The adverse consequences of posttraumatic stress on quality of life have been well documented. It is, however, possible that it is not the intrusive re-experiencing and hyperarousal posttraumatic stress symptoms that have an impact on quality of life per se, but the inflexible efforts to avoid internal experiences and emotions related to the traumatic event, and the way these emotions are expressed and experienced. Previous research shows that both experiential avoidance and emotion regulation have been found to be etiologically central to the development and maintenance of psychological problems in trauma survivors. The degree to which experiential avoidance and emotion regulation act together as toxic underlying mechanisms to explain the relationship between posttraumatic stress and quality of life is, however, yet to be examined. Quality of life is now regarded as an important outcome variable across a broad range of conditions and problem areas. The quality of life concept has generated a large body of research and yet its assessment has been a challenge for researchers. The WHOQOL-BREF is considered to be one of the few genuine quality of life measures but it has received much criticism, especially regarding the poor psychometric performance of its social relationships domain. The aim of the current thesis was twofold. The first aim involved the revision of the WHOQOL-BREF through the enhancement of the social relationships domain. In Study I 986 ill and healthy individuals from five countries worldwide completed the Pilot Revised WHOQOL-BREF (WHOQOL-BREF-R) along with measures of life satisfaction, anxiety, and depression for the detailed psychometric analysis of the scale. Study I confirmed the limitations of the social relationships domain, and despite its improvement, the performance of the overall scale was found to be poor. In fact, findings from modern and robust techniques challenged the 4-factor structure of the WHOQOL-BREF. Instead, results supported the performance of a 3-factor solution, which led to the development of a psychometrically sound measure. Study II is preceded by a systematic review of the literature investigating experiential avoidance as a mediator in trauma survivors with posttraumatic stress. Ten studies were identified and organised in two categories assessing experiential avoidance as a mediator between: 1) trauma exposure and posttraumatic stress, and 2) posttraumatic stress and maladaptive behaviours. Findings suggest that the development and maintenance of posttraumatic stress symptoms and maladaptive behaviours in the aftermath of trauma can be explained through the use of experiential avoidance. Methodological limitations and future directions for research are discussed. The WHOQOL-BREF-R was then used in Study II, which explored an integrative mediation model whereby experiential avoidance and emotion regulation were tested as mediators in the relationship between posttraumatic stress symptomatology and quality of life in trauma exposed adults. The two mediators were also explored for their overlapping relationship. A total of 360 participants from the community completed self-report measures of posttraumatic stress, experiential avoidance, emotion regulation, and quality of life. With the use of path analysis Study II found experiential avoidance and emotion regulation to be two distinct constructs that together act as an underlying mechanism explaining the impact of posttraumatic stress on quality of life. Alternative mediating models were explored. The current study makes an important contribution in the area of trauma and in the conceptualisation and assessment of quality of life. Findings can be considered as a first step towards an integrative mediation model of toxic mechanisms in trauma and quality of life. Additionally, the favourable psychometric properties of the WHOQOL-BREF-R make it a powerful tool for use in quality of life research.

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An alarming portion of youth experience traumatic events during childhood, and there is a robust body of literature documenting the adverse consequences of trauma exposure on the developing child. Fortunately, numerous empirically-supported phase-based interventions have been developed for youth that target the deleterious effects of trauma. While several of these interventions have demonstrated symptom reduction from the baseline to completion of treatment, much less is known regarding the trajectory of posttraumatic stress symptoms (PTSS) during the course of treatment. Information in this regard may have important implications for service delivery and help to illuminate the mechanisms of change responsible for treatment outcomes. Furthermore, gender-related differences in the prevalence and expression of PTSS following trauma exposure have been observed, but the reasons for these differences is unclear and there is a paucity of research concerning whether boys and girls may progress differently through trauma-focused treatment. As a result, the aims of this study were to (1) examine the progression of PTSS during the various components of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT); (2) assess whether symptoms progress differently for males and females; (3) examine whether (a) sexual abuse history or (b) age moderates any gender-related symptom differences identified; and (4) explore the trauma narratives of boys and girls. This study utilized an embedded sequential mixed methods design. For the quantitative strand, aggregate scores on the UCLA Posttraumatic Stress Disorder Reaction Index (UCLA PTSD-RI) were mapped for the entire sample and then according to gender at baseline, during various components of TF-CBT, and at termination among a sample (N = 138) of polyvictimized youth ages 7-18 who completed TF-CBT at a university-based child trauma treatment clinic. Mixed Analysis of Variance (ANOVA) analyses were conducted for each of the outcome measures (UCLA-PTSD RI overall, arousal, avoidance, and intrusion scores) to examine whether there were symptom differences between males and females from baseline to completion of TF-CBT, and 2 X 2 full factorial ANOVAs were conducted to determine whether sexual violence history or age moderated the relationship between gender and symptom severity during any phase of TF-CBT. For the qualitative strand, trauma narratives (N = 16) completed during TF-CBT were analyzed through the use of thematic analysis. Findings revealed that males and females reported differences in PTSS symptoms from baseline to termination of treatment, and during various phases of treatment. Additionally, thematic analysis of the trauma narratives augmented findings from the quantitative strand and revealed variations in the narratives of males and females. Although further investigation is warranted, study findings help to further understand the complex interplay between gender and the progression of PTSS during treatment. Implications for practice, policy and social work education are discussed.

Medical interpreter services will be essential for developing and implementing culturally relevant interventions and treatment for limited English proficiency (LEP) populations. This study sought to identify the possible risks or protective factors that may be associated with vicarious traumatization (VT) or vicarious posttraumatic growth among medical interpreters in behavioral health settings. A 2-step cluster analysis was conducted yielding 2 distinct groupings of medical interpreters (Subtype 1, n = 73; Subtype 2, n = 101). The most important predictor determining the 2 subtypes was whether the participant had a personal history of trauma. In addition, there were significant differences between the 2 subtypes among the following variables: Trauma and Attachment Belief Scale T-scores of VT; years as a medical interpreter; years as a behavioral health medical interpreter; level of education as it relates to interpreting; personal history of trauma; personal or family history similar to any of the trauma survivors served in the past year; specific mental health training; sought personal therapy related to exposure to traumatic material from work environment; current relationship status; race; and whether spoken, sign, or both spoken and sign language interpretation was provided. The results of this quantitative study further support the constructivist self-development theory where VT is the result of the accumulated effects of repeated exposure to trauma material in combination with the person of the provider. Understanding these risk and protective factors will continue to support the provision of effective treatment of LEP individuals in behavioral health settings and the ongoing professional development of behavioral health medical interpreters.

The number of women diagnosed as infertile continues to grow every year. The psychological impact of the infertility experience has been said to create distress equivalent to that associated with life-threatening illnesses and has been linked with posttraumatic stress disorder (PTSD). Using shattered assumption and stress-buffering theory, this quantitative causal comparative study explored the potential functional relationship between infertility and PTSD. The majority of the (all-female) participants were 24- to 34-year-old college graduates. A 2 X 3 factorial between-subjects ANOVA examined and compared the cause and effect of the independent variables, fertility treatment and psychological intervention, on the dependent variable, PTSD. A multiple linear regression was conducted to understand PTSD symptomology scores. The results revealed that the type of infertility treatment does not impact PTSD symptomatology in medically diagnosed women. However, the main effect of psychological treatment was significant, as was infertility treatment by psychological treatment interaction. Additionally, the impact of fertility problems on the participant's physical health was the highest ranking predictor, which suggests that stress levels in women receiving infertility treatment are equivalent to those in women with cancer, AIDS, and heart disease, as suggested by other researchers. This study has implications for positive social change, in that it may promote better understanding of the psychological impact of infertility and decreased PTSD symptomatology for medically diagnosed infertile women. It opens the door for future research about the effectiveness of psychological intervention, and provides awareness of possible PTSD susceptibility.

Despite 30 years of research advancements, PTSD treatment remains a trial-and-error process as 22 veterans per day commit suicide to relieve their symptoms. Foa and Kozak's emotional processing theory informed this correlational study which included secondary data consisting of participants' self-rated scale scores to examine whether the independent variables number of deployments, guilt, depression, and anxiety predicted the dependent variable PTSD symptom reduction in a veteran sample with combat deployments and associated PTSD symptoms who completed accelerated resolution therapy (ART). An analysis of whether mean PTSD symptom reduction amounts differed by symptom severity levels was also completed. The study aimed to identify the first predictive treatment-matching model for PTSD symptom reduction by use of ART. A multiple regression analysis to determine whether the predictor variables predicted PTSD symptom reduction by use of ART resulted in nonsignificant findings (p = .517). A Welch ANOVA test to determine if mean PTSD symptom reduction differed among the low, moderate, and high PTSD symptom severity groups showed significant results (p = .002). Games-Howell post hoc analysis showed that mean differences in PTSD symptom reduction from the low to high PTSD symptom severity group was significant (p = .001) with a 26.1 point mean reduction for the high symptom severity group and a greater than 10-point mean PTSD symptom reduction for the low and moderate symptom severity groups. The findings confirmed a need for treatment-matching algorithm studies to predict which PTSD interventions most benefit veterans suffering with PTSD to reduce trial-and-error treatment approaches, associated comorbidities, and high rates of suicides.

<p>Antalet barn som upplever våld i familjen är stort och upplevelsen kan leda till utveckling av Posttraumatisk stresstörning (PTSD). Syftet med studien är att fördjupa kunskapen om barn som upplevt våld i familjen och som visar tecken på PTSD. Frågeställningar som studien avser att besvara är (1) vilken betydelse har våldets karaktär för utvecklingen av PTSD hos barn? (2) vilken betydelse har barnets psykosociala hälsa för utvecklingen av PTSD? (3) hur kan tillfrisknandeprocessen hos barn som visar tecken på PTSD förstås? Studien har både en kvantitativ och en kvalitativ ansats samt en pre-post design. Studien inkluderar 14 barn som upplevt våld i familjen och som besvarat Children´s revised imapct of event scale (CRIES) vid Trappan-enheten i Uppsala under 2007. Resultatet visar att många barn visar tecken på PTSD till följd av våld i familjen. Våldets karaktär samt tiden som våldet pågått är avgörande faktorer för om barn visar tecken på PTSD eller inte. Resultatet visar även att god psykosocial hälsa inte motverkar utveckling av</p><p>PTSD hos barn. Vid andra mätningen är det färre barn som visar tecken på PTSD.</p> / <p>A large number of children experience domestic violence and this experience can lead to the development of Posttraumatic stress disorder (PTSD). The purpose of this study is to create a deeper knowledge regarding children who have experienced domestic violence and are showing signs of PTSD. The research questions of this study are (1) to what</p><p>extent does the type of violence matter for the development of PTSD in children? (2) to what extent does the child’s psychosocial health matter for the development of PTSD?</p><p>(3) how can the recovery process in children who show signs of PTSD be understood? The approach of the study is both quantitative and qualitative and the design is pre-post.</p><p>The study includes 14 children who all have experienced domestic violence and who have answered Children´s revised impact of event scale (CRIES) at Trappan-enheten in</p><p>Uppsala during 2007. The result shows that many children show signs of PTSD after the experience of domestic violence. The type of violence and the duration of violence are essential factors for the development of PTSD. The results also show that good psychosocial health does not prevent the development of PTSD. At the second measuring</p><p>fewer children show signs of PTSD.</p>

<p><strong>SAMMANFATTNING</strong></p><p><strong>Syfte: </strong>Att beskriva förekomst av posttraumatisk stress och behov av känslomässigt stöd bland föräldrar till barn med hjärntumör vid två månader efter barnets diagnos (T2) respektive 12 månader efter avslutad cytostatika-/strålbehandling eller 18 månader efter operation av barn som inte fått cytostatika-/strålbehandling (T6). Syftet var också att jämföra behovet av känslomässigt stöd bland föräldrar med möjlig PTSD och hos de föräldrar som inte visar symtom på möjlig PTSD vid T2 respektive T6. <strong>Urval:</strong> 42 föräldrar till barn med hjärntumör deltog i studien: 20 mödrar och 22 fäder. <strong>Metod: </strong>Designen var deskriptiv longitudinell. Nivåer av PTSS och förekomst av möjlig PTSD mättes med PTSD Checklist Civilian, föräldrars behov av känslomässigt stöd mättes med ett studiespecifikt formulär. <strong>Resultat:</strong> Nivåer av PTSS hos föräldrar till barn med hjärntumör var lägre vid T6 än vid T2. Vid T2 hade 17 % möjlig PTSD jämfört med 5 % vid T6. Behovet av att samtala med psykolog var oförändrat lågt mellan T2 och T6, men behovet minskade över tid gällande att samtala med läkare, sjuksköterska, kurator, partner, vänner och övriga. <strong>Slutsats: </strong>Även om nivåer av PTSS och behovet av känslomässigt stöd på gruppnivå minskar över tid, bör vårdpersonal ändå uppmärksamma förälderns individuella behov av stöd. <strong></strong></p> / <p><strong>ABSTRACT</strong></p><p><strong>Aim:</strong> To describe occurrence of posttraumatic stress and the need of emotional support among parents of children with brain tumour two months after the child has been diagnosed (T2) respectively 12 months after completed chemo-/radiotherapy or 18 months after surgery of those children who did not receive chemo-/radiotherapy (T6). The aim was also to compare the need of emotional support between parents with occurrence of potential PTSD and parents who did not show any symptoms of potential PTSD at T2 and T6 respectively. <strong>Sample:</strong> 42 parents of children with brain tumour participated in the study: 20 mothers and 22 fathers. <strong>Method:</strong> The design was descriptive longitudinal. Levels of PTSS and occurrence of potential PTSD was measured by PTSD Checklist Civilian. Parents’ need of emotional support was measured with a study specific questionnaire. <strong>Results:</strong> Levels of PTSS was lower at T6 than T2. At T2 17 % had possible PTSD compared with 5 % at T6. The need to talk to a psychologist was unchanged low between T2 and T6, but the need declined over time concerning to talk with a doctor, nurse, welfare officer, partner, friends and others. <strong>Conclusion:</strong> Even if levels of PTSS and the need of emotional support in group level decline over time, nursing staff should still be ware of the parents’ individual need of support.</p>

<p>Being severely burned is a traumatic life event that affects the victim both physically and psychologically. Recovery can be a long process that is dependent in part upon psychological factors, but research in this area is still quite limited. The main aim of the thesis was to explore coping, personality and cognitive processes in long-term and short-term adaptation. The participants were recruited from three separate samples of former and consecutive adult burn patients. </p><p>A questionnaire, the Coping with Burns Questionnaire (CBQ), was developed to retrospectively assess coping. It consisted of six coping factors related in different ways to self-reported health status. Regarding personality, the former patients displayed slightly more Neuroticism than people in general, suggesting an overrepresentation of premorbid neurotic personality traits. Avoidant coping was related to poorer perceived health status, more maladaptive personality traits, and was a strong predictor of psychological symptoms at three months post-burn. Regarding cognitive processes, a moderate attentional bias towards burn-related information was found in the former patients when using the emotional Stroop task. This indicates that the burn may still be an important issue years after the event. Finally, former patients’ reactions to participating in a trauma-related postal survey were investigated. A majority felt that participation was positive or even beneficial, while a small subgroup felt that participation was cumbersome or negative. </p><p>To summarise, although many burn patients adapt well in the long run, the burn may still be a significant theme and the subgroup of Avoidant copers are especially vulnerable. The CBQ seems to be an adequate tool for discerning individuals at risk for poor adjustment. Trauma-related postal questionnaires are well accepted by a majority of former burn patients. Although long-term prospective follow-ups are needed to further validate the results, it is suggested that early screening of psychological factors could be of value in burn care.</p>

Being severely burned is a traumatic life event that affects the victim both physically and psychologically. Recovery can be a long process that is dependent in part upon psychological factors, but research in this area is still quite limited. The main aim of the thesis was to explore coping, personality and cognitive processes in long-term and short-term adaptation. The participants were recruited from three separate samples of former and consecutive adult burn patients. A questionnaire, the Coping with Burns Questionnaire (CBQ), was developed to retrospectively assess coping. It consisted of six coping factors related in different ways to self-reported health status. Regarding personality, the former patients displayed slightly more Neuroticism than people in general, suggesting an overrepresentation of premorbid neurotic personality traits. Avoidant coping was related to poorer perceived health status, more maladaptive personality traits, and was a strong predictor of psychological symptoms at three months post-burn. Regarding cognitive processes, a moderate attentional bias towards burn-related information was found in the former patients when using the emotional Stroop task. This indicates that the burn may still be an important issue years after the event. Finally, former patients’ reactions to participating in a trauma-related postal survey were investigated. A majority felt that participation was positive or even beneficial, while a small subgroup felt that participation was cumbersome or negative. To summarise, although many burn patients adapt well in the long run, the burn may still be a significant theme and the subgroup of Avoidant copers are especially vulnerable. The CBQ seems to be an adequate tool for discerning individuals at risk for poor adjustment. Trauma-related postal questionnaires are well accepted by a majority of former burn patients. Although long-term prospective follow-ups are needed to further validate the results, it is suggested that early screening of psychological factors could be of value in burn care.