Mechanisms of Efficacy of CBT for Cambodian Refugees with PTSD: Improvement in Emotion Regulation and Orthostatic Blood Pressure Response

Based on the results of a randomized controlled trial, we examined a model of the mechanisms of efficacy of culturally adapted cognitive-behavior therapy (CBT) for Cambodian refugees with pharmacology-resistant posttraumatic stress disorder (PTSD) and comordid orthostatic panic attacks (PAs). Twelve patients were in the initial treatment condition, 12 in the delayed treatment condition. The patients randomized to CBT had much greater improvement than patients in the waitlist condition on all psychometric measures and on one physiological measure-the systolic blood pressure response to orthostasis (d = 1.31)-as evaluated by repeated-measures MANOVA and planned contrasts. After receiving CBT, the Delayed Treatment Group improved on all measures, including the systolic blood pressure response to orthostasis. The CBT treatment's reduction of PTSD severity was significantly mediated by improvement in orthostatic panic and emotion regulation ability. The current study supports our model of the generation of PTSD in the Cambodian population, and suggests a key role of decreased vagal tone in the generation of orthostatic panic and PTSD in this population. It also suggests that vagal tone is involved in emotion regulation, and that both vagal tone and emotion regulation improve across treatment

Anxiety Disorder Presentations in Asian Populations: A Review

Contains fulltext : 174911.pdf (publisher's version ) (Open Access)This article reviews typical anxiety presentations in Asia, and among Asian refugees. In Asia, there are multiple functional somatic syndromes that are common anxiety presentations. These distress syndromes often produce catastrophic cognitions about anxiety-type somatic and psychological symptoms. These functional somatic syndromes should be understood, and specifically assessed and addressed, in order to optimize the evaluation and treatment of anxiety disorders among Asian individuals

Disentangling multiple high-energy emission components in the Vela X pulsar wind nebula with the FermiFermi Large Area Telescope

Context. Vela X is a pulsar wind nebula in which two relativistic particle populations with distinct spatial and spectral distributions dominate the emission at different wavelengths. An extended 2° × 3°nebula is seen in radio and GeV gamma rays. An elongated cocoon prevails in X-rays and TeV gamma rays.Aims. We use ~9.5 yr of data from the Fermi Large Area Telescope (LAT) to disentangle gamma-ray emission from the two components in the energy range from 10 GeV to 2 TeV, bridging the gap between previous measurements at GeV and TeV energies.Methods. We determine the morphology of emission associated to Vela X separately at energies 100 GeV, and compare it to the morphology seen at other wavelengths. Then, we derive the spectral energy distribution of the two gamma-ray components over the full energy range.Results. The best overall fit to the LAT data is provided by the combination of the two components derived at energies 100 GeV. The first component has a soft spectrum, spectral index 2.19 ± 0.16−0.22+0.05, and extends over a region of radius 1.°36±0.°04, consistent with the size of the radio nebula. The second component has a harder spectrum, spectral index0.9 ± 0.3−0.1+0.3, and is concentrated over an area of radius 0.°63±0.°03, coincident with the X-ray cocoon that had already been established as accounting for the bulk of the emission at TeV energies.Conclusions. The spectrum measured for the low-energy component corroborates previous evidence for a roll-over of the electron spectrum in the extended radio nebula at energies of a few tens of GeV possibly due to diffusive escape. The high-energy component has a very hard spectrum: if the emission is produced by electrons with a power-law spectrum, the electrons must be uncooled, and there is a hint that their spectrum may be harder than predictions by standard models of Fermi acceleration at relativistic shocks