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.

This program of research investigated the nature and processes of autobiographical memory deficits in posttraumatic stress disorder (PTSD). Study 1 examined the proposition that difficulties in the retrieval of specific memories present a risk factor for posttraumatic psychopathology. A prospective study of fire-fighters found that a significant predictor of posttraumatic stress was a deficit in retrieving specific memories to positive cues before trauma. Study 2 investigated whether autobiographical retrieval deficits in PTSD can be modified by psychological treatment. Results found that as PTSD symptoms reduced following treatment, individuals with PTSD retrieved more specific memories to positive cues. Together, these results indicated that specific retrieval deficits to positive cues present a vulnerability factor for PTSD. However, this memory style appears to be receptive to modification following therapy. Study 3 investigated the association between autobiographical retrieval deficits and impaired problemsolving in PTSD. Participants with PTSD retrieved more overgeneral categoric memories and took longer to retrieve memories than non-PTSD trauma controls. This deficit was associated with impaired social problem-solving, suggesting that specific retrieval is related to successful problem solving. In an analogue design, Studies 4 and 5 investigated the proposition that resource limitations may underpin autobiographical retrieval deficits. Results generally supported the proposal that reduced cognitive resources may be a mechanism contributing to specific retrieval deficits. Studies 6 and 7 examined rumination as another possible mechanism responsible for these retrieval deficits. Study 6 found high anxious participants retrieved fewer specific memories to positive cues following rumination, compared to distraction. Study 7 found evidence that negative rumination in the high anxious group increased categoric retrieval, whereas positive rumination had no effect. Study 8 found retrieval of trauma-related self-defining memories was strongly associated with personal goals connected to the trauma. Study 9 found that discrepancies in one???s self construct were related to the retrieval of trauma memories to positive cues. This program of research extends current theories of autobiographical memory by identifying risk, maintenance, and recovery factors in the context of PTSD.

The term “post-traumatic stress disorder” (PTSD) is a relatively new diagnostic label, being formally recognized in 1980 in the Diagnostic Statistical Manual for Psychiatric Illness – Third Edition (DSM-III) of the American Psychiatric Association (APA, 1980). Complex Post-Traumatic Stress Disorder (CP) is a more recently discussed, and newly-classified, phenomenon, initially discussed in the early 1990s (Herman, 1992a). Thus, as research into effective treatments for CP is sparse, the treatment of CP is the topic of this study, in which a guideline-based treatment program developed by the researcher for the treatment of CP is implemented and evaluated. Ten individuals participated in this study, undertaking individualized, guideline-based treatment programs spanning a period of six months. In providing background information relevant to this study, an explanation is provided regarding the nature of CP, and the reasons for its consideration as a separate phenomenon to PTSD. The adequacy of the PTSD formulation in enabling effective assessment and treatment of CP is also explored, with endorsement of previous researchers’ conclusions that the CP construct is more useful than the PTSD construct for assessing and treating survivors of long-term and multiple forms of abuse. The PTSD classification is restrictive, and not necessarily appropriate for certain forms of trauma (such as prolonged trauma, or multiple forms of trauma), as such trauma experiences may lead to specific effects that lay outside those formerly associated with PTSD. Such effects include alterations in affect regulation, consciousness, self-perception, interpersonal relationships, and in systems of meaning. Following discussion regarding the PTSD/CP classification, an examination of treatment methods currently used in the treatment of PTSD, and a review of treatment outcome studies, takes place. The adequacy of primary treatment methods in treating CP symptoms is then examined, with the conclusion that a range of treatment methods could potentially be useful in the treatment of CP symptoms. Individuals with a diagnosis of CP may benefit from the adoption of an eclectic approach, drawing on different treatment options for different symptoms, and constantly evaluating client progress and re-evaluating interventions. This review of treatment approaches is followed by details of an initial study undertaken to obtain feedback from individuals who had suffered long-term/multiple trauma and who had received treatment. Participants in this initial study were asked open-ended questions regarding the treatment approach they had experienced, the most useful aspect of the treatment, the least useful aspect, and other strategies/treatment approaches that may have been useful – but which were not used. The feedback obtained from these individuals was used to inform the development of treatment guidelines for use in the main study, as were recommendations made by Chu (1998). The predominant focus of the treatment guidelines was “ego strengthening”, a term coined by Chu (1998) to describe the “initial (sometimes lengthy) period of developing fundamental skills in maintaining supportive relationships, developing self-care strategies, coping with symptomatology, improving functioning, and establishing a positive self identity” (p.75). Using a case study approach, data are then presented relating to each of the ten individuals involved in the treatment program: details of his/her trauma experience(s)and the impact of the trauma (as perceived by each individual); details of each individual’s treatment program (as planned, and as implemented); post-treatment evaluation of the positive and negative aspects of the treatment program (from the therapist’s perspective); and details of the symptoms reported by the individual post-treatment, via psychometric assessment and also during interview. Analysis and discussion of the data relating to the ten participants in the study are the focal point of this study. The evaluation of the effectiveness of each individual’s treatment has been based predominantly on qualitative data, obtained from an analysis of language (discourse analysis) used by participants to describe their symptoms pre- and post-treatment. Both blatant and subtle changes in the language used by participants to describe themselves, their behaviour, and their relationships pre- and post-treatment have provided an insight into the possible changes that occurred as a result of the treatment program. The language used by participants has been a rich source of data, one that has enabled the researcher to obtain information that could not be obtained using psychometric assessment methods. Most of the participants in this study portrayed notable changes in many of the CP symptoms, including being more stable and having improved capacity to explore their early abuse. Although no direct cause-effect relationship between the participants’ treatment program and the improvements described can be established from this study, the participants’ perception that the program assisted them with their symptoms, and reported many aspects of “ego strengthening”, is of major importance. Such self-perception of strength and empowerment is important if an individual is going to be able to deal with past trauma experiences. In fact, abreactive work may have a greater chance of succeeding if those who have experienced long-term or multiple trauma are feeling more empowered, and more stable, as were the participants in this study (post-intervention). In concluding this study, recommendations have been made in regard to the use of guideline-based treatment programs in the responsible treatment of CP. Strengths and limitations of this study have also been highlighted, and recommendations have been made regarding possibilities for future research related to CP treatment. On the whole, this study has supported strongly other research that highlights the importance of focusing on “ego strengthening” in assisting those who have suffered long-term/multiple trauma experiences. Thus, a guideline-based program focusing on assisting sufferers of long-term trauma with some, or all, of the symptoms of CP, is recommended as an important first stage of any treatment of individuals who have experienced long-term/multiple trauma, allowing them to develop the emotional and psychological strength required to deal with past traumatic events. Clinicians who are treating patients whose history depicts long-term or multiple trauma experiences (either from their childhood, or at some stage in their adult life) need, therefore, to be mindful of assessing individuals for symptoms of CP – so that they can treat these symptoms prior to engaging in any work associated directly with the past traumatic experiences.

The clinical adherence to and combination of methods with EMDR to treat PTSD has not been explored. This is of some concern as 27 000 clinicians are trained in EMDR globally. This exploratory study gained information on Australian trained EMDR clinicians' adherence to EMDR, and the methods they combined with EMDR to treat PTSD. Survey responses from 126 clinicians were analysed using predominantly descriptive statistics. The findings of this study showed that the majority of respondents perceived that they closely adhered to the standard EMDR treatment. However, respondents reported adhering more closely to the phases than the steps of EMDR. Statistically significant findings showed that more experienced EMDR level 1 clinicians were more likely to add steps and phases to EMDR, and to change the standard sequence of steps. Clinicians with greater years of experience were also more likely to change the standard sequence of steps. In addition, more experienced EMDR level 2 clinicians, were less likely to educate their clients about PTSD. Almost all respondents combined EMDR with other methods to treat PTSD. Combined methods included CBT, hypnosis / relaxation, system / solution focused methods and exposure. This research has contributed to theory and practice by uncovering that clinicians appear to use EMDR differently to researchers, by changing EMDR to meet client needs, combining EMDR with other methods and Holly Byron 16/9/99 vi therapies, and introducing EMDR in the mid stage of treatment. These findings are vital to reduce the scientist-practitioner divide by accurately testing EMDR's efficacy and enabling future controlled trials to reflect the clinical use of EMDR.

Thesis (Ph. D.)--University of Hong Kong, 2007. / Title proper from title frame. Also available in printed format.

This program of research investigated the nature and processes of autobiographical memory deficits in posttraumatic stress disorder (PTSD). Study 1 examined the proposition that difficulties in the retrieval of specific memories present a risk factor for posttraumatic psychopathology. A prospective study of fire-fighters found that a significant predictor of posttraumatic stress was a deficit in retrieving specific memories to positive cues before trauma. Study 2 investigated whether autobiographical retrieval deficits in PTSD can be modified by psychological treatment. Results found that as PTSD symptoms reduced following treatment, individuals with PTSD retrieved more specific memories to positive cues. Together, these results indicated that specific retrieval deficits to positive cues present a vulnerability factor for PTSD. However, this memory style appears to be receptive to modification following therapy. Study 3 investigated the association between autobiographical retrieval deficits and impaired problemsolving in PTSD. Participants with PTSD retrieved more overgeneral categoric memories and took longer to retrieve memories than non-PTSD trauma controls. This deficit was associated with impaired social problem-solving, suggesting that specific retrieval is related to successful problem solving. In an analogue design, Studies 4 and 5 investigated the proposition that resource limitations may underpin autobiographical retrieval deficits. Results generally supported the proposal that reduced cognitive resources may be a mechanism contributing to specific retrieval deficits. Studies 6 and 7 examined rumination as another possible mechanism responsible for these retrieval deficits. Study 6 found high anxious participants retrieved fewer specific memories to positive cues following rumination, compared to distraction. Study 7 found evidence that negative rumination in the high anxious group increased categoric retrieval, whereas positive rumination had no effect. Study 8 found retrieval of trauma-related self-defining memories was strongly associated with personal goals connected to the trauma. Study 9 found that discrepancies in one???s self construct were related to the retrieval of trauma memories to positive cues. This program of research extends current theories of autobiographical memory by identifying risk, maintenance, and recovery factors in the context of PTSD.

This program of research investigated the nature and processes of autobiographical memory deficits in posttraumatic stress disorder (PTSD). Study 1 examined the proposition that difficulties in the retrieval of specific memories present a risk factor for posttraumatic psychopathology. A prospective study of fire-fighters found that a significant predictor of posttraumatic stress was a deficit in retrieving specific memories to positive cues before trauma. Study 2 investigated whether autobiographical retrieval deficits in PTSD can be modified by psychological treatment. Results found that as PTSD symptoms reduced following treatment, individuals with PTSD retrieved more specific memories to positive cues. Together, these results indicated that specific retrieval deficits to positive cues present a vulnerability factor for PTSD. However, this memory style appears to be receptive to modification following therapy. Study 3 investigated the association between autobiographical retrieval deficits and impaired problemsolving in PTSD. Participants with PTSD retrieved more overgeneral categoric memories and took longer to retrieve memories than non-PTSD trauma controls. This deficit was associated with impaired social problem-solving, suggesting that specific retrieval is related to successful problem solving. In an analogue design, Studies 4 and 5 investigated the proposition that resource limitations may underpin autobiographical retrieval deficits. Results generally supported the proposal that reduced cognitive resources may be a mechanism contributing to specific retrieval deficits. Studies 6 and 7 examined rumination as another possible mechanism responsible for these retrieval deficits. Study 6 found high anxious participants retrieved fewer specific memories to positive cues following rumination, compared to distraction. Study 7 found evidence that negative rumination in the high anxious group increased categoric retrieval, whereas positive rumination had no effect. Study 8 found retrieval of trauma-related self-defining memories was strongly associated with personal goals connected to the trauma. Study 9 found that discrepancies in one???s self construct were related to the retrieval of trauma memories to positive cues. This program of research extends current theories of autobiographical memory by identifying risk, maintenance, and recovery factors in the context of PTSD.

Thesis (Ph.D.)--University of Nebraska-Lincoln, 2006. / Title from title screen (site viewed on Feb. 22, 2007). PDF text: vii, 119 p. : ill. UMI publication number: AAT 3217587. Includes bibliographical references. Also available in paper, microfilm and microfiche format.

This thesis explores mental health problems relating to war and natural disaster and suicidal behaviour in the Nicaraguan population. The more specific aims of the study were to assess the prevalence and sociodemographic correlates of mental disorder in a community-based study during time of war (Paper I), to assess the mental health impact of Hurricane Mitch in 1998 (Paper II), to assess the incidence of hospitalized parasuicide cases and groups at risk (Paper III), and to examine suicide intent among attempters relating to gender, suicide method and sociodemographic factors and identify predictors for repetition of an attempt (Paper IV). Method: Based on 4453 family food ration books for families living in an urban area of León, Subtiava, 219 families including 746 adults were selected through a systematic sampling procedure. The study was conducted in 1987 during the war. We were able to reach 584 adults for interview according to the Present State Examination for ICD-9 diagnoses and Self-Report Questionnaire (Paper I). In Paper II, 496 adult primary health care attendees were interviewed six months after Hurricane Mitch according to the Harvard Trauma Questionnaire and were diagnosed for post-traumatic stress disorder (PTSD) according to DSM-IV. In Papers III and IV, all cases from León city admitted to HEODRA Hospital for a suicide attempt over a three-year period (n=233) were interviewed regarding sociodemographic factors and method, time and place of the suicide attempt. A subgroup of 204 cases was interviewed using the Suicide Intent Scale (SIS). Out of those 106 cases were followed-up regarding repetition of attempt or completed suicide after a mean period of 1172 days. Results: In the Paper I study, the one-month prevalence of any mental disorder was 28.8% for men and 30.8% for women. Among men, alcoholism was the most common diagnosis, whereas neurosis, crisis reaction and depression were dominant among women. Alcoholism was scored as the second most severe disorder after psychosis in terms of functional level. In the Mitch study six months after the hurricane, traumatic events were common and 39% reported death or serious injury of a close relative as a result of the hurricane. The prevalence of PTSD ranged from 4.5% in the least damaged area to 9.0% in the worst damaged area. At the prolonged follow-up six months later, half of the cases still retained their diagnosis. Trauma-related symptoms were common and death of a relative, destroyed house, female sex, illiteracy and previous mental health problems were associated with a higher level of symptoms. Suicidal ideation was reported among 8.5% and was significantly associated with previous mental health problems and illiteracy. The studies regarding hospitalized parasuicides showed the highest rate among girls aged 15–19 years (302 attempts per 100 000 inhabitants and year). After drug intoxication, pesticide was the second most common method and most often used by men (23%). Half of the women had recent contact with health care services before attempting suicide. There were significant peaks regarding time of attempt in terms of seasonal and diurnal distribution. Overall scores regarding seriousness of the intent (SIS) were equal between the sexes, but the pattern of SIS items showed significant gender differences in terms of relation to background factors and method used. For women, having a child was one factor associated with higher seriousness. Factor analysis of SIS items revealed a four-factor solution, explaining 59% of the variance. Risk for fatal repetition was 3.2% after three years and for non-fatal repetition 4.8%. During follow-up, three men (11%) had completed suicide but no women. We failed to identify any predictors for repetition from background factors or SIS. Conclusion: The studies have identified different groups at risk for mental health problems relating to war and disasters. Parasuicide rates equalled those from European countries. Whereas young girls dominated, attempts among men were more severe in terms of the methods used and completed suicide at follow-up. SIS seemed to give a meaningful pattern among women but not for men. In our study, seriousness of attempt in terms of method or suicide intent did not predict repetition. Overall non-fatal repetition rate was very low as compared to other studies.

The curiosity of different beliefs to “tragedy” between the two worlds, Eastern where tragedy is unpleasant and Western where tragedy is praised as high art form since Ancient Greek. The reason that they are very different as two ends from one point and how to present them directly to understandable stage in art forms itself are questioned. This essay is a research into philosophical living and belief relates to tragedy in Eastern and Western views toward tragedy in art forms. The way tragedy has been put differently and the way people treat this feeling. There is a border which is deep-seated into each cultures. The relation of time is used to explain tragedy in Ancient Greek. Western tragedy is big enough to play a main role while Eastern tragedy play a part of the whole in one legend or story. The study of Andy Warhol’s method “Traumatic Realism” which is relevant to starting question explains the direction of using repetition as presentation in order to bring viewers get into trauma at its surface. Picasso’s painting “Tragedy”, Edward Gorey’s storytelling illustration “The Hapless Child”, and Marina Abramovic’s performance “Balkan Baroque”, are used to discuss their techniques and statements based on tragedy from different forms. There is a touching point from Warhol’s and Abramovic’s works. Conclusion talks about the method to present tragedy right there in the work. Selections of pictures are used to tell direction of tragedy in the work. Hierarchy of perception and changing of time in works are explained by Ancient Greek tragedy philosophy and Warhol’s repetition. Feeling is gradually changed. Traces can be found. Time is taking it away.