Special Issue "Post-traumatic Stress Disorder: Assessment and Treatment Considerations"

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A special issue of Behavioral Sciences (ISSN 2076-328X).

Deadline for manuscript submissions: closed (31 August 2014)

Special Issue Editor

Guest Editor
Dr. Diane Castillo (Website)

Women's Stress Disorder Treatment Team, R.G. Murphy VAMC, Department of Psychiatry, The University of New Mexico, Albuquerque, NM 8713, USA
Interests: PTSD; Women's PTSD, trauma disorders; traumatic stress; Prolonged Exposure therapy (PE); Cognitive Processing Therapy (CPT); developing new (group) treatment models for PE and CPT for PTSD

Special Issue Information

Dear Colleagues,

This special issue addresses current methods of assessment and treatment of Post-Traumatic Stress Disorder (PTSD), since its diagnostic inception in 1980. The most recent hallmark of diagnostic evolution is noted with the publication of the 2013 Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5). PTSD first appeared in DSM-III in 1980 with 12 symptoms, in DSM-III-R in 1987 with 17; and finally, in the DSM-IV taxonomy for the longest standing 17-symptom structure from 1994 to 2013. The DSM-5 clinical trials empirically describe PTSD and symptom structure, expanding diagnostic veracity and directing our understanding for the future. PTSD treatment has equally evolved since 1980, with evidence-based exposure and cognitive treatments leading the way. A wide variety of treatments were implemented early on, examining the interventions we knew best: cognitive, typically used for depression and general anxiety; and exposure, used in phobias. Meta-analyses led the International Society for Traumatic Stress Studies (ISTSS) and the VA/DoD practice guidelines to recommend cognitive and exposure as first line treatments for PTSD. Great strides have been made in the dissemination of these two interventions, as well as the application of complimentary alternative methods for treating PTSD, through both individual and group delivery methods. Today’s picture of PTSD in diagnosis and treatment is quite different from that of 33 years past. The American Vietnam Veteran’s return from combat overwhelmingly called the system to task to assess and treat a previously unknown psychiatric disorder and the mental health research and treatment community responded, examining diagnostic presentation not only of combat-produced symptoms, but expanding to an understanding of all types of trauma; from questioning its existence to identifying strategies for prevention, evaluation, and effective treatment. This special issue pulls together articles on state-of-the-art assessments and treatments for PTSD in 2013 and the future.

Dr. Diane Castillo
Guest Editor

Submission

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. Papers will be published continuously (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are refereed through a peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Behavioral Sciences is an international peer-reviewed Open Access quarterly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 300 CHF (Swiss Francs). English correction and/or formatting fees of 250 CHF (Swiss Francs) will be charged in certain cases for those articles accepted for publication that require extensive additional formatting and/or English corrections.

Keywords

  • PTSD
  • trauma
  • assessment
  • treatment
  • gender

Published Papers (10 papers)

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Research

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Open AccessArticle Developing the PTSD Checklist-I/F for the DSM-IV (PCL-I/F): Assessing PTSD Symptom Frequency and Intensity in a Pilot Study of Male Veterans with Combat-Related PTSD
Behav. Sci. 2015, 5(1), 59-69; doi:10.3390/bs5010059
Received: 14 October 2014 / Revised: 16 January 2015 / Accepted: 27 January 2015 / Published: 3 February 2015
Cited by 1 | PDF Full-text (147 KB) | HTML Full-text | XML Full-text
Abstract
The widely used posttraumatic stress disorder (PTSD) Checklist (PCL) has established reliability and validity, but it does not differentiate posttraumatic symptom frequency from intensity as elements of posttraumatic symptom severity. Thus, the PCL in its existing form may not provide a comprehensive [...] Read more.
The widely used posttraumatic stress disorder (PTSD) Checklist (PCL) has established reliability and validity, but it does not differentiate posttraumatic symptom frequency from intensity as elements of posttraumatic symptom severity. Thus, the PCL in its existing form may not provide a comprehensive appraisal of posttraumatic symptomatology. Because of this, we modified the PCL to create the PCL-I/F that measures both frequency and intensity of PTSD symptoms via brief self-report. To establish validity and internal consistency of the PCL-I/F, we conducted a pilot study comparing PCL-I/F scores to structured diagnostic interview for PTSD (the Clinician Administered PTSD Scale [CAPS]) in a male combat veteran sample of 92 participants. Statistically significant correlations between the PCL-I/F and the CAPS were found, suggesting initial validation of the PCL-I/F to screen and assess frequency and intensity of combat-related PTSD symptoms. Implications are discussed for screening and assessment of PTSD related to combat and non-combat trauma. Full article
Open AccessArticle Specificity of Cognitive and Behavioral Complaints in Post-Traumatic Stress Disorder and Mild Traumatic Brain Injury
Behav. Sci. 2015, 5(1), 43-58; doi:10.3390/bs5010043
Received: 27 August 2014 / Revised: 6 January 2015 / Accepted: 22 January 2015 / Published: 30 January 2015
Cited by 1 | PDF Full-text (400 KB) | HTML Full-text | XML Full-text
Abstract
Characterization of cognitive and behavioral complaints is explored in Post-traumatic stress disorder (PTSD) and mild traumatic brain injury (MTBI) samples according to the severity of PTSD, depression and general anxiety conditions. Self-reported questionnaires on cognitive and behavioral changes are administered to PTSD, [...] Read more.
Characterization of cognitive and behavioral complaints is explored in Post-traumatic stress disorder (PTSD) and mild traumatic brain injury (MTBI) samples according to the severity of PTSD, depression and general anxiety conditions. Self-reported questionnaires on cognitive and behavioral changes are administered to PTSD, MTBI, MTBI/PTSD and control groups. Confounding variables are controlled. All groups report more complaints since the traumatic event. PTSD and MTBI/PTSD groups report more anxiety symptoms, depression and complaints compared to the MTBI group. Relatives of the PTSD group confirm most of the behavioral changes reported. Results suggest the utility of self-reported questionnaires to personalize cognitive and behavioral interventions in PTSD and MTBI to cope with the impacts of the traumatic event. Full article
Open AccessArticle Objective Neuropsychological Deficits in Post-Traumatic Stress Disorder and Mild Traumatic Brain Injury: What Remains Beyond Symptom Similarity?
Behav. Sci. 2014, 4(4), 471-486; doi:10.3390/bs4040471
Received: 1 September 2014 / Revised: 15 October 2014 / Accepted: 24 November 2014 / Published: 1 December 2014
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Abstract
This exploratory study intends to characterize the neuropsychological profile in persons with post-traumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI) using objective measures of cognitive performance. A neuropsychological battery of tests for attention, memory and executive functions was administered to [...] Read more.
This exploratory study intends to characterize the neuropsychological profile in persons with post-traumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI) using objective measures of cognitive performance. A neuropsychological battery of tests for attention, memory and executive functions was administered to four groups: PTSD (n = 25), mTBI (n = 19), subjects with two formal diagnoses: Post-traumatic Stress Disorder and Mild Traumatic Brain Injury (mTBI/PTSD) (n = 6) and controls (n = 25). Confounding variables, such as medical, developmental or neurological antecedents, were controlled and measures of co-morbid conditions, such as depression and anxiety, were considered. The PTSD and mTBI/PTSD groups reported more anxiety and depressive symptoms. They also presented more cognitive deficits than the mTBI group. Since the two PTSD groups differ in severity of PTSD symptoms but not in severity of depression and anxiety symptoms, the PTSD condition could not be considered as the unique factor affecting the results. The findings underline the importance of controlling for confounding medical and psychological co-morbidities in the evaluation and treatment of PTSD populations, especially when a concomitant mTBI is also suspected. Full article
Open AccessArticle Prescribing Clinicians’ Perspectives on Evidence-Based Psychotherapy for Posttraumatic Stress Disorder
Behav. Sci. 2014, 4(4), 410-422; doi:10.3390/bs4040410
Received: 21 August 2014 / Revised: 20 September 2014 / Accepted: 8 October 2014 / Published: 21 October 2014
Cited by 2 | PDF Full-text (107 KB) | HTML Full-text | XML Full-text
Abstract
Evidence-based psychotherapies (EBP) for Posttraumatic Stress Disorder are not utilized to their full extent within the Department of Veterans Affairs (VA). VA provides care to many persons with PTSD and has been in the forefront of clinical practice guidelines and EBP training [...] Read more.
Evidence-based psychotherapies (EBP) for Posttraumatic Stress Disorder are not utilized to their full extent within the Department of Veterans Affairs (VA). VA provides care to many persons with PTSD and has been in the forefront of clinical practice guidelines and EBP training and dissemination. Yet VA continues to find EBP implementation difficult. Veterans with PTSD often initially present to prescribing clinicians, who then help make care decisions. It is therefore critical that these clinicians correctly screen and triage appropriate mental health care. The purpose of this study was to assess VA prescribing clinicians’ knowledge, perceptions, and referral behaviors related to EBPs for PTSD and to identify facilitators and barriers to implementing EBPs within VA. We conducted qualitative interviews with 26 VA prescribing clinicians. Limited access to EBPs was the most commonly noted barrier. The clinicians we interviewed also held specific beliefs and behaviors that may delay or deter EBPs. Strategies to improve utilization also emerged. Findings suggest the need for increased access to EBPs, training to optimize the role of prescribing clinicians in helping Veterans with PTSD make appropriate care decisions, and specific organizational changes to facilitate access and effective referral systems for EBPs. Full article
Open AccessArticle Implementing an Assessment Clinic in a Residential PTSD Program
Behav. Sci. 2014, 4(3), 243-264; doi:10.3390/bs4030243
Received: 22 May 2014 / Revised: 11 July 2014 / Accepted: 29 July 2014 / Published: 6 August 2014
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Abstract
Creating useful treatment plans can help improve services to consumers of mental health services. As more evidence-based practices are implemented, deciding what treatment, at what time, for whom becomes an important factor in facilitating positive outcomes. Readiness for trauma-focused treatments for Posttraumatic [...] Read more.
Creating useful treatment plans can help improve services to consumers of mental health services. As more evidence-based practices are implemented, deciding what treatment, at what time, for whom becomes an important factor in facilitating positive outcomes. Readiness for trauma-focused treatments for Posttraumatic Stress Disorder (PTSD) such as Cognitive Processing Therapy or Prolonged Exposure Therapy may influence whether an individual can successfully complete either protocol. In addition, components of adjunctive therapies such as Acceptance and Commitment Therapy or Dialectical Behavior Therapy may be useful in moving a particular patient toward readiness and successful completion of treatment. Psychological assessment adds valuable data to inform these types of treatment decisions. This paper describes the implementation of a psychological assessment clinic in a residential PTSD treatment setting. Barriers to implementation, use of the data, and Veterans’ reactions to the feedback provided to them are included. Full article
Open AccessArticle Cultural Adaptations of Prolonged Exposure Therapy for Treatment and Prevention of Posttraumatic Stress Disorder in African Americans
Behav. Sci. 2014, 4(2), 102-124; doi:10.3390/bs4020102
Received: 31 December 2013 / Revised: 25 April 2014 / Accepted: 6 May 2014 / Published: 14 May 2014
Cited by 3 | PDF Full-text (246 KB) | HTML Full-text | XML Full-text
Abstract
Posttraumatic stress disorder (PTSD) is a highly disabling disorder, afflicting African Americans at disproportionately higher rates than the general population. When receiving treatment, African Americans may feel differently towards a European American clinician due to cultural mistrust. Furthermore, racism and discrimination experienced [...] Read more.
Posttraumatic stress disorder (PTSD) is a highly disabling disorder, afflicting African Americans at disproportionately higher rates than the general population. When receiving treatment, African Americans may feel differently towards a European American clinician due to cultural mistrust. Furthermore, racism and discrimination experienced before or during the traumatic event may compound posttrauma reactions, impacting the severity of symptoms. Failure to adapt treatment approaches to encompass cultural differences and racism-related traumas may decrease treatment success for African American clients. Cognitive behavioral treatment approaches are highly effective, and Prolonged Exposure (PE) in particular has the most empirical support for the treatment of PTSD. This article discusses culturally-informed adaptations of PE that incorporates race-related trauma themes specific to the Black experience. These include adding more sessions at the front end to better establish rapport, asking directly about race-related themes during the assessment process, and deliberately bringing to the forefront race-related experiences and discrimination during treatment when indicated. Guidelines for assessment and the development of appropriate exposures are provided. Case examples are presented demonstrating adaptation of PE for a survivor of race-related trauma and for a woman who developed internalized racism following a sexual assault. Both individuals experienced improvement in their posttrauma reactions using culturally-informed adaptations to PE. Full article
Open AccessArticle Effectiveness of Group-Delivered Cognitive Therapy and Treatment Length in Women Veterans with PTSD
Behav. Sci. 2014, 4(1), 31-41; doi:10.3390/bs4010031
Received: 21 October 2013 / Revised: 13 December 2013 / Accepted: 6 January 2014 / Published: 10 January 2014
Cited by 2 | PDF Full-text (235 KB) | HTML Full-text | XML Full-text
Abstract
The effectiveness and length of group-delivered cognitive treatment for Posttraumatic Stress Disorder (PTSD) was examined in a sample of women veterans. The sample included 271 primarily non-Hispanic white (61%) and Hispanic (25%) women veterans treated in 8-, 10-, or 12-group length sessions [...] Read more.
The effectiveness and length of group-delivered cognitive treatment for Posttraumatic Stress Disorder (PTSD) was examined in a sample of women veterans. The sample included 271 primarily non-Hispanic white (61%) and Hispanic (25%) women veterans treated in 8-, 10-, or 12-group length sessions with manualized cognitive therapy for PTSD. Outcome was measured with the PTSD Symptom Checklist (PCL) in an intention-to-treat analysis (N = 271), in completer subjects (n = 172), and with group as the unit of analysis (n = 47 groups). Significant decreases in PTSD were found in the full sample (effect size [ES] range = 0.27 to 0.38), completers (ES range = 0.37 to 0.54), and group as the unit of analysis (ES range = 0.71 to 0.92), suggesting effectiveness of cognitive group treatment for PTSD. PCL scores significantly improved in the 8, 10, and 12 group lengths, with no differences between each. Clinical improvement showed a third decreasing 10 or more PCL points and 22% no longer meeting PTSD diagnostic criteria, with the best results in the 10-session group. The results suggest group-delivered cognitive therapy is an effective, efficient, time-limited treatment for PTSD. Full article
Open AccessArticle Psychological Distress and Post-Traumatic Symptoms Following Occupational Accidents
Behav. Sci. 2013, 3(4), 587-600; doi:10.3390/bs3040587
Received: 23 August 2013 / Revised: 15 October 2013 / Accepted: 21 October 2013 / Published: 25 October 2013
PDF Full-text (175 KB) | HTML Full-text | XML Full-text
Abstract
Depression and post-traumatic stress disorder frequently occur as a consequence of occupational accidents. To date, research has been primarily focused on high-risk workers, such as police officers or firefighters, and has rarely considered individuals whose occupational environment involves the risk of severe, [...] Read more.
Depression and post-traumatic stress disorder frequently occur as a consequence of occupational accidents. To date, research has been primarily focused on high-risk workers, such as police officers or firefighters, and has rarely considered individuals whose occupational environment involves the risk of severe, but not necessarily life-threatening, injury. Therefore, the present study was aimed at assessing the psychological consequences of accidents occurring in several occupational settings (e.g., construction and industry). Thirty-eight victims of occupational accidents (injured workers) and 38 gender-, age-, and years of education-matched workers who never experienced a work accident (control group) were recruited. All participants underwent a semi-structured interview administered by a trained psychologist, and then were requested to fill in the questionnaires. Injured workers reported more severe anxious, post-traumatic and depressive symptoms, and poorer coping skills, as compared to controls. In the injured group low levels of resilience predicted post-traumatic symptomatology, whereas the degree of physical injury and the length of time since the accident did not play a predictive role. The results suggest that occupational accidents may result in a disabling psychopathological condition, and that a brief psychological evaluation should be included in the assessment of seriously injured workers. Full article

Review

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Open AccessReview Post-Traumatic Stress Disorder among Cardiac Patients: Prevalence, Risk Factors, and Considerations for Assessment and Treatment
Behav. Sci. 2015, 5(1), 27-40; doi:10.3390/bs5010027
Received: 30 September 2014 / Accepted: 2 December 2014 / Published: 23 December 2014
Cited by 2 | PDF Full-text (128 KB) | HTML Full-text | XML Full-text
Abstract
There is increasing awareness of the impact of post-traumatic stress disorder (PTSD) on physical health, particularly cardiovascular disease. We review the literature on the role of trauma in the development of cardiovascular risk factors and disease, aftermath of a cardiac event, and [...] Read more.
There is increasing awareness of the impact of post-traumatic stress disorder (PTSD) on physical health, particularly cardiovascular disease. We review the literature on the role of trauma in the development of cardiovascular risk factors and disease, aftermath of a cardiac event, and risk for recurrence in cardiac patients. We explore possible mechanisms to explain these relationships, as well as appropriate assessment and treatment strategies for this population. Our main conclusion is that screening and referral for appropriate treatments are important given the high prevalence rates of PTSD in cardiac populations and the associated impact on morbidity and mortality. Full article
Open AccessReview Latino Veterans with PTSD: A Systematic Review
Behav. Sci. 2014, 4(3), 320-340; doi:10.3390/bs4030320
Received: 4 June 2014 / Revised: 11 July 2014 / Accepted: 16 August 2014 / Published: 3 September 2014
Cited by 1 | PDF Full-text (350 KB) | HTML Full-text | XML Full-text
Abstract
Latinos have a long history of military service with recent service including combat conditions and multiple deployments, which are highly associated with posttraumatic stress disorder (PTSD). Clinical acumen underscores the importance of culture in assessment and treatment, but there has been little [...] Read more.
Latinos have a long history of military service with recent service including combat conditions and multiple deployments, which are highly associated with posttraumatic stress disorder (PTSD). Clinical acumen underscores the importance of culture in assessment and treatment, but there has been little scientific literature that investigates the unique needs of veteran Latinos with PTSD. The primary goal of this systematic review was to analyze the existing literature on Latino veterans with PTSD and to critically evaluate attention to cultural issues. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses were used to guide this review. Peer-reviewed, research reports written in English on Latino Veterans with PTSD since 1980 were included; 20 were assessment related, and nine were treatment related. All studies were quantitative. Only 13 studies mentioned culture as part of the context for Latino veterans, and only seven included cultural factors as part of the study design. Present findings highlight a lack of research focused on understanding cultural factors related to the assessment and treatment of Latino veterans with PTSD. Culturally-informed research on Latino veterans from current wars, Latina veterans and Latino veteran treatment outcomes are necessary to provide culturally-appropriate care to this growing veteran subgroup. Full article

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