Personality Functioning Improvement during Psychotherapy Is Associated with an Enhanced Capacity for Affect Regulation in Dreams: A Preliminary Study.

BACKGROUND: Clinical case illustrations of patients with an impairment of personality functioning (IPF) have repeatedly reported that progress during psychotherapy is reflected by alterations in dream content. However, quantitative studies based on samples of psychotherapy patients are scarce. As a core component of both personality functioning and contemporary psychodynamic dream theory, the construct of affect regulation is of specific significance in this context. AIMS: To test if improvement in personality functioning in the course of psychotherapy is associated with an increasing ability to regulate affects in dreams. METHOD: In a longitudinal design, affect regulation was compared in N = 94 unsolicited dream reports from the first vs. last third of long term psychotherapy of ten patients with initial IPF. Dream reports were transcribed from recordings of the sessions. Expert ratings of the level of personality functioning were obtained using the Scales of Psychological Capacities. The capacity for affect regulation was assessed using the Zurich Dream Process Coding System. Group differences were assessed using linear mixed models, controlling for dream length as well as the nested structure of this data set. RESULTS: Patients demonstrated an increased capacity for affect regulation in dreams that was primarily evident in three core features: the complexity of dream elements (cf., e.g., parameter attributes, p = 0.024); the extent of affective involvement in the dream ego (cf., e.g., parameter subject feeling, p = 0.014); and the flexibility to regulate the dynamics of safety/involvement processes (p ≤ 0.001). This pattern was especially prominent in a subgroup (n = 7) of patients with more pronounced improvements in personality functioning. CONCLUSION: These findings support the hypotheses that decreasing IPF during psychotherapy is associated with increases in the capacity for affect regulation in dreams. Thus, researchers and therapists can utilize dream reports to illuminate the important aspects of treatment progress in clinical practice.

Mediators of Outcome in Trauma-Focused Psychotherapy with Youth: A Systematic Review.

This article aimed to provide a systematic narrative synthesis of existing studies on the mediators of change in psychotherapy with adolescents (10-19 years) and transition age youth (TAY) (20-29 years) who have experienced trauma-related symptoms or posttraumatic disorder. Additionally, we were interested in identifying psychotherapy-, trauma type-, and clients' age- and gender-specific mediators of treatment outcome. Following the preferred reporting items for systematic reviews and meta-analyses, a total of 3,723 studies published in PubMed and PsycINFO databases were screened against inclusion criteria, revealing 15 eligible studies. No studies with only TAY were found; therefore, all results were limited to therapy with adolescents. Cognitive mediators were tested in 66% of selected studies, followed by parents/family-related, mental-health-related, therapy-related, and behavioral mediators. Moderate evidence was found for posttraumatic cognitions, whereas therapeutic alliance seemed to be a promising candidate for future research. Striking absence of non-cognitive-behavioral therapy interventions, emotional and adolescent-specific mediators, as well as studies with males and in non-Western societies was evident. Future original studies would benefit from applying methodological rigor in respect to mediation testing.

Pre-event attachment anxiety and avoidance predict posttraumatic stress symptom severity - Results from a longitudinal population-based study.

Attachment-related anxiety and avoidance have been identified as risk factors for psychopathology following traumatic events. However, the predictive value of pre-event attachment orientations for PTSD symptoms in the general population remains unclear. Attachment anxiety and avoidance, as well as symptoms of anxiety and depression, were assessed in autumn 2010 (T0) in 270 adult members of a Dutch research panel. PTSD symptoms were assessed in April (T1), August (T2), and December (T3) 2012 for events occurring within one year before T1. The predictive value of attachment orientations for severity and remission of PTSD cluster and total scores was estimated by latent growth curve analyses controlling for gender, age, and pre-event psychopathology. Attachment anxiety predicted higher posttraumatic stress severity at T1, while attachment avoidance predicted lower initial posttraumatic stress levels, together adding 7.4 % independently explained variance. Higher attachment anxiety was related to more remission of PTSD total scores (6.0 % independently explained variance) which might be understood as an effect of regression to the mean. In conclusion, insecure attachment orientation predicts PTSD symptoms in the general population. Our results advocate the significance of pre-traumatic factors for the prediction of posttraumatic stress and the consideration of attachment orientations in clinical work with trauma survivors.

Patients' perception of side effects in cognitive-behavior, psychodynamic, and psychoanalytic outpatient psychotherapy.

OBJECTIVE: To assess and compare the frequency of psychotherapeutic side effects in different psychotherapeutic approaches. METHOD: Side effects were assessed across 17 domains through structured interviews with 45 outpatients in cognitive-behavior, psychodynamic, and psychoanalytic psychotherapy. RESULTS: Almost every patient (95.6%) reported at least one side effect, with a mean of 4.7 affected domains. Most frequent complaints were that problems were seen as more complex (60.0-80.0%), worsening of pre-existing symptoms (46.7-60%), occurrence of new symptoms (20.0-53.3%), feeling uncomfortable in treatment (33.3-40.0%), tensions with therapist (26.7-46.7%), as well as conflicts with current family and with family of origin (both 13.3-46.7%). Differences between therapeutic orientations were mostly non-significant. CONCLUSION: Psychotherapy is regularly accompanied by side effects, independent of different theoretical orientations. Psychotherapists need to be familiar with side effects in order to inform patients about treatment-associated risks and to recognize and manage side effects.

To what extent do post-traumatic mental health and other problems reflect pre-existing problems? Findings from the prospective comparative population-based VICTIMS-study.

BACKGROUND: Findings from prospective studies question the assumption that mental health problems observed in traumatized adults mainly reflect the effects of potentially traumatic events. AIMS: Aim of the present comparative prospective study is to clarify the extent to which victims of potentially traumatic events with mental health, social, financial, and/or legal problems, already suffered from such problems before these events. METHOD: Data was extracted from three surveys of the prospective VICTIMS-study (T1 = 2018, T2 = 2019, T3 = 2020), conducted with the population-based longitudinal LISS-panel. Differences between victims (n = 340, victimized by violence, accidents, and serious threats in the 12 months before T3) and nonvictims (n = 3,872, not victimized by such events in this period), were examined using multivariate logistic regression analyses. RESULTS: The large majority of victims with current (at T3) anxiety and depression symptomatology (74%), general mental health problems (71%), partner/family (67%), financial (76%), and legal problems (58%), and lack of support (79%), already had these problems (at T1 and/or at T2). A similar pattern was observed among nonvictims. Of the victims with current probable PTSD (at T3), 87% already had any mental health problem. At T3, among both groups, the incidence of problems was substantially lower than their prevalence. The large majority of victims with post-event mental health, social, financial, and legal problems already suffered from these problems in the past. CONCLUSIONS: When victims seek help for their problems, professional care providers should be aware that in most cases, as among nonvictims, these problems are chronic/re-current rather than new problems.

Guilt is effectively induced by a written auto-biographical essay but not reduced by experimental pain.

Introduction: The aim of the present study was (1) to validate the method of guilt-induction by means of a written auto-biographical essay and (2) to test whether experimental pain is apt to alleviate the mental burden of guilt, a concept receiving support from both empirical research and clinical observation. Methods: Three independent groups of healthy male participants were recruited. Group allocation was not randomized but within group pain/sham administration was counterbalanced over the two test-days. Groups were tested in the following consecutive order: Group A: guilt induction, heat-pain/sham, N = 59; Group B: guilt induction, cold-pressure-pain/sham, N = 43; Group C: emotionally neutral induction, heat-pain/sham, N = 39. Guilt was induced on both test-days in group A and B before pain/sham administration. Visual analog scale (VAS) guilt ratings immediately after pain/sham stimulation served as the primary outcome. In a control group C the identical heat-pain experiment was performed like in group A but a neutral emotional state was induced. Results: A consistently strong overall effect of guilt-induction (heat-pain: p < 0.001, effect size r = 0.71; CPT-pain p < 0.001, r = 0.67) was found when compared to the control-condition (p = 0.25, r = 0.08). As expected, heat- and cold-pressure-stimuli were highly painful in all groups (p < 0.0001, r = 0.89). However, previous research supporting the hypothesis that pain is apt to reduce guilt was not replicated. Conclusion: Although guilt-induction was highly effective on both test-days no impact of pain on behavioral guilt-ratings in healthy individuals could be identified. Guilt induction per se did not depend on the order of testing. The result questions previous experimental work on the impact of pain on moral emotions.

Differences in mental health problems, coping self-efficacy and social support between adults victimised before and adults victimised after the COVID-19 outbreak: population-based prospective study.

BACKGROUND: Victims of violence, accidents and threats are at risk for mental health problems. Lower coping self-efficacy and social support levels increase this risk. Although highly relevant, it is unknown if the coronavirus disease 2019 (COVID-19) pandemic amplifies these risks. AIMS: To examine if the prevalence, incidence and/or mean scores for post-traumatic stress disorder (PTSD), anxiety and depression symptoms, general mental health problems, coping self-efficacy, lack of emotional support and social acknowledgement are higher among adults victimised in the year after the COVID-19 outbreak compared with adults victimised in a similar period before the outbreak. Also, to compare symptoms, problems and support within non-victims during the same period. METHOD: Data was extracted from four surveys of the VICTIMS study (March 2018, 2019, 2020, 2021), based on a random sample of the Dutch population. Multivariate logistic regression analyses and mixed-effects models were used to examine differences between the two victim groups (2019: n = 421, 2021: n = 319) and non-victims (n = 3245). RESULTS: Adults victimised after the outbreak more often had PTSD, anxiety and depression symptoms, general mental health problems and lower coping self-efficacy than those victimised before. They did not differ in lack of support and acknowledgement. Both victim groups differed from non-victims, where mental health problems and lack of support levels were much lower and almost stable. CONCLUSIONS: The COVID-19 pandemic had a negative impact on the mental health and coping self-efficacy levels of victims, whereas mental health problems among non-victims remained virtually stable. Mental healthcare workers, general practitioners and victim services should take this impact into account.

Psychometric properties and validity of the German version of the Post-Traumatic Diagnostic Scale for DSM-5 (PDS-5).

Background: The availability of psychometrically sound instruments for the assessment of Post-Traumatic Stress Disorder (PTSD) is indispensable for clinical and scientific work with individuals suffering from trauma-related distress. Objective: The aim of the present study was to translate the Post-Traumatic Diagnostic Scale for DSM-5 (PDS-5) into German and to evaluate its psychometric properties as well as convergent, discriminant, and factorial validity. Method: The authorized German translation of the PDS-5 was completed by 270 patients admitted to specialized outpatient trauma clinics. Of these, 57.8% completed the PDS for a second time (mean time between assessments was 12.0 days). In order to examine convergent and discriminant validity of the PDS-5, the Post-traumatic Stress Disorder Checklist for DSM-5 as well as Patient Health Questionnaire subscales assessing depression (PHQ-9), somatization (PHQ-15), and Generalized Anxiety Disorder (GAD-7) were applied. Results: The PDS-5 total score showed excellent internal consistency (α = .91) and re-test reliability (rho = .84). Convergent validity was supported by a strong correlation with the total score of the Post-traumatic Stress Disorder Checklist for DSM-5 (PCL-5; rho = .91). Correlations with Patient Health Questionnaire subscales of depression (rho = .81), anxiety (rho = .72), and somatization (rho = .65) were significantly lower (all p < .001) indicating discriminant validity of the PDS-5. Confirmative Factor Analysis did not result in a clear preference for one of the tested models. Defining a diagnostic cut-off value of ≥36 based on ROC analysis resulted in high sensitivity (.92) and specificity (.96) compared to a probable PTSD diagnosis according to the PCL-5. Conclusions: In summary, our results indicate that the German PDS-5 translation provides valid and reliable information concerning both PTSD severity and diagnosis.

Antecedentes: La disponibilidad de instrumentos psicométricamente sólidos para la evaluación del trastorno de estrés postraumático (TEPT) es indispensable para el trabajo clínico y científico con personas que sufren angustia relacionada con el trauma.Objetivo: El objetivo del presente estudio fue traducir la Escala de Diagnóstico Postraumático del DSM-5 (PDS-5) al alemán y evaluar sus propiedades psicométricas, así como su validez convergente, discriminante y factorial.Método: La traducción al alemán autorizada del PDS-5 fue completada por 270 pacientes ingresados en clínicas de trauma ambulatorias especializadas. De estos, el 57,8% completó la PDS por segunda vez (el tiempo medio entre evaluaciones fue de 12,0 días). Con el fin de examinar la validez convergente y discriminante del PDS-5, la lista de verificación del trastorno de estrés postraumático para el DSM-5, así como las subescalas de depresión del Cuestionario de salud del paciente (PHQ-9), de somatización (PHQ-15) y de trastorno de ansiedad generalizada (GAD-7) fueron aplicadas.Resultados: La puntuación total del PDS-5 mostró una excelente consistencia interna (α = .91) y confiabilidad al reaplicar (rho = .84). La validez convergente fue apoyada por una fuerte correlación con la puntuación total de la lista de verificación de trastorno de estrés postraumático para el DSM-5 (PCL-5; rho = .91). Las correlaciones con las subescalas del Cuestionario de Salud del Paciente de depresión (rho = .81), ansiedad (rho = .72) y somatización (rho = .65) fueron significativamente más bajas (todas p <.001) lindicando validez discriminante del PDS-5. El Análisis Factorial Confirmativo no resultó en una preferencia clara por uno de los modelos probados. La definición de un valour de corte de diagnóstico de ≥36 basado en el análisis ROC resultó en una alta sensibilidad (.92) y especificidad (.96) en comparación con un diagnóstico de TEPT probable según el PCL-5.Conclusiones: En resumen, nuestros resultados indican que la traducción al alemán PDS-5 proporciona información válida y confiable sobre la severidad y diagnóstico del TEPT.

Differences in attachment dimensions and reflective functioning between traumatized juvenile offenders and maltreated non-delinquent adolescents from care services.

BACKGROUND: Adverse childhood experiences, especially maltreatment, are regarded as significant risk factors for the development of antisocial behavior in adolescence. However, possible correlates are still to be investigated after considering the history of criminal records and the experience of institutionalization. OBJECTIVE: In this study, differences in attachment anxiety and avoidance, and reflective functioning (RF) between traumatized incarcerated juvenile offenders and non-delinquent adolescents institutionalized in child services because of domestic violence were examined. PARTICIPANTS, SETTING AND METHOD: Forty-two juvenile offenders (Nfemale = 19) and 43 inmates of institutions for adolescents without parental care (Nfemale = 20) with the history of trauma filled in the childhood trauma and attachment dimensions questionnaires, and were scored on the Reflective Functioning Scale. Groups were matched on age and education. RESULTS: Results indicate that both groups reported equally high levels of attachment anxiety and avoidance. Male juvenile offenders had lower scores on reflective functioning than both female convicted minors (B = 1.06; Odds Ratio = 2.88; Nagelkerkes R2 = 45) and non-delinquent adolescents of both genders (B = -.65; Odds Ratio = .52; Nagelkerkes R2 = 42). In comparison to non-convicted males, male offenders also had higher scores on the control scale of idealization (B = .35; Odds Ratio = 1.42; Nagelkerkes R2 = 42). No differences between females with and without a history of crimes were found. CONCLUSIONS: Results indicate a need for building RF in both traumatized samples, especially in male delinquents, and encourage further research in females.

Psychometric evaluation of the Hamburg Nightmare Questionnaire (HNQ).

Background: Nightmares are a widespread phenomenon. In comparison to the general population, they occur in mentally ill and especially in traumatized individuals with an increased frequency. Despite the high prevalence, there is no short questionnaire in the German language that is able to characterize nightmares, to differentiate between different nightmare types and to assess their impact on daytime functioning. Objective: The Hamburg Nightmare Questionnaire (HNQ) has been developed as a short self-rating instrument to fill this gap. Method: Psychometric characteristics of the HNQ were evaluated in a sample of 707 German soldiers passing through the standard diagnostics of the Center for Mental Health at the German Armed Forces Hospital Hamburg. Results: The results of this study show satisfactory psychometric characteristics as a sound factorial structure and adequate internal consistency for the HNQ as well as initial indications of the construct validity of its subscales. Conclusions: The HNQ is a reliable and economic tool for the assessment of posttraumatic nightmares in clinical as well as research settings.

Antecedentes: Las pesadillas son un fenómeno ampliamente generalizado. En comparación con la población general, las pesadillas ocurren con una mayor frecuencia en personas con enfermedad mental y, especialmente, en personas traumatizadas. A pesar de su alta prevalencia, no existe ningún cuestionario breve en idioma alemán que sea capaz de caracterizar las pesadillas, diferenciarlas en tipos, y evaluar su impacto sobre la funcionalidad durante el periodo de vigilia.Objetivo: Se desarrolló el Cuestionario de Pesadillas de Hamburgo (HNQ, por sus siglas en inglés) como un instrumento de valoración breve auto-aplicado para subsanar esta brecha.Método: Se evaluaron las características psicométricas del HNQ a partir de una muestra de 707 soldados alemanes que eran sometidos a los diagnósticos estándar del Centro para la Salud Mental del Hospital de Hamburgo de las Fuerzas Armadas Alemanas.Resultados: Los resultados de este estudio mostraron características psicométricas satisfactorias, tales como una firme estructura factorial y una adecuada consistencia interna para el HNQ, así como indicadores iniciales de la validez del constructo de sus subescalas.Conclusiones: El HNQ es una herramienta confiable y económica para la evaluación de pesadillas postraumáticas tanto en el ámbito clínico como en el de investigación.

Aetiology and treatment of nightmare disorder: State of the art and future perspectives.

This consensus paper provides an overview of the state of the art in research on the aetiology and treatment of nightmare disorder and outlines further perspectives on these issues. It presents a definition of nightmares and nightmare disorder followed by epidemiological findings, and then explains existing models of nightmare aetiology in traumatized and non-traumatized individuals. Chronic nightmares develop through the interaction of elevated hyperarousal and impaired fear extinction. This interplay is assumed to be facilitated by trait affect distress elicited by traumatic experiences, early childhood adversity and trait susceptibility, as well as by elevated thought suppression and potentially sleep-disordered breathing. Accordingly, different treatment options for nightmares focus on their meaning, on the chronic repetition of the nightmare or on maladaptive beliefs. Clinically, knowledge of healthcare providers about nightmare disorder and the delivery of evidence-based interventions in the healthcare system is discussed. Based on these findings, we highlight some future perspectives and potential further developments of nightmare treatments and research into nightmare aetiology.

The experience of transplantation as reflected in dream life: A case study illustrating the mental processing of a lung transplant.

Although it is well known that a lung transplant enhances the recipient's quality of life, our knowledge of how it is processed mentally is limited. In this study, interviews were conducted with a lung-transplant patient two weeks, three months, and six months after surgery so as to investigate the relevant unconscious processing mechanisms. A dream reported in the first interview was analysed in accordance withapplying the Zurich Dream Process Coding System. A 'transplantation complex' was reconstructed on the basis of various sources of information (the dream and the waking narratives). The principal aspects of the transplantation complex that emerged from both the dream and the waking narratives concerned the oral-sadistic phantasy that the donor had been killed and that his lung, or soul, had been violently incorporated in the patient. The main unconscious themes involved in the processing of the transplant were found to have been already laid down in the dream and to have been presented in it in the form of visual analogues. According to our interpretation of the data analysed, powerful cannibalistic phantasies and death wishes played an important part in the processing of the transplant. These archaic phantasies may have been actualized by the transplant.

Association of posttraumatic nightmares and psychopathology in a military sample.

OBJECTIVE: Nightmares are among the most frequent and disturbing symptoms of posttraumatic stress disorder (PTSD). However, basic research questions regarding key associations between certain nightmare characteristics, especially replicativeness, and posttraumatic psychopathology need further empirical elaboration. METHOD: Sixty-two German soldiers (mean age 33.8 years, 17.7% females) admitted to a hospital-based treatment program for veterans completed extensive assessments consisting of clinical interviews and self-rating measures with respect to sociodemographic characteristics and psychopathology as well as dream-related variables. RESULTS: Although nightmare distress, frequency, and replicativeness were all linked to PTSD symptomatology, only the latter proved to be a significant predictor of PTSD diagnosis. Moreover, none of these nightmare characteristics predicted a depression diagnosis. CONCLUSIONS: The replicativeness of nightmares appears to be a key variable for understanding the relationship between posttraumatic nightmares and PTSD, whereas nightmare frequency and distress appear to be more aptly defined as generic markers of mental health. (PsycINFO Database Record

Altered Pain Perception and Fear-Learning Deficits in Subjects With Posttraumatic Stress Disorder.

There is growing evidence that fear-learning abnormalities are involved in the development of posttraumatic stress disorder (PTSD) and chronic pain. More than 50% of PTSD patients suffer from chronic pain. This study aimed to examine the role of fear-learning deficits in the link between pain perception and PTSD. We included 19 subjects with PTSD and 21 age- and sex-matched healthy control subjects in a fear-conditioning experiment. The conditioned stimulus (CS) consisted of visual signs flashed upon a screen in front of each subject. The unconditioned stimulus was either a low or high temperature impulse delivered through a thermal contact thermode on the subjects' hand. A designation of 'CS-' was assigned to CS always followed by nonpainful low-temperature stimuli; a designation of 'CS+' was given to CS that were randomly followed by either a low or a more painful high temperature. Skin conductance was used as a physiological marker of fear. In healthy control subjects, CS+ induced more fear than CS-, and a low-temperature stimulus induced less subjective pain after CS- than after CS+. PTSD subjects failed to demonstrate such adaptive conditioning. Fear ratings after CS presentation were significantly higher in the PTSD group than in the control group. There were significant interaction effects between group and the type of CS on fear and pain ratings. Fear-learning deficits are a potentially promising, specific psychopathological factor in altered pain perception associated with PTSD. Deficits in safety learning may increase fear and, consequently, pain sensations. These findings may contribute to elucidating the pathogenesis behind the highly prevalent comorbidity that exists between PTSD and pain disorders, and to developing new treatments. PERSPECTIVE: This study provides new insights into the pathogenesis of chronic pain in patients with PTSD. The findings may help to develop new treatment strategies for this highly prevalent comorbidity in PTSD.

Association of Trait Resilience With Peritraumatic and Posttraumatic Stress in Patients With Myocardial Infarction.

OBJECTIVE: Acute myocardial infarction (MI) is a life-threatening condition, leading to immediate fear and distress in many patients. Approximately 18% of patients develop posttraumatic stress disorder in the aftermath of MI. Trait resilience has shown to be a protective factor for the development of posttraumatic stress disorder. However, whether this buffering effect has already an impact on peritraumatic distress and applies to patients with MI is elusive. METHODS: We investigated 98 consecutive patients with acute MI within 48 hours after having reached stable circulatory conditions and 3 months thereafter. Peritraumatic distress was assessed retrospectively with three single-item questions about pain, fear, and helplessness during MI. All patients completed the Posttraumatic Diagnostic Scale (PDS) and the Resilience Scale to self-rate posttraumatic stress and trait resilience. RESULTS: Multivariate models adjusting for sociodemographic and medical factors showed that trait resilience was not associated with peritraumatic distress, but significantly so with posttraumatic stress. Patients with greater trait resilience showed lower PDS scores (b = -0.06, p < .001). There was no significant relationship between peritraumatic distress scores and PDS scores; resilience did not emerge as a moderator of this relationship. CONCLUSIONS: The findings suggest that trait resilience does not buffer the perception of acute MI as stressful per se but may enhance better coping with the traumatic experience in the longer term, thus preventing the development of MI-associated posttraumatic stress. Trait resilience may play an important role in posttraumatic stress symptoms triggered by medical diseases such as acute MI.

Is there a common pathway to developing ASD and PTSD symptoms?

Numerous studies have identified risk factors for acute and long-term posttraumatic stress symptoms following traumatic exposure. However, little is known about whether there are common pathways to the development of acute stress disorder (ASD) and posttraumatic stress disorder (PTSD). Research suggests that a common path to ASD and PTSD may lie in peritraumatic responses and cognitions. The results of structural equation modeling in a national sample of Danish bank robbery victims (N=450) show that peritraumatic panic, anxiety sensitivity, and negative cognitions about self were significant common risk factors for both ASD severity and PTSD severity when controlled for the effect of the other risk factors. The strongest common risk factor was negative cognitions about self. Future research should focus on replicating these results as they point to possible areas of preventive and treatment actions against the development of traumatic stress symptoms.

Psychopathology and resident status - comparing asylum seekers, refugees, illegal migrants, labor migrants, and residents.

PURPOSE: This study aimed to describe, compare, and predict mental health outcomes of different migrant groups and native residents in Switzerland. SUBJECTS AND METHODS: Asylum seekers (n=65); refugees holding permanent protection visas (n=34); illegal migrants (n=21); labor migrants (n=26); and residents (n=56) completed an assessment by questionnaire. Main outcome variables were symptoms of posttraumatic stress, anxiety and depression. It was tested whether resident status predicted psychopathology over and above the influence of control variables including social desirability, traumatic event types and post-migration resources. RESULTS: Asylum seekers (54.0%) and refugees (41.4%) fulfilled criteria of PTSD most frequently. Clinically relevant symptoms of anxiety and depression were most frequently reported by asylum seekers (84.6% and 63.1%, resp.) and illegal migrants (both 47.6%). Resident status contributed to psychopathology over and above the influence of control variables. CONCLUSIONS: Overall, asylum seekers, refugees, and illegal migrants showed high psychiatric morbidity. Differences in resident status appear to be specifically associated with mental health outcomes. This association persists even when controlling for social desirability, post-migration resources and traumatic events. This emphasizes the importance of current socio-political living conditions for mental health, even with respect to the psychopathological sequelae of past traumatic experiences.

Changes in close relationships between cancer patients and their partners.

PURPOSE: Distress caused by cancer may have an important impact on the quality of a couple's relationship. This investigation examined perceived relationship changes in a sample of cancer patients and their partners, accounting for gender and role (i.e., patient or partner). PATIENTS AND METHODS: A total of 209 patients with different cancer types and stages and their partners completed questionnaires with items on psychological distress (anxiety and depression), quality of life, and perceptions regarding positive and negative relationship changes. RESULTS: A total of 149 patients (71.3%) and 156 partners (74.6%) reported that the diagnosis of cancer had changed their relationship. Of these, 121 (57.9%) patients and 116 (55.5%) partners reported positive changes only, whereas eight patients (3.8%) and 18 partners (8.6%) indicated negative changes only. Twenty patients (9.6%) and 22 partners (10.5%) had experienced both positive and negative changes. In male patients and partners, negative dyadic changes were associated with lower quality of life and higher levels of anxiety and depression. This finding was similar in female partners, but not in female patients. The association between perceived negative relationship changes and both increased psychological distress and reduced quality of life remained significant even when controlled for gender and congruency of perception. CONCLUSIONS: Although most couples in our sample reported growing closer while dealing with cancer, a small but sizeable percentage observed negative changes in their relationships, and these negative changes resulted in increased psychological distress and worse quality of life. Female partners were at greatest risk for these negative perceptions.

Predictors of children's sleep onset and maintenance problems after road traffic accidents.

BACKGROUND: Sleep onset and maintenance problems are a frequent complaint after traumatic events in children. However, the association of traumatic experiences and disturbed sleep remains to be explained. OBJECTIVE: To examine the incidence of sleep onset and maintenance problems in children after road traffic accidents and identify potential predictors of sleep onset and maintenance problems, including putative psychopathological mechanisms as well as stressors affecting the family system. METHOD: In 33 children treated for injuries after road traffic accidents, sleep and measures of psychopathology were assessed 10 days, 2 months, and 6 months after hospital admission. The predictive value of four clusters of predictor variables for children's sleep onset and maintenance problems was prospectively tested by multiple regression analyses. These clusters included socio-demographic, injury- and accident-related, and psychopathological variable clusters as well as factors reflecting stressors concerning mothers and family. RESULTS: Children suffering from posttraumatic stress reported a prolonged subjective sleep latency. The severity of sleep onset and maintenance problems was predicted by female sex and the child's as well as mothers' posttraumatic stress disorder (PTSD) severity. CONCLUSIONS: Sleep onset and maintenance problems in children after trauma appear to result from a complex interaction of multiple factors. Our findings support the transactional model of sleep-wake regulation that bears implications for the development of adequate intervention strategies.

Combining biofeedback and Narrative Exposure Therapy for persistent pain and PTSD in refugees: a pilot study.

OBJECTIVE: Many traumatised refugees suffer from both persistent pain and posttraumatic stress disorder (PTSD). To date, no specific guidelines exist for treatment of this group of patients. This paper presents data on a pilot treatment study conducted with 15 traumatised refugees with persistent pain and PTSD. METHODS: Participants received 10 sessions of pain-focused treatment with biofeedback (BF) followed by 10 sessions of Narrative Exposure Therapy (NET). Structured interviews and standardised questionnaires were used to assess symptoms of pain intensity, pain disability, PTSD and quality of life directly before and after treatment and at 3 months follow-up. RESULTS: Following the combined intervention, participants showed a significant reduction in both pain and PTSD symptoms, as well as improved quality of life. Additionally, biofeedback increased motivation for subsequent trauma-focused therapy, which in turn was related to larger PTSD treatment gains. CONCLUSION: This pilot study provides initial evidence that combining BF and NET is safe, acceptable, and feasible in patients with co-morbid persistent pain and PTSD.