Posttraumatic stress disorder (PTSD) is associated with significant functional impairments and disruptions in cognitive functioning. Functional recovery and remediation of cognitive difficulties are oft over-looked treatment targets in this population, despite their significant contribution to the burden of PTSD to the individual and to society. Existing literature suggests that functional impairment and cognitive dysfunction may not respond to first-line treatments for PTSD. Thus, the focus of this thesis was to examine symptom dimensions associated with cognitive dysfunction and functional impairment among individuals with PTSD, and to investigate a novel approach to cognitive remediation, Goal Management Training (GMT), in this population. Study one in this thesis is a review in which we identified a strong relation between dissociative symptoms and neuropsychological functioning, transdiagnostically and among individuals with PTSD. The hypothesis that dissociative symptoms would be strongly related to functional impairment among individuals with PTSD was explored in study two. We found that dissociative symptoms mediated the relation between PTSD symptoms and functional impairment among a sample of military members, veterans, and first responders with PTSD. Study three identified that emotion regulation difficulties and dissociative symptoms most strongly predicted functional impairment among civilians with PTSD and high rates of exposure to childhood abuse and neglect. In study four we investigated the effectiveness of a cognitive training program, Goal Management Training (GMT), in improving cognitive functioning, clinical symptoms, and functional impairment among inpatients with PTSD. Participation in GMT was associated with improved cognitive functioning and increased ability to engage in goal directed behaviours when highly emotional. This thesis highlights the importance of assessing emotion regulation difficulties and dissociative symptoms in order to target functional impairment and cognitive dysfunction among individuals with PTSD. Moreover, it provides evidence for a potential treatment approach to ameliorate these difficulties. / Thesis / Doctor of Philosophy (PhD) / Posttraumatic stress disorder (PTSD) is a mental health condition that develops after exposure to a traumatic event. It is associated with reduced functioning in important areas of life, including social relationships, work performance, and self-care. PTSD is also associated with reduced cognitive functioning in areas such as memory, planning, and organization. This thesis focuses on examining variables that may be related to these difficulties, including specific symptoms such as difficulty managing emotions and difficulties remaining in the present moment (dissociation). We also investigate a treatment program, Goal Management Training (GMT), aimed at teaching skills to improve cognitive and daily functioning. By understanding what contributes to cognitive functioning and functional difficulties in individuals with PTSD and by providing evidence for a treatment that can improve these difficulties, we hope to improve the lives of individuals with PTSD.

Epigenetics is a rapidly growing field that has provided insight into the etiology of many physiological mechanisms. Research around post-traumatic stress disorder (PTSD) has evolved immensely since expanding to include an epigenetic lens. Researchers have studied which gene loci are associated with PTSD to understand how genes can become either over or under expressed when exposed to trauma. The three main epigenetic factors that assist with regulating the genome are: DNA methylation, histone modification (including methylation and acetylation), and noncoding RNA. Each factor utilizes a different mechanism to help with either the upregulation or downregulation of a specific gene. Within PTSD research, the impacts of these genome modifications have been studied to understand how they regulate the common physiological symptoms associated with PTSD diagnoses. These symptomologies include decreased basal cortisol levels, decreased cardiovascular health, decreased immune function, and increased mortality. Many epigenetic studies have explored how changes in specific gene loci contribute to these physiological dysregulations. Some genes of interest include nuclear receptor subfamily 3 group C member 1 (NR3C1), FK506 binding protein 5 (FKBP5), and spindle and kinetochore-associated protein 2 (SKA2). Many studies have been conducted examining the DNA methylation activity of each gene in those with PTSD diagnoses and those without. However, research continues to produce mixed results. While some studies show an increase of DNA methylation for a specific gene in subjects with PTSD, other studies evidence a decrease of DNA methylation for the same gene. Examining the reasons for conflicting evidence is valuable to further understand the epigenetic mechanisms that occur. After conducting a literature review, four confounding factors have been identified as contributors to such mixed results. The first factor is the difference in each study’s definition of trauma, as well as the diagnostic tools they use to identify subjects with PTSD. The second factor is the samples used to detect epigenetic changes. Most samples collected in epigenetic studies of PTSD include whole blood samples, salivary samples, and only rarely, brain tissue samples. These different sample types, when cross-compared, can contribute to discrepancies in DNA methylation data. Furthermore, whole blood samples are not only vulnerable to intrinsic factor variabilities, but external factor variabilities. The third factor is a difference in subject population across the literature. Many studies are focused on either combat-veterans (with all male subjects) or child cohorts. These differences in demographics make it difficult to compare groups, as research indicates several epigenetic factors such as DNA methylation activity are sex, ethnicity, and age dependent. Finally, the fourth confounding factor is age at onset of trauma. Many studies show that trauma exposure in childhood leads to more severe symptoms compared to trauma exposure in adulthood. It is important to consider these factors and account for confounding variables when conducting future research. In doing so, more robust and accurate research can be produced. A more refined understanding of the epigenetic etiology of PTSD, as well as its epigenetic biomarkers, will likely yield greater insight into PTSD diagnoses, as well as best treatment practices.

The purpose of this study was to examine whether a newly developed Internet-based, eight-week self-change program, Self-Help Intervention Program for the Consequences of Trauma (SHICT), was effective to treat trauma consequences. The SHICT consisted of education, anxiety management skills, cognitive restructuring, and exposure modules that included writing exposure and in vivo exposure. It also provided a mastery approach where individuals begin treatment with the least anxiety-provoking component (i.e., relaxation) and progress to the most fearful component (i.e., exposure). This approach was employed to ensure that trauma victims learn and become skilled users of anxiety-reducing coping techniques and decrease the likelihood of untoward responses to writing exposure. Thirty-three participants were randomly assigned to either a SHICT condition or a wait-list condition and 27 completed participation. Trauma-related symptoms, state anxiety, depression, coping skills, social support, and self-efficacy were assessed at pre and post-treatment. Results indicated that overall the SHICT group reduced symptoms and increased coping skills more significantly than the control group. Particularly, individuals in the SHICT group decreased intensity and frequency of avoidance behavior, frequency of intrusion, state anxiety, and depression more significantly than those in the control group. The SHICT group also increased general coping skills and coping self-efficacy more significantly than the control group. The SHICT produced medium to large effect sizes in many symptom and coping-related measures. The SHICT group demonstrated more clinically significant improvement than the control group in several symptom and coping-related measures. Increased coping self-efficacy and perceived social support levels and decreased wishful thinking coping were significantly correlated with symptom improvement. Both exposure and cognitive skills mastery levels were significantly correlated with decreased intensity and frequency of avoidance behavior. / Ph. D.

Findings from numerous laboratory studies on thought suppression suggest that engaging in deliberate thought suppression may lead to the ironic effects of becoming preoccupied by the very same thoughts one wishes to avoid. Based on the results of these laboratory studies, a sophisticated model of thought suppression (i.e., Ironic Process Theory) has been developed. It has been argued that Ironic Process Theory can inform our understanding of the processes involved in the development and maintenance of clinical disorders such as PTSD. Unfortunately, to date, several important issues that are relevant to the successful application of this model specifically to PTSD have not been explored in detail. One such issue has to do with whether different types of thought suppression strategies that use different types of distracters lead to different levels of preoccupation. The current investigation examined whether the use of minor worries as distracters would lead to greater levels of preoccupation than the use of positive thoughts (Study 1). Eighty-one female undergraduates were assigned to one of three experimental conditions (suppress-worry, suppress-positive, control). Those in the suppression groups were asked to distract themselves from target thoughts using minor worries vs. positive thoughts whereas the participants in the control condition were asked to think about anything they liked. This was followed by instructions to think about anything for all three groups. Results indicated that although the two suppression groups differed on later preoccupation with previously suppressed thoughts, they did not do so in a significant manner. Study 1 also examined the potential mediating role of mental load when mental load is measured. No support for the mediational role of mental load was found. Study 2 further investigated the mediational role of mental load, this time through experimental manipulation. Forty female undergraduates were assigned to one of four experimental conditions (suppress-worry/no load, suppress-worry/load, suppress-positive/no load, suppress-positive/load). The same instructions used in Study 1 were given with the addition of a 10-digit number-recall task for those in the load condition. No support for the mediational role of mental load was found. Results are discussed in relation to theory and practice. / Ph. D.

This study investigated the potential regulatory effects of various coping strategies on Posttraumatic Stress Disorder (PTSD). It first divided PTSD symptoms and selected coping strategies into cognitive, social/motivational, and emotional types. The study then conceptualized each of the preceding types of coping strategies as being controlled stress responses and the PTSD symptoms as being semiautomatic stress responses. It lastly proposed that coping strategies be further divided into activating controlled stress response and deactivating controlled stress response. Controlled stress responses are coping strategies that are consciously initiated and implemented. Semiautomatic stress responses are PTSD symptoms that spontaneously emerge without conscious intent. Activating controlled stress responses consisted of the following coping strategies: seeking understanding, avoidant actions, and expressing feelings. Deactivating controlled stress responses encompassed: positive cognitive restructuring, emotion-focused support, and physical release of emotions. Semiautomatic stress responses entailed: reexperiencing, numbing, and arousal symptoms. It was proposed that cognitive, social/motivational, and emotional activating controlled stress responses would increase corresponding cognitive, social/motivational, and emotional semiautomatic stress responses. In the same vein, it was expected that cognitive, social/motivational, and emotional deactivating controlled stress responses would decrease respective semiautomatic stress responses. To illustrate, it was predicted that with regard to the cognitive regulatory system, its activating cognitive controlled stress response (seeking understanding) would exacerbate the frequency of associated cognitive semiautomatic stress responses (reexperiencing PTSD symptoms) whereas its deactivating cognitive controlled stress response (positive cognitive restructuring) would ameliorate it. Path analyses were conducted on correlation matrices whose elements represented two coping strategies (e.g., an activating controlled stress response: seeking understanding, and a deactivating controlled stress response: positive cognitive restructuring) and one PTSD symptom cluster of the same nature (e.g., the semiautomatic stress response: reexperiencing). Data were obtained from a sample of sixty-four children and adolescents ages 8-18. The coping strategies were assessed via ratings on items included in the How I Cope Under Pressure (HICUPS) instrument and the PTSD clusters through the use of the Diagnostic Interview for Children and Adolescents (DICA). Only one hypothesis was partially supported. It was found that the social/motivational activating controlled stress response (avoidant actions) indeed increased social/motivational semiautomatic stress responses (numbing symptoms). / Ph. D.

Recent advancements in the general child disaster literature underscore the important role of coping in children's postdisaster adjustment. Religious coping in children, a potentially important category of coping strategies, has received little attention until recent years. Moreover, its role in the context of post fire adjustment has not been studied. The present study examined the psychometric soundness of the Religious Coping Activities Scale (RCAS; Pargament et al., 1990) in children and adolescents and explored its utility in predicting children's religious coping over time: moreover, the study evaluated its role in predicting PTSD symptomatology over an extended period of time. This investigation included 140 children and adolescents (ages 8-18). Factor analyses of the RCAS revealed a 6-factor solution very similar to the factor structure in the original study. This finding suggests that the RCAS is a promising instrument to measure children's religious coping efforts. Hypotheses concerning the prediction of children's religious coping were only partially supported. Regression analyses indicated mixed findings in terms of the contributions of selected variables to the prediction of children's Spiritually Based Coping and Religious Discontent. Overall, the regression model predicted Religious Discontent better than Spiritually Based Coping. A mixed-effects regression model and hierarchical regression analyses were both employed to examine the role of children's religious coping in predicting short-term and long-term PTSD symptomatology following the residential fires. Results from the mixed-effects regression indicated that loss, time since the fire, child's age, race, and race by age interaction significantly predicted children's PTSD symptoms over time. However, time specific regression analyses revealed different predictive power of the variables across the three assessment waves. Specifically, analyses with Time 1 data revealed the same findings as did the mixed-effects model, except that time since the fire was not a significant predictor in this analysis. General coping strategies appeared to be the only salient predictors for PTSD at Time 2. Finally, Religious Discontent appeared to be negatively related to PTSD at a later time. / Ph. D.

Biophilia: the close relationship between architecture and nature. In my thesis, I look to embrace that relationship by designing housing for homeless veterans. For veterans, this connection helps the space become a place of healing and reconnection to nature, which is proven to have a positive impact in our health and wellness. The building becomes a container of nature, where the presence of green features and natural elements are present from the moment you come into the building, the choice of materials, the different activities and position of the spaces to welcome the most amount of natural elements into the building. This creates an indoor/outdoor environment where the resident feels secure by the walls but also welcome by nature. The building captures nature through different activities and moments, where both nature and architecture work together to create a space of healing and peace, a place of freedom, but at the same time a place of security and stability. An oasis in the city, which helps homeless veterans start over and create a space they can call home. The building is equipped to offer different activities and purposes not only for the residents, but also for the employees and visitors. The building becomes a welcoming space for the neighbors but also for nature. The building welcomes different species and promotes the creation of different habitats that can serve the growth of the ecosystem. / Master of Architecture / How can Architecture and Nature work together to create healing spaces? The purpose of this thesis was to study the relationship between nature and architecture. Today, rapid growth in cities and urbanization has cause these two to be seen as separate or different, creating spaces that do not promote human well-being and healthy spaces. When in fact, when both nature and architecture work together, it creates the best and healthiest spaces for human health, performance and well-being. In this project, I focused on creating healing spaces for homeless veterans; a group that is increasing in number in large cities such as Washington D.C. Veterans are falling into homelessness due to Post-traumatic stress disorder, making it hard for them to adapt back into their normal life. Many of them live in poor conditions on the street, shelters and cars; spaces that are not suitable for people living with this disorder. Instead, I am proposing a transitional housing project where they will be trained, offered job opportunities, and a space where they will in constant presence of nature from the moment they walk into the building until they get to their room. This is because biophilic design has proven to improve the perfomance, quality of life, and health of humans. The residents of this project will have an efficient building with communal spaces, spaces for active and passive recreation, and different connections to nature to improve and expedite their healing.

Since it was first included in the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1980, post-traumatic stress disorder (PTSD) has become a medical and cultural phenomenon. Moreover, it has led to the belief that PTSD is a universal aspect of human experience. Traumatic Formations and Psychiatric Codifications: A Rhetorical History of Post-traumatic Stress Disorder challenges this view by examining the rhetorical processes by which PTSD and its predecessor diagnoses were codified. Using critical techniques taken from rhetorical studies, Science and Technology in Society studies, and historiography, this dissertation examines the social, medical, and institutional formations that created the need for psychological trauma to be codified as an actionable psychiatric diagnosis at four specific historical moments, beginning in Victorian England and culminating with the offical codification of PTSD in 1980. By attending to the rhetorical processes of codifying unique post-traumatic illnesses over the course of 150 years, this dissertation argues that post-traumatic illnesses are better understood as dynamic entities that respond to specific social problems. Furthermore, it finds that the diagnoses themselves must conform to the constraints of their day as determined by the institutions (government, military, or disciplinary) that call upon psychiatric medicine to intervene in social problems. Traumatic Formations presents four historical case studies: railway spine in Victorian England, shell shock in World War I, post-Vietnam syndrome in the 1970s, and PTSD in 1980. After introducing the project in the first chapter, Chapter 2 examines how British legal courts in the late ninteenth century called upon physicians to determine whether train accident survivors were entitled to monetary compensation for their psychological injuries. To make psychological trauma legible to legal courts, British physicians codified railway spine as a psychological effect of a physical injury, thus connecting victims' mental problems to the accidents they survived. Chapter 3 analyzes how the shell shock epidemic in World War I ushered in a shift in theoretical understandings of psychological trauma. When psychiatrists located near the frontlines of combat demonstrated that soldiers did not need to be exposed to exploding munitions to manifest the symptoms associated with shell shock, medical professionals and the British military came to understand shell shock as a psychological problem rather than a physical malady. Chapter 4 examines how a small group of antiwar psychiatrists advocated for military veterans who had trouble readjusting to civilian life after fighting in the Vietnam War. They persuaded the American public, the federal government, and mental health clinicians that the veterans' adjustment problems were the result of a new psychological illness called post-Vietnam syndrome. Chapter 5 analyzes how post-Vietnam syndrome become PTSD. In the process of convincing the APA to include PTSD in the 1980 edition of the DSM, many of the unique features of post-Vietnam syndrome were compromised so that the PTSD diagnosis could be applied to people who were traumatized by events other than war. / Ph. D.

Interpersonal Violence in the form of school shootings is prevalent in American society and can negatively impact the mental health of survivors. Black, Indigenous and People of Color (BIPOC) tend to bear the worse outcomes following such events due in part by effects of complex trauma (e.g., minority stress). Using the Andersen Model of Behavioral Healthcare Use within a sample of 4,627 students who were enrolled at the time of the Virginia Tech 4/16 shooting, the current thesis sought to: (1) examine predisposing factors as a mediator of the relationship among racial identity and help seeking, (2) to examine enabling factors as a mediator of the relationship among racial identity and help seeking and (3) to examine need factors as a mediator of the relationship among racial identity and help seeking. Using negative binomial regressions within a mediational framework, the relationships among racial identity and help seeking were assessed, with variables capturing predisposing, enabling, and need components of the Andersen Model of Behavioral Healthcare Use entered as mediators. The results showed that predisposing factors mediated the relationship among racial identity and help seeking behavior in Asian, Black, and White students, but not Latinx students. Enabling factors mediated the relationship among racial identity and help seeking in Asian and Latinx students, but not Black and White students. Need factors mediated the relationship among racial identity and help seeking behavior in White students, but not in Asian, Black or Latinx students. Clinical implications of these results and future directions are discussed. / M.S. / Mass shootings in educational settings negatively impact the mental health of survivors, especially Black, Indigenous and People of Color (BIPOC) who often bear the worst outcomes to these events. Individuals who are survivors of mass shootings don’t often utilize mental healthcare services despite their effectiveness in trauma exposed populations. This study uses the Andersen Behavioral Model of Healthcare Use to examine the help seeking behavior of students following the Virginia Tech 4/16 shooting. The results of this study indicated that Asian, Black and White students’ functioning in several areas of their life (e.g., social life, academic life) prior to the event explained the relationship between racial identity and help seeking behavior. Social support factors also explained the help seeking behavior of Asian and Latinx students. Lastly, students’ need as measured by their posttraumatic stress symptoms explained the relationship among racial identity and help seeking behavior in White students. Clinical implications stressing the importance of widened outreach following mass trauma are discussed.

Master of Architecture / This thesis explores the transformative potential of designing spaces that prioritize healing, connection, and mindfulness, especially for those with post-traumatic stress disorder (PTSD). It uses intentional design choices like natural light, wood, water, and granite to create a relaxing and grounding environment. Geometric Islamic patterns are incorporated to enhance visual appeal and provide a sense of order. By prioritizing healing, connection, and mindfulness, we can create spaces that alleviate PTSD symptoms and empower individuals on their journey towards healing and well-being.