Dissertations / Theses on the topic 'Posttraumatic stress disorder (PTSD)'

Posttraumatic Stress Disorder (PTSD) is an anxiety disorder characterised by disturbed arousal, altered attention, and fear processing, and a reduction in the ability to perform cognitive tasks. Predominant neurophysiological models of PTSD have been focused on alterations in fear-related regulation, and few incorporate broader changes in generic executive control which may underlie many of the clinical symptoms and cognitive deficits in PTSD. This thesis aimed to investigate the neurophysiology of executive inhibitory control in PTSD using a Go/NoGo response inhibition task and converging functional imaging, structural imaging and electrophysiological measures. The first series of studies aimed to elucidate a normative neural network model of inhibitory control, and are consistent with normative control involving the activation of a mainly right-lateralised ventral lateral prefrontal cortex (VLPFC) network. Inhibitory control-related activation was found to be affected by levels of anxiety and changes in underlying neural structure; alterations in frontal cortical maturation and volume were related to additional activation of bilateral frontal cortical regions and the dorsal striatum, with anxiety increasing the demand on inhibitory control-related activation. In contrast to healthy participants, PTSD was associated with reduced inhibitory control as indexed by inhibitory behaviour, diminished activation of the right VLPFC, and slowed inhibition-related information processsing. PTSD participants relied on the greater activation of a left fronto-striatal inhibition network to support control, with the activation affected by levels of PTSD severity and comorbid anxiety. This left fronto-striatal activation in PTSD was related to underlying increases in fronto-striatal neural structure. Further, the ability to efficiently engage a left fronto-striatal network in PTSD during inhibitory control predicted better response to cognitive behavior for PTSD, consistent with the proposal that an improved ability to flexibly engage control systems may facilitate the resolution of PTSD symptoms. Taken together, this program of research extends current neurophysiological model of PTSD to show that PTSD involves a fundamental disturbance in the function and structure of key fronto-striatal response control networks associated with inhibitory control.

This thesis explored the epidemiology of Posttraumatic Stress Disorder (PTSD) and different aspects of the disorder. Firstly, we investigated the lifetime prevalence of traumatic experiences and PTSD in the general adult population in Sweden and evaluated the impact of different trauma types, trauma frequency, and perceived distress. The results show that traumatic experiences are common and PTSD is not rare; roughly one out of ten traumatic events results in PTSD, with a 5.6% lifetime prevalence. The female/male ratio is 2:1. The risk for PTSD increases considerably with a high trauma-associated emotional impact. The distressing impact of a given trauma appears to be higher in women than in men, indicating an increased vulnerability in women. Secondly, we hypothesized that traffic road accidents (TRA’s) are one of the most prevalent types of traumatic events in Swedish society; therefore, we examined the impact of event and response characteristics associated with TRA’s on PTSD development. The data demonstrate that of those who had experienced a TRA (n=1074, 58.9%), 6.1% reported lifetime PTSD. TRA’s associated with fatal accidents and injury to oneself and related to high distress more than double the risk for PTSD. Thirdly, we compared the relative merits of the DSM-IV’s three-factor solution for PTSD symptoms to alternative models. We found that the symptomatology is equally well accounted for using all factor analytic models as yet presented in the literature; the DSM-IV, we found, provides as good a fit to data as other models. Fourthly, we examined the neurofunctional correlates of PTSD symptoms and whether a treatment-induced (serotonin reuptake inhibitor - SSRI) reduction of PTSD symptoms is associated with altered rCBF during symptom provocation. Our results indicate that PTSD symptoms correlates with areas involved in memory, emotion, attention, and motor control and that SSRI treatment normalizes provocation-induced rCBF in these areas.

The associated features, high rates of comorbidity and chronicity of Posttraumatic Stress Disorder (PTSD) and Borderline Personality Disorder (BPD) raise questions regarding the distinctiveness of the two disorders. The present study expands upon previous literature by providing an investigation of clinical features across two groups: PTSD only and comorbid PTSD and BPD in a sample of male veterans (n=178). Results suggest that the two groups were distinct, with the comorbid group displaying higher levels of depression, hostility, alcohol use and general psychopathology. Groups did not differ on rates of personal trauma, adult sexual abuse, childhood sexual abuse, attack, accident or disaster. The two groups did differ significantly on rates of childhood violence.

Includes bibliographical references
Objective: The main aim of this thesis is to analyze data from the South African Stress and Health (SASH) study and , for the first time, generate information on the epidemiology of traumatic event s (TEs) and posttraumatic stress disorder (PTSD), and on the association of TEs with other psychopathological and physical health outcomes. Methods: A literature review was done to provide information current knowledge in the field. Cross - tabulations, Chi - squared tests and logistic regression analyses were then conducted SASH data to determine the prevalence of the different types of trauma and PTSD and the associations between the sociodemographic variables and TEs and PTSD on the one hand, and TEs and PTSD, other psychopathology and chronic physical conditions on the other . Results: The most common traumatic events were the unexpected death of a loved one and witnessing trauma. Lifetime prevalence of PTSD was 2.3%, and the conditional prevalence of PTSD after trauma exposure was 3.5%. PTSD conditional risk and burden were both highest for witnessing trauma. Witnessing trauma was commonest among males and those with low - average education. There was statistically significant association between witnessing and PTSD, mood, and anxiety disorders. Exposure to any TE significantly increased the odds of all the physical conditions, and the odds of having a physical condition were directly related to the number of lifetime traumatic events. Sexual violence and unexpected death of a loved one significantly increased the odds of all the e physical conditions assessed, while war events were only associated with respiratory conditions. Apart from war events, accidents and witnessing trauma were associated with the fewest physical conditions. Conclusions: Consistent with the literature, trauma and PTSD in South Africa are not distributed according to the socio - demographic factors or trauma types observed in other countries. Witnessing trauma is common in South Africa and increases the risk of mood and anxiety disorders. Finally, TE exposure is associated with chronic physical conditions in a dose - response manner. Trauma interventions must therefore focus also on those not directly affected, and routine evaluation for chronic physical conditions is recommended for survivors of all trauma.

Existing research suggests that childbirth may be a significant trigger of posttraumatic stress disorder (PTSD) in the postpartum period. While literature presents important results regarding the prevalence and risk factors of postpartum PTSD, several gaps remain. The current study examined the factor structure of perinatal PTSD by comparing two supported structures of PTSD. Additionally, structural equation modeling (SEM) was used to examine whether subjective birthing experiences and objective childbirth characteristics mediated the relationship between psychosocial variables (history of trauma, fear of childbirth, and social support) and postpartum PTSD. Women were recruited during pregnancy from the University of Iowa Hospitals and Clinics. Symptoms of PTSD, OCD, and depression, as well as risk factors for postpartum PTSD were measured at pregnancy, 4, 8, and 12 weeks postpartum. Additionally, structured clinical interviews were conducted to assess for depression, PTSD, OCD, and mania. Five factor structures were examined using confirmatory factor analysis, including two four factor models with correlated latent factors, two four factor hierarchical models, and a unidimensional model. All models resulted in adequate global fit and excellent component fit. The most parsimonious model, the unidimensional model was retained. The SEM showed that subjective perceptions of childbirth mediated the relationship between fear of childbirth and postpartum PTSD at 4 weeks postpartum. At 8 weeks postpartum, objective childbirth characteristics mediated the relationship between fear of childbirth and postpartum PTSD and there was a direct relationship between fear of childbirth and postpartum PTSD. The current study supports a hierarchical or unidimensional structure of PTSD in perinatal samples emphasizing the importance of a higher-order, shared dimension of PTSD symptoms. It further emphasizes the importance of fear of childbirth and both subjective and objective birthing experiences in predicting postpartum psychopathology. Future research should examine these symptoms and risk factors in a more diverse and at-risk sample. Additionally, accurate assessments, and influential interventions for postpartum PTSD should be further examined.

Posttraumatic stress disorder is a prevalent and disabling disorder that can occur following experience of trauma. Contemporary clinical models of PTSD assert that memories for trauma are poorly elaborated and inadequately integrated into autobiographical memory (AM). Recent work of cognitive psychologists suggests, however, that trauma memories remain highly accessible and form a cognitive reference point for the organisation of autobiographical knowledge, leading to the development of trauma-centred identity. The current study sought to explore further the relationships between PTSD symptoms, the phenomenological properties of AM for trauma, and trauma-centred identity. A community sample of 82 participants (male, n = 24; mean age = 36.10 years, SD = 10.82) was recruited. A within-subjects, correlational design was employed. Participants completed online questionnaires relating to PTSD symptoms, the phenomenological properties of a trauma memory and negative memory, and centrality of event to identity. Participants also provided written narratives of both a trauma and negative event. Differences between traumatic and negative memories, and relationships between trauma memory features and both PTSD and centrality were assessed using computerised textual analysis and self-report measures. Results indicated that trauma memories were significantly less coherent, less detailed, and contained fewer spatial references but more cognitive process terms than negative memories. PTSD symptoms correlated significantly with fragmentation of trauma memories and with use of the present tense in trauma narratives. A sense of reliving when remembering trauma and use of present tense were both significantly associated with centrality of event. Results were thus primarily consistent with contemporary clinical theories of PTSD with certain 3 elements of the centrality position also demonstrated. Findings were discussed in relation to the study’s methodological limitations, including difficulties encountered through LIWC’s lack of consideration of context when counting lexical items. Theoretical implications regarding the measurement of constructs such as fragmentation were outlined. Findings supported current treatment guidelines.

This paper reviews Posttraumatic Stress Disorder (PTSD) in Veterans and military members primarily from Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF). A literature review was conducted to explain symptom differentiation, treatments, and secondary health problems among Veterans with PTSD. This paper analyzed current literature and applied findings from the research to best nursing care recommendations for health care members that may not be knowledgeable about PTSD symptoms and needs of Veterans with PTSD when they are hospitalized in an acute care setting. With approximately 75% of Veterans seeking care outside of military based facilities, it is important to educate health care members on the evidence-based best care practices.

The purpose of this study was to analyze the effectiveness of acceptance and commitment therapy (ACT) in a group setting for 8 weeks on the symptoms of posttraumatic stress disorder (PTSD) for women diagnosed with PTSD due to childhood trauma who have not served in the military. ACT was developed using contextualism with relational frame theory being the foundation for contextualism. Women diagnosed with PTSD due to childhood trauma were found to have higher rates of attempted suicide, higher rates of mental health disorders, as well as higher rates of medical disorders than those who were not diagnosed with PTSD. The PTSD symptoms were measured using the PTSD checklist-civilian (PCL-C). The PCL-C was completed during Session 1 and Session 8 of ACT group therapy. There was a total of 24 PCL-C score sheets utilized for this study and only the score sheets of women diagnosed with PTSD due to childhood trauma who did not have a thought disorder were included. The research design was considered a pre-experimental design and the statistical design used was ANOVA with repeated measures using subject x trials. Cohen's estimate of small effect size was used. Secondary data analysis was conducted using archival data from a community mental health agency. According to the statistical measure of the repeated ANOVA the null hypothesis was rejected as there was sufficient evidence to support that using ACT in a group setting for 8 weeks can decrease PTSD symptoms as measured by the PCL-C. This study contributes to social change by decreasing symptoms of PTSD, therefore decreasing suicidal thoughts, as well as behaviors, and lead to an increase in overall functioning and prosocial behaviors.

The goal of the study was to determine the effect of the neurolinguistic programming procedure of visual-kinesthetic dissociation on symptoms of posttraumatic stress disorder in a sample of Vietnam combat veterans. Thirty-eight veterans in a Veterans Administration treatment program were given three sessions of either visual-kinesthetic dissociation or regular program activities. Overall post-traumatic symptoms, re-experiencing symptoms, and amount of sleep were measured before and after treatment and at a three month follow-up. Results indicated that the treatment program itself had no significant effect on symptoms measured, nor did the addition of visual-kinesthetic dissociation provide any incremental symptom relief.

Posttraumatic stress disorder (PTSD) is a serious condition with debilitating symptoms which affects military veterans and has been understudied in the older population. Aside from treating the veterans of the Vietnam War and World War II, as service members from more recent conflicts age, the mental healthcare system needs to be able to treat them with empathy and effective therapies. As there is a need for future research focusing on this population, this paper reviews the current literature and utilizes Grounded theory to further the research related to PTSD in aging veterans. A selection of mental health clinicians with experience treating this population were interviewed and the results discussed. Those therapists who work for the Department of Veterans Affairs (VA) most often use Cognitive Behavioral Therapy to treat their clients, with Prolonged Exposure Therapy being the next most popular therapeutic modality. Those clinicians who are separate from the VA are able to employ therapies such as Cognitive Restructuring or blend theories to meet the precise needs of individual veterans. Also addressed are the differences and commonalities in PTSD symptoms between veterans of different conflict eras. Based upon these interviews, suggestions were made for changes to the treatment of military-related PTSD.

The wars in Afghanistan (OEF) and Iraq (OIF) represent the most sustained American combat operations since the Vietnam War. A wealth of research has shown the frequency and intensity of exposure to combat experiences is positively correlated with risk for chronic PTSD and associated impairments in veterans, a “dose-response” continuum (Fischer, 2014; Hoge, Messer, McGurk, & Koffman, 2004; Maguen et al., 2015; Philips et al., 2017; Pitman, 2006; Ricks, 2004; Rona et al., 2014). Reported prevalence rates for symptoms of PTSD in OEF and OIF veterans vary, but researchers suggest 14% of treatment-seeking veterans and up to 21% of OEF and OIF veterans meet criteria for PTSD (Angkaw et al., 2013). The Department of Veteran Affairs (VA), the Department of Defense (DoD), community agencies, and private mental health providers strive to help veterans reintegrate into civilian life. Efforts have been made to reduce barriers to treatment by developing interventions more appealing to veterans. One such modality gaining traction and support is therapeutic riding (TR). TR teaches veterans about horsemanship, how to ride, and serves as a tool for connection, as well as, physical and emotional healing (Notgrass & Pettinelli, 2015). This study was designed to answer the following research question: How do OEF and OIF veterans diagnosed with symptoms of PTSD experience the use of TR as a tool for their recovery? The post-intentional phenomenology, was utilized to ascertain how four veterans participating in TR were changed by the experience. Intentionality promoted an understanding of TR through its emphasis on the connections made during their participation. Data was gathered using a whole-part-whole investigative approach, whereby, themes were explored separately then brought together as a whole (Vagle, 2014). The research question and sub-questions facilitated further understanding of TR and its utilization by OEF and OIF veterans in the domains of perceived personal change, social connection, mental and emotional wellbeing, and environment. There were eleven tentative manifestations of change and five influencing factors which emerged through data discovery. Constructs were illuminated and further explored. The exploratory research implications seemed to support previous findings, suggesting TR had positive effects on PTSD symptom recovery for OEF and OIF veterans.

Abstract BACKGROUND: The PTSD Checklist-civilian (PCL-C) is one of the most commonly used self-report measures of PTSD symptoms, however, little is known about its validity when used in pregnancy. This study aims to evaluate the reliability and validity of the PCL-C as a screen for detecting PTSD symptoms among pregnant women. METHODS: A total of 3372 pregnant women who attended their first prenatal care visit in Lima, Peru participated in the study. We assessed the reliability of the PCL-C items using Cronbach's alpha. Criterion validity and performance characteristics of PCL-C were assessed against an independent, blinded Clinician-Administered PTSD Scale (CAPS) interview using measures of sensitivity, specificity and receiver operating characteristics (ROC) curves. We tested construct validity using exploratory and confirmatory factor analytic approaches. RESULTS: The reliability of the PCL-C was excellent (Cronbach's alpha =0.90). ROC analysis showed that a cut-off score of 26 offered optimal discriminatory power, with a sensitivity of 0.86 (95% CI: 0.78-0.92) and a specificity of 0.63 (95% CI: 0.62-0.65). The area under the ROC curve was 0.75 (95% CI: 0.71-0.78). A three-factor solution was extracted using exploratory factor analysis and was further complemented with three other models using confirmatory factor analysis (CFA). In a CFA, a three-factor model based on DSM-IV symptom structure had reasonable fit statistics with comparative fit index of 0.86 and root mean square error of approximation of 0.09. CONCLUSION: The Spanish-language version of the PCL-C may be used as a screening tool for pregnant women. The PCL-C has good reliability, criterion validity and factorial validity. The optimal cut-off score obtained by maximizing the sensitivity and specificity should be considered cautiously; women who screened positive may require further investigation to confirm PTSD diagnosis.
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The purpose of this study was to determine the effect of posttraumatic stress disorder (PTSD), diagnosed prospectively during pregnancy, on the occurrence of low birthweight (<2500 grams) and preterm delivery (<37 weeks gestational age). A cohort of 1362 women was recruited from prenatal care visits and screened for depression, panic disorder, posttraumatic stress disorder, and substance use. Current episodes of PTSD were assessed using the MINI International Neuropsychiatric Interview. Pregnancy outcomes were abstracted from hospital records after delivery, and the data were analyzed using logistic regression. Two hundred sixty two women (33%) were lost to follow-up due to unavailable medical records, leaving 1100 women in the final analyses. Among these 1100 women, 31 (3%) were found to have PTSD during pregnancy. Substance use in pregnancy, panic disorder, major and minor depressive disorders, and prior preterm delivery were significantly associated with PTSD in the sample, while age, language spoken, and race were not. Low birthweight (LBW) was present in 6.5% of sampled women and was not significantly associated with a diagnosis of PTSD in pregnancy when adjusting for potential confounders. However, LBW was significantly associated with minor depressive disorder OR= 1.82 (CI=1.01, 3.29). Preterm delivery occurred in 7.0% of those without and 16.1% of those with PTSD (p=0.055). Because prior preterm delivery data were not available for 33% of women with PTSD, this variable was included only in secondary analyses. However, the association between PTSD and preterm delivery depended on this variable, with OR= 2.82 (0.95, 8.38) before controlling for prior preterm delivery and OR=3.35 (1.04, 10.85) after controlling for prior preterm delivery. These data suggest that a possible association of PTSD and preterm delivery was limited by the low rates of PTSD in this cohort and the inability to control for all confounders. Taken together, these findings provide limited support for the hypothesized association between PTSD and preterm delivery and no support for an association of PTSD with LBW.

Post-Traumatic Stress Disorder (PTSD) has affected millions of veterans who have served in the United States Military. PTSD causes severe impairments in one's mental health, and is correlated with homelessness, substance abuse, and unemployment. Recently, the United States Department Veterans Affairs has been funded more to improve services of mental health and other health care services. Specifically, this study was interested in exploring the perceptions that veterans have of the quality of services that have been provided for PTSD. Results indicated that the participants who utilized services felt individual and family therapy services were most helpful in reducing PTSD symptoms. Medication was less helpful suggesting further research on what types of medication are helpful. Participants also reported group therapy and service connected disability financial assistance were not helpful even though a majority of participants did not access it. Research indicates that veterans do not perceive services to be helpful; therefore they do not utilize them. Additional research can focus on exploring why veterans have not utilized services. Social workers can intervene by educating veterans about PTSD and the services that are provided in addition to other community agencies. Furthermore, social workers can evaluate returning veterans and their perception of the quality of services they have received to further improve services.

Understanding temporal relations among posttraumatic stress disorder (PTSD) symptom dimensions has received increasing attention in research. However, current findings in this area are limited by group-level approaches, which are based on inter-individual variation. PTSD is a heterogeneous syndrome and symptoms are likely to vary across individuals and time. Thus, it is important to examine temporal relations among PTSD symptom dimensions as dynamic processes and at the level of intra-individual variation. The aim of the present study was to capture temporal dynamics among PTSD symptom dimensions at an individual level using unified structural equation modeling (uSEM). World Trade Center (WTC) 9/11 responders (N = 202) oversampled for current PTSD (18.3% met criteria in past month) were recruited from the Long Island site of the WTC health program. Using ecological momentary assessment (EMA), PTSD symptoms were assessed three times a day over seven consecutive days. The person-specific temporal relations among PTSD symptom dimensions were estimated with individual-level uSEM. For the sample as a whole, hyperarousal played a key role in driving the other three symptom dimensions longitudinally, with the strongest effect in intrusive symptoms. However, daily temporal relations among PTSD symptoms were idiosyncratic. Although hyperarousal was a strong predictor of subsequent symptom severity, only 33.95% of the sample showed this predictive effect while others showed more evident temporal relations between intrusion and avoidance. Implications for personalized health care and recommendations for future research using individual-level uSEM in psychopathology are discussed.

Posttraumatic Stress Disorder (PTSD) is an anxiety disorder that affects over 7.7 million adults and carries an estimated societal cost of $3.1 billion every year. People develop PTSD after exposure to a traumatic event. Alone or combined, approved pharmacotherapies or psychotherapy are somewhat effective, but symptoms for many remain refractory. Emerging evidence suggests that opiate systems may modulate the development and expression of PTSD, and their role can be investigated preclinically. Pavlovian fear conditioning is a preclinical model which elicits behaviors mirroring those that occur in humans during and after exposure to trauma. This presents an experimental tool that can help elucidate the opiate mechanisms involved in traumatic memory as well as the resulting fear behavior. Mu opioid receptor (MOR) analgesics, such as morphine, are often given as a response to trauma, and there is emerging evidence that they are, at least partially, protective against PTSD. The kappa opioid receptor (KOR) system has also been implicated in stress-related processes, with KOR agonists reported to enhance stress in both laboratory animals and in humans, and KOR antagonists reported to attenuate stress-like behaviors preclinically. This project attempted to clarify part of the role of the mu and kappa opiate receptor systems in mediating effects of Pavlovian fear conditioning in mice as a predictor of their involvement in some of the signs and symptoms of PTSD. Kappa agonists increased acute fear responses but surprisingly also facilitated fear extinction learning. This would suggest that the use of kappa agonists might increase the efficiency and effectiveness of this therapy and could improve existing PTSD patient outcomes. MOR agonists, as well as KOR antagonists reduced acute and long-term fear behavior. These results support that the use KOR analgesics like morphine and fentanyl in the treatment of trauma could have an added benefit of reducing the emergence and persistence of PTSD. Self-medication may help explain the comorbidity of opioid abuse in PTSD patient populations. Understanding the relative effects of these opiate ligands could lead to more informed usage of MOR analgesics which vary in mu and kappa receptor activity under battlefield and other traumatic conditions.

Interventions are needed to help the functional impairment of veterans, especially with regard to symptoms of Posttraumatic Stress Disorder. This pilot study examines how EEG biofeedback impacts PTSD symptoms in veterans of mixed age and race at The Bell Shelter in Los Angeles. As the method of data collection, this quantitative study employed a Likert scale questionnaire tracking 23 symptoms of PTSD for both the experimental and control groups at the same weekly intervals. This study examined whether there was a difference between the PTSD symptoms in the five veterans receiving treatment as compared to the five veterans who did not receive treatment during the study, but had the option of receiving treatment after the study was completed. Results of the data indicate a significant remediation of Posttraumatic Stress Disorder symptoms in the experimental group after undergoing 20 sessions of EEG biofeedback, in contrast to the control group.

Posttraumatic stress disorder (PTSD) is complex and no one theory can fully explain the development and maintenance of PTSD symptoms. In Scotland, where trauma focused care initiatives are being considered, little is known about the extent of trauma history and associated symptoms presenting in primary care services. Furthermore, subthreshold posttraumatic stress disorder (sPTSD) has recently been associated with clinically significant impairment. With PTSD symptoms often comorbid with other psychopathology such as depression, individuals potentially seek treatment for these symptoms rather than underlying trauma which therefore may go unrecognised. Studies on the effectiveness of psychological treatment for PTSD demonstrate reasonable efficacy for well developed interventions. However, up to half of individuals may not make significant clinical improvements and withdrawal rates are high. This suggests that current treatments are not acceptable to some individuals and may be ineffective for others. In light of such clinical challenges the aim of the thesis was to investigate the incidence and nature of trauma symptoms in an Adult Psychological Therapies Service. Firstly, a systematic review was conducted to appraise the current level of evidence for prevalence and impairment associated with sPTSD. Secondly, an empirical study was undertaken to review the prevalence of trauma history and symptoms in the service. This was followed by an investigation of the relationships between processes posited to underpin many forms psychological distress by a promising new treatment approach called Acceptance and Commitment Therapy (ACT). These include; cognitive fusion, experiential avoidance and valued action. A quantitative cross sectional design collecting self report questionnaire data was used and mixed statistical methodology employed. Results from the systematic review suggest that PTSD was associated with the most impairment, followed by sPTSD, then no PTSD. Subthreshold PTSD was reported to be as, or more prevalent than, PTSD. The results from the empirical study found 89 per cent reported exposure to one or more traumatic events, 51 per cent met PTSD screening criteria, whilst a further 7 per cent reached a sPTSD diagnostic cut-off. Trauma history was positively correlated with increased psychological distress at initial assessment. Cognitive fusion, experiential avoidance and valued action were all correlated with trauma symptom severity. Both cognitive fusion and experiential avoidance mediated the relationship between number of traumatic events and trauma symptom severity in a simple mediation model. However, multiple mediation analysis demonstrated that experiential avoidance, over and above cognitive fusion, explained 33 per cent of the variance. In addition, cognitive fusion and experiential avoidance jointly had a significant indirect effect on the relationship between trauma history and valued action. The implications of the findings and further directions are discussed.

The increased intensity of modern life and the experiences in combat situations has brought on enormous stress and has led many individuals to develop posttraumatic stress disorder (PTSD). Hypnosis is one of the treatment methods available to professionals and has been proven to provide fast, reliable results in multiple studies. Despite these results, the lack of understanding of the physiological effects of hypnosis on the brain has prevented its use as a common treatment method for PTSD. By examining the differences between the effectiveness of hypnosis in military and civilian populations, the aim of this meta-analysis was to isolate the ideal personal characteristics and causes of the trauma that make hypnosis an effective treatment. The first 2 research questions compared the mean effect sizes and their ranges between the 2 populations and extracted the personality characteristics that would make treatment of PTSD by hypnosis successful based on the comparison itself and analysis of the populations from the currently available research and the biases in the studies. The final research question was aimed at comparing the success of cognitive behavioral therapy (CBT) in combination with hypnosis and the duration of the treatment method. The analyses based on the quantitative results led to the conclusion that military personnel experience a higher successful rate of treatment for PTSD through hypnotherapy combined with CBT. This suggests that hypnotherapy can be recommended for individuals who have respect toward authority and schedules. The provided guidelines were intended to increase the popularity of hypnosis, and if implemented, will produce positive social change because more people will be able to find faster, more reliable relief from PTSD, improving not only the patient's quality of life but also the quality of life of those around him.

Combat-related posttraumatic stress disorder (PTSD) is a psychological condition researchers have cited as a major cause of marital discord and divorce for veterans with PTSD. This study examined the psychological construct of locus of control among the wives of veterans diagnosed with combat-related PTSD and whether or not it was a predictor of marital satisfaction within this context. An extensive search of the current literature revealed no previous studies that had investigated this relationship. Utilizing the family systems theory to address this gap, this study sought to compare reported marital satisfaction in wives with an internal locus of control to those with an external locus of control. Participants for this study were 111 wives of veterans with combat-related PTSD, each of whom completed a demographic questionnaire, the Kansas Marital Satisfaction Survey, and the Duttweiler Internal Control Index. A multiple linear regression was conducted to determine if age, number of years married, number of children, level of education, household income, and internal locus of control were predictors of marital satisfaction reported by wives of veterans with combat-related PTSD. The results indicated that an internal locus of control accounted for a significant degree of the variance in marital satisfaction while the demographic variables were not significant predictors. This study contributes to social change by providing an empirical insight into the relationship between locus of control and marital satisfaction in wives of veterans with PTSD. The results of this study could help improve the quality of life of veterans with PTSD by enhancing awareness of locus of control to practitioners while developing a therapeutic treatment plan that will fit the veteran's locus of control orientation.

Posttraumatic stress disorder (PTSD) is a debilitating condition that results from the experience of a traumatic event. Natural kinds are mind-independent entities found in nature and are the objects of scientific inquiry. It is common to deny that PTSD is a natural kind, but extant denials assume a thesis of natural kinds that can be called “essentialism”. According to essentialism, many entities are not natural kinds that one would expect should be natural kinds. The homeostatic cluster view of natural kinds offers an alternative that accommodates these cases, including, superficially, the claim that PTSD is a natural kind. I introduce two novel objections to this claim and recommend a distinction aimed to resolve the newly introduced problems.

The Official Publication of the Canadian Academy of Audiology, Marc Fagelson writes about how awareness and consideration of the special needs of patients with PTSD – the increased need to monitor the acoustical environment

Stigmatization has shown to negatively impact service members with Posttraumatic Stress Disorder (PTSD). Published research has shown stigma to significantly affect service members through increased suicide, homicide, unemployment, homelessness, and criminal justice system interaction rates. Additionally, stigma also affects overall readiness and cohesion of the military organization. However, little research has focused on the perceptions of Reserve Officer Training Corps (ROTC) cadets about service members with a combat-related stress disorder in which they will eventually be charged with leading. The purpose of this quantitative study was to measure a cohort of ROTC cadets and determine their perceptions about service members serving with PTSD. Socialization theory was used as the lens to measure ROTC cadet's acceptance into the military culture. The study population consisted of 14 cadets within 5 ROTC battalions in Louisiana. Fisher's exact test revealed no significant relationships among ROTC cadet's overall perceptions. However, valuable insight was discovered regarding religion and branch of service the cadets intended to commission with as potential significant variables regarding their perceptions about PTSD. Further research, including a larger population size, is still needed to determine how these perceptions impact currently serving service members. Implications for positive social change include improved knowledge about PTSD and the stigma associated with negative perceptions, which will improve education through socialization into the military culture and reduce suicide, homicide, criminal justice system interaction, homelessness, and unemployment rates in addition to improving the overall readiness and cohesion of the Armed Forces.

Thesis advisor: Elizabeth A. Kensinger
Though people tend to remember emotional information with extreme vividness, this vividness often comes at the cost of memory for surrounding information. The goal of this dissertation is to investigate this memory trade-off and how it is influenced by focused attention, trait anxiety, and posttraumatic stress disorder (PTSD). In each study, participants were shown composite pictures that included an emotional or neutral item placed on a neutral background. Later, they were shown the same items and backgrounds separately. A memory trade-off occurred when participants were more likely to remember emotional items and forget the associated backgrounds as compared to equivalent memory for neutral items and backgrounds. The results from the first chapter revealed that the amount of overt visual attention on an emotional item did not predict the presence of the memory trade-off. However, when it was task relevant to disengage one's attention from the emotional item, the memory trade-off was dampened. Further, dividing attention had no effect on the memory trade-off. The results of the second chapter demonstrated that the memory trade-off was enhanced for emotional items with high levels of arousal as compared to low arousal items. This enhancement was especially strong for individuals with high trait anxiety, when this information was negative and arousing, and when the scene was remembered with a sense of familiarity. Further, for items and backgrounds that were vividly recollected, individuals with higher levels of anxiety were less likely to be able to modulate the memory trade-off, even when it was task relevant to attend to background information. The third chapter revealed that people with PTSD have a larger memory trade-off for both positive and negative information, despite the lack of overall item memory differences. These studies reveal that attention may not be the only factor that influences the memory trade-off and that the memory trade-off may be influenced by trait anxiety and PTSD
Thesis (PhD) — Boston College, 2011
Submitted to: Boston College. Graduate School of Arts and Sciences
Discipline: Psychology

Trauma due to sexual assault becomes a life changing event during a child's critical developmental years. Bronfenbrenner's ecological systems theory outlines the process of understanding an individual's environment and how disruptions in one level may affect other levels. This study determined if gender and ethnicity among sexually traumatized children diagnosed with post-traumatic stress disorder (PTSD) predict symptom severity as measured by the Trauma Symptom Checklist for Children (TSCC) after controlling for the socioeconomic level and home environment. The population consisted of 126 children aged 8 through 16 with at least a second-grade reading level. Multiple regression examined whether male and female children were significantly different concerning the magnitude of PTSD symptom presentation. Multiple regression was also used to test whether gender and ethnicity played a significant role in predicting specific symptoms. Female gender had statistically significant predictive power concerning anger and sexual concern. Age at intake was associated with significantly higher scores for anxiety, anger, and dissociation. Home environment was a statistically significant predictor for anxiety, depression, PTSD, and sexual concern with children living in a foster home having significantly higher symptom severity in these domains. Socioeconomic status was the strongest predictor variable. The addition of sexual assault in the diagnostic criteria for the diagnosis of PTSD with the adoption of DSM-5 indicate a justification for further research. Increased awareness of inefficiencies in identification of symptoms and inadequacies in training trauma providers are indicative of social change. Further knowledge of PTSD symptom expression propagates a new protocol when treating traumatized children.

A growing body of research has indicated that the levels of suicidal behaviour are particularly heightened among individuals with Posttraumatic Stress Disorder (PTSD). Two theoretical models of suicide, the Cry of Pain Model of suicide (CoP; Williams, 1997) and the Schematic Appraisals Model of Suicide (SAMS; Johnson, Gooding & Tarrier, 2008) have proposed that perceptions of defeat and entrapment are key components of the psychological mechanisms which drive suicidal behaviour. The SAMS has also emphasized the importance of psychological resilience factors for preventing suicide risk. Resilience to suicide has been recently defined as a set of appraisals which buffer the impact of risk factors on suicidal behaviour. The first aim of this thesis was to investigate the role of perceptions of defeat and entrapment in suicidal behaviour in those with full or subthreshold PTSD. The second aim of this thesis was to obtain empirical evidence for the presence of resilience factors to suicidal behaviour in PTSD. Initially, a comprehensive narrative review and a meta-analysis were conducted to examine the magnitude of the association between various forms of suicidal behaviour and a PTSD diagnosis and the role of comorbid depression in this association. Both, the narrative review and the meta-analysis demonstrated a strong positive association between suicidal behaviour and PTSD, and supported the mediating impact of comorbid depression in this association. A re-analysis of a previous dataset of individuals with PTSD was also pursued to establish the relevance of negative perceptions/appraisals to suicidal behaviour in those with PTSD. Next, three empirical studies were designed to investigate the utility of perceptions of defeat and entrapment in explaining suicidal behaviour in those with full or subthreshold PTSD. The outcomes across the three studies supported the hypothesis that defeat and entrapment represent the proximal psychological drivers of suicidal behaviour in PTSD and fully account for the suicidogenic effects of negative self-appraisals and PTSD symptoms. Two additional empirical studies were conducted to examine resilience factors to suicidal behaviour among individuals with full or subthreshold PTSD. The first of these studies provided evidence that high levels of perceived social support buffered the impact of PTSD symptoms on suicidal behaviour. The last study supported the efficacy of a resilience-boosting technique, the Broad-Minded Affective Coping procedure (BMAC), to enhance the experience of positive emotions and improve mood amongst individuals diagnosed with PTSD. Together, the current results support the SAMS' postulation concerning the role of perceptions of defeat and entrapment in the emergence of suicidal behaviour in PTSD and highlight the importance of boosting resilience as a means of targeting suicidal behaviour in those with PTSD. Clinical implications of these findings are outlined throughout the thesis.

Although men are more likely to experience traumatic events, the risk of developing Posttraumatic Stress Disorder is at least twice as high in women than in men after exposure to comparable traumas. These findings are more consistent in response to some types of trauma (e.g., assaultive violence) than others (e.g., natural disaster). There has been very little systematic study of the sources of these gender differences. This study began to explore the contribution of gender-related beliefs about appropriate responses to trauma by investigating the impact of victim sex and trauma type as well as participant sex, sex-role orientation, and personal trauma history on attitudes towards victims. Ninety-three male and 179 female students were administered the Bem Sex Role Inventory, the Trauma History Questionnaire, and a vignette measure of attitudes towards victims. Participants evaluated male victims significantly less favorably than female victims, and females had more positive attitudes towards victims than males. Feminine sex-typed and androgynous women rated victims more favorably than masculine sex-typed men and women. The interaction between sex of victim and trauma type was not significant. A positive relation was observed between personal trauma exposure and attitudes towards male victims among male participants only. These findings contribute towards a theoretical understanding of gender and PTSD, and also have important clinical applications.

Combat veterans with posttraumatic stress disorder (PTSD) related symptoms often require the use of complementary therapeutic aids, such as service dogs, to assist them in their recovery in addition to traditional evidence-based therapy. Anecdotal literature was available on the use of service dogs, but quantitative research has not been conducted to answer the question of what the impact was of the use of service dogs on reducing symptoms of PTSD among combat and non-combat veterans. Attachment theory was one of the most common theoretical frameworks for exploring the use of service dogs for treating combat PTSD. The theoretical framework for this study was derived from Bowlby's theory on attachment and the work done with Ainsworth to review the possible correlations between secure and insecure attachment styles and the impact of using service dogs. Three surveys were selected to measure PTSD related symptoms, service dog tasks, and attachment styles of the 64 participants to be able to look at PTSD-related symptoms and attachment theory in relation to service dog tasks. This study did not show a difference between combat veterans and non-combat veterans who use service dogs in the reduction of PTSD-related symptoms, but the study did show that there was a positive relationship between PTSD-related symptoms and the use of service dogs. Participants' answers supported anecdotal reports of the positive effect of the use of service dogs. The results of the current research provide implications for positive social change by providing important information in relation to service dogs could improve the quality of life and more manageable psychological symptoms, and that attachment styles should be considered as a mitigating factor which was missing in previous research.

Thesis (PhD)--Stellenbosch University, 2014.
ENGLISH ABSTRACT: Posttraumatic stress disorder (PTSD) is a severe, chronic and debilitating psychiatric disorder that can present after the experience of a life-threatening traumatic event. D-cycloserine (DCS), a partial N-methyl-D-aspartate (NMDA) receptor agonist, has been found to augment cognitive behavioural therapy by facilitating fear extinction; however, the precise mechanisms whereby DCS ameliorates fear triggered by a traumatic context remains to be fully elucidated. This study aimed to (i) identify the molecular mechanisms of intrahippocampally administered DCS in facilitating fear extinction in a rat model of PTSD by investigating gene expression profiles in the left dorsal hippocampus (LDH) of male Sprague Dawley rats and (ii) determine whether microRNA (miRNA) expression and DNA methylation mediated these gene expression changes. An adapted version of the PTSD animal model described by Siegmund and Wotjak (2007) was utilised. The total number of 120 rats were grouped into four experimental groups (of 30 rats per group) based on fear conditioning and the intrahippocampal administration of either DCS or saline: (1) fear conditioned + intrahippocampal saline administration (FS), (2) fear conditioned + intrahippocampal DCS administration (FD), (3) control + intrahippocampal saline administration (CS) and (4) control + intrahippocampal DCS administration (CD). Behavioural tests (the light/dark [L/D] avoidance test, forced swim test and open field test) were conducted to assess anxiety and PTSD-like behaviours. The L/D avoidance test was the most sensitive behavioural test of anxiety and was subsequently used to differentiate maladapted (animals that displayed anxiety-like behaviour) and well-adapted (animals that did not display anxiety-like behaviour) subgroups. In order to identify genes that were differentially expressed between FS maladapted (FSM) (n = 6) vs. FD well-adapted (FDW) (n = 6) groups, RNA sequencing was performed on the Illumina HiSeq 2000 which generated more than 60 million reads per sample. This was followed by subsequent bioinformatics analyses (using the software programs TopHat, Bowtie, Cuffdiff and Bio-Ontological Relationship Graph (BORG) database (that identifies genes that may be biologically relevant) to identify biologically relevant differentially expressed genes between the treatment groups. Epigenetic mechanisms mediating observed differences in gene expression were investigated by conducting DNA methylation and miRNAseq analyses in the FDW and FSM experimental groups. DNA methylation was investigated using real-time quantitative PCR (qPCR) amplification followed by high resolution melt analysis on the Rotor-GeneTM 6000. Differences in miRNA expression levels between the FDW and FSM groups were investigated by sequencing the miRNA fraction on the MiSeq platform. The bioinformatics pipeline used to analyse the RNAseq data identified 93 genes that were significantly downregulated in the FDW group compared to the FSM group. Forty-two of these genes were predicted to be biologically relevant (based on BORG analysis). Integrative network analyses revealed subsets of differentially expressed genes common across biological functions, pathways and disorders. The co-administration of DCS and behavioural fear extinction downregulated immune system genes and genes that transcribe proinflammatory and oxidative stress molecules. These molecules mediate neuroinflammation and subsequently cause neuronal damage. DCS also regulated genes involved in learning and memory processes. Additionally, a subset of the genes, which have been found to be associated with disorders that commonly co-occur with PTSD (such as cardiovascular disease, metabolic disease, Alzheimer‘s and Parkinson‘s disease), was downregulated by the co-administration of DCS and behavioural fear extinction. In order to determine whether real-time qPCR analysis would be sensitive enough to detect differential expression in those genes found to be differentially expressed in RNAseq analysis, the expression of nine genes was analysed using SYBR Green qPCR technology. In the LDH, six of the nine genes were found to be differentially expressed between FDW and FSM groups and one gene, matrix metallopeptidase 9 (MMP9), was observed to be differentially expressed between these two groups in the blood. Three of the nine genes for which differential expression levels were investigated using SYBR Green real-time qPCR, contained CpG islands and were used for CpG island DNA methylation analysis. Results indicated that CpG island DNA methylation did not mediate differential gene expression of TRH, NPY or MT2A. Bioinformatics analysis of miRNAseq data identified 23 miRNAs that were differentially expressed between the FDW and FSM groups. Several of these miRNAs have previously been found to be involved in brain development and behavioural measures of anxiety. Furthermore, functional luciferase analysis indicated that the upregulation of rno-mi31a-5p could have facilitated the downregulation of interleukin 1 receptor antagonist gene (IL1RN) as detected in RNAseq. RNAseq and miRNAseq analyses in this PTSD animal model identified differentially expressed genes and miRNAs that serve to broaden our understanding of the mechanism whereby DCS facilitates fear extinction. To this end, immune system genes and genes transcribing proinflammatory and oxidative stress molecules were among the genes that were found to be differentially expressed between the FDW and FSM groups. Based on the results obtained, it can be hypothesised that DCS attenuates neuroinflammation and subsequent neuronal damage, and also regulates genes involved in learning and memory processes. Concomitantly, these gene expression alterations mediate optimal neuronal functioning, plasticity, learning and memory (such as fear extinction memory) which contribute to the fear extinction process. Furthermore, biologically relevant differentially expressed genes that were associated with DCS facilitation of fear extinction and with other chronic medical conditions, such as cardiovascular disease and metabolic diseases, might help to explain the co-occurrence of these disorders with PTSD. In conclusion, Identifying the molecular underpinnings of DCS-mediated fear extinction brings us closer to understanding the process of fear extinction and could, in future work be used to explore novel therapeutic targets to effectively treat PTSD and related disorders.
AFRIKAANSE OPSOMMING: Posttraumatiese stressindroom is 'n ernstige, kroniese aftakelende psigiatriese toestand wat kan ontwikkel na 'n lewensgevaarlike traumatiese gebeurtenis. Daar is bevind dat die gesamentlike toediening van D-sikloserien (DCS), 'n N-metiel-D-aspartaat (NMDA) reseptor agonis, en kognitiewe gedragsterapie effektief is in die bemiddeling van vrees uitwissing; maar die presiese meganisme waar deur DCS die vrees wat deur 'n traumatiese konteks ontlok word verminder, is egter onduidelik. Hierdie studie het beoog om (i) die molekulêre meganismes te identifiseer waardeur intra-hippokampaal toegediende DCS vrees uitwissing fasiliteer, in 'n rot model van posttraumatiese stressindroom, deur geen uitdrukkingsprofiele in the linker dorsale hippokampus (LDH) van manlike Sprague Dawley rotte te ondersoek en (ii) om te bepaal of mikroRNA (miRNA) uitdrukking en DNA metilering die veranderinge in geen uitdrukking bemiddel het. 'n Gewysigde weergawe van die posttraumatiese stressindroom diere model, beskryf deur Siegmund en Wotjak (2007), was gebruik tydens die studie. Rotte was in vier groepe verdeel, vrees kondisionering + soutwater (FS), vrees kondisionering + DCS (FD), kontrole + soutwater (CS) en kontrole + DCS (CD). Gedragstoetse was uitgevoer om angstige, vreesvolle en posttraumatiese stressindroom-tipe gedrag te evalueer. Gedurende die lig/donker (L/D) vermydingstoets het die FS groep aansienlik meer tyd in die donker kompartement deurgebring ('n indikasie van vreesvolle gedrag) in vergelyking met die CS en die FD groepe wat meer tyd in die verligte kompartement deurgebring het ('n indikasie van vreeslose gedrag). Die L/D toets was die mees sensitiewe gedragstoets vir angstige en vreesvolle gedrag en was gevolglik gebruik om die diere te sub-groepeer in wanaangepaste (diere wat angstige en vreesvolle gedrag vertoon het) en goedaangepaste (diere wat nie angstige en vreesvolle gedrag vertoon het nie) subgroepe. Nuwe generasie RNA volgordebepaling (RNAseq) van die LDH RNA en daaropvolgende bioinformatiese analise was uitgevoer om gene te identifiseer wat differensieel uitgedruk is tussen die twee behandelingsgroepe van belang in die betrokke studie, naamlik FS wanaangepaste (FSM) teenoor FD goedaangepaste (FDW) groepe. Epigenetiese analises was uitgevoer om te bepaal of differensieel uitgedrukte miRNAs of CpG-eiland DNA metilasie die differensiële geenuitdrukking bemiddel het. Bioinformatiese analises van die RNAseq data het 93 gene geïdentifiseer waarvan die geen uitdrukking beduidend onderdruk was in die FDW groep in vergelyking met die FSM groep; 42 van hierdie gene was voorspel om biologies relevant te wees. Geïntegreerde netwerk analise het onthul dat sekere van die differensieel uitgedrukte gene gemeenskaplik was tussen verskeie biologiese funksies, padweë en versteurings. DCS het die uitdrukking van immuun-sisteem gene en pro-inflammatoriese en oksidatiewe stres gene verlaag. Hierdie molekules medieer neuro-inflammasie wat gevolglik tot neurale skade lei. DCS het ook gene gereguleer wat betrokke is by leer en geheue prosesse. DCS het onder meer ook die geenuitdrukking verlaag van 'n sub-groep van gene wat voorheen geassosier is met komorbiede versteurings van PTSD. SYBR Green real-time qPCR (werklike tyd kwantitatiewe polimerase ketting reaksie) analise was ondersoek om te bepaal of hierdie metode sensitief genoeg sou wees om die verlaagde geen-uitdrukking van verskeie van die biologies relevante differensieel uitgedrukte gene te identifiseer, in dieselfde LDH komplementêre DNA (cDNA) monsters as wat in die RNAseq gebruik is, asook in die bloed cDNA monsters. SYBR Green real-time qPCR was in staat om ses, van die nege, differensieel uitgedrukte gene in die LDH cDNA monsters en een geen, matriks metallopeptidase 9 (MMP9), in die bloed cDNA monsters op te tel. Drie van die gene waarvoor SYBR Green real-time qPCR gebruik is om differensiële geenuitdrukking te toets, het CpG eilande bevat en was gevolglik gebruik in CpG eiland DNA metilering analises. Resultate het getoon dat CpG eiland DNA metilering nie die differensiële geenuitdrukking van TRH, NPY of MT2A gedryf het nie. Bioinformatiese analises van die miRNAseq data het 23 miRNAs geïdentifiseer wat differensieël uitgedruk was tussen die FDW en FSM groepe. Verskeie van hierdie miRNAs is reeds voorheen beskryf om betrokke te wees in brein ontwikkeling en angs gedrags metings. Funksionele luciferase analises het verder aangedui dat die verhoogde uitdrukking van rno-mi31a-5p moontlik die verlaagde geen uitdrukking van IL1RN, soos waargeneem in die RNAseq data, kon bewerkstellig het. RNAseq en miRNAseq analises in hierdie posttraumatiese stressindroom dieremodel het differensieël uitgedrukte gene en miRNAs geïdentifiseer wat dien om die verstaanswyse te verbreed van hoe DCS die vrees uitwissings proses fasiliteer. Die meganismes waardeur DCS vrees uitwissings bewerkstellig het sluit die verlaging van immuun-sisteem geen-uitdrukking in, sowel as verlaagde uitdrukking van gene wat pro-inflammatoriese en oksidatiewe stress gene transkribeer. DCS het daardeur neuro-inflammasie en gevolglike neurale skade voorkom. DCS het daarmee saam ook gene gereguleer wat betrokke is by leer en geheue prosesse. Hierdie gesamentlike veranderings in geen uitdrukking het gelei tot die uiteindelike bewerkstelling van optimale neurale funksionering, plastisiteit, leer en geheue prosesse wat uiteindelik bygedra het tot vrees uitwissing. Biologies relevante differensieël uitgedrukte gene wat ook geassosieer was met ander kondisies, soos middel verwante versteurings en metaboliese versteurings, kan help om die komorbiditeit met posttraumatiese stressindroom te verklaar. Identifisering van die molekulêre grondslae van DCS bemiddelde vrees uitwissing verbreed ons begrip en verstaan van vrees uitwissing en kan moontlik, in toekomstige navorsing gebruik word om nuwe innoverende terapeutiese teikens te verken om sodoende posttraumatiese stressindroom meer effektief te kan behandel.

Posttraumatic stress disorder (PTSD) is currently known as the silent killer among combat veterans who have served in Operation Iraqi Freedom, Operation Enduring Freedom, and Operation New Dawn. Many combat veterans do not know or understand that they may be suffering from mental illness/disorders such as PTSD and turn to maladaptive behavior, resulting in criminal justice involvement (CJI). The goal of this study was to assess a relationship between PTSD and CJI among combat veterans. This study used cognitive behavior theory to understand the relationship between PTSD, CJI, and combat. This study used a predictive correlational design and statistical analysis of retrospective archival data (N=146) provided by the Department of Veteran Affairs to find the correlation between PTSD, CJI, and combat. The 5 research questions were: Does PTSD positively predict CJI in combat veterans? Does criminal history pre combat positively predict CJI in combat veterans who have PTSD? Does combat trauma experience positively predict CJI in combat veterans with PTSD? Does deployment length positively predict PTSD in combat veterans? And do multiple deployments positively predict PTSD in combat veterans? This study determined that PTSD did not significantly predict CJI and that criminal history did not predict PTSD. However, this study did predict that multiple deployments and length of deployment does predict PTSD in combat veterans. This study provides a way to bring change to how veterans are treated in the criminal justice system. This is important for many reasons, such as the positive social change it will have on the veteran community through providing insight on the changes that need to be made in PTSD awareness education and possible change in assessment and treatment of PTSD.

The goal of this dissertation is to investigate the factors that increase risk for posttraumatic stress disorder (PTSD) in Latinos. Although the overall rates of psychiatric disorders in the Latino community are similar to Caucasian Americans, the risk for PTSD among Latinos is higher. This thesis discusses the general components of trauma and stress, as well as the prevalence of PTSD in various Latino subgroups. This thesis also covers a number of cultural-specific values, stressors, and help-seeking attitudes that increase the risk of PTSD among Latinos. Moreover, a culturally-responsive intervention program treating PTSD among Latinas who are victims of intimate partner violence (IPV) is proposed.

Background Posttraumatic stress disorder (PTSD) brings with it diagnostic symptoms that can be debilitating and persist for years. Left untreated, PTSD can have far-reaching and damaging consequences – for the individual, families, communities, and society at large. While early detection and intervention is recognized as key to the effective treatment of PTSD, many who suffer from PTSD do not seek essential health services. The aim of this study was to answer the research question: based on existing literature, what are the barriers and facilitators to help-seeking for individuals with PTSD? Methods A systematic review, modeled on the Joanna Briggs Institute (JBI) methodology for systematic reviews, examined studies cited in PsycINFO, Medline, Embase, CINAHL and PILOTS published from January 2000 to November 2015. Eligible studies measured barriers and facilitators to help-seeking for adults with PTSD. Two reviewers independently screened citations and double data extraction was exercised. Results Of 1,759 potentially relevant citations, sixteen studies were included, published between 2003 and 2015 and based in five countries, predominantly within the United States (n=12). Thirteen studies focused on military as a target population. Eight principal barrier themes and seven principal facilitator themes were identified, under which supportive subthemes were categorized. Conclusions In identifying prominent barriers and facilitators to help-seeking for individuals with PTSD, this review highlights opportunities to inform policies and programs that educate and promote PTSD knowledge and recognition, reduce public and personal stigma, improve access and availability of care, and encourage social support for patients and families living with PTSD.

In the past decade, the military has deployed approximately 1 million members into combat, and a factor that plagues the military veterans returning from combat is the prevalence of posttraumatic stress disorder (PTSD). A factor to examine is preparedness training before combat because the research has shown that postcombat resilience training has been effective in reducing symptoms of PTSD. Using the social cognitive theory, the purpose of this study was to determine whether self-reported preparedness training before deployments was related to lower severity of self-reported PTSD. Based on prior research, age and gender are other variables that this study examined. Participants were a sample population of veterans who completed a quantitative survey, which included demographics, the Posttraumatic Stress Disorder Check List, and the Training and Deployment Preparation survey, Section H of the DRRI-2. Data collected from the survey were input into the SPSS program and analyzed using multiple linear regressions. Results reflected that preparedness training had an inverse correlation relationship to self-reported PTSD severity, age had a predictive relationship, and gender did not show a significant relationship. It appears that preparedness training for combat does help reduce self-reported severity of PTSD in veterans returning with PTSD symptoms. Providing preparedness training before combat may help in reducing this phenomenon. The results of the present study, developing procedures and therapeutic measures to help veterans in need can be generalized into the mainframe of social and behavioral change for all individuals dealing with PTSD, including first responders.

This qualitative research study explores what veterans living in the Appalachian region experience in receiving care for Posttraumatic Stress Disorder through personal interviews. These interviews will give insight into how veterans in Appalachia perceive their care through specific questions pertaining to healthcare for Posttraumatic Stress Disorder. A convenient sample of veterans attending the specific study site was used for this study. An email, which contained information about the background and nature of the study was used for participant recruitment of veterans. In addition, flyers with the same information were posted throughout the study site. This study will highlight specific details of veterans’ care for Posttraumatic Stress Disorder that will help to accumulate information on the care given to veterans in Appalachia. The Appalachian region is described by the Appalachian Regional Commission as "a 205,000 square mile region that follows the spine of the Appalachian Mountains from southern New York to northern Mississippi"(The Appalachian region- Appalachian Regional Commission, n.d.).

In conducting this study, the ultimate goal was to determine whether parents and other caregivers of individuals with disabilities are experiencing higher levels of Posttraumatic Stress Disorder (PTSD) symptoms as compared to the general population. Individuals with Autism Spectrum Disorder (ASD), intellectual disabilities and other disabilities are more likely to engage in aggressive behaviors such as hitting, kicking, biting, screaming, and self-injurious behavior. Research has also shown that parents of children with special needs have higher levels of stress, and special education teachers are leaving the field due to burnout. In addition to comparing PTSD levels of these caregivers with the general population, results of parents in this sample size were compared with the results of other caregivers. Using the PTSD Checklist – Civilian version (PCL-C), a self-report questionnaire, PTSD total scores, the three subscale scores which included re-experiencing, avoidance/numbing, and hyperarousal were analyzed. In total PCL-C scores and the subscale scores, the respondents’ results were statistically significant, with a mean score of 46.7 as compared to 29 with the general population. In addition, results demonstrated that parents and other caregivers that worked with an individual with a disability who engaged in aggressive behavior had a higher mean score than those who didn’t among this population. When divided into two groups, parents had a higher mean than the other caregivers. Future research can be done on PTSD treatments for this specific population without having to remove them from their environments in order to help reduce burnout and attrition among caregivers of individuals with disabilities.

Since the establishment of the individual augmentee role within the U.S. Navy, little research has examined this nontraditional role associated with combat units. The majority of combat-related posttraumatic stress disorder (PTSD) research has been dedicated to Army and Marine Corps personnel with little research conducted on the Navy population. The purpose of this nonexperimental study was to identify the prevalence of combat-related PTSD symptomology for Navy personnel returning from an augmentee tour. The link between component and tour length and the presence of individual resilience factors on PTSD were examined. The theoretical foundation of this research included the cognitive link between the single and multiple exposures to traumatic events and the automatic conditioned responses related to the combat-related trauma using a retrospective view of archival datasets. Data analysis included a chi square test of independence and factoral analysis of variance to identify the combat-related PTSD symptoms and its associated variables. The sample size was a stratified random sampling of 570 cases. The results of this analysis support an association between location of tours and PTSD symptomology as well as a small effect between number of deployments and PTSD symptomology irrespective of status. These results will benefit the U.S. Navy enlisted personnel by increasing the awareness of a trend in combat-related PTSD, identify protective factors in resilience, and showcase the need for greater focus of these issues within Navy policy and leadership.

Considerable research has demonstrated a link between thoughts of revenge, or vengeful rumination, and the development of posttraumatic stress disorder (PTSD) symptoms, particularly in situations involving interpersonal trauma. Personality factors have been related to both vengefulness and PTSD. No study to date has simultaneously examined the unique contributions of vengefulness and personality factors in the development of PTSD symptoms. Therefore, the present study addressed these questions in an inpatient sample by comparing contributions of the Big Five personality factors and vengeful rumination to the development of PTSD symptoms through correlation, hierarchical regression, and omnibus regression analyses. Results showed that Neuroticism predicted PTSD symptoms better than other personality factors, that Neuroticism and Agreeableness predicted vengeful rumination in opposite directions, and that personality factors and vengeful rumination each added unique variance in the prediction of PTSD symptoms. Future directions and implications are discussed.

Posttraumatic stress disorder (PTSD) is a debilitating mental illness that affects thousands of military service members and veterans every year. Strongly associated with PTSD are symptoms of depression, life satisfaction and physical health complaints. Playing video games has been shown in the past to reduce symptoms of PTSD, other mental illnesses, and reduce the experience of pain. The purpose of this study was to examine these relationships, specifically regarding a 3-4 hour per week duration that has been particularly beneficial to military service members in the past. Participants included n = 400 military service members or veterans who had served in a combat zone and was relatively representative of the U.S. military population. Participants completed a number of measures assessing PTSD and depressive symptoms, life satisfaction, physical health, military service, and video game play behaviors. Results indicated that no relationship exists between the duration of video game play PTSD symptoms severity, unless the PTSD symptoms were present first. A linear relationship was also noted between video game play duration and depressive symptoms. No significant relationship was observed between video game play duration and life satisfaction or physical health ailments. These findings seem to contradict some of the previous literature, though may indicate that playing video games as a utilization of an avoidance strategy could be detrimental to one’s mental health.

Refugee torture survivors often present with a myriad of psychological challenges, such as posttraumatic stress and depression, stemming from their exposure to torture and other pre- and post-settlement experiences (Gong-Guy and colleagues, 1991). The present study examined the moderating effect of four coping processes (i.e., family support, religious beliefs, political beliefs, and will to survive) on the relationship between cumulative torture and posttraumatic stress disorder (PTSD) among a sample of 204 (N=204) adult refugee torture survivors. Subjects completed a demographic questionnaire, the Torture Severity Scale (TSS; Kira, Lewandowski, Templin, Ramaswamy, Ozkan, Hammad, & Mohanesh, 2006), the Clinician Administered PTSD Scale (CAPS-2; Weathers, Keane, & Davidson, 2001), and the Means of Survival Scale (MOS; Kira, 2012). Twenty-three percent (N = 74) of the sample endorsed clinically significant levels of PTSD. Torture and PTSD were positively associated, indicating that greater exposure to cumulative torture is associated with greater trauma symptoms (r[2] = .18, pppppp2 = .039; F (2,323) = 7.55, p=.001. None of the interaction terms examined accounted for significant variation in PTSD symptoms. Study findings will help counseling psychologists devise the most appropriate treatment plans and strategies to treat posttraumatic stress reactions among refugee torture survivors, as well as inform future interventions developed for this vulnerable population.