FITT

 

FITT Model: Impact on the Adult

  • Summary
  • Assessment Measures
  • Interventions
  • References

 

Summary

The impact of trauma on adults is well documented within the literature in response to a variety of types of trauma and in many populations, including to some degree within the context of urban poverty, with particular attention paid throughout to the characteristics of and factors that contribute to the development of Post-Traumatic Stress Disorder (PTSD). Adults surviving the stress of urban poverty are not only more likely to experience multiple traumatic events, they are also more likely to develop trauma related symptoms that impact their functioning, health and well-being. Further, they are less likely to have access to the resources that may facilitate the successful negotiation of a traumatic event. Factors contributing to a higher risk of developing PTSD and trauma related symptoms generally include prior individual or family psychiatric history, childhood abuse, low socio-economic status, lack of education, low intelligence, other previous trauma or adverse childhood experience, severity of the traumatic experience, isolation, life stress, and a genetic predisposition. On the other hand, the literature identifies the following factors as potentially protective from the negative impacts of trauma: easygoing temperament, high intellectual ability, positive family environment, internal locus of control, coping skills, social support, self-regulation and spirituality. Researchers and clinicians have developed a variety of tools to assess adult responses to trauma, with two of the most consistently used instruments being the PTSD Checklist (PCL) and the Structured Clinical Interview for DSM-IV, PTSD module (SCID-PTSD). Empirical evidence indicates that the most successful interventions designed to address trauma symptoms are rooted in cognitive behavioral therapy, with the dominant treatment modalities being prolonged exposure, cognitive therapy, cognitive processing therapy, and stress inoculation therapy, as well as eye movement desensitization and reprocessing (EMDR) interventions.

 

Assessment Measures

Name of Instrument Author(s) Domains Assessed Age Range Source/Form (self report, observation, lab, other) # of items Time Cost Training Required Where to obtain  Psychometric Properties Other comments:
Clinician Administered PTSD Scale (CAPS) Blake, Weathers, Nagy, Kaloupek, Charney, & Keane, 1995 Diagnostic criteria for PTSD Adult Structured diagnostic interview 30 1 hour for entire interview, 30 min. if assessing core symptoms  Informal version free from NCPTSD. From publisher: $104.50 initial kit. $3.80/ interview booklet (pkgs of 10) Training manual or Training CD-ROM  Request from National Center for PTSD: Click Here
OR Western Psychological Services
Well validated Assesses core symptoms, more items if including all DSM-IV criteria & associated symptoms
Structured Clinical Interview for DSM-IV, PTSD module (SCID-PTSD) First, Spitzer, Gibbon, & Williams, 1996 Diagnostic criteria for PTSD Adult Structured diagnostic interview 19 10 min. Clinician's version, $167 initial kit (administration booklet, 5 score sheets, user's guide). $13.20/ score sheet (pkg of 5) Read manual and watch training DVD  The Clinician Version of the SCID-I (SCID-CV), and the SCID-II, may be purchased from American Psychiatric Press (800-368-5777). Strong evidence for reliability and validity (as specifically related to diagnoses of PTSD)  Determines only the presence or absence of PTSD, not the severity or frequency of symptoms.
PTSD Checklist (PCL)  Weathers et al., 1993 Diagnostic criteria for PTSD Adult Self-report 17 5 min. Free Familiarity w/administration, scoring guidelines, and interpretation Request from National Center for PTSD: Click Here Strong evidence for reliability and validity May be scored dichotomously (presence or absence of PTSD) or continuously (to measure symptom severity). The respondent is asked to rate how much the problem described in each statement has bothered him/her over the past month.
Childhood Trauma Questionnaire (CTQ) Bernstein, D. P. & Fink, L., 1998 Caregiver history of abuse/neglect during childhood. The scale assesses three types of abuse (Emotional, Physical, Sexual), two types of neglect (Emotional, Physical), plus 2 validity scales. 12 and over Self-report 28 5 min.  $149 for kit (manual, 25 forms). $2.36/form (pkgs of 25). Familiarity w/administration, scoring guidelines, and interpretation Pearson Assessment Strong evidence for reliability and validity  
Trauma Symptom Inventory (TSI) Briere, J., 1995 Measure of trauma symptoms. The TSI comprises 3 validity scales and 9 clinical scales (anxious arousal, depression, anger/ irritability, intrusive experiences, defensive avoidance, dissociation, sexual concerns, dysfunctional sexual behavior, impaired self-reference, tension reduction behavior). Adults (18 years+) Self-report 100 20 min. $210 for introductory kit. $2.10/ answer sheet (pkgs of 25). $1.52/ profile forms (pkgs of 25.) Familiarity w/administration, scoring guidelines, and interpretation Psychological Assessment Resources 800.331.8378 Strong evidence for reliability and validity It has been normed in the general population. There is an 86-item alternate version, the TSI-A, that does not contain the sexual concerns or dysfunctional sexual behavior scales for use in circumstances where sexual item content is not desired. A scoring program is available.
Life Stressor Checklist-Revised Wolfe, J., Kimerling, R., Brown, P., Chrestman, K., & Levin, K., 2003 Questionnaire about stressful life events. Covers disasters, accidents,  incarceration, foster/adoption, parental divorce, financial problems, physical or mental illnesses, victim of crimes, child abuse, neglect, miscarriage or abortion, separation from your child, grief, etc. Adult Self-report 30 15-30 min. Free Familiarity w/administration, scoring guidelines, and interpretation Write to: Rachel Kimerling, PhD; Education Division National Center for PTSD; VA Palo Alto Health Care System; Building 334-PTSD; 795 Willow Road; Menlo Park, CA 94025 Strong evidence for reliability and validity When answering the questions, the respondent is asked to think about stressful events over their whole lifetime and endorse whether or not they have experienced a specific event. Then the respondent is asking to answer questions about how it affected them. Especially sensitive to concerns of women. 
Posttraumatic Stress Diagnostic Scale (PDS)  Foa, E. B., Cashman, L., Jaycox, L., & Perry, K., 1997    PTSD diagnosis, symptom severity score, symptom severity rating, level of impairment in functioning Adult Self-report 49 10 -15 min. $64 starter kit (manual, 1 booklet, 10 answer sheets, 10 worksheets). Reorder kit $150 (50 answer sheets, 50 worksheets). Familiarity w/administration, scoring guidelines, and interpretation Pearson Assessment Strong evidence for reliability and validity  Can be used to screen for PTSD symptoms or to assess severity and functioning in patients previously diagnosed with PTSD. 
Brief Symptom Inventory (BSI) Derogatis, L. R. 1993 Inventory of psychological symptoms. The BSI yields three global indices of distress, Global Severity Index (GSI) and nine subscales including Anxiety, Depression, Hostility, Obsessive-Compulsive, Somatization, Interpersonal Sensitivity, Phobic Anxiety, Paranoid Ideation, Psychoticism. 13 and over Self-report 53 less than 10 min. $109 initial kit (manual, 50 answer sheets, 50 profile forms). $1.15/ answer sheet (pkg of 50). $0.53/profile form (pkg of 50). Familiarity w/administration, scoring guidelines, and interpretation Pearson Assessment Strong evidence for reliability and validity  The BSI is normed on psychiatric populations heavily represented by lower SES and African Americans. Frequently appeared in the literature to assess adult functioning and psychopathology. Computer scoring available. 
CAGE Ewing, J., 1984 Measures problems related to alcohol or drug abuse. Adult Self-report 4 + 1 less than 1 minute  Free Familiarity w/administration, scoring guidelines, and interpretation Available in the public domain (Can access via online search engine by entering "CAGE and Ewing.") Strong evidence for reliability and validity (in terms of identifying problematic drinking)  "yes" answers to 2 questions indicates dependency; "yes" answers to 3 questions confirms dependency. Adding the question about the frequency of drinking > or =6 drinks on an occasion improves both sensitivity and specificity.  Frequently appeared in the literature to assess adult functioning and psychopathology
Beck Depression Inventory II (BDI-II)  Beck, A.T., Steer, R.A., & Brown,G.K., 1996 Depression severity, 4 point scale, multiple symptoms: sadness, pessimism, past failure, loss of pleasure, guilty feelings, punishing feelings, self-dislike, self-criticism, suicidal thoughts, crying, agitation, loss of interest, indecisiveness, worthlessness, loss of energy, changes in sleep, irritability, changes in appetite, concentration, tiredness or fatigue 13 and over Self-report 21 5-10 min. $109 initial kit (manual, 25 forms). $1.96/ form (pkgs of 25). Familiarity w/administration, scoring guidelines, and interpretation Pearson Assessment Strong evidence for reliability and validity   
Beck Anxiety Inventory Beck, A.T., & Steer, R.A., 1993 Severity of Anxiety, 4 point scale: cognitive and physiological symptoms Adult Self-report 21 5-10 minutes $109 initial kit (manual, 25 forms). $1.96/ form (pkgs of 25). Familiarity w/administration, scoring guidelines, and interpretation Pearson Assessment Strong evidence for reliability and validity  Noted gender differences
Pittsburg Sleep Quality Index Buysse, D.J., Reynolds III, C.F., Monk, T.H., Berman, S.R., & Kupfer, D.J., 2000 Sleep quality during the previous month, distinguish between good and poor sleepers. Domains include subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleep medications and daytime dysfunction. Adult Self-Report and Partner Report 19 for self; 5 for bed partner 5-10 minutes Free, with permission for use  Familiarity w/administration, scoring guidelines, and interpretation Link - University of Pittsburgh Sleep Medicine Institute: Click Here Strong evidence for reliability and validity  
Addiction Severity Index McLellan, A.T., Luborski, J., Cacciola, J., Griffith, P., McGrahan, C., O'Brien, P. ,1979 History, frequency, and consequences of drug and alcohol use. 5 other domains: medical, legal, employment, social/family, and psychological functioning. Rating scale of 0-4 Adult Face-to-face structured interview 161 30-45 minutes for a skilled & trained technician. Free Two day training session on administration and scoring. Can be provided on-site. Download from: Click Here Strong evidence for reliability and validity  Higher score indicates greater need for treatment.
Dissociative Experiences Scale, II Bernstein-Carlson, E., & Putnam, F., 1993 Help patients identify psychopathology and quantify dissociative experiences: memory, identity, cognition, feelings of derealization, depersonalization, absorption, imaginative involvement. Ranges from never (0%) to always (100%).  Adult Self-report 28 10 min. $12, unlimited use Familiarity w/administration, scoring guidelines, and interpretation Order from Sidran Instistute: Click Here Strong evidence for reliability and validity (as a screener)  Available in many languages

 

References

Adkins, J. W., Weathers, F. W., McDevitt-Murphy, M., & Daniels, J. B. (2008). Psychometric properties of seven self-report measures of posttraumatic stress disorder in college students with mixed civilian trauma exposure. Journal of Anxiety Disorders, 22, 1393-1402.

Briere, J. (1996). Psychometric review of Trauma Symptom Inventory (TSI). In B. H. Stamm (Ed.), Measurement of stress, trauma, and adaptation (pp. 381-383). Lutherville, MD: Sidran Press.

Beck, A.T. (1986). The Beck Depression Inventory. San Antonio, TX: The Psychological Corporation.

Beck, A.T., & Steer, R.A. (1993). Beck Anxiety Inventory Manual. San Antonio, TX: Psychological Corporation.

Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the Beck Depression Inventory-II, Psychological Corporation, San Antonio, TX.

Bernstein, E. M. & Putnam, F. W. (1986). Development, reliability, and validity of a dissociation scale. Journal of Nervous and Mental Disease, 174, 727–735.

Blake, D. D., Weathers, F. W., Nagy, L. M., Kaloupek, D. G., Gusman, F. D., Charney, D. S., & Keane, T. M. (1995). The development of a clinician-administered PTSD scale. Journal of Traumatic Stress, 8, 75-90.

Blanchard, E.B., et al. (1996). Psychometric properties of the PTSD Checklist (PCL). Behaviour Research & Therapy, 34, 669-673.

Bradley, K.A., Kivlahan, D. R., Bush, K. R., McDonell, M. B., & Fihn, S. D. ; Ambulatory Care Quality Improvement Project Investigators. (2001). Variations on the CAGE alcohol screening questionnaire: strengths and limitations in VA general medical patients. Alcohol Clinical and Experimental Research, 25, 1472-8.

Bradley, R., Schwartz, A. C., & Kaslow, N. J. (2005). Posttraumatic Stress Disorder symptoms among low-income, African American women with a history of intimate partner violence and suicidal behaviors: Self-esteem, social support, and religious coping. Journal of Traumatic Stress, 18, 685-696.

Briere, J. (1995). Manual for the Trauma Symptom Inventory (TSI). Lutz, FLA: Psychological Assessment Resources.

Buysse, D. J., Reynolds, C. F., Monk, T. H., et al. (1989). Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Research, 28, 193–213.

Carlson, E. B., & Putnam, F. W. (1993). An update on the Dissociative Experiences Scale. Dissociation: Progress in the Dissociative Disorders, 6, 16-27.

Derogatis, L. R. (1993). Brief Symptom Inventory (BSI). National Computer Systems, Inc.

Derogatis, L.R. and P.M. Spencer, The Brief Symptom Inventory (BSI) Administration, Scoring, and Procedures Manual. 1982, Baltimore: Johns Hopkins University School of Medicine, Clinical Psychometrics Research Unit.

Dozois, D. J. A., Dobson, K. S., & Ahnberg, J.L. (1998). A psychometric evaluation of the Beck Depression Inventory-II. Psychological Assessment, 2, 83-89.

Ewing, J. A. (1984). Detecting Alcoholism: The CAGE Questionnaire. Journal of the American Medical Association, 252, 1905-1907.

First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. (1996). Structured Clinical Interview for the DSM-IV Axis I Disorders.

Foa, E. B., Cashman, L., Jaycox, L., & Perry, K. (1997). The validation of a self-report measure of posttraumatic stress disorder: The Posttraumatic Diagnostic Scale. Psychological Assessment, 9(4), 445–451.

Hewitt, P.L., & Norton, G.R. (1993). The Beck Anxiety Inventory: A psychometric analysis. Psychological Assessment, 5(4), 408-12.

McLellan, A. T., Luborsky, L., Cacciola, J. M., Griffith, J., Evans, F., Barr, H., & O'Brien, C. (1985). New data from the Addiction Severity Index: Reliability and validity in three centers. The Journal of Nervous and Mental Disease, 173, 412-423.

Weathers, F. W., et al. (1993). The PTSD checklist: Reliability, validity and diagnostic utility. In Annual Meeting of the International Society for Traumatic Stress Studies. San Antonio, TX.

Wolfe, J. W., Kimerling, R., Brown, P., Chrestman, K., Levin, K. (1996). Psychometric review of the Life Stressor Checklist-Revised Measurement of Stress, Trauma, and Adaptation.

 

Interventions

Treatment Name

Developer/

Citation

Essential Elements

Research Evidence & Outcomes

URL for Additional Information

Cognitive-Behavioral Therapy (Prolonged Exposure Therapy)

Edna Foa, Hembree & Rothbaum (2007)

3 components: psychoeducation, imaginal exposure (recounting the trauma and emotional reliving of the trauma); in vivo exposure (gradually approaching reminders of the trauma)

Empirical studies demonstrate positive results for exposure therapy in treating PTSD in a variety of populations including Vietnam Veterans, sexual assault survivors and mixed trauma survivors.

http://www.nrepp.samhsa.gov/ViewIntervention.aspx?id=89

Cognitive Processing Therapy (CPT)

Patricia Resick & Monica Schnicke (1992)

Includes both cognitive and exposure components. Manualized to be conducted over 12 sessions, individual or group format

Developed for use with sexual assault survivors, successful in reducing PTSD symptoms and trauma-related guilt

https://cpt.musc.edu/index

Eye Movement Desensitization and Reprocessing (EMDR)

Francine Shapiro (1993)

8 phases of treatment combining aspects of exposure therapy, cognitive therapy, psychodynamic therapy and eye movement stimulation.

Meta-analysis of studies evaluating CBT & EMDR highlights the effectiveness of CBT and EMDR for dealing with trauma, but questions the necessity of the eye movement stimulation aspect of EMDR.

http://www.nrepp.samhsa.gov/ViewIntervention.aspx?id=199

Stress Inoculation Training

Donald Meichenbaum (1985)

3 phases of treatment: conceptualization phase (includes psychoeducation & goal setting); coping skills acquisition and rehearsal (relaxation training); application and follow through (may include in vivo and imaginal exposure)

2 studies demonstrated effectiveness in treating PTSD with SIT in female sexual assault survivors

http://www.melissainstitute.org/documents/stress_inoculation.pdf

“comprehensive, integrated, trauma-informed, and consumer-involved services”

Women, Co-occurring Disorder and Violence Study (WCDVS); Substance Abuse and Mental Health Services Administration

(SAMHSA) (2000).

Designed for women experiencing mental health and substance use disorders who have a history of physical and/or sexual abuse

9 sites are currently implementing these services, early results indicate potential to reduce both posttraumatic stress symptoms and severity of drug use

http://www.prainc.com/wcdvs/publications/default.asp