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This program of research investigated the nature and processes of autobiographical memory deficits in posttraumatic stress disorder (PTSD). Study 1 examined the proposition that difficulties in the retrieval of specific memories present a risk factor for posttraumatic psychopathology. A prospective study of fire-fighters found that a significant predictor of posttraumatic stress was a deficit in retrieving specific memories to positive cues before trauma. Study 2 investigated whether autobiographical retrieval deficits in PTSD can be modified by psychological treatment. Results found that as PTSD symptoms reduced following treatment, individuals with PTSD retrieved more specific memories to positive cues. Together, these results indicated that specific retrieval deficits to positive cues present a vulnerability factor for PTSD. However, this memory style appears to be receptive to modification following therapy. Study 3 investigated the association between autobiographical retrieval deficits and impaired problemsolving in PTSD. Participants with PTSD retrieved more overgeneral categoric memories and took longer to retrieve memories than non-PTSD trauma controls. This deficit was associated with impaired social problem-solving, suggesting that specific retrieval is related to successful problem solving. In an analogue design, Studies 4 and 5 investigated the proposition that resource limitations may underpin autobiographical retrieval deficits. Results generally supported the proposal that reduced cognitive resources may be a mechanism contributing to specific retrieval deficits. Studies 6 and 7 examined rumination as another possible mechanism responsible for these retrieval deficits. Study 6 found high anxious participants retrieved fewer specific memories to positive cues following rumination, compared to distraction. Study 7 found evidence that negative rumination in the high anxious group increased categoric retrieval, whereas positive rumination had no effect. Study 8 found retrieval of trauma-related self-defining memories was strongly associated with personal goals connected to the trauma. Study 9 found that discrepancies in one???s self construct were related to the retrieval of trauma memories to positive cues. This program of research extends current theories of autobiographical memory by identifying risk, maintenance, and recovery factors in the context of PTSD.

Migraine is a frequent debilitating neurological disorder that is considered to be genetically complex with a multifactorial mode of inheritance. It has a high prevalence with approximately 18% of women and 6% of men suffering from the disorder. Migraine is characterized by severe head pain with associated nausea, emesis, photophobia, phonophobia, and neurological disturbances. The International Headache Society (IHS) has classified various types of migraine according to their clinical features. The two main subtypes of migraine are migraine without aura (MO), occurring in ~70-75% of migraineurs, and migraine with aura (MA) which occurs in ~25% of migraineurs. Some people experience both types of attack in their lives. While the precise pathogenesis of migraine is unknown, it is widely accepted that short-term alterations in neuronal activity occur in relation to the attack, along with temporary changes in the cerebral vasculature. Trigeminal nerve activation is also considered pivotal to progression of a migraine attack. Neurotransmitters, especially serotonin (5-hydroxytryptamine, 5-HT), platelet activation and sympathetic hyperactivity all appear to play a part, whether as part of the primary triggering event, or as a response mechanism. Migraine imparts a significant burden on society, both socially and financially. The World Health Organization has identified migraine among the world's top 20 leading causes of disability, with an impact that extends far beyond individual suffering. There is significant evidence from family and twin studies to indicate a strong genetic component to migraine. The current understanding of migraine is that it is a polygenic multifactorial disorder. It has been postulated that genetic factors set the individual migraine threshold, with environmental influences playing a modulating role. It is likely that many genes may provide an important although moderate contribution to an individual’s migraine susceptibility. The identification of migraine susceptibility genes has been the focus of substantial research to date and could eventually lead to improved treatments and greater understanding of the disorder. Several loci have shown promise, although these need to be followed up by both replication and functional studies to determine a definitive causative role. This research investigated the role of both hormonal and vascular related genes as candidate genes that may play a role in migraine susceptibility due to the well-known role of hormones and vascular changes in some migraineurs. The estrogen receptor (ESR) and progesterone receptor (PGR) genes are potential migraine candidates due to the recognized hormonal influence on migraine susceptibility. Migraines in women frequently occur during the childbearing years and are often influenced by significant hormonal milestones. The fluctuating hormone levels of the menstrual cycle have been implicated in migraine but a definitive role is yet to be established. It has been suggested that factors additional to circulating hormone levels may be at play. This research considered that variation in the ESR 1 and PGR genes may confer an increased migraine risk. To investigate the potential role of these genes in migraine, association studies investigating variants in ESR 1 and PGR were undertaken in two independent casecontrol cohorts. This was followed up by mutation screening and gene expression analysis in an effort to elucidate a functional role for these genes in the pathogenesis of migraine. Vascular genes also represent likely migraine candidates as alterations in both vascular function and cerebral blood flow are well known in migraine. Furthermore, cortical spreading depression (CSD), a depolarization wave that propagates across the brain cortex and has been speculated to cause the neurological symptoms that present in MA, has also been linked to vascular dysfunction. The methylenetetrahydrofolate reductase (MTHFR) and methionine synthase (MTRR) genes both play a role in vascular functioning and were thus considered potential migraine candidates for this study. Both are involved in the pathway of homocysteine metabolism. Impaired activity of these enzymes can lead to mild hyperhomocysteinemia which is believed to lead to oxidative arterial damage. This may in turn impact on migraine susceptibility, possibly through the activation of trigeminal fibres. The MTHFR 677T allele results in an amino acid change in the catalytic domain of the enzyme leading to mild hyperhomocysteinemia. This particular variant has been implicated in migraine in four separate studies. One of these studies also suggested a role for the MTHFR 1298C allele in migraine. This allele also results in an amino acid change and reduced enzyme activity. Similarly, the MTRR 66G allele results in an amino acid change and has been associated with reduced activity of MTRR and increased plasma homocysteine concentration. To investigate the role of the ESR 1, PGR, MTHFR and MTRR genes in migraine, samples from two large independent case control cohorts were investigated. Cohort 1 was comprised of 275 migraineur samples and 275 age, sex and ethnicity matched controls while cohort 2 comprised 300 cases and 300 matched controls. All individuals were collected at the Genomics Research Centre with migraine diagnosis undertaken by HIS criteria and migraine affected individuals designated as MO or MA. Results of analysis of ESR 1 indicated a positive association with migraine in the two large independent cohorts for the exon 8 G594A polymorphism (P = 0.003; P = 8x10-6). Similarly, the PGR analysis showed a positive association with migraine for the PROGINS allele (P = 0.02; P = 0.003). Results also showed that individuals with both ESR 1 and PGR susceptibility alleles were 3.2 times more likely to suffer migraine those those with no susceptibility alleles. As the ESR 1 variant is synonymous, a mutation analysis was undertaken in a small sub-sample of individuals carrying the susceptibility allele, but no mutations were detected in these particular samples. Detailed mutation analysis of ESR 1 in a larger study group may be warranted. An ESR 1 and PGR expression analysis by RT-PCR was undertaken to examine if there were any notable expression level changes in migraineurs versus controls and additionally whether the susceptibility genotypes influenced gene expression. Altered expression levels may point to a functional change in the gene. Although results did not show any significant difference in expression levels in the case/control group, nor any influence in gene expression conferred by the specific susceptibility genotypes, ESR 1 expression did appear to be down-regulated in the migraine group and more specifically in the migraine susceptibility genotype subgroup. A larger study group may therefore be warranted to detect any potential genuine changes in gene expression. Overall, these results suggested that these hormonal genes appear to play a role in migraine susceptibility, although further studies are needed to define this. Results of the MTHFR 677 analysis showed that the TT genotype was significantly associated with the MA subgroup in a joint analysis of the two independent cohorts (P = 0.004). Results of analysis of MTHFR 1298, which is tightly linked to the 677 locus, showed a significant association in female migraineurs (P = 0.009). Similarly, results of the MTRR analysis also showed a significant difference between the female case and control groups with the G allele over-represented in female migraineurs (P = 0.022) These results may indicate that a significant gender effect appears in this locus as well as the MTHFR 1298 locus although results may also be due to a larger number of female migraineurs conferring increased statistical power to the gender subgroup. Interaction analysis of the MTHFR 1298 locus and the MTRR locus showed that females who carried both variants under a recessive model were 5 times more likely to suffer migraine those those with no susceptibility genotypes. Overall these results indicated that these vascular genes appear to play a role in migraine susceptibility. The final study focused on 6 genetic variants that had shown a positive association with migraine and/or MA in the same large association population analysed in this research. The aim of this study was to provide preliminary data on the potential role of genetic profiling in migraine. Using the genotypic data to create vascular and hormonal risk profiles based on positive association and interaction of MTHFR 677 T and ACE D alleles, and MTHFR 1298 AA and MTRR GG genotypes as vascular variants; and positive association and interaction of ESR 1 594 A and PGR PROGINS as hormonal variants, this study was able to demonstrate the relevance of genetic risk profiling to migraine. Results showed a significantly higher proportion of individuals with at least one genetic risk profile in the migraine group compared to those in the control group (P = 6 x 10-6). Individuals who possessed either the vascular and/or hormonal genetic risk profile were 8.6 times more likely to suffer from migraine than those who possessed a ‘no risk’ profile. This indicated a greater effect than the individual effect of each of these variants. Furthermore individuals who possessed a vascular or both risk profiles were more likely to suffer nausea, emesis, phonophobia and photophobia, and have a mother who also suffered migraine. Overall, the genetic profiling approach provided interesting preliminary data on migraine susceptibility and indicated that such an approach may prove very useful for migraine diagnosis, particularly when all migraine genes have been identified. In conclusion this study provided the first indication that hormone receptor genes play a role in migraine susceptibility. Hormones have long been considered to play a role in the disorder but this study has provided the first molecular evidence to support this premise. In addition, this study showed that vascular related genes also play a role in migraine susceptibility. Finally, this study has clearly shown that migraine is a complex disorder involving multiple genes. Although a number of studies have implicated neurotransmitter related genes in the disorder, the present study is the first to show that both vascular and hormonal genes also play a role in migraine susceptibility. Thus there now appear to be three classes of genes that affect migraine susceptibility and although this study has implicated new variants, the preliminary genetic profiling study has shown that not all predisposing variants involved in the disorder have been defined.

This study compared the motor performance of children identified with Developmental Coordination Disorder (DCD) with those of a matched group categorised as typically developing (TD). Based on the existing literature, vertical jumping was the task selected as it is a fundamental movement skill (Gallahue & Ozmun, 2002), and a single optimal coordination pattern has been shown to exist (e.g., Bobbert & van Ingen Schenau, 1998).Within the conceptual framework developed for this enquiry, jump height, the performance outcome, was the highest level variable. Level 2 variables described the centre of mass displacement at key instants during the jumping movement. Level 3 variables identified measures of velocity, force and power, which underpin the movement, and level 4 variables described the countermovement specific to this task. This provided a more thorough analysis than previously reported in DCD literature for jumping. The objective of this study was to identify possible mechanisms of DCD in order to advance the understanding of this impairment. A cross-sectional sample (n = 165) of males and females aged between 5 and 12 years was drawn from a school in Victoria, Australia. Using the Movement–Assessment Battery for Children (M-ABC), 62 children from the sample were identified as having DCD with total impairment scores below the 15th percentile for their age-band (Henderson & Sugden, 1992). From the remaining children assessed, who all scored above the 15th percentile, 62 were matched with the DCD group to form the TD group (n= 62). Participants performed three maximal vertical jumps, standing on a single forceplate. Each child’s best vertical jump was analysed using forceplate (700 Hz) and 2D sagittal kinematic data from a single camera video (50 Hz) capture. The results confirmed previous findings that DCD children jump lower than their TD peers, although there was a considerable overlap in motor ability between the groups. Peak VCOM occurred earlier in the jumping movement in the DCD group, when compared to the TD group. This meant a longer elapsed time from the instant of peak VCOM to take-off, which was attributed to coordination error. The earlier occurrence of peak VCOM in the DCD group could be explained by the lower shank angular velocity at take-off. In addition, the DCD group produced lower jump impulse and peak power. Further probing of the jump height data revealed an interesting relationship between age band and jump height that was gender specific. It was noted that for the DCD males, less than 1% of the variance found in jump height could be accounted for by age-band. In contrast, the explained variance for jump height by age-band was 24% for the TD males. The females showed similar relationships for jump height and age-band in both groups. It was thought that this may reflect physical activity avoidance caused by greater social pressures on boys to be good at sports (e.g., Parker & Larkin, 2003).In addition, a further analysis of the DCD group data was undertaken to compare those who had difficulties in dynamic balance and those who did not. In this analysis, body mass was found to have a significant effect on leg stiffness (Kleg), and when accounted for as a covariate, greater Kleg in the DCD group with dynamic balance difficulties was found. A possible explanation is that for the DCD group with dynamic balance difficulties, the transition from joint flexion to extension during the countermovement was problematic, and resulted in excessive muscle co-activation. This study provides some possible directions for further investigations into coordination issues for DCD children. The time elapsed from peak VCOM to take-off and the shank angular velocities at take-off were identified as key indicators of a poorly coordinated jump. High levels of Kleg reflected difficulties in the transition from joint flexion to extension during the countermovement in those DCD children with dynamic balance problems. Based on these key variables and others that differentiated between groups a more parsimonious conceptual framework is presented. For future enquiry, a more holistic approach for the study of children with such impairments is recommended. This includes exploring the environment these children are exposed to in order to gain a more thorough understanding of practice and learning effects. Understanding of differences in motor ability requires an expanded framework to include information on genetic and socio-cultural factors, and their impact upon important psychology, physical fitness, nutrition, body composition and physical activity parameters.

The term “post-traumatic stress disorder” (PTSD) is a relatively new diagnostic label, being formally recognized in 1980 in the Diagnostic Statistical Manual for Psychiatric Illness – Third Edition (DSM-III) of the American Psychiatric Association (APA, 1980). Complex Post-Traumatic Stress Disorder (CP) is a more recently discussed, and newly-classified, phenomenon, initially discussed in the early 1990s (Herman, 1992a). Thus, as research into effective treatments for CP is sparse, the treatment of CP is the topic of this study, in which a guideline-based treatment program developed by the researcher for the treatment of CP is implemented and evaluated. Ten individuals participated in this study, undertaking individualized, guideline-based treatment programs spanning a period of six months. In providing background information relevant to this study, an explanation is provided regarding the nature of CP, and the reasons for its consideration as a separate phenomenon to PTSD. The adequacy of the PTSD formulation in enabling effective assessment and treatment of CP is also explored, with endorsement of previous researchers’ conclusions that the CP construct is more useful than the PTSD construct for assessing and treating survivors of long-term and multiple forms of abuse. The PTSD classification is restrictive, and not necessarily appropriate for certain forms of trauma (such as prolonged trauma, or multiple forms of trauma), as such trauma experiences may lead to specific effects that lay outside those formerly associated with PTSD. Such effects include alterations in affect regulation, consciousness, self-perception, interpersonal relationships, and in systems of meaning. Following discussion regarding the PTSD/CP classification, an examination of treatment methods currently used in the treatment of PTSD, and a review of treatment outcome studies, takes place. The adequacy of primary treatment methods in treating CP symptoms is then examined, with the conclusion that a range of treatment methods could potentially be useful in the treatment of CP symptoms. Individuals with a diagnosis of CP may benefit from the adoption of an eclectic approach, drawing on different treatment options for different symptoms, and constantly evaluating client progress and re-evaluating interventions. This review of treatment approaches is followed by details of an initial study undertaken to obtain feedback from individuals who had suffered long-term/multiple trauma and who had received treatment. Participants in this initial study were asked open-ended questions regarding the treatment approach they had experienced, the most useful aspect of the treatment, the least useful aspect, and other strategies/treatment approaches that may have been useful – but which were not used. The feedback obtained from these individuals was used to inform the development of treatment guidelines for use in the main study, as were recommendations made by Chu (1998). The predominant focus of the treatment guidelines was “ego strengthening”, a term coined by Chu (1998) to describe the “initial (sometimes lengthy) period of developing fundamental skills in maintaining supportive relationships, developing self-care strategies, coping with symptomatology, improving functioning, and establishing a positive self identity” (p.75). Using a case study approach, data are then presented relating to each of the ten individuals involved in the treatment program: details of his/her trauma experience(s)and the impact of the trauma (as perceived by each individual); details of each individual’s treatment program (as planned, and as implemented); post-treatment evaluation of the positive and negative aspects of the treatment program (from the therapist’s perspective); and details of the symptoms reported by the individual post-treatment, via psychometric assessment and also during interview. Analysis and discussion of the data relating to the ten participants in the study are the focal point of this study. The evaluation of the effectiveness of each individual’s treatment has been based predominantly on qualitative data, obtained from an analysis of language (discourse analysis) used by participants to describe their symptoms pre- and post-treatment. Both blatant and subtle changes in the language used by participants to describe themselves, their behaviour, and their relationships pre- and post-treatment have provided an insight into the possible changes that occurred as a result of the treatment program. The language used by participants has been a rich source of data, one that has enabled the researcher to obtain information that could not be obtained using psychometric assessment methods. Most of the participants in this study portrayed notable changes in many of the CP symptoms, including being more stable and having improved capacity to explore their early abuse. Although no direct cause-effect relationship between the participants’ treatment program and the improvements described can be established from this study, the participants’ perception that the program assisted them with their symptoms, and reported many aspects of “ego strengthening”, is of major importance. Such self-perception of strength and empowerment is important if an individual is going to be able to deal with past trauma experiences. In fact, abreactive work may have a greater chance of succeeding if those who have experienced long-term or multiple trauma are feeling more empowered, and more stable, as were the participants in this study (post-intervention). In concluding this study, recommendations have been made in regard to the use of guideline-based treatment programs in the responsible treatment of CP. Strengths and limitations of this study have also been highlighted, and recommendations have been made regarding possibilities for future research related to CP treatment. On the whole, this study has supported strongly other research that highlights the importance of focusing on “ego strengthening” in assisting those who have suffered long-term/multiple trauma experiences. Thus, a guideline-based program focusing on assisting sufferers of long-term trauma with some, or all, of the symptoms of CP, is recommended as an important first stage of any treatment of individuals who have experienced long-term/multiple trauma, allowing them to develop the emotional and psychological strength required to deal with past traumatic events. Clinicians who are treating patients whose history depicts long-term or multiple trauma experiences (either from their childhood, or at some stage in their adult life) need, therefore, to be mindful of assessing individuals for symptoms of CP – so that they can treat these symptoms prior to engaging in any work associated directly with the past traumatic experiences.

The clinical adherence to and combination of methods with EMDR to treat PTSD has not been explored. This is of some concern as 27 000 clinicians are trained in EMDR globally. This exploratory study gained information on Australian trained EMDR clinicians' adherence to EMDR, and the methods they combined with EMDR to treat PTSD. Survey responses from 126 clinicians were analysed using predominantly descriptive statistics. The findings of this study showed that the majority of respondents perceived that they closely adhered to the standard EMDR treatment. However, respondents reported adhering more closely to the phases than the steps of EMDR. Statistically significant findings showed that more experienced EMDR level 1 clinicians were more likely to add steps and phases to EMDR, and to change the standard sequence of steps. Clinicians with greater years of experience were also more likely to change the standard sequence of steps. In addition, more experienced EMDR level 2 clinicians, were less likely to educate their clients about PTSD. Almost all respondents combined EMDR with other methods to treat PTSD. Combined methods included CBT, hypnosis / relaxation, system / solution focused methods and exposure. This research has contributed to theory and practice by uncovering that clinicians appear to use EMDR differently to researchers, by changing EMDR to meet client needs, combining EMDR with other methods and Holly Byron 16/9/99 vi therapies, and introducing EMDR in the mid stage of treatment. These findings are vital to reduce the scientist-practitioner divide by accurately testing EMDR's efficacy and enabling future controlled trials to reflect the clinical use of EMDR.

A single case study using a narrative approach to therapy was undertaken to examine the process and outcomes of therapy with a case of a 12 year old boy who presented with what could be described as an "anxiety disorder". The results were contrasted with the possible process and outcomes should a cognitive-behavioural approach have been used. This aspect of the Study was necessarily a speculative endeavour. Specific behaviours of the client and significant others were measured pre, post and followup. Positive changes occurred in the following behaviours: absence from school, reports of victimization, positive and negative self statements and statements by significant others.