This study aimed to examine the predictor variables of psychological distress and perceived growth among the survivors of motor vehicle accidents. Demographic characteristics as pre-accident variables, cognitive appraisals of the accident as accident related factors, coping strategies and social support as post-accident variables were used as predictors of distress and perceived growth. 200 adults (142 males and 58 females, ages between 18 and 65) participated in the study. Data was collected by a questionnaire which consisted of four parts. Three trained interviewers who were undergraduate psychology students, administered the questionaire individually. The first part examined on socio-demographic variables. The second part explored variables related to the accident, such as the status of the survivor as driver or non-driver, existence of injury or death to others in the accident, treatment after the accident, duration of hospitalization. The third part focused on the subject&rsquo / s accident related appraisals such as perceived level of responsibility, fear, helplessness, danger, thinking of death to oneself or others, sense of control, perceived level of injury severity. The fourth part contained five scales. Psychological distress was assessed by Impact of Event Scale (IES). Coping strategies were assessed by Ways of Coping Questionnaire (WCQ). Stress Related Growth Scale (SRGS) was used to examine perceived growth. Social support was assessed via Social Support Scale and Depression scores of the participants were assessed by Beck Depression Inventory. The results revealed that the present sample was moderately distressed. The current distress level was significantly related to perceived growth. The general distress level was predicted by age, perceived threat and helplessness coping. Considering intrusive symptoms, age, not having social security entitlement, depression, perceived threat and helplessness coping were found to be significant predictors. Considering avoidant symptoms, years of education, depression and fatalistic coping were found to be significant predictors. Not having an insurance policy, perceived threat, optimistic/problem solving coping and fatalistic coping were found to be significant predictors of percieved growth following motor vehicle accident. The findings are discussed within psychological distress and perceived growth. Limitations of the study, directions for future research and clinical implications are proposed.

No description available.

Posttraumatic Stress Disorder (PTSD) is a psychiatric condition that can develop following exposure to a traumatic event involving actual or threatened death or serious injury. Responses include intense fear, helplessness or horror. Symptoms are characterised into clusters, described as re-experiencing, avoidance, and arousal. These symptoms, which are also evident in other conditions, have been associated with dysfunctions in the central acetylcholinergic system. Benefits from administering acetylcholinesterase inhibitors (AChEI) to people suffering these symptoms have been demonstrated. Donepezil hydrochloride, a reversible inhibitor of the enzyme acetylcholinesterase, is used in the treatment of conditions with difficulties in cognitive function, but has not been used in PTSD. The aim of this thesis was to determine (1) whether there was a difference in the ACh system in people with PTSD and (2) whether administration of an AChEI would change the symtomatology. IDEX (I¹ ² ³ iododexetimide) has been useful in imaging muscarinic-ACh receptors using Single Photon Emission Computerised Tomography (SPECT) and was utilised to investigate whether cholinergic activity in PTSD is altered. One hundred and sixty eight potential subjects were screened and eleven PTSD subjects were enrolled in the IDEX SPECT study. Three healthy non-PTSD control subjects also completed the study. Due to technical complications only the data obtained from eight PTSD and two control subjects was available for analysis. Imaging data for 2 further healthy non-PTSD control subjects were obtained from another study. Sixteen subjects were enrolled in the donepezil open label study (assessed at baseline, Week 2, 6 and 10). Nine PTSD subjects completed the 10-week trial and seven withdrew prematurely (at or after Week 2) due to side effects or a worsening of PTSD symptoms. For the IDEX SPECT study, a voxel-by-voxel statistical analysis of the PTSD subject group versus the control group showed both areas of reduced and increased IDEX uptake. Significant clusters in the PTSD group with a reduced IDEX uptake centred around the bilateral hippocampus, left insula and right precuneus, while increased IDEX uptake appeared in the caudate head. For the donepezil study, in the per-protocol analysis (including only the 9 subjects that completed the protocol), all psychological assessments revealed a difference between the totals obtained at the Week 10 visit compared to those at the Baseline visit and the improvement was in the order of 51%. The intention-to-treat analysis (including all 16 subjects), a repeated measures Analysis of Variance (ANOVA) with a mixed models approach showed that all psychological measures demonstrated statistically significant benefits of the treatment. All subjects who completed the protocol recounted considerable improvement in their overall PTSD symptom profile, which covered symptoms in each of the three clusters. The results of the IDEX SPECT study suggest that alterations in ACh binding in PTSD are evident and may begin to explain a part of the altered cognitive symptomatology apparent in this condition. The pilot open label donepezil trial provided some preliminary evidence that treatment with an AChEI can lessen the intrusions and distress associated with traumatic memories in people with PTSD. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1374974 / Thesis (M.Med.Sc.) -- University of Adelaide, School of Medicine, 2009

Doctor of Philosophy / Despite the demonstrated efficacy of cognitive-behavioural therapy for chronic pain, recent research has attempted to identify predictors of treatment outcome in order to improve the effectiveness of such treatments. This research has indicated that variables such as the nature of the onset of the pain and psychopathology are associated with poor adjustment to chronic pain. Accordingly, these variables might also be predictive of poor response to treatment. Individuals who experience a sudden onset of pain following an injury or accident, particularly when the instigating event is experienced as psychologically traumatic, may present for treatment with high levels of distress, including symptoms consistent with a posttraumatic stress response. The impact of this type of onset of pain and posttraumatic stress symptoms on adjustment to chronic pain and treatment outcome is the focus of this thesis. Three studies were conducted to clarify and extend earlier research findings in this area. Using 536 patients referred for treatment in a tertiary referral pain management centre, the first study examined the psychometric properties of a widely used self-report measure of posttraumatic stress symptoms (the PTSD Checklist, or PCL), modified for use in a chronic pain sample. This study provided preliminary support for the suitability of the PCL as a self-report measure of Posttraumatic Stress Disorder (PTSD) symptoms in chronic pain patients. However, the study also highlighted a number of issues with the use of self-report measures of posttraumatic stress symptoms in chronic pain patient samples. In particular, PCL items enquiring about symptoms which are a common aspect of the chronic pain experience (e.g. irritability, sleep problems) appeared to contribute to high mean scores on the PCL Avoidance and Arousal subscales. Furthermore, application of diagnostic cut-off scores and an algorithm recommended for the PCL in other trauma groups suggested that a much larger proportion of the sample was identified as potentially meeting diagnostic criteria for PTSD than would have been expected from previous research. The second study utilised the modified PCL to investigate the impact of different types of onset of pain (e.g. traumatic onset) and posttraumatic stress symptoms on adjustment to chronic pain in a sample of 196 chronic pain patients referred to the same centre. For patients who experienced the onset of pain related to a specific event, two independent experts in the field of PTSD determined whether these events satisfied the definition of a traumatic event according to DSM-IV diagnostic criteria. Adjustment was assessed through a number of validated measures of mood, disability, pain experience, and pain-related cognitions. Contrary to expectations, comparisons between patients who had experienced different types of onset of pain revealed few significant differences between them. That is, analyses comparing patients presenting with accident-related pain, or pain related to other specific events, to patients who had experienced spontaneous or insidious onset of pain revealed no significant differences between the groups on measures of pain severity, pain-related disability, and symptoms of affective distress after adjustment for age, pain duration, and compensation status. Similarly, comparisons between patients who had experienced a potentially traumatic onset of pain with those who had experienced a non-traumatic or spontaneous or insidious onset of pain also revealed no significant differences on the aforementioned variables. In contrast, compensation status, age, and a number of cognitive variables were significant predictors of pain severity, pain-related disability, and depression. The final study investigated the impact of type of pain onset and posttraumatic stress symptoms on response to a multidisciplinary cognitive-behavioural pain management program. Unlike the previous study, this treatment outcome study revealed a number of differences between onset groups. Most notably, patients who had experienced an insidious or spontaneous onset of pain reported greater improvements in pain severity and maintained these improvements more effectively over a one month period than patients who had experienced pain in the context of an accident or other specific incident. There was also limited evidence that improvements in depression favoured patients who had experienced an insidious or spontaneous and non-traumatic onset of pain. Consistent with this, posttraumatic stress symptoms were a significant predictor of treatment outcome, with higher levels of symptoms being associated with smaller improvements in pain-related disability and distress. Notably, this study also revealed that certain cognitive variables (i.e. catastrophising, self-efficacy, and fear-avoidance beliefs) were also significant predictors of treatment outcome, consistent with previous findings in the pain literature. This provided some perspective on the relative roles of both PTSD symptoms and cognitive variables in adjustment to persisting pain and treatment response. These findings were all consistent with expectations and with previous research. Implications for future research and for the assessment and treatment of chronic pain patients who present with posttraumatic stress symptoms are discussed.

Doctor of Philosophy / Despite the demonstrated efficacy of cognitive-behavioural therapy for chronic pain, recent research has attempted to identify predictors of treatment outcome in order to improve the effectiveness of such treatments. This research has indicated that variables such as the nature of the onset of the pain and psychopathology are associated with poor adjustment to chronic pain. Accordingly, these variables might also be predictive of poor response to treatment. Individuals who experience a sudden onset of pain following an injury or accident, particularly when the instigating event is experienced as psychologically traumatic, may present for treatment with high levels of distress, including symptoms consistent with a posttraumatic stress response. The impact of this type of onset of pain and posttraumatic stress symptoms on adjustment to chronic pain and treatment outcome is the focus of this thesis. Three studies were conducted to clarify and extend earlier research findings in this area. Using 536 patients referred for treatment in a tertiary referral pain management centre, the first study examined the psychometric properties of a widely used self-report measure of posttraumatic stress symptoms (the PTSD Checklist, or PCL), modified for use in a chronic pain sample. This study provided preliminary support for the suitability of the PCL as a self-report measure of Posttraumatic Stress Disorder (PTSD) symptoms in chronic pain patients. However, the study also highlighted a number of issues with the use of self-report measures of posttraumatic stress symptoms in chronic pain patient samples. In particular, PCL items enquiring about symptoms which are a common aspect of the chronic pain experience (e.g. irritability, sleep problems) appeared to contribute to high mean scores on the PCL Avoidance and Arousal subscales. Furthermore, application of diagnostic cut-off scores and an algorithm recommended for the PCL in other trauma groups suggested that a much larger proportion of the sample was identified as potentially meeting diagnostic criteria for PTSD than would have been expected from previous research. The second study utilised the modified PCL to investigate the impact of different types of onset of pain (e.g. traumatic onset) and posttraumatic stress symptoms on adjustment to chronic pain in a sample of 196 chronic pain patients referred to the same centre. For patients who experienced the onset of pain related to a specific event, two independent experts in the field of PTSD determined whether these events satisfied the definition of a traumatic event according to DSM-IV diagnostic criteria. Adjustment was assessed through a number of validated measures of mood, disability, pain experience, and pain-related cognitions. Contrary to expectations, comparisons between patients who had experienced different types of onset of pain revealed few significant differences between them. That is, analyses comparing patients presenting with accident-related pain, or pain related to other specific events, to patients who had experienced spontaneous or insidious onset of pain revealed no significant differences between the groups on measures of pain severity, pain-related disability, and symptoms of affective distress after adjustment for age, pain duration, and compensation status. Similarly, comparisons between patients who had experienced a potentially traumatic onset of pain with those who had experienced a non-traumatic or spontaneous or insidious onset of pain also revealed no significant differences on the aforementioned variables. In contrast, compensation status, age, and a number of cognitive variables were significant predictors of pain severity, pain-related disability, and depression. The final study investigated the impact of type of pain onset and posttraumatic stress symptoms on response to a multidisciplinary cognitive-behavioural pain management program. Unlike the previous study, this treatment outcome study revealed a number of differences between onset groups. Most notably, patients who had experienced an insidious or spontaneous onset of pain reported greater improvements in pain severity and maintained these improvements more effectively over a one month period than patients who had experienced pain in the context of an accident or other specific incident. There was also limited evidence that improvements in depression favoured patients who had experienced an insidious or spontaneous and non-traumatic onset of pain. Consistent with this, posttraumatic stress symptoms were a significant predictor of treatment outcome, with higher levels of symptoms being associated with smaller improvements in pain-related disability and distress. Notably, this study also revealed that certain cognitive variables (i.e. catastrophising, self-efficacy, and fear-avoidance beliefs) were also significant predictors of treatment outcome, consistent with previous findings in the pain literature. This provided some perspective on the relative roles of both PTSD symptoms and cognitive variables in adjustment to persisting pain and treatment response. These findings were all consistent with expectations and with previous research. Implications for future research and for the assessment and treatment of chronic pain patients who present with posttraumatic stress symptoms are discussed.

Diss. (sammanfattning) Umeå : Univ., 2004. / Härtill 4 uppsatser.

Thesis (Ph. D.)--Miami University, Dept. of Psychology, 2004. / Title from second page of PDF document. Includes bibliographical references (p. 68-74).

Inledning: Ett psykiskt trauma kan ibland medföra utveckling av dissociativa symtom. Syfte: Studien undersökte vad som varit betydelsefullt för psykoterapeuten i det psykoterapeutiska arbetet med patienter med trauma och dissociation. Metod: En kvalitativ studie valdes. Fem legitimerade psykoterapeuter intervjuades, alla med lång erfarenhet av traumaterapi och psykodynamisk terapi. Resultat: I denna studie menar informanterna att trauma och dissociation är ett underskattat forskningsområde och betonar vikten av diagnosen, enkel PTSD och dissociativa störningar. Informanterna beskriver sina erfarenheter och svårigheter av att arbeta med traumatiserade och dissocierade patienter.  Den terapeutiska ramen står för trygghet och stabilitet men också gränssättning i det terapeutiska kontraktet. Informanterna indelar det psykoterapeutiska arbetet i 3 faser: Stabilisering, bearbetning och integrering. I terapeutrollen belyser Informanterna att det är särskilt viktigt med egenvård, kompetensutveckling, handledning och andra stödfunktioner vid arbete med patienter med trauma och dissociation.  Informanterna beskriver hur de påverkas starkt känslomässigt och kroppsligt i sitt terapeutiska arbete. Traumatisk överföring och motöverföring betonas som en viktig del som informationskälla för att kunna föra processen framåt vid traumabehandling. Slutsatser: Framgångfaktorer vid traumabehandling är att blanda olika teorier och tekniker som anknytningsteori och terapier som i, EMDR, hypnos och symboldrama men även kroppsterapi som integreras med psykoterapi. Psykoterapeutens roll har stor betydelse för att föra fram arbetsprocessen. Kroppsliga och starka överföringar och motöverföringar sker i mötet med dessa patienter, de tar ofta med sig skräckupplevelser in i terapirummet som måste härbärgeras av psykoterapeuten.

Submitted by Noeme Timbo (noeme.timbo@metodista.br) on 2017-06-01T18:55:08Z No. of bitstreams: 1 Celia Mendes de Sousa.pdf: 1112765 bytes, checksum: c120510735266288b8fb36111eeaa8ce (MD5) / Made available in DSpace on 2017-06-01T18:55:08Z (GMT). No. of bitstreams: 1 Celia Mendes de Sousa.pdf: 1112765 bytes, checksum: c120510735266288b8fb36111eeaa8ce (MD5) Previous issue date: 2017-05-17 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / This study aimed to investigate violence against women as a risk factor for the development of Post Traumatic Stress Disorder (PTSD) and its associations with the psychodynamics of these subjects. The participants were five women, aged over 18 years, victims of violence and attended at a Reference and Support Center for Women in the metropolitan region of São Paulo. At first, a questionnaire was used to collect sociodemographic data, past history of the subject and crime (violence suffered). The other instruments used were: the Childhood Trauma Questionnaire (QUESI), the Traumatic Stress Symptom Screening Instrument (Portuguese version of the Screen for Posttraumatic Stress Symptoms - SPTSS) And the Thematic Apperception Test. For the development of the present study the qualitative descriptive combined with a quantitative analysis was carried out as a research method, based on the data obtained in the questionnaire and the scale. The results indicate that four of the five participants present symptoms compatible with the disorder, confirming the hypothesis that the violence committed against women contributes to the development of symptoms related to Post Traumatic Stress Disorder, evidencing itself as one of the risk factors For the occurrence of the disorder. The experience of the situation of violence in a chronic and / or prolonged way appears as aggravating in the appearance and maintenance of the symptoms; On the other hand, social support, favorable family history and perception of aggression as violence and crime are considered as protective factors in this condition. / Este estudo teve como objetivo investigar a violência contra a mulher como fator de risco para o desenvolvimento do Transtorno de Estresse Pós-Traumático (TEPT) e suas associações com a psicodinâmica destes sujeitos. Os participantes foram cinco mulheres, com idade acima de 18 anos, vítimas de violência e atendidas em um Centro de Referência e Apoio à Mulher da região metropolitana de São Paulo. Num primeiro momento foi aplicado um questionário para coleta de dados sociodemográficos, história passada do sujeito e o crime (violência sofrida). Os demais instrumentos utilizados foram: o Childhood Trauma Questionnaire (Questionário Sobre Traumas na Infância (QUESI) – tradução para o português), o Instrumento de Rastreio para Sintomas de Estresse Pós-Traumático (versão em português do Screen for Posttraumatic Stress Symptoms – SPTSS) e o Teste de Apercepção Temática. Para o desenvolvimento do presente estudo adotou-se como método de pesquisa o descritivo-qualitativo combinado a uma análise quantitativa, realizada a partir dos dados obtidos no questionário e na escala. Os resultados apontam que quatro das cinco participantes apresentam sintomas compatíveis com o transtorno, confirmando a hipótese de que a violência cometida contra a mulher contribui para o desenvolvimento de sintomas relativos ao Transtorno de Estresse Pós-Traumático, evidenciando-se como um dos fatores de risco para a ocorrência do transtorno. A vivência da situação de violência de forma crônica e/ou prolongada aparece como agravante no surgimento e manutenção dos sintomas; por outro lado, o apoio social, histórico familiar favorável e percepção das agressões enquanto violência e crime são tidos como fatores protetivos nesta condição.

Researchers examining issues of recent veterans of military conflicts in Iraq and Afghanistan have found evidence of psychological distress and difficulty adjusting to civilian life post-deployment. Changes in educational benefits offered to veterans will likely facilitate greater numbers of veterans to enter academia in the coming years. This survey of 49 college student veterans at a large Midwestern university was designed to reveal the frequency and intensity of psychological distress, PTSD and alcohol misuse. Relationships between these constructs and the constructs of social support, stigma and barriers to psychological care, life satisfaction, traumatic experiences, attitudes toward help seeking, and service utilization are reported. A history of mental health service utilization since military service was reported by many respondents. PTSD and alcohol misuse symptoms were reported by many college student veterans and incidence in this sample was greater than the incidence previously reported in the literature on veterans. Stigma was found to be negatively correlated with attitudes toward help seeking. Post deployment social support was found to be negatively associated with psychological distress and positively associated with service utilization. Implications and limitations of these findings are presented and future directions for research and intervention are discussed.