There is a lack of studies investigating PTSD in countries with a low human development index and also among refugee populations (Onyut et al., 2004; Stevens et al., 2013). The purpose of the present study was to investigate coping strategies used by Congolese refugees, a heavily traumatised population. Using a mixed-methods design, two studies were conducted on samples of Congolese refugees. Interviews (N=10) were conducted to study coping strategies. Thematic analysis generated five themes: 1) religion, 2) social coping, 3) problem-solving, 4) resignation, and 5) avoidance. Furthermore, differences in coping strategies between individuals with low (n=23) and high (n=24) PTSD symptom severity1 were examined statistically. The results showed that the low PTSD symptom severity group used significantly more adaptive coping strategies compared to the other group (p=.004). No difference was found in maladaptive coping strategies (p=ns). The results of both the qualitative and quantitative analyses suggest that religious meaning-making and social coping are important in this context.

The role of factors which influenced individual differences in post-trauma outcome were explored using a multi-method design, in response to recommendations in the literature that self-report data should be incorporated into studies of post-traumatic stress disorder (PTSD). In part 1, a psychophysiological study with process interviews was tested for feasibility and acceptability with a small-scale sample (n = 17) and found individual differences between how participants described responding to trauma-related picture stimuli. Five primary response types were identified: avoidance, acceptance, increased attendance, dismissal and confrontation. In part 2, resilient and recovered individuals (n = 11) were interviewed in depth about their experiences of coping with trauma and transcripts were analysed using an interpretative phenomenological approach. Themes identified were attitudes and beliefs, emotion regulation, narrative development, support and safety and recovery. Some resilient participants described initial use of avoidance as a coping strategy but moved from this position towards acceptance of their trauma in their recovery journey. Therefore avoidance may play a more helpful role than has previously been thought. The importance of specific attributes of factors positively associated with recovery from trauma and potential interactions between these factors was discussed.

Many who suffer with Post-Traumatic Stress Disorder (PTSD) fear the stigma associated with seeking treatment. Often the stigma even prevents sufferers from reaching out for support, resources, or education. The purpose of this project was to design an application (app) to bridge the gap between patient and provider by supplementing patient learning and teaching a yogic breathing technique to overcome an acute stress state. To accomplish this, an extensive literature review sought to determine the viability of pairing complimentary alternative methods (CAM) of treatment with application-based interventions. A specific aim also included evaluation of an app available on the market using industry standard tools, the Systems Usability Scale and HONcode measures, to determine areas for improvement. Applications can present a viable alternative to reaching patients who are unable or refuse to seek provider assistance. There are few apps to address mental health concerns; furthermore, patients may not use applications because they fear bias within the content or the lack of a quality product. Of the applications available on the market created by professional providers, there is a noted lack of aesthetics, user-friendliness, and reliability. To address aesthetics and user-friendliness, the new application is module based and incorporates basic web-application design principles. To address reliability, the new application answered all the objective criteria in the HONcode and scored higher on the subjective Systems Usability Scale than a leading app on the market, as evaluated by the project lead. This application presents an opportunity to determine the success of pairing patient education and CAM with technology. While it is beyond the scope of this project, the new application is ready for a pilot testing to obtain feedback on the content, structure, and usability, before launching on GoogleApps™ for open access.

To qualify for a diagnosis of posttraumatic stress disorder the DSM-IV requires that individuals report dominant emotions of fear, helplessness, and horror during the trauma. Despite this stipulation, traumatic events can elicit a myriad of emotions other than fear such as anger, guilt or shame, sadness, and numbing. The present study examined which emotional reactions to a stressful event in a college student sample are associated with the highest levels of PTSD symptoms. Results suggest mixed support for the DSM-IV criteria. Although participants who experienced a dominant emotion of fear reported high PTSD symptomatology, participants who experienced anger, disgust-related emotions, and sadness reported PTSD symptoms of equivalent severity. Participants also reported experiencing other emotions more frequently than they reported experiencing fear. Coping style was unrelated to dominant emotion experienced; however, dysfunctional coping was associated with worse outcomes in terms of PTSD symptoms. These results have diagnostic and treatment limitations.

The purpose of this study was to determine the effect of high intensity interval training (HIIT) on post traumatic stress disorder (PTSD) and to compare the results of HIIT to a short, deep breathing session (BRTH) that is commonly used to manage PTSD symptoms. Previous research has demonstrated a positive effect of exercise on PTSD and related mental health concerns. Seven volunteers (six females and one male) participated in this study. All participants completed two groups of sessions, one comprised of three HIIT sessions and one of three BRTH sessions. Each group of sessions took place over approximately ten days, with a 4-week washout period between the two protocols. The HIIT sessions each involved eight sets of a work rest ratio of 20-second exercise to 10-second rest, with a 60-second break between the fourth and the fifth set for a total of 5 minutes. The BRTH sessions involved the use of an established 5-minute deep breathing PTSD therapy protocol. PTSD symptoms were measured using the PTSD Checklist (PCL). PCL measures were taken before (pre-test) and after (post-test) the intervention. Within the HIIT intervention, mean post-test Total PCL scores were significantly reduced compared to pre-test scores (p < 0.005), while BRTH scores did not significantly change. Two subscales in the PCL, Intrusion and Avoidance were also significantly reduced (p < 0.0005) following HIIT but not BRTH. All other subscales scores were lower following both HIIT and BRTH, though were not statistically significant different from pre-test values. No statistical between-intervention differences were detected. The preliminary results from this research provide evidence that acute use of HIIT exercise provides similar or better positive effects on PTSD symptoms as BRTH and that HIIT exercise can be used as a symptom management tool for PTSD. / Graduate

Revisión por pares / El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / OBJECTIVE: To examine the construct validity of the 9 item Traumatic Events Questionnaire (TEQ) and to evaluate the extent to which experiences of trauma assessed using the TEQ are associated with symptoms of psychiatric disorders among 3342 pregnant women in Lima, Peru. METHODS: Symptoms of depression were assessed using the Patient Health Questionnaire-9 (PHQ-9) and Edinburgh Postnatal Depression Scale (EPDS) while the PTSD Checklist-civilian (PCL-C) and Generalized Anxiety Disorder-7 (GAD-7) were used to assess symptoms of PTSD and generalized anxiety. Hierarchical logistic regression procedures were used to evaluate relations between TEQ and symptoms of psychiatric disorders. RESULTS: The majority of participants (87.8%) experienced at least one traumatic event (mean = 2.5 events). The trauma occurrence score was moderately correlated with symptoms of PTSD (PCL-C: rho = 0.38, P-value < 0.0001), depression (EPDS: rho = 0.31, P-value < 0.0001; PHQ-9: rho = 0.20, P-value < 0.0001), and GAD (GAD-7: rho = 0.29, P-value < 0.0001). Stronger correlations were observed between the trauma intensity score with symptoms of psychiatric disorders (PCL-C: rho = 0.49, P-value < 0.0001; EPDS: rho = 0.36, P-value < 0.0001; PHQ-9: rho = 0.31, P-value < 0.0001; GAD-7: rho = 0.39, P-value < 0.0001). CONCLUSION: Given the high burden of trauma experiences and the enduring adverse consequences on maternal and child health, there is an urgent need for integrating evidence-based trauma informed care programs in obstetrical practices serving Peruvian patients. / Revisión por pares

Malingered posttraumatic stress disorder (PTSD) poses a formidable clinical challenge in personal injury and disability cases because of the apparent ease in feigning PTSD and the supposed link (proximate cause) to the claimed damages. The effective assessment of feigned PTSD is particularly challenging because this diagnosis is both easier to fake than other Axis I disorders and more difficult to detect. As an additional confound, some patients with genuine PTSD produce highly variable, elevated profiles on multiscale inventories that are difficult to distinguish from feigned PTSD. The current study examined whether the Personality Assessment Inventory (PAI) can effectively differentiate between genuine and feigned PTSD in 109 inpatients from a trauma unit. The two most effective scales were the MAL and the NDS scales. As a primary focus, the current study was the first empirical investigation of Resnick's model of malingered PTSD that is comprised of three subtypes: pure malingering (pure-M), partial malingering (partial-M), and false imputation (false-I). The primary goal was to evaluate whether each feigning group was able to (a) effectively simulate PTSD symptoms and diagnoses and (b) avoid being classified as feigning. The partial-M group proved to be the best feigning group in achieving these two goals. Furthermore, the use of well-defined groups, including an indeterminate band (i.e., unclassified) around each cut score, was explored. Overall, the use of well-defined groups improved accuracy in classification and reduced the number of false-positives.

The present study examined men and women veterans diagnosed with posttraumatic stress disorder (PTSD) and substance use disorder (SUD). Women in the general public have been found to be at greater risk for a diagnosis of PTSD with life-long symptoms. Current literature involving military men and women veterans is at odds over which gender is more likely to have both PTSD and SUD. This study assessed the variables of gender and diagnosis. It also studied whether the age of female veterans affects their likelihood of having both PTSD and SUD. Archival data were gathered from the Veterans Administration (VA) for veterans seeking care at the VA during Fiscal Years 2011 and 2012. These data were stored on the VA Information Resource Center database; data came from VA medical diagnoses using the International Classifications of Diseases -9 (ICD-9). Participants were 38,656 women veterans and 785,052 male veterans. A chi-square test for goodness of fit revealed that male veterans were more likely than were female veterans to have the comorbid diagnosis of PTSD and SUD. This analysis revealed that women veterans in the 45 - 54 age groups were at greatest risk for the comorbid diagnosis. Women may not seek treatment at the VA because they lack childcare, it is dominated by mainly male veterans, and/or they may have a misconception of services for women. Part of social justice is including women veterans because they have historically been underserved by mental health and research. This study highlights the need for more research into improving health and mental healthcare for women at VA facilities.

The wars in Afghanistan (OEF) and Iraq (OIF) represent the most sustained American combat operations since the Vietnam War. A wealth of research has shown the frequency and intensity of exposure to combat experiences is positively correlated with risk for chronic PTSD and associated impairments in veterans, a “dose-response” continuum (Fischer, 2014; Hoge, Messer, McGurk, & Koffman, 2004; Maguen et al., 2015; Philips et al., 2017; Pitman, 2006; Ricks, 2004; Rona et al., 2014). Reported prevalence rates for symptoms of PTSD in OEF and OIF veterans vary, but researchers suggest 14% of treatment-seeking veterans and up to 21% of OEF and OIF veterans meet criteria for PTSD (Angkaw et al., 2013). The Department of Veteran Affairs (VA), the Department of Defense (DoD), community agencies, and private mental health providers strive to help veterans reintegrate into civilian life. Efforts have been made to reduce barriers to treatment by developing interventions more appealing to veterans. One such modality gaining traction and support is therapeutic riding (TR). TR teaches veterans about horsemanship, how to ride, and serves as a tool for connection, as well as, physical and emotional healing (Notgrass & Pettinelli, 2015). This study was designed to answer the following research question: How do OEF and OIF veterans diagnosed with symptoms of PTSD experience the use of TR as a tool for their recovery? The post-intentional phenomenology, was utilized to ascertain how four veterans participating in TR were changed by the experience. Intentionality promoted an understanding of TR through its emphasis on the connections made during their participation. Data was gathered using a whole-part-whole investigative approach, whereby, themes were explored separately then brought together as a whole (Vagle, 2014). The research question and sub-questions facilitated further understanding of TR and its utilization by OEF and OIF veterans in the domains of perceived personal change, social connection, mental and emotional wellbeing, and environment. There were eleven tentative manifestations of change and five influencing factors which emerged through data discovery. Constructs were illuminated and further explored. The exploratory research implications seemed to support previous findings, suggesting TR had positive effects on PTSD symptom recovery for OEF and OIF veterans.

Accuracy in applying diagnostic concepts is one of the most important aspects of any mental health professional’s work. Inaccuracy in diagnosing, or misdiagnosing, can lead to numerous problems including inappropriate and potentially harmful treatment, inaccurate prognosis, stigma, and wasted or misutilized resources. For mental health professionals, inaccuracy in diagnosing can happen both intentionally and unintentionally. The severity of a person’s symptoms or the level of functional impairment the person is experiencing are two factors which can easily confound diagnostic accuracy. The present study sought to determine how each of these factors contribute to diagnostic accuracy independently and in conjunction with one another. Participants were invited the complete the current study online and were presented with two vignettes representing varying levels of symptom severity and functional impairment severity. We asked participants to rate the severity of each (symptoms and impairment), to provide diagnostic opinions, and to provide treatment recommendations. We found that in rating the severity of symptoms or impairment, and in providing diagnoses, the presence of one (symptoms or impairment) tended to overshadow the absence of the other. However, severity ratings of either symptom or impairment severity were predictive of rates in diagnosing and recommending treatment. Additionally, we found that regardless of the presence of a diagnosis, most participants believe that the person represented in the vignette would benefit from treatment. Based on these findings, it seems when conceptualizing case vignettes, professionals may be viewing symptoms and functional impairment as more interchangeable than as different components of a diagnosis.