Most Effective Posttraumatic Stress Disorder Cure

Phobia Release Program

The curative methods that are described in the 5-Day Phobia Release Course are psychologically proven and are vouched for by many phobic patients, who no longer feel the fear. Each technique is something that you can perform them on your own. Each technique is easy, described in plain, ordinary English and requires no more than a couple of minutes to do. In all, the course contains 9 exercises, organized into 5 days for your convenience. You also receive some background information about Neuro-Linguistic Programming and references for further reading on Nlp if you are interested in learning more.

Phobia Release Program Summary


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Contents: E-book And Audio Course
Author: Jan Heering
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This is one of the best e-books I have read on this field. The writing style was simple and engaging. Content included was worth reading spending my precious time.

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What are the symptoms of a specific phobia

What characterizes specific phobias What differentiates specific phobias from social phobias What is the male to female ratio for specific phobia What is the age of onset of specific phobias What are the most common types of specific phobias What is the most effective psychotherapy for specific phobias What is the pharmacologic treatment of specific phobias What are important differential diagnoses for specific phobias Specific phobias involve fear of specific objections or situations not associated with being scrutinized.

Treatment Of Depression Comorbid With Gad Ocd And Ptsd

In the treatment of comorbidity, the clinician has to choose whether to treat the disorders simultaneously or sequentially. Few guidelines exist for the treatment of comorbidity between depression and GAD, OCD, and PTSD, although it has been suggested that depression should be treated prior to treatment of OCD (Abramowitz, 2004). In addition, results from treatment outcome research suggest that if the primary anxiety disorder is treated, depressive symptoms do improve (i.e., Ehlers et al., 2005). Irrespective of whether the disorders are treated simultaneously or sequentially, it is important to monitor both conditions consistently throughout treatment to gauge the progress of therapy and to reconsider the plan if treatment progress is not optimal. We recommend that whether to treat the disorders concurrently or sequentially be decided on a case-by-case basis, based on the case formulation. For example, if the assessment suggests that the anxiety disorder is primary and of greater...

Mood Disorders Depression Anxiety Posttraumatic Stress Disorder

Depression, anxiety, and posttraumatic stress disorder (PTSD) often coexist and are generally called mood disorders. Thirty percent of people with FM are currently depressed and 60 percent have a lifetime history that includes a depressive episode. There are several subtypes of depression, each having a slightly different clinical presentation and treatment. Generally, depression is diagnosed based on a history of feeling down, sad, blue, hopeless, guilty, anxious, or fatigued. Besides mood changes, there are often changes in eating and sleeping patterns, all of which can interfere with daily life and normal functioning. As PTSD is an extreme anxiety disorder that is disabling and exhibits permanent neurological changes. Although an estimated 50 to 90 percent of people encounter some trauma over their lifetime, only about 8 percent will develop full-blown PTSD. It can either appear after a person encounters a single traumatic event or ongoing terrifying experiences, such as military...

Posttraumatic stress disorder

Post-traumatic stress disorder (PTSD) An emotional condition that often occurs after direct or indirect exposure to a terrifying event in which a child witnessed or actually experienced physical harm. Traumatic events that can cause post-traumatic stress disorder (PTSD) include violent assaults, physical or sexual abuse, shootings, natural disasters, or car accidents. One out of 13 Americans will develop PTSD during their lifetime, which is especially common among girls and women, who are about twice as likely as boys or men to develop PTSD. This may be due to the fact that girls and women tend to experience domestic violence, rape, or abuse more often. Most children with PTSD try to avoid any reminders or thoughts of the trauma, but despite this, they often reexperience the ordeal in intense flashbacks, memories, nightmares, or frightening thoughts. Feelings of guilt from surviving an event in which friends or family died is also often a common feature of PTSD. Any traumatic event...

Case Conceptualization Of Comorbidity Of Gad Ocd And Ptsd

The case conceptualization of comorbidity is crucial in treatment. The approach described in this section is adapted from Persons and Davidson (2001). The case formulation needs to be modified to account for comorbidity between depression and GAD, OCD, or PTSD. For the patient with comorbidity, the problem list likely includes difficulties related to both depression and the anxiety disorder. Some of these problems may result from the depression, the anxiety, or both disorders. The patient's mood, cognitive, behavioral, situational, and interpersonal difficulties need to be described in concrete terms. For GAD, OCD, and PTSD, avoidance may be a particularly prominent problem. Patients with GAD may use worry as a way to avoid more salient emotional topics (Borkovec, 1994), whereas patients with OCD may avoid stimuli that trigger their obsessions and compulsions, and patients with PTSD may avoid situations that trigger their intrusive thoughts related to the traumatic event. Unique...

Assessment Of Comorbidity Of Gad Ocd And Ptsd

Due to the high rate of current co-occurrence between depression and anxiety, it is always important for the clinician to inquire about anxiety disorders when interviewing patients who present for treatment of depression. However, the need to inquire is accentuated when soft signs are present. For example, a patient with a history of abuse would prompt a clinician to inquire about PTSD. A history of unreasonable fears, such as those related to contamination, would indicate the need to screen for OCD. A patient who repeatedly discusses worries regarding the future may prompt the clinician to inquire about GAD. The clinician should also gather a thorough list of the patient's reported anxiety and depressive symptoms. From this list, the clinician can inquire about how the anxiety and depressive symptoms relate to each other, which aids in understanding the patient's situation, to guide choices for the selection of psychotherapy and medication if needed (Belzer & Schneier, 2004). It has...

Modifying Standard CT for Depression and Comorbid Gad Ocd and PTSD

In the case of PTSD, clinicians may need to slow the pace of therapy, because patients may be at risk of dissociation when discussing traumatic events. It will likely be difficult to use cognitive restructuring techniques designed to challenge the content of cognitions (e.g., What is the evidence for a negative event ), because these patients' histories include exposure to a traumatic event thus, they may have real-life evidence to support their cognitive distortions (e.g., a rape victim may believe that all men are dangerous ). When engaging in cognitive restructuring, it is important for the clinician not only to acknowledge the evidence from a traumatic event but also to assist the patient in acknowledging evidence that does not support the cognitive distortions (e.g., It is true that I am the survivor of rape, but there are men in this world who are not dangerous ). Furthermore, it may be more helpful to engage in interventions designed to modify the process of thinking, for...

Posttraumatic Stress Disorder Ptsd And Substance Abuse

Following extreme stresses beyond the realm of normal human experience, symptoms of anxiety including intrusive recollections of the trauma, au-tonomic hyperactivity, and nightmares have long been observed, but PTSD as a psychiatric diagnosis is much newer. Following recognition of this disorder, the link with substance abuse has been the subject of a number of studies. Rates of alcoholism in PTSD range from 40 to 80 percent, while other forms of substance abuse may range from 20 to 50 percent. This high rate of substance abuse has led to the hypothesis that the drug use may be explained by a self-medication theory. Jelinek (1984) has proposed that in the treatment of PTSD, those with substance abuse be divided into groups with abuse that preceded the trauma and those whose abuse followed the trauma. This latter group is considered as a ''self-medication group,'' and in this group treatment of the PTSD is felt to be the primary goal. Following treatment for the PTSD, it is believed...

Specific Phobia

SP is diagnosed when an individual experiences persistent and irrational fear of particular objects or situations and actively avoids contact with such objects or situations. Specific phobia is one of the most common anxiety disorders. In the United States, approximately 11 of people will suffer from SP at some point in their lives (Kessler et al., 1994). Four subtypes are specified including animal, natural environment, situ-ational, and blood-injection-injury types. Ample evidence exists that behavioral approaches, including direct exposure to the phobic stimuli, is the preferred treatment method for a wide variety of SPs (e.g., Marks, 1988 Page, 1994 Ost, 1996 Ost, Brandberg, & Alm 1997 Ost, Hellstrom, & Kaver, 1992). In behavioral therapy, individuals are instructed to gradually expose themselves to feared objects or situations. Often, cognitive components, which are designed to help individuals challenge irrational fears associated with phobic objects or situations, are...

Molecular Theory of Disease

Damage to the blood-brain barrier (BBB) as a result of trauma or disease permits hormones (molecules), such as epinephrine, or toxic substances to reach the brain. Normally, the BBB keeps the contents within blood vessels from reaching the brain. Closely packed endothelial cells line blood vessels. The endothelial cell membrane has transport systems that facilitate the movement of desired molecules and nutrients into the brain, while keeping undesirable molecules out. Damage to the BBB from trauma may be involved in posttraumatic stress disorder.

Obsessive Compulsive Disorder

Post-Traumatic Stress Disorder Children who experience a physical or emotional trauma, such as witnessing a shooting, surviving physical or sexual abuse, or being in a car accident, may develop post-traumatic stress disorder (PTSD). Children are more easily traumatized than adults An event that may not be traumatic to an adult might be to a child, such as a turbulent plane ride. As a result of the trauma, a child may reexperi-ence the event through nightmares, constant thoughts about what happened, or by reenacting the event while playing. A child with PTSD will experience symptoms of general anxiety, including trouble sleeping and eating or being irritable. Many children may exhibit other physical symptoms as well, such as being easily startled.

Psychosocial Concerns

Cancer survivors with preexisting anxiety or affective disorders appear to be at greatest risk for ongoing distress.25 Changes to body image from cancer therapy, such as that resulting from mastectomy or colostomy, can be a source of problems with psychological adjustment.72 Distress appears to dissipate with time, however. There are a small proportion of patients who experience ongoing effects characteristic of posttraumatic stress disorder.73 Having a spouse or partner decreases the risk of psychological sequelae,74 although these caregivers may also themselves be adversely

QOL in Long Term Survivors of Breast Cancer

Eleven of the 16 studies discussed psychological domain QOL outcomes for long-term survivors.4,32,41,44,45,47-51,53 Although survivors and controls tend to report similar QOL in most psychological domains,4 studies report significant psychological concerns among breast cancer survivors including depression and symptoms of Posttraumatic Stress Disorder.32,41,50,53 Survivors report being overly stressed and worried about the future, and having little control over Posttraumatic Stress Disorder (PTSD) Posttraumatic Stress Disorder Checklist-Civilian Conditioned Nausea and Vomiting MOS Social Support Survey

Alisa R Singer Keith S Dobson David J A Dozois

Generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), and posttraumatic stress disorder (PTSD) are challenging to treat, especially when these disorders are comorbid with depression. Consequently, clinicians must be familiar with a number of issues specific to each disorder and their comorbid condition, including epidemiological considerations, assessment strategies, case conceptualization, and intervention techniques. In this chapter, we present the challenges of treating patients with these complex conditions and highlight strategies for overcoming barriers. A case example illustrates the various points made throughout this chapter.

Clinical and Epidemiological Studies

Epidemiological and clinical studies support a strong association between depression and GAD, OCD, and PTSD. The National Comorbidity Survey (NCS) demonstrated that 58 of primarily depressed patients also experienced an anxiety disorder, estimating the rate of comorbidity between depression and GAD to be 17.2 (Kessler et al., 1996). The NCS found that of those individuals with a primary diagnosis of current GAD, 39 had current major depression and 22 had current dysthymia (Judd et al., 1998). Studies also suggest comorbidity rates of 21-54 between depression and OCD (Abramowitz, 2004). Epidemiological and clinical studies also indicate that up to 56 of individuals have concurrent PTSD and depression, and that as many as 95 of individuals with PTSD have a lifetime history of major depression (Bleich, Koslowsky, Dolev, & Lerer, 1997). In clinical studies, an association between depression and anxiety is also supported. Brown and Barlow (1992), for example, found that 55 of patients with...

Behavioral Interventions

To address behavioral avoidance, the addition of exposure interventions may be especially helpful. For example, in the case of PTSD, patients have difficulty retrieving a complete memory of the trauma, although they involuntarily experience recurrent thoughts and images of the event in a very vivid and emotional way. PTSD is believed to arise because of the poor elaboration and incorporation of the memory of the trauma into autobiographical memory, leading to poor voluntary recall and cueing of intrusions by stimuli that may be temporarily associated with the trauma thus, one target of PTSD treatment is the patient's systematic exposure to the memory of the event through recall with a therapist (Ehlers & Clark, 2000). In vivo exposure is also used to target avoidance of the current life triggers of PTSD symptoms (Ehlers & Clark, 2000) and to obtain data to disconfirm the misappraisals.

Case Illustration Referral Route and Presenting Problems

Mary, a 45-year-old, unemployed European American woman, was referred to an outpatient service by her psychiatrist for CT for depression. At the time of the initial assessment, Mary tended to make vague statements that lacked emotional details, although she appeared visibly upset and tearful. She reported feeling depressed and hopeless for the last 3 years. She requested therapy for her depression. Based on the results from a SCID-I interview, Mary met MDD criteria (depressed mood, lack of motivation, appetite disturbance, difficulty concentrating, and feelings of worthlessness). She denied having suicidal ideation. She also met the criteria for PTSD (e.g., recurrent thoughts, avoidance of thoughts and people, diminished range of affect, irritability, and sleep disturbance) in response to a hostage taking that had taken place 3 years earlier. Her score on the PTSD Checklist (PCL Weathers, Litz, Huska, & Keane, 1991) indicated that she met the criteria for PTSD. A score of 33 on the...

Emotional or Internalizing Disorders

Anxiety disorders in children are most likely to fall into the DSM-IV diagnostic categories of generalized anxiety disorder, simple phobia, separation anxiety disorder, obsessive-compulsive disorder, or posttraumatic stress disorder. Children diagnosed with generalized anxiety disorder have a consistent pattern, lasting six months or more, of uncontrollable and excessive anxiety or worry, with the concerns covering a broad range of events or activities. In addition to worry, symptoms include irritability, restlessness, fatigue, difficulty in concentrating, muscle tension, and sleep disturbances. Deborah Beidel found that this disorder commonly begins at around age ten, is persistent, frequently co-occurs with depression, and is often accompanied by a number of physical symptoms such as sweating, suffering from chills, feeling faint, and having a racing pulse. (abnormal thoughts, images, or impulses) or compulsions (repetitive acts). Posttraumatic stress disorder symptoms develop in...

Onset Make a Difference

Although clinical lore has long attributed bipolar symptoms in children to trauma, there have been few systematic studies of this issue. Kessler et a reported elevated rates of BD among adults and adolescents with post-traumatic stress disorder (PTSD) 34 and Helzer et a 35 found high rates of BD among adults with PTSD. Neither of these studies determined if the BD was primary or secondary to the trauma. In a longitudinal study, Wozniak et a 36 identified pediatric BD as an important antecedent for, rather than consequence of, traumatic life events. Although these findings need independent replication, they suggest that clinicians treating traumatized children should not dismiss severe irritability and mood lability as consequences of the trauma. These may indicate an underlying BD, and thus have implications for treatment.

Patients With Severe Trauma

Many patients with depression have a history of trauma, and some have a history of more severe abuse or neglect. They may develop an independent posttraumatic stress disorder, or the depressive symptoms may overlap with symptoms of that disorder. These patients may find it particularly painful and disruptive to explore their traumatic episodes and may at times experience therapy as more disruptive than helpful. Therapists must use patience, empathy, and tact in exploring the trauma over what may be a period of months or years. They must also be alert to countertrans-ference wishes to avoid the painful material.

The Mediational Role of Maternal Functioning

As compared to school-age children, the maternal role may be more salient during the preschool years because of fewer competing socialization influences, e.g. teachers and peers therefore we focused on the role of maternal functioning as a crucial mediator in the linkage between exposure to community violence and child problems (Linares, Heeren, Bronfman, Zuckerman, Augustyn, & Tronick, 2001). There is substantial evidence from the developmental and family relations literature that mothers' own histories of interpersonal victimization (e.g., community or intra-family violence) are associated with global, and stress-specific symptoms of psychological distress. For example, victimized women (mothers) suffer from poor physical health (Koss, Woodruff, & Koss, 1990), increased distress, and show a higher risk for PTSD symptoms, as compared with nonvictimized women (Breslau, Glenn, Davis, Andreski, & Peterson, 1991 North, Smith, & Spitz-Nagel, 1994 Zlotnick, Warshaw, Shea, & Keller, 1997)....

Assuming That the Problem Is Everyone Elses Fault

There are several problems with this belief. First, everyone else can't be nice to you all the time. Secondly, even if they could be, fibromyalgia is caused by a problem from within your body. Sure, stress can make it worse. (Read Chapter 13 for more on stress.) But, with the exception of post-traumatic stress disorder (PTSD see Chapter 3), caused by an extreme emotional crisis, everyday stress doesn't cause FMS in the first place. So if you're making the mistake of blaming everyone else for your symptomatic flare-ups, stop it right now. Instead, work with your doctor to create a plan to improve your situation.

Selfhumor And Gallows Humor

Group psychotherapy has been regarded as the most effective intervention in the treatment of Vietnam veterans with post-traumatic stress disorder, (PTSD) (Brende, 1981 Walter & Nash, 1981 Roller, Marmar, & Kanas, 1992 Howard 2000). It has been proposed by Howard (2000) and other theorists that one of the central tenets of trauma theory is the need for getting in touch with the feelings associated with the traumatic memories. Once the feelings have been accessed, then words need to be found in order to work through the trauma (Herman 1992 Parson, 1993 Goodwin & Weiss, 1998 Howard, 2000).

Alison E Field and Kendrin R Sonneville

Few studies have studied the association between stress and the development of binge eating. In a cross sectional study of African American and Caucasian young adult women, recalled trauma and stress were significantly related to binge eating (Harrington et al. 2006). In addition, among 5692 adults in the National Comorbidity Survey-Replication Study, 3.5 per cent of the women and 2.0 per cent of the men reported a lifetime history of BED. Approximately 90 per cent of women and 98 per cent of men with a lifetime history of BED reported past trauma and 26 per cent of the women and 24 per cent of the men reported a lifetime history of PTSD (Mitchell et al. 2012). However, due to the study design the temporal relationship between stress and binge eating is not entirely clear. Mitchell, K. S., Mazzeo, S. E., Schlesinger, M. R., Brewerton, T. D., and Smith, B. N. (2012) Comorbidity of partial and subthreshold ptsd among men and women with eating disorders in the national comorbidity...

Michael J Devlin Stephen A Wonderlich B Timothy Walsh and James E Mitchell

Plugging after bariatric surgery 184 positive body-related activities 85, 86 post-traumatic stress disorder (PTSD) 56, 57, 60, 93, 222 Post Traumatic Stress Disorder Reaction Index (UCLA-PTSD RI) 57 prevention of BED information on genetics used for 37 programs for 222-4 and risk factors for BED 218-22 problem-solving therapy 199 Project EAT 221 UCLA PTSD Reaction Index 57 Uganda 156

How the Arteries Are Damaged by Hostile Type A Behavior

Arteries That Feed The Heart Muscle

This chapter focused on the part of personality psychology related to physical adjustment and health. It began with several models of the personality and illness link. It then examined the concept of stress as the subjective reaction to extreme events, which often involve conflicting feelings, and over which one has little or no control The stress response comes in four distinct varieties acute, episodic acute, chronic, and traumatic. Traumatic stress can evolve into a disorder , called posttraumatic stress disorder, in which the person experiences nightmares or flashbacks, di ficulties sleepin Daily Hassles 597 Acute Stress 598 Episodic Acute Stress 598 Traumatic Stress 598 Posttraumatic Stress Disorder (PTSD) 599 Chronic Stress 599 Additive Effects 599 Primary Appraisal 599 Secondary Appraisal 599 Positive Reappraisal 602 Problem-Focused Coping 602 Creating Positive Events 603 Dispositional Optimism 603

Stimulants eg Amphetamines Sedatives eg Barbiturates prescribed drugs eg Tranquilizers Cocaine Heroin other Opiates

In 1994, the American Psychiatric Association released the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). This version is applicable to both children and adults, which has made it an integral part of school and child psychology, especially when dealing with attention deficit hyperactivity disorder (ADHD). The DSM-IV functions as a way of organizing and recognizing cognitive and personality disorders, as well as addictive and disruptive behaviors. The DSM-IV was also used in the late 1990s (in conjunction with part of the DIS) to help determine substance abuse treatment needs for prisoners and to screen veterans for post-traumatic stress disorder (PTSD). Breslau, N., ET AL. (1999). Short screening scale for DSM-IV posttraumatic stress disorder. American Journal of Psychiatry, 156, 908. Eaton, W. W., ET AL. (2000). A Comparison of Self-Report and Clinical Diagnostic Interviews for Depression Diagnostic Interview Schedule and Schedules for Clinical...

L Oriana Linares Nicole A Morin

Based on the community violence studies of the early 1990s, between 44-82 of school-aged children and youth are exposed to community violence, depending on definitional criteria, methodology, and sample characteristics (Overstreet, 2000 Stein, Jaycox, Kataoka, Rhodes, & Vestal, 2003). According to the early studies, by the end of elementary school, almost all children residing in high crime innercity areas of Washington and New Orleans had heard (98 ) or witnessed (90 ) moderate to severe levels of violent occurrences (Richters & Martinez, 1993 Osofsky, Wewers, Hann, & Fick, 1993). School-aged children exposed to community violence are at risk for an array of problematic behavior including lower self-competence (Farver, Ghosh, & Garcia, 2000), high levels of distress (Martinez & Richters, 1993), depression (Durant, Getts, Cadenhead, Emans, & Woods, 1995), post-traumatic stress disorder (Fitzpatrick & Boldizar, 1993 Jaycox, Stein, Kataoka, Wong, Fink, Escudero, & Zaragoza, 2002),...

Phobic Anxiety On The Auricle

Among anxiety disorders, panic attacks with or without agoraphobia are frequent and auricular diagnosis may confirm the existence of or the tendency to develop this mental disorder. There are certain areas that remain tender to pressure even several weeks after a single panic attack it is possible, however, that such tenderness may reflect the patient's concern about further attacks (on the left of Fig. 5.21). Another possibility regarding this area may be associated with specific phobias brought

Regarding Gulf War Syndrome

Female veterans and PTSD A survey of 1,259 female veterans who received care at a veterans' facility in Puget Sound, Washington, was reported in Archives of Internal Medicine in 2004. The researchers found that 21 percent of the women (266 women) were positive for PTSD. The women with PTSD were significantly more likely to have fibromyalgia, irritable bowel syndrome, chronic pelvic pain, premenstrual syndrome, obesity, and other health problems than were the female veterans without PTSD. For example, of the female veterans with PTSD, 19.2 percent had fibromyalgia, compared to 8 percent of the women veterans without PTSD. Clearly, PTSD is a risk factor for fibromyalgia. Some researchers have speculated that the military people who served in the Gulf during the war may have contracted a viral or bacterial infection that could have led to their symptoms, perhaps one that was further aggravated by the heightened stress of undergoing warfare in another country. Others think that the severe...


McNally, R., Bryant R. & Ehlers, A. (2003). Does early psychological intervention promote recovery from posttraumatic stress Psychological Science in the Public Interest, 4, 45-47. Mitchell, T. & Everly, G. (2001). Critical Incident Stress Debriefing An Operations Manual for CISD, Defusing and Other Group Crisis Intervention Services. New York Chevron Publishing Corp. National Institute for Health & Clinical Excellence. (2005). Clinical Guideline 26-Posttraumatic Stress Disorder. NICE Guidelines London Royal College of Psychiatrists Leicester British Psychological Society. Orner, R King, S Avery, A., Bretherton, R Stolz, P. & Omerond, J. (2003). Coping and adjustment strategies used by emergency staff after traumatic incidents. The Australasian Journal of Disaster and Trauma Studies, 1. Rutter, M. (2007). From sympathy to empathy-organizations learn to respond to trauma. Journal of Counselling at Work, (55), 9-11. U.S. National Child Traumatic Stress Network & National Centre for...

Conclusion And Contraindications

International Journal of Group Psychotherapy, 31 367-378. Goodwin, M. &.Weiss, D. (1998). Double trauma A group therapy approach for Vietnam veterans suffering from war and childhood trauma. International Journal of Group Psychotherapy, 48 39-53. Herman, J.L. (1992). Trauma and recovery. New York Basic Books. Howard, S. (2000). Measuring Outcomes in a PTSD Day Program for Vietnam Veterans. Unpublished Dissertation, as Section 11 of the examination for Fellowship of The Royal Australian and New Zealand College of Psychiatrists. Australia. Roller, P., Marmar, C.R. & Kanas, N. (1992). Psychodynamic group treatment of post traumatic stress disorder in Vietnam veterans. International Journal of Group Psychotherapy, 42 225-246. Ostrower, C. (2000). Humor As a Defense Mechanism in the Holocaust. Unpublished Doctoral Dissertation, Tel-Aviv University, Israel. Parson, E.R. (1993). Posttraumatic narcissism. Healing traumatic alterations in the self through curvilinear group psychotherapy. In...

Characteristics of Neighborhoods and Schools that Impact the Mental Health and Risk Behavior of Children and Youth

Positive Affirmations Youth

One of the most important characteristics of violence exposure for child and youth development is its chronicity children in violent schools or in violent neighborhoods are often exposed to multiple repeated violent or even traumatic events. Thus, violence becomes something that children assimilate This has indeed been found relative to the events of September 11th, 2001. In our study of New York City adolescents, exposure to the single-event of the terrorist attacks had relatively few effects on their mental health and behavior problems up to 2 years later relative to their exposure to community violence. Specifically, media exposure to the event was associated with heightened symptoms of post-traumatic stress, direct exposure to the event (e.g., seeing the planes hit, the towers fall, or smelling smoke) was associated with increased social mistrust, and having a family member at, injured in, or killed in the World Trade Center was associated with increased social mistrust (Aber,...

Reward Deficiency Syndrome

Individuals tend to be at risk of multiple addictive, impulsive and compulsive behavioural problems, such as severe alcoholism, cocaine, heroin, marijuana and nicotine addiction, pathological gambling, sex addiction, chronic violence, posttraumatic stress disorder, risk taking behaviours and antisocial behaviour. As such, the use of tyrosine as a precursor to dopamine has a theoretical basis for use in this condition (Blum etal 2000).

HOME and Socio Emotional Development

Studies show that scores on HOME reflect many factors in addition to parental social status (Bradley & Caldwell, 1978), including parental personality (Allen, Affleck, McQueeney, & McGrade, 1982 Bergerson, 1989 Fein et al., 1993 Pederson et al., 1988 Reis, Barbera-Stein, & Bennett, 1986), parental substance abuse (Fried, O'Connell, & Watkinson, 1992 Noll et al., 1989 Ragozin et al., 1978), parental IQ (Longstreth et al., 1981 Plomin & Bergeman, 1991), family structure (Bradley et al., 1982, 1984), parental knowledge about child development and attitudes toward child rearing (Reis et al., 1986), social support (Bradley et al., 1987, 1989 Wandersman & Unger, 1983), psychosocial climate of the home (Bradley et al., 1987 Gottfried & Gottfried, 1984 Nihira, Mink, & Meyers, 1981 Wandersman & Unger, 1983), presence of traumatic events (Bradley et al., 1987), and a variety of other community and cultural factors. Ragozin, Landesman-Dwyer, & Streissguth (1980) also observed a birth order...

Stressrelated disorders

Alterations in CRF activity have been described in a range of neuroendocrine, neurological and psychiatric disorders, including major depressive disorder, post-traumatic stress disorder (PTSD), schizophrenia, and dementia. In depression, an increased number of CRF-immunoreactive neurones has been reported at the level of the PVN (Raadsheer et al, 1994) and in situ hybridization revealed markedly elevated CRF mRNA levels in the PVN of depressed patients (Raadsheer et al, 1995). An increased CRF-like immunoreactivity has been documented in the Moreover, a substantial number of animal data point to an important role of CRF in the mediation of anxiety and the regulation of food intake (Steckler and Holsboer, 1999). Clinically, an abnormal response in the combined dexamethasone CRF test can be seen in panic disorder (Schreiber et al, 1996). In PTSD, the CRF system is also hyperactive (Bremner et al, 1997 Baker et al, 1999 Kasckow et al, 2001). In this respect it is interesting to note that...

Trisha M Karr Heather Simonich and Stephen A Wonderlich

Childhood physical abuse is the second most common form of child maltreatment and legal definitions vary from state to state, but broadly defined CPA is any physical act by a caregiver that results in a child being injured. CPA is the only type of abuse reported more often by males than females (30 per cent vs. 20 per cent, respectively) in the general population (MacMillan et al. 1997). CPA has been linked to a variety of negative mental health outcomes in adulthood, such as post-traumatic stress disorder (PTSD), aggressive behavior, substance dependence, depression, poor communication skills, and lack of empathy toward others (Gershoff 2008). Importantly, childhood physical abuse is also associated with violent or criminal behavior as well as abusive behaviors in intimate relationships (Grogan-Kaylor 2004). It is crucial to consider the effects of experiencing multiple forms of child maltreatment given that many children who experience one type of maltreatment will also be exposed...

The Effect of Comorbidity on the Process and Outcome of Cognitive Therapy

Most of the literature regarding cognitive therapy (CT) of GAD, OCD, and PTSD describes treatments in which the disorders are considered in isolation. Most well-controlled, randomized clinical trials have focused on pure cases of anxiety or depression and have shown promising outcomes in the treatment of these conditions (Chambless & Ollendick, 2001). Yet the samples utilized in the empirically supported treatment literature include few (if any) participants who have comorbid depression and anxiety (e.g., Ladouceur et al., 2000). that nontargeted depressive symptoms improve as a result oftreatment aimed at GAD and PTSD. Meta-analytic data indicate that depressive symptoms also improve with CT aimed at treating GAD (cf. Chambless & Gillis, 1993). In addition, depressive symptoms appear to improve following CT for PTSD (Ehlers, Clark, Hackmann, McManus, & Fennell, 2005).

Treatment of Social Phobia in Individuals with Depression

Clinical trials examining the impact of comorbid depression on the treatment of social phobia have produced equivocal results. Van Velzen, Emmelkamp, and Scholing (1997) found that comorbid anxiety or depression did not affect treatment outcome of exposure treatment for social phobia. Their comprised sample 18 patients with social phobia, with either comorbid anxiety or depression, compared to 43 individuals without these comorbidities. Likewise, Turner, Beidel, Wolff, Spaulding, and Jacob (1996) found no differences in treatment outcomes for social phobia treatment In contrast to these studies, the negative impact of depression on social phobia treatment outcome was shown in studies by Chambless, Tran, and Glass (1997) and Scholing and Emmelkamp (1999). Chambless et al. (1997) examined the prognostic value ofpretreatment depression, as well as personality disorder traits, patients' expectations of treatment, clinician-rated breadth and severity of impairment, and frequency of...

Israel Liberzon1 Samir Khan2 and Elizabeth A Young3

Abstract Posttraumatic stress disorder (PTSD) is a potential consequence of being exposed to or witnessing an event provoking fear, helplessness, or horror. It is characterized by several debilitating symptoms including persistent hyperarousal, unwanted memories and thought intrusions, and hyperavoidance of stimuli or situations associated with the original trauma. The neurobiological mediators of these symptoms, however, still require elucidation, and animal models are particularly well suited for investigation of these mechanisms. Although the behavioral literature contains a large number of models that involve exposing animals to intense stressors, only a few of these are able to reproduce the biological and behavioral features of PTSD characteristic of a pathophysiological stress response. Among these are models involving single episodes of inescapable shock, which produce several bio-behavioral effects characteristic of PTSD, including opioid-mediated analgesia, noradrenergic...

The Ethics of Good Intentions

The key lesson learned from early research on self-help therapies, that good intentions do not assure effective therapies, continues to be demonstrated. Ehlers and colleagues randomly assigned motor vehicle accident survivors diagnosed with posttraumatic stress disorder to receive therapist-administered cognitive therapy, a self-help booklet, or repeated assessments (Ehlers et al., 2003). While cognitive therapy was demonstrated to be effective, the self-help booklet was not superior to simple repeated assessments. Of greater concern, outcome for the self-help group was actually worse than for repeated assessments on two measures. Findings on the ill-advisability of conducting critical incident debriefings with trauma victims came as a surprise to many. Like self-help instructional materials, the concept of early intervention in the aftermath of trauma was based on the best of intentions. Research had demonstrated that the majority of people are resilient after trauma, but a...

Effectiveness of Self Help Treatments

In the last three decades, over 60 SH studies, including 43 randomized controlled studies and 11 field trials, have examined the effectiveness of various forms of SH interventions for anxiety disorders and fear-related problems. This chapter focuses on SH programs that utilized books, tapes, or computer Internet-based materials and that were the primary treatment employed. Studies that targeted diagnosable anxiety disorders and sub-clinical levels of anxiety were examined. Targeted disorders included panic disorder (PD), specific phobia (SP), social phobia (SoP), generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), posttraumatic stress disorder (PTSD), and subclinical problems such as test anxiety and interpersonal anxiety.

Food stress and reward

These stress-induced changes (ie, allostatic load) are not without consequences. MRI has shown that stress-related disorders such as recurrent depressive illness or posttraumatic stress disorder are associated with atrophy of the hippocampus 92,93 . Impairment of the hippocampus decreases the reliability and accuracy of contextual memories. This decrement may exacerbate stress by preventing access to the information needed to decide that a situation is not an emotional or physical threat. Also, the suppression of routine sensory input from the body that normally occurs might, under these circumstances, be felt as discomfort or pain. There is evidence that an-tidepressants can reverse these changes 94 .

Intervention Guidelines

SIT is a flexible and individually tailored alliance-based intervention used with individuals, couples, and groups. Sessions are as short as twenty minutes and range in frequency from eight to forty sessions. SIT has been utilized successfully to prepare patients undergoing medical procedures (Meichenbaum, 2005) and with patients suffering from anxiety (Suinn, 1990), stress disorders, addictions (Meichenbaum, 2005), and anger control problems (Deffenbacher & McKay, 2000). The Joint Department of Defense and Veteran's Administration Clinical Practice Guidelines (2003) designates SIT as a Class A treatment for post-traumatic stress disorder (PTSD). Additionally, Meichenbaum (1993) found SIT to be useful for individuals adjusting to the military.

Defining anxiety disorders

Post-traumatic stress disorder According to the NIMH, about 7.7 million American adults suffer from post-traumatic stress disorder (PTSD). Individuals with PTSD may periodically relive former traumatic experiences, such as combat, sexual assaults, childhood abuse, or other events. They may also become emotionally empty. PTSD increases the risk for fibromyalgia. In a study of 1,259 female military veterans with and without PTSD (reported in Archives of Internal Medicine in 2004), the 266 female vets with PTSD had a greater rate of fibromyalgia (19.2 percent) than female vets without PTSD (8 percent).

Treatment Interventions and Outcome

Mary completed 14 cognitive-behavioral therapy sessions. In the first treatment session, the clinician provided feedback in a collaborative manner regarding the assessment and diagnostic findings. Mary agreed with the conceptualization, and she and her clinician discussed her goals for therapy. Mary reported that her main objective was to be less depressed. The clinician suggested that therapy begin with an increase in Mary's social involvements and pleasurable activities. A schedule of pleasurable activities was generated, which included walking her dog, going to the store, and making phone calls to friends. Mary was reluctant, because socialization triggered PTSD symptoms, but she was hopeful about the potential benefits. Her homework was to keep a daily record of her activities and to monitor her mood and anxiety three times per day. By the third session, it became clear that the treatment of Mary's depression was affected by her PTSD symptoms. She had attempted to go to public...

Prevalence of Psychiatric Disorders

In a more recent study, among a sample of adults diagnosed with first onset head and neck or lung malignancies, the 12-month incidence of posttraumatic stress disorder was found to be 14 , 20 for other anxiety disorders, and 20 for depressive disorders.7 Okamura et al. found that among a sample of women who experienced a first recurrence of breast cancer, 42 met diagnostic criteria for major depressive or adjustment disorder.8

Longterm reactions

If the death or loss happened suddenly, unexpectedly or in a particularly traumatic way, the event can potentially influence different aspects of the child's development. It is well known that traumatic events of this nature can alter a child's character and the shaping of their personality, their readiness to meet the future (reduced belief in the future), their ability to regulate strong feelings, their choice of career and their relationships with others (fear of losing those who are dear to them). As long as the children have caring adults and good care, there is little reason to expect that they will grow up with a greater risk of developing long-term psychological problems. It should be noted, however, that there is an increased risk of developing depression in children who lose parents in childhood. Small children are protected by their lack of ability to see the long-term consequences ofa traumatic situation, and they understand danger to a lesser degree. As long as parents...

The Psychiatrist

A psychiatrist or other mental health provider such as a psychiatric mental health nurse practitioner (PMHNP), medical social worker, or psychologist can be helpful with co-morbid mood disorders that do not respond to the standard therapies used in primary care. Unipolar disorder (depression without mood swings), anxiety disorder, and posttraumatic stress disorder (PTSD, an anxiety disorder that develops after exposure to an ordeal) are more common in FM than the general population. There is additional evidence that a mild form of bipolar disorder (mood swings that move from depression to exaggerated happiness) may also be overrepresented in FM. Any of the psychiatric providers mentioned earlier can diagnose these conditions and provide cognitive behavioral therapies and other counseling strategies to improve symptoms. Additionally, a psychiatrist or PMHNP can prescribe medications for mood disorders. Because sleep disorders such as insomnia are common in mental health conditions,...

Case Illustration

S, a 34-year-old, single African American female with a 10th-grade education, overdosed on her antidepressant medication with a moderate degree of suicide intent and lethality following occupational stressors that led to her job termination. The patient attributed her depressive symptoms to her recurrent poor job evaluations during the past year. In addition, Ms. S had been experiencing significant symptoms of posttraumatic stress disorder (PTSD) due to her history of chronic sexual abuse at the age of 14, and witnessing at the age of 28 the killing of her boyfriend by gang members. Her first and only other reported suicide attempt was at the age of 15, when she confided in her mother about the sexual molestation by the mother's live-in boyfriend. However, her mother reportedly did not believe her daughter's account of the abuse and allowed the perpetrator to remain in the household. The patient had a history of alcohol, marijuana, and cocaine abuse prior to her boyfriend's death...


Dissociation is one mechanism that is used by the ego as a way to maintain its integrity for survival, and is a response to severe trauma (Gabbard, 1994). Research suggests that childhood physical abuse may be an antecedent to the development of combat-related posttraumatic stress disorder (PTSD) (Bremner, Southwick, Johnson, Yehuda, & Charney, 1993).When doing group therapy with a veteran who is known to dissociate it can present a number of challenges for the group therapist. In particular, it is important for the therapist to be able to hold the patient's unbearable mental states of mind in mind for the patient (Hinshelwood, 1994). Having worked with war veterans for eight years, a case will be presented as a descriptor of the dissoci t ve experience.

Diagnostic Features

Diagnostically, GAD, PTSD, and OCD share a number of common features with depression. Repetitive, negative thinking is common to both depression and GAD. The repetitive thinking in GAD is in the form of worry, the content of which typically regards possible negative outcomes for future events (Dozois, Dobson, & Westra, 2004). In depression, the repetitive thinking is in the form of rumination which has been defined as behaviors and thoughts that focus the individual's attention on his her depressive symptoms, and the implications and consequences of these symptoms (Nolen-Hoeksema, 1991). Individuals tend to negatively appraise themselves, their feelings, behaviors, situations, life stresses, and ability to cope. Depression and OCD also share the common feature of negative repetitive thinking. However, the main distinction is that the obsessions are ego-dystonic in OCD, which means that the thoughts are mood-incongruent and cause the individual distress, whereas the negative thinking...

Treatment Plan

It was decided that individual CT interventions would address Mary's depressive symptoms, avoidance behaviors, as well as her sense of mistrust of others and vulnerability to harm. Initially, treatment was intended to focus on Mary's depression, which she reported as her primary concern. The clinician would initially address her depressive symptoms with behavioral activation interventions to increase Mary's social involvements and pleasurable activities. At the beginning of treatment, the clinician decided that, should posttraumatic stress symptoms arise as Mary became more behaviorally active, therapy would also focus on imaginal exposure to the traumatic event, as well as in vivo exposure to her daily triggers. Cognitive interventions would also be employed to treat the PTSD by helping Mary to challenge her negative perceptions of her own behavior during the event, its


Individuals are usually considered to be ready to terminate therapy once they have achieved a healthy body weight and can eat all foods free of guilt or anxiety. For a complete recovery, extensive treatment may be required from six months to two years, and for as long as three to five years in cases where other psychiatric conditions are present. For some, eating disorders will be a lifelong struggle, with stressful or traumatic events triggering relapses that may require occasional check-in therapy to restore healthful eating patterns.


Some researchers have suggested that cancer survivors may respond to the psychological distress and uncertainty about the future by displaying posttraumatic stress disorder (PTSD)-like symptoms similar to those experienced by victims of war or environmental disasters.20 Some of these symptoms have been reported as somatic vigilance and recurrent recollection of illness-related events, as well as symptomatology around anniversary dates. However, these symptoms appear to dissipate over time as the fear of recurrence lessens. Other studies have reported symptoms characteristic of stress or trauma symptoms in survivors of cancer, such as avoidant behaviors, intrusive thoughts, and heightened arousability.21

Jeffrey A Lieberman2

Abstract Both preclinical and clinical evidence suggest that atypical antipsychotics may modulate the stress response in a manner that is distinct from conventional agents. For example, atypical antipsychotics have anxiolytic-like actions in a number of animal models. The mechanisms underlying these anxiolytic effects are not clear, but it is possible that antipsychotic-induced alterations in GABAergic neurosteroids play a role. Atypical antipsychotics also demonstrate unique effects in prefrontal cortex stress paradigms focusing on dopamine alterations. Data that mild stress also increases extracellular GABA levels in prefrontal cortex but not striatum, with no concurrent effects on glycine levels is presented. Neurosteroids may be relevant to these prefrontal cortex investigations. The authors review the emerging stress-modulatory profile of atypical antipsychotics and discuss potential ramifications of these findings for the therapeutic efficacy of these compounds. In addition to...

Rachel Yehuda

Abstract This chapter discusses how neuroendocrine findings in posttraumatic stress disorder (PTSD) potentially inform us about hypothalamic -pituitary-adrenal (HPA) alterations in PTSD and highlight alterations relevant to the identification of targets for drug development. The majority of studies demonstrate alterations consistent with an enhanced negative feedback inhibition of Cortisol on the pituitary, and or an overall hyperreactivity of other target tissues (adrenal gland, hypothalamus) in PTSD. However, findings of low Cortisol and increased reactivity of the pituitary in PTSD are also consistent with reduced adrenal output. The observations in PTSD are part of a growing body of neuroendocrine data providing evidence of insufficient glucocorticoid signaling in stress-related neuropsychiatric disorders. The study of the neuroendocrinology of posttraumatic stress disorder (PTSD) has been illuminating in highlighting alterations that have not historically been associated with...

Figure 613

Freud's ideas on repression emerged from his clinical experiences, with the repression he claimed to have observed mostly involving traumatic events that had happened to his patients. Researchers cannot produce such repression in their participants for obvious ethical reasons. However, attempts have been made to study a repression-like phenomenon in the laboratory. The evidence has come from studies on normal individuals known as repressors, having low scores on trait anxiety (a personality factor relating to anxiety susceptibility) and high scores on defensiveness. Repressors describe themselves as controlled and relatively unemotional. According to Weinberger, Schwartz, and Davidson (1979), those who score low on trait anxiety and on defensiveness are the truly low-anxious, those high on trait anxiety and low on defensiveness are the high-anxious, and those high on both trait anxiety and defensiveness are the defensive high-anxious. Those who believe in repressed memories of...


Breast cancer than among control women matched on demographics.25,26 There may be no major differences in quality of life between women having undergone a mastectomy compared to those having breast conserving surgery.27 Other studies also suggest that only a minority of patients have significant psychological distress. For example, older adult long-term cancer survivors do not demonstrate clinical levels of posttraumatic stress disorder although over 25 have clinical depression or display important symptoms of psychological distress related to the continuing effects of cancer and its treatment.28

Scott Crow

I have had lifelong depression , which my therapist says sounds like recurring episodes of major depression, about nine bouts in total, each lasting six months to a year. I've no history of substance use disorder except for a drinking pattern suggestive of alcohol abuse in college. I've had occasional panic attacks and some diffuse anxiety, primarily focused on eating-related issues. My therapist says I've no OCD, no PTSD, and no social phobia.