J. Gayle Beck

Although models have been proposed to explain common factors that maintain comorbid pain and PTSD [Sharp TJ, Harvey AG. Chronic pain and posttraumatic stress disorder: mutual maintenance? Clin Psychol Rev 2001; 21: 857-77], the exact nature of the relationship between these two conditions and their impact on quality of life (QOL) is unknown. The aim of the present investigation was to examine the unique and interactive effects of PTSD and pain on role functioning and life satisfaction--two important domains of QOL. The study utilized a help-seeking sample of motor vehicle accident (MVA) survivors whose accidents resulted in symptoms of comorbid PTSD and pain (N=192). Hierarchical regression models were used to examine the relationship between four PTSD symptom clusters, pain, and the interaction of each cluster and pain on role functioning and life satisfaction separately. Results of these analyses revealed a significant interaction of pain and emotional numbing on role functioning, suggesting a multiplicative effect on this domain of QOL. Decomposition of this interaction revealed a negative association between numbing and functioning at low levels of pain but no relationship at higher levels. A marginal interaction of pain and hyperarousal also was noted for life satisfaction. Decomposition of the interaction effect revealed a marginal association between hyperarousal and decreased satisfaction only at high levels of pain. A main effect of emotional numbing on decreased life satisfaction also was observed in this model, suggesting a unique influence of numbing. The results of the current research indicate that the synergistic relationship of pain and PTSD may vary across domains of QOL.

The current study is a replication and extension of previous research that has found support for a relationship between posttraumatic numbing and hyperarousal. This study examined this association while controlling for depression in 345 motor vehicle accident survivors. Additionally, the relationships among specific hyperarousal symptoms and numbing were explored. Results provided further evidence for an association between hyperarousal and numbing, even while controlling for the influence of depression, and revealed that all hyperarousal symptoms (except hypervigilance) contribute to this association.

Individuals who experience a serious motor vehicle accident (MVA) are at increased risk for psychological problems, particularly Posttraumatic Stress Disorder (PTSD). In this article, we review the literature on PTSD among MVA survivors, with particular attention to available instruments to screen for and assess symptomatology of the disorder. Approaches to the treatment of PTSD in this population are reviewed, separated into interventions designed to prevent PTSD in unselected samples, treatment targeting individuals with Acute Stress Disorder that are designed to prevent subsequent development of PTSD, and therapy for individuals with chronic PTSD. Treatment process issues are discussed, in an effort to integrate empirical findings with clinical observations. The empirical literature suggests several approaches to treatment that have good potential outcomes, although continued work is needed to identify factors that predict treatment response, as well as augment individual-based treatment formats.

Although older adults represent the fastest-growing segment of the population, we have just begun to understand the nature of anxiety and depression in this age group. In this review, current models of anxiety and depression are examined, with consideration of similarities and differences between data drawn from younger and older adults. Studies that look at the content of specific cognitions associated with anxiety, depression, and cognitive processes, such as attention and memory, are examined. Consideration is given to areas for clinical application and future research.