Interactive effects of traumatic brain injury and anxiety sensitivity on PTSD symptoms: A replication and extension in two clinical samples.
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ABSTRACT:
SUBMITTER: Albanese BJ
PROVIDER: S-EPMC5986097 | biostudies-literature | 2018 Aug
REPOSITORIES: biostudies-literature
Publications
Interactive effects of traumatic brain injury and anxiety sensitivity on PTSD symptoms: A replication and extension in two clinical samples.
Albanese Brian J BJ Macatee Richard J RJ Boffa Joseph W JW Bryan Craig J CJ Zvolensky Michael J MJ Schmidt Norman B NB
Cognitive therapy and research 20180119 4
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Project description:ObjectivePrior research has identified different PTSD symptom (PTSS) trajectories over months and years posttrauma that warrant different levels of clinical attention. Earlier identification of at-risk trauma victims can facilitate efficient and appropriate intervention efforts.MethodUsing latent class growth analysis, we examined daily PTSS trajectories beginning 6 weeks postinjury in 68 injury victims. Resulting classes were compared on key characteristics at 6 and 21 weeks postinjury.ResultsThree trajectories were identified: a nonreactive class (67.8%) with low initial symptom levels that remained low, a moderate-stable class (27.9%) with elevated symptom levels that remained constant, and a severe-increasing class (4.4%) with high symptom levels that increased.ConclusionsHigh-risk injury victims can be identified by their daily PTSS, allowing for early identification of those at risk for elevated distress and in greater need for intervention. (PsycINFO Database Record
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Project description:Insomnia disorder is impairing and prevalent, particularly among individuals with comorbid anxiety disorders. Despite the availability of effective computerized treatments for insomnia, there are few that target both insomnia as well as co-occurring anxiety symptoms. The current study tests the efficacy of a computerized treatment for anxiety sensitivity cognitive concerns, a transdiagnostic risk factor for anxiety, mood, and insomnia symptoms, against a repeated contact control, on reducing insomnia symptoms. Hypotheses were tested in a mixed clinical sample of community individuals presenting for a treatment study (n = 151) who were followed up 1-, 3- and 6-months after treatment. Results indicated that the anxiety sensitivity intervention resulted in reductions in insomnia symptoms and clinically significant insomnia scores at 3- and 6-month follow-ups. These reductions remained significant when covarying for concurrent reductions in depression and anxiety. Models accounted for 15-54% of the variance in follow-up insomnia symptoms. Current findings add to a growing body of literature suggesting anxiety sensitivity may play a causal role in insomnia symptoms. Results also suggest that targeting anxiety sensitivity may be an effective way to reduce insomnia symptoms in a brief and portable intervention that also reduces symptoms commonly comorbid with insomnia disorder.
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Project description:Traumatic brain injury (TBI) is one of the most common injuries to military personnel, a population often exposed to stressful stimuli and emotional trauma. Changes in sensory processing after TBI might contribute to TBI-post traumatic stress disorder (PTSD) comorbidity. Combining an animal model of TBI with an animal model of emotional trauma, we reveal an interaction between auditory sensitivity after TBI and fear conditioning where 75 dB white noise alone evokes a phonophobia-like phenotype and when paired with footshocks, fear is robustly enhanced. TBI reduced neuronal activity in the hippocampus but increased activity in the ipsilateral lateral amygdala (LA) when exposed to white noise. The white noise effect in LA was driven by increased activity in neurons projecting from ipsilateral auditory thalamus (medial geniculate nucleus). These data suggest that altered sensory processing within subcortical sensory-emotional circuitry after TBI results in neutral stimuli adopting aversive properties with a corresponding impact on facilitating trauma memories and may contribute to TBI-PTSD comorbidity.
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Project description:ObjectivePosttraumatic stress disorder (PTSD) is often associated with heightened physiological reactivity during fear conditioning procedures, but results vary across studies. This study examined whether anxiety sensitivity (AS), or the fear of arousal-related sensations, strengthens the relationship between PTSD symptoms and skin conductance responses (SCR) during fear conditioning and extinction. Because gonadal hormones implicated in fear learning fluctuate across the menstrual cycle, the stability of these relationships in women was examined in 2 distinct menstrual cycle phases.MethodThirty-two trauma-exposed women, half of whom had PTSD, completed the Clinician-Administered PTSD Scale, Anxiety Sensitivity Inventory, and a fear conditioning and extinction paradigm during the midluteal (mLP) and early-follicular (eFP) menstrual cycle phases.ResultsIn the mLP, stronger SCR to stimuli paired with shock (CS +) during fear acquisition significantly predicted greater PTSD symptoms only when AS was high and after removing an outlier. This appeared driven by effects on Numbing and Hyperarousal symptom clusters. Other hypothesized interactions between AS and CS responses were not significant. However, in the eFP, differential SCR between the CS + and CS- during extinction predicted significantly greater PTSD symptoms, and there was a trend for this effect being stronger as AS increased.ConclusionsResults offer preliminary evidence that high AS contributes to a stronger relationship between SCR during fear acquisition and PTSD symptoms, at least among women in the mLP. Further research investigating the impact of individual differences in traits such as AS on the relationship between conditioned fear responses and PTSD symptoms is warranted. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Project description:Traumatic brain injury (TBI) is a common combat injury, often through explosive blast, and produces heterogeneous brain changes due to various mechanisms of injury. It is unclear whether the vulnerability of white matter differs between blast and impact injury, and the consequences of microstructural changes on neuropsychological function are poorly understood in military TBI patients. Diffusion tensor imaging (DTI) techniques were used to assess the neurocircuitry in 37 U.S. service members (29 mild, 7 moderate, 1 severe; 17 blast and 20 nonblast), who sustained a TBI while deployed, compared to 14 nondeployed, military controls. High-dimensional deformable registration of MRI diffusion tensor data was followed by fiber tracking and tract-specific analysis along with region-of-interest analysis. DTI results were examined in relation to post-concussion and post-traumatic stress disorder (PTSD) symptoms. The most prominent white matter microstructural injury for both blast and nonblast patients was in the frontal fibers within the fronto-striatal (corona radiata, internal capsule) and fronto-limbic circuits (fornix, cingulum), the fronto-parieto-occipital association fibers, in brainstem fibers, and in callosal fibers. Subcortical superior-inferiorly oriented tracts were more vulnerable to blast injury than nonblast injury, while direct impact force had more detrimental effects on anterior-posteriorly oriented tracts, which tended to cause heterogeneous left and right hemispheric asymmetries of white matter connectivity. The tractography using diffusion anisotropy deficits revealed the cortico-striatal-thalamic-cerebellar-cortical (CSTCC) networks, where increased post-concussion and PTSD symptoms were associated with low fractional anisotropy in the major nodes of compromised CSTCC neurocircuitry, and the consequences on cognitive function were explored as well.
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Project description:This study examined the extent to which mothers' physiological arousal (i.e., skin conductance level [SCL] augmentation) and regulation (i.e., respiratory sinus arrhythmia [RSA] withdrawal) interacted to predict subsequent maternal sensitivity. Mothers' (N = 176) SCL and RSA were measured prenatally during a resting baseline and while watching videos of crying infants. Maternal sensitivity was observed during a free-play task and the still-face paradigm when their infants were 2 months old. The results demonstrated that higher SCL augmentation but not RSA withdrawal predicted more sensitive maternal behaviors as a main effect. Additionally, SCL augmentation and RSA withdrawal interacted, such that well-regulated maternal arousal was associated with greater maternal sensitivity at 2 months. Further, the interaction between SCL and RSA was only significant for the negative dimensions of maternal behavior used to derive the measure of maternal sensitivity (i.e., detachment and negative regard) suggesting that well-regulated arousal is particularly important for inhibiting the tendency to engage in negative maternal behaviors. The results replicate findings from mothers in previous studies and demonstrate that the interactive effects of SCL and RSA in relation to parenting outcomes are not sample specific. Considering joint effects of physiological responding across multiple biological systems may enhance understanding of the antecedents of sensitive maternal behavior.
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Project description:Generalized anxiety and symptoms of post-traumatic stress disorder (PTSD) are common among individuals forcibly displaced during war and conflict. Blast exposure may be one important contributor of such symptoms. The aims of this study were to provide data on blast-related experiences of internally displaced persons (IDPs) and refugees following Russia's invasion of Ukraine, and to assess the influence of blast exposure on generalized anxiety, and PTSD flashbacks and nightmares. An online health needs survey was distributed to Ukrainian IDPs and refugees between April and July 2022 using Facebook Ads Manager. Participants reported whether they experienced blast exposure since the beginning of the invasion, and whether they took medication for a mental health condition before the war started. Finally, they completed measures of generalized anxiety (GAD-2), and PTSD flashbacks and nightmares. Analyses included 3253 IDPs and 5073 refugees (N = 8326). Results revealed that 67.6% of total participants- 79.9% of IDPs and 61.7% of refugees-reported blast exposure since Russia's invasion. Further, 69.1% (95% CI: 68.05, 70.15) of total participants met the cut-off for generalized anxiety in which further diagnostic evaluation was warranted. Compared to refugees, IDPs reported higher generalized anxiety and greater frequency of PTSD symptoms, specifically flashbacks and nightmares. Further analyses revealed that the impact of blast exposure on flashback frequency was stronger among IDPs compared to refugees (β = 0.51; t(8322) = 11.88, p < .0001, 95% CI: 0.43, 0.60) and among participants with pre-existing mental health conditions compared to those without (β = 0.18; t(8157) = 2.50, p = .013, 95% CI: 0.04, 0.33). Mental health and psychosocial support must be prioritised within humanitarian relief for both IDPs and refugees and especially among people with underlying mental health conditions.
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Project description:BackgroundInjury patients are at risk for mental health problems, which could result in slower recovery and affect health-related quality of life (HRQoL), health care utilization, and return to work (RTW).ObjectiveIn this study, we determined the prevalence of symptoms indicative of probable depression, anxiety, and post-traumatic stress disorder (PTSD) and their association with HRQoL, health care utilization, and RTW in adult injury patients.MethodData on unintentional injuries in adult patients were retrieved from the Dutch Injury Surveillance System (DISS) and a six-month follow-up questionnaire that included the Hospital Anxiety and Depression Scale (HADS) and Impact of Event Scale-Revised (IES-R) to assess depression, anxiety, and posttraumatic stress disorder (PTSD) symptoms, and items on HRQoL (measured with the EQ-5D-5 L and EQ visual analogue scale), health care utilization and RTW. Logistic regression analyses assessed the association between depression, anxiety, and PTSD and HRQoL, health care utilization, and RTW.ResultsAt six months post-injury, 22% (n = 665/3060) of included patients had scores indicative of probable anxiety disorder (14%), depression (16%), and/or PTSD (6%). These patients had reduced EQ-5D utility scores [β: -0.26 (95% CI: -0.28, -0.23)] and were less likely to RTW [OR: 2.12 (95% CI: 1.34, 3.37)] compared to their counterparts. Both mental and physical health care utilization were significantly higher in patients with symptoms indicative of depression, anxiety, and/or PTSD.ConclusionsIn injury patients, there is a high occurrence of depression, anxiety, and PTSD symptoms, which is associated with lower HRQoL, higher health care utilization, and lower RTW rates. These results underline the importance of screening and treatment of these symptoms in this population to enhance good recovery of injury patients.
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Project description:ObjectiveA latent disease explanation cannot exclusively explain post-concussion symptoms after mild traumatic brain injury (mTBI). Network analysis offers an alternative form of explanation for relationships between symptoms. The study aimed to apply network analysis to post-concussion symptoms in two different mTBI cohorts; an acute treatment-seeking sample and a sample 10 years post-mTBI.MethodThe treatment-seeking sample (n = 258) were on average 6 weeks post-injury; the 10 year post mTBI sample (n = 193) was derived from a population-based incidence and outcomes study (BIONIC). Network analysis was completed on post-concussion symptoms measured using the Rivermead Post-Concussion Questionnaire.ResultsIn the treatment-seeking sample, frustration, blurred vision, and concentration difficulties were central to the network. These symptoms remained central in the 10 year post mTBI sample. A Network Comparison Test revealed evidence of a difference in network structure across the two samples (p = 0.045). However, the only symptoms that showed significant differences in strength centrality across samples were irritability and restlessness.ConclusionThe current findings suggest that frustration, blurred vision and concentration difficulties may have an influential role in the experience and maintenance of post-concussion symptoms. The impact of these symptoms may remain stable over time. Targeting and prioritising the management of these symptoms may be beneficial for mTBI rehabilitation.
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Project description:Increasing evidence has shown that the Covid-19 outbreak, and subsequent school closures and exam cancellations that followed, has impacted adolescent mental health. The current cross-sectional study examined rates of depression, anxiety and Post Traumatic Stress Disorder (PTSD)-like symptoms about Covid-19 in adolescents and whether current or past mental health support, additional support in school, keyworker status, poorer household relationships since the outbreak of Covid-19 or reduced physical activity were associated with elevated levels of depression, anxiety or PTSD-like symptoms. Lastly, it examined perceived changes in mental health due to the Covid-19 pandemic, school closures and the cancellation of exams. A total of 899 adolescents (14-18 years) took part in the 'in isolation instead of in school' (INISS) project. Findings indicated that older adolescents, females, those who currently or previously received mental health support or additional support in school and adolescents who reported poorer relationships at home since Covid-19 were more likely to meet clinical threshold levels for their mental health. Adolescents highlighted worsening of their mental health due to Covid-19 and school closures with mixed positive and negative impact of exam cancellations. Adolescents experiencing clinical threshold levels of depression and anxiety uniquely reported worsening of their mental health since the Covid-19 pandemic, school closures and exam cancellations. Understanding the rates, perceptions and factors associated with increases in depression, anxiety and PTSD-like symptoms in adolescents during the Covid-19 pandemic will inform national policy in supporting adolescent mental health and recovery from the Covid-19 pandemic.
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