Nagrinėti tyrimai rodo, jog depresija, stresas, jo įveika bei emociniai veiksniai yra susiję su didesne mirštamumo nuo širdies ligų rizika, didesne infarkto tikimybe ir neigiamomis operacijos pasekmėmis, tačiau į tai menkai atsižvelgiama. Norint pasiekti sėkmingus rezultatus tiek paciento fiziologinės, tiek psichologinės sveikatos atžvilgiu, reikia ilgalaikio ir nuoseklaus komandos darbo. Psichosocialiniai veiksniai tiek gydytojų, tiek pačių pacientų vertinami gana skeptiškai, todėl dažnai pakankamai neatsižvelgiama į paciento psichinės būklės įtaką sveikatai, ligos vystymuisi ir gijimui, todėl svarbu atskleisti širdies kraujagyslių sistemos ligomis sergančių asmenų emocinės būklės bei stresogeninių situacijų įveikimo strategijų ypatumus ir jų sąsajas. Anketinėje apklausoje dalyvavo 169 dalyviai: 52 Kauno medicinos universiteto klinikos Kardiologinių bei Širdies centro skyrių pacientai, besigydantys stacionare, kuriems buvo atlikta širdies kraujagyslių operacija ir 67 Kauno medicinos universiteto klinikos Kardiologinių bei Širdies centro skyrių pacientai, besigydantys stacionare be kardiochirurginių intervencijų bei 50 asmenų, profilaktiškai besitikrinantys Kauno medicinos universiteto šeimos klinikoje, kurie sudarė kontrolinę grupę. Tyrime dalyvavę pacientai užpildė HAD (depresijos ir nerimo įvertinimo klausimyną), įveikos strategijų klausimyną – COPE bei potrauminio streso sindromo simptomų skalę (PSS-SR). Kontrolinės grupės respondentai nepildė potrauminio streso... [toliau žr. visą tekstą] / Despite, it is known from previous research that depression, stress, coping and other emotional factors contribute to cardiac patients’ mortality, higher risk of myocardial infarct and operation complications, attention is insufficiently paid on psychological factors. It is necessary long-term and consecutive team work, so as to achieve great physiological and psychological patients’ health. Doctors and patients usually devalue the impact of psychosocial factors on cardiac patients health, therefore it is important to reveal cardiac patients’ the emotional conditions, coping strategies and their connections. 169 participant were chosen for this research: 52 cardiac patients with surgery intervention, 67 cardiac patients without surgery intervention and 50 participants in control group. Research participant were asked to fill in Hospital Anxiety and Depression scale (HAD), coping questionnaire – COPE and PTSD Symptom Scale – self report version (PSS-SR). The control group were not asked to fill in PTSD Symptom Scale – self report version (PSS-SR). It was found that cardiac patients have high level of anxiety and depression. Cardiac patients with a surgery intervention more often use emotion oriented coping strategies than healthy persons. Post-traumatic stress disorder prevalence among cardiac patients is running 25%. Poor emotional state is not linked with problem oriented coping among cardiac patients; it is associated with focus on and venting of emotions and... [to full text]

Posttraumatic Stress Disorder (PTSD) is an anxiety disorder characterised by disturbed arousal, altered attention, and fear processing, and a reduction in the ability to perform cognitive tasks. Predominant neurophysiological models of PTSD have been focused on alterations in fear-related regulation, and few incorporate broader changes in generic executive control which may underlie many of the clinical symptoms and cognitive deficits in PTSD. This thesis aimed to investigate the neurophysiology of executive inhibitory control in PTSD using a Go/NoGo response inhibition task and converging functional imaging, structural imaging and electrophysiological measures. The first series of studies aimed to elucidate a normative neural network model of inhibitory control, and are consistent with normative control involving the activation of a mainly right-lateralised ventral lateral prefrontal cortex (VLPFC) network. Inhibitory control-related activation was found to be affected by levels of anxiety and changes in underlying neural structure; alterations in frontal cortical maturation and volume were related to additional activation of bilateral frontal cortical regions and the dorsal striatum, with anxiety increasing the demand on inhibitory control-related activation. In contrast to healthy participants, PTSD was associated with reduced inhibitory control as indexed by inhibitory behaviour, diminished activation of the right VLPFC, and slowed inhibition-related information processsing. PTSD participants relied on the greater activation of a left fronto-striatal inhibition network to support control, with the activation affected by levels of PTSD severity and comorbid anxiety. This left fronto-striatal activation in PTSD was related to underlying increases in fronto-striatal neural structure. Further, the ability to efficiently engage a left fronto-striatal network in PTSD during inhibitory control predicted better response to cognitive behavior for PTSD, consistent with the proposal that an improved ability to flexibly engage control systems may facilitate the resolution of PTSD symptoms. Taken together, this program of research extends current neurophysiological model of PTSD to show that PTSD involves a fundamental disturbance in the function and structure of key fronto-striatal response control networks associated with inhibitory control.

Doctor of Clinical Psychology/ Master of Science (DCP/ MSc) / A number of international studies reveal high prevalence rates of posttraumatic stress disorder (PTSD) within homeless populations. Recent research on PTSD indicates that cognitive responses to trauma are critical in determining who develops the disorder. In Australia, a number of studies indicate exceptionally high rates of trauma experience among homeless adults, yet PTSD has not been investigated in this cohort. Therefore, the primary aim of this project was to improve understanding of PTSD and related cognitions in a sample of homeless adults in Sydney. The project attempts to determine the prevalence of PTSD and its onset in relation to homelessness (Study One) and also explores the role of cognitions in PTSD (Study Two). The sample consisted of seventy homeless men and women aged 18 to 73 years, who were randomly sampled through eight homeless services. A computer-assisted face-to-face structured clinical interview was conducted for each participant. The majority of the sample stated that they had experienced at least one traumatic event in their lifetime (98.2%). The twelve-month prevalence of PTSD was higher among homeless adults in Sydney in comparison to the Australian general population (41.1% versus 1.5%). In 59.1% of cases, the onset of PTSD was found to have occurred before the age of the first reported homeless episode. In a comparison of those with and without a current diagnosis of PTSD, it was found that those with PTSD scored significantly higher overall on measures of posttraumatic cognitions and early maladaptive schemas. In particular, this group scored higher on schemas that centre on the world being entirely dangerous and the self being totally inept. A mediational analysis showed that when trauma and mental health care were controlled, the relationship between early maladaptive schemas and PTSD symptom severity was mediated by posttraumatic cognitions. It was concluded that homeless adults in Sydney frequently experience trauma and PTSD, which typically precedes homelessness. It was also concluded that among homeless adults, posttraumatic cognitions and early maladaptive schemas appear to play an important role in PTSD and may be associated with symptom severity. These findings have implications for public policy on homelessness and mental health, homeless service provision, PTSD theory, and PTSD treatment for homeless adults.

By using the theoretical framework developed by Schaefer and Moos (1998), this study examined the mechanisms through which personal beliefs in ultimate justice affect posttraumatic growth in female survivors of sexual assault. Problem solving, spiritual coping, and meaning making were examined as potential mediators between beliefs in ultimate justice and posttraumatic growth through a path analysis. In total, 144 female community survivors, psychology students, and other participants were recruited from a large mid-western university (mean age = 29.3). The online survey was composed of a demographic questionnaire, the Revised Sexual Experiences Survey (Koss et al., 2007), Emotion Thermometer (Mitchell, 2001), Posttraumatic Growth Inventory (Tedeschi & Calhoun, 1996), Belief in Immanent and Ultimate Justice Scale (Maes, 1998), Trauma Resilience Scale (Madsen & Abell, 2010), and the Meaning in Life Questionnaire (Steger, Frazier, Oishi, & Kaler, 2006). Results indicate that problem solving and spirituality significantly mediated the relationship between belief in ultimate justice and posttraumatic growth. Search for meaning significantly mediated the relationship between beliefs in ultimate justice and distress. Implications for practice and research are discussed. Keywords: sexual assault, posttraumatic growth, belief in a just world, meaning making, coping

Posttraumatic stress disorder (PTSD) is a debilitating mental illness that affects thousands of military service members and veterans every year. Strongly associated with PTSD are symptoms of depression, life satisfaction and physical health complaints. Playing video games has been shown in the past to reduce symptoms of PTSD, other mental illnesses, and reduce the experience of pain. The purpose of this study was to examine these relationships, specifically regarding a 3-4 hour per week duration that has been particularly beneficial to military service members in the past. Participants included n = 400 military service members or veterans who had served in a combat zone and was relatively representative of the U.S. military population. Participants completed a number of measures assessing PTSD and depressive symptoms, life satisfaction, physical health, military service, and video game play behaviors. Results indicated that no relationship exists between the duration of video game play PTSD symptoms severity, unless the PTSD symptoms were present first. A linear relationship was also noted between video game play duration and depressive symptoms. No significant relationship was observed between video game play duration and life satisfaction or physical health ailments. These findings seem to contradict some of the previous literature, though may indicate that playing video games as a utilization of an avoidance strategy could be detrimental to one’s mental health.

xv, 134 p. : ill. A print copy of this thesis is available through the UO Libraries. Search the library catalog for the location and call number. / Prior research finds that exposure to traumatic stress negatively impacts physical and mental health, and that the social context in which trauma occurs is an important predictor of symptom development. Eight-hundred thirty-three members of an ethnically diverse longitudinal cohort study in Hawaii were surveyed about their personal exposure to several types of traumatic events, socioeconomic resources, mental health symptoms, and health status. Rates of trauma exposure were predicted to vary as a function of type of trauma and participant gender and ethnicity. In addition, access to social resources and the relational context of trauma were predicted to be associated with symptom reports in this ethnically diverse sample of men and women. Results replicated findings that while men and women are exposed to similar rates of trauma overall, women report more exposure to traumas high in betrayal. while men report exposure to more lower-betrayal traumas. Women also reported more mental health symptoms, and traumas higher in betrayal were generally more predictive of symptoms. Ethnic group variation in trauma exposure and physical and mental health symptoms was also present: ethnic groups with lower socioeconomic status generally reported more trauma exposure and symptoms, although in some cases the pattern of results was not straightforward. This study adds new information about the prevalence of traumatic stress and mental health symptoms across ethnic groups in Hawaii, and how these relate to social context. In addition, this study provides preliminary information on the independent contribution of neglect and household dysfunction to the prediction of symptoms. The relevance of these results can be summarized with three main arguments. First, measures of trauma exposure must include events that occur across relational contexts if they are to be gender equitable and most predictive of symptoms. Second, gender and ethnic group differences in symptoms are largely explained by differential trauma exposure and differential access to educational and economic resources. Third, prevention and intervention efforts must address both trauma exposure and social context, as each is implicated in the presentation of symptoms. / Committee in charge: Jennifer Freyd, Chairperson, Psychology; Anne Simons, Member, Psychology; Gerard Saucier, Member, Psychology; Debra Merskin, Outside Member, Journalism and Communication

Sexual trauma, in addition to being a human rights violation, harms people in numerous ways, including negative psychological and physical outcomes. Body-based interventions reduce sexual trauma symptoms, but limited information exists about how these interventions work. Researchers propose changes in internal body sensation awareness (i.e., interoceptive awareness; IA) as a potential mechanistic explanation. We are not aware of any studies testing that claim. Further, there is scant extant information on IA – sexual trauma relationships. Before evaluating mechanistic therapeutic hypotheses, studies need to test sexual trauma – IA associations. We focus on this understudied area here. Through a multi-method study (behavioral, self-report and qualitative data), we tested the associations between IA and sexual trauma among females. Aim 1: Characterize IA among sexual trauma survivors. We hypothesized that survivors would have significantly lower self-reported IA than existing literature. Aim 2: Quantify the amount of variance IA explains in posttraumatic stress disorder (PTSD) symptoms. We hypothesized that IA would predict significant variance in PTSD, such that increases in IA would predict increases in PTSD. We expected that an IA – dissociation symptom interaction would qualify that main effect via weakening it for survivors with higher dissociation. Aim 3: Through a moderated mediation model, test if IA mediates the sexual trauma – PTSD association. We hypothesized that IA would mediate that association. Further, we predicted that the IA – PTSD relationship would be moderated by dissociation: higher dissociation would attenuate the IA – PTSD association. In this manuscript, we report results from two samples: 1) University (n = 153), and 2) community (n = 21) participants. Given ongoing community participant recruitment, the following are university participant results. Aim 1: Self-reported IA is significantly lower among survivors than comparator samples. Aim 2: Behavioral IA explained significant variance in PTSD, though opposite to the direction we predicted: we observed that as IA increased, PTSD decreased. We observed a significant interaction between self-reported IA and dissociation in predicting declines in PTSD. PTSD symptoms were lowest among survivors with high dissociation and high IA. Aim 3: IA did not mediate the sexual trauma – PTSD association. We discuss clinical implications, limitations and future directions.

Background Posttraumatic stress disorder (PTSD) brings with it diagnostic symptoms that can be debilitating and persist for years. Left untreated, PTSD can have far-reaching and damaging consequences – for the individual, families, communities, and society at large. While early detection and intervention is recognized as key to the effective treatment of PTSD, many who suffer from PTSD do not seek essential health services. The aim of this study was to answer the research question: based on existing literature, what are the barriers and facilitators to help-seeking for individuals with PTSD? Methods A systematic review, modeled on the Joanna Briggs Institute (JBI) methodology for systematic reviews, examined studies cited in PsycINFO, Medline, Embase, CINAHL and PILOTS published from January 2000 to November 2015. Eligible studies measured barriers and facilitators to help-seeking for adults with PTSD. Two reviewers independently screened citations and double data extraction was exercised. Results Of 1,759 potentially relevant citations, sixteen studies were included, published between 2003 and 2015 and based in five countries, predominantly within the United States (n=12). Thirteen studies focused on military as a target population. Eight principal barrier themes and seven principal facilitator themes were identified, under which supportive subthemes were categorized. Conclusions In identifying prominent barriers and facilitators to help-seeking for individuals with PTSD, this review highlights opportunities to inform policies and programs that educate and promote PTSD knowledge and recognition, reduce public and personal stigma, improve access and availability of care, and encourage social support for patients and families living with PTSD.

This research portfolio examines the impact of trauma exposure in the emergency services. Emergency services represent a unique population in that they are frequently and repeatedly exposed to distressing and potentially traumatic situations. Firstly, a systematic review was conducted looking at factors that may potentially predict positive outcomes following trauma exposure in firefighters, namely the concept of posttraumatic growth (PTG). A review of the existing evidence was conducted across five databases. Studies were assessed against inclusion criteria and 12 studies were included. Results suggested that PTG was generally either not significantly or weakly related to other factors. Variables that were associated with PTG were aspects of the trauma exposure, post-traumatic stress severity and organisational and operational factors; however results were limited by methodological quality. Overall, the current evidence base has not identified strong predictors of PTG and associations appear multifactorial. Results indicate that PTG appears to have limited clinical utility in firefighters and that future research should improve upon the methodological limitations of the existing evidence base. The second part of the portfolio consists of an empirical study exploring the levels of post-traumatic stress symptom (PTSS) severity in ambulance clinicians and a cross-sectional analysis of factors relating to PTSS severity and psychological wellbeing in this population. A total of 508 ambulance clinicians (Paramedics and Ambulance Technicians) were recruited across Scotland. The relationships between PTSS severity, psychological wellbeing, self-compassion and psychological inflexibility were analysed using structural equation modelling. Results showed approximately 50% demonstrate clinically concerning levels of PTSS in the ambulance service and a strong positive relationship between psychological inflexibility and PTSS severity as well as with psychological wellbeing. Self-compassion had a small association with psychological wellbeing but was not significantly associated with PTSS severity. The potential impact of relying on post-traumatic stress disorder criteria of symptoms lasting for four weeks or more may mask the extent of PTSS experienced in this population. Findings indicate concerning levels of trauma symptomology within a representative ambulance service sample, and suggest the need for further investigation into potential causal relationships between psychological flexibility and PTSS in order to deliver effective interventions to reduce PTSS severity in this population.

This thesis portfolio consists of two key pieces of work, a systematic review and an empirical research project, both of which explore outcomes associated with traumatic experiences. Systematic Review – There is a growing body of literature which demonstrates that, alongside the difficulties people may experience following trauma, many individuals are also likely to report growth following the struggle to come to terms with the event. This review explores the evidence for a relationship between reported growth and distress following civilian, interpersonal trauma. The review includes 13 studies which met the inclusion criteria (9 cross-sectional and 4 prospective). Findings are inconsistent and suggest that prospective study designs are more likely than cross-sectional designs to report significant relationships. A number of methodological issues and the implications for future research are discussed. Empirical Research Project – Survivors of childhood sexual abuse (CSA) present with a wide range of difficulties and the current evidence base for the treatment of complex trauma is limited. It is proposed that self-compassion and forgiveness based approaches may have the potential to be of benefit to this population. This cross-sectional study explored the relationships between posttraumatic stress symptoms, dissociation, self-blame, self-compassion and forgiveness. A clinical sample of adult survivors of CSA (N = 19) completed all measures. In keeping with previous literature, significant relationships were found between posttraumatic stress and both dissociation and self-blame. Forgiveness was positively correlated with dissociation, but not the other variables and no significant relationships were found between self-compassion and the variables of interest. Findings, implications and study limitations are discussed.