A Scheme for Categorizing Traumatic Military Events
ABSTRACT A common assumption among clinicians and researchers is that war trauma primarily involves fear-based reactions to life-threatening situations. However, the authors believe that there are multiple types of trauma in the military context, each with unique perievent and postevent response patterns. To test this hypothesis, they reviewed structured clinical interviews of 122 active duty service members and assigned the reported index (principal, most currently distressing) events to one or more of the following categories: Life Threat to Self, Life Threat to Others, Aftermath of Violence, Traumatic Loss, Moral Injury by Self, and Moral Injury by Others. They found high interrater reliability for the coding scheme and support for the construct validity of the categorizations. In addition, they discovered that certain categories were related to psychiatric symptoms (e.g., reexperiencing of the traumatic event, guilt, anger) and negative thoughts about the world. Their study provides tentative support for use of these event categories.
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ABSTRACT: We comment on Smith, Duax, and Rauch’s (2013--this issue) explication of their approach to treating perpetration-related guilt and shame using prolonged exposure (PE) therapy, with the aim of promoting a discourse about the mechanisms, techniques, and assumptions that underlie the treatment of moral injury in veterans and service members. We first discuss the theoretical foundation underlying PE and consider the extent to which it accounts for the phenomenology of moral injury. We then examine the treatment strategies used in the PE approach and the mechanisms by which these techniques ameliorate perpetration-related guilt and shame. We also briefly highlight points of similarity and contrast between PE and adaptive disclosure, a brief cognitive behavioral intervention targeting combat-related moral injury and traumatic loss.Cognitive and Behavioral Practice 11/2013; 20(4):471–475. DOI:10.1016/j.cbpra.2013.05.002 · 1.33 Impact Factor
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ABSTRACT: Recent research has provided compelling evidence of mental health problems in military spouses and children, including post-traumatic stress disorder (PTSD), related to the war-zone deployments, combat exposures, and post-deployment mental health symptoms experienced by military service members in the family. One obstacle to further research and federal programs targeting the psychological health of military family members has been the lack of a clear, compelling, and testable model to explain how war-zone events can result in psychological trauma in military spouses and children. In this article, we propose a possible mechanism for deployment-related psychological trauma in military spouses and children based on the concept of moral injury, a model that has been developed to better understand how service members and veterans may develop PTSD and other serious mental and behavioral problems in the wake of war-zone events that inflict damage to moral belief systems rather by threatening personal life and safety. After describing means of adapting the moral injury model to family systems, we discuss the clinical implications of moral injury, and describe a model for its psychological treatment.Clinical Child and Family Psychology Review 07/2013; DOI:10.1007/s10567-013-0146-y · 4.75 Impact Factor
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ABSTRACT: To assess pain and anxiety during bone marrow aspiration/biopsy (BMA) among patients versus health-care professionals (HCPs). 235 adult hematologic patients undergoing BMA were included. BMA was performed by 16 physicians aided by nine registered nurses (RNs). Questionnaires were used to obtain patients and HCPs ratings of patients' pain and anxiety during BMA. Patterns of ratings for pain and anxiety among patients HCPs were estimated with proportions of agreement P(A), Cohen's kappa coefficient (κ), and single-measure intra-class correlation (ICC). We also explored if associations of ratings were influenced by age, sex, type and duration of BMA. The P(A) for occurrence of rated pain during BMA was 73% between patients and RNs, and 70% between patients and physicians, the corresponding κ was graded as fair (0.37 and 0.33). Agreement between patients and HCPs regarding intensity of pain was moderate (ICC=0.44 and 0.42). Severe pain (VAS>54) was identified by RNs and physicians in 34% and 35% of cases, respectively. Anxiety about BMA outcome and needle insertion was underestimated by HCPs. P(A) between patients and RNs and patients and physicians regarding anxiety ranged from 53% to 59%. The corresponding κ was slight to fair (0.10-0.21). ICC showed poor agreement between patients and HCPs regarding intensity of anxiety (0.13-0.36). We found a better congruence between patients and HCPs in pain ratings than in anxiety ratings, where the agreement was low. RNs and physicians underestimated severe pain as well as anxiety about BMA outcome and needle insertion.European journal of oncology nursing: the official journal of European Oncology Nursing Society 02/2012; 16(3):323-9. DOI:10.1016/j.ejon.2011.07.009 · 1.79 Impact Factor