Towards an exposure-dependent model of post-traumatic stress

shutterstock_232886320
Imagine sitting at your desk at work, on a Friday afternoon, just waiting for the weekend to begin. Then; a loud bang, the walls are shaking, your office windows shatter. With ears ringing, you crawl out into the corridor. The guy in the office next to yours is hurt. His shirt is covered in blood. You help him down the stairs. There’s smoke and dust everywhere. By the main entrance you pass someone who is beyond help.

Or; you are on summer holiday, relaxing at the family cottage. Suddenly, your husband calls out, telling you to come and watch the news. On the TV you see pictures from the bombed-out office building where you normally spend your workdays. You try to remember; who among your colleagues is on holiday this week? And who is at work, now possibly dead or injured? You immediately call a colleague; all she can tell you is that a bomb has gone off. No one knows what to do next.

On July 22nd 2011, these scenarios sadly became reality when a right-wing extremist triggered a car bomb in the executive government quarters in Oslo, Norway. Several office buildings were severely damaged in the blast. Luckily, as the terror attack happened on a Friday afternoon in July, a lot of people were on holiday or had gone home for the day. Still, 8 people were killed and more than 200 were injured. The Norwegian nation was in shock.

In a new study published in Psychological Medicine, researchers at the Norwegian Centre of Violence and Traumatic Stress have examined patterns of post-traumatic stress reactions (from approx. 10 months to 3 years after the attack) in the government employees who were or were not present at work at the time of this terrible attack. What they found might hold an important key to our understanding of post-traumatic stress disorder.

For government employees who were at work that fateful day, anxiety provoking intrusive memories from the incident seem to be the main driver behind prolonged stress. Together these primary symptoms seem to work as the “psychological engine” behind the development of other common post-traumatic stress reactions, in some cases (24%), creating the complex, heterogeneous post-traumatic stress symptomatology we see in sufferers of post-traumatic stress disorder.

However, for the indirectly exposed employees (those who were on holiday or had gone home) dysphoric arousal (sleeping difficulties, irritability and problems concentrating) emerged as the best predictors of prolonged symptom severity. Although present in their symptomatology, intrusions of that fateful day do not include the same horrific details (e.g. smoke, blood, fire), and therefore do not seem to provoke the same anxious arousal. Instead a sequel of dysphoric arousal and emotional numbing, possibly related to depressive symptoms or negative affect, seem to emerge.

Why is this difference important?

This difference is important because it adds important empirical clues to contemporary theories that help us understand the development and chronicity of post-traumatic stress disorder. And in turn, it sheds light on how to treat sufferers of this debilitating disorder.

The full paper, “Towards an exposure-dependent model of post-traumatic stress: longitudinal course of post-traumatic stress symptomatology and functional impairment after the 2011 Oslo bombing” by Ø. Solberg, M. S. Birkeland, I. Blix, M. B. Hansen and T. Heir can be viewed here free of charge for a limited time

Early screening spots emergency workers at greater risk of mental illness

Ambulance

Study offers new direction for preventative interventions to increase mental resilience to stress and trauma

Emergency services workers who are more likely to suffer episodes of mental ill health later in their careers can be spotted in the first week of training. That’s the conclusion of a Wellcome Trust funded study carried out with trainee paramedics.

Researchers from the University of Oxford and King’s College London wanted to see if they could identify risk factors that made people more likely to suffer post-traumatic stress (PTSD) or major depression (MD) when working in emergency services. Their results are published in the journal Psychological Medicine.

Dr Jennifer Wild from the University of Oxford explained: ‘Emergency workers are regularly exposed to stressful and traumatic situations and some of them will experience periods of mental illness. Some of the factors that make that more likely can be changed through resilience training, reducing the risk of PTSD and depression. We wanted to test whether we could identify such risk factors, making it possible to spot people at higher risk early in their training and to develop interventions that target these risk factors to strengthen their resilience.’

The researchers followed a group of around 400 new ambulance staff through the first two years of their three-year training period. During the initial six-week classroom phase of the training, the students were given a number of assessments to establish their thinking styles, coping behaviour, psychiatric history and personality traits.

Follow up sessions were carried out every four months for the next two years to see if any of the participants had had PTSD or depression. After two years, a final assessment looked at quality of life, as well as smoking, alcohol and drug use, days off work, weight change, burnout and insomnia.

Professor Anke Ehlers said: ‘While just under one in five experienced PTSD or depression in the two years, most got better by the next four-month follow-up.

‘However, there were still lasting effects. Those who had reported mental ill health were more likely to have sleep problems at 2 years. They were also more likely to have days off work. Paramedics who developed an episode of PTSD were also more likely to report gaining weight and smoking.’

The team found that even accounting for past psychiatric history, people were more likely to experience PTSD and depression if they had lower perceived resilience to trauma, or if they dwelled on stressful events from the past before they started their training.   Significantly, the number of traumatic incidents they experienced could not be used to predict PTSD but was relevant to predicting MD, suggesting a cumulative risk of different exposures to trauma for depression.

Dr Wild said: ‘This is not about screening out particular people in training. Early assessment means that those who are more at risk can be offered training to improve their resilience to stressful and traumatic experiences. That has the potential to reduce episodes of PTSD and major depression and improve the long term health of a valued and essential workforce.’

The full paper has been published Open Access in Psychological Medicine, ‘A prospective study of pre-trauma risk factors for post-traumatic stress disorder and depression’ by  J. Wild et al. can be viewed here free of charge.

Source: Early screening spots emergency workers at greater risk of mental illness- University of Oxford/News

A Mental Healthcare Model for Mass Trauma Survivors

Blog post by Metin Basoglu, Professor of Psychiatry, & Ebru Salcioglu, Associate Professor of Psychology and Research Associate, Trauma Studies, Department of Psychological Medicine, Institute of Psychiatry, King’s College London & Istanbul Center for Behavior Research and Therapy (ICBRT / DABATEM), Turkey

Mass trauma events, such as wars, armed conflicts, acts of terror, political violence, torture, and natural disasters affect millions of people around the world. Currently there is no mental healthcare model that is capable of addressing the needs of masses of trauma-exposed people, particularly the dispossessed populations of developing countries that often bear the brunt of mass trauma events. Effective dealing with this problem requires interventions that are (1) theoretically sound, (2) proven to be effective, (3) brief, (4) easy to train therapists in their delivery, (5) practicable in different cultures, and (6) suitable for dissemination through media other than professional therapists, such as lay people, self-help tools, and mass media. Current treatments commonly used with trauma survivors do not meet more than two or three of these requirements. The last requirement is particularly important, as even the most effective treatment is of limited use if it cannot be widely disseminated to millions of people in need of help. Read more of this post

%d bloggers like this: