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Treating the Trauma of Rape: Cognitive Behavioral Therapy for PTSD
... Tämä voi olla yksi keskeinen tekijä, joka johtaa, ylläpitää ja voimistaa PTSDoireita (Cameron, Palm & Follette, 2010;Rosenthal, Cheavens, Lynch & Follette, 2006). Välttelyn on ajateltu estävän epäsuotuisien ko kemusten kohtaamista ja käsittelemistä, mikä on keskeistä näistä kokemuksista ja PTSD:stä toi pumisessa (Cohen ym., 2020;Foa & Rothbaum, 1998). ...
... Kadirin kontaktia nykyhetkeen ja paikkaan (Foa & Rothbaum, 1998;Schauer ym., 2011). ...
... NET:n osuudessa välttelyä (kognitiivinen ja emotionaalinen) ja altistusten tehoa arvioitiin asiakkaan subjektiivisella arvioinnilla (subjective units of distress, SUDS: Wolpe, 1990), jolla arvioidaan sitä, miten suurta ahdistuneisuutta tai ahdinkoa asiakas kokee tapaamisten aikana (Foa & Rothbaum, 1998). Kadir arvioi asteikolla 0-10 ennen altistusta, altistuksen aikana ja sen jälkeen sitä, miten voimakasta ahdistusta, pelkoa tai muuta sellaista hän kullakin hetkellä koki. ...
Tässä tapaustutkimuksessa pyritään kuvaamaan ja arvioimaan traumaperäisen välttelyoireilun roolia lasten PTSD:ssä, välttelyoireilun näkymistä hoidon aikana, sekä välttelyoireilun muuttumista hoidon myötä. 7-vuotiaan pakolaislapsen PTSD:n hoitoa ja hoidon tuloksellisuutta esitellään yksityiskohtaisesti. Hoitomuotona on traumafokusoituneen kognitiivisen käyttäytymisterapian ja narratiivisen altistusterapian yhdistelmähoito. Hoidon tuloksellisuutta ja sen mahdollisia vaikutusmekanismeja pohditaan tieteellisen tutkimuksen valossa. Erityisesti keskitytään kuvaamaan ja pohtimaan välttelyn merkitystä PTSD:n kehittymisessä ja oireiden pitkittymisessä. Välttelyllä nähdään yleisesti olevan keskeinen merkitys PTSD:n kehittymisessä, ja välttelyn eri osa-alueet (kognitiivinen, emotionaalinen, toiminnallinen) vaikuttavat oireiluun eri tavoin riippuen mm. siitä, miten pitkä aika traumatapahtumasta on kulunut. Välttelyoireilun merkityksestä lasten PTSD:ssä on kuitenkin ristiriitaisia näkemyksiä, eikä tutkimuksia ole juurikaan tehty lapsilla. Tämä tapaustutkimus lisää tietoa välttelyn merkityksestä sekä hoidon tuloksellisuudesta lasten PTSD:ssä, ja on ensimmäinen, joka esittelee traumafokusoituneen kognitiivisen käyttäytymisterapian ja narratiivisen altistusterapian yhdistelmähoitoa.
... Here, PTSD and PTG are common specific negative and positive posttraumatic outcomes (Thomas et al., 2021), respectively, and their high incidence rate in traumatized individuals requires explanation. There are various theories of trauma, including the shattered assumptions theory (Janoff-Bulman, 1992), the emotional processing theory of PTSD (Foa & Rothbaum, 1998), the cognitive theory of PTSD (Ehlers & Clark, 2000), Tedeschi and Calhoun's (2004) PTG model, and the organismic valuing theory of PTG (Joseph & Linley, 2005), which provide different explanations for the high incidence of PTSD and PTG. However, these theories have several limitations. ...
... Recent trauma-related cognitive theories comprise two distinct types. One type focuses on PTSD and includes the shattered assumptions theory (Janoff-Bulman, 1992), the emotional processing theory of PTSD (Foa & Rothbaum, 1998), and the cognitive theory of PTSD (Ehlers & Clark, 2000). The other type focuses on PTG and includes Tedeschi and Calhoun's (2004) PTG model and the organismic valuing theory of growth through adversity (Joseph & Linley, 2005). ...
... This theoretical model includes cognitive regulation, emotional regulation, and social support, which extends existing cognitive theories of PTSD and PTG (e.g., Ehlers & Clark, 2000;Foa & Rothbaum, 1998;Janoff-Bulman, 1992;Joseph & Linley, 2005;Tedeschi & Calhoun, 2004) and sheds important light to trauma psychology-related theories, research, practice, and policy. First, previous theories pay insufficient attention to the importance of acute stress reactions, confound PTSD with acute stress reactions, and do not differentiate these two types of reactions, which may limit the effectiveness of psychological interventions. ...
Objective: This theoretical review proposes a three-phase process model of posttraumatic stress disorder (PTSD) and posttraumatic growth (PTG). Method: By combining trauma-related theories, emotional regulation theories, social support theories, and empirical study findings to elucidate the mechanisms underlying PTSD and PTG, we then propose our model. Results: The proposed model highlights the dynamic characteristics of the PTSD and PTG developmental processes as well as their coexistence and places equal emphasis on the roles of cognitive and emotional activities and social support in three distinct dynamic phases of PTSD and PTG. It emphasizes that PTSD and PTG share similar prerequisites but that these two outcomes later diverge and ultimately manifest via three distinct phases. The specific roles of cognitive regulation, emotional regulation, and social support, and the potential theoretical and practical implications of this model, are discussed. Conclusions: This integrative and dynamic process model has the potential to advance scientific understanding of the mechanisms underlying PTSD and PTG.
... Symptoms that exposure-focused treatments target include anxious avoidance of feared stimuli related to panic, agoraphobia, and PTSD and ritual behavior used to counter obsessions of people with obsessive-compulsive disorder (OCD). These cognitive (25) and behavioral (26) therapies often focus on cognitive responses to unruly emotional reactions and on theories derived from Pavlovian conditioning research or fightversus-flight paradigms (27). Examples include cognitive therapy (25), prolonged exposure (26), and acceptance and commitment therapy (ACT) (28). ...
... These cognitive (25) and behavioral (26) therapies often focus on cognitive responses to unruly emotional reactions and on theories derived from Pavlovian conditioning research or fightversus-flight paradigms (27). Examples include cognitive therapy (25), prolonged exposure (26), and acceptance and commitment therapy (ACT) (28). Exposure-based therapies differ from one another in their cognitive versus behavioral theoretical and technical emphases but are more structured and symptom focused than affect-focused therapies. ...
... Developing a hierarchy of fears using the Subjective Units of Distress Scale (29) and confronting those fears in sessions and in vivo, starting with milder fears and progressing to the worst ones, build patient confidence in fighting anxieties, habituating to situations, and recognizing that the associated cues are not inherently dangerous (27). Reliving disjointed traumatic histories creates a coherent narrative of the trauma the patient has been fighting to suppress, leading the patient to accept it as a terrible story but one that no longer needs to be desperately avoided (26). ...
The authors discuss the two broad domains of affect-focused and exposure-focused psychotherapies, defining the characteristics and potential advantages and disadvantages of each. The two domains differ in their theoretical approaches, structures, and techniques. Exposure-focused therapies have come to dominate research and practice, leading to the relative neglect of affect-focused therapies. When the two approaches have been examined in well-conducted clinical trials, they generally appear to be equally beneficial for treating common mood, anxiety, and trauma disorders, although further research may better define differential therapeutics. The authors argue for better training in affect awareness and tolerance across psychotherapies and use a brief case vignette to illustrate several aspects of these different approaches.
... Symptoms that exposure-focused treatments target include anxious avoidance of feared stimuli related to panic, agoraphobia, and PTSD and ritual behavior used to counter obsessions of people with obsessive-compulsive disorder (OCD). These cognitive (25) and behavioral (26) therapies often focus on cognitive responses to unruly emotional reactions and on theories derived from Pavlovian conditioning research or fightversus-flight paradigms (27). Examples include cognitive therapy (25), prolonged exposure (26), and acceptance and commitment therapy (ACT) (28). ...
... These cognitive (25) and behavioral (26) therapies often focus on cognitive responses to unruly emotional reactions and on theories derived from Pavlovian conditioning research or fightversus-flight paradigms (27). Examples include cognitive therapy (25), prolonged exposure (26), and acceptance and commitment therapy (ACT) (28). Exposure-based therapies differ from one another in their cognitive versus behavioral theoretical and technical emphases but are more structured and symptom focused than affect-focused therapies. ...
... Developing a hierarchy of fears using the Subjective Units of Distress Scale (29) and confronting those fears in sessions and in vivo, starting with milder fears and progressing to the worst ones, build patient confidence in fighting anxieties, habituating to situations, and recognizing that the associated cues are not inherently dangerous (27). Reliving disjointed traumatic histories creates a coherent narrative of the trauma the patient has been fighting to suppress, leading the patient to accept it as a terrible story but one that no longer needs to be desperately avoided (26). ...
We divide psychotherapies into two broad categories, affect-focused and exposure-focused, and detail the advantages and disadvantages of each.
... Individuals' distorted thoughts and beliefs about themselves and the world are referred to as negative cognitions. Most trauma-related theoretical frameworks hold negative and inflexible appraisals of the stressful experience as the only mechanism that controls traumatized individuals' beliefs, and these cognitions have a significant impact on the emotional response to the distressing event (Foa & Riggs, 1993).According to Foa and Rothbaum (1998), dysfunctional cognitions reinforce a person's belief that the world is a dangerous place and that he or she is incapable of properly and effectively dealing with a traumatic incident. This view is regarded to be the cause of post-traumatic stress and generalized negative beliefs about oneself and the world. ...
... This is also consistent with earlier research that suggests a person's perspective or appraisal of the traumatic incident and its effects may play a significant role in the etiology and maintenance of PTSD and other mental health difficulties (Foa, et al., 1999;Ehlers & Clark, 2000). According to Foa and Rothbaum (1998) healthy coping from the negative effects of violence can be either protected or discouraged by maladaptive thoughts. The fourth hypothesis of the study explores the mediating role of posttraumatic cognitions between husband's violence and PTSD. ...
... Emotional processing theory presented by Foa and Riggs (1993) and Foa and Rothbaum, (1998) supported the findings of the current study by implying that negative evaluations and interpretations of violence may have a role in developing trauma in women who have been subjected to domestic violence. Negative cognitions, according to Briere and Elliott (2003), include views that a person is "helpless, inadequate, or weak." ...
... Prolonged Exposure Treatment (PE) was developed by Edna Foa and her colleagues, is a leading approach to PTSD treatment, and has achieved a high level of empirical support (summarized by Rothbaum, Meadows, Resick, & Foy, 2000). Prolonged exposure treatment is based on a learning model of anxiety in which continued avoidance of the feared situation prevents habituation and/or extinction of the fear response (Foa, Steketee, & Rothbaum, 1989;Foa & Rothbaum, 1998). The goal of treatment is to activate the trauma-related material and expose the client (through imaginal and in vivo stimuli) over a prolonged period of time until the anxiety diminishes. ...
... Prolonged Exposure's protocol consists of a series of nine sessions which include elements of psychoeducation, breathing/relaxation practice, written homework, in vivo exposure homework between sessions, verbal discussion, and a central element of imaginal exposure both in session and between sessions. In-session exposure requires the client to describe the scene to the therapist repeatedly between 45-60 minutes (Foa & Rothbaum, 1998;Foa, Rothbaum, Riggs, & Murdock, 1990). ...
... PE addresses the client's avoidant responses through presentation of the rationale of the method, direct encouragement, reassurance, and availability by phone between sessions (Foa & Rothbaum, 1998). ...
The authors contend that the primary therapeutic element in psychological treatments for posttraumatic stress disorder is imaginal exposure, and that differences among major approaches are determined more by secondary techniques designed to circumvent the client’s avoidant defenses against exposure. A study is described comparing Prolonged Exposure, Eye Movement Desensitization and Reprocessing, and the Counting Method with 51 multiply-traumatized women. Measures of PTSD were significantly reduced by all three methods, but differences among the methods were negligible. Because the Counting Method utilizes only imaginal exposure as a therapeutic element, support is given to the more parsimonious conclusion that imaginal exposure may be both the necessary and sufficient factor in therapeutic effect, countering a trend in the field toward more complex, multi-faceted treatment packages.
... Intrusive memory, which refers to an involuntary re-experience of a traumatic event in the form of flashback, nightmares or intrusive images, is a key symptom of posttraumatic stress disorder (PTSD; Ehlers et al., 2004;Foa & Rothbaum, 1998). Various environmental stimuli or previously stored memories can act as triggers for these memories. ...
... They are usually experienced as images, sounds, tastes or smells. During these intrusions, people with PTSD usually experience the same emotions as those experienced at the time of the event (Ehlers & Clark, 2000;Foa & Rothbaum, 1998;Hackmann et al., 2004). Many PTSD theories (Brewin et al., 2010;Ehlers & Clark, 2000) suggest that these intrusive memories are due to deficits in the way traumatic memories are organised in autobiographical memory. ...
... According to poor integration view, poor integration of traumatic memories results in unintentional retrievals, which can easily be triggered by matching environmental cues (Ehlers & Clark, 2000;Foa & Rothbaum, 1998;Hellawell & Brewin, 2002). Previous studies support this claim by showing that traumatic memories are dominated by perceptual and sensory qualities (Hellawell & Brewin, 2002), slower to retrieve (Kleim et al., 2008) and lack temporal and conceptual coherence Hellawell & Brewin, 2002;Jelinek et al., 2009;Jones et al., 2007;Krans et al., 2009). ...
Poor integration and landmark views make opposing claims regarding the relationship between post-traumatic stress symptoms and trauma memory integration. This study tested these approaches using an event cluster paradigm. In total, 126 participants (Nptsd = 61; Nnon-ptsd = 65) remembered memories from the same story as trauma, positive and neutral memories and reported whether each memory was directly retrieved or generated. Moreover, the retrieval time (RT) was recorded. Finally, the participants completed the Centrality of Event Scale (CES) and Post-traumatic Stress Disorder Symptom Scale-Self Report (PSS-SR). The results demonstrated that participants with post-traumatic stress disorder (PTSD) recalled their clusters of memories more slowly and less directly than those without PTSD. However, the CES predicted PTSD severity more strongly than RT and retrieval strategy. These results suggest that traumatic memories are more disorganised but perceived as more central in PTSD.
... Though these appraisals could occur as momentary thoughts, they are typically understood to represent relatively stable underlying interpretations in response to trauma. Altering appraisal productsbeliefs is a primary focus of interventions for trauma (Foa & Rothbaum, 1998;Resick & Schnicke, 1992), and changes in these products-beliefs are associated with symptom improvement (Foa & Rauch, 2004;Resick et al., 2008). Emphasis is particularly placed on the importance of negative appraisal beliefs about the self in predicting posttraumatic psychopathology (e.g., Dunmore, Clark, & Ehlers, 2001;Ehlers, Maercker, & Boos, 2000;Ehlers & Steil, 1995;Foa & Riggs, 1993;Kleim, Ehlers, & Glucksman, 2012). ...
... If biased information processing does indeed promote and maintain biased products-beliefs, this suggests treatments for PTSD should target not only the distorted products but also the biased processing style from which they emerge. Cognitive therapies for PTSD emphasize modification of beliefs surrounding the meaning of the traumatic event (Foa & Rothbaum, 1998;Resick & Schnicke, 1992;Resick et al., 2008) but give relatively less attention to modifying interpretive biases per se. This study raises the possibility that treatment may benefit from greater emphasis on biases in appraisal processes. ...
Biased appraisal is central to cognitive theories of posttraumatic stress, but little research has examined the potentially distinct meanings of the term. The ongoing process of appraising social information and the beliefs that emerge as products of that process can be distinguished conceptually. This study sought to examine whether these 2 meanings are empirically distinct as well, and if so, to begin exploring potential relations between these appraisal constructs and posttraumatic stress symptoms. Soldiers (N = 424) preparing for deployment to Iraq or Afghanistan were administered measures of each construct. Results of confirmatory factor analysis suggest that the appraisal process and the products of that process (i.e., beliefs) are indeed distinct. Structural equation models are consistent with cognitive bias and social information processing literatures, which posit that a biased appraisal process may contribute to the development of dysfunctional beliefs and posttraumatic stress symptoms following trauma. The potential utility of distinctly conceptualizing and measuring the appraisal process in both clinical and research settings is discussed.
... At the root of PTSD and other trauma-related mental health problems are posttraumatic cognitions, the predominant model of which includes three discrete cognitions: negative views of the self, negative views of the world, and self-blame. Trauma can change or strengthen each of these cognitions by interfering with previously learned information (Foa & Rothbaum, 2001). For example, negative views of the self may emerge as someone seeing themselves as competent before a traumatic event, but believing they cannot trust themselves or their judgment in the aftermath of trauma due to a disruption of their self-image. ...
... For example, negative views of the self may emerge as someone seeing themselves as competent before a traumatic event, but believing they cannot trust themselves or their judgment in the aftermath of trauma due to a disruption of their self-image. Negative views of the world consist of beliefs that the world is a dangerous place, and one must be on guard at all times, and can be exacerbated by stimulus-danger associations that develop (e.g., assault by a person in a blue shirt, then associating blue shirts with danger; Foa et al., 1999;Foa & Rothbaum, 2001). Self-blame cognitions are dysfunctional beliefs that one is at fault for a traumatic event. ...
Military veterans are exposed to a number of traumatic stressors during their military service. These stressors may be related to combat (e.g., rifle and mortar fire, improvised explosive devices) and situations other than combat (e.g., sexual assault, training accidents). Both forms of traumatic stressors are associated with negative mental health consequences, in part due to the meaning veterans make of them (i.e., posttraumatic cognitions). Posttraumatic cognitions that develop in the aftermath of trauma often involve negative thoughts of the self, the world, and self-blame. However, trauma is not the only factor associated with posttraumatic cognitions. Another factor that may influence posttraumatic cognitions is personality, which is often conceptualized in terms of five traits (agreeableness, conscientiousness, extraversion, neuroticism, and openness). Research suggests that of these traits, neuroticism has the strongest association with posttraumatic cognitions over and above trauma, although this has not been examined with respect to military trauma. In this study, we examined the influence of military trauma (i.e., combat and noncombat trauma), and personality traits on posttraumatic cognitions in a sample of veterans (N = 93) recruited through Amazon’s Mechanical Turk. Results suggest that neuroticism had a strong association with each posttraumatic cognition and that combat and negative life events had small associations with negative thoughts of the self and the world, respectively. These findings highlight the role of personality in posttraumatic cognitions and underscore the importance of considering neuroticism in clinical treatment.
... Experts in the field of posttraumatic stress emphasize the importance of psychoeducation about common reactions during and after trauma exposure in conjunction with additional cognitive behavioral techniques (e.g., Foa & Rothbaum, 2001;Resick et al., 2017). Psychoeducation within the cognitive behavioral framework provides corrective information that can be used to challenge maladaptive cognitions and behaviors that contribute to the development and maintenance of trauma-related psychopathology (Foa & Rothbaum, 2001). ...
... Experts in the field of posttraumatic stress emphasize the importance of psychoeducation about common reactions during and after trauma exposure in conjunction with additional cognitive behavioral techniques (e.g., Foa & Rothbaum, 2001;Resick et al., 2017). Psychoeducation within the cognitive behavioral framework provides corrective information that can be used to challenge maladaptive cognitions and behaviors that contribute to the development and maintenance of trauma-related psychopathology (Foa & Rothbaum, 2001). Prior research suggests that brief psychoeducation-based interventions may significantly disrupt the development and maintenance of PTSD symptoms (e.g., Gould et al., 2007;Pratt et al., 2005;Short et al., 2020). ...
Tonic immobility (TI) is a defensive response that may occur during traumatic events. Although TI is adaptive in certain circumstances, it has been shown to contribute to increased trauma‐related symptoms and poorer recovery. However, current frontline treatments for posttraumatic stress disorder (PTSD) have not focused significant attention on the experience of TI. Thus, the aim of this study was to develop and test the impact of a brief TI‐focused psychoeducation (TIP) intervention on posttraumatic cognitions and PTSD symptoms relative to a health education control intervention. The sample included 46 adults with elevated PTSD symptoms who endorsed prior TI episodes. After providing informed consent, participants were randomly assigned to either the active or control intervention and completed self‐report questionnaires including the tonic immobility questionnaire (TIQ‐R), Life Events Checklist for DSM‐5 (LEC‐5), Posttraumatic Stress Checklist for DSM‐5 (PCL‐5), Posttraumatic Cognitions Inventory (PTCI), and Positive and Negative Affect Schedule (PANAS) at baseline, 1‐week, and 1‐month follow‐up assessments. Results from linear mixed effects models indicated that participants in the TIP condition reported significantly larger reductions in posttraumatic cognitions and PTSD symptoms at 1‐week, ds = 0.48 and 0.84, respectively, and 1‐month, ds = 0.67 and 0.74. The findings suggest that TIP is a promising intervention that may be used to reduce posttraumatic cognitions and PTSD symptoms associated with TI. Given the ease of access, TIP could be used as a standalone intervention or as an add‐on to existing evidence‐based treatments for PTSD.
... For significant differences between nodes from this figure, see supplementary Figure S3. exposure to traumatic memories while inhibiting avoidance behaviours (Foa & Rothbaum, 1998). For PSP, cues that remind them of PPTE (re-experiencing) may be unavoidable, however driving a desire to avoid due to the frequency of cues. ...
Background: Due to the nature of their work, Public Safety Personnel (PSP; e.g., firefighters, paramedics, police officers) are frequently exposed to potentially psychological traumatic events (PPTE) and are at increased risk of developing posttraumatic stress symptoms (PTSS) compared to the general population. To date, there are a limited number of published studies that have used the statistical tools of network analysis to examine PTSS in PSP, typically relying on small, homogenous samples. Basic procedures: The current study used a large (n=5,319) and diverse sample of PSP to estimate a network of PTSS and exploratory graph analysis to assess alternative structures of symptom clustering, compared to traditional latent models. Main findings: The results of the analyses estimated two symptom clusters which differed from most latent models of PTSS. Re-experiencing and avoidance symptoms clustered together, instead of in two clusters. Similarly, hyperarousal symptoms (hypervigilance, sleep disturbance, startle reflex, concentration difficulties) clustered in a single community instead of two or three clusters in many latent models of PTSS. The symptom of detachment played the most central role in the network and acted as a bridge symptom between numerous clusters of symptoms. The least central symptom was amnesia, which also had the most inconsistent pattern of clustering and bridging. Other bridge symptoms included negative emotions, difficulty concentrating, and reckless behaviour. Principal conclusions: The symptom of detachment played a pervasive role in centrality and bridging in a network of PTSS in PSP. Future research is necessary to identify whether central PTSS differ across populations based on their PPTE type (e.g., combat, assault, rape) or typical environmental factors (e.g., group cohesion in PSP and military).
... Together, these findings partially supported hypotheses and were consistent with previous studies. A robust body of research suggests that cumulative exposure to stressful life events is associated with decrements in adults' and children's emotion regulation capacities (Foa & Rothbaum, 1998;McDonagh-Coyle et al., 2001;Orsillo et al., 2004;Wade et al., 2022;Weissman et al., 2019). The present study expanded on this body of work, guided by transactional theories of stress, by including objective and subjective experiences of COVID-related stress as predictors of children's emotion regulation. ...
Background
The COVID-19 pandemic disrupted family life, with disproportionate impacts on families who are racially and economically marginalized. Decades of developmental research emphasize how caregivers’ or children’s emotional responses to stressors shape children’s post-exposure adaptation. Less work has examined the intersection of parents’ and children’s lived experiences of the pandemic, and their co-contribution to children’s adaptation.
Objective
The study’s goal was to examine both COVID-related and lifetime stressors and their associations with maternal perception of children’s emotional regulation and distress in the context of the COVID-19 pandemic.
Methods
In a sample of 72 mothers and their children (M = 7.94 years) who are American, low-income, and predominantly Black, we examined whether parent-reported maternal and child factors co-contributed to children’s emotion regulation and COVID-related distress. Between November 2020-March 2021, mothers reported on their emotion regulation difficulties, their child’s emotion regulation, their child’s lifetime exposure to stressors, their child’s exposure to COVID-specific stressors, and their own and their child’s perception of COVID-related disruptions as distressing.
Results
Our results parse differential predictors: children’s lifetime stressor exposure and maternal emotion regulation difficulties predicted children’s emotion regulation; children’s exposure to COVID-related stressors, maternal subjective COVID-related stress, and maternal emotion regulation difficulties predicted children’s subjective COVID-related stress.
Conclusions
Although limited by reliance on parent report, findings highlight the importance of considering children’s experiences of distress and emotion regulation during the COVID-19 pandemic in broader contexts, including the context of parent’s own regulatory capacities and perceptions of stress, as well as children’s lifetime experiences of stressors.
... These findings are consistent with prior research showing that negative childhood events contribute to the development of catastrophizing beliefs, such as that the world is not good, meaningful, and worthwhile [87] and that the world is extremely dangerous [88] . A variety of traumatic events alter people's thoughts and beliefs [89][90][91] , so we would expect that the more negative the parent-child relationship during childhood, the higher the level of cognitive distortions, which in turn would contribute to the development of catastrophizing. ...
This study was aimed to investigate the psychological mechanisms underlying non-suicidal self-injurious behavior. For this purpose, we hypothesized that dysfunctional child modes act as a psychological mechanism to influence the relationship between negative parent-child relationships in childhood and current cognitions (catastrophizing), emotions (emotional dysregulation and depression), and behaviors (non-suicidal self-injurious behaviors). A sample of 430 college students (male 97, female 333) with experience of non-suicidal self-injurious behavior was selected to test the multi-mediation effects of child schema mode (angry, impulsive), catastrophizing, emotional dysregulation, and depression on the relationship between negative parent-child relationships in childhood and non-suicidal self-injury. As a result of structural equation modeling analysis, it was found that negative parent-child relationships in childhood directly influenced child schema mode, catastrophizing, depression, and non-suicidal self-injurious behaviors. In addition, it was found that negative parent-child relationships in childhood were dually mediated by child schema mode and depression and child schema mode and emotional dysregulation. The present study highlights the mediating role of child schema modes as a psychological mechanism underlying the relationship between negative parent-child relationships in childhood and non-suicidal self-injurious behavior. Based on these findings, the usefulness and direction of schema therapy interventions in the field of non-suicidal self-injury counseling are discussed.
... According to the model of Ehlers and Clark [5], the cognitive and emotional activities of people in the trauma face are one of the main factors that affect the consequences of experiencing a traumatic event. Based on the available evidence, Efron suggests that problems in the emotional processing of cognitive activities in the form of uncontrollable rumination related to a traumatic event cause PTSD and maintain its symptoms [9]. Rumination is specified by the inability to get rid of repetitive verbal thoughts and worry, which often includes self-blame and catastrophic events or painful experiences. ...
... The treatment requires individuals to revisit their trauma and process emotions through imaginal and in-vivo exposures to stimulate new learning over the course of eight to fifteen, 90-min sessions [27]. PE was originally developed to treat civilian sexual assault survivors [28], and a recent meta-analysis found that there is a larger magnitude of change in civilian efficacy studies compared with military samples [29]. PE is based on emotional-processing theory, which posits that recovery from trauma requires exposure to corrective information to counteract ways of thinking and responding that were memorialized during and reinforced after trauma [30]. ...
Purpose of Review
In the last 15 years, there has been a burgeoning interest in moral injury, particularly among veterans and in high-risk occupational contexts. Estimates of exposure frequency to potentially morally injurious events (PMIEs) are high among veterans. Psychotherapies for posttraumatic stress disorder (PTSD) have been posited as sufficient for treating moral injury, which is tacitly conceptualized as a form of trauma. Several psychotherapies have also been developed to treat moral injury, or specific aspects of the purported syndrome (e.g., guilt). We describe and critically review individual and group psychotherapies that are putatively designed to address moral injury.
Recent Findings
There have been no randomized controlled trials using a primary endpoint of moral injury. Instead, investigators have chiefly argued that existing evidence-based therapies for PTSD are de facto appropriate for PMIE-exposed individuals. Consequently, there is insufficient evidence to suggest a best-practice approach.
Summary
There is still no consensus definition of moral injury, nor a widely used gold standard outcome measure, which has led to a body of research with significant validity issues. Clinical trials are needed that use clinically significant moral injury as an entry criterion, repeated assessments of moral injury symptoms, and the functional impact of those symptoms.
... The PTCS-SF contains three dimensions, each of them consisting of four items: personal changes ("My ability to cope with stress is …"); relational changes ("My trust in other people is …"); and existential changes ("I appreciate life …"). The items reflect the main domains of posttraumatic changes after trauma (Foa & Rothbaum, 1998;Janoff-Bulman, 1989). The items are neutrally worded and rated on a 5-point Likert response scale. ...
Objective: Over the past few decades, there has been a substantial increase of interest worldwide in how trauma can cause posttraumatic changes such as posttraumatic growth (PTG) and posttraumatic depreciation (PTD), and whether there exist gender-specific patterns of such changes. Despite the increase in interest, no studies have yet examined PTG and PTD in gender stratified models. Method: Latent profile analysis was used to explore PTG and PTD using the Posttraumatic Change Scale-Short Form in a gender stratified sample of Afghanistan veterans (n = 6,205, 8.3% females). Associations between profiles and predictors (trauma type), and outcome variables (anxiety, depression, and posttraumatic stress symptoms) were explored using R3STEP and Bolck–Croon–Hagenaars procedures in Mplus. Results: A three-profile model was found to be the best fitting model for female veterans, while a five-profile model was optimal for the male veterans, indicating there are gender-specific patterns in posttraumatic change. For both females and males, higher loads of trauma exposure were associated with conforming to the depreciation profiles, however, growth-related profiles also reported more trauma experiences than the no-change profile. Belonging to the depreciation profiles was associated with higher symptoms of anxiety, depression, and posttraumatic stress for both female and male veterans. Conclusion: A person may experience posttraumatic depreciation in one life domain, and at the same time growth in another. Male and female veterans differ in their unique profiles of posttraumatic change. Awareness of idiosyncratic profiles of growth and depreciation may improve postdeployment support and intervention strategies.
... Güvenli fiziksel ortam travmatik yaşam olayı deneyimlemiş kişilerle terapötik ilişki kurabilmesi için son derece önemlidir (Greenberg, 2021). Özellikle cinsel istismar, deprem, sel, savaş, terör, şiddet gibi fiziksel bütünlüğü tehdit eden travmalarla çalışılırken fiziksel ortamın terapötik ilişki için ayrıca bir önemi vardır (Figley, 2012;Foa ve Rothbaum, 2001). Bu kapsamda öncelikle grup çalışması için grup üyelerine kendilerini güvenli ve rahat hissettirecek fiziksel ortamın sağlanması gerekmektedir (Nisbet Wallis, 2002). ...
Travma, bireyin başa çıkma yeteneğini aşan, işlevselliğini önemli ölçüde bozan, fiziksel, psikososyal ve bilişsel açıdan olumsuz etkilere neden olan bir olaya veya olaylar dizisine verilen tepkidir. Sosyal hizmet uzmanları şiddet, ihmal, istismar, hastalık, kayıp, afet ve göç gibi çeşitli travmatik yaşam olaylarını deneyimleyen müracaatçılarla çalışmaktadır. Sosyal hizmet uzmanları travmatik stres tepkileri gösteren müracaatçılarla grupla sosyal hizmet uygulamaları gerçekleştirmektedir. Travmanın çok yönlü etkileri, travmatik yaşam olayını deneyimleyen bireylerin ihtiyaçlarını karşılamaya yönelik etkili müdahale için özel bir çerçeve gerektirmektedir. Travmanın etkisini anlamayı, tanımayı ve tepki vermeyi içeren travma bilgili yaklaşım bunların başında gelmektedir. Bu çalışmanın amacı grupla sosyal hizmet uygulamalarında travma bilgili yaklaşımın nasıl kullanılacağı ile ilgili ilkelerin ortaya konulmasıdır. Travma bilgili yaklaşım, sosyal hizmet müdahalelerinin travma yaşayan bireylerin ihtiyaçlarına ve deneyimlerine duyarlı olmasını sağlayarak yeniden travmatizasyonu en aza indirmeyi, iyileşmeyi ve dayanıklılığı desteklemeyi amaçlamaktadır. Travma bilgili yaklaşımın güvenlik, güvenilirlik ve şeffaflık, güçlendirme, seçim, saygı, iş birliği ve karşılıklılık ilkeleri bulunmaktadır. Bu ilkeler grupla sosyal hizmet uygulamalarında güvenlik ve güven duygusunun oluşturulması, açık iletişimin ve karşılıklı saygının geliştirilmesi, seçim ve iş birliği yapabilmenin desteklenmesi ve nihai olarak güçlenmenin sağlanması için bir çerçeve sunmaktadır.
... Another study showed that PTSD was associated more with emotional states recalled from the school shooting than with proximity [48]. Three recent psychological theories which explain the production of PTSD following witnessing or experiencing traumatic events were analyzed: the emotional processing theory, the dual representation theory and the cognitive theory [49][50][51][52]. Regarding the number of traumatic events experienced by the participants, those who had been exposed to 4 or more of the 16 traumatic events were 2.6 times more likely to have PTSD than participants who had experienced 0-3 traumatic events. ...
Background: Since the middle of April 2023, Sudan has experienced a large armed conflict, which resulted in millions of its people leaving their homes, being internally displaced persons (IDPs) inside the country and externally displaced to neighboring countries. A lot of them were exposed to different kinds of trauma, violence, and injuries, making them more vulnerable to psychological disorders, particularly post-traumatic stress disorder (PTSD). This study aimed to estimate the prevalence of PTSD and determine the associated risk factors among IDPs in Abo Hamad Town, Nahr Neel State, Sudan in December 2023. To our knowledge, few studies explored PTSD among IDPs in Sudan. Materials and Methods: This is a cross-sectional community-based household study in Abo Hamad Town, Nahr Neel State, Sudan. A total of 118 adult IDPs were interviewed. A pre-tested and structured questionnaire assessed the participants' socio-demographic, clinical, and psychosocial characteristics and substance and displacement-related factors. The Short Post-traumatic Stress Disorder Rating Interview (SPRINT) scale was used to examine PTSD among them. Data were collected during two weeks by a well-trained team supervised by a consultant psychiatrist. Data were analysed using the SPSS version 22. Descriptive results were displayed using frequency tables. Bivariate and multivariate logistic regression was used to identify the association between the outcome and independent variables. A p-value equal or less than 0.05 was considered statistically significant at 95% CI. Results: The study comprised 118 participants, 72.9% female and 27.1% male. The mean age was 29.94 years (SD+11.84). Most were educated; 57.6% were university graduates, and 22% had secondary education. Married individuals accounted for 46.6% of the sample, while 45.0% were single. More than half (53.4%) of the participants were unemployed. Over two-thirds (67.8%) had been displaced for over four months. A lack of social support was reported by half (50.9%) of the participants. While 16.9% had a chronic medical condition, 5.1% were identified as having a mental illness. The prevalence of PTSD among Internally displaced persons was found to be 70.3%, and a quarter (27.1%) had severe symptoms. The most frequent event was the participant located in an area prone to shooting, which was reported by 90.7% of respondents, followed by property destruction, difficulty lodging, forced detachment from family, and abnormal death of a family member or friend, reported by 53.4%, 50.8%, 37.3%, and 34.7% respectively. Experiencing multiple events was common, and more than half (52.5%) of the participants experienced four or more traumatic events. Related factors with significant association with PTSD were female gender, torture, witnessing the murder of a stranger, and multiple traumatic events experienced by the respondent. Conclusion: This study showed an alarming high prevalence of PTSD among IDPs in an urban setting. Factors found to be significantly associated with PTSD were being female, experiencing torture, witnessing the murder of a stranger and exposure to multiple traumatic events. Further studies are required to investigate PTSD in IDPs, and psychological support services are of paramount importance to manage PTSD and reduce the suffering of IDPs.
... According to the latest version of the effective treatments for PTSD (Forbes et al., 2020), prolonged exposure (Foa et al., 2019), cognitive processing therapy (Resick et al., 2017), eye movement desensitization and reprocessing therapy (Shapiro, 2018), and trauma-focused cognitive behavior therapy (CBT; J. A. Cohen et al., 2017) are some of the effective PTSD psychotherapies. In metaanalytic studies (Bradley et al., 2005;Coventry et al., 2020;Deng et al., 2019;Kothgassner et al., 2019;Lenz et al., 2017;Mclean et al., 2022;Rometsch-Ogioun El Sount et al., 2019;Wei & Chen, 2021), trauma-focused CBT (J. A. Cohen et al., 2017), cognitive processing therapy (Resick et al., 2017), exposure therapy (Foa & Rothbaum, 1998), eye movement desensitization and reprocessing (Shapiro, 2018), narrative exposure therapy (NET; Schauer et al., 2005), and prolonged exposure (Foa et al., 2019) are found to be the most effective psychological interventions in reducing PTSD symptoms. ...
Objective: Several primary studies examined the effectiveness of various psychotherapies in treating earthquake-related posttraumatic stress disorder (PTSD). Variations in methods, employed psychotherapy approaches, and differences across studies warrant a systematic review and meta-analysis. Method: In this study, first, a systematic review of experimental studies aiming to reduce the symptoms of PTSD in the aftermath of an earthquake was carried out. Second, a meta-analysis of cognitive behavior therapy (CBT) and narrative exposure therapy (NET) was conducted. Results: Several psychological treatments were used for treating earthquake-related PTSD. However, only CBT and NET were tested in multiple studies. Meta-analysis results suggested that CBT and NET significantly reduce earthquake-related PTSD symptoms compared to control groups. Conclusions: Results suggest that CBT and NET are promising psychological treatment options. Further research on NET and other major PTSD interventions (e.g., prolonged exposure, eye movement desensitization and reprocessing, cognitive processing therapy) is needed.
... Cognitive theories that address intrusive memories have typically focused on these experiences in the context of PTSD. Such theories include the cognitive model of PTSD (Ehlers & Clark, 2000), the emotional processing model (Foa & Rothbaum, 1998) and the dual representation model (DRT; Brewin, Dalgleish, & Joseph, 1996;Brewin et al., 2010). Such theories have often linked the experience of intrusive memories to individual differences in how autobiographical memories of traumatic experiences are stored. ...
Objectives
Research in adults suggests that intrusive memories and intrusive thoughts (often referred to as intrusive cognitions) are common in members of the general population and are often seen in clinical disorders. However, little is known about the experience of intrusive cognitions in adolescents, particularly in adolescents with major depressive disorder (MDD) and post‐traumatic stress disorder (PTSD). The present study sought to gather fundamental data on these phenomena (i.e., frequency, characteristics and appraisals of intrusive cognitions) in adolescents with MDD and PTSD.
Methods
Adolescents aged 11–18 with MDD ( n = 11), PTSD ( n = 13) and a non‐clinical control group ( n = 25) completed structured interviews concerning their intrusive memories and thoughts.
Results
Intrusive thoughts were common in all three groups but were particularly frequently experienced in the MDD group. Intrusive memories were expectedly very common in the PTSD group but also experienced by over half of the adolescents with MDD. Both clinical groups reported more negative emotions in response to their intrusive thoughts or memories and appraised these cognitions more negatively than the non‐clinical group.
Conclusion
Intrusive memories and thoughts are common experiences in adolescents with MDD and PTSD. Emotions and appraisals relating to these cognitions may be targets for psychological intervention in this age group. However, small sample sizes limit the conclusions that can be drawn. Replication is needed with larger numbers of clinical participants.
... IPT is a time-limited, manualized treatment developed by the late Gerald L. Klerman and Myrna M. Weissman in the 1970s, arising from and heavily supported by clinical outcome research. 8,9 Like supportive and psychodynamic psychotherapies, IPT is affect-focused, in contrast to exposure-focused treatments such as Prolonged Exposure 10 and Eye Movement Desensitization and Reprocessing (EMDR). 11 Affect-and exposure-focused treatments are 2 broad psychotherapeutic categories employing fundamentally different stances and interventions (see Table 1). ...
Importance: Extensively researched, exposure-focused therapies have dominated the treatment of posttraumatic stress disorder (PTSD). No treatment benefits all patients. Interpersonal psychotherapy (IPT), a nonexposure, affect-focused treatment, has emerged over 2 decades as an alternative evidence-based PTSD intervention. Objective: This narrative review critically assesses IPT outcomes for PTSD. Time limited IPT focuses on affect toleration and the interpersonal consequences of trauma rather than on reconstructing the trauma narrative and exposure to traumatic cues. Evidence Review: The author searched the outcome literature on IPT for adults with syndromal PTSD and drew upon personal involvement in studies since 2001. Subsyndromal PTSD studies and 1 adolescent trial were excluded. Findings: Thirteen published studies of IPT targeted PTSD in individual and group formats for 592 civilians (n = 8, 6 randomized controlled trials [RCTs]) and 187 military veterans (n = 5, 1 RCT). Some trials had methodological limitations. IPT surpassed outcomes of waiting lists and other weak controls and was noninferior to evidence-based PTSD treatments including Prolonged Exposure (n = 2) and sertraline (n = 1). Depression and other outcomes improved. The RCTs demonstrate IPT efficacy for PTSD and allow preliminary exploration of outcome mediators and moderators and differential therapeutics. Conclusion: While the number of studies remains limited, research by multiple investigators in differing populations supports the efficacy of IPT as a non trauma-focused PTSD treatment and justifies its inclusion in PTSD treatment guidelines. More research is necessary to determine how IPT compares to exposure-focused treatments in patient preference, attrition, and response for PTSD comorbid with major depression or due to sexual trauma.
... There are several models describing the emergence of PTSD, however here we will focus on three models specifically accounting for the emergence and maintenance of intrusive memories. One seminal model informing treatment for PTSD, Emotional Processing Theory [15][16][17], proposes the trauma memory is inadequately processed due to high levels of distress. This results in a trauma memory network separate from other memory systems which is activated by a variety of stimuli associated with the trauma [18]. ...
Purpose of Review
Intrusive memories are common in the aftermath of trauma, and these can develop into a pervasive, distressing symptom of posttraumatic stress disorder (PTSD). Sleep disturbances have been shown to contribute to later development and maintenance of overall PTSD symptoms, including intrusive memories of trauma. This paper summarises recent research examining the role of sleep in the development of trauma-related intrusive memories.
Recent Findings
There have been initial conflicting results across a small number of studies, namely, whether sleep following experimental analogue trauma results in increased or decreased frequency of later intrusive memories. However, the results of three recent meta-analyses suggest a beneficial effect of sleep early after analogue trauma exposure.
Summary
The relationship between sleep following analogue trauma and reduction in intrusive memory frequency may be due to the role of sleep in the consolidation and integration of traumatic memories into existing autobiographical knowledge. More research is needed to investigate the mechanism of action for this relationship.
... In addition, since adults can be more successful in distinguishing their thoughts and emotions compared to children and adolescents, they may be treated early for displaying dysfunctional thoughts in the intervention process (Cohen 1998, Feather andRonan 2010). Along with some of the differences and similarities mentioned, most of the cognitive techniques used were first developed for the adult group of trauma victims, and their effects were examined and then adapted for the child and adolescent group (Foa et al. 1991, Foa and Rothbaum 2001, Horesh et al. 2017. In this context, the cognitive intervention techniques used with traumatized children/adolescents in the previous section can also be used when working with traumatized adults. ...
Trauma is considered a significant event that causes intense fear and anxiety and frequent avoidance owing to its unfolding and persistence. Post-traumatic stress disorder (PTSD) may develop when the distress and symptoms caused by the development and acute nature of the trauma do not resolve spontaneously over time. Incompatibility with one's existing schemas and the emergence of new nonfunctional schemas are both effective in the development of PTSD. Thus, while working with trauma victims, attempts to restructure the existing traumatic cognitions by doing assessments about traumatic cognitions play an effective role in reinterpreting the traumatic experience. This review study examines the nature of trauma, the expression of trauma according to cognitive therapy, widely recognized cognitive models explaining trauma, and frequently utilized effective cognitive methods for trauma victims. The impact of cognitive processes on the development and continuation of trauma was expressed, and the models of different experts explaining trauma were discussed in detail. Furthermore, considering the contribution of cognitive therapy intervention techniques for PTSD in healthily reevaluating the trauma, cognitive therapy methods that are thought to contribute to both the victim and mental health professionals are included.
... Th e brief treatment program (BREATHE) is a standard three-session intervention for PTSD (Mueser et al., 2008), which includes three weekly sessions of breathing retraining and psychoeducation about PTSD and trauma. Breathing retraining is a selfmanagement strategy for the reduction of anxiety and arousal used in many CBT programs for PTSD and other anxiety disorders (Foa & Rothbaum, 1998). An interactive teaching style is used when educating and practicing breathing retraining, with handouts and worksheets facilitating the application of information to clients' personal experiences (Mueser et al., 2008). ...
Studies suggest that a three-session brief treatment program (Brief Relaxation, Education, and Trauma Healing [BREATHE]) can help treat posttraumatic stress disorder (PTSD) and symptoms of trauma; however, the program has not been examined via telehealth. Thus, the current study evaluated the feasibility of BREATHE delivered via telehealth. The intervention included breathing retraining and psychoeducation about PTSD and trauma. Thirty participants from the community with confirmed PTSD diagnoses participated in this telehealth program. Treatment retention was high, and participants showed decreased PTSD symptoms, posttraumatic cognitions, depression, anxiety, overall psychiatric symptoms, and internalized stigma and increased resiliency at posttreatment and 3-month follow up. Results suggest that a telehealth brief treatment program for PTSD is feasible and effective for individuals with PTSD. [ Journal of Psychosocial Nursing and Mental Health Services, xx (x), xx–xx.]
... Szczególną rolę w rozwoju PTSD odgrywa poznawczo-emocjonalne przetwarzanie traumy. Na jego znaczenie wskazuje wielu badaczy [11][12][13]. Jednym ze wskaźników poznawczego przetwarzania traumy jest ruminowanie o doświadczonej sytuacji traumatycznej. Znaczenie ruminacji w rozwoju zaburzeń po stresie urazowym akcentuje poznawczy model PTSD, opracowany przez Ehlers i Clarka [14]. ...
Cel pracy
Problemy ze zdrowiem psychicznym należą do najczęściej zgłaszanych dolegliwości wśród osób, które były hospitalizowane z powodu Covid-19. Celem badania było ustalenie u osób hospitalizowanych z powodu Covid-19 częstości występowania PTSD oraz wyznaczenie predyktorów ryzyka jego wystąpienia.
Metoda
Badaniami objęto 250 osób po hospitalizacji z powodu Covid-19. Zastosowano kilka standaryzowanych narzędzi pomiaru, tj. PCL-5; PSS-10; ERRI; SPP-15 and PANAS.
Wyniki
Ogółem 55,6% badanych kwalifikowało się do diagnozy PTSD. Były to w większości osoby hospitalizowane powyżej 2 tygodni, o cięższym przebiegu choroby, badani w okresie 3 miesięcy po hospitalizacji. Do modelu regresji wprowadzono czynniki związane z przebiegiem leczenia oraz zmienne psychologiczne, zarówno zwiększające ryzyko wystąpienia PTSD, tj. spostrzegany stres, ruminowanie natrętne i emocje negatywne, jak i czynniki chroniące, tj. prężność, ruminowanie refleksyjne i emocje pozytywne. Ogólnie model regresji wyjaśnia 72% wariancji całkowitej. Najbardziej znaczące dla predykcji PTSD okazały się ruminacje natrętne, wyjaśniające 59% wariancji oraz spostrzegany stres (12%).
Wnioski
Osoby z rozpoznaniem PTSD wymagają pomocy terapeutycznej, dlatego tak ważne jest zidentyfikowanie czynników ryzyka, które mogą być pomocnych w usprawnieniu procesu terapii oraz ułatwieniu podejmowania działań profilaktycznych.
... Models of in vivo exposure (e.g., Craske et al., 2014) explicitly ask clients to change their attitude toward distress from an intolerable state that necessarily needs to be avoided to an unpleasant inner state that may be acknowledged as such but still tolerated and, in certain contexts, even pursued. Similarly, PE relies on openness and active attention to feared or avoided affective states and external environments (Foa & Rothbaum, 1998). Therefore, emotional clarity, which is defined as the subjective experience of knowing how one feels (Salovey et al., 1995), and emotional awareness, defined as one's predisposition to pay attention to emotion (Palmieri et al., 2009), may be essential prerequisites for optimal treatment response. ...
Alexithymia is the inability to identify and recognize emotions. The present study examined the impact of alexithymia on prolonged exposure (PE) therapy. Participants (n = 68) with PTSD underwent 10 PE sessions. Alexithymia was assessed via the Toronto Alexithymia Scale (TAS-20) and the emotional clarity and awareness subscales of the Difficulties in Emotion Regulation Scale. Treatment outcomes were assessed via the PTSD checklist and Clinician-Administered PTSD Scale for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition at posttreatment and 6-month follow-up. Those with high alexithymia were more likely to endorse experiencing a full PTSD diagnosis immediately posttreatment, χ²(1) = 12.53, p = .002, and at 6-month follow-up, χ²(1) = 11.21, p = .004. Alexithymia was associated with delayed treatment effects on avoidance, with a significant reduction in symptomology observed from pre- to follow-up, t(51) = 4.52, p < .001, and not from pre- to posttreatment. Although both the low and high alexithymia groups showed significant changes in negative changes in thinking and mood, F(2, 14) = 9.18, p = .001, d = 1.57 and F(2, 50) = 13.86, p = .001, d = 1.49, respectively, the high alexithymia group exhibited a marginally lesser magnitude of treatment effect. Although those with significantly greater difficulties with emotional clarity were more likely to drop out of PE treatment, emotional clarity and awareness did not moderate treatment response. Our results confirm the efficacy of PE but also highlight that those with alexithymia show a delayed treatment response and may be at greater risk of pathology after treatment.
... Netzwerkmodelle. Die emotionale Verarbeitungstheorie (Foa & Kozak, 1986;Foa & Rothbaum, 1998) erweitert das Modell der Gedächtnisdualität um die subjektive Bewertung der Reaktion: Ein auslösender Stimulus wird mit der initial aufgetretenen (Furcht-)Reaktion sowie der subjektiven Bewertung gepaart. Diese Aspekte werden miteinander verknüpft abgespeichert und als sogenanntes Furchtnetzwerk im Gedächtnis repräsentiert. ...
... Paul's temporal network did not include any relationships strong enough to be retained after regularization. In Paul's case, it may be most prudent to focus on prolonged exposure (Foa & Rothbaum, 1998) or cognitive processing therapy (Resick et al., 2017). This differentiates him from Jessica and Alia, both of whom may have benefited from additional skills beyond gold-standard PTSD treatments. ...
Objective: Network analysis aims to identify links between symptoms that may serve to maintain one other; the current study uses network analysis to identify relationships between posttraumatic stress disorder (PTSD) symptoms as they unfold over time within individuals. We also examine whether positive affect (PA) may buffer subsequent PTSD symptoms in daily life and compare single individual networks to the average within-person effects. Method: Fifty-two individuals (76.9% female; 84.6% white) who had experienced a Criterion A trauma participated in the 2-week study and reported their PA and PTSD symptom levels five times a day at 2-hr intervals (M surveys completed = 60.4). Multilevel and regularized individual-only network models were generated using vector autoregression. Results: Feeling distant from others was the PTSD symptom most closely connected to lower PA; it was also the most connected to other PTSD symptoms. PA items did not predict lower PTSD at the next time point, except for one bidirectional relationship. Feeling on edge was the symptom with the largest magnitude of relationships to other symptoms in the multilevel network, but this was only reflected in 38.5% of the individual networks. Three example individual networks are described and discussed for clinical implications. Conclusions: We did not find evidence to support the hypothesis that PA buffers PTSD symptom severity on the time scale assessed (2 hr). Feeling distant from others was a bridge between lower PA and PTSD symptoms and may indicate social support as an important factor in treating trauma survivors.
... According to clinical practice guidelines, Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT) are among the PTSD treatments with the strongest empirical support (VA/DOD Clinical Practice Guideline, 2023). PE, developed by Foa and Rothbaum (1998), is a cognitive behavioral treatment designed to target avoidance of trauma-related stimuli via three main components: imaginal exposure, emotional processing, and in vivo exposure. PE is typically delivered in individual 90-minute sessions over the course of eight to 15 weeks (Foa et al., 2019). ...
Purpose
The purpose of the current study was to conduct a comprehensive meta-analytic review of Cognitive Processing Therapy (CPT) for PTSD among military personnel and veterans. Additionally, we sought to examine potential moderators of treatment outcomes including type of comparison condition (e.g., active trauma-focused, active non-trauma-focused), CPT version (i.e., CPT with and without the written trauma account), sample type (veteran or military personnel), age, gender, and race.
Methods
Nine articles with 1,804 participants were retained for this meta-analysis.
Results
CPT, when compared to all comparison conditions, exhibited a medium effect on PTSD symptom reduction (Hedge’s g = − 0.48, 95% CI: -1.05, 0.08). Regarding moderators, the effect was larger for non-trauma-focused active comparators versus trauma-focused active comparators (Qbetween = 16.69, pbetween < 0.001, Hedge’s g = − 0.57 and − 0.14, respectively). Further, CPT with the written trauma account outperformed CPT without the written trauma account (Qbetween = 4.53, pbetween = 0.03, Hedge’s g = − 0.86 and − 0.23, respectively), and veteran samples saw slightly more symptom reduction than military personnel (Qbetween = 15.50, pbetween < 0.001, Hedge’s g = − 0.51 and − 0.45, respectively). Notably, age, gender, and race did not moderate the effect of CPT on PTSD.
Conclusions
Findings support the continued use of CPT for PTSD symptoms among veterans and military personnel and call into question the removal of the written trauma account.
... Among cognitive theories in the PTSD literature (e.g. Brewin et al., 1996;Ehlers & Clark, 2000;Foa & Rothbaum, 2001), the Ehlers and Clark (2000)'s model is one of the most widely researched ones. According to the model, people with PTSD tend to process the traumatic event and its consequences in a way that produces a sense of ongoing threat. ...
Introduction
Given the high rate of trauma exposure among children and adolescents, it is important to understand the risk factors for post-traumatic stress disorder (PTSD). Anxiety sensitivity has been implicated in multiple anxiety disorders, and an emerging evidence base has explored the relationship between this construct and PTSD. The present review investigated the size of the relationship between anxiety sensitivity and PTSD symptoms among children and adolescents exposed to trauma.
Method
A systematic search on multiple electronic databases (MEDLINE, PsycINFO, CINAHL and PTSDpubs) returned a total of 2916 records, among which six (n = 1331) met study inclusion criteria and were included in our random effects meta-analysis.
Results
Our results indicated a large effect size (r = .56, 95% CI = 0.47 − 0.64) for the relationship between anxiety sensitivity and PTSD symptoms; there was significant between-study heterogeneity.
Conclusion
This supported current cognitive models of anxiety and PTSD. Clinical implications, strengths and limitations of the review were discussed.
... To this end, various cognitive operations are performed to adjust existing beliefs to the changed reality, or to maintain them unchanged. Foa and Rothbaum (1998) also point to the role of beliefs in posttraumatic adaptation. The importance of negative cognitive schemas in the development of PTSD symptoms is also emphasized by Ehlers and Clark (2000). ...
Helping those who have experienced trauma exposes the helpers to secondary traumatization. The mechanisms of its development are most often explained using the cognitive model of trauma processing. The aim of the research is to determine how disturbances of core beliefs and cognitive processing in the form of coping with stress are associated with secondary traumatic stress (STS) and secondary posttraumatic growth (SPTG). The study was conducted among psychologists and social workers (N = 240), working with people after traumatic experiences. Four standardized measurement tools were used. Based on the differential diagnosis, four types of consequences were identified. Discriminant analysis was used to establish the optimal configuration of predictors explaining the differences between the four subgroups. Two significant discriminant functions were significant, each identifies different beliefs and coping strategies. The first is associated with the disruptions of core beliefs about the world and cognitive processing in the form of a non-adaptive strategy; the second—with disturbed beliefs about oneself and adaptation strategies. Our results show a much greater exposure of social workers to the negative consequences of secondary traumatic stress disorder. A system of constant monitoring should be introduced, and the principles of prevention and therapy should be implemented.
... Others have highlighted the unique chronicity and ongoing perpetrations of racism as distinct from single-incident traumas upon which current conceptualizations of PTSD are predicated (e.g., Bryant-Davis & Ocampo, 2005). Thus, these traditionally Eurocentric conceptualizations are the basis for empirically supported PTSD treatments such as prolonged exposure (Foa & Rothbaum, 2001) and cognitive-processing therapy (Resick et al., 2016), which both involve repeated reference and exposure to singular traumatic event and are typically appropriate only once the trauma survivor has exited the traumatic situation. However, because people of color continue to live in a world in which racist institutions, culture, and encounters are ubiquitous, it is unknown whether these "gold-standard" PTSD treatments are well suited for treating racial trauma. ...
COVID-19 propelled anti-Asian racism around the world; although empirical research has yet to examine the phenomenology of racial trauma affecting Asian communities. In our mixed-methods study of 215 Asian participants of 15 ethnicities, we examined experiences of racism during COVID and resulting psychological sequelae. Through qualitative content analysis, themes emerged of emotional, cognitive, and behavioral changes resulting from these racialized perpetrations, including internalizing emotions of fear, sadness, and shame; negative alterations in cognitions, such as reduced trust and self-worth; and behavioral isolation, avoidance, and hypervigilance, in addition to positive coping actions of commitment to racial equity initiatives. We engaged in data triangulation with quantitative Mann-Whitney U tests and found that individuals who experienced COVID discrimination had significantly higher racial trauma and posttraumatic stress disorder scores compared with individuals who did not. Our convergent findings provide clinicians with novel ways to assess the ongoing impact of racial trauma and implement appropriate interventions for clients.
Adolescents in domestic work in Nigeria are at heightened risk of mental health problems resulting from sexual abuse, exploitation, condition of work and neglect. One of such mental health problems is Posttraumatic Stress Disorder (PTSD). This paper explored posttraumatic stress disorder among adolescents in domestic work in the Nigerian context. According to APA (2013) PTSD has five cluster symptoms such as exposure to traumatic events (directly or vicariously), intrusive symptoms, Persistent avoidance of stimuli associated with the traumatic event(s), Negative alteration in cognitions and mood associated with the traumatic event(s) and Marked alterations in arousal and reactivity associated with the traumatic event(s). Ignoring the challenges faced by adolescents in domestic work can lead to disruptions in education, risk for child abuse, mental health issues, poor knowledge of sexual and reproductive health (SRH) services as well as proper transition to adulthood. Psychological interventions such as Trauma-focused cognitive behavioural therapy, Eye movement Desensitization and Reprocessing therapy and Play therapy were identified and should be utilized for adolescents with PTSD. This study recommended the need to create awareness among the general public on risks adolescents in domestic work face, need for better parenting education for parents who sent their children for domestic work and need for the implementation of legal instruments that protect children and promote their well-being.
The purpose of this study was to explore potential similarities and differences in the ways boys and girls appraise and interpret their traumatic experiences, and better understand how gender roles, performance, and socialization processes may impact trauma experiences, appraisals, and narratives within the context of trauma-focused treatment. We used thematic analysis to analyze the trauma narratives of youth ( N = 16) ages 8–16 who had experienced multiple types ( M = 5.38) of child maltreatment and who were receiving Trauma-focused Cognitive Behavioral Therapy to address clinically elevated posttraumatic stress symptoms. Four themes emerged: variations in the content of negative cognitions, differences in relational emotion, adoption of socially prescribed gender roles, and symptom differences. Although many similarities existed in youth’s trauma narratives, differences emerged that point to the importance of social context and the ways gender role expectations and socialization processes influence youth’s appraisal of and responses to traumatic events. Findings indicate the importance of considering distress tolerance, relational emotion, gender identity development, and role socialization within the treatment milieu.
Psychoanalytic and later psychodynamic traditions (PD) historically preceded behavioural and cognitive-behavioural approaches (CBT). Similarly, several waves of CBT evolved over the years, each one proposing to address the limitations of previous theories and practices. Predictably, the more recent theories were presented as improvements or counter-arguments against the shortcomings of previous traditions, creating an adversarial relationship among proponents of each view. This book discusses various perspectives, within but also outside each of these traditions, based on original reports of experts in each area. The current volume makes no effort to present one view as superior to the other. At the same time, it will make no effort to present an integrative view, as we believe that it is not to the benefit of our patients to promote approaches that have not been put to the test, either empirically or practically, when separate traditions have cumulative evidence to present as to their effectiveness. At a conceptual level, each tradition ought to have the theoretical breadth and depth to encompass most aspects of what the clinician will encounter and that having the need to borrow from other traditions may mark the limits of each perspective. However, what the book does aim for is to present in detail how each tradition conceptualizes and treats anxiety disorders and in doing so to highlight the theoretical constructs and clinical methodologies that may point to similar etiological and maintenance mechanism and to mechanisms of action that bring about positive chance. That is, even when different terminologies, concepts and even aims are presented, the targeted mechanism and produced outcome may share essential similarities. The following sections aim to address these points.
Successful school shootings represent an extremely stressful psychological event for all those involved. In the last 10 years, a number of psychological intervention plans for the aftercare of school shootings have emerged from the acute management of this extreme situation at an international level (Séguin et al., Psychol Trauma 5(3):268–276, 2013). In the present chapter, the psychological consequences and burdens for victims are discussed at the beginning (1). It then draws attention to the relevance of aftercare. Then, (2) the core elements (structure and demands) of recent aftercare programs are presented. Subsequently, selected (3) emergency psychological acute care, (4) short-term to medium-term, (5) trauma-focused, and (6) longer-term intervention measures for children, adolescents, and adults are discussed in more detail. Finally, on the basis of the present book chapter (7), the findings, consequences, and recommendations obtained are summarized.
This study examined the effectiveness of cognitive behaviour therapy (CBT) in reducing posttraumatic stress disorder (PTSD) among Nigerian journalists reporting violence in Nigeria. The study utilised a quasi-experimental design with the between-within-subject model. The sample size was 580 Nigerian journalists reporting three selected violent activities-banditry, farmers/herders conflict and separatist agitation. The analysis showed that prior to the intervention, all the journalists reported high mean scores on PTSD symptoms. However, the post-intervention analysis revealed a significant reduction in PTSD symptoms of journalists in the CBT group, but those in the non-CBT group did not significantly improve. A follow-up evaluation after 12 months revealed a steady decline in the PTSD symptoms of journalists in the CBT group. Still, those in the non-CBT group did not record a significant reduction. No significant interacting effect of gender was detected. However, there was a significant interactive effect of perceived organizational support on the treatment condition, p = 0.001, ηp² = 0.052. We highlighted the implications of these results on control master theory and journalism practice.
First responders and public service personnel (e.g., firefighters, emergency medical services [EMS] personnel, police officers, etc.) encounter a variety of high stress situations that can leave long-lasting effects on both the mental and physical health of this particular group. Individuals in these roles are asked to return to work, often quickly, following exposure to a high-stress and/or traumatic situation. This type of occupation places these individuals at increased risk for a range of psychiatric outcomes, including but not limited to depressive symptoms, posttraumatic stress, problematic substance use, and sleep difficulties (e.g., Jones S, J Am Psychiatr Nurses Assoc 23(3):200–214. https://doi.org/10.1177/1078390317695266, 2017). Furthermore, suicidal thoughts and behaviors are also commonly seen in this particular group. When comparing first responders and public safety personnel to the general population, it is common to see heightened levels of these types of mental health concerns that could eventually lead to psychiatric disorders. In fact, rates of suicidal thoughts and behaviors are far greater in public service personnel than in the general population (e.g., SAMHSA, Disaster Technical Assistance Center Supplemental Research Bulletin (7). https://www.samhsa.gov/sites/default/files/dtac/supplementalresearchbulletin-firstresponders-may2018.pdf, 2018). For instance, one study found that those in an EMS role were significantly more likely to die by suicide than those in the general population (Vigil et al., Prehosp Emerg Care 23(3):340–345. https://doi.org/10.1080/10903127.2018.1514090, 2019). Many do not receive or even attempt to seek the support that may help them navigate these symptoms and learn healthy coping following traumatic incidents. With the heightened severity and risk issues highlighted here, it is imperative that clinicians have as many tools as possible to address them in the most effective way.
Post-traumatic stress disorder (PTSD) and related trauma spectrum psychiatric disorders, including major depression, borderline personality disorder, and the dissociative disorders, are associated with considerable morbidity and loss of function. Treatment of these disorders, which include medications and psychotherapy, have limitations. New neuromodulation approaches targeting the underlying neurobiology of these disorders—including elevated inflammation, impaired autonomic nervous system activity, and alterations in brain areas that mediate emotion and the stress response—could improve the treatment and management of these patients. Vagal nerve stimulation (VNS) blocks sympathetic and inflammatory responses, and modulates brain areas involved in stress. Implantable VNS devices are approved for treatment refractory depression. New generation transcutaneous VNS devices that stimulate branches of the vagus nerve via the neck (cervical) or ear (auricular) are potentially applicable to trauma spectrum psychiatric disorders. This chapter reviews the effects of VNS on neurobiology and applications to patients with these psychiatric disorders.
This chapter will examine the scientific status of a significant segment of what might be called the “social justice movement” within psychology (e.g., Sue, Counsel Psychol 45(5):706–716, 2017), as this movement relates to longstanding problems of prejudice, bias, discrimination, and oppression. Nothing in this chapter is meant to suggest that there are not social and interpersonal problems that are not real. These problems have been shown to be widespread, harmful, and relevant to the tasks of a psychologist and the clients they serve (Pieterse et al., J Counsel Psychol 59(1):1–9, 2012). To date, however, the scientific status of much of these efforts in psychology—and particularly the resultant scientific and practical progressiveness of these efforts—are questioned. Moreover, the quality of these efforts—particularly the scientific quality of the set of unique constructs this movement utilizes to understand and modify these problems is useful to critically examine. The importance of these problems should necessitate using the most effective problem-solving tools available, as well as the use of the most effective means to produce consensus on these divisive issues. Science is an unparalleled problem-solving process.
This chapter focuses on the training and supervision of evidence-based therapies for trauma cases. Building on decades of efficacy research that resulted in “well-established” therapies for trauma, Drs. Brown, Lang, and Sharma-Patel begin by summarizing dissemination and intervention science as it relates to mental health interventions for trauma. They then discuss best practices in training (launch activities, learning sessions, and ongoing supervision/consultation), highlighting what is unique about doing training and supervision in the context of trauma. Finally, using a parallel process, Drs. Brown, Lang, and Sharma-Patel systematically present how each element of trauma-specific therapy can be used to enhance supervision. Finally, given the vulnerability of trauma clinicians to secondary traumatic stress, the authors discuss how to embed self-care in supervision and consultation.KeywordsTraumaPTSDTherapySupervisionConsultationTrainingCBTTrauma-informed careTherapeutic allianceSelf-careCase conceptualizationEvaluationPsychoeducationExposureAffect identification and modulationCognitive restructuring
Post-traumatic stress disorder is a clinical and social reality. There is a high prevalence of combined substance abuse in patients with PTSD. It also points to the medical and social difficulties in providing care for this group of patients. This article discusses topical issues of PTSD comorbidity and substance abuse. Substance abuse alters and significantly aggravates the clinical presentation of PTSD. A significant role of psychological factors, including premorbid personality traits, in the formation of addictive behavior is demonstrated in this article. Current data from neurobiological research are considered. The increased rate of PTSD diagnosis, including patients with comorbid substance abuse, as well as the high level of combined medical and social problems, reflect the significance and relevance of this problem.
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