Iris M. Engelhard

Posttraumatic stress disorder after pregnancy loss

This prospective longitudinal study investigated the prevalence of posttraumatic stress disorder (PTSD) in response to pregnancy loss. About 1,370 women were recruited in the early stages of pregnancy and 113 of them had a subsequent pregnancy loss. One and four months after pregnancy loss, they were assessed for PTSD with the Posttraumatic Symptom Scale. Depression was also assessed. The majority had an early loss, i.e., within 20 weeks. At one month, the prevalence of PTSD was 25%, and the symptom-severity was similar to other traumatized populations. Women with PTSD had increased risk of depression: 34% of PTSD cases and 5% of non-cases reported depression. At four months, 7% met the criteria for PTSD, of which half were chronic. In contrast, rates for depression had not declined. The results indicate that pregnancy loss is potentially traumatic, putting women at risk of developing PTSD. In most cases, the disorder is immediate and persists for several months.

UPDATED META-ANALYSIS OF CLASSICAL FEAR CONDITIONING IN THE ANXIETY DISORDERS

The aim of the current study was twofold: (1) to systematically examine differences in fear conditioning between anxiety patients and healthy controls using meta‐analytic methods, and (2) to examine the extent to which study characteristics may account for the variability in findings across studies. Forty‐four studies (published between 1920 and 2013) with data on 963 anxiety disordered patients and 1,222 control subjects were obtained through PubMed and PsycINFO, as well as from a previous meta‐analysis on fear conditioning (Lissek et al. ). Results demonstrated robustly increased fear responses to conditioned safety cues (CS−) in anxiety patients compared to controls during acquisition. This effect may represent an impaired ability to inhibit fear in the presence of safety cues (CS−) and/or may signify an increased tendency in anxiety disordered patients to generalize fear responses to safe stimuli resembling the conditioned danger cue (CS+). In contrast, during extinction, patients show stronger fear responses to the CS+ and a trend toward increased discrimination learning (differentiation between the CS+ and CS−) compared to controls, indicating delayed and/or reduced extinction of fear in anxiety patients. Finally, none of the included study characteristics, such as the type of fear measure (subjective vs. psychophysiological index of fear), could account significantly for the variance in effect sizes across studies. Further research is needed to investigate the predictive value of fear extinction on treatment outcome, as extinction processes are thought to underlie the beneficial effects of exposure treatment in anxiety disorders.

Peritraumatic dissociation and posttraumatic stress after pregnancy loss: a prospective study

This study examined (1). predictors for peritraumatic dissociation, (2). its relations with acute and chronic symptoms of posttraumatic stress disorder (PTSD), and (3). pathways regarding these relations in response to pregnancy loss. In early pregnancy, about 1370 women volunteers completed questionnaires for neuroticism, control over emotions, dissociative tendencies, absorption, and prior life events. Of these, 126 subsequently experienced pregnancy loss and most of them completed measures 1 month (N = 118) and 4 months (N = 104) later. At 1 month, peritraumatic dissociation, memory of pregnancy loss (degree of fragmentation, sensory impressions, and emotional intensity), thought suppression, and PTSD symptoms were assessed, and at 4 months, PTSD symptoms were re-assessed. Peritraumatic dissociation was predicted by prior low control over emotions, dissociative tendencies, and lower education. It was not predicted by neuroticism, absorption, and prior life events. Peritraumatic dissociation was related to acute PTSD symptoms and LISREL analyses indicated that self-reported memory fragmentation and thought suppression of pregnancy loss mediated this relation. It also predicted chronic PTSD symptoms, and this relation was mediated by acute PTSD symptoms.

Posttraumatic stress disorder after pre-eclampsia: an exploratory study.

Information about the psychological sequelae of pre-eclampsia (PE) is scarce. Post-traumatic stress disorder (PTSD) may develop after exposure to a stress condition. This study explored whether PE predisposes to PTSD in patients and their partners. Primiparas with a recent history of preterm PE (n=18), preterm birth (PT; n=29), term PE (n=23), or uneventful term birth (C; n=43), and most of their partners completed questionnaires measuring PTSD, depression and related psychological factors. About one-fourth of patients developed PTSD after preterm PE as well as after PT. It occurred in 17% after term PE and in none of the control subjects. A substantial minority of partners was also affected. PTSD symptoms were strongly related to individual psychological characteristics (peritraumatic dissociation, negative interpretations of symptoms, and thought suppression) rather than to objective indicators of condition-severity. The data suggest that PE predisposes to PTSD, primarily but not exclusively resulting from concomitant preterm birth.

The relationship between neuroticism, pre-traumatic stress, and post-traumatic stress: a prospective study

Abstract The personality trait of Neuroticism has been repeatedly associated with symptoms of post-traumatic stress disorder (PTSD). However, the nature of this relationship is unclear. There are at least two possible interpretations: neuroticism might be a risk factor for PTSD symptoms, or, alternatively, the relationship might be based on content overlap in arousal symptoms. With a prospective design, this study tested both possibilities. About 1370 women volunteers completed questionnaires early in pregnancy, measuring neuroticism and ‘baseline’ arousal symptoms, and for every 2 months thereafter until 1 month after the due date of birth. Of these, 126 had a pregnancy loss, and most of them were assessed for PTSD symptoms 1 month later. The results showed that pre-trauma neuroticism strongly predicted PTSD symptoms, and particularly PTSD arousal symptoms, after pregnancy loss. However, neuroticism was also strongly related to pre-trauma arousal. After statistically controlling for pre-trauma arousal symptoms, the relationship between neuroticism and PTSD symptoms after pregnancy loss was no longer significant. In other words, neuroticism did not predict rises in these symptoms from pre to post-trauma. This suggests that PTSD arousal symptoms tap a specific aspect of neuroticism, and that content-overlap largely accounts for the relationship between neuroticism and PTSD symptoms.

Low specificity of symptoms on the post-traumatic stress disorder (PTSD) symptom scale: A comparison of individuals with PTSD, individuals with other anxiety disorders and individuals without psychopathology

OBJECTIVES Screening for post-traumatic stress disorder (PTSD) takes place in clinical and research settings where diagnostic interviews are not feasible, and typically relies on self-report instruments like the PTSD symptom scale (PSS). Concerns have been raised about the specificity of PTSD symptoms assessed by questionnaires. This study examined whether the PSS distinguishes between patients with PTSD and those with other anxiety disorders or healthy controls. DESIGN A between-participants design was employed. METHODS The participants were 65 individuals with PTSD, 40 individuals with other anxiety disorders and 40 healthy controls. They completed the PSS with respect to a range of stressful life-events. RESULTS Using this instrument, 86% of individuals with PTSD and 5% of healthy controls endorsed sufficient symptoms to meet the PTSD diagnosis. This was also the case for 43% of individuals with other anxiety disorders, and self-reported symptoms related to traumatic events and aversive events that are generally not considered traumatic. CONCLUSIONS The findings suggest that many people screened positive for PTSD may actually be suffering from another anxiety disorder.

How does EMDR work

Eye movement desensitisation and reprocessing (EMDR) is an effective treatment for alleviating trauma symptoms, and the positive effects of this treatment have been scientifically confirmed under well-controlled conditions. This has provided an opportunity to explore how EMDR works. The present paper reports on the findings of a long series of experiments that disproved the hypothesis that eye movements or other ‘dual tasks’ are unnecessary. These experiments also disproved the idea that ‘bilateral stimulation’ is needed; moving the eyes up and down produces the same effect as horizontal eye movement, and so do tasks that require no eye movement at all. However, it is important that the dual task taxes working memory. Several predictions can be derived from the working memory explanation for eye movements in EMDR. These seem to hold up extremely well in critical experimental tests, and create a solid explanation on how eye movements work. This paper discusses the implications that this theory and the empirical findings may have for the EMDR technique.

The impact of taxing working memory on negative and positive memories

Background: Earlier studies have shown that horizontal eye movement (EM) during retrieval of a negative memory reduces its vividness and emotionality. This may be due to both tasks competing for working memory (WM) resources. This study examined whether playing the computer game “Tetris” also blurs memory. Method: Participants recalled negative and positive memories in three conditions: recall only, recall with concurrent EM, and recall with playing Tetris. Before and after these conditions, vividness, emotionality, and physiological startle responses during recall were measured. Results: A reaction time task showed that EM and Tetris draw on WM, compared to no dual-task. Compared to recall only, EM and Tetris both decreased reported emotionality and startle responses. Conclusions: The effects of EM and Tetris did not differ, even though the tasks differed in the degree of taxing WM. This suggests that taxing WM and its effects on emotional memories may not be linearly related. Potential clinical implications are discussed. For the abstract or full text in other languages, please see Supplementary files under Reading Tools online

The sense of coherence in early pregnancy and crisis support and posttraumatic stress after pregnancy loss: A prospective study

Abstract A. Antonovsky (1987) defined the sense of coherence (SOC) as the ability to perceive a stressor as comprehensible, manageable, and meaningful. In this prospective study of pregnant women, the authors tested the relationships between the SOC in early pregnancy and crisis support and symptom severity of posttraumatic stress disorder (PTSD) and depression after pregnancy loss. A total of 1,372 women completed questionnaires in early pregnancy, including measures for the SOC and depressive symptoms, and were followed for every 2 months thereafter until 1 month after the birth due-date. Of this group, 126 women had a pregnancy loss, and 118 of them completed measures for crisis support, PTSD, and depression about 1 month later. The results showed that a stronger SOC in early pregnancy renders women somewhat resilient to symptoms of PTSD and depression after pregnancy loss, which appears to be due to the mobilization of crisis support.

Memory consistency for traumatic events in Dutch soldiers deployed to Iraq.

Retrospective accounts of traumatic events are consistently associated with symptoms of post-traumatic stress disorder (PTSD). This has often been interpreted as causal impact of such events on psychological functioning, but recent studies suggest that the causal direction is (partly) reversed: high levels of PTSD symptoms may be associated with amplified recollections of precipitating traumatic events. The aim of this prospective study was to index the consistency with which Dutch Army soldiers reported traumatic stressors and nontraumatic stressors on their deployment to Iraq, and to examine to what extent PTSD symptoms and pre-existing reporting biases, such as that arising from neuroticism, affect memory inconsistency. Retrospective accounts of stressors were highly variable over time. Individuals with higher levels of PTSD symptoms and neuroticism, lower levels of extraversion and fewer prior missions, were more prone to increased reporting over time.