Posttraumatic Stress Disorder (PTSD) is an anxiety disorder characterised by disturbed arousal, altered attention, and fear processing, and a reduction in the ability to perform cognitive tasks. Predominant neurophysiological models of PTSD have been focused on alterations in fear-related regulation, and few incorporate broader changes in generic executive control which may underlie many of the clinical symptoms and cognitive deficits in PTSD. This thesis aimed to investigate the neurophysiology of executive inhibitory control in PTSD using a Go/NoGo response inhibition task and converging functional imaging, structural imaging and electrophysiological measures. The first series of studies aimed to elucidate a normative neural network model of inhibitory control, and are consistent with normative control involving the activation of a mainly right-lateralised ventral lateral prefrontal cortex (VLPFC) network. Inhibitory control-related activation was found to be affected by levels of anxiety and changes in underlying neural structure; alterations in frontal cortical maturation and volume were related to additional activation of bilateral frontal cortical regions and the dorsal striatum, with anxiety increasing the demand on inhibitory control-related activation. In contrast to healthy participants, PTSD was associated with reduced inhibitory control as indexed by inhibitory behaviour, diminished activation of the right VLPFC, and slowed inhibition-related information processsing. PTSD participants relied on the greater activation of a left fronto-striatal inhibition network to support control, with the activation affected by levels of PTSD severity and comorbid anxiety. This left fronto-striatal activation in PTSD was related to underlying increases in fronto-striatal neural structure. Further, the ability to efficiently engage a left fronto-striatal network in PTSD during inhibitory control predicted better response to cognitive behavior for PTSD, consistent with the proposal that an improved ability to flexibly engage control systems may facilitate the resolution of PTSD symptoms. Taken together, this program of research extends current neurophysiological model of PTSD to show that PTSD involves a fundamental disturbance in the function and structure of key fronto-striatal response control networks associated with inhibitory control.

Doctor of Clinical Psychology/ Master of Science (DCP/ MSc) / A number of international studies reveal high prevalence rates of posttraumatic stress disorder (PTSD) within homeless populations. Recent research on PTSD indicates that cognitive responses to trauma are critical in determining who develops the disorder. In Australia, a number of studies indicate exceptionally high rates of trauma experience among homeless adults, yet PTSD has not been investigated in this cohort. Therefore, the primary aim of this project was to improve understanding of PTSD and related cognitions in a sample of homeless adults in Sydney. The project attempts to determine the prevalence of PTSD and its onset in relation to homelessness (Study One) and also explores the role of cognitions in PTSD (Study Two). The sample consisted of seventy homeless men and women aged 18 to 73 years, who were randomly sampled through eight homeless services. A computer-assisted face-to-face structured clinical interview was conducted for each participant. The majority of the sample stated that they had experienced at least one traumatic event in their lifetime (98.2%). The twelve-month prevalence of PTSD was higher among homeless adults in Sydney in comparison to the Australian general population (41.1% versus 1.5%). In 59.1% of cases, the onset of PTSD was found to have occurred before the age of the first reported homeless episode. In a comparison of those with and without a current diagnosis of PTSD, it was found that those with PTSD scored significantly higher overall on measures of posttraumatic cognitions and early maladaptive schemas. In particular, this group scored higher on schemas that centre on the world being entirely dangerous and the self being totally inept. A mediational analysis showed that when trauma and mental health care were controlled, the relationship between early maladaptive schemas and PTSD symptom severity was mediated by posttraumatic cognitions. It was concluded that homeless adults in Sydney frequently experience trauma and PTSD, which typically precedes homelessness. It was also concluded that among homeless adults, posttraumatic cognitions and early maladaptive schemas appear to play an important role in PTSD and may be associated with symptom severity. These findings have implications for public policy on homelessness and mental health, homeless service provision, PTSD theory, and PTSD treatment for homeless adults.

Posttraumatic stress disorder (PTSD) is a debilitating mental illness that affects thousands of military service members and veterans every year. Strongly associated with PTSD are symptoms of depression, life satisfaction and physical health complaints. Playing video games has been shown in the past to reduce symptoms of PTSD, other mental illnesses, and reduce the experience of pain. The purpose of this study was to examine these relationships, specifically regarding a 3-4 hour per week duration that has been particularly beneficial to military service members in the past. Participants included n = 400 military service members or veterans who had served in a combat zone and was relatively representative of the U.S. military population. Participants completed a number of measures assessing PTSD and depressive symptoms, life satisfaction, physical health, military service, and video game play behaviors. Results indicated that no relationship exists between the duration of video game play PTSD symptoms severity, unless the PTSD symptoms were present first. A linear relationship was also noted between video game play duration and depressive symptoms. No significant relationship was observed between video game play duration and life satisfaction or physical health ailments. These findings seem to contradict some of the previous literature, though may indicate that playing video games as a utilization of an avoidance strategy could be detrimental to one’s mental health.

Sexual trauma, in addition to being a human rights violation, harms people in numerous ways, including negative psychological and physical outcomes. Body-based interventions reduce sexual trauma symptoms, but limited information exists about how these interventions work. Researchers propose changes in internal body sensation awareness (i.e., interoceptive awareness; IA) as a potential mechanistic explanation. We are not aware of any studies testing that claim. Further, there is scant extant information on IA – sexual trauma relationships. Before evaluating mechanistic therapeutic hypotheses, studies need to test sexual trauma – IA associations. We focus on this understudied area here. Through a multi-method study (behavioral, self-report and qualitative data), we tested the associations between IA and sexual trauma among females. Aim 1: Characterize IA among sexual trauma survivors. We hypothesized that survivors would have significantly lower self-reported IA than existing literature. Aim 2: Quantify the amount of variance IA explains in posttraumatic stress disorder (PTSD) symptoms. We hypothesized that IA would predict significant variance in PTSD, such that increases in IA would predict increases in PTSD. We expected that an IA – dissociation symptom interaction would qualify that main effect via weakening it for survivors with higher dissociation. Aim 3: Through a moderated mediation model, test if IA mediates the sexual trauma – PTSD association. We hypothesized that IA would mediate that association. Further, we predicted that the IA – PTSD relationship would be moderated by dissociation: higher dissociation would attenuate the IA – PTSD association. In this manuscript, we report results from two samples: 1) University (n = 153), and 2) community (n = 21) participants. Given ongoing community participant recruitment, the following are university participant results. Aim 1: Self-reported IA is significantly lower among survivors than comparator samples. Aim 2: Behavioral IA explained significant variance in PTSD, though opposite to the direction we predicted: we observed that as IA increased, PTSD decreased. We observed a significant interaction between self-reported IA and dissociation in predicting declines in PTSD. PTSD symptoms were lowest among survivors with high dissociation and high IA. Aim 3: IA did not mediate the sexual trauma – PTSD association. We discuss clinical implications, limitations and future directions.

Background Posttraumatic stress disorder (PTSD) brings with it diagnostic symptoms that can be debilitating and persist for years. Left untreated, PTSD can have far-reaching and damaging consequences – for the individual, families, communities, and society at large. While early detection and intervention is recognized as key to the effective treatment of PTSD, many who suffer from PTSD do not seek essential health services. The aim of this study was to answer the research question: based on existing literature, what are the barriers and facilitators to help-seeking for individuals with PTSD? Methods A systematic review, modeled on the Joanna Briggs Institute (JBI) methodology for systematic reviews, examined studies cited in PsycINFO, Medline, Embase, CINAHL and PILOTS published from January 2000 to November 2015. Eligible studies measured barriers and facilitators to help-seeking for adults with PTSD. Two reviewers independently screened citations and double data extraction was exercised. Results Of 1,759 potentially relevant citations, sixteen studies were included, published between 2003 and 2015 and based in five countries, predominantly within the United States (n=12). Thirteen studies focused on military as a target population. Eight principal barrier themes and seven principal facilitator themes were identified, under which supportive subthemes were categorized. Conclusions In identifying prominent barriers and facilitators to help-seeking for individuals with PTSD, this review highlights opportunities to inform policies and programs that educate and promote PTSD knowledge and recognition, reduce public and personal stigma, improve access and availability of care, and encourage social support for patients and families living with PTSD.

Human immunodeficiency virus (HIV) is a virus that affects the body’s immune system (Centers for Disease Control [CDC], 2016a). HIV is a worldwide epidemic and disproportionately impacts youth in the United States. Youth living with HIV (YLWH) face significant mental health problems, namely depression, anxiety, and posttraumatic stress disorder (PTSD) with rates of these disorders discrepant from those in the general population. In addition to psychological difficulties, health literacy is another factor that influences individuals with HIV and is a priority of research with adolescents (Kalichman et al., 2000; Manganello, 2008). The National HIV/AIDS Strategy: Update 2020 (White House Office of National AIDS Policy, 2015) identified youth, ages 13 to 24 years, as a key population needing broad support not only for HIV prevention but also engagement in care including improving mental health and health literacy. The current study explored the extent to which YLWH were health literate in addition to the extent to which they exhibited psychological symptoms of depression, anxiety, and posttraumatic stress disorder. Furthermore, the study examined the extent to which health literacy and psychological symptoms were associated with health outcomes. A total of 145 YLWH between the ages of 13 and 25 years participated in the study. Participants completed the Center for Epidemiologic Studies Depression Scale (CES-D; Radloff, 1977), Generalized Anxiety Disorder-7 Item Scale (GAD-7; Spitzer, Kroenke, Williams, & Lowe, 2006), Primary Care-PTSD Screen (PC-PTSD; Prins et al., 2003), and Brief Estimate of Health Knowledge and Action-HIV Version (Osborn, Davis, Bailey, & Wolf, 2010). Of the 145 participants, 103 completed the CES-D, 144 completed the GAD-7, 131 completed the PC-PTSD, and 102 completed the BEHKA-HIV. In addition, participants’ biological markers of immune functioning (i.e., CD4 count and viral load) were obtained from medical abstraction. Results indicated the sample reported high levels of symptoms of depression, anxiety, and PTSD. Thirty-five percent of participants screened positive for depressive symptoms, 26% screened positive for anxiety symptoms, and 21% screened positive for PTSD symptoms. Participants had a moderate amount of HIV knowledge and the majority reported taking their medications under most conditions. Age was a significant predictor of CD4 count and viral load such that increasing age was associated with worse immune system functioning. Educational attainment was a significant predictor of CD4 count and to a lesser extent viral load indicating that greater education was associated with better immune system functioning. There was an interaction between mode of transmission and psychological symptoms. For perinatally infected youth, greater psychological symptoms were associated with a decline in CD4 count. The same decline was not seen for behaviorally infected youth. Health literacy (knowledge and action) added significantly to the explanation of the variance in viral load. Decreasing action scores were statistically associated with an increased likelihood of having a detectable viral load. These findings point to the need for prevention and intervention mental health services for YLWH. Future research should determine prevention and intervention strategies for mental health issues with YLWH in particular. Additionally, health literacy is an important factor that should be addressed by practitioners working with YLWH. More research needs to be conducted to determine the best way to measure health literacy in YLWH and how to intervene with improving health literacy.

Magister Psychologiae - MPsych / Significant research efforts have focused on developing treatments for trauma survivors and evaluating their effectiveness. However, little attention has been given to understanding the impact of working with trauma survivors on psychologists. This research aimed to address this gap in the literature. In South Africa, there is a scarcity of published qualitative studies that focus on the experiences of VT among psychologists who work with survivors of trauma. Given the increasing prevalence of traumatic events in South Africa and increasing patient load, psychologists may be vulnerable to the development of VT. Beneficial treatments for trauma survivors largely depend on psychologists who can effectively handle their clients' intense traumatic material. If a psychologist is adversely affected by the work of trauma, the quality of treatment for trauma survivors will be compromised (Figley, 1999). Hence, it is critical that research continues to explore the effects of VT and ways to ameliorate them. Aim: to explore the experiences of VT among a group of psychologists from Cape Town, South Africa, who work with trauma survivors and the related coping strategies used by them. This research aimed to expand the local research on the phenomenon of VT. Findings of the study will help to facilitate a better understanding of vicarious impact of trauma work as well as the related coping techniques used by psychologists. Identification of protective factors and effective coping mechanisms of those professionals in this study was a distinct contribution to the South African literature base. This study has practical implications for training, supervision and clinical practice for psychologists in South Africa to enhance the efficiency of psychological service delivery. Exploring the challenges South African psychologists experience as a result of working with trauma survivors may help inform policy and develop effective programmes to address the effects of VT. As such, psychologists would be better equipped to care both for themselves and their clients, and to ensure ethical and professional practice.

The cross-cultural applicability of the PTSD diagnosis has been widely disputed in recent years. Consequently, an examination of the psychometric properties of instruments that are used to assess traumatized individuals of various cultures is of utmost importance. To respond to this need, the overall goal of this dissertation was to evaluate the psychometric properties of the Harvard Trauma Questionnaire (HTQ; Mollica et al., 1992), a measure that was developed to assess trauma symptoms across cultures. In the first study, I conducted a search of all publications and dissertations that used the symptoms scales of the HTQ. This search revealed that the HTQ is commonly used by trauma researchers, however only a minority of them reported using established translation and cultural adaptation procedures to adapt the instrument for their specific sample. In addition, of the 384 studies considered for inclusion, only 44% of them reported internal consistency estimates of their sample. I then performed reliability generalization analyses on Cronbach’s alpha coefficients to assess the reliability properties of the HTQ symptom scales. Overall, 103 samples were included in the analyses, representing various cultures, languages and countries of study. The findings of this study indicated that both the HTQ-16 and 30 symptom scales are likely to provide reliable scores across diverse populations. However, the evidence supporting the reliability of scores produced for the re-experiencing, avoidance/numbing and arousal subscales is less strong. Significant moderating effects were found for various sample and methodological variables, such as the gender composition of the sample, cultural group, cultural orientation of the country of origin and trauma type. Building upon the findings of study 1, I performed validity generalization (VG) analyses to assess the overall construct validity of the HTQ symptom scales in Study 2. Seventy-five independent samples were included in the VG that evaluated the convergent and discriminant validity properties of both the HTQ-16 and HTQ-30. The findings revealed that the convergent validity properties of the HTQ-16 are supported to some extent, but the discriminant validity properties are not. Furthermore, there was limited support for either the convergent or discriminant validity of the HTQ-30. Several significant moderating effects were also found for both scales (i.e. age, gender, cultural group, recruitment site, trauma type, being an original sample). Although these studies shed some light into the overall psychometric strength of the HTQ symptom scales, the decision whether to use this instrument for the assessment of PTSD should also be guided by evidence-based assessment guidelines.

abstract: With the rise of Posttraumatic Stress Disorder (PTSD) among adults in the United States, understanding the processes of trauma, trauma related disorders, and the long-term impact of living with them is an area of continued focus for researchers. This is especially a concern in the case of current and former military service members (veterans), whose work activities and deployment cycles place them at an increased risk of exposure to trauma-inducing experiences but who have a low rate of self-referral to healthcare professionals. There is thus an urgent need for developing procedures for early diagnosis and treatment. The present study examines how the tools and findings of the field of linguistics may contribute to the field of trauma research. Previous research has shown that cognition and language production are closely linked. This study focuses on the role of prosody in PTSD and pilots a procedure for the data collection and analysis. Data consist of monologic talk from a sample of student-veterans and analyzed with speech software (Praat) for pauses greater than 250 milliseconds per 100 words. The pause frequency was compared to a PCL-5 score, an assessment used to check for PTSD symptoms and evaluate need for further assessment and possible diagnosis of PTSD. This pilot study found the methods successfully elicited data that could be used to measure and test the research questions. Although the findings of the study were inconclusive due to limitations of the participant pool, it found that the research model proved effect as a model for future linguistic research on trauma. / Dissertation/Thesis / Masters Thesis English 2020

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