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Consistent with this formulation, in 1994, the DSM-IV dramatically altered its definition of a traumatic event and seemed to acknowledge the role of subjective interpretation in psychotraumatogenesis The DSM-IV stated that to be considered a traumatic event, the event must engender fear, helplessness, or horror (American Psychiatric Association, 1994, p 428) Clearly, fear, helplessness, and horror are all subjective states resulting from appraisal or interpretation It seems reasonable to assume that everything we consciously perceive undergoes a process of psychological filtering Conceptually, an event that becomes a trauma is an event that breaches an individual s protective psychological filtering mechanisms Many authors (Girdano, Everly, & Dusek, 2001; Rahe, 1974) concede that these psychological filters typically consist of factors such as personality traits, culture, prior related experiences, self-concept, and, certainly, an individual s coping mechanisms and resources.

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But some recent writers point to a far more specific factor when asking what makes a traumatic event traumatic The factor is that of the person s extremely important and characterologically anchored schemas, or worldviews From this perspective, a traumatic event is one that violates or destroys a very important and deeply held belief about yourself or your world (Everly, 1993b, 1994; Frank & Frank, 1991) In doing so, the traumatic event can be seen to threaten the structural integrity of the core foundations of personality This notion has been recognized by the World Health Organization (WHO; 1992), which, in its International Classification of Disease-10, noted that traumatic experiences may lead to a fundamental alteration in personality Under the category of Enduring Personality Change after Catastrophic Experience (F620), WHO recognizes the notion that personality can be lastingly altered by trauma.

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Evidence justifying the potential cost savings and quality assurance that is made possible by integrating psychosocial assessment and intervention into health care delivery comes from many sources including epidemiological investigations, health services research, health costs analyses, and treatment efficacy studies. By integrating epidemiological and health services research, we can identify disease comorbidities that account for the highest utilization patterns. Health costs analyses consider the cost of illness and cost of treatment and are used to define the amounts that should be allocated to benefits packages. Costeffectiveness can be tracked through actual cash outlay or through hospital admissions, lengths of stay, number of outpatient visits for follow-up, and the use of expensive (e.g., surgery) and less expensive (e.g., medications) procedures. Some of the psychosocial factors associated with health care costs involve those directly related to medical utilization (short-term cost effects) while others relate more directly to treatment success and recovery and rehabilitation rates ( longer term cost effects). These forms of research are complemented by treatment efficacy studies that test the effects of interventions on the net costs of medical illnesses. These studies are helpful in developing empirically validated guidelines for primary prevention strategies as well as recommendations for treatment choices (i.e., triaging) for people already diagnosed with a medical condition. Successful triaging may result in a recommendation for a synergistic combination of pharmacological (e.g., antidepressant) and psychosocial interventions (e.g., supportive group therapy or individual counseling) that can complement the treatment of the primary medical condition (e.g., cancer) by enhancing adherence to a selfcare routine/ lifestyle change or adjustment to the side effects of the medication. I have proposed that such a synthesis depends on knowledge of patients psychosocial characteristics and health behavior patterns. Realizing this synthesis on a routine basis could aid in

In the final analysis, it may be argued that PTSD represents a phenomenological insult or injury to the structure and function of the essence of an individual s being, that is, the.

Listing 17-2 (continued)

Again, the stick figure needs to land. Fortunately, the squatting figure can be reused, by just moving the squatting character over to the right in your image editor. The standing figure (Figure 38-1) can also be moved to the right in your image editor to make the stick figure stand where it should have landed. The two figures created are shown in Figures 38-6 and 38-7.

Model 2 2.222*** .006 .982*** .034*** .766*** .221* .113** .031 .014 .007 .080*** .410*** .041 .113

the most effective way to encourage patients to adopt exercise activities for which they lack self-efficacy is to expose them to the recommended activity in gradually increasing doses [performance], arrange for them to see others similar to themselves performing the activity [modeling], have respected health care providers offer encouragement by providing reassurance and emphasizing the patient s accomplishments [persuasion], and arrange the setting of the activity so as to induce a relaxed but upbeat mood [arousal, physiological state].

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