts to characterize PTSD as a monolithic disorder. Overall, our assessment of the literature addresses the great challenge in developing a behavioral and biomarker-based diagnosis of PTSD.
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Affiliation(s)
- Phillip R Zoladz
- Department of Psychology, Sociology, & Criminal Justice, Ohio Northern University, 525 S. Main St., Ada, OH, 45810, USA
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Youngner CG, Burton MS, Price M, Zimmerman L, Kearns MC, Houry D, Rothbaum BO. The contributions of prior trauma and peritraumatic dissociation to predicting post-traumatic stress disorder outcome in individuals assessed in the immediate aftermath of a trauma. West J Emerg Med 2012; 13:220-4. [PMID: 22900118 PMCID: PMC3415825 DOI: 10.5811/westjem.2012.3.11777] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Revised: 03/13/2012] [Accepted: 03/19/2012] [Indexed: 11/29/2022] Open
Abstract
Objective This study analyzed predictors of post-traumatic stress disorder (PTSD) in civilian trauma victims to assess how peritraumatic dissociation (PD) relates to PTSD symptom development. We examined PD and PTSD symptoms from a prior trauma simultaneously to better understand the extent to which past and current reactions to a trauma can predict the development of PTSD for a current trauma. Methods Participants (N=48) were recruited from the emergency department (ED) of a large, southeastern hospital and assessed immediately after a trauma and again at 4 weeks and 12 weeks post-trauma. We used both self-report and interviewer-based questionnaires to assess PD and PTSD symptoms for prior and current trauma. Results A hierarchical linear regression revealed that at 4-week follow up, when controlling for several demographic variables and trauma type, a model including both PD and PTSD symptoms from a prior trauma significantly predicted PTSD outcome (F(47)= 3.70, p=0.00), with PD and prior PTSD symptoms significantly contributing 17% and 9% of variance respectively. At 12 weeks, PTSD symptoms from prior trauma (β=0.094, p=0.538) and PD (β=−0.017, p=0.909) did not account for a significant proportion of the variance in PTSD for the enrolling trauma. Conclusion Prior and current reactions to trauma are both important factors in predicting the development of PTSD symptoms to a current trauma. The more immediate measurement of PD during presentation to the ED may explain the strength of its relationship to PTSD symptom development. Furthermore, our findings support the use of PTSD symptoms of a past trauma, as opposed to trauma frequency, as a predictor of PTSD from a subsequent trauma. Methodological limitations and future directions are discussed.
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Joscelyne A, McLean S, Drobny J, Bryant RA. Fear of memories: the nature of panic in posttraumatic stress disorder. Eur J Psychotraumatol 2012; 3:19084. [PMID: 23130094 PMCID: PMC3488113 DOI: 10.3402/ejpt.v3i0.19084] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2012] [Revised: 09/27/2012] [Accepted: 10/02/2012] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Although there is increasing evidence that panic attacks are common in posttraumatic stress disorder (PTSD), little is known if posttraumatic panic is comparable to panic attacks observed in panic disorder (PD). OBJECTIVE This study examined the cognitive responses to panic attacks in participants with PD and PTSD. METHOD Participants with PD (n=22) and PTSD (n=18) were assessed on the Anxiety Disorder Interview Schedule for DSM-IV and subsequently administered the Agoraphobic Cognitions Questionnaire and a measure of fears related to trauma memories. RESULTS Although participants did not differ in terms of catastrophic appraisals about somatic sensations, PTSD participants were more likely to experience fears about trauma memories and being harmed by trauma again during their panic attacks than PD participants. CONCLUSIONS These findings suggest that although PTSD participants fear somatic outcomes during panic attacks, their panic attacks are distinguished by a marked fear of trauma memories.
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Affiliation(s)
- Amy Joscelyne
- School of Psychology, University of New South Wales, Sydney, Australia
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