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This grouping reflects the prominence that external events have in the aetiology of certain psychiatric conditions. In response to developments in research and theory, allied to the importance of clinical utility in a wide variety of health settings, significant changes have been made to the comparable grouping in ICD-10. These include a reformulation of PTSD aimed at highlighting what differentiates it from other disorders, and the introduction of a distinction between PTSD and a new disorder, Complex PTSD. Prolonged Grief Disorder is another new addition based on what is now extensive research on how grief differs from depression and responds to different kinds of treatment. Like PTSD, Adjustment Disorder has been reformulated to highlight specific symptoms and processes.
Overgeneralizations by psychologists of the research evidence on memory and eyewitness testimony, such as “memory decays with time” or “memories are fluid and malleable,” are beginning to appear in legal judgements and guidance documents, accompanied by unwarranted disparagement of lay beliefs about memory. These overgeneralizations could have significant adverse consequences for the conduct of civil and criminal law.
The objectives of this study were to develop and refine EMPOWER (Enhancing and Mobilizing the POtential for Wellness and Resilience), a brief manualized cognitive-behavioral, acceptance-based intervention for surrogate decision-makers of critically ill patients and to evaluate its preliminary feasibility, acceptability, and promise in improving surrogates’ mental health and patient outcomes.
Part 1 involved obtaining qualitative stakeholder feedback from 5 bereaved surrogates and 10 critical care and mental health clinicians. Stakeholders were provided with the manual and prompted for feedback on its content, format, and language. Feedback was organized and incorporated into the manual, which was then re-circulated until consensus. In Part 2, surrogates of critically ill patients admitted to an intensive care unit (ICU) reporting moderate anxiety or close attachment were enrolled in an open trial of EMPOWER. Surrogates completed six, 15–20 min modules, totaling 1.5–2 h. Surrogates were administered measures of peritraumatic distress, experiential avoidance, prolonged grief, distress tolerance, anxiety, and depression at pre-intervention, post-intervention, and at 1-month and 3-month follow-up assessments.
Part 1 resulted in changes to the EMPOWER manual, including reducing jargon, improving navigability, making EMPOWER applicable for a range of illness scenarios, rearranging the modules, and adding further instructions and psychoeducation. Part 2 findings suggested that EMPOWER is feasible, with 100% of participants completing all modules. The acceptability of EMPOWER appeared strong, with high ratings of effectiveness and helpfulness (M = 8/10). Results showed immediate post-intervention improvements in anxiety (d = −0.41), peritraumatic distress (d = −0.24), and experiential avoidance (d = −0.23). At the 3-month follow-up assessments, surrogates exhibited improvements in prolonged grief symptoms (d = −0.94), depression (d = −0.23), anxiety (d = −0.29), and experiential avoidance (d = −0.30).
Significance of results
Preliminary data suggest that EMPOWER is feasible, acceptable, and associated with notable improvements in psychological symptoms among surrogates. Future research should examine EMPOWER with a larger sample in a randomized controlled trial.
We investigated work-related exposure to stressful and traumatic events in police officers, including repeated exposure to traumatic materials, and predicted that ICD-11 complex PTSD (CPTSD) would be more prevalent than posttraumatic stress disorder (PTSD). The effects of demographic variables on exposure and PTSD were examined, along with whether specific types of exposure were uniquely associated with PTSD or CPTSD.
An online survey covering issues about trauma management, wellbeing and working conditions was disseminated via social media and official policing channels throughout the UK. In total, 10 401 serving police officers self-identified as having been exposed to traumatic events. Measurement of PTSD and CPTSD utilised the International Trauma Questionnaire.
The prevalence of PTSD was 8.0% and of CPTSD was 12.6%. All exposures were associated with PTSD and CPTSD in bivariate analyses. Logistic regression indicated that both disorders were more common in male officers, and were associated independently with frequent exposure to traumatic incidents and traumatic visual material, and with exposure to humiliating behaviours and sexual harassment, but not to verbal abuse, threats or physical violence. Compared to PTSD, CPTSD was associated with exposure to humiliating behaviours and sexual harassment, and also with lower rank and more years of service.
CPTSD was more common than PTSD in police officers, and the data supported a cumulative burden model of CPTSD. The inclusion in DSM-5 Criterion A of work-related exposure to traumatic materials was validated for the first time. Levels of PTSD and CPTSD mandate enhanced occupational mental health services.
Terrorist attacks have increased globally since the late 1990s with clear evidence of psychological distress across both adults and children and young people (CYP). After the Manchester Arena terrorist attack, the Resilience Hub was established to identify people in need of psychological and psychosocial support.
To examine the severity of symptoms and impact of the programme.
The hub offers outreach, screening, clinical telephone triage and facilitation to access evidenced treatments. People were screened for trauma, depression, generalised anxiety and functioning who registered at 3, 6 and 9 months post-incident. Baseline scores were compared between screening groups (first screen at 3, 6 or 9 months) in each cohort (adult, CYP), and within groups to compare scores at 9 months.
There were significant differences in adults' baseline scores across screening groups on trauma, depression, anxiety and functioning. There were significant differences in the baseline scores of CYP across screening groups on trauma, depression, generalised anxiety and separation anxiety. Paired samples t-tests demonstrated significant differences between baseline and follow-up scores on all measures for adults in the 3-month screening group, and only depression and functioning measures for adults in the 6-month screening group. Data about CYP in the 3-month screening group, demonstrated significant differences between baseline and follow-up scores on trauma, generalised anxiety and separation anxiety.
These findings suggest people who register earlier are less symptomatic and demonstrate greater improvement across a range of psychological measures. Further longitudinal research is necessary to understand changes over time.
The World Health Organization's proposals in ICD-11, released for comment by member states in 2018, introduce for the first time in a major diagnostic system a distinction between post-traumatic stress disorder (PTSD) and complex post-traumatic stress disorder (CPTSD). This article sets the new diagnosis of CPTSD within the context of previous similar formulations, describes its definition and requirements, and reviews the evidence concerning its epidemiology, differential diagnosis, assessment and treatment.
Previous research has identified a vulnerability paradox in global mental health: contrary to positive associations at the individual level, lower vulnerability at the country level is accompanied by a higher prevalence in a variety of mental health problems in national populations. However, the validity of the paradox has been challenged, specifically for bias from modest sample sizes and reliance on a survey methodology not designed for cross-national comparisons.
To verify whether the paradox applies to suicide, using data from a sizable country sample and an entirely different data source.
We combined data from the World Health Organization 2014 suicide report and the country vulnerability index from the 2016 World Risk Report. Suicide was predicted in different steps based on gender, vulnerability and their interaction, World Bank income categories, and suicide data quality.
A negative association between country vulnerability and suicide prevalence in both women and men was found. Suicide rates were higher for men, regardless of country vulnerability. The model predicting suicide in 96 countries based on gender, vulnerability, income and data quality had the best goodness-of-fit compared with other models. The vulnerability paradox is not accounted for by income or data quality, and exists across and within income categories.
The study underscores the relevance of country-level factors in the study of mental health problems. The lower mental disorder prevalence in more vulnerable countries implies that living in such countries fosters protective factors that more than compensate for the limitations in professional healthcare capacity.
Self-criticism is a ubiquitous feature of psychopathology and can be
combatted by increasing levels of self-compassion. However, some patients
are resistant to self-compassion.
To investigate whether the effects of self-identification with virtual
bodies within immersive virtual reality could be exploited to increase
self-compassion in patients with depression.
We developed an 8-minute scenario in which 15 patients practised
delivering compassion in one virtual body and then experienced receiving
it from themselves in another virtual body.
In an open trial, three repetitions of this scenario led to significant
reductions in depression severity and self-criticism, as well as to a
significant increase in self-compassion, from baseline to 4-week
follow-up. Four patients showed clinically significant improvement.
The results indicate that interventions using immersive virtual reality
may have considerable clinical potential and that further development of
these methods preparatory to a controlled trial is now warranted.
Determinants of cross-national differences in the prevalence of mental illness are poorly understood.
To test whether national post-traumatic stress disorder (PTSD) rates can be explained by (a) rates of exposure to trauma and (b) countries' overall cultural and socioeconomic vulnerability to adversity.
We collected general population studies on lifetime PTSD and trauma exposure, measured using the WHO Composite International Diagnostic Interview (DSM-IV). PTSD prevalence was identified for 24 countries (86 687 respondents) and exposure for 16 countries (53 038 respondents). PTSD was predicted using exposure and vulnerability data.
PTSD is related positively to exposure but negatively to country vulnerability. Together, exposure, vulnerability and their interaction explain approximately 75% of variance in the national prevalence of PTSD.
Contrary to expectations based on individual risk factors, we identified a paradox whereby greater country vulnerability is associated with a decreased, rather than increased, risk of PTSD for its citizens.
I suggest it is premature to assume memory reconsolidation provides a unifying model of psychotherapeutic change given our current state of knowledge, and that other basic memory mechanisms, also supported by neuroscience, have a stronger claim at present. In particular, I propose that retrieval competition provides a more plausible alternative to memory reconsolidation.
Backgound: Limited data suggest that crime may have a devastating impact on older people. Although identification and treatment may be beneficial, no well-designed studies have investigated the prevalence of mental disorder and the potential benefits of individual manualized CBT in older victims of crime. Aims: To identify mental health problems in older victims of common crime, provide preliminary data on its prevalence, and conduct a feasibility randomized controlled trial (RCT) using mixed methods. Method: Older victims, identified through police teams, were screened for symptoms of anxiety, depression or post-traumatic stress disorder (PTSD) one (n = 581) and 3 months (n = 486) after experiencing a crime. Screen positive participants were offered diagnostic interviews. Of these, 26 participants with DSM-IV diagnoses agreed to be randomized to Treatment As Usual (TAU) or TAU plus our manualized CBT informed Victim Improvement Package (VIP). The latter provided feedback on the VIP. Results: Recruitment, assessment and intervention are feasible and acceptable. At 3 months 120/486 screened as cases, 33 had DSM-IV criteria for a psychiatric disorder; 26 agreed to be randomized to a pilot trial. There were trends in favour of the VIP in all measures except PTSD at 6 months post crime. Conclusions: This feasibility RCT is the first step towards improving the lives of older victims of common crime. Without intervention, distress at 3 and 6 months after a crime remains high. However, the well-received VIP appeared promising for depressive and anxiety symptoms, but possibly not posttraumatic stress disorder.
Over-involved parenting is commonly hypothesized to be a risk factor for the development of anxiety disorders in childhood. This parenting style may result from parental attempts to prevent child distress based on expectations that the child will be unable to cope in a challenging situation. Naturalistic studies are limited in their ability to disentangle the overlapping contribution of child and parent factors in driving parental behaviours. To overcome this difficulty, an experimental study was conducted in which parental expectations of child distress were manipulated and the effects on parent behaviour and child mood were assessed. Fifty-two children (aged 7 – 11 years) and their primary caregiver participated. Parents were allocated to either a “positive” or a “negative” expectation group. Observations were made of the children and their parents interacting whilst completing a difficult anagram task. Parents given negative expectations of their child's response displayed higher levels of involvement. No differences were found on indices of child mood and behaviour and possible explanations for this are considered. The findings are consistent with suggestions that increased parental involvement may be a “natural” reaction to enhanced perceptions of child vulnerability and an attempt to avoid child distress.
Late disclosure or nondisclosure during Home Office interviews is commonly cited as a reason to doubt an asylum seeker's credibility, but disclosure may be affected by other factors.
To determine whether and how sexual violence affects asylum seekers' disclosure of personal information during Home Office interviews.
Twenty-seven refugees and asylum seekers were interviewed using semi-structured interviews and self-report measures.
The majority of participants reported difficulties in disclosing. Those with a history of sexual violence reported more difficulties in disclosing personal information during Home Office interviews, were more likely to dissociate during these interviews and scored significantly higher on measures of posttraumatic stress symptoms and shame than those with a history of non-sexual violence.
The results indicate the importance of shame, dissociation and psychopathology in disclosure and support the need for immigration procedures sensitive to these issues. Judgments that late disclosure is indicative of a fabricated asylum claim must take into account the possibility of factors related to sexual violence and the circumstances of the interview process itself.
Terrorist attacks can have psychological effects on the general public.
To assess the medium-term effects of the July 2005 London bombings on the general population in London and to identify risk factors for persistent effects.
We telephoned 1010 Londoners 11–13 days after the bombings to assess stress levels, perceived threat and travel intentions. Seven months later, 574 respondents were contacted again and asked similar questions, and questions concerning altered perceptions of self and the world.
‘Substantial stress' (11%), perceived threat to self (43%) and reductions in travel because of the bombings (19%) persisted at a reduced level; other perceived threats remained unchanged. A more negative world view was common. Other than degree of exposure to the bombings, there were no consistent predictors of which people with short-term reactions would develop persistent reactions.
A longer-term impact of terrorism on the perceptions and behaviour of Londoners was documented.
We review the current literature relating to mental health following
terrorist attacks. Studies assessing symptoms of stress in the general
population and those assessing the mental health of direct victims are
considered. Use of mental health services following an attack is reviewed
and recommendations are offered.
A literature search yielded no studies investigating Wegner's (1989) proposal that repeated suppression attempts and rebound opportunities (indulgence cycles) lead to an escalation of intrusions, providing a mechanism whereby an unwanted intrusive thought may develop into a clinical obsession. It was predicted, based on Wegner's (1994) ironic process theory of mental control, that individuals high in trait obsessionality would exhibit an increase in thought frequency as a function of indulgence cycle and that those low in trait obsessionality would display a corresponding decrease in thought frequency. Participants (N=40) were asked to suppress and then express a personally relevant obsessive intrusive thought through two indulgence cycles. There was no significant escalation in thoughts across indulgence cycles for the high obsessionality group, but the low obsessionality group were significantly more successful at suppression. The results confirm previous research suggesting that trait obsessionality has an impact upon the effectiveness of thought suppression.
The coexistence of posttraumatic stress disorder (PTSD) and
traumatic head or brain injury (TBI) in the same individual
has been proposed to be paradoxical. It has been argued that
individuals who sustain a TBI and have no conscious memory of
their trauma will not experience fear, helplessness and horror
during the trauma, nor will they develop reexperiencing symptoms
or establish the negative associations that underlie avoidance
symptoms. However, single case reports and incidence studies
suggest that PTSD can be diagnosed following TBI. We highlight
critical issues in assessment, definitions, and research methods,
and propose two possible resolutions of the paradox. One resolution
focuses on ambiguity in the criteria for diagnosing PTSD. The
other involves accepting that TBI patients do experience similar
symptoms to other PTSD patients, but that there are crucial
differences in symptom content. (JINS, 2003, 9,