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Martin ZT, Shah AJ, Ko YA, Sheikh SAA, Daaboul O, Haddad G, Goldberg J, Smith NL, Lewis TT, Quyyumi AA, Bremner JD, Vaccarino V. Exaggerated Peripheral and Systemic Vasoconstriction During Trauma Recall in Posttraumatic Stress Disorder: A Co-Twin Control Study. Biol Psychiatry 2024; 96:278-286. [PMID: 38142719 PMCID: PMC11192861 DOI: 10.1016/j.biopsych.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 11/23/2023] [Accepted: 12/14/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND Individuals with posttraumatic stress disorder (PTSD) face an increased risk of cardiovascular disease, but the mechanisms linking PTSD to cardiovascular disease remain incompletely understood. We used a co-twin control study design to test the hypothesis that individuals with PTSD exhibit augmented peripheral and systemic vasoconstriction during a personalized trauma recall task. METHODS In 179 older male twins from the Vietnam Era Twin Registry, lifetime history of PTSD and current (last month) PTSD symptoms were assessed. Participants listened to neutral and personalized trauma scripts while peripheral vascular tone (Peripheral Arterial Tone ratio) and systemic vascular tone (e.g., total vascular conductance) were measured. Linear mixed-effect models were used to assess the within-pair relationship between PTSD and vascular tone indices. RESULTS The mean age of participants was 68 years, and 19% had a history of PTSD. For the Peripheral Arterial Tone ratio analysis, 32 twins were discordant for a history of PTSD, and 46 were discordant for current PTSD symptoms. Compared with their brothers without PTSD, during trauma recall, participants with a history of PTSD had greater increases in peripheral (β = -1.01, 95% CI [-1.72, -0.30]) and systemic (total vascular conductance: β = -1.12, 95% CI [-1.97, -0.27]) vasoconstriction after adjusting for cardiovascular risk factors. Associations persisted after adjusting for antidepressant medication use and heart rate and blood pressure during the tasks. Analysis of current PTSD symptom severity showed consistent results. CONCLUSIONS PTSD is associated with exaggerated peripheral and systemic vasoconstrictor responses to traumatic stress reminders, which may contribute to elevated risk of cardiovascular disease.
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Affiliation(s)
- Zachary T Martin
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Amit J Shah
- Rollins School of Public Health, Emory University, Atlanta, Georgia; Emory University School of Medicine, Emory University, Atlanta, Georgia; Joseph Maxwell Cleland Atlanta VA Medical Center, Decatur, Georgia
| | - Yi-An Ko
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | | | - Obada Daaboul
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - George Haddad
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Jack Goldberg
- Seattle Epidemiologic Research and Information Center, U.S. Department of Veterans Affairs Office of Research and Development, Seattle, Washington
| | - Nicholas L Smith
- Seattle Epidemiologic Research and Information Center, U.S. Department of Veterans Affairs Office of Research and Development, Seattle, Washington
| | - Tené T Lewis
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Arshed A Quyyumi
- Emory University School of Medicine, Emory University, Atlanta, Georgia
| | - J Douglas Bremner
- Emory University School of Medicine, Emory University, Atlanta, Georgia; Joseph Maxwell Cleland Atlanta VA Medical Center, Decatur, Georgia
| | - Viola Vaccarino
- Rollins School of Public Health, Emory University, Atlanta, Georgia; Emory University School of Medicine, Emory University, Atlanta, Georgia.
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Savard MA, Merlo R, Samithamby A, Paas A, Coffey EBJ. Approaches to studying emotion using physiological responses to spoken narratives: A scoping review. Psychophysiology 2024:e14642. [PMID: 38961524 DOI: 10.1111/psyp.14642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 06/07/2024] [Accepted: 06/12/2024] [Indexed: 07/05/2024]
Abstract
Narratives are effective tools for evoking emotions, and physiological measurements provide a means of objectively assessing emotional reactions - making them a potentially powerful pair of tools for studying emotional processes. However, extent research combining emotional narratives and physiological measurement varies widely in design and application, making it challenging to identify previous work, consolidate findings, and design effective experiments. Our scoping review explores the use of auditory emotional narratives and physiological measures in research, examining paradigms, study populations, and represented emotions. Following the PRISMA-ScR Checklist, we searched five databases for peer-reviewed experimental studies that used spoken narratives to induce emotion and reported autonomic physiological measures. Among 3466 titles screened and 653 articles reviewed, 110 studies were included. Our exploration revealed a variety of applications and experimental paradigms; emotional narratives paired with physiological measures have been used to study diverse topics and populations, including neurotypical and clinical groups. Although incomparable designs and sometimes contradictory results precluded general recommendations as regards which physiological measures to use when designing new studies, as a whole, the body of work suggests that these tools can be valuable to study emotions. Our review offers an overview of research employing narratives and physiological measures for emotion study, and highlights weaknesses in reporting practices and gaps in our knowledge concerning the robustness and specificity of physiological measures as indices of emotion. We discuss study design considerations and transparent reporting, to facilitate future using emotional narratives and physiological measures in studying emotions.
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Affiliation(s)
- Marie-Anick Savard
- Department of Psychology, Concordia University, Montreal, Quebec, Canada
- International Laboratory for Brain, Music and Sound Research (BRAMS), Montreal, Quebec, Canada
- Centre for Research on Brain, Language and Music (CRBLM), Montreal, Quebec, Canada
| | - Raphaëlle Merlo
- International Laboratory for Brain, Music and Sound Research (BRAMS), Montreal, Quebec, Canada
- Centre for Research on Brain, Language and Music (CRBLM), Montreal, Quebec, Canada
- École de Psychologie, Université Laval, Québec, Quebec, Canada
| | - Abiraam Samithamby
- Department of Psychology, Concordia University, Montreal, Quebec, Canada
- International Laboratory for Brain, Music and Sound Research (BRAMS), Montreal, Quebec, Canada
- Centre for Research on Brain, Language and Music (CRBLM), Montreal, Quebec, Canada
| | - Anita Paas
- Department of Psychology, Concordia University, Montreal, Quebec, Canada
- International Laboratory for Brain, Music and Sound Research (BRAMS), Montreal, Quebec, Canada
- Centre for Research on Brain, Language and Music (CRBLM), Montreal, Quebec, Canada
| | - Emily B J Coffey
- Department of Psychology, Concordia University, Montreal, Quebec, Canada
- International Laboratory for Brain, Music and Sound Research (BRAMS), Montreal, Quebec, Canada
- Centre for Research on Brain, Language and Music (CRBLM), Montreal, Quebec, Canada
- Montreal Neurological Institute (MNI), McGill University, Montreal, Quebec, Canada
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Pape V, Sammer G, Hanewald B, Schäflein E, Rauschenbach F, Stingl M. Apples and oranges: PTSD patients and healthy individuals are not comparable in their subjective and physiological responding to emotion induction and bilateral stimulation. Front Psychol 2024; 15:1406180. [PMID: 38933577 PMCID: PMC11203994 DOI: 10.3389/fpsyg.2024.1406180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Accepted: 05/28/2024] [Indexed: 06/28/2024] Open
Abstract
Objectives Bilateral stimulation is a core element of Eye Movement Desensitization and Reprocessing Therapy, a psychotherapeutic intervention for the treatment of Posttraumatic Stress Disorder (PTSD). Promising previous findings showed measurable physiological effects of bilateral stimulation in healthy individuals, but studies that replicated these findings in PTSD patients are sparse. Methods 23 patients with PTSD and 30 healthy controls were confronted with affective standard scripts (pleasant, neutral, unpleasant) while bilateral tactile stimulation was applied. Monolateral and no stimulation served as control conditions. Noise-induced startle reflex response (valence measure) and galvanic skin response (arousal measure) were used for physiological responses and the valence and arousal scale of the Self-Assessment-Manikin for subjective responses. Results Both groups showed a subjective distress reduction for unpleasant scripts and a subjective attention increase for positive scripts under bilateral stimulation. In healthy individuals, this was also for physiological measures, and a general startle-reducing effect of bilateral stimulation in the absence of affective stimuli was found. In PTSD patients, however, the effects were restricted on the subjective level, and no concomitant physiological effects were observed. Conclusions and significance The findings indicate, that generalizing the effects of BLS in healthy individuals to PTSD patients may be problematic. The herein-reported group differences can be explained by PTSD-specific peculiarities in emotion processing and cognitive processing style.
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Affiliation(s)
- Valeska Pape
- Center for Psychiatry and Psychotherapy Justus-Liebig-University Giessen, Giessen, Germany
- Clinic and Policlinic for Psychiatry and Psychotherapy, University of Rostock, Rostock, Germany
| | - Gebhard Sammer
- Center for Psychiatry and Psychotherapy Justus-Liebig-University Giessen, Giessen, Germany
| | - Bernd Hanewald
- Center for Psychiatry and Psychotherapy Justus-Liebig-University Giessen, Giessen, Germany
| | - Eva Schäflein
- Faculty of Medicine, Department of Psychotherapy and Psychosomatic Medicine, Technische Universität Dresden, Dresden, Germany
| | - Fritz Rauschenbach
- Clinic and Policlinic for Psychiatry and Psychotherapy, University of Rostock, Rostock, Germany
| | - Markus Stingl
- Center for Psychiatry and Psychotherapy Justus-Liebig-University Giessen, Giessen, Germany
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Kumar SA, Franz MR, Brock RL, DiLillo D. Posttraumatic Stress and Parenting Behaviors: The Mediating Role of Emotion Regulation. JOURNAL OF FAMILY VIOLENCE 2020; 35:417-426. [PMID: 35664666 PMCID: PMC9162433 DOI: 10.1007/s10896-019-00124-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
PURPOSE Maternal trauma has been linked with problematic parenting, including both harsh and permissive behaviors. However, little is known about mechanisms accounting for this association. The current study examined the potential impact of posttraumatic stress disorder (PTSD) and emotion regulation on dysfunctional parenting behaviors in a sample of community mothers. We hypothesized a mediation model wherein PTSD would be associated with dysfunctional parenting (i.e., lax and overreactive behaviors) indirectly through deficits in maternal emotion regulation. METHOD Seventy-eight community mothers of 18- to 36-month-old children were administered the Clinician Administered PTSD Scale for DSM-5 (CAPS-5) and 19 mothers met criteria for PTSD. Mothers also completed self-report measures of difficulties with emotion regulation and maternal laxness and overreactivity in parenting. RESULTS Results revealed that emotion dysregulation fully mediated relations between PTSD status and lax (but not overreactive) parenting behaviors. Compared to mothers without PTSD, those with PTSD reported greater lax parenting behaviors indirectly through greater emotion dysregulation. CONCLUSIONS Mothers with PTSD may struggle to parent assertively when trauma symptoms interfere with emotion regulation abilities. The current study highlights the need to design interventions focused on helping trauma-exposed mothers manage distress, ultimately aiming to enhance parenting effectiveness and improve child outcomes.
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Affiliation(s)
- Shaina A. Kumar
- University of Nebraska-Lincoln, Psychology Department, 238 Burnett Hall, Lincoln, Nebraska 68588-0308
| | - Molly R. Franz
- University of Nebraska-Lincoln, Psychology Department, 238 Burnett Hall, Lincoln, Nebraska 68588-0308
| | - Rebecca L. Brock
- University of Nebraska-Lincoln, Psychology Department, 238 Burnett Hall, Lincoln, Nebraska 68588-0308
| | - David DiLillo
- University of Nebraska-Lincoln, Psychology Department, 238 Burnett Hall, Lincoln, Nebraska 68588-0308
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Siev J, Behar E, Fortune MR. Attentional Bias and Training in Individuals With High Dental Anxiety. Front Psychol 2020; 11:1057. [PMID: 32581933 PMCID: PMC7296083 DOI: 10.3389/fpsyg.2020.01057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 04/27/2020] [Indexed: 12/28/2022] Open
Abstract
Dental anxiety is common and associated with negative outcomes. According to information-processing models, anxiety is maintained by maladaptive patterns of processing threatening information. Furthermore, attention training interventions can reduce anxiety in one session. Fifty-three individuals with high levels of dental anxiety completed a Posner reaction-time task. Participants were randomized to attention training or control using a dot-probe task, and then attentional bias was remeasured using another Posner task. Participants then completed a script-driven imaginal exposure task. Results indicated that individuals high in dental anxiety exhibit threat-relevant attentional bias. There was mixed evidence about the efficacy of attention training. On the one hand, training did not eliminate attentional bias and training condition did not predict distress during the imagery task. On the other hand, cue dependency scores in the control group were higher for dental than neutral cues, but did not differ in the training group. In addition, cue dependency scores for both dental and neutral cues predicted subjective anxiety in anticipation of the imagery task. The mixed results of training are considered in terms of the possibility that it enhanced attentional control, rather than reducing bias.
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Affiliation(s)
- Jedidiah Siev
- Department of Psychology, Swarthmore College, Swarthmore, PA, United States
| | - Evelyn Behar
- Department of Psychology, Hunter College, The City University of New York, New York, NY, United States
| | - Meghan R. Fortune
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, United States
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Raudales AM, Weiss NH, Schmidt NB, Short NA. The role of emotion dysregulation in negative affect reactivity to a trauma cue: Differential associations through elicited posttraumatic stress disorder symptoms. J Affect Disord 2020; 267:203-210. [PMID: 32217220 PMCID: PMC10923236 DOI: 10.1016/j.jad.2020.02.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 12/16/2019] [Accepted: 02/08/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND Recent research has linked emotion dysregulation with increases in subjective ratings of negative affect (NA reactivity) to trauma reminders, a central symptom of posttraumatic stress disorder (PTSD). The current study adds to this burgeoning line of research by exploring elicited PTSD symptoms as a mechanism explicating the relation between emotion dysregulation and NA reactivity following trauma cue exposure. METHODS Participants were 60 treatment-seeking marijuana users with insomnia symptoms who reported exposure to a traumatic event. Participants were administered questionnaires assessing emotion dysregulation, PTSD symptoms, and NA prior to and/or after listening to a personalized trauma script, and subsequently completed a diagnostic interview. RESULTS Results demonstrated that greater emotion dysregulation was associated with heightened NA reactivity through re-experiencing symptoms, but not avoidance or dissociation symptoms, even after accounting for past 30-day PTSD symptom severity and pre-trauma script NA. These effects were driven by the dimensions of emotion dysregulation characterized by nonacceptance of negative emotions and limited access to effective emotion regulation strategies. LIMITATIONS This study requires replication among other clinical samples, and is limited by use of self-report measures. CONCLUSIONS Findings provide novel empirical support for one mechanism through which emotion dysregulation may confer vulnerability to PTSD symptomology, and offer implications for refining PTSD treatments.
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Affiliation(s)
- Alexa M Raudales
- University of Rhode Island, Department of Psychology, 142 Flagg Road, Kingston, RI 02881 USA.
| | - Nicole H Weiss
- University of Rhode Island, Department of Psychology, 142 Flagg Road, Kingston, RI 02881 USA
| | - Norman B Schmidt
- Florida State University, Department of Psychology, 1107W. Call St., Tallahassee, FL 32306-4301 USA.
| | - Nicole A Short
- University of Rhode Island, Department of Psychology, 142 Flagg Road, Kingston, RI 02881 USA
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Beck JG, Dodson TS, Pickover AM, Woodward MJ, Lipinski AJ, Tran HN. The effects of shame on subsequent reactions to a trauma analog. J Anxiety Disord 2019; 66:102108. [PMID: 31387013 DOI: 10.1016/j.janxdis.2019.102108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 05/07/2019] [Accepted: 06/21/2019] [Indexed: 11/25/2022]
Abstract
The current study examined the effects of experimentally-induced shame on subsequent reactions to a trauma analog. Participants were 88 college-aged women randomly assigned to a shame prime condition or to a control (neutral) condition. Participants then were presented with an analog trauma audiotape depicting dating violence. Participants reported intrusive thoughts relating to the trauma analog in the two days following the procedure. Negative (shame, guilt) and positive (pride, positive affect) emotions were monitored throughout the procedure. Results indicated that the shame prime successfully increased shame in the Shame condition alone. After the trauma analog, increases in shame were noted in both conditions. In contrast, guilt reduced in the Shame condition, while this emotion increased in the Control condition, contrary to hypothesis. Shame and guilt were somewhat volatile for participants in the Shame condition in the two days following the lab procedure, while individuals in the Control condition reported steadily decreasing levels of these emotions. No between-condition differences were noted in the frequency of intrusions in the two days following the laboratory procedure, contrary to hypothesis. Results are discussed in light of our current understanding of shame and its role in PTSD, with suggestions to guide future research.
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Affiliation(s)
- J Gayle Beck
- Department of Psychology, The University of Memphis, United States.
| | - Thomas S Dodson
- Department of Psychology, The University of Memphis, United States
| | | | - Matthew J Woodward
- Department of Psychological Sciences, Western Kentucky University, United States
| | | | - Han N Tran
- Department of Psychology, The University of Memphis, United States
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Walker FR, Thomson A, Pfingst K, Vlemincx E, Aidman E, Nalivaiko E. Habituation of the electrodermal response - A biological correlate of resilience? PLoS One 2019; 14:e0210078. [PMID: 30682040 PMCID: PMC6347437 DOI: 10.1371/journal.pone.0210078] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 12/17/2018] [Indexed: 01/06/2023] Open
Abstract
Current approaches to quantifying resilience make extensive use of self-reported data. Problematically, this type of scales is plagued by response distortions–both deliberate and unintentional, particularly in occupational populations. The aim of the current study was to develop an objective index of resilience. The study was conducted in 30 young healthy adults. Following completion of the Connor-Davidson Resilience Scale (CD-RISC) and Depression/Anxiety/Stress Scale (DASS), they were subjected to a series of 15 acoustic startle stimuli (95 dB, 50 ms) presented at random intervals, with respiration, skin conductance and ECG recorded. As expected, resilience (CD-RISC) significantly and negatively correlated with all three DASS subscales–Depression (r = -0.66, p<0.0001), Anxiety (r = -0.50, p<0.005) and Stress (r = -0.48, p<0.005). Acoustic stimuli consistently provoked transient skin conductance (SC) responses, with SC slopes indexing response habituation. This slope significantly and positively correlated with DASS-Depression (r = 0.59, p<0.005), DASS-Anxiety (r = 0.35, p<0.05) and DASS-Total (r = 0.50, p<0.005) scores, and negatively with resilience score (r = -0.47; p = 0.006), indicating that high-resilience individuals are characterized by steeper habituation slopes compared to low-resilience individuals. Our key finding of the connection between habituation of the skin conductance responses to repeated acoustic startle stimulus and resilience-related psychometric constructs suggests that response habituation paradigm has the potential to characterize important attributes of cognitive fitness and well-being–such as depression, anxiety and resilience. With steep negative slopes reflecting faster habituation, lower depression/anxiety and higher resilience, and slower or no habituation characterizing less resilient individuals, this protocol may offer a distortion-free method for objective assessment and monitoring of psychological resilience.
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Affiliation(s)
| | | | | | - Elke Vlemincx
- Queen Mary University of London, London, United Kingdom
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Torrisi R, Arnautovic E, Pointet Perizzolo VC, Vital M, Manini A, Suardi F, Gex-Fabry M, Rusconi Serpa S, Schechter DS. Developmental delay in communication among toddlers and its relationship to caregiving behavior among violence-exposed, posttraumatically stressed mothers. RESEARCH IN DEVELOPMENTAL DISABILITIES 2018; 82:67-78. [PMID: 29754762 DOI: 10.1016/j.ridd.2018.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 03/16/2018] [Accepted: 04/07/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES This study aimed to understand if maternal interpersonal violence-related posttraumatic stress disorder (IPV-PTSD) is associated with delayed language development among very young children ("toddlers"). METHODS Data were collected from 61 mothers and toddlers (ages 12-42 months, mean age = 25.6 months SD = 8.70). Child expressive and receptive language development was assessed by the Ages and Stages Questionnaire (ASQ) communication subscale (ASQCS) that measures language acquisition. Observed maternal caregiving behavior was coded from videos of 10-min free-play interactions via the CARE-Index. Correlations, Mann-Whitney tests, and multiple linear regression were performed. RESULTS There was no significant association between maternal IPV-PTSD severity and the ASQCS. Maternal IPV-PTSD severity was associated with continuous maternal behavior variables (i.e. sensitive and controlling behavior on the CARE-Index) across the entire sample and regardless of child gender. Maternal sensitivity was positively and significantly associated with the ASQCS. Controlling behavior was negatively and significantly associated with the ASQCS. CONCLUSIONS Results are consistent with the literature that while maternal IPV-PTSD severity is not associated with child language delays, the quality of maternal interactive behavior is associated both with child language development and with maternal IPV-PTSD severity. Further study is needed to understand if the level of child language development contributes to intergenerational risk or resilience for relational violence and/or victimization.
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Affiliation(s)
- R Torrisi
- Child and Adolescent Psychiatry Service, Geneva University Hospitals, Geneva, Switzerland
| | - E Arnautovic
- Child and Adolescent Psychiatry Service, Geneva University Hospitals, Geneva, Switzerland
| | - V C Pointet Perizzolo
- Child and Adolescent Psychiatry Service, Geneva University Hospitals, Geneva, Switzerland
| | - M Vital
- Child and Adolescent Psychiatry Service, Geneva University Hospitals, Geneva, Switzerland
| | - A Manini
- Child and Adolescent Psychiatry Service, Geneva University Hospitals, Geneva, Switzerland
| | - F Suardi
- Child and Adolescent Psychiatry Service, Geneva University Hospitals, Geneva, Switzerland
| | - M Gex-Fabry
- Department of Psychiatry, University of Geneva Faculty of Medicine, Geneva, Switzerland
| | - S Rusconi Serpa
- Child and Adolescent Psychiatry Service, Geneva University Hospitals, Geneva, Switzerland
| | - D S Schechter
- Department of Psychiatry, University of Geneva Faculty of Medicine, Geneva, Switzerland; Department of Child and Adolescent Psychiatry, New York Langone University School of Medicine, New York, NY, USA.
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Carnevali L, Koenig J, Sgoifo A, Ottaviani C. Autonomic and Brain Morphological Predictors of Stress Resilience. Front Neurosci 2018; 12:228. [PMID: 29681793 PMCID: PMC5897537 DOI: 10.3389/fnins.2018.00228] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 03/22/2018] [Indexed: 12/30/2022] Open
Abstract
Stressful life events are an important cause of psychopathology. Humans exposed to aversive or stressful experiences show considerable inter-individual heterogeneity in their responses. However, the majority does not develop stress-related psychiatric disorders. The dynamic processes encompassing positive and functional adaptation in the face of significant adversity have been broadly defined as resilience. Traditionally, the assessment of resilience has been confined to self-report measures, both within the general community and putative high-risk populations. Although this approach has value, it is highly susceptible to subjective bias and may not capture the dynamic nature of resilience, as underlying construct. Recognizing the obvious benefits of more objective measures of resilience, research in the field has just started investigating the predictive value of several potential biological markers. This review provides an overview of theoretical views and empirical evidence suggesting that individual differences in heart rate variability (HRV), a surrogate index of resting cardiac vagal outflow, may underlie different levels of resilience toward the development of stress-related psychiatric disorders. Following this line of thought, recent studies describing associations between regional brain morphometric characteristics and resting state vagally-mediated HRV are summarized. Existing studies suggest that the structural morphology of the anterior cingulated cortex (ACC), particularly its cortical thickness, is implicated in the expression of individual differences in HRV. These findings are discussed in light of emerging structural neuroimaging research, linking morphological characteristics of the ACC to psychological traits ascribed to a high-resilient profile and abnormal structural integrity of the ACC to the psychophysiological expression of stress-related mental health consequences. We conclude that a multidisciplinary approach integrating brain structural imaging with HRV monitoring could offer novel perspectives about brain-body pathways in resilience and adaptation to psychological stress.
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Affiliation(s)
- Luca Carnevali
- Neuroimaging Laboratory, Santa Lucia Foundation, Rome, Italy.,Stress Physiology Lab, Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, Parma, Italy
| | - Julian Koenig
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.,University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Andrea Sgoifo
- Stress Physiology Lab, Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, Parma, Italy
| | - Cristina Ottaviani
- Neuroimaging Laboratory, Santa Lucia Foundation, Rome, Italy.,Department of Psychology, Sapienza University of Rome, Rome, Italy
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Walker FR, Pfingst K, Carnevali L, Sgoifo A, Nalivaiko E. In the search for integrative biomarker of resilience to psychological stress. Neurosci Biobehav Rev 2017; 74:310-320. [DOI: 10.1016/j.neubiorev.2016.05.003] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 04/26/2016] [Accepted: 05/06/2016] [Indexed: 12/20/2022]
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Gelkopf M, Lapid Pickman L, Grinapol S, Werbeloff N, Carlson EB, Greene T. Peritraumatic Reaction Courses During War in Individuals With Serious Mental Illness: Gender, Mental Health Status, and Exposure. Psychiatry 2017; 80:382-398. [PMID: 29466110 DOI: 10.1080/00332747.2017.1286893] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE We assessed in vivo symptom courses of early psychological responses during war and investigated the influence of exposure, gender, and a prior diagnosis of severe mental illness (SMI). METHOD Participants were 181 highly exposed individuals from the general population and community psychiatric rehabilitation centers. A 30-day twice-daily Internet-smartphone-based intensive assessment two weeks into the 2014 Israel-Gaza war estimated peritraumatic symptom clusters, sense of threat, negative emotions and cognitions, and siren exposure during two periods that varied in exposure level. Piecewise growth curve modeling procedures were performed. RESULTS We found different courses for most variables, gender, and SMI status. Women were more reactive two weeks into the war but reduced their reactivity level at a faster pace than males, reaching lower symptom levels one month later. Women's courses were characterized by arousal, negative emotionality, sense of threat, and reactivity to siren exposure. No-SMI men had a stable course followed by a significant reduction in arousal, negative emotions, avoidance, and perceived threat during a "return to routine" lower-level intensity period of the war. Individuals with SMI had higher reactivity levels at study onset; but while women with SMI improved over time, men with SMI worsened. SMI reactivity was characterized by negative cognitions, intrusions, and avoidance. CONCLUSIONS Early reactions during prolonged exposure to war are variable, dynamic, and affected by exposure context. Symptoms, emotions, and cognitions develop differentially over time and are affected by gender and mental health status. The identification of various early stress courses should inform primary intervention strategies.
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Dutton CE, Badour CL, Jones AC, Mischel ER, Feldner MT. Affective lability predicts decreased habituation in posttraumatic stress symptom responding during a single laboratory session of imaginal exposure. J Anxiety Disord 2016; 43:52-57. [PMID: 27517669 PMCID: PMC5056138 DOI: 10.1016/j.janxdis.2016.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 06/03/2016] [Accepted: 07/21/2016] [Indexed: 11/15/2022]
Abstract
Affective lability, or the instability of emotional states, is associated with heightened levels of trauma-related emotional responding and posttraumatic stress disorder (PTSD) symptoms. However, the impact of affective lability, specifically on habituation to idiographic trauma cues, has yet to be examined among trauma-exposed individuals. The current study examined differential response trajectories to trauma-related imaginal exposure as a function of affective lability. Specifically, 72 women with a history of sexual victimization participated in a laboratory-based study involving a single session of repeated imaginal exposures to idiographic traumatic event cues. As hypothesized, participants higher in affective lability reported less reduction in trauma-cue elicited posttraumatic stress symptoms across exposure trials. Given these results, it will be important to continue to extend these laboratory findings to better understand how elevated affective lability is related to response to trauma-focused exposure therapy among individuals with PTSD or other trauma-related psychopathology (e.g., borderline personality disorder).
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Affiliation(s)
| | | | | | | | - Matthew T. Feldner
- Department of Psychological Science, University of Arkansas,Laureate Institute for Brain Research, Tulsa, Oklahoma
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14
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Ben-Amitay G, Kimchi N, Wolmer L, Toren P. Psychophysiological Reactivity in Child Sexual Abuse. JOURNAL OF CHILD SEXUAL ABUSE 2016; 25:185-200. [PMID: 26934544 DOI: 10.1080/10538712.2016.1124309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Sexual abuse has physiological and emotional implications. The purpose of this study is to evaluate the neurobiological sequels of childhood sexual trauma by monitoring physiological variables among sexually abused girls and women compared to controls. We assessed posttrauma and traumatic life events of 35 females sexually abused in their childhood (age range 7-51 years) and 25 control females (age range 7-54 years). Electroencephalography, frontalis electromyography, electrodermal activity, and heart rate parameters were recorded while watching sets of pictures representing neutral and trauma-suggestive stimuli. A minority of participants met the Diagnostic and Statistical Manual of Mental Disorders criteria for post-traumatic stress disorder. Abused females displayed significant elevations in heart rate, electromyography, and electroencephalography while viewing allusive stimuli and elevated heart rate while viewing neutral stimuli. The dysfunctional regulation of the physiological stress system associated with child sexual abuse may endanger the victims with various stress and anxiety disorders.
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Affiliation(s)
- Galit Ben-Amitay
- a Tel Aviv Brull Community Mental Health Center , Clalit Health Services , Tel Aviv , Israel
- b The Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Nir Kimchi
- a Tel Aviv Brull Community Mental Health Center , Clalit Health Services , Tel Aviv , Israel
- c Cohen-Harris Resilience Center , the Association for Children at Risk , Tel Aviv , Israel
| | - Leo Wolmer
- c Cohen-Harris Resilience Center , the Association for Children at Risk , Tel Aviv , Israel
- d Baruch Ivcher School of Psychology , Herzlyia Interdisciplinary Center , Herzliya , Israel
| | - Paz Toren
- a Tel Aviv Brull Community Mental Health Center , Clalit Health Services , Tel Aviv , Israel
- b The Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
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15
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Scheiderer EM, Wang T, Tomko RL, Wood PK, Trull TJ. Negative Affect Instability among Individuals with Comorbid Borderline Personality Disorder and Posttraumatic Stress Disorder. Clin Psychol Sci 2015; 4:67-81. [PMID: 26904388 DOI: 10.1177/2167702615573214] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Ecological momentary assessment (EMA; Stone & Shiffman, 1994) was utilized to examine affective instability (AI) in the daily lives of outpatients with borderline personality disorder (BPD; n=78) with and without posttraumatic stress disorder (PTSD). A psychiatric control group (n=50) composed of outpatients with major depressive disorder/dysthymia (MDD/DYS) was employed to compare across subgroups: BPD-only, BPD+PTSD, MDD/DYS-only, and MDD/DYS+PTSD. Compared to the BPD-only group, the BPD+PTSD group had significantly greater instability of fear and sadness, but did not significantly differ in instability of hostility or aggregate negative affect. This pattern of elevated instability of fear and sadness was not present-and, in fact, was reversed-in the MDD/DYS group. Results emphasize the importance of examining AI within the context of specific comorbidities and affect types. Treatment and research addressing AI in the context of BPD-PTSD comorbidity may benefit from a focus on fear and sadness as separate from hostility or general negative affect.
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Affiliation(s)
| | - Ting Wang
- Department of Psychological Sciences, University of Missouri - Columbia
| | - Rachel L Tomko
- Department of Psychological Sciences, University of Missouri - Columbia
| | - Phillip K Wood
- Department of Psychological Sciences, University of Missouri - Columbia
| | - Timothy J Trull
- Department of Psychological Sciences, University of Missouri - Columbia
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16
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Mindful attention regulation and non-judgmental orientation in depression: A multi-method approach. Biol Psychol 2014; 101:36-43. [DOI: 10.1016/j.biopsycho.2014.06.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 06/06/2014] [Accepted: 06/18/2014] [Indexed: 01/28/2023]
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17
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Badour CL, Feldner MT, Blumenthal H, Knapp A. Preliminary evidence for a unique role of disgust-based conditioning in posttraumatic stress. J Trauma Stress 2013; 26:280-7. [PMID: 23526662 PMCID: PMC4070374 DOI: 10.1002/jts.21796] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Independent lines of evidence have linked posttraumatic stress symptomatology to both peritraumatic disgust (i.e., disgust experienced during a traumatic event) and posttraumatic disgust reactivity in response to traumatic event cues among individuals exposed to traumatic events. Much of this work suggests disgust, defined as a rejection/revulsion response aimed at distancing oneself from a potential source of contamination, may be important in understanding the nature of posttraumatic stress reactions even after accounting for the more frequently studied affective states of fear and anxiety. The current investigation provided a preliminary test of a model of disgust in posttraumatic stress among a sample of 54 community-recruited women with a history sexual victimization. Both peritraumatic disgust (r = .31) and posttraumatic disgust reactivity (r = .42) in response to an idiographic traumatic event script were significantly associated with posttraumatic stress symptom severity. After accounting for variability-associated peritraumatic fear and posttraumatic anxious reactivity, an indirect effect of peritraumatic disgust through posttraumatic disgust reactivity also was found, suggesting that one mechanism through which peritraumatic disgust relates to posttraumatic stress is through its relation with increased posttraumatic disgust reactivity. These findings highlight the importance of further elucidating the nature of disgust in relation to traumatic events and subsequent posttraumatic stress reactions.
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Affiliation(s)
- Christal L Badour
- Department of Psychology, University of Arkansas, Fayetteville, AR 72701, USA.
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18
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Badour CL, Feldner MT. Trauma-related reactivity and regulation of emotion: associations with posttraumatic stress symptoms. J Behav Ther Exp Psychiatry 2013; 44:69-76. [PMID: 22922079 PMCID: PMC3508380 DOI: 10.1016/j.jbtep.2012.07.007] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Revised: 07/13/2012] [Accepted: 07/30/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Both emotional reactivity to traumatic event cues and difficulties regulating emotion have been linked to posttraumatic stress symptom severity. The current study uniquely extended these two lines of research by examining the degree to which these two factors alone, and in combination, account for variability in posttraumatic stress symptom severity. METHOD Self-reported emotion regulation difficulties, and both subjective and physiological reactivity in response to a script-driven imagery procedure, were assessed among a community sample of 21 adult women with a history of interpersonal assault. Relationships with an interview-based measure of posttraumatic stress symptom severity were examined. RESULTS Results were consistent with hypotheses. Both traumatic event-related emotional reactivity and emotion regulation difficulties independently predicted posttraumatic stress symptom severity. A significant interaction also emerged such that traumatic event-related emotional reactivity and posttraumatic stress symptom severity were only significantly associated at relatively elevated levels of emotion regulation difficulties. LIMITATIONS Limitations included the use of a self-report questionnaire to assess emotion regulation difficulties, relatively small sample size, and lack of evidence regarding generalizability across gender or other traumatic event types. CONCLUSIONS These results highlight that the interaction of heightened emotional reactivity and difficulties regulating emotion may be particularly influential in posttraumatic stress symptom severity.
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Affiliation(s)
- Christal L Badour
- University of Arkansas, 216 Memorial Hall, Department of Psychological Science, Fayetteville, AR 72701, USA.
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19
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Marx BP, Bovin MJ, Suvak MK, Monson CM, Sloan DM, Fredman SJ, Humphreys KL, Kaloupek DG, Keane TM. Concordance between physiological arousal and subjective distress among Vietnam combat veterans undergoing challenge testing for PTSD. J Trauma Stress 2012; 25:416-25. [PMID: 22848013 DOI: 10.1002/jts.21729] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This study examined concordance between physiological arousal and subjective distress during a laboratory challenge task. Data were collected during the multisite VA Cooperative Study 334 in the early 1990s examining psychophysiological arousal among combat-exposed Vietnam veterans with (n = 775) and without (n = 369) posttraumatic stress disorder (PTSD). Study participants were presented with 6 standardized neutral scenes and 6 standardized combat scenes. Participants provided a subjective rating of distress after each slide. During the presentation, levels of heart rate (HR) and skin conductance (SC) were recorded. Using linear mixed effects modeling, both HR level and SC level exhibited significant positive associations with subjective distress ratings (pr = .33, p < .001 and pr = .19, p < .001, respectively). Individuals with PTSD demonstrated greater concordance between their distress ratings and SC level during exposure to combat slides than participants without PTSD (pr = .28, p < .001 vs. pr = .18, p < .001). Although a significant association was found between subjective distress and HR reactivity and SC reactivity, these findings were not moderated by PTSD status. The results of these analyses suggest that patients' reports of distress during exposure-based treatments might serve as approximate measures of actual physiological arousal.
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Affiliation(s)
- Brian P Marx
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA.
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20
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van Ee E, Kleber RJ, Mooren TTM. War trauma lingers on: Associations between maternal posttraumatic stress disorder, parent-child interaction, and child development. Infant Ment Health J 2012; 33:459-468. [PMID: 28520264 DOI: 10.1002/imhj.21324] [Citation(s) in RCA: 114] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Maternal traumatization has been proposed as a risk factor for child development, but the mechanisms involved are poorly understood. This study analyzed the interrelations among maternal posttraumatic stress symptoms, parent-child interaction (emotional availability), and infants' psychosocial functioning and development among 49 asylum-seeker and refugee mothers and their children (18-42 months). Measures included assessment of mothers' trauma and comorbid symptoms (Harvard Trauma Questionnaire: R.F. Mollica et al., 1992; Hopkins Symptom Checklist: L. Derogatis, R. Lipman, K. Rickels, E. Uhlenhuth, & L. Covi, 1974), emotional availability within parent-child interaction (Emotional Availability Scales: Z. Biringen, 2008), and infants' psychosocial functioning (Child Behavior Checklist: T.M. Achenbach & L.A. Rescorla, 2000) and development (Bayley Scales of Infant Development: B.F. van der Meulen, S.A.J. Ruiter, H.C. Spelberg, & M. Smrkovsky, 2000). The results show that higher levels of maternal posttraumatic stress symptoms are associated with a higher level of psychosocial problems of infants, but not with delays in their mental or psychomotor development. The results also show that higher levels of maternal posttraumatic stress symptoms are associated with higher levels of insensitive, unstructuring, or hostile, but not intrusive, parent-child interactions. Infants show lower levels of responsiveness and involvement to their traumatized mothers. Parent-child interaction did not function as a mediator between maternal trauma symptoms and infants' psychosocial functioning. Results are discussed in relation to the dyad's regulation of emotions. Results implicate a need to reestablish attunement between traumatized mothers and their nontraumatized children.
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21
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Decker SE, Naugle AE, Carter-Visscher R, Bell K, Seifert A. Ethical issues in research on sensitive topics: participants' experiences of distress and benefit. J Empir Res Hum Res Ethics 2012; 6:55-64. [PMID: 21931238 DOI: 10.1525/jer.2011.6.3.55] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
While many studies ask participants to disclose sensitive information or to participate in emotionally arousing tasks, little is known about participants' subjective experiences of discomfort and benefit. Ethics review committees, therefore, have little information about participant experiences to guide their informed decision-making. We asked undergraduate females about their experiences in a study that included an experimental session, interviews, and self-report measures on sensitive topics. We examined results overall, and compared the responses of individuals with and without childhood abuse experiences. Participants who had experienced child abuse were more likely to report distress due to remembering the past, but also more likely to report that participation was helpful. Implications for future research, and recommendations for review boards, are discussed.
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Affiliation(s)
- Suzanne E Decker
- Department of Psychology, Western Michigan University, 1903 W. Michigan Avenue, Kalamazoo, MI 49008-5439, USA.
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22
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Sack M, Cillien M, Hopper JW. Acute dissociation and cardiac reactivity to script-driven imagery in trauma-related disorders. Eur J Psychotraumatol 2012. [PMID: 23198029 PMCID: PMC3509425 DOI: 10.3402/ejpt.v3i0.17419] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Potential acute protective functions of dissociation include modulation of stress-induced psychophysiological arousal. This study was designed to explore whether acute dissociative reactions during a stress experiment would override the effects of reexperiencing. METHODS Psychophysiological reactions during exposure to script-driven trauma imagery were studied in relation to acute responses of reexperiencing and dissociative symptoms in 61 patients with histories of exposure to a variety of traumas. Acute symptomatic responses were assessed with the Responses to Script-Driven Imagery Scale (RSDI), and participants were divided into four groups by median splits of RSDI reexperiencing and dissociation subscale scores. RESULTS In a comparison of the high RSDI reexperiencing groups with low versus high acute dissociative symptoms, the high dissociators exhibited significantly lower heart rate (HR) during trauma script and a significantly smaller script-induced decrease in parasympathetic cardiac activity. HR reactivity to the trauma script was negatively correlated with acute dissociative symptom severity. CONCLUSIONS Acute dissociative reactions are a potential moderator of response to experimental paradigms investigating psychologically traumatized populations. We therefore suggest that future research on psychophysiological stress reactions in traumatized samples should routinely assess for acute dissociative symptoms.
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Affiliation(s)
- Martin Sack
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Germany
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23
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Sansone RA, Wiederman MW, Hatic A, Flath L. Childhood trauma and emotional reactivity to hypothetical media events: a pilot study. PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2010; 12. [PMID: 21085562 DOI: 10.4088/pcc.09l00898blu] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Randy A Sansone
- Department of Psychiatry and Internal Medicine, Wright State University School of Medicine; Department of Psychiatry Education, Kettering Medical Center, Dayton; and Sycamore Primary Care Center, Miamisburg, Ohio ; Department of Human Relations, Columbia College, Columbia, South Carolina ; and Department of Internal Medicine, Kettering Medical Center, Dayton, Ohio
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24
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Ehlers A, Suendermann O, Boellinghaus I, Vossbeck-Elsebusch A, Gamer M, Briddon E, Martin MW, Glucksman E. Heart rate responses to standardized trauma-related pictures in acute posttraumatic stress disorder. Int J Psychophysiol 2010; 78:27-34. [PMID: 20450940 PMCID: PMC2965012 DOI: 10.1016/j.ijpsycho.2010.04.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Revised: 04/22/2010] [Accepted: 04/25/2010] [Indexed: 12/02/2022]
Abstract
Physiological responses to trauma reminders are one of the core symptoms of posttraumatic stress disorder (PTSD). Nevertheless, screening measures for PTSD largely rely on symptom self-reports. It has been suggested that psychophysiological assessments may be useful in identifying trauma survivors with PTSD (Orr and Roth, 2000). This study investigated whether heart rate (HR) responses to standardized trauma-related pictures distinguish between trauma survivors with and without acute PTSD. Survivors of motor vehicle accidents or physical assaults (N=162) watched standardized trauma-related, generally threatening and neutral pictures at 1 month post-trauma while their ECG was recorded. At 1 and 6 months, structured clinical interviews assessed PTSD diagnoses. Participants completed self-report measures of PTSD severity and depression, peritraumatic responses, coping behaviors and appraisals. Trauma survivors with acute PTSD showed greater HR responses to trauma-related pictures than those without PTSD, as indicated by a less pronounced mean deceleration, greater peak responses, and a greater proportion showing HR acceleration of greater than 1 beat per minute. There were no group differences in HR responses to generally threatening or neutral pictures. HR responses to trauma-related pictures contributed to the prediction of PTSD diagnosis over and above what could be predicted from self-reports of PTSD and depression. HR responses to trauma-related pictures were related to fear and data-driven processing during the trauma, safety behaviors, suppression of trauma memories, and overgeneralized appraisals of danger. The results suggest that HR responses to standardized trauma-related pictures may help identify a subgroup of patients with acute PTSD who show generalized fear responses to trauma reminders. The early generalization of triggers of reexperiencing symptoms observed in this study is consistent with associative learning and cognitive models of PTSD.
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Affiliation(s)
- Anke Ehlers
- King's College London, Institute of Psychiatry, Department of Psychology, London, UK.
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25
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Suendermann O, Ehlers A, Boellinghaus I, Gamer M, Glucksman E. Early heart rate responses to standardized trauma-related pictures predict posttraumatic stress disorder: a prospective study. Psychosom Med 2010; 72:301-8. [PMID: 20124426 PMCID: PMC2865997 DOI: 10.1097/psy.0b013e3181d07db8] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate whether chronic posttraumatic stress disorder can be predicted by heart rate responses (HRR) and skin conductance responses (SCR) to standardized trauma-related pictures at 1 month after trauma has ocurred. Trauma survivors with PTSD report heightened physiological responses to a wide range of stimuli. It has been suggested that associative learning and stimulus generalization play a key role in the development of these symptoms. Some studies have found that trauma survivors with PTSD show greater physiological responses to individualized trauma reminders in the initial weeks after trauma than those without PTSD. METHODS Survivors of motor vehicle accidents or physical assaults (n = 166) watched standardized trauma-related, generally threatening, and neutral pictures at 1 month post trauma, as their HRR and SCR were recorded. PTSD symptoms were assessed with structured clinical interviews at 1 month and 6 months; self-reports of fear responses and dissociation during trauma were obtained soon after the trauma. RESULTS At 1 month, trauma survivors with PTSD showed greater HRR to trauma-related pictures than those without PTSD, but not to general threat or neutral pictures. HRR to trauma-related pictures predicted PTSD severity at 1 month and 6 months, and were related to fear and dissociation during trauma. SCR were not related to PTSD. CONCLUSION HRR to standardized trauma reminders at 1 month after the trauma differentiate between trauma survivors with and without PTSD, and predict chronic PTSD. RESULTS are consistent with a role of associative learning in PTSD and suggest that early stimulus generalization may be an indicator of risk for chronic PTSD.
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Affiliation(s)
- Oliver Suendermann
- King’s College London, Institute of Psychiatry, Department of Psychology, London, UK
| | - Anke Ehlers
- King’s College London, Institute of Psychiatry, Department of Psychology, London, UK
| | - Inga Boellinghaus
- King’s College London, Institute of Psychiatry, Department of Psychology, London, UK
| | - Matthias Gamer
- University Medical Center Hamburg-Eppendorf, Department of Systems Neuroscience, Martinistr. 52, 20246 Hamburg, Germany
| | - Edward Glucksman
- King’s College Hospital, Accident and Emergency Department, London, UK
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26
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McTeague LM, Lang PJ, Laplante MC, Cuthbert BN, Shumen JR, Bradley MM. Aversive imagery in posttraumatic stress disorder: trauma recurrence, comorbidity, and physiological reactivity. Biol Psychiatry 2010; 67:346-56. [PMID: 19875104 PMCID: PMC3747632 DOI: 10.1016/j.biopsych.2009.08.023] [Citation(s) in RCA: 179] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2009] [Revised: 07/07/2009] [Accepted: 08/03/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is characterized as a disorder of exaggerated defensive physiological arousal. The novel aim of the present research was to investigate within PTSD a potential dose-response relationship between past trauma recurrence and current comorbidity and intensity of physiological reactions to imagery of trauma and other aversive scenarios. METHODS A community sample of principal PTSD (n = 49; 22 single-trauma exposed, 27 multiple-trauma exposed) and control (n = 76; 46 never-trauma exposed, 30 trauma exposed) participants imagined threatening and neutral events while acoustic startle probes were presented and the eye-blink response (orbicularis occuli) was recorded. Changes in heart rate, skin conductance level, and facial expressivity were also indexed. RESULTS Overall, PTSD patients exceeded control participants in startle reflex, autonomic responding, and facial expressivity during idiographic trauma imagery and, though less pronounced, showed heightened reactivity to standard anger, panic, and physical danger imagery. Concerning subgroups, control participants with and without trauma exposure showed isomorphic patterns. Within PTSD, only the single-trauma patients evinced robust startle and autonomic responses, exceeding both control participants and multiple-trauma PTSD. Despite greater reported arousal, the multiple-trauma relative to single-trauma PTSD group showed blunted defensive reactivity associated with more chronic and severe PTSD, greater mood and anxiety disorder comorbidity, and more pervasive dimensional dysphoria (e.g., depression, trait anxiety). CONCLUSIONS Whereas PTSD patients generally show marked physiological arousal during aversive imagery, concordant with self-reported distress, the most symptomatic patients with histories of severe, cumulative traumatization show discordant physiological hyporeactivity, perhaps attributable to sustained high stress and an egregious, persistent negative affectivity that ultimately compromises defensive responding.
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27
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Abstract
The authors examine the question of whether posttraumatic stress disorder (PTSD) should continue to be classified with the anxiety disorders in the upcoming revision of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V; American Psychiatric Association) classification system. They examine four areas of research that challenge the placement of PTSD among the anxiety disorders: research on peritraumatic emotions and their association with later PTSD symptoms, the role of emotions over the course of PTSD, physiological reactivity and emotional responses, and comorbidity patterns. The authors conclude with the recommendation that PTSD be included among a new category of traumatic stress disorders in DSM-V.
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Affiliation(s)
- Patricia A Resick
- National Center for PTSD, VA Boston Healthcare System, & Boston University School of Medicine, Boston, MA 02130, USA.
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28
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Shin LM, Bush G, Whalen PJ, Handwerger K, Cannistraro PA, Wright CI, Martis B, Macklin ML, Lasko NB, Orr SP, Pitman RK, Rauch SL. Dorsal anterior cingulate function in posttraumatic stress disorder. J Trauma Stress 2007; 20:701-12. [PMID: 17955522 DOI: 10.1002/jts.20231] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Lisa M Shin
- Department of Psychology, Tufts University, Medford, MA 02155, USA.
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29
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Tull MT, Barrett HM, McMillan ES, Roemer L. A preliminary investigation of the relationship between emotion regulation difficulties and posttraumatic stress symptoms. Behav Ther 2007; 38:303-13. [PMID: 17697854 DOI: 10.1016/j.beth.2006.10.001] [Citation(s) in RCA: 390] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2006] [Accepted: 10/07/2006] [Indexed: 11/25/2022]
Abstract
This study examined the relationship between posttraumatic stress (PTS) symptoms and particular aspects of emotion regulation difficulties among trauma-exposed individuals. Participants were an ethnically diverse sample of 108 undergraduates from an urban university. PTS symptom severity was found to be associated with lack of emotional acceptance, difficulty engaging in goal-directed behavior when upset, impulse-control difficulties, limited access to effective emotion regulation strategies, and lack of emotional clarity. Further, overall difficulties in emotion regulation were associated with PTS symptom severity, controlling for negative affect. Finally, individuals exhibiting PTS symptoms indicative of a PTSD diagnosis reported greater difficulties with emotion regulation than those reporting PTS symptoms at a subthreshold level. The implications of these findings for research and treatment are discussed.
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Affiliation(s)
- Matthew T Tull
- Center for Addictions, Personality, and Emotion Research and Department of Psychology, University of Maryland, College Park, MD 20742, USA.
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30
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Stam R. PTSD and stress sensitisation: a tale of brain and body Part 1: human studies. Neurosci Biobehav Rev 2007; 31:530-57. [PMID: 17270271 DOI: 10.1016/j.neubiorev.2006.11.010] [Citation(s) in RCA: 116] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2006] [Revised: 11/28/2006] [Accepted: 11/30/2006] [Indexed: 12/29/2022]
Abstract
Post-traumatic stress disorder (PTSD) is a chronic, debilitating psychiatric disorder that can follow exposure to extreme stressful experiences. It is characterised by hyperarousal and increased startle responses, re-experiencing of the traumatic event, withdrawal or avoidance behaviour and emotional numbing. The focus of this review is on aspects that have received less attention. PTSD develops only in a substantial minority of people exposed to traumatic stress, and possible individual traits that increase vulnerability are discussed. An overview is given of the wide variety of physiological disturbances that accompany PTSD and may contribute to disability, including neuroendocrine, cardiovascular, gastrointestinal and immune function and pain sensitivity. Brain imaging and pharmacological studies have generated some insight into the circuitry that may be involved in the generation of PTSD symptoms. Major limitations of human studies so far are the issue of causality and our lack of understanding of the underlying molecular substrates in the brain, which are easier to address in relevant animal models and will be discussed in a companion paper.
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Affiliation(s)
- Rianne Stam
- Department of Pharmacology and Anatomy, Rudolf Magnus Institute of Neuroscience, Utrecht, the Netherlands.
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31
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Affiliation(s)
- Gillinder Bedi
- National Research Centre for the Prevention of Child Abuse,
- Department of Psychology, Monash University
- Department of Social Work, Monash University , Melbourne, Victoria, Australia
| | - Chris Goddard
- National Research Centre for the Prevention of Child Abuse,
- Department of Social Work, Monash University , Melbourne, Victoria, Australia
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Rabe S, Dörfel D, Zöllner T, Maercker A, Karl A. Cardiovascular correlates of motor vehicle accident related posttraumatic stress disorder and its successful treatment. Appl Psychophysiol Biofeedback 2006; 31:315-30. [PMID: 17094031 PMCID: PMC1705541 DOI: 10.1007/s10484-006-9027-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2006] [Accepted: 10/02/2006] [Indexed: 10/26/2022]
Abstract
Persons with posttraumatic stress disorder (PTSD) have been shown to display elevated baseline cardiovascular activity and a heightened physiological reactivity to trauma-related stimuli. Study 1 examined differences in baseline heart rate (HR) and HR reactivity in 68 survivors of motor vehicle accidents (MVAs) and healthy controls without MVA. MVA survivors with PTSD (n=26), subsyndromal PTSD (n=22), traumatized controls without PTSD (non-PTSD with MVA, n=20) and healthy controls without MVA (HC, n=27) underwent measurement of HR during baseline and exposure to a neutral, positive, negative, and trauma-related picture. PTSD patients showed elevated baseline HR and increased HR reactivity only during exposure to the trauma-related picture. Study 2 investigated whether the elevated physiological responses observed in Study 1 normalized after cognitive behavioral therapy (CBT). We conducted a randomized, controlled treatment trial comparing CBT (n=17) to a Wait-list condition (WLC, n=18). Results showed a greater decrease in HR reactivity for CBT than for WLC. The change in HR reactivity was associated with clinical improvement.
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Affiliation(s)
- Sirko Rabe
- Department of Psychology, Dresden University of Technology, Dresden, Germany.
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Casada JH, Roache JD. Dissociation of physiology and behavior in PTSD. Int J Psychophysiol 2006; 62:243-8. [PMID: 16814888 DOI: 10.1016/j.ijpsycho.2006.04.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2005] [Revised: 04/14/2006] [Accepted: 04/25/2006] [Indexed: 11/17/2022]
Abstract
We have previously reported that subjects with posttraumatic stress disorder (PTSD) differ from trauma controls in their ability to produce and withhold responses in the Stop-Signal Task depending on the motivational context as determined by financial reward. This experiment measured skin conductance and heart rate to assess autonomic changes accompanying these different patterns of behavior. Fowles hypothesized that heart rate would increase with behavioral activation and that increases in skin conductance would accompany behavioral inhibition. Both PTSD and comparison groups showed the expected behavioral changes in response to rewards, but they differed in their physiological responses. The subjects in the traumatized comparison group showed changes in skin conductance and heart rate consistent with Fowles' hypothesis and the observed changes in behavioral inhibition and activation. However, PTSD subjects showed no significant change in either physiological measure. These results demonstrate a dissociation between autonomic reactivity and motivated behavior in PTSD that may represent one aspect of emotional numbing.
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Affiliation(s)
- J H Casada
- University of Texas Health Science Center at San Antonio, TX, USA.
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Abstract
Of the biological measures in the field of traumatic stress studies, the script-driven imagery paradigm has yielded the most consistent data. Approximately, two-thirds of individuals with a diagnosis of posttraumatic stress disorder (PTSD) exhibit heightened psychophysiologic reactivity while listening to audiotaped descriptions of their traumatic autobiographical memories. Nevertheless, these findings do not necessarily indicate the presence of PTSD or even that the memories are genuine. For example, people reporting (presumably) false memories of having been abducted by space aliens similarly exhibit heightened reactivity, even though they do not suffer from PTSD. To enhance the validity of diagnostic decision making in the forensic and policy arenas, we can use the methods of historians, specifically, consulting archival records to verify trauma histories and supplement biological data.
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Affiliation(s)
- Richard J McNally
- Department of Psychology, Harvard University, 1230 William James Hall, 33 Kirkland Street, Cambridge, MA 02138, USA.
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Friedman MJ, Wang S, Jalowiec JE, McHugo GJ, McDonagh-Coyle A. Thyroid hormone alterations among women with posttraumatic stress disorder due to childhood sexual abuse. Biol Psychiatry 2005; 57:1186-92. [PMID: 15866559 DOI: 10.1016/j.biopsych.2005.01.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2004] [Revised: 10/19/2004] [Accepted: 01/12/2005] [Indexed: 11/15/2022]
Abstract
BACKGROUND Research on thyroid activity among male combat veterans with posttraumatic stress disorder (PTSD) has consistently shown elevations in total triiodothyronine (TT3) and inconsistent elevations of other thyroid variables. This study is the first large scale investigation of thyroid function in women with PTSD. METHODS Thyroid function was measured in 63 women with PTSD due to childhood sexual abuse (PTSD-CSA) in comparison with a community sample of 42 women without current PTSD-CSA. Clinical measures included the Clinician Administered PTSD Scale (CAPS), the Evaluation of Lifetime Stressors, the Trauma Assessment for Adults and the Beck Depression Inventory. RESULTS Women with PTSD-CSA showed significant elevations in Total T3 and the TT3/free thyroxine (TT3/FT4) ratio, the FT3/TT3 ratio, and modest reductions in thyroid stimulating hormone relative to our community sample. These findings could not be explained by the influence of prior trauma, lifetime PTSD or depressive symptoms. CONCLUSIONS Altered thyroid activity, especially elevated Total T3 levels, was found in women with PTSD associated with childhood sexual abuse.
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Brawman-Mintzer O, Monnier J, Wolitzky KB, Falsetti SA. Patients with generalized anxiety disorder and a history of trauma: somatic symptom endorsement. J Psychiatr Pract 2005; 11:212-5. [PMID: 15920396 DOI: 10.1097/00131746-200505000-00010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The authors investigated the types and rates of trauma exposure and differences in symptom endorsement in a clinical sample of patients diagnosed with generalized anxiety disorder (GAD). Fifty-eight patients with GAD were assessed using the Structured Clinical Interview (SCID) and Trauma Assessment for Adults. In order to explore the relationship between specific traumatic event(s) and clinical presentation, the presence of somatic symptoms associated with GAD, including muscle tension, autonomic hyperactivity, and vigilance/scanning clusters (using DSM-III-R criteria), were examined. Patients with a history of sexual assault before 18 years (25.9%) endorsed fewer somatic symptoms, specifically fewer motor tension and autonomic GAD symptoms, than patients with other types of trauma. These findings indicate that early exposure to serious trauma, specifically childhood sexual assault, may lead to a different clinical presentation in GAD patients.
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Li CSR, Kosten TR, Sinha R. Sex differences in brain activation during stress imagery in abstinent cocaine users: a functional magnetic resonance imaging study. Biol Psychiatry 2005; 57:487-94. [PMID: 15737663 DOI: 10.1016/j.biopsych.2004.11.048] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2004] [Revised: 11/17/2004] [Accepted: 11/26/2004] [Indexed: 11/21/2022]
Abstract
BACKGROUND Because stress mediates drug seeking and relapse, and sex differences have been observed in stress and in the development of cocaine addiction, in this study we used functional neuroimaging to examine the effect of sex on stress responses in abstinent cocaine users. METHODS In a functional magnetic resonance imaging session, 17 male and 10 female cocaine-dependent subjects participated in script-guided imagery of neutral or stress situations. Subjects rated imagery vividness, anxiety, and cocaine craving for each trial. Brain activation during the stress and neutral imagery periods relative to their own baseline was examined in individual subjects. Sex contrast was obtained in second-level group analysis. RESULTS Female subjects demonstrated more activation, compared with male subjects, in left middle frontal, anterior cingulate, and inferior frontal cortices and insula, and right cingulate cortex during stress imagery. Region of interest analysis showed that the change of activity in left anterior cingulate and right posterior cingulate cortices both correlated inversely with the change of craving rating during stress imagery. CONCLUSIONS The greater left frontolimbic activity in women suggests that women might use more verbal coping strategies than do men while experiencing stress. The results also suggest a distinct role of the cingulate cortices in modulating stress-induced cocaine craving.
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Affiliation(s)
- Chiang-Shan Ray Li
- Department of Psychiatry, Yale University, New Haven, Connecticut 06519, USA.
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Weaver TL, Chard KM, Mechanic MB, Etzel JC. Self-injurious behaviors, PTSD arousal, and general health complaints within a treatment-seeking sample of sexually abused women. JOURNAL OF INTERPERSONAL VIOLENCE 2004; 19:558-575. [PMID: 15104861 DOI: 10.1177/0886260504262965] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Eighty-nine adult female survivors of childhood sexual abuse, presenting for psychological treatment, were assessed for self-reported rates of self-injurious behaviors (SIB), health complaints, and posttraumatic stress disorder (PTSD) symptoms of physiological arousal. A composite measure of current SIB was significantly and positively associated with health complaints, PTSD arousal, and three measures of sexual abuse severity: age of onset for sexual abuse, injury experienced during the sexual abuse, and perceived life threat. Tests of mediation revealed that symptoms of PTSD arousal mediated the relationship between earlier age of onset for sexual abuse and SIB. PTSD arousal moderated the relationship between sexual-abuse-related injury and SIB. SIB was a unique predictor of health complaints, even after controlling for sexual abuse severity and PTSD arousal.
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