Faculty Bibliography

OBJECTIVE: The aim of this study was to determine the reliability and validity of a proposed measure of peritraumatic dissociation and, as part of that effort, to determine the relationship between dissociative experiences during disturbing combat trauma and the subsequent development of posttraumatic stress disorder (PTSD). METHOD: A total of 251 male Vietnam theater veterans from the Clinical Examination Component of the National Vietnam Veterans Readjustment Study were examined to determine the relationship of war zone stress exposure, retrospective reports of dissociation during the most disturbing combat trauma events, and general dissociative tendencies with PTSD case determination. RESULTS: The total score on the Peritraumatic Dissociation Experiences Questionnaire--Rater Version was strongly associated with level of posttraumatic stress symptoms, level of stress exposure, and general dissociative tendencies and weakly associated with general psychopathology scales from the MMPI-2. Logistic regression analyses supported the incremental value of dissociation during trauma, over and above the contributions of level of war zone stress exposure and general dissociative tendencies, in accounting for PTSD case determination. CONCLUSIONS: These results provide support for the reliability and validity of the Peritraumatic Dissociation Experiences Questionnaire--Rater Version and for a trauma-dissociation linkage hypothesis: the greater the dissociation during traumatic stress exposure, the greater the likelihood of meeting criteria for current PTSD

Process and content were studied in 4 16-session segments of a psychodynamically oriented therapy group involving a total of 15 Vietnam veterans suffering from posttraumatic stress disorder (PTSD). On the Group Climate Questionnaire, the group scored significantly higher in the Engaged dimension and significantly lower in the Avoiding and Conflict dimensions than contrasting samples of neurotic and psychotic groups. There was no evidence of group stages. Topics related to symptoms of PTSD were discussed most frequently (43.1%), followed by issues concerning relations with others (32.4%), general group therapy issues (13.7%), and other topics (10.8%).

The authors' experience with a model of time-limited dynamic therapy for posttraumatic stress disorder (PTSD) and pathological grief has evolved over more than a decade of work that preceded formal manuals delineating treatment principles. Their accumulated experiences in training using this model suggests that a minimum of 2 yrs training in psychodynamics and psychopathology, supervised long-term dynamic psychotherapy experience, and some familiarity with brief therapy approaches is essential prerequisite knowledge. Because training needs to be sequential, they suggest the use of previous cases illustrating nuances of techniques with different personality styles, different levels of adaptive functioning, and implications of each of these factors for conducting treatment. They suggest liberal use of previously recorded cases in the context of ongoing tracking of adherence to a manual.

Interviews were conducted with a nationally representative sample of 1,200 male Vietnam veterans and the spouses or co-resident partners of 376 of these veterans. The veteran interview contained questions to determine the presence of posttraumatic stress disorder (PTSD) and items tapping family and marital adjustment, parenting problems, and violence. The spouse or partner (S/P) interview assessed the S/P's view of these items, as well as her view of her own mental health, drug, and alcohol problems and behavioral problems of school-aged children living at home. Compared with families of male veterans without current PTSD, families of male veterans with current PTSD showed markedly elevated levels of severe and diffuse problems in marital and family adjustment, in parenting skills, and in violent behavior. Clinical implications of these findings are discussed

Exposure to combat frequently imparts a sense of aloneness, guilt, and helplessness. These and other intrapsychic and interpersonal issues need to be addressed in treating Vietnam veterans suffering from posttraumatic stress disorder (PTSD). Group therapy is proposed as a core treatment modality for dealing with these problems. A model is proposed in which patients are treated for 1 year or more in weekly groups that meet for 16-week sequential segments. Clinical guidelines are made explicit to new members by the co-therapists. Discussion topics deal not only with traumatic experiences related to combat, but also with important pre- and postwar issues that are relevant to the symptoms of PTSD. Timely integration and working through of these issues in the group is critical

The National Vietnam Veterans Readjustment Study (NVVRS) estimated the lifetime prevalence of posttraumatic stress disorder (PTSD) to be 30.9% among male theater veterans and 26% among females; lifetime prevalence of partial PTSD was an additional 22.5% and 21.2%, respectively; current prevalence of partial PTSD was 11.1% in males and 7.8% in females. NVVRS findings indicate that of the 1.7 million veterans who ever experienced significant symptoms of PTSD after the Vietnam War, approximately 830,000 (49%) still experience clinically significant distress and disability from symptoms of PTSD.

To determine if Vietnam theater veterans were more likely than controls to have a specific psychiatric disorder other than posttraumatic stress disorder, the rates of specific psychiatric disorders were estimated using the Diagnostic Interview Schedule for national samples of veterans who served in Vietnam, other veterans of the Vietnam era, and matched civilian controls. Overall, there were few differences in rates of disorder between theater and other veterans; there were somewhat more differences between theater veterans and civilians. There were striking differences, however, in rates for most disorders, both lifetime and current, between male theater veterans with high levels of exposure to war zone stress and other male veterans or civilians. Female veterans exposed to high levels of war zone stress also had higher rates than other female respondents for several disorders

Examined among older depressed adults treated in behavioral, cognitive, or brief dynamic therapy the alliance-outcome associations over and above initial symptomatic change as therapy progressed. 111 patients (aged 60-80 yrs) and 10 therapists completed the California Psychotherapy Alliances Scales after the 5th, 10th, and 15th sessions. For each time point, a hierarchical multiple regression analysis was conducted with the Beck Depression Inventory. Substantial associations of alliance with outcome were found only when analyses were conducted separately in behavior, cognitive, and brief dynamic therapy. Partial correlations were in the opposite directions across treatment conditions.