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Public Safety Personnel (PSP) and Military Personnel (MP) face high rates of potentially traumatic exposures as part of their on-the-job service. As a result, they frequently experience highly impactful Occupational Stress Injuries (OSI), which contribute to complex experiences of mental, health, social, and functional injuries. The individual experience of these injuries is mediated by domain of the causal stressor, including whether it stemmed from an operational factor (i.e., the unique operational demands of the position) or an organizational factor (i.e., systemic stressors associated with employment environment). Military Sexual Trauma (MST) and Military Sexual Misconduct (MSM) are two organizational stressors which involve systemically-normalized sexual violence and discrimination within military environments. MSM and MST unfairly target equity-deserving community members, such as woman-identifying personnel and 2SLGBTQIA+ personnel. By belonging to an equity-deserving community, these communities face an additive impact of distinctive personal factors (e.g., person-specific factors such as gender identity or sexual orientation), which predicate more complex experiences of OSI. In Chapter 2 (Study 1), we qualitatively outline how PSP personally describe their experience of OSI-related PTSD symptoms. In Chapter 3 (Study 2), we qualitatively examine the emotional, social, and functional outcomes of an organizational stressor, MSM, in an equity-deserving community of MP (i.e., woman-identifying military Veterans). Finally, in Chapter 4 (Study 3), we qualitatively assess the mental, social, and functional implications of MST in another equity-deserving population (i.e., the 2SLBTQIA+ military community) using a scoping review methodology. / Thesis / Doctor of Philosophy (PhD) / Public Safety Personnel (PSP) and Military Personnel (MP) experience greater exposure to potentially traumatic experiences as part of their occupational duties than do civilians. As a result, they are more likely to suffer negative mental, social, health, and functional outcomes, known as Occupational Stress Injuries (OSI). The individual expression of OSI is mediated both by the domain of the original stressor (i.e., organizational, or operational), and, by person-specific factors, such as belonging to an equity-deserving population of service. Through qualitative research methods, this thesis examines the mental, social, health and functional outcomes of OSI in military and Public Safety Personnel (i.e., MP and PSP, respectively), as well as how membership in equity-deserving communities impacts these outcomes.

Posttraumatic stress disorder (PTSD) co-occurs with substance use disorders at high rates, but the neurobiological basis of this relationship remains largely unknown. Identifying mechanisms that underlie this association is necessary, and recognizing pathologies shared by these disorders may provide pertinent information in understanding their functional relationship. Separate lines of evidence suggest that PTSD and drug addiction may share a common feature, that is, dysregulation of the brain's reward circuitry. We hypothesize that PTSD results in reduced dopaminergic neurotransmission which may contribute to deficient reward function and vulnerability to drug-seeking behavior. To address this hypothesis, we combined single-prolonged stress (SPS), a rodent model of PTSD, with a series of behavioral and neuropharmacological assays to assess dopaminergic reward function and cocaine intake. The results of the studies presented herein extend our understanding of the effects of severe stress on drug reinforcement and consumption, and establish a potential mechanism by which PTSD produces deficient reward function through alterations in the dopamine system. A modified SPS procedure consisting of 2 hours of restraint, 20 minutes of group swimming, isoflurane exposure until loss consciousness, and 7 days of isolation was used to induce severe stress in our studies. Initial studies were conducted to examine the effect of SPS on cocaine-conditioned reward and anhedonia-like behavior in adult male Sprague-Dawley rats. Using a biased conditioned place preference paradigm, unstressed controls demonstrated a significant preference for the cocaine-paired context following four pairings with cocaine (5-20 mg/kg, i.p.). Preference for the cocaine-paired side was significantly lower in rats exposed to SPS, suggesting a deficit in the rewarding properties of cocaine following exposure to severe stress. Anhedonia-like behavior was assessed by a two-bottle choice sucrose preference test. Robust consumption of sucrose solution (0.25-1%) was observed in rats that underwent control handling, however, SPS significantly reduced sucrose intake compared to controls. These results suggest an increase in anhedonia-like behavior or a reduction in the rewarding effects of sucrose as a non-drug reinforcer. Finally, basal behavioral activity in SPS rats was compared to unstressed controls in a 24-hour test. Results indicate a significant reduction in spontaneous nocturnal activity following SPS versus control handling. In contrast, hyperlocomotion induced by an acute cocaine injection (5-20 mg/kg, i.p.) was unaltered between rats that underwent SPS or control handling. These data suggest that deficient behavioral activity may be specific to voluntary movements or behavior, and support an increase in anhedonia following exposure to SPS. Intravenous cocaine self-administration was conducted to examine the effect of SPS on the acquisition, motivation, and escalation of cocaine intake. Acquisition of cocaine self-administration was studied using an escalating dose regimen in which rats had sequential access to 0.1875, 0.375, and 0.75 mg/kg/infusion on a fixed-ratio 1 schedule of reinforcement. Rats exposed to SPS did not significantly differ from control handled animals in the latency to meet acquisition criteria (consumption of 6.75 mg/kg/day for 3 consecutive days) or the general pattern and level of cocaine intake at each dose. A subsequent study assessing the breakpoint for cocaine self-administration using a progressive-ratio schedule of reinforcement determined a dose-dependent increase in motivation to work for cocaine (0-1.5 mg/kg/infusion) across both experimental groups. However, motivation to obtain cocaine was similar between SPS and unstressed rats, as there was no significant difference in breakpoint for cocaine self-administration at any dose of cocaine tested. To evaluate potential differences in the transition to escalated cocaine intake, self-administration was measured using an extended-access procedure in which unlimited cocaine (0.375 mg/kg/infusion) was available for six hours daily. Upon extended-access to cocaine, SPS significantly attenuated cocaine intake compared to control handling over 14 sessions. Despite a significant reduction in cocaine intake, rats exposed to SPS still significantly escalated their cocaine intake over the course of 14 days. These results suggest that escalation of cocaine intake occurred in the presence of lower total doses of cocaine in the SPS exposed animals compared to controls. In addition, SPS rats demonstrated a greater percent increase in cocaine consumption compared to controls. This finding suggests that rats exposed to SPS compensated for a decrease in cocaine reinforcement by escalating their intake to a greater magnitude than controls. These studies indicate that SPS may not alter the acquisition of cocaine self-administration or motivation for cocaine. However, the finding of reduced cocaine intake upon extended-access in SPS rats is consistent with a deficit in cocaine-induced reward. The ability of SPS rats to escalate cocaine intake in the presence of less cocaine, or a greater magnitude of escalated cocaine intake than controls, may reflect mechanisms leading to enhanced vulnerability to cocaine abuse. To understand the mechanisms of reduced reward and behavior in the SPS model of PTSD, a series of neurochemical assays was used to assess the ability of SPS to induce dysfunction of dopaminergic neurotransmission. Using high performance liquid chromatography, tissue levels of dopamine and the dopamine metabolites DOPAC and HVA were measured immediately and one week following SPS or control handling. Tissue obtained from SPS rats demonstrated significant decreases in dopamine, DOPAC, and HVA content in both the nucleus accumbens and caudate putamen immediately following SPS and one week later, suggesting a potential deficit in dopaminergic tone. Quantitative autoradiography was used measure the density of dopamine transporters and dopamine D1 and D2 receptors. [3H]WIN35428 binding to dopamine transporters was higher in the nucleus accumbens of SPS rats compared to controls, suggesting an increase in dopamine transporter density following severe stress. The level of [3H]WIN35428 binding in the caudate putamen was not different between groups. [3H]Raclopride binding to D2 receptors was significantly reduced in both the nucleus accumbens and caudate putamen following SPS versus control handling. These results suggest a decrease in the density of striatal D2 receptors. D1 receptor expression was not significantly altered by SPS, as no significant difference in [3H]SCH23390 binding was detected in SPS rats compared to controls. A preliminary functional assessment of dopamine transporters revealed a significant increase in dopamine uptake in the nucleus accumbens of SPS rats compared to controls, whereas uptake in the caudate putamen was unaltered between groups. Enhanced dopamine uptake following SPS is consistent with the increase in dopamine transporter density observed in the nucleus accumbens of SPS rats. Activation of D1 receptors and G-protein mediated transduction was assessed using an adenylyl cyclase assay with the D1 agonist SKF82958. In the caudate putamen, a significant decrease in D1 receptor-stimulated cAMP production was revealed in SPS rats compared to controls, whereas SKF82958-induced cAMP was unchanged in the nucleus accumbens. Finally, the function of D2 dopamine receptors was assessed by D2 receptor-stimulated [35S]GTPγS binding using quinpirole. In the caudate putamen, [35S]GTPγS binding following stimulation of D2 receptors was enhanced by SPS compared to control handling, whereas no difference was observed between groups in the nucleus accumbens. These results indicate increased D2 receptor-mediated activation of G-proteins in the caudate putamen following SPS. In summary, the studies described herein tested the hypothesis that reduced dopaminergic function may be a mechanism for deficient reward and heightened susceptibility to drug use in PTSD. Results demonstrated a significant reduction in cocaine-conditioned reward, as well as attenuated sucrose preference and spontaneous activity in rats exposed to SPS. These findings are consistent with the presence of a dysfunctional reward system which may contribute to anhedonia-like behavior in PTSD. Furthermore, reward deficits may promote altered patterns of cocaine taking behavior and vulnerability to substance abuse. Results demonstrated significant escalation of drug intake following exposure to SPS, which occurred in the presence of less cocaine than controls. A greater increase in cocaine intake was observed in SPS rats over the course of escalation, which may reflect a mechanism for enhanced vulnerability to the development of a substance use disorder in PTSD. Dopaminergic dysfunction may contribute to deficient reward capacity and an altered pattern of cocaine intake in SPS. SPS-induced alterations in dopamine function included a reduction in striatal dopamine content alongside enhanced dopamine transporter levels and function. Mild alterations in D2 receptor density and the function of D1 and D2 receptors were also observed. These findings support the hypothesis that PTSD results in reduced dopaminergic neurotransmission, which may contribute to deficient reward function and altered drug-seeking behavior. Identifying the pathology of PTSD, such as altered dopamine neurotransmission, may lead to enhanced treatment strategies and interventions to prevent substance abuse in persons with PTSD. / Pharmacology

This MFA graduate thesis explores the intersection of therapeutic photography, generational trauma, and Christian spirituality in promoting spiritual healing in disabled veterans diagnosed with post-traumatic stress disorder (PTSD). Drawing from personal experience, rigorous biblical training, and extensive research, I argue that incorporating faith-based practices and beliefs can complement existing PTSD support and enhance spiritual and mental well-being. Through the lens of generational trauma, the thesis analyzes the complex interplay between individual and collective trauma. It posits that the healing process is intrinsically linked to the restoration of the individual and community. I present a framework for therapeutic photography that incorporates Christian spiritual principles and offers practical guidelines for implementation in conjunction with therapeutic photography. The thesis concludes with a call to action for faith-based communities, mental health practitioners, and policymakers to recognize and address the spiritual and artistic therapeutic needs of disabled veterans with PTSD.

No / In this article we reflect on the relatively recent emphasis on Palestinian children's mental health and well-being in the context of exposure to chronic warlike conditions, as we position this trend within the larger framework of the generations-long history of political turmoil and suffering. We describe how a process that started with no attention to psychosocial health of children in relation to exposure to dispossession, expulsion, occupation, repression and military attacks, proceeded with a focus on presumed mental disorders, and the more recent approach of designing context appropriate and community-based psychosocial interventions.

The post traumatic symptoms of children (6-16 yrs) involved in automobile accidents were assessed an average of 9 months following the event. Measures included children's ratings of post traumatic symptoms on the Reaction Index, the Impact of Events Scale, and the Diagnostic Interview for Children and Adolescents-Revised (DICA-R). Results indicated a range of posttraumatic symptomatology among accident victims. Despite low levels of physical injury, approximately one fourth of the sample children reported moderate to severe levels of trauma. As expected, higher injury levels were related to more PTSD symptoms on the diagnostic interview. When controlling for injury level, bicyclists and pedestrians reported higher levels of PTSD symptoms than motor vehicle occupants. Younger children reported higher levels and more frequent PTSD symptoms. As indicated on the diagnostic interview, prior history of an accident was related to fewer PTSD symptoms, suggesting a buffering effect of prior history. Also, children who reported higher levels of social support reported less frequent PTSD symptoms. Lastly, reciprocal processes of fear and avoidance were supported as greater self-reported fear was related to increased PTSD symptomatology. A discussion of the differences between self-report and interview measures of PTSD is included, as factors related to PTSD varied according to the measurement utilized. The importance of direct assessment of children's symptoms is stressed and areas of future research are suggested. / Ph. D.

This study examined chronic psychological and psychophysiological post-traumatic sequelae among eleven adolescent survivors of a fatal bus crash by means of a multimethod strategy. Measures included a structured DSM-m-R post-traumatic stress disorder (PTSD) interview using the Diagnostic Interview for Children and AdolescentsRevised (DICA-R), self-report measures of PTSD symptoms with the Reaction Index, and the Impact of Events Scale. Other measures of stress-related symptomatology included the State-Trait Anxiety Inventory, Fear Survey Schedule-IT, Anxiety Sensitivity Index, Anxiety Frequency Index, and Beck Depression Inventory. In addition, heart rate (HR) reactivity to mental arithmetic (MA), demographic questions, and crash questions was assessed. Survivors were compared to control subjects matched for age, gender, race, and socioeconomic status, among other demographic characteristics. Multivariate analyses of the psychiatric interview data indicated that survivors evidenced significantly higher levels of past PTSD symptoms experienced after the crash, with a significant group by gender interaction, F (3,17) = 5.22, P = .01. Current (past month) levels of PTSD symptoms were also significantly higher among survivors four years after the crash, F (3,17) = 8.82, P < .01, although PTSD symptomatology decreased overall during that time, F (3,17) = 15.52, P < .01. Survivors and controls did not differ significantly on other measures of PTSD and other stress-related symptomatology. Repeated measures analyses of HR response scores revealed greater HR reactivity to questions about the crash among survivors, F (1, 14) = 18.55, P < .01, and by gender, F (1, 14) = 5.21, P = .04. Similar analyses found greater variability in survivors' HR standard deviations (an index of autonomic lability) F (1,14) = 5.21, P = .03 in response to the crash interview. Survivors' HR did not differ from controls' on the MA task. Findings are discussed theoretically and methodologically within the contexts of neurological and conditioning models of PTSD. No relationship between HR reactivity and psychiatric symptomatology was found. Furthermore, this investigation did not find support for the neurological kindling theory. Areas of future research using psychophysiological assessment are proposed to more specifically elicit autonomic arousal. Detailed case studies of four individual response patterns are included as a heuristic for further physiological research and for clinical applications with adolescent trauma victims. / Ph. D.

Post-traumatic stress disorder (PTSD) is a psychiatric disorder that is caused by exposure to traumatic or stressful events in life. 3,4-Methylenedioxymethamphetamine (MDMA) has been shown to be an effective agent in drug-assisted psychotherapy for PTSD. In this systematic review, we aim to evaluate the effect MDMA has on functional connectivity in healthy individuals and individuals with PTSD and investigate the potential mechanisms via which MDMA exerts its effects in MDMA-assisted psychotherapy for PTSD patients. A total of 134 articles from Web of Science and Medline EBSCO were screened and 5 articles relevant for the systematic review were identified. After MDMA administration, an increase and decrease in functional connectivity in multiple brain areas and networks was observed, such as the thalamus, visual cortex, anterior cingulate cortex, hippocampus, amygdala, prefrontal cortex, default mode network, cerebellar network, sensorimotor network, salience network, and executive network. Notably, MDMA increased amygdala-hippocampal functional connectivity which may link to improved emotion regulation and fear extinction in patients receiving MDMA-assisted therapy. The findings evidence the complex effects of MDMA on brain connectivity and highlight the need for further research in this area, although MDMA-assisted therapy does prove to be a promising alternative for treating PTSD.

Research Objectives: Every day in the United States 110 people are killed with firearms, and more than 230 are shot and survive. Survivors of community-based gun violence encounter complex challenges, including increased mental health risks and re-victimization, amidst societal stigma and weakened trust in support systems. The fear of community-based gun violence substantially distorts the way that millions of people live their lives producing detrimental mental repercussions not only for survivors but for their family members as well. Research shows that parents and other family members of child and adolescent gunshot survivors experience an increase in mental health disorders. Typically, Post-Traumatic Stress Disorder is a concept used to understand the traumatic aftermath and symptomatology of this type of violence. However, it overlooks the anticipatory threat of community-based gun violence, which continually influences future decisions and behaviors while lacking the historical context that accounts for the disproportionate nature of community-based gun violence (e.g. race and socioeconomic status). Continuous Traumatic Stress (CTS) focuses on the ongoing anticipation of future threats and traumas, rather than those from the past. CTS has mainly been utilized within the international literature in war-torn countries and highlights how persistent poverty, racial and gender-based violence, as well as violence committed by institutional actors (e.g. law enforcement), continuously traumatizes vulnerable populations. Understanding community-based gun violence through CTS may provide a new perspective of its psychological and social impact. As a result, a CTS pilot scale was developed to focus on how often participants have experienced community violence and the frequency in which it consumed their thought process. Moreover, little research has investigated the impact of gun violence on the family system. This study seeks to help fill these gaps by applying CTS and family systems theory (FST) to understand the continuous traumatic stressors that community-based gun violence and their families experience post injury and how is this violence perceived to impact on the family system. Methods: This qualitative study used a hermeneutic phenomenological approach to conduct 21 separate qualitative interviews between November 2022 and March 2024 with survivors of gun violence and their chosen family members from Brooklyn, NY. Participants were first asked questions pertaining to CTS and were then administered the CTS pilot scale. The pilot scale gathered lifetime data about their exposure to direct and indirect violence as context for the present and future based threats that have been highlighted within the CTS literature. They were then asked questions pertaining to FST. The interviews were transcribed verbatim and then analyzed by a team of three researchers. Given that the hermeneutic phenomenology is not restricted to a set of analytical techniques, a deductive thematic analysis approach was first used to utilize a predefined set of codes, rooted in the foundational components of family systems theory and CTS to begin the analysis. Then an inductive thematic analysis approach was then used to analyze the data to derive concepts and themes that were not apparent in the FST or CTS literature. Results: Qualitative analysis from interviews with gunshot survivors and their chosen family members yielded three key thematic findings pertaining to FST. 1) Alterations in Communication 2) Reconstructing Masculinity and 3) Identity and Support Changes. Qualitative analysis pertaining to CTS with gunshot survivors and their chosen family members yielded three key thematic findings: 4) Absence of protection 5) Present and Anticipated Trauma and 6) Post Traumatic Growth. Conclusion: Specific implications for the field of social work, including those who work with survivors of community violence are outlined. Additionally, this chapter details modifications to social work practices and policies aimed to reduce gun violence that may improve outcomes for social workers and participants. The chapter closing by addressing the theoretical implications for CTS and FST, implications for future research, and finally, disclosing limitations.

Post-traumatic stress disorder (PTSD) is a highly debilitating mental illness that is incited by various types of trauma and causes core symptoms of re-experiencing, hyperarousal, avoidance of trauma-related stimuli, and negative cognition and mood. It is accompanied by functional, social, and occupational impairment, as well as higher risks of medical comorbidities and mortality. Estimates indicate that PTSD affects 3.9% of the global population, and 7-9% of the US population, with only 50% of those with persistent PTSD treatment-seeking. The gold standard of PTSD treatment is prolonged exposure therapy and cognitive processing theory, with the addition of antidepressants; however, dropout rates are high likely due to the adverse effects of worsening re-experiencing of trauma and exacerbating behaviors of avoidance. As a result, alternative therapies such as transcranial magnetic stimulation (TMS) represent more tolerable treatment options. Historically, literature on TMS is promising for its low risk of side effects and efficacy, but there is no general consensus on treatment-specific targets, frequency of treatment delivery, or long-term efficacy. This proposed study will evaluate the use of neuroimaging guided intermittent theta burst stimulation, a form of TMS, for core PTSD symptom reduction and its efficacy up to one year in duration to potentially reduce the morbidity and mortality sequelae of PTSD.