World Veterans Consider Needs of Children, Families
By William Yule, PhD
Contributing editor, Child Trauma
The World Veterans Federation held its First International Conference on Psycho-social Consequences of War in the beautiful city of Dubrovnik, Croatia in April 1998. The Croatian Patriotic War Veterans Association hosted the meeting under the auspices of the European Society of Traumatic Stress Studies. Prominent among the presenters were many members and board members of ISTSS. More than 350 participants from more than 36 countries listened as Serge Wourgraft, president of the WVF, reminded them of the federation's objective to bring together those who have endured the sufferings of war to work for peace and ensure that the needs of veterans and their families are recognized and met. This note reports on the sessions that specifically considered the needs of children and families.
Robert Pynoos gave a masterly overview of the effects of war on adolescents spelling out the implications of adult adjustment, particularly if traumatic reactions go unattended. Pynoos described his project undertaken jointly with UCLA and UNICEF in Bosnia in which a 16-week intervention is being delivered to adolescents at the highest risk following careful screening of secondary schools.
Zahava Solomon followed by giving an overview of the impact of war stress on the families of veterans. Lessons from Israeli studies point to the need to consider direct and indirect effects of war trauma on veterans as well as their spouses and children. The cross-generational effects also are most keenly manifest among Israeli families.
Three symposia then permitted the presentation and discussion of work conducted mainly in Croatia and Bosnia. Many of the projects had been undertaken in collaboration with academics from the international community, and the influence of UNICEF and Psychosocial Advisor Rune Stuvland was evident. Gordana Kuterovac Jagodic from the University of Zagreb presented the results of a survey undertaken in Croatia which established the high rates of stress reactions among children. Vera Danes, a child psychiatrist from Sarajevo, described the impact of the war on the referrals to the university clinic. Not surprisingly, PTSD, rarely diagnosed pre-war, became a significant part of the university's work. Eva Delale described a project developed by the Society for Psychological Assistance from Zagreb. The organization made imaginative use of a two-week summer camp designed to deal with the traumatic stress presented by children. Participants were sensitive to the need to provide continuing support after the camp so that issues raised could be dealt with afterwards.
A team from the University of London described the large-scale projects based in Mostar and Zenica undertaken in collaboration with UNICEF and authorities in Bosnia. I described the overall framework intended to develop local capacity to meet the mental-health needs of children in a sustainable way. The project involved developing a skills-training package delivered to over 2,500 primary-school teachers. Patrick Smith presented the early results of a survey of 3,000 children in Mostar using a battery of self-completed questionnaires developed with UNICEF. A one-in-10 sample compiled data from mothers and established direct exposure to war traumas as more important than maternal reactions in determining the level of child traumatic-stress reactions. Sean Perrin described the development and delivery of training in Central Bosnia and highlighted problems overcome during the training of 2,600 primary-school teachers. Berima Hacam, a child psychologist from the Centre for Children and Families on Mostar, described how the program developed a community-based, accessible service in which a part-time psychologist and four part-time teachers trained for the project not only followed up the high-risk group identified in the survey but also acquired 130 new cases in 1997, mostly after the international advisors had left for home.
Hedi Fried from the Jewish community in Stockholm addressed the issue of meeting the needs of the children of Holocaust survivors. Elderly survivors shun therapy but can be involved in dialogue support groups with their children which opens communication across the generations.
Ellinor Major from the Psychosocial Centre for Refuges in Oslo presented her findings on a follow-up study of more than 450 Norwegian resistance fighters from World War II. The children of veterans who had been less able to discuss their experiences had more health and mental-health problems, though the majority of concentration-camp survivors coped remarkably well.
A cross-generational presentation by three members of the Gruden family from Zagreb highlighted the particular role and needs of young widows following the loss of their husbands in war. The issue of when and whether to remarry is a poignant and difficult one to negotiate. Nerima Becirevic described the model developed by the Catholic Relief Services in Bosnia to identify and meet the needs of high-risk families in Sarajevo.
Explicit in most of the discussion was the view that if the traumatic reactions of children and adolescents are not satisfactorily resolved, they will continue to display difficulties in interpersonal and intrapersonal adjustments leading in turn to future conflicts. Children become directly traumatized by seeing horrific war-related events and indirectly by its effects on their families. Returning veterans may deal with their own needs at the expense of those of their families and may even inflict abuse on them. Most of the intervention projects had adopted a model of identifying the families or children at the greatest risk and meeting some of their needs by training local counterparts to deliver support and therapy, often at a high level of sophistication. Closing speaker Ofra Ayalon from Israel raised and commented on the theme of the tension between simply providing services and doing so in a way as to gather data to evaluate them scientifically.
Psychosocial interventions are seen as an integral part of any peace and reconciliation process. Certainly, it was most heartening that under the auspices of the WVF, veterans and mental health professionals from countries so recently involved on opposing sides in armed conflict could come together to try to learn the lessons for a peaceful future.
Report on Mid-year Board Meeting
By Sandra Bloom, MD
There has always been a tension in the ISTSS, a tension for the most part creative. The Society originated from the turbulent atmosphere of the 1970s and 1980s social movements and the active advocacy efforts of many founding members. But the credibility of the ISTSS as the foremost authority on evidence-based approaches to the understanding and treatment of posttraumatic stress disorders derives from the careful scientific and clinical efforts of its members. The dialectics between science and practitioner, research and advocacy have always been present, and with the release of Childhood Remembered: A Report on the Current Scientific Knowledge Base and Its Applications, members can see a fine example of the synthesis of the two.
The mid-year board meeting addressed many issues, including a report of the significant progress of the Practice Guideline Committee under the leadership of Edna Foa; the further development of a plan for the distribution of the memory pamphlet and a discussion about the June press briefing organized by Laurie Pearlman; the formation of a Task Force on Multicultural Membership chaired by John Briere; and a NIH restructuring update by Virginia Cain from the Office of Behavioral and Social Science Research.
Within the last 15 years, an explosion of knowledge about the traumatic stress field has occurred and in some areas -- particularly crime victimization -- enormous problems have been acknowledged and funded nationally and internationally. Trauma professionals are confronted with many concerns, some of which represent a backlash against this explosion of knowledge and its implications for the Society. In the managed-care environment that now dominates the practice of medicine and mental-health delivery in the United States, trauma professionals witness the degradation and minimization of service for trauma victims while around the world, human-rights violations continue to fuel the intergenerational transmission of trauma.
Several members pointed out that the forces at work here cannot be understood entirely through rational processes. However, trauma professionals can develop hypotheses about these forces by using examining experiences with patients. For patients exposed to interpersonal or state-supported violence, a dynamic to their victimization hinges on the abuse of power. To the extent that trauma professionals represent them, they too can become victimized by that dynamic -- it is not a neutral scenario.
From Janet through Kardiner to the present, efforts to bring into cultural awareness the reality of trauma have met with denial and suppression and will do so again unless the Society succeeds in establishing a permanent, enduring organization that will survive the expected counterattacks, denial, and repression about knowledge of traumatic stress.
Some members recalled that in the struggle to create and maintain veterans counseling centers, the better we did, the more intense were the attacks. This rang true to those working with victims of childhood abuse. It seems that the more effective intervention strategies have become, the more economically, legally, and socially difficult it has become to provide those interventions. It is helpful to see this struggle in a larger historical context in the hope that a repeat of the past can be avoided.
Along these same lines, other members pointed out the constraints that our professional disciplines and integrity place on our ability to respond to attacks. Often we are not on a level playing field because we must always use information responsibly and treat other people respectfully regardless of how much we disagree with their facts or innuendos.
Among the board members, there existed a general consensus that the Society's strength lies in using the evidence provided by science and clinical practice to fulfill its mission of disseminating information about the effects of trauma. There was also a consensus that publishing scientific findings in academic journals is necessary but not sufficient. To have a more significant impact, trauma professionals must get the information to colleagues as well as the public.
This movement from theory to research to clinical practice to public policy is one that is also consistent with the present emphasis at the NIH of considering the implications and end value even of the basic sciences. This emphasis on getting the word out, for some members, was considered best stated as dissemination of knowledge rather than advocacy while others considered it the best form of advocacy. It was clear that though we may differ on the words we use, we are not beyond reaching a consensus on actual action.
"For me the question isn't to advocate or not, but how we advocate and what will we advocate for ... Part of maturing as an organization is looking beyond at other issues affecting our patients and our members. How can we, in a data-based empirical way, bring our influence to bear in a way that improves peoples' lives?...Even good science must be defended," one member says.
Another member pointed out that in the real world, vital decisions are made based on how a position is presented and who presents it.
"I strongly support advocacy because it is the way society allocates resources and decides what to take seriously. But it should be data and information-based advocacy. If we don't make the case for us, no one else will," the second member says.
It also became clear that we would prefer to be in a proactive rather than a reactive position to issues that affect traumatic stress studies.
"Part of the dissemination process therefore is going to necessitate active debate and we are going to have to actively debate it. People won't just come to the knowledge. You can be moderate, be reasonable, do good science and still get killed," the second member continues.
One of the European members pointed out a difference between the Unites States and some other European countries in that in the United States the clients have no voice, no power. He urged that the Society consider ways to actively involve consumers in efforts to restore mental-health funding. The discussion expanded to the need to develop alliances with similar organizations nationally and internationally to use the influence of size to get the message across. Another board member urged us to consider how we can best develop stories that reflect our knowledge and how to creatively grab the public's attention.
After the round-table discussion, Jeanine Cogan, SPSSI public policy scholar for the American Psychological Association Public Policy Office, discussed how professional organizations can responsibly provide education to public officials and inform public policy. Cogan urged the board members to consider developing relationships with the government through personal visits and Congressional briefings. As a result, the board voted to form a Task Force of Public Policy, chaired by Bessel van der Kolk. The task force will look into the development of a public policy initiative by the ISTSS. As a distinguished researcher and clinician, van der Kolk will provide valuable leadership to this effort.
First Report of Psychological Debriefing Abandoned -- The End of an Era?
By Anna Avery and Roderick
Note: There will be an invited response to this article by Jeffery Mithchell, PhD, in the fall issue of Traumatic StressPoints.
The Lincolnshire Joint
Emergency Services Initiative for Staff at Risk Following Critical Incidents
was established in 1989 with participation from local fire and rescue, police,
ambulance, and health and social services. To complement the priority given
to critical incident stress education and training, a group of staff from emergency
services were trained in the technique of critical incident stress debriefing
as advocated by
Jeffrey Mitchell, president of the International Critical Incident Stress Foundation. The iniative assumed that by intervening at an early stage after a critical incident and convening psychological debriefing meetings for emergency responders, it should be possible to prevent the development of longer term psychological problems.
Research carried out during the mid- and late-1990s casts some doubt on the capacity of the critical incident stress-management service to deliver the anticipated outcomes. As reported in a recent issue of the ESTSS newsletter, a working group was established in Lincolnshire to review published outcome evidence and consider implications for future delivery of staff-support services.
The working group sought to define an evidence-based position with respect to the hotly argued and passionate controversies that characterize the ongoing debate about the status of psychological debriefing. This is not an easy task considering published reports draw data from a broad range of critical incidents of varying degrees of severity using subject populations rarely, if ever, chosen at random or using matched-group methodologies. Timing of interventions, training of debriefers, and differences in populations studied make comparisons across studies fraught with uncertainties.
Briefly summarized, the evidence position holds that though psychological debriefing has strong supporters, is widely used, and generally rated as a helpful procedure, no consistent evidence of its effectiveness as a preventive intervention in terms of post-traumatic morbidity exists. Reviews by Bisson and Deahl (1994) and Raphael, Meldrum, and McFarlane (1995) concluded that factors other than the presence or absence of psychological debriefing in the recovery environment determine outcomes for individuals exposed to traumatic stressors.
On this basis, the working group concluded that though the published evidence is inconclusive, it is extremely imprudent to continue to make claims for psychological debriefing not supported by evidence. Furthermore, the implications of the emergent uncertainties called for a review of critical incident staff-support protocols so that these could reflect the need to appraise unfolding situations with a view to offering flexible options for post-incident response rather than rely on a single prescriptive intervention protocol.
Singled out for particular consideration by the working group were those studies reporting attendance at debriefing meetings to be associated with higher risk of developing adverse psychological reactions and functional impairments than documented for those not debriefed (Bisson, Jenkins, Alexander, and Bannister, 1997; Gersons and Carlier, and Vrijlandt, 1997). One likely implication of these studies suggests that in future personal litigation cases involving emergency services, legal argument will be informed by expert witnesses advocating the existence of circumstances when psychological debriefing is contradicted. At such times, an employer's responsibility under duty-to-care regulations is to ensure psychological debriefing is not sanctioned.
On the basis of evidence gathered from an audit of local debriefing meeting between 1991 and 1995, the working group reached a consensus that only major disasters and life-threatening situations could likely evoke psychological reactions of such intensity and severity as to warrant mobilization of critical incident staff-support services for all responder staff. A more typical scenario shows that critical events carry particular risks for certain individuals but by no means everyone.
The paramount challenge for providers of staff-support services is therefore to identify those most at risk and target help to them. In so doing, the explicit assumption should be that responder staff do have coping strategies and personal strengths that improve prognosis compared to other victim groups subjected to similar stressors. The rationale for the new staff-support response protocol is no longer drawn from crisis intervention theory but, whenever possible, relies on published evidence about risk factors, risk assessment, and a salutogenic perspective on human response to trauma.
In practical terms, the implication for current staff-support services is that help is initially provided for managers and supervisors of responder staff. This ensures that the impact of events is systematically assessed, information in booklet form is disseminated to staff and their families, advise is offered as to who may be most at risk of developing longer term psychological reactions, and a range of staff-support services are considered for their appropriateness at various stages post incident. Incident review and follow-up meetings (IReF-meetings) can be convened but only after it has been established that this is what the responders want and deemed appropriate given prevailing circumstances. At each stage of support provision, the line manager or supervisor and members of a dedicated support team must agree on a action plan which crucially incorporates arrangements for review and closure.
So, a review that started with a recognition that the Lincolnshire Joint Emergency Services Initiative would be well advised to review its debriefing protocol, has culminated in a broad service review of all aspects of staff-support provision. After consulting nationally and internationally on a new response protocol, a decision was formally taken in October 1997 to discontinue use of the critical incident stress debriefing protocol.
The working group takes
the view that future critical incident staff-
support services should be flexibly provided, undergo constant review in light of published evidence, and the manner of delivery a compromise between ideals of methodological rigor and that which is acceptable to service users. For instance, some emergency services view the use of formal questionnaires and rating scales with extreme suspicion. In view of what is now understood about traumatic stress reactions and their course over time, no justification exists for claiming they are consistently prevented by one-off early interventions. This means the rationale for critical incident stress-management services has to be restated, and within the Lincolnshire Joint Emergency Services Initiative therapeutic fervor has been tempered so that the aim we aspire to achieve is to effect an improvement in the quality of the recovery environment. While extremely general in formulation, this aim can be operationalized for research purposes by referring to the now considerable evidence about what constitutes quality in the recovery environment (e.g. extent of hyperarousal, group cohesion, and social support).
Current service arrangements lack the conviction-led certainty that inspired original schemes to provide staff-support services, but evidence-led practice confers on the Lincolnshire Joint Emergency Services Initiative a freedom of practice it did not enjoy while confined by the evangelical orthodoxy sometimes manifest in psychotraumatology.
The Initiative received notification of a three-year grant awarded to evaluate the new service protocol.
Bisson, J., & Deahl, M. (1994). Psychological debriefing and prevention of post-traumatic stress -- More research is needed. British Journal of Psychiatry, 165, 717-720.
Bisson, J., Jenkins, P. L., Alexander, J., & Bannister, C. (1997). Randomized controlled trial of psychological debriefing for victims of acute burn trauma. British Journal of Psychiatry, 171, 78-81.
Gerson, B.P.R., Carlier, I.V.E., & Vrijlandt, I. (1997). Some urgent questions regarding the practice of debriefing on the basis of research findings in Amsterdam. Paper presented at the Fifth European Conference, Maastricht, The Netherlands.
Raphael, B., Meldrum, L., & McFarlane, A. (1995). Does debriefing after psychological trauma work? British Medical Journal, 310, 1479-1480.
The Judge from Down Under
By Frank Ochberg, MD
Contributing editor, Media
Alexander "Sandy" McFarlane, ISTSS president-elect and Adelaide, Australia native, served as a judge for the Dart Award for Excellence in Reporting on Victims of Violence presented in East Lansing, Michigan in June.
After serving on a panel with three professional journalists and one victim advocate, McFarlane felt the experience changed his perspective on dealing with the media. He explained that though his work as an international trauma expert brings him into frequent contact with reporters, his concern for privacy of clients and dignity of victims causes him to speak in generalities, avoiding personal details.
"Now I realize it is precisely those details -- the source of good clinical case histories and the source of good newspaper stories -- that must be told," McFarlane says.
McFarlane's participation in selecting the winner of the $10,000 award brings, for the first time in its five-year history, a cross-cultural dimension to this annual event.
Australian and American media-watchers express concern about yellow journalism, pandering to prurient interests, and blurring the boundary between news and entertainment.
"Rupert Murdoch comes from my home town," notes McFarlane at a dinner for Dart judges.
But Mike Lloyd, editor
of the Grand Rapids Press, observed that readers spend less than 12 minutes
with their daily paper, skip most articles, and skim the rest. A journalist
must attract a reader in the first
column-inch and hold that reader with a compelling story.
To reach the average reader in America or Australia, a reporter must reveal those personal, private details that are at once interesting and educational -- a lesson that Murdoch understands and McFarlane learned in June.
Trauma clinicians who serve as sources for the media can help patients as well as the profession by mastering the art of telling the trauma story while protecting privacy.
The Dart Award was presented to the Pittsburgh Post-Gazette for its series, "Children of the Underground." Outstanding photography and reporting illustrated the secret network that shelters boys and girls who escape from sexual abuse at home.
"By its very nature, this is a story where people want to hide from public view," says Eric Freedman, Dart judge.
All judges agreed that the winning entry allowed victims of violence to tell their stories with dignity, sensitivity, and respect.
For more information visit http://www.journalism.msu.edu/victims.html.
ISTSS Forms New Special Interest Group
The ISTSS has formed a new Special Interest Group on Victims and Media, chaired by Roger Simpson, journalism professor. Contact Simpson via e-mail at: firstname.lastname@example.org
Journalists, journalism students, and media educators are welcome as ISTSS members.
Therapist Self-Disclosure Can Be a Balancing Act
By Deborah Mandell, MA
A trauma group I run recently participated in a ropes course. This was at the request of the group as a means of furthering their ability to connect with each other on a deeper level. Ropes courses are designed to foster team building and group problem solving, and provide for individual challenges and safe risk-taking. My task was to negotiate the balance between therapist and group participant. As I have a fear of heights, I knew that this would be particularly challenging. I felt however that the group was ready to see me as an individual and was ready to explore the dynamics such an experience would generate.
The results were overwhelmingly positive. From the beginning of the day there was a reversal in roles. In most activities, my group members became the leaders, with me experiencing the most difficulties and fear. I was real that day in a way that is not available in the usual therapeutic milieu. I shook with fear, took risks and also chose not to take others. I was able to share the very heart of myself, without needing to share any of the details of my life.
One of the many issues associated with doing trauma work is the question of therapist self-disclosure. I have chosen carefully over the years to disclose something when I think it will be therapeutically helpful. Usually I lean toward minimal disclosure. While I think that this has best served my clients' interests, it has in some situations created a barrier.
A door has opened for the group to explore intimacy on a deeper level. We have a new set of metaphors to describe experiences, and I am now part of them. This is a milestone in the group process, as it lets me into their circle in a way I could never be part of before.
While I expected there to be large shifts in the group after the course, I never imagined the impact on me. The therapist's chair provides a safe haven for choosing to be, or not be, intimate. I realize how protected I am as a therapist. I am embarking on a new journey with this group, one in which I am more intimate and therefore more empathic. Martha Manning (New York Times Book Review, p. 32, Nov. 2, 1997) describes empathy as "a dynamic process, involving two people's ability to express their thoughts and feelings to each other in ways that add, change and, most important continue the relationship." These are goals central to my work.
I believe that when we as therapists can be human, the greatest healing can happen. This can happen when you cry for a client who has never been able to cry for herself. Or it can happen when you walk across a beam forty feet in the air, with your legs shaking so badly that you are sure you can hardly stand.
This article was reprinted from the Winter 1998 issue of Traumatic StressPoints (Vol. 12, No. 1, p. 8) because the author's name was incorrectly listed. Our apologies to the author.
Traumatic StressPoints: Information for Authors
Traumatic StressPoints accepts brief articles (250500 words) on topics related to the study and treatment of traumatic stress related disorders. Topic areas include innovative programs and treatment approaches, assessment/diagnosis, theory on the biological and/or psychological bases of PTSD, policy and legal issues, and other relevant subjects. Articles may deal specifically with particular types of traumatic experiences, including violence, sexual abuse, rape, incest, war, torture & imprisonment, refugees, disasters, emergency service workers, death and bereavement issues, and others.
For deadline information contact Felicia Strong at ISTSS headquarters (847/480-9080 or fax 847/480-9283). Completed articles should be mailed to Felicia Strong, Managing Editor, ISTSS, 60 Revere Drive, Suite 500, Northbrook, IL 60062. Where possible, please include a photograph of the primary author for publication.
If available, a version of the article on floppy disk (in any standard word processing or ASCII text format) should also be included. Articles may also be sent via e-mail to F.Strong@istss.org.
For more information on the suitability of an article for publication, contact Editor Art Blank, MD, at 301/469-8665 or fax 301/469-2470.
Quadrennial Report of U.N. Activities
By Yael Danieli, PhD;
Ellen Frey-Wouters, PhD, LLB
Contributing editors, International Organizations
The U.N. requires nongovernment organizations to submit periodic reports of activities to maintain accredited status. This report was prepared to conform to the required U.N. format, and covers ISTSS activities from 19941997.
Aim and Purpose
The International Society for Traumatic Stress Studies is dedicated to the discovery and dissemination of knowledge and to advancing policy, program, and service initiatives that seek to reduce traumatic stressors as well as their immediate and long-term consequences. Since its inception in 1985, the Society has provided a forum for sharing research, clinical strategies, public policy concerns, and theoretical formulations on trauma around the world through its education and training programs and publications. The ISTSS commitment to the international dimensions of traumatic stress renders its status at and involvement with all relevant aspects of the work of the United Nations an integral part of its mission. From 1993 to the present, the number of countries represented in the Society's membership increased from 29 to 39.
Participation in the ECOSOC and Its Subsidiary Bodies
ISTSS representatives attended the meetings of the Economic and Social Council and its subsidiary organs including, the Commission on Crime Prevention and Criminal Justice, the Commission on Human Rights and the Subcommission on the Prevention of Discrimination and Protection of Minorities (e.g. the Working Group on Indigenous Populations, the Commission on Population and Development, the Commission for Social Development, the Commission on the Status of Women, and the Commission on Sustainable Development).
Oral and Written Statements Made By ISTSS representatives
Attendance at International Conferences
Cooperation with U.N. Programs and Bodies
Other Relevant Activities
Consultations and Cooperation with U.N. Officials
ISTSS consults regularly with officials of the U.N. Secretariat. These include John Langmore, Director, Division for Social Policy and Development; Andrew Joseph, Director, WHO Liaison Office with the U.N., New York; Janet Nelson, Senior Public Affairs Officer, UNICEF; Jane Connors, Chief, Women's Rights Unit, U.N. Division for the Advancement of Women; Akiko Ito, Social Affairs Officer, Division for Social Policy and Development; Hans Corell, the Legal Counsel; Gillian Sorenson, Assistant Secretary-General; Rosario Green, Assistant Secretary-General; Eduardo Vetere, Director, Commission on Crime Prevention and Criminal Justice, Vienna; Elsa Stamatopoulou, Chief, New York Office of the U.N. Centre for Human Rights; Nigel S. Rodley, Special Rapporteur on Torture for the Commission on Human Rights; John Orley, WHO, Geneva; Mary Petevi, UNHCR, Geneva; Phillippe L. Boulle, Department of Humanitarian Affairs, Geneva; Flavio Del Ponte, Department of Peace Keeping Operations; Christine Ainetter Brautigam, U.N. Commission on the Status of Women.
Studies and Articles Regarding the U.N.
An ISTSS representative served as chief editor of the book International Responses to Traumatic Stress: Humanitarian, Human Rights, Justice, Peace and Development Contributions, Collaborative Actions and Future Initiatives (Y. Danieli, N.S. Rodley & L. Weisath, Editors) published in 1996 for and on behalf of the United Nations by Baywood Publishing Company, Inc. The book, with a Foreword contributed by Boutros Boutros-Ghali, Secretary-General of the U.N., was launched 5 December, 1995 at a meeting in the Trusteeship Council Chamber at U.N. Headquarters. The event was hosted by the governments of Norway and the Philippines. Royalties from the book are paid to the UN.
Advertise and Display
StressPoints accepts classified advertising for position openings and positions wanted. Rates are $100 for the first 50 words and $75 for every 50 words thereafter. Payment may be made via check (U.S. funds on U.S. bank) or credit card (Visa, Mastercard). (Display advertising is also available.)
For specifications, rates, and advertising deadline information, contact Managing Editor Felicia Strong at ISTSS headquarters: phone 847/480-9028, fax 847/480-9282 or e-mail F.Strong@istss.org.
By David Lisak, PhD
Contributing editor, Book reviewer
Psychobiology of Posttraumatic Stress Disorder. Edited by R. Yehuda and A.C. McFarlane. Annals of the New York Academy of Sciences, Vol. 821. New York: The New York Academy of Sciences, 1997.
The recent torrent of findings in neuroscience has had an enormous impact on the understanding of psychological trauma. Neurobiological research has begun to uncover the neural mechanisms underlying some of the clinical hallmarks of posttraumatic symptoms and states. This research confirms some long-held perspectives based on clinical research and challenges some others.
Neurobiological research and what it tells us about the phenomena of trauma are important not only to neurobiological researchers but also to trauma researchers and clinicians. This research promises -- and is beginning to deliver -- answers to fundamental questions about the nature of posttraumatic symptoms, its course, and ultimately, new methods for treatment. As the understanding of the neurobiology of posttraumatic symptoms increases, so too will the understanding of how interventions -- psychological and psychopharmacological -- can interrupt those symptom processes. More fundamentally, this new generation of neuroscience research has already upended the old reductionistic assumption that formerly underlay much neurobiological research. The brain not only acts on the environment through its control on mental states and behavior, it also is profoundly altered by its environment.
This book stems directly from a conference of the same title sponsored by the New York Academy of Sciences in September 1996. The book is divided into seven parts. Part 1 covers the epidemiological and empirical basis for studies of the biology of PTSD, including chapters on its prevalence, longitudinal course, and associated comorbid disorders and familial risk factors. Part 2 summarizes the major psychobiological findings in PTSD research. Chapters focus on the sensitization of the hypothalamic-pituitary-adrenal axis, structural brain changes, evidence from neuroimaging studies and psychophysiological reactivity, noradrenergic alterations, and the psychobiology of sleep disturbances in PTSD patients. Part 3 addresses neurodevelopmental issues. Two chapters summarize findings on neurophysiological and neuroanatomical changes associated with chronic childhood abuse, a model of the neurodevelopmental impact of trauma, and a chapter that focuses specifically on the possible mechanisms by which early trauma can induce long-term vulnerability to mood and anxiety disorders. Part 4 tackles the neurobiology of memory impairment in PTSD. Two chapters review, respectively, the performance of PTSD patients on standardized memory tests and content-dependent memory abnormalities in PTSD. Other chapters focus on memory and dissociation, the neurobiology of traumatic memory, hormonal influences on the regulation of memory storage, and a basic chapter on the neural basis of fear conditioning.
Part 5 begins the book's turn toward linking basic neurobiological research to clinical observations of PTSD patients. One chapter provides a detailed review of research on the impact of stress on the structure and function of the hippocampus and its attendant impact on cognitive functioning. Other chapters outline, respectively, the kindling paradigm as an explanatory model of PTSD symptomology, stressor-induced oscillation as a model for the alternation in PTSD between intrusive and avoidant symptoms, and research on the acoustic startle reflex. The section concludes with two overview chapters that summarize animal models that can be applied to PTSD and synthesizes many of the findings presented in earlier chapters.
Part 6 addresses the psychobiology of treatment. The first two chapters summarize, respectively, the findings of studies of drug treatment for chronic and acute PTSD, both addressing the relative inadequacy of available pharmacological treatments. The third chapter summarizes findings on biological markers of PTSD symptomology with the view to designing objective measures of treatment outcome, while the fourth focuses on psychological processes related the recovery from PTSD.
The final section of the book consists of 31 posters presented at the Psychobiology of Posttraumatic Stress Disorder Conference in 1996. The posters detail findings from specific studies on a broad range of topics from cortisol levels in various traumatized groups to electrophysiology and PTSD to MRI assessment of structural abnormalities in PTSD to neurobiological alterations in nonhuman primates.
This volume shares the same limitation inherent in all compendia of research, particularly in such a fast-evolving field: the inevitability of datedness. However, the book provides a mixture of data and synthesis and covers so much material that it is likely to remain a useful reference for some time. In addition to its obvious usefulness to researchers in the field of traumatic stress, the book has much to offer clinicians who wish to understand and integrate into their work the expanding knowledge base on the psychobiology of trauma. Finally, the book would be an excellent addition to the reading list of any advanced graduate-level course in psychological trauma.
Compiled by Arthur S. Blank Jr., MD
Readers who have recently published or have seen a new article on a traumatic stress topic can have it listed here by sending a copy to Art Blank, Jr., MD, 8 Carderock CT., Bethesda, MD 20817. If you have recently authored or seen a relevant book, please send a publisher's brochure or other material describing the book.
The following references were published in 1998, unless otherwise noted.
Addy, Cheryl L., Garrison, C. Z., & Chilappagari, S. (1998). Prevalence of PTSD in a community sample of older adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 37 (2), 147.
Bower, B. (1998). Monkeys provide models of child abuse. Science News, 153 (21), 324.
Bryant, R. A., & Harvey, A. G. (1998). Relationship between acute stress disorder and posttraumatic stress disorder following mild traumatic brain injury. The American Journal of Psychiatry, 155 (5), 625.
Epstein, J. N., Saunders, B. E., & Resnick, H. S. (1998). PTSD as a mediator between childhood rape and alcohol use in adult women. Child Abuse & Neglect, 22 (3), 223.
Ferrada-Noli, M., Asberg, & M., Sundbom, E. (1998). Suicidal behavior after severe trauma, part 1: PTSD diagnoses, psychiatric comordibity, and assessments of suicidal behavior. Journal of Traumatic Stress, 11 (1). 103.
Fontana, A. , & Rosenheck, R. (1998). Effects of compensation seeking on treatment outcomes among Veterans with post-traumatic stress disorder. Journal of Nervous and Mental Disease, 186 (4), 223.
Freed, D., Bowler, R., & Fleming, I. (1998). Post-traumatic stress disorder as a consequence of a toxic spill in Northern California. Journal of Applied Social Psychology, 28 (3), 264.
Frueh, B. C., Brady, K. L., & de Arellano, M. A. (1998). Racial differences in combat-related PTSD: Empirical findings and conceptual issues. Clinical Psychology Review, 18 (3), 287.
Giroux, H. (1998). Innocence lost: Child beauty pageants and the politics of abuse. New Art Examiner, 25 (9), 26.
Graham-Bermann, S. A., & Levendosky, A. A. (1998). Traumatic stress symptoms in children of battered women. Journal of Interpersonal Violence, 13 (1), 111.
Harvey, A. G., & Bryant, R. A. (1998). Predictors of acute stress following mild traumatic brain injury. Brain Injury : BI, 12 (2), 147.
Hickling, E.J., Gillen, R., & Taylor, A. (1998). Traumatic brain injury and posttraumatic stress disorder: A preliminary investigation of neuropsychological test results in PTSD secondary to motor vehicle accidents. Brain Injury : BI, 12 (4), 265.
Holdsworth, L. (Spring 1998). Is it repressed memory with delayed recall or is it false memory syndrome? The controversy and its potential legal implications. Law & Psychology Review, 22, 103.
Kilpatrick, K.L., & Williams, L.M. (1998). Potential mediators of post-traumatic stress disorder in child witnesses to domestic violence. Child Abuse & Neglect, 22 (4), 319.
King, L. A., King, D. W., & Adams, G. A. (1998). Resilience-recovery factors in post-traumatic stress disorder among female and male Vietnam veterans: Hardiness, postwar social support, and additional stressful life events. Journal of Personality and Social Psychology, 74 (2), 420.
Lewis, A. (Winter 1998). Remembering the barbarian: Memory and repression in Monika Maron's animal triste. The German Quarterly, 71 (1), 30.
Lipian, M.S. (1998). Fading reveries: Repressed-memory madness in the UK. The Lancet, 351, 1673.
MacMillan, H.L.(1998). Child abuse: A community problem. Canadian Medical Association Journal, 158 (10), 1301.
Mirza, K. A. H., Bhadrinath, B. R., & Gilmour, C. (1998). Post-traumatic stress disorder in children and adolescents following road traffic accidents. The British Journal of Psychiatry. 172, 443.
Najavits, L. M., Gastfriend, D. R., & Weiss, R. D. (1998). Cocaine dependence with and without PTSD among subjects in the national institute on drug abuse collaborative cocaine treatment study. The American Journal of Psychiatry, 155 (2), 214.
Parson, E. R. (Spring 1998). Traumatic stress personality disorder (TrSPD), Part II: Trauma assessment using the rorschach and self-report tests. Journal of Contemporary Psychotherapy, 28 (1), 45.
Reynolds, M., & Brewin, C. R. (1998). Intrusive cognitions, coping strategies and emotional responses in depression, post-traumatic stress disorder and a non-clinical population. Behaviour Research and Therapy, 36 (2), 135.
Rothschild, B. (1998). Post-traumatic stress disorder: Identification and disorder. Soziale Arbeit Schweiz, 3. [English version available from author.}
Sanchez, K. G. (Winter 1998). Barring the media from the courtroom in child abuse cases: Who should prevail? Buffalo Law Review, 46 (1), 217.
Sauter, J., & Franklin, C. (1998). Assessing Post-Traumatic Stress Disorder in Children: Diagnostic and Measurement Strategies. Research on Social Work Practice, 8 (3), 251.
Shalev, A. Y., Sahar, T., & Pitman, R. K. A prospective study of heart rate response following trauma and the subsequent development of posttraumatic stress disorder. Archives of General Psychiatry, 55 (6), 553.
Shearer, R. A., & Davidhizar, R. E. (1998). Recognizing a post-traumatic stress disorder in a nursing student. Journal of Nursing Education, 37 (5), 222.
Silove, D., Steel, Z., & Mohan, P. (1998). Trauma exposure, postmigration stressors, and symptoms of anxiety, depression and post-traumatic stress in Tamil asylum-seekers: Comparison with refugees and immigrants. Acta Psychiatrica Scandinavica, 97 (3), 175.
Sims, A., & Sims, D. (1998). The PHenomenology of post-traumatic stress disorder. A symptomatic study of 70 victims of psychological trauma. Psychopathology, 31 (2), 96.
Weine, S. M., Vojvoda, D., & Lazrove, S. (1998). PTSD symptoms in Bosnian refugees 1 year after resettlement in the United States. The American Journal of Psychiatry, 155 (4), 562.
Wolfe, J., Sharkansky, E. J., & Ouimette, P. C. (1998). Sexual harassment and assault as predictors of PTSD symptomatology among U.S. female persian gulf war military. Journal of Interpersonal Violence, 13 (1), 40.
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Tedeschi, R.G., Park, C.L., & Calhoun, L.G. (1998). Posttraumatic Growth: Positive Change in the Aftermath of Crisis. Mahwah, NJ: Lawrence Lrlbaum Associates Ltd.
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