Management of Post-Traumatic Stress Disorder in the Military: An Intervention Model

Military Forces are involved in combat, peacekeeping operations and disaster management. The nature of such operations include violent conflict, death of women and children, child soldiers and own forces. These traumatic circumstances can contribute to the development of post traumatic stress disorder (PTSD) in members involved. This article discusses the role and function of psychological debriefing for trauma with operational military units. It also proposes a preliminary intervention model to manage PTSD in military forces.     

The Use of Psychoendocrine Strategies in Post-Traumatic Stress Disorder1

An overview is presented of a pilot psychoendocrine study of PTSD inpatients in comparison with several subgroups of schizophrenic and affective disorder patients. Using a hormonal profile including Cortisol, norepinephrine, epinephrine, testosterone, and thyroxine, it was found that the mean values for the PTSD group were at or near the extreme end of the range for every hormone measured, i.e., relatively low for Cortisol and high for the remaining hormones. The possible clinical meaning of these findings is considered in the light of prior psychoendocrine research on chronic stress. The hormonal alterations in PTSD appear to be persistent and suggest the possibility of being linked largely to traits or character structure, perhaps particularly to cognitive variables related to defense and coping mechanisms, as reviewed in detail for each hormonal system. There appears to be a potential for a fruitful union between the traumatic stress and psychoendocrine fields and some future strategies for developing and strengthening such a union are suggested.     

Post-Traumatic Stress Disorder Among Salvadoran Women:

Previous research has documented post-traumatic stress disorder among Salvadoran refugees in this country, but information on refugees living in El Salvador is not available. This study investigated the patterns of psychological distress and documented the existence of PTSD in Salvadoran refugee women in El Salvador. A team of U.S. mental health workers traveled to a refugee camp in El Salvador to interview women about their traumatic experiences and current symptoms of distress. This study provides strong evidence that many refugee women in El Salvador have developed PTSD and that many others show significant signs of distress. Data from this study also provided insight into clinical issues for Salvadoran women experiencing PTSD. In response to requests from Salvadoran mental health providers, a treatment program was developed to help Salvadoran women reduce their distress. Goals of the treatment included associating distress with the trauma as a normal reaction to a very abnormal event, reducing feelings of loss of control, reducing "survivor guilt," and lessening anxiety and high arousal level. These goals were accomplished using cognitive-behavioral and community-oriented strategies.     

Post-Traumatic Stress Disorder in Vietnamese Women

This article describes the extraordinary events Vietnamese women immigrants and refugees experienced prior to their resettlement in the United States. Oral history data illustrate the need for sensitization to issues of Post-Traumatic Stress Disorder and the historical-cultural background of this special population. Oral history narratives from five Vietnamese women suggest differences in the way men and women define wartime trauma, and that women's biological makeup may precipitate some stress reactions unique to women. These narratives are examined in terms of Post-Traumatic Stress Disorder (PTSD), a diagnosis that has been applied primarily to male veterans in treating their physical and psychological problems resulting from war, not to Vietnamese women who lived under war conditions.     

Attachment Theory and Post-Traumatic Stress Disorder

Attachment theory is applied to understanding and treatment of the anxiety condition of post-traumatic stress disorder in adults. Conceptualized as intensified attachment behavior which is elicited at separation or loss or threat of separation, PTSD responses represent an inherent, though exaggerated, attempt to ensure protection and security. The secure base of a therapeutic relationship reduces the intensity of responses and provides an opportunity to review experiences relevant to current distress in order to affirm emotional reactions and come to terms with distressing events. Implications for prevention are discussed.     

Comorbidity of attention Deficit Hyperactivity Disorder and Post-Traumatic Stress Disorder

Attention Deficit Hyperactivity Disorder (ADHD) and Post-Traumatic Stress Disorder (PTSD) show a high degree of comorbidity in traumatized children. Two hypotheses may help explain this relationship: children with ADHD are at higher risk for trauma due to their impulsivity, dangerous behaviors, and parents who may have a genetic predisposition for impairment of their own impulse control; and hyperarousal induced by severe trauma and manifested by hypervigilance and poor concentration may impair attention to create an ADHD-like syndrome. Four illustrative cases are presented, and implications for treatment are discussed.     

创伤后应激障碍病因及发病机制的研究进展

创伤后应激障碍(post-traumatic stress disorder,PTSD)是一种严重的应激相关障碍,指个体面临异常强烈的精神应激后延迟发生的精神障碍,文献报告PTSD的终生患病率为1%～14%,高危人群研究发现PTSD的患病率为3%～58%,女性约为男性的两倍[1]。PTSD的病因及发病机制较为复杂,涉及很多方面,本文将对PTSD病因及发病机制的研究进展进行综述。     

创伤后应激障碍病因及发病机制的研究进展

创伤后应激障碍(post-traumatic stress disorder,PTSD)是一种严重的应激相关障碍,指个体面临异常强烈的精神应激后延迟发生的精神障碍,文献报告PTSD的终生患病率为1%～14%,高危人群研究发现PTSD的患病率为3%～58%,女性约为男性的两倍[1].PTSD的病因及发病机制较为复杂,涉及很多方面,本文将对PTSD病因及发病机制的研究进展进行综述.     

The Biological Findings in Post-Traumatic Stress Disorder: A Review1

In this paper the authors review the literature on biological and treatment studies of post-traumatic stress disorder (PTSD) and present current unifying hypotheses regarding the pathophysiology. The psychophysiological studies stress overarousal, while endocrine studies suggest a decreased Cortisol production in denial and low symptom states with increases in highly symptomatic states. Suggestive evidence is provided that PTSD is associated with permanent changes in brain mechanisms involving the locus coeruleus, amygdala, and the hypothalamo-pituitary-adrenal axis. Drug treatments are promising but not fully satisfactory as yet. Directions for further research are provided.     

The time of trauma: Husserl's phenomenology and Post-Traumatic Stress Disorder

The phenomenology of inner temporalizing developed by Edmund Husserl provides a helpful framework for understanding a type of experiencing that can be part of the Post-Traumatic Stress Disorder (PTSD). My paper extrapolates hints from Husserl's work in order to describe those memories — flashbacks — that come so strongly to consciousness as to overtake the experiencer. Husserl's work offers several clues: his view of inner temporalization by which conscious experiences flow in both a serial and a nonserial manner; a characterization of process memory as distinct from representational memory; and the notion of telos, which takes human subjectivity as intrinsically changeable, for example, by means of a retroactive cancellation that would allow the PTSD experiencer to re-process the original meaning of the traumatic experience into a meaning that fits the current situation and thus allows a recovery.     

中学生创伤后成长、创伤后应激障碍的发展趋势:心理复原力的预测效应

以问卷调查的方法对汶川震后初一年级的学生进行2.5年的追踪研究,通过多层线性模型(HLM)来探索创伤后成长(PTG)和创伤后应激障碍(PTSD)的发展趋势以及心理复原力对二者的预测效应。结果发现,随着时间的发展,心理复原力仅在第二次施测时呈显著下降趋势,PTSD与PTG均呈现出先下降后上升的非线性发展趋势;心理复原力的三个因子对PTG均有显著的正向预测作用,力量因子对PTSD有显著负向预测作用,其中,乐观因子可进一步预测PTG的发展速度,力量因子可进一步预测PTSD的发展速度;在灾后中学生PTG的增长、PTSD的降低中,心理复原力可以分别解释18.87%和14.74%的变异。     

Behavioural Treatment of Post-Traumatic Stress Disorder Associated with Recovered Memories

Post-traumatic stress disorder (PTSD) is sometimes associated with recovered memories (RMs) of traumatic events. That is, the sufferer reports having forgotten traumatic events for a period of time, only to recall them later on. As the memories of traumatic events are recalled, post-traumatic stress disorder may emerge. The cause of recovered memories is uncertain and is the subject of debate. Some recovered memories may be reasonably accurate, while others may be ''recollections'' of imagined rather than actual events. It is unclear whether conventional PTSD therapies, such as behaviour therapy, are appropriate and effective in treating PTSD-RM. The present article considers these issues in the context of a case study, in which a patient with PTSD-RM was treated with behaviour therapy ( in vivo and imaginal exposure). The patient sought treatment because he wanted relief from his PTSD symptoms, regardless of whether his recovered memories were accurate (he was completely convinced in the accuracy of the memories). Treatment outcome was compared with the outcome of 13 PTSD patients who did not have recovered memories, who were also treated with behaviour therapy. Results suggest that PTSD-RM can be effectively treated with behaviour therapy. However, such treatment is unlikely to be appropriate for all cases of PTSD- RM. Selection criteria are discussed.     

Forgetting Trauma: Socially Shared Retrieval‐induced Forgetting and Post‐traumatic Stress Disorder

Memory for related but unpracticed aspects of an event can be impaired by selectively retrieving parts of the same event. This occurs when selective retrieval [within‐individual retrieval‐induced forgetting (WI‐RIF)] is undertaken by individuals and has been extended to social contexts—RIF can be produced in listeners [socially shared retrieval‐induced forgetting (SS‐RIF)] by a speaker's selective recounting. The effects of post‐traumatic stress disorder (PTSD) on WI‐RIF and SS‐RIF were examined by two experiments. In Experiment 1, combat veterans (with or without PTSD) and non‐veteran dyads participated in a RIF paired‐associates paradigm adapted for combat‐related stimuli. WI‐RIF and SS‐RIF occurred for combat‐related and neutral pairs regardless of group. However, greater WI‐RIF and SS‐RIF for combat‐related words were shown by individuals with PTSD. These findings were replicated by Experiment 2, in which either a combat‐related or neutral story was learned by participants, and selective retrieval was embedded in a conversation. That the selective retrieval of trauma‐related stimuli leads to enhancement of induced forgetting for individuals with PTSD under certain conditions is suggested by these data. Copyright © 2011 John Wiley & Sons, Ltd.     

Psychosocial predictors of chronic Post-Traumatic Stress Disorder in Sri Lankan tsunami survivors

This study aimed to determine whether psychological factors associated with Post-Traumatic Stress Disorder (PTSD) identified in Western samples generalize to low Social-Economical-Status (SES) populations in an underdeveloped Asian country. The study included 113 survivors of the 2004-tsunami on the south coast of Sri Lanka, recruited from 4 preschools and 10 villages for displaced persons. With logistic regressions the relations between interview-based PTSD diagnosis and psychological factors were assessed, controlling for putative confounders. Fifteen months post-trauma the prevalence of PTSD was 52.2%. Multivariate analyses indicated that negative interpretation of tsunami-memories was significantly (P < 0.005) related to PTSD. Of the putative confounders, gender and (non-replaced) lost work equipment were related to current PTSD (P < 0.05). The results indicate that the relation between negative interpretation of trauma memories and PTSD is quite universal, suggesting that interventions focusing on this factor may be important in treatment of tsunami survivors who are suffering from chronic PTSD.     

Symptoms of Post-Traumatic Stress Disorder in Bereaved Children and Adolescents: Factor Structure and Correlates

This study investigated the factor structure and correlates of posttraumatic stress-disorder (PTSD) symptoms among children and adolescents confronted with the death of a loved one. Three hundred thirty-two bereaved children and adolescents (aged 8–18; 56.9 % girls) who all received some form of psychosocial support after their loss, completed self-report measures of PTSD, together with measures tapping demographic and loss-related variables, depression, prolonged grief, and functional impairment. Parent-rated indices of impairment were also collected. We first evaluated the fit of six alternative models of the factor structure of PTSD symptoms, using confirmatory factor analyses. Outcomes showed that the 4-factor numbing model from King et al. (Psychological Assessment 10, 90–96, 1998), with distinct factors of reexperiencing, avoidance, emotional numbing, and hyperarousal fit the data best. Of all participants, 51.5 % met DSM-IV criteria for PTSD. PTSD-status and scores on the PTSD factors varied as a function of age and gender, but were unrelated to other demographic and loss-related variables. PTSD-status and scores on the PTSD factors were significantly associated symptom-levels of depression, prolonged grief, and functional impairment. Findings complement prior evidence that the DSM-IV model of the factor structure of PTSD symptoms may not represent the best conceptualization of these symptoms and highlight the importance of addressing PTSD symptoms in children and adolescents seeking help after bereavement.     

Steps Toward Evaluating Post-Traumatic Stress Reaction as a Psychiatric Disorder1

This brief paper summarizes comments made in discussing papers given in the November 1988 NIHM workshop “Traumatic Stress: Defining Terms and Instruments”. It raises questions about current criteria for posttraumatic stress in terms of the traumatic events considered appropriate, the coherence of the syndrome described, and the scarcity of data on its course, its familiarity, and its relationship to other syndromes. It is suggested that long-term studies of general population cases will be needed to answer these questions.     

A Primer Of Closed Head Injury Sequelae In Post-Traumatic Stress Disorder

Abstract

By definition, an individual diagnosed with post-traumatic stress disorder (PTSD) has been exposed to a serious threat of physical harm that engenders concomitant feelings of fear, helplessness, or horror (American Psychiatric Association, 1994). According to the current diagnostic taxonomy, PTSD may develop when the person witnesses harm against someone else or learns of harm occurring to an intimate other. Yet, all too often, PTSD is associated with the direct experience of physical injury through assault, accident, or other violence. As such, individuals with PTSD are at increased risk of having sustained a head injury, particularly during the traumatic events that elicited the PTSD symptoms (Knight, 1996). Consistent with this assertion, there are indications that individuals who sustain a head injury are increasingly likely to develop subsequent PTSD (Bryant & Harvey, 1998; Chemtob et al., 1998), with the prevalence of PTSD in this population estimated to be as high as 30% (Bryant & Harvey, 1996). Moreover, among people with PTSD, those who have sustained head injuries are apt to have more severe symptoms than those who have not (Chemtob et al., 1998).     

Pavlovian Eyeblink Conditioning in Combat Veterans With and Without Post-Traumatic Stress Disorder

Several recent studies have investigated relationships between post-traumatic stress disorder (PTSD) and learning and memory problems. These reports have found in general that not only does PTSD affect trauma-related memories, but when patients with PTSD are compared with similar trauma patients without PTSD, general memory impairments have been found. The present paper reports a study in which associative learning, using Pavlovian eyeblink conditioning, was investigated in combat veterans with and without chronic PTSD, using interstimulus intervals of 500 and 1000 msec in two separate experiments. Although several recent reports suggest that larger-magnitude autonomic conditioned responses occur in patients with PTSD during Pavlovian conditioning, the present study found evidence of impaired Pavlovian eyeblink conditioning in combat veterans with and without PTSD, compared to non-combat veterans. Although these data suggest that combat leads to an impaired associative learning process regardless of whether PTSD is apparent, a group of community-dwelling combat veterans not under medical treatment showed normal conditioning, suggesting that variables other than prior combat must also be involved.