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1.
Trials ; 25(1): 419, 2024 Jun 27.
Article in English | MEDLINE | ID: mdl-38937769

ABSTRACT

BACKGROUND: Mental health literacy is a promising avenue of intervention for addressing the development of psychopathology, as well as its associated consequences, such as a decrease in academic performance. The current study aims to test the effectiveness of such an intervention in high school students, focusing on two main formats of delivery: (1) automated and (2) blended. METHODS: To achieve this aim, a randomized clinical trial with direct comparisons at three time points between three conditions (automated, blended, and waitlist) was designed. Power analyses yielded a necessary sample size of 264 high school students. The participants will be selected from Romanian high schools. DISCUSSION: The current study aims to contribute to the mental health literacy literature by testing the effectiveness of an educational intervention concerning mental health in terms of its benefits for reducing psychopathology and increasing academic performance. The success of such an intervention bears important implications for addressing mental health in the educational system. TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT06217744, version 1, 22 January 2024.


Subject(s)
Academic Performance , Health Literacy , Mental Health , Randomized Controlled Trials as Topic , Students , Humans , Adolescent , Students/psychology , Romania , Female , Male , Health Knowledge, Attitudes, Practice
2.
Evol Psychol ; 19(2): 14747049211028798, 2021.
Article in English | MEDLINE | ID: mdl-34180252

ABSTRACT

We investigated the reasons for pornography consumption using a bottom-up approach (i.e., open-ended questionnaire) and proposed that those reasons would reflect a short-term mating orientation of individuals that watch pornography and a strategy that should help them to attract or maintain potential mates easier (i.e., a fitness increasing strategies) by enhancing their sexual knowledge through pornography watching. In Study 1 (N = 276), relying on an open-ended questionnaire and a content analysis, we identified 78 reasons for why people claim to consume pornography. In Study 2 (N = 322), we grouped those reasons into categories using a series of factor analyses, resulting in four dimensions of reasons for watching pornography: (1) increased sex drive, (2) enhancing sexual performance, (3) social and instrumental reasons, and (4) lack of relational and emotional skills. The content of these factors supported the idea that the reasons for consuming pornography are reflections of a short-term mating orientation and a way to enhance their sexual knowledge and performance. Individuals with higher scores on the dimensions of reasons for pornography consumptions had higher scores on the Dark Triad traits and sociosexuality, mate-value and slow life history strategies (in the case of enhancing sexual performance dimension). In Study 3 (N = 327), we tested to what extent the factorial structure of the reasons for pornography consumption can be confirmed via Confirmatory factor analysis and tested the convergent validity of the reasons to consume pornography.


Subject(s)
Erotica , Sexual Behavior , Emotions , Humans , Libido , Surveys and Questionnaires
3.
J Clin Psychol ; 76(10): 1818-1831, 2020 10.
Article in English | MEDLINE | ID: mdl-32602592

ABSTRACT

OBJECTIVE: To compare the efficacy of cognitive evolutionary therapy (CET) with cognitive therapy (CT) for depression. METHODS: Ninety-seven participants (78 females/19 males) were randomized to a single-blinded controlled trial (CET: n = 51 vs. CT: n = 46). Assessments were conducted at baseline, Sessions 4 and 8, posttreatment, and 3-month follow-up. Clinical diagnoses were made with Structured Clinical Interview for DSM-IV (SCID) and self-reports for depression and secondary outcomes. RESULTS: Although both groups showed significant reductions in depressive symptomatology, the overall Time × Treatment group interaction in the intent to treat analysis was not significant (p = .770, posttreatment: d = 0.39). However, CET was superior to CT at increasing engagement in social and enjoyable activities (p = .040, posttreatment: d = 0.83, p = .040) and showed greater reductions than the CT group in behavioral inhibition/avoidance (p = .047, d = 0.62). The between-group differences generally diminished at the 3-month follow-up. CONCLUSIONS: CET is a novel therapy for depression that may add therapeutic benefits beyond those of CT.


Subject(s)
Cognitive Behavioral Therapy/methods , Depression/therapy , Adult , Depression/psychology , Female , Follow-Up Studies , Humans , Male , Single-Blind Method , Treatment Outcome
4.
Memory ; 28(6): 724-740, 2020 07.
Article in English | MEDLINE | ID: mdl-32462992

ABSTRACT

This study investigated predictors of involuntary and voluntary memories of stressful virtual reality scenarios. Thirty-two veterans of the two Persian Gulf Wars completed verbal memory tests and diagnostic assessments. They were randomly assigned to a Recounting (16) or a Suppression (16) condition. After immersion in the VR scenarios, the Recounting group described the scenarios and the Suppression group suppressed thoughts of the scenarios. One week later, participants completed surprise voluntary memory tests and another thought suppression task. The best predictors of voluntary memory were verbal memory ability, dissociation, and to a lesser extent, physiological arousal before and after scenarios. Dissociation and physiological stress responses selectively affected memory for neutral elements. Higher distress during scenarios impaired voluntary memory but increased the frequency of involuntary memories. Physiological stress responses promoted more frequent involuntary memories immediately after the scenarios. More frequent initial involuntary memories, tonic physiological arousal, and stronger emotional responses to dangerous events predicted difficulty inhibiting involuntary memories at follow-up. The effects of thought suppression were transient and weaker than those of other variables. The findings suggest that posttraumatic amnesia and involuntary memories of adverse events are more related to memory ability and emotional and physiological stress responses than to post-exposure suppression.


Subject(s)
Emotions , Memory, Episodic , Mental Recall , Stress Disorders, Post-Traumatic/psychology , Veterans/psychology , Virtual Reality , Adult , Female , Humans , Male , Middle Aged , Young Adult
5.
Trials ; 18(1): 215, 2017 05 12.
Article in English | MEDLINE | ID: mdl-28494802

ABSTRACT

BACKGROUND: Depression has become one of the leading contributors to the global disease burden. Evidence-based treatments for depression are available, but access to them is still limited in some instances. As technology has become more integrated into mental health care, computerized cognitive behavioral therapy (CBT) protocols have become available and have been recently transposed to mobile environments (e.g., smartphones) in the form of "apps." Preliminary research on some depression apps has shown promising results in reducing subthreshold or mild to moderate depressive symptoms. However, this small number of studies reports a low statistical power and they have not yet been replicated. Moreover, none of them included an active placebo comparison group. This is problematic, as a "digital placebo effect" may explain some of the positive effects documented until now. The aim of this study is to test a newly developed mobile app firmly grounded in the CBT theory of depression to determine whether this app is clinically useful in decreasing moderate depressive symptoms when compared with an active placebo. Additionally, we are interested in the app's effect on emotional wellbeing and depressogenic cognitions. METHODS/DESIGN: Romanian-speaking adults (18 years and older) with access to a computer and the Internet and owning a smartphone are included in the study. A randomized, three-arm clinical trial is being conducted (i.e., active intervention, placebo intervention and delayed intervention). Two hundred and twenty participants with moderate depressive symptoms (i.e., obtaining scores >9 and ≤16 on the Patient Health Questionnaire, PHQ-9) will be randomized to the three conditions. Participants undergoing therapy, presenting serious mental health problems, or legal or health issues that would prevent them from using the app, as well as participants reporting suicidal ideation are excluded. Participants randomized to the active and placebo interventions will use the smartphone app for 6 weeks. A short therapist check-in via phone will take place every week. Participants in the delayed-intervention condition will be given access to the app after 6 weeks from randomization. The primary outcome is the level of depressive symptomatology. The intervention delivered through the app to the active condition includes psychoeducational materials and exercises based on CBT for depression, while the placebo intervention uses a sham version of the app (i.e., similar structure of courses and exercises). DISCUSSION: To our knowledge, this study protocol is the first to test the efficacy of a smartphone app for depressive symptomatology in the form of a randomized controlled trial (RCT) that includes an active placebo condition. As such, this can substantially add to the body of evidence supporting the use of apps designed to decrease depression. TRIAL REGISTRATION: ClinicalTrials.gov, identifier: NCT03060200 . Registered on 1 February 2017. The first participant was enrolled on 17 February 2017.


Subject(s)
Cognitive Behavioral Therapy/instrumentation , Depression/therapy , Mobile Applications , Smartphone , Therapy, Computer-Assisted/instrumentation , Affect , Clinical Protocols , Cognition , Depression/diagnosis , Depression/psychology , Emotions , Health Knowledge, Attitudes, Practice , Health Services Accessibility , Humans , Patient Education as Topic , Psychiatric Status Rating Scales , Research Design , Romania , Surveys and Questionnaires , Therapy, Computer-Assisted/methods , Time Factors , Treatment Outcome
6.
J Clin Psychol ; 73(1): 5-64, 2017 01.
Article in English | MEDLINE | ID: mdl-27684405

ABSTRACT

INTRODUCTION: Internet-based cognitive behavioral therapy for depression (iCBT) has been advanced as a valuable alternative treatment option, generating promising results. However, little is known about its underlying mechanisms of change. OBJECTIVE: We aimed to provide an overview of the state of the art regarding the mechanisms of iCBT for adult depression, in the context of iCBT efficacy. METHOD: We conducted a systematic qualitative review of 37 randomized clinical trials, assessed the risk of bias in the included studies, and used a systematic evaluative framework to establish the scientific status of iCBT, based on evidence regarding clinical efficacy and mechanisms of change. RESULTS: Findings indicated that iCBT mechanisms of change are clearly underinvestigated, although iCBT is relatively efficacious, at least in the short term. The quality of iCBT randomized clinical trials proved to be suboptimal. CONCLUSIONS: The iCBT theory should be clearly specified and adequately investigated to design and implement highly efficacious therapeutic packages. Without considering the iCBT mechanisms of change along with iCBT efficacy, the extent to which iCBT is an empirically validated treatment remains questionable.


Subject(s)
Cognitive Behavioral Therapy/methods , Depressive Disorder/therapy , Outcome Assessment, Health Care , Psychotherapeutic Processes , Telemedicine/methods , Adult , Humans
7.
Trials ; 17(1): 609, 2016 12 28.
Article in English | MEDLINE | ID: mdl-28031038

ABSTRACT

BACKGROUND: Depression is a major challenge worldwide, with significant increasing personal, economic, and societal costs. Although empirically supported treatments have been developed, they are not always available for patients in routine clinical care. Therefore, we need effective and widely accessible strategies to prevent the onset of the very first depressive symptoms. Mental health apps could prove a valuable solution for this desideratum. Although preliminary research has indicated that such apps can be useful in treating depression, no study has attempted to test their utility in preventing depressive symptoms. The aim of this exploratory study is to contrast the efficacy of a smartphone app in reducing cognitive vulnerability and mild depressive symptoms, as risk factors for the onset of depression, against a wait-list condition. More specifically, we aim to test an app designed to (1) decrease general cognitive vulnerability and (2) promote engagement in protective, adaptive activities, while (3) counteracting (through gamification and customization) the tendency of premature dropout from intervention. METHODS/DESIGN: Romanian-speaking adults (18 years and older) with access to a computer and the Internet and who own a smartphone are included in the study. Two parallel randomized clinical trials are conducted: in the first one, 50 participants free of depressive symptoms (i.e., who obtain scores ≤4 on the Patient Health Questionnaire, PHQ-9) will be included, while in the second one 50 participants with minimal depressive symptoms (i.e., who obtain PHQ-9 scores between 5 and 9) will be included. Participants undergoing therapy, presenting with substance abuse problems, psychotic symptoms, and organic brain disorders, or serious legal or health issues that would prevent them from using the app, as well as participants reporting suicidal ideation are excluded. Participants randomized to the active intervention will autonomously use the smartphone app for 4 weeks, while the others will be given access to the app after 4 weeks from randomization. The primary outcomes are (1) cognitive vulnerability factors as defined within the cognitive behavioral therapy (CBT) paradigm (i.e., dysfunctional cognitions, irrational beliefs, and negative automatic thoughts) (for the first trial), and (2) level of depressive symptomatology (for the second trial). The app includes self-help materials and exercises based on CBT for depression, presented in a tailored manner and incorporating gamification elements aimed at boosting motivation to use the app. DISCUSSION: This study protocol is the first to capitalize on the ubiquity of smartphones to large-scale dissemination of CBT-based strategies aimed at preventing depression in non-clinical populations. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02783118 . Registered on 26 May 2016.


Subject(s)
Affect , Cognition , Cognitive Behavioral Therapy/instrumentation , Cognitive Dysfunction/therapy , Depression/therapy , Mobile Applications , Smartphone , Telemedicine/instrumentation , Clinical Protocols , Cognitive Dysfunction/diagnosis , Cognitive Dysfunction/psychology , Depression/diagnosis , Depression/psychology , Humans , Patient Health Questionnaire , Psychiatric Status Rating Scales , Research Design , Romania , Severity of Illness Index , Time Factors , Treatment Outcome
8.
J Clin Psychol ; 71(1): 72-84, 2015 Jan.
Article in English | MEDLINE | ID: mdl-25099348

ABSTRACT

OBJECTIVE: The objective of the present study was to examine the associations between sleep disturbance, posttraumatic stress disorder (PTSD), and functional disability in a population exposed to a singular traumatic event. METHOD: The participants were a population of 2,453 predominantly male utility workers who were deployed to the World Trade Center site in the aftermath of the 9/11 attack. They underwent psychiatric screenings comprising measures of sleep disturbance, PTSD, and functional disability. RESULTS: Analyses indicated that (a) rates of sleep disturbances were significantly higher among participants diagnosed with PTSD than those without, (b) PTSD severity was significantly associated with sleep disturbance, and (c) sleep disturbance moderated the relationship between PTSD and disability. CONCLUSION: Sleep disturbance is associated with occupational, social functioning, and PTSD severity, suggesting that ameliorating sleep may lead to increased occupational and social functioning, as well as better treatment responses in PTSD.


Subject(s)
Occupational Diseases/epidemiology , Occupational Diseases/psychology , Sleep Disorders, Intrinsic/epidemiology , Sleep Disorders, Intrinsic/psychology , Stress Disorders, Post-Traumatic/psychology , Adult , Disability Evaluation , Disabled Persons/psychology , Female , Humans , Interview, Psychological , Male , Middle Aged , New York City/epidemiology , Occupational Exposure/adverse effects , Regression Analysis , September 11 Terrorist Attacks/psychology , Stress Disorders, Post-Traumatic/epidemiology
9.
Trials ; 15: 83, 2014 Mar 19.
Article in English | MEDLINE | ID: mdl-24641778

ABSTRACT

BACKGROUND: Depression is estimated to become the leading cause of disease burden globally by 2030. Despite existing efficacious treatments (both medical and psychotherapeutic), a large proportion of patients do not respond to therapy. Recent insights from evolutionary psychology suggest that, in addition to targeting the proximal causes of depression (for example, targeting dysfunctional beliefs by cognitive behavioral therapy), the distal or evolutionary causes (for example, inclusive fitness) should also be addressed. A randomized superiority trial is conducted to develop and test an evolutionary-driven cognitive therapy protocol for depression, and to compare its efficacy against standard cognitive therapy for depression. METHODS/DESIGN: Romanian-speaking adults (18 years or older) with elevated Beck Depression Inventory (BDI) scores (>13), current diagnosis of major depressive disorder or major depressive episode (MDD or MDE), and MDD with comorbid dysthymia, as evaluated by the Structured Clinical Interview for DSM-IV (SCID), are included in the study. Participants are randomized to one of two conditions: 1) evolutionary-driven cognitive therapy (ED-CT) or 2) cognitive therapy (CT). Both groups undergo 12 psychotherapy sessions, and data are collected at baseline, mid-treatment, post-treatment, and the 3-month follow-up. Primary outcomes are depressive symptomatology and a categorical diagnosis of depression post-treatment. DISCUSSION: This randomized trial compares the newly proposed ED-CT with a classic CT protocol for depression. To our knowledge, this is the first attempt to integrate insights from evolutionary theories of depression into the treatment of this condition in a controlled manner. This study can thus add substantially to the body of knowledge on validated treatments for depression. TRIAL REGISTRATION: Current Controlled Trials ISRCTN64664414The trial was registered in June 2013. The first participant was enrolled on October 3, 2012.


Subject(s)
Cognitive Behavioral Therapy/methods , Depression/therapy , Research Design , Clinical Protocols , Depression/diagnosis , Depression/psychology , Humans , Psychiatric Status Rating Scales , Romania , Surveys and Questionnaires , Time Factors , Treatment Outcome
10.
Clin Case Rep ; 2(5): 228-36, 2014 Oct.
Article in English | MEDLINE | ID: mdl-25614817

ABSTRACT

KEY CLINICAL MESSAGE: We present an evolutionary-driven cognitive-behavioral intervention for a moderately depressed patient. Standard cognitive and behavioral therapy techniques focused on the patient's perfectionistic and self-downing beliefs, while novel, evolutionary-informed techniques were used to guide behavioral activation and conceptualize secondary emotional problems related to anger. The treatment reduced depressive symptomatology and increased evolutionary fitness.

11.
J Trauma Stress ; 24(5): 506-14, 2011 Oct.
Article in English | MEDLINE | ID: mdl-22095774

ABSTRACT

This study examined the long-term mental health outcomes of 2,960 nonrescue disaster workers deployed to the World Trade Center site in New York City following the September 11, 2001 (9/11) terrorist attacks. Semistructured interviews and standardized self-report measures were used to assess the prevalence of posttraumatic stress disorder (PTSD) and other psychopathology 4 and 6 years after the attacks. Clinician-measured rates of PTSD and partial PTSD 4-years posttrauma were 8.4% and 8.9%, respectively, in a subsample of 727 individuals. Rates decreased to 5.8% and 7.7% for full and partial PTSD 6 years posttrauma. For the larger sample, self-report scores revealed probable PTSD and partial PTSD prevalence to be 4.8% and 3.6% at 4 years, and 2.4% and 1.8% at 6 years. Approximately 70% of workers never met criteria for PTSD. Although PTSD rates decreased significantly over time, many workers remained symptomatic, with others showing delayed-onset PTSD. The strongest predictors of ongoing PTSD 6 years following 9/11 were trauma history (odds ratio (OR) = 2.27, 95% confidence interval (CI) [1.06, 4.85]); the presence of major depressive disorder 1-2 years following the trauma (OR = 2.80, 95% CI [1.17, 6.71]); and extent of occupational exposure (OR = 1.31, 95% CI [1.13, 1.51]). The implications of the findings for both screening and treatment of disaster workers are discussed.


Subject(s)
Emergency Responders/psychology , September 11 Terrorist Attacks/psychology , Stress Disorders, Post-Traumatic/epidemiology , Stress Disorders, Post-Traumatic/physiopathology , Humans , Interviews as Topic , Longitudinal Studies , New York City/epidemiology , Odds Ratio , Surveys and Questionnaires
12.
Depress Anxiety ; 28(3): 210-7, 2011 Mar.
Article in English | MEDLINE | ID: mdl-21394854

ABSTRACT

BACKGROUND: Recent attention has begun to be focused on the effects of disaster recovery work on nonrescue workers. The goal of this study was to assess the prevalence and predictors of posttraumatic stress disorder (PTSD) and related symptoms in a population of utility workers deployed to the World Trade Center (WTC) site in the aftermath of 9/11. METHODS: Utility workers deployed to the WTC site were screened at their place of employment between 10 and 34 months following the WTC attacks, utilizing both structured interviews and self-report measures. PTSD symptoms were assessed by the CAPS and the PCL; co-morbid disorders were also assessed. 2,960 individuals with complete CAPS and PCL data were included in the analyses. RESULTS: Eight percent of participants had symptoms consistent with full PTSD, 9.3% with subthreshold PTSD, 6% with MDD, 3.5% with GAD, and 2.5% with panic disorder. Although risk factors included psychiatric and trauma history, 51% of individuals with probable PTSD had neither; subjective perception of threat to one's life was the best predictor of probable PTSD. Extent of exposure predicted 89% of PTSD cases in those without a psychiatric or trauma history, but only 67% of cases among those with both. CONCLUSIONS: Nonrescue workers deployed to a disaster site are at risk for PTSD and depression. Extent of exposure affected the most vulnerable workers differently than the least vulnerable ones. These results suggest that the relationship among predictors of PTSD may be different for different vulnerability groups, and underscore the importance of screening, education, and prevention programs for disaster workers.


Subject(s)
Occupational Diseases/epidemiology , Occupational Diseases/psychology , September 11 Terrorist Attacks/psychology , September 11 Terrorist Attacks/statistics & numerical data , Stress Disorders, Post-Traumatic/epidemiology , Stress Disorders, Post-Traumatic/psychology , Adult , Anxiety Disorders/diagnosis , Anxiety Disorders/epidemiology , Anxiety Disorders/psychology , Comorbidity , Depressive Disorder, Major/diagnosis , Depressive Disorder, Major/epidemiology , Depressive Disorder, Major/psychology , Disability Evaluation , Female , Follow-Up Studies , Humans , Male , Mass Screening , Middle Aged , New York City , Occupational Diseases/diagnosis , Panic Disorder/diagnosis , Panic Disorder/epidemiology , Panic Disorder/psychology , Risk , Stress Disorders, Post-Traumatic/diagnosis
13.
J Clin Psychol ; 65(7): 684-94, 2009 Jul.
Article in English | MEDLINE | ID: mdl-19388060

ABSTRACT

Empirical evidence suggests that social and occupational disability plays a significant role in posttraumatic stress disorder (PTSD). The purpose of this study was to assess the role of social/occupational disability and to identify predictors of the development of PTSD in a group of disaster relief workers (DRWs) who had been deployed to the World Trade Center (WTC) following September 11, 2001. Eight hundred forty-two utility workers completed a battery of comprehensive tests measuring PTSD and social occupational functioning. Results indicated a significant association between PTSD symptoms and impaired social/occupational functioning. Symptomatic workers were also more likely to have a history of trauma, panic disorder, and depression. Those with a history of trauma, depression, generalized anxiety disorder or panic reported significantly more disability than those without a psychiatric history. Careful screening of PTSD and social/occupational functioning in DRWs following a disaster is warranted so that early treatment can be undertaken to prevent a chronic and disabling course.


Subject(s)
Occupational Diseases/psychology , September 11 Terrorist Attacks/psychology , Stress Disorders, Post-Traumatic/psychology , Adult , Analysis of Variance , Cross-Sectional Studies , Disability Evaluation , Female , Humans , Male , Middle Aged , Occupational Diseases/epidemiology , Psychiatric Status Rating Scales , Regression Analysis , Relief Work , Social Behavior , Socioeconomic Factors , Stress Disorders, Post-Traumatic/epidemiology , Stress Disorders, Post-Traumatic/etiology , Surveys and Questionnaires
14.
J Anxiety Disord ; 23(4): 557-61, 2009 May.
Article in English | MEDLINE | ID: mdl-19117719

ABSTRACT

The present study examined the relationships between memories for a single incident traumatic event - the 9/11 attack on the World Trade Center (WTC)--and posttraumatic stress disorder (PTSD). 2641 disaster restoration workers deployed at the WTC site in the aftermath of the attack were evaluated longitudinally, one year apart, for PTSD, using clinical interviews. Their recollection of the traumatic events was also assessed at these times. The results showed that recall of traumatic events amplified over time and that increased endorsement of traumas at Time 2 was associated with more severe PTSD symptoms. It was also shown that, of all the exposure variables targeted, memory of the perception of life threat and of seeing human remains were differentially associated with PTSD symptoms. Implications of the results are also discussed.


Subject(s)
Life Change Events , Memory Disorders/etiology , September 11 Terrorist Attacks/psychology , Stress Disorders, Post-Traumatic/etiology , Diagnostic and Statistical Manual of Mental Disorders , Female , Humans , Male , Memory Disorders/diagnosis , Middle Aged , Severity of Illness Index , Stress Disorders, Post-Traumatic/diagnosis , Surveys and Questionnaires
15.
J Anxiety Disord ; 23(2): 223-9, 2009 Mar.
Article in English | MEDLINE | ID: mdl-18755571

ABSTRACT

This prospective longitudinal study examined the ability of re-experiencing, avoidance, numbing, and hyperarousal symptoms to predict persistence of posttraumatic stress disorder (PTSD) in disaster workers followed for 2 years. Cluster analyses suggested that overall severity was the best predictor of PTSD at follow up, but for groups with PTSD of moderate severity, numbing symptoms were also associated with PTSD at the 2-year follow up. Regression analyses with all four symptom groups as independent variables found that only numbing and re-experiencing symptoms predicted PTSD at the 1 year follow up, and only numbing symptoms predicted PTSD at the 2-year follow up. Findings suggest that numbing symptom severity could be used as a risk index of very chronic PTSD, especially when the overall PTSD severity falls in the moderate range.


Subject(s)
Affect , Stress Disorders, Post-Traumatic/diagnosis , Stress Disorders, Post-Traumatic/psychology , Adult , Arousal/physiology , Diagnostic and Statistical Manual of Mental Disorders , Escape Reaction , Female , Follow-Up Studies , Humans , Male , Occupational Diseases/epidemiology , Prospective Studies , Rescue Work , Severity of Illness Index , Stress Disorders, Post-Traumatic/epidemiology
16.
J Nerv Ment Dis ; 196(11): 844-6, 2008 Nov.
Article in English | MEDLINE | ID: mdl-19008736

ABSTRACT

Although anger is an important feature of posttraumatic stress disorder (PTSD) it is unclear whether it is simply concomitant or plays a role in maintaining symptoms. A previous study of disaster workers responding to the terrorist attacks of September 11, 2001 () indicated that those with PTSD evidenced more severe anger than those without. The purpose of this study was to conduct a 1-year follow-up to assess the role of anger in maintaining PTSD. Workers with PTSD continued to report more severe anger than those without; there were statistically significant associations between changes in anger, PTSD severity, depression, and psychiatric distress. Multiple regression analysis indicated initial anger severity to be a significant predictor of PTSD severity at follow-up, which is consistent with the notion that anger maintains PTSD. One implication is that disaster workers with high anger may benefit from early intervention to prevent chronic PTSD.


Subject(s)
Anger , Relief Work , September 11 Terrorist Attacks/psychology , Stress Disorders, Post-Traumatic/diagnosis , Adult , Cross-Sectional Studies , Female , Follow-Up Studies , Humans , Male , Mass Screening , Middle Aged , New York City , Personality Inventory/statistics & numerical data , Psychometrics/statistics & numerical data , Reproducibility of Results , Stress Disorders, Post-Traumatic/epidemiology , Stress Disorders, Post-Traumatic/psychology
17.
J Clin Psychiatry ; 68(11): 1639-47, 2007 Nov.
Article in English | MEDLINE | ID: mdl-18052556

ABSTRACT

OBJECTIVE: This preliminary study endeavored to evaluate the use of virtual reality (VR) enhanced exposure therapy for the treatment of posttraumatic stress disorder (PTSD) consequent to the World Trade Center attacks of September 11, 2001. METHOD: Participants were assigned to a VR treatment (N = 13) or a waitlist control (N = 8) group and were mostly middle-aged, male disaster workers. All participants were diagnosed with PTSD according to DSM-IV-TR criteria using the Clinician-Administered PTSD Scale (CAPS). The study was conducted between February 2002 and August 2005 in offices located in outpatient buildings of a hospital campus. RESULTS: Analysis of variance showed a significant interaction of time by group (p < .01) on CAPS scores, with a between-groups posttreatment effect size of 1.54. The VR group showed a significant decline in CAPS scores compared with the waitlist group (p < .01). CONCLUSIONS: Our preliminary data suggest that VR is an effective treatment tool for enhancing exposure therapy for both civilians and disaster workers with PTSD and may be especially useful for those patients who cannot engage in imaginal exposure therapy.


Subject(s)
Psychotherapy/methods , September 11 Terrorist Attacks/psychology , Stress Disorders, Post-Traumatic/etiology , Stress Disorders, Post-Traumatic/therapy , User-Computer Interface , Adult , Demography , Diagnostic and Statistical Manual of Mental Disorders , Female , Humans , Male , Middle Aged , Severity of Illness Index , Stress Disorders, Post-Traumatic/diagnosis , Surveys and Questionnaires
18.
Int J Emerg Ment Health ; 8(4): 267-74, 2006.
Article in English | MEDLINE | ID: mdl-17131772

ABSTRACT

This study documents the prevalence of male childhood sexual abuse (CSA) and psychological sequelae in a sample of disaster workers deployed to the World Trade Center (WTC) site following the September 11, 2001 terrorist attack. There are limited data on male CSA and its psychological impact, especially on a large non-treatment seeking sample. As part of a mandatory medical screening program, workers were assessed with well-validated and widely used clinician interview and self-report measures following their involvement in the restoration of services to Ground Zero and surrounding areas of lower Manhattan. Frequency of CSA measured by the Traumatic Events Interview (TEI) was 4.3% (n = 92). Clinician interview and self-report data were analyzed using t-tests, revealing statistically significant relationships (but not clinically meaningful scores) between CSA and scores on the CAPS, PCL, BDI, STAXI, and SDS. Further analyses revealed that individuals endorsing CSA were three-times more likely to score high (vs. low) on the BDI and CAPS. Since disaster workers traditionally summon images of strength and mastery, professionals may overlook CSA and symptoms of depression and PTSD in this population.


Subject(s)
Child Abuse, Sexual/psychology , Child Abuse, Sexual/statistics & numerical data , Relief Work , September 11 Terrorist Attacks/psychology , Stress Disorders, Post-Traumatic/psychology , Adult , Child , Cross-Sectional Studies , Humans , Interview, Psychological , Life Change Events , Male , Middle Aged , New York City , Personality Assessment/statistics & numerical data , Personality Inventory/statistics & numerical data , Psychometrics , Risk Factors , Statistics as Topic , Stress Disorders, Post-Traumatic/epidemiology
19.
Ann N Y Acad Sci ; 1071: 500-1, 2006 Jul.
Article in English | MEDLINE | ID: mdl-16891607

ABSTRACT

Recent research suggests that virtual reality (VR) enhanced exposure therapy may enhance the efficacy of treatment through increasing patient engagement in the exposure. This study evaluated the use of VR in the treatment of PTSD following the WTC attack of September 11, 2001. Individuals in a 14 session VR-enhanced treatment (n=9) were compared to a waitlist (WL) control group (n=8). ANOVA showed a significant interaction of time by group (p<.01) with a large effect size of 1.53. The VR group showed significantly greater post-treatment decline in CAPS scores compared to the WL. Our preliminary data suggests that VR is an effective tool for enhancing exposure therapy for both civilians and disaster workers who suffer from PTSD.


Subject(s)
Computer Graphics , Stress Disorders, Post-Traumatic/therapy , Terrorism , Adult , Female , Humans , Male , Middle Aged , New York City , Psychotherapy
20.
J Trauma Stress ; 19(2): 307-12, 2006 Apr.
Article in English | MEDLINE | ID: mdl-16612826

ABSTRACT

This study examined male utility disaster workers' responses to referral for trauma-specific psychotherapy. Among 328 workers offered referral for symptoms related to the World Trade Center (WTC) attacks during psychological screening, approximately 48% chose to accept, 28% chose to consider only, and 24% chose to decline. Analyses examined predisposing factors, i.e., age, race/ethnicity, marital status, education, previous mental health treatment, and previous disorder; as well as illness level; i.e., posttraumatic stress disorder (PTSD), depression, and general psychiatric distress; current treatment; and time of referral as predictors of referral response. PTSD (specifically reexperiencing and hyperarousal symptoms), depressive symptoms, and previous mental health treatment were positively associated with workers' accepting referral. Implications and limitations of these findings are discussed.


Subject(s)
Occupational Exposure/adverse effects , Patient Acceptance of Health Care , Rescue Work , September 11 Terrorist Attacks/psychology , Stress Disorders, Post-Traumatic/rehabilitation , Humans , Logistic Models , Male , Middle Aged , New York City , Psychotherapy , Referral and Consultation , Severity of Illness Index , Stress Disorders, Post-Traumatic/etiology
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