Combatting ageism through virtual embodiment? Using explicit and implicit measures.

OBJECTIVES: Ageism is defined as stereotypes, prejudice, and discrimination towards people because of their age. Although ageism can be directed towards people of any age group, most research has focused on ageism towards older people. Ageism towards older people is known to have a significant impact on their health and wellbeing and to even result in higher healthcare costs. The present study evaluated the use of virtual embodiment (VE) to reduce self- and other-directed ageism. DESIGN, SETTING, AND PARTICIPANTS: We randomized 80 individuals between the ages of 18 and 35 years to one of two conditions: VE as an older or a younger avatar. RESULTS: No differences were found on explicit measures of ageism. Once multiple comparisons were accounted for, a nonsignificant reduction in implicit age bias following exposure to the older avatar (Cohen's d = .75, p = .02) also was found. CONCLUSIONS: Past research has established the effectiveness of VE in relation to implicit measures. However, once both explicit and implicit measures are included and multiple comparisons are accounted for, neither explicit nor implicit measures of ageism show a significant effect. Given the multidimensional nature of ageism, further research is needed to establish the effectiveness of VE once multiple measures of ageism are considered.

A Novel Integrative Psychotherapy for Psychogenic Nonepileptic Seizures Based on the Biopsychosocial Model: A Retrospective Pilot Outcome Study.

BACKGROUND: Psychogenic nonepileptic seizures (PNES) represent one of the most sizable treatment challenges in neuropsychiatry. Although the underlying mechanism is far from being understood, several interventions have been suggested. However, patients with comorbid psychiatric diagnoses and epilepsy are excluded from most intervention studies. OBJECTIVE: To To present a within-group posttreatment vs pretreatment study representing the retrospective clinical results of an integrative psychotherapy model. METHODS: We present the clinical results of 22 patients with PNES diagnosed in an epilepsy center and treated in our neuropsychiatry clinic using an integrative rehabilitative psychotherapy. Therapy included presenting the diagnosis, psychoeducation, seizure reduction behavioral techniques, and coping with past and present stressors. Insomuch as integrative biopsychosocial psychotherapy is based on an individualized treatment protocol for each patient, treatment was individualized and case specific. RESULTS: By the end of treatment, 36% of patients had become seizure free and a further 54% achieved a major seizure reduction (reduction of more than 70%). Seventy-two percent of patients kept at least 70% seizure reduction at follow-up. Global Assessment of Functioning scores improved from a mean of 43.09 to a mean of 72.81 at the end of treatment and 69.72 at follow-up. In addition, we present 3 case descriptions that emphasize the individualized nature of psychotherapeutic decisions. CONCLUSIONS: Our results support the feasibility and effectiveness of biopsychosocial based integrative psychotherapy for PNES and set principles for future treatment and prospective clinical trials in the field of individualized psychotherapy.

Treating posttraumatic stress disorder across cultures: A systematic review of cultural adaptations of trauma-focused cognitive behavioral therapies.

OBJECTIVE: Although trauma-focused cognitive-behavioral therapies (CBTs) for posttraumatic stress disorder (PTSD) have been applied worldwide, the nature of how these Western-based interventions are applied in diverse settings has varied. This paper systematically reviewed the literature on how trauma-focused CBTs have been applied and adapted cross-culturally. METHOD: A systematic review of studies that discuss the process of cultural adaptation of trauma-focused CBTs. RESULTS: Seventeen papers were included and varied in the comprehensiveness of the adaptation process. Two studies stated that a theoretical framework was followed. Almost one-third of the studies did not report whether local stakeholders were involved in the process of application. Fifteen studies examined the efficacy of the adaptations and the results were positive, but the methodology and quality varied. CONCLUSION: There are inconsistencies in how trauma-focused CBTs are culturally adapted. A systematic approach to the transportation of such therapies would enable greater investigation into the necessity and efficacy of such adaptations.

[DEEP BRAIN STIMULATION FOR OBSESSIVE COMPULSIVE DISORDER: CASE REPORT OF THE FIRST OCD PATIENT IN ISRAEL].

INTRODUCTION: Treatment-resistant obsessive-compulsive disorder (OCD) is considered a severe psychiatric disorder that causes severe functional decline. In the past, these patients were treated by selective ablation of neuronal pathways related to the pathophysiology of OCD. Deep brain stimulation is an effective and safe treatment alternative that enables reversible changes in neural circuits and reduces OCD symptoms. In this paper we present the outcome of a treatment-resistant OCD patient who underwent deep brain stimulation procedure for the first time in Israel. The patient has achieved a significant decline in OCD symptoms as well as improvement in personal and social functioning. The discussion focuses on methods to implement deep brain stimulation for OCD patients in Israel.

The Role of Narcissistic Vulnerability in Predicting Adult Posttraumatic Symptoms from Childhood Sexual Abuse.

The aim of the present study is to determine whether narcissistic vulnerability can aid in clarifying the debate regarding the relationship between childhood sexual abuse (CSA) and adulthood adjustment to traumatic events. 157 survivors (mean age = 31.1, SD = 10.9) of a traumatic event (war activities and road and work accidents) were assessed 1 week, 1, and 4 months following the event. Of the 157 participants, 15 reported experiencing CSA, and 26 reported experiencing childhood physical abuse (CPA). In the first-week assessment, patients were administered the Narcissistic Vulnerability Scale (NVS) and the Beck Depression Inventory (BDI). In the follow-up assessments, subjects were interviewed on the Clinician-Administered PTSD Scale. Narcissistic vulnerability was found, both in 1- and 4-month follow-ups, to increase the likelihood of participants who experienced CSA to develop PTSD symptoms later in their adult life, when exposed to other additional trauma. Narcissistic vulnerability, in both follow-ups, did not increase the likelihood of participants who experienced CPA to develop PTSD symptoms later in their life when exposed to other additional trauma. The NVS predicted the development of PTSD symptoms in the whole sample, both in the 1- and 4-month follow-ups, above and beyond the prediction of the BDI. In other words, narcissistic vulnerability can add additional information above and beyond general negative emotionality. In conclusion, it is recommended to take into consideration the interplay between CSA and the individual's narcissistic vulnerability when assessing the long term effects of CSA such as acute or chronic PTSD.

Childbirth as a traumatic event for attendant fathers.

Background: Negative reactions such as post-traumatic stress disorder (PTSD) following childbirth have been increasingly reported in mothers, particularly following objectively and subjectively difficult childbirth experiences. A small body of research has examined fathers' reactions to childbirth, with mixed results.Objective: The study aimed to further these studies, investigating whether objective and subjective aspects of fathers' participation in childbirth were related to levels of PTSD and fear of childbirth symptoms, in the first year following childbirth.Method: In total, 224 fathers whose partners had given birth within the previous 12 months answered online questionnaires that examined participation in childbirth, subjective appraisals, levels of fear of childbirth, and PTSD symptoms. Data were analysed using structural equation modelling, examining both direct and indirect effects.Results: Approximately 6% of fathers reported symptoms consistent with probable PTSD. Negative cognitions mediated the path between an emergency caesarean and PTSD. Fear of childbirth was related to emergency caesareans and lack of information from the medical team.Conclusions: Future studies should examine the level of fathers' participation, their subjective appraisal of childbirth, and fear of childbirth, when assessing fathers' reactions to childbirth.

Fathers may report fear of childbirth, not just PTSD, following a traumatic childbirth.Negative appraisal mediates the relationship between an emergency caesarean and PTSD.Fear of childbirth is related to lower levels of information sharing by staff.

Childbirth, trauma and family relationships.

Background: Childbirth is a major life event with expected positive outcomes, yet for some women postnatal psychopathological symptoms may harm women's interpersonal relationships. We hypothesized that higher levels of postnatal depression, post-traumatic stress (PTSD) symptoms, and fear of childbirth would be associated with mother-baby bond disorders and relationship dissatisfaction in couples.Method: A cross-sectional self-report online questionnaire was used to survey partnered women who had delivered in the year prior to the study. We used a convenience sample of 228 women recruited through purposive and snowball sampling. Childbirth experience, PTSD symptoms, attachment style, depression, mother-baby bond disorders, and couple relationship dissatisfaction were measured.Results: Women with higher PTSD and postnatal depression scores reported higher levels of mother-baby bond disorders-a relationship fully mediated by postnatal depression symptoms. Women who perceived childbirth as fearful or anxiety provoking had higher levels of PTSD and postnatal depression symptoms. Fearful and anxious birth perception was positively associated with mother-baby bond disorders-an association partly mediated by PTSD symptoms. Insecure attachment style was not found to be significantly associated with fearful or anxious perceptions of childbirth.Limitations: Women who have postnatal PTSD/depression are less inclined to participate in a study of this nature. Also, online surveys prevented the use of clinical diagnoses of PTSD and depression.Discussion and conclusions: Our results suggest that PTSD and postnatal depression affect women's mental health and family bonding. Women should be assessed for negative traumatic birth experiences, PTSD, and depression, to allow targeted observation for psychopathologies and therapeutic interventions.

Depression, not posttraumatic stress disorder (PTSD), is related to increased couple dissatisfaction.Both PTSD and depression are related to increased mother-baby bond disorders.Fear of childbirth increases as symptoms of PTSD and depression increase.

Interrupting traumatic memories in the emergency department: a randomized controlled pilot study.

BACKGROUND: The hours immediately following a traumatic event may present a window of opportunity to interrupt the consolidation of memories of the traumatic event, and this may prevent PTSD development. This theory has been validated in a series of analogue studies, showing that a visuo-spatial task reduces intrusive memories, however clinical studies are scarce. OBJECTIVE: This pilot RCT examined the use of a semi-immersive Virtual Reality visuospatial task, as an intervention to interrupt memory consolidation, in the Emergency Department (ED) in the immediate hours following a traumatic event. We hypothesised that participants who had received the intervention would present with lower levels of PTSD symptoms than the control group who received no intervention. METHOD: Seventy-seven adult survivors of traumatic events, meeting study criteria, were recruited in the ED of a Level III Trauma Centre. Survivors arrived at the ED less than one hour, on average, after the trauma. After signing informed consent, participants were randomized to the SnowWorld intervention or control group. Both groups completed self-report questionnaires, and the intervention group used SnowWorld for up to 10 minutes. RESULTS: No significant differences between the intervention and control groups were found regarding PTSD symptom levels two weeks and six months following the traumatic event. CONCLUSIONS: These results add to the growing literature examining the use of a concurrent task to reduce intrusions following a traumatic event. In contrast to previous clinical studies, this study did not show significant group differences; however, it replicates an analogue study that used a specifically developed app. Further studies are needed to elucidate possible reasons for these conflicting results.

Antecedentes: Las horas que siguen inmediatamente a un evento traumático podrían presentar una ventana de oportunidad para interrumpir la consolidación de las memorias del evento traumático, y esto podría prevenir el desarrollo del TEPT. Esta teoría ha sido validada en una serie de estudios análogos, mostrando que una tarea viso-espacial reduce las memorias intrusivas; los estudios clínicos son escasos.Objetivo: este ensayo controlado aleatorio (RCT en su sigla en inglés) piloto examinó el uso de una tarea viso-espacial de Realidad Virtual semi-inmersa como una intervención para interrumpir la memoria de consolidación en el Departamento de Emergencia, en las horas siguientes a un evento traumático. Hipotetizamos que al seguimiento aquellos que habían recibido la intervención presentarían niveles más bajos de los síntomas del TEPT que el grupo control.Método: Fueron reclutados en el Departamento de Emergencia (ED en su sigla en inglés) de un Centro de Trauma de Nivel III, 77 sobrevivientes adultos de eventos traumáticos, cumpliendo los criterios del estudio; los sobrevivientes llegaron al ED en promedio menos de una hora luego del trauma. Luego de firmar el consentimiento informado, fueron aleatorizados a la intervención SnowWorld o al grupo control. Ambos grupos completaron cuestionarios de auto-reporte, y el primer grupo usó SnowWorld por un máximo de 10 minutos.Resultados: No se encontraron diferencias significativas entre los grupos de estudio en los niveles de los síntomas de TEPT dos semanas y seis meses luego del evento traumático.Conclusiones: Este estudio no replicó los estudios clínicos y análogos previos. Esto puede deberse a las diferencias metodológicas, y los estudios futuros deberían tomarlos en cuenta.

Cognitive behavior therapy for panic disorder.

Panic Disorder affects around 3.5% of the population during their lifetime, affecting twice as many women. It is often comorbid with depression and other anxiety disorders. Panic disorder can be assessed by a variety of interviews and self-report questionnaires. The theoretical model underlying CBT explains panic from both a learning perspective as well as a cognitive one. Treatment comprises of both behavioral and cognitive components. Treatment outcome studies show that CBT is an effective, acceptable and cost-effective treatment for Panic Disorder.

Cognitive behavioral treatment for persons with psychosis: a new direction in psychological intervention.

Psychotic symptoms appear frequently in schizophrenia and other related disorders, and until relatively recently were not generally considered to be amenable to psychological interventions. Recent studies have changed these conceptualizations. Theoretical models, based on a stress vulnerability perspective, show how misinterpretations of anomalous experiences are factors in both the development and maintenance of psychosis. This review describes CBT treatment for persons with psychosis which focuses on education about symptoms and the cognitive model as well as a collaborative exploration of thoughts and schemas surrounding delusions and hallucinations. Treatment outcome studies show that CBT is an effective and acceptable treatment for psychosis.

Correction: Shared trauma reality in war: Mental health therapists' experience.

[This corrects the article DOI: 10.1371/journal.pone.0191949.].

Shared trauma reality in war: Mental health therapists' experience.

INTRODUCTION: Shared traumatic reality occurs when therapists are doubly exposed to a traumatic event, both through their clients' experience, along with their own direct exposure. Studies have shown that a shared traumatic reality can lead to both positive and negative outcomes for therapists. Most studies have examined these reactions sometime after the end of the traumatic event, and less is known about reactions that occur during a traumatic event. In addition, most studies have assumed, rather than examined, indirect exposure. In this study, we extend this literature by examining direct and indirect exposure of therapists during a war situation, and their psychological reactions. METHOD: Over a period of two months in 2014, 70% of the Israeli population was exposed to rocket fire. Geographical areas differed in terms of amount of exposure, and its potential danger. 151 therapists living throughout Israel were assessed via an Internet based survey in the middle of the war, and were assessed for the effects on their professional and personal lives, degree of burnout, ways of coping and symptoms levels of PTSD and psychological distress. RESULTS: These indicate that significant differences in direct exposure occurred depending on place of residence. PTSD levels were related to higher direct exposure, as well as prior trauma exposure, but not to indirect exposure. Indirect exposure, as measured by increased workload, was related to increased distress and emotional exhaustion. DISCUSSION: These data shed light on the effects of direct and indirect exposure to a shared traumatic experience of war amongst therapists. The data support previous studies showing a greater effect of direct exposure on PTSD. Since indirect exposure appears to negatively impact burnout and psychological distress, rather than PTSD, this study shows that symptoms other than PTSD should be the result of in a shared traumatic reality.

Subthalamic theta activity: a novel human subcortical biomarker for obsessive compulsive disorder.

Obsessive-compulsive disorder (OCD) is a common and serious psychiatric disorder. Although subthalamic nucleus deep brain stimulation (DBS) has been studied as a treatment for OCD patients the underlying mechanism of this treatment and the optimal method of stimulation are unknown. To study the neural basis of subthalamic nucleus DBS in OCD patients we used a novel, implantable DBS system with long-term local field potential sensing capability. We focus our analysis on two patients with OCD who experienced severe treatment-resistant symptoms and were implanted with subthalamic nucleus DBS systems. We studied them for a year at rest and during provocation of OCD symptoms (46 recording sessions) and compared them to four Parkinson's disease (PD) patients implanted with subthalamic nucleus DBS systems (69 recording sessions). We show that the dorsal (motor) area of the subthalamic nucleus in OCD patients displays a beta (25-35 Hz) oscillatory activity similar to PD patients whereas the ventral (limbic-cognitive) area of the subthalamic nucleus displays distinct theta (6.5-8 Hz) oscillatory activity only in OCD patients. The subthalamic nucleus theta oscillatory activity decreases with provocation of OCD symptoms and is inversely correlated with symptoms severity over time. We conclude that beta oscillations at the dorsal subthalamic nucleus in OCD patients challenge their pathophysiologic association with movement disorders. Furthermore, theta oscillations at the ventral subthalamic nucleus in OCD patients suggest a new physiological target for OCD therapy as well as a promising input signal for future emotional-cognitive closed-loop DBS.

Posttraumatic growth and recovery from addiction.

Background: It is well documented that individuals coping with adverse events report both negative outcomes, such as posttraumatic stress symptoms, as well as positive changes, described as posttraumatic growth. Positive changes are also reported in people who have recovered from substance abuse. It seems plausible from the literature that both of these types of positive changes have elements in common. To date, no published studies have examined positive outcomes among people who have recovered from addiction. Objectives: In this study, posttraumatic growth in individuals who were formerly addicted to alcohol or substances, termed 'addiction-related growth,' was examined. Addiction-related growth refers to the growth that an individual undergoes as a result of the addiction itself, and the recovery from the addiction. A successful recovery from addiction is associated with positive changes, particularly regarding spirituality and meaning-making, and the construct of addiction-related growth may explain why. Method: This cross-sectional study examined growth among 104 individuals who had recovered from addiction who were recruited from addiction treatment programmes, between February and July 2012. Questionnaires assessed demographics and substance abuse use and treatment, posttraumatic growth (PTGI); social support (Perceived Social Support Questionnaire); and help-seeking (Willingness to Seek Help Scale). Data was analysed using an analysis of variance (ANOVA), Pearson correlations, and multiple regression. Results: Results indicated that addiction-related growth is a phenomenon that accurately captures the positive changes experienced as a result of an individual's struggle with addiction and recovery. This growth was found to be associated with participation in 12-steps programmes, and to be predicted by levels of perceived social support. Conclusions: The results show that recovery from addiction is associated with addiction-related growth. These positive changes, along with the importance of communal social support, resemble the changes that take place as a result of processes described in 12-steps programmes.

Planteamiento: Está bien documentado que los individuos que se enfrentan a acontecimientos adversos indican tanto resultados negativos ­tales como síntomas de estrés postraumático­ como cambios positivos descritos como crecimiento postraumático. También se indican cambios positivos en personas que se han recuperado del abuso de sustancias. A partir de la literatura, parece plausible que ambos tipos de cambios positivos tengan elementos en común. Hasta la fecha, ningún estudio publicado ha examinado resultados positivos entre las personas que se han recuperado de una adicción. Objetivos: En este estudio, se examinó el crecimiento postraumático, denominado 'crecimiento relacionado con la adicción', en individuos que antes eran adictos al alcohol o a otras sustancias. El crecimiento relacionado con la adicción se refiere al crecimiento que un individuo experimenta como resultado de la adicción en sí, y de recuperarse de la adicción. El éxito de la recuperación de la adicción se asocia con cambios positivos, particularmente en lo que respecta a la espiritualidad y a dotar de significado, y el constructo del crecimiento relacionado con la adicción puede explicar por qué. Método: Este estudio transversal examinó el crecimiento en 104 individuos que se habían recuperado de una adicción, que fueron reclutados de los programas de tratamiento de adicciones, entre febrero y julio de 2012. Los cuestionarios evaluaron la demografía, y el abuso de sustancias y su tratamiento; el crecimiento postraumático (PTGI); el apoyo social (Cuestionario de apoyo social percibido, o Perceived Social Support Questionnaire); y la búsqueda de ayuda (Escala de disposición para buscar ayuda o Willingness to Seek Help Scale). Los datos se analizaron mediante un análisis de varianza (ANOVA), correlaciones de Pearson y regresión múltiple. Resultados: Los resultados indicaron que el crecimiento relacionado con la adicción es un fenómeno que capta con precisión los cambios positivos experimentados como resultado de la lucha de un individuo con la adicción y la recuperación. Se encontró que este crecimiento estaba asociado con la participación en programas de doce pasos y que se predecía por los niveles de apoyo social percibido. Conclusiones: Los resultados muestran que la recuperación de la adicción está asociada con el crecimiento relacionado con la adicción. Estos cambios positivos, junto con la importancia del apoyo social comunitario, se asemejan a los cambios que se producen como resultado de los procesos descritos en los programas de doce pasos.

Distress Levels among Parents of Active Duty Soldiers during Wartime.

Objective: Military service is a highly stressful period both for the soldiers serving and for their parents. Surprisingly, parents' experience has been mostly ignored in the research. This study's goal is to shed light on the experience and distress levels of parents of active duty combat soldiers during Operation Protective Edge, a military operation carried out by the Israel Defense Forces during July and August of 2014. Methods: During the advanced stages of the operation, 69 parents of Israeli male combat soldiers (55 mothers and 14 fathers) completed an online survey measuring symptoms of Posttraumatic Stress Disorder (PTSD-Checklist-5) and distress (Brief Symptom Inventory-18). Participants were recruited using a convenience sample, by posting ads on the public Facebook pages of the researchers and of the groups dedicated to parents of Israeli soldiers. Results: Parents' depression and anxiety symptom levels were higher than depression and anxiety symptom levels of the adult community norms in Israel. General distress rates of parents were similar to those presented by adults in southern Israel who were exposed for 7 years to the ongoing threat of daily rocket fire from Gaza, and higher than rates of a non-threatened Israeli population. Finally, 20.2% of the parents presented PTSD-like symptoms, a higher percentage than the probable PTSD diagnosis rates that were found in the general population in Israel during previous terror waves. Conclusion: This study provides preliminary evidence of soldiers' parents' distress and indicates the need for a better understanding of the impact of military service on soldiers' parents.

Differential effect of exposure-based therapy and cognitive therapy on post-traumatic stress disorder symptom clusters: A randomized controlled trial.

A question remains regarding differential effects of exposure-based versus non-exposure-based therapies on specific post-traumatic stress disorder (PTSD) symptom clusters. Traumatized emergency room patients were randomized to receive prolonged exposure (PE) or cognitive therapy (CT) without exposure. PE/CT had no differential effect on individual symptom clusters, and change in total PTSD score remained significant even after controlling for the reductions in all three symptom clusters. In addition, baseline levels of PTSD avoidance/intrusion/hyperarousal did not moderate the effects of PE and CT on total PTSD symptom scores. Taken together, these findings challenge the notion that PE and CT are specifically, and differentially, useful in treating one particular PTSD symptom cluster. PRACTITIONER POINTS: Despite their different theoretical backgrounds and techniques, the notion that PE and CT (without exposure) target different PTSD symptoms was not confirmed in this study. Thus, both interventions may in fact be equally effective for treating intrusion, avoidance and hyperarousal symptoms. Baseline levels of avoidance, intrusion and hyperarousal may not be good a priori indicators for PTSD treatment selection. The effect of PE and CT on PTSD as a whole does not seem to depend on a reduction in any specific symptom cluster. These findings indicate that exposure and non-exposure interventions may lead to similar results in terms of reductions in specific PTSD symptoms. It is quite possible that individual PTSD clusters may respond to therapy in an inter-related fashion, with one cluster affecting the other.

Posttraumatic Stress Disorder, Parenting, and Marital Adjustment among a Civilian Population.

While psychopathology in general is linked to poorer marital and parental satisfaction, there is a paucity of data regarding these interactions in parents with Posttraumatic stress disorder (PTSD). The current study addresses this issue among a civilian population. Two hundred trauma-exposed parents, mean age of 37.2, 62% mothers, were assessed using self-report questionnaires, for background variables, PTSD symptoms using the Posttraumatic Stress Diagnostic Scale (PDS), depression symptoms (Beck Depression Inventory, BDI), marital satisfaction (Dyadic Adjustment Scale, DAS-7), parenting behavior (Alabama Parenting Questionnaire, APQ-9), and parenting satisfaction (Parenting Satisfaction Questionnaire). We hypothesized that positive parenting behavior and parenting satisfaction would be negatively correlated with PTSD symptom levels, and that this relationship would be mediated by marital satisfaction; the independent effects of depression on marital and parenting functioning were also examined. Data was analyzed using structural equation modeling (SEM). Results indicated that PTSD was related to poorer parenting behavior (B = 0.089, p = 0.033), depression had a negative impact on parenting satisfaction (B = 0.983, p = 0.003), and marital satisfaction (B = -0.672, p = 0.004), and marital satisfaction fully mediated the relationship between depression and parenting. The findings demonstrated that the effects of PTSD can cast a pall not only over the individual but over the entire family. Interventions are needed to address these issues.

Long-term outcome of early interventions to prevent posttraumatic stress disorder.

BACKGROUND: Failing to prevent posttraumatic stress disorder (PTSD) has major clinical and public health consequences. This work evaluates the 3-year outcome of offering early interventions to survivors with acute PTSD. METHODS: Adults admitted consecutively to the hospital with acute DSM-IV PTSD were randomized, between June 2003 and October 2007, to 12 weeks of prolonged exposure (n = 63) or cognitive therapy (n = 40) or concealed SSRI (escitalopram; n = 23) versus placebo (n = 23). Eighty-two participants who declined treatment were followed as well. Treatment started 1 month after the traumatic event, and participants were reassessed 5 and 36 months later. Assessors were blinded to treatment allocation and acceptance. The Clinician-Administered PTSD Scale (CAPS) evaluated PTSD and PTSD symptoms. Self-reported symptoms, general functioning, and employment status were secondary outcomes. Participants lost to follow-up were missing completely at random. RESULTS: Prolonged exposure and cognitive therapy significantly reduced PTSD and PTSD symptoms between 1 and 5 months (mean CAPS total scores [95% CI] at 1 month: prolonged exposure = 73.59 [68.21-78.96] and cognitive therapy = 71.78 [66.92-78.93]; mean CAPS total scores [95% CI] at 5 months: prolonged exposure = 28.59 [21.89-35.29] and cognitive therapy = 29.48 [21.32-37.95], P < .001), and their results remained stable. At 3 years, however, the study groups had similar levels of PTSD symptoms (mean CAPS total scores [95% CI]: prolonged exposure = 31.51 [20.25-42.78]; cognitive therapy = 32.08 [20.74-43.42]; SSRI = 34.31 [16.54-52.07]; placebo = 32.13 [20.15-44.12]; and no intervention = 30.59 [19.40-41.78]), similar prevalence of PTSD (28.6%-46.2%), and similar secondary outcomes. CONCLUSION: Early prolonged exposure and cognitive therapy accelerated the recovery from acute PTSD. Their effect remained stable, however, without reducing the 3-year prevalence of the disorder. The lingering prevalence of PTSD, despite efficient interventions, illustrates a nonremitting, treatment-refractory subset of survivors and outlines a major clinical and public health challenge. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00146900.

PTSD following terrorist attacks: a prospective evaluation.

OBJECTIVE: This study evaluated the prevalence of posttraumatic stress disorder (PTSD) and the longitudinal course of early PTSD symptoms in survivors of terrorist attacks. It additionally assessed the effect of continuous terrorism on the course of early symptoms of PTSD. METHOD: Thirty-nine survivors of terrorist attacks and 354 survivors of motor vehicle accidents were evaluated upon admission to a general hospital emergency room and 1 week and 4 months later. Heart rate was measured upon admission to the emergency room. Peritraumatic dissociation was assessed at 1 week. PTSD symptoms, anxiety, and depression were measured at 1 week and 4 months. The Clinician-Administered PTSD Scale conferred a diagnosis of PTSD at 4 months. Additionally, the course of early PTSD symptoms during an era of frequent terrorist attacks (N=137) was compared with that seen during years of relative calm (N=256). RESULTS: Survivors of terrorist attacks had higher rates of PTSD than motor vehicle accident survivors (37.8% versus 18.7%). The type of traumatic event, however, did not add to the prediction of PTSD from the emergency room heart rate, peritraumatic dissociation symptoms, and early PTSD symptoms. The longitudinal course of early PTSD symptoms was not affected by the greater frequency of terrorist attacks. CONCLUSIONS: Early symptoms are reliable risk indicators of PTSD across events and circumstances. Converging effects of terror-induced fear, adjustment, and resiliency might explain the lack of effect of intense terrorism on the course of PTSD symptoms.

Social relationship satisfaction and PTSD: which is the chicken and which is the egg?

BACKGROUND: Impaired social relationships are linked with higher levels of posttraumatic stress disorder (PTSD), but the association's underlying dynamics are unknown. PTSD may impair social relationships, and, vice versa, poorer relationship quality may interfere with the recovery from PTSD. OBJECTIVE: This work longitudinally evaluates the simultaneous progression of PTSD symptoms and social relationship satisfaction (SRS) in a large cohort of recent trauma survivors. It also explores the effect of cognitive behavior therapy (CBT) on the association between the two. METHOD: Consecutive emergency department trauma admissions with qualifying PTSD symptoms (n=501) were assessed 3 weeks and 5 months after trauma admission. The World Health Organization Quality of Life evaluated SRS and the Clinician Administered PTSD Scale evaluated PTSD symptom severity. Ninety-eight survivors received CBT between measurement sessions. We used Structural Equation Modeling to evaluate cross-lagged effects between the SRS and PTSD symptoms. RESULTS: The cross-lagged effect of SRS on PTSD was statistically significant (ß=-0.12, p=0.01) among survivors who did not receive treatment whilst the effect of PTDS on SRS was nil (ß=-0.02, p=0.67). Both relationships were non-significant among survivors who received CBT. DISCUSSION: SRS and PTSD are highly associated, and this study shows that changes in SRS in the early aftermath of traumatic events contribute to changes in PTSD, rather than vice versa. SRS impacts natural recovery, but not effective treatment. This study suggests that being satisfied with one's relationships might be considered as an important factor in natural recovery from trauma, as well as in intervention.