A broader view of trauma: A biopsychosocial-evolutionary view of the role of the traumatic stress response in the emergence of pathology and/or growth

Dying and caring on the edge: Taiwan's surviving nurses' reflections on taking care of patients with severe acute respiratory syndrome

In 2003, Taiwan's nurses were terrified by severe acute respiratory syndrome (SARS), and four of them sacrificed their life in the course of their work with SARS patients. This study attempted to identify the stage-specific difficulties encountered by Taiwan's surviving frontline nurses during the anti-SARS process. A two-step within-method qualitative triangulation research design was used to obtain the in-depth and confidential thoughts of 200 participants during the precaring, tangible caring, and postcaring stages. Six major types of stage-specific difficulties with and threats to the quality of care of SARS patients were identified according to each specific stage of the caring process. Four themes were further explored; these are discussed to provide a background context in obtaining better understanding of the multifaceted needs of nurses during this crisis. Consequently, a conceptual framework was developed to depict this complex phenomenon.

Violence exposure, a chronic psychosocial stressor, and childhood lung function

OBJECTIVE

Chronic psychosocial stressors, including violence, and neuropsychological and behavioral development in children as well as physiologic alterations that may lead to broader health effects.

METHODS

We studied the relationship between violence and childhood lung function in a prospective birth cohort of 313 urban children (age range = 6-7 years). Mothers reported on their child's lifetime exposure to community violence (ETV) and interparental conflict in the home (Conflict Tactics Scale (CTS)) within 1 year of the lung function assessment.

RESULTS

In linear regression analyses, adjusting for maternal education, child's age, race, birthweight, tobacco smoke exposure, and medical history, girls in the highest CTS verbal aggression tertile had a 5.5% (95% confidence interval (CI) = -9.6, -1.5) decrease in percent predicted forced expiratory volume (FEV(1)) and a 5.4% (95% CI = -9.7, -1.1) decrease in forced vital capacity (FVC) compared with girls in the lowest tertile. The CTS verbal aggression subscale was associated with lung function among boys in the same direction, albeit this was not statistically significant. Boys in the highest ETV tertile had a 3.4% (95% CI = -8.0, 1.1) lower FEV(1) and 5.3% lower FVC (95% CI = -10.2, -0.4) compared with boys in the lowest tertile. The ETV score was not a significant predictor of girls' lung function.

CONCLUSIONS

Interparental conflict, specifically verbal aggression, and ETV were associated with decreased childhood lung function independent of socioeconomic status, tobacco smoke exposure, birthweight, and respiratory illness history. Gender differences were noted based on the type of violence exposure, which may warrant further exploration.

Psychological outcomes and measurement of maternal posttraumatic stress disorder during the perinatal period

For many parents, labor, delivery, and/or the perinatal and neonatal periods present significant stressors that result in clinically significant parental feelings of psychological distress or trauma. This review article identifies known preexisting risk, and protective, factors for such distress, focusing on individual variables and familial or other social support networks. Research describing the full range of possible psychological reactions is also presented, loosely categorized as representing psychological outcomes of resiliency or growth, externalized distress, and internalized distress. These outcomes are viewed as neither linear nor mutually exclusive, and specific implications for each outcome are presented. The primary focus of this review is on the most well understood internalizing distress outcome during the perinatal period, maternal posttraumatic stress reactions. The utility of a brief, freely available measure quantifying such distress is also overviewed, including standards for its usage. Healthcare and particularly nursing staff are encouraged to attend to the range of possible psychological outcomes that may emerge during the perinatal period, identifying distressed mothers, so that they may be referred for care. The review concludes by presenting recommended future directions for research regarding the measurement of posttraumatic stress disorder in parents.

Evolutionary theory, psychiatry, and psychopharmacology

Darwin's seminal publications in the nineteenth century laid the foundation for an evolutionary approach to psychology and psychiatry. Advances in 20th century evolutionary theory facilitated the development of evolutionary psychology and psychiatry as recognized areas of scientific investigation. In this century, advances in understanding the molecular basis of evolution, of the mind, and of psychopathology, offer the possibility of an integrated approach to understanding the proximal (psychobiological) and distal (evolutionary) mechanisms of interest to psychiatry and psychopharmacology. There is, for example, growing interest in the question of whether specific genetic variants mediate psychobiological processes that have evolutionary value in specific contexts, and of the implications of this for understanding the vulnerability to psychopathology and for considering the advantages and limitations of pharmacotherapy. The evolutionary value, and gene-environmental mediation, of early life programming is potentially a particularly rich area of investigation. Although evolutionary approaches to psychology and to medicine face important conceptual and methodological challenges, current work is increasingly sophisticated, and may prove to be an important foundational discipline for clinicians and researchers in psychiatry and psychopharmacology.

Posttraumatic growth in clinical psychology - a critical review and introduction of a two component model

Positive psychological or personal changes in the aftermath of trauma, defined as the result of the struggle with highly stressful events, have recently elicited heightened attention by trauma researchers. This article aims at summarizing the most important theoretical models and conceptualizations of posttraumatic growth (PTG) and addresses the issue of the adaptive significance of this phenomenon. It further renders a thorough empirical review of the relationship between PTG and psychological adjustment. European findings are specifically incorporated. As a conclusion, a two component cognitive model of PTG will be proposed that may explain the contradicting empirical findings in regard to the relationship between mental health and PTG. The Janus-Face model of PTG [Maercker, A. and Zoellner, T. (2004). The Janus face of self-perceived growth: Toward a two-component model of posttraumatic growth. Psychological Inquiry, 15, 41-48.] incorporates a constructive and an illusory aspect. On this basis, findings regarding relevant cognitive factors as predictors of PTG are summarized and evaluated. The article ends with a discussion of fruitful future research directions and how PTG can add a new perspective into trauma therapy.

Growth following adversity: theoretical perspectives and implications for clinical practice

A number of literatures and philosophies throughout human history have conveyed the idea that there is personal gain to be found in suffering, and it is an idea central to the existential-humanistic tradition of psychology. However, it is only relatively recently that the topic of growth following adversity has become the focus for empirical and theoretical work. In this paper, we review theoretical models of growth, and discuss the implications of growth for clinical practice. Three main theoretical perspectives are reviewed, the functional-descriptive model, the meta-theoretical person-centered perspective, and the biopsychosocial-evolutionary view. It is proposed that these three approaches to theory offer different but complementary levels of analysis, and that theoretical integration between them is possible. We then go on to explore the implications of this theoretical integration for clinical practice, and conclude with a consideration of the role of therapy in facilitating growth following adversity.

The psychobiology of PTSD: coping with trauma

Posttraumatic stress disorder (PTSD) is one of the few psychiatric conditions where a specific psychosocial stressor is explicitly tied to etiology. Although a majority of people experience a traumatic event in their life, most of them will not develop PTSD or other mental health problems such as depressive or anxiety disorders. Emotional and neurobiological responses to psychosocial stressors show striking individual variation. In this paper cognitive appraisal and coping factors are explored as potential sources of individual differences in the neuroendocrinological stress response, and subsequently in mental health outcome. Continued study of the psychobiology of trauma and PTSD will enhance our understanding of adaptation to psychosocial stressors and support efforts to treat associated psychological and biological sequelae.

Stress-induced enhancement of fear learning: an animal model of posttraumatic stress disorder

Fear is an adaptive response that initiates defensive behavior to protect animals and humans from danger. However, anxiety disorders, such as Posttraumatic Stress Disorder (PTSD), can occur when fear is inappropriately regulated. Fear conditioning can be used to study aspects of PTSD, and we have developed a model in which pre-exposure to a stressor of repeated footshock enhances conditional fear responding to a single context-shock pairing. The experiments in this chapter address interpretations of this effect including generalization and summation or fear, inflation, and altered pain sensitivity. The results of these experiments lead to the conclusion that pre-exposure to shock sensitizes conditional fear responding to similar less intense stressors. This sensitization effect resists exposure therapy (extinction) and amnestic (NMDA antagonist) treatment. The pattern predicts why in PTSD patients, mild stressors cause reactions more appropriate for the original traumatic stressor and why new fears are so readily formed in these patients. This model can facilitate the study of neurobiological mechanisms underlying sensitization of responses observed in PTSD.

Effects of appraisal and coping on the neuroendocrine response to extreme stress

Although many people are exposed to extreme stress, only some of them develop psychobiological disturbances that can lead to posttraumatic stress disorder (PTSD) or other posttrauma psychopathology. This paper examines the effects of different types of appraisal and coping to find clues to how individuals differ in their neuroendocrine responses to extreme stress. It proposes a conceptual model for components of the adult response to stressors. Threat appraisal and defensive coping may play crucial roles in determining the neuroendocrine response to trauma with potential mental health consequences, particularly PTSD.

Combat stress reactions, posttraumatic stress disorder, cumulative life stress, and physical health among Israeli veterans twenty years after exposure to combat

This study examined the association of initial combat stress reaction (CSR), chronic post-traumatic stress disorder (PTSD) and cumulative life stress on physical health 20 years after the 1982 war with Lebanon, in a sample of 504 Israeli veterans of the war. Two groups were assessed: male veterans who fought and suffered from CSR and a matched group of male veterans from the same units who did not exhibit such reactions. Twenty years following the war, participants were asked to rate their general physical health status, report health complaints and risk behaviors, and were screened for PTSD. CSR and, to a greater extent, PTSD, were found to be associated with general self-rated health, chronic diseases and physical symptoms, and greater engagement in risk behaviors. CSR and PTSD were also related to greater cumulative life stress since the war. Both negative and positive life events were independently related to most of the physical health measures but did not account for the associations of CSR and PTSD with poorer health. Tests of the interactions between CSR, PTSD and life stress in their association with physical health and risk behaviors showed that PTSD suppressed the effects of additional life stress (negative life events had a weaker effect on health among participants with PTSD).