An Unbearable Illumination of Truth is a series of sculptures created to explore the connection between trauma and healing. The sculptural exhibition addresses economic, occupational, childhood, sexual, and gender-based trauma. These sculptures incorporate familiar motifs and visual metaphors to express narratives of varying types of traumas. A broad range of sculptural materials (such as wood, fabric, and found objects) and methods are used to create these symbolic, objective forms. The juxtaposition of shelters with other forms and materials visually enacts the themes of vulnerability and intrigue that characterizes traumatic incidents. Shelters are referenced throughout this entire body of work as an allegory for identity. Ultimately, this work is intended to induce empathy and raise awareness of important, underlying social issues that revolve around trauma. This message is especially important today due to a dramatic increase of trauma related issues as a result of the COVID-19 pandemic.

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An increasing number of women are serving in the military. We initiated a retrospective study to evaluate vitamin D status and monitoring in female veterans, and to examine the potential link between vitamin D status, age, race, post-traumatic stress disorder (PTSD), health care costs, and utilization. Approximately 44 percent of the 3,608 female veterans evaluated between 2001 and 2010 were vitamin D deficient (25(OH)D < 20 ng/ml), a rate substantially higher than that of the general population. While younger (<55 years) and older (55+ years) women did not differ significantly in initial vitamin D status, older women had significantly more vitamin D monitoring and follow-up testing than younger women. Approximately 44 percent of vitamin D deficient women did not receive follow-up vitamin D testing. Minority female veterans were most likely to be vitamin D deficient. Female veterans with PTSD did not differ from others regarding their initial vitamin D status; those that were initially deficient were significantly more likely to receive follow-up testing and were more likely to achieve a replete state. Vitamin D deficiency in female veterans was also associated with increased health-care costs. Appropriate monitoring and replacement of vitamin D should be offered to all female veterans.

Rationale and objective: Post-traumatic stress disorder (PTSD) and alcohol use disorder (AUD) are disorders of learning and memory that often occur comorbidly. Exposure to trauma-related cues can increase alcohol intake in PTSD patients that are using alcohol to self-medicate. The recurrence of anxiety symptoms with subsequent alcohol use may initiate a destructive cycle where stress and alcohol exposure impair the function of the prefrontal cortex (PFC). While the incidence of these disorders has steadily increased, current therapies and treatments often lack efficacy. Thus, investigation into the underlying neurocircuitry responsible for the establishment and maintenance of these disorders is necessary to develop novel treatment targets. Methods: The present study examined the effects of ethanol exposure on the ability to create new learned associations around previously conditioned fear cues in a rat model. Animals were exposed to fear conditioning followed by chronic intermittent ethanol to translationally model trauma exposure followed by alcohol abuse. Optogenetics was used to inhibit the prelimbic (PrL) or infralimbic (IfL) cortex during fear memory reconsolidation, and fear behaviors were measured during subsequent extinction and spontaneous recovery tests. Results and conclusion Chronic ethanol exposure led to deficits in fear extinction learning and increased freezing during spontaneous recovery, both of which were prevented following inhibition of the PrL, but not the IfL, during memory reconsolidation. These results support the involvement of the PrL in fear learning and memory, and strongly suggest that the PrL could serve as a potential target for the treatment of the learning and memory deficits that occur following exposure to stress and alcohol.

The persistence of shame-based reactions to child maltreatment (CM) has been associated with poor posttraumatic adjustment. Despite evidence that the postpartum period is a vulnerable time for women with CM histories, little is known about the consequences of maltreatment-specific (MS) shame for postpartum functioning. The current study examined individual differences in MS shame among a sample of women during the postpartum period (n = 100) as well as prospective relations from MS shame to postpartum psychopathology at 6-, 12-, 15-, and 18-month postpartum. Linear growth curve (LGC) analyses showed that MS shame predicted higher levels of depression symptoms but not post-traumatic stress disorder (PTSD) symptoms at all time points whereas path analyses showed that shame mediated the relations from multi-maltreatment to both depression and PTSD symptoms at all time points. Results point to the long-term consequences of MS shame during postpartum and the importance of attending to shame in clinical care of maltreatment survivors who present with postpartum psychopathology.

Objectives: The purpose of this study was to compare hearing difficulties and hearing aid outcomes in veterans with Posttraumatic Stress Disorder (PTSD) to a group of veterans with no medical diagnosis of PTSD. Our hypothesis was that veterans with PTSD would have poorer hearing aid outcomes in certain domains (e.g., those related to loudness or interactions with the environment) relative to patients without PTSD. Assessing these differences could help identify unique factors that may lead to the development of tailored aural rehabilitation for hearing aid users with PTSD. Design: This descriptive study employed subjective outcome measures and surveys; the Abbreviated Profile for Hearing Aid Benefit (APHAB) served as the primary outcome measure. An additional questionnaire was developed to assess views of the subjects’ hearing in unaided and aided conditions in an effort to explore the relation between hearing aid benefit and PTSD symptoms. A total of 60 veterans with sensorineural hearing loss and bilateral hearing aid use were recruited from the Audiology Clinic at the James H. Quillen Veterans Affairs Medical Center in Mountain Home, TN. Participants were divided into two groups of subjects either with or without PTSD (n=30 in each). Diagnosis of PTSD was confirmed via a chart review of the veteran’s medical record. Results: Results from the APHAB revealed a significant difference between groups in global benefit scores as well as the aversiveness subscale in the unaided condition. Overall, the PTSD group showed lower benefit scores, however outcomes indicated that both groups received benefit when aided. Results from the study questionnaire showed a significant difference between the two groups in both unaided and aided conditions for the questions focused on hyper-arousal and re-experiencing symptoms. Conclusions: Hearing aid users with PTSD perceive less benefit from hearing aid use on traditional hearing aid outcome measures. Additionally, these hearing aid users were more affected by hyper-arousal, re-experiencing symptoms, and avoidance compared to hearing aid users without PTSD. The clinical implications of this work suggest that hearing aid users with PTSD may need modified hearing aid fittings and/or additional counseling to meet their unique listening needs.

PTSD is a mental health condition that affects many people over the course of their life (National Comorbidity Survey, 2005), including veterans (Litz & Schlenger, 2009). However, many do not experience clinical levels of distress and some experience posttraumatic growth (PTG) resulting from such an event (Tedeschi, Park, & Calhoun, 1998). The Psychological Flexibility Model, of which Acceptance and Commitment Therapy (ACT; Hayes, Strosahl, & Wilson, 1999) is based, may help explain these phenomena. The purpose of this study was to examine these relationships utilizing a measure simultaneously assessing psychological flexibility and inflexibility. It was hypothesized that psychologically inflexible behaviors would predict PTSD symptom severity, while flexible behaviors would predict PTG. Furthermore, each of psychological inflexibility and flexibility would account for unique variance in PTSD symptom severity and PTG, respectively. Finally, the domains of ACT were examined to assess the strength each component has in the maintenance of these experiences. Results indicated that both psychological inflexibility and flexibility predicted PTSD symptoms and PTG, respectively, and each predicted unique variance in these experiences. Of the individual components, cognitive fusion, experiential avoidance, inaction, and lack of contact with the present moment all contributed to PTSD symptom severity, while values clarity, lack of contact with the present moment, and present moment awareness contributed to PTG. These results suggest the psychological flexibility model overall is consistent with the experience of PTSD symptoms and the posttraumatic growth. Though further experimental methods are needed, the application of psychological flexibility through ACT could enhance PTSD treatments.

This study examined individual variability in the strength of association between psychophysiological reactivity to trauma cues and clinician-rated PTSD symptoms in a sample of female survivors of sexual and non-sexual assault. PTSD is a heterogeneous disorder, and individual differences in symptom presentation and accompanying comorbidities may be accounted for by internalizing and externalizing latent temperament-based dimensions of psychopathology. The present study proposed that these dimensions may also account for heterogeneity in the association between psychophysiological reactivity and PTSD. Prior research has demonstrated that most individuals with PTSD display elevated psychophysiological reactivity when exposed to trauma reminders, although some do not. As well, research has shown that externalizing pathologies are typically associated with diminished psychophysiological reactivity to aversive cues whereas internalizing pathologies are associated with elevated psychophysiological reactivity. This study therefore employed structural equation modeling to test hypotheses that externalizing and internalizing pathologies would display mitigating and enhancing moderator effects, respectively, on the prediction of PTSD by psychophysiological reactivity. To that end, confirmatory factor analysis first established a viable internalizing and externalizing model based on an array of clinical measures in one participant subgroup (n = 329) and then affirmed the reliability of the model in a second subgroup (n = 245). Structural equation modeling in the latter subgroup, in which PTSD was regressed on Internalizing, Externalizing, and Psychophysiological Reactivity factors as well as Internalizing by Psychophysiological Reactivity and Externalizing by Psychophysiological Reactivity moderator terms, revealed a significant moderator effect for externalizing but not internalizing pathology. However, the nature of the externalizing moderator effect differed from the hypothesized direction, with higher levels of externalizing pathology strengthening the association between PTSD and psychophysiological reactivity rather than weakening it. It therefore appears that variability in the association between PTSD and psychophysiological reactivity may be partially accounted for by individual differences in the externalizing dimension of psychopathology. As well, the psychophysiology of the externalizing dimension may also be marked by heterogeneity, with externalizing pathology being linked with increased rather than decreased psychophysiological reactivity among women who have experienced sexual or non-sexual assault.

The lifetime prevalence of posttraumatic stress disorder (PTSD) ranges from 1 to 14 percent in the general population. Diagnosis is based on criteria that address hallmark symptoms of the disorder from re-experiencing the trauma to hyperarousal, emotional numbing, and avoidance of memories, thoughts, or feelings associated with the event. PTSD is particularly prevalent in vulnerable populations and comorbid with substance use disorders, serious mental illness, or both. Psychological treatment options are more strongly recommended than pharmacological treatment by the American Psychological Association (APA); however, the efficacy of psychotherapy is less studied in vulnerable populations for fear that substance use or mental health outcomes will worsen. Prolonged exposure (PE) therapy and cognitive processing therapy (CPT) are the most investigated forms of cognitive behavioral therapy (CBT) in vulnerable populations and involve overcoming the trauma through repeated exposure for PE or processing with a clinician for CPT. A review of all randomized controlled trials (RCTs) that have evaluated the effect of either form of CBT on non-combat PTSD, substance use disorder (SUD), and mental health outcomes found that PE administered alongside SUD treatment had the greatest positive impact on PTSD and SUD outcomes. PE also had a better impact than CPT on PTSD outcomes in individuals with PTSD and serious mental illness (SMI); however, neither form of CBT performed substantially better than the other with respect to mental health outcomes. In future studies, the impact of psychological treatments on PTSD and other health outcomes needs to be assessed on the same variables in larger populations of vulnerable individuals that are inclusive and representative of those receiving care for SUD and SMI in community health care settings.

A dissertation submitted in partial fulfilment of the requirements for the degree of Master of Arts (Counselling Psychology) in the Department of Psychology, University of Zululand, South Africa, 2004. / The present study examined Public Order Police Officers' perceptions of traumatic symptomatology. The study consists of three aims. The first aim was to ascertain the type of traumatic symptomatology members of the Public Order Police experience. The second aim was to determine whether rank has an influence on perceptions of traumatic symptomatology. The third aim was to establish if a relationship existed between experiences of traumatic symptomatology and the respondent characteristics of gender, age or work experience. The study revealed that half of the sample experienced stress as a type of symptomatology. It was also found that: 43% experienced depression; 29% experienced psychosomatic complaints; 28% experienced family and marital problems; 26% experienced alcohol or drug abuse; 25% experienced aggressive behaviour; and 22% of the Public Order Police experienced suicide as a type of traumatic symptomatology. This study also found that no relationship existed between: police rank, gender, length of service and traumatic symptomatology. The only relationship that existed in this study was between age and Public Order Police Officers' perceptions of traumatic symptomatology. The general consensus in literature is that the expression of personal feelings is severely limited within the police culture (Joyce, 1989; Kroes, 1985; Pogrebin & Poole, 1991; Burgers, 1994). The police culture may influence the manner in which police officers respond to traumatic events, family members, the community and psychological treatment To add to the problem, many officers fear asking for help. The creed of the male-dominated police profession reflects a predominantly macho attitude; police officers perceive themselves as problem solvers, not people with problems (Reiser, 1974). It can be argued in this study that untreated trauma can be manifested through subtle traumatic symptoms if psychological treatment is not sought. The findings of this study highlight the need for these members to be counselled to benefit themselves, family and the community.