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.

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.

There is growing evidence to suggest an inverse association between physical activity and symptoms of posttraumatic stress disorder (PTSD). However, the mechanisms are not well understood and much of the research in this area stems from cross-sectional studies, thereby limiting what is known about these relationships at the intra-individual level. Chapter 1 of this dissertation is a systematic review examining the literature on the association between physical activity and PTSD in a variety of study designs (i.e., cross-sectional, longitudinal, and intervention). Chapters 2 and 3 used data from a 7-day diary study of 15 participants with a diagnosis of PTSD. In this study, participants completed twice daily surveys on mobile phones and wore Fitbit accelerometers measuring physical activity and sleep. Chapter 2 used multilevel modeling to examine the within-person and between-person associations between physical activity and symptoms of PTSD, sleep, positive and negative affect, and coping. Multiple operationalizations of physical activity were used (i.e., self-report and accelerometer-measured) in order to explore and better understand which metrics are most strongly related to psychosocial factors. Results from Chapter 2 add to the literature by providing evidence of within-person associations between physical activity and PTSD symptoms over the course of the day, such that on days when participants are more physically active than usual, they also report fewer symptoms of PTSD that evening. Chapter 3 discusses the utility of using N-of-1 study designs with an emphasis on the benefits of using frequent repeated measurements in clinical practice. Three case examples are presented to illustrate the intra-individual variability that is observed in symptoms of PTSD, affect, and health behaviours. These examples provide rationale for the use of intensive measurement designs in order to fully capture and understand how and when variables fluctuate over time. / Graduate

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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.

Posttraumatic Stress Disorder (PTSD) is a psychiatric condition that can develop following exposure to a traumatic event involving actual or threatened death or serious injury. Responses include intense fear, helplessness or horror. Symptoms are characterised into clusters, described as re-experiencing, avoidance, and arousal. These symptoms, which are also evident in other conditions, have been associated with dysfunctions in the central acetylcholinergic system. Benefits from administering acetylcholinesterase inhibitors (AChEI) to people suffering these symptoms have been demonstrated. Donepezil hydrochloride, a reversible inhibitor of the enzyme acetylcholinesterase, is used in the treatment of conditions with difficulties in cognitive function, but has not been used in PTSD. The aim of this thesis was to determine (1) whether there was a difference in the ACh system in people with PTSD and (2) whether administration of an AChEI would change the symtomatology. IDEX (I¹ ² ³ iododexetimide) has been useful in imaging muscarinic-ACh receptors using Single Photon Emission Computerised Tomography (SPECT) and was utilised to investigate whether cholinergic activity in PTSD is altered. One hundred and sixty eight potential subjects were screened and eleven PTSD subjects were enrolled in the IDEX SPECT study. Three healthy non-PTSD control subjects also completed the study. Due to technical complications only the data obtained from eight PTSD and two control subjects was available for analysis. Imaging data for 2 further healthy non-PTSD control subjects were obtained from another study. Sixteen subjects were enrolled in the donepezil open label study (assessed at baseline, Week 2, 6 and 10). Nine PTSD subjects completed the 10-week trial and seven withdrew prematurely (at or after Week 2) due to side effects or a worsening of PTSD symptoms. For the IDEX SPECT study, a voxel-by-voxel statistical analysis of the PTSD subject group versus the control group showed both areas of reduced and increased IDEX uptake. Significant clusters in the PTSD group with a reduced IDEX uptake centred around the bilateral hippocampus, left insula and right precuneus, while increased IDEX uptake appeared in the caudate head. For the donepezil study, in the per-protocol analysis (including only the 9 subjects that completed the protocol), all psychological assessments revealed a difference between the totals obtained at the Week 10 visit compared to those at the Baseline visit and the improvement was in the order of 51%. The intention-to-treat analysis (including all 16 subjects), a repeated measures Analysis of Variance (ANOVA) with a mixed models approach showed that all psychological measures demonstrated statistically significant benefits of the treatment. All subjects who completed the protocol recounted considerable improvement in their overall PTSD symptom profile, which covered symptoms in each of the three clusters. The results of the IDEX SPECT study suggest that alterations in ACh binding in PTSD are evident and may begin to explain a part of the altered cognitive symptomatology apparent in this condition. The pilot open label donepezil trial provided some preliminary evidence that treatment with an AChEI can lessen the intrusions and distress associated with traumatic memories in people with PTSD. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1374974 / Thesis (M.Med.Sc.) -- University of Adelaide, School of Medicine, 2009

Posttraumatic Stress Disorder (PTSD) is a psychiatric condition that can develop following exposure to a traumatic event involving actual or threatened death or serious injury. Responses include intense fear, helplessness or horror. Symptoms are characterised into clusters, described as re-experiencing, avoidance, and arousal. These symptoms, which are also evident in other conditions, have been associated with dysfunctions in the central acetylcholinergic system. Benefits from administering acetylcholinesterase inhibitors (AChEI) to people suffering these symptoms have been demonstrated. Donepezil hydrochloride, a reversible inhibitor of the enzyme acetylcholinesterase, is used in the treatment of conditions with difficulties in cognitive function, but has not been used in PTSD. The aim of this thesis was to determine (1) whether there was a difference in the ACh system in people with PTSD and (2) whether administration of an AChEI would change the symtomatology. IDEX (I¹ ² ³ iododexetimide) has been useful in imaging muscarinic-ACh receptors using Single Photon Emission Computerised Tomography (SPECT) and was utilised to investigate whether cholinergic activity in PTSD is altered. One hundred and sixty eight potential subjects were screened and eleven PTSD subjects were enrolled in the IDEX SPECT study. Three healthy non-PTSD control subjects also completed the study. Due to technical complications only the data obtained from eight PTSD and two control subjects was available for analysis. Imaging data for 2 further healthy non-PTSD control subjects were obtained from another study. Sixteen subjects were enrolled in the donepezil open label study (assessed at baseline, Week 2, 6 and 10). Nine PTSD subjects completed the 10-week trial and seven withdrew prematurely (at or after Week 2) due to side effects or a worsening of PTSD symptoms. For the IDEX SPECT study, a voxel-by-voxel statistical analysis of the PTSD subject group versus the control group showed both areas of reduced and increased IDEX uptake. Significant clusters in the PTSD group with a reduced IDEX uptake centred around the bilateral hippocampus, left insula and right precuneus, while increased IDEX uptake appeared in the caudate head. For the donepezil study, in the per-protocol analysis (including only the 9 subjects that completed the protocol), all psychological assessments revealed a difference between the totals obtained at the Week 10 visit compared to those at the Baseline visit and the improvement was in the order of 51%. The intention-to-treat analysis (including all 16 subjects), a repeated measures Analysis of Variance (ANOVA) with a mixed models approach showed that all psychological measures demonstrated statistically significant benefits of the treatment. All subjects who completed the protocol recounted considerable improvement in their overall PTSD symptom profile, which covered symptoms in each of the three clusters. The results of the IDEX SPECT study suggest that alterations in ACh binding in PTSD are evident and may begin to explain a part of the altered cognitive symptomatology apparent in this condition. The pilot open label donepezil trial provided some preliminary evidence that treatment with an AChEI can lessen the intrusions and distress associated with traumatic memories in people with PTSD. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1374974 / Thesis (M.Med.Sc.) -- University of Adelaide, School of Medicine, 2009

Background: Most of the neurocognitive research in Posttraumatic Stress Disorder (PTSD) thus far focused on impairment in learning and memory, neglecting the impact of PTSD on executive functioning processes. Therefore, this study specifically aims to investigate the impact of PTSD on frontal lobe executive functioning. Given the high prevalence rate for traumatic event exposure in South Africa, this study provides important findings on the role intact executive functioning plays in all areas of daily functioning, including the maintenance of good mental and physical health. Methods: Executive functions were assessed using an Executive Functioning Battery consisting of the three subtests of the Delis Kaplan Executive Functioning System (e.g., Trail Making Test, Colour-Word Interference Test, and Tower Test), as well as the Executive Functioning Index. The study sample consisted of 88 adult South African citizens who were divided into two groups (PTSD+; n = 44; PTSD–; n = 44) with different levels of trauma exposure. Results: PTSD was linked with impairment in executive functioning domains such as attention, cognitive flexibility, inhibition, working memory, and planning. Important gender differences were also reported in terms of empathy and organisation. In addition, education also appeared to affect frontal lobe executive functioning differently. Conclusions: The data suggest that overall, PTSD impaired executive functioning processes. It is therefore critical that assessment of executive functioning form part of a comprehensive treatment plan for individuals diagnosed with PTSD. / Mini Dissertation (MA)--University of Pretoria, 2019. / Psychology / MA / Unrestricted

Background: The literature suggests a consensus that individuals can become traumatised through listening to another’s trauma. Much of this research, however, has focused on individuals who have had direct, face-to-face contact with the primary victims of trauma. It therefore appears that there is a paucity of research looking at contact which is less direct, such as telephone contact. Aims: The current research aimed to explore the levels of secondary traumatic stress and posttraumatic stress disorder in a sample of Samaritan telephone volunteers, with a view to understanding some of the correlates of trauma. It also aimed to explore the personal construct systems of a sub-sample of Samaritan telephone volunteers, and explore any relationships between personal construct systems and trauma. Method: A cross-sectional design was employed. Questionnaires were used to assess levels of secondary traumatic stress and posttraumatic stress in Samaritan telephone volunteers spread across the United Kingdom. Repertory grid technique was used with a sub-sample of Samaritan telephone volunteers to elicit bipolar constructs comparing themselves and others. Results: 299 Samaritan telephone volunteers completed or partially completed the questionnaires, and of these 50 volunteers completed the repertory grids. Levels of secondary trauma (as determined by the Modified Secondary Trauma Scale) correlated with discrepancy in construing of the current and ideal self, levels of posttraumatic stress and exposure to potentially traumatic events. The Samaritans were not found to be suffering with secondary trauma. Degree of elaboration of self-construing reduced after the named traumatic event, and there was a significant difference in degree of elaboration for ‘self after traumatic event’ on the emergent poles of constructs. Conclusions: This research appears to be the first dedicated to assessing secondary trauma in telephone crisis line volunteers, lending some support to Sewell and Cromwell’s (1990) personal construct model of posttraumatic stress. The findings of this study challenge crisis lines to think about secondary trauma, and to implement some teaching and training around this area. Additionally, it reinforces that further research in the area is needed, and highlights the relative merits of employing a repertory grid methodology alongside questionnaires in understanding trauma.

No description available.