Kate B. Nooner

Treatment for PTSD Related to Childhood Abuse: A Randomized Controlled Trial

OBJECTIVE Posttraumatic stress disorder (PTSD) related to childhood abuse is associated with features of affect regulation and interpersonal disturbances that substantially contribute to impairment. Existing treatments do not address these problems or the difficulties they may pose in the exploration of trauma memories, an efficacious and frequently recommended approach to resolving PTSD. The authors evaluated the benefits and risks of a treatment combining an initial preparatory phase of skills training in affect and interpersonal regulation (STAIR) followed by exposure by comparing it against two control conditions: Supportive Counseling followed by Exposure (Support/Exposure) and skills training followed by Supportive Counseling (STAIR/Support). METHOD Participants were women with PTSD related to childhood abuse (N=104) who were randomly assigned to the STAIR/Exposure condition, Support/Exposure condition (exposure comparator), or STAIR/Support condition (skills comparator) and assessed at posttreatment, 3 months, and 6 months. RESULTS The STAIR/Exposure group was more likely to achieve sustained and full PTSD remission relative to the exposure comparator, while the skills comparator condition fell in the middle (27% versus 13% versus 0%). STAIR/Exposure produced greater improvements in emotion regulation than the exposure comparator and greater improvements in interpersonal problems than both conditions. The STAIR/Exposure dropout rate was lower than the rate for the exposure comparator and similar to the rate for the skills comparator. There were significantly lower session-to-session PTSD symptoms during the exposure phase in the STAIR/Exposure condition than in the Support/Exposure condition. STAIR/Exposure was associated with fewer cases of PTSD worsening relative to both of the other two conditions. CONCLUSIONS For a PTSD population with chronic and early-life trauma, a phase-based skills-to-exposure treatment was associated with greater benefits and fewer adverse effects than treatments that excluded either skills training or exposure.

The NKI-Rockland Sample: A Model for Accelerating the Pace of Discovery Science in Psychiatry

The National Institute of Mental Health strategic plan for advancing psychiatric neuroscience calls for an acceleration of discovery and the delineation of developmental trajectories for risk and resilience across the lifespan. To attain these objectives, sufficiently powered datasets with broad and deep phenotypic characterization, state-of-the-art neuroimaging, and genetic samples must be generated and made openly available to the scientific community. The enhanced Nathan Kline Institute-Rockland Sample (NKI-RS) is a response to this need. NKI-RS is an ongoing, institutionally centered endeavor aimed at creating a large-scale (N > 1000), deeply phenotyped, community-ascertained, lifespan sample (ages 6–85 years old) with advanced neuroimaging and genetics. These data will be publically shared, openly, and prospectively (i.e., on a weekly basis). Herein, we describe the conceptual basis of the NKI-RS, including study design, sampling considerations, and steps to synchronize phenotypic and neuroimaging assessment. Additionally, we describe our process for sharing the data with the scientific community while protecting participant confidentiality, maintaining an adequate database, and certifying data integrity. The pilot phase of the NKI-RS, including challenges in recruiting, characterizing, imaging, and sharing data, is discussed while also explaining how this experience informed the final design of the enhanced NKI-RS. It is our hope that familiarity with the conceptual underpinnings of the enhanced NKI-RS will facilitate harmonization with future data collection efforts aimed at advancing psychiatric neuroscience and nosology.

Factors related to posttraumatic stress disorder in adolescence.

Studies of posttraumatic stress disorder (PTSD) in adolescence published from 2000 to 2011 indicate that adolescents are at greater risk of experiencing trauma than either adults or children, and that the prevalence of PTSD among adolescents is 3–57%. Age, gender, type of trauma, and repeated trauma are discussed as factors related to the increased rates of adolescent PTSD. PTSD in adolescence is also associated with suicide, substance abuse, poor social support, academic problems, and poor physical health. PTSD may disrupt biological maturational processes and contribute to the long-term emotion and behavior regulation problems that are often evident in adolescents with the disorder. Recommendations are presented for practice and research regarding the promotion of targeted prevention and intervention services to maximize adolescents’ strengths and minimize vulnerabilities. Public policy implications are discussed.

Youth self-report of physical and sexual abuse: A latent class analysis

OBJECTIVE To determine if meaningful groups of at-risk pre-adolescent youth could be identified based on their self-report of physical and sexual abuse histories. METHODS Youth participating in a consortium of ongoing longitudinal studies were interviewed using an audio-computer assisted self-interview (A-CASI) when they were approximately 12 years of age to obtain information about their perceived experiences of physical (18 items) and sexual (12 items) abuse. In addition, Child Protective Service records were reviewed and the taxonomy developed for defining maltreatment characteristics (Barnett, Manly, & Cicchetti, 1993) was applied. A total of 795 youth completed the age 12 interview and had their records reviewed during the period from birth to the time of their age 12 interview. A latent variable modeling approach, specifically latent class analysis (LCA), was used to generate profiles of youth based on their endorsements of the physical and sexual abuse items. These profiles were then compared to CPS reports of physical or sexual abuse to determine their validity. RESULTS The LCA identified 4 interpretable classes or groups of pre-adolescent youth. Based on the pattern of responses to specific items the classes were identified as follows: (1) no physical or sexual abuse; (2) high physical abuse/low sexual abuse; (3) no physical abuse/moderate sexual abuse; and (4) high physical and sexual abuse. Follow-up analyses indicated that the odds of a CPS report for Classes 2, 3, and 4 compared to Class 1 were significantly greater (2.21, 2.55, and 5.10, respectively). CONCLUSION The latent variable modeling approach allowed for the identification of meaningful groups of youth that accounted for both the occurrence of multiple types of abuse as well as differing severities associated with each type. It is suggested that this methodological approach may be most useful in future efforts to identify the antecedents and consequences of maltreatment. PRACTICE IMPLICATIONS The results of the present study not only have implications for future research efforts, but also suggest that in practice, youth at-risk for maltreatment may be reliable and valid reporters of their physical and sexual abuse experiences.

Relationship of Trauma Symptoms to Amygdala-Based Functional Brain Changes in Adolescents

In this pilot study, amygdala connectivity related to trauma symptoms was explored using resting-state functional magnetic resonance imaging (R-fMRI) in 23 healthy adolescents ages 13-17 years with no psychiatric diagnoses. Adolescents completed a self-report trauma symptom checklist and a R-fMRI scan. We examined the relationship of trauma symptoms to resting-state functional connectivity of the amygdala. Increasing self-report of trauma symptoms by adolescents was associated with increasing functional connectivity with the right amygdala and a local limbic cluster and decreasing functional connectivity with the amygdala and a long-range frontoparietal cluster to the left amygdala, which can be a hallmark of immaturity. These pilot findings in adolescents provide preliminary evidence that even mild trauma symptoms can be linked to the configuration of brain networks associated with the amygdala.

The Role of Early Experience and Cognitive Vulnerability: Presenting a Unified Model of the Etiology of Panic

Cognitive vulnerability models have been developed to explicate the etiology of panic and other anxiety disorders. This study takes a step forward by presenting a unified vulnerability model that incorporates a continuum of proximal and distal factors involved in the etiology of panic. The present study tested distal elements of the model, including childhood histories of vicarious and instrumental learning, and cognitive constructs such as anxiety sensitivity and perceived control. Our study found that parental modeling of the dangerousness of anxiety symptoms accounted for more model variance than from direct experiences with arousal-reactive symptoms or from parental reinforcement of the child’s own sick role behavior when experiencing arousal reactive symptoms. We found that parental modeling independently predicted model variance even when perceived control was included in the model. Our results indicated that low perceived anxiety control and anxiety about bodily symptoms uniquely accounted for variance in the model. Our findings add to the growing body of research and suggest that anxiety about bodily symptoms and low perceived control together may interact to create a stronger distal vulnerability construct for panic than either construct alone in individuals whose childhood caregivers may have modeled fear of anxiety symptoms. The results of this study provide support for the inclusion of distal factors in unified cognitive vulnerability models of panic disorder as well as for future prospective research of these constructs.

Brain Function Associated with Cooccurring Trauma and Depression Symptoms in College Students

ABSTRACT The goal of this pilot study was to determine if functional brain differences are present among individuals with high and low cooccurring trauma and depression symptoms. This pilot study examined how the P300 latency component of event-related potentials (ERPs), measured using electroencephalography (EEG) while participants performed a go/no-go task, might be associated with cooccurring self-report of trauma and depression symptoms in a sample of college students (N = 38). Alpha-corrected independent sample t tests revealed statistically significant differences in ERP P300 peak latencies between those in the high cooccurring trauma and depression symptoms group (n = 12) and those in the low group (n = 26) for all 3 midline electrode sites (Fz, Cz, and Pz). This pilot study provides preliminary evidence of differential brain functioning in individuals experiencing cooccurring trauma and depression symptoms. Accordingly, these findings support future research examining brain functioning in cooccurring symptoms.

Trauma Symptoms and Executive Functioning in Children: A Pilot Report on Depression and Anxiety as Mediators

Trauma Symptoms and Executive Functioning in Children: A Pilot Report on Depression and Anxiety as Mediators Trauma symptoms have been linked to long-term defects in executive functioning in clinical samples of youth. Symptoms of depression and anxiety, which commonly co-occur with traumatic symptoms, may also play a role in executive functioning deficits. These associations have yet to be explored in healthy children, who may hold important clues for fostering resilience following trauma.

An examination of sex differences on neurocognitive functioning and behavior problems in maltreated youth.

Objective: In the developmental traumatology model, the biological construct of sex is considered a moderator that may negatively influence child maltreatment sequelae including those pertaining to neurocognitive function. Method: This study examined sex-differences in neurocognitive function and behavior problems in maltreated boys (n = 42), maltreated girls (n = 56) versus nonmaltreated boys (n = 45) and girls (n = 59). Maltreated boys were hypothesized to have poorer neurocognitive functioning than maltreated girls, and nonmaltreated boys and girls, in all neurocognitive domains, particularly pertaining to executive function and attention. We also examined correlations between cognitive function and parent report of child behavior problems for maltreated and nonmaltreated children. Results: Maltreated boys performed more poorly on measures of intelligence, attention, language, memory, executive function, and academic achievement in both reading and math than nonmaltreated boys. Maltreated boys did not perform more poorly on these cognitive measures or behavioral measures than maltreated girls, except for one memory measure. Maltreated girls performed more poorly on measures of intelligence, language, memory, executive function, and academic achievement than nonmaltreated girls. Maltreated girls with better visual-spatial skills had more internalizing and externalizing problems. Effect sizes for these sex differences ranged from small to large. Conclusions: Both maltreated boys and girls showed poorer cognitive function than their nonmaltreated sex-matched controls. Maltreated girls had subtle sparing of attention and short-term memory (STM). Understanding sex differences in neurocognitive functioning may have implications for designing large population studies of maltreated youth.

Clinic Outcome Assessment of a Brief Course Neurofeedback for Childhood ADHD Symptoms.

Neurofeedback (NFB) is a noninvasive neurocognitive intervention that relies on the principles of operant conditioning to retrain brainwave patterns associated with concentration, relaxation, and attention. When conducting NFB, electrodes are attached to the scalp and connected to a computer, which reads the brain waves. Brain waves in the desired range are reinforced (e.g., earning points), while brain waves outside of the range are punished (e.g., hearing beeping tone). Typical neurofeedback batteries for childhood attention deficit hyperactivity disorder (ADHD) symptoms involve 30–40 neurofeedback sessions, each lasting 30–60 min. NFB can help children with ADHD symptoms learn which brain waves are associated with focused attention and which are not. NFB can involve teaching children to modify specific brainwaves associated with ADHD symptoms. Beta waves (13–30 Hz) are related to concentration and alertness, while alpha (8– 12 Hz) and theta (4–8 Hz) waves are associated with relaxation. Additionally, theta waves are associated with daydreaming and lethargy. Some NFB treatments for ADHD symptoms utilize theta/beta training to increase beta wave activity to target concentration and decrease theta wave activity to target unfocused behavior. Other NFB treatments utilize sensorimotor rhythm (SMR) training (13–15 Hz), a brain wave rhythm associated with relaxation and attentiveness. NFB has received BLevel 1 Best Support^ as an evidence-based treatment for childhood ADHD according to the American Academy of Pediatrics. Receiving this designation means that there have been studies with sufficient sample size indicating that NFB is safe for use with children. It also means that studies have demonstrated that NFB is effective in reducing ADHD symptoms in children. However, evaluations of neurofeedback outside of research trials have been more limited, meaning it is not yet known how laboratory studies translate to real clinical practice.