You'll feel better in the morning: slow wave activity and overnight mood regulation in interepisode bipolar disorder

BACKGROUND

Sleep disturbances are prominent correlates of acute mood episodes and inadequate recovery in bipolar disorder (BD), yet the mechanistic relationship between sleep physiology and mood remains poorly understood. Using a series of pre-sleep mood inductions and overnight sleep recording, this study examined the relationship between overnight mood regulation and a marker of sleep intensity (non-rapid eye movement sleep slow wave activity; NREM SWA) during the interepisode phase of BD.

METHODS

Adults with interepisode BD type 1 (BD; n = 20) and healthy adult controls (CTL; n = 23) slept in the laboratory for a screening night, a neutral mood induction night (baseline), a happy mood induction night, and a sad mood induction night. NREM SWA (0.75-4.75 Hz) was derived from overnight sleep EEG recordings. Overnight mood regulation was evaluated using an affect grid pleasantness rating post-mood induction (pre-sleep) and the next morning.

RESULTS

Overnight mood regulation did not differ between groups following the sad or happy inductions. SWA did not significantly change for either group on the sad induction night compared with baseline. In BD only, SWA on the sad night was related to impaired overnight negative mood regulation. On the happy induction night, SWA increased relative to baseline in both groups, though SWA was not related to overnight mood regulation for either group.

CONCLUSIONS

These findings indicate that SWA disruption may play a role in sustaining negative mood state from the previous night in interepisode BD. However, positive mood state could enhance SWA in bipolar patients and healthy adults.

Rotational cooling of HD+ molecular ions by superelastic collisions with electrons

Merging an HD+ beam with velocity matched electrons in a heavy ion storage ring we observed rapid cooling of the rotational excitations of the HD+ ions by superelastic collisions (SEC) with the electrons. The cooling process is well described using theoretical SEC rate coefficients obtained by combining the molecular R-matrix approach with the adiabatic nuclei rotation approximation. We verify the DeltaJ=-2 SEC rate coefficients, which are predicted to be dominant as opposed to the DeltaJ=-1 rates and to amount to (1-2)x10;{-6} cm;{3} s;{-1} for initial angular momentum states with J< or =7, to within 30%.

Pre-sleep imagery under the microscope: a comparison of patients with insomnia and good sleepers

During the pre-sleep period and in the natural home environment patients with insomnia (N=20) and good sleepers (N=20) were asked to record when an image came to mind by pressing a handheld counter. They then provided an oral description of the image and indicated whether the image was 'pleasant', 'unpleasant', or 'neutral' (responses captured via a voice-activated tape recorder). Subjective and objective (actigraphy) estimates of sleep-onset latency (SOL) were recorded. On both the handheld counter and the audiotape recording, participants with insomnia reported fewer images than the good sleepers. The insomnia group had a higher percentage of unpleasant images compared to good sleepers. For the insomnia group, but not the good sleeper group, there was a positive correlation between unpleasant images and subjective SOL. The insomnia group experienced more images regarding 'intimate relationships' and 'sleep' and fewer regarding 'random/non-connected topics' compared to the good sleeper group. The results are discussed with reference to proposals made by Borkovec, Ray and Stöber (Cognitive Ther. Res., 22, (1998) 561) in the context of generalised anxiety disorder (GAD).

A cognitive model of insomnia

Insomnia is one of the most prevalent psychological disorders, causing sufferers severe distress as well as social, interpersonal, and occupational impairment. Drawing on well-validated cognitive models of the anxiety disorders as well as on theoretical and empirical work highlighting the contribution of cognitive processes to insomnia, this paper presents a new cognitive model of the maintenance of insomnia. It is suggested that individuals who suffer from insomnia tend to be overly worried about their sleep and about the daytime consequences of not getting enough sleep. This excessive negatively toned cognitive activity triggers both autonomic arousal and emotional distress. It is proposed that this anxious state triggers selective attention towards and monitoring of internal and external sleep-related threat cues. Together, the anxious state and the attentional processes triggered by it tricks the individual into overestimating the extent of the perceived deficit in sleep and daytime performance. It is suggested that the excessive negatively toned cognitive activity will be fuelled if a sleep-related threat is detected or a deficit perceived. Counterproductive safety behaviours (including thought control, imagery control, emotional inhibition, and difficulty problem solving) and erroneous beliefs about sleep and the benefits of worry are highlighted as exacerbating factors. The unfortunate consequence of this sequence of events is that the excessive and escalating anxiety may culminate in a real deficit in sleep and daytime functioning. The literature providing preliminary support for the model is reviewed and the clinical implications and limitations discussed.

Insomnia: symptom or diagnosis?

Is insomnia a clinical entity in its own right or is it simply a symptom of an underlying medical or psychological disorder? The widely held view among many clinicians and researchers is that insomnia is secondary to or an epiphenomenon of a 'primary' medical or psychological disorder. Consequently, insomnia 'symptoms' have tended to be trivialized or ignored. This paper aims to highlight the assumptions and implications of distinguishing between 'primary' and 'secondary' insomnia and reviews the evidence for the distinction by considering (1) issues relating to the diagnosis and classification of insomnia, (2) whether insomnia is a symptom of other medical and psychological disorders, (3) whether insomnia is comorbid with other disorders, (4) whether insomnia is 'secondary' to other disorders, and (5) whether insomnia occurs in the absence of comorbidity. It is concluded that viewing insomnia as a symptom or epiphenomenon of other disorders can be unfounded. This view may deprive many patients of treatment, which might not only cure their insomnia, but may also reduce symptoms associated with the assumed 'primary' disorder. Finally, directions for future research to further illuminate the relationship between insomnia and comorbid disorders are discussed.

Chronic pain and posttraumatic stress disorder: mutual maintenance?

Common sequelae following a traumatic event include chronic pain and posttraumatic stress disorder (PTSD). Over the last decade, the literature relating to PTSD has become progressively more sophisticated, resulting in well-supported theories and treatments for sufferers. Equivalent research relating to chronic pain has more recently gathered momentum. However, to date there has been minimal attention devoted to the concurrence of the two disorders, even though high comorbidity has been noted. This review begins by briefly summarizing the literature relating to the two disorders in terms of symptoms, prevalence and comorbidity. It explicates the major psychological theories of chronic pain and PTSD and reviews the evidence relating what factors maintain the disorders. A number of pathways by which chronic pain and PTSD may be mutually maintaining are highlighted. We conclude that chronic pain and PTSD are mutually maintaining conditions and that there are several pathways by which both disorders may be involved in the escalation of symptoms and distress following trauma. Treatment implications are considered, as are issues for future research.

Reconstructing trauma memories: a prospective study of "amnesic" trauma survivors

The purpose of this study was to investigate memory for trauma in patients who were initially amnesic of the trauma as a result of mild traumatic brain injury (MTBI). Motor vehicle accident survivors who sustained a MTBI were assessed for their memory within 1-month posttrauma (n = 79) and again at 2-years posttrauma (n = 50). Consistent with their brain injury, all patients reported significant amnesia of their accident at initial assessment. At 2-year posttrauma, 40% were able to remember their accident. Reporting memory for the trauma was associated with shorter duration of posttraumatic amnesia. These findings suggest that people reconstruct memories of trauma in the absence of complete encoding of the experience. Possible mechanisms for memory reconstruction are considered.

Simulated malingering in pain patients: a study with the Pain Patient Profile

OBJECTIVE

To investigate the utility of the Pain Patient Profile (P3) in detecting those who are faking or exaggerating complaints of pain while attempting to avoid detection.

METHOD

A control group of pain patients ('Pain Controls'; PC; N = 62) was compared with a general clinical group who did not report pain but were instructed to simulate malingered pain ('General Rehabilitation Simulators', GR, N = 34); and a group whose primary problem was chronic pain who were instructed to exaggerate the extent of their pain and related problems ('Pain Simulators' PS; N = 26).

RESULTS

Both groups of simulating participants reported significantly higher scores on all clinical scales (anxiety, depression, somatization) compared with non-simulating control participants and were more likely to obtain an abnormal T-score on the clinical scales. The validity scale was able to differentiate the PS group from the PC group, but the GR group was not differentiated from the PC group by the validity scale.

CONCLUSIONS

The results indicate that with further study, the P3 may be a useful adjunct to the clinical assessment of symptom magnification in pain claimants.

Telephone crisis intervention skills: a simulated caller paradigm

Counseling skills were evaluated in a telephone counseling service for Vietnam veterans. Thirty simulated crisis calls were made to telephone counselors by experienced clinical psychologists. The counselors' responses were rated on dimensions that indexed general counseling skills, knowledge of veteran needs, and provision of appropriate advice. Whereas the majority of callers demonstrated adequate counseling skills, many lacked knowledge of veterans' posttraumatic stress, common veteran terminology, and the nature of veterans' experiences. The findings suggest that telephone counseling services that target specific populations should employ comprehensive training to ensure that counselors possess adequate and relevant knowledge about callers and their presenting problems. The simulated caller paradigm appears to be an effective paradigm for training and evaluation of telephone counselors.

Suppressing and attending to pain-related thoughts in chronic pain patients

Attempted suppression of pain-related thoughts was investigated in consecutive referrals for pain management (N = 39). Participants monitored their pain-related thoughts for three 5-min periods. In period 1, all participants were instructed to think about anything. For period 2, participants were instructed to either suppress pain-related thoughts, attend to pain-related thoughts, or to continue to think about anything. In period 3, all participants were again instructed to think about anything. Participants instructed to attend to their pain reported more pain-related thoughts than suppressors and controls in both periods 2 and 3. Suppressors experienced reduced pain-related thoughts during period 2. There was no immediate enhancement or delayed increase.

Pre-sleep cognitive activity: a comparison of sleep-onset insomniacs and good sleepers

OBJECTIVE

Pre-sleep cognitive activity has been implicated in the maintenance of sleep-onset insomnia. The present study aimed to investigate the focus of attention, content and characteristics of cognition during the pre-sleep period.

METHOD

A semi-structured clinician-administered interview designed to index the content of pre-sleep cognition was completed by individuals diagnosed with sleep-onset insomnia (N = 30) and good sleepers (N = 30).

RESULT

The pre-sleep cognitive activity of insomniacs could be distinguished from that of good sleepers by being more focused on worries, problems and noises in the environment, and less focused on 'nothing in particular'. In terms of content, the insomnia group were more likely to think about not sleeping or about something that had happened during the day. Insomniacs experienced their pre-sleep cognitive activity as more occupying, less intentional, for a longer duration, and as causing more difficulty with sleep onset compared to good sleepers. Pre-sleep imagery was reported at similar rates across diagnosis, but was more distressing and more likely to be associated with strong physical sensations for the insomniac group compared with the good sleeper group.

CONCLUSION

The present study provides a comprehensive investigation of pre-sleep cognitive activity and raises a number of areas for future research including monitoring of bodily sensations, imagery, problem-solving and non-active strategies in facilitating sleep onset.

Memory for acute stress disorder symptoms: a two-year prospective study

The present study aimed to index the accuracy of memory for acute trauma symptoms by comparing the symptoms reported by motor vehicle accident (MVA) victims within 1 month posttrauma with the recall of these symptoms at 2 years posttrauma. Ninety-two consecutive MVA admissions were assessed for the presence of acute stress disorder (ASD) within 1 month posttrauma. At 2 years posttrauma, 61% (N = 56) of the sample were reassessed for posttraumatic stress disorder (PTSD) and for accuracy of recall of the symptoms reported during the first assessment. At least one of the four ASD diagnostic clusters was recalled inaccurately by 75% of patients. High levels of posttraumatic stress severity and high subjective ratings of injury severity at 2 years posttrauma were associated with errors of addition (i.e., recalling the presence of acute symptoms 2 years posttrauma that were not reported during the first assessment). Low levels of posttraumatic stress severity and low subjective ratings of injury severity at 2 years posttrauma were associated with errors of omission (i.e., omitting to recall acute symptoms 2 years posttrauma that were reported during the first assessment). These results suggest that retrospective reports of acute stress symptoms should be interpreted cautiously because of the influence of current symptoms on recall of acute symptoms.

A prospective study of psychophysiological arousal, acute stress disorder, and posttraumatic stress disorder

This study investigated the role of acute arousal in the development of posttraumatic stress disorder (PTSD). Hospitalized motor-vehicle-accident survivors (n = 146) were assessed for acute stress disorder (ASD) within 1 month of the trauma and were reassessed (n = 113) for PTSD 6 months posttrauma. Heart rate (HR) and blood pressure (BP) were assessed on the day of hospital discharge. Participants with subclinical ASD had higher HR than those with ASD and no ASD. Participants who developed PTSD had higher HR in the acute posttrauma phase than those without PTSD. Diagnosis of ASD and resting HR accounted for 36% of the variance of the number of PTSD symptoms. A formula composed of a diagnosis of ASD or a resting HR of > 90 beats per minute possessed strong sensitivity (88%) and specificity (85%) in predicting PTSD. These findings are discussed in terms of acute arousal and longer term adaptation to trauma.

Two-year prospective evaluation of the relationship between acute stress disorder and posttraumatic stress disorder following mild traumatic brain injury

OBJECTIVE

To assess the ability of acute stress disorder to predict posttraumatic stress disorder (PTSD), the relationship between acute stress disorder and PTSD over the 2 years following mild traumatic brain injury was determined.

METHOD

Survivors of motor vehicle accidents who sustained mild traumatic brain injuries were assessed for acute stress disorder within 1 month of the trauma (N=79) and for PTSD at 6 months (N=63) and 2 years (N=50) posttrauma.

RESULTS

Acute stress disorder was diagnosed in 14% of the patients. Among the patients who participated in all three assessments, 80% of the subjects who met the criteria for acute stress disorder were diagnosed with PTSD at 2 years. Of the total initial group, 73% of those diagnosed with acute stress disorder had PTSD at 2 years.

CONCLUSIONS

This study provides further support for the utility of the acute stress disorder diagnosis as a predictor of PTSD but indicates that the predictive power of the diagnostic criteria can be increased by placing greater emphasis on reexperiencing, avoidance, and arousal symptoms.

The relationship between acute stress disorder and posttraumatic stress disorder: a 2-year prospective evaluation

Previous research established that 78% of a sample of motor vehicle accident survivors initially diagnosed with acute stress disorder (ASD) were subsequently diagnosed with posttraumatic stress disorder (PTSD) at 6 months posttrauma. Although the previous study provided initial evidence for the utility of the ASD diagnosis, the relationship between ASD and PTSD was assessed over a relatively short period. The present study reassessed that original sample 2 years following the trauma to establish the longer term relationship between ASD and PTSD. ASD was diagnosed in 13% of participants, and 21% were diagnosed with subsyndromal ASD. In terms of participants who participated in all 3 assessments, 63% who met the criteria for ASD, 70% who met the criteria for subsyndromal ASD, and 13% who did not meet the criteria for ASD were diagnosed with PTSD at 2 years posttrauma. These findings indicate the importance of considering multiple pathways to the development of PTSD.

The relationship between acute stress disorder and posttraumatic stress disorder: a 2-year prospective evaluation

Previous research established that 78% of a sample of motor vehicle accident survivors initially diagnosed with acute stress disorder (ASD) were subsequently diagnosed with posttraumatic stress disorder (PTSD) at 6 months posttrauma. Although the previous study provided initial evidence for the utility of the ASD diagnosis, the relationship between ASD and PTSD was assessed over a relatively short period. The present study reassessed that original sample 2 years following the trauma to establish the longer term relationship between ASD and PTSD. ASD was diagnosed in 13% of participants, and 21% were diagnosed with subsyndromal ASD. In terms of participants who participated in all 3 assessments, 63% who met the criteria for ASD, 70% who met the criteria for subsyndromal ASD, and 13% who did not meet the criteria for ASD were diagnosed with PTSD at 2 years posttrauma. These findings indicate the importance of considering multiple pathways to the development of PTSD.

A qualitative investigation of the organization of traumatic memories

OBJECTIVE

Previous research has indicated that cohesive organization of traumatic memories may be necessary for the processing and resolution of post-trauma symptoms. The present study aimed to evaluate the qualitative features of memory organization, dissociation and perception of threat in traumatic memories recalled by individuals with and without acute stress disorder (ASD).

DESIGN

Survivors of motor vehicle accidents (MVA) with either ASD or no ASD participated in a study on traumatic memories within 12 twelve days of the MVA.

METHOD

Participants' audiotaped recollections of their memories of the MVA were coded in terms of disorganized structure, dissociative content and perception of threat.

RESULT

The recollections of ASD participants were characterized by disorganization and dissociation more than those of non-ASD participants.

CONCLUSION

The current findings suggest that disorganized memory structure may be one process that impedes access to, and modification of, trauma-related cognitive schema.

Dissociative symptoms in acute stress disorder

This study provides a profile of symptoms, and particularly dissociative symptoms, in the diagnosis of acute stress disorder (ASD) following motor vehicle accidents (MVAs). Consecutive adult non-brain-injured admissions to a major trauma hospital (N = 92) were assessed between 2 days and 4 weeks following an MVA. Presence of ASD was determined by a structured clinical interview. The occurrence of full and subsyndromal ASD was approximately 13% and 21%, respectively. The majority of those who met criteria for subsyndromal ASD did not meet the ASD criteria for dissociation. At least 80% of individuals who reported derealization also reported reduced awareness and depersonalization. This significant overlap between dissociative symptoms questions the discriminatory power and conceptual independence of the dissociative criteria. These findings suggest the need for a more refined conceptual and operational understanding of dissociative symptoms in the acute trauma stage.

Predictors of acute stress following motor vehicle accidents

The aim of this study was to investigate the predictors of acute stress following motor vehicle accidents (MVA). Sixty-two consecutive adult admissions to a hospital were assessed between two days and four weeks following a MVA. Participants were assessed for acute stress disorder (ASD) with a structured clinical interview and administered the Beck Depression Inventory (BDI), Coping Style Questionnaire, Dissociative Experiences Scale, and the Eysenck Personality Inventory. The prevalences of full and sub-syndromal ASD were 16.1% and 14.5%, respectively. BDI, history of psychiatric treatment, history of posttraumatic stress disorder (PTSD), and history of previous MVA accounted for 61% of the variance of acute stress severity. The findings indicate that predictors of acute stress severity are comparable to the predictors of PTSD and highlight the possibility of identifying those who may benefit from early treatment.

Postconcussive symptoms and posttraumatic stress disorder after mild traumatic brain injury

Postconcussive symptoms after mild traumatic brain injury (MTBI) may be exacerbated by anxiety associated with posttraumatic stress. The aim of this study was to investigate the relationship between postconcussive symptoms and posttraumatic stress disorder (PTSD) in an MTBI population. Survivors of motor vehicle accidents who either sustained an MTBI (N = 46) or no TBI (N = 59) were assessed 6 months posttrauma for PTSD and postconcussive symptoms. Postconcussive symptoms were more evident in MTBI patients with PTSD than those without PTSD, and in MTBI patients than non-TBI patients. Further, postconcussive symptoms were significantly correlated with PTSD symptoms. These findings indicate that postconcussive symptoms may be mediated by an interaction of neurological and psychological factors after MTBI.

Treatment of acute stress disorder: a comparison of cognitive-behavioral therapy and supportive counseling

Acute stress disorder (ASD) is a precursor of chronic posttraumatic stress disorder (PTSD). Twenty-four participants with ASD following civilian trauma were given 5 sessions of either cognitive-behavioral therapy (CBT) or supportive counseling (SC) within 2 weeks of their trauma. Fewer participants in CBT (8%) than in SC (83%) met criteria for PTSD at posttreatment. There were also fewer cases of PTSD in the CBT condition (17%) than in the SC condition (67%) 6 months posttrauma. There were greater statistically and clinically significant reductions in intrusive, avoidance, and depressive symptomatology among the CBT participants than among the SC participants. This study represents the 1st demonstration of successful treatment of ASD with CBT and its efficacy in preventing chronic PTSD.

The influence of traumatic brain injury on acute stress disorder and post-traumatic stress disorder following motor vehicle accidents

This study compared the acute stress disorder and post-traumatic stress disorder (PTSD) symptom profiles in motor vehicle accident survivors who sustained a mild traumatic brain injury (MTBI) or no TBI. Consecutive adult patients who sustained a MTBI (n = 79) and no TBI (n = 92) were assessed for acute stress disorder within 1 month of their trauma and reassessed for PTSD (MTBI: n = 63; non-TBI; n = 72) 6-months post-trauma. Comparable rates of acute stress disorder and PTSD were reported in MTBI and non-TBI patients. Intrusive memories and fear and helplessness in response to the trauma were reported less frequently by MTBI than non-TBI patients at the acute phase. Six-months post-trauma fewer MTBI patients than non-TBI reported fear and helplessness in response to the trauma. These findings suggest that, whereas impaired consciousness at the time of a trauma may reduce the frequency of traumatic memories in the initial month post-trauma, MTBI does not result in a different profile of longer-term PTSD.

Treatment of acute stress disorder: a comparison of cognitive-behavioral therapy and supportive counseling

Acute stress disorder (ASD) is a precursor of chronic posttraumatic stress disorder (PTSD). Twenty-four participants with ASD following civilian trauma were given 5 sessions of either cognitive-behavioral therapy (CBT) or supportive counseling (SC) within 2 weeks of their trauma. Fewer participants in CBT (8%) than in SC (83%) met criteria for PTSD at posttreatment. There were also fewer cases of PTSD in the CBT condition (17%) than in the SC condition (67%) 6 months posttrauma. There were greater statistically and clinically significant reductions in intrusive, avoidance, and depressive symptomatology among the CBT participants than among the SC participants. This study represents the 1st demonstration of successful treatment of ASD with CBT and its efficacy in preventing chronic PTSD.

The role of valence in attempted thought suppression

Thought control was investigated in participants (N = 72) who were shown either a violent, humorous or neutral film and then administered either suppression or nonsuppression instructions. Following the presentation of a three minute segment from one film, participants monitored their thoughts for two 3-minute periods. In Period 1, participants were administered suppression or nonsuppression instructions relating to thoughts of the film. In Period 2, participants were instructed to think about anything. During both periods participants were instructed to press a response button if they had a trauma-related thought. Participants who viewed the violent film gave higher ratings of distress and lower pleasantness ratings than those who viewed the humorous and neutral films. Participants who were given suppression instructions demonstrated a delayed increase in trauma-related thoughts in the period subsequent to suppression across the valence conditions.

Autobiographical memory in acute stress disorder

Survivors of motor vehicle accidents with acute stress disorder (ASD) or with no ASD participated in a study on autobiographical memory within a week of their trauma. In Experiment 1, participants were provided cue words to elicit autobiographical memories of both an unconstrained time period and their trauma. Participants with ASD reported fewer specific memories to positive cue words than did non-ASD participants, even when the influence of depression was controlled. In Experiment 2, the same participants were assessed for posttraumatic stress disorder (PTSD) 6 months posttrauma. Poor recall of specific memories of the trauma in Experiment 1 accounted for 25% of the variance of PTSD severity. Accessibility of trauma memories in the acute posttrauma phase may have significant implications for longer term adjustment.

Acute stress disorder after mild traumatic brain injury

The debate continues over whether a posttraumatic response occurs in those who have sustained a traumatic brain injury (TBI). The aim of this study was to investigate the incidence of acute stress disorder (ASD) in the mild TBI population. Patients who sustained a mild TBI after a motor vehicle accident (N = 79) were assessed for the presence of ASD. ASD was diagnosed in 13.9% of patients, and 5.1% were diagnosed with subsyndromal ASD. Dissociative, reexperiencing, and avoidance symptoms were found to have moderate to high predictive power. This study highlights the significant number of patients who experience an acute trauma response after TBI and raises the possibility that those with ASD denote those for whom an early intervention may prevent longer-term psychopathology. Diagnostic difficulties in defining ASD after TBI are discussed.

The effect of attempted thought suppression in acute stress disorder

Attempted suppression of traumatic memories was investigated in survivors of motor vehicle accidents with acute stress disorder (ASD; n = 24) and without ASD (n = 24). Participants monitored their trauma-related thoughts for three 5-minute periods. In Period 1, participants were instructed to think about anything. For Period 2, participants were administered suppression or non-suppression instructions relating to thoughts of the trauma. In Period 3, participants were again instructed to think about anything. ASD participants reported higher ratings of anxiety, frequency of trauma-related thoughts, and attempted suppression of trauma-related thoughts than non-ASD participants. Participants who were given suppression instructions demonstrated a delayed increase in trauma-related thoughts in the period subsequent to suppression.

The relationship between acute stress disorder and posttraumatic stress disorder: a prospective evaluation of motor vehicle accident survivors

Motor vehicle accident survivors (n = 92) were assessed for acute stress disorder (ASD) within 1 month of the trauma and reassessed (n = 71) for posttraumatic stress disorder (PTSD) 6 months posttrauma. ASD was diagnosed in 13% of participants, and a further 21% had subclinical levels of ASD. At follow-up, 78% of ASD participants and 60% of subclinical ASD participants met criteria for PTSD. The strong predictive power of acute numbing, depersonalization, a sense of relieving the trauma, and motor restlessness, in contrast to the low to moderate predictive power of other symptoms, indicates that only a subset of ASD symptoms is strongly related to the development of chronic PTSD. Although these findings support the use of the ASD diagnosis, they suggest that the dissociative and arousal clusters may require revision.

Relationship between acute stress disorder and posttraumatic stress disorder following mild traumatic brain injury

OBJECTIVE

The aim of this study was to index the frequency of occurrence of acute stress disorder following mild traumatic brain injury and to determine its utility in predicting posttraumatic stress disorder (PTSD).

METHOD

Consecutive adult patients who sustained a mild traumatic brain injury following a motor vehicle accident (N = 79) were assessed for acute stress disorder within 1 month of their trauma with the Acute Stress Disorder Inventory, a structured clinical interview based on DSM-IV criteria. Patients were followed up 6 months after the trauma (N = 63) and were administered the PTSD module of the Composite International Diagnostic Interview.

RESULTS

Acute stress disorder was diagnosed in 14% of patients, and at follow-up 24% satisfied criteria for PTSD. Six months after the trauma PTSD was diagnosed in 82% of patients who had been diagnosed with acute stress disorder and in 11% of those who had not been diagnosed with acute stress disorder.

CONCLUSIONS

These findings point to the frequency of PTSD following mild traumatic brain injury. While the criteria for acute stress disorder are useful in identifying those individuals who are at risk of developing chronic PTSD, the findings suggest that current criteria require modification in order to optimally predict PTSD following mild traumatic brain injury.

Predictors of acute stress following mild traumatic brain injury

The aim of this study was to investigate the predictors of acute stress disorder (ASD) following mild traumatic brain injury (MTBI). Patients who sustained MTBI following a motor vehicle accident (n = 48) were assessed with a structured interview within 18 days of the trauma for the presence of ASD and administered the Beck Depression Inventory (BDI), Coping Style Questionnaire, Dissociative Experiences Scale, and the Eysenck Personality Inventory. ASD was diagnosed in 14.6% of patients and 4.2% were diagnosed with sub-syndromal ASD. BDI scores and avoidant coping were significant predictors of ASD and acute stress severity. This study provides further evidence that traumatic stress reactions occur following MTBI and highlights the possibility of identifying those who may benefit from early intervention.

Acute stress disorder: a critical review of diagnostic issues

Acute stress disorder (ASD) is a recently developed diagnosis that describes posttraumatic stress reactions that occur in the first month following a trauma. Diagnostic criteria include dissociative, intrusive, avoidance, and arousal symptoms. ASD was driven by the proposal that trauma leads to dissociative reactions, and these are predictive of longer-term psychopathology. This paper reviews a series of anomalies in the diagnostic criteria, highlights discrepancies between criteria for ASD and posttraumatic stress disorder (PTSD), and illustrates the lack of empirical evidence for some assumptions inherent in the conceptualization of ASD. It is argued that future revisions of ASD criteria need to be based on empirical evidence of acutely traumatized individuals.

Attentional bias in posttraumatic stress disorder

This study investigated preferential encoding of threat material in subjects with posttraumatic stress disorder (PTSD) with a modified dot-probe paradigm. This paradigm indexes attentional bias by measuring response latency to name neutral target words that are presented adjacent to or distant from threat words. Motor vehicle accident survivors with PTSD (n = 15), subclinical PTSD (n = 15), and low anxiety (n = 15) were required to name target words that were presented either adjacent to or distant from strong threat, mild threat, positive, and neutral words. PTSD subjects named targets faster when they were in close proximity to mild threat words. Results suggested that PTSD subjects' attention was drawn to the mild threat stimuli and are discussed in the context of network models of PTSD.

Visual imagery in posttraumatic stress disorder

Visual imagery is reported to play a central role in posttraumatic stress disorder (PTSD). This pilot investigation examined visual imagery ability in patients with varying degrees of posttraumatic stress. Eighty one survivors of motor vehicle accidents with either (a) diagnosed PTSD, (b) diagnosed Specific Phobia, or (c) no psychiatric diagnosis and low anxiety were assessed on a measure of vividness of visual imagery. Low Anxiety subjects displayed superior visual imagery compared to PTSD and Specific Phobic subjects. Incidence of flashbacks and nightmares, however, was associated with visual imagery ability in PTSD subjects. Findings suggest that visual imagery ability may be associated with PTSD flashbacks. These results are discussed in terms of use of imagery-based treatments with traumatized patients, and of the need for further investigation of the role that imagery plays in posttraumatic adjustment.

Initial posttraumatic stress responses following motor vehicle accidents

Posttraumatic stress was assessed in 114 motor vehicle accident (MVA) victims within 2 weeks of hospital admission. Approximately one third of patients reported high levels of posttraumatic stress anxiety. Intrusion symptoms were best predicted by fear of the MVA and absence of head injury. Avoidance symptoms were best predicted by fear of the accident and recent stressful events. Findings indicate that intrusion and avoidance responses to trauma are mediated by different patterns of injury-related and response-related factors.

Posttraumatic stress reactions in volunteer firefighters

Volunteer firefighters in NSW were surveyed for experiences of posttraumatic stress. Firefighters were asked to describe their experiences of stress and indices were obtained of psychological disturbance. Findings indicated that most firefighters felt that their safety had been threatened. One-quarter of firefighters indicated that they experienced significant levels of posttraumatic stress, although many respondents attributed their stress to personal events. Posttraumatic stress was associated with multiple and recent critical incidents. Findings are discussed in terms of etiological factors of posttraumatic stress and the need for appropriate intervention.

Cognitive-behavior therapy for generalized anxiety disorder

Overall, cognitive-behavior therapy shows promise as a treatment for GAD. The modest treatment gains reported to date may be in part due to the characterologic nature of GAD and the high rate of comorbidity. An important trend emerging in studies that provide long-term outcome data, however, is the substantial reduction in the use of anxiolytic medication in treated subjects. As a result, Brown et al have suggested that such cognitive-behavior therapy may offer an approach for discontinuing these medications in patients with GAD. Because the benefits of cognitive-behavioral treatment appear to be maintained at long-term follow-up assessment, cognitive-behavior therapy may provide a long-term and cost-effective solution to GAD. The maintenance of treatment gains following a relatively short period of intervention (5-20 sessions) is particularly impressive given that the GAD population is characterized by individuals who say that they have "always been worriers" and who previously have been very difficult to treat. Future research is required to explore the specific effects that "nonspecific" methods offer. In addition, because some studies (e.g., Barlow et al) reported that dropouts in treatment were high and that many patients were left with some residual anxiety, there is clearly still a need for further research to find more focused and successful treatments.

Eye movement and electrodermal responses to threat stimuli in post-traumatic stress disorder

A core feature of post-traumatic stress disorder (PTSD) is hypervigilence to threatening material. This study measured processing of threat material in PTSD with simultaneously acquired initial eye movements and electrodermal activity, following presentation of threatening and neutral words. Ten PTSD subjects and 10 controls were presented with 4 words in parafoveal range. On trials in which a threat word was present, PTSD subjects demonstrated initial eye fixations on the threat word more than controls. PTSD subjects also demonstrated more orienting responses on all trials than controls. These results suggest that processing of threat information in PTSD can be usefully investigated with convergent psychophysiological methodologies.

Processing threatening information in posttraumatic stress disorder

The authors used a modified Stroop task to study how people with posttraumatic stress disorder (PTSD) process threatening information. Participants were motor vehicle accident (MVA) survivors with either PTSD (n = 15), simple phobia of driving (n = 15), or low anxiety (n = 15). Participants named colors of 4 types of words: strong threat words (MVA related), mild threat words (MVA related), positive words, and neutral words. Participants with PTSD demonstrated greater interference on strong threat words than those with simple phobia or low anxiety. Contrary to expectation, participants with simple phobia did not display an interference effect. Findings suggest that individuals with PTSD and simple phobia may process threatening information differently. The nature of attentional bias in different anxiety conditions following trauma is discussed.

Processing threatening information in posttraumatic stress disorder

The authors used a modified Stroop task to study how people with posttraumatic stress disorder (PTSD) process threatening information. Participants were motor vehicle accident (MVA) survivors with either PTSD (n = 15), simple phobia of driving (n = 15), or low anxiety (n = 15). Participants named colors of 4 types of words: strong threat words (MVA related), mild threat words (MVA related), positive words, and neutral words. Participants with PTSD demonstrated greater interference on strong threat words than those with simple phobia or low anxiety. Contrary to expectation, participants with simple phobia did not display an interference effect. Findings suggest that individuals with PTSD and simple phobia may process threatening information differently. The nature of attentional bias in different anxiety conditions following trauma is discussed.

Avoidant coping style and post-traumatic stress following motor vehicle accidents

Predictors of post-traumatic intrusive symptomatology were studied in 56 motor vehicle accident (MVA) survivors 12 months after their MVA. Measures were obtained on Ss' subjective response to the trauma, objective indices of injury severity, coping response (Coping Style Questionnaire), and post-traumatic stress (Impact of Event Scale; IES). Significant levels of intrusive and avoidance symptomatology were reported by 20% of MVA survivors. An avoidant coping style and compensation accounted for 41% of variance of IES-Intrusion scores. Findings are discussed in terms of the role of avoidance behaviour in post-traumatic adjustment.

Acute stress response: a comparison of head injured and non-head injured patients

Acute stress responses were investigated in head injured (N = 38) and non-head injured (N = 38) motor vehicle accident victims immediately following their trauma. Results indicated that amnesia of the traumatic event was associated with less acute post-traumatic stress, intrusive symptoms, perceived injury, and fear of future risk. A proportion of head injured patients reported intrusive and avoidance symptoms despite being amnesic of their trauma. Findings are discussed in terms of the differential post-traumatic adjustment of head injured and non-head injured traumatized patients.

Posttraumatic stress in volunteer firefighters. Predictors of distress

Posttraumatic stress was studied in volunteer firefighters who regularly engage in threatening situations. In response to a survey of firefighters across New South Wales, Australia, 751 firefighters completed questionnaires concerning trauma experiences and posttraumatic stress levels. The presence of posttraumatic stress was best predicted by a combination of event-related and response-related aspects of the trauma. Firefighters' proximity to death, perceived severity of trauma, and fear of the traumatic event were closely associated with posttraumatic stress. In addition, the presence of stresses subsequent to the trauma, including unemployment and the loss of a loved one, was also related to posttraumatic stress. Findings are discussed in terms of etiological factors in posttraumatic stress and the need for adequate coping resources to manage the aftermath of a traumatic event.

Psychological impairment following motor vehicle accidents

This study investigated the rate of psychological impairment and stressful life events in survivors of motor vehicle accidents. Fifty-six patients who had been hospitalised because of motor-vehicle-accident-related injuries were reviewed twelve months after the accident. In this sample, 41 per cent of patients reported significant levels of psychological impairment. Patients reporting psychological disturbance were characterised by having more pain, unemployment, substance abuse, avoidance of road transport and compensation claims. Only 44 per cent of patients reporting significant psychological impairment had sought professional help for their conditions. Psychological dysfunction following motor vehicle accidents appears to be a common occurrence, and education of medical personnel and survivors is required to enhance identification and management of this problem.