Loretta S. Malta

A controlled evaluation of cognitive behaviorial therapy for posttraumatic stress in motor vehicle accident survivors

Seventy-eight motor vehicle accident survivors with chronic (greater than 6 months) PTSD, or severe sub-syndromal PTSD, completed a randomized controlled comparison of cognitive behavioral therapy (CBT), supportive psychotherapy (SUPPORT), or a Wait List control condition with two detailed assessments. Scores on the CAPS showed significantly greater improvement for those in CBT in comparison to the Wait List and to the SUPPORT conditions. The SUPPORT condition in turn was superior (p=0.012) to the Wait List. Categorical diagnostic data showed the same results. An analysis of CAPS scores including drop-outs (n=98) also showed CBT to be superior to Wait List and to SUPPORT with a trend for SUPPORT to be superior to Wait List. The CBT condition led to significantly greater reductions in co-morbid major depression and GAD than the other two conditions. Results held up well at a 3-month follow-up on the two active treatment conditions.

Two studies of psychiatric morbidity among motor vehicle accident survivors 1 year after the crash.

We assessed the psychiatric co-morbidity associated with chronic posttraumatic stress disorder (PTSD) (1-2 years) secondary to personal injury motor vehicle accidents (MVAs) in two studies. In Study 1, we compared the results of SCID assessments for 75 treatment-seeking MVA survivors (51 with PTSD and 24 with symptoms but no PTSD). In Study 2, we compared similar results among 132 MVA survivors who had been followed prospectively for 12+ months after their accidents (19 with PTSD, 32 who had PTSD but who had remitted, and 81 who never met criteria for PTSD). We found comparable levels of current co-morbid major depression (53%), any mood disorder (62-68%), generalized anxiety disorder (26%) and any anxiety disorder (42%) for both groups of participants with chronic PTSD. These rates of co-morbidity were higher than those found in non-PTSD comparison groups with similar MVA histories.

Changes in Physiological Arousal to Gambling Cues Among Participants in Motivationally Enhanced Cognitive–Behavior Therapy for Pathological Gambling: A Preliminary Study

Despite somewhat high attrition and relapse rates, cognitive–behavioral interventions for pathological gambling seem promising. As a possible remedy to these problems, we conducted a preliminary study of gambling-specific cognitive–behavior therapy (CBT) with the addition of motivational enhancement techniques (MET) for the treatment of pathological gamblers. Data on psychophysiological arousal upon exposure to imagined gambling vignettes were collected at both pre- and posttreatment. Results indicate that participants showed decreases in degree of arousal during the vignettes from pre- to posttreatment. There was also a strong dose–response relationship between reductions in gambling symptoms and reductions in arousal. These findings are discussed, as are their implications for further study of pathological gambling.

Psychometric properties of a measure of aggressive driving: the Larson Driver's Stress Profile

This paper presents three studies on Larsons 1996 Drivers Stress Profile, a measure of aggressive driving tendencies. In Study 1, utilizing 33 individuals (15 men, 18 women) who took the test twice with one week between tests, we found the test to have good test-retest reliability (r = .93). In Study 2, utilizing 176 individuals (77 men, 99 women), we found different preliminary norms for men and women and good internal consistency (.93). We also found significant correlation between the total test scores and age (r = −.27) and a significant correlation (age corrected) between total test scores and number of self-reported MVAs (r = .28). An exploratory factor analysis indicated that three factors, including 28 of the 40 items, accounted for 43.4% of the variance. In Study 3, utilizing the same subjects as in Study 2 (84 individuals from the community of average age 35.3 yr.; 92 college students of average age 18.9 yr.), we found the full scale scores correlated significantly with scores on Trait Anger and Anger Out and Type A Behavior, especially speed and impatience. Finally, scores correlated significantly with the Deffenbacher Driving Anger Scale (r = .57) but clearly tapped processes different, in part, from those measured by the Deffenbacher, et al. scale (1994). Overall, the Drivers Stress Profile appears to be a sound, reliable, and valid scale for use with aggressive driving.

Psychophysiological assessment of compulsive gamblers' arousal to gambling cues: a pilot study.

Psychophysiological assessments measuring heart rate, systolic and diastolic blood pressure, and skin resistance level were conducted on 7 male compulsive gamblers and on 7 age and gender matched controls while both groups performed mental arithmetic and listened to individualized tapes of the gamblers preferred form of gambling and an individualized fear tape. Heart rate responses of the gamblers to the 2 gambling audiotapes were significantly greater than those found for the controls whereas the groups did not differ on mental arithmetic or the fear provoking scene, confirming some degree of cue-specific arousal in gamblers. The other physical responses did not yield such strong results. If physiological arousal provides the motivational basis for gambling and is maintained on an intermittent schedule of reinforcement, the findings may have implications for the treatment of compulsive gambling.

One- and two-year prospective follow-up of cognitive behavior therapy or supportive psychotherapy.

We followed up over 90% of 57 motor vehicle accident survivors, who completed a controlled comparison of cognitive behavioral therapy (CBT) to supportive psychotherapy (SUPPORT). One-year results showed a continued significant advantage on categorical diagnosis (PTSD or not) and structured interview measures (CAPS) for CBT over SUPPORT. Other measures generally showed the same results. At two years, we were able to follow-up only 75% of one-year completers. Although there continued to be arithmetic differences favoring CBT over SUPPORT, with these attenuated samples only differences on PTSD Checklist and Impact of Event Scale scores and in overall categorical diagnoses were significant. There was very modest improvement from end of treatment to the two-year follow-up.

Prediction of response to psychological treatment among motor vehicle accident survivors with PTSD

We sought to predict posttreatment PTSD symptom scores (Clinician-Administered PTSD Scale scores) among motor vehicle accident (MVA) survivors with PTSD who had received either cognitive behavioral treatment (CBT; n = 30) or supportive psychotherapy (SUPPORT; n = 27) using pretreatment variables. We could account for 43% (CBT) to 70% (SUPPORT) of variance in the measure of PTSD symptoms. The most consistent predictors were pretreatment PTSD symptom scores. Comorbid conditions, especially depression, and degree of initial impairment were also significant predictors.

Psychophysiological Reactivity of Aggressive Drivers: An Exploratory Study

In the United States, motor vehicle accidents are the leading cause of accidental death and injury. Aggressive driving, which has been identified as a major risk factor for motor vehicle accidents by transportation authorities, is thus an important topic of study. This study compared the physiological reactivity of self-referred aggressive and nonaggressive drivers. Heart rate, blood pressure, facial muscle activity, and skin resistance were monitored as participants listened to idiosyncratic vignettes of driving and fear-provoking scenarios, as well as during a standard stressor task (mental arithmetic). The results were that aggressive drivers exhibited significant increases in muscle tension and blood pressure during the driving vignettes, relative to controls. They also responded to the fear vignette and mental arithmetic in a qualitatively different fashion from that of controls. The aggressive drivers responded to these stimuli with less overall heart rate and electrodermal reactivity, but increased blood pressure and muscle tension. In contrast, the controls responded to the fear vignette and mental arithmetic primarily with increased heart rates and decreased skin resistance. The findings suggest that both physiological hyperarousal as well as differential responses to stressful stimuli may contribute to aggressive driving. Implications for interventions with this population are discussed.

The psychophsiology of aggressive drivers: comparison to non-aggressive drivers and pre- to post-treatment change following a cognitive-behavioural treatment

Twenty drivers were remanded to our treatment program by the courts following arrests related to serious aggressive driving behaviors. Ten additional drivers entered our program in response to our advertisements thus identifying themselves as aggressive drivers. Psychophysiological assessments were conducted on all 30 drivers and heart rate (HR), systolic and diastolic blood pressure (SBP and DBP), and skin resistance level (SRL) were measured in response to exposure to a mental arithmetic neutral stressor, two idiosyncratic, audio-taped, aggressive driving vignettes (audio 1 and audio 2), and one non-driving related fearful vignette. Fourteen non-aggressive driving controls also completed the assessment. The results indicated that the aggressive drivers (ADs) showed significantly more SBP responsivity during audio 1 and audio 2 and significantly less SBP reactivity during the mental arithmetic stressor than the controls. The aggressive drivers then completed a four-week, group intervention which included relaxation techniques specifically targeting aggressive driving behaviors. The same psychophysiological assessment was conducted at post-treatment. The results showed significant pre- to post-treatment decreases in HR, p<0.003, SBP, p<0.01, and DBP, p<0.02 during audio 1. Similarly, decreases were evident in audio 2 in SBP, p<0.03 only. No decreases in reactivity occurred during the neutral stressor or fearful situation.