The relationships between posttraumatic stress symptom clusters and marital intimacy among war veterans.

This study examined (a) the relationships between posttraumatic stress disorder (PTSD) symptom clusters and marital intimacy among Israeli war veterans and (b) the role of self-disclosure and verbal violence in mediating the effects of PTSD avoidance and hyperarousal symptoms on marital intimacy. The sample consisted of 219 participants divided into 2 groups: ex-prisoners of war (ex-POWs; N = 125) and a comparison group of veterans who fought in the same war but were not held in captivity (N = 94). Ex-POWs displayed higher levels of PTSD symptoms and verbal violence and lower levels of self-disclosure than did controls. Although ex-POWs and controls did not differ in level of marital intimacy, they did, however, present a different pattern of relationships between PTSD clusters and intimacy. In ex-POWs, self-disclosure mediated the relations between PTSD avoidance and marital intimacy. Verbal aggression was also found via indirect effect of hyperarousal on marital intimacy. The results point to the importance of self-disclosure and verbal violence as interpersonal mechanisms for the relations between posttraumatic symptoms on marital intimacy of ex-POWs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-control predicts later symptoms of posttraumatic stress disorder.

Self-control, often defined as the ability to control one's thoughts and actions, is one of the most important constructs in psychology. However, the relationship of self-control to clinical disorders has rarely been directly examined. The current study sought to explore this relationship by examining whether self-control predicted posttraumatic stress disorder (PTSD) symptoms in a longitudinal study of 65 inner-city women. Results showed that baseline levels of self-control predicted PTSD symptoms at 3-month follow-up above and beyond other variables in the model. This research combines clinical and social psychological research to reveal the potential role of self-control in protecting against future symptoms of PTSD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Anger, hostility, and posttraumatic stress disorder in trauma-exposed adults: A meta-analysis.

This meta-analysis synthesizes the available data on the strength of association between anger and posttraumatic stress disorder (PTSD) and between hostility and PTSD, covering 39 studies with trauma-exposed adults. Effect sizes did not differ for anger and hostility, which could therefore be combined; effect sizes for anger expression variables were analyzed separately. The analyses revealed large effects. The weighted mean effect size (r) was .48 for anger-hostility, .29 for anger out, .53 for anger in, and -.44 for anger control. Moderator analyses were conducted for anger-hostility, showing that effect sizes were substantially larger with increasing time since the event and that effect sizes were larger in samples with military war experience than in samples that had experienced other types of traumatic events. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Posttraumatic stress disorder treatment in correctional settings: A brief review of the empirical literature and suggestions for future research.

This article reviews the available empirical studies of posttraumatic stress disorder (PTSD) treatments for correctional populations. Despite the large numbers of prisoners and their high rates of victimization and traumatic disorders, few targeted treatments are available, and even fewer have been studied and empirically supported. The treatment modalities that have been studied include two exposure, two cognitive, and two skills-based approaches investigated in a total of eight studies. Four studies that met criteria for this review were conducted with women, three with juvenile males, and one with a single man. The studies possess many methodological weaknesses, and some outcomes have been disappointing. In the hopes of preventing further suffering, revictimization, and recidivism, it is imperative that further development and investigation of targeted treatments continue in this understudied and vulnerable population. Much progress has been made in the treatment of PTSD in the general population, so these approaches could be explored in the correctional system as well. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Couple adjustment and posttraumatic stress disorder symptoms in National Guard veterans of the Iraq war.

Relationship adjustment and posttraumatic stress disorder (PTSD) symptoms were assessed across two time points in a sample of 313 married or partnered National Guard soldiers recently returned from combat duty in Iraq. Structural equation modeling using a four-factor model for PTSD found the latent variable dysphoria (reflecting generalized distress including aspects of emotional numbing and arousal) had the strongest independent contribution to predicting relationship adjustment at Time 1 and indirectly predicted poorer relationship adjustment at Time 2. Exploratory analysis of gender differences (n = 33 women; n = 280 men) suggested a different pattern of relations between PTSD factors and relationship adjustment among female soldiers at Time 1, with a trend toward trauma specific avoidance being more highly related to relationship adjustment. Clinical and research implications are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Posttraumatic stress disorder symptoms, physiological reactivity, alcohol problems, and aggression among military veterans.

This study examined the association between posttraumatic stress disorder (PTSD) symptomatology and aggressive behavior among a sample of male Vietnam veterans (N = 1,328). Results indicated that the hyperarousal PTSD symptom cluster evidenced the strongest positive association with aggression at the bivariate level when compared with the other PTSD symptom clusters. When the PTSD symptom clusters were examined together as predictors, hyperarousal symptoms evidenced a significant positive relationship with aggression, and avoidance/numbing symptoms were negatively associated with aggression. Examination of potential mediators indicated that hyperarousal symptoms were directly associated with aggression and indirectly related to aggression via alcohol problems. Reexperiencing symptoms were associated with aggression only indirectly and through their positive association with physiological reactivity and negative association with alcohol problems. Study results highlight the complexity of the relationship between PTSD symptoms and aggression, and suggest possible mechanisms explaining this association. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Together in pain: Attachment-related dyadic processes and posttraumatic stress disorder.

We used actor–partner interdependence modeling to explore associations among attachment-related dyadic processes, posttraumatic stress disorder (PTSD) in war veterans, and secondary traumatic stress (STS) in their wives. A sample of 157 Israeli couples (85 former prisoners of war and their wives and a comparison group of 72 veterans not held captive and their wives) completed self-report scales assessing attachment insecurities (anxiety, avoidance) and PTSD symptoms. For both groups of veterans and their wives, attachment anxiety was associated with the severity of their own and their spouses' PTSD and STS. Avoidant attachment was associated with PTSD and STS only in couples that included a former prisoner of war. A complex pattern of associations involving avoidant attachment was observed in the actor–partner analyses of these couples. The study demonstrates that attachment-related dyadic processes play a role in the development and maintenance of PTSD in traumatized veterans and STS in their wives. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A different kind of comorbidity: Understanding posttraumatic stress disorder and chronic pain.

Many traumatic events leave lingering physical injuries and chronic pain in their wake, in addition to trauma-related psychopathology. In this review, we provide an overview of developments in the recent literature on comorbid posttraumatic stress disorder (PTSD) and chronic pain. Starting with the conceptual models presented by Sharp and Harvey (2001) and Asmundson, Coons, Taylor, and Klatz (2002), this review summarizes newer studies that examine prevalence of these comorbid conditions. Additionally, we present an updated synthesis of research on factors that may maintain both chronic physical pain and PTSD in trauma survivors. Consideration of the impact of this comorbidity on psychosocial assessment and treatment also is discussed, with particular attention to issues that warrant additional research. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

An evaluation of cognitive processing therapy for the treatment of posttraumatic stress disorder related to childhood sexual abuse.

This study compared the effectiveness of cognitive processing therapy for sexual abuse survivors (CPT-SA) with that of the minimal attention (MA) given to a wait-listed control group. Seventy-one women were randomly assigned to 1 of the 2 groups. Participants were assessed at pretreatment and 3 times during posttreatment: immediately after treatment and at 3-month and 1-year follow-up, using the Clinician-Administered Posttraumatic Stress Disorder (PTSD) Scale (D. Blake et al., 1995), the Beck Depression Inventory (A. T. Beck, R. A. Steer, & G. K. Brown, 1996), the Structured Clinical Interview for the DSM-IV (R. L. Spitzer, J. B. W. Williams, & M. Gibbon, 1995; M. B. First et al., 1995), the Dissociative Experiences Scale-II (E. M. Bernstein & F. W. Putnam, 1986), and the Modified PTSD Symptom Scale (S. A. Falsetti, H. S. Resnick, P. A. Resick, & D. G. Kilpatrick, 1993). Analyses suggested that CPT-SA is more effective for reducing trauma-related symptoms than is MA, and the results were maintained for at least 1 year. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Posttraumatic stress disorder and physical health symptoms among women seeking help for relationship aggression.

This study examined associations between intimate partner aggression and physical health symptoms among a sample of help-seeking women experiencing relationship aggression (N = 388). Using a structural equation modeling framework, the authors found posttraumatic stress disorder (PTSD) symptoms to fully mediate the associations of both physical and psychological aggression with physical health symptoms. The influence of PTSD symptoms on physical health symptoms was partially mediated by anger/irritability. Results were consistent with studies from other trauma groups suggesting that PTSD is pivotal with respect to explaining the effects of trauma on health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationships among sexual satisfaction, marital quality, and marital instability at midlife.

Sexual satisfaction, marital quality, and marital instability have been studied over the life course of couples in many previous studies, but less in relation to each other. On the basis of the longitudinal data from 283 married couples, the authors used autoregressive models in this study to examine the causal sequences among these 3 constructs for husbands and wives separately. Results of cross-lagged models, for both husbands and wives, provided support for the causal sequences that proceed from sexual satisfaction to marital quality, from sexual satisfaction to marital instability, and from marital quality to marital instability. Initially higher levels of sexual satisfaction resulted in an increase in marital quality, which in turn led to a decrease in marital instability over time. Effects of sexual satisfaction on marital instability appear to have been mediated through marital quality. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The psychophysiology of posttraumatic stress disorder: A meta-analysis.

This meta-analysis of 58 resting baseline studies, 25 startle studies, 17 standardized trauma cue studies, and 22 idiographic trauma cue studies compared adults with and without posttraumatic stress disorder (PTSD) on psychophysiological variables: facial electromyography (EMG), heart rate (HR), skin conductance (SC), and blood pressure. Significant weighted mean effects of PTSD were observed for HR (r = .18) and SC (r = .08) in resting baseline studies; eyeblink EMG (r = .13), HR (r = .23), and SC habituation slope (r = .21) in startle studies; HR (r = .27) in standardized trauma cue studies; and frontalis EMG (r = .21), corrugator EMG (r = .34), HR (r = .22), and SC (r = .19) in idiographic trauma cue studies. The most robust correlates of PTSD were SC habituation slope, facial EMG during idiographic trauma cues, and HR during all study types. Overall, the results support the view that PTSD is associated with elevated psychophysiology. However, the generalizability of these findings is limited by characteristics of the published literature, including its disproportionate focus on male veterans and neglect of potential PTSD subtypes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Neuropsychological functioning in posttraumatic stress disorder and alcohol abuse.

Studies have shown differences in neuropsychological functioning between groups with posttraumatic stress disorder (PTSD) and control participants. Because individuals with PTSD often have a history of comorbid alcohol abuse, the extent to which an alcohol confound is responsible for these differences remains a concern. The current study compares neuropsychological testing scores in 4 groups of veterans with and without PTSD (PTSD+ and PTSD-, respectively) and with and without a history of alcohol abuse (ETOH+ and ETOH-, respectively): n for PTSD+/ETOH- = 30, n for PTSD+/ETOH- = 37, n for PTSD-/ETOH+ = 30, and n for PTSD-/ETOH- = 31. Results showed that PTSD, when alcohol, educational level, vocabulary, and depression are controlled for, was associated with decreased verbal memory, attention, and processing speed performance. Alcohol abuse history was associated with decreased visual memory performance. By controlling for alcohol and depression, the authors can more conclusively demonstrate that verbal memory and attention differences are associated with PTSD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship between posttraumatic stress symptoms and sexual risk: Examining potential mechanisms.

Little is known about behavioral and psychological mechanisms that may explain relationships between posttraumatic stress and sexual risks. As rates of HIV infection among African American women remain significantly higher than for other female subgroups, research on sexual risk among African American women is needed. The present study examines the relationships of posttraumatic stress symptoms as measured by the Posttraumatic Stress Disorder Checklist-Civilian Version with sexual risk behaviors, sexual sensation-seeking, and sexual compulsivity in 30 undergraduate African American women with any reported history of sexual intercourse. Higher posttraumatic stress symptoms were associated with more sexual partners, greater frequency of vaginal sex without a condom, and endorsement of sex while under the influence of a substance. Posttraumatic stress symptoms were negatively correlated with perceived sexual control, but were not significantly correlated with sexual compulsivity or sensation-seeking. Perceived sexual control was negatively associated with frequency of unprotected sex and sex under the influence. The preliminary evidence from this small sample suggests sexual control may mediate the relationship of the posttraumatic stress symptoms with unprotected sex. These results are generally consistent with previous findings suggesting posttraumatic stress is associated with sexual risk. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alcohol use disorder history moderates the relationship between avoidance coping and posttraumatic stress symptoms.

Avoidance coping (AVC) is common in individuals with posttraumatic stress disorder (PTSD) and in individuals with alcohol use disorder (AUD). Given that PTSD and AUD commonly co-occur, AVC may represent a risk factor for the development of comorbid posttraumatic stress and alcohol use. In this study, the relationship between AVC and PTSD symptoms (PTSS) was examined in individuals with versus without AUDs. Motor vehicle accident (MVA) victims were assessed 6 weeks postaccident for AUD history (i.e. diagnoses of current or past alcohol abuse or dependence) and AVC. PTSS were assessed 6 weeks and 6 months post-MVA. All analyses were conducted on the full sample of MVA victims as well as on the subset of participants who were legally intoxicated (blood alcohol concentration ≥ 0.08) during the accident. It was hypothesized that the relationship between AVC and PTSS would be stronger in those individuals with an AUD history and especially strong in the subset of individuals who were legally intoxicated during the MVA. Results were largely supportive of this hypothesis, even after controlling for in-hospital PTSS, gender, and current major depression. Early assessment of AUD history and avoidance coping may aid in detecting those at elevated risk for PTSD, and intervening to reduce AVC soon after trauma may help buffer the development of PTSD + AUD comorbidity. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Predictors of posttraumatic stress disorder following cancer.

This study investigated the predictors of posttraumatic stress disorder (PTSD) following a diagnosis of cancer. Individuals who were recently diagnosed with 1st onset head and neck or lung malignancy (N = 82) were assessed within 1 month of diagnosis for acute stress disorder (ASD) and other psychological responses including depression; individuals were reassessed (N = 63) for PTSD 6 months following their cancer diagnosis. At the initial assessment ASD was diagnosed in 28% of participants, and 22% met criteria for PTSD at 6-months follow-up. Peritraumatic dissociative symptoms at the time of receiving one's cancer diagnosis was the sole predictor of PTSD severity at 6-months follow-up. Elevated dissociative symptoms and greater distress at the initial assessment were the best predictors of PTSD caseness at 6-months follow-up. This study provides evidence for identifying recently diagnosed cancer patients who may benefit from psychological assistance in order to prevent chronic psychopathology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mindfulness in the treatment of posttraumatic stress disorder among military veterans.

How might a practice that has its roots in contemplative traditions, seeking heightened awareness through meditation, apply to trauma-related mental health struggles among military veterans? In recent years, clinicians and researchers have observed the increasing presence of mindfulness in Western mental health treatment programs. Mindfulness is about bringing an attitude of curiosity and compassion to present experience. This review addresses the above question in a detailed manner with an emphasis on the treatment of military veterans suffering from posttraumatic stress disorder (PTSD) and related psychopathology. In addition, the integration of mindfulness with current empirically supported treatments for PTSD is discussed with specific attention to directions for future research in this area. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Perceived barriers to care among veterans health administration patients with posttraumatic stress disorder.

Despite the availability of specialty posttraumatic stress disorder (PTSD) care within Department of Veterans Affairs (VA) facilities, many VA patients with PTSD do not seek needed PTSD treatment. This study examined institutional and stigma-related barriers to care among a large diverse group of Vietnam and Iraq/Afghanistan veterans who had been diagnosed with PTSD by a VA provider. A total of 490 patients who had not received VA treatment for PTSD in the previous 2 years (31% response rate) were asked about psychological symptoms and reasons for not using care. Stigma related barriers (concerns about social consequences and discomfort with help-seeking) were rated as more salient (rated in the “slightly” to “moderately” problematic range) than institutional factors (not “fitting into” VA care, staff skill and sensitivity, and logistic barriers; rated in the “not at all” to “slightly” problematic range). Regression analyses revealed that younger age and White females were associated with higher ratings on not fitting into VA health care, whereas non-White males were associated with higher ratings on logistic barriers. PTSD symptoms were positively associated with perceived barriers to care, with the most consistent results observed for PTSD avoidance symptoms. Magnitude of effects was generally small, suggesting the possibility that other factors not assessed in this study may also contribute to perceptions of barriers to care. Future research should attend to the effects of stigma, as well as institutional barriers to care, on VA mental health treatment seeking. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The implication of combat-induced stress reaction, PTSD, and attachment in parenting among war veterans.

This study examined parental functioning, parental satisfaction, and concern for offspring during their child's military service, among war veterans, some of whom suffered from acute combat-induced stress reaction (CSR) and posttraumatic stress disorder (PTSD). In addition, we examined the additive and interactive contributions of CSR, PTSD and attachment dimensions to parenting measures. The sample consisted of 477 participants divided into two groups: a clinical group of veterans who had been diagnosed with CSR on the battlefield (N = 267), and a matched control group of veterans who did not suffer from CSR (NCSR; N = 210). CSR, PTSD, avoidant-attachment, and anxious-attachment, were all related to lower levels of parental functioning and satisfaction. Veterans who suffered from both CSR and PTSD reported more concern for their offspring during their child's military service compared to veterans with PTSD but without antecedent CSR. Attachment dimensions and specifically attachment-avoidance, made the greatest contribution to parenting measures, followed by posttraumatic symptoms. In addition, attachment-avoidance moderated the relationship between posttraumatic symptoms and parental functioning. Theoretical and clinical implications of these results are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Holographic reprocessing: Empirical evidence to reduce posttraumatic cognitions in women veterans with PTSD from sexual trauma and abuse.

Holographic reprocessing (HR) facilitates holistic reappraisal of attributions regarding interpersonal violence and maltreatment. The authors tested the feasibility to train therapists to run a protocol using HR to reduce negative thoughts associated with posttraumatic stress disorder (PTSD) in women veterans who have had sexual trauma or abuse. The study assessed pre- and postscores on the Posttraumatic Cognitions Inventory (PTCI) in a naturalistic clinical setting with 5 therapists. The protocol consisted of screening for PTSD, followed by an average of 9 HR treatment sessions. Twenty-two women were referred to the study; 17 enrolled and completed treatment (0% dropout rate). Significant decreases were found on all scales of the PTCI, with large effect sizes: total negative thoughts, t(16) = 4.42, p