Combat-related posttraumatic stress disorder (PTSD) is a psychological condition researchers have cited as a major cause of marital discord and divorce for veterans with PTSD. This study examined the psychological construct of locus of control among the wives of veterans diagnosed with combat-related PTSD and whether or not it was a predictor of marital satisfaction within this context. An extensive search of the current literature revealed no previous studies that had investigated this relationship. Utilizing the family systems theory to address this gap, this study sought to compare reported marital satisfaction in wives with an internal locus of control to those with an external locus of control. Participants for this study were 111 wives of veterans with combat-related PTSD, each of whom completed a demographic questionnaire, the Kansas Marital Satisfaction Survey, and the Duttweiler Internal Control Index. A multiple linear regression was conducted to determine if age, number of years married, number of children, level of education, household income, and internal locus of control were predictors of marital satisfaction reported by wives of veterans with combat-related PTSD. The results indicated that an internal locus of control accounted for a significant degree of the variance in marital satisfaction while the demographic variables were not significant predictors. This study contributes to social change by providing an empirical insight into the relationship between locus of control and marital satisfaction in wives of veterans with PTSD. The results of this study could help improve the quality of life of veterans with PTSD by enhancing awareness of locus of control to practitioners while developing a therapeutic treatment plan that will fit the veteran's locus of control orientation.

Trauma exposure among youth in the United States is a common event. Although the number of individuals who meet criteria for a diagnosis of posttraumatic stress disorder (PTSD) is only a small percentage of those exposed to trauma, many individuals who do not meet full criteria for PTSD continue to experience problematic posttraumatic stress symptomology. Acceptance and commitment therapy (ACT) is an empiricallybased psychological intervention that has shown effectiveness in the treatment of a number of concerns among both adults and adolescents. ACT has shown preliminary effectiveness in the treatment of adult PTSD, but its effectiveness in treating adolescent posttraumatic stress is currently unknown. Using a multiple-baseline design, the present study investigated the effectiveness of a 10-week ACT protocol to treat adolescents experiencing posttraumatic stress. Seven individuals between the ages of 12 and 17 participated in the treatment, four of who were from a community sample and three who were in residential care to treat comorbid eating disorders. Structured interviews were completed at pretreatment and individuals reported baseline data for anywhere from 7 to 66 days before engaging in treatment. Symptom and process measures were completed at each session. Postassessment was completed one week following the final session. Results revealed a decrease in posttraumatic stress symptomology across both samples, with a 73.7% mean reduction in self-reported posttraumatic stress symptomology and a mean reduction of 58.8% on clinician-rated measures of PTSD. Overall results provide preliminary support for ACT as an effective treatment for adolescent posttraumatic stress. Empirical and clinical implications of results as well as limitations and future directions are discussed.

Previous studies evaluating the impact of trauma history and PTSD on pain sensitivity yield inconsistent findings; the presence of trauma-related negative affective states may account for these discrepancies. Therefore, the proposed study aimed to evaluate the effect of trauma-related negative affect and PTSD symptoms on sensory and affective components of pain sensitivity among trauma-exposed women. Adult women (N = 87) with low and high PTSD symptoms underwent an emotional disclosure paradigm, during which they wrote about a traumatic event or a neutral topic. Participants then completed a pain induction procedure. Compared to women with low PTSD symptoms, women with high PTSD symptoms demonstrated increased time to pain detection (e.g., threshold) and ability to withstand pain (e.g., tolerance), as well as increased pain intensity and when accounting for relevant covariates. Women with high PTSD symptoms who wrote about their worst traumatic experience reported higher pain unpleasantness relative to women with high PTSD symptoms who wrote about the neutral topic and women with low PTSD symptoms who wrote about either topic. Results suggest that PTSD symptoms and trauma-related negative affect may facilitate alterations in pain sensitivity in trauma-exposed women, but this relationship is complex and requires further exploration.

Children account for approximately 34% of the burn-injured population in the United States and are particularly at risk for developing posttraumatic stress disorder (PTSD) or other significant psychopathology (i.e., behavioral and attentional difficulties, acute stress, depression, anxiety, phobias, dissociative symptoms, and enuresis). There is a significant risk that quality of life (QOL) can have a negative impact on children who have sustained a burn injury, particularly within the domain of social functioning. Specifically, children who meet the criteria for PTSD following a burn injury are at an increased risk of experiencing impairment in overall QOL. However, there remains significant evidence that a substantial portion of children exhibit satisfactory QOL outcomes following a burn injury at a level comparable to their noninjured peers. This positive outcome may be attributed to the child's level of resiliency--the protective factors that positively influence their ability to adjust and move forward following a traumatic event. Research on risk and resiliency of posttraumatic stress symptoms (PTSS) in pediatric burn survivors is limited. For psychological assessment and burn treatment to be successful, it is important to understand the resilient qualities that are present in children who experience positive post-burn-injury outcomes. By focusing on a child's mental health strengths and by building his or her resilience, a health professional may prevent or lessen the child's adjustment difficulty or psychopathological symptoms. Thus, the primary purpose of this study was to identify the relation between pediatric burn injury, demographic variables, resilience and QOL outcome with regard to PTSS. Demographic information (e.g, gender, age, household income, and diagnoses) and burn injury characteristics (e.g., age at time of burn, total body surface area injured, number or days spent in the hospital, and number of surgeries) were considered with regard to PTSS, resiliency, and QOL outcome. Further analysis efforts compared results from the Resiliency Scales for Children and Adolescents (RSCA) with scores obtained from the University of California at Los Angeles Posttraumatic Stress Reaction Index for Diagnostic and Statistical Manual--Fourth Edition (UCLA PTSD Reaction Index for DSM-IV; Reaction Index). Identical analyses were performed regarding the RSCA and the Pediatric Quality of Life Inventory, Version 4.0 (PedsQL 4.0). Analyses indicated a significant relation between PTSS severity and resilience, with positive resilience outcomes correlated to lower levels of PTSS severity. Further, a significant relation was found between QOL and PTSS, with positive QOL functioning related to lower levels of PTSS. Finally, a significant relation was found between resilience and QOL: Participants who endorse higher levels of resilience demonstrate better QOL outcomes. Overall, demographic information and burn injury characteristics did not significantly affect results regarding PTSS severity. Clinical implications and future areas of research are discussed.

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.

Despite high rates of alcohol and marijuana use and dating violence among individuals between the ages of 15 and 24, limited research has examined a link between substance use and dating violence within adolescent samples. Moreover, although both problem drinking and dating violence perpetration have been linked to a history of childhood maltreatment (CM), few studies have examined the potential mechanisms of a relationship between these variables. The current study tested the predictive role of CM in adolescent alcohol and cannabis use and dating violence perpetration in a sample of youth with CM histories; in particular, we were interested in predicting the temporal co-occurrence of these behaviours. It was hypothesized that trauma symptomatology would play a mediating role in this relationship. Results demonstrated that only witnessing emotional domestic violence predicted the co-occurrence of substance use and dating violence; in general, trauma symptomatology was not found to be a significant mediator.

Traditionally, it was believed that young children did not experience long-term negative effects resulting from a traumatic experience. Many professionals continue to assume that the effects of trauma on infants (0-3 years) are transient and that intervention is unnecessary. However, research has shown that infants and young children can develop posttraumatic stress disorder (PTSD; Scheeringa, Peebles, Cook, & Zeanah, 2001). Symptoms consistent with older children and adults (i.e., re-experiencing, avoidance/emotional numbing, and hyperarousal) have been found with infants and young children exposed to trauma. The purpose of this dissertation was to better understand the nature of trauma in early childhood using a multidimensional approach. Three studies were conducted to determine the effects of trauma and PTSD on young children. Study 1 considered the effectiveness of using the Child Behaviour Checklist (CBCL), a popular measure of childrens adjustment, to screen for PTSD symptoms in a sample of young children. Results suggested that the PTSD subscale of the CBCL correctly identified 71% of children with PTSD. Study 2 examined the role that potentially traumatic events, as well as family and child characteristics, play in the development of symptoms of PTSD by surveying a community sample. Results suggested that certain events were more likely to be associated with symptoms of PTSD and that children with younger mothers and higher rates of internalizing problems were more likely to experience symptoms of PTSD. Study 3 explored the effects of trauma on young childrens emotional, physiological and relational functioning, and was conducted in two phases: Phase I considered PTSD symptom expression, physiological stress-response (i.e., salivary cortisol) and quality of attachment in children recruited from a community sample; and Phase II considered PTSD symptoms, quality of attachment and maternal psychological distress in the development of PTSD in a clinical sample of young children. Results found that in Phase I PTSD symptoms were not associated with either cortisol level or quality of attachment, although effect sizes were moderate. Phase II results found a direct and significant association between quality of attachment and PTSD symptoms. A non-significant but moderate effect size was found for the link between maternal psychological distress and PTSD symptoms. Findings are discussed with regards to their implications for future research and clinical practice.

The aims of this thesis were to estimate the lifetime prevalence of physical, sexual, and psychological abuse in a random population-based sample of women aged 18-60 years; to estimate current suffering thereof; and to investigate associations between abuse and health problems, more specifically to study abuse related variables associated with somatization and PTSD, respectively. The studies had a cross-sectional design. Studies I and II comprised 4150 women 18-60 years. Study III included 547 women, and study IV consisted of 213 women, randomly selected from the population-based sample of the first two studies. The first study found lifetime prevalence rates of 19.4% for physical abuse, 9.2% for sexual abuse, and 18.2% for psychological abuse. Abused women reported more ill-health and a less advantageous social situation than non-abused women. There was an association between magnitude of abuse and health problems. Even a low magnitude of abuse was substantially associated with ill-health. In the second study we found that of the 27.5% of women who had reported any kind of abuse in the first study, 69.5 % reported current suffering thereof. Abused suffering women reported more health problems than abused non-suffering women and non-abused women, and abused non-suffering women reported more health problems than non-abused women. In study three, psychological abuse and sexual abuse without penetration were found to be associated with somatization. Physical abuse and sexual abuse with penetration were not associated with somatization, when adjustments for other kinds of abuse were made. In study four, PTSD and somatization were found to be separately reported phenomena in abused women, although PTSD was positively associated with having somatic symptoms. Women with PTSD reported higher total magnitude of abuse and a higher number of perpetrators than women with somatization. Sexually abused women with PTSD more often described their experience as an act of abuse compared with sexually abused women with somatization. The present thesis demonstrates that even a low magnitude of abuse is associated with health problems. It also shows that a majority of the abused women, when investigating lifetime history of abuse, reported current suffering thereof, which warrants considering abuse an important societal problem. The relationship between somatization and posttraumatic stress in abused women is discussed in relation to abuse variables. Other factors than severity of abuse, such as whether the abused woman herself perceives her experience as abuse, seem to be more decisive for development of somatization in abused women. The findings suggest that PTSD is not a necessary mediator between abuse and somatization.

This study examined the role of filial responsibility as a mediator between parental depression and posttraumatic stress symptomatology (PTSS) in Bosnian youths. The sample consisted of 145 6PthP-8PthP grade boys and girls and their parents. Unfairness and caregiving scales were combined in an interaction term to test the hypothesis. Parental depression significantly predicted parental report of adolescent PTSS but the filial responsibility variables did not significantly mediate the relationship between parental depression and PTSS. A post-hoc analysis examined the role of filial responsibility mediating the relationship between parental education level and PTSS. The interaction terms did not significantly mediate the relationship but the unfairness variable significantly mediated the relationship between parental education level and adolescent report of PTSS.