An examination of PTSD symptoms and relationship functioning in U.S. soldiers of the Iraq War over time

The belief that U.S. forces regularly violate the norm of noncombatant immunity (i.e., the notion that civilians should not be targeted or disproportionately harmed during hostilities) has been widely held since the outset of the Iraq War. Yet the evidence suggests that the U.S. military has done a better job of respecting noncombatant immunity in Iraq than is commonly thought. It also suggests that compliance has improved over time as the military has adjusted its behavior in response to real and perceived violations of the norm. This behavior is best explained by the internalization of noncombatant immunity within the U.S. military's organizational culture, especially since the Vietnam War. Contemporary U.S. military culture is characterized by an “annihilation-restraint paradox”: a commitment to the use of overwhelming but lawful force. The restraint portion of this paradox explains relatively high levels of U.S. adherence with the norm of noncombatant immunity in Iraq, while the tension between annihilation and restraint helps to account for instances of noncompliance and for why Iraqi civilian casualties from U.S. operations, although low by historical standards, have still probably been higher than was militarily necessary or inevitable.

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Genetic and Environmental Predictors of Adolescent PTSD Symptom Trajectories Following a Natural Disaster

Brain Sciences ◽

10.3390/brainsci9060146 ◽

2019 ◽

Vol 9 (6) ◽

pp. 146 ◽

Cited By ~ 1

Author(s):

Sheerin ◽

Kovalchick ◽

Overstreet ◽

Rappaport ◽

Williamson ◽

...

Keyword(s):

Genetic Variation ◽

Environmental Factors ◽

Natural Disaster ◽

Symptom Improvement ◽

Ptsd Symptoms ◽

Environmental Predictors ◽

Longitudinal Course ◽

Symptom Trajectories ◽

Rare Genetic Variation ◽

Over Time

: Genes, environmental factors, and their interplay affect posttrauma symptoms. Although environmental predictors of the longitudinal course of posttraumatic stress disorder (PTSD) symptoms are documented, there remains a need to incorporate genetic risk into these models, especially in youth who are underrepresented in genetic studies. In an epidemiologic sample tornado-exposed adolescents (n = 707, 51% female, Mage = 14.54 years), trajectories of PTSD symptoms were examined at baseline and at 4-months and 12-months following baseline. This study aimed to determine if rare genetic variation in genes previously found in the sample to be related to PTSD diagnosis at baseline (MPHOSPH9, LGALS13, SLC2A2), environmental factors (disaster severity, social support), or their interplay were associated with symptom trajectories. A series of mixed effects models were conducted. Symptoms decreased over the three time points. Elevated tornado severity was associated with elevated baseline symptoms. Elevated recreational support was associated with lower baseline symptoms and attenuated improvement over time. Greater LGLAS13 variants attenuated symptom improvement over time. An interaction between MPHOSPH9 variants and tornado severity was associated with elevated baseline symptoms, but not change over time. Findings suggest the importance of rare genetic variation and environmental factors on the longitudinal course of PTSD symptoms following natural disaster trauma exposure.

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Impacts of rTMS on Refractory Depression and Comorbid PTSD Symptoms at a Military Treatment Facility

Military Medicine ◽

10.1093/milmed/usaa148 ◽

2020 ◽

Vol 185 (9-10) ◽

pp. e1420-e1427

Author(s):

Sean Wilkes ◽

Celia Ona ◽

Michael Yang ◽

Pingyang Liu ◽

Amber Benton ◽

...

Keyword(s):

Repeated Measures ◽

Mixed Model ◽

Repetitive Transcranial Magnetic Stimulation ◽

Active Duty ◽

Ptsd Symptoms ◽

Refractory Depression ◽

Antidepressant Medications ◽

Treatment Of Depression ◽

Changes Over Time ◽

Over Time

Abstract Introduction Repetitive transcranial magnetic stimulation (rTMS) as a treatment for depression has been studied for over two decades. Repetitive TMS was approved by the Food and Drug Administration in 2008 for the treatment of depression after at least one failed trial of an antidepressant medication of adequate dose and duration. This study evaluated whether rTMS treatments may be associated with measurable improvements in depression and post-traumatic stress disorder (PTSD) symptoms for treated military beneficiaries in Hawaii suffering from depression. It also examined the number of failed medication trials that patients underwent before rTMS treatment. Materials and Methods A retrospective chart review of 77 rTMS patients who received and completed treatment between January 1, 2010 and October 31, 2016 was performed. Under a typical treatment regimen, patients receive rTMS for 6 weeks as well as weekly psychiatric assessments, which included completion of Beck’s Depression Inventory (BDI) and PTSD Checklist (PCL). A mixed model repeated measures analysis was done assuming an autoregressive order one covariance structure to evaluate changes over time. Adjusted analyses were done to assess whether changes over time differed by age, prior diagnosis of PTSD, active duty status, and gender. Results The majority of patients were from the army (74%) and 56% were on active duty. Just over half (53%) were male. Most patients (52%) had completed trials of three or more different antidepressant medications before initiation of treatment with rTMS. The mean number of antidepressant trials was 2.7. BDI and PCL scores were significantly lower at end of treatment on average compared to the pretreatment baseline scores. Mean differences for BDI and PCL were significant with P < 0.001 15, 30, and 45 days after TMS treatment was initiated. Overall, 44% of patients experienced a reduction ≥10 points on BDI, and 38% experienced a reduction ≥10 points on PCL. Additionally, scores fell similarly regardless of whether or not patients had a comorbid diagnosis of PTSD. Conclusions Our research suggests that rTMS treatments may produce a reduction in symptoms of both depression and PTSD in patients with refractory depression and comorbid PTSD. It may be a useful alternative to antidepressants in the treatment of depression in the military population, including those with comorbid PTSD. Broader implementation of this treatment modality may prove beneficial for the purposes of military readiness, given current policies and restrictions on service members who are initiated on antidepressant medications.

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Explaining Memory Amplification: Is It All About the Test Format?

Clinical Psychological Science ◽

10.1177/2167702617744326 ◽

2017 ◽

Vol 6 (3) ◽

pp. 394-406

Author(s):

Melanie K. T. Takarangi ◽

Jacinta M. Oulton ◽

Deryn Strange

Keyword(s):

Recognition Test ◽

Traumatic Events ◽

Memory Test ◽

Ptsd Symptoms ◽

Test Format ◽

Memory Errors ◽

Amplification Effect ◽

Written Descriptions ◽

Response Biases ◽

Over Time

Trauma-exposed people commonly exhibit a “memory amplification” effect, endorsing exposure to more traumatic events over time. Studies reporting this phenomenon have typically relied on checklists, where participants read event descriptions and indicate (yes/no) their exposure. We examined whether that approach is vulnerable to response biases and memory errors. In two experiments, participants viewed negative photos and completed an Old-New recognition test. In Experiment 1, participants completed either a photo recognition test or description test—composed of written descriptions of negative photos. In Experiment 2, we measured analogue PTSD symptoms and participants completed the description test twice, 24 hr apart. Those in the description test condition performed worse on the memory test and were more biased to endorse negative photos compared with the photo test condition. Furthermore, this bias to endorse negative photos increased over time and was related to analogue PTSD symptoms. Overall, our findings suggest that test format plays a role in memory amplification.

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Diagnosis and Treatment of PTSD-Related Compulsive Checking Behaviors in Veterans of the Iraq War: The Influence of Military Context on the Expression of PTSD Symptoms

American Journal of Psychiatry ◽

10.1176/appi.ajp.2009.08091315 ◽

2009 ◽

Vol 166 (7) ◽

pp. 762-767 ◽

Cited By ~ 19

Author(s):

Peter W. Tuerk ◽

Anouk L. Grubaugh ◽

Mark B. Hamner ◽

Edna B. Foa

Keyword(s):

Iraq War ◽

Diagnosis And Treatment ◽

Ptsd Symptoms ◽

Compulsive Checking

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Vicarious Stress: Patterns of Disturbance and Use of Mental Health Services by Those Indirectly Affected by the Oklahoma City Bombing

Psychological Reports ◽

10.2466/pr0.2001.89.2.331 ◽

2001 ◽

Vol 89 (2) ◽

pp. 331-338 ◽

Cited By ~ 8

Author(s):

Ginny Sprang

Keyword(s):

Mental Health ◽

Psychological Effects ◽

Oklahoma City ◽

First Year ◽

Mental Health Intervention ◽

Oklahoma City Bombing ◽

Ptsd Symptoms ◽

Survey Analysis ◽

Stress Patterns ◽

Over Time

This study explored the intermediate psychological effects of terrorism on adults not directly affected by the Oklahoma City bombing by examining the course of PTSD and subthreshold PTSD symptoms over time and whether treatment affected this course. The respondents were interviewed at 3-mo. intervals for 18 mo. following an initial 6-mo. survey. Analysis suggested avoidance, re-experiencing, and increased arousal symptoms in this population were limited over time, declining with or without treatment between 6 and 9 mo. Conversely, victimization symptoms remained high without mental health intervention for the first year after the disaster. The study also examined the nature and occurrence of comorbidity in groups seeking and not seeking treatment.

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Imagery rescripting for the treatment of trauma in voice hearers: a case series

Behavioural and Cognitive Psychotherapy ◽

10.1017/s1352465819000237 ◽

2019 ◽

Vol 47 (6) ◽

pp. 709-725 ◽

Cited By ~ 10

Author(s):

Georgie Paulik ◽

Craig Steel ◽

Arnoud Arntz

Keyword(s):

Meta Analysis ◽

Case Series ◽

Drop Out ◽

Assessment Tools ◽

Ptsd Symptoms ◽

Post Traumatic Stress ◽

Post Intervention ◽

Imagery Rescripting ◽

Over Time

AbstractBackground: High rates of trauma and post-traumatic stress disorder (PTSD) are reported in people who hear voices (auditory hallucinations). A recent meta-analysis of trauma interventions in psychosis showed only small improvements in PSTD symptoms and voices. Imagery Rescripting (ImRs) may be a therapy that is more effective in this population because it generalizes over memories, which is ideal in this population with typically repeated traumas.Aims: The primary aims of this study were to investigate whether ImR reduces (1) PTSD symptoms, and (2) voice frequency and distress in voice hearers.Method: We used a single arm open trial study, case-series design. Twelve voice hearers with previous traumas that were thematically related to their voices participated. Brief weekly assessments (administered in sessions 1–8, post-intervention, and at 3-month follow-up) and longer measures (administered pre-, mid- and post-intervention) were administered. Mixed regression analysis was used to analyse the results.Results: There was one treatment drop-out. Results of the weekly measure showed significant linear reductions over time in all three primary variables – voice distress, voice frequency, and trauma intrusions – all with large effect sizes. These effects were maintained (and continued to improve for trauma intrusions) at 3-month follow-up. On the full assessment tools, all measures showed improvement over time, with five outcomes showing significant time effects: trauma, voice frequency, voice distress, voice malevolence and stress.Conclusions: The findings of the current study suggest that ImRs for PTSD symptoms is generally well tolerated and can be therapeutically beneficial among individuals who hear voices.

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Development of Self-Directedness and Cooperativeness in Relation to Post-Traumatic Stress Disorder Symptom Trajectories After Military Deployment

Chronic Stress ◽

10.1177/2470547018803511 ◽

2018 ◽

Vol 2 ◽

pp. 247054701880351

Author(s):

Alieke Reijnen ◽

Elbert Geuze ◽

Rosalie Gorter ◽

Eric Vermetten

Keyword(s):

Military Personnel ◽

Post Traumatic Stress Disorder ◽

Traumatic Stress ◽

Stress Disorder ◽

Character Traits ◽

Ptsd Symptoms ◽

Post Traumatic Stress ◽

Symptom Trajectories ◽

Post Traumatic ◽

Over Time

Background Personality traits, such as the character traits self-directedness and cooperativeness, might play a role in the risk of developing post-traumatic stress disorder (PTSD) after deployment to a combat zone. However, it is unclear whether these traits are preexisting risk factors or if event-related changes might also be associated with PTSD symptoms over time. Therefore, the current aim was to assess if military deployment is associated with changes in cooperativeness and self-directedness and to study how these traits are related to PTSD symptom trajectories. Methods In a large cohort of military personnel (N = 1007), measurements were performed before, at one and six months, and two and five years after deployment to Afghanistan. Linear mixed-effect models were used to assess the individual change in the traits over time and to study the relation with potential predictors. Results Cooperativeness was found to remain stable, whereas self-directedness was found to slightly decrease over time. This decrease was related to the development of PTSD symptoms over time. Furthermore, lower levels of self-directedness were associated with the symptomatic trajectories of PTSD symptoms. Lower levels of cooperativeness were only associated with the recovered PTSD trajectory. Conclusions So, not only do the findings confirm that lower levels of these character traits are associated with the development of PTSD symptoms, it was also shown that there are differences in the relation between these traits and the course of PTSD symptoms. Studying methods to promote the levels of these character traits might help to improve the resiliency of military personnel.

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