Currently, only the TSI assesses complex traumatic reactions and patient response styles. However, its feigning scale, ATR, uses a flawed detection strategy and is potentially confounded by experiences of complex PTSD. As a consequence, clinicians using the TSI to evaluate severely traumatized patients have no useful method for discriminating genuine and feigned responding. Several detection strategies have demonstrated utility within evaluations of feigned trauma including the assessment of rare symptoms, symptom combinations, symptom selectivity, and symptom severity. The current study created scales on the TSI according to these strategies using a development sample of 107 severely traumatized patients. Validation of all TSI feigning scales was then performed with a second independent sample of 71 severely traumatized patients using a mixed simulation design. Results found support for each scale's convergent validity with SIRS primary scales (M rs = .52) and discriminant validity with measures of defensiveness on the SIRS (M rs = -.07) and TSI (M rs = -.19). Each scale also produced expectedly mild to moderate relationships with SADS-C clinical scales (M rs = .32) and the SCID-IV PTSD module (M rs = -.02). Support for their criterion validity was only moderate (M ds = .69) when comparing the scores of genuine patients to those simulating disability. Potential explanations for this trend were reviewed, including (a) the impact of comorbidity, (b) the restrictions associated with creating embedded feigning scales, and (c) the influence of simulator knowledge in analogue designs. Limitations of the study and future avenues of research were discussed.

Abstract EXAMINATION OF BASAL NEUROENDOCRINE LEVELS IN OIF/OEF/OND VETERANS By Sage E. Hawn, B.S. A thesis submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy at Virginia Commonwealth University. Virginia Commonwealth University, 2015. Major Director: Ananda B. Amstadter, PhD. Associate Professor Departments of Psychiatry, Psychology, & Human and Molecular Genetics High rates of combat exposure exist among veterans of the recent conflicts, and are associated with debilitating mental health conditions, including posttraumatic stress disorder (PTSD). Numerous psychosocial and biologic factors are associated with PTSD, including the HPA-axis. The present study aimed to compare baseline neuroendocrine levels by trauma group (PTSD, trauma exposed [TE], and non-trauma controls [NTC]) among a sample of young veterans. An exploratory aim was to examine potential moderators of the relation between PTSD and basal cortisol/ACTH. Group differences in cortisol were nominally significant, with the NTC group having significantly higher cortisol than the PTSD group. Sleep disturbance was the only moderator of this relationship in cortisol, although lifetime trauma load significantly predicted basal cortisol across all models. No significant effects were demonstrated for ACTH. Examining effects of trauma on basal physiology provides a critical stepping ground for future investigations that may inform targeted prevention and intervention efforts.

College student and Amazon's Mechanical TURK (MTURK) samples are regularly utilized in trauma research. Recent literature, however, has criticized these samples for not being generalizable to the general U.S. population. Measurement invariance (MI) using confirmatory factor analyses (CFA), is rarely utilized in trauma research, even though the analysis can determine whether groups are invariant across factor structure, factor loadings, item intercepts, and residual error variances on a given measure of PTSD symptom severity. The purpose of this study was to determine whether college student (n = 255) and MTURK (n = 316) samples are invariant on the PCL-5. Model fit indices indicated the 7-factor Hybrid model was the best fitting model, but the 6-factor anhedonia model was the most parsimonious model. Both models demonstrated equivalence in factor structures (configural invariance), factor loadings (metric invariance), intercepts (scalar invariance), and residuals (strict invariance), indicating MTURK and college student samples are similar in regards to PTSD symptom severity. These findings provide evidence that these groups can be combined in future studies to increase sample size for trauma research. Only the Anhedonia factor exhibited mean differences between groups, which may be related to true differences between college students and MTURK survey-takers. Thus, there is further evidence that the findings from trauma studies using these populations are generalizable to each other.

Magister Artium (Psychology) - MA(Psych) / Due to the recent findings that the majority of South African’s have been exposed to high levels of trauma, the effects of trauma on mental health and wellbeing have become an important area of research in the South African context. Although many individuals in our country experience high exposure and multiple incidences of trauma, there are a significant number of people who seem to cope well in the face of adverse circumstances and trauma and do not develop stress symptomology as a result of exposure to a traumatic event. These individuals are viewed as resilient as they are able to utilize protective factors at their disposal, aiding them in preventing the development of symptoms associated with Posttraumatic Stress Disorder (PTSD). A large body of literature exists that identifies various protective factors, which may have a positive influence on an individual’s response to a traumatic event, thus making them more resilient. However, there is a gap in the South African research on the relationship between exposure to trauma, protective factors and the development of PTSD. The aim of this study is to explain how protective factors mediate PTSD symptoms. It investigates protective factors that resilient individuals utilize in the face of trauma such as; internal characteristics or traits, various demographic factors (i.e., age, gender), supportive interpersonal relationships, religious affiliation and community and family factors that have been identified as protective factors in the literature. Resilience emerged as significant in that it mitigated the development of posttraumatic symptoms (PTS) amongst the sample of university students. This indicates that despite the high incidences of exposure to trauma, individuals have the ability to be resilient, which therefore serves as a protective factor in the event of trauma. The present study constitutes a secondary analysis of previously collected survey data. The data being analysed is from a quantitative, cross-sectional survey that adopted a non-random, convenience sampling method. Logistic regression was undertaken in order to determine the relationship between age, religious affiliation, type of exposure, resilience and posttraumatic stress exposure. Only resilience emerges as a significant predictor underlying its importance for mediating traumatic outcomes. It highlights the importance od including protective factors in future research and interventions.

Childhood trauma exposure is associated with a range of adverse outcomes, including post-traumatic stress disorder (PTSD). Parents are often children’s main source of support following a trauma. However, little is known about the experiences of parents in supporting their child post-trauma and research into the relationship between parenting and childhood PTSD has yielded mixed findings. The five papers in this thesis aimed to investigate the role of parental responses in child adjustment following child trauma exposure. Paper 1 presents a meta-analytic review of the association between parenting and child PTSD symptoms. A small, yet highly significant relationship between parenting and child PTSD was identified, but given the limited number of studies available and the potential influence of methodological factors, only tentative conclusions are made. Nonetheless, the finding that parenting is associated with child PTSD informed the following four papers in this thesis. Paper 2 qualitatively examined parents’ experiences of supporting their children following single-incident trauma and presentation at an Emergency Department. As no child in Paper 2 accessed psychological treatment post-trauma, Paper 3 presents an investigation of parents’ views of providing care for children with clinically significant levels of post-traumatic distress. The trauma-specific aspects of parental support identified in Papers 2 and 3 highlight the need for a validated measure of post-trauma parental responses. Paper 4 describes the development and preliminary evaluation of a measure of parental appraisals and behaviours following trauma exposure. Finally, the majority of studies that examined parenting behaviours in Paper 1 were conducted in a Western, low-risk context; therefore, the aim of Paper 5 was to examine the views of parents of trauma exposed children in the peri-urban settlement of Khayelitsha, South Africa. Overall, the results indicate that parental responses are associated with child PTSD symptoms and highlight the strategies used by parents to promote child recovery.

Literature Review: Background: Compassion-facilitating interventions (CFIs) seek to increase feelings of reassurance, safeness and well-being, and are suggested as a new psychotherapeutic approach to treat post-traumatic stress. Objectives: This review summarises and synthesises the literature investigating CFIs for post-traumatic stress disorder (PTSD) in clinical adult populations. Method: A systematic review of the experimental and intervention literature to date was completed using PubMed, PsycINFO, and Web of Knowledge databases. Results: CFIs show large to medium effect sizes in reducing PTSD in traumatised populations. However, many studies did not compare these interventions to active control conditions, and for the few studies that did, compassion-facilitating interventions were not better at reducing PTSD than the active control conditions. There was also not enough evidence in these studies to indicate a mechanism of change in these interventions. Conclusions: CFIs may be an effective intervention in PTSD, but more high quality research is needed to establish their efficacy over and above well established PTSD treatments. More research is also needed to identify the psychological mechanisms at work in decreasing PTSD symptoms Empirical Paper: Objective: Compassion-facilitating interventions are thought to be promising for treating post-traumatic stress disorder (PTSD). It is theorised that inducing self compassion through a compassion-facilitating meditation task would interrupt the psychological processes that cause emotional distress and trauma-related intrusions that form post-trauma. Methods: A student sample (n = 72) was exposed to a trauma-film and then either listened to a neutral-emotion audio mediation or a compassion-facilitating meditation (CFM). Self-reported distress, self-compassion and self-criticism were measured at baseline, post-film, post-audio meditation and for seven days following the experiment. Measures of sympathetic arousal and parasympathetic activation were measured at baseline and during the trauma film and audio meditation. Trauma-related intrusions were measured for seven days following the experiment. Results: Lower self-reported distress and higher self-compassion were reported over the seven day follow-up, but not directly after the meditation. No statistical differences between conditions over time were found for any of the physiological measures but skin conductance was higher in the CFM group, contrary to predictions. There were also no statistical differences found between the two conditions in terms of sum daily intrusions following trauma-exposure. Conclusions: This research supports the hypothesis that facilitating self compassion can disrupt some of the observed processes post-trauma, namely felt distress, although only after a delay. These findings are relevant to the theoretical models of PTSD and future clinical interventions.

After a hostage negotiation incident, it is common practice for either no debriefing to occur or a formal, administration-attended debriefing to discuss issues and possible emotional as well as, psychological stressors with the hostage negotiation team members. However, many times negotiators are reluctant to be honest in front of administrators or supervisors about their weaknesses as they feel this will lead to termination or loss of service weapon. Little is known about what effect, if any, best practice hostage negotiation after incident debriefings would have given regarding possible psychological distresses on the negotiators as well as effects on team bonding. The purpose of this qualitative study was to investigate whether and how after incident hostage negotiation debriefing strategies lower PTSD symptoms among hostage negotiators. The theoretical framework for this study was Kelley's followership theory. The sample was 12 negotiators from a local county negotiation team and a local city negotiation team. The research questions focused on hostage negotiator preference for debriefing strategies, honesty in debriefings in relation to stressors, opinions of the meeting's effects on dealing with trauma, and effects on team bond building. The results were that peer run, peer driven debriefing strategies are most wanted and most effective for hostage negotiators. The positive social change implications are numerous, including a more effective, more mentally fit, and closer bonded hostage negotiation team capable of saving more lives who in turn will have a healthier family life, which will resonate into the community.

Existing research suggests that childbirth may be a significant trigger of posttraumatic stress disorder (PTSD) in the postpartum period. While literature presents important results regarding the prevalence and risk factors of postpartum PTSD, several gaps remain. The current study examined the factor structure of perinatal PTSD by comparing two supported structures of PTSD. Additionally, structural equation modeling (SEM) was used to examine whether subjective birthing experiences and objective childbirth characteristics mediated the relationship between psychosocial variables (history of trauma, fear of childbirth, and social support) and postpartum PTSD. Women were recruited during pregnancy from the University of Iowa Hospitals and Clinics. Symptoms of PTSD, OCD, and depression, as well as risk factors for postpartum PTSD were measured at pregnancy, 4, 8, and 12 weeks postpartum. Additionally, structured clinical interviews were conducted to assess for depression, PTSD, OCD, and mania. Five factor structures were examined using confirmatory factor analysis, including two four factor models with correlated latent factors, two four factor hierarchical models, and a unidimensional model. All models resulted in adequate global fit and excellent component fit. The most parsimonious model, the unidimensional model was retained. The SEM showed that subjective perceptions of childbirth mediated the relationship between fear of childbirth and postpartum PTSD at 4 weeks postpartum. At 8 weeks postpartum, objective childbirth characteristics mediated the relationship between fear of childbirth and postpartum PTSD and there was a direct relationship between fear of childbirth and postpartum PTSD. The current study supports a hierarchical or unidimensional structure of PTSD in perinatal samples emphasizing the importance of a higher-order, shared dimension of PTSD symptoms. It further emphasizes the importance of fear of childbirth and both subjective and objective birthing experiences in predicting postpartum psychopathology. Future research should examine these symptoms and risk factors in a more diverse and at-risk sample. Additionally, accurate assessments, and influential interventions for postpartum PTSD should be further examined.

The purpose of this study was to determine whether the Minnesota Multiphasic Personality Inventory (MMPI) could be used to discriminate between Vietnam veterans with Post-Traumatic Stress Disorder and those with other mental disorders. Scores on the 13 validity and clinical scales of the MMPI were used as predictor variables in two discriminant analyses. The first of these was performed in replication of studies in which cases of substance-abuse disorder were eliminated from the non-PTSD comparison group. Substance- abuse cases were included in the second discrimination. The results indicated that while the MMPI can be used to discriminate PTSD from non-PTSD veterans, this discrimination is weakened by the presence of cases with substance abuse disorders in the non-PTSD comparison group.

The term “post-traumatic stress disorder” (PTSD) is a relatively new diagnostic label, being formally recognized in 1980 in the Diagnostic Statistical Manual for Psychiatric Illness – Third Edition (DSM-III) of the American Psychiatric Association (APA, 1980). Complex Post-Traumatic Stress Disorder (CP) is a more recently discussed, and newly-classified, phenomenon, initially discussed in the early 1990s (Herman, 1992a). Thus, as research into effective treatments for CP is sparse, the treatment of CP is the topic of this study, in which a guideline-based treatment program developed by the researcher for the treatment of CP is implemented and evaluated. Ten individuals participated in this study, undertaking individualized, guideline-based treatment programs spanning a period of six months. In providing background information relevant to this study, an explanation is provided regarding the nature of CP, and the reasons for its consideration as a separate phenomenon to PTSD. The adequacy of the PTSD formulation in enabling effective assessment and treatment of CP is also explored, with endorsement of previous researchers’ conclusions that the CP construct is more useful than the PTSD construct for assessing and treating survivors of long-term and multiple forms of abuse. The PTSD classification is restrictive, and not necessarily appropriate for certain forms of trauma (such as prolonged trauma, or multiple forms of trauma), as such trauma experiences may lead to specific effects that lay outside those formerly associated with PTSD. Such effects include alterations in affect regulation, consciousness, self-perception, interpersonal relationships, and in systems of meaning. Following discussion regarding the PTSD/CP classification, an examination of treatment methods currently used in the treatment of PTSD, and a review of treatment outcome studies, takes place. The adequacy of primary treatment methods in treating CP symptoms is then examined, with the conclusion that a range of treatment methods could potentially be useful in the treatment of CP symptoms. Individuals with a diagnosis of CP may benefit from the adoption of an eclectic approach, drawing on different treatment options for different symptoms, and constantly evaluating client progress and re-evaluating interventions. This review of treatment approaches is followed by details of an initial study undertaken to obtain feedback from individuals who had suffered long-term/multiple trauma and who had received treatment. Participants in this initial study were asked open-ended questions regarding the treatment approach they had experienced, the most useful aspect of the treatment, the least useful aspect, and other strategies/treatment approaches that may have been useful – but which were not used. The feedback obtained from these individuals was used to inform the development of treatment guidelines for use in the main study, as were recommendations made by Chu (1998). The predominant focus of the treatment guidelines was “ego strengthening”, a term coined by Chu (1998) to describe the “initial (sometimes lengthy) period of developing fundamental skills in maintaining supportive relationships, developing self-care strategies, coping with symptomatology, improving functioning, and establishing a positive self identity” (p.75). Using a case study approach, data are then presented relating to each of the ten individuals involved in the treatment program: details of his/her trauma experience(s)and the impact of the trauma (as perceived by each individual); details of each individual’s treatment program (as planned, and as implemented); post-treatment evaluation of the positive and negative aspects of the treatment program (from the therapist’s perspective); and details of the symptoms reported by the individual post-treatment, via psychometric assessment and also during interview. Analysis and discussion of the data relating to the ten participants in the study are the focal point of this study. The evaluation of the effectiveness of each individual’s treatment has been based predominantly on qualitative data, obtained from an analysis of language (discourse analysis) used by participants to describe their symptoms pre- and post-treatment. Both blatant and subtle changes in the language used by participants to describe themselves, their behaviour, and their relationships pre- and post-treatment have provided an insight into the possible changes that occurred as a result of the treatment program. The language used by participants has been a rich source of data, one that has enabled the researcher to obtain information that could not be obtained using psychometric assessment methods. Most of the participants in this study portrayed notable changes in many of the CP symptoms, including being more stable and having improved capacity to explore their early abuse. Although no direct cause-effect relationship between the participants’ treatment program and the improvements described can be established from this study, the participants’ perception that the program assisted them with their symptoms, and reported many aspects of “ego strengthening”, is of major importance. Such self-perception of strength and empowerment is important if an individual is going to be able to deal with past trauma experiences. In fact, abreactive work may have a greater chance of succeeding if those who have experienced long-term or multiple trauma are feeling more empowered, and more stable, as were the participants in this study (post-intervention). In concluding this study, recommendations have been made in regard to the use of guideline-based treatment programs in the responsible treatment of CP. Strengths and limitations of this study have also been highlighted, and recommendations have been made regarding possibilities for future research related to CP treatment. On the whole, this study has supported strongly other research that highlights the importance of focusing on “ego strengthening” in assisting those who have suffered long-term/multiple trauma experiences. Thus, a guideline-based program focusing on assisting sufferers of long-term trauma with some, or all, of the symptoms of CP, is recommended as an important first stage of any treatment of individuals who have experienced long-term/multiple trauma, allowing them to develop the emotional and psychological strength required to deal with past traumatic events. Clinicians who are treating patients whose history depicts long-term or multiple trauma experiences (either from their childhood, or at some stage in their adult life) need, therefore, to be mindful of assessing individuals for symptoms of CP – so that they can treat these symptoms prior to engaging in any work associated directly with the past traumatic experiences.