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Fractured Pasts: The Structure of the Life Story in Sexual-Trauma Survivors With Posttraumatic Stress Disorder.

ABSTRACT: We examined the organization of past and future affective autobiographical knowledge in sexual-trauma survivors compared with control participants. Participants (N = 113) divided their past (and future) life into chapters (e.g., "college," "marriage"), then characterized each chapter using positive or negative attributes. Sexual-trauma survivors (n = 27) endorsed a greater proportion of negative attributes, demonstrated greater affective compartmentalization (separation of positive and negative attributes into different chapters), and showed reduced redundancy (consistent endorsement across chapters) of positive attributes relative to control participants (n = 23). Groups did not differ on negative redundancy for past life structure or any metrics for future life structure. In a secondary analysis, we compared life structures for the sexual-trauma group and for individuals with chronic depression but no sexual-trauma history (n = 30) and matched control participants (n = 56), which revealed significantly greater negative redundancy in the depressed group. The distinct life structure presented by sexual-trauma survivors may reflect efforts to constrain the impact of trauma on an individual's self-identity.

SUBMITTER: Clifford G

PROVIDER: S-EPMC7411540 | biostudies-literature | 2020 Jul

REPOSITORIES: biostudies-literature

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Fractured Pasts: The Structure of the Life Story in Sexual-Trauma Survivors With Posttraumatic Stress Disorder.

Clifford Georgina G Hitchcock Caitlin C Dalgleish Tim T

Clinical psychological science : a journal of the Association for Psychological Science 20200618 4

We examined the organization of past and future affective autobiographical knowledge in sexual-trauma survivors compared with control participants. Participants (<i>N</i> = 113) divided their past (and future) life into chapters (e.g., "college," "marriage"), then characterized each chapter using positive or negative attributes. Sexual-trauma survivors (<i>n</i> = 27) endorsed a greater proportion of negative attributes, demonstrated greater affective compartmentalization (separation of positive ...[more]

PMID: 32832257

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Project description:BackgroundRates of posttraumatic stress disorder (PTSD) among injury survivors are higher relative to the general population, supporting the need to identify those most at risk for PTSD following injury given negative impact of PTSD on recovery. Perceived life threat and assaultive trauma are consistent risk factors for subsequent PTSD development, although less work has explored them in combination. The current study evaluated whether trauma type (assaultive vs. nonassaultive) and perceived life threat, together, led to greater PTSD symptoms 1 month and 6 months postinjury.MethodsParticipants included adult injured trauma survivors admitted to a level 1 trauma center. While hospitalized, perceived life threat during trauma was assessed and mechanism of injury was collected via record review and was collapsed into two categories: assaultive and nonassaultive. The Clinician-Administered PTSD Scale (Diagnostic and Statistical Manual of Mental Disorders [Fifth Edition]) was administered at 1 month (N = 137) and 6 months (N = 220) after injury.ResultsThe four symptoms clusters of PTSD (intrusions, avoidance, hyperarousal, and negative mood/cognitions) were examined using four 2 (time) × 2 (life threat) × 2 (trauma type) mixed methods analyses of variance to assess differences based on risk factors and time. Results showed significant interaction effects of life threat, trauma type, and time for intrusive symptoms and avoidance symptoms. Individuals with life threat during assaultive traumas maintained heightened intrusive symptoms across time and increased avoidance at 6 months. On the other hand, participants with either life threat or assaultive traumas had decreased symptoms at 6 months.ConclusionExperiencing assaultive trauma and life threat led to greater symptoms of PTSD. Individuals with assaultive traumas who experienced life threat may represent a specific at-risk group following injury. Avoidance can protract functional impairment and impede access to care, negatively impacting recovery. This study highlights a need to assess for these peritrauma factors during hospitalization and supports early intervention targeting avoidance and intrusive symptoms in this group.Level of evidencePrognostic/Epidemiologic, Level IV.

Project description:ImportanceFirst-line treatment for posttraumatic stress disorder (PTSD) in the US Department of Veterans Affairs (VA), ie, trauma-focused therapy, while effective, is limited by low treatment initiation, high dropout, and high treatment refraction.ObjectiveTo evaluate the effectiveness of Trauma Center Trauma-Sensitive Yoga (TCTSY) vs first-line cognitive processing therapy (CPT) in women veterans with PTSD related to military sexual trauma (MST) and the hypothesis that PTSD outcomes would differ between the interventions.Design, setting, and participantsThis multisite randomized clinical trial was conducted from December 1, 2015, to April 30, 2022, within 2 VA health care systems located in the southeast and northwest. Women veterans aged 22 to 71 years with MST-related PTSD were enrolled and randomized to TCTSY or CPT.InterventionsThe TCTSY intervention (Hatha-style yoga focusing on interoception and empowerment) consisted of 10 weekly, 60-minute group sessions, and the CPT intervention (cognitive-based therapy targeting modification of negative posttraumatic thoughts) consisted of 12 weekly, 90-minute group sessions.Main outcome and measuresSociodemographic data were collected via self-report survey. The primary outcome, PTSD symptom severity, was assessed using the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) and PTSD Checklist for DSM-5 (PCL-5). Assessments were conducted at baseline, midintervention, 2 weeks post intervention, and 3 months post intervention.ResultsOf 200 women veterans who consented to participate, the intent-to-treat sample comprised 131 participants (mean [SD] age, 48.2 [11.2] years), with 72 randomized to TCTSY and 59 randomized to CPT. Treatment was completed by 47 participants (65.3%) in the TCTSY group and 27 (45.8%) in the CPT group, a 42.6% higher treatment completion rate in the TCTSY group (P = .03). Both treatment groups improved over time on the CAPS-5 (mean [SD] scores at baseline: 36.73 [8.79] for TCTSY and 35.52 [7.49] for CPT; mean [SD] scores at 3 months: 24.03 [11.55] for TCTSY and 22.15 [13.56]) and the PCL-5 (mean [SD] scores at baseline: 49.62 [12.19] for TCTSY and 48.69 [13.62] for CPT; mean [SD] scores at 3 months: 36.97 [17.74] for TCTSY and 31.76 [12.47]) (P < .001 for time effects). None of the group effects or group-by-time effects were significant. Equivalence analyses of change scores were not significantly different between the TCTSY and CPT groups, and the two one-sided test intervals fell within the equivalence bounds of plus or minus 10 for CAPS-5 for all follow-up time points.Conclusions and relevanceIn this comparative effectiveness randomized clinical trial, TCTSY was equivalent to CPT in reducing PTSD symptom severity, with both groups improving significantly. The higher treatment completion rate for TCTSY indicates its higher acceptability as an effective and acceptable PTSD treatment for women veterans with PTSD related to MST that could address current VA PTSD treatment limitations.Trial registrationClinicalTrials.gov Identifier: NCT02640690.

Dataset Information

Fractured Pasts: The Structure of the Life Story in Sexual-Trauma Survivors With Posttraumatic Stress Disorder.

Publications

Fractured Pasts: The Structure of the Life Story in Sexual-Trauma Survivors With Posttraumatic Stress Disorder.

Similar Datasets

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