Browsing by Subject "Stress Disorders, Post-Traumatic"
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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 Cardiovascular Risk Indicators and Health-Related Quality of Life in Women Veterans with PTSD(2018-07-26) Anderson, Elizabeth Hallen; Surís, Alina; Fu, Qi; Pai, Anushka; Shivakumar, Geetha; Smith, JuliaPosttraumatic stress disorder (PTSD) is one of the most prevalent disorders among women veterans treated at the Veterans Health Administration and is associated with a wide range of negative physical health outcomes, including the development of cardiovascular disease. In addition, PTSD has a negative impact on an individual's subjective perception of the health-related quality of his or her own life. The majority of studies examining the complex relationship between PTSD and health have utilized primarily male populations. To better understand the impact of PTSD on laboratory-based and self-reported measures of health in women veterans, this study used multivariate analyses of variance to compare cardiovascular risk indicators (resting heart rate, blood pressure, and muscle sympathetic nerve activity) and physical and mental health-related quality of life (SF-36) in a sample of women veterans with PTSD to a sample of nonveteran women without PTSD. In addition, hierarchical multiple regression analyses were used to examine the relationship between PTSD symptom criteria groups and sympathetic nervous system activity indicators and physical and mental health-related quality of life. Results revealed no significant differences between women veterans with PTSD and healthy controls in regards to cardiovascular risk indicators, however women veterans with PTSD reported significantly worse physical and mental health related quality of life. Contrary to expectations, the hyperarousal symptom criteria group was not found to be a significant and unique predictor of sympathetic nervous system activity indicators nor health related quality of life. However, clinician-rated non-hyperarousal PTSD symptom severity was found to be a significant and unique predictor of physical health-related quality of life. Further analysis demonstrated that, of the four PTSD symptom criteria groups, only clinician-rated re-experiencing symptom severity approached being a significant predictor of worse physical health-related quality of life. Since re-experiencing symptoms appear to be an important mechanism by which women veterans make judgments about their physical health, clinically targeting such symptoms in PTSD interventions may result in improved health-related quality of life. Given the relatively young state of research in women veterans with PTSD, it is important to confirm and build on previous research findings for this unique population.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 Cognitive Processing Therapy and Trauma-Related Negative Cognitions: Relationship and Effect on Treatment(2017-07-27) Holliday, Ryan Phillip; Surís, Alina; Morris, E. Ellen; LePage, James; Jackson, Jamylah; Pai, AnushkaCognitive Processing Therapy (CPT) is based on the theory that posttraumatic stress disorder (PTSD) is a disorder of non-recovery after an exposure to a qualifying trauma. This non-recovery results in assimilated and overaccomodated trauma-related cognitions which negatively affects an individual's schema pertaining to self, the world, and self-blame. This post-trauma alteration in an individual's schema is typically expressed and reinforced in the form of trauma-related negative cognitions (NCs). Although the theoretical underpinnings of NCs as well as their effect on symptom severity in individuals with PTSD have been studied, the role of NCs in therapeutic outcome is less understood. In particular, although CPT specifically targets and addresses NCs, there is limited research regarding the role of NCs during and after CPT treatment. This dissertation consisted of two studies. The purpose of the first study was to examine the overall effectiveness of CPT in attenuating NCs from pre- to post-treatment. To address this study's aim, a meta-analysis of current peer-reviewed clinical trials that assessed NCs at pre- and post-CPT treatment was conducted. The purpose of the second study was to determine if NCs predict therapeutic outcome (i.e., decreases in PTSD and depression symptom severity) over the course of CPT treatment and at follow-up. To address this study's aim, a secondary analysis of a randomized clinical trial of CPT in women and men with military sexual trauma (MST)-related PTSD was performed. Specifically, cross-lagged panel analyses were conducted with NC scores entered as a predictor of subsequent reductions in PTSD and depression symptoms over the course of treatment and follow-up. The first study concluded that CPT had a large effect size in reducing NCs from pre- to post-treatment. Results from the second study were indicative that NCs about self-blame predict subsequent reductions in PTSD symptom severity over the course of CPT and follow-up in veterans with MST-related PTSD. These studies provide further information regarding the effectiveness of CPT in addressing NCs as well as the mediating role of NCs during and after treatment.Item A DRM Study of Trauma Memory Among Employees of New York City Companies Affected by the September 11, 2001 Attacks(2015-03-24) Triantafyllou, Dinara; North, Carol S.BACKGROUND: PTSD has been found to be associated with abnormalities in memory function. This relationship has not previously been studied with the Deese-Roediger-McDermott (DRM) false memory paradigm in disaster-exposed populations. OBJECTIVE: This study aims to describe the relationship between exposure to trauma, PTSD, and changes in memory. METHODS: Three years after the September 11 (9/11) attacks, 281 participants from a volunteer sample of 379, recruited from eight companies affected by the attacks, completed an interview about their disaster experience, a structured diagnostic interview, and the DRM paradigm. RESULTS: It was hypothesized that participants with PTSD would demonstrate more associative errors, termed false alarms to critical lures, compared to those without PTSD. This hypothesis was not supported; the only predictor of false alarms to critical lures was direct 9/11 trauma exposure. CONCLUSION: The finding that 9/11 trauma exposure was associated with false alarms to critical lures suggests that neural processing of trauma exposure memory may involve associative elements of overgeneralization coupled with insufficient inhibition of responses to related but harmless stimuli. Future research will be needed to differentiate psychopathology, such as PTSD, from physiological fight-or-flight responses to trauma.Item The Effect of Rapamycin Paired with Traumatic Memory Activation on Cognitive Performance in Veterans Diagnosed with PTSD(2012-05-18) Anderson, Elizabeth Hallen; Surís, Alina; North, Carol S.; Powell, Craig M.BACKGROUND: Many individuals with posttraumatic stress disorder (PTSD) experience cognitive impairment in addition to the characteristic psychological symptoms. Animal studies have shown that rapamycin, a protein synthesis inhibitor that targets the protein kinase mTOR, can prevent the reconsolidation of a reactivated fear memory, thereby reducing its emotional strength at a neurochemical level. The aim of the current study was to determine if pairing rapamycin with traumatic memory reactivation in male veterans with combat-related PTSD would lead to an improvement in cognitive performance, based on scores from the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) at baseline and 1-month follow-up. SUBJECTS: A sample of 54 male veterans with combat-related PTSD receiving healthcare at a large southwestern VA medical center participated in the study. METHODS: In a double-blind, placebo-controlled study, male veterans with combatrelated PTSD were administered either a single dose of rapamycin or placebo, followed by a script-driven memory reactivation task. Measures included the RBANS, Clinician Administered PTSD Scale (CAPS), and the Quick Inventory of Depressive Symptomatology (QIDS). RESULTS: A repeated measures ANOVA was conducted to assess the impact of two different interventions (rapamycin, placebo) on participants' scores on the RBANS, across two time periods (baseline, one-month follow-up). The main effect comparing the two type of interventions revealed no significant differences in the effectiveness of the two interventions in the entire sample; F (1,48) = .01, p = .921, partial eta squared < .001. When the sample was limited to participants who demonstrated a clinically significant reduction (≥ 20 points) in their CAPS score, a repeated measures ANOVA revealed a significant interaction between time and treatment intervention; Wilks Lambda = .44, F (1, 13) = 16.74, p = .001, partial eta squared = .563. Pairwise comparisons showed a significant improvement between baseline and one-month follow-up on the RBANS for participants in the placebo group, mean difference = 10.00, p = .002. DISCUSSION: Based on these results, a single rapamycin treatment does not appear to be detrimental or beneficial to cognitive performance. Furthermore, a clinically significant reduction in PTSD symptoms due to rapamycin is not associated with an improvement in cognitive performance.Item The Effects of Depression on Hypertension in Females with Military Sexual Trauma (MST)-Related PTSD(2016-05-18) Ali, Sania; Surís, Alina; Shivakumar, Geetha; Pai, Anushka; Dubois, ChelitaBACKGROUND: Posttraumatic stress disorder (PTSD) and depression have been linked with cardiovascular disease, specifically hypertension. Additionally, PTSD and major depression independently increase the likelihood of hypertension. Military sexual trauma (MST) is also associated with greater psychiatric and cardiovascular symptom severity. Comorbid depression and PTSD have an established relationship with hypertension; however, this association has yet to be studied in female veterans with MST-related PTSD. SUBJECTS: Data were used from baseline assessments of a recently published randomized clinical trial (RTC), with information from 113 female veterans with MST-related PTSD used for the present study. Only female veterans were included in the present study METHOD: A retrospective electronic chart review was conducted to determine the presence or absence of hypertension. Baseline diagnosis of comorbid major depressive disorder (Structured Clinical Interview for DSM-IV), and depression symptom severity (Beck Depression Inventory-II) were used in statistical analyses to examine the relationship between depression and hypertension in the sample. RESULTS: Neither comorbid major depressive disorder nor depression symptom severity were significant risk factors for hypertension in the sample. Subsequent exploratory analyses produced an expected finding that African American/Black race was associated with hypertension in our sample. DISCUSSION: Providers should be aware of the risk for hypertension in female veterans with MST-related PTSD who identify as African American regardless of the presence of comorbid depression or greater depressive symptom severity. Future researchers should expand upon our findings by examining the effect of age as well as comorbid physical health disorders (e.g., diabetes, hyperlipidemia) on hypertension in women with MST-related PTSD.Item Expectancy, Adherence, and Depression as Predictors of Therapeutic Outcome as Measured by PTSD Symptoms in Veterans with MST(2012-05-18) Azimipour, Solaleh; Surís, Alina; North, Carol S.; Thoman, Lisa V.BACKGROUND: The aim of this study was to explore the association between treatment outcome expectancy, adherence to treatment, and depressive symptoms on symptom reduction in the treatment of PTSD in Veterans. SUBJECTS: Participants were female and male veterans from a large Southwestern Veterans Administration Healthcare System. A total of 129 participants were randomized to receive cognitive processing therapy (CPT) or present-centered therapy (PCT). Participants completed baseline assessments prior to starting 12 sessions of therapy. METHODS: Data from the Clinician Administered PTSD Scale (CAPS), the PTSD Checklist (PCL), Beck Depression Inventory II (BDI-II), the 16-Item Quick Inventory of Depression Symptomatology (QIDS), Expectancy of Therapeutic Outcome (ETO), homework assigned to the participants, and the number of therapy sessions completed were used in the analysis of the hypotheses. Spearman correlations and multiple regressions were used to analyze the data RESULTS: Both number of sessions attended in the CPT group and number of sessions attended in both groups combined were significantly associated with an improvement in depression symptoms as measured by change in the QIDS score (CPT ? = .31, both ? = .29). Attendance to sessions in the CPT group was not associated with change in the PCL score. The total average minutes spent on homework in the CPT group was significantly associated with worsening of PTSD symptoms as measured by an increase in the CAPS score (? = -.51) in one model and by an increase in the PCL score (? = -.30) in a separate model. The percent of homework assignments completed in the CPT group was significantly associated with improvement in PTSD symptoms as measured by a decrease in the CAPS score (? = .32). A significant relationship was found between outcome expectancy and the number of sessions attended in the PCT group (? = .42;.39). The relationship between baseline depression symptom level as measured by the QIDS and the total average number of minutes spent on homework fell short of significance in the CPT group, p = .07. There were no significant associations between baseline depression and treatment outcome expectancy. DISCUSSION: Greater outcome expectancy was associated with increased attendance to sessions in the PCT group, but not in the CPT group. However, greater expectancy did not predict adherence to homework and the amount of time spend doing homework. As expected, in the CPT group as well as both groups together, greater attendance to sessions was associated with an improvement in symptoms of depression. Greater adherence to homework assignments was associated with an improvement in PTSD symptoms. Contrary to predictions however, greater time spent doing the homework was associated with a worsening of PTSD symptoms and greater depression at baseline was associated with greater time spent completing homework. Furthermore, baseline depression did not predict treatment outcome expectancy, and expectancy did not predict PTSD and depression symptoms at treatment completion. IMPLICATIONS: A greater expectation of benefit from treatment could be an indication that an individual is motivated to change. It is possible that expectations of treatment, attendance to therapy sessions, and completing homework in between sessions, are the key to benefiting from therapy.Item Factors Associated with Posttraumatic Growth in Trauma Patients and ICU Family Members(2017-07-10) Roden-Foreman, Kenleigh; Robinson, Richard C.; Warren, Ann Marie; Roaten, Kimberly Dayle; Bennett, Monica; Petrey, LauraEach year in the United States, over three million people are hospitalized for traumatic injuries and five million are admitted to intensive care units (ICUs) as a result of traumatic injury or critical illness. Although the traditional benchmark for successful care in these settings has been patient survival, there has been an increased awareness of psychosocial issues that continue to impact patients' and family members' quality of life beyond the hospital stay. The experience of a traumatic injury or serious illness, for patients or their families, can be challenging to recover from both physically and psychologically. Extensive literature shows that presence of a psychological disorder can lead to or exacerbate negative physical health outcomes in patients, including increased risk of re-hospitalization, greater healthcare costs, and poorer quality of life. From the perspective of family members, psychological strain may hinder carrying out necessary caregiving activities for the patient, and this strain may continue unchecked since the majority of support and resources are directed at patients, not their caregivers. The primary emphasis of psychology, medicine, and related disciplines tends to be on ways in which traumatic events are precursors to distress and, potentially, severe psychological and physical dysfunction. Although this focus is understandable given the prevalence of research and clinical training on the topic, substantially less literature describes the influence of positive psychological outcomes. Posttraumatic growth (PTG) describes positive change resulting from a struggle with highly challenging events, such as sustaining a traumatic injury or witnessing a family member in the ICU. To date, no studies have examined factors associated with PTG in a heterogeneous sample of trauma patients or in the families of trauma/critical care ICU patients. The present studies sought to fill these gaps in the literature. The first study determined factors associated with PTG in a mixed trauma patient population one year post-injury. The second study did the same, but examined PTG in family members of trauma/critical care ICU patients one year post-hospitalization. By identifying variables related to growth, clinical interventions may be targeted to bolster those areas in hopes of improving outcomes in patients and their family members.Item Gender Differences Within Posttraumatic Stress Disorder Due to Military Sexual Trauma(2015-08-31) Matlock, Alyse Nichole; Surís, Alina; Roaten, Kimberly Dayle; Koehler, HeidiBACKGROUND: Posttraumatic Stress Disorder (PTSD) is a trauma- and stressor-related disorder which may develop after an individual has been exposed to a traumatic event. One cause of PTSD is military sexual trauma (MST), which refers to sexual assault or harassment that a veteran experienced during his or her military service. Evidence suggests that gender may play a role in the symptomatologic expression of PTSD, with men being more likely to evidence externalizing behaviors of posttraumatic distress (e.g., substance use and state-anger) and women more likely to display internalizing symptoms (e.g., feelings of emotional numbing, withdrawal, and depression). The goal of the current study is to understand if discernable differences between men and women regarding expression of PTSD symptomatology exist, which may affect traditional treatments for MST-related PTSD. SUBJECTS: 129 participants (114 female and 15 male) were enrolled in the larger study, a randomized controlled trial (RCT) comparing two treatments for PTSD. The current study utilized data from 15 men and 15 women matched on age, military branch, and number of tours from the larger RCT. METHOD: This study utilized data from the initial RCT with all data collection and analyses taking place at the Dallas VAMC. Participants were given questionnaires to assess demographic variables (Demographic Questionnaire), PTSD symptom severity (Clinician Administered PTSD Scale; CAPS), depression (Quick Inventory of Depressive Symptomatology; QIDS), previous and current substance use (Structured Clinical Interview for DSM-IV Axis I Disorder; SCID-I), and state-anger (State-Trait Anger Expression Inventory-2; STAXI-2). It was hypothesized that females with MST-related PTSD would report more internalizing symptoms of PTSD (e.g., depression, emotional numbing, and withdrawal) compared to males with MST-related PTSD. Conversely, it was hypothesized that males with MST-related PTSD would report greater externalizing symptoms of PTSD (e.g., substance use and state-anger) than females with MST-related PTSD. RESULTS: No significant differences were found for either hypotheses. DISCUSSION: Despite no significant gender differences regarding posttraumatic distress between males and females found, the results are important because they suggest that other factors, such as trauma type, may be more influential in shaping posttraumatic symptom expression as opposed to gender.Item Identifying Trauma Factors That Predict Suicide Specific Helplessness in Female Veterans with Chronic PTSD Resulting from Military Sexual Trauma(2009-09-04) Bass, Christina Marie; Surís, AlinaRESEARCH OBJECTIVE: This study attempts to understand the contribution of post-traumatic stress disorder (PTSD), resulting from Military Sexual Trauma (MST), and depressive symptoms to suicide specific hopelessness. It also examines specifically which of the PTSD symptom clusters is associated with this type of hopelessness along with the interaction of PTSD symptoms and suicide-specific hopelessness as it might relate to suicidal ideation. METHODS: A sample of 86 female veterans receiving mental or physical healthcare at a Southwestern Veteran Administration (VA) Healthcare System participated in the study. Participants were interviewed using the Clinician Administered PTSD Scale (CAPS); were assessed for depressive symptoms with the Beck Depression Inventory (BDI-II) and suicide-specific hopelessness with the Suicide Cognitions Scale (SCS). RESULTS: A linear regression indicated that trauma symptoms, as measured by the CAPS, accounted for a significant percentage of the variance in suicide-specific hopelessness (R2 = 18.2, p = 0.002). Contrary to expectations, when examined independently and along with the other symptom clusters, regression analysis revealed that the avoidant symptom cluster was not significantly associated with suicide-specific hopelessness (R2 = 9.5, p = .08 and t = - .66, p = 0.51). As expected, depressive symptoms as measured by the BDI-II, accounted for a significant portion of the variance of suicide-specific hopelessness (R2 = 48.8, p < 0.001). However, trauma symptoms did not contribute more than depressive symptoms (t = 0.54, p = 0.59 and t = 6.95, p = 0.001respectively). Lastly, a significant interaction between suicide-specific hopelessness and trauma symptoms was found to be associated with a positive endorsement of suicidal ideation (t = -4.193, p = 0.001). CONCLUSION: Female veterans with chronic PTSD resulting from Military Sexual Trauma (MST) are at risk for experiencing suicidal thoughts and behaviors.Item The Impact of Cognitive Processing Therapy On Quality of Life and Healthcare Use in Veterans with Posttraumatic Stress Disorder Due to Military Sexual Trauma(2013-12-30) Fekadu, Rahel Abay; Surís, Alina; Smith, Julia; Minhajuddin, AbuBACKGROUND: Military Sexual Trauma (MST) is a psychological trauma that resulted from a physical assault of a sexual nature, battery of a sexual nature, or sexual harassment (U.S. Code (1720D of Title 38)). Research indicates that MST is associated with increased likelihood of developing Posttraumatic Stress Disorder (PTSD). Veterans who are diagnosed with PTSD due to MST experience a range of comorbid disorders and psychological sequelae including impaired quality of life (Suris et al., 2006), and utilized more primary healthcare services compared to those without PTSD (Frayne, Chiu, Iqbal, Berg, Laungani, Cronkite, Pavao, & Kimerling, 2010). The current study seeks to examine the effectiveness of Cognitive Processing Therapy (CPT), compared to Present Centered Therapy (PCT), on quality of life, health related quality of life and healthcare utilization in veterans who were diagnosed with PTSD due to MST. SUBJECTS: One hundred and ninety veterans with MST were enrolled in to the study and randomized into either CPT or PCT. However, due to fidelity issues data were analyzed for Eighty-six (72 female and 14 male) veterans. METHOD: Data for the proposed study is taken from a larger randomized controlled clinical trial that was conducted at a large Southwestern Veteran Administration Medical Center to evaluate the effectiveness of Cognitive Processing Therapy (CPT) in comparison with Present Centered Therapy (PCT) for PTSD due to MST (Suris et al., 2013). Participants received 12 therapy sessions, bi-weekly, over a six-week period. Data were acquired using face-to-face interviews and written questionnaires at baseline, treatment completion, and at two-month, four-month, and six-month follow-ups. RESULTS: Participants in both treatments did not differ in terms of health related quality of life, quality of life, and healthcare utilization. However, participants in both conditions reported improvement on three of the SF-36 subscales (General Mental Health, Role Limitation Due to Emotional Problems and Vitality), quality of life, and healthcare utilization subscales (Psychotherapy, Outpatient, Hospitalization). DISCUSSION: Although we failed to reject the null hypothesis, the trend indicates that both CPT and PCT are efficacious in terms of improving subjective wellbeing and health related quality of life as well as lowering health care consumption.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 The Influence of Demographic Factors, Resilience, and Other Psychological Factors in Predicting Caregiver Burden in Trauma ICU Populations(2020-12-01T06:00:00.000Z) Patel, Sarita; Warren, Ann Marie; Bennett, Monica; Robinson, Richard C.; Howe-Martin, Laura; Foreman, Michael; Petrey, LauraAlthough only a small number of studies specifically focus on caregivers of ICU patients, findings suggest that these caregivers can experience a substantial burden. Although negative psychological states, including depression and posttraumatic stress disorder (PTSD), are gaining attention in the literature following the injury of a family member, less attention has been paid to the role that potentially protective psychological factors, such as resilience, may have in one's response to injury or critical illness in a family member. The purpose of this study is to examine the role of specific demographics factors and resilience in predicting caregiver burden, depression, and PTSD symptoms in caregivers of trauma patients. Eligible individuals were identified based on their family member's medical diagnosis through the trauma service admission list at Baylor University Medical Center (BUMC), a Level I trauma center and part of the Baylor Scott & White Healthcare system. Participants (aged 18-82, N=91, 73.6% female) completed brief self-report measures assessing depression, PTSD and resilience at baseline, and completed brief self-report measures assessing depression, PTSD, and caregiver burden at three-month follow-up. Regression analyses were used to determine the association between resilience and each outcome (caregiver burden, depression, and PTSD). Results illustrated significant associations between resilience and depression and PTSD separately. Exploratory analyses were conducted to determine the role of demographic factors in predicting caregiver burden, depression, and PTSD over time. A series of linear and logistic regressions were conducted to evaluate the intersectionality of the demographic factors and each outcome. Findings suggest that higher levels of resilience may significantly be associated with lower rates of depression and PTSD. Additionally, the interaction of several demographic factors may significantly be associated with higher rates of depression and PTSD. Current study findings suggest that certain demographic factors are associated with higher levels of depression and PTSD in caregivers. Although further exploration is warranted before drawing firm conclusions, this novel information may be used to direct future research, educate caregivers, clinicians and researchers, and inform the development of interventions specific to this population.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 Promoting Resilience in Unaccompanied Asylum-Seeking and Refugee Minors(2020-03-17) Niño, Ana Patricia; Mihalic, Angela; Loria, Hilda; Patterson, Abigail M.BACKGROUND: In 2018, the European Union received 20,000 applications from unaccompanied asylum-seeking minors (UAMs) applying for international protection, and 60,000 UAMs from Central America were apprehended at the US-Mexico border. These unaccompanied minors are vulnerable, and the traumas they face impact their mental health. As such, it is important to design mental health interventions that promote resilience and address the unique mental health needs of unaccompanied minors. OBJECTIVE: This literature review will summarize the existing literature to identify mental health interventions and other resilience factors that can promote the mental health of UAMs resettled in Europe and the United States. METHODS: Scopus was searched for articles published in Europe and the US. Titles and abstracts were screened based on the inclusion and exclusion criteria, which resulted in 41 qualitative and quantitative studies of interest. RESULTS: In addition to violence, poverty and war in their countries of origin and extreme physical hardships in their migration journeys, UAMs also faced adjustment and acculturation- specific stressors in the host country. All of these factors negatively impacted UAMs' mental health. The average number of traumatic experiences for each UAM ranged from 6-9. The prevalence of mental health pathology was 24-38% for anxiety, 15-43% for depression and 16- 73% for post-traumatic stress disorder. In addition, UAMs faced unique barriers to mental health service utilization, which included low perceived need of mental health services and distrust of both mental health services and providers. Group psychotherapeutic interventions promoted social interactions and trust-building in UAMs but showed no clinically significant decrease in PTSD symptoms. Individual trauma-based psychotherapeutic interventions clinically improved PTSD symptoms in 66-83.3% of participants. Lastly, strong social bonds, high-support housing, continued spiritual-practice and access to education were protective factors that promoted UAMs' resilience. CONCLUSION: Although UAMs have faced multiple adversities, both in their countries of origin and host countries, there are potential interventions to promote resilience and treat mental health pathologies. Culturally- adjusted, individual trauma-focused therapy has shown the best mental health outcomes for UAMs with clinical PTSD. Considerations and suggestions for future research are discussed.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 The Role of Incarceration in Treatment-Seeking Veterans with PTSD: Evaluating Differences in Trauma Symptoms, Suicidality, and Substance Use(August 2021) Sligar, Kylie Blake; LePage, James; Jeon-Slaughter, Haekyung; Shivakumar, Geetha; Pai, Anushka; Smith, JuliaVeterans are an at-risk population with increased chances of exposure to trauma, mental health diagnoses, substance use, and suicidality. Individuals who have been incarcerated demonstrate similar increased risks. As such, when a Veteran also has a history of incarceration, these risks may be exacerbated. It is posited the rate of PTSD among Veterans is 11-20% (National Center of PTSD, 2019). Additionally, it is estimated over 120,000 Veterans are currently incarcerated, with as many as 67% having a mental illness or substance use disorder (Finlay et al., 2017; Bronson et al., 2015). This study aimed to examine how a history of incarceration may impact trauma symptoms in Veterans, and how this differs when compared to Veterans without an incarceration history. The data did not support overall differences between these two groups; however, exploratory analyses suggest potential areas of future directions. Exploratory analyses suggest potential differences in PTSD symptomology, specifically increased endorsement of Cluster C / avoidance among Veterans with PTSD, and increased risk taking among Veterans with PTSD and an incarceration history. Results also suggested higher rates of substance use treatment among Veterans with PTSD and an incarceration history. Lastly, analyses suggest higher endorsement of feeling "tense and keyed up" among Veterans with PTSD. No differences were found between groups in areas of PTSD severity, number of endorsed trauma events, suicidality, or adverse childhood events.Item The Role of Social Support in PTSD and Depression Symptom Severity(2014-12-22) Bird, Jessica Lynne; Surís, Alina; North, Carol S.; Smith, JuliaBACKGROUND: Many individuals diagnosed with posttraumatic stress disorder (PTSD) have been shown to experience symptoms of avoidance. These symptoms decrease access to social support, which has been shown to be a resilience factor associated with developing PTSD after trauma. MST-related PTSD represents a relative gap in the research. The aim of the current study was to determine if the presence of social support was associated with less MST-related PTSD and depressive symptom severity. SUBJECTS: A sample of 128 participants from a larger study that was examining the effectiveness of Cognitive Processing Therapy (CPT) in survivors of MST. METHOD: The scores of the CAPS, BDI-II, and three questions from the VPAT, a questionnaire specifically developed for the larger study at baseline were compared to see if an association existed between PTSD and depression symptom severity and social support. RESULTS: A series of simple linear regressions were run with the total score of the CAPS, individual criteria of the CAPS against the total social support score and each individual question pertaining to social support. Additionally, the total BDI-II score was run against the total social support score as well as each individual question on the VPAT pertaining to social support. DISCUSSION: Based on these results, it appears that the presence of social support is not associated with less PTSD symptom severity. Moreover, the presence of social support was not related to less depressive symptom severity.Item [Southwestern News](1997-10-31) Mullen, KrisThe date for this news release was not printed on the front page. The date can be located on the last page (2) of the news release just below the web site URL. The date is consistent with the original organization within the binders.