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Sensory Modulation and Peritraumatic Stress Symptoms During Operation Guardian of the Walls
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The COVID-19 pandemic has created an ongoing global crisis. The unprecedented shock has been particularly devastating for tourism-based cities and has tested their resilience. This study addresses the mitigating role of urban resilience in the interplay between acute crises and the phenomenon of urban outmigration. Leveraging a unique dataset collected during the first national lockdown that followed the outbreak of COVID-19 in the city of Eilat (Israel)—a geographically isolated single economic sector-based city with no feasible options to commute—we offer here a new conceptual framework and an empirical framework for measuring perceived resilience. Using validated psychometric questionnaires and employing the nested hierarchical modeling approach, we estimate the impact of perceived resilience on the decision to migrate from the city. We find that even though Eilat has all the attributes to experience significant out-migration, its residents are not inclined towards migration due to its prior investment in resilience measures, which strengthened the local community and created a unique credo shared by its residents. These findings call for policymakers to focus on long-term resilience schemes directed at increasing the appeal that cities have for their residents and ensuring their endurance in times of extreme hardship.
Background
The COVID-19 pandemic might be experienced as an ongoing traumatic event and could result in peritraumatic stress symptoms. Evidence implies that individuals’ levels of death anxiety, anxiety sensitivity, and difficulties in emotion regulation may contribute to their peritraumatic stress symptomatology in the aftermath of trauma exposure.
Objective
The current study aimed to explore these hypotheses in the context of the COVID-19 pandemic.
Method
An online survey was conducted among a convenience sample of 846 Israeli adults from April 2 to 19 April 2020. COVID-19-related stressors, death anxiety, anxiety sensitivity, difficulties in emotion regulation, and peritraumatic stress symptoms were assessed via self-report questionnaires.
Results
Analyses indicated significant relations between death anxiety, anxiety sensitivity, and emotion regulation difficulties, on the one hand, and peritraumatic stress symptoms, on the other. Three distinct profiles were identified. Furthermore, profile type – namely having low, medium, and high levels of death anxiety, anxiety sensitivity, and emotion dysregulation – had a significant effect in explaining peritraumatic stress symptoms.
Conclusions
Results suggest that during the pandemic, levels of death anxiety, anxiety sensitivity, and emotion dysregulation may explain heterogeneity in individuals’ trauma-related symptomatology.
Post-traumatic stress disorder (PTSD) is triggered by an individual experiencing or witnessing a traumatic event, often precipitating persistent flashbacks and severe anxiety that are associated with a fearful and hypervigilant presentation. Approximately 14–30% of traumatized individuals present with the dissociative subtype of PTSD, which is often associated with repeated or childhood trauma. This presentation includes symptoms of depersonalization and derealization, where individuals may feel as if the world or self is “dream-like” and not real and/or describe “out-of-body” experiences. Here, we review putative neural alterations that may underlie how sensations are experienced among traumatized individuals with PTSD and its dissociative subtype, including those from the outside world (e.g., touch, auditory, and visual sensations) and the internal world of the body (e.g., visceral sensations, physical sensations associated with feeling states). We postulate that alterations in the neural pathways important for the processing of sensations originating in the outer and inner worlds may have cascading effects on the performance of higher-order cognitive functions, including emotion regulation, social cognition, and goal-oriented action, thereby shaping the perception of and engagement with the world. Finally, we introduce a theoretical neurobiological framework to account for altered sensory processing among traumatized individuals with and without the dissociative subtype of PTSD.
Background
Sensory processing is essential for the interaction with the environment and for adequate daily function. Sensory processing may deteriorate with aging and restrict daily activity performance. Aging may also affect Executive functions (EFs) which are critical for daily activity performance. Yet, most studies refer separately to the impacts of sensory processing or EFs and use clinical evaluations that do not necessarily reflect functional restrictions in real life. This study aims to describe the prevalence of altered sensory processing in the elderly as expressed in daily life scenarios and explore whether EFs mediate between altered sensory processing and daily activity performance in older adults.
Methods
This cross-sectional study included 167 healthy independently functioning people aged 65 and above who were living in the community, had sufficient cognitive status and no symptoms of depression (based on the GDS and the MMSE). All participants completed a socio-demographic-health questionnaire, the Adolescent/Adult Sensory Profile, the Behavior Rating Inventory of Executive Function–Adult Version and the Daily Living Questionnaire.
Results
Altered sensory processing, and mainly by the reduced ability to register and modulate sensory input from daily environment, were prevalent in older adults. Their impacts on daily activity performance were mediated by executive dysfunctions.
Conclusions
Executive dysfunctions may worsen the negative effects of altered sensory processing on daily activity performance in older adults. The interaction between EFs and sensory processing should receive growing attention in intervention and prevention programs for older adults, with the emphasis on their expressions and implications on peoples’ function in real life context.
Background:
Difficulty modulating sensory input related to multi-sensory integration dysfunction, specifically the sensory over-responsive (SOR) type, is associated with psychological distress and hyperalgesia in children and adults. Scares reports suggest atypical autonomic nervous system (ANS) reactivity to innocuous sensory stimuli in children with SOR. Thus, the ANS may contribute to sensory stimuli responses and psychological distress. This exploratory study aimed to characterize the ANS reactivity to single and dual pain stimulation, and in relation to psychological distress in adults with SOR.
Methods:
Healthy women with SOR (n = 9) vs. without SOR (n = 9) underwent two runs of single pain stimulation and a third run comprised of dual pain stimulation. Pain was self-rated, while heart rate variability was measured and analyzed in the time and frequency domains. In addition, questionnaires assessing anxiety and somatization were utilized.
Results:
While controls demonstrated a vagal tone withdrawal (root mean square of successive differences in R-R-intervals; (RMSSD)) p = 0.029 from base-line to the third run, this was absent in the SOR group. However, no group differences were found in pain ratings. Furthermore, groups differed in the correlations between R-R mean and the level of both anxiety (p = 0.006) and somatization (p < 0.001); while in the SOR group, higher levels of anxiety and somatization correlated with shorter R-R intervals, the opposite was found in the control group.
Conclusions:
This is the first study to demonstrate in women with SOR atypical vagal tone reactivity to challenging pain load. Vagal tone reactivity is related to both pain ratings and psychological distress.
Background: A continuous effort has been devoted to identifying factors that contribute to individual differences in pain perception. Amongst the personality traits, Neuroticism is assumed to be the most significant moderator of experimental and clinical pain. Multi-sensory responsiveness to daily sensations has been shown to be associated with pain perception. Yet, neither the relationship between personality traits and multi-sensory responsiveness nor the impact of both these factors to pain perception have been examined. Thus, this study aims to explore the contribution of both multi-sensory responsiveness and personality traits to pain perception in a daily context. Methods: A community-based sample of 204 adults completed the Sensory Responsiveness Questionnaire-Intensity Scale (SRQ-IS); the Big Five Inventory (BFI); and the Pain Sensitivity Questionnaire (PSQ). Results: The partial eta-square demonstrated that the SRQ-IS Aversive sub-scale score had the strongest relationship with the PSQ-Total score, accounting for 9% of the variation. The regression coefficient relating PSQ-Total score with SRQ-IS Aversive, and BFI sub-scales of Extraversion, Neuroticism and Openness-to-Experience scores was found to be r = 0.39 (p < 0.0001), accounting for 16% of the variance, and yielding a large effect size. Discussion: To the best of our knowledge this is the first study to report on the interplay between aversive responsiveness to daily sensations and personality traits of Neuroticism, Openness-to-Experience, and Extraversion as contributing factors to daily pain sensitivity, amongst which aversive responsiveness was found as the major contributing factor. This study may broaden the understanding of the pain experience variability, both in practice and in experimental research.
Sensory modulation disorder (SMD) affects sensory processing across single or multiple sensory systems. The sensory over-responsivity (SOR) subtype of SMD is manifested clinically as a condition in which non-painful stimuli are perceived as abnormally irritating, unpleasant, or even painful. Moreover, SOR interferes with participation in daily routines and activities (Dunn, 2007; Bar-Shalita et al., 2008; Chien et al., 2016), co-occurs with daily pain hyper-sensitivity, and reduces quality of life due to bodily pain. Laboratory behavioral studies have confirmed abnormal pain perception, as demonstrated by hyperalgesia and an enhanced lingering painful sensation, in children and adults with SMD. Advanced quantitative sensory testing (QST) has revealed the mechanisms of altered pain processing in SOR whereby despite the existence of normal peripheral sensory processing, there is enhanced facilitation of pain-transmitting pathways along with preserved but delayed inhibitory pain modulation. These findings point to central nervous system (CNS) involvement as the underlying mechanism of pain hypersensitivity in SOR. Based on the mutual central processing of both non-painful and painful sensory stimuli, we suggest shared mechanisms such as cortical hyper-excitation, an excitatory-inhibitory neuronal imbalance, and sensory modulation alterations. This is supported by novel findings indicating that SOR is a risk factor and comorbidity of chronic non-neuropathic pain disorders. This is the first review to summarize current empirical knowledge investigating SMD and pain, a sensory modality not yet part of the official SMD realm. We propose a neurophysiological mechanism-based model for the interrelation between pain and SMD. Embracing the pain domain could significantly contribute to the understanding of this condition’s pathogenesis and how it manifests in daily life, as well as suggesting the basis for future potential mechanism-based therapies.
Although maladaptive sensory processing has been observed among individuals with persistent heightened anxiety, it is unclear if difficulties processing sensory input early in life lead to anxiety disorders in adulthood and what mechanisms would drive this progression. In a transdiagnostic clinical sample of 231 adults characterized by heightened difficulties with emotion regulation, the present study sought to examine whether: (a) childhood sensory processing disorder (SPD) symptoms predict an increased probability of an anxiety disorder diagnosis in adulthood; and (b) difficulties with emotion regulation and adult SPD symptoms mediate this relationship. Participants were administered the Structured Clinical Interview for Axis-I disorders and self-reported symptoms of SPD experienced in childhood and adulthood. Results suggested that childhood SPD symptoms were significantly associated with a higher likelihood of a lifetime anxiety disorder diagnosis. Difficulties with emotion regulation fully mediated the relationship between childhood SPD and (a) any anxiety disorder in adulthood and, specifically (b) current generalized anxiety disorder (GAD). Further, we found evidence for a candidate model accounting for the relationship among childhood SPD, adulthood SPD, difficulties with emotion regulation, and anxiety disorders in adulthood. Specifically, our data indicated that high symptoms of SPD in childhood may lead to high SPD symptoms in adulthood, which then lead to high emotion dysregulation, ultimately conferring vulnerability for an anxiety disorder diagnosis. Taken together, these findings provide preliminary evidence for how sensory processing impairments in childhood may relate to anxiety through difficulties regulating emotion regulation.
Background:
Existing WHO estimates of the prevalence of mental disorders in emergency settings are more than a decade old and do not reflect modern methods to gather existing data and derive estimates. We sought to update WHO estimates for the prevalence of mental disorders in conflict-affected settings and calculate the burden per 1000 population.
Methods:
In this systematic review and meta-analysis, we updated a previous systematic review by searching MEDLINE (PubMed), PsycINFO, and Embase for studies published between Jan 1, 2000, and Aug 9, 2017, on the prevalence of depression, anxiety disorder, post-traumatic stress disorder, bipolar disorder, and schizophrenia. We also searched the grey literature, such as government reports, conference proceedings, and dissertations, to source additional data, and we searched datasets from existing literature reviews of the global prevalence of depression and anxiety and reference lists from the studies that were identified. We applied the Guidelines for Accurate and Transparent Health Estimates Reporting and used Bayesian meta-regression techniques that adjust for predictors of mental disorders to calculate new point prevalence estimates with 95% uncertainty intervals (UIs) in settings that had experienced conflict less than 10 years previously.
Findings:
We estimated that the prevalence of mental disorders (depression, anxiety, post-traumatic stress disorder, bipolar disorder, and schizophrenia) was 22·1% (95% UI 18·8-25·7) at any point in time in the conflict-affected populations assessed. The mean comorbidity-adjusted, age-standardised point prevalence was 13·0% (95% UI 10·3-16·2) for mild forms of depression, anxiety, and post-traumatic stress disorder and 4·0% (95% UI 2·9-5·5) for moderate forms. The mean comorbidity-adjusted, age-standardised point prevalence for severe disorders (schizophrenia, bipolar disorder, severe depression, severe anxiety, and severe post-traumatic stress disorder) was 5·1% (95% UI 4·0-6·5). As only two studies provided epidemiological data for psychosis in conflict-affected populations, existing Global Burden of Disease Study estimates for schizophrenia and bipolar disorder were applied in these estimates for conflict-affected populations.
Interpretation:
The burden of mental disorders is high in conflict-affected populations. Given the large numbers of people in need and the humanitarian imperative to reduce suffering, there is an urgent need to implement scalable mental health interventions to address this burden.
Funding:
WHO; Queensland Department of Health, Australia; and Bill & Melinda Gates Foundation.
Preliminary evidence supports a possible association between post-traumatic stress disorder (PTSD) and sensory modulation disorder (SMD). Nevertheless, the research focusing on this relationship in children is notably limited. This study examined children with and without PTS symptoms, by comparing their mothers’ perceptions of their responses to sensory events in daily life. Mothers of 134 non-referred children aged 5–11, exposed to continuous traumatic stress due to political violence, completed the UCLA-RI and the Short Sensory Profile questionnaires. Significant differences emerged between children with different levels of PTS symptoms in various sensory modalities. Furthermore, half of the symptomatic children had suspected clinically significant deficits in sensory processing. In addition, PTSD symptoms were significantly associated with most of the sensory processing scores. Logistic regression indicated that the overall sensory processing score was a significant predictor of group classification. The results indicate that children with PTS symptoms may be at increased risk for sensory processing deficits. Evaluation of sensory processing should be incorporated into the routine evaluation of this population in order to determine whether this is an additional factor contributing to a child’s difficulties in participating in daily activities. Subsequent intervention programs should then address the multiple needs of these children.
Although most veterans in the Department of Veterans Affairs (VA) health system are treated for posttraumatic stress disorder (PTSD) in the outpatient setting, the VA has approximately 40 residential PTSD treatment facilities across the country for those requiring more intensive care. The symptom profiles of these veterans are poorly understood. Thus, the current study was designed to characterize classes of PTSD symptoms in a national sample of veterans undergoing residential treatment. We analyzed latent classes of PTSD symptoms among 2,452 veterans entering VA PTSD residential treatment in fiscal year 2013. The model with the best fit was a 4-class model comprising a low symptom class, moderate symptom class with high reexperiencing symptoms, a moderate symptom class with high emotional numbing, and a high symptom class. Compared to classes identified in outpatient samples, these classes were similar in type but greater in severity. Classes differed by age, race/ethnicity, trauma type, co-occurring medical conditions, co-occurring psychiatric conditions, and social functioning. Compared to the moderate class with high emotional numbing, those in the moderate class with high reexperiencing symptoms were more likely to be non-White, have greater pain severity, greater sleep problems, and were less likely to be depressed. Our findings suggest that veterans in residential treatment who have more severe PTSD symptoms also experience other medical and psychosocial stressors. A better understanding of symptom profiles may help to create more individualized treatment planning and thus potentially improve care for these veterans.
Objective:
We assessed in vivo symptom courses of early psychological responses during war and investigated the influence of exposure, gender, and a prior diagnosis of severe mental illness (SMI).
Method:
Participants were 181 highly exposed individuals from the general population and community psychiatric rehabilitation centers. A 30-day twice-daily Internet-smartphone-based intensive assessment two weeks into the 2014 Israel-Gaza war estimated peritraumatic symptom clusters, sense of threat, negative emotions and cognitions, and siren exposure during two periods that varied in exposure level. Piecewise growth curve modeling procedures were performed.
Results:
We found different courses for most variables, gender, and SMI status. Women were more reactive two weeks into the war but reduced their reactivity level at a faster pace than males, reaching lower symptom levels one month later. Women's courses were characterized by arousal, negative emotionality, sense of threat, and reactivity to siren exposure. No-SMI men had a stable course followed by a significant reduction in arousal, negative emotions, avoidance, and perceived threat during a "return to routine" lower-level intensity period of the war. Individuals with SMI had higher reactivity levels at study onset; but while women with SMI improved over time, men with SMI worsened. SMI reactivity was characterized by negative cognitions, intrusions, and avoidance.
Conclusions:
Early reactions during prolonged exposure to war are variable, dynamic, and affected by exposure context. Symptoms, emotions, and cognitions develop differentially over time and are affected by gender and mental health status. The identification of various early stress courses should inform primary intervention strategies.
To determine the number of clusters in the clustering analysis that has a broad range of applied sciences, such as physics, chemistry, biology, engineering, economics etc., many methods have been proposed in the literature. The aim of this paper is to determine the number of clusters of a dataset in a model-based clustering by using an Analytic Hierarchy Process (AHP). In this study, the AHP model has been created by using the information criteria Akaike's Information Criterion (AIC), Approximate Weight of Evidence (AWE), Bayesian Information Criterion (BIC), Classification Likelihood Criterion (CLC), and Kullback Information Criterion (KIC). The achievement of the proposed approach has been tested on common real and synthetic datasets. The proposed approach based on the corresponding information criteria has produced accurate results. The currently produced results have been seen to be more accurate than those corresponding to the information criteria.
Exposure and sense of threat have been associated with stress symptoms, yet these relationships have not been clarified during the peritraumatic period. We investigated the mediating role of sense of threat in the link between exposure to rocket warning sirens and stress symptoms during wartime, and the effect of severe mental illness (SMI) status and gender on this mediation. A 30-day twice-daily smartphone-based intensive assessment of exposure to sirens, sense of threat, and peritraumatic stress symptoms was performed during the 2014 Israel-Gaza conflict. Participants included 182 highly exposed individuals with or without SMI. Multilevel structural equation modeling analysis was performed, with SMI status and gender as confounders. Exposure affected the level of peritraumatic stress symptoms both directly, b = 1.07, p < .001, 95% CI [0.32, 1.82], and indirectly, b = 0.78, p < .001, 95% CI [0.24, 1.33], through sense of threat. The effect of sense of threat on stress symptoms was larger in the SMI group, b = 0.86, p < .001, 95% CI [0.31, 1.40]. Gender did not have a significant effect. Sense of threat has a key role in symptom development during the peritraumatic timeframe. Intervention and prevention efforts should start early and focus on promoting a sense of safety, particularly with people with SMI.
This study examined the psychometric properties of the posttraumatic stress disorder (PTSD) Checklist for Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (PCL-5; Weathers, Litz, et al., 2013b) in 2 independent samples of veterans receiving care at a Veterans Affairs Medical Center (N = 468). A subsample of these participants (n = 140) was used to define a valid diagnostic cutoff score for the instrument using the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5; Weathers, Blake, et al., 2013) as the reference standard. The PCL-5 test scores demonstrated good internal consistency (α = .96), test-retest reliability (r = .84), and convergent and discriminant validity. Consistent with previous studies (Armour et al., 2015; Liu et al., 2014), confirmatory factor analysis revealed that the data were best explained by a 6-factor anhedonia model and a 7-factor hybrid model. Signal detection analyses using the CAPS-5 revealed that PCL-5 scores of 31 to 33 were optimally efficient for diagnosing PTSD (κ(.5) = .58). Overall, the findings suggest that the PCL-5 is a psychometrically sound instrument that can be used effectively with veterans. Further, by determining a valid cutoff score using the CAPS-5, the PCL-5 can now be used to identify veterans with probable PTSD. However, findings also suggest the need for research to evaluate cluster structure of DSM-5. (PsycINFO Database Record
Thirty participants with post-traumatic stress (PTS) symptoms and 30 healthy controls completed the Post-Traumatic Stress Disorder Symptom Scale (PSS-SR) and the Adolescent/Adult Sensory Profile (AASP). Participants with PTS symptoms vacillated between sensory sensitivity, sensation avoiding, and low registration. Sensation avoiding and low registration correlated with intrusive thoughts related to PTS. Discriminant Analysis classified 73% of the study group and 80% of the controls. PTS may be related to hypersensitivity and low registration. Further studies about the sensory profile of people with PTS symptoms may contribute to research and optimize evaluation and intervention for people with PTSD.
There is a compelling need for varied “trauma specific” treatment models for children and adolescents with complex trauma in residential treatment whose affect and behavioral dysregulation disrupts daily living and impedes treatment engagement. This conceptual paper introduces exploratory applications of sensory motor approaches to the treatment of affect and behavioral dysregulation. Sensory Integration, a specialization within occupational therapy (Ayres 1972, 2004) provides knowledge of the sensory motor systems and strategies for sensory modulation that addresses arousal regulation, which underlies this dysregulation. The article describes three clinically supported approaches to the use of sensory modulation in residential treatment sites: use of sensory rooms; use of sensory integration occupational therapists at residential treatment sites; and a trauma psychotherapy that utilizes sensory motor strategies to improve regulation and support trauma processing.
We conducted a latent class analysis (LCA) on 249 recent motor vehicle accident (MVA) victims to examine subgroups that differed in posttraumatic stress disorder (PTSD) symptom severity, current major depressive disorder and alcohol/other drug use disorders (MDD/AoDs), gender, and interpersonal trauma history 6-weeks post-MVA. A 4-class model best fit the data with a resilient class displaying asymptomatic PTSD symptom levels/low levels of comorbid disorders; a mild psychopathology class displaying mild PTSD symptom severity and current MDD; a moderate psychopathology class displaying severe PTSD symptom severity and current MDD/AoDs; and a severe psychopathology class displaying extreme PTSD symptom severity and current MDD. Classes also differed with respect to gender composition and history of interpersonal trauma experience. These findings may aid in the development of targeted interventions for recent MVA victims through the identification of subgroups distinguished by different patterns of psychiatric problems experienced 6-weeks post-MVA.
The development of a self-report measure of subjectively assessed social support, the Multidimensional Scale of Perceived Social Support (MSPSS), is described. Subjects included 136 female and 139 male university undergraduates. Three subscales, each addressing a different source of support, were identified and found to have strong factorial validity: (a) Family, (b) Friends, and (c) Significant Other. In addition, the research demonstrated that the MSPSS has good internal and test-retest reliability as well as moderate construct validity. As predicted, high levels of perceived social support were associated with low levels of depression and anxiety symptomatology as measured by the Hopkins Symptom Checklist. Gender differences with respect to the MSPSS are also presented. The value of the MSPSS as a research instrument is discussed, along with implications for future research.
An important interest in mixture modeling is the investigation of what types of individuals belong to each latent class by relating classes to covariates, concurrent outcomes and distal outcomes, also known as auxiliary variables. This article presents results from real data examples and simulations to show how various factors, such as the degree to which people are classified correctly into latent classes and sample size, can impact the estimates and standard errors of auxiliary variable effects and testing mean equality across classes. Based on the results of the examples and simulations, suggestions are made about how to select auxiliary variables for a latent class analysis.
We conducted a systematic review of the literature to explore the longitudinal course of PTSD in DSM-5-defined trauma exposed populations to identify the course of illness and recovery for individuals and populations experiencing PTSD.
We reviewed the published literature from January 1, 1998 to December 31, 2010 for longitudinal studies of directly exposed trauma populations in order to: (1) review rates of PTSD in the first year after a traumatic event; (2) examine potential types of proposed DSM-5 direct trauma exposure (intentional and non-intentional); and (3) identify the clinical course of PTSD (early onset, later onset, chronicity, remission, and resilience). Of the 2537 identified articles, 58 articles representing 35 unique subject populations met the proposed DSM-5 criteria for experiencing a traumatic event, and assessed PTSD at two or more time points within 12 months of the traumatic event.
The mean prevalence of PTSD across all studies decreases from 28.8% (range = 3.1-87.5%) at 1 month to 17.0% (range = 0.6-43.8%) at 12 months. However, when traumatic events are classified into intentional and non-intentional, the median prevalences trend down for the non-intentional trauma exposed populations, while the median prevalences in the intentional trauma category steadily increase from 11.8% to 23.3%. Across five studies with sufficient data, 37.1% of those exposed to intentional trauma develop PTSD. Among those with PTSD, about one third (34.8%) remit after 3 months. Nearly 40% of those with PTSD (39.1%) have a chronic course, and only a very small fraction (3.5%) of new PTSD cases appears after three months.
Understanding the trajectories of PTSD over time, and how it may vary by type of traumatic event (intentional vs. non-intentional) will assist public health planning and treatment.
Mixture modeling is a widely applied data analysis technique used to identify unobserved heterogeneity in a population. Despite mixture models' usefulness in practice, one unresolved issue in the application of mixture models is that there is not one commonly accepted statistical indicator for deciding on the number of classes in a study population. This article presents the results of a simulation study that examines the performance of likelihood-based tests and the traditionally used Information Criterion (ICs) used for determining the number of classes in mixture modeling. We look at the performance of these tests and indexes for 3 types of mixture models: latent class analysis (LCA), a factor mixture model (FMA), and a growth mixture models (GMM). We evaluate the ability of the tests and indexes to correctly identify the number of classes at three different sample sizes (n D 200, 500, 1,000). Whereas the Bayesian Information Criterion performed the best of the ICs, the bootstrap likelihood ratio test proved to be a very consistent indicator of classes across all of the models considered.
Logistic regression with binary and multinomial outcomes is commonly used, and researchers have long searched for an interpretable measure of the strength of a particular logistic model. This article describes the large sample properties of some pseudo-R 2 statistics for assessing the predictive strength of the logistic regression model. We present theoretical results regarding the convergence and asymptotic normality of pseudo-R 2 s. Simulation results and an example are also presented. The behavior of the pseudo-R 2 s is investigated numerically across a range of conditions to aid in practical interpretation.
We explored the relationships between sensory modulation and health-related quality of life (HRQOL), social supports, and mental health symptoms of anxiety and depression.
Twenty-eight adult volunteers ages 18-60 participated in the study. Fourteen adults were sensory overresponsive (SOR), and 14 adults in a matched comparative group were not sensory overresponsive (NSOR). All participants were tested using self-administered measures of sensory processing.
Significant differences were found between SOR and NSOR groups on symptoms of anxiety, depression, and 4 of 8 indicators of HRQOL.
Several analyses exploring the relationships among the variables tested suggest that sensory response style, whether comparing SOR and NSOR groups or exploring the correlation of the response quadrants of the Adolescent/Adult Sensory Profile, appears significantly and differentially related to symptoms of affective mental health and quality-of-life indicators, including social participation.
Trauma survivors who suffer from posttraumatic stress disorder (PTSD) symptoms may be particularly vulnerable when facing the COVID-19 pandemic. Yet trauma exposure may also lead to salutogenic outcomes, known as posttraumatic growth (PTG). Nevertheless, the implications of PTG attributed to prior trauma, for trauma survivors’ adjustment when facing additional stressors, are unclear. Addressing this gap, 528 Israeli trauma survivors were assessed for PTG and PTSD symptoms attributed to prior trauma, as well as peritraumatic stress symptoms related to the pandemic, as part of an online survey. Analyses revealed that being younger, female, quarantined, negatively self-rating one’s health status, and suffering from PTSD symptoms were associated with elevated peritraumatic stress symptoms. Furthermore, PTG attributed to prior trauma made a significant contribution in explaining elevated intrusion, avoidance, and hyperarousal symptoms. The present results point to the need for clinicians to take into account reports of PTG attributed to prior trauma when treating trauma survivors during the current pandemic.
Objective
The novel coronavirus (COVID-19) is a substantial stressor that could eventuate in psychological distress. Evidence suggests that individuals previously exposed to traumatic events, and particularly to continuous traumatic stress (CTS), might be more vulnerable to distress when facing additional stressors. This study aimed to investigate these suppositions in the context of the ongoing shelling of Israel from the Israel-Gaza border, which continues even amidst the COVID-19 crisis.
Method
An online survey was conducted among Israel's general population. The sample included 976 participants. Seven-hundred-and-ninety-three participants had been exposed to traumatic events, with 255 participants reporting CTS. Trauma exposure, COVID-19-related stressors, and psychological distress related to COVID-19 (anxiety, depression, and peritraumatic stress symptoms) were assessed.
Results
Most participants reported experiencing at least one psychiatric symptom related to COVID-19. Being younger, female, not in a relationship, having a below-average income, being diagnosed with the disease, living alone during the outbreak, having a close other in a high-risk group, and negatively self-rating one's health status were associated with elevated distress. Individuals who had been exposed to trauma, and to CTS in particular, had elevated anxiety, depression, and peritraumatic stress symptoms compared to individuals without such a history or to survivors of non-ongoing traumatic events. CTS moderated the relations between PTSD symptoms, anxiety symptoms, and peritraumatic stress symptoms, with significantly stronger relations found among individuals exposed to CTS.
Limitations
This study relied on convenience sampling.
Conclusions
Trauma survivors, and particularly traumatized individuals exposed to CTS, seem at risk for psychological distress related to COVID-19.
Objective:
This comparative cross-sectional study aimed to characterize individuals with substance use disorder (SUD) in self-perception of pain sensitivity, experimental auditory aversiveness, and non-noxious sensory responsiveness, as well as examine the associations with SUD.
Methods:
Therapeutic community (TC) individuals with SUD (N = 63, male 88.9%) and healthy controls (N = 60, male 86.7%) completed the Pain Sensitivity Questionnaire (PSQ) and the Sensory Responsiveness Questionnaire-Intensity Scale (SRQ-IS), followed by a psychophysical auditory battery, the Battery of Averseness to Sounds (BAS)-Revised.
Results:
The SUD group scored higher on the PSQ (P < 0.0001), BAS-R aversiveness (P < 0.0001), BAS-R-unpleasantness (P < 0.0001), and on the aftersensation of auditory aversiveness (P < 0.0001) and unpleasantness (P < 0.000). Fifty-four percent of the SUD group vs 11.7% of the control group were identified as having sensory modulation dysfunction (SMD; P < 0.0001). Logistic regression modeling revealed that the SRQ-IS-Aversive score had a stronger relationship, indicating a 12.6-times odds ratio for SUD (P = 0.0002). Finally, a risk score calculated from a linear combination of the logistic regression model parameters is presented based on the PSQ and SRQ.
Conclusions:
This is the first study to explore sensory and aversive domains using experimental and self-reporting in situ, revealing pain perception alteration that co-occurs with high prevalence of SMD, specifically of the over-responsive type. Findings may be significant in clinical practice for treating pain, and for expanding therapeutic modalities as part of broader rehabilitation in TC and beyond, to better meet personalized therapy.
The present guide provides a practical guide to conducting latent profile analysis (LPA) in the Mplus software system. This guide is intended for researchers familiar with some latent variable modeling but not LPA specifically. A general procedure for conducting LPA is provided in six steps: (a) data inspection, (b) iterative evaluation of models, (c) model fit and interpretability, (d) investigation of patterns of profiles in a retained model, (e) covariate analysis, and (f) presentation of results. A worked example is provided with syntax and results to exemplify the steps.
Children with a history of maltreatment exhibit differences in a variety of domains, including sensory processing. However, little is known about how domain-specific sensory processing deficits differ by the type of maltreatment experienced. The focus of the current study was to investigate the relationship between abuse, neglect, or no maltreatment on seven sensory domains in a sample of adopted children. Caregivers of 408 adopted children (M= 7.89, SD= 2.03) reported their child’s history of maltreatment (abuse, neglect, or no maltreatment) and sensory processing abilities (Short Sensory Profile). Seventy-nine percent of the sample had sensory processing dysfunction (definite difference = 41%; probable difference = 38%). Children with a history of abuse (n = 147) had impairments in tactile sensitivity (84.4%) and taste/smell sensitivity (47.6%). Children with a history of neglect (n = 125) scored differently in underresponsive/seeks sensation (Neglect = 83.2%; Abuse = 57.8%). Both groups had significant differences in underresponsive/seeks sensation and auditory filtering. In summary, children with a history of adversity had domain-specific sensory processing differences that varied by the type of maltreatment experienced. These findings suggest that children may benefit from evaluation by an occupational therapist taking their specific history of maltreatment into account. Implications for allied health and mental health providers are discussed.
Objective:
People with sensory overresponsiveness (SOR) perceive nonpainful stimuli as noxious and demonstrate hyperalgesia and lingering sensation to laboratory pain stimuli. Electroencephalography (EEG) of cortical activity at rest is widely used to explore endophenotypes but has not yet been tested in people with SOR. Therefore, we investigated the characteristics of resting-state EEG in participants with SOR.
Method:
Resting-state EEG (5-min, eyes-closed recording) was compared in participants with (n = 9) and without (n = 12) SOR.
Results:
Participants with SOR demonstrated a global reduction of the EEG activity, including significantly lower θ and α1 activity as well as faster peak α frequency. Higher sensory-responsiveness scores were associated with high peak α power in participants without SOR.
Conclusion:
Reduced α activity is commonly interpreted as an electrophysiological indicator of arousal and sensitivity to pain. The EEG pattern of response may partly explain the reported ongoing daily alertness to environmental stimuli in participants with SOR.
Context:
Although the subjective trauma exposure criterion was removed from the DSM-5 criteria set for posttraumatic stress disorder (PTSD), emerging literature suggests that peritraumatic distress may be useful in predicting outcomes after exposure to a stressful event.
Method:
We conducted a comprehensive review of the literature examining the association between peritraumatic distress and PTSD and other psychiatric outcomes. The 57 studies herein varied in both experimental design and target populations.
Results:
Forty-eight studies found associations between peritraumatic distress and PTSD outcome measures, 23 found associations between peritraumatic distress and other psychiatric outcomes, and three found associations between peritraumatic distress and PTSD-related symptoms or other psychiatric outcomes after non-Criterion A stressful events by DSM-5 criteria.
Conclusion:
Peritraumatic distress is associated with PTSD symptom severity, other psychiatric symptoms, and severity of PTSD-related symptoms after exposure to non-Criterion A events, suggesting that peritraumatic distress is a risk factor for various psychiatric outcomes and furthering our understanding of the impact of subjective experience on trauma psychopathology.
Objective:
Chronic pain patients show hypersensitivity to sensory non-painful stimuli. Sensory over-responsiveness (SOR) to innocuous daily stimuli, experienced as painful, is prevalent in 10% of the healthy population. This altered sensory processing may be an expression of over facilitation, or a less efficient pain inhibitory process in the pain pathways. We therefore aimed at investigating specifically the pain inhibitory system of subjects with SOR who are otherwise healthy, not studied as of yet.
Methods:
Thirty healthy subjects, divided into SOR (N=14) and Non-SOR (N=16) based on the Sensory Responsiveness Questionnaire (SRQ), were psychophysically tested in order to evaluate: i) hyperalgesic responses; ii) adaptation/sensitization to 14 phasic heat stimuli; iii) habituation; iv) six min. after-sensation; and v) conditioned pain modulation (CPM) (i.e. phasic heat stimuli applied with and without hand immersion in hot water bath).
Results:
The SOR group differed from the non-SOR individuals in i) a steeper escalation in NPS ratings to temperature increase (p=0.003) indicating hyperalgesia; ii) increased sensitization (p=<.001); iii) habituation responses (p<0.001); iv) enhanced pain ratings during the after-sensation (p=0.006); and v) no group difference was found in CPM.
Conclusions:
SOR is associated with a pro-nociceptive state, expressed by amplification of experimental pain, yet with sufficient inhibitory processes. Our results support previous findings of enhanced facilitation of pain transmitting pathways however reveal preserved inhibitory mechanisms, though slower to react. This article is protected by copyright. All rights reserved.
Background:
Several studies have examined the sensory component in Obsesseive Compulsive Disorder (OCD) and described an OCD subtype which has a unique profile, and that Sensory Phenomena (SP) is a significant component of this subtype. SP has some commonalities with Sensory Over Responsivity (SOR) and might be in part a characteristic of this subtype. Although there are some studies that have examined SOR and its relation to Obsessive Compulsive Symptoms (OCS), literature lacks sufficient data on this interplay.
Objectives:
First to further examine the correlations between OCS and SOR, and to explore the correlations between SOR modalities (i.e. smell, touch, etc.) and OCS subscales (i.e. washing, ordering, etc.). Second, to investigate the cluster analysis of SOR and OCS dimensions in adults, that is, to classify the sample using the sensory scores to find whether a sensory OCD subtype can be specified. Our third goal was to explore the psychometric features of a new sensory questionnaire: the Sensory Perception Quotient (SPQ).
Method:
A sample of non clinical adults (n=350) was recruited via e-mail, social media and social networks. Participants completed questionnaires for measuring SOR, OCS, and anxiety.
Results:
SOR and OCI-F scores were moderately significantly correlated (n=274), significant correlations between all SOR modalities and OCS subscales were found with no specific higher correlation between one modality to one OCS subscale. Cluster analysis revealed four distinct clusters: (1) No OC and SOR symptoms (NONE; n=100), (2) High OC and SOR symptoms (BOTH; n=28), (3) Moderate OC symptoms (OCS; n=63), (4) Moderate SOR symptoms (SOR; n=83). The BOTH cluster had significantly higher anxiety levels than the other clusters, and shared OC subscales scores with the OCS cluster. The BOTH cluster also reported higher SOR scores across tactile, vision, taste and olfactory modalities. The SPQ was found reliable and suitable to detect SOR, the sample SPQ scores was normally distributed (n=350).
Conclusions:
SOR is a dimensional feature that can influence the severity of OCS and may characterize a unique sensory OCD subtype.
Several studies documented the involvement of sensory perception in emotional processes. The long-term consequences of traumatic experiences and alexithymia have been demonstrated as well. However, the role of extreme sensory processing patterns, traumatic childhood experiences, and alexithymia has not been thoroughly examined in major affective disorders. The present study aimed to: (1) compare unipolar/bipolar patients with regard to their sensory processing patterns, alexithymia, childhood traumatic experiences and quality of life; (2) examine the correlations between sensory processing patterns and childhood traumatic experiences; (3) investigate the relative contribution of diagnostic groups (unipolar/bipolar), sensory processing patterns, alexithymia, and childhood traumatic experiences in predicting quality of life. The sample included 336 participants, 197 with unipolar and 139 with bipolar disorder. All participants completed the Adolescent/Adult Sensory Profile (AASP), Toronto Alexithymia Scale, Childhood Trauma Questionnaire (CTQ), Beck Depression Inventory (BDI)-II, and Short Form 12 Health Survey version 2 (SF-12). Bipolar patients showed significantly higher physical neglect, emotional abuse, and emotional neglect compared with unipolar patients. Both in unipolar and bipolar groups, lower registration of sensory input as well as hypersensitivity correlated with enhanced childhood trauma events. Reduced sensory sensitivity accounted for 11% of the variance in physical health composite score (PCS) of SF-12 whereas reduced depression accounted for 8% of the variance in mental health composite score (MCS). Furthermore, elevated MCS was predicted by depression, physical and emotional neglect. Sensory processing patterns and childhood traumatic experiences may specifically characterize individuals with major affective disorders and play a role in the prediction of their quality of life.
The objective of this study was to identify and synthesize research about how sensory factors affect daily life of children. We designed a conceptual model to guide a scoping review of research published from 2005 to October 2014 (10 years). We searched MEDLINE, CINAHL, and PsycINFO and included studies about sensory perception/processing; children, adolescents/young adults; and participation. We excluded studies about animals, adults, and review articles. Our process resulted in 261 articles meeting criteria. Research shows that children with conditions process sensory input differently than peers. Neuroscience evidence supports the relationship between sensory-related behaviors and brain activity. Studies suggest that sensory processing is linked to social participation, cognition, temperament, and participation. Intervention research illustrates the importance of contextually relevant practices. Future work can examine the developmental course of sensory processing aspects of behavior across the general population and focus on interventions that support children’s sensory processing as they participate in their daily lives.
Objective:
Atypical sensory modulation (ASM) is characterized by over- or underresponsiveness to sensory stimuli in one or more sensory systems. Faulty sensory information processing could result in anxiety. Because the relation between ASM and psychological distress has not been examined, we explored psychological distress and ASM in the general population.
Method:
A community-based sample of 204 adults (105 men; mean age = 27.4 yr, standard deviation = 3.71) completed the Sensory Responsiveness Questionnaire-Intensity Scale (SRQ-IS; Bar-Shalita, Seltzer, Vatine, Yochman, & Parush, 2009); the Brief Symptom Inventory (BSI; Derogatis & Coons, 1993); and the Short Form-36 Health Survey, Version 2 (SF-36; Ware, Kosinski, & Gandek, 2005).
Results:
The ASM group displayed considerably more distress symptoms than the comparison group. Multivariate linear regression showed SRQ-IS and SF-36 scores as significant predictors of BSI score (r = .64).
Conclusion:
ASM may be a risk factor for developing other mental health concerns.
Understanding sensory processing and sensory processing disorders such as sensory modulation disorder (SMD) is crucial for occupational therapy practitioners. SMD is increasingly identified by families, teachers, special educators, and professionals in other health related fields as an issue for children with a variety of conditions. In a recent issue of the American Journal of Occupational Therapy (AJOT), guest editors Schaaf and Davies (2010) enthusiastically asserted a "perfect storm" has arrived, and we must seize this opportunity to emerge as the leaders in the evolution of the theory of sensory integration and the treatment of people who experience participation limitations related to problems in processing and integrating sensory information. Our terminology must be clear, our role must be clearly delineated, our expertise must be defined, and our interventions must be evidence based (p. 363). It is with this declaration that we define, examine, and anticipate future research on the topic of sensory modulation from both a physiological and behavioral perspective. Here we define and organize the term SMD, including patterns of the clinical presentation of disorders that fall under it. Neuroscience foundations relative to modulation and modulation dysfunction are considered, and tentative links between neuroscience and behavior are presented. Finally, we look at concepts of intervention for disorders of sensory modulation.
Background:
Sensory Modulation Disorder (SMD) interferes with the daily life participation of otherwise healthy individuals and is characterized by over-, under- or seeking responsiveness to naturally occurring sensory stimuli. Previous laboratory findings indicate pain hyper-sensitivity in SMD individuals suggesting CNS alteration in pain processing and modulation. However, laboratory studies lack ecological validity, and warrant clinical completion in order to elicit a sound understanding of the phenomenon studied. Thus, this study explored the association between sensory modulation and pain in a daily life context in a general population sample.
Methods:
Daily life context of pain and sensations were measured in 250 adults (aged 23-40 years; 49.6% males) using 4 self-report questionnaires: Pain Sensitivity Questionnaire (PSQ) and Pain Catastrophizing Scale (PCS) to evaluate the sensory and cognitive aspects of pain; the Sensory Responsiveness Questionnaire (SRQ) to appraise SMD; and the Short Form - 36 Health Survey, version 2 (SF36) to assess health related Quality of Life (QoL).
Results:
Thirty two individuals (12.8%) were found with over-responsiveness type of SMD, forming the SOR-SMD group. While no group differences (SOR-SMD vs. Non-SMD) were found, low-to-moderate total sample correlations were demonstrated between the SRQ-Aversive sub-scale and i) PSQ total (r=0.31, p<0.01) and sub-scales scores (r=0.27-0.28, p<0.01), as well as ii) PCS total and the sub-scales of Rumination and Helplessness scores (r=0.15, p<0.05). PSQ total and sub-scale scores were more highly correlated with SRQ-Aversive in the SOR-SMD group (r=0.57-0.68, p=0.03-<0.01) compared to Non-SMD group. The Physical Health - Total score (but not the Mental Health - Total) of the SF36 was lower for the SOR-SMD group (p=0.03), mainly due to the difference in the Body pain sub-scale (p=0.04).
Conclusions:
Results suggest that SOR-SMD is strongly associated with the sensory aspect of pain but weakly associated with the cognitive aspect. This indicates that SMD co-occurs with daily pain sensitivity, thus reducing QoL, but less with the cognitive-catastrophizing manifestation of pain perception.
The authors investigated trends in probable post-traumatic stress disorder (PTSD) prevalence in the general population of New York City in the first 6 months after the September 11 terrorist attacks. Three random digit dialing telephone surveys of adults in progressively larger portions of the New York City metropolitan area were conducted 1 month, 4 months, and 6 months after September 11, 2001. A total of 1,008, 2,001, and 2,752 demographically representative adults were recruited in the three surveys, respectively. The current prevalence of probable PTSD related to the September 11 attacks in Manhattan declined from 7.5% (95% confidence interval: 5.7, 9.3) 1 month after September 11 to 0.6% (95% confidence interval: 0.3, 0.9) 6 months after September 11. Although the prevalence of PTSD symptoms was consistently higher among persons who were more directly affected by the attacks, a substantial number of persons who were not directly affected by the attacks also met criteria for probable PTSD. These data suggest a rapid resolution of most of the probable PTSD symptoms in the general population of New York City in the first 6 months after the attacks. The psychological consequences of a large-scale disaster in a densely populated urban area may extend beyond persons directly affected by the disaster to persons in the general population.
Purpose
The purpose of the study was to examine the relationship between extreme sensory reactivity as expressed in daily living situations, and trait and state anxiety, among healthy individuals.
Procedures
One hundred and thirty-five healthy individuals filled in the Adolescent/Adult Sensory Profile regarding their responses to daily sensory experiences. Anxiety was assessed by Spielberger's State-Trait Anxiety Inventory.
Findings
Participants with sensory hypersensitivity, as well as those with Low Registration of sensory input, showed elevated trait anxiety and state anxiety. Men with lower registration had more elevated trait anxiety than women. Sensation Avoiding was found to be the significant predictor for state anxiety.
Conclusion
Trait anxiety and state anxiety might be related to extreme sensory processing patterns. Occupational therapy intervention with people who express enhanced anxiety level should refer to their sensory reactivity as a means to optimise intervention outcomes, increase their self-confidence, improve their functioning and participation in daily living, and enhance their wellbeing.
The high prevalence of trauma exposure and subsequent negative consequences for both survivors and society as a whole emphasize the need for secondary prevention of posttraumatic stress disorder. However, clinicians and relief workers remain limited in their ability to intervene effectively in the aftermath of trauma and alleviate traumatic stress reactions that can lead to chronic PTSD. The scientific literature on early intervention for PTSD is reviewed, including early studies on psychological debriefing, pharmacological, and psychosocial interventions aimed at preventing chronic PTSD. Studies on fear extinction and memory consolidation are discussed in relation to PTSD prevention and the potential importance of immediate versus delayed intervention approaches and genetic predictors are briefly reviewed. Preliminary results from a modified prolonged exposure intervention applied within hours of trauma exposure in an emergency room setting are discussed, along with considerations related to intervention reach and overall population impact. Suggestions for future research are included. Prevention of PTSD, although currently not yet a reality, remains an exciting and hopeful possibility with current research approaches translating work from the laboratory to the clinic.
The impact of sensory defensiveness on performance, behaviour and adjustment of children has been addressed in the literature, but little has been written concerning its impact on adults. The purpose of this study was to explore whether sensory-defensive adults had more symptoms of anxiety, depression and pain than adults without sensory defensiveness. Participants were 32 volunteers who were normal functioning adults aged 21 to 48 years, without physical or psychological diagnoses or history of abuse. They were screened to eliminate persons with undiagnosed psychological problems using the Forty-eight Item Counseling Evaluation. Participants were assigned to a sensory-defensive or non-sensory-defensive group based on their score on the ADULT-SI, a sensory history interview, which assesses sensory defensiveness in adults. The two groups were matched for age, gender and race. Participants were then administered the IPAT Anxiety Scale, the IPAT Depression Scale and the Pain Apperception Test. Differences were found between sensory-defensive and non-defensive adults in anxiety (p=0.014) and depression (p=0.019), but not in pain perception. Analysis of the screening scores of the Forty-eight Item Counseling Evaluation indicated an unexpected difference between groups in psychological adjustment (p=0.005). This study supports clinical impressions that sensory-defensive adults differ from non-defensive adults in some psychological parameters. A sequela of sensory defensiveness in adults may be a tendency towards increased symptoms of anxiety and depression. Further, investigation of sensory defensiveness and its sequelae in adults is recommended, using larger samples, more sensitive tools and various diagnostic categories. Exploration of the impact of sensory defensiveness on adult roles and performance and life satisfaction is also recommended. Copyright © 1999 Whurr Publishers Ltd.
To examine how peritraumatic distress modulates the severity of posttraumatic stress disorder (PTSD) according to the timing of the PTSD symptom assessments.
A systematic literature review of English- and French-language studies having administered the Peritraumatic Distress Inventory (PDI) was conducted. Meta-analyses were performed on correlations relating PDI and PTSD symptom scores obtained from the sampled studies. The meta-analyses, which included calculations of regression slopes, took into consideration the time at which PTSD symptoms were assessed following the traumatic event and the timing of the PDI assessment.
The literature review yielded a total of 22 studies. The meta-analysis performed over all studies resulted in a pooled correlation coefficient of 0.55 between the PDI and PTSD symptom scores. Meta-regression analyses conducted over all data revealed no apparent decrease in the correlations according to the timing of the PTSD symptom assessments. However, there were numerical or statistically significant declines in regression slopes when the meta-regressions were separately conducted on studies having administered the PDI either within, or following, a 1-month period after a traumatic event.
While PDI or PTSD symptom score correlations remain generally significant, they tend to decline as time elapses between the traumatic event and the PTSD assessment. This suggests there may be factors other than peritraumatic distress that increasingly account for the long-term trajectory PTSD symptoms.