The STRS (shortness of breath, tremulousness, racing heart, and sweating): A brief checklist for acute distress with panic-like autonomic indicators; development and factor structure.

BACKGROUND: Peritraumatic response, as currently assessed by Posttraumatic Stress Disorder (PTSD) diagnostic criterion A2, has weak positive predictive value (PPV) with respect to PTSD diagnosis. Research suggests that indicators of peritraumatic autonomic activation may supplement the PPV of PTSD criterion A2. We describe the development and factor structure of the STRS (Shortness of Breath, Tremulousness, Racing Heart, and Sweating), a one page, two-minute checklist with a five-point Likert-type response format based on a previously unpublished scale. It is the first validated self-report measure of peritraumatic activation of the autonomic nervous system. METHODS: We selected items from the Potential Stressful Events Interview (PSEI) to represent two latent variables: 1) PTSD diagnostic criterion A, and 2) acute autonomic activation. Participants (a convenience sample of 162 non-treatment seeking young adults) rated the most distressing incident of their lives on these items. We examined the factor structure of the STRS in this sample using factor and cluster analysis. RESULTS: Results confirmed a two-factor model. The factors together accounted for 68% of the variance. The variance in each item accounted for by the two factors together ranged from 41% to 74%. The item loadings on the two factors mapped precisely onto the two proposed latent variables. CONCLUSION: The factor structure of the STRS is robust and interpretable. Autonomic activation signs tapped by the STRS constitute a dimension of the acute autonomic activation in response to stress that is distinct from the current PTSD criterion A2. Since the PTSD diagnostic criteria are likely to change in the DSM-V, further research is warranted to determine whether signs of peritraumatic autonomic activation such as those measured by this two-minute scale add to the positive predictive power of the current PTSD criterion A2. Additionally, future research is warranted to explore whether the four automatic activation items of the STRS can be useful as the basis for a possible PTSD criterion A3 in the DSM-V.

Cognitive trauma therapy for battered women with PTSD (CTT-BW).

This article describes a second treatment-outcome study of cognitive trauma therapy for battered women with posttraumatic stress disorder (PTSD; CTT-BW). CTT-BW includes trauma history exploration: PTSD education; stress management; exposure to abuse and abuser reminders; self-monitoring of negative self-talk; cognitive therapy for guilt; and modules on self-advocacy, assertiveness, and how to identify perpetrators. One hundred twenty-five ethnically diverse women were randomly assigned to immediate or delayed CTT-BW. PTSD remitted in 87% of women who completed CTT-BW, with large reductions in depression and guilt and substantial increases in self-esteem. White and ethnic minority women benefited equally from CTT-BW. Similar treatment outcomes were obtained by male and female therapists and by therapists with different levels of education and training. Gains were maintained at 3- and 6-month follow-ups.

Cognitive trauma therapy for battered women with PTSD: preliminary findings.

This paper describes a treatment-outcome study of Cognitive Trauma Therapy for Battered Women (CTT-BW) with PTSD. Derived from psychological learning principles, CTT-BW emphasizes the role of irrational beliefs and evaluative language in chronic PTSD. CTT-BW includes trauma history exploration, PTSD psychoeducation, stress management, psychoeducation about dysfunctional self-talk and self-monitoring of self-talk, exposure to abuse reminders, Cognitive Therapy for Trauma-Related Guilt (E. S. Kubany & F. P. Manke, 1995), and modules on assertiveness, managing contacts with former partners, self-advocacy strategies, and avoiding revictimization. Thirty-seven ethnically diverse women were assigned to Immediate or Delayed CTT-BW. PTSD remitted in 30 of 32 women who completed CTT-BW. Gains were maintained at 3-month follow-up. CTT-BW was efficacious across ethnic backgrounds. Issues related to disseminability of CTT-BW are discussed.