Browsing by Subject "Military Personnel"
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Item Aggregate Sexual Trauma Load, Quality of Life, and Psychiatric Comorbidity in Veterans with Military and Civilian Sexual Trauma(2015-04-16) Williams, Rush Ciarán; Surís, Alina; Krebaum, Steven; Mullen, Kacy; Robinson, Reed; Thoman, Lisa V.Over the last two decades, Military Sexual Trauma (MST) has received growing national attention. Among veterans, approximately 24% of women and 1% of men have experienced MST. Veterans with MST are particularly at-risk for a variety of mental health concerns, including Posttraumatic Stress Disorder (PTSD) and depression. MST survivors are also likely to experience diminished quality of life, including engagement in risk-taking behaviors, marital problems, and interpersonal difficulties. This suggests that individuals with higher lifetime incidence of sexual trauma (including MST) may be at increased risk for poorer outcomes in quality of life and psychiatric symptoms. Moreover, relatively little attention has been paid to examining the differences in psychological sequelae among those who have experienced sexual trauma as children, and those whose sexual trauma exposure is limited to adulthood. To date, the majority of sexual trauma literature has focused primarily on civilian trauma, and comparatively few studies have specifically examined quality of life sequelae in Veterans with MST. This study examined aggregate sexual trauma load (i.e. lifetime incidence of sexual trauma, childhood sexual assault, and severity of sexual trauma) as a predictor of overall quality of life and severity of PTSD and depressive symptoms. Categorical linear regression analyses were performed on the variables of interest as predictors of scores on the Quality of Life Inventory (QOLI), Clinician Administered PTSD Scale (CAPS), and Quick Inventory of Depressive Symptomatology (QIDS). A significant relationship was found between history of childhood sexual assault and severity of depression symptoms. Further, a non-significant trend was found between total incidence of prior sexual trauma and overall quality of life. No significant differences were found among the other variables of interest. Results highlight the need for specific attention to depressive symptomatology and the commonplace nature of severe sexual trauma in this population, as well as the need for future research with more heterogeneous and diverse samples. Conclusions, limitations, and implications are discussed.Item Cognitions and Anger in Veterans with Post-Traumatic Stress Disorder from Military Sexual Trauma(2011-02-01) Dhingra, Anupma Veera; Surís, AlinaMilitary sexual trauma affects both males and females in the military. Treatment for PTSD from MST follows from clinical trials of therapies among sexual trauma victims. However, research suggests that MST may be different from other traumatic events in the severity and manifestation of PTSD symptoms and sequelae. This study examined trauma-related cognitions and anger in PTSD from MST and how these PTSD-related sequelae manifest across genders, ethnicities, and sexual trauma history groups. Individuals with history of MST only and MST + childhood sexual trauma reported more negative cognitions about the self and self-blame for the trauma than individuals with MST + other adult sexual trauma. Male gender was associated a higher report of with inward expression of anger and overall expression of anger compared to females. African Americans and Hispanics reported more State Anger than Caucasians in the sample. PTSD-related cognitions and anger were examined together to assess correlation. Significant positive correlations were found between cognition scales and anger scales. Only anger control had a negative correlation with the report of negative cognitions of self. No significant differences were found in the analyses of PTSD severity and B, C, D symptom patterns across gender, ethnic groups, and sexual trauma history groups. A model assessing the independent contribution of anger, trauma-related cognitions, and sexual trauma group on PTSD severity revealed that a State Anger subscale and negative cognitions about self were significant in explaining PTSD severity. Non-significant findings on gender and ethnicity with qualitative differences on means implore the need for replication with larger sample sizes to increase power. Conclusions and implications are discussed.Item Improving Understanding of Cognitive Processing Therapy: Patterns and Predictors of Symptom Change(2018-07-27) Holder, Nicholas Davis; Surís, Alina; Emmett, Gloria; LePage, James; Morris, E. Ellen; Pai, AnushkaSurvivors of military sexual trauma (MST) are more likely to develop posttraumatic stress disorder (PTSD) than survivors of combat and other sexual traumas. Cognitive processing therapy (CPT) has been identified as one of the most effective PTSD treatments, and is the only treatment validated for veterans with MST-related PTSD. Existing research has emphasized studying pre-post change in total PTSD symptom severity; however, PTSD symptoms may not respond equivalently to CPT. Specifically, re-experiencing symptoms may predict change in other symptom criteria, and sleep disturbance may remain even after successful treatment. Improved understanding of the patterns and predictors of symptom change may help optimize treatment outcome. The current dissertation investigated variability in symptom change during and after CPT using data from a randomized clinical trial of CPT for MST-related PTSD. In the first study, the pattern and temporal precedence of change in PTSD symptom criteria during and after CPT was assessed using three cross-lagged panel analyses. Hyperarousal, avoidance, and re-experiencing symptoms were entered as a predictor of subsequent change in the PTSD symptom criteria. A logarithmic pattern of change was found for all symptom criteria. Hyperarousal symptoms predicted and temporally preceded change in avoidance symptoms. No criteria predicted or temporally preceded change in hyperarousal or re-experiencing symptoms. The aim of the second study was to describe the prevalence of sleep disturbance in veterans with MST-related PTSD and identify predictors of change in sleep disturbance following CPT using a multiple regression analysis. Sleep disturbance was prominent at baseline affecting 100% of the sample. Clinically significant sleep disturbance remained prevalent at posttreatment regardless of total symptom improvement. Results of the multiple regression analysis did not identify significant predictors of change in sleep disturbance following CPT. PTSD symptoms did not resolve uniformly during and after CPT in this sample. Focusing on pre-post change in total PTSD symptoms likely ignores important differences in symptom change. Describing variability in symptom change can provide patients more realistic treatment expectations, and can allow providers to look for a characteristic pattern of change during treatment. Further research is needed to link elements of CPT to these patterns of symptom change.Item Physical, Emotional, and Cognitive Mediators of Therapeutic Expectations for Treating PTSD Related to Military Sexual Trauma(2017-04-06) Raja, Annia Waheed; Surís, Alina; Businelle, Michael; Koehler, Heidi; Thoman, Lisa V.; Robinson, ReedPTSD due to military sexual trauma affects both male and female Veterans, and Veterans with MST-related PTSD contend with a host of physical, emotional, and cognitive sequelae. Evidence-based treatments for MST-related PTSD broadly focus on reducing symptoms by increased exposure and/or emotional processing of physical, emotional, and cognitive triggers. However, given the high treatment dropout rates for Veterans with PTSD and given that avoidance symptoms are most predictive of a PTSD diagnosis for Veterans with MST, research suggests that it may be important to understand the role of pretreatment symptoms and therapeutic expectations for Veterans seeking treatment for PTSD related to MST. This study investigated whether physical, emotional, and cognitive variables mediated the relationship between pre-treatment PTSD severity and therapeutic expectations for Veterans seeking Cognitive Processing Therapy or Present-Centered Therapy for PTSD due to MST. Additionally, this study examined whether the relationship between pre-treatment therapeutic expectations and change in PTSD severity (pre-post treatment) was moderated by treatment type. Results indicated that the relationship between pre-treatment PTSD severity and therapeutic expectations was significantly mediated, within separate models, by posttraumatic cognitions and suicide-related cognitions. Results did not indicate significant moderation by treatment type of the relationship between pre-treatment therapeutic expectations and change in PTSD severity. Clinical implications for significant findings include recommendations for assessing posttraumatic cognitions before, during, and after treatment, bolstering hopefulness and strengthening the therapeutic alliance prior to commencing treatment, and directly addressing interpersonal factors for Veterans with greater PTSD severity and/or lower therapeutic expectations prior to treatment.Item The Role of Cognitive Processing Therapy in Treating Post Traumatic Cognitions and Symptoms Associated with Military Sexual Trauma(2013-05-17) Vera, Kristie Marie; Surís, Alina; Thoman, Lisa V.; Smith, JuliaBACKGROUND: Military Sexual Trauma (MST) is psychological trauma that results from sexual assault while in the military service. One common anxiety disorder following MST is Posttraumatic Stress Disorder (PTSD). Negative cognitions about the event, the self, and the world are hypothesized to be associated with the onset and persistence of PTSD. SUBJECTS: The participant data for this study was taken from a larger study that examined the effectiveness of Cognitive Processing Therapy (CPT) for treating Military Sexual Trauma-related (MST) Post Traumatic Stress Disorder (PTSD). The sample consisted of 76 participants, 63 female veterans and 13 male veterans. METHOD: Participants were randomized into two groups who received either CPT or PCT. The participants were assessed at baseline using the CAPS, PCL, BDI-II and PTCI. They participated in 12 therapy sessions and were assessed using the same measures at post-treatment, 2, 4, and 6-month follow-ups. RESULTS: The current study provides preliminary evidence that the number of negative cognitions is decreased over time in both CPT and PCT interventions for veterans with PTSD related to MST. Also, that the decrease in number of negative cognitions is positively related with decreased PTSD and depressions symptoms. DISCUSSION: These findings are important because they support the idea that negative cognitions contribute to PTSD and depression symptoms, while also providing evidence that CPT and PCT are effective in reducing negative cognitions.Item Suicide Cognitions Among Veterans: A Construct for Assessment and Intervention(2019-07-09) Wiblin, Jessica Leigh; LePage, James; Surís, Alina; Hughes, Jennifer L.; Morris, E. Ellen; Richardson, ColleenMilitary veterans represent a population that is more likely to be exposed to traumatic events and therefore diagnosed with posttraumatic stress disorder (PTSD) compared to civilian men and women. Military sexual trauma (MST) is a traumatic event endorsed by approximately 28% of women veterans and 1.5% of male veterans. Not only are survivors of MST more likely to be diagnosed with PTSD than survivors of other traumas, they are also at risk for significant psychosocial consequences and comorbid psychiatric diagnoses. Of particular significance, veterans with MST-related PTSD report increased suicidal ideation and report higher incidences of suicidal self-directed violence (SDV). The Veterans Health Administration (VHA) has placed emphasis on both screening for MST and suicide prevention efforts. As a result, providers within the VHA have a greater opportunity to provide clinical care to a vulnerable population. However, research is mixed regarding whether veteran survivors of MST are more or less likely to utilize health care services within the VHA. Women veterans who have experienced MST in particular have been found to be less likely to utilize VHA health care services. This dissertation sought to increase understanding of suicide cognitions as a construct for assessment as well as potential treatment-seeking barriers and consists of two studies, each a secondary analysis of an RCT examining the efficacy of CPT in treating MST-related PTSD. The aim of the first study was to evaluate the psychometric properties of the SCS and identify the optimal factor structure. A four-factor structure was identified and the SCS was psychometrically valid in this sample. The purpose of the second study was to investigate whether suicide cognitions predict greater or lesser medical and mental health care utilization among female veterans with MST-related PTSD. Both logistic regression analyses and hierarchical multiple linear regression analyses were conducted to identify whether SCs predict medical (inpatient and outpatient) and mental health (inpatient and outpatient) care utilization. Decreased physical health concerns and unbearability predicted inpatient medical care utilization. These studies provide additional support for how SCs can be utilized to improve assessment of suicide risk, as well as inform clinical approaches.