Thesis (Ph. D.)--University of Chicago, Dept. of Political Science, June 2001. / Includes bibliographical references. Also available on the Internet.

Self-compassion is a psychological construct that involves being open to experiencing one's pain and suffering and directing feelings of kindness inwards during moments of distress. Research has found that high levels of self-compassion are negatively associated with depression, anxiety, rumination, and avoidance, and positively associated with overall quality of life. The present study looked at self-compassion as a predictor of psychopathology and functional outcomes in a sample of trauma-exposed OEF/OIF veterans. Baseline data was used from Project PREDICT from of the Department of Veteran Affairs VISN 17 Center of Excellence for Research with Returning War Veterans. The relations among self-compassion, mindfulness, and experiential avoidance were analyzed. Structural equation modeling was used and results found that higher levels of self-compassion and mindfulness predicted lower levels of psychopathology and higher overall functioning. In addition, experiential avoidance partially or fully mediated the association between mindfulness and self-compassion and PTSD symptoms, psychological distress, and functionality. Supplemental regression analyses were also conducted examining the relationship between mindfulness and self-compassion with several outcome variables. Results found that self-compassion significantly contributed to the model predicting acceptance of chronic pain. In addition, mindfulness significantly contributed to the model predicting problematic alcohol use. These findings suggest that inclusion of acceptance-based interventions, specifically self-compassion and mindfulness, may improve emotional distress as well as overall functioning in trauma-exposed combat veterans. / text

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Thesis (M.B.A.)--Naval Postgraduate School, September 2005. / Includes bibliographical references (p. 127-130). Full text available through DTIC database

Thesis (M.S.W.)--Smith College School for Social Work, Northampton, Mass., 2009. / Includes bibliographical references (p. 52-54).

This study served as a preliminary investigation of the effectiveness of an understudied complementary (to traditional treatment approaches) intervention for military related PTSD. Specifically, the utilization of a nonprofit organization’s intensive three-week training program and use of psychiatric service dogs (PSDs) for PTSD and associated symptom amelioration. The sample included two separate cohorts of military veterans (n = 7 and n = 5) with prior diagnoses of PTSD. Participants completed a battery of self-report measures assessing PTSD and related symptoms, depression, perception of social support, anger, and overall quality of life. Participants also completed an attention bias task that was utilized to objectively assess changes in attentional bias to threat. Participants completed the measures one month prior to the training (baseline), at arrival to the training site, at the end of each week of the training, and at one and six month follow-up. Results indicated that, for all participants, there was a statistically significant decrease in PTSD and depression symptoms. In addition, for most participants, these decreases were both clinically significant and reliable. Further, participants reported significant reductions in anger and improvement in perceived social support and quality of life. Data from the attentional bias task was inconclusive. Limitations of the study include a lack of control group and small sample size. Despite this, the findings of this study indicate that utilizing PSDs as a complementary treatment for PTSD could yield beneficial results in terms of symptom amelioration and improvement to overall quality of life for veterans suffering from PTSD.

Purpose: With the obesity epidemic ever increasing, the purpose of this quality improvement project is to assess if Veteran’s Administration (VA) primary care providers have knowledge of and/or application barriers of the Veteran’s Administration/Department of Defense Clinical Practice Guideline for Screening and Management of Overweight and Obesity (SMOOG) in the VA primary care clinic in southern Arizona. Background: The prevalence of obesity seen in adults in the U.S. escalated from 15% to 34%, which is more than double from 1980 to 2008. Active military and Veterans obesity rates rose in similar fashion. The implementation of practice guidelines is critical to effective treatment to counteract the rising rates of overweight and obesity. Adherence to clinical practice guidelines often remains low causing an omission of therapies recommended in the guidelines. Methods: This quality improvement project used a descriptive methodology. Initially, SMOOG was evaluated using the AGREE II instrument. Next, a survey was administered to primary care providers to identify provider knowledge of and barriers to utilization of the SMOOG guidelines. Inclusion criteria for this study are: VA employed primary care provider and practicing primary care for at least 1 year. The 20-question survey measured providers’ knowledge and perceptions of their use of the VA/DoD SMOOG. Results: Evaluation using the AGREE II tool revealed the lowest possible quality scores observed in the Applicability domain. Based upon the results of the evaluation SMOOG is recommended for use with modifications specifically improving its applicability. Fifteen primary care providers participated in the survey. The results revealed that few primary care providers use SMOOG in clinical practice and barriers exist to implementation of SMOOG. Conclusions: Assessing providers’ knowledge, perceptions, and barriers to SMOOG provides insight towards the next steps in addressing the rising prevalence of obesity among U.S. Veterans. An appraisal of SMOOG revealed that the guideline was developed with a high quality in the areas of evidence and clear presentation, but is clearly deficient in its applicability of implementation of the recommendations. The data obtained serves as an initial step to inform future research into synthesizing and guiding an implementation strategy.

Essentially, the subject of this thesis is the problem of multiple hospital admissions, and the possible psychosocial etiology of these admissions. Chronic readmissions to hospital are of concern to social workers, to hospital personnel, and to the wider community, in view of the numerous and varied concommitant problems which may involve not only the patient, but any number of other persons or projects in the community. A survey of the several hundred referrals made to the Medical Social Service Department at Shaughnessy Hospital, Vancouver, during the fiscal year studied (1952-53) points up the fact that more than half of this referral group constitutes patient readmissions, and that at least one-quarter of the readmitted group might be considered as having a chronic readmission pattern. The manner in which this present study is approached is through detailed examination of data on district office files and medical social service case records, relative to a group of fifty-one veteran patients with a chronic readmission pattern, referred to the Medical Social Service Department at Shaughnessy, for varied medical-social problems. Findings of this study indicate that psychosocial factors, at least among the group selected, weigh heavily in a pattern of chronic hospital readmissions. Judging from the retarded referrals, there does not seem to be a sufficient awareness, on the part of a number of hospital personnel, that the admission pattern of many veterans contains a substantial psychosocial element, and/or if such is realized, that medical social services might be beneficial in rehabilitating the patients concerned. The onus for remedying this situation lies not only with the staff of the Medical Social Service Department at Shaughnessy, but with administration, with the medical staff, and with all DVA personnel interested in helping the veteran to function adequately outside the hospital setting. / Arts, Faculty of / Social Work, School of / Graduate

Vitamin D deficiency (25(OH)D < 20 ng/mL) is likely to be present in about 40% of veterans and is associated with much higher health care costs and service use. The prevalence of vitamin D deficiency is likely to be higher in certain subgroups such as ethnic minorities, those who are chronically ill, and nursing home residents. The lack of adequate sunlight exposure and poor dietary intake are common contributors to this deficient state. Moreover, vitamin D deficiency has also been noted in individuals taking vitamin D supplements within the recommended daily intake. To achieve a 25(OH)D value in the normal range (30-100 ng/mL), many studies indicate a much higher daily oral intake than currently recommended is needed. Inadequate vitamin D dosing may account for failure of some studies to show a benefit. Testing for vitamin D insufficiency levels remains suboptimal and serial monitoring in veterans to assess if a vitamin D-replete state has been achieved also remains less than adequate. The lack of evidence-based guidelines for testing and monitoring has hampered optimal management of this very common condition. The cardiovascular, immunologic, anti-infective, and oncologic benefits of a vitamin D-replete state are becoming recognized. Achieving a vitamin D-replete state may prolong longevity. Achieving adequate vitamin D status in US veterans is an important health measure that should be undertaken.

The purpose of this two phase policy alignment analysis is to evaluate the degree to which the Interstate Compact on Educational Opportunity for Military Dependent Children has been aligned in the Virginia Compact statute and the degree to which three school divisions heavily populated by military dependent students have aligned local school policy to the statute. The Interstate Compact was intended to mitigate the transitional challenges military dependent students experienced as they navigated a patchwork of local policies through the establishment of aligned state statute in all states to add a layer of uniform policy in each school system. School personnel rely on local school policy to provide uniform guidance for student records and enrollment, placement and attendance, eligibility, and graduation. This qualitative approach used document analysis to first compare the content of the Interstate Compact to the Virginia statute, then second, analyzed local school division policy documents using priori codes derived from the Virginia statute to determine the degree of alignment to the Virginia statute. The findings reveal a loose coupling of state statute to local policy impacting military dependent students. The Compact was developed collaboratively at the national level, however gaps in policy alignment at the local level may continue to hinder school personnel from providing uniform guidance according the data from this policy analysis.