Post-traumatic Stress Disorder Issues Research Articles

Providers' and Administrators' Perceptions of Complementary and Integrative Health Practices Across the Veterans Health Administration.

Use of complementary and integrative health (CIH) therapies is being promoted by the Veterans Health Administration (VA), but promotion may not equate to adoption. The purpose of this study was to explore whether perceptions regarding CIH at one VA medical center (VAMC) were similar to perceptions from a sample of other VAMCs. This article reports a subset of qualitative findings from a mixed-methods study. Sites were recruited through a VA-wide CIH listserver. On the basis of site description (e.g., therapies offered, interest in CIH), sustained site interest, and geographic location, recorded interviews of 22 persons were conducted at 6 sites across the country. Interviewees were asked the same questions as the single-site VAMC study respondents. Variable access to CIH services across the VA created the need for workarounds. Multiple barriers (e.g., limited space and challenging credentialing) and facilitators (e.g., strong champion and high veteran demand) were cited. Respondents described nonpharmacologic pain control, the usefulness in treating mental health and/or post-traumatic stress disorder issues, and improvement of staff morale as additional reasons to promote CIH. Findings confirmed those from the earlier single-site VAMC phase of the study. Even the highest-performing sites reported struggling to meet veterans' demands for delivery of CIH. Almost half of active-duty military personnel report the use of at least one type of CIH therapy. As active-duty personnel transition to veteran status, both their physical and mental healthcare needs can potentially benefit from CIH therapies. The VA must actively support local enthusiastic CIH proponents and receive congressional support if it is to actually meet its stated goal of providing personalized, proactive, patient-driven healthcare through the promotion of comprehensive CIH services to veterans.

Interview: Does Complex Trauma Exist? A “Long View” Based on Science and Service in the Trauma Field

I’m very happy to share some thoughts about this topic. For a long time I have been following the professional dialogue about posttraumatic stress disorder (PTSD), psychological trauma, domestic violence, interpersonal violence, and then the emergence of a condition called complex trauma. I believe that one of the very first places that Judy Herman discussed complex trauma was in my living room in Brookline, as part of the Harvard Study Group on Trauma. That group comprised 25 to 30 people who consistently attended a monthly meeting in Boston, starting in the mid-1980s and continuing until my sabbatical year in 1993 when, for a variety of reasons, it never picked up again. This group gathered people who were doing some of the foundational work on psychological trauma. It included colleagues in Boston at many of the key academic and clinical institutions, some who were visiting Boston for one reason or another, and some whom we would invite from elsewhere in the country to talk with our group about concepts of psychological trauma. Over time the people who comprised the Harvard Study Group on Trauma and those who presented to that group emerged as some of the leading figures in the field, including some who defined key concepts related to psychological trauma. Initially, the group met at the home of Henry Murray’s1 wife (Nina). Their home was in the shadows of Harvard’s William James Hall–a particularly wonderful place to have a conversation about a disorder that was not well-accepted by mainstream psychology and psychiatry. Bessel van der Kolk also hosted the group at times in his beautiful South End row house. One evening Judy Herman spoke about her concerns about the issues of PTSD and the very different patient population she was seeing at the Victims of Violence program at Cambridge Hospital. Her take on it was that many of the people who were given diagnoses of personality disorders were really people who suffered considerable domestic violence, child physical abuse, child sexual abuse, and neglect in ongoing ways. The nature of the distinction was that these were ongoing psychological traumas–ongoing oppression, ongoing stress associated with living in abusive situations, whether it was the spouse, or the parents, or the uncle, or whomever. It was this ongoing nature of it, the sense that “there is no safety,” “no place where anything is safe,” that I think led her to think a bit differently about what conventionally was called personality disorders (borderline being one, but not the only one). She gave birth to the notion of complex trauma and it received a great deal of attention from lots of people at the time who were seeing patients with this same set of problems. I would characterize the patients being discussed as those with dysregulated emotion, cognition, and behavior. The common thread was the existence of this background of ongoing, abusive environments. Interestingly, the syndrome

Mental health in the wake of flooding in pakistan: an ongoing humanitarian crisis.

When natural disasters such as flooding affect a region, ill-health tends to follow. This commentary reviews the epidemiological evidence and considers the implications of the rate and prevalence of mental disorder in the flood-affected regions of Pakistan. In particular, the risk of increasing disability is highlighted. Given the limited resources for psychiatric assessment and treatment available currently in Pakistan, the case is made for investment and aid to prevent the significant long-term mental health consequences that could arise from the recent natural disaster. Rainfall in Pakistan varies radically. The monsoon season (from July to early September) is marked by heavy downpour. This phenomenon, along with monsoon depressions arising from the Bay of Bengal, leads to extremely high flood peaks in rivers and generalized flooding. With an average of 579,732 people subjected to potential damage each year, Pakistan is ranked 9th out of 162 countries affected by flood.1 Last year the province of Khyber Pakhtunkhwa received the highest recorded rainfall in the last 80 years, killing more than 1600 people and affecting more than 14 million people.2 In the immediate aftermath, deployed aid and rescue teams combatted acute infectious diseases and the immediate after effects as best as they could. However, as the emergency situation stabilized and mental euphoria of surviving the flood began to wane, issues of post-traumatic stress disorder (PTSD), survivors' guilt and generalized depression were seen lurking in the background. In addition, the army predicted that rebuilding the infrastructure could take upto 6 months, during which those affected would remain displaced in relief camps across the country, creating not only a physical but also a cultural displacement from the conservative rural to liberal urban and peri-urban areas. Mental health issues often take a back seat to the more immediate effects of natural disasters obviously because complications related to mental health do not usually become apparent until much later. As experience shows, both financial and physical relief efforts reach a peak a few weeks after natural disasters and gradually begin to decline in the chronic phase where much effort is still required. Nevertheless, complications related to mental health following floods have been extensively described in various journals published internationally. In terms of long term morbidity, PTSD is arguably the most important of these. Over the past few years, there have been a number of publications that have focused on the prevalence of PTSD in regions affected by severe flooding.3-7 In 1993, Tobin and Ollenburger found that up to 71% of the questioned adults, with no symptoms of anxiety prior to the event, described symptoms of PTSD 3 months after extensive flooding in the American Midwest.8 More recently, Huang et al. carried out a survey amongst individuals affected by floods in China, 2 years after the event and found 9.2% of the subjects to be 'probable PTSD-positive'. 9 The incidence of psychiatric symptoms has been shown to be directly linked with the dissatisfaction of help received during the floods.10 Research has also shown that the risk of developing PTSD is dependent on age and gender. While analyzing mental health effects of floods in Bihar, Telles et al. found that, compared to younger individuals, prevalence of the condition was greater in survivors over 60 years. 11

Issues of PTSD and Blast-induced Traumatic Brain Injury in Armed Conflicts and Terrorists Attacks

Military conflicts and terrorisms attacks often result in both Posttraumatic Stress Disorder (PTSD) and blast-induced traumatic brain injuries. These conditions exist along a continuum of severity and this may have profound consequences particularly among those individuals who present with subthreshold PTSD or unrecognized blast-induced traumatic brain injury. The Diagnostic and Statistical Manual of Mental Disorders past approach has relied upon a categorical diagnostic system only. It is argued that a mixed categorical-dimensional classification system would be of greater benefit, especially since this system would include subthreshold conditions that do not meet DSM criteria for a diagnosis but that have demonstrable impacts upon an individuals’ functioning. This paper explores these issues in the hope of generating greater aware among practitioners’ and the general public.

Memory and emotion: the making of lasting memories

Most of us remember where we were and what we were doing on September 11, 2001. Why do most experiences leave little trace while some-even terrible ordeals that people wish they could forget-leave memories that last a lifetime? That is the mystery at the heart of this book. Drawing on fascinating research and case studies, James McGaugh, a distinguished neuroscientist, reveals that the key to understanding how memories are created may well be understanding how they are lost. He shows that lasting memories are not stored instantly. Why the delay? The author explains how the slow consolidation of memory has important adaptive consequences. It allows physiological processes activated by experiences to regulate the strength of the memory of the experiences. Emotionally arousing experiences induce the release of stress hormones, which act on the brain to influence the consolidation of our memories of recent experience. These findings have important implications for the controversial issues of post-traumatic stress disorder and repressed memory syndrome. From the prescientific writings of William James to the animal studies of the memory-research pioneers Pavlov, Thorndike, and Tolman, to the latest research of psychologists and neurologists drawing on PET imaging studies of the brain and laboratory experiments involving a variety of drugs, this succinct book provides a wealth of information.

Panel 2: Speaker 3

Panel 2: Speaker 3

Post-Traumatic Stress Disorder in Vietnamese Women

This article describes the extraordinary events Vietnamese women immigrants and refugees experienced prior to their resettlement in the United States. Oral history data illustrate the need for sensitization to issues of Post-Traumatic Stress Disorder and the historical-cultural background of this special population. Oral history narratives from five Vietnamese women suggest differences in the way men and women define wartime trauma, and that women's biological makeup may precipitate some stress reactions unique to women. These narratives are examined in terms of Post-Traumatic Stress Disorder (PTSD), a diagnosis that has been applied primarily to male veterans in treating their physical and psychological problems resulting from war, not to Vietnamese women who lived under war conditions.