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Despite a high proportion of the population experiencing traumatic events within their lifetime, the number of individuals who go on to develop posttraumatic stress disorder (PTSD) is comparatively small; herein highlighting the importance of individual differences in imparting risk and resilience towards the development and maintenance of PTSD. Existing literature illustrates that biological and ecological factors are important in predicting PTSD development, with pathological vulnerabilities excepting their effects at pre- peri- and post trauma stages. Whilst cognitive and emotion based models of PTSD account for the role of a minority of known pre-trauma risk factors, individual differences in peri- and post trauma processes are held as critical to the development of PTSD. The broad range of risk factors implicated in the empirical literature, and necessity of traumatic exposure to PTSD, implicates the utility of a diathesis-stress conceptualisation of PTSD development. The current thesis employed an analogue VR-trauma paradigm to investigate the respective importance of vulnerability factors at each stage, in the prediction of analogue PTSD symptoms (memory problems, startle responses, re-exposure fear habituation), whilst measuring affective and electrophysiological concomitance. Findings supported the importance of peri-traumatic responses in the prediction of PTSD, where present, showing increased predictive capacities over pre- and post-trauma factors. Biological and ecological factors also illustrated important predictive associations, with genetic SNPs implicated in reflex startle and cardiac responses towards intrusive memories. Moreover, peri-traumatic HR decelerations and accelerations mediated the association between pre-trauma factors and cued recall inaccuracy and intrusion severity respectively. Results support existing cognitive and emotional models in their emphasis on peri-traumatic processes but suggest the added utility of a diathesis stress conceptualisation of the development of PTSD, in highlighting the importance of pre-trauma biological and ecological risk and resilience factors.

In den Jahren 1992-1995 kamen ca. 35 Tausend bosnische Kriegsflüchtlinge nach Berlin und wurden vorübergehend geduldet. Nach Kriegsende 1995 sollten sie schnellstmöglich wieder zurückkehren. Traumatisierte und Ältere ohne Angehörige im Heimatland wurden weiterhin geduldet bis Bosnien-Herzegowina wieder aufgebaut ist. Doch der Wiederaufbau verlief schleppend. Mit dem Friedensvertrag von Dayton begannen nicht Frieden und Wiederaufbau, sondern die Konsolidierung der ethnischen Grenzen in demokratischen Strukturen. Deshalb sahen viele Flüchtlinge keine Möglichkeit in ihre Heimatorte zurückzukehren und versuchten ihre Rückkehr hinauszuschieben. Möglich war dies mithilfe der Attestierung einer kriegsbedingten Posttraumatischen Belastungsstörung und ihre psychotherapeutische Behandlung, die den Inhabenden und ihren Familienmitgliedern eine Aufenthaltsverlängerung ermöglichte und ab dem Jahr 2000 den Erhalt eines dauerhaften Aufenthaltstitels. Die Verbindung einer psychischen Krankheit und ihrer Psychotherapie mit einem Aufenthaltsrecht ist neu in der Geschichte des deutschen Ausländerrechts und obwohl Berliner Psychiater, Psychiaterinnen, Psychologinnen und Psychologen maßgeblich an der Schaffung der „Traumatisiertenregelung“ beteiligt waren, wurden ihre Atteste von der Berliner Verwaltung in Frage gestellt. In der Dissertation werden die Standpunkte der Flüchtlinge, Behandelnden und der Verwaltung dargelegt und ihre Interaktionen beschrieben.Die Rolle des Krankheitskonzeptes der Posttraumatischen Belastungsstörung wird als "boundary object" (Star/Griesemer 1989) untersucht. Der Schwerpunkt liegt auf den Lebenswelten und Taktiken der Flüchtlinge, sich in Berlin zurechtzufinden und Anerkennung und Verständnis für ihre Situation zu finden. Ihre Bedürfnisse wurden in einen psychotherapeutischen Bedarf übersetzt und damit den Berliner Psychotherapeutinnen und -therapeuten ein neues Betätigungs- und Professionalisierungfeld geboten, was kritisch hinterfragt wird. / From 1992 until 1995 about 35 thousand Bosnian war refugees fled to Berlin and were allowed to stay temporarily. After the end of the war in 1995 they were expected to leave as soon as possible. Traumatized persons and elderly without relatives in Bosnia had the possibility to prolong their visa until Bosnia is reconstructed. But the rebuilding process progressed only slowly. With the end of the war did not start the expected peace time and rebuilding but the consolidation of ethnic borders inside democratic structures. Therefore many refugees did not see a possibility to return to their property and tried to delay their return. This was possible with an medical statement certifying a war related posttraumatic stress disorder and their psychotherapeutic treatment. These medical statements ensured the extension of the visa for the concerned person and its family members. From 2000 onwards they could receive a permanent residence title. The connection of a mental illness and psychotherapy with residence entitlements is a novelty in the German aliens law. And despite the fact that psychiatrists and psychologists from Berlin were leading actors in the establishment of the „regularization of the traumatized“ their medical/psychological statements were impeached by the authorities. The dissertation describes the viewpoints of refugees, treating physicians and psychologists and the authorities and how they interact with each other. Additionally is the concept of posttraumatic stress disorder examined and discussed as „boundary object“ (Star/Griesemer 1989). An important aspect is the description of life worlds and tactics of the refugees to get along in Berlin, to gain respect and appreciation for their situation. Their needs were translated into a psychotherapeutic demand and this led to the invention of a new field of work and professionalization for psychotherapists in Berlin. This development is critically reflected.

Changing trends within the mental health system treatment practices demand exploration of the cultural context of assessment and treatment of Black/African Americans. Culturally competent assessments include a realistic integration of historical context. Clinicians counseling Black/African Americans must be prepared to assess and address PTSD, racial trauma, micro-aggressions, and other known (or unknown) issues that may affect Black/African Americans. In addition, clinicians must be prepared for the depth and permanence of race-based stress and trauma, as well as the idea that said stress and trauma can result from unaddressed environmental, familial, and/or individual factors. The purpose of this study is to explore cultural competence in the practices of clinicians working with Black/African Americans clients as it relates to assessment, treatment and engagement. Through the exploration of current multicultural counseling and assessment trends, the study explores the origins of stress and trauma in American descendents of African slaves, and proposes an evaluation of clinicians' mental health assessment for PTSD with said clients based on those implications. Exploring to what extent a culturally-proficient clinician engages Black/African Americans clients from initial through on-going assessment and treatment process in conjunction with the professional literature on treatment practices, research suggests that Black/African American clients do suffer from intergenerational trauma and are often mis- or under-diagnosed for mental health issues. With proper assessment of Black/African Americans, the reduction of misdiagnosed or under diagnosed cases of Posttraumatic stress disorder (PTSD), as well as other mental health conditions will occur. / Graduation date: 2012

Anxiety disorders are very common and the primary feature is abnormal or inappropriate anxiety. Fear and anxiety is often mediated by the amygdala, a brain structure rich in substance P (SP) and neurokinin 1 (NK1) receptors. To learn more about how the human amygdala is modulated by fear and anxiety in event-triggered anxiety disorders and to investigate if the SP/NK1 receptor system is affected, regional cerebral blood flow (rCBF) ([15O]-water; Study I and II) and the SP/NK1 receptor system ([11C]GR205171; Study III and IV) were studied with positron emission tomography (PET). In Study I we investigated the neural correlates of affective startle modulation in persons with specific phobia by measuring rCBF during exposure to fearful and non-fearful pictures, paired and unpaired with acoustic startle stimuli. Fear-potentiated startle was associated with activation of the affective part of the anterior cingulate cortex and the left amygdaloid–hippocampal area. In Study II short-term drug treatment effects on rCBF in patients diagnosed with social phobia was evaluated, comparing the NK1 receptor antagonist GR205171 to the selective serotonin reuptake inhibitor citalopram and placebo. Social anxiety and neural activity in the medial temporal lobe including the amygdala was significantly reduced by both drugs but not placebo. In Study III we investigated if activity in the SP/NK1 receptor system in the amygdala would be affected by fear provocation in individuals with specific snake or spider phobia. Fear provocation was associated with a decreased uptake of the NK1 antagonist [11C]GR205171 in the amygdala, possibly explained by an increase in endogenous SP release occupying the NK1 receptors. Study IV was conducted to explore the resting state NK1 receptor availability in PTSD patients as compared to healthy controls. Increased resting state binding of the tracer [11C]GR205171 in the amygdala of patients with PTSD suggested an increased amount of available receptors. In summary, fear and fear-potentiated startle modulates the human amygdala, possibly through the SP/NK1 receptor system.

Providing aid to the inhabitants struck by the stress incentives is on a good level. The findings show that the system of aid providing is set and guarantees its functionality as well as efficiency. Its part is also the preparation of the members of components of the Integrated Rescue System to provide the aid during the stress load of the inhabitants. It is provided on the sufficient level with a significant effort of services bodies and services bodies for its development and structuring. The problem consists in the level of preparedness of the inhabitants. Their behaviour does not correspond to the needs, the people behave in a chaotic way, do not respect the instructions, underestimated the danger. The reason is not that no suitable conditions were created for their preparation or that such a preparation was not performed at all. It was found out that the offer for the substantial education of inhabitants is on the sufficient level and has an adequate scope. Also its forms cover real expectations. The problem is its limited usage by inhabitants for the reason of underestimation of risks and danger. The people are indifferent and persuaded they personally cannot be endangered or struck. The consequence is the state in which neither the individuals nor their communities are prepared on the extraordinary events and they do not know how to behave during them rationally and safely. This leads to the further deepening of the stress load and to the gradation of the initiated psychological problems. As a solution, the creation of a general public meaning is recommended alerting to danger of extraordinary events and to the necessity of a responsible personal preparation on them, including the awareness of the associated psychological endangerment.

Based on longitudinal ethnographic fieldwork in Bosnia and Herzegovina I trace ontologies of posttraumatic stress disorder (PTSD) and their enactments among veterans of the 1992-1995 war. My aim is to problematize and rethink social constructionists' approaches in medical anthropology that discuss war trauma and PTSD in relation to naturalistic models and treat them as constructed realities not determined by the nature of things. I argue that such a standpoint produces a particular epistemological/ontological side-effect: it allows medical anthropologists to craft a purely social ontology of trauma and PTSD by claiming that the realness of these "constructs" is a result of psychiatric discourse, moral economy of contemporary societies or Western (intellectual, political, and medical) hegemony. Considering the ontology of PTSD as an empirical question I analyze the enactments of PTSD in four settings: the ethnographic genre itself, the organization of war veterans with PTSD in the city of Tuzla, the veterans' welfare system in the Federation of Bosnia and Herzegovina, and Bosnian public arena. I argue that PTSD is practiced as a heterogeneous and multiple reality that cannot be situated solely either in the realm of human organism (and explained by naturalistic models) or society and culture (and...

The diploma thesis called "The process of moving towards the optimal supervision system of crisis interventions of the Police of the Czech republic" is connected with the future deriving of the project within the structural fund of European Union. The aims of the project is to support, implement and move to optimal supervision for crisis interventions of the Police of the Czech Republic. The thesis is a first research step for initial ideas about supervision and its systematic implementation to individual regional directorates of the Police of the Czech Republic. The theoretical part is focused on the basic concepts in the field of crisis intervention and supervision. The main chapters are supplemented by topics with an overlap into the system of the Police of the Czech Republic. The empirical part was performed using an online questionnaire survey. The research sample was a set of police crisis interventions from all regions of the Czech Republic, where the crisis assistance is provided by the team of the crisis intervention. There are several aims in the diploma thesis. The main one is to map and to describe the current system of supervision of crisis interventions and to compare individual regions in the area of providing supervision. Another aim is to find out various psychosocial aspects such...

Based on longitudinal ethnographic fieldwork in Bosnia and Herzegovina I trace ontologies of posttraumatic stress disorder (PTSD) and their enactments among veterans of the 1992-1995 war. My aim is to problematize and rethink social constructionists' approaches in medical anthropology that discuss war trauma and PTSD in relation to naturalistic models and treat them as constructed realities not determined by the nature of things. I argue that such a standpoint produces a particular epistemological/ontological side-effect: it allows medical anthropologists to craft a purely social ontology of trauma and PTSD by claiming that the realness of these "constructs" is a result of psychiatric discourse, moral economy of contemporary societies or Western (intellectual, political, and medical) hegemony. Considering the ontology of PTSD as an empirical question I analyze the enactments of PTSD in four settings: the ethnographic genre itself, the organization of war veterans with PTSD in the city of Tuzla, the veterans' welfare system in the Federation of Bosnia and Herzegovina, and Bosnian public arena. I argue that PTSD is practiced as a heterogeneous and multiple reality that cannot be situated solely either in the realm of human organism (and explained by naturalistic models) or society and culture (and...