Overcoming Traumatic Events In Your Past

Phobia Release Program

The curative methods that are described in the 5-Day Phobia Release Course are psychologically proven and are vouched for by many phobic patients, who no longer feel the fear. Each technique is something that you can perform them on your own. Each technique is easy, described in plain, ordinary English and requires no more than a couple of minutes to do. In all, the course contains 9 exercises, organized into 5 days for your convenience. You also receive some background information about Neuro-Linguistic Programming and references for further reading on Nlp if you are interested in learning more.

Phobia Release Program Summary


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The Outcome Of Psychological Treatment For Specific Phobias

The following review discusses the treatment of claustrophobia, fear of flying, routine dental treatment, injections and blood injury and of spiders because, according to a Medline search from 1984, they have probably received the most attention in psychological studies. In addition, however, these phobias probably differ in the impairment of daily functioning and quality of life that they produce in afflicted people. Spider phobia probably has least impact on subjects but others, most notably injection phobia, can be life threatening. On the other hand, the treatment of spider phobia has probably been investigated for theoretical interest more than other fears. Reviews have claimed that the most successful treatment of specific phobias has required the exposure of subjects to the situations that have provoked their fear (Marks, 1987). The present review discusses subsequent studies that have examined different approaches and new ways of implementing exposure, as suggested by...

Posttraumatic stress disorder PTSD

Psychiatry has always recognized that mental disorders can follow traumatic events. The names have tended to change over the years, including 'shell shock', 'war neurosis', or 'battle fatigue'. However, it was only in 1980 that DSM-III described PTSD it appears in ICD also, and the diagnosis has evolved significantly since its introduction. PTSD is described in survivors of major traumatic experiences of a kind outside the normal range of human experience. Such experiences include large-scale disasters, whether natural or man-made, which cause multiple deaths and injuries (for example, transport accidents and earthquakes) wartime combat or individual trauma such as rape or domestic fire. The DSM sets out definitions of the various aspects necessary for a diagnosis of PTSD.

Posttraumatic Stress Disorder

Although there are many forms of psychological injury that can be the focus of a compensation claim (including chronic pain, cognitive impairment, postconcussive syndrome, depression), this review will focus onposttraumatic stress disorder (PTSD). This condition is diagnosed when the individual has (a) suffered a traumatic experience, and subsequently suffers (b) re-experiencing (e.g. flashbacks, nightmares), (c) avoidance (e.g. effortful avoidance of trauma-related thoughts, emotional numbing), and (d) hyperarousal (e.g. insomnia, irritability) symptoms. According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV American Psychiatric Association, 1994), PTSD has the distinctive feature of including a precipitating stressor as part of the disorder's definition. This establishes a straightforward connection between a triggering traumatic event and a variety of observed symptoms (Freckelton, 1997). Such a relationship enables PTSD to be susceptible to...

Specific phobias

Specific phobia is a type of disorder in which the affected individual displays a marked and enduring fear of specific situations or objects. Individuals with specific phobias experience extreme fear as soon as they encounter a defined situation or object, a phobic stimulus. For example, an individual with a specific phobia of dogs will become anxious when coerced to confront a dog. The specific phobia triggers a lot of distress or significantly impairs an affected individual. Mental health professionals use the Diagnostic and Statistical Manual of Mental Disorders (the DSM) to diagnose mental disorders. The 2000 edition of this manual (the Fourth Edition Text Revision, also called the DSM-IV-TR) classifies specific phobia as a type of anxiety disorder. Formerly, specific phobia was known as simple phobia. In the last few years, mental health professionals have paid more attention to specific phobias. Specific phobia has a unique position among the anxiety disorders in that...

PTSD controversies

Received compensation for harassment in the workplace on the basis of PTSD, when the initial definition of PTSD related to serious physical trauma. As indicated above, there are doubts about the 'post' in PTSD. The very name 'PTSD' may be misleading, in that it assumes that the trauma is causative, while not mentioning the importance of vulnerability. Further, the clinician has to make a judgement about the severity of trauma when he was not there and is not in any case an expert on it. Critics have suggested that these inherent flaws in the concept of PTSD should lead to its removal from the international classifications of psychiatry. However, it seems likely to be with us for some time yet.

Prevention of PTSD

'The road to hell is paved with good intentions' might be our watchword here, at least in respect of well-meaning efforts to prevent PTSD. Efforts to encourage - or even require - those who have been exposed to trauma to talk things over with a counsellor or other adviser, either individually or in a group, come under the heading of debriefing. To many, both in the mental health professions and in the wider community, it would seem natural and obvious that such an endeavour would be helpful. After all, 'it's good to talk'. Unfortunately, the evidence shows that this can actually be harmful, increasing rates of PTSD at follow-up - the exact opposite of what it was designed to do. It seems that most people actually do better on their own than if they are directed down a mental health route informal support mechanisms, whether going to the pub with workmates or having a good cry with loved ones, seem more healthy. Accordingly, the NICE PTSD guideline (http www.nice.org.uk page. aspx o...

Treatment of PTSD

'All PTSD sufferers should be offered a course of trauma-focused psychological treatment (trauma-focused cognitive behavioural therapy or eye movement desensitization and reprocessing),' recommends the NICE PTSD guideline As regards CBT, this is a laudable sentiment, but it is wishful thinking there are just not enough therapists.

The Influence of Litigation

A very common issue in litigation proceedings is the extent to which the litigation procedure influences symptoms or symptom reporting. In the case of PTSD, there is a long tradition of attributing reported symptoms to 'compensation neurosis'. After World War I, authorities perceived that compensation for shell shock contributed to the persistence of symptoms after the war (Bonhoeffer, 1926). As a result, The National The evidence pertaining to symptom reporting decreasing after litigation resolution is very mixed. There is increasing research that PTSD symptoms persist after compensation has been settled (Brooks and McKinlay, 1992 Bryant and Harvey, in press-a Mayou, Bryant and Duthie, 1993 McFarlane, 1995), and this pattern of findings reflects evidence from studies ofback injury and chronic pain (Evans, 1984 Mendelson, 1995a). There is also evidence that symptom exaggeration is particularly prevalent in compensation-seeking individuals (Frueh, Smith and Barker, in press). There are...

Causes and symptoms

When PTSD was first suggested as a diagnostic category for DSM-III in 1980, it was controversial precisely because of the central role of outside stressors as causes of the disorder. Psychiatry has generally emphasized the internal weaknesses or deficiencies of individuals as the source of mental disorders prior to the 1970s, war veterans, rape victims, and other trauma survivors were often blamed for their symptoms and regarded as cowards, moral weaklings, or masochists. The high rate of psychiatric casualties among Vietnam veterans, however, led to studies conducted by the Veterans Administration. These studies helped to establish PTSD as a legitimate diagnostic entity with a complex set of causes. BIOCHEMICAL PHYSIOLOGICAL CAUSES. Present neurobiological research indicates that traumatic events cause lasting changes in the human nervous system, including abnormal secretions of stress hormones. In addition, in PTSD patients, researchers have found changes in the amygdala and the...

Physical Psychological And Socioeconomic Sequelae

Apart from the physical injuries sustained by child soldiers, another area of concern for aid agencies and healthcare workers is the psychological health of these children. A recent Belgian study revealed the extent of this problem in a voluntary survey of former child soldiers of Uganda's notorious Lord's Resistance Army. Of the 301 children interviewed, 77 had witnessed at least one killing, 39 had been forced to kill, 39 had abducted other children, 63 had looted and burned civilian homes, and 52 had been seriously beaten. A secondary survey was conducted on a randomly selected subgroup of 75 children, of whom 71 agreed to participate. They completed a questionnaire designed to evaluate the extent of posttraumatic stress disorder (PTSD). A score of greater than 24 on the impact of event scale-revised (IES-R), which is a self-report scale akin to the DSM-IV criteria for PTSD, indicates clinically significant symptoms. The mean IES-R score was 53.5, with 97 of participants falling...

Internalizing Disorders Anxiety Disorders

Separation anxiety disorder (SAD) Excessive and age-inappropriate anxiety about separation from the home or attachment figures that lasts for at least 4 weeks and begins before age 18 years. Specific phobia Age-inappropriate and marked fear in response to the presence or anticipation of a specific object or situation (e.g., animals, injections, seeing blood) the fear persists for at least 6 months and is excessive or unreasonable. Exposure provokes immediate anxiety and is avoided or endured with intense anxiety and distress children may not recognize that their fear is excessive or unreasonable. Main subtypes involve phobias of animals and insects, blood-injection-injury, specific situations (e.g., elevators, flying, enclosed places), and other types (e.g., loud sounds, costumed characters). Posttraumatic stress disorder (PTSD) Persistent anxiety (a duration of at least 1 month) after an overwhelming traumatic event that is outside the range of usual human experience. The response to...

The Psychobiology Of Stress

Ship Breasting Dolphins

Current views hold that the threshold for activating the CEA and BNST is regulated by extra-hypothalamic CRH. Similar to stimulation of the CEA, microinfusions of CRH into the CEA produce fear behaviors in primates (reviewed by Rosen & Schulkin, 1998). The fear-inducing effects of CRH are mediated by CRH1 receptors, and experiences that increase fearful reactions to events also tend to increase CRH1 receptors in these regions (for review, see Steckler & Holsboer, 1999). There is also increasing evidence that CRF2 receptors may be involved in regulating anxiety and related states. These facts would seem to argue for a close coupling between fear anxiety and elevations in CORT. As reflected in syndromes such as posttraumatic stress disorder (PTSD), however, this is not always the case. Whereas elevated NE and EPI have been described in PTSD, remarkably, basal cortisol levels are normal or even suppressed and the L-HPA response to stressors is often dampened although levels of CRH are...

Legal Remedies as a Result of Being Involved in a Single Life Threatening Situation

In the absence of specific legislation relating to a possible claim for PTSD which the employee alleges was caused while at work, we must turn to the common law for assistance. The tort of negligence is essentially concerned with compensating people who suffer from the careless acts (or sometimes omissions) of others. It does not provide a remedy, however, for everyone who suffers loss. Negligence liability will only arise where the law provides that the defendant owed the claimant a duty of care (Donoghue v. Stevenson, 1932). In many cases the fact the claimant owes the defendant a duty of care will be beyond argument, for example in the case of the employer and employee relationship. Perhaps what is more problematic is for the employee to prove that his or her employer has breached that legal duty, by falling below the appropriate standard of care, and that it was the employer's negligent act or omission which caused the damage to the employee. That said there appears to be two...

Review Of Anger Treatment Outcomes

Thus for example, conventional CBT-based approaches towards the assessment and treatment of PTSD (for example, Foa, Steketee & Olasov-Rothbaum, 1989) continue to underestimate the significance of anger, despite compelling evidence regarding its salience (Gerlock, 1994 Novaco & Chemtob, 1998).

Zyprexa see Olanzapine

May occur with panic disorder Amenorrhea (loss of menstrual periods) anorexia nervosa bulimia nervosa Amnesia (memory loss) acute stress disorder Alzheimer's disease dissociative amnesia dissociative fugue dissociative identity disorder post-traumatic stress disorder vascular dementia Wernicke-Korsakoff syndrome Anxiety schizotypal personality disorder separation anxiety disorder sleep terror disorder social phobia specific phobias substance abuse substance intoxication Apathy disorder major depressive disorder nightmare disorder post-traumatic stress disorder Attention-seeking behavior of specific feared situations or objects specific phobias post-traumatic stress disorder Depression

Reward Deficiency Syndrome

Individuals tend to be at risk of multiple addictive, impulsive and compulsive behavioural problems, such as severe alcoholism, cocaine, heroin, marijuana and nicotine addiction, pathological gambling, sex addiction, chronic violence, posttraumatic stress disorder, risk taking behaviours and antisocial behaviour. As such, the use of tyrosine as a precursor to dopamine has a theoretical basis for use in this condition (Blum etal 2000).

The Relational Stance

The more the therapist practices from some theory of blank screen, neutrality, silence, or distance, the more the PTSD patient will feel anxious pressure to find the real person in the therapist to feel safe and the more the therapist will be setting limits and demarcating boundaries. Although it may seem like a question of semantics, the distinction between stating limits and setting limits gets to the heart of the way authenticity, real engagement, and mutuality operate in relational-cultural therapy. Rather than setting limits, which involves use of power over the other and often carries connotations of the pathological and overwhelming nature of the patient's needs, it is important for the therapist (and patient) to state their limits. This involves making use of the therapist's authentic responsiveness and inviting the patient into a relationship where there is respect for difference, tolerance, and learning about how each person affects the other. Both therapist and patient hold...

Borderline Personality Disorder A Critique

Reactions to an abnormal level of threat they are physiologically determined, sometimes part of strategic adaptation to aversive conditions that threaten the lives of the victims. These adaptations involve an extreme survival effort (van der Kolk, McFarlane, & Weisaeth, 1996). Many of these strategies of disconnection and responses are etched in the biochemistry of the abuse survivor and lead to symptoms and behaviors that interfere with healing through connection, which survivors so desperately want and need. For instance, these strategies can involve a complete closing down emotionally at the first hint of interpersonal disappointment the withdrawal can leave the person with an immediate sense of safety, but the larger movement toward the deeper safety of connection is compromised by these strategies. The paradox of longing for authentic, healing connection at the same time that the individual is terrified of the vulnerability necessary to move into real connection is dramatically...

Psychometric Techniques

The most studied measure to index genuineness of clinical presentation is the MMPI MMPI-2 (Hathoway and McKinley, 1991). The MMPI-2 has an array of validity scales designed to index motivation underlying responses to items about psychopathology, including the F, Fb, L, K, Gough Dissimulation Index, Fp, S and Mp (for reviews, see Butcher and Miller, 1999 Greene, 1997 Pope, Butcher and Seelen, 2000). The ability of the MMPI-2 to discriminate between genuine and malingered presentations has been studied in a range of populations, including chronic pain, brain injury, and PTSD (Butcher and Miller, 1999). A number of studies have indicated the utility of the MMPI-2 to distinguish genuine from malingered PTSD (Fairbank et al., 1985). Even when malingerers are given information about PTSD, The PAI (Morey, 1991) is another self-report personality inventory designed to assess response styles, clinical disorders, treatment planning and screen for psychopathology. The PAI was developed to...

Contemporary Theories Of Personality Disorders And Treatment

Another central issue is the impact of chronic mental illness on the personality system. Many individuals who are not treated or are not compliant with treatment and who have active clinical syndromes may begin to show gradual deterioration of the integrity of their personality system. Psychotic episodes or traumatic events certainly have major impact on personality functioning. it is imperative that the clinician working with individuals with severe trauma and psychotic disturbance do everything possible to maintain the integrity of the individual's personality system.

Summary And Conclusions

Exposure therapies are the treatment of choice in adult specific phobia, social phobia, agoraphobia, and obsessive-compulsive disorder (Emmelkamp, 2004) and have also been found quite effective in phobic children (Nauta et al., 2003). Studies of the behavioural treatment of depression have come to a standstill due to the rise of cognitive therapy in this area but the lack of further research into the behavioural treatment of depression is not justified by the data. There are still a number of important issues that need to be addressed. For example, we have no idea why cognitive therapy, behavioural interventions, IPT and pharmacotherapy work equally well with depressed patients, although various researchers provide various theoretical explanations. Unfortunately, to date there is no evidence that

Mental Illness and Substance Abuse

Homeless adolescents also have very high rates of mental health problems and substance abuse. In a study from Seattle, 83 of street youths had been physically and or sexually victimized after leaving home, and 18 met criteria for posttraumatic stress disorder (Stewart, et al., 2004). Across the U.S., 55 of street youth and 34 of shelter youth had used illicit drugs other than marijuana since leaving home, in comparison to 13 of youth who had never been runaway or homeless (Greene, et al., 1997). Street youth use a wide range of drugs, including hallucinogens, amphetamines, sedative tranquilizers, inhalants, cocaine, and opiates. Unfortunately, the initiation of injection drug use is quite common, with an incidence rate of 8.2 per 100 person-years among street youth in Montreal (Roy, et al., 2003).

Pharmacological Toxicological Effects 51 Neurological Effects

A randomized, 25-week, placebo-controlled study by Volz and Kieser showed a significant benefit from the use of kava-kava extract WS 1490 over placebo in treating anxiety disorders of nonpsychotic origin. The study included 101 patients suffering from agoraphobia, specific phobia, generalized anxiety disorder, or adjustment disorder with anxiety as per the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised who

Role Of Mutual Empathy In The Therapeutic Process

If, however, we are empathically failed, misunderstood, humiliated, violated, or abused and we attempt to protest or to register our injury and we are not responded to but are ignored, further hurt, punished, and so forth, we learn that we cannot authentically represent ourselves in this relationship. if this occurs in a relationship with a powerful and important other (e.g., parent, teacher, boss) on whom we are dependent, we begin to distort our experience to try to fit in. We begin to deny our own pain to be accepted by this other person. As a result, we disconnect from ourselves. As Gilligan (1982) notes, we begin to keep ourselves out of relationship to stay in relationship. We move out of authenticity to stay in the semblance of connection. Authentic connection, however, suffers both our connection with the other and the connection with our own experience are weakened. We can trace the effect of chronic disconnection most clearly in cases of childhood abuse, the most obvious and...

Theories Of Personality Development

The idea that the experiences of childhood are important determiners of adult personality is a part of folklore as old as humanity itself. However, Sigmund Freud proposed the first systematic theory of how childhood experiences leave an imprint on the individual that persists into adulthood. To Freud, adult personality and character are end products of the frustrations and conflicts experienced by the child during the oral, anal, phallic, latency, and genital stages of psychosexual development. At each of these stages, sexual energies are concentrated on a particular region of the body and conflicts develop with regard to their expression. Failure to progress from one psychosexual stage to another, referred to as fixation, results in the sexual energies of the person becoming permanently attached to that stage. In addition, traumatic events or extreme stress can result in regression, a reenact-ment of behaviors typical of an earlier psychosexual stage. For example, nail-biting,...

Commonly Occurring Disorders

Indian and Native youth and adults are at high risk for or have a high prevalence of the following mental retardation, speech impediments, learning disabilities, developmental disabilities, Attention Deficit Hyperactivity Disorder, Conduct Disorder, psychoactive substance abuse and dependence, depression, simple phobias, social phobias, separation anxiety, overanxious disorder, obsessive-compulsive disorder, and posttraumatic stress disorder (Manson et al., 1997 Manson & Brenneman, 1995 Manson, Walker, & Kivlahan, 1987). In addition, American Indian and Alaska Native youth experience high rates of Fetal Alcohol Effects or Fetal Alcohol Syndrome, otitis media, which can contribute to language and speech delays (McShane, 1982), suicide (Blum, Harmon, Harris, Bergeisen, & Resnick, 1992), and child abuse and neglect (Manson et al., 1997).

Individual life experience

Adverse experiences in childhood, such as losing one's mother or father, or being sexually abused, would be expected to increase the risk of psychiatric disorder in adult life, and most research studies tend to confirm this long-term association. There is also evidence for a short-term effect whereby psychosocial stress in adult life can precipitate psychiatric illness in predisposed people. This effect applies both for individual life events of a common kind, such as family bereavement or divorce, and for extraordinary disasters (see Chapter 6 on PTSD). Chronic social stresses, such as marital difficulties or bad housing, can also contribute. In contrast, supportive social networks, and close confiding relationships with others, provide some protection against psychiatric disorder following adverse life events.

Dissociation and dissociative disorders

Moderate or severe forms of dissociation are caused by such traumatic experiences as childhood abuse, combat, criminal attacks, brainwashing in hostage situations, or involvement in a natural or transportation disaster. Patients with acute stress disorder, post-traumatic stress disorder (PTSD), conversion disorder, or somatization disorder may develop dissociative symptoms. Recent studies of trauma indicate that the human brain stores traumatic memories in a different way than normal memories. Traumatic memories are not processed or integrated into a person's ongoing life in the same fashion as normal memories. Instead they are dissociated, or split off, and may erupt into consciousness from time to time without warning. The affected person cannot control or edit these memories. Over a period of time, these two sets of memories, the normal and the traumatic, may coexist as parallel sets without being combined or blended. In extreme cases, different sets of dissociated memories may...

Historical Significance

The term posttraumatic stress disorder was introduced in 1980 in the DSM-III, although the concept of this disturbance has a long history. In the past, it the syndrome was recognized in wartime as shell shock or war neurosis, because it was seen most commonly in wartime situations. Many of its typical symptoms, however, such as intrusive thoughts and autonomic arousal, were also recognized in victims of other traumatic events, such as natural disasters.

Differential Diagnosis

The differential diagnosis for PTSD includes major depression, adjustment disorder, panic disorder, generalized anxiety disorder, acute stress disorder, obsessive compulsive disorder, depersonalization disorder, factitious disorder, or malingering. Occasionally, a physical injury may have occurred during the stressor so that a mental disorder secondary to brain injury must be considered as well. Many patients with PTSD meet criteria for another Axis I disorder (e.g., major depression, panic disorder), in which case both disorders should be diagnosed.

Preexisting Conditions

The empirical literature on PTSD highlights the importance of considering the potential contributing role of pre-existing conditions. The possibility that an individual claiming for a psychological injury has suffered a psychological condition prior to the precipitating event, or had a vulnerability to the psychological injury, is significant in all compensation claims for PTSD. Considering that 9 of the population will suffer PTSD at some time in their lives (Breslau et al., 1991), there is a significant proportion of claimants of PTSD who will have suffered PTSD prior to the alleged event. Further, the National Comorbidity Survey in the USA found that 61 of men and 51 of women reported having at least one traumatic event in their life (Kessler et al., 1995), and most of these people reported multiple traumatic experiences. It is likely that most claimants will have had a traumatic event occur prior to the one that is the focus of the claim, and the effects of the earlier events need...

Physiological Assessment

Some commentators have suggested that more sensitive assessment of psychological injury, including PTSD, can be achieved with psychophysiological measurement (Friedman, 1991 Pitman and Orr, 1993). This notion is based on the premise that malingerers may be less able to mimic biological markers of PTSD than self-reported symptoms. The basis for this perspective is the considerable evidence that people with PTSD can be distinguished from those without PTSD on a range of autonomic responses to cues that are specific to their trauma (for a review, see Orr and Kaloupek, 1997). For example, heart rate, skin conductance response, and eyeblink startle have been repeatedly found to be elevated in PTSD individuals when presented with trauma reminders. Further, there is recent evidence that functional magnetic resonance imaging (fMRI) can effectively distinguish the neural networks activated in PTSD and control participants when subliminally presented with threatening stimuli (Rauch et al.,...

Nature of the Alleged Event

Identifying the nature of the event that allegedly caused the injury also needs to recognize recent research developments. Whereas DSM-III-R described the stressor as 'a psychologically distressing event that is outside the range of usual human experience' (APA, 1987), DSM-IV (APA, 1994) deleted this constraint. These changes have allowed a wider range of events to be claimed as possible causes of the disorder. Prior to the definition of PTSD in DSM-IV, there was much concern from legal representatives that broadening the definition to the point of not specifically defining the stressor would create excessive opportunity for people to claim damages based on a PTSD presentation. Most jurisdictions adhere to the principle of foreseeability, in which one would expect the injury to occur following the relevant event (Spaulding, 1988). There is much research that informs us about the likelihood of PTSD developing after a specific event. There is largely a direct relationship between the...

Methodological Issues

The current evidence pertaining to malingered PTSD highlights that an underlying issue for malingering assessments is the level of sophistication of malingering research. Defending the use of any technique to detect malingered PTSD requires awareness of and confidence in the methods used to develop that technique. Simulation studies vary enormously in terms of the extent to which they use actual disordered populations, engage in coaching of simulators, use empirically derived and standardised simulation instructions, and provide sufficient incentives to motivate simulators. These issues raises serious concerns about generalisability of these findings to forensic settings where one needs to make decisions about a potentially malingered presentation. For example, the Carr-Walker and Bryant (2001) study instructed college students to feign PTSD after being given a summary description of PTSD symptoms. This methodology, which is common among simulation studies, can be criticised on the...

Treatment Comparisons

This research in EMDR can be viewed as having two phases. The first phase from Shapiro's seminal 1989 paper up until 1998 was characterised by research examining whether EMDR was an effective psychotherapeutic procedure for post traumatic stress disorder, and the contribution of its various elements, especially eye movements. The second phase from 1999 largely accepted EMDR as an effective treatment for PTSD (Foa, 2000) and now focused on research comparing the effectiveness and efficiency of EMDR directly with variations of exposure. Maxfield & Hyer (2002) rate most of this research according to the 'gold standard' of research (Foa & Meadows, 1997) and according to the degree of treatment fidelity.

The Rationale For Adjunctive Psychological Treatments

Bipolar disorder has a median age of onset in the mid-20s, but most individuals report that they experienced symptoms or problems up to 10 years before diagnosis. Thus, the early evolution of BP may impair the process of normal personality development or may mean that the person starts to employ maladaptive behaviours from adolescence onwards. Co-morbid anxiety disorders, including panic and post-traumatic stress disorder (PTSD) and other mental health problems are common accompaniments of BP and as many as 40 of subjects may have inter-episode sub-syndromal depression (Judd et al., 2002). Although many individuals manage to complete tertiary education and establish a career path, they may then experience loss of status or employment after repeated relapses. One year after an episode of BP, only 30 of individuals have returned to their previous level of social and vocational functioning. Interpersonal relationships may be damaged or lost as a consequence of behaviours during a manic...

Outcome Research In Emdr

There are currently, at the time of writing, 20 randomised controlled (RCTs) in EMDR and PTSD, (not including follow-up RCTs) and also four meta-analyses. This is a considerable outcome research base in a relatively short period of 17 years since the seminal paper on EMDR and represents a considerably greater research interest in this area than in any other single approach to PTSD, whether psychological or pharmacological. Although some of the earlier studies were criticised for lacking methodological rigour (Lohr, Tolin & Lilienfeld, 1998), later studies have by-and-large adhered to 'the gold standard' criteria of Foa & Meadows (1997) - random selection, standard treatment delivery, objective standardised measures, and clear inclusion and exclusion rules for clients (diagnostic criteria). Of the 20 RCTs, two are comparisons with waiting list or delayed treatment controls, three are component analyses, and 15 are treatment comparisons. Of the treatment comparisons, eight are...

Cognitive Therapy for Anxiety Disorders

Cognitive therapy for PTSD typically involves exposure to traumatic memories, behavioural 'stress inoculation' training and cognitive restructuring (Foa & Rothbaum, 1997 Resick & Schnicke, 1992). While there is considerable controversy about which of these elements is effective, there is evidence that as a whole cognitive therapy leads to clinically significant improvements in PTSD symptomatology (Devilly & Spence, 1999 Foa et al., 1999 Marks etal., 1998).

Assessment And Intervention

Indication of a cathartic process that will inevitably resolve with time. People who obtain high scores on posttraumatic stress disorder (PTSD) scales after a major incident are often those individuals whose scores remain elevated a year later. A chronic sense of personal distress, which is exacerbated by bereavement, may be mistaken for expressed grief precipitated by bereavement. Alarcon (1984) suggests that an individual with a personality disorder will have difficulties that reflect ongoing problems in establishing interpersonal relationships rather than grief for a lost relationship. Rosenblatt (1997) cautions that talking about the loss is seen as healthy expression of grief in Euro-American counselling now but may not be seen as appropriate bereavement behaviour in another culture. There is some evidence that those who avoided intense feelings of grief did not have a worse outcome at 14 months than those who experienced emotional distress Bonnano et al. (1995). A study of 253...

QOL in Long Term Survivors of Breast Cancer

Eleven of the 16 studies discussed psychological domain QOL outcomes for long-term survivors.4,32,41,44,45,47-51,53 Although survivors and controls tend to report similar QOL in most psychological domains,4 studies report significant psychological concerns among breast cancer survivors including depression and symptoms of Posttraumatic Stress Disorder.32,41,50,53 Survivors report being overly stressed and worried about the future, and having little control over

Psychosocial Concerns

Cancer survivors with preexisting anxiety or affective disorders appear to be at greatest risk for ongoing distress.25 Changes to body image from cancer therapy, such as that resulting from mastectomy or colostomy, can be a source of problems with psychological adjustment.72 Distress appears to dissipate with time, however. There are a small proportion of patients who experience ongoing effects characteristic of posttraumatic stress disorder.73 Having a spouse or partner decreases the risk of psychological sequelae,74 although these caregivers may also themselves be adversely

The Psychoanalytical View

More recent research revealed that women with vaginismus have significantly increased comorbid anxiety disorders, whereas depression rates are not found to be increased (4,19,20). The role of childhood sexual trauma is unclear, since different frequency rates are found (3,4), and the presence of increased rates of posttraumatic stress disorder has not been investigated as yet. Psychological characteristics, measured with self-report instruments, do not unequivocally corroborate the presence of anxiety disorders. Personality traits found to be more often present in this group suggest the presence of self-focused attention and negative self-evaluation in the etiology or maintenance of vaginismus (3,20). Sexual functioning may be impaired with regard to sexual desire and arousal response during sexual activity. Psychopathology and impaired psychological functioning may be caused as well as effect of vaginismus. Experimental evidence thus far documented the role of experienced threat in...

Research Examples Of Stressful Life Events

The relationship between stressful life events and the individual's response is indirect in that it is mediated by the perception and evaluation of the disaster impact on the individual as well as the community level. As shown in the empirical data, attempts to examine psychological and physiological correlates of disastrous traumatic events need to allow for short-term as well as long-term analyses of the effects to cover full symptomatology.

Acute stress disorder

Acute stress disorder (ASD) is an anxiety disorder characterized by a cluster of dissociative and anxiety symptoms that occur within a month of a traumatic stressor. It is a relatively new diagnostic category and was added to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) in 1994 to distinguish time-limited reactions to trauma from the farther-reaching and longer-lasting post-traumatic stress disorder (PTSD). Published by the American Psychiatric Association, the DSM contains diagnostic criteria, research findings, and treatment information for mental disorders. It is the primary reference for mental health professionals in the United States. ASD, like PTSD, begins with exposure to an extremely traumatic, horrifying, or terrifying event. Unlike PTSD, untreated, however, ASD is likely to progress to PTSD. t The immediate cause of ASD is exposure to trau-ma an extreme stressor involving a threat to life or the prospect of serious injury...

Robert E Antosia md mph

Recovery After the immediate response is completed, long-term recovery begins. Depending on the severity, this process may take months to years to complete. The goals are to promote the recovery of individuals as well as the restoration of the economic and civil life of the community. Victims remain at risk for depression, guilt, and posttraumatic stress disorder. Displaced populations are particularly vulnerable. The

Diagnosis Or Disability

Compensation is only awarded if damage can actually be demonstrated (Epstein, 1995). Compensation is usually awarded on the basis of the degree of impairment that impedes the claimant's capacity to function in a range of domains. A common mistake, in compensation-related assessments, involves the distinction between diagnosis and impairment. It is important that the assessment of psychological injury goes beyond the simple level of diagnostic definitions and addresses how psychological injury is adversely affecting the individual. For example, an individual may not suffer sufficient symptoms to meet a particular diagnostic threshold but may, nonetheless, display marked impairment as a result of the psychological injury. Alternatively, although an individual may suffer a range of PTSD symptoms, the individual may be able to function very ably. Establishing the level of damage secondary to psychological injury is not simple. In defining damages, different jurisdictions distinguish...

Communicable Disease

Posttraumatic Stress Disorder. A number of studies have examined the occurrence of posttraumatic stress disorder and or depression among immigrants residing in urban areas. However, these studies did not consider separately the impact of urban living on individuals' experience of symptoms. A study of 460 Vietnamese immigrants in Orange County, California found that 35 were experiencing symptoms of posttraumatic stress disorder (Yamamoto, et al., 1989, cited in Shapiro, et al., 1999). In comparison, the National Comorbidity Survey, based on a stratified, multi-stage, area probability sample of noninstitutionalized civilian individuals ages 15 to 54 in the U.S., reported a 12-month prevalence of 3.9 for PTSD (Kessler, et al., 1999). 2.2.3.b. Depression. A recent study of 215 Vietnamese immigrants, also conducted in Orange County, California, found that the younger adults in the study were more likely to be highly acculturated and employed, but were more likely to be depressed...

Other Applications

The success of IPT in treating unipolar mood disorders has led to its expansion to treat other psychiatric disorders. Frank and colleagues in Pittsburgh have been assessing a be-haviourally modified version of IPT as a treatment adjunctive to pharmacotherapy for bipolar disorder. Further, IPT is increasingly being applied for a range of non-mood disorders. There are intriguing applications of IPT as treatment for bulimia (Agras et al., 2000 Fairburn et al., 1993 Wilfley et al., 1993, 2000) and anorexia nervosa social phobia (Lipsitz et al., 1999), posttraumatic stress disorder, borderline personality disorder and other conditions. Life events, the substrate of IPT, are ubiquitous, but how useful it is to focus on them may vary from disorder to disorder. There have been two negative trials of interpersonal therapy for substance disorders (Carroll, Rounsaville & Gawin, 1991 Rounsaville et al., 1983), and it seems unlikely that an outwardly focused treatment such as IPT would be useful...

The Emdr Procedure

Particular emphasis will be placed on the nature of the client's psycho-pathology and the client's suitability for EMDR. Contraindications such as suicidal ideation, organic problems that could interfere with processing, and motivational issues, are assessed. Secondary gain factors accruing from the psycho-pathology are identified and may be addressed in the treatment plan. Suitable targets are identified for processing in the treatment phase. Such targets for processing or reprocessing are usually traumatic events or disturbing incidents seminal in the clients presenting problems. Present stimuli that trigger emotional disturbance in the client will also be targeted, as well as anticipated future situations that could elicit disturbance. The EMDR assessor will be particularly listening out for examples of trauma or critical incidents in clients' histories, as well as paying particular attention to the words clients use to describe themselves in relation to...

Spider Phobia

Trials in adults and children (Table 20.4) show, without exception, that exposure to live spiders, usually in a graded manner, produces improvement in measures of anxiety and behavioural tolerance. Simulated exposure by virtual reality (VR) or computer-aided presentation of somebody else being confronted by spiders (vicarious exposure), exposure with distraction, focussed or elaborated attention or with counter-conditioning (reciprocal inhibition) or exposure plus cognitive therapy or self-instruction manuals all reduce anxiety and improve tolerance. One session, an hour or more, can be sufficient. In one study (Smith et al., 1997), however, exposure to irrelevant stimuli, elevators, by computer display was as effective as similar exposure to spiders but it is not clear if sufficient subjects were tested to examine differences between the treatments. No study has included subjects with additional psychological problems. In only five is impairment of functioning addressed, all by Work...

Stress Syndromes

Three of the most publicized states associated with prolonged stress are burnout, bereavement, and posttraumatic stress disorder. The symptoms of burnout, a condition precipitated by the stress of overwork, include emotional exhaustion, reduced productivity, and feelings of depersonalization. The emotional exhaustion in burnout may be accompanied by physical symptoms such as headaches and backaches, in addition to social withdrawal. Compulsive, insecure workaholics whose jobs have ceased to provide them with self-fulfillment are particularly prone to burnout. Such individuals attempt to compensate for low self-esteem from off-the-job activities by dedicating themselves to their jobs and becoming workaholics. One of the most dramatic and widely discussed disorders stemming from the Vietnam War is posttraumatic stress disorder (PTSD). Similar conditions were called shell shock in World War I and combat fatigue insomnia or combat neurosis in World War II and the Korean War. PTSD is, of...

Natural Disasters

Both short- and long-term psychological and physiological effects of disasters have been widely studied. Large-scale disasters leave behind at least three groups of victims (a) individuals who have witnessed the event, (b) individuals who were absent then, but are effected by the devastation, and (c) rescue personnel confronted with the devastation. Such extreme experiences have often been studied in trauma research. Individuals who were exposed to extreme stressors are prone to develop PTSD. Very often, the onset of the disorder is delayed for years (see also Kimerling, Clum, & Wolfe, 2000). Surprisingly, according to McMillen et al. (2000), victims of natural disasters report the lowest rates of PTSD. On the contrary, Madakasira and O'Brien (1987) found a high incidence of acute PTSD in victims of a tornado ve months postdisaster. Again, methodological differences make it dif -cult to compare various studies, especially when short-term and long-term effects are mingled. Green (1995)...


DSM-III-R posttraumatic stress disorder (PTSD) in a second NCS article. PTSD was strongly comorbid with other lifetime DSM-III-R disorders in both men and women especially the affective disorders, the anxiety disorders, and the substance use disorders. In another NCS report, Magee, Eaton, Wittchen, McGonagle, and Kessler (1996) reported that lifetime phobias are highly comorbid with each other, with other anxiety disorders, and with affective disorders they were more weakly comorbid with alcohol and drug dependence. As with major depression, comorbid phobias are generally more severe than pure phobias.

Cultural Knowledge

There are many accessible, brief texts that summarize the population characteristics as well as the brief history of the major Asian ethnic groups in the United States (e.g., Cao & Novas, 1996 Kitano & Daniels, 1995). This background knowledge about the demographic characteristics and the history of various Asian ethnic groups serves as a necessary building block for performing culturally competent assessment and treatment. The knowledge of cultural diversity within the Asian American population will make it less likely for the clinician to make broad stereotypical assumptions about their Asian American clients. For example, although many traditional Asian cultures hold Confucian gender roles, the Filipino culture prior to the Spanish domination held much more egalitarian gender roles (Sustento-Seneriches, 1997). By knowing which Asian ethnic groups entered the United States at which points in the history, the clinician is able to narrow the questions needed to assess the particular...


Sertraline is used to treat depression, obsessive-compulsive disorder, panic disorder, and posttraumatic stress disorder. Serotonin, one of the neurotransmitters, is a brain chemical that carries nerve impulses from one nerve cell to another. Researchers think that depression and certain other mental disorders may be caused, in part, because there is not enough serotonin being released and transmitted in the brain. Like the other SSRI antidepressants, flu-voxamine (Luvox), fluoxetine (Prozac), and paroxetine (Paxil), sertraline increases the level of brain serotonin (also known as 5-HT). Increased serotonin levels in the brain may be beneficial in patients with obsessive-compulsive disorder, alcoholism, certain types of headaches, post-traumatic stress disorder (PTSD), pre-menstrual tension and mood swings, and panic disorder. Sertraline is not more or less effective than the other SSRI drugs although selected characteristics of each drug in this class may offer greater benefits in...

Social Phobia

E. posttraumatic stress disorder Immigrants from countries with a high frequency of social unrest, wars, and civil conflicts may show high rates of Posttraumatic Stress Disorder (PTSD) (Boehnlein & Kinzie, 1995). These immigrants may be particularly reluctant to divulge experience of torture and trauma because of their political immigrant status (DSM-IV, 1994, p. 426). In the specific case of practitioners providing mental health services to American Indians and Alaska Natives, McNeil, Kee, and Zvolensky (1999) suggested an assessment of historical events leading to cultural abuses and discrimination against these groups (see Paniagua, 1998, pp. 77-81) and how these historical (aversive) events may lead to intergen-erational Posttraumatic Stress Disorder among members of these groups (McNeil et al., 1999, p. 62). In the case of Acute Stress Disorder, the severity of this disorder may be determined by cultural differences in the implications of loss. Coping behaviors may also be...

Hispanic Americans

Versus being loco (crazy) (Paniagua, 1998). Furthermore, they need to be prepared to face the dilemma they will encounter when dealing with specific clinical issues in the context of cultural values. For example, suppose a man who has migrated to the United States from a Latin American country experiences symptoms associated with posttraumatic stress disorder. Suppose further that the client was a victim of natural disaster such as severe flooding. The clinician must take into account the personal and cultural belief systems held by the client and avoid addressing the problem solely as a reaction to flooding. It is quite possible the client may not view the natural disaster as random and unprovoked by his own behavior. In this case, a clinician who is open and willing to address the client's recurrent feelings of distress in the context of a spiritual belief system will likely be more effective in helping the client. Furthermore, the client might also be blaming himself for failing to...

Types of trauma

What about the 'post' in PTSD Since the concept was formulated, it has become clear that the delay between trauma and onset of symptoms - to which the 'post' in PTSD refers - only occurs in a minority of patients (e.g. 10-20 per cent). The vast majority develop symptoms straightaway.


How common is PTSD Community surveys show that exposure to traumatic events is the rule rather than the exception, having happened to up to 90 per cent of subjects at some time. PTSD is much less common, being found in less than 10 per cent in the same surveys. This apparent discrepancy is because Not all those exposed to a traumatic event develop PTSD. PTSD tends to resolve naturally in many cases. As would be expected, rates of PTSD after accidents are somewhat higher, and figures of approximately 20 per cent at 3 months and 15 per cent at 1 year have been suggested among road traffic accident victims who attend hospital. Those who appear to have felt entirely out of control during the traumatic incident appear most at risk. The disorder may persist for years, with relapses at anniversaries. Many cases are complicated by alcohol misuse.


A few cases have been reported of dissociative episodes triggered by fragrances associated with traumatic experiences. Patients in treatment for post-traumatic stress disorder (PTSD) or any of the dissociative disorders should consult their therapist before they use aromatherapy.


Serotonin is a brain chemical that carries nerve impulses from one nerve cell to another. Researchers think that depression and certain other mental disorders may be caused, in part, because there is not enough serotonin being released and transmitted in the brain. Like the other SSRI antidepressants, fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil), fluvoxamine increases the level of brain serotonin (also known as 5-HT). Increased serotonin levels in the brain may be beneficial in patients with obsessive-compulsive dirder, alcoholism, certain types of headaches, post-traumatic stress disorder (PTSD), pre-menstrual tension and mood swings, and panic disorder.


The major etiological event leading to PTSD is the stressor. Because not all persons who experience a major stressor develop the disorder, other variables such as underlying personality and biological vulnerability are undoubtedly important. Stressors of all types may contribute to the development of PTSD, but they must be severe enough to be outside the range of normal human experience. Certain experiences are highly linked to the development of PTSD witnessing a friend being killed in action, witnessing wartime atrocities, and, especially, participating in atrocities. Individual differences that can predispose to the development of PTSD include age, history of emotional disturbance, social support, and proximity to the stressor. Eighty percent of young children who sustain a burn injury, for example, show symptoms of posttraumatic stress 1-2 years after the initial injury, but only 30 of adults who sustain this injury have symptoms after 1 year. Persons with a prior history of...


Many commentators have suggested that it is useful to draw a distinction between salient symptoms that may be more susceptible to successful malingering and subtle symptoms that malingerers are less likely to report (Rogers, 1997a). Bryant and Harvey (1998) required treatment-seeking PTSD participants and malingerers to listen to a sound effect of a crashing car, and then report their cognitive and affective responses to this stimulus. Their responses were audiorecorded and subsequently rated on a range of domains by independent psychologists. This study found that simulators and PTSD participants could not be distinguished in terms of their levels of imagery, intrusiveness of the reported memories, belief in the reality of the memory, affect, or movement of imagery. Simulators only differed from PTSD participants in that the latter reported trying to distract themselves from their memories to a greater extent than simulators. This study highlights that whereas it is difficult to...

Occupational Culture

Change environment, organisations need time to manage and absorb the change. This requires clear direction from management, good communication and senior staff keeping in touch with grass roots. Callan (cited in Brown and Campbell, 1994) notes that police organisations can use the concept of stress to blame an individual's failure, rather than implicate organisational structures, and seek to indemnify themselves against corporate failures. The case of the Hillsborough football disaster (where many people were killed and injured in the crush of fans attempting to get into a penned area of the stadium) provides an example of the singling out of individuals upon whom to lay blame. It also illustrates some issues with respect to the suffering of PTSD which are discussed later in terms of legal remedies.

Issue Of Malingering

A central question within compensation assessments is the extent to which the presentation is genuine, malingered, or exaggerated (Lipton, 1994 McGuire, 1999 Resnick, 1984). The concern over the genuineness of reported posttraumatic symptoms necessitates the development of an objective and accurate evaluation process to ascertain whether or not a client has exaggerated or malingered psychological symptoms (Grillo et al., 1994). The accurate assessment of psychological symptoms following a traumatic event is difficult because PTSD symptoms rely heavily on the self-report of subjective symptoms (Raifman, 1983 Resnick, 1984 Rosen, 1995 Sparr and Pankratz, 1983 Zisken, 1995). Obtaining objective measurement or verification of reported symptoms is often difficult (Freckelton, 1997). Further, growing awareness of symptoms allows many individuals to feign PTSD with a reasonable knowledge base about expected symptoms (Fear, 1996 Gerardi, Blanchard and Kolb, 1989 Lees-Haley, 1992 Mendelson,...

From 1999 Onward

Ironson et al. (2002) compared EMDR to prolonged exposure (PE) in 22 community-based PTSD victims. Both treatments produced significant reductions in PTSD and depression symptoms at the end of treatment and at three months follow up. However, seven out of 10 subjects had 70 reduction in PTSD symptoms after three sessions in the EMDR group, compared with two out of 12 with PE, with a significantly lower dropout rate in the EMDR group. However sample size was small and assessors not entirely blind. Lee et al. (2002) compared EMDR with stress inoculation training (SIT) plus prolonged exposure in 24 randomly assigned PTSD subjects. There were no significant differences between EMDR and SIT plus PE on global measures post treatment, except for significant improvement on intrusion symptoms in the EMDR group, and EMDR showed significantly greater improvement on trauma and distress measures at three months follow up. Sample size again was low and assessors not blind to treatment assignment....


Van Etten & Taylor (1998) was a meta-analysis of all treatments for PTSD, which indicated that behaviour therapy, SSRIs, and EMDR were the most effective forms of treatment. They also specified that EMDR appeared to be the 'more efficient' form of therapy, given that EMDR necessitated one third the amount of time to achieve its effects compared to outcomes reported in behaviour therapy research. Maxfield & Hyer (2002) in a meta-analysis of all PTSD outcome studies with EMDR found studies with greater scientific rigour yielded larger effect sizes, and that there was a significant correlation between effect size and treatment fidelity. Bradley et al. (2005) in a meta-analysis of studies on psychotherapy for PTSD between 1980 and 2003 found that EMDR and cognitive behaviour therapy were both effective treatments for PTSD, and were equally effective.


Breast cancer than among control women matched on demographics.25,26 There may be no major differences in quality of life between women having undergone a mastectomy compared to those having breast conserving surgery.27 Other studies also suggest that only a minority of patients have significant psychological distress. For example, older adult long-term cancer survivors do not demonstrate clinical levels of posttraumatic stress disorder although over 25 have clinical depression or display important symptoms of psychological distress related to the continuing effects of cancer and its treatment.28


In this final section, three topics in treating Asian American clients are highlighted (a) techniques for establishing credibility, (b) importance of maintaining flexibility with respect to the parameters of treatment as well as therapeutic approaches, and (c) availability of case studies that illustrate how to translate broad cultural concepts into cultural formulations of individual cases. These are necessarily broad descriptions that only introduce the reader to potential cultural issues in treatment with Asian Americans. The clinician faced with actual Asian American client cases should consult more specific resources. For example, the volume edited by E. Lee (1997) contains chapters on working with Asian Americans at different stages of the life cycle (children, adolescents, young adults, elderly), with various DSM-IV diagnoses (schizophrenia, major depression, posttraumatic stress disorder PTSD , substance abuse, anxiety disorders), using various treatment approaches...