Low back pain (LBP) is the top reason for Soldiers to seek medical care and one of the top reasons to be medically discharged. Mental health problems and psychosocial stressors have been increasing in Soldiers and are also top causes for medical discharge. Dysregulated stress has contributed to many Soldiers and Veterans to develop chronic LBP as well as mental health disorders like post-traumatic stress disorder (PTSD). Research suggests that psychosocial characteristics, as opposed to physical factors or tissue health, contribute to chronic pain the most. Focusing entirely on tissues for individuals seeking care for LBP can increase disability and vulnerability. Attributing physical pain to mental health concerns, however, risks stigmatizing patients or making them feel dismissed. The purpose of this dissertation was to develop a pain neuroscience education (PNE) program for Veterans and Soldiers with LBP and stress and determine if PNE is more effective in improving disability, PTSD symptoms, and beliefs about pain compared to traditional education about back pain and stress. This dissertation demonstrated that Veterans with PTSD can comprehend the neuroscience of pain and PTSD at a comparable level to a highly educated Veteran and medical panel without PTSD when adjusting for education. Since a proportion of participants were concerned that using military examples in PNE might increase PTSD symptoms, however, results from pilot testing suggested that the PNE materials developed for this dissertation should be tested in a clinical trial to ensure they do not increase PTSD symptoms. A systematic review and meta-analysis demonstrated that Veterans with PTSD have higher depression and pain-catastrophizing beliefs for a large effect size compared to Veterans without PTSD. Furthermore, Veterans with PTSD have significantly lower pain self-efficacy with a large effect size. Compared to Veterans without PTSD, Veterans with PTSD have higher pain and disability. These results, however, were not confirmed in Veterans presenting to a Physical Therapy clinic. In fact, this dissertation revealed that many of the negative outcomes previously attributed to PTSD in the literature may be due to the correlation between PTSD symptoms and pain-catastrophizing beliefs rather than from trauma. Furthermore, Veterans with chronic LBP do not appear to have different sensitivity levels to pressure based on PTSD symptoms. Finally, the results from a randomized controlled trial provide evidence that PNE greatly improves the confidence of Veterans and Soldiers to increase participation in social, work, and life roles despite the pain as measured by the pain self-efficacy questionnaire. Participants in the experimental group were more likely to achieve a meaningful reduction in disability at the 8-week follow-up compared to the control group. Furthermore, Veterans and Soldiers with LBP were more satisfied with how PNE explains pain and believed the PNE curriculum connected with their military experiences better than traditional psychosocial education about stress. Participants in the experimental arm were less likely to believe that exercise is harmful compared to traditional education. Finally, PNE improved PTSD symptoms beyond the clinically meaningful threshold in the experimental arm. In conclusion, PNE appears to be an effective treatment for PTSD, disability, and pain-related beliefs in Veterans and Soldiers with chronic LBP. These results should be replicated in a larger sample to ensure generalizability beyond the current study.

Goodbye to All That Again concerns the odyssey of an Iraq War veteran who must complete his journey past desert combat and academic strife in order to reclaim his heroic identity. The novel uses a fragmented storytelling mode that offers readers thirteen years of the protagonist’s timeline in a nonlinear sequence. Through this technique, the novel evokes the cognitive disassociation experienced by individuals who suffer Post Traumatic Stress and echoes the postmodern practices employed by American military novelists such as Joseph Heller and Tim O’Brien for the last sixty years. GOODBYE TO ALL THAT AGAIN seeks to intervene in the discourse of the American war novel by updating the depiction of military members from unwilling draftees, the situation Heller and O’Brien portray, to that of career-driven volunteers. The novel also considers adjustment concerns raised by the political correctness movement, a bar to civilian reintegration unknown by prior generations of veterans. In doing so, the writer hopes to adjust the zeitgeist, a major concern of his practice as detailed in his STATEMENT OF PURPOSE, toward a more accurate representation of military members so that society can more effectively meet their needs.

Since 9/11 over 2.77 million U.S. service members have deployed 5.4 million times to a theater of war with the majority serving in the U.S. Army. The increased stress inherent in a single combat deployment grows exponentially with each subsequent deployment, resulting in behavioral issues and suicide attempts and ideations. This study's purpose, following resilience theory, was to explore the associations of military life experiences (permanent changes of station, promotions, retirements, etc.) and deployment characteristics (number of deployments, operational specialties, combined lengths of deployments, etc.) to postdeployment resilience in U.S. military personnel. The study's design was a quantitative correlational research design; 102 participants were recruited through social media. Protective factors associated with resilience served as the dependent variable. The independent variables were time and transitions. Covariates included demographic data (age, gender, ethnicity, marital status, rank, branch of service, years of service, etc.), number of combat deployments, and combined length of deployments. The target population consisted of military service members with at least one combat deployment and had been redeployed for a minimum of one year. Results of this study may provide positive social change by identifying points and periods in the redeployment and post redeployment timeline service members can focus on to improve protective factors. Additionally, as Global War on Terror (GWOT) veterans begin leaving the service at an increased rate data focused on resilience may assist military mental health providers with developing treatment strategies that reinforce affect protective factors.

My research focused on five women in Aotearoa naming and defining their experiences ten or more years after leaving an intimate partner violence relationship. An increasing amount of literature has been published reporting the prevalence of intimate partner violence among women in our society, including surveys documenting devastating short and long-term health effects. However, little has been published about the long-term experiences of women who have survived such abuse. I was interested in making more visible the experiences of long-term survivors of intimate partner violence. I wondered what the challenges and legacies from experiences of intimate partner violence are and what contributes to women rebuilding their lives after intimate partner violence. In this research utilised a participatory action research approach informed by a critical feminist theoretical perspective. I selected two data collection methods, individual interviews followed by a focus group interview bringing the participants together. The findings identified nineteen themes emerging from the individual and focus group interviews. Some expressed the long-term challenges and legacies of intimate partner violence, such as feelings of powerlessness, guilt and shame and feeling silenced. Others reflected ways women rebuilt their lives, such as empowerment, resilience, courage and the importance of education and meaningful work. Interpreting the findings, empowerment was often juxtaposed with powerlessness, living side by side within the inner world of the long-term survivor of intimate partner violence in equal tension. This study affirms that challenges and legacies from intimate partner violence continue to affect women many years after leaving violence. Despite these challenges and legacies, women work very hard to rebuild their lives, care for their children and attain autonomy, independence and control of their lives. Women spent time and energy to recover ‘well enough’ from such violence, in order to lead a productive and functioning life.

The psychological trauma from a traumatic event is known to be 'contagious' for a witness. Psychotherapists who work with traumatised clients can potentially experience terror, anger and despair; causing secondary traumatic stress that can lead to compassion fatigue and burnout. So, how do psychotherapists, who often carry their own trauma histories, bear such fear and pain when being with and listening empathically to traumatised clients without feeling overwhelmed or losing a sense of hope? The purpose of this grounded theory study was to identify the main concerns of psychotherapists when working with traumatised clients and to describe and generate a conceptual model that explains the processes therapists use to continually manage these concerns. Over a period of ten months, eleven psychotherapists with a minimum of five years work experience were recruited from the New Zealand Association of Psychotherapists (NZAP). Constant comparative analysis of eleven interviews generated through open-ended questions was carried out. A total of twenty-one drawings obtained at different stages of the participant interviews, were used to fully capture the inner world of the traumatic impact. The emerging theory, whose development is grounded in the data, shows that psychotherapists grow through three main psychosocial developmental stages of balancing the impact of trauma: DOING to protect from pain and fear, BALANCING doing with being, and BEING with trust, pain and joy. The participants, however, were likely to involuntarily recycle the three stages when experiencing personal traumatic stress or organisational stressors, in addition to holding clients' trauma. The intention of this research was to raise awareness of work-related traumatic stress, and to provide an educational conceptual model to assist psychotherapists' understanding of how to positively manage secondary traumatic stress and its impact on the physical, emotional and spiritual, before it manifests in burnout, disillusionment or illness.

Attentional bias effects for threat and emotional words were investigated, using both the emotional Stroop and emotional lexical decision paradigms. Twenty-eight controls and twenty-eight survivors of sexual assault participated in this study, which comprised three key comparisons. First, key predictions of the threat and emotionality hypotheses were compared, in particular specific and general threat effects, and positive and negative emotionality effects. Second, two separate group comparisons were conducted, specifically controls versus survivors of sexual assault overall, and a matched subset of controls versus PTSD positive survivors of sexual assault versus PTSD negative survivors of sexual assault. Third, performance on the emotional Stroop task and emotional lexical decision task paradigms were compared directly. Slowed colour naming responses (i.e. interference) were observed for both threat effects and emotionality effects in the emotional Stroop task. For the emotional lexical decision task, slowed lexical decisions (i.e. interference) were observed for threat effects, whereas speeded lexical decisions (i.e. facilitation) were observed for emotionality effects. The findings of the current study indicate that threat and emotionality effects may co-exist in both control and survivor populations. The relationship between the presence or absence of PTSD symptoms and threat and emotionality effects requires further investigation with larger sample sizes. There may be a relationship between the presence of PTSD symptoms and specific threat effects, however the findings of the current study for general threat information were inconclusive. No relationship was evident between the presence of absence of PTSD symptoms and positive or negative emotionality effects. The current findings suggest that the emotional Stroop task may be better suited to quantifying threat effects but not emotionality effects, whereas the emotional lexical decision task appears to be able to quantify both threat and emotionality effects.

Posttraumatic Stress Disorder (PTSD) is a psychiatric condition that can develop following exposure to a traumatic event involving actual or threatened death or serious injury. Responses include intense fear, helplessness or horror. Symptoms are characterised into clusters, described as re-experiencing, avoidance, and arousal. These symptoms, which are also evident in other conditions, have been associated with dysfunctions in the central acetylcholinergic system. Benefits from administering acetylcholinesterase inhibitors (AChEI) to people suffering these symptoms have been demonstrated. Donepezil hydrochloride, a reversible inhibitor of the enzyme acetylcholinesterase, is used in the treatment of conditions with difficulties in cognitive function, but has not been used in PTSD. The aim of this thesis was to determine (1) whether there was a difference in the ACh system in people with PTSD and (2) whether administration of an AChEI would change the symtomatology. IDEX (I¹ ² ³ iododexetimide) has been useful in imaging muscarinic-ACh receptors using Single Photon Emission Computerised Tomography (SPECT) and was utilised to investigate whether cholinergic activity in PTSD is altered. One hundred and sixty eight potential subjects were screened and eleven PTSD subjects were enrolled in the IDEX SPECT study. Three healthy non-PTSD control subjects also completed the study. Due to technical complications only the data obtained from eight PTSD and two control subjects was available for analysis. Imaging data for 2 further healthy non-PTSD control subjects were obtained from another study. Sixteen subjects were enrolled in the donepezil open label study (assessed at baseline, Week 2, 6 and 10). Nine PTSD subjects completed the 10-week trial and seven withdrew prematurely (at or after Week 2) due to side effects or a worsening of PTSD symptoms. For the IDEX SPECT study, a voxel-by-voxel statistical analysis of the PTSD subject group versus the control group showed both areas of reduced and increased IDEX uptake. Significant clusters in the PTSD group with a reduced IDEX uptake centred around the bilateral hippocampus, left insula and right precuneus, while increased IDEX uptake appeared in the caudate head. For the donepezil study, in the per-protocol analysis (including only the 9 subjects that completed the protocol), all psychological assessments revealed a difference between the totals obtained at the Week 10 visit compared to those at the Baseline visit and the improvement was in the order of 51%. The intention-to-treat analysis (including all 16 subjects), a repeated measures Analysis of Variance (ANOVA) with a mixed models approach showed that all psychological measures demonstrated statistically significant benefits of the treatment. All subjects who completed the protocol recounted considerable improvement in their overall PTSD symptom profile, which covered symptoms in each of the three clusters. The results of the IDEX SPECT study suggest that alterations in ACh binding in PTSD are evident and may begin to explain a part of the altered cognitive symptomatology apparent in this condition. The pilot open label donepezil trial provided some preliminary evidence that treatment with an AChEI can lessen the intrusions and distress associated with traumatic memories in people with PTSD. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1374974 / Thesis (M.Med.Sc.) -- University of Adelaide, School of Medicine, 2009

Thesis (M.A.)--York University, 2004. Graduate Programme in Social Anthropology. / Typescript. Includes bibliographical references (leaves 233-250). Also available on the Internet. MODE OF ACCESS via web browser by entering the following URL: http://gateway.proquest.com/openurl?url%5Fver=Z39.88-2004&res%5Fdat=xri:pqdiss&rft%5Fval%5Ffmt=info:ofi/fmt:kev:mtx:dissertation&rft%5Fdat=xri:pqdiss:MQ99313

Thesis (M.Sc.)--Memorial University of Newfoundland, 2005. / Bibliography: leaves 44-54.

Thesis (M.A.)--York University, 2003. Graduate Programme in Psychology. / Typescript. Includes bibliographical references (leaves 93-101). Also available on the Internet. MODE OF ACCESS via web browser by entering the following URL: http://wwwlib.umi.com/cr/yorku/fullcit?pMQ86319