For some people, exposure to trauma results in the development of psychological maladjustment in the form of posttraumatic stress disorder. Veterans returning from combat zones tend to meet criteria for PTSD at rates significantly higher than what is observed in the general population. Mental health professionals, particularly those working with U.S. Department of Veterans Affairs, play an important role in the recovery of these Veterans. Research suggests that facilitating trauma therapy and/or being exposed second-hand to traumatic material can have negative consequences for the therapist. The current study focuses on the impact of trauma therapy on therapists who work with combat veterans through the VA. The study includes seven psychologists in the state of Iowa employed by VA. Findings support previous research by highlighting the impact therapy has on the clinician providing it. The impact of facilitating trauma therapy or working with traumatized populations is not wholly positive or negative, but often both. The current study suggests that what clinicians do in response to hearing trauma narratives that is of key importance.

The State of Kentucky has a high and increasing number of reported cases of traumatic brain injury (TBI), mostly attributed to motor vehicle crashes, falls, and being struck by or against an object. Young adults are among those most at-risk for experiencing a TBI through motor vehicle crashes. Using existing data from the Kentucky Post-School Outcomes Center (KyPSO), 90 youth with TBI were identified within a period of 6-years of the longitudinal study (2012-2017). The majority were males and White. Descriptive statistics, chi square, and logistic regression were used to examine the post-secondary outcomes for youth with TBI, using four demographic variables: gender, ethnicity, residence, and rural or urban status. None of these were associated with post-secondary outcomes for the sample. The results indicated that more than 50% of the youth with TBI had positive outcomes, yet they rarely used the services provided for them in the schools or at the workplace. This study suggests that, although the demographic characteristics did not predict post-secondary outcomes, other variables within education and employment yielded interesting results that could benefit rehabilitation counselors.

In the United States, 2.8 million people suffer a traumatic brain injury (TBI) annually. Between 25%-50% of TBI injuries happen under alcohol intoxication. It is not understood how alcohol impacts patient outcomes via secondary injury pathways. Secondary injury pathways offer a window for therapeutic interventions, but there has been little success finding effective medications. Slice cultures offer a way to study secondary injury mechanisms in a controlled manner. The transection injury can model excitotoxicy seen following TBI. The current studies examined the effect of alcohol intoxication and withdrawal at the time of injury, and the effect of a calpain inhibitor (MDL-28170) on cell death following a transection injury. Intoxication had no effect on cell death compared to the TBI condition. In the ethanol withdrawal (EWD) study, EWD did not increase cell death following the TBI except at 72 hours. There was no effect of MDL on cell death. The severity of the model may have caused a ceiling effect. Additionally, imaging points may not have been sufficient for proper characterization. Future studies should use a different injury mechanism and other imaging times should be considered.

Researchers have agreed that most rape victims vii experience stress-related symptoms similar to post-traumatic stress disorder. There have also been numerous studies that have tried to predict the severity of those stress-related symptoms, but the literature is inconclusive. Lack of perceived control is consistently mentioned in the rape research literature as being present in rape victims, but no study has empirically examined the relationship between perceived control and a rape victim's stress-related symptoms. The purpose of this study was to empirically examine the relationship between perceived control and stress-related symptoms in rape victims. This was accomplished by comparing a group of 33 subjects who reported being victims of rape with a group of 50 subjects who did not report being victims of rape. Mean stress-related symptom scores were correlated with perceived control scores; also, factors, including group membership and the time elapsed since a rape, were regressed onto the subjects' stress-related symptom scores. The correlations between stress-related symptoms and perceived control in the rape victim group were statistically significant, but the relationship was not present for the nonvictim group. Also, nonsignificant results were obtained for joint effects between perceived control and group membership, along with perceived control and time since a victim had been raped. The results suggest that low perceived control is a good predictor for elevated stress-related symptoms. Further research may clarify the relationship between perceived control and stress-related symptoms in rape victims.

La réalité clinique que nous rencontrons dans un cadre psychanalytique classique ou lors desséances psychanalytiques nous amène, souvent en premier-plan, des moments où les patientsutilisent ce cadre comme un instrument de construction, une construction qui se réalise dans lenégatif de la relation avec le psychanalyste, comme une tentative de recréer la « formeoriginaire ». Il s’agit des moments dans lesquels le patient amène dans la situation analytique desformes de manifestation des expériences archaïques ou du potentiel traumatique, des formesappartenant à un espace-temps non psychisé, potentiel, un temps qui garde l’actualité de sesexpressions suite à un manque traitement, d’élaboration de ses contenus.J’ai commencé en partant des deux hypothèses suivantes :L’apparition violente des éléments archaïques ou celle du potentiel traumatique dans la situationanalytique représente une forme de manifestation de l’actuel, qui n’a pas la forme élaborée d’unemétaphore, ni la forme primaire de la représentation, mais une forme archaïque, inaccessible à lapsychisation, dans une forme semblable à la présentation, Darstellung, qui aspire à la représentation,c’est-à-dire à une transformation dans une forme accessible aux processus primairesd’élaboration.Au moment où les expériences archaïques et le potentiel traumatique pénètrent violemment lasituation analytique avec des réalités archaïques en répétant un actuel qui est en dehors du tempspsychique de celui des patients, ceux-là ils veulent vivre et se trouver un Ici et Maintenant.Chacun des cas présentés dans cette thèse représente des expériences qui ont tout d'aborddémarrées de l'exploration du potentiel de chaque situation clinique à part. Le cadrepsychanalytique, le cadre de l'analyse avec les enfants institutionnalisés ou le cadre desconsultations psychanalytiques avec les couples mère-enfant offrent une potentialité spatiotemporelledans laquelle la dynamique relationnelle bénéficie d'un espace et temps desexpressions flottantes et associatives. Ce processus de la libre dynamique des contenus amenéspar les patients et celle des formes dont je les ai reçues et élaborées ces contenus ont représentél'accès à cette expérience d'ici et maintenant qui nous a porté vers ce qui a finalement représentéla solution de sortie de l'impasse et celle de continuer les processus de transformation. / The clinical situations we encounter within the classic psychoanalytical setting during thepsychoanalytic sessions bring us, often in foreground, moments when the patients use the settingas a construction tool, a construction that is developed in the negative of the relationship betweenthe patient and the psychoanalyst, as an attempt to recreate the "original shape". These are themoments in which the patient brings within the analytic situation different forms of expression ofthe archaic experiences or of the traumatic potential, forms coming from a space-time nonintegrated,a time that keeps the actuality of his expressions due to an not-enough elaboration ofits contents.I started on the basis of the following hypothesis:The violent appearance of the archaic elements or of the traumatic potential within the analyticsituation is a form of manifestation of the actual, which has not been developed the form of ametaphor, nor the primary form of representation, but an archaic form, inaccessible to thesymbolization process, in a shape similar to the presentation, Darstellung, which aspires to representation,that is to say, to a transformation in a form accessible to the primary developmentalprocesses.. When the archaic experiences and traumatic potential violently penetrate the analytic situationwith archaic realities repeating an actual that is outside of the psychic time of the patients, thosethey want to live and be a Here and Now.6 Each of the cases presented in this thesis represents experiences that first started to explore thepotential of each clinical situation at hand. The psychoanalytic setting, the setting of the analysiswith institutionalized children or the setting of the psychoanalytic consultations with the motherchildcouples, offer a spatiotemporal potentiality in which the relational dynamics benefit from aspace and time in a floating and associative expression. This process of free dynamic contentbrought by patients together with the forms in which I have received and developed such contentopened the access to the experience of the here and now, bringing us to what eventuallyrepresented the solution exit from the impasse and that continue the developing andtransformation process.

Current theories of PTSD propose that impaired retrieval of trauma memories may impede processing of these memories and subsequent trauma recovery. This thesis investigated memory retrieval processes in trauma survivors with and without symptoms of posttraumatic stress, and in non-traumatised individuals exposed to a highly arousing event. Study 1 examined deliberate avoidance of unwanted memories in recent trauma survivors. The results indicated that attempts to forget were associated with poorer recall of forgotten information, but the size of this effect did not depend on the presence or absence of Acute Stress Disorder (ASD). Study 2 investigated automatic retrieval inhibition in trauma survivors with or without Posttraumatic Stress Disorder (PTSD). The results suggested that repeated retrieval of trauma-related information by individuals with PTSD can cause inhibition of related, but unpractised information. Studies 3 and 4 examined the relationship between the vantage point of trauma memories, avoidance and posttraumatic stress symptomatology. The findings indicated that recalling a traumatic event from an observer perspective is associated with post trauma avoidance. They also showed that an observer vantage point in the initial few weeks after trauma is associated with poorer long-term post trauma adjustment. Studies 5, 6 and 7 were analogue studies which analysed the impact of heightened arousal on memory retrieval in novice skydivers. The results suggested that elevated arousal can interfere with retrieval of information related to the arousal-inducing event. Study 7 also indicated that autobiographical memory for the event may be impaired. Finally, Study 8 examined the qualities of trauma memories that were accessed via different modes of retrieval. The results provided evidence that intrusive memories were experienced as more realistic and with more intense affect than memories for the same event that were deliberately retrieved. Together, the findings of this program of research extend current theories of PTSD by highlighting the mechanisms through which retrieval of trauma memories may be impaired. The results suggest that the quality of trauma memories is affected by avoidance processes, elevated arousal and level of conscious control the individual exerts over retrieval.

Comorbidity between substance use disorders and post traumatic stress disorder (PTSD) is common. Despite evidence to suggest that people with heroin dependence are at particular risk of PTSD, there is a dearth of research focussing on the interrelationship between these disorders. The present thesis aims to identify the prevalence of PTSD among people with heroin dependence, the correlates of this comorbidity, and its impact on treatment outcomes, the utilisation of treatment services, and treatment costs. Study 1 examines the epidemiology of PTSD and heroin dependence among 10,641 Australian adults who participated in the National Survey of Mental Health and Wellbeing. The prevalence of PTSD was highest among people with heroin or other opioid use disorders compared with any other drug class (33.2%). Comorbid PTSD was associated with poorer occupational functioning, and poorer physical and mental health. While general population studies provide crucial population estimates they do not allow for a detailed examination of the relationship between highly disabling but low prevalence disorders. The remaining studies were undertaken using a sample of 615 treatment seeking and non-treatment seeking dependent heroin users. Study 2 examines the prevalence and correlates of this comorbidity. PTSD was common (lifetime 41%; current 31%) and was associated with a more severe clinical profile. Studies 3 and 4 were based on follow-up data on this large cohort. Study 3 is the first study to examine the impact of PTSD on 2 year treatment outcomes for heroin dependence. Across the 2 year period, those with current PTSD at baseline performed more poorly in terms of their occupational functioning, physical and mental health. Study 4 found that this did not equate to the greater use of treatment services or an increased cost to the health care system among those with PTSD. It is concluded that PTSD and heroin dependence are highly comorbid conditions, and that this comorbidity is associated with poorer functioning and poorer treatment outcomes. Individuals entering treatment for heroin dependence should be assessed for PTSD so that they may receive appropriate treatment and referral. Further research is also needed to determine how best to treat this comorbidity.

This thesis explores the ways in which a number of individuals survived their experiences of severe and perpetrated trauma. I theorise the participant’s survival adaptations in terms of hope which I positioned as being an active relational process. A case study method was used to collect data from intersubjective-psychoanalytically informed therapy sessions, from three participants who each received 12, 60 minute therapy sessions. I utilised a hermeneutic ontology from the work of Gadamer, who contended that the development of understanding and meanings results from an active intersubjective process. This ontology and design enabled the research to capture and interpret aspects of the dynamic development of personal meanings about the experiences of surviving traumas. Central to my notions of hope is the concept of intersubjectivity which is based upon the work of Winnicott, Fairbairn, Ferenczi, Meares, Stern and Bromberg. Using their ideas about relatedness and identification I argue that survivors expressed hopeful intentions and actions through their conscious and unconscious adaptive strategies. I explore the peritraumatic hopeful adaptations the survivors made such as identifying with the aggressor, the splitting of self, and the overt valuing of relatedness. I further argue that hopeful intentions can be seen in such actions as the survivor remembering their trauma rather than re-enacting it, in their efforts in narrating their trauma histories despite their fears, shame and difficulties in finding a listener. The thesis concludes by exploring some of the ramifications for society of hope, trauma and witnessing: foremost being the need to recognise the vulnerable in our communities and the difficulties we face in meeting the challenges of knowing their stories. / Doctor of Philosophy (PhD)

Very little is known about the effects of paediatric traumatic brain injury (TBI) on prospective memory, the memory for future intentions such as remembering to post a letter in the morning or do homework. The main aim of this thesis was to redress that shortcoming in the literature. To investigate the effects of paediatric TBI on prospective memory as reliably and fully as possible, the study of children and adolescents with brain injuries was preceded by a developmental study. Given that the process of recovery from brain injury is imposed on the ongoing process of development, it is important to understand more about the normal developmental trajectory of prospective memory first of all. Study 1 compared the prospective-memory performance of 88 normally developing children, adolescents and young adults. The main task was computerised, and its design was influenced by a prefrontal-lobe model because prospective memory is believed to be mediated by the prefrontal regions of the brain. Variables associated with prefrontal-lobe capacity were manipulated: the cognitive demand of an ongoing task, and the importance of the prospective task. Results of Study 1 found that children remembered to respond to fewer prospective cues than adolescents or adults, but that adolescents and adults remembered similarly. Further, the differences between the children's performance and the adolescents' and adults' widened as the cognitive demand of the ongoing task increased. However, the effects of increasing the cognitive demand did not vary between the adolescents and adults. It made no difference to anyone's performance whether the importance of remembering the prospective cues was stressed or not. On the other hand, performance on executive functions, as measured by the Self-Ordered Pointing Task (SOPT), the Stroop Colour Word Interference Test (Stroop), and the Tower of London (TOL), which are also believed to be affected by prefrontal capacity, produced the same age effects as were produced on the computerised prospective-memory task. Further, performance on the SOPT and Stroop predicted performance on the high-demand level of the prospective-memory task. Study 2 compared 34 children and adolescents with TBI with the non-injured children and adolescents from Study 1 on the same tasks. Results revealed that overall those with TBI had poorer prospective-memory performance than their non-injured peers. However, a different pattern of impairment was evident in the children than in the adolescents. Specifically, the children with TBI performed similarly to their non-injured peers, but the adolescents with TBI were significantly worse than the non-injured adolescents. This trend was most noticeable as the cognitive demand of the ongoing task increased. Further, the age and injury effects were reflected in the performances on the executive-function tests, and the TOL predicted performance on the high-demand, prospective-memory task in those with TBI. Study 3 aimed to examine the ecological validity of Study 2, by investigating whether the impairments in prospective memory in young people with TBI measured quantitatively, were matched with qualitative data. Twelve parents of children and adolescents with mild to severe TBI were interviewed about whether or not their children's injuries impacted on their memory (retrospective and prospective) in everyday life. Results showed that in general most children suffered memory losses as a result of their brain injuries, and that prospective-memory loss caused particular hardships for the children and their families. Taken together, the results of the current research revealed that the development of prospective memory reaches a peak of maturity in adolescence, and that adolescents with TBI show greater decrements in prospective memory than adolescents without TBI, but that this pattern is not evident in children, where those with TBI were not significantly different from those without. These findings give support to the prefrontal-lobe model of prospective memory by showing that prefrontal maturity, which reaches a peak during adolescence, reflects the prospective-memory performance of healthy adolescents, and prefrontal injury, which is very common with TBI, shows the effects of deficits more during adolescence than in earlier years when the prefrontal regions are not yet fully developed. Study 3 showed that impairments in prospective memory that result from TBI translate into disabilities in the real world. As a follow up it is recommended that rehabilitation strategies be designed to assist young people with prospective-memory impairments adjust better to school and the demands of everyday living. The prefrontal-lobe model should guide the design of such strategies.

Although it is well established that persons with traumatic brain injury (TBI) experience word retrieval difficulties, the underlying cause of these deficits is not known. Difficulties with word retrieval have negative social implications as they can impact on the ability to converse with others. The overarching goal of this dissertation was to determine the underlying cause of problems with word retrieval after TBI. To test word retrieval in this dissertation, participants were given a series of word fluency tasks and the speed of word generation was measured. In addition to measuring interresponse times, procedures used by Rohrer, Wixted, Salmon and Butters (1995) were also followed. This involved the calculation of parameter estimates to investigate whether slowed retrieval or degraded semantic stores were responsible for the patients� word retrieval difficulties. One parameter (N) was a measure of the total number of retrievable words and the second parameter (tau) was an estimate of mean latency. Study 1 was designed to trial the procedure and equipment adopted throughout this dissertation to analyse speech. University students were presented with categories on a computer screen and asked to generate as many exemplars as possible in 60 seconds. A PowerLab Chart sound system was used to measure the time that each word was generated. The results of Study 1 showed that the methodology of previous research could be replicated using the PowerLab Chart sound system. In Study 2, persons with postconcussion syndrome (PCS) and matched controls were given two word fluency tasks. Results showed that on both tasks patients recalled fewer words, had longer pauses between words, and took significantly longer to generate their first word than controls. Also, patients had a significantly reduced N relative to controls, but there was no difference in tau between patients and controls. Given that the participants had not finished responding and that parameter estimates require responses to be exhausted, Study 3 was designed to replicate the findings of Study 2 using an extended recall period. In Study 3, patients with PCS and matched controls completed a series of word fluency tasks and were given extended periods of time to generate words. Results showed that the patients obtained significantly fewer words on two of the tasks, but no evidence of slowed retrieval was found. There was also no difference in the estimates of N and tau between patients and controls. As the patients in Study 3 sustained more minor injuries than those in Study 2, Study 4 tested patients with severe TBI. In Study 4, patients with severe TBI and matched controls were given a series of word fluency tasks. Results showed that the patients generated fewer words and experienced slowed retrieval. Again, there was no difference in the estimates of N and tau between patients and controls. The results of Study 4 confirmed the hypothesis that slowed word retrieval is a consequence of TBI. Taken together, the results of this dissertation show that an underlying slowness of processing is the primary cause of problems with word retrieval in persons with TBI.