At least one-quarter of service members who have returned from combat in Iraq and Afghanistan meet the criteria for a mental health diagnosis, of which Posttraumatic Stress Disorder (PTSD) is the most common. Social support provided by close relationships has been shown to be a buffer against PTSD symptoms. However, PTSD can also have devastating effects on couple relationships, hampering this form of social support. One promising intervention for PTSD has been the use of service dogs specially trained to perform tasks related to PTSD symptoms. Anecdotally, there are promising individual outcomes for veterans with PTSD who are partnered with service dogs; however, the effects of these service dogs on the couple relationship for veterans who are married or in long-term relationships has yet to be explored. Seven couples participated in in-depth, semi-structured interviews related to their experiences of their relationship before, during, and after acquiring a service dog trained to respond to PTSD symptoms. Responses were analyzed using interpretative phenomenological analysis. Themes derived were loss of self, living with the enemy, to hope or not to hope, running the gauntlet, pawsitive reinforcements, and turning the tide. Results are weighed against existing literature in the field, clinical and public policy considerations are offered, and directions for future research are proposed. / Master of Science

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.

Indiana University-Purdue University Indianapolis (IUPUI) / This thesis applies the ontological turn to the war fiction of veteran authors, Kurt Vonnegut and Tim O’Brien. It argues that some veteran authors desire to communicate truth through fiction. Choosing to communicate truth through fiction hints at a new perspective on reality and existence that may not be readily accepted or understood by those who lack combat experience. The non-veteran understanding of war can be more informed by entertaining the idea that a multiplicity of realities exists. Affirming the combat veteran reality—the post-war ontology—and acknowledging the non-veteran reality—rooted in what I label “pre-war” or “civilian” ontology—helps enhance the reader’s understanding of what veteran authors attempt to communicate through fiction. This approach reframes the dialogic interaction between the reader and the perspectives presented in veteran author’s fiction through an emphasis on “radical alterity” to the point that telling and reading such stories represent distinct ontological journeys. Both Kurt Vonnegut and Tim O’Brien provide intriguing perspectives on reality through their fiction, particularly in the way their characters perceive and express morality, guilt, time, mortality, and even existence. Vonnegut and O’Brien’s war experiences inform these perspectives. This does not imply that the authors hold an identical perspective on the world or that combat experience yields an ontological understanding of the world common to every veteran. It simply asserts that applying the ontological turn to these writings, and the writings of other combat veterans, reveals that those who experience combat first-hand often walk away from those experiences with a changed ontological perspective.

Le chien de service (CS) émerge comme modalité d’assistance à la gestion des symptômes reliés au trouble de stress post-traumatique (TSPT) auprès des vétérans. Les tâches qu’il accomplit et les changements qu’il induit sur l’activité physique et le sommeil, deux des habitudes de vie perturbées par le TSPT, demeurent peu étudiés à ce jour. Les objectifs spécifiques de cette thèse étaient de : 1) spécifier les rôles et les tâches accomplis par le CSTSPT, les avantages et les obstacles reliés à son utilisation ainsi que les recommandations souhaitables pour améliorer l’efficacité du CSTSPT, 2) décrire la sédentarité, l’activité physique, et le sommeil avant et après l’acquisition d’un CSTSPT à l’aide de l’actigraphie et de questionnaires standardisés et examiner si les changements post-acquisition s’accompagnaient d’un élargissement des aires de déplacement et d’une diminution de l’intensité des symptômes reliés au TSPT et ceux dépressifs, et 3) explorer s’il y a des associations entre la sédentarité, l’activité physique, et l’intensité des symptômes reliés au TSPT et ceux dépressifs avant l’acquisition d’un CSTSPT, ainsi qu’entre les changements de la sédentarité, l’activité physique, et le sommeil, avant et après l’acquisition d’un CSTSPT auprès de vétérans vivant avec un TSPT chronique. Ces objectifs ont été poursuivis à l’aide : d’une étude de cas exploratoire transversale réalisée auprès de 10 vétérans experts utilisant leur CSTSPT depuis deux à quatre ans (objectif/étude 1), une étude exploratoire prépost intervention sans groupe contrôle complétée par 18 vétérans vivant avec un TSPT chronique (objectif/étude 2), et d’une étude corrélationnelle réalisée auprès 27 vétérans vivant un TSPT chronique (objectif/étude 3). Les résultats de l’étude 1 soutiennent que le CSTSPT accomplit plusieurs rôles (p. ex., détecter les symptômes intrusifs) et tâches (p. ex., réveiller le vétéran lors d’un cauchemar), et qu’il procure plusieurs avantages (p. ex. faciliter la gestion des symptômes), malgré la présence d’obstacles (p. ex. coûts reliés à son utilisation). Les constats rapportés supportent l’émission de recommandations (p. ex. création d’un programme national de CSTSPT) afin d’améliorer son utilisation. Les résultats de l’étude 2 indiquent que l’acquisition d’un CSTSPT améliore le pourcentage de temps quotidien d’éveil dédié à réaliser de l’activité physique d’intensité modérée, le nombre de pas réalisés par jour, l’étendue des aires de déplacement (c.-à-d., voisinage et extérieur de la ville), et l’intensité des symptômes reliés au TSPT et ceux dépressifs. Aucune amélioration significative n’a été observée pour le sommeil mesuré par actigraphie, alors que les résultats Pittsburgh Sleep Quality Index indiquent une amélioration de la qualité du sommeil et de l’efficacité du sommeil, ainsi qu’une diminution des perturbations du sommeil. Les résultats de l’étude 3 révèlent des associations faibles et modérées qui suggèrent la présence d’effets synergiques entre l’activité physique, le sommeil et les symptômes associés au TSPT et ceux dépressifs. En conclusion, les résultats confirment que le CSTSPT représente une modalité d’assistance prometteuse pour la gestion des symptômes reliés au trouble de stress post-traumatique (TSPT). / The psychiatric service dog (SDPTSD) is emerging as an assistive modality for the management of symptoms associated with post-traumatic stress disorder (PTSD) among veterans. The scientific evidence pertaining to the tasks the SDPTSD accomplishes and the changes brought about its acquiring on physical activity and sleep, two of the life habits perturbed by PTSD, remain limited. The specific objectives of this thesis were thus to: 1) specify the roles and tasks accomplished by the SDPTSD, the advantages and obstacles associated to its use, and recommendations to increase its efficacy, 2) describe sedentariness, physical activity, and sleep before and after the acquiring of a SDPTSD using actigraphy and standardized questionnaires and examining if the changes reported following its acquiring were accompanied by an expansion of mobility areas and a diminution of the intensity of PTSD-related and depressive symptoms, and 3) explore the associations between 1) sedentariness, physical activity, and the intensity of PTSD-related and depressive symptoms, and 2) sedentariness, physical activity, and sleep three months before and nine months after the acquiring of a SDPTSD among veterans living with chronic PTSD. These specific objectives were carried out with an exploratory cross-sectional case study realized among 10 expert veterans who had been using their SDPTSD for two to four years (objective/study 1), a prepost intervention exploratory study without a control group realized among 18 veterans living with chronic PTSD (objective/study 2), and a correlational study realized among 27 veterans living with chronic PTSD (objective/study 3). In brief, the results of study 1 showed that the SDPTSD accomplishes several roles (e.g., detecting intrusive symptoms), and tasks (e.g., awakening the veteran during a nightmare), and that it brings several advantages (e.g., facilitating symptom management), despite obstacles (e.g., cost related to its use). Observations gathered in this study support issuance of recommendations (e.g., creating a national SDPTSD program) to improve its use. The results of study 2 suggest that the acquiring of a SDPTSD improves the percentage of daily awake time dedicated to practising physical activity of moderate intensity, the number of steps per day, mobility areas (neighborhood and outside of town), and the intensity of PTSD-related and depressive symptoms. No significative improvements emerged when considering actigraphic sleep results, although results at the Pittsburgh Sleep Quality Index revealed an improved sleep quality and efficiency and a diminution of sleep perturbations. The results of study 3 uncovered weak and moderate correlations suggesting the presence of synergic effects between physical activity, sleep and the intensity of PTSD-related and depressive symptoms. In conclusion, these encouraging results confirm that the SDPTSD is a promising assistive aid in the management of PTSD-related symptoms.