A prospective study of psychological adjustment during and after forehead flap nasal reconstruction.

The psychological effects of staged nasal reconstruction with a forehead flap were prospectively investigated. Thirty-three patients underwent nasal reconstruction with forehead flaps between March 2017 and July 2020. Three questionnaires were used to assess psychosocial functioning before surgery (time 1), 1 week after forehead flap transfer (time 2), 1 week after forehead flap division (time 3), and after refinement procedures (time 4). The patients were categorized into three groups according to the severity of nasal defects. Between- and within-group comparisons were conducted. All patients reported increased satisfaction with their appearance during nasal reconstruction. For most patients, levels of distress and social avoidance were highest before reconstruction (time 1). Both levels decreased as reconstruction advanced, and were significantly improved by times 3 and 4. The stage of reconstruction had a greater effect on these levels than did severity of nasal defect. Nasal reconstruction with forehead flap is beneficial physically and psychologically. Psychological evaluation before and after surgery facilitates patient-surgeon interactions and further enhances outcomes.

Predicting DSM-5 PTSD symptomatology 6 months to 2 years after burn: The role of early psychological risk factors.

BACKGROUND: Major burn injuries may have long-term mental health consequences, such as posttraumatic stress disorder (PTSD). This study extended prior work to investigate DSM-5 PTSD symptoms at 6 months, 1 year, and 2 years post-burn as well as the contribution of two sets of early psychological risk factors to DSM-5 PTSD symptoms: Established PTSD risk factors (prior adjustment problems, past trauma, perception of life threat, peritraumatic emotions and dissociation) and theory-derived cognitive factors (negative appraisals of the trauma and its sequelae, memory disorganization, trauma-related rumination, and thought suppression). METHOD: The current study recruited a sample of 118 adult burn patients (75.4% men, mean age 41.8, mean TBSA 18.3%) consecutively admitted to a large regional burn center in Northern Taiwan, who were assessed at 6, 12, and 24 months following their burn injury. RESULTS: A total of 11.0%, 5.9%, and 7.6% met probable DSM-5 PTSD at 6 months, 1 year, and 2 years post-burn, respectively. The rates rose to 15.3%, 10.2%, and 11.0% using the cutoff method. After controlling for covariates, the regression model with theory-derived cognitive factors explained an additional significant 15.9%, 17.2%, and 17.7% of the variance in DSM-5 PTSD symptoms at 6 months, 1 year, and 2 years post-burn, respectively. In contrast, the regression model with established PTSD risk factors explained an additional significant 7.2%, 14.4%, and 10.5% of the variance in DSM-5 PTSD symptoms at 6 months, 1 year, and 2 years post-burn, respectively. Of all predictors, negative appraisals of intrusions was consistently and strongly predictive of DSM-5 PTSD symptomatology post-burn across time, followed by prior depression. CONCLUSIONS: The results underscore the role of early cognitive risk factors in the development and persistence of DSM-5 PTSD symptomatology following burn injury.

Forehead Flap Reconstruction in Different Nasal Defect: 58 Patients' Psychological Outcomes.

Forehead flap nasal reconstruction is a lengthy process; the final outcome requires multiple stages and several months to achieve. After flap transfer, the pedicle flap has to be kept attached to the face for weeks, which may lead to a variety of psychosocial distress and challenges for patients. From April 2011 to December 2016, 58 patients who underwent forehead flap reconstruction for nasal reconstruction were included. The general satisfaction questionnaire, Derriford Appearance Scale 19, and Brief Fear of Negative Evaluation Scale, were utilized to assess the change in psychosocial functioning over 4 time points: preoperative (time 1), 1 week after forehead flap transfer (time 2), 1 week after forehead flap division (time 3), and final outcome after refinement procedures (time 4). The patients were also divided into 3 groups based on the severity of nasal defects: defects involving only a single subunit (n=19), subtotal nasal defects (n=25), and total nasal defects (n=13). Between- and within-group comparisons were conducted. The vast majority of patients had the highest levels of postoperative distress and social avoidance immediately after flap transfer; these levels decreased after flap division and refinement procedures. The psychosocial functioning was more strongly affected by the stage time point than by the severity of the original nasal defects. The forehead flap nasal reconstruction can not only help patients gain a relatively normal nose but also restore their self-esteem and social confidence. The lengthy process is beneficial and worthwhile, even though it involves short-term psychosocial distress.

PTSD and depression in adult burn patients three months postburn: The contribution of psychosocial factors.

OBJECTIVE: Burn injuries can be traumatic and increase the risk of posttraumatic stress disorder (PTSD) and major depression (MDD). The current study examined the incremental contribution of established predictors of PTSD and theory-derived cognitive predictors to PTSD and depression early after burn. METHODS: Participants were 118 adult burn patients consecutively admitted to the largest burn center in Taiwan who completed a baseline assessment, of which 101 (85.6%) were reassessed 3-month post-burn. RESULTS: Three months after the burn, 17.8% and 17.8% of participants met probable DSM-5 PTSD and MDD, respectively. The rates rose to 24.8% and 31.7% using a cut-off of 28 on the Posttraumatic Diagnostic Scale for DSM-5 and 10 on the Patient Health Questionnaire-9, respectively. After controlling for potential confounders, the model with established predictors uniquely explained 26.0% and 16.5% of the variance of PTSD and depressive symptoms 3-month post-burn, respectively. The model with theory-derived cognitive predictors uniquely explained 17.4% and 14.4% of the variance, respectively. Posttrauma social support and thought suppression remained significant predictors of both outcomes. CONCLUSION: A sizeable subset of burn patients suffer from PTSD and depression early after burn. Social and cognitive factors are implicated in the development and recovery of post-burn psychopathology.

Trends in suicide attempts and suicide deaths before and during the COVID-19 pandemic in New Taipei City, Taiwan: an interrupted time-series analysis.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic is an unprecedented global health crisis that may cause mental health problems and heighten suicide risk. We investigated the impact of the COVID-19 pandemic on trends in suicide attempts and suicide deaths in New Taipei City, Taiwan. METHODS: The current study used the official daily data on suicide attempts and deaths in New Taipei City, Taiwan (4 million inhabitants) between 2015 and 2020 from the Taiwan National Suicide Prevention Reporting System. Interrupted time-series (ITS) analyses with parameters corrected by the estimated autocorrelations were applied on weekly aggregated data to examine whether the suicide trends during the early COVID-19 pandemic (late January to July 2020) deviated from previous trends (January 2015 to late January 2020). The impact due to the suicide prevention policy change was also examined (since August 2020). RESULTS: ITS analyses revealed no significant increases in both mean and trend on weekly suicide deaths during the COVID-19 pandemic and after the policy change. In contrast, there was a significant increasing trend in weekly suicide attempts since the COVID-19 outbreak at the rate of 1.54 attempts per week (95% confidence interval 0.49-2.60; p = 0.004). Sex difference analysis revealed that, however, this increasing trend was observed only in females not in males. CONCLUSIONS: The COVID-19 pandemic has different impacts on suicides attempts and deaths during the early pandemic in New Taipei City, Taiwan. The COVID-19 outbreak drastically increased the trend of suicide attempts. In contrast, the number of suicide deaths had remained constant in the investigated periods.

Psychometric properties of the Chinese version of the Centrality of Event Scale across multiple trauma-exposed Taiwanese samples.

The widely used Centrality of Event Scale (CES) measures the extent that a traumatic event serves as a central component of self-identity, a reference point, and a turning point in an individual's life story. The present study aimed to develop a Chinese version of the CES and assess its reliability, criterion validity, and factor structure. Data were collected from three samples of trauma-exposed Taiwanese individuals (N = 939), including 420 earthquake survivors, 300 trauma-exposed community adults, and 219 trauma-exposed undergraduate students. We conducted an exploratory factor analysis and confirmatory factor analysis and compared the resulting models with a one-factor model and the originally proposed model. The results indicated that a new three-factor model, S-Bχ2 (167, N = 519) = 687.01, p < .001, CFI = .95, IFI = .95, NNFI = .94, RMSEA = .078, SRMR = .047, might better represent the construct compared to the one-factor or originally proposed model. Furthermore, the Chinese CES demonstrated excellent internal consistency, Cronbach's αs = .89-.94; adequate 1-month reliability, rs = .54-.64, and 6-month temporal stability, rs = .52-.67; and good concurrent and predictive validity. The findings indicate that the Chinese version of the CES demonstrates good psychometric properties with a three-factor structure, and it could be used to assess event centrality among nonclinical trauma-exposed Taiwanese adults.

Long-term mental health outcomes of severe burn injury: A 5-year follow-up of the 2015 Formosa Fun Coast Water Park fire disaster.

OBJECTIVE: Severe burn injuries have profound mental health impacts on individuals, such as posttraumatic stress disorder (PTSD) and major depressive disorder (MDD). Many burn survivors also report positive psychosocial changes, termed posttraumatic growth (PTG). This study investigated long-term mental health of severe burn injury (i.e., PTSD, MDD, and PTG) and the longitudinal influences of coping strategies and social support. METHODS: Ninety-nine adult burn survivors of the 2015 Formosa Fun Coast Water Park fire disaster participated in the 5-year follow-up (Wave 3, W3), with 93% completing the earlier 2- (Wave 1, W1) and 3-year follow-up (Wave 2, W2). Participants averaged 22.1 years of age at burn, and 62.6% were females. The mean total body surface area burned (TBSA) was 50.3%, with a mean length of hospital stay of 87.6 days. RESULTS: Five years after the 2015 fire disaster, 13.1%, and 14.1% of the survivors met probable DSM-5 PTSD and MDD, while 51.5% reported significant PTG. After controlling for demographic, burn-specific, and baseline outcome variables, avoidance coping at W2 prospectively predicted PTSD and depressive symptoms at W3 (p = .003 and 0.04), with medium-to-large and medium effect sizes (sr2 = 0.10 and 0.05). Approach coping at W2 prospectively predicted PTG at W3 (p = .014), with a medium-to-large effect size (sr2 = 0.07). CONCLUSION: Rates of probable PTSD and MDD were still relatively high in long-term burn survivors. However, PTG continued to be highly prevalent. Our findings highlight the importance of coping in affecting the long-term mental health of severe burn injury.

The facilitating role of dispositional mindfulness in the process of posttraumatic growth: A prospective investigation.

OBJECTIVE: Traumatic events can lead not only to psychological distress but also to posttraumatic growth (PTG). As trauma challenge one's fundamental assumptions, traumatized individuals may initially experience intrusive rumination. However, these challenged assumptions could facilitate further cognitive processing of trauma (i.e., deliberate rumination), which in turn fosters PTG. Adaptive cognitive processes, such as reduced rumination, have been linked to dispositional mindfulness. Thus, the current study aimed to investigate the potential role of dispositional mindfulness in the process of PTG. METHOD: A 3-wave longitudinal design was employed to capture temporal changes in PTG. At the initial assessment (time 1), 259 traumatized individuals were assessed with regard to their trauma experiences, core belief challenge, intrusive and deliberate rumination, posttraumatic stress symptoms (PTSS), PTG, and dispositional mindfulness. The surveys were repeated after 1 month (time 2) and 7 months (time 3). RESULTS: Over time, the first indirect association of core belief challenge was increased PTG through recent intrusive and deliberate rumination, and the second indirect association of core belief challenge was decreased PTG through recent intrusive rumination and PTSS. In addition, dispositional mindfulness significantly moderated these 2 indirect associations. Individuals with a medium level of mindfulness at time 1 had lower levels of rumination and PTSS at time 3 compared to individuals with a low level of mindfulness. CONCLUSIONS: In the face of trauma, dispositional mindfulness promotes resilience through a subsequent reduction in rumination and PTSS. Our results highlight the protective role of dispositional mindfulness in long-term outcomes of trauma exposure. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Burn severity and long-term psychosocial adjustment after burn injury: The mediating role of body image dissatisfaction.

BACKGROUND: Persons with severe burns often develop long-term psychosocial difficulties such as posttraumatic stress disorder (PTSD) and depression. Significant appearance changes following burn injury (e.g., scarring and disfigurement) can lead to body image dissatisfaction (BID) that causes psychological problems. Using a two-wave longitudinal design, this study examined the association between burn severity and psychosocial adjustment after burns (symptoms of PTSD and depression), particularly through the mediating role of BID. METHOD: Participants were 111 burn survivors of the 2015 Formosa Fun Coast Water Park explosion. The mean age was 24.23 years, and 62.2% were female. The average TBSA burned was 50.3%, and the mean length of stay (LOS) in hospital was 85.44 days. Data were collected two (Time 1, T1) and three years (Time 2, T2) after the 2015 explosion. A composite burn severity score (CBSS) was additionally created based on TBSA and LOS. RESULTS: Three main findings emerged: (1) burn severity (TBSA, LOS, and CBSS) were significantly associated with T1 BID and T2 depressive symptoms, but not with T2 PTSD symptoms; (2) T1 BID significantly mediated the relationship between burn severity (TBSA and CBSS) and T2 PTSD symptoms, after controlling for T1 PTSD symptoms; and (3) T1 BID significantly mediated the relationship between burn severity (TBSA, LOS, and CBSS) and T2 depressive symptoms, after controlling for T1 depressive symptoms. CONCLUSIONS: The current findings highlight the importance of BID in the development and maintenance of psychosocial maladjustment long after burn injury.

Dimensionality of DSM-5 PTSD symptoms: Validation of the Chinese version of the posttraumatic diagnostic scale for DSM-5 across multiple trauma samples.

The Posttraumatic Diagnostic Scale for DSM-5 (PDS-5) is an updated DSM-5 version of the PDS, a widely used measure for PTSD. The PDS-5 has recently been shown to possess sound psychometric properties and awaits cross-cultural validation. The present study aimed first, to evaluate the psychometric properties of the Chinese version of the PDS-5; second, to evaluate alternative factor models of DSM-5 PTSD symptoms with multiple trauma samples. Data were collected from five samples of Taiwanese trauma-exposed individuals (total N = 903): 138 burn injury survivors, 403 earthquake survivors, 181 trauma-exposed young adults, 91 trauma-exposed undergraduates, and 90 female domestic violence survivors. The Chinese PDS-5 possessed excellent internal consistency (α s = .94-.95) and satisfactory five-week (r = .80) and one-year temporal stability (r = 0.76). Convergent, concurrent, and discriminant validity were also established. Consistent with recent studies, confirmatory factor analyses demonstrated the best fit of a seven-factor Hybrid model, followed by a six-factor Anhedonia model across multiple trauma samples.

PTSD, depression and posttraumatic growth in young adult burn survivors: Three-year follow-up of the 2015 Formosa fun coast water park explosion in Taiwan.

OBJECTIVE: The 2015 Formosa Fun Coast Water Park explosion was a devastating disaster in Taiwan, leaving 15 dead and 484 burn injured. The present study estimated the prevalence of probable PTSD, major depression (MDD), and significant posttraumatic growth (PTG) in burn survivors three years after the explosion. Potential predictors of PTSD and depressive symptoms and PTG (demographic, burn-related, and psychosocial variables) were examined. METHODS: Participants were 125 young adult burn survivors. The mean age at the incident was 22.4 years (SD = 4.1) and 62.4% were female. The average total body surface area burned was 51.6% (SD = 19.2%). RESULTS: Three years after the explosion, 16.8% and 8.8% of the burn survivors met DSM-5 criteria of probable PTSD and MDD. Gender differences were observed in the prevalence of MDD but not PTSD. PTG was still highly prevalent, with 47.2%, 78.4%, and 84.0% of participants reporting significant PTG at the total scale, subscale, and item levels, respectively. Using hierarchical regression, psychosocial variables explained large amounts of variance in PTSD and depressive symptoms and PTG post-burn (△R2 = 0.411, 0.377, and 0.523) beyond that explained by demographic and burn-related variables. More avoidance and less approach coping predicted greater PTSD and/or depression symptoms post-burn. More approach coping and greater social support strongly predicted higher PTG post-burn. CONCLUSION: Rates of probable PTSD and MDD were relatively high in burn survivors, however, PTG was also highly prevalent. Coping styles and social support may play distinct roles in psychosocial adjustment after burn injury.

Posttraumatic growth among burn survivors 2 years after the 2015 Formosa Fun Coast Water Park explosion in Taiwan.

OBJECTIVE: Posttraumatic growth (PTG) is commonly observed in trauma survivors. Information on PTG and its predictors among burn survivors is relatively limited. The present study sought to investigate the prevalence and predictors of PTG in burn survivors. The predictors of interest included the variables from Tedeschi and Calhoun's model of PTG (core belief challenge, deliberate rumination, trauma disclosure, and perceived social support) and positive personality attributes (resilience, grateful disposition, and dispositional forgiveness). METHOD: Participants were 116 burn survivors of the 2015 Formosa Fun Coast Water Park explosion in Taiwan. The mean age at the event was 22.3 years (SD = 4.2), with the average total body surface area (TBSA) burned of 49.5% (SD = 19.6). RESULTS: Two years after the explosion, 51.7% of the burn survivors experienced "significant" PTG (i.e., at least moderate growth). This proportion rose to 80.2% and 88.8% when assessing PTG at the domain and item levels, respectively. The variables from Tedeschi and Calhoun's model and positive personality attributes both significantly and substantially predicted PTG postburn, after adjusting for demographic and burn characteristics. Moderation analyses revealed that the effect of deliberate rumination on PTG postburn was stronger among those with low and moderate levels of resilience. The effect of trauma disclosure on PTG postburn was stronger among those with low and moderate dispositional forgiveness. CONCLUSION: These findings highlight the applicability of psychological theories of PTG to trauma-related growth of burn survivors. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Predictors for Excellent Versus Partial Response to Prolonged Exposure Therapy: Who Needs Additional Sessions?

In practice, the duration of psychotherapy is determined by the patient's response to treatment. Identifying predictors for treatment responses is of great clinical utility to guide clinicians in their treatment planning. Demographic characteristics, trauma history, comorbidity, and early reduction of posttraumatic stress disorder (PTSD) symptoms were examined as predictors of excellent versus partial response to prolonged exposure therapy (PE) for PTSD. Participants were 96 female assault survivors with chronic PTSD who received at least eight PE sessions with or without cognitive restructuring. Participants were classified as excellent responders (n = 27) or partial responders (n = 69) based on whether they achieved at least 70% improvement in self-reported PTSD severity on the PTSD Symptom Scale-Self-Report at the end of Session 8. Excellent responders terminated therapy after Session 9, and partial responders were offered up to three additional sessions. Logistic regression was conducted to investigate predictors of response to PE. Results showed that prior interpersonal violence and comorbid alcohol use disorder were associated with partial response. Comorbid depressive disorder and early PTSD symptom reduction were associated with excellent response. Being treated by a cognitive behavioral therapy expert predicted higher excellent response for patients with a history of prior interpersonal violence. The model accounted for 56.6% of the variance in treatment response and correctly predicted responder status for 83.3% of the sample. These findings contribute to the field's understanding of factors that predict or moderate response to PE and have implications for treatment planning.

Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Predictores de Respuesta Excelente Versus Parcial a la Terapia De Exposición Prolongada: ¿Quién Necesita Más Sesiones? RESPUESTA A LA EXPOSICIÓN PROLONGADA POR TEPT En la práctica, la duración de la psicoterapia está determinada por la respuesta del paciente al tratamiento. La identificación de predictores para las respuestas al tratamiento es de gran utilidad clínica para guiar a los clínicos en su planificación de tratamiento. Características demográficas, historia de trauma, comorbilidad y una reducción temprana de los síntomas del trastorno de estrés postraumático (TEPT) fueron examinados como predictores de respuesta excelente versus respuesta parcial a la terapia de exposición prolongada (EP) para el TEPT. Las participantes fueron 96 mujeres sobrevivientes de asalto con TEPT crónico que recibieron al menos ocho sesiones de EP con o sin reestructuración cognitiva. Las participantes fueron clasificadas como respondedores excelentes (n = 27) o respondedores parciales (n = 69) en función de si lograron al menos un 70% de mejoría en el autoinforme de severidad del TEPT en la Escala de Síntomas Auto-reportados de TEPT al final de la sesión 8. Los respondedores excelentes terminaron la terapia después de la sesión 9, y se ofreció tres sesiones adicionales a los respondedores parciales. Se realizó una regresión logística para investigar los predictores de respuesta a la EP. Los resultados mostraron violencia interpersonal previa y comorbilidad de trastorno por consumo de alcohol asociados con respuesta parcial. Comorbilidad de trastorno depresivo y reducción temprana del síntoma de TEPT se asoció con una excelente respuesta. Ser tratado por un experto en terapia de comportamiento cognitivo (TCC) predijo una respuesta excelente superior para los pacientes con antecedentes de violencia interpersonal. El modelo dio cuenta del 56.6% de la varianza en la respuesta al tratamiento y predijo correctamente el estado del respondedor para el 83.3% de la muestra. Estos hallazgos contribuyen a la esfera de comprensión de los factores que predicen o moderan la respuesta a la EP y tienen implicaciones para planificación del tratamiento.

Prevalence and predictors of posttraumatic stress disorder and depressive symptoms among burn survivors two years after the 2015 Formosa Fun Coast Water Park explosion in Taiwan.

Background: Posttraumatic stress disorder (PTSD) and depressive symptoms are relatively common in burn survivors. Several previously reported risk factors (e.g. burn severity) have not consistently predicted psychological adjustment post-burn. Empirically-derived risk factors of PTSD from the meta-analysis and theory-derived cognitive variables may be of great predictive value. Objective: This study investigated the prevalence of probable DSM-5 PTSD and major depression (MDD) and the predictors of PTSD and depressive symptoms in burn survivors of the 2015 Formosa Fun Coast Water Park explosion. Three sets of predictors were examined: (a) burn-related variables; (b) empirically-derived risk factors from the meta-analysis; and (c) theory-derived cognitive variables. Method: Participants were 116 burn survivors of the Formosa Fun Coast Water Park explosion. The mean age at the disaster was 22.3 ± 4.2 years; the average total body surface area burned (TBSA) was 49.5%. Results: Of our participants, 12.9 and 20.7% met DSM-5 probable PTSD and MDD two years after the Formosa Fun Coast Water Park explosion. No gender differences were observed. For the prediction of PTSD symptoms post-burn, theory-derived cognitive variables (adjusted R2 = .562, 95% CI [.423, .638]) performed best and provided significantly better prediction than empirically-derived risk factors from the meta-analysis (adjusted R2 = .337, 95% CI [.180, .412]) and burn-related variables (adjusted R2 = .313, 95% CI [.156, .389]). In contrast, the three sets of variables examined provided similar predictions for depressive symptoms post-burn (adjusted R2 = .267-.295). Random forest regression revealed that theory-derived cognitive variables, particularly negative appraisal of symptoms and maladaptive cognitive coping, were considered the most important predictors of PTSD symptoms post-burn. Conclusion: The prevalence of probable PTSD and MDD were relatively higher in burn survivors. Theory-derived cognitive variables substantially improve predictions for PTSD symptoms post-burn.

Antecedentes: El Trastorno de Estrés Post-traumático (TEPT) y los síntomas depresivos son relativamente frecuentes entre sobrevivientes a quemaduras. Varios factores de riesgo previamente reportados (por ej., severidad de la quemadura) no han predicho sistemáticamente el ajuste psicológico post-quemadura. Factores de riesgo de TEPT empíricamente derivados de meta-análisis y variables cognitivas derivadas de la teoría pueden tener gran valor predictivo. Objetivo: Este estudio investigó la prevalencia de probable TEPT y depresión mayor (DM), según DSM-5, y los predictores de TEPT y síntomas depresivos en sobrevivientes de quemaduras de la explosión en el Formosa Coast Water Park del año 2015. Tres grupos de predictores fueron examinados: (a) variables relacionadas con la quemadura; (b) factores de riesgo empíricamente derivados de meta-análisis; y (c) variables cognitivas derivadas de la teoría. Método: Participaron 116 sobrevivientes de quemaduras de la explosión en el Formosa Coast Water Park. La edad promedio al momento del desastre fue 22.3±4.2 años; la superficie corporal quemada total promedio fue 49.5%. Resultados: De nuestros participantes, 12.9% y 20.7% cumplieron criterios para probable TEPT y DM según DSM-5 tras dos años de ocurrida la explosión en el Formosa Coast Water Park. No se observaron diferencias por género. Respecto a la predicción de síntomas de TEPT post-quemadura, las variables cognitivas derivadas de la teoría (R2 ajustado = 0.562, IC 95% [0.427, 638]) rindieron mejor y entregaron una predicción significativamente mejor que los factores de riesgo derivados de meta-análisis (R2 ajustado = 0.337, IC 95% [0.180, 0.412] y que las variables relacionadas con la quemadura (R2 ajustado = 0.313, IC 95% [0.156, 0.389]). En contraste, los tres grupos de variables examinadas entregaron similar predicción para síntomas depresivos post-quemadura (R2 ajustado = 0.267-0.295). La regresión de bosques aleatorios reveló que las variables derivadas de la teoría, particularmente valoración negativa de síntomas y afrontamiento cognitivo desadaptativo, fueron consideradas los más importantes predictores de síntomas de TEPT post-quemadura. Conclusión: La prevalencia de probable TEPT y DM fue relativamente alta entre los sobrevivientes de quemaduras. Las variables cognitivas derivadas de la teoría mejoran sustancialmente las predicciones para síntomas de TEPT post-quemadura.

Negative Cognitions Prior to Trauma Predict Acute Posttraumatic Stress Disorder Symptomatology.

Based on emotional processing theory, preexisting negative cognitions may contribute to the development of posttraumatic stress disorder (PTSD) symptoms. The present study prospectively examined the association between preexisting PTSD-related cognitions and subsequent acute PTSD symptoms, and the potential mediators of this association. We also compared the effect of preexisting depressive cognitions and preexisting PTSD-related cognitions on PTSD symptoms. In the current study, 810 Taiwanese undergraduates completed a baseline survey (T1), of which 73.1% (n = 592) participated in a second survey two months later (T2). Of those who completed both surveys, 97 experienced a trauma at least one week before T2; this group comprised the final sample. Hierarchical regression showed that preexisting PTSD-related cognitions (ß = .38, p < .001, sr2 = .117), but not preexisting depressive cognitions (ß = .11, p = .315, sr2 = .011), were a significant and substantial predictor of acute PTSD symptoms after we controlled for established pretrauma risk factors (i.e., gender, prior trauma, and prior psychological problems). Multiple mediation analysis revealed that negative appraisal of symptoms (a1 b1 = 0.90, 95% CI [0.16, 2.18], PM = .251) and trauma-related rumination (a3 b3 = 1.23, 95% CI [0.23, 2.86], PM = .341), but not trauma memory disorganization (a2 b2 = 0.65, 95% CI [-0.17, 1.92], PM = .182), significantly mediated between preexisting PTSD-related cognitions and acute PTSD symptoms. Our findings highlight the role of preexisting negative cognitions in acute PTSD symptomatology. The development of PTSD symptoms is likely determined by the interaction of risk factors before and after trauma.

Changes in PTSD and Depression During Prolonged Exposure and Client-Centered Therapy for PTSD in Adolescents.

Depressive symptoms are common among individuals with posttraumatic stress disorder (PTSD). Prolonged exposure therapy (PE) for PTSD has been found to alleviate both PTSD and depressive symptoms, but relatively little is known about the pattern of PTSD and depressive symptom change during treatment. This study aimed to investigate the relationship between changes in PTSD and depression during PE for adolescent (PE-A) and client-centered therapy (CCT). The moderating role of PE-A versus CCT and the possible differences across symptom clusters of PTSD were also examined. Participants were 61 female adolescents with sexual-assault-related PTSD randomized to PE-A (n = 31) or CCT (n = 30). Participants completed the Beck Depression Inventory and the Child PTSD Symptom Scale at pre-, mid-, and posttreatment and before each treatment session. Multilevel mediation analysis indicated a reciprocal but asymmetrical relationship between changes in PTSD and depression during treatment in the overall sample. Moderated mediation analysis showed that the reciprocal relation was observed only during PE-A. Reductions in PTSD led to reductions in depression to a greater extent (48.7%), 95% confidence interval [30.2, 67.2], than vice versa (22.0%), [10.6, 33.4]. For participants receiving CCT, reduction in PTSD led to reductions in depression (31.6%), [11.8, 51.4], but not vice versa (7.4%), [-7.1, 21.9]. The reciprocal relationship between PTSD and depression was also observed across different symptoms clusters of PTSD. Our findings suggest that changes in PTSD led to changes in depressive symptoms to a greater extent than vice versa across PE-A and CCT.

Attachment Dimensions and Post-traumatic Symptoms Following Interpersonal Traumas versus Impersonal Traumas in Young Adults in Taiwan.

Greater risk of post-traumatic stress disorder (PTSD) is seen in individuals exposed to interpersonal traumatic events. Based on an attachment perspective, interpersonal trauma exposure may activate one's attachment insecurity system and disrupt affect, behaviour and interpersonal function, which may in turn create more difficulties to cope with interpersonal traumas and exacerbate PTSD symptomatology. The present study examined whether attachment anxiety relative to attachment avoidance would be a stronger predictor of greater PTSD symptoms following interpersonal traumas versus impersonal traumas in a Taiwanese sample. One hundred and sixty-two trauma-exposed Taiwanese young adults completed the measures of symptoms of depression, anxiety and PTSD, and attachment anxiety and attachment avoidance. In this Taiwanese study, higher attachment anxiety was observed in individuals who were exposed to interpersonal traumas. The interpersonal trauma group reported greater PTSD symptoms than did the impersonal trauma group. Specifically, after controlling for age, occurrence of trauma and distress of trauma, attachment anxiety, but not attachment avoidance, predicted more PTSD total severity and avoidance symptoms in the interpersonal trauma group. The findings may be pertinent to attachment anxiety-related hyperactivating strategies, as well as specific cultural values and a forbearance strategy applied to regulate traumatic distress in a collectivist society. Copyright © 2016 John Wiley & Sons, Ltd.

Cognitive Mediation of Symptom Change in Exposure and Response Prevention for Obsessive-Compulsive Disorder.

This study examined cognitive mediators of symptom change during exposure and response prevention (EX/RP) for obsessive-compulsive disorder (OCD). Based on cognitive models of OCD, obsessive beliefs were hypothesized as a mediator of symptom change. Participants were 70 patients with primary OCD receiving EX/RP either as part of a randomized controlled trial (n=38) or in open treatment following nonresponse to risperidone or placebo in the same trial (n=32). Blinded evaluations of OCD severity and self-report assessments of three domains of obsessive beliefs (i.e., responsibility/threat of harm, importance/control of thoughts, and perfectionism/intolerance of uncertainty) were administered during acute (Weeks 0, 4 and 8) and maintenance treatment (Weeks 12 and 24). Study hypotheses were examined using cross-lagged multilevel modeling. Contrary to predictions, the obsessive beliefs domains investigated did not mediate subsequent OCD symptom reduction. In addition, OCD symptoms did not significantly mediate subsequent change in obsessive beliefs. The present study did not find evidence of cognitive mediation during EX/RP for OCD, highlighting the need to investigate other plausible mediators of symptom improvement.

Mechanisms of symptom reduction in a combined treatment for comorbid posttraumatic stress disorder and alcohol dependence.

OBJECTIVE: To examine the mechanisms of prolonged exposure (PE) and naltrexone (NAL) that underlie symptom reduction among individuals with comorbid posttraumatic stress disorder (PTSD) and alcohol dependence (AD). We hypothesized that (a) reduction in negative cognitions mediates PTSD improvement during PE; (b) reduction in alcohol craving mediates reduction in drinking frequency during NAL treatment; and (c) PTSD improvement mediates reduction in craving and alcohol use during PE. METHOD: Participants were 159 individuals meeting the DSM-IV diagnosis of PTSD and AD randomly assigned to 1 of 4 conditions: PE + NAL, PE + placebo (PBO), supportive counseling (SC) + NAL; and SC + PBO. All participants received supportive counseling. RESULTS: Lagged multilevel mediational analyses indicated that (a) a reciprocal relationship between cognitive change and PTSD improvement was observed in PE + NAL, PE + PBO, and SC + NAL, but not in SC + PBO; (b) reduction in craving significantly mediated subsequent decrease in alcohol use in PE + NAL and SC + PBO, but not in PE + PBO and SC + NAL; and (c) PTSD improvement significantly mediated subsequent reduction of craving in PE + PBO, and mediated decrease in alcohol use in PE + NAL. CONCLUSIONS: The efficacy of combining PE and NAL for reducing alcohol use among those with comorbid PTSD/AD seems to be through reduction in both PTSD symptoms and craving. These findings shed light on the mechanism of PE and highlight the central role of PTSD in the maintenance of alcohol craving and use in patients with comorbid PTSD/AD.

Are 60-minute prolonged exposure sessions with 20-minute imaginal exposure to traumatic memories sufficient to successfully treat PTSD? A randomized noninferiority clinical trial.

The study aims to determine whether 60-minute sessions of prolonged exposure (PE) that include 20 minutes of imaginal exposure (IE) are noninferior to the standard 90-minute sessions that include 40 minutes of IE in treating posttraumatic stress disorder (PTSD) and to explore the relationship of treatment outcome to within- and between-session habituation and change in negative cognitions. Thirty-nine adult veterans with chronic PTSD were randomly assigned to 90-minute (n=19) or 60-minute (n=20) sessions of PE. PTSD symptoms were assessed by an unaware independent evaluator before and after treatment and at 6-month follow-up. Self-reports of depression and negative cognitions were assessed before and after treatment. Participants in both conditions showed significant reductions in PTSD symptoms. Sixty-minute sessions were found to be noninferior to 90-minute sessions in reducing PTSD symptoms, as the upper bound of the 95% confidence interval for the difference between conditions in the PTSD Symptom Scale-Interview (posttreatment: 6.00; follow-up: 6.77) was below the predefined noninferiority margin (7.00). Participants receiving shorter sessions showed less within- and between-session habituation than those receiving longer sessions, but no group differences in reductions in negative cognitions were found. The current findings indicate that the outcomes of 60-minute sessions of PE do not differ from those of 90-minute sessions. In addition, change in trauma-related cognitions and between-session habituation are both potential mechanisms of PE.