Psychophysiological assessment of trauma-focused Group Music and Imagery therapy for women with PTSD or CPTSD using script-driven imagery. A randomised controlled study.

BackgroundIn posttraumatic stress disorder (PTSD), physiological reactions during trauma scripts have been anchored to the diagnosis. According to the construct of research domain criteria, physiological reactions and self-rating scales could be used to evaluate treatment effects.ObjectiveIn the present study, self-rated PTSD symptoms combined with physiological reactions during trauma script were used as outcome measurements in the domain of arousal/regulatory systems in a controlled randomised study of Group Music and Imagery (GrpMI) treatment for females with PTSD or complex posttraumatic stress disorder (CPTSD) related to violence and/or sexual abuse.Methods45 traumatised women were randomised to 12 weeks of active treatment or waiting. Before and after the intervention, an assessment was done using physiological measurements during script-driven imagery (SDI) procedures. Subjective Units of Distress (SUD) were collected immediately after the trauma script (TS). Reactions during the SDI procedure were reported using the Responses to Script Driven Imagery (RSDI) scale, measuring re-experiencing, avoidance, and dissociation. Self-reported PTSD symptoms were accessed using the PTSD checklist for DSM-5 (PCL-5). Heart rate (HR), heart rate variability (HRV), and electrodermal activity were sampled during the baseline (BL) and TS conditions of the SDI procedure. As a measure of trauma-related reactivity, the difference between TS and BL was used for statistical calculations. HRV measures included high (HF; 0.15-0.4 Hz) and low (LF; 0.03-0.15 Hz) frequency band power, the LF/HF ratio, and the root mean square of successive inter-beat differences (RMSSD). Measures of electrodermal activity included skin conductance levels (SCL) and frequencies of non-specific skin conductance responses (NS-SCR). Further, correlations between self-rated PTSD symptoms and physiological reactivity measures were analysed.ResultsDuring the TS, the absolute levels of HR, LF/HF-ratio, and NS-SCR, as well as the trauma-related reactivity of HR, RMSSD, HF, LF/HF-ratio, SCL, and NS-SCR, showed significant changes indicating decreased arousal during trauma script after treatment. Compared to the waitlist control, an interaction analysis showed significant treatment effects in the BL level of HR, the absolute TS level of HR and HF, and the trauma-related reactivity of RMSSD and HF, suggesting an improvement of vagal function in the treatment group. Significant treatment-related reductions were found in symptoms of PTSD, re-experiencing and avoidance, as well as SUD. The changes pre- to post-treatment in HR reactivity and self-rated PTSD symptoms correlated significantly. Furthermore, the initial HR reactivity predicted treatment outcome as measured with PCL-5.ConclusionIn the evaluation of treatment methods for PTSD, a combination of self-report and physiological measures seems to be feasible. The physiological measures, in combination with a robust decrease in self-rated PTSD symptoms, indicate that trauma-focused GrpMI is a promising treatment for PTSD or CPTSD. More studies are needed to confirm the results, and further research comparing with other active treatments is necessary to establish the precise role of the treatment.BackgroundIn posttraumatic stress disorder (PTSD), physiological reactions during trauma scripts have been anchored to the diagnosis. According to the construct of research domain criteria, physiological reactions and self-rating scales could be used to evaluate treatment effects.ObjectiveIn the present study, self-rated PTSD symptoms combined with physiological reactions during trauma script were used as outcome measurements in the domain of arousal/regulatory systems in a controlled randomised study of Group Music and Imagery (GrpMI) treatment for females with PTSD or complex posttraumatic stress disorder (CPTSD) related to violence and/or sexual abuse.Methods45 traumatised women were randomised to 12 weeks of active treatment or waiting. Before and after the intervention, an assessment was done using physiological measurements during script-driven imagery (SDI) procedures. Subjective Units of Distress (SUD) were collected immediately after the trauma script (TS). Reactions during the SDI procedure were reported using the Responses to Script Driven Imagery (RSDI) scale, measuring re-experiencing, avoidance, and dissociation. Self-reported PTSD symptoms were accessed using the PTSD checklist for DSM-5 (PCL-5). Heart rate (HR), heart rate variability (HRV), and electrodermal activity were sampled during the baseline (BL) and TS conditions of the SDI procedure. As a measure of trauma-related reactivity, the difference between TS and BL was used for statistical calculations. HRV measures included high (HF; 0.15-0.4 Hz) and low (LF; 0.03-0.15 Hz) frequency band power, the LF/HF ratio, and the root mean square of successive inter-beat differences (RMSSD). Measures of electrodermal activity included skin conductance levels (SCL) and frequencies of non-specific skin conductance responses (NS-SCR). Further, correlations between self-rated PTSD symptoms and physiological reactivity measures were analysed.ResultsDuring the TS, the absolute levels of HR, LF/HF-ratio, and NS-SCR, as well as the trauma-related reactivity of HR, RMSSD, HF, LF/HF-ratio, SCL, and NS-SCR, showed significant changes indicating decreased arousal during trauma script after treatment. Compared to the waitlist control, an interaction analysis showed significant treatment effects in the BL level of HR, the absolute TS level of HR and HF, and the trauma-related reactivity of RMSSD and HF, suggesting an improvement of vagal function in the treatment group. Significant treatment-related reductions were found in symptoms of PTSD, re-experiencing and avoidance, as well as SUD. The changes pre- to post-treatment in HR reactivity and self-rated PTSD symptoms correlated significantly. Furthermore, the initial HR reactivity predicted treatment outcome as measured with PCL-5.ConclusionIn the evaluation of treatment methods for PTSD, a combination of self-report and physiological measures seems to be feasible. The physiological measures, in combination with a robust decrease in self-rated PTSD symptoms, indicate that trauma-focused GrpMI is a promising treatment for PTSD or CPTSD. More studies are needed to confirm the results, and further research comparing with other active treatments is necessary to establish the precise role of the treatment

Optimality in Goal-Dependent Analysis of Sharing

We face the problems of correctness, optimality and precision for the static analysis of logic programs, using the theory of abstract interpretation. We propose a framework with a denotational, goal-dependent semantics equipped with two unification operators for forward unification (calling a procedure) and backward unification (returning from a procedure). The latter is implemented through a matching operation. Our proposal clarifies and unifies many different frameworks and ideas on static analysis of logic programming in a single, formal setting. On the abstract side, we focus on the domain Sharing by Jacobs and Langen and provide the best correct approximation of all the primitive semantic operators, namely, projection, renaming, forward and backward unification. We show that the abstract unification operators are strictly more precise than those in the literature defined over the same abstract domain. In some cases, our operators are more precise than those developed for more complex domains involving linearity and freeness. To appear in Theory and Practice of Logic Programming (TPLP

Trauma-focused group music and imagery with women suffering from PTSD/complex PTSD:A feasibility study

Women who have been exposed to physical, psychological and/or sexual abuse, often with a history of childhood abuse and neglect, frequently suffer from post-traumatic stress disorder (PTSD) or complex posttraumatic stress disorder (CPTSD). However, the evidence-based treatments recommended for this population help only 50%, so there is a need to investigate complementary methods. In this study one such promising method has been explored: trauma-focused Group Music and Imagery (GrpMI). In a nonrandomised clinical setting the feasibility of GrpMI and the suitability of chosen measurements were explored. Ten participants with PTSD/CPTSD were enrolled in the pilot study, five in each group. All participants completed the treatment. The primary outcome was symptoms of PTSD measured at pre-, postand follow-up. The secondary outcomes were dissociation and quality of life. The results showed a decrease in PTSD and dissociative symptoms, and an increase in quality of life following treatment. This tendency was maintained at follow-up. An analysis of individual, semi-structured interviews with the participants after the termination of the treatment showed that the participants found the group treatment helpful and acceptable. Since the findings indicate that trauma-focused GrpMI has a positive effect on the psychological health of the women, a larger randomised controlled study is needed