This document contains a summary of the current topic course: A Clinical Perspective on Today's Issues. It is a summary of the literature for the second interim exam.
A Clinical Perspective on Today’s Issues
Noa Kreike
December 2022
Inhoud
Lecture 7
Summary Literature Interim Exam 2............................................................................................................. 1
A Clinical Perspective on Today’s Issues........................................................................................................ 1
Brewin et al. (2009) Reformulating PTSD for DSM-V: Life After Criterion A...................................................3
Evaluation of three criticisms of PTSD....................................................................................................... 3
Improving the diagnosis of PTSD............................................................................................................... 3
Potential advantages and disadvantages of the proposed diagnostic criteria...........................................3
Ozer (2003) Predictors of Posttraumatic Stress Disorder and Symptoms in Adults; A Meta-Analysis............4
Prevalence of PTSD................................................................................................................................... 4
Prior Reviews and Focus of the Present Meta-Analysis.............................................................................4
Results...................................................................................................................................................... 4
Discussion................................................................................................................................................. 5
Ehlers and Clark (2000) A Cognitive Model of Posttraumatic Stress Disorder...............................................5
A cognitive model of PTSD........................................................................................................................ 5
Features of PTSD explained by the model................................................................................................. 7
Treatment implications............................................................................................................................. 7
Watkins et al. (2018) Treating PTSD: A Review of Evidence-Based Psychotherapy Interventions.................8
Diagnostic criteria and treatment guidelines............................................................................................8
Strongly recommended treatments.......................................................................................................... 8
Implications and future directions............................................................................................................ 8
Van den Hout & Engelhard (2012) How Does EMDR Work?..........................................................................9
Van Emmerik & Kamphuis (2015) Writing Therapies for Post-Traumatic Stress and Post-Traumatic Stress
Disorder: A Review of Procedures and Outcomes.......................................................................................10
Cacioppo & Hawkley (2009) Perceived Social Isolation and Cognition........................................................10
Cacioppo et al. (2015) Loneliness: Clinical Import and Interventions..........................................................11
Definition of loneliness........................................................................................................................... 11
Dimensions of loneliness......................................................................................................................... 11
Consequences of loneliness.................................................................................................................... 12
Interventions to reduce loneliness.......................................................................................................... 12
1
,Heinrich & Gullone (2006) The Clinical Significance of Loneliness: A literature Review..............................13
Social relationships and their function.................................................................................................... 13
Loneliness............................................................................................................................................... 13
The lonely prototype............................................................................................................................... 13
Antecedent and maintaining factors....................................................................................................... 13
Shaver & Mikulincer (2011) An Attachment-Theory Framework for Conceptualizing Interpersonal
Behaviour.................................................................................................................................................... 14
Basic concepts in attachment theory and research................................................................................. 14
Attachment-style differences in interpersonal behaviour.......................................................................14
Attachment-related cognitive motivational predispositions....................................................................15
Attachment-related differences in the processing of social information.................................................15
Antecedents of individual differences in attachment style......................................................................16
Brewin et al. (2009) Reformulating PTSD for DSM-V: Life After Criterion A..................................................2
Lecture 8
Ozer (2003) Predictors of Posttraumatic Stress Disorder and Symptoms in Adults; A Meta-Analysis...........3
Ehlers and Clark (2000) A Cognitive Model of Posttraumatic Stress Disorder...............................................4
Lecture 9
Watkins et al. (2018) Treating PTSD: A Review of Evidence-Based Psychotherapy Interventions.................6
Van den Hout & Engelhard (2012) How Does EMDR Work?.........................................................................7
Van Emmerik & Kamphuis (2015) Writing Therapies for Post-Traumatic Stress and Post-Traumatic Stress
Disorder: A Review of Procedures and Outcomes......................................................................................... 8
Lecture 10 & 11
Cacioppo & Hawkley (2009) Perceived Social Isolation and Cognition..........................................................9
Cacioppo et al. (2015) Loneliness: Clinical Import and Interventions..........................................................10
Heinrich & Gullone (2006) The Clinical Significance of Loneliness: A literature Review..............................11
Shaver & Mikulincer (2011) An Attachment-Theory Framework for Conceptualizing Interpersonal
Behaviour................................................................................................................................................... 12
2
,Brewin et al. (2009) Reformulating PTSD for DSM-
V: Life After Criterion A
Evaluation of three criticisms of PTSD
Criticism 1: PTSD pathologizes normal distress
The view is that reactions to stress are time-limited and that PTSD symptoms will resolve themselves.
However, extreme stress can lead to severe psychopathology and medical conditions. Also, normal
reactions to extreme stress do not correct themselves with PTSD.
Criticism 2: Inadequacy of criterion A - Issues:
- How broadly or narrowly should trauma be defined?
In the DSM-IV not personally experiencing the event was added to broaden the definition of
criterion A. Also events that involve a build-up of stress over a longer period of time can cause
PTSD.
In the DSM-IV criteria A2 people had to react to the traumatic event with intense fear,
helplessness, or horror, but only a small number of people have this reaction that meet the rest
of the criteria for PTSD. It is not a necessary criteria, because it is not assumed that the original
emotions are stable over time.
- Can trauma be measured reliably and validity?
- What is the relationship between trauma and PTSD?
PTSD plays a central role in the psychological response to trauma
Criticism 3: Symptom overlap with other disorders
Intrusive memory, image or thought is a criterion that is also a characteristic for depression as well.
Emotional and physical arousal elicited by specific situations and avoidance of those situations are
characteristics for phobias as well, and many more. Flashbacks and traumatic nightmares are criteria
solely for PTSD.
Improving the diagnosis of PTSD
Criterion A should be abolished, because it is unlikely that there is a formulation of the criterion were all
the problems and inconsistencies are addressed. Specifying events is undesirable, because of individual
differences in sensitization and vulnerability. PTSD should be refocused on reexperiencing in the present
accompanied by fear, because this is the focus in treatment and makes PTSD distinct from other
disorders.
Potential advantages and disadvantages of the proposed diagnostic
criteria
Elimination criterion A will insure that people do not have PTSD simply because the event is not
‘traumatic’ enough or because the specific emotions were not felt at that time. Furthermore, PTSD will
become more comparable with other disorders like anxiety disorder or depression.
3
, Ozer (2003) Predictors of Posttraumatic Stress
Disorder and Symptoms in Adults; A Meta-
Analysis
Post-Traumatic Stress Disorder (PTSD) was first introduced in the DSM-III. Traumatic events usually come
with very high adrenergic arousal and this high arousal comes back with reexperiencing. The amygdala
and hippocampus are involved in the registration of dangerous events and in the formation of
reexperiencing. This meta-analysis focusses on the difference between static predictors and predictors
that are influenced by the psychological and neurobiological processes after an traumatic event.
Prevalence of PTSD
Prevalence of PTSD is high amongst veterans, immigrants and refugees (specially when immigrated due to
conflict). More than 50% of people experience atraumatic event in their lifetime, but only about 7% will
suffer from PTSD. This gap led to the question if there are any risk factors for developing PTSD.
Prior Reviews and Focus of the Present Meta-Analysis
Prior research of Brewin et al. (2000) estimated the impact of several predictors. These predictors can be
categorized into three groups:
1. Historical or static person characteristics (intelligence, childhood adversity, family history)
2. Trauma severity
3. Social support and intercurrent life stress between traumatic event and PTSD symptoms
They found different associations between the predictors and the PTSD severity. They also found different
associations for different people suffering from PTSD. Therefore, they concluded that a general
vulnerability model for all cases of PTSD should not be made.
The focus of this study is on two types of predictors:
1. Person characteristics salient for psychological processing and functioning
2. Aspects of the traumatic event
The study included in total seven predictors that are listed in the result section below
Results
1. History of at least one ither trauma prior to the event
Correlation = .17. There is no difference in prior childhood or adult trauma. More strongly
correlated was having a prior trauma that involved noncombat interpersonal violence (rape,
assault, domestic violence, etc.) compared to combat exposure.
2. Psychological adjustment prior to the event
Correlation = .17. This predictor measured problems with adjusting. There was no difference
found between the types of samples that were studied.
3. Family history of psychopathology
Correlation = range from -.06 to .43, and it did not vary for different types of samples. It did vary
for the type of event and the method for assessing PTSD.
4. Perceived life threat during the event
Correlation = .26, and it did not vary for different types of samples. It was strongest for samples
were there was more time between the event and the assessment.
5. Perceived social support following the event
Correlation = -.28, and it did not vary for different types of samples. It was strongest for samples
were there was more time between the event and the assessment.
6. Peritraumatic emotionality (high levels of emotion)
Correlation = .26
7. Peritraumatic dissociation
4
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