Stepped and Standard Care for Childhood Trauma

2015 ◽  
Vol 27 (6) ◽  
pp. 653-663 ◽  
Author(s):  
Alison Salloum ◽  
Brent J. Small ◽  
John Robst ◽  
Michael S. Scheeringa ◽  
Judith A. Cohen ◽  
...  
Keyword(s):  
Behavioral Therapy ◽  
Stepped Care ◽  
Post Traumatic Stress ◽  
Related Data ◽  
Stress Symptoms ◽  
Parental Treatment ◽  
Post Traumatic ◽  
Intent To Treat ◽  
Delivery Approach

Objective: This study explored the feasibility of stepped care trauma-focused cognitive behavioral therapy (SC-TF-CBT) relative to TF-CBT with children (aged 8–12). Method: Children ( N = 33) with post-traumatic stress symptoms (PTSS) were randomly assigned (2:1) to SC-TF-CBT or TF-CBT. SC-TF-CBT consisted of Step 1, parent-led therapist-assisted treatment, and Step 2 (nine TF-CBT sessions). TF-CBT consisted of 12 therapist-directed sessions. Baseline, post-Step 1, posttreatment, and 3-month follow-up assessments occurred. Cost-related data were collected throughout the treatment. Results: In all, 64% (intent-to-treat) to 82% (completers) responded to Step 1. Group × Time interactions were not statistically significant for PTSS ( p = .888), severity ( p = .576), and internalizing ( p = .862)/externalizing ( p = .974) symptoms, indicating comparable improvements in outcomes across both conditions. There were no significant differences in parental treatment credibility ( p = .440), expectations ( p = .664), and satisfaction ( p = .768). SC-TF-CBT total costs were significantly lower than TF-CBT (Effect Size [ES] = 1.61, confidence interval [CI] = [0.65, 2.59], p < .0001). Conclusion: Step 1 may be a viable service delivery approach although further research is needed.

scholarly journals Randomized Clinical Trial of Telephone-Administered Cognitive-Behavioral Therapy to Reduce Post-Traumatic Stress Disorder and Distress Symptoms After Hematopoietic Stem-Cell Transplantation

2010 ◽  
Vol 28 (23) ◽  
pp. 3754-3761 ◽  
Author(s):  
Katherine N. DuHamel ◽  
Catherine E. Mosher ◽  
Gary Winkel ◽  
Larissa E. Labay ◽  
Christine Rini ◽  
...  
Keyword(s):  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Behavioral Therapy ◽  
Ptsd Symptoms ◽  
Post Traumatic Stress ◽  
Hematopoietic Stem ◽  
General Distress ◽  
Distress Symptoms ◽  
Post Traumatic

Purpose A significant number of survivors of hematopoietic stem-cell transplantation (HSCT) report enduring adverse effects of treatment, including illness-related post-traumatic stress disorder (PTSD) symptoms and general distress. We report results of a randomized clinical trial that tested the effects of a 10-session, telephone-administered cognitive-behavioral therapy (CBT) intervention on PTSD, depression, and distress symptoms. Methods Survivors who had undergone HSCT 1 to 3 years earlier (N = 408) were assessed for study eligibility. Those who met study eligibility criteria (n = 89) completed a baseline assessment that included a clinical interview and self-report measures of PTSD symptoms (the primary outcome) and depression and general distress (the secondary outcomes). Next, they were randomly assigned to CBT or an assessment-only condition. Survivors in the CBT group completed 10 individual telephone-based CBT sessions (T-CBT) that included strategies to reduce PTSD symptoms, depression, and general distress. Follow-up assessments occurred at 6, 9, and 12 months after the baseline assessment. Results Linear mixed-model analyses revealed that, compared with HSCT survivors in the assessment-only condition, survivors who completed T-CBT reported fewer illness-related PTSD symptoms, including less avoidance (P < .001) and fewer intrusive thoughts (P < .05) as well as less general distress and fewer depressive symptoms (P < .05) even after controlling for potential demographic and medical covariates. These results were consistent across the three follow-up assessments. Conclusion A brief, telephone-administered CBT intervention developed for HSCT survivors is an efficacious treatment for reducing illness-related PTSD symptoms and general distress.

scholarly journals Uncharted Waters: Treating Trauma Symptoms in the Context of Early Psychosis

2019 ◽  
Vol 8 (9) ◽  
pp. 1456 ◽  
Author(s):  
Folk ◽  
Tully ◽  
Blacker ◽  
Liles ◽  
Bolden ◽  
...  
Keyword(s):  
Traumatic Stress ◽  
Psychotic Disorders ◽  
Behavioral Therapy ◽  
Specialty Care ◽  
Early Psychosis ◽  
Psychotic Symptoms ◽  
Trauma Symptoms ◽  
Post Traumatic Stress ◽  
Stress Symptoms ◽  
Post Traumatic

Psychosis is conceptualized in a neurodevelopmental vulnerability-stress framework, and childhood trauma is one environmental factor that can lead to psychotic symptoms and the development of psychotic disorders. Higher rates of trauma are associated with higher psychosis risk and greater symptom frequency and severity, resulting in increased hospitalization rates and demand on outpatient primary care and mental health services. Despite an estimated 70% of individuals in the early stages of psychosis reporting a history of experiencing traumatic events, trauma effects (post-traumatic anxiety or depressive symptoms) are often overlooked in psychosis treatment and current interventions typically do not target commonly comorbid post-traumatic stress symptoms. We presented a protocol for Trauma-Integrated Cognitive Behavioral Therapy for Psychosis (TI-CBTp), an approach to treating post-traumatic stress symptoms in the context of early psychosis care. We provided a brief summary of TI-CBTp as implemented in the context of Coordinated Specialty Care and presented preliminary data supporting the use of TI-CBTp in early psychosis care. The preliminary results suggest that individuals with comorbid psychosis and post-traumatic stress symptoms can be appropriately and safely treated using TI-CBTp within Coordinated Specialty Care.

Short-term follow-up of post-traumatic stress symptoms in motor vehicle accident victims

1995 ◽  
Vol 33 (4) ◽  
pp. 369-377 ◽  
Author(s):  
Edward B. Blanchard ◽  
Edward J. Hickling ◽  
Alisa J. Vollmer ◽  
Warren R. Loos ◽  
Todd C. Buckley ◽  
...  
Keyword(s):  
Traumatic Stress ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Post Traumatic Stress ◽  
Short Term ◽  
Vehicle Accident ◽  
Stress Symptoms ◽  
Post Traumatic

scholarly journals Hospital workers mental health during the COVID-19 pandemic: methods of data collection and characteristics of study sample in a university hospital in Milan (Italy)

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
A Fattori ◽  
F Cantù ◽  
A Comotti ◽  
V Tombola ◽  
E Colombo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Traumatic Stress ◽  
University Hospital ◽  
Psychological Wellbeing ◽  
Post Traumatic Stress ◽  
Hospital Workers ◽  
Stress Symptoms ◽  
Post Traumatic ◽  
Psychological Impairment

Abstract Background The COVID-19 pandemic is currently a severe challenge for healthcare workers, with a considerable impact on their mental health. In order to focus preventive and rehabilitation measures it’s fundamental to identify risk factors of such psychological impairment. We designed an observational longitudinal study to systematically examine the psychological wellbeing of all employees in a large University Hospital in Italy, using validated psychometric scales in the context of the occupational physician’s health surveillance, in collaboration with Psychiatric Unit. Methods The study started after ethical approval in August 2020. For each worker, the psychological wellbeing is screened in two steps. The first level questionnaire collects sociodemographic characteristics, personal and occupational COVID-19 exposure, worries and concerns about COVID-19, general psychological discomfort (GHQ-12), post-traumatic stress symptoms (IES-R) and anxiety (GAD-7). Workers who score above the cut-off in at least one scale are further investigated by the second level questionnaire composed by PHQ-9, DES-II and SCL-90. If second level shows psychological impairments, we offer individual specialist treatment (third level). We plan to follow-up all subjects to monitor symptoms and possible chronicization; we aim to investigate potential risk factors through univariate analysis and multivariate logistic regressions. Results Preliminary results refer to a sample of 550 workers who completed the multi-step evaluation from August to December 2020, before vaccination campaign started. The participation rate was 90%. At first level screening, 39% of the subjects expressed general psychological discomfort (GHQ-12), 22% post-traumatic stress symptoms (IES-R), and 21% symptoms of anxiety (GAD-7). Women, nurses, younger workers, subjects with COVID-19 working exposure and with an infected family member showed significantly higher psychological impairment compared to colleagues. After the second level screening, 12% and 7% of all workers showed, respectively, depressive and dissociative symptoms; scorings were significantly associated with gender and occupational role. We are currently extending sample size and evaluating subjects over a period of further 12 months. Conclusions The possibility to perform a systematic follow-up of psychological wellbeing of all hospital workers, directly or indirectly exposed to pandemic consequences, constitutes a unique condition to detect individual, occupational, and non-occupational risk factors for psychological impairment in situations of prolonged stress, as well as variables associated with symptoms chronicization.

scholarly journals A-11 The Contribution of Psychological Stress to Adolescent Post-Concussive Symptoms Across Recovery

2020 ◽  
Vol 35 (6) ◽  
pp. 784-784
Author(s):  
T Tarkenton ◽  
C Presley ◽  
T Meredith-Duliba ◽  
T Caze ◽  
L Hynan ◽  
...  
Keyword(s):  
Psychological Stress ◽  
Sport Injury ◽  
Initial Visit ◽  
Post Traumatic Stress ◽  
Stress Symptoms ◽  
Traumatic Amnesia ◽  
Ptsd Checklist ◽  
Post Traumatic ◽  
Linear Regressions

Abstract Objective The aim of this study was to explore whether less commonly explored injury factors account for variance in post-concussive symptoms across recovery. Method Participants aged 12–18 (n = 440) who reported to clinic within 14 days of concussion sustained in either sport injury, MVA, fall, or hit were selected from the ConTex registry. A PCS log, PHQ-8, and GAD-7 were completed at initial visit and 3-month follow-up. Separate hierarchical linear regressions determined predictors of PCS scores at both time points. Demographic, premorbid, injury, and psychological factors were entered in Step 1–4, respectively. A sample subset completed the PTSD Checklist (PCL-5) at initial (n = 58) and 3-month visits (n = 27). Exploratory analyses added the PCL-5 to determine whether post-traumatic stress symptoms contributed to the model. Results At initial visit, sex, post-traumatic amnesia (PTA), PHQ-8, and GAD-7 significantly predicted PCS total scores (p &lt; .001), accounting for 43% of the variance. At 3-month follow-up, PTA dropped out of the model, and psychiatric history and mechanism of injury became significant, explaining an additional 15% of the variance in PCS scores (R2 = .58, p &lt; .001). In exploratory analyses, when PCL-5 scores were added to the final models, demographic, premorbid, and injury factors did not remain significant, and the PCL-5 significantly contributed to the variance in PCS scores at both initial (p = .01) and 3-month follow-up (p &lt; .001). Conclusions Psychological stress and context of injury may be strong predictors of PCS in addition to demographic and premorbid factors. These findings warrant continued investigation of less explored injury factors contribution to initial mTBI presentation and recovery.

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