Thesis (Ph. D.)--West Virginia University, 2004. / Title from document title page. Document formatted into pages; contains iv, 71 p. : ill. (some col.). Includes abstract. Includes bibliographical references (p. 29-32).

Thesis (Ph. D.)--University of Rhode Island, 2004. / Typescript. Includes bibliographical references (leaves 256-274).

Thesis (M.A.)--Ball State University, 2009. / Title from PDF t.p. (viewed on June 07, 2010). Includes bibliographical references (p. 27-31).

Thesis (Ph. D.)--University of Wyoming, 2007. / Title from PDF title page (viewed on June 30, 2010). Includes bibliographical references (p. 68-77).

Studies indicate a high prevalence of traumatic life experiences in the life histories of people with severe mental illnesses such as psychosis. High rates of posttraumatic stress disorder (PTSD) have also been found within these groups. Conversely, psychotic symptoms such as auditory hallucinations have been identified in cases of chronic PTSD suggesting a significant overlap between psychotic spectrum disorders and trauma disorders. To date however, few studies exist investigating the specific link between the onset and content of auditory hallucinations and traumatic life events. A dominant cognitive model within the clinical literature suggests that voices are intrusive thoughts that are misattributed to an external source because they are ego-dystonic. The content of intrusive voices may originate from traumatic life experiences that result in the formation of dysfunctional core beliefs. Examination of the compatibility of this account with cognitive models of PTSD, suggests the conceptualisation of a second account of voices where voices occur as flashbacks resulting from unresolved trauma. The current study aimed to investigate the link between trauma and voices by developing a method to collect in-depth qualitative data from a clinical sample of voice hearers diagnosed with psychotic spectrum disorders. A combined narrative and IPA approach was employed to guide data collection and analysis of five subjective accounts of voice and trauma experiences. Case vignettes were constructed based on clinical history, trauma history and voice content of participants and the data investigated for evidence of the two models of voices across accounts. Findings support both conceptual models, identifying a clear link between the onset and thematic content of voices and trauma. They also highlight the importance of taking a dual approach to treatment of psychotic symptoms and PTSD. The study also emphasises the need to collect data within a iii. therapeutic relationship in order to address the ethical and professional issues inherent in this area of research.

Posttraumatic stress disorder (PTSD) is complex and no one theory can fully explain the development and maintenance of PTSD symptoms. In Scotland, where trauma focused care initiatives are being considered, little is known about the extent of trauma history and associated symptoms presenting in primary care services. Furthermore, subthreshold posttraumatic stress disorder (sPTSD) has recently been associated with clinically significant impairment. With PTSD symptoms often comorbid with other psychopathology such as depression, individuals potentially seek treatment for these symptoms rather than underlying trauma which therefore may go unrecognised. Studies on the effectiveness of psychological treatment for PTSD demonstrate reasonable efficacy for well developed interventions. However, up to half of individuals may not make significant clinical improvements and withdrawal rates are high. This suggests that current treatments are not acceptable to some individuals and may be ineffective for others. In light of such clinical challenges the aim of the thesis was to investigate the incidence and nature of trauma symptoms in an Adult Psychological Therapies Service. Firstly, a systematic review was conducted to appraise the current level of evidence for prevalence and impairment associated with sPTSD. Secondly, an empirical study was undertaken to review the prevalence of trauma history and symptoms in the service. This was followed by an investigation of the relationships between processes posited to underpin many forms psychological distress by a promising new treatment approach called Acceptance and Commitment Therapy (ACT). These include; cognitive fusion, experiential avoidance and valued action. A quantitative cross sectional design collecting self report questionnaire data was used and mixed statistical methodology employed. Results from the systematic review suggest that PTSD was associated with the most impairment, followed by sPTSD, then no PTSD. Subthreshold PTSD was reported to be as, or more prevalent than, PTSD. The results from the empirical study found 89 per cent reported exposure to one or more traumatic events, 51 per cent met PTSD screening criteria, whilst a further 7 per cent reached a sPTSD diagnostic cut-off. Trauma history was positively correlated with increased psychological distress at initial assessment. Cognitive fusion, experiential avoidance and valued action were all correlated with trauma symptom severity. Both cognitive fusion and experiential avoidance mediated the relationship between number of traumatic events and trauma symptom severity in a simple mediation model. However, multiple mediation analysis demonstrated that experiential avoidance, over and above cognitive fusion, explained 33 per cent of the variance. In addition, cognitive fusion and experiential avoidance jointly had a significant indirect effect on the relationship between trauma history and valued action. The implications of the findings and further directions are discussed.

Adherence to treatment recommendations following medical care for pediatric conditions is critically important for promoting optimal physical and psychological well-being. While it has been a focus of many studies across pediatric chronic illness populations, there is a dearth of research examining adherence following pediatric unintentional injury. Empirical evidence from studies with pediatric chronic illness samples indicates that youth experience a number of barriers to adherence to medical recommendations. Adherence is especially difficult for adolescents due to the unique challenges of this developmental period. A mixed methods research approach was utilized to gain a holistic understanding of potential psychological barriers to adherence following adolescent injury. Quantitative analyses examined the potential predictive roles of adolescent psychological [i.e., posttraumatic stress (PTSD), depression, quality of life] and relational (i.e., parent PTSD and depression) factors on adherence. Results of analyses were insignificant; thus, qualitative data was collected to deepen the understanding of barriers to adherence. Findings from qualitative data analyses suggested that a number of barriers to adherence to treatment recommendations exist, including: concern of pain medication addiction, competing activities, treatment side effects, health status, desire for autonomy, and symptoms of depression. Results of qualitative analyses also revealed the presence of additional factors that could facilitate adherence to treatment recommendations. Taking into consideration findings from both quantitative and qualitative analyses, adherence may be best conceptualized as a result of a dynamic decision-making process influenced by numerous interacting factors. This study is the first to examine barriers to adherence among adolescents following unintentional injury and provides an initial roadmap for understanding the mechanisms involved in this complex process. / Ph. D.

Thesis (Ph. D.)--University of California, San Diego and San Diego State University, 2006. / Vita. Includes bibliographical references (leaves 103-116).

This study focused on trauma and seeked to demonstrate that the application of a Buberian understanding to the experience of trauma can help shed light on the impact of trauma on a sufferer's life. The aim of the study was to gain an understanding of the impact of trauma on interpersonal relationships as well as to determine components of psychotherapy found most helpful in the recovering process.

This investigation examined the association between Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) posttraumatic stress disorder (PTSD; American Psychological Association, 1994) symptoms as measured by the Children’s PTSD Inventory (CPTSDI; Saigh, 2003a) and the Wechsler Intelligence Scale for Children, 3rd Edition (WISC-III; Wechsler, 1991) scores of 78 traumatized children (mean age = 13.42 years, SD = 2.68 years). Child diagnostic interviews determined that the participants did not have major comorbid disorders and were not taking medications that could influence cognitive functioning. Significant inverse correlations were observed between the different symptom CPTSDI clusters and the WISC-III Verbal indices. Moreover, with the exception of the WISC-III Block Design subtest, nonsignificant correlations were observed between the WISC-III Performance measures and the CPTSDI symptom clusters. Theoretical and clinical implications are considered.