Nexhmedin Morina | University of Münster (original) (raw)
Papers by Nexhmedin Morina
Death Studies Publication details, including instructions for authors and subscription information:
Study Objectives: To compare the efficacy of guided online and individual face-to-face cognitive ... more Study Objectives:
To compare the efficacy of guided online and individual face-to-face cognitive behavioral treatment for insomnia (CBT-I) to a wait-list condition.
Methods:
A randomized controlled trial comparing three conditions: guided online; face-to-face; wait-list. Posttest measurements were administered to all conditions, along with 3- and 6-mo follow-up assessments to the online and face-to-face conditions. Ninety media-recruited participants meeting the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for insomnia were randomly allocated to either guided online CBT-I (n = 30), individual face-to-face CBT-I (n = 30), or wait-list (n = 30).
Results:
At post-assessment, the online (Cohen d = 1.2) and face-to-face (Cohen d = 2.3) intervention groups showed significantly larger treatment effects than the wait-list group on insomnia severity (insomnia severity index). Large treatment effects were also found for the sleep diary estimates (except for total sleep time), and anxiety and depression measures (for depression only in the face-to-face condition). Face-to-face treatment yielded a statistically larger treatment effect (Cohen d = 0.9) on insomnia severity than the online condition at all time points. In addition, a moderate differential effect size favoring face-to-face treatment emerged at the 3- and 6-mo follow-up on all sleep diary estimates. Face-to-face treatment further outperformed online treatment on depression and anxiety outcomes.
Conclusions:
These data show superior performance of face-to-face treatment relative to online treatment. Yet, our results also suggest that online treatment may offer a potentially cost-effective alternative to and complement face-to-face treatment.
Research on the dimensionality of post-traumatic stress disorder (PTSD) has generally failed to p... more Research on the dimensionality of post-traumatic stress disorder (PTSD) has generally failed to provide support for the three clusters of PTSD suggested in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). However, much research has been restricted to samples in North America and Western European countries. The aim of the current study was to test four alternative factor models among a relatively understudied population–young civilian survivors of war who had experienced war-related events as adolescents–in order to establish whether the factor structure of PTSD is consistent among various traumatized populations and age groups. Using the Posttraumatic Stress Diagnostic Scale, the results indicated that the four-factor model including intrusion, avoidance, hyperarousal, and numbing factors provided a better fit than the three-factor model suggested by the DSM-IV. The current study offers additional support from another population for a four-factor model of PTSD that implies a separation of avoidance and numbing items. Case conceptualization and treatment implications are discussed.
Behaviour Research and Therapy, 2015
In virtual reality exposure therapy (VRET), patients are exposed to virtual environments that res... more In virtual reality exposure therapy (VRET), patients are exposed to virtual environments that resemble feared real-life situations. The aim of the current study was to assess the extent to which VRET gains can be observed in real-life situations. We conducted a meta-analysis of clinical trials applying VRET to specific phobias and measuring treatment outcome by means of behavioral laboratory tests or recordings of behavioral activities in real-life. Data sources were searches of databases (Medline, PsycInfo, and Cochrane). We included in total 14 clinical trials on specific phobias. Results revealed that patients undergoing VRET did significantly better on behavioral assessments following treatment than before treatment, with an aggregated uncontrolled effect size of g = 1.23. Furthermore, patients undergoing VRET performed better on behavioral assessments at post-treatment than patients on wait-list (g = 1.41). Additionally, results of behavioral assessment at post-treatment and at follow-up revealed no significant differences between VRET and exposure in vivo (g = -0.09 and 0.53, respectively). Finally, behavioral measurement effect sizes were similar to those calculated from self-report measures. The findings demonstrate that VRET can produce significant behavior change in real-life situations and support its application in treating specific phobias.
Psychotherapy and Psychosomatics, 2015
Zeitschrift für Psychosomatische Medizin und Psychotherapie, 2007
The concept of disorders of extreme stress not otherwise specified (DESNOS) was designed to encom... more The concept of disorders of extreme stress not otherwise specified (DESNOS) was designed to encompass the psychopathological consequences of interpersonal and ongoing traumatic experiences. This study examined the prevalence rate of DESNOS among students who reported having gone through war experiences. The sample consisted of 55 Kosovar students who had been exposed to war-related events. The various variables were recorded with the Structured Interview for Disorders of Extreme Stress (SIDES), the Impact of Event Scale-Revised (IES-R), and the Brief Symptom Inventory (BSI). 16.4% of the participants met the criteria for posttraumatic stress disorder but none of them could be diagnosed as suffering from DESNOS. However, the symptoms somatization, altered relationships, and altered systems of meaning were reported by 21-37% of the participants. The DESNOS total score was found to be a better predictor of psychiatric distress than posttraumatic stress symptoms. The results argue again...
Psychotherapie, Psychosomatik, medizinische Psychologie, 2008
A large body of literature stresses the role of experiential avoidance as a developmental and mai... more A large body of literature stresses the role of experiential avoidance as a developmental and maintenance factor of many forms of psychopathology including post-traumatic stress disorder. For the first time, the current study examined the relationship between experiential avoidance and war-related post-traumatic symptoms. 123 students in Kosovo who reported war-related experiences took part in this study. Results show that experiential avoidance was significantly correlated with post-traumatic symptoms above and beyond the number of traumatic experiences.
Journal of Traumatic Stress, 2014
The World Health Organization recently proposed a reformulation of posttraumatic stress disorder ... more The World Health Organization recently proposed a reformulation of posttraumatic stress disorder (PTSD) for the 11(th) edition of the International Classification of Diseases (ICD-11), employing only 6 symptoms. The aim of this study was to investigate the impact of this reformulation of PTSD as compared to criteria according to Diagnostic and Statistical Manual of Mental Disorders (4th ed., DSM-IV; American Psychiatric Association, 1994) on the prevalence of current PTSD as well as comorbid major depressive episode and anxiety disorders other than PTSD. Study 1 involved previously collected interviews with 560 Kosovar civilian war survivors; Study 2 employed a previously collected sample of 142 British war veterans. Results revealed no change in the diagnostic status under the criteria proposed for ICD-11 in 87.5% of civilian war survivors and 91.5% of war veterans. Participants who only met the newly proposed criteria showed lower rates of comorbid major depressive episode than participants who only met DSM-IV criteria (13.6% vs. 43.8% respectively). Rates of comorbid anxiety disorders did not significantly differ between participants who lost or gained a PTSD diagnosis under the proposed criteria.
Zeitschrift für Klinische Psychologie und Psychotherapie, 2007
Traumatology, 2006
ABSTRACT Using structural equation modeling, the present study investigated the relationship betw... more ABSTRACT Using structural equation modeling, the present study investigated the relationship between after-effects of war-related traumatic events, generalized self-efficacy, self-esteem, subjective well-being, and distress. Questionnaires (Impact of Event Scale–Revised, Positive and Negative Affect Schedule, Satisfaction With Life Scale, Rosenberg Self-Esteem Scale, and Generalized Self-Esteem) were administered to 214 civilian war survivors in Kosovo. The results show a high prevalence of traumatic experiences (83%) with high psychological distress. The severity of traumatic stress was accompanied by negative affectivity and was inversely related to self-esteem. The other self-related constructs neither had an impact nor were found to be diminished by the amount of traumatic stress experienced.
Psychotherapy and Psychosomatics, 2012
^ 15 on the Posttraumatic Stress Diagnostic Scale (PDS) . Past-PTSD individuals (n = 19) met full... more ^ 15 on the Posttraumatic Stress Diagnostic Scale (PDS) . Past-PTSD individuals (n = 19) met full PTSD criteria in the past; no-PTSD individuals (n = 21) had never met full PTSD criteria. Group characteristics are similar to those of epidemiological studies , indicating the representativeness of the sample. Current-PTSD individuals scored higher on PDS and Beck's depression inventory (BDI) [16] than past-PTSD and no-PTSD individuals, supporting the validity of the group distinction. Current-PTSD individuals had more co-morbid disorders at the time of assessment as compared to past-PTSD and no-PTSD individuals .
PPmP - Psychotherapie · Psychosomatik · Medizinische Psychologie, 2008
A large body of literature stresses the role of experiential avoidance as a developmental and mai... more A large body of literature stresses the role of experiential avoidance as a developmental and maintenance factor of many forms of psychopathology including post-traumatic stress disorder. For the first time, the current study examined the relationship between experiential avoidance and war-related post-traumatic symptoms. 123 students in Kosovo who reported war-related experiences took part in this study. Results show that experiential avoidance was significantly correlated with post-traumatic symptoms above and beyond the number of traumatic experiences.
PLoS ONE, 2014
In virtual reality exposure therapy (VRET) for anxiety disorders, sense of presence in the virtua... more In virtual reality exposure therapy (VRET) for anxiety disorders, sense of presence in the virtual environment is considered the principal mechanism that enables anxiety to be felt. Existing studies on the relation between sense of presence and level of anxiety, however, have yielded mixed results on the correlation between the two. In this meta-analysis, we reviewed publications on VRET for anxiety that included self-reported presence and anxiety. The comprehensive search of the literature identified 33 publications with a total of 1196 participants. The correlation between self-reported sense of presence and anxiety was extracted and meta-analyzed. Potential moderators such as technology characteristics, sample characteristics including age, gender and clinical status, disorder characteristics and study design characteristics such as measurements were also examined. The random effects analysis showed a medium effect size for the correlation between sense of presence and anxiety (r = .28; 95% CI: 0.18-0.38). Moderation analyses revealed that the effect size of the correlation differed across different anxiety disorders, with a large effect size for fear of animals (r = .50; 95% CI: 0.30-0.66) and a no to small effect size for social anxiety disorder (r = .001; 95% CI: 20.19-0.19). Further, the correlation between anxiety and presence was stronger in studies with participants who met criteria for an anxiety disorder than in studies with a non-clinical population. Trackers with six degrees of freedom and displays with a larger field of view resulted in higher effect sizes, compared to trackers with three degrees of freedom and displays with a smaller field of view. In addition, no difference in effect size was found for the type of presence measurement and the type of anxiety measurement. This meta-analysis confirms the positive relation between sense of presence and anxiety and demonstrates that this relation can be affected by various moderating factors.
PLoS ONE, 2014
While high prevalence rates of psychological symptoms have been documented in civilian survivors ... more While high prevalence rates of psychological symptoms have been documented in civilian survivors of war, little is known about the mechanisms by which trauma exposure might lead to poor psychological outcomes in these populations. One potential mechanism that may underpin the association between war-related traumatic experiences and psychopathology is interpersonal sensitivity. In the current study, we applied structural equation modeling to investigate the impact of interpersonal sensitivity on posttraumatic stress disorder (PTSD) symptoms, depression symptoms, and anger responses following exposure to war trauma. 3313 survivors of the war in the former Yugoslavia were identified and selected using a multistage, probabilistic sampling frame and random walk technique. Participants were interviewed regarding trauma exposure, interpersonal sensitivity, and PTSD symptoms, depression symptoms, and anger responses. Structural equation modeling analyses revealed that the relationship between trauma and PTSD symptoms and depression symptoms was partly statistically mediated by interpersonal sensitivity. Further, findings indicated that the relationship between trauma and anger responses was fully statistically mediated by interpersonal sensitivity. These results suggest that interpersonal sensitivity may function as a key mechanism that contributes to psychopathology following trauma.
PLoS ONE, 2011
Little is known about the long-term impact of the killing of a parent in childhood or adolescence... more Little is known about the long-term impact of the killing of a parent in childhood or adolescence during war on distress and disability in young adulthood. This study assessed current prevalence rates of mental disorders and levels of dysfunction among young adults who had lost their father due to war-related violence in childhood or adolescence.
PLoS ONE, 2013
The study aimed at examining the diagnostic utility of the Impact of Event Scale-Revised (IES-R) ... more The study aimed at examining the diagnostic utility of the Impact of Event Scale-Revised (IES-R) as a screening tool for posttraumatic stress disorder (PTSD) in survivors of war. The IES-R was completed by two independent samples that had survived the war in the Balkans: a sample of randomly selected people who had stayed in the area of former conflict (n = 3,313) and a sample of refugees to Western European countries (n = 854). PTSD was diagnosed using the MINI International Neuropsychiatric Interview. Prevalence of PTSD was 20.1% in the Balkan sample and 33.1% in the refugee sample. Results revealed that when considering a minimum value of specificity of 0.80, the optimally sensitive cut-off score for screening for PTSD in the Balkan sample was 34. In both the Balkan sample and the refugee sample, this cut-off score provided good values on sensitivity (0.86 and 0.89, respectively) and overall efficiency (0.81 and 0.79, respectively). Further, the kappa coefficients for sensitivity for the cut-off of 34 were 0.80 in both samples. Findings of this study support the clinical utility of the IES-R as a screening tool for PTSD in large-scale research studies and intervention studies if structured diagnostic interviews are regarded as too labor-intensive and too costly.
The Journal of Nervous and Mental Disease, 2007
The current study examined the relationship between experiential avoidance and psychological dist... more The current study examined the relationship between experiential avoidance and psychological distress after war-related traumatic experiences among 152 Kosovar civilian war survivors. Results showed significant correlations between experiential avoidance and psychological distress. Participants who scored high on experiential avoidance reported more impaired psychological functioning and lower subjective quality of life than those who scored low on experiential avoidance. Results of this study indicate that experiential avoidance may be a significant factor in understanding war-related psychological distress.
Death Studies Publication details, including instructions for authors and subscription information:
Study Objectives: To compare the efficacy of guided online and individual face-to-face cognitive ... more Study Objectives:
To compare the efficacy of guided online and individual face-to-face cognitive behavioral treatment for insomnia (CBT-I) to a wait-list condition.
Methods:
A randomized controlled trial comparing three conditions: guided online; face-to-face; wait-list. Posttest measurements were administered to all conditions, along with 3- and 6-mo follow-up assessments to the online and face-to-face conditions. Ninety media-recruited participants meeting the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for insomnia were randomly allocated to either guided online CBT-I (n = 30), individual face-to-face CBT-I (n = 30), or wait-list (n = 30).
Results:
At post-assessment, the online (Cohen d = 1.2) and face-to-face (Cohen d = 2.3) intervention groups showed significantly larger treatment effects than the wait-list group on insomnia severity (insomnia severity index). Large treatment effects were also found for the sleep diary estimates (except for total sleep time), and anxiety and depression measures (for depression only in the face-to-face condition). Face-to-face treatment yielded a statistically larger treatment effect (Cohen d = 0.9) on insomnia severity than the online condition at all time points. In addition, a moderate differential effect size favoring face-to-face treatment emerged at the 3- and 6-mo follow-up on all sleep diary estimates. Face-to-face treatment further outperformed online treatment on depression and anxiety outcomes.
Conclusions:
These data show superior performance of face-to-face treatment relative to online treatment. Yet, our results also suggest that online treatment may offer a potentially cost-effective alternative to and complement face-to-face treatment.
Research on the dimensionality of post-traumatic stress disorder (PTSD) has generally failed to p... more Research on the dimensionality of post-traumatic stress disorder (PTSD) has generally failed to provide support for the three clusters of PTSD suggested in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). However, much research has been restricted to samples in North America and Western European countries. The aim of the current study was to test four alternative factor models among a relatively understudied population–young civilian survivors of war who had experienced war-related events as adolescents–in order to establish whether the factor structure of PTSD is consistent among various traumatized populations and age groups. Using the Posttraumatic Stress Diagnostic Scale, the results indicated that the four-factor model including intrusion, avoidance, hyperarousal, and numbing factors provided a better fit than the three-factor model suggested by the DSM-IV. The current study offers additional support from another population for a four-factor model of PTSD that implies a separation of avoidance and numbing items. Case conceptualization and treatment implications are discussed.
Behaviour Research and Therapy, 2015
In virtual reality exposure therapy (VRET), patients are exposed to virtual environments that res... more In virtual reality exposure therapy (VRET), patients are exposed to virtual environments that resemble feared real-life situations. The aim of the current study was to assess the extent to which VRET gains can be observed in real-life situations. We conducted a meta-analysis of clinical trials applying VRET to specific phobias and measuring treatment outcome by means of behavioral laboratory tests or recordings of behavioral activities in real-life. Data sources were searches of databases (Medline, PsycInfo, and Cochrane). We included in total 14 clinical trials on specific phobias. Results revealed that patients undergoing VRET did significantly better on behavioral assessments following treatment than before treatment, with an aggregated uncontrolled effect size of g = 1.23. Furthermore, patients undergoing VRET performed better on behavioral assessments at post-treatment than patients on wait-list (g = 1.41). Additionally, results of behavioral assessment at post-treatment and at follow-up revealed no significant differences between VRET and exposure in vivo (g = -0.09 and 0.53, respectively). Finally, behavioral measurement effect sizes were similar to those calculated from self-report measures. The findings demonstrate that VRET can produce significant behavior change in real-life situations and support its application in treating specific phobias.
Psychotherapy and Psychosomatics, 2015
Zeitschrift für Psychosomatische Medizin und Psychotherapie, 2007
The concept of disorders of extreme stress not otherwise specified (DESNOS) was designed to encom... more The concept of disorders of extreme stress not otherwise specified (DESNOS) was designed to encompass the psychopathological consequences of interpersonal and ongoing traumatic experiences. This study examined the prevalence rate of DESNOS among students who reported having gone through war experiences. The sample consisted of 55 Kosovar students who had been exposed to war-related events. The various variables were recorded with the Structured Interview for Disorders of Extreme Stress (SIDES), the Impact of Event Scale-Revised (IES-R), and the Brief Symptom Inventory (BSI). 16.4% of the participants met the criteria for posttraumatic stress disorder but none of them could be diagnosed as suffering from DESNOS. However, the symptoms somatization, altered relationships, and altered systems of meaning were reported by 21-37% of the participants. The DESNOS total score was found to be a better predictor of psychiatric distress than posttraumatic stress symptoms. The results argue again...
Psychotherapie, Psychosomatik, medizinische Psychologie, 2008
A large body of literature stresses the role of experiential avoidance as a developmental and mai... more A large body of literature stresses the role of experiential avoidance as a developmental and maintenance factor of many forms of psychopathology including post-traumatic stress disorder. For the first time, the current study examined the relationship between experiential avoidance and war-related post-traumatic symptoms. 123 students in Kosovo who reported war-related experiences took part in this study. Results show that experiential avoidance was significantly correlated with post-traumatic symptoms above and beyond the number of traumatic experiences.
Journal of Traumatic Stress, 2014
The World Health Organization recently proposed a reformulation of posttraumatic stress disorder ... more The World Health Organization recently proposed a reformulation of posttraumatic stress disorder (PTSD) for the 11(th) edition of the International Classification of Diseases (ICD-11), employing only 6 symptoms. The aim of this study was to investigate the impact of this reformulation of PTSD as compared to criteria according to Diagnostic and Statistical Manual of Mental Disorders (4th ed., DSM-IV; American Psychiatric Association, 1994) on the prevalence of current PTSD as well as comorbid major depressive episode and anxiety disorders other than PTSD. Study 1 involved previously collected interviews with 560 Kosovar civilian war survivors; Study 2 employed a previously collected sample of 142 British war veterans. Results revealed no change in the diagnostic status under the criteria proposed for ICD-11 in 87.5% of civilian war survivors and 91.5% of war veterans. Participants who only met the newly proposed criteria showed lower rates of comorbid major depressive episode than participants who only met DSM-IV criteria (13.6% vs. 43.8% respectively). Rates of comorbid anxiety disorders did not significantly differ between participants who lost or gained a PTSD diagnosis under the proposed criteria.
Zeitschrift für Klinische Psychologie und Psychotherapie, 2007
Traumatology, 2006
ABSTRACT Using structural equation modeling, the present study investigated the relationship betw... more ABSTRACT Using structural equation modeling, the present study investigated the relationship between after-effects of war-related traumatic events, generalized self-efficacy, self-esteem, subjective well-being, and distress. Questionnaires (Impact of Event Scale–Revised, Positive and Negative Affect Schedule, Satisfaction With Life Scale, Rosenberg Self-Esteem Scale, and Generalized Self-Esteem) were administered to 214 civilian war survivors in Kosovo. The results show a high prevalence of traumatic experiences (83%) with high psychological distress. The severity of traumatic stress was accompanied by negative affectivity and was inversely related to self-esteem. The other self-related constructs neither had an impact nor were found to be diminished by the amount of traumatic stress experienced.
Psychotherapy and Psychosomatics, 2012
^ 15 on the Posttraumatic Stress Diagnostic Scale (PDS) . Past-PTSD individuals (n = 19) met full... more ^ 15 on the Posttraumatic Stress Diagnostic Scale (PDS) . Past-PTSD individuals (n = 19) met full PTSD criteria in the past; no-PTSD individuals (n = 21) had never met full PTSD criteria. Group characteristics are similar to those of epidemiological studies , indicating the representativeness of the sample. Current-PTSD individuals scored higher on PDS and Beck's depression inventory (BDI) [16] than past-PTSD and no-PTSD individuals, supporting the validity of the group distinction. Current-PTSD individuals had more co-morbid disorders at the time of assessment as compared to past-PTSD and no-PTSD individuals .
PPmP - Psychotherapie · Psychosomatik · Medizinische Psychologie, 2008
A large body of literature stresses the role of experiential avoidance as a developmental and mai... more A large body of literature stresses the role of experiential avoidance as a developmental and maintenance factor of many forms of psychopathology including post-traumatic stress disorder. For the first time, the current study examined the relationship between experiential avoidance and war-related post-traumatic symptoms. 123 students in Kosovo who reported war-related experiences took part in this study. Results show that experiential avoidance was significantly correlated with post-traumatic symptoms above and beyond the number of traumatic experiences.
PLoS ONE, 2014
In virtual reality exposure therapy (VRET) for anxiety disorders, sense of presence in the virtua... more In virtual reality exposure therapy (VRET) for anxiety disorders, sense of presence in the virtual environment is considered the principal mechanism that enables anxiety to be felt. Existing studies on the relation between sense of presence and level of anxiety, however, have yielded mixed results on the correlation between the two. In this meta-analysis, we reviewed publications on VRET for anxiety that included self-reported presence and anxiety. The comprehensive search of the literature identified 33 publications with a total of 1196 participants. The correlation between self-reported sense of presence and anxiety was extracted and meta-analyzed. Potential moderators such as technology characteristics, sample characteristics including age, gender and clinical status, disorder characteristics and study design characteristics such as measurements were also examined. The random effects analysis showed a medium effect size for the correlation between sense of presence and anxiety (r = .28; 95% CI: 0.18-0.38). Moderation analyses revealed that the effect size of the correlation differed across different anxiety disorders, with a large effect size for fear of animals (r = .50; 95% CI: 0.30-0.66) and a no to small effect size for social anxiety disorder (r = .001; 95% CI: 20.19-0.19). Further, the correlation between anxiety and presence was stronger in studies with participants who met criteria for an anxiety disorder than in studies with a non-clinical population. Trackers with six degrees of freedom and displays with a larger field of view resulted in higher effect sizes, compared to trackers with three degrees of freedom and displays with a smaller field of view. In addition, no difference in effect size was found for the type of presence measurement and the type of anxiety measurement. This meta-analysis confirms the positive relation between sense of presence and anxiety and demonstrates that this relation can be affected by various moderating factors.
PLoS ONE, 2014
While high prevalence rates of psychological symptoms have been documented in civilian survivors ... more While high prevalence rates of psychological symptoms have been documented in civilian survivors of war, little is known about the mechanisms by which trauma exposure might lead to poor psychological outcomes in these populations. One potential mechanism that may underpin the association between war-related traumatic experiences and psychopathology is interpersonal sensitivity. In the current study, we applied structural equation modeling to investigate the impact of interpersonal sensitivity on posttraumatic stress disorder (PTSD) symptoms, depression symptoms, and anger responses following exposure to war trauma. 3313 survivors of the war in the former Yugoslavia were identified and selected using a multistage, probabilistic sampling frame and random walk technique. Participants were interviewed regarding trauma exposure, interpersonal sensitivity, and PTSD symptoms, depression symptoms, and anger responses. Structural equation modeling analyses revealed that the relationship between trauma and PTSD symptoms and depression symptoms was partly statistically mediated by interpersonal sensitivity. Further, findings indicated that the relationship between trauma and anger responses was fully statistically mediated by interpersonal sensitivity. These results suggest that interpersonal sensitivity may function as a key mechanism that contributes to psychopathology following trauma.
PLoS ONE, 2011
Little is known about the long-term impact of the killing of a parent in childhood or adolescence... more Little is known about the long-term impact of the killing of a parent in childhood or adolescence during war on distress and disability in young adulthood. This study assessed current prevalence rates of mental disorders and levels of dysfunction among young adults who had lost their father due to war-related violence in childhood or adolescence.
PLoS ONE, 2013
The study aimed at examining the diagnostic utility of the Impact of Event Scale-Revised (IES-R) ... more The study aimed at examining the diagnostic utility of the Impact of Event Scale-Revised (IES-R) as a screening tool for posttraumatic stress disorder (PTSD) in survivors of war. The IES-R was completed by two independent samples that had survived the war in the Balkans: a sample of randomly selected people who had stayed in the area of former conflict (n = 3,313) and a sample of refugees to Western European countries (n = 854). PTSD was diagnosed using the MINI International Neuropsychiatric Interview. Prevalence of PTSD was 20.1% in the Balkan sample and 33.1% in the refugee sample. Results revealed that when considering a minimum value of specificity of 0.80, the optimally sensitive cut-off score for screening for PTSD in the Balkan sample was 34. In both the Balkan sample and the refugee sample, this cut-off score provided good values on sensitivity (0.86 and 0.89, respectively) and overall efficiency (0.81 and 0.79, respectively). Further, the kappa coefficients for sensitivity for the cut-off of 34 were 0.80 in both samples. Findings of this study support the clinical utility of the IES-R as a screening tool for PTSD in large-scale research studies and intervention studies if structured diagnostic interviews are regarded as too labor-intensive and too costly.
The Journal of Nervous and Mental Disease, 2007
The current study examined the relationship between experiential avoidance and psychological dist... more The current study examined the relationship between experiential avoidance and psychological distress after war-related traumatic experiences among 152 Kosovar civilian war survivors. Results showed significant correlations between experiential avoidance and psychological distress. Participants who scored high on experiential avoidance reported more impaired psychological functioning and lower subjective quality of life than those who scored low on experiential avoidance. Results of this study indicate that experiential avoidance may be a significant factor in understanding war-related psychological distress.
To increase the accessibility and efficiency of virtual reality exposure therapy (VRET) this pape... more To increase the accessibility and efficiency of virtual reality exposure therapy (VRET) this paper proposes a system for home-based use where patients with social phobia are supported by a virtual health agent. We present an overview of our system design, and discuss key techniques such as (1) dialogue techniques to create automated free speech dialogue between virtual characters and patients in virtual reality worlds; (2) a multi-modal automatic anxiety feed-back-loop mechanism to control patients’ anxiety level; and (3) motivational techniques applied by a virtual health agent. The system was evaluated in a pi-lot study where five patients with social phobia utilized our home-based VRET system. The results showed that the system was able to evoke the required anxi-ety in patients and that over time self-reported anxiety and heart rate gradually decreased as expected in exposure therapy.