Thesis (Ph. D.)--University of Texas at Austin, 2000. / Vita. Includes bibliographical references (leaves 140-151). Available also in a digital version from Dissertation Abstracts.

The experience of psychosis (e.g. threatening symptoms such as persecutory delusion and terrifying hallucinations) and its treatment (e.g. coercive measures such as involuntary admission and seclusion) are distressing. In view of the potential severity of the distress associated with psychosis, previous research has applied the trauma model to understand the experience of psychosis and its treatment and found that 11-67% of psychotic patients presented with clinically significant PTSD reactions in response to their psychosis and treatment experience. This phenomenon is termed as post-psychotic PTSD (PP-PTSD). However, previous research generally failed to find consistent relationship between PP-PTSD reactions and objective psychotic and treatment experiences (except for positive psychotic symptoms). Cognitive conceptualization of PTSD opines that it is the cognitive appraisal of the traumatic event, rather than the trauma per se, that is related to the development of PTSD. The present study aims to contribute to a better understand of PP-PTSD through a cognitive perspective. The present study applies Ehlers and Clark’s cognitive model of PTSD in understanding PP-PTSD. It explores the roles of fear of relapse and perceived risk of relapse, attribution of the causes of psychosis, perceived stigma and rejection and perceived consequence of the psychotic illness in PP-PTSD. The present study was a cross-sectional study and recruited 38 patients with schizophrenia-spectrum disorders. Semi-structured interview was used to determine whether the patients met the PP-PTSD diagnosis. The patient’s positive psychotic symptoms and social and occupational functioning were assessed by semi-structured interview while their PP-PTSD symptoms, trauma history and cognitive appraisals were measured using self-report questionnaires. Results showed that 15.8% of patients meet the full criteria of PP-PTSD and more than 50% of patients demonstrated some PP-PTSD reactions, which provides support for the application of the PP-PTSD construct in the local context. Treatment experiences were found to induce more severe PP-PTSD reactions than psychotic experience. Cognitive appraisals were found to be associated with PP-PTSD and there was some support for the application of Ehlers and Clark’s model in PP-PTSD. Specially, the present study found that fear of relapse, higher perceived risk of relapse, perceived helplessness and self-blame of causing the onset of psychosis, stable attribution of the cause of psychosis onset, perceived stigma, perceived large and chronic consequence of psychosis were all associated with more severe PP-PTSD reactions. Fear of relapse was also found to predict PP-PTSD severity. Clinical implications on the prevention, assessment and treatment with reference to the present results are discussed. / published_or_final_version / Clinical Psychology / Master / Master of Social Sciences

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The long-term psychological effects of surviving a major disaster are poorly understood. A survey of survivors of the Piper Alpha oil platform disaster (1988) was undertaken to examine the role of factors relating to: the trauma; the survivors, and the survivors’ circumstances in relation to long-term outcome. Methods: Ten years after the disaster 78% (46/59) of the survivors were located, and, of these, 72% (33/46) agreed to be participate in a study conducted by questionnaire, diagnostic interview and semi-structured interview. In total, 61% of all survivors participated in this study. A further three individuals (7%) completed postal self-report measures. Results: High levels of physical disorder, general psychopathology and post-traumatic symptoms were reported. Twenty one percent (7/33) of the survivors who participated in the study still met the most stringent diagnostic criteria for PTSD over 10 years after the disaster; 73% met the same rule within three months of the disaster. Features such as physical injury, personal exposure to certain stressors during the trauma, survivor guilt, anger and employment difficulties were significantly correlated with long-term general and specific post-traumatic psychopathology and with social and occupational function. Features of the legal proceedings were also associated with long-term outcome. Whilst the media was experienced as intrusive, no statistically significant associations with long-term outcome were found. Treatment was generally accessible to participating survivors (97%) with non-professional help (82%) and outreach (69%; 25/36) widely used. Although many difficulties were experienced 61% of participants could identify some positive outcomes from the experience. Discussion: This study emphasises the need to consider a broad range of factors affecting outcome including the individual’s experience during a traumatic event, pre-existing stressors and factors relating to the response to the disaster and their environment. High rates of help-seeking were found to co-exist with high symptoms levels and this may relate to treatment effectiveness or failure to apply appropriate treatment in disaster populations. Attention to issues such as employment difficulties and compensation processes may improve survivor well-being in the long-term after disasters. Conclusions: This long-term follow-up of survivors of a major disaster has confirmed that the impact of a disaster is durable and extensive with psychological services required over prolonged periods.

This report examines the state of research regarding the psychological impact of war on American soldiers deployed in military operations in Afghanistan (Operation Enduring Freedom) and Iraq (Operation Iraqi Freedom). Particular focus is given to examination of marital and relationship satisfaction within the Hispanic soldier and veteran population. A wide range of research examines the traumatic aftereffects of wartime service with predominant themes of posttraumatic stress, depression, anxiety, and substance abuse appearing across the literature. Examination of the Hispanic population is disputed with researchers producing conflicting findings: some researchers have indicated an increased risk of psychological disturbances in Hispanic wartime veterans while other have found no such difference between the Hispanic and majority groups. Attempts to explain these discrepant results have ranged from differences in acculturation, to potentially increased traumatic exposure, or to underlying feelings of persecution and alienation. However, consistent results were found in regards to the negative relationship between traumatic exposure and romantic relationship satisfaction. Younger males of lower socioeconomic status with increased trauma exposure and comorbid mental health diagnoses consistently reported less relationship satisfaction than their peers. Given the nature of family and the importance of close relationships within the Hispanic culture, it is increasingly necessary for clinicians working with Hispanic veterans to be aware of these findings. This author purposes that future researchers explore this concept of relationship satisfaction within the Hispanic veteran population with attention given to potentially mediating variables such as level of acculturation and traumatic experience exposure. / text

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The purpose of this study is to provide an inclusive portrait of the experience of female spouses living with traumatized male Canadian soldiers healing from Post-Traumatic Stress Disorder (PTSD). By facilitating the articulation of the spouses' stories this research gives a voice to and fosters appreciation for this neglected population. As well, this study helps clarify the needs and possible therapeutic interventions for spouses of soldiers in psychotherapy for PTSD. Although recently there has been an increased focus on addressing PTSD in soldiers, there has been comparatively little research and clinical attention given to the soldiers' families. For this study, in-depth interviews were conducted with six spouses of former peacekeeping Canadian soldiers who received group therapy for PTSD. Using the Life Story interview method, a spontaneous picture of the spouses' experiences was elicited as part of a comprehensive relationship narrative. This provided the opportunity for understanding the experience of living with a soldier in treatment for PTSD within a couple relationship and larger social context. Narrative summaries were created from the interviews and follow-up was conducted with each participant to gain feedback on these narratives. Participants were also given the opportunity to read each other's narratives and discuss their impressions. The narrative summaries are presented along with thematic results. The participants' stories revealed instances of aggression, primary trauma and problems related to their husbands' periods of alcohol abuse, so Figley's model of Secondary Traumatic Stress was not the best conceptual fit to explain the experiences of these women. Limited support was found, however, for Hobfoll's (1998)model of a loss spiral to help describe the descent into chronic disability associated with combat-related PTSD as well as the difficulties soldiers experience in their transition from military service. This study's implications for practice include recommendations for groups for military spouses; the need to address the iatrogenic suffering of soldiers and their spouses; treatment recommendations for soldiers with PTSD. Future research also needs to include delivery and evaluation of a group-based counselling intervention for the spouses of traumatized soldiers.

Fatal earthquakes such as that which occurred in Christchurch on February 22nd 2011, can result in survivors having difficulties with cognitively processing the event, which may be the precursor to posttraumatic stress symptoms. Trauma related dissociation has been proposed to be a mechanism related to these cognitive processing difficulties. Most research focusing on information processing and dissociation post-trauma has conducted controlled analogue studies or has not focused solely on information processing and dissociation. There is also scant research on these constructs across therapy. In response to this gap in research, two studies were developed. An association was proposed between dissociation and information processing as demonstrated by an increase in conceptual processing and a reduction in dissociation. It was predicted that an improvement in these constructs would be related to a reduction in PTSD symptoms over therapy. Study1 applied a case-study design to 5 individuals who were attending therapy for post-traumatic stress disorder in response to the trauma they had experienced from the Christchurch earthquakes. Study 2 assessed information processing and dissociation (via self and observer report) in 20 individuals who had direct exposure to the effects of the earthquake. Earthquake information processing and dissociation were assessed as they were happening nearly two year’s post-quake using correlation analyses and hierarchical regressions. The hypotheses were partially confirmed, in that an increase in conceptual processing was not shown to be associated with a reduction in dissociation. However, an increase in conceptual processing was shown to be related to trauma symptom improvement particularly for re-experiencing symptoms. In addition, study 2 demonstrated a possible relationship between trait dissociation and arousal symptoms. These findings partially support the proposed role information processing and dissociation play in the recovery from PTSD. The findings suggest that trauma related difficulties should be assessed as early as possible to resolve issues related to a delay in symptom reporting.

Despite the established relationship between Post-Traumatic Stress Disorder (PTSD) and depression in Western cultures, research concerning the prevalence rates and relationship between the comorbid disorders in Non-Western communities remains sparse. The present study explored the relationship between PTSD and comorbid depression in citizens currently living in Ghana, West Africa. Ghanaian Nationals (n=140) completed the PTSD and demographic sections of the Structured Clinical Interview for the DSM-IV (SCID-I), as well as the Center for Epidemiological Studies Depression Scale (CES-D). Both measures were administered through interview format. Results revealed a lower prevalence rate of PTSD than expected. Further analysis demonstrated that meeting the diagnostic criteria for PTSD increased the chance of meeting the diagnostic criteria for depression, as well as increased depression scores. To confirm that the prevalence rates found in this study were reflective of actual cases of depression (not measurement error) a scale reliability analysis was conducted on the CES-D. The results of this analysis confirmed internal consistency. Results suggest that although the prevalence rate of PTSD was low, a relationship is present between the disorders in a non-Western sample. The reliability of the measures means that PTSD and depression were assessed for, but what is not certain is whether the actual construct of the disorders could occur differently in a non-Western sample, causing a different presentation of symptoms. Future research is needed to examine the Western construct of PTSD and depression to determine if there is a different presentation of symptoms not accounted for by Western measures. / Department of Psychological Science

The aim of this thesis was to investigate psychological factors influencing the development and maintenance of post-traumatic symptoms, with particular attention to the role of dissociation. The concept of dissociation is at present not well understood, and a secondary aim of this thesis was to clarify its meaning and structure and enable its assessment. Chapter 2 reports the development and testing of a questionnaire measuring trait dissociation, and the factor analysis of this questionnaire into seven sub-factors with low to medium intercorrelations, along with an analysis of the reliability and validity of this questionnaire, which was used in the subsequent studies. Chapters 3 and 4 consist of experimental studies investigating the relationship between dissociation and later intrusive memories using a videotape of scenes from road traffic accidents as a stimulus. The first study attempted to manipulate dissociation, while the second used extreme scorers on the trait dissociation questionnaire. The manipulation of dissociation proved difficult, but both studies showed a relationship between dissociation and later intrusions. Chapters 6 and 7 report on two prospective clinical studies following road traffic accident victims over the first six months following their accident, and investigates the role of dissociation and other psychological factors in the development of post-traumatic symptoms. Both state and trait dissociation, and the emotional numbing subfactor of dissociation in particular, predict the later development and maintenance of other post-traumatic symptoms. Persistent dissociation was more predictive of later symptoms than dissociation in the first few days after the accident. These results are discussed in relation to current thinking about the concept of dissociation and the DSM diagnoses of post-traumatic stress disorder and acute stress disorder. In particular it seems useful to distinguish between components of dissociation in terms of their relationship to PTSD. Possible future research and clinical implications are also addressed.