Doctor of Psychology (PsyD), Wright State University, 2024, School of Professional Psychology

Chronic pain and posttraumatic stress disorder (PTSD) are highly prevalent but lack interventions that address their comorbidity. Written exposure therapy (WET) is an evidenced-based brief intervention designed to focus on PTSD. The intervention that has been developed in this dissertation has been named CronP (chronic pain and PTSD) and delivers a modified digital version of WET in tandem with a clinician. The digital intervention will consist of five modules containing writing prompts to be completed each week prior, during, or after seeing a clinician. The goal in providing the intervention in digital form is to enhance therapeutic efficiency and provide a format of treatment in which the individual can participate in what they may perceive as their safe space (home, etc.). This could include having the individual engage in the writing portions without the clinician present while at the provider's office and reduce the time needed in the clinician's office unlike traditional WET. The two aims of this dissertation are 1) to provide a review of literature investigating the possible usefulness of a digital intervention addressing the comorbidity of chronic pain and PTSD and 2) to present a proposal for a digital intervention that delivers a modified version of WET to reduce both perceived chronic pain intensity and PTSD symptoms. For purposes of this study a digital intervention is operationally defined as follows: A format that can be accessed by any number of electronic devices (e.g., cell phone, tablet, desktop, etc.) through a website portal.

Committee: Julie Williams Psy.D., ABPP. (Committee Chair); Lyndsay Griffin Colvin Psy.D. (Committee Member); Michelle Schultz Psy.D. (Committee Member) Subjects: Clinical Psychology; Cognitive Psychology; Cognitive Therapy; Health; Health Education; Mental Health; Psychology; Psychotherapy; Therapy

Master of Science, The Ohio State University, 2020, Psychology

Although aging is associated with cognitive decline across different domains of functioning, environmental factors may contribute to individual differences in these processes. For example, cognitive decline can be exacerbated by environmental factors such as stress. However, the extent to which cognitive outcomes are impacted by the number of different stressful events experienced versus the severity of PTSD symptoms remains unclear. Veterans who served in the armed forces during the Vietnam War can aid researchers' understanding of the relationship between these environmental insults and cognitive outcomes associated with aging. Here, we examine the relationship among stress, traumatic brain injury, and change in cognition over a one-year period in 186 participants from the Vietnam Veterans Alzheimer's Disease Neuroimaging Initiative Project (ADNI-DoD), a publicly available dataset. We will test these relationships by pursuing three specific aims. Specific Aim 1 is focused on assessing the effect of both number of stressful experiences and posttraumatic stress disorder (PTSD) symptoms on change in cognitive functioning during a one-year period. Specific Aim 2 is to investigate whether changes in cognition are mediated by cortical thickness using a whole-brain analysis approach. Specific Aim 3 will assess the differential impact of having a traumatic brain injury (TBI) on the relationship between stress and cognitive decline. This study's results will clarify the relationship among stressful experiences and symptoms of PTSD, TBI, and cognitive outcomes. These results can be used to inform future research directions, as well as public policy. Finally, by getting a more thorough understanding of the relationship among these factors, researchers can design interventions that may ameliorate cognitive decline.

Committee: Jasmeet Hayes (Advisor); Scott Hayes (Committee Member); Baldwin Way (Committee Member) Subjects: Psychology

Psy. D., Antioch University, 2016, Antioch Santa Barbara: Clinical Psychology

War-zone stressors among Service members can lead to adverse psychological consequences that fall outside the scope of post-traumatic stress disorder. Combat stressors can also result in moral injury. Moral injury is an emerging psychological construct. One proposed definition of moral injury is the perpetration of, failure to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations. The current study used this proposed definition to conduct a qualitative phenomenological investigation of the lived experience of moral injury among combat Veterans of the wars in Iraq and/or Afghanistan. Eight male combat Veterans who self-identified as having the experience of moral injury as put forth in the proposed definition, were individually interviewed. Qualitative analysis was utilized to uncover themes related to morally injurious events and psychological sequela. The findings revealed support for the proposed definition of moral injury as well as six themes describing morally injurious experiences: shame, guilt, and feeling unforgivable connected to the involvement of children in war; shame, guilt, and anger for taking part in killing others; shame, guilt, anger, and feeling unforgivable when they did not speak-out regarding morally injurious events they were a part of as a group; no longer holding the same religious/spiritual beliefs; a loss of meaning in life after viewing death and a sense that they deserved to be disgraced after the way they handled the human remains of the enemy and witnessing others disgrace human remains of the enemy; and difficulty reconnecting emotionally with loved ones after their morally injurious experiences in combat. The most endorsed theme by the Veterans related to morally injurious experiences with children in war. Results suggest an important area for future research could help to define ways to prepare Service members for encountering child soldiers as well as potential ways to manage (open full item for complete abstract)

Committee: Ronald Pilato Psy. D. (Committee Chair); Sharleen O'Brien Psy. D. (Committee Co-Chair); Capt. William P. Nash M.D.,MC USN (Ret.) (Other) Subjects: Armed Forces; Military Studies; Psychology

Master of Science, University of Akron, 2009, Biology

The immune system is responsible for protecting the body from disease by identifying by destroying pathogenic microorganisms, materials and even dangerous self-cells. This protection is carried out by specialized cells which are found in the bone marrow, circulating blood, thymus, lymph nodes, spleen, as well as other lymphatic tissues. These cells each carry out specific functions and convey different types of protection. Modulation of the balance of either the number or functionality of these immune cells can lead to immune deficiency, susceptibility to disease, or autoimmune disorders such as chronic inflammation. A number of studies have shown that the immune system can be affected by both physical and psychological stresses, such as depression and post-traumatic stress disorder (PTSD). In the present study we examined immune status in women victims of intimate partner violence (IPV). Immune system parameters measured included both immune cell counts as well as functionality of the cells. The results indicated that victims of IPV who suffered from depression and PTSD showed significantly higher baseline activity of natural killer (NK) cells and decreased change in NK cell activity when stimulated with heat shock protein 60 (HSP60). This drop in reactivity to a typical cellular stress signal could put PTSD positive IPV victims at risk for a number of diseases, including cancer development and viral infection. Also, an increased basal activity of NK cells could indicate an autoimmune pathology. These results may lead to a better understanding of the health issues associated with IPV, PTSD, and depression, and will hopefully assist in the development of better and more complete therapies.

Committee: James Holda PhD (Advisor) Subjects: Biology; Health; Immunology; Psychobiology; Womens Studies

Ph.D., Antioch University, 2025, Antioch Seattle: Counselor Education & Supervision

A qualitative research study focused on Autistic adults explored the lived experiences of trauma. Participants included Autistic adults who have either been professionally diagnosed with Autism Spectrum Disorder or who self-identify as Autistic. Data was collected through a survey with 12 open-ended questions. A thematic analysis revealed six themes: (a) adverse childhood experiences, (b) exposure to violence and loss, (c) difficulty relating to others, (d) complex mind and sensory experiences, (e) medical and mental health challenges, and (f) autistic identity. The themes revealed instances of Autistic people experiencing trauma in ways that differ and vary in clinical presentation from their neurotypical counterparts. Implications and recommendations for professional counseling and counselor education are discussed based on these findings. This dissertation is available in open access at AURA (https://aura.antioch.edu) and OhioLINK ETD Center (https://etd.ohiolink.edu).

Committee: Stephanie Thorson-Olesen PhD (Committee Chair); Amanda Falkers EdD (Committee Member); Keiko Sano PhD (Committee Member) Subjects: Behavioral Sciences; Counseling Education; Counseling Psychology; Therapy

Doctor of Psychology (Psy.D.), Xavier University, 2025, Psychology

The present study sought to experimentally investigated the role of emotional numbing as a mediator in the relationship between posttraumatic stress symptoms and callous-unemotional traits in an adolescent sample seeking mental health or substance use treatment. Additionally, the relation of trauma exposure on treatment outcome and level of care referral was examined. Adolescents ages 11-19 (N = 119) who completed an intake for potential IOP treatment were enrolled in the study. Those who reported trauma were administered measures of posttraumatic stress, callous-unemotional traits, and emotional numbing during routine intake procedures. Referral decision, IOP substance abuse treatment outcome and duration were collected and their relation to trauma tested. Intended mediation analyses could not be conducted due to insufficient power. Trauma exposure was predictive of requiring intensive outpatient level of care or greater but was not associated with substance use disorder treatment outcome or days of treatment. More research is needed to better understand the role of trauma on treatment need and emotional numbing on developmental trajectories for youth with trauma history who develop callous-unemotional traits.

Committee: Susan Kenford (Advisor); Hannah Lubman (Committee Member); Stacey Raj (Committee Member) Subjects: Psychology

Doctor of Psychology (Psy.D.), Xavier University, 2024, Psychology

Social media use has risen dramatically in recent years, leading to increased opportunities to be exposed to racist content online. The purpose of this study was to determine whether social media use mediated the relation between experienced online racism and both problem use and posttraumatic stress symptoms in a sample of Black college students. A total of 108 participants who identified as Black were recruited through the online research platform Prolific. Mediation results demonstrated that experienced online racism was significantly and positively associated with both problem alcohol use (c path; B = .01, p = .004) and posttraumatic stress symptoms (c path; B = .31 .41, p = .001) However, social media use was not significantly associated with problem alcohol use (b path; B = .00, p = .07) and PTSD symptoms (b path; B = -.00, p = .90).Social media did not act as a mediator between experienced online racism and either alcohol-related problems (c' path; B = .01, p = .006) and posttraumatic stress symptoms (c' path; B = .31, p = .001). Results did not change when controlling for negative affect, alcohol consumption and natal sex. However, the direct effects of experienced online racism and both problem alcohol use and PTSD symptoms remained significant in all cases. Overall, these findings suggest that while greater social media can be deleterious in certain contexts, it does not always confer risk but exposure to online racism in any dose is pernicious.

Committee: Susan Kenford Ph.D. (Committee Chair); Kyle Stephenson Ph.D. (Committee Member); Kathleen Hart Ph.D., ABPP (Committee Member) Subjects: Psychology

PhD, University of Cincinnati, 2024, Medicine: Neuroscience/Medical Science Scholars Interdisciplinary

Posttraumatic Stress Disorder (PTSD) is a highly prevalent psychiatric disorder. Inflammation, and specifically severe asthma, has been implicated in PTSD through genetic and epidemiological studies, though few studies have explored mechanisms. Previous studies in our lab have noted deficits in extinction, a PTSD-relevant fear behavior, in a severe, but not mild/moderate model of allergic airway inflammation induced by aeroallergen house dust mite (HDM) that had been accompanied by an increase in brain Interleukin 17 A (IL-17A)+ cells. T helper 17 (Th17)/IL-17A immune responses are regulators of severe, neutrophilic airway inflammation, suggesting it may be responsible for observed severity-dependent extinction deficits. However, we had yet to demonstrate the mechanistic role of Th17/IL-17A. In this dissertation, we utilized a model of mild/moderate and severe asthma to assess differences in extinction, a PTSD-relevant behavior, and explore the dependence of this effect on Th17/IL-17A. Additionally, we pursued the role of a novel immunosensory node, the subfornical organ (SFO) as a mediator of lung-to-brain communication. It is uniquely positioned to respond to peripheral immune insults as it has a “leaky”, fenestrated blood-brain barrier (BBB) and contains a variety of cell types (microglia, astrocytes, neurons, pericytes, endothelial cells, etc.). Thus, the SFO serves as a unique window connecting the periphery, the central nervous system, and an extinction regulatory brain region, the infralimbic cortex. We hypothesized that HDM-induced Th2/Th17 airway inflammation selectively impairs extinction via SFO-engaged mechanisms. Chapter 2 pursued the hypothesis that extinction deficits are associated with an HDM-induced Th2/Th17- phenotype, representing severe airway inflammation, but not a Th2-skewed response, representing mild/moderate and that these deficits were driven by IL-17A signaling. To achieve this, we utilized a model of severe airway inflammation in (open full item for complete abstract)

Committee: Eric Wohleb Ph.D. (Committee Chair); James Herman Ph.D. (Committee Member); Renu Sah Ph.D. (Committee Member); Teresa Reyes Ph.D. (Committee Member); Ian Lewkowich Ph.D. (Committee Member) Subjects: Neurosciences

Doctor of Psychology (Psy.D.), Xavier University, 2024, Psychology

Trauma workers experience both negative and positive effects from working with individuals who have experienced trauma, which can include secondary traumatic stress (STS) and vicarious posttraumatic growth (VPTG). Some research suggests that supervision is a protective factor or an effective coping strategy for emotional distress related to trauma work (Cohen & Collens, 2013). Little is known about the existence of STS and VPTG in clinicians-in- training and the role of supervision in the occurrence of these phenomena. This study investigated the relationship between STS and VPTG, and whether quality of supervision predicts STS and VPTG among clinicians-in-training. Participants (n = 71) were students enrolled in graduate-level clinical or counseling psychology programs. Participants completed questionnaires measuring STS, VPTG, supervision quality, and Posttraumatic Stress Disorder (PTSD). PTSD was included as a covariate due to the high rates among trainees (Victor et al., 2022), the association of PTSD with STS (Cosden et al., 2016), and PTSD functioning as the most severe form of STS (Sprang et al., 2021). Clinicians-in-training appear to be experiencing lower levels of STS and VPTG compared to providers who have graduated from their respective programs. There was a linear, positive relationship between STS and VPTG. Findings do not support quality of supervision as a predictor of STS and VPTG among clinicians-in-training.

Committee: Jennifer E. Gibson (Committee Chair); Ginny Sprang (Committee Member); Kim J. Rosenzweig (Committee Member); Jennifer Phillips (Committee Member) Subjects: Clinical Psychology; Counseling Psychology; Psychology; Psychotherapy

Doctor of Philosophy, University of Toledo, 2023, Psychology - Clinical

Posttraumatic stress disorder (PTSD) and substance use disorders frequently co-occur. There is also evidence that emotion dysregulation underlies the development and maintenance of co-occurring PTSD and substance use disorders, including opioid use disorder (OUD). Thus, interventions designed to specifically target emotion dysregulation may have utility in addressing this co-occurrence. The aim of this study was to adapt an existing treatment that targets emotion dysregulation (emotion regulation group therapy) to a brief individualized protocol and assess its preliminary efficacy for reducing PTSD symptoms, emotion regulation difficulties, negative affect, and substance-use related outcomes. Using a multiple baseline experimental design, the intervention was evaluated in a patient sample of adults in medication-assisted treatment for OUD (N = 4) with probable PTSD. Participants completed daily assessments during a 2- or 4-week baseline phase, a 4-week treatment phase, and 4-week post-intervention phase. Results demonstrate that by the end of the treatment phase, two participants demonstrated reliable decreases in emotion regulation difficulties, two participants demonstrated reliable decreases in negative affect, two participants demonstrated reliable decreases in craving, and one participant demonstrated a reliable increase in medication adherence self-efficacy. By the end of the follow-up period, three participants demonstrated reliable decreases in PTSD symptoms, one participant demonstrated a further reliable decrease in emotion regulation difficulties, one participant demonstrated a reliable improvement in medication adherence, one participant demonstrated a reliable improvement in medication adherence self-efficacy, two participants demonstrated further reliable decreases in negative affect, one participant demonstrated a further reliable decrease in craving, and one participant demonstrated a reliable decrease in substance use. Results provide preliminary e (open full item for complete abstract)

Committee: Kamala London-Newton (Committee Chair); Matthew Tull (Committee Member); Kim Gratz (Committee Member); Wesley Bullock (Committee Member); Jason Rose (Committee Member); Shannon Sauer-Zavala (Committee Member) Subjects: Clinical Psychology

Master of Arts in Psychology, Cleveland State University, 2023, College of Sciences and Health Professions

The COVID-19 pandemic is a collective trauma that caused profound disruptions in day-to-day life and negatively impacted the psychological well-being of many emerging adults. Existing research shows that experiencing quarantine due to disease exposure or illness exacerbates psychological distress, particularly among people with existing symptoms of posttraumatic stress disorder (Solomon et al., 2021). Research points to problematic alcohol and other substance use as a mechanism in the development and maintenance of PTSD (Tripp et al., 2020). However, alcohol and other substance use has yet to be implicated in the exacerbation of PTSD symptoms among emerging adults in the context of the COVID-19 pandemic. The present study attempts to address these gaps in the scientific literature. It was hypothesized that A) pre-pandemic PTSD symptoms will positively associate with PTSD symptoms measured during the pandemic, B) problematic alcohol and other substance use will mediate the relationship between pre-pandemic PTSD symptoms and PTSD symptoms during the pandemic, and C) emerging adults who experience quarantine due to COVID-19 exposure or illness will report elevated symptoms of PTSD relative to those who did not. Participants (N=39) from the first wave of the study completed measures for the second wave of the study via an online survey between December 2021 and March 2022. Participants reported on their symptoms of psychological distress, use of alcohol and other substances, and quarantine experience. As expected, symptoms of PTSD at wave 1 predicted symptoms of PTSD at wave 2. However, no mediating effects of problematic alcohol or other substance use on the association between PTSD symptoms at waves 1 and 2 were detected. Similarly, quarantine experience was not found to moderate the relationship between PTSD symptoms at waves 1 and 2. These results suggest that symptoms of PTSD among young adults worsened under the conditions of the COVID-19 pandemic, but there was n (open full item for complete abstract)

Committee: Elizabeth Goncy (Advisor); Kathleen Reardon (Committee Member); Ilya Yaroslavsky (Committee Member) Subjects: Psychology; Public Health

DNP, Otterbein University, 2024, Nursing

General anesthesia is an induced state of unconsciousness administered by anesthesia providers to obtain patient amnesia, analgesia, and akinesia. Adult patients with posttraumatic stress disorder (PTSD) are at risk for general anesthesia-related complications throughout the perioperative setting. Emergence delirium is a clinically significant postoperative complication that patients with PTSD have an increased risk of developing. Postoperative complications of emergence delirium include patient or medical staff injury, surgical site damage, prolonged postanesthesia care unit (PACU) stay, and increased medical care costs. Evidence demonstrates that implementing preventive interventions decreases the incidence of emergence delirium. There are no standardized, evidence-based general anesthesia guidelines for adult patients with PTSD. This project aimed to develop an evidence-based practice guideline for adult patients receiving general anesthesia with PTSD or at-risk for developing emergence delirium. A comprehensive literature search utilizing a PICO question was implemented to analyze and synthesize available evidence to develop the evidence-based guideline. Utilizing the Plan-Do-Study-Act (PDSA) quality improvement model, this project outlines a plan for implementing and evaluating the evidence-based practice guideline.

Committee: Brian Garrett (Advisor); Joy Shoemaker (Committee Member); Amy Bishop (Committee Member) Subjects: Health Sciences; Medicine; Nursing

Psy. D., Antioch University, 0, Antioch Seattle: Clinical Psychology

Posttraumatic-stress disorder (PTSD) remains one of the most pervasive health conditions to affect the 2.7 million United States service members deployed to Iraq and Afghanistan since 2001. Untreated and/or inadequately treated PTSD can further lead to an array of health risks including anxiety, depression, substance abuse, social and occupational impairments, poorer quality of physical health, decreased overall perception of quality of life, and increase the risk of suicide. Considering these risks, the Department of Veterans Affairs (VA) and Department of Defense (DoD) created the VA/DOD Clinical Practice Guidelines (CPGs) for the Management of PTSD and Acute Stress Reaction (ASR), highlighting the strongest evidence-based approaches to treatment for clinicians providing care for service members. The CPGs further outlines the importance of providing clients/patients with psychoeducation regarding PTSD and treatment options, offering a client-centered approach through a Shared Decision-Making Model (SDM), while also illustrating known barriers to treatment, and concerns regarding early termination. Successful implementation of the CPGs is expected to enhance assessment of client's/patient's needs and assist in determining and providing effective care. The number of veterans suffering with PTSD continues to be an alarming concern, one with life-threatening implications. While this concern is recognized among clinicians, statistics continue to highlight the vast number of those suffering with PTSD and PTSD related conditions, further pressing the need to explore additional ways to improve the efficacy of treatment. The purpose of this study is to explore the post 9/11 military population's experience in seeking treatment, as reflected by the CPGs recommendations, while further exploring their views regarding ways to improve the efficacy of assessing and treating PTSD. This dissertation is available in open access at AURA, https://aura.antioch.edu/, and Ohio Link ETD (open full item for complete abstract)

Committee: Mark Russell (Committee Chair); Jeff Hansen (Committee Member); Michael Sakuma (Committee Member) Subjects: Military Studies; Psychology

MA, Kent State University, 2022, College of Arts and Sciences / Department of Psychological Sciences

The novel coronavirus (COVID-19) pandemic is a widespread salient stressor and continues to contribute to individual- and societal-level psychological burdens. With traumatic stressors, resources such as social support and coping self-efficacy (CSE) may protect against poor mental health outcomes. CSE involves how confident one is in their ability to cope effectively with challenges or threats, and higher CSE is an important predictor of better posttraumatic recovery. Moreover, social support can enable and improve CSE. The current study examined the potential protective roles of social support and CSE in attenuating posttraumatic stress disorder (PTSD) symptoms. Participants (n = 612; 59% female) completed questionaries assessing psychological distress (Kessler Psychological Distress Scale) at baseline and 6-month follow-up, and social support (Interpersonal Support Evaluation List-12), CSE (Coping Self-Efficacy Scale), and PTSD symptoms (Impact of Event Scale-Revised) at six months. PTSD symptoms were also evaluated using a semi-structured interview (PTSD Symptom Scale – Interview for DSM-5) at the 6-month follow-up for a subset of participants. First, Pearson correlations between study measures were conducted. Next, a path analysis was conducted using SPSS Amos to examine the direct and indirect pathways from psychological distress to PTSD symptoms that are accounted for by social support and CSE. Lastly, a Pearson correlation was conducted between the IES-R and PSS-I-5 to examine the convergent validity between a self-report measure and semi- structured interview that assesses PTSD symptoms. All associations between study measures were significant and in the expected directions. Greater baseline psychological distress was associated with higher levels of PTSD symptoms (r = .51, p < .001) six months later. Higher levels of CSE were associated with lower levels of PTSD symptoms (r = -.49, p < .001). All direct effects in the path analysis were significant except (open full item for complete abstract)

Committee: Joel Hughes (Advisor); Amy Sato (Committee Member); John Gunstad (Committee Member); John Updegraff (Committee Member) Subjects: Clinical Psychology; Mental Health; Psychology

Master of Arts, Case Western Reserve University, 2022, Psychology

Impairments in executive functioning (EF) have been associated with more severe symptomatology following trauma exposure, including posttraumatic stress disorder (PTSD; Bomyea & Lang, 2016) and major depressive disorder (Olff et al., 2014). The overarching goal of this study was to examine the relationship between EF and PTSD treatment outcomes. Participants (N = 136) received 10 weeks of prolonged exposure therapy (PE) or PE plus sertraline. EF was assessed at baseline using the Automated Operation Span Task (AOSPAN). Poorer baseline EF performance was associated with more severe PTSD at post-treatment. Higher depression symptoms strengthened this relationship. Particularly among individuals with residual depression symptoms, impaired EF prior to treatment initiation is associated with more severe post-treatment PTSD symptoms. These findings highlight the importance of assessing for impairments in EF before treatment and the continuing need to explore the benefit of augmenting evidence-based treatments for PTSD.

Committee: Norah Feeny Ph.D. (Committee Chair); Arin Connell Ph.D. (Committee Member); Robert Greene Ph.D. (Committee Member) Subjects: Clinical Psychology

MA, Kent State University, 2022, College of Arts and Sciences / Department of Psychological Sciences

Following pediatric injury, children are at risk for experiencing functional impairment and psychological distress. The current study examined the trajectory of health-related quality of life (HRQoL), as well as posttraumatic stress disorder (PTSD) symptoms (PTSS) and depression symptoms in child injury victims up to six-months post-injury. Given the role that parents have on a child's psychological and physical health outcomes, we also examined the influence of child-reported parenting behaviors on HRQoL, PTSS, and depression symptoms. A sample of 143 children were recruited from an emergency department following an acute injury. Analyses revealed a significant increase in HRQoL (B=.074, SE=.007, 95% CI [.060, .088], p<.001), decrease in PTSS (B=-.024, SE=.005, 95% CI [-.033, -.014], p<.001), and decrease in depression symptoms (B=-.012, SE=.004, 95% CI [-.020, -.004], p=.004) from one-week to six-months post-injury. Although baseline differences in use of corporal punishment were associated with lower levels of HRQoL (B=-2.59, SE=.739, p<.001), and higher levels of PTSS (B=1.56, SE=.611, p=.011), and depression symptoms (B=1.47, SE=.468, p=.002), use of corporal punishment was not related to the trajectory of child outcomes over time. Parental supervision significantly predicted the trajectory of HRQoL (B=.004, SE=.002, p=.012) and depression (B=-.002, SE=.001, p=.032), but not PTSS. Children who reported frequent parental supervision had lower HRQoL and higher depression symptoms than children who reported less frequent supervision. Results support the potential use of psychoeducation regarding effective parenting practices in order to benefit a child's mental and physical health post-injury.

Committee: Douglas Delahanty (Advisor); Amy Sato (Committee Member); Christopher Flessner (Committee Member); Jeffrey Ciesla (Committee Member) Subjects: Psychology

Doctor of Philosophy (Ph.D.), Bowling Green State University, 2022, Psychology/Clinical

Introduction. Survivors of military sexual trauma (MST) and combat trauma (CT) are at disproportionate risk for disordered eating, including restricting, bingeing, and purging. Four unique correlates of disordered eating in trauma survivors have been identified: trauma-related self-blame, emotion regulation challenges, body dissatisfaction, and dissociation. However, little research has sought to better understand the underlying factors that may influence disordered eating in survivors of MST and CT. Further research examining mechanisms of disordered eating among MST and CT survivors is needed to understand the unique factors maintaining disordered eating in this unique population. Methods. Using a concurrent mixed-methods design, the present study examined four potential catalysts (trauma-related self-blame, emotion regulation challenges, body dissatisfaction, and dissociation) for disordered eating among MST and/or CT survivors by means of quantitative and qualitative analysis. Quantitative data were collected from 246 participants (72.8% men) on Amazon Mechanical Turk and Reddit who completed measures examining MST exposure (47.2%), CT exposure (87.4%), trauma-related self-blame, emotion regulation challenges, body dissatisfaction, dissociation, and disordered eating subtypes (bingeing, purging, and restricting). Six parallel mediation analyses were conducted. These analyses examined trauma-related self-blame, emotion regulation challenges, body dissatisfaction, and dissociation as mediators of the relationships between MST and CT, separately, with subtypes of disordered eating (purging, restricting, and bingeing). Analyses of Covariance were also completed to examine rates of disordered eating by trauma exposure type (MST exposure, CT exposure, MST and CT Exposure, and No MST or CT Exposure). In tandem, qualitative interviews with six MST and/or CT survivors who reported at least one symptom of disordered eating were performed. Interviews focused on understa (open full item for complete abstract)

Committee: Abby Braden Ph.D. (Committee Chair); Man Zhang Ph.D. (Committee Member); Dara Musher-Eizenman Ph.D. (Committee Member); Catherine Stein Ph.D. (Committee Member) Subjects: Clinical Psychology; Psychology

M.A., University of Toledo, 2022, Psychology - Clinical

Posttraumatic stress disorder (PTSD) is a chronic and disabling disorder that affects a significant proportion of individuals exposed to traumatic events (Liu et al., 2017). Women are more than twice as likely as men to develop PTSD (Koenen et al., 2017). As such, sex-based biological vulnerabilities for the development and maintenance of this disorder warrant further research. Previous research (e.g., Garcia et al., 2018; Li & Graham, 2017) has suggested that one such vulnerability, differences in sex hormone levels, may contribute to the disparity in observed rates of PTSD. However, little research to date has examined the role of hormonal contraceptive (HC) use in the mechanisms underlying the maintenance of PTSD symptoms. To that end, this study examined the relationship of HC use to attentional bias to threat among female survivors of recent (< 12 months) sexual assault between the ages of 18 and 35. Ninety-nine participants recruited via Prolific completed online surveys assessing HC use, lifetime traumatic event exposure, PTSD symptoms, depression and anxiety symptoms, peritraumatic distress, emotion dysregulation, treatment history, reading ability, and demographic information, as well as an online behavioral dot probe task assessing attentional bias to general threat words and sexual assault-related words. Hierarchical linear regression analyses were conducted to examine main effects of and interactions between PTSD symptom severity and HC status on attentional bias to general and sexual assault-related threat words. Across analyses, HC demonstrated a significant positive main effect on attentional bias to sexual assault-related words above and beyond relevant covariates (bs = 14.268 – 14.767, ps = 0.011 – 0.014). HC use demonstrated no significant main effect on attentional bias to general threat words (ps > 0.05). There was no evidence of an interaction effect between HC use and PTSD symptoms across models (ps > 0.05). Results suggest that HC use is posi (open full item for complete abstract)

Committee: Matthew Tull (Committee Chair); Andrew Geers (Committee Member); Kim Gratz (Committee Member) Subjects: Psychology

Doctor of Philosophy (Ph.D.), Bowling Green State University, 2022, Psychology/Clinical

The present research examined the perceived service and support needs of family members (i.e., partners, parents, other relatives) of individuals with PTSD. A major goal of the present research was to develop a self-report inventory of family needs suitable for assessment, research, and clinical uses. The present research consisted of two studies using independent samples of adult family members. Study 1 is a qualitative study that examined the personal accounts of services and supports reported as needs by 47 family members of people with PTSD. Thematic analysis of these accounts indicated that family members experienced a wide array of needs including Information Needs, Health and Wellness Needs, Service Type Needs, Service Quality Needs, Relationship Needs, and Community Needs. Grounded in the experiences of family members, the PTSD Family Support Needs Inventory (PFSNI), a 58 item self-report measure was developed for Study 2 that consisted of six domains to assess the degree of unmet family member needs. Study 2 examined psychometric properties of the PFSNI using an independent sample of 135 family members of adults living with PTSD. To help establish the validity of the PFSNI, Study 2 examined how scores on the PFSNI related to self-report measures that could help demonstrate criterion validity (PTSD Understanding measure), convergent validity (measures of Knowledge about PTSD, Caregiving Personal Gain, Caregiving Overload, Caregiving Burden, and Family Coping with PTSD), and discriminant validity (Social Desirability measure). The PFSNI demonstrated acceptable internal item consistency across needs domains and test-retest reliability over a two-week period. Exploratory hierarchical multiple regression analyses indicated that, even after accounting for demographics and severity of impact of PTSD and mental health on the family, the degree of participant unmet needs reported on the PFSNI significantly predicted family members' reports of well-being (i.e., C (open full item for complete abstract)

Committee: Catherine Stein Ph.D. (Advisor); Jenny Toonstra Ph.D. (Other); Dara Musher-Eizenman Ph.D. (Committee Member); Carolyn Tompsett Ph.D. (Committee Member) Subjects: Psychology

Master of Arts in Psychology, Cleveland State University, 2021, College of Sciences and Health Professions

This study aimed to observe how trauma experienced by military personnel and veterans relate to an individual's level of aggression. The second aim was to examine the role of relationship satisfaction as a protective factor in this association. In the current study, 96 active-duty military personnel and veterans completed self-report surveys to assess for PTSD symptoms, relationship satisfaction, and general aggressive tendencies. Results indicated that PTSD symptoms were positively associated with general aggressive tendencies and relationship satisfaction moderates the relationship (at a trend level) at low levels of PTSD symptoms, but not at high levels of PTSD symptoms. However, when controlling for Criterion E in a sensitivity analysis, this interaction became statistically significant. As service members and veterans experience more symptoms of PTSD, the more generally aggressive they tend to be. When service members and veterans have few symptoms of PTSD and have high levels of relationship satisfaction, they are generally less aggressive than when they have few symptoms of PTSD and have low levels of relationship satisfaction. When service members and veterans have many symptoms of PTSD, having high or low levels of relationship satisfaction does not affect levels of general aggressive tendencies. Therefore, clinicians should assess for these variables during initial evaluations and throughout treatment planning and should consider the timing of different therapeutic interventions when working with service members and veterans.

Committee: Elizabeth Goncy (Committee Chair); Eric Allard (Committee Member); Ilya Yaroslavsky (Committee Member) Subjects: Clinical Psychology