Interactive effects of cumulative lifetime traumatic brain injuries and combat exposure on posttraumatic stress among deployed military personnel

Growing research links Traumatic Brain Injury (TBI) with greater posttraumatic stress disorder (PTSD) symptoms. Much of this research has focused on the influence of the presence or severity of a single TBI while neglecting the potential cumulative effects of multiple TBIs incurred across an individual’s lifetime on combat-related PTSD. The present study addressed this gap using a sample of 157 military service members and 4 civilian contractors who underwent structured TBI interviews at a military hospital in Iraq and completed the Combat Experiences Scale (CES) and Posttraumatic Checklist – Military (PCL-M). Results indicated that a greater number of lifetime TBIs were associated with greater PTSD symptoms when accounting for the presence and severity of a recent, deployment-related TBI. Additionally, a significant interaction of number of lifetime TBIs and combat exposure emerged, indicating that exposure to combat yielded greater PTSD symptoms among those with multiple lifetime TBIs compared to those with one or zero lifetime TBIs. These data suggest that incurring multiple TBIs may amplify the link between combat exposure and PTSD and underscore the need to screen for lifetime TBI history.     

Psychological impact of remote combat/graphic media exposure among US Air Force intelligence personnel

Since 2001 there has been a significant increase in the use of intelligence, surveillance, and reconnaissance (ISR) analysis for tactical, operational, and strategic decision makers engaged in global operations. To meet this demand, US Air Force intelligence personnel participate in remote combat and graphic media exploitation operations (e.g., review of still imagery, video, and audio), the long-term psychological effects of which are not well understood. Research to date has focused primarily on outcomes related to how intelligence personnel work, versus the specifics of what they do. Military psychologists embedded in ISR units conducted studies to address this gap. Intelligence analysts participated in focus groups and surveys assessing the frequency of exposure, previous exposures to other potentially traumatic events, symptoms of PTSD, moral injury, and other psychosocial experiences. Results showed that exposure levels, albeit virtual, rivaled or exceeded those reported by a sample of special operations forces. Results also showed that specific types of exposures (e.g., witnessing US military casualties, civilian casualties, atrocities committed by the enemy) are related to increased posttraumatic stress and other sequelae that may not adequately be captured by standard posttraumatic stress disorder screening measures. The results contribute to the existing literature on posttraumatic stress, shed new light on the emerging construct of moral injury, and highlight challenges presented by remote combat and graphic media exploitation operations to force health sustainment and performance optimization. The authors provide directions for future research and recommendations for ongoing assessment, monitoring, and selection and training of ISR personnel.     

Cumulative trauma and midlife well-being in American women who served in Vietnam: effects of combat exposure and postdeployment social support

Background and Objectives: Research increasingly demonstrates that trauma exposure can have cumulative effects, yet much remains to be learned about effects of cumulative trauma, particularly regarding longer term adjustment. One such trauma, combat exposure, is insufficiently understood, especially for women, who are increasingly engaged in professional combat activities. Design: The study comprised a cross-sectional survey assessing multiple aspects of current well-being in women approximately 25 years after their service in Vietnam during the Vietnam War. Methods: Participants were 1374 women (78% military and 22% nonmilitary; mean age = 59.7). This study investigated the relations between three separate categories of trauma exposure (childhood, adulthood, and combat) and well-being and examined whether perceived social support at return from Vietnam moderated the association between combat exposure and well-being. Results: While both childhood and adulthood trauma exposure related to midlife well-being, combat exposure still uniquely predicted outcomes. Further, postdeployment perceived social support moderated the association of combat and well-being: recollected higher perceived social support at homecoming buffered participants from the links between combat exposure and well-being. Conclusions: These results may have important implications for interventions to reduce the impact of traumatic experiences, particularly in light of the increasing exposure of women to direct combat events.     

Marital intimacy,family support,and secondary traumatization: A study of wives of veterans with combat stress reaction

Abstract

The main aim of the study was to assess the role of family variables in the process of secondary traumatization among wives of post-traumatic veterans. We compared a sample of 49 wives of Israeli veterans with combat stress reaction (CSR) from the 1982 Lebanon War with a sample of 31 wives of Israeli veterans who fought in the war without developing CSR. We assessed their psychological reactions to the war, their health status six years later, and their reported levels of marital intimacy and family support after the war. When compared with controls, wives of veterans with CSR reported more negative emotions and lower perceived intimacy after the war, and greater severity of psychiatric and somatic symptoms six years later. Results also indicate that the greater the perceived marital intimacy, the less the negative emotions wives of veterans with CSR felt after the war and the better their health status six years later. In addition, wives of veterans with CSR who reported having received more support from their families after the war reported more anxiety and hostility than wives who received less support. The roles of marital intimacy and family support in the process of secondary traumatization were discussed.     

Psychological Impact of Terrorism on Children and Families in the United States

Summary

This article reviews the literature on the psychological impact of terrorism on children and families in the United States. It includes studies of the 1993 World Trade Center bombing in New York City and the 1995 bombing of the Alfred P. Murrah Federal Building in Oklahoma City, as well as the September 11 attacks. These studies explore the impact of various forms and degrees of exposure to terrorism on children across the development spectrum and on the relationships between parental and child reactions. The article concludes with a framework for future research on children's adaptation following mass trauma.     

Narrative exposure therapy for posttraumatic stress disorder in tortured refugees: A preliminary uncontrolled trial

Halvorsen, J.Ø. & Stenmark, H. (2010). Narrative exposure therapy for posttraumatic stress disorder in tortured refugees: A preliminary uncontrolled trial. Scandinavian Journal of Psychology 51, 495–502. Torture has severe mental health effects, especially in terms of posttraumatic stress disorder (PTSD) and depression. However, there is still a lack of empirical treatment studies. The present paper presents data on 16 torture survivors receiving 10 sessions of narrative exposure therapy (NET). Symptoms of PTSD and depression, assessed by Clinician‐Administered PTSD Scale (CAPS) and Hamilton Rating Scale for Depression (HRSD), decreased significantly from pre‐treatment to 6‐month follow‐up, with Cohen’s d effect sizes of 1.16 and 0.84, respectively. Although treatment gains were moderate, further research on evidence‐based treatments for PTSD and depression in refugee torture survivors is warranted.     

Media exposure to terrorism and people's risk perception: The role of environmental sensitivity and psychophysiological response to stress

Terrorist attacks have a destabilizing impact on the general population, causing distress and fear. However, not all individuals are equally susceptible to the effects of terror threat. This study aimed to examine whether exposure to terrorism-related pictures interacted with individual differences in environmental sensitivity and psychophysiological response to stress to explain people's risk perception, operationalized as perceived likelihood of a terrorist attack and willingness to trade off one's privacy to increase national security. Ninety-five university students were randomly assigned to one of two conditions (terrorism-related vs. neutral pictures). After watching the pictures, they answered questions concerning risk perception and completed questionnaires. Stress was induced by the Mannheim Multicomponent Stress Test, during which heart rate was recorded. Results showed that the perceived likelihood of future attacks was affected by the interaction between exposure to terrorism pictures and psychophysiological reactivity to stress, whereas willingness to trade off one's privacy to improve national security was influenced by the interaction between exposure to terrorism pictures and environmental sensitivity. The study suggests that individuals high in sensitivity and psychophysiological stress reactivity are particularly affected by terrorism-related pictures. Psychologists should direct their efforts to raise general awareness of the negative effects, especially for some people, of such media coverage.     

Effectiveness of online word of mouth on exposure to an Internet-delivered intervention

The use of online word of mouth (WOM) seems a promising strategy to motivate young people to visit Internet-delivered interventions. An Internet-delivered intervention aimed at changing implicit attitudes related to alcohol was used in two experiments to test effectiveness of e-mail invitations on a first visit to the intervention. The results of the first experiment (N = 196) showed that an invitation by e-mail from a friend was more effective to attract young adults (aged 18–24 years) to the intervention website than an invitation from an institution. A 2 × 2 design was used in the second experiment (N = 236) to test manipulations of argument strength and the use of peripheral cues in invitations. Results showed that weak arguments were more effective to attract young adults to the intervention website when an incentive was withheld. These results need to be taken into account when using online WOM as a strategy to improve exposure to Internet-delivered interventions.     

Psychological resilience: the impact of affectivity and coping on state anxiety and positive emotions during and after the Washington,DC sniper killings

This research examined the impact of affectivity and coping on state anxiety and positive emotions among young adults living in the Washington, DC metro area both during and after the Washington, DC sniper killings. Participants completed questionnaires during three waves of data collection: (1) during the sniper attacks (n=92); (2) within two weeks after the snipers were captured (n=45); and (3) six months later (n=43). Affectivity (measured by neuroticism) was significantly associated with state anxiety and positive emotions during all three time periods. Coping (measured by constructive thinking) predicted state anxiety and positive emotions during the shootings, but was unrelated to either outcome immediately after the attacks, and marginally related to them six months later. Consistent with the Dynamic Model of Affect, state anxiety and positive emotions were more strongly (and negatively) correlated with each other during the killings than they were after the snipers were apprehended. Taken together, these results support transactional models of stress that emphasize the interaction between dispositional and situational influences, and they suggest that affectivity reflects a fundamental set of reactions to one's environment, while coping dispositions result in more stress-specific responses. Additional theoretical and practical implications of these findings are also discussed.     

Teacher stress: An eight-year follow-up study on teachers' work,stress, and health

Abstract

The purpose of this study was to compare teacher stress between the years 1983 and 1991. Seventy teachers in comprehensive and upper secondary schools participated in the study. The teachers were studied first during the school year 1983–84 and again eight years later during the autumn term of 1991 by means of repeated questionnaires. During this 8-year period the general working situation among the teachers had remained quite stable: Most of them had remained at the same school teaching the same subjects at the same level. The results showed a drop in the teachers' well-being over the period. In particular, those over 55 years of age showed more emotional stress reactions in 1991 than eight years earlier. Furthermore, they evaluated their social relations with pupils as worse in 1991 compared to 1983. A half both of those with low emotional stress reactions and those high in them in 1983 were stilll in the same categories in 1991. Emotional stress reactions were reflected in simultaneous work ability and psychosomatic health data. Moreover, long-term stress was seen to lead to various psychosomatic complaints, but these were not reflected in self-rated health status. The results suggest that teacher stress is not necessarily a short-lived problem, and ways of preventing or reducing stress (e.g. continuing education, counseling, co-operation) should be employed.     

Effects of live exposure on symptoms of posttraumatic stress disorder: the role of reduced behavioral avoidance in improvement

Although the effectiveness of cognitive-behavioral treatment in posttraumatic stress disorder (PTSD) is well established, few studies examined its effects on individual PTSD symptoms and possible mechanisms of improvement in symptoms. In a previous randomized controlled study [Ba?og lu, M., Salciog lu, E., Livanou, M., Kalender, D., & Acar, G. (2005). Single-session behavioral treatment of earthquake-related posttraumatic stress disorder: A randomized waitlist controlled trial. Journal of Traumatic Stress, 18, 1-11] a single session of behavioral treatment involving self-exposure instructions was highly effective in reducing earthquake-related PTSD. In the present study we examined the effects of treatment on each PTSD symptom and which symptoms improved early in treatment. Because the intervention focused solely on behavioral avoidance, we hypothesized that avoidance would be the first symptom to change and that reduction in avoidance would generalize to all other symptoms. The results showed significant between-groups treatment effect on only behavioral avoidance early in treatment (week 6). At 6 months post-treatment recovery rates ranged from 60% to 89% for 15 PTSD symptoms, including the numbing symptoms. Lack of improvement in avoidance was associated with lack of improvement in 12 symptoms. The critical process in recovery thus appeared to be increased sense of control associated with reduction in avoidance. These findings imply that live exposure to fear cues designed to enhance sense of control might be sufficient for recovery from PTSD.     

Sex,strain, and housing: Variables influencing the effects of prior shock exposure on shock-induced aggression

A series of experiments was conducted to investigate sex, housing conditions, and strain as possible factors influencing the interference effect of prior exposure to shock on shock-induced aggression. In albino subjects, female rats and rats housed in community cages evidenced the greatest suppression in aggression following prior exposure to shock. In addition, ten sessions of prior exposure to shock produced a greater suppression in shock-induced fighting than 20 sessions of prior exposure to shock. The prior shock effect was not obtained with hooded subjects. Responsivity to shock was also investigated to determine whether the prior exposure to shock attenuation of shock-induced fighting was a consequence of reduced activity in response to shock. Responsivity to shock measured with an isometric platform accounted for less than 4% of the variance in shock-induced fighting in the single experiment that obtained a correlation between responsivity and shock-induced aggression.     

Prevalence of Children's Exposure to Domestic Violence and Child Maltreatment: Implications for Prevention and Intervention

The purpose of this paper is to review research on the prevalence of children's exposure to domestic violence, to consider the available literature on the co-occurrence of domestic violence and child maltreatment, and to gain more understanding about the impact of exposure on children. There is clear evidence indicating that both severe and moderate violence occurs frequently in homes among family members and that children are exposed to this violence. However, because of differing definitions of what constitutes domestic violence and variability in research methodologies for collecting the data, there are significant discrepancies in prevalence reports across studies. Of great concern is the immediate impact on the children and the long-term consequences for their later relationships. Fewer studies have been done on the co-occurrence of domestic violence and child maltreatment. However, it is likely that children who live in homes where domestic violence occurs are more likely to be abused and neglected. On the basis of available research, there is little doubt that vast numbers of children are exposed to domestic violence and that children's responses vary widely depending on their risk and vulnerability, as well as the structure of their environments. A developmental risk and protective factors framework will be used to integrate the information on children's exposure to violence.     

Insights from a deradicalization program in Indonesian prisons: The potential benefits of psychological intervention prior to ideological discussion

Discussions that are based on religious understanding and aimed at reducing terrorists' hostility have been used as a central part of terrorist deradicalization programs in many countries where acts of Islamic terrorism are prevalent. Currently, various psychological approaches such as presenting social support and providing counseling sessions are being applied alongside religious discussions. Observers of these programs have reported benefits and positive responses to the psychological approaches, but there is still a lack of empirical evidence confirming this. In the current study, we examine the effects of two psychological interventions—emotional expression training and cognitive flexibility training—in predicting detainees’ acceptance of the idea of democratic life. We investigated the observational records taken during the psychological interventions and religious discussions. Results showed no main effect of emotional expression and cognitive flexibility in predicting one’s acceptance of democratic civil life, but there was a significant interaction between the two predictors. Among those who scored high in cognitive flexibility, detainees who scored also high in emotional expression were significantly more agreeable towards the state’s sovereignty over belief in an Islamic caliphate during religious discussions. Our findings suggest that psychological interventions do indeed offer benefits for detainees’ deradicalization programs.     

Social anxiety and posttraumatic stress in combat veterans: relations to well-being and character strengths

There are few studies examining the relationship between psychopathology and positive experiences and traits. Although initial studies suggest persons with posttraumatic stress disorder (PTSD) are at increased risk for excessive social anxiety, there have been no studies to date evaluating how these conditions might interact to affect positive experiences and traits. Using self-report scales, informant ratings, and experience-sampling methodologies, we examined the association of social anxiety with well-being and character strengths in veterans with and without PTSD. Controlling for PTSD and trait negative affect, social anxiety was negatively related to global ratings of well-being and character strengths. Social anxiety also accounted for incremental variance in day-to-day well-being (i.e., daily affect balance, percentage of pleasant days, positive social activity, self-esteem, gratitude) over a 14-day assessment period. Although veterans with PTSD reported lower levels of global and daily well-being and character strengths than veterans without PTSD, a diagnosis of PTSD failed to exhibit unique relationships with these constructs. Building on a growing body of work, these data suggest that social anxiety is uniquely associated with disturbances in positive experiences, events, and traits. Our findings support the value of directly addressing social anxiety in the study and treatment of PTSD.     

Being well at work: the impact of organizational climate and social identity on employee stress and self-esteem over time

In organizational psychology, staff perceptions of organizational climate have been found to be an important predictor of employee outcomes, such as employee stress. However, only a small pool of research has investigated the psychological mechanism that underpins the relationship, and no past literature has explored how the relationship persists over time. This paper uses the social identity approach to investigate whether social identification predicts and mediates the relationship between staff perceptions of organizational climate and their levels of stress and self-esteem over time. Employing a sample of public school teachers, the study was conducted over two years (N = 281, 65 schools). The results indicated that social identification fully mediated the relationship between organizational climate and self-esteem longitudinally but showed no significant relationship with stress. The implications of these findings are discussed, with recommendations for future research.     

Attachment Patterns as Mediators of the Link Between Combat Exposure and Posttraumatic Symptoms: A Study Among Portuguese War Veterans

We analyzed the role of both attachment anxiety and attachment avoidance as a mediators of the effects of combat exposure on posttraumatic stress disorder (PTSD) symptoms. Participants were Portuguese veterans (N = 60) divided into 2 groups: 30 suffered from chronic PTSD (nonrecovered) and 30 had remission from PTSD (recovered). Combat exposure, attachment patterns, and PTSD symptoms were assessed through self-report measures. Mediation test was performed by conducting several hierarchical regression analyses. Results showed higher attachment anxiety among nonrecovered participants. We did not find statistically significant differences between groups for both attachment avoidance and combat exposure level scores. In mediation analysis, at first step, attachment avoidance was not a significant predictor of PTSD symptoms, and attachment avoidance did not enter in subsequent analysis. Attachment anxiety was a partial mediator of the effect of combat exposure on PTSD symptoms. Implications of the findings for both attachment theory and clinical intervention on trauma are discussed.     

The impact of stress on marital quality: A stress-vulnerability theory

This article outlines a stress-vulnerability theory for describing how stress impacts marital quality. Implications for therapy are also discussed based on the stress-vulnerability theory.Appreciation is expressed to Joan Jurich, PhD for her helpful comments during the development of this theory.     

Positive affect predicts less reacquisition of fear: relevance for long-term outcomes of exposure therapy

Much emphasis in fear conditioning research is placed on understanding extinction learning, partly because of its application in treating anxiety disorders. Return of fear after extinction is a problem affecting long-term maintenance of treatment gains. The present study evaluated whether positive affect (PA) is associated with lower rates of reacquisition, or, an increase in fear following re-pairings of the conditional stimulus (CS+) and unconditional stimulus (US; e.g. electric shock) after extinction. Results showed that higher PA before and after extinction was associated with less CS+ fear during reacquisition as measured by skin conductance arousal and US expectancy. Conversely, negative affect was not associated with reacquisition of fear using any measure. These results provide implications for reducing reacquisition with exposure therapy for anxiety disorders.