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Trauma history and increased exposure to combat and sexual trauma may account for heightened rates of PTSD among military populations. This study assessed trauma type and exposure history, diagnostic impressions, and PTSD severity in a large clinical dataset (n = 2463) of veterans presenting for PTSD evaluation at a Midwestern VA Medical Center between the years 2006 and 2013. The degree of lifetime trauma exposure was pronounced, with approximately 76% of the sample reporting exposure to at least four traumatic events. Higher numbers of lifetime trauma and higher levels of combat exposure were associated with more severe PTSD symptoms. Sexual trauma and combat trauma were more predictive of PTSD than other trauma types. Sexual trauma was associated with more severe PTSD than combat and other trauma.

Background: Veterans with posttraumatic stress disorder (PTSD) exhibit marked deficits in emotion regulation. Past research has demonstrated underengagement of the prefrontal cortex during regulation of negative affect in those with PTSD, but has been unable to find evidence of impaired downregulation of the amygdala. One possibility is that there exists variability in amygdala reactivity that cuts across diagnostic status and which can be characterized using a continuous measure of individual differences. In healthy/nontraumatized volunteers, individual variability in amygdala engagement during emotion processing and regulation has been shown to relate to habitual use of regulation strategies., Methods: The current study examined whether self-reported use of cognitive reappraisal and expressive suppression regulation strategies correlated with brain activation during cognitive reappraisal in combat-exposed veterans with (n = 28) and without PTSD (combat-exposed controls, CEC; n = 20)., Results: Results showed that greater self-reported use of cognitive reappraisal was associated with less activation in the right amygdala during volitional attempts to attenuate negative affect using reappraisal, irrespective of PTSD diagnosis., Conclusions: This finding is in line with prior work and extends evidence of an association between habitual use of regulation strategies and amygdala engagement during emotion regulation to a trauma-exposed sample of individuals both with and without PTSD. Furthermore, by providing evidence of individual differences in regulation-related amygdala response in a traumatized sample, this result may increase understanding of the neural mechanisms that support variability in symptom manifestation observed across individuals with PTSD., (© 2016 Wiley Periodicals, Inc.)

Low social support is associated with greater prevalence and severity of posttraumatic stress disorder (PTSD). However, the factors that explain the association between social support and PTSD are not well understood. In the current study, 741 VA patients who presented to a PTSD clinic between 2005 and 2013 completed assessments of symptom severity and social support. Analysis of variance and linear regression tested the associations between social support, sociodemographic characteristics, and PTSD symptom severity. In adjusted analyses, social support was robustly associated with PTSD severity (β = -0.30, p < 0.001). After stratification by combat era, this association remained significant for all era veterans except veterans of the post-Vietnam/Desert Storm era. Other sociodemographic characteristics did not affect the association between social support and PTSD. Our findings suggest that the detrimental effects of poor social support pervade across sociodemographic groups and that efforts to improve social support in veterans with PTSD are needed.

Posttraumatic stress disorder (PTSD) - a debilitating disorder characterized by severe deficits in emotion regulation - is prevalent among U.S. military veterans. Research into the pathophysiology of PTSD has focused primarily on emotional reactivity, showing evidence of heightened neural response during negative affect provocation. By comparison, studies of brain functioning during the voluntary regulation of negative affect are limited. In the current study, combat-exposed U.S. military veterans with (n=25) and without (n=25) PTSD performed an emotion regulation task during electroencephalographic (EEG) recording. The late positive potential (LPP) was used as a measure of sustained attention toward, and processing of, negative and neutral pictures, and was scored prior to and after instructions to either maintain or down-regulate emotional response using the strategy of cognitive reappraisal. Results showed that groups did not differ in picture-elicited LPP amplitude either prior to or during cognitive reappraisal; reappraisal reduced the LPP in both groups over time. Time-dependent increases in LPP amplitude as a function of emotional reactivity maintenance were evident in the non-PTSD group only. This latter finding may signal PTSD-related deficits in sustained engagement with emotion-processing over the course of several seconds., (Published by Elsevier Ireland Ltd.)

Previous research has consistently demonstrated that Prolonged Exposure (PE) therapy is an effective treatment for posttraumatic stress disorder (PTSD). Traditionally, PE has been studied and delivered on an individual basis. However, the growing number of Veterans in need of PTSD treatment has led to increased interest in group therapies as an efficient way to provide access to care. The current study examined a group and individual hybrid treatment that was developed based on PE principles. Treatment was 12 weeks in length and consisted of 12 one-hour group sessions focused on in vivo exposures, and an average of approximately five-hour long individual imaginal exposure sessions. Data for this study were derived from 67 veterans who participated in 12 cohorts of the Group PE. Significant reductions in PTSD and depression symptoms were found in both completers and intent-to-treat sample analyses. The clinical implications of these findings are discussed., (Published by Elsevier Ltd.)

Emotional Processing Theory proposes that habituation to trauma-related stimuli is an essential component of PTSD treatment. However, the mechanisms underlying treatment-related habituation are not well understood. We examined one psychophysiological measure that holds potential for elucidating the biological processes involved in treatment response: trauma-potentiated startle response. Seventeen OEF/OIF combat Veterans participated in the study and completed three assessments using a trauma-potentiated startle paradigm over PTSD treatment. Results revealed different patterns of trauma-potentiated startle across treatment for responders and nonresponders, but no differences in within task habituation. Responders showed an increase followed by a decrease in trauma-potentiated startle, whereas nonresponders showed a relatively flat response profile. Results suggested that PTSD patients who engage with emotional content as demonstrated by greater startle reactivity may be more likely to respond to PTSD treatment. Furthermore, trauma-potentiated startle shows promise as an objective measure of psychophysiological responses involved in PTSD recovery., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Objectives: Depression and anxiety are associated with significantly increased healthcare costs that include costs of non-psychiatric medical care. PTSD has been found to be related to many negative health perceptions and outcomes (e.g., [Resnick, H.S., Acierno, R., Kilpatrick, D.G., 1997. Health impact of interpersonal violence: II. Medical and mental health outcomes. Behavioral Medicine 23, 65-78]). The presence of comorbid depression and anxiety disorders in patients with posttraumatic stress disorder (PTSD) is well documented. This study aims to examine the effects of depression and anxiety on health satisfaction in veterans with PTSD., Methods: The current study utilizes archival data from a clinical sample of combat veterans (N=249) with and without PTSD in order to examine the unique contributions of anxiety and depression to reported health satisfaction., Results: After controlling for PTSD severity, combat exposure, and age, when both anxiety and depression are examined simultaneously in a regression to predict health satisfaction only depression significantly contributed and accounted for 10% of model variance., Conclusions: While both depression and anxiety are related to more negative reported health satisfaction among veterans in a PTSD clinic, depression appears to be a main contributor., Limitations: Evaluation and treatment seeking veterans may differ from a full range of veterans with PTSD. Closer examination with measures of depression and anxiety that more precisely separate these constructs is warranted. Finally, it is not known whether reported health satisfaction is related to an objective difference in health status or is more indicative of subjective expression of distress., (Published by Elsevier B.V.)