Thesis (Ed.D.)--Boston University / Background: Season-ending injuries, particularly those to the anterior cruciate ligament (ACL), continue at a high-rate in many sports, particularly ski racing. Although many factors are thought to contribute to this injury rate in both genders, no study has looked at possible psychological influences. Hypothesis: There is a form of post-traumatic stress disorder (PTSD) that affects athletes after seeing someone in their own sport sustain a serious injury. The result could be a decrease in performance both on and off the mountain. In the worst-case scenario, this change in tactics could result in injury to themselves, representing an "injury contagion". Study Design: Case-control study; Level of evidence, 3. Methods: Students at four Eastern ski academies were studied for 3 consecutive years (2002-2005). The subjects ranged in age from 13-19 and consisted of 277 men (60.3%) and 182 women (39.7% ). When a subject sustained a season-ending injury, a peer group of that subject was tested for both psychological and performance effects. The results of this testing was compared to previous baseline testing and a similarly constructed control group from an academy without such an injury. Results: There were twelve season-ending injuries sustained over the three-year period. Significant data results were obtained from one aspect of the psychological testing of the peer group. There was a trend toward a possible "injury contagion" i.e. injury to a member of the peer group soon after injury to a teammate. Conclusions: Although the results of this study were inconclusive in establishing the existence of an "injury contagion", there were data to establish a psychological affect on some athletes after injury to one of their teammates. Clinical Relevance: Although a teammate's injury did not measurably effect performance and only showed mild evidence of a possible injury contagion, there were significant psychological affects noted in female subjects. School personnel should be trained in basic counseling techniques specific to this problem.

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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