Faculty Bibliography

Sleep disturbance is an essential symptom of posttraumatic stress disorder, and recent evidence suggests that disrupted sleep may play an important role in the development of posttraumatic stress disorder following traumatic stress. The authors review several aspects of sleep as it relates to posttraumatic stress disorder. First, there is an association between traumatic stress and different components of disrupted sleep in children and adolescents. Second, sleep disruption appears to be a core feature of other pediatric anxiety disorders, and the authors consider if this preexisting sleep vulnerability may explain in part why preexisting anxiety disorders are a risk factor for developing posttraumatic stress disorder following a traumatic event. Third, the authors consider attachment theory and the social context of trauma and sleep disruption. This article concludes with a consideration of the therapeutic implications of these findings

Exposure to multiple traumas, particularly in childhood, has been proposed to result in a complex of symptoms that includes posttraumatic stress disorder (PTSD) as well as a constrained, but variable group of symptoms that highlight self-regulatory disturbances. The relationship between accumulated exposure to different types of traumatic events and total number of different types of symptoms (symptom complexity) was assessed in an adult clinical sample (N = 582) and a child clinical sample (N = 152). Childhood cumulative trauma but not adulthood trauma predicted increasing symptom complexity in adults. Cumulative trauma predicted increasing symptom complexity in the child sample. Results suggest that Complex PTSD symptoms occur in both adult and child samples in a principled, rule-governed way and that childhood experiences significantly influenced adult symptoms

The development and exacerbation of many psychiatric and neurologic conditions are associated with dysregulation of the hypothalamic pituitary adrenal (HPA) axis as measured by aberrant levels of cortisol secretion. Here we report on the relationship between the amplitude of diurnal cortisol secretion, measured across 3 typical days in 18 healthy individuals, and blood oxygen level dependant (BOLD) response in limbic fear/stress circuits, elicited by in-scanner presentation of emotionally negative stimuli, specifically, images of the World Trade Center (WTC) attack. Results indicate that subjects who secrete a greater amplitude of cortisol diurnally demonstrate less brain activation in limbic regions, including the amygdala and hippocampus/parahippocampus, and hypothalamus during exposure to traumatic WTC-related images. Such initial findings can begin to link our understanding, in humans, of the relationship between the diurnal amplitude of a hormone integral to the stress response, and those neuroanatomical regions that are implicated as both modulating and being modulated by that response

Reviews the book, Creative interventions with traumatized children edited by Cathy A. Malchiodi (see record 2008-02507-000). Trauma and its subsequent effects in children and adolescents is a growing concern in the field of child and adolescent psychiatry. As a result, effective treatments are a real and pressing need in this field, as well as for other mental health practitioners working with this population. This book offers some much needed innovative ways of treating these children and adolescents that are based on thoughtful evidence and multiple experienced practitioners. This book consists of fifteen chapters written by thirteen different authors who are all in the field of creative and expressive arts. These chapters are divided in four broad areas: basics of expressive arts therapy, interventions with individuals, interventions with families and groups, and intervention as prevention. Strengths of this book are the numerous examples of creative works produced by the child and adolescent patients of the various contributors,which are contained in nearly every chapter, and the case examples of how these therapies were utilized with specific patients. In sum, this book provides nonverbal strategies and treatments for practitioners to use, in particular in populations where words may initially and repeatedly fail these children in therapy.

Frontolimbic structures involved in fear conditioning have also been associated with hypothalamic-pituitary-adrenal (HPA)-axis modulation, including amygdaloid, hippocampal, and ventromedial prefrontal cortex regions. Although HPA-axis function and endocrine changes have been investigated in the context of stress provocation, much research has not been conducted using functional neuroimaging in the study of the HPA axis and frontolimbic function in response to emotional stimuli. Using functional magnetic resonance imaging, the association of blood-oxygen-level dependent signal with salivary cortisol in response to an emotional visual scene paradigm was investigated, with prescan and postscan salivary cortisol analyzed as a covariate of interest during specific conditions. Cortisol reactivity to the paradigm was positively associated with amygdalar and hippocampal activity and negatively associated with ventromedial prefrontal cortex activity in conditions involving emotional imagery

This study sought to identify variables associated with functional impairment in persons exposed to terrorism. A sample of adults who sought treatment for psychological distress related to the 2001 World Trade Center attack completed standardized self-report measures of PTSD symptoms, expectancies of ability to regulate negative moods, interpersonal problems, and social-occupational impairment. A multiple regression analysis found that PTSD numbing symptoms, beliefs about the ability to regulate negative moods, feelings of social discomfort and expectations of being disliked, income level, and relationship status significantly predicted 58% of the variance in social-occupational impairment. The results suggest that treatments targeting PTSD numbing symptoms as well as maladaptive expectations about social interactions and one's ability to manage negative affect may have utility for persons adversely affected by mass violence

The association between traumatic events and psychopathology has long been recognized, and the literature on posttraumatic stress disorder (PTSD) has burgeoned since this entity was introduced into the diagnostic nomenclature. This literature has been characterized by a range of clinical controversies about the optimal diagnosis and treatment of PTSD. In response, several systematic reviews of treatment, clinical guidelines, and consensus statements about PTSD have been generated, but their conclusions are not always consistent. Our aim here is to provide a concise overview of the literature on PTSD, focusing in particular on recent investigations and publications, with the objective of summarizing practical clinical implications and suggesting future research opportunities. We consider, in turn, the diagnosis and evaluation, psychobiology, pharmacotherapy, psychotherapy, and prevention of PTSD

This report reviews and critiques the psychotherapy literature for the treatment of posttraumatic stress disorder (PTSD) and systematically presents data on sample size, rates of completion and effect sizes. Substantial progress has been made in the use of cognitive behavioral therapies and eye movement desensitization and reprocessing for the resolution of PTSD. Innovations in PTSD treatments are identified. Further advances are needed in the treatment of populations with complex and chronic forms of PTSD such as those found in childhood abuse populations, refugee populations, and those experiencing chronic mental illness. The need to address comorbid emotional, social, and physical health consequences of trauma, to implement treatments in community-based settings, and to incorporate larger systems of care into study designs is noted