Publications of Interest

Publications of Interest – August 2017

Dan Nothmann, PsyD, Editor

A sampling of recent articles on PTSD focusing on factors of reslience. Boelen PA, Lenferink LIM. (2017) “Experiential acceptance and trait-mindfulness as predictors of analogue post-traumatic stress.” Psychology and Psychotherapy. 2017 Jul 14. doi: 10.1111/papt.12138. [Epub ahead of print] PubMed PMID: 28707425.

OBJECTIVES: Experiential acceptance and trait-mindfulness are associated with posttraumatic stress disorder (PTSD) after traumatic events. This study was a preliminary attempt to examine (1) associations of experiential acceptance and trait-mindfulness with post-traumatic stress (PTS) associated with negative, but not necessarily traumatizing, life events (‘analogue’ PTS), (2) the role of these variables in the context of neuroticism as well as worry and rumination – two other regulatory strategies associated with PTS, and (3) the impact of pre-trauma tendencies towards experiential acceptance and mindfulness on analogue PTS. DESIGN: Data were obtained from two distinct student samples. A first sample provided cross-sectional data. In a second sample, indices of acceptance, mindfulness, neuroticism, worry, and rumination were tapped at inclusion into the study, and analogue PTS and confrontation with stressful life events were subsequently assessed 1 year later. RESULTS: In the cross-sectional sample, higher acceptance and mindfulness were associated with lower analogue PTS, even when controlling for neuroticism, worry, and rumination. In the prospective sample, pre-trauma mindfulness (but not experiential acceptance, neuroticism, worry, and rumination) assessed at baseline predicted levels of analogue PTS 1 year later. CONCLUSIONS: Findings suggest that experiential acceptance and trait-mindfulness are incrementally related to PTS beyond neuroticism, worry, and rumination and that pre-trauma traitmindfulness may be a resilience factor protecting against severe PTS. PRACTITIONER POINTS: We examined associations of experiential acceptance and trait-mindfulness with post-traumatic stress (PTS) associated with negative life events (‘analogue’ PTS). Experiential acceptance and trait-mindfulness were associated with concurrent analogue PTS, over and above neuroticism, worry, and rumination. Pre-trauma trait-mindfulness (but not pre-trauma experiential acceptance) significantly predicted analogue PTS in prospective analyses. Enhancing mindfulness skills could be a useful tool to reduce the risk of PTS in trauma-exposed samples.

Reprints: Boelen PA. Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, The Netherlands.
Email: P.A.Boelen@uu.nl

Carlson EB, Palmieri PA, Spain DA. (2017). “Development and preliminary performance of a risk factor screen to predict posttraumatic psychological disorder after trauma exposure.” General Hospital Psychiatry. 2017 May;46:25-31. doi: 10.1016/j.genhosppsych.2016.12.011. Epub 2016 Dec 27. PubMed PMID: 28622811.

OBJECTIVE: We examined data from a prospective study of risk factors that increase vulnerability or resilience, exacerbate distress, or foster recovery to determine whether risk factors accurately predict which individuals will later have high posttraumatic (PT) symptom levels and whether brief measures of risk factors also accurately predict later symptom elevations. METHOD: Using data from 129 adults exposed to traumatic injury of self or a loved one, we conducted receiver operating characteristic (ROC) analyses of 14 risk factors assessed by full-length measures, determined optimal cutoff scores, and calculated predictive performance for the nine that were most predictive. For five risk factors, we identified sets of items that accounted for 90% of variance in total scores and calculated predictive performance for sets of brief risk measures. RESULTS: A set of nine risk factors assessed by full measures identified 89% of those who later had elevated PT symptoms (sensitivity) and 78% of those who did not (specificity). A set of four brief risk factor measures assessed soon after injury identified 86% of those who later had elevated PT symptoms and 72% of those who did not. CONCLUSIONS: Use of sets of brief risk factor measures shows promise of accurate prediction of PT psychological disorder and probable PTSD or depression. Replication of predictive accuracy is needed in a new and larger sample.

Reprints: Carlson EB. National Center for Posttraumatic Stress Disorder, VA Palo Alto Health Care System, 795 Willow Rd., Menlo Park, CA 94025, USA
Email: eve.carlson@va.gov

Pearson-Leary J, Eacret D, Chen R, Takano H, Nicholas B, Bhatnagar S. (2017). “Inflammation and vascular remodeling in the ventral hippocampus contributes to vulnerability to stress.” Translational Psychiatry. 2017 Jun 27;7(6):e1160. doi: 10.1038/tp.2017.122. PubMed PMID: 28654094; PubMed Central PMCID: PMC5537643.

During exposure to chronic stress, some individuals engage in active coping behaviors that promote resiliency to stress. Other individuals engage in passive coping that is associated with vulnerability to stress and with anxiety and depression. In an effort to identify novel molecular mechanisms that underlie vulnerability or resilience to stress, we used nonbiased analyses of microRNAs in the ventral hippocampus (vHPC) to identify those miRNAs differentially expressed in active (long-latency (LL)/resilient) or passive (short-latency (SL)/vulnerable) rats following chronic social defeat. In the vHPC of active coping rats, miR-455-3p level was increased, while miR-30e-3p level was increased in the vHPC of passive coping rats. Pathway analyses identified inflammatory and vascular remodeling pathways as enriched by genes targeted by these microRNAs. Utilizing several independent markers for blood vessels, inflammatory processes and neural activity in the vHPC, we found that SL/vulnerable rats exhibit increased neural activity, vascular remodeling and inflammatory processes that include both increased blood-brain barrier permeability and increased number of microglia in the vHPC relative to control and resilient rats. To test the relevance of these changes for the development of the vulnerable phenotype, we used pharmacological approaches to determine the contribution of inflammatory processes in mediating vulnerability and resiliency. Administration of the pro-inflammatory cytokine vascular endothelial growth factor-164 increased vulnerability to stress, while the non-steroidal anti-inflammatory drug meloxicam attenuated vulnerability. Collectively, these results show that vulnerability to stress is determined by a re-designed neurovascular unit characterized by increased neural activity, vascular remodeling and pro-inflammatory mechanisms in the vHPC. These results suggest that dampening inflammatory processes by administering anti- inflammatory agents reduces vulnerability to stress. These results have translational relevance as they suggest that administration of anti-inflammatory agents may reduce the impact of stress or trauma in vulnerable individuals.

Reprints: Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, Email: pearsonlearyj@email.chop.edu

Musazzi L, Tornese P, Sala N, Popoli M. (2017). “Acute or Chronic? A Stressful Question.” Trends in Neuroscience. 2017 Aug 1. pii: S0166-2236(17)30136-4.doi: 10.1016/j.tins.2017.07.002. [Epub ahead of print] Review. PubMed PMID: 28778394.

Stress is a primary risk factor for neuropsychiatric disorders; at times, even a single trauma can trigger psychopathology. Many rodent models of neuropsychiatric disorders use chronic stress, measuring readouts at the end of long protocols. In a way, traditional chronic models overlook a crucial question: how does the physiological response to stressor(s) turn into a maladaptive pathway that may verge towards psychopathology? Recent evidence suggests that studying the long-term consequences of acute stress would provide critical information on the role of stress in psychopathology. This new conceptual framework could enable us to understand the determinants of a pro-adaptive versus maladaptive trajectory of stress response, and also to study the mechanism of rapid-acting antidepressants, such as ketamine, that target the glutamate system directly. Reprints: Laboratory of Neuropsychopharmacology and Functional Neurogenomics – Dipartimento di Scienze Farmacologiche e Biomolecolari and Center of Excellence on Neurodegenerative Diseases, Università di Milano, Milano, Italy. Email: maurizio.popoli@unimi.it Teche SP, Barros AJS, Rosa RG, Guimarães LP, Cordini KL, Goi JD, Hauck S, Freitas LH. (2017). “Association between resilience and posttraumatic stress disorder among Brazilian victims of urban violence: a cross-sectional case-control study.” Trends in Psychiatry and Psychotherapy. 2017 Apr-Jun;39(2):116-123. doi: 10.1590/2237-6089-2016-0070. PubMed PMID: 28700041. Introduction: This study investigated the association between resilience and posttraumatic stress disorder (PTSD) among Brazilian victims of urban violence. It also compared defense mechanisms, parental bonding, and childhood trauma between those who developed PTSD and those who did not. Methods: This cross-sectional case-control study included 66 adult subjects exposed to recent urban violence in southern Brazil – 33 with PTSD and 33 healthy controls matched by sex and age – who were administered the Resilience Scale, Defense Style Questionnaire, Parental Bonding Instrument, and Childhood Trauma Questionnaire. The statistical tests used were the McNemar test for categorical variables, the Wilcoxon signed-rank test for continuous asymmetric variables, and the paired Student t-test for continuous symmetric variables. Results: The PTSD group showed lower total Resilience Scale scores compared with controls (128.4±20.7 vs. 145.8±13.1, respectively; p = 0.01), along with a lower ability to solve situations and lower personal values that give meaning to life (p = 0.019). They also had lower rates of mature defense mechanisms (p < 0.001) and higher rates of emotional (p = 0.001) and physical (p = 0.003) abuse during childhood. Conclusion: Lower levels of resilience, especially the ability to solve situations and having personal values that give meaning to life, immature defense mechanisms, and emotional and physical abuse in childhood are associated with PTSD in adult Brazilian victims of urban violence.

Reprints: Teche SP. Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.

If you have published an article or know of an article that you think should be included in this column, please send the complete citation, and if possible, reprint address and email, to Dan Nothmann, Psy.D., 20 Crossroads Dr., Ste. 103, Owings Mills, MD 21117 or email it to DNothmann@Comcast.net. Copies of complete articles are especially welcome

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