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Tsur N, Talmon A. Post-Traumatic Orientation to Bodily Signals: A Systematic Literature Review. TRAUMA, VIOLENCE & ABUSE 2023; 24:174-188. [PMID: 34159853 DOI: 10.1177/15248380211025237] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Theoretical literature suggests that trauma and (PTSD) may instigate changes in the interpretation of bodily signals. Some findings support these inquiries, revealing that exposure to traumatic events and PTSD are associated with pain catastrophizing, body vigilance, fear of pain, and other manifestations of bodily perceptions and interpretations. However, these findings are not integrated into an inclusive empirically based conceptualization, thus leading to a limited comprehension of this phenomenon. This systematic literature review was conducted to synthesize the existing literature referring to orientation to bodily signals. Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the review included a final of 48 manuscripts that addressed orientation to bodily signals among participants (aged 18 and above) and its potential associations with PTSD. The review revealed that most studies assessed one orientation manifestation, which was tested for its link to PTSD. The majority of the manuscripts were cross-sectional and included participants who faced combat, vehicle accidents, or various types of traumas. Only five manuscripts focused on interpersonal trauma and abuse. Most manuscripts reported significant correlations, revealing that trauma and PTSD are associated with a negative, catastrophic and frightful interpretation of bodily signals. These findings emphasize the need to encapsulate the various manifestations of orientation to bodily signals under a unified construct, as proposed by the term post-traumatic orientation to bodily signals. Further research is needed to illuminate the circumstances and processes by which trauma is implicated in post-traumatic orientation to bodily signals.
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Affiliation(s)
- Noga Tsur
- Bob Shapell School of Social Work, Tel Aviv University, Israel
| | - Ada Talmon
- Bob Shapell School of Social Work, Tel Aviv University, Israel
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2
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Abstract
This review examines the role of trauma in psychiatric morbidity and analogous psychoneurobiological changes. Trauma is a necessary criterion for Post-Traumatic Stress Disorder (PTSD), however, trauma history is highly correlated with a variety of psychiatric conditions. Some evidence suggests that Major Depressive Disorder (MDD) is the most common psychiatric condition that arises following trauma. Approximately 50% of PTSD cases present with co-morbid MDD. Overlapping symptomatology and neurobiology between these conditions underlie the debate over whether these phenomena result from problematic nosology or whether comorbid MDD + PTSD is a distinct phenotype of trauma-related psychopathology. Regardless, similar treatment approaches have been employed historically, with varying success. The drug-assisted psychotherapy treatment model, which combines pharmacological and psychotherapeutic approaches, is currently being trialled as a novel treatment approach in psychiatry. Both psilocybin- and 3,4-Methylenedioxymethamphetamine (MDMA)-assisted psychotherapy have received Food and Drug Administration 'breakthrough therapy' designation for the treatment of resistant MDD and PTSD, respectively. This paper reviews the therapeutic rationale of both psilocybin and MDMA for treating both trauma-related MDD and PTSD.
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Affiliation(s)
- Catherine I V Bird
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Nadav L Modlin
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - James J H Rucker
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
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3
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Scherer M, Ladysh R, Dass-Brailsford P. Profiles of trauma histories as predictors of depression among women living with HIV. AIDS Care 2021; 34:784-791. [PMID: 33882767 DOI: 10.1080/09540121.2021.1916872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study examined co-occurring psychosocial problems among 120 women living with HIV (WLWH) in Washington, DC, USA. Participants completed a demographic survey, PHQ-9 (depressive symptoms), the Life Stressor Checklist (stressful events) and the PCL-C (PTSD symptoms in civilian populations). We calculated descriptive statistics and chi-square solutions for participant demographics. Classes of trauma history were established using latent class analysis (LCA). Latent indicators were extracted from participant self-reported traumatic histories on the LSC-R. Traumatic events have been found to be predictive of both depression. Latent class solution selection was guided by utility in evaluating and discriminating between classes as predictors of scales measuring depression or trauma exposure. Three distinct classes of trauma histories were identified: a high trauma (HT) class, an abuse/neglect (AN) class and a childhood trauma (CT) class. Binary logistic regression analyses determined whether trauma profiles predicted depression or PTSD after controlling for age, marital status, race and education. Participants in both the AN and CT class were over five times more likely than those in the HT class to endorse depressive symptoms. Classes differed significantly on whether they endorse depressive symptoms (p = .008) and marital status (p = .009), while PTSD appeared to trend toward significance (p = .085).
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Affiliation(s)
- Michael Scherer
- Clinical Psychology Department, The Chicago School of Professional Psychology, Washington, DC, USA.,Clinical Psychology Department, Pacific Institute for Research and Evaluation, Calverton, MD, USA
| | - Rachel Ladysh
- Clinical Psychology Department, The Chicago School of Professional Psychology, Washington, DC, USA
| | - Priscilla Dass-Brailsford
- Clinical Psychology Department, The Chicago School of Professional Psychology, Washington, DC, USA.,Department of Psychiatry, Georgetown University, Washington, DC, USA
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4
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Klein AB, Dutra SJ, Bovin MJ, Keane TM, Marx BP. The Role of Negative Affect in Differentiating Posttraumatic Stress Disorder, Depression, and Their Comorbidity Among United States Veterans. J Trauma Stress 2021; 34:322-332. [PMID: 33174307 DOI: 10.1002/jts.22612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 09/18/2020] [Accepted: 09/23/2020] [Indexed: 11/10/2022]
Abstract
Following trauma exposure, two frequently co-occurring forms of psychopathology include posttraumatic stress disorder (PTSD) and major depressive disorder (MDD). Although these diagnoses have been identified as distinct constructs, the proper classification of these disorders remains a challenge due to overlapping symptoms. Instead, systematically establishing higher- and lower-order personality traits associated with each diagnosis may avoid this confound and improve differential diagnosis. In the present study, we examined how higher-order negative affect and its lower-order facets (i.e., anxiousness, emotional lability, and separation insecurity) may be associated with a diagnosis of PTSD only, MDD only, both diagnoses, or neither diagnosis. Participants were 1,175 veterans enrolled in the Veterans After Discharge Longitudinal Registry. Higher- and lower-order negative affect were assessed using the Personality Inventory for DSM-5 (PID-5), and PTSD and MDD diagnoses were based on the Structured Clinical Interview for DSM-5 (SCID-5). Multinomial logistic regressions were used to model the association between higher- and lower-order negative affect and diagnostic status, after controlling for potential covariates. Diagnostic utility analyses were conducted to examine the degree to which higher- and lower-order negative affect classified participants across groups. Higher-order negative affect and lower-order anxiousness differentiated diagnostic groups, ORs = 1.76-4.66, and had strong specificity and negative predictive value for individuals with PTSD and MDD and those with MDD only. These findings help explain the role of higher-order negative affect and lower-order anxiousness in differentiating PTSD from MDD and comorbid PTSD and MDD and may have implications for assessment, differential diagnosis, and treatment planning.
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Affiliation(s)
- Alexandra B Klein
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Sunny J Dutra
- Department of Clinical Psychology, William James College, Newton, Massachusetts, USA
| | - Michelle J Bovin
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Terence M Keane
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Brian P Marx
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
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5
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Post LM, Youngstrom E, Connell AM, Zoellner LA, Feeny NC. Transdiagnostic emotion regulation processes explain how emotion-related factors affect co-occurring PTSD and MDD in relation to trauma. J Anxiety Disord 2021; 78:102367. [PMID: 33592520 DOI: 10.1016/j.janxdis.2021.102367] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 11/15/2020] [Accepted: 02/02/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) co-occur at high rates and greater disorder severity. Studies examining the contributions of specific emotion regulation (ER) processes and negative affect (NA) to PTSD and MDD co-occurrence are scarce. This study investigated a transdiagnostic understanding of the nature of PTSD and MDD co-occurrence by examining the roles of NA, ER processes, and negative mood regulation (NMR) expectancies in PTSD and MDD in relation to trauma. METHODS Structural equation modeling was used to examine the roles of emotionality, PTSD, and MDD constructs in 200 individuals with primary PTSD. RESULTS ER processes fully mediated the relationships between NA and PTSD (β = .40, p < .001) and MDD (β = .48, p < .001), and NMR expectancies and PTSD (β = -.31, p < .001) and MDD (β = -.37, p < .001). CONCLUSIONS NA and NMR expectancies exert their effects on PTSD and MDD almost entirely through ER processes. ER appears to be a transdiagnostic process, partly accounting for the co-occurrence between PTSD and MDD. Co-occurrence models could benefit by incorporating ER processes to inform diagnostic classification and criteria and clinical intervention improved by specifically targeting ER processes.
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Affiliation(s)
- Loren M Post
- Case Western Reserve University, Department of Psychological Sciences, 10900 Euclid Ave., Cleveland, OH, 44106, USA.
| | - Eric Youngstrom
- University of North Carolina at Chapel Hill, Department of Psychology, CB#3270 Davie Hall, Chapel Hill, NC, 27599, USA
| | - Arin M Connell
- Case Western Reserve University, Department of Psychological Sciences, 10900 Euclid Ave., Cleveland, OH, 44106, USA
| | - Lori A Zoellner
- University of Washington, Department of Psychology, Box 351525, Seattle, WA, 98195, USA
| | - Norah C Feeny
- Case Western Reserve University, Department of Psychological Sciences, 10900 Euclid Ave., Cleveland, OH, 44106, USA
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6
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Kline AC, Cooper AA, Rytwinski NK, Feeny NC. The Effect of Concurrent Depression on PTSD Outcomes in Trauma-Focused Psychotherapy: A Meta-Analysis of Randomized Controlled Trials. Behav Ther 2021; 52:250-266. [PMID: 33483121 PMCID: PMC7826446 DOI: 10.1016/j.beth.2020.04.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 04/29/2020] [Accepted: 04/29/2020] [Indexed: 10/24/2022]
Abstract
The co-occurrence of depression with posttraumatic stress disorder (PTSD) is common and associated with greater severity and impairment than PTSD alone, but the effects on PTSD treatment outcomes are unclear. This study investigated the impact of baseline depression on PTSD symptom change and dropout in a meta-analysis of 44 randomized controlled trials (N = 4,866) of trauma-focused psychotherapies for PTSD. Analyses included 107 active (k = 71) and control (k = 36) conditions. Baseline depression was indexed within samples as (a) continuous symptom severity (e.g., Beck Depression Inventory), standardized across depression measures and (b) proportion of patients with comorbid depressive disorder diagnosis. Among active conditions reporting continuous depression scores (k = 62), greater depression severity predicted smaller PTSD treatment effect sizes (ß = -.36, p = .002), but not dropout (ß = .25, p = .18). Categorical depressive diagnosis rates (k = 29)-reported less frequently-were not associated with treatment effects or dropout in active conditions. Greater depression severity may reflect a risk factor for attenuated response in PTSD psychotherapies, potentially demanding complementary strategies within trauma-focused interventions. Variability between trials in baseline depression symptoms may suggest the need to consider this sample characteristic when comparing treatment outcomes across studies.
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Affiliation(s)
- Alexander C. Kline
- Case Western Reserve University, Department of Psychological Sciences, 11220 Bellflower Road, Cleveland, Ohio, USA 44106-7123
| | - Andrew A. Cooper
- University of Toronto Scarborough, 1265 Military Trail, Toronto, Ontario, M1C 1A4, Canada
| | - Nina K. Rytwinski
- Walsh University, School of Behavioral and Health Sciences, 2020 East Maple St., North Canton, OH, USA, 44720
| | - Norah C. Feeny
- Case Western Reserve University, Department of Psychological Sciences, 11220 Bellflower Road, Cleveland, Ohio, USA 44106-7123
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7
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Mekawi Y, Watson-Singleton NN, Dixon HD, Fani N, Michopoulos V, Powers A. Validation of the difficulties with emotion regulation scale in a sample of trauma-exposed Black women. J Clin Psychol 2020; 77:587-606. [PMID: 32762085 DOI: 10.1002/jclp.23036] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 06/12/2020] [Accepted: 07/20/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND The Difficulties in Emotion Regulation Scale (DERS) is commonly used to assess dimensions of emotion dysregulation, including emotion nonacceptance, limited strategies, and difficulty with goal-directed behavior, impulse control, and emotional clarity. Despite considerable work examining the DERS' factor structure, reliability, and validity, there is limited psychometric support for its use with Black women. OBJECTIVES (1) Examine the factor structure of the DERS; (2) Compare fit of short-form versions; and (3) Assess whether scores differ based on diagnoses. METHOD Sample consisted of Black women (n = 667) recruited in urban, community hospital setting. RESULTS The DERS-18 correlated traits model without awareness demonstrated the best fit, χ2 (80) = 261.09, root mean square error of approximation = 0.06 [0.05, 0.07], comparative fit index = 0.99, Tucker Lewis Index = 0.98, weighted root mean square residual = 0.89. Additionally, those with current diagnoses of posttraumatic stress disorder (PTSD) or major depressive disorder (MDD) reported higher dysregulation (vs. lifetime/no diagnoses). Further, women with comorbid PTSD/MDD reported greater dysregulation (vs. single disorder/no diagnoses). CONCLUSIONS This study provides evidence supporting the model fit, reliability, and validity of the DERS-18 for Black women.
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Affiliation(s)
- Yara Mekawi
- Department of Psychiatry and Brain Science, Emory School of Medicine, Atlanta, Georgia, USA
| | | | - Hayley D Dixon
- Department of Psychiatry and Brain Science, Emory School of Medicine, Atlanta, Georgia, USA
| | - Negar Fani
- Department of Psychiatry and Brain Science, Emory School of Medicine, Atlanta, Georgia, USA
| | - Vasiliki Michopoulos
- Department of Psychiatry and Brain Science, Emory School of Medicine, Atlanta, Georgia, USA
| | - Abigail Powers
- Department of Psychiatry and Brain Science, Emory School of Medicine, Atlanta, Georgia, USA
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8
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Abstract
Posttraumatic stress disorder (PTSD) treatments primarily address traumatic memories, despite PTSD's association with both traumatic and positive memory difficulties. Addressing this gap, we explored the perspectives of trauma-exposed individuals with mental health treatment experience on therapeutically addressing positive memories. A treatment-seeking sample from a community mental health center (n1 = 60) and a community sample from Amazon's Mechanical Turk (n2 = 123) were queried on the acceptability, feasibility, and delivery/components of a pilot positive memory technique. Results indicated interest or willingness in therapeutically discussing positive memories; most endorsed benefits were improved mood, positive thoughts, and self-esteem. Few barriers were identified (e.g., lack of evidence) compared with feasibility factors (ease/usefulness, improved satisfaction/tolerability, and engagement in PTSD treatment). Preferred treatment components included identifying/discussing positive memories, eliciting associated positive affect, and writing about the positive memory as homework. Results provide formative support for the development and integration of a positive memory technique into PTSD treatments.
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9
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Contractor AA, Banducci AN, Dolan M, Keegan F, Weiss NH. Relation of positive memory recall count and accessibility with post-trauma mental health. Memory 2019; 27:1130-1143. [PMID: 31189410 PMCID: PMC6643998 DOI: 10.1080/09658211.2019.1628994] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 05/31/2019] [Indexed: 10/26/2022]
Abstract
Positive memory encoding and retrieval deficits have an empirical relation with several post-trauma outcomes. Drawing from the Contractor et al. model, we examined relations between positive memory characteristics and post-trauma mental health indicators. A trauma-exposed community sample of 203 participants (Mage = 35.40 years; 61.10% female) was recruited via Amazon's Mechanical Turk. Participants completed measures of posttraumatic stress disorder (PTSD; PTSD Checklist for DSM-5), depression (Patient Health Questionnaire-9), posttraumatic cognitions (Posttraumatic Cognitions Inventory), affect (Positive and Negative Affect Schedule), count/number of recalled specific positive memories (Autobiographical Memory Test) and accessibility of a specific positive memory (i.e., subjective ease of recalling details of a memory; Memory Experiences Questionnaire-Short Form). Linear regression results indicated that PTSD intrusion severity, PTSD negative alterations in cognitions and mood (NACM) severity, PTSD alterations in arousal and reactivity (AAR) severity, self-blame, and positive affect significantly and negatively predicted the count of specific positive memories. Further, PTSD NACM severity, PTSD AAR severity, negative cognitions about the self, and negative affect significantly and negatively predicted accessibility of a specific positive memory. Thus, count/accessibility of specific positive memories was associated with several post-trauma mental health indicators; this highlights the relevance and potential impact of integrating positive memories into trauma treatment.
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Affiliation(s)
- Ateka A Contractor
- a Department of Psychology , University of North Texas , Denton , TX , USA
| | - Anne N Banducci
- b The National Center for PTSD at VA Boston Healthcare System , Boston , MA , USA
- c Boston University School of Medicine , Boston , MA , USA
| | - Megan Dolan
- a Department of Psychology , University of North Texas , Denton , TX , USA
| | - Fallon Keegan
- a Department of Psychology , University of North Texas , Denton , TX , USA
| | - Nicole H Weiss
- d Department of Psychology , University of Rhode Island , Kingston , RI , USA
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10
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Choi JY. Predictors of the co-occurrence of posttraumatic stress disorder and depressive disorder in psychiatric outpatients. Compr Psychiatry 2019; 89:40-45. [PMID: 30593972 DOI: 10.1016/j.comppsych.2018.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 11/19/2018] [Accepted: 12/14/2018] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION We explored the predictors of co-occurring depressive disorder (DD) in individuals with posttraumatic stress disorder (PTSD) in an outpatient psychiatric setting. METHODS Participants (N = 170; mean age = 40.78, SD = 16.15 years; 58.8% women) included 71 adult patients who met the criteria for a PTSD diagnosis and 99 adult patients who met the criteria for a comorbid PTSD/DD diagnosis. Potential predictors included trauma types (focusing on trauma characteristics), history of previous traumatic experiences (i.e., the number of lifetime traumatic events before current trauma and childhood maltreatment), and post-trauma variables (i.e., elapsed time since the current traumatic event and the severity of PTSD symptoms). RESULTS A logistic regression analysis-including demographic variables, trauma types, history of previous traumatic experiences, and post-trauma variables that showed significant differences between the two groups-was conducted. The effects of repeated trauma (OR = 13.18, 95% CI [3.44, 50.48], p < .001), the number of lifetime traumatic events (OR = 1.04, 95% CI [1.01, 1.51], p = .044), and childhood maltreatment (OR = 1.23, 95% CI [1.01, 1.51], p = .004) were associated with a greater likelihood of concurrent PTSD/DD. CONCLUSION Cumulative characteristics such as maltreatment and the number of lifetime traumatic events before the current trauma as well as repetitive properties of the most recent trauma present a key risk factor for co-occurring PTSD/DD.
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Affiliation(s)
- Ji Young Choi
- Department of Child Studies, Inha University, Incheon, Republic of Korea.
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11
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Alhalal E, Ford-Gilboe M, Wong C, AlBuhairan F. Factors mediating the impacts of child abuse and intimate partner violence on chronic pain: a cross-sectional study. BMC Womens Health 2018; 18:160. [PMID: 30285706 PMCID: PMC6171313 DOI: 10.1186/s12905-018-0642-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 09/04/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Most research on the health impacts of intimate partner violence (IPV) and child abuse has been conducted in Western countries and may not be generalizable to women living in different contexts, such as Saudi Arabia. Chronic pain, a disabling health issue associated with experiences of both child abuse and IPV among women, negatively impacts women's well-being, quality of life, and level of functioning. Yet, the psychosocial mechanisms that explain how abuse relates to chronic pain are poorly understood. We developed and tested a theoretical model that explains how both IPV and child abuse are related to chronic pain. METHODS We recruited a convenience sample of 299 Saudi women, who had experienced IPV in the past 12 months, from nine primary health care centers in Saudi Arabia between June and August 2015. Women completed a structured interview comprised of self-report measures of IPV, child abuse, PTSD, depressive symptoms, chronic pain, and social support. Using Structural equation modeling (SEM), we analyzed the proposed model twice with different mental health indicators as mediators: PTSD symptoms (Model 1) and depressive symptoms (Model 2). RESULTS Both models were found to fit the data, accounting for 31.6% (Model 1) and 32.4% (Model 2) of the variance in chronic pain severity. In both models, mental health problems (PTSD and depressive symptoms) fully mediated the relationship between severity of IPV and child abuse and chronic pain severity. Perceived family support partially mediated the relationship between abuse severity and depressive symptoms. CONCLUSIONS These results underscore the significance of considering lifetime abuse, women's mental health (depressive and PTSD symptoms) and their social resources in chronic pain management and treatment.
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Affiliation(s)
- Eman Alhalal
- Nursing College, King Saud University, Riyadh, Saudi Arabia
| | - Marilyn Ford-Gilboe
- Arthur Labatt Family School of Nursing, Western University, London, ON Canada
| | - Carol Wong
- Arthur Labatt Family School of Nursing, Western University, London, ON Canada
| | - Fadia AlBuhairan
- Department of Pediatrics and Adolescent Medicine, AlDara Hospital and Medical Center, Riyadh, Saudi Arabia
- Department of Population, Family, and Reproductive Health Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD USA
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12
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Contractor AA, Brown LA, Caldas SV, Banducci AN, Taylor DJ, Armour C, Shea MT. Posttraumatic stress disorder and positive memories: Clinical considerations. J Anxiety Disord 2018; 58:23-32. [PMID: 30025253 DOI: 10.1016/j.janxdis.2018.06.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 06/02/2018] [Accepted: 06/22/2018] [Indexed: 12/31/2022]
Abstract
Encoding and retrieval difficulties, and avoidance of both traumatic and positive memories, are associated with posttraumatic stress disorder (PTSD) symptoms. However, most PTSD research and clinical work has solely examined the role of traumatic memories in the maintenance/resolution of PTSD symptoms. This review provides a comprehensive discussion of the literature on positive memories and PTSD. First, we review theories and evidence on the relations between trauma, PTSD, and memory processes (particularly positive memories). Next, we propose a conceptual model that integrates evidence from experimental and positive/memory-based intervention research and highlights hypothesized mechanisms underlying the potential effectiveness of targeting positive memories in PTSD interventions. Specifically, we discuss how targeting positive memories could (1) increase positive affect and reduce negative affect, (2) correct negative cognitions, (3) increase specificity of retrieving autobiographical memories, and (4) be effectively integrated/sequenced with and enhance the effects of trauma-focused interventions. Lastly, we suggest clinical research avenues for investigating the relations between positive memories and PTSD, to possibly alter the current PTSD intervention paradigm focused only on traumatic memories. Overall, our proposed model drawing from experimental and intervention research, and outlining potential effects of targeting positive memories to reduce PTSD severity, needs further empirical investigation.
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Affiliation(s)
| | - Lily A Brown
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Daniel J Taylor
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Cherie Armour
- Institute of Mental Health Sciences, School of Psychology, Ulster University, Northern Ireland, UK
| | - M Tracie Shea
- Providence Veterans Affairs Medical Center, Providence, USA; Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, USA
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Ben Barnes J, Hayes AM, Contractor AA, Nash WP, Litz BT. The structure of co-occurring PTSD and depression symptoms in a cohort of Marines pre- and post-deployment. Psychiatry Res 2018; 259:442-449. [PMID: 29131993 DOI: 10.1016/j.psychres.2017.10.045] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 10/03/2017] [Accepted: 10/31/2017] [Indexed: 10/18/2022]
Abstract
Symptoms of posttraumatic stress disorder (PTSD) and major depressive disorder are the most frequently co-occurring problems following potentially traumatic events. It is unclear whether these comorbidities represent two correlated but distinct disorders or a common post-event response. We sought to inform this question by examining the distinctiveness of PTSD and depression symptoms at four cross-sectional time points, using data from a parent prospective longitudinal study of 858 Marines evaluated before deployment and approximately 1, 5, and 8 months after returning from the Afghanistan war. We conducted a series of cross-sectional confirmatory factor analyses of PTSD and depression symptoms at each time point, using the Posttraumatic Stress Disorder Checklist IV and the Beck Depression Inventory II. Analyses indicated that across all four assessments, self-reported symptoms on the measures were best explained by distinct but correlated subclusters of symptoms within each measure. This structure was supported by the data both before and after deployment, even with increases in average PTSD symptoms after deployment. These findings suggest that despite shared method variance and some symptom overlap, self-reports of PTSD and depression symptoms across a stressful combat deployment show distinct symptom subclusters rather than a general common trauma reaction in this sample of Marines.
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Affiliation(s)
- J Ben Barnes
- Department of Psychological and Brain Sciences, University of Delaware, Wolf Hall 108, 105 The Green, Newark, DE 19716, United States.
| | - Adele M Hayes
- Department of Psychological and Brain Sciences, University of Delaware, Wolf Hall 108, 105 The Green, Newark, DE 19716, United States
| | - Ateka A Contractor
- Department of Psychology, University of North Texas, Denton, TX, United States
| | - William P Nash
- Headquarters, United States Marine Corps, Arlington, VA, United States
| | - Brett T Litz
- VA Boston Healthcare System, Massachusetts Veterans Epidemiology Research and Information Center, Boston, MA, United States; Boston University, Boston, MA, United States
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14
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Fox A, Helmer D, Tseng CL, Patrick-DeLuca L, Osinubi O. Report of Autonomic Symptoms in a Clinical Sample of Veterans with Gulf War Illness. Mil Med 2017. [DOI: 10.1093/milmed/usx052] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Apollonia Fox
- War Related Illness and Injury Study Center, VA New Jersey Health Care System, 385 Tremont Ave
- Mailstop 129, East Orange, NJ 07018
| | - Drew Helmer
- War Related Illness and Injury Study Center, VA New Jersey Health Care System, 385 Tremont Ave
- Mailstop 129, East Orange, NJ 07018
| | - Chin-Lin Tseng
- War Related Illness and Injury Study Center, VA New Jersey Health Care System, 385 Tremont Ave
- Mailstop 129, East Orange, NJ 07018
| | - Lydia Patrick-DeLuca
- War Related Illness and Injury Study Center, VA New Jersey Health Care System, 385 Tremont Ave
- Mailstop 129, East Orange, NJ 07018
| | - Omowunmi Osinubi
- War Related Illness and Injury Study Center, VA New Jersey Health Care System, 385 Tremont Ave
- Mailstop 129, East Orange, NJ 07018
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15
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Alhalal E, Ford-Gilboe M, Wong C, AlBuhairan F. Reliability and validity of the Arabic PTSD Checklist Civilian Version (PCL-C) in women survivors of intimate partner violence. Res Nurs Health 2017; 40:575-585. [PMID: 29130548 DOI: 10.1002/nur.21837] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 09/14/2017] [Indexed: 11/11/2022]
Abstract
Although intimate partner violence (IPV) survivors are at high risk for developing posttraumatic stress disorder (PTSD), PTSD has been considered a disorder specific to Western culture. There is a lack of reliable and valid measures of PTSD symptomology available in the Arab world, and there is still no clear evidence about the underlying factor structure of PTSD symptomology in the context of IPV. Thus, in the present study we investigated the construct validity (factor structure), internal consistency, and concurrent validity of a translated version of the PTSD Checklist Civilian Version (PCL-C) in a sample of 299 Saudi women who had experienced IPV. Four competing models (DSM-IV, Emotional Numbing, Dysphoria, and Dysphoric Arousal) were specified and estimated using confirmatory factor analysis (CFA). The five-factor Dysphoric Arousal model provided superior fit with the data compared to the alternative models, supporting construct validity of the Arabic PCL-C. The factor loadings for the five-factor Dysphoric Arousal model ranged from .31 to .83. A relatively high correlation between the Arabic PCL-C and Arabic Center for Epidemiologic Studies-Depression (CES-D) Scale (r = .78, p < .05) provided evidence of concurrent validity. The total scale also demonstrated internal consistency reliability (α = .89). Overall, the study supports the Dysphoric Arousal model in representing PTSD symptoms among IPV survivors, the reliability and validity of the Arabic version of PCL-C, and the cross-cultural applicability of PTSD symptoms.
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Affiliation(s)
- Eman Alhalal
- Nursing College, King Saud University, Riyadh, Saudi Arabia
| | - Marilyn Ford-Gilboe
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
| | - Carol Wong
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
| | - Fadia AlBuhairan
- Population Health Research, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia
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16
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Harding KA, Willey B, Ahles J, Mezulis A. Disentangling vulnerabilities from outcomes: Distinctions between trait affect and depressive symptoms in adolescent and adult samples. J Affect Disord 2016; 199:42-53. [PMID: 27085163 PMCID: PMC4862942 DOI: 10.1016/j.jad.2016.02.065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 02/28/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Trait negative affect and trait positive affect are affective vulnerabilities to depressive symptoms in adolescence and adulthood. While trait affect and the state affect characteristic of depressive symptoms are proposed to be theoretically distinct, no studies have established that these constructs are statistically distinct. Therefore, the purpose of the current study was to determine whether the trait affect (e.g. temperament dimensions) that predicts depressive symptoms and the state affect characteristic of depressive symptoms are statistically distinct among early adolescents and adults. We hypothesized that trait negative affect, trait positive affect, and depressive symptoms would represent largely distinct factors in both samples. METHOD Participants were 268 early adolescents (53.73% female) and 321 young adults (70.09% female) who completed self-report measures of demographic information, trait affect, and depressive symptoms. RESULTS Principal axis factoring with oblique rotation for both samples indicated distinct adolescent factor loadings and overlapping adult factor loadings. Confirmatory factor analyses in both samples supported distinct but related relationships between trait NA, trait PA, and depressive symptoms. LIMITATIONS Study limitations include our cross-sectional design that prevented examination of self-reported fluctuations in trait affect and depressive symptoms and the unknown potential effects of self-report biases among adolescents and adults. CONCLUSIONS Findings support existing theoretical distinctions between adolescent constructs but highlight a need to revise or remove items to distinguish measurements of adult trait affect and depressive symptoms. Adolescent trait affect and depressive symptoms are statistically distinct, but adult trait affect and depressive symptoms statistically overlap and warrant further consideration.
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Affiliation(s)
- Kaitlin A Harding
- Seattle Pacific University, Marston 107, 3307 3rd Ave West, Suite 107, Seattle, WA 98119, United States.
| | - Brittany Willey
- Seattle Pacific University, Marston 107, 3307 3rd Ave West, Suite 107, Seattle, WA 98119, United States
| | - Joshua Ahles
- Seattle Pacific University, Marston 107, 3307 3rd Ave West, Suite 107, Seattle, WA 98119, United States
| | - Amy Mezulis
- Seattle Pacific University, Marston 107, 3307 3rd Ave West, Suite 107, Seattle, WA 98119, United States
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