Background: Preliminary evidence suggests there are differences in how older people and younger people with posttraumatic stress disorder (PTSD) present. However, currently little robust evidence exists relating to the presentation, assessment and intervention of PTSD in a rapidly ageing population. Faced with limited and conflicting evidence, clinical psychologists are reliant on their clinical expertise to make decisions in this context. Method: Eight studies reporting current prevalence of PTSD in older people were systematically reviewed. Semi-structured interviews with eight clinical psychologists with experience of assessment and intervention of post-traumatic stress symptomology in older people were analysed according to grounded theory methods. The analysis abstracted categories of data to construct a substantive theory of clinical decision making in this context. Results: Current and 12 month prevalence of PTSD ranged from 0.7% to 4.0% and 0.2% to 0.4% respectively. Partial PTSD was estimated at 1% to 10%. The quality of evidence limits the generalisability of the results. ‘Balancing complexity, resources and demand’ emerged from participants’ accounts as the core theoretical category, underpinning decision making in this context. Seven sub-categories comprise the model, ‘culture’; ‘NHS’; ‘clinician competencies’; “what the client brings”; ‘reconciling understanding’; ‘tailoring’ and ‘therapeutic relationship’. Conclusions: PTSD appears to be relatively rare among older people but more research is required to better understand the presentation and prevalence of full and partial PTSD. The theoretical model is broadly consistent with extant literature pertaining to the adaptation of psychological therapy for older people, offering further detail on implementation and the influence of treatment non-specific factors.

Previous literature has shown that combat veteran posttraumatic stress disorder (PTSD) affects attachment quality, as well as sexual satisfaction and functioning. This study used internet survey methods from 253 male combat veterans in committed relationships to analyze the correlations between PTSD symptoms, attachment quality, sexual satisfaction, and sexual functioning in romantic relationships. The results indicate that PTSD symptoms from combat veterans are correlated with attachment quality, sexual satisfaction, and sexual functioning in romantic relationships. Implications for professionals and future research are explored.

Thesis (PhD)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Posttraumatic stress disorder (PTSD) is a severe, chronic and debilitating psychiatric disorder that can present after the experience of a life-threatening traumatic event. D-cycloserine (DCS), a partial N-methyl-D-aspartate (NMDA) receptor agonist, has been found to augment cognitive behavioural therapy by facilitating fear extinction; however, the precise mechanisms whereby DCS ameliorates fear triggered by a traumatic context remains to be fully elucidated. This study aimed to (i) identify the molecular mechanisms of intrahippocampally administered DCS in facilitating fear extinction in a rat model of PTSD by investigating gene expression profiles in the left dorsal hippocampus (LDH) of male Sprague Dawley rats and (ii) determine whether microRNA (miRNA) expression and DNA methylation mediated these gene expression changes. An adapted version of the PTSD animal model described by Siegmund and Wotjak (2007) was utilised. The total number of 120 rats were grouped into four experimental groups (of 30 rats per group) based on fear conditioning and the intrahippocampal administration of either DCS or saline: (1) fear conditioned + intrahippocampal saline administration (FS), (2) fear conditioned + intrahippocampal DCS administration (FD), (3) control + intrahippocampal saline administration (CS) and (4) control + intrahippocampal DCS administration (CD). Behavioural tests (the light/dark [L/D] avoidance test, forced swim test and open field test) were conducted to assess anxiety and PTSD-like behaviours. The L/D avoidance test was the most sensitive behavioural test of anxiety and was subsequently used to differentiate maladapted (animals that displayed anxiety-like behaviour) and well-adapted (animals that did not display anxiety-like behaviour) subgroups. In order to identify genes that were differentially expressed between FS maladapted (FSM) (n = 6) vs. FD well-adapted (FDW) (n = 6) groups, RNA sequencing was performed on the Illumina HiSeq 2000 which generated more than 60 million reads per sample. This was followed by subsequent bioinformatics analyses (using the software programs TopHat, Bowtie, Cuffdiff and Bio-Ontological Relationship Graph (BORG) database (that identifies genes that may be biologically relevant) to identify biologically relevant differentially expressed genes between the treatment groups. Epigenetic mechanisms mediating observed differences in gene expression were investigated by conducting DNA methylation and miRNAseq analyses in the FDW and FSM experimental groups. DNA methylation was investigated using real-time quantitative PCR (qPCR) amplification followed by high resolution melt analysis on the Rotor-GeneTM 6000. Differences in miRNA expression levels between the FDW and FSM groups were investigated by sequencing the miRNA fraction on the MiSeq platform. The bioinformatics pipeline used to analyse the RNAseq data identified 93 genes that were significantly downregulated in the FDW group compared to the FSM group. Forty-two of these genes were predicted to be biologically relevant (based on BORG analysis). Integrative network analyses revealed subsets of differentially expressed genes common across biological functions, pathways and disorders. The co-administration of DCS and behavioural fear extinction downregulated immune system genes and genes that transcribe proinflammatory and oxidative stress molecules. These molecules mediate neuroinflammation and subsequently cause neuronal damage. DCS also regulated genes involved in learning and memory processes. Additionally, a subset of the genes, which have been found to be associated with disorders that commonly co-occur with PTSD (such as cardiovascular disease, metabolic disease, Alzheimer‘s and Parkinson‘s disease), was downregulated by the co-administration of DCS and behavioural fear extinction. In order to determine whether real-time qPCR analysis would be sensitive enough to detect differential expression in those genes found to be differentially expressed in RNAseq analysis, the expression of nine genes was analysed using SYBR Green qPCR technology. In the LDH, six of the nine genes were found to be differentially expressed between FDW and FSM groups and one gene, matrix metallopeptidase 9 (MMP9), was observed to be differentially expressed between these two groups in the blood. Three of the nine genes for which differential expression levels were investigated using SYBR Green real-time qPCR, contained CpG islands and were used for CpG island DNA methylation analysis. Results indicated that CpG island DNA methylation did not mediate differential gene expression of TRH, NPY or MT2A. Bioinformatics analysis of miRNAseq data identified 23 miRNAs that were differentially expressed between the FDW and FSM groups. Several of these miRNAs have previously been found to be involved in brain development and behavioural measures of anxiety. Furthermore, functional luciferase analysis indicated that the upregulation of rno-mi31a-5p could have facilitated the downregulation of interleukin 1 receptor antagonist gene (IL1RN) as detected in RNAseq. RNAseq and miRNAseq analyses in this PTSD animal model identified differentially expressed genes and miRNAs that serve to broaden our understanding of the mechanism whereby DCS facilitates fear extinction. To this end, immune system genes and genes transcribing proinflammatory and oxidative stress molecules were among the genes that were found to be differentially expressed between the FDW and FSM groups. Based on the results obtained, it can be hypothesised that DCS attenuates neuroinflammation and subsequent neuronal damage, and also regulates genes involved in learning and memory processes. Concomitantly, these gene expression alterations mediate optimal neuronal functioning, plasticity, learning and memory (such as fear extinction memory) which contribute to the fear extinction process. Furthermore, biologically relevant differentially expressed genes that were associated with DCS facilitation of fear extinction and with other chronic medical conditions, such as cardiovascular disease and metabolic diseases, might help to explain the co-occurrence of these disorders with PTSD. In conclusion, Identifying the molecular underpinnings of DCS-mediated fear extinction brings us closer to understanding the process of fear extinction and could, in future work be used to explore novel therapeutic targets to effectively treat PTSD and related disorders. / AFRIKAANSE OPSOMMING: Posttraumatiese stressindroom is 'n ernstige, kroniese aftakelende psigiatriese toestand wat kan ontwikkel na 'n lewensgevaarlike traumatiese gebeurtenis. Daar is bevind dat die gesamentlike toediening van D-sikloserien (DCS), 'n N-metiel-D-aspartaat (NMDA) reseptor agonis, en kognitiewe gedragsterapie effektief is in die bemiddeling van vrees uitwissing; maar die presiese meganisme waar deur DCS die vrees wat deur 'n traumatiese konteks ontlok word verminder, is egter onduidelik. Hierdie studie het beoog om (i) die molekulêre meganismes te identifiseer waardeur intra-hippokampaal toegediende DCS vrees uitwissing fasiliteer, in 'n rot model van posttraumatiese stressindroom, deur geen uitdrukkingsprofiele in the linker dorsale hippokampus (LDH) van manlike Sprague Dawley rotte te ondersoek en (ii) om te bepaal of mikroRNA (miRNA) uitdrukking en DNA metilering die veranderinge in geen uitdrukking bemiddel het. 'n Gewysigde weergawe van die posttraumatiese stressindroom diere model, beskryf deur Siegmund en Wotjak (2007), was gebruik tydens die studie. Rotte was in vier groepe verdeel, vrees kondisionering + soutwater (FS), vrees kondisionering + DCS (FD), kontrole + soutwater (CS) en kontrole + DCS (CD). Gedragstoetse was uitgevoer om angstige, vreesvolle en posttraumatiese stressindroom-tipe gedrag te evalueer. Gedurende die lig/donker (L/D) vermydingstoets het die FS groep aansienlik meer tyd in die donker kompartement deurgebring ('n indikasie van vreesvolle gedrag) in vergelyking met die CS en die FD groepe wat meer tyd in die verligte kompartement deurgebring het ('n indikasie van vreeslose gedrag). Die L/D toets was die mees sensitiewe gedragstoets vir angstige en vreesvolle gedrag en was gevolglik gebruik om die diere te sub-groepeer in wanaangepaste (diere wat angstige en vreesvolle gedrag vertoon het) en goedaangepaste (diere wat nie angstige en vreesvolle gedrag vertoon het nie) subgroepe. Nuwe generasie RNA volgordebepaling (RNAseq) van die LDH RNA en daaropvolgende bioinformatiese analise was uitgevoer om gene te identifiseer wat differensieel uitgedruk is tussen die twee behandelingsgroepe van belang in die betrokke studie, naamlik FS wanaangepaste (FSM) teenoor FD goedaangepaste (FDW) groepe. Epigenetiese analises was uitgevoer om te bepaal of differensieel uitgedrukte miRNAs of CpG-eiland DNA metilasie die differensiële geenuitdrukking bemiddel het. Bioinformatiese analises van die RNAseq data het 93 gene geïdentifiseer waarvan die geen uitdrukking beduidend onderdruk was in die FDW groep in vergelyking met die FSM groep; 42 van hierdie gene was voorspel om biologies relevant te wees. Geïntegreerde netwerk analise het onthul dat sekere van die differensieel uitgedrukte gene gemeenskaplik was tussen verskeie biologiese funksies, padweë en versteurings. DCS het die uitdrukking van immuun-sisteem gene en pro-inflammatoriese en oksidatiewe stres gene verlaag. Hierdie molekules medieer neuro-inflammasie wat gevolglik tot neurale skade lei. DCS het ook gene gereguleer wat betrokke is by leer en geheue prosesse. DCS het onder meer ook die geenuitdrukking verlaag van 'n sub-groep van gene wat voorheen geassosier is met komorbiede versteurings van PTSD. SYBR Green real-time qPCR (werklike tyd kwantitatiewe polimerase ketting reaksie) analise was ondersoek om te bepaal of hierdie metode sensitief genoeg sou wees om die verlaagde geen-uitdrukking van verskeie van die biologies relevante differensieel uitgedrukte gene te identifiseer, in dieselfde LDH komplementêre DNA (cDNA) monsters as wat in die RNAseq gebruik is, asook in die bloed cDNA monsters. SYBR Green real-time qPCR was in staat om ses, van die nege, differensieel uitgedrukte gene in die LDH cDNA monsters en een geen, matriks metallopeptidase 9 (MMP9), in die bloed cDNA monsters op te tel. Drie van die gene waarvoor SYBR Green real-time qPCR gebruik is om differensiële geenuitdrukking te toets, het CpG eilande bevat en was gevolglik gebruik in CpG eiland DNA metilering analises. Resultate het getoon dat CpG eiland DNA metilering nie die differensiële geenuitdrukking van TRH, NPY of MT2A gedryf het nie. Bioinformatiese analises van die miRNAseq data het 23 miRNAs geïdentifiseer wat differensieël uitgedruk was tussen die FDW en FSM groepe. Verskeie van hierdie miRNAs is reeds voorheen beskryf om betrokke te wees in brein ontwikkeling en angs gedrags metings. Funksionele luciferase analises het verder aangedui dat die verhoogde uitdrukking van rno-mi31a-5p moontlik die verlaagde geen uitdrukking van IL1RN, soos waargeneem in die RNAseq data, kon bewerkstellig het. RNAseq en miRNAseq analises in hierdie posttraumatiese stressindroom dieremodel het differensieël uitgedrukte gene en miRNAs geïdentifiseer wat dien om die verstaanswyse te verbreed van hoe DCS die vrees uitwissings proses fasiliteer. Die meganismes waardeur DCS vrees uitwissings bewerkstellig het sluit die verlaging van immuun-sisteem geen-uitdrukking in, sowel as verlaagde uitdrukking van gene wat pro-inflammatoriese en oksidatiewe stress gene transkribeer. DCS het daardeur neuro-inflammasie en gevolglike neurale skade voorkom. DCS het daarmee saam ook gene gereguleer wat betrokke is by leer en geheue prosesse. Hierdie gesamentlike veranderings in geen uitdrukking het gelei tot die uiteindelike bewerkstelling van optimale neurale funksionering, plastisiteit, leer en geheue prosesse wat uiteindelik bygedra het tot vrees uitwissing. Biologies relevante differensieël uitgedrukte gene wat ook geassosieer was met ander kondisies, soos middel verwante versteurings en metaboliese versteurings, kan help om die komorbiditeit met posttraumatiese stressindroom te verklaar. Identifisering van die molekulêre grondslae van DCS bemiddelde vrees uitwissing verbreed ons begrip en verstaan van vrees uitwissing en kan moontlik, in toekomstige navorsing gebruik word om nuwe innoverende terapeutiese teikens te verken om sodoende posttraumatiese stressindroom meer effektief te kan behandel.

Background: Traumatic musculoskeletal injury (TMsI) often leads to chronic pain and post-traumatic stress disorder (PTSD). This study examined factors of a modified diathesis-stress model in the development of PTSD symptoms following TMsI. Methods: 205 patients were recruited in this prospective, observational study. Within 14 days of injury, participants completed an in-hospital questionnaire investigating acute symptoms of anxiety, depression, pain, and PTSD. Results: Logistic regression identified multiple factors associated with symptoms of PSTD (p<.0001). Neuropathic pain (odds ratio[OR]=1.091, 95% confidence interval[CI] 1.020-1.168), general anxiety (OR=1.176, 95%CI 1.046-1.318), pain anxiety (OR=1.056, 95%CI 1.018-1.094), and pain catastrophizing (OR=1.168, 95%CI 1.016-1.348) were associated with acute symptoms of PTSD. Conclusions: The results support the modified diathesis-stress model indicating that neuropathic pain, general anxiety, pain anxiety, and pain catastrophizing are associated with symptoms of PTSD. Future studies should examine the influence of these acute factors on the development of chronic pain and PTSD following TMsI.

This study began testing the Sewell and Williams (in press) model that differing trauma types yield differing presentations in social versus event processing domains. Other hypotheses explored trauma type with levels of guilt, and shame-proneness with anxiety. Volunteers were 44 male combat veterans being treated for PTSD. Data analyses determined whether trauma type related to guilt and perceived social support and whether shame-proneness related to levels of anxiety. High shame persons may process anxiety and social support differently than low shame persons. Results can assist professionals understand how a person's functioning is affected by certain types of trauma. Future research should focus on increasing social support for persons who have experienced trauma.

<p>Involuntary episodic memories are memories that come into consciousness without preceding retrieval effort. These memories are commonplace and are relevant to multiple mental disorders. However, they are vastly understudied. We use a novel paradigm to elicit involuntary memories in the laboratory so that we can study their neural basis. In session one, an encoding session, sounds are presented with picture pairs or alone. In session two, in the scanner, sounds-picture pairs and unpaired sounds are reencoded. Immediately following, participants are split into two groups: a voluntary and an involuntary group. Both groups perform a sound localization task in which they hear the sounds and indicate the side from which they are coming. The voluntary group additionally tries to remember the pictures that were paired with the sounds. Looking at neural activity, we find a main effect of condition (paired vs. unpaired sounds) showing similar activity in both groups for voluntary and involuntary memories in regions typically associated with retrieval. There is also a main effect of group (voluntary vs. involuntary) in the dorsolateral prefrontal cortex, a region typically associated with cognitive control. Turning to connectivity similarities and differences between groups again, there is a main effect of condition showing paired > unpaired sounds are associated with a recollection network. In addition, three group differences were found: (1) increased connectivity between the pulvinar nucleus of the thalamus and the recollection network for the voluntary group, (2) a higher association between the voluntary group and a network that includes regions typically found in frontoparietal and cingulo-opercular networks, and (3) shorter path length for about half of the nodes in these networks for the voluntary group. Finally, we use the same paradigm to compare involuntary memories in people with posttraumatic stress disorder (PTSD) to trauma-controls. This study also included the addition of emotional pictures. There were two main findings. (1) A similar pattern of activity was found for paired > unpaired sounds for both groups but this activity was delayed in the PTSD group. (2) A similar pattern of activity was found for high > low emotion stimuli but it occurred early in the PTSD group compared to the control group. Our results suggest that involuntary and voluntary memories share the same neural representation but that voluntary memories are associated with additional cognitive control processes. They also suggest that disorders associated with cognitive deficits, like PTSD, can affect the processing of involuntary memories.</p> / Dissertation

Combat and war zone veterans are particularly vulnerable to developing Posttraumatic Stress Disorder (PTSD) due to the increased risk of experiencing trauma inherent in military service. Insomnia and nightmares are core symptoms of PTSD and can be factors in the development, maintenance, and exacerbation of PTSD. However, sleep disturbance has received relatively little attention from a treatment point of view until recently. Recent research has demonstrated that cognitive behavioral therapy for insomnia (CBT-I) and imagery rehearsal therapy (IRT) for nightmares are effective stand alone and combination treatments for sleep disturbance in civilian and veteran populations. Although group interventions are lower in cost and more efficient to deliver in a VA setting, studies have yet to test the feasibility and efficacy of group CBT-I/IRT combination treatment for veterans with PTSD. The current pilot study investigated the feasibility and efficacy of a combined CBT-I and IRT protocol intervention for insomnia and nightmares delivered in a group format to a sample of mixed theater veterans with PTSD. Participants (n = 34) were randomly assigned to either a treatment (n = 17) or waitlist control condition (n = 17). After baseline assessment, participants assigned to the treatment condition participated in six weekly group sessions of combined CBT-I and IRT and completed posttreatment and two month follow-up assessments. Those in the waitlist condition completed a six week waiting period. After completing post-waitlist assessment, they were given the opportunity to receive the treatment. Authors hypothesized that those in the treatment condition would experience significant improvement on self-report measures of sleep, nightmare frequency, PTSD-related sleep disturbance, beliefs about sleep, and overall PTSD and depression severity compared to the waitlist condition at posttreatment and two-month follow-up. These hypotheses were largely supported by the study results with some notable exceptions. Significant condition by time interactions were found on measures of sleep and nightmares, beliefs about sleep, and depression at posttreatment. Treatment gains were maintained at two month follow-up for sleep variables but not nightmare frequency or depression. There were no condition by time interactions for measures of PTSD or PTSD-related sleep disturbance at posttreatment. In sum, the findings of this study indicate that a combined CBT-I and IRT delivered in a group format was effective in reducing insomnia symptoms, nightmare frequency, and depression in a sample of mixed theater veterans with PTSD. The study also demonstrated the feasibility of this treatment approach with this population suggesting that a larger randomized controlled study is warranted.

ETUDE 1- Le traumatisme de l’accouchement prématuré et de la césarienne, un sentiment de culpabilité, une anxiété et une ambivalence envers l’enfant et l’équipe médicale ont été rapportés. Des difficultés dans l’investissement du lien mère-enfant et dans l’accès au rôle de mère ainsi que l’importance du partage d’expérience avec des femmes ayant accouché avant-terme ont également été identifiés. Enfin, des signes de dépression postnatale et de stress posttraumatique ont été relevés. ETUDE 2- 53% des participantes ont rapporté un score à l’IES-R indiquant un probable ESPT. La présence de symptômes de dépression postnatale (ß = 0,40, p< 0,05), de difficultés pendant la grossesse (ß= 0,20, p< 0,05), la perception maternelle de l’enfant comme étant vulnérable (ß = 0,17, p< 0,05), l’insatisfaction de la grossesse (ß = -0,13; p< 0,05) et des cognitions maternelles mal-adaptées (ß = -0,12, p< 0,05) étaient indépendamment associés à l’intensité des symptômes d’ESPT. ETUDE 3- 3 profils de femmes ont été identifiés: les parturientes au profil « dépressif », « faible niveau de symptômes » et les mères du groupe « dépressif anxieux traumatisé ». Nos résultats démontrent également une forte comorbidité entre troubles anxieux et dépression postnatale ainsi que l’influence négative des symptômes de dépression postnatale sur le lien mère-enfant. ETUDE 4- 64,3% des femmes de l’échantillon ont rapporté un score à l’EPDS indiquant une possible dépression postnatale. Le placement de l’enfant sous assistance respiratoire (ß = 0,23, p< 0,05), le type de prématurité (ß= 0,16, p< 0,05), et la baisse de la qualité de la relation conjugale (ß = -0,39, p< 0,05) étaient indépendamment associés à l’intensité des symptômes de dépression postnatale. / STUDY 1- Trauma of premature birth and c-section, feelings of guilt, anxiety, ambivalence towards the infant, the medical staff and the infant’s hospital discharge, were all part of their perception. Furthermore, difficulties for mothers to define themselves as such and the importance of sharing with women who have been through the same experience were evidenced. Postpartum depression and PTSD symptoms were also highlighted. STUDY 2- 53% of participants scored above the cut-off for probable PTSD. Increased postpartum depressive symptoms (ß = 0.40, p< .05), difficulties during pregnancy (ß= 0.20, p< .05), maternal perception of infant vulnerability (ß = 0.17, p< .05), decreased satisfaction with delivery (ß = -0.13; p< .05) and cognitions relating to role change (ß = -0.12, p< .05) were independently associated with PTSD symptoms. STUDY 3- 3 profiles were highlighted: “depressive”, “low level of symptoms” and “anxious-depressive-traumatized” mothers. Our findings also evidenced a high comorbidity between anxious and depressive symptoms as well as a negative impact of postpartum depression on mother-infant bond. STUDY 4- 64.3% of our sample reported a score on the EPDS highlighting a probable postpartum depression. Having an infant who experienced ventilator support (ß = 0.23, p< 0,05), type of prematurity (ß= 0.16, p< 0,05), and decreased quality of marital relationship (ß = -0.39, p< 0,05) were independently associated with the intensity of postpartum depressive symptoms.

Doctor of Philosophy / Department of Human Nutrition / Mark D. Haub / Mark D. Haub / Psychological problems and human error are leading causes of death and disability among military service members. Strategies to improve the psychological health and cognitive performance of those in the military are much needed. Recent advances in neuroscience suggest that omega-3 fatty acids may play an important role in the psychological well-being of those in the military. The purpose of this research was to explore the relationship between omega-3 status and psychological outcome variables among soldiers deploying to combat. Data collection was preceded by the development and reliability testing of a novel food frequency questionnaire (FFQ) designed to capture intake from contemporary sources of omega-3 fatty acids including functional foods and supplements. Based on the instrument assessment study (Chapter 2) conducted among university students (n = 165), this FFQ appears to be a comprehensive and reliable (n = 54, ρ = 0.86, p < 0.001) instrument for measuring docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) intakes in young adults. As described in Chapter 3, intake of EPA + DHA as estimated by the FFQ was positively correlated (r = 0.39, p < 0.001) with biomarker measurements of omega-3 status. Primary data were obtained from a volunteer sample of soldiers (n = 272) scheduled for deployment to Iraq. Preliminarily analyses revealed relationships between attention deficit hyperactivity disorder (ADHD) screening scores and psychological outcome variables (Chapter 4). Primary analyses (Chapter 5) indicated intake of EPA + DHA was not significantly correlated with mood, nor were omega-3 exposure variables correlated with cognitive performance based on the required p value (< 0.001) calculated using the Bonferroni correction for multiple tests. Among participants with EPA + DHA intakes at or below the median, omega-3 HUFA was related (p < 0.002) to happiness (β = -0.46), depression (β = 0.44), and fatigue (β = 0.43). Although exploratory in nature, the results of this study suggest a relationship between omega-3 fatty acids and mood. Given the current concerns regarding the psychological health of those in the military, additional research is warranted.

Thesis advisor: Aimee Seiler / In the effort to take responsibly and effect positive change in the lives of our children, we must begin by identifying and applying the most effective methods to help them overcome obstacles to mental and emotional well-being. In conjunction with a limited number of quantitative studies, anecdotal evidence suggests that animal-assisted therapies and activities promote positive outcomes for children who have been physically abused and who have developed behavioral and emotional disorders. Chapter one will address the current state of the research on the impact of physical abuse on children's physical, social and emotional beings. Understanding what we know about what abused children must cope with, chapter two will examine service provision under the current system known as the continuum of care. Finally, chapter three will introduce animal assisted therapy and illustrate the ways in which it can strengthen and support services that are already in place for children who are struggling with behavioral and emotional disorders that result from physical abuse. Before the argument for including animal assisted programs as a supplement to services currently provided can be made, this therapeutic approach deserves to be appropriately standardized and evaluated. Allocating more resources to research that will develop the breath and depth of knowledge in the field of animal assisted therapy is a necessary step in improving the quality of care. / Thesis (BA) — Boston College, 2004. / Submitted to: Boston College. College of Arts and Sciences. / Discipline: Education, Lynch School of. / Discipline: College Honors Program.