PSYCHOSOCIAL TREATMENTS FOR POSTTRAUMATIC STRESS DISORDER: A Critical Review

Foa, Edna B.; Meadows, Elizabeth A.

doi:10.1146/annurev.psych.48.1.449

Cited by 646 publications

(478 citation statements)

References 76 publications

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“…In line with the cross-state continuity assumption, we suggest that the ensemble of emotional-imagery processes constituting fear memories underlies a variety of clinical conditions characterized by anxiety and fear, such as panic disorder, phobia, and PTSD (Foa & Meadows, 1997;Mineka & Zimbarg, 2006;VanOyen Witvliet, 1997) as well as dysphoric dreams and nightmares.…”

Section: Memory Element Activationsupporting

confidence: 69%

Disturbed dreaming, posttraumatic stress disorder, and affect distress: A review and neurocognitive model.

Levin

Nielsen

2007

Psychological Bulletin

527

557

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Nightmares are common, occurring weekly in 4%-10% of the population, and are associated with female gender, younger age, increased stress, psychopathology, and dispositional traits. Nightmare pathogenesis remains unexplained, as do differences between nontraumatic and posttraumatic nightmares (for those with or without posttraumatic stress disorder) and relations with waking functioning. No models adequately explain nightmares nor have they been reconciled with recent developments in cognitive neuroscience, fear acquisition, and emotional memory. The authors review the recent literature and propose a conceptual framework for understanding a spectrum of dysphoric dreaming. Central to this is the notion that variations in nightmare prevalence, frequency, severity, and psychopathological comorbidity reflect the influence of both affect load, a consequence of daily variations in emotional pressure, and affect distress, a disposition to experience events with distressing, highly reactive emotions. In a cross-state, multilevel model of dream function and nightmare production, the authors integrate findings on emotional memory structures and the brain correlates of emotion.Keywords: nightmares, distress, neurophysiology of fear memory, posttraumatic stress disorder, psychopathology Nightmares are the most common form of disturbed dreaming. Vivid, with emotions escalating at times to the brink of terror, they are manifestations of the dramatic autonomic and cognitive fluctuations that can arise during rapid eye movement (REM) sleep and, under certain circumstances, during Stage 2 sleep. Nightmares can be simple and benign or so emotionally severe that they beg for comparison with psychotic episodes (C. Fisher, Byrne, Edwards, & Kahn, 1970;Hartmann, 1984;Sullivan, 1962). Occasional nightmares are almost ubiquitous in the general population. However, frequent distressing nightmares are more common than generally thought, affecting 4%-10% of individuals by conservative estimates. Nightmares are also extremely common following trauma exposure. Posttraumatic nightmares may depict traumarelated content and, in cases of chronic posttraumatic stress disorder (PTSD), may at times replicate the trauma with great distress (for review, see Mellman & Pigeon, 2005).There has been a proliferation of experimental work on posttraumatic and nontraumatic nightmares in the past 15 years, the vast majority of which has examined the psychopathological correlates of individuals with frequent nightmares. Furthermore, recent advances in neuroscience have greatly expanded our understanding of dreaming and related brain functions (Maquet, 2000;Maquet et al., 2000) as well as the pathogenic mechanisms implicated in fear conditioning and the development of PTSD (LeDoux, 2000;Ohman & Mineka, 2001). However, despite the clear implications of these developments for understanding nightmares, there are still no comprehensive models of nightmare etiology and no conceptual frameworks for understanding the link between posttraumatic and nontraumatic nightm...

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Section: Memory Element Activationsupporting

confidence: 69%

Disturbed dreaming, posttraumatic stress disorder, and affect distress: A review and neurocognitive model.

Levin

Nielsen

2007

Psychological Bulletin

527

557

View full text Add to dashboard Cite

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“…At the 1-year follow-up, the narrative exposure therapy effect sizes (1.6 for PDS and 1.9 for CIDI) indicated a clinically significant change for PTSD symptoms that did not occur in the other groups. These results indicate that the wellestablished knowledge about the efficacy of exposure techniques for the treatment of PTSD (Foa, 2000) can be transferred to refugee populations living in unsafe conditions. All groups improved somewhat during the 1-year period after therapy, according to indicators of anxiety, depression, and overall mental health.…”

Section: Discussionmentioning

confidence: 83%

“…Within the past decade, empirical knowledge about effective psychotherapeutic treatment for PTSD has rapidly increased (Foa, 2000). Treatment for PTSD is well studied in civilian populations with victims of traumatic events who live in industrialized countries, such as the United States, Europe, or Australia.…”

mentioning

confidence: 99%

A Comparison of Narrative Exposure Therapy, Supportive Counseling, and Psychoeducation for Treating Posttraumatic Stress Disorder in an African Refugee Settlement.

Neuner¹,

Schauer²,

Klaschik³

et al. 2004

Journal of Consulting and Clinical Psychology

526

406

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“…Treatments of these disorders often rely on progressive extinction of fear memories (Zarate and Agras, 1994;Dadds et al, 1997;Foa, 2000). However, there is little direct evidence for any molecular dysfunction that may predispose individuals to such disorders.…”

Section: Introductionmentioning

confidence: 99%

Glutamate NMDA Receptors within the Amygdala Participate in the Modulatory Effect of Glucocorticoids on Extinction of Conditioned Fear in Rats

Yang

Chao

et al. 2006

Neuropsychopharmacol

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Recent results show that brain glucocorticoids are involved in the dysregulation of fear memory extinction in post-traumatic stress disorder patients. The present study was aimed to elucidate the possible mechanism of glucocorticoids on the conditioned fear extinction. To achieve these goals, male SD rats, fear-potentiated startle paradigm, and Western blot were used. We found that (1) systemic administration of the synthetic glucocorticoid agonist dexamethasone (DEX) facilitated extinction of conditioned fear in a dose-dependent manner (0.05, 0.1, 0.5, or 1.0 mg/kg, i.p.); (2) systemic administration of the glutamate NMDA receptor antagonist (7)-HA966 (6.0 mg/kg, i.p.) and intra-amygdala infusion of the NMDA receptor antagonists MK801 (0.5 ng/side, bilaterally) or D,L-2-amino-5-phosphonovaleric acid (AP5, 2.0 ng/side, bilaterally) blocked the DEX facilitation effect; (3) the corticosteroid synthesis inhibitor metyrapone (25 mg/kg. s.c.) blocked extinction and this was prevented by co-administration of NMDA receptor agonist D-cycloserine (DCS, 5.0 mg/kg, i.p.); (4) co-administration of DEX and DCS in subthreshold doses provided a synergistic facilitation effect on extinction (0.2 and 5 mg/kg, respectively). Control experiments indicated that co-administration of DEX and DCS did not alter the expression of conditioned fear and the effect was not due to lasting damage to the amygdala. These results suggest that glutamate NMDA receptors within the amygdala participate in the modulatory effect of glucocorticoids on extinction.

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PSYCHOSOCIAL TREATMENTS FOR POSTTRAUMATIC STRESS DISORDER: A Critical Review

Cited by 646 publications

References 76 publications

Disturbed dreaming, posttraumatic stress disorder, and affect distress: A review and neurocognitive model.

Disturbed dreaming, posttraumatic stress disorder, and affect distress: A review and neurocognitive model.

A Comparison of Narrative Exposure Therapy, Supportive Counseling, and Psychoeducation for Treating Posttraumatic Stress Disorder in an African Refugee Settlement.

Glutamate NMDA Receptors within the Amygdala Participate in the Modulatory Effect of Glucocorticoids on Extinction of Conditioned Fear in Rats

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