Psychophysiological Assessment of PTSD

The prominent role of psychophysiological mechanisms in PTSD etiology and course are undeniable. Most psychophysiological assessment of PTSD has been relegated to research purposes. There are a few clinical applications, specifically for prediction of adjustment and treatment outcomes.

Psychophysiological assessment typically involves measurement of one of four key physiological systems outlined by Orr, Metzger, Miller, and Kaloupek (2004): cardiovascular measurement, such as blood pressure and heart rate measurement, with electrocardiograms (ECG); electrodermal measurement of skin conductance; electromyographic measurement of muscle activity; and electro-cortical measurement with electroencephalograms (EEG). Evidence of the various symptoms and components of PTSD has been provided. Reactivity to trauma-related cues, numbing of general responsiveness, sleep disturbance, irritability and anger, difficulty concentrating, hypervigilance, exaggerated startle responses, and persistent autonomic arousal have all been measurable and assessed using various psychophysiological techniques, lending solid evidence for many biological theories and models of PTSD. For now, however, the use of complex psychophysiological measures in the clinical setting is limited. For purposes of this chapter, only research findings relevant to potential clinical application will be discussed.

Altered baseline heart rate in traumatized individuals may be a good predictor of future PTSD development. Initial elevation in heart rate has been shown to be related to development of PTSD in motor vehicle accident victims (Bryant, Harvey, Guthrie, & Moulds, 2000). Blanchard, Hickling, Galovski, and Veazey (2002) made similar findings with elevated heart rate's predictive value.

It is proposed by Orr et al. (2004) that progress in treatment and treatment outcome can be psychophysiologically measured. Foa and Kozak (1986) propose that treatment gains are observable when patients rate their subjective distress to trauma cues as less distressing over time. In addition to subjective verbal ratings and reports, a patient's reactivity to trauma cues could be measured physiologically. Pitman, Orr, Altman, and Longpre (1996) found that measured reductions in heart rate, skin conductance, and facial electromyography (EMG) during treatment were correlated with a reduction in daily intrusive symptoms. Further, Shalev, Orr, and Pitman (1992) found that psychophysiological responses to imagery presentation were responsive to psychiatric improvements. Boudewyns and Hyer (1990) found that a decrease in skin conductance in response to trauma imagery was correlated with higher scores on an adjustment measure up to 3 months after treatment.

Ultimately, the utility and practicality of psychophysiological measures in clinical practice are limited at this time. However, with innovations in computer technology and more affordable technology becoming available, it might be that in just a few years pencil-and-paper tests of symptoms will be replaced or at least augmented by the types of psychophysiological measures mentioned here.

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