Matt J. Gray

Psychometric Properties of the Life Events Checklist.

The Life Events Checklist (LEC), a measure of exposure to potentially traumatic events, was developed at the National Center for Posttraumatic Stress Disorder (PTSD) concurrently with the Clinician Administered PTSD Scale (CAPS) to facilitate the diagnosis of PTSD. Although the CAPS is recognized as the gold standard in PTSD symptom assessment, the psychometric soundness of the LEC has never been formally evaluated. The studies reported here describe the performance of the LEC in two samples: college undergraduates and combat veterans. The LEC exhibited adequate temporal stability, good convergence with an established measure of trauma history—the Traumatic Life Events Questionnaire (TLEQ)— and was comparable to the TLEQ in associations with variables known to be correlated with traumatic exposure in a sample of undergraduates. In a clinical sample of combat veterans, the LEC was significantly correlated, in the predicted directions, with measures of psychological distress and was strongly associated with PTSD symptoms.

Coping style use predicts posttraumatic stress and complicated grief symptom severity among college students reporting a traumatic loss

Problem-focused coping, and active and avoidant emotional coping were examined as correlates of grief and posttraumatic stress disorder (PTSD) severity among 123 college students reporting the unexpected death of an immediate family member, romantic partner, or very close friend. The authors administered to participants, via the Internet, 5 survey instruments that measured demographic characteristics, traumatic event exposure (Stressful Life Events Screening Questionnaire; L. Goodman, C. Corcoran, K. Turner, N. Yuan, & B. L. Green, 1998), complicated grief (CG) severity (Inventory of Complicated Grief-Revised-Short Form; A. E. Latham & H. G. Prigerson, 2004; H. G. Prigerson & S. C. Jacobs, 2001), PTSD severity (PTSD Checklist; F. W. Weathers, B. T. Litz, D. S. Herman, J. A. Huska, & T. M. Keane, 1993), and coping style use (Brief COPE; C. S. Carver, 1997). Results demonstrated that CG and PTSD severity were both significantly positively correlated with problem-focused, and active and avoidant emotional coping styles. The authors used path analysis to control for time since the loss and trauma frequency and found that only avoidant emotional coping remained significant in predicting CG and PTSD severity. Results are discussed in terms of their clinical implications for treating individuals with traumatic losses.

Emotional numbing in posttraumatic stress disorder: current and future research directions

Objective: Despite being understudied and poorly understood relative to the chronic fear, anxiety and other aversive emotional states that occur in the immediate aftermath of trauma, emotional numbing has become a core defining feature of posttraumatic stress disorder (PTSD). Method: This paper seeks to briefly review the literature bearing on these seemingly disparate emotional responses to trauma as well as theoretical accounts of emotional numbing that have been proffered to date. We then offer an alternative theory of posttraumatic emotional functioning and review empirical support for this model. Result: The experience of trauma produces very intense emotions such as overwhelming fear, horror, and anxiety, and these reactions can linger for a lifetime. Many trauma survivors also report restrictions in their emotional experience – a phenomenon most commonly referred to as emotional numbing. In contrast to previous accounts of posttraumatic emotional functioning our model posits that individuals with PTSD have difficulty expressing positive emotions as a result of re-experiencing states. We further argue that patients with PTSD are capable of experiencing and expressing the full range of emotions that were available pretraumatically. Conclusion: Our model holds that individuals with PTSD are not, in fact, ‘emotionally numb’ as a result of traumatic experience. Rather, PTSD is associated with hyperresponsivity to negatively valenced emotional stimuli. Consequently, patients with PTSD require more intense positive stimulation to access the full complement of appetitive or pleasant emotional behaviour.

A longitudinal analysis of PTSD symptom course: delayed-onset PTSD in Somalia peacekeepers.

Posttraumatic stress disorder (PTSD) typically follows an acute to chronic course. However, some trauma victims do not report significant symptoms until a period of time has elapsed after the event. Although originally dismissed as an artifact of retrospective methodologies, recent prospective studies document apparent instances of delayed-onset PTSD. Little is known currently about factors associated with the delayed onset of PTSD. This study was designed to examine the course of PTSD in a sample of 1,040 U.S. military peacekeepers who served in Somalia. A small but nontrivial subset of participants endorsed clinically significant levels of PTSD after a period of minimal distress, the magnitude of which cannot be ascribed to minor waxing and waning of symptoms. War-zone exposure and perceived meaningfulness of the mission, as rated by soldiers after returning to the United States, predicted symptom course over the next 18 months.

Adaptive Disclosure: An Open Trial of a Novel Exposure-Based Intervention for Service Members With Combat-Related Psychological Stress Injuries

We evaluated the preliminary effectiveness of a novel intervention that was developed to address combat stress injuries in active-duty military personnel. Adaptive disclosure (AD) is relatively brief to accommodate the busy schedules of active-duty service members while training for future deployments. Further, AD takes into account unique aspects of the phenomenology of military service in war in order to address difficulties such as moral injury and traumatic loss that may not receive adequate and explicit attention by conventional treatments that primarily address fear-inducing life-threatening experiences and sequelae. In this program development and evaluation open trial, 44 marines received AD while in garrison. It was well tolerated and, despite the brief treatment duration, promoted significant reductions in PTSD, depression, negative posttraumatic appraisals, and was also associated with increases in posttraumatic growth.

Acute psychological impact of disaster and large-scale tauma: limitations of traditional interventions and future practice recommendations.

Nearly everyone will experience emotional and psychological distress in the immediate aftermath of a disaster or other large-scale traumatic event. Although extremely upsetting and disruptive, the reaction is understood best as a human response to inordinate adversity, which in the majority of cases remits over time without formal intervention. Nevertheless, some people experience sustained difficulties. To prevent chronic post-traumatic difficulties, mental health professionals provide early interventions soon after traumatic exposure. These interventions typically take the form of single-session debriefings, which have been applied routinely following disasters. The research bearing on these traditional forms of early crisis interventions has shown that, although well-received by victims, there is no empirical support for their continued use. However, promising evidence-based, early interventions have been developed, which are highlighted. Finally, traumatic bereavement and complicated grief in survivors of disasters, an area largely neglected in the field, is discussed.

Behavioral Interventions for Recent Trauma: Empirically Informed Practice Guidelines.

Despite the successes in the treatment of chronic trauma-related distress, little attention has been devoted to developing behavioral interventions to be delivered soon after traumatic exposure in an effort to promote positive posttraumatic adjustment and to minimize the likelihood of enduring psychopathology. As a result, other forms of early intervention have filled this void and have been widely disseminated and applied, despite the lack of compelling evidence attesting to their efficacy. This article reviews the literature bearing on early interventions for trauma, including the encouraging outcomes of recently developed behavioral treatments. Empirically informed practice guidelines for intervening with recently traumatized individuals are presented. Future treatment development efforts will need to address an issue that has been largely neglected in traditional treatment models for traumatized populations—that of traumatic bereavement. Behavioral interventions may be particularly well-equipped to address this source of distress.

Trauma professionals' attitudes toward and utilization of evidence-based practices

This study was designed to evaluate attitudes toward and utilization of evidence-based practices (EBPs) among mental health professionals specializing in trauma. An Internet survey was completed by 461 trauma professionals who were recruited via International Society for Traumatic Stress Studies membership rolls and electronic mailing lists of trauma special interest groups. Although a minority of participants held negative views of EBPs, the overwhelming majority of respondents were supportive of the EBP movement. Theoretical orientation, training model, and age were associated with EBP attitudes. Favorable EBP attitudes were not as strongly related to reported clinical behaviors as might reasonably be expected. Even respondents utilizing unsupported treatments espoused positive EBP opinions, suggesting that practitioners may hold widely varying evidentiary standards.

Psychopathology Following Interpersonal Violence: A Comparison of Risk Factors in Older and Younger Adults

A randomly selected sample of 549 women age 55 years and older and 2,669 women age 18–34 years was interviewed via telephone to determine prevalences of physical and sexual assault, posttraumatic stress disorder (PTSD) symptomatology, and depression. Prevalences of sexual and physical assaults were lower in older compared to younger women. In addition, given a trauma, prevalences and proportionate risk of posttraumatic psychopathology and depression were also lower for older, relative to younger women. Specifically, multivariate analyses revealed that sexual assault predicted only PTSD avoidance in older adults, but all forms of PTSD symptomatology and depression in younger adult women. Similarly, physical assault predicted only PTSD re-experiencing symptoms in older women, but all forms of PTSD symptoms and depression in younger women. Self-reported health status was not associated with any increased risk of psychopathology, and low income predicted increased avoidance and depression only in younger women.

Rape and Physical Violence: Comparison of Assault Characteristics in Older and Younger Adults in the National Women's Study

This study compared characteristics of recently occurring assaults against younger adults (age 18–34 years) with those of distant-past assaults against older adults (age 55–89 years) when they were younger. Responses of a subset of participants in the National Womens Study were the source of data for this study. With the exception of perceived life threat during assault (more prevalent in younger women), assault characteristics did not vary greatly by age in terms of proportions reporting that they had seen the perpetrator before; the event was one in a series; they or the perpetrator were under the influence of a substance; they actually experienced injury; and they reported the assault to authorities. Consistent with previous research, younger women reported greater prevalences of assault than older women.