Dissociative disorders in Vietnam combat veterans

A group of Vietnam combat veterans were surveyed to determine the quantity and quality of their dissociative symptoms. The results suggest that the symptoms of post-traumatic stress disorder (PTSD) and dissociative disorders in this group of patients may be much more closely intertwined than we have heretofore considered. Those who suffer from PTSD have a continuum of severity of dissociative symptoms ranging from the frequent experience of a partially forgotten traumatic experience to the rare occurrence of a full blown case of multiple personality disorder (MPD). Most cases of MPD are related to trauma during childhood in environments fraught with extreme ambivalence and victimization, in association with abandonment and betrayal. However, the high frequency of dissociative symptoms and even occasional occurrences of MPD in Vietnam veterans suggests a similarity in the environmental factors associated with the Vietnam war.     

Anhedonia and emotional numbing in combat veterans with PTSD

We explored relationships between anhedonia and posttraumatic stress disorder (PTSD) symptom clusters, including their role in predicting psychiatric comorbidity. Our measure of anhedonia was derived from an examination of the latent structure of the Beck Depression Inventory. We found evidence for a two-factor solution, leading to anhedonia and undifferentiated, global depressive symptoms scales. In primary analyses, anhedonia had a unique positive relationship with PTSD's emotional numbing symptoms and minimal relationships with other PTSD symptoms. Upon examining the incremental validity of appetitive functioning (i.e., anhedonia, emotional numbing) over and above aversive functioning (i.e., re-experiencing, avoidance, and hyper-arousal PTSD symptoms) variables, greater emotional numbing increased the likelihood of being diagnosed with a major depressive disorder, and greater anhedonia increased the likelihood of being diagnosed with additional anxiety disorders and to a lesser extent, psychotic disorders. Results were consistent with research on the distinction of appetitive and aversive functioning, providing insight into the nature of PTSD.     

Comprehensive system Rorschach data on Vietnam combat veterans

To better understand and, therefore, treat Vietnam combat veterans with a diagnosis of posttraumatic stress disorder (PTSD), the Rorschach was administered to 50 patients so diagnosed. The most important findings were that, on average: (a) These patients have a low level of stress tolerance and are, therefore, likely to respond impulsively to stressful situations; (b) this low stress tolerance appears to be a long-term adjustment problem; and (c) their perception of reality is unconventional and often distorted. A primary therapeutic indication from these data is that the use of structure would be important for successful therapy. Other findings and therapeutic recommendations are also discussed.     

Gestalt therapy in the treatment of Vietnam veterans experiencing PTSD symptomatology

In the author's clinical work with Vietnam veterans experiencing symptoms of PTSD, Gestalt theory and concepts have proven to be very helpful in (a) conceptualizing what sustains Vietnam as a deleterious problem in the lives of these veterans and (b) providing techniques which are effective in helping them overcome their Vietnam-related troubles. Although of great potential, the author feels that the effective application of Gestalt therapy techniques necessitates the kind of prudent clinical discretion which ordinarily requires a solid background in general psychotherapy and specialized training in Gestalt theory, concepts, and techniques.     

Process and content in a long-term PTSD therapy group for Vietnam veterans

Process and content were studied in four 16-session segments of a psychodynamically oriented therapy group for Vietnam veterans suffering from posttraumatic stress disorder (PTSD). On the Group Climate Questionnaire (GCQ-S), the group scored significantly higher in the Engaged dimension and significantly lower in the Avoiding and Conflict dimensions than contrasting samples of neurotic and psychotic groups. There was no evidence of group stages. Topics related to symptoms of PTSD were discussed most frequently (43.1%), followed by issues concerning relations with others (32.4%),general group therapy issues (13.7%), and other topics (10.8%). Clinical implications of these findings are discussed.The authors thank Tom Metzler, M.A., and Heidi Ronfeldt, B.S., for their assistance with the data analysis.Parts of this paper were presented at the American Group Psychotherapy Association Annual Meeting, February 15–20, 1993, San Diego, CA.     

Treating post-traumatic stress disorder among Vietnam combat veterans: An existential perspective

In the existential therapeutic approach the traumatic event is not divorced from the totality of one's life. The authors believe that finding some degree of meaning in the traumatic event is essential and that the recovery process begins when one feels that meaning and the sense of self are congruent.     

The Vietnam veteran and his preschool child: Child rearing as a delayed stress in combat veterans

Integral to a successful readjustment following his Vietnam combat experience, is the veteran's ability to make the transition from the reflex of combat aggressiveness, to adaptive, nondestructive aggression in his current life. Child rearing has been observed to stress the veteran's working through of this very necessary, though often difficult, transition. Specifically, the activity and agression of the terrible two's and the preschool child, particularly males, reawakens the painful affects of combat aggression and sadism. Attempts to control the aggressiveness in his children and himself may lead to maladaptive coping and symptom breakthrough in the veteran, his child and/or his family unit. Two case examples, one brief, one more detailed, illustrate this observation.Paper read at Symposium on War Babies: Delayed Effects of Warmaking, Disaster and Persecution on Children, Xth International Congress of Child and Adolescent Psychiatry, Dublin, July 26, 1982.     

The reparation of the self: Clinical and theoretical dimensions in the treatment of Vietnam combat veterans

This paper discusses a broad range of theoretical and clinical issues pertaining to a proposed approach to individual psychotherapy with Vietnam combat veterans. Called theself-reparative process, this approach features four phases, ranging in the first from anactive behavioral-cognitive approach to the fourth phase that utilizes a less active, psychoanalytic approach. This range of approaches is essential in order to adapt to the ongoing progressivespectrum-of-needs of the veterans, with the objective of increasing psychological control to resolving narcissistic rage and building a cohesive self.The views contained in this paper represent those of the author, who is solely responsible for its contents. As such, the views herein are not necessarily those of the Veterans Administration. Paper presented at a Queens Hospital Center (affiliation of Long Island Jewish-Hillside Medical Center) Department of Psychiatry, Grand Rounds in Jamaica, New York on April 10, 1981. The author acknowledges the gracious assistance of Doctors Scott Mykel and Robert Mednick of Queens Hospital Center during the first draft of this paper.     

The impact of posttraumatic growth,transformational leadership,and self-efficacy on PTSD and depression symptom severity among combat Veterans

Previous research has established self-efficacy as essential to postdeployment adjustment among Veterans, and perceived transformational leadership is well known for its positive effects on follower outcomes across contexts. However, little is known regarding how transformational leadership may relate to posttraumatic growth and self-efficacy in fostering psychological wellbeing among combat Veterans. The purpose of this study was to examine the role of transformational leadership in predicting posttraumatic stress disorder (PTSD) and depression symptoms among combat Veterans, as well as how posttraumatic growth and postdeployment coping self-efficacy may influence these relations. The study sample consisted of 130 combat Veterans recruited from a university, Veterans Affairs medical center, and the greater community. Path analysis based on bootstrapped resampling revealed postdeployment coping self-efficacy and perceived transformational leadership as predictors of lower PTSD and depression symptom severity. In addition, mediation modeling revealed that postdeployment coping self-efficacy mediated the relation between transformational leadership and both PTSD and depression, while posttraumatic growth did not predict PTSD symptoms. These findings may aid in the prediction of PTSD and depression symptoms among Veterans, which may then influence pre-deployment leadership training among military personnel as well as clinical treatment protocols for Veterans.     

The changing relationship between psychology and contemporary spiritual direction

As recently as the late 1970's, the relationship between spiritual direction and psychology was tentative and cautious. During the last decade, however, psychological methods and perspectives have been increasingly utilized in spiritual direction. This article examines how clinical psychology, developmental psychology, the psychology of women, and professional psychology are becoming increasingly relevant to the contemporary practice of spiritual direction in the United States, and how, in the process, the relationship between psychology and spiritual direction is changing.     

Differentiating overreporting and extreme distress: MMPI-2 use with compensation-seeking veterans with PTSD

This purpose of this study was to examine overreporting on the Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) in compensation-seeking veterans with posttraumatic stress disorder (PTSD). A sample of veterans tested during a V.A. hospital compensation and pension exam were given the MMPI-2 and measures of PTSD, depression, and combat exposure. Veteran's MMPI-2s were only included in the analyses if their profile was extremely exaggerated, as measured by an F scale T score above 80, did not elevate the MMPI-2 VRIN and TRIN scales, and had a primary diagnosis of PTSD (n = 127). Using the Infrequency-Psychopathology, F(p), scale to distinguish overreporting from distress, it was found that 98 veterans elevated profiles due to distress, whereas 29 elevated due to overreporting, F(p) below and above 7, respectively. Differences between groups on MMPI-2 clinical scales and the other measures were assessed. Implications of these findings for assessing veteran response style and using the MMPI-2 with a PTSD population are discussed.     

Regressive experiences in Vietnam veterans: Their relationship to war,post-traumatic symptoms and recovery

Regression has been commonly associated with war and postwar symptomatology. Posttraumatic symptoms have been considered regressive when manifested by chronic dependent behavior or outbursts of primitive, aggressive behavior. Recovery from regressive symptoms may in itself induce regressive experiences since recovery necessarily leads to another change in ego boundaries; rigid or fused boundaries becoming realigned, intact, and flexible. Recovery therefore requires a stable and trusting therapeutic relationship to gradually permit such changes. Psychological treatment of Vietnam veterans often has occurred in phases with immediate management of regressive symptoms occurring during early phases and induction of regressive states has often occurred during late phases to facilitate integration of split-off traumatic experiences and emotions.     

The relationship between self-efficacy and depression in adolescents

This study examined the self-efficacy status of depressed versus nondepressed adolescents. As predicted, self-efficacy was negatively correlated with depression. A three-way interaction of Sex x Age x Level of Depression suggested separate analyses for males and females. Regression analysis revealed age-related changes in the dependence of depression scores on general, academic, physical and social self-efficacy status. It was concluded that self-efficacy has an important relationship with adolescent depression. The implications of these findings are discussed.     

The relationship between depression and smoking in adolescents

The literature suggests that smokers are more likely to be depressed, while people who are depressed are more likely to smoke. The purpose of the present study was to determine the strength of the relationship between smoking, depression, intention to smoke, and several psychosocial and environmental factors. The participants (98 high school and college students aged 16 to 19 years) completed a paper-and-pencil questionnaire consisting of the Multiscore Depression Inventory (MDI) and items regarding smoking behavior as well as psychosocial and environmental factors. Correlation, stepwise regression, and discriminant analyses were then conducted. It was found that participants were more likely to smoke if their parents smoked, if their scores on the MDI indicated instrumental helplessness and social isolation/withdrawal, or if they were older. Participants were more likely to state intention to smoke in the future if they had MDI scores indicating instrumental helplessness, if they were older, if their parents smoked, if their MDI scores indicated social intro-version, or if they resided with a guardian. Participants were also more likely to have smoked for more years if their parents smoked or if their scores on the MDI indicated instrumental helplessness. Further, participants were more likely to have scores on the MDI indicative of higher depression levels if they had low grades or if their parents smoked.