Sherry A. Falsetti

Screening for PTSD in a substance abuse sample: Psychometric properties of a modified version of the PTSD symptom scale self-report

The high rate of posttraumatic stress disorder (PTSD) among substance use disorder (SUD) patients has been documented in research protocols, but there is evidence that it is markedly under-diagnosed in clinical settings. To address the need for a brief self-report measure to identify SUD patients who may benefit from further assessment and/or treatment for PTSD, the psychometric properties of a modified version of the PTSD Symptom Scale Self-Report (PSSSR) were examined in a treatment-seeking SUD sample (N = 118). The modified version of the PSS-SR, which measures both frequency and severity of PTSD symptoms, demonstrated good internal consistency reliability and was correlated with other self-report measures of trauma-related symptomatology. Comparisons between a structured PTSD diagnostic interview and the modified PSS-SR indicated that 89% of the PTSD positive patients were correctly classified by the modified PSS-SR. The clinical relevance of these findings was discussed.

Frequency and Severity of Panic Attack Symptoms in a Treatment Seeking Sample of Trauma Victims

This study assessed the frequency and seventy of panic attack symptoms and panic attacks that develop in relation to the experience of traumatic events in 62 subjects seeking treatment for trauma-related symptomatology. Results indicated a high incidence of panic attacks (69%). Many individuals also thought they were going crazy or losing control (72%) or having a heart attack (38%) within the 2 weeks prior to assessment. These findings indicate that similar to panic disordered patients, many trauma victims with posttraumatic stress disorder (PTSD) not only experience physiological symptoms of panic, but are also fearful of these symptoms.

Experience with anxiety and depression treatment studies: implications for designing irritable bowel syndrome clinical trials

This report highlights various considerations regarding the potential effects of concurrent psychiatric conditions and a history of abuse in patient volunteers for clinical trials in irritable bowel syndrome (IBS). Even though many studies have used psychological rating scales to assess personality and psychological traits of patients with IBS, the prevalence of the different psychiatric diagnoses (i.e., categorical assessment) in patients with IBS has only recently been assessed systematically. Recent studies of treatment-seeking patients have indicated that the majority of individuals (50% to 90%) who seek treatment for IBS have a lifetime history or currently have one or more common psychiatric conditions: major depressive disorder, generalized anxiety disorder, panic disorder, social phobia, somatization disorder, and posttraumatic stress disorder. Traditional clinical wisdom is that the presence of a psychiatric disorder increases the likelihood that an IBS patient will seek treatment. However, recent data suggest that IBS and psychiatric disorders are associated regardless of treatment-seeking status. Patients with psychiatric disorders should be included in clinical IBS studies, because this reflects the actual patient population. Extrapolating from the psychiatric literature, inclusion of patients with IBS with mild to moderate anxiety or depression is warranted.

Cognitive behavioral treatment of PTSD with comorbid panic attacks

Many individuals that experience traumatic events such as sexual and physical assault develop posttraumatic stress disorder (PTSD). More recently, research has indicated that a significant proportion of PTSD sufferers may also have comorbid panic attacks. Although there are several effective treatments that focus on alleviating PTSD symptoms, until now there were no treatments that focused on also treating comorbid panic attacks. Multiple channel exposure therapy (M-CET) is the first treatment developed to specifically treat comorbid PTSD and panic attacks. It is also unique in that it has been used to treat women who have multiple trauma histories as well as a wide range of different types of traumatic event exposure in a group format. This treatment is described in a session by session format and special considerations in implementing the treatment are discussed.

Violent Crime and Mental Health

Violent crime has become one of the most significant concerns among people today (Kilpatrick, Seymour, & Boyle, 1991), and rates of violent crime have risen substantially in America as well as in other countries around the world (Reiss & Roth, 1993; Rosenberg & Fenley, 1991). Many Americans have been victims of violent crime sometime during their lives, and many other Americans, who have not yet been victimized, fear becoming violent crime victims in the future (Kilpatrick et al., 1991). This fear of crime among Americans is not unfounded. In 1990, more than 23,000 people in the United States were homicide victims (Reiss & Roth, 1993), and over 6 million violent crimes were disclosed to interviewers from the National Crime Victimization Survey (Bureau of Justice Statistics, 1990). As a consequence, violent crime and fear of violent crime have become important antecedents of fear and anxiety in America. Moreover, violent crime is a predominant contributing factor to the development of mental health problems, most commonly, posttraumatic stress disorder (PTSD) (Breslau, Davis, Andreski, & Peterson, 1991; Kilpatrick et al., 1989; Resnick, Kilpatrick, Dansky, Saunders, & Best, 1993).

Utility of the Trauma Symptom Inventory’s Atypical Response Scale in Detecting Malingered Post-Traumatic Stress Disorder

The authors examined the Trauma Symptom Inventory’s (TSI) ability to discriminate 88 student post-traumatic stress disorder (PTSD) simulators screened for genuine PTSD from 48 clinical PTSD-diagnosed outpatients. Results demonstrated between-group differences on several TSI clinical scales and the Atypical Response (ATR) validity scale. Discriminant function analysis using ATR revealed 75% correct patient classification but only 48% correct simulator classification, with an overall correct classification rate of 59% (positive predictive power [PPP] = .71; negative predictive power [NPP] = .51). Individual ATR cutoff scores did not yield impressive classification results, with the optimal cutoff (T score = 61) correctly classifying only 61% of simulators and patients (PPP = .66, NPP = .54). Although ATR was not developed as a malingered PTSD screen, instead serving as a general validity screen, caution is recommended in its current clinical use for detecting malingered PTSD.

Multiple Channel Exposure Therapy for Women with PTSD and Comorbid Panic Attacks

Multiple channel exposure therapy (M‐CET; Falsetti & Resnick, 2000) was developed to treat posttraumatic stress disorder (PTSD) with comorbid panic attacks and can be administered in a group format. In addition to being a cost‐effective way to provide treatment, group treatment for those with PTSD has been proposed as potentially very beneficial for addressing feelings of shame related to the traumatic event as well as social isolation in general (Foy et al., 2000). Previous studies of M‐CET indicate that it may be effective for the treatment of PTSD with comorbid panic attacks (Falsetti et al., 2001, 2003, 2005). The authors examine the relationship of PTSD and panic symptoms pre‐ and posttreatment and present 6‐month follow‐up data on the long‐term effectiveness of M‐CET.

Multiple channel exposure therapy: Combining cognitive-behavioral therapies for the treatment of posttraumatic stress disorder with panic attacks

A large proportion of patients who present for treatment of posttraumatic stress disorder (PTSD) experience comorbid panic attacks, yet it is unclear to what extent currently available PTSD treatment programs address this problem. Here we describe a newly developed treatment, multiple-channel exposure therapy (M-CET), for comorbid PTSD and panic attacks. The treatment utilizes elements of cognitive processing therapy treatment for PTSD and elements of panic control treatment to target physiological, cognitive, and behavioral symptoms. Preliminary results suggest that M-CET may provide a promising treatment program for a subset of patients with PTSD who experience panic attacks. In addition, guidelines for conducting M-CET with clients who have been exposed to diverse traumatic events are provided.

Intrusive thoughts in posttraumatic stress disorder

This article reviews the literature on prevalence, associated features, assessment, and treatment of intrusive symptoms associated with posttraumatic stress disorder (PTSD). Research indicates that among trauma survivors, intrusive thoughts and imagery are quite common and distressing. It appears that early intrusions may be predictive of long-term distress and that avoidance and suppression can maintain intrusions. The treatment outcome literature for PTSD indicates that current cognitive behavioral treatments are effective in reducing intrusions. New data from a recent treatment outcome study for PTSD with comorbid panic attacks, using Multiple Channel Exposure Therapy, also suggest that this treatment is effective in significantly reducing intrusions.

Patients with generalized anxiety disorder and a history of trauma: somatic symptom endorsement.

The authors investigated the types and rates of trauma exposure and differences in symptom endorsement in a clinical sample of patients diagnosed with generalized anxiety disorder (GAD). Fifty-eight patients with GAD were assessed using the Structured Clinical Interview (SCID) and Trauma Assessment for Adults. In order to explore the relationship between specific traumatic event(s) and clinical presentation, the presence of somatic symptoms associated with GAD, including muscle tension, autonomic hyperactivity, and vigilance/scanning clusters (using DSM-III-R criteria), were examined. Patients with a history of sexual assault before 18 years (25.9%) endorsed fewer somatic symptoms, specifically fewer motor tension and autonomic GAD symptoms, than patients with other types of trauma. These findings indicate that early exposure to serious trauma, specifically childhood sexual assault, may lead to a different clinical presentation in GAD patients.