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Towards an exposure-dependent model of post-traumatic stress: longitudinal course of post-traumatic stress symptomatology and functional impairment after the 2011 Oslo bombing

Published online by Cambridge University Press:  09 September 2016

Ø. Solberg ,
M. S. Birkeland ,
I. Blix ,
M. B. Hansen  and
T. Heir
Ø. Solberg*
Affiliation:
Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
M. S. Birkeland
Affiliation:
Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
I. Blix
Affiliation:
Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
M. B. Hansen
Affiliation:
Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
T. Heir
Affiliation:
Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
*
*Address for correspondence: Ø. Solberg, Ph.D., Norwegian Centre for Violence and Traumatic Stress Studies, Gullhaugveien 1-3, 5 etg, 0484 Oslo, Norway. (Email: oivis@psykologi.uio.no)
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Abstract

Background

Our understanding of the dynamics of post-traumatic stress symptomatology and its link to functional impairment over time is limited.

Method

Post-traumatic stress symptomatology (Post-traumatic Checklist, PCL) was assessed three times in 1-year increments (T1, T2, T3) following the Oslo bombing of 22 July, 2011, in directly (n = 257) and indirectly exposed (n = 2223) government employees, together with demographics, measures of exposure and work and social adjustment. The dynamics of post-traumatic stress disorder symptom cluster interplay were examined within a structural equation modelling framework using a cross-lagged autoregressive panel model.

Results

Intrusions at T1 played a prominent role in predicting all symptom clusters at T2 for the directly exposed group, exhibiting especially strong cross-lagged relationships with avoidance and anxious arousal. For the indirectly exposed group, dysphoric arousal at T1 played the most prominent role in predicting all symptom clusters at T2, exhibiting a strong relationship with emotional numbing. Emotional numbing seemed to be the main driver behind prolonged stress at T3 for both groups. Functional impairment was predominately associated with dysphoric arousal and emotional numbing in both groups.

Conclusions

For directly exposed individuals, memories of the traumatic incident and the following intrusions seem to drive their post-traumatic stress symptomatology. However, as these memories lose their potency over time, a sequela of dysphoric arousal and emotional numbing similar to the one reported by the indirectly exposed individuals seems to be the main driver for prolonged post-traumatic stress and functional impairment. Findings are discussed using contemporary models within an exposure-dependent perspective of post-traumatic stress.

Keywords

Exposurefunctional impairmentpost-traumatic stress
Type
Original Articles
Information
Psychological Medicine , Volume 46 , Issue 15 , November 2016 , pp. 3241 - 3254
Copyright
Copyright © Cambridge University Press 2016 

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References

APA (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn (DSM-IV) . American Psychiatric Association: Washington, DC.Google Scholar
APA (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th edn. American Psychiatric Association: Washington, DC.Google Scholar
Armour, C, Műllerová, J, Elhai, JD (2016). A systematic literature review of PTSD's latent structure in the Diagnostic and Statistical Manual of Mental Disorders: DSM-IV to DSM-5. Clinical Psychology Review 44, 60–74.Google Scholar
Berman, NC, Wheaton, MG, Mcgrath, P, Abramowitz, JS (2010). Predicting anxiety: the role of experiential avoidance and anxiety sensitivity. Journal of Anxiety Disorders 24, 109–113.Google Scholar
Birkeland, MS, Hafstad, GS, Blix, I, Heir, T (2015). Latent classes of posttraumatic stress and growth. Anxiety, Stress, & Coping 28, 272–286.Google Scholar
Blanchard, EB, Jones-Alexander, J, Buckley, TC, Forneris, CA (1996). Psychometric properties of the PTSD Checklist (PCL). Behaviour Research and Therapy 34, 669–673.Google Scholar
Breslau, N (2001). The epidemiology of posttraumatic stress disorder: What is the extent of the problem? Journal of Clinical Psychiatry 62, 16–22.Google Scholar
Browne, M, Cudeck, R (1992). Alternative ways of assessing model fit. Sociological Methods & Research 21, 230–258.Google Scholar
Bryant, RA, Creamer, M, O'Donnell, M, Silove, D, McFarlane, AC (2010). Sleep disturbance immediately prior to trauma predicts subsequent psychiatric disorder. Sleep 33, 69–74.CrossRefGoogle ScholarPubMed
Byllesby, BM, Charak, R, Durham, TA, Wang, X, Elhai, JD (2016 a). The underlying role of negative affect in the association between PTSD, major depressive disorder, and generalized anxiety disorder. Journal of Psychopathology and Behavioral Assessment, 1–11.Google Scholar
Byllesby, BM, Durham, TA, Forbes, D, Armour, C, Elhai, JD (2016 b). An investigation of PTSD's core dimensions and relations with anxiety and depression. Psychological Trauma: Theory, Research, Practice, and Policy 8, 214–217.Google Scholar
Catarino, A, Küpper, CS, Werner-Seidler, A, Dalgleish, T, Anderson, MC (2015). Failing to forget: inhibitory-control deficits compromise memory suppression in posttraumatic stress disorder. Psychological Science 26, 604–616.Google Scholar
Dobie, DJ, Kivlahan, DR, Maynard, C, Bush, KR, Davis, TM, Bradley, KA (2004). Posttraumatic stress disorder in female veterans: association with self-reported health problems and functional impairment. Archives of Internal Medicine 164, 394–400.CrossRefGoogle ScholarPubMed
Dougall, AL, Craig, KJ, Baum, A (1999). Assessment of characteristics of intrusive thoughts and their impact on distress among victims of traumatic events. Psychosomatic Medicine 61, 38–48.CrossRefGoogle ScholarPubMed
Ehlers, A, Clark, DM (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy 38, 319–345.Google Scholar
Ehlers, A, Hackmann, A, Michael, T (2004). Intrusive re-experiencing in post-traumatic stress disorder: phenomenology, theory, and therapy. Memory 12, 403–415.Google Scholar
Elhai, JD, Palmieri, PA (2011). The factor structure of posttraumatic stress disorder: a literature update, critique of methodology, and agenda for future research. Journal of Anxiety Disorders 25, 849–854.CrossRefGoogle ScholarPubMed
Enders, C (2010). Applied Missing Data Analysis. Guilford Press: New York.Google Scholar
Fani, N, Tone, EB, Phifer, J, Norrholm, SD, Bradley, B, Ressler, KJ, Kamkwalala, A, Jovanovic, T (2012). Attention bias toward threat is associated with exaggerated fear expression and impaired extinction in PTSD. Psychological Medicine 42, 533–43.Google Scholar
Forbes, D, Creamer, M, Biddle, D (2001). The validity of the PTSD checklist as a measure of symptomatic change in combat-related PTSD. Behaviour Research and Therapy 39, 977–986.Google Scholar
Germain, A (2013). Sleep disturbances as the hallmark of PTSD: where are we now? American Journal of Psychiatry 170, 372–382.Google Scholar
Gootzeit, J, Markon, K (2011). Factors of PTSD: differential specificity and external correlates. Clinical Psychology Review 31, 993–1003.CrossRefGoogle ScholarPubMed
Graham, JW (2009). Missing data analysis: making it work in the real world. Annual Review of Psychology 60, 549–576.Google Scholar
Hansen, MB, Nissen, A, Heir, T (2013). Proximity to terror and post-traumatic stress: a follow-up survey of governmental employees after the 2011 Oslo bombing attack. BMJ Open 3, 1–5.CrossRefGoogle Scholar
Heir, T, Piatigorsky, A, Weisæth, L (2010). Posttraumatic stress symptom clusters associations with psychopathology and functional impairment. Journal of Anxiety Disorders 24, 936–940.Google Scholar
Hem, C, Hussain, A, Wentzel-Larsen, T, Heir, T (2012). The Norwegian version of the PTSD Checklist (PCL): Construct validity in a community sample of 2004 tsunami survivors. Nordic Journal of Psychiatry 66, 355–359.Google Scholar
Holowka, D, Marx, BP (2012). Assessing PTSD-related functional impairment and quality of life. In: The Oxford Handbook of Traumatic Stress Disorders, pp. 315–330. Oxford University Press, Inc.: New York.Google Scholar
Hu, L, Bentler, PM (1999). Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Structural Equation Modeling 6, 1–55.Google Scholar
Lee, CW, Cuijpers, P (2013). A meta-analysis of the contribution of eye movements in processing emotional memories. Journal of Behavior Therapy and Experimental Psychiatry 44, 231–239.Google Scholar
Leer, A, Engelhard, IM, Van Den Hout, MA (2014). How eye movements in EMDR work: changes in memory vividness and emotionality. Journal of Behavior Therapy and Experimental Psychiatry 45, 396–401.Google Scholar
Little, TD (2013). Longitudinal Structural Equation Modeling. The Guilford Press: New York.Google Scholar
Litz, BT (1992). Emotional numbing in combat-related post-traumatic stress disorder: a critical review and reformulation. Clinical Psychology Review 12, 417–432.Google Scholar
Litz, BT, Litz, BT, Gray, MJ (2002). Emotional numbing in posttraumatic stress disorder: current and future research directions. Australian and New Zealand Journal of Psychiatry 36, 198–204.CrossRefGoogle ScholarPubMed
Maguen, S, Stalnaker, M, Mccaslin, S, Litz, BT (2009). PTSD subclusters and functional impairment in Kosovo peacekeepers. Military Medicine 174, 779–785.Google Scholar
Marshall, GN, Schell, TL, Glynn, SM, Shetty, V (2006 a). The role of hyperarousal in the manifestation of posttraumatic psychological distress following injury. Journal of Abnormal Psychology 115, 624–628.Google Scholar
Marshall, RD, Turner, JB, Lewis-Fernandez, R, Koenan, K, Neria, Y, Dohrenwend, BP (2006 b). Symptom patterns associated with chronic PTSD in male veterans: new findings from the National Vietnam Veterans Readjustment Study. Journal of Nervous and Mental Disease 194, 275–278.Google Scholar
May, CL, Wisco, BE (2016). Defining trauma: how level of exposure and proximity affect risk for posttraumatic stress disorder. Psychological Trauma: Theory, Research, Practice, and Policy 8, 233–240.Google Scholar
Mendlowicz, MV, Stein, MB (2000). Quality of life in individuals with anxiety disorders. American Journal of Psychiatry 157, 669–682.Google Scholar
Mundt, JC, Marks, IM, Shear, MK, Greist, JM (2002). The Work and Social Adjustment Scale: a simple measure of impairment in functioning. British Journal of Psychiatry 180, 461–464.Google Scholar
Muthén, B, Muthén, LK (1998–2014). Mplus (Version 7.2). Muthén & Muthén: Los Angeles.Google Scholar
Nissen, A, Birkeland Nielsen, M, Solberg, Ø, Bang Hansen, M, Heir, T (2015). Perception of threat and safety at work among employees in the Norwegian ministries after the 2011 Oslo bombing. Anxiety, Stress, & Coping 28, 650–662.Google Scholar
O'Donnell, ML, Elliott, P, Lau, W, Creamer, M (2007). PTSD symptom trajectories: from early to chronic response. Behaviour Research and Therapy 45, 601–606.Google Scholar
Palyo, SA, Clapp, JD, Beck, JG, Grant, DM, Marques, L (2008). Unpacking the relationship between posttraumatic numbing and hyperarousal in a sample of help-seeking motor vehicle accident survivors: replication and extension. Journal of Traumatic Stress 21, 235–238.Google Scholar
Parslow, RA, Jorm, AF (2007). Pretrauma and posttrauma neurocognitive functioning and PTSD symptoms in a community sample of young adults. American Journal of Psychiatry 164, 509–515.Google Scholar
Pietrzak, R, Feder, A, Schechter, C, Singh, R, Cancelmo, L, Bromet, E, Katz, C, Reissman, D, Ozbay, F, Sharma, V (2014). Dimensional structure and course of post-traumatic stress symptomatology in World Trade Center responders. Psychological Medicine 44, 2085–2098.Google Scholar
Pietrzak, RH, Goldstein, MB, Malley, JC, Rivers, AJ, Southwick, SM (2010). Structure of posttraumatic stress disorder symptoms and psychosocial functioning in Veterans of Operations Enduring Freedom and Iraqi Freedom. Psychiatry Research 178, 323–329.Google Scholar
Rodriguez, P, Holowka, DW, Marx, BP (2012). Assessment of posttraumatic stress disorder–related functional impairment: a review. Journal of Rehabilitation Research and Development 49, 649–666.Google Scholar
Rubin, DC, Berntsen, D, Bohni, MK (2008). A memory-based model of posttraumatic stress disorder: evaluating basic assumptions underlying the PTSD diagnosis. Psychological Review 115, 985.Google Scholar
Sack, M, Lempa, W, Steinmetz, A, Lamprecht, F, Hofmann, A (2008). Alterations in autonomic tone during trauma exposure using eye movement desensitization and reprocessing (EMDR) – results of a preliminary investigation. Journal of Anxiety Disorders 22, 1264–1271.Google Scholar
Satorra, A, Bentler, PM (2001). A scaled difference chi-square test statistic for moment structure analysis. Psychometrika 66, 507–514.Google Scholar
Schell, TL, Marshall, GN, Jaycox, LH (2004). All symptoms are not created equal: the prominent role of hyperarousal in the natural course of posttraumatic psychological distress. Journal of Abnormal Psychology 113, 189–197.CrossRefGoogle Scholar
Shnaider, P, Vorstenbosch, V, Macdonald, A, Wells, SY, Monson, CM, Resick, PA (2014). Associations between functioning and PTSD symptom clusters in a dismantling trial of cognitive processing therapy in female interpersonal violence survivors. Journal of Traumatic Stress 27, 526–534.Google Scholar
Solberg, Ø, Blix, I, Heir, T (2015). The aftermath of terrorism: posttraumatic stress and functional impairment after the 2011 Oslo bombing. Frontiers in Psychology 6, 1–8.Google Scholar
Solomon, Z, Horesh, D, Ein-Dor, T (2009). The longitudinal course of posttraumatic stress disorder symptom clusters among war veterans. Journal of Clinical Psychiatry 70, 837.Google Scholar
Stickgold, R (2002). EMDR: a putative neurobiological mechanism of action. Journal of Clinical Psychology 58, 61–75.Google Scholar
van den Hout, MA, Eidhof, MB, Verboom, J, Littel, M, Engelhard, IM (2013). Blurring of emotional and non-emotional memories by taxing working memory during recall. Cognition and Emotion 28, 717–727.Google Scholar
Weathers, FW, Litz, BT, Herman, DS, Huska, JA, Keane, TM (1993). The PTSD Checklist (PCL): Reliability, Validity, And Diagnostic Utility. Annual Meeting of the International Society for Traumatic Stress Studies: San Antonio, TX.Google Scholar
Yoshihama, M, Horrocks, J (2005). Relationship between emotional numbing and arousal symptoms in American women of Japanese descent who experienced interpersonal victimization. Journal of Anxiety Disorders 19, 443–459.Google Scholar
Zatzick, DF, Marmar, CR, Weiss, DS, Browner, WS, Metzler, TJ, Golding, JM, Stewart, A, Schlenger, WE, Wells, KB (1997). Posttraumatic stress disorder and functioning and quality of life outcomes in a nationally representative sample of male Vietnam veterans. American Journal of Psychiatry 154, 1690–1695.Google Scholar
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