Detecting Negative Response Bias Within the Trauma Symptom Inventory–2 (TSI-2): a Review of the Literature

This systematic review was performed to summarize existing research on the symptom validity scales within the Trauma Symptom Inventory–Second Edition (TSI-2), a relatively new self-report measure designed to assess the psychological sequelae of trauma. The TSI-2 has built-in symptom validity scales to monitor response bias and alert the assessor of non-credible symptom profiles. The Atypical Response scale (ATR) was designed to identify symptom exaggeration or fabrication. Proposed cutoffs on the ATR vary from ≥ 7 to ≥ 15, depending on the assessment context. The limited evidence available suggests that ATR has the potential to serve as measure of symptom validity, although its classification accuracy is generally inferior compared to well-established scales. While the ATR seems sufficiently sensitive to symptom over-reporting, significant concerns about its specificity persist. Therefore, it is proposed that the TSI-2 should not be used in isolation to determine the validity of the symptom presentation. More research is needed for development of evidence-based guidelines about the interpretation of ATR scores.

EMDR Treatment of Childhood Sexual Abuse for a Child Molester: Self-Reported Changes in Sexual Arousal

Expanding on previous findings that eye movement desensitization and reprocessing (EMDR) therapy may alter deviant sexual arousal in adult child molesters with a history of childhood sexual abuse (CSA), this article describes the changes reported following the application of EMDR therapy to the memories of CSA in an adult male who had sexually offended against prepubescent children. The client had previously completed a cognitive behavioral intervention to address his offending behavior. EMDR therapy took place over 11 months and consisted of 32 sessions, including preparation and review phases. The aim of the therapy was to alleviate current reported distress and symptoms of posttraumatic stress disorder (PTSD) related to his memories of CSA. The client reported positive changes in emotional, cognitive, and physiological functioning, consistent with reductions on a range of subscales of the Trauma Symptom Inventory 2 and the Inventory of Altered Self-Capacities. However, on completion of therapy, he also reported a reduction in the frequency and strength of sexual arousal to children, which was maintained at a 3-year follow-up, although this was not a target for treatment. The experiences described during the EMDR process by this client are discussed and related to the adaptive information processing (AIP) model and previous findings on reported changes in sexual arousal in this client group.

Erfassung der komplexen posttraumatischen Belastungsstörung mit dem revidierten Trauma Symptom Inventory (TSI-2)

Zusammenfassung Theoretischer Hintergrund Diese Studie überprüfte die Anwendbarkeit des revidierten Trauma Symptom Inventory (TSI-2) als Diagnoseverfahren für die komplexe posttraumatische Belastungsstörung (KPTBS) nach der Betaversion des ICD-11. Bislang wurde dafür kein Verfahren etabliert. Methode Auf Basis des TSI-2 wurde ein diagnostischer Algorithmus entwickelt. Dieser wurde in einer Stichprobe von 100 psychiatrisch hospitalisierten Patientinnen und Patienten mit aversiven und/oder traumatischen Erfahrungen getestet. Es werden die Häufigkeit der KPTBS eingeschätzt, Geschlechts- und Altersunterschiede überprüft, sowie Gruppenunterschiede zwischen traumatisierten und nicht-traumatisierten Studienteilnehmern und solchen mit und ohne KPTBS berichtet. Ergebnisse Nach dem hier angewandten TSI-2-Algorithmus für KTPSB lag die Häufigkeit bei 5%. Es wurden tendenzielle Geschlechtsunterschiede bezüglich der KPTBS-Symptomatik zum Nachteil der Frauen beobachtet und jüngere Patienten waren häufiger als ältere betroffen. Traumatisierte wiesen gegenüber nicht-traumatisierten Personen ein erhöhtes Ausmass an psychopathologischer Symptomatik auf. Schlussfolgerung Diese Ergebnisse sind erste Hinweise dafür, dass es eventuell möglich ist einige Skalen des TSI-2 zu kombinieren und auf dieser Basis die wahrscheinliche Diagnose der KPTBS nach der Betaversion des ICD-11 zu stellen.

Altered Cortical Gamma-Amino Butyric Acid in Female Veterans With Suicidal Behavior: Sex Differences and Clinical Correlates

Background Suicide is a public health concern in the civilian and veteran populations. Stressful life events are precipitating factors for suicide. The neurochemical underpinnings of the association between stress/trauma and suicide risk are unclear, especially with regard to sex differences. We hypothesized that gamma-amino butyric acid (GABA), the major inhibitory neurotransmitter, may be a neurochemical candidate that is critical in the association between stress and suicide risk in veterans. Methods Proton magnetic resonance spectroscopy at 3.0 Tesla was used to measure in vivo neurochemistry in the anterior cingulate cortex (predominantly the dorsal anterior cingulate cortex) of 81 veterans (16 females), including 57 (11 females) who endorsed past suicidal ideation and/or suicide attempt and 24 (5 females) with no history of suicidal ideation and/or suicide attempt. Suicidal behavior (SB) was defined as the presence of suicidal ideation and/or suicide attempt. Results We observed no significant differences in GABA/creatine + phosphocreatine (Cr + PCr) between veterans with SB (SB+) and without SB (SB−). However, the female SB+ group showed significantly reduced GABA/Cr + PCr versus the female SB− group. We observed a trend-level significant negative correlation between GABA/Cr + PCr and the Defensive Avoidance subscale on the Trauma Symptom Inventory in the SB+ group. In contrast, the SB− group exhibited a positive relationship between the two variables. Furthermore, we found significant negative correlations between GABA/Cr + PCr and Hamilton Rating Scale for Depression scores as well as between GABA/Cr + PCr and several subscales of the Trauma Symptom Inventory in female veterans. Conclusions This study suggests that reduced GABA/Cr + PCr ratio in the anterior cingulate cortex, which may be related to altered inhibitory capacity, may underlie suicide risk in female veterans. Further, the negative association between GABA/Cr + PCr and stress symptomatology and depression scores suggests that magnetic resonance spectroscopy studies may shed light on intermediate phenotypes of SB.

TINGKAT TRAUMA DALAM KALANGAN GURU BIMBINGAN DAN KONSELING SERTA GURU AGAMA PADA SEKOLAH LANJUTAN ATAS DI KOTA BANDA ACEH PASCA GEMPA DAN TSUNAMI

Gempa dan tsunami yang terjadi pada tanggal 26 Desember Tahun 2004 di Kota Banda Aceh, diduga banyak mayarakat, tidak terkecuali guru Bimbingan Konseling dan Agama di Sekolah Lanjutan Atas (SLTA) akan mengalami trauma pasca peristiwa tersebut. Patel (2003) menyatakan trauma adalah suatu peristiwa yang menyebabkan ketakutan dalam kehidupan seseorang dan menimbulkan stress yang negatif. Ada beberapa jenis trauma, yaitu: (1) Trauma Personal (korban perkosaan, kematian orang tercinta, korban kejahatan, dll) Perang dan keganasan, (2) Trauma Mayor (bencana alam, kebakaran, dll), trauma ini umumnya menyebabkan trauma pada sejumlah besar orang pada masa yang sama seperti peristiwa tsunami. Penelitian ini bertujuan untuk mengetahui tingkat trauma yang dialami guru bimbingan konseling dan guru agama di SLTA. Penelitian ini mengunakan intrumen Trauma Symptom Inventory (TSI) yang sudah di adaptasikan dalam bahasa Indonesia dan sudah di uji validitas dan reliabilitasnya. Hasil penelitian menunjukkan bahwa tingkat trauma guru bimbingan konseling dan agama rata-rata berada di tingkat rendah. Pernyataan ini didasari dari temuan hasil penelitian pada tingkat respon dua skala TSI yaitu skala validitas indikator ATR, RL dan INC berada pada tingkat rendah, begitu juga pada skala klinik yang terdiri dari empat dimensi yaitu dimensi Dysphoric Mood, terdiri dari tiga indikator yaitu: AA, D dan AI; (2) Post Traumatic Stress Disorder (PTSD) dengan indikator IE, DA dan DIS; (3) Dysfunction Sexualden SC dan DSB, dan (4) Self Dysfunction dengan indikator ISR dan TRB juga rendah.