Trauma Recovery - The 20 Most Influential Papers on Posttraumatic Stress

Trauma Recovery is a site dedicated to exactly what you might guess, recovery from trauma. Eva Alisi, Ph.D. is the blogger and trauma therapist who has created this blog for "psychologists, researchers, and other professionals working with children & adolescents" - and I might add, those who work with survivors of childhood incest and sexual abuse.

Recently she posted a collection of the 20 most influential papers on posttraumatic stress, a collection that I find very useful because my readings have been in a whole other realm. Few of the authors in this list were familiar to me - and she only knew about half of them (which makes me feel better). I hope you will find some useful material here as well. There will be a discussion on Twitter tomorrow on this topic - see the info in her article.

And by the way, she is currently soliciting suggestions for the 20 most inspiring/enthusiasm-producing papers. A few of mine are below.

The 20 most influential papers on posttraumatic stress

Posted on 22 March 2012

 

 

Which papers have shaped your thoughts on traumatic stress and recovery? Which articles do you often refer to? These questions will be the starting point for the next #traumaresearch chat on Twitter in exactly a week (March 28th in the US, 29th in Australia; see your local time).

Meanwhile, I have had a look at which publications have been most influential in terms of citations. For the methods (e.g., I have excluded articles focused on measures), see below. These are the most cited papers, with links to free full-text pdfs or abstracts:

1. Kessler et al. (1995) Posttraumatic stress disorder in the national comorbidity survey. Archives of General Psychiatry. 3437 citations
2. Breslau et al. (1991) Traumatic events and posttraumatic stress disorder in an urban population of young adults. Archives of General Psychiatry. 1181 citations
3. Kendall-Tackett et al. (1993) Impact of sexual abuse on children: A review and synthesis of recent empirical studies. Psychological Bulletin. 981 citations
4. Ehlers & Clark (2000) A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy. 978 citations
5. Brewin et al. (2000). Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. Journal of Consulting and Clinical Psychology. 976 citations
6. Hoge et al. (2004). Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. New England Journal of Medicine 351. 965 citations
7. Resnick et al. (1993). Prevalence of civilian trauma and posttraumatic stress disorder in a representative national sample of women. Journal of Consulting and Clinical Psychology. 887 citations
8. Breslau et al. (1998). Trauma and posttraumatic stress disorder in the community: The 1996 Detroit area survey of trauma. Archives of General Psychiatry. 824 citations
9. Sapolsky (2000). Glucocorticoids and hippocampal atrophy in neuropsychiatric disorders. Archives of General Psychiatry. 806 citations
10. Bremner et al. (1995). MRI-based measurement of hippocampal volume in patients with combat- related posttraumatic stress disorder. American Journal of Psychiatry. 798 citations
11. Ozer et al. (2003). Predictors of posttraumatic stress disorder and symptoms in adults: A meta-analysis Psychological Bulletin. 726 citations
12. Galea et al. (2002). Psychological sequelae of the September 11 terrorist attacks in New York City. New England Journal of Medicine. 713 citations
13. Campbell (2002). Health consequences of intimate partner violence. Lancet. 689 citations
14. McEwen (2000). The neurobiology of stress: From serendipity to clinical relevance. Brain Research. 661 citations
15. Heim et al. (2000). The potential role of hypocortisolism in the pathophysiology of stress-related bodily disorders. Psychoneuroendocrinology. 627 citations
16. Nolen-Hoeksema (1991). A Prospective Study of Depression and Posttraumatic Stress Symptoms After a Natural Disaster: The 1989 Loma Prieta Earthquake. Journal of Personality and Social Psychology. 615 citations
17. Foa et al. (1991). Treatment of posttraumatic stress disorder in rape victims: A comparison between cognitive-behavioral procedures and counseling. Journal of Consulting and Clinical Psychology. 571 citations
18. Helzer et al. (1987). Post-traumatic stress disorder in the general population: Findings of the epidemiologic catchment area survey. New England Journal of Medicine. 564 citations.
19. Bremner et al. (1997). Magnetic resonance imaging-based measurement of hippocampal volume in posttraumatic stress disorder related to childhood physical and sexual abuse – A preliminary report. Biological Psychiatry. 549 citations
20. Rauch et al. (1996).  A symptom provocation study of posttraumatic stress disorder using positron emission tomography and script-driven imagery. Archives of General Psychiatry. 534 citations

I knew only about half of this list…so I’ll have to catch up on some reading  A number of articles describe the epidemiology of posttraumatic stress, while others are more theoretical in nature or review a body of literature. For me, I think the second and third types have been more influential than the first. I’ll do a specific search for papers on children and adolescents, and compare them with my personal list next week.

(Method: I did a search in Scopus (“posttraumatic stress” OR “post-traumatic stress” OR “traumatic stress” OR “post-trauma stress” OR “traumatised” OR “traumatized” OR ”PTSD” in the title or abstract), had them listed according to number of citations and selected the papers that focused on posttraumatic mental health, excluding articles on instruments.)

For what it's worth, here are a few of the most "inspiring" articles for me (in no particular order).

1. van der Kolk, BA, Pelcovitz, D, Roth, S, Mandel, FS, McFarlane, A, and Herman, JL. (1996). Dissociation, Affect Dysregulation and Somatization: The complex nature of adaptation to trauma. American Journal of Psychiatry, 153(7), Festschrift Supplement, 83-93.
2. Shore, AN. (2001). The Effects of Early Relational Trauma on Right Brain Development, Affect Regulation, and Infant Mental Health. Infant Mental Health Journal, 22; 201-269.
3. Tedeschi, RG, and Calhoun, LG. (2004). Posttraumatic Growth: Conceptual Foundations and Empirical Evidence. Psychological Inquiry, Vol. 15, No 1; 1-18.
4. Porges, SW. (1995). Orienting in a defensive world: Mammalian modifications of our evolutionary heritage. A Polyvagal Theory. Psychophysiology, 32; 301-318. 
5. Lamagna, J and Gleiser, KA. (2007). Building a Secure Internal Attachment: An Intra-Relational Approach to Ego Strengthening and Emotional Processing with Chronically Traumatized Clients. Journal of Trauma & Dissociation, Vol. 8(1); 25-52. doi:10.1300/J229v08n01_03

This last one is an excellent combination of relational, intersubjective psychoanalytic techniques with parts work (ego states or subpersonalities). Very useful model that I would love to be fully trained to use.

Jill Suttie - Two Views on Trauma (from Greater Good)

Jill Suttie reviews two new books about trauma at the Greater Good site. One book reinforces what we know to be true: children who suffer trauma and neglect are more likely to experience serious illness later in life. The other book explores a somewhat newer idea in trauma work, that traumatic experiences can sometimes propel people to new and more integrated life experiences (Richard Tedeschi has been a leader in this field since the early 1990s - he is part of the UNC Charlotte Post-Traumatic Growth group - some online papers here).

Two Views on Trauma

By Jill Suttie | March 23, 2012
Is there an upside to trauma? Two new books offer two different perspectives.   
 

Trauma, by definition, is not good. The Merriam Webster’s online dictionary defines it as “a disordered psychic or behavioral state resulting from severe mental or emotional stress or physical injury.” Many of us look at trauma as an unavoidable state brought on by an unexpected event, something that might occur after a natural disaster or war.

Basic Books, 2012, 301 pages

But two new books give us a somewhat different look at trauma. Scared Sick: The Role of Childhood Trauma in Adult Disease, by Robin Karr-Morse, examines early childhood trauma in the form of very preventable parental neglect and abuse and its role in increasing the risk of adult disease later in life. What Doesn’t Kill Us: The New Psychology of Posttraumatic Growth, by Stephen Joseph, on the other hand, looks at the potential benefits of using trauma as a springboard for furthering personal growth.

According to Karr-Morse—a family therapist involved in Oregon State’s child welfare reform movement—many of the newest findings in neuroscience and health research are showing a link between adult health and the stress produced by childhood trauma. Trauma—particularly the kind caused by ongoing, repetitive injury, like that experienced in violent homes or homes stressed through poverty—is associated with a heightened fear response, which bathes the brain in harmful neuro-chemicals that can cause lasting damage. Kids who experience trauma are more prone to experience higher levels of stress, anxiety, and depression. They also are more susceptible to disease and to engaging in unhealthy coping strategies—like using drugs, drinking alcohol, or smoking—which further risk their health.

Karr-Morse writes of the importance of positive early attachments—loving and attentive care that gives kids a sense of security and trust early in life—in preventing childhood trauma. But she knows that stressed parents, especially those who didn’t experience positive attachments themselves, can easily fall prey to abusing or otherwise stressing their kids. Frightening statistics about higher rates of disease and shorter life-spans for adults who’ve suffered childhood trauma lends gravity to the case she make: As a society, we would be better off health-wise if there were better prenatal and post-natal support programs for parents.

Basic Books, 2011, 268 pages

After reading Scared Sick, it’s a bit disorienting to read What Doesn’t Kill Us, a book by psychologist Stephen Joseph which highlights a completely different take on trauma: its potential benefits.

Joseph, a professor of psychology, health, and social care at the University of Nottingham, UK, is an expert the growing field of posttraumatic growth—a positive spin on posttraumatic stress disorder (PTSD) that emphasizes the possibility of transforming extreme adversity into an opportunity to learn rather than an overpowering obstacle. He presents a model for posttraumatic growth—which he calls THRIVE—that involves recognizing your strengths, reframing your experience in a more positive way [i.e. focusing on being a survivor rather than a victim], and nurturing positive changes in your life.

Of course, this would seem like a pat and simplistic notion if Joseph didn’t have the research to back up his claims. Joseph and colleagues have studied people who’ve gone through disasters and found that many are able to weather the experience better with appropriate interventions. And his target audience is not abused children, who would probably be unable to make use of the highly structured, cognitive exercise outlined in the THRIVE model.

Yet, when we consider the fact that adult mental health and child abuse are intertwined, it seems clear that these two books are complimentary rather than at odds. Perhaps if we could help adults heal from their psychological wounds and support them in being the good parents to their kids, we’d be able to build a more healthy society for all.