Medical Library

Entering exile: Trauma, mental health, and coping among Tibetan refugees arriving in Dharamsala, India.

Each year thousands of Tibetans escape Chinese-controlled Tibet. The authors present findings on the experiences, coping strategies, and psychological distress (depression, anxiety, somatization, and posttraumatic stress disorder) of 769 Tibetan refugees arriving in Dharamsala, India (2003-2004). Distress increased significantly with greater trauma exposure. However, despite a high prevalence of potentially traumatizing events, levels of psychological distress were extremely low. Coping activity (primarily religious) and subjective appraisals of trauma severity appeared to mediate the psychological effects of trauma exposure. The potential impact of other variables, including culturally determined attitudes about trauma and timing of assessment, are discussed.

Sachs E, Rosenfeld B, Lhewa D, Rasmussen A, Keller A.

Department of Psychology, Fordham University, Bronx, NY.

Resting electroencephalogram asymmetry and posttraumatic stress disorder.

The valence-arousal (W. Heller, 1993) and approach-withdrawal (R. J. Davidson, 1998a) models hypothesize that particular patterns of hemispheric brain activity are associated with specific motivational tendencies and psychopathologies. We tested several of these predictions in two groups-a posttraumatic stress disorder (PTSD) and a \”supercontrol\” group, selected to be maximally different from those with PTSD. Contrary to almost all hypotheses, individuals with PTSD did not differ from controls on resting electroencephalogram (EEG) asymmetry. Particular aspects of PTSD were also not related to EEG hemisphere differences. Our null findings are consistent with the few studies that have examined resting EEG asymmetries in PTSD and suggest that PTSD may be associated with different processes than psychopathologies previously examined in studies of hemispheric brain activity (e.g., major depressive disorder, panic disorder).

Shankman SA, Silverstein SM, Williams LM, Hopkinson PJ, Kemp AH, Felmingham KL, Bryant RA, McFarlane A, Clark CR.

Department of Psychology and Psychiatry, University of Illinois at Chicago, Chicago, IL.

Mechanisms of anger and treatment outcome in combat veterans with posttraumatic stress disorder.

Research has identified anger as prominent in, and an influence on, treatment outcome for military veterans with posttraumatic stress disorder (PTSD). This study examined factors influencing the relationship between anger and outcome to improve treatment effectiveness. Participants comprised 103 veterans attending PTSD treatment. Measures of PTSD and comorbidity were obtained at intake and 9-month follow-up. Measures also included potential mediators of therapeutic alliance, social support, problematic/undermining relationships and fear of emotion. Path analyses supported anger as a predictor of treatment outcome, with only fear of anger and alcohol comorbidity accounting for the variance between anger and outcome. To improve treatment effectiveness, clinicians need to assess veterans\’ anger, aggression, and alcohol use, as well as their current fear of anger and elucidate the relationship between these factors.

Forbes D, Parslow R, Creamer M, Allen N, McHugh T, Hopwood M.

Australian Centre for Posttraumatic Mental Health and Department of Psychiatry, University of Melbourne, Victoria, Australia.

Association of child sexual abuse and dating victimization with mental health disorder in a sample of adolescent girls.

The study\’s aim was to assess the association between adolescent girls\’ recall of child sexual abuse (CSA) and prevalence of dating victimization in early romantic relationships and to explore the link between multiple trauma history and mental disorders. When demographics and teacher-reported behavioral problems during childhood were controlled, the risk of presenting with at least one internalized or externalized mental health disorder was higher for adolescent girls with multiple victimization (history of CSA and dating victimization) than for adolescents with no multiple trauma history. Results highlight a strong association between reports of multiple traumatic experiences and mental health disorders of teenaged girls and the need to assess for a broader range of victimization experiences in the design of intervention services.

Hébert M, Lavoie F, Vitaro F, McDuff P, Tremblay RE.

Department of Sexology, Université du Québec à Montréal, Québec, Canada.

PTSD symptom clusters are differentially related to substance use among community women exposed to intimate partner violence.

Women who experience intimate partner violence (IPV) have higher rates of posttraumatic stress disorder (PTSD) and substance abuse compared to women who do not experience IPV. However, the extent to which IPV-related PTSD symptoms are related to women\’s substance use involvement largely has been unexplored. The current study investigated PTSD symptomatology and substance use in a community sample of 212 IPV-exposed women. Drug-using women reported higher PTSD severity scores compared to women who reported no substance use or alcohol use only. Moreover, the reexperiencing, avoidance and numbing, and arousal clusters demonstrated unique associations with substance use involvement. Findings not only elucidate the associations among IPV-related PTSD symptoms and substance use, but they also can inform community-based preventive interventions.

Sullivan TP, Holt LJ.

Department of Psychiatry, Yale University School of Medicine, New Haven, CT.

PTSD diagnoses, subsyndromal symptoms, and comorbidities contribute to impairments for breast cancer survivors.

The clinical importance of posttraumatic stress disorder (PTSD) symptomatology for cancer patients is unclear. The association between the magnitude of cancer-related PTSD symptoms, comorbidity, and functioning is tested. Breast cancer patients (N = 74) were assessed at diagnosis/surgery, followed, and screened for cancer-related PTSD 18 months later. Participants then completed diagnostic interviews and PTSD (n = 12), subsyndromal PTSD (n = 5), and no symptom (n = 47) patient groups were identified. Posttraumatic stress disorder cases were distinguished by having experienced violent traumas and anxiety disorders predating cancer, whereas subsyndromal cases were not. Also, longitudinal data show that PTSD covarys with poorer functioning and lower quality of life among breast cancer survivors. Both PTSD and subsyndromal PTSD were associated with employment absenteeism and the seeking of mental health services.

Shelby RA, Golden-Kreutz DM, Andersen BL.

Department of Psychology, Ohio State University, Columbus, OH.

Acute dissociation predicts rapid habituation of skin conductance responses to aversive auditory probes.

The present study examined how acute dissociation, trait-like dissociative symptoms, and physiological reactivity relate to each other. Sixty-nine undergraduate students were exposed to 14 aversive auditory probes, while their skin conductance responses were measured. A combination of self-reported anxiety and trait-like dissociation was found to predict variability in peritraumatic dissociation levels induced by the aversive probes. Furthermore, high levels of acute dissociation were associated with faster habituation of skin conductance responding, while trait-like dissociation was unrelated to habituation. Interestingly, individuals who reported childhood trauma displayed elevated skin conductance responses. Our findings contribute to the growing body of evidence indicating that subjective feelings of acute dissociation have their objective concomitants, notably fast habituation of physiologic responses.

Giesbrecht T, Merckelbach H, Burg LT, Cima M, Simeon D.

Department of Experimental Psychology, Maastricht University, the Netherlands and Department of Psychiatry, Mount Sinai School of Medicine, New York, NY.

A field test of group based exposure therapy with 102 veterans with war-related posttraumatic stress disorder.

Group-based exposure therapy (GBET) was field-tested with 102 veterans with war-related posttraumatic stress disorder (PTSD). Nine to 11 patients attended 3 hours of group therapy per day twice weekly for 16-18 weeks. Stress management and a minimum of 60 hours of exposure was included (3 hours of within-group war-trauma presentations per patient, 30 hours of listening to recordings of patient\’s own war-trauma presentations and 27 hours of hearing other patients\’ war-trauma presentations). Analysis of assessments conducted by treating clinicians pre-, post- and 6-month posttreatment suggests that GBET produced clinically significant and lasting reductions in PTSD symptoms for most patients on both clinician symptoms ratings (6-month posttreatment effect size delta = 1.22) and self-report measures with only three dropouts.

Ready DJ, Thomas KR, Worley V, Backscheider AG, Harvey LA, Baltzell D, Rothbaum BO.

Mental Health Service Line, VA Medical Center–Atlanta, Decatur, GA and Emory University School of Medicine, Emory University, Atlanta, GA.

Symptom comparison across multiple solicitation methods among Burundians with traumatic event histories.

Debate continues over whether posttraumatic stress disorder (PTSD) symptoms are more biologically based and therefore relatively universal or are more culturally constructed. This study aimed to describe traumatic stress reactions in a Burundian sample and to investigate the influences of the solicitation method (open-ended questions and standardized measures) and psychoeducation (as a process of acculturation) on symptoms reported. Standardized measures showed that distress was manifested in somatization, anxiety, and depression, and less so in specific PTSD symptoms. Content analysis of open-ended questions revealed frequent material complaints. Prior exposure to Western ideas about trauma was predictive of more severe PTSD symptoms. The implications of the findings are discussed in terms of how methodological and cultural factors may influence posttraumatic reactions in nonindustrialized settings.

Yeomans PD, Herbert JD, Forman EM.

Department of Psychology, Drexel University, Philadelphia, PA.

Strengths of character and posttraumatic growth.

How are strengths of character related to growth following trauma? A retrospective Web-based study of 1,739 adults found small, but positive associations among the number of potentially traumatic events experienced and a number of cognitive and interpersonal character strengths. It was concluded that growth following trauma may entail the strengthening of character.

Peterson C, Park N, Pole N, D\’Andrea W, Seligman ME.

Department of Psychology, University of Michigan, Ann Arbor, MI.