Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults.
Brewin, C.R., Andrews, B., & Valentine, J.D. (2000).
Journal of Consulting and Clinical Psychology, 68(5), 748-766.
Predictors of posttraumatic stress disorder and symptoms in adults: a meta-anlaysis
Ozer, Weiss & Lipsey 2003

Predictors of PTSD

Exposure to trauma may not always be sufficient to explain the development of PTSD, but when people are exposed to traumatic events, the risk of PTSD is enhanced reliably. Individual vulnerability factors have a role to play in understanding PTSD.

The strongest predictors of PTSD are factors occuring during of after the trauma.

Gender, age at trauma and race predict PTSD in some populations, but not others. Education, previous trauma and general childhood adversity predicts PTSD more consistently but to a varying extend. Psychiatric history, reported childhood abuse, and family psychiatric history have predictive effects.

By a relatively small extent, the risk of PTSD is enhanced by the effects of: female gender, greater social, educational and intellectual disadvantages, psychiatric history and various types of previous adversity

The risk of PTSD is enhanced by factors occurring during or after the trauma like: peritraumatic dissociation, preceived support, preceived life threat  and peritraumatic emotions.

Testing a DSM-5 reformulation of posttraumatic stress disorder: Impact on prevalence and comorbidity among treatment-seeking civilian trauma survivors.
Van Emmerik, A.A.P., & Kamphuis, J.H. (2011).
Journal of Traumatic Stress, 24, 213-217.

Introduction

The Brewin criteria for PTSD suggest abolishing criterion A, and retaining a subset of symptoms from criteria B to D, as well as the duration (criterion E) and impairment (criterion F) criteria. The symptom criteria Brewin proposes are: 1) distressing dreams 2) vivid daytie images or flashbacks 3) avoidance of internal trauma reminders 4) hypervigilance 5) exaggerated startle response.

Conclusion

The Brewin criteria do no appreciably affect overall PTSD prevalence or comorbidity. They do impact diagnostic status at the individual level. Approximately two-thirds of participants who lost the PTSD diagnosis qualified for treatment for a comorbid disorder. Reducing symptom overlap of PTSD with depression and anxiety disorders did not reduce comorbidity.

Criterion A is not essential to diagnosing PTSD.

A cognitive model of posttraumatic stress disorder
Ehlers, A., & Clark, D.M. (2000)
Behaviour Research and Therapy, 38, 319-345.

Abstract

PTSD becomes persistent when individuals process trauma in a way that leads to a sense of serous, current threat. This sense of threat arises as a consequence of: 1) excessively negative appraisals of the trauma and/or its sequelae 2) a disturbance of autobiographical memory. This is characterized by poor elaboration and contextualisation, strong associative memory and strong perceptual priming.

Change in the negative appraisals and trauma memory are prevented by a series of problematic behavioural and cognitive strategies.

Symptoms of posttraumatic stress disorder (PTSD) include: 1) repeated and unwanted re-experiencing of the event 2) hyperarousal 3) emotional numbing 4) avoidance of stimuli (including thoughts) which could serve as reminders for the event.

A cognitive model of PTSD

Overview

PTSD occurs only if individuals process the traumatic event and/or its sequealae in a way which produces a sense of serious current threat.

Two processes lead to a sense of current threat 1) individual differences in the appraisal of the trauma and/or its sequelae 2) individual differences in the nature of the memory for the event and its link to other autobiographical memories.

Once activated, the perception of current threat is accompanied by intrusions and other reexperiencing symptoms, symptoms of arousal, anxiety and other emotional responses.

The perceived threat motivates a series of behavioural and cognitive responses that are intended to reduce perceived threat and distress in the short-term, but have the consequence of preventing cognitive change and maintaining the disorder.

Appraisal of the trauma and/or its sequelae

Individuals with PTSD are unable to see the trauma as a time-limited event that does not have global negative implications for their future. These individuals are characterized by idiosyncratic negative appraisals of the traumatic event and/or its sequelae that have the common effect of creating a sense of serous current threat. This threat can be external or internal (for example: threat to one’s view of oneself as a capable person).

Appraisal of the traumatic event

Several types of appraisal can produce a sense of current threat: 1) individuals may overgeneralise from the event, as a consequence perceive a range of normal activities as more dangerous than they really are 2) exaggerate the probability of further catastrophic events as general, or think that they ‘attract disaster’.

Appraisals of the way one felt or behaved during the even can have long-term threatening

Protocollaire behandelingen voor volwassenen met psychische klachten
Hoofdstuk 6
Protocollaire behandeling van patiënten met een posttraumatische-stressstoornis: imaginaire exposure en exposure in vivo.

Inleiding

Een posttraumatische-stresstoornis (PTSS) kan ontstaan na het meemaken van een trauma. De belangrijkste symptomen zijn: 1) herbelevingen 2) vermijding van prikkels die geassocieerd zijn met het trauma 3) negatieve veranderingen in cognities en stemming 4) verhoogde arousal.

Als iemand naast de PTSS-symptomen ook symptomen heeft van derealisatie en/of depersonalisatie, wordt dit een dissociatief subtype genoemd.

Voor de behandeling van PTSS dis het van belang om de herinnering aan de traumatische gebeurtenis op te halen uit het geheugen en deze te bewerken. Het heeft als doel om pathologische elementen van het geheugen te corrigeren die ten grondslag liggen aan de angstsensaties. Hiervoor moet eerste het angstnetwerk in het geheugen geactiveerd worden. Ook moet nieuwe corrigerende informatie toegevoegd worden die incompatibel is met de bestaande pathologische informatie. Exposure is hiervoor geschikt.

Onderzoeksbevindingen

Exposure is bewezen effectief.

Kenmerken van het trauma zelf hebben geen relatie met de behandelresultaten. Hetzelfde geld voor comorbiditeit.

Bij comorbiditeit is vaak de PTSS de centrale bron van de stoornissen. Hierbij hoeft de PTSS behandeling niet aangepast te worden.

Behandelingen waarin alleen imaginaire exposure werd toegepast zijn minder effectief dan behandelingen waarin exposure in vivo werd toegevoegd.

Factoren tijdens de behandeling zijn van invloed op het resultaat. Sociale steun en compliance aan de behandeling voorspellen het behandelresultaat. Groepsbehandelingen zijn minder effectief.

Assessment

De diagnose PTSS wordt bij voorkeur gesteld aan de hand van een gestructureerd interview.

Behandelprotocol

Imaginaire exposure en exposure in vivo staan centraal. De cliënt wordt herhaaldelijk en langdurig geconfronteerd met de angst oproepende herinneringen aan het trauma, door het opnieuw in gedachten te beleven. Ook wordt de cliënt blootgesteld aan triggers die de angst oproepen.

De behandeling bestaat uit tien sessies van negentig minuten.

De PTSS-klachtenschaal wordt voor elke sessie afgenomen en gescoord, en besproken. Het sessieplanningsforumulier wordt gebruikt om de sessies te plannen en de volgorde van de traumatische situaties te bepalen. De subective-units-of-distress-schaal wordt gebruikt om aan te geven hoeveel angst er op het moment wordt ervaren.

Op het formulier ‘Angstige verwachtingen’ kan de cliënt voorafgaand aan de exposure aangeven wat de gevreesde verwachting is als de exposure wordt uitgevoerd. Na de sessie kan worden aangegeven in hoeverre deze verwachtingen zijn uitgekomen.

Op

Writing therapies for Post-Traumatic Stress and Post-Traumatic Stress Disorder
Van Emmerik, A., & Kamphuis, J.H. (2015)
A review of procedures and outcomes

Abstract

Writing is an effective psychological treatment of post-traumatic stress disorder. The model includes three phases: 1) focusing on imaginal exposure to traumatic memories 2) cognitive restructuring and coping 3) social sharing and closure.

Writing therapy

Therapeutic model

The basic therapeutic model of writing therapy includes three phases, whose effects cannot be completely disentangled.

Imaginal exposure to traumatic memories

The goal of the first phase is to expose clients to their traumatic memories, in order to achieve habituation and extinction of the fearful and other negative emotional responses that reactivation of these memories evoke.

Clients are asked to write a detailed account of the traumatic event, focusing on the most painful facts and emotions associated with the event. Clients are instructed to write in the first person and in the present tense. They must pay attention to their sensory experiences and bodily sensations during the event and to facts and feelings they have avoided.

The clinician’s primary task is to read the client’s essay and to determine with the client 1) what are the most painful facts and feelings 2) explore if any facts or feelings have been avoided 3) instruct the client to focus on precisely these facts and feelings in subsequent writing assignments.

Cognitive restructuring and coping

Targets the maladaptive cognitions and coping behaviours that may underlie the symptoms.

Clients write their best possible advice to an imaginal close associate that has experienced the traumatic event. The advice should concern how best to deal with the event and its consequences, making use of the client’s personal experiences.

Possible elements of the advice include: 1) aspects of the event that the other person has overlooked and that may shed a more positive light on the situation 2) alternative interpretations of the event 3) adaptive ways of coping 4) reflections on the meaning that the event may acquire.

The clinicians role is to identify and challenge any dysfunctional aspects of the advice and to instruct clients to apply the advice to themselves in a subsequent assignment.

Social sharing and closure

The goals are: 1) foster or promote social support by inviting clients to share their experiences in a dignified letter to a (true) close associate. The letter should describe the most important aspects of the traumatic event and its impact on the client’s life. The letter should explicitly state its