Rolf J. Kleber

Brief psychotherapy for posttraumatic stress disorders.

A large-scale study of the effectiveness of psychotherapeutic methods for the treatment of posttraumatic stress disorders was conducted. The sample consisted of 112 persons suffering from serious disorders resulting from traumatic events (bereavement, acts of violence, and traffic accidents) that had taken place not more than 5 years before. Trauma desensitization, hypnotherapy, and psychodynamic therapy were tested for their effectiveness in comparison with a waiting-list control group. The results indicated that treated cases were significantly lower in trauma-related symptoms than the control group.

Construct Validation of the Dutch Version of the Impact of Event Scale

The Impact of Event Scale (ES; M. J. Horowitz, N. Wilner, & W. Alvarez, 1979) is a worldwide-used self-report measure to assess the frequency of intrusive and avoidant phenomena after a variety of traumatic experiences. The purpose of this article is to assess the psychometric value of the Dutch version of the IES (D. Brom & R. J. Kleber, 1985) in several samples of individuals who had experienced various traumatic stressors. The reliability and structure of the IES were evaluated in 3 different samples (total N = 1.588). The reliability of the Dutch version of the IES was adequate across the various stressors. The construct validity was assessed by using confirmatory factor analyses. Outcomes revealed a robust structure over the various samples, generally supporting the composition of the original IES.

Acute and chronic job stressors among ambulance personnel : Predictors of health symptoms

Objectives: To predict symptomatology (post-traumatic distress, fatigue, and burnout) due to acute and chronic work related stressors among ambulance personnel. Methods: Data were gathered from 123 ambulance workers in The Netherlands in a longitudinal design. At two measurements they completed standardised questionnaires to assess health symptoms, such as the Impact of Event Scale, the Maslach Burnout Inventory, and the Checklist Individual Strength. Acute stressors were assessed with specific questions, and chronic work related stressors were measured with the Questionnaire on the Experience and Assessment of Work. Results: Most of the ambulance workers had been confronted with acute stressors in their work. They also reported more chronic work related stressors than a reference group. Of the participants, more than a tenth suffered from a clinical level of post-traumatic distress, a tenth reported a fatigue level that put them at high risk for sick leave and work disability and nearly a tenth of the personnel suffered from burnout. Best predictors of symptomatology at time 2 were lack of social support at work and poor communication, such as not being informed about important decisions within the organisation. Conclusions: Ambulance personnel are at risk to develop health symptoms due to work related stressors. Although, acute stressors are related to health symptoms, such as fatigue, burnout, and post-traumatic symptoms, it was not found to predict health symptoms in the long term. Main risk factors have to do with social aspects of the work environment, in particular lack of support from the supervisor as well as colleagues and poor communication. When implementing workplace interventions these social aspects need to be taken into account.

Victims of traffic accidents: Incidence and prevention of post-traumatic stress disorder

The psychological consequences of traffic accidents have been rarely the subject of research. Responses of serious traffic accidents and the effects of an outreach program for victims were studied in a research project. Subjects selected from police registers participated in a preventive counseling program or in a monitoring group. Foci of this study were the way in which the subjects coped with the event and the symptoms that might develop. Measurements were carried out 1 month and 6 months after the accident. The results indicate that an average of about 10% of the victims suffer from post-traumatic stress disorders and that although counseling is appreciated by victims, it could not be proven that it was effective in preventing disorders.

Multigenerational Perspectives on Coping with the Holocaust Experience: An Attachment Perspective for Understanding the Developmental Sequelae of Trauma across Generations

In this paper, we advance a new approach to the intergenerational transmission of Holocaust experiences, by focusing on attachment theory. The approach is used as a framework for interpretation of the results of three studies on Holocaust survivors and their offspring, from different countries (The Netherlands, Canada, and Israel), and based on different conceptual approaches and methods of data collection (quantitative as well as qualitative). The literature is divided with regard to the extent and depth of long-term effects of the Holocaust. Attachment theory allows the integration of the phenomena of attachment, separation, and loss, which appear to be core concepts in the three studies presented here. The notion of insecure-ambivalent attachment sheds some light on the observed preoccupation with issues of attachment and separation in the second generation. Furthermore, the theme of “the conspiracy of silence” is discussed in the context of attachment disorganisation. Attachment theory transcends the traditional boundaries between clinical and nonclinical interpretations, in stressing the continuous and cumulative nature of favourable and unfavourable child-rearing circumstances. In this context, insecure attachment should be regarded as coping with suboptimal child-rearing environments.

Building child trauma theory from longitudinal studies: a meta-analysis.

Many children are exposed to traumatic events, with potentially serious psychological and developmental consequences. Therefore, understanding development of long-term posttraumatic stress in children is essential. We aimed to contribute to child trauma theory by focusing on theory use and theory validation in longitudinal studies. Forty studies measuring short-term predictors and long-term posttraumatic stress symptoms were identified and coded for theoretical grounding, sample characteristics, and correlational effect sizes. Explicit theoretical frameworks were present in a minority of the studies. Important predictors of long-term posttraumatic stress were symptoms of acute and short-term posttraumatic stress, depression, anxiety, and parental posttraumatic stress. Female gender, injury severity, duration of hospitalization, and elevated heart rate shortly after hospitalization yielded small effect sizes. Age, minority status, and socioeconomic status were not significantly related to long-term posttraumatic stress reactions. Since many other variables were not studied frequently enough to compute effect sizes, existing theoretical frameworks could only be partially confirmed or falsified. Child trauma theory-building can be facilitated by development of encouraging journal policies, the use of comparable methods, and more intense collaboration.

Delayed Posttraumatic Stress Disorder: Systematic Review, Meta-Analysis, and Meta-Regression Analysis of Prospective Studies

OBJECTIVE Prevalence estimates of delayed posttraumatic stress disorder (PTSD) have varied widely in the literature. This study is the first to establish the prevalence of delayed PTSD in prospective studies and to evaluate associated factors through meta-analytic techniques. DATA SOURCES Studies were located by an electronic search using the databases EMBASE, MEDLINE, and PsycINFO. Search terms were posttraumatic stress disorder [include all subheadings] AND (delayed OR prospective OR longitudinal OR follow-up). Results were limited to journal articles published between 1980 and April 4, 2008. STUDY SELECTION We included longitudinal, prospective studies of humans exposed to a potentially traumatic event that assessed participants at 1 to 6 months after the event, that included a follow-up of at least 12 months after the event, and that specified rates of new onset and remission between assessments in study completers. DATA EXTRACTION Data were extracted concerning the study design, demographic features, and event-related characteristics and the number of PTSD cases at first assessment, the number of PTSD cases among study dropouts, and the number of new event-related PTSD cases at each subsequent assessment among study completers. Data from 24 studies were included. Four of these provided additional data on initial subthreshold PTSD and subsequent risk of delayed PTSD. DATA SYNTHESIS The proportion of PTSD cases with delayed PTSD was 24.8% (95% CI = 22.6% to 27.2%) after adjusting for differences in study methodology, demographic features, and event-related characteristics. Military combat exposure, Western cultural background, and lower cumulative PTSD incidence were associated with delayed PTSD. Participants with initial subthreshold PTSD were at increased risk of developing delayed PTSD. CONCLUSIONS Delayed PTSD was found among about a quarter of PTSD cases and represents exacerbations of prior symptoms.

Western Conceptualizations and Eastern Experience: A Cross-Cultural Study of Traumatic Stress Reactions Among Tibetan Refugees in India

This study investigated the nature and impact of traumatic experiences among Tibetan refugees in India. It explored the applicability of western conceptualizations of reactions to traumatic events among this cultural group. A randomly selected sample of refugee camp students was assessed on measures of psychological and physical complaints, and on impact as well as severity of traumatic experiences. Respondents had experienced multiple traumatic events. The majority reported ongoing health problems. More than half demonstrated symptoms of intrusion–avoidance. Those with more traumatic experiences reported more symptoms of anxiety and depression (psychologically and, particularly, somatically manifested). Cultural differences in types of experienced traumatic events and manifestations of distress are discussed, as are implications for cross-cultural trauma research using western conceptualizations and instruments.

The trauma of war in Sierra Leone

Civilians are increasingly targeted in todays wars. To reduce military casualties, civilians are used as protective shields; to facilitate guerrilla warfare, they are abducted or enslaved; torture, rape, and executions are carried out to undermine morale and to eradicate the cultural links and self-esteem of the population. Most civilians in zones of conflict witness war-related traumatic events such as shootings, killings, rape, and loss of family members. The extent of psychosocial problems that results from this mass exposure to traumatic events may ultimately threaten the prospects for long-term stability in society.

Childbirth and Posttraumatic Stress Responses

Childbirth has been identified as a possible traumatic experience, leading to traumatic stress responses and even to the development of posttraumatic stress disorder (PTSD). The current study investigated the psychometric properties of the Dutch version of the Impact of Event Scale-Revised (IES-R) in a group of women who recently gave birth (N = 435). In addition, a comparison was made between the original IES and the IES-R. The scale showed high internal consistency (α = 0.88). Using confirmatory factor analysis no support was found for a three-factor structure of an intrusion, an avoidance, and a hyperarousal factor. Goodness of fit was only reasonable, even after fitting one intrusion item on the hyperarousal scale. The IES-R correlated significantly with scores on depression and anxiety self-rating scales, as well as with scores on a self-rating scale of posttraumatic stress disorder. Although the IES-R can be used for studying posttraumatic stress reactions in women who recently gave birth, the origi...