Trauma-related sleep disturbance and self-reported physical health symptoms in treatment-seeking female rape victims.

The purpose of the study was to assess the relationship between trauma-related sleep disturbance and physical health symptoms in treatment-seeking female rape victims. A total of 167 participants were assessed for PTSD symptoms, depression, sleep disturbance, and frequency of self-reported health symptoms. Results demonstrated that trauma-related sleep disturbance predicted unique variance in physical health symptoms after other PTSD and depression symptoms were controlled. The findings suggest that trauma-related sleep disturbance is one potential factor contributing to physical health symptoms in rape victims with PTSD.

Revictimization rates and method variance: a meta-analysis.

The present meta-analytic review examined revictimization rates and sources of variance among rates provided by 19 empirical studies of adult females. In this review, revictimization refers to the occurrence of at least one incident of childhood sexual abuse followed by a subsequent incident of adult sexual victimization. Studies were included in the review if they provided rates of revictimization and had a comparison sample of nonrevictimized women. The overall effect size for revictimization was .59, a moderate effect, suggesting a definite relationship between childhood victimization and adult victimization experiences. The overall effect size was heterogeneous and various study characteristics and definition issues were examined to determine their effect on revictimization rates. The most striking, although not surprising finding, was that studies in which more inclusive definitions of abuse were utilized yielded smaller effect sizes than studies that used more restrictive definitions of abuse. Studies that examine victimization or revictimization are often concerned with learning more about the phenomenon with the expectation that by understanding the underlying mechanism, prevention and treatment can be better focused. The interpretation given to results from past and future studies should take into account those factors found to influence estimations of revictimization rates.

A bibliotherapy approach to relapse prevention in individuals with panic attacks.

The present study examined a relapse prevention (RP) program delivered via bibliotherapy in the treatment of individuals with panic attacks. Compared with a wait list control group, individuals receiving RP exhibited significant reductions on measures of frequency of panic attacks, panic cognitions, anticipatory anxiety, avoidance, and depression. In addition, individuals in the RP group were more likely to attain a "clinically significant change" in status on both panic-free status and level of avoidance more frequently than individuals in the control group. When compared with treatment effects evaluated in two prior phases of the study, the obtained results appear to be the product of a synchronous effect of bibliotherapy and minimal phone contact during the 6-month follow-up period. The results reflect the importance of brief therapist contact in increasing motivation for active participation in bibliotherapy interventions.

Childhood stress leads to later suicidality via its effect on cognitive functioning.

The present study examined the etiology of suicidal behavior from cognitive and developmental perspectives in a sample of 181 suicidal and nonsuicidal college students. We hypothesized that cognitive functioning would serve as a mediator between early life events and suicidal behavior. The present study examined child maltreatment, family instability, and poor general family environment as early negative life events, and examined self-esteem, locus of control, hopelessness, and problem-solving deficits as cognitive factors. In addition, individuals' perceived social support before age 18 and current social support and life stress were also examined in relation to the preceding variables. A series of structural equation analyses indicated that early negative life events have a mild impact on suicidal behavior, but a stronger impact on cognitive deficits, which in turn have a strong impact on suicidal behavior.

Associations among symptoms of depression and posttraumatic stress disorder and self-reported health in sexually assaulted women.

Symptoms of depression and posttraumatic stress disorder (PTSD) were examined for their association with health status in a sample of sexual assault victims. Hypotheses were that symptoms of each disorder would account for unique variance in health status among individuals exposed to traumatic stressors. Fifty-seven sexually assaulted college women were assessed for prior victimization history, assault characteristics, and depressive and PTSD symptoms. When prior history of sexual victimization, assault severity, and physical reactions during the assault were controlled, hierarchical multiple regression models indicated that symptoms of PTSD and depression were significantly associated with global health perceptions and severity of self-reported health symptoms. Only PTSD symptoms were significantly associated with reproductive health symptoms. The results suggest that both symptoms of PTSD and depression account for the relationship between exposure and health impairment among sexual assault victims.

Relationships among trauma exposure, chronic posttraumatic stress disorder symptoms, and self-reported health in women: replication and extension.

Fifty-two women who served during the Vietnam era were assessed for war-zone exposure, traumatic life events, post-traumatic stress disorder (PTSD), and self-reported health status. Symptoms of PTSD were examined as mediators in the relationship between traumatic exposure and subsequent reports of health problems. Results showed that PTSD symptoms accounted significantly for variance in health problems reported by women with prior traumatic stressor exposure. When the cardinal symptom domains of PTSD (re-experiencing, numbing, avoidance, hyper-arousal) were analyzed separately, the symptom cluster representing hyper-arousal accounted uniquely for the variance associated with health complaints, beyond that contributed by other symptom clusters. Discussion of the results focuses on mechanisms underlying the relationship between specific symptoms of PTSD and self-reported health. Implications for intervention within the medical system are also considered.

Meta-analytic investigation of the effectiveness of self-regulatory components in the treatment of adult problem behaviors.

The present paper utilized meta-analysis to examine the effectiveness of interventions in which components of self-regulation theories (e.g., self-monitoring, self-reinforcement) were the primary treatment intervention utilized in treating habit disturbances, depression, anxiety and health-related problems with adults. The effect size (ES)1 comparing interventions utilizing all combinations of self-regulatory components to no intervention at all was d = .25 (p < .005). The ES comparing interventions utilizing self-monitoring (SM) plus any other self-regulatory component(s) to interventions utilizing SM alone was d = .42 (p < .001). Differential effectiveness was demonstrated for various combinations of self-regulatory components.

Interpersonal violence: expanding the search for long-term sequelae within a sample of battered women.

Lifetime sexual and physical victimization histories were examined within a shelter and outpatient sample of battered women (N = 43). Rates of prior victimization were very high with 71% of women reporting a childhood experience of physical abuse and 53% of women reporting a childhood experience of sexual abuse. These experiences were then examined as predictors of intra- and interpersonal functioning. Difficulties with identity development, low self-worth, borderline personality characteristics, and (at the trend level) difficulties with intimacy, received some support as long-term outcomes associated with reports of chronic experiences of childhood physical abuse. These findings provide some empirical support for the theorized relationship between childhood abuse and difficulties in the domains of intra- and interpersonal functioning.

A comparison of bibliotherapy and group therapy in the treatment of panic disorder.

This study investigated 2 methods of disseminating a cognitive-behavioral intervention for panic disorder (PD). Thirty-six Ss who met diagnostic criteria for PD according to the Anxiety Disorders Interview Schedule-Revised were randomly assigned to 1 of 3 conditions: bibliotherapy (BT), group therapy (GT), or a waiting-list control (WL) condition. Interventions lasted 8 weeks and were followed by a posttest, along with 3- and 6-month follow-up assessments. Results indicated that both the BT and GT treatments were more effective than the WL condition in reducing frequency of panic attacks, severity of physical panic symptoms, catastrophic cognitions, agoraphobic avoidance, and depression and that the BT and GT treatments were more effective in increasing self-efficacy. Both interventions maintained their effects throughout the follow-up periods and produced clinically significant levels of change among the majority of treated Ss.

Life stress, social support, and problem-solving skills predictive of depressive symptoms, hopelessness, and suicide ideation in an Asian student population: a test of a model.

The present study tested both a stress-problem-solving model and a stress-social support model in the etiology of depressive symptoms, hopelessness, and suicide ideation for a group of Asian international students in the United States. Problem-solving skills and social support were hypothesized as two mediators between life stress and depressive symptoms, hopelessness, and suicide ideation. The results from a series of stepwise regression analyses and a path analysis support the hypotheses, indicating that these models generalized to a sample of Asian international students. The roles of social support and problem-solving skills in depressive symptoms and hopelessness are discussed. The results also suggest that hopelessness may serve as a cognitive factor directly affecting depressive symptoms and indirectly affecting suicide ideation.

Early family environments and traumatic experiences associated with borderline personality disorder.

Childhood trauma experiences (e.g., sexual abuse, physical abuse, witnessed violence, and early separation experiences) and family environment characteristics were assessed with a questionnaire from a sample of depressed female inpatients; 17 were diagnosed as having borderline personality disorder (BPD), and 19 received no such diagnosis (NBPD). Significantly more BPD individuals than NBPD individuals reported histories of sexual abuse, physical abuse, and witnessed violence. Of these trauma variables, sexual abuse emerged as the only significant predictor of dimensional BPD score, even after physical abuse, subjective depression score, diagnostic differences between groups, and family environment were controlled. Early separation experiences were nonsignificantly different between groups. Although the BPD families were reported to be distinctive for several different family environment characteristics, the control dimension significantly predicted dimensional borderline score even after sexual abuse was controlled. These results suggest that sexual abuse and general family environment need further study for a fuller understanding of BPD symptomatology.

A meta-analysis of treatments for panic disorder.

In a meta-analysis, the authors compared the effectiveness of psychological and pharmacological treatments for panic disorder. Percentage of agoraphobic subjects in the sample and duration of the illness were unrelated to effect size (ES). Type of dependent variable was generally unrelated to treatment outcome, although behavioral measures yielded significantly smaller ESs. Dependent measures of general anxiety, avoidance, and panic attacks yielded larger ESs than did depression measures. Choice of control was related to ES, with comparisons with placebo controls greater than comparisons with exposure-only or "other treatment" controls. Psychological coping strategies involving relaxation training, cognitive restructuring, and exposure yielded the most consistent ESs; flooding and combination treatments (psychological and pharmacological) yielded the next most consistent ESs. Antidepressants were the most effective pharmacological intervention.

On the stress/parasuicide or parasuicide/stress relationship.

The question of whether high stress leads to attempting suicide (parasuicide) or suicide attempters are more likely to report high stress was examined in a one-year follow-up study of 98 persons, 47 of whom had attempted suicide. Cross-lagged panel correlations between stress and parasuicide provided both concurrent and predictive validity that stress as measured by life changes leads to parasuicide. A high relationship between stress at baseline and stress at follow-up provided support for the notion that some individuals experience chronic stress and that such individuals may be the ones at risk for future suicide attempts.

Psychosocial factors affecting genital herpes recurrences: linear vs mediating models.

Psychosocial factors (emotional distress, stress, health locus of control, and social support) and genital herpes activity (episode frequency, severity, and duration) were assessed for 46 individuals with recurrent genital herpes infections (HSV) in order to predict psychosocial status associated with herpes episodes. Multiple regression analyses revealed that stress and emotional distress accounted for 52% of HSV episode frequency variance, whereas 49% of the episode severity variance was determined by emotional distress and health locus of control. The buffering effects of time and health locus of control were functional only for herpes frequency. Linear predictive models appear to offer a better opportunity for understanding how psychosocial factors affect genital herpes outbreaks than do interactive or buffering models. Results were discussed in terms of the biopsychosocial model of health.

Etiology and treatment of panic disorders.

At this point in time, what do we know concerning the etiology and treatment of panic disorders? First, it appears that panic disorder is reached through multiple paths. Genetic vulnerability manifested through biological vulnerability appears to be a factor in at least some instances of this disorder. Environmental factors, such as interpersonal and other forms of stress, as well as various cognitive processing errors, also likely play a part in the development of panic. Whether these factors are additive or not or whether they combine in some other way to increase the probability that panic will develop is simply unknown at this time. A number of behavioral treatment techniques have developed within the past ten years as ways of ameliorating panic disorder. These techniques have been tied conceptually to etiological models of panic. In addition to exposure techniques, various physiologically based approaches (e.g., breathing retraining) and cognitively based approaches have been studied. These approaches target not only the avoidance behavior of agoraphobia, but also the panic attacks themselves. It appears safe to say that these techniques currently provide a viable alternative to pharmacological agents. Nonetheless, controlled studies that directly assess the relative merits of behavioral and pharmacological techniques are vitally needed. The present review uncovered a number of research questions and methodological issues. Unresolved etiological issues requiring clarification in the near future include the following: (1) Are stressful events important in the development of panic, or are they more incidentally related? Important in answering this question will be studies comparing panic disordered individuals with others suffering from such disorders as dysthymic reaction as well as other anxiety disorders. Also important will be longitudinal studies of individuals found to be suffering from panic disorder in order to determine whether exacerbations are stress related. (2) Are catastrophic thinking and other cognitive errors primary or secondary to panic disorder? That is, are such cognitive problems stable characteristics of panic disordered persons, or do they develop secondarily to panic disorders? (3) What determines whether an individual who develops panic disorder will also develop avoidance behavior? Along these same lines, will treatment approaches that successfully reduce panic have the secondary effect of reducing the prevalence of agoraphobia? (4) Are the behavioral techniques currently being developed to treat panic disorders viable with more severe types of agoraphobia, and will they add significantly to improvement rates when paired with exposure techniques?

Guided imaginal coping: an integrative treatment for panic disorder.

Contemporary models suggest that persons with panic disorder inaccurately attribute somatic anxiety symptoms to catastrophic causes. This consequently exacerbates their physiological symptoms, triggering full-blown panic attacks. Researchers have modified catastrophic thinking using cognitive therapy, but typically have not employed these techniques during actual episodes of heightened arousal. Thus, reported cognitive changes may not generalize to naturalistic situations involving hyperreactivity. This study describes use of an intervention which simultaneously combines symptom exposure and cognitive therapy techniques. The client treated here experienced reductions in panic attack frequency as well as duration and became less depressed as therapy progressed. Discussion addresses potential causal mechanisms and directions for future research.

Examining the interaction effects of coping style and brief interventions in the treatment of postsurgical pain.

The present study sought to ameliorate two major deficiencies in the literature on treating response to surgery, viz., the failure to compare clearly delineated treatments, alone and in combination; and the failure to examine treatment X coping style interactions. Information imparting and brief relaxation were examined in this study as they interacted with an avoidance-sensitization coping style. No differences were found between treatments or coping styles. Sensitizers, on the other hand, were found to profit most from the relaxation training. Avoiders appeared to do well when they were left alone. The interaction effect was demonstrated for both self-report measures of pain and a behavioral measure of potency of medications ingested. The effects on self-report of pain were more evident on the second postsurgical day than on the fourth postsurgical day. The results indicate that brief relaxation training, often the only kind available to the medical psychologist dealing with surgical patients, is best confined to patients with a sensitizing coping style. Further, the results of this study, in conjunction with a reanalysis of previous studies, cast considerable doubt on information imparting when presented alone as a viable technique for reducing the distress consequent on surgery.