Progress and Controversy in the Study of Posttraumatic Stress Disorder

Department of Psychology, Harvard University, 33 Kirkland Street, Cambridge, Massachusetts 02138, USA.
Annual Review of Psychology (Impact Factor: 21.81). 02/2003; 54(1):229-52. DOI: 10.1146/annurev.psych.54.101601.145112
Source: PubMed


Research on posttraumatic stress disorder (PTSD) has been notable for controversy as well as progress. This article concerns the evidence bearing on the most contentious issues in the field of traumatic stress: broadening of the definition of trauma, problems with the dose-response model of PTSD, distortion in the recollection of trauma, concerns about "phony combat vets," psychologically toxic guilt as a traumatic stressor, risk factors for PTSD, possible brain-damaging effects of stress hormones, recovered memories of childhood sexual abuse, and the politics of trauma.

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    • "cesses that produce sensory details that are not well integrated conceptually (e.g., Brewin, Dalgleish, & Joseph, 1996; Ehlers & Clark, 2000; Horowitz, 1976; for reviews from various perspectives , see Brewin & Holmes, 2003; Dalgleish, 2004; McNally, 2003a, b; Porter & Birt, 2001; and Shobe & Kihlstrom, 1997). According to an alternative view, incoherence can be understood in terms of cognitive and affective processes that have been developed to account for memory in general. "
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    ABSTRACT: We examined the coherence of trauma memories in a trauma-exposed community sample of 30 adults with and 30 without posttraumatic stress disorder. The groups had similar categories of traumas and were matched on multiple factors that could affect the coherence of memories. We compared the transcribed oral trauma memories of participants with their most important and most positive memories. A comprehensive set of 28 measures of coherence including 3 ratings by the participants, 7 ratings by outside raters, and 18 computer-scored measures, provided a variety of approaches to defining and measuring coherence. A multivariate analysis of variance indicated differences in coherence among the trauma, important, and positive memories, but not between the diagnostic groups or their interaction with these memory types. Most differences were small in magnitude; in some cases, the trauma memories were more, rather than less, coherent than the control memories. Where differences existed, the results agreed with the existing literature, suggesting that factors other than the incoherence of trauma memories are most likely to be central to the maintenance of posttraumatic stress disorder and thus its treatment. (PsycINFO Database Record
    Journal of Abnormal Psychology 11/2015; DOI:10.1037/abn0000126 · 4.86 Impact Factor
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    • "It has long been recognised that some people who survive a life-threatening event (such as a disaster) unscathed physically may experience subsequent severe psychological difficulties (see Gersons & Carlier, 1992; Jones et al. 2003; McNally, 2003; Shay, 1991). In 1980 the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-III) revision task force included a new diagnostic category of Post-Traumatic Stress Disorder (PTSD) in DSM- III, which defined PTSD as a syndrome arising in response to " …a stressor that would evoke symptoms of distress in almost everyone " (American Psychiatric Association, 1980, p. 238). "
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    ABSTRACT: ABSTRACT Background: There are numerous reports that those involved in disaster response and recovery are at-risk of developing post-traumatic stress disorder, acute stress reaction, or secondary traumatic stress. There are few reports of research concerning the experiences of post-disaster field research interviewers. During the period 2009—2014, post-bushfire research interviews were conducted with residents affected by seven major bushfire events in four Australian states. This report describes findings from follow-up surveys of those who conducted five of these post-bushfire research interview studies. The aim was to investigate (a) the nature of their experiences; and (b) their perceptions of the adequacy of the training and preparation for the work. Method: Sixty-five post-bushfire research interviewers were contacted and invited to take part in an interview or complete a survey questionnaire about their post-bushfire research experiences. Thirty-three researchers (51%) provided 38 responses: one researcher described experiences on each of three deployments, three researchers described their experiences on each of two deployments. Results: Of the 38 responses, 9 (24%) described no stress symptoms associated with the interviews; 26 (68%) described little to mild levels of stress symptoms; 3 (8%) reported moderate levels of stress symptoms. Twenty three researchers (64%) reported that their experiences overall were positive. Reports about training and preparation were mostly positive. Conclusions: Interviewing residents affected by future disaster events will be psychologically impactful for many who conduct post-disaster field research. For the majority, the experience will probably have some distressing elements, but will be viewed positively overall. A small percentage will experience moderate levels of secondary stress, especially if the event involved multiple fatalities, but this will be relatively transient. The approach to training and preparation used for the post-bushfire field interviews is probably adequate, but needs to be evaluated more rigorously.
    Report number: BNHCRC 2015.114, Affiliation: La Trobe University School of Psychology & Public Health and Bushfire & Natural Hazards CRC
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    • "The generalized nature of future simulations and the high prevalence of semantic details suggest that PTSD is a biological response that puts the afflicted individual in an extended state of preparedness for subsequent catastrophe (Cantor, 2009). PTSD symptoms are highly associated with the context or setting in which the traumatic episode took place (Ehlers & Clark, 2000; McNally, 2003). Environmental cues would have been strong predictors of recurrent threat in ancestral environments, where adverse reactions to traumatic events evolved in the first place (Tooby & Cosmides, 1990). "
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    ABSTRACT: In this paper, we examine the relationship between episodic foresight and anxiety from an evolutionary perspective, proposing that together they confer an advantage for modifying present moment decision-making and behaviour in the light of potential future threats to fitness. We review the body of literature on the role of episodic foresight in anxiety, from both proximate and ultimate perspectives. We propose that anxious feelings associated with episodic simulation of possible threat-related future events serve to imbue these simulations with motivational currency. Episodic and semantic details of a future threat may be insufficient for motivating its avoidance, but anxiety associated with a simulation can provoke adaptive threat management. As such, we detail how anxiety triggered by a self-generated, threat-related future simulation prepares the individual to manage that threat (in terms of its likelihood and/or consequences) over greater temporal distances than observed in other animals. We then outline how anxiety subtypes may represent specific mechanisms for predicting and managing particular classes of fitness threats. This approach offers an inroad for understanding the nature of characteristic future thinking patterns in anxiety disorders and serves to illustrate the adaptive function of the mechanism from which clinical anxiety deviates. Episodic foresight can elicit anxiety even when there are no immediate environmental cues of fitness threats. Anxiety may be a mechanism by which simulations of future events are imbued with motivational currency, to ensure the management of potential future threats to fitness. Subtypes of anxiety disorders may reflect different mechanisms for effectively managing certain potential future threats to fitness. Understanding the utility of episodic foresight in anxiety disorders may lead to new insights into diagnosis and treatment. © 2015 The British Psychological Society.
    03/2015; DOI:10.1111/bjc.12080
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