The role of dissociation-related beliefs about memory in trauma-focused treatment.

OBJECTIVE: Dysfunctional cognitions play a central role in the development of post-traumatic stress disorder (PTSD). However the role of specific dissociation-related beliefs about memory has not been previously investigated. This study aimed to investigate the role of dissociation-related beliefs about memory in trauma-focused treatment. It was hypothesized that patients with the dissociative subtype of PTSD would show higher levels of dissociation-related beliefs, dissociation-related beliefs about memory would decrease after trauma-focused treatment, and higher pre-treatment dissociation-related beliefs would be associated with fewer changes in PTSD symptoms. METHOD: Post-traumatic symptoms, dissociative symptoms, and dissociation-related beliefs about memory were assessed in a sample of patients diagnosed with PTSD (n = 111) or the dissociative subtype of PTSD (n = 61). They underwent intensive trauma-focused treatment consisting of four or eight consecutive treatment days. On each treatment day, patients received 90 min of individual prolonged exposure (PE) in the morning and 90 min of individual eye movement desensitization and reprocessing (EMDR) therapy in the afternoon. The relationship between dissociation-related beliefs about memory and the effects of trauma-focused treatment was investigated. RESULTS: Dissociation-related beliefs about memory were significantly associated with PTSD and its dissociative symptoms. In addition, consistent with our hypothesis, patients with the dissociative subtype of PTSD scored significantly higher on dissociation-related beliefs about memory pre-treatment than those without the dissociative subtype. Additionally, the severity of these beliefs decreased significantly after trauma-related treatment. Contrary to our hypothesis, elevated dissociation-related beliefs did not negatively influence treatment outcome. CONCLUSION: The results of the current study suggest that dissociation-related beliefs do not influence the outcome of trauma-focused treatment, and that trauma-focused treatment does not need to be altered specifically for patients experiencing more dissociation-related beliefs about memory because these beliefs decrease in association with treatment.

This study investigated the role of dissociation-related beliefs about memory on trauma-focused treatment.Dissociation-related beliefs were related to post-traumatic and dissociative symptoms, and were especially prominent in patients with the dissociative subtype of post-traumatic stress disorder.Dissociation-related beliefs about memory do not impact the effectiveness of trauma-focused treatment. In fact, trauma-focused treatment effectively decreased these beliefs, suggesting that dissociation-related beliefs about memory should not be a determining factor in withholding patients from receiving trauma-focused therapy.

Predictors of treatment dropout in patients with posttraumatic stress disorder due to childhood abuse.

Background: Knowledge about patient characteristics predicting treatment dropout for post-traumatic stress disorder (PTSD) is scarce, whereas more understanding about this topic may give direction to address this important issue. Method: Data were obtained from a randomized controlled trial in which a phase-based treatment condition (Eye Movement Desensitization and Reprocessing [EMDR] therapy preceded by Skills Training in Affect and Interpersonal Regulation [STAIR]; n = 57) was compared with a direct trauma-focused treatment (EMDR therapy only; n = 64) in people with a PTSD due to childhood abuse. All pre-treatment variables included in the trial were examined as possible predictors for dropout using machine learning techniques. Results: For the dropout prediction, a model was developed using Elastic Net Regularization. The ENR model correctly predicted dropout in 81.6% of all individuals. Males, with a low education level, suicidal thoughts, problems in emotion regulation, high levels of general psychopathology and not using benzodiazepine medication at screening proved to have higher scores on dropout. Conclusion: Our results provide directions for the development of future programs in addition to PTSD treatment or for the adaptation of current treatments, aiming to reduce treatment dropout among patients with PTSD due to childhood abuse.

Personality disorder traits, maladaptive schemas, modes and coping styles in participants with complex dissociative disorders, borderline personality disorder and avoidant personality disorder.

OBJECTIVE: The schema mode model offers a new conceptualisation of complex dissociative disorders (CDD) as it explains shifts between identities as shifts between schema modes. Furthermore, in this model CDD is conceived as personality pathology, incorporating core features of personality disorders. This study tested the assumptions of this schema mode model of CDD. METHOD: Questionnaires measuring personality disorder traits, schemas, schema modes and coping styles were filled out by patients with CDD, borderline personality disorder and avoidant personality disorder (N = 210), and their scores on the various constructs were compared. RESULTS: Participants with CDD were characterised by specific schizoid, schizotypal, borderline and avoidant personality traits and early maladaptive schemas in the domains of disconnection and rejection and over-vigilance and inhibition. The most pronounced schema modes were the dysfunctional parent modes, avoidant coping modes and the vulnerable child mode. For coping styles, no differences were found between the diagnostic groups. CONCLUSION AND DISCUSSION: On all outcome measures participants with CDD scored at the level of personality disorders and showed a unique pattern different from participants with borderline and avoidant personality disorder. This suggests that CDD shows features akin to a personality disorder. A clinical implication is that an adapted form of schema therapy might present a viable treatment option for CDD.

Schema therapy for Dissociative Identity Disorder: a case report.

Treatment for Dissociative Identity Disorder (DID) often follows a practice-based psychodynamic psychotherapy approach that is conducted in three phases: symptom stabilization, trauma processing, and identity integration and rehabilitation. The percentage of patients that reach the third phase is relatively low, treatment duration is long, and the effects of this treatment on the core DID symptoms have been found to be small or absent, leaving room for improvement in the treatment of DID. Schema Therapy (ST) is an integrative psychotherapy that has been proposed as a treatment for DID. This approach is currently being investigated in several studies and has the potential to become an evidence-based treatment for DID. This case report presents an overview of the protocol adaptations for DID ST treatment. The presented case concerns a 43-year-old female patient with DID, depressive disorder (recurrent type), PTSD, cannabis use disorder, and BPD. Functioning was very low. She received 220 sessions of ST, which included direct trauma processing through Imagery Rescripting (ImRs). The patient improved in several domains: she experienced a reduction of PTSD symptoms, as well as dissociative symptoms, there were structural changes in the beliefs about the self, and loss of suicidal behaviors. After treatment she was able to stop her punitive mode, to express her feelings and needs to others, and to participate adequately in social interaction. This case report indicates that ST might be a viable treatment for DID, adding to a broader scope of treatment options for this patient group.

The Dissociation-Related Beliefs About Memory Questionnaire (DBMQ): Development and psychometric properties.

OBJECTIVE: Discontinuities in memory are the hallmark symptoms of most dissociative disorders but are also reported by patients diagnosed with related disorders, including PTSD. Memory discontinuity is most evident in dissociative identity disorder (DID), where patients may report amnesia in 1 identity for information available in other identities (i.e., interidentity amnesia). Studies indicate that even though patients subjectively report interidentity amnesia for material learned in, or pertaining to, another identity, objective findings show evidence of transfer of that material between identities. Subjective reports of dissociative amnesia may be explained by specific dissociation-related metamemory beliefs, which hinder voluntary retrieval, personal acknowledgment, and processing of memories. This study aimed to develop a questionnaire indexing metamemory beliefs related to trait dissociation. METHOD: Two studies in nonclinical populations provided information about the factor structure (Studies 1 and 2) of the newly developed Dissociation-related Beliefs about Memory Questionnaire (DBMQ). Information was also provided about the construct validity (Studies 2 and 3), and reliability of the scale (all 3 studies) in nonclinical as well as a clinical population. RESULTS: Results indicated sound psychometric properties of a short 16-item DBMQ with subscales assessing Fragmentation, Positive beliefs about amnesia, Lack of self-reference, and Fear of losing control, and correlations specifically with trait dissociation and posttraumatic avoidance symptoms. A sample of DID patients (N = 19) showed increased scores on the DBMQ. CONCLUSION: The DBMQ provides a short, reliable, and valid tool for indexing dissociation-related metamemory beliefs. These beliefs were associated with trait dissociation and posttraumatic avoidance symptoms. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A Network Approach to Trauma, Dissociative Symptoms, and Psychosis Symptoms in Schizophrenia Spectrum Disorders.

BACKGROUND: Dissociative experiences commonly occur in schizophrenia spectrum disorders (SSD). Yet little is known about how dissociative experiences in SSD are related to SSD symptoms. Accordingly, we investigated the relations between dissociative experiences and SSD symptoms, focusing on symptoms bridging these 2 symptom clusters as well as their relation to reported trauma history. STUDY DESIGN: Network analyses were conducted on the responses of 248 individuals with an SSD who enrolled from multiple mental health centers in The Netherlands. Dissociative experiences were assessed via the Dissociative Experience Scale, SSD symptoms using the Positive and Negative Syndrome Scale, and trauma history through the Trauma History Questionnaire. STUDY RESULTS: The results indicated that dissociative symptoms in SSD are mostly independent of other symptoms, but that emotional distress bridges between the dissociative and SSD symptom clusters. Furthermore, results revealed associations between positive and negative SSD symptoms and trauma through emotional distress, whereas dissociative symptoms remained relatively isolated. CONCLUSION: Because SSD symptoms and dissociative experiences clustered relatively independent from each other, our findings promote the idea of tailored treatment approaches for individuals with an SSD with frequent dissociative experiences, specifically targeting these symptoms.

Predictors and moderators of treatment outcomes in phase-based treatment and trauma-focused treatments in patients with childhood abuse-related post-traumatic stress disorder.

Background: Knowledge of treatment predictors and moderators is important for improving the effectiveness of treatment for PTSD due to childhood abuse.Objective: The first aim of this study was to test the potential predictive value of variables commonly associated with PTSD resulting from a history of repeated childhood abuse, in relation to treatment outcomes. The second aim was to examine if complex PTSD symptoms act as potential moderators between treatment conditions and outcomes.Method: Data were obtained from a randomized controlled trial comparing a phase-based treatment (Skills Training in Affect and Interpersonal Regulation [STAIR] followed by Eye Movement Desensitization and Reprocessing [EMDR] therapy; n = 57) with a direct trauma-focused treatment (EMDR therapy only; n = 64) in people with PTSD due to childhood abuse. The possible predictive effects of the presence of borderline personality disorder, dissociative symptoms, and suicidal and self-injurious behaviours were examined. In addition, it was determined whether symptoms of emotion regulation difficulties, self-esteem, and interpersonal problems moderated the relation between the treatment condition and PTSD post-treatment, corrected for pre-treatment PTSD severity.Results: Pre-treatment PTSD severity proved to be a significant predictor of less profitable PTSD treatment outcomes. The same was true for the severity of dissociative symptoms, but only post-treatment, and not when corrected for false positives. Complex PTSD symptoms did not moderate the relationship between the treatment conditions and PTSD treatment outcomes.Conclusions: The current findings suggest that regardless of the common comorbid symptoms studied, immediate trauma-focused treatment is a safe and effective option for individuals with childhood-related PTSD. However, individuals experiencing severe symptoms of PTSD may benefit from additional treatment sessions or the addition of other evidence-based PTSD treatment approaches. The predictive influence of dissociative sequelae needs further research.The study design was registered in The Dutch trial register (https://www.trialregister.nl/trialreg/admin/rctview.asp?TC = 5991) NTR5991 and was approved by the medical ethics committee of Twente NL 56641.044.16 CCMO.

One of first studies that aimed to identify multiple potential predictors and moderators in patients with PTSD related to childhood abuse.Only severe PTSD predicted worse treatment outcomes.The predictive influence of dissociative sequelae needs further research.

The Tonic Immobility Scale in adolescent and young adult rape victims: Support for three-factor model.

OBJECTIVE: A substantial number of sexual assault victims report experiencing some form of peritraumatic tonic immobility (TI). A self-report questionnaire that is widely used to assess TI retrospectively is the Tonic Immobility Scale (TIS). This study explored the factor structure of the TIS in a clinical sample of adolescent and young adults. METHOD: The sample comprised 131 female rape victims, aged 13-25, who were referred for specialized trauma-focused treatment. An exploratory factor analysis (EFA) was performed. RESULTS: The EFA showed support for a three-factor model, with factors TI, Fear, and Detachment. Item correlations ranged from .32 to .57 for TI, from .14 to .35 for Fear, and .29 for the two Detachment items. CONCLUSIONS: We found support for a three-factor solution distinguishing TI, fear, and detachment, suggesting the need to further develop the TIS with different subscales in varying age groups and clinical samples. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Early intervention with eye movement desensitization and reprocessing (EMDR) therapy to reduce the severity of post-traumatic stress symptoms in recent rape victims: a randomized controlled trial.

Background: About 40% of rape victims develop post-traumatic stress disorder (PTSD) within three months after the assault. Considering the high personal and societal impact of PTSD, there is an urgent need for early (i.e. within three months after the incident) interventions to reduce post-traumatic stress in victims of rape. Objective: To assess the effectiveness of early intervention with eye movement desensitization and reprocessing (EMDR) therapy to reduce symptoms of post-traumatic stress, feelings of guilt and shame, sexual dysfunction, and other psychological dysfunction (i.e. general psychopathology, anxiety, depression, and dissociative symptoms) in victims of rape. Method: This randomized controlled trial included 57 victims of rape, who were randomly allocated to either two sessions of EMDR therapy or treatment as usual ('watchful waiting') between 14 and 28 days post-rape. Psychological symptoms were assessed at pre-treatment, post-treatment, and 8 and 12 weeks post-rape. Linear mixed models and ANCOVAs were used to analyse differences between conditions over time. Results: Within-group effect sizes of the EMDR condition (d = 0.89 to 1.57) and control condition (d = 0.79 to 1.54) were large, indicating that both conditions were effective. However, EMDR therapy was not found to be more effective than watchful waiting in reducing post-traumatic stress symptoms, general psychopathology, depression, sexual dysfunction, and feelings of guilt and shame. Although EMDR therapy was found to be more effective than watchful waiting in reducing anxiety and dissociative symptoms in the post-treatment assessment, this effect disappeared over time. Conclusions: The findings do not support the notion that early intervention with EMDR therapy in victims of rape is more effective than watchful waiting for the reduction of psychological symptoms, including symptoms of post-traumatic stress. Further research on the effectiveness of early interventions, including watchful waiting, for this specific target group is needed.

Antecedentes: Aproximadamente el 40% de las víctimas de violación desarrollan trastorno de estrés postraumático (TEPT) dentro de los tres meses posteriores a la agresión. Teniendo en cuenta el alto impacto personal y social del TEPT, existe una necesidad urgente de intervenciones tempranas (es decir, dentro de los tres meses posteriores al incidente) para reducir el estrés postraumático en las víctimas de violación.Objetivo: Evaluar la efectividad de la intervención temprana con terapia de desensibilización y reprocesamiento por movimiento ocular (EMDR en su sigla en inglés) para reducir los síntomas de estrés postraumático, sentimientos de culpa y vergüenza, disfunción sexual, y otras disfunciones psicológicas (es decir, psicopatología general, ansiedad, depresión, y síntomas disociativos) en víctimas de violación.Método: Este ensayo controlado aleatorizado incluyó a 57 víctimas de violación, que fueron asignadas al azar a dos sesiones de terapia EMDR o al tratamiento habitual ("espera vigilante") entre 14 y 28 días después de la violación. Los síntomas psicológicos se evaluaron antes del tratamiento, después del tratamiento, y 8 y 12 semanas después de la violación. Se utilizaron modelos lineales mixtos y ANCOVAs para analizar las diferencias entre las condiciones a lo largo del tiempo.Resultados: Los tamaños del efecto dentro del grupo de la condición EMDR (d = 0.89 a 1.57) y la condición de control (d = 0.79 a 1.54) fueron grandes, lo que indica que ambas condiciones fueron efectivas. Sin embargo, no se encontró que la terapia EMDR fuera más efectiva que la espera vigilante para reducir los síntomas de estrés postraumático, la psicopatología general, la depresión, la disfunción sexual, y los sentimientos de culpa y vergüenza. Aunque se encontró que la terapia EMDR era más efectiva que la espera vigilante para reducir la ansiedad y los síntomas disociativos en la evaluación posterior al tratamiento, este efecto desapareció con el tiempo.Conclusiones: Los hallazgos no apoyan la noción de que la intervención temprana con terapia EMDR en víctimas de violación sea más efectiva que la espera vigilante para la reducción de los síntomas psicológicos, incluyendo los síntomas del estrés postraumático. Se necesitan más investigaciones sobre la efectividad de las intervenciones tempranas, incluida la espera vigilante, para este grupo objetivo específico.

The Sense of Self Over Time: Assessing Diachronicity in Dissociative Identity Disorder, Psychosis and Healthy Comparison Groups.

Dissociative experiences have been associated with diachronic disunity. Yet, this work is in its infancy. Dissociative identity disorder (DID) is characterized by different identity states reporting their own relatively continuous sense of self. The degree to which patients in dissociative identity states experience diachronic unity (i.e., sense of self over time) has not been empirically explored. This study examined the degree to which patients in dissociative identity states experienced diachronic unity. Participants were DID adults (n=14) assessed in adult and child identity states, adults with a psychotic illness (n=19), adults from the general population (n=55), children from the general population (n=26) and adults imagining themselves as children (n=23). They completed the Diachronic Disunity Scale (DDS), the Dissociative Experiences Scale (DES), and the Self-Concept Clarity Scale (SCCS). Diachronic disunity was not limited to psychiatric groups, but evident to some degree in all adult and child samples. The DID adult sample experienced more dissociation and self-confusion than the psychosis and adult comparison groups, but did not differ on the diachronic measure. DID patients in their child identity states and child comparisons showed disunity and were significantly different from child simulators, who showed relatively more unity. Results suggest that DID patients in either adult or child dissociative identity states, like those in other samples, do not universally experience themselves as having a consistent sense of self over time.

Intrusions related to indirectly experienced events in clinical offspring of World War Two survivors.

Negative events may not only linger on in the form of intrusive memories in the minds of those directly exposed but also in those who are only indirectly confronted with these events. The aim of the present study was to investigate if intrusions referring to indirectly experienced traumatic events do indeed occur, and to compare their frequency and characteristics to intrusions about directly experienced negative events. Participants (N = 98) were adult postwar offspring of World War Two survivors currently in treatment in one of two clinics specialized in the treatment of war victims. We examined the frequency and characteristics of intrusions about indirectly experienced (i.e., parent war-related) events and two types of directly (self-) experienced events: Self-experienced traumatic events and negative events related to participants' upbringing. Intrusions referring to indirectly experienced traumatic events did indeed occur. The frequency as well as other characteristics of these intrusions did not differ from those of both types of intrusions about directly experienced events. The similarities between intrusions related to different types of events emphasize the (re)constructive nature of memory. Our findings indicate that traumatic events not only affect those directly involved but may also continue to plague the next generation.

Assessing the application of latent class and latent profile analysis for evaluating the construct validity of complex posttraumatic stress disorder: cautions and limitations.

Background: The diagnosis of complex posttraumatic stress disorder (CPTSD) has been suggested for inclusion in the 11th version of the International Classification of Diseases (ICD-11), with support for its construct validity coming from studies employing Latent Class Analysis (LCA) and Latent Profile Analysis (LPA). Objective: The current study aimed to critically evaluate the application of the techniques LCA and LPA as applied in previous studies to substantiate the construct validity of CPTSD. Method: Both LCA and LPA were applied systematically in one sample (n = 245), replicating the setup of previous studies as closely as possible. The interpretation of classes was augmented with the use of graphical visualization. Results: The LCA and LPA analyses indicated divergent results in the same dataset. LCA and LPA partially supported the existence of classes of patients endorsing different PTSD and CPTSD symptom patterns. However, further inspection of the results with scatterplots did not support a clear distinction between PTSD and CPTSD, but rather suggested that there is much greater variability in clinical presentations amongst adult PTSD patients than can be fully accounted for by either PTSD or CPTSD. Discussion: We argue that LCA and LPA may not be sufficient methods to decide on the construct validity of CPTSD, as different subgroups of patients are identified, depending on the statistical exact method used and the interpretation of the fit of different models. Additional methods, including graphical inspection should be employed in future studies.

Antecedentes: El diagnóstico de Trastorno por Estrés Postraumático Complejo (TEPTC) ha sido sugerido para su inclusión en la 11ª versión de la Clasificación Internacional de Enfermedades (CIE-11), con el respaldo de su validez de constructo proveniente de estudios que emplean Análisis de Clases Latentes (LCA) y Análisis de Perfil Latente (APL).Objetivo: El presente estudio tuvo como objetivo evaluar críticamente la aplicación de las técnicas LCA y APL, utilizadas en estudios anteriores, para corroborar la validez de constructo del TEPTC.Método: Se aplicaron sistemáticamente, tanto la técnica LCA como la técnica APL, en una muestra (n = 245), que buscó replicar lo más fielmente posible las configuraciones empleadas en estudios previos. La interpretación de las clases se potenció con el uso de visualización gráfica.Resultados: Los análisis LCA y APL indicaron resultados divergentes en el mismo conjunto de datos. LCA y APL apoyaron parcialmente la existencia de clases de pacientes que validan diferentes patrones de síntomas para el TEPT y el TEPTC. Sin embargo, una mayor inspección de los resultados con diagramas de dispersión no respaldó una distinción clara entre el TEPT y el TEPTC, sino que sugirieron que existe una variabilidad mucho mayor en las presentaciones clínicas entre los pacientes adultos con TEPT de lo que pueda explicarse ya sea por el TEPT o el TEPTC.Discusión: Proponemos que los análisis LCA y APL pueden ser métodos insuficientes para decidir sobre la validez de constructo del TEPTC, ya que se identifican diferentes subgrupos de pacientes, que depende del método estadístico utilizado y la interpretación del ajuste de diferentes modelos. En futuros estudios deben emplearse métodos adicionales que incluyan la inspección gráfica.

Do early interventions prevent PTSD? A systematic review and meta-analysis of the safety and efficacy of early interventions after sexual assault.

Objective: To review the safety and efficacy of early interventions after sexual assault in reducing or preventing posttraumatic stress disorder (PTSD). Method: Systematic searches were performed on studies (1980-2018) that examined the efficacy of interventions for PTSD within 3 months after sexual assault. Results: The review identified 7 studies (n = 350) with high risk of bias that investigated 5 interventions. Only two studies reported on safety. Contact with the authors of six studies provided no indications for the occurrence of adverse events. Two studies reported the efficacy using PTSD diagnosis as dependent variable but found no difference between groups. All studies reported on efficacy using PTSD severity as dependent variable. For the meta-analysis, 4 studies (n = 293) were included yielding significantly greater reductions of PTSD severity than standard care at 2 to 12 months follow-up (g = -0.23, 95% CI [-0.46, 0.00]), but not at 1 to 6 weeks post-intervention (g = -0.28, 95% CI [-0.57, 0.02]). The heterogeneity of the interventions precluded further analyses. Discussion: Findings suggest that early interventions can lead to durable effects on PTSD severity after sexual assault. However, due to limited availability of data, it is impossible to draw definite conclusions about safety and efficacy of early interventions, and their potential to prevent PTSD.

Objetivo: revisar la seguridad y eficacia de intervenciones tempranas tras abuso sexual para reducir o prevenir trastorno de estrés postraumático (TEPT).Método: se realizaron búsquedas sistemáticas sobre estudios (1980-2018) que examinaron la eficacia de intervenciones para TEPT dentro de 3 meses tras un abuso sexual.Resultados: la revisión identificó 7 estudios (n=350) con alto riesgo de sesgos, que investigaron 5 intervenciones. Sólo 2 estudios reportaron sobre seguridad. El contacto con los autores de 6 estudios no proporcionó indicios de ocurrencia de eventos adversos. Dos estudios reportaron la eficacia de usar el diagnóstico de TEPT como una variable dependiente, pero no encontraron diferencias entre los grupos. Todos los estudios reportaron sobre eficacia usando la severidad de TEPT como variable dependiente. Para el meta-análisis, 4 estudios (n=293) fueron incluidos, brindando reducciones significativamente mayores de la severidad de TEPT que el cuidado estándar a los 2 y 12 meses de seguimiento (g=−0.23, 95% IC [−0.46, 0.00]), pero no respecto a 1 y 6 semanas post-intervención (g=−0.28, 95% IC [−0.57, 0.02]). La heterogeneidad de las intervenciones impidió mayores análisis.Discusión: los hallazgos sugieren que las intervenciones tempranas pueden llevar a efectos duraderos sobre la severidad de TEPT tras abuso sexual. Sin embargo, debido a la disponibilidad limitada de los datos, es imposible sacar conclusiones definitivas sobre la seguridad y eficacia de las intervenciones tempranas, y su potencial para prevenir TEPT.

Intergenerational consequences of the Holocaust on offspring mental health: a systematic review of associated factors and mechanisms.

Exposure to war and violence has major consequences for society at large, detrimental impact on people's individual lives, and may also have intergenerational consequences. To gain more insight into these intergenerational consequences, research addressing the impact of the Holocaust on offspring is an important source of information. The aim of the current study was to systematically review the mechanisms of intergenerational consequences by summarizing characteristics in Holocaust survivors and their offspring suggested to impact the offspring's mental health. We focused on: 1) parental mental health problems, 2) (perceived) parenting and attachment quality, 3) family structure, especially parental Holocaust history, 4) additional stress and life events, and 5) psychophysiological processes of transmission. We identified 23 eligible studies published between 2000 and 2018. Only Holocaust survivor studies met the inclusion criteria. Various parent and child characteristics and their interaction were found to contribute to the development of psychological symptoms and biological and epigenetic variations. Parental mental health problems, perceived parenting, attachment quality, and parental gender appeared to be influential for the mental well-being of their offspring. In addition, having two survivor parents resulted in higher mental health problems compared to having one survivor parent. Also, there was evidence suggesting that Holocaust survivor offspring show a heightened vulnerability for stress, although this was only evident in the face of actual danger. Finally, the results also indicate intergenerational effects on offspring cortisol levels. Clinical and treatment implications are discussed.

La exposición a la guerra y la violencia tiene consecuencias importantes para la sociedad en general, un impacto perjudicial en la vida individual de las personas, y también puede tener consecuencias intergeneracionales. Para obtener más información sobre estas consecuencias intergeneracionales, la investigación que aborda el impacto del Holocausto en la descendencia es una fuente importante de información. El objetivo del presente estudio fue revisar sistemáticamente los mecanismos de las consecuencias intergeneracionales resumiendo las características de los sobrevivientes del Holocausto y sus descendientes, que podrían impactar la salud mental de la descendencia. Nos centramos en: 1) los problemas de salud mental de los padres, 2) la calidad (percibida) de la crianza y el apego, 3) la estructura familiar, especialmente antecedentes del Holocausto de los padres, 4) el estrés y los eventos de la vida adicionales, y 5) los procesos psicofisiológicos de la transmisión. Identificamos 23 estudios elegibles publicados entre 2000 y 2018. Solo los estudios de sobrevivientes del Holocausto cumplieron con los criterios de inclusión. Se descubrió que diversas características de los padres y de los hijos y su interacción contribuyen al desarrollo de los síntomas psicológicos y las variaciones biológicas y epigenéticas. Los problemas de salud mental de los padres, la crianza percibida, la calidad del apego, y el género parental parecieron influir en el bienestar mental de sus hijos. Además, tener dos padres sobrevivientes resultó en mayores problemas de salud mental en comparación con tener uno de los padres sobrevivientes. Además, hubo evidencia que sugiere que los descendientes de los sobrevivientes del Holocausto muestran una mayor vulnerabilidad al estrés, aunque esto fue solo evidente ante el peligro real. Finalmente, los resultados también indican los efectos intergeneracionales en los niveles de cortisol de la descendencia. Se discuten las implicaciones clínicas y de tratamiento.

Early intervention with eye movement desensitisation and reprocessing (EMDR) therapy to reduce the severity of posttraumatic stress symptoms in recent rape victims: study protocol for a randomised controlled trial.

Background: It is estimated that more than 40% of rape victims develops a posttraumatic stress disorder (PTSD), a statistic that is relatively high compared to other types of trauma. PTSD can affect the victims' psychological, sexual, and physical health. Therefore, there is an urgent need for early interventions to prevent the onset of PTSD in this target group. Objective: This randomised controlled trial (RCT) examines the efficacy of early Eye Movement Desensitisation and Reprocessing (EMDR) therapy aimed to reduce the severity of posttraumatic stress symptoms in victims of recent rape. Methods: Subjects (N = 34) are individuals of 16 years and older who present themselves within 7 days post-rape at one of the four participating Sexual Assault Centres in the Netherlands. The intervention consists of two sessions of EMDR therapy between day 14 and 28 post-rape, while the control group receives treatment as usual, consisting of careful monitoring of stress reactions by a case-manager across two contacts during 1-month post-rape. Baseline assessment, posttreatment assessment and follow-up assessments at 8 and 12-weeks post-rape will be used to assess the development of posttraumatic stress symptoms. In addition, the efficacy of the intervention on psychological and sexual functioning will be determined. Linear mixed model analysis will be used to explore the differences within and between the EMDR group and control group at the various time points. Conclusions: The results of this RCT may help the dissemination and application of evidence-based preventative treatments for PTSD after rape.

Antecedentes: Se ha estimado que más del 40% de las víctimas de violación desarrollan un trastorno de estrés postraumático (TEPT), una estadística que es relativamente alta en comparación a otros tipos de trauma. El TEPT puede afectar la salud psicológica, sexual, y física de las víctimas. Por lo tanto, existe una necesidad urgente por intervenciones tempranas para prevenir la aparición de TEPT en este grupo objetivo.Objetivo: Este ensayo controlado aleatorio (RCT en sus siglas en inglés) examina la eficacia de una terapia temprana de Desensibilización y Reprocesamiento por Movimiento Ocular (EMDR en sus siglas en inglés) orientada a reducir la severidad de los síntomas de estrés postraumáticos en las víctimas recientes de una violación.Método: Los sujetos (N=34) son individuos de 16 años y más, que se presentan en uno de los cuatro Centros de Agresión Sexual participantes en los Países Bajos dentro de los 7 días posteriores a la violación. La intervención consiste de dos sesiones de terapia EMDR entre el día 14 y 28 luego de la violación, mientras que el grupo control recibe tratamiento habitual, el que consiste en un monitoreo cuidadoso de las reacciones de estrés en dos contactos durante un mes posterior a la violación, a cargo de un encargado del caso. La evaluación inicial (línea base), de post-tratamiento, y de seguimiento a las 8 y 12 semanas posteriores a la violación serán usadas para medir el desarrollo de los síntomas de estrés postraumático. Además, la eficacia de la intervención en el funcionamiento psicológico y sexual será determinada. Los análisis de modelos mixtos lineales serán usados.Conclusión: Los resultados de este RCT ayudarían a la difusión y aplicación de los tratamientos preventivos basados en la evidencia para el TEPT luego de una violación.

Schema therapy for Dissociative Identity Disorder (DID): rationale and study protocol.

Background: A category of disorders frequently associated with a history of trauma are the dissociative disorders, of which Dissociative Identity Disorder (DID) is the most severe and chronic form. DID is associated with high levels of impairment, treatment utilization, and treatment costs, yet systematic research into treatment effects is scarce. Practice-based clinical guidelines advise a phase-based approach which is lengthy and has rather high reported dropout rates. Therefore, in the current proposal the efficacy of an alternative treatment for DID (i.e. schema therapy) is tested. Objective: The aim of this study is to critically test the effectiveness of schema therapy for DID patients, for whom at present no evidence-based treatment is available. Method: In light of the low prevalence of DID, and the proposed treatment length of three years, a case series experimental approach is used (non-concurrent multiple baseline design). Ten outpatients are included, who are diagnosed with DID by an independent rater using the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D-R), which is double-checked by another independent expert. Primary outcomes are a (bi)weekly assessed state measure of dissociative symptoms, a pre-, post- and follow-up measure of the presence of the DID diagnosis, and drop-out rate. Secondary outcomes include various measures of trait dissociative symptoms, comorbid symptomatology, and global symptomatic distress. Trial registration: Netherlands Trial Register (NTR): NTR4496.

Antecedentes: Una categoría de trastornos frecuentemente asociados con un historial de trauma son los trastornos disociativos, de los cuales el trastorno de identidad disociativo (DID, por sus siglas en inglés) es la forma más grave y crónica. El DID se asocia con altos niveles de deterioro, utilización y costos de tratamiento, aunque la investigación sistemática sobre los efectos de tratamiento es escasa. Las guías clínicas basadas en la práctica aconsejan un enfoque basado en fases que es largo y tiene tasas reportadas de deserción más bien altas. Por lo tanto, en la propuesta actual, se prueba la eficacia de un tratamiento alternativo para DID (es decir, terapia de esquema). Objetivo: El objetivo de este estudio es probar críticamente la efectividad de la terapia de esquema para pacientes con DID, para quienes en la actualidad no hay disponible un tratamiento basado en la evidencia. Método: En vista de la baja prevalencia de DID y la duración del tratamiento de tres años propuesto, se utiliza un enfoque experimental de series de casos (diseño de línea base múltiple no concurrente). Se incluyen diez pacientes ambulatorios, que son diagnosticados con DID por un evaluador independiente usando el SCID-D-R, que es verificado por otro experto independiente. Los resultados primarios son una medida (bi)semanal de estado de síntomas disociativos, una medida previa, posterior y de seguimiento de la presencia del diagnóstico de DID, y tasa de deserción. Los resultados secundarios incluyen diversas medidas de los síntomas de rasgos disociativos, sintomatología comórbida y malestar sintomático global.

Manipulating the reported age in earliest memories.

Previous work suggests that the estimated age in adults' earliest autobiographical memories depends on age information implied by the experimental context [e.g., Kingo, O. S., Bohn, A., & Krøjgaard, P. (2013). Warm-up questions on early childhood memories affect the reported age of earliest memories in late adolescence. Memory, 21(2), 280-284. doi: 10.1080/09658211.2012.729598 ] and that the age in decontextualised snippets of memory is younger than in more complete accounts (i.e., event memories [Bruce, D., Wilcox-O'Hearn, L. A., Robinson, J. A., Phillips-Grant, K., Francis, L., & Smith, M. C. (2005). Fragment memories mark the end of childhood amnesia. Memory & Cognition, 33(4), 567-576. doi: 10.3758/BF03195324 ]). We examined the malleability of the estimated age in undergraduates' earliest memories and its relation with memory quality. In Study 1 (n = 141), vignettes referring to events happening at age 2 rendered earlier reported ages than examples referring to age 6. Exploratory analyses suggested that event memories were more sensitive to the age manipulation than memories representing a single, isolated scene (i.e., snapshots). In Study 2 (n = 162), asking self-relevant and public-event knowledge questions about participants' preschool years prior to retrieval yielded comparable average estimated ages. Both types of semantic knowledge questions rendered earlier memories than a no-age control task. Overall, the reported age in snapshots was younger than in event memories. However, age-differences between memory types across conditions were not statistically significant. Together, the results add to the growing literature indicating that the average age in earliest memories is not as fixed as previously thought.

Simulated car driving and its association with cognitive abilities in patients with schizophrenia.

OBJECTIVES: Patients with schizophrenia commonly suffer from impairments in various aspects of cognition. These deficits were shown to have detrimental effects on daily life functioning and might also impair car driving. This study is the first to examine driving behaviour of patients with schizophrenia using an advanced driving simulator, and to explore the role of cognitive abilities of people with schizophrenia for driving. METHODS: Non-acute patients with schizophrenia (n = 31) and healthy comparison participants (n = 31) performed a comprehensive neuropsychological assessment and driving simulator rides. Neuropsychological and driving performances were compared between groups. Moreover, associations were explored between cognitive functions and driving behaviour in the entire group. RESULTS: Patients with schizophrenia revealed impairments in multiple aspects of cognition. In the driving simulator, patients with schizophrenia showed no indication of deviant driving in terms of number of collisions or reacting to critical situations, and even showed better lane control compared to healthy individuals. However, patients with schizophrenia drove significantly slower than healthy individuals, and caused more hindrance to the car behind while merging on the motorway. Slower driving was associated with lower test scores on attention and processing speed. Hindering the car behind was associated with test performance on planning and inhibition. CONCLUSIONS: It is concluded that driving of patients with schizophrenia is characterized by a relatively slow speed, and can also be impaired in certain aspects, i.e. hindering a car behind while merging. Cognitive functions are crucial for driving, and should be target of treatment.