ABSTRACT
OBJECTIVES: Posttraumatic stress disorder (PTSD) and cannabis use disorder (CUD) commonly co-occur. Conditioned associations between psychological trauma cues, distress, cannabis use, and desired relief outcomes may contribute to the comorbidity. These conditioned associations can be studied experimentally by manipulating trauma cue exposure in a cue-reactivity paradigm (CRP) and examining effects on affective and cognitive outcomes in participants with and without PTSD. However, traditional CRPs take place in-lab limiting recruitment/power. We aimed to examine the effects of CRP condition (trauma and neutral) and PTSD group (likely PTSD+ and PTSD-) on affective and craving outcomes using a stand-alone online expressive writing CRP. METHODS: Participants (n = 202; 43.6% male; Mage = 42.94 years, SD = 14.71) with psychological trauma histories and past-month cannabis use completed a measure of PTSD symptoms (PTSD Checklist-5 for DSM-5 [PCL-5]) and were randomized to complete either a trauma or neutral expressive writing task. Then they completed validated measures of affect (Positive and Negative Affect Schedule-Short Form [PANAS-SF]) and cannabis craving (Marijuana Craving Questionnaire-Short Form [MCQ-SF]). RESULTS: Linear mixed models tested the hypothesized main and interactive effects of CRP condition (trauma and neutral) and PTSD group (likely PTSD+ and PTSD-) on negative and positive affect (PANAS-SF) and cannabis craving dimensions (MCQ-SF). The hypothesized main effects of trauma versus neutral expressive writing were found for negative affect and the expectancy dimension of cannabis craving and of PTSD group for negative affect and all cannabis craving dimensions; no interactions were observed. CONCLUSIONS: Expressive writing appears a useful online CRP. Interventions focused on reducing negative affect and expectancy craving to trauma cues may prevent/treat CUD among cannabis users with PTSD. PLAIN LANGUAGE SUMMARY TITLE: The Use of an Online Expressive Writing as a Trauma Cue Exposure: Effects on Craving and Emotions.
People who have gone through trauma sometimes experience both post-traumatic stress disorder (PTSD) and a tendency to use cannabis excessively (cannabis use disorder or CUD). Researchers believe that there's a connection between traumatic memories, emotional distress, cannabis use, and the relief people feel afterward. These associations can be studied experimentally by using a cue-reactivity paradigm (CRP) to examine effects on craving and affective outcomes in those with and without PTSD. This study included 202 participants who had a history of trauma and reported regular cannabis use. They were randomly assigned to write about a traumatic or neutral personal experience. After, they filled out questionnaires about their PTSD symptoms, emotions (both positive and negative), and cravings for cannabis during the task. We expected that the type of writing task (those assigned to the trauma vs. neutral condition) and PTSD status would be associated with increased cannabis craving, negative emotions, and reduced positive emotions. We found that writing about trauma increased negative feelings and positive expectations about using cannabis for relief, especially for those with PTSD. People with PTSD also seemed to have more ongoing negative feelings and cravings for cannabis. The authors suggest that traditional in-lab experiments might be necessary to fully understand how trauma reminders can influence cravings and emotions in individuals with PTSD-CUD.
ABSTRACT
This paper investigates the relations between displacement, home, trauma and the self in the experience of refugees, which has become an issue of unexpected and far-reaching proportions in recent times. It questions to what extent and under what conditions displacement in the world may be traumatic and how trauma may be considered the effect of an inner displacement. Refugees' lives are marked by forced migration that is related to a certain suffering due to the changes in their family, relational, social and cultural lives. The paper explores the extent to which these changes can represent a break so significant as to be traumatic. It outlines the way in which traumatic experiences can produce an inner displacement and reorganization of one's mental life that leads to a focus on traumatic complexes. Under the most severe traumatic conditions, this can be understood as a displacement of the central axis of Self, in which the ego complex yields its position to other complexes, with a deep change in the organization and functioning of self. The experience of refugees highlights the way in which we live in a matrix of conscious and unconscious links between inner and outer worlds that need deeper and simultaneous consideration to understand their implications and mutual resonances for the psyche. Clinical cases of refugees will illustrate some aspects of these interconnections.
Cet article explore les relations entre le déplacement, le « chez-soi ¼ (home), le traumatisme et le Soi dans l'expérience des réfugiés. L'article pose la question de jusqu'à quel point et dans quelles conditions le déplacement dans le monde peut être traumatique, et de comment le traumatisme peut être considéré comme l'effet d'un déplacement intérieur. La vie des réfugiés est marquée par la migration forcée, en lien avec une forme de souffrance due aux changements dans leur vie familiale, relationnelle, sociale et culturelle. Cet article explore le degré avec lequel ces changements peuvent représenter une rupture si marquante qu'elle en est traumatique. Il souligne la manière par laquelle les expériences traumatiques peuvent produire un déplacement intérieur et une réorganisation de notre vie psychique qui conduit à se concentrer sur les complexes traumatiques. Dans des conditions traumatiques les plus sévères, ceci peut être compris comme un déplacement de l'axe central du Soi, dans lequel le complexe du moi cède sa position à d'autres complexes, avec un changement profond dans l'organisation et le fonctionnement du Soi. L'expérience des réfugiés souligne la manière dont le Soi est immergé dans une matrice de liens conscients et inconscients entre les mondes intérieurs et extérieurs qui nécessitent une réflexion plus profonde et concomitante pour comprendre leurs incidences et résonances mutuelles pour la psyché. Des cas cliniques de réfugiés illustreront quelques aspects de ces interconnections.
El presente trabajo investiga las relaciones entre desplazamiento, hogar, trauma y Self en la experiencia de personas refugiadas. Cuestiona el alcance y las condiciones en las que el desplazamiento en el mundo puede ser traumático y cómo el trauma puede ser considerado el efecto de un desplazamiento interno. Las vidas de refugiados están marcadas por migraciones forzadas que se relacionan a cierto sufrimiento debido a cambios en las familias, las relaciones, la vida cultural y social. El trabajo explora en qué medida estos cambios pueden representar un quiebre tan significativo como para ser traumático. Delinea el modo en el cual las experiencias traumáticas pueden producir un desplazamiento interno y la reorganización de la vida mental que conduce hacia un foco en los complejos traumáticos. Bajo las condiciones traumáticas más severas, esto puede ser comprendido como un desplazamiento del eje central del Self, en el cual, el complejo del ego cede su posición a otros complejos, con un cambio profundo en la organización y funcionamiento del Self. La experiencia de refugiados destaca el modo en el que el Self queda inmerso en una matriz de lazos conscientes e incosncientes entre los mundos internos y externos que necesitan ser considerados de modo profundo y simultáneamente para comprender sus implicancias y las resonancias mutuas para la psique. Casos clínicos de refugiados ilustrarán algunos aspectos de estas interconexiones.
Subject(s)
Ego , Psychoanalytic Therapy , Psychological Trauma/psychology , Refugees/psychology , Adult , Female , Humans , Male , Middle Aged , Psychological Trauma/therapy , Young AdultABSTRACT
We reported a case of a 10-year-old girl who developed a PTSD-like syndrome after watching a horror movie. After 6 years, the now 16-year-old patient still fulfilled the DSM-IV criteria for PTSD, except for the trauma itself. We reviewed the scientific literature for case reports of PTSD-like syndrome induced by horror movies and found 13 cases. In only two was the presence of the DSM criteria confirmed. Watching horror movies may thus trigger PTSD-like syndromes in vulnerable viewers
O caso de uma menina de 10 anos de idade que desenvolveu síndrome do tipo transtorno de estresse pós-traumático (TEPT) após assistir a filme de terror é relatado. Após seis anos, a paciente ainda preenchia os critérios do DSM-IV para TEPT. Em revisão da literatura, identificamos 13 casos de síndrome TEPT-símile induzida por filmes de terror, mas o diagnóstico baseado em critérios DSM foi feito em dois casos apenas. Filmes de terror podem desencadear síndromes TEPT-símile em pessoas vulneráveis.
Presentamos el caso de una niña de 10 años que desarrolló un síndrome tipo trastorno de estrés postraumático (TEPT) después de ver una película de terror. Al cabo de seis años, la paciente aún cumplía con los criterios del DSM-IV para el TEPT. Durante la revisión de la literatura, identificamos 13 casos de síndromes similares al TEPT, inducidos por películas de terror, pero el diagnóstico basado en los criterios DSM fue hecho solo en dos casos. Películas de terror pueden desencadenar síndromes similares al TEPT en espectadores vulnerables.
Cet article décrit le cas d'une jeune fille de 10 ans qui a développé un syndrome qui ressemble à celui du stress post-traumatique (SSPT) après avoir regardé un film d'horreur. Six ans plus tard, la patiente présentait toujours les symptômes du SSPT correspondants aux critères du DSM-IV. La littérature scientifique a été examinée à la recherche de cas semblables et treize cas semblables ont été recensés. La présence des critères DSM-IV a été confirmée uniquement dans deux cas. Nous concluons que l'exposition à des films d'horreur peut déclencher un syndrome du type SSPT chez les personnes vulnérables.
Dieser Artikel beschreibt den Fall eines 10-jährigen Mädchens, das ein PTBS-ähnliches Syndrom entwickelte, nachdem sie einen Horrorfilm angeschaut hatte. Sechs Jahre später zeigte die nun 16 Jahre alte Patientin nach wie vor PTBS Symptome auf, die den Kriterien des DSM-IV entsprachen. Wir forschten in der wissenschaftlichen Literatur nach Fallberichten des PTBS-ähnlichen Syndroms, die durch Horrorfilme induziert wurden und fanden 13 Fälle. In nur zwei Fällen wurden die DSM-IV-Kriterien bestätigt. Wir kommen zum Schluss, dass bei anfälligen Personen, die sich Horrorfilmen aussetzen, es zu PTBS-ähnlichen Syndromen kommen kann.
ABSTRACT
OBJECTIVE: Post-traumatic stress disorder is pervasive in low- and middle-income countries. There is evidence to suggest that post-traumatic stress disorder is more common among people living with HIV than non-infected matched controls. We carried out a systematic review of interventions for adult post-traumatic stress disorder from resource poor settings with a focus on people living with HIV. METHODS: We included all studies that investigated interventions for adult post-traumatic stress disorder from resource poor settings with a focus on interventions that were either randomised controlled trials or observational cohort studies carried out from 1980 to May 2015. RESULTS: Of the 25 articles that were identified for full review, two independent reviewers identified seven studies that met our study inclusion criteria. All randomised controlled trials (RCT) (n = 6) used cognitive behavioural therapy-based interventions and focused on people living with HIV in resource poor settings. There was only one study focusing on the use of lay counsellors to address post-traumatic stress disorder but core competencies were not described. There were no intervention studies from Africa, only an observational cohort study from Rwanda. CONCLUSION: Rigorously evaluated interventions for adult post-traumatic stress disorder in people living with HIV are rare. Most were undertaken in resource poor settings located in high-income countries. There is a need for research on the development and implementation of appropriate interventions for post-traumatic stress disorder in people living with HIV in low- and middle-income countries.
Subject(s)
HIV Infections/epidemiology , HIV Infections/psychology , Stress Disorders, Post-Traumatic/epidemiology , Stress Disorders, Post-Traumatic/therapy , Adult , Developing Countries , HumansABSTRACT
OBJECTIVE: Postnatal depression is linked to adverse outcomes for parent and child, with metacognition and parenting experiences key variables in the development and maintenance of depression. The attachment between mother and infant is especially vulnerable to the effects of untreated postnatal depression. Despite high levels of reported postnatal stress symptoms, less attention has been given the relationship between attachment, metacognition, and postnatal traumatic symptoms in the context of birth trauma. This study tested several hypotheses regarding the relationships between recalled parenting experiences, metacognition, postnatal symptoms of posttraumatic stress disorder and depression and perceptions of the mother-infant bond, confirming and extending upon metacognitive and mentalization theories. METHOD: A Web-based, cross-sectional, self-report questionnaire design was employed in an analog sample of new mothers. Participants were 502 women recruited via open-access Web sites associated with birth organizations. Structural equation modeling was employed for the principal analysis. RESULTS: Metacognition fully mediated the relationship between recalled parenting experiences and postnatal psychological outcomes. Posttraumatic stress was indirectly associated with maternal perceptions of the bond, with this relationship mediated by depression. CONCLUSION: Metacognition may have a key role in postnatal psychological distress. Where postnatal depression or traumatic birth experiences are identified, screening for posttraumatic stress is strongly indicated.
