The Primary Care Posttraumatic Stress Disorder (PC-PTSD) screen (Prins et al., 2003) is used by the Department of Defense to identify military members who are at increased risk of PTSD. This screen has been offered to all returning deployers since 2005. However, validation studies of PC-PTSD scores from military samples have seldom employed a significant number of female subjects and no published studies have examined it for gender bias. Ruling out bias is important because routine under-identification of PTSD risk in any group could result in hindered access to needed assessment and/or care. With the current proportion of military females historically high (Women’s Research & Education Institute, 2007), it is imperative that the PC-PTSD be analyzed to ensure measurement equivalence across gender. Using a large sample of male and female veterans returning from deployment, the validity of the PC-PTSD scores was first examined by conducting a differential item functioning (DIF) analysis across male and female subgroups. Then, using a clinical diagnosis as the criterion, both logistic regression and diagnostic likelihood ratio methods were employed to assess for differential predictive validity by gender. Finally, confirmatory factor analysis (CFA) was used to examine convergent and divergent validity in a two-factor model containing both PC-PTSD and depression screen responses. Results revealed no statistically significant gender-related DIF or differential prediction of PTSD by PC-PTSD scores. Good convergent and divergent validity were also observed in the CFA analysis. The results generally supported the continued use of the PC-PTSD with both male and female military veterans returning from deployment. Limitations of the study and recommendations for future research were discussed.

Lucid Dreaming (LD) is defined as the phenomenon of becoming consciously aware of dreaming while still dreaming. In sleep laboratory experiments LD has been verified to occur during REM sleep stage by proficient lucid dreamers who have signaled while becoming lucid through specific pre-determined eye-movements. Using this method, (lucid) dreamed activity has been shown to correlate with both psychophysiological and neurophysiological responses to those observable if the same activity was to be performed during wakefulness. LD has also shown potential to be of therapeutic value, in reducing recurrent nightmare frequency. Recurrent nightmare sufferers engaging in Lucid Dreaming Treatment (LDT) show reduced nightmare frequency after treatment. As such, LDT has been suggested to be effective in the treatment of posttraumatic nightmares in Posttraumatic Stress Disorder (PTSD). The attitude and feeling of control provided by LDT has been shown to be fruitful also in fearful waking situations, indicating that LDT might be effective in disorders epitomized by fear.

Trauma research has been predominantly focused on the study of the negative psychological sequelae of traumatic experience. Recently, however, increased empirical attention has been paid to the potential for positive changes, or posttraumatic growth, derived from survivors’ struggle with trauma. There is evidence accumulating in support of this phenomenon following various types of traumatic events. Using an online, cross-sectional design, the present study examined posttraumatic growth among 143 survivors of interpersonal violence. Furthermore, the relationship between posttraumatic growth and the severity of psychological distress symptoms, as well as between growth and hope was explored. Results indicated that the severity of depressive symptoms was negatively related to growth, while the severity of posttraumatic stress disorder symptoms and hope were found to positively predict growth. Associations between posttraumatic growth and demographic and interpersonal violence characteristics did not emerge. The potential implications of these findings and directions for future research are discussed.

Trauma research has been predominantly focused on the study of the negative psychological sequelae of traumatic experience. Recently, however, increased empirical attention has been paid to the potential for positive changes, or posttraumatic growth, derived from survivors’ struggle with trauma. There is evidence accumulating in support of this phenomenon following various types of traumatic events. Using an online, cross-sectional design, the present study examined posttraumatic growth among 143 survivors of interpersonal violence. Furthermore, the relationship between posttraumatic growth and the severity of psychological distress symptoms, as well as between growth and hope was explored. Results indicated that the severity of depressive symptoms was negatively related to growth, while the severity of posttraumatic stress disorder symptoms and hope were found to positively predict growth. Associations between posttraumatic growth and demographic and interpersonal violence characteristics did not emerge. The potential implications of these findings and directions for future research are discussed.

As men and women return from serving on the frontlines of Operations Enduring Freedom (OEF; Afghanistan) and Iraqi Freedom (OIF; Iraq), many struggle with emotional or behavioral difficulties stemming from the stresses of battle. However, research has shown that these service members may be unwilling or unable to recognize or report such difficulties due to such factors as amnesia, avoidance, or cognitive impairment. Hence, the burden to recognize distress and encourage treatment increasingly falls on peers, friends, and especially intimate partners. Given that this responsibility is often placed on significant others, it is imperative to determine which symptoms are amenable to detection by informants and which are not. The current study examined the ability of female spouses of Vietnam veterans to report on various indicators of posttraumatic stress disorder (PTSD) using the Mississippi Scale for Combat-Related PTSD. Item response theory (IRT) analyses were conducted with a dataset composed of both self- and informant reports using the same items regarding the same individual in order to examine the item-level properties. Results from these analyses indicated that the ability of both spouses and veterans to detect PTSD symptoms varies across item content and that items themselves do not relate equally to, or become diagnostic at the same level of, PTSD. Overall, veterans showed greater sensitivity to their own symptoms and were able to provide more information than their spouses for nearly every item rated by independent experts to be overt or covert. However, some items provided greater information when endorsed by the spouse versus the veteran even though, consistent with the majority of other items, these items were endorsed by the spouse only once the PTSD symptoms had reached greater severity. Implications of these findings as well as future directions for research regarding observer reports of PTSD symptomatology were explored.

Expressive Writing (EW) involves asking participants to write emotionally about stressful life events and has been associated with improvements in psychological and physical health. The purpose of the current study was to extend previous work by examining the moderating and mediating role of emotion regulation within the EW intervention. Sixty participants who had experienced a traumatic event were recruited from the community and were assigned to an EW or control writing condition. Measures assessing emotion regulation and indices of psychological and physical health were administered at baseline and one month follow-up to determine changes in symptomatology. In comparison to control writing, EW led to significant improvements in depression, emotional clarity, and to a lesser degree emotional awareness. Although no other group differences were found, all participants demonstrated significant improvements in their symptoms of posttraumatic stress, reported physical health, overall emotion regulation abilities, their ability to accept their emotions, engage in goal directed behaviour when distressed, and access emotion regulation strategies they perceive as effective. No support was found for our moderation hypothesis. However, a significant moderation was discovered revealing that difficulties engaging in goal directed behaviour when distressed moderated improvements in posttraumatic stress symptoms. Specifically, control participants with this emotion regulation deficit demonstrated significantly poorer outcomes than control participants without this deficit; in comparison to the EW group participants who improved similarly on posttraumatic stress symptoms regardless of their level of difficulties at baseline engaging in goal directed behavour when distressed. Additionally, baseline emotion regulation abilities predicted improvements on psychological health (but not physical health) outcome measures for both groups. No support was found for our mediation hypothesis. Exploratory analyses revealed that the EW group demonstrated greater emotional arousal in response to their writing in sessions 1 and 2, but that by session 3 their arousal had significantly decreased and was equivalent to that of the control group, which showed no changes in arousal across sessions. No support was found for the moderating or mediating influence of arousal on outcome. Results will be discussed within a model of emotional expression and emotion regulation and compared to the existing EW literature.

Expressive Writing (EW) involves asking participants to write emotionally about stressful life events and has been associated with improvements in psychological and physical health. The purpose of the current study was to extend previous work by examining the moderating and mediating role of emotion regulation within the EW intervention. Sixty participants who had experienced a traumatic event were recruited from the community and were assigned to an EW or control writing condition. Measures assessing emotion regulation and indices of psychological and physical health were administered at baseline and one month follow-up to determine changes in symptomatology. In comparison to control writing, EW led to significant improvements in depression, emotional clarity, and to a lesser degree emotional awareness. Although no other group differences were found, all participants demonstrated significant improvements in their symptoms of posttraumatic stress, reported physical health, overall emotion regulation abilities, their ability to accept their emotions, engage in goal directed behaviour when distressed, and access emotion regulation strategies they perceive as effective. No support was found for our moderation hypothesis. However, a significant moderation was discovered revealing that difficulties engaging in goal directed behaviour when distressed moderated improvements in posttraumatic stress symptoms. Specifically, control participants with this emotion regulation deficit demonstrated significantly poorer outcomes than control participants without this deficit; in comparison to the EW group participants who improved similarly on posttraumatic stress symptoms regardless of their level of difficulties at baseline engaging in goal directed behavour when distressed. Additionally, baseline emotion regulation abilities predicted improvements on psychological health (but not physical health) outcome measures for both groups. No support was found for our mediation hypothesis. Exploratory analyses revealed that the EW group demonstrated greater emotional arousal in response to their writing in sessions 1 and 2, but that by session 3 their arousal had significantly decreased and was equivalent to that of the control group, which showed no changes in arousal across sessions. No support was found for the moderating or mediating influence of arousal on outcome. Results will be discussed within a model of emotional expression and emotion regulation and compared to the existing EW literature.

<p>Posttraumatic stress disorder (PTSD) is common, chronic, and associated with greater risk of postoperative mortality in veterans. Therefore, the purpose of this dissertation was to determine if elective outpatient surgery had a persistent and deleterious effect on the physical or mental health of veterans, and also to explore factors that contributed to postoperative health change in this population. A longitudinal, mixed method, quasi-experimental, nonequivalent control group study was conducted. Physical and mental health, depressive symptom severity, posttraumatic symptom severity, and pain severity were measured in 29 veterans with PTSD before undergoing outpatient elective surgery, one week after surgery, one month after surgery, and three months after surgery. For comparison, parallel data were collected from a control group of 31 veterans with PTSD at enrollment, one week after enrollment, one month after enrollment, and three months after enrollment. Subjects who displayed clinically significant or distressing changes in health status after surgery were interviewed to identify factors associated with postoperative health change. Subjects in the surgical group reported significant declines in subjective physical and mental health at one week, but not one or three months after outpatient elective surgery. Depressive symptoms severity and posttraumatic symptom severity were unchanged after surgery by surgery. Subjects reported that this physical and mental distress was driven by acute postoperative pain, but that underlying chronic pain remained influential throughout their postoperative course.</p> / Dissertation

Posttraumatic stress disorder (PTSD) is a debilitating condition that results from the experience of a traumatic event. Natural kinds are mind-independent entities found in nature and are the objects of scientific inquiry. It is common to deny that PTSD is a natural kind, but extant denials assume a thesis of natural kinds that can be called “essentialism”. According to essentialism, many entities are not natural kinds that one would expect should be natural kinds. The homeostatic cluster view of natural kinds offers an alternative that accommodates these cases, including, superficially, the claim that PTSD is a natural kind. I introduce two novel objections to this claim and recommend a distinction aimed to resolve the newly introduced problems.

Childhood maltreatment increases risk for Posttraumatic Stress Disorder (PTSD). Maladaptive patterns of attention to threat-related stimuli warrant examination as possible contributing risk factors. It remains unclear whether persistent threat-processing biases are differentially apparent in adults who were maltreated as children and either did, or did not, develop later PTSD. The present study examined associations among attention bias, childhood maltreatment, and PTSD in adults. We hypothesized that attentional bias toward threat significantly mediates associations between childhood maltreatment and adult PTSD symptoms. 183 adults with and without childhood maltreatment histories participated in this study, which involved completion of a range of clinical measures; attention bias was measured by the Dot Probe task. We found that attention bias toward happy faces partially mediated the relationship between childhood maltreatment and PTSD avoidance and numbing symptoms. Childhood maltreatment, happy face attention bias, and perceived racially discriminative experiences all accounted for significant variance in PTSD symptoms.