With the advancement of protective gear and medical aid, soldiers are now surviving traumatic experiences that were once fatal. As a result, the prevalence of brain injury and posttraumatic stress disorder in military service members has grown. Those who have obtained brain injury are at risk of developing chronic traumatic encephalopathy, a neurodegenerative syndrome. To date, there is no cure, treatment, or diagnostic method (besides autopsy) for chronic traumatic encephalopathy. Because chronic traumatic encephalopathy and posttraumatic stress disorder present many of the same symptoms and have the possibility of deriving from the same traumatic experience, an investigation of a potential link is necessary. This study explores the possibility of chronic traumatic encephalopathy being misdiagnosed as posttraumatic stress disorder. This is done by analyzing the frequency of brain injury along with the comorbidity of posttraumatic stress disorder and brain injury. This thesis also proclaims the need for research that attempts to develop diagnostic criterion and treatment methods for chronic traumatic encephalopathy.

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INTRODUCTION: Since September 11, 2001, over 2.5 million military service members have been deployed to combat zones to support operations in the War on Terror and over 250,000 service members transition out of the military every year (United States Department of Veterans Affairs, 2022). Evidence-based research suggests that this cohort of post-9/11 combat veterans can struggle with community reintegration and associated functional difficulties in the areas of disruption of identity, challenged beliefs about self and others due to trauma and moral injury, occupational disengagement, and limitations with social and role participation. OBJECTIVES: Many combat veterans find themselves returning home by a different way, struggling to find their place in the civilian world while maintaining their identity as a warrior. Occupational therapy can bridge the functional divide between these two worlds by helping modern-day warriors rebuild and reclaim their roles, occupations, and purpose. Master of Two Worlds is an interactive multimedia workbook designed to facilitate posttraumatic growth and community reintegration for post-9/11 combat veterans in the VA system with or without a mental health diagnosis. METHOD/APPROACH: The workbook uses Campbell’s (2008) Hero’s Journey framework to help veterans form a cohesive life narrative, determine new goals, and acquire civilian occupational skills. Readers will be able to access interactive multimedia videos and activities with their cell phones through QR codes in the workbook. Practical hands-on workbook activities focus on self-care, habit and routine formation, spirituality, and social and leisure participation, as well as integrating roles and identity to empower mastery of the military and civilian worlds. A mixed-methods pilot study will be conducted at the VA Long Beach Healthcare System (VALBHS). Quantitative data will be collected pre- and post-intervention using the following standardized outcome measures: Military to Civilian Questionnaire (M2C-Q), the PTSD Checklist for DSM-5 (PCL-5), and the Posttraumatic Growth Inventory – Expanded version (PTGI-X). Qualitative data will be collected via one-on-one interviews. ANTICIPATED OUTCOMES: Successful community reintegration of post-9/11 combat veterans through forming a new civilian occupational identity that integrates the warrior experiences as expressed through establishing healthy habits and routines, developing new priorities, goals, and possibilities for the future, redefining personal moral code to heal from moral injury, establishing a close social support network, and finding a sense of personal strength. Results and or Practice Implications: It is hypothesized that results will demonstrate statistically significant score changes on the outcome measures. Dissemination of the workbook will take place through an interdisciplinary community of practice on the national VA level and through key VA staff at strategic clinics within the system. CONCLUSION: Combat is a form of trauma. Posttraumatic growth and community reintegration are the ultimate successful outcomes of war trauma. It is incumbent on practitioners in occupational therapy to facilitate these outcomes for the betterment of those who have served and for society.

Alcohol use disorder (AUD) and post-traumatic stress disorder (PTSD) are debilitating conditions that often co-occur, with an estimated 41-79% comorbidity rate. A major concern with the co-occurrence of these disorders is the tendency for one to exacerbate the other. Specifically, symptoms related to PTSD are a significant risk factor for the development of AUD, and alcohol abuse worsens PTSD symptoms. This cycle, along with a lack of effective pharmacological treatment options, leads to significant behavioral and physiological deficits. Additionally, remission for comorbid AUD and PTSD is much more difficult to attain due to exacerbated symptomology and a lack of FDA-approved medications. In recent years, cannabidiol (CBD), a non-psychoactive compound found in cannabis, has been a focus of study due to its therapeutic potential. Researchers have demonstrated the anxiolytic and anti-inflammatory effects of CBD in both humans and animals, showing its promise as a novel therapeutic agent in the treatment of psychiatric disorders. The purpose of this study is to investigate the hypothesis that CBD will reduce fear-related behaviors and neuroinflammation in a rat model of comorbid AUD and PTSD. Our AUD/PTSD model utilized restraint stress and chronic intermittent ethanol exposure procedures. To investigate changes in future stress sensitivity all animals were exposed to a contextual fear conditioning paradigm, which was used to train the animals to associate environmental and auditory cues (environment appearance and tone) with an aversive stimulus (mild foot-shock). 30 minutes prior to each conditioning session, rats received an intraperitoneal injection of CBD (20mg/kg) or 0.9% Saline. Once the animals learned to associate the cues with a shock, they were exposed to an extinction learning procedure that involved presentation of the cue alone (no shock). This procedure parallels exposure therapy in humans, allowing for the assessment adaptations to fear learning. The amount of time the rats remain still (freezing) during the tone represents fear-related behavior. Our current results indicate rats with a history of stress and alcohol exposure displayed significantly higher freezing behaviors and this effect was significantly decreased with CBD treatment. This suggests that when CBD is administered during fear learning, it is able to attenuate heightened stress sensitivity associated with AUD/PTSD. To evaluate how CBD mediates the neuroinflammatory response associated with AUD and PTSD, brains from the rats were extracted and analyzed for the inflammatory cytokine tumor necrosis factor a (TNF-a). Specific regions of interest included the medial prefrontal cortex and hippocampus, areas associated with anxiety, memory, and addiction. Neuroinflammation analyses are still ongoing, however it is predicted that rats who received CBD will show a reduction in inflammation in the medial prefrontal cortex and hippocampus. Taken together, the current results show promise for CBD to reduce enhanced fear-related behavior associated with comorbid AUD and PTSD.

The development of posttraumatic stress disorder (PTSD) and severe weather phobia (SWP) symptoms in relation to weather-related trauma was examined. Participants were college students (N = 815) enrolled at Mississippi State University. Findings suggest that distinct factors (specifically, disorder-specific cognitions and anxiety sensitivity) contribute to the development of PTSD and in the onset of SWP symptoms following exposure to weather-related trauma. A weather trauma model taking into account disorder-specific cognitive vulnerabilities, previous exposure to weather-related trauma, and levels of anxiety sensitivity is suggested to provide an explanation for these differences. The results suggest that prevention and treatment efforts should address learned fear response, aim at reducing anxiety sensitivity, and target disorder-specific cognitions.

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