Early trauma-focused cognitive-behavioural therapy to prevent chronic post-traumatic stress disorder and related symptoms: A systematic review and meta-analysis

Background Early trauma-focused cognitive-behavioural therapy (TFCBT) holds promise as a preventive intervention for people at risk of developing chronic post-traumatic stress disorder (PTSD). The aim of this review was to provide an updated evaluation of the effectiveness of early TFCBT on the prevention of PTSD in high risk populations. Methods We performed a systematic literature search in international electronic databases (MEDLINE, EMBASE, PsycINFO, CENTRAL, CINAHL, ISI and PILOTS) and included randomised controlled trials comparing TFCBT delivered within 3 months of trauma, to alternative interventions. All included studies were critically appraised using a standardised checklist. Two independent reviewers selected studies for inclusion and assessed study quality. Data extraction was performed by one reviewer and controlled by another. Where appropriate, we entered study results into meta-analyses. Results Seven articles reporting the results of five RCTs were included. All compared TFCBT to supportive counselling (SC). The study population was patients with acute stress disorder (ASD) in four trials, and with a PTSD diagnosis disregarding the duration criterion in the fifth trial. The overall relative risk (RR) for a PTSD diagnosis was 0.56 (95% CI 0.42 to 0.76), 1.09 (95% CI 0.46 to 2.61) and 0.73 (95% CI 0.51 to 1.04) at 3–6 months, 9 months and 3–4 years post treatment, respectively. A subgroup analysis of the four ASD studies only resulted in RR = 0.36 (95% CI 0.17 to 0.78) for PTSD at 3–6 months. Anxiety and depression scores were generally lower in the TFCBT groups than in the SC groups. Conclusion There is evidence for the effectiveness of TFCBT compared to SC in preventing chronic PTSD in patients with an initial ASD diagnosis. As this evidence originates from one research team replications are necessary to assess generalisability. The evidence about the effectiveness of TFCBT in traumatised populations without an ASD diagnosis is insufficient

Associations between adverse childhood experiences and adversities later in life. Survey data from a high-risk Norwegian sample

Background: A history of childhood abuse and neglect (CAN) is associated with exposure to later negative life events. CAN at an early age, multiple cooccurring exposures (cumulative events), and a high severity and frequency of exposure have potential detrimental long-term effects. Objective: The present study examines the relationship between the severity of CAN and the prevalence of school difficulties and hardship at school, adult adversity and mental health. Participants and Settings: Participants were recruited from in- and out patient mental health or substance abuse treatment facilities, child protective services (CPS),and prisons (N=809, age range = 13–66, mean age= 27.62,SD=10.47). Methods: Exposure to childhood maltreatment was assessed by the Childhood Trauma Questionnaire Short Form (CTQ-SF). After adjusting for gender and age, we conducted a risk ratio regression analysis to investigate associations between severity of child abuse and neglect and hardship at school, adult adversity and adult mental health. Results: The moderate and severe level groups of CAN had statistically significant higher risk ratios for experiences of school difficulties, hardship at school, adult adversity and mental health problems. A robust dose-response was found between severity levels. Conclusion: At an individual level the findings highlight the association between exposure to abuse and adult adversity, underscoring the importance of targeting individuals with high risk of exposure to CAN to reduce the negative long-term risk for Polyvictimization.publishedVersio

Impact of childhood trauma on antipsychotic effectiveness in schizophrenia spectrum disorders: A prospective, pragmatic, semi-randomized trial

Antipsychotic medications are generally effective in ameliorating psychotic symptoms in schizophrenia spectrum disorders (SSDs). Identifying predictors associated with poor treatment response is important for a personalized treatment approach. Childhood trauma (CT) may have a general and differential effect on the effectiveness of different types of antipsychotics in SSDs. The Bergen-Stavanger-Trondheim-Innsbruck (BeSt InTro) study is a pragmatic, researcher-initiated, semi-randomized trial. The present study aimed to investigate symptom change (the Positive and Negative Syndrome Scale) from baseline to 1, 3, 6, 12, 26, 39 and 52 weeks of antipsychotic treatment (amisulpride, aripiprazole and olanzapine) by group (CT/no CT). Participants (n = 98) with diagnoses within the schizophrenia spectrum (F20–29 in the International Classification of Diseases — 10th Revision) were randomized to receive amisulpride, aripiprazole or olanzapine, and for this study categorized into groups of none and low CT, and moderate to severe CT according to thresholds defined by the Childhood Trauma Questionnaire Short-Form manual. CT in SSDs predicted an overall slower treatment response and less antipsychotic effectiveness after 26 weeks of treatment, which was statistically nonsignificant at 52 weeks. Secondary analyses showed a differential effect of CT related to type of antipsychotic medication: patients with SSDs and CT who received olanzapine showed less antipsychotic effectiveness throughout 52 weeks of treatment. The intention-to-treat and per-protocol analyses were convergent. Our findings indicate that in patients with SSD and CT, delayed response to antipsychotics could be expected, and a longer evaluation period before considering change of medication may be recommended.publishedVersio

Does childhood trauma influence cognitive functioning in schizophrenia? The association of childhood trauma and cognition in schizophrenia spectrum disorders.

Childhood trauma (CT) is a risk factor for schizophrenia spectrum disorders (SSDs), and cognitive impairment is a core feature and a vulnerability marker of SSDs. Studies of the relationship between CT and cognitive impairment in SSDs are inconclusive. In addition, few studies have examined differential effects of CT subtypes, e.g. physical, sexual or emotional abuse/neglect, on cognitive functioning. The present study therefore aimed to examine the effects of CT and CT subtypes on cognitive impairment in SSD. Participants (n = 78) with SSDs completed a comprehensive neuropsychological test battery and the Childhood Trauma Questionnaire Short-Form (CTQ-SF). We compared global cognitive performance as well as scores in seven subdomains (verbal abilities, visuospatial abilities, learning, memory, attention/working memory, executive abilities and processing speed) between participants reporting no CT and those reporting CT experiences using independent samples t-tests as well as linear regression analyses to control for possible confounders. CT subtype physical neglect was associated with attention and working memory after controlling for positive and negative psychosis symptoms, years of education, antipsychotics, gender and age, and adjustment of multiple testing. Our results indicate that the observed heterogeneity in cognitive impairment in SSDs, especially attention/working memory abilities, may in part be associated with childhood physical neglect

Childhood maltreatment trauma: a comparison between patients in treatment for substance use disorders and patients in mental health treatment

Background: While previous research has found strong associations between childhood maltreatment trauma and substance use disorders (SUDs), the role of possible moderating effects of gender and mediating effects of psychopathology and SUD is unclear. Objective: The objective of this study was to investigate differences in self-reported childhood maltreatment trauma, general psychological distress, and post-traumatic stress symptoms between 112 patients in treatment for substance use disorders (SUD group) and 112 matched controls with mild to moderate mental health disorders (comparison group). Methods: Childhood maltreatment trauma was measured by the Childhood Trauma Questionnaire – Short Form (CTQ-SF). General psychological distress was measured by the Symptom Checklist-90 – Revised (SCL-90-R), and post-traumatic stress symptoms were measured by the Impact of Event Scale – Revised (IES-R). Results: The SUD group reported more severe childhood maltreatment trauma than the comparison group. Females in the SUD group reported more severe and various forms of trauma compared to males. The SUD group reported higher mean scores on the SCL-90-R, but the proportions of people with caseness scores on the IES-R and the SCL-90-R were similar in the two samples. The SUD group reported more avoidance symptoms than the comparison group. Conclusion: This study adds further evidence to the repeatedly found strong associations between childhood maltreatment trauma and SUD, implying that the prevention of childhood maltreatment trauma may reduce the occurrence of SUD. Furthermore, patients with SUD should be screened for childhood maltreatment trauma, and the results should be applied in trauma-informed as well as trauma-focused interventions aimed to help this population. The association appears to be particularly strong for female substance users

Psykososiale tiltak ved store ulykker og katastrofer

In September 2004, the Directorate for Health and Social Affairs commissioned the Norwegian Knowledge Centre for the Health Services to do a systematic review of the effects of psychosocial interventions after crises, accidents and disasters. We assembled an external expert panel consisting of five persons to assist the systematic review work. It was decided to focus exclusively on interventions after large accidents (transport or industrial accidents) and disasters. We carried out systematic searches in international research databases, study selection according to set criteria, study quality assessments with the use of checklists, and summaries on standardised data collection forms. Results from the included studies were summarised in text only. Fourteen studies were included in the report: six randomised controlled trials, six controlled before-and-after studies, and two cohort studies. Four RCTs investigated the effects of psychological debriefing (PD) after large traumatic events. Two of these reported reductions in psychological distress after PD, but none of the studies were sufficiently methodologically robust to produce reliable effect estimates. The remaining ten studies included various other therapeutic modalities, from specific interventions like “Eye Movement Desensitization and Reprocessing (EMDR) and “Experimental Mastery Technique” to more general group psychotherapy. No or marginal differences in psychological distress between the intervention and control groups were observed. A major trend seemed to be that several types of psychosocial interventions may be beneficial. However, the potential effects of these interventions remain uncertain due to poor study quality, low number of studies, small samples and heterogeneity

Longitudinal Relationships between Perceived Social Support and Symptom Outcomes: Findings from a sample of Adult Survivors of Childhood Sexual Abuse

Cross-sectional studies have consistently reported an inverse association between perceived social support and the severity of mental health symptoms among adult survivors of childhood sexual abuse (CSA). However, there is a lack of longitudinal studies investigating the bidirectional association between social support and the severity of symptoms among adult CSA-survivors, as well as the role of relational problems in predicting perceived social support and symptom levels over time. The present study addressed these questions in a sample of primarily female CSA-survivors. Methods In a three-wave, four-year longitudinal study of 506 CSA-survivors (94.9% women, 5.1% men) recruited from support centers for sexual abuse survivors in Norway, we used cross-lagged panel structural equation modeling to examine the directionality of the longitudinal associations between perceived social support and symptoms of posttraumatic stress, anxiety, depression and insomnia. Results Cross-lagged panel analyses revealed significant weak reciprocal associations between perceived social support and depression, posttraumatic stress symptoms and anxiety symptoms, but not with insomnia symptoms. The observed effects were partly overlapping and partly inconsistent across the different symptom domains. Relational problems predicted social support cross-sectionally and longitudinally, whereas only cross-sectional associations were found between the relational problems variable and mental health symptoms. Theoretical and clinical implications of the findings are discussed, alongside methodological limitations of the study

Longitudinal Relationships between Perceived Social Support and Symptom Outcomes: Findings from a sample of Adult Survivors of Childhood Sexual Abuse

Cross-sectional studies have consistently reported an inverse association between perceived social support and the severity of mental health symptoms among adult survivors of childhood sexual abuse (CSA). However, there is a lack of longitudinal studies investigating the bidirectional association between social support and the severity of symptoms among adult CSA-survivors, as well as the role of relational problems in predicting perceived social support and symptom levels over time. The present study addressed these questions in a sample of primarily female CSA-survivors. Methods In a three-wave, four-year longitudinal study of 506 CSA-survivors (94.9% women, 5.1% men) recruited from support centers for sexual abuse survivors in Norway, we used cross-lagged panel structural equation modeling to examine the directionality of the longitudinal associations between perceived social support and symptoms of posttraumatic stress, anxiety, depression and insomnia. Results Cross-lagged panel analyses revealed significant weak reciprocal associations between perceived social support and depression, posttraumatic stress symptoms and anxiety symptoms, but not with insomnia symptoms. The observed effects were partly overlapping and partly inconsistent across the different symptom domains. Relational problems predicted social support cross-sectionally and longitudinally, whereas only cross-sectional associations were found between the relational problems variable and mental health symptoms. Theoretical and clinical implications of the findings are discussed, alongside methodological limitations of the study