Megan C. Kearns

Early Intervention May Prevent the Development of Posttraumatic Stress Disorder: A Randomized Pilot Civilian Study with Modified Prolonged Exposure

BACKGROUND Posttraumatic stress disorder (PTSD) is a major public health concern with long-term sequelae. There are no accepted interventions delivered in the immediate aftermath of trauma. This study tested an early intervention aimed at modifying the memory to prevent the development of PTSD before memory consolidation. METHODS Patients (n = 137) were randomly assigned to receive three sessions of an early intervention beginning in the emergency department compared with an assessment only control group. Posttraumatic stress reactions (PTSR) were assessed at 4 and 12 weeks postinjury and depression at baseline and week 4. The intervention consisted of modified prolonged exposure including imaginal exposure to the trauma memory, processing of traumatic material, and in vivo and imaginal exposure homework. RESULTS Patients were assessed an average of 11.79 hours posttrauma. Intervention participants reported significantly lower PTSR than the assessment group at 4 weeks postinjury, p < .01, and at 12 weeks postinjury, p < .05, and significantly lower depressive symptoms at week 4 than the assessment group, p < .05. In a subgroup analysis, the intervention was the most effective at reducing PTSD in rape victims at week 4 (p = .004) and week 12 (p = .05). CONCLUSIONS These findings suggest that the modified prolonged exposure intervention initiated within hours of the trauma in the emergency department is successful at reducing PTSR and depression symptoms 1 and 3 months after trauma exposure and is safe and feasible. This is the first behavioral intervention delivered immediately posttrauma that has been shown to be effective at reducing PTSR.

DBT-enhanced cognitive-behavioral treatment for trichotillomania: A randomized controlled trial

Background and aims Limited treatment options are available for trichotillomania (TTM) and most have modest outcomes. Suboptimal treatment results may be due to the failure of existing approaches to address all TTM styles. Methods Thirty-eight DSM-IV TTM participants were randomly assigned across two study sites to Dialectical Behavior Therapy (DBT) -enhanced cognitive-behavioral treatment (consisting of an 11-week acute treatment and 3-month maintenance treatment) or a minimal attention control (MAC) condition. MAC participants had active treatment after the 11-week control condition. Follow-up study assessments were conducted three and six months after the maintenance period. Results Open trial treatment resulted in significant improvement in TTM severity, emotion regulation (ER) capacity, experiential avoidance, anxiety and depression with changes generally maintained over time. In the randomized controlled trial, those with active treatment had greater improvement than those in the MAC condition for both TTM severity and ER capacity. Correlations between changes in TTM severity and ER capacity were not reported at post-treatment but did occur in maintenance and follow-up indicating reduced TTM severity with improved ER capacity. Conclusions DBT-enhanced cognitive-behavioral treatment is a promising treatment for TTM. Future studies should compare this approach to other credible treatment interventions and investigate the efficacy of this approach in more naturalistic samples with greater comorbidity.

Avoidant Coping and Treatment Outcome in Rape-Related Posttraumatic Stress Disorder.

OBJECTIVE This study investigated the impact of avoidant coping on treatment outcome in rape-related posttraumatic stress disorder (PTSD). METHOD Adult women with rape-related PTSD (N = 62) received 9 sessions of prolonged exposure (PE) or eye movement desensitization and reprocessing (EMDR). The mean age for the sample was 34.7 years, and race or ethnicity was reported as 67.7% Caucasian, 25.8% African American, 3.2% Latina, and 3.2% other. PTSD was assessed with the PTSD Symptom Scale-Self-Report (Foa, Riggs, Dancu, & Rothbaum, 1993), and avoidant coping was assessed using the Coping Strategies Inventory-Disengagement subscale (CSI-D; Tobin, Holroyd, Reynolds, & Wigal, 1989). RESULTS Pretreatment avoidant coping was negatively associated with posttreatment PTSD symptom severity even when controlling for initial severity of total PTSD symptoms and when removing PTSD avoidance symptoms from the analysis to account for potential overlap between avoidant coping and PTSD avoidance symptoms: ΔR2 = .08, b* = -0.31, 95% CI [-0.17, -0.01], t(60) = -2.27, p = .028. The CSI-D pretreatment mean score of 100 predicted a 96% likelihood of experiencing clinically significant change (CSC) during treatment. A CSI-D pretreatment score of 61 was associated with a 40% likelihood of experiencing CSC. CONCLUSIONS PE and EMDR appear to be beneficial for women who frequently engage in avoidant coping responses following rape. A small subset of women with initially low levels of avoidant coping are unlikely to experience a therapeutic response from PE or EMDR.

Emergency Department Predictors of Posttraumatic Stress Reduction for Trauma-Exposed Individuals With and Without an Early Intervention

OBJECTIVE Recent data have supported the use of an early exposure intervention to promote a reduction in acute stress and posttraumatic stress disorder (PTSD) symptoms after trauma exposure. The present study explored a comprehensive predictive model that included history of trauma exposure, dissociation at the time of the trauma and early intervention, and physiological responses (cortisol and heart rate) to determine which variables were most indicative of reduced PTSD symptoms for an early intervention or treatment as usual. METHOD Participants (n = 137) were randomly assigned to the early intervention condition (n = 68) or assessment-only condition (n = 69) while receiving care at the emergency department of a Level 1 trauma center. Follow-up assessments occurred at 4 and 12 weeks posttrauma. RESULTS Findings suggested that dissociation at the time of the 1st treatment session was associated with reduced response to the early intervention. No other predictors were associated with treatment response. For treatment as usual, cortisol levels at the time of acute care and dissociation at the time of the traumatic event were positively associated with PTSD symptoms. CONCLUSIONS Dissociation at the time at which treatment starts may indicate poorer response to early intervention for PTSD. Similarly, dissociation at the time of the event was positively related to PTSD symptoms in those who received treatment as usual.

Sexual revictimization and interpersonal effectiveness.

This study utilized a cross-sectional design in order to explore the relationship between interpersonal effectiveness, defined as level of assertiveness, social perception, and perceived self-efficacy, and repeated sexual victimization in adolescence and adulthood. In addition, we compared global versus situation-specific measures of interpersonal effectiveness. Results indicated that global measures of interpersonal effectiveness failed to differentiate victim groups, and there were also no group differences in social perception. However, on situation-specific measures, revictimized women were significantly lower than nonvictims on sexual assertiveness and sexual self-efficacy. These results support the hypothesis that interpersonal functioning is related to sexual revictimization and highlight the need to measure interpersonal functioning specifically in sexual situations as it relates to women’s sexual assault history.

Disclosure of Sexual Victimization: The Effects of Pennebaker's Emotional Disclosure Paradigm on Physical and Psychological Distress

Research suggests that many sexual assault survivors do not disclose their experience, which may increase associated distress. Pennebakers emotional disclosure paradigm has been shown to ameliorate psychological and physical distress in individuals exposed to stressful events. The current study assessed the effectiveness of this paradigm with sexual assault survivors (N = 74). College women with a history of sexual assault wrote about their most severe victimization or about how they spend their time (control). Then 73 women (98.6%) completed a 1-month follow-up assessment. Results indicated that across writing sessions, the disclosure group reported greater reductions in negative mood immediately post-writing. However, both groups showed significant reductions in physical complaints, psychological distress, and traumatic stress symptoms at the 1-month follow-up, suggesting no added benefit to disclosure of a sexual assault using a brief written paradigm.

Dating violence and injury among youth exposed to violence

OBJECTIVES: To assess gender differences in the proportion of adolescents reporting teen dating violence (TDV) and the frequency of TDV at multiple age points across adolescence in a high-risk sample of youth with previous exposure to violence. METHODS: A cross-sectional, high-risk sample of boys and girls (n = 1149) ages 11 to 17 years completed surveys assessing TDV and self-defense. Indices of TDV included perpetration and victimization scales of controlling behaviors, psychological TDV, physical TDV, sexual TDV, fear/intimidation, and injury. RESULTS: More girls reported perpetrating psychological and physical TDV, whereas twice as many boys reported sexual TDV perpetration. More girls reported fear/intimidation victimization than boys. When comparing the frequency of TDV across adolescence, boys reported more sexual TDV victimization at younger ages, and girls demonstrated a trend toward more victimization at older ages. Likewise, younger boys reported more fear/intimidation and injury perpetration and injury victimization than younger girls. However, by age 17, girls reported more injury perpetration than boys, and reports of injury victimization and use of self-defense did not differ. Notably, despite potential parity in injury, girls consistently reported more fear/intimidation victimization associated with TDV. CONCLUSIONS: Contrary to data suggesting that girls experience far more sexual TDV and injury, these data suggest that at specific times during adolescence, boys among high-risk populations may be equally at risk for victimization. However, the psychological consequences (fear) are greater for girls. These findings suggest a need to tailor strategies to prevent TDV based on both age- and gender-specific characteristics in high-risk populations.

The mediating role of trauma-related symptoms in the relationship between sexual victimization and physical health symptomatology in undergraduate women

Previous research suggests that posttraumatic stress symptomatology is a partial mediator of the relationship between sexual assault history in adolescence/adulthood and physical health symptomatology (e.g., Eadie, Runtz, & Spencer-Rodgers, 2008). The current study assessed a broader, more inclusive potential mediator, trauma-related symptoms in the relationship between sexual victimization history (including both childhood and adolescent/adulthood sexual victimizations) and physical health symptomatology in a college sample. Participants were 970 young women (M = 18.69, SD = 1.01), who identified mostly as Caucasian (86.7%), from 2 universities who completed a survey packet. Path analysis results provide evidence for trauma-related symptoms as a mediator in the relationship between adolescent/adulthood sexual assault and physical health symptomatology, χ(2) (1, N = 970) = 1.55, p = .21; comparative fit index = 1.00; Tucker-Lewis index = 0.99; root mean square error of approximation = .02, 90% confidence interval [.00, .09], Bollen-Stine bootstrap statistic, p = .29. Childhood sexual abuse was not related to physical health symptomatology, but did predict trauma-related symptoms. Implications of these findings suggest that college health services would benefit from targeted integration of psychiatric and medical services for sexual assault survivors given the overlap of psychological and physical symptoms.

Predictors of victim-perpetrator relationship stability following a sexual assault: a brief report.

The researchers assessed the predictors of victim–perpetrator relationship stability following a sexual assault. Participants included 254 women sexually assaulted by a friend, casual dating partner, or steady dating partner. Results suggested that most victim–perpetrator relationships (75%) continued following the sexual assault. Greater trauma symptomatology, less perpetrator blame, and nondisclosure of the assault by victims predicted relationship continuation with the perpetrator. Additionally, the odds of continuing the relationship were greater following acts of sexual coercion than following acts of completed rape. Close relationships (steady dating partner) were more likely to continue following the sexual assault than less close relationships (friends and casual dating partners). Unexpectedly, the odds of relationship stability were greater for women without histories of childhood sexual abuse than women with histories of childhood sexual abuse. Implications for future research and intervention are discussed.

The Contributions of Prior Trauma and Peritraumatic Dissociation to Predicting Post-Traumatic Stress Disorder Outcome in Individuals Assessed in the Immediate Aftermath of a Trauma

Objective This study analyzed predictors of post-traumatic stress disorder (PTSD) in civilian trauma victims to assess how peritraumatic dissociation (PD) relates to PTSD symptom development. We examined PD and PTSD symptoms from a prior trauma simultaneously to better understand the extent to which past and current reactions to a trauma can predict the development of PTSD for a current trauma. Methods Participants (N=48) were recruited from the emergency department (ED) of a large, southeastern hospital and assessed immediately after a trauma and again at 4 weeks and 12 weeks post-trauma. We used both self-report and interviewer-based questionnaires to assess PD and PTSD symptoms for prior and current trauma. Results A hierarchical linear regression revealed that at 4-week follow up, when controlling for several demographic variables and trauma type, a model including both PD and PTSD symptoms from a prior trauma significantly predicted PTSD outcome (F(47)= 3.70, p=0.00), with PD and prior PTSD symptoms significantly contributing 17% and 9% of variance respectively. At 12 weeks, PTSD symptoms from prior trauma (β=0.094, p=0.538) and PD (β=−0.017, p=0.909) did not account for a significant proportion of the variance in PTSD for the enrolling trauma. Conclusion Prior and current reactions to trauma are both important factors in predicting the development of PTSD symptoms to a current trauma. The more immediate measurement of PD during presentation to the ED may explain the strength of its relationship to PTSD symptom development. Furthermore, our findings support the use of PTSD symptoms of a past trauma, as opposed to trauma frequency, as a predictor of PTSD from a subsequent trauma. Methodological limitations and future directions are discussed.