Refugee Children & Adolescents and PTSD

Research Paper Title

Traumatic experiences of conditional refugee children and adolescents and predictors of post-traumatic stress disorder: data from Turkey.

Background

The researchers aimed to determine traumatic events, mental health problems and predictors of PTSD in a sample of conditional refugee children.

Methods

The sociodemographic features, chief complaints, traumatic experiences and psychiatric diagnoses according to DSM-5 were evaluated retrospectively.

Results

20.7% (n = 70) of children experienced the armed conflict or exposed to firefights at their country of origin. Most common diagnoses were anxiety disorders (n = 82, 24.3%), major depressive disorder (n = 52, 15.4%) and PTSD (n = 43, 12.7%). Age, number of traumatic experiences, explosion and sexual violence are the most important predictors for PTSD.

Conclusions

The results suggest that the number of traumas exposed as well as their nature predicted PTSD diagnosis. Refugee children have increased risk for psychiatric problems after migration and resettlement underlining the importance of an adequate follow-up for mental health and ensuring social support networks.

Reference

Yektas, C., Erman, H. & Tufan, A.E. (2021) Traumatic experiences of conditional refugee children and adolescents and predictors of post-traumatic stress disorder: data from Turkey. doi: 10.1080/08039488.2021.1880634. Online ahead of print.

Book: The Resilience Workbook

Book Title:

The Resilience Workbook – Essential Skills to Recover from Stress, Trauma, and Adversity.

Author(s): Glenn R. Schiraldi (PhD).

Year: 2017.

Edition: First (1st), Illustrated Edition.

Publisher: New Harbinger.

Type(s): Paperback and Kindle.

Synopsis:

What is resilience, and how can you build it? In The Resilience Workbook, Glenn Schiraldi-author of The Self-Esteem Workbook-offers invaluable insight and outlines essential skills to help you bounce back from setbacks and cultivate a growth mindset.

Why do some people sail through life’s storms, while others are knocked down? Resilience is the key. Resilience is the ability to recover from difficult experiences, such as death of loved one, job loss, serious illness, terrorist attacks, or even just daily stressors and challenges. Resilience is the strength of body, mind, and character that enables people to respond well to adversity. In short, resilience is the cornerstone of mental health.

Combining evidence-based approaches including positive psychology, cognitive behavioural therapy (CBT), acceptance and commitment therapy (ACT), mindfulness, and relaxation, The Resilience Workbook will show you how to bounce back and thrive in any difficult situation. You will learn how to harness the power of your brain’s natural neuroplasticity; manage strong, distressing emotions; and improve mood and overall well-being. You will also discover powerful skills to help you prevent and recover from stress-related conditions like post-traumatic stress disorder (PTSD), anxiety, depression, anger, and substance abuse disorders.

When the going gets tough, you need real, proven-effective skills to manage your stress and heal from setbacks. The comprehensive and practical exercises in this workbook will help you cultivate resilience, stay calm under pressure, and face all of life’s challenges.

Book: Emotion Efficacy Therapy

Book Title:

Emotion Efficacy Therapy: A Brief, Exposure-Based Treatment for Emotion Regulation Integrating ACT and DBT.

Author(s): Matthew McKay (PhD) and Aprilia West (PSyD, MT).

Year: 2016.

Edition: First (1st).

Publisher: New Harbinger.

Type(s): Paperback and Kindle.

Synopsis:

If you treat clients with emotion regulation disorders – including depression, anxiety, post-traumatic stress disorder (PTSD), bipolar disorder, and borderline personality disorder (BPD) – you know how important it is for these clients to take control of their emotions and choose their actions in accordance with their values. To help, emotion efficacy therapy (EET) provides a new, theoretically-driven, contextually-based treatment that integrates components from acceptance and commitment therapy (ACT) and dialectical behaviour therapy (DBT) into an exposure-based protocol. In doing so, EET targets the transdiagnostic drivers of experiential avoidance and distress intolerance to increase emotional efficacy.

This step-by-step manual will show you how to help your clients confront and accept their pain, and learn to apply new adaptive responses to emotional triggers. Using a brief treatment that lasts as little as eight weeks, you will be able to help your clients understand and develop a new relationship with their emotions, learn how to have mastery over their emotional experience, practice values-based action in the midst of being emotionally triggered, and stop intense emotions from getting in the way of creating the life they want.

Using the transdiagnostic, exposure-based approach in this book, you can help your clients manage difficult emotions, curb negative reactions, and start living a better life. This book is a game changer for emotion exposure treatment!

What is Exposure Therapy?

Introduction

Exposure therapy is a technique in behaviour therapy to treat anxiety disorders. Exposure therapy involves exposing the target patient to the anxiety source or its context without the intention to cause any danger. Doing so is thought to help them overcome their anxiety or distress. Procedurally, it is similar to the fear extinction paradigm developed studying laboratory rodents. Numerous studies have demonstrated its effectiveness in the treatment of disorders such as generalised anxiety disorder (GAD), social anxiety disorder, obsessive-compulsive disorder (OCD), post traumatic stress disorder (PTSD), and specific phobias.

Brief History

The use of exposure as a mode of therapy began in the 1950s, at a time when psychodynamic views dominated Western clinical practice and behavioural therapy was first emerging. South African psychologists and psychiatrists first used exposure as a way to reduce pathological fears, such as phobias and anxiety-related problems, and they brought their methods to England in the Maudsley Hospital training programme.

Joseph Wolpe (1915-1997) was one of the first psychiatrists to spark interest in treating psychiatric problems as behavioural issues. He sought consultation with other behavioural psychologists, among them James G. Taylor (1897-1973), who worked in the psychology department of the University of Cape Town in South Africa. Although most of his work went unpublished, Taylor was the first psychologist known to use exposure therapy treatment for anxiety, including methods of situational exposure with response prevention – a common exposure therapy technique still being used. Since the 1950s several sorts of exposure therapy have been developed, including systematic desensitisation, flooding, implosive therapy, prolonged exposure therapy, in vivo exposure therapy, and imaginal exposure therapy.

Medical Uses

Generalised Anxiety Disorder

There is empirical evidence that exposure therapy can be an effective treatment for people with generalised anxiety disorder, citing specifically in vivo exposure therapy, which has greater effectiveness than imaginal exposure in regards to generalized anxiety disorder. The aim of in vivo exposure treatment is to promote emotional regulation using systematic and controlled therapeutic exposure to traumatic stimuli.

Phobia

Exposure therapy is the most successful known treatment for phobias. Several published meta-analyses included studies of one-to-three hour single-session treatments of phobias, using imaginal exposure. At a post-treatment follow-up four years later 90% of people retained a considerable reduction in fear, avoidance, and overall level of impairment, while 65% no longer experienced any symptoms of a specific phobia.

Agoraphobia and social anxiety disorder are examples of phobias that have been successfully treated by exposure therapy.

Post Traumatic Stress Disorder

Virtual reality exposure (VRE) therapy is a modern but effective treatment of post-traumatic stress disorder (PTSD). This method was tested on several active duty Army soldiers, using an immersive computer simulation of military settings over six sessions. Self-reported PTSD symptoms of these soldiers were greatly diminished following the treatment. Exposure therapy has shown promise in the treatment of co-morbid PTSD and substance abuse.

Obsessive Compulsive Disorder

Exposure and response prevention (also known as exposure and ritual prevention; ERP or EX/RP) is a variant of exposure therapy that is recommended by the American Academy of Child and Adolescent Psychiatry (AACAP), the American Psychiatric Association (APA), and the Mayo Clinic as first-line treatment of obsessive compulsive disorder (OCD) citing that it has the richest empirical support for both youth and adolescent outcomes.

ERP is predicated on the idea that a therapeutic effect is achieved as subjects confront their fears, but refrain from engaging in the escape response or ritual that delays or eliminates distress. In the case of individuals with OCD or an anxiety disorder, there is a thought or situation that causes distress. Individuals usually combat this distress through specific behaviours that include avoidance or rituals. However, ERP involves purposefully evoking fear, anxiety, and or distress in the individual by exposing him/her to the feared stimulus. The response prevention then involves having the individual refrain from the ritualistic or otherwise compulsive behaviour that functions to decrease distress. The patient is then taught to tolerate distress until it fades away on its own, thereby learning that rituals are not always necessary to decrease distress or anxiety. Over repeated practice of ERP, patients with OCD expect to find that they can have obsessive thoughts and images but not have the need to engage in compulsive rituals to decrease distress.

The AACAP’s practise parameters for OCD recommends cognitive behavioural therapy, and more specifically ERP, as first line treatment for youth with mild to moderate severity OCD and combination psychotherapy and pharmacotherapy for severe OCD. The Cochrane Review’s examinations of different randomised control trials echoes repeated findings of the superiority of ERP over waitlist control or pill-placebos, the superiority of combination ERP and pharmacotherapy, but similar effect sizes of efficacy between ERP or pharmacotherapy alone.

Techniques

Exposure therapy is based on the principle of respondent conditioning often termed Pavlovian extinction. The exposure therapist identifies the cognitions, emotions and physiological arousal that accompany a fear-inducing stimulus and then tries to break the pattern of escape that maintains the fear. This is done by exposing the patient to progressively stronger fear-inducing stimuli. Fear is minimised at each of a series of steadily escalating steps or challenges (a hierarchy), which can be explicit (“static”) or implicit (“dynamic” – refer to Method of Factors) until the fear is finally gone. The patient is able to terminate the procedure at any time.

There are three types of exposure procedures. The first is in vivo or “real life.” This type exposes the patient to actual fear-inducing situations. For example, if someone fears public speaking, the person may be asked to give a speech to a small group of people. The second type of exposure is imaginal, where patients are asked to imagine a situation that they are afraid of. This procedure is helpful for people who need to confront feared thoughts and memories. The third type of exposure is interoceptive, which may be used for more specific disorders such as panic or post-traumatic stress disorder. Patients confront feared bodily symptoms such as increased heart rate and shortness of breath. All types of exposure may be used together or separately.

While evidence clearly supports the effectiveness of exposure therapy, some clinicians are uncomfortable using imaginal exposure therapy, especially in cases of PTSD. They may not understand it, are not confident in their own ability to use it, or more commonly, they see significant contraindications for their client.

Flooding therapy also exposes the patient to feared stimuli, but it is quite distinct in that flooding starts at the most feared item in a fear hierarchy, while exposure starts at the least fear-inducing.

Exposure and Response Prevention

In the exposure and response prevention (ERP or EX/RP) variation of exposure therapy, the resolution to refrain from the escape response is to be maintained at all times and not just during specific practice sessions. Thus, not only does the subject experience habituation to the feared stimulus, but they also practice a fear-incompatible behavioural response to the stimulus. The distinctive feature is that individuals confront their fears and discontinue their escape response. The American Psychiatric Association recommends ERP for the treatment of OCD, citing that ERP has the richest empirical support.

While this type of therapy typically causes some short-term anxiety, this facilitates long-term reduction in obsessive and compulsive symptoms. Generally, ERP incorporates a relapse prevention plan toward the end of the course of therapy.

Mindfulness

A 2015 review pointed out parallels between exposure therapy and mindfulness, stating that mindful meditation “resembles an exposure situation because [mindfulness] practitioners ‘turn towards their emotional experience’, bring acceptance to bodily and affective responses, and refrain from engaging in internal reactivity towards it.” Imaging studies have shown that the ventromedial prefrontal cortex, hippocampus, and the amygdala are all affected by exposure therapy; imaging studies have shown similar activity in these regions with mindfulness training.

Research

Exposure therapy can be investigated in the laboratory using Pavlovian extinction paradigms. Using rodents such as rats or mice to study extinction allows for the investigation of underlying neurobiological mechanisms involved, as well as testing of pharmacological adjuncts to improve extinction learning.

What is Psychological First Aid?

Introduction

Psychological first aid (PFA) is a technique designed to reduce the occurrence of post-traumatic stress disorder. It was developed by the National Centre for Post Traumatic Stress Disorder (NC-PTSD), a section of the United States Department of Veterans Affairs, in 2006. It has been spread by the International Federation of Red Cross and Red Crescent Societies, Community Emergency Response Team (CERT), the American Psychological Association (APA) and many others. It was developed in a two-day intensive collaboration, involving more than 25 disaster mental health researchers, an online survey of the first cohort that used PFA and repeated reviews of the draft.

Refer to Crisis Intervention and Mental health First Aid.

Definition

According to the NC-PTSD, psychological first aid is an evidence-informed modular approach for assisting people in the immediate aftermath of disaster and terrorism to reduce initial distress and to foster short and long-term adaptive functioning. It was used by non-mental health experts, such as responders and volunteers. Other characteristics include non-intrusive pragmatic care and assessing needs. PFA does not necessarily involve discussion of the traumatic event. Just like physical first aid, psychological first aid focuses on providing effective initial support to individuals in distress.

Components

  • Protecting from further harm.
  • Opportunity to talk without pressure.
  • Active listening.
  • Compassion.
  • Addressing and acknowledging concerns.
  • Discussing coping strategies.
  • Social support.
  • Offer to return to talk.
  • Referral.

Steps

  • Contact and engagement.
  • Safety and comfort.
  • Stabilization.
  • Information gathering.
  • Practical assistance.
  • Connection with social supports.
  • Coping information.
  • Linkage with services.

Brief History

Before PFA, there was a procedure known as debriefing. It was intended to reduce the incidences of post traumatic stress disorder (PTSD) after a major disaster. PTSD is now widely known to be debilitating; sufferers experience avoidance, flashbacks, hyper-vigilance, and numbness. Debriefing procedures were made a requirement after a disaster, with a desire to prevent people from developing PTSD. The idea behind it was to promote emotional processing by encouraging recollection of the event. Debriefing has origins with the military, where sessions were intended to boost morale and reduce distress after a mission. Debriefing was done in a single session with seven stages: introduction, facts, thoughts and impressions, emotional reactions, normalisation, planning for future, and disengagement.

Debriefing was found to be at best, ineffective, and at worst, harmful. There are several theories as to why debriefing increased incidents of PTSD. First, those who were likely to develop PTSD were not helped by a single session. Second, being re-exposed too soon to the trauma could lead to retraumatisation. Exposure therapy in cognitive behavioural therapy (CBT) allows the person to adjust to the stimuli before slowly increasing severity. Debriefing did not allow for this. Also, normal distress was seen to be pathological after a debriefing and those who had been through a trauma thought they had a mental disorder because they were upset. Debriefing assumes that everyone reacts the same way to a trauma, and anyone who deviates from that path, is pathological. But there are many ways to cope with a trauma, especially so soon after it happens.

PFA seems to address many of the issues in debriefing. It is not compulsory and can be done in multiple sessions and links those who need more help to services. It deals with practical issues which are often more pressing and create stress. It also improves self efficacy by letting people cope their own way. PFA has attempted to be culturally sensitive, but whether it is or not has not been shown. However, a drawback is the lack of empirical evidence. While it is based on research, it is not proven by research. Like the debriefing method, it has become widely popular without testing.

Today, PFA has been widely used not just for crisis intervention for natural disasters, but also personal crises such as when individuals face traumatic losses of loved ones or pets, or when organisations go through critical incidents such as the suicide or death of a colleague.

Linking Putative Blood Somatic Mutations, Alzheimer’s & PTSD

Research Paper Title

Putative Blood Somatic Mutations in Post-Traumatic Stress Disorder-Symptomatic Soldiers: High Impact of Cytoskeletal and Inflammatory Proteins.

Background

The recently discovered autism/intellectual disability somatic mutations in postmortem brains, presenting higher frequency in Alzheimer’s disease subjects, compared with the controls. They further revealed high impact cytoskeletal gene mutations, coupled with potential cytoskeleton-targeted repair mechanisms.

The current study was aimed at further discerning if somatic mutations in brain diseases are presented only in the most affected tissue (the brain), or if blood samples phenocopy the brain, toward potential diagnostics.

Methods

Variant calling analyses on an RNA-seq database including peripheral blood samples from 85 soldiers (58 controls and 27 with symptoms of post-traumatic stress disorder, PTSD) was performed.

Results

High (e.g. protein truncating) as well as moderate impact (e.g., single amino acid change) germline and putative somatic mutations in thousands of genes were found. Further crossing the mutated genes with autism, intellectual disability, cytoskeleton, inflammation, and DNA repair databases, identified the highest number of cytoskeletal-mutated genes (187 high and 442 moderate impact). Most of the mutated genes were shared and only when crossed with the inflammation database, more putative high impact mutated genes specific to the PTSD-symptom cohorts versus the controls (14 versus 13) were revealed, highlighting tumour necrosis factor specifically in the PTSD-symptom cohorts.

Conclusions

With microtubules and neuro-immune interactions playing essential roles in brain neuroprotection and Alzheimer-related neurodegeneration, the current mutation discoveries contribute to mechanistic understanding of PTSD and brain protection, as well as provide future diagnostics toward personalised military deployment strategies and drug design.

Reference

Sragovich, S., Gershovits, M., Lam, J.C.K., Li, V.O.K. & Gozes, I. (2021) Putative Blood Somatic Mutations in Post-Traumatic Stress Disorder-Symptomatic Soldiers: High Impact of Cytoskeletal and Inflammatory Proteins. Journal of Alzheimer’s Disease. doi: 10.3233/JAD-201158. Online ahead of print.

Quiet Explosions: Healing the Brain (2019)

Introduction

Professional athletes, military veterans and first responders share their stories of recovery from traumatic brain injury, post-traumatic stress disorder and depression.

Outline

Learn how athletes, veterans and civilians with Traumatic Brain Injury and PTSD are becoming healthy and healing their brains. A humanistic doc about the journey of ten different individuals from near suicide to recovery, and a real life.

Read more @ https://quietexplosions.com/.

Trivia

  • Traumatic brain injury (TBI) impacts 2 million people per year. Professional athletes, military veterans and first-responders share their recovery stories after suffering severe PTSD and depression.
  • Joe Rogan and Super Bowl MVP Mark Rypien, NFL running back Anthony Davis and Ben Driebergen, Marine veteran and winner of CBS’s 35th “Survivor” season, are featured in this enlightening documentary.

Production & Filming Details

  • Director(s): Jerri Sher.
  • Producer(s):
    • Michael Levy … consulting producer.
    • Jerri Sher … producer.
  • Writer(s): Jerri Sher.
  • Music: Omri Lahav.
  • Cinematography: Casey Lynch.
  • Editor(s): Elisa Bonora.
  • Production:
  • Distributor(s): Cinema Libre Studio (2020) (USA) (all media).
  • Release Date: 07 June 2019 (US)
  • Running Time: 89 minutes.
  • Rating: 16+.
  • Country: US.
  • Language: English.

Video Link

Book: The Post-Traumatic Stress Disorder Sourcebook

Book Title:

The Post-Traumatic Stress Disorder Sourcebook, Revised and Expanded Second Edition: A Guide to Healing, Recovery, and Growth.

Author(s): Glenn R. Schiraldi (PhD).

Year: 2016.

Edition: Second (2nd).

Publisher: McGraw-Hill Education.

Type(s): Paperback and Kindle.

Synopsis:

The Post-Traumatic Stress Disorder Sourcebook, Revised and Expanded Second Edition introduces survivors, loved ones, and helpers to the remarkable range of treatment alternatives and self-management techniques available today to break through the pain and realise recovery and growth.

This updated edition incorporates all-new diagnostics from the DSM-5 and covers the latest treatment techniques and research findings surrounding the optimisation of brain health and function, sleep disturbance, new USDA dietary guidelines and the importance of antioxidants, early childhood trauma, treating PTSD and alcoholism, the relationship between PTSD and brain injury, suicide and PTSD, somatic complaints associated with PTSD, and more.

Is there Satisfaction with Telehealth PTSD Treatment?

Research Paper Title

Factors contributing to veterans’ satisfaction with PTSD treatment delivered in person compared to telehealth.

Background

Telehealth is an increasingly popular treatment delivery modality for mental healthcare, including evidence-based treatment for complex and intense psychopathologies such as post-traumatic stress disorder (PTSD). Despite the growing telehealth literature, there is a need for more confirmatory research on satisfaction with PTSD telehealth treatment, particularly among veterans, for whom the most rapid and permanent expansion of telehealth services has been implemented through the Department of Veterans Affairs.

Methods

The current paper integrates data from two concurrent PTSD treatment outcome studies that compared prolonged exposure therapy delivered both in person and via telehealth for veterans (N = 140). Using two different measures of satisfaction (the Charleston Psychiatric Outpatient Satisfaction Scale-Veteran Affairs Version (CPOSS) and the Service Delivery Perception Questionnaire (SDPQ)), the researchers hypothesized that PTSD improvement would predict satisfaction, but that delivery modality (in person vs telehealth) would not.

Results

Results only partially supported the hypotheses, in that PTSD symptom improvement was associated with greater satisfaction, and in-person treatment modality was associated with satisfaction as measured by the CPOSS (but not the SDPQ). Subgroup differences by sex were found, such that male veterans, typically with combat-related trauma, were more satisfied with their PTSD treatment compared to female veterans, who were most frequently seen in this study for military sexual trauma.

Conclusions

Altogether, results illustrate a need for additional satisfaction studies with diverse samples and large sample sizes. Future research may benefit from examining satisfaction throughout treatment, identifying predictors of greater PTSD improvement, and further examining demographic subgroups.

Reference

White, C.N., Kauffman, B.Y. & Acierno, R. (2021) Factors contributing to veterans’ satisfaction with PTSD treatment delivered in person compared to telehealth. Journal of Telemedicine and Telecare. doi: 10.1177/1357633X20987704. Online ahead of print.

Linking PTSD, Trauma, & ASD

Research Paper Title

Heightened risk of posttraumatic stress disorder in adults with autism spectrum disorder: The role of cumulative trauma and memory deficits.

Background

Individuals with Autism Spectrum Disorder (ASD) are known to be at increased risk of exposure to traumas such as maltreatment and abuse, however less is known about possible susceptibility towards the development of Posttraumatic Stress Disorder (PTSD) and associated risk factors.

This study investigated the rates of trauma exposure and PTSD, and the role of cumulative trauma exposure and memory as risk factors for PTSD in adults who self-reported having received an ASD diagnosis, compared to a typically developing (TD) comparison group.

Methods

Questionnaires assessing self-reported frequency of trauma exposure (LEC), PTSD symptomology (PCL-S) and memory (EMQ- R and BRIEF-A) were completed online by 38 ASD adults and 44 TD adults.

Results

Rates of trauma exposure and PTSD symptomatology were significantly higher in the ASD group, compared to the TD group, with deficits in working memory and everyday memory mediating this association. Interestingly, a cumulative effect of trauma exposure on PTSD symptom severity was only found in the ASD group.

Conclusions

High rates of trauma and probable PTSD in ASD adults highlight the importance of routine screening. Cumulative trauma exposure and memory deficits may act to increase risk of PTSD in ASD; longitudinal research is called for.

Reference

Rumball, F., Brook, L., Happe, F. & Karl, A. (2021) Heightened risk of posttraumatic stress disorder in adults with autism spectrum disorder: The role of cumulative trauma and memory deficits. Research in Developmental Disabilities. doi: 10.1016/j.ridd.2020.103848. Online ahead of print.