Oral and Posters, June 8

The roles of peritraumatic heart rate and acoustic startle reflex in predicting traumatic memory processing C. Chou, R. La Marca, A. Steptoe and C. Brewin Clinical Psychology, University College London, London, UK; Klinische Psychologie und Psychotherapie, Psychologisches Institut, Universität Zürich, Zurich, Switzerland; Institute of Epidemiology and Health Care, University College London, London, UK

Sleep appears to play an important role in emotional memory processing and emotional coping. Disturbed sleep (nightmares and insomnia) is one of the key symptoms of posttraumatic stress disorder (PTSD) and may play an important role in the aetiology and/ or maintenance of PTSD. Polysomnographic studies in PTSD patients have reported mainly on changes in REM characteristics and arousal regulation. However, little is known about the relation between sleep disturbances and emotional memory processing in PTSD. A previous sleep study in healthy subjects suggests the occurrence of adaptive changes in sleep architecture after emotional experiences, which benefit emotional housekeeping and the attenuation of emotional responses towards negative emotional experiences (manuscript under submission). The current controlled patient study assesses the impact of an induced, emotionally distressing experience on sleep parameters in PTSD patients, including the distribution of sleep stages, REM sleep-related variables, and EEG power spectral parameters. In addition, we will analyse how sleep changes in response to the stressor relate to emotional attenuation over sleep. The main experimental groups are traumatized police officers and veterans with PTSD (N025) and without PTSD (N 025). We will also include a control group of non-trauma exposed controls (N 025). The experimental set up involves presentation of neutral or distressing film fragments in the evening, followed by polysomnography (EEG -F3, F4, C4, O2-referenced to linked A1'A2; EOG; EMG; ECG; respiratory signals; limb movements) of undisturbed, whole night sleep, and cued recall of film content on the next evening. The order of the film conditions is counterbalanced across subjects. Emotional state and physiological measurements (ECG, respiratory effort, GSR, and plethysmogram) are assessed before and after film viewing and cued recall. Physiological signals are recorded during the film and stills as well. Preliminary results will be presented and discussed.
Physiological reactivity of individuals with PTSD and support during a trauma oriented social interaction with a significant other: a gender-comparative analysis S. Guay 1 , N. Nachar 2 , M. E. Lavoie 3 , A. Marchand 4  Overt behavioral support processes and physiological responses are dimensions that have been much overlooked in the exploration of the links between social support and posttraumatic stress disorder (PTSD). A multi-method strategy was developed to study physiological reactivity during a supportive interaction with a significant other. The mean and variability of heart rate (HR) of 52 participants with PTSD (40 women) were respectively measured in four phases: (1) a 2-minute resting baseline, (2) a-10 minute neutral interaction with the significant other, (3) a 15-minute active interaction with the significant other evoking the impacts of PTSD on their lives, and (4) a 2-minute recovery phase. Our results revealed a significant increase in HR responses during the trauma-oriented discussion. This HR response increase was significant in comparison to all other control periods, i.e., the preceding neutral discussion with a significant other as well as the initial and final resting periods (p B0.01). Men and women from our sample showed similar HR mean and variability during each phase. Although there was no link between the intensity of PTSD symptoms (measured with the CAPS) and women's HR at all phases, significant positive correlations were found for men during phases 1, 3, and 4 (rs 0.62, psB0.05) with HR variability. During phase 3, the more the men expressed emotions to their significant other, the less HR variability was observed (r 00.40, p B0.05). Our findings suggest that PTSD symptoms are more strongly associated with the physiological reactivity of men before, during, and after an interaction with a significant other about their trauma. Clinical strategies addressing these issues will be discussed.

Miscellaneous
Development and validation of a scale to measure trauma-related guilt and shame K. Derks 1 , W. Van Der Veld 1 , G. Näring 1 , E. Becker 1 and J. Krans 2 1 Behavioural Science Institute, Radboud University Nijmegen, The Netherlands; 2 University of New South Wales, Sydney, Australia Although scholars agree that emotions of guilt and shame are critical in the development of posttraumatic stress disorder (PTSD) symptoms after a traumatic event, measurement instruments of these emotions in relation to trauma are still limited. Additionally, the existing scales principally measure trauma-related guilt, and the emotion of shame is often not included, even though a body of clinical research on psychological trauma indicates that the emotion shame is important in the development and course of PTSD symptoms. Moreover, the existing measures fail to recognize that these moral trauma-related emotions do not only have a cognitive component but also a behavioral reaction. As guilt is essentially a constructive moral emotion, associated with feelings of responsibility and agency, it results in a desire to repair what one has possibly done wrong. However, this repair behavior is not part of the existing instruments that measure trauma-related guilt. Just like guilt, shame has, next to the cognitive component (negative self-evaluations, ''I am a bad person''), its own behavioral element: withdrawal (e.g., hiding). Shame makes one want to withdraw and to avoid dealing with the consequences of traumatic events. We addressed these issues by developing and validating a new scale that measures both trauma-related guilt and shame experiences. The scale contains two guilt subscales that assess negative behavior-evaluations (cognitive) and the tendency to repair (behavioral) following a traumatic event, and two shame subscales that measure negative self-evaluations and withdrawal behavior following a traumatic event. Our scale's ability to distinguish these two classes of responses (cognitive and behavioral) and its ability to include both trauma-related guilt and shame represents a vital advantage of the scale over existing instruments. Consequently, it has the potential to be an important tool for identifying trauma-related guilt and shame.
The degree of dissociative and posttraumatic stress in oncology A. Gallo Dipartimento di Scienze dell'Uomo, Università degli studi di Urbino ''Carlo Bo'', Italy A traumatic event is considered a stressful event that overwhelms the resilience of the subject. A traumatic event can be an isolated incident or repetitive causing a chronic trauma in the patient. The shift to the subjective experience of trauma led to a definition of traumatization as an individual response at cognitive, affective and defensive level. In this sense, an event becomes ''traumatic'' according to the way in which the subject experiences it in his or her inner world, i.e., in relation to the quality of his or her personal reality. Traumatic experiences act on splitting up higher integrative functions and this creates the existence of dissociative phenomena and psychopathological disorders such as posttraumatic stress disorder (PTSD). The disruption resulting from psychological trauma however does not seem to be a defense of the mind, but rather a side effect that has grave repercussions on the ability of the individual to regulate emotional, and metacognitive capabilities in relation to one's own identity. The seriousness of the dissociative disorder and PTSD when associated with traumatic histories of development can worsen the prognosis if they are present as an illness in combination with other disorders. In fact, if we try to analyze a dramatic context such as cancer, it is noted that the communication of a poor diagnosis can be characterized as a critical time for the development of this phenomena. In this situation, it seems to be essential for a specific intervention to reduce symptoms and return the patient to a normal level of functioning in order to be able to manage the organic pathology.
A study that investigated the psychometric properties of the Hungarian versions of the Impact of Event Scale-Revised (IES-R; Weiss & Marmar, 1996) and the Impact of Future Events Scale (IFES; Deeprose & Holmes, 2010) in a sample of healthy subjects is presented. The IES-R is a 22-item self-report measure that assesses subjective distress along three subscales after traumatic events. The previously available and validated Hungarian version of the Impact of Event Scale (Horowitz et al., 1979) is updated and retranslated to fully assess all posttraumatic symptoms. The IFES is a 24-item scale that was developed based on the IES-R and assesses the impact of intrusive, prospective, personally relevant imagery of events occurring to the respondent in the near future. The two scales are tested in one time with the purpose of exploring possible connections between effects of past events and the impact of future events on the individual. The psychometric properties of the Hungarian versions of the scales were tested in a sample of 200 healthy subjects. The internal consistency, testÁretest reliability, convergent and divergent validity, factor structure, as well as information about the translation process are discussed. The process of the analysis of the convergent and divergent validity raises transdiagnostical questions.

Cultural Issues and Trauma
Holocaust survivors and their post-war relationships: women's coping, healing, and interpersonal bonds G. Mapel New York University, New York, NY, USA There is an unidentified discrepancy in the literature. One body of literature suggests that social support aids recovery from trauma (Tedeschi & Calhoun, 2004), while another asserts that trauma leads to difficulties in establishing and maintaining relationships so that access to support is restricted (Krystal, 2006). Thus, the two bodies of literature, taken together, reflect a paradox first identified and referred to as a ''bind'' by Banks (2006): trauma survivors need social support to heal; yet, due to their exposure to trauma, some survivors are left relationally challenged. This paradox is exacerbated in the case of complex trauma. Research supports the presence of a traumatic syndrome that differs from posttraumatic stress disorder (PTSD) in terms of severity and complexity of symptom presentation (Ford, Stockton, Kaltman, & Green, 2006;Ford & Kidd, 1998). Herman (1992) coined the term ''complex post-traumatic stress disorder'' (p. 119) to capture this more severe and complex presentation. People with complex PTSD suffer in the interpersonal realm. It is not just that complex trauma is (1) severe in nature and (2) often occurs over an extended period of time, but that (3) it is trauma inflicted upon individuals by human perpetrators that leads to its devastating and long-lasting effects, including impaired relations with others (Ford, Stockton, Kaltman, & Green, 2006). Survivors of the Holocaust have endured the extreme end of the complex trauma spectrum.
Ethnic minority youth survivors of the Utøya-massacre, and their sense of belonging in the Norwegian society in the aftermath of 7/22 M. Aadnanes and M. Hauge Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Violence and Trauma -Children and Youth Unit, Oslo, Norway Background: On 22 July 2011, the Norwegian Labor Party's youth organization was attacked during their annual gathering at the small island of Utøya. The terrorist action was an attack on the government's immigration policy and the multicultural Norway. The perpetrator's intention was to start a war against Islam and against multiculturalism. His goal was a monocultural Norway. Thus, the politically active youth from ethnic minority groups who was at Utøya did not only represent the ''liberal immigration policy,'' they were also a manifestation of it. The study is a part of the larger ongoing study: ''The terrorist attack: Experiences and reactions among Utøya survivors,'' conducted at the Norwegian Center of Violence and Traumatic Stress Studies. Aim: The purpose of the study is to explore ethnic minority youths' sense of belonging in the Norwegian society in the wake of the terror attack at Utøya. In the aftermath of the attack, there has been a heated debate in the media about immigration and integration policies in Norway. Among the 325 participants in the first round of data collection, 11.3% (N 036.7) had immigrant background. In the second phase of data collection, these were asked about whether their sense of belonging in the Norwegian society had changed in the wake of the terror attack, and if so, in what way. Method: Open-ended, qualitative questions about belonging were included in the semi-structured interviews with survivors of ethnic minority background 12 months after the attack. Narratives about experiences of belonging will be subject of qualitative content analysis. The content is currently analysed, and results will be presented at the conference. Background: Despite a growing number of studies and reports indicating a very high and increasing prevalence of trauma exposure in Greenlandic adolescents, the knowledge on this subject is still very limited. Methods: In a Greenlandic sample from four different schools in two different minor towns in Northern Greenland, 269 students, aged 12 to 18 (M015.4; SD01.84) were assessed for their level of exposure to 20 potentially traumatic events (PTEs) along with the psychological impact of these events. Results: Of the Greenlandic students, 86% had been directly exposed to at least one PTE and 74.3% had been indirectly exposed to at least one PTE. The mean number of directly experienced PTEs was 2.8 and the mean number of indirectly experienced PTEs was 3.9. The most frequent direct events recorded were death of someone close, near drowning, threatened to be beaten, humiliation or persecution by others, and attempted suicide. The estimated lifetime prevalence of PTSD was 17.1%, whereas another 14.2% reached a subclinical level of posttraumatic stress disorder (PTSD) (missing the full diagnosis by one symptom). Following exposure, girls were three times more likely to suffer from PTSD compared to boys. Education level of the father, type of school, living in a single parent household, and being exposed to multiple direct and indirect PTEs were significantly associated with an increase in PTSD symptoms. Conclusion: The findings indicate that various types of PTEs that Greenlandic adolescents are exposed to have the potential to result in substantial mental health problems. Furthermore, the findings indicate that Greenlandic adolescents are more exposed to certain specific PTEs than adolescents in similar studies from other nations. This study revealed that Greenlandic girls are particularly vulnerable toward experiencing PTEs. Indeed, in general, girls reported more experiences of direct and indirect PTEs. Furthermore, girls reported being more commonly exposed to specific types of PTEs compared to boys.

Posters, June 8
Project TIC-Talk: tailoring trauma informed care to lesbian, gay, bisexual, transgender, and questioning youth I. Seilicovich and S. Strahl The Village Family Services, North Hollywood, CA, USA Childhood trauma has been proven to have detrimental effects into adulthood oftentimes resulting in mental and physical health challenges as well as substance abuse (Felitti et al., 1998). Research indicates that lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth are at higher risk for trauma and face greater psychosocial challenges compared to other teens (GLSEN, 2009). Effective intervention is critical to maximizing outcomes for traumaexposed youth, and trauma informed care is a ''seminal concept in emerging efforts to address trauma in the lives of children'' (Hodas, 2006, page 6). Trauma-informed care (TIC) uses a strengths-based approach to address trauma and promote resiliency (Hodas, 2006). There is currently a gap in tailoring TIC to LGBTQ adolescents, in spite of their increased exposure to traumatic events. To fill the gap, The Village Family Services in Los Angeles, California, developed TIC-Talk, a replicable, single-session training specifically for providers working with LGBTQ trauma-exposed youth. The evidencesupported lessons of TIC-Talk include concepts and theory as well as concrete steps required to diffuse this innovation. The information provided generalizes to both clinical and non-clinical settings including schools, community-based organizations, and juvenile justice facilities. Evaluation results indicate an increased understanding and implementation of TIC.

Responding to Disasters
Psychosocial crisis management in CBRN incidents: recommendations for a hospital staff training curriculum S. Ludwig, G. Zurek, D. Wagner, K. Cummings and R. Bering Center of Psychotraumatology, Krefeld, Germany Introduction: The risk of chemical, biological, and radioactive and nuclear (CBRN) accidents and attacks has grown in the past several years. Studies have shown that CBRN incidents have an impact on population mental health. However, it is clear that even small-scale CBRN incidents can cause psychological stress that affect disaster management. For this reason, the European commission supports international collaboration in CBRN risk management. Methods: According to our survey, hospitals are often not prepared for such incidents. Based on the current knowledge on stress response reactions in crisis management, we examined the differences between general disaster situations and stress responses in CBRN incidents. Pilot trainings and workshops were conducted in Berlin, Krefeld, and Madrid. Results: We created a model that clarifies the interface between stress responses and CBRN incidents, and focuses on differentiated knowledge about CBRN specialties. Our CBRN stress response model focuses on the psychological impact as a framework for addressing the emotional, cognitive, and behavioral effects. Via a consensus process, we defined recommendations on how to prepare hospital staff on psychosocial care assistance in case of CBRN incidents. We conclude that psychological models are needed to understand the difference between CBRN and other major incidents. We recommend implementing CBRN training for nursing staff and physicians in hospitals as a regular part of the training curriculum. Posttraumatic growth is an increasing popular field, which emphasizes the potential developmental possibilities after a trauma. Posttraumatic growth has been defined as the experience of positive change that occurs following highly challenging life crises. It is supposed to be manifested as an increased appreciation for life in general, more meaningful interpersonal relationships, an increased sense of personal strength, changed priorities, and a richer existential and spiritual life. A number of concerns have been raised pertaining method and normative pressure on clients. During the last 10 years, the Danish rape crisis center in Aarhus has gathered information from victims of rape and sexual assault in relation to the victims' qualitative experience of changes in life perspective and trauma-specific learning following the traumatic experience. We will present data from 350 Danish victims of rape or sexual assault on their experiences of changes after the incident. We have conducted a qualitative analysis of positive and negative life changes three months post-assault. Also, we have conducted a longitudinal study of positive and negative life changes 3, 6, and 12 months postassault exploring the associations between life changes and psychological well-being. The data are currently being processed, but preliminary results show that only 1/7 of the participants report a positive change three months following the assault. Furthermore, the experience of positive change three month following the assault is significantly associated with lower levels of PTSD symptoms. We hope that the results will be able to contribute to the discussion concerning the concept and methodology of posttraumatic growth following rape. How can we learn about the causes and effects of disasters without adding to the trauma of survivors, the bereaved, and personnel involved? This poster will present the coordinating function that has been set up after the terrorist attacks in Norway in 2011 with this explicit ambition in mind. The terrorist attacks in Norway on 22nd July in Norway left 77 people dead, most of them youths, several hundreds wounded, and an entire nation in shock and grief. A small, peaceful country marked by openness and trust saw its the government district in smoke and ruins, and some of its most idealistic and politically engaged young people callously massacred. A number of project in disciplines ranging from trauma medicine via psychology and the social sciences to the humanities has raised a broad array of research questions regarding causes, effects, the response of institutions, and the public at large. The plethora of possible angles raised the question of shielding those directly affected from the possibility of further research-induced traumatization. The Norwegian Research Ethics Committees were given the task of coordinating research where those directly affected participate. The primary objective is to safeguard the interests of those affected by the attacks. The tasks are: Monitoring the load on the informant group Maintaining an overview of ongoing and planned research activities Contributing to the exchange of information between researchers Building networks and creating meeting places This poster will introduce the setup of the function, reflect on the work and the lessons learned so far, and introduce plans for the way forward. The purpose is to share the experiences made and to invite the conference participants into a discussion about the concept of such a coordinating effort. Complexity for residents in Fukushima: Forced migration, evacuation decision, and discrimination after the nuclear power plant accident M. Oe and M. Maeda Kurume University, Kurume, Japan Still ca. 150,000 Fukushima residents are leaving their homes. They are worrying about the radiation levels in space and their radiation exposure, ceaselessly after the Fukushima Daiichi power plant accident. For example, although it was already known that radioactive substance were not released in a circle and strongly affected by geographical conditions, the evacuation zone was settled only within 20 km from the power plant at March 2011. Afterward, Japanese government recognized that there were high radioactive areas outside 30 km radius. This zone was called ''planned evacuation zone'' and 7,000 residents (including 2,100 voluntary evacuees in advance) were forced to leave at April 2011. This means thatinhabitants in this area had exposed high radioactivity without official warning for one month. They show anger even against the local people who live nearby the power, because some local governments have reaped a high profit margin for about 40 years. The parents have guilty to their small children. On the other hand, within 30 km zone, this was set up as the emergency evacuation preparation zone, were relaxed at September 2011. However, after the one year of this notice, only 10 % of inhabitants returned, due to lack of infrastructure construction and anxiety for the potential health risk in the long term. It might seem a strange phenomenon that only few people decided to relocate permanently outside Fukushima. This is partly because they are discriminated as ''radioactive material-contaminated citizens'' by others. Shigemura et al. reported about discrimination among TEPCO workers (JAMA, 2012). Discrimination against residents in Fukushima was also reported. In this poster presentation, we will try to focus on migration, discrimination and thecomplexity of their feelings and emotions according to the interviews of staffs in a psychiatric hospital in Minami-soma city.

The Spectrum of Trauma-Related Disorders
The effect of time perspective and of the emotional regulation difficulties on the PTSD symptoms among substance abuse Inpatients M. Almeida 1 and J. Rocha 2 1 Universidade Portucalense Infante D. Henrique, DCEP, Porto, Portugal; 2 Instituto Superior de Ciências da Saú de -Norte, CESPU-UnIPSa-CICS, Porto, Portugal Given the clinical relevance of the co-occurrence of post traumatic stress disorder (PTSD) among substance abuse inpatients, as well as the fact that PTSD is frequently underdiagnosed in this population, becomes relevant to research connections between factors that may be implicated in PTSD. Furthermore, recent publications highlight the relevance of time perspective in PTSD treatment strategies. Also, recent research suggests that emotion regulation difficulties may contribute to the development, maintenance, and exacerbation of PTSD among substance abusers. We aim to assess the importance of the studied constructs in order to integrate them, if justifiable, in the therapeutic program treatment. Sample consists of 72 substance abuse inpatients being treated in a therapeutic community, who received a questionnaire composed by a socio demographic section and the Portuguese versions of the Zimbardo Time Perspective Inventary*Revised, Trancendental Future Time Perspective Scale, Temporal Perspective Inventory*Negative Future Subscale, Difficulties in Emotin Regulation Scale and Impact of Event Scale*Revised. The frequency of participants with IES-R results above the cutoff value (35) was 71%. Time perspective dimensions, in particular, past perspectives, on stepwise multiple regression predict 35.5% of IES-R. Furthermore, emotional regulation difficulties have also revealed of high importance, Emotional Clarity and Strategies model has R 2 0.343. In addition, several significant correlations between traumatic stress, emotional regulation difficulties, and time perspective dimensions are observed. Screening PTSD should be integrated in routine assessment and both time perspective and emotional regulations difficulties are relevant when defining treatment plans. The present findings support the existence of pervasive effects on the way patients consider their past experiences. This study sought to determine the correlates of somatization disorder among a group of women recruited from a semi-urban and rural area in eastern Turkey. Dissociative Disorders Interview Schedule, Posttraumatic Stress Disorder (PTSD) section of the Structured Clinical Interview for DSM-IV, Dissociative Experiences Scale, Beck Scale for Suicidal Ideation, Hamilton Depression Rating Scale, Childhood Abuse and Neglect Questionnaire, and a Checklist for PTSD criterion A Traumatic Events were administered to participants with somatization disorder and 40 non-clinical controls recruited from the same region. Exposure to traumatic events of any type was high in both groups. However, women with somatization disorder reported criterion A traumatic events and/or childhood abuse and/or neglect more frequently than the comparison subjects (90% and 60% reported at least one type of trauma, respectively). Current depressive disorder (N 033, 77.5%), (N 022, 55%), current PTSD (N 012, 30%), dissociative disorder (N 011, 27.5%), borderline personality disorder (N 06, 15%) were more frequent in the somatization disorder group compared to the controls. Childhood emotional (25%) and physical abuse (20%), and emotional neglect (30%), suicide attempts (22.5%), and self-mutilative behavior (20%) were reported significantly more often in the somatization group. Interestingly, 37.5% of the somatization group reported at least one type of extrasensory/supernatural experience (including possession), whereas none of the controls did. In this group of women with endemically high exposition to traumatic events in childhood and adulthood, the high number of somatic complaints represented a complex PTSD covering wide psychiatric comorbidity rather than merely a somatization disorder. Somatization refers to the expression of psychological distress through somatic symptoms. In order to help a person with somatization, it is important to identify the source of his/her psychological distress. The aims of this study are to identify the main subjectively perceived stressors in children with somatization and to explore the relationship between somatic symptoms, anxiety, and number and intensity of those stressors. Research was made at the Department of Pediatrics, University Hospital Centre Zagreb. Participants were all children (14 boys and 46 girls) aged from 10 to 18 years referred to pediatric psychologist due to somatic complaints of an unexplained organic origin in the period from May to December 2012. Participants filled in anxiety questionnaire (SKAD-64) and sentence completion test. Based on the sentence completion test and clinical interview, main stressors were identified and participants rated each of these stressors on a scale from 1 to 5. In 36% of participants the main Posters, June 8 stressor was school, in 21% family relationships, in 16% relationships with peers, and 18% highlighted their somatic symptoms as a main source of stress. In this sample, 43% of children had heightened level of anxiety with17% in a clinical range. We found significant positive correlation between anxiety score and number (r 00.351, p00.01) and overall intensity (r 00.363, p00.01) of stressors. No significant difference in anxiety, number, and overall intensity of stressors was found regarding the type of symptoms (headache, syncope, cardiac, gastrointestinal). Our results showed a positive relationship between anxiety and number and intensity of stressors in children with somatization. Since stress is an important factor in development of somatization, it is important to identify its sources in order to help our patients develop more effective coping mechanisms. Objectives: Previous studies have shown insecure attachment as a risk factor for mental disorders. Furthermore, research has uncovered attachment styles as moderators between critical incidents and the occurrence of PTSD. However, there is little information whether patients with PTSD differ in their attachment patterns from patients with other mental disorders and healthy controls. Method: Therefore, we compared patients with PTSD (n02666), patients with other mental disorders (n011110) and students as healthy controls (n 084). Attachment style was assessed by the Relationship Questionnaire (RQ-2). Chi-square tests and ANOVAs were applied for estimating group differences. Results: Results demonstrate that 64.3% of controls may be classified as having a secure pattern of attachment while the majority of patients with PTSD as well as patients with other mental disorders developed a fearful-avoidant (39.9%/30.3%) or preoccupied (28.9%/27.0%) attachment style. There were statistically significant effects for the secure (pB0.001, h 2 00.01) and the fearful-avoidant (pB0.001, h 2 00.02) attachment patterns between the three groups: Patients with PTSD showed more rarely a secure but more often a fearful-avoidant attachment style compared to patients with other mental disorders and healthy controls, too. While only 35.7% of healthy controls had insecure attachment patterns, 81.5% of the patients with other mental disorders and 87.5% of the persons with PTSD belonged to the group of insecure-attached persons. Discussion: Results stress the importance to give attention to attachment patterns and their possible consequences in working with psychosomatic patients, particularly in presence of PTSD. Limitations of the study are the small sample size of healthy controls as well as measuring attachment styles by a self-report instrument.
Psychometric evaluation of the Grief Questionnaire for children and adolescents P. Fornaro, J. Unterhitzenberger and R. Rosner Katholische Universität, Psychologie, Eichstätt-Ingolstadt, Germany Complicated Grief (CG) is discussed to be added as a new diagnosis in DSM-V and ICD-11. Therefore, the need for evaluated inventories on CG will be high. For adults, e.g., the Inventory of Complicated Grief (ICG) is well disseminated and evaluated. However, concerning children and adolescents, there is hardly any psychometric evaluation reported for grief instruments. We investigated the psychometric properties of the Grief Questionnaire for Children and Adolescents (CG-CA) which was first used in a study with adolescents in Rwanda. The CG-CA consists of 36 items, which were mainly extracted from the Extended Grief Inventory (EGI) and supplemented with grief-related trauma items. 69 Adolescents (52% male) aged 14 to 18 years (M 016.3, SD 01.16) completed the CG-CA at two measurement points and provided data for the evaluation. An exploratory factor analysis revealed the existence of two factors. The questionnaire showed a high internal consistency (a 00.94). Furthermore, the CG-CA showed good concurrent and construct validity. The effect size for a correlation with impairment of daily functioning was high. A cut-off for an indicated CG-treatment was computed with a sensitivity of 85.3% and a specificity of 85.9%. This suggests evidence for the test's high predictive validity. The findings indicate that the CG-CA is a suitable questionnaire for assessing CG. Nevertheless the examination of its psychometric properties took place in a small orphaned sample in a third-world country setting. To increase external validity, it needs to be evaluated in a general population sample and*as criteria for CG are mainly based on research in western countries* evaluation should take place in this region as well.
The traumatic real beyond the dream: the repetition in the symptomatic phenomena related to trauma F. D'Antonio Dipartimento di Scienze dell'Uomo, Universitá degli Studi di Urbino ''Carlo Bo'', Urbino, Italy Symbolic and real define two aspects in opposition of subjective experience; they offer a clinical perspective to the reading of trauma and trauma-related symptomatic phenomena. The symbolic order coincides with the ''laws of language'' that structure the unconscious, whereas the real order is opposed to the symbolic; it is the ''unknown,'' anxiety and drive, and concerns the ''unassimilable'' part of the trauma. A traumatic event is a ''real'' experience that is ''beyond the functioning of the unconscious'' and beyond the laws that structure the dream formation, as theorized by Freud and transposed into linguistics by Jacques Lacan. The trauma breaks the defensive power of the symbolic order and creates a fixation on the real of the body. This fixation implies a real repetition of the traumatic event that is persistently identical with itself. Repetition, beyond the power of representation of the dream, is the generating principle of symptomatic phenomena, such as nightmares and flashbacks, which characterize the tendency to relive the traumatic event compulsorily within the posttraumatic disorders. Anxiety is the signal of the encounter with real: the phenomenon that reveals the irruption of the ''traumatic real'' beyond the protective shield of the symbolic. Within this theoretical and clinical perspective, ''put in to words the events,'' as a process of symbolization and attribution of meaning to the ''real'' traumatic experience, becomes the principle that guides a possible therapeutic intervention on the traumatized subject.
to their maternal sensitivity scores, that mothers who suffered from PTSD showed a more healthy maternal behavior (0.61 [case 1] and 0.59 [case 2]) as compared to mothers with no psychopathology (0.41 [case 3] and 0.37 [case 4]). Interestingly, supporting those findings, neuroimaging results for mothers with childhood trauma histories showed greater brain activation during exposure to one's own infant relative to an unfamiliar infant in regions associated with social cognition (e.g., fusiform gyrus, precuneus) and emotionempathy (e.g., anterior cingulate cortex, insula). In contrast, the mother without childhood trauma history exhibited a lack of response in brain regions associated with social cognition and emotion-empathy. In conclusion, the findings in traumatized mothers with PTSD provide some evidence for these mothers' ability to break the cycle of intergenerational transmission of trauma. We also performed a voxel-based whole-brain meta-analysis of functional neuroimaging studies investigating the neural correlates of healthy mothers' attachment experiences by examining brain response while mothers viewed pictures, videos, or heard sounds of their infants. Results indicated a comparable neuronal response pattern observed in three mothers with a childhood trauma history described above, thus providing further evidence for the capacity of women with a history of critical life events for resilience. Perceived anxiety of family among Japanese and Korean firefighters was investigated. 535 Japanese firefighters dispatched to the disaster areas severely affected by the Great East Japan Earthquake participated in the study following 3Á4 months after the earthquake (N 0511, who gave valid responses to the questionnaire). 1,507 Korean firefighters were requested to answer one of the two questionnaires (A: traumatic stress, B: general mental health) via e-mail, the valid responses to the questionnaire were 533 (N A 0267, N B 0266). Results of Korean firefighters (N 0266) were compared with Japanese in terms of perception of family's anxiety, 9 items about whether one has felt the anxiety of one's family. First of all, of the participants, only 23.4% of Japanese and 22.6% of Korean participants responded affirmatively to the item, ''There were no family that felt stress, or anxiety about my dispatch,'' suggesting that three-quarters of participants in both country believed that their families had experienced anxiety related to their rescue work. With regard to the difference between two countries, affirmative rate of Japanese was higher than Korean in following items. (1) My family felt anxiety because of the frightful spectacle of the disaster area in media coverage (x 2 (1) 057.902, p B0.001).
(2) My family felt anxiety because they didn't know about my activities in the disaster area (x 2 (1) 05.245, p B0.05). In following items, the affirmative rate of Korean was higher. (1) My family felt anxiety because my appearance was changed by stress (x 2 (1) 022.321, p B0.001).
(2) My family felt anxiety because they did not know how to relieve my stress (x 2 (1) 028.026, p B0.001). These findings indicate the need to provide mental health care to family members of firefighters when conducting interventions for firefighters. This study examined the relation between experience of corporal punishment in childhood and later health outcomes as measured by number of physical illnesses, health risk behaviors, psychological risk, and lack of health-promoting behaviors in young adulthood. It has been suggested that physical abuse and physical discipline exist on a continuum, such that they are quantitatively, not qualitatively, different. Research supports a link between child physical abuse and numerous negative outcomes, including physical health sequelae (e.g., Felitti, 1998). Considering that corporal punishment is used by the majority of American parents, it is important to examine if this parenting practice is associated with comparable developmental outcomes. Thus, the current study investigated if corporal punishment might have a similar, albeit less severe, impact on later health outcome as physical abuse. Research has further suggested that family environment can affect the relation between corporal punishment and outcome, with parental warmth and consistency moderating the relation between parenting practices and subsequent outcomes. We further examined the moderating effect of parental warmth and consistency to determine if harsh parenting has a less detrimental impact within the context of a warm and consistent environment. In this sample of 188 young college adults, corporal punishment did not predict physical illnesses, risk behaviors (including activities related to substance use and sexual behaviors), psychological risk (including symptoms and diagnoses of mental illness, sleep problems, life difficulties, and disabilities), or health-promoting behaviors (including routine health maintenance activities) when controlling for age and sex. However, the relation between corporal punishment and number of physical illnesses was significantly moderated by parental consistency. In addition, parental warmth was found to be a significant, unique predictor for risk behaviors and psychological risk, with higher levels of warmth related to lower levels of risk behaviors and psychological risk.
Self-blame and PTSD in adolescents surviving terrorism: the mediating role of school connectedness U. Moscardino 1 , S. Scrimin 1 , F. Capello 1 and G. Altoè 2 1 Department of Developmental and Social Psychology, University of Padova, Padova, Italy; 2 Department of Pedagogy, Psychology, Philosophy, University of Cagliari, Cagliari, Italy Researchers agree that coping strategies are key determinants of youth psychological adjustment following terrorism (Pfefferbaum, Noffsinger, & Wind, 2012). In particular, self-blame related to survivor guilt has been shown to increase the risk of posttraumatic stress disorder (PTSD) in adolescents (Drury & Williams, 2012). School connectedness, defined as students' perceptions of being accepted by the school and identifying themselves as being part of the school, is strongly associated with positive psychological outcomes (e.g., Resnick et al., 1997). However, the role of school connectedness in the relationship between self-blame and adolescent PTSD after terrorist activities remains unexplored. The aim of this small-scale, cross-sectional study is to examine whether school connectedness mediates the link between self-blame and PTSD in adolescents who survived the 2004 terrorist attack against school no. 1 in Beslan, Russia. Sixty adolescents (aged 14Á18 years) directly and indirectly exposed to the attack completed measures of coping, school connectedness, and PTSD three years after the traumatic event. More than half of adolescents (N 041, 68.3%) met full criteria for PTSD. No associations emerged between age, gender, exposure, and diagnosis of PTSD. We found a relationship between self-blame and diagnosis of PTSD (OR 01.88, 95% CI 01.12, 3.16). We also found a relationship between self-blame and school connectedness (B 0(0.26, SE 00.06, pB0.05). Mediation analysis indicated that, after adjusting for relevant covariates, school connectedness partially mediated the relationship between self-blame and presence of PTSD, with an OR reduction of 23%. Findings suggest that adolescent survivors of terrorist attacks may benefit from school-based interventions aimed at teaching proactive coping skills as well as supporting students' sense of belonging and emotional bonding to teachers, peers, and the school environment.
Attachment style has been hypothesized as a mediating variable which may predict differential outcome in causal models of intimate partner violence (IPV) (Lettieri, 1996). Perpetrators and victims of IPV are more likely to have insecure attachment types when compared with individuals in non-violent relationships (Goldenson et al., 2007). This study examines the predictive role of adult attachment styles in relation to IPV perpetration and victimization to determine if attachment insecurity is a unique predictor of victimization or perpetration when child abuse experiences, witnessing interparental abuse, and adult cognitive distortions are incorporated in the causal model. Female college students (N 0189) completed the following measures: The Revised Conflict Tactics Scale (IPV), Childhood Maltreatment Interview Schedule Short Form (childhood maltreatment and witnessing parental IPV), Experiences in Close Relationships Revised (adult anxious-and avoidant-attachment), and the Cognitive Distortions Scale (negative cognitions). In this relatively highfunctioning sample, preliminary regression analyses revealed that anxious attachment predicted psychological abuse perpetration [F(1, 149) 09.075, p00.003] and psychological abuse victimization [F(1, 146) 013.493, p B0.001]. Anxious attachment and cognitive distortions of self-blame were correlated [r(178) 00.517, p B0.001], and both emerged as unique predictors depending on the order of entry of the variables within hierarchical regression analyses. These analyses indicated childhood abuse, as well as anxious attachment and self-blame, are important pathways to adult IPV in our sample of young adult females. While childhood abuse appears to be an important distal predictor of IPV victimization and perpetration, adult anxious attachment and self-blame serve as more proximal predictors. The common thread between these latter variables is a negative self-evaluation in relational functioning. Our findings suggest that childhood maltreatment experiences set in motion a cognitive framework that predicts later trauma, such as IPV.
Posttraumatic stress disorder symptoms in the first weeks following the preterm infant's hospital discharge N. Goutaudier 1 , E. Bui 2 , N. Séjourné 1 and H. Background: Although over 5% of women develop clinically significant posttraumatic stress disorder (PTSD) symptoms directly related to their experience of giving birth, few data are available regarding prevalence and features associated with PTSD symptoms following preterm birth. This study aims to examine features associated with PTSD symptoms following the preterm birth. Method: Within 4 weeks of the infant's hospital discharge [mean (SD) time since discharge 02.2 (1.0) weeks), 110 French women (mean (SD) age 029.5 (4.3) years] who delivered prematurely [mean (SD) time since delivery 014.5 (3.5) weeks] completed the Impact of Event Scale-Revised (IES-R, range 0Á88) and the Edinburgh Postnatal Depression Scale (EPDS, range 0Á30), the Multidimensional Scale of Perceived Social Support and the Dyadic Adjustment Scale. Demographic and clinical data and information related to traumatic event exposure were also collected. Results: Mean (SD) IES-R and EPDS scores were 25.24 (18.31) and 22.19 (6.79), respectively and 30% of mothers (n033) scored above the cut-off for probable PTSD. IES-R score correlated with depressive symptoms (r00.42, pB0.05), C-section delivery (r00.22, pB0.05), prior traumatic exposure, (r 00.21, p B0.05), and gynecological history (r 00.20, pB0.05) but not with perception of partner's support and quality of marital relationship (all ps 0.10). Multivariate analyses revealed that increased postpartum depressive symptoms (ß00.45, p B0.05), having undergone a c-section (ß00.23, pB0.05), traumatic event exposure in the 12 months prior to childbirth (ß00.19, p B0.05), were independently associated with PTSD symptoms, and explained 28.0% of the variance in PTSD symptoms. Conclusion: PTSD symptoms were independently associated with increased depressive symptoms, c-section and prior traumatic exposure, suggesting that these factors might be involved in the development or maintenance of PTSD symptoms after preterm delivery. Future longitudinal studies examining the long-term impact of premature birth are warranted.
Rates and predictors of posttraumatic stress disorder of children and adolescents in foster care E. Rimane 1 , E. Groh 2 , J. Arnold 2 , M. Hagl 2 and R. Rosner 1 1 Kathollische Universität, Psychologie, Eichstaett/Ingolstadt, Germany; 2 Ludwig-Maximilians-University, Munich, Germany Background: Causes for children to be placed in foster families are very often connected with psychotrauma. Regarding these background, it is surprising that there exists comparably only little research about posttraumatic stress disorder (PTSD) in foster children. Furthermore, a comparison between the results of international studies is complicated as the foster care systems in different countries vary considerably. The aim of this study is to examine the rate of PTSD in a sample of German foster children. Possible risk factors for the development of PTSD in foster children are analyzed. Methods: Seventy-four foster children (10Á18 years old) and their foster parents were studied using a wide range of diagnostic instruments. Among these were the Child Behavior Checklist, the Child Dissociative Checklist, the Childhood Trauma Questionnaire, and a detailed questionnaire to explore family relationships. PTSD was assessed using the German version of the Clinician-Administered PTSD Scale for Children and Adolescents (CAPS-CA). Results: Five percent of the foster children fulfilled a PTSD diagnosis according to DSM-IV criteria, 22% regarding to ICD-10 criteria. Significant correlations between the severity of PTSD and some risk factors were found. These include the sum score of the Childhood Trauma Questionnaire (CTQ), the age of entering the foster family, and the reasons for the outplacement. Entering these three predictors in a regression model, only the CTQ sum score remained significant. Discussion: Compared to other internationally published foster children studies, the rate of PTSD is quite small. Possibly this might be due to the recruitment conditions, leading to an oversampling of healthy children. As there were only few PTSD cases, it is not surprising that most of the assumed predictors remained insignificant. Nevertheless, the CTQ seems to be a good predictor for PTSD in foster children.

Resilient emotional competence in pediatric diabetes G. Regini
Dipartimento di Scienze dell'Uomo, Università degli studi di Urbino ''Carlo Bo'', Urbino, Italy Diabetes is a chronic disease whose abrupt onset triggers traumatic experiences and requires a psychological adjustment to the patients and their family. Achieving this adaptation is a necessary goal for the proper control of the disease. On the contrary, patients may conflict with it, exposing them at high risk of psycho-physical complications. The ability to favour bio-psycho-behavioural adjustments, posttraumatic, allows the remodelling of the internal state of the child, promotes, and activates resilience, i.e. the capacity of the Self to selforganize. This process is facilitated by the integration of a sense of Self by state transitions ensuring continuity of experience and inner cohesion, as well as the emotional regulation and attachment experiences. According to Schore's model, situations of attachment influence the development of the right hemisphere, dominant for processing, expressing and regulating the emotional information. The two components (sympathetic and parasympathetic) of the ANS not only regulate automatic and somatic aspects of emotional states but also of the stress response, so the attachment relationship is able to directly model the maturation of systems of stress management that act on an unconscious level in the brain of the child. Affective experiences regulated (and unregulated) are stored in the orbitofrontal system in its cortical and sub-cortical connections, these internal interpersonal representations fulfil the role of biological regulators that control the mental processes, allowing the development of homeostasis, but also the maturation of the orbitofrontal cortex itself, so of self-regulatory and stress recovery mechanisms. In chronic disease, activation of recovery through emotional re-channelling represents an important protective factor both with respect to the possibility of future re-traumatisation and to facilitate the adaptation. shaped lives of victimized children and the same images will continue to shape the lives of generations to come. Communal wounds are the reality of Bosnia-Herzegovina. In turn, such anti-human behavior may create a disconnect with memory. The product of intractable ethnic hatreds cannot be a simplistic explanation when recalling violent memories. The further the past recedes, the closer it becomes. With a qualitative design, Bosnian young adults will be asked to remember wrongs suffered, which represents an unbearable crime against humanity. Reconciliation efforts have become the forerunner in postconflict peace building. A process toward sustainable peace includes changing destructive behavior patterns between former enemies into constructive relationships to further empower Bosnian young adults for communal reconciliation. Background: In 20th century, Lithuania underwent two World Wars, Nazi and Soviet occupations*the last one lasted for 50 years. These socialÁpolitical transformations included forced integration into Soviet Union, political repressions, and constraints in all the country. The research question is what kind of effect this has on current mental health in the general population. Methods and participants: We analysed a non-clinical sample of middle-aged participants. The sample was divided into two groups: one of those participants, whose mother or father survived Soviet or Nazi political repression, and the others, who were matched according to socio-demographic characteristics and whose parents did not directly experience political repressions. The participants completed the questionnaire which assessed their life-time trauma experiences, present posttraumatic stress reactions, and subjective consequences of parents' political repression to their life. In continuing study, participants from the general population were asked about their attitudes towards the social transformations in the country to analyse the consequences of political repression to broader population. Results: The results show that two non-clinical samples of middle-aged participants did not differ in PTSD reactions, but parents' experiences of political repression were considered as having affected their life and psychological well-being. So in a broader sample, effects of social transformations were analysed and the results show the importance of these historical events in the country.

Evidence-Based Practice on Trauma
Psychotherapeutic interventions from the western world in war-traumatized children*a meta-analysis A. Nocon, S. Von Jan and R. Rosner Katholische Universität Eichstaett-Ingolstadt, Eichstaett, Germany Background: There has been lately some effort in the treatment of traumatized child and adolescent post-conflict populations, and a growing body of evidence shows that psychotherapyis effective in this group. However, with treatments usually being designed and applied in industrialized countries, little is known whether the treatment context has any impact on its outcome. A bibliography and meta-analysis were used to examine interventions for children and adolescents that were applied in industrialized countries vs. those applied in war-torn countries of origin. Methods: A literature search produced 21 studies covering 14 different kinds of psychotherapeutic interventions; of these, only 9 both (1) were randomized and (2) reported pre-and post-intervention scores. Five studies investigated the effects of psychotherapy in refugees seeking asylum in western countries, 2 investigated the effects of psychotherapy in refugees seeking asylum in countries with similar to the original culture, and 14 examined interventions in displaced youth in their country of origin. Results: Both cognitive behavior therapies (CBT) and psychodynamic interventions were effective for trauma symptoms. The methodological quality of the retrieved studies, however, was very diverse. Most treatment studies for refugees in western countries did not use a control group. The only randomized controlled trial (RCT) applied to refugees in the United States reported no differences between play therapy and traumafocused CBT. RCTs applied to refugees in their country of origin/ similar cultureyielded Cohen's d between 0.27 and 1.80. Non-RCT effects were between 0.61and 1.31 for treatment in western countries, and between 0.03 and 0.91 in the original/neighbor country. Limitations: Limitations included methodological inconsistencies across studies and lack of a randomized control group design, yielding few studies for meta-analysis. Conclusions: The superiority of a specific intervention might change with the treatment context. Further research is needed to identify the most effective treatment in a specific context. Post-disaster environments pose a unique set of mental health delivery challenges, requiring intervention delivery readily deployable and maximally effective. Our knowledge is limited with respect to the impact such challenges have on intervention outcomes among children survivors of disasters presenting with post-traumatic symptoms. We used meta-analysis to assess whether interventions vary in efficacy across intervention types, settings, and levels of professional training. Thirty-three studies were identified that provided outcome data on interventions for children exposed to natural and man-made disasters, wars, accidents, and other sudden traumatic events. Interventions were carried out in school and health or mental health settings, and intervention providers included mental health professionals and teachers and other school professionals. Large effect sizes were found for interventions in reducing PTSD symptoms, and intervention conditions resulted in better outcomes than control conditions. Outcomes varied by the type of intervention, but not by the setting in which the intervention was carried out or by the providers' training level. Generally, exposure therapies yielded the largest and psychological debriefing/ crisis the smallest effect sizes. Children receiving interventions in schools did not differ from children in health or mental health settings. Mental health professionals and teachers and other school professionals had similar success when delivering interventions for children survivors of disasters. Our results suggest that special attention be paid to the type of intervention utilized to reduce PTSD symptoms in this population, but that schools and teachers can serve as appropriate resources for effective intervention delivery.

Moderators of intervention
Evaluating a multidisciplinary public approach for treating victims of rape and sexual assault in Denmark L. H. Nielsen and A. Elklit Department of Psychology, National Center for Psychotraumatology, University of Southern Denmark, Denmark In Denmark, around 500 rapes are reported to the police every year and it is estimated that around three to four times more are actually committed. International research has established that rape is an extremely traumatic event that can have long-term negative consequences for victims including psychological, sexual, behavioral, and physical problems. Rape traumas do not exist in a cultural and societal vacuum. Hence, experiences with the legal, medical, and mental health system following a rape can profoundly affect victims' well-being following an assault*both in a positive and negative way   Campbell et al., 1999). In Denmark, the first multidisciplinary public approach for treating victims of rape and sexual assault was established in 1999 (Bramsen, Elklit & Nielsen, 2009). This approach has not yet been evaluated, so we do not know whether we are inadvertently hurting the victims we are trying to help and how this might affect them. The aim of the current Ph.D. project is to evaluate how victims of rape and sexual assault in Denmark experience the help they receive through the multidisciplinary public system and how they perceive their interactions with the different professionals they meet in this system (police officers, nurses, medical examiners, psychologists, and attorneys among others). The aim of the project is to evaluate: (1) Does the multidisciplinary public approach meet the needs of victims of rape and sexual assault when they approach the system for help? (2) Does the system unintentionally re-victimize the victims they are trying to help and in what way does this affect the psychologically well-being of the victims following a sexual assault? Evaluation data is collected in the acute phase following the rape and at follow-up six months post-assault and this is combined with psychological data already collected at the rape crisis center at the same intervals. Assessment trauma is, as much in children as in adults, the first step when planning the therapy. But, there is a lack of validated children assessment instruments in some trauma fields when a research is designed in Spanish. Some complex trauma symptoms as dissociation in paediatric population could not be measured by any validated questionnaire in our language. We think revising the most accurate assessment instruments in Spanish could be useful for Spanish-speaking researchers in children's trauma. In addition, revising also the main fields related to complex trauma could be interesting to recall researchers and clinicians that it is important not to forget any of those fields to have a wide and exhaustive profile of the trauma impact in children.

Spanish-validated tests in paediatric psychological trauma assessment
''Actimeter'' as an innovative tool for the objective measurement of sleep disorder of torture survivors with complex PTSD U. H. Harlacher and L. Nordin DIGNITY*Danish Institute Against Torture, Copenhagen, Denmark An ''actimeter'' is a watch-like device worn around the wrist, which continuously measures and stores (hand/arm) movements. The accumulated data over about one week deliver, besides other, sleep-related data that allow for the quantitative analysis of important parameters like total sleep duration, sleep-latency, and frequency of sleep interruptions. First experiences using this tool as a part of the interdisciplinary treatment of sleep problems at DIGNITY in Copenha-gen, where torture survivors with complex PTSD and other complex problems are treated, are positive. Wearing the advice continuously during one week is well tolerated by most clients. The quantitative measurement seems to be reliable since there is a god correlation with the client's subjective description of physical activity during the day. Besides for measurement, the advice is also usable as a therapeutic tool since most clients become motivated and curious about to inspect and analyze the results since corrections of negative expectations, e.g., about the duration of the first sleep-phase, can be made and since it is easier to identify potential interventions, e.g., correction of timing of medication. The device will be presented, its use explained, and experiences made with the tool so far will be presented using case descriptions including actimeter-outcome graphs.
Very brief exposure in PTSD*a pilot project on tortured and traumatised refugees L. Nordin and U. H. Harlacher DIGNITY*Danish Institute Against Torture, Copenhagen, Denmark Fear responses can be activated outside of awareness by masked phobic stimuli with a very brief stimulus onset (Ö hman & Soares, 1994). Within experimental psychology research, it has long been known that very brief stimuli can trigger physiological responses, i.e., stimuli that do not lead to conscious perception may trigger a response. When an anxiety provoking image is shown on the computer screen so fast that it only appears as a flash of light, subjects respond by exhibiting a measurable physiological response corresponding to an anxiety response. Siegel and Weinberger (2009) have shown that very brief exposure (25 ms) to images of spiders promoted approach towards a live tarantula. This pilot trial is a modified replication on tortured and traumatised refugees suffering from posttraumatic stress disorder (PTSD). Additional to Siegel and Weinberger's (2009) experiment, physiological parameters will be measured with a non-invasive 64-channel electroencephalograph, heart rate, and electric skin conductance. The objective is to evaluate whether very brief evoked responses can also be observed with PTSD-related stimuli in traumatised refugees and whether repeated very brief exposure will result in decreasing avoidance of trauma stimuli. The experiment and experiences made will be presented, using case-descriptions including data from the physiological parameters.