Explore the vast range of titles available.

From World War I until today, the United States has failed to provide adequate transition support to millions of veterans leaving military service. Instead of providing meaningful jobs, access to quality health care and education, and fair and equitable housing, veterans learn that when their military service is done, they are now fighting a new battle--a failed bureaucracy that has let them and other veterans down for the past 100 years. It's not as if we as a nation haven't tried. The Veterans Health Administration (VHA) has seen the largest increase in funding in its history and has been given several free passes when the budget axe arrives. Federal funding and grants for education have also enjoyed similar financial favor; and housing opportunities have been increased. Yet on a rudimentary level, we as a nation cannot stop believing that GI Joe and Jane can't wait to come back home and pick up right where they left off before their military services began. The truth is, that person is gone and is not coming back. Many veterans, particularly those with PTSD are lost when returning home. [This book] hopes to break this cycle. In their own words, veterans, caregivers, and the family members that love them are given the opportunity to tell us what is truly broken in the military to civilian transition. Advances in clinical treatment, the presentation of a new, fast-track job training program, and new awareness for the challenges facing all military veterans changes our way of understanding of who the twenty-first century veteran is. Through this understanding, we can change their lives and they can change ours. -- Back cover.

Transactional cascades among child internalizing and externalizing symptoms, and fathers’ and mothers’ posttraumatic stress disorder (PTSD) symptoms were examined in a sample of families with a male parent who had been deployed to recent military conflicts in the Middle East. The role of parents’ positive engagement and coercive interaction with their child, and family members’ emotion regulation were tested as processes linking cascades of parent and child symptoms. A subsample of 183 families with deployed fathers and nondeployed mothers and their 4- to 13-year-old children who participated in a randomized control trial intervention (After Deployment: Adaptive Parenting Tools) were assessed at baseline prior to intervention, and at 12 and 24 months after baseline, using parent reports of their own and their child's symptoms. Parents’ observed behavior during interaction with their children was coded using a multimethod approach at each assessment point. Reciprocal cascades among fathers’ and mothers’ PTSD symptoms, and child internalizing and externalizing symptoms, were observed. Fathers’ and mothers’ positive engagement during parent–child interaction linked their PTSD symptoms and their child's internalizing symptoms. Fathers’ and mothers’ coercive behavior toward their child linked their PTSD symptoms and their child's externalizing symptoms. Each family member's capacity for emotion regulation was associated with his or her adjustment problems at baseline. Implications for intervention, and for research using longitudinal models and a family-systems perspective of co-occurrence and cascades of symptoms across family members are described.

\"They called it Shell Shock provides a new perspective on the psychological reactions to the traumatic experiences of combat. In the Great War, soldiers were incapacitated by traumatic disorders at an epidemic scale that surpassed anything known from previous armed conflicts. Drawing upon individual histories from British and German servicemen, this book illustrates the universal suffering of soldiers involved in this conflict and its often devastating consequences for their mental health. Dr Stefanie Linden explains how shell shock challenged the fabric of pre-war society, including its beliefs about gender (superiority of the male character), class (superiority of the officer class) and scientific progress. She argues that the shell shock epidemic had enduring consequences for the understanding of the human mind and the power that it can exert over the body.\"

BACKGROUND:Patients with posttraumatic stress disorder (PTSD) have significant medical morbidity, which may be mediated by hypothalamic pituitary axis (HPA) dysfunction and reflected in cortisol output. Many veterans with PTSD are hesitant to engage in trauma-focused exposure treatments; therefore briefer, non–exposure-based treatments are needed; one such promising approach is an abbreviated Primary Care brief Mindfulness Program (PCbMP). OBJECTIVE:This study investigated the relationship between dose-response to participation in a veterans PCbMP program and diurnal cortisol. Cortisol reflects HPA function and PTSD is associated with HPA dysregulation. RESEARCH DESIGN:Veterans with PTSD were identified in PC and randomly assigned to treatment as usual (TAU, n=21) or participation in brief 4-week Mindfulness Based Stress Reduction program (n=19). SUBJECTS:Veterans (n=40) (mean age, 48±16 y; 90% men) with PTSD referred through their VA PC provider and randomly assigned to PCbMP or TAU. MEASURE:As an objective indicator of HPA function, salivary diurnal cortisol was measured from samples collected across 2 consecutive days at baseline and follow-up. RESULTS:Analyses revealed that significant changes in cortisol were associated with PCbMP treatment engagement and dosing (number of mindfulness program sessions completed). Veterans completing 4 mindfulness-based meditation sessions significantly reduced their cortisol awakening response (P≤0.05); and had significant changes in cortisol area under the curve increase compared with TAU participants (P≤0.05). Results indicate that PCbMP has a beneficial physiological impact on veterans with PTSD with a minimum of 4 weeks of practice.

BACKGROUND:Several evidence-based treatments are available to veterans diagnosed with posttraumatic stress disorder (PTSD). However, not all veterans benefit from these treatments or prefer to engage in them. OBJECTIVES:The current study explored whether (1) a mantram repetition program (MRP) increased mindful attention among veterans with PTSD, (2) mindful attention mediated reduced PTSD symptom severity and enhanced psychological well-being, and (3) improvement in mindful attention was due to the frequency of mantram repetition practice. RESEARCH DESIGN:Data from a randomized controlled trial comparing MRP plus treatment as usual (MRP+TAU) or TAU were analyzed using hierarchical linear models. SUBJECTS:A total of 146 veterans with PTSD from military-related trauma were recruited from a Veterans Affairs outpatient PTSD clinic (71 MRP+TAU; 75 TAU). MEASURES:The Clinician Administered PTSD Scale (CAPS), PTSD Checklist (PCL), the Brief Symptom Inventory-18 depression subscale, Health Survey SF-12v2, and Mindfulness Attention Awareness Scale (MAAS) were used. Frequency of mantram repetition practice was measured using wrist-worn counters and daily logs. RESULTS:Intent-to-treat analyses indicated greater increases in mindful attention, as measured by the MAAS, for MRP+TAU as compared with TAU participants (P<0.01). Mindful attention gains mediated previously reported treatment effects on reduced PTSD symptoms (using both CAPS and PCL), reduced depression, and improved psychological well-being. Frequency of mantram repetition practice in turn mediated increased mindful attention. CONCLUSIONS:The MRP intervention and specifically, mantram practice, improved mindful attention in veterans with PTSD, yielding improved overall psychological well-being. MRP may be a beneficial adjunct to usual care in veterans with PTSD.

Background Combat post-traumatic stress disorder (PTSD) involves significant suffering, impairments in social and occupational functioning, substance use and medical comorbidity, and increased mortality from suicide and other causes. Many veterans continue to suffer despite current treatments. Deep brain stimulation (DBS) has shown promise in refractory movement disorders, depression and obsessive-compulsive disorder, with deep brain targets chosen by integration of clinical and neuroimaging literature. The basolateral amygdala (BLn) is an optimal target for high-frequency DBS in PTSD based on neurocircuitry findings from a variety of perspectives. DBS of the BLn was validated in a rat model of PTSD by our group, and limited data from humans support the potential safety and effectiveness of BLn DBS. Methods/Design We describe the protocol design for a first-ever Phase I pilot study of bilateral BLn high-frequency DBS for six severely ill, functionally impaired combat veterans with PTSD refractory to conventional treatments. After implantation, patients are monitored for a month with stimulators off. An electroencephalographic (EEG) telemetry session will test safety of stimulation before randomization to staggered-onset, double-blind sham versus active stimulation for two months. Thereafter, patients will undergo an open-label stimulation for a total of 24 months. Primary efficacy outcome is a 30% decrease in the Clinician Administered PTSD Scale (CAPS) total score. Safety outcomes include extensive assessments of psychiatric and neurologic symptoms, psychosocial function, amygdala-specific and general neuropsychological functions, and EEG changes. The protocol requires the veteran to have a cohabiting significant other who is willing to assist in monitoring safety and effect on social functioning. At baseline and after approximately one year of stimulation, trauma script-provoked 18 FDG PET metabolic changes in limbic circuitry will also be evaluated. Discussion While the rationale for studying DBS for PTSD is ethically and scientifically justified, the importance of the amygdaloid complex and its connections for a myriad of emotional, perceptual, behavioral, and vegetative functions requires a complex trial design in terms of outcome measures. Knowledge generated from this pilot trial can be used to design future studies to determine the potential of DBS to benefit both veterans and nonveterans suffering from treatment-refractory PTSD. Trial registration PCC121657 , 19 March 2014.

Acute stress disorder involves prominent symptoms of threat avoidance. Preliminary cross-sectional data suggest that such threat-avoidance symptoms may also manifest cognitively, as attentional threat avoidance. Confirming these findings in a longitudinal study might provide insights on risk prediction and anxiety prevention in traumatic exposures. Attention-threat bias and post-traumatic symptoms were assessed in soldiers at two points in time: early in basic training and 23 weeks later, during advanced combat training. Based on random assignment, the timing of the repeat assessment occurred in one of two schedules: for a combat simulation group, the repeat assessment occurred immediately following a battlefield simulation exercise, and for a control group, the assessment occurred shortly before this exercise. Both groups showed no threat-related attention bias at initial assessments. Following acute stress, the combat simulation group exhibited a shift in attention away from threat whereas the control group showed no change in attention bias. Stronger threat avoidance in the combat simulation group correlated with severity of post-traumatic symptoms. Such an association was not found in the control group. Acute stress may lead some individuals to shift their attention away from threats, perhaps to minimize stress exposure. This acute attention response may come at a psychological cost, given that it correlates with post-traumatic stress disorder (PTSD) symptoms. Further research is needed to determine how these associations relate to full-blown PTSD in soldier and civilian populations.

Background Outcome expectancy, or the degree to which a client believes that therapy will result in improvement, is related to improved treatment outcomes for multiple disorders. There is a paucity of research investigating this relation in regards to posttraumatic stress disorder (PTSD). Additionally, the bulk of the research on outcome expectancy and treatment outcomes has relied mostly on self‐report outcome measures. Methods The relation between outcome expectancy on self‐report measures, clinician‐rated measures, and two biological indices (fear‐potentiated startle and cortisol reactivity) of PTSD symptoms was explored. The sample included combat veterans (N = 116) treated with virtual reality exposure therapy for PTSD. Results Results supported a negative association between outcome expectancy and both self‐report and clinician‐rated symptoms at the conclusion of treatment, but outcome expectancy was related to the magnitude of change during treatment for self‐report measures only. Outcome expectancy was unrelated to biological measures of treatment response. Conclusions These findings suggest that outcome expectancy may be related to patient and clinician perceptions of outcomes, but not biological indices of outcome for PTSD.

Background A portable practice of repeating a mantram—a sacred word or phrase—has been shown to reduce the severity of posttraumatic stress disorder (PTSD) symptoms in veterans with military trauma. It is thought that the intervention re-directs attention and initiates relaxation to decrease symptom severity, but there may be other mechanisms that may contribute to this improvement. Purpose We tested the hypothesis that increases in existential spiritual wellbeing (ESWB) would mediate reductions in self-reported PTSD symptoms following a group mantram intervention. Method Veterans diagnosed with PTSD from war-related trauma completed 6 weeks of case management plus a group mantram intervention ( n  = 66) as part of a randomized trial. Measures included PTSD Checklist (PCL) and Functional Assessment of Chronic Illness Therapy–Spiritual Wellbeing. Path analysis was conducted on those who completed treatment to assess ESWB as a possible mediator of change in PCL from baseline to post-treatment. Results A significant indirect effect, −2.24, 95% CI (−4.17, −1.05) of the mantram intervention on PCL change was found. The path from the mantram intervention to ESWB change was significant and positive ( B  = 4.89, p  < 0.0001), and the path from ESWB change to PCL change was significant and negative ( B  = −0.46, p  = 0.001), thus supporting the hypothesis. Conclusions Findings suggest that one contributing mechanism that partially explains how the mantram intervention reduces PTSD symptom severity in veterans may be by increasing levels of ESWB.

Introduction Smaller hippocampal volumes are one of the most consistent findings in neuroimaging studies of post‐traumatic stress disorder (PTSD). However, very few prospective studies have assessed changes in hippocampal gray matter prior to and following therapy for PTSD, and no neuroimaging studies to date have longitudinally assessed military populations. Methods A pilot study was conducted, assessing patients with combat‐related PTSD with structural MRI. Participants were then assigned either to a treatment group or waiting‐list control group. After the treatment group received multimodal psychological therapy for approximately 6 weeks, both groups completed a second neuroimaging assessment. Results Region‐of‐interest analysis was used to measure gray matter volume in the hippocampus and amygdala. There was a group by time interaction; the therapy group (n = 6) showed a significant increase in hippocampal volume and a nonsignificant trend toward an increase in amygdala volume following therapy, while no change was observed in the waiting‐list group (n = 9). Conclusions This study provides initial evidence for increases in gray matter volume in the hippocampus in response to therapy for combat‐related PTSD. Patients with combat‐related PTSD were allocated to either a therapy group or a waiting‐list control group and assessed with structural neuroimaging at two time points. The therapy group showed an increase in hippocampal volume following therapy, while no change was observed in the waiting‐list group. This study provides first evidence for increases in gray matter volume in the hippocampus in response to psychotherapy for combat‐related PTSD.