Beth S. Gershuny

Treatment of pharmacotherapy-refractory posttraumatic stress disorder among Cambodian refugees: a pilot study of combination treatment with cognitive-behavior therapy vs sertraline alone.

Cambodian refugees with posttraumatic stress disorder (PTSD) represent a cohort in severe need of treatment, but little information is available to guide treatment choices. We selected a sample of pharmacotherapy-refractory individuals to test the efficacy of combination treatment with sertraline and cognitive-behavior therapy (CBT) for treating PTSD. Participants in this pilot study were ten Khmer-speaking women who had been at a mean age of 22-26 years during the Pol Pot period (1975-1979). These patients were randomly assigned to either sertraline alone or combined treatment. We found that combined treatment offered additional benefit in the range of medium to large effect sizes for PTSD and associated symptoms. Our findings indicate that substantial gains can be achieved by adding CBT to pharmacotherapy for PTSD, and that a program of CBT emphasizing information, exposure, and cognitive-restructuring can be successfully modified for Khmer-speaking refugees.

Symptoms of posttraumatic stress and death anxiety in persons with HIV and medication adherence difficulties.

The present study examined the frequency and correlates of self-reported symptoms of posttraumatic stress among patients with HIV and medication adherence problems. Self-report data revealed that more than half of participants met diagnostic criteria for posttraumatic stress disorder (PTSD) according to the Posttraumatic Diagnostic Scale PDS. Death anxiety was associated with overall PTSD symptom severity scores as well as severity scores for reexperiencing, avoidance, and arousal symptoms. The association between death anxiety and total PTSD severity, reexperiencing and avoidance symptom scores remained after controlling for depression and satisfaction with social support. Anxiety, as manifested by PTSD symptoms should be routinely assessed among patients with HIV, and variables such as death anxiety, social support, and depression are appropriate targets for mental health interventions.

Peritraumatic dissociation and PTSD severity: do event-related fears about death and control mediate their relation?

Relations among peritraumatic dissociation, PTSD severity, event-related fear (i.e. fear experienced during traumatic event) about death, and event-related fear about losing control were examined in the current study. Particular emphasis was placed on testing whether or not fears about death and losing control mediate the relation between peritraumatic dissociation and PTSD severity in a sample of 146 nontreatment-seeking university women. Results indicated that event-related fears about death and losing control accounted for the relation between peritraumatic dissociation and PTSD severity; that is, the effect of peritraumatic dissociation on PTSD severity was eliminated after controlling for these fears. Speculations about findings are discussed.

Connections among symptoms of obsessive–compulsive disorder and posttraumatic stress disorder: a case series

Theoretical, clinical, and empirical implications of the functional connections between symptoms of obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) are abundant. As such, four cases are presented here of men and women who met criteria for comorbid OCD and PTSD. All had been diagnosed with treatment-resistant OCD and were seeking treatment from an OCD specialty clinic or institute, all reported a history of traumatic experiences prior to the onset of OCD, and all appeared to demonstrate negative treatment outcomes. Upon examination, it appeared that symptoms of OCD and PTSD were connected such that decreases in OCD-specific symptoms related to increases in PTSD-specific symptoms, and increases in OCD-specific symptoms related to decreases in PTSD-specific symptoms. Speculations about the function of OCD symptoms in relation to post-traumatic psychopathology are put forth; and theoretical, research, and treatment implications are discussed.

Cognitive-behavioral therapy for depression. Applications and outcome.

This article discusses cognitive-behavioral therapy for depression, including evidence for its efficacy and how to choose between this therapy and antidepressants. The use of this therapy to prevent relapse also is presented.

Fatal Distraction: The Impact of Mortality Salience on Dissociative Responses to 9/11 and Subsequent Anxiety Sensitivity

Two studies examined whether dissociation from 9/11-related thoughts and emotions would be higher after mortality salience (MS) relative to a control condition. Because dissociation is believed to contribute to anxiety disorders, we also examined whether higher ratings of dissociation after MS would lead to higher reported anxiety sensitivity. In Study 1, MS participants reported higher levels of peritraumatic dissociation from 9/11 and higher levels of anxiety sensitivity than control participants who contemplated an upcoming exam. Furthermore, the extent to which MS induced higher levels of anxiety sensitivity was fully mediated by the extent to which MS caused greater dissociation. In Study 2, we examined whether heightened anxiety sensitivity is specifically a consequence of MS-induced dissociation or whether MS-induced worldview bolstering also causes higher anxiety sensitivity. Results indicated that MS participants reported more peritraumatic dissociation from 9/11 or bolstered support for their worldview; but, whereas higher dissociation in response to a death reminder led to higher anxiety sensitivity, worldview bolstering did not. Implications for understanding the role of mortality concerns in psychological reactions to 9/11 and other acts of terrorism are briefly discussed.

Relation Between Trauma and Psychopathology: Mediating Roles of Dissociation and Fears About Death and Control

ABSTRACT We investigated mediational relations among trauma, dissociation, psychopathology (e.g., PTSD, borderline personality disorder, bulimic behaviors), and fears about death and lacking control in a sample of 325 non-treatment-seeking women. With the use of structural equation modeling, findings indicated that: (1) dissociation accounted for 27% of variance in the trauma-psychopathology relation (significant partial mediation), and (2) general ongoing fears about death and control accounted for an additional 20% of variance in the trauma-psychopathology relation beyond what was already accounted for by dissociation (total of 47% of variance explained in the trauma-psychopathology relation; significant partial mediation). Findings are discussed, and postulations about relations are proposed.

Depression in comorbid obsessive-compulsive disorder and posttraumatic stress disorder.

Previous findings suggested a unique role that depression symptoms might play in the comorbid relationship between obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD). However, the nature of this role remains unclear. Thus, the current study examined ways in which OCD and PTSD symptoms vary as a function of depression, as well as the mediating role of depression in the OCD-PTSD relationship, in 104 individuals seeking treatment for refractory OCD. Findings revealed that depressed individuals in the treatment-refractory OCD sample report higher levels of overall obsessing and greater severity of PTSD. In addition, depression appeared to mediate the relation between OCD and PTSD. Implications of findings are discussed.

Idiosyncratic Severity Profiles of Obsessive Compulsive Dysfunction: A Detailed Self Report Assessment of a Multifaceted Syndrome

In this paper we present an assessment method designed to detect specific individual severity profiles of obsessive–compulsive areas of dysfunction. This method is based on the Obsessive Compulsive Symptoms Rating Scale (OCSRS; Wilhelm and Steketee 2006), a comprehensive self-report instrument that measures the severity of a wide variety of symptom categories associated with obsessive compulsive disorder (OCD). A total of 127 patients diagnosed with OCD completed the OCSRS and other measures of OCD, anxiety, and depression. Statistical analyses confirmed the convergent and discriminant validity of the OCSRS symptom categories, and indicated that each of these symptom clusters contains internally-consistent symptoms that can be meaningfully measured by a single severity score. Additional analyses demonstrated the clinical utility of this fine-grained severity assessment of OCD. The findings indicate that the severity profile of the OCSRS provides unique information that may be useful for a variety of research and clinical purposes.

The use of rationalization and denial to reduce accident-related and illness-related death anxiety

Subjects read stories depicting the death of an individual through either an accident or a terminal illness. The subjects then answered questions designed to measure the extent to which various defense mechanisms were elicited by the stories. In Experiment 1, the subjects used rationalization more than denial or repression after reading the accident story, but they used all three defenses with equal magnitude after the illness story. In Experiment 2, rationalization was again used more than denial after the accident story, and the two defenses were used with similar magnitude after the illness story. There may be specific trauma-defense relationships whose existence depends on specific characteristics of both the type of trauma and the type of defense mechanism.