Date of Award

Spring 1999

Document Type

Dissertation - Restricted

Degree Name

Doctor of Philosophy (PhD)



First Advisor

Melchert, Tim

Second Advisor

Grunert, Brad

Third Advisor

Rusch, Mark


The symptomology of posttraumatic stress disorder (PTSD) has been acknowledged and documented for more than one hundred years but formal recognition of PTSD did not occur until 1980 (American Psychiatric Association, 1980). The social and financial consequences of PTSD are far reaching and support the need for accessible, effective and timely treatment. Work-related injuries represent a special subset of those experiencing PTSD. Annually, 16 million persons experience upper extremity injuries, many of whom are likely to develop PTSD (Krieger, Kelsey, Harris & Pastides, 1981). Current research suggests that cognitive behavioral exposure-based therapies are the most effective to date for the treatment of PTSD. This study expanded the growing empirical data regarding prognostic factors for persons diagnosed with PTSD following upper extremity injuries by exploring the impact of early versus delayed imaginal exposure on amelioration of PTSD symptomology. The subjects were 60 participants who naturalistically fell into the early (30-60 days) and the delayed (greater then 120 days) treatment groups. These participants were referred to the Medical College of Wisconsin for treatment of PTSD resulting from traumatic injuries. All participants were assessed for PTSD symptomology using nine measures at onset of treatment, end of treatment and at 6-month follow up evaluations. A licensed psychologist using imaginal exposure treated all participants. Doubly multivariate analysis of variance yielded significant within-subject effects across all dependent variables at the three measurement points ( p <.001). There were no significant differences between groups in either reduction in PTSD symptomology or return to work status. Additionally, univariate F tests supported the efficacy of imaginal exposure for the reduction of PTSD symptomology across time (p <.001). The number of treatment sessions between the early versus delayed treatment group was significant (p <.001) using a West of independence. This indicated that the early treatment group required fewer treatment sessions than did the delayed treatment group. The significant findings of this research were discussed. Implications of these findings for the treatment of PTSD and suggestions for future research were outlined.



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