Attachment Patterns as Mediators of the Link Between Combat Exposure and Posttraumatic Symptoms A Study Among Portuguese War Veterans.

Attachment Patterns as Mediators of the Link Between CombatExposure and Posttraumatic Symptoms: A Study Among Portuguese WarVeterans.

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Rui Aragao Oliveira

InternationalPsychoanalytical Association

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Weanalyzed the role of both attachment anxiety and attachment avoidanceas mediators of the effects of combat exposure on PTSD symptoms.Participants were Portuguese veterans (N=60) divided into two groups:30 suffered from chronic PTSD (non-recovered) and 30 had remissionfrom PTSD (recovered). Combat exposure, attachment patterns and PTSDsymptoms were assessed through self-report measures. Mediation testwas performed by conducting several hierarchical regression analyses.Results showed higher attachment anxiety among non-recoveredparticipants. We did not find statistically significant differencesbetween groups for both attachment avoidance and combat exposurelevel scores. In mediation analysis, at first step, attachmentavoidance was not a significant predictor of PTSD symptoms, andattachment avoidance did not enter in subsequent analysis. Attachmentanxiety was a partial mediator of the effect of combat exposure onPTSD symptoms. Implications of the findings for both attachmenttheory and clinical intervention on trauma are discussed.

Efficacy of structured approach therapy in reducing PTSD inreturning veterans: A randomized clinical trial


The U.S. military deployed in support to Operation Iraqi Freedom(OIF) and Operation Enduring Freedom (OEF) show high rates ofposttraumatic stress disorder (PTSD) and relationship, partner, andparenting distress. Given the pervasive effect of combat-related PTSDon returning veterans and its effect on their loved ones, theinvestigators have developed a couples-based treatment, structuredapproach therapy (SAT), to reduce PTSD while simultaneouslydecreasing relationship and partner distress. This study presentstreatment outcome data measuring PTSD and relationship outcomes froma randomized clinical trial (RCT) comparing SAT, a manualized12-session novel couples-based PTSD treatment, to a annualized12-session couples-based educational intervention (PTSD FamilyEducation [PFE]). Data were collected from 57 returning veteransmeeting Diagnostic and Statistical Manual of Mental Disorders (fourthedition, text revision DSM-IV-TR) criteria for PTSD and theircohabiting partners data collection was scheduled for pre-treatment,post treatment, and 3-month follow-up. Findings from anintent-to-treat analysis revealed that veterans receiving SAT showedsignificantly greater reductions in self-rated (PTSD Checklist p &lt.0006) and Clinician-Administered PTSD Scale (CAPS)-rated PTSD (p &lt.0001) through the 3-month follow-up compared with veterans receivingPFE 15 of 29 (52%) veterans receiving SAT and 2 of 28 (7%) receivingPFE no longer met DSM-IV-TR criteria for PTSD. Furthermore, SAT wasassociated with significant improvements in veteran relationshipadjustment, attachment avoidance, and state anxiety. Partners showedsignificant reductions in attachment anxiety. This couples-basedtreatment for combat-related PTSD appears to have a strongtherapeutic effect on combat-related PTSD in recently returnedveterans.

Clinicalapproaches to addressing spiritual struggle in veterans with PTSD


Trauma survivors often face difficult spiritual challenges as theyattempt to reconcile the experience of trauma with theirspiritual/religious beliefs. Spirituality has been found to beassociated with a range of indices of well-being, and it is acomponent of many clients` coping skills and treatment strategies.However, many clinicians do not routinely assess or incorporate thisdomain of functioning in psychological services. This articledescribes a model for conceptualizing how trauma can impactspirituality by reviewing the possible consequences of eachposttraumatic stress disorder (PTSD) symptom cluster on clients`belief systems and spiritual practices. Specific implications fortreatment are described for each symptom cluster. A case studyhighlights many of the spirituality issues and intervention optionsdescribed in this model. Ethical issues surrounding addressingspiritual factors in trauma survivors are considered, and cliniciansare encouraged to further explore this domain with their clients.

Inadequate treatment and research for PTSD at the VA


The article by Karlin and Cross clearly laid out how to disseminateand implement evidence-based psychotherapy in the Veterans HealthAdministration. The only problem is that the list of evidence-basedpsychotherapies notably missed one of the most highly regarded andeffective evidence-based psychotherapies for posttraumatic stressdisorder (PTSD), eye movement desensitization and reprocessing(EMDR).