The neurobiology of PTSD: implications for nurses

Posttraumatic stress disorder (PTSD) is a disabling and prevalent psychiatric disorder. Researchers and scientists have developed a neurobiological basis, which provides a framework for understanding the complexities of PTSD, for many symtoms of the disorder. The estimated lifetime prevalence of PTSD among adult Americans is 7.8%, with women twice as likely as men to have PTSD. Onset of symptoms can occur years after exposure to trauma, and the duration of the illness can last a lifetime. Patients with PTSD often encounter multiple psychosocial problems that result from the symptoms they experience, and their distorted perceptions can affect relationships within the family and the workplace. Nurses in various roles (e.g., educator, therapist, prescriber, case manager, staff nurse) may encounter individuals with PTSD. The nursing profession has traditionally sought to explain sophisticated language to patients in understandable terms, and nurses serve in encouraging, supporting, and evaluating roles, all of which will be increasingly important as science and technology discover more information about the neurobiological basis for mental illnesses.     

Occupation as therapy for trauma recovery: a case study

In this case study, a young women who has chronic verbal, emotional, and physical abuse and was exposed to repetitive adult acts of abuse as a child initially presented with Posttraumatic Stress Disorder (PTSD) marked by constriction and disconnection, which resulted in her feeling passive and tortured. As part of her occupational therapy intervention, based on the occupational adaptation, psychoanalytic, and recovery frames of reference, she was able to use her skills as a musician and lyricist to work through her trauma by performing heavy metal music. She used work to express emotions and tell and retell her story to audiences eager to hear her. Work helped her develop an identity that allowed her to be active in the world and reach out to others through her music. This case study focuses on the intervention - how music and occupation functioned as a foundation for relieving her PTSD.     

Volunteers and the risk of posttraumatic stress disorder

Symptoms of posttraumatic stress disorder (PTSD) result from exposure to a traumatic event and influence a person's ability to cope psychologically. Recent documentation from emergency rooms shows that medical personnel, including volunteers who treated severely injured people, can develop symptoms of PTSD even though the volunteers themselves were not personally subjected to the stressful event. This article finds similar results among adolescents who volunteered with Magen David Adom (MDA), Israel's national emergency medical, disaster, ambulance, and blood bank service. Because of the security threats Israel has faced, these adolescents are likely to be exposed to traumatic events during their volunteer service, and some may develop PTSD. This article explores who is most susceptible to developing PTSD and the underlying theories of why that may be the case. Since the adolescents' motives to volunteer vary, the article proposes that volunteers with certain motives retain their enthusiasm for volunteering despite the danger of developing PTSD symptoms. It also finds that some of the motives to volunteer correlated with a reduction in the level of PTSD symptoms. Understanding the adolescents' motivations to volunteer will help nonprofit leaders and managers allocate volunteers according to their motivations and the levels of threat a particular job entails.     

Intimate partner violence and PTSD: the moderating role of emotion-focused coping

Intimate partner violence (IPV) affects millions of women every year, often resulting in posttraumatic stress disorder (PTSD). The strength of the relationship between IPV and PTSD has been shown to be affected by factors such as the amount of violence exposure and the style of coping in which the individual engages. For example, emotion-focused coping has been shown to be strongly related to IPV exposure and the expression of PTSD symptoms. This topic was explored in IPV survivors, with the finding that more frequent use of emotion-focused coping was associated with both higher violence exposure and heightened PTSD symptoms. Regression analyses revealed that emotion-focused coping moderated the relationship between IPV exposure and PTSD symptoms. More specifically, the results suggest that while individuals low on emotion-focused coping had fewer PTSD symptoms than women who frequently used emotion-focused coping, these individuals reported higher PTSD symptoms in the presence of frequent violence exposure. For individuals who frequently engaged in emotion-focused coping, violence exposure was less strongly associated with symptoms of PTSD.     

Posttraumatic stress disorder symptomatology and comorbid depressive symptoms among abused women referred from emergency department care

Posttraumatic stress disorder (PTSD) is common among victims of intimate partner violence (IPV) as is comorbid depression. Comorbid depression may exacerbate PTSD severity and chronicity. This study sampled female IPV victims from an urban emergency department to assess the relationship between PTSD symptomatology in the previous 12 months and current depressive symptomatology and to evaluate independent predictors of PTSD symptomatology. Half of respondents had symptoms consistent with PTSD. Those with PTSD symptomatology had significantly higher mean total depression scores and mean scores on 3 of 4 depression subscales than those without PTSD. Depressive symptomatology, being married, sexual IPV, severity of physical IPV, and partner's consumption of 5 or more alcoholic drinks per occasion at least once a month independently predicted PTSD symptomatology. Our findings underscore the important roles these factors play in IPV-related PTSD and the need for prompt identification and intervention of those at risk.     

Secondary traumatic stress, psychological distress, sharing of traumatic reminiscences, and marital quality among spouses of Holocaust child survivors

In this study, we examined the issue of secondary traumatic stress (STS) among spouses of Holocaust survivors who were children during the World War II. STS is defined as comprising the same components as posttraumatic stress disorder (PTSD), except that the person evidencing the symptoms has not actually been exposed to the traumatic event(s), but has developed them as a result of caring for someone with PTSD. Participants were 90 couples who completed self-report questionnaires regarding posttraumatic symptoms, psychological distress, and marital quality. The results showed that about one-third of the spouses suffered from some degree of STS symptoms. Secondary traumatic stress symptoms and psychological distress among spouses were significantly related to hostility, anger, paranoia, and interpersonal sensitivity in the survivor, but unrelated to whether the survivor had shared his/her reminiscences with the spouse. Female spouses were found to suffer more distress than male spouses, especially when their partner suffered high levels of PTSD. The results suggest that STS is, to a large degree, related to the demands of living with a symptomatic survivor, possibly more than to the empathic element thought to be central to this syndrome.     

Posttraumatic stress disorder (PTSD) symptoms among firefighters: Roles of resilience and locus of control

Firefighting is a an extremely stressful occupation that risks exposure to traumatic events as part of the job. Despite this, the literature on stress and trauma pays little attention to this occupation and its generalization to other, high risk occupations. This study examined resilience and work locus of control as predictors of posttraumatic stress disorder (PTSD) symptoms among Nigerian firefighters. Participants were 116 paid, professional firefighters (98 males and 18 females) who completed the Post-Traumatic Stress Disorder Checklist-Civilian Version (PCL-C), Resilience Scale (RS-14), and Work Locus of Control Scale (WLCS) and provided vital demographic information. Multiple regression analysis was used to analyze the data. Results showed that resilience negatively predicted PTSD symptoms such that higher resilience was associated with fewer symptoms of PTSD. Work locus of control was a positive predictor of PTSD symptoms, indicating that externality of control beliefs in the workplace was associated with more PTSD symptoms. Relevant demographic factors especially higher years of service, being a senior firefighter, and higher educational status were associated with lower PTSD symptoms. Findings underscore the potential value of resilience training and implementing behavioral health programs to modify firefighters’ external locus of control beliefs. Interventions should consider resilience and locus of control focused interventions as protective factors for PTSD.     

PTSD Symptoms in Abused Latino Children

This exploratory study looks at a sample of abused Latino children and evaluates the relationship of PTSD symptoms to other symptoms, characteristics of the abuse, and demographics. The results indicate that Latino children have a wide range of distress, with some children being highly symptomatic and others with few symptoms. The scores on the PTSD Inventory were related to scores on measures of anxiety, behavior problems, dissociation, and verbal IQ. They were not related to the scores on depression, performance or full scale IQ, gender, or age. The relationship of PTSD symptoms to language of the child and abuse type are equivocal. A discussion of the practice implications is included.     

Pathological Gambling and Posttraumatic Stress Disorder: A Study of the Co-Morbidity versus Each Alone

This report is the first empirical study to compare pathological gambling (PG), posttraumatic stress disorder (PTSD), and their co-occurrence. The sample was 106 adults recruited from the community (35 with current PG; 36 with current PTSD, and 35 with BOTH). Using a cross-sectional design, the three groups were rigorously diagnosed and compared on various measures including sociodemographics, psychopathology (e.g., dissociation, suicidality, comorbid Axis I and II disorders), functioning, cognition, life history, and severity of gambling and PTSD. Overall, the PG group reported better psychological health and higher functioning than PTSD or BOTH; and there were virtually no differences between PTSD and BOTH. This suggests that it is the impact of PTSD, rather than comorbidity per se, that appears to drive a substantial increase in symptoms. We also found high rates of additional co-occurring disorders and suicidality in PTSD and BOTH, which warrants further clinical attention. Across the total sample, many reported a family history of substance use disorder (59%) and gambling problems (34%), highlighting the intergenerational impact of these. We also found notable subthreshold PTSD and gambling symptoms even among those not diagnosed with the disorders, suggesting a need for preventive care. Dissociation measures had mixed results. Discussion includes methodology considerations and future research areas.     

Effects of trauma exposure on anger, aggression, and violence in a nonclinical sample of men

This study assessed the impact of traumatic exposure and posttraumatic stress disorder (PTSD) symptoms on anger, aggression, and violence among civilian male college students. Results suggest that civilian men who have been exposed to a potentially traumatic event (PTE) and report symptoms of PTSD indicate more trait anger, more internal anger and hostility, and more aggression and violence than men who do not report symptoms of PTSD. Results are contrasted to those found in clinical samples of male veterans with PTSD and discussed in terms of understanding and treating anger and aggression in non-clinical, trauma-exposed populations.     

Trauma Focused Cognitive Behavioral Therapy with Children of Incarcerated Parents

This paper explores children’s trauma symptoms related to parental incarceration and lays the groundwork for the implementation of Trauma Focused Cognitive Behavioral Therapy (TF-CBT) within a clinical community-based setting treating children and adolescents affected by parental incarceration. Children and adolescents who experience parental incarceration are more likely to develop symptoms of post-traumatic stress disorder (PTSD): depression, anger, aggression, and isolating and self-harming behaviors. Although parental incarceration is a known source of trauma, there are no documented studies examining effective clinical treatments to reduce the effects of the trauma experienced by these children and adolescents. Except for children and adolescents affected by parental incarceration, TF-CBT, a promising model for treating and reducing the symptoms of PTSD, has been successfully applied to various populations affected by trauma. Children of incarcerated parents resemble populations treated with TF-CBT in earlier applications. In this paper, we present a case illustration that examines the application of TF-CBT with one child who experienced trauma symptoms related to parental incarceration, while discussing the results of that application and the potential for broader applicability of TF-CBT within community-based organizations that treat the population of children and families affected by parental incarceration.     

The relative effects of intimate partner physical and sexual violence on post-traumatic stress disorder symptomatology

This study examined the relative effects of intimate partner physical and sexual violence on Post-Traumatic Stress Disorder (PTSD) symptomatology. Severity of physical and sexual violence as well as PTSD severity were assessed in a sample of 62 help-seeking battered women. The results of this study were consistent with prior research, finding significant and positive relationships between physical and sexual violence as well as sexual violence and PTSD symptoms. In order to further clarify these relationships, the unique effects of sexual violence on PTSD were examined after controlling for physical violence severity. Results indicated that sexual violence severity explained a significant proportion of the variance in PTSD severity beyond that which was already accounted for by physical violence severity. These findings have important implications for mental health and social service professionals who work with battered women.     

Prevalence and predictors of PTSD among a college sample

Objective:This study examined the prevalence and correlates of probable posttraumatic stress disorder (PTSD) in freshman entering college and prospective associations of probable PTSD with additional outcomes. Participants: 2,310 students with data collected from Fall 2014 through Spring 2015. Methods: Incoming freshman completed a survey assessing for relevant variables at the beginning of fall semester and during the spring semester. Results: Seventy percent of the sample endorsed experiencing at least one potentially traumatic event (PTE). 34.4% of PTE exposed individuals met criteria for probable PTSD. Female sex, higher depressive and anxiety symptoms, and interpersonal PTE count were positively associated with PTSD symptoms. Higher PTSD symptoms were associated with higher anxiety and depressive symptoms, and new-onset interpersonal PTE. Conclusions: Identification of factors contributing to risk for PTSD is essential to inform prevention and intervention efforts. Intervention efforts should be targeted to students experiencing PTSD symptoms as they enter college.     

A Couple-Based Approach to the Reduction of PTSD Avoidance Symptoms: Preliminary Findings

This study reports preliminary findings regarding the feasibility and efficacy of a novel couple-based treatment, named Strategic Approach Therapy (SAT), for reducing avoidance symptoms of posttraumatic stress disorder (PTSD). Six male Vietnam combat veterans diagnosed with PTSD and their cohabitating marital partners participated in 10 weeks of SAT treatment. Self-report, clinician ratings, and partner ratings of PTSD symptoms were obtained before the first session and after the tenth session of treatment. Veterans reported statistically significant reductions in self-reported, clinician-rated, and partner-rated effortful avoidance, emotional numbing, and overall PTSD severity. These data indicate that SAT offers promise as an effective treatment for PTSD avoidance symptoms.     

Experience of cumulative trauma disorders on life roles of worker and family member: a case study of a married couple

The prevalence of diagnosed cumulative trauma disorders (CTD) within the workforce comes at a high price for employers burdened with financial losses from missed work and worker's compensation costs. Research has focused primarily on the impact of CTD on the worker role within the workplace, overlooking the impact on roles across multiple environments [24,35,54]. Furthermore, the influence of CTD on life roles of a spouse has not been examined. This single case study illustrated the experience of CTD within a marital relationship through the use of grounded theory. Results indicated that adaptations to CTD symptoms were least altering to the established routines and roles of the couple. With progression of symptoms, the spouse without symptoms was relied on more heavily for adaptations to manage pain. The results of this study indicate that occupational therapists must examine the client's valued roles and incorporate the family into intervention strategies.     

PTSD symptoms among men and women survivors of intimate partner violence: the role of risk and protective factors

The purpose of this cross-sectional analysis of the National Violence Against Women Survey was to characterize current symptoms of posttraumatic stress disorder (PTSD) among 185 men and 369 women survivors of intimate partner violence (IPV). In this subsample, 24% of women and 20% of men had current moderate-to-severe PTSD symptoms. PTSD scores were higher for women than men. Protective factors that appear to increase resiliency of survivors were higher education and income, being currently married, and reporting that IPV had stopped. Higher physical or psychological IPV scores, current depressive symptoms, and the survivor having left the relationship at least once were associated with risk of moderate-to-severe symptoms of PTSD. Protective factors may be used to boost resiliency of IPV survivors and reduce PTSD symptoms.     

Differentiation of the Self and Posttraumatic Symptomatology Among ex-POWs and Their Wives

War captivity is a highly traumatic experience which sometimes has deleterious effects on both ex-POWs and their wives. This study examined the relationships between posttraumatic stress disorder (PTSD) symptoms and differentiation among male ex-prisoners of war (ex-POWs; n  = 103), their wives ( n  = 82), and comparable controls. Results show that ex-POWs and their wives endorsed more PTSD symptoms than controls. Ex-POWs endorsed more cut-off and fusion than controls, while their wives endorsed only more fusion than control wives. Finally, the relationship between differentiation and PTSD was found to be stronger among ex-POW couples than among control couples. The unique characteristics of war captivity and the relationships between avoidance symptoms and cut-off were suggested as possible explanations .     

The Trauma Trifecta of Military Sexual Trauma: A Case Study Illustrating the Integration of Mind and Body in Clinical Work with Survivors of MST

Military sexual trauma (MST) has recently received much attention from the media in contemporary society. With the ever-increasing population of United States service members returning from the Iraq and Afghanistan wars, it is vital for any mental health practitioner to be aware of the epidemic that is sexual assault in the military, the unique trauma experiences of the MST survivor, and treatment implications incorporating multiple psychological theories. This article explores three factors, referred to as the trauma trifecta, in which the effects of MST are exacerbated: the loss of professional and personal identity, the regulatory functions of self harm behaviors, and the retraumatization that many service members endure as a result of the distinctive characteristics of the military culture and its service to veterans. A case study with clinical interventions will be utilized to demonstrate this concept of “the trauma trifecta” and the unique challenges in treating the PTSD symptoms that can result from MST in clinical therapy. Drawing from multiple theories in clinical treatment, this paper illustrates the strengths and limitations of cognitive-behavioral techniques, highlights the integration of feminist theory to illustrate the obstacles of power structures, and mind–body interventions, bridging the gap between talk therapy and body therapy. Through this unique integration of multiple therapies, the case study illustrates the veteran’s reengagement with her body and the reformulation of her identity post MST.     

Does writing reduce posttraumatic stress disorder symptoms?

To see if writing about their trauma lessened PTSD and related symptoms, 57 undergraduates, previously screened for traumatic experiences, wrote for 15 minutes on 4 days across 2 weeks about either their trauma or a trivial topic. They reported PTSD, impact, suicide ideas, dissociation, and depression pre-, post-, and at 6-week follow-up testing. Trauma and trivial writers were not different. Surprisingly, at follow-up everyone reported less severe PTSD symptoms, impact, and dissociation, and fewer health visits, but about the same suicidal ideation and depression. On PTSD symptoms and impact, the pattern of improvement was different: Those writing about trauma got worse at posttesting, but improved to better than their initial state by follow-up. Those writing about a trivial topic got better by posttesting, and held that position at follow-up. In this project, writing seemed to reduce PTSD symptoms regardless of whether it concerned the trauma or what they ate for lunch.