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Disgust and imaginal exposure to memories of sexual trauma: Implications for the treatment of posttraumatic stress.

ABSTRACT: OBJECTIVE:Emerging evidence identifies disgust as a common and persistent reaction following sexual victimization that is linked to posttraumatic stress disorder (PTSD). Importantly, evidence suggests that compared with fear, disgust may be less responsive to repeated exposure, which may have implications for the treatment of PTSD. The current study sought to fill a gap in the existing literature by examining reductions in sexual trauma cue-elicited disgust and anxiety upon repeated imaginal exposure. METHOD:Seventy-two women with a history of sexual victimization completed a single laboratory-based session that involved repeated imaginal exposure to idiographic disgust- and fear-focused sexual trauma scripts. RESULTS:Results demonstrated that although anxiety and disgust declined at similar rates across exposure trials (t = -.24, p = .81), ratings of disgust (B0 = 61.93) were elevated compared with ratings of anxiety at initiation (B0 = 51.03; t = 4.49, p < .001) of exposure even when accounting for severity of PTSD symptoms. Moreover, change in disgust significantly predicted improvement in script-elicited PTSD symptoms across the course of exposure for individuals exhibiting significant decline in anxiety (B = .006, t = 2.00, p = .048). Change in script-elicited PTSD symptoms was minimal (and was not predicted by the decline in disgust) for individuals exhibiting less change in anxiety (B = -.002, t = -0.46, p = .65). CONCLUSION:These results add to an increasing literature documenting the importance of disgust in the development, maintenance, and treatment of sexual-trauma-related PTSD. (PsycINFO Database Record

SUBMITTER: Badour CL

PROVIDER: S-EPMC5014431 | biostudies-literature | 2016 May

REPOSITORIES: biostudies-literature

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Disgust and imaginal exposure to memories of sexual trauma: Implications for the treatment of posttraumatic stress.

Badour Christal L CL Feldner Matthew T MT

Psychological trauma : theory, research, practice and policy 20150921 3

<h4>Objective</h4>Emerging evidence identifies disgust as a common and persistent reaction following sexual victimization that is linked to posttraumatic stress disorder (PTSD). Importantly, evidence suggests that compared with fear, disgust may be less responsive to repeated exposure, which may have implications for the treatment of PTSD. The current study sought to fill a gap in the existing literature by examining reductions in sexual trauma cue-elicited disgust and anxiety upon repeated imag ...[more]

PMID: 26390105

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Project description:ImportancePhysicians are exposed to traumatic events during their work, but the impact and outcomes of these exposures are understudied.ObjectiveTo determine the prevalence and associations of work-related trauma exposure and posttraumatic stress disorder (PTSD) among a cohort of resident physicians in their internship year of training.Design, setting, and participantsThis cohort study involved physicians entering internship at US residency programs nationwide in 2018. Participants completed a baseline survey 1 to 2 months before commencing internship, as well as follow-up surveys at 4 time points during internship. Statistical analysis was performed from April 2020 to January 2021.ExposuresTwelve months of internship.Main outcomes and measuresPrevalence of work-related trauma and prevalence of PTSD among those who experienced work-related trauma. Trauma exposure and PTSD symptoms were assessed using the Primary Care PTSD Screen for Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (PC-PTSD-5). Risk factors assessed included depression, anxiety, early family environment, stressful life experiences, medical specialty, hours worked, and concern about medical errors.ResultsAmong 1134 interns who completed the PC-PTSD-5 at month 12 of internship, 665 (58.6%) were female and 695 (61.6%) were non-Hispanic White; the mean (SD) age was 27.52 (2.50) years. There were 640 interns (56.4%) who reported work-related trauma exposure; among these interns with trauma exposure, 123 (19.0%) screened positive for PTSD. Overall, 123 of 1134 training physicians (10.8%) screened positive for PTSD by the end of internship year, as compared with a 12-month PTSD prevalence rate of 3.6% in the general population. Multivariable logistic regression analyses, adjusting for demographic characteristics, indicated that risk factors associated with trauma exposure included non-Hispanic White race/ethnicity (odds ratio [OR], 1.51 [95% CI, 1.14-2.01]; P = .004), more hours worked (OR, 1.01 [95% CI, 1.00-1.03]; P = .03), early family environment (OR, 1.03 [95% CI, 1.01-1.05]; P < .001), and stressful life experiences at baseline (OR, 1.46 [95% CI, 1.06-2.01]; P = .02). Risk factors associated with PTSD were being unmarried (OR, 2.00 [95% CI, 1.07-3.73]; P = .03) and non-Hispanic White (OR, 1.77 [95% CI, 1.01-3.11]; P = .05), concern about medical errors (OR, 1.21 [95% CI, 1.00-1.46]; P = .05), stressful life experiences during internship (OR, 1.43 [95% CI, 1.14-1.81]; P = .002), depression at month 12 of internship (OR, 2.52 [95% CI = 1.36-4.65], P = .003), and anxiety at month 12 of internship (OR, 2.14, [95% CI, 1.13-4.04]; P = .02).Conclusions and relevanceThis study found that work-related PTSD was 3 times more prevalent among intern physicians than the general population. These findings suggest that effective interventions to reduce trauma exposure and mitigate the effects of trauma are needed.

Project description:ObjectiveThere is mounting evidence that traumatic life events play a role in auditory hallucinations (AH). Theory suggests that some AH are decontextualized trauma memory intrusions. Exposure-based trauma-focused therapies that target trauma memory intrusions may therefore be a promising new treatment. We aimed to assess the feasibility and acceptability of a standard protocol trauma-focused imaginal exposure intervention for trauma-related AH and to provide initial proof of concept regarding potential effects on AH.DesignWe conducted a single-arm case series of a six session (90 min per session) imaginal exposure intervention for trauma-related AH with assessments at baseline, post-therapy, and one-month follow-up.ResultsFifteen people were recruited and eligible to start the intervention. Participants reported high levels of satisfaction; however, temporary distress and symptom exacerbation were common and contributed to discontinuation. There was a large reduction in AH severity at one-month follow-up (adjusted d = 0.99), but individual response was highly variable. There were also large reductions in post-traumatic stress disorder symptoms and the intrusiveness of the trauma memory.ConclusionsImaginal exposure for trauma-related AH is generally acceptable and may have large effects on AH severity for some people. However, temporary distress and symptom exacerbation are common and can lead to discontinuation. Low referral rates and uptake also suggest feasibility issues for standalone imaginal exposure for AH. The intervention may be more feasible and acceptable in the context of a broader trauma-focused therapy. Well-powered trials are needed to determine efficacy and factors that impact on acceptability and therapy response.Practitioner pointsSome AH can be understood as trauma memory intrusions that lack temporal and spatial contextualization and are therefore experienced without autonoetic awareness. Imaginal exposure to trauma memories associated with AH may be an effective intervention for some people. Temporary distress and symptom exacerbation may be common when using standard trauma-focused imaginal exposure for AH. This can impact on the acceptability of the therapy and should be considered in future development and delivery.

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Disgust and imaginal exposure to memories of sexual trauma: Implications for the treatment of posttraumatic stress.

Publications

Disgust and imaginal exposure to memories of sexual trauma: Implications for the treatment of posttraumatic stress.

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