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PTSD in Sexual Trauma Victims
by
Abby Kneitz
AN HONORS THESIS
for the HONORS COLLEGE
Submitted to the University Honors College
at Texas Tech University in
partial fulfillment of the
requirement for
the degree designation of
HIGHEST HONORS
MAY 2015
Approved by:
_______________________________
Michael C. Parent, Ph.D.
Assistant Professor, Psychology
____________ Date
_______________________________
Margaret Piper, B.A.
Department of Psychology
____________ Date
_______________________________
Keira V. Williams, Ph.D.
Assistant Professor, Honors College
____________ Date
_______________________________
Michael San Francisco, Ph.D.
Dean, Honors College
____________ Date
PTSD IN SEXUAL TRAUMA VICTIMS
ii
Abstract
Post Traumatic Stress Disorder (PTSD) identifies a traumatic or catastrophic event that
marks the origin of a specific condition, as well as symptoms that are directly related to
the event. The present study aims to experimentally examine mechanisms of Post
Traumatic Stress Disorder in women and predisposition for anxiety in response to
“everyday life” stressors among both women who have and have not experienced trauma.
We hypothesized that individuals who have experienced trauma will have significantly
different affective responses to trauma-related stressors, and will have more difficulty
recalling general information presented due to avoidance and stress if they are subjected
to trauma-related material. Participants read four mock newspaper articles, including
neutral articles, a trauma condition article, and a control article (dental pain) under the
pretense that they would be asked to recall information afterwards. Dental pain was
chosen to control for potential unpleasant or upsetting feelings that may have arisen from
reading the sexual assault article, akin to the use of the same stimulus themes for control
conditions in Terror Management research (Arndt, Greenburg, Schimel, Pyszczynski &
Solomon, 2002; Peters, Greenburg, Williams & Schneider, 2005). The participants also
completed survey materials, including PCL-C, PANAS-X, and LEC-5 in order to assess
affect and likelihood of PTSD. A total of 43 undergraduate women participated in the
study, in which 14% of the participant’s scores on the PCL-C and LEC-5 indicated that
they had experienced sexual trauma, and 86% indicated that they did not experience
sexual trauma. The condition the participants were assigned to (dental pain or sexual
trauma) had no significance on negative affect (p=0. 83). However, the PCL-C scores
were significant and positive (p=0.001), so those with more trauma history also had more
PTSD in Sexual Trauma Victims
iii
negative affect, regardless of the condition to which they were assigned. In addition, the
interaction between condition and the PCL-C scores was also significant, indicating that
there was a relationship between more trauma experience and more negative affect in the
trauma condition. Those who had a significant level of trauma did not appear more
affected by the trauma related article than those who had no trauma experiences.
However, they did have more negative affect regardless of whether it was in response to
the dental pain condition or the sexual trauma condition. The data show that level of
trauma experienced does not inhibit the ability to recall information when subjected to
everyday levels of stress, such as reading a newspaper article that reminds one of trauma.
Thus, daily life stressors that remind individuals of trauma do not significantly impact
their negative affect or induce enough stress to impair cognitive function, and the null
hypothesis failed to be rejected. The results gathered from this experiment could testify
against the validity of the clinical lore that PTSD patients are extremely sensitive to the
reminders of their trauma (Stoll et al., 1999).
PTSD IN SEXUAL TRAUMA VICTIMS
iv
TABLE OF CONTENTS
Abstract........................................................................................................................................... ii
Table of Contents........................................................................................................................... iv
Introduction..................................................................................................................................... 1
Chapter 1: Literature Review ......................................................................................................... 1
Chapter 2: Method.......................................................................................................................... 7
Chapter 3: Results......................................................................................................................... 10
Chapter 3: Discussion………....................................................................................................... 12
Chapter 4: Conclusion.................................................................................................................. 14
Appendix A................................................................................................................................... 16
Appendix B................................................................................................................................... 17
Appendix C................................................................................................................................... 18
Appendix D................................................................................................................................... 20
Appendix E................................................................................................................................... 22
Appendix F.................................................................................................................................... 24
Appendix G................................................................................................................................... 28
Appendix H................................................................................................................................... 29
Appendix I.................................................................................................................................... 30
Appendix J.................................................................................................................................... 31
Appendix K................................................................................................................................... 32
References..................................................................................................................................... 33
1
PTSD IN SEXUAL TRAUMA VICTIMS
Introduction
Post Traumatic Stress Disorder (PTSD) identifies a traumatic or catastrophic event that
marks the origin of a specific condition, as well as symptoms that are directly related to the
event. This includes re-experiencing the stressor, as well as avoidance of stimuli that remind the
individual of the stressor (Breslau, et al., 2002). PTSD is reported to occur in 55 percent of
reported rape victims (Yehuda, 2002). In addition, more than 50 percent of PTSD cases in
women are the result of sexual and physical assault. In juxtaposition, only 15 percent of men
with PTSD develop it from this kind of trauma (Yehuda, 2002). The present study aims to
experimentally examine mechanisms of Post Traumatic Stress Disorder in women and
predisposition for anxiety in response to “everyday life” stressors among both women who have
and have not experienced trauma. We hypothesized that individuals who have experienced
trauma will have significantly different affective responses to trauma-related stressors, and will
have more difficulty recalling information presented due to avoidance and stress if they are
subjected to trauma-related material.
Literature Review
Posttraumatic stress disorder (PTSD) commonly occurs after persons are threatened by
injury or mortality. Often, PTSD may arise after traumatic experiences such as rape, assault, or
combat. Three symptoms, lasting for a minimum of one month at a severity serious enough to
debilitate daily life, characterize PTSD: re-experiencing the event (e.g., flashbacks), avoidance
symptoms (e.g., attempts to avoid situations similar to those in which the trauma occurred), and
hyperarousal (i.e., increased physiological stress). When these symptoms last for an extended
period of time, social and professional performance can be impaired (Ehlers and Clark, 2007).
PTSD in Sexual Trauma Victims
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Ehlers and Clark proposed that these symptoms persist due to a belief that there is an existing
danger, which triggers responses that aim to reduce the observed threat and anxiety in the short
term. However, these responses may ultimately hinder mental healing.
A related problem is that PTSD may impair memory of the event, causing undeveloped
recollection of the circumstances in which it occurred, and often an oversimplification of events.
Thus, stimuli may cause inadvertent recovery of unrecalled details and a wide range of behaviors
may seem much more perilous than they are in reality (Ehlers and Clark, 2007). In addition, the
reinforcement by others to engage in this inhibited state of behavior in order to manage
emotional distress actually intensifies the symptoms of PTSD (Ehlers and Clark, 2007). For
example, a friend or relative could tell the person with PTSD that his or her avoidance behaviors
are perfectly normal, considering their experiences. Thus, the behavior is justified and there is no
resolution to change it.
Both Ehlers and Clark (2007) and Yehuda and LeDoux (2007) agree that temporary
PTSD is a natural response to a distressing experience, and the continuation of the symptoms for
an extended period is necessary for a formal diagnosis of PTSD. Most people begin to process
the event and recover after a period of about three months. Consequently, PTSD is most
accurately designated as a long-term condition, in which psychological healing after a traumatic
event may be inhibited. However, even those who recover can regress following a distressing
reminder or troublesome incident (Yehuda and LeDoux, 2007; Ehlers and Clark, 2007).
Physiological changes have been observed with acute exposure to a stressor, including
increased activity of the sympathetic and decreased activity of the parasympathetic nervous
system: discharge of adrenocortico-stimulating hormone from the pituitary, cortisol from the
adrenal cortex, and catecholamines from the adrenal medulla (Munck, 1984). In addition,
PTSD in Sexual Trauma Victims
3
associated physiological alterations in the function of the autonomic nervous system and organs,
such as heart rate, blood pressure, respiration, and skin conductance, were noted. Stress response
is normally automatically regulated by cortisol negative feedback inhibition, equilibrating stressrelated physiological responses after cessation of the stressor (Munck, et al., 1984).
Studies show that veterans with chronic PTSD demonstrate increased peripheral
catecholamine levels (Yehuda et al., 1999), as well as increased other autonomic measures
compared to controls, in response to stressors (O’Donnell et al., 2004). Though the stressors
were no longer actively occurring in reality, participants did not attain physiological stability.
Additional research has revealed that PTSD patients had an overall general increase in amygdala
activation compared to controls (both non-trauma and trauma-exposed people without PTSD) in
response to endangering stimuli, such as masked faces. Because physiological responses do not
require conscious processing, individuals affected with a hyperactive amygdala, such as those
with PTSD, are increasingly vulnerable (Yehuda &LeDoux, 2007).
It has been shown that damage to the medial prefrontal cortex (mPFC) in rodents
interferes with reduced or extinguished conditioned fear responses, which are usually treated by
repetitive exposure to the stressor without being trailed by negative consequences (Yehuda and
& LeDoux, 2007). Furthermore, research has shown that prolonged stress can cause the
amygdala to develop into a hyperactive state, and in juxtaposition, the mPFC to become weaker.
Consequently, chronic exposure to stressors can cause an overactive amygdala, facilitating fear
responses without the mPFC to adequately intercede and inhibit the amygdala. This
physiological insufficiency could be a process that maintains PTSD symptoms. According to
Yehuda and LeDoux, PTSD may arise from strong associative learning, such as fear
conditioning: a conditioned fear response (CRs) is caused by a neutral conditioned stimulus (CS)
PTSD in Sexual Trauma Victims
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after a connection is made by an unconditioned stressful stimulus (US). This ultimately causes an
unconditioned stress response (URS). When this idea is applied to PTSD, an individual reacts to
a traumatic stressor (US) with anxiety and panic (UCR), then continues to elicit this response
when exposed to reminders (CR), even long after the stressor (CS) is terminated.
Fear may occur due to the combination of information in pathways of the lateral nucleus
of the amygdala for conditioned and unconditioned stimuli (Yehuda & LeDoux, 2007). When
exposed to a conditioned stimulus, activity is then transmitted to the central amygdala, which
connects to the hypothalamic and brainstem areas that control hormonal, behavioral, ANS, and
central arousal response. Neither conditioned nor unconditioned responses, however, require a
conscious processing of stimuli in order to elicit physiological responses.
Recent research investigations concerning the link between PTSD and specific trauma
have been underway. In 2009, a study was performed in which adults with a history of physical
or sexual assault were assessed using an interview process that included assault severity,
background factors, and cognitive processing during the attack in an effort to find links with
PTSD onset and persistence. Ninety-two participants were included, each of who had
experienced physical or sexual assault at least three months prior to the interview. Scores on the
two versions of PTSD Symptom Scale (PSS-SR) allowed groups to be categorized by how they
scored on current symptoms and retrospective ratings of symptoms in the one-month period after
the attack. Groups were divided into the following categories: one group with no PTSD, a PTSD
group, the recovered PTSD group, and the persistent PTSD group (Dunmore et al., 1998).
In the first part of the interview process, participants were asked to reveal demographic
information, other traumatic events, psychological difficulties before and after the assault, and
specific questions about the “nature and severity” of the assault. In addition, they were asked to
PTSD in Sexual Trauma Victims
5
describe the assault in their own words. Questionnaires were given that attempted to evaluate
whether early cognitions were related to the onset of PTSD, focusing on insights during and/or in
the month after the assault, as well as assessment of thoughts during the assault, including
occurrence of mental defeat, mental planning, mental confusion, and detachment. A third
questionnaire was given in which participants recounted emotions they had during the attack, as
well as a possible interpretation for the emotion (e.g. “If I can react like that, I must be very
unstable”). Additional questionnaires included whether or not the participant blamed themselves,
considerations of preliminary post-trauma symptoms, sensitivities to other people’s reactions,
realized permanent changes, dysfunctional cognitive/behavioral strategies, and beliefs impacted
by assault.
The results indicated that there were no substantial differences between the groups in sex,
age, marital status (at interview and assault), education, employment (at interview and assault),
socioeconomic status, or income. The PTSD group was more likely to have experienced
childhood abuse and/or other traumatic events, and reported more psychological difficulties
before their assault. The PTSD group was also more likely to have perceived life threat, threat of
injury, and/or have felt they had no control during the assault. Those with PTSD were more
likely to have viewed others’ responses as negative, and less likely to see them as positive. In
addition, the PTSD group was more likely to consider their lives to be permanently damaged
after the assault. Overall, considerations for the onset and persistence of PTSD were mental
confusion, mental defeat, negative view of emotions, perceived discouraging reactions from
others, change viewed to be permanent, avoidance and security seeking activities, and
viewpoints before and after the attack (Dunmore, Clark, & Ehlers, 1998).
Apparently very little is known about the consequences of trauma in daily life in regard
PTSD in Sexual Trauma Victims
6
to emotional responses and experiences (Glaser et al., 2006). Previous research on animal and
human demonstrates that childhood trauma may have acute and chronic effects into adult life,
influencing emotional and psychological health as well as behavior (Glaser et al., 2006). The
Experience Sampling Method (ESM) is one method to analyze feelings and psychological states
in response to daily life struggles, as well as background information. A study of young adults
(ages 20-44) with somatic complaints who had frequently visited a general practitioner at least
fifteen times within the past three years, with no specific organic diagnosis, was performed. It
included six consecutive days of reporting ten self-assessment rubrics at random times during the
day, disclosing thoughts, mood, and context. Subjects were asked to also report on a scale of 1-7
whether a significant event had occurred which could influence their assessments.
The final study was conducted with 90 people, of which 32% had a history of reported
trauma. The investigation revealed that among this sample, childhood trauma was related to a
greater emotional response to day-to-day stressors, thus reinforcing the theory that childhood
trauma has persistent side effects on adult cognitive functioning. Adults subjected to trauma as
children respond with significantly more distress and negative sentiments when encountering
daily stressors. In addition, results also demonstrated that trauma experienced before ten years of
age was significantly associated with increased negative emotional response to daily stress. This
indicates that trauma at a younger age may be detrimental to adult psychological health (Glaser
et al., 2006).
While work by Dunmore, Clark, and Ehlers (1998) aimed to assess the impact of
reminders of trauma on persons who have experienced trauma, the paradigm used by those
investigators involved “reminders” in the form of asking participants to report on their trauma
experience—potentially much more of an impactful event than the sort of reminders that may
PTSD in Sexual Trauma Victims
7
occur in everyday life, such as reading about a traumatic event in a newspaper. While the study
assessed many factors regarding the onset and continuation of PTSD, the study itself could have
been very traumatic to the participants, who had all experienced some type of assault and were
asked to relive it. Furthermore, there was no evaluation on how the PTSD affected the
participants on a daily basis. In juxtaposition, the study done by Glaser et al. (2006) focused on
emotional and psychological reactions of adults to everyday life stressors as a result of childhood
trauma, whereas the present study is focusing on trauma that occurred in adulthood. In our study,
we aim to evaluate physiological stress reactions to easily encountered reminders (i.e.,
newspaper articles) of assault among persons with and without trauma histories, without asking
participants to re-experience their assaults.
Method
Participants
A total of 43 undergraduate women participated in the study. According to scores on the
LEC checklist 14% participants reported that they had experienced sexual trauma, and 86%
reported that they did not experience sexual trauma. Participants ranged in age from 18-24
(M=19.08, Mdn=19.00, SD=1.30). 72.1% of participants identified themselves as
White/European American, 14.0% as Hispanic/Latino, 2.3% as Asian/Asian American, 9.3% as
African American/Black, 0% as Alaskan Native, 0% as Native Hawaiian/Pacific Islander, and
4.7% as other.
Procedure
After receiving approval from the university’s Institutional Review Board, participants
were recruited from the psychology participant pool at a large university in West Texas.
Participants saw an announcement for the study and clicked a link that directed them to sign-up
PTSD in Sexual Trauma Victims
8
options for open research participation spots. Upon arriving at their session, participants were
seated at a testing terminal opposite a research assistant. Upon being seated, the research
assistant attached physiological stress monitoring equipment to participants to collect data on
pulse and galvanic skin response (GSR). Connection points for the equipment were made on the
right hand. The participants were then directed to the link for the study. Those who wished to
continue participating indicated informed consent to the requirements of the study. Participants
read four mock newspaper articles under the pretense that they would be asked to recall
information afterwards. The articles were formatted to appear as though they were taken from an
actual local newspaper. The participant first read a neutral article, and then were randomly
assigned to either read a fabricated story about a sexual assault in Lubbock, Texas, or a
fabricated story about a botched dental procedure at a (non-existent) local dentist. The latter
story was chosen to control for potential unpleasant or upsetting feelings that may have arisen
from reading the sexual assault article, akin to the use of the same stimulus themes for control
conditions in Terror Management research (Arndt, Greenburg, Schimel, Pyszczynski &
Solomon, 2002; Peters, Greenburg, Williams & Schneider, 2005). Lastly, they viewed the two
remaining neutral articles. As participants moved through the articles, their time to move to each
new page was recorded in the online survey system.
Following completion of the PANAS-X, participants were asked to complete a quiz on
the content of the articles to test recollection of information within the articles as a third measure
of stress (e.g., “The article stated that the FFA Convention has been meeting for how many
years?”). If the article(s) did cause a significant stress response, cognitive performance could be
compromised and result in a lower score for recall of story material. Participants then completed
the demographic form, Life Events Checklist, and PCL-C. Deception about the specific goal of
PTSD in Sexual Trauma Victims
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the study of the study (but not the activities participants engage in during the study) was used to
avoid priming participants to think about sexual assault by stating that the study is about
processing of newspaper articles. After completing all the measures of the study, the participants
were able to view a debriefing page, describing the specific intent for the research, along with
contact information for the researchers.
Measure
Demographics. Participants were asked about their age, race/ethnicity, economic status,
and sexual orientation.
Life Events Checklist. Participants in both conditions completed this checklist in order
to assess PTSD levels within the sample population. The checklist is based on a 5 point system,
in which the participants can rate scale descriptors by answering that the event “happened to
me,” “witnessed it,” “learned about it,” “part of my job,” “not sure,” or “doesn’t apply.” The Life
Events checklist has demonstrated strength as a screening measure to access varying levels of
PTE exposure (Maheux & Price, 2015; Bliese, et al., 2008).
PCL-C. Participants in both conditions completed this self-report measure that assesses
the 20 symptoms of PTSD according to the DSM-5. The purpose of this measure is to monitor
symptom change, screen individuals for PTSD, and to make a PTSD diagnosis. Participants can
rate scale descriptors by answering the questions with “Not at all”, “A little bit,” “Moderately,”
“Quite a bit,” and “Extremely.” This measure has been demonstrated to perform well as a
clinical screening measure for PTSD (Bliese, et al., 2008).
PANAS-X. After reading the articles, participants in both conditions completed the
PANAS-X. This survey scales combined state affect, and has been shown to be stable over time,
PTSD in Sexual Trauma Victims
10
correspond to peer-judgments, and are considerably related to measures of personality and
emotionality. The data show that PANAS-X scales can accurately measure variances in affect in
individuals on a long-term basis (Watson & Clark, 1999).
Results
In Table 1, the percentage of participants experiencing each event on LEC checklist is
presented.
Table 1
LEC Checklist Experience
Item
Event
Natural disaster (for example, flood, hurricane, tornado,
earthquake)
1
2 Fire or explosion
Experience
30.2%
18.6%
Transportation accident (for example, car accident, boat
3 accident, train wreck, plane crash)
4
5
6
7
Serious accident at work, home, or during recreational
activity
Exposure to toxic substance (for example, dangerous
chemicals, radiation)
Physical assault (for example, being attacked, hit,
slapped, kicked, beaten up)
Assault with a weapon (for example, being shot,
stabbed, threatened with a knife, gun, bomb)
Sexual assault (rape, attempted rape, made to perform
any type of sexual act through force or threat of harm)
8
9 Other unwanted or uncomfortable sexual experience
55.8%
23.3%
2.3%
30.2%
7.0%
14.0%
16.3%
Combat or exposure to a war-zone (in the military or as
10 a civilian)
11
12
13
14
15
Captivity (for example, being kidnapped, abducted, held
hostage, prisoner of war)
Life-threatening illness or injury
Severe human suffering
Sudden violent death (for example, homicide, suicide)
Sudden accidental death
Serious injury, harm, or death you caused to someone
else
16
17 Any other very stressful event or experience
2.3%
4.7%
39.5%
11.6%
14.0%
16.3%
4.7%
46.5%
Table 2 demonstrated that the condition the participants were assigned to (dental pain or
sexual trauma) had no significance on negative affect (p=0. 83). However, the PCL-C scores
PTSD in Sexual Trauma Victims
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were significant and positive (p=0.00), so those with more trauma history also had more negative
affect, regardless of the condition to which they were assigned. In addition, the interaction
between condition and the PCL-C scores was also significant, indicating that there was a
relationship between more trauma experience and more negative affect in the trauma condition.
Table 2
Negative
Affect
Model
Step 1
Step 2
Predictor
Constant
Condition
PCL-C Scores
Constant
Condition
PCL-C Scores
Interaction
Unstandardized B
0.86
0.03
0.30
0.82
0.02
0.32
0.15
SE B
0.18
0.12
0.09
0.17
0.11
0.09
0.07
Standardized B
0.03
0.46
0.03
0.50
0.30
p
0.00
0.83
0.00
0.00
0.83
0.00
0.03
For Table 3, the condition assigned was significant for positive affect (p=0.02). The PCLC scores were not significant (p=0.84), so there was no relationship between trauma history and
positive affect for the conditions. The interaction between the condition and the PCL-C scores
was not significant (p=0.70), indicating that there was no relationship between amount of trauma
experience and positive affect in the conditions.
Table 3
Positive
Affect
Model
Step 1
Step 2
Predictor
Constant
Condition
PCL-C Scores
Constant
Condition
PCL-C Scores
Interaction
Unstandardized B
2.90
-0.53
-0.04
2.89
-0.53
-0.03
0.05
SE B
0.31
0.21
0.16
0.32
0.21
0.16
0.12
Standardized B
-0.38
-0.04
-0.38
-0.03
0.06
p
0.00
0.01
0.80
0.00
0.02
0.84
0.70
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Data on recall before and after the conditions is displayed in Tables 4 & 5; however,
there was no significant difference in the ability of those with trauma experience to recall
information before and after the condition was presented.
Table 4
Prerecall
Model
Step 1
Step 2
Table 5
Post Recall
Model
Step 1
Step 2
Predictor
Constant
Condition
PCL-C Scores
Constant
Condition
PCL-C Scores
Interaction
Unstandardized B
1.24
-0.28
-0.01
1.22
-0.28
0.01
0.10
SE B
0.37
0.24
0.19
0.37
0.24
0.19
0.14
Predictor
Constant
Condition
PCL-C Scores
Constant
Condition
PCL-C Scores
Interaction
Unstandardized B
2.63
0.12
0.12
2.66
0.12
-0.06
-0.09
SE B
0.55
0.36
0.28
0.56
0.37
0.29
0.22
Standardized B
-0.18
-0.01
-0.18
0.01
0.11
Standardized B
0.05
-0.03
0.05
-0.04
-0.07
p
0.00
0.26
0.96
0.00
0.26
0.97
0.50
p
0.00
0.74
0.86
0.00
0.74
0.83
0.67
Discussion
The results show that there was enough trauma experience in the sample population to
have significant results. Most participants reported substantial experiences indicative of trauma.
Those who had a significant level of trauma did not appear more affected by the trauma-related
article than those who had no trauma experiences. However, they did have more negative affect
regardless of whether it was in response to the dental pain condition or the sexual trauma
PTSD in Sexual Trauma Victims
13
condition. In addition, those with significant trauma experience were more affected by the
trauma condition than the dental pain condition.
Participants did seem to be more affected by the trauma article than the dental pain
article, as there was less positive affect reported by those who were assigned the trauma
condition. However, participants who had experienced higher levels of trauma were around
average in positive affect response to either condition.
The data show that level of trauma experienced does not inhibit the ability to recall
information when subjected to every day levels of stress, such as reading a newspaper article that
reminds one of trauma. While those individuals who have experienced trauma did have overall
more negative affective responses, they were not significantly different from the control
population for the trauma condition. Thus, daily life stressors that remind individuals of trauma
do not significantly impact their negative affect or induce enough stress to impair cognitive
function, and the null hypothesis failed to be rejected.
Limitations of These Studies
Due to time restrictions, the physiological data was not analyzed in conjunction with the
survey system, as it is a very complex analysis that will require several hours of matching data.
This analysis is predicted to show that individuals with trauma histories will have higher initial
physiological reactivity, but then will not have any substantial differences. This finding would
juxtapose the clinical belief that those with PTSD will have greater sensitivity to daily reminders
of trauma.
Technological limitations. The finger sensors that detected physiological responses had
Velcro that was much too big for many of the participants, and required the Velcro to overlap
PTSD in Sexual Trauma Victims
14
underneath the sensor. If this study were to be reproduced, ordering a smaller size or trimming
the Velcro might be a way to avoid any inaccuracies due to this limitation.
Demographic limitations. The majority of the participants were between the ages of 1824, which is heavily skewed toward the younger side of the population. However, several studies
show that college students are at a high-risk for rape, as they are within the same age
demographic as the majority of rape victims. This rate peaks between the ages of 16-19 years
old, but the second highest rate occurs between the ages of 20-24 years old. These groups have a
vulnerability that is about 4 times higher than the mean of all women (Bureau of Justice
Statistics, 1984). Furthermore, 45% of all alleged rapists that have been arrested are under 25
years of age (Federal Bureau of Investigation, 1986). In October 2014, 68.4% of 2014 high
school graduates were enrolled in colleges or universities (U.S. Bureau of Labor Statistics,
2015). Thus, even this limited sample population seems to have a high enough incidence of
sexual assault to obtain meaningful results.
Modality limitations. There were a few imperfections in the modality study, such as the
inability to control the outside environment. In some instances, there were loud conversations
outside the lab that could have caused the participants to alter their reports on the PANAS-X.
Conclusions
The results gathered from this experiment could testify against the validity of the clinical
lore that PTSD patients are extremely sensitive to the reminders of their trauma (Stoll et al.,
1999).
This experiment was overall very successful, but had a few limitations, such as a larger
and more diverse sample population, more accurate monitoring of physiological responses, and a
PTSD in Sexual Trauma Victims
15
more stable environment without loud outside noises. In addition, the physiological data would
have added more reliability on the study, rather than just depending on on self-reported emotions
and responses. In addition, it would counter any arguments against a low-power effect. If these
were changed by future researchers, the results would be much more credible and influential.
This research, with a more perfected study and a larger sample population, could
potentially guide clinicians to better treat their patients based on increased knowledge about
PTSD and everyday life stressors. Previous studies, such as those done by Dunmore, Clark, and
Ehlers (1998) intended to evaluate the effect of trauma reminders for people who have
experienced trauma, but the study was potentially very stressful for the participants, as they were
asked to recount the events that occurred. In addition, this narrating of trauma experiences is not
something that would occur in daily life, and is certainly not a subtle reminder of the trauma.
Furthermore, the studies performed by Glaser et al. in 2006 were concentrated on how childhood
trauma impacted daily life stressors as adults. In this study, participant reactions were measured
in relation to trauma cues that could be easily encountered in daily life (i.e., newspaper articles),
and how trauma experience is related to affect. Since there seems to be very little data on how
PTSD patients’ stress responses are triggered by trauma cues in daily life, this research seems to
be very relevant and worth looking into further. The implications for this study might be for
clinicians to focus on areas of the disorder other than daily life stressors, since individuals with a
high likelihood of PTSD seem to be doing just fine when exposed to easily encountered
reminders.
.
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Appendix A: Informed Consent
Please share your thoughts in our research project!
What is this project studying?
This study is assessing reactions to newspaper articles. This study will help us learn
more about how news stories affect behavior.
What would I do if I participate?
In this study, you will be prompted to complete questions regarding your experiences,
mood over the past week, and health, and evaluate newspaper articles.
Can I quit if I become uncomfortable?
Yes. Dr. Parent and the Protection Board have reviewed this survey and think you can
answer them comfortably. However, you can stop answering the questions or leave at
any time. You will keep all the benefits of participating if you stop.
How long will participation take?
We are asking as much as 30 minutes of your time.
How are you protecting privacy?
The survey will not ask any personal information in order to protect your privacy. The
research assistant will collect your name from your ID card before you begin to credit
you with participation. The record of you having come in cannot be linked back to your
survey answers.
I have some questions about this study. Who can I ask?
Dr. Parent from the Psychology Department at Texas Tech University is running this
study. If you have questions, then you can reach him at (806) 742-3711 or email
[email protected]. Texas Tech University also has a Board that protects the
rights of people who participate in research. You can ask them questions at (806) 7423905. You can also mail them at the Institutional Review Board for the Protection of
Human Subjects, Office of the Vice President for Research, Texas Tech University,
Lubbock, TX 79409.
How will I benefit from participating?
You will receive 0.5 research credits for your participation.
Please sign below if you agree to participate in this study.
Signature
Print name
Date
PTSD in Sexual Trauma Victims
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Appendix B: Demographics
1. What is your gender?
1. Man
2. Woman
3. Transgender
2. What is your age in years?
3. Think of the scale below as representing where people stand in the United
States, with regard to wealth/income/jobs. On the right are people who are the
best off—those who have the most money, the most education, and the most
respected jobs. At the left are the people who are the worst off—who have the
least money, the least education, and the least respected job or no job. Where
would you rank yourself on this scale?
(visual analog scale)
4. Below, please indicate your race/ethnicity. Please feel free to use text
boxes to further specify.
1. American Indian or Alaska Native
2. Asian or Asian American
3. Black or African American
4. Hispanic or Latina/o
5. Native Hawaiian or other Pacific Islander
6. White
7. Other
5. Regarding sexual orientation, do you identify as (click all that apply):
1. Heterosexual
2. Bisexual
3. Gay
4. A different identity:
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Appendix C: Neutral Article #1
Woman wins $808,114 payout after
dentist botched tooth extraction
November 18, 2014
Michael Inman
A botched extraction in which part of a tooth was forced into a woman's sinus cavity has
cost a dentist more than $800,000 in damages.
A Lubbock woman has won more than $800,000 in damages after a piece of tooth was
forced into her sinus cavity during a botched molar extraction.
Mary Ann Robinson visited Dr Hock Nien Ng with a toothache in December 2009.
An inspection revealed the upper right molar had extensive decay under an existing
filling.
Dr Ng told her the options were either a tooth extraction or root canal therapy.
She opted to have the tooth pulled, but the procedure went wrong when the crown of the
tooth broke.
Dr Ng continued with the extraction, taking breaks in between to see other patients, and
managed to remove part of the root of the tooth.
He then took a further X-ray and continued, but accidently pushed the remaining part of
the tooth into her sinus cavity.
Dr Ng stitched the socket and told her she required surgery.
Ms Robinson then went to Covenant Hospital's emergency department after feeling ill
and was referred to the maxillofacial unit at the Texas Tech University Health Science
Center.
She was given antibiotics in preparation for surgery.
She reported that water would come out of her nose when she had a drink.
But Ms Robinson lost control and sensation in the right side of her face – which was later
diagnosed as Bell's Palsy – and developed an infection which required admission to
hospital.
PTSD in Sexual Trauma Victims
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She underwent surgery about a week after the botched extraction, with doctors
successfully removing the piece of tooth that had been freely moving within her sinus
cavity.
The operation was successful, but Ms Robinson then lost sensation in her upper teeth and
gums.
She then suffered an infection to her jaw bone and required treatment until September
2011.
Ms Robinson's career as a vet was severely affected by her continued health issues.
She launched civil action against the dentist, claiming personal injury as a result of
negligence.
But Dr Ng argued he had continued the procedure upon her instruction.
Master David Mossop, in a judgment published in the ACT Supreme Court on Tuesday,
found in Ms Robinson's favour and awarded her $808,114 to cover damages, loss of
income, and out-of-pocket expenses.
Original Article: http://www.canberratimes.com.au/act-news/woman-wins-808114payout-after-dentist-botched-tooth-extraction-20141118-11oumb.html
PTSD in Sexual Trauma Victims
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Appendix D: Trauma Condition
Prosecutors: Man sexually assaulted
woman, held her captive for more than
12 hours
July 13, 2014
By Geoff Ziezulewicz
LAJ reporter
A West Lubbock man who prosecutors say sexually assaulted a woman and held her
against her will for more than 12 hours beginning Tuesday night was ordered held on
$300,000 bail Sunday.
Darrick Williams, 53, of the 7200 block of South Indiana Ave, is charged with
aggravated criminal sexual assault and aggravated kidnapping in the incident, which
began about 9 p.m. Tuesday, according to First Assistant District Attorney Wade Jackson
and Lubbock County court records.
The woman had stopped at Williams’ business and had a cigarette, Gamboney said.
She tried to leave after about 15 minutes but Williams refused to let her go, Gamboney
said.
He then took the woman’s purse and struck her in the face repeatedly, according to
Gamboney.
The woman had a knife but Williams took it from her and sliced her thumb, Gamboney
said.
Williams then ordered the woman to remove her clothing and clean herself, Gamboney
said, then Williams sexually assaulted her.
The woman tried to leave the storefront several times but Williams would not allow her
to go, Gamboney said, as he had locked the door and had the key in his pocket.
Three other females showed up at one point and smoked crack
PTSD in Sexual Trauma Victims
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cocaine with Williams, Gamboney said.
Two left but one remained and had sex with Williams, Gamboney said.
Williams at one point pulled off the victim’s shorts and attempted to have sex with her as
well, he said.
When the woman fought Williams off, he slapped her and forced her to perform oral sex
on him, according to Gamboney.
Williams told the woman throughout the incident that he was going to kill her,
Gamboney said.
Early Wednesday, the victim was able to persuade Williams to give her phone back to
her, Gamboney said, and she texted a friend and told her she had been kidnapped.
Police arrived and took Williams into custody, Gamboney said. The entire ordeal lasted
just less than 13 hours.
Original Article: http://articles.chicagotribune.com/2014-07-13/news/chi-prosecutorsman-sexually-assaulted-woman-held-her-captive-for-more-than-12-hours20140713_1_man-assaulted-woman-calumet-park-13-hours
PTSD in Sexual Trauma Victims
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Appendix E: Neutral Article #2
LUBBOCK TO HOST THE 83RD
ANNUAL TEXAS FFA CONVENTION
By: Texas FFA
July 01, 2011
Lubbock will extend a West Texas welcome to an estimated 10,000 FFA members,
agricultural science teachers and supporters July 11-15, 2011, as the 83rd Annual Texas
FFA Convention gets underway. Texas Tech University’s United Spirit Arena will serve
as headquarters for the event.
Members of the agricultural youth leadership organization will spend the week attending
leadership workshops, hearing nationally acclaimed motivational speakers, being
recognized for their outstanding achievements and serving as the legislative body for the
Texas FFA Association.
Nearly $2 million in scholarships will be awarded to FFA members throughout the
convention and an estimated 1,396 members will receive the Lone Star FFA Degree, the
highest degree of active membership bestowed by a state FFA association. Members will
also be competing for state titles in public speaking and agriscience events. In the interest
of premier leadership, personal growth and career success, the Texas FFA Association is
also offering an opportunity for students to compete in the second annual Spanish version
Creed Speaking Event. The FFA Creed is a five-paragraph statement recited by members
to reflect their growing belief in agriculture and agricultural education. The Creed
delivery and the five-minute question-answer period will be conducted entirely in
Spanish.
The convention would not be possible without the continued efforts of the Texas FFA
Convention Host Committee. The host committee is assembled from key leaders within
the host city. The 2011 host committee is chaired by Jeff Lansdell of CEV Multimedia,
Ltd. This convention will bring more than $4 million in economic impact to the city of
Lubbock. “All businesses in Lubbock need to prepare for this massive influx of students,
teachers and parents to Lubbock for this, the largest convention in Lubbock for
2011,”said Jeff Lansdell, Chairman of the Host Committee.
Texas FFA will honor soldiers and all American military service personnel, including
Retired Marine Corporal Anthony Villarreal, during the Honoring Our Heroes Ceremony
on Wednesday, July 13. In 2008, Villarreal suffered severe burns when a roadside bomb
detonated near the vehicle he was riding in on a mail and water run in Afghanistan. It was
his third combat tour; the first two were in Iraq.
The Texas FFA reunites Texas FFA Past State Officers (P.S.O.) through decade reunions.
More than 800 individuals have served as Texas FFA State Officers since the association
PTSD in Sexual Trauma Victims
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was established in 1929. Serving as a state FFA officer is a rare experience, creating a
small, unique alumni. The Past State Officers Alumni Association meets annually in
conjunction with the convention, holding officer team reunions in ten-year increments
and supporting the Texas FFA Association. The officer teams that served in 1950-1951,
1960-1961, 1970-1971, 1980-1981, 1990-1991 and 2000-2001 will hold reunions in
Lubbock this year. Notable members of the Texas FFA Past State Officer Alumni
Association include current Texas Agriculture Commissioner Todd Staples and former
U.S. Congressmen Bill Sarpalius. The past state officer luncheon will be held on
Thursday, July 14th, 2011 at noon.
Other organizations taking part in the Texas FFA Convention include the Texas FFA
Foundation, Texas Collegiate FFA, Texas FFA Alumni and the Vocational Agriculture
Teachers Association of Texas (VATAT). We hope to see you at this year’s 83rd Texas
FFA Convention!
Original Article: http://news.texasffa.org/article.aspx?ID=135
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Appendix F: Neutral Article #3
Idalou boy raising money for Kidd's Kids
IDALOU, TX (KCBD) - The Team Bray Fundraiser was held in Idalou on
Saturday in an effort to raise money for Kidd’s Kids.
The donations help The Kidd Kraddick in the Morning show sends kids with chronic or
terminal illnesses and their families on an all-expense paid trip to Walt Disney World in
Florida.
Despite never going on a Kidd’s Kids trip, 15-year-old Bray Reed was behind the
fundraising. He was born with Caudal Regression Syndrome and kidney failure.
“He took his dad’s kidney at the age of two,” Bray’s mom, Misty Reed said. “Last year
he was diagnosed with stage four Hodgkin’s Lymphoma.”
After undergoing chemo therapy in Fort Worth, Bray came home to a welcome home
party put on by the community.
More than $2,000 dollars was collected for Kidd’s Kids, and that is when the Team Bray
Fundraiser came about.
“I just wanted to help kids like me in my state,” Bray said. “I knew they needed to get
away from all the hospitals and all the pain they go through every day. I just wanted them
to get away from that.”
Bray didn’t stop there. Now in remission, he worked to make sure more money was
raised this year.
“I just gathered some friends and said, ‘let’s make it bigger this year,’ and it happened,”
Bray said. “I am really blessed that it did. It feels like I am a hero to them, because they
get to do something fun and not worry about hospitals.”
“I could not have asked for anything better.” Misty said. “I am super, super blessed to
have Bray, and I wouldn’t change it for anything. He is my hero.”
If you would like to donate to the cause, a Team Bray Fundraiser bank account has been
set up at First Capital Bank of Texas at 6811 Indiana Ave in Lubbock.
You may also donate directly to Kidd’s Kids at www.kiddkids.com
Copyright 2014 KCBD. All rights reserved.
Original Article: http://www.kcbd.com/story/26239802/idalou-boy-raising-money-forkidds-kid
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Appendix F: Neutral Article #4
The South Plains Wildlife Center hosted
open house Saturday
Birds of prey were on display on the arms of several volunteers at
the Saturday open house
Posted: December 22, 2012 - 6:11pm
By CHRIS HOFF
AVALANCHE-JOURNAL
Bird lovers flocked together on Saturday for an open house at the South Plains Wildlife
Rehabilitation Center in South Lubbock. The event from 11 a.m. to 2 p.m. was a chance
for visitors to see the center; it is normally not open to the public.
In 2013 the wildlife center will celebrate 25 years of helping animals and serving South
Plains residents. Founder Carol Lee didn’t start out to create a wildlife center, she
explained in the center’s newsletter. In the 1980s she worked at a veterinary clinic and
was troubled by the birds that had to be euthanized — sometimes even healthy birds.
Once she started bringing birds home, one step progressed to the next.
The center’s newsletter, “The Mockingbird Chronicles,” is an homage to the first wild
bird she successfully raised and released.
At the wildlife center the birds are just like people, Ami Knox, the center’s assistant
manager, explained, they are more comfortable with some people than others. She chats
while a retail hawk named Samantha perches on her arm. Samantha’s vision was
damaged and so she can’t be released back into the wild.
“She can see her prey,” Knox said. “But she misses it when she goes after it.”
The retail hawk is native to Texas; some of the birds will migrate to South America in the
winter and some will not. The Swainson hawk, such as Toenails — perched on the arm of
Tom McLaughlin — is a similar looking bird that migrates south during the winter.
Samantha has been at the center for about 10 years, while Toenails arrived about five
years ago.
“They each have their own personality,” Knox said of the birds at the center. “They each
have individual and unique stories that brought them to us.”
PTSD in Sexual Trauma Victims
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Knox pointed out it is difficult to find and experience many of the birds the center has in
the wild. The birds are brought to the South Plains Wildlife Rehabilitation Center by
residents, game wardens and animal control officers.
If you find a larger prey bird you’re thinking of taking into the center, Knox warns of
their talons.
“We usually suggest people use a thick blanket to cover them,” Knox said, “or call a
game warden.”
Working at the wildlife center is something Knox loves.
“It is great to be able to work with animals one on one,” Knox said.
For Maya Silberbush, the center is a reminder of similar places in her home country of
Israel.
“We love animals,” Silberbush said. “We come from Israel; we have lots of places like
this.”
Silberbush came to Lubbock with her husband a year ago. He plans on studying one more
year at Texas Tech before they return.
A fellow student at Tech, Heather Hightower, had a Mississippi Kite named Hawkeye.
“They’re gorgeous animals,” Hightower said, “and they’re so smart.”
Hawkeye was raised at the wildlife center; Hightower has been volunteering there for the
last year.
“I love it,” Hightower said. “I love the fact I get to help animals.”
A successful stay at the center for birds results in their release into the wild.
“It is a rewarding experience,” Hightower said. “Especially when we can release them, I
love hearing they got to go back into the wild.”
Hightower is studying chemistry and biology and planning on using her experience
volunteering to get into graduate school. She points out many of the birds at the center
are illegal to have as pets, and it is even illegal to possess one of their feathers.
“It gives you an idea of what Mother Nature is really like,” Hightower said of being at the
wildlife center.
PTSD in Sexual Trauma Victims
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The barn owl Jasper was on the arm of Gail Barnes, the education and volunteer
coordinator. Jasper, who was born at the center 19 years ago, has been there a good deal
longer than Barnes who started 13 years ago.
Last year Barnes took the birds to 110 environmental education events across West
Texas, from Midland to the border and north into the Panhandle region. These
experiences teach children about the habitat and diet of the birds and explain how
the drought has harmed them.
“They need to learn about our natural resources,” Barnes said of the students. “We want
to make sure the birds of prey are here for our future.”
The birds of prey are important for controlling rodent and insect populations, Barnes
explained.
She added, in doing so they help to limit the spread of a number of diseases.
Original Article: http://lubbockonline.com/local-news/2012-12-22/south-plains-wildlifecenter-hosted-open-house-saturday
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Appendix G: Test of Content Recall
1. The article stated that the FFA Convention has been meeting for how many years?
a. 2 years
b. 11 years
c. 83 years
d. 150 years
2. The second annual Creed Delivery competition will be in what language?
a. French
b. English
c. Spanish
d. Portuguese
3. Bray Reed has never gone on a Kidd’s Kid trip.
a. True
b. False
4. Where is Bray Reed from?
a. Lubbock
b. Wolfforth
c. Idalou
d. Muleshoe
5. What is the name of the newsletter published by South Plains Wildlife Center?
a. The Mockingbird Journal
b. The Mockingjay Chronicles
c. Lubbock Avalanche Journal
d. The Mockingbird Chronicles
6. What does the article say is a successful stay for birds at the Wildlife Center?
a. Nursing them back to full health
b. The rehab of broken wings
c. Release into the wild
d. Becoming calm around humans
PTSD in Sexual Trauma Victims
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Appendix H:
Positive and Negative Affectivity Schedule – Expanded Form 5 pt. scale, 1=Not
at all, 5=Extremely
This scale consists of a number of words and phrases that describe different feelings and emotions. Read
each item and then click the appropriate answer in the space next to that word. Indicate to what extent
you have felt this way during the past week. Use the following scale to record your answers:
1
not at all
2
a little
3
moderately
4
quite a bit
5
extremely
cheerful
sad
active
angry at self
disgusted
calm
guilty
enthusiastic
attentive
afraid
joyful
downhearted
bashful
tired
nervous
sheepish
sluggish
amazed
lonely
distressed
daring
shaky
sleepy
blameworthy
surprised
happy
excited
determined
strong
timid
hostile
frightened
scornful
alone
proud
astonished
relaxed
alert
jittery
interested
irritable
upset
lively
loathing
delighted
angry
ashamed
confident
inspired
bold
at ease
energetic
fearless
blue
scared
concentrating
disgusted
with self
shy
drowsy
dissatisfied
with self
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Appendix I:
PTSD in Sexual Trauma Victims
31
Appendix J:
PTSD IN SEXUAL TRAUMA VICTIMS
32
Appendix K: Debriefing
Thank you for participating in this project! We appreciate your assistance.
You checked in with a research assistant, and will receive your credit for participation
shortly. Note that the credit system is not automated so credits may take a few days to
appear in your SONA account.
The Gender, Sexuality, and Behavioral Health lab is currently working on a project
examining sexual trauma. The aim of this study was to look at sensitivity to everyday
things that might make someone think about trauma (newspaper articles, in this study).
The articles you viewed were fabricated news articles designed to allow us to see how
you physically reacted to them.
If you have any questions about this research, you may contact the lead investigator, Dr.
Mike Parent, at [email protected], or by phone at (806) 742-3711. You can also
contact the Human Research Protection Program, Office of the Vice President for
Research, Texas Tech University, Lubbock, TX 79409, at 806-742- 2064.
If you feel that you need to speak with someone to discuss your own or other’s
experiences regarding trauma, you may contact the Student Counseling Center offered by
Texas Tech University. They can be reached at (806) 742-3674.
Thank you!
PTSD in Sexual Trauma Victims
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