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Silander NC, Chesire DJ, Scott KS. Psychological Prophylaxis: An Integrated Psychological Services Program in Trauma Care. J Clin Psychol Med Settings 2020; 26:291-301. [PMID: 30341469 DOI: 10.1007/s10880-018-9586-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The primary medical goals of acute care are restoration of physical health and return to physical function. However, in response to traumatic events and injuries, psychological factors are critical to one's overall recovery. Both pre-morbid psychiatric comorbidities and post-injury psychological compromise affect physical and psychological recovery in inpatient trauma populations. The Psychological Services Program (PSP), a model trauma/acute care program, addresses these critical factors in a Level 1 Trauma Center. The program routinely treats over one-quarter of the trauma patients at any given time. The incorporation of the PSP into treatment team care ensures that patients in need of mental health support can be identified and treated during their recovery. This unique model is recommended as a potential injury prevention and recovery intervention strategy for the myriad mental health comorbidities that may function as risk factors for poor post-injury adaptation and also as risk factors for possible future traumatic injury.
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Affiliation(s)
- Nina C Silander
- Brooks Rehabilitation Hospital, 3599 University Blvd S., Jacksonville, FL, USA.
| | - David J Chesire
- Division of Acute Care Surgery, Department of Surgery, College of Medicine/Jacksonville, University of Florida, Jacksonville, FL, USA
| | - Kamela S Scott
- Division of Acute Care Surgery, Department of Surgery, College of Medicine/Jacksonville, University of Florida, Jacksonville, FL, USA
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Lenglet A, Lopes-Cardozo B, Shanks L, Blanton C, Feo C, Tsatsaeva Z, Idrisov K, Bolton PA, Pintaldi G. Outcomes of an individual counselling programme in Grozny, Chechnya: a randomised controlled study. BMJ Open 2018; 8:e019794. [PMID: 30139892 PMCID: PMC6112398 DOI: 10.1136/bmjopen-2017-019794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To evaluate the effectiveness of individual counselling on functioning of clients participating in a mental health intervention in a humanitarian setting. DESIGN Randomised controlled trial. SETTING Mental health programme implemented by Médecins Sans Frontières in Grozny, Republic of Chechnya. PARTICIPANTS 168 eligible clients were randomly assigned to the intervention and waitlisted (2 months) arms between November 2014 and February 2015. INTERVENTION Individual counselling sessions. MAIN OUTCOME MEASURES Change in functioning was measured using the Short Form 6 (SF6) and gender-specific locally adapted Chechen functioning instruments in the intervention group at the end of counselling and the waitlisted group after their waitlisted period. Unadjusted differences in gain scores (DGSs) between intervention and waitlisted groups were calculated with effect size (Cohen's d) for both tools. Linear regression compared the mean DGS in both groups. RESULTS The intervention group (n=78) improved compared with waitlisted controls (n=80) on the SF6 measures with moderate to large effect sizes: general health (DGS 12.14, d=0.52), body pain (DGS 10.26, d=0.35), social support (DGS 16.07, d=0.69) and emotional functioning (DGS 16.87, d=0.91). Similar improvement was seen using the Chechen functioning instrument score (female DGS -0.33, d=0.55; male DGS -0.40, d=0.99). Adjusted analysis showed significant improvement (p<0.05) in the intervention group for all SF6 measures and for the Chechen functioning instrument score in women but not men (p=0.07). CONCLUSIONS Individual counselling significantly improved participants' ability to function in the intervention group compared with the waitlisted group. Further research is needed to determine whether similar positive results can be shown in other settings and further exploring the impact in male clients' population. TRIAL REGISTRATION NUMBER NTR4689.
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Affiliation(s)
- Annick Lenglet
- Médecins Sans Frontières, Operational Centre Amsterdam, Amsterdam, The Netherlands
| | - Barbara Lopes-Cardozo
- Emergency Response and Recovery Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Leslie Shanks
- Médecins Sans Frontières, Operational Centre Amsterdam, Amsterdam, The Netherlands
| | - Curtis Blanton
- Emergency Response and Recovery Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | - Kyuri Idrisov
- Psychiatry Department, Chechnya State University, Grozny, Republic of Chechnya
| | - Paul A Bolton
- Departments of International Health and Mental Health,Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Giovanni Pintaldi
- Médecins Sans Frontières, Operational Centre Amsterdam, Amsterdam, The Netherlands
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Breathing biofeedback as an adjunct to exposure in cognitive behavioral therapy hastens the reduction of PTSD symptoms: a pilot study. Appl Psychophysiol Biofeedback 2016; 40:25-31. [PMID: 25750106 PMCID: PMC4375291 DOI: 10.1007/s10484-015-9268-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Although trauma-focused cognitive behavioral therapy (TF-CBT) with exposure is an effective treatment for posttraumatic stress disorder (PTSD), not all patients recover. Addition of breathing biofeedback to exposure in TF-CBT is suggested as a promising complementary technique to improve recovery of PTSD symptoms. Patients (n = 8) with chronic PTSD were randomized to regular TF-CBT or TF-CBT with complementary breathing biofeedback to exposure. PTSD symptoms were measured before, during and after TF-CBT with the Impact of Event Scale-Revised. The results show that breathing biofeedback is feasible and can easily be complemented to TF-CBT. Although PTSD symptoms significantly decreased from pre to post treatment in both conditions, there was a clear trend towards a significantly faster (p = .051) symptom reduction in biofeedback compared to regular TF-CBT. The most important limitation was the small sample size. The hastened clinical improvement in the biofeedback condition supports the idea that breathing biofeedback may be an effective complementary component to exposure in PTSD patients. The mechanism of action of breathing biofeedback may relate to competing working memory resources decreasing vividness and emotionality, similar to eye movement desensitization and reprocessing. Future research is needed to examine this.
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Lee JK, Choi HG, Kim JY, Nam J, Kang HT, Koh SB, Oh SS. Self-resilience as a protective factor against development of post-traumatic stress disorder symptoms in police officers. Ann Occup Environ Med 2016; 28:58. [PMID: 27777782 PMCID: PMC5067890 DOI: 10.1186/s40557-016-0145-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 10/03/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study was conducted to check whether self-resilience, one of the characteristics known to affect the occurrence of post-traumatic stress disorder (PTSD) symptoms after experiencing traumatic events, could serve as a protective factor for police officers whose occupational factors are corrected. METHODS We conducted a cross-sectional study in which 112 male police officers in Gangwon Province participated. They visited the Wonju Severance Christian Hospital Occupational Environment Center for medical check-ups from June to December 2015. Their general characteristics were identified using structured questionnaires, and they were asked to fill in the Korean Occupational Stress Scale-Short Form (KOSS-SF). Further, the Center for Epidemiologic Studies-Depression Scale (CES-D), Connor-Davidson Resilience Scale-Korean (CD-RI-K), and Impact of Event Scale-Revised-Korean version (IES-R-K) were used to evaluate their job stress, depression, self-resilience, and PTSD symptoms. Logistic regression analysis was conducted to correct their personal, occupational, and psychological factors to analyze the relationship between self-resilience and PTSD symptoms. RESULTS Among 112 respondents who experienced a traumatic event, those with low self-resilience had significantly higher rate of PTSD symptoms than those with high self-resilience even after correcting for the covariate of general, occupational, and psychological characteristics (odds ratio [OR] 3.51; 95 % CI: 1.06-19.23). CONCLUSIONS Despite several limitations, these results suggest that a high degree of self-resilience may protect police officers from critical incident-related PTSD symptoms.
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Affiliation(s)
- Jong-Ku Lee
- Department of Occupational and Environmental Medicine, Wonju Severance Christian Hospital, Wonju College of Medicine, Yonsei University, 20 ilsan-ro, Wonju, Gangwon 220-701 South Korea
| | - Hyeon-Gyeong Choi
- Department of Occupational and Environmental Medicine, Wonju Severance Christian Hospital, Wonju College of Medicine, Yonsei University, 20 ilsan-ro, Wonju, Gangwon 220-701 South Korea
| | - Jae-Yeop Kim
- Department of Occupational and Environmental Medicine, Wonju Severance Christian Hospital, Wonju College of Medicine, Yonsei University, 20 ilsan-ro, Wonju, Gangwon 220-701 South Korea
| | - Juhyun Nam
- Department of Occupational and Environmental Medicine, Wonju Severance Christian Hospital, Wonju College of Medicine, Yonsei University, 20 ilsan-ro, Wonju, Gangwon 220-701 South Korea
| | - Hee-Tae Kang
- Department of Occupational and Environmental Medicine, Wonju Severance Christian Hospital, Wonju College of Medicine, Yonsei University, 20 ilsan-ro, Wonju, Gangwon 220-701 South Korea
| | - Sang-Baek Koh
- Department of Occupational and Environmental Medicine, Wonju Severance Christian Hospital, Wonju College of Medicine, Yonsei University, 20 ilsan-ro, Wonju, Gangwon 220-701 South Korea
- Department of Preventive Medicine, Wonju College of Medicine, Yonsei University, 20 ilsan-ro, Wonju, 220-701 Gangwon South Korea
| | - Sung-Soo Oh
- Department of Occupational and Environmental Medicine, Wonju Severance Christian Hospital, Wonju College of Medicine, Yonsei University, 20 ilsan-ro, Wonju, Gangwon 220-701 South Korea
- Department of Preventive Medicine, Wonju College of Medicine, Yonsei University, 20 ilsan-ro, Wonju, 220-701 Gangwon South Korea
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Pinjarkar RG, Sudhir PM, Math SB. Brief cognitive behavior therapy in patients with social anxiety disorder: a preliminary investigation. Indian J Psychol Med 2015; 37:20-5. [PMID: 25722507 PMCID: PMC4341305 DOI: 10.4103/0253-7176.150808] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
CONTEXT Cognitive behavior therapy (CBT) is the treatment of choice in anxiety disorders. However, there is little evidence for the effectiveness brief CBT in social anxiety. AIMS We examined the effectiveness of a brief CBT of six sessions in patients with social anxiety disorder. SETTINGS AND DESIGN A single case design study baseline; post and 1 month follow-up was adopted. MATERIALS AND METHODS Seven patients with a DSM IV diagnosis of social anxiety underwent 6 weekly sessions of brief CBT. Their diagnosis was confirmed using structured diagnostic interviews. They were assessed at baseline, post and 1-month follow-up on CGI- Severity, Leibowitz Social Anxiety Scale (LSAS), Social Phobia Rating Scale, Brief Fear of Negative Evaluation, and Beck's Depression Inventory. STATISTICAL ANALYSIS Data were analyzed using the method of clinical significance. RESULTS Results indicated that brief CBT was effective in reducing social anxiety in all patients. Brief CBT was also effective in reducing social avoidance and self consciousness. However, brief CBT was not effective in reducing fear of negative evaluation in all patients, suggesting the need for longer duration for cognitive changes in some dysfunctional beliefs. CONCLUSIONS This preliminary case series indicates that brief CBT may be a promising and a cost and time effective approach to managing for social anxiety.
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Affiliation(s)
- Ravikant G Pinjarkar
- Department of Clinical Psychology, Maharashtra Institute of Mental Health, Sassoon Hospital Campus, Pune, Maharashtra, India
| | - Paulomi M Sudhir
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
| | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
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6
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Ahmadizadeh M, Ahmadi K, Anisi J, Ahmadi AB. Assessment of Cognitive Behavioral Therapy on Quality of Life of Patients with Chronic War-related Post-traumatic Stress Disorder. Indian J Psychol Med 2013; 35:341-5. [PMID: 24379492 PMCID: PMC3868083 DOI: 10.4103/0253-7176.122222] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) is the one of the most commonly observed psychiatric disorder in veterans. The condition can lead to considerable social, occupational, and interpersonal dysfunction. PTSD occurring after combat injury appears to be strongly correlated with the extent of injury, and develops over several months. Present study was designed for assessing the cognitive behavioral therapy in the quality of life (QOL) of war-related PTSD in veterans compared to control group and compare applied treatments with each other. MATERIALS AND METHODS In the present study, we assessment effects of cognitive behavioral therapy such as problem solving, exposure therapy and their combination on QOL in 120 Iranian PTSD patients veterans after Iran-Iraq war. They were randomly allocated to one of four equal interventional groups: (a) Problem solving therapy (b) exposure therapy (c) combined therapy (exposure therapy plus problem solving) (d) control group. Before and after study intervention, patients were evaluated by short form-36 (SF-36) questionnaire. RESULTS Post-test and follow-up SF-36 scores were 55.6±4 and 55.1±3.6 in exposure therapy, 50±4.4 and 56.1±3.8 in problem solving, and 48.73±3.8 and 50.9±4.2 in combined therapy. In comparing to control group, all intervention showed significant improvement in QOL in PTSD patients. CONCLUSION According to the results of the present study, behavioral therapy can improve QOL in PTSD patients.
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Affiliation(s)
| | - Khodabakhsh Ahmadi
- Behavioral Sciences Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Jafar Anisi
- Behavioral Sciences Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Amir Bahrami Ahmadi
- Occupational Medicine Research Center, Iran University of Medical Sicences, Tehran, Iran
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7
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Otis C, Marchand A, Courtois F. Risk factors for posttraumatic stress disorder in persons with spinal cord injury. Top Spinal Cord Inj Rehabil 2013; 18:253-63. [PMID: 23459174 DOI: 10.1310/sci1803-253] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE Many of the events that cause spinal cord injury (SCI) are traumatic events that can result in posttraumatic stress disorder (PTSD). It therefore appears that most persons with SCI are at risk for developing PTSD. This study retrospectively examined risk factors for PTSD symptoms in a sample of 71 persons with SCI. METHOD The Structured Clinical Interview for DSM-IV was used to assess full and partial PTSD diagnoses. Self-administered questionnaires were used to measure potential risk factors. RESULTS Results indicated that 11% of the participants met the criteria for full PTSD, and an additional 20% met the criteria for partial PTSD at some point after their SCI. Hierarchical linear regression analyses revealed that trauma history, peritraumatic reactions, and intolerance of uncertainty predicted the number of PTSD symptoms. CONCLUSION This study highlights the importance of trauma history, peritraumatic reactions, and intolerance of uncertainty in the development of PTSD symptoms. Patients at risk for PTSD should be identified early in the rehabilitation process and could benefit from psychological interventions with the aim of preventing PTSD development.
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Affiliation(s)
- Catherine Otis
- Department of Psychology, Université du Québec à Montréal , Montréal, Québec, Canada
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8
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Gillihan SJ, Aderka IM, Conklin PH, Capaldi S, Foa EB. The Child PTSD Symptom Scale: psychometric properties in female adolescent sexual assault survivors. Psychol Assess 2012; 25:23-31. [PMID: 22867010 DOI: 10.1037/a0029553] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Traumatic experiences are common among youths and can lead to posttraumatic stress disorder (PTSD). In order to identify traumatized children who need PTSD treatment, instruments that can accurately and efficiently evaluate pediatric PTSD are needed. One such measure is the Child PTSD Symptom Scale (CPSS), which has been found to be a reliable and valid measure of PTSD symptom severity in school-age children exposed to natural disasters (Foa, Johnson, Feeny, & Treadwell, 2001). However, the psychometric properties of the CPSS are not known in youths who have experienced other types of trauma. The current study aims to fill this gap by examining the psychometric properties of the interview (CPSS-I) and self-report (CPSS-SR) administrations of the CPSS in a sample of 91 female youths with sexual abuse-related PTSD, a population that is targeted in many treatment studies. Scores on both the CPSS-I and CPSS-SR demonstrated good to excellent internal consistency. One-week test-retest reliability assessed for CPSS-SR scores was excellent (r=.86); interrater reliability of CPSS-I scores was also excellent (r=.87). Symptom-based diagnostic agreement between the CPSS-SR and CPSS-I was excellent at 85.5%; scores on both the CPSS-SR and CPSS-I also demonstrated good convergent validity (74.5-76.5% agreement) with the PTSD module of The Schedule of Affective Disorders and Schizophrenia for School-Age Children--Revised for DSM--IV (K-SADS; Kaufman, Birmaher, Brent, & Rao, 1997). The strong psychometric properties of the CPSS render it a valuable instrument for PTSD screening as well as for assessing symptom severity.
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Affiliation(s)
- Seth J Gillihan
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 1910, USA
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9
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Ruggiero KJ, Resnick HS, Paul LA, Gros K, McCauley JL, Acierno R, Morgan M, Galea S. Randomized controlled trial of an internet-based intervention using random-digit-dial recruitment: the Disaster Recovery Web project. Contemp Clin Trials 2012; 33:237-46. [PMID: 22008248 PMCID: PMC3253875 DOI: 10.1016/j.cct.2011.10.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Accepted: 10/04/2011] [Indexed: 11/19/2022]
Abstract
Disasters occur with high frequency throughout the world and increase risk for development of mental health problems in affected populations. Research focused on the development and evaluation of secondary prevention interventions addressing post-disaster mental health has high potential public-health impact. Toward this end, internet-based interventions (IBIs) are particularly attractive in that they: (1) offer a low-cost means of delivering standardized, targeted, personalized intervention content to a broad audience; and (2) are easily integrated within a stepped care approach to screening and service delivery. We describe a unique study design intended to evaluate an IBI with a disaster-affected population-based sample. Description and rationale are provided for sampling selection and procedures, selection of assessment measures and methods, design of the intervention, and statistical evaluation of critical outcomes. Unique features of this intervention include the use of a population-based sample, telephone and internet-based assessments, and development of a highly individualized web-based intervention. Challenges related to the development and large-scale evaluation of IBIs targeting post-disaster mental health problems, as well as implications for future research and practice are discussed.
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Affiliation(s)
- Kenneth J Ruggiero
- National Crime Victims Research and Treatment Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St., MSC861, Charleston, SC 29425, USA.
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10
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De Silva M, MacLachlan M, Devane D, Desmond D, Gallagher P, Schnyder U, Brennan M, Patel V. Psychosocial interventions for the prevention of disability following traumatic physical injury. Cochrane Database Syst Rev 2009; 2009:CD006422. [PMID: 19821365 PMCID: PMC3428876 DOI: 10.1002/14651858.cd006422.pub3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Traumatic physical injury can result in many disabling sequelae including physical and mental health problems and impaired social functioning. OBJECTIVES To assess the effectiveness of psychosocial interventions in the prevention of physical, mental and social disability following traumatic physical injury. SEARCH STRATEGY The search was not restricted by date, language or publication status. We searched the following electronic databases; Cochrane Injuries Group Specialised Register, CENTRAL (The Cochrane Library 2009, Issue 1), MEDLINE (Ovid SP), EMBASE (Ovid SP), PsycINFO (Ovid SP), Controlled Trials metaRegister (www.controlled-trials.com), AMED (Allied & Complementary Medicine), ISI Web of Science: Social Sciences Citation Index (SSCI), PubMed. We also screened the reference lists of all selected papers and contacted authors of relevant studies. The latest search for trials was in February 2008. SELECTION CRITERIA Randomised controlled trials that consider one or more defined psychosocial interventions for the prevention of physical disability, mental health problems or reduced social functioning as a result of traumatic physical injury. We excluded studies that included patients with traumatic brain injury (TBI). DATA COLLECTION AND ANALYSIS Two authors independently screened the titles and abstracts of search results, reviewed the full text of potentially relevant studies, independently assessed the risk of bias and extracted data. MAIN RESULTS We included five studies, involving 756 participants. Three studies assessed the effect of brief psychological therapies, one assessed the impact of a self-help booklet, and one the effect of collaborative care. The disparate nature of the trials covering different patient populations, interventions and outcomes meant that it was not possible to pool data meaningfully across studies. There was no evidence of a protective effect of brief psychological therapy or educational booklets on preventing disability. There was evidence from one trial of a reduction in both post-traumatic stress disorder (PTSD) and depressive symptoms one month after injury in those who received a collaborative care intervention combined with a brief psycho-educational intervention, however this was not retained at follow up. Overall mental health status was the only disability outcome affected by any intervention. In three trials the psychosocial intervention had a detrimental effect on the mental health status of patients. AUTHORS' CONCLUSIONS This review provides no convincing evidence of the effectiveness of psychosocial interventions for the prevention of disability following traumatic physical injury. Taken together, our findings cannot be considered as supporting the provision of psychosocial interventions to prevent aspects of disability arising from physical injury. However, these conclusions are based on a small number of disparate trials with small to moderate sample sizes and are therefore necessarily cautious. More research, using larger sample sizes, and similar interventions and patient populations to enable pooling of results, is needed before these findings can be confirmed.
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Affiliation(s)
- Mary De Silva
- London School of Hygiene & Tropical MedicineNutrition & Public Health Intervention Research UnitKeppel StreetLondonUKWC1E 7HT
| | - Malcolm MacLachlan
- Trinity College, University of DublinCentre for Global Health and School of PsychologyDublinIreland
| | - Declan Devane
- National University of Ireland GalwaySchool of Nursing and MidwiferyÁras MoyolaUniversity RoadGalwayIreland
| | - Deirdre Desmond
- National University of IrelandDepartment of PsychologyJohn Hume BuildingMaynoothCo. KildareIreland
| | | | - Ulrich Schnyder
- University HospitalDepartment of PsychiatryCulmannstrasse 8ZurichSwitzerlandCH‐9091
| | - Muireann Brennan
- Centers for Disease Control and PreventionInternational Emergency & Refugee Health Branch1600 Clifton Road NE MS E‐97AtlantaGAUSA30333
| | - Vikram Patel
- London School of Hygiene & Tropical MedicineNutrition & Public Health Intervention Research UnitKeppel StreetLondonUKWC1E 7HT
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Rubin DC, Berntsen D, Bohni MK. A memory-based model of posttraumatic stress disorder: evaluating basic assumptions underlying the PTSD diagnosis. Psychol Rev 2008; 115:985-1011. [PMID: 18954211 PMCID: PMC2762652 DOI: 10.1037/a0013397] [Citation(s) in RCA: 314] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
In the mnemonic model of posttraumatic stress disorder (PTSD), the current memory of a negative event, not the event itself, determines symptoms. The model is an alternative to the current event-based etiology of PTSD represented in the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; American Psychiatric Association, 2000). The model accounts for important and reliable findings that are often inconsistent with the current diagnostic view and that have been neglected by theoretical accounts of the disorder, including the following observations. The diagnosis needs objective information about the trauma and peritraumatic emotions but uses retrospective memory reports that can have substantial biases. Negative events and emotions that do not satisfy the current diagnostic criteria for a trauma can be followed by symptoms that would otherwise qualify for PTSD. Predisposing factors that affect the current memory have large effects on symptoms. The inability-to-recall-an-important-aspect-of-the-trauma symptom does not correlate with other symptoms. Loss or enhancement of the trauma memory affects PTSD symptoms in predictable ways. Special mechanisms that apply only to traumatic memories are not needed, increasing parsimony and the knowledge that can be applied to understanding PTSD.
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Affiliation(s)
- David C Rubin
- Department of Psychology and Neuroscience, Duke University
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12
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Resnick HS, Acierno R, Amstadter AB, Self-Brown S, Kilpatrick DG. An acute post-sexual assault intervention to prevent drug abuse: updated findings. Addict Behav 2007; 32:2032-45. [PMID: 17275198 PMCID: PMC1986828 DOI: 10.1016/j.addbeh.2007.01.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2006] [Revised: 12/01/2006] [Accepted: 01/03/2007] [Indexed: 11/23/2022]
Abstract
Sexual assault and rape routinely produce extreme distress and negative psychological reactions in victims. Further, past research suggests that victims are at increased risk of developing substance use or abuse post-rape. The post-rape forensic medical exam may itself exacerbate peritraumatic distress because it includes cues that may serve as reminders of the assault, thereby potentiating post-assault negative sequelae. To address these problems, a two-part video intervention was developed to take advantage of the existing sexual assault forensic exam infrastructure, and to specifically (a) minimize anxiety/discomfort during forensic examinations, thereby reducing risk of future emotional problems, and (b) prevent increased substance use and abuse following sexual assault. Updated findings with a sample of 268 sexual assault victims participating in the forensic medical exam and completing one or more follow-up assessments at: (1)<3 months post-assault; (2) 3 to 6 months post-assault; or (3) 6 months or longer post-assault indicated that the video was associated with significantly lower frequency of marijuana use at each time point, among women who reported use prior to the assault.
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Affiliation(s)
- Heidi S Resnick
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425-0742, USA.
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13
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Keane TM, Marshall AD, Taft CT. Posttraumatic stress disorder: etiology, epidemiology, and treatment outcome. Annu Rev Clin Psychol 2007; 2:161-97. [PMID: 17716068 DOI: 10.1146/annurev.clinpsy.2.022305.095305] [Citation(s) in RCA: 217] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Posttraumatic stress disorder (PTSD) results from exposure to a traumatic event that poses actual or threatened death or injury and produces intense fear, helplessness, or horror. U.S. population surveys reveal lifetime PTSD prevalence rates of 7% to 8%. Potential reasons for varying prevalence rates across gender, cultures, and samples exposed to different traumas are discussed. Drawing upon a conditioning model of PTSD, we review risk factors for PTSD, including pre-existing individual-based factors, features of the traumatic event, and posttrauma social support. Characteristics of the trauma, particularly peritraumatic response and related cognitions, and posttrauma social support appear to confer the greatest risk for PTSD. Further work is needed to disentangle the interrelationships among these factors and elucidate the underlying mechanisms. Based upon existing treatment outcome studies, we recommend use of exposure therapies and anxiety management training as first-line treatment for PTSD. Among psychopharmacological treatments, selective serotonin reuptake inhibitors evidence the strongest treatment effects, yet these effects are modest compared with psychological treatments.
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Affiliation(s)
- Terence M Keane
- VA Boston Healthcare System, Boston University School of Medicine, Boston, Massachusetts 02130, USA.
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14
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Resnick H, Acierno R, Waldrop AE, King L, King D, Danielson C, Ruggiero KJ, Kilpatrick D. Randomized controlled evaluation of an early intervention to prevent post-rape psychopathology. Behav Res Ther 2007; 45:2432-47. [PMID: 17585872 PMCID: PMC2040305 DOI: 10.1016/j.brat.2007.05.002] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2006] [Revised: 04/30/2007] [Accepted: 05/07/2007] [Indexed: 11/27/2022]
Abstract
A randomized between-group design was used to evaluate the efficacy of a video intervention to reduce post-traumatic stress disorder (PTSD) and other mental health problems, implemented prior to the forensic medical examination conducted within 72 h post-sexual assault. Participants were 140 female victims of sexual assault (68 video/72 nonvideo) aged 15 years or older. Assessments were targeted for 6 weeks (Time 1) and 6 months (Time 2) post-assault. At Time 1, the intervention was associated with lower scores on measures of PTSD and depression among women with a prior rape history relative to scores among women with a prior rape history in the standard care condition. At Time 2, depression scores were also lower among those with a prior rape history who were in the video relative to the standard care condition. Small effects indicating higher PTSD and Beck Anxiety Inventory (BAI) scores among women without a prior rape history in the video condition were observed at Time 1. Accelerated longitudinal growth curve analysis indicated a videoxprior rape history interaction for PTSD, yielding four patterns of symptom trajectory over time. Women with a prior rape history in the video condition generally maintained the lowest level of symptoms.
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Affiliation(s)
- Heidi Resnick
- Medical University of South Carolina, Charleston, SC 29425, USA.
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Tarrier N, Humphreys AL. PTSD and the Social Support of the Interpersonal Environment: The Development of Social Cognitive Behavior Therapy. J Cogn Psychother 2003. [DOI: 10.1891/jcop.17.2.187.57440] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We will argue that, although the evidence for the effectiveness of cognitive-behavioral treatment, of PTSD is compelling, not all patients engage or respond to treatment and in those who do, residual symptomatology is not uncommon. We then briefly examine the literature on the influence of the interpersonal and emotional aspects of social support on the development, maintenance, and treatment of post-traumatic stress disorder (PTSD). Two areas of social support are suggested as potentially important to the study of PTSD: (1) the literature on expressed emotion (EE) and the underlying beliefs held by significant others which influence their negative coping behaviors and interactions with the patient, and (2) examination of the concept of reciprocity, the ability to receive and provide social support. Finally, we suggest a range of possible treatment options suggested by this review as possible adjuncts to conventional CBT. These include formal family interventions, re-engagement with social networks, and modification of perceptions of social interactions.
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Benight CC, Swift E, Sanger J, Smith A, Zeppelin D. Coping Self-Efficacy as a Mediator of Distress Following a Natural Disaster. JOURNAL OF APPLIED SOCIAL PSYCHOLOGY 1999. [DOI: 10.1111/j.1559-1816.1999.tb00120.x] [Citation(s) in RCA: 120] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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