(Loss of) the super soldier: combat-injuries, body image and veterans' romantic relationships.

PURPOSE: Some military personnel sustain physical injuries that alter their appearance, such as limb-loss and scarring. Veterans injured this way may experience body image distress and mental and physical wellbeing difficulties. While research with civilians indicates those with appearance-altering conditions may experience relationship difficulties, this issue remained unexplored among combat-injured veterans. This study aimed to understand how veterans who sustained appearance-altering combat injuries experienced and understood their changed appearance within the context of their romantic relationships. MATERIALS AND METHOD: Semi-structured interviews with four male UK combat-injured veterans were conducted and analysed using Interpretative Phenomenological Analysis. RESULTS: Three superordinate themes were generated: (loss of) the super solider; new states of vulnerability; and injury tests relationships. CONCLUSIONS: Masculinity was central to participants' military identity and represented by their military bodies. Following injury and the loss of their military body, some experienced relationship challenges including a test to the foundations and commitment of their relationships. In contrast, some veterans' relationships grew stronger, especially among participants who described dyadic coping. Additional challenges were related to decreased self-confidence, appearance concerns, and sex and intimacy. Implications for the provision of relationship support for combat-injured veterans and their partners through the long-term trajectory of rehabilitation are discussed.Implications for RehabilitationChanges to veterans' body and physique following appearance-altering combat-injuries may affect identity, self-esteem, confidence, perceived attractiveness, sexual activity, and romantic relationships.Appearance-altering combat injuries may test the stability and strength of existing romantic relationships and introduce new challenges in initiating new romantic relationships.Peer support is helpful for combat-injured veterans adjusting to appearance-altering injuries and the impact on their romantic and intimate relationships.Combat-injured veterans may benefit from specific relationship support provided during their rehabilitation and recovery, to help alleviate relationship difficulties, minimise relationship breakdown, and support those whose relationships end post-injury.

"You can't un-ring the bell": a mixed methods approach to understanding veteran and family perspectives of recovery from military-related posttraumatic stress disorder.

BACKGROUND: Military-related posttraumatic stress disorder (PTSD) is a complex diagnosis with non-linear trajectories of coping and recovery. Current approaches to the evaluation of PTSD and treatment discontinuation often rely on biomedical models that dichotomize recovery based on symptom thresholds. This approach may not sufficiently capture the complex lived experiences of Veterans and their families. To explore conceptualizations of recovery, we sought perspectives from Veterans and their partners in a pilot study to understand: 1) how Veterans nearing completion of treatment for military-related PTSD and their partners view recovery; and 2) the experience of progressing through treatment towards recovery. METHODS: We employed a concurrent mixed methods design. Nine Veterans nearing the end of their treatment at a specialized outpatient mental health clinic completed quantitative self-report tools assessing PTSD and depressive symptom severity, and an individual, semi-structured interview assessing views on their treatment and recovery processes. Veterans' partners participated in a separate interview to capture views of their partners' treatment and recovery processes. Descriptive analyses of self-report symptom severity data were interpreted alongside emergent themes arising from inductive content analysis of qualitative interviews. RESULTS: While over half of Veterans were considered "recovered" based on quantitative assessments of symptoms, individual reflections of "recovery" were not always aligned with these quantitative assessments. A persistent narrative highlighted by participants was that recovery from military-related PTSD was not viewed as a binary outcome (i.e., recovered vs. not recovered); rather, recovery was seen as a dynamic, non-linear process. Key components of the recovery process identified by participants included a positive therapeutic relationship, social support networks, and a toolkit of adaptive strategies to address PTSD symptoms. CONCLUSIONS: For participants in our study, recovery was seen as the ability to navigate ongoing issues of symptom management, re-engagement with meaningful roles and social networks, and a readiness for discontinuing intensive, specialized mental health treatment. The findings of this study highlight important considerations in balancing the practical utility of symptom severity assessments with a better understanding of the treatment discontinuation-related needs of Veterans with military-related PTSD and their families, which align with a contemporary biopsychosocial approach to recovery.

Cost-Effectiveness of Individual Placement and Support Compared to Transitional Work Program for Veterans with Post-traumatic Stress Disorder.

Post-traumatic stress disorder (PTSD) leads to significant disability, unemployment, and substantial healthcare costs. The cost-effectiveness of vocational rehabilitation (VR) interventions is important to consider when determining which services to offer. This study assesses the cost-effectiveness and return on investment of Individual Placement and Support (IPS) compared to transitional work (TW) programs. Employment outcomes from a multisite randomized trial comparing IPS to TW in military veterans with PTSD (n = 541) were linked to Veterans Health Administration (VHA) archival medical record databases to examine the comparative cost-effectiveness and return on investment. Effectiveness was defined as hours worked and income earned in competitive jobs. Costs for VR, mental health, and medical care and income earned from competitive sources were annualized and adjusted to 2019 US dollars. The annualized mean cost per person of outpatient (including vocational services) were $3970 higher for IPS compared to TW ($23,245 vs. $19,276, respectively; P = 0.004). When TW income was included in costs, mean grand total costs per person per year were similar between groups ($29,828 IPS vs. $26,772 TW; P = 0.17). The incremental cost-effectiveness analysis showed that while IPS is more costly, it is also more effective. The return on investment (excluding TW income) was 32.9% for IPS ($9762 mean income/$29,691 mean total costs) and 29.6% for TW ($7326 mean income/$24,781 mean total costs). IPS significantly improves employment outcomes for individuals with PTSD with negligible increase in healthcare costs and yields very good return on investment compared to non-IPS VR services.

Dog training alleviates PTSD symptomatology by emotional and attentional regulation.

Background: Post-Traumatic Stress Disorder (PTSD) symptoms include re-experiencing, avoidance, hyperarousal, and cognitive deficits, reflecting both emotional and cognitive dysregulation. In recent years, non-pharmacological approaches and specifically animal-assisted therapy have been shown to be beneficial for a variety of disorders such as Attention-Deficit/Hyperactivity Disorder, Autism Spectrum Disorder, and PTSD. However, little is mentioned in the literature about the reciprocal effects of the animal-human interaction. Objective: To evaluate the effects of a one-year dog training programme on PTSD symptomatology in youngsters with PTSD and on dogs' behaviour. Methods: Fifty-three adolescents, previously exposed to interpersonal trauma, were clinically diagnosed with PTSD and assigned to a dog-training programme group (n = 30) and a control group (n = 23) that engaged in other training programmes (e.g. cooking, hairstyling, etc.). Both groups were evaluated at baseline and following 12-months by The Clinician-Administered PTSD Scale for DSM-5 in Children and Adolescents (CAPS-CA-5) and Beck-Depression Inventory (BDI). Additionally, we physiologically measured both emotional and attention dysregulation. Results: Post-12-months training, a significant alleviation of PTSD symptomatology accompanied by lower depression severity was observed in the dog-training group, compared with a insignificant recovery in the control group. Furthermore, improved emotional and attentional regulation was observed in the dog-training group. Measuring the dogs' behaviour revealed increased anxiety and decreased selective attention performance, which was inversely correlated with the beneficial effects observed in the dog-training programme group. Conclusions: Our findings emphasize the role of emotional and attentional regulations on the dog-handler interface, as evidence-based support for the beneficial effects of the dog-training programme, as either a non-pharmacological intervention or as complementary to anti-depressants treatment of PTSD. Though pharmacological treatments increase the patients' well-being by treating certain PTSD symptoms, our suggested dog-training programme seems to influence the PTSD diagnostic status, thus may be implemented in civilians and veterans with PTSD.

Antecedentes: Los síntomas de trastorno de estrés postraumático (TEPT) incluyen re-experimentación, evitación, hiperalerta y déficits cognitivos, reflejando desregulación tanto emocional como cognitiva. En los últimos años, se demostró que los enfoques no farmacológicos y específicamente la terapia asistida por animales son beneficiosos para una variedad de trastornos como el Trastorno por Déficit Atencional e Hiperactividad, el Trastorno del Espectro Autista y el TEPT. Sin embargo, poco se menciona en la literatura acerca de los efectos recíprocos de la interacción animal-humano.Objetivo: Evaluar los efectos de un programa de adiestramiento canino de un año en la sintomatología de TEPT en los jóvenes con TEPT y en el comportamiento de los perros.Métodos: Cincuenta y tres adolescentes, previamente expuestos a trauma interpersonal, fueron diagnosticados clínicamente con TEPT y asignados a un grupo de programa de adiestramiento canino (n = 30) y a un grupo control (n = 23) que participaron en otros programas de adiestramiento (ej., cocinar, peluquería, etc). Ambos grupos fueron evaluados al inicio y después de 12 meses mediante la Escala de TEPT administrada por el Clínico del DSM-5 en niños y adolescentes (CAPS-CA-5 por sus siglas en inglés) y el Inventario de Depresión de Beck (BDI). Adicionalmente, medimos fisiológicamente la desregulación emocional y de la atención.Resultados: Después del entrenamiento de 12 meses, se observó un alivio significativo de la sintomatología de TEPT junto con una disminución de la severidad de la depresión en el grupo de adiestramiento canino, comparado con una recuperación insignificante en el grupo control. Además, se observó una mejoría en la regulación emocional y de la atención en el grupo de adiestramiento canino. La medición del comportamiento de los perros reveló un aumento de la ansiedad y disminución del rendimiento de la atención selectiva, que se correlacionó inversamente con los efectos beneficiosos observados en el grupo del programa de adiestramiento canino.Conclusiones: Nuestros hallazgos enfatizan el rol de la regulación emocional y de atención en la interfaz del entrenador de perros, como soporte basado en la evidencia para los efectos beneficiosos del programa de adiestramiento canino, tanto como tratamiento no farmacológico como complementario al tratamiento antidepresivo del TEPT. Aunque los tratamientos farmacológicos fomentan el bienestar de los pacientes al tratar ciertos síntomas del TEPT, nuestro programa de adiestramiento canino sugerido parece influir en el estado diagnóstico de TEPT, por lo que puede implementarse en civiles y veteranos con TEPT.

The psychophysiological response during post-traumatic stress disorder treatment with modular motion-assisted memory desensitisation and reconsolidation (3MDR).

Background: Psychophysiological changes are part of post-traumatic stress disorder (PTSD) symptomatology and can signal emotional engagement during psychological treatment. Objectives: The aim of this study was to explore psychophysiological responses during multi-modular motion-assisted memory desensitization and reconsolidation (3MDR) therapy. Increased self-reported distress, substantially increased heart rate (HR) and breathing rate (BR) were expected at the start of therapy and predicted to improve over time. Since physical exercise demands during therapy were low, any large HR or BR responses were considered part of the psychophysiological response. Methods: This study used pooled data collected during a randomized controlled trial of 3MDR, which demonstrated significant improvement as measured by the Clinician Administered PTSD Scale. Whilst attending therapy, HR and BR data, subjective units of distress (SUD) score and phrases to describe feelings whilst exposed to trauma-related images were collected continuously from 37 UK male military veterans with PTSD. Results: HR and BR were significantly increased throughout all sessions (p < .01 for both). Whilst HR was raised slightly remaining on average below 100 beats/minute, BR was increased substantially with average values between 40 and 50 breaths/minute. SUD scores were very high during therapy which concurred with the many negative feelings experienced during therapy sessions. Across the course of the treatment, SUD scores (p < .01) and negative feelings were reduced (p < .001), and positive feelings have increased (p < .01) significantly, reflecting improvements in clinicians assessed PTSD symptoms. Across therapy sessions, HR (p = .888) and BR (p = .466) responses did not change. Conclusions: The strong psychophysiological response alongside high levels of self-reported distress and negative feelings is interpreted as high emotional engagement during therapy. A novel finding was the very significant BR increase throughout recorded sessions. Future PTSD research should include BR response to therapy and explore breathing control as a treatment target.

Antecedentes: Los cambios psicofisiológicos son parte de la sintomatología del trastorno de estrés postraumático (TEPT) y pueden indicar un compromiso emocional durante el tratamiento psicológico.Objetivos: El objetivo de este estudio fue explorar las respuestas psicofisiológicas durante la terapia multimodular de desensibilización y reconsolidación de la memoria asistida por movimiento (3MDR). Se esperaba un aumento de la angustia autoinformada, un aumento sustancial de la frecuencia cardíaca (FC) y la frecuencia respiratoria (FR) al inicio de la terapia y se predijo que mejoraría con el tiempo. Dado que las demandas del ejercicio físico durante la terapia fueron bajas, cualquier respuesta grande de FC o FR se consideró parte de la respuesta psicofisiológica.Métodos: Este estudio utilizó datos agrupados recopilados durante un ensayo controlado aleatorio de 3MDR, que demostró una mejora significativa según lo medido por la Entrevista de TEPT Administrada por el Médico. Mientras asistían a la terapia, se recopilaron continuamente datos de FC y FR, puntuación de las unidades subjetivas de angustia (SUD en su sigla en inglés), y frases para describir los sentimientos mientras estaban expuestos a imágenes relacionadas con el trauma; de 37 veteranos militares masculinos del Reino Unido con TEPT.Resultados: FC y FR aumentaron significativamente a lo largo de todas las sesiones (p < .01 para ambas). Mientras que la FC se elevó ligeramente permaneciendo en promedio por debajo de 100 latidos por minuto, la FR aumentó sustancialmente con valores promedio entre 40 y 50 respiraciones por minuto. Los puntajes de SUD fueron muy altos durante la terapia, lo que coincidió con los muchos sentimientos negativos experimentados durante las sesiones de terapia. A lo largo del tratamiento, las puntuaciones SUD (p < .01) y los sentimientos negativos se redujeron (p < .001), y los sentimientos positivos aumentaron (p < .01) de manera significativa, lo que refleja mejoras en los síntomas de TEPT evaluados por el médico. A lo largo de las sesiones de terapia, las respuestas de FC (p = .888) y FR (p = .466) no cambiaron.Conclusiones: La fuerte respuesta psicofisiológica junto con los altos niveles de angustia autoinformada y sentimientos negativos se interpreta como un alto compromiso emocional durante la terapia. Un hallazgo novedoso fue el aumento muy significativo de FR durante las sesiones grabadas. La investigación futura del TEPT debería incluir la respuesta de la FR a la terapia y explorar el control de la respiración como un objetivo del tratamiento.

Improving racial disparities in unmet palliative care needs among intensive care unit family members with a needs-targeted app intervention: The ICUconnect randomized clinical trial.

INTRODUCTION: The technologies used to treat the millions who receive care in intensive care unit (ICUs) each year have steadily advanced. However, the quality of ICU-based communication has remained suboptimal, particularly concerning for Black patients and their family members. Therefore we developed a mobile app intervention for ICU clinicians and family members called ICUconnect that assists with delivering need-based care. OBJECTIVE: To describe the methods and early experiences of a clustered randomized clinical trial (RCT) being conducted to compare ICUconnect vs. usual care. METHODS AND ANALYSIS: The goal of this two-arm, parallel group clustered RCT is to determine the clinical impact of the ICUconnect intervention in improving outcomes overall and for each racial subgroup on reducing racial disparities in core palliative care outcomes over a 3-month follow up period. ICU attending physicians are randomized to either ICUconnect or usual care, with outcomes obtained from family members of ICU patients. The primary outcome is change in unmet palliative care needs measured by the NEST instrument between baseline and 3 days post-randomization. Secondary outcomes include goal concordance of care and interpersonal processes of care at 3 days post-randomization; length of stay; as well as symptoms of depression, anxiety, and post-traumatic stress disorder at 3 months post-randomization. We will use hierarchical linear models to compare outcomes between the ICUconnect and usual care arms within all participants and assess for differential intervention effects in Blacks and Whites by adding a patient-race interaction term. We hypothesize that both compared to usual care as well as among Blacks compared to Whites, ICUconnect will reduce unmet palliative care needs, psychological distress and healthcare resource utilization while improving goal concordance and interpersonal processes of care. In this manuscript, we also describe steps taken to adapt the ICUconnect intervention to the COVID-19 pandemic healthcare setting. ENROLLMENT STATUS: A total of 36 (90%) of 40 ICU physicians have been randomized and 83 (52%) of 160 patient-family dyads have been enrolled to date. Enrollment will continue until the end of 2021.

Neural changes following equine-assisted therapy for posttraumatic stress disorder: A longitudinal multimodal imaging study.

BACKGROUND: While effective treatments for posttraumatic stress disorder (PTSD) exist, many individuals, including military personnel and veterans fail to respond to them. Equine-assisted therapy (EAT), a novel PTSD treatment, may complement existing PTSD interventions. This study employs longitudinal neuro-imaging, including structural magnetic resonance imaging (sMRI), resting state-fMRI (rs-fMRI), and diffusion tensor imaging (DTI), to determine mechanisms and predictors of EAT outcomes for PTSD. METHOD: Nineteen veterans with PTSD completed eight weekly group sessions of EAT undergoing multimodal MRI assessments before and after treatment. Clinical assessments were conducted at baseline, post-treatment and at 3-month follow-up. RESULTS: At post-treatment patients showed a significant increase in caudate functional connectivity (FC) and reduction in the gray matter density of the thalamus and the caudate. The increase of caudate FC was positively associated with clinical improvement seen immediately at post-treatment and at 3-month follow-up. In addition, higher baseline caudate FC was associated with greater PTSD symptom reduction post-treatment. CONCLUSIONS: This exploratory study is the first to demonstrate that EAT can affect functional and structural changes in the brains of patients with PTSD. The findings suggest that EAT may target reward circuitry responsiveness and produce a caudate pruning effect from pre- to post-treatment.

Mediating role of post-traumatic growth in the relationship between inadequate disaster recovery and mental health outcomes: long-term evidence from the Wenchuan earthquake.

Background: The mental health outcomes from disasters have aroused great concern worldwide, yet few studies incorporate a long-term disaster recovery perspective. Evidence has also emerged about the importance of the social determinants of mental health, but aspects of recovery including disruptions to livelihoods and social networks remain relatively understudied. Objective: This study utilizes cognitive adaptation theory to examine the long-term relationship between inadequate disaster recovery and mental health outcomes while considering domains of post-traumatic growth (PTG) as mediators. Methods: A cross-sectional study was conducted among 1369 adult survivors of the 2008 Wenchuan earthquake. Correlation analyses and multivariable regression analyses examined the association between inadequate disaster recovery and mental health outcomes, while parallel multiple mediator models and structural equation model explored the mediating role of PTG among these relationships. Results: 52.2% and 8.1% of the respondents reported inadequate recovery on livelihood and social ties, respectively. Inadequate disaster recovery was associated with higher levels of PTSD and depressive symptoms, and this association was partially mediated by PTG. Lower reported PTG on the interpersonal relationship and new possibilities domains mediated the association between inadequate livelihood recovery on PTSD and depressive symptom severity, and enhanced personal strength mediated the association between inadequate social ties recovery on these symptoms. Conclusion: Enhancing disaster recovery is essential for mental health protection, and PTG may be a valuable starting point in cognitive therapy to protect against stress responses after trauma.

Antecedentes: Los resultados de salud mental de los desastres han despertado una gran preocupación en todo el mundo, sin embargo, pocos estudios incorporan una perspectiva de recuperación de desastres a largo plazo. También ha surgido evidencia sobre la importancia de los determinantes sociales de la salud mental, pero los aspectos de la recuperación, incluidas las alteraciones de los medios de subsistencia y las redes sociales, siguen siendo relativamente poco estudiados.Objetivo: Este estudio utiliza la teoría de la adaptación cognitiva para examinar la relación a largo plazo entre la recuperación inadecuada ante desastres y los resultados de salud mental, al tiempo que considera los dominios del crecimiento postraumático (DCP) como mediadores.Métodos: Se realizó un estudio transversal entre 1369 adultos sobrevivientes del terremoto de Wenchuan del 2008. Los análisis de correlación y los análisis de regresión multivariado examinaron la asociación entre la recuperación inadecuada a desastres y los resultados en salud mental, mientras que los modelos paralelos de múltiples mediadores y los modelos de ecuaciones estructurales exploraron el papel mediador de la DCP entre estas relaciones.Resultados: El 52,2% y el 8,1% de los encuestados informaron una recuperación inadecuada de los medios de subsistencia y los lazos sociales, respectivamente. La recuperación de desastres inadecuada se asoció con niveles más altos de TEPT y síntomas depresivos, y esta asociación fue parcialmente mediada por DCP. Un menor DCP reportado sobre la relación interpersonal y los nuevos dominios de posibilidades mediaron la asociación entre la recuperación inadecuada de los medios de subsistencia en el TEPT y la gravedad de los síntomas depresivos, y el aumento de la fuerza personal medió la asociación entre la recuperación inadecuada de los lazos sociales en estos síntomas.Conclusión: Mejorar la recuperación ante desastres es esencial para la protección de la salud mental, y la DCP puede ser un punto de partida valioso en la terapia cognitiva para proteger contra las respuestas al estrés después de un trauma.

Dynamics of Child soldiers' Psychosocial Rehabilitation and Well-being: Perspectives from Bioecological Systems Theory in the Democratic Republic of Congo.

Background research on children associated with armed forces and armed groups (CAAFAG) and the analysis of how to facilitate their social reintegration and human development reveals a variety of complex individual and collective challenges with which they are confronted; however, their social and cultural environment, and the risks that may impede their future development and well-being, remain understudied. This empirical research reports the results of descriptive and correlational analyses of data emanating from author-administered interviews, and focus group discussions with 128 CAAFAG and two psychologists working with them in rehabilitation centers in the eastern Democratic Republic of Congo. The entire sample involved relatively young participants (N = 130, M = 17.11, SD = 4.28), with the youngest child aged 11. The outcomes sustain that the psychosocial rehabilitation programme framed within Urie Bronfenbrenner's bioecological systems theory shows promising effects in enhancing CAAFAG's well-being, human growth; and in reducing potential violent behavior.

Defining post-traumatic stress disorder recovery in veterans: Benchmarking symptom change against functioning indicators.

Improved metrics of Post-traumatic stress disorder (PTSD) treatment response that extend beyond a focus on symptom reduction to incorporate meaningful, patient-centred indicators of functioning are needed in veteran populations. The aim of this study was to extend previous research by investigating whether indicators of functioning can successfully distinguish against symptom response categories derived from the Post-Traumatic Stress Disorder Checklist (PCL-5) pre- and post- PTSD treatment. Participants were 472 veterans receiving hospital-based treatment for PTSD. In addition to the PCL-5, measures included quality of life, social relationships, physical health and psychological distress. Four mutually exclusive, progressive response categories were used to define treatment response including: No Response, Response, Response and Below Threshold, and Remission. PTSD symptom reductions were associated with corresponding improvements in broader indicators of functioning. However, it was only when the magnitude of symptom reduction placed the individual in the 'Response and Below Threshold' category that improvement on functioning measures achieved levels indicative of a good end state. Traditional metrics of treatment 'response' in PTSD treatment do not necessarily indicate recovery on important functioning indicators. Only when an individual both responds to treatment and drops below threshold for probable disorder are they likely to report having meaningful levels of functioning.

Caring for Child Psychotrauma: Lessons from Bosnia.

The war in Bosnia and Herzegovina (1992-1995) was an extremely hard traumatic event with different losses, separations of people, injuries, hard physical and psychical suffering of everyone. Children were especially in difficult conditions. One of the most remarkable things about children, as anyone who works with them soon finds out, is their resilience. While children are vulnerable to psychic damage and, if the damage is deep enough, to delays in emotional and even physical growth, they also have an astonishing capacity to bounce back. This is one of the most rewarding things about treating traumatized children. For many children, it takes very little, perhaps only some words of understanding, to help them tap into their own ability to heal. Taking care of child war psycho-trauma was a difficult task for me, as the war-time head of Department of psychiatry, without enough knowledge in child psycho-trauma and as person with a high responsibility, to organize together with other psychological caretakers of children, especially refugee children. This presentation will be some kind of my remembrance of period of 20-25 years ago when we, I think did good work of what we could and what we knew.

[Stress-Related Disorders in Rehabilitation]. / Belastungsbezogene Störungen in der Rehabilitation.

Due to significant changes in the new ICD-11 classification, stress-related disorders have advanced further into clinical and scientific focus. In contrast to the ICD-10 classification, complex posttraumatic stress disorder as well as prolonged grief have been established as independent diagnoses. Additionally, the diagnostic criteria for adjustment disorder were newly conceptualized and refined. Stress-related disorders have a high relevance for out- and inpatient rehabilitation centers. Posttraumatic stress disorder (PTSD) has a 1-year-prevalence in Germany of 1-2%. Comorbidities such as depression or anxiety disorders are common. PTSD may also result from physical illness and can in turn complicate the course of the disease or even lead to chronification of symptoms. The most effective treatment is a trauma-focused psychotherapy, which usually takes place in an outpatient setting. Psychosomatic inpatient rehabilitation is a valuable resource in the treatment plan of PTSD. The optimal point is mostly following the acute therapy when reintegration to work and social life is the aim. As rehabilitation centers can provide a safe therapeutic setting for patients, allowing them to open up about their trauma, it can pave the way to a trauma focused treatment. Additionally, socio-medical aspects of trauma-related disorders will be touched upon in this overview.

Occupational therapy for military personnel and military veterans experiencing post-traumatic stress disorder: A scoping review.

INTRODUCTION: As the rate of post-traumatic stress disorder (PTSD) among military personnel and military veterans continues to rise, occupational therapists are increasingly concerned with the impact of this disorder on health, occupational performance, and quality of life. However, the literature on occupational therapy for military personnel and military veterans with PTSD has not been summarised. METHOD: The objective was to identify what is known from the published, peer-reviewed literature, about the services provided by occupational therapists to military personnel and military veterans experiencing PTSD. Arksey and O'Malley's five steps for scoping reviews were utilised. A search of three databases identified 27 articles. RESULTS: Of the 27 papers reviewed, 13 papers discussed military personnel, 13 for military veterans, and 1 reported on both populations. Of these 27, 9 research papers provided data to support the efficacy of interventions, whereas 2 papers reported occupational performance issues. Eight opinion and eight service description papers were included. The most commonly mentioned interventions across the reviewed papers were stress and anger, or coping skills (n = 11), returning to duty (n = 9), physical training (n = 7), and sleep hygiene (n = 6). CONCLUSION: Occupational therapists provide services to military personnel who are vulnerable to PTSD from combat and operational stress. Rarely did publications address intervention efficacy for military personnel. Additionally, there is a paucity of literature that addresses occupational therapy interventions following transition from military service for veterans with PTSD specific to facilitating reintegration to civilian life. Despite this, occupational therapists are well suited to enable military veterans to build upon their existing strengths, skills, and professional identities to minimise the impact of PTSD on daily life and to reach their full potential.

COVID-19: Understanding and mitigating trauma in ICU survivors.

The spread of coronavirus disease 2019 (COVID-19) has placed many individuals in need of critical care, with a high proportion of hospitalized patients being admitted to intensive care units (ICU) to treat acute outcomes of COVID-19 (e.g., respiratory failure via mechanical ventilation). The ICU is known to be a setting where individuals are at a high risk of experiencing significant psychological difficulties, and patients with COVID-19 are particularly susceptible to such experiences, which can impact their recovery process (e.g., postintensive care syndrome). This article seeks to highlight the intersection between critical care related to trauma and COVID-19 and point providers toward opportunities for anticipating and managing secondary effects in effort to promote psychological adaptation. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Evaluating care farming as a means to care for those in trauma and grief.

The interrelationships between nature, health, and wellbeing are increasingly recognized and incorporated into therapeutic interventions. Care farming, the concept of utilizing agricultural places and practices for providing care, therapy, and rehabilitation, is a paradigmatic example of this shift. This mixed method study empirically evaluates the efficacy of care farming as an intervention for individuals affected by traumatic grief, a complex experiential condition. Both quantitative and qualitative results suggest this care farm intervention was beneficial, yielding significant reductions in subjective distress to grief intensity. The study's findings add to the growing body of evidence on care farming and support green care as a therapeutic potential for individuals affected by traumatic grief.

[Posttraumatic Stress Disorder in Digital Work Environment - A Case Report]. / Posttraumatische Belastungsstörung in der digitalen Arbeitswelt.

For the purpose of illustration, we briefly characterize a 36-year-old male who developed classic symptoms of post-traumatic stress disorder after work-related exposure to digital presentation of physical and sexual violence against animals and human beings as a social media content moderator.After having been incapacitated for work for a period of 10 months, the patient was referred for socio-medical assessment. Based on his high resilience and motivation it was concluded that the patient will regenerate and will be available for professional reorientation to re-enter the labor market within 6 months. Nonetheless, we ascertained a total suspension of work performance regarding his last insurable employment.This secondary, digital exposition is not described in the formally valid ICD-10 classification, but in the current valid version of DSM-5 it is included into the Criteria A4. Here, exposure via electronic instruments, television, movies or photographs is excluded, unless it is linked to work activity.This exemplifies the potential risks for mental health due to digital impressions during work and related socio-medical and actuarial consequences.

Functional neurology after the Second World War: The beginnings of neurology on screen (III).

Treatment of functional symptoms has a long history, and interventions were often used in soldiers returning from battle. On the 75th anniversary of the end of the Second World War, I review the portrayal of neurology in documentary film. Two documentaries were released in 1946 and 1948 (Let There Be Light and Shades of Gray, respectively), which showed a number of soldiers with functional neurology including paralysis, stuttering, muteness, and amnesia. The films showed successful treatments with hypnosis and sodium amytal by psychoanalytic psychiatrists. These documentaries link neurology with psychiatry and are remarkable examples of functional neurology and its treatment on screen.