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The Development and Experience of Combat-Related PTSD: A Demand for Neurofeedback as an Effective Form of Treatment
Abstract
Veterans experience a considerable course of posttraumatic stress disorder (PTSD), and because of several psychosocial issues, traditional interventions and traditional intervention settings are ineffective for this population. A new cutting-edge approach, known as neurofeedback, trains clients to control and manipulate their central nervous system and ameliorate physiological symptoms of stress disorders. The authors delineate how neurofeedback can be an effective and innovative intervention for PTSD experienced by the military population.
... PTSD has led to dissociative subtypes of PTSD in the DSM V(Schiavone et al., 2018).According toFragedakis and Toriello (2014) individuals in abusive relationships may experience the prolonged ooding of stress hormones. The excessive ooding of the stress hormones, over time, in uences the brain's structure to react with hypervigilance to stimuli(Fragedakis & Toriello, 2014). ...
... PTSD has led to dissociative subtypes of PTSD in the DSM V(Schiavone et al., 2018).According toFragedakis and Toriello (2014) individuals in abusive relationships may experience the prolonged ooding of stress hormones. The excessive ooding of the stress hormones, over time, in uences the brain's structure to react with hypervigilance to stimuli(Fragedakis & Toriello, 2014). During a traumatic event or situation, the brain releases stress hormones that activate the sympathetic nervous system response: ght, ight, or freeze(Fragedakis & Toriello, 2014). ...
... The excessive ooding of the stress hormones, over time, in uences the brain's structure to react with hypervigilance to stimuli(Fragedakis & Toriello, 2014). During a traumatic event or situation, the brain releases stress hormones that activate the sympathetic nervous system response: ght, ight, or freeze(Fragedakis & Toriello, 2014). PTSD is considered a complex issuedue to the neurological and emotional responses and physiological stimulation (Fragedakis & Toriello, 2014; Sullivan et al., 2018). ...
Given the prevalence of post-traumatic stress disorder symptoms in intimate partner violence survivors, the need for personalized treatment plans for intimate partner violence (IPV) survivor post-traumatic stress disorder (PTSD) care, and no comparison of eye movement desensitization and reprocessing (EMDR) and neurofeedback therapy (NFB) in response to PTSD care, the researcher aimed to fill the gap in research. Using archival data, a comparison between EMDR therapy and NFB therapy in response to IPV survivor PTSD was analyzed. While there exists support for each modality in the existing literature, there does not exist a comparison of the two in response to IPV survivor PTSD symptoms. The theoretical lens utilized for the study were the theory of neuroscience (TN) and humanistic person-centered theory (PCT). The applied research methodology was quantitative, and the research design was ex-post-facto quasi-experimental. Findings did not support a statistically significant difference between the EMDR group and the NFB group in response to pre and post PTSD symptoms thereby failing to reject the null hypothesis for the main research question of the study. Findings pertaining to the sub-questions however noted a statically significant decrease in pre-and post-mean scores within the EMDR group and the NFB group thereby rejecting the null hypotheses for both sub-questions. The study’s findings suggest that NFB carries similar relief of PTSD symptoms as EMDR does. Several limitations pertaining to the study sample’s characteristics, external factors, and the study’s design exist. For example, given the study’s design, a control group was not present. Recommendations for future research include considering the interventions, ENDR and NFB, during the conceptualization and development of theories to test into practice while also testing the efficacy of other alternative therapeutic interventions that serve to be helpful for PTSD care. By doing so, researchers may be able to develop appropriate, effective, and restorative care for IPV survivors suffering from PTSD symptoms along with a wide variety of other mental health concerns.
... A variety of factors have been proposed to contribute to treatment resistance among veterans. These include stigma, fear of confronting trauma experiences, the number and frequency of sessions involved in these interventions, concerns about confidentiality, compromised relationships with therapists, and fear of being seen as weak [20][21][22]. ...
... As reviewed above, current conventional treatments for veterans who have experienced trauma are in some cases insufficient to result in full recovery. Limitations include challenges related to lack of treatment engagement [17][18][19][20][21][22] and residual symptoms after treatment completion [16], as well as these interventions not addressing some sequalae of MST [16], complex PTSD and comorbidities [6][7][8], moral injury [30,31], substance use [32], and disruptions of attachment [33]. EAS interventions have the potential to address some ...
Equine-assisted services (EAS) are being increasingly used as complementary interventions for military veterans who have experienced trauma. However, there is limited evidence of benefit for this population and almost no literature describing desired potential outcomes and possible mechanisms of action. The aim of this article is to address these gaps by reviewing the extant literature of animal-assisted interventions in general, and equine-assisted services in particular, with the goal of providing guidance for future investigations in the field. Currently, the field is in the early stage of scientific development, but published results are promising. Interventions that enhance treatment compliance and/or outcomes could benefit this population. Preliminary results, reviewed herein, indicate that EAS interventions might benefit the military veteran population by enhancing treatment engagement and therapeutic alliance, as well as contributing to symptom reduction and resulting in various transdiagnostic benefits. It is recommended that future studies include exploration of potential beneficial outcomes discussed herein as well as investigate suggested mechanisms of action.
... There is evidence to suggest that NFTs may impart general benefits, such as encouraging better regulation of physiological arousal (Fragedakis & Toriello, 2014), decreasing anxiety (Moore, 2000), increasing positive mood (Raymond, Varney, Parkinson, & Gruzelier, 2005), and improving attentional function (Norris, Lee, Burshteyn, & Cea-Aravena, 2008). Given that these domains are nonspecific and common across a number of conditions, it is not surprising that NFTs have been applied to conditions as diverse as fibromyalgia (Kayiran, Dursun, Dursun, Ermutlu, & Karamürsel,, 2010), posttraumatic stress disorder (PTSD; Fragedakis & Toriello, 2014;Gapen et al., 2016), schizophrenia (Surmeli, Ertem, Eralp, & Kos, 2012), and attention-deficit/hyperactivity disorder (ADHD; Gevensleben et al., 2014;Meisel, Servera, Garcia-Banda, Cardo, & Moreno, 2014). ...
... There is evidence to suggest that NFTs may impart general benefits, such as encouraging better regulation of physiological arousal (Fragedakis & Toriello, 2014), decreasing anxiety (Moore, 2000), increasing positive mood (Raymond, Varney, Parkinson, & Gruzelier, 2005), and improving attentional function (Norris, Lee, Burshteyn, & Cea-Aravena, 2008). Given that these domains are nonspecific and common across a number of conditions, it is not surprising that NFTs have been applied to conditions as diverse as fibromyalgia (Kayiran, Dursun, Dursun, Ermutlu, & Karamürsel,, 2010), posttraumatic stress disorder (PTSD; Fragedakis & Toriello, 2014;Gapen et al., 2016), schizophrenia (Surmeli, Ertem, Eralp, & Kos, 2012), and attention-deficit/hyperactivity disorder (ADHD; Gevensleben et al., 2014;Meisel, Servera, Garcia-Banda, Cardo, & Moreno, 2014). ...
Objectives
Interest in neurofeedback therapies (NFTs) has grown exponentially in recent years, encouraged both by escalating public interest and the financial support of health care funding agencies. Given NFTs’ growing prevalence and anecdotally reported success in treating common effects of acquired brain injury (ABI), a systematic review of the efficacy of NFTs for the rehabilitation of ABI-related cognitive impairment is warranted.
Methods
Eligible studies included adult samples (18+ years) with ABI, the use of neurofeedback technology for therapeutic purposes (as opposed to assessment), the inclusion of a meaningful control group/condition, and clear cognitive–neuropsychological outcomes. Initial automated search identified n = 86 candidate articles, however, only n = 4 studies met the stated eligibility criteria.
Results
Results were inconsistent across studies and cognitive domains. Methodological and theoretical limitations precluded robust and coherent conclusions with respect to the cognitive rehabilitative properties of NFTs. We take the results of these systematic analyses as a reflection of the state of the literature at this time. These results offer a constructive platform to further discuss a number of methodological, theoretical, and ethical considerations relating to current and future NFT–ABI research and clinical intervention.
Conclusions
Given the limited quantity and quality of the available research, there appears to be insufficient evidence to comment on the efficacy of NFTs within an ABI rehabilitation context at this time. It is imperative that future work increase the level of theoretical and methodological rigour if meaningful advancements are to be made understanding and evaluating NFT–ABI applications.
... The main task of the EEG reader was to interpret the data by parsing the data stream containing PoorSignal, EEG Raw Value, EEG Raw Value Volts, Attention Level, Meditation Level, Blink Strength, Delta (1-3 Hz), Theta (4-7 Hz), Alpha Low (8-9 Hz), Alpha High (10-12 Hz), Beta Low (13)(14)(15)(16)(17), Beta High (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30), Gamma Low (31)(32)(33)(34)(35)(36)(37)(38)(39)(40), and Gamma Mid (41)(42)(43)(44)(45)(46)(47)(48)(49)(50). The data stream itself is composed of packets, an initial code identifying the following information in the row itself. ...
... These kind of systems could be used in the training of individuals, or for treatment of particular disorders, such as post-traumatic stress disorder [46]. ...
Virtual Reality with associated hardware and software advances is becoming a viable tool in neuroscience and similar fields. Technology has been harnessed to modify a user’s state of mind for some time through different approaches. Combining this background with merged reality systems, it is possible to develop intelligent tools which can manipulate brain states and enhance training mechanisms.
... Various methods, including Internet-based cognitive therapy with psychoeducation, 14 mindfulnessbased therapies, 15 and behavioral therapy interventions such as psychoeducation, breathing exercises, and relaxation training, 16 have shown promise. Additional techniques, like neurofeedback and music interventions, 17,18 are effective in reducing PTSD-related symptoms. These findings suggest that both trauma exposure-based and nonexposure-based treatments can potentially alleviate PTSD symptoms. ...
Objective
Individuals who have experienced traumatic events often encounter a variety of changes in their lives and and may suffer from them. To help and alleviate these traumatic stress, we developed an evidence-based mobile application (app) for easy accessibility. This study aimed to test the effects of the mobile app for traumatic stress management using neurofeedback-based meditation and binaural beat music.
Method
Fifty-eight participants were enrolled in a pilot randomized controlled trial (Trial Registration Number: KCT007724) consisting of two groups: (a) experimental group (n = 28) and (b) control group (n = 30). Participants used the mobile app 3 days a week at home for 4 weeks, engaging in neurofeedback-based meditation and binaural beat music. Participants completed self-report measures (SCL-47-R, Psychological Well-Being Post-traumatic Changes questionnaire) and EEG test (emotional stability, anti-stress) at a pretreatment and 1-month follow-up.
Results
Participants in the experimental group demonstrated significant improvements in psychological well-being (F = 16.37, p < 0.001), emotional stability (F = 10.38; p = 0.002), and the anti-stress index (F = 11.37; p = 0.001).
Conclusion
The results of this pilot trial, involving a neurofeedback-based meditation and binaural beat-centered music intervention, provide preliminary support and a readily accessible option for individuals seeking to recover from the effects of traumatic events. Additionally, we have established the groundwork for subsequent research to study the efficacy of a neurofeedback-based meditation program and a binaural beat-centered music intervention for those who have experienced traumatic events.
... Results from studies such as these emphasize the potential use of alpha neurofeedback training and alpha asymmetry training to decrease PTSD and stress related symptoms commonly experienced by the law enforcement population. Similar to the recommendation of Fragedakis and Toriello (2014) related to utilizing neurofeedback for combat-related to PTSD, it is our recommendation that clinicians and researchers consider alpha and alpha asymmetry training when developing neurofeedback treatment plans for law enforcement officers. Integrating informed, empirically based neurofeedback protocols for officers can decrease maladaptive symptoms and the potential onset of comorbid concerns such as substance use (Hammond, 2007;Othmer & Othmer, 2009). ...
Occupational and organizational stressors impact workplace performance and contribute to mental health concerns among law enforcement officers. Although literature focuses on identifying the degree of relationship that these two factors have within this specific profession, studies offer limited solutions for decreasing associated symptoms relating to stressors. Implementing an intervention that acknowledges law enforcement factors such as psychological and physiological concerns, workplace culture, and mental health stereotypes could significantly impact both those that serve within this career as well as the community. In this article, we explore the use of trauma-informed neurofeedback a therapeutic intervention for the treatment of occupational and organizational stressors commonly experienced by law enforcement officers. We also present recommendations for clinical practice and research.
... A variety of factors have been proposed to contribute to treatment resistance among veterans. These include stigma, fear of confronting trauma experiences, the number and frequency of sessions involved in these interventions, concerns about confidentiality, compromised relationships with therapists, and fear of being seen as weak [20][21][22]. ...
Equine-assisted services (EASs) are being increasingly used as complementary interventions for military veterans who have experienced trauma. However, there is limited evidence of benefit for this population and almost no literature describing the desired potential outcomes and possible mechanisms of action. The aim of this article is to address these gaps by reviewing the extant literature of animal-assisted interventions in general, and equine-assisted services in particular, with the goal of providing guidance for future investigations in the field. Currently, the field is in the early stage of scientific development, but published results are promising. Interventions that enhance treatment compliance and/or outcomes could benefit this population. Preliminary results, reviewed herein, indicate that EAS interventions might benefit the military veteran population by enhancing treatment engagement and therapeutic alliance, as well as by contributing to symptom reduction and resulting in various transdiagnostic benefits. It is recommended that future studies include exploration of potential beneficial outcomes discussed herein, as well as investigate suggested mechanisms of action.
... This allows those unresolved memories to be released and processed with less risk of client re-traumatization that is common in talk or exposure therapy (Lake, 2015). -Neurofeedback has proven to be superior to so-called "evidence-based" PTSD treatment in terms of effectiveness, temporal efficiency, and cost (Fragedakis and Toriello, 2014;van der Kolk, 2014). -A collateral benefit is the reduced risk of secondary trauma for the clinician. ...
This paper reviews how and why ILF Neurofeedback has proven to be a parsimonious and efficient way to remediate the neuro-physiological effects of trauma. Reference is made to several large- and small-scale institutional proof of concept experimental studies each addressing a specific kind of trauma. It ends with a case report by the author (Kirk) working with an American combat veteran. It makes the argument that given its success that ILF Neurofeedback and Alpha-Theta training become accepted as part of an integrative and holistic approach for treating survivors of trauma.
... Besides psychological and pharmacological treatments, there are a number of alternative and emerging treatments targeting different aspects of PTSD symptomology. These can include clinical treatments such as deep brain stimulation [25], noninvasive brain stimulation via repetitive transcranial magnetic stimulation, transcranial direct current stimulation [26], and neurofeedback [27]. Emerging therapies may also include cognitive-based conjoint therapy for PTSD [28], animal-assisted therapy [29], and yoga or mindfulness-based therapies [30]. ...
Background:
The COVID-19 pandemic has resulted in significant changes to everyday life, including social distancing mandates, changes to health care, and a heightened risk of infection. Previous research has shown that Canadian Armed Forces (CAF) Veterans are at higher risk of developing mental and physical health conditions. Veterans and their families may face unique social challenges that can compound with pandemic-related disruptions to negatively impact well-being.
Objective:
This study aims to longitudinally characterize the mental health of CAF Veterans and spouses of CAF Veterans throughout the pandemic and to understand the dynamic influences of pandemic-related stressors on psychological health over time.
Methods:
We employed a prospective longitudinal panel design using an online data collection platform. Study participation was open to all CAF Veterans and spouses of CAF Veterans residing in Canada. Participants were asked to complete a comprehensive battery of assessments representing psychological well-being, chronic pain, health care access patterns, physical environment, employment, social integration, and adjustment to pandemic-related lifestyle changes. Follow-up assessments were conducted every three months over an 18-month period. This study was approved by the Western University Health Sciences and Lawson Health Research Institute Research Ethics Boards.
Results:
Baseline data were collected between July 2020 and February 2021. Three population segments participated in the study: 1047 Veterans, 366 spouses of Veterans, and 125 Veterans who are also spouses of Veterans completed baseline data collection. As of November 2021, data collection is ongoing, with participants completing the 9 or 12-month follow-up surveys depending on their date of self-enrollment. Data collection across all timepoints will be complete in September 2022.
Conclusions:
This longitudinal survey is unique in its comprehensive assessment of domains relevant to Veterans and spouses of Veterans during the COVID-19 pandemic, ranging from occupational, demographic, social, mental and physical domains, to perceptions and experiences with health care treatments and access. The results of this study will be used to inform policy for Veteran and Veteran family support, and to best prepare for similar emergencies should they occur in the future.
Clinicaltrial:
International registered report:
DERR1-10.2196/34984.
... Besides psychological and pharmacological treatments, there are a number of alternative and emerging treatments targeting different aspects of PTSD symptomology. These can include clinical treatments such as deep brain stimulation [25], noninvasive brain stimulation via repetitive transcranial magnetic stimulation, transcranial direct current stimulation [26], and neurofeedback [27]. Emerging therapies may also include cognitive-based conjoint therapy for PTSD [28], animal-assisted therapy [29], and yoga or mindfulness-based therapies [30]. ...
Background:
Over 85% of active members of the Canadian Armed Forces have been exposed to potentially traumatic events linked to the development of posttraumatic stress disorder (PTSD). At the time of transition to civilian life, as high as 1 in 8 veterans may be diagnosed with PTSD. Given the high prevalence of PTSD in military and veteran populations, the provision of effective treatment considering their unique challenges and experiences is critical for mental health support and the well-being of these populations.
Objective:
This paper presents the protocol for a meta-analysis and systematic review that will examine the effectiveness of treatment approaches for military-related PTSD.
Methods:
This PROSPERO-preregistered meta-analysis is being conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and Cochrane guidelines. A comprehensive search of the literature was conducted using the databases PsycInfo, Medline, Embase, CINAHL, and ProQuest Dissertation & Theses. Effect sizes will be computed based on changes in PTSD symptom scores over time across studies using validated PTSD scales. A multilevel meta-analysis will examine the overall effects, between-study effects, and within-study effects of available evidence for PTSD treatments in military populations. Effect sizes will be compared between pharmacotherapeutic, psychotherapeutic, and alternative/emerging treatment interventions. Finally, meta-regression and subgroup analyses will explore the moderating roles of clinical characteristics (eg, PTSD symptom clusters), treatment approaches (eg, therapeutic orientations in psychotherapy and alternative therapies and classifications of drugs in pharmacotherapy), as well as treatment characteristics (eg, length of intervention) on treatment outcomes.
Results:
The literature search was completed on April 14, 2021. After the removal of duplicates, a total of 12,002 studies were screened for inclusion. As of July 2021, title and abstract screening has been completed, with 1469 out of 12,002 (12.23%) studies included for full-text review. Full review is expected to be completed in the summer of 2021, with initial results expected for publication by early winter of 2021.
Conclusions:
This meta-analysis will provide information on the current state of evidence on the efficacy and effectiveness of various treatment approaches for military-related PTSD and identify factors that may influence treatment outcomes. The results will inform clinical decision-making for service providers and service users. Finally, the findings will provide insights into future treatment development and practice recommendations to better support the well-being of military and veteran populations.
Trial registration:
PROSPERO CRD42021245754; https://tinyurl.com/y9u57c59.
International registered report identifier (irrid):
DERR1-10.2196/33151.
... Besides psychological and pharmacological treatments, there are a number of alternative and emerging treatments targeting different aspects of PTSD symptomology. These can include clinical treatments such as deep brain stimulation [25], noninvasive brain stimulation via repetitive transcranial magnetic stimulation, transcranial direct current stimulation [26], and neurofeedback [27]. Emerging therapies may also include cognitive-based conjoint therapy for PTSD [28], animal-assisted therapy [29], and yoga or mindfulness-based therapies [30]. ...
BACKGROUND
Over 85% of active members of the Canadian Armed Forces (CAF) have been exposed to potentially traumatic events linked to the development of posttraumatic stress disorder (PTSD). At the time of transition to civilian life, as high as one in eight Veterans has a diagnosis of PTSD. Given high rates of PTSD in military and Veteran populations, the provision of effective treatment with considerations for their unique challenges and lived experiences is critical in the support of their mental health and well-being.
OBJECTIVE
The current paper overviews the protocol for conducting a meta-analysis and systematic review substantiating evidence of treatment approaches and effectiveness in treating military-related PTSD.
METHODS
The PROSPERO pre-registered meta-analysis is being conducted in accordance with PRISMA and Cochrane guidelines. A comprehensive search of the literature was conducted using the databases PsycInfo, Medline, Embase, CINAHL, and ProQuest Dissertations and Theses. After removal of duplicates, a total of 12,002 studies were screened for inclusion.
RESULTS
Effect sizes will be computed based on changes in PTSD symptom scores over time across studies using validated PTSD scales. A multi-level meta-analysis will examine the overall effects, between-studies effects, and within-studies effects of available evidence for PTSD treatments in military populations. Effect sizes will be compared between pharmacotherapeutic, psychotherapeutic, and alternative/emerging treatment interventions. Finally, meta-regression and sub-group analyses will explore the moderating roles of clinical characteristics (e.g., PTSD symptom clusters), treatment approaches (e.g., therapeutic orientations in psychotherapy and alternative therapies and classifications of drugs in pharmacotherapy), and treatment characteristics (e.g., length of intervention) on treatment outcomes.
CONCLUSIONS
This meta-analysis will provide the current state of evidence on the efficacy and effectiveness of various treatment approaches in military-related PTSD while identifying factors that may influence treatment outcomes. Results will inform clinical decision-making for service providers and service users. Finally, findings will provide insights for future treatment development and practice recommendations to better support the well-being of military and Veteran populations.
... Seeking treatment can be stigmatizing or perceived as a sign of weakness in military culture (Nash et al., 2009). In an effort to avoid stigma, some Veterans remain in denial of their traumatic experiences (Fragedakis & Toriello, 2014). In doing so, Veterans may develop unhealthy coping mechanisms, including but not limited to substance abuse, suicidal thoughts, and suicidal ideation (Bennett et al., 2013;Ramsawh et al., 2014). ...
Military deployment and reintegration challenges permeate the lives and relationships of Veterans, their spouses, and their families. Among these challenges, 23% of post-9/11 Veterans have been diagnosed with posttraumatic stress disorder (PTSD). Psychiatric service dogs have been found to help clinically alleviate PTSD symptoms when used as a complementary intervention. However, minimal research exists that explores the role of the service dog as a mechanism for cultivating resilience within the military family system. Researchers utilized a qualitative, constant comparative approach to analyze self-reported experiences of 101 individuals, including Veterans (n = 67) and their spouses (n = 34). Analyzed through the framework of the Theory of Resilience and Relational Load (Afifi et al., 2016), findings suggest complex communication processes that facilitate relational and family adaptation. These processes encompassed (a) the role of the service dog in building emotional reserves, (b) relational load introduced when caring for the service dog, and (c) the service dog’s facilitation of relational maintenance behaviors among family members that contributed to communal orientation. Based on the results of this qualitative analysis, researchers suggest educational interventions where service dog trainers and mental health practitioners can incorporate relational maintenance strategies and family-focused approaches to integrating service dogs as military family members.
... Other studies found that only 38-45% of Veterans who met the criteria for mental health disorders indicated that they wanted to seek out empirically based treatment (cognitive processing, exposure therapy, and EMDR), with nonresponse rates as high as 50% (Hoge et al., 2006;Schottenbauer et al., 2008). Seeking treatment is often stigmatized as a sign of weakness in military culture (Fragedakis & Toriello, 2014); therefore, Veterans may often remain in denial of the effects of their traumatic experiences in an effort to avoid this negative stigma. Complementary interventions with limited stigma may be necessary to reach Veterans with PTSD because reducing stigma may contribute to increased participation and completion rates for Veterans receiving PTSD treatment (Davis et al., 2014;Mittal et al., 2013). ...
Objective:
The objective of this study was twofold: to describe the benefits and drawbacks of a posttraumatic stress disorder (PTSD) service dog from the perspective of Veterans with service dogs and to compare these reports to the expectations of Veterans who were on a waitlist for a PTSD service dog.
Method:
A total of 128 U.S. post-9/11 Veterans with PTSD were recruited from a nonprofit service dog provider (K9s for Warriors), including n = 69 with a PTSD service dog and n = 59 on the waitlist. Participant responses to open-ended survey questions were analyzed with conventional content analysis and classified into 214 codes across six subthemes, creating three larger themes. A subset (20%) of the data was independently coded to establish interrater reliability (Cohen's κ = .804). Frequency data were used to compare theme and subtheme prevalence between groups.
Results:
Veterans' experiences and expectations were centered on the effects the service dogs had on Veteran mental health, human-dog interaction, and the associated drawbacks. Although the majority of Veterans reported benefits from their service dogs, the findings revealed that Veterans on the waitlist more frequently mentioned benefits than those with a service dog. Study findings suggest that the drawbacks expected from service dogs differ from the drawbacks experienced.
Conclusion:
Understanding expectations versus experiences provides critical information for mental health professionals who are informing Veterans on individualized interventions for PTSD. This knowledge will enable professionals to temper expectations and educate Veterans on specific benefits and drawbacks so that they have a more rounded view of PTSD service dogs. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
... Yet even with increasing availability and use of these effective interventions, approximately half of all of veterans with combat-related PTSD either decline to enter or drop out of treatment (DeViva et al., 2016;Goetter et al., 2015;Hoge et al., 2015;Monson et al., 2006;Peterson, Foa, & Riggs, 2011). Some of the alleged causes underlying these poor participation and substantial dropout rates include the high number and duration of sessions required for these interventions, veterans not wanting to be perceived as "weak" by asking for help or grappling with stigma related to help-seeking, and significant levels of veteran avoidance or denial in addressing their trauma experiences (Fragedakis & Toriello, 2014;Hoge et al., 2015;Hoyt & Candy, 2011). Poor therapeutic relationships with some mental health clinicians and veterans' resistance to having formal records of their PTSD diagnosis/treatment may also lead to these participation and dropout rates (Hoge, 2011). ...
Canine-assisted interventions have emerged as an increasingly popular means to engage and assist veterans coping with military-associated trauma responses. The present study evaluates the use of a 14-week service dog training program for these trauma-impacted veterans. The service dog program guides veterans in small group cohorts on how to train their own dog to be their personal service animal. All 71 veterans participating in this investigation had been diagnosed with PTSD . Fifty-five veterans (77%) finished the entire 14-week program and took all pretests and posttests. Compared to pretest scores, participants reported significant decreases in self-disturbance, posttraumatic stress, externalization, and somatization after completing the program. Participants experienced significant reductions in a broad scope of psychological impacts associated with their PTSD including interpersonal difficulties and suicidality. Findings provide evidence that service dog training programs may be an effective therapeutic alternative to traditional approaches that PTSD -impacted veterans are willing to utilize.
... However, half or more of veterans who could benefit resist beginning or stop participating partially through a course of sessions (Department of Veterans Affairs and Department of Defense, 2017;DeViva et al., 2016;Goetter et al., 2015;Hoge et al., 2014;Monson et al., 2006;Peterson, Foa, & Riggs, 2011). Suspected reasons for this resistance include the frequency and number of sessions involved in these interventions, high level of avoidance in confronting their trauma experiences, impaired relationships with therapists, a sense of stigma when asking for help, a wish to not be seen as "weak," and perceptions related to confidentiality (Fragedakis & Toriello, 2014;Hoge et al., 2014;Hoyt & Candy, 2011). ...
Objective:
The objective of this study was to test effectiveness and feasibility of equine-facilitated cognitive processing therapy (EF-CPT), a manualized adaptation of the cognitive processing therapy model for veterans with posttraumatic stress disorder (PTSD) championed by the Department of Veterans Affairs, in which equine-facilitated activities are integrated into face-to-face sessions.
Method:
Twenty-seven veterans with a diagnosis of PTSD participated (Mage = 51; 78% male) in a pretest-posttest design. Veterans were seen by a single psychologist for 12 sessions of individual EF-CPT. Instruments included: PTSD Checklist (PCL), Trauma Related Guilt Inventory (TRGI), Working Alliance Inventory (WAI), and the Human Animal Bond Scale (HABS). We hypothesized improvement on all measures, low attrition, and good model fidelity. Paired sample t tests were conducted using SPSS.
Results:
PCL scores improved significantly (M1 = 68.25, M2 = 35.96, p ≤ .001), as did TRGI scores (p ≤ .001 on all scales). HABS and WAI indicated good working relationship. Two individuals attended one session and did not return (both under the age of 50); there was no other attrition (7% rate). Audio of sessions was reviewed for fidelity; there were variations in temporal order of session plans, which is within the acceptable flexibility of the manual.
Conclusions and implications for practice:
This manualized intervention has promise as an effective and well-tolerated treatment for veterans with PTSD. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
... Yet even with increasing availability and use of these effective interventions, approximately half of all of veterans with combat-related PTSD either decline to enter or drop out of treatment (DeViva et al., 2016;Goetter et al., 2015;Hoge et al., 2015;Monson et al., 2006;Peterson, Foa, & Riggs, 2011). Some of the alleged causes underlying these poor participation and substantial dropout rates include the high number and duration of sessions required for these interventions, veterans not wanting to be perceived as "weak" by asking for help or grappling with stigma related to help-seeking, and significant levels of veteran avoidance or denial in addressing their trauma experiences (Fragedakis & Toriello, 2014;Hoge et al., 2015;Hoyt & Candy, 2011). Poor therapeutic relationships with some mental health clinicians and veterans' resistance to having formal records of their PTSD diagnosis/treatment may also lead to these participation and dropout rates (Hoge, 2011). ...
Service dog programs are increasingly being explored as complementary or alternative interventions for military veterans with posttraumatic stress disorder (PTSD). This paper details the results of a control group, pre-and-post pilot investigation evaluating the use of a 14-week service dog training program for veterans in central Florida. Thirty veterans diagnosed with PTSD, 15 in the intervention group and 15 in the waitlist controlled group, completed all pretests and posttests measures, consisting of the 136-item Trauma Symptom Inventory-2 and the 36-item World Health Organization–Disability Assessment Schedule 2.0. Compared to demographically similar veterans in the control group, participants who completed the service dog training program demonstrated significant decreases in posttraumatic symptomatology, intra/interpersonal difficulties associated with psychological trauma, and in disabilities secondary to their PTSD. Study findings, in combination with results from two other recently published controlled investigations, provide evidence supporting the endorsement and use of service dog programs as helpful complementary or alternative treatment options for some veterans. Social work practitioners may want to consider referring their veteran clients with PTSD to qualified service dog programs for adjunctive support when they are having difficulty engaging with or benefiting from office-based traditional therapy approaches.
... Then more theta-brain-waves might be introduced (Batty et al., 2006). This makes ASC methods such as clinical hypnosis, music therapy (Wang, Lib, Panb, & Chena, 2014), and neurofeedback (Fragedakis & Toriello, 2014;Kirk, 2016) interesting. ...
Safe-place inductions are considered important altered states of consciousness (ASC) to be (re)installed during trauma-informed psychotherapy. Coregulation aimed at changing implicit relational knowing and increasing integration and coherence through relational work and hypnotic techniques is crucial, as clients’ abilities to self-soothe and regulate have become seriously impaired. Thus, resource-oriented metaphors as inner strength imagery is advocated. Also, methods such as creative-arts therapy and neurofeedback will induce ASCs, as most methods used with complex traumatized clients, due to their high hypnotizability. When positive or soothing imagery or relationally held suggestions for changed attentional focus are added to both psychodynamic psychotherapy and CBT, a hetero-hypnosis will be induced—a prerequisite for phase-specific trauma therapy aimed at changing inner schemas and scripts.
... As can be seen in Table 2, of the 1,406 total publications in JCD from 1994-2016, an even smaller percentage of manuscripts on the neuro-search terms were identified. Some of the notable articles identified in this search focused on topics such as: limitations of left-right brain lateralization interventions in counseling (Robbins, 1985); neuropsychological assessment (Lewis & Sinnett, 1987); mind-body self-care (Schure, Christopher, & Christopher, 2008); CBT, neuroscience, and post-traumatic stress disorder (Makinson & Young, 2012); neurofeedback in counseling research and practice (Fragedakis & Toriello, 2014;Myers & Young, 2012); and neurodevelopmental components of the stress response system (Kindsvatter & Geroski, 2014). Continuing the trend identified in the JMHC articles, most of these articles were conceptual in nature. ...
Despite the growing momentum to infuse neuroscience into counseling, neuroscience-related publications are relatively scant in flagship counseling journals. In response, this January 2017 edition of the Journal of Mental Health Counseling introduces a new section entitled “Neurocounseling” that will remedy this gap in the literature. This article provides a rationale for the creation of the Neurocounseling section that includes a discussion of current trends in research initiatives, the evolution of the term neurocounseling, and the existing neuroscience-related publications in flagship counseling journals. Additionally, this article outlines the vision for the Neurocounseling section that will aid readers as they conceptualize and conduct neurocounseling research as well as prepare manuscripts for publication.
... New headsets such as Oculus Rift and others, when combined with this technology offer ways to interact that were not possible before and biofeedback will play an important role in interactive immersion. This immersion could be toward training individuals to deal with stressful conditions (such as post-traumatic stress disorder [18]) or controlling body reactions, on demand. ...
As virtual reality becomes more accessible and the technology becomes greatly improved to immerse the individual in real time, there will be an impact upon the human brain and its direct functioning over states of mind. For as long as humans have noted that the brain responds to lights and sounds to aid or alter moods and mind states, technology has been used in one way or another to induce some desirable mood. This paper investigates how virtual technology could be used to forward this idea.
Background:
The world faces a mental health crisis with elevated rates of depression, anxiety, and post-traumatic stress, leaving a profound impact on daily quality of life (QOL). Current treatments show varying degrees of efficacy and carry burdensome challenges. Evidence exists for use of an innovative neurotechnology to reduce symptoms of depression, anxiety, and post-traumatic stress disorder (PTSD), but the science is lacking for use in the general population.
Purposes:
The purpose of this pilot study was to explore the effects of microcurrent neurofeedback on depression, anxiety, PTSD symptoms, and QOL in adults.
Methodology:
This was a one-group, exploratory pilot study that tested outcomes of depression, anxiety, PTSD risk, suicide risk, and QOL in 20 adults using convenience sampling. IASIS microcurrent neurofeedback (I-MCN) was the intervention that was delivered twice a week for 10 weeks; data collection was baseline, 5 weeks, and 10 weeks.
Results:
Depression, anxiety, PTSD risk, and QOL improved significantly by the 10th and 20th session; suicidal risk showed nonsignificant reduction. Use of a more feasible interventional procedure established a foundation for use in clinical settings for the population.
Conclusions:
Using a more simpler procedure than what was used in a previous study reflected positive outcomes earlier and sustained over 10 weeks. This safe and effective technology carries rare but easily overcome adverse effects and could be an alternative to existing treatments or treatment-resistant conditions.
Implications:
Advanced practice nurses can apply the evidence to reduce symptoms of depression, anxiety, and PTSD. Randomized controlled trials and testing on diverse populations are needed.
This thesis explores the destruction and reconstruction of individuality from controversial various dimensions in The Handmaid's Tale. As a further matter, the state is operating tactically on individual's identity so as to implant a collectivist behaviorism frame of mindset. The fragmentation of identity occurs when the fundamentalist state imposes certain-strict conventional norms upon society; hence individuality gets obliterated. In this research, we explore the destruction of identity via the exploration of Offred, Serena Joy, Moira, Janine, and aunts' characters. A few of them are tolerating, a few are defiant, a few are mediated to the regime. The women are victims of a totalitarian system and they, themselves, are involved in degrading other women. The aim of the government Gilead is to grasp every move related to one's individuality as well as limiting individual's desires, hopes, dreams, language, and beliefs. Furthermore, color-coded outfits, religion, sexual violence/repression, and language are implements that are utilized to attain their objective. We draw on Hannah Arednt's The History of Totalitarianism to explore how individuality gets obliterated. III Dedication This thesis is the fruit of countless and laborious sacrifices. This paper is enthusiastically and proudly dedicated to the people who serve as inspiration through the researchers' efforts, from parents and guardians to classmates and circle of friends who extended their help during problems while doing this work. We appreciate and admire the advice and recommendation from our best teacher and supervisor, Miss. Lanja, who, without any hesitation, supported us during the writing of this work. We will also thank our Department of English language faculty and staff. Above all, to our God Almighty, who showered us His blessings in our everyday lives, especially for the strength, courage, patience, wisdom, time, and guidance in realizing this work. IV Acknowledgement To our Almighty God for the gift of wisdom and knowledge and the courage to complete my research. This research would not have been possible without the guidance and help of some who have somehow contributed to the preparation and completion of this research and provided valuable support. First of all, we are deeply grateful to Miss Lanja, our best adviser, for helping and supporting us with her endless patience and understanding during our dissertation writing. She inspires us and shares the knowledge and great ideas that have made us enthusiastic about our work. We would like to express our sincere gratitude for their unwavering support and encouragement to complete this study. Complementing this effort would not have been possible without the participation and support of so many people whose names may not be all listed. We are profoundly grateful and appreciative of your contribution. However, we would like to express our deepest gratitude for the following points: Dr. Sabir Hassan, Head of, and all teachers who provided valuable advice and recommendations. Last but not least, we would like to express our sincere gratitude to our family for their efforts in writing this paper.
Background: The core intrinsic connectivity networks (ICNs), encompassing the default-mode network (DMN), salience network (SN) and central executive network (CEN), have been shown to be dysfunctional in individual’s with internalizing disorders (IDs; e.g. major depressive disorder, MDD; generalized anxiety disorder, GAD; social anxiety disorder, SOC). As such, source-localised electroencephalogram neurofeedback (EEG-NFB) therapy targeting key cortical nodes within these networks has the potential to reduce symptoms associated with IDs and restore normal core ICN function. We intend to conduct a transdiagnostic, randomized, double-blind, sham-controlled, dose-response, parallel-group trial of standardized low-resolution electromagnetic tomography electrophysiological infraslow (<0.1 Hz) fluctuation neurofeedback (sLORETA eISF-NFB) 3 times per week over 4 weeks in participants (n=60) with IDs. Our primary aim will be to assess the clinical efficacy of sLORETA eISF-NFB via relevant patient-reported outcomes (PROs).
Methods: We will randomly assign participants with a current diagnosis of MDD, GAD, and/or SOC to one of four groups: 1) 12 sessions of posterior cingulate cortex (PCC) up-training (n=15), 2) 6 sessions of yoked-sham training followed by 6 sessions of PCC up-training (n=15), 3) 12 sessions of concurrent mid-cingulate (MCC) down-training and PCC up-training (n=15), or 4) 6 sessions of yoked-sham training followed by 6 sessions of concurrent MCC down-training and PCC up-training. Transdiagnostic PROs, as well as resting-state neuro-physiological measures (EEG; electrocardiography, ECG; electrodermal activity, EDA), will be collected from all subjects at baseline, mid-training, 1 week post-training, and 1 month post-training. We will further compare baseline PROs and neuro-physiological measures to age- and sex-matched non-ID (i.e. no ID diagnosis) controls.
Discussion: This protocol will outline the rationale and research methodology for a clinical trial of sLORETA eISF-NFB targeting key nodes within the core ICNs in a population with IDs with the primary aim being to assess its specific (e.g. non-placebo induced) efficacy via PROs.
Trial Registration: Our study was prospectively registered with the Australia New Zealand Clinical Trials Registry (ANZCTR; Trial Id: ACTRN12619001428156)
The impact of posttraumatic stress disorder (PTSD) on our combat veterans and their families is extensive. Symptoms of anxiety and the effects of sleep disturbance have a negative impact on daily functioning (Wright et al., 2011). The presence of a dog has demonstrated a reduction in anxiety symptoms, which may have a positive influence on improved sleep (Shearer, Hunt, Chowdhury, & Nicol, 2016). The Veterans Administration (VA) has been using canines to assist combat veterans in reintegrating into civilian life, and most currently, as a part of psychological therapy (Rubenstein, 2012). This research examined the impact on combat veterans with PTSD of receiving and training a service dog using Stake’s (2006) collective case study model. Interviews were conducted with fifteen combat veterans diagnosed with PTSD participating in a 14-week program for receiving and training their own service dog. The goal of the study was to explore the veterans’ experience of the training program, as well as determine any effect on their PTSD symptoms. Symptom severity decreases were reported, which had the residual effects of decreased anxiety symptoms, sleep disturbance, and nightmares.
Comorbid posttraumatic stress disorder (PTSD) and substance use (SU) is a growing health concern among Canadian veterans. Veterans are increasingly seeking symptom relief for PTSD and comorbid SU by engaging service dogs (SDs). Despite promising results, the efficacy of SDs in aiding veterans warrants further investigation. An exploratory patient-oriented, longitudinal, time-series, mixed-methods research design was employed with a sample of five Canadian veterans matched with SDs from AUDEAMUS, Inc. PTSD and SU were measured at six time points over 1 year with the Posttraumatic Stress Disorder Checklist for the Diagnostic and Statistical Manual for Mental Disorders, 5th Edition (PCL-5), Drug Use Screening Inventory Revised Substance Use Subscale (DUSI-R SU), and one-on-one semi-structured interviews. There were clinically significant decreases in the veterans' PTSD scores with the PCL-5. Interview content complemented these results. Veterans offered accounts of ways in which their SDs directly supported and helped manage their PTSD and related symptoms. While DUSI-R SU scale changes were non-significant, during interviews each veteran reported a decrease in their use of opioids and alcohol, while some reported an increase in their use of medical cannabis. However, veterans also highlighted ways in which their SDs sometimes contributed to increases in their PTSD and related symptoms, as well as their SU. This was particularly evident during the early stages of training and bonding. This study makes an important contribution to the emerging field examining the potential benefit of SDs for veterans diagnosed with PTSD. Additionally, this study is novel in its identification of the SDs beneficial contributions to veterans' comorbid problematic use of substances.
Many of the most challenging issues military members and their families are facing are trauma related. Agencies and treatment providers working with military members and their families should be able to recognize and respond to symptoms based on a trauma informed care perspective. This article describes frequent trauma responses found in this population and how to assess these reactions. It explores and endorses a Trauma-informed care treatment framework for understanding and intervening with military-connected clients that centrally emphasizes
individual, family, and systems strengths, adaptation, and resiliency and that is built on the five essential care principles of safety, trustworthiness, choice, collaboration, and empowerment. The article further highlights research-supported, adjunctive, and alternative trauma-informed clinical interventions for members, veterans, and their families along with providing guidance on how to adjust these approaches for these clients.
This study evaluated the use of an 8-week Equine Assisted Activities and Therapy ( EAAT ) program for trauma-impacted veterans. There were 48 participants. EAAT programs have emerged as one alternative intervention for veterans who may have declined or dropped out of more traditional research-supported approaches. The EAAT program examined here incorporates CPT techniques in conjunction with guided interactions with horses. Program completers reported decreased PTSD symptoms and reduced signs of depression. Participants’ assessment of their quality of life improved significantly after the EAAT program. They also described a significantly increased ability to depend on others when needing help that was accompanied with a significant sense of relationship anxiety. The results provide evidence that EAAT may be effective for veterans with trauma-related mood, anxiety, and functioning difficulties. They also show that trauma-impacted veterans are more willing to initiate and continue to participate in EAAT programs in contrast to traditional trauma interventions.
This content analysis provides an overview of suicide articles published in 24 counseling journals between 1996 and 2016. A total of 78 articles were published, representing 0.74% of the total published literature within these journals. The Journal of Mental Health Counseling published the highest number of articles. In addition to the number of articles published during this 21-year period, the focus areas within suicide, the type of article (research or conceptual), and the type of research are identified. Results indicated the highest focus areas were in assessment, theory/attitudes toward suicide, and special populations. Implications such as increasing discussions of suicide, especially related to youth; incorporating theories of suicide into practice; and recommendations for counselor educators in teaching suicide are provided.
The Adverse Childhood Experiences (ACE) Study provided compelling evidence that abuse, neglect, and other ACEs are the most potent risk factors for the development of health, mental health, and substance use problems. Such negative health-related outcomes parallel the cumulative exposure of the developing brain to the stress response, with resulting impairment in multiple brain structures and functions. Collectively, these sequelae can manifest during childhood, adolescence, or adulthood. We and others have posited that counseling and other psychotherapeutic interventions need to address the individual's multilayered ecology (i.e., biological, psychological, social, cultural/contextual). Neurocounseling can provide a heuristic framework to more effectively assess, conceptualize, and counsel people with a history of ACEs. We provide an update of the clinical neuroscience of ACEs and its implications for counseling, including how contemporary interventions (e.g., mindfulness) can potentially have positive benefits for such individuals.
Background & aims:
Despite the thorough mapping of brain pathways involved in eating behavior, no treatment aimed at modulating eating dysregulation from its neurocognitive root has been established yet. We aimed to evaluate the effect of N.I.R. H.E.G. (Near Infra-Red Hemoencephalography) neurofeedback training on appetite control, weight and food-related brain activity.
Methods:
Six healthy male participants with overweight or mild obesity went through 10 N.I.R. H.E.G. neurofeedback sessions designed to practice voluntary activation of the prefrontal cortex. Weight, eating behavior, appetite control and brain activity related to food and self-inhibition based on fMRI were evaluated before and after neurofeedback training.
Results:
Our study group demonstrated a positive trend of increased self-control and inhibition related to food behavior, reduced weight and increased activation during an fMRI response-inhibition task (Go-No-Go - GNG) in the predefined region of interest (ROI): superior orbitofrontal cortex (sOFC).
Conclusions:
N.I.R. H.E.G. holds a promising potential as a feasible neurofeedback platform for modulation of cortical brain circuits involved in self-control and eating behavior and should be further evaluated and developed as a brain modifying device for the treatment and prevention of obesity.
Counselors are well positioned to contribute to the growing body of brain-based research literature. This chapter provides an introduction to the principles needed to design brain-based research and program evaluation in counseling. The importance of evidence-based and ethical practice is emphasized. The chapter also explores the feasibility of conducting controlled experiments versus single-subject research.
This study assessed the extent to which perceived self-efficacy (PSE) to function in battle was related to combat stress reaction (CSR) and to posttraumatic stress disorder (PTSD). Frontline soldiers who were treated for CSR during the 1982 war in Lebanon (F-group) were compared with a matched control group of soldiers who participated in the same battles but did not reveal overt signs of CSR (C-1), and to a second control group of soldiers who were combat-alerted but did not actively participate in battle (C-2). All subjects responded to a series of questionnaires assessing PSE, PTSD, and the Impact of Event Scale (IES) one year following the war. Results indicated a lower level of combat PSE for the F-group compared to the C-1 and C-2 groups. Analysis of PSE by current PTSD status produced an interaction between PTSD and study group. Only soldiers in the F-group diagnosed as PTSD reported a low level of PSE. The remaining soldiers did not differ regardless of PTSD status. A similar interaction was obtai...
A previous comprehensive bibliography of neurofeedback outcome studies was published by the author in 2001. Since that time there have been many new publications as the field of neurofeedback continues maturing, and a few older references were discovered. Therefore a new update of references under categories for various clinical conditions is provided.
EEG biofeedback (neurofeedback) originated in the late 1960s as a method for retraining brainwave patterns through operant conditioning. Since that time a sizable body of research has accumulated on the effectiveness of neurofeedback in the treatment of uncontrolled epilepsy, ADD/ADHD, anxiety, alcoholism, posttraumatic stress disorder, and mild head injuries. Studies also provide encouraging indications that neurofeedback offers a treatment alternative for use with learning disabilities, stroke, depression, fibromyalgia, autism, insomnia, tinnitus, headaches, problems with physical balance, and for the enhancement of peak performance. At a time when an increasing number of people are concerned with negative effects from relying solely on medication treatments, neurofeedback may offer an additional treatment alternative for many conditions. This article assists the reader to understand how neurofeedback works, how assessment allows neurofeedback to be individualized, and briefly reviews evidence for the neurofeedback treatment of many conditions. The public is cautioned that in selecting a practitioner for the treatment of the kinds of medical, psychiatric and psychological conditions cited above, a practitioner should be licensed for independent practice in their state or province and should ideally also be certified by a legitimately recognized body.
The application of neurofeedback to post traumatic stress disorder (PTSD) in returning veterans is described herein and is illustrated with two case histories. Initially, frequency-based electroencephalogram training was employed to promote functional recovery, in the manner of the traditional sensorimotor rhythm/beta approach. An optimization procedure was employed in which the reinforcement frequency is tailored to the client on the basis of symptom response, with particular regard for the regulation of arousal. Low frequencies, down to .01 Hz, have been found especially useful in the remediation of post- traumatic stress disorder. This training was complemented with traditional alpha-theta work as pioneered at the Menninger Foundation and by Peniston. The objective here is experiential, because prior traumas typically are revisited in a nonforced, nontraumatic manner. The benign witnessing of traumas consolidates the experience of safety for which the prior training laid the groundwork. Collectively, this approach has been found to be much better tolerated than traditional exposure therapies. In addition, it is helpful in the shedding of substance dependencies that are common in treatment-resistant PTSD
combat exposure is a consistent predictor of posttraumatic stress (PTS). Understanding factors that might buffer the effects of combat exposure is crucial for helping service members weather the stress of war. In a study of U.S. Ma-rines returning from Iraq, hierarchical multiple regression analyses revealed that unit cohesion and combat exposure predicted PTS, depression, and anger. Furthermore, results indicated that unit cohesion may be an important buffer, possibly limiting the development of PTS and depression following combat exposure.
Since October 2001, approximately 1.7 million U.S. troops have deployed as part of Operation Enduring Freedom (OEF; Afghanistan) and Operation Iraqi Freedom (OIF; Iraq). The pace of the deployments in these current conflicts is unprecedented in the history of the all-volunteer force (Belasco, 2007; Bruner, 2006). Not only are a higher proportion of the armed forces being deployed, but deployments have been longer, redeployment to combat has been common, and breaks between deployments have been infrequent (Hosek, Kavanagh, and Miller, 2006). At the same time, episodes of intense combat notwithstanding, these operations have employed smaller forces and have produced casualty rates of killed or wounded that are historically lower than in earlier prolonged wars, such as Vietnam and Korea. Advances in both medical technology and body armor mean that more servicemembers are surviving experiences that would have led to death in prior wars (Regan, 2004; Warden, 2006). However, casualties of a different kind have emerged in large numbers--invisible wounds, such as post traumatic stress disorder. As with safeguarding physical health, safeguarding mental health is an integral component of the United States' national responsibilities to recruit, prepare, and sustain a military force and to address service-connected injuries and disabilities. But safeguarding mental health is also critical for compensating and honoring those who have served our nation.
Stigma and organizational barriers have been identified as factors for why a small proportion of soldiers with psychological problems seek professional help. In this article, we examine the impact of negative attitudes toward treatment on treatment seeking among soldiers previously deployed to Afghanistan or Iraq (n = 2,623). We asked soldiers with psychological problems questions about stigma, organizational barriers, negative attitudes toward treatment, and whether they sought treatment for their psychological problems. We found that negative attitudes about treatment inversely predicted treatment seeking. These results provide a more comprehensive examination of reasons that soldiers do not seek needed treatment and highlight the need for policy aimed at reducing negative attitudes toward mental health treatment.
This article provides an overview of treatment services for posttraumatic stress disorder (PTSD) at a major U.S. Army medical center, including lessons learned that can be applied to a variety of military and civilian treatment settings. The processes of postdeployment and subsequent behavioral health screenings are detailed. Treatment options for active duty, National Guard, and reserve military personnel returning from deployment in Afghanistan and Iraq are discussed. Case vignettes on the utilization of treatment options by servicemembers are considered. Recommendations for providers regarding the facilitation of group and individual treatment for PTSD in servicemembers are provided.
While concerns about the psychological effects of war are not new, only recently has systematic attention been paid to such problems among past and present military personnel. There is increasing recognition that mental health has serious implications for operational performance, retention, and compensation. Although little controlled research exists with this population, preliminary evidence suggests that psychological treatments for posttraumatic stress disorder may be beneficial, albeit less so than for civilian populations. This article reviews evidence for each of several psychological treatment stages: stabilization and engagement, psychoeducation, symptom management, prolonged exposure, cognitive restructuring, and relapse prevention, with particular reference to the clinical issues raised by military personnel. Possible explanations for reduced treatment effects in this population compared with civilians are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The present study examined the effects of leadership and unit cohesion on mental health stigma and perceived barriers to care. A sample of 680 soldiers from combat support units were surveyed 3 months after their return from combat operations in Iraq. The survey included scales on psychological symptoms and perceptions of leader behaviors and unit cohesion, as well as items assessing stigma and barriers to care. The sample was used to test the independent and interactive effects of leadership and unit cohesion on soldiers’ perceptions of stigma and barriers to care. Analyses yielded significant interaction effects between leadership and cohesion in predicting stigma and barriers to care, while controlling for the effects of mental health symptoms. Soldiers who rated their leaders more highly and who reported higher unit cohesion also reported lower scores on both stigma and perceived barriers to care. Thus, positive leadership and unit cohesion can reduce perceptions of stigma and barriers to care, even after accounting for the relationship between mental health symptoms and these outcomes. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
People who have experienced traumatic events have higher rates than the general population of a wide range of serious and life-threatening illnesses including cardiovascular disease, diabetes, gastrointestinal disorders, and cancer. An important question, for both researchers and clinicians, is why this occurs. Researchers have discovered that traumatic events dysregulate the hypothalamic-pituitary-adrenal axis and sympathetic nervous system. More recently, research from the field of psychoneuroimmunology (PNI) suggests that traumatic life events can lead to health problems through dysregulation of another key system: the inflammatory response. Prior trauma “primes” the inflammatory response system so that it reacts more rapidly to subsequent life stressors. Elevated inflammation has an etiologic role in many chronic illnesses. Recent PNI studies also suggest some interventions that can serve as adjuncts to traditional trauma treatment. These treatments include long-chain omega-3 fatty acids, exercise, and sleep interventions. Each of these interventions downregulates inflammation, which will likely halt the progression to chronic disease for some trauma survivors. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
With the end of Operation Iraqi Freedom (known by most as the“WaronTerror”),deployedsoldiersandother personnel of the United States armed services and National Guard are returning home. Operation Enduring Freedom in Afghanistan continues. More than 4,000 individuals have died in these war-related operations, and a far greater number endure lingering harm. In addition to physical devastation of lost limbs, vision, hearing, and mobility, injury often manifests in the form of neuropsychological and neuropsychiatric impairment. Perhaps the most commonly acknowledged of these maladies is Post-Traumatic Stress Disorder (PTSD), a potentially life-altering hazard of war-relatedevents. In tribute to all armed forces and other wartime personnel for their untoldbraveryandselflessness,thisissueofNeuropsychology
Recent research shows that Virtual Reality (VR) exposure or bio-neuro feedback can help professionals to cope with possibly traumatic events. This paper presents a neuro-bio VR system that combines both methods in order to further improve the prevention and therapy of trauma-related disorders. This system can harmonize the VR exposure to user's personal experiences by systematically showing scenes and stressors, and monitoring the corresponding EEG, heart rate and skin conductance responses. The paper describes the set-up of a first experiment that is being conducted to test the effects of the VR stressors on bio-neuro markers and their dependency on the specific scene (do scene-specific effects appear?). The results of this experiment will be included in the poster.
The aim of the present study was to provide a critical review of prevalence estimates of combat-related post-traumatic stress disorder (PTSD) among military personnel and veterans, and of the relevant factors that may account for the variability of estimates within and across cohorts, including methodological and conceptual factors accounting for differences in prevalence rates across nations, conflicts/wars, and studies. MEDLINE and PsycINFO databases were examined for literature on combat-related PTSD. The following terms were used independently and in combinations in this search: PTSD, combat, veterans, military, epidemiology, prevalence. The point prevalence of combat-related PTSD in US military veterans since the Vietnam War ranged from approximately 2% to 17%. Studies of recent conflicts suggest that combat-related PTSD afflicts between 4% and 17% of US Iraq War veterans, but only 3-6% of returning UK Iraq War veterans. Thus, the prevalence range is narrower and tends to have a lower ceiling among combat veterans of non-US Western nations. Variability in prevalence is likely due to differences in sampling strategies; measurement strategies; inclusion and measurement of the DSM-IV clinically significant impairment criterion; timing and latency of assessment and potential for recall bias; and combat experiences. Prevalence rates are also likely affected by issues related to PTSD course, chronicity, and comorbidity; symptom overlap with other psychiatric disorders; and sociopolitical and cultural factors that may vary over time and by nation. The disorder represents a significant and costly illness to veterans, their families, and society as a whole. Further carefully conceptualized research, however, is needed to advance our understanding of disorder prevalence, as well as associated information on course, phenomenology, protective factors, treatment, and economic costs.
Over 35% of returned Iraq and Afghanistan veterans in VA care have received mental health diagnoses; the most prevalent is post-traumatic stress disorder (PTSD). Little is known about these patients' use of non-mental health medical services and the impact of mental disorders on utilization.
To compare utilization across three groups of Iraq and Afghanistan veterans: those without mental disorders, those with mental disorders other than PTSD, and those with PTSD.
National, descriptive study of 249,440 veterans newly utilizing VA healthcare between October 7, 2001 and March 31, 2007, followed until March 31, 2008.
We used ICD9-CM diagnostic codes to classify mental health status. We compared utilization of outpatient non-mental health services, primary care, medical subspecialty, ancillary services, laboratory tests/diagnostic procedures, emergency services, and hospitalizations during veterans' first year in VA care. Results were adjusted for demographics and military service and VA facility characteristics.
Veterans with mental disorders had 42-146% greater utilization than those without mental disorders, depending on the service category (all P < 0.001). Those with PTSD had the highest utilization in all categories: 71-170% greater utilization than those without mental disorders (all P < 0.001). In adjusted analyses, compared with veterans without mental disorders, those with mental disorders other than PTSD had 55% higher utilization of all non-mental health outpatient services; those with PTSD had 91% higher utilization. Female sex and lower rank were also independently associated with greater utilization.
Veterans with mental health diagnoses, particularly PTSD, utilize significantly more VA non-mental health medical services. As more veterans return home, we must ensure resources are allocated to meet their outpatient, inpatient, and emergency needs.
Real-time functional magnetic resonance imaging (fMRI) affords the opportunity to explore the feasibility of self-regulation of functional brain networks through neurofeedback. We localised emotion networks individually in thirteen participants using fMRI and trained them to upregulate target areas, including the insula and amygdala. Participants achieved a high degree of control of these networks after a brief training period. We observed activation increases during periods of upregulation of emotion networks in the precuneus and medial prefrontal cortex and, with increasing training success, in the ventral striatum. These findings demonstrate the feasibility of fMRI-based neurofeedback of emotion networks and suggest a possible development into a therapeutic tool.
Comorbidity is associated with worse health outcomes, more complex clinical management, and increased health care costs. There is no agreement, however, on the meaning of the term, and related constructs, such as multimorbidity, morbidity burden, and patient complexity, are not well conceptualized. In this article, we review definitions of comorbidity and their relationship to related constructs. We show that the value of a given construct lies in its ability to explain a particular phenomenon of interest within the domains of (1) clinical care, (2) epidemiology, or (3) health services planning and financing. Mechanisms that may underlie the coexistence of 2 or more conditions in a patient (direct causation, associated risk factors, heterogeneity, independence) are examined, and the implications for clinical care considered. We conclude that the more precise use of constructs, as proposed in this article, would lead to improved research into the phenomenon of ill health in clinical care, epidemiology, and health services.
One of the diagnostic criteria for posttraumatic stress disorder (PTSD) is an exaggerated startle response; however, this phenomenon has not been verified empirically. The authors compared 20 Vietnam combat veterans with PTSD and 18 combat veterans without PTSD on the eyeblink reflex electromyographic response of the startle reaction. Subjects in both groups who failed to show an eyeblink response to the startle stimuli were eliminated from further analyses. Among the remaining subjects, the 13 with PTSD had a significantly greater startle response amplitude than the 12 control subjects at intermediate intensities of acoustic stimuli. The relationship between startle responsivity and both negative and positive symptoms was also investigated.
Data were obtained on the general population epidemiology of DSM-III-R posttraumatic stress disorder (PTSD), including information on estimated life-time prevalence, the kinds of traumas most often associated with PTSD, sociodemographic correlates, the comorbidity of PTSD with other lifetime psychiatric disorders, and the duration of an index episode.
Modified versions of the DSM-III-R PTSD module from the Diagnostic Interview Schedule and of the Composite International Diagnostic Interview were administered to a representative national sample of 5877 persons aged 15 to 54 years in the part II subsample of the National Comorbidity Survey.
The estimated lifetime prevalence of PTSD is 7.8%. Prevalence is elevated among women and the previously married. The traumas most commonly associated with PTSD are combat exposure and witnessing among men and rape and sexual molestation among women. Posttraumatic stress disorder is strongly comorbid with other lifetime DSM-III-R disorders. Survival analysis shows that more than one third of people with an index episode of PTSD fail to recover even after many years.
Posttraumatic stress disorder is more prevalent than previously believed, and is often persistent. Progress in estimating age-at-onset distributions, cohort effects, and the conditional probabilities of PTSD from different types of trauma will require future epidemiologic studies to assess PTSD for all lifetime traumas rather than for only a small number of retrospectively reported "most serious" traumas.
Although most people will gradually recover from the psychological effects of a traumatic event, PTSD will develop in a substantial proportion. PTSD appears to represent a failure to recover from a nearly universal set of emotions and reactions and is typically manifested as distressing memories or nightmares related to the traumatic event, attempts to avoid reminders of the trauma, and a heightened state of physiological arousal. Studies of the biologic mechanisms of PTSD have delineated circumscribed alterations in brain regions, such as the amygdala and hippocampus, that are associated with fear and memory, as well as changes in hormonal, neurochemical, and physiological systems involved in coordinating the body's response to stress. The treatment of PTSD involves educating the patient about the nature of the disorder, providing a safe and supportive environment for discussing traumatic events and their impact, and relieving the distress associated with memories and reminders of the event. A variety of approaches, such as exposure therapy, cognitive therapy, and pharmacotherapy, have been found to be effective in the treatment of PTSD.
This article presents the clinical approach developed by a Canadian biofeedback practitioner for the assessment and treatment of police and military clients, especially those with post traumatic stress disorder (PTSD). The author conducted a clinical practice for more than 25 years primarily with male police and military clients. He examines the impact on treatment effectiveness of a number of factors, such as how police and military clients differ from civilian populations, the definition of trauma in this population, Diagnostic and Statistical Manual of Mental Disorders (4th edition; DSM-IV) diagnostic criteria, the assessment of post-traumatic stress disorder, risks and coping factors, consequences of PTSD, DSM-IV conundrums, epidemiology, and other reactions to traumatic events.
Background:
Data were obtained on the general population epidemiology of DSM-III-R posttraumatic stress disorder (PTSD), including information on estimated lifetime prevalence, the kinds of traumas most often associated with PTSD, sociodemographic correlates, the comorbidity of PTSD with other lifetime psychiatric disorders, and the duration of an index episode.Methods:
Modified versions of the DSM-III-R PTSD module from the Diagnostic Interview Schedule and of the Composite International Diagnostic Interview were administered to a representative national sample of 5877 persons aged 15 to 54 years in the part II subsample of the National Comorbidity Survey.Results:
The estimated lifetime prevalence of PTSD is 7.8%. Prevalence is elevated among women and the previously married. The traumas most commonly associated with PTSD are combat exposure and witnessing among men and rape and sexual molestation among women. Posttraumatic stress disorder is strongly comorbid with other lifetime DSM-III-R disorders. Survival analysis shows that more than one third of people with an index episode of PTSD fail to recover even after many years.Conclusions:
Posttraumatic stress disorder is more prevalent than previously believed, and is often persistent. Progress in estimating age-at-onset distributions, cohort effects, and the conditional probabilities of PTSD from different types of trauma will require future epidemiologic studies to assess PTSD for all lifetime traumas rather than for only a small number of retrospectively reported "most serious" traumas.
The signature wounds of the lraq War are traumatic brain injury and post traumatic stress disorder (PSTD). Due to an emergent need to address the symptoms of these wounds in returning Marines and navy corpsmen, a memorandum of understanding between the U.S. Marine Corps and East Carolina University's Psychophysiology Lab and Biotfeedback Clinic was signed and training services were begun in February 2008. The Training for Optimal Performance program involves a biofeedback circuit-training method in which marines and navy corpsmen participate in a graded exposure protocol that includes virtual reality, cognitive retraining, neurofeedback, heart rate variability, and relationship and resiliency training. Preliminary results indicate that this approach is effective in ameliorating symptoms of traumatic brain injury and PTSD.
The literature regarding neurofeedback treatment of anxiety associated with post traumatic stress disorder (PTSD) is reviewed. The results of quantitative electroencephalograph (QEEG) guided neurofeedback training for anxiety in nineteen PTSD patients is analyzed, along with the change in anxiety in four control patients who did not do neurofeedback. Those who did neurofeedback training experienced clinically significant reductions in anxiety, whereas there was no significant change in anxiety in the control group. QEEG-guided neurofeedback appears to be effective in a higher percentage of patients than non–QEEG-guided training in increasing alpha and theta, based on results in the published literature.
Consistent with the 2009 Standards of the Council for Accreditation of Counseling and Related Educational Programs, counselors must understand neurobiological behavior in individuals of all developmental levels. This requires understanding the brain and strategies for applying neurobiological concepts in counseling practice, training, and research. Neurofeedback, biofeedback for the brain, is one modality based in neuroscience that empowers individuals to recognize, monitor, and self-regulate brain wave activity to create greater wellness. Neurofeedback has significant potential in counseling preparation, research, and practice.
Mild traumatic brain injury (MTBI) and posttraumatic stress disorder (PTSD) are considered the “signature injuries” of combat soldiers returning from Iraq and Afghanistan. Both disorders can greatly affect the functioning of soldiers, yet the disorders often go undetected or are misdiagnosed by both military and civilian health care providers. This article provides information about MTBI and PTSD in returning combat soldiers along with implications for assessment and diagnosis.
The experience of providing self-regulating therapy to combat-injured infantry soldiers at Madigan Army Medical Center is rich in lessons and potential benefits. ''Wounded Warriors'' from Operation Iraqi Freedom/ Operation Enduring Freedom (OIF/OEF) deployments with prolonged somatic symptoms of chronic traumatic headache, disordered sleep, cognitive and affective deficits, and autonomic hyperarousal are assessed in the Neurology Service. The Psychophysiology Clinic is an embedded biobehavioral treatment program within the Neurology Service and provides biofeedback-assisted therapies. Three years ago my patient referrals reflected the significant problem of unresolving mild traumatic brain injury (mTBI) in the context of posttraumatic stress disorder (PTSD). I have observed that psychophysiology offers an amazing therapeu- tic opportunity to address the ''chronification'' effects of the comorbid symptoms linked in mTBI and PTSD. Chronifica- tion here indicates that in these individuals, the acute response to both physical and emotional trauma becomes transformed into a cluster of chronic and self-maintaining conditions. The symptoms of headaches and insomnia evolve into progressive chronic patterns. This chronification process develops more readily in the presence of emotional vulner- ability and autonomic nervous system (ANS) hyperreactivity. The mediating process that amplifies and perpetuates symptoms may be explained by neurologic mechanisms such as sensitization or reduced inhibitory activity. Yet it is also relevant to consider that faulty or maladaptive learning with continued stress reactivity are underlying risk factors. This article reports my clinical experiences supporting the contention that psychophysiologic therapy takes the short route for the most gain in modifying the behavioral risk factors of ineffective conditioned responses.
Both during and after the 1914–18 war, shell-shocked men joined others labelled as deviants in the later nineteenth and early twentieth centuries. Stereotypes were available to cope with an avalanche of psychiatric casualties, the treatment of whom was uncertain and mostly ineffective. When lost for aetiology or proven treatment, both doctors and those who wrote about manliness and morale converged on a notion of shell shock which located it within the degenerate categories well known at the time.
This article provides an overview of stigma associated with mental health and substance abuse treatment in military settings and discusses articles included in this issue. These articles examine the predictors of and barriers to treatment entry; assess the influence of military culture and unit influences on attitudes toward treatment; examine unique challenges associated with reserve personnel; and address policy changes to improve access to care. We review challenges associated with reducing stigma and the importance of policy, culture, education, and leadership to effect the desired changes.
Persons with co-occurring mental and substance use disorders have a more persistent and refractory illness course than those without dual diagnosis. However, few studies have assessed the effects of cognitive-behavioral and biobehavioral treatments on brain function and behavioral indices in people with comorbid drug abuse and posttraumatic stress disorder (PTSD). In this conceptual review, we propose an integrated approach to assessment and treatment utilizing cognitive neuroscience methods, conventional psychotherapeutic treatment and neurofeedback therapy to assess the recovery of cognitive and emotional functions affected by chronic psychostimulant drug abuse co-occurring with PTSD. We review cognitive and motivational factors (e.g., craving, hypersensitivity to drug- and threat-related cues, deficient executive top-down control etc.) involved in addiction and PTSD, and discuss reasons for their persistence and high vulnerability to relapse in cocaine and methamphetamine users with co-morbid PTSD undergoing behavioral treatment. Incorporating neuroscience assessment methods to assess the effects of psychotherapy and neurofeedback interventions for comorbid disorders may provide significant potential for identifying side-by-side psychophysiological with clinical markers of treatment progress, and may also provide useful information for planning interventions.
Reviews the literature on the effectiveness of counseling, and discusses its consequences for professional practice. The research literature shows treated clients fare substantially better than controls. The effects of counseling seem to be relatively lasting, except for substance abuse, eating disorders, recurrent depression, and personality disorders. These effects are attained in relatively brief time periods, with the percentage of clients who show substantial improvement increasing as the number of counseling sessions increases. There continues to be little evidence of specific efficacy for particular techniques or counseling theories, and a small portion of clients seem to deteriorate while undergoing counseling interventions. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Posttraumatic stress disorder (PTSD) is a well recognized reaction to traumatic events, such as assault, disasters, and severe accidents. The symptoms include involuntary reexperiencing of aspects of the event, hyperarousal, emotional numbing, and avoidance of stimuli that could serve as reminders of the event. Many people experience at least some of these symptoms in the immediate aftermath of a traumatic event. A large proportion recover in the ensuing months or years, but in a significant subgroup the symptoms persist, often for many years (Ehlers, Mayou, & Bryant, 1998; Rothbaum, Foa, Riggs, Murdock, & Walsh, 1992; Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995). This raises the question of why PTSD persists in some individuals and how the condition can be treated. The present chapter overviews our group's cognitive approach to these questions. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The psychological experiences of combat training may be understood as having three interlocking components: the acceptance of psychological control, the equation of masculine identity with military performance, and the equation of the entire military mission with raw agression. These processes produce individuals with a well-honed emotional edge. The consequences both immediate and delayed of placing such individuals in a situation as ambiguous and frustrating as the Vietnam War are cause for grave concern.
This paper focuses upon problematic patterns of thought and behavior among Vietnam combat veterans identified with Post-traumatic Stress Disorder which are associated with difficulties in emotional, interpersonal, and vocational functioning. The following patterns have been identified: intolerance of mistakes, denial of personal difficulties, anger as a problem-solving strategy, hypervigilance, and absolutistic thinking. The realistic and adaptive origins of these patterns in the combat enviroment are identified, and their maladaptiveness outside the combat enviroment is described. Consideration is also given to why such patterns persist years after the last combat experience. Finally, the implications for psychotherapy of the verteran with PTSD are discussed.
The literature on assessment of PTSD in combat veterans is discussed as it relates to several major diagnostic issues. Studies bearing on the validity of the PTSD diagnosis are presented. Additionally, a multidimensional assessment of PTSD is described in detail. The major assessment instruments currently used are discussed and the research supporting the selection of each of the assessment tools is presented.
Psychophysiological reactivity has been well documented in WWII, Korean Conflict, and Vietnam veterans with posttraumatic stress disorder (PTSD). In addition, these individuals have demonstrated cognitive impairments within the domains of attention, concentration, new learning, and memory. However, there has been no research examining the impact of physiological arousal on attention in individuals with PTSD. This study documents the level of physiological arousal and associated disruption of attentional abilities in 28 Persian Gulf War veterans (18 without PTSD or other psychopathology and 10 with PTSD). This population represents a group of combat trauma victims who experienced a relatively acute onset of PTSD, thus providing a unique opportunity to compare prior psychophysiological and cognitive results with a group of veterans who manifested a recent onset of PTSD. Results indicated relatively comparable psychophysiological reactivity and arousal between Persian Gulf War veterans with PTSD and Persian Gulf War veterans without PTSD. Furthermore, attentional processes of veterans with PTSD were not more disrupted than in comparison soldiers. Results suggest that the intensity and chronicity of the disorder may impact physiological arousal and disruption of cognitive functioning. Following Persian Gulf War veterans with PTSD over time may reveal that psychophysiological arousal becomes more pronounced with chronicity, perhaps as memory networks become strengthened and/or neuroendocrine systems become increasingly disrupted.
While there are many studies of comorbidity in combat veterans with posttraumatic stress disorder (PTSD), studies of PTSD from other sources of trauma (e.g., disasters, crimes, and civil violence) are just beginning to emerge. This is the first formal review comparing patterns of comorbidity in PTSD from different sources of trauma. Specific attention is given to the relative frequencies of substance abuse, depression, generalized anxiety, phobic, panic, somatization, psychotic, and personality disorders. The findings reveal that although similarities exist, the comorbidity profiles differ according to the type of trauma experienced and the population studied. Additionally, the evidence suggests that the associated psychiatric disorders are not truly comorbid, but are interwoven with the PTSD.
Research has indicated significant comorbid psychopathology with chronic posttraumatic stress disorder (PTSD) in samples of war veterans. The present paper examines the issue of comorbidity in a disaster sample to learn whether findings from veterans generalized to this event. A total of 193 subjects exposed to the Buffalo Creek dam collapse of 1972 were examined 14 years later using diagnoses derived from the Structured Clinical Interview for DSM-III (SCID). Past and present PTSD was found in a significant portion of the sample. Major depression was the next most common diagnosis and was highly related to PTSD. Anxiety disorders were also common. The overlap with other diagnoses was quite similar to that found in a sample of Vietnam veterans we studied earlier, except that the disaster sample had fewer dysthymic disorders, substance abusers, and antisocial personality disorders. Possible explanations for comorbidity in chronic PTSD were discussed and it was suggested that the morphology of PTSD may be quite stable in at least some other nonveteran trauma populations.
The diagnosis and clinical understanding of posttraumatic stress disorder (PTSD) rests upon the explicit identification of traumatic experiences that give rise to a well-defined constellation of symptoms. Most efforts to investigate the characteristics of these experiences have attempted to specify war zone stressors as objectively as possible. In this study, we add specification of the psychological meaning of war zone stressors to their objective specification. Eleven traumas are organized in terms of four roles that veterans played in the initiation of death and injury; namely, target, observer, agent, and failure. These roles can be ordered in terms of the degree of personal responsibility involved in the initiation of death and injury. The relationships of these roles to current symptomatology were examined in combination with a set of objective measures of war zone stressors. The sample consisted of the first 1709 Vietnam theater veterans who were assessed in a national evaluation of the PTSD Clinical Teams initiative of the Department of Veterans Affairs. Results show that having been a target of others' attempts to kill or injure is related more uniquely than any other role to symptoms that are diagnostic criteria for PTSD. On the other hand, having been an agent of killing and having been a failure at preventing death and injury are related more strongly than other roles to general psychiatric distress and suicide attempts.(ABSTRACT TRUNCATED AT 250 WORDS)
The author reports findings from recent psychophysiological and biochemical research on Vietnam combat veterans with chronic posttraumatic stress disorder. Applying these data and the analogy of the known functional and structural defects in the peripheral (cranial) sensory system consequent to high-intensity stimulation, he hypothesizes that cortical neuronal and synaptic changes occur in posttraumatic stress disorder as the consequence of excessive and prolonged sensitizing stimulation leading to depression of habituating learning. He postulates that the "constant" symptoms of the disorder are due to the changes in the agonistic neuronal system which impair cortical control of hindbrain structures concerned with aggressive expression and the sleep-dream cycle.