There is an increasing awareness of the tragic consequences of post-traumatic stress disorder (PTSD) among first responders in Canada. There is also an increasing awareness of the lack of understanding about the economic and social costs of PTSD in Canada. This article aims to briefly review the current evidence on the prevalence rates of PTSD, the economic costs associated with PTSD, and the costs and efficacy of various treatment strategies, to provide a framework for future research on the economic analysis of PTSD. Estimates suggest that as many as 2.5 million adult Canadians and 70,000 Canadian first responders have suffered from PTSD in their lifetimes. While we could not find any evidence on the economic cost of PTSD specifically, a recent estimate suggests that mental illness in the Canadian labour force results in productivity losses of $21 billion each year. Research from Australia suggests that expanded mental health care may improve the benefits of treatment over traditional care, and more cost-effectively. Given the methodological challenges in the existing studies and the paucity of evidence on Canada, more Canadian studies on prevalence, on the economic and social costs of PTSD, and on the costs and effectiveness of various treatment options are encouraged.
Substance use disorders (SUDs) are highly comorbid with posttraumatic stress disor- der (PTSD). The relationship between substance abuse and trauma is complex and bidirectional, with shared social risk factors and biological pathways. Youth with cooc- curring PTSD and SUD often have more severe challenges than teens with either dis- order alone, with treatment needs that may involve multiple community systems. Integrated treatment principles and recommendations are discussed. Two clinical cases are reviewed to illustrate these treatment principles.
Posttraumatic stress disorder (PTSD) is defined as a psychiatric disorder; however, PTSD co-occurs with multiple somatic manifestations. People living with PTSD commonly manifest dysregulations in the systems that regulate the stress response, including the hypothalamic-pituitary-adrenal (HPA) axis, and development of a pro-inflammatory state. Additionally, somatic autoimmune and inflammatory diseases and disorders have a high rate of co-morbidity with PTSD. Recognition and understanding of the compounding effect that these disease states can have on each other, evidenced from poorer treatment outcomes and accelerated disease progression in patients suffering from co-morbid PTSD and/or other autoimmune and inflammatory diseases, has the potential to lead to additional treatment opportunities.
Although biological systems have evolved to promote stress-resilience, there is variation in stress-responses. Understanding the biological basis of such individual differences has implications for understanding Posttraumatic Stress Disorder (PTSD) etiology, which is a maladaptive response to trauma occurring only in a subset of vulnerable individuals.
The Encyclopedia of Mental Disorders defines posttraumatic stress disorder (PTSD) as “a complex disorder in which a person’s memory, emotional responses, intellectual processes, and nervous system have been disrupted by one or more traumatic experiences.” PTSD is classified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a “trauma and stressor-related disorder” and is the only psychiatric diagnosis (along with acute stress disorder) that depends on a factor outside the person—namely, a traumatic stressor that is outside the range of usual experience.
Salloum and colleagues have presented data in support of a novel and cost-effective approach to the treatment of PTSD in young children. In this commentary I outline an argument for why their stepped-care model may be an important change to how psychological therapies for trauma- exposed youth are delivered, and propose further caveats that need to be addressed in future research.
This chapter gives an insight in the possibilities and limitations of the prevention of Posttraumatic Stress Disorder (PTSD). An elaboration upon the diagnosis, criteria, onset and prevalence demonstrates the enormous impact of PTSD. Prevalence rates vary between countries and with the intensity of missions, but are lower in non-US Western countries. The risk factors for PTSD are well documented, as well as relationships between PTSD and an individual’s psychological, biological, and social functioning.
Previous findings on the impact of co-occurring posttraumatic stress disorder (PTSD) in patients with borderline personality disorder (BPD) have revealed inconsistencies, which may have been related to small sample sizes or differences in the presence of childhood sexual abuse (CSA). In this study, the potentially aggravating impact of PTSD and the role of CSA were examined in a large cohort of BPD patients.
Current treatments for stress-related psychiatric disorders, such as depression and PTSD, are inadequate. Cognitive behavioral psychotherapies, including exposure therapy, are an alternative to pharmacotherapy, but the neurobiological mechanisms are unknown. Preclinical models demonstrating therapeutic effects of behavioral interventions are required to investigate such mechanisms. Exposure therapy bears similarity to extinction learning. Thus, we investigated the therapeutic effects of extinction learning as a behavioral intervention to model exposure therapy in rats, testing its effectiveness in reversing chronic stress-induced deficits in cognitive flexibility and coping behavior that resemble dimensions of depression and PTSD.
Posttraumatic growth (PTG) is defined as a positive psychological change that can emerge following a traumatic life event. Although documented in noninterventional studies of traumatized individuals, there are scant data on the potential for therapy to induce or improve PTG. Thus, the primary goal of this study was to examine changes in PTG in a controlled trial of cognitive–behavioral conjoint therapy for posttraumatic stress disorder versus waitlist (CBCT for PTSD; Monson & Fredman, 2012).
Posttraumatic stress disorder (PTSD) has been shown to have a variety of negative health and mental health effects on those who are afflicted (Kessler et al., 2000), as well as negative effects on relationships with intimate partners and close relatives (Whisman, Sheldon, & Goering, 2000). Families are likely to be impacted by the specific nature of the sustained trauma.
There are currently several interventions for posttraumatic stress disorder (PTSD) that meet the definition of “evidence-based therapies” as outlined by the Institute of Medicine (2012). The current chapter examines one such group of interventions: recreational therapy. Recreational therapy refers to treatments designed to help restore prior levels of functioning resulting from injury or illness, or to promote health and wellness.
In this volume, after a brief discussion of phenomenology of posttraumatic stress disorder (PTSD), the current guidelines and clinical consensus surrounding treatment, and the limitations of available treatment supported by sufficient evidence necessary to receive endorsement in practice guidelines, we describe emerging treatments that demonstrate varying degrees of promise for relieving the suffering associated with PTSD.
Canine-assisted therapies are being used increasingly both by veterans and the civilian community for mental and emotional support. During the past decade, a growing body of scientific research has provided evidence that human–animal interactions can improve social competence and reduce physiological, psychological, and behavioral effects of stress and social isolation.
Elevated shame and dissociation are common in dissociative identity disorder (DID) and chronic posttraumatic stress disorder (PTSD) and are part of the constellation of symptoms defined as complex PTSD. Previous work examined the relationship between shame, dissociation, and complex PTSD and whether they are associated with intimate relationship anxiety, relationship depression, and fear of relationships. This study investigated these variables in traumatized clinical samples and a nonclinical community group.
Most people experience at least one potentially traumatic event (PTE) during their life. Many will develop only transient distress and not a psychological illness. Even the most inherently horrific event does not invariably lead to the development of a psychological disorder while an individual with sufficient vulnerability may develop post-traumatic stress disorder (PTSD) after what appears be an event of low magnitude. The diagnosis of PTSD differs fro most psychiatric disorders as it includes an aetiological factor, the traumatic event, as a core criterion. The DSM 5 core symptoms of PTSD are grouped into four key symptom clusters: re-experiencing, avoidance, negative cognitions and mood, and arousal. Symptoms must be present for at least one month and cause functional impairment. PTSD patients can avoid engaging in treatment and assertive follow-up may be necessary.
We developed an ACT-based manual to treat comorbid PTSD and substance use. A pilot trial with veterans suggested the treatment was feasible and credible. Participants were generally satisfied and offered qualitative feedback. We describe manual revisions aimed at improving treatment retention and impact. Additional strategies for adapting ACT for PTSD/SUD are offered for consideration
Posttraumatic stress disorder (PTSD) often develops following trauma exposure. Sleep disturbances, especially nightmares, are highly comorbid with PTSD and may exacerbate symptoms. The current study examined the relationship between sleep disturbances and PTSD among college students. Results indicated that PTSD-related sleep disturbances, most notably trauma-related nightmares, were associated with PTSD.
Clinicians and researchers have found differential diagnosis to be difficult, particularly for conceptually similar disorders. One category of particular interest has been distress or internalizing disorders, theorized to be related via an underlying construct of generalized distress or negative affect. The present study attempted to address the comorbidity of three distress disorders – posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and generalized anxiety disorder (GAD) – using latent analyses by controlling for the variance attributable to negative affect.
This chapter consists of two sections. Section 1, by John Violanti, describes a case study of resiliency factors among police officers involved in Hurricane Katrina six years post-storm. Section 2, by Douglas Paton, describes (1) developing a model that facilitates learning from experience, (2) anticipating future issues and (3) proactively developing resilience and adaptive capacity in police officers and organizations.
It is unclear which potentially modifiable risk factors best predict post-trauma psychiatric disorders. We aimed to identify pre-trauma risk factors for post-traumatic stress disorder (PTSD) or major depression (MD) that could be targeted with resilience interventions. Method Newly recruited paramedics (n = 453) were assessed for history of mental disorders with structured clinical interviews within the first week of their paramedic training and completed self-report measures to assess hypothesized predictors. Participants were assessed every 4 months for 2 years to identify any episodes of PTSD and MD; 386 paramedics (85.2%) participated in the follow-up interviews.
Posttraumatic stress disorder (PTSD) is a trauma-evoked syndrome, with variable prevalence within the human population due to individual differences in coping and resiliency. In this review, we discuss evidence supporting the relevance of neuropeptide Y (NPY), a stress regulatory transmitter in PTSD. We consolidate findings from preclinical, clinical, and translational studies of NPY that are of relevance to PTSD with an attempt to provide a current update of this area of research.
Exposure therapy (EXP) is an extensively studied and supported treatment for anxiety and trauma-related disorders. EXP works by exposing the patient to the feared object or situation in the absence of danger in order to overcome the related anxiety. Various technologies including head-mounted displays (HMDs), scent machines, and headphones have been used to augment the exposure therapy process by presenting multi-sensory cues (e.g., sights, smells, sounds) to increase the patient’s sense of presence.
Eye movement desensitization and reprocessing therapy (EMDR) is by now a well-established treatment for posttraumatic stress disorder (PTSD). There is good evidence for its efficacy and together with trauma-focused cognitive behavioral therapy (TF-CBT) it is considered to be the first-line treatment for PTSD (Bisson, Roberts, Andrew, Cooper, & Lewis, 2013).
Emergency services workers who are more likely to suffer episodes of mental ill health later in their careers can be spotted in the first week of training. Researchers wanted to see if they could identify risk factors that made people more likely to suffer post-traumatic stress (PTSD) or major depression (MD) when working in emergency services.
Cognitive restructuring and imagery modification for PTSD (CRIM-PTSD) is a new short intervention. It consists of the cognitive restructuring of core trauma-related dysfunctional beliefs about the self and the use of imagery to encourage more functional beliefs. A randomized controlled trial showed that CRIM was effective for reducing posttraumatic stress disorder (PTSD) in survivors of childhood sexual abuse (CSA) when it focused on the feeling of being contaminated. For this study, CRIM was adapted to treat PTSD symptoms more generally and after various types of trauma by addressing the patients’ negative self-concept.
More investigation is needed to understand how specific posttraumatic stress disorder (PTSD) symptom clusters relate to the internal experience of anger and overt negative behaviors in response to anger (negative expressivity). We investigated whether anger mediated relations between PTSD symptom clusters and negative expressivity. Multiple regression revealed lower PTSD intrusion symptoms associated with higher levels of negative expressivity. Anger mediated this relationship. Higher avoidance symptoms related to higher negative expressivity. Clinical implications, limitations, and strengths are discussed.
Posttraumatic stress disorder (PTSD) has been associated with eating disorders (EDs) and addictive behaviors, including the relatively new construct food addiction. However, few studies have investigated mechanisms that account for these associations, and men are underrepresented in studies of EDs and food addiction. The results highlight the importance of investigating PTSD as a risk factor for food addiction and ED symptoms and the potential mediating role of emotion regulation in the development of PTSD and EDs in order to identify targets for treatments.
Critical incident stress debriefing (CISD) is a psychoeducational group intervention offered after exposure to potentially traumatizing events. This exploratory inquiry examined how mental health and peer facilitators utilized elements of group work practices during CISD interventions. Narratives from 16 mental health and 14 peer facilitators reported how elements of group planning, performing, and processing appear. Important group-process aspects included attention to establishing ground rules and defining boundaries for confidentiality, managing member disclosure, and pacing the process to prevent harm from over-processing the traumatic event. Implications for practice suggest that following best practice guidelines in group work is protective of the CISD process and the participants.
Because posttraumatic stress disorder (PTSD) is one of the few psychological conditions that predict suicidal behavior among those who think about suicide, many patients with PTSD present clinically with elevated suicide risk. Expert consensus and practice guidelines recommend against trauma-focused treatments for patients with elevated suicide risk, however. Research aimed at understanding the common mechanisms that underlie the association of PTSD and suicide risk has led to several advances in the effective care of suicidal patients diagnosed with PTSD. Based on these results, various combinations and sequences of suicide-focused treatments, risk management procedures, and trauma-focused treatments are implicated.
Stigma has been described as one of the largest barriers for those who have been diagnosed with a mental disorder, with negative consequences impacting all facets of life, including the workplace. Although many population-based anti-stigma initiatives exist, the need for workplace interventions is being recognized, particularly as the financial costs of mental disorders in the workplace mount. Specific workplace-focused programs are emerging to address this need. The present paper describes efforts to reduce the stigma related to mental disorders in the workplace. Following the review, suggestions are made for future workplace anti-stigma interventions, as well as a discussion of considerations for researchers who evaluate such programs.
In this phenomenological study, the essence of being a first responder spouse was described through the lived experiences of the participants. The objective of this phenomenological study was to answer the question, “What is the experience of being the spouse of a first responder?” The qualitative results identified significant barriers and stressors that exist within the first responder family system and implications for clinical practice with this population.
Conventional wisdom suggests that repeated traumatic exposure should strongly relate to increased posttraumatic stress disorder (PTSD) symptoms. However, research with first responders, who are repeatedly exposed to traumatic events, finds inconsistent links to PTSD. A total of 69 firefighters with differing duty-related traumatic-exposure were tested on an innovative performance-based regulatory choice flexibility paradigm and evaluated for PTSD symptoms using clinical interviews.
First responders are generally considered to be at greater risk for full or partial posttraumatic stress disorder (PTSD) than most other occupations because their duties routinely entail confrontation with traumatic stressors. These critical incidents typically involve exposure to life threat, either directly or as a witness. There is a substantial literature that has examined the risk factors, symptom presentation, course, and comorbidities of PTSD in this population. However, to our knowledge, there are no systematic reviews of treatment studies for first responders. We conducted a systematic review of the PTSD treatment literature (English and non-English) in order to evaluate such treatment proposals based on what is known about treating PTSD in first responders.
Responding to critical incidents may result in 5.9–22 % of first responders developing psychological trauma and posttraumatic stress disorder. These impacts may be physical, mental, and/or behavioral. This population remains at risk, given the daily occurrence of critical incidents. Given the multiplicity of impacts from psychological trauma and the inadequacies of responder treatment intervention research thus far, this paper proposes a paradigmatic shift from single/double treatment interventions to a multi-modal approach to first responder victim needs. A conceptual framework based on psychological trauma is presented and possible multi-modal interventions selected from the limited, extant first responder research are utilized to illustrate how the approach would work and to encourage clinical and experimental research into first responder treatment needs.
First responders routinely experience work-related events that meet the definition of a traumatic stressor. Despite the high exposure to traumatic events, prevalence rates of posttraumatic stress disorder (PTSD) are relatively low. This discrepancy points to the potential value of identifying factors that distinguish those traumatic stressors that produce ongoing traumatic stress symptoms from those that do not. The present study surveyed 181 first responders from rural settings. A repeated-measures design was used to compare characteristics of traumatic stressors that were or were not associated with ongoing PTSD symptoms.
The current study was a systematic review examining probable posttraumatic stress disorder (PTSD) in first responders following man-made mass violence. A systematic literature search yielded 20 studies that fit the inclusion criteria. The prevalence rates of probable PTSD across all 20 studies ranged from 1.3% to 22.0%. This paper is meant to serve as a call for additional research and to encourage more breadth in the specific incidents that are examined.
Firefighters participate in activities with intense physical and psychological stress. The occupational obligations may be responsible for the psychological and musculoskeletal problems experienced by firefighters. Early recognition and response to psychosomatic issues in firefighters is of high importance.
Norway experienced two terror attacks on July 22, 2011. A car bomb exploded in the Oslo government district killing eight people. Shortly after, 69 adolescents gathered at a political youth camp were shot and killed at Utøya Island. First responders were exposed to multiple risk factors for the development of posttraumatic stress symptoms (PTSS).
This study sought to examine the prevalence of sudden gains and deteriorations (i.e., symptom reduction/improvement during treatment) and their influence on treatment outcomes among World Trade Center responders with probable posttraumatic stress disorder. Thirty-six outpatient clients received at least three sessions of integrative psychotherapy, which included elements of psychodynamic and cognitive-behavioral therapy approaches, under routine clinical conditions.
First responders—police officers, firefighters, emergency medical technicians (EMTs), and paramedics—experience significant job-related stressors and exposures that may confer increased risk for mental health morbidities (e.g., posttraumatic stress disorder [PTSD], suicidal thoughts and behaviors) and hastened mortality (e.g., death by suicide). Inherent in these occupations, however, are also factors (e.g., camaraderie, pre-enlistment screening) that may inoculate against the development or maintenance of psychiatric conditions.
First responders are an often ignored group facing emotional and physical stress that is similar to that of law enforcement personnel and military veterans. Fifty first responder employees were invited to participate in the study, of which 34 completed the following psychological and biological measures. A substantial portion of first responders met criteria for PTSD and anxiety. Assessing the impact of these conditions may best be achieved through physical health measures (cortisol, BMI, heart rate) in addition to psychometric screening tools (PCL, CESD, STICSA).
Acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) are psychological reactions that develop in some people following the experience of traumatic events such as major disaster, war, sexual or physical assault, motor vehicle accidents, and torture. Exposure to a traumatic event is not an uncommon experience. Large community surveys in Australia and overseas reveal that 50–65 per cent of people report at least one traumatic event in their lives. The volume of research studies on the treatment of ASD and PTSD published over the past decade, and the emerging consensus from those studies, warrants the development of clinical practice guidelines. The guidelines were developed in accord with National Health and Medical Research Council guideline development requirements, by a working party comprising key trauma experts from throughout Australia, in consultation with a multidisciplinary panel comprising representatives of the range of health professionals involved in the care of people with ASD and PTSD, and service users.
Emergency workers perform a vital role in our society. They protect the rule of law, ensure our safety and provide assistance in emergencies. Surveys consistently show that emergency workers are one of the most valued and trusted occupational groups. However, there is increasing realisation that emergency work can come at a cost. Large numbers of emergency workers report ongoing psychological consequences from exposure to trauma, most notably post-traumatic stress disorder (PTSD). This guideline helps emergency workers and their clinicians as they work together towards recovery.
Mental health, mental illness and stress-related disability are especially ill-defined, complex and controversial issues when considered in the context of the workplace. Currently, a knowledge gap exists between mental health professionals and employers regarding symptom-based models of illness and function based models of work performance. As a result, psychiatric disorders affecting workers are under-identified and under-treated and likely result in unmitigated impairment and disability. The authors examine several conceptual models for workplace mental illness across medical and psychological disciplines and propose a unifying construct. The utility of the existing screening methods for common workplace illnesses and their potential application are reviewed. The challenges of diagnosis and effective treatment of workplace mental illness are highlighted within an “occupational mental health system” with suggestions for future research directions.
Mental health problems are a serious issue in our society. The Qualaxia Network supports effective actions that promote mental health, prevention and treatments for common mental disorders.
Qualaxia is a network of researchers, experts, decision-makers, managers and clinicians. The network’s goal is making documents believed to be particularly important on the subject of public mental health easily accessible.
Evidence Exchange Network is a knowledge exchange network that brings together mental health and addition stakeholders from across Ontario. It lists current researchers in the area of mental health and their area of focus. The site also includes webinars based on research in this area.