The folk psychiatry model: Developing a measure of lay perceptions of PTSD

Whereas existing data verify the importance of support networks in facilitating resilience following trauma, the sociocultural perceptions of posttrauma difficulties that provide context for these interactions remain largely unexplored. Folk psychiatry models propose that lay explanations of mental illness can be quantified along distinct moralizing, medicalizing, and psychologizing dimensions. The current project aimed to develop a trauma-specific measure capturing lay explanations of posttraumatic stress disorder (PTSD) based on this framework. Data were collected from three samples of Mechanical Turk respondents (N₁ = 367; N₂ = 365; N₃ = 401) as well as an independent sample of university students (N₄ = 311). Factor analysis of the final, 13-item Folk Psychiatry Measure-PTSD (FPM-P) indicated close fit of a correlated three-factor model in MTurk and student respondents. Across samples, moralizing beliefs about PTSD (e.g., people with PTSD lack a moral compass) evidenced moderate-to-strong correlations with general attitudes toward those with mental illness, including positive associations with authoritarianism, social restrictiveness, blame, anger, and perceived dangerousness. Negative associations with benevolence and support for community-based care were also noted. Medicalizing beliefs (e.g., PTSD is caused by a chemical imbalance) demonstrated more modest associations with negative attitudes, as noted through weak correlations with increased authoritarianism, anger, and lower benevolence toward those experiencing psychological difficulties. Finally, psychologizing explanations (e.g., people with poor relationships and low social support are at greater risk of developing PTSD) evidenced weak but positive associations with benevolence and pity for those with mental health concerns. Implications and cultural-based nuances of the scale are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Automated Classification of Dyadic Conversation Scenarios using Autonomic Nervous System Responses

Two people's physiological responses become more similar as those people talk or cooperate, a phenomenon called physiological synchrony. The degree of synchrony correlates with conversation engagement and cooperation quality, and could thus be used to characterize interpersonal interaction. In this study, we used a combination of physiological synchrony metrics and pattern recognition algorithms to automatically classify four different dyadic conversation scenarios: two-sided positive conversation, two-sided negative conversation, and two one-sided scenarios. Heart rate, skin conductance, respiration and peripheral skin temperature were measured from 16 dyads in all four scenarios, and individual as well as synchrony features were extracted from them. A two-stage classifier based on stepwise feature selection and linear discriminant analysis achieved a four-class classification accuracy of 75.0% in leave-dyad-out crossvalidation. Removing synchrony features reduced accuracy to 65.6%, indicating that synchrony is informative. In the future, such classification algorithms may be used to, e.g., provide real-time feedback about conversation mood to participants, with applications in areas such as mental health counseling and education. The approach may also generalize to group scenarios and adjacent areas such as cooperation and competition.

Development and Validation of the Disclosure Expectancy Scale

Although the disclosure of traumatic experiences is believed to influence trajectories of post-trauma recovery, less is known about individual differences that affect survivors' motivation to share. The current project describes the development and evaluation of the Disclosure Expectancy Scale (DExS), a novel instrument intended to assess survivors' expectations about the potential risks and benefits of disclosure. Items targeting both positive and negative expectancies were generated based on existing research and the authors' clinical experience with various survivor populations. Preliminary analyses in trauma-exposed undergraduates (N = 359) offer support for hypothesized positive and negative expectancy dimensions with evidence for the convergent and discriminant validity of scores. Subsequent evaluation in active-duty, help-seeking military personnel (N = 35) provides further evidence of validity based on correlations with relevant clinical measures. A final regression demonstrating unique effects of initial disclosure expectancies on post-traumatic stress disorder (PTSD) severity following trauma-focused treatment highlights the predictive validity of DExS scores.

Trauma cognitions as intervening variables in the relation of chronic child abuse and thwarted interpersonal needs

OBJECTIVE

Chronic childhood trauma is consistently linked to negative mental health outcomes in adulthood, but research exploring specific paths of risk remains limited. The aims of the current study were to examine trauma cognitions as intervening variables in the relation of chronic victimization with perceived burdensomeness and thwarted belongingness, variables implicated in transdiagnostic risk for psychopathology.

METHOD

Semistructured interviews were used to identify university students reporting exposure to systematic physical and/or sexual violence prior to age 18 (n = 101) versus those experiencing other Criterion-A events (n = 254). Trauma cognitions (self, world, and self-blame) and thwarted interpersonal needs (burdensomeness and thwarted belongingness) were measured using scores from the posttrauma cognitions inventory (PTCI) and the Interpersonal Needs Questionnaire-10 (INQ-10). Path models in these cross-sectional data were evaluated to assess the indirect effects of chronic abuse on burdensomeness and thwarted belongingness through self, world, and blame cognitions.

RESULTS

An initial model indicated associations of chronic victimization on self (p = .044) and world (p = .005) scales of the PTCI and a unique effect of self-beliefs on INQ-10 burdensomeness (p < .001). An indirect effect of abuse on burdensomeness through self-beliefs was supported (p = .050). A second model identified direct effects of PTCI self (p < .001) and world (p < .001) scores on thwarted belongingness as well as an indirect effect of chronic abuse on belongingness through world beliefs (p = .026).

CONCLUSIONS

While typically assessed within the context of posttraumatic stress disorder, results suggest that shifts in fundamental beliefs about the self and the world may have more general impacts on perceptions of burdensomeness and belonging in survivors of early, systematic abuse. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Public beliefs about trauma and its consequences: Profiles and correlates of stigma

Public stereotypes about trauma exposure and its likely consequences have the potential to influence levels of support extended to survivors in the larger community. The current project sought to examine unique profiles of stereotype endorsement both within and across participants sampled from distinct populations. Trauma-related stereotypes involving symptom course, dangerousness, employability, social functioning, predictability, character, and treatment need were examined in undergraduate (N ₁ = 404; N ₂ = 502) and MTurk (N ₃ = 364) samples. Sympathizing [low overall endorsement], Fearful [high overall endorsement], Pejorative [high endorsement + moralizing beliefs], Safety-Focused [intermediate endorsement + dangerousness], and Performance-Focused [intermediate endorsement + employability] groups were replicated in latent profile models across all samples. Stereotype profiles demonstrated hypothesized associations with general perspectives of mental illness although support for consistent relations with respondent characteristics (e.g., sex; personal exposure to trauma; reported exposure in friends/family) was limited. Data suggest that trauma stereotypes are endorsed at high frequencies in the general community and conform to systematic patterns of prejudice that may be overlooked in more global assessments of stigma.

Interacting with a friend after a trauma film reduces anxiety and intrusive memories

OBJECTIVE

Interpersonal factors have been linked with psychological adjustment to trauma, but how interpersonal factors influence trauma response is still unclear. Experimental paradigms such as the trauma film paradigm offer a valuable approach for studying this complex dynamic. However, few studies have used the trauma film paradigm to examine the interpersonal context of trauma response, and no studies have incorporated friends into the trauma film paradigm. The purpose of the current study was to examine how inclusion of a friend influenced reactions to a trauma analog.

METHOD

One hundred young adult females were randomized to watch a brief stressful film of a sexual assault either with or without a friend and the Friend Present condition was given an opportunity to interact following the film. Participants were evaluated on distress during the film, skin conductance, anxiety and negative affect immediately postfilm (preinteraction) and 5 minutes later (postinteraction), and intrusive memories over a three-day period.

RESULTS

No differences were found between conditions on skin conductance or subjective distress during the film. However, the Friend Present condition experienced a greater reduction in state anxiety from preinteraction to postinteraction and greater decreases in intrusive memories over the three-day period.

CONCLUSIONS

Findings show the inclusion of a friend mitigated trauma-related stress reactions and suggest that interacting with a friend aided in adaptive processing of the stressor. Findings indicate that additional work is needed to examine how platonic relationships can be targeted to improve prevention and intervention efforts in trauma-related outcomes. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Trauma and aggression: Evaluating the influence of primed hostility and survivor sex

OBJECTIVES

The relation between posttrauma symptoms and aggression is an area of growing interest in the larger clinical literature. The current project looked to examine the impact of primed hostility on aggressive responding in men and women with and without a history of prior trauma.

DESIGN

Experimental aggression paradigm assessed in a 2 (Group) × 2 (Sex) × 2 (Prime) mixed factorial ANOVA.

METHODS

Trauma-naïve participants (N = 52) and survivors reporting active symptoms (N = 43) were exposed to hostile and neutral lexical primes in what was presented as a reaction time task played against an unseen 'opponent'. In actuality, 'wins' and 'losses' during the task were assigned by an automated system. The intensity of an aversive sound blast delivered by participants to the supposed opponent in trials the participant 'won' served as an index of behavioural aggression.

RESULTS

Repeated-measures ANOVA identified a between-by-within interaction of exposure group and lexical prime (p = .010; η p 2 $$ {\eta}_p^2 $$  = .070), with trauma-exposed participants (p = .002, Δ = .30), but not controls (p = .159, Δ = .11), demonstrating elevations in aggression subsequent to hostile priming. A sex by prime interaction (p = .001; η p 2 $$ {\eta}_p^2 $$  = .117) similarly indicated elevated aggression following hostile priming in men (p = .007, Δ = .58) as compared to women (p = .062, Δ = .10).

CONCLUSIONS

Results offer preliminary support for the association of situationally primed hostility and biological sex with aggressive responding in survivors reporting active symptoms.

Automatic Estimation of Interpersonal Engagement During Naturalistic Conversation Using Dyadic Physiological Measurements

Physiological responses of two interacting individuals contain a wealth of information about the dyad: for example, the degree of engagement or trust. However, nearly all studies on dyadic physiological responses have targeted group-level analysis: e.g., correlating physiology and engagement in a large sample. Conversely, this paper presents a study where physiological measurements are combined with machine learning algorithms to dynamically estimate the engagement of individual dyads. Sixteen dyads completed 15-min naturalistic conversations and self-reported their engagement on a visual analog scale every 60 s. Four physiological signals (electrocardiography, skin conductance, respiration, skin temperature) were recorded, and both individual physiological features (e.g., each participant's heart rate) and synchrony features (indicating degree of physiological similarity between two participants) were extracted. Multiple regression algorithms were used to estimate self-reported engagement based on physiological features using either leave-interval-out crossvalidation (training on 14 60-s intervals from a dyad and testing on the 15th interval from the same dyad) or leave-dyad-out crossvalidation (training on 15 dyads and testing on the 16th). In leave-interval-out crossvalidation, the regression algorithms achieved accuracy similar to a 'baseline' estimator that simply took the median engagement of the other 14 intervals. In leave-dyad-out crossvalidation, machine learning achieved a slightly higher accuracy than the baseline estimator and higher accuracy than an independent human observer. Secondary analyses showed that removing synchrony features and personality characteristics from the input dataset negatively impacted estimation accuracy and that engagement estimation error was correlated with personality traits. Results demonstrate the feasibility of dynamically estimating interpersonal engagement during naturalistic conversation using physiological measurements, which has potential applications in both conversation monitoring and conversation enhancement. However, as many of our estimation errors are difficult to contextualize, further work is needed to determine acceptable estimation accuracies.

The effects of blood in self-injurious cutting: Positive and negative affect regulation

OBJECTIVE

Seeing one's own blood may be a factor in affect regulation in nonsuicidal self-injury (NSSI). This study examined changes in a negative (NA) and positive affect (PA) in response to a finger prick eliciting a small drop of participants' blood.

METHODS

Two groups (NSSI; N = 56 and Control; N = 70) of undergraduate students were randomly assigned to receive a finger prick and look at blood, receive a finger prick and not look at blood, or receive a sham finger prick. Following a mood induction, participants completed the PANAS three times: Time 1 (pre mood-induction, baseline), Time 2 (post-mood induction), and Time 3 (post-finger prick condition), and a Pain Severity Scale.

RESULTS

A significant three-way interaction revealed that the NSSI: Blood Group had an increased positive effect between Time 2 and Time 3.

CONCLUSION

Blood serves an important function in NSSI and requires additional research to fully understand the relationship.

Interpersonal Functioning and Trauma: The Role of Empathy in Moderating the Association of PTSD and Interpersonal Functioning

Research demonstrates consistent associations between symptoms of posttraumatic stress disorder (PTSD) and reductions in interpersonal functioning. Moderators of this association, however, remain relatively unexplored. The current study aimed to examine the extent to which aspects of empathic responding may influence the relation between PTSD symptom dimensions and interpersonal functioning in students exposed to significant trauma. Participants (N = 94, 85.1% female, 86.2% White/Non-Hispanic) completed an initial screening to assess for trauma exposure and associated symptoms of PTSD. Interpersonal functioning and dimensions of empathic responding were measured using a series of self-report and lab-based tasks. Hierarchical regression models provided evidence for a consistent association between post-trauma arousal-reactivity and reductions in interpersonal functioning. Results also indicated a moderating effect of affective empathy (β = -.37, p = .010, f² = .086). Simple slopes and Johnson-Neyman plots identified an association between arousal-reactivity and functioning at low (β = 1.57, p < .001, f² = .301) versus high (β = .31, p = .417, f² = .008) levels of empathic response to a positively valenced film. Results offer preliminary support for a potential buffering effect of affective empathy on interpersonal functioning in individuals reporting chronic, trauma-related symptoms.

Moderators of PTSD symptom change in group cognitive behavioral therapy and group present centered therapy

To examine moderators of change during group-based intervention for Posttraumatic Stress Disorder (PTSD), multilevel models were used to assess trajectories of symptom clusters in male veterans receiving trauma focused Group Cognitive Behavioral Treatment (gCBT; N = 84) or non-trauma focused Group Present Centered Therapy (gPCT; N = 91; Sloan et al., 2018). Separate models were conducted for symptom clusters in each intervention, examining pre-treatment PTSD symptoms, pre-treatment depression severity, age, index trauma, and outcome expectancies as potential moderators. Unconditioned growth models for both gCBT and gPCT showed reductions in intrusions, avoidance, negative cognitions/mood, and arousal/reactivity (all p < .001). Distinct moderators of recovery emerged for each treatment. Reductions in avoidance during gCBT were strongest at high levels of pre-treatment PTSD symptoms (low PTSD: p =  .964, d = .05; high PTSD: p < .001, d = 1.31) whereas positive outcome expectancies enhanced reductions in cognitions/mood (low Expectancy: p =  .120, d = .50; high Expectancy: p < .001, d = 1.13). For gPCT, high levels of pre-treatment depression symptoms negatively impacted change in both intrusion (low depression: p < .001, d = .96; high depression: p =  .376, d = .22) and arousal/reactivity (low depression: p < .001, d = .95; high depression: p =  .092, d = .39) symptoms. Results support the importance of examining trajectories of change and their moderators for specific treatments, particularly when contrasting trauma focused and non-trauma focused treatments.

PTSD and anger: Evaluation of an indirect effect model in a civilian trauma sample

BACKGROUND AND OBJECTIVES

Theoretical models propose that PTSD symptoms and subjective anger are indirectly associated through hostile attribution bias, physiological reactivity, and aggressive psycho-motor scripts (Chemtob, Novaco, Hamada, Gross, & Smith, 1997). Originally developed to account for symptoms observed in military personnel, proposed anger mechanisms have received limited attention in civilian populations. The current study looked to evaluate the generalizability of Chemtob et al.'s model in trauma-exposed university students (N = 152).

METHODS

Trauma exposure and corresponding symptoms were assessed during an initial screening procedure. Hostile attributions and aggressive scripts were examined prior to a laboratory-based anger induction procedure. Physiological reactivity was monitored throughout the provocation task. Ratings of subjective anger and anger recovery were completed following the induction period. Relations of post-trauma symptoms with subjective anger through hypothesized anger processes were examined using bootstrapped estimates of indirect effects.

RESULTS

A significant indirect effect of PTSD severity on state-level anger was noted for hostile attribution bias (ab = 0.020, 95% CI [0.002, 0.041]) and a marginal effect through aggressive inclinations (ab = 0.015, 95% CI [-0.001, 0.039]). Data failed to provide evidence for physiological reactivity as an intervening variable. Trauma symptoms did not moderate anger recovery following the provocation task.

LIMITATIONS

Induction of anger in a sub-clinical sample may limit tests of hypothesized effects and the generalizability of the present findings.

CONCLUSIONS

Results indicate the proposed model may be applicable beyond combat trauma samples and suggest potential anger-related targets for PTSD treatment.

The pattern of symptom change during prolonged exposure therapy and present-centered therapy for PTSD in active duty military personnel

BACKGROUND

Few studies have investigated the patterns of posttraumatic stress disorder (PTSD) symptom change in prolonged exposure (PE) therapy. In this study, we aimed to understand the patterns of PTSD symptom change in both PE and present-centered therapy (PCT).

METHODS

Participants were active duty military personnel (N = 326, 89.3% male, 61.2% white, 32.5 years old) randomized to spaced-PE (S-PE; 10 sessions over 8 weeks), PCT (10 sessions over 8 weeks), or massed-PE (M-PE; 10 sessions over 2 weeks). Using latent profile analysis, we determined the optimal number of PTSD symptom change classes over time and analyzed whether baseline and follow-up variables were associated with class membership.

RESULTS

Five classes, namely rapid responder (7-17%), steep linear responder (14-22%), gradual responder (30-34%), non-responder (27-33%), and symptom exacerbation (7-13%) classes, characterized each treatment. No baseline clinical characteristics predicted class membership for S-PE and M-PE; in PCT, more negative baseline trauma cognitions predicted membership in the non-responder v. gradual responder class. Class membership was robustly associated with PTSD, trauma cognitions, and depression up to 6 months after treatment for both S-PE and M-PE but not for PCT.

CONCLUSIONS

Distinct profiles of treatment response emerged that were similar across interventions. By and large, no baseline variables predicted responder class. Responder status was a strong predictor of future symptom severity for PE, whereas response to PCT was not as strongly associated with future symptoms.

A Brief Measure of Interpersonal Interaction for 2-Player Serious Games: Questionnaire Validation

Background

Competitive and cooperative serious games have become increasingly popular in areas such as rehabilitation and education and have several potential advantages over single-player games. However, they are not suitable for everyone, and the user experience in competitive and cooperative serious games depends on many factors. One important factor is the verbal interaction between players, but the effect of this factor has not been extensively studied because of the lack of a validated measurement tool.

Objective

This paper aimed to validate a brief questionnaire that measures the verbal interaction between 2 players of a serious game. The questionnaire consists of 8 questions pertaining to the amount of conversation, its valence (positive or negative emotion), and its game relatedness.

Methods

The questionnaire was validated with 30 pairs of participants who played a competitive serious game for 10 min while being recorded with cameras. The questionnaire was filled out by both participants, an in-person observer, and 2 members of our research group who watched the videos. Results from these raters were used to develop questionnaire instructions, and the finalized questionnaire was given to 2 additional raters who were trained on 5 videos and then rated the other 25 videos independently.

Results

The questionnaire’s interrater reliability is excellent for the amount of conversation and its game relatedness (intraclass correlation coefficients [ICCs] above 0.9). Interrater reliability is fair to good for conversation valence (ICCs between 0.4 and 0.7). We believe that the lower interrater reliability for valence is primarily because of a limited spread of valence values in our sample. Furthermore, questionnaire ratings were significantly correlated with players’ personality characteristics (eg, amount of conversation was correlated with extraversion) and pressure/tension experienced in the competitive game.

Conclusions

The validated questionnaire has the potential to be a useful tool for studying user experience in competitive and cooperative serious games. Furthermore, it could be adapted for other applications such as entertainment games. However, it has only been validated with unimpaired university students in a 2-player competitive serious game and should next be validated with different target populations (eg, stroke survivors) and different game designs (eg, cooperative games).

Development and Evaluation of the Perpetration-Induced Distress Scale for Measuring Shame and Guilt in Civilian Populations

Although the topic of moral injury (MI) has been garnering increasing attention in recent years within military populations, research has rarely applied the concept to civilian contexts. Extant literature on distinct acts of perpetration or transgressions suggests similar emotional, cognitive, and behavioral patterns of distress associated with appraisals of wrongdoing. However, the absence of a psychometrically sound measure to detect and quantify pathological levels of distress associated with perpetrating harm against others has hindered additional research from being conducted on the topic. The current research presents the Perpetration-Induced Distress Scale (PIDS) as a valid and reliable measurement of distress associated with MI within civilian contexts. Factor analytic techniques revealed a two-factor solution characterized by perpetration-induced distress related to maladaptive reactions to shame (seven items) and guilt/self-blame (seven items). The PIDS demonstrated favorable temporal stability over a 1-week period as well as excellent internal reliability. Further, the PIDS evidenced convergent validity with functional impairment, posttraumatic stress disorder, and existing scales of shame and guilt; associations were large (rs = 0.62-0.87). The development of the PIDS represents one of the first studies to measure MI within a civilian population and indicates evidence that additional research on the topic is warranted.

Stability of reported trauma over extended intervals: Initial evaluation of an exposure screening protocol

The reliability and validity of reported exposure to significant trauma is critical to research evaluating outcomes following serious and distressing life events. The current study examined the reliability of reported exposure to disaster, fire, transportation accidents, physical assault, and sexual assault across 5- (N = 251), 12- (N = 223), and 24-month (N = 109) intervals in undergraduates completing a screening measure of probable trauma (N = 3,045). Concordance with later responses to an alternate checklist and events assessed via clinical interview was examined in a subset of participants (N = 274). Five-month reliabilities ranged from good to fair (κ = .40-.71) and were similar to 1-2 week retest estimates in the extant literature. Reliabilities for fire, accidents, and sexual assault remained stable over 12- and 24-month intervals. Coefficients for disaster and physical assault decreased over time. Agreement with the alternate checklist was fair to excellent in those completing the follow-up assessment (κ = .51-.87). Concordance with interview-based trauma was acceptable for accidents (κ = .52) and sexual violence (κ = .82) but poor for disaster, fire, and physical assault (κ = .34-.38). Specificity, negative predictive power, and negative likelihood ratios suggest checklists may hold utility in ruling out previous trauma. Sensitivities indicate that screening instruments may broadly capture individuals experiencing traumatic life events although positive predictive power was limited except in the prediction of traffic accidents and sexual assault. Variability across domains suggests that the properties of checklist measures could be better conceptualized at the level of individual exposure events. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Exploring the relation between posttraumatic stress disorder and interpersonal outcomes: The role of social acknowledgment and trauma type

OBJECTIVES

Research demonstrates consistent relations between posttrauma symptoms and interpersonal dysfunction. The current study examined the extent to which perceptions of community rejection account for the relation between posttraumatic stress disorder (PTSD) and interpersonal outcomes in students exposed to assaultive and nonassaultive trauma.

METHOD

Participants (N = 137; 66.4% female; M = 20 years) completed a trauma history interview, questionnaires assessing symptom severity, social disapproval, and interpersonal outcomes.

RESULTS

Assault survivors (n = 83) reported greater symptoms (d = 0.57), disapproval (d = 0.80), and social impairment (d = 0.51) relative to the nonassault group (n = 54). However, regression analyses indicated stronger associations between PTSD and community disapproval in survivors of nonassaultive (β = 0.69; p < 0.001) versus assaultive (β = 0.34; p < 0.001) events. Indirect effects of PTSD on perceived support and interpersonal functioning through social disapproval were also larger for nonassaultive versus assaultive groups (p < 0.05).

CONCLUSION

Despite greater dysfunction among assault survivors, perceptions of disapproval may be a more salient factor for interpersonal dynamics following nonassaultive trauma.

A naturalistic longitudinal study of extended inpatient treatment for adults with borderline personality disorder: An examination of treatment response, remission and deterioration

BACKGROUND

Experts express reluctance to hospitalize patients with borderline personality disorder (BPD) for more than a few days, arguing that extended inpatient care leads to deterioration and adverse events. To date, there is no empirical support for these assertions.

AIMS

The current study examined the assumption of iatrogenic effects among BPD adults.

METHODS

Clinically significant and reliable change in symptoms, functional capacities, and adverse events were quantified for both inpatients with BPD (n = 245) and a well-matched inpatient reference (n = 220) sample. Latent growth curve (LGC) models were used to evaluate moderators of the trajectory of PHQ-9 depression scores over the course of hospitalization.

RESULTS

Large effect size improvements were observed in depression, anxiety, suicidal ideation and functional disability among patients with BPD (Cohen's d ≥ 1.0) and those in the reference sample (Cohen's d ≥ .80). Clinical deterioration and adverse events were rare (occurring in no more than 1.1% of BPD and reference patients on any outcome) with no difference across patient cohorts. BPD diagnosis failed to influence the trajectory of continuous depression severity. Rather, trait emotion dysregulation was associated with initial depression severity.

CONCLUSIONS

Twenty-five years ago it was assumed that adults with BPD could not benefit from psychiatric treatment. Today there are a number of effective evidence-based outpatient treatments for BPD, but beliefs about extended inpatient treatment have changed little. Current results indicate that extended inpatient treatment can result in significant and clinically meaningful symptomatic and functional improvement in BPD patients without iatrogenic effects.

Predictive Relationship Between Parental Beliefs and Accommodation of Pediatric Anxiety

Behavior performed by parents to assist a youth in avoiding or alleviating anxiety, known as accommodation, is ubiquitous among pediatric anxiety disorders and strongly related to poor treatment outcome. According to cognitive-behavioral theory, the beliefs parents hold regarding accommodation should predict parental accommodating behavior. Unfortunately, little is known about the beliefs parents hold regarding accommodation, as there exists no validated measure of this construct. First, the psychometric properties were examined for the Parental Accommodation Scale (PAS), a novel measure of parental accommodating behavior frequency (PAS-Behavior scale) and parental beliefs about accommodation (PAS-Belief scale). Second, the relationship between parental beliefs about accommodation and accommodation frequency was examined. Results provide preliminary evidence of the internal consistency and convergent validity of the PAS. Stronger positive beliefs about accommodation significantly predicted accommodation frequency, even after controlling for youth anxiety severity. Specifically, beliefs that accommodation prevents youth from losing behavioral and emotional control significantly predicted accommodation frequency. Therefore, efforts to decrease accommodation in clinical settings should involve correcting maladaptive parental beliefs about accommodation, with a particular emphasis on beliefs regarding the necessity of accommodation in preventing a youth from losing behavioral and emotional control.

A prospective examination of risk factors in the development of intrusions following a trauma analog

Several factors have been linked to the severity of posttraumatic distress, although retrospective designs in much of the literature limit conclusions regarding the temporal relation between risk factors and corresponding symptoms. To address these concerns, the current project employed an analog trauma paradigm to assess the impact of background characteristics, stress response, and post-stressor affect regulation on subjective distress and intrusive memories experienced during the subsequent processing of emotional stimuli. University students (N = 184; 56% female, 42% White/Non-Hispanic) were shown graphic scenes of a televised suicide. Physiological activation was recorded during exposure with emotion ratings collected following the film. Participants then viewed a sadness- or humor-eliciting prime under instructions to inhibit or naturally express emotion. Intrusions experienced during the priming film and residual distress at study's conclusion were rated prior to debriefing. Hierarchical regression identified reductions in emotional valence as a robust predictor of intrusions and distress. Sympathetic activation and exposure to the sadness prime were associated with intrusion frequency, whereas attenuated parasympathetic response predicted intrusion intensity. Expressive inhibition demonstrated a unique association with residual distress. Results suggest peritraumatic processes and post-exposure factors may hold more prominent relations with immediate trauma-related distress as compared to pre-existing survivor characteristics.

An Open Effectiveness Trial of a Multimodal Inpatient Treatment for Depression and Anxiety Among Adults With Serious Mental Illness

OBJECTIVE

This prospective open effectiveness trial examined symptom change trajectories and rates of remission from depression and anxiety in an intensive multimodal inpatient treatment for adults with serious mental illness (SMI). Patient baseline characteristics were examined as mediators/moderators of treatment response.

METHODS

Adult inpatients with SMI (N = 994) completed an average of 39 days of inpatient treatment. Latent growth curve (LGC) methods were used to model symptom trajectories, estimating expected remission based on individual patterns of change observed across the sample.

RESULTS

Absolute reductions in symptoms were substantial, with large effect size improvements for both depression (d = 1.21, 95% CI [1.13, 1.29]) and anxiety (d = 1.13, 95% CI [1.05, 1.21]). For those presenting with elevated depressive symptoms (Patient Health Questionnaire-Depression ≥ 5.0; 87.5% of the sample), 46.9% evidenced remission from admission to discharge. Among patients presenting with significant anxiety (Patient Health Questionnaire-Generalized Anxiety Disorder Screener ≥ 5.0; 84.5% of the sample), 50.0% evidenced remission from admission to discharge. Mediation analyses revealed that depression and anxiety severity decreased more rapidly with increasing age and initial levels of experiential avoidance.

CONCLUSIONS

Rates of remission of depression and anxiety were greater than anticipated in this large cohort of adult SMI inpatients and may be related to intensity and length of hospitalization.

PATTERNS OF CHANGE IN RESPONSE TO PROLONGED EXPOSURE: IMPLICATIONS FOR TREATMENT OUTCOME

BACKGROUND

Assessment of response to Prolonged Exposure (PE) suggests some patients may experience discontinuous change involving sudden symptom reductions and/or temporary exacerbations. The current study looked to (1) isolate profiles of PE response among treatment-seeking veterans and (2) identify factors associated with unique patterns of change.

METHODS

Archival records were examined for veterans receiving PE through a specialty Veterans Affairs Medical Center (VAMC) clinic (N = 109). Latent profile analysis was used to extract response trajectories defined by change in weekly PTSD Checklist (PCL) scores. Associations with provider status (staff vs. intern), setting (in-person vs. telehealth), initial severity (PTSD; depression), and eventual treatment gains were examined.

RESULTS

Three profiles were observed. Rapid Responders (18.3%) evidenced sharp reductions at Week 2 and again between Weeks 5 and 6. Linear Responders (40.4%) demonstrated gradual reductions throughout the 10-week assessment window. Delayed Responder (41.3%) scores were relatively stable over the evaluation period although final session outcomes indicated reliable change (PCLΔ > 10) in 40% of patients. Profiles were similar with respect to provider status, treatment setting, and initial symptom severity. Rapid Responders evidenced lower final session scores relative to Linear (g = 1.13) and Delayed (g = 1.85) groups, with Linear Responders reporting lower end scores than Delayed Responders (g = 1.02).

CONCLUSIONS

Anticipating patterns of recovery and their association with therapeutic outcome is of immense clinical value. Sudden gains emerged as a strong predictor of enhanced response. Data also suggest potential benefits of extending standard intervention for patients who fail to demonstrate an immediate response to PE.

Expressive inhibition in response to stress: implications for emotional processing following trauma

Expressive inhibition--the willful restriction of expressed emotion--is documented in individuals reporting trauma-related distress, but its impact on global affective functioning remains unclear. Theoretical models propose that chronic activation of negative emotion and deliberate restriction of affect operate synergistically to produce trauma-related emotional deficits. The current project examined the impact of these factors on subjective experience and physiological activation following exposure to an analog trauma. University students (N=192; Mage=20, 57% female, 42% White/Non-Hispanic) viewed a graphic film depicting scenes of a televised suicide. Participants then viewed either a sadness- or humor-eliciting film under instructions to inhibit [nsadness=45, nhumor=52] or naturally express emotion [nsadness=48, nhumor=47]. Expressive inhibition was associated with restricted amusement specifically among participants viewing the humor film. Inhibition also produced attenuated sympathetic and parasympathetic recovery, irrespective of film assignment. Evidence of disruptions in emotional processing supports models identifying inhibition as a possible mechanism in post-trauma affect dysregulation.

The Association of Mental Health Conditions With Employment, Interpersonal, and Subjective Functioning After Intimate Partner Violence

This study explored the associations of posttraumatic stress disorder (PTSD), generalized anxiety disorder (GAD), and depressive symptoms with employment, social support, and subjective functioning in 100 women who were seeking mental health assistance after intimate partner violence. Depressive disorders showed significant associations with low levels of social support, diminished self-esteem, reduced quality of life, and elevated negative social problem-solving orientation. PTSD severity was significantly associated with low self-esteem and elevated negative problem orientation, while severity of GAD was only associated with negative problem orientation. Results are discussed in light of current service models for women who have experienced intimate partner violence.

The driving behavior survey as a measure of behavioral stress responses to MVA-related PTSD

Numerous treatments are available that address the core symptoms of posttraumatic stress disorder (PTSD). However, there are a number of related behavioral stress responses that are not assessed with PTSD measures, yet these behavioral stress responses affect quality of life. The goal of the current study was to investigate whether a recently developed measure of behavioral stress response, the Driving Behavior Survey (DBS), was sensitive to change associated with treatment among a group of participants diagnosed with PTSD. The DBS indexes anxious driving behavior, which is frequently observed among individuals with motor vehicle accident-related PTSD. Participants (n = 40) were racially diverse adults (M age = 40.78, 63% women) who met diagnostic criteria for motor vehicle accident-related PTSD. Hierarchical linear modeling analyses indicated that participants who were assigned to a brief, exposure-based intervention displayed significant reductions on the DBS subscales relative to participants assigned to the wait-list control condition (r = .41–.43). Moreover, mediational analyses indicated that the observed reductions on the DBS subscales were not better accounted for by reductions in PTSD. Taken together, these findings suggest that the DBS subscales are sensitive to changes associated with PTSD treatment and can be used to augment outcome assessment in PTSD treatment trials.

The Driving Behavior Survey as a measure of behavioral stress responses to MVA-related PTSD

Numerous treatments are available that address the core symptoms of posttraumatic stress disorder (PTSD). However, there are a number of related behavioral stress responses that are not assessed with PTSD measures, yet these behavioral stress responses affect quality of life. The goal of the current study was to investigate whether a recently developed measure of behavioral stress response, the Driving Behavior Survey (DBS), was sensitive to change associated with treatment among a group of participants diagnosed with PTSD. The DBS indexes anxious driving behavior, which is frequently observed among individuals with motor vehicle accident-related PTSD. Participants (n=40) were racially diverse adults (M age=40.78, 63% women) who met diagnostic criteria for motor vehicle accident-related PTSD. Hierarchical linear modeling analyses indicated that participants who were assigned to a brief, exposure-based intervention displayed significant reductions on the DBS subscales relative to participants assigned to the wait-list control condition (r=.41-.43). Moreover, mediational analyses indicated that the observed reductions on the DBS subscales were not better accounted for by reductions in PTSD. Taken together, these findings suggest that the DBS subscales are sensitive to changes associated with PTSD treatment and can be used to augment outcome assessment in PTSD treatment trials.

Expressive inhibition following interpersonal trauma: an analysis of reported function

Existing research indicates veterans with posttraumatic stress disorder (PTSD) may deliberately inhibit the expression of emotion. However, the degree to which inhibition generalizes to other trauma populations and the specific reasons survivors with PTSD inhibit expression remains unclear. The present study looked to evaluate expressive inhibition among survivors of intimate partner violence (N = 74), to determine reasons for inhibition in this population, and to examine whether any justifications for inhibition are unique to individuals with PTSD. The frequency and intensity of inhibition scores were similar to those noted in previous research although no differences were observed across women with and without PTSD. Self-reported justifications for inhibition indicated five general themes: Concern for others, Mistrust/fear of exploitation, Perception of others as indifferent/uncaring, Control/Experiential avoidance, and Situation-specific inhibition. Only mistrust/exploitation motives were uniquely associated with PTSD. Whereas expressive inhibition may be elevated within help-seeking samples, individuals who develop PTSD appear to hold unique reasons for restricting emotional expression.

Properties of the Driving Behavior Survey among individuals with motor vehicle accident-related posttraumatic stress disorder

Data suggest anxious drivers may engage in problematic behaviors that place themselves and others at increased risk of negative traffic events. Three domains of problematic behavior--exaggerated safety/caution, performance deficits, and hostile/aggressive behaviors--previously were identified during development of the Driving Behavior Survey (DBS), a novel measure of anxiety-related behavior. Extending this research, the current study examined the psychometric properties of DBS scores among individuals with posttraumatic stress disorder (PTSD) subsequent to motor vehicle trauma (N=40). Internal consistencies and 12-week test-retest reliabilities for DBS scales ranged from good to excellent. Comparison of scores to normative student data indicated dose-response relationships for safety/caution and performance deficit subscales, with increased frequency of anxious behavior occurring within the PTSD sample. Associations with standard clinical measures provide additional evidence for anxiety-related driving behavior as a unique marker of functional impairment, distinct from both avoidance and disorder-specific symptoms.

Interpersonal Change Following Intensive Inpatient Treatment

OBJECTIVE

Persons admitted for inpatient psychiatric care often present with interpersonal difficulties that disrupt adaptive social relations and complicate the provision of treatment. Whereas domains of psychosocial functioning in this population demonstrate clear growth in response to intervention, the impact of treatment on more complex patterns of interpersonal behavior has been largely overlooked within the existing literature. Interpersonal profiles characteristic of psychiatric inpatients were identified in the current study to determine rates of transition to adaptive functioning following hospitalization.

METHODS

Personality disturbance was assessed in 513 psychiatric inpatients using the Inventory of Interpersonal Problems. Scores were analyzed within a series of latent profile models to isolate unique interpersonal profiles at admission and at discharge. Longitudinal modeling was then employed to determine rates of transition from dysfunctional to adaptive profiles. Relationships with background characteristics, clinical presentation, and treatment response were explored.

RESULTS

Normative, Submissive, and Hostile/Withdrawn profiles emerged at both admission and discharge. Patients in the Normative profile demonstrated relatively moderate symptoms. Submissive and Hostile/Withdrawn profiles were related to known risk factors and elevated psychopathology. Approximately half of the patients who had been identified as Submissive or Hostile/Withdrawn transitioned to the Normative profile by discharge. Transition status evidenced modest associations with background characteristics and clinical presentation. Treatment engagement and reduction of clinical symptoms were strongly associated with adaptive transition.

CONCLUSION

Maladaptive interpersonal profiles characteristic of psychiatric inpatients demonstrated categorical change following inpatient hospitalization. Enhanced therapeutic engagement and overall reductions in psychiatric symptoms appear to increase potential for interpersonal change.

Translation and cross-cultural adaptation of the Brazilian Portuguese version of the Driving Behavior Survey (DBS)

BACKGROUND

Fear of driving has been recognized as a complex diagnostic entity. For this reason, the use of psychometric instruments is fundamental to advancing research in this area. Psychometric instruments are also necessary for clinical care, as they can help conceptualize the disorder and plan adequate treatment.

OBJECTIVE

To describe the cross-cultural adaptation of a Brazilian version of the Driving Behavior Survey (DBS).

METHODS

The process consisted of: 1) two translations and back-translations carried out by independent evaluators; 2) development of a brief version by four bilingual experts in mental health; 3) experimental application; and 4) investigation of operational equivalence.

RESULTS

The adaptation process is described and a final Brazilian version of the DBS is presented.

CONCLUSION

A new instrument is now available to assess the driving behaviors of the Brazilian population, facilitating research in this field.

Modeling trajectory of depressive symptoms among psychiatric inpatients: a latent growth curve approach

OBJECTIVE

Changes in the parameters of inpatient psychiatric care have inspired a sizable literature exploring correlates of prolonged intervention as well as symptom change over varying lengths of hospitalization. However, existing data offer limited insight regarding the nature of symptom change over time. Objectives of this longitudinal research were to (1) model the trajectory of depressive symptoms within an inpatient psychiatric sample, (2) identify characteristics associated with unique patterns of change, and (3) evaluate the magnitude of expected gains using objective clinical benchmarks.

METHOD

Participants included 1,084 psychiatric inpatients treated between April 2008 and December 2010. Latent growth curve modeling was used to determine the trajectory of Beck Depression Inventory II depressive symptoms in response to treatment. Age, gender, trauma history, prior hospitalization, and DSM-IV diagnoses were examined as potential moderators of recovery.

RESULTS

Results indicate a nonlinear model of recovery, with symptom reductions greatest following admission and slowing gradually over time. Female gender, probable trauma exposure, prior psychiatric hospitalization, and primary depressive diagnosis were associated with more severe trajectories. Diagnosis of alcohol/substance use, by contrast, was associated with more moderate trajectories. Objective benchmarks occurred relatively consistently across patient groups, with clinically significant change occurring between 2-4 weeks after admission.

CONCLUSIONS

The nonlinear trajectory of recovery observed in these data provides insight regarding the dynamics of inpatient recovery. Across all patient groups, symptom reduction was most dramatic in the initial week of hospitalization. However, notable improvement continued for several weeks after admission. Results suggest that timelines for adequate inpatient care are largely contingent on program-specific goals.

Technological advances in the treatment of trauma: a review of promising practices

Given the availability of empirically supported practices for addressing posttraumatic stress disorder and other forms of trauma-related distress, the development and implementation of new technology to deliver these treatments is exciting. Technological innovations in this literature aim to expand availability of empirically based intervention, increase treatment adherence and acceptability, and overcome barriers commonly encountered with conventional trauma-focused treatment. Much of the current research on these technological developments consists of brief reviews and case studies of the separate therapy modalities. Although this work serves to document the appeal and utility of these innovations, it does not provide comprehensive information about the host of options available. To that end, the three general categories of technological advances in trauma therapy (i.e., videoconferencing, e-Health, virtual reality) are reviewed here, including information regarding their empirical support and suggestions for future research and clinical practice.

Treatment of PTSD in older adults: Do cognitive-behavioral interventions remain viable?

The literature examining trauma among older adults is growing, but little is known about the efficacy of empirically supported interventions for PTSD within this population. Clinical writing on this topic often implies that cognitive-behavioral treatments may be ineffective or inappropriate for older adults with PTSD given physical and/or cognitive vulnerabilities. Review of the limited research in this area, however, provides little support for the claim that cognitive-behavioral interventions are ineffective in treating PTSD among the elderly. In an effort to explicate specific issues related to treatment process and outcome among older survivors of trauma, a case series is presented outlining the treatment of three older adults within the context of a structured, cognitive-behavioral group intervention. Observations from this case series suggests that cognitive-behavioral interventions continue to be useful in treating PTSD with this population. Specific treatment issues unique to older adults are explored and recommendations for future research are discussed.

Exploring negative emotion in women experiencing intimate partner violence: shame, guilt, and PTSD

This study explored the association of shame and guilt with PTSD among women who had experienced intimate partner violence (IPV). Sixty-three women were assessed by a research clinic serving the mental health needs of women IPV survivors. Results indicated that shame, guilt-related distress, and guilt-related cognitions showed significant associations with PTSD but global guilt did not. When shame and guilt were examined in the context of specific forms of psychological abuse, moderation analyses indicated that high levels of both emotional/verbal abuse and dominance/isolation interacted with high levels of shame in their association with PTSD. Neither guilt-related distress nor guilt-related cognitions were moderated by specific forms of psychological abuse in their association with PTSD. These data support the conceptualization of shame, guilt distress, and guilt cognitions as relevant features of PTSD. Results are discussed in light of proposed changes to diagnostic criteria for PTSD.

A different kind of co-morbidity: Understanding posttraumatic stress disorder and chronic pain

Many traumatic events leave lingering physical injuries and chronic pain in their wake, in addition to trauma-related psychopathology. In this review, we provide an overview of developments in the recent literature on co-morbid posttraumatic stress disorder (PTSD) and chronic pain. Starting with the conceptual models presented by Sharp and Harvey (2001) and Asmundson, Coons, Taylor, and Klatz (2002), this review summarizes newer studies that examine prevalence of these co-morbid conditions. Additionally, we present an updated synthesis of research on factors that may maintain both chronic physical pain and PTSD in trauma survivors. Consideration of the impact of this co-morbidity on psychosocial assessment and treatment also is discussed, with particular attention to issues that warrant additional research.

The Driving Behavior Survey: scale construction and validation

Although long recognized in the clinical literature, problematic behavior characteristic of anxious drivers has received little empirical attention. The current research details development of a measure of anxious driving behavior conducted across three studies. Factor analytic techniques identified three dimensions of maladaptive behaviors across three college samples: anxiety-based performance deficits, exaggerated safety/caution behavior, and anxiety-related hostile/aggressive behavior. Performance deficits evidenced convergent associations with perceived driving skill and were broadly related to driving fear. Safety/caution behaviors demonstrated convergence with overt travel avoidance, although this relationship was inconsistent across studies. Safety/caution scores were associated specifically with accident- and social-related driving fears. Hostile/aggressive behaviors evidenced convergent relationships with driving anger and were associated specifically with accident-related fear. Internal consistencies were adequate, although some test-retest reliabilities were marginal in the unselected college sample. These data provide preliminary evidence for utility of the measure for both research and clinical practice.

Physical and psychosocial functioning following motor vehicle trauma: relationships with chronic pain, posttraumatic stress, and medication use

Chronic pain and PTSD are known to hold substantial comorbidity following traumatic injury. Although pharmacological agents have been examined in the treatment of pain and PTSD individually, little is known regarding the relationship of medication use with functioning in patients with comorbid conditions. This research examined the relationships of pain, PTSD, and medication use across physical and psychosocial functioning in patients with chronic pain following motor vehicle injury (N=234). Separate analyses were conducted for opioids, SSRIs, and sedative/anxiolytics, respectively. Several relevant effects were noted: (1) Pain evidenced strong associations with reduced functioning across both physical and psychosocial domains, (2) Opioid use held interactive relationships with PTSD across both functioning domains. Specifically, opioids were associated with greater physical impairment in patients without comorbid PTSD. Opioids also were related to greater psychosocial impairment in patients without PTSD while PTSD was associated with greater impairment in patients not using opioids, (3) Opioid use evidenced a marginal interaction with pain on psychosocial functioning. Opioids were associated with greater psychosocial impairment among patients with high-pain, and high-pain was associated with greater impairment among opioid users, (4) SSRIs held a marginal interaction with PTSD such that PTSD was related to poorer psychosocial functioning only among individuals not using an SSRI, and (5) Anxiolytic use evidenced a marginal interaction with PTSD on physical functioning although no between-group differences were noted. These data suggest that PTSD symptomology may be an important consideration in determining treatment modality for patients experiencing pain subsequent to traumatic injury.

Drunk in Public, Drunk in Private: The Relationship Between College Students, Drinking Environments and Alcohol Consumption

This study examines environmental differences in public (bars) and private (parties) drinking settings among of-age (21 and up years of age) and underage (18-20 years of age) college students attending college near the US/Mexico border. A random telephone survey of graduate and undergraduate students attending two large public universities in the southwestern United States was conducted during the 2000-2003 academic years. A university-based social science research laboratory conducted the telephone interviews with respondents who reported an occasion in the past 28 days where alcohol was being consumed (N = 4,964). The data were analyzed using ordinary least squares multiple regression. The results suggests that drinking settings contributed to the amount of alcohol consumed by respondents. Additionally, environmental factors contributing to drinking vary by setting. In general, having many people intoxicated at an event, BYOB parties, playing drinking games, and having illicit drugs available contribute to heavier drinking.

Understanding the interpersonal impact of trauma: contributions of PTSD and depression

To build on the growing literature on interpersonal relationships among individuals with PTSD, this study examined the separate influences of PTSD symptoms and depression on functioning with friends, romantic partners, and family. To examine the influence of measurement, both interviewer-rated assessment of interpersonal functioning and self-reported assessment of perceived social support were included. The sample included 109 community members who sought help for mental health problems in the aftermath of a serious motor vehicle accident. Building on previous research, hierarchical regression models were used to examine the impact of re-experiencing, avoidance, emotional numbing, and hyperarousal on relationship functioning, followed by depression. Results suggest that assessment modality makes a difference in understanding factors contributing to interpersonal strain. When assessed by an interviewer, depression seems to play a larger role in interpersonal strain, relative to PTSD symptoms. When assessed via self-reported perceived social support, weaker associations were observed, which highlighted the role of emotional numbing. Results are discussed in light of the possible role that PTSD comorbidity with depression plays in interpersonal functioning following a traumatic event, with implications for future research.

Understanding the relationship between PTSD and social support: the role of negative network orientation

Network orientation is conceptualized as an individual's attitudes and expectations regarding the usefulness of support networks in coping with stress. The present research examined the potential for network orientation to explicate the well documented association between post-traumatic stress disorder (PTSD) and attenuated social support. Data collected from survivors of serious motor vehicle trauma (N=458) were used to test the hypothesis that severity of PTSD would hold a significant indirect relationship with social support through negative network orientation. Childhood victimization and elapsed time from the accident were examined as potential moderators of this indirect relationship. Consistent with hypotheses, path analyses demonstrated a significant indirect relationship between PTSD and social support through negative network orientation. Specifically, this indirect effect was the result of a direct association between PTSD severity and negative network orientation and an inverse association between negative network orientation and social support. This pattern of relationships was invariant across mode of PTSD assessment (interview vs. self-report). No moderation effects were noted. These data suggest that network orientation may be an important factor in understanding interface of interpersonal processes and post-trauma pathology.

The impact of event scale-revised: psychometric properties in a sample of motor vehicle accident survivors

This study examined the factor structure, internal consistency, concurrent validity, and discriminative validity of the Impact of Event Scale-Revised (IES-R, [Weiss, D. S. & Marmar, C. R. (1997). The Impact of Event Scale-Revised. In: J. P. Wilson & T. M. Keane (Eds.). Assessing psychological trauma and PTSD (pp. 399-411). New York: Guilford Press]) in a sample of 182 individuals who had experienced a serious motor vehicle accident. Results supported the three-factor structure of the IES-R, Intrusion, Avoidance, and Hyperarousal, with adequate internal consistency noted for each subscale. Support was obtained for the concurrent and discriminative validity, as well as the absence of social desirability effects. Although some differences were noted between the IES-R Avoidance subscale and diagnostically based measures of this cluster of symptoms, these differences do not necessarily signify measurement problems with the IES-R. The IES-R seems to be a solid measure of post-trauma phenomena that can augment related assessment approaches in clinical and research settings.

Beer and bongs: differential problems experienced by older adolescents using alcohol only compared to combined alcohol and marijuana use

Alcohol and other drug problems experienced by adolescents who use only alcohol compared to those who use both alcohol and marijuana (A + M) is studied. Using the national longitudinal survey of youth 1994 data, forward multiple regression analyses revealed that impulsivity, A + M use (compared to alcohol-only use), age, sex, religiosity, frequency of substance use were associated with a higher number of behavioral problems. Youth with more alcohol problems were found to be binge drinkers, impulsive, more frequent alcohol users, and nonHispanic. Implications and future research needs are discussed.

Environmental predictors of heavy episodic drinking

This study examined the relationship between environmental characteristics and heavy episodic drinking by examining college students' last drinking events. For this study, 409 undergraduate students attending a large public university were randomly selected. Students were asked to report on their last drinking event within the 30-day period prior to being surveyed. There were 274 drinking events analyzed. Bivariate analyses and multiple logistic regression analysis were used to identify contextual factors predictive of heavy episodic drinking in specific drinking events. Drinking with friends, drinking beer and hard liquor, and having many people intoxicated at an event were predictive of heavy episodic drinking events. Dating events were protective of heavy episodic drinking. Implications for future research and prevention are discussed.

Substance use problems reported by college students: combined marijuana and alcohol use versus alcohol-only use

This study examines the relationships among selected demographic characteristics, alcohol use only, alcohol plus marijuana use and substance-use related problems. Data are from 409 randomly selected undergraduate college students attending a large urban university. Poly-substance users were more likely than alcohol only users to be younger and experience all substance-use related problems studied. The relationship between poly-substance use and increased substance use-associated problems was also identified when controlling for other common predictors of substance use problems.