Richard Bryant

A Multisite Analysis of the Fluctuating Course of Posttraumatic Stress Disorder

Publisher: American Medical Association (AMA)

Date: 08-2013

DOI: 10.1001/JAMAPSYCHIATRY.2013.1137

Abstract: Delayed-onset posttraumatic stress disorder (PTSD) accounts for approximately 25% of PTSD cases. Current models do not adequately explain the delayed increases in PTSD symptoms after trauma exposure. To test the roles of initial psychiatric reactions, mild traumatic brain injury (MTBI), and ongoing stressors on delayed-onset PTSD. In this prospective cohort study, patients were selected from recent admissions to 4 major trauma hospitals across Australia. A total of 1084 traumatically injured patients were assessed during hospital admission from April 1, 2004, through February 28, 2006, and 785 (72.4%) were followed up at 3, 12, and 24 months after injury. Severity of PTSD was determined at each assessment with the Clinician-Administered PTSD Scale. Of those who met PTSD criteria at 24 months, 44.1% reported no PTSD at 3 months and 55.9% had subsyndromal or full PTSD. In those who displayed subsyndromal or full PTSD at 3 months, PTSD severity at 24 months was predicted by prior psychiatric disorder, initial PTSD symptom severity, and type of injury. In those who displayed no PTSD at 3 months, PTSD severity at 24 months was predicted by initial PTSD symptom severity, MTBI, length of hospitalization, and the number of stressful events experienced between 3 and 24 months. These data highlight the complex trajectories of PTSD symptoms over time. This study also points to the roles of ongoing stress and MTBI in delayed cases of PTSD and suggests the potential of ongoing stress to compound initial stress reactions and lead to a delayed increase in PTSD symptom severity. This study also provides initial evidence that MTBI increases the risk of delayed PTSD symptoms, particularly in those with no acute symptoms.

Bulimia nervosa, restrained, and unrestrained eaters: A comparison of non-binge eating behavior

Publisher: Wiley

Date: 09-1998

DOI: 10.1002/(SICI)1098-108X(199809)24:2<185::AID-EAT8>3.0.CO;2-A

Abstract: This study investigated non-binge eating behavior in bulimia nervosa, restrained and unrestrained eaters. Nine females with bulimia nervosa, 12 female restrained eaters, and 13 female unrestrained eaters were administered the Eating Disorder Inventory-2 (EDI-2), the Body Shape Questionnaire, the Beck Depression Inventory, the Rosenberg Self-Esteem Scale, and the Revised Restraint Scale (RRS). All subjects were videotaped during a midday meal and their eating behavior was subsequently rated using the Eating Behaviour Rating Scale (EBRS). EBRS ratings were higher for bulimic than for unrestrained subjects. Restrained subjects' ratings did not differ from those of either bulimic or unrestrained subjects. EBRS scores were positively correlated with RRS and EDI-2 total scores. Bulimic subjects display aberrant eating behavior, and the extent to which subjects engage in maladaptive eating behavior is related to the degree of eating pathology. These results support the utility of the EBRS as a useful index of eating behaviors in clinical and nonclinical populations.

Memory on the beach: An Australian memory (and hypnosis) laboratory

Publisher: Springer Science and Business Media LLC

Date: 26-08-2005

DOI: 10.1007/S10339-005-0013-Y

Abstract: The memory (and hypnosis) lab at the University of New South Wales investigates a broad range of memory topics. We try to find innovative methods from cognitive and clinical psychology to address theoretical and empirical questions about memory. We aso use hypnosis as one major methodological tool in our investigations of memory (as well as other cognitive processes). In this paper, we review the projects currently underway in our memory (and hypnosis) lab.

Mindfulness-Based Resilience Training in the Workplace: Pilot Study of the Internet-Based Resilience@Work (RAW) Mindfulness Program (Preprint)

Publisher: JMIR Publications Inc.

Date: 08-03-2018

DOI: 10.2196/PREPRINTS.10326

Abstract: he impact of mental illness on society is far reaching and has been identified as the leading cause of sickness absence and work disability in most developed countries. By developing evidence-based solutions that are practical, affordable, and accessible, there is potential to deliver substantial economic benefits while improving the lives of in idual workers. Academic and industry groups are now responding to this public health issue. A key focus is on developing practical solutions that enhance the mental health and psychological resilience of workers. A growing body of research suggests resilience training may play a pivotal role in the realm of public health and prevention, particularly with regards to protecting the long-term well-being of workers. ur aim is to examine whether a mindfulness-based resilience-training program delivered via the internet is feasible and engaging to a group of high-risk workers. Additionally, we aim to measure the effect of the Resilience@Work Resilience@Work Mindfulness program on measures of resilience and related skills. he current pilot study recruited 29 full-time firefighters. Participants were enrolled in the 6-session internet-based resilience-training program and were administered questionnaires prior to training and directly after the program ended. Measurements examined program feasibility, psychological resilience, experiential avoidance, and thought entanglement. articipants reported greater levels of resilience after Resilience@Work training compared to baseline, with a mean increase in their overall resilience score of 1.5 (95% CI -0.25 to 3.18, t14=1.84, P=.09). Compared to baseline, participants also reported lower levels of psychological inflexibility and experiential avoidance following training, with a mean decrease of -1.8 (95% CI -3.78 to 0.20, t13=-1.94, P=.07). With regards to cognitive fusion (thought entanglement), paired-s les t tests revealed a trend towards reduction in mean scores post training (P=.12). his pilot study of the Resilience@Work program suggests that a mindfulness-based resilience program delivered via the Internet is feasible in a high-risk workplace setting. In addition, the firefighters using the program showed a trend toward increased resilience and psychological flexibility. Despite a number of limitations, the results of this pilot study provide some valuable insights into what form of resilience training may be viable in occupational settings particularly among those considered high risk, such as emergency workers. To the best of our knowledge, this is the first time a mindfulness-based resilience-training program delivered wholly via the internet has been tested in the workplace.

Progesterone and mental imagery interactively predict emotional memories

Publisher: Elsevier BV

Date: 2015

DOI: 10.1016/J.PSYNEUEN.2014.09.005

Abstract: Different lines of research suggest that the consolidation of emotional memories is influenced by (a) endogenous levels of sex hormones, and (b) in idual differences in the capacity to use vivid mental imagery. No studies to date have investigated how these factors may interact to influence declarative emotional memories. This study examined the interacting influence of progesterone and mental imagery strength on emotional memory consolidation. Twenty-four men, 20 women from the low progesterone (follicular) menstrual phase, and 20 women from the high progesterone (mid-luteal) phase of the cycle were assessed using an objective performance-based measure of mental imagery strength, and then shown a series of aversive and neutral images. Half of the images were accompanied by instructions to process sensory features, and the remaining half to process the conceptual characteristics of the images. Two days later, all participants returned for a surprise free recall memory test. The interaction of progesterone and mental imagery strength significantly predicted recall of visually processed, but not verbally processed, negative images. These data suggest that mental imagery strength may be one mechanism underlying the documented association between endogenous progesterone and enhanced emotional memory performance in the literature.

Self-Orientation Modulates the Neural Correlates of Global and Local Processing

Publisher: Public Library of Science (PLoS)

Date: 13-08-2015

DOI: 10.1371/JOURNAL.PONE.0135453

An evaluation of the DSM-5 factor structure for posttraumatic stress disorder in survivors of traumatic injury

Publisher: Elsevier BV

Date: 2015

DOI: 10.1016/J.JANXDIS.2014.11.004

Abstract: Confirmatory factor analytic studies of the latent structure of DSM-5 PTSD symptoms using self-report data (Elhai et al., 2012 Miller et al., 2013) have found that the four-factor model implied by the DSM-5 diagnostic criteria provided adequate fit to their data. However, the fit of this model is yet to be assessed using data derived from gold standard structured interview measures. This study evaluated the fit of the DSM-5 four-factor model and an alternative four-factor model in 570 injury survivors six years post-injury using the Clinician Administered PTSD Scale (Blake et al., 1990), updated to include items measuring new DSM-5 symptoms. While both four-factor models fitted the data well, very high correlations between the 'Intrusions' and 'Avoidance' factors in both models and between the 'Negative Alterations in Cognitions and Mood' and 'Arousal and Reactivity' factors in the DSM-5 model and the 'Dysphoria' and 'Hyperarousal' factors in the alternative model were evident, suggesting that a more parsimonious two-factor model combining these pairs of factors may adequately represent the latent structure. Such a two-factor model fitted the data less well according to χ(2) difference testing, but demonstrated broadly equivalent fit using other fit indices. Relationships between the factors of each of the four-factor models and the latent factors of Fear and Anxious-Misery/Distress underlying Internalizing disorders (Krueger, 1999) were also explored, with findings providing further support for the close relationship between the Intrusion and Avoidance factors. However, these findings also suggested that there may be some utility to distinguishing Negative Alterations in Cognition and Mood symptoms from Arousal and Reactivity symptoms, and/or Dysphoria symptoms from Hyperarousal symptoms. Further studies are required to assess the potential discriminant validity of the two four-factor models.

TOWARD AN INTEGRATED PROFILE OF EMOTIONAL INTELLIGENCE: INTRODUCING A BRIEF MEASURE

Publisher: World Scientific Pub Co Pte Lt

Date: 03-2005

DOI: 10.1142/S0219635205000677

Abstract: Over the last decade, an increasing number of research studies have focused on the construct of Emotional Intelligence (EI), which may be broadly defined as the capacity to perceive and regulate emotions in oneself as well as those of others. Researchers have generally adopted an organizational or management focus to the study of EI, however studies which adopt a more integrated perspective by combining psychological with biological measures, may help in further elucidating this relatively abstract construct. The first objective of this paper was to report on the psychometric properties of a brief, self-report measure of EI (Brain Resource Inventory for Emotional intelligence Factors or BRIEF), comprising internal emotional capacity (IEC), external emotional capacity (EEC) and self concept (SELF). Second, we further explored the validity of the measure by assessing the relationships between the BRIEF and variables considered relevant to the understanding of EI (including gender, age, personality, cognitive intelligence and resting state electroencephalography, EEG). The BRIEF possessed sound psychometric properties (internal consistency, r=0.68-0.81 test-retest reliability, r=0.92 construct validity with the Self Report Emotional Intelligence Test, r=0.70). As hypothesized, females were found to score higher than males on EI. EI was associated more with personality than with cognitive ability, and EEG was found to explain a significant portion of the variance in EI scores. The finding that low EI is related to underarousal of the left-frontal cortex (increased theta EEG) is consistent with research on patients with depression, as well as attention deficit hyperactivity disorder. Although EI did not display age-related increases, this might relate to the exclusion of adolescents from our s le. In conclusion, examination of the way in which EI measures relate to a complementary range of psychological and biological measures may help to further elucidate this construct.

PREDICTING SEVERITY OF NON-CLINICAL DEPRESSION: PRELIMINARY FINDINGS USING AN INTEGRATED APPROACH

Publisher: World Scientific Pub Co Pte Lt

Date: 03-2006

DOI: 10.1142/S0219635206001069

Abstract: Depression is characterized by disturbances in affect, cognition, brain and body function, yet studies have tended to focus on single domains of dysfunction. An integrated approach may provide a more complete profile of the range of deficits characterized by depressed in iduals, but it is unclear whether this approach is able to predict depression severity over and above that predicted by single tasks or domains of function. In this study, we examined the value of combining multiple domains of function in predicting depression severity. Participants contained in the International Brain Database, (www.brainresource.com) had completed three testing components including a web-based questionnaire of Personal History, the Brain Resource Cognition battery of Neuropsychological tests, Personality assessment and Psychophysiological testing. Two hundred and sixty six of these participants were able to be classified as either non-depressed, mild-moderately or severely (non-clinically) depressed, based on a depression screening questionnaire. Analysis of variance identified variables on which the categorized participants differed. Significant variables were then entered into a series of stepwise regressions to examine their ability to predict depression scores. An integrated model including measures of affect (increased Neuroticism decreased Emotional Intelligence), cognition (increased variability of reaction time during a working memory task decreased "name the word component score" in the verbal interference task), brain (decreased left-lateralized P150 ERP component during a working memory task) and body function (increased negative skin conductance level gradient) were found to predict more of the variation in depression severity than any single domain of function. On the basis of behavioral as well as Psychophysiological findings reported in this study, it was suggested that deficits in subclinically depressed in iduals are more pronounced during automatic stages of stimulus processing, and that performance in these in iduals may improve (to the level displayed by controls) when task demands are increased. Findings also suggest that it is important to consider disturbances across different domains of function in order to elucidate depression severity. Each domain may contribute unique explanatory information consistent with an integrative model of depression, taking into account the role of both behavior and underlying neural changes.

The heritability of mental health and wellbeing defined using COMPAS-W, a new composite measure of wellbeing

Publisher: Elsevier BV

Date: 09-2014

DOI: 10.1016/J.PSYCHRES.2014.04.033

Abstract: Mental health is not simply the absence of mental illness rather it is a distinct entity representing wellness. Models of wellbeing have been proposed that emphasize components of subjective wellbeing, psychological wellbeing, or a combination of both. A new 26-item scale of wellbeing (COMPAS-W) was developed in a cohort of 1669 healthy adult twins (18-61 years). The scale was derived using factor analysis of multiple scales of complementary constructs and confirmed using tests of reliability and convergent validity. Bivariate genetic modeling confirmed its heritability. From an original 89 items we identified six independent subcomponents that contributed to wellbeing. The COMPAS-W scale and its subcomponents showed construct validity against psychological and physical health behaviors, high internal consistency (average r=0.71, Wellbeing r=0.84), and 12-month test-retest reliability (average r=0.62, Wellbeing r=0.82). There was a moderate contribution of genetics to total Wellbeing (heritability h(2)=48%) and its subcomponents: Composure (h(2)=24%), Own-worth (h(2)=42%), Mastery (h(2)=40%), Positivity (h(2)=42%), Achievement (h(2)=32%) and Satisfaction (h(2)=43%). Multivariate genetic modeling indicated genetic variance was correlated across the scales, suggesting common genetic factors contributed to Wellbeing and its subcomponents. The COMPAS-W scale provides a validated indicator of wellbeing and offers a new tool to quantify mental health.

Individual differences in susceptibility to false memories for neutral and trauma-related words

Publisher: Informa UK Limited

Date: 06-2013

DOI: 10.1080/13218719.2012.692932

Mental Health Following Separation in a Disaster: The Role of Attachment

Publisher: Wiley

Date: 07-01-2016

DOI: 10.1002/JTS.22071

Abstract: Short-term separation from close family members during a disaster is a highly salient event for those involved. Yet, its subsequent impact on mental health has received little empirical attention. One relevant factor may be attachment style, which influences patterns of support-seeking under threatening conditions. In iduals (N = 914) affected by the 2009 Victorian bushfires in southeastern Australia were assessed for disaster experiences, depression, posttraumatic stress disorder (PTSD) symptoms, and attachment style 3-4 years after the fires. Using multigroup structural equation modelling, in iduals who reported separation from close family members during the bushfires (n = 471) were compared to those who reported no separation (n = 443). Cross-sectional results indicated that separated in iduals had higher levels of PTSD symptoms. Furthermore, attachment anxiety was more strongly positively associated with depression among separated (b = 0.62) versus not separated in iduals (b = 0.32). Unexpectedly, among separated in iduals, attachment avoidance had a statistically weaker association with depression (b = 0.17 vs. b = 0.35) and with PTSD symptoms (b = 0.06 vs. b = 0.22). These results suggest that attachment anxiety lifies a negative reaction to separation meanwhile, for avoidant in iduals, separation in times of danger may facilitate defensive cognitive processes.

Acute exercise-induced enhancement of fear inhibition is moderated by BDNF Val66Met polymorphism

Publisher: Springer Science and Business Media LLC

Date: 09-04-2019

DOI: 10.1038/S41398-019-0464-Z

Abstract: Rodent research indicates that acute physical exercise facilitates fear learning and inhibition. Expression of brain-derived neurotrophic factor (BDNF) may moderate the memory enhancing effects of acute exercise. We assessed the role of acute exercise in modulating extinction retention in humans, and investigated the extent to which the BDNF polymorphism influenced extinction retention. Seventy non-clinical participants engaged in a differential fear potentiated startle paradigm involving conditioning and extinction followed by random assignment to either intense exercise ( n = 35) or no exercise ( n = 35). Extinction retention was assessed 24 h later. Saliva s les were collected to index BDNF genotype. Exercised participants displayed significantly lower fear 24 h later relative to non-exercised participants. Moderation analyses indicated that after controlling for gender, the BDNF Val66Met polymorphism moderated the relationship between exercise and fear recovery 24 h later, such that exercise was associated with greater fear recovery in in iduals with the Met allele. These findings provide initial evidence that acute exercise can impact fear extinction in humans and this effect is reduced in Met-allele carriers. This finding accords with the role of BDNF in extinction learning, and has implications for augmenting exposure-based therapies for anxiety disorders.

Irritability through Research Domain Criteria: an opportunity for transdiagnostic conceptualisation

Publisher: Royal College of Psychiatrists

Date: 2021

DOI: 10.1192/BJO.2020.168

Abstract: Irritability is a transdiagnostic phenomenon that, despite its ubiquity and significant impact, is poorly conceptualised, defined and measured. As it lacks specificity, efforts to examine irritability in adults by using a diagnostic category perspective have been hamstrung. Therefore, using a Research Domain Criteria (RDoC) approach to examine irritability in adults, which spans many constructs and domains, may have a better chance of yielding underlying mechanisms that can then be mapped onto various diagnostic categories. Recently, a model has been proposed for irritability in children and adolescents that uses the RDoC framework however, this model, which accounts for chronic, persistent irritability, may not necessarily transpose to adults. Therefore, use of the RDoC framework to examine irritability in adults is urgently needed, as it may shed light on this currently amorphous phenomenon and the many disorders within which it operates.

Cortisol response and psychological distress predict susceptibility to false memories for a trauma film

Publisher: Informa UK Limited

Date: 23-10-2016

DOI: 10.1080/09658211.2015.1102287

Abstract: For eyewitness testimony to be considered reliable, it is important to ensure memory remains accurate following the event. As many testimonies involve traumatic, as opposed to neutral, events, it is important to consider the role of distress in susceptibility to false memories. The aim of this study was to investigate whether cortisol response following a stressor would be associated with susceptibility to false memories. Psychological distress responses were also investigated, specifically, dissociation, intrusions, and avoidance. Participants were allocated to one of three conditions: those who viewed a neutral film (N = 35), those who viewed a real trauma film (N = 35), and a trauma "reappraisal" group where participants were told the film was not real (N = 35). All received misinformation about the film in the form of a narrative. Participants provided saliva s les (to assess cortisol) and completed distress and memory questionnaires. Cortisol response was a significant predictor of the misinformation effect. Dissociation and avoidance were related to confabulations. In conclusion, following a stressor an in idual may differ with regard to their psychological response to the event, and also whether they experience a cortisol increase. This may affect whether they are more distressed later on, and also whether they remember the event accurately.

Imagining the future in Complicated Grief

Publisher: Hindawi Limited

Date: 27-07-2011

DOI: 10.1002/DA.20866

Abstract: Complicated Grief (CG) is a chronic and debilitating consequence of bereavement. Although sharing features with depression and anxiety, CG is associated with independent negative health outcomes. Despite these significant health costs, relatively little is known about the cognitive mechanisms that contribute to the maintenance of CG. The ability to envisage the future is important for adaptive functioning. This study investigates future-related thinking in CG. Twenty-one in iduals with CG and 24 bereaved in iduals without CG were asked to imagine specific events that may take place in their future and recall specific autobiographical memories in response to cue words, and complete a personal goals task. CG participants were less specific in their imagining of future positive events and were more likely to imagine future events relating to their loss. The extent to which in iduals were able to imagine a specific future event was significantly correlated with recalling specific memories. The tendency to imagine loss-related events in the future was associated with holding grief-related goals. These results are consistent with propositions of the self-memory system model of autobiographical memory and shed light on factors that may maintain grieving in people affected by CG.

A confirmatory factor analysis of the acute stress disorder interview

Publisher: Wiley

Date: 06-2008

DOI: 10.1002/JTS.20333

Abstract: Acute stress disorder (ASD) was introduced in 1994 to describe posttraumatic stress reactions that occur in the initial month after trauma exposure. Although it comprises the distinct symptom clusters of dissociation, reexperiencing, avoidance, and arousal, there have been no confirmatory factor analyses of the construct. In this study, 587 in iduals admitted to five major hospitals after traumatic injury were administered the Acute Stress Disorder Interview. Forty-four participants met criteria for ASD. Confirmatory factor analysis based on the four symptom clusters described the Acute Stress Disorder Interview responses. These data provide the first confirmatory factor analysis of the ASD symptoms, and are discussed in terms of the 4-factor models repeatedly found in s les of chronic posttraumatic stress disorder.

Distant Memories

Publisher: SAGE Publications

Date: 09-2009

DOI: 10.1111/J.1467-9280.2009.02393.X

Abstract: Adopting an observer perspective to recall trauma memories may function as a form of avoidance that maintains posttraumatic stress disorder (PTSD). We conducted a prospective study to analyze the relationship between memory vantage point and PTSD symptoms. Participants (N = 947) identified the vantage point of their trauma memory and reported PTSD symptoms within 4 weeks of the trauma 730 participants repeated this process 12 months later. Initially recalling the trauma from an observer vantage point was related to more severe PTSD symptoms at that time and 12 months later. Shifting from a field to an observer perspective a year after trauma was associated with greater PTSD severity at 12 months. These results suggest that remembering trauma from an observer vantage point is related to both immediate and ongoing PTSD symptoms.

Dissociative responses to conscious and non-conscious fear impact underlying brain function in post-traumatic stress disorder

Publisher: Cambridge University Press (CUP)

Date: 25-02-2008

DOI: 10.1017/S0033291708002742

Abstract: Dissociative reactions in post-traumatic stress disorder (PTSD) have been regarded as strategic responses that limit arousal. Neuroimaging studies suggest distinct prefrontal responses in in iduals displaying dissociative and hyperarousal responses to threat in PTSD. Increased prefrontal activity may reflect enhanced regulation of limbic arousal networks in dissociation. If dissociation is a higher-order regulatory response to threat, there may be differential responses to conscious and automatic processing of threat stimuli. This study addresses this question by examining the impact of dissociation on fear processing at different levels of awareness. Functional magnetic resonance imaging (fMRI) with a 1.5-T scanner was used to examine activation to fearful ( versus neutral) facial expressions during consciously attended and non-conscious (using backward masking) conditions in 23 in iduals with PTSD. Activation in 11 in iduals displaying non-dissociative reactions was compared to activation in 12 displaying dissociative reactions to consciously and non-consciously perceived fear stimuli. Dissociative PTSD was associated with enhanced activation in the ventral prefrontal cortex for conscious fear, and in the bilateral amygdala, insula and left thalamus for non-conscious fear compared to non-dissociative PTSD. Comparatively reduced activation in the dissociative group was apparent in dorsomedial prefrontal regions for conscious fear faces. These findings confirm our hypotheses of enhanced prefrontal activity to conscious fear and enhanced activity in limbic networks to non-conscious fear in dissociative PTSD. This supports the theory that dissociation is a regulatory strategy invoked to cope with extreme arousal in PTSD, but this strategy appears to function only during conscious processing of threat.

Neural Networks of Information Processing in Posttraumatic Stress Disorder: A Functional Magnetic Resonance Imaging Study

Publisher: Elsevier BV

Date: 07-2005

DOI: 10.1016/J.BIOPSYCH.2005.03.021

Abstract: Neuroimaging studies report reduced medial prefrontal cortical (particularly anterior cingulate) but enhanced amygdala response to fear signals in posttraumatic Stress Disorder (PTSD). We investigated whether anterior cingulate-amygdala dysregulation in PTSD would generalize to salient, but nonthreat related signals. In iduals with PTSD (n = 14) and age and sex-matched nontraumatized controls (n = 14) completed an auditory oddball paradigm adapted to functional magnetic resonance imaging at a 1.5-T field strength. Controls displayed bilateral activation in ventral anterior cingulate and amygdala networks, and PTSD subjects showed bilateral dorsal anterior cingulate and amygdala activation to targets relative to nontargets. Compared to controls, PTSD subjects showed enhanced responses to targets in the dorsal and rostral anterior cingulate, and left amygdala. Whole-brain analyses confirmed the expected pattern of distributed prefrontal-parietal responses to targets in the oddball task. Greater activity in posterior parietal somatosensory regions was observed in PTSD. Our findings of enhanced anterior cingulate responses in PTSD contrast with reports of reduced activity for threat stimuli, suggesting that the latter may be specific to processing of threat-related content. Activation in rostral and dorsal anterior cingulate, left amygdala and posterior parietal networks in response to salient, nonthreatening stimuli may reflect generalized hypervigilance.

Disorder specificity despite comorbidity: Resting EEG alpha asymmetry in major depressive disorder and post-traumatic stress disorder

Publisher: Elsevier BV

Date: 10-2010

DOI: 10.1016/J.BIOPSYCHO.2010.08.001

Positive affect training to reduce mental health problems during the COVID-19 pandemic: a proof-of-concept randomised clinical trial

Publisher: BMJ

Date: 06-2023

DOI: 10.1136/BMJMENT-2023-300737

Abstract: The social restrictions occurring during the pandemic contributed to loss of many sources of reward, which contributes to poor mental health. This trial evaluated a brief positive affect training programme to reduce anxiety, depression and suicidality during the pandemic. In this single-blind, parallel, randomised controlled trial, adults who screened positive for COVID-19-related psychological distress across Australia were randomly allocated to either a 6-session group-based programme based on positive affect training (n=87) or enhanced usual care (EUC, n=87). Primary outcome was total score on the Hospital Anxiety and Depression Scale—anxiety and depression subscales assessed at baseline, 1-week post-treatment, 3 months (primary outcome time point) as well as secondary outcome measures of suicidality, generalised anxiety disorder, sleep impairment, positive and negative mood and COVID-19-related stress. Between 20 September 2020 and 16 September 2021, 174 participants were enrolled into the trial. Relative to EUC, at 3-month follow-up the intervention led to greater reduction on depression (mean difference 1.2 (95% CI 0.4 to 1.9)), p=0.003), with a moderate effect size (0.5 (95% CI 0.2 to 0.9)). There were also greater reduction of suicidality and improvement in quality of life. There were no differences in anxiety, generalised anxiety, anhedonia, sleep impairment, positive or negative mood or COVID-19 concerns. This intervention was able to reduce depression and suicidality during adverse experiences when rewarding events were diminished, such as pandemics. Strategies to improve positive affect may be useful to reduce mental health issues. ACTRN12620000811909.

The dynamic course of psychological outcomes following the Victorian Black Saturday bushfires

Publisher: SAGE Publications

Date: 11-11-2020

DOI: 10.1177/0004867420969815

Abstract: To profile the long-term mental health outcomes of those affected by the 2009 Black Saturday bushfires and to document the course of mental health since the disaster. The longitudinal Beyond Bushfires study included 1017 respondents (Wave 1 3–4 years after the fires), 736 (76.1%) at Wave 2 (5 years after the fires) and 525 (51.6%) at Wave 3 (10 years after the fires). The survey indexed fire-related and subsequent stressful events, probable posttraumatic stress disorder, major depressive disorder, alcohol use, severe distress and receipt of health services for mental health problems. Relative to their status 3–4 years after the fires, there were reduced rates of fire-related posttraumatic stress disorder (6.2% vs 12.2%), general posttraumatic stress disorder (14.9% vs 18.7%) and severe distress (4.4% vs 7.5%) at 10 years. There were comparable rates between Wave 1 and Wave 3 for depression (10.9% vs 8.3%) and alcohol abuse (21.8% vs 18.5%). Of people in high-affected regions, 22.1% had posttraumatic stress disorder, depression or severe distress at Wave 3. One-third to one-half of participants who reported probable posttraumatic stress disorder or depression at any assessment did not display the disorder at the next assessment. Worsening of mental health at Wave 3 was associated with the extent of property loss, exposure to recent traumatic events or recent stressful life events. Only 24.6% of those with a probable disorder had sought professional help for this in the previous 6 months. Approximately one-fifth of people from high-affected areas have a probable psychological disorder a decade after the fires. Mental health appears to fluctuate for those who are not consistently resilient, apparently as a result of ongoing stressors. The observation that most people with probable disorder are not receiving care highlights the need for further planning about managing long-term mental health needs of disaster-affected communities.

What works for whom when treating major depression with psychotherapy?

Publisher: SAGE Publications

Date: 24-05-2022

DOI: 10.1177/00048674221100425

A prospective study of rapid breathing and the development of posttraumatic panic disorder.

Publisher: American Psychological Association (APA)

Date: 2014

DOI: 10.1037/A0034792

Change in visa status amongst Mandaean refugees: Relationship to psychological symptoms and living difficulties

Publisher: Elsevier BV

Date: 05-2011

DOI: 10.1016/J.PSYCHRES.2010.12.015

Abstract: Policies of deterrence, including the use of detention and temporary visas, have been widely implemented to dissuade asylum seekers from seeking protection in Western countries. The present study examined the impact of visa status change on the mental health of 97 Mandaean refugees resettled in Australia. At the time of the first survey (2004), 68 (70%) participants held temporary protection visas (TPVs) and 29 (30%) held permanent residency (PR) status, whereas by the second survey (2007), 97 (100%) participants held PR status. We tested a meditational model to determine whether the relationship between change in visa status and change in psychological symptoms was mediated by change in living difficulties associated with the visa categories. The conversion of visa status from TPV to PR status was associated with significant improvements in PTSD and depression symptoms, and increases in mental health-related quality of life (MHR-QOL). The relationship between change in visa status and reduced PTSD and depression symptoms was mediated by reductions in living difficulties. In contrast, the relationship between change in visa status and increased MHR-QOL was not mediated by changes in living difficulties. These results suggest that restriction of rights and access to services related to visa status negatively affect the mental health of refugees. Implications for government policies regarding refugees are discussed.

Posttraumatic stress disorder following cancer

Publisher: Elsevier BV

Date: 05-2002

DOI: 10.1016/S0272-7358(01)00118-0

Abstract: Life-threatening illness has recently been recognized as a stressor that can precipitate posttraumatic stress disorder (PTSD). This development has raised questions over the extent to which the PTSD diagnosis is applicable to the psychological reaction to being diagnosed with cancer. This paper identifies the core conceptual issues pertaining to cancer-related PTSD, critically reviews the empirical literature on PTSD following cancer, and considers the possible mechanisms and course of PTSD following a diagnosis of cancer. Specific issues that need to be considered in the assessment and treatment of cancer-related PTSD are reviewed. This review highlights that there is a need for stronger empirical base to guide clinical management of PTSD in cancer patients.

Prescription memory: Is it time to change the script?

Publisher: SAGE Publications

Date: 11-2020

DOI: 10.1177/0004867420969807

Autobiographical memory following cognitive behaviour therapy for complicated grief

Publisher: Elsevier BV

Date: 03-2011

DOI: 10.1016/J.JBTEP.2010.08.006

Abstract: A deficit in the ability to retrieve specific autobiographical memories has been linked to a number of negative consequences, including poor problem solving skills, reduced ability to imagine the future, and the onset of symptoms following trauma. This study investigated the impact of cognitive behaviour therapy (CBT) on memory retrieval specificity in patients with Complicated Grief (CG). Twenty in iduals with CG who were seeking treatment were administered an autobiographical memory task (AMT) before and after completing a 10-week CBT program. Pre-treatment retrieval specificity did not predict treatment outcome. However, there was a significant correlation between symptom reduction and increased specific retrieval to positive cues following treatment. These results suggest that overgeneral retrieval in CG can be modified by CBT, and may point to one means by which CBT can alleviate CG symptoms.

Experimental and numerical studies on failure behaviours of sandstones subject to freeze-thaw cycles

Publisher: Elsevier BV

Date: 11-2021

DOI: 10.1016/J.TRGEO.2021.100655

Posttraumatic stress disorder and prolonged grief in refugees exposed to trauma and loss

Publisher: Springer Science and Business Media LLC

Date: 09-04-2014

DOI: 10.1186/1471-244X-14-106

Stroop colour word test as a measure of attentional deficit following mild head injury

Publisher: Informa UK Limited

Date: 05-1995

DOI: 10.1080/13854049508401600

Torture exposure and the functional brain: investigating disruptions to intrinsic network connectivity using resting state fMRI

Publisher: Springer Science and Business Media LLC

Date: 26-01-2022

DOI: 10.1038/S41398-022-01795-3

Abstract: Torture has profound psychological and physiological consequences for survivors. While some brain structures and functions appear altered in torture survivors, it is unclear how torture exposure influences functional connectivity within and between core intrinsic brain networks. In this study, 37 torture survivors (TS) and 62 non-torture survivors (NTS) participated in a resting-state fMRI scan. Data-driven independent components analysis identified active intrinsic networks. Group differences in functional connectivity in the default mode network (DMN), salience network (SN) and central executive network (CEN) of the triple network model, as well any prefrontal network, were examined while controlling for PTSD symptoms and exposure to other potentially traumatic events. The analysis identified 25 networks eight comprised our networks of interest. Within-network group differences were observed in the left CEN (lCEN), where the TS group showed less spectral power in the low-frequency band. Differential internetwork dynamic connectivity patterns were observed, where the TS group showed stronger positive coupling between the lCEN and anterior dorsomedial and ventromedial DMN, and stronger negative coupling between a lateral frontal network and the lCEN and anterior dorsomedial DMN (when contrasted with the NTS group). Group differences were not attributed to torture severity or dissociative symptoms. Torture survivors showed disrupted dynamic functional connectivity between a laterally-aligned lCEN that serves top-down control functions over external processes and the midline DMN that underpins internal self-referential processes, which may be an adaptive response to mitigate the worst effects of the torture experience. This study provides a critical step in mapping the neural signature of torture exposure to guide treatment development and selection.

Simulating Emotional Responses in Posttraumatic Stress Disorder: An fMRI Study

Publisher: Springer Science and Business Media LLC

Date: 06-2010

DOI: 10.1007/S12207-010-9071-2

Early visual processing is enhanced in the midluteal phase of the menstrual cycle

Publisher: Elsevier BV

Date: 12-2015

DOI: 10.1016/J.PSYNEUEN.2015.08.022

Abstract: Event-related potential (ERP) studies have revealed an early attentional bias in processing unpleasant emotional images in women. Recent neuroimaging data suggests there are significant differences in cortical emotional processing according to menstrual phase. This study examined the impact of menstrual phase on visual emotional processing in women compared to men. ERPs were recorded from 28 early follicular women, 29 midluteal women, and 27 men while they completed a passive viewing task of neutral and low- and high- arousing pleasant and unpleasant images. There was a significant effect of menstrual phase in early visual processing, as midluteal women displayed significantly greater P1 litude at occipital regions to all visual images compared to men. Both midluteal and early follicular women displayed larger N1 litudes than men (although this only reached significance for the midluteal group) to the visual images. No sex or menstrual phase differences were apparent in later N2, P3, or LPP. A condition effect demonstrated greater P3 and LPP litude to highly-arousing unpleasant images relative to all other stimuli conditions. These results indicate that women have greater early automatic visual processing compared to men, and suggests that this effect is particularly strong in women in the midluteal phase at the earliest stage of visual attention processing. Our findings highlight the importance of considering menstrual phase when examining sex differences in the cortical processing of visual stimuli.

The Course of Psychological Disorders in the 1st Year After Cancer Diagnosis.

Publisher: American Psychological Association (APA)

Date: 2005

DOI: 10.1037/0022-006X.73.4.763

Prior Trauma and Psychiatric History as Risk Factors for Intentional and Unintentional Injury in Australia

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 02-2009

DOI: 10.1097/TA.0B013E31815D965E

Preliminary Evidence of the Short Allele of the Serotonin Transporter Gene Predicting Poor Response to Cognitive Behavior Therapy in Posttraumatic Stress Disorder

Publisher: Elsevier BV

Date: 06-2010

DOI: 10.1016/J.BIOPSYCH.2010.03.016

Abstract: This study was intended to assess the extent to which the low-expression alleles of the serotonin transporter gene promoter predict poor response to cognitive behavior therapy in patients with posttraumatic stress disorder (PTSD). Forty-five patients with PTSD underwent an 8-week exposure-based cognitive behavior therapy program and provided mouth swabs or saliva s les to extract genomic DNA and classify in iduals according to four allelic forms (S(A), S(G), L(A), L(G)) of the 5-HTT-linked polymorphic region (5-HTTLPR). We determined whether the 5-HTTLPR genotype predicted change in PTSD severity following treatment (n = 45) and 6 months later (n = 42). After controlling for pretreatment PTSD severity and number of treatment sessions, the 5-HTTLPR low-expression genotype group (S or L(G) allele carriers) displayed more severe PTSD 6 months following treatment relative to other patients. This study suggests a genetic contribution to treatment outcome following cognitive behavior therapy and implicates the serotonergic system in response to exposure-based treatments in PTSD.

Posttraumatic Stress Disorder After Injury: Does Admission to Intensive Care Unit Increase Risk?

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 09-2010

DOI: 10.1097/TA.0B013E3181BC0923

The Relationship Between Acute Stress Disorder and Posttraumatic Stress Disorder Following Cancer.

Publisher: American Psychological Association (APA)

Date: 2005

DOI: 10.1037/0022-006X.73.2.360

UTILITY OF THE DIMENSIONS OF ANGER REACTIONS-5 (DAR-5) SCALE AS A BRIEF ANGER MEASURE

Publisher: Hindawi Limited

Date: 25-06-2013

DOI: 10.1002/DA.22148

Abstract: Anger is a common emotional sequel in the aftermath of traumatic experience. As it is associated with significant distress and influences recovery, anger requires routine screening and assessment. Most validated measures of anger are too lengthy for inclusion in self-report batteries or as screening tools. This study examines the psychometric properties of a shortened 5-item version of the Dimensions of Anger Reactions (DAR), an existing screening tool. Responses to the DAR-5 were analysed from a s le of 486 college students with and without a history of trauma exposure. The DAR-5 demonstrated strong internal reliability and concurrent validity with the State Trait Anger Expression Inventory-2 (STAXI-2). Confirmatory factor analysis supported a single factor model of the DAR-5 for the trauma-exposed and nontrauma subs les. A screening cut-off point of 12 on the DAR-5 successfully differentiated high and low scorers on STAXI-2 Trait Anger and PCL posttraumatic stress scores. Further discriminant validity was found with depression symptom scores. The results support use of the DAR-5 for screening for anger when a short scale is required.

Secure attachment priming protects against relapse of fear in Young adults

Publisher: Springer Science and Business Media LLC

Date: 13-11-2021

DOI: 10.1038/S41398-021-01715-X

Abstract: Previous studies have shown that activating the attachment system attenuates fear learning. This study aimed to explore whether attachment priming can also impact on fear extinction processes, which underpin the management of anxiety disorders. In this study, 81 participants underwent a standard fear conditioning and extinction protocol on day 1 and returned 24 h later for an extinction recall and reinstatement test. Half the participants were primed to imagine their closest attachment figure prior to undergoing extinction training, while the other half were instructed to imagine a positive situation. Fear-potentiated startle and subjective expectancies of shock were measured as the primary indicators of fear. Attachment priming led to less relapse during the reinstatement test at the physiological but not subjective levels. These findings have translational potential to imply that activating awareness of attachment figures might augment long-term safety memories acquired in existing treatments to reduce relapse of fear.

Resting electroencephalogram asymmetry and posttraumatic stress disorder

Publisher: Wiley

Date: 2008

DOI: 10.1002/JTS.20319

Abstract: The valence-arousal (W. Heller, 1993) and approach-withdrawal (R. J. Davidson, 1998a) models hypothesize that particular patterns of hemispheric brain activity are associated with specific motivational tendencies and psychopathologies. We tested several of these predictions in two groups-a posttraumatic stress disorder (PTSD) and a "supercontrol" group, selected to be maximally different from those with PTSD. Contrary to almost all hypotheses, in iduals with PTSD did not differ from controls on resting electroencephalogram (EEG) asymmetry. Particular aspects of PTSD were also not related to EEG hemisphere differences. Our null findings are consistent with the few studies that have examined resting EEG asymmetries in PTSD and suggest that PTSD may be associated with different processes than psychopathologies previously examined in studies of hemispheric brain activity (e.g., major depressive disorder, panic disorder).

An investigation of approach behaviour in Prolonged Grief

Publisher: Elsevier BV

Date: 08-2019

DOI: 10.1016/J.BRAT.2019.05.002

Abstract: Prolonged Grief (PG) is recognized as a potentially debilitating post-bereavement syndrome. Theoretical models of PG highlight the importance of both approach and avoidance behaviours in maintaining the syndrome. Research to date has focussed primarily on investigating avoidance in response to loss reminders. Comparatively few studies have indexed approach behaviours in PG. We use a quasi-experimental paradigm to simultaneously examine approach and avoidance behaviours to reminders of the deceased. Fifty-five bereaved in iduals with and without PG responded to stimuli showing the deceased's name, an attachment figure's name, a neutral name, or a letter string, by pulling or pushing a joystick according to a whether the stimuli was a word or not. Concurrent visual feedback created the illusion that the images were either approaching or receding from the participant. Participants with PG were quicker to pull than push the three name stimuli, with quicker pulling of the deceased and attachment name than the neutral name. Non-PG participants responded more quickly to the attachment name but evidenced no relative approach or avoidance of any stimuli. Findings provide behavioural evidence about approach behaviour in PG, and are discussed with references to models that recognise the role of yearning for the deceased in PG.

TOWARD AN INTEGRATED PROFILE OF DEPRESSION: EVIDENCE FROM THE BRAIN RESOURCE INTERNATIONAL DATABASE

Publisher: World Scientific Pub Co Pte Lt

Date: 03-2005

DOI: 10.1142/S0219635205000665

Abstract: Clinical depression is one of the most common psychiatric disorders in adults, yet non-clinical depression in the community may go unnoticed, despite high prevalence rates and significant psychosocial impairment. The aim of the current study was to classify 1,226 in iduals from a community s le on the basis of depression scores (using the Depression Anxiety Stress Scales, DASS) and to determine whether depression in a non-clinical s le differed significantly from healthy controls on a profile of multimodal measures. The data analyzed in this study included personality, emotional intelligence, cognition and psychophysiology. It was predicted that non-clinically depressed participants would differ from healthy controls on measures of personality (increased neuroticism decreased extraversion), emotional intelligence (decreased), cognition (impairments in executive dysfunction and memory impairment), psychophysiology (increased resting-state, right-frontal activation diminished skin conductance) after controlling for gender, age, handedness and years of education. Findings provide support for the majority of hypotheses, though no evidence was found for memory impairment or frontal hemispheric asymmetry. Longitudinal studies are needed to determine the extent to which of these findings will have utility for the prediction of depression onset and treatment response/non-response.

Irritability in Mood Disorders: Neurobiological Underpinnings and Implications for Pharmacological Intervention

Publisher: Springer Science and Business Media LLC

Date: 21-05-2021

DOI: 10.1007/S40263-021-00823-Y

Abstract: Feeling irritable is a common experience, both in health and disease. In the context of psychiatric illnesses, it is a transdiagnostic phenomenon that features across all ages, and often causes significant distress and impairment. In mood disorders, irritability is near ubiquitous and plays a central role in diagnosis and yet, despite its prevalence, it remains poorly understood. A neurobiological model of irritability posits that, in children and adolescents, it is consequent upon deficits in reward and threat processing, involving regions such as the amygdala and frontal cortices. In comparison, in adults with mood disorders, the few studies that have been conducted implicate the amygdala, orbitofrontal cortices, and hypothalamus however, the patterns of activity in these areas are at variance with the findings in youth. These age-related differences seem to extend to the neurochemistry of irritability, with links between increased monoamine transmission and irritability evident in adults, but aberrant levels of, and responses to, dopamine in youth. Presently, there are no specific treatments that have significant efficacy in reducing irritability in mood disorders. However, treatments that hold some potential and warrant further exploration include agents that act on serotonergic and dopaminergic systems, especially as irritability may serve as a prognostic indicator for overall clinical responsiveness to specific medications. Therefore, for understanding and treatment of irritability to advance meaningfully, it is imperative that an accurate definition and means of measuring irritability are developed. To achieve this, it is necessary that the subjective experience of irritability, both in health and illness, is better understood. These insights will inform an accurate, comprehensive, and valid interrogation of the qualities of irritability in health and illness, and allow not only a clinical appreciation of the phenomenon, but also a deeper understanding of its important role within the development and manifestation of mood disorders.

Selective Prevention of Depression in Workers Using a Smartphone App: Randomized Controlled Trial

Publisher: JMIR Publications Inc.

Date: 24-08-2023

DOI: 10.2196/45963

Abstract: There is increasing evidence that depression can be prevented however, universal approaches have had limited success. Appropriate targeting of interventions to at-risk populations has been shown to have potential, but how to selectively determine at-risk in iduals remains unclear. Workplace stress is a risk factor for depression and a target for intervention, but few interventions exist to prevent depression among workers at risk due to heightened stress. This trial aimed to evaluate the efficacy of a smartphone-based intervention in reducing the onset of depression and improving related outcomes in workers experiencing at least moderate levels of stress. A randomized controlled trial was conducted with participants who were currently employed and reported no clinically significant depression and at least moderate stress. The intervention group (n=1053) were assigned Anchored, a 30-day self-directed smartphone app-based cognitive behavioral- and mindfulness-based intervention. The attention-control group (n=1031) were assigned a psychoeducation website. Assessment was performed via web-based self-report questionnaires at baseline and at 1-, 3-, and 6-month postbaseline time points. The primary outcome was new depression caseness aggregated over the follow-up period. The secondary outcomes included depressive and anxiety symptoms, stress, well-being, resilience, work performance, work-related burnout, and quality of life. Analyses were conducted within an intention-to-treat framework using mixed modeling. There was no significant between-group difference in new depression caseness (z score=0.69 P=.49) however, those in the Anchored arm had significantly greater depressive symptom reduction at 1 month (Cohen d=0.02 P=.049) and 6 months (Cohen d=0.08 P=.03). Anchored participants also showed significantly greater reduction in anxiety symptoms at 1 month (Cohen d=0.07 P=.04) and increased work performance at 1 month (Cohen d=0.07 P=.008) and 6 months (Cohen d=0.13 P=.01), compared with controls. Notably, for Anchored participants completing at least two-thirds of the intervention, there was a significantly lower rate of depression onset (1.1%, 95% CI 0.0%-3.7%) compared with controls (9.0%, 95% CI 6.8%-12.3%) at 1 month (z score=4.50 P .001). Significant small to medium effect sizes for most secondary outcomes were seen in the highly engaged Anchored users compared with controls, with effects maintained at the 6-month follow-up for depressive symptoms, well-being, stress, and quality of life. Anchored was associated with a small comparative reduction in depressive symptoms compared with controls, although selective prevention of case-level depression was not observed in the intention-to-treat analysis. When users adequately engaged with the app, significant findings pertaining to depression prevention, overall symptom reduction, and functional improvement were found, compared with controls. There is a need for a greater focus on engagement techniques in future research. Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000178943 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378592

Impact of the diagnostic changes to post-traumatic stress disorder for DSM-5 and the proposed changes to ICD-11

Publisher: Royal College of Psychiatrists

Date: 09-2014

DOI: 10.1192/BJP.BP.113.135285

Abstract: There have been changes to the criteria for diagnosing post-traumatic stress disorder (PTSD) in DSM-5 and changes are proposed for ICD-11. To investigate the impact of the changes to diagnostic criteria for PTSD in DSM-5 and the proposed changes in ICD-11 using a large multisite trauma-exposed s le and structured clinical interviews. Randomly selected injury patients admitted to four hospitals were assessed 72 months post trauma ( n = 510). Structured clinical interviews for PTSD and major depressive episode, as well as self-report measures of disability and quality of life were administered. Current prevalence of PTSD under DSM-5 scoring was not significantly different from DSM-IV (6.7% v. 5.9%, z = 0.53, P = 0.59). However, the ICD-11 prevalence was significantly lower than ICD-10 (3.3% v. 9.0%, z =–3.8, P .001). The PTSD current prevalence was significantly higher for DSM-5 than ICD-11 (6.7% v. 3.3%, z = 2.5, P = 0.01). Using ICD-11 tended to show lower rates of comorbidity with depression and a slightly lower association with disability. The diagnostic systems performed in different ways in terms of current prevalence rates and levels of comorbidity with depression, but on other broad key indicators they were relatively similar. There was overlap between those with PTSD diagnosed by ICD-11 and DSM-5 but a substantial portion met one but not the other set of criteria. This represents a challenge for research because the phenotype that is studied may be markedly different according to the diagnostic system used.

A population study of prolonged grief in refugees

Publisher: Cambridge University Press (CUP)

Date: 19-08-2019

DOI: 10.1017/S2045796019000386

Abstract: Despite the frequency that refugees suffer bereavement, there is a dearth of research into the prevalence and predictors of problematic grief reactions in refugees. To address this gap, this study reports a nationally representative population-based study of refugees to determine the prevalence of probable prolonged grief disorder (PGD) and its associated problems. This study recruited participants from the Building a New Life in Australia (BNLA) prospective cohort study of refugees admitted to Australia between October 2013 and February 2014. The current data were collected in 2015–2016, and comprised 1767 adults, as well as 411 children of the adult respondents. Adult refugees were assessed for trauma history, post-migration difficulties, probable PGD, post-traumatic stress disorder (PTSD) and mental illness. Children were administered the Strengths and Difficulties Questionnaire. In this cohort, 38.1% of refugees reported bereavement, of whom 15.8% reported probable PGD this represents 6.0% of the entire cohort. Probable PGD was associated with a greater likelihood of mental illness, probable PTSD, severe mental illness, currently unemployed and reported disability. Children of refugees with probable PGD reported more psychological difficulties than those whose parents did not have probable PGD. Probable PGD was also associated with the history of imprisonment, torture and separation from family. Only 56.3% of refugees with probable PGD had received psychological assistance. Bereavement and probable PGD appear highly prevalent in refugees, and PGD seems to be associated with disability in the refugees and psychological problems in their children. The low rate of access to mental health assistance for these refugees highlights that there is a need to address this issue in refugee populations.

A pilot randomized controlled trial of a brief early intervention for reducing posttraumatic stress disorder, anxiety and depressive symptoms in newly diagnosed head and neck cancer patients

Publisher: Wiley

Date: 08-10-2012

DOI: 10.1002/PON.3208

Abstract: Head and neck cancer (HNC) patients have a high incidence of cancer-related posttraumatic stress disorder (PTSD) and other anxiety and depressive disorders. We report the results from the first pilot randomized controlled trial in which the efficacy of an early cognitive-behavioral therapy (CBT) program was compared with a non-directive supportive counseling (SC) intervention in reducing PTSD, general anxiety and depressive symptoms, and improving perceived quality of life in newly diagnosed, distressed HNC patients undergoing radiotherapy. Thirty-five HNC patients (mean age=54.8 years 80% males) with elevated levels of PTSD, depression or anxiety were randomized to seven in idual sessions of a multi-modal CBT or non-directive SC, concurrent with patients' radiotherapy. The SC intervention provided non-directive counseling support. PTSD, anxiety and depressive symptoms (primary outcomes), and cancer-related appraisals and quality of life (secondary outcomes) were assessed pre-intervention (baseline), 1 month, 6 months and 12 months post-intervention by diagnostic clinical interviews and validated self-report questionnaires. The CBT and SC interventions were found to be equal in their effects in reducing PTSD and anxiety symptoms both in the short and longer term. However, up to 67% of patients in the CBT program no longer met clinical or sub-clinical PTSD, anxiety and/or depression by 12 months post-treatment compared with 25% of patients who received SC. Findings indicate that the early provision of psychotherapy has utility in reducing PTSD, anxiety and depressive symptoms, and preventing chronic psychopathology in distressed HNC patients.

Anterior cingulate activity to salient stimuli is modulated by autonomic arousal in Posttraumatic Stress Disorder

Publisher: Elsevier BV

Date: 07-2009

DOI: 10.1016/J.PSCYCHRESNS.2008.12.005

Abstract: Reduced ventral anterior cingulate (vACC) activity to threat is thought to reflect an impairment in regulating arousal networks in posttraumatic stress disorder (PTSD). Concurrent functional magnetic resonance imaging (fMRI) and skin conductance response (SCR) recording were used to examine neural functioning when arousal networks are engaged. Eleven participants with PTSD and 11 age- and sex-matched non-traumatized controls performed an oddball task that required responding to salient, non-trauma-related auditory target tones embedded in lower frequency background tones. Averaged target-background analyses revealed significantly greater dorsal ACC, supramarginal gyrus, and hippoc al activity in PTSD relative to control participants.With-SCR target responses resulted in increased vACC activity in controls, and dorsal ACC activity in PTSD. PTSD participants had reduced vACC activity relative to controls to target tones when SCR responses were present. This reduction in vACC in PTSD relative to controls was not apparent in without-SCR responses. These findings suggest that a reduction in vACC in PTSD occurs specifically when arousal networks are engaged.

A latent profile analysis of moral injury appraisals in refugees

Publisher: Informa UK Limited

Date: 11-11-2019

DOI: 10.1080/20008198.2019.1686805

Support for the mutual maintenance of pain and post-traumatic stress disorder symptoms

Publisher: Cambridge University Press (CUP)

Date: 08-10-2009

DOI: 10.1017/S0033291709991310

Abstract: Pain and post-traumatic stress disorder (PTSD) are frequently co-morbid in the aftermath of a traumatic event. Although several models attempt to explain the relationship between these two disorders, the mechanisms underlying the relationship remain unclear. The aim of this study was to investigate the relationship between each PTSD symptom cluster and pain over the course of post-traumatic adjustment. In a longitudinal study, injury patients ( n =824) were assessed within 1 week post-injury, and then at 3 and 12 months. Pain was measured using a 100-mm Visual Analogue Scale (VAS). PTSD symptoms were assessed using the Clinician-Administered PTSD Scale (CAPS). Structural equation modelling (SEM) was used to identify causal relationships between pain and PTSD. In a saturated model we found that the relationship between acute pain and 12-month pain was mediated by arousal symptoms at 3 months. We also found that the relationship between baseline arousal and re-experiencing symptoms, and later 12-month arousal and re-experiencing symptoms, was mediated by 3-month pain levels. The final model showed a good fit [χ 2 =16.97, df=12, p .05, Comparative Fit Index (CFI)=0.999, root mean square error of approximation (RMSEA)=0.022]. These findings provide evidence of mutual maintenance between pain and PTSD.

Induced arousal and reexperiencing in acute stress disorder

Publisher: Elsevier BV

Date: 2005

DOI: 10.1016/J.JANXDIS.2004.05.001

Abstract: This study investigated the relationship of hyperarousal and intrusive symptoms in acute stress disorder (ASD). Civilian trauma survivors with ASD (n = 18) and without ASD (n = 14) completed a hyperventilation provocation test (HVPT) and then completed the Physical Reactions Scale. All participants provided a narrative describing their hyperventilation experience that was audiotaped and independently coded. In iduals with ASD reported greater numbers of intrusive memories and reported greater distress than non-ASD participants. More ASD than non-ASD participants experienced a flashback-type reaction during the hyperventilation. Intrusive symptoms were significantly correlated with elevated arousal following the HVPT. The findings provide evidence that reexperiencing is directly associated with elevated states of arousal.

Enhanced amygdala and medial prefrontal activation during nonconscious processing of fear in posttraumatic stress disorder: An fMRI study

Publisher: Wiley

Date: 24-05-2008

DOI: 10.1002/HBM.20415

Psychological outcomes following the Victorian Black Saturday bushfires

Publisher: SAGE Publications

Date: 22-05-2014

DOI: 10.1177/0004867414534476

Abstract: We aimed to map the prevalence and predictors of psychological outcomes in affected communities 3–4 years after the Black Saturday bushfires in the state of Victoria, Australia. Baseline assessment of a longitudinal cohort study in high-, medium-, and low-affected communities in Victoria. Participants included 1017 residents of high-, medium-, and low-affected fire communities. Participants were surveyed by means of a telephone and web-based interview between December 2011 and January 2013. The survey included measures of fire-related post-traumatic stress disorder (PTSD) and general PTSD from other traumatic events, major depressive episode, alcohol use, and general psychological distress. The majority of respondents in the high- (77.3%), medium- (81.3%), and low-affected (84.9%) communities reported no psychological distress on the K6 screening scale. More participants in the high-affected communities (15.6%) reported probable PTSD linked to the bushfires than medium- (7.2%) and low-affected (1.0%) communities (odds ratio (OR): 4.57, 95% confidence interval (CI): 2.61–8.00, p = 0.000). Similar patterns were observed for depression (12.9%, 8.8%, 6.3%, respectively) (OR: 1.83, 95% CI: 1.17–2.85, p = 0.008) and severe psychological distress (9.8%, 5.0%, 4.9%, respectively) (OR: 2.08, 95% CI: 1.23–3.55, p = 0.007). All communities reported elevated rates of heavy drinking (24.7%, 18.7%, 19.6%, respectively) however, these were higher in the high-affected communities (OR: 1.39, 95% CI: 1.01–1.89, p = 0.04). Severe psychological distress was predicted by fear for one’s life in the bushfires, death of someone close to them in the bushfires, and subsequent stressors. One-third of those with severe psychological distress did not receive mental health assistance in the previous month. Several years following the Black Saturday bushfires the majority of affected people demonstrated resilience without indications of psychological distress. A significant minority of people in the high-affected communities reported persistent PTSD, depression, and psychological distress, indicating the need for promotion of the use of health and complementary services, community-based initiatives, and family and other informal supports, to target these persistent problems.

Changes in Anterior Cingulate and Amygdala After Cognitive Behavior Therapy of Posttraumatic Stress Disorder

Publisher: SAGE Publications

Date: 02-2007

DOI: 10.1111/J.1467-9280.2007.01860.X

Impact of displacement context on psychological distress in refugees resettled in Australia: a longitudinal population-based study

Publisher: Cambridge University Press (CUP)

Date: 2022

DOI: 10.1017/S2045796022000324

Abstract: Refugees typically spend years in a state of protracted displacement prior to permanent resettlement. Little is known about how various prior displacement contexts influence long-term mental health in resettled refugees. In this study, we aimed to determine whether having lived in refugee c s v. community settings prior to resettlement impacted the course of refugees' psychological distress over the 4 years following arrival in Australia. Participants were 1887 refugees who had taken part in the Building a New Life in Australia study, which comprised of five annual face-to-face or telephone surveys from the year of first arrival in Australia. Latent growth curve modelling revealed that refugees who had lived in c s showed greater initial psychological distress (as indexed by the K6) and faster decreases in psychological distress in the 4 years after resettling in Australia, compared to those who had lived in community settings. Investigation of refugee c characteristics revealed that poorer access to services in c s was associated with greater initial distress after resettlement, and greater ability to meet one's basic needs in c s was associated with faster decreases in psychological distress over time. These findings highlight the importance of the displacement context in influencing the course of post-resettlement mental health. Increasing available services and meeting basic needs in the displacement environment may promote better mental health outcomes in resettled refugees.

Practitioner perceptions of Skills for Psychological Recovery: A training programme for health practitioners in the aftermath of the Victorian bushfires

Publisher: SAGE Publications

Date: 12-2010

DOI: 10.3109/00048674.2010.513674

Abstract: Objective: Following the February 2009 Victorian bushfires, Australia's worst natural disaster, the Australian Centre for Posttraumatic Mental Health, in collaboration with key trauma experts, developed a three-tiered approach to psychological recovery initiatives for survivors with training specifically designed for each level. The middle level intervention, designed for delivery by allied health and primary care practitioners for survivors with ongoing mild-moderate distress, involved a protocol still in draft form called Skills for Psychological Recovery (SPR). SPR was developed by the US National Center for PTSD and US National Child Traumatic Stress Network. This study examined health practitioner perceptions of the training in, and usefulness of, SPR. Methods: From a range of disciplines 342 health practitioners attended one of 25 one-day workshops on the delivery of SPR. Perceptions of evidence-based care and attitudes to manualized interventions were assessed at the commencement of the workshop. Following the workshop, participants’ perceptions of their confidence in applying, and perceived usefulness of, each module were assessed. A subset of 20 participants recorded their ongoing use of SPR recording 61 cases. Results: The vast majority of participants rated the SPR modules as useful for survivors of disasters and expressed confidence in implementing the intervention following the training. Participants’ pre-workshop attitudes towards evidence-based care and manualized interventions affected their perceptions of the usefulness of the protocol. The ‘Promoting positive activities’ and ‘Rebuilding healthy social connections’ modules were least influenced by variations in these perceptions. Conclusions: This study provides preliminary evidence that SPR is perceived by health providers from varying disciplines and paradigms as an acceptable and useful intervention for disaster survivors with moderate levels of mental health difficulties. Future SPR dissemination efforts may benefit from focusing on modules with the strongest evidence base and which are most amenable to practitioner acceptance and uptake.

Imaginal exposure alone and imaginal exposure with cognitive restructuring in treatment of posttraumatic stress disorder.

Publisher: American Psychological Association (APA)

Date: 08-2003

DOI: 10.1037/0022-006X.71.4.706

Abstract: This study investigated the extent to which providing cognitive restructuring (CR) with prolonged imaginal exposure (IE) would lead to greater symptom reduction than providing IE alone for participants with posttraumatic stress disorder (PTSD). Fifty-eight civilian survivors of trauma with PTSD were randomly allocated to IE/CR, IE, or supportive counseling (SC). Treatment involved 8 in idual weekly sessions with considerable homework. Independent assessments were conducted pretreatment, posttreatment, and at 6-month follow-up. IE/CR and IE resulted in reduced PTSD and depression compared with SC at posttreatment and follow-up. Further, IE/CR participants had greater reductions in PTSD and maladaptive cognitive styles than IE participants at follow-up. These findings suggest that providing CR in combination with IE may enhance treatment gains.

The temporal relationship between posttraumatic stress disorder and problem alcohol use following traumatic injury.

Publisher: American Psychological Association (APA)

Date: 11-2014

DOI: 10.1037/A0037920

Abstract: Chronic alcohol abuse is a major public health concern following trauma exposure however, little is known about the temporal association between posttraumatic stress disorder (PTSD) symptoms and problem alcohol use. The current study examined the temporal relationship between PTSD symptom clusters (re-experiencing, effortful avoidance, emotional numbing, and hyperarousal) and problem alcohol use following trauma exposure. This study was a longitudinal survey of randomly selected traumatic injury patients interviewed at baseline, 3 months, 12 months, and 24 months following injury. Participants were 1,139 injury patients recruited upon admission from 4 Level 1 trauma centers across Australia. Participants were assessed using the Clinician Administered PTSD Scale and Alcohol Use Disorders Identification Test. Results indicated that high levels of re-experiencing, effortful avoidance, and hyperarousal symptoms at 12 months were associated with greater increases (or smaller decreases) in problem alcohol use between 12 and 24 months. Findings also suggested that high levels of problem alcohol use at 12 months were associated with greater increases (or smaller decreases) in emotional numbing symptoms between 12 and 24 months. These findings highlight the critical importance of the chronic period following trauma exposure in the relationship between PTSD symptoms and problem alcohol use.

White matter anisotropy and response to cognitive behavior therapy for posttraumatic stress disorder

Publisher: Springer Science and Business Media LLC

Date: 05-01-2021

DOI: 10.1038/S41398-020-01143-3

Abstract: Trauma-focused cognitive behavior therapy (TF-CBT) is the gold standard treatment for posttraumatic stress disorder (PTSD), up to one-half of PTSD patients remain treatment non-responders. Although studies have used functional MRI to understand the neurobiology of treatment response, there is less understanding of the role of white matter brain structures in response to TF-CBT. Thirty-six treatment-seeking PTSD patients and 33 age-gender matched healthy controls completed diffusion-weighted imaging scans at baseline. Patients underwent nine sessions of TF-CBT treatment and PTSD symptom severity was assessed with the Clinician-Administered PTSD Scale before and after completing treatment. Patients were assessed to estimate the reduction in overall symptoms and also specifically fear and dysphoric symptoms of PTSD. Tract-based spatial statistical analyses were performed for the PTSD group to evaluate whole-brain correlations of fractional anisotropy (FA) with improvement in overall, fear, and dysphoric symptoms using non-parametric permutation inference testing ( p FWE 0.05). Next, we evaluated if these significant measures also characterized PTSD from controls. Greater improvement in dysphoric symptoms was found correlated with lower FA in white matter regions associated with the limbic system, frontal cortex, thalamic association and projection fibers, corpus callosum, and tracts related to the brainstem. White matter anisotropy was not found associated with either overall or fear symptoms. FA in the significant clusters was similar between PTSD and controls. White-matter related to key functional regions may also play an important role in response to TF-CBT. Our results underscore the heterogeneity of PTSD and the need to evaluate distinct symptom phenotypes in treatment studies.

A Brief, Early Cognitive-Behavioral Program for Cancer-Related PTSD, Anxiety, and Comorbid Depression

Publisher: Elsevier BV

Date: 11-2014

DOI: 10.1016/J.CBPRA.2014.05.002

Cross-lagged analyses of anger and PTSD symptoms among veterans in treatment.

Publisher: American Psychological Association (APA)

Date: 02-2022

DOI: 10.1037/TRA0001084

Abstract: Anger is a salient feature of posttraumatic mental health which is linked to posttraumatic stress disorder (PTSD) and may have implications for treatment. However, the nature of associations involving anger and PTSD remains unclear. The aim of the present study was to examine bidirectional influences involving anger and International Classification of Diseases (ICD)-11 PTSD symptom clusters over time among treatment-seeking veterans. Current or ex-serving members ( The majority of participants (78%) exhibited significant anger problems at intake. Cross-lagged analyses showed anger was associated with relative increases in PTSD symptoms of intrusive reexperiencing and avoidance at posttreatment, whereas no reverse effects of any PTSD symptoms on anger were observed. Anger continued to influence changes in heightened sense of threat and avoidance symptoms at three-months posttreatment. Anger influences change in specific PTSD symptoms over time among military veterans in treatment and may interfere with treatments for PTSD. Veterans who present to clinical services with anger problems may benefit from anger interventions prior to commencing trauma-focused treatment. The findings have additional implications for conceptual models of the relationship between anger and PTSD. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Beyond Bushfires: Community, Resilience and Recovery - A longitudinal mixed method study of the medium to long term impacts of bushfires on mental health and social connectedness

Publisher: Springer Science and Business Media LLC

Date: 04-11-2013

DOI: 10.1186/1471-2458-13-1036

A longitudinal analysis of posttraumatic stress disorder symptoms and their relationship with Fear and Anxious-Misery disorders: Implications for DSM-V

Publisher: Elsevier BV

Date: 12-2010

DOI: 10.1016/J.JAD.2010.05.005

Abstract: This paper examined the hypothesis that PTSD-unique symptom clusters of re-experiencing, active avoidance and hyperarousal were more related to the fear hobic disorders, while shared PTSD symptoms of dysphoria were more closely related to Anxious-Misery disorders (MDD/GAD). Confirmatory factor and correlation analyses examining PTSD, anxiety and mood disorder data from 714 injury survivors interviewed 3, 12 and 24-months following their injury supported this hypothesis with these relationships remaining robust from 3-24 months posttrauma. Of the nine unique fear-oriented PTSD symptoms, only one is currently required for a DSM-IV diagnosis. Increasing emphasis on PTSD fear symptoms in DSM-V, such as proposed DSM-V changes to mandate active avoidance, is critical to improve specificity, ensure inclusion of dimensionally distinct features and facilitate tailoring of treatment.

Posttraumatic intrusive symptoms across psychiatric disorders

Publisher: Elsevier BV

Date: 06-2011

DOI: 10.1016/J.JPSYCHIRES.2010.11.012

Abstract: Reexperiencing symptoms are a key feature of posttraumatic stress disorder (PTSD). This study investigated the pattern of reexperiencing symptoms in non-PTSD posttraumatic disorders. This study recruited 1084 traumatically injured patients during hospital admission and conducted follow-up assessment 12 months later (N = 817, 75%). Twelve months after injury, 22% of patients reported a psychiatric disorder they had never experienced prior to the traumatic injury. One-third of patients with a non-PTSD disorder satisfied the PTSD reexperiencing criteria. Whereas patients with a non-PTSD disorder were more likely to experience intrusive memories, nightmares, psychological distress and physiological reactivity to reminders, only patients with PTSD were likely to experience flashback memories (OR: 11.41, 95% CI: 6.17-21.09). The only other symptom that was distinctive to PTSD was dissociative amnesia (OR: 4.50, 95% CI: 2.09-9.71). Whereas intrusive memories and reactions are common across posttraumatic disorders, flashbacks and dissociative amnesia are distinctive to PTSD.

Correlates of acute stress disorder in cancer patients

Publisher: Wiley

Date: 06-2007

DOI: 10.1002/JTS.20253

Abstract: This study investigated the correlates of acute stress disorder (ASD) following a diagnosis of cancer. Adults diagnosed with first onset head, neck, or lung malignancy (N = 82) were assessed within one month of diagnosis using the ASD Interview, and the Structured Clinical Interview for DSM-IV to index the incidence of ASD and other affective disorders following their cancer diagnosis. Participants were also administered questionnaires that assessed dissociative symptoms, coping strategies, and quality of life. Acute stress disorder was diagnosed in 28% of participants. Acute stress disorder severity was associated with gender, elevated dissociative responses, trait anxiety, and preoccupation with one's diagnosis, and a decline in cognitive functioning. This study provides evidence for identifying recently diagnosed cancer patients who may benefit from psychological assistance.

Profiles of exposure to potentially traumatic events in refugees living in Australia

Publisher: Cambridge University Press (CUP)

Date: 2021

DOI: 10.1017/S2045796021000068

Abstract: Refugees and asylum-seekers are typically exposed to multiple potentially traumatic events (PTEs) in the context of war, persecution and displacement, which confer elevated risk for psychopathology. There are significant limitations, however, in extant approaches to measuring these experiences in refugees. The current study aimed to identify profiles of PTE exposure, and the associations between these profiles and key demographics, contextual factors (including ongoing stressors, method of travel to Australia and separation from family), mental health and social outcomes, in a large s le of refugees resettled in Australia. Participants were 1085 from Arabic, Farsi, Tamil and English-speaking refugee backgrounds who completed an online or pen-and-paper survey in their own language. Constructs measured included PTE exposure, demographics, pre-displacement factors, ongoing stressors, post-traumatic stress disorder symptoms, depression symptoms, anger reactions, plans of suicide and social engagement. Latent class analysis identified four profiles of PTE exposure, including the torture and pervasive trauma class, the violence exposure class, the deprivation exposure class and the low exposure class. Compared to the low exposure class, participants in the trauma-exposed classes were more likely to be male, highly educated, from Farsi and Tamil-speaking backgrounds, have travelled to Australia by boat, experience more ongoing stressors and report both greater psychological symptoms and social engagement. This study found evidence for four distinct profiles of PTE exposure in a large s le of resettled refugees, and that these were associated with different demographic, psychological and social characteristics. These findings suggest that person-centred approaches represent an important potential avenue for investigation of PTE exposure in refugees, particularly with respect to identifying subgroups of refugees who may benefit from different types or levels of intervention according to their pre-migration PTE experiences.

Tonic and Phasic Heart Rate as Predictors of Posttraumatic Stress Disorder

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 04-2007

DOI: 10.1097/PSY.0B013E3180417D04

The Additive Benefit of Hypnosis and Cognitive-Behavioral Therapy in Treating Acute Stress Disorder.

Publisher: American Psychological Association (APA)

Date: 04-2005

DOI: 10.1037/0022-006X.73.2.334

A prospective study of appraisals in childhood posttraumatic stress disorder

Publisher: Elsevier BV

Date: 10-2007

DOI: 10.1016/J.BRAT.2007.04.009

Abstract: This study investigated the predictors of posttraumatic stress disorder (PTSD) in children following a diagnosis of traumatic injury. Children (N=76) aged between 7 and 13 who were admitted to hospital following injury were assessed within a month of trauma for acute stress disorder (ASD), negative appraisals, as well as parental stress reactions. Children (N=62) were re-assessed 6-months later for PTSD and negative appraisals. The majority of the variance of chronic posttraumatic stress was accounted for by negative appraisals about future harm. This study supports cognitive models of PTSD, and suggests that younger children who exaggerate their vulnerability after trauma exposure are high risk for PTSD after trauma.

Evaluation of the Dispositional Hope Scale in injury survivors

Publisher: Elsevier BV

Date: 08-2009

DOI: 10.1016/J.JRP.2009.03.002

Should A2 be a diagnostic requirement for posttraumatic stress disorder in DSM-V?

Publisher: Elsevier BV

Date: 04-2010

DOI: 10.1016/J.PSYCHRES.2009.05.012

Abstract: The requirement that trauma survivors experience fear, helplessness or horror (Criterion A2) as a part of their posttraumatic stress disorder (PTSD) diagnosis was introduced into DSM-IV. The imminent re-definition of PTSD in DSM-V highlights the need for empirical studies to validate the utility of the A2 requirement. We aimed to identify (i) how often A2 was associated with PTSD (B-F criteria) at 3 months after trauma and (ii) what was the peritraumatic emotional experience for those who met PTSD criteria but were A2 negative. In a prospective design cohort study we assessed the peritraumatic emotional experience of 535 injury patients in four Australian hospitals. These patients were followed up 3 months later and assessed for PTSD using a structured clinical interview. The majority of those who developed PTSD (B-F criterion) at 3 months met A2 criteria. A substantial minority, however (23%), did not meet A2 criteria. Those PTSD patients who were A2 negative fell into three groups: (i) those who experienced subthreshold levels of A2 (ii) those who experienced intense peritrauma emotional responses other than fear, helplessness or horror and (iii) those who were amnesic to their peritrauma emotional experience. These findings do not support the inclusion of A2 as diagnostic requirement for DSM-V.

Longitudinal analysis of latent classes of psychopathology and patterns of class migration in survivors of severe injury

Publisher: Physicians Postgraduate Press, Inc

Date: 14-04-2015

DOI: 10.4088/JCP.14M09075

The Assessment of Post‐traumatic Stress Disorder for Workers' Compensation in Emergency Service Personnel

Publisher: Informa UK Limited

Date: 12-2013

DOI: 10.1111/AP.12009

Evidence is king: A defence of evidence‐based recommendations

Publisher: Wiley

Date: 06-2022

DOI: 10.1111/BDI.13235

Make lithium great again!

Publisher: Wiley

Date: 06-2020

DOI: 10.1111/BDI.12942

Physiological arousal and dissociation in acute trauma victims during trauma narratives

Publisher: Wiley

Date: 2005

DOI: 10.1002/JTS.20019

Abstract: The aim of the present study was to examine whether the finding of suppressed physiological activity in dissociative rape-trauma victims (Griffin, Resick, & Mechanic, 1997) was replicable in a nonsexual assault trauma group. A s le of 17 high-dissociating (HD) participants and 18 low-dissociating (LD) participants who had experienced a motor vehicle accident or physical assault described their trauma while skin conductance, heart rate activity, and self-reported mood were recorded. HD in iduals demonstrated a trend for elevated heart rate during the experiment compared with LD participants, but both groups displayed comparable skin-conductance levels. Curve estimation analysis indicated that the two groups had a similar pattern of physiological responding during the trauma narratives. These findings challenge the notion that dissociative reactions are associated with reduced psychophysiological arousal after trauma.

Development and validation of the Child Post‐Traumatic Cognitions Inventory (CPTCI)

Publisher: Wiley

Date: 25-03-2009

DOI: 10.1111/J.1469-7610.2008.01995.X

Abstract: Negative trauma-related cognitions have been found to be a significant factor in the maintenance of post-traumatic stress disorder (PTSD) in adults. Initial studies of such appraisals in trauma-exposed children and adolescents suggest that this is an important line of research in youth, yet empirically validated measures for use with younger populations are lacking. A measure of negative trauma-related cognitions for use with children and adolescents, the Child Post-Traumatic Cognitions Inventory (CPTCI), is presented. The measure was devised as an age-appropriate version of the adult Post-Traumatic Cognitions Inventory (Foa et al., 1999). The CPTCI was developed and validated within a large (n = 570) s le, comprising community and trauma-exposed s les of children and adolescents aged 6-18 years. Principal components analysis suggested a two-component structure. These components were labelled 'permanent and disturbing change' and 'fragile person in a scary world', and were each found to possess good internal consistency, test-retest reliability, convergent validity, and discriminative validity. The reliability and validity of these sub-scales was present regardless of whether the measure was completed in the acute phase or several months after a trauma. Scores on these sub-scales did not vary with age. The CPTCI is a reliable and valid measure that is not specific to the type of trauma exposure, and shows considerable promise as a research and clinical tool. The structure of this measure suggests that appraisals concerning the more abstract consequences of a trauma, as well as physical threat and vulnerability, are pertinent factors in trauma-exposed children and adolescents, even prepubescent children.

Habituation of distress during exposure and its relationship to treatment outcome in post-traumatic stress disorder and prolonged grief disorder

Publisher: Informa UK Limited

Date: 12-04-2023

DOI: 10.1080/20008066.2023.2193525

Latent structure of the proposed ICD-11 post-traumatic stress disorder symptoms: Implications for the diagnostic algorithm

Publisher: Royal College of Psychiatrists

Date: 03-2015

DOI: 10.1192/BJP.BP.114.150078

Abstract: The latent structure of the proposed ICD-11 post-traumatic stress disorder (PTSD) symptoms has not been explored. To investigate the latent structure of the proposed ICD-11 PTSD symptoms. Confirmatory factor analyses using data from structured clinical interviews administered to injury patients ( n = 613) 6 years post-trauma. Measures of disability and psychological quality of life (QoL) were also administered. Although the three-factor model implied by the ICD-11 diagnostic criteria fit the data well, a two-factor model provided equivalent, if not superior, fit. Whereas diagnostic criteria based on this two-factor model resulted in an increase in PTSD point prevalence (5.1% v. 3.4% z = 2.32, P .05), they identified in iduals with similar levels of disability ( P = 0.933) and QoL ( P = 0.591) to those identified by the ICD-11 criteria. Consistent with theorised reciprocal relationships between re-experiencing and avoidance in PTSD, these findings support an alternative diagnostic algorithm requiring at least two of any of the four re-experiencing/avoidance symptoms and at least one of the two hyperarousal symptoms.

Early life trauma predicts self-reported levels of depressive and anxiety symptoms in nonclinical community adults: Relative contributions of early life stressor types and adult trauma exposure

Publisher: Elsevier BV

Date: 2013

DOI: 10.1016/J.JPSYCHIRES.2012.08.006

Abstract: Exposure to early life trauma is a known risk factor for depression and anxiety disorders in adulthood. This study aimed to evaluate the relative contributions of early life versus adult trauma in predicting levels of depressive and anxiety symptoms in nonclinical community adults. 1209 nonclinical community adults (18-70 years 45% male) were assessed for mental health status, early life stressors, lifetime trauma exposure, and self-reported levels of depressive and anxiety symptoms. A subset of the full s le subjected to group comparisons (n = 1088) indicated that early life stressor exposure primarily accounted for significantly higher depressive and anxiety symptom scores when compared against adults reporting to be free of childhood stressor or adult trauma exposure. Subsequent hierarchical multiple regression analyses of this subset using five distinct early life stressor types, namely 'Interpersonal violation', 'Family breakup', 'Disasters/war', 'Familial health trauma/death' and 'Personal health trauma' derived from principal component analysis of a wide range of self-reported early stressor events in the full s le, showed childhood 'Interpersonal violation' differentially predicted higher self-reported depressive and anxiety symptom scores in both males and females. Adult trauma exposure did not significantly predict these symptom scores. These findings underline the relative importance of exposure to 'interpersonal violation' relative to other types of early life stressors and adult trauma in the risk of depressive and anxiety symptoms in nonclinical community adults.

Novel insights into irritability: the relationship between subjective experience, age and mood

Publisher: Royal College of Psychiatrists

Date: 28-10-2021

DOI: 10.1192/BJO.2021.1033

Abstract: The relationship between irritability as a subjective experience and the behavioural indicators typically used to measure the construct are not known. Its links to mood, and contextual relationships, vary with age and are yet to be thoroughly examined. First, to interrogate the relationship between the subjective experience of irritability and mood, and that with its behavioural indicators. Second, to determine how these relationships vary with age and over time. This study examined data from a previous clinical trial of adolescents and young adults ( N = 82) with bipolar disorder, who received a psychological intervention over 18 months. Participants completed a battery of questionnaires, which included assessments of irritability. Analyses of covariance were conducted to examine the interaction between mood symptoms, subjective measures of irritability, behavioural measures of irritability and age over time. Subjective irritability scores differed significantly over time when controlling for manic, but not depressive, symptom scores. Further, subjective irritability significantly differed when controlling for behavioural measures of irritability (temper outbursts and argumentativeness). There were significant interactions between scores of depressive symptoms, temper outbursts and subjective irritability with age, wherein younger participants showed no correlation between depressive symptoms and temper outbursts. In addition, younger participants showed lower correlations between subjective irritability and both depressive and temper outburst scores, than older participants. Subjective irritability is linked to mood morbidity and behavioural outbursts, and these relationships are contingent on age. Our novel findings suggest that subjective irritability should be assessed in greater detail in patients with mood disorders.

A Qualitative Study of the Expectations, Experiences, and Perceptions That Underpin Decisions Regarding PTSD Treatment in Help-seeking Veterans

Publisher: Oxford University Press (OUP)

Date: 26-11-2022

DOI: 10.1093/MILMED/USAC374

Abstract: A range of evidence-based treatments are available for PTSD. However, many veterans with PTSD do not engage in these treatments. Concurrently, various novel PTSD treatments with little or no evidence based are increasingly popular among veterans. This qualitative study explored the expectations, experiences, and perceptions of help-seeking veterans with PTSD to improve understanding of how these veterans make treatment decisions. Fifteen treatment-seeking veterans with PTSD participated in the study. Participants took part in semi-structured interviews. Data were analyzed using interpretative phenomenological analysis. A number of themes and subthemes emerged from the data, providing a detailed account of the factors that influenced participants’ treatment decisions. Most participants were in an acute crisis when they made the initial decision to seek treatment for their PTSD. In choosing a specific treatment, they tended to follow recommendations made by other veterans or health professionals or orders or directions from their superiors, health providers, or employers. Few participants actively considered the scientific evidence supporting different treatments. Participants had a strong preference for treatment provided by or involving other veterans. They reported finding PTSD treatments helpful, although some were not convinced of the value of evidence-based treatments specifically. Many participants reported negative experiences with treatment providers. These findings will inform strategies to improve engagement of veterans in evidence-based PTSD treatments and advance progress toward veteran-centered care.

Are Negative Cognitions Associated With Severe Acute Trauma Responses?

Publisher: Cambridge University Press (CUP)

Date: 03-2005

DOI: 10.1375/BECH.22.1.22.66783

Abstract: Recent cognitive models of trauma response predict that negative trauma appraisals are central to the development of psychopathological stress reactions. Fifty-nine civilian survivors of motor vehicle accidents (MVA n = 24) and nonsexual assaults ( n = 35) were assessed within 4 weeks of their traumatic event for acute stress disorder (ASD), prior traumatic events and prior mental health contact, and were administered the Anxiety Sensitivity Index and the Posttraumatic Cognitions Inventory. Participants who were diagnosed with ASD displayed more maladaptive appraisals about their functioning following their trauma and reported higher levels of concern regarding anxiety symptoms than those who were not diagnosed with ASD. Negative beliefs were strongly associated with acute stress severity. These findings are discussed in the context of cognitive mechanisms that may influence maladaptive adjustment following trauma.

Conceptualising Post-Disaster Recovery: Incorporating Grief Experiences

Publisher: Oxford University Press (OUP)

Date: 12-2015

DOI: 10.1093/BJSW/BCV122

Cognitive behaviour therapy of acute stress disorder: a four-year follow-up

Publisher: Elsevier BV

Date: 04-2003

DOI: 10.1016/S0005-7967(02)00179-1

Abstract: The aim of this study was to index the long-term benefits of early provision of cognitive behavior therapy to trauma survivors with acute stress disorder. Civilian trauma survivors (n = 80) with acute stress disorder were randomly allocated to either cognitive behavior therapy (CBT) or supportive counseling (SC) - 69 completed treatment, and 41 were assessed four years post-treatment for post-traumatic stress disorder (PTSD) with the Clinician Administered PTSD Scale. Two CBT patients (8%) and four SC patients (25%) met PTSD criteria at four-year follow-up. Patients who received CBT reported less intense PTSD symptoms, and particularly less frequent and less avoidance symptoms, than patients who received SC. These findings suggest that early provision of CBT in the initial month after trauma has long-term benefits for people who are at risk of developing PTSD.

Is There a Mutual Relationship Between Opposite Attentional Biases Underlying Anxiety?

Publisher: American Psychological Association (APA)

Date: 2011

DOI: 10.1037/A0022019

Abstract: Current models that account for attentional processes in anxiety have proposed that high-trait anxious in iduals are characterized by a hypervigilant-avoidant pattern of attentional biases to threat. We adopted a laboratory conditioning procedure to induce concomitant hypervigilance and avoidance to threat, emphasizing a putative relationship between lower-level reactive and upper-level controlled attentional mechanisms as the core account of attentional processes involved in the development and maintenance of anxiety. Eighty high- and low-trait anxious participants underwent Pavlovian conditioning to a human face. Eye tracking was used to monitor attentional changes to the conditioned stimulus (CS+) face and the neutral stimulus (CS-) face, presented at 200, 500, and 800 ms durations. The high-anxious participants developed the expected attentional bias toward the CS+ at 200 ms presentation time and attentional avoidance at 500 and 800 ms durations. Hypervigilance to aversive stimuli at 200 ms and later avoidance to the same stimuli at 500 and 800 ms were associated with higher levels of galvanic skin conductance to the CS+. The low-anxious in iduals developed the opposite attentional pattern with an initial tendency to orient attention away from the aversive stimuli in the 200 ms condition and to orient attention toward aversive stimuli in the remaining time. The differential modulation between hypervigilance and avoidance elicited in the two groups by the conditioning procedure suggests that vulnerability to anxiety is characterized by a latent relationship between erse attentional mechanisms. Within this relationship, hypervigilance and avoidance to threat operate at different stages of information processing suggesting fuzzy boundaries between early reactive and later-strategic processing of threat.

A critical review of psychological treatments of posttraumatic stress disorder in refugees

Publisher: Elsevier BV

Date: 04-2011

DOI: 10.1016/J.CPR.2010.10.004

Abstract: Despite much research evidence that refugees suffer from elevated rates of posttraumatic stress disorder (PTSD), relatively few studies have examined the effectiveness of psychological treatments for PTSD in refugees. The field of refugee mental health intervention is dominated by two contrasting approaches, namely trauma-focused therapy and multimodal interventions. This article firstly defines these two approaches, then provides a critical review of 19 research studies that have been undertaken to investigate the efficacy of these treatments. Preliminary research evidence suggests that trauma-focused approaches may have some efficacy in treating PTSD in refugees, but limitations in the methodologies of studies caution against drawing definitive inferences. It is clear that research assessing the treatment of PTSD in refugees is lagging behind that available for other traumatized populations. The review examines important considerations in the treatment of refugees. A theoretical framework is offered that outlines contextual issues, maintaining factors, change mechanisms and the distinctive challenges to traditional trauma-focused treatments posed by the needs of refugees with PTSD.

Design and Control of a Magnetically-Actuated Anti-Interference Microrobot for Targeted Therapeutic Delivery

Publisher: Institute of Electrical and Electronics Engineers (IEEE)

Date: 09-2023

DOI: 10.1109/LRA.2023.3295648

The push and pull of grief: Approach and avoidance in bereavement

Publisher: Elsevier BV

Date: 09-2015

DOI: 10.1016/J.JBTEP.2015.02.010

Abstract: Prolonged Grief (PG) is recognized as a post-bereavement syndrome that is associated with significant impairment. Although approach and avoidance tendencies have both been hypothesized to play key roles in maintaining PG symptoms, understanding of these relationships has been limited by a reliance on self-report methodology. This study applies an experimental paradigm to simultaneously investigate the relationship between PG severity and approach-avoidance behavioral tendencies. Fifty-five bereaved in iduals with and without PG completed a behavioral measure of approach and avoidance responding in which they pulled or pushed a joystick in response to grief-related, positive, negative and neutral images that appeared on a computer screen. Concurrent visual feedback created the illusion that the images were either approaching or receding from the participant. Half of the participants also received a prime designed to activate their grief prior to the task. Irrespective of prime condition, PG participants pulled grief-related images more quickly than they pushed them. This difference was not observed in response to non-grief related images. Non PG participants showed no difference in their reaction times to grief-stimuli. This study was undertaken in a nonclinical setting and the majority of participants had lost a loved one due to chronic illness. Future research with treatment-seeking populations and sudden loss will be needed to explore the generalizability of the findings. The findings from this study provide preliminary evidence supporting models of PG that integrate approach and avoidance tendencies.

An examination of the structure of posttraumatic stress disorder in relation to the anxiety and depressive disorders

Publisher: Elsevier BV

Date: 07-2011

DOI: 10.1016/J.JAD.2011.02.011

Abstract: The nature and structure of posttraumatic stress disorder (PTSD) has been the subject of much interest in recent times. This research has been represented by two streams, the first representing a substantive body of work which focuses specifically on the factor structure of PTSD and the second exploring PTSD's relationship with other mood and anxiety disorders. The present study attempted to bring these two streams together by examining structural models of PTSD and their relationship with dimensions underlying other mood and anxiety disorders. PTSD, anxiety and mood disorder data from 989 injury survivors interviewed 3-months following their injury were analyzed using a series of confirmatory factor analyses (CFA) to identify the optimal structural model. CFA analyses indicated that the best fitting model included PTSD's re-experiencing (B1-5), active avoidance (C1-2), and hypervigilance and startle (D4-5) loading onto a Fear factor (represented by panic disorder, agoraphobia and social phobia) and the PTSD dysphoria symptoms (numbing symptoms C3-7 and hyperarousal symptoms D1-3) loading onto an Anxious Misery/Distress factor (represented by depression, generalized anxiety disorder and obsessive compulsive disorder). The findings have implications for informing potential revisions to the structure of the diagnosis of PTSD and the diagnostic algorithm to be applied, with the aim of enhancing diagnostic specificity.

Genomic influences on self-reported childhood maltreatment

Publisher: Springer Science and Business Media LLC

Date: 27-01-2020

DOI: 10.1038/S41398-020-0706-0

Fear of Cultural Extinction and Psychopathology Among Mandaean Refugees: An Exploratory Path Analysis

Publisher: Wiley

Date: 07-08-2009

DOI: 10.1111/J.1755-5949.2009.00094.X

Early Exposure to Traumatic Stressors Impairs Emotional Brain Circuitry

Publisher: Public Library of Science (PLoS)

Date: 20-09-2013

DOI: 10.1371/JOURNAL.PONE.0075524

The prospective course of postconcussion syndrome: The role of mild traumatic brain injury.

Publisher: American Psychological Association (APA)

Date: 2011

DOI: 10.1037/A0022580

Abstract: To investigate whether postconcussion syndrome (PCS) represents long-term sequelae associated with mild traumatic brain injury (mTBI). Prospective consecutive admissions to a Level 1 trauma hospital were assessed a mean 4.9 days and again 106.2 days post-injury. The final s le comprised 62 mTBI and 58 nonbrain injured trauma controls (TC). Change or lack of change in in idual PCS-like symptoms and PCS was examined. Multilevel logistic regression was used to analyze whether mTBI predicts 3-month PCS (Time 2 T2) whether predictors of PCS (within 14 days of injury, Time 1 T1) predict 3-month PCS, and how change in these predictors from T1 to T2 were associated with change in PCS status. Variables included demographic, injury-related, financial incentives, neuropsychological, and psychiatric disorder. MTBI did not predict PCS. PCS was comparable (T1: mTBI: 40.3%, TC: 50.0% T2: mTBI: 46.8%, TC: 48.3%). At T2, 38.6% were new cases of PCS between 30.8% and 86.2% reported either a new or more frequent symptom. A pre-injury depressive or anxiety disorder (OR = 2.99, 95% CI [1.38, 6.45]), and acute posttraumatic stress (OR = 1.05, 95% CI [1.00, 1.00]) were early markers of PCS, regardless of mTBI. An interaction between time and posttraumatic stress disorder (PTSD) suggested the relationship between the severity of PTSD symptoms and PCS strengthened over time (OR = 2.66, 95% CI [1.08, 6.55]). Pain was related to PCS. Females were more likely than males to have PCS. The data suggest the phenomenon of PCS in trauma patients does not show an association with mTBI.

Neural responses to masked fear faces: Sex differences and trauma exposure in posttraumatic stress disorder.

Publisher: American Psychological Association (APA)

Date: 02-2010

DOI: 10.1037/A0017551

Abstract: Although women have a greater propensity than men to develop posttraumatic stress disorder (PTSD) following trauma, sex differences in neural activations to threat have received little investigation. This study tested the prediction that trauma would heighten activity in automatic fear-processing networks to a greater extent in women than in men. Functional magnetic resonance imaging (fMRI) data were recorded in 23 participants with PTSD (13 women, 10 men), 21 trauma-exposed controls (9 women, 12 men), and 42 non-trauma-exposed controls (22 women, 20 men) while they viewed masked facial expressions of fear. Exposure to trauma was associated with enhanced brainstem activity to fear in women, regardless of the presence of PTSD, but in men, it was associated only with the development of PTSD. Men with PTSD displayed greater hippoc al activity to fear than did women. Both men and women with PTSD showed enhanced amygdala activity to fear relative to controls. The authors conclude that greater brainstem activation to threat stimuli may contribute to the greater prevalence of PTSD in women, and greater hippoc al activation in men may subserve an enhanced capacity for contextualizing fear-related stimuli.

The association between the oxytocin receptor gene (OXTR) and hypnotizability

Publisher: Elsevier BV

Date: 10-2013

DOI: 10.1016/J.PSYNEUEN.2013.03.002

Abstract: Hypnosis has puzzled scientists for centuries, and particularly the reason why some people are prone to engaging in suggested experiences discordant with external reality. Absorption in internal experience is one key component of the hypnotic response. The neuropeptide oxytocin has been posited to heighten sensitivity to external cues, and it is possible that in idual differences in oxytocin-related capacity to engage in external or internal experiences influences hypnotic response. To test this proposal, 185 Caucasian in iduals provided saliva s les for analysis of polymorphisms in the oxytocin receptor gene, COMT, and independently completed standardized measures of hypnotizability and absorption. Participants with the GG genotype at rs53576 were characterized by lower hypnotizability and absorption scores than those with the A allele there was no association between hyponotizability and COMT. These findings provide initial evidence that the capacity to respond to suggestions for altered internal experience is influenced by the oxytocin receptor gene, and is consistent with evidence that oxytocin plays an important role in modulating the extent to which people engage with external versus internal experiences.

Neuroimaging-based classification of PTSD using data-driven computational approaches: A multisite big data study from the ENIGMA-PGC PTSD consortium

Publisher: Elsevier BV

Date: 12-2023

DOI: 10.1016/J.NEUROIMAGE.2023.120412

Disability After Injury

Publisher: Physicians Postgraduate Press, Inc

Date: 15-02-2013

DOI: 10.4088/JCP.12M08011

Evaluation of the Dimensions of Anger Reactions-5 (DAR-5) Scale in combat veterans with posttraumatic stress disorder

Publisher: Elsevier BV

Date: 12-2014

DOI: 10.1016/J.JANXDIS.2014.09.015

Abstract: After a traumatic event many people experience problems with anger which not only results in significant distress, but can also impede recovery. As such, there is value to include the assessment of anger in routine post-trauma screening procedures. The Dimensions of Anger Reactions-5 (DAR-5), as a concise measure of anger, was designed to meet such a need, its brevity minimizing the burden on client and practitioner. This study examined the psychometric properties of the DAR-5 with a s le of 163 male veterans diagnosed with Posttraumatic Stress Disorder. The DAR-5 demonstrated internal reliability (α=.86), along with convergent, concurrent and discriminant validity against a variety of established measures (e.g., HADS, PCL, STAXI). Support for the clinical cut-point score of 12 suggested by Forbes et al. (2014, Utility of the dimensions of anger reactions-5 (DAR-5) scale as a brief anger measure. Depression and Anxiety, 31, 166-173) was observed. The results support considering the DAR-5 as a preferred screening and assessment measure of problematic anger.

The impact of fear for family on mental health in a resettled Iraqi refugee community

Publisher: Elsevier BV

Date: 03-2010

DOI: 10.1016/J.JPSYCHIRES.2009.08.006

Abstract: The current study aimed to evaluate the impact of fear for family remaining in the country of origin and under potential threat on the mental health of refugees. Adult Mandaean refugees (N=315) from Iraq, living in Sydney, Australia, were interviewed regarding fear for family in Iraq, fear of genocide, pre-migration trauma, post-migration living difficulties and psychological outcomes. Participants with immediate family in Iraq reported higher levels of symptoms of PTSD and depression, and greater mental health-related disability than those without family in Iraq. Intrusive fears about family independently predicted risk of PTSD, depression and disability after controlling for trauma exposure and current living difficulties. Threat to family members living in a context of ongoing threat predicted psychopathology and disability in Mandaean refugees. The effect of ongoing threat to family still living in conflict-ridden countries on the mental health of refugees should be further considered in the context of healthcare.

Factors associated with COVID-19 vaccine hesitancy amongst refugees in Australia

Publisher: Informa UK Limited

Date: 2021

DOI: 10.1080/20008198.2021.1997173

Intrusive Memories of Distressing Information: An fMRI Study

Publisher: Public Library of Science (PLoS)

Date: 29-09-2016

DOI: 10.1371/JOURNAL.PONE.0140871

A Study of the Protective Function of Acute Morphine Administration on Subsequent Posttraumatic Stress Disorder

Publisher: Elsevier BV

Date: 03-2009

DOI: 10.1016/J.BIOPSYCH.2008.10.032

Abstract: To index the extent to which acute administration of morphine is protective against development of posttraumatic stress disorder (PTSD). Consecutive patients admitted to hospital after traumatic injury (n=155) were assessed for current psychiatric disorder, pain, and morphine dose in the initial week after injury and were reassessed for PTSD and other psychiatric disorders 3 months later (n=120). Seventeen patients (14%) met criteria for PTSD at 3 months. Patients who met criteria for PTSD received significantly less morphine than those who did not develop PTSD there was no difference in morphine levels in those who did and did not develop major depressive episode or another anxiety disorder. Hierarchical regression analysis indicated that PTSD severity at 3 months was significantly predicted by acute pain, mild traumatic brain injury, and elevated morphine dose in the initial 48 hours after trauma, after controlling for injury severity, gender, age, and type of injury. Acute administration of morphine may limit fear conditioning in the aftermath of traumatic injury and may serve as a secondary prevention strategy to reduce PTSD development.

Selective Prevention of Depression in Workers Using a Smartphone App: Randomized Controlled Trial (Preprint)

Publisher: JMIR Publications Inc.

Date: 25-01-2023

DOI: 10.2196/PREPRINTS.45963

Abstract: here is increasing evidence that depression can be prevented however, universal approaches have had limited success. Appropriate targeting of interventions to at-risk populations has been shown to have potential, but how to selectively determine at-risk in iduals remains unclear. Workplace stress is a risk factor for depression and a target for intervention, but few interventions exist to prevent depression among workers at risk due to heightened stress. his trial aimed to evaluate the efficacy of a smartphone-based intervention in reducing the onset of depression and improving related outcomes in workers experiencing at least moderate levels of stress. randomized controlled trial was conducted with participants who were currently employed and reported no clinically significant depression and at least moderate stress. The intervention group (n=1053) were assigned i Anchored /i , a 30-day self-directed smartphone app-based cognitive behavioral- and mindfulness-based intervention. The attention-control group (n=1031) were assigned a psychoeducation website. Assessment was performed via web-based self-report questionnaires at baseline and at 1-, 3-, and 6-month postbaseline time points. The primary outcome was new depression caseness aggregated over the follow-up period. The secondary outcomes included depressive and anxiety symptoms, stress, well-being, resilience, work performance, work-related burnout, and quality of life. Analyses were conducted within an intention-to-treat framework using mixed modeling. here was no significant between-group difference in new depression caseness ( i z /i score=0.69 i P /i =.49) however, those in the i Anchored /i arm had significantly greater depressive symptom reduction at 1 month (Cohen i d /i =0.02 i P /i =.049) and 6 months (Cohen i d /i =0.08 i P /i =.03). i Anchored /i participants also showed significantly greater reduction in anxiety symptoms at 1 month (Cohen i d /i =0.07 i P /i =.04) and increased work performance at 1 month (Cohen i d /i =0.07 i P /i =.008) and 6 months (Cohen i d /i =0.13 i P /i =.01), compared with controls. Notably, for i Anchored /i participants completing at least two-thirds of the intervention, there was a significantly lower rate of depression onset (1.1%, 95% CI 0.0%-3.7%) compared with controls (9.0%, 95% CI 6.8%-12.3%) at 1 month ( i z /i score=4.50 i P /i & .001). Significant small to medium effect sizes for most secondary outcomes were seen in the highly engaged i Anchored /i users compared with controls, with effects maintained at the 6-month follow-up for depressive symptoms, well-being, stress, and quality of life. lt i Anchored /i was associated with a small comparative reduction in depressive symptoms compared with controls, although selective prevention of case-level depression was not observed in the intention-to-treat analysis. When users adequately engaged with the app, significant findings pertaining to depression prevention, overall symptom reduction, and functional improvement were found, compared with controls. There is a need for a greater focus on engagement techniques in future research. ustralian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000178943 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378592

Neural biases to covert and overt signals of fear: dissociation by trait anxiety and depression.

Publisher: MIT Press - Journals

Date: 10-2007

DOI: 10.1162/JOCN.2007.19.10.1595

Abstract: Although biases toward signals of fear may be an evolutionary adaptation necessary for survival, heightened biases may be maladaptive and associated with anxiety or depression. In this study, event-related potentials (ERPs) were used to examine the time course of neural responses to facial fear stimuli (versus neutral) presented overtly (for 500 msec with conscious attention) and covertly (for 10 msec with immediate masking to preclude conscious awareness) in 257 nonclinical subjects. We also examined the impact of trait anxiety and depression, assessed using psychometric ratings, on the time course of ERPs. In the total subject group, controlled biases to overtly processed fear were reflected in an enhancement of ERPs associated with structural encoding (120–220 msec) and sustained evaluation persisting from 250 msec and beyond, following a temporo-occipital to frontal topography. By contrast, covert fear processing elicited automatic biases, reflected in an enhancement of ERPs prior to structural encoding (80–180 msec) and again in the period associated with automatic orienting and emotion encoding (230–330 msec), which followed the reverse frontal to temporo-occipital topography. Higher levels of trait anxiety (in the clinical range) were distinguished by a heightened bias to covert fear (speeding of early ERPs), compared to higher depression which was associated with an opposing bias to overt fear (slowing of later ERPs). Anxiety also heightened early responses to covert fear, and depression to overt fear, with subsequent deficits in emotion encoding in each case. These findings are consistent with neural biases to signals of fear which operate automatically and during controlled processing, feasibly supported by parallel networks. Heightened automatic biases in anxiety may contribute to a cycle of hypervigilance and anxious thoughts, whereas depression may represent a “burnt out” emotional state in which evaluation of fear stimuli is prolonged only when conscious attention is allocated.

International and indigenous diagnoses of mental disorder among Vietnamese living in Vietnam and Australia

Publisher: Royal College of Psychiatrists

Date: 04-2009

DOI: 10.1192/BJP.BP.108.050906

Abstract: Whether the prevalence rates of common mental disorders can be compared across countries depends on the cultural validity of the diagnostic measures used. To investigate the prevalence of Western and indigenously defined mental disorders among Vietnamese living in Vietnam and in Australia, comparing the data with an Australian-born s le. Comparative analysis of three multistage population surveys, including s les drawn from a community living in the Mekong Delta region of Vietnam ( n =3039), Vietnamese immigrants residing in New South Wales, Australia ( n =1161), and an Australian-born population ( n =7961). Western-defined mental disorders were assessed by the Composite International Diagnostic Interview (CIDI) 2.0 and included DSM–IV anxiety, mood and substance use disorders as well as the ICD–10 category of neurasthenia. The Vietnamese surveys also applied the indigenously based Phan Vietnamese Psychiatric Scale (PVPS). Functional impairment and service use were assessed. The prevalence of CIDI mental disorders for Mekong Delta Vietnamese was 1.8% compared with 6.1% for Australian Vietnamese and 16.7% for Australians. Inclusion of PVPS mental disorders increased the prevalence rates to 8.8% for Mekong Delta Vietnamese and 11.7% for Australian Vietnamese. Concordance was moderate to good between the CIDI and the PVPS for Australian Vietnamese (area under the curve (AUC)=0.77) but low for Mekong Vietnamese (AUC=0.59). PVPS- and CIDI-defined mental disorders were associated with similar levels of functional impairment. Cultural factors in the expression of mental distress may influence the prevalence rates of mental disorders reported across countries. The findings have implications for assessing mental health needs at an international level.

Correction: Torture exposure and the functional brain: investigating disruptions to intrinsic network connectivity using resting state fMRI

Publisher: Springer Science and Business Media LLC

Date: 21-02-2022

DOI: 10.1038/S41398-022-01839-8

A Cognitive Attachment Model of prolonged grief: Integrating attachments, memory, and identity

Publisher: Elsevier BV

Date: 08-2013

DOI: 10.1016/J.CPR.2013.05.001

Abstract: Prolonged grief (PG), otherwise known as complicated grief, has attracted much attention in recent years as a potentially debilitating condition that affects approximately 10% of bereaved people. We propose a model of PG that integrates processes of attachment, self-identity, and autobiographical memory. The paper commences with a discussion of the PG construct and reviews current evidence regarding the distinctiveness of PG from other bereavement related-outcomes. We then review the evidence regarding the dysfunctional attachments, appraisals, and coping styles that people with PG display. Recent evidence pertaining to the patterns of autobiographical memory in PG is described in the context of the self-memory system. This system provides a unifying framework to understand the roles of personal memories, identity, attachments, and coping responses in PG. The proposed model places emphasis on how one's sense of identity influences yearning, memories of the deceased, appraisals, and coping strategies, to maintain a focus on the loss. The model is discussed in relation to existing models of PG. The potential for shaping treatment strategies to shift perceptions of the self is then outlined. Finally, we outline future directions to test propositions stemming from the model and enhance our understanding of the mechanisms underlying PG.

Autobiographical memory bias in social anxiety

Publisher: Informa UK Limited

Date: 10-10-2013

DOI: 10.1080/09658211.2013.844261

Abstract: In social anxiety the psychological self is closely related to the feared stimulus. Socially anxious in iduals are, by definition, concerned about how the self is perceived and evaluated by others. As autobiographical memory is strongly related to views of the self it follows that biases in autobiographical memory play an important role in social anxiety. In the present study high (n = 19) and low (n = 29) socially anxious in iduals were compared on autobiographical memory bias, current goals, and self-discrepancy. In iduals high in social anxiety showed a bias towards recalling more negative and more social anxiety-related autobiographical memories, reported more current goals related to overcoming social anxiety, and showed larger self-discrepancies. The pattern of results is largely in line with earlier research in in iduals with PTSD and complicated grief. This suggests that the relation between autobiographical memory bias and the self is a potentially valuable trans-diagnostic factor.

The mental health of Farsi-Dari speaking asylum-seeking children and parents facing insecure residency in Australia.

Publisher: Elsevier BV

Date: 10-2022

DOI: 10.1016/J.LANWPC.2022.100548

The impact of torture on interpersonal threat and reward neurocircuitry

Publisher: SAGE Publications

Date: 11-09-2020

DOI: 10.1177/0004867420950819

Abstract: Torture adversely influences emotional functioning, but the neurophysiological mechanisms underpinning its impact are unknown. This study examined how torture exposure affects the neural substrates of interpersonal threat and reward processing. Male refugees with ( N = 31) and without ( N = 27) torture exposure completed a clinical interview and functional magnetic resonance imaging scan where they viewed fear, happy and neutral faces. Between-group activations and neural coupling were examined as moderated by posttraumatic stress disorder symptom severity and cumulative trauma load. Posttraumatic stress disorder symptom severity and trauma load significantly moderated group differences in brain activation and connectivity patterns. Torture survivors deactivated the ventral striatum during happy processing compared to non-torture survivor controls as a function of increased posttraumatic stress disorder symptom severity – particularly avoidance symptoms. The ventral striatum was more strongly coupled with the inferior frontal gyrus in torture survivors. Torture survivors also showed left hippoc al deactivation to both fear and happy faces, moderated by trauma load, compared to controls. Stronger coupling between the hippoc us and frontal, temporoparietal and subcortical regions during fear processing was observed, with pathways being predicted by avoidance and hyperarousal symptoms. Torture exposure was associated with distinct brain activity and connectivity patterns during threat and reward processing, dependent on trauma exposure and posttraumatic stress disorder symptom severity. Torture appears to affect emotional brain functioning, and findings have the potential to guide more targeted interventions for torture survivors.

Channelling response: A novel perspective and therapeutic paradigm

Publisher: SAGE Publications

Date: 31-07-2020

DOI: 10.1177/0004867420945363

Trauma at the hands of another: Longitudinal study of differences in the posttraumatic stress disorder symptom profile following interpersonal compared with noninterpersonal trauma

Publisher: Physicians Postgraduate Press, Inc

Date: 11-2012

DOI: 10.4088/JCP.10M06640

Suicide and suicidality in contemporary serving and ex-serving Australian Defence Force personnel.

Publisher: SAGE Publications

Date: 16-03-2021

DOI: 10.1177/0004867421998751

Abstract: The risk of suicide in contemporary serving and ex-serving Australian Defence Force personnel is an area of significant concern, driving government-directed inquiries, community c aigns and most recently, the establishment of a permanent National Commissioner for Defence and Veteran Suicide Prevention. This concern is mirrored in international militaries and despite investment in prevention programmes, suicide is a leading cause of death in military populations. This review seeks to summarise recent findings from Australian research regarding the magnitude and factors associated with suicide and suicidality in contemporary serving and ex-serving Australian Defence Force populations and discusses research findings, implications and future opportunities. Initial review of the prevalence of suicide and suicidality in the general community and military populations is presented, followed by review of recent research findings pertaining to suicides and suicidal thoughts, plans and attempts in contemporary serving and ex-serving Australian Defence Force personnel. Key findings are presented from the 2010 Australian Defence Force Mental Health and Wellbeing Prevalence Study and the 2015 Transition and Wellbeing Research Programme. Differences between serving and ex-serving Australian Defence Force cohorts were observed, with rates of completed suicide in ex-serving Australian Defence Force males more than double that of serving Australian Defence Force males, and increased risk for suicidality observed among those who had recently transitioned out of full-time Australian Defence Force service. Risk for increased suicidality and completed suicide is particularly evident for younger males of lower ranks, and those who have been medically discharged. The findings provide insight into career phases and groups that should be followed-up and targeted for prevention and early intervention programmes, including prior to and several years following transition out of full-time military service. Further research to better understand the factors that influence those who develop suicidal ideation, and those who progress to plans and attempts, will inform a more sophisticated approach to suicide prevention programmes.

Predictors of posttraumatic stress disorder following cancer.

Publisher: American Psychological Association (APA)

Date: 2005

DOI: 10.1037/0278-6133.24.6.579

Abstract: This study investigated the predictors of posttraumatic stress disorder (PTSD) following a diagnosis of cancer. In iduals who were recently diagnosed with 1st onset head and neck or lung malignancy (N = 82) were assessed within 1 month of diagnosis for acute stress disorder (ASD) and other psychological responses including depression in iduals were reassessed (N = 63) for PTSD 6 months following their cancer diagnosis. At the initial assessment ASD was diagnosed in 28% of participants, and 22% met criteria for PTSD at 6-months follow-up. Peritraumatic dissociative symptoms at the time of receiving one's cancer diagnosis was the sole predictor of PTSD severity at 6-months follow-up. Elevated dissociative symptoms and greater distress at the initial assessment were the best predictors of PTSD caseness at 6-months follow-up. This study provides evidence for identifying recently diagnosed cancer patients who may benefit from psychological assistance in order to prevent chronic psychopathology.

Stepped early psychological intervention for posttraumatic stress disorder, other anxiety disorders, and depression following serious injury

Publisher: Wiley

Date: 04-2012

DOI: 10.1002/JTS.21677

Abstract: The best approach for implementing early psychological intervention for anxiety and depressive disorders after a traumatic event has not been established. This study aimed to test the effectiveness of a stepped model of early psychological intervention following traumatic injury. A s le of 683 consecutively admitted injury patients were screened during hospitalization. High-risk patients were followed up at 4-weeks postinjury and assessed for anxiety and depression symptom levels. Patients with elevated symptoms were randomly assigned to receive 4-10 sessions of cognitive-behavioral therapy (n = 24) or usual care (n = 22). Screening in the hospital identified 89% of those who went on to develop any anxiety or affective disorder at 12 months. Relative to usual care, patients receiving early intervention had significantly improved mental health at 12 months. A stepped model can effectively identify and treat injury patients with high psychiatric symptoms within 3 months of the initial trauma.

Prolonged grief and attachment security: A latent class analysis

Publisher: Elsevier BV

Date: 10-2018

DOI: 10.1016/J.PSYCHRES.2018.07.038

Abstract: The death of a loved one has been associated with a wide range of mental health outcomes. Attachment theory is one of the primary paradigms for understanding bereavement outcome, yet there is comparatively little examination of the relationship between attachment style and bereavement responses. In this study we use Latent Class Analysis to identify subgroups of bereaved in iduals based on patterns of prolonged grief (PG) and major depression symptom co-occurrence in 285 bereaved in iduals. We then explored the relationship between these subgroups and attachment anxiety and avoidance. Three new subgroups of in iduals were identified: one showing high levels of PGD and depression (PGD/depression), one showing high depression (Depression), and one showing few symptoms (Low). Attachment anxiety significantly differentiated between the three groups the highest levels of attachment anxiety predicted membership of the PGD/depression group, the lowest levels, membership of the Low group. Attachment avoidance was predictive of greater depressive symptoms, with higher levels of attachment avoidance differentiating the two symptom groups (PGD/depression and depression) from the Low symptom group. These findings underscore the relevance of insecure attachment style to the current understanding of PGD.

An exploratory study of the association of acute posttraumatic stress, depression, and pain to cognitive functioning in mild traumatic brain injury

Publisher: American Psychological Association (APA)

Date: 2015

DOI: 10.1037/NEU0000192

Abstract: Few studies have examined whether psychological distress and pain affect cognitive functioning in the acute to subacute phase (up to 30 days postinjury) following mild traumatic brain injury (mTBI). The current study explored whether acute posttraumatic stress, depression, and pain were associated with performance on a task of selective and sustained attention completed under conditions of increasing cognitive demands (standard, auditory distraction, and dual-task), and on tests of working memory, memory, processing speed, reaction time (RT), and verbal fluency. At a mean of 2.87 days (SD = 2.32) postinjury, 50 adult mTBI participants, consecutive admissions to a Level 1 trauma hospital, completed neuropsychological tests and self-report measures of acute posttraumatic stress, depression, and pain. A series of canonical correlation analyses was used to explore the relationships of a common set of psychological variables to various sets of neuropsychological variables. Significant results were found on the task of selective and sustained attention. Strong relationships were found between psychological variables and speed (r(c) = .56, p = .02) and psychological variables and accuracy (r(c) = .68, p = .002). Pain and acute posttraumatic stress were associated with higher speed scores (reflecting more correctly marked targets) under standard conditions. Acute posttraumatic stress was associated with lower accuracy scores across all task conditions. Moderate but nonsignificant associations were found between psychological variables and most cognitive tasks. Acute posttraumatic stress and pain show strong associations with selective and sustained attention following mTBI.

Activating the attachment system modulates neural responses to threat in refugees with PTSD

Publisher: Oxford University Press (OUP)

Date: 10-07-2021

DOI: 10.1093/SCAN/NSAB077

Abstract: Social attachment systems are disrupted for refugees through trauma and forced displacement. This study tested how the attachment system mitigates neural responses to threat in refugees with posttraumatic stress disorder (PTSD). Refugees with PTSD (N = 28) and refugee trauma-exposed controls (N = 22) viewed threat-related stimuli primed by attachment cues during a functional magnetic resonance imaging scan. Group differences and the moderating effects of avoidant or anxious attachment style and grief related to separation from family on brain activity and connectivity patterns were examined. Separation grief was associated with increased amygdala but decreased ventromedial prefrontal cortical (VMPFC) activity to the attachment prime and decreased VMPFC and hippoc al activity to attachment primed threat in the PTSD (vs trauma-exposed control) group. Avoidant attachment style was connected with increased dorsal frontoparietal attention regional activity to attachment prime cues in the PTSD group. Anxious attachment style was associated with reduced left amygdala connectivity with left medial prefrontal regions to attachment primed threat in the PTSD group. Separation grief appears to reduce attachment buffering of threat reactivity in refugees with PTSD, while avoidant and anxious attachment style modulated attentional and prefrontal regulatory mechanisms in PTSD, respectively. Considering social attachments in refugees could be important to post-trauma recovery, based within changes in key emotion regulation brain systems.

Changes in neural responses during affective and non-affective tasks and improvement of posttraumatic stress disorder symptoms following trauma-focused psychotherapy

Publisher: Springer Science and Business Media LLC

Date: 09-03-2023

DOI: 10.1038/S41398-023-02375-9

Abstract: At least one-third posttraumatic stress disorder (PTSD) patients do not respond to trauma-focused psychotherapy (TF-psychotherapy), which is the treatment of choice for PTSD. To clarify the change mechanisms that may be associated with treatment response, this study examined changes in neural activations during affective and non-affective processing that occur with improvement of symptoms after TF-psychotherapy. This study assessed PTSD treatment-seeking patients ( n = 27) prior to and after TF-psychotherapy using functional magnetic resonance imaging when they completed three tasks: (a) passive viewing of affective faces, (b) cognitive reappraisal of negative images, and (c) non-affective response inhibition. Patients then underwent 9 sessions of TF-psychotherapy, and were assessed on the Clinician-Administered PTSD Scale following treatment. Changes in neural responses in affect and cognitive processing regions-of-interest for each task were correlated with reduction of PTSD severity from pretreatment to posttreatment in the PTSD cohort. Data from 21 healthy controls was used for comparison. Improvement of symptoms in PTSD were associated with increased activation of left anterior insula, reductions in the left hippoc us and right posterior insula during viewing of supraliminally presented affective images, and reduced connectivity between the left hippoc us with the left amygdala and rostral anterior cingulate. Treatment response was also associated with reduced activation in the left dorsolateral prefrontal cortex during reappraisal of negative images. There were no associations between response and activation change during response inhibition. This pattern of findings indicates that improvement of PTSD symptoms following TF-psychotherapy is associated with changes in affective rather than non-affective processes. These findings accord with prevailing models that TF-psychotherapy promotes engagement and mastery of affective stimuli. Clinical Trials Registration: Trial Registration: Prospectively registered at Australian and New Zealand Clinical Trials Registry, ACTRN12612000185864 and ACTRN12609000324213. www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=83857

A longitudinal analysis of alcohol consumption and the risk of posttraumatic symptoms

Publisher: Elsevier BV

Date: 11-2009

DOI: 10.1016/J.JAD.2009.01.017

Abstract: Previous studies investigating the impact of alcohol ingestion on the emergence of posttraumatic psychological symptoms have generated contradictory findings. One thousand forty-five patients, admitted to hospital following traumatic injury were assessed during hospitalisation for patterns of alcohol consumption prior to the injury and also during the month prior to reassessment at 3 months. Anxiety, depression and posttraumatic stress disorder (PTSD) were assessed post accident and at 3 months. In a sub s le (n=167), blood alcohol levels were measured at the time of admission to emergency departments. Moderate alcohol consumption prior to and following the accident predicted lower levels of psychological distress at 1 week and 3 months. No significant relationship was found between the blood alcohol level and psychiatric outcomes. PTSD predicted the emergence of alcohol abuse following the accident, suggesting self-medication in a subgroup of survivors. The impact of alcohol consumption upon injury severity and the nature of injury was not controlled for and some non-participation may have been related to patterns of alcohol consumption. We relied on retrospective reports of alcohol use obtained shortly after the traumatic injury to index prior alcohol use and these reports may have been influenced by mood states at the time of recall. Our follow-up was limited to 3 months and there is a need for longer-term assessment of the relationship between prior alcohol use and subsequent posttraumatic adjustment. Given the potential impact of alcohol use on traumatic injury and post-injury recovery, we advocate active screening and early intervention strategies that focus on moderate alcohol usage.

A predictive screening index for posttraumatic stress disorder and depression following traumatic injury.

Publisher: American Psychological Association (APA)

Date: 2008

DOI: 10.1037/A0012918

Abstract: Posttraumatic stress disorder (PTSD) and major depressive episode (MDE) are frequent and disabling consequences of surviving severe injury. The majority of those who develop these problems are not identified or treated. The aim of this study was to develop and validate a screening instrument that identifies, during hospitalization, adults at high risk for developing PTSD and/or MDE. Hospitalized injury patients (n = 527) completed a pool of questions that represented 13 constructs of vulnerability. They were followed up at 12 months and assessed for PTSD and MDE. The resulting database was split into 2 subs les. A principal-axis factor analysis and then a confirmatory factor analysis were conducted on the 1st subs le, resulting in a 5-factor solution. Two questions were selected from each factor, resulting in a 10-item scale. The final model was cross-validated with the 2nd subs le. Receiver-operating characteristic curves were then created. The resulting Posttraumatic Adjustment Scale had a sensitivity of .82 and a specificity of .84 when predicting PTSD and a sensitivity of .72 and a specificity of .75 in predicting posttraumatic MDE. This 10-item screening index represents a clinically useful instrument to identify trauma survivors at risk for the later development of PTSD and/or MDE.

Duration of posttraumatic stress disorder predicts hippocampal grey matter loss

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 28-10-2009

DOI: 10.1097/WNR.0B013E3283300FBC

Eye movement and electrodermal responses to threat stimuli in post-traumatic stress disorder

Publisher: Elsevier BV

Date: 12-1995

DOI: 10.1016/0167-8760(95)00036-4

Abstract: A core feature of post-traumatic stress disorder (PTSD) is hypervigilence to threatening material. This study measured processing of threat material in PTSD with simultaneously acquired initial eye movements and electrodermal activity, following presentation of threatening and neutral words. Ten PTSD subjects and 10 controls were presented with 4 words in parafoveal range. On trials in which a threat word was present, PTSD subjects demonstrated initial eye fixations on the threat word more than controls. PTSD subjects also demonstrated more orienting responses on all trials than controls. These results suggest that processing of threat information in PTSD can be usefully investigated with convergent psychophysiological methodologies.

The mental health effects of changing from insecure to secure visas for refugees

Publisher: SAGE Publications

Date: 29-05-2023

DOI: 10.1177/00048674231177950

Abstract: In response to growing numbers of refugees worldwide, host governments are increasingly implementing temporary protection policies however, little is known regarding the mental health impact of these policies. This online longitudinal study investigated whether refugees who transitioned from low visa security (e.g. short-term transient visas) to medium (e.g. temporary protection visas) or high visa (e.g. permanent visas) security showed changes in depression symptoms, social difficulties and immigration-related fears. Participants were 1,201 refugees and asylum-seekers from Arabic, Farsi, Tamil or English-speaking backgrounds. Study variables were measured prior to and after change in visa status (6 months apart). Refugees who transitioned from low to medium security visas showed reduced immigration-related fear ( B = −0.09, 95% confidence interval = −0.29 to −0.06), but no change in depression symptoms or social difficulties compared to those who retained low visa security. Refugees who transitioned from low to high security visas showed reduced depression symptoms ( B = −0.02, 95% confidence interval = −0.04 to −0.01), social difficulties ( B = −0.04, 95% confidence interval = −0.05 to −0.01) and immigration-related fear ( B = −0.03, 95% confidence interval = −0.06 to −0.01) compared to those who retained low visa security. Findings indicate that the increased security afforded by temporary protection policies (vs short-term transient visas) did not translate into improved mental health and social outcomes for refugees. In contrast, permanent protection was associated with significant improvements in psychological and social functioning. These results have important policy implications for countries who have committed to protect and facilitate improved mental health among refugees.

The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders: Major depression summary

Publisher: Wiley

Date: 12-2020

DOI: 10.1111/BDI.13035

Abstract: To provide a succinct, clinically useful summary of the management of major depression, based on the 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders (MDcpg To develop the MDcpg The depression summary provides a systematic approach to diagnosis, and a logical clinical framework for management. The latter begins with Actions, which include important strategies that should be implemented from the outset. These include lifestyle changes, psychoeducation and psychological interventions. The summary advocates the use of antidepressants in the management of depression as Choices and nominates seven medications that can be trialled as clinically indicated before moving to Alternatives for managing depression. Subsequent strategies regarding Medication include Increasing Dose, Augmenting and Switching (MIDAS). The summary also recommends the use of electroconvulsive therapy (ECT), and discusses how to approach non-response. The major depression summary provides up to date guidance regarding the management of major depressive disorder, as set out in the MDcpg

Resilience@Work Mindfulness Program: Results From a Cluster Randomized Controlled Trial With First Responders

Publisher: JMIR Publications Inc.

Date: 19-02-2019

DOI: 10.2196/12894

The functional epistasis of 5‐HTTLPR and BDNF Val66Met on emotion processing: a preliminary study

Publisher: Wiley

Date: 03-10-2012

DOI: 10.1002/BRB3.99

Trajectory of post-traumatic stress following traumatic injury: 6-year follow-up

Publisher: Royal College of Psychiatrists

Date: 05-2015

DOI: 10.1192/BJP.BP.114.145516

Abstract: Traumatic injuries affect millions of patients each year, and resulting post-traumatic stress disorder (PTSD) significantly contributes to subsequent impairment. To map the distinctive long-term trajectories of PTSD responses over 6 years by using latent growth mixture modelling. Randomly selected injury patients ( n = 1084) admitted to four hospitals around Australia were assessed in hospital, and at 3, 12, 24 and 72 months. Lifetime psychiatric history and current PTSD severity and functioning were assessed. Five trajectories of PTSD response were noted across the 6 years: (a) chronic (4%), (b) recovery (6%), (c) worsening/recovery (8%), (d) worsening (10%) and (e) resilient (73%). A poorer trajectory was predicted by female gender, recent life stressors, presence of mild traumatic brain injury and admission to intensive care unit. These findings demonstrate the long-term PTSD effects that can occur following traumatic injury. The different trajectories highlight that monitoring a subset of patients over time is probably a more accurate means of identifying PTSD rather than relying on factors that can be assessed during hospital admission.

Interactions between BDNF Val66Met polymorphism and early life stress predict brain and arousal pathways to syndromal depression and anxiety

Publisher: Springer Science and Business Media LLC

Date: 20-01-2009

DOI: 10.1038/MP.2008.143

Abstract: In idual risk markers for depression and anxiety disorders have been identified but the explicit pathways that link genes and environment to these markers remain unknown. Here we examined the explicit interactions between the brain-derived neurotrophic factor (BDNF) Val66Met gene and early life stress (ELS) exposure in brain (amygdala-hippoc al-prefrontal gray matter volume), body (heart rate), temperament and cognition in 374 healthy European volunteers assessed for depression and anxiety symptoms. Brain imaging data were based on a subset of 89 participants. Multiple regression analysis revealed main effects of ELS for body arousal (resting heart rate, P=0.005) and symptoms (depression and anxiety, P<0.001) in the absence of main effects for BDNF. In addition, significant BDNF-ELS interactions indicated that BDNF Met carriers exposed to greater ELS have smaller hippoc al and amygdala volumes (P=0.013), heart rate elevations (P=0.0002) and a decline in working memory (P=0.022). Structural equation path modeling was used to determine if this interaction predicts anxiety and depression by mediating effects on the brain, body and cognitive measures. The combination of Met carrier status and exposure to ELS predicted reduced gray matter in hippoc us (P<0.001), and associated lateral prefrontal cortex (P<0.001) and, in turn, higher depression (P=0.005). Higher depression was associated with poorer working memory (P=0.005), and slowed response speed. The BDNF Met-ELS interaction also predicted elevated neuroticism and higher depression and anxiety by elevations in body arousal (P<0.001). In contrast, the combination of BDNF V/V genotype and ELS predicted increases in gray matter of the amygdala (P=0.003) and associated medial prefrontal cortex (P<0.001), which in turn predicted startle-elicited heart rate variability (P=0.026) and higher anxiety (P=0.026). Higher anxiety was linked to verbal memory, and to impulsivity. These effects were specific to the BDNF gene and were not evident for the related 5HTT-LPR polymorphism. Overall, these findings are consistent with the correlation of depression and anxiety, yet suggest that partially differentiated gene-brain cognition pathways to these syndromes can be identified, even in a nonclinical s le. Such findings may aid establishing an evidence base for more tailored intervention strategies.

The 2020 Royal Australian and New Zealand College of psychiatrists clinical practice guidelines for mood disorders: Bipolar disorder summary

Publisher: Wiley

Date: 12-2020

DOI: 10.1111/BDI.13036

Mapping frontal-limbic correlates of orienting to change detection

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 12-02-2007

DOI: 10.1097/WNR.0B013E328010FF80

A multisite randomized controlled effectiveness trial of cognitive processing therapy for military-related posttraumatic stress disorder

Publisher: Elsevier BV

Date: 04-2012

DOI: 10.1016/J.JANXDIS.2012.01.006

Abstract: Cognitive processing therapy (CPT) is currently applied in military veteran mental health services in many countries. This study tests the effectiveness of community-administered CPT for military-related PTSD under randomized controlled conditions. Fifty-nine treatment-seeking veterans with military-related PTSD were randomly allocated to receive 12 twice-weekly 60 min sessions of CPT or an equivalent period of usual treatment at veterans' community based counseling services. Intent to treat analyses found significantly greater improvement for participants receiving CPT over usual treatment at post-treatment and 3 month follow-up. CPT also produced greater improvements in anxiety, depression, social and dyadic relationships than usual treatment. No CPT related adverse events occurred during the trial. This trial reports the first randomized controlled trial evidence that CPT is an effective treatment for military PTSD and co-morbid conditions when compared to usual treatment and delivered in community settings by clinicians from erse disciplines, preferred treatment orientation and levels of experience.

Mental health following traumatic injury: Toward a health system model of early psychological intervention

Publisher: Elsevier BV

Date: 03-2008

DOI: 10.1016/J.CPR.2007.07.008

Abstract: In 2005, over 2 million people in the United States of America were hospitalised following non-fatal injuries. The frequency with which severe injury occurs renders it a leading cause of posttraumatic stress disorder and other trauma-related psychopathology. In order to develop a health system model of early psychological intervention for this population, we review the literature that pertains to mental health early intervention. The relevant domains include prevalence of psychopathology following traumatic injury, the course of symptoms, screening, and early intervention strategies. On the basis of available evidence, we propose a health system model of early psychological intervention following traumatic injury. The model involves screening for vulnerability within the hospital setting, follow-up screening for persistent symptoms at one month posttrauma, and early psychological intervention for those who are experiencing clinical impairment. Recommendations are made to facilitate tailoring early intervention psychological therapies to the special needs of the injury population.

Prevalence of posttraumatic stress disorder after infectious disease pandemics in the twenty-first century, including COVID-19: a meta-analysis and systematic review

Publisher: Springer Science and Business Media LLC

Date: 04-02-2021

DOI: 10.1038/S41380-021-01036-X

The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders

Publisher: SAGE Publications

Date: 22-12-2020

DOI: 10.1177/0004867420979353

Abstract: To provide advice and guidance regarding the management of mood disorders, derived from scientific evidence and supplemented by expert clinical consensus to formulate s that maximise clinical utility. Articles and information sourced from search engines including PubMed, EMBASE, MEDLINE, PsycINFO and Google Scholar were supplemented by literature known to the mood disorders committee (e.g. books, book chapters and government reports) and from published depression and bipolar disorder guidelines. Relevant information was appraised and discussed in detail by members of the mood disorders committee, with a view to formulating and developing consensus-based recommendations and clinical guidance. The guidelines were subjected to rigorous consultation and external review involving: expert and clinical advisors, key stakeholders, professional bodies and specialist groups with interest in mood disorders. The Royal Australian and New Zealand College of Psychiatrists mood disorders clinical practice guidelines 2020 (MDcpg 2020 ) provide up-to-date guidance regarding the management of mood disorders that is informed by evidence and clinical experience. The guideline is intended for clinical use by psychiatrists, psychologists, primary care physicians and others with an interest in mental health care. The MDcpg 2020 builds on the previous 2015 guidelines and maintains its joint focus on both depressive and bipolar disorders. It provides up-to-date recommendations and guidance within an evidence-based framework, supplemented by expert clinical consensus. Gin S Malhi (Chair), Erica Bell, Darryl Bassett, Philip Boyce, Richard Bryant, Philip Hazell, Malcolm Hopwood, Bill Lyndon, Roger Mulder, Richard Porter, Ajeet B Singh and Greg Murray.

Altered white matter microstructural organization in posttraumatic stress disorder across 3047 adults: results from the PGC-ENIGMA PTSD consortium

Publisher: Springer Science and Business Media LLC

Date: 19-12-2019

DOI: 10.1038/S41380-019-0631-X

The role of anger and ongoing stressors in mental health following a natural disaster

Publisher: SAGE Publications

Date: 13-01-2015

DOI: 10.1177/0004867414565478

Abstract: Research has established the mental health sequelae following disaster, with studies now focused on understanding factors that mediate these outcomes. This study focused on anger, alcohol, subsequent life stressors and traumatic events as mediators in the development of mental health disorders following the 2009 Black Saturday Bushfires, Australia’s worst natural disaster in over 100 years. This study examined data from 1017 (M = 404, F = 613) adult residents across 25 communities differentially affected by the fires and participating in the Beyond Bushfires research study. Data included measures of fire exposure, posttraumatic stress disorder, depression, alcohol abuse, anger and subsequent major life stressors and traumatic events. Structural equation modeling assessed the influence of factors mediating the effects of fire exposure on mental health outcomes. Three mediation models were tested. The final model recorded excellent fit and observed a direct relationship between disaster exposure and mental health outcomes (b = .192, p .001) and mediating relationships via Anger (b = .102, p .001) and Major Life Stressors (b = .128, p .001). Each gender was compared with multiple group analyses and while the mediation relationships were still significant for both genders, the direct relationship between exposure and outcome was no longer significant for men ( p = .069), but remained significant (b = .234, p .001) for women. Importantly, anger and major life stressors mediate the relationship between disaster exposure and development of mental health problems. The findings have significant implications for the assessment of anger post disaster, the provision of targeted anger-focused interventions and delivery of government and community assistance and support in addressing ongoing stressors in the post-disaster context to minimize subsequent mental health consequences.

The relationship between acute stress disorder and posttraumatic stress disorder in injured children

Publisher: Wiley

Date: 2007

DOI: 10.1002/JTS.20282

Abstract: This study indexed the relationship between acute stress disorder (ASD) and subsequent posttraumatic stress disorder (PTSD) in injured children. Consecutive children between 7-13 years admitted to a hospital after traumatic injury (n = 76) were assessed for ASD. Children were followed up 6-months posttrauma (n = 62), and administered the PTSD Reaction Index. Acute stress disorder was diagnosed in 10% of patients, and 13% satisfied criteria for PTSD. At 6-months posttrauma, PTSD was diagnosed in 25% of patients who were diagnosed with ASD. Acute stress reactions that did not include dissociation provided better prediction of PTSD than full ASD criteria. These findings suggest that the current ASD diagnosis is not optimal in identifying younger children who are high risk for PTSD development.

Online group-based cognitive-behavioural therapy for adolescents and young adults after cancer treatment: A multicenter randomised controlled trial of Recapture Life-AYA

Publisher: Springer Science and Business Media LLC

Date: 03-08-2012

DOI: 10.1186/1471-2407-12-339

Trauma at the Hands of Another

Publisher: Physicians Postgraduate Press, Inc

Date: 26-11-2013

DOI: 10.4088/JCP.13M08374

A mixed-method study of expert psychological evidence submitted for a cohort of asylum seekers undergoing refugee status determination in Australia

Publisher: Elsevier BV

Date: 12-2013

DOI: 10.1016/J.SOCSCIMED.2013.08.029

Abstract: The levels of exposure to conflict-related trauma and the high rates of mental health impairment amongst asylum seekers pose specific challenges for refugee decision makers who lack mental health training. We examined the use of psychological evidence amongst asylum decision makers in New South Wales, Australia, drawing on the archives of a representative cohort of 52 asylum seekers. A mixed-method approach was used to examine key mental health issues presented in psychological reports accompanying each asylum application, including key documents submitted for consideration of asylum at the primary and review levels. The findings indicated that the majority of decision makers at both levels did not refer to psychological evidence in their decision records. Those who did, particularly in the context of negative decisions, challenged the expert findings and rejected the value of such evidence. Asylum seekers exhibiting traumatic stress symptoms such as intrusive thoughts and avoidance, as well as memory impairment, experienced a lower acceptance rate than those who did not across the primary and review levels. The findings raise concern that trauma-affected asylum seekers may be consistently disadvantaged in the refugee decision-making process and underscore the need to improve the understanding and use of mental health evidence in the refugee decision-making setting. The study findings have been used to develop a set of guidelines to assist refugee decision makers, mental health professionals and legal advisers in improving the quality and use of psychological evidence within the refugee decision-making context.

The impact of trauma exposure on the development of PTSD and psychological distress in a volunteer fire service

Publisher: Elsevier BV

Date: 12-2018

DOI: 10.1016/J.PSYCHRES.2018.06.058

Abstract: Emergency service workers (ESWs) are at increased risk of trauma-related mental disorders. However, volunteer ESWs, who comprise the majority of firefighters in Western countries, have limited access to the necessary support services for mental health problems. This study aimed to examine the impact of the level and types of trauma exposure on the development of mental disorders in a volunteer fire service. Members of an Australian volunteer fire service (N = 459) completed a cross-sectional survey. Information on the number and types of distressing critical incidents involved within the last year was collected. Validated, self-report measures were used to determine probable post-traumatic stress disorder (PTSD) and psychological distress caseness. The risk of probable PTSD was significantly higher for those with the most frequent involvement with distressing incidents and the highest levels of cumulative trauma exposure. Being trapped in a dangerous situation or being assaulted by other people, resulted in the greatest odds of developing a mental disorder. Volunteer fire service members with the highest levels of trauma exposure and involvement with particular types of critical incidents are at elevated risk of mental health problems. The implications for the provision of psychological support measures amongst volunteer emergency services are discussed.

Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders

Publisher: SAGE Publications

Date: 12-2015

DOI: 10.1177/0004867415617657

Abstract: To provide guidance for the management of mood disorders, based on scientific evidence supplemented by expert clinical consensus and formulate recommendations to maximise clinical salience and utility. Articles and information sourced from search engines including PubMed and EMBASE, MEDLINE, PsycINFO and Google Scholar were supplemented by literature known to the mood disorders committee (MDC) (e.g., books, book chapters and government reports) and from published depression and bipolar disorder guidelines. Information was reviewed and discussed by members of the MDC and findings were then formulated into consensus-based recommendations and clinical guidance. The guidelines were subjected to rigorous successive consultation and external review involving: expert and clinical advisors, the public, key stakeholders, professional bodies and specialist groups with interest in mood disorders. The Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders (Mood Disorders CPG) provide up-to-date guidance and advice regarding the management of mood disorders that is informed by evidence and clinical experience. The Mood Disorders CPG is intended for clinical use by psychiatrists, psychologists, physicians and others with an interest in mental health care. The Mood Disorder CPG is the first Clinical Practice Guideline to address both depressive and bipolar disorders. It provides up-to-date recommendations and guidance within an evidence-based framework, supplemented by expert clinical consensus. Professor Gin Malhi (Chair), Professor Darryl Bassett, Professor Philip Boyce, Professor Richard Bryant, Professor Paul Fitzgerald, Dr Kristina Fritz, Professor Malcolm Hopwood, Dr Bill Lyndon, Professor Roger Mulder, Professor Greg Murray, Professor Richard Porter and Associate Professor Ajeet Singh. Professor Carlo Altamura, Dr Francesco Colom, Professor Mark George, Professor Guy Goodwin, Professor Roger McIntyre, Dr Roger Ng, Professor John O’Brien, Professor Harold Sackeim, Professor Jan Scott, Dr Nobuhiro Sugiyama, Professor Eduard Vieta, Professor Lakshmi Yatham. Professor Marie-Paule Austin, Professor Michael Berk, Dr Yulisha Byrow, Professor Helen Christensen, Dr Nick De Felice, A/Professor Seetal Dodd, A/Professor Megan Galbally, Dr Josh Geffen, Professor Philip Hazell, A/Professor David Horgan, A/Professor Felice Jacka, Professor Gordon Johnson, Professor Anthony Jorm, Dr Jon-Paul Khoo, Professor Jayashri Kulkarni, Dr Cameron Lacey, Dr Noeline Latt, Professor Florence Levy, A/Professor Andrew Lewis, Professor Colleen Loo, Dr Thomas Mayze, Dr Linton Meagher, Professor Philip Mitchell, Professor Daniel O’Connor, Dr Nick O’Connor, Dr Tim Outhred, Dr Mark Rowe, Dr Narelle Shadbolt, Dr Martien Snellen, Professor John Tiller, Dr Bill Watkins, Dr Raymond Wu.

The role of estrogen in intrusive memories

Publisher: Elsevier BV

Date: 11-2013

DOI: 10.1016/J.NLM.2013.07.005

Abstract: Intrusive memories are highly vivid, emotional and involuntary recollections which cause significant distress across psychological disorders including posttraumatic disorder (PTSD). Recent evidence has potentially extended our understanding of the development of intrusive memories by identifying biological factors which significantly impact on memories for emotionally arousing stimuli. This study investigated the role of stress on the development of intrusions for negative and neutral images, and indexed the potential contributions of sex (estrogen and progesterone) and stress (noradrenaline and cortisol) hormones. Whilst viewing the images, half the participants underwent a cold pressor stress (CPS) procedure to induce stress while the control participants immersed their hands in warm water. Saliva s les were collected to index estrogen, progesterone and noradrenergic and cortisol response. Participants (55 university students, 26 men, 29 women) viewed a series of negatively arousing and neutral images. Participants completed recall and intrusions measures 2 days later. Negative images resulted in greater recall and more intrusions than neutral images. In the cold water condition females recalled fewer neutral memories than males. Cortisol increase predicted decreased recall of negative memories in males, and estrogen predicted increased intrusions of negative images in women. These findings are consistent with evidence that circulating levels of ovarian hormones influence memory for emotionally arousing events, and provides the first evidence of the influence of sex hormones on intrusive memories. These results provide one possible explanation for the higher incidence of anxiety disorders in women.

Social problem solving in complicated grief

Publisher: Wiley

Date: 11-2010

DOI: 10.1348/014466510X487040

Cortical volume abnormalities in posttraumatic stress disorder: an ENIGMA-psychiatric genomics consortium PTSD workgroup mega-analysis

Publisher: Springer Science and Business Media LLC

Date: 07-12-2020

DOI: 10.1038/S41380-020-00967-1

The familial influence of loss and trauma on refugee mental health: A multilevel path analysis

Publisher: Wiley

Date: 25-01-2011

DOI: 10.1002/JTS.20608

Abstract: Although the impact of human rights violations on the mental health of refugees has been well documented, little is known about these effects at a family level. In this study the authors examined the relationships among loss, trauma, and mental health at the in idual and family levels in resettled Mandaean refugees (N = 315). Trauma, loss, posttraumatic stress disorder, depression, complicated grief, and mental health-related quality of life were assessed. A multilevel path analysis revealed that loss and trauma significantly impacted on psychological outcomes at both the in idual and family levels. Effect sizes ranged from .21 to .68 at the in idual level, and .38 to .99 at the family level, highlighting the importance of the family when considering the psychological impact of refugee-related trauma.

Could irritability be the key to unlocking the enigma of mixed states?

Publisher: Wiley

Date: 12-2020

DOI: 10.1111/BDI.13029

The Psychiatric Sequelae of Traumatic Injury

Publisher: American Psychiatric Association Publishing

Date: 03-2010

DOI: 10.1176/APPI.AJP.2009.09050617

Abstract: Traumatic injury affects millions of people each year. There is little understanding of the extent of psychiatric illness that develops after traumatic injury or of the impact of mild traumatic brain injury (TBI) on psychiatric illness. The authors sought to determine the range of new psychiatric disorders occurring after traumatic injury and the influence of mild TBI on psychiatric status. In this prospective cohort study, patients were drawn from recent admissions to four major trauma hospitals across Australia. A total of 1,084 traumatically injured patients were initially assessed during hospital admission and followed up 3 months (N=932, 86%) and 12 months (N=817, 75%) after injury. Lifetime psychiatric diagnoses were assessed in hospital. The prevalence of psychiatric disorders, levels of quality of life, and mental health service use were assessed at the follow-ups. The main outcome measures were 3- and 12-month prevalence of axis I psychiatric disorders, levels of quality of life, and mental health service use and lifetime axis I psychiatric disorders. Twelve months after injury, 31% of patients reported a psychiatric disorder, and 22% developed a psychiatric disorder that they had never experienced before. The most common new psychiatric disorders were depression (9%), generalized anxiety disorder (9%), posttraumatic stress disorder (6%), and agoraphobia (6%). Patients were more likely to develop posttraumatic stress disorder (odds ratio=1.92, 95% CI=1.08-3.40), panic disorder (odds ratio=2.01, 95% CI=1.03-4.14), social phobia (odds ratio=2.07, 95% CI=1.03-4.16), and agoraphobia (odds ratio=1.94, 95% CI=1.11-3.39) if they had sustained a mild TBI. Functional impairment, rather than mild TBI, was associated with psychiatric illness. A significant range of psychiatric disorders occur after traumatic injury. The identification and treatment of a range of psychiatric disorders are important for optimal adaptation after traumatic injury.

Onset of common mental disorders and suicidal behavior following women's first exposure to gender based violence: a retrospective, population-based study

Publisher: Springer Science and Business Media LLC

Date: 18-11-2014

DOI: 10.1186/S12888-014-0312-X

Australian guidelines for the treatment of adults with acute stress disorder and post-traumatic stress disorder

Publisher: SAGE Publications

Date: 08-2007

DOI: 10.1080/00048670701449161

Abstract: Over the past 2–3 years, clinical practice guidelines (CPGs) for post-traumatic stress disorder (PTSD) and acute stress disorder (ASD) have been developed in the USA and UK. There remained a need, however, for the development of Australian CPGs for the treatment of ASD and PTSD tailored to the national health-care context. Therefore, the Australian Centre for Posttraumatic Mental Health in collaboration with national trauma experts, has recently developed Australian CPGs for adults with ASD and PTSD, which have been endorsed by the National Health and Medical Research Council (NHMRC). In consultation with a multidisciplinary reference panel (MDP), research questions were determined and a systematic review of the evidence was then conducted to answer these questions (consistent with NHMRC procedures). On the basis of the evidence reviewed and in consultation with the MDP, a series of practice recommendations were developed. The practice recommendations that have been developed address a broad range of clinical questions. Key recommendations indicate the use of trauma-focused psychological therapy (cognitive behavioural therapy or eye movement desensitization and reprocessing in addition to in vivo exposure) as the most effective treatment for ASD and PTSD. Where medication is required for the treatment of PTSD in adults, selective serotonin re-uptake inhibitor antidepressants should be the first choice. Medication should not be used in preference to trauma-focused psychological therapy. In the immediate aftermath of trauma, practitioners should adopt a position of watchful waiting and provide psychological first aid. Structured interventions such as psychological debriefing, with a focus on recounting the traumatic event and ventilation of feelings, should not be offered on a routine basis.

A comparison of the functional connectome in mild traumatic brain injury and post‐traumatic stress disorder

Publisher: Wiley

Date: 07-10-2023

DOI: 10.1002/HBM.26101

Abstract: Post‐traumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI) often co‐occur in the context of threat to one's life. These conditions also have an overlapping symptomatology and include symptoms of anxiety, poor concentration and memory problems. A major challenge has been articulating the underlying neurobiology of these overlapping conditions. The primary aim of this study was to compare intrinsic functional connectivity between mTBI (without PTSD) and PTSD (without mTBI). The study included functional MRI data from 176 participants: 42 participants with mTBI, 67 with PTSD and a comparison group of 66 age and sex‐matched healthy controls. We used network‐based statistical analyses for connectome‐wide comparisons of intrinsic functional connectivity between mTBI relative to PTSD and controls. Our results showed no connectivity differences between mTBI and PTSD groups. However, we did find that mTBI had significantly reduced connectivity relative to healthy controls within an extensive network of regions including default mode, executive control, visual and auditory networks. The mTBI group also displayed hyperconnectivity between dorsal and ventral attention networks and perceptual regions. The PTSD group also demonstrated abnormal connectivity within these networks relative to controls. Connectivity alterations were not associated with severity of PTSD or post‐concussive symptoms in either clinical group. Taken together, the similar profiles of intrinsic connectivity alterations in these two conditions provide neural evidence that can explain, in part, the overlapping symptomatology between mTBI and PTSD.

Interpersonal violence and mental health outcomes following disaster

Publisher: Royal College of Psychiatrists

Date: 04-12-2020

DOI: 10.1192/BJO.2019.82

Abstract: Disasters pose a documented risk to mental health, with a range of peri- and post-disaster factors (both pre-existing and disaster-precipitated) linked to adverse outcomes. Among these, increasing empirical attention is being paid to the relation between disasters and violence. This study examined self-reported experiences of assault or violence victimisation among communities affected by high, medium, and low disaster severity following the 2009 bushfires in Victoria, Australia. The association between violence, mental health outcomes and alcohol misuse was also investigated. Participants were 1016 adults from high-, medium- and low-affected communities, 3–4 years after an Australian bushfire disaster. Rates of reported violence were compared by areas of bushfire-affectedness. Logistic regression models were applied separately to men and women to assess the experience of violence in predicting general and fire-related post-traumatic stress disorder, depression and alcohol misuse. Reports of experiencing violence were significantly higher among high bushfire-affected compared with low bushfire-affected regions. Analyses indicated the significant relationship between disaster-affectedness and violence was observed for women only, with rates of 1.0, 0 and 7.4% in low, medium and high bushfire-affected areas, respectively. Among women living in high bushfire-affected areas, negative change to income was associated with an increased likelihood of experiencing violence (odds ratio, 4.68). For women, post-disaster violence was associated with more severe post-traumatic stress disorder and depression symptoms. Women residing within high bushfire-affected communities experienced the highest levels of violence. These post-disaster experiences of violence are associated with post-disaster changes to income and with post-traumatic stress disorder and depression symptoms among women. These findings have critical implications for the assessment of, and interventions for, women experiencing or at risk of violence post-disaster.

The BDNF Val66Met polymorphism moderates the relationship between Posttraumatic Stress Disorder and fear extinction learning

Publisher: Elsevier BV

Date: 05-2018

DOI: 10.1016/J.PSYNEUEN.2018.03.002

Abstract: The low expression Met allele of the BDNF Val66Met polymorphism is associated with impaired fear extinction in healthy controls, and poorer response to exposure therapy in patients with Posttraumatic Stress Disorder (PTSD). Given that fear extinction underlies exposure therapy, this raises the question of the impact of BDNFVal66Met polymorphism on fear extinction in PTSD, yet this question has not yet been examined. One hundred and six participants (22 PTSD, 46 trauma-exposed controls (TC) and 38 non-trauma exposed controls (NTC)) completed a fear conditioning and extinction task and saliva s les were taken for DNA extraction and genotyped for the BDNF Val66Met polymorphism. Moderation analyses using PROCESS examined whether BDNF genotype (Val-Val vs Met carriers) moderated the relationship between PTSD symptom severity (and diagnostic status) and skin conductance response (SCR) litude during fear extinction. The PTSD group displayed significantly slower fear extinction learning compared to TC and NTC in the early extinction phase. The BDNF Val66Met polymorphism moderated the relationship between PTSD and fear extinction learning, such that poorer fear extinction learning was associated with greater PTSD symptom severity (and PTSD diagnostic status) in in iduals with the low-expression Met allele, but no relationship was demonstrated in in iduals with the Val-Val allele. This study reveals that impaired fear extinction learning is particularly evident in in iduals with PTSD who carry the low-expression BDNF Met allele and importantly not in those with the Val-Val allele. This provides novel evidence of a link between BDNF and impaired fear extinction learning in PTSD, which may contribute to poorer response to exposure therapy.

A mega-analysis of vertex and gyral cortical thickness differences in adults with and without PTSD

Publisher: Research Square Platform LLC

Date: 06-10-2022

DOI: 10.21203/RS.3.RS-2085479/V1

Abstract: A number of studies of posttraumatic stress disorder (PTSD) report thinner cerebral cortical gyri using gyrus-based analysis or thinner foci within the gyri using vertex-based analysis. However, the locations of these findings are inconsistent across studies, and the spatial transformations required during vertex-based analysis may affect the focal findings. A mega-analysis using a large number of subjects from multiple PTSD studies could potentially identify more reproducible cortical thickness abnormalities. Investigating both the vertex and gyral thicknesses simultaneously may verify the vertex-based focal findings using gyral data without imposing any spatial transformation. Here we aggregated data from 24 international laboratories using ENIGMA standardized procedures for 949 adult PTSD patients and 1493 controls without PTSD (age 18 to 65 years). We examined whether gyral and vertex cortical thickness are (a) different between subjects with PTSD and controls and (b) associated with PTSD symptom severity in trauma-exposed subjects. Regions with overlapping thinner cortical gyri and thinner vertex clusters were located in frontal, temporal, parietal, and occipital cortices. Thinner right lateral orbitofrontal and right lingual gyri and concomitantly thinner vertex clusters in the anterior portions of both gyri were associated with PTSD symptom severity. Convergent findings in these locations suggest focally thinner cortex in these gyri, which may be involved in altered processing and regulation of emotion and sensory inputs underlying posttraumatic stress symptoms.

Heart rate after trauma and the specificity of fear circuitry disorders

Publisher: Cambridge University Press (CUP)

Date: 15-06-2011

DOI: 10.1017/S0033291711000948

Abstract: Fear circuitry disorders purportedly include post-traumatic stress disorder (PTSD), panic disorder, agoraphobia, social phobia and specific phobia. It is proposed that these disorders represent a cluster of anxiety disorders triggered by stressful events and lead to fear conditioning. Elevated heart rate (HR) at the time of an aversive event may reflect strength of the unconditioned response, which may contribute to fear circuitry disorders. This prospective cohort study assessed HR within 48 h of hospital admission in 602 traumatically injured patients, who were assessed during hospital admission and within 1 month of trauma exposure for lifetime psychiatric diagnosis. At 3 months after the initial assessment, 526 patients (87%) were reassessed for PTSD, major depressive disorder, panic disorder, agoraphobia, social phobia, obsessive compulsive disorder and generalized anxiety disorder. At the 3-month assessment there were 77 (15%) new cases of fear circuitry disorder and 87 new cases of non-fear circuitry disorder (17%). After controlling for gender, age, type of injury and injury severity, patients with elevated HR (defined as ⩾96 beats per min) at the time of injury were more likely to develop PTSD [odds ratio (OR) 5.78, 95% confidence interval (CI) 2.32–14.43], panic disorder (OR 3.46, 95% CI 1.16–10.34), agoraphobia (OR 3.90, 95% CI 1.76–8.61) and social phobia (OR 3.98, 95% CI 1.42–11.14). Elevated HR also predicted new fear circuitry disorders that were not co-morbid with a non-fear circuitry disorder (OR 7.28, 95% CI 2.14–24.79). These data provide tentative evidence of a common mechanism underpinning the onset of fear circuitry disorders.

Oxytocin as a moderator of hypnotizability

Publisher: Elsevier BV

Date: 2012

DOI: 10.1016/J.PSYNEUEN.2011.05.010

Abstract: Since hypnosis was popularly recognized in the nineteenth century, the phenomenon of hypnotizability has remained poorly understood. The capacity to increase hypnotizability has important implications because it may increase the number of people who can benefit from hypnotic interventions for psychological and medical conditions. Current theories emphasize that rapport between hypnotist and subject is pivotal to motivate the respondent to engage in strategies that allows them to suspend reality and respond to suggestions. The neuropeptide oxytocin is implicated in social bonding, and enhances a range of social behaviors in animals and humans. This study tested the proposal that oxytocin administration, which enhances social bonding in humans, may enhance hypnotic responding by administering intranasal spray of oxytocin or placebo prior to hypnosis in 40 low hypnotizable male subjects. When low hypnotizable in iduals were administered oxytocin via nasal spray, their level of hypnotic responding increased significantly compared to hypnotic responding levels prior to oxytocin administration. This is the first demonstration of a neurochemical basis for hypnotic responding, and points to a potential neural mechanism to explain hypnotizability.

Feasibility, acceptability, and safety of the Recapture Life videoconferencing intervention for adolescent and young adult cancer survivors

Publisher: Wiley

Date: 28-11-2018

DOI: 10.1002/PON.4938

Abstract: Online psychological therapies provide a way to connect adolescent and young adult (AYA) cancer survivors to evidence-based support. We aimed to establish the feasibility, acceptability, and safety of Recapture life, a six-session group-based online cognitive-behavioural intervention, led by a facilitator, for AYAs in the early post-treatment period. A randomised-controlled trial compared Recapture Life to an online peer-support group control and a waitlist control. Participants could nominate a support person. Acceptability was assessed using study opt-in and retention rates, participant-reported benefits/burdens of participation, and group facilitator burden. We also assessed the feasibility (eg, frequency/impact of technological difficulties) and psychological safety (ie, occurrence of clinically concerning distress) of the program. Sixty-one participants took part (45 AYAs, 51.1% female 19 support people). The opt-in rate was 30%, the enrolment rate was 87%, and 75% of participants took part in ≥5/6 sessions. AYAs reported high benefit and low burden of participation. Overall, 95 online group sessions were conducted few required rescheduling by group facilitators (3%), but many took place outside of office hours (~90 hours). It took 40 days on average to create online groups, but established weekly sessions commenced quickly (M = 4.0 minutes). Technological difficulties were common but had a low impact on intervention delivery. Although 54% of AYAs returned a clinically concerning distress screen at some point, none reflected acute mental health risks. The data largely indicate that Recapture Life is an acceptable, feasible, and safe model of evidence-based psychological support for AYAs during early survivorship, which nevertheless experienced common challenges in online/AYA intervention delivery.

Post-traumatic amnesia and the nature of post-traumatic stress disorder after mild traumatic brain injury

Publisher: Cambridge University Press (CUP)

Date: 11-2009

DOI: 10.1017/S1355617709990671

Abstract: The prevalence and nature of post-traumatic stress disorder (PTSD) following mild traumatic brain injury (MTBI) is controversial because of the apparent paradox of suffering PTSD with impaired memory for the traumatic event. In this study, 1167 survivors of traumatic injury (MTBI: 459, No TBI: 708) were assessed for PTSD symptoms and post-traumatic amnesia during hospitalization, and were subsequently assessed for PTSD 3 months later ( N = 920). At the follow-up assessment, 90 (9.4%) patients met criteria for PTSD (MTBI: 50, 11.8% No-TBI: 40, 7.5%) MTBI patients were more likely to develop PTSD than no-TBI patients, after controlling for injury severity (adjusted odds ratio: 1.86 95% confidence interval, 1.78–2.94). Longer post-traumatic amnesia was associated with less severe intrusive memories at the acute assessment. These findings indicate that PTSD may be more likely following MTBI, however, longer post-traumatic amnesia appears to be protective against selected re-experiencing symptoms. ( JINS , 2009, 15 , 862–867.)

The relationship between moral injury appraisals, trauma exposure, and mental health in refugees

Publisher: Hindawi Limited

Date: 10-08-2018

DOI: 10.1002/DA.22787

Abstract: Refugees are often exposed to multiple traumatic experiences, leading to elevated rates of psychological disorders. There is emerging evidence that appraisals of traumatic events as violating deeply held moral beliefs and frameworks (i.e., moral injury) impact negatively on refugee mental health. Despite this, no research has systematically investigated moral injury appraisals in refugees. Participants were 222 refugees from erse backgrounds who had recently resettled in Australia. They completed measures of mental health in Arabic, Farsi, Tamil, or English through an online survey. This study first investigated the factor structure of the Moral Injury Appraisals Scale (MIAS), and then examined the relationship between the moral injury factors and key predictor (age, gender, trauma exposure) and outcome (Posttraumatic stress disorder [PTSD] symptom clusters, anger, and depression) variables. Confirmatory factor analyses of the MIAS supported a two-factor model, comprising a Moral Injury-Other (MI-Other) factor (i.e., interpreting the violation as being enacted by others) and a Moral Injury-Self (MI-Self) factor (i.e., interpreting the violation as being enacted by oneself). Structural equation modeling analyses indicated that both factors were predicted by higher trauma exposure, and both predicted more severe anger and depression. Notably, while MI-Other was associated with more severe PTSD, MI-Self was associated with lower levels of intrusions. These results suggest that there may be subtypes of moral injury appraisals that are associated with different mental health outcomes. These findings have potential implications for designing treatments that address the psychological impact of the refugee experience.

Flipping the Paradigm: A Qualitative Exploration of Research Translation Centres in the UK and Australia

Publisher: Research Square Platform LLC

Date: 15-08-2020

DOI: 10.21203/RS.3.RS-16464/V2

Abstract: Background: Over the past decade Research Translation Centres (RTC’s) have been established in many countries. These Centres (sometimes referred to as Academic Health Science Centres) are designed to bring universities and health care providers together in order to accelerate the generation and translation of new evidence that is responsive to health service and community priorities. This has the potential to effectively ‘flip’ the traditional research and education paradigms because it requires active participation and continuous engagement with stakeholders (especially service users, the community and frontline clinicians). Although investment and expectations of RTCs are high, the literature confirms a need to better understand the processes RTCs use to mobilise knowledge, build workforce capacity and co-produce research with patients and the public to ensure population impact and drive healthcare improvement is needed. Methods: Semi structured interviews were conducted with selected leaders and members from select RTCs in England and Australia. Convenience s ling was utilised to identify RTC’s, based on their geography, accessibility and availability. Purposive s ling and a snowballing approach was employed to recruit in idual participants for interviews that were conducted face to face or via videoconferencing. Interviews were recorded, transcribed verbatim and analysed using a reflexive and inductive approach. This involved two researchers comparing codes and interrogating themes that were analysed inductively against the study aims and through meetings with the research team. Results : A total of 41 participants, 22 from England and 19 from Australia were interviewed. Five major themes emerged including (1) dissonant metrics, (2) different models of leadership (3) public-patient involvement and research co-production (4) workforce development (5) barriers to collaboration. Conclusions : Participants identified the need for performance measures that capture community impact. Better aligned success metrics, enhanced leadership, strategies to partner with patients and the public, enhanced workforce development and strategies to enhance collaboration were all identified as crucial for RTCs to succeed.

Ethical Research in Partnership with an Indigenous Community

Publisher: SAGE Publications

Date: 2009

DOI: 10.1080/10398560902948738

Abstract: Objective: The aim of this paper is to describe the implementation of the Community Safety Research Project (CSRP) focusing on violence prevention among Aboriginal communities in western NSW in order to examine how practice converges with contemporary ethical guidelines. Method: A comparison was made of key project elements with the principles outlined in existing ethical guidelines, outlining the concrete issues that need to be confronted in practice. Results: The approach being pursued is consonant with the principles of contemporary guidelines the results of the first phase qualitative study inquiring into workers’ perceptions of violence revealed some differences in the understanding of violence between Aboriginal and non-Aboriginal workers, with some ethical implications. Conclusions: Ethical approaches to research among Aboriginal communities include, but extend well beyond, the principle of avoiding harm. A comprehensive approach to ethical research requires significant ongoing expenditure of effort and resources with implications for project development, management and funding.

International meta-analysis of PTSD genome-wide association studies identifies sex- and ancestry-specific genetic risk loci

Publisher: Springer Science and Business Media LLC

Date: 08-10-2019

DOI: 10.1038/S41467-019-12576-W

Abstract: The risk of posttraumatic stress disorder (PTSD) following trauma is heritable, but robust common variants have yet to be identified. In a multi-ethnic cohort including over 30,000 PTSD cases and 170,000 controls we conduct a genome-wide association study of PTSD. We demonstrate SNP-based heritability estimates of 5–20%, varying by sex. Three genome-wide significant loci are identified, 2 in European and 1 in African-ancestry analyses. Analyses stratified by sex implicate 3 additional loci in men. Along with other novel genes and non-coding RNAs, a Parkinson’s disease gene involved in dopamine regulation, PARK2 , is associated with PTSD. Finally, we demonstrate that polygenic risk for PTSD is significantly predictive of re-experiencing symptoms in the Million Veteran Program dataset, although specific loci did not replicate. These results demonstrate the role of genetic variation in the biology of risk for PTSD and highlight the necessity of conducting sex-stratified analyses and expanding GWAS beyond European ancestry populations.

Treating Prolonged Grief Disorder

Publisher: American Medical Association (AMA)

Date: 12-2014

DOI: 10.1001/JAMAPSYCHIATRY.2014.1600

Abstract: Prolonged grief disorder (PGD) is a potentially disabling condition that affects approximately 10% of bereaved people. Grief-focused cognitive behavior therapy (CBT) has been shown to be effective in treating PGD. Although treatments for PGD have focused on exposure therapy, much debate remains about whether exposure therapy is optimal for PGD. To determine the relative efficacies of CBT with exposure therapy (CBT/exposure) or CBT alone for PGD. A randomized clinical trial of 80 patients with PGD attending the outpatient University of New South Wales Traumatic Stress Clinic from September 17, 2007, through June 7, 2010. All patients received 10 weekly 2-hour group therapy sessions that consisted of CBT techniques. Patients also received 4 in idual sessions, in which they were randomized to receive exposure therapy for memories of the death or supportive counseling. Measures of PGD by clinical interview and self-reported measures of depression, cognitive appraisals, and functioning at the 6-month follow-up. Intention-to-treat analyses at follow-up indicated a significant quadratic time×treatment condition interaction effect (B [SE], 0.49 [0.16] t120.16=3.08 [95% CI, 0.18-0.81] P=.003), indicating that CBT/exposure led to greater PGD reductions than CBT alone. At follow-up, CBT/exposure led to greater reductions in depression (B [SE], 0.35 [0.12] t112.65=2.83 [95% CI, 0.11-0.60] P=.005), negative appraisals (B [SE], 0.68 [0.25] t109.98=2.66 [95% CI, 0.17-1.18] P=.009), and functional impairment (B [SE], 0.24 [0.08] t111.40=3.01 [95% CI, 0.08-0.40] P=.003) than CBT alone. In terms of treatment completers, fewer patients in the CBT/exposure condition at follow-up (14.8%) met criteria for PGD than those in the CBT condition (37.9%) (odds ratio, 3.51 95% CI, 0.96-12.89 χ2=3.81 P=.04). Including exposure therapy that promotes emotional processing of memories of the death is an important component to achieve optimal reductions in PGD severity. Facilitating emotional responses to the death may promote greater changes in appraisals about the loss, which are associated with symptom reduction. Promotion of emotional processing techniques in therapies to treat patients with PGD is needed. anzctr.org.au Identifier: ACTRN12609000229279.

NICE guideline for depression ranks short‐term psychodynamic psychotherapy (STTP)

Publisher: Wiley

Date: 08-2022

DOI: 10.1111/BDI.13251

Compensation seeking and disability after injury: The role of compensation-related stress and mental health

Publisher: Physicians Postgraduate Press, Inc

Date: 26-08-2015

DOI: 10.4088/JCP.14M09211

Neural activity during response inhibition associated with improvement of dysphoric symptoms of PTSD after trauma-focused psychotherapy—an EEG-fMRI study

Publisher: Springer Science and Business Media LLC

Date: 14-04-2021

DOI: 10.1038/S41398-021-01340-8

Abstract: Although trauma-focused cognitive behavioural therapy (TF-CBT) is the frontline treatment for posttraumatic stress disorder (PTSD), up to one half of patients do not respond optimally to this treatment. Inhibitory functions are important for successful management of PTSD, yet there is a dearth of knowledge regarding the extent to which neural mechanisms unpinning response inhibition are associated with TF-CBT response. Treatment-seeking PTSD patients ( n = 40) were assessed during a response inhibition task (the Go/No-Go task) while undergoing functional magnetic imaging (fMRI) and event-related potentials (ERP) in separate sessions. PTSD symptom severity was assessed with the Clinician-Administered PTSD Scale, before undergoing nine sessions of TF-CBT. They were then reassessed post-treatment to estimate reduction in fear and dysphoric symptoms of PTSD. Although neural responses during the inhibitory task did not predict overall symptom change, reduced activation in the left precuneus and the right superior parietal cortex predicted greater improvement in dysphoric symptoms. ERP responses during response inhibition indicated that lower P3 peak latency predicted greater reduction of dysphoric symptoms. There were no significant predictors of changes of fear symptoms. These findings indicate that neural activity associated with response inhibition can act as a predictive biomarker of TF-CBT response for PTSD symptoms. This pattern of findings underscores the importance of delineating the role of biomarkers to predict remission of subtypes of PTSD.

Peritraumatic dissociation mediates the relationship between acute panic and chronic posttraumatic stress disorder

Publisher: Elsevier BV

Date: 05-2011

DOI: 10.1016/J.BRAT.2011.03.003

Abstract: Although peritraumatic dissociation predicts subsequent posttraumatic stress disorder (PTSD), little is understood about the mechanism of this relationship. This study examines the role of panic during trauma in the relationship between peritraumatic dissociation and subsequent PTSD. Randomized eligible admissions to 4 major trauma hospitals across Australia (n=244) were assessed during hospital admission and within one month of trauma exposure for panic, peritraumatic dissociation and PTSD symptoms, and subsequently re-assessed for PTSD three months after the initial assessment (n=208). Twenty (9.6%) patients met criteria for PTSD at 3-months post injury. Structural equation modeling supported the proposition that peritraumatic derealization (a subset of dissociation) mediated the effect of panic reactions during trauma and subsequent PTSD symptoms. The mediation model indicated that panic reactions are linked to severity of subsequent PTSD via derealization, indicating a significant indirect relationship. Whereas peritraumatic derealization is associated with chronic PTSD symptoms, this relationship is influenced by initial acute panic responses.

Corrigendum to “A mixed-method study of expert psychological evidence submitted for a cohort of asylum seekers undergoing refugee status determination in Australia” [Soc Sci Med 98 (2013) 106–115]

Publisher: Elsevier BV

Date: 08-2015

DOI: 10.1016/J.SOCSCIMED.2015.05.030

Integrating objective gene-brain-behavior markers of psychiatric disorders

Publisher: World Scientific Pub Co Pte Lt

Date: 03-2007

DOI: 10.1142/S0219635207001465

Abstract: There is little consensus about which objective markers should be used to assess major psychiatric disorders, and predict/evaluate treatment response for these disorders. Clinical practice relies instead on subjective signs and symptoms, such that there is a "translational gap" between research findings and clinical practice. This gap arises from: a) a lack of integrative theoretical models which provide a basis for understanding links between gene-brain-behavior mechanisms and clinical entities b) the reliance on studying one measure at a time so that linkages between markers are their specificity are not established and c) the lack of a definitive understanding of what constitutes normative function. Here, we draw on a standardized methodology for acquiring multiple sources of genomic, brain and behavioral data in the same subjects, to propose candidate markers of selected psychiatric disorders: depression, post-traumatic stress disorder, schizophrenia, attention-deficit/hyperactivity disorder and dementia disorders. This methodology has been used to establish a standardized international database which provides a comprehensive framework and the basis for testing hypotheses derived from an integrative theoretical model of the brain. Using this normative base, we present preliminary findings for a number of disorders in relation to the proposed markers. Establishing these objective markers will be the first step towards determining their sensitivity, specificity and treatment prediction in in idual patients.

The Longitudinal Association Between Posttraumatic Stress Disorder, Emotion Dysregulation, and Postmigration Stressors Among Refugees

Publisher: SAGE Publications

Date: 21-04-2023

DOI: 10.1177/21677026231164393

Abstract: Although emotion dysregulation has been robustly associated with posttraumatic stress disorder (PTSD), there is relatively little understanding of this process in refugees. Specifically, longitudinal methodology has not been used to examine the relationship between emotion dysregulation and PTSD among refugees. In this study, we investigated the temporal relationship between emotion dysregulation, postmigration stressors, and PTSD clusters (reexperiencing, avoidance, negative alterations in mood and cognition [NAMC], and hyperarousal) from the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders among a community s le of refugees ( N = 1,081) over a 2-year period. Random intercept cross-lagged panel analysis found that emotion dysregulation was antecedent to within-persons increases in reexperiencing and NAMC symptoms over time and bidirectionally associated with hyperarousal and postmigration stressors. In addition, postmigration stressors were antecedent to within-persons increases in reexperiencing, avoidance, and NAMC and bidirectionally associated with hyperarousal symptoms. Findings provide novel evidence in support of postmigration stressors and emotion dysregulation as mechanisms maintaining PTSD and highlight the potential utility of tailoring interventions to address these factors.

Effectiveness of a Videoconferencing-Delivered Psychological Intervention for Mental Health Problems during COVID-19: A Proof-of-Concept Randomized Clinical Trial

Publisher: S. Karger AG

Date: 07-12-2021

DOI: 10.1159/000520283

Abstract: b i Introduction: /i /b Anxiety and depression have increased markedly during the COVID-19 pandemic. There is a lack of evidence-based strategies to address these mental health needs during the pandemic. b i Objective: /i /b We aim to conduct a proof-of-concept trial of the efficacy of a brief group-based psychological intervention delivered via videoconferencing for adults in Australia distressed by the pandemic. b i Methods: /i /b In this single-blind, parallel, randomised controlled trial, adults who screened positive for COVID-related psychological distress across Australia were randomly allocated to either a 6-session group-based program based on behavioural principles ( i n /i = 120) or enhanced usual care (EUC, i n /i = 120). Primary outcome was total score on the Hospital Anxiety and Depression (HADS) anxiety and depression subscales assessed at baseline, 1 week posttreatment, 2 months (primary outcome time point), and 6 months after treatment, as well as secondary outcome measures of worry, sleep impairment, anhedonia, mood, and COVID-19-related stress. b i Results: /i /b Between May 20, 2020, and October 20, 2020, 240 patients were enrolled into the trial. Relative to EUC, at 2 months participants receiving intervention showed greater reduction on anxiety (mean difference, 1.4 [95% CI, 0.3 to 2.6], i /i = 0.01 effect size, 0.4 [95% CI, 0.1 to 0.7]) and depression (mean difference, 1.6 [95% CI, 0.4 to 2.8], p = 0.009 effect size, 0.4 [95% CI, 0.2 to 0.7]) scales. These effects were maintained at 6 months. There were also greater reductions of worry, anhedonia, COVID-19-related fears, and contamination fears. b i Conclusions: /i /b This trial provides initial evidence that brief group-based behavioural intervention delivered via videoconferencing results in moderate reductions in common psychological problems arising during the COVID-19 pandemic. This program may offer a viable and scalable means to mitigate the rising mental health problems during the pandemic.

Cognitive-Behavioural Treatment of Posttraumatic Stress Disorder Following Awareness under Anaesthesia: A Case Study

Publisher: Cambridge University Press (CUP)

Date: 20-10-2005

DOI: 10.1017/S1352465805002468

Abstract: The aim of the current paper is to describe the tailoring of cognitive-behavioural treatment for a female client who developed posttraumatic stress disorder (PTSD) subsequent to awareness under anaesthetic during an emergency caesarean procedure. Treatment consisted of prolonged and in vivo exposure, and cognitive restructuring over eight sessions. Assessment was conducted prior to treatment, immediately after treatment, and at 6- and 24-month follow-up. Follow-up at 24 months demonstrated good outcome, with the client no longer meeting criteria for PTSD.

Greater sleep disturbance and longer sleep onset latency facilitate SCR-specific fear reinstatement in PTSD

Publisher: Elsevier BV

Date: 11-2018

DOI: 10.1016/J.BRAT.2018.08.005

Abstract: Fear reinstatement is one of several paradigms designed to measure fear return following extinction, as a laboratory model for the relapse of Posttraumatic Stress Disorder (PTSD) symptoms. Sleep is a key factor in emotional memory consolidation, and here we examined the relationship between sleep quality and fear reinstatement in PTSD, relative to trauma-exposed and non-exposed controls. The Pittsburgh Sleep Quality Index (PSQI) was used as a subjective measure of sleep quality, and skin conductance responses (SCR) and unconditioned stimulus (US)-expectancy ratings were used to index threat responses during a differential fear conditioning, extinction, and reinstatement paradigm. There were no significant between-group differences in the reinstatement of conditioned responding. Sleep disturbance and sleep onset latency were significant moderators between reinstatement of fear and PTSD symptom severity, such that there was a positive relationship between PTSD symptoms and fear reinstatement for higher levels - but not lower levels - of sleep disturbance and sleep onset latency. To our knowledge, this is the first study to investigate PTSD-specific reinstatement patterns and sleep as a boundary condition of reinstatement. Future research using polysomnographic measures of sleep-wave architecture may further clarify the relationship between fear reinstatement and sleep quality in clinical s les with PTSD relative to controls.

Peritraumatic and persistent panic attacks in acute stress disorder

Publisher: Elsevier BV

Date: 10-2003

DOI: 10.1016/S0005-7967(03)00150-5

Abstract: This study examined the prevalence of peritraumatic and persistent panic symptoms following trauma. Survivors of civilian trauma (n=30) with either acute stress disorder (ASD) or no acute stress disorder (non-ASD) were administered the Panic Module of the Structured Clinical Interview for DSM-IV (SCID). Participants also completed the Impact of Event Scale, Acute Stress Disorder Scale, Beck Depression Inventory, Beck Anxiety Inventory, and the Anxiety Sensitivity Index. Panic attacks were experienced by 77% of participants during their trauma, and 47% reported recurrent panic attacks post-trauma. ASD participants demonstrated more panic symptoms during and after their trauma than non-ASD participants. Posttraumatic panic was most strongly associated with anxiety sensitivity. These findings are discussed in terms of cognitive factors that may mediate posttrauma panic and treatment implications for managing posttraumatic anxiety. There is increasing evidence that panic attacks play a role in psychopathological response to trauma. A significant proportion of people with panic disorder report a history of trauma (). Moreover, two-thirds of trauma survivors report panic attacks within the previous 2 weeks (). There is also evidence that people with posttraumatic stress disorder (PTSD) display elevated levels of anxiety sensitivity (). Recent attention has focused on acute panic reactions because of proposals that panic during trauma may condition trauma-related cues to subsequent panic (). There is evidence that panic attacks occur in 53-90% of trauma survivors during the traumatic experience (). Further, people with acute stress disorder (ASD) are more likely to report peritraumatic panic attacks than non-ASD in iduals. ASD is a useful framework in which to investigate the role of panic in posttraumatic stress because ASD describes acute responses to trauma that are strongly predictive of chronic PTSD (). This study investigated the relationship between peritraumatic panic and ongoing panic attacks following trauma. Specifically, we indexed panic attacks during trauma and subsequent to trauma in trauma survivors with and without ASD. We also indexed the extent to which distorted interpretations about somatic sensations may be associated with panic attacks following trauma. We considered that the strong evidence that maladaptive appraisals of somatic sensations mediate panic () is directly relevant to posttraumatic panic. We hypothesized that ASD participants would report more peritraumatic and persistent panic than non-ASD participants, and that this panic would be associated with dysfunctional interpretations about somatic stimuli.

Do Distress Responses to a Traumatic Film Predict Susceptibility to the Misinformation Effect?

Publisher: Informa UK Limited

Date: 10-2013

DOI: 10.1080/15299732.2013.804475

Abstract: The misinformation effect is defined as an impairment in memory for past events due to exposure to misleading information (E. F. Loftus, 2005 ). Some people may be more susceptible to the misinformation effect than others, and this may also depend on their response to a distressing event. The purpose of the current study was to investigate several key factors that may contribute to misinformation susceptibility for distressing events, namely posttraumatic stress disorder symptoms such as avoidance, intrusions, and dissociation. Participants watched either a neutral or trauma film, rated their level of distress, and completed measures of trait and state dissociation. When participants returned a week later, misinformation was introduced via an eyewitness statement and free recall was assessed. Findings indicated that dissociation was related to higher distress ratings following the film but was not related to acceptance of misinformation. However, avoidance scores were related to increased recall of misinformation items, and reported experiences of intrusions were related to greater accuracy. These results are discussed in light of the paradoxical negative emotion hypothesis.

An investigation of potential neural correlates of intrusive retrieval of distressing memories

Publisher: Elsevier BV

Date: 03-2018

DOI: 10.1016/J.JBTEP.2017.08.004

Abstract: Despite the prevalence of intrusive memories across psychological disorders, little is known about the neural networks that underpin this form of memory. This study used functional magnetic resonance imaging (fMRI) to identify neural circuits associated with the retrieval of intrusive memories. Participants with moderate levels of anxiety (N = 30) underwent a cold pressor task to induce a physiological stress response, after which they viewed 10 neutral and 10 negative film clips. In a method designed to induce intrusive memories, participants then completed an fMRI scan in which they viewed short (2 s) depictions of neutral components from the original film clips. There were no significant differences in activations during intrusion and non-intrusion responses. Exploratory analyses comparing intrusive responses to neutral stimuli found the insula, inferior frontal gyrus, precuneus, right cerebellum and bilateral supplementary motor area were uniquely activated during experience of intrusions (compared to the neutral cue baseline), whereas no significant activations were in response to negative scenes that did not trigger intrusions. This study did not compare the different neural processes implicated in intrusive and intentional emotional memories. The limited intrusions that could be elicited in the scanning environment restricted the number of trials that could be employed. Although no differences in neural activations were observed between intrusive and non-intrusive responses, the observation of precuneus involvement is consistent with models that propose that intrusive memories are impacted by the extent to which there is contextual integration of the relevant memories.

The latent structure of the Peritraumatic Dissociative Experiences Questionnaire

Publisher: Wiley

Date: 02-2009

DOI: 10.1002/JTS.20388

Abstract: The Peritraumatic Dissociative Experiences Questionnaire (PDEQ) is a widely used measure of peritraumatic dissociation, and is presumably a unidimensional construct. Two hundred forty-seven in iduals admitted to five hospitals after traumatic injury were administered the Clinician Administered PTSD Scale, the Hospital Anxiety and Depression Scale, and the PDEQ. Factor analysis indicated that the PDEQ involved two factors containing four items each: one factor (altered awareness) indexes alterations in awareness and the other (derealization) reflects distortions in perceptions of the self and the world. Only the derealization factor was associated with acute stress, anxiety, and depression symptoms. Cross-validation with independent data provided only partial support for the 2-factor structure model. These data indicate that peritraumatic dissociation may involve two distinct constructs.

Association of Torture and Other Potentially Traumatic Events With Mental Health Outcomes Among Populations Exposed to Mass Conflict and Displacement

Publisher: American Medical Association (AMA)

Date: 05-08-2009

DOI: 10.1001/JAMA.2009.1132

Abstract: Uncertainties continue about the roles that methodological factors and key risk factors, particularly torture and other potentially traumatic events (PTEs), play in the variation of reported prevalence rates of posttraumatic stress disorder (PTSD) and depression across epidemiologic surveys among postconflict populations worldwide. To undertake a systematic review and meta-regression of the prevalence rates of PTSD and depression in the refugee and postconflict mental health field. An initial pool of 5904 articles, identified through MEDLINE, PsycINFO and PILOTS, of surveys involving refugee, conflict-affected populations, or both, published in English-language journals between 1980 and May 2009. Surveys were limited to those of adult populations (n > or = 50) reporting PTSD prevalence, depression prevalence, or both. Excluded surveys comprised patients, war veterans, and civilian populations (nonrefugees/asylum seekers) from high-income countries exposed to terrorist attacks or involved in distal conflicts (> or = 25 years). Methodological factors (response rate, s le size and design, diagnostic method) and substantive factors (sociodemographics, place of survey, torture and other PTEs, Political Terror Scale score, residency status, time since conflict). A total of 161 articles reporting results of 181 surveys comprising 81,866 refugees and other conflict-affected persons from 40 countries were identified. Rates of reported PTSD and depression showed large intersurvey variability (0%-99% and 3%-85.5%, respectively). The unadjusted weighted prevalence rate reported across all surveys for PTSD was 30.6% (95% CI, 26.3%-35.2%) and for depression was 30.8% (95% CI, 26.3%-35.6%). Methodological factors accounted for 12.9% and 27.7% PTSD and depression, respectively. Nonrandom s ling, small s le sizes, and self-report questionnaires were associated with higher rates of mental disorder. Adjusting for methodological factors, reported torture (Delta total R(2) between base methodological model and base model + substantive factor [DeltaR(2)] = 23.6% OR, 2.01 95% CI, 1.52-2.65) emerged as the strongest factor associated with PTSD, followed by cumulative exposure to PTEs (DeltaR(2) = 10.8% OR, 1.52 95% CI, 1.21-1.91), time since conflict (DeltaR(2) = 10% OR, 0.77 95% CI, 0.66-0.91), and assessed level of political terror (DeltaR(2) = 3.5% OR, 1.60 95% CI, 1.03-2.50). For depression, significant factors were number of PTEs (DeltaR(2) = 22.0% OR, 1.64 95% CI, 1.39-1.93), time since conflict (DeltaR(2) = 21.9% OR, 0.80 95% CI, 0.69-0.93), reported torture (DeltaR(2) = 11.4% OR, 1.48 95% CI, 1.07-2.04), and residency status (DeltaR(2) = 5.0% OR, 1.30 95% CI, 1.07-1.57). Methodological factors and substantive population risk factors, such as exposure to torture and other PTEs, after adjusting for methodological factors account for higher rates of reported prevalence of PTSD and depression.

Posttraumatic disorders following injury: an empirical and methodological review

Publisher: Elsevier BV

Date: 07-2003

DOI: 10.1016/S0272-7358(03)00036-9

Abstract: Although there has been a marked increase in research on psychological disorders following physical injury in recent years, there are many discrepancies between the reported findings. This paper reviews the prevalence outcomes of recent studies of the mental health sequelae of physical injury with a focus on posttraumatic stress disorder (PTSD), acute stress disorder (ASD), and depression. The review critically outlines some of the methodological factors that may have contributed to these discrepancies. The phenomenological overlap between organic and psychogenic symptoms, the use of narcotic analgesia, the role of brain injury, the timing and content of assessments, and litigation are discussed in terms of their potential to confound findings with this population. Recommendations are proposed to clarify methodological approaches in this area. It is suggested that a clearer understanding of the psychological effects of physical injury will require the widespread adoption of more rigorous, standardized and transparent methodological procedures.

Psychological First Aid Following Trauma: Implementation and Evaluation Framework for High-Risk Organizations

Publisher: Guilford Publications

Date: 09-2011

DOI: 10.1521/PSYC.2011.74.3.224

Abstract: International clinical practice guidelines for the management of psychological trauma recommend Psychological First Aid (PFA) as an early intervention for survivors of potentially traumatic events. These recommendations are consensus-based, and there is little published evidence assessing the effectiveness of PFA. This is not surprising given the nature of the intervention and the complicating factors involved in any evaluation of PFA. There is, nevertheless, an urgent need for stronger evidence evaluating its effectiveness. The current paper posits that the implementation and evaluation of PFA within high risk organizational settings is an ideal place to start. The paper provides a framework for a phasic approach to implementing PFA within such settings and presents a model for evaluating its effectiveness using a logic- or theory-based approach which considers both pre-event and post-event factors. Phases 1 and 2 of the PFA model are pre-event actions, and phases 3 and 4 are post-event actions. It is hoped that by using the Phased PFA model and evaluation method proposed in this paper, future researchers will begin to undertake the important task of building the evidence about the most effective approach to providing PFA in high risk organizational and community disaster settings.

The Brain-Derived Neurotrophic Factor Val66Met Polymorphism Predicts Response to Exposure Therapy in Posttraumatic Stress Disorder

Publisher: Elsevier BV

Date: 06-2013

DOI: 10.1016/J.BIOPSYCH.2012.10.033

Mild traumatic brain injury does not predict acute postconcussion syndrome

Publisher: BMJ

Date: 03-2008

DOI: 10.1136/JNNP.2007.126565

Abstract: The aetiology of postconcussion syndrome (PCS) following mild traumatic brain injury (mTBI) remains controversial. Identifying acute PCS (within the first 14 days after injury) may optimise initial recovery and rehabilitation, identify those at risk and increase understanding of PCS. To examine predictors of acute outcome by investigating the relationship between preinjury psychiatric disorder, demographic factors, injury related characteristics, neuropsychological and psychological variables and acute PCS. Prospective study of consecutive trauma admissions to a level 1 trauma hospital. The final s le comprised 90 patients with mTBI and 85 non-brain injured trauma controls. In iduals were administered a PCS checklist, and neuropsychological and psychological measures. Multiple imputation of missing data in multivariable logistic regression and bivariate logistic regressions were used to predict acute PCS at a mean of 4.90 days after injury. Diagnosis of acute PCS was not specific to mTBI (mTBI 43.3% controls 43.5%). Pain was associated with acute PCS in mTBI. The strongest effect for acute PCS was a previous affective or anxiety disorder (OR 5.76, 95% CI 2.19 to 15.0). Females were 3.33 times more likely than males to have acute PCS (95% CI 1.20 to 9.21). The effect of acute post-traumatic stress and neuropsychological function on acute PCS was relatively small. Higher IQ was associated with acute PCS. There is a high rate of acute PCS in both mTBI and non-brain injured trauma patients. PCS was not found to be specific to mTBI. The use of the term PCS may be misleading as it incorrectly suggests that the basis of PCS is a brain injury.

Amygdala-prefrontal dissociation of subliminal and supraliminal fear.

Publisher: Wiley

Date: 09-11-2006

DOI: 10.1002/HBM.20208

Attentional bias in complicated grief

Publisher: Elsevier BV

Date: 09-2010

DOI: 10.1016/J.JAD.2010.01.070

Abstract: Complicated Grief (CG) is a debilitating potential consequence of bereavement. Despite the significant health costs associated with CG, relatively little is known about the cognitive processes associated with the condition. This study investigated information processing in CG. Twenty four in iduals with CG and 25 bereaved in iduals without CG completed a modified emotional Stroop task in which they were presented with death-related and neutral cue words. Half of the participants were also given instructions to suppress thoughts of their loved one's death while completing the task. CG participants were slower to color name death-related words than No-CG participants, and were slower to color name death-related words than neutral words. This pattern of findings suggests an attentional bias towards loss-related events. This study represents the first demonstration of an information bias within CG. Consistent with cognitive models of CG, it is possible that dysphoric mood and preoccupation with the loss are maintained by selectively attending to reminders of the loss.

THE TEMPORAL RELATIONSHIP BETWEEN MENTAL HEALTH AND DISABILITY AFTER INJURY

Publisher: Hindawi Limited

Date: 03-07-2014

DOI: 10.1002/DA.22288

Abstract: This longitudinal study investigated the temporal relationship patterns between disability and mental health after injury, with a focus on posttraumatic stress disorder (PTSD), depression, and anxiety. We conducted a multi-sited longitudinal cohort study with a large s le of hospital patients admitted after injury (N = 1,149, mean age = 37.9, 73.6% male). Data were collected prior to discharge from hospital, and follow-up assessments took place 3 and 12 months postinjury. A cross-lagged structural equation model (SEM) was used to assess the prospective relationship between posttraumatic stress, anxiety, and depression symptoms and disability while controlling for demographic characteristics and objective measures of injury severity. Acute depression significantly predicted 3-month disability, and 3-month PTSD severity significantly predicted 12-month disability. Premorbid disability had a significant effect on acute anxiety, depression, and posttraumatic stress symptoms, and 3-month depression but disability after the injury did not predict 12-month psychopathology. We did not find a reciprocal relationship between disability and psychopathology. Rather we found that depression played a role in early disability while PTSD played a role in contributing to long-term delays in the recovery process. The results of this study highlight the need for mental health screening for symptoms of PTSD and depression in the acute aftermath of trauma, combined with early intervention programs in injury populations.

Trauma modulates amygdala and medial prefrontal responses to consciously attended fear

Publisher: Elsevier BV

Date: 2006

DOI: 10.1016/J.NEUROIMAGE.2005.03.047

Abstract: Effective fear processing relies on the amygdala and medial prefrontal cortex (MPFC). Post-trauma reactions provide a compelling model for examining how the heightened experience of fear impacts these systems. Post-traumatic stress disorder (PTSD) has been associated with excessive amygdala and a lack of MPFC activity in response to nonconscious facial signals of fear, but responses to consciously processed facial fear stimuli have not been examined. We used functional MRI to elucidate the effect of trauma reactions on amygdala-MPFC function during an overt fear perception task. Subjects with PTSD (n = 13) and matched non-traumatized healthy subjects (n = 13) viewed 15 blocks of eight fearful face stimuli alternating pseudorandomly with 15 blocks of neutral faces (stimulus duration 500 ms ISI 767 ms). We used random effects analyses in SPM2 to examine within- and between-group differences in the MPFC and amygdala search regions of interest. Time series data were used to examine amygdala-MPFC associations and changes across the first (Early) versus second (Late) phases of the experiment. Relative to non-traumatized subjects, PTSD subjects showed a marked bilateral reduction in MPFC activity (in particular, right anterior cingulate cortex, ACC), which showed a different Early-Late pattern to non-traumatized subjects and was more pronounced with greater trauma impact and symptomatology. PTSD subjects also showed a small but significant enhancement in left amygdala activity, most apparent during the Late phase, but reduction in Early right amygdala response. Over the time course, trauma was related to a distinct pattern of ACC and amygdala connections. The findings suggest that major life trauma may disrupt the normal pattern of medial prefrontal and amygdala regulation.

Requiring both avoidance and emotional numbing in DSM-V PTSD: Will it help?

Publisher: Elsevier BV

Date: 05-2011

DOI: 10.1016/J.JAD.2010.10.032

Abstract: The proposed DSM-V criteria for posttraumatic stress disorder (PTSD) specifically require both active avoidance and emotional numbing symptoms for a diagnosis. In DSM-IV, since both are included in the same cluster, active avoidance is not essential. Numbing symptoms overlap with depression, which may result in spurious comorbidity or overdiagnosis of PTSD. This paper investigated the impact of requiring both active avoidance and emotional numbing on the rates of PTSD diagnosis and comorbidity with depression. We investigated PTSD and depression in 835 traumatic injury survivors at 3 and 12 months post-injury. We used the DSM-IV criteria but explored the potential impact of DSM-IV and DSM-V approaches to avoidance and numbing using comparison of proportion analyses. The DSM-V requirement of both active avoidance and emotional numbing resulted in significant reductions in PTSD caseness compared with DSM-IV of 22% and 26% respectively at 3 and 12 months posttrauma. By 12 months, the rates of comorbid PTSD in those with depression were significantly lower (44% vs. 34%) using the new criteria, primarily due to the lack of avoidance symptoms. These preliminary data suggest that requiring both active avoidance and numbing as separate clusters offers a useful refinement of the PTSD diagnosis. Requiring active avoidance may help to define the unique aspects of PTSD and reduce spurious diagnoses of PTSD in those with depression.

The latent structure of the Peritraumatic Dissociative Experiences Questionnaire

Publisher: Wiley

Date: 04-2009

DOI: 10.1002/JTS.20414

Abstract: This paper has been retracted due to a publisher's error: the order of the authors was incorrect. The Editor and Publisher of the Journal of Traumatic Stress apologize to the authors and our readership. The Peritraumatic Dissociative Experiences Questionnaire (PDEQ) is a widely used measure of peritraumatic dissociation, and is presumably a unidimensional construct. Two hundred forty-seven in iduals admitted to five hospitals after traumatic injury were administered the Clinician Administered PTSD Scale, the Hospital Anxiety and Depression Scale, and the PDEQ. Factor analysis indicated that the PDEQ involved two factors containing four items each: one factor (altered awareness) indexes alterations in awareness and the other (derealization) reflects distortions in perceptions of the self and the world. Only the derealization factor was associated with acute stress, anxiety, and depression symptoms. Cross-validation with independent data provided only partial support for the 2-factor structure model. These data indicate that peritraumatic dissociation may involve two distinct constructs.

Distinct amygdala-autonomic arousal profiles in response to fear signals in healthy males and females.

Publisher: Elsevier BV

Date: 11-2005

DOI: 10.1016/J.NEUROIMAGE.2005.06.035

Abstract: The amygdala has a key role in regulating arousal and vigilance, and responds to both visual and vocal signals of fear, including facial expressions of fear. In this study, we used functional MRI to examine sex differences in the magnitude, extent, lateralization and time course of amygdala responses to facial signals of fear, in a relatively large s le of males and females. Skin conductance was recorded simultaneously with functional imaging to examine concomitant changes in emotional arousal, and to provide an independent index of response attenuation. Scanning and skin conductance recording was undertaken during perception of facial fear stimuli. Sex differences were apparent in the laterality and time course of fear perception. In males, the right amygdala and autonomic arousal attenuated over the late half of the experiment. By contrast, females showed persistent bilateral amygdala responses, with a tendency towards greater left amygdala engagement during the late phase. Females also showed a greater general extent of amygdala response. We suggest that distinct evolutionary pressures might contribute to a lower threshold for vigilance to signals of danger in females, reflected in a profile of sustained amygdala-arousal interaction.

A Network Approach to Understanding Quality of Life Impairments in Prolonged Grief Disorder

Publisher: Wiley

Date: 08-04-2019

DOI: 10.1002/JTS.22383

Abstract: Prolonged grief (PGD) is a potentially debilitating consequence of bereavement that is experienced by 7%-10% of bereaved in iduals. In recent years, PGD has been the focus of increasing interest as it is associated with a range of significant negative physical and mental health outcomes. To date, however, there is little understanding of how impairment is associated with in idual PGD symptom interactions. Network analysis is an innovative statistical approach that has been productively applied to examine how symptoms of psychopathology influence and reinforce each other. In this study, we examined the association between PGD symptoms and quality of life (QoL) impairments. Data from 215 bereaved in iduals were used to construct networks comprising PGD symptoms and different facets of QoL. The results showed that PGD symptoms of meaninglessness and role confusion were linked with reduced psychological QoL, trust difficulties were linked with reduced social QoL, and bitterness was linked with reduced environmental QoL. These results are consistent with models that highlight the importance of self-identity and loss of meaning in PGD. By elucidating pathways of dysfunction, these findings offer clinical implications that may help to improve outcomes for persons with PGD.

Effectiveness of a brief group behavioural intervention on psychological distress in young adolescent Syrian refugees: A randomised controlled trial

Publisher: Public Library of Science (PLoS)

Date: 12-08-2022

DOI: 10.1371/JOURNAL.PMED.1004046

Abstract: Millions of young adolescents in low- and middle-income countries (LMICs) affected by humanitarian crises experience elevated rates of poor mental health. There is a need for scalable programs that can improve the mental health of young adolescents. This study evaluated the effectiveness of a nonspecialist delivered group-based intervention (Early Adolescent Skills for Emotions (EASE)) to improve young adolescents’ mental health. In this single-blind, parallel, controlled trial, Syrian refugees aged 10 to 14 years in Jordan were identified through screening of psychological distress as defined by scores ≥15 on the Paediatric Symptom Scale. Participants were randomised to either EASE or enhanced usual care (EUC) involving referral to local psychosocial services (on a 1:1.6 ratio). Participants were aware of treatment allocation but assessors were blinded. Primary outcomes were scores on the Paediatric Symptom Checklist (PSC internalising, externalising, and attentional difficulty scales) assessed at week 0, 9 weeks, and 3 months after treatment (primary outcome time point). It was hypothesised that EASE would result in greater reductions on internalising symptoms than EUC. Secondary outcomes were depression, posttraumatic stress, well-being, functioning, school belongingness, and caregivers’ parenting and mental health. Between June 2019 and January 2020, 1,842 young adolescent refugees were screened for eligibility on the basis of psychological distress. There were 520 adolescents (28.2%) who screened positive, of whom 471 (90.6%) agreed to enter the trial. Overall, 185 were assigned to EASE and 286 to EUC, and 169 and 254 were retained at 3 months for EASE and EUC, respectively. Intent-to-treat analyses indicated that at 3 months, EASE resulted in greater reduction on the PSC-internalising scale than EUC (estimated mean difference 0.69, 95% CI 0.19 to 1.19 p = 0.007 effect size, 0.38) but there were no differences for PSC-externalising (estimated mean difference 0.24, 95% CI −0.43 to 0.91 p = 0.49 effect size, −0.10), PSC-attentional problem (estimated mean difference −0.01, 95% CI −0.51 to 0.54 p = 0.97 effect size, −0.01) scores, or on depression, posttraumatic stress, well-being, functioning, or school belongingness. Relative to EUC, caregivers in EASE had less psychological distress (estimated mean difference 1.95, 95% CI 0.71 to 3.19 p = 0.002) and inconsistent disciplinary parenting (mean difference 1.54, 95% CI 1.03 to 2.05 p 0.001). Secondary analyses that (a) focused on adolescents with probable internalising disorders (b) completed the 3-month assessment and (c) controlled for trauma exposure did not alter the primary results. Mediation analysis indicated that for caregivers in the EASE condition, reduction in inconsistent disciplinary parenting was associated with reduced attentional (β = 0.11, SE 0.07 95% CI 0.003, 0.274) and internalising (β = 0.11, SE 0.07 95% CI 0.003, 0.274) problems in their children. No adverse events were attributable to the intervention. A limitation was that EUC was not matched to EASE in terms of facilitator attention or group involvement. EASE led to reduced internalising problems in young refugee adolescents and was associated with reduced distress and less inconsistent disciplinary parenting in caregivers. This intervention has the potential as a scalable intervention to mitigate young adolescents’ emotional difficulties in LMIC. Prospectively registered at Australian and New Zealand Clinical Trials Registry: ACTRN12619000341123 .

Resilience@Work Mindfulness Program: Results From a Cluster Randomized Controlled Trial With First Responders (Preprint)

Publisher: JMIR Publications Inc.

Date: 27-11-2018

DOI: 10.2196/PREPRINTS.12894

Abstract: growing body of research suggests that resilience training can play a pivotal role in creating mentally healthy workplaces, particularly with regard to protecting the long-term well-being of workers. Emerging research describes positive outcomes from various types of resilience training programs (RTPs) among different occupational groups. One specific group of workers that may benefit from this form of proactive resilience training is first responders. Given the nature of their work, first responders are frequently exposed to stressful circumstances and potentially traumatic events, which may impact their overall resilience and well-being over time. his study aimed to examine whether a mindfulness-based RTP (the Resilience@Work [RAW] Mindfulness Program) delivered via the internet can effectively enhance resilience among a group of high-risk workers. e conducted a cluster randomized controlled trial (RCT) comprising 24 Primary Fire and Rescue and Hazmat stations within New South Wales. Overall, 12 stations were assigned to the 6-session RAW Mindfulness Program and 12 stations were assigned to the control condition. A total of 143 active full-time firefighters enrolled in the study. Questionnaires were administered at baseline, immediately post training, and at 6-month follow-up. Measurements examined change in both adaptive and bounce-back resilience as well as several secondary outcomes examining resilience resources and acceptance and mindfulness skills. ixed-model repeated measures analysis found that the overall test of group-by-time interaction was significant (P=.008), with the intervention group increasing in adaptive resilience over time. However, no significant differences were found between the intervention group and the control group in terms of change in bounce-back resilience (P=.09). At 6-month follow-up, the group receiving the RAW intervention had an average increase in their resilience score of 1.3, equating to a moderate-to-large effect size compared with the control group of 0.73 (95% CI 0.38-1.06). Per-protocol analysis found that compared with the control group, the greatest improvements in adaptive resilience were observed among those who completed most of the RAW program, that is, 5 to 6 sessions (P=.002). he results of this RCT suggest that mindfulness-based resilience training delivered in an internet format can create improvements in adaptive resilience and related resources among high-risk workers, such as first responders. Despite a number of limitations, the results of this study suggest that the RAW Mindfulness Program is an effective, scalable, and practical means of delivering online resilience training in high-risk workplace settings. To the best of our knowledge, this is the first time a mindfulness-based RTP delivered entirely via the internet has been tested in the workplace. ustralian New Zealand Clinical Trials Registry ACTRN12615000574549 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368296 (Archived by WebCite at 5w4xtrpw).

A Comparison of the Capacity of <em>DSM-IV]</em> and <em>DSM-5]</em> Acute Stress Disorder Definitions to Predict Posttraumatic Stress Disorder and Related Disorders

Publisher: Physicians Postgraduate Press, Inc

Date: 11-11-2014

DOI: 10.4088/JCP.13M08731

Mindfulness-Based Resilience Training in the Workplace: Pilot Study of the Internet-Based Resilience@Work (RAW) Mindfulness Program

Publisher: JMIR Publications Inc.

Date: 11-09-2018

DOI: 10.2196/10326

Hypnotherapy and cognitive behaviour therapy of acute stress disorder: A 3-year follow-up

Publisher: Elsevier BV

Date: 09-2006

DOI: 10.1016/J.BRAT.2005.04.007

Abstract: The long-term benefits of cognitive behaviour therapy (CBT) for trauma survivors with acute stress disorder were investigated by assessing patients 3 years after treatment. Civilian trauma survivors (n=87) were randomly allocated to six sessions of CBT, CBT combined with hypnosis, or supportive counselling (SC), 69 completed treatment, and 53 were assessed 2 years post-treatment for post-traumatic stress disorder (PTSD) with the Clinician-Administered PTSD Scale. In terms of treatment completers, 2 CBT patients (10%), 4 CBT/hypnosis patients (22%), and 10 SC patients (63%) met PTSD criteria at 2-years follow-up. Intent-to-treat analyses indicated that 12 CBT patients (36%), 14 CBT/hypnosis patients (46%), and 16 SC patients (67%) met PTSD criteria at 2-year follow-up. Patients who received CBT and CBT/hypnosis reported less re-experiencing and less avoidance symptoms than patients who received SC. These findings point to the long-term benefits of early provision of CBT in the initial month after trauma.

Trauma and posttraumatic stress disorder modulate polygenic predictors of hippocampal and amygdala volume

Publisher: Springer Science and Business Media LLC

Date: 16-12-2021

DOI: 10.1038/S41398-021-01707-X

Abstract: The volume of subcortical structures represents a reliable, quantitative, and objective phenotype that captures genetic effects, environmental effects such as trauma, and disease effects such as posttraumatic stress disorder (PTSD). Trauma and PTSD represent potent exposures that may interact with genetic markers to influence brain structure and function. Genetic variants, associated with subcortical volumes in two large normative discovery s les, were used to compute polygenic scores (PGS) for the volume of seven subcortical structures. These were applied to a target s le enriched for childhood trauma and PTSD. Subcortical volume PGS from the discovery s le were strongly associated in our trauma/PTSD enriched s le ( n = 7580) with respective subcortical volumes of the hippoc us ( p = 1.10 × 10 −20 ), thalamus ( p = 7.46 × 10 −10 ), caudate ( p = 1.97 × 10 −18 ), putamen ( p = 1.7 × 10 −12 ), and nucleus accumbens ( p = 1.99 × 10 −7 ). We found a significant association between the hippoc al volume PGS and hippoc al volume in control subjects from our s le, but was absent in in iduals with PTSD (GxE (beta = −0.10, p = 0.027)). This significant GxE (PGS × PTSD) relationship persisted ( p 1 × 10 −19 ) in four out of five threshold peaks (0.024, 0.133, 0.487, 0.730, and 0.889) used to calculate hippoc al volume PGSs. We detected similar GxE (G × ChildTrauma) relationships in the amygdala for exposure to childhood trauma (rs4702973 p = 2.16 × 10 −7 ) or PTSD (rs10861272 p = 1.78 × 10 −6 ) in the CHST11 gene. The hippoc us and amygdala are pivotal brain structures in mediating PTSD symptomatology. Trauma exposure and PTSD modulate the effect of polygenic markers on hippoc al volume (GxE) and the amygdala volume PGS is associated with PTSD risk, which supports the role of amygdala volume as a risk factor for PTSD.

Comorbidity in the prediction of Cognitive Processing Therapy treatment outcomes for combat-related posttraumatic stress disorder

Publisher: Elsevier BV

Date: 03-2014

DOI: 10.1016/J.JANXDIS.2013.12.002

Abstract: This paper examines clinical predictors of posttraumatic stress disorder (PTSD) treatment outcomes following Cognitive Processing Therapy (CPT) in Australian military veterans. Fifty nine treatment seeking veterans were enrolled in a randomized controlled trial comparing 12 sessions of CPT (n = 30) with usual treatment (n = 29) at three community-based veterans counseling centers. PTSD and key co-morbidities (depression, anxiety, anger and alcohol use) were measured. Growth curve modeling was used to examine factors which influenced PTSD severity post-treatment. For the CPT condition, baseline anger was the only co-morbidity predictive of change in PTSD severity over time. Participants with higher anger scores showed less of a decrease in PTSD severity over time. Higher anxiety in participants in treatment as usual was significantly associated with better treatment gains. This research suggests that veterans experiencing high levels of anger might benefit from targeted anger reduction strategies to increase the effectiveness of CPT treatment for PTSD.

The impact of 5-HTTLPR on acute serotonin transporter blockade by escitalopram on emotion processing: Preliminary findings from a randomised, crossover fMRI study

Publisher: SAGE Publications

Date: 08-05-2014

DOI: 10.1177/0004867414533837

Abstract: Benefit from antidepressant treatment such as selective serotonin reuptake inhibitors (SSRIs) may depend on in idual differences in acute effects on neural emotion processing. The short (‘S’) allele of the serotonin transporter (5-HTT)-linked polymorphic region (5-HTTLPR) is associated with both negative emotion processing biases and poorer treatment outcomes. Therefore, the aim of the present study was to explore the effects of 5-HTTLPR on the impact of the SSRI escitalopram during processing of positive and negative emotional images, as well as neutral stimuli. The study employed a double-blind, randomised, placebo-controlled crossover design on 36 healthy Caucasian female participants who underwent functional magnetic resonance imaging (fMRI) scanning following placebo or escitalopram treatment, separated by a 7-day washout period. Changes in the left amygdala signal with escitalopram treatment during processing of emotional stimuli were linearly related to the 5-HTTLPR ‘S’ allele load such that the signal to positive stimuli decreased and the signal to negative stimuli increased with an increasing number of low-expressing ‘S’ alleles. While 5-HTTLPR subgroups were small in size, in idual subject changes with treatment and task condition increase confidence in the findings. While preliminary, our findings comprise the first pharmacogenetic study demonstrating an effect of the 5-HTTLPR ‘S’ allele load on escitalopram-induced changes in amygdala activity during emotional processing, consistent with a 5-HTT expression dosage model. The present findings have implications for the impact of this polymorphism on antidepressant efficacy in patients with mood and anxiety disorders.

COVID-19 restrictions and age-specific mental health—U.S. probability-based panel evidence

Publisher: Springer Science and Business Media LLC

Date: 04-08-2021

DOI: 10.1038/S41398-021-01537-X

Abstract: Social distancing, self-isolation, quarantining, and lockdowns arising from the COVID-19 pandemic have been common restrictions as governments have attempted to limit the rapid virus transmission. In this study, we identified drivers of adverse mental and behavioral health during the COVID-19 pandemic and whether factors such as social isolation and various restrictions serve as additional stressors for different age groups. Univariate and multivariate regression analyses were conducted on a unique dataset based on a national probability-based survey dedicated to understanding the impact of COVID-19 in the U.S., which includes 19 questions on the in idual impact of restrictions, bans, and closures. The analysis used a moderate distress scale built on five questions related to mental health for 3,646 respondents. The mental health of young adults (18−34 years old) was the most affected by restrictions, while that of older adults ( years old) was less affected. In addition, demographic and health characteristics associated with differences in mental health varied by age group. The findings in this analysis highlight the differential mental health needs of different age groups and point to the marked necessity for differentiated and targeted responses to the mental health effects of COVID-19 by age group.

Emotional Reactivity, Emotion Regulation Capacity, and Posttraumatic Stress Disorder in Traumatized Refugees: An Experimental Investigation

Publisher: Wiley

Date: 02-2019

DOI: 10.1002/JTS.22371

Abstract: Refugees who suffer from posttraumatic stress disorder (PTSD) often react with strong emotions when confronted with trauma reminders. In this study, we aimed to investigate the associations between low emotion regulation capacity (as indexed by low heart rate variability [HRV]), probable PTSD diagnosis, and fear and anger reaction and recovery to trauma-related stimuli. Participants were 81 trauma-exposed refugees (probable PTSD, n = 23 trauma-exposed controls, n = 58). The experiment comprised three 5-min phases: a resting phase (baseline) an exposition phase, during which participants were exposed to trauma-related images (stimulus) and another resting phase (recovery). We assessed HRV at baseline, and fear and anger were rated at the end of each phase. Linear mixed model analyses were used to investigate the associations between baseline HRV and probable DSM-5 PTSD diagnosis in influencing anger and fear responses both immediately after viewing trauma-related stimuli and at the end of the recovery phase. Compared to controls, participants with probable PTSD showed a greater increase in fear from baseline to stimulus presentation, d = 0.606. Compared to participants with low emotion regulation capacity, participants with high emotion regulation capacity showed a smaller reduction in anger from stimulus presentation to recovery, d = 0.548. Our findings indicated that following exposure to trauma-related stimuli, probable PTSD diagnosis predicted increased fear reactivity, and low emotion regulation capacity predicted decreased anger recovery. Impaired anger recovery following trauma reminders in the context of low emotion regulation capacity might contribute to the increased levels of anger found in postconflict s les.

Mechanisms underlying the mental health impact of family separation on resettled refugees

Publisher: SAGE Publications

Date: 28-10-2021

DOI: 10.1177/0004867420967427

Abstract: Many refugees experience prolonged separation from family members, which research suggests has adverse effects on mental health and post-displacement outcomes in refugee populations. We examine mental health differences in refugees separated and not separated from their families, and key post-migration factors and cultural mechanisms that may underlie this impact. A s le of 1085 refugees resettled in Australia, of which 23.3% were separated from all of their immediate family, took part in an online battery of survey measures indexing pre- and post-migration refugee experiences, mental health symptoms, disability and in idualistic/collectivistic self-identity. Family separation was used as a predictor of mental health outcomes in a series of linear regressions, and the separated and non-separated groups were compared in multigroup path analysis models to examine group-specific indirect effects. The separated group reported greater exposure to pre-migration potentially traumatic events and higher levels of post-migration living difficulties compared to the non-separated group. Family separation predicted higher post-traumatic stress and depression symptoms, but not disability, after controlling for potentially traumatic event exposure, age and sex. Path analyses revealed distinct indirect effects for separated and non-separated groups. Principally, higher collectivistic self-identity was associated with elevated post-traumatic stress, depression and disability symptoms via social-related post-migration living difficulties such as isolation and loneliness in the separated group whereas collectivism was linked with increased depression symptoms via economic-related post-migration living difficulties in the non-separated group. These findings indicate that family separation powerfully influences mental health outcomes, but that its effect may be mediated by the type of post-migration stress experienced in the settlement environment and culturally bound differences in how the sense of self is interconnected with family.

Sex hormones predict the sensory strength and vividness of mental imagery

Publisher: Elsevier BV

Date: 04-2015

DOI: 10.1016/J.BIOPSYCHO.2015.02.003

Abstract: Mystery surrounds the cause of large in idual differences in mental imagery vividness and strength, and how these might map onto mental disorders. Here, we report the concentration of sex hormones predicts the strength and vividness of visual mental imagery. We employed an objective measure of imagery utilizing binocular rivalry and a subjective questionnaire to assess imagery. The strength and vividness of imagery was greater for females in the mid luteal phase than both females in the late follicular phase and males. Further, imagery strength and vividness were significantly correlated with salivary progesterone concentration. For the same participants, performance on visual and verbal working memory tasks was not predicted by progesterone concentration. These results suggest sex hormones might influence visual imagery, but not general working memory. As hormone concentration changes over time, this implies a partial dynamic basis for in idual differences in visual mental imagery, any dependent cognition and mental disorders.

A randomized controlled trial of exposure therapy and cognitive restructuring for posttraumatic stress disorder.

Publisher: American Psychological Association (APA)

Date: 2008

DOI: 10.1037/A0012616

Abstract: Previous studies have reported that adding cognitive restructuring (CR) to exposure therapy does not enhance treatment gains in posttraumatic stress disorder (PTSD). This study investigated the extent to which CR would augment treatment response when provided with exposure therapy. The authors randomly allocated 118 civilian trauma survivors with PTSD to receive 8 in idually administered sessions of either (a) imaginal exposure (IE), (b) in vivo exposure (IVE), (c) IE combined with IVE (IE/IVE), or (d) IE/IVE combined with CR (IE/IVE/CR). There were fewer patients with PTSD in the IE/IVE/CR (31%) condition than the IE (75%), IVE (69%), and IE/IVE (63%) conditions at a 6-month follow-up assessment. The IE/IVE/CR condition resulted in larger effect sizes than each of the other conditions in terms of PTSD and depressive symptoms. These findings suggest that optimal treatment outcome may be achieved by combining CR with exposure therapy in treating PTSD patients.

Stressors and Supports in Postdisaster Recovery: Experiences After the Black Saturday Bushfires

Publisher: Informa UK Limited

Date: 14-03-2021

DOI: 10.1080/0312407X.2021.1874029

Prolonged grief in refugees, parenting behaviour and children’s mental health

Publisher: SAGE Publications

Date: 30-10-2020

DOI: 10.1177/0004867420967420

Self-defining memories in complicated grief

Publisher: Elsevier BV

Date: 12-2008

DOI: 10.1016/J.BRAT.2008.09.003

Abstract: There is increasing attention to the mechanisms underpinning maladaptive responses to bereavement. This study indexed self-defining memories in bereaved in iduals with and without complicated grief (CG). Participants with and without complicated grief (N=40) were asked to describe three self-defining memories. Results showed that CG participants provided more self-defining memories involving the deceased. Both groups were equally likely to report their loved one's death as a self-defining moment, however, the no-CG group showed more evidence of benefit finding in their memory narratives and experienced less negative emotion on recall. The findings suggest that CG is associated with distinctive patterns of autobiographical memory that are linked to self-identity. The pattern is consistent with self-memory system models of autobiographical remembering, and suggests that grieving in iduals who experience ongoing yearning for their loved one view their self-identity as more closely linked to the deceased are more distressed by memories involving the loss.

The management of depression: the evidence speaks for itself

Publisher: Royal College of Psychiatrists

Date: 09-09-2022

DOI: 10.1192/BJP.2022.133

Abstract: Comparing the recommendations of two recently published national clinical practice guidelines for depression, this editorial highlights the concordance of advice concerning the selection and sequencing of therapies. Lifestyle and psychological interventions feature prominently and there is broad agreement regarding medication choice and optimisation strategies. The guidelines are therefore a useful resource.

Secure attachment primes reduce fear consolidation

Publisher: Hindawi Limited

Date: 05-05-2021

DOI: 10.1002/DA.23166

Refugee visa insecurity disrupts the brain’s default mode network

Publisher: Informa UK Limited

Date: 08-06-2023

DOI: 10.1080/20008066.2023.2213595

Amygdala and ventral anterior cingulate activation predicts treatment response to cognitive behaviour therapy for post-traumatic stress disorder

Publisher: Cambridge University Press (CUP)

Date: 16-11-2007

DOI: 10.1017/S0033291707002231

Abstract: Although cognitive behaviour therapy (CBT) is the treatment of choice for post-traumatic stress disorder (PTSD), approximately half of patients do not respond to CBT. No studies have investigated the capacity for neural responses during fear processing to predict treatment response in PTSD. Functional magnetic resonance imaging (fMRI) responses of the brain were examined in in iduals with PTSD ( n =14). fMRI was examined in response to fearful and neutral facial expressions presented rapidly in a backwards masking paradigm adapted for a 1.5 T scanner. Patients then received eight sessions of CBT that comprised education, imaginal and in vivo exposure, and cognitive therapy. Treatment response was assessed 6 months after therapy completion. Seven patients were treatment responders (defined as a reduction of 50% of pretreatment scores) and seven were non-responders. Poor improvement after treatment was associated with greater bilateral amygdala and ventral anterior cingulate activation in response to masked fearful faces. Excessive fear responses in response to fear-eliciting stimuli may be a key factor in limiting responses to CBT for PTSD. This excessive amygdala response to fear may reflect difficulty in managing anxiety reactions elicited during CBT, and this factor may limit optimal response to therapy.

Functional connectivity of amygdala subnuclei in PTSD: a narrative review

Publisher: Springer Science and Business Media LLC

Date: 16-10-2023

DOI: 10.1038/S41380-023-02291-W

Heterogeneity of non-conscious fear perception in posttraumatic stress disorder as a function of physiological arousal: an fMRI study.

Publisher: Elsevier BV

Date: 11-2009

DOI: 10.1016/J.PSCYCHRESNS.2009.04.012

Abstract: While posttraumatic stress disorder (PTSD) is often characterised by an excessive fear response and hyperarousal, research has generally neglected other clinical characteristics including hypoarousal. Findings indicate that concurrent autonomic activity is associated with increased non-conscious processing of fear, highlighting that autonomic responsivity may be an important determinant in the degree of activation within the brainstem-amygdala-MPFC (medial prefrontal cortex) network.

Rare copy number variation in posttraumatic stress disorder.

Publisher: Springer Science and Business Media LLC

Date: 21-09-2022

DOI: 10.1038/S41380-022-01776-4

Abstract: Posttraumatic stress disorder (PTSD) is a heritable (h

Heart rate as a predictor of posttraumatic stress disorder in children

Publisher: Elsevier BV

Date: 2007

DOI: 10.1016/J.GENHOSPPSYCH.2006.10.002

Abstract: This study indexed the relationship between resting heart rates (HRs) after injury and subsequent posttraumatic stress disorder (PTSD) in children. Children aged between 7 and 12 years who were hospitalized after traumatic injury (n=76) had their resting HR assessed after injury and were assessed for PTSD 6 months after injury (n=62). Full/subsyndromal PTSD was diagnosed in 27% of children. Children with full/subsyndromal PTSD had higher HRs after trauma than those without PTSD. Children with an elevated HR were more likely to develop PTSD after controlling for age, sex and injury severity (adjusted odds ratio=5.89). These findings accord with the proposal that fear conditioning shortly after trauma contributes to PTSD in children.

Treating Acute Stress Disorder Following Mild Traumatic Brain Injury

Publisher: American Psychiatric Association Publishing

Date: 03-2003

DOI: 10.1176/APPI.AJP.160.3.585

Abstract: Acute stress disorder permits early identification of trauma survivors who are at risk of developing chronic posttraumatic stress disorder (PTSD). This study aimed to prevent PTSD in people who developed acute stress disorder after a mild brain injury by early provision of cognitive behavior therapy. Twenty-four civilian trauma survivors with acute stress disorder were given five in idually administered sessions of either cognitive behavior therapy or supportive counseling within 2 weeks of their trauma. Fewer patients receiving cognitive behavior therapy than supportive counseling met criteria for PTSD at a posttreatment evaluation (8% versus 58%, respectively). There were also fewer cases of PTSD at a 6-month follow-up evaluation among those receiving cognitive behavior therapy (17%) than among those receiving supportive counseling (58%). Patients in the cognitive behavior therapy condition displayed less reexperiencing and avoidance symptoms at the follow-up evaluation than patients receiving supportive counseling. These findings suggest that PTSD following mild brain injury can be effectively prevented with early provision of cognitive behavior therapy.

Lithium should be borne in mind: Five key reasons

Publisher: SAGE Publications

Date: 28-06-2020

DOI: 10.1177/0004867420934189

Exploration of delayed-onset posttraumatic stress disorder after severe injury

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 2013

DOI: 10.1097/PSM.0B013E3182761E8B

Influence of comorbid depression on fear in posttraumatic stress disorder: An fMRI study

Publisher: Elsevier BV

Date: 08-2007

DOI: 10.1016/J.PSCYCHRESNS.2007.01.010

Abstract: Posttraumatic Stress Disorder (PTSD) is thought to involve a dysregulation of medial prefrontal-amygdala activity in response to fear. PTSD studies, however, have been confounded by comorbid depression, which shows similar dysregulation. Amygdala and medial prefrontal activity was reduced in PTSD-depression compared to PTSD-alone s les, highlighting the need to account for comorbidity.

Brief videoconferencing psychological intervention for reducing COVID-19 related distress: study protocol for a randomized controlled trial

Publisher: Springer Science and Business Media LLC

Date: 09-03-2021

DOI: 10.1186/S12889-021-10529-X

Abstract: Globally COVID-19 has had a profound impact on the psychological wellbeing of millions of people, and there is an urgent imperative to address elevated levels of distress during the COVID-19 pandemic. The World Health Organization (WHO) has developed Problem Management Plus (PM+), a low intensity psychological intervention for adults experiencing psychological distress. This paper outlines the study protocol for a trial that tests the effectiveness of an adapted version of PM+ to reduce distress associated with COVID-19. A single-blind, parallel, randomized controlled trial will be carried out for distressed people across Australia. via video conferencing on a small group basis. Following informed consent, adults that screen positive for levels of psychological distress (General Health Questionnaire-12 (GHQ-12 score ≥ 3) and have access to videoconferencing platform will be randomised to an adapted version of gPM+ ( n = 120) or enhanced treatment as usual (ETAU) (n = 120). The primary outcome will be reduction in psychological distress including anxiety and depression at 2-months post treatment. Secondary outcomes include worry, sleep problems, anhedonia, social support, and stress in relation to COVID-19. The trial aims assess whether an adapted version of videoconferencing PM+ that is specifically designed to target COVI-19 related distress will result in reduced distress relative to enhanced usual care. This trial was prospectively registered on the ANZCTR on 14/4/20 ( ACTRN12620000468921 ).

Hypnotizability and Posttraumatic Stress Disorder: A Prospective Study

Publisher: Informa UK Limited

Date: 10-2003

DOI: 10.1076/ICEH.51.4.382.16407

Abstract: Although there is converging evidence that posttraumatic stress disorder (PTSD) is associated with higher levels of hypnotizability, there are no studies concerning the stability of hypnotizability levels following trauma. Acutely traumatized participants with acute stress disorder (N = 45) were administered the Stanford Hypnotic Clinical Scale (SHCS) within 4 weeks of their trauma. Participants were subsequently administered a brief cognitive-behavior therapy program. Six months after treatment, participants were re-assessed with the SHCS. Although SHCS scores were generally stable (r = .47), two thirds of participants responded differently across the 2 assessments. Increased SHCS scores at the second assessment were correlated with elevated PTSD avoidance scores. This finding suggests that elevated hypnotizability in PTSD populations may not be entirely stable and may be associated with specific PTSD responses.

Australian guidelines for the prevention and treatment of posttraumatic stress disorder: Updates in the third edition

Publisher: SAGE Publications

Date: 27-08-2021

DOI: 10.1177/00048674211041917

Abstract: This paper describes the development of the third edition of the National Health and Medical Research Australian Guidelines for the Prevention and Treatment of Acute Stress Disorder, posttraumatic stress disorder and Complex posttraumatic stress disorder, highlighting key changes in scope, methodology, format and treatment recommendations from the previous 2013 edition of the Guidelines. Systematic review of the international research was undertaken, with GRADE methodology used to assess the certainty of the evidence, and evidence to decision frameworks used to generate recommendations. The Guidelines are presented in an online format using MAGICApp. Key changes since the publication of the 2013 Guidelines include a new conditional recommendation for Child and Family Traumatic Stress Intervention for children and adolescents with symptoms within the first 3 months of trauma, and a strong recommendation for trauma-focused cognitive behaviour therapy for the child alone or with a caregiver, for those with diagnosed posttraumatic stress disorder. For adults with posttraumatic stress disorder, strong recommendations are made for specific types of trauma-focused cognitive behaviour therapy and conditional recommendations are made for five additional psychological interventions. Where medication is indicated for adults with posttraumatic stress disorder, venlafaxine is now conditionally recommended alongside sertraline, paroxetine or fluoxetine. These Guidelines, based on systematic review of the international literature, are intended to guide decision making for practitioners, service planners, funders and those seeking treatment for trauma related mental health concerns. For an Australian Guideline, a critical limitation is the absence of research on the treatment of Australian Aboriginal and Torres Strait Islander peoples. The new online format of the Australian posttraumatic stress disorder Guidelines means that they can be updated as sufficient new evidence becomes available.

A Prospective Study of Autobiographical Memory and Posttraumatic Stress Disorder Following Cancer.

Publisher: American Psychological Association (APA)

Date: 2005

DOI: 10.1037/0022-006X.73.2.293

The capacity of acute stress disorder to predict posttraumatic psychiatric disorders

Publisher: Elsevier BV

Date: 02-2012

DOI: 10.1016/J.JPSYCHIRES.2011.10.007

Abstract: One rationale for establishing the acute stress disorder diagnosis was to identify recently trauma-exposed people who may develop later posttraumatic stress disorder (PTSD). This study conducted a multi-site assessment of the extent to which ASD predicts subsequent PTSD, and also major depressive disorder, panic disorder, agoraphobia, social phobia, specific phobia, generalized anxiety disorder, and substance use disorder, 12 months after trauma. Consecutive admissions to 5 major trauma hospitals across Australia (N = 1084) were assessed during hospital admission and within one month of trauma exposure and subsequently re-assessed for psychiatric disorder 12 months after the initial assessment (N = 859). Whereas 120 (10%) patients met criteria for ASD in the initial month after trauma, 83 (10%) met criteria for PTSD, and 268 (31%) had any psychiatric disorder at 12 months. In terms of those diagnosed with ASD, 28 (36%) subsequently met criteria for PTSD and 50 (65%) subsequently developed any psychiatric disorder. Whereas the majority of people with ASD subsequently develop a psychiatric disorder, most people with a disorder at 12 months do not initially display ASD.

Intrinsic connectomes underlying response to trauma-focused psychotherapy in post-traumatic stress disorder

Publisher: Springer Science and Business Media LLC

Date: 05-08-2020

DOI: 10.1038/S41398-020-00938-8

Abstract: Although trauma-focused cognitive behavior therapy (TF-CBT) is the frontline treatment for post-traumatic stress disorder (PTSD), up to one-half of patients are treatment nonresponders. To understand treatment nonresponse, it is important to understand the neural mechanisms of TF-CBT. Here, we used whole-brain intrinsic functional connectivity analysis to identify neural connectomic signatures of treatment outcome. In total, 36 PTSD patients and 36 healthy in iduals underwent functional MRI at pre-treatment baseline. Patients then underwent nine sessions of TF-CBT and completed clinical and follow-up MRIs. We used an established large-scale brain network atlas to parcellate the brain into 343 brain regions. Pairwise intrinsic task-free functional connectivity was calculated and used to identify pre-treatment connectomic features that were correlated with reduction of PTSD severity from pretreatment to post treatment. We formed a composite metric of intrinsic connections associated with therapeutic outcome, and then interrogated this composite metric to determine if it distinguished PTSD treatment responders and nonresponders from healthy control status and changed post treatment. Lower pre-treatment connectivity for the cingulo-opercular, salience, default mode, dorsal attention, and frontoparietal executive control brain networks was associated with treatment improvement. Treatment responders had lower while nonresponders had significantly greater connectivity than controls at pretreatment. With therapy, connectivity significantly increased for responders and decreased for nonresponders, while controls remain unchanged over this time period. We provide evidence that the intrinsic functional architecture of the brain, specifically connectivity within and between brain networks associated with external vigilance, self-awareness, and cognitive control, may characterize a positive response to TF-CBT for PTSD.

Functional connectivity reveals inefficient working memory systems in post-traumatic stress disorder

Publisher: Elsevier BV

Date: 06-2009

DOI: 10.1016/J.PSCYCHRESNS.2008.07.014

Abstract: We applied a covariance-based multivariate analysis to functional magnetic resonance imaging (fMRI) data to investigate abnormalities in working memory (WM) systems in patients with post-traumatic stress disorder (PTSD). Patients (n=13) and matched controls (n=12) were scanned with fMRI while updating or maintaining trauma-neutral verbal stimuli in WM. A multivariate statistical analysis was used to investigate large-scale brain networks associated with these experimental tasks. For the control group, the first network reflected brain activity associated with WM updating and principally involved bilateral prefrontal and bilateral parietal cortex. Controls' second network was associated with WM maintenance and involved regions typically activated during storage and rehearsal of verbal material, including lateral premotor and inferior parietal cortex. In contrast, PTSD patients appeared to activate a single fronto-parietal network for both updating and maintenance tasks. This is indicative of abnormally elevated activity during WM maintenance and suggests inefficient allocation of resources for differential task demands. A second network in PTSD, which was not activated in controls, showed regions differentially activated between WM tasks, including the anterior cingulate, medial prefrontal cortex, fusiform and supplementary motor area. These activations may be linked to hyperarousal and abnormal reactivity, which are characteristic of PTSD.

Early Stage Assessment and Course of Acute Stress Disorder After Mild Traumatic Brain Injury

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 03-2009

DOI: 10.1097/NMD.0B013E318199FE7F

Reduced Amygdala and Ventral Striatal Activity to Happy Faces in PTSD Is Associated with Emotional Numbing

Publisher: Public Library of Science (PLoS)

Date: 03-09-2014

DOI: 10.1371/JOURNAL.PONE.0103653

Impact of acute administration of escitalopram on the processing of emotional and neutral images: a randomized crossover fMRI study of healthy women

Publisher: CMA Joule Inc.

Date: 07-2014

DOI: 10.1503/JPN.130118

Lifetime Prevalence of Gender-Based Violence in Women and the Relationship With Mental Disorders and Psychosocial Function

Publisher: American Medical Association (AMA)

Date: 03-08-2011

DOI: 10.1001/JAMA.2011.1098

Abstract: Intimate partner physical violence, rape, sexual assault, and stalking are pervasive and co-occurring forms of gender-based violence (GBV). An association between these forms of abuse and lifetime mental disorder and psychosocial disability among women needs to be examined. To assess the association of GBV and mental disorder, its severity and comorbidity, and psychosocial functioning among women. A cross-sectional study based on the Australian National Mental Health and Well-being Survey in 2007, of 4451 women (65% response rate) aged 16 to 85 years. The Composite International Diagnostic Interview version 3.0 of the World Health Organization's World Mental Health Survey Initiative was used to assess lifetime prevalence of any mental disorder, anxiety, mood disorder, substance use disorder, and posttraumatic stress disorder (PTSD). Also included were indices of lifetime trauma exposure, including GBV, sociodemographic characteristics, economic status, family history of mental disorder, social supports, general mental and physical functioning, quality of life, and overall disability. A total of 1218 women (27.4%) reported experiencing at least 1 type of GBV. For women exposed to 3 or 4 types of GBV (n = 139), the rates of mental disorders were 77.3% (odds ratio [OR], 10.06 95% confidence interval [CI], 5.85-17.30) for anxiety disorders, 52.5% (OR, 3.59 95% CI, 2.31-5.60) for mood disorder, 47.1% (OR, 5.61 95% CI, 3.46-9.10) for substance use disorder, 56.2% (OR, 15.90 95% CI, 8.32-30.20) for PTSD, 89.4% (OR, 11.00 95% CI, 5.46-22.17) for any mental disorder, and 34.7% (OR, 14.80 95% CI, 6.89-31.60) for suicide attempts. Gender-based violence was associated with more severe current mental disorder (OR, 4.60 95% CI, 2.93-7.22), higher rates of 3 or more lifetime disorders (OR, 7.79 95% CI, 6.10-9.95), physical disability (OR, 4.00 95% CI, 1.82-8.82), mental disability (OR, 7.14 95% CI, 2.87-17.75), impaired quality of life (OR, 2.96 95% CI, 1.60-5.47), an increase in disability days (OR, 3.14 95% CI, 2.43-4.05), and overall disability (OR, 2.73 95% CI, 1.99-3.75). Among a nationally representative s le of Australian women, GBV was significantly associated with mental health disorder, dysfunction, and disability.

Dissociation in Acute Stress Disorder After a Hyperventilation Provocation Test

Publisher: Cambridge University Press (CUP)

Date: 26-04-2006

DOI: 10.1017/S1352465806002931

Abstract: This study investigated the relationship of hyperarousal and dissociation in acute stress disorder (ASD). Civilian trauma survivors with ASD ( n = 17) and without ASD ( n = 15) and non-traumatized controls ( n = 14) completed a hyperventilation provocation test and were administered the Beck Anxiety Inventory, the Anxiety Sensitivity Index, the Dissociative Experiences Scale, the Peritraumatic Dissociative Experiences Questionnaire, the Physical Reactions Scale, and the Agoraphobic Cognitions Questionnaire. In iduals with ASD demonstrated more panic, dissociation, and maladaptive interpretations about their arousal during the hyperventilation than non-ASD or control participants. Dissociation was associated with anxiety sensitivity and peritraumatic panic attacks. These findings suggest that hyperarousal and dissociation are highly associated in ASD and that catastrophic attributions may play a mediating role in this relationship.

The association between menstrual cycle and traumatic memories

Publisher: Elsevier BV

Date: 06-2011

DOI: 10.1016/J.JAD.2010.10.049

Abstract: Women in the mid-luteal phase of the menstrual cycle have been shown to have stronger emotional memories than other women. We investigated the extent to which experiencing a traumatic event during the luteal phase of the menstrual cycle is associated with stronger traumatic flashback memories. Consecutive female patients admitted to hospital after traumatic injury (n=138) were assessed for days since last menstruation, as well as assessment of flashbacks. Twenty three (17%) women were in the mid-luteal phase (18-24) days at the time of trauma exposure and 29 (21%) were in the mid-luteal phase at the time of assessment. Women were more likely to experience flashback memories if they were in the luteal phase during the trauma (22% vs. 9%), adjusted OR: 3.64 [95%CI: 0.99-13.29] after controlling for injury severity, age, trauma type, and mild traumatic brain injury. Women in the luteal phase at assessment were 4.89 times more likely to have flashbacks. Adjusted OR: 4.89 [95%CI: 1.39-17.86]. Increased glucocorticoid release associated with the luteal phase of the menstrual cycle may facilitate consolidation of trauma memories.

Posttraumatic Disorders Following Injury: Assessment and Other Methodological Considerations

Publisher: Kluwer Academic Publishers

Date: 2006

DOI: 10.1007/0-387-25610-5_4

Impaired autobiographical memory in complicated grief

Publisher: Elsevier BV

Date: 04-2010

DOI: 10.1016/J.BRAT.2009.12.006

Abstract: This study investigated the relationship between autobiographical memory and goals in complicated grief (CG). Twenty-four in iduals with CG and 21 bereaved in iduals without CG completed an autobiographical memory task and a personal goals task. CG participants were more likely to recall memories related to their loss, particularly in response to negative cues. There was a positive relationship between the proportion of loss-related memories recalled and the proportion of grief-related goals held by in iduals after controlling for symptom level. In iduals with CG also showed impaired retrieval of specific autobiographical memories in response to both positive and negative cues. These results suggest that CG is characterised by impaired and biased retrieval of specific autobiographical memories. These patterns are consistent with propositions stemming from the self-memory models of autobiographical memory.

Linkage Projects - Grant ID: LP180100681

Start Date: 07-2020

End Date: 07-2024

Amount: $664,511.00

Funder: Australian Research Council

Linkage Projects - Grant ID: LP120200284

Start Date: 11-2012

End Date: 06-2017

Amount: $559,467.00

Funder: Australian Research Council

Australian Laureate Fellowships - Grant ID: FL0992334

Start Date: 08-2009

End Date: 02-2015

Amount: $2,321,000.00

Funder: Australian Research Council

Linkage Projects - Grant ID: LP100100702

Start Date: 12-2010

End Date: 07-2015

Amount: $632,000.00

Funder: Australian Research Council

Linkage Projects - Grant ID: LP0212048

Start Date: 05-2002

End Date: 05-2005

Amount: $445,180.00

Funder: Australian Research Council

Linkage Projects - Grant ID: LP0989719

Start Date: 05-2009

End Date: 05-2013

Amount: $410,000.00

Funder: Australian Research Council

Linkage Projects - Grant ID: LP130100822

Start Date: 06-2014

End Date: 10-2016

Amount: $623,748.00

Funder: Australian Research Council

Discovery Projects - Grant ID: DP110105274

Start Date: 2011

End Date: 06-2014

Amount: $216,819.00

Funder: Australian Research Council

Discovery Projects - Grant ID: DP0208796

Start Date: 05-2002

End Date: 12-2005

Amount: $147,000.00

Funder: Australian Research Council

Linkage - International - Grant ID: LX0883033

Start Date: 07-2008

End Date: 06-2010

Amount: $84,000.00

Funder: Australian Research Council

Special Research Initiatives - Grant ID: SR0354494

Start Date: 2004

End Date: 02-2004

Amount: $10,000.00

Funder: Australian Research Council

Linkage Projects - Grant ID: LP0990696

Start Date: 07-2010

End Date: 03-2014

Amount: $1,021,140.00

Funder: Australian Research Council

Discovery Projects - Grant ID: DP0557103

Start Date: 2005

End Date: 06-2008

Amount: $180,000.00

Funder: Australian Research Council

Discovery Projects - Grant ID: DP0665838

Start Date: 07-2006

End Date: 06-2011

Amount: $560,000.00

Funder: Australian Research Council

Discovery Projects - Grant ID: DP0877576

Start Date: 03-2008

End Date: 06-2011

Amount: $178,000.00

Funder: Australian Research Council

Linkage Projects - Grant ID: LP200301253

Start Date: 2022

End Date: 12-2025

Amount: $837,040.00

Funder: Australian Research Council

Linkage Projects - Grant ID: LP100200164

Start Date: 03-2011

End Date: 12-2016

Amount: $1,285,047.00

Funder: Australian Research Council