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ABSTRACT: Exposure to chronic interpersonal violence (IPV) has been associated with psychiatric impairment; however, few studies have investigated attention processes and psychophysiology in this population.
We investigated self-report and physiological correlates of attention biases in 27 IPV-exposed women.
Participants completed self-report measures of trauma history, posttraumatic stress disorder (PTSD) symptoms, and dissociation; were monitored physiologically during baseline; and responded to an emotional dot probe task.
Participants showed bias away from positive and anxiety words, and toward IPV words. Lower baseline respiratory sinus arrhythmia (RSA) and higher skin conductance levels were associated with bias away from anxiety cues. Greater total PTSD symptoms were associated with bias toward IPV cues, and greater PTSD intrusion and avoidance symptoms were associated with lower RSA. Individuals exposed to more types of trauma had lower heart rates.
These data extend the research on emotion-cognition interactions in PTSD and other anxiety disorders to chronic IPV survivors, in part confirming avoidance and intrusion symptom and attention bias relations found in studies. The present work also draws attention to a group that tends to experience a range of severe symptoms associated with apparent blunting in autonomic activity, and suggests that self-report may not be sensitive to physiological and attention alterations in chronic IPV samples.
European journal of psychotraumatology. 01/2013; 4.
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ABSTRACT: Though researchers have examined trauma's impact on adults in laboratory and treatment settings, few studies have integrated laboratory assessments into psychotherapy process research. This study examined the relationship between trauma-focused therapy processes (prolonged exposure, stress inoculation training, and psychodynamic) and changes in both subjective symptoms and laboratory-assessed cognition (i.e., attention biases and implicit memory) and psychophysiology (i.e., skin conductance and respiratory sinus arrhythmia, or RSA) following 12 sessions of real world therapy. The clients (27 women with severe interpersonal violence histories) showed only modest changes after 12 sessions (marginal posttraumatic stress disorder [PTSD] symptom reduction; significant reduction in attention biases and implicit memory). However, their improvement was predicted by certain psychotherapeutic processes. Clients whose therapists utilized more psychodynamic therapy techniques showed significantly greater reductions in PTSD symptoms and improved RSA, and marginally improved attention biases and implicit memory. Clients whose therapists utilized more stress inoculation techniques had significantly improved PTSD and RSA, and marginally improved implicit memory. Clients whose therapists used more prolonged exposure techniques had marginally worse outcomes with respect to attention biases and physiology. These findings, which are limited by the unknown validity of the therapy process measures, risk of Type I error, and small sample size, nonetheless raise the importance of examining alternatives to exposure therapy when treating highly traumatized clients. Furthermore, they represent a novel use of laboratory assessments in naturalistic treatment research. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Psychological Trauma Theory Research Practice and Policy 06/2012; 4(4):438-446. · 0.89 Impact Factor
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ABSTRACT: To examine the associations of alcohol expectancy outcomes and valuations with intention to use.
A total of 157 adolescent nonusers completed anonymous self-report surveys.
Adolescents who perceived more access to alcohol, expected less negative and more positive drinking outcomes, and evaluated positive outcomes favorably reported greater intentions to drink in adulthood.
Findings may be useful for efforts to further delay the initiation of alcohol use.
Journal of Adolescent Health 07/2011; 49(1):105-7. · 3.33 Impact Factor
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Journal of Adolescent Health 07/2011; 49(1):108-9. · 3.33 Impact Factor
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ABSTRACT: The Critical Incident History Questionnaire indexes cumulative exposure to traumatic incidents in police by examining incident frequency and rated severity. In over 700 officers, event severity was negatively correlated (r(s) = -.61) with frequency of exposure. Cumulative exposure indices that varied emphasis on frequency and severity-using both nomothetic and idiographic methods-all showed satisfactory psychometric properties and similar correlates. All indices were only modestly related to posttraumatic stress disorder (PTSD) symptoms. Ratings of incident severity were not influenced by whether officers had ever experienced the incident. Because no index summarizing cumulative exposure to trauma had superior validity, our findings suggest that precision is not increased if frequency is weighted by severity.
Journal of Traumatic Stress 12/2010; 23(6):734-43. · 2.72 Impact Factor
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ABSTRACT: This article has been withdrawn at the request of the authors and/or editor. The Publisher apologizes for any inconveniences this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.
Journal of Adolescent Health 05/2010; · 3.33 Impact Factor
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ABSTRACT: This paper investigates cognitive and physiological precursors of orthostatic panic (OP), that is, panic upon standing, which is a key complaint among traumatized Cambodian refugees. Prior research links OP to hypotension (lower blood pressure) and catastrophic cognitions. A clinical sample of 102 Cambodian refugees were assessed for posttraumatic stress disorder (PTSD), recent OP attacks, and anticipatory anxiety before engaging in an orthostatic challenge (OC) task during which they were monitored for blood pressure. After the task, they were assessed for OC-induced culture-related catastrophic cognitions, flashbacks, and panic attacks. We found that participants with recent OP (
n = 60) had more PTSD, greater anticipatory anxiety before the OC, a larger drop in systolic blood pressure during the OC, more OC-induced catastrophic cognitions and flashbacks, and more severe OC-induced panic attack symptoms. Regression models showed that the severity of OC-induced panic symptoms was predicted by the magnitude of SBP drop and mediated by more severe catastrophic cognitions and flashbacks. Implications of the findings for cross-cultural psychopathology research and the treatment of both panic and PTSD in Cambodian refugees are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Psychological Trauma Theory Research Practice and Policy 02/2010; 2(1):63-70. · 0.89 Impact Factor
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ABSTRACT: Studies of civilians typically find that female gender is a risk factor for posttraumatic stress disorder (PTSD). Police and military studies often find no gender differences in PTSD. We compared 157 female police officers and 124 female civilians on several variables including trauma exposure, peritraumatic emotional distress, current somatization, and cumulative PTSD symptoms. We found that despite greater exposure to assaultive violence in the officer group, female civilians reported significantly more severe PTSD symptoms. Elevated PTSD symptoms in female civilians were explained by significantly more intense peritraumatic emotional distress among female civilians. We also found that female officers showed a stronger direct relationship between peritraumatic emotional distress and current somatization. Our findings suggest that apparent gender differences in PTSD may result from differences in peritraumatic emotionality, which influence subsequent PTSD and somatization symptoms. Emotionality may be more important than biological sex in understanding gender differences in PTSD.
Journal of anxiety disorders 04/2009; 23(6):767-74. · 2.68 Impact Factor
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ABSTRACT: Posttraumatic stress disorder (PTSD) has been most consistently associated with exaggerated physiologic reactivity to startling sounds when such sounds occur in threatening contexts. There is conflicting evidence about whether startle hyperreactivity is a preexisting vulnerability factor for PTSD or an acquired result of posttrauma neural sensitization. Until now, there have been no prospective studies of physiologic reactivity to startling sounds in threatening contexts as predictors of PTSD symptoms.
One hundred and thirty-eight police academy cadets without current psychopathology were exposed to repeated 106-dB startling sounds under increasing (low, medium, or high) threat of mild electric shock while their eye-blink electromyogram, skin conductance, heart rate, and subjective fear responses were recorded. Measures of response habituation were also calculated. Following 1 year of exposure to police-related trauma, these participants were assessed for PTSD symptom severity.
After accounting for other baseline variables that were predictive of PTSD symptom severity (age and general psychiatric distress), more severe PTSD symptoms were prospectively and independently predicted by the following startle measures: greater subjective fear under low threat, greater skin conductance under high threat, and slower skin conductance habituation.
These results imply that hypersensitivity to contextual threat (indexed by greater fear under low threat), elevated sympathetic nervous system reactivity to explicit threat (indexed by larger responses under high threat), and failure to adapt to repeated aversive stimuli (evidenced by slower habituation) are all unique preexisting vulnerability factors for greater PTSD symptom severity following traumatic stress exposure. These measures may eventually prove useful for preventing PTSD.
Biological psychiatry 09/2008; 65(3):235-40. · 8.93 Impact Factor
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ABSTRACT: Relatively few studies focus on the psychological effects of trauma exposure on Asian Americans. This article presents secondary analyses of a random survey of 118 Asian American and 762 European American survivors of the 1994 Northridge, California earthquake. Asian American participants reported more psychiatric distress and were more than twice as likely to meet caseness criteria on the Brief Symptom Inventory. Ethnic differences remained after accounting for group differences in age, immigrant status, and exposure to the earthquake. Moreover, moderator analyses showed that Asian Americans were not more sensitive to these risk factors but that ethnic differences were explained by the interaction of ethnicity and having a foreign born parent. Though more work needs to be done to understand the basis of these differences, these findings challenge model minority myths about Asian American people and draw attention to their potential need for greater mental health resources following a natural disaster.
The Journal of nervous and mental disease 09/2008; 196(8):597-604. · 1.77 Impact Factor
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ABSTRACT: How are strengths of character related to growth following trauma? A retrospective Web-based study of 1,739 adults found small, but positive associations among the number of potentially traumatic events experienced and a number of cognitive and interpersonal character strengths. It was concluded that growth following trauma may entail the strengthening of character.
Journal of Traumatic Stress 05/2008; 21(2):214-7. · 2.72 Impact Factor
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ABSTRACT: Because ethnoracial minorities are a growing part of the U.S. population yet are underrepresented in the psychopathology literature, we reviewed the evidence for differences in prevalence and treatment of posttraumatic stress disorder (PTSD) in African Americans, Latino Americans, Asian and Pacific Islander Americans, and American Indians. With respect to prevalence, Latinos were most consistently found to have higher PTSD rates than their European American counterparts. Other groups also showed differences that were mostly explained by differences in trauma exposure. Many prevalence rates were varied by subgroup within the larger ethnoracial group, thereby limiting broad generalizations about group differences. Regarding service utilization, some studies of veterans found lower utilization among some minority groups, but community-based epidemiological studies following a traumatic event found no differences. Finally, in terms of treatment, the literature contained many recommendations for culturally sensitive interventions but little empirical evidence supporting or refuting such treatments. Taken together, the literature hints at many important sources of ethnoracial variation but raises more questions than it has answered. The article ends with recommendations to advance work in this important area.
Clinical Psychology Science and Practice 02/2008; 15(1):35 - 61. · 2.92 Impact Factor
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Nnamdi Pole
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ABSTRACT: This meta-analysis of 58 resting baseline studies, 25 startle studies, 17 standardized trauma cue studies, and 22 idiographic trauma cue studies compared adults with and without posttraumatic stress disorder (PTSD) on psychophysiological variables: facial electromyography (EMG), heart rate (HR), skin conductance (SC), and blood pressure. Significant weighted mean effects of PTSD were observed for HR (r = .18) and SC (r = .08) in resting baseline studies; eyeblink EMG (r = .13), HR (r = .23), and SC habituation slope (r = .21) in startle studies; HR (r = .27) in standardized trauma cue studies; and frontalis EMG (r = .21), corrugator EMG (r = .34), HR (r = .22), and SC (r = .19) in idiographic trauma cue studies. The most robust correlates of PTSD were SC habituation slope, facial EMG during idiographic trauma cues, and HR during all study types. Overall, the results support the view that PTSD is associated with elevated psychophysiology. However, the generalizability of these findings is limited by characteristics of the published literature, including its disproportionate focus on male veterans and neglect of potential PTSD subtypes.
Psychological Bulletin 10/2007; 133(5):725-46. · 14.46 Impact Factor
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ABSTRACT: Childhood trauma may confer risk for adult psychopathology by altering emotional and physiological responses to subsequent stressors. Few studies have distinguished effects of childhood trauma from effects of current Axis I psychopathology on adult psychophysiological reactivity. The authors exposed 90 psychiatrically healthy police cadets to startling sounds under increasing threat of shock while assessing their eyeblink electromyogram (EMG), skin conductance (SC), and heart rate responses. When compared with those who did not endorse early trauma (n = 65), cadets reporting childhood trauma (n = 25) reported less positive emotion and showed greater SC responses across all threat levels. They also showed threat-dependent elevations in reported negative emotions and EMG responses. Results suggest that childhood trauma may lead to long-lasting alterations in emotional and psychophysiological reactivity even in the absence of current Axis I psychopathology.
Journal of Abnormal Psychology 06/2007; 116(2):352-61. · 4.86 Impact Factor
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Nnamdi Pole
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ABSTRACT: Though many studies have reported psychophysiological differences between individuals with and without posttraumatic stress disorder (PTSD), there have been inconsistencies in the magnitude of observed effect sizes across studies. Following a meta-analysis of the effect of current PTSD on psychophysiology during resting baseline, startle, standard trauma cue, and idiographic trauma cue studies, the author examined moderators of the obtained effect sizes. Results revealed that, among several moderators examined, greater PTSD effects on psychophysiology were most consistently associated with trauma-free control groups, greater PTSD symptom severity, and studies using earlier rather than more recent diagnostic criteria for PTSD (e.g., DSM-III versus DSM-IV).
Annals of the New York Academy of Sciences 08/2006; 1071:422-4. · 3.15 Impact Factor
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Charles R Marmar,
Shannon E McCaslin,
Thomas J Metzler,
Suzanne Best,
Daniel S Weiss,
Jeffery Fagan,
Akiva Liberman, Nnamdi Pole,
Christian Otte,
Rachel Yehuda,
David Mohr,
Thomas Neylan
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ABSTRACT: We provide an overview of previous research conducted by our group on risk and resilience factors for PTSD symptoms in police and other first responders. Based on our work, the findings of other investigators on individual differences in risk for PTSD, and drawing on preclinical studies fear conditioning and extinction, we propose a conceptual model for the development of PTSD symptoms emphasizing the role of vulnerability and resilience to peritraumatic panic reactions. We tested this conceptual model in a cross-sectional sample of police officers (n = 715). Utilizing an hierarchical linear regression model we were able to explain 39.7% of the variance in PTSD symptoms. Five variables remained significant in the final model; greater peritraumatic distress (beta = 0.240, P < .001), greater peritraumatic dissociation (beta = 0.174, P < .001), greater problem-solving coping (beta = 0.103, P < .01), greater routine work environment stress (beta = 0.182, P < .001), and lower levels of social support (beta = -0.246, P < .001). These results were largely consistent with the proposed conceptual model. Next steps in this line of research will be to test this model prospectively in a sample of 400 police academy recruits assessed during training and currently being followed for the first 2 years of police service.
Annals of the New York Academy of Sciences 08/2006; 1071:1-18. · 3.15 Impact Factor
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ABSTRACT: This study examines whether pre- or post-dexamethasone salivary cortisol is related to cumulative critical incident exposure, peritraumatic responses, or post-traumatic stress disorder (PTSD) symptom severity. Thirty active duty police officers completed the study protocol, which included measures of peritraumatic emotional distress, peritraumatic dissociation, duty-related trauma exposure, and PTSD symptoms. Salivary cortisol was consolidated into three outcome variables: (1) pre-dexamethasone free cortisol levels at 1, 30, 45, and 60 min after awakening, (2) post-dexamethasone cortisol levels at the identical wake times, and (3) percentage of cortisol suppression. Control variables included age, gender, average daily alcohol use, night shift work, routine work environment stressors, and salivary dexamethasone levels. Zero order correlations showed that greater levels of PTSD symptoms, peritraumatic distress, and peritraumatic dissociation were associated with lower levels of pre-dexamethasone cortisol levels on awakening, but were not associated with the other two cortisol variables. A trend was also noted for older subjects to have lower pre-dexamethasone cortisol on awakening. When these four predictors were entered simultaneously in a regression analysis, only age and PTSD symptom severity significantly predicted pre-dexamethasone awakening cortisol levels. These results replicate previous research indicating a relationship between greater PTSD symptoms and lower levels of basal cortisol on awakening, and extend this finding to a previously unstudied non-treatment seeking population, urban police.
Psychoneuroendocrinology 06/2005; 30(4):373-81. · 5.81 Impact Factor
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ABSTRACT: Several studies have found that Hispanic Americans have higher rates of posttraumatic stress disorder (PTSD) than non-Hispanic Caucasian and Black Americans. The authors identified predictors of PTSD symptom severity that distinguished Hispanic police officers (n=189) from their non-Hispanic Caucasian (n=317) and Black (n=162) counterparts and modeled them to explain the elevated Hispanic risk for PTSD. The authors found that greater peritraumatic dissociation, greater wishful thinking and self-blame coping, lower social support, and greater perceived racism were important variables in explaining the elevated PTSD symptoms among Hispanics. Results are discussed in the context of Hispanic culture and may be important for prevention of mental illness in the fastest growing ethnic group in the United States.
Cultural Diversity and Ethnic Minority Psychology 06/2005; 11(2):144-61. · 1.36 Impact Factor
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ABSTRACT: Childhood trauma is a risk factor for anxiety disorders in adulthood. One possible mechanism for this association is an increased neuroendocrine response to stress in adults with a history of childhood trauma.
In a cross-sectional study, 76 police academy recruits (mean [+/-SD] age 28 +/- 5 years, 10 female) were exposed to a video depicting real-life officers exposed to highly stressful incidents. Salivary cortisol and 3-methoxy-4-hydroxy-phenylglycol (MHPG, the major metabolite of norepinephrine) were collected at baseline, immediately after the video, and 20 min after the video. Childhood trauma before age 14 was assessed with an interview (Life Stressor Checklist-Revised).
Exposure to the video elicited significant MHPG and cortisol responses in both groups. Recruits with childhood trauma histories (n = 16) had a significantly greater MHPG response, as evidenced by a group effect (F = 8.0, p < .01), and a group x time interaction (F = 4.1, p < .05). The cortisol response did not differ between groups.
Police academy recruits with childhood trauma histories have an increased catecholamine response to psychological stress. This might serve as a risk factor for anxiety disorders in recruits, and these findings might generalize to other groups with a history of childhood trauma.
Biological Psychiatry 02/2005; 57(1):27-32. · 8.28 Impact Factor
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ABSTRACT: Peritraumatic dissociation (PD) is one of the best predictors of posttraumatic stress disorder (PTSD). In this pilot study, we examined cardiovascular psychophysiology and negative emotions in 19 adults who, retrospectively, reported experiencing high or low levels of PD during the worst trauma of their lives. In a contiguous series of ten-minute phases, they rested, thought about, talked about, and recovered from talking about their index trauma. We hypothesized that greater PD would be associated with more negative emotion, lower cardiovascular activity, and greater discordance between negative emotions and cardiovascular activity. Our main findings were that PD was associated with lower blood pressure prior to talking about the trauma, greater negative emotion while talking about the trauma, and greater emotional and cardiovascular discordance throughout the experiment. These findings add to the very limited empirical data on physiological concomitants of peritraumatic dissociation and may aid in developing preventive interventions for PTSD.
Journal of Trauma & Dissociation 02/2005; 6(4):51-67. · 1.23 Impact Factor
