Michael G. Griffin

Participation in trauma research: Is there evidence of harm?

Few studies have examined the impact of trauma research participation upon trauma survivors. Empirical data regarding reactions to research participation would be very useful to address the question of whether it is harmful for trauma survivors to participate in trauma studies. We examined participant reactions to different trauma assessment procedures in domestic violence (N = 260), rape (N = 108), and physical assault (N = 62) samples. Results indicated that participation was very well tolerated by the vast majority of the trauma survivors. Participants generally found that the assessment experience was not distressing and was, in fact, viewed as an interesting and valuable experience. The findings suggest that trauma survivors are not too fragile to participate in trauma research even in the acute aftermath of a traumatic experience.

How Well Does Cognitive-Behavioral Therapy Treat Symptoms of Complex PTSD? An Examination of Child Sexual Abuse Survivors Within A Clinical Trial

Are brief cognitive-behavioral treatments for posttraumatic stress disorder (PTSD) also effective for the wider range of symptoms conceptualized as complex PTSD? Female rape victims, most of whom had extensive histories of trauma, were randomly assigned to cognitive-processing therapy, prolonged exposure, or a delayed-treatment waiting-list condition. After determining that both types of treatment were equally effective for treating complex PTSD symptoms, we divided the sample of 121 participants into two groups depending upon whether they had a history of child sexual abuse. Both groups improved significantly over the course of treatment with regard to PTSD, depression, and the symptoms of complex PTSD as measured by the Trauma Symptom Inventory. Improvements were maintained for at least 9 months. Although there were group main effects on the Self and Trauma factors, there were no differences between the two groups at posttreatment once pretreatment scores were covaried. These findings indicate that cognitive-behavioral therapies are effective for patients with complex trauma histories and symptoms patterns.

Pattern of Change in Prolonged Exposure and Cognitive-Processing Therapy for Female Rape Victims With Posttraumatic Stress Disorder

Curve estimation techniques were used to identify the pattern of therapeutic change in female rape victims with posttraumatic stress disorder (PTSD). Within-session data on the Posttraumatic Stress Disorder Symptom Scale were obtained, in alternate therapy sessions, on 171 women. The final sample of treatment completers included 54 prolonged exposure (PE) and 54 cognitive-processing therapy (CPT) completers. For both PE and CPT, a quadratic function provided the best fit for the total PTSD, reexperiencing, and arousal scores. However, a difference in the line of best fit was observed for the avoidance symptoms. Although a quadratic function still provided a better fit for the PE avoidance, a linear function was more parsimonious in explaining the CPT avoidance variance. Implications of the findings are discussed.

Trauma Reactivity, Avoidant Coping, and PTSD Symptoms: A Moderating Relationship?

In the immediate aftermath of a traumatic event, many individuals experience physiological reactivity in response to reminders of the traumatic event that typically lessens over time. However, an overreliance on avoidant coping strategies may interfere with the natural recovery process, particularly for those who are highly reactive to trauma reminders. In the current investigation, we examined avoidant coping as a moderator of the association between heart rate reactivity to a trauma monologue measured shortly after a traumatic event and severity of posttraumatic stress disorder (PTSD) symptoms measured several months later. Fifty-five female survivors of assault completed PTSD diagnostic interviews and a self-report coping measure and participated in a trauma monologue procedure that included continuous heart rate measurement. These procedures were completed within 1 month of the assault and again 3 months postassault. After we controlled for the effect of initial symptom levels, the interaction of heart rate reactivity to the trauma monologue and avoidant coping measured at Time 1 was associated with PTSD symptom severity at Time 2. Individuals who are relatively highly reliant on avoidant coping strategies and relatively highly reactive to trauma reminders may be at greatest risk of maintaining or potentially increasing their PTSD symptoms within the first few months following the trauma. These findings may help inform early intervention efforts for survivors of traumatic events.

Beyond Fear The Role of Peritraumatic Responses in Posttraumatic Stress and Depressive Symptoms Among Female Crime Victims

This study examines peritraumatic (and posttrauma) responses in a sample of female crime victims who had been sexually or physically assaulted within the previous 2 months. Women were interviewed about their emotional and behavioral responses during the trauma and assessed for posttraumatic stress disorder and depression symptomatology. Results indicate that women experience a wide range of behavioral and emotional responses during a traumatic event and that these responses have implications for posttrauma adjustment. Women who experienced behaviors typical of a freeze response are more likely to have a greater degree of symptomatology after the assault. Peritraumatic emotions, other than fear, such as sadness, humiliation, and anger, also appear to be related to posttrauma depression symptoms. These findings highlight the necessity of exploring the full range of possible reactions during a trauma.

A comparison of normal forgetting, psychopathology, and information-processing models of reported amnesia for recent sexual trauma

This study assessed memories for sexual trauma in a nontreatment-seeking sample of recent rape victims and considered competing explanations for failed recall. Participants were 92 female rape victims assessed within 2 weeks of the rape; 62 were also assessed 3 months postassault. Memory deficits for parts of the rape were common 2 weeks postassault (37%) but improved over the 3-month window studied (16% still partially amnesic). Hypotheses evaluated competing models of explanation that may account for reported recall deficits. Results are most consistent with information-processing models of traumatic memory.

Norepinephrine modulation of social memory: evidence for a time-dependent functional recovery of behavior.

We tested the hypothesis that central nervous system (CNS) norepinephrine (NE) modulates the ability of an adult male rat to remember significant novel stimuli. Behavioral tests evaluated NE effects on general exploration and social memory. Results were that neither depletion nor elevation of NE impaired general exploration. Findings from the social memory setting suggested that animals tested 2 weeks after NE depletion were unable to discriminate novel from familiar juveniles in situations where untreated controls had no difficulty. Elevation of CNS NE, conversely, produced improved discrimination performance compared with control animals. Results suggest that activation of the CNS NE system is involved in the memory for novel stimuli. Performance of the NE-depleted group tested 3 months after treatment indicates a time-dependent functional recovery can occur in the presence of virtually total CNS NE depletion.

Panic following trauma: the etiology of acute posttraumatic arousal

Two studies examined the contributing factors for panic symptoms following trauma. In Study 1, survivors of sexual and nonsexual assaults (N=105) were assessed at 2 weeks postcrime. Prior trauma, psychiatric history, crime characteristics, and peritraumatic dissociation were assessed. Posttraumatic panic was modestly predicted by childhood sexual abuse (CSA) experiences, a history of Anxiety and Depression, and peritraumatic dissociation. Childhood physical abuse (CPA), Adult Victimization, crime variables, and a prior history of Substance Use disorders and posttraumatic stress disorder (PTSD) were not implicated. In Study 2, the role of peritraumatic panic in predicting later arousal was also examined in a similar sample who were assessed within 6 weeks of their trauma (N=93). Presence of significant arousal during trauma predicted frequency of posttrauma panic attacks, but not its severity. In contrast to Study 1, prior history of PTSD, perception of life threat, and the index trauma being a sexual assault all predicted posttrauma panic, whereas prior trauma exposure and depression did not. These findings are discussed in terms of cognitive and arousal factors that may influence posttrauma panic.

A prospective assessment of auditory startle alterations in rape and physical assault survivors

This study used a prospective design to investigate startle reactivity following trauma exposure. Startle response was evaluated using loud tones during which measures of eyeblink electromyogram (EMG) and heart rate (HR) were collected. Participants were 40 female sexual or physical assault survivors assessed at 1 month and 6 months postassault. There were no significant differences in startle reactivity between posttraumatic stress disorder (PTSD) and non-PTSD groups at the initial assessment. However, at 6 months postassault there was a significantly greater EMG and HR response in the PTSD group as well as a significant increase in startle reactivity from 1 month to 6 months postassault. The findings lend support to a sensitization model of trauma reactivity in which startle response develops over time along with PTSD symptoms.

Stress-induced analgesia: prediction of posttraumatic stress symptoms in battered versus nonbattered women

BACKGROUND Chronic and inescapable trauma is implicated in the stress-induced analgesia (SIA) response. METHODS A sample of 27 chronically battered women was compared with 28 trauma-exposed nonbattered women on their SIA response at 1 month postindex assault. RESULTS For the battered women sample, the SIA response at 1 month postindex assault was found to significantly predict an increase in posttraumatic stress disorder-related hyperarousal at 3 months postindex assault. Furthermore, the battered women showed a significant increase in depression symptoms from 1 to 3 months postindex assault compared with the nonbattered women, who showed a significant decrease. CONCLUSIONS The findings suggest that the chronic and inescapable nature of trauma exposure in the battered women might account for an SIA response that is qualitatively different from that seen in the nonbattered women. It is suggested that the mechanism underlying the SIA response in battered women might be opioid mediated and that it might be responsible for the significant prediction of physiologic hyperarousal. Furthermore, this hyperarousal might moderate the relationship between the SIA response and depression.