Therapeutic response to Cognitive Processing Therapy in White and Black female veterans with military sexual trauma-related PTSD

Cognitive Processing Therapy (CPT) is an evidence-based treatment (EBT) for posttraumatic stress disorder (PTSD) which has been validated for female veterans with military-related PTSD. Existing trials have enrolled predominantly White veterans with some studies documenting higher rates of early termination from EBTs among Black females when compared to White females. Data from a previously published randomized clinical trial were used to evaluate the effectiveness of CPT for Black female veterans with military sexual trauma (MST)-related PTSD. Reductions in PTSD symptom severity, number of sessions attended, and early termination rates were compared between Black (n = 20) and White (n = 16) female veterans. A hierarchical linear modeling approach was used, with PTSD symptom severity over the course of treatment and follow-up entered as a level-1 variable and race (Black or White) entered as a level-2 predictor. Piecewise growth curves analyses revealed that both Black and White female veterans experienced significant reductions in PTSD symptom severity over the course of treatment and gains were maintained up to 6 months post-treatment. Race was not found to be a significant predictor of change in the slope of PTSD symptom severity over the course of CPT treatment. Additionally, number of sessions attended and rates of early termination did not significantly differ based on race. Results suggest that CPT was a well-tolerated and effective psychotherapeutic treatment for this sample regardless of racial self-identification.     

Posttraumatic stress disorder and retrospectively reported stressor exposure: a longitudinal prediction model

There has been recent concern about the degree to which posttraumatic stress disorder (PTSD) symptomatology influences reports of prior exposure to highly stressful life events. In this longitudinal study of 2,942 male and female Gulf War veterans, the authors documented change in stressor reporting across 2 occasions and the association between change and PTSD symptom severity. A regression-based cross-lagged analysis was used to examine the relationship between PTSD symptom severity and later reported stressor exposure. Shifts in reporting over time were modestly associated with PTSD symptom severity. The cross-lagged analysis revealed a marginal association between Time 1 PTSD symptom severity and Time 2 reported stressor exposure for men and suggested that later reports of stressor exposure are primarily accounted for by earlier reports and less so by earlier PTSD symptomatology.     

Linking attentional control and PTSD symptom severity: the role of rumination

Although deficits in attentional control have been linked to posttraumatic stress disorder (PTSD), the mechanism that may account for this association has not been fully elucidated. The present study examined rumination as a mediator of the relationship between attentional control and PTSD symptoms. Veterans with PTSD and trauma-exposed veterans without PTSD completed measures of attentional control, rumination, and PTSD symptom severity. As predicted, the findings showed that veterans with PTSD reported significantly lower levels of attentional control than veterans without PTSD. Veterans with PTSD also reported significantly higher levels of rumination than veterans without PTSD. Subsequent analysis of the total sample revealed that the relationship between attentional control and PTSD symptom severity was accounted for by excessive rumination. Attentional control may contribute to PTSD symptoms through excessive rumination. Attentional control and rumination may be important targets for PTSD interventions.     

Rumination,Resilience, and Posttraumatic Stress Disorder Symptom Severity Among Veterans of Iraq and Afghanistan

This study investigated the relationships among combat exposure, intrusive, and deliberate rumination, resilience, and posttraumatic stress disorder (PTSD) among service members who deployed to Iraq or Afghanistan (N = 191). Participants completed an online survey and hierarchical linear regression results indicated that enlisted rank, higher combat exposure, lower resilience, and higher intrusive rumination predicted higher levels of PTSD symptom severity. Resilience moderated the relationship between combat exposure and PTSD symptom severity, such that participants who had higher levels of resilience had lower levels of PTSD symptom severity at all levels of combat exposure. These findings suggest the importance of increasing resilience in combat veterans, specifically those of enlisted rank and veterans exposed to higher levels of combat. Findings also suggest that teaching veterans how to control or minimize intrusive rumination might help lower PTSD severity.     

The Vietnam veteran on wal: The relation of post-traumatic stress disorder to criminal behavior

The purpose of this paper is to conceptualize the relationship of Post-Traumatic Stress Disorder (PTSD) in Vietnam veterans to criminal behavior. A conceptual framework is discussed which proposes that the disposition to criminal behavior is determined by whether or not the veteran enters into the survivor mode of functioning as a behavioral defense mechanism against the disorder. It is hypothesized that there exists a relationship between the severity of PTSD and the tendency to commit illegal acts. The Vietnam Era Stress Inventory (Wilson and Krauss, 1980) was used to assess PTSD among a volunteer national sample of Vietnam combat veterans (N = 114) participating in the Veterans Administration's counseling program known as Operation Outreach. The results strongly supported the hypothesis and indicated that combat role variables, exposure to stressors in Vietnam and the severity of PTSD were significantly correlated with criminal acts.     

Predictors of Partner Engagement in PTSD Treatment

A telephone survey was conducted to identify predictors of treatment engagement in 83 cohabitating female partners of 83 Vietnam theater veterans with combat-related post-traumatic stress disorder (PTSD). The survey assessed veterans for their trauma history and PTSD symptoms. Partners were assessed for caregiver burden, patient–partner involvement, PTSD treatment engagement, self-efficacy relating to PTSD, beliefs about benefits of PTSD treatment, and PTSD treatment barriers. Significant predictors of partner PTSD treatment engagement were the couple’s income, patient–partner involvement, and partner caregiver burden. These findings have implications for family interventions that may increase partner PTSD treatment engagement and improve PTSD treatment outcome.     

MMPI configural interpretation as applied to posttraumatic stress disorder in Vietnam veterans

This study investigated the systems of Minnesota Multiphasic Personality Inventory (MMPI) configural interpretation of Skinner and Jackson (1978) and Kunce (1979) with Vietnam veterans with posttraumatic stress disorder (PTSD). MMPI profiles of four groups differing in combat exposure were compared on four MMPI configural variables from Kunce (1979) and Skinner and Jackson (1978). The four groups were (a) PTSD sufferers, (b) Vietnam combat veterans without PTSD, (c) Vietnam noncombat veterans, and (d) Vietnam era veterans. All groups were further divided into hospitalized versus nonhospitalized subgroups. Dependent variables were Skinner and Jackson's (a) sociopathic modal profile, (b) neurotic profile, (c) psychotic profile, and (d) Kunce's emotional expression (enthusiastic-reserved) dimension. Results indicated that hospitalized PTSD subjects had significantly higher scores on Skinner and Jackson's neurotic profile; both hospitalized and nonhospitalized PTSD subjects had higher scores on the psychotic profile and were more "reserved" on Kunce's emotional expression dimension. Results were interpreted in terms of configural MMPI interpretation systems and the adjustment of Vietnam veterans with PTSD. PTSD was viewed as exhibiting cognitive, somatic, and affective features.     

MMPI Configural Interpretation as Applied to Posttraumatic Stress Disorder in Vietnam Veterans

This study investigated the systems of Minnesota Multiphasic Personality Inventory (MMPI) configural interpretation of Skinner and Jackson (1978) and Kunce (1979) with Vietnam veterans with posttraumatic stress disorder (PTSD). MMPI profiles of four groups differing in combat exposure were compared on four MMPI configural variables from Kunce (1979) and Skinner and Jackson (1978). The four groups were (a) PTSD sufferers, (b) Vietnam combat veterans without PTSD, (c) Vietnam noncombat veterans, and (d) Vietnam era veterans. All groups were further divided into hospitalized versus nonhospitalized subgroups. Dependent variables were Skinner and Jackson's (a) sociopathic modal profile, (b) neurotic profile, (c) psychotic profile, and (d) Kunce's emotional expression (enthusiastic-reserved) dimension. Results indicated that hospitalized PTSD subjects had significantly higher scores on Skinner and Jackson's neurotic profile; both hospitalized and nonhospitalized PTSD subjects had higher scores on the psychotic profile and were more "reserved" on Kunce's emotional expression dimension. Results were interpreted in terms of configural MMPI interpretation systems and the adjustment of Vietnam veterans with PTSD. PTSD was viewed as exhibiting cognitive, somatic, and affective features.     

The MMPI-2 as a predictor of symptom change following treatment for posttraumatic stress disorder

This study sought to examine the impact of personality factors on symptom change following treatment for 141 Vietnam veterans with chronic combat-related posttraumatic stress disorder (PTSD) using the Minnesota Multiphasic Personality Inventory-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989). A series of partial correlation and linear multivariate regression analyses identified social alienation, associated with anger and substance use, as the most potent negative predictor of symptom change. Of the scales assessing personality disorder, Borderline Personality was identified as the strongest negative predictor of outcome. Regression analyses examining the most salient scales identified 5 items that contributed 14% of the variance in the prediction of change scores independently of the 21% accounted for by pretreatment PTSD severity.     

The psychophysiology of combat-induced post-traumatic stress disorder in Vietnam veterans

The psychophysiological responses of heart rate (HR), systolic and diastolic blood pressure, skin conductance level and forehead electromyogram were compared during: rest, mental arithmetic and combat sounds of gradually increasing intensity for five groups of Ss: Vietnam veterans with post-traumatic stress disorder (PTSD); Vietnam veterans without PTSD but with comparable levels of combat experience; Vietnam veterans with other psychiatric disorders; Vietnam-era veterans; and nonveteran phobics. HR response to low-intensity combat sounds provided good discrimination between veterans with PTSD and the other groups and seems to resemble a conditioned emotional response.     

Distress in spouses of Vietnam veterans: associations with communication about deployment experiences

Emerging literature shows a consistent pattern of relationship and psychological distress in spouses or partners of combat veterans with symptoms of posttraumatic stress disorder (PTSD). One possible mechanism of partners' distress posited in clinical literature is that excessive discussion of traumatic events from deployment may have negative effects on partners. At the extreme, some partners are suggested to develop PTSD-like symptoms, or secondary traumatic stress. Despite these hypotheses, there have been few empirical tests of the effects of communicating about such events. In a sample of 465 combat veterans and their spouses who participated in the Family Interview Component of the National Vietnam Veterans Readjustment Study, we explored how the extent of couples' deployment-related communication was associated with partner relationships and psychological distress, and whether such associations were moderated by the severity of veterans' PTSD symptoms. Results showed that Vietnam-specific communication correlated negatively with relationship distress, but the effect was negligible after controlling for overall communication in the relationship. On the other hand, Vietnam-specific communication did not correlate with psychological distress, but the association was significantly moderated by veterans' PTSD symptom severity. Specifically, communication about Vietnam was increasingly and positively associated with partners' psychological distress as veterans' symptoms of PTSD rose into the clinical range, but nonsignificantly and negatively associated with such distress as PTSD symptoms decreased below this level. The findings support previous clinical recommendations that couples' discussions of potentially traumatic events be approached cautiously, and they suggest a need to attend to the content of couples' communications when conducting dyadic interventions for PTSD.     

Examination of the Relationship Between PTSD and Distress Tolerance in a Sample of Male Veterans With Comorbid Substance Use Disorders

Distress tolerance (DT), the perceived or actual ability to tolerate negative emotional or physical states, is inversely related to posttraumatic stress disorder (PTSD) symptoms in civilian, community samples. No studies to date have examined the relationship between DT and PTSD in clinical samples of veterans with a comorbid diagnosis of PTSD and a substance use disorder (SUD). Thus, the present study examined the relationship between DT and PTSD in a sample of predominately African American, male veterans (n = 75) diagnosed with comorbid PTSD and SUD (according to a structured clinical interview). Results of hierarchical linear regression models indicated that DT was inversely related to total PTSD symptom severity score, above and beyond depressive symptoms and SUD severity. Of the 4 symptom clusters, DT was inversely associated with intrusions and hyperarousal. These findings are discussed in light of previous work with civilian samples. Determining whether treatment incorporating DT skills would be useful for veterans undergoing PTSD treatment should be evaluated.     

Childhood Sexual Assault,Quality of Life,and Psychiatric Comorbidity in Veterans With Military and Civilian Sexual Trauma

Veterans with military sexual trauma (MST) are at risk for a variety of psychiatric conditions, including posttraumatic stress disorder (PTSD) and depression. Survivors of MST are also likely to experience diminished quality of life (QoL). Individuals with higher lifetime incidence of sexual trauma may also be at increased risk for poorer outcomes in QoL and psychiatric symptomatology. The differences in psychological sequelae among those who have experienced sexual trauma as children, and those whose sexual trauma exposure is limited to adulthood are relatively understudied. The majority of sexual trauma literature has focused primarily on civilian trauma, and comparatively few studies have specifically examined psychosocial sequelae (e.g., QoL) in veterans with MST. This study examined how childhood sexual abuse (CSA) affects overall QoL as well as severity of PTSD and depressive symptoms. Veterans who reported CSA had significantly greater depression symptom severity than veterans who did not. No significant differences in PTSD symptom severity or QoL were found between veterans who did and did not report CSA. Results highlight the need for further examination of the relationship between CSA and depression in veterans with MST-related PTSD who also report CSA.     

A longitudinal test of the bi-directional relations between avoidance coping and PTSD severity during and after PTSD treatment

Avoidance coping and symptoms of posttraumatic stress disorder (PTSD) covary. However, relatively little research has examined the bi-directional relation between these constructs among individuals in treatment for PTSD. The current longitudinal study examined the reciprocal associations between avoidance coping and PTSD symptom severity during and after residential PTSD treatment among a sample of 1073 military veterans (88.9% male; M_age = 52.39 years) with chronic, treatment-resistant PTSD. Greater avoidance coping at intake predicted more severe PTSD symptoms at discharge, and severity of PTSD symptoms at discharge predicted increased avoidance at follow-up. Conversely, PTSD symptom severity at intake was not related to avoidance coping at discharge, and in turn avoidance coping at discharge was not related to PTSD symptom severity at follow-up. These findings offer a number of important clinical implications including evidence suggesting avoidance may predict poorer treatment response among individuals seeking treatment for chronic PTSD, and that greater end-of-treatment PTSD symptom severity may predict increased avoidance following treatment.     

Posttraumatic stress disorder in a national sample of female and male Vietnam veterans: risk factors, war-zone stressors, and resilience-recovery variables

Relationships among pretrauma risk factors (e.g., family instability, childhood antisocial behavior), war-zone stressors (e.g., combat, perceived threat), posttrauma resilience-recovery variables (e.g., hardiness, social support), and posttraumatic stress disorder (PTSD) symptom severity were examined. Data from a national sample of 432 female and 1,200 male veterans were analyzed using structural equation modeling. For both genders, direct links to PTSD from pretrauma, war-zone, and posttrauma variable categories were found; several direct associations between pretrauma and posttrauma variables were documented. Although war-zone stressors appeared preeminent for PTSD in men, posttrauma resilience-recovery variables were more salient for women. Researchers, policymakers, and clinicians are urged to take a broad view on trauma and its sequelae, especially regarding possible multiple exposures over time and the depletion and availability of important resources.     

Initial examination of a multidimensional model of trauma-related guilt: Applications to combat veterans and battered women

Guilt is conceptualized as a multidimensional construct consisting of negative affect and a set of interrelated cognitions. Guilt magnitude is thought to be a function of the magnitudes of six variables posited as primary components of guilt: a negative event, distress, perceptions of responsibility, lack of justification, wrongdoing, and false beliefs about preoutcome knowledge. The model was tested with samples of Vietnam veterans and battered women. Participants rated their reactions to and perceived roles in trauma-related events. Among Vietnam veterans, distress ratings were highly correlated with guilt severity. Cognitive guilt-component variables were significantly correlated with guilt in both groups. In multiple regression, guilt components accounted for 61% of variance in veterans' guilt and 44% of variance in women's guilt. Among veterans, distress ratings were highly correlated with measures of PTSD and depression. In both groups, cognitive guilt-component variables were positively correlated with psychopathology. Results support the view that beliefs about one's role in trauma are important factors in posttrauma adjustment.     

Validation of a brief measure of posttraumatic stress disorder: the Distressing Event Questionnaire (DEQ)

The Distressing Event Questionnaire (DEQ) is a brief instrument for assessing posttraumatic stress disorder (PTSD) according to criteria provided in Diagnostic and Statistical Manual of Mental Disorders (4th ed.). The DEQ possesses high internal consistency and exhibited satisfactory short-term temporal stability in studies with Vietnam War combat veterans and battered women. In a sample of Vietnam War veterans and 4 separate samples of abused women (with histories of incest, rape, intimate partner abuse, or prostitution and abuse), the DEQ exhibited very good discriminative validity when judged against structured interview assessment of PTSD. The DEQ exhibited strong convergent validity with other PTSD measures and other indexes of adjustment and also exhibited strong convergent validity as a measure of PTSD across ethnic groups in both the veteran sample and the combined women's sample.     

Neuropsychological Performance in Gulf War Era Veterans: Traumatic Stress Symptomatology and Exposure to Chemical–Biological Warfare Agents

Because complaints of diminished concentration and memory are among the most common health symptoms reported by Gulf War (GW) veterans with unexplained illnesses, this study investigated neuropsychological functions among GW veterans and controls. Relationships between neuropsychological performance, severity of posttraumatic stress disorder (PTSD) symptomatology, and exposure to chemical–biological warfare agents (CBW) were assessed. Participants were 225 veterans recruited from three cohorts: GW-deployed veterans from Ft. Devens, MA ( n = 141) and New Orleans, LA (n = 37), and Germany-deployed veterans from a Maine National Guard unit (n = 47). A comprehensive evaluation was completed. Severity of subclinical PTSD symptomatology was significantly related to scores on specific neuropsychological tests. PTSD symptom severity in GW-deployed veterans was found to be greater and associated with a broader range of neuropsychological deficits than in Germany-deployed veterans. PTSD severity was associated with lower performance on a range of neuropsychological tasks, whereas CBW exposure contributed to performance deficits on specific cognitive tasks.     

Normative mid-life concerns among Vietnam veterans with post-traumatic stress disorders: Some preliminary empirical findings

Most Vietnam veterans are now in the mid-life years. Veterans suffering from post-traumatic stress disorder (PTSD) may find that mid-life concerns both precipitate and exacerbate their PTSD symptomatology. Preliminary research with four groups of adult males supports this notion. A cross-sectional study with nonveteans, Vietnam era noncombatants, Vietnam combat veterans not in treatment, and Vietnam veterans in treatment for PTSD suggests that the mid-life issues of affiliation, identity, demonic guilt, and work may be the most problematic. Implications for treatment are discussed.