Peri-Traumatic Reactions and Intrusive Imagery - Essay Example

?Order 510445 Topic: Literature review on 2 scholarly/research paper My topics are about Posttraumatic Stress Disorder (PTSD). The first one, Posttraumatic stress symptoms in London school children following September 11, 2001: An exploratory investigation of peri-traumatic reactions and intrusive imagery, is from the Journal of Behavior Therapy and Experimental Psychiatry and was written by Emily A. Holmes, Cathy Creswell and Thomas G. O’Connor. The second one, Relationships between memory inconsistency for traumatic events following 9/11 and PTSD in disaster restoration workers was written by Cezar Giosan, Loretta Malta, Nimali Jayasinghe, Liza Spielman and JoAnn Difede and can be found in the Journal of Anxiety Disorders. Whilst they are both related to the September 11, 2001 terrorist attacks on the World Trade Center buildings in New York City and the Pentagon in Washington, D.C., the two scholarly/research papers differ in many ways in undertaking the studies. ‘On the morning of September 11, 2001, 19 Al-Qaeda terrorists hijacked four commercial passenger jet airliners. The hijackers intentionally crashed two of airliners into the Twin Towers of the World Trade Center in New York City, killing everyone on board and many others working in the buildings’ (Wikipedia 2011). Both towers collapsed, destroying nearby buildings. ‘The hijackers crashed a third airliner in the Pentagon in Arlington, Virginia and the fourth plane crashed into a field after some of its passengers and flight crew attempted to retake control of the plane, which the hijackers had redirected toward Washington, D.C. to target either the Capitol building or the White House. Nearly 3000 victims and 19 hijackers died in the terrorist attacks’ (Fox 2010). In the first study, possible posttraumatic stress reactions in London school children following 9/11 attack was investigated with focus on intrusive imagery. Though the attack was in the United States, the events were extensively reported worldwide through television coverage, radio, internet, and photographs in the print media. The scenes depicted in the media coverage contained death, serious injury and massive human suffering. The aim of the study was to test the hypothesis that children’s intrusive imagery in combination with their peri-traumatic responses to the event (the children’s cognitive responses reported to occur at the time of trauma) may predict their short and long term posttraumatic stress reactions. Anyone, young and old alike can experience symptoms of posttraumatic stress after an indirect exposure to traumatic events. Several studies in the US document the effects of September 11 in relation to indirect exposure on adults (Ahern et.al.,2002; Blanchard, Rowell, Kuhn, Rogers, and Wittrock, 2005; DeLisi et.al., 2003; Galea et.al., 2002; Lawyer et.al.,2006; Silver, Holman, McIntosh, Poulin & Gil-Rivas, 2002) and children (Columbia University Mailman School of Public Health & New York State Psychiatric Institute, 2002; Duggal, Berezkin & John, 2002; Gil-Rivas, Holman & Silver, 2004; Schuster et.al., 2001). Schlenger et.al. (2002) found that 60% of parents in New York City reported that their child was upset by the attacks. Parents also reported that their child had at least one posttraumatic stress symptom. ‘Posttraumatic stress disorder (PTSD) is an emotional illness that is classified as an anxiety disorder and usually develops as a result of a terribly frightening, life-threatening, or highly unsafe experience’ (MedicineNet.com 2011). Symptoms include recurrent re-experiencing of the trauma (e.g. flashbacks, nightmares), phobia of places and people, general numbing and trouble in concentrating. The main aim of the study was to examine report of intrusive imagery of the events, both in content and in relation to the development and persistence of posttraumatic stress symptoms associated with the 9/11 attack. The focus was on symptom development rather than diagnostic criteria. ‘Laboratory studies have demonstrated that emotional memory is stronger than memory neutral materials. Furthermore, emotional memory is more likely to take an image-based (perceptual) rather than verbal form (Artnz, de Groot, & Kindt, 2005). On the other hand, the second study is about the Relationships between memory inconsistency for traumatic events following 9/11 and PTSD in disaster restoration workers. ‘Two thousand six hundred forty one disaster restoration workers deployed at the World Trade Center site in the aftermath of the attack were evaluated longitudinally, one year apart, for PTSD using clinical interviews’ (Giosan et.al, 2009). The workers were exposed to traumatizing events such as discovering human remains and having to quickly evacuate unsafe structures to avoid collapses. Researchers argue on the accuracy of memory of traumatic events. Some say they are stable and indelible whilst others contend, saying that like other memories, memory for traumatic events is subject to alteration. However, more ‘recent studies suggest that when activated by cues, memories undergo a dynamic process of reconsolidation during which they become vulnerable to change’ (van Giezen et.al.,2005). ‘Human subject research also suggests that fabricated details can be incorporated into memory and believed to be true even in the face of contradictory facts’ (Loftus & Kaufman, 1992; Loftus & Ketcham, 1991). The purpose of this study was to examine the relationships between change in retrospective reports of potentially traumatizing events and PTSD. The two studies vary in many ways. One, they used different populations in handling their studies. In the first one, they used school children ranging from age 10 to 11, relatively focused on a small sample and narrow age group. The participants were only 76 children, 39 of which were girls and 37 were boys. In the 76 children, 42.1% were white British, 6.6% with special education needs and 34.2% were qualified for free school meals indicating a moderate-level of social economic deprivation. In the second study, they used a bigger number of participants – 2641 middle-aged disaster restoration workers, predominantly male, Caucasian, married and had at least a high school education. These workers actually saw the devastating damages while in the first one, the London school children were in a remote geographical location and were only informed about the traumatizing event through media coverage. Both studies are similar in examining 2 time collection of data but they vary on the time interval. In the first study, they had it 2 months after the 9/11 attack and 6 months later to test the persistence of symptoms. On the other hand, the second one had their data collected at Time 1 – from 05/02-09/04 (nearly three years after the attack) and Time 2 – 01/03-01/05, a year after the first collection of data. The instrument used in the first study is through a written questionnaire from the experimenter which was read aloud by the teachers to the children within the classroom. They had it first on 11 November 2001 and again on 11 March 2002. Whilst for the restoration workers, they underwent an interview as part of an annual screening program for WTC disaster restoration workers using the ‘Clinician-Administered PTSD scale (CAPS), a widely used PTSD interview that yields a categorical diagnosis and a total PTSD symptom score, calculated by summing frequency and intensity scores for each symptom; and scores for each of the three symptom clusters: re-experiencing (intrusions, nightmares, flashbacks, distress and physiological reactions to reminders; avoidance/numbing and hyperarousal (insomnia, anger, concentration problems, hypervigilance, exaggerated startle responses. The questionnaire for the workers examined 11 exposure variables such as witnessed people jumping from the towers, saw human remains, concerned about someone who was at WTC, knew someone injured in the attack, knew someone killed in the attack, attended funerals or memorial services, assisted people affected by the attack, displaced from residence, had to be evacuated for safety while working at the site, perceived life danger while working at the site and disturbed by the smell’ (Giosan 2009). The London children, however, ‘completed a purpose-designed questionnaire consisting of 10 items regarding their exposure to the events of 9/11 based on informal piloting to index the types of media they had been exposed to, communication with others and affiliation to the U.S. Children then completed five questions about their subjective experience at the time of witnessing the events (peri-traumatic responses) and one about their posttrauma appraisal of safety. These questions addressed emotions associated with a diagnosis of PTSD: fear, helplessness, horror, dissociation and perceived life threat’ (Holmes 2007). In the assessment, they were given definition of intrusive imagery. They were asked “Have any picture memories of that day popped into your head when you didn’t want them to in the last 2 weeks?” Checklist includes images of pictures of the buildings falling down, people trying to get out or away from the buildings, picture of aeroplanes flying in the building, etc. For the data analyses on the second study, they conducted a mixed Group x Time Anova for each of the 11 exposure variable. The group variable had four levels bases on endorsements of Times 1 and 2 – yes-yes (endorsed exposure to the variable at both interviews), no-no (denied exposure at both interviews, no-yes (endorsed exposure at Time 2 only (remembering group) and yes-no (endorsed exposure at Time 1 only (forgetting group). The results of the second study revealed that the majority (62.9%) increased the number of variable. 17% decreased the number of variables endorsed, and 20.1% endorsed the same number of variables at both interview. The total memory score changed significantly between Time 1 and Time2 and a greater number of variables were endorsed at Time 2. The correlation between the memory change score and Time 2 Total CAPS score and PTSD symptom cluster scores was significant, suggesting that an increase in the number of variables at Time 2 was associated with more severe PTSD symptoms at follow-up. The same results were found for Time 1 PTSD symptom clusters re-experiencing, avoidance/numbing and hyperarousal. More severe Time 1 hyperarousal symptoms predicted an increase in the number of endorsed stressors at Time 2, whereas more severe Time 1 avoidance/numbing symptoms predicted. The study on the restoration workers offer support to the notion that memory traumatic events is flexible and subject to change. We found out that recall of both objective traumatic events (saw human remains) and subjective events (perceived life danger) changed over time, therefore, inconsistent. This study also duplicated the memory amplification effect in a civilian sample on a single incident trauma wherein majority endorsed more exposure variables at follow-up. Therefore, the results of this study shows that a memory amplification effect occurs in civilian as well as war veterans and it can be associated with single incident traumas as well as combat exposure. In addition, the collected findings suggest that report of trauma exposure appears to be most consistently related to concurrent re-experiencing systems. The results in the London children study shows that at both points, the mean posttraumatic stress symptom score was significantly higher for those who endorsed “yes” to the peri-traumatic measures, highest was both in helplessness and feeling that the world was now a more dangerous place. On the intrusive imagery reported of September 11, 35% of children reported they experienced intrusive images at 2 months post and 25% at 6 months post. For children reporting no life threat, and no images, symptoms were low and thus symptoms change low. For children reporting either life threat (but no images), or images (but no life threat), symptoms decreased over time. In contrast, if children both reported life threat and images, their symptoms persisted. ‘Verbatim examples of free report images include, “I see people sitting, standing, lying and just filled with tears”, “Black smoke coming round the building”, “People jumping out of windows”, “I have pictures of Bin Laden laughing”, “George Bush and his army in the White House”, “I saw my uncle trying to get out” and “As if I was in Manhattan and was right next to the World Trade Center”. All images provided in the response format were rated as being linked to September 11’ (Holmes 2007). Two key findings emerged from the London children study. It was found out that a significant minority of our sample who witnessed the attacks of 9/11 on TV from a geographically remote location, reported posttraumatic stress type symptoms up to 6 months after the attacks. Second, we found that report of intrusive imagery combined with peri-traumatic experience of threat, predicted persistence of traumatic stress symptoms from 2 to 6 months. It shows that even without physically experiencing the event or by just watching the attack from the footage, people may still suffer from PTSD. It is possible that the continuing coverage of events may account for some of the stress reactions observed, as the amount of TV viewing has been implicated in the severity of the stress reaction. Also, the reaction of others, particularly adults present at the time of witnessing the trauma may influence child’s peri-traumatic interpretations due to mind conditioning and influence. To sum it up, the two studies handled the topics quite well except that they had certain limitations whilst doing the studies. On the London children, a very small sample was used and they concentrated on a narrow age range. Also, they relied on self-reported questionnaires which could be subject to a bias in recall when tested 2 months after. On the part of the restoration workers, the time of first data collection was done almost three years after the attack, quite long for a person to accurately recollect what happened on the event. The two literature reviews are in a way similar as they used the same event which is the 9/11 attack. But they are different in terms of the methods, participants, instruments and data analyses used. They defined the boundaries of the topic similarly because they both used reliable participants, statistical tools and scientific data to arrive to their conclusions. References Ahern, J, Galea, S, Resnick, H, Kilparick, D, Bucuvalas, M, Gold, J et.al. 2002, ‘Television images and psychological symptoms after the Sept. 11 terrorist attacks, Psychiatry: Interpersonal and Biological Processes, 65, 289-300. Artntz, A, De Groot, C & Kindt, M 2005, ‘Emotional memory is perceptual’, Journal of Bachelor Therapy and Experimental Psychiatry, 36(1), 19-34. Blanchard, LB, Rowell, D, Kuhn, L, Rogers, R & Winttrock, D 2005, ‘Posttraumatic stress and depressive symptoms in a college population one year after the Sept. 11 attacks: The effect of proximity, Behavior Research and Therapy, 43, 143-150. Columbia University Mailman School of Public Health and New York State Psychiatric Inst., 2002. DeLisi, LE, Maurizio, A, Yost, M, Paparozzi, CF, Fulchino, C, Katz, CL, et.al. 2003, ‘A survey of New Yorkers after the Sept.11, 2001, terrorist attacks, American Journal of Psychiatry, 160m 780-783. Duggal, HS, Berezkin, G & John, V 2002, ‘PTSD and TV viewing of World Trade Center, Journal of the American Academy of Child and Adolescent Psychiatry, 41(5), 494-495. Fox 2010,’September 11 attacks’[online] available at: http//www.google.com.ph. Galea, S, Resnick, H, Ahern, J, Gold, J, Bucuvalas, M, Kilpatrick, D et.al.2002, ‘Posttraumatic stress disorder in Manhattan, New York City, after the September 11th terrorist attacks, Journal of Urban Health – Bulletin of the New York Academy of Medicine, 79, 340-353. Gil-Rivas, V, Holman, LA & Silver, RC 2004, ‘Adolescent vulnerability following the Sept.11th terrorist attacks: A study of parents and their children, Applied Developmental Science, 8, 130-142. Giosan, C, Malta, L, Jayasinghe, N, Spielman, L, Difede, J 2009, ‘Relationships between memory inconsistency for traumatic events following 9/11 and PTSD in disaster restoration workers’, Journal of Anxiety Disorders, 23, 557-561. Holmes, E, Creswell, C, O’Connor, T 2007, ‘Posttraumatic stress symptoms in London school children following Sept.11, 2001: An exploratory investigation of peri-traumatic reactions and intrusive imagery, Journal of Behavior Therapy & Experimental Psychiatry, 36, 474-490. Lawyer, SR, Resnick, HS, Galea, S, Ahern, J, Kilpatrick, DG, & Vlahov, D 2006, ‘Predictors of peritraumatic reactions and PTSD following the Sept 11th terrorist attacks, Psychiatry – Interpersonal and Biological Processes, 69, 130-141. Loftus, EF & Ketcham, K 1991, Witness for the defense, New York: St. Martin’s Press. Loftus, EF & Kaufman, L 1992, ‘Why do traumatic events sometimes produce good memory(flashbulbs) and sometimes no memory (repression)? In E. Winograd & U. Neisser (Eds), Affect and accuracy in recall: studies of “flashbulb” memories, Cambridge, Cambridge University Press. MedicineNet.com 2011, ‘Posttraumatic Stress Disorder’[online] available at: http://www.medicinenet.com. Schlenger, WE, Caddell, JM, Ebert, L, Jordan, BK, Rourke, KM, Wilson, D et.al. 2002, ‘Psychological reactions to terrorist attacks – Findings from the national study of Americans’ reactions to Sept. 11, JAMA – Journal of the American Medical Association, 288, 581-588. Schuster, MA, Stein, BD, Jaycox, L, Collins, RL, Marshall, GN, Elliott, MN, et.al.2001, ‘A national survey of stress reactions after the Sept. 11, 2001, terrorist attacks, New England Journal of Medicine, 345, 1507-1512. Silver, RC, Holman, EA, McIntosh, DN, Poulin, M, & Gil-Rivas, V 2002, ‘Nationwide longitudinal study of psychological responses to Sept. 11, JAMA – Journal of the American Medical Association, 288, 1235-1244. Read More