This study explored posttraumatic growth (PTG) in people with aphasia and is the qualitative arm of a larger mixed-methods study. After an initial experimental session, 23 people with aphasia (PWA; 12 females and 11 males) completed a 60-minute semi-structured interview during which participants expanded on previously-given questionnaire responses and then answered five additional open-ended questions about communication in their daily life. Interviews were transcribed orthographically and coded using reflexive codebook analysis. A stakeholder with aphasia was consulted to gain insight from an insider's perspective about whether codes and themes captured the experiences of aphasia. Reflexive codebook analysis revealed two themes. Within the first theme, "Recovery is a Journey," there were two categories: "Moving Toward Growth" and "Engagement." The second theme, "Having Aphasia is Challenging, but I've Grown," included four categories: "Challenges and Reactions," "Perception of Self," "General Philosophy of Life," and "Relatedness." Findings suggest that PWA experience PTG across all three primary domains: (1) changed perception of self, (2) changed relationship with others, and (3) changed general philosophy of life and that the challenging circumstances associated with aphasia were integral to the development of PTG. Findings also highlight that PTG does not necessarily develop in a linear trajectory for PWA, but that processes such as acceptance and slowing down may contribute to the development of PTG in this population. Future research should quantitatively investigate the trajectory of PTG for PWA, assess interventions that may facilitate PTG, and examine how PTG contributes to overall recovery.

Perinatal mood disorders such as postpartum depression and postpartum posttraumatic stress disorder are an area of growing concern. There have been few studies regarding ways to identify women at risk of developing these disorders in the antepartum period. During the antepartum period, women attend prenatal appointments with their provider to assess the health of their pregnancy. This period is ideal to administer emotional health questionnaires to identify if patients may be at risk of developing postpartum mood disorders. The aim of this study was to identify if there are differences on antepartum emotional health questionnaire scores between women who have postpartum mood disorders, and those who do not. The data come from 19 women undergoing scheduled cesarean deliveries at Boston Medical Center. The questionnaires collected information about stress, depression, anxiety, and symptoms of postpartum depression and posttraumatic stress disorder. We compared the scores of the women who had postpartum depression and postpartum posttraumatic stress disorder to the women who did not, to examine if the scores in the antepartum period correlated with postpartum mood disorders. We did not find any differences between the postpartum depression group, but did find a difference on one questionnaire between the postpartum posttraumatic stress disorder group. Within our cohort, we found similar incidences of postpartum depression, postpartum posttraumatic stress disorder, and self-harm/suicidal ideations compared to national incidences. Future studies should include more participants and a more heterogenous cohort as it pertains to cesarean delivery type, indication for cesarean delivery, intrapartum events, and histories of depression, anxiety, posttraumatic stress disorder, and other mood disorders. Although we only found a difference on one questionnaire for one of the postpartum mood disorders, future studies should prioritize the antepartum period as a time to identify and address concerns of postpartum mood disorders.

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The diagnosis of Complicated Grief (CG) is being proposed for inclusion in DSM–5. As such, it has been the focus of several studies purporting to build evidence of its validity and its conceptual and statistical distinction from Posttraumatic Stress Disorder (PTSD) and depression (Bonanno et al., 2007; Golden & Dalgleish, 2010; Prigerson et al., 1995b). However, previous research has focused predominantly on bereavement caused by non-violent means (e.g., prolonged terminal illness). This study attempts to explore the nature of CG among a sample of students who survived a mass shooting. Exploratory and confirmatory factor analytic procedures were used to examine and confirm the factor structure of CG as reported in previous studies (e.g., Boelen & van den Bout, 2005; Dillen, Fontaine, & Verhofstadt-Denève, 2008). A refined CG scale was then used as a criterion to demonstrate how different types of traumatic exposure contribute to symptoms of CG and/or posttraumatic stress (PTS). It was hypothesized that exposure items related to bereavement would be more related to CG than to PTS, whereas direct exposure to the shootings would be more closely related to PTS than to CG. Results of exploratory and confirmatory factor analyses supported CG as a unitary construct distinct from PTS and from anxiety/depression. Logistic regression results demonstrated that bereavement status was significantly predicted by CG but not PTS: Participants who scored 1 standard deviation above the mean on the CG scale were 14.64 times more likely to have been bereaved than were those who scored at the mean. SEM analyses were used to provide an additional test of this hypothesis. The final model had acceptable fit as assessed by RMSEA = .046, CI = .043–.049, SRMR = .048, and CFI = .990; however, the Satorra-Bentler Scaled Ï 2 = 1507.82, df = 589, p < .001, did not support the model. Overall, results of SEM suggested that interpersonal loss (i.e., whether a friend was killed, injured, or escaped from the shootings) predicted CG but not PTS, whereas perceived threat predicted both CG and PTS. / Ph. D.

This study investigated the use of "naturalistic stressors" such as physical restraint and animal pheromones on the etiology of Posttraumatic Stress Disorder in a murine model. Pilot data suggest that stress effects may lead to an increase in the amount of time needed for cutaneous wounds to heal. Pilot data to support the creation of this model are presented suggesting that a delayed stress response may inhibit healing rates. In the present study an animal model of PTSD was used to investigate the effect of stress on the immune system. Yehuda and Antelman's (1993) nonhuman animal model of Posttraumatic Stress Disorder was tested with respect to the animals' immune response to cutaneous wounding. Additionally, effects of stress on exploratory behavior and activity were examined. The findings support the hypothesis that restraint and pheremonal stress and housing arrangements influence the ability of mice to heal a 1.5 mm punch biopsy, and exploratory behavior. The findings also support a profile for the Post-Traumatic Mouse. / Ph. D.

Posttraumatic stress disorder (PTSD) is accompanied by marked alterations in cognition and behavior, particularly when negative, high-value information is present (Aupperle, Melrose, Stein, & Paulus, 2012; Hayes, Vanelzakker, & Shin, 2012) . However, the underlying processes are unclear; such alterations could result from differences in how this high value information is updated or in its effects on processing future information. To untangle the effects of different aspects of behavior, we used a computational psychiatry approach to disambiguate the roles of increased learning from previously surprising outcomes (i.e. associability; Li, Schiller, Schoenbaum, Phelps, & Daw, 2011) and from large value differences (i.e. prediction error; Montague, 1996; Schultz, Dayan, & Montague, 1997) in PTSD. Combat-deployed military veterans with varying levels of PTSD symptoms completed a learning task while undergoing fMRI; behavioral choices and neural activation were modeled using reinforcement learning. We found that associability-based loss learning at a neural and behavioral level increased with PTSD severity, particularly with hyperarousal symptoms, and that the interaction of PTSD severity and neural markers of associability based learning predicted behavior. In contrast, PTSD severity did not modulate prediction error neural signal or behavioral learning rate. These results suggest that increased associability-based learning underlies neurobehavioral alterations in PTSD. / Master of Science

The present study aimed to investigate sleep disturbances and negative emotions as predictors of posttraumatic stress disorder (PTSD) symptom trajectories in a publicly available longitudinal dataset of patients (N = 1127; mean age = 36.53; SD = 13.29; 65.5% women) who presented to a U.S. emergency department (ED) in the early aftermath of a trauma exposure. Latent growth curve models were fitted iteratively to characterize PTSD symptom trajectories over 1-year. Models then examined the simultaneous influence of sleep disturbances (i.e., insomnia symptoms, nightmares, and sleep duration) and negative emotions (i.e., feelings of anxiety and depression) on PTSD symptom trajectories, as well as whether negative emotions mediate the link between sleep disturbances and PTSD symptom trajectories. Results indicated that (a) PTSD symptom trajectories reflected a quadratic trend across time, although there was variability between individuals, (b) both sleep disturbances and negative emotions were uniquely associated with PTSD symptom trajectories, and (c) negative emotions partially explained associations between sleep disturbances and PTSD symptom trajectories. The results from this study can potentially aid detection of modifiable risk factors during the early course of PTSD and inform cognitive-behavioral intervention efforts.