This study served as a preliminary investigation of the effectiveness of an understudied complementary (to traditional treatment approaches) intervention for military related PTSD. Specifically, the utilization of a nonprofit organization’s intensive three-week training program and use of psychiatric service dogs (PSDs) for PTSD and associated symptom amelioration. The sample included two separate cohorts of military veterans (n = 7 and n = 5) with prior diagnoses of PTSD. Participants completed a battery of self-report measures assessing PTSD and related symptoms, depression, perception of social support, anger, and overall quality of life. Participants also completed an attention bias task that was utilized to objectively assess changes in attentional bias to threat. Participants completed the measures one month prior to the training (baseline), at arrival to the training site, at the end of each week of the training, and at one and six month follow-up. Results indicated that, for all participants, there was a statistically significant decrease in PTSD and depression symptoms. In addition, for most participants, these decreases were both clinically significant and reliable. Further, participants reported significant reductions in anger and improvement in perceived social support and quality of life. Data from the attentional bias task was inconclusive. Limitations of the study include a lack of control group and small sample size. Despite this, the findings of this study indicate that utilizing PSDs as a complementary treatment for PTSD could yield beneficial results in terms of symptom amelioration and improvement to overall quality of life for veterans suffering from PTSD.

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.

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / Women have a higher prevalence of post-traumatic stress disorder (PTSD) than men, with a peak during the reproductive years. PTSD during pregnancy adversely impacts maternal and infant health outcomes. The objectives of this study were to estimate the prevalence of antepartum PTSD symptoms in a population of pregnant Peruvian women and to examine the impact of number of traumatic events and type of trauma experienced. The Traumatic Events Questionnaire was used to collect data about traumatic exposures. The Post-traumatic Stress Disorder Checklist-Civilian Version (PCL-C) was used to assess PTSD. Multivariable logistic regression procedures were used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (95% CI). Three thousand three hundred seventy-two pregnant women were interviewed. Of the 2920 who reported experiencing one or more traumatic events, 41.8% met criteria for PTSD (PCL-C score ≥ 26). A quarter of participants had experienced four or more traumas, and 60.5% of those women had PTSD. Interpersonal trauma was most strongly associated with PTSD (aOR, 3.20; 95% CI, 2.74-3.74), followed by unspeakable trauma (aOR, 2.87; 95% CI, 2.35-3.50), and structural trauma (aOR, 1.39; 95% CI, 1.15-1.67). These findings indicate the high prevalence of PTSD during pregnancy in the Peruvian population, which is relevant to other countries suffering from terrorism, war, or high rates of violence. This underscores the importance of screening for PTSD in pregnancy. / Revisión por pares

Diese Arbeit ist Teil einer prospektiv geplanten, nicht interventionellen Querschnittsstudie, in welcher psychische Belastungen nach allogener Stammzelltransplantation untersucht wurden. Hierfür wurden von Juli bis August 2011 Daten von 50 Patienten der KMT Ambulanz der Universitätsklinik Würzburg erhoben. Die Studienteilnehmer wurden hinsichtlich Angst, Depression und Posttraumatischer Belastungsstörung (PTBS) nach allogener Stammzelltransplantation befragt. Diese Dissertation beschäftigte sich ausschließlich mit der Entwicklung einer PTBS nach allogener Transplantation. Zur Datenerhebung wurde die Posttraumatic Checklist Civilian Version (PCL-C) als etablierter und standardisierter Fragebogen verwendet. Neun Patienten gaben den Fragebogen nicht bzw. unvollständig ab, wodurch sich eine endgültige Studienteilnehmerzahl von n=41 ergab. Das mittlere Alter betrug 53,4 Jahre (21-74 Jahre), 68% waren männlich und 85% waren verheiratet. 22 Personen (54%) litten an myeloischen Tumoren, 19 (46%) litten an lymphatischen Tumoren. Die Mehrheit der Patienten erhielt periphere Blutstammzellen eines mit ihnen nicht verwandten Spenders (51%). Zum Zeitpunkt der Datenerhebung lag die Transplantation im Schnitt 21,9 Monate zurück. Von den 41 untersuchten Patienten litten laut PCL-C sechs Personen (14,6%) nach der Cut off Methode und fünf Personen (12,2%) nach der Cluster Methode an einer PTBS. Von einer partiellen PTBS waren zwei Patienten (4,9%) betroffen. Das am häufigsten angegebene PTBS-Symptom war das Erleben von Intrusionen (41,5%). Weder soziodemographische (Alter, Geschlecht, Familienstand) noch somatische Variablen (CMV Reaktivierung, akute oder chronische GvHD) zeigten eine signifikante Korrelation mit dem Auftreten einer PTBS. Ebenso konnte kein Zusammenhang zwischen der Zeit nach Transplantation und einer möglichen psychischen Regeneration festgestellt werden. Von den sechs PTBS Patienten, die mittels PCL-C ermittelt werden konnten, wurden zwei gar nicht, drei mit Psychopharmaka und nur einer mit Psychopharmaka und Psychotherapie behandelt. Somit sind die Ergebnisse als Momentaufnahme zu verstehen, die einen Bedarf für eine optimierte Versorgung reflektiert. Dies unterstreicht auch die Notwendigkeit der Durchführung weiterer, analytischer und gegebenenfalls auch interventioneller Studien in diesem Bereich, um einer PTBS vorzubeugen oder diese frühzeitig zu erkennen und entsprechend adäquat zu behandeln. / Patients undergoing allogeneic stem cell transplantation face both physical and psychological distress. The aim of this cross-sectional pilot study was to measure the appearance of posttraumatic stress disorder (PTSD) after allogeneic stem cell transplantation. Fifty patients having undergone allogeneic stem cell transplantation were screened while attending the outpatient clinic of the Department of Medicine II at Wuerzburg University Hospital in Germany from July till August 2011. Forty-one patients completed the self- administered, validated questionnaire Posttraumatic Checklist Civilian Version (PCL-C). The average age was 53.4 years, 68% were male and 85% were married. Twenty-two patients (54%) suffered from myeloid and 19 (46 %) from lymphatic malignancies. The majority of the patients received peripheral blood stem cells from an unrelated donor (51%). At the time of data collection, the transplantation was about 21.9 months ago. PCL-C results were interpreted by using two different methods. Using the cut off method revealed 6 patients (14.6 %) to suffer from PTSD. Applying the cluster method 5 patients (12.2 %) fulfilled the criteria of PTSD. Two patients (4.9 %) did not meet all criteria of PTSD but suffered from the subclinical form of PTSD. Intrusion was the symptom which was addressed the most (41.5 %). There were no links between PTSD and sociodemographic (age, gender, marital status) or somatic variables (CMV reactivation, acute or chronic GvHD). Furthermore, no associations with time after transplantation or psychological regeneration could be identified. Out of the 6 patients identified to suffer from PTSD two did not receive any treatment at all, three got psychiatric medication and one person was treated by both medication and psychotherapy. The results of this study underline that a considerable number of patients suffer from PTSD after allogeneic stem cell transplantation but only a minority are diagnosed or treated sufficiently. Further studies are needed to prevent, diagnose and treat PTSD more adequately.

Suicide is a significant public health concern in the U.S., with over 40,000 suicides reported in 2014. For veterans, risk for suicide is even greater; for instance, of the over 40,000 suicides in 2014, 18% were comprised of veterans, although veterans account for only 8% of the U.S. population. Heightened suicide risk in veterans may be due to increased exposure to trauma (e.g., military sexual trauma, combat) and its negative cognitive-emotional sequelae (i.e., shame, guilt, PTSD). However, not all veterans who experience these negative symptoms manifest suicide risk, potentially due to the presence of protective factors. One such factor, self-compassion, involves responding to oneself in a caring and helpful manner in times of distress and may buffer against suicide risk by allowing the individual to look past global negative self-evaluations (i.e., shame), breaking the ruminative cycle over past actions (i.e., guilt), and helping to alleviate PTSD symptoms. This premise, however, has not been tested. We hypothesized that shame/guilt and PTSD symptoms (in two separate models) would mediate the relation between self-compassion and suicide risk, such that higher levels of self-compassion will be associated with lower levels of shame/guilt and, in turn, to decreased PTSD symptoms and reduced suicide risk. Participants (N=317; 65.6% male (n=208); 83.6% Caucasian (n=265), Mean Age=47.54, SD=16.34) were community-dwelling veterans who self-identified as having experienced a trauma, and completed the Self-Compassion Scale-Short Form, Differential Emotions Scale-IV, PTSD Checklist-Military Version, and the Suicide Behaviors Questionnaire-Revised. Bivariate correlations and serial mediation analyses were conducted covarying age, sex, ethnicity, VHA usage, service era, and depressive symptoms. Supporting hypotheses, in serial mediation analyses (10000 bootstrapped samples), the direct effect of self-compassion on suicide risk was reduced, but remained significant, when shame and PTSD symptoms (Model 1; c'=-.846, p=.002, CI=-1.39 to -.306) and guilt and PTSD symptoms (Model 2; c'=-.588, p=.043, CI=-1.15 to -.020), were added as mediators, indicating mediation. Further, there were significant total and specific indirect effects in both models. Our results suggest that the relation between self-compassion and suicide risk may be due, in part, to beneficial changes in cognitive-emotional factors and subsequent decreased severity of PTSD symptoms. Engaging in self-kindness and mindfulness may provide a more-balanced, rather than judgmental and overly-responsible, view of one’s self, thereby reducing risk for psychopathology and suicide. Our findings may have clinical implications. Encouraging the development of self-compassion (e.g., Mindful Self-Compassion, Compassion-Focused Therapy) and addressing shame, guilt, and PTSD symptoms (e.g., Cognitive Processing Therapy, Adaptive Disclosure), may reduce suicide risk in the veteran population.

<p> Symptoms of post-traumatic stress disorder (PTSD) have been linked to different aspects of romantic relationship functioning. The literature demonstrates mixed results on which type of PTSD symptom is most impactful for successful romantic relationships. Many studies have examined this association both cross sectionally and longitudinally, and in many different populations. This association is of importance particularly for those highly exposed to trauma, such as those in the National Guard. The current study had two aims. The first was to examine the rates of change in Guard member’s (N = 175) PTSD and relationship functioning and their partners (N = 176) relationship functioning, across three waves following deployment. The second was to investigate the unique impact of each PTSD symptom cluster (re-experiencing, avoidance, and hyperarousal) occurring in the Guard Member on their own and their partner’s measures of relationship functioning. These aims were achieved through a secondary data analysis of a larger study that followed National Guard families from predeployment throughout reintegration. For the purposes of this analysis, Guard Member’s and their partners were assessed on relationship functioning measures 2 months, 8 months, and 13 months after deployment. The Guard member’s PTSD symptoms were assessed at the same time points. Multilevel modelling revealed that the Guard member’s PTSD symptoms and relationship functioning did not change significantly over time. Partner’s relationship functioning did not change either, with the exception of active engagement. Regression analysis revealed that Guard member’s PTSD <em>avoidance</em> symptoms are most strongly associated with both the Guard member and their partners ratings of relationship functioning. These findings identify an important area of possible intervention.  </p>

The current and long standing wars in Iraq and Afghanistan are producing a large population of soldiers returning home with extensive physical and mental illnesses. The most common mental health illness in soldiers is Post-Traumatic Stress Disorder (PTSD). A large portion of these soldiers are not being treated for their mental illness because they are not seeking help, they cannot find or access help and they are being misdiagnosed. This failure to get appropriate and timely mental health treatment for PTSD causes a wide array of adverse effects personally and on the community. Soldiers suffering from untreated PTSD are more likely to be unemployed, divorced, use more medical services, be abusive to their spouses, and get fired from employment. The purpose of this thesis is to promote an understanding about why many of these soldiers are not being treated for PTSD, inform nurses about how to detect soldiers in need of care and aid them to get appropriate care. This research was conducted through nursing and psychiatric databases as well as information from the Veterans Administration and books to further expand upon resources and studies on this topic.

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Anger is a pervasive problem after individuals experience traumatic stress that heightens the risk for violence, health problems, poor relationships, and poor treatment outcomes. Previous research has demonstrated a moderate relationship between anger and posttraumatic stress disorder (PTSD), yet this research also highlights that anger has not been rigorously measured in the context of PTSD. Thus, this study concerns the development of a complimentary measure to assess anger in the context of PTSD. Participants were 435 undergraduate students. The participants were given a battery including the proposed scale and measures of trauma exposure, PTSD, anger, depression, anxiety, and social desirability to assess. Exploratory factor analyses revealed that a hierarchical, four-factor model was the best model. The Posttraumatic Anger Scale appeared psychometrically sound, with excellent internal consistency, good evidence of validity, and good model fit. This scale may provide implications for clinical work, specifically for the assessment and tracking of anger symptoms connected to PTSD. Additionally, this scale may assist with research by predicting treatment outcomes, aggression, and PTSD. / Master of Science