Marylene Cloitre, Ph.D.

Treatment of complex PTSD: Results of the ISTSS expert clinician survey on best practices
Cloitre, Marylene; Courtois, Christine A; Charuvastra, Anthony; Carapezza, Richard; Stolbach, Bradley C; Green, Bonnie L
2011 Dec;24(6):615-627, Journal of traumatic stress
This study provides a summary of the results of an expert opinion survey initiated by the International Society for Traumatic Stress Studies Complex Trauma Task Force regarding best practices for the treatment of complex posttraumatic stress disorder (PTSD). Ratings from a mail-in survey from 25 complex PTSD experts and 25 classic PTSD experts regarding the most appropriate treatment approaches and interventions for complex PTSD were examined for areas of consensus and disagreement. Experts agreed on several aspects of treatment, with 84% endorsing a phase-based or sequenced therapy as the most appropriate treatment approach with interventions tailored to specific symptom sets. First-line interventions matched to specific symptoms included emotion regulation strategies, narration of trauma memory, cognitive restructuring, anxiety and stress management, and interpersonal skills. Meditation and mindfulness interventions were frequently identified as an effective second-line approach for emotional, attentional, and behavioral (e.g., aggression) disturbances. Agreement was not obtained on either the expected course of improvement or on duration of treatment. The survey results provide a strong rationale for conducting research focusing on the relative merits of traditional trauma-focused therapies and sequenced multicomponent approaches applied to different patient populations with a range of symptom profiles. Sustained symptom monitoring during the course of treatment and during extended follow-up would advance knowledge about both the speed and durability of treatment effects
— id: 147691, year: 2011, vol: 24, page: 615, stat: Journal Article,

Differential activity of subgenual cingulate and brainstem in panic disorder and PTSD
Tuescher, Oliver; Protopopescu, Xenia; Pan, Hong; Cloitre, Marylene; Butler, Tracy; Goldstein, Martin; Root, James C; Engelien, Almut; Furman, Daniella; Silverman, Michael; Yang, Yihong; Gorman, Jack; LeDoux, Joseph; Silbersweig, David; Stern, Emily
2011 Mar;25(2):251-257, Journal of anxiety disorders
Most functional neuroimaging studies of panic disorder (PD) have focused on the resting state, and have explored PD in relation to healthy controls rather than in relation to other anxiety disorders. Here, PD patients, posttraumatic stress disorder (PTSD) patients, and healthy control subjects were studied with functional magnetic resonance imaging utilizing an instructed fear conditioning paradigm incorporating both Threat and Safe conditions. Relative to PTSD and control subjects, PD patients demonstrated significantly less activation to the Threat condition and increased activity to the Safe condition in the subgenual cingulate, ventral striatum and extended amygdala, as well as in midbrain periaquaeductal grey, suggesting abnormal reactivity in this key region for fear expression. PTSD subjects failed to show the temporal pattern of activity decrease found in control subjects
— id: 134298, year: 2011, vol: 25, page: 251, stat: Journal Article,

Implementation of a screen and treat program for child posttraumatic stress disorder in a school setting after a school suicide
Charuvastra, Anthony; Goldfarb, Elizabeth; Petkova, Eva; Cloitre, Marylene
2010 Aug;23(4):500-503, Journal of traumatic stress
To provide effective treatments for childhood posttraumatic stress disorder (PTSD) children with PTSD must first be identified. The authors implemented a 'screen and treat' program following a widely witnessed school suicide. Three months after the suicide, exposed students received the Child Trauma Symptom Questionnaire at school. Parents received the questionnaire to rate their children's PTSD symptoms. Children with scores > or =5 received follow-up interviews and those diagnosed with PTSD were referred for treatment. Ninety-six percent of exposed students were screened, 14% screened positive, and 6% had PTSD. Child and parent agreement was generally poor. All children with PTSD were successfully referred to treatment. Screen and treat programs using existing clinical instruments are efficient and acceptable for use in school settings following trauma
— id: 112040, year: 2010, vol: 23, page: 500, stat: Journal Article,

Treatment for PTSD related to childhood abuse: a randomized controlled trial
Cloitre, Marylene; Stovall-McClough, K Chase; Nooner, Kate; Zorbas, Patty; Cherry, Stephanie; Jackson, Christie L; Gan, Weijin; Petkova, Eva
2010 Aug;167(8):915-924, American journal of psychiatry
OBJECTIVE: Posttraumatic stress disorder (PTSD) related to childhood abuse is associated with features of affect regulation and interpersonal disturbances that substantially contribute to impairment. Existing treatments do not address these problems or the difficulties they may pose in the exploration of trauma memories, an efficacious and frequently recommended approach to resolving PTSD. The authors evaluated the benefits and risks of a treatment combining an initial preparatory phase of skills training in affect and interpersonal regulation (STAIR) followed by exposure by comparing it against two control conditions: Supportive Counseling followed by Exposure (Support/Exposure) and skills training followed by Supportive Counseling (STAIR/Support). METHOD: Participants were women with PTSD related to childhood abuse (N=104) who were randomly assigned to the STAIR/Exposure condition, Support/Exposure condition (exposure comparator), or STAIR/Support condition (skills comparator) and assessed at posttreatment, 3 months, and 6 months. RESULTS: The STAIR/Exposure group was more likely to achieve sustained and full PTSD remission relative to the exposure comparator, while the skills comparator condition fell in the middle (27% versus 13% versus 0%). STAIR/Exposure produced greater improvements in emotion regulation than the exposure comparator and greater improvements in interpersonal problems than both conditions. The STAIR/Exposure dropout rate was lower than the rate for the exposure comparator and similar to the rate for the skills comparator. There were significantly lower session-to-session PTSD symptoms during the exposure phase in the STAIR/Exposure condition than in the Support/Exposure condition. STAIR/Exposure was associated with fewer cases of PTSD worsening relative to both of the other two conditions. CONCLUSIONS: For a PTSD population with chronic and early-life trauma, a phase-based skills-to-exposure treatment was associated with greater benefits and fewer adverse effects than treatments that excluded either skills training or exposure
— id: 111617, year: 2010, vol: 167, page: 915, stat: Journal Article,

Treatment for complex PTSD
Jackson, Christie; Nissenson, Kore; Cloitre, Marylene
Treatment resistant anxiety disorders: Resolving impasses to symptom remission New York, NY : Routledge/Taylor & Francis Group, 2010,
(from the chapter) Treatments for posttraumatic stress disorder (PTSD) were originally proposed to address the consequences of a specific traumatic event, such as a rape or an automobile accident. It is now acknowledged that single incidents of trauma are rare, and among those who are exposed to trauma multiple traumatic exposures are the norm rather than the exception. PTSD related to chronic and repeated forms of trauma (e.g., childhood abuse, domestic violence, being a witness to genocide) is associated with a more complex constellation of symptoms that can be especially resistant to treatment. In this chapter, we describe PTSD in its more complex forms and introduce a modular sequential treatment approach that has been successful in addressing complex PTSD symptoms and in resolving some of the difficulties that have been identified in using traditional PTSD treatments. We provide an overview of the treatment, its evidence base, and clinical case vignettes illustrating the application of these interventions.
— id: 5269, year: 2010, vol: , page: 75, stat: Chapter,

Grief in childhood: Fundamentals of treatment in clinical practice
Pearlman, Michelle Y; Schwalbe, Karen D'Angelo; Cloitre, Marylene
Washington, DC : American Psychological Association; US, 2010,
(from the publicity materials) Children vary in their response to the death of a loved one. Some children develop relatively few symptoms or problems, while others face significant or prolonged symptoms, such as posttraumatic stress disorder or anxiety. Similarly, children vary in their circumstances and preferences. Thus, clinicians who work with bereaved children must customize interventions to meet the specific needs of each individual child. This book presents Integrated Grief Therapy for Children--an evidence-based model for treating bereaved children that draws extensively on cognitive-behavioral, family systems, and narrative approaches to therapy. The model shows clinicians how to assess the needs of bereaved children, treat common distressing symptoms (depression, posttraumatic stress disorder, anxiety, and behavioral problems), and address the grief itself while fostering resilience. Because emotional and behavioral problems following grief are manifested in different ways, the model allows for flexibility based on the age, symptom presentation, and needs of the child. And because the inclusion of a surviving parent or caregiver is critical to working with grieving children, the model involves the parent in the interventions. With a thorough literature review on bereavement in childhood, extensive case examples and dialogues to illustrate therapeutic techniques, and over 20 activity handouts that therapists can photocopy and use in sessions, this book provides everything needed to treat bereaved children.
— id: 2120, year: 2010, vol: , page: , stat: ,

Assessing grieving children and teaching basic coping skills
Pearlman, Michelle Y; Schwalbe, Karen D'Angelo; Cloltre, Marylene
Grief in childhood: Fundamentals of treatment in clinical practice Washington, DC : American Psychological Association, 2010,
(from the chapter) When seeking clinical services, bereaved families present with various needs, including guidance regarding what to expect and how to cope as well as help in dealing with specific symptoms or problems that follow the death of a loved one. A thorough assessment should always be conducted to determine treatment needs. This chapter presents the clinician with guidelines for assessing and educating bereaved children as well an introduction to the basic skill components of integrated grief therapy for children.
— id: 5297, year: 2010, vol: , page: 279, stat: Chapter,

Coping skills for grieving children
Pearlman, Michelle Y; Schwalbe, Karen D'Angelo; Cloltre, Marylene
Grief in childhood: Fundamentals of treatment in clinical practice Washington, DC : American Psychological Association, 2010,
(from the chapter) This chapter introduces integrated grief therapy for children (IGTC) strategies that may help the bereaved child and parent to cope with potentially overwhelming thoughts and feelings about themselves, others, and the world, so that they can resume the tasks of daily living. It primarily focuses on the cognitive-behavioral therapy coping skills previously reviewed for the treatment of specific symptoms and applies them toward distressing grief-related thoughts and feelings. Three types of coping skills (cognitive, affective, and behavioral) are presented in this chapter. Cognitive coping skills include cognitive restructuring (including the use of strategies such as the 'thought detective'), self-monitoring through the use of awareness and thought diaries, positive self-talk, and distraction. These interventions are designed to help children reduce maladaptive ways of thinking that impact their behaviors, feelings, and general mood. Affective coping skills include the use of imagery to evoke positive feelings, along with relaxation strategies. Affective coping skills are designed to help children reduce overwhelming feelings, including sadness, worry, and anger. Behavioral coping techniques include the encouragement of self-care for both parent and child, psychoeducation about the impact of avoidance, and problem-solving strategies. Coping skills are important not only for the child but also for the parent. As noted throughout the IGTC approach, it is important for the therapist to aid the surviving parent not only for reducing his or her own distress but also for the impact of parental functioning on bereaved children. Educating the parent about coping skills thus helps parents manage their own thoughts, feelings, and behaviors and reinforce the skills with their child at home.
— id: 5291, year: 2010, vol: , page: 279, stat: Chapter,

Fostering resilience and concluding the treatment
Pearlman, Michelle Y; Schwalbe, Karen D'Angelo; Cloltre, Marylene
Grief in childhood: Fundamentals of treatment in clinical practice Washington, DC : American Psychological Association, 2010,
(from the chapter) This chapter provided guidelines for clinicians to help foster resilience in bereaved children and their families and to complete the therapy process. Focusing on the resilience of children impacted by grief and loss is a key component of integrated grief therapy for children (IGTC). The ideas presented, which include interventions that promote the development of child, family, and environmental factors that are known to be protective for this population, are weaved throughout the IGTC approach to develop and use existing strengths within the family. The concept of resilience is especially important to discuss in depth as treatment comes to an end to help bereaved children and their families effectively cope and successfully move forward despite their loss. The therapy is considered complete when the child and surviving parent feel that they have achieved their goals and are able to rely on each other for support in times of stress.
— id: 5289, year: 2010, vol: , page: 203, stat: Chapter,

Initiating the grief-focused phase of treatment
Pearlman, Michelle Y; Schwalbe, Karen D'Angelo; Cloltre, Marylene
Grief in childhood: Fundamentals of treatment in clinical practice Washington, DC : American Psychological Association, 2010,
(from the chapter) The current chapter provides an introduction to the grief-focused phase of integrated grief therapy for children. Important concepts related to bereavement and loss are presented, including ways of discussing these topics with the bereaved child and his or her caregiver. Caregivers will learn normative reactions to loss based on the age of the child, along with information about how to best support the child as they grieve. Changes in family roles and responsibilities along with other secondary losses are also addressed, and goals for this phase of treatment are established. Finally, this chapter emphasizes the importance of fostering resilience and developing problem-solving skills to manage grief-related difficulties and everyday stressors.
— id: 5292, year: 2010, vol: , page: 279, stat: Chapter,

Introduction to integrated grief therapy for children (IGTC)
Pearlman, Michelle Y; Schwalbe, Karen D'Angelo; Cloltre, Marylene
Grief in childhood: Fundamentals of treatment in clinical practice Washington, DC : American Psychological Association, 2010,
(from the chapter) Given the widespread occurrence and potential for trauma and other negative physical and mental health consequences of losing a loved one in childhood, it is important for every clinician who works with children to understand how best to help them cope with these types of loss experiences. To meet this need, this book offers an evidence-based model of treatment--called integrated grief therapy for children (IGTC)--that can be applied to various symptoms and circumstances with bereaved children. IGTC goes beyond other child therapy approaches by not only addressing specific presenting symptoms, such as depression and anxiety, but also attending to the child's areas of strength and fostering resilience. Although most of the interventions in IGTC are cognitive-behaviorally based, the theoretical framework also integrates principles from family systems work, interpersonal therapy, and narrative approaches. This book contains everything needed to successfully implement IGTC, including instructions for specific components of the therapy, sample dialogues to illustrate concepts, and activity handouts that therapists can photocopy and use in sessions. The primary intended audience for this book is the therapists, social workers, psychologists, psychiatrists, and other professionals who provide mental health services to children and families. However, caregivers of bereaved children can also benefit from the book. This chapter defines some basic terminology, outlines the components of IGTC, and explains how the book is organized.
— id: 5299, year: 2010, vol: , page: 279, stat: Chapter,

Making memories and integrating past and present
Pearlman, Michelle Y; Schwalbe, Karen D'Angelo; Cloltre, Marylene
Grief in childhood: Fundamentals of treatment in clinical practice Washington, DC : American Psychological Association, 2010,
(from the chapter) This chapter provides integrated grief therapy for children (IGTC) strategies and techniques that give bereaved children the space and the opportunity to talk about their loved one and thus to maintain an ongoing connection with the person. The first step in this process is eliciting positive memories of the deceased from the child (e.g., Haine, Ayers, Sandler, & Wolchik, 2008) while addressing the complex and potentially conflicted emotions the child has about the person and the loss experience. After allowing the child to reflect and feel connected to his or her lost loved one, the child should then be encouraged and helped to share memories in session with the surviving caregiver. Rituals can be created to help the family to continue this type of remembrance at home, ensuring that the child will have opportunities to reminisce about the person who died with supportive family members and friends. Finally, this process involves addressing changes in identity that often come about after a significant loss. The goal of these strategies is for the child to preserve and organize his or her different memories of the deceased, allowing him or her to maintain an attachment to the parent and also enabling a sense of continuity of self before and after the loss. The framework is consistent with Worden's (1996) tasks of mourning for children, which include (a) accepting the reality of the loss, (b) working through the pain and emotions associated with the loss, (c) adapting to an environment without the deceased, and (d) relocating the deceased into their emotional lives and finding ways to memorialize them. To begin this type of work with the bereaved child, the therapist must ensure that the child is prepared to manage the multiple and distressing feelings that inevitably emerge when processing memories of the deceased. In light of the challenging nature of this process, the tasks described in this chapter build on everything the child has learned up until this point in treatment. It is particularly important that the child has had the opportunity to build coping skills for managing grief and has had the opportunity to work through the potentially traumatic aspects of the parent's death before beginning to share and integrate his or her memories of the deceased.
— id: 5290, year: 2010, vol: , page: 279, stat: Chapter,

Managing behavior problems in grieving children
Pearlman, Michelle Y; Schwalbe, Karen D'Angelo; Cloltre, Marylene
Grief in childhood: Fundamentals of treatment in clinical practice Washington, DC : American Psychological Association, 2010,
(from the chapter) This chapter provides guidance on how to manage the types of behavior problems that can develop after a loss. It includes skill-building interventions, such as increasing parental warmth, improving verbal communication, and establishing or reestablishing routines after a loss, and strategies for effective discipline, such as positive reinforcement. The importance of working directly with parents is emphasized to help create positive environments, increase positive parent-child interactions, and use effective limit-setting strategies. The integrated grief therapy for children strategies described in this chapter are based on techniques that have been previously found effective in troubleshooting problem behaviors in young children (e.g., Brinkmeyer & Eyberg, 2003; Kazdin, 2003; Webster-Stratton, 1992). Strategies that are thought to have particular relevance to the types of behavior problems seen among bereaved children have been selected. Depending on the presenting needs of the child, strategies presented in this chapter may be introduced through individual sessions with the parent or by alternating time spent with the child and parent during session.
— id: 5293, year: 2010, vol: , page: 279, stat: Chapter,

Risk and protective factors, clinical presentations, and treatment interventions: A review of the literature
Pearlman, Michelle Y; Schwalbe, Karen D'Angelo; Cloltre, Marylene
Grief in childhood: Fundamentals of treatment in clinical practice Washington, DC : American Psychological Association, 2010,
(from the chapter) The current chapter reviews the risk and protective factors that predict distress in bereaved children, common presenting problems, and research on treatment interventions. The chapter also indicates how the current research has informed the development of our treatment model, integrated grief therapy for children.
— id: 5298, year: 2010, vol: , page: 279, stat: Chapter,

Treating anxiety symptoms in grieving children
Pearlman, Michelle Y; Schwalbe, Karen D'Angelo; Cloltre, Marylene
Grief in childhood: Fundamentals of treatment in clinical practice Washington, DC : American Psychological Association, 2010,
(from the chapter) Given the plethora of evidence on the effectiveness of cognitive-behavioral therapy (CBT) in treating anxious children, integrated grief therapy for children (IGTC) pulls from these therapies to create a CBT-based approach for use with bereaved children demonstrating significant anxiety symptoms. This chapter presents the IGTC approach for treating anxiety symptoms (including generalized anxiety disorder, separation anxiety disorder, and subthreshold levels of anxiety) following loss. Psychoeducation, cognitive and behavioral coping skills, and the role of the parent in helping children suffering from anxiety are presented. Children are taught to be aware of when they experience anxious arousal and to use anxiety management strategies during these times. A step-by-step plan for coping with anxiety, as well as opportunities for practicing these coping skills, is provided. Much of the clinical research on anxious children, including studies involving individual and group treatments as wells as preventive interventions, has been based on the work of Kendall and his colleagues (e.g., Kendall, 1990; Kendall, Aschenbrand, & Hudson, 2003). The coping strategies presented in this chapter are based in part on the strategies presented in the Coping Cat treatment manual, developed by Kendall (1990) for use with anxious children and adolescents, and other cognitive-behavioral treatments for anxiety. The Coping Cat treatment program has been evaluated in several randomized clinical trials (Kendall, 1994; Kendall et al., 1997) and has been deemed empirically supported (Kazdin & Weisz, 1998). Strategies that are thought to have particular relevance to the types of worries and anxieties seen among bereaved children have been selected for the IGTC model. The techniques are illustrated with examples from our clinical experiences with bereaved children and are adapted for use with this population.
— id: 5294, year: 2010, vol: , page: 279, stat: Chapter,

Treating depression symptoms in grieving children
Pearlman, Michelle Y; Schwalbe, Karen D'Angelo; Cloltre, Marylene
Grief in childhood: Fundamentals of treatment in clinical practice Washington, DC : American Psychological Association, 2010,
(from the chapter) This chapter introduces specific strategies from the integrated grief therapy for children model for treating symptoms of depressed mood in bereaved children. It also provides directions for addressing areas that may be impacted by child and adolescent depression, such as school performance and relationships with peers and family members. Interventions to address the child's negative thoughts, improve self-esteem, and increase pleasurable events and activities are also included.
— id: 5296, year: 2010, vol: , page: 279, stat: Chapter,

Treating posttraumatic stress disorder symptoms in grieving children
Pearlman, Michelle Y; Schwalbe, Karen D'Angelo; Cloltre, Marylene
Grief in childhood: Fundamentals of treatment in clinical practice Washington, DC : American Psychological Association, 2010,
(from the chapter) The death of a loved one is a potentially traumatic event that creates risk for the development of posttraumatic stress disorder (PTSD). This chapter presents the integrated grief therapy for children approach for treating symptoms of PTSD following loss. The way in which PTSD manifests in bereaved children, as well as risk factors for the development of this disorder, is described, and appropriate interventions are introduced. Primary interventions include coping strategies to improve functioning and the creation of a trauma narrative to reduce PTSD symptoms.
— id: 5295, year: 2010, vol: , page: 279, stat: Chapter,

Safe enough to sleep: sleep disruptions associated with trauma, posttraumatic stress, and anxiety in children and adolescents
Charuvastra, Anthony; Cloitre, Marylene
2009 Oct;18(4):877-891, Child & adolescent psychiatric clinics of North America
Sleep disturbance is an essential symptom of posttraumatic stress disorder, and recent evidence suggests that disrupted sleep may play an important role in the development of posttraumatic stress disorder following traumatic stress. The authors review several aspects of sleep as it relates to posttraumatic stress disorder. First, there is an association between traumatic stress and different components of disrupted sleep in children and adolescents. Second, sleep disruption appears to be a core feature of other pediatric anxiety disorders, and the authors consider if this preexisting sleep vulnerability may explain in part why preexisting anxiety disorders are a risk factor for developing posttraumatic stress disorder following a traumatic event. Third, the authors consider attachment theory and the social context of trauma and sleep disruption. This article concludes with a consideration of the therapeutic implications of these findings
— id: 104730, year: 2009, vol: 18, page: 877, stat: Journal Article,

Effective psychotherapies for posttraumatic stress disorder: a review and critique
Cloitre, Marylene
2009 Jan;14(1 Suppl 1):32-43, CNS spectrums
This report reviews and critiques the psychotherapy literature for the treatment of posttraumatic stress disorder (PTSD) and systematically presents data on sample size, rates of completion and effect sizes. Substantial progress has been made in the use of cognitive behavioral therapies and eye movement desensitization and reprocessing for the resolution of PTSD. Innovations in PTSD treatments are identified. Further advances are needed in the treatment of populations with complex and chronic forms of PTSD such as those found in childhood abuse populations, refugee populations, and those experiencing chronic mental illness. The need to address comorbid emotional, social, and physical health consequences of trauma, to implement treatments in community-based settings, and to incorporate larger systems of care into study designs is noted
— id: 96214, year: 2009, vol: 14, page: 32, stat: Journal Article,

A developmental approach to complex PTSD: childhood and adult cumulative trauma as predictors of symptom complexity
Cloitre, Marylene; Stolbach, Bradley C; Herman, Judith L; van der Kolk, Bessel; Pynoos, Robert; Wang, Jing; Petkova, Eva
2009 Oct;22(5):399-408, Journal of traumatic stress
Exposure to multiple traumas, particularly in childhood, has been proposed to result in a complex of symptoms that includes posttraumatic stress disorder (PTSD) as well as a constrained, but variable group of symptoms that highlight self-regulatory disturbances. The relationship between accumulated exposure to different types of traumatic events and total number of different types of symptoms (symptom complexity) was assessed in an adult clinical sample (N = 582) and a child clinical sample (N = 152). Childhood cumulative trauma but not adulthood trauma predicted increasing symptom complexity in adults. Cumulative trauma predicted increasing symptom complexity in the child sample. Results suggest that Complex PTSD symptoms occur in both adult and child samples in a principled, rule-governed way and that childhood experiences significantly influenced adult symptoms
— id: 138380, year: 2009, vol: 22, page: 399, stat: Journal Article,

Best practices in psychotherapy for adults
Courtois, Christine A; Ford, Julian D; Cloitre, Marylene
Treating complex traumatic stress disorders: An evidence-based guide New York, NY, US: Guilford Press, 2009,
(from the chapter) The purpose of this chapter is to present best-practice guidelines for treatment of adults with complex traumatic stress disorders. Psychotherapy for adults with complex traumatic stress disorders is widely practiced but still in the early phases of scientific and clinical validation. While awaiting the results of systematic clinical research, therapists can nevertheless benefit from the application of the practice principles and evolving treatment interventions developed specifically for complex traumatic stress disorders and the dissociative disorders. Guidelines and models for the treatment of PTSD are applicable to clients with complex traumatic stress disorders, but they cannot be assumed fully or even effectively to ameliorate or resolve the complex self-regulation problems and dissociation that originate when developmentally adverse interpersonal traumas derail or impair the growing child's ability to function adaptively. The extant clinical knowledge base suggests that safety-focused, strengths-based, self-defining, self-regulation enhancing, self-integrating, avoidance challenging, individualized approaches to treatment, delivered by emotionally healthy and professionally responsible therapists who have specialized training and professional resources to support this very demanding work, make an important difference in the lives of clients who have had substantial life adversity.
— id: 5021, year: 2009, vol: , page: 82, stat: Chapter,

Diurnal cortisol amplitude and fronto-limbic activity in response to stressful stimuli
Cunningham-Bussel, Amy C; Root, James C; Butler, Tracy; Tuescher, Oliver; Pan, Hong; Epstein, Jane; Weisholtz, Daniel S; Pavony, Michelle; Silverman, Michael E; Goldstein, Martin S; Altemus, Margaret; Cloitre, Marylene; Ledoux, Joseph; McEwen, Bruce; Stern, Emily; Silbersweig, David
2009 Jun;34(5):694-704, Psychoneuroendocrinology
The development and exacerbation of many psychiatric and neurologic conditions are associated with dysregulation of the hypothalamic pituitary adrenal (HPA) axis as measured by aberrant levels of cortisol secretion. Here we report on the relationship between the amplitude of diurnal cortisol secretion, measured across 3 typical days in 18 healthy individuals, and blood oxygen level dependant (BOLD) response in limbic fear/stress circuits, elicited by in-scanner presentation of emotionally negative stimuli, specifically, images of the World Trade Center (WTC) attack. Results indicate that subjects who secrete a greater amplitude of cortisol diurnally demonstrate less brain activation in limbic regions, including the amygdala and hippocampus/parahippocampus, and hypothalamus during exposure to traumatic WTC-related images. Such initial findings can begin to link our understanding, in humans, of the relationship between the diurnal amplitude of a hormone integral to the stress response, and those neuroanatomical regions that are implicated as both modulating and being modulated by that response
— id: 96215, year: 2009, vol: 34, page: 694, stat: Journal Article,

Best practices in psychotherapy for children and adolescents
Ford, Julian D; Cloitre, Marylene
Treating complex traumatic stress disorders: An evidence-based guide New York, NY, US: Guilford Press, 2009,
(from the chapter) Chapter three describes evidence-based best practice for the treatment of complex traumatic stress disorders in children and adolescents. In addition to describing empirically supported and empirically based psychotherapy models, the authors describe clinicians' observations and key features of children and families that may be relevant to the assessment and psychotherapy of toddlers, children, adolescents, and families with complex traumatic stress disorders.
— id: 5022, year: 2009, vol: , page: 59, stat: Chapter,

Review of Creative interventions with traumatized children
Graham, Regina; Cloitre, Marylene
2009 ;19(3):327-328 June, Journal of child & adolescent psychopharmacology
Reviews the book, Creative interventions with traumatized children edited by Cathy A. Malchiodi (see record 2008-02507-000). Trauma and its subsequent effects in children and adolescents is a growing concern in the field of child and adolescent psychiatry. As a result, effective treatments are a real and pressing need in this field, as well as for other mental health practitioners working with this population. This book offers some much needed innovative ways of treating these children and adolescents that are based on thoughtful evidence and multiple experienced practitioners. This book consists of fifteen chapters written by thirteen different authors who are all in the field of creative and expressive arts. These chapters are divided in four broad areas: basics of expressive arts therapy, interventions with individuals, interventions with families and groups, and intervention as prevention. Strengths of this book are the numerous examples of creative works produced by the child and adolescent patients of the various contributors,which are contained in nearly every chapter, and the case examples of how these therapies were utilized with specific patients. In sum, this book provides nonverbal strategies and treatments for practitioners to use, in particular in populations where words may initially and repeatedly fail these children in therapy.
— id: 102147, year: 2009, vol: 19, page: 327, stat: Journal Article,

Cognitive-behavioral therapy
Jackson, Christie; Nissenson, Kore; Cloitre, Marylene
Treating complex traumatic stress disorders: An evidence-based guide New York, NY, US: Guilford Press, 2009,
(from the chapter) Cognitive-behavioral therapy (CBT) seeks to improve functioning and emotional well-being by identifying the beliefs, feelings, and behaviors associated with psychological disturbance, and revising them through critical analysis and experiential exploration to be consistent with desired outcomes and positive life goals. This approach to psychotherapy is in distinct contrast to the traditions that came before it, and expresses an optimistic philosophy about human nature that is consistent with the American pragmatism from which it emerged: that new ways of thinking, behaving, and feeling are possible, and that the client can effect change. Advances in CBT research have traditionally emphasized symptom reduction or resolution, yet the evolution of CBT for complex traumatic stress disorder has also focused on the dynamics of the therapeutic relationship, and we highlight such approaches in this chapter. CBT provides skills training that can address not only PTSD but also the emotion regulation and interpersonal disorganization characteristic of clients with complex trauma histories. Skills help clients prepare for and engage in trauma memory work, as well as promoting a sense of mastery in place of feeling 'less than.' CBT is an individualized assessment-guided approach, which facilitates objective assessment of treatment progress and clients' engagement in therapy. Another strength of CBT is its efficacy with psychiatric conditions that often involve complex trauma (e.g., schizophrenia, bipolar disorder, and eating disorders). CBT also can achieve positive outcomes with difficult disorders within a relatively short time period
— id: 5020, year: 2009, vol: , page: 243, stat: Chapter,

Correlates of functional impairment in treatment-seeking survivors of mass terrorism
Malta, Loretta S; Levitt, Jill T; Martin, Allison; Davis, Lori; Cloitre, Marylene
2009 Mar;40(1):39-49, Behavior therapy
This study sought to identify variables associated with functional impairment in persons exposed to terrorism. A sample of adults who sought treatment for psychological distress related to the 2001 World Trade Center attack completed standardized self-report measures of PTSD symptoms, expectancies of ability to regulate negative moods, interpersonal problems, and social-occupational impairment. A multiple regression analysis found that PTSD numbing symptoms, beliefs about the ability to regulate negative moods, feelings of social discomfort and expectations of being disliked, income level, and relationship status significantly predicted 58% of the variance in social-occupational impairment. The results suggest that treatments targeting PTSD numbing symptoms as well as maladaptive expectations about social interactions and one's ability to manage negative affect may have utility for persons adversely affected by mass violence
— id: 93573, year: 2009, vol: 40, page: 39, stat: Journal Article,

Frontolimbic function and cortisol reactivity in response to emotional stimuli
Root, James C; Tuescher, Oliver; Cunningham-Bussel, Amy; Pan, Hong; Epstein, Jane; Altemus, Margaret; Cloitre, Marylene; Goldstein, Martin; Silverman, Michael; Furman, Daniella; Ledoux, Joseph; McEwen, Bruce; Stern, Emily; Silbersweig, David
2009 Mar 4;20(4):429-434, Neuroreport
Frontolimbic structures involved in fear conditioning have also been associated with hypothalamic-pituitary-adrenal (HPA)-axis modulation, including amygdaloid, hippocampal, and ventromedial prefrontal cortex regions. Although HPA-axis function and endocrine changes have been investigated in the context of stress provocation, much research has not been conducted using functional neuroimaging in the study of the HPA axis and frontolimbic function in response to emotional stimuli. Using functional magnetic resonance imaging, the association of blood-oxygen-level dependent signal with salivary cortisol in response to an emotional visual scene paradigm was investigated, with prescan and postscan salivary cortisol analyzed as a covariate of interest during specific conditions. Cortisol reactivity to the paradigm was positively associated with amygdalar and hippocampal activity and negatively associated with ventromedial prefrontal cortex activity in conditions involving emotional imagery
— id: 96212, year: 2009, vol: 20, page: 429, stat: Journal Article,

Cape Town consensus on posttraumatic stress disorder
Stein, Dan J; Cloitre, Marylene; Nemeroff, Charles B; Nutt, David J; Seedat, Soraya; Shalev, Arieh Y; Wittchen, Hans-Ulrich; Zohar, Joseph
2009 Jan;14(1 Suppl 1):52-58, CNS spectrums
The association between traumatic events and psychopathology has long been recognized, and the literature on posttraumatic stress disorder (PTSD) has burgeoned since this entity was introduced into the diagnostic nomenclature. This literature has been characterized by a range of clinical controversies about the optimal diagnosis and treatment of PTSD. In response, several systematic reviews of treatment, clinical guidelines, and consensus statements about PTSD have been generated, but their conclusions are not always consistent. Our aim here is to provide a concise overview of the literature on PTSD, focusing in particular on recent investigations and publications, with the objective of summarizing practical clinical implications and suggesting future research opportunities. We consider, in turn, the diagnosis and evaluation, psychobiology, pharmacotherapy, psychotherapy, and prevention of PTSD
— id: 96213, year: 2009, vol: 14, page: 52, stat: Journal Article,

Social bonds and posttraumatic stress disorder
Charuvastra, Anthony; Cloitre, Marylene
2008 ;59:301-328, Annual review of psychology
Retrospective and prospective studies consistently show that individuals exposed to human-generated traumatic events carry a higher risk of developing Posttraumatic Stress Disorder (PTSD) than those exposed to other kinds of events. These studies also consistently identify perceptions of social support both before and after a traumatic event as an important factor in the determining vulnerability to the development of PTSD. We review the literature on interpersonal traumas, social support and risk for PTSD and integrate findings with recent advances in developmental psychopathology, attachment theory and social neuroscience. We propose and gather evidence for what we term the social ecology of PTSD, a conceptual framework for understanding how both PTSD risk and recovery are highly dependent on social phenomena. We explore clinical implications of this conceptual framework
— id: 78347, year: 2008, vol: 59, page: 301, stat: Journal Article,

Attachment organization, emotion regulation, and expectations of support in a clinical sample of women with childhood abuse histories
Cloitre, Marylene; Stovall-McClough, Chase; Zorbas, Patty; Charuvastra, Anthony
2008 Jun;21(3):282-289, Journal of traumatic stress
Despite the consistent documentation of an association between compromised attachment and clinical disorders, there are few empirical studies exploring factors that may mediate this relationship. This study evaluated the potential roles of emotion regulation and social support expectations in linking adult attachment classification and psychiatric impairment in 109 women with a history of childhood abuse and a variety of diagnosed psychiatric disorders. Path analysis confirmed that insecure attachment was associated with psychiatric impairment through the pathways of poor emotion regulation capacities and diminished expectations of support. Results suggest the relevance of attachment theory in understanding the myriad psychiatric outcomes associated with childhood maltreatment and in particular, the focal roles that emotion regulation and interpersonal expectations may play
— id: 79355, year: 2008, vol: 21, page: 282, stat: Journal Article,

Salivary cortisol in foster children: a pilot study
Linares, L O; Stovall-McClough, K C; Li, M; Morin, N; Silva, R; Albert, A; Cloitre, M
2008 Jun;32(6):665-670, Child abuse & neglect
— id: 86649, year: 2008, vol: 32, page: 665, stat: Journal Article,

Cumulative trauma and posttraumatic stress disorder among children exposed to the 9/11 World Trade Center attack
Mullett-Hume, Elizabeth; Anshel, Daphne; Guevara, Vivianne; Cloitre, Marylene
2008 Jan;78(1):103-108, American journal of orthopsychiatry
Two and one-half years after the September 11, 2001 World Trade Center attack, 204 middle school students in an immigrant community located near Ground Zero were assessed for posttraumatic stress disorder (PTSD) symptoms as influenced by 'dose' of exposure to the attack and accumulated lifetime traumas. Ninety percent of students reported at least one traumatic event other than 9/11 (e.g., community violence) with an average of 4 lifetime events reported. An interaction was obtained such that the dose-response effect depended on presence of other traumas. Among students with the lowest number of additional traumas, the usual dose-response pattern of increasing PTSD symptoms with increasing 9/11 exposure was observed; among those with medium to high cumulative life trauma, PTSD symptoms were substantially higher and uniformly so regardless of 9/11 exposure dose. Results suggest that traumas that precede or follow mass violence often have as much as if not greater impact on long-term symptom severity than high-dose exposure to the event. Implications regarding the presence of continuing or previous trauma exposure for postdisaster and early intervention policies are discussed
— id: 81057, year: 2008, vol: 78, page: 103, stat: Journal Article,

Adult attachment and posttraumatic stress disorder in women with histories of childhood abuse
Stovall-McClough, K. Chase; Cloitre, Marylene; McClough, Joel F
Clinical applications of the Adult Attachment Interview New York, NY, US: Guilford Press, 2008,
(from the chapter) The Adult Attachment Interview (AAI; George, Kaplan, fit Main, 1996) is a unique investigative tool designed to measure internal representations of attachment and has wide-ranging clinical applications. This chapter focuses on its use in a research sample of women with histories of prolonged childhood physical and/or sexual abuse that were recruited for participation in a treatment outcome study for abuse-related symptoms (Cloitre, Koenen, Cohen, & Han, 2002). In this chapter, we explore the relationship between attachment classifications and the clinical presentation and symptom picture of women in our sample, with a focus on the three primary attachment categories of secure, dismissing, and preoccupied. We then consider the relationship between unresolved trauma (as measured by the AAI) and clinical symptoms, with a particular focus on posttraumatic stress disorder (PTSD). Finally, based on our recent findings, we discuss the theoretical inferences that can be proposed regarding the maintenance of traumatized states of mind and their implications for treatment.
— id: 4674, year: 2008, vol: , page: 320, stat: Chapter,

The flexible application of a manualized treatment for PTSD symptoms and functional impairment related to the 9/11 World Trade Center attack
Levitt, Jill T; Malta, Loretta S; Martin, Allison; Davis, Lori; Cloitre, Marylene
2007 Jul;45(7):1419-1433, Behaviour research & therapy
The purpose of this treatment effectiveness study was to evaluate the flexible application of a manualized cognitive behavioral treatment (CBT) for PTSD and related symptoms in survivors of the 9/11 terrorist attack on the World Trade Center. Treatment delivery ranged from 12 to 25 sessions; therapist experience ranged from no prior training to extensive training in CBT; and training and supervision of clinicians in the treatment manual was considerably less than that required in a randomized clinical trial (RCT). Paired t-tests demonstrated significant pre-post reductions in symptoms of PTSD and depression for the flexible application of the treatment. A benchmarking analysis revealed that the moderate-to-large effect sizes found for these variables were similar to those obtained in an RCT of the same treatment. Furthermore, effect sizes on measures of outcomes particularly relevant to this population of mass violence survivors such as functional impairment, use of alcohol and drugs to cope, and use of social support to cope, were also medium to large
— id: 73799, year: 2007, vol: 45, page: 1419, stat: Journal Article,

Treating survivors of childhood abuse: psychotherapy for the interrupted life
Cloitre M; Cohen LR; Koenen KC
New York, New York : Guilford Publications, Inc. The Guilford Press, 2006,
— id: 1130, year: 2006, vol: , page: , stat: ,

Caring for kids after trauma, disaster and death : a guide for parents and professionals
Koplewicz, Harold S; Cloitre, Marylene
New York : New York University Child Study Center, 2006,
— id: 1778, year: 2006, vol: , page: , stat: ,

The New York Consortium for Effective Trauma Treatment
Marshall, Randall D; Neria, Yuval; Suh, Eun Jung; Amsel, Lawrence V; Kastan, John; Eth, Spencer; Davis, Lori; Cloitre, Marylene; Schwarzbaum, Gila; Yehuda, Rachel; Rosenthal, Jack
9/11: Mental health in the wake of terrorist attacks New York, NY, US: Cambridge University Press, 2006,
From the first chaotic days after the attacks of September 11, 2001, the co-directors of the Consortium shared a collective sense of alarm that the need for mental health services in our community would greatly exceed capacity to provide evidence-based treatment for trauma-related problems and disorders. Because federal programs almost exclusively emphasize the public health objective of restoring the general population to a semblance of normal functioning, we worried that there would not be adequate programs devoted to helping persons developing serious psychiatric disorder as a result of the attacks. Subsequent epidemiological studies (reviewed in this volume) confirmed our impression, but by the time these data were available--many months after 9/11--we were already well underway with the project of providing intensive training to a group of clinicians at each of our centers, who could, then serve as expert treatment providers, and, more importantly, clinician experts available to the community for educational programs. In sum, the Consortium was a rapidly implemented large-scale project with the overall objective of disseminating evidence-based treatments for trauma-related disorders to the greater New York community. In this chapter, Randall D. Marshall presents an introduction and acknowledgments. Next, Jack Rosenthal discusses the New York Times Company Foundation. Then, Randall D. Marshall, Yuval Neria, Eun Jung Suh, and Lawrence Amsel discuss trauma studies and services, the New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons. Subtopics include the first few weeks; creating the Consortium; enhancing expertise in trauma treatment; developing a focus on training and a state-of-the-art training program; results of the training project; other beneficial consequences of the Consortium project; and conclusions. Then, John Kastan and Spencer Eth discuss St. Vincent Catholic Centers of New York, Behavioral Health Services and New York Medical College. Next, Lori Davis and Marylene Cloitre discuss the New York University Child Study Center, New York University School of Medicine. Finally, Gila Schwarzbaum and Rachel Yehuda discuss the Mental Health Mandate of September 11, Mount Sinai School of Medicine. Randall D. Marshall ends the chapter with concluding thoughts. (PsycINFO Database Record (c) 2008 APA, all rights reserved)
— id: 4689, year: 2006, vol: , page: 311, stat: Chapter,

Increased brainstem volume in panic disorder: a voxel-based morphometric study
Protopopescu, Xenia; Pan, Hong; Tuescher, Oliver; Cloitre, Marylene; Goldstein, Martin; Engelien, Almut; Yang, Yihong; Gorman, Jack; LeDoux, Joseph; Stern, Emily; Silbersweig, David
2006 Mar 20;17(4):361-363, Neuroreport
Neurocircuitry models of panic disorder have hypothesized that the panic attack itself stems from loci in the brainstem including the ascending reticular system and respiratory and cardiovascular control centers. Voxel-based morphometry with acobian modulation was used to examine gray matter volume changes in 10 panic disorder patients and 23 healthy controls. The panic disorder patients had a relatively increased gray matter volume in the midbrain and rostral pons of the brainstem. Increased ventral hippocampal and decreased regional prefrontal cortex volumes were also noted at a lower significance threshold. This finding has implications for pathophysiologic models of panic disorder, and provides structural evidence for the role of the brainstem in neurocircuitry models of panic disorder
— id: 90514, year: 2006, vol: 17, page: 361, stat: Journal Article,

Alcohol problems in adolescents and young adults: Epidemiology, neurobiology, prevention, and treatment
Rudin, Steven B; Volpp, Serena Y; Marshall, Randall D; Stovall-McClough, K. Chase; Cloitre, Marylene; Lindenmayer, J. P; Khan, Anzalee; Javitt, Daniel C; Laruelle, Marc; Galanter, Marc
New York, NY, US: Springer Science + Business Media, 2006,
(from the cover) Adolescence is a time of major change and new experiences--and experimenting with drinking is often one of them. Alcohol continues to be the substance of choice for today's youth, leading to serious physical, psychological, and social consequences. Alcohol Problems in Adolescents and Young Adults ably addresses this growing trend. It comprehensively presents a wide-ranging clinical picture of teen drinking--epidemiology, neurobiology, behavioral phenomena, diagnostic and assessment issues, prevention and treatment data--in a developmental context. Fifty expert contributors display the scientific rigor, practical wisdom, and nuanced analysis that readers have come to expect from previous volumes. Among the subjects studied in depth: Initiation of alcohol use/abuse, Risk and protective factors for alcohol dependence, High-risk adolescent populations, Drinking habits of college students, Long-range consequences of teenage drinking, Family-, school-, and community-based prevention programs and Treatment of comorbid substance and psychiatric disorders. Clinicians, researchers, and policy makers will find this a bedrock source of evidence-based knowledge, whether one's goal is choosing an age-appropriate assessment tool for eighth graders, preventing drinking among high school students, or understanding the alcohol-friendliness of campus culture. Here is a critical resource for all professionals dedicated to helping youngsters grow up sober
— id: 1450, year: 2006, vol: , page: , stat: ,

Unresolved attachment, PTSD, and dissociation in women with childhood abuse histories
Stovall-McClough, K Chase; Cloitre, Marylene
2006 Apr;74(2):219-228, Journal of consulting & clinical psychology
The primary objective of this study was to examine unresolved trauma as assessed by the Adult Attachment Interview and current psychiatric symptoms, focusing on posttraumatic stress disorder (PTSD) and dissociation, in a group of adult female childhood abuse survivors. The authors examined psychiatric symptoms and attachment representations in a group with (n = 30) and without (n = 30) abuse-related PTSD. The findings revealed that unresolved trauma carried a 7.5-fold increase in the likelihood of being diagnosed with PTSD and was most strongly associated with PTSD avoidant symptoms rather than dissociative symptoms. The utility of a PTSD framework for understanding unresolved trauma and the role of intentional avoidance of trauma cues in the maintenance of traumatized states of mind are discussed
— id: 90566, year: 2006, vol: 74, page: 219, stat: Journal Article,

Traumatic Reactions to Terrorism: The Individual and Collective Experience
Stovall-McClough, K. Chase; Cloitre, Marylene
Psychological effects of catastrophic disasters: Group approaches to treatment New York, NY, US: Haworth Press, 2006,
(from the chapter) Traumatic events produce extreme fear and horror and significantly disrupt feelings of security. Trauma has profound and enduring effects on both victims and their loved ones. A great deal is understood about the short- and long-term effects of trauma, especially with regard to experiences such as combat, rape, and accidents. The impact of terrorism as a traumatic experience, however, is significantly less well understood. In this chapter, we attempt to provide a comprehensive discussion and a review of the literature pertinent to the terrorism experience. We also provide a discussion of terrorism from an attachment theory perspective. Using this framework, we examine terrorism as a unique trauma in its ability to disrupt feelings of security on both an individual and a community level. This chapter also provides a comprehensive review of research on the psychological impact of terrorism, emphasizing both individual and community factors that are important in predicting risk and resilience. Included in this discussion will be the latest research emerging from the September 11 attacks. Finally, we will discuss the role of attachments and community support in repairing a sense of security and promoting recovery from terrorism.
— id: 4009, year: 2006, vol: , page: 113, stat: Chapter,

Fear-related activity in subgenual anterior cingulate differs between men and women
Butler, Tracy; Pan, Hong; Epstein, Jane; Protopopescu, Xenia; Tuescher, Oliver; Goldstein, Martin; Cloitre, Marylene; Yang, Yihong; Phelps, Elizabeth; Gorman, Jack; Ledoux, Joseph; Stern, Emily; Silbersweig, David
2005 Aug 1;16(11):1233-1236, Neuroreport
Functional magnetic resonance imaging in association with an instructed fear/anticipatory anxiety paradigm was used to explore sex differences in the human fear response. During anticipation of mild electrodermal stimulation, women, as compared with men, demonstrated increased activity in the subgenual anterior cingulate cortex and functionally related regions of the insula and brainstem. The subgenual anterior cingulate cortex is a region critical for emotional control implicated in the pathogenesis of psychiatric disease. Present findings suggest a contributory neural substrate for the greater susceptibility of women to anxiety and affective disorders, and emphasize the importance of considering participant sex when designing and interpreting functional neuroimaging studies
— id: 90520, year: 2005, vol: 16, page: 1233, stat: Journal Article,

Beyond PTSD: Emotion Regulation and Interpersonal Problems as Predictors of Functional Impairment in Survivors of Childhood Abuse
Cloitre, Marylene; Miranda, Regina; Stovall-McClough, K. Chase; Han, Hyemee
2005 ;36(2):119-124 Spr, Behavior therapy
This study sought to determine the relative contribution of problems in emotion regulation and interpersonal functioning compared to PTSD symptoms in predicting functional impairment among women with childhood abuse histories. One hundred sixty-four treatment-seeking women completed measures of emotion regulation, interpersonal problems, PTSD symptoms, and social adjustment. Severity of PTSD symptoms was a significant predictor of functional impairment. In addition, after controlling for the effects of PTSD symptomatology, emotion regulation and interpersonal problems were both significant predictors and together made contributions to functional impairment equal to that of PTSD symptoms. These data indicate that emotion regulation and interpersonal problems play an important role in functional impairment among women with a history of childhood abuse. These factors should be taken into account in treatment planning to ensure successful rehabilitation from the long-term effects of chronic childhood trauma. (journal abstract)
— id: 64189, year: 2005, vol: 36, page: 119, stat: Journal Article,

Complex Trauma in Children and Adolescents
Cook, Alexandra; Spinazzola, Joseph; Ford, Julian; Lanktree, Cheryl; Blaustein, Margaret; Cloitre, Marylene; DeRosa, Ruth; Hubbard, Rebecca; Kagan, Richard; Liautaud, Joan; Mallah, Karen; Olafson, Erna; van der Kolk, Bessel
2005 ;35(5):390-398 May, Psychiatric annals
The immediate and long-term consequences of children's exposure to maltreatment and other traumatic experiences are multifaceted. Emotional abuse and neglect, sexual abuse, and physical abuse, as well as witnessing domestic violence, ethnic cleansing, or war, can interfere with the development of a secure attachment within the caregiving system. Complex trauma exposure results in a loss of core capacities for self-regulation and interpersonal relatedness. Children exposed to complex trauma often experience lifelong problems that place them at risk for additional trauma exposure and cumulative impairment (e.g., psychiatric and addictive disorders; chronic medical illness; legal, vocational, and family problems). These problems may extend from childhood through adolescence and into adulthood. This article describes a new theoretical framework for understanding complex trauma in children, explains how to apply the new framework to assessment of traumatized children and families, and discusses intervention models designed specifically for traumatized children and their families.
— id: 55767, year: 2005, vol: 35, page: 390, stat: Journal Article,

A Clinician's Guide to STAIR/MPE: Treatment for PTSD Related to Childhood Abuse
Levitt, Jill T; Cloitre, Marylene
2005 ;12(1):40-52, Cognitive & behavioral practice
(from the journal abstract) Women who have PTSD related to childhood abuse have significant deficits in the areas of emotion regulation and interpersonal skills. These problems are associated with impaired functioning in social, work, and home life. In addition, there is substantial clinical concern that limited emotion-regulation skills puts this population at risk for early dropout and symptom exacerbation in treatment focusing on emotional processing of traumatic memories. Skills Training in Affective and Interpersonal Regulation plus Modified Prolonged Exposure (STAIR/MPE) is an evidence-based, 2-phase cognitive behavioral treatment designed to address these concerns. Specifically, this treatment targets PTSD symptoms, emotion-regulation deficits, and interpersonal difficulties. The purpose of this article is to describe the rationale for and clinical application of STAIR/MPE, detailing the essential clinical components and presenting relevant case examples.
— id: 56329, year: 2005, vol: 12, page: 40, stat: Journal Article,

Differential time courses and specificity of amygdala activity in posttraumatic stress disorder subjects and normal control subjects
Protopopescu, Xenia; Pan, Hong; Tuescher, Oliver; Cloitre, Marylene; Goldstein, Martin; Engelien, Wolfgang; Epstein, Jane; Yang, Yihong; Gorman, Jack; LeDoux, Joseph; Silbersweig, David; Stern, Emily
2005 Mar 1;57(5):464-473, Biological psychiatry
BACKGROUND: Previous neuroimaging studies have demonstrated exaggerated amygdala responses to negative stimuli in posttraumatic stress disorder (PTSD). The time course of this amygdala response is largely unstudied and is relevant to questions of habituation and sensitization in PTSD exposure therapy. METHODS: We applied blood oxygen level dependent functional magnetic resonance imaging and statistical parametric mapping to study amygdala responses to trauma-related and nontrauma-related emotional words in sexual/physical abuse PTSD and normal control subjects. We examined the time course of this response by separate analysis of early and late epochs. RESULTS: PTSD versus normal control subjects have a relatively increased initial amygdala response to trauma-related negative, but not nontrauma-related negative, versus neutral stimuli. Patients also fail to show the normal patterns of sensitization and habituation to different categories of negative stimuli. These findings correlate with measured PTSD symptom severity. CONCLUSIONS: Our results demonstrate differential time courses and specificity of amygdala response to emotional and control stimuli in PTSD and normal control subjects. This has implications for pathophysiologic models of PTSD and treatment response. The results also extend previous neuroimaging studies demonstrating relatively increased amygdala response in PTSD and expand these results to a largely female patient population probed with emotionally valenced words
— id: 90523, year: 2005, vol: 57, page: 464, stat: Journal Article,

Women and anxiety disorders: implications for diagnosis and treatment
Cloitre M; Yonkers KA; Pearlstein T; Altemus M; Davidson KW; Pigott TA; Shear MK; Pine D; Ross J; Howell H; Brogan K; Rieckmann N; Clemow L
2004 Sep;9(9 Suppl 8):1-16, CNS spectrums
Community studies indicate that 19% of men and 31% of women will develop some type of anxiety disorder during their lifetime. The impact of gender is profound in that it increases the likelihood of developing an anxiety disorder by 85% in women compared to men. Sex difference in prevalence rates are apparent as early as age 6, when girls are twice as likely as boys to have an anxiety disorder. In the National Comorbidity Survey, the prevalence rates for panic disorder in women and men were 5% and 2%, respectively. Agoraphobia, which often coexists with panic disorder, has a lifetime prevalence rate of 7% in women and 3.5% in men. Prevalence of trauma is increased in young women as well, and is experienced earlier in life; 62% of sexual assaults are inflicted on females <18 years of age, and 29% occur in children <11 years of age. Comorbidity of anxiety in women complicates other medical conditions as well. For example, panic disorder is highly comorbid with CHD, which remains the leading cause of death in women in developed countries. Fluctuations in reproductive hormone levels during the female life cycle is thought to be responsible for modulating anxiety. This is often implicated in the later age of onset, the more sudden and acute symptom emergence, and the more episodic course of OCD in women, and in the high prevalence (47.4%) of PMDD. Pregnancy appears to be a protective period for some anxiety disorders, including panic, while for others, such as OCD, it may be associated with onset. Hormonal changes during pregnancy, such as increased prolactin, oxytocin, and cortisol, may contribute to the suppression of stress response that occurs during this period. Despite a large and growing body of literature on anxiety disorders in general, the available data relating to women and girls falls short of informing aspects of diagnosis, treatment, and prevention that may entail sex differences. Additional work is required to understand the biological and psychosocial causes of these differences
— id: 56006, year: 2004, vol: 9, page: 1, stat: Journal Article,

Aristotle Revisited: The Case of Recovered Memories. [References]
Cloitre, Marylene.
2004 ;11(1):42-46 Spr, Clinical Psychology: Science & Practice
(from the journal abstract) The experimental manipulations of the scientific enterprise, which has identified the myriad and intriguing ways memory can fail, has been too easily translated to mean that memory regularly does fail. This commentray attempts to reverse that perception by bringing background data to the forefront: a review of the data across all studies reveals that memory is consistently accurate and more accurate than not. In addition, the remarkable accuracy and the occasional inaccuracies of memory are unified under the perspective that memory, like other cognitive functions, is an active component in the processes of successful adaptation to the environment. The implications of this perspective are directed towards clinicians who, in addition to considering the scholarship, are confronted with the immediate reality of reports of recovered memories and the need to respond compassionately and ethically to their patients. (PsycIN
— id: 45442, year: 2004, vol: 11, page: 42, stat: Journal Article,

Therapeutic alliance, negative mood regulation, and treatment outcome in child abuse-related posttraumatic stress disorder
Cloitre, Marylene; Stovall-McClough, K C; Miranda, Regina; Chemtob, Claude M
2004 Jul;72(3):411-416, Journal of consulting & clinical psychology
This study examined the related contributions of the therapeutic alliance and negative mood regulation to the outcome of a 2-phase treatment for childhood abuse-related posttraumatic stress disorder (PTSD). Phase 1 focused on stabilization and preparatory skills building, whereas Phase 2 was comprised primarily of imaginal exposure to traumatic memories. Hierarchical regression analyses indicated the strength of the therapeutic alliance established early in treatment reliably predicted improvement in PTSD symptoms at posttreatment. Furthermore, this relationship was mediated by participants' improved capacity to regulate negative mood states in the context of Phase 2 exposure therapy. In the treatment of childhood abuse-related PTSD, the therapeutic alliance and the mediating influence of emotion regulation capacity appear to have significant roles in successful outcome
— id: 45994, year: 2004, vol: 72, page: 411, stat: Journal Article,

Treating Life-Impairing Problems Beyond PTSD: Reply to Cahill, Zoellner, Feeny, and Riggs (2004)
Cloitre, Marylene; Stovall-McClough, K. Chase; Levitt, Jill T
2004 ;72(3):549-551 Jun, Journal of consulting & clinical psychology
This reply to the comment by Cahill, Riggs, Zoellner, and Feeny (2004; see record 2004-95166-018) on the article by Cloitre, Koenen, Cohen, and Han (2002; see record 2002-18226-001) reiterates that an important goal of treatment research among chronically traumatized populations is to address problems that impair life functioning, including not only posttraumatic stress disorder but also emotion regulation difficulties and interpersonal problems. The need for further research on symptom exacerbation and drop-out rates in exposure-based treatment for child abuse survivors is discussed. An ongoing follow-up study is described, which is designed to assess the relative utility of STAIR and modified PE individually versus their combination in meeting 'good outcome' standards as defined above. (journal abstract)
— id: 64191, year: 2004, vol: 72, page: 549, stat: Journal Article,

The 9/11 experience: who's listening to the children?
Koplewicz, Harold S; Cloitre, Marylene; Reyes, Kimberly; Kessler, Lena S
2004 Sep;27(3):491-504, Psychiatric clinics of North America
In the 2 plus years since the terrorist attacks of Sept. 11, 2001, a substantial number of children have developed psychiatric disorders, severe psychological distress, and functional impairment. Despite significant financial support, the availability of mental health services, and the presence of relatively sophisticated mental health providers, a surprisingly large gap has emerged between documented need and service use. This article identifies some of the factors that appear to have contributed to this situation and potential remedies for ongoing difficulties
— id: 46862, year: 2004, vol: 27, page: 491, stat: Journal Article,

Intergenerational Links Between Mothers and Children with PTSD Spectrum Illness
Linares, L. Oriana; Cloitre, Marylene
Posttraumatic stress disorders in children and adolescents: Handbook New York, NY, US: W W Norton & Co., 2004,
(from the chapter) This chapter examines familial components of posttraumatic stress disorder (PTSD) by focusing on the intergenerational relationships of child and maternal exposure to violence, and their associations of child and maternal PTSD symptomatology in a community sample of motherchild dyads residing in high-crime neighborhoods. The authors examine child and maternal exposure to community violence (CV), and domestic violence (DV), as well as subsequent risk for PTSD in a high-risk sample of 160 disadvantaged dyads in Boston. The presence of a chronic and prolonged stressor in the life of young children--namely exposure to chronic CV in their neighborhoods--was related to child internalizing and externalizing problems, after controlling for socioeconomic differences and exposure to family violence. In this chapter, the authors will consider PTSD symptoms regarding child exposure to community violence and to two psychosocial factors that may be associated with increased risk for PTSD in preschool children. These are exposure to maternal trauma and maternal PTSD. The authors define child exposure to CV as the Criterion A1 event required in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), in which the child witnessed or experienced, in the presence of the mother, actual or a threat of serious injury. The study of intergenerational PTSD symptoms is an important first step in furthering our understanding of the possible psychosocial mechanisms by which exposure to violent events culminates in adverse psychological consequences for young children.
— id: 3783, year: 2004, vol: , page: 177, stat: Chapter,

Enhanced Cellular Immune Response in Women With PTSD Related to Childhood Abuse
Altemus, Margaret; Cloitre, Marylene; Dhabhar, Firdaus S
2003 Sep;160(9):1705-1707, American journal of psychiatry
OBJECTIVE: Disturbed regulation of both the hypothalamic-pituitary-adrenal (HPA) axis and the sympathoadrenomedullary system in posttraumatic stress disorder (PTSD) suggests that immune function, which is modulated by these systems, also may be dysregulated in individuals with PTSD. METHOD: Delayed-type hypersensitivity skin test responses were measured in 16 women with PTSD due to childhood sexual or physical abuse and 15 women who did not have a history of abuse, other trauma, or psychiatric disorders. HPA axis activity was assessed by examination of circadian salivary cortisol levels and a single time point measurement of plasma cortisol. RESULTS: Delayed-type hypersensitivity was enhanced in women with PTSD. Cortisol measures did not differ between PTSD and healthy comparison subjects. CONCLUSIONS: These results suggest that cell-mediated inflammatory reactions are greater in individuals with PTSD
— id: 37244, year: 2003, vol: 160, page: 1705, stat: Journal Article,

Biased cognitive processing of cancer-related information among women with family histories of breast cancer: evidence from a cancer stroop task
Erblich, Joel; Montgomery, Guy H; Valdimarsdottir, Heiddis B; Cloitre, Marylene; Bovbjerg, Dana H
2003 May;22(3):235-244, Health psychology
Stimuli associated with sources of stress have been shown to interfere with cognition. The authors hypothesized that women with the stress of having a family history of breast cancer (FH+) would exhibit greater interference on a task with cancer-related stimuli than women without cancer in the family (FH-). The authors developed a modified Stroop color-naming task to test this hypothesis in a sample of FH+ (n = 72) and FH- (n = 96) women. Consistent with the hypotheses, FH+ women had longer color-naming times and more errors (ps < .01) on a cancer word list relative to noncancer lists. This biased processing was not mediated by the significantly higher perceived risk, general distress, or cancer-specific distress in FH+ women. Maladaptive alterations in processing cancer stimuli may have important clinical implications, as these women must process complex cancer-related information critical to their health (e.g., options for chemoprevention, screening)
— id: 37246, year: 2003, vol: 22, page: 235, stat: Journal Article,

Peritraumatic dissociation and PTSD severity: do event-related fears about death and control mediate their relation?
Gershuny, Beth S; Cloitre, Marylene; Otto, Micheal W
2003 Feb;41(2):157-166, Behaviour research & therapy
Relations among peritraumatic dissociation, PTSD severity, event-related fear (i.e. fear experienced during traumatic event) about death, and event-related fear about losing control were examined in the current study. Particular emphasis was placed on testing whether or not fears about death and losing control mediate the relation between peritraumatic dissociation and PTSD severity in a sample of 146 nontreatment-seeking university women. Results indicated that event-related fears about death and losing control accounted for the relation between peritraumatic dissociation and PTSD severity; that is, the effect of peritraumatic dissociation on PTSD severity was eliminated after controlling for these fears. Speculations about findings are discussed
— id: 37247, year: 2003, vol: 41, page: 157, stat: Journal Article,

An open-label pilot study of divalproex sodium for posttraumatic stress disorder related to childhood abuse
Goldberg, Joseph F; Cloitre, Marylene; Whiteside, Joyce E; Han, Hyemee
2003 ;64(1):45-54 Jan, Current therapeutic research
The aim of this study was to obtain pilot data on the use of divalproex sodium for the treatment of PTSD among adult civilian outpatients with a history of childhood physical and/or sexual abuse. Outpatients with a primary psychiatric diagnosis of PTSD received open-label, flexibly dosed divalproex sodium as adjuvant therapy or monotherapy for 8 weeks. Overall and subcluster PTSD features, as well as affective symptoms and clinical global improvement, were monitored using standardized assessment scales. A total of 7 patients (age range, 29-57 years) were enrolled. At a mean (SD) peak dosage of 1500 (661) mg/d, significant improvement occurred in overall PTSD symptom severity and in the diagnostic subclusters of hyperarousal and avoidance. Depressive symptoms also were significantly improved from baseline. Divalproex sodium was well tolerated, except in 1 patient who prematurely discontinued treatment due to cognitive adverse events. These provisional findings support the possible utility of divalproex sodium therapy for adult outpatients with PTSD related to physical and/or sexual abuse during childhood. Controlled trials with larger sample sizes powered to show safety and efficacy are needed to substantiate these initial findings.
— id: 38070, year: 2003, vol: 64, page: 45, stat: Journal Article,

A high risk twin study of combat-related PTSD comorbidity
Koenen, Karestan C; Lyons, Michael J; Goldberg, Jack; Simpson, John; Williams, Wesley M; Toomey, Rosemary; Eisen, Seth A; True, William R; Cloitre, Marylene; Wolfe, Jessica; Tsuang, Ming T
2003 Jun;6(3):218-226, Twin research
Combat-related posttraumatic stress disorder (PTSD) is highly comorbid with other mental disorders. However, the nature of the relationship between PTSD and other mental disorders remains unclear. A discordant high-risk twin design was used on data from a sub-sample of the male-male twin pair members of the Vietnam Era Twin Registry to examine whether patterns of comorbidity are consistent with a psychopathological response to combat exposure or reflect familial vulnerability to psychopathology. Mental disorders were assessed via the Mental Health Diagnostic Interview Schedule Version I
— id: 37245, year: 2003, vol: 6, page: 218, stat: Journal Article,

Early intervention with traumatized children
Silva, Raul R; Cloitre, Marylene; Davis, Lori; Levitt, Jill; Gomez, Sandy; Ngai, Irene; Brown, Elissa
2003 Winter;74(4):333-347, Psychiatric quarterly
With the events of September 11th, childhood trauma has come to the forefront of national attention. One of the common psychiatric outcomes of trauma is Posttraumatic Stress Disorder (PTSD). Despite the fact that certain vulnerabilities may contribute to the development of PTSD in traumatized youth, the existence of an identifiable stressor provides a unique opportunity for early intervention. Cognitive Behavioral Treatment (CBT) interventions are considered by many to be the mainstay of treatment of children and adolescents with PTSD. More severe cases of PTSD are often treated with medications in the community. In this article we present a CBT program--developed by our site--STAIR--and provide useful guides and rationales for clinicians to work with when treating this population. We will also briefly review the available literature on the psychopharmacologic interventions to help guide the physician when confronted with such treatment decisions
— id: 46224, year: 2003, vol: 74, page: 333, stat: Journal Article,

Reorganization of unresolved childhood traumatic memories following exposure therapy
Stovall-McClough, K Chase; Cloitre, Marylene
2003 Dec;1008(4):297-299, Annals of the New York Academy of Sciences
As part of an ongoing randomized clinical trial for childhood-abuse-related PTSD, this study examined the association between PTSD and unresolved attachment as measured by the Adult Attachment Interview in a sample of 52 female childhood-abuse survivors. Results revealed that 55% of the sample was classified as preoccupied and almost 75% was classified as unresolved with regard to trauma. In a preliminary sample of 18 women who completed treatment, 13 were unresolved before treatment and 8 lost their unresolved status following treatment. This effect was significantly more pronounced in the exposure condition compared to the skills training condition
— id: 42933, year: 2003, vol: 1008, page: 297, stat: Journal Article,

Understanding revictimization among childhood sexual abuse survivors: An interpersonal schema approach
Cloitre, Marylene; Cohen, Lisa R; Scarvalone, Polly
2002 ;16(1):91-112 Spr, Journal of cognitive psychotherapy
Revictimization among women (aged 31-50 yrs) with a history of childhood sexual abuse was investigated within the context of a developmental model of interpersonal schemas. Data from the Interpersonal Schema Questionnaire (ISQ) revealed contrasting schema characteristics among sexually revictimized women (n = 26), compared to those only abused in childhood (n = 18), and those never abused or assaulted (n = 25). Both revictimized women and never victimized women significantly generalized their predominant parental schemas to current relationships and differed only in the content of the schemas. The generalized parental schema of revictimized women viewed others as hostile and controlling while that of never victimized women viewed others as warm and noncontrolling. Women who had only been abused in childhood held schemas of parents as hostile but not controlling and did not generalize from parental to current schemas. The tendency to generalize observed in the first two groups suggest that 'repetition compulsion' is not limited to those who were traumatized and are psychologically distressed. In this article, reasons for the absence of generalization among the childhood abuse only group are explored and implications for the treatment of childhood trauma survivors are discussed.
— id: 38071, year: 2002, vol: 16, page: 91, stat: Journal Article,

Skills training in affective and interpersonal regulation followed by exposure: a phase-based treatment for PTSD related to childhood abuse
Cloitre, Marylene; Koenen, Karestan C; Cohen, Lisa R; Han, Hyemee
2002 Oct;70(5):1067-1074, Journal of consulting & clinical psychology
Fifty-eight women with posttraumatic stress disorder (PTSD) related to childhood abuse were randomly assigned to a 2-phase cognitive-behavioral treatment or a minimal attention wait list. Phase 1 of treatment included 8 weekly sessions of skills training in affect and interpersonal regulation; Phase 2 included 8 sessions of modified prolonged exposure. Compared with those on wait list, participants in active treatment showed significant improvement in affect regulation problems, interpersonal skills deficits, and PTSD symptoms. Gains were maintained at 3- and 9-month follow-up. Phase 1 therapeutic alliance and negative mood regulation skills predicted Phase 2 exposure success in reducing PTSD, suggesting the value of establishing a strong therapeutic relationship and emotion regulation skills before exposure work among chronic PTSD populations
— id: 37248, year: 2002, vol: 70, page: 1067, stat: Journal Article,

Differential diagnosis of PTSD in women
Cloitre, Marylene; Koenen, Karestan C; Gratz, Kim L; Jakupcak, Matthew
Gender and PTSD New York, NY, US: Guilford Press, 2002,
(from the chapter) The specific aims of this chapter are to review data that advance our understanding of the influence of gender on posttraumatic stress disorder (PTSD) differential diagnosis among women, to provide practical guidelines for clinicians involved in assessing female trauma clients, and to identify fruitful directions for future research. We specifically address the issue of gender and differential diagnosis between PTSD and other Axis I disorders by considering (1) the presence and character of a traumatic stressor, (2) the ability of clinicians to discriminate between PTSD and other Axis I disorders, (3) evidence for the conceptual independence of PTSD and frequent comorbidities, and (4) the impact of PTSD compared to other disorders on functional impairment. The differential diagnosis of PTSD and the Axis II disorders also receive significant attention, including gender differences in Axis II patterns, treatment implications related to gender and Axis II diagnoses, and the relationship of complex PTSD to both PTSD and Axis II disorders. This chapter underscores the relationship between PTSD, other Axis I disorders, and the characterological or personality disorders related to reactions to stress or trauma.
— id: 3084, year: 2002, vol: , page: 117, stat: Chapter,

Posttraumatic stress disorder and extent of trauma exposure as correlates of medical problems and perceived health among women with childhood abuse
Cloitre M; Cohen LR; Edelman RE; Han H
2001 ;34(3):1-17, Women & health
This study examined the relative contributions of Posttraumatic Stress Disorder (PTSD) symptoms and the extent of trauma exposure as factors contributing to the current health status of childhood abuse survivors. Sixty-seven women with a history of familial childhood abuse (sexual and/or physical) and twenty-nine women with no abuse history were assessed on two distinct aspects of health status: reported number of medical problems and perceptions of overall health. Women with abuse were found to have a greater number of medical problems and poorer perceived physical well-being than the no abuse comparison group. Regression analyses of the women with abuse histories revealed that trauma exposure was a stronger predictor than PTSD symptoms of medical problems. PTSD symptoms, however, were better predictors of the experience of physical well-being than trauma exposure. These results suggest that the nature of a traumatic exposure, especially when there is repeated, cumulative trauma may be more significant to medical problems than the psychological symptoms of PTSD. Perceived health, however, appears to be predominantly influenced by psychological factors, suggesting the importance of these variables in the quality of life of multiply traumatized women
— id: 37249, year: 2001, vol: 34, page: 1, stat: Journal Article,

The impact of borderline personality disorder on process group outcome among women with posttraumatic stress disorder related to childhood abuse
Cloitre M; Koenen KC
2001 Jul;51(3):379-398, International journal of group psychotherapy
The outcome of a 12-week interpersonal process group therapy for women with postraumatic Stress Disorder (PTSD) related to childhood sexual abuse with and without borderline personality disorder (BPD) was assessed by comparing three naturally occurring treatment conditions: groups that did not have any members with borderline personality disorder (BPD-) (n = 18), groups in which at least one member carried the diagnosis (BPD+)(n = 16), and a 12-week waitlist (WL) (n = 15). PTSD, anger, depression, and other symptoms were significantly reduced in the BPD- groups. However, the BPD+ and WL conditions did not show any pre- to posttreatment improvements. Furthermore, the BPD+ condition showed a significant worsening on measures of anger. Analyses within the BPD+ condition indicated that women with and without the diagnosis experienced equal posttreatment increases in anger problems. These latter results suggest the presence of an anger 'contagion' effect. That is, women without BPD did well in the BPD- groups but showed increased anger similar to the BPD+ women when treated in groups with them. Implications for client-treatment matching considerations in PTSD group therapy are discussed
— id: 37250, year: 2001, vol: 51, page: 379, stat: Journal Article,

Consequences of childhood abuse among male psychiatric inpatients: Dual roles as victims and perpetrators
Cloitre, Marylene; Tardiff, Kenneth; Marzuk, Peter M; Leon, Andrew C; Portera, Laura
2001 ;14(1):47-61 Jan, Journal of traumatic stress
Assessed the relationship between retrospective self-reports of childhood abuse and subsequent interpersonal violence among 354 consecutive male inpatients (aged 18-59 yrs) admitted to a psychiatric hospital. Data were obtained through clinical interviews. Three logistic regressions reveal that the association between childhood abuse and 3 mutually exclusive adult negative outcomes were as follows: (1) being a perpetrator of violence, (2) being a victim of violence, and (3) being a perpetrator and victim. The results suggest that, among men with significant psychiatric impairments and childhood abuse, rates of adult victimization are high, and the most frequent negative outcome reflects involvement in dual roles of perpetrator and victim. The possible dynamics of this relationship are discussed.
— id: 38072, year: 2001, vol: 14, page: 47, stat: Journal Article,

Morbidity of comorbid psychiatric diagnoses in the clinical presentation of panic disorder
Apfeldorf WJ; Spielman LA; Cloitre M; Heckelman L; Shear MK
2000 ;12(2):78-84, Depression & anxiety
This study seeks to determine how panic disorder patients with anxiety and depression comorbidity differ from panic disorder patients without comorbidity at the time of presentation for treatment. One-hundred seventy-one panic disorder patients presenting for their initial assessment and treatment at the Payne Whitney Anxiety Disorders Clinic agreed to participate and completed self-report and diagnostic assessments. Sixty-seven percent of panic disorder subjects were found to have at least one comorbid anxiety or depression diagnosis. Age and gender ratio were not affected by the presence of comorbid diagnoses. Comorbidity significantly contributed to psychological distress and symptom load, overall impairment, and interpersonal impairment
— id: 37252, year: 2000, vol: 12, page: 78, stat: Journal Article,

A comparison of posttraumatic stress disorder with and without borderline personality disorder among women with a history of childhood sexual abuse: etiological and clinical characteristics
Heffernan K; Cloitre M
2000 Sep;188(9):589-595, Journal of nervous & mental disease
The overlap in definition and presentation between posttraumatic stress disorder (PTSD) and borderline personality disorder (BPD) has raised questions about the relationship of these disorders. Are they separate disorders, variants of the same disorder, or comorbid conditions? The present study examined etiological variables and current functioning among two groups of outpatient women with a history of childhood sexual abuse: those with PTSD only (N = 45) and those with PTSD and BPD (N = 26). The groups did not differ in severity, frequency, or number of perpetrators of their childhood sexual abuse, or whether the perpetrator was a family member or not. The additional diagnosis of BPD was associated with earlier age of abuse onset and significantly higher rates of physical and verbal abuse by mother. Severity and frequency of PTSD symptoms were not affected by BPD diagnosis, suggesting that the personality disorder and PTSD are independent symptom constructs. The PTSD+BPD group scored higher on several other clinical measures including anger, dissociation, anxiety, and interpersonal problems. They did not differ in their frequency of use of mental health services but tended to be less compliant in their treatment. These and other findings are discussed, and implications for treatment are considered
— id: 37254, year: 2000, vol: 188, page: 589, stat: Journal Article,

Childhood trauma as a correlate of lifetime opiate use in psychiatric patients
Heffernan K; Cloitre M; Tardiff K; Marzuk PM; Portera L; Leon AC
2000 Sep-Oct;25(5):797-803, Addictive behaviors
Associations have been reported between childhood sexual and/or physical abuse and adult substance abuse in general. This study investigated the relationship between childhood abuse and opiate use in particular among 763 consecutively admitted psychiatric inpatients. Patients were interviewed about demographic information, alcohol and drug use, and history of interpersonal violence. Opiate users were 2.7 times more likely to have a history of childhood sexual and/or physical abuse than nonopiate users, after controlling for diagnostic and sociodemographic variables. Opiate use was higher among those reporting physical abuse alone (24.1%) or both physical and sexual abuse (27%) than among those reporting sexual abuse alone (8.8%). Implications of these findings are discussed
— id: 37253, year: 2000, vol: 25, page: 797, stat: Journal Article,

Maximizing treatment outcome in post-traumatic stress disorder by combining psychotherapy with pharmacotherapy
Marshall RD; Cloitre M
2000 Aug;2(4):335-340, Current psychiatry reports
There are no systematic data available on combining medication and psychotherapy in the treatment of individuals with post-traumatic stress disorder (PTSD), despite its widespread practice. Careful review of the acute trials literature reveals that psychosocial and pharmacologic treatments each leave a substantial proportion of individuals with residual symptoms. This paper discusses a treatment model involving a phase- oriented treatment approach that begins with pharmacotherapy and continues with trauma-focused psychotherapy. Other combined approaches also are discussed. A rationale supporting the need for psychosocial treatment in the majority of patients who receive pharmacotherapy for chronic PTSD is presented
— id: 37251, year: 2000, vol: 2, page: 335, stat: Journal Article,

Rape and sexual assault of adult women
Hughes, Dawn M.; Cloitre, Marylene
Medical management of the violent patient : clinical assessment and theapy New York : M. Dekker, 1999,
— id: 4082, year: 1999, vol: , page: ?, stat: Chapter,

Intentional forgetting and clinical disorders
Cloitre, Marylene
Intentional forgetting: Interdisciplinary approaches Mahwah, N.J. : L. Erlbaum Associates, 1998,
(from the chapter) Clinical research has typically identified 2 distinct types of unusual cognitive activities in clinical samples. One concerns the presence of intrusive thoughts and memories where processing resources are disproportionally allotted to threatening or negative information. The other concerns impoverished memory for information that derives from diminished encoding or impaired retrieval abilities. Because the directed-forgetting paradigm demands engagement in enhanced or excessive remembering and forgetting, it has the potential to elicit processing biases that, under other conditions, would remain latent. This chapter reviews studies which have used the directed-forgetting paradigm with clinical populations, including those with obsessive-compulsive disorder, panic disorder, childhood trauma, child abuse and borderline personality disorder, and posttraumatic stress disorder (PTSD).
— id: 3086, year: 1998, vol: , page: 395, stat: Chapter,

Sexual revictimization: Risk factors and prevention
Cloitre, Marylene
Cognitive-behavioral therapies for trauma New York : Guilford Press, 1998,
(from the chapter) Research data indicate that retraumatized women make up the largest subgroup of sexually assaulted women. Given this, sexual assault research should have as a priority the identification of the psychological characteristics of women with a history of childhood sexual abuse that put them 'at risk' for adult sexual assault. It is also important to begin developing prevention programs for at-risk women and adolescent girls that target and reduce these risk factors. This chapter reviews the available data on the potential assault risk factors among women with a history of childhood abuse. It also presents a developing model of retraumatization and a cognitive-behavioral intervention designed to reduce risk for repeated sexual assaults. Topics discussed include theoretical orientation: a social-developmental perspective; affect regulation; interpersonal relatedness; posttraumatic stress disorder (PTSD) as a risk factor for retraumatization; a proposed treatment model: skills training in affect and interpersonal relatedness regulation/prolonged exposure; assessment; guidelines for selection; and clinical application.
— id: 3085, year: 1998, vol: , page: 278, stat: Chapter,

Cognitive behavioral group therapy vs phenelzine therapy for social phobia: 12-week outcome
Heimberg RG; Liebowitz MR; Hope DA; Schneier FR; Holt CS; Welkowitz LA; Juster HR; Campeas R; Bruch MA; Cloitre M; Fallon B; Klein DF
1998 Dec;55(12):1133-1141, Archives of general psychiatry
BACKGROUND: This article presents results of the acute treatment phase of a 2-site study comparing cognitive behavioral group therapy (CBGT) and treatment with the monoamine oxidase inhibitor phenelzine sulfate for social phobia. METHODS: One hundred thirty-three patients from 2 sites received 12 weeks of CBGT, phenelzine therapy, pill placebo administration, or educational-supportive group therapy (an attention-placebo treatment of equal credibility to CBGT). The 'allegiance effect,' ie, the tendency for treatments to seem most efficacious in settings of similar theoretical orientation and less efficacious in theoretically divergent settings, was also examined by comparing responses to the treatment conditions at both sites: 1 known for pharmacological treatment of anxiety disorders and the other for cognitive behavioral treatment. RESULTs: After 12 weeks, phenelzine therapy and CBGT led to superior response rates and greater change on dimensional measures than did either control condition. However, response to phenelzine therapy was more evident after 6 weeks, and phenelzine therapy was also superior to CBGT after 12 weeks on some measures. There were few differences between sites, suggesting that these treatments can be efficacious at facilities with differing theoretical allegiances. CONCLUSIONS: After 12 weeks, both phenelzine therapy and CBGT were associated with marked positive response. Although phenelzine therapy was superior to CBGT on some measures, both were more efficacious than the control conditions. More extended cognitive behavioral treatment and the combination of modalities may enhance treatment effect
— id: 37255, year: 1998, vol: 55, page: 1133, stat: Journal Article,

Posttraumatic stress disorder, self- and interpersonal dysfunction among sexually retraumatized women
Cloitre M; Scarvalone P; Difede JA
1997 Jul;10(3):437-452, Journal of traumatic stress
This study assessed self and interpersonal dysfunction as well as posttraumatic stress disorder (PTSD) among three groups of women: women sexually assaulted in both childhood and adulthood, women sexually assaulted only in adulthood and women who were never assaulted. Rates of PTSD were high and equivalent in the two assault groups. However, retraumatized women were more likely to be alexithymic, show dissociation scores indicating risk for dissociative disorders, and to have attempted suicide compared to the other two groups, who did not differ from each other. Additionally, only the retraumatized women experienced clinically significant levels of interpersonal problems. The findings suggest that formulations more inclusive than PTSD are required to capture the psychological difficulties experienced by this population. Treatment implications are discussed
— id: 37257, year: 1997, vol: 10, page: 437, stat: Journal Article,

Conscious and unconscious memory: A model of functional amnesia
Cloitre, Marylene
Cognitive science and the unconscious Washington, DC : American Psychiatric Press, 1997,
(from the chapter) Elucidates the characteristics of implicit/explicit memory distinction and assesses the extent to which this framework provides a useful context in which to conceptualize and test the nature of functional amnesia. Each section of the chapter describes studies that support 1 of the points needed to develop the model: (1) the dissociable nature of implicit and explicit memory, (2) the perceptual-sensory nature of implicit memory, (3) selective aspects of conscious memory, and (4) differential selectivity in explicit and implicit memory. Several studies are presented and reviewed in connection with each of the 4 requirements. The model is applied to the assessment of memory functioning among persons who have experienced traumatic events (in particular, childhood abuse) and a broader discussion of the role of cognitive science in the study of traumatic memories of early-life abuse.
— id: 3087, year: 1997, vol: , page: 55, stat: Chapter,

Acute psychiatric responses to the explosion at the World Trade Center: a case series
Difede J; Apfeldorf WJ; Cloitre M; Spielman LA; Perry SW
1997 Aug;185(8):519-522, Journal of nervous & mental disease
— id: 37256, year: 1997, vol: 185, page: 519, stat: Journal Article,

Memory performance among women with parental abuse histories: enhanced directed forgetting or directed remembering?
Cloitre M; Cancienne J; Brodsky B; Dulit R; Perry SW
1996 May;105(2):204-211, Journal of abnormal psychology
Performance on a directed forgetting task was assessed in 24 individuals with borderline personality disorder and early life parental abuse, 24 borderline individuals with no history of abuse, and 24 healthy nonclinical controls under conditions of explicit and implicit memory. In the explicit memory condition, individuals with abuse histories showed greater differential recall of 'to-be-remembered' versus 'to-be-forgotten' material compared to the 2 comparison groups. Implicit memory performance was equivalent for all 3 groups. The enhanced selective memory in the abused group was the result of better recall for 'remember' and not poorer recall for 'forget' information, indicating that abused individuals have an enhanced ability to sustain attention to designated 'remember' information. Because most people with childhood abuse recall their abuse, enhanced remembering of designated events (e.g., information not associated with abuse) may be a coping strategy
— id: 37260, year: 1996, vol: 105, page: 204, stat: Journal Article,

Childhood abuse and subsequent sexual assault among female inpatients
Cloitre M; Tardiff K; Marzuk PM; Leon AC; Portera L
1996 Jul;9(3):473-482, Journal of traumatic stress
The relationship between a history of childhood abuse and subsequent sexual assault was assessed among 409 consecutive female inpatient admissions. A total of 45% of the sample reported a history of some form of childhood abuse and 22% reported at least one adulthood sexual assault. A hierarchical logistic regression indicated that, after controlling for sociodemographic and diagnostic variables, women with a history of childhood abuse were 3.1 times more likely to have experienced an adult sexual assault compared to those without abuse. There was a higher prevalence of adult sexual assault among women reporting only physical abuse or physical and sexual abuse than those reporting only sexual abuse, indicating the significance of physical abuse as a potential risk factor for adult sexual assault
— id: 37258, year: 1996, vol: 9, page: 473, stat: Journal Article,

Social-vocational adjustment in unipolar mood disorders: results of the DSM-IV field trial
Evans S; Cloitre M; Kocsis JH; Keitner GI; Holzer CP; Gniwesch L
1996 Jun 5;38(2-3):73-80, Journal of affective disorders
430 patients participating in the DSM-IV field trial receiving a DSM-III-R SCID-derived diagnosis of episodic major depression (n = 131), dysthymic disorder (n = 37) and double depression (n = 262) completed the social adjustment scale-self-report (Weissman and Bothwell, 1976). Patients with double depression demonstrated greater social morbidity than those suffering from episodic major depression or dysthymic disorder (P < 0.05). Significant predictors of high social morbidity in double depressives included severity of symptoms (P < 0.0001), followed by age of onset of first major depression (P < 0.04). Subscale analysis revealed that double depressives were significantly more impaired in work outside the home and in terms of their financial status (P < 0.05)
— id: 37259, year: 1996, vol: 38, page: 73, stat: Journal Article,

Distress reduction during the structured clinical interview for DSM-III-R
Scarvalone PA; Cloitre M; Spielman LA; Jacobsberg L; Fishman B; Perry SW
1996 Jan 31;59(3):245-249, Psychiatry research
In an attempt to assess the influence of standardized diagnostic interviews on psychological distress in research volunteers, the Visual Analogue Scale (VAS) was used to measure anxiety and depression during the Structured Clinical Interview for DSM-III-R, Non-patient version (SCID). Subjects were 50 adults with concerns related to the human immunodeficiency virus who were seeking testing and treatment in research trials. Repeated measures analysis of variance showed significant decreases in distress by the end of the interview: 72% of subjects reported diminished anxiety, and 54% reported diminished depression. Thus, the SCID appeared to provide a positive interview experience, a finding that may serve to reassure subjects, their families, and review boards regarding participation in studies that employ structured interviews
— id: 21966, year: 1996, vol: 59, page: 245, stat: Journal Article,

Relationship of dissociation to self-mutilation and childhood abuse in borderline personality disorder
Brodsky BS; Cloitre M; Dulit RA
1995 Dec;152(12):1788-1792, American journal of psychiatry
OBJECTIVE: This study sought to document the prevalence of dissociative experiences in adult female inpatients with borderline personality disorder and to explore the relationship between dissociation, self-mutilation, and childhood abuse history. METHOD: A treatment history interview, the Dissociative Experiences Scale, the Sexual Experiences Questionnaire, and the Hamilton Depression Rating Scale were administered to 60 consecutively admitted female inpatients with borderline personality disorder as diagnosed by the Structured Clinical Interview for DSM-III-R Personality Disorders. RESULTS: Fifty percent of the subjects had a score of 15 or more on the Dissociative Experiences Scale, indicating pathological levels of dissociation. Fifty-two percent reported a history of self-mutilation, and 60% reported a history of childhood physical and/or sexual abuse. The subjects who dissociated were more likely than those who did not to self-mutilate and to report childhood abuse. They also had higher levels of current depressive symptoms and psychiatric treatment. Multiple regression analysis demonstrated that each of these variables predicted dissociation when each of the others was controlled for, and that self-mutilation was the most powerful predictor of dissociation. CONCLUSIONS: Female inpatients with borderline personality disorder who dissociate may represent a sizable subgroup of patients with the disorder who are at especially high risk for self-mutilation, childhood abuse, depression, and utilization of psychiatric treatment. The strong correlation between dissociation and self-mutilation independent of childhood abuse history should alert clinicians to address these symptoms first while exercising caution in attributing them to a history of abuse
— id: 37261, year: 1995, vol: 152, page: 1788, stat: Journal Article,

Memory bias does not generalize across anxiety disorders
Cloitre M; Cancienne J; Heimberg RG; Holt CS; Liebowitz M
1995 Mar;33(3):305-307, Behaviour research & therapy
Individuals with social phobia were compared with normal controls on their memory for socially-related threat words in contrast to positive and neutral words. A memory paradigm used in a previous study of panic disorder patients [Cloitre, M. & Liebowitz, M. R. (1991) Cognitive Therapy and Research, 15, 609-619] was applied to test the generalizability of findings of threat-biased memory in a semantic memory task (free recall) and a perceptual memory task (high-speed recognition) to social phobics. No evidence of threat-related memory bias among social phobics was obtained. Since both the social phobic and control groups showed better memory for affectively valenced (threat and positive) compared to neutral information, it is unlikely that the absence of threat-biased memory among social phobics was the result of insensitive measurement
— id: 37262, year: 1995, vol: 33, page: 305, stat: Journal Article,

Psychodynamic perspectives
Cloitre, Marylene; Shear, M. Katherine
Social phobia: Clinical and research perspectives Washington, DC : American Psychiatric Press, 1995,
(from the chapter) begin . . . with a brief historical overview of psychoanalytic theory and its application to issues of social functioning / the major portion of the paper is an elaboration and extension of P. Gilbert's psychobiological model of social anxiety and social phobia (Gilbert 1989, Trower and Gilbert 1989) / the defense/safety model . . . incorporates important ideas of a psychodynamic nature but draws on many other disciplines, particularly ethological theory, with which to interpret the experience of social anxiety present recent social and biological research that allows us to speculate on biological and environmental variables that may be relevant to the development of the defense/safety system / present a case history of an individual with social phobia that received a dynamic interpretation . . . and apply the defense/safety model in order to extend the interpretation of the case as well as to identify additional treatment suggestions
— id: 3088, year: 1995, vol: , page: 163, stat: Chapter,

Emotion-focused treatment for panic disorder: A brief, dynamically informed therapy
Shear, M. Katherine; Cloitre, Marylene; Heckelman, Leora
Dynamic therapies for psychiatric disorders : axis I New York : BasicBooks, 1995,
(from the chapter) present the background and methods for a brief emotion-focused therapy intervention for panic disorder patients / this treatment is derived from psychodynamic principles but is not [a] psychodynamic psychotherapy / efficacy of this treatment has some early empirical support, but full confirmation of its efficacy and effectiveness in comparison with other active treatments awaits further study
— id: 3089, year: 1995, vol: , page: 267, stat: Chapter,

Implicit and explicit memory for catastrophic associations to bodily sensation words in panic disorder
Cloitre, Marylene; Shear, M. Katherine; Cancienne, James; Zeitlin, Sharon B
1994 ;18(3):225-240 Jun, Cognitive therapy & research
Investigated explicit (cued recall) and implicit (word completion) memory bias for catastrophic associations among 24 individuals with panic disorder (PD), 24 clinician controls, and 24 normal controls. Compared to both control groups, the PD group showed biased explicit and implicit memory for catastrophic associations to bodily sensation words (e.g., palpitation-coronary) compared to positive (e.g., smiles-elation) and neutral (e.g., groceries-coupons) word pairs of equal relatedness. Results support cognitive formulations of panic disorder which suggest that individuals with PD have biased memory for catastrophic associations and that these biases can occur in both conscious (explicit) and nonconscious (implicit) memory processes.
— id: 38073, year: 1994, vol: 18, page: 225, stat: Journal Article,

Does mood-congruence or causal search govern recall bias? A test of life event recall
Raphael KG; Cloitre M
1994 May;47(5):555-564, Journal of clinical epidemiology
Recall bias has been hypothesized to occur as a function of mood congruence or causal-search related mechanisms. This study tested whether either mechanism related to recall of stressful life events over a year. Respondents consisted of 136 cases suffering from chronic facial pain and 131 acquaintance controls. After reporting life events for 1 year at monthly intervals, respondents attempted to recall these same events at year-end. Mood and likelihood of engaging in causal search were also ascertained at year-end. Results showed no effect of mood congruence or causal search on recall of event occurrence. However, mood did influence subjective appraisal of those events that were recalled. In addition, a significant mood-related memory deficit was detected. Findings indicate that mood-related memory deficit may reduce effect sizes artifactually. Furthermore, when assessing effects of recall bias, recall of event occurrence must be considered separately from subjective appraisal of event characteristics
— id: 37264, year: 1994, vol: 47, page: 555, stat: Journal Article,

Cognitive behavioral treatment compared with nonprescriptive treatment of panic disorder
Shear MK; Pilkonis PA; Cloitre M; Leon AC
1994 May;51(5):395-401, Archives of general psychiatry
BACKGROUND: The efficacy of cognitive behavioral treatment for panic disorder has been established in controlled studies. However, little is known about the efficacy of other psychological treatments. We report the results of a study comparing cognitive behavioral treatment with a focused nonprescriptive treatment for panic. METHODS: Three sessions of panic-related information were provided in each treatment, followed by 12 sessions of either nonprescriptive, reflective listening (non-prescriptive treatment) or a treatment package that included breathing retraining, muscle relaxation, cognitive reframing, and exposure to interoceptive and agoraphobic stimuli (cognitive behavioral treatment). RESULTS: Posttreatment and 6-month follow-up assessments revealed a good response to both treatments. We observed a high rate of panic remission and significant improvement in associated symptoms in subjects in each treatment group. CONCLUSION: These findings raise questions about the specificity of cognitive behavioral treatment
— id: 37263, year: 1994, vol: 51, page: 395, stat: Journal Article,

Psychomotor agitation and retardation
Cloitre, Marylene; Katz, Martin M; van Praag, Herman M
Symptoms of depression New York : Wiley, 1993,
(from the chapter) recent studies that have focused on psychomotor activity in depression have made significant and unique contributions in understanding the onset, course, and treatment assessment of depression / identifies the nonverbal characteristics of depression associated with psychomotor agitation and retardation / the relationship between motor activity and other symptoms of depression is then discussed / global measures of motor activity as well as specific nonverbal behaviors associated with communicative effort are discussed in terms of their ability to predict treatment response a review of the nonverbal changes that occur during treatment indicates that recovery is associated with a shift from impoverished and disjointed movement behavior to a richer, more coherent and individual presentation of self / nonverbal behavior is studied in relation to efforts to discriminate among subtypes of depression and more generally different types of psychiatric disorders
— id: 3091, year: 1993, vol: , page: 207, stat: Chapter,

Expressive characteristics of anxiety in depressed men and women
Katz MM; Wetzler S; Cloitre M; Swann A; Secunda S; Mendels J; Robins E
1993 Aug;28(4):267-277, Journal of affective disorders
This study was aimed at identifying the expressive, movement, and social behaviors associated with anxiety in the syndrome of major depression. The sample consisted of 97 hospitalized male and female depressed patients. Expressive and social behaviors were evaluated prior to treatment in a structured videotaped interview. Anxiety was measured using a multi-vantaged approach including doctor's rating, nurse's rating, patient self-report, and a separate video rating. Results indicate that anxiety was significantly associated with agitation, distressed facial expression, bodily discomfort, and poor social interaction in both sexes. Men and women differed in certain respects: anxiety was highly related to motor retardation in women only, and to hostility in men only. Differences in the pattern of expressive behavior between high and low anxious, depressed patients were clearly significant, and several were large enough to serve as clinical indicators. These findings help to characterize the expressive features of anxiety in the context of severe depression, and add to the growing literature on sex differences in depression
— id: 37265, year: 1993, vol: 28, page: 267, stat: Journal Article,

Methodologies for studying cognitive features of emotional disorder
Segal, Zindel V; Cloitre, Marylene
Psychopathology and cognition San Diego : Academic Press, 1993,
(from the chapter) examine some of the methodologies available for the study of attention, interpretation of ambiguous stimuli, judgments, and memory processes in anxiety and depressive disorders comorbidity of depression and anxiety
— id: 3090, year: 1993, vol: , page: 19, stat: Chapter,

Reaction time to threat stimuli in panic disorder and social phobia
Cloitre M; Heimberg RG; Holt CS; Liebowitz MR
1992 Nov;30(6):609-617, Behaviour research & therapy
Two studies assessed response time among clinically anxious subjects and normal controls when presented with threat, positive and neutral stimuli under perceptual (lexical decision) and semantic (category decision) task conditions. In Study 1, panic disorder subjects' (n = 14) performance was compared to that of matched normal controls (n = 14) while in Study 2 social phobic subjects (n = 24) were compared to matched normal controls (n = 24). Relative to matched normal controls, panic disorder subjects but not social phobics tended to show greater slowing in performance on the more cognitively complex (category) task. A second finding, consistent across both studies was that, compared to the normal control groups, both panic and social phobic groups showed significantly slowed responses to threat words in both the perceptual and semantic tasks. Such findings are directly counter to the predictions of a mood congruence hypothesis. This apparent contradiction is resolved by a review of the literature which indicates that mood-related facilitation effects are obtained only in tasks which tap awareness of threat information rather than speed of response. It is suggested that while anxiety may produce enhanced awareness of threat, it may inhibit responsiveness to it. The results of these studies are seen as consistent with ethological theories of inhibited motoric responses under certain threat conditions. Furthermore, the findings suggest that caution is indicated in interpreting slowed reaction time to threat stimuli in tasks such as the Stroop color naming task as purely the result of attentional processes
— id: 37266, year: 1992, vol: 30, page: 609, stat: Journal Article,

Avoidance of emotional processing: A cognitive science perspective
Cloitre, Marylene
Cognitive science and clinical disorders San Diego : Academic Press, 1992,
(from the chapter) explores the empirical evidence for the notion that individuals can avoid attending to, analyzing, and remembering information that is painful or threatening / there has been increased interest among clinicians and cognitive psychologists in understanding the cognitive processes that guide these experiences / one goal . . . is to review processes such as selective attention, selective memory, and memory dissociations, and suggest that they provide plausible cognitive bases for the operation of emotionally driven avoidance strategies / a second aim . . . is to provide an outline of a cognitive affective model of functional amnesia and suggestions for ways in which this model might be tested reviews the literature in both areas, making an effort to identify similarities between attentional strategies used to selectively search the external environment and potential search strategies used during memory scanning
— id: 3092, year: 1992, vol: , page: 19, stat: Chapter,

Perceptions of control in panic disorder and social phobia
Cloitre, Marylene; Heimberg, Richard G; Liebowitz, Michael R; Gitow, Andrea
1992 ;16(5):569-577 Oct, Cognitive therapy & research
Used H. Levenson's (1973) Locus of Control Scales to assess perceptions of control in 14 individuals with panic disorder and 14 with social phobia, compared with 14 normal controls. Both anxiety disorder groups (ADGs) showed a lower sense of internal control compared with the controls. The 2 ADGs showed contrasting externality orientations. Panic-disordered Ss viewed events as proceeding in a random and uncontrollable way, while social phobics viewed events as controlled by powerful others. Partial correlations confirmed the unique relationship between each disorder and a particular externality orientation and indicated that low internal perceptions of control were strongly influenced by the presence of beliefs in chance and powerful others.
— id: 38074, year: 1992, vol: 16, page: 569, stat: Journal Article,

Memory bias in panic disorder: An investigation of the cognitive avoidance hypothesis
Cloitre, Marylene; Liebowitz, Michael R
1991 ;15(5):371-386 Oct, Cognitive therapy & research
14 individuals with panic disorder and 14 normal controls performed 2 memory tasks: a high-speed recognition task that measured perceptual memory and a free recall task that measured semantic memory. Ss' memory for threatening, positive, and neutral words was evaluated. In contrast to normal controls, panic disorder Ss showed better perceptual memory and better semantic memory for threat words compared to positive and neutral words. Results suggest that panic disorder Ss engaged in preferential processing of threat information at both a perceptual and semantic level of analysis. The results do not support a 'cognitive avoidance' hypothesis, which predicts the inhibition of more elaborate and meaningful processing of threat stimuli in anxious Ss.
— id: 38075, year: 1991, vol: 15, page: 371, stat: Journal Article,

Is major depression comorbid with temporomandibular pain and dysfunction syndrome? A pilot study
Gallagher RM; Marbach JJ; Raphael KG; Dohrenwend BP; Cloitre M
1991 Sep;7(3):219-225, Clinical journal of pain
There is a lack of information about the precise strength of the relationship between chronic pain and depression. In a prior study, women with temporomandibular pain and dysfunction syndrome (TMPDS) had much higher scores than did controls on a measure of nonspecific psychological distress. The question arose as to whether rates of clinical depression are also unusually high in TMPDS patients. Their former treating clinician rates cases for likely lifetime presence or absence of depression. A subset of those rated as likely depressed then had their diagnoses verified independently through a structured clinical interview by a psychiatrist and clinical psychologist. Results revealed a minimum lifetime prevalence rate for major depression of 41%. A rate of this magnitude in TMPDS cases is clearly much higher than would be found for women of similar background in the general population
— id: 37267, year: 1991, vol: 7, page: 219, stat: Journal Article,

Problems of recall and misclassification with checklist methods of measuring stressful life events
Raphael KG; Cloitre M; Dohrenwend BP
1991 ;10(1):62-74, Health psychology
The prevalent use of life event category checklists to facilitate event recall may be one reason that previous studies find that life events play only a small and ambiguous role in the development of health problems. In this study, 136 persons with temporomandibular pain disorder syndrome (TMPDS) and 131 healthy controls reported the occurrence of life events in 10 monthly interviews, using an event category checklist. At the end of the study, they reported retrospectively and in detail about life events over the previous monthly periods. Only one quarter of the event categories appeared in both the monthly interviews and retrospective report for the same period. Detailed analyses revealed problems of inaccuracy inherent in checklists that exacerbate problems of recall. The findings indicate that checklist category approaches should not be used when the goal is to understand the role of stress in adverse health outcomes. Suggestions are made about more adequate methods
— id: 37268, year: 1991, vol: 10, page: 62, stat: Journal Article,

Cognitive-behavior therapy for panic disorder delivered by psychopharmacologically oriented clinicians
Welkowitz, Lawrence A; Papp, Laszlo A; Cloitre, Marylene; Liebowitz, Michael R; et al
1991 ;179(8):473-477 Aug, Journal of nervous & mental disease
A cognitive-behavioral treatment program for panic disorder was delivered by staff members of a psychiatric center that traditionally uses pharmacological methods. Seven clinicians who were not previously exposed to behavioral techniques were trained by a behavioral psychologist to use a treatment program consisting of breathing control, cognitive restructuring, and exposure to panic-eliciting somatic cues. Of the 24 panic disorder patients treated as part of this training, 14 were panic-free after treatment and 3 showed moderate improvement and decreased frequency of panic. A case example of a 40-yr-old female demonstrates the application of behavioral techniques to individual patients. Discussion focuses on training in behavioral methods and problems in exporting behavioral technology to psychopharmacological treatment centers.
— id: 38076, year: 1991, vol: 179, page: 473, stat: Journal Article,

Anxiety and depression: discrete diagnostic entities?
Liebowitz MR; Hollander E; Schneier F; Campeas R; Fallon B; Welkowitz L; Cloitre M; Davies S
1990 Jun;10(3 Suppl):61S-66S, Journal of clinical psychopharmacology
Some forms of anxiety and affective disorder, such as panic disorder and major depression, appear distinct, while other forms, such as generalized anxiety disorder and chronic depression or dysthymia, may lie on a continuum and blend with each other. However, even panic disorder and major depression have many common features. Moreover, for reasons not yet clear, they occur together frequently, and their combined occurrence in the same patient has been associated with greater severity and chronicity, decreased treatment responsiveness, and, possibly, increased familial prevalence of anxiety and/or depression. Finally, studies of primary care patients suggest the frequent occurrence of a mixed anxiety-depressive disorder that may often be subsyndromal by DSM-III-R criteria but is nevertheless associated with prominent distress and/or impairment
— id: 37269, year: 1990, vol: 10, page: 61S, stat: Journal Article,

Linguistic anaphors, levels of representation, and discourse
Cloitre, Marylene; Bever, Thomas G
1988 ;3(4):293-322, Language & cognitive processes
Four studies with 126 college students contrasted the processing of anaphor resolution for 2 types of anaphors: pronouns and repeated nouns. Ss were presented with an antecedent-related probe, following 2 sentence discourses ending in a pronoun or repeated noun. Ss made 1 of 3 judgments about the probe word: recognition, category decision, or lexical decision. Stronger facilitation in the category task occurred following the pronoun; facilitation in the lexical decision task occurred only following the noun-anaphor. In the recognition study, response times to probe words were faster following the pronoun and showed a greater facilitation for concrete than for abstract probes. Data support the notion that pronouns provide greater immediate sensitivity to conceptual aspects of the antecedent. When the probe word was presented at a 250-msec delay, responses following the noun-anaphor also showed a greater facilitation to concrete probes.
— id: 38077, year: 1988, vol: 3, page: 293, stat: Journal Article,

The psychological impact of prenatal DES exposure in women: A comparison of short-term and long-term effects
Cloitre, Marylene; Ehrhardt, A. A; Veridiano, N. P; Meyer-Bahlburg, Heino F
1988 ;8(3):149-168 Jun, Journal of psychosomatic obstetrics & gynaecology
Diethylstilbestrol (DES) was administered to pregnant women with at-risk pregnancies in the US until 1971 when it was banned because of dangerous effects on offspring. The psychological impact of knowledge of DES exposure on young women was evaluated and compared for 3 time points: (1) following the disclosure of their DES exposure, (2) following their 1st DES-related examination, and (3) at the time of the interview. 60 DES-exposed daughters (aged 17.9-32.6 yrs) described their reactions and worries at each time point. Results show that (1) most Ss initially reacted with mild to moderate levels of distress, (2) the DES exam served to reduce worry, and (3) there was an increase in distress from the time following the 1st exam to the present. The focus of worries changed from cancer risk to worries about pregnancy difficulties.
— id: 38078, year: 1988, vol: 8, page: 149, stat: Journal Article,

The effect of kind of anaphor on the accessibility of antecedent information processing
Cloitre, Marylene
Ann Arbor : University Microfilms International, 1987,
— id: 1101, year: 1987, vol: , page: , stat: ,