ABSTRACT
This article describes the development and validation of the Race-Related Stressor Scale (RRSS), a questionnaire that assesses exposure to race-related stressors in the military and war zone. Validated on a sample of 300 Asian American Vietnam veterans, the RRSS has high internal consistency and adequate temporal stability. Hierarchical regression analyses revealed that exposure to race-related stressors accounted for a significant proportion of the variance in posttraumatic stress disorder (PTSD) symptoms and general psychiatric symptoms, over and above (by 20% and 19%, respectively) that accounted for by combat exposure and military rank. The RRSS appears to be a psychometrically sound measure of exposure to race-related stressors for this population. Race-related stressors as measured by the RRSS appear to contribute uniquely and substantially to PTSD symptoms and generalized psychiatric distress.
Subject(s)
Asian/psychology , Combat Disorders/psychology , Personality Inventory/statistics & numerical data , Prejudice , Veterans/psychology , Combat Disorders/diagnosis , Humans , Male , Middle Aged , Psychometrics , Reproducibility of Results , Stress, Psychological/complications , Vietnam , WarfareABSTRACT
Angry patients with conjoined post-traumatic stress disorder often direct their anger at health care providers during the course of treatment. Such misplaced anger can interfere with treatment. Emerging treatments for trauma-related anger are effective. However, even in the course of psychotherapy for trauma-related anger, these patients direct anger at their therapists, compromising the treatment alliance and increasing the likelihood of premature termination. A case example is presented to illustrate the effect of anger on the treatment alliance. A therapeutic strategy is proposed to reduce the likelihood of premature treatment termination in these high-risk patients. This strategy may also be helpful in primary care contexts.
Subject(s)
Anger , Combat Disorders/psychology , Combat Disorders/therapy , Military Personnel/psychology , Physician-Patient Relations , Treatment Refusal/psychology , Adult , Humans , Male , Military Psychiatry/methods , Psychotherapy/methods , WarfareABSTRACT
We examined the ability of Vietnam veterans with PTSD to focus attention on a primary digit detection task while concurrently viewing neutral or Vietnam-related picture and word distractors. Controlling for combat exposure, military service, and psychopathology, veterans with PTSD took longer to detect the target when Vietnam-related pictures were distractors. There were no reaction time differences when word stimuli were distractors. The latency effect was specific to trials with trauma-related pictures and did not spread to neutral trials interleaved within a mixed block of trauma and neutral pictures. Individuals with PTSD recalled proportionally more Vietnam-related words than other groups, implying differential attention to Vietnam-related words. Attending to trauma-related pictures interferes with performance of a concurrent task by individuals with PTSD.
Subject(s)
Attention/physiology , Cognition/physiology , Memory/physiology , Mental Processes/physiology , Stress Disorders, Post-Traumatic/psychology , Adult , Humans , Male , Mental Recall , Psychiatric Status Rating Scales , Stress Disorders, Post-Traumatic/diagnosis , Veterans/psychology , VocabularyABSTRACT
Given the association of injury and posttraumatic stress disorder (PTSD), we examined whether head injury might be associated with increased frequency and severity of PTSD. Using a mail survey, we queried 143 male combat veterans with and without PTSD, who had previously participated in PTSD research in our laboratory, about their history of head injury. Respondents with a PTSD diagnosis were significantly more likely to report a history of head injury than those without. Patients with a history of head injury also reported more severe symptoms of PTSD compared with PTSD patients without head injury. The association of head injury and PTSD was not due to greater combat exposure in the head-injured group. Head injury is associated with a greater likelihood of developing combat-related PTSD and with more severe PTSD symptoms. This retrospective study did not address mechanisms that could account for this finding. The results indicate head injury should be systematically assessed by both nonpsychiatric and psychiatric physicians concerned with the psychological sequelae of exposure to victimizing experiences.
Subject(s)
Combat Disorders/epidemiology , Craniocerebral Trauma/epidemiology , Combat Disorders/diagnosis , Comorbidity , Craniocerebral Trauma/diagnosis , Humans , Male , Middle Aged , Retrospective Studies , Severity of Illness Index , Veterans/psychology , Veterans/statistics & numerical dataABSTRACT
This study examined the cardiovascular correlates of posttraumatic stress disorder (PTSD) in Vietnam combat veterans using 24-hr ambulatory blood pressure and heart rate monitoring. Veterans with PTSD (n = 11) exhibited significantly higher heart rate and diastolic blood pressure across the 24 hr than veterans without PTSD (n = 7) (80.8 vs. 71.9 bpm, and 80.1 vs. 71.5 mm Hg, respectively). Heart rate during sleep was also significantly higher among veterans with PTSD, compared to veterans without PTSD (71.0 vs. 62.7 bpm). These results, based on a more naturalistic measurement methodology used outside the laboratory, support an association between PTSD and increased chronic cardiovascular arousal.
Subject(s)
Arousal , Blood Pressure/physiology , Combat Disorders/diagnosis , Heart Rate , Veterans/psychology , Adult , Arousal/physiology , Blood Pressure Monitors , Circadian Rhythm/physiology , Combat Disorders/physiopathology , Combat Disorders/psychology , Diastole/physiology , Electrocardiography, Ambulatory , Heart Rate/physiology , Humans , Male , Middle Aged , Personality Inventory , VietnamABSTRACT
Despite the clinical and social impact of posttraumatic stress disorder (PTSD), there are few controlled studies investigating its treatment. In this investigation, the effectiveness of two psychotherapeutic interventions for PTSD were compared using a randomized controlled outcome group design. Thirty five combat veterans diagnosed with combat-related PTSD were treated with either (a) 12 sessions of eye movement desensitization and reprocessing, EMDR (n = 10), (b) 12 sessions of biofeedback-assisted relaxation (n = 13), or (c) routine clinical care, serving as a control (n = 12). Compared with the other conditions, significant treatment effects in the EMDR condition were obtained at posttreatment on a number of self-report, psychometric, and standardized interview measures. Relative to the other treatment group, these effects were generally maintained at 3-month follow-up. Psychophysiological measures reflected an apparent habituation effect from pretreatment to posttreatment but were not differentially affected by treatment condition.
Subject(s)
Biofeedback, Psychology/methods , Combat Disorders/rehabilitation , Desensitization, Psychologic/methods , Adult , Analysis of Variance , Chi-Square Distribution , Combat Disorders/psychology , Eye Movements , Follow-Up Studies , Humans , Male , Middle Aged , Psychological Tests , United States , Veterans/psychologyABSTRACT
We present word and picture stimuli constituting a validated stimulus set appropriate for cognitive investigations of posttraumatic stress disorder (PTSD). Combat related and neutral words and pictures were rated by Vietnam veterans with PTSD and by three comparison groups along four dimensions: unpleasantness, Vietnam relevance, stressfulness, and memorability. There were distinctive patterns of responses by the PTSD group which efficiently discriminated the individuals in this group from those in the control groups. These stimuli have the potential to be developed as a diagnostic instrument.
Subject(s)
Psychiatric Status Rating Scales , Stress Disorders, Post-Traumatic/psychology , Veterans/psychology , Adult , Humans , Male , Stress Disorders, Post-Traumatic/diagnosis , United States , VietnamABSTRACT
OBJECTIVE: Following a catastrophic natural disaster, the authors evaluated whether brief psychological intervention (debriefing 6 months later) reduced disaster-related psychological distress as measured by the Impact of Event Scale. METHOD: Two groups of subjects who had been exposed to Hurricane Iniki in Hawaii were assessed before and after participating in a multihour debriefing group. The intervention aimed to provide ventilation of feelings, normalization of responses, and education about normal psychological reactions to the disaster in a context of group support. To provide a partial control for the passage of time, the pretreatment assessment of the second group was concurrent with the posttreatment assessment of the first group. RESULTS: A repeated measures analysis of variance indicated that Impact of Event Scale scores were reduced in both groups after the treatment. CONCLUSIONS: There is preliminary empirical support for the effectiveness of postdisaster psychological intervention and for the feasibility of treatment research in postdisaster environments.
Subject(s)
Crisis Intervention , Disasters , Stress, Psychological/prevention & control , Adult , Analysis of Variance , Crisis Intervention/methods , Disaster Planning , Feasibility Studies , Female , Hawaii , Humans , Life Change Events , Male , Stress Disorders, Post-Traumatic/prevention & control , Stress Disorders, Post-Traumatic/psychology , Stress Disorders, Post-Traumatic/therapy , Stress, Psychological/psychology , Stress, Psychological/therapyABSTRACT
With a randomized group design, a 12-session anger treatment was evaluated with severely angry Vietnam War veterans suffering combat-related posttraumatic stress disorder (PTSD). Eight participants in anger treatment and 7 in a routine clinical care control condition completed multiple measures of anger control, anger reaction, and anger disposition, as well as measures of anxiety, depression, and PTSD at pre- and posttreatment. Controlling for pretreatment scores, significant effects were found on anger reaction and anger control measures but not on anger disposition or physiological measures. Eighteen-months follow-up (for both completers and dropouts) supported the posttreatment anger control findings. The challenges of treatment research with this refractory population are discussed.
Subject(s)
Anger , Cognitive Behavioral Therapy/standards , Combat Disorders/complications , Combat Disorders/therapy , Expressed Emotion , Veterans/psychology , Analysis of Variance , Anger/physiology , Expressed Emotion/physiology , Follow-Up Studies , Humans , Male , Middle Aged , Treatment OutcomeABSTRACT
We describe a typology of regulatory deficits associated with anger in combat-related posttraumatic stress disorder (PTSD). Cognitive, arousal, and behavioral domain deficits in anger regulation were observed clinically in PTSD patients with high levels of anger who were participating in a multi-year trial of a structured anger treatment. We also describe a category of patients whose anger type we have termed "ball of rage." These patients exhibit regulatory deficits in all three domains of anger regulation. We offer a conceptual framework to advance the understanding of anger associated with PTSD and to guide its effective treatment.
Subject(s)
Adaptation, Psychological , Anger , Combat Disorders/psychology , Veterans/psychology , Arousal , Cognitive Behavioral Therapy , Combat Disorders/diagnosis , Combat Disorders/therapy , Humans , Internal-External Control , Male , Middle Aged , Models, Psychological , Psychiatric Status Rating ScalesABSTRACT
Veterans with (n = 10) and without (n = 10) posttraumatic stress disorder (PTSD) participated in an exploratory study of facial reactivity to neutral slides and to slides depicting unpleasant combat-related material that were previously determined to be emotionally evocative. It was found that the zygomaticus major (cheek), masseter (jaw), and lateral frontalis (forehead) muscles were especially reactive to the combat slides in the veterans with PTSD, suggesting the importance of facial emotional expression in this disorder. The PTSD participants' self-reports of overall distress paralleled these effects. However, autonomic reactivity did not reflect general arousal effects due to the visual stimuli, showing both the sensitivity of facial muscle assessment in this context and the need for further research on the relationship between stimulus modality and physiological trauma reactions. Additional directions for research in this area are discussed including efforts to correlate subjective and physiological reactions.
Subject(s)
Facial Muscles/physiology , Stress Disorders, Post-Traumatic/psychology , Veterans/psychology , Warfare , Adult , Attention/physiology , Autonomic Nervous System/physiology , Electromyography , Galvanic Skin Response/physiology , Heart Rate/physiology , Humans , Male , Middle Aged , PsychometricsABSTRACT
A total of 118 combat veterans seeking services at the VA Medical Center in Honolulu were assessed on a variety of demographic and psychometric dimensions, permitting the first systematic comparison on the measured variables between veterans with and without PTSD in the multicultural population of veterans in Hawaii. The results have implications for medical interventions with this population.
Subject(s)
Stress Disorders, Post-Traumatic/epidemiology , Veterans , Adult , Aged , Hawaii , Humans , MMPI , Male , Middle Aged , Socioeconomic Factors , Stress Disorders, Post-Traumatic/diagnosis , Surveys and Questionnaires , Veterans/psychology , Veterans/statistics & numerical dataABSTRACT
Post-traumatic stress disorder (PTSD) was observed in a 24 year-old female following severe Guillain-Barre syndrome (GBS). A review of the literature uncovered no previously mentioned examples of PTSD resulting from GBS or other medical illnesses. GBS-induced PTSD shared the features of PTSD seen following other traumatic events.
Subject(s)
Polyradiculoneuropathy/psychology , Stress Disorders, Post-Traumatic/psychology , Acute Disease , Adult , Fear , Female , Humans , Internal-External Control , Polyradiculoneuropathy/therapy , Respiration, Artificial/psychology , Social Isolation , Stress Disorders, Post-Traumatic/diagnosisABSTRACT
Empirical evidence of a relationship between combat-related PTSD and increased anger is lacking. In this study, 24 veterans of the Vietnam War with posttraumatic stress disorder (PTSD) scored significantly higher on an Anger factor comprising multiple measures of anger than did comparison groups of 23 well-adjusted Vietnam combat veterans and 12 noncombat Vietnam-era veterans with psychiatric diagnoses. In contrast, the 3 groups did not differ significantly on orthogonal factors, one of which comprised cognitive impulsivity measures and the other of which reflected motor impulsivity. Changes in heart rate in response to provocation loaded positively on the Anger factor and negatively on the 2 Impulsivity factors. Concurrent depression and trait anxiety did not have an effect on level of anger in individuals with PTSD. These empirical findings support and extend the clinical evidence regarding PTSD and anger.
Subject(s)
Anger , Combat Disorders/psychology , Impulsive Behavior , Stress Disorders, Post-Traumatic/etiology , Adult , Depressive Disorder/complications , Humans , Male , Middle Aged , Mood Disorders/complications , Stress Disorders, Post-Traumatic/complicationsABSTRACT
Fifty-seven Special Forces Vietnam Veterans were studied to determine if special selection and rigorous training affected the frequency and pattern of predictors of post-traumatic stress disorder (PTSD). No absolute immunity to PTSD was conferred. Frequency (25%) and predictors of PTSD were similar to those reported for other groups of Vietnam Veterans. Symptoms of PTSD were associated with poorer pre-service relationships, being wounded, being wounded after return from R&R, having friends missing in action, feeling guilt over the death of a friend, lack of emotional preparation to leave the unit or service, and failure to discuss feelings upon return from Vietnam.
Subject(s)
Stress Disorders, Post-Traumatic/epidemiology , Veterans , Humans , Male , Predictive Value of Tests , United States , Vietnam , WarfareSubject(s)
Asian/psychology , Stress Disorders, Post-Traumatic/ethnology , Veterans/psychology , Adult , Hawaii , Humans , Japan/ethnology , Male , VietnamABSTRACT
Results of a national survey of randomly selected psychiatrists revealed that 51% (N = 131) of the 259 respondents had had a patient who committed suicide. This event had an impact on both their personal and their professional lives. Sixty-five psychiatrists reported stress levels in the weeks following the suicide that were comparable to levels reported in studies of people seeking treatment after the death of a parent. Younger, less-experienced clinicians were more affected by a patient's suicide than older clinicians with more experience. Implications of these results for the training and practice of psychiatrists are discussed.
