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Actual for You - PTSD Among Military Personnel: A Review
The statistics supplied by research databases such as Forrester and comScore, provide very useful and important information on the impact of Internet marketing today. Within this topic, we can also consider statistics on search engines such as Google and Yahoo, and realize the importance each provides in terms of visibility and traffic generated. But how does search engine visibility impact consumers, Internet based companies or just the curious industry readers?Statistics on the use of search engines for 2006Last year it was estimated that MSN Search held a 13.2% share of searches in the US market in March 2006 (comScore Media Metrix Ratings), while Google Sites led the pack with 2.7 billion search queries performed, followed by Yahoo Sites (1.8 bln), MSN-Microsoft (849,000), Time-Warner Network (486,000), and Ask Jeeves/Ask Network (376,000).What does this mean for you?More and more people are turning to the search engines to find information and unless all your web content is optimized for the search engines you're losing business hand over fist.Search engine visibility is no longer optional - it's a must. All your content must be optimized - web pages, press releases, blogs, RSS feeds. And if you are podcasting (and you should be!) you need to optimize the podcast and the show notes page.Now is the time to learn how to find the best 'long tail' key phrases that can bring you high rankings and search engine visibility fast, while you work on the broader 'head' words.If you are in the BtoB space, Google visibility is essential. Studies show that while BtoB buyers find 25% of their data in print trade magazines and 30% in online newsletters, the other 45% use Google search. Search engine optimization (SEO) is an integral part of marketing and PR today. And it's a great source of marketing information. Marketing and PR people need to work with their SEO and SEM folk on keyword research and strategy.If you don't have someone in-house who can steer you in the right direction, contact me and we can work with you to identify your keywords and phrases and show you how to obtain great search engine visibility.
PTSD scale for the SCL-90 derived by Saunders et al. (1990) has 28-items that best discriminated women with crime-related PTSD from non-cases. Using the Diagnostic Interview Scale (DIS) as criterion, this scale obtained good sensitivity (.75) and high specificity (.90).
The Penn Inventory (Hammarberg, 1992) was developed and validated with both combat veterans and trauma-exposed non-veterans. This 26-item instrument has high internal consistency (alpha = .94), and test-retest reliability (.96). Sensitivity was found to be .90 and specificity was 1.0 among a sample of 83 veterans, and in a sample of disaster survivors sensitivity was 0.94 and specificity of 1.0.
Other self-report measures of PTSD include, Modified PTSD Scale (MPSS-SR) (Falsetti et al., 1993), Posttraumatic Stress Disorder Diagnostic Scale (PDS) (Foa, 1995), and Davidson Trauma Scale (DTS) (1997).
III. Psycho-physiological assessment of PTSD
Exposure to cues of a traumatic event provoked a systematic physiological response across several measurement domains (e.g., heart rate, skin conductance, EMG, and blood pressure). Blanchard et al. (1982) found that the heart rate response could correctly classify 95.5 percent of the combined sample of 11 male Vietnam veterans suffering from PTSD and 11 non-veteran controls. Blanchard et al. (1982) and Malloy et al. (1983) found that this reactivity predicts the PTSD diagnosis while using auditory and audiovisual cues. Pitman et al. (1987) also observed similar reactivity using personal scripts of traumatic events that were then read to subjects. A 15-site clinical trial conducted by the Department of Veterans Affairs’ Cooperative Study Program later found that psycho-physiological assessment approach could be a useful diagnostic tool in discriminating cases of PTSD from non-cases (Keane et al., 1988). Biological alterations in central noradrenergic activity, the hypothalamic-pituitary-adrenocortic
One of the strategies that franchises often employ to maintain the integrity of the franchise system and insure control and consistency throughout the franchise company is to use a standardized confidential operations manual. Yet, we all know that the only thing that is constant use change. This is why the confidential operations manual in any franchisor company must be constantly updated. But, how do you know if all the franchisees have been diligent in updating their manual, so that everyone is doing everything the same way?Many franchisors today put the manuals online in a company intranet system and the company itself makes the changes. This is a good strategy, however opens the door to downloadable theft of proprietary information. In our company we decided to use paper manuals, in binders, which were extremely hard to copy. To insure that our franchisees updated their manual, we decided to add a clause into our franchise agreements and make them agree prior to the commencement of their franchise to above all else keep the confidential operations manual up-to-date;3.12 Confidential Operations Manual3.12.1 Updating Manual And SystemFranchisee acknowledges that the Service Marks, Confidential Operations Manual, and System, including any future amendments or modifications to them, have substantial value, and that the conditions, restrictions, covenants not to compete, and other limitations imposed by this Agreement are necessary, equitable, and reasonable for the general benefit of Franchisee, Franchisor, and others enjoying any lawful economic interest in the Service Marks, Confidential Operations Manual, and System.Franchisor may change or modify any part of the Service Marks, Confidential Operations Manual, or System from time to time at its sole discretion. Franchisee will accept, use, and protect, for the purposes of this Franchise Agreement, all changes and modifications as if they were a part of the Service Marks, Confidential Operations Manual, and System at the time this Franchise Agreement is executed. Franchisee will bear all costs and expenses which may be reasonably necessary as a result of such changes or modifications. Under no circumstances will Franchisor be liable to Franchisee for any damages, costs, losses, or detriments related to of these changes or modifications.Complete and detailed uniformity of the Service Marks, Confidential Operations Manual, and System under the varying conditions to be experienced by our Franchisees may not be possible or practicable. Therefore Franchisor reserves the right, at its discretion, to accommodate Franchisees special needs, or those of any other of our franchisees. These needs may result from the peculiarities of a particular site or location, density of population, business potential, populations of trade area, existing business practices, requirements of local law or local customers, zoning require
The Vietnam War and the plight of veterans in USA have generated much media interest because of its comprehensibility, easy accessibility, and since it added public interest to disasters of great magnitude. For many, PTSD places responsibility for their suffering on factors outside themselves, factors over which they often had neither responsibility nor control (Friedman, 2000) thus providing an explanatory model. Gersons and Carlier (1992) looking at the history of PTSD, commented that the introduction of the new diagnosis of PTSD was seen and felt to be in recognition of the psychological consequences of war, especially as experienced by Vietnam veterans. After the description of PTSD in the 1980, there was a major increase in research interest in PTSD (Blake, Albano, & Keane, 1992) with majority of them being on victims of war or sexual violence.
Post Traumatic Stress Disorder (PTSD)
PTSD is a natural emotional reaction to a deeply shocking and disturbing experience. It is a normal reaction to an abnormal situation. Post Traumatic Stress Disorder (PTSD) is defined in DSM-IV, the fourth edition of the American Psychiatric Association's Diagnostic and Statistical Manual. For a doctor or mental health professional to be able to make a diagnosis, the condition must be defined in DSM-IV or its international equivalent, the World Health Organization's ICD-10. The focus of the DSM-IV (American Psychiatric Association, 1994) definition of Post Traumatic Stress Disorder is a single life-threatening event or threat to integrity. However, the symptoms of traumatic stress also arise from an accumulation of small incidents rather than one major incident.
History of PTSD
PTSD is considered to be the renaming or the synthesis of an age-old condition. The psychological effect of exposure to combat-related traumatic events, then called physioneurosis was first scientifically studied in 1941 by A. Kardiner (Kolb, 1993). Research interest in this area peaked during and after the world wars. Keiser’s (1968) book The Traumatic Neurosis describes specific problems following trauma supporting the existence of PTSD prior to the Vietnam War. The studies done among survivors of World War II death & prisoner of war (PoW) camps, and the Vietnam War accelerated the growth of studies related to PTSD among military personnel.
In 1968, the Diagnostic and Statistical Manual of Mental Disorders (2nd ed., DSM-II; American Psychiatric Association, 1968, p.49) mentioned about the effects of traumatic stress as ‘fear associated with military combat and manifested by trembling, running, and hiding’. In 1969, the Manual of the International Statistical Classification of Diseases, Injuries, and Causes of Death (8th ed.; ICD-8; World Health Organization, 1969, p.158) referred to condition as ‘combat fatigue’. Common patterns in the psychological sequel of women who had been sexually assaulted, termed as rape trauma syndrome, and combat related trauma contributed to a set of cluster of symptoms that represented PTSD.
Posttraumatic stress disorder (PTSD) was introduced in ICD in its 9th edition, in 1978, and in DSM in its 3rd edition, in 1980. In 1994, the acute short-term effects of exposure to a traumatic event were introduced in DSM-IV as acute stress disorder (ASD).
Measures of PTSD
I. Structured Clinical Interviews
The Structured Clinical Interview for DSM-III-R (SCID; Spitzer, Williams, Gibbon & First, 1990) has been the interview most frequently used to date to evaluate the presence or absence of PTSD. The SCID provides a comprehensive evaluation of Axis I and Axis II diagnoses. The PTSD module is concise and relatively easy to administer and score, while addressing the major diagnostic features of the disorder. Kulka et al. (1990) found a kappa of .93 when a second clinician listened to audiotapes of the target interview and then made independent diagnoses. McFall et al. (1990) reported 100 percent diagnostic reliability between two clinicians who completed independent SCIDs on ten subjects. Keane, Kolb and Thomas (1988) observed a kappa of .68 for PTSD SCID diagnoses derived from two independent clinicians who individually interviewed the same patients (N = 37). Kulka et al. (1990) also found the SCID diagnosis to be strongly correlated with other indices of PTSD (i.e., the Mississippi Scale, the Impact of Event Scale, the PK-Scale of the MMPI). These results suggest that the PTSD module of the SCID is a measure with respectable reliability and validity. The limitation of this instrument is that it yields only dichotomous information about each symptom and therefore severity of disorder and changes in symptom level cannot be easily detected.
The Diagnostic Interview Scale (DIS-NIMH) is a highly structured interview that correlated highly with other known measures of PTSD (Watson et al., 1991) but when used in a community sample, where the base rate of PTSD was low, the DIS performed poorly, with estimates of .23 for sensitivity and .28 for kappa (Kulka et al. 1991).
The PTSD-Interview by Watson et al. (1991) yields both dichotomous and continuous scores, thus addressing some of the limitations of the SCID and DIS. Reports of high test-retest reliability (.95), internal stability (alpha = .92), sensitivity (.89), specificity (.94), and kappa (.82) recommend this instrument for use in diagnosing PTSD. Compared to other clinical instruments, this instrument asks the subjects to make their own rating of symptom severity, thereby minimizing the role of the experienced clinician in the diagnostic process.
The Structured Interview for PTSD (SI-PTSD) (Davidson et al.1989) has continuous and dichotomous symptoms ratings. High test-retest reliability (.71), inter-rater reliability (.97 - .99) and perfect diagnostic agreement (N = 34) have been reported. Utility analyses have revealed sensitivity of .96, specificity of .80, and a kappa of .79 when compared to the SCID.
The Clinician Administered PTSD Scale (Blake et al., 1990) is available in both lifetime and current versions. The CAPS contains 17 diagnostic symptoms of PTSD, its 8 associated features, symptom severity measures in terms of frequency & intensity, indices of impairment in social and occupational functioning, and an assessment of validity of patient responses. The CAPS also provides continuous and dichotomous scores to suit the needs of the investigator/ clinician. Sound psychometric properties in terms of reliability and validity have been reported (Weathers, 1992).
II. Self-report scales
The PK-Scale of the MMPI (Keane et al., 1984) consists of 49 items that differentiated PTSD from non-PTSD patients in both a test sample and a cross-validation sample of veterans. Eighty-two percent of 200 subjects were correctly classified using a cut-off score of 30. Subsequent studies have not found the same diagnostic hit rate. The performance of PK in the NVVRS (Kulka et al., 1991) indicates that the MMPI-2 (Lyons and Keane, 1992) modifications have not altered the general interrelationship of PK with other measures of PTSD.
The Mississippi Scale (Keane, Caddell & Taylor, 1988) is available in both combat and civilian versions. It is a 35 item instrument that has high internal consistency (alpha = .94), test-retest reliability (.97), sensitivity (.93), and specificity (.89). This instrument performed effectively in both clinical settings (e.g., McFall, Smith, Roszell et al., 1990) and in field/community settings (e.g., Kulka et al., 1991), indicating its general utility for measuring PTSD across settings and for different purposes (e.g., research or clinical).
Impact of Event Scale (Horowitz, Wilner & Alvarez, 1979) focuses upon the assessment of intrusions and avoidant/numbing responses. IES is the single most widely used instrument for assessing the psychological consequences of exposure to traumatic events. The scale has good internal consistency (.78 for intrusion, .82 for avoidance) and test-retest reliability (.89 for intrusion, .79 for avoidance). Recent studies have found the IES to correlate well with other indices of PTSD. The Impact of events scale-Revised (IES-R) (Weiss and Marmer, 1997) to parallel the DSM-IV criteria for PTSD, is also self-report measure designed to assess current subjective distress for any specific life event. The three sub scales measures, avoidance (the tendency to avoid thoughts or reminders about the incident), intrusion (difficulty in staying asleep, dissociative-like re-experiencing of when experiencing true flash-back), and hyper arousal (feeling irritated, angry, difficulty in getting sleep). In addition to the 3 subscale scores, IES-R gives an overall impact of events score (sum of the 3 subscales) also.
PTSD scale for the SCL-90 derived by Saunders et al. (1990) has 28-items that best discriminated women with crime-related PTSD from non-cases. Using the Diagnostic Interview Scale (DIS) as criterion, this scale obtained good sensitivity (.75) and high specificity (.90).
The Penn Inventory (Hammarberg, 1992) was developed and validated with both combat veterans and trauma-exposed non-veterans. This 26-item instrument has high internal consistency (alpha = .94), and test-retest reliability (.96). Sensitivity was found to be .90 and specificity was 1.0 among a sample of 83 veterans, and in a sample of disaster survivors sensitivity was 0.94 and specificity of 1.0.
Other self-report measures of PTSD include, Modified PTSD Scale (MPSS-SR) (Falsetti et al., 1993), Posttraumatic Stress Disorder Diagnostic Scale (PDS) (Foa, 1995), and Davidson Trauma Scale (DTS) (1997).
III. Psycho-physiological assessment of PTSD
Exposure to cues of a traumatic event provoked a systematic physiological response across several measurement domains (e.g., heart rate, skin conductance, EMG, and blood pressure). Blanchard et al. (1982) found that the heart rate response could correctly classify 95.5 percent of the combined sample of 11 male Vietnam veterans suffering from PTSD and 11 non-veteran controls. Blanchard et al. (1982) and Malloy et al. (1983) found that this reactivity predicts the PTSD diagnosis while using auditory and audiovisual cues. Pitman et al. (1987) also observed similar reactivity using personal scripts of traumatic events that were then read to subjects. A 15-site clinical trial conducted by the Department of Veterans Affairs’ Cooperative Study Program later found that psycho-physiological assessment approach could be a useful diagnostic tool in discriminating cases of PTSD from non-cases (Keane et al., 1988). Biological alterations in central noradrenergic activity, the hypothalamic-pituitary-adrenocortica
Employees are a lot like cars or houses. The amount of care, attention to detail, and feelings of permanency we project toward our cars or houses is comparable to the way employees view their work relationship. Consider the analogy.Employee RentersWhen we rent a car or a house, we are less likely to spend a lot of time caring for it, nurturing it, or preserving it. On vacation, when we hit a big bump on the road, we say, “no big deal… it’s a rental.” Or if we knick the wall of our rented apartment we say, “oh well, we’ll be moving soon.” Our attention to the little details are not as precise because we know our relationship with that particular car or house is not going to last forever.Some of our employees are also renters. They view their jobs from a temporary perspective. With the short-timer approach, they are less likely to give great attention to the accuracy or precision of their work. They believe that the quality of their work is “no big deal” because they won’t be there for very long. As a result, performance suffers and they look to move on as quickly as they can, once they’ve gotten what they wanted from our employment.Employee OwnersOn the flip side, when we own our own house or car, we are more likely to spend time on the maintenance. We concern ourselves with the cleanliness and appearance of our property. If the car gets a scratch, we may touch it up. More regularly, we give the house a fresh coat of paint. Our property is something we are proud of and usually, we expect to own it for an extended length of time.Many of our employees are owners. They approach their work with a sense of pride. They work hard to maintain the quality of their work, as well as the quality of their relationships because they know that they’ll be there for an extended period.In this day of layoffs, reorganizations and downsizing, we are creating more opportunities for the renters to thrive. As leaders, we must do our best to create owners and the owner mentality. Recently, the Gallup Organization interviewed two million employees at 700 companies nationwide. A significant finding of the report was that employee tenure and productivity are directly related to the relationship between the employee and their immediate supervisor. Employee tenure and productivity are key indicators of an employee owner.The conclusion is obvious. If you are a supervisor, you are responsible for creating employee owners. Spend more time cultivating the owners and retaining them for the long term. Don’t spend your time on renters. They’re going to be moving on anyway.
In 1968, the Diagnostic and Statistical Manual of Mental Disorders (2nd ed., DSM-II; American Psychiatric Association, 1968, p.49) mentioned about the effects of traumatic stress as ‘fear associated with military combat and manifested by trembling, running, and hiding’. In 1969, the Manual of the International Statistical Classification of Diseases, Injuries, and Causes of Death (8th ed.; ICD-8; World Health Organization, 1969, p.158) referred to condition as ‘combat fatigue’. Common patterns in the psychological sequel of women who had been sexually assaulted, termed as rape trauma syndrome, and combat related trauma contributed to a set of cluster of symptoms that represented PTSD.
Posttraumatic stress disorder (PTSD) was introduced in ICD in its 9th edition, in 1978, and in DSM in its 3rd edition, in 1980. In 1994, the acute short-term effects of exposure to a traumatic event were introduced in DSM-IV as acute stress disorder (ASD).
Measures of PTSD
I. Structured Clinical Interviews
The Structured Clinical Interview for DSM-III-R (SCID; Spitzer, Williams, Gibbon & First, 1990) has been the interview most frequently used to date to evaluate the presence or absence of PTSD. The SCID provides a comprehensive evaluation of Axis I and Axis II diagnoses. The PTSD module is concise and relatively easy to administer and score, while addressing the major diagnostic features of the disorder. Kulka et al. (1990) found a kappa of .93 when a second clinician listened to audiotapes of the target interview and then made independent diagnoses. McFall et al. (1990) reported 100 percent diagnostic reliability between two clinicians who completed independent SCIDs on ten subjects. Keane, Kolb and Thomas (1988) observed a kappa of .68 for PTSD SCID diagnoses derived from two independent clinicians who individually interviewed the same patients (N = 37). Kulka et al. (1990) also found the SCID diagnosis to be strongly correlated with other indices of PTSD (i.e., the Mississippi Scale, the Impact of Event Scale, the PK-Scale of the MMPI). These results suggest that the PTSD module of the SCID is a measure with respectable reliability and validity. The limitation of this instrument is that it yields only dichotomous information about each symptom and therefore severity of disorder and changes in symptom level cannot be easily detected.
The Diagnostic Interview Scale (DIS-NIMH) is a highly structured interview that correlated highly with other known measures of PTSD (Watson et al., 1991) but when used in a community sample, where the base rate of PTSD was low, the DIS performed poorly, with estimates of .23 for sensitivity and .28 for kappa (Kulka et al. 1991).
The PTSD-Interview by Watson et al. (1991) yields both dichotomous and continuous scores, thus addressing some of the limitations of the SCID and DIS. Reports of high test-retest reliability (.95), internal stability (alpha = .92), sensitivity (.89), specificity (.94), and kappa (.82) recommend this instrument for use in diagnosing PTSD. Compared to other clinical instruments, this instrument asks the subjects to make their own rating of symptom severity, thereby minimizing the role of the experienced clinician in the diagnostic process.
The Structured Interview for PTSD (SI-PTSD) (Davidson et al.1989) has continuous and dichotomous symptoms ratings. High test-retest reliability (.71), inter-rater reliability (.97 - .99) and perfect diagnostic agreement (N = 34) have been reported. Utility analyses have revealed sensitivity of .96, specificity of .80, and a kappa of .79 when compared to the SCID.
The Clinician Administered PTSD Scale (Blake et al., 1990) is available in both lifetime and current versions. The CAPS contains 17 diagnostic symptoms of PTSD, its 8 associated features, symptom severity measures in terms of frequency & intensity, indices of impairment in social and occupational functioning, and an assessment of validity of patient responses. The CAPS also provides continuous and dichotomous scores to suit the needs of the investigator/ clinician. Sound psychometric properties in terms of reliability and validity have been reported (Weathers, 1992).
II. Self-report scales
The PK-Scale of the MMPI (Keane et al., 1984) consists of 49 items that differentiated PTSD from non-PTSD patients in both a test sample and a cross-validation sample of veterans. Eighty-two percent of 200 subjects were correctly classified using a cut-off score of 30. Subsequent studies have not found the same diagnostic hit rate. The performance of PK in the NVVRS (Kulka et al., 1991) indicates that the MMPI-2 (Lyons and Keane, 1992) modifications have not altered the general interrelationship of PK with other measures of PTSD.
The Mississippi Scale (Keane, Caddell & Taylor, 1988) is available in both combat and civilian versions. It is a 35 item instrument that has high internal consistency (alpha = .94), test-retest reliability (.97), sensitivity (.93), and specificity (.89). This instrument performed effectively in both clinical settings (e.g., McFall, Smith, Roszell et al., 1990) and in field/community settings (e.g., Kulka et al., 1991), indicating its general utility for measuring PTSD across settings and for different purposes (e.g., research or clinical).
Impact of Event Scale (Horowitz, Wilner & Alvarez, 1979) focuses upon the assessment of intrusions and avoidant/numbing responses. IES is the single most widely used instrument for assessing the psychological consequences of exposure to traumatic events. The scale has good internal consistency (.78 for intrusion, .82 for avoidance) and test-retest reliability (.89 for intrusion, .79 for avoidance). Recent studies have found the IES to correlate well with other indices of PTSD. The Impact of events scale-Revised (IES-R) (Weiss and Marmer, 1997) to parallel the DSM-IV criteria for PTSD, is also self-report measure designed to assess current subjective distress for any specific life event. The three sub scales measures, avoidance (the tendency to avoid thoughts or reminders about the incident), intrusion (difficulty in staying asleep, dissociative-like re-experiencing of when experiencing true flash-back), and hyper arousal (feeling irritated, angry, difficulty in getting sleep). In addition to the 3 subscale scores, IES-R gives an overall impact of events score (sum of the 3 subscales) also.
PTSD scale for the SCL-90 derived by Saunders et al. (1990) has 28-items that best discriminated women with crime-related PTSD from non-cases. Using the Diagnostic Interview Scale (DIS) as criterion, this scale obtained good sensitivity (.75) and high specificity (.90).
The Penn Inventory (Hammarberg, 1992) was developed and validated with both combat veterans and trauma-exposed non-veterans. This 26-item instrument has high internal consistency (alpha = .94), and test-retest reliability (.96). Sensitivity was found to be .90 and specificity was 1.0 among a sample of 83 veterans, and in a sample of disaster survivors sensitivity was 0.94 and specificity of 1.0.
Other self-report measures of PTSD include, Modified PTSD Scale (MPSS-SR) (Falsetti et al., 1993), Posttraumatic Stress Disorder Diagnostic Scale (PDS) (Foa, 1995), and Davidson Trauma Scale (DTS) (1997).
III. Psycho-physiological assessment of PTSD
Exposure to cues of a traumatic event provoked a systematic physiological response across several measurement domains (e.g., heart rate, skin conductance, EMG, and blood pressure). Blanchard et al. (1982) found that the heart rate response could correctly classify 95.5 percent of the combined sample of 11 male Vietnam veterans suffering from PTSD and 11 non-veteran controls. Blanchard et al. (1982) and Malloy et al. (1983) found that this reactivity predicts the PTSD diagnosis while using auditory and audiovisual cues. Pitman et al. (1987) also observed similar reactivity using personal scripts of traumatic events that were then read to subjects. A 15-site clinical trial conducted by the Department of Veterans Affairs’ Cooperative Study Program later found that psycho-physiological assessment approach could be a useful diagnostic tool in discriminating cases of PTSD from non-cases (Keane et al., 1988). Biological alterations in central noradrenergic activity, the hypothalamic-pituitary-adrenocortic
Here are the top ways to build a relationship with your donors.AttractionMost non profit foundations run their relationship model on the foundation of a powerful relationship being trust. The issue with allowing trust to become your first variable in relationship building is that trust is usually not the first attribute that begins a relationship. The inception of any relationship is attraction. We don't walk up to people and ask, "Hey, can I trust you? Great! Let's go out sometime". If your website is outdated or not optimized for search engines you are instantly loosing hundreds of thousands of dollars in donations. More important, even if you have killer designs, with beautiful graphics, have you ever considered the location of your donation button? The location of your donation graphic, type of graphic you are using and link position is the single most important update you should be concerned with right now. If your non profit website is not attractive to your potential donor, you just lost an incredibly valuable opportunity.you must have a modern day design in 2007. Don't expect a static website with outdated information to convert for you anymore.TrustBuilding trust online is one of the most studied and tested physiological methods of non profit internet marketing. Most people want to place the responsibility for trust in a relationship on someone else. They base their trust on how someone acts towards them. But, we've discovered that trust in a relationship doesn't start with your visitors; it starts with your foundation and how willing you are to open up and allow your visitors in.Make sure you have your Guidestar and Verisign banners on your website.CommitmentIs your foundation committed to providing regularly updated content? Remember my notes about the difference between a partnership and relationship environment? Partnership environment visitors look for one of three things on a website: entertainment, products or information. Non profits have content. We have information. We have to use that opportunity of providing information to tell a story so compelling that the visitor donates and enters our marketing funnel. Even if you do have a support group environment such as chat rooms, message boards and blogs, the initial visit is for current, up to date knowledge. Think about it for a second. If you are a non profit for cancer research, you are 1 of about 93,000,000 web pages (according to Google) competing for the same information. There is a good chance that you don't have any added information that another website provides unless you have up to date news posted on your website often.Make sure to add news articles directly on home page.GratitudeThe strongest relationship building technique your non profit foundation can have is to l
The Diagnostic Interview Scale (DIS-NIMH) is a highly structured interview that correlated highly with other known measures of PTSD (Watson et al., 1991) but when used in a community sample, where the base rate of PTSD was low, the DIS performed poorly, with estimates of .23 for sensitivity and .28 for kappa (Kulka et al. 1991).
The PTSD-Interview by Watson et al. (1991) yields both dichotomous and continuous scores, thus addressing some of the limitations of the SCID and DIS. Reports of high test-retest reliability (.95), internal stability (alpha = .92), sensitivity (.89), specificity (.94), and kappa (.82) recommend this instrument for use in diagnosing PTSD. Compared to other clinical instruments, this instrument asks the subjects to make their own rating of symptom severity, thereby minimizing the role of the experienced clinician in the diagnostic process.
The Structured Interview for PTSD (SI-PTSD) (Davidson et al.1989) has continuous and dichotomous symptoms ratings. High test-retest reliability (.71), inter-rater reliability (.97 - .99) and perfect diagnostic agreement (N = 34) have been reported. Utility analyses have revealed sensitivity of .96, specificity of .80, and a kappa of .79 when compared to the SCID.
The Clinician Administered PTSD Scale (Blake et al., 1990) is available in both lifetime and current versions. The CAPS contains 17 diagnostic symptoms of PTSD, its 8 associated features, symptom severity measures in terms of frequency & intensity, indices of impairment in social and occupational functioning, and an assessment of validity of patient responses. The CAPS also provides continuous and dichotomous scores to suit the needs of the investigator/ clinician. Sound psychometric properties in terms of reliability and validity have been reported (Weathers, 1992).
II. Self-report scales
The PK-Scale of the MMPI (Keane et al., 1984) consists of 49 items that differentiated PTSD from non-PTSD patients in both a test sample and a cross-validation sample of veterans. Eighty-two percent of 200 subjects were correctly classified using a cut-off score of 30. Subsequent studies have not found the same diagnostic hit rate. The performance of PK in the NVVRS (Kulka et al., 1991) indicates that the MMPI-2 (Lyons and Keane, 1992) modifications have not altered the general interrelationship of PK with other measures of PTSD.
The Mississippi Scale (Keane, Caddell & Taylor, 1988) is available in both combat and civilian versions. It is a 35 item instrument that has high internal consistency (alpha = .94), test-retest reliability (.97), sensitivity (.93), and specificity (.89). This instrument performed effectively in both clinical settings (e.g., McFall, Smith, Roszell et al., 1990) and in field/community settings (e.g., Kulka et al., 1991), indicating its general utility for measuring PTSD across settings and for different purposes (e.g., research or clinical).
Impact of Event Scale (Horowitz, Wilner & Alvarez, 1979) focuses upon the assessment of intrusions and avoidant/numbing responses. IES is the single most widely used instrument for assessing the psychological consequences of exposure to traumatic events. The scale has good internal consistency (.78 for intrusion, .82 for avoidance) and test-retest reliability (.89 for intrusion, .79 for avoidance). Recent studies have found the IES to correlate well with other indices of PTSD. The Impact of events scale-Revised (IES-R) (Weiss and Marmer, 1997) to parallel the DSM-IV criteria for PTSD, is also self-report measure designed to assess current subjective distress for any specific life event. The three sub scales measures, avoidance (the tendency to avoid thoughts or reminders about the incident), intrusion (difficulty in staying asleep, dissociative-like re-experiencing of when experiencing true flash-back), and hyper arousal (feeling irritated, angry, difficulty in getting sleep). In addition to the 3 subscale scores, IES-R gives an overall impact of events score (sum of the 3 subscales) also.
PTSD scale for the SCL-90 derived by Saunders et al. (1990) has 28-items that best discriminated women with crime-related PTSD from non-cases. Using the Diagnostic Interview Scale (DIS) as criterion, this scale obtained good sensitivity (.75) and high specificity (.90).
The Penn Inventory (Hammarberg, 1992) was developed and validated with both combat veterans and trauma-exposed non-veterans. This 26-item instrument has high internal consistency (alpha = .94), and test-retest reliability (.96). Sensitivity was found to be .90 and specificity was 1.0 among a sample of 83 veterans, and in a sample of disaster survivors sensitivity was 0.94 and specificity of 1.0.
Other self-report measures of PTSD include, Modified PTSD Scale (MPSS-SR) (Falsetti et al., 1993), Posttraumatic Stress Disorder Diagnostic Scale (PDS) (Foa, 1995), and Davidson Trauma Scale (DTS) (1997).
III. Psycho-physiological assessment of PTSD
Exposure to cues of a traumatic event provoked a systematic physiological response across several measurement domains (e.g., heart rate, skin conductance, EMG, and blood pressure). Blanchard et al. (1982) found that the heart rate response could correctly classify 95.5 percent of the combined sample of 11 male Vietnam veterans suffering from PTSD and 11 non-veteran controls. Blanchard et al. (1982) and Malloy et al. (1983) found that this reactivity predicts the PTSD diagnosis while using auditory and audiovisual cues. Pitman et al. (1987) also observed similar reactivity using personal scripts of traumatic events that were then read to subjects. A 15-site clinical trial conducted by the Department of Veterans Affairs’ Cooperative Study Program later found that psycho-physiological assessment approach could be a useful diagnostic tool in discriminating cases of PTSD from non-cases (Keane et al., 1988). Biological alterations in central noradrenergic activity, the hypothalamic-pituitary-adrenocortic
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II. Self-report scales
The PK-Scale of the MMPI (Keane et al., 1984) consists of 49 items that differentiated PTSD from non-PTSD patients in both a test sample and a cross-validation sample of veterans. Eighty-two percent of 200 subjects were correctly classified using a cut-off score of 30. Subsequent studies have not found the same diagnostic hit rate. The performance of PK in the NVVRS (Kulka et al., 1991) indicates that the MMPI-2 (Lyons and Keane, 1992) modifications have not altered the general interrelationship of PK with other measures of PTSD.
The Mississippi Scale (Keane, Caddell & Taylor, 1988) is available in both combat and civilian versions. It is a 35 item instrument that has high internal consistency (alpha = .94), test-retest reliability (.97), sensitivity (.93), and specificity (.89). This instrument performed effectively in both clinical settings (e.g., McFall, Smith, Roszell et al., 1990) and in field/community settings (e.g., Kulka et al., 1991), indicating its general utility for measuring PTSD across settings and for different purposes (e.g., research or clinical).
Impact of Event Scale (Horowitz, Wilner & Alvarez, 1979) focuses upon the assessment of intrusions and avoidant/numbing responses. IES is the single most widely used instrument for assessing the psychological consequences of exposure to traumatic events. The scale has good internal consistency (.78 for intrusion, .82 for avoidance) and test-retest reliability (.89 for intrusion, .79 for avoidance). Recent studies have found the IES to correlate well with other indices of PTSD. The Impact of events scale-Revised (IES-R) (Weiss and Marmer, 1997) to parallel the DSM-IV criteria for PTSD, is also self-report measure designed to assess current subjective distress for any specific life event. The three sub scales measures, avoidance (the tendency to avoid thoughts or reminders about the incident), intrusion (difficulty in staying asleep, dissociative-like re-experiencing of when experiencing true flash-back), and hyper arousal (feeling irritated, angry, difficulty in getting sleep). In addition to the 3 subscale scores, IES-R gives an overall impact of events score (sum of the 3 subscales) also.
PTSD scale for the SCL-90 derived by Saunders et al. (1990) has 28-items that best discriminated women with crime-related PTSD from non-cases. Using the Diagnostic Interview Scale (DIS) as criterion, this scale obtained good sensitivity (.75) and high specificity (.90).
The Penn Inventory (Hammarberg, 1992) was developed and validated with both combat veterans and trauma-exposed non-veterans. This 26-item instrument has high internal consistency (alpha = .94), and test-retest reliability (.96). Sensitivity was found to be .90 and specificity was 1.0 among a sample of 83 veterans, and in a sample of disaster survivors sensitivity was 0.94 and specificity of 1.0.
Other self-report measures of PTSD include, Modified PTSD Scale (MPSS-SR) (Falsetti et al., 1993), Posttraumatic Stress Disorder Diagnostic Scale (PDS) (Foa, 1995), and Davidson Trauma Scale (DTS) (1997).
III. Psycho-physiological assessment of PTSD
Exposure to cues of a traumatic event provoked a systematic physiological response across several measurement domains (e.g., heart rate, skin conductance, EMG, and blood pressure). Blanchard et al. (1982) found that the heart rate response could correctly classify 95.5 percent of the combined sample of 11 male Vietnam veterans suffering from PTSD and 11 non-veteran controls. Blanchard et al. (1982) and Malloy et al. (1983) found that this reactivity predicts the PTSD diagnosis while using auditory and audiovisual cues. Pitman et al. (1987) also observed similar reactivity using personal scripts of traumatic events that were then read to subjects. A 15-site clinical trial conducted by the Department of Veterans Affairs’ Cooperative Study Program later found that psycho-physiological assessment approach could be a useful diagnostic tool in discriminating cases of PTSD from non-cases (Keane et al., 1988). Biological alterations in central noradrenergic activity, the hypothalamic-pituitary-adrenocortic
One of the old saws of public speaking says that you should 'Tell em what you're gonna tell 'em. Tell 'em. Then tell 'em what you told 'em.' When you want to make a point during your presentation, you can use a similar formula. You tell 'em the point, illustrate the point, then tell 'em the point again. This formula, however, can seem boring and redundant if you don't spice it up a little. One way to do it is to use humor. Here's the formula:1. Make your point.2. Illustrate your point (in our example below we're using a humorous two-liner, but you could use props, humorous props, funny stories, serious stories, case studies, etc.)3. Restate your point.Here's an example where your point is 'The Importance of Communication.'1. First make your point by saying, Accurate and clear communication is an important part of our everyday lives.2. Then illustrate your point. In this case use a humorous two-liner. It's like the student pilot who was asked over the radio to state his altitude and location. He said, 'I'm five feet nine and I'm in the left seat.'3. Then restate your point in a slightly different manner by saying, You can see how what we may think is clear communication could be interpreted incorrectly especially when people are under pressure.When you use humor in a public setting . . . especially when you are speaking to a business audience, or any audience who is not specifically there for humor, make the humor reinforce your point and you will get a much better response.
PTSD scale for the SCL-90 derived by Saunders et al. (1990) has 28-items that best discriminated women with crime-related PTSD from non-cases. Using the Diagnostic Interview Scale (DIS) as criterion, this scale obtained good sensitivity (.75) and high specificity (.90).
The Penn Inventory (Hammarberg, 1992) was developed and validated with both combat veterans and trauma-exposed non-veterans. This 26-item instrument has high internal consistency (alpha = .94), and test-retest reliability (.96). Sensitivity was found to be .90 and specificity was 1.0 among a sample of 83 veterans, and in a sample of disaster survivors sensitivity was 0.94 and specificity of 1.0.
Other self-report measures of PTSD include, Modified PTSD Scale (MPSS-SR) (Falsetti et al., 1993), Posttraumatic Stress Disorder Diagnostic Scale (PDS) (Foa, 1995), and Davidson Trauma Scale (DTS) (1997).
III. Psycho-physiological assessment of PTSD
Exposure to cues of a traumatic event provoked a systematic physiological response across several measurement domains (e.g., heart rate, skin conductance, EMG, and blood pressure). Blanchard et al. (1982) found that the heart rate response could correctly classify 95.5 percent of the combined sample of 11 male Vietnam veterans suffering from PTSD and 11 non-veteran controls. Blanchard et al. (1982) and Malloy et al. (1983) found that this reactivity predicts the PTSD diagnosis while using auditory and audiovisual cues. Pitman et al. (1987) also observed similar reactivity using personal scripts of traumatic events that were then read to subjects. A 15-site clinical trial conducted by the Department of Veterans Affairs’ Cooperative Study Program later found that psycho-physiological assessment approach could be a useful diagnostic tool in discriminating cases of PTSD from non-cases (Keane et al., 1988). Biological alterations in central noradrenergic activity, the hypothalamic-pituitary-adrenocortical axis, the endogenous opioid system, and the sleep cycle have been associated with PTSD (Friedman, 1991). Therefore a biological approach can complement psychological diagnostic techniques.
Role of personality in the development of PTSD
The contribution of predeployment personality traits and exposure to traumatic events during deployment to the development of PTSD symptoms was studied (Bramsen, Dirkzwager, & Van Der Ploeg, 2000) among 572 male veterans of UN Protection Force in former Yugoslavia. Other than exposure to traumatic events during deployment, personality traits of negativism and psychopathology had the highest unique contribution to the prediction of PTSD symptom severity.
Among a random sample of 1007 young adults, with rate of PTSD in those who were exposed to traumatic events being 23.6% and a lifetime prevalence of 9.2%, Breslau, Davis, Andreski, & Peterson (1991) found that risk factors for PTSD following exposure included early separation from parents, neuroticism, preexisting anxiety or depression, and family history of anxiety.
Carlier, Lamberts, & Gersons (1997) found among 262 traumatized police officers, in which 7% had PTSD & 34% had posttraumatic stress symptoms or subthreshold PTSD, trauma severity was the only predictor of posttraumatic stress symptoms identified at both 3 and 12 months posttrauma. At 3 months post-trauma, symptomatology was further predicted by introversion, difficulty in expressing feelings, emotional exhaustion at time of trauma, insufficient time allowed by employer for coming to terms with the trauma, dissatisfaction with organizational support, and insecure job future. At 12 months post-trauma, posttraumatic stress symptoms were further predicted by lack of hobbies, acute hyperarousal, subsequent traumatic events, job dissatisfaction, brooding over work, and lack of social interaction support in the private sphere. Individuals who experienced one or more traumatic events were selected (N=3238) from respondents of the National Comorbidity Survey Part II (N=5877). In separate regression analyses, elevated levels of neuroticism and self-criticism were each significantly associated with PTSD among men and women who had experienced one or more traumatic events. After controlling for types of traumas experienced and other previously identified factors, neuroticism remained significantly associated with PTSD in women and both neuroticism and self-criticism remained significant in men (Cox, Macpherson, Enns, & Mcwilliams, 2004).
The strongest vulnerability factors for both PTSD and subthreshold PTSD were neuroticism and adverse events in early childhood as found in a study involving 1721 older adults (Van Zelst, De Beurs, Beekman, Deeg, & Van Dyck, 2003).
A review of studies on personality in the etiology and expression of PTSD by Miller (2003) concludes that high negative emotionality (NEM) is the primary personality risk factor for the development of PTSD whereas low constraint/inhibition (CON) and low positive emotionality (PEM) serve as moderating factors that influence the form and expression of the disorder through their interaction with NEM. A pre-morbid personality characterized by high NEM combined with low PEM is thought to predispose the trauma-exposed individual towards an internalizing form of posttraumatic response characterized by marked social avoidance, anxiety, and depression. On the other hand, high NEM combined with low CON is hypothesized to predict an externalizing form of posttraumatic reaction characterized by marked impulsivity, aggression, and a propensity towards antisociality and substance abuse.
Cluster analyses (Miller, Greif, & Smith, 2003) of Multidimensional Personality Questionnaires (MPQs) completed by combat veterans revealed subgroups that differed on measures relating to the externalization versus internalization of distress. The MPQ profile of the externalizing cluster was defined by low constraint and harm-avoidance coupled with high alienation and aggression. Individuals in this cluster also had histories of delinquency and high rates of substance-related disorder. In comparison, the MPQ profile of the internalizing cluster was characterized by lower positive emotionality, alienation, and aggression and higher constraint, and individuals in this cluster showed high rates of depressive disorder. These findings suggest that dispositions toward externalizing versus internalizing psychopathology may account for heterogeneity in the expression of posttraumatic responses, as well as patterns of co morbidity.
Schnurr, Friedman, & Rosenberg (1993) tried to assess the predictors of combat-related life time symptoms of PTSD among 131 male Vietnam and Vietnam-era veterans who had taken the MMPI in college and who were interviewed as adults with the Structured Clinical Interview for DSM-III-R. Scores on the basic MMPI scales were used to predict combat exposure, lifetime history of any PTSD symptoms given exposure, and lifetime PTSD classification (symptoms only, subthreshold PTSD, or full PTSD). The findings indicated that scores on MMPI scales were within the normal range and no scale predicted combat exposure. Hypochondriasis, psychopathic deviate, masculinity-femininity, and paranoia scales predicted PTSD symptoms. Depression, hypomania, and social introversion predicted diagnostic classification among subjects with PTSD symptoms. The effects persisted when amount of combat exposure was controlled for. This supports the findings of similar studies that pre-military personality can affect vulnerability to lifetime PTSD symptoms in men exposed to combat
Co-morbidity with anxiety disorders
Co-morbidity studies have shown stronger link of PTSD with anxiety disorders than with other disorders. There is a stronger family history of anxiety disorders than of affective disorders in PTSD sufferers. PTSD shares symptomatology with panic disorder, phobic anxiety, generalized anxiety disorder, and obsessive-compulsive disorder. PTSD like anxiety disorders involves an abnormality in sympathetic system activity.
PTSD among female military personnel
The psychological impact of military service and associated experiences like PTSD were studied commonly among Vietnam War (1959 to 1975) veterans. The significant stressors among female military personnel ranged from hazardous occupational tasks to sexual assault (Wolfe et al. 1993). Women veterans exposed to combat during service were primarily Army nurses (Dienstfrey, 1988). In the earliest study of women and war stress participating 89 female Vietnam veterans, 50% experienced symptoms suggestive of PTSD, and 20% had significantly disruptive symptoms (Schnaier, 1985). Interviews conducted (Norman, 1988) among 50 nurses who served in Vietnam War, found that the intensity of war-time stressors were related to the continuation of higher levels of intrusive and avoidant stress symptoms. Military service at a younger age, less military and professional experience, occupational trauma involving extensive exposure to death and dying were associated with poor post war adjustment (Paul, 1985). Army nurses with less than two years of registered nurse experience prior to their assignment were found to be more at risk for negative outcomes like poor social relations, and difficulty in coping with stressful situations (Baker et al., 1989).
The National Vietnam Veterans Readjustment Study (Kulka et al., 1990) using the Mississippi Scale for Combat-Related PTSD found that females had lower rates of PTSD than male combatants, and women had the disorder in relation to the level of war-zone exposure. A study (Leda, Rosenheck, & Gallup, 1992) among 19,313 Vietnam Veterans found that in comparison with males, significant higher proportion of female homeless veterans were diagnosed as having major psychiatric disorders.
Social support functioned as a substantial moderator of initial PTSD. Stretch et al (1985) found that despite clear-cut exposure, female active duty personnel had significantly less PTSD than their discharged veteran cohorts, suggesting that social support served as an important moderator in the attenuation of PTSD.
Leon et al. (1990) found that coping involving increased self-blame, and focusing on negative affect and cognitions were associated with poorer outcome among female Vietnam veterans. Coping patterns characterized with expressing feelings, seeking emotional support, and searching for meaning in the events experienced, were associated with good psychological functioning, whereas u
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