Article

The Live Memory of Annihilation as a Hindrance to Existence: A Proposal for the “A” Criterion in PTSD Psychosocial Interventions

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Introduction: The continuing violence in endemic foci has been one of the greatest challenges to contemporary society. This article is based on a survey of patients who have experienced violence and developed Posttraumatic Stress Disorder (PTSD). Our fundamental idea was to analyze how these individuals narrate their trauma story and how they perceive its psychological repercussions. We chose Charles Sanders Peirce’s semiotics as our theoretical framework for its recognized role in semantic analysis. Method: The methodology chosen was qualitative. We interviewed 20 individuals who suffered urban violence, considered as good informants, determined by saturation sampling, according to Patton’s concept. We build the categorical classification deriving from the sample using the grounded theory approach. Of the 20 selected individuals, 16 had PTSD, determined by the CAPS scale. Four patients who had experienced violence but not developed PTSD were also interviewed. Results: The qualitative categories that we found in the present research concentrated in the semantic fields of hate, fear and trauma. The concept of trauma was found to be an experience of disruption and paralysis of the psyche, a forced cessation in the history of life and of the experience of time. The narrative of PTSD respondents reflected a state of permanent fear arising from an action triggered by hate. Conclusions: The conceptual categories found in this study illuminate the A criterion required for the diagnosis of PTSD. Besides the experience of horror due to the danger of death, our patients experienced trauma as a time paralysis caused by the memory of the event. The trauma narrative leading to PTSD displays the mark of the horror of the individual undergoing the experience of barbaric violence. The psychosocial intervention proposal entails approaching the trauma through a continuity project.

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Little is known about the total population prevalence and societal costs of posttraumatic stress disorder (PTSD); this report reviews relevant literature on these topics. A literature search of computerized databases for published reports on trauma and PTSD was conducted. This literature was reviewed to find data on general population exposure to trauma, conditional risk of PTSD among those exposed to trauma both in focused samples of trauma victims and in general population samples, and the adverse consequences of PTSD. PTSD was found to be a commonly occurring disorder that often has a duration of many years and is frequently associated with exposure to multiple traumas. The impairment associated with PTSD in U.S. samples, where the majority of research on these consequences has been carried out, is comparable to, or greater than, that of other seriously impairing mental disorders. Risk of suicide attempts is particularly high among people with PTSD. Available evidence suggests that the prevalence of PTSD and the adverse emotional and psychological consequences of PTSD are much greater in the many countries around the world that are in the midst of armed conflicts involving political, racial, or ethnic violence. PTSD is a highly prevalent and impairing condition. Only a minority of people with PTSD obtain treatment. Early and aggressive outreach to treat people with PTSD could help reduce the enormous societal costs of this disorder.
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Symptom exacerbation (i.e., treatment side effects) has often been neglected in the psychotherapy literature. Although prolonged exposure has gained empirical support for the treatment of chronic posttraumatic stress disorder (PTSD), some have expressed concem that imaginal exposure, a component of this therapy, may cause symptom exacerbation, leading to inferior outcome or dropout. In the present study, symptom exacerbation was examined in 76 women with chronic PTSD. To define a "reliable" exacerbation, we used a method incorporating the standard deviation and test-retest reliability of each outcome measure. Only a minority of participants exhibited reliable symptom exacerbation. Individuals who reported symptom exacerbation benefited comparably from treatment. Further, symptom exacerbation was unrelated to dropout. Thus, although a minority of individuals experienced a temporary symptom exacerbation, this exacerbation was unrelated to outcome.
Article
The authors present a multidimensional meta-analysis of studies published between 1980 and 2003 on psychotherapy for PTSD. Data on variables not previously meta-analyzed such as inclusion and exclusion criteria and rates, recovery and improvement rates, and follow-up data were examined. Results suggest that psychotherapy for PTSD leads to a large initial improvement from baseline. More than half of patients who complete treatment with various forms of cognitive behavior therapy or eye movement desensitization and reprocessing improve. Reporting of metrics other than effect size provides a somewhat more nuanced account of outcome and generalizability. The majority of patients treated with psychotherapy for PTSD in randomized trials recover or improve, rendering these approaches some of the most effective psychosocial treatments devised to date. Several caveats, however, are important in applying these findings to patients treated in the community. Exclusion criteria and failure to address polysymptomatic presentations render generalizability to the population of PTSD patients indeterminate. The majority of patients posttreatment continue to have substantial residual symptoms, and follow-up data beyond very brief intervals have been largely absent. Future research intended to generalize to patients in practice should avoid exclusion criteria other than those a sensible clinician would impose in practice (e.g., schizophrenia), should avoid wait-list and other relatively inert control conditions, and should follow patients through at least 2 years.
Article
To foster a more in-depth understanding of the psychological processes leading to terrorism, the author conceptualizes the terrorist act as the final step on a narrowing staircase. Although the vast majority of people, even when feeling deprived and unfairly treated, remain on the ground floor, some individuals climb up and are eventually recruited into terrorist organizations. These individuals believe they have no effective voice in society, are encouraged by leaders to displace aggression onto out-groups, and become socialized to see terrorist organizations as legitimate and out-group members as evil. The current policy of focusing on individuals already at the top of the staircase brings only short-term gains. The best long-term policy against terrorism is prevention, which is made possible by nourishing contextualized democracy on the ground floor.
Article
Few studies have examined treatments for complicated grief--a debilitating condition that can develop after the loss of a loved one. This study compared the effectiveness of cognitive-behavioral therapy with a nonspecific treatment with supportive counseling (SC). Using a minimization method, 54 mourners with clinically significant levels of complicated grief were allocated to 1 of 3 treatment conditions: (a) a condition of 6 sessions of cognitive restructuring (CR) and 6 sessions of exposure therapy (ET; CR + ET), (b) a condition in which these interventions were applied in reversed order (ET + CR), and (c) 12 sessions of SC. Outcomes showed that the 2 cognitive-behavioral therapy conditions produced more improvement in complicated grief and general psychopathology than SC in the completers and intention-to-treat groups. Comparison of the cognitive-behavioral conditions showed that "pure" exposure was more effective than "pure" cognitive restructuring, that adding ET to CR led to more additional improvement than adding CR to ET, and that ET + CR was more efficacious than CR + ET. Effect sizes of ET + CR were encouraging and compare favorably with those found in earlier bereavement intervention studies.