Gina P. Owens

A comparison of OEF and OIF veterans and Vietnam veterans receiving cognitive processing therapy.

The current wars in Iraq and Afghanistan are producing large numbers of veterans who have experienced a variety of combat stressors. The potential impact of combat exposure has been established, including significant rates of posttraumatic stress disorder (PTSD). Limited research has examined potential differences between veteran groups and one study to date has examined differences between eras in terms of treatment response. The present study seeks to examine cohort differences between Operation Enduring Freedom and Operation Iraqi Freedom veterans and Vietnam veterans (N = 101) before and after completing treatment for PTSD using cognitive processing therapy. Findings suggest that veterans from these eras responded differently to treatment and there are multiple variables that should be considered in future cohort studies.

Posttraumatic Stress Disorder, Guilt, Depression, and Meaning in Life Among Military Veterans

Veterans of various service eras (N = 174) completed an Internet survey about combat exposure, posttraumatic stress disorder (PTSD) symptoms, depression, guilt, and meaning in life. Results of a hierarchical regression indicated that younger age; higher levels of combat exposure, depression, and guilt; and lower meaning in life predicted greater PTSD severity. The interaction between meaning in life and depression also was significant, with a stronger inverse relation between meaning and PTSD at lower levels of depression. Meaning in life may be an important treatment concern for veterans with PTSD symptoms, particularly at higher levels of functioning.

The Relationship Between Maladaptive Cognitions, Anger Expression, and Posttraumatic Stress Disorder Among Veterans in Residential Treatment

ABSTRACT Ninety-nine veterans receiving treatment in a residential program for posttraumatic stress disorder (PTSD) were assessed to determine changes in maladaptive cognitions, anger expression, PTSD, and depression after receiving cognitive therapy. Veterans completed the Cognitive Distortions Scale (CDS), Trauma-Related Guilt Inventory, Beck Depression Inventory-II, State-Trait Anger Expression Inventory-2, and PTSD Checklist-Military. Paired samples t tests indicated significant differences from pre- to posttreatment for PTSD, depression, and CDS subscales. A hierarchical linear regression was conducted to determine predictors of posttreatment PTSD severity. Significant predictors were pretreatment cognitions related to wrongdoing and hopelessness and the interaction between anger expression and pretreatment PTSD severity. The interaction indicated that low pretreatment anger was associated with lower levels of posttreatment PTSD as baseline levels of PTSD severity increased.

Group-Level Coping as a Moderator Between Heterosexism and Sexism and Psychological Distress in Sexual Minority Women

The purpose of this study was: (1) to examine concurrently the relationship between heterosexist events and sexist events and psychological distress and (2) to investigate sexual orientation–based and gender-based group-level coping as potential moderators of the heterosexism–distress and sexism–distress links among 282 lesbian and bisexual women. Findings from the Internet survey revealed that, when examined together, both heterosexism and sexism were unique and additive predictors of psychological distress. Results also supported a moderating role of feminist group-level coping in the link between number of sexist events and psychological distress, with the difference between the high–and low–feminist-activity groups occurring at the lower levels of sexism. Thus, it appears that high involvement in feminist activities may provide a buffer against the negative effects of sexism, but only when sexist events are relatively low in number.

Do Coping Styles Moderate or Mediate the Relationship Between Internalized Heterosexism and Sexual Minority Women's Psychological Distress?

The purpose of this study was to test tenets of both minority stress and lesbian feminist/sexual identity development theories by examining the potential moderating and mediating roles of individual coping styles (i.e., problem-solving and avoidant coping) in the relationship between internalized heterosexism and lesbian and bisexual (sexual minority) womens psychological distress. Participants included 323 sexual minority women who completed an Internet survey. Results revealed that avoidant coping partially mediated the relationship between internalized heterosexism and psychological distress. No support was found for the mediating role of problem-solving coping or for the moderating roles of problem-solving and avoidant coping in the link between internalized heterosexism and psychological distress. Feminist strategies that may be useful for clinicians working with clients to reduce internalized heterosexism are provided.

A Preliminary Investigation of Mental Health Needs and Barriers to Mental Health Care for Female Veterans of Iraq and Afghanistan

Fifty female veterans of the wars in Iraq and Afghanistan completed an Internet survey related to their mental health needs, service utilization, and barriers to seeking mental health care within the Veterans Administration (VA) system. Veterans completed several self-report measures including the PTSD Checklist—Military, Center for Epidemiologic Scales—Depression, and Hopkins Symptom Checklist—21. The most frequently reported concerns for which participants indicated they needed counseling were depression, relationship issues, anxiety, and anger management. Although 78% of respondents reported that they felt they needed treatment in the past year, 42% of these individuals indicated that they did not seek counseling. Two commonly reported barriers to seeking mental health services in the VA were long waiting periods for appointments and prior bad experiences. Mental health concerns and symptoms of returning female veterans indicate the need for treatment, but a significant gap remains in the self-reported need for assistance and seeking of services.

Changes in posttraumatic cognitions predict changes in posttraumatic stress disorder symptoms during cognitive processing therapy.

OBJECTIVE Although cognitive processing therapy (CPT) has strong empirical support as a treatment for posttraumatic stress disorder (PTSD), studies have not directly examined the proposed change mechanisms that underlie CPT-that change in trauma-related cognitions produces change in PTSD and depression symptoms. To improve the understanding of underlying mechanisms of psychotherapeutic change, this study investigated longitudinal association between trauma-related cognitions, PTSD, and depression among veterans receiving CPT during a 7-week residential PTSD treatment program. METHOD All 195 veterans met DSM-IV-TR diagnosis for PTSD. The sample was 53% male with a mean age of 48 years. Self-reported race was 50% White and 45% African American. The Posttraumatic Cognitions Inventory was used to assess trauma-related cognitions. The PTSD Checklist and Beck Depression Inventory-II were used to assess PTSD and depression, respectively. Cross-lagged panel models were used to test the longitudinal associations between trauma-related cognitions, PTSD, and depression. Measures were administered at three time points: pre-, mid-, and posttreatment. RESULTS Change in posttraumatic cognitions (self-blame; negative beliefs about the self) preceded change in PTSD. In addition, (a) change in negative beliefs about the self preceded change in depression, (b) change in depression preceded change in self-blame cognitions, and (c) change in depression preceded change in PTSD. CONCLUSION Findings support the hypothesized underlying mechanisms of CPT in showing that change in trauma-related cognitions precedes change in PTSD symptoms. Results suggest that reduction of depression may be important in influencing reduction of PTSD among veterans in residential PTSD treatment.

The Impact of Personality Disorders on Treatment Outcome for Veterans in a Posttraumatic Stress Disorder Residential Treatment Program

This study evaluated the effect of comorbid personality disorders on treatment outcome for male and female Veterans with posttraumatic stress disorder (PTSD). One hundred and sixty-six Veterans participated in a PTSD Residential Rehabilitation Program, which included cognitive processing therapy (CPT) provided in a combined individual and group format. Sixty-six percent of participants met criteria at pre-treatment for at least one personality disorder. No difference was found between participants with and without personality disorders on pre-treatment demographic variables, self-reported PTSD symptoms, or clinician-assessed PTSD symptoms. However, differences were found between the groups on self-reported depression symptoms. When controlling for pre-treatment self-reported depression symptoms, results indicated that both groups had significant reductions on PTSD outcome measures, regardless of the presence of a personality disorder. Additionally, a comparable number of participants with and without personality disorders no longer met criteria for PTSD following treatment. Findings suggest that Veterans with personality disorders can benefit from a CPT-based PTSD residential program.

The Effect of Self Efficacy and Meaning in Life on Posttraumatic Stress Disorder and Depression Severity Among Veterans

OBJECTIVE The current study examined the relationships among combat exposure, presence of and search for meaning in life, general and social self-efficacy, and both posttraumatic stress disorder (PTSD) and depression symptom severity for a Veteran sample (N = 93). METHOD Participants completed an online survey comprising the Combat Exposure Scale, Meaning in Life Questionnaire, Self-Efficacy Scale, Depression subscale of the Depression, Anxiety, Stress Scales-21, and PTSD Checklist-Specific Stressor version. The majority of participants were male and Caucasian. Participants served in various service eras RESULTS To determine factors that predicted PTSD and depression severity, separate hierarchical linear regressions were performed. In the final PTSD model, rank, combat exposure, and general self-efficacy were significant predictors, with officer rank, lower combat exposure, and higher general self-efficacy associated with lower PTSD severity. The interaction between combat exposure and general self-efficacy was also significant, with self-efficacy moderating the relationship between combat exposure and PTSD severity. For depression, rank, presence of meaning in life, and general self-efficacy were significant predictors in the model, with officer rank, higher presence of meaning in life, and general self-efficacy associated with lower depression severity. CONCLUSION A focus on strengthening self-efficacy may assist with lower levels of PTSD and depression symptomatology after combat trauma.

Violations of War: Testing the Meaning–Making Model Among Vietnam Veterans

OBJECTIVE Posttrauma adjustment theories postulate that intense stressors violate peoples beliefs about the world and perceived ability to achieve valued goals. Failure to make meaning from traumatic events exacerbates negative adjustment (e.g., PTSD), whereas success facilitates positive adjustment (e.g., stress-related growth). The current study aimed to test this model of direct and indirect effects among a sample of veterans. METHOD Vietnam veterans (N = 130) completed assessment measures in an online survey format. Participants were largely male (91%) and Caucasian (93%) with a mean age of 61 years. RESULTS Results supported basic model tenets, linking military stress severity to violations of beliefs and goals. In the final model, only goal violations carried indirect effects of severity on PTSD symptoms. Presence of and search for meaning carried a portion of the indirect effects between goal violations and both PTSD and stress-related growth. CONCLUSION Findings suggest that traumatic stress may disrupt peoples goals and meaning-making may center on these disruptions.