Todd C. Buckley

PSYCHOMETRIC PROPERTIES OF THE PTSD CHECKLIST (PCL)

The psychometric properties of the PTSD Checklist (PCL), a new, brief, self-report instrument, were determined on a population of 40 motor vehicle accident victims and sexual assault victims using diagnoses and scores from the CAPS (Clinician Administered PTSD Scale) as the criteria. For the PCL as a whole, the correlation with the CAPS was 0.929 and diagnostic efficiency was 0.900 versus CAPS. Examination of the individual items showed wide ranging values of individual item correlations ranging from 0.386 to 0.788, and with diagnostic efficiencies of 0.700 or better for symptoms. We support the value of the PCL as a brief screening instrument for PTSD.

A controlled evaluation of cognitive behaviorial therapy for posttraumatic stress in motor vehicle accident survivors

Seventy-eight motor vehicle accident survivors with chronic (greater than 6 months) PTSD, or severe sub-syndromal PTSD, completed a randomized controlled comparison of cognitive behavioral therapy (CBT), supportive psychotherapy (SUPPORT), or a Wait List control condition with two detailed assessments. Scores on the CAPS showed significantly greater improvement for those in CBT in comparison to the Wait List and to the SUPPORT conditions. The SUPPORT condition in turn was superior (p=0.012) to the Wait List. Categorical diagnostic data showed the same results. An analysis of CAPS scores including drop-outs (n=98) also showed CBT to be superior to Wait List and to SUPPORT with a trend for SUPPORT to be superior to Wait List. The CBT condition led to significantly greater reductions in co-morbid major depression and GAD than the other two conditions. Results held up well at a 3-month follow-up on the two active treatment conditions.

The impact of severity of physical injury and perception of life threat in the development of post-traumatic stress disorder in motor vehicle accident victims

For 98 victims of recent (1 to 4 months post-accident) motor vehicle accidents who sought medical attention as a result of the accident, we obtained data on the extent of physical injury using blind ratings with the Abbreviated Injury Scale (AIS), as well as victims reports of their perceptions of how much danger they perceived at the time of the accident and the degree of life threat (fear of dying) they perceived. AIS scores significantly predicted (P < 0.01) development of post-traumatic stress disorder (PTSD) (r point biserial = 0.302) and development of post-traumatic stress symptoms (PTSS) (r = 0.311) as did perception of life threat (r point biserial = 0.294 for PTSD and r = 0.229 for PTSS). A multiple regression equation combining AIS and life threat accounted for 12.2% of variance in PTSS scores.

Prediction of remission of acute posttraumatic stress disorder in motor vehicle accident victims

One hundred forty five individuals who sought medical attention as a result of a motor vehicle accident (MVA), and who were initially assessed 1 to 4 months post-MVA, were followed up prospectively for 6 months to determine how many of the 55 with posttraumatic stress disorder (PTSD) and the 43 with sub-syndromal PTSD would remit and what variables would predict remission. Thirty (55%) of those with initial PTSD had remitted at least in part by 6 months while 67% of those with sub-syndromal PTSD had remitted (and 5% had worsened). Four variables, including severity of initial symptoms, degree of initial physical injury, relative degree of physical recovery by 4 months and whether a close family member suffered a trauma during the follow-up interval, combined to classify 6-month clinical status of 84% of those with initial PTSD secondary to MVAs.

Short-term follow-up of post-traumatic stress symptoms in motor vehicle accident victims

Ninety-eight victims of recent motor vehicle accidents (MVA), who sought medical attention as a result of the MVA, were followed up prospectively 6 months after the initial assessment, using Keller, Lavori, Friedman, Nielsen, Endicott, McDonald-Scott and Andreasens (Archives of General Psychiatry, 44, 540-548, 1987) LIFE methodology so that month-by-month changes in post-traumatic stress disorder (PTSD) symptoms could be determined. For the 40 MVA victims who initially met the full criteria for PTSD, 10 no longer met the criteria 4 months after the initial assessment, a decrease significant at the P < 0.01 level, and 20 no longer met the full criteria at 6 months (P < 0.001). On a symptom-by-symptom basis, there were significant declines among the fraction of those who initially met the criteria for PTSD for all avoidance and numbing symptoms by the 6-month follow-up, whereas most of the hyperarousal symptoms did not show significant declines.

Effects of attribution of responsibility for motor vehicle accidents on severity of PTSD symptoms, ways of coping, and recovery over six months

In light of Delahanty et al.s (1997) identification of attribution of responsibility for a motor vehicle accident (MVA) as a powerful determinant of initial level of distress from the trauma and of early remission of PTSD, we reexamined data from Blanchard and Hicklings (1997) prospective follow-up of 158 MVA survivors. Despite differences between the two samples (Delahanty sample recruited from hospitals 2–3 weeks post-MVA and predominantly male; our sample recruited from outpatient care 1–4 months post-MVA and predominantly female) we replicated Delahantys findings: those with PTSD who blame themselves for the MVA are less symptomatic initially and recover more rapidly in the first 6 months than those with PTSD who blame another party for the accident.

Effects of Litigation Settlements on Posttraumatic Stress Symptoms in Motor Vehicle Accident Victims

In order to investigate the effects of the initiation of litigation and its settlement on victims of motor vehicle accidents (MVAs), we followed up 132 MVA victims from an initial assessment 1 to 4 months post-MVA for 1 year. Of the 67 who had initiated litigation. 18 (27%) settled within the 12 months, while 49 still had litigation pending; 65 never initiated litigation. Those who initiated litigation had more severe injuries and higher initial levels of posttraumatic stress (PTS) symptoms. All three groups improved in major role function and had reduced PTS symptoms over the 1 year follow-up. Those whose suits were still pending, as well as those whose suits had been settled, showed no reduction in measures of anxiety or depression, whereas the nonlitigants did show improvement on these measures.

Automatic and Strategic Processing of Threat Stimuli: A Comparison Between PTSD, Panic Disorder, and Nonanxiety Controls

This study evaluated 2 hypotheses derived from the theoretical work of A. T. Beck and D. A. Clark (1997). Two anxiety disorder groups, posttraumatic stress disorder (PTSD) and panic disorder (PD), and a nonanxiety control group participated in a modified-Stroop study. The study evaluated whether the diagnostic groups could be differentiated on the basis of responses to stimulus valence and content at different stages of information processing (IP). We found no support for the hypothesis that the diagnostic groups would be sensitive to stimulus valence at automatic stages of IP. Consistent with the second of our 2 hypotheses, the PD group showed delayed vocal responses when processing disorder-specific threat stimuli at strategic stages of IP. The PTSD group showed a generalized valence effect at strategic stages of IP, evincing delayed vocal responses to all stimuli with negative valence. The clinical implications of these findings are discussed, as are directions for future research.

Treatment-related changes in cardiovascular reactivity to trauma cues in motor vehicle accident-related PTSD

We have conducted a randomized, controlled trial comparing a combination of cognitive and behavioral treatments (CBT), supportive psychotherapy (SUPPORT), or an assessment-only wait-list (WAITLIST) control. To study psychophysiological reactivity in PTSD we measured heart rate (HR) reactivity to idiosyncratic audiotaped descriptions of the motor vehicle accident (MVA) that the participants had survived, both before and after each of the treatments. Results showed significantly greater reduction in HR reactivity for those receiving CBT (n = 25) than for either those in SUPPORT (n = 26) or WAITLIST (n = 22). The latter two conditions did not differ. There were significant but low-level correlations between changes in CAPS scores and changes in HR reactivity collapsing across all groups.

Direction of Temperature Control in the Thermal Biofeedback Treatment of Vascular Headache

In order to test for the specific therapeutic effects of thermal biofeedback (TBF) for hand warming on vascular headache (HA), 70 patients with chronic vascular HA were randomly assigned to TBF for hand warming, TBF for hand cooling, TBF for stabilization of hand temperature, or biofeedback to suppress alpha in the EEG. Patients in each condition initially had high levels of expectation of therapeutic benefit and found the treatment rationales highly credible. Participants in each condition received 12 treatment sessions on a twice-per-week basis. Based on daily HA diary data gathered for 4 weeks prior to treatment and 4 weeks after treatment, HA Index was significantly (p=.003) reduced as was HA medication consumption. There were no differential reducations in HA Index or Medication Index among the four conditions. Global self-reports of improvement gathered at the end of the post-treatment monitoring period also did not differ among the four conditions. We were unable to demonstrate a specific effect of TBF for hand warming on vascular HA activity.