Larry Minikes 8/14/19 Larry Minikes 8/14/19

Survivors' near-miss experiences on 9/11 linked to post-traumatic stress

Findings contribute to an understanding of what counts as exposure to trauma

July 11, 2019

Science Daily/University at Buffalo

People who narrowly avoid disaster do not necessarily escape tragedy unharmed, and their knowledge of the victims' fate shapes how survivors respond to traumatic events, according to the results of a new paper by a University at Buffalo psychologist that explores the effects of near-miss experiences associated with the 9/11 terrorist attacks.

"There is a misfortune to being fortunate," says Michael Poulin, an associate professor of psychology at UB and lead author of the paper published in the journal Social Psychological and Personality Science.

"You would think that having a near-miss experience is unequivocally good news. That means it didn't happen to you. Although obviously that's far more preferable than having tragedy befall you, it turns out that merely being aware of that fact can be burdensome -- and it's particularly true when it's vivid that others were not as fortunate."

Poulin's study, with Roxane Cohen Silver, professor of psychological science, medicine and public health at The University of California, Irvine, deepens the understanding of how large-scale trauma affects mental health.

"We tend to focus understandably on those who were affected, but our data suggest that even people who were not directly affected in any obvious way can be upset by mentally comparing what didn't happen to them in light of what actually happened to someone else, who easily could have been them."

Despite the frequency with which "survivor guilt" appears in casual conversation and popular culture, this study turns out to be among the few to directly examine near miss experiences.

"Survivor guilt is widely understood to be true, almost like a kind of clinical lore," says Poulin, an expert in stress and coping. "But in the context of near-miss experiences, there's just not much there if you go looking for empirical data on the existence of survivor guilt."

Near-miss experiences are difficult to study because of the challenges involved in finding a representative sample, but 9/11 provided Poulin and Silver with the opportunity to conduct rigorous research on the phenomenon -- even though neither of the scientists were at first interested in doing so.

"This project shaped much of my graduate career," says Poulin. "Professor Silver, my co-author and advisor at the time, studies responses to trauma, in particular mass tragedies. Despite that focus, as a research team we talked it over and agreed not to go anywhere near this event. It was too raw and painful to think about a psychological study."

That conversation changed in the days after the attack when media outlets began speculating on its psychological effects with no research to support their commentary.

"What we originally considered to be exploitative suddenly appeared to be necessary," says Poulin. "This was something that needed to be studied."

The researchers used a 1,433-participant sample provided by an online research company, which assessed a near-miss experience by asking, "Did you or someone close to you experience a near miss as a result of the Sept. 11 terrorist attacks?"

Some examples include:

· My brother-in-law on the 90th floor where he works called in sick.

· I got a job in the World Trade Center a couple months before, and did not take it.

· My son-in-law would have been on that flight, but my daughter got sick and he took her to the hospital.

The findings suggest that the near-miss participants reported higher levels of re-experiencing symptoms (sudden, traumatic memories of the event) that persisted over three years and probable post-traumatic stress disorder.

The PTSD is, not surprisingly, affected more by direct exposure, but that near-misses exist as an independent predictor suggests that their role is not related exclusively to familiarity with the victims.

"I think this study contributes to a broader debate that people are having in the world of psychology about what counts as being exposed to trauma," says Poulin. "This is also something clinicians should continue to be aware of in terms of evaluating their clients' mental health.

"It's not just 'Did this happen to you?'" "But 'Did something almost happen to you?'" Poulin notes that these findings are based on one event of a particular magnitude and whether they can be generalized is still as yet an unanswered empirical question.

"But it would be important to find that answer," he says.

https://www.sciencedaily.com/releases/2019/07/190711122703.htm

Larry Minikes 8/12/19 Larry Minikes 8/12/19

Children develop PTSD when they ruminate over their trauma

March 26, 2019

Science Daily/University of East Anglia

A new study shows that children are more likely to suffer PTSD if they think their reaction to a traumatic event is not 'normal'. While most children recover well after a traumatic event, some go on to develop PTSD that may stay with them for months, years, or even into adulthood. The research reveals that children begin down this route when they have trouble processing their trauma and perceive their symptoms as a sign that something is seriously wrong.

While most children recover well after a traumatic event, some go on to develop PTSD that may stay with them for months, years, or even into adulthood.

A new study, published today, reveals that children begin down this route when they have trouble processing their trauma and perceive their symptoms as being a sign that something is seriously wrong.

Lead researcher Prof Richard Meiser-Stedman, from UEA's Norwich Medical School, said: "Symptoms of PTSD can be a common reaction to trauma in children and teenagers. These can include distressing symptoms like intrusive memories, nightmares and flashbacks. Health professionals steer away from diagnosing it in the first month after a trauma because, rather than being a disorder, it's a completely normal response.

"Many children who experience a severe traumatic stress response initially can go on to make a natural recovery without any professional support. But a minority go on to have persistent PTSD, which can carry on for much longer.

"We wanted to find out more about why some children have significant traumatic stress symptoms in the days and weeks after a trauma and while others do not, and importantly -- why some recover well without treatment, while others go on to experience more persistent problems."

The research team worked with over 200 children aged between eight and 17 whaumao had attended a hospital emergency department following a one-off traumatic incident. These included events such as car crashes, assaults, dog attacks and other medical emergencies.

These young people were interviewed and assessed for PTSD between two and four weeks following their trauma, and again after two months.

The research team split the children's reactions into three groups -- a 'resilient' group who did not develop clinically significant traumatic stress symptoms at either time point, a 'recovery' group who initially displayed symptoms but none at the two month follow up, and a 'persistent' group who had significant symptoms at both time points.

The team also examined whether social support and talking about the trauma with friends or family may be protective against persistent problems after two months. They also took into account factors including other life stressors and whether the child was experiencing on-going pain.

Dr Meiser-Stedman said: "We found that PTSD symptoms are fairly common early on -- for example between two and four weeks following a trauma. These initial reactions are driven by high levels of fear and confusion during the trauma.

"But the majority of children and young people recovered naturally without any intervention.

"Interestingly the severity of physical injuries did not predict PTSD, nor did other life stressors, the amount of social support they could rely on, or self-blame.

"The young people who didn't recover well, and who were heading down a chronic PTSD track two months after their trauma, were much more likely to be thinking negatively about their trauma and their reactions -- they were ruminating about what happened to them.

"They perceived their symptoms as being a sign that something was seriously and permanently wrong with them, they didn't trust other people as much, and they thought they couldn't cope.

"In many cases, more deliberate attempts to process the trauma -- for example, trying to think it through or talk it through with friends and family -- were actually associated with worse PTSD. The children who didn't recover well were those that reported spending a lot of time trying to make sense of their trauma. While some efforts to make sense of trauma might make sense, it seems that it is also possible for children to get 'stuck' and spend too long focusing on what happened and why.

"The young people who recovered well on the other hand seemed to be less bothered by their reactions, and paid them less attention."

https://www.sciencedaily.com/releases/2019/03/190326081345.htm

Larry Minikes 2/14/19 Larry Minikes 2/14/19

Brain biomarkers could help identify those at risk of severe PTSD

Study links brain activity related to associative learning with PTSD symptom severity

January 28, 2019

Science Daily/NIH/National Institute of Mental Health

A study has shed light on the neurocomputational contributions to the development of post-traumatic stress disorder in combat veterans. The findings revealed distinct patterns for how the brain and body respond to learning danger and safety depending on the severity of PTSD symptoms. These findings could help explain why symptoms of PTSD can be severe for some people but not others.

"Researchers have thought that the experience of PTSD, in many ways, is an overlearned response to survive a threatening experience," said Susan Borja, Ph.D., chief of the NIMH Dimensional Traumatic Stress Research Program. "This study clarifies that those who have the most severe symptoms may appear behaviorally similar to those with less severe symptoms, but are responding to cues in subtly different, but profound, ways."

PTSD is a disorder that can sometimes develop after exposure to a traumatic event. People with PTSD may experience intrusive and frightening thoughts and memories of the event, experience sleep problems, feel detached or numb, or may be easily startled. While almost half of all U.S. adults will experience a traumatic event in their life, most do not develop PTSD.

One theory explaining why some symptoms of PTSD develop suggests that during a traumatic event, a person may learn to view the people, locations, and objects that are present as being dangerous if they become associated with the threatening situation. While some of these things may be dangerous, some are safe. PTSD symptoms result when these safe stimuli continue to trigger fearful and defensive responses long after the trauma has occurred.

Despite the prominence of this theory, the way in which this learning occurs is not well understood. In this study, Ilan Harpaz-Rotem, Ph.D., associate professor of psychiatry at Yale University, New Haven, Connecticut, Daniela Schiller, Ph.D., associate professor of psychiatry and neuroscience at the Icahn School of Medicine at Mount Sinai, New York City, and colleagues examined how the mental adjustments performed during learning and the way in which the brain tracks these adjustments relate to PTSD symptom severity.

Combat veterans with varying levels of PTSD symptom severity completed a reversal learning task in which two mildly angry human faces were paired with a mildly aversive stimulus. During the first phase of this task, participants learned to associate one face with the mildly aversive stimulus. During the second phase of this task this association was reversed, and participants learned to associate the second face with the mildly aversive stimulus.

Although all participants, regardless of PTSD symptomology, were able to perform the reversal learning, when the researchers took a closer look at the data, they found highly symptomatic veterans responded with greater corrections in their physiological arousal (i.e., skin conductance responses) and several brain regions to cues that did not predict what they had expected.

The amygdala, a brain area involved in associative learning, value encoding, and emotional responses, was particularly important. Both smaller amygdala volume and less precise tracking of the negative value of the face stimuli in the amygdala independently predicted PTSD symptom severity. Differences in value tracking and associability were also found in other brain regions involved in computation related to threat learning, such as the striatum, the hippocampus, and the dorsal anterior cingulate cortex.

"What these results tell us is that PTSD symptom severity is reflected in how combat veterans respond to negative surprises in the environment -- when predicted outcomes are not as expected -- and the way in which the brain is attuned to these stimuli is different," said Dr. Schiller. "This gives us a more fine-grained understanding of how learning processes may go awry in the aftermath of combat trauma and provides more specific targets for treatment."

"One's inability to adequately adjust expectations for potentially aversive outcomes has potential clinical relevance as this deficit may lead to avoidance and depressive behavior," said Dr. Harpaz-Rotem.

https://www.sciencedaily.com/releases/2019/01/190128125319.htm

Larry Minikes 10/3/17 Larry Minikes 10/3/17

Sleep deprivation could reduce intrusive memories of traumatic scenes

July 1, 2015

Science Daily/University of Oxford

A good night's sleep could be the wrong response to trauma

A good night's sleep has long been recommended to those who have experienced a traumatic event. But a new study provides preliminary experimental work suggesting it could actually be the wrong thing to do.

The research, conducted in Oxford's Wellcome Trust-funded Sleep and Circadian Neuroscience Institute (SCNi) and published in the journal Sleep, showed that sleep deprivation might prevent people from consolidating memories of experimental trauma (emotional film clips in the study), reducing their tendency to experience flashbacks.

Dr Kate Porcheret, from Oxford's Nuffield Department of Clinical Neurosciences, said: 'We wanted to see what effect sleep deprivation would have on the development of intrusive memories -- what in a clinical setting are called flashbacks. After showing participants a film of scenes with traumatic content, as an analogue to trauma, they were either kept in a sleep laboratory and deprived of sleep or sent home to have a normal night's sleep in their own bed.'

Each person then kept a diary in which they recorded any intrusive memories, however fleeting, recording as much information as possible so that the research team could check that the intrusive images were linked to the film.

Dr Katharina Wulff, from the SCNi, said: 'The sleep-deprived group experienced fewer intrusive memories than those who had been able to sleep normally. Both groups experienced more of these involuntary memories in the first two days and a reducing number in the following days. We know that sleep improves memory performance including emotional memory, but there may be a time when remembering in this way is unhelpful.'

The team stress that further research is needed as there is currently limited understanding of intrusive memories of emotional events as well as of the role of sleep in responding to real trauma, and that real-life trauma cannot be directly replicated in an laboratory study.

Dr Porcheret added: 'Finding out more how sleep and trauma interact means we can ensure people are well cared for after a traumatic event. These are really important research questions to pursue further. For example, it is still common for patients to receive sedatives after a traumatic event to help them sleep, even though we already know that for some very traumatised people this may be the wrong approach. That is why we need more research in both experimental and clinical settings into how our response to psychological trauma is affected by sleep -- and lack of sleep too.'

http://www.sciencedaily.com/releases/2015/07/150701104841.htm

Larry Minikes 9/1/17 Larry Minikes 9/1/17

Positive personality traits may protect police at high risk for PTSD

January 6, 2015

Science Daily/University at Buffalo

A new study looked at police officers in the New Orleans area during and after Hurricane Katrina. The results suggested that they were shielded from PTSD by the protective qualities not only in the immediate aftermath of the hurricane, but years later as well.

Personal traits such as resilience, satisfaction with life and a grateful disposition may help shield police officers from symptoms of post-traumatic stress disorder (PTSD) in the aftermath of a natural disaster.

This is the case even though repeated exposure to traumatic events has been found to provoke PTSD and police officers are exposed repeatedly to traumatic events. These are the conclusions of a new study that looked at police officers in the New Orleans area during and in the immediate aftermath of Hurricane Katrina. The results suggested that they were shielded from PTSD by the protective qualities not only in the immediate aftermath of the hurricane, but years later as well.

"We found that symptoms of PTSD significantly decreased among subjects as resilience, satisfaction with life and gratitude increased," says researcher John Violanti, PhD, professor of epidemiology and environmental health at the University at Buffalo and an internationally known expert on police stress. "This also was true among officers -- excluded from the study -- who did not work during the hurricane.

"This study extends our understanding of how positive factors are associated with reduced PTSD symptoms, and can inform and guide treatment modalities for PTSD," Violanti says.

"In this sample, unlike in studies of civilian populations, an experience of posttraumatic personal growth did not appear to mitigate PTSD symptoms in police officers, though the other three protective characteristics we studied did," Violanti says.

He elaborates on the study's results: "As in previous research, resilience scores decreased as the level of alcohol intake increased in the officers. "Gratitude scores were highest among African American officers, followed closely by Caucasians, with the lowest scores reported by Hispanic, Native American and Japanese officers. Officers with high and very high life satisfaction reported fewer PTSD symptoms, although given the cross-sectional nature of the study, it is difficult to say whether experiencing PTSD symptoms results in dissatisfaction with life or vice versa.

http://www.sciencedaily.com/releases/2015/01/150106104136.htm

officers in the New Orleans area during and after Hurricane Katrina. The results suggested that they were shielded from PTSD by the protective qualities not only in the immediate aftermath of the hurricane, but years later as well.