The purpose of this dissertation was to examine coping and outcomes of grief for atheist individuals during bereavement. The landscape of grief research has significantly changed since the days of Freud, and widely accepted stage theory models of grief have not held up to empirical review (Wortman & Silver, 1989). Emerging research examines factors that may lead to positive changes as a result of loss or trauma, known as posttraumatic growth. However, atheist individuals continue to be an understudied group in the psychological and bereavement literature, while people with religious beliefs continue to receive the most focus (Brewster, Robinson, Sandil, Esposito, & Geiger, 2014; D’Andrea & Sprenger, 2007). This study explored how cognitive (e.g., assumptions about the world), existential (e.g., meaning), and behavioral (active and emotional) coping methods are associated with posttraumatic growth, complicated grief, and psychological distress in a believer and atheist sample after the death of a close friend or family member. Specifically, posttraumatic growth, complicated grief, and psychological distress were regressed onto the three types of coping (cognitive, existential, and behavioral) using a hierarchical regression analysis. The first analysis controlled for demographic variables and the second analysis consisted of matched groups on demographic variables that were found to be associated with grief outcomes in prior research (e.g., Bonanno et al., 2008; Bonanno, Galea, Bucciarelli, & Vlahov, 2007). Exploratory bivariate correlations were conducted to assess interrelations between the variables of interest. Additionally, MANOVA was used to assess differences in demographic variables between the believer and atheist sample. Significant cognitive, existential, and behavioral coping methods were found to be associated with posttraumatic growth, complicated grief, and psychological distress. Furthermore, the endorsement of a belief in God(s) was significantly and positively associated with posttraumatic growth, but also significantly and positively associated with complicated grief and psychological distress. Results from this study can be used to identify appropriate clinical strategies for counselors working with grieving atheists, and will deepen the breadth of literature on bereavement and coping within diverse populations. Limitations and directions for future research are also discussed.

Combat-related posttraumatic stress disorder (PTSD) is a psychological condition researchers have cited as a major cause of marital discord and divorce for veterans with PTSD. This study examined the psychological construct of locus of control among the wives of veterans diagnosed with combat-related PTSD and whether or not it was a predictor of marital satisfaction within this context. An extensive search of the current literature revealed no previous studies that had investigated this relationship. Utilizing the family systems theory to address this gap, this study sought to compare reported marital satisfaction in wives with an internal locus of control to those with an external locus of control. Participants for this study were 111 wives of veterans with combat-related PTSD, each of whom completed a demographic questionnaire, the Kansas Marital Satisfaction Survey, and the Duttweiler Internal Control Index. A multiple linear regression was conducted to determine if age, number of years married, number of children, level of education, household income, and internal locus of control were predictors of marital satisfaction reported by wives of veterans with combat-related PTSD. The results indicated that an internal locus of control accounted for a significant degree of the variance in marital satisfaction while the demographic variables were not significant predictors. This study contributes to social change by providing an empirical insight into the relationship between locus of control and marital satisfaction in wives of veterans with PTSD. The results of this study could help improve the quality of life of veterans with PTSD by enhancing awareness of locus of control to practitioners while developing a therapeutic treatment plan that will fit the veteran's locus of control orientation.

Trauma exposure among youth in the United States is a common event. Although the number of individuals who meet criteria for a diagnosis of posttraumatic stress disorder (PTSD) is only a small percentage of those exposed to trauma, many individuals who do not meet full criteria for PTSD continue to experience problematic posttraumatic stress symptomology. Acceptance and commitment therapy (ACT) is an empiricallybased psychological intervention that has shown effectiveness in the treatment of a number of concerns among both adults and adolescents. ACT has shown preliminary effectiveness in the treatment of adult PTSD, but its effectiveness in treating adolescent posttraumatic stress is currently unknown. Using a multiple-baseline design, the present study investigated the effectiveness of a 10-week ACT protocol to treat adolescents experiencing posttraumatic stress. Seven individuals between the ages of 12 and 17 participated in the treatment, four of who were from a community sample and three who were in residential care to treat comorbid eating disorders. Structured interviews were completed at pretreatment and individuals reported baseline data for anywhere from 7 to 66 days before engaging in treatment. Symptom and process measures were completed at each session. Postassessment was completed one week following the final session. Results revealed a decrease in posttraumatic stress symptomology across both samples, with a 73.7% mean reduction in self-reported posttraumatic stress symptomology and a mean reduction of 58.8% on clinician-rated measures of PTSD. Overall results provide preliminary support for ACT as an effective treatment for adolescent posttraumatic stress. Empirical and clinical implications of results as well as limitations and future directions are discussed.

Previous studies evaluating the impact of trauma history and PTSD on pain sensitivity yield inconsistent findings; the presence of trauma-related negative affective states may account for these discrepancies. Therefore, the proposed study aimed to evaluate the effect of trauma-related negative affect and PTSD symptoms on sensory and affective components of pain sensitivity among trauma-exposed women. Adult women (N = 87) with low and high PTSD symptoms underwent an emotional disclosure paradigm, during which they wrote about a traumatic event or a neutral topic. Participants then completed a pain induction procedure. Compared to women with low PTSD symptoms, women with high PTSD symptoms demonstrated increased time to pain detection (e.g., threshold) and ability to withstand pain (e.g., tolerance), as well as increased pain intensity and when accounting for relevant covariates. Women with high PTSD symptoms who wrote about their worst traumatic experience reported higher pain unpleasantness relative to women with high PTSD symptoms who wrote about the neutral topic and women with low PTSD symptoms who wrote about either topic. Results suggest that PTSD symptoms and trauma-related negative affect may facilitate alterations in pain sensitivity in trauma-exposed women, but this relationship is complex and requires further exploration.

Trauma due to sexual assault becomes a life changing event during a child's critical developmental years. Bronfenbrenner's ecological systems theory outlines the process of understanding an individual's environment and how disruptions in one level may affect other levels. This study determined if gender and ethnicity among sexually traumatized children diagnosed with post-traumatic stress disorder (PTSD) predict symptom severity as measured by the Trauma Symptom Checklist for Children (TSCC) after controlling for the socioeconomic level and home environment. The population consisted of 126 children aged 8 through 16 with at least a second-grade reading level. Multiple regression examined whether male and female children were significantly different concerning the magnitude of PTSD symptom presentation. Multiple regression was also used to test whether gender and ethnicity played a significant role in predicting specific symptoms. Female gender had statistically significant predictive power concerning anger and sexual concern. Age at intake was associated with significantly higher scores for anxiety, anger, and dissociation. Home environment was a statistically significant predictor for anxiety, depression, PTSD, and sexual concern with children living in a foster home having significantly higher symptom severity in these domains. Socioeconomic status was the strongest predictor variable. The addition of sexual assault in the diagnostic criteria for the diagnosis of PTSD with the adoption of DSM-5 indicate a justification for further research. Increased awareness of inefficiencies in identification of symptoms and inadequacies in training trauma providers are indicative of social change. Further knowledge of PTSD symptom expression propagates a new protocol when treating traumatized children.

Children account for approximately 34% of the burn-injured population in the United States and are particularly at risk for developing posttraumatic stress disorder (PTSD) or other significant psychopathology (i.e., behavioral and attentional difficulties, acute stress, depression, anxiety, phobias, dissociative symptoms, and enuresis). There is a significant risk that quality of life (QOL) can have a negative impact on children who have sustained a burn injury, particularly within the domain of social functioning. Specifically, children who meet the criteria for PTSD following a burn injury are at an increased risk of experiencing impairment in overall QOL. However, there remains significant evidence that a substantial portion of children exhibit satisfactory QOL outcomes following a burn injury at a level comparable to their noninjured peers. This positive outcome may be attributed to the child's level of resiliency--the protective factors that positively influence their ability to adjust and move forward following a traumatic event. Research on risk and resiliency of posttraumatic stress symptoms (PTSS) in pediatric burn survivors is limited. For psychological assessment and burn treatment to be successful, it is important to understand the resilient qualities that are present in children who experience positive post-burn-injury outcomes. By focusing on a child's mental health strengths and by building his or her resilience, a health professional may prevent or lessen the child's adjustment difficulty or psychopathological symptoms. Thus, the primary purpose of this study was to identify the relation between pediatric burn injury, demographic variables, resilience and QOL outcome with regard to PTSS. Demographic information (e.g, gender, age, household income, and diagnoses) and burn injury characteristics (e.g., age at time of burn, total body surface area injured, number or days spent in the hospital, and number of surgeries) were considered with regard to PTSS, resiliency, and QOL outcome. Further analysis efforts compared results from the Resiliency Scales for Children and Adolescents (RSCA) with scores obtained from the University of California at Los Angeles Posttraumatic Stress Reaction Index for Diagnostic and Statistical Manual--Fourth Edition (UCLA PTSD Reaction Index for DSM-IV; Reaction Index). Identical analyses were performed regarding the RSCA and the Pediatric Quality of Life Inventory, Version 4.0 (PedsQL 4.0). Analyses indicated a significant relation between PTSS severity and resilience, with positive resilience outcomes correlated to lower levels of PTSS severity. Further, a significant relation was found between QOL and PTSS, with positive QOL functioning related to lower levels of PTSS. Finally, a significant relation was found between resilience and QOL: Participants who endorse higher levels of resilience demonstrate better QOL outcomes. Overall, demographic information and burn injury characteristics did not significantly affect results regarding PTSS severity. Clinical implications and future areas of research are discussed.

Research suggests that individuals experience Posttraumatic Growth (PTG) from chronic health conditions, such as the diagnosis and treatment of cancer. How PTG is perceived at early time points following stressful events and whether PTG reflects a coping process or actual outcome remains uncertain. Researchers have implemented research methodologies to validate reports of PTG (e.g., corroboration by partners/significant others), although most research designs are cross-sectional, which limit conclusions and subsequent implications. The current longitudinal study examined cancer patients` and significant others` perceptions of Anticipated Posttraumatic Growth (APTG), dispositional and situational coping, and PTG at three time points spanning pre-treatment to 9 months later. Participants consisted of 87 mixed-cancer patients and 55 collaterals (e.g., spouses, family members, friends, or other community members). At pre-treatment, patients and collaterals completed a modified Posttraumatic Growth Inventory (PTGI) to assess APTG. Collaterals also completed a modified PTGI for patients. Results revealed that patients and collaterals reported high levels of APTG for themselves compared to reports of PTG in the literature. Patients` APTG was significantly higher than collaterals` APTG, although patients and collaterals experienced similar levels of PTG. Overall, patients over-anticipated PTG for all growth scales, and with the exception of the PTG scale of new possibilities, collaterals under-anticipated the level of growth they reported. For corroboration of growth, collaterals were accurate in anticipating the amount of PTG patients would experience, with the exception of the PTG scale of new possibilities. For patients, dispositional planning coping moderated a relationship between PTG and APTG, and situational planning coping mediated a relationship between APTG and PTG. Results of the current study provide evidence for APTG as a possible illusory phenomena, a coping process, and animportant precursor for later PTG. Additionally, the results have important considerations for the impact of cancer on the family and for growth as an observable construct. The findings are discussed in terms of relevant theory and implications for clinicians.

Posttraumatic Stress Disorder (PTSD) is an anxiety disorder characterised by disturbed arousal, altered attention, and fear processing, and a reduction in the ability to perform cognitive tasks. Predominant neurophysiological models of PTSD have been focused on alterations in fear-related regulation, and few incorporate broader changes in generic executive control which may underlie many of the clinical symptoms and cognitive deficits in PTSD. This thesis aimed to investigate the neurophysiology of executive inhibitory control in PTSD using a Go/NoGo response inhibition task and converging functional imaging, structural imaging and electrophysiological measures. The first series of studies aimed to elucidate a normative neural network model of inhibitory control, and are consistent with normative control involving the activation of a mainly right-lateralised ventral lateral prefrontal cortex (VLPFC) network. Inhibitory control-related activation was found to be affected by levels of anxiety and changes in underlying neural structure; alterations in frontal cortical maturation and volume were related to additional activation of bilateral frontal cortical regions and the dorsal striatum, with anxiety increasing the demand on inhibitory control-related activation. In contrast to healthy participants, PTSD was associated with reduced inhibitory control as indexed by inhibitory behaviour, diminished activation of the right VLPFC, and slowed inhibition-related information processsing. PTSD participants relied on the greater activation of a left fronto-striatal inhibition network to support control, with the activation affected by levels of PTSD severity and comorbid anxiety. This left fronto-striatal activation in PTSD was related to underlying increases in fronto-striatal neural structure. Further, the ability to efficiently engage a left fronto-striatal network in PTSD during inhibitory control predicted better response to cognitive behavior for PTSD, consistent with the proposal that an improved ability to flexibly engage control systems may facilitate the resolution of PTSD symptoms. Taken together, this program of research extends current neurophysiological model of PTSD to show that PTSD involves a fundamental disturbance in the function and structure of key fronto-striatal response control networks associated with inhibitory control.

Doctor of Clinical Psychology/ Master of Science (DCP/ MSc) / A number of international studies reveal high prevalence rates of posttraumatic stress disorder (PTSD) within homeless populations. Recent research on PTSD indicates that cognitive responses to trauma are critical in determining who develops the disorder. In Australia, a number of studies indicate exceptionally high rates of trauma experience among homeless adults, yet PTSD has not been investigated in this cohort. Therefore, the primary aim of this project was to improve understanding of PTSD and related cognitions in a sample of homeless adults in Sydney. The project attempts to determine the prevalence of PTSD and its onset in relation to homelessness (Study One) and also explores the role of cognitions in PTSD (Study Two). The sample consisted of seventy homeless men and women aged 18 to 73 years, who were randomly sampled through eight homeless services. A computer-assisted face-to-face structured clinical interview was conducted for each participant. The majority of the sample stated that they had experienced at least one traumatic event in their lifetime (98.2%). The twelve-month prevalence of PTSD was higher among homeless adults in Sydney in comparison to the Australian general population (41.1% versus 1.5%). In 59.1% of cases, the onset of PTSD was found to have occurred before the age of the first reported homeless episode. In a comparison of those with and without a current diagnosis of PTSD, it was found that those with PTSD scored significantly higher overall on measures of posttraumatic cognitions and early maladaptive schemas. In particular, this group scored higher on schemas that centre on the world being entirely dangerous and the self being totally inept. A mediational analysis showed that when trauma and mental health care were controlled, the relationship between early maladaptive schemas and PTSD symptom severity was mediated by posttraumatic cognitions. It was concluded that homeless adults in Sydney frequently experience trauma and PTSD, which typically precedes homelessness. It was also concluded that among homeless adults, posttraumatic cognitions and early maladaptive schemas appear to play an important role in PTSD and may be associated with symptom severity. These findings have implications for public policy on homelessness and mental health, homeless service provision, PTSD theory, and PTSD treatment for homeless adults.

Despite high rates of alcohol and marijuana use and dating violence among individuals between the ages of 15 and 24, limited research has examined a link between substance use and dating violence within adolescent samples. Moreover, although both problem drinking and dating violence perpetration have been linked to a history of childhood maltreatment (CM), few studies have examined the potential mechanisms of a relationship between these variables. The current study tested the predictive role of CM in adolescent alcohol and cannabis use and dating violence perpetration in a sample of youth with CM histories; in particular, we were interested in predicting the temporal co-occurrence of these behaviours. It was hypothesized that trauma symptomatology would play a mediating role in this relationship. Results demonstrated that only witnessing emotional domestic violence predicted the co-occurrence of substance use and dating violence; in general, trauma symptomatology was not found to be a significant mediator.