Applicability of hypnosis to the treatment of Complex PTSD and dissociation.

In considering the applicability of hypnosis to treating Complex PTSD (C-PTSD) we examine the relationship between trauma, hypnosis, and dissociation, the latter being a common response to traumatization that is particularly salient in C-PTSD. We then provide an overview of the nature of C-PTSD, which research is beginning to demonstrate is considerably more prevalent than the more circumscribed PTSD syndrome depicted in the DSM. Building on this foundation, we discuss the reasons why hypnotically structured treatment is particularly well suited for C-PTSD, explaining how each of the major aspects of this syndrome can be addressed within a hypnotic framework.

The varied relationship between hypnosis and dissociative phenomena: Implications for traumatology.

Although metanalytic evidence exists to support the long-term efficacy of hypnotic interventions in the treatment of trauma, assertions that hypnosis may induce trauma or exacerbate existing posttraumatic reactions through activating dissociative processes seem to persist in some circles. While multiple studies have established that hypnotic induction produces dissociative phenomena, what has not yet been clearly explicated is the degree to which varieties of dissociative phenomena differentially elicited by hypnotic induction tend to skew toward the pathological or nonpathological end of the continuum of dissociation. The authors of the current study explore the connection between hypnotic susceptibility and facets of dissociation, employing the Harvard Group Scale of Hypnotic Susceptibility: A (HGSHS:A) and the State Scale of Dissociation (SSD). A significantly greater change in state dissociation was observed in their hypnosis condition as compared with a novel control condition (t (82) = 3.235, p =.002, d =.70), confirming that a relationship appears to exist between hypnosis and dissociation. A discussion of the differential effect of hypnosis on SSD subscales follows, specifically indicating less activation of the more putatively pathological facets, namely identity confusion and identity alteration. This finding may serve to assuage some concerns around the potential for iatrogenesis in working with traumatized patients.

Cardiovascular risks in relation to posttraumatic stress severity among young trauma-exposed women.

BACKGROUND: Posttraumatic stress is associated with elevated risk for cardiovascular disease (CVD). Relatively little research, particularly among women, has documented mechanisms by which PTSD might confer CVD risk during early adulthood. The purpose of the present study was to examine whether the number and relative levels of CVD risk factors are associated with posttraumatic stress symptom severity among young, trauma-exposed women. METHODS: Participants were premenopausal women ages 19-49 with varying levels of posttraumatic stress and no history of chronic medical illness (n = 54), and were recruited from mental health clinics and the general community. Posttraumatic stress severity was assessed with a structured clinical interview (Clinician-Administered PTSD Scale). The CVD risk factors assessed were lipids (total cholesterol, triglycerides, high- and low-density lipoproteins), resting blood pressure (BP), body mass index (BMI), no exercise in typical week, and cigarette smoking. RESULTS: Posttraumatic stress severity was associated with lower high-density lipoprotein levels and higher triglycerides, greater systolic and diastolic BP, greater BMI, and a greater number of total CVD risk factors. LIMITATIONS: The main limitation is the limited number of participants who displayed clinical levels on some of the CVD risk factors (e.g., BP). Nonetheless, most participants exhibited more than one CVD risk factor, indicating the potential for many of the women in this relatively young sample to progress toward greater risk later in life. CONCLUSIONS: The present results support the contention that, in the absence of medical illness, posttraumatic stress symptom severity among young women is associated with several CVD risk factors early in life.

Childhood disclosure of sexual abuse: Necessary but not necessarily sufficient.

Prevention programs often encourage sexually abused children to disclose without fully considering the potential for adverse consequences. This study examined the impact of disclosure on abuse cessation and later adult symptomatology. A clinical sample of 301 adult survivors completed the Impact of Event Scale (IES/IES-R), and the Beck Depression Inventory (BDI-II). Participants were divided into 3 groups: Nondisclosure (n=221), Disclosure/Abuse Ended (n=25), and Disclosure/Abuse Continued (n=55). Multivariate analyses of covariance, adjusting for abuse characteristics (age of onset, penetration, and number of perpetrators) and other trauma exposure, revealed significant differences in psychiatric symptom severity among the three groups, Wilks' λ=0. 95, F (6, 584)=2.69, p=0.014, ηp2=0.03. Specifically, those in the Disclosure/Abuse Continued group scored significantly higher on the IES/IES-R Intrusion subscale (p=0.04) and the BDI-II (p=0.01), as compared to the Nondisclosure group. The Disclosure/Abuse Ended group did not differ significantly from the other groups. Results suggest that disclosure may be detrimental unless adequate steps are taken to ensure abuse cessation and appropriate treatment.

Psychophysiological Reactivity and PTSD Symptom Severity among Young Women.

Mixed findings with regard to cardiovascular reactivity (CVR) and posttraumatic stress disorder (PTSD) have suggested a need to further explore the nature of this relationship and factors that might explain differences in reactivity across and within samples. In the present study, the severity of PTSD symptoms was investigated in relation to CVR among young women. In addition, we examined whether severity within PTSD symptom clusters and level of dissociative symptoms were related to CVR. Heart rate, systolic and diastolic blood pressure, cardiac output (CO) and total peripheral resistance (TPR) reactivity in response to an oral speaking task were assessed for 58 young trauma-exposed civilian women with varying levels of PTSD symptomatology (from no symptoms to high severity of PTSD). The PTSD severity sub-scores for the DSM-V symptom clusters and total PTSD severity were based on structured interview (Clinician Administered PTSD Scale), and dissociative symptoms were assessed using the Dissociative Experiences Scale. Severity of total PTSD symptoms was associated with greater CO reactivity (r = .48, p < .01) and lower TPR reactivity (r = -.50, p < .01). Significant associations were not observed for heart rate or blood pressure. Results did not vary according to severity of symptoms within PTSD symptom cluster, with correlations for CO reactivity ranging from .40 to .49 and correlations for TPR reactivity ranging from -.40 to -.50 within symptom clusters. Dissociative symptoms were not significantly correlated with the CVR measures. Results partially supported the expectation that PTSD severity is one factor that would be associated with CVR, and suggest that reactivity for the underlying components of blood pressure (CO and TPR) provide additional information in probing stress reactivity in PTSD.

Are hypnosis and dissociation related? New evidence for a connection.

The authors revisit the question of the existence of a relationship between hypnotizability and dissociative capacity. In the present study, the State Scale of Dissociation (SSD) replaced the commonly employed Dissociative Experiences Scale (DES) as a measure of dissociation, due to the latter capturing primarily pathological aspects of dissociation. Relationships between the Harvard Scale of Hypnotic Susceptibility, Form A (HGSHS:A), the SSD, and the Phenomenology of Consciousness Inventory (PCI) were assessed in the context of hypnosis. Robust results were found when comparing pre- to post-SSD scores, suggesting heightened nonpathological forms of dissociation are indeed related to hypnotizability. The appropriateness of the DES and similar trait-based measures for evaluating hypnotic phenomena is discussed as well as the relationships between PCI and SSD subscales.

How ineffective family environments can compound maldevelopment of critical thinking skills in childhood abuse survivors.

The high stress of childhood abuse is associated with neurobiological detriments to executive function. Child abuse survivors may also be cognitively and relationally disadvantaged as a result of being raised in emotionally impoverished families that lack cohesion, organization, flexibility, self-expression, and moral and ethical values and fail to provide opportunities for effective learning. A review of literature demonstrates how dysfunctional family of origin environments common to child abuse survivors, concomitant with the extreme stress of overt acts of abuse, can act as a barrier to the development of higher-order critical thinking skills. The article concludes by discussing ramifications of critical thinking skill deficits in child abuse survivors and highlights the importance of integrating and prioritizing critical thinking skills training in treatment.

Complex traumatic stress in the pediatric medical setting.

There has been a recent increase in research focusing on child complex traumatic stress following prolonged or repeated trauma. These traumatic stress reactions often affect many aspects of the child's functioning, including psychological, behavioral, and physical health. In addition, complex traumatic stress experienced by youth with serious medical conditions may influence health issues such as medical adherence, emotional adjustment to illness, and pain management. This article reviews and delineates the current state of the literature on the impact of complex traumatic stress in childhood on mental and physical health as well as on these pediatric health-related issues. To date, few empirical studies have directly addressed this association. Several features associated with complex traumatic stress, such as emotion regulation difficulties, disruptive behavior, and family conflict, have indirectly been demonstrated to interfere with pediatric adherence, medical coping, and pain management. This demonstrates the need for more focused research in this area.

Motivated forgetting and misremembering: perspectives from betrayal trauma theory.

Individuals are sometimes exposed to information that may endanger their well-being. In such cases, forgetting or misremembering may be adaptive. Childhood abuse perpetrated by a caregiver is an example. Betrayal trauma theory (BTT) proposes that the way in which events are processed and remembered will be related to the degree to which a negative event represents a betrayal by a trusted, needed other. Full awareness of such abuse may only increase the victim's risk by motivating withdrawal or confrontation with the perpetrator, thus risking a relationship vital to the victim's survival. In such situations, minimizing awareness of the betrayal trauma may be adaptive. BTT has implications for the larger memory and trauma field, particularly with regard to forgetting and misremembering events. This chapter reviews conceptual and empirical issues central to the literature on memory for trauma and BTT as well as identifies future research directions derived from BTT.

Benefits of a contextual approach to understanding and treating complex trauma.

The conceptual framework and treatment rationale of contextual therapy are described. Contextual therapy was specifically fashioned for survivors of prolonged child abuse (PCA). It is grounded in the observation that contexts beyond abuse trauma, especially restrictions in psychological development stemming from growing up in an ineffective family environment, appreciably impact the adjustment of many PCA survivors. Contextual therapy proposes that remediation of developmental gaps commonly manifested by PCA survivors is essential to equip them to (a) benefit from rather than be debilitated by trauma processing and (b) move beyond symptom reduction to the attainment of adequate social and occupational functioning.

Review of the theater of trauma: american modernist drama and the psychological struggle for the american mind, 1900-1930.

Reviews the book, The Theater of Trauma: American Modernist Drama and the Psychological Struggle for the American Mind, 1900-1930 by Michael Cotsell (2005). For most of the 20th century, psychoanalytic theory and its myriad offshoots so pervasively influenced literary criticism in the United States that for many it is difficult to imagine examining American literature of that era through any other psychological lens. In his new book The Theater of Trauma: American Modernist Drama and the Psychological Struggle for the American Mind, 1900-1930, Michael Cotsell alerts us to the existence of an alternate psychological perspective that dominated the American landscape before Freudian analysis gained widespread acceptance on this side of the Atlantic--dissociationism. He makes a compelling case that from the waning years of the 19th through the early decades of the 20th century American modernist drama was primarily shaped not by psychoanalytic thought, but by dissociationist psychology. Cotsell argues that it is dissociationism that informed and sustained the modernist sensibility in American drama, and that once dissociationist psychology was eclipsed by psychoanalytic theory, the demise of modernist playwriting was inevitable. Despite the breadth of this book, it is no more realistic that a single work could provide the last word on the relevance of dissociationism to drama than that one volume could offer a comprehensive discussion of the pertinence of psychoanalytic theory to the theater. Cotsell reminds us of the existence of a conceptual framework that carries tremendous explanatory power in its capacity to cogently link the realm of the psychological and personal to that of the social and political. The continued ubiquity of trauma and dissociation in contemporary life render the dissociationist perspective as relevant today as it was in the modernist epoch. Consequently, the significance of The Theater of Trauma extends well beyond the specific territory it covers; it lies in its potential to open new vistas for psychology, for literary criticism, and a wide spectrum of other disciplines concerned with the interface between society and individual experience. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Family of origin environments in two clinical samples of survivors of intra-familial, extra-familial, and both types of sexual abuse.

OBJECTIVE: It has been suggested that survivors of ongoing childhood sexual abuse (CSA) tend to have been reared in ineffective family environments that render them particularly vulnerable to maltreatment and which foster psychological difficulties beyond those accounted for solely by their abuse. If this conjecture is valid, one would expect that the family of origin environments of CSA survivors would be disturbed whether their abuser was intra-familial or extra-familial. To assess this hypothesis, two studies compared the childhood family of origin environments and supportive parenting characteristics of a clinical sample of women sexually abused by family members only (the intra-familial group), by non-family members only (the extra-familial group), and by both family and non-family members (the "both" group). METHOD: Study 1 compared the three groups (total N = 213) using the Family Environment Scale (FES). Study 2 compared groups (total N = 86) on the positive parenting scales of the Exposure to Abusive and Supportive Environments Parenting Inventory (EASE-PI). RESULTS: In Study 1, multivariate analyses indicated significant differences on the independence, cohesion, and conflict subscales of the FES. Pairwise comparisons revealed that the extra-familial group reported significantly higher levels of family independence and lower levels of conflict than the other two groups. In addition, the extra-familial group reported higher levels of cohesion than the intra-familial group. However, the effect sizes of these comparisons were extremely small. In Study 2, multivariate analyses revealed no group differences on the EASE-PI scales. CONCLUSIONS: Low effect sizes on the three significant FES scales, non-significance on the remaining seven FES scales, and non-significance on the EASE-PI scales suggest that there is considerable similarity in the family of origin environments of adult female CSA survivors seeking therapy regardless of whether their perpetrators were family members, non-family members, or both family and non-family members.

Discriminating malingered from genuine civilian posttraumatic stress disorder: a validation of three MMPI-2 Infrequency scales (F, Fp, and Fptsd).

The Infrequency-Posttraumatic Stress Disorder scale (Fptsd), recently created for the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), has demonstrated incremental validity over other MMPI-2 scales in malingered posttraumatic stress disorder (PTSD) detection. Fptsd was developed with combat-exposed PTSD patients, potentially limiting its use with PTSD patients in general. The current study evaluated the MMPI-2's F, Infrequency-Psychopathology scale (Fp), and Fptsd scales in discriminating genuine civilian PTSD among 41 adult victims of child sexual abuse from a group of 39 students instructed to simulate PTSD. Analyses demonstrated Fptsd's incremental validity over F but not over Fp. Based on the two studies examining Fptsd, Fptsd may be more appropriate for combat trauma victims, and Fp may be more appropriate for civilian trauma victims.

MMPI-2 F scale elevations in adult victims of child sexual abuse.

The present study assessed whether the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) F scale elevations may reflect genuine trauma-related distress and/or psychopathology, rather than malingering, in a clinical sample of adult child sexual abuse (CSA) victims. Eighty-eight women seeking outpatient treatment for CSA after-effects participated. Self-report measures of dissociation, posttraumatic stress, depression, and family environment individually correlated significantly with F, and collectively accounted for 40% of its variance. Dissociation was the strongest predictor. Findings suggest that high F elevations may reflect genuine problem areas often found among CSA victims, rather than symptom overreporting.

Contextual Treatment of Dissociative Identity Disorder.

Evidence for the effectiveness of contextual therapy, a new approach for treating adult survivors of prolonged child abuse (PCA), is provided via case studies of three women with Dissociative Identity Disorder (DID). Contextual therapy is based on the premise that it is not only traumatic experiences that account for PCA survivors' psychological difficulties. Even more fundamentally, many survivors grow up in an interpersonal context in which adequate resources for secure attachment and acquisition of adaptive living skills are not available. As a result, they are left with lasting deficits that undermine not only their current functioning, but also their ability to cope with reliving their traumatic memories in therapy. The primary focus of this treatment approach, therefore, is on developing capacities for feeling and functioning better in the present, rather than on extensive exploration and processing of the client's trauma history or, in the case of DID, of identity fragments. Treatment of the three cases presented ranged from eight months to two and one-half years' duration, and culminated in very positive outcomes. The women's reports of achievements, such as obtaining and maintaining gainful employment, greater self-sufficiency, and the establishment of more intimate and gratifying relationships, indicated marked improvements in daily functioning. Objective test data obtained at admission and discharge, and in one case, at follow-up, documented substantial reductions in dissociative, posttraumatic stress, depressive, and other symptoms.