Childbirth, trauma and family relationships.

Background: Childbirth is a major life event with expected positive outcomes, yet for some women postnatal psychopathological symptoms may harm women's interpersonal relationships. We hypothesized that higher levels of postnatal depression, post-traumatic stress (PTSD) symptoms, and fear of childbirth would be associated with mother-baby bond disorders and relationship dissatisfaction in couples.Method: A cross-sectional self-report online questionnaire was used to survey partnered women who had delivered in the year prior to the study. We used a convenience sample of 228 women recruited through purposive and snowball sampling. Childbirth experience, PTSD symptoms, attachment style, depression, mother-baby bond disorders, and couple relationship dissatisfaction were measured.Results: Women with higher PTSD and postnatal depression scores reported higher levels of mother-baby bond disorders-a relationship fully mediated by postnatal depression symptoms. Women who perceived childbirth as fearful or anxiety provoking had higher levels of PTSD and postnatal depression symptoms. Fearful and anxious birth perception was positively associated with mother-baby bond disorders-an association partly mediated by PTSD symptoms. Insecure attachment style was not found to be significantly associated with fearful or anxious perceptions of childbirth.Limitations: Women who have postnatal PTSD/depression are less inclined to participate in a study of this nature. Also, online surveys prevented the use of clinical diagnoses of PTSD and depression.Discussion and conclusions: Our results suggest that PTSD and postnatal depression affect women's mental health and family bonding. Women should be assessed for negative traumatic birth experiences, PTSD, and depression, to allow targeted observation for psychopathologies and therapeutic interventions.

Depression, not posttraumatic stress disorder (PTSD), is related to increased couple dissatisfaction.Both PTSD and depression are related to increased mother-baby bond disorders.Fear of childbirth increases as symptoms of PTSD and depression increase.

Interrupting traumatic memories in the emergency department: a randomized controlled pilot study.

BACKGROUND: The hours immediately following a traumatic event may present a window of opportunity to interrupt the consolidation of memories of the traumatic event, and this may prevent PTSD development. This theory has been validated in a series of analogue studies, showing that a visuo-spatial task reduces intrusive memories, however clinical studies are scarce. OBJECTIVE: This pilot RCT examined the use of a semi-immersive Virtual Reality visuospatial task, as an intervention to interrupt memory consolidation, in the Emergency Department (ED) in the immediate hours following a traumatic event. We hypothesised that participants who had received the intervention would present with lower levels of PTSD symptoms than the control group who received no intervention. METHOD: Seventy-seven adult survivors of traumatic events, meeting study criteria, were recruited in the ED of a Level III Trauma Centre. Survivors arrived at the ED less than one hour, on average, after the trauma. After signing informed consent, participants were randomized to the SnowWorld intervention or control group. Both groups completed self-report questionnaires, and the intervention group used SnowWorld for up to 10 minutes. RESULTS: No significant differences between the intervention and control groups were found regarding PTSD symptom levels two weeks and six months following the traumatic event. CONCLUSIONS: These results add to the growing literature examining the use of a concurrent task to reduce intrusions following a traumatic event. In contrast to previous clinical studies, this study did not show significant group differences; however, it replicates an analogue study that used a specifically developed app. Further studies are needed to elucidate possible reasons for these conflicting results.

Antecedentes: Las horas que siguen inmediatamente a un evento traumático podrían presentar una ventana de oportunidad para interrumpir la consolidación de las memorias del evento traumático, y esto podría prevenir el desarrollo del TEPT. Esta teoría ha sido validada en una serie de estudios análogos, mostrando que una tarea viso-espacial reduce las memorias intrusivas; los estudios clínicos son escasos.Objetivo: este ensayo controlado aleatorio (RCT en su sigla en inglés) piloto examinó el uso de una tarea viso-espacial de Realidad Virtual semi-inmersa como una intervención para interrumpir la memoria de consolidación en el Departamento de Emergencia, en las horas siguientes a un evento traumático. Hipotetizamos que al seguimiento aquellos que habían recibido la intervención presentarían niveles más bajos de los síntomas del TEPT que el grupo control.Método: Fueron reclutados en el Departamento de Emergencia (ED en su sigla en inglés) de un Centro de Trauma de Nivel III, 77 sobrevivientes adultos de eventos traumáticos, cumpliendo los criterios del estudio; los sobrevivientes llegaron al ED en promedio menos de una hora luego del trauma. Luego de firmar el consentimiento informado, fueron aleatorizados a la intervención SnowWorld o al grupo control. Ambos grupos completaron cuestionarios de auto-reporte, y el primer grupo usó SnowWorld por un máximo de 10 minutos.Resultados: No se encontraron diferencias significativas entre los grupos de estudio en los niveles de los síntomas de TEPT dos semanas y seis meses luego del evento traumático.Conclusiones: Este estudio no replicó los estudios clínicos y análogos previos. Esto puede deberse a las diferencias metodológicas, y los estudios futuros deberían tomarlos en cuenta.

A Novel Integrative Psychotherapy for Psychogenic Nonepileptic Seizures Based on the Biopsychosocial Model: A Retrospective Pilot Outcome Study.

BACKGROUND: Psychogenic nonepileptic seizures (PNES) represent one of the most sizable treatment challenges in neuropsychiatry. Although the underlying mechanism is far from being understood, several interventions have been suggested. However, patients with comorbid psychiatric diagnoses and epilepsy are excluded from most intervention studies. OBJECTIVE: To To present a within-group posttreatment vs pretreatment study representing the retrospective clinical results of an integrative psychotherapy model. METHODS: We present the clinical results of 22 patients with PNES diagnosed in an epilepsy center and treated in our neuropsychiatry clinic using an integrative rehabilitative psychotherapy. Therapy included presenting the diagnosis, psychoeducation, seizure reduction behavioral techniques, and coping with past and present stressors. Insomuch as integrative biopsychosocial psychotherapy is based on an individualized treatment protocol for each patient, treatment was individualized and case specific. RESULTS: By the end of treatment, 36% of patients had become seizure free and a further 54% achieved a major seizure reduction (reduction of more than 70%). Seventy-two percent of patients kept at least 70% seizure reduction at follow-up. Global Assessment of Functioning scores improved from a mean of 43.09 to a mean of 72.81 at the end of treatment and 69.72 at follow-up. In addition, we present 3 case descriptions that emphasize the individualized nature of psychotherapeutic decisions. CONCLUSIONS: Our results support the feasibility and effectiveness of biopsychosocial based integrative psychotherapy for PNES and set principles for future treatment and prospective clinical trials in the field of individualized psychotherapy.

Subthalamic theta activity: a novel human subcortical biomarker for obsessive compulsive disorder.

Obsessive-compulsive disorder (OCD) is a common and serious psychiatric disorder. Although subthalamic nucleus deep brain stimulation (DBS) has been studied as a treatment for OCD patients the underlying mechanism of this treatment and the optimal method of stimulation are unknown. To study the neural basis of subthalamic nucleus DBS in OCD patients we used a novel, implantable DBS system with long-term local field potential sensing capability. We focus our analysis on two patients with OCD who experienced severe treatment-resistant symptoms and were implanted with subthalamic nucleus DBS systems. We studied them for a year at rest and during provocation of OCD symptoms (46 recording sessions) and compared them to four Parkinson's disease (PD) patients implanted with subthalamic nucleus DBS systems (69 recording sessions). We show that the dorsal (motor) area of the subthalamic nucleus in OCD patients displays a beta (25-35 Hz) oscillatory activity similar to PD patients whereas the ventral (limbic-cognitive) area of the subthalamic nucleus displays distinct theta (6.5-8 Hz) oscillatory activity only in OCD patients. The subthalamic nucleus theta oscillatory activity decreases with provocation of OCD symptoms and is inversely correlated with symptoms severity over time. We conclude that beta oscillations at the dorsal subthalamic nucleus in OCD patients challenge their pathophysiologic association with movement disorders. Furthermore, theta oscillations at the ventral subthalamic nucleus in OCD patients suggest a new physiological target for OCD therapy as well as a promising input signal for future emotional-cognitive closed-loop DBS.

Correction: Shared trauma reality in war: Mental health therapists' experience.

[This corrects the article DOI: 10.1371/journal.pone.0191949.].

Shared trauma reality in war: Mental health therapists' experience.

INTRODUCTION: Shared traumatic reality occurs when therapists are doubly exposed to a traumatic event, both through their clients' experience, along with their own direct exposure. Studies have shown that a shared traumatic reality can lead to both positive and negative outcomes for therapists. Most studies have examined these reactions sometime after the end of the traumatic event, and less is known about reactions that occur during a traumatic event. In addition, most studies have assumed, rather than examined, indirect exposure. In this study, we extend this literature by examining direct and indirect exposure of therapists during a war situation, and their psychological reactions. METHOD: Over a period of two months in 2014, 70% of the Israeli population was exposed to rocket fire. Geographical areas differed in terms of amount of exposure, and its potential danger. 151 therapists living throughout Israel were assessed via an Internet based survey in the middle of the war, and were assessed for the effects on their professional and personal lives, degree of burnout, ways of coping and symptoms levels of PTSD and psychological distress. RESULTS: These indicate that significant differences in direct exposure occurred depending on place of residence. PTSD levels were related to higher direct exposure, as well as prior trauma exposure, but not to indirect exposure. Indirect exposure, as measured by increased workload, was related to increased distress and emotional exhaustion. DISCUSSION: These data shed light on the effects of direct and indirect exposure to a shared traumatic experience of war amongst therapists. The data support previous studies showing a greater effect of direct exposure on PTSD. Since indirect exposure appears to negatively impact burnout and psychological distress, rather than PTSD, this study shows that symptoms other than PTSD should be the result of in a shared traumatic reality.

Social relationship satisfaction and PTSD: which is the chicken and which is the egg?

BACKGROUND: Impaired social relationships are linked with higher levels of posttraumatic stress disorder (PTSD), but the association's underlying dynamics are unknown. PTSD may impair social relationships, and, vice versa, poorer relationship quality may interfere with the recovery from PTSD. OBJECTIVE: This work longitudinally evaluates the simultaneous progression of PTSD symptoms and social relationship satisfaction (SRS) in a large cohort of recent trauma survivors. It also explores the effect of cognitive behavior therapy (CBT) on the association between the two. METHOD: Consecutive emergency department trauma admissions with qualifying PTSD symptoms (n=501) were assessed 3 weeks and 5 months after trauma admission. The World Health Organization Quality of Life evaluated SRS and the Clinician Administered PTSD Scale evaluated PTSD symptom severity. Ninety-eight survivors received CBT between measurement sessions. We used Structural Equation Modeling to evaluate cross-lagged effects between the SRS and PTSD symptoms. RESULTS: The cross-lagged effect of SRS on PTSD was statistically significant (ß=-0.12, p=0.01) among survivors who did not receive treatment whilst the effect of PTDS on SRS was nil (ß=-0.02, p=0.67). Both relationships were non-significant among survivors who received CBT. DISCUSSION: SRS and PTSD are highly associated, and this study shows that changes in SRS in the early aftermath of traumatic events contribute to changes in PTSD, rather than vice versa. SRS impacts natural recovery, but not effective treatment. This study suggests that being satisfied with one's relationships might be considered as an important factor in natural recovery from trauma, as well as in intervention.

Early intervention for preventing posttraumatic stress disorder: an Internet-based virtual reality treatment.

BACKGROUND: Posttraumatic stress disorder (PTSD) develops in approximately 20% of people exposed to a traumatic event, and studies have shown that cognitive-behavioral therapy (CBT) is effective as a treatment for chronic PTSD. It has also been shown to prevent PTSD when delivered early after a traumatic event. However, studies have shown that uptake of early treatment is generally low, and therefore, the need to provide interventions through other mediums has been identified. The use of technology may overcome barriers to treatment. OBJECTIVE: This paper describes a randomized controlled trial that will examine an early CBT intervention for PTSD. The treatment incorporates virtual reality (VR) as a method for delivering exposure-based elements of the treatment. The intervention is Internet based, such that the therapist and patient will "meet" in a secure online site. This site will also include multi-media components of the treatment (such as videos, audios, VR) that can be accessed by the patient between sessions. METHOD: Two hundred patients arriving to a Level 1 emergency department following a motor vehicle accident will be randomly assigned to either treatment or control groups. Inclusion criteria are age 18-65, PTSD symptoms 2 weeks posttrauma related to current trauma, no suicidality, no psychosis. Patients will be assessed by telephone by a team blind to the study group, on four occasions: before and after treatment, and 6 and 12 months posttreatment. The primary outcome is PTSD symptoms at follow up. Secondary outcomes include depression and cost effectiveness. Analyses will be on an intention-to-treat basis. DISCUSSION: The results will provide more insight into the effects of preventive interventions, in general, and Internet-based early interventions, in particular, on PTSD, in an injured population, during the acute phase after trauma. We will discuss possible strengths and limitations.

Prolonged exposure and virtual reality-enhanced imaginal exposure for PTSD following a terrorist bulldozer attack: a case study.

In this case study, virtual reality was used to augment imaginal exposure in a protocol based on prolonged exposure. A 29-year-old male patient developed posttraumatic stress disorder after surviving a deadly terrorist bulldozer attack on two civilian buses and several cars in Jerusalem; the traumas witnessed by the survivor included a decapitation. The crowded bus in which the patient was riding was pushed over onto its side by the terrorist, injuring, trapping, and terrifying the passengers and causing gasoline to leak. Guided by his therapist, the patient entered an immersive computer-generated virtual world to go "back" to the scene of the traumatic event to help him gain access to his memories of the event, process and reduce the intensity of the emotions (fear/anger) associated with his pathological memories, and change unhealthy thought patterns. Traumatic memories of childhood abuse and traumatic memories of the bulldozer terrorist attack were treated using imaginal exposure while the patient was in the virtual environment BusWorld. The patient showed large posttreatment reductions in PTSD symptoms, and his Clinician-Administered PTSD Scale (CAPS) scores dropped from 79 pretreatment to zero immediately posttreatment, and CAPS was still at zero 6 months later. Although case studies are inconclusive by nature, these encouraging preliminary results suggest that further exploration of the use of virtual reality during modified prolonged exposure for PTSD is warranted. As terrorist attacks increase in frequency and severity worldwide, research is needed on how to minimize the psychological consequences of terrorism.

Gender differences in responses to traumatic events: a prospective study.

Gender differences in psychological responses to motor vehicle accidents were examined as part of a large-scale prospective study of PTSD. Participants were recruited from an emergency room (n = 275) and interviewed 1 week, 1 month, and 4 months later. No gender differences were seen in the prevalence or recovery from PTSD, or in symptom levels at 1- and 4 months. Women had a higher prevalence of lifetime- and postaccident generalized anxiety disorder. Gender differences were found regarding the type, but not the total number, of potentially traumatic events previously experienced. These results suggest that gender differences in responses to traumatic events are not explained by exposure as such, but rather may result from gender-specific attributes of the event.