Vietnam Combat Veterans Research Articles

Use of the Hand Test in the Assessment of Combat-Related Stress

This study investigated the effectiveness of the Hand Test in discriminating the differential symptomatology of posttraumatic stress (PTS) in Vietnam combat veterans (VCVs). Participants were 108 VCV outpatients, 85 of whom met the Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994) criteria for posttraumatic stress disorder (PTSD), and 23 patients that were found to meet some, but not the minimum criteria, required for a diagnosis of PTSD by the DSM-IV. The latter group of patients was classified into a subclinical PTSD, posttraumatic stress symptoms (PTSS) group. Results showed higher levels of overall psychopathology, a vulnerable capacity for coping, and a tendency for feelings of inadequacy and inferiority in the PTSD group. The PTSD group also exhibited more limited interaction with the world around them than the PTSS group, which may be indicative of withdrawal, apathy, or a lack of concern with environmental activities and goals. These findings are discussed in relation to the assessment, understanding, and treatment of PTS symptomatology and PTSD.

Female partners' estimations of male veterans' combat-related PTSD severity.

This study investigated concordance between male Vietnam veterans' and their female partners' reports of veterans' posttraumatic stress disorder (PTSD) symptoms. Fifty male Vietnam combat veterans and their partners rated the severity of their own PTSD symptoms. Also, partners rated the severity of veterans' symptoms. Results indicated modest levels of agreement in reports of symptom presence/absence. Partner ratings of veterans' PTSD severity were positively correlated with veteran reports and partners' own self-reported PTSD symptoms. After controlling for veterans' self-reported symptoms, partners' symptoms significantly predicted their estimates of veterans' avoidance symptoms, but not veterans' reexperiencing or hyperarousal symptoms. Theoretical and practical implications of these findings are discussed.

Effectiveness of anxiety management training in the treatment of posttraumatic stress disorder: a preliminary report

This preliminary study investigated the effectiveness of anxiety management training (AMT), a coping skills treatment similar to systematic desensitization, in comparison to implosive therapy (IT), an exposure-based treatment, for treating six Vietnam combat veterans with posttraumatic stress disorder (PTSD). The Clinician Administered PTSD Interview Scale (CAPS; Blake et al. (1988), The Behaviour Therapist, 18, 187–188) and a self-monitoring measure ( Weathers et al., 1991) were used as dependent measures. A single-subject, multiple-baseline, crossover design (ABC/ACB) was employed. A new statistic for such designs ( Mueser et al. (1991), Behaviour Modification, 15, 134–155), based on classical test theory, was used to assess treatment effects on intrusive war memories and avoidance of stimuli reminiscent of war. Within-subject results indicated that AMT and IT were similarly effective in reducing the frequency and intensity of intrusions and avoidance. This preliminary report therefore suggests that it may be productive to investigate multidimensional approaches (combining coping skills, exposure-based, and other approaches) to the treatment of combat-related PTSD as Foa et al. (1991), Journal of Consulting and Clinical Psychology, 59, 715–723 and Nishith et al. (1995), Behaviour Therapy, 26, 319–335 have for rape-related PTSD.

Elevated Cytotoxicity in Combat Veterans with Long-Term Post-traumatic Stress Disorder: Preliminary Observations

Resting immune [WBC and differential cell counts, lymphocyte phenotyping (CD2, CD4, CD8, CD16, CD20, and CD56), and NK activity] and endocrine (cortisol, prolactin, growth hormone, and DHEA-SO4) parameters were measured in 10 male, Vietnam combat veterans diagnosed with long-term post-traumatic stress disorder (PTSD) and 9 control Vietnam combat veterans without a PTSD diagnosis but with a comparable history of alcohol abuse. Subjects completed a battery of psychological questionnaires. We report on preliminary observations of the relationship between PTSD and physiological and psychological parameters. With some important exceptions, PTSD patients did not differ from the age-matched control group with regard to hormone levels or lymphocyte phenotypes. However, NK activity was higher in the PTSD population than in the controls. Beck, Mississippi, and Combat Exposure scores were significantly elevated in the PTSD population. In contrast to previous observations in depressed populations, depression (indicated by elevated Beck scores), comorbid with PTSD, was associated withincreasednatural cytotoxicity.

Plasma dopamine beta-hydroxylase activity in psychotic and non-psychotic post-traumatic stress disorder

Recognition and treatment of comorbid chronic psychotic symptoms in post-traumatic stress disorder (PTSD) has become of increasing clinical interest. Altered dopamine beta-hydroxylase (DBH) activity has been reported in mood disorders. Plasma DBH is reduced in major depression with psychosis and elevated in bipolar disorder with psychosis compared with their respective non-psychotic diagnostic groups. DBH is likely a trait marker with interindividual variations secondary to genetic polymorphism. We therefore evaluated DBH activity in PTSD patients with and without psychotic features and compared these groups with age- and gender-matched control subjects. Vietnam combat veterans with PTSD (n=19) (including patients with and without psychotic features) and normal control subjects (n=22) had plasma DBH enzyme activity assayed photometrically. DBH was significantly higher in patients with PTSD with psychotic features than in patients without psychotic features (80.6±13.4 vs. 42.1±7.3 mM/min, P<0.01) and was also higher than normal control subjects (46.12±4.93, P<0.01). Plasma DBH activity may differentiate psychotic and non-psychotic subtypes of PTSD. The observed changes are, interestingly, opposite to those seen in psychotic depression but comparable to psychotic bipolar disorder. Since DBH is a genetic marker, this may reflect individual vulnerabilities to develop psychosis in the context of trauma.

Lower precombat intelligence is a risk factor for posttraumatic stress disorder.

The authors examined the relation between intelligence and posttraumatic stress disorder (PTSD) by studying the association among precombat intelligence, current intelligence, and self-reported PTSD symptoms. Military aptitude test results were obtained in 59 PTSD and 31 non-PTSD Vietnam combat veterans who had undergone a psychodiagnostic interview and current intelligence testing. People with lower precombat intelligence were more likely to develop PTSD symptoms as assessed by the Clinician-Administered PTSD Scale even after adjustment for extent of combat exposure. The association between current intelligence and PTSD was no longer significant after adjusting for precombat intelligence. These results suggest that lower pretrauma intelligence increases risk for developing PTSD symptoms, not that PTSD lowers performance on intelligence tests.

Auditory Event-Related Potentials to Tone Stimuli in Combat-Related Posttraumatic Stress Disorder

This study attempted to replicate findings of abnormal auditory event-related potentials (ERPs) in posttraumatic stress disorder (PTSD) in a sample of Vietnam combat veterans. Veterans with combat-related PTSD, divided into unmedicated (unmed-PTSD, n = 12) and medicated (med-PTSD, n = 22) groups, and veterans without PTSD (non-PTSD, n = 10) completed a three-tone “oddball” target detection task while ERPs were measured. Individuals with comorbid panic disorder (PD) were excluded from the primary analyses. Parietal P3 amplitude to the target tone was significantly smaller in unmed-PTSD compared to med-PTSD and non-PTSD groups. These differences did not remain significant when an adjustment was made for level of depression. Parietal P3 amplitude was also negatively correlated with state anxiety. Secondary analyses within the unmed-PTSD group indicated that participants with comorbid PD ( n = 3) had the largest parietal P3 amplitudes to target tones. Results are consistent with attentional or concentration deficits in PTSD and highlight the importance of considering comorbid diagnoses. The absence of ERP differences between med-PTSD and non-PTSD participants suggests that psychotropic medication may normalize these deficits.

Application of cognitive therapy for trauma-related guilt (CT-TRG) with a Vietnam veteran troubled by multiple sources of guilt

Kubany and Manke (1995) presented a model of guilt that emphasizes its cognitive elements and described a structured cognitive therapy format aimed at alleviating trauma-related guilt (CT-TRG). This article illustrates the practice of CT-TRG with a Vietnam combat veteran suffering from several “classic” Vietnam War-related sources of guilt. Seven sources of guilt were addressed over 7 hours in a 1-day “marathon” therapy session. After therapy, the veteran reported dramatic reductions in guilt, PTSD, and depression symptomatology and a marked increase in self-esteem. These improvements were sustained at 8- and 22-month follow-ups. It is suggested that intensive treatment of multiple guilt issues may be necessary to alleviate overall guilt among many combat veterans and survivors of other kinds of traumatic events as well. Numerous descriptions of therapist-client interactions illustrate some of the nuances of CT-TRG and may facilitate its implementation by interested clinicians.

Minnesota Multiphasic Personality Inventory profiles of Vietnam combat veterans with posttraumatic stress disorder and their children.

Forty children of 28 fathers who are Vietnam veterans with posttraumatic stress disorder (PTSD) completed the Minnesota Multiphasic Personality Inventory. Each of the fathers had at least one elevated clinical scale. Fathers averaged eight elevated clinical scales, and compared to more recent norms, fathers averaged seven elevated clinical scales. Seventy-eight percent of the children had at least one clinically elevated scale (averaging three elevated clinical scales). Compared to contemporary normal adolescents and adults, 65% of children had at least one clinically elevated scale (still averaging three elevated clinical scales). No consistent MMPI profile patterns emerged within or across the two groups. No gender differences were detected among child MMPI profiles. Forty percent of the children reported illegal drug use, and 35% reported behavior problems. Fifteen percent of children reported previous violent behavior. Eighty-three percent of the children reported elevated Cook-Medley hostility scores as compared to an age-matched national normative sample. Children with higher PK scores were also significantly more likely to report higher Cook-Medley hostility scores. Forty-five percent of children reported significant elevations on the PTSD/PK subscales.

Memory and anxiety disorders.

Experimental psychopathologists have identified varying patterns in memory bias in people with depressive and anxiety disorders. Individuals suffering from depression tend to exhibit explicit memory deficits for positively-valanced material, and sometimes exhibit biases for retrieving negative self-relevant information as well. Most studies, however, provide scant evidence for implicit memory biases in depression. In contrast to depression, anxiety disorders are rarely associated with enhanced explicit memory for threat-related information (with the exception of panic disorder). Evidence for implicit memory biases for threat in these syndromes is mixed. After providing an overview of findings on memory abnormalities in depressive and anxiety disorders, data from several new studies bearing on posttraumatic stress disorder (PTSD) in Vietnam combat veterans and in women with histories of childhood sexual abuse are presented. Involving directed forgetting, implicit memory and autobiographical cueing paradigms, these experiments point to a pattern of abnormalities linked to PTSD rather than to trauma per se.

Physiologic responses to non-startling tones in Vietnam veterans with post-traumatic stress disorder

We evaluated eyeblink and autonomic reactivity to non-startling acoustic stimuli in a convenience sample of Vietnam combat veterans. Twenty veterans with current PTSD and 19 veterans who never had PTSD were exposed to 15 consecutive 86-dB, 500-ms, 100-Hz tones with 40-ms rise and fall times, while orbicularis oculi electromyogram (EMG), skin conductance (SC) and heart rate (HR) responses were measured. PTSD subjects had higher resting HR levels and produced larger averaged HR responses across the 15 tone presentations compared to non-PTSD subjects. Skin conductance and EMG responses did not differ between the groups. Results suggest that previous findings of larger HR responses to loud tones in PTSD extend to lower intensity, non-startling stimuli, but that the magnitude of the HR response appears smaller to the lower intensity stimuli. Previously observed differences in the magnitude of the eyeblink response and rate of decline of SC responses in PTSD to high intensity stimuli appear to disappear when using non-startling stimuli.

Chronic posttraumatic stress disorder and chronic pain in Vietnam combat veterans

A study was conducted to investigate chronic pain patterns in Vietnam veterans with posttraumatic stress disorder (PTSD). Combat veterans with PTSD completed standardized PTSD severity, pain, somatization, and depression measures. Of 129 consecutive out-patient combat veterans with PTSD, 80% reported chronic pain. In descending order were limb pain (83%), back pain (77%), torso pain (50%), and headache pain (32%). Compared to PTSD combat veterans without chronic pain, PTSD veterans who reported chronic pain reported significantly higher somatization as measured by the Minnesota Multiphasic Inventory 2 hypochondriasis and hysteria subscales. In the sample of 103 combat veterans with PTSD and chronic pain, MMPI 2 hypochondriasis scores and B PTSD symptoms (reexperiencing symptoms) were significantly related to pain disability, overall pain index, and current pain level. MMPI 2 hypochondriasis and depression scores were also significantly related to percent body pain. These results are discussed in the context of current conceptualizations of PTSD.

Predictors of emotional numbing in posttraumatic stress disorder

AbstractLittle is known about the mechanisms underlying emotional numbing (EN). The functional relationship between other classes of posttraumatic stress disorder (PTSD) symptoms and EN is also not well understood. In the present study, we examined the statistical predictors of EN. We hypothesized that the severity of EN would be most strongly associated with the hyperarousal symptoms rather than the avoidance symptoms of PTSD, or comorbid depression or substance abuse. This prediction was derived from psychological and biological models that posit EN to be a product of the depletion of emotional resources subsequent to chronic hyperarousal. Using hierarchical multiple regression in two separate samples of Vietnam combat veterans, we found hyperarousal symptoms to be the most robust predictor of EN. These data suggest that there is a substantive relationship between hyperarousal symptoms and EN in PTSD.

Combat veterans with posttraumatic stress disorder exhibit decreased habituation of the P1 midlatency auditory evoked potential

The current study used a paired stimulus paradigm to investigate the P1 midlatency auditory evoked potential in Vietnam combat veterans with posttraumatic stress disorder (PTSD) and three comparison groups: alcohol dependents, combat-exposed normals, and combat-unexposed normals. Compared to each comparison group, PTSD subjects exhibited significantly diminished habituation of the P1 potential. P1 potential habituation within the PTSD group, correlated significantly with intensity of PTSD reexperiencing symptoms, such as trauma-related nightmares and flashbacks. These findings are discussed as consistent with a sensory gating defect at the brainstem level in PTSD, and are further discussed in the context of other psychophysiological measures in PTSD and of P1 potential findings in psychiatric disorders other than PTSD.

Hope, coping, and social support in combat‐related posttraumatic stress disorder

AbstractDispositional hope, coping and perceived social support were assessed among Vietnam combat veterans upon admission to and discharge from inpatient treatment for posttraumatic stress disorder (PTSD). Veterans reported lower dispositional hope than any previously described sample, and hope did not increase at discharge from treatment. At admission, higher hope was correlated with greater perceived social support coming from family (this relationship persisted when controlling for depression and PTSD symptoms). At discharge, higher hope was associated with greater perceived social support coming from family and friends and the use of adaptive coping strategies. Results indicate that hope confers a beneficial effect once veterans undergo treatment for combat‐related PTSD, a finding that suggests that hope may be “gone but not lost” for these individuals.

Neurological status of combat veterans and adult survivors of sexual abuse PTSD.

We found higher levels of positive soft neurological signs in PTSD participants than in participants who also experienced similar trauma but did not develop PTSD. This finding was replicated in two samples, that is, Vietnam combat veterans and adult female survivors of childhood sexual abuse, despite differences in gender, age, nature of trauma, and period of life when the trauma occurred. Past developmental history of participants and a substance abuse history of first-degree relatives also differentiated PTSD from non-PTSD groups in both combat and sexual abuse samples. Evidence for neurological impairment and compromised developmental history raises the possibility of pretrauma impairment as a risk factor for the development of PTSD.

Implicit and explicit memory for trauma-related information in PTSD.

Experiments on content-dependent memory abnormalities in PTSD suggest several conclusions. First, PTSD patients exhibit enhanced recall of words related to trauma relative to trauma-exposed persons with the disorder. Recognition tests, however, appear insensitive to these effects. Second, PTSD patients do not exhibit implicit memory biases for trauma cues on implicit memory tasks that are strongly influenced by perceptual (e.g., orthographic) aspects of input. They may, however, exhibit enhanced implicit memory for trauma-related material on conceptually more complex tasks. Third, directed forgetting research suggests that adult survivors of childhood sexual abuse who have PTSD exhibit memory deficits only for neutral and positive material, not for material related to their abuse. Psychiatrically healthy survivors exhibit normal memory performance in this paradigm. Fourth, autobiographical memory research indicates that trauma survivors, especially those with PTSD, are characterized by difficulties retrieving specific memories from their past in response to cue words. These findings are especially dramatic in Vietnam combat veterans whose self-presentational style suggests a fixation to the war and a failure of their autobiography to unfold.

Neuropsychological assessment of Vietnam combat veterans with and without PTSD.

Neuropsychological assessment of Vietnam combat veterans with and without PTSD.

Visual imagery and perception in posttraumatic stress disorder. A positron emission tomographic investigation.

Relative regional cerebral blood flow (rCBF) changes were measured in Vietnam combat veterans with and without posttraumatic stress disorder (PTSD) during exposure to combat-related stimuli. Positron emission tomography was used to measure rCBF in 7 combat veterans with PTSD (PTSD group) and 7 healthy combat veterans (control group) who viewed and generated visual mental images of neutral, negative, and combat-related pictures. Unlike control subjects, subjects with PTSD had increased rCBF in ventral anterior cingulate gyrus and right amygdala when generating mental images of combat-related pictures; when viewing combat pictures, subjects with PTSD showed decreased rCBF in Broca's area. Results suggest that ventral anterior cingulate gyrus and right amygdala play a role in the response of combat veterans with PTSD to mental images of combat-related scenes. Reexperiencing phenomena of PTSD, which often involve emotional visual mental imagery, may be likewise associated with increased rCBF in these regions.

Posttraumatic stress disorder and the states-of-mind model : Evidence of specificity

We conducted a study to examine whether the states-of-mind (SOM) model (Schwartz & Garamoni, 1986) could successfully differentiate between Vietnam combat veterans who suffered from posttraumatic stress disorder (PTSD) and Vietnam combat veterans who did not. Veterans completed a battery of questionnaires that assessed the balance of cognitions (SOM ratios), extent of combat exposure, and symptomatology. The results supported our predictions: After matching the groups according to combat exposure and controlling general psychopathology, we found that (a) the combat veterans who suffered from PTSD reported more maladaptive SOM than combat veterans who did not suffer from PTSD, and (b) maladaptive SOM related to intrusive, but not avoidant, PTSD symptomatology.