Jeremiah A. Schumm

Posttraumatic Stress Disorder Symptoms, Physiological Reactivity, Alcohol Problems, and Aggression Among Military Veterans

This study examined the association between posttraumatic stress disorder (PTSD) symptomatology and aggressive behavior among a sample of male Vietnam veterans (N = 1,328). Results indicated that the hyperarousal PTSD symptom cluster evidenced the strongest positive association with aggression at the bivariate level when compared with the other PTSD symptom clusters. When the PTSD symptom clusters were examined together as predictors, hyperarousal symptoms evidenced a significant positive relationship with aggression, and avoidance/numbing symptoms were negatively associated with aggression. Examination of potential mediators indicated that hyperarousal symptoms were directly associated with aggression and indirectly related to aggression via alcohol problems. Reexperiencing symptoms were associated with aggression only indirectly and through their positive association with physiological reactivity and negative association with alcohol problems. Study results highlight the complexity of the relationship between PTSD symptoms and aggression, and suggest possible mechanisms explaining this association.

Change in posttraumatic stress disorder symptoms: do clinicians and patients agree?

This study assessed the longitudinal association between clinician and patient ratings of posttraumatic stress disorder (PTSD) symptoms over the course of 2 different randomized clinical trials of veterans with chronic PTSD. One trial, the Department of Veterans Affairs Cooperative Study 420 (CSP 420; N = 360) compared trauma-focused and present-centered group therapies, and the 2nd trial compared cognitive processing theory and a waitlist control condition (N = 60). Linear mixed effects modeling revealed significant associations between clinician ratings (Clinician-Administered PTSD Scale; CAPS; D. D. Blake et al., 1990) and patient ratings (Posttraumatic Stress Disorder Checklist; PCL; F. W. Weathers, B. T. Litz, J. A. Herman, J. A. Huska, & T. M. Keane, 1993) in total and symptom clusters of PTSD. Contrary to hypothesis, the amount of change on the CAPS ranged from .75 to .82 standard deviations for every 1 standard deviation change on the PCL. The CAPS and PCL were more closely associated in the trauma-focused vs. present-centered treatment condition in CSP 420, and especially regarding hyperarousal symptoms. When comparing categorization of clinically significant change on the CAPS and PCL, the authors found no differences in the percentages of agreement between clinicians and patients in improvement and exacerbation. The value of multimodal assessment of PTSD treatment outcomes is discussed.

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.

An Examination of Family Adjustment Among Operation Desert Storm Veterans

This study examined interrelationships among combat exposure, symptoms of posttraumatic stress disorder (PTSD), and family adjustment in a sample of male and female Operation Desert Storm veterans (N = 1,512). In structural equation models for both male and female veterans, higher combat exposure was associated with higher PTSD symptoms, which in turn were associated with poorer family adjustment, although these indirect effects did not reach statistical significance. The model for female veterans evidenced a significant direct negative association between combat exposure and family adjustment when it statistically accounted for PTSD symptoms. When the relative impacts of separate PTSD symptom groupings were examined, those reflecting withdrawal/numbing symptoms and arousal/lack of control symptoms significantly and indirectly accounted for the negative effects of combat exposure on family adjustment. Study findings indicate a number of possible pathways through which war-zone deployments negatively impact military families and suggest several avenues for future research.

Family-of-Origin Maltreatment, Posttraumatic Stress Disorder Symptoms, Social Information Processing Deficits, and Relationship Abuse Perpetration

In this study, the authors examined the interrelations among family-of-origin maltreatment variables, posttraumatic stress disorder (PTSD) symptoms, social information processing deficits, and male-to-female psychological and physical intimate relationship abuse perpetration in adulthood among a community sample of 164 men and their partners. In bivariate analyses, higher family-of-origin childhood parental rejection was associated with the perpetration of psychological and physical abuse in adulthood, and childhood exposure to interparental violence was also associated with adult psychological abuse perpetration. Structural equation modeling analyses indicated that when childhood variables and other study variables were considered together, only childhood parental rejection was associated with the abuse perpetration outcomes, and these effects were indirect through PTSD symptoms and social information processing deficits. Results indicate a need for further investigation into the mechanisms accounting for the impact of early maltreatment on the development of abusive intimate relationship behavior.

Exploring the efficacy of a residential treatment program incorporating cognitive processing therapy-cognitive for veterans with PTSD and traumatic brain injury†‡

As the numbers of military personnel participating in the wars in Afghanistan and Iraq continue to grow, the percentage of individuals who return with both a traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD) also increases. Although there appears to be significant overlap in the symptoms resulting from PTSD and TBI, the best course of treatment remains an area of controversy. The authors present initial findings from a Veterans Administration residential program for comorbid PTSD and TBI. Forty-two participants completed a program comprising psychoeducational groups and cognitive skill building that was augmented with a modification of standard cognitive processing therapy. The results suggest that residential programs that incorporate this form of cognitive therapy can anticipate meaningful participation from patients, and that it may be an effective approach to treat PTSD in individuals with a history of TBI.

Posttraumatic stress disorder and health functioning in a non-treatment- seeking sample of Iraq war veterans: A prospective analysis

To evaluate the impact of posttraumatic stress disorder (PTSD) on health-related functioning, we assessed 800 U.S. Army soldiers before and after 1-year military deployments to Iraq. As part of the Neurocognition Deployment Health Study procedures, each soldier completed at both time points self-report indexes of PTSD symptom severity, health behaviors (smoking, alcohol use), and somatic health-related functioning. Participants also completed a health-symptom checklist at the postdeployment assessment. Structural equation modeling revealed that postdeployment PTSD severity was associated with change in somatic health-related functioning, with postdeployment health symptoms as an intermediary variable. These relationships were independent of health risk behaviors, which had little association with somatic symptoms or PTSD. Our findings highlight the functional impact of PTSD, which extends beyond psychological symptoms to health-related daily functioning.

Revictimization and interpersonal resource loss predicts PTSD among women in substance-use treatment

Child physical abuse (CPA) and child sexual abuse (CSA) were hypothesized to be associated with revictimization and interpersonal resource loss in adulthood. These adulthood experiences were, in turn, hypothesized to increase risk for current posttraumatic stress disorder (PTSD). High-risk women were recruited from an innercity drug and alcohol treatment center (N = 105). Interpersonal resource losses, partner-produced physical assault, adulthood rape, CPA, and CSA had direct effects on PTSD. CPA and CSA also had indirect effects on PTSD through rape, which, in turn, predicted PTSD. Results suggest that the traumatic origins of current PTSD among substance-using women are multifaceted and support the importance of considering interpersonal coping resources in evaluating and treating female substance users.

Examining the link between posttraumatic stress disorder symptoms and dating aggression perpetration

This study examined the role of posttraumatic stress disorder (PTSD) symptoms with respect to dating aggression perpetration among a sample of 199 undergraduates. Almost one-third of the overall sample reported physical dating aggression perpetration in the past year, and approximately 80% reported engaging in psychological dating aggression. Structural equation modeling (SEM) analyses indicated that the effects of trauma exposure on dating aggression were fully indirect via PTSD symptoms. PTSD symptoms were associated with psychological dating aggression in part through its association with anger, and alcohol problems were also directly related to this outcome. Results generalize findings from other populations suggesting the salience of trauma and PTSD symptoms in intimate relationship aggression and point to possible etiological pathways for these associations.

Cognitive Processing Therapy for Veterans with Comorbid PTSD and Alcohol Use Disorders

Posttraumatic stress disorder (PTSD) and alcohol-use disorders (AUD) frequently present comorbidity in veteran populations. Traditionally those with alcohol dependence have been excluded from PTSD treatment outcome studies, thus we do not know how those with alcohol dependence may tolerate or respond to PTSD-specific interventions; no studies to date have examined the extent to which cognitive PTSD interventions are tolerated or effective for those with comorbid PTSD/AUD. The present study examines the extent to which CPT is tolerated by and effective in treating PTSD symptoms for veterans with PTSD and AUD, as compared to veterans with PTSD only in an outpatient treatment setting. Data were obtained through chart review of 536 veterans diagnosed with PTSD who had received at least 1 session of CPT at a Midwestern US Veterans Affairs hospital. Nearly half (n=264, 49.3%) of the veterans in the study exhibited a current or past AUD diagnosis. Participants were grouped into the following diagnostic groups: current AUD (past 12 months), past AUD (prior to 12 months), and no AUD. Participants completed an average of 9 sessions of CPT with no significant difference between AUD diagnostic groups on the number of CPT sessions completed. Individuals with past AUD had higher initial symptoms of self-reported PTSD symptoms than those with no AUD. All groups reported significant reductions in PTSD symptoms and depression over time. Overall, the results suggest that CPT appears well tolerated among veterans with comorbid AUD and is associated with significant reductions in symptoms of PTSD and depression in an outpatient treatment setting.