Traumatic Stress

Charles R. Figley was the 1994 recipient of the Lifetime Achievement Award from the International Society for Traumatic Stress Studies. Figley's impact on the field can be seen in his community involvement and in his nearly 20 years of writing. During those years, byhis actions and words, he has called our attention to both the direct and indirect victims of trauma. M+His most recent book, Compassion Fatigue: Coping with Secondary PTSD Among Those Who reat the Traumatized, is a landmark contribution to the STS literature. In this chapter, Figley outlines the logic of his thinking and helps the reader understand the context from which STS can arise.

Service Members experience trauma on the literal battlefield so severe that it has a terminal effect on their faith. Many civilians may also experience events that produce a paralyzing effect through trauma on the figurative battlefield. Religious Existential Counseling allows a person to witness the effect of trauma on the personal belief system in which a triggered emotional response leads into a behavior, which may affect a person’s identity, their inner world and belief system. The inner world harbors many aspects of the identity, but one in particular is the belief system. The fact in which a person may disengage from the social world by a triggered emotional response, may lead into a change of behavior, affecting one’s identity, or even the core belief system. The belief system empowers a person to do many things such as minimize the effect of trauma, find meaning and purpose, and prepare for future trauma with self-confidence. The belief system interprets the signals of the core and translates them into the behavioral patterns. Behaviorally, the belief system acts as it has been taught, influenced, or inspired by its predecessor parts of the identity and core.  Evidence for this research presupposes that a reaction point, in which a person may acknowledge the response of the disengagement, may be identified and addressed prior to an effect to minimize the consequences. The behavior that ensues from any effect can be validated and normalized through discovery of the recognition of the limitation and acceptance in which a person has the option of self-care or professional counseling. If this person does not identify the disengagement trigger, or validate the response to the stimulus, the negative behavior will manifest and affect a person’s ability to choose. This ultimately affects the internal dimensions of the identity and distresses the spiritual world, or soul. A person can experience stress so intense that the core of their being is traumatized to their spiritual core. The spiritual core of the identity, exercised in the physical expression in a religious relationship to God, is the refuge and strength that is available. The three concepts that have been proven through research to have an influence on  trauma as one enters into spiritual fellowship with other like-believers, finding meaning and purpose in life through this fellowship, which creates an ongoing relationship with God. Whether a person can determine the location of the spiritual part of his or her identity, does not negate the fact that everyone is spiritual. Each person worships something in life. It is the spiritual core that focuses on a relationship with God, a higher power, that can provide that resilience and prevention of the sustained trauma on a literal or figurative battlefield.

Health is a fundamental component of well-being. Children's health affects their ability to succeed in school and engage in other learning opportunities within the contexts of their family, neighborhood, and community. This brief examines the relationship between the health of children and that of their parents, and between the availability of emotional support for parenting and children's health, based on a large national sample. We use parent self-reports of health, which prior research has determined are valid measures of health status for both parents and their children. We find that, controlling for demographic and household characteristics, children's health is strongly associated with the health of their parents, suggesting that approaches addressing two-generation health may be beneficial. However, the availability of emotional support for parenting is not significantly associated with children's health.

Twenty three adolescents with a history of cancer, 27 physically abused adolescents, and 23 healthy, nonabused adolescents were administered structured posttraumatic stress disorder (PTSD) interviews and self-report questionnaires regarding family functioning. Thirty five percent of adolescent cancer subjects met criteria for lifetime PTSD as compared to only 7% of the abused adolescents: 17% of the cancer subjects and 11% of the abuse subjects met criteria for current PTSD. Adolescents with cancer viewed their mothers and fathers as significantly more caring and more protective than the comparison and abused adolescents. Cancer subjects who met criteria for lifetime PTSD save their families as significantly more chaotic than those who did not have PTSD. Eighty three percent of cancer subjects who had lifetime PTSD also had mothers who had PTSD.

Posttraumatic nightmares are a hallmark of PTSD and distinct from general nightmares as they are often repetitive and faithful representations of the traumatic event. This paper presents data from a pilot study that examined the use of Imagery Rehearsal in treating combat-related nightmares of 12 Vietnam veterans with PTSD. Three treatment groups, comprising 4 veterans in each, completed standardised treatment across 6 sessions. Treatment effects were investigated using nightmare diaries and established instruments, including the IES-R, BDI, BAI, and SCL-90-R. The data demonstrate significant reductions in nightmares targeted, and improvements in PTSD and comorbid symptomatology. The paper recommends that, on the basis of the promising preliminary data, a randomised control trial be established to assess imagery ability and attidude toward nightmares.

... which originally read “I hurt myself accidently,” was changed to read “I have attempted to harm myself' to more accurately reflect the question's intent. To increase the range of scores within each personality type. ... Page 8. ... This predictive power was accomplished using a brief TEQ. ...

Because the war was relatively brief, casualties relatively light, and the Nation sanctioned the war socially, veterans of Desert Shield/Storm and their families were not anticipated to suffer symptoms of trauma or re-entry stress beyond that expected in routine peacetime military deployments. However, the authors argue that the stress imposed on families by Desert Shield/Storm was not analogous to that of routine deployments. The call to duty was unexpected, disruptive, and “hazardous” (i.e., highly dangerous) which places it in the category of a “catastrophic” stressor as defined by McCubbin and Figley (1983). The deployment was a call to war, which creates unique stress beyond those experienced during peacetime deployments. The deployment also carried with it prolonged “anticipation of trauma.” For these reasons, the authors argue, the deployment to Desert Shield/Storm created a situation of “family trauma” for veterans and their families. Suggestions are offered for education, prevention and treatment for families undergoing unexpected wartime military deployments.

Despite substantially higher rates of posttraumatic stress disorder (PTSD) among male inmates than among men in the general population, there is a dearth of research on PTSD among incarcerated men. The current study addresses traumatic events that precede PTSD and psychiatric disorders that are comorbid with PTSD in an inmate sample. Seeing someone seriously injured or killed, being sexually abused, and being physically assaulted were the three most commonly reported antecedent traumas to PTSD. Lifetime and current rates of mood disorders, anxiety disorders, and antisocial personality disorder were elevated among inmates with a diagnosis of PTSD. Two hundred and thirteen inmates participated in the study. Sixty-nine participants (33%) met lifetime DSM–III–R criteria for PTSD, and 45 (21%) met current criteria. The findings are compared with general population samples, and implications of the findings are discussed.

Pregnancy and childbirth are traditionally recognised as life events that are to be cherished and celebrated. However, recent media coverage and official reports of deaths by suicide, including the last report of the Confidential Enquiry on Maternal and Child Health (CEMACH) (2004) have raised public and health professionals’ awareness of the potential dangers of mental health problems to mothers during pregnancy and in the first year after giving birth. Suicidality has been reported as a common symptom in postpartum psychosis (PPP) (Burt and Stein, 2002). While PPP is a rare event following birth, other more common mental health issues associated with childbirth are correlated positively with suicide. This has led to the US Congress introducing a ‘House Resolution’ (H.Res 51) encouraging the US National Institutes of Health to investigate the mental health issues associated with postpartum mental health problems (Lindahl et al, 2005). Surprisingly, there is a paucity of literature investigating the prevalence of suicide during pregnancy and the year after giving birth. Lindahl et al (2005), in a systematic review of prevalence studies of maternal suicide, identified only nine studies globally that have attempted to identify the scope of the problem of maternal suicide.

The relative values of imaginal and real-life exposure exercises were tested in this study by randomizing 14 patients who met DSM-III-R criteria for PTSD at least 6 months after the initiating trauma to one of two groups. Group 1 (n=7) had four, weekly, hour-long sessions of imaginal exposure followed by four, weekly, hour-long sessions of live exposure. Group 2 (n=7) had the reverse order of four live exposure sessions followed by four imaginal exposure sessions. Both groups improved significantly on both PTSD-specific measures and measures of general health post-treatment, and significantly further on 7 out of 12 measures at follow up 12 months post-treatment. Clinical improvement was in the order of 65–80% reduction in target symptoms. On one measure only (problem 2 — phobic avoidance), live exposure yielded more improvement than imaginal exposure whether given first or second. The importance of both live and imaginal exposure to all relevant cues, behavioral and cognitive, is discussed, together with the value of self-exposure homework for patients with PTSD.

Did you know the most dominant apes and monkeys are usually the kindest? They share the most food, groom others more often, break up fights, are slow to anger, and breathe in a relaxed manner. Those on the bottom of the social hierarchy are the opposite. They are stingy, combative, irritable, anxious, depressed, and they breathe shallowly. It is not easy for a submissive primate to become dominant. They have mindsets, mannerisms, and muscle tension that keep them from escaping their subordinate social strategy and the chronic stress it produces.

All of this generalizes to people. If you want to be free of negative emotion, you need to rehabilitate physical trauma in your breath, eyes, face, voice, heart, gut, spine, and brain. Program Peace will coach you to do precisely this by first retraining your breathing pattern, and then walking you through dozens of innovative and effective self-care exercises. After creating new mindsets and mannerisms, and learning to reinvigorate muscles you never knew you had, you will find yourself more confident, healthier, kinder, and reprogrammed for peace.

Data regarding the development of a structured interview measuring alterations that may accompany extreme stress are presented. A list of 27 criteria often seen in response to extreme trauma and not addressed by DSM-IV criteria for posttraumatic stress disorder (PTSD) were generated based on a systematic review of the literature and a survey of 50 experts. A structured interview for disorders of extreme stress (SIDES) measuring the presence of these criteria was administered to 520 subjects as part of the DSM-IV PTSD field trials. Inter-rater reliability as measured by Kappa coefficients for lifetime Disorders of Extreme Stress was .81. Internal consistency using coefficient alpha ranged from .53 to .96. Results indicate that the SIDES is a useful tool for investigation of response to extremes stress.

Swedes are developing a new collection of pharmacy approaches based on chemistry of love.  Love is a drug.  Oxytocin, prolactin, etc. help with over 300 body functions.  Here is a bibliography for over 60 clinical trials and over 40 diseases where motherly touch/gentle massage  had positive impact.

Two hundred thirty four participants in the DSM-IV Posttraumatic Stress Disorder (PTSD) Field Trial who reported sexual and/or physical abuse were evaluated. Participants were categorized according to type of abuse (physical, sexual, both), duration of abuse (acute versus chronic), and onset of abuse (early versus late). Separate logistic regression analyses examined the relationship between age of onset, duration, abuse type, and the complex PTSD (CP) lifetime diagnosis for women and men. Sexually abused women, especially those who also experienced physical abuse, had a higher risk of developing CP, although CP symptoms occurred at a high base rate among physically abused women. The theoretical implications and incremental clinical usefulness of targeting CP symptoms with abused populations are discussed.

The practitioners of village stability operations operate nearly entirely in the spaces of communities damaged by combinations of traumatizing violence, loss, displacement, starvation, death and dismemberment. Their organization, equipping and training is focused on the most apparent physical security and developmental needs by those who fund and support their deployments and to a lesser extent on reparation of political dialogue as part of restorative justice and the reparative process. The psychological and sociological damage that these practitioners encounter however, often leads to frustration, overextension of personnel and resources and eventual failure. This paper explores the existence, nature and depth of psychological and sociological damage to communities traumatized by violent conflict. The purpose of this research is to establish a baseline of psychosocial-cultural intelligence on conflict societies that can be used to plan, prepare and execute peace operations and humanitarian missions. This psychosocial-cultural intelligence or understanding of traumatized communities provides peace operations and humanitarian missions with analysis and method to engage and influence traumatized communities to the point that they are able to provide for their self-sustainment without participation in communal violence. By exposing the pathology of sociological trauma at the family, village and tribal levels of structure, we can begin to unwind and resolve intractable conflicts in failing and failed societies despite limited time and resources of peace operations donors and practitioners.

Contents
The challenge of stabilizing villages and tribes in conflict ........................................................................... 3
Trauma and the family’s sociological structure ............................................................................................ 6
Village stability, trauma and the sociocentric family.................................................................................. 10
Internal identities and external locus of control in sociocentric families ............................................... 11
Communication and meaning in the sociocentric family ........................................................................ 14
The emotional logic of violence, shame, and trauma.................................................................................. 16
The rage of shame in sociocentric community ........................................................................................ 17
Psychological pathways to violence & suicidal terrorism ...................................................................... 21
Connecting failed states to traumatized communities ................................................................................. 22
Intractable cultural conflict: generational transmission of trauma .............................................................. 24
Crossing the trauma barrier - reestablishing meaning in traumatized communities ................................... 27
Relieving sociological trauma and rebuilding society ................................................................................ 31
Conclusion .................................................................................................................................................. 33
Bibliography ............................................................................................................................................... 35

Comment: This chapter develops portions of an invited symposium presentation I gave at ISTSS in November 2004 . In particular, we conduct a "10 year follow up" of a surprisingly scathing keynote address that developmental psychopathology pioneer Norman Garmezy gave at ISTSS. In that address, Garmezy criticized the traumatic stress field for its naive, inconsistent, and confusing approach to defining and studying resilience, and for failing to take advantage of 15 years' worth of work in developmental psychopathology. A (heavily) annotated version of my symposium presentation is available under the "Talks" tab herein (note that my symposium presentation contains some content not subsequently developed in my subsequent chapters and articles; i.e., unique content).