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Posttraumatic stress disorder (PTSD) is complex and no one theory can fully explain the development and maintenance of PTSD symptoms. In Scotland, where trauma focused care initiatives are being considered, little is known about the extent of trauma history and associated symptoms presenting in primary care services. Furthermore, subthreshold posttraumatic stress disorder (sPTSD) has recently been associated with clinically significant impairment. With PTSD symptoms often comorbid with other psychopathology such as depression, individuals potentially seek treatment for these symptoms rather than underlying trauma which therefore may go unrecognised. Studies on the effectiveness of psychological treatment for PTSD demonstrate reasonable efficacy for well developed interventions. However, up to half of individuals may not make significant clinical improvements and withdrawal rates are high. This suggests that current treatments are not acceptable to some individuals and may be ineffective for others. In light of such clinical challenges the aim of the thesis was to investigate the incidence and nature of trauma symptoms in an Adult Psychological Therapies Service. Firstly, a systematic review was conducted to appraise the current level of evidence for prevalence and impairment associated with sPTSD. Secondly, an empirical study was undertaken to review the prevalence of trauma history and symptoms in the service. This was followed by an investigation of the relationships between processes posited to underpin many forms psychological distress by a promising new treatment approach called Acceptance and Commitment Therapy (ACT). These include; cognitive fusion, experiential avoidance and valued action. A quantitative cross sectional design collecting self report questionnaire data was used and mixed statistical methodology employed. Results from the systematic review suggest that PTSD was associated with the most impairment, followed by sPTSD, then no PTSD. Subthreshold PTSD was reported to be as, or more prevalent than, PTSD. The results from the empirical study found 89 per cent reported exposure to one or more traumatic events, 51 per cent met PTSD screening criteria, whilst a further 7 per cent reached a sPTSD diagnostic cut-off. Trauma history was positively correlated with increased psychological distress at initial assessment. Cognitive fusion, experiential avoidance and valued action were all correlated with trauma symptom severity. Both cognitive fusion and experiential avoidance mediated the relationship between number of traumatic events and trauma symptom severity in a simple mediation model. However, multiple mediation analysis demonstrated that experiential avoidance, over and above cognitive fusion, explained 33 per cent of the variance. In addition, cognitive fusion and experiential avoidance jointly had a significant indirect effect on the relationship between trauma history and valued action. The implications of the findings and further directions are discussed.

Adherence to treatment recommendations following medical care for pediatric conditions is critically important for promoting optimal physical and psychological well-being. While it has been a focus of many studies across pediatric chronic illness populations, there is a dearth of research examining adherence following pediatric unintentional injury. Empirical evidence from studies with pediatric chronic illness samples indicates that youth experience a number of barriers to adherence to medical recommendations. Adherence is especially difficult for adolescents due to the unique challenges of this developmental period. A mixed methods research approach was utilized to gain a holistic understanding of potential psychological barriers to adherence following adolescent injury. Quantitative analyses examined the potential predictive roles of adolescent psychological [i.e., posttraumatic stress (PTSD), depression, quality of life] and relational (i.e., parent PTSD and depression) factors on adherence. Results of analyses were insignificant; thus, qualitative data was collected to deepen the understanding of barriers to adherence. Findings from qualitative data analyses suggested that a number of barriers to adherence to treatment recommendations exist, including: concern of pain medication addiction, competing activities, treatment side effects, health status, desire for autonomy, and symptoms of depression. Results of qualitative analyses also revealed the presence of additional factors that could facilitate adherence to treatment recommendations. Taking into consideration findings from both quantitative and qualitative analyses, adherence may be best conceptualized as a result of a dynamic decision-making process influenced by numerous interacting factors. This study is the first to examine barriers to adherence among adolescents following unintentional injury and provides an initial roadmap for understanding the mechanisms involved in this complex process. / Ph. D.

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Thesis advisor: Paul Kline / This three paper dissertation considers whether yoga--a popular mind-body practice combining physical postures and movement, mindfulness, and breath exercises--may be a useful component of treatment for adult trauma survivors. The first paper involves a systematic review and meta-analyses of the current evidence base for yoga in the treatment of anxiety, depression, and PTSD among trauma survivors. The second and third papers are grounded in a single, mixed-methods multi-wave data source aimed at examining yoga's contribution to recovery for adult women who have complex trauma histories (i.e., sustained and/or multiple traumatic experiences such as recurring physical or sexual abuse). The second paper is a quantitative study employing hierarchical linear and logistic regression to examine associations between yoga practice and reductions in traumatic symptomology over time. The third paper is a hermeneutic phenomenological study exploring how women with complex trauma histories experience practicing yoga and its potential role in their coping and healing processes over time. Taken together, these three papers offer insights into the complex healing needs of adult survivors suffering from the effects of traumatization, and the promising role of yoga within their recovery processes. / Thesis (PhD) — Boston College, 2014. / Submitted to: Boston College. Graduate School of Social Work. / Discipline: Social Work.

Posttraumatic stress disorder (PTSD) is a common psychiatric disorder and is associated with impairment in multiple domains. Research on the development of PTSD symptoms is often limited by the use of cross-sectional designs and retrospective reports of pre-trauma factors. The trauma film paradigm allows for the measurement of pre-trauma factors to determine which variables serve as prospective predictors of posttraumatic stress symptom development. Two factors which may predict posttraumatic stress symptom development are distress intolerance and attentional control. Research suggests distress intolerance is related to posttraumatic stress symptoms, but this relationship has only been shown cross-sectionally. Research has further shown attention control prospectively predicts posttraumatic stress symptoms. Cross-sectional research also suggests attentional control moderates the relationship between distress intolerance and posttraumatic stress symptoms. The current study used the trauma film paradigm to investigate whether attentional control moderates the relationship between distress intolerance and posttraumatic stress symptoms. The current study findings were mixed, but suggest that attentional control does not moderate the association between distress intolerance and posttraumatic stress symptoms. These results suggest distress intolerance and attentional control may not be important variables in the development of posttraumatic stress symptoms.

The goal of this dissertation is to investigate the factors that increase risk for posttraumatic stress disorder (PTSD) in Latinos. Although the overall rates of psychiatric disorders in the Latino community are similar to Caucasian Americans, the risk for PTSD among Latinos is higher. This thesis discusses the general components of trauma and stress, as well as the prevalence of PTSD in various Latino subgroups. This thesis also covers a number of cultural-specific values, stressors, and help-seeking attitudes that increase the risk of PTSD among Latinos. Moreover, a culturally-responsive intervention program treating PTSD among Latinas who are victims of intimate partner violence (IPV) is proposed.

The current report reviews the recent literature on the relationship between Posttraumatic Stress Disorder (PTSD), sexual assault, and the resulting psychological impact on college women. This document is an overview of PTSD and sexual assault as defined in recent literature, and then reviews the significant impact both factors have on the college woman and her surrounding environment. Intervention and prevention strategies for the negative consequences of sexual assault and PTSD are included. Finally, this report provides suggestions for counselors on appropriate treatment and intervention plans for a college campus. / text

Thesis (Ph. D.)--Drexel University, 2007. / Includes abstract and vita. Includes bibliographical references (leaves 72-81).