PTSD Relief Self-help Audio Program

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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Posttraumatic Stress Disorder

Although there are many forms of psychological injury that can be the focus of a compensation claim (including chronic pain, cognitive impairment, postconcussive syndrome, depression), this review will focus onposttraumatic stress disorder (PTSD). This condition is diagnosed when the individual has (a) suffered a traumatic experience, and subsequently suffers (b) re-experiencing (e.g. flashbacks, nightmares), (c) avoidance (e.g. effortful avoidance of trauma-related thoughts, emotional numbing), and (d) hyperarousal (e.g. insomnia, irritability) symptoms. According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV American Psychiatric Association, 1994), PTSD has the distinctive feature of including a precipitating stressor as part of the disorder's definition. This establishes a straightforward connection between a triggering traumatic event and a variety of observed symptoms (Freckelton, 1997). Such a relationship enables PTSD to be susceptible to...

Nature Of Posttraumatic Stress Disorder

Posttraumatic stress disorder was first recognized as an official psychiatric diagnosis in 1980 with the creation of the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III). As it was when first categorized, PTSD is defined by the current nosological compendium of psychiatric disorders, the DSM-IV, as an anxiety disorder The essential feature of Posttraumatic Stress Disorder is the development of characteristic symptoms following exposure to an extreme traumatic stressor involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one's physical integrity or witnessing an event that involves death, serious injury, or a threat to the physical integrity of another person or learning about unexpected Everly (1989, 1993a, 1994) has proposed that PTSD is best understood phenomenolog-ically as a manifestation of two inextricably intertwined, interacting factors

Prevalence Of Posttraumatic Stress Disorder

The lifetime prevalence experienced by adults for exposure to one or more traumatic events (as defined by the DSM-IV) has been estimated to be more than 89 in an urban community area investigation (Breslau et al., 1998). 2. Overall, among those exposed to extreme trauma, about 9 percent ultimately develop post-traumatic stress disorder (U.S. DHHS, 1999, p. 237), but this statistic may be misleading. 3. Given the especially severe forms of traumatic stressors, the risk of developing PTSD was found to be about 34 (current prevalence) in response to mass disasters (North et al., 1999), about 49 in response to rape, and about 53 (lifetime prevalence) in response to captivity, kidnapping, or torture (Breslau et al., 1998). 4. When considering the risk of developing PTSD within high risk occupational groups, the prevalence of posttraumatic stress disorder ranged from 15 to 31 for samples of urban firefighters based on a traumatic exposure prevalence ranging from 85 to 91 (Beaton, Murphy, &...

The Outcome Of Psychological Treatment For Specific Phobias

The following review discusses the treatment of claustrophobia, fear of flying, routine dental treatment, injections and blood injury and of spiders because, according to a Medline search from 1984, they have probably received the most attention in psychological studies. In addition, however, these phobias probably differ in the impairment of daily functioning and quality of life that they produce in afflicted people. Spider phobia probably has least impact on subjects but others, most notably injection phobia, can be life threatening. On the other hand, the treatment of spider phobia has probably been investigated for theoretical interest more than other fears. Reviews have claimed that the most successful treatment of specific phobias has required the exposure of subjects to the situations that have provoked their fear (Marks, 1987). The present review discusses subsequent studies that have examined different approaches and new ways of implementing exposure, as suggested by...

Robert E Antosia md mph

Recovery After the immediate response is completed, long-term recovery begins. Depending on the severity, this process may take months to years to complete. The goals are to promote the recovery of individuals as well as the restoration of the economic and civil life of the community. Victims remain at risk for depression, guilt, and posttraumatic stress disorder. Displaced populations are particularly vulnerable. The

Psychological Factors In Personality Disorders

Finally, it is worth remembering that single traumatic events are rarely, by themselves, associated with pathological sequelae, while continuously adverse circumstances lead to cumulative effects (Rutter, 1989). Thus, we cannot understand the impact of childhood trauma outside a longitudinal and developmental context.

Cognitive Therapy for Anxiety Disorders

Cognitive therapy for PTSD typically involves exposure to traumatic memories, behavioural 'stress inoculation' training and cognitive restructuring (Foa & Rothbaum, 1997 Resick & Schnicke, 1992). While there is considerable controversy about which of these elements is effective, there is evidence that as a whole cognitive therapy leads to clinically significant improvements in PTSD symptomatology (Devilly & Spence, 1999 Foa et al., 1999 Marks etal., 1998).

Diagnosis Or Disability

Compensation is only awarded if damage can actually be demonstrated (Epstein, 1995). Compensation is usually awarded on the basis of the degree of impairment that impedes the claimant's capacity to function in a range of domains. A common mistake, in compensation-related assessments, involves the distinction between diagnosis and impairment. It is important that the assessment of psychological injury goes beyond the simple level of diagnostic definitions and addresses how psychological injury is adversely affecting the individual. For example, an individual may not suffer sufficient symptoms to meet a particular diagnostic threshold but may, nonetheless, display marked impairment as a result of the psychological injury. Alternatively, although an individual may suffer a range of PTSD symptoms, the individual may be able to function very ably. Establishing the level of damage secondary to psychological injury is not simple. In defining damages, different jurisdictions distinguish...

Nature of the Alleged Event

Identifying the nature of the event that allegedly caused the injury also needs to recognize recent research developments. Whereas DSM-III-R described the stressor as 'a psychologically distressing event that is outside the range of usual human experience' (APA, 1987), DSM-IV (APA, 1994) deleted this constraint. These changes have allowed a wider range of events to be claimed as possible causes of the disorder. Prior to the definition of PTSD in DSM-IV, there was much concern from legal representatives that broadening the definition to the point of not specifically defining the stressor would create excessive opportunity for people to claim damages based on a PTSD presentation. Most jurisdictions adhere to the principle of foreseeability, in which one would expect the injury to occur following the relevant event (Spaulding, 1988). There is much research that informs us about the likelihood of PTSD developing after a specific event. There is largely a direct relationship between the...

Preexisting Conditions

The empirical literature on PTSD highlights the importance of considering the potential contributing role of pre-existing conditions. The possibility that an individual claiming for a psychological injury has suffered a psychological condition prior to the precipitating event, or had a vulnerability to the psychological injury, is significant in all compensation claims for PTSD. Considering that 9 of the population will suffer PTSD at some time in their lives (Breslau et al., 1991), there is a significant proportion of claimants of PTSD who will have suffered PTSD prior to the alleged event. Further, the National Comorbidity Survey in the USA found that 61 of men and 51 of women reported having at least one traumatic event in their life (Kessler et al., 1995), and most of these people reported multiple traumatic experiences. It is likely that most claimants will have had a traumatic event occur prior to the one that is the focus of the claim, and the effects of the earlier events need...

The Influence of Litigation

A very common issue in litigation proceedings is the extent to which the litigation procedure influences symptoms or symptom reporting. In the case of PTSD, there is a long tradition of attributing reported symptoms to 'compensation neurosis'. After World War I, authorities perceived that compensation for shell shock contributed to the persistence of symptoms after the war (Bonhoeffer, 1926). As a result, The National The evidence pertaining to symptom reporting decreasing after litigation resolution is very mixed. There is increasing research that PTSD symptoms persist after compensation has been settled (Brooks and McKinlay, 1992 Bryant and Harvey, in press-a Mayou, Bryant and Duthie, 1993 McFarlane, 1995), and this pattern of findings reflects evidence from studies ofback injury and chronic pain (Evans, 1984 Mendelson, 1995a). There is also evidence that symptom exaggeration is particularly prevalent in compensation-seeking individuals (Frueh, Smith and Barker, in press). There are...

Psychometric Techniques

The most studied measure to index genuineness of clinical presentation is the MMPI MMPI-2 (Hathoway and McKinley, 1991). The MMPI-2 has an array of validity scales designed to index motivation underlying responses to items about psychopathology, including the F, Fb, L, K, Gough Dissimulation Index, Fp, S and Mp (for reviews, see Butcher and Miller, 1999 Greene, 1997 Pope, Butcher and Seelen, 2000). The ability of the MMPI-2 to discriminate between genuine and malingered presentations has been studied in a range of populations, including chronic pain, brain injury, and PTSD (Butcher and Miller, 1999). A number of studies have indicated the utility of the MMPI-2 to distinguish genuine from malingered PTSD (Fairbank et al., 1985). Even when malingerers are given information about PTSD, The PAI (Morey, 1991) is another self-report personality inventory designed to assess response styles, clinical disorders, treatment planning and screen for psychopathology. The PAI was developed to...

Physiological Assessment

Some commentators have suggested that more sensitive assessment of psychological injury, including PTSD, can be achieved with psychophysiological measurement (Friedman, 1991 Pitman and Orr, 1993). This notion is based on the premise that malingerers may be less able to mimic biological markers of PTSD than self-reported symptoms. The basis for this perspective is the considerable evidence that people with PTSD can be distinguished from those without PTSD on a range of autonomic responses to cues that are specific to their trauma (for a review, see Orr and Kaloupek, 1997). For example, heart rate, skin conductance response, and eyeblink startle have been repeatedly found to be elevated in PTSD individuals when presented with trauma reminders. Further, there is recent evidence that functional magnetic resonance imaging (fMRI) can effectively distinguish the neural networks activated in PTSD and control participants when subliminally presented with threatening stimuli (Rauch et al.,...

Methodological Issues

The current evidence pertaining to malingered PTSD highlights that an underlying issue for malingering assessments is the level of sophistication of malingering research. Defending the use of any technique to detect malingered PTSD requires awareness of and confidence in the methods used to develop that technique. Simulation studies vary enormously in terms of the extent to which they use actual disordered populations, engage in coaching of simulators, use empirically derived and standardised simulation instructions, and provide sufficient incentives to motivate simulators. These issues raises serious concerns about generalisability of these findings to forensic settings where one needs to make decisions about a potentially malingered presentation. For example, the Carr-Walker and Bryant (2001) study instructed college students to feign PTSD after being given a summary description of PTSD symptoms. This methodology, which is common among simulation studies, can be criticised on the...

Empirical Challenges to Conceptual Distinctions

Studies of diagnosable disorders as risk factors are also complicated by the high degree of co-morbidity. Depressive disorders are quite commonly co-morbid with GAD (Kessler et al, 2008 Moffitt et al, 2007). Depressive disorders are also often co-morbid with other anxiety disorders (e.g., post-traumatic stress disorder), though less so than with GAD (Watson, 2009a). Anger and closely related emotional symptoms such as irritability are common in depressive disorders, and their co-occurrence with depression is further associated with increased likelihood of co-morbid anxiety disorders (Fava et al, 2009). The DSM-IV diagnosis most specifically related to anger and aggressive behavior The close association between anxiety and depression in general, and between MDD and GAD in particular, has prompted efforts to revise the related conceptual models and diagnostic frameworks. In one influential alternative, Clark and Watson (1991) suggested that anxiety and depression share a common core of...

Effects of Adult Adversity

Suspicious attitudes can also be viewed as a rational response to environments that are truly threatening and combative behavior can be adaptive under those conditions. Therefore, it is not surprising that cynicism and mistrust are more prevalent in those faced with harsh life circumstances. This may help explain the high levels of hostility typically reported by members of lower socioeconomic status and minority groups (e.g., Barefoot et al, 1991). It is also consistent with the hostile attitudes present in those who have suffered trauma. Anger proneness is one of the hallmark symptoms of Post Traumatic Stress Disorder (PTSD Orth and Wieland, 2006 Jakupcak et al, 2007). Although hostile tendencies are elevated in all types of trauma victims, they are especially prevalent in men whose exposure was related to military experiences. The prevalence of PTSD in women is high as well and is most often associated with sexual trauma. The presence of anger proneness can partially explain the...

Summary And Conclusions

Exposure therapies are the treatment of choice in adult specific phobia, social phobia, agoraphobia, and obsessive-compulsive disorder (Emmelkamp, 2004) and have also been found quite effective in phobic children (Nauta et al., 2003). Studies of the behavioural treatment of depression have come to a standstill due to the rise of cognitive therapy in this area but the lack of further research into the behavioural treatment of depression is not justified by the data. There are still a number of important issues that need to be addressed. For example, we have no idea why cognitive therapy, behavioural interventions, IPT and pharmacotherapy work equally well with depressed patients, although various researchers provide various theoretical explanations. Unfortunately, to date there is no evidence that

Outcome Research In Emdr

There are currently, at the time of writing, 20 randomised controlled (RCTs) in EMDR and PTSD, (not including follow-up RCTs) and also four meta-analyses. This is a considerable outcome research base in a relatively short period of 17 years since the seminal paper on EMDR and represents a considerably greater research interest in this area than in any other single approach to PTSD, whether psychological or pharmacological. Although some of the earlier studies were criticised for lacking methodological rigour (Lohr, Tolin & Lilienfeld, 1998), later studies have by-and-large adhered to 'the gold standard' criteria of Foa & Meadows (1997) - random selection, standard treatment delivery, objective standardised measures, and clear inclusion and exclusion rules for clients (diagnostic criteria). Of the 20 RCTs, two are comparisons with waiting list or delayed treatment controls, three are component analyses, and 15 are treatment comparisons. Of the treatment comparisons, eight are...

Treatment Comparisons

This research in EMDR can be viewed as having two phases. The first phase from Shapiro's seminal 1989 paper up until 1998 was characterised by research examining whether EMDR was an effective psychotherapeutic procedure for post traumatic stress disorder, and the contribution of its various elements, especially eye movements. The second phase from 1999 largely accepted EMDR as an effective treatment for PTSD (Foa, 2000) and now focused on research comparing the effectiveness and efficiency of EMDR directly with variations of exposure. Maxfield & Hyer (2002) rate most of this research according to the 'gold standard' of research (Foa & Meadows, 1997) and according to the degree of treatment fidelity.

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

Traumatic Experiences

Total posttraumatic stress disorder (PTSD) symptoms (with individual symptom categories showing slightly lower heritabilities reexperiencing 36 , avoidance 28 , numbing 36 , and hyperarousal 29 ). Although it is reasonable to think that etiologic factors affecting the likelihood of traumatic exposures might differ from those influencing PTSD symptomatology after the occurrence of a traumatic event, additive genetic effects on the experience of assaultive trauma correlated highly with genetic variance in PTSD symptoms (all r's 0.70). These results suggest that liability to both trauma and PTSD symptomatology involves overlapping genetic influences. Finally, other research on this sample has shown personality variables, particularly adult and juvenile antisocial traits, to account for a significant proportion of the genetic variance in assaultive trauma (Jang et al, 2003). Like the literature on stressful life events, then, heritable personality characteristics and associated...

Gene Stress Interaction Acute Stressors

Children, genetic influences accounted for 5560 of the variance in salivary cortisol measured at baseline and following performance of a challenging video game and for 44 of baseline-to-task cortisol reactivity (Steptoe et al, 2009). Also, similar heritability was observed for salivary and total cortisol, ACTH, and heart rate responses to the trier social stress test (TSST), a composite stress protocol involving mental arithmetic and public speaking before an audience, in an earlier study of adolescent young adult twins (Federenko et al, 2004). Not surprisingly, one target of molecular studies has been the GR gene (NR3C1). Genotyping four putatively functional NR3C1 polymorphisms, labeled N363S, ER22 23EK, 9p , and an intronic marker of unknown function, Bcll, Wust and colleagues (2004) found TSST-elicited salivary cortisol responses in males to be greatest among carriers of the 363S allele and blunted in participants homozygous for the Bcll GG allele. In a subsequent study, the Bcll...

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

Psychological Theories

According to Millon (1981, 1996), the development of any personality disorder, including BPD, is a function of biological, psychological, and social factors. Borderline personality disorder, in Millon's conceptualization, is a dysfunctional, or extreme, variant of dependent, histrionic, and passive-aggressive personality disorders. As such, the etiology, including biological underpinnings and psychosocial experiences, is related to the subtype. The more dependent types generally have more sluggish temperaments and a history of being overnurtured (with the inevitable metamessage that the child is incompetent and requires care). The more histrionic types have highly active temperaments and were reinforced for performing for their parents and others. The passive-aggressive (negativistic) types tend to have moody, irascible temperaments and were raised with extreme inconsistency. In all cases, repeated failures of their attempts to cope with the world have led to increasing desperation....

Review Of Anger Treatment Outcomes

Thus for example, conventional CBT-based approaches towards the assessment and treatment of PTSD (for example, Foa, Steketee & Olasov-Rothbaum, 1989) continue to underestimate the significance of anger, despite compelling evidence regarding its salience (Gerlock, 1994 Novaco & Chemtob, 1998).

The HPA Axis Under Challenge

Including psychological stress protocols (e.g., cognitive tasks or public speaking paradigms (for an overview, see Kudielka et al, 2009) and a wide variety of pharmacological provocations, physical exercise, or intake of standardized meals. While psychological stressors are central stimuli that are processed at higher brain levels, pharmacological challenge tests are specifically tailored to act at certain levels of the HPA system and operate in a dose-dependent manner. The HPA axis is regulated by the negative feedback action of cortisol on receptors in the hippocampus, hypothalamus. and pituitary gland. The dexamethasone suppression test is used to test HPA axis negative feedback efficiency by determining the degree to which endogenous cortisol release is suppressed by intake of oral dexamethasone. This synthetic glucocorti-coid acts primarily by binding to glucocorticoid receptors in the pituitary gland, mimicking the negative feedback effects of endogenous cortisol such that ACTH...

Hypothalamic PituitaryThyroid Axis

In critically ill patients, the low T3 syndrome has been considered a predictor for mortality (Chopra, 1997). In patients with anorexia nervosa, the low T3 syndrome as well as a smaller volume of the thyroid gland has been observed, which are both reversible after weight gain (Munoz and Argente, 2002). In PTSD and major depression, both hyper- and hypoactivity of the hypothalamic-pituitary-thyroid axis have been described (Boscarino, 2004 Newport and Nemeroff, 2000).

Assessment And Intervention

Indication of a cathartic process that will inevitably resolve with time. People who obtain high scores on posttraumatic stress disorder (PTSD) scales after a major incident are often those individuals whose scores remain elevated a year later. A chronic sense of personal distress, which is exacerbated by bereavement, may be mistaken for expressed grief precipitated by bereavement. Alarcon (1984) suggests that an individual with a personality disorder will have difficulties that reflect ongoing problems in establishing interpersonal relationships rather than grief for a lost relationship. Rosenblatt (1997) cautions that talking about the loss is seen as healthy expression of grief in Euro-American counselling now but may not be seen as appropriate bereavement behaviour in another culture. There is some evidence that those who avoided intense feelings of grief did not have a worse outcome at 14 months than those who experienced emotional distress Bonnano et al. (1995). A study of 253...

The Assumptive Beliefs And Explanatory Worldviews

Experiences that challenge, threaten, or invalidate core assumptions or general beliefs about the world serve as the potential foundations for dysphoria and or maladaptive coping patterns. Traumatic events serve to challenge, threaten, or invalidate core charac-terologically based assumptions, hence their pathogenic nature. 3. The need to believe in a fair and just world when violated gives rise to frustration, cynicism, and the belief that the end justifies the means (violence may be a common behavioral reaction). For example, a significant injustice (death or injury of a child), a criminal escaping justice, bad things happening to good people, and evil conquering over good all represent potential traumatic events.

The Rationale For Adjunctive Psychological Treatments

Bipolar disorder has a median age of onset in the mid-20s, but most individuals report that they experienced symptoms or problems up to 10 years before diagnosis. Thus, the early evolution of BP may impair the process of normal personality development or may mean that the person starts to employ maladaptive behaviours from adolescence onwards. Co-morbid anxiety disorders, including panic and post-traumatic stress disorder (PTSD) and other mental health problems are common accompaniments of BP and as many as 40 of subjects may have inter-episode sub-syndromal depression (Judd et al., 2002). Although many individuals manage to complete tertiary education and establish a career path, they may then experience loss of status or employment after repeated relapses. One year after an episode of BP, only 30 of individuals have returned to their previous level of social and vocational functioning. Interpersonal relationships may be damaged or lost as a consequence of behaviours during a manic...

Physical Psychological And Socioeconomic Sequelae

Apart from the physical injuries sustained by child soldiers, another area of concern for aid agencies and healthcare workers is the psychological health of these children. A recent Belgian study revealed the extent of this problem in a voluntary survey of former child soldiers of Uganda's notorious Lord's Resistance Army. Of the 301 children interviewed, 77 had witnessed at least one killing, 39 had been forced to kill, 39 had abducted other children, 63 had looted and burned civilian homes, and 52 had been seriously beaten. A secondary survey was conducted on a randomly selected subgroup of 75 children, of whom 71 agreed to participate. They completed a questionnaire designed to evaluate the extent of posttraumatic stress disorder (PTSD). A score of greater than 24 on the impact of event scale-revised (IES-R), which is a self-report scale akin to the DSM-IV criteria for PTSD, indicates clinically significant symptoms. The mean IES-R score was 53.5, with 97 of participants falling...

Historical Significance

The term posttraumatic stress disorder was introduced in 1980 in the DSM-III, although the concept of this disturbance has a long history. In the past, it the syndrome was recognized in wartime as shell shock or war neurosis, because it was seen most commonly in wartime situations. Many of its typical symptoms, however, such as intrusive thoughts and autonomic arousal, were also recognized in victims of other traumatic events, such as natural disasters.

Differential Diagnosis

The differential diagnosis for PTSD includes major depression, adjustment disorder, panic disorder, generalized anxiety disorder, acute stress disorder, obsessive compulsive disorder, depersonalization disorder, factitious disorder, or malingering. Occasionally, a physical injury may have occurred during the stressor so that a mental disorder secondary to brain injury must be considered as well. Many patients with PTSD meet criteria for another Axis I disorder (e.g., major depression, panic disorder), in which case both disorders should be diagnosed.

Legal Remedies as a Result of Being Involved in a Single Life Threatening Situation

In the absence of specific legislation relating to a possible claim for PTSD which the employee alleges was caused while at work, we must turn to the common law for assistance. The tort of negligence is essentially concerned with compensating people who suffer from the careless acts (or sometimes omissions) of others. It does not provide a remedy, however, for everyone who suffers loss. Negligence liability will only arise where the law provides that the defendant owed the claimant a duty of care (Donoghue v. Stevenson, 1932). In many cases the fact the claimant owes the defendant a duty of care will be beyond argument, for example in the case of the employer and employee relationship. Perhaps what is more problematic is for the employee to prove that his or her employer has breached that legal duty, by falling below the appropriate standard of care, and that it was the employer's negligent act or omission which caused the damage to the employee. That said there appears to be two...

Pharmacological Toxicological Effects 51 Neurological Effects

A randomized, 25-week, placebo-controlled study by Volz and Kieser showed a significant benefit from the use of kava-kava extract WS 1490 over placebo in treating anxiety disorders of nonpsychotic origin. The study included 101 patients suffering from agoraphobia, specific phobia, generalized anxiety disorder, or adjustment disorder with anxiety as per the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised who

Theories Of Personality Development

The idea that the experiences of childhood are important determiners of adult personality is a part of folklore as old as humanity itself. However, Sigmund Freud proposed the first systematic theory of how childhood experiences leave an imprint on the individual that persists into adulthood. To Freud, adult personality and character are end products of the frustrations and conflicts experienced by the child during the oral, anal, phallic, latency, and genital stages of psychosexual development. At each of these stages, sexual energies are concentrated on a particular region of the body and conflicts develop with regard to their expression. Failure to progress from one psychosexual stage to another, referred to as fixation, results in the sexual energies of the person becoming permanently attached to that stage. In addition, traumatic events or extreme stress can result in regression, a reenact-ment of behaviors typical of an earlier psychosexual stage. For example, nail-biting,...

Gene Stress Interaction Life Events and Other Natural Stressors

Another series of studies has examined polymorphic variation in FKBP5, which encodes a co-chaperone of heat stress protein-90, FK506 binding protein-5, that helps regulate binding affinity of the glucocorticoid receptor (GR). In a depressed patient sample, TT genotype at rs1360780 was found to be associated with a more rapid response to antidepressant treatment and greater recurrence of depressive episodes, higher levels of FKBP5 expression in lymphocytes, and a blunted adrenocorticotropin hormone (ACTH) response to dex CRH challenge, relative to those carrying one or more copies of the alternate C allele (Binder et al, 2004). This polymorphism and another FKBP5 SNP, rs3800373, also predicted peritraumatic dissociation, a risk factor for PTSD, among medically injured children (Koenen et al, 2005), and these and two other SNPs analogously predicted adult PTSD symptomatology in interaction with childhood abuse (but not adult trauma exposure) among predominantly low-income, African...

Issue Of Malingering

A central question within compensation assessments is the extent to which the presentation is genuine, malingered, or exaggerated (Lipton, 1994 McGuire, 1999 Resnick, 1984). The concern over the genuineness of reported posttraumatic symptoms necessitates the development of an objective and accurate evaluation process to ascertain whether or not a client has exaggerated or malingered psychological symptoms (Grillo et al., 1994). The accurate assessment of psychological symptoms following a traumatic event is difficult because PTSD symptoms rely heavily on the self-report of subjective symptoms (Raifman, 1983 Resnick, 1984 Rosen, 1995 Sparr and Pankratz, 1983 Zisken, 1995). Obtaining objective measurement or verification of reported symptoms is often difficult (Freckelton, 1997). Further, growing awareness of symptoms allows many individuals to feign PTSD with a reasonable knowledge base about expected symptoms (Fear, 1996 Gerardi, Blanchard and Kolb, 1989 Lees-Haley, 1992 Mendelson,...

Discussion

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

Selfreport

Many commentators have suggested that it is useful to draw a distinction between salient symptoms that may be more susceptible to successful malingering and subtle symptoms that malingerers are less likely to report (Rogers, 1997a). Bryant and Harvey (1998) required treatment-seeking PTSD participants and malingerers to listen to a sound effect of a crashing car, and then report their cognitive and affective responses to this stimulus. Their responses were audiorecorded and subsequently rated on a range of domains by independent psychologists. This study found that simulators and PTSD participants could not be distinguished in terms of their levels of imagery, intrusiveness of the reported memories, belief in the reality of the memory, affect, or movement of imagery. Simulators only differed from PTSD participants in that the latter reported trying to distract themselves from their memories to a greater extent than simulators. This study highlights that whereas it is difficult to...

Other Applications

The success of IPT in treating unipolar mood disorders has led to its expansion to treat other psychiatric disorders. Frank and colleagues in Pittsburgh have been assessing a be-haviourally modified version of IPT as a treatment adjunctive to pharmacotherapy for bipolar disorder. Further, IPT is increasingly being applied for a range of non-mood disorders. There are intriguing applications of IPT as treatment for bulimia (Agras et al., 2000 Fairburn et al., 1993 Wilfley et al., 1993, 2000) and anorexia nervosa social phobia (Lipsitz et al., 1999), posttraumatic stress disorder, borderline personality disorder and other conditions. Life events, the substrate of IPT, are ubiquitous, but how useful it is to focus on them may vary from disorder to disorder. There have been two negative trials of interpersonal therapy for substance disorders (Carroll, Rounsaville & Gawin, 1991 Rounsaville et al., 1983), and it seems unlikely that an outwardly focused treatment such as IPT would be useful...

Stress Syndromes

Three of the most publicized states associated with prolonged stress are burnout, bereavement, and posttraumatic stress disorder. The symptoms of burnout, a condition precipitated by the stress of overwork, include emotional exhaustion, reduced productivity, and feelings of depersonalization. The emotional exhaustion in burnout may be accompanied by physical symptoms such as headaches and backaches, in addition to social withdrawal. Compulsive, insecure workaholics whose jobs have ceased to provide them with self-fulfillment are particularly prone to burnout. Such individuals attempt to compensate for low self-esteem from off-the-job activities by dedicating themselves to their jobs and becoming workaholics. One of the most dramatic and widely discussed disorders stemming from the Vietnam War is posttraumatic stress disorder (PTSD). Similar conditions were called shell shock in World War I and combat fatigue insomnia or combat neurosis in World War II and the Korean War. PTSD is, of...

The Emdr Procedure

Particular emphasis will be placed on the nature of the client's psycho-pathology and the client's suitability for EMDR. Contraindications such as suicidal ideation, organic problems that could interfere with processing, and motivational issues, are assessed. Secondary gain factors accruing from the psycho-pathology are identified and may be addressed in the treatment plan. Suitable targets are identified for processing in the treatment phase. Such targets for processing or reprocessing are usually traumatic events or disturbing incidents seminal in the clients presenting problems. Present stimuli that trigger emotional disturbance in the client will also be targeted, as well as anticipated future situations that could elicit disturbance. The EMDR assessor will be particularly listening out for examples of trauma or critical incidents in clients' histories, as well as paying particular attention to the words clients use to describe themselves in relation to...

From 1999 Onward

Ironson et al. (2002) compared EMDR to prolonged exposure (PE) in 22 community-based PTSD victims. Both treatments produced significant reductions in PTSD and depression symptoms at the end of treatment and at three months follow up. However, seven out of 10 subjects had 70 reduction in PTSD symptoms after three sessions in the EMDR group, compared with two out of 12 with PE, with a significantly lower dropout rate in the EMDR group. However sample size was small and assessors not entirely blind. Lee et al. (2002) compared EMDR with stress inoculation training (SIT) plus prolonged exposure in 24 randomly assigned PTSD subjects. There were no significant differences between EMDR and SIT plus PE on global measures post treatment, except for significant improvement on intrusion symptoms in the EMDR group, and EMDR showed significantly greater improvement on trauma and distress measures at three months follow up. Sample size again was low and assessors not blind to treatment assignment....

Metaanalyses

Van Etten & Taylor (1998) was a meta-analysis of all treatments for PTSD, which indicated that behaviour therapy, SSRIs, and EMDR were the most effective forms of treatment. They also specified that EMDR appeared to be the 'more efficient' form of therapy, given that EMDR necessitated one third the amount of time to achieve its effects compared to outcomes reported in behaviour therapy research. Maxfield & Hyer (2002) in a meta-analysis of all PTSD outcome studies with EMDR found studies with greater scientific rigour yielded larger effect sizes, and that there was a significant correlation between effect size and treatment fidelity. Bradley et al. (2005) in a meta-analysis of studies on psychotherapy for PTSD between 1980 and 2003 found that EMDR and cognitive behaviour therapy were both effective treatments for PTSD, and were equally effective.

Summary and Outlook

In this chapter we treated the major neuroendocrine systems and their role in health and stress-related disorders, such as depression, PTSD, infertility, or eating disorders. It becomes evident that neuroendocrine systems are tightly intertwined with each other and perturbations in one system may cause multiple dysregulations in the others. Environmental events, and stress in particular, have profound effects on proper neuroendocrine functioning and may thus affect disease onset, maintenance, or progression.

George S Everly Jr

Treatment, it may be argued, should be the natural corollary of assessment, and assessment should be the natural corollary of phenomenology. Thus, it would seem that the most valuable assessment formulations would focus not only on florid symptomatic presentations but also on more core undergirding phenomenological substrates. By focusing on core foundational substrates, the key to the most efficient and effective treatments may reside in targeting the cause of the condition, rather than targeting only its symptoms. In this chapter, the assessment of posttraumatic stress disorder (PTSD) is examined. This examination, however, is not a review of the plethora of symptom-based diagnostic tools that are keyed to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV). Such tools are highly correlated to the specific DSM-IV diagnostic criteria for PTSD residing within diagnostic Clusters B, C, and D, that is, reexperiencing, withdrawal numbing, and arousal,...

Occupational Culture

Change environment, organisations need time to manage and absorb the change. This requires clear direction from management, good communication and senior staff keeping in touch with grass roots. Callan (cited in Brown and Campbell, 1994) notes that police organisations can use the concept of stress to blame an individual's failure, rather than implicate organisational structures, and seek to indemnify themselves against corporate failures. The case of the Hillsborough football disaster (where many people were killed and injured in the crush of fans attempting to get into a penned area of the stadium) provides an example of the singling out of individuals upon whom to lay blame. It also illustrates some issues with respect to the suffering of PTSD which are discussed later in terms of legal remedies.

Etiology

The major etiological event leading to PTSD is the stressor. Because not all persons who experience a major stressor develop the disorder, other variables such as underlying personality and biological vulnerability are undoubtedly important. Stressors of all types may contribute to the development of PTSD, but they must be severe enough to be outside the range of normal human experience. Certain experiences are highly linked to the development of PTSD witnessing a friend being killed in action, witnessing wartime atrocities, and, especially, participating in atrocities. Individual differences that can predispose to the development of PTSD include age, history of emotional disturbance, social support, and proximity to the stressor. Eighty percent of young children who sustain a burn injury, for example, show symptoms of posttraumatic stress 1-2 years after the initial injury, but only 30 of adults who sustain this injury have symptoms after 1 year. Persons with a prior history of...

Empirical Findings

PACL scales have been used to study occupational preferences (Plante & Boccaccini, 1997 Strack, 1994), the characteristics of competitive athletes (Gat & McWhirter, 1998), family systems (Gontag & Erickson, 1996 Horton & Retzlaff, 1991), individual differences in social judgment (Moore, Smith, & Gonzalez, 1997), interpersonal problems (Pincus & Wiggins, 1990), and outcomes among elderly veterans with posttraumatic stress disorder (Hyer & Boyd, 1996). The PACL Problem Indicator scale

Spider Phobia

Trials in adults and children (Table 20.4) show, without exception, that exposure to live spiders, usually in a graded manner, produces improvement in measures of anxiety and behavioural tolerance. Simulated exposure by virtual reality (VR) or computer-aided presentation of somebody else being confronted by spiders (vicarious exposure), exposure with distraction, focussed or elaborated attention or with counter-conditioning (reciprocal inhibition) or exposure plus cognitive therapy or self-instruction manuals all reduce anxiety and improve tolerance. One session, an hour or more, can be sufficient. In one study (Smith et al., 1997), however, exposure to irrelevant stimuli, elevators, by computer display was as effective as similar exposure to spiders but it is not clear if sufficient subjects were tested to examine differences between the treatments. No study has included subjects with additional psychological problems. In only five is impairment of functioning addressed, all by Work...