Background: Current literature on caregivers of children with chronic illnesses and developmental disabilities primarily focuses on negative aspects of adjustment, with maternal stress and depression as common outcome variables (Duvdevany & Abboud, 2003; Shin and Crittenden, 2003). While these pediatric caregivers have been shown to struggle more than caregivers of typically developing children, the possibility of positive psychological outcomes from such an experience is only beginning to be explored (Kim, Greenberg, Seltzer & Krauss, 2003; Scallan, Senior & Reilly, 2010). One such positive outcome is the idea of Posttraumatic Growth (PTG), a construct for which a widely accepted theoretical model exists (Tedeschi & Calhoun, 2004). This model has yet to be empirically validated and fails to provide an exhaustive picture of PTG. The current study aims to document this phenomenon among caregivers of children with Williams, empirically evaluate a portion of the proposed theoretical model, and explore possible extensions of the model in the form of health behaviors. Methods: Participants included 104 primary caregivers of children with Williams syndrome who were recruited through the Williams Syndrome Association List serve. Caregivers completed an online survey through SurveyMonkey software that included the posttraumatic growth inventory, the deliberate rumination scale, the MOS social support survey, and the taking care of yourself questionnaire. Results: The vast majority of caregivers reported some degree of growth following a diagnosis of Williams syndrome (M =55.91, SD =22.63), consistent with reports of other pediatric caregivers (Polantinsky & Esprey, 2000). Further, perceived social support was found to predict posttraumatic growth, F(2,73) = 2.488, p=.029, consistent with model predictions. However, perceived social support was not predictive of an increase in deliberate rumination, F(2,72) = 0.143, p=.867, failing to support the mediational model. Finally, posttraumatic growth was not found to predict health behaviors, although those caregivers who reported more posttraumatic growth also reported being less bothered by sleep-related caregiving burdens. Conclusion: Posttraumatic growth is prevalent among Williams syndrome caregivers, indicating the need for future research in facilitating this process among pediatric caregivers and patients alike. Further, a better understanding of the cognitive constructs involved in the posttraumatic growth process is essential. This improved understanding will facilitate more accurate measurement tools for evaluating these cognitive processes along with additional clarity with regards to the theoretical model. Finally, the identification of health behaviors and health belief constructs that are impacted by posttraumatic growth would improve the depth of the theoretical model and improve overall understanding of the construct.

This study examined illness-related uncertainty and primary appraisals of threat, centrality, and challenge as predictors of acute stress disorder (ASD) symptoms in parents of children hospitalized in a pediatric intensive care unit (PICU). Ultimately, a mediational pathway was tested to determine if primary appraisal was a mechanism that accounted for the impact of uncertainty on ASD symptoms. Ancillary study aims were to assess the degree to which parents perceived uncertainty in the PICU environment, and to determine the prevalence of ASD among parents in this setting. Self-report data was collected from 77 parents (57 mothers, 19 fathers) of children hospitalized in a PICU for a minimum of 48 hours. Descriptive analyses showed that parents perceived a high degree of uncertainty and 57% of parents met diagnostic criteria for ASD. Unexpected admission was the only objective medical status variable significantly related to uncertainty, threat appraisal, and ASD symptoms. Consistent with hypotheses, results from hierarchical regression analyses showed that perceived uncertainty and primary appraisals of threat accounted for significant variance in parents’ ASD symptoms; however, neither centrality nor challenge appraisals were related to parents’ ASD symptoms. Because threat was the only appraisal dimension found to be directly related to ASD symptoms, it was the only dimension tested in the mediational model. Consistent with the hypothesis, threat appraisals fully mediated the effect of uncertainty on ASD symptoms; results from a Sobel test confirmed the significance of full mediation. This study is the first to examine uncertainty, primary appraisal, and ASD symptoms in this population. Results clarify that it is not the mere perception of uncertainty that adversely impacts parental adjustment, but rather how it is appraised, and therefore, point to a practical area for in-hospital interventions targeting parents’ pediatric medical traumatic stress symptoms. Although a substantial body of empirical research supports a relation between uncertainty and maladaptive outcomes, studies also link uncertainty to positive outcomes. Future research should include positive indicators of adjustment and examine how appraisals vary according to sources of uncertainty.

Combat and war zone veterans are particularly vulnerable to developing Posttraumatic Stress Disorder (PTSD) due to the increased risk of experiencing trauma inherent in military service. Insomnia and nightmares are core symptoms of PTSD and can be factors in the development, maintenance, and exacerbation of PTSD. However, sleep disturbance has received relatively little attention from a treatment point of view until recently. Recent research has demonstrated that cognitive behavioral therapy for insomnia (CBT-I) and imagery rehearsal therapy (IRT) for nightmares are effective stand alone and combination treatments for sleep disturbance in civilian and veteran populations. Although group interventions are lower in cost and more efficient to deliver in a VA setting, studies have yet to test the feasibility and efficacy of group CBT-I/IRT combination treatment for veterans with PTSD. The current pilot study investigated the feasibility and efficacy of a combined CBT-I and IRT protocol intervention for insomnia and nightmares delivered in a group format to a sample of mixed theater veterans with PTSD. Participants (n = 34) were randomly assigned to either a treatment (n = 17) or waitlist control condition (n = 17). After baseline assessment, participants assigned to the treatment condition participated in six weekly group sessions of combined CBT-I and IRT and completed posttreatment and two month follow-up assessments. Those in the waitlist condition completed a six week waiting period. After completing post-waitlist assessment, they were given the opportunity to receive the treatment. Authors hypothesized that those in the treatment condition would experience significant improvement on self-report measures of sleep, nightmare frequency, PTSD-related sleep disturbance, beliefs about sleep, and overall PTSD and depression severity compared to the waitlist condition at posttreatment and two-month follow-up. These hypotheses were largely supported by the study results with some notable exceptions. Significant condition by time interactions were found on measures of sleep and nightmares, beliefs about sleep, and depression at posttreatment. Treatment gains were maintained at two month follow-up for sleep variables but not nightmare frequency or depression. There were no condition by time interactions for measures of PTSD or PTSD-related sleep disturbance at posttreatment. In sum, the findings of this study indicate that a combined CBT-I and IRT delivered in a group format was effective in reducing insomnia symptoms, nightmare frequency, and depression in a sample of mixed theater veterans with PTSD. The study also demonstrated the feasibility of this treatment approach with this population suggesting that a larger randomized controlled study is warranted.

This diploma thesis is focusing on the posttraumatic growth in professional fire fighters. The theoretical part deals with models of the posttraumatic growth and factors which affect this process. Another constituent of the work is a treatise about psychological aspects of the fire fighter job execution. One section of the work, the empirical section, is based on the Czech version of a questionnaire method called "Posttraumatic Growth Inventory ". It is a questionnaire that discovers the level of achieved posttraumatic growth in 5 areas; personal strength, new possibilities, relating to others, appreciation of life and spiritual change. The research sample that consisted of 100 professional firemen verified the relationship between the posttraumatic growth and other aspects of respondents' lives. The research showed following discovery. The marital status, the fact if the respondent has a family, the time which passed since experiencing a difficult incident, the subjectively perceived intensity of an event, the level of distress, psychological well-being, behaviour of type A, cognitive resilience of an individual, strategy of bearing the burden of "negative view", "the concentration on a problem" and "the mineralization of threats" is not connected with the grade of obtained posttraumatic growth....

ETUDE 1- Le traumatisme de l’accouchement prématuré et de la césarienne, un sentiment de culpabilité, une anxiété et une ambivalence envers l’enfant et l’équipe médicale ont été rapportés. Des difficultés dans l’investissement du lien mère-enfant et dans l’accès au rôle de mère ainsi que l’importance du partage d’expérience avec des femmes ayant accouché avant-terme ont également été identifiés. Enfin, des signes de dépression postnatale et de stress posttraumatique ont été relevés. ETUDE 2- 53% des participantes ont rapporté un score à l’IES-R indiquant un probable ESPT. La présence de symptômes de dépression postnatale (ß = 0,40, p< 0,05), de difficultés pendant la grossesse (ß= 0,20, p< 0,05), la perception maternelle de l’enfant comme étant vulnérable (ß = 0,17, p< 0,05), l’insatisfaction de la grossesse (ß = -0,13; p< 0,05) et des cognitions maternelles mal-adaptées (ß = -0,12, p< 0,05) étaient indépendamment associés à l’intensité des symptômes d’ESPT. ETUDE 3- 3 profils de femmes ont été identifiés: les parturientes au profil « dépressif », « faible niveau de symptômes » et les mères du groupe « dépressif anxieux traumatisé ». Nos résultats démontrent également une forte comorbidité entre troubles anxieux et dépression postnatale ainsi que l’influence négative des symptômes de dépression postnatale sur le lien mère-enfant. ETUDE 4- 64,3% des femmes de l’échantillon ont rapporté un score à l’EPDS indiquant une possible dépression postnatale. Le placement de l’enfant sous assistance respiratoire (ß = 0,23, p< 0,05), le type de prématurité (ß= 0,16, p< 0,05), et la baisse de la qualité de la relation conjugale (ß = -0,39, p< 0,05) étaient indépendamment associés à l’intensité des symptômes de dépression postnatale. / STUDY 1- Trauma of premature birth and c-section, feelings of guilt, anxiety, ambivalence towards the infant, the medical staff and the infant’s hospital discharge, were all part of their perception. Furthermore, difficulties for mothers to define themselves as such and the importance of sharing with women who have been through the same experience were evidenced. Postpartum depression and PTSD symptoms were also highlighted. STUDY 2- 53% of participants scored above the cut-off for probable PTSD. Increased postpartum depressive symptoms (ß = 0.40, p< .05), difficulties during pregnancy (ß= 0.20, p< .05), maternal perception of infant vulnerability (ß = 0.17, p< .05), decreased satisfaction with delivery (ß = -0.13; p< .05) and cognitions relating to role change (ß = -0.12, p< .05) were independently associated with PTSD symptoms. STUDY 3- 3 profiles were highlighted: “depressive”, “low level of symptoms” and “anxious-depressive-traumatized” mothers. Our findings also evidenced a high comorbidity between anxious and depressive symptoms as well as a negative impact of postpartum depression on mother-infant bond. STUDY 4- 64.3% of our sample reported a score on the EPDS highlighting a probable postpartum depression. Having an infant who experienced ventilator support (ß = 0.23, p< 0,05), type of prematurity (ß= 0.16, p< 0,05), and decreased quality of marital relationship (ß = -0.39, p< 0,05) were independently associated with the intensity of postpartum depressive symptoms.

Doctor of Philosophy / Department of Human Nutrition / Mark D. Haub / Mark D. Haub / Psychological problems and human error are leading causes of death and disability among military service members. Strategies to improve the psychological health and cognitive performance of those in the military are much needed. Recent advances in neuroscience suggest that omega-3 fatty acids may play an important role in the psychological well-being of those in the military. The purpose of this research was to explore the relationship between omega-3 status and psychological outcome variables among soldiers deploying to combat. Data collection was preceded by the development and reliability testing of a novel food frequency questionnaire (FFQ) designed to capture intake from contemporary sources of omega-3 fatty acids including functional foods and supplements. Based on the instrument assessment study (Chapter 2) conducted among university students (n = 165), this FFQ appears to be a comprehensive and reliable (n = 54, ρ = 0.86, p < 0.001) instrument for measuring docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) intakes in young adults. As described in Chapter 3, intake of EPA + DHA as estimated by the FFQ was positively correlated (r = 0.39, p < 0.001) with biomarker measurements of omega-3 status. Primary data were obtained from a volunteer sample of soldiers (n = 272) scheduled for deployment to Iraq. Preliminarily analyses revealed relationships between attention deficit hyperactivity disorder (ADHD) screening scores and psychological outcome variables (Chapter 4). Primary analyses (Chapter 5) indicated intake of EPA + DHA was not significantly correlated with mood, nor were omega-3 exposure variables correlated with cognitive performance based on the required p value (< 0.001) calculated using the Bonferroni correction for multiple tests. Among participants with EPA + DHA intakes at or below the median, omega-3 HUFA was related (p < 0.002) to happiness (β = -0.46), depression (β = 0.44), and fatigue (β = 0.43). Although exploratory in nature, the results of this study suggest a relationship between omega-3 fatty acids and mood. Given the current concerns regarding the psychological health of those in the military, additional research is warranted.

Hurricane exposure places youth at risk for psychological distress such as symptoms of Posttraumatic Stress Disorder (PTSD), anxiety, and depression, while social support may contribute to resilience following disasters. This study examined associations among family and peer social support, level of hurricane exposure, and psychological distress using both a large single-time assessment sample (N = 1098) and a longitudinal sample followed over a six-month period (n = 192). Higher levels of hurricane exposure were related to lower levels of social support from family and peers as well as to higher levels of psychological distress. Higher levels of family and peer social support demonstrated both concurrent and longitudinal associations with lower levels of psychological distress, with associations varying by social support source and psychological distress outcome. Findings suggested that the protective effects of high peer social support against the development of PTSD symptoms may be diminished by high hurricane exposure.

Societal discourses and rigid gender norms, tenaciously reinforced by media representations, prevent men from being recognized as survivors of sexual violence (Gulas, McKeage, & Weinberger, 2010; Heber, 2017). Consequently, research on the ability of male survivors of sexual violence to acquire positive characteristics as a result of their victimization, termed posttraumatic growth (PTG), is limited (Tedeschi & Calhoun, 2004a). This thesis assesses the experience of PTG for male survivors of sexual violence, specifically analyzing the role of gender norms, coping styles, and service access in the production, or lack thereof, of PTG. Through the concepts of gender norms and coping, the experience of PTG for male survivors is contextualized, providing insight into how these forces individually and collectively facilitate or hinder the experience of PTG. A qualitative comparative analysis is conducted in order to establish a configuration of causal factors that are associated with the presence and absence of PTG for male survivors (N=9). Only one of the five hypotheses this thesis tests are supported; high stability (no interruption) of service access is associated with PTG. This thesis argues that the use of coping styles and service access is intertwined with conflicts between their gender and victimization, where male survivors utilize certain forms of coping or services depending on the degree to which they need to regain feelings of control.

Thesis advisor: Aimee Seiler / In the effort to take responsibly and effect positive change in the lives of our children, we must begin by identifying and applying the most effective methods to help them overcome obstacles to mental and emotional well-being. In conjunction with a limited number of quantitative studies, anecdotal evidence suggests that animal-assisted therapies and activities promote positive outcomes for children who have been physically abused and who have developed behavioral and emotional disorders. Chapter one will address the current state of the research on the impact of physical abuse on children's physical, social and emotional beings. Understanding what we know about what abused children must cope with, chapter two will examine service provision under the current system known as the continuum of care. Finally, chapter three will introduce animal assisted therapy and illustrate the ways in which it can strengthen and support services that are already in place for children who are struggling with behavioral and emotional disorders that result from physical abuse. Before the argument for including animal assisted programs as a supplement to services currently provided can be made, this therapeutic approach deserves to be appropriately standardized and evaluated. Allocating more resources to research that will develop the breath and depth of knowledge in the field of animal assisted therapy is a necessary step in improving the quality of care. / Thesis (BA) — Boston College, 2004. / Submitted to: Boston College. College of Arts and Sciences. / Discipline: Education, Lynch School of. / Discipline: College Honors Program.

Thesis advisor: Belle Liang / The study of treatments for complex posttraumatic stress disorder (CPTSD), especially in cases of chronic childhood abuse, has revealed that traditional trauma treatments often lack success due to the complexity of symptom presentation. CPTSD often manifests as a lack of integration between the self and the body. While certain coping strategies used by survivors during the trauma experiences, such as dissociation, may be adaptive in the short-term, prolonged use posttrauma comes at a cost--resulting in a loss of awareness of one's emotional and physical being in the present moment. Mindfulness-based interventions, such as hatha yoga, show promise as alternative or complementary treatments for CPTSD. Furthermore, current trauma treatments have been criticized for their primary focus on psychopathology. More recent conceptualizations of trauma recovery call for a paradigm shift that recognizes not only the need for symptom-reduction, but also the encouragement of positive development and personal growth (i.e., stronger sense of self, relationships with others, and perspective on life). This qualitative study explored the experiences of women with CPTSD in a 10-week, trauma-informed hatha yoga class, specifically examining perceived changes with regard to symptom reduction and personal growth. Six themes were identified through qualitative content analysis. Theme 1 describes the yoga practice and study design characteristics that influenced participants' experiences. Themes 2 through 6 reflect participants' increased feelings of Gratitude and compassion, Relatedness, Acceptance, Centeredness, and Empowerment (referred to as G.R.A.C.E. themes). Findings are discussed in the context of current literature. Limitations of the study are also presented along with recommendations for future research and clinical work. / Thesis (PhD) — Boston College, 2011. / Submitted to: Boston College. Lynch School of Education. / Discipline: Counseling, Developmental, and Educational Psychology.