Post-traumatic stress disorder (PTSD) is a psychiatric condition that can develop when people experience a stressful and life-threatening event. Clinical research indicates that the presence of a state of hyperarousal after a traumatic experience is the best predictor of a subsequent diagnosis of PTSD. The role of arousal peptides called orexins (hypocretins) in a PTSD-like condition produced by exposing rats to a single episode of footshocks (5× 2 s episodes of 1.5 mA) was investigated in this thesis. The first part of my thesis involves the characterization of the footshock model of PTSD and the second part examines the involvement of orexins in this footshock model. The following findings are reported. First, shock rats that exhibited a high level of anxiety to a novel tone (high responders, HR) the day after the footshock exposure subsequently displayed more avoidance when compared to shock rats that exhibited a low level of anxiety (low responders, LR). These results highlight the importance of individual differences in the reaction to a strong fear-inducing experience. Second, the orexin precursor peptide prepro-orexin (ppOX) mRNA was found to be elevated in rats at 6 and 14 days after exposure to footshocks. In addition, ppOX mRNA levels were found to be positively correlated with anxiety at 14 days post-shock. Third, pre-shock injections of the corticotropin releasing factor receptor antagonist antalarmin were found to attenuate the anxiety expressed to the shock chamber and eliminate the correlation between ppOX mRNA levels and anxiety. Fourth, systemic injections of the nonselective orexin receptor antagonist TCS-1102 was found to attenuate the anxiety expressed in rats at 14 days post-shock. Fifth, TCS-1102 was found to have anxiolytic effects that were specific for the HR. The results of these experiments provide evidence linking the orexin system to the anxiety produced by exposure of rats to footshocks. They also provide preclinical evidence in support of the use of orexin antagonists for the treatment of anxiety in PTSD.

The first study examined the role of perceived adverse parenting and early maladaptive schemas in the development of PTSD in Australian and New Zealand Vietnam war-veterans (N = 220). Veterans diagnosed with PTSD scored higher on the Young Schema Questionnaire and had higher scores on the Measure of Parental Style (MOPS) than veterans not diagnosed with PTSD. Only three childhood negative events were associated with PTSD: witnessing domestic violence; mother unemployed; and living with a stepfather. These variables may relate to research on negative family environment being associated with PTSD, whereas schemas may relate to parenting. The finding of strong relationships between negative life events data and adverse parenting endorses the MOPS as a valid instrument. Admission to hospital in Vietnam was the only war variable related to PTSD. Schemas mediated the negative parenting - PTSD link, and the Vietnam War experience - PTSD link. The results suggest that early maladaptive schemas have an important role in the development or maintenance of PTSD in Vietnam veterans. The second study measured at baseline, termination and three months the early maladaptive schemas, PTSD, anxiety, depression, and relationships of war-veterans (n = 54) participating in a PTSD group treatment program that included schema-focused therapy. Scores on the PTSD Check List, the Hospital Anxiety and Depression Scale, and 17 schemas decreased significantly after treatment. The Abbreviated Dyadic Adjustment Scale and the Assessment of Quality of Life scores indicated that the veterans’ current relationships improved. Partners of veterans also experienced enhanced relationships. All gains were maintained at three-month follow-up. The five schema domains were associated with an improvement in PTSD symptoms, with gains on the impaired autonomy domain being associated with 26.3% of the changes in PTSD. Change scores for the schema treatment were compared to a similar earlier manualised CBT program. Pre-treatment measures were similar in both groups. Nevertheless, PTSD and anxiety improved significantly more for the schema-focused therapy group. Although the second study was not a randomised control comparison, both studies support the feasibility of schema-focused therapy to assist veterans with PTSD.

Recent global conflicts have increased North American military involvement, leading to higher rates of combat-related stress amongst soldiers. Although physical activity is directly correlated with improvements in mental health, the relationship between physical activity and combat-related stress has not been investigated. Using a mixed methodology approach, in this study, local military and ex-military personnel from Winnipeg, Canada, participated in a six week physical activity program in order to examine the influence of physical activity on combat-related stress. It was found that Canadian military members regularly deal with post-combat stressors, value camaraderie, and consider post-deployment support inadequate. The findings may lead to the integration of physical activity into the healing options of war related emotional stress. Future recommendations from this study are proposed. / February 2016

The thesis includes three papers: paper 1 is a literature review, paper 2 is an empirical study and paper 3 is a critical reflection. Paper 1 and 2 have been prepared for submission to Clinical Psychology and Psychotherapy. Paper 1 systematically reviews the qualitative literature pertaining to individual experiences of psychotherapy for PTSD. A meta-synthesis of twelve studies was facilitated using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) principles. The meta-synthesis aimed to explore aspects of psychotherapy for PTSD that were deemed helpful or unhelpful. The strengths and limitations of the study are considered, as are their implications for clinical practice. Paper 2 was a qualitative exploration of basic emotions and the affective phenomena of PTSD. Semi-structured interviews were conducted with ten participants and transcripts were analysed using a deductive-inductive thematic analysis. The results highlight the importance of considering a range of basic emotions in the assessment, formulation and psychotherapy relating to PTSD. The strengths and limitations of the study are considered, as are their implications for clinical practice. Paper 3 is not intended for publication and is a critical reflection of the overall study process. It evaluates the strengths and limitations of both paper 1 and paper 2 in more detail, in addition to offering a critical and reflective account of conducting the research.

BACKGROUND: In recent years, studies have increasingly pointed to a number of different mechanisms that potentially form the foundation for the neurodegenerative pathology seen in Post-Traumatic Stress Disorder (PTSD). One such mechanism is neural damage due to oxidative stress. This study attempted to identify significantly altered expression levels of particular genes of interest between PTSD and control groups, as well as between PTSD samples and samples exhibiting commonly seen PTSD comorbidities, major depressive disorder (MDD), and depressive disorder not otherwise specified (DepNOS). The genes of interest being pursued in the study encompass the production of reactive oxygen species, such as inflammatory response mechanisms, the processes that control the removal of reactive oxygen species (ROS), and genes that are activated in response to oxidative stress. Other genes of interest involve factors important in the structural integrity of the prefrontal cortex, such as junction proteins, the blood-brain barrier, such as aquaporins, and neuronal integrity. These genes were included due to the evidence of structural degeneration in PTSD patients. A total of 54 genes were tested in all four groups. OBJECTIVES: To identify and determine genetic differences amongst individuals with PTSD in comparison to non-PTSD sufferers, and sufferers of common PTSD comorbidities. METHODS: The expression levels of the genes of interest were measured using quantitative polymerase chain reaction (qPCR) techniques. RNA is extracted and collected from tissues samples of deceased military PTSD patients from the prefrontal cortex. The prefrontal cortex derived RNA is used as the experimental samples, due to the prevalence of the pathology of PTSD in this region. Complimentary DNA (cDNA) is reverse transcribed from the collected RNA, and then products of genes of interest are amplified during the qPCR reaction using specifically designed primers. The expression level of the genes of interest were then compared to the ubiquitously expressed gene 18s for normalization calculations. Genetic expression levels in the PTSD, MDD, and DepNOS cohorts were then normalized to the expression of non-PTSD controls. RESULTS: Of the 54 genes of interest analyzed, two genes, NQO1 and IL-6, exhibited significantly decreased and increased levels of expression in comparison to the control group, respectively (p < 0.05). Alongside this, NQO1 showed significantly decreased expression in comparison to the DepNOS cohort, while IL-6 exhibited significantly increased expression in comparison to the MDD cohort (p < 0.05). CONCLUSION: Two genes involved with the production and elimination of reactive oxygen species were identified with having significantly altered levels of expression. NQO1, which facilitates the removal of ROS was shown to have significantly lower expression when compared to the control group, indicating an inhibited ability to remove ROS readily. Furthermore, IL-6, a proinflammatory cytokine and a promotor of ROS production, exhibited significantly increased expression, indicating a potential increase in ROS formation. Together these results indicate a potential mechanism for the production and accumulation of ROS in patients with PTSD, leading to the observed neurodegeneration. / 2018-07-11T00:00:00Z

AN ABSTRACT OF THE THESIS OF CATHRINE HOEKSTRA, for the Master of Arts Degree in English, presented on May 6, 2016 at Southern Illinois University Carbondale. TITLE: INVISIBLE WOUNDS: PROCESSING TRAUMA IN WAR NARRATIVES THROUGHOUT LITERATURE MAJOR PROFESSOR: Dr. Edward Brunner Many Veterans face “invisible wounds” of war. By examining various types of war narratives in literature we can understand how these veterans cope with their invisible wounds and what others can do to help them process their trauma. This project considers types of trauma theory in addition to several short stories by Tim O’Brien and Phil Klay. Veterans of Vietnam, Iraq, and Afghanistan often face these “invisible wounds,” and these stories help us see that trauma in its complexity. War itself is a traumatic experience, but for some veterans post-traumatic-stress occurs after the war is over. It is my hope through this project we can understand the invisible wounds of war such as post-traumatic-stress disorder and traumatic brain injury while also understanding combat stress and the struggles that veterans face in their civilian life. By examining two texts of short stories from two completely different wars, we can look at trauma from different points of view. During Vietnam some veterans were faced with isolation, often times tempted with alcohol, drugs and suicide. These members of the armed forces were not welcomed home in most cases, and Tim O’Brien’s short stories let us understand just how daunting it was to be at war, and how storytelling is key to comprehending the difficulties of this war. Drawing on another kind of wartime experience is Phil Klay, who brings about the bureaucracies of Iraq and the difficulty that some Marines face when they are home trying to integrate into civilian life. Sometimes the stories are difficult, raw, and hard to comprehend, but processing trauma also allows one to improve the quality of life. By listening to these stories we are making the storyteller valued, and we are also learning about historical and cultural contexts. In my time as a Graduate Teaching Assistant, I was fortunate to work with student-veterans returning to the university after deployments. These students, all from diverse backgrounds allowed me to understand what it truly means to listen to the story and be attentive to what these students wanted and needed. By introducing war narratives, short stories, and poems in the classroom we give student-veterans an opportunity to see that writing is not only an outlet for self-expression, but also a way to let the public know what military life and deployments are like.

The current study examined the relation between symptoms of PTSD and depression with bullying victimization. Bullying victimization is a highly prevalent phenomenon that nearly half of all students experience (Gan, Zhong, Das, Gan, Willis, & Tully, 2014). Rates of bullying follow a linear trend through elementary grades, and plateau or peak in middle school (Atria, Strohmeier, & Spiel, 2007; Hoover, Oliver, Hazler, 1992; Nansel et al., 2001). Bullying increases a student’s likelihood to experience a range of emotional and behavioral disorders, such as anxiety, depression, and Oppositional Defiant Disorder (ODD), suggesting that bullying is a distressing life event for children. Yet only a small number of studies have provided evidence for the relation between bullying and symptoms of PTSD. This study sought to add support to a growing body of literature evaluating associations between these two variables, while also exploring possible moderators. Results suggested a significant relations among symptoms of PTSD, depression, andbullying victimization. This study identified several other significantly related variables, such as social support and gender, but failed to identify significant moderating variables between symptoms of PTSD and bullying victimization. This study also provided evidence for the relation between witnessing bullying and negative emotional reactions. The results, clinical implications, and limitations of this study are discussed.

No description available.

Purpose: Describe the perceptions of military registered nurses (RNs) on being prepared to provide nursing care during a deployment. Background: Injuries sustained by war are different from trauma-related injuries occurring within the Unites States. Nurses who provide care during overseas deployment encounter patients with poly-trauma, multiple and highly complex injuries; consequently, this type of nursing requires strong clinical skills beyond what is required in stateside facilities. Additionally, military nurses undergo intense stress related to overseas deployment in a war zone. In fact, military medical providers have one of the highest rates of post-traumatic stress post-deployment. Methods: This project employed a qualitative, case study approach. Semi-structured interviews were conducted with military RNs who worked as nurses during overseas deployment. A script was developed to guide the interview, and further discussion stemmed from participant responses. Recorded interviews were transcribed into text and analyzed for commonalities. Findings: Five military nurses who previously provided nursing care during overseas employment participated in this study. Commonalities included the realization that higher acuity injuries are seen in a deployed setting versus a military stateside hospital. Participants also shared fears that they would not be prepared enough to provide excellent patient care. Another commonality was not knowing how to prepare for an unknown experience. A positive commonality was the sense of pride expressed by the participants regarding their military service and deployment experience. All participants outlined what they had learned and what might have helped them to better prepare for deployment. Unanimously, more clinically relevant training was recommended. The participants shared that they had grown and changed from their deployment experience. Implications: All five participants felt a gap in perceived adequate pre-deployment preparation. They believed they lacked the training to care for the high acuity patients they would encounter during overseas deployment; this shook their self-confidence and caused them to worry about being an effective team member. Military preparedness programs should be expanded to include skills and knowledge relevant to nursing in high acuity, hostile environments. Research looking at the personal preparations, specifically mental and emotional, of military members may be helpful in determining any links between mental resilience and the development of PTSD.

Background Individually both migraine and post-traumatic stress disorder (PTSD) prevalence estimates are higher among women. However, there is limited data on the association of migraine and PTSD in women during pregnancy. Methods We examined the association between migraine and PTSD among women attending prenatal clinics in Peru. Migraine was characterized using the International Classification of Headache Disorders (ICHD)-III beta criteria. PTSD was assessed using the PTSD Checklist-Civilian Version (PCL-C). Multivariable logistic regression analyses were performed to estimate odds ratios (OR) and 95% confidence intervals (CI) after adjusting for confounders. Results Of the 2922 pregnant women included, 33.5% fulfilled criteria for any migraine (migraine 12.5%; probable migraine 21.0%) and 37.4% fulfilled PTSD criteria. Even when controlling for depression, women with any migraine had almost a 2-fold increased odds of PTSD (OR: 1.97; 95% CI: 1.64–2.37) as compared to women without migraine. Specifically, women with migraine alone (i.e. excluding probable migraine) had a 2.85-fold increased odds of PTSD (95% CI: 2.18–3.74), and women with probable migraine alone had a 1.61-fold increased odds of PTSD (95% CI: 1.30–1.99) as compared to those without migraine, even after controlling for depression. In those women with both migraine and comorbid depression, the odds of PTSD in all migraine categories were even further increased as compared to those women without migraine. Conclusion In a cohort of pregnant women, irrespective of the presence or absence of depression, the odds of PTSD is increased in those with migraine. Our findings suggest the importance of screening for PTSD, specifically in pregnant women with migraine.