Peritraumatic tonic immobility is associated with posttraumatic stress symptoms in undergraduate Brazilian students

Portugal, Liana Catarina Lima; Pereira, Mirtes Garcia; Alves, Rita de Cássia; Tavares, Gisella; Lobo, Isabela; Rocha-Rego, Vanessa; Marques‐Portella, Carla; Mendlowicz, Mauro V.; Coutinho, Evandro Silva Freire; Fiszman, Adriana; Volchan, Eliane; Figueira, Ivan; Oliveira, Letícia

doi:10.1590/s1516-44462012000100011

Cited by 26 publications

(16 citation statements)

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“…Based on TI Scale (TIS-C: Forsyth et al, 2000), we used a four-item measure of motor aspects of TI which has been validated (Lima et al, 2010) and employed in previous studies (Rocha-Rego et al, 2009; Volchan et al, 2011; Portugal et al, 2012): (i) froze or paralyzed; (ii) unable to move; (iii) unable to call out or scream, and (iv) unable to escape. Total scores range from zero to 24.…”

Section: Methodsmentioning

confidence: 99%

“…For retrospective reports, in a large epidemiological sample, greater TI scores were found to be associated with PTSD (Kalaf et al, 2015). Other studies observed that retrospective reports of peritraumatic TI are correlated with the severity of PTSD symptoms (Fiszman et al, 2008; Rocha-Rego et al, 2009; Lima et al, 2010; Portugal et al, 2012; Maia et al, 2015; Kleine et al, 2018).…”

Section: Introductionmentioning

confidence: 97%

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Tonic Immobility in PTSD: Exacerbation of Emotional Cardiac Defense Response

et al. 2019

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Among defensive behaviors, tonic immobility (TI) is considered the last defensive resort when life is at extreme risk. Post-Traumatic Stress Disorder (PTSD) is the main psychiatric consequence resulting from exposure to traumatic events. Increasing evidence indicate an association between peritraumatic tonic immobilility and severity of PTSD. Cardiac defense response, a reactivity to perceived danger or threat, has been studied by recording heart rate changes that follows the presentation of an unpredictable intense auditory aversive stimulus. The aim of this study was to investigate potential distinctiveness in cardiac defense response among PTSD patients who presented – compared to those that did not – TI reaction in the laboratory setting. Patients ( N = 17) completed the TI questionnaire for signs of immobility elicited by passive listening to their autobiographical trauma script. After a while, they were exposed to an intense white noise, while electrocardiogram was recorded. The heart rate during the 80 s after the noise, subtracted from baseline, was analyzed. Higher reports of TI to the trauma script were associated with stronger and sustained heart rate accelerations after the noise. The effects on cardiac defense response add to increasing evidence that some PTSD patients are prone to repeated re-experiences of TI, which may implicate in a potentially distinct pathophysiology and even a new PTSD subtype.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 97%

Tonic Immobility in PTSD: Exacerbation of Emotional Cardiac Defense Response

et al. 2019

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“…Along with other peritraumatic stress reactions, TI has been reported as a risk factor for Posttraumatic Stress Disorder – PTSD [10], [14], [15]. Fiszman et al [11] showed that among victims of violence TI predicted the severity of posttraumatic stress symptoms, as well as a poor response to treatment.…”

Section: Introductionmentioning

confidence: 99%

Structural Validity of the Tonic Immobility Scale in a Population Exposed to Trauma: Evidence from Two Large Brazilian Samples

et al. 2014

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BackgroundTonic Immobility is a temporary state of motor inhibition in situations involving extreme fear. The first scale developed for its assessment was the 10-item Tonic Immobility Scale (TIS). However, there are still few studies on its structural (dimensional) validity. The objective of this study was to reassess the factor structure of the TIS applied to representative samples exposed to general trauma of two Brazilian mega-cities.MethodsThe sample comprised 3,223 participants reporting at least one traumatic experience. In São Paulo (n = 2,148), a Confirmatory Factor Analysis (CFA) first tested the originally proposed two-dimensional structure. This was followed by sequential Exploratory Structural Equation Models to identify the best fitting model, and subsequently tested in Rio de Janeiro (n = 1,075) via CFA. Alternative reduced versions were further explored using the aggregate sample. Model-based Item Response Theory (IRT) location parameters were also investigated.ResultsAn absence of factor-based convergent and discriminant validity rejected the original proposition. However, the one-dimensional structure still held several residual correlations. Further exploration indicated the sustainability of reduced versions with seven (alternative A) and six (alternative B) items. Both presented excellent fit and no relevant residual item correlation. According to the IRT location parameters, items in alternative B covered a wider range of the latent trait. The Loevinger's H scalability coefficients underscored this pattern.ConclusionsThe original model did not hold. A one-factor solution was the most tenable in both large samples, but with significant item residual correlations, indicating that content redundancies persisted. Further reduced and simplified versions of the TIS proved promising. Although studies are yet to be carried out in other settings, it is the authors' impression that the restricted versions of the TIS are already apt for use in epidemiologic studies since the pros tend to outweigh the cons (as outlined in the Discussion section).

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“…The tonic immobility response has been documented in animals for more than three centuries ( Maser and Gallup, 1977 ). In humans, studies have demonstrated that tonic immobility also occurs, especially during a life-threatening event ( Suarez and Gallup, 1979 ; Galliano and Noble, 1993 ; Heidt et al, 2005 ; Fusé et al, 2007 ; Bados et al, 2008 ; Bovin et al, 2008 ; Abrams et al, 2009 ; Humphreys et al, 2010 ; Portugal et al, 2012 ). Recently, studies found that tonic immobility was a predictor of the severity of posttraumatic stress disorder (PTSD) symptoms and of poor response to pharmacological treatment in PTSD patients who had been exposed to urban violence ( Fiszman et al, 2008 , Rocha-Rego et al, 2009 ; Lima et al, 2010 ).…”

Section: Introductionmentioning

confidence: 99%

“…Recently, studies found that tonic immobility was a predictor of the severity of posttraumatic stress disorder (PTSD) symptoms and of poor response to pharmacological treatment in PTSD patients who had been exposed to urban violence ( Fiszman et al, 2008 , Rocha-Rego et al, 2009 ; Lima et al, 2010 ). Moreover, tonic immobility was significantly associated with PTSD symptoms in a non-clinical sample ( Portugal et al, 2012 ). Taken together, these studies suggest that the occurrence of this defensive reaction is not uncommon in humans and its occurrence might reflect how intense the traumatic event is perceived by the individual.…”

Section: Introductionmentioning

confidence: 99%

Exposure to trauma-relevant pictures is associated with tachycardia in victims who had experienced an intense peritraumatic defensive response: the tonic immobility

et al. 2014

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Tonic immobility is an involuntary, last-ditch defensive reaction characterized by physical inactivity in a context of inescapable threat that has been described in many species, including humans. The occurrence of this defensive response is a predictor of the severity of psychiatric disorders and may be considered as an index of an intense reaction to a traumatic event. Here, we investigated whether the retrospective reports of peritraumatic tonic immobility reaction in participants exposed to a traumatic event would modify their cardiac responses to pictures related to their trauma. Using a questionnaire of life-threating events, we selected students who experienced violent crime as their most intense trauma and students who had never experienced a violent crime trauma, but experienced other traumatic events. All participants completed a questionnaire that estimated the intensity of tonic immobility during their most intense trauma. Electrocardiographic recordings were collected during exposure to pictures. Participants viewed emotional pictures (human attack with guns) and neutral pictures. These emotional stimuli were selected to be trauma-relevant to the violent crime group and non trauma-relevant to the no violent crime trauma group. Violent crime group showed a positive correlation between heart rate changes after viewing trauma-related pictures and tonic immobility scores. We observed that low tonic immobility scores were associated with bradycardia and high scores with tachycardia in response to trauma-relevant pictures. For the no violent crime group, no significant correlation was detected. These results suggest that the relevance of the stimuli and the magnitude of the defensive response during a previous trauma event were important factors triggering more intense defensive responses.

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Peritraumatic tonic immobility is associated with posttraumatic stress symptoms in undergraduate Brazilian students

Abstract: This automatic reaction under extreme life threatening stress, although adaptive for defense, may have pathological consequences as implied by its association with PTSD symptoms.

Cited by 26 publications

References 30 publications

Tonic Immobility in PTSD: Exacerbation of Emotional Cardiac Defense Response

Tonic Immobility in PTSD: Exacerbation of Emotional Cardiac Defense Response

Structural Validity of the Tonic Immobility Scale in a Population Exposed to Trauma: Evidence from Two Large Brazilian Samples

Exposure to trauma-relevant pictures is associated with tachycardia in victims who had experienced an intense peritraumatic defensive response: the tonic immobility

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