Occupational exposure to traumatic evidence and posttraumatic stress symptoms in forensic science professionals: Prevalence and patterns.

Forensic science professionals are routinely exposed to potentially traumatizing evidence. This study aimed to estimate the prevalence of occupational posttraumatic stress disorder (PTSD) among forensic science professionals, identify job-related correlates of PTSD symptoms, and examine the role of social support in mitigating PTSD symptomology. In response to recruitment through the American Academy of Forensic Sciences, the American Society of Crime Laboratory Directors, and Evidence Technology Magazine, 449 forensic science professionals participated in the current study. Results found that 73.5% (n = 330) of the overall sample experienced at least one work-related traumatic event consistent with meeting Criterion A for PTSD, and these rates were higher for field-based respondents (n = 203, 87.9%). The prevalence of past-month provisional PTSD was 21.6% for the full sample. Disaggregated PTSD rates were 29.0% and 14.5% for field-based and non-field-based respondents, respectively. These rates were 6- to 8-fold higher than the past-year prevalence of PTSD in the general US population, estimated to be 3.5%, and were found to be at least as high as those observed in prior epidemiological research with non-treatment seeking members of the US military deployed to war zones in Iraq and Afghanistan. Results further showed that social support was protective against PTSD symptomology. The high rates of occupational exposure to trauma and consequent PTSD symptomology observed in this large sample of forensic science professionals highlight the under-acknowledged psychological risks of these occupations and the need for enhanced attention to mental health resources for these professionals.

Optimal per test cutoff scores and combinations of failure on multiple embedded performance validity tests in detecting performance invalidity in a mixed clinical sample.

We tested the usefulness of six embedded performance validity tests (EPVTs) in identifying performance invalidity in a mixed clinical sample. Using a retrospective design, 181 adults were classified as valid (n = 146) or invalid (n = 35) performance based upon their performance on one of three standalone PVTs (Test of Memory Malingering, Victoria Symptom Validity Test, Dot Counting Test). Multiple cutoffs were identified corresponding to predetermined false positive rates of 0, 5, 10, and 15% for each of six EPVTs. EPVT cutoffs corresponding to the predetermined false positive benchmarks were generally more conservative than currently established scores. Sensitivity was low (.0%-42.9%) for individual EPVTs across these cutoffs and was moderately improved by the combination of multiple EPVT failures. The optimal number of EPVT failures using the 10% false positive rate was ≥ 2. Although the overall classification accuracy of 80.7% and specificity of 89.0% were comparable to prior research, the sensitivity of 45.7% was more modest than previous estimates. Low sensitivities indicate that this combination of EPVTs failed to detect a majority of invalid performers.

Racial Disparities in Pregnancy-associated Intimate Partner Homicide.

Pregnancy-associated femicide accounts for a mortality burden at least as high as any of the leading specific obstetric causes of maternal mortality, and intimate partners are the most common perpetrators of these homicides. This study examined pregnancy-associated and non-pregnancy-associated intimate partner homicide (IPH) victimization among racial/ethnic minority women relative to their non-minority counterparts using several sources of state-level data from 2003 through 2017. Data regarding partner homicide victimization came from the National Violent Death Reporting System, natality data were obtained from the Centers for Disease Control and Prevention's National Center for Health Statistics, and relevant sociodemographic information was obtained from the U.S. Census Bureau. Findings indicated that pregnancy and racial/ethnic minority status were each associated with increased risk for partner homicide victimization. Although rates of non-pregnancy-associated IPH victimization were similar between Black and White women, significant differences emerged when limited to pregnancy-associated IPH such that Black women evidenced pregnancy-associated IPH rates more than threefold higher than that observed among White and Hispanic women. Relatedly, the largest intraracial discrepancies between pregnant and non-pregnant women emerged among Black women, who experienced pregnancy-associated IPH victimization at a rate 8.1 times greater than their non-pregnant peers. These findings indicate that the racial disparities in IPH victimization in the United States observed in prior research might be driven primarily by the pronounced differences among the pregnant subset of these populations.

Is Disgust Proneness Associated With Anxiety and Related Disorders? A Qualitative Review and Meta-Analysis of Group Comparison and Correlational Studies.

Research suggests that disgust may be linked to the etiology of some anxiety-related disorders. The present investigation reviews this literature and employs separate meta-analyses of clinical group comparison and correlational studies to examine the association between disgust proneness and anxiety-related disorder symptoms. Meta-analysis of 43 group comparison studies revealed those high in anxiety disorder symptoms reported significantly more disgust proneness than those low in anxiety symptoms. Although this effect was not moderated by clinical versus analogue studies or type of disorder, larger group differences were observed for those high in anxiety symptoms associated with contagion concerns compared to those high in anxiety symptoms not associated with contagion concerns. Similarly, meta-analysis of correlational data across 83 samples revealed moderate associations between disgust proneness and anxiety-related disorder symptoms. Moderator analysis revealed that the association between disgust proneness and anxiety-related disorder symptoms was especially robust for anxiety symptoms associated with contagion concerns. After controlling for measures of negative affect, disgust proneness continued to be moderately correlated with anxiety-related disorder symptoms. However, negative affect was no longer significantly associated with symptoms of anxiety-related disorders when controlling for disgust proneness. The implications of these findings are discussed in the context of a novel transdiagnostic model.

Augmenting cognitive processing therapy to improve sleep impairment in PTSD: A randomized controlled trial.

OBJECTIVE: Despite the success of empirically supported treatments for posttraumatic stress disorder (PTSD), sleep impairment frequently remains refractory after treatment. This single-site, randomized controlled trial examined the effectiveness of sleep-directed hypnosis as a complement to an empirically supported psychotherapy for PTSD (cognitive processing therapy [CPT]). METHOD: Participants completed either 3 weeks of hypnosis (n = 52) or a symptom monitoring control condition (n = 56) before beginning standard CPT. Multilevel modeling was used to investigate differential patterns of change to determine whether hypnosis resulted in improvements in sleep, PTSD, and depression. An intervening variable approach was then used to determine whether improvements in sleep achieved during hypnosis augmented change in PTSD and depression during CPT. RESULTS: After the initial phase of treatment (hypnosis or symptom monitoring), the hypnosis condition showed significantly greater improvement than the control condition in sleep and depression, but not PTSD. After CPT, both conditions demonstrated significant improvement in sleep and PTSD; however, the hypnosis condition demonstrated greater improvement in depressive symptoms. As sleep improved, there were corresponding improvements in PTSD and depression, with a stronger relationship between sleep and PTSD. CONCLUSION: Hypnosis was effective in improving sleep impairment, but those improvements did not augment gains in PTSD recovery during the trauma-focused intervention. (PsycINFO Database Record

Change in Trauma Narratives and Perceived Recall Ability over a Course of Cognitive Processing Therapy for PTSD.

This study sought to evaluate changes in written trauma narratives completed during a course of Cognitive Processing Therapy (CPT). Participants were 22 female survivors of interpersonal assault who represented a subset of participants from two larger CPT treatment trials. Participants completed two written trauma narratives over the course of treatment. We predicted that narratives would increase in length and peritraumatic detail, and that participants would perceive an increase in their recall ability for important aspects of the trauma. Although narrative length and amount of peritraumatic detail did not change significantly from first to final narrative, participants evidenced changes in the content of the peritraumatic details. Patients commonly omitted assaultive acts from one of their narratives. There was a greater degree of fluctuation within the reporting of sexual assaults, as compared to physical assaults, with 55% of participants reporting a forced sexual act in one narrative, but not the other. Participants did not report significant changes in perceived recall ability for the traumatic event after completing the narratives, but did report improvements in perceived recall from pre to posttreatment. Overall, findings indicate that clients included different details (but not more details) in their final narrative, and that perceived increases in recall ability may not be a typical experience for clients as they complete written narratives in the context of trauma treatment.

Ethical issues and ethical therapy associated with anxiety disorders.

The prevalence of anxiety disorders is among the highest of all psychiatric diagnoses, with a lifetime morbidity rate of nearly 30%. Given this prevalence, it is important to identify effective and ethical treatments. Empirically based treatments considered efficacious for anxiety disorders largely include cognitive behavioral treatments (CBT), and among these, exposure therapy stands out as both useful and potentially concerning. Ethical concerns regarding exposure treatment for anxiety include fears of symptom exacerbation, high treatment dropout rates, client safety concerns, and the blurring of boundary lines between therapists and clients. Although concerns have been raised regarding exposure treatment generally, specific concerns have been raised related to the treatment of post-traumatic stress disorder (PTSD) given the vulnerable nature of the population. Despite these concerns, research largely supports both the efficacy and safety of exposure therapy. The present chapter provides a review of extant literature highlighting potential ethical concerns, research regarding the raised concerns, and suggestions for minimizing risk in treatment.

Changes in Anger in Relationship to Responsivity to PTSD Treatment.

This study examined the clinical course of different dimensions of anger and their relationship to change in posttraumatic stress disorder (PTSD) in a sample of 139 female survivors of interpersonal violence suffering from PTSD. Specifically, this study evaluated differences in the rates of change in anger dimensions by responsivity to treatment status (responders, non-responders, and drop-outs). Responders and non-responders did not differ in rate of change on state anger and anger directed inward, suggesting that treatment led to improvements in these dimensions of anger regardless of final PTSD diagnosis. Responders did evidence statistically significantly more change in trait anger and control over one's anger than did the non-responders, suggesting that changes in these dimensions of anger may be related to recovery from PTSD. Individuals who terminated therapy prematurely did not experience the same gains in state anger, trait anger, or anger-in as those who completed treatment. Differences in rates of change (linear versus quadratic growth patterns), particularly with respect to continued improvement in anger following treatment completion are discussed.

Manualized therapy for PTSD: flexing the structure of cognitive processing therapy.

OBJECTIVE: This study tested a modified cognitive processing therapy (MCPT) intervention designed as a more flexible administration of the protocol. Number of sessions was determined by client progress toward a priori defined end-state criteria, "stressor sessions" were inserted when necessary, and therapy was conducted by novice CPT clinicians. METHOD: A randomized, controlled, repeated measures, semicrossover design was utilized (a) to test the relative efficacy of the MCPT intervention compared with a symptom-monitoring delayed treatment (SMDT) condition and (b) to assess within-group variation in change with a sample of 100 male and female interpersonal trauma survivors with posttraumatic stress disorder (PTSD). RESULTS: Hierarchical linear modeling analyses revealed that MCPT evidenced greater improvement on all primary (PTSD and depression) and secondary (guilt, quality of life, general mental health, social functioning, and health perceptions) outcomes compared with SMDT. After the conclusion of SMDT, participants crossed over to MCPT, resulting in a combined MCPT sample (n = 69). Of the 50 participants who completed MCPT, 58% reached end-state criteria prior to the 12th session, 8% at Session 12, and 34% between Sessions 12 and 18. Maintenance of treatment gains was found at the 3-month follow-up, with only 2 of the treated sample meeting criteria for PTSD. Use of stressor sessions did not result in poorer treatment outcomes. CONCLUSIONS: Findings suggest that individuals respond at a variable rate to CPT, with significant benefit from additional therapy when indicated and excellent maintenance of gains. Insertion of stressor sessions did not alter the efficacy of the therapy.

Measurement of anxious traits: a contemporary review and synthesis.

Trait anxiety is a characteristic predisposition to appraise stimuli as threatening and respond with anxiety. Trait anxiety is proposed to serve as a vulnerability factor for greater frequency and intensity of anxiety experiences as well as the development of anxious pathology. Cognitive, behavioral, and physiological components of trait anxiety have been described. Common self-report measures of trait anxiety are reviewed with an emphasis on: components assessed, factor structure, internal consistency, reliability, and construct validity. Measures were selected if instructions ask individuals to endorse items based on their characteristic, rather than a time sensitive, response. Selection criteria resulted in a focus on the following measures: the State-Trait Anxiety Inventory (STAI), Beck Anxiety Inventory-Trait (BAIT), Cognitive Somatic Anxiety Questionnaire (CSAQ), Endler Multidimensional Anxiety Scales-Trait (EMAS-T), Four Systems Anxiety Questionnaire (FSAQ), State-Trait Inventory for Cognitive and Somatic Anxiety (STICSA), and the Three Systems Anxiety Questionnaire (TSAQ). While the STAI has the advantage of normative data and frequent use in prior research, newer measures, such as the BAIT and the STICSA, demonstrate greater discriminant validity. The strengths and weaknesses of each of the reviewed measures are highlighted. Recommendations for measure selection and future research are provided.

Predictors of physical assault victimization: findings from the National Survey of Adolescents.

Exposure to interpersonal victimization during childhood and adolescence is prevalent and has been found to be associated with negative physical and mental health outcomes. The present study examined the relations between childhood violence exposure and mental health on subsequent exposure to new physical assault in young adults using longitudinal nationally representative, prospective data from the initial (Wave I) and follow-up interviews (Wave II) of the National Survey of Adolescents (NSA). Among the 1,753 participants who completed both assessment time points, 15.8% reported a new physical assault experience at Wave II. Results indicated that racial/ethnic status, gender, history of child physical abuse, witnessed violence drug use, and family drug problems reported at Wave I were all significant predictors of new physical assault. Implications are discussed.

Predictors of rape: findings from the National Survey of Adolescents.

The current report examines data for 872 female adolescents obtained during the initial and follow-up interviews of the National Survey of Adolescents, a nationally representative sample. Lifetime prevalence of violence exposure reported was 12% and 13% for sexual assault, 19% and 10% for physical assault/punishment, and 33% and 26% for witnessing violence at Waves I and II, respectively. Racial/ethnic status, posttraumatic stress disorder (PTSD), childhood sexual abuse (CSA), and family drug problems emerged as significant predictors of new rape. Each of the PTSD symptom clusters significantly predicted new rape and analyses supported the mediational role of PTSD between CSA and new rape. African American or other racial identity was associated with lower risk.

Secondary trauma symptoms in clinicians: a critical review of the construct, specificity, and implications for trauma-focused treatment.

Advocates of the concept of secondary traumatization propose that clinicians who provide trauma-focused treatment may be particularly at risk for experiencing secondary trauma symptoms. This specific symptom presentation purportedly develops following exposure to the traumatic experiences described by their clients. Consequently, these professionals have advocated for increases in resources devoted to the prevention and treatment of secondary trauma symptoms (e.g., enhanced clinician training, increase in availability of treatment options for affected trauma workers, etc.). A review of empirical literature examining prevalence and specificity of secondary trauma symptoms in trauma clinicians is provided. Findings are mixed and often indicate that trauma clinicians are not frequently experiencing "clinically significant" levels of symptoms and that these symptoms may not be uniquely associated with trauma-focused treatment. Finally, it is argued that additional clarification and research on the criterion, course, and associated impairment are needed. Recommendations for future research are provided.

Attributional style and anxiety sensitivity as maintenance factors of posttraumatic stress symptoms: A prospective examination of a diathesis-stress model.

Diathesis-stress models of posttraumatic stress disorder (PTSD) assert that traumatic events function as stressors that interact with vulnerabilities to influence the development of PTSD. The present study prospectively examined negative attributional style (NAS) and anxiety sensitivity (AS) as maintenance factors for PTSD in female adult sexual assault victims. A diathesis-stress model was tested by examining interactions between the vulnerabilities and negative life events. The present study included both the traditional three-factor model of PTSD (re-experiencing, avoidance and emotional numbing, and arousal) and the dysphoria four-factor model of PTSD (re-experiencing, avoidance, arousal, and dysphoria). Robust regression analyses revealed that negative life events at Time 2 significantly predicted increases in all clusters of the three-factor model (i.e., re-experiencing, avoidance and numbing, and arousal) and the re-experiencing, arousal, and dysphoria clusters of the four-factor model (but not avoidance). Neither NAS nor AS significantly independently predicted any of the symptom clusters for either model. Both NAS and AS interacted with negative life events to predict increases in the avoidance and numbing symptoms. However, examination of the dysphoria four-factor model of PTSD revealed that the NAS and AS interactions with negative life events only predicted dysphoria symptoms.

Cognitive vulnerabilities to the development of PTSD: a review of four vulnerabilities and the proposal of an integrative vulnerability model.

While some individuals develop PTSD subsequent to traumatic experiences, many individuals resume prior functioning naturally. Diathesis-stress models suggest that stable individual differences present in individuals prior to trauma may serve as vulnerability factors to symptom development. The high levels of comorbidity and symptom similarity suggest that established vulnerability factors for anxiety and depression may also serve as vulnerability factors for PTSD. The examination of multiple vulnerability factors simultaneously may increase understanding of the etiology of PTSD and comorbid post-trauma symptomatology and account for a greater percentage of variance in PTSD symptoms. In addition, the vulnerability factors may be related to distinct sets of symptoms, with vulnerabilities predicting the PTSD symptoms most similar to their associated disorders. Research examining the relations between attributional style, rumination, anxiety sensitivity, and the looming cognitive style and the development of PTSD after trauma exposure is reviewed and suggestions for future research are provided.

The Disgust Scale: item analysis, factor structure, and suggestions for refinement.

In the 4 studies presented (N = 1,939), a converging set of analyses was conducted to evaluate the item adequacy, factor structure, reliability, and validity of the Disgust Scale (DS; J. Haidt, C. McCauley, & P. Rozin, 1994). The results suggest that 7 items (i.e., Items 2, 7, 8, 21, 23, 24, and 25) should be considered for removal from the DS. Secondary to removing the items, exploratory and confirmatory factor analyses revealed that the DS taps 3 dimensions of disgust: Core Disgust, Animal Reminder Disgust, and Contamination-Based Disgust. Women scored higher than men on the 3 disgust dimensions. Structural modeling provided support for the specificity of the 3-factor model, as Core Disgust and Contamination-Based Disgust were significantly predictive of obsessive- compulsive disorder (OCD) concerns, whereas Animal Reminder Disgust was not. Results from a clinical sample indicated that patients with OCD washing concerns scored significantly higher than patients with OCD without washing concerns on both Core Disgust and Contamination-Based Disgust, but not on Animal Reminder Disgust. These findings are discussed in the context of the refinement of the DS to promote a more psychometrically sound assessment of disgust sensitivity.

Interpretation biases in victims and non-victims of interpersonal trauma and their relation to symptom development.

Previous studies examining information processing in posttraumatic stress disorder (PTSD) have focused on attention and memory biases, with few studies examining interpretive biases. The majority of these studies have employed lexically based methodologies, rather than examining the processing of visual information. In the present study, victims (N=40) and non-victims (N=41) of interpersonal trauma viewed a series of short positive, neutral, and threatening filmstrips of social situations with ambiguous endings. Participants were then asked about their perceptions and interpretations of the situations. Victims perceived threatening situations as more predictable and more quickly increasing in risk than non-victims. Trauma status interacted with the perceived predictability of positive situations and the perceived speed with which neutral situations reached their conclusion to predict anxious symptoms. In addition, trauma status interacted with the perceived increase in risk of positive situations to predict PTSD symptoms. The implications of these findings for theories of PTSD are discussed.