What Determines Posttraumatic Stress and Growth Following Various Traumatic Events? A Study in a Turkish Community Sample

Cultural adaptation of the guidelines for offering mental health first aid to a person after a potentially traumatic event: a delphi expert consensus study in Brazil

BACKGROUND

Traumatic events increase the risk of mental disorders. In a country with relatively under-developed mental health support systems, services to assist people who have experienced potentially traumatic events may be unavailable. In such situations, people in the community become key sources of support. However, they do not always have the knowledge and skills to offer effective help. This study reports on the cultural adaptation for Brazil of the English-language mental health first aid guidelines for helping someone who has experienced a potentially traumatic event.

METHODS

A Delphi expert consensus study with two expert panels, one comprising health professionals with experience in the treatment of trauma (n = 33) and the other comprising people with lived experience, (n = 29) was conducted. A questionnaire containing 131 statements from the English language guidelines was translated into Brazilian Portuguese. Participants were asked to rate the importance of actions to be taken to help a person who has experienced a potentially traumatic event and to suggest new items where appropriate.

RESULTS

Data were collected over two survey rounds. A total of 149 items were included in the final guidelines (110 items from the English-language guidelines and 39 new items created from expert panel comments, in the second round). Immediate action items were endorsed by both panels, while items related to encouraging victims were rejected by the professional panel. The suggested statements mostly related to providing psychological support and attending to the person's subjective experience rather than providing material or structural support.

CONCLUSION

While there were many similarities with the English-language guidelines for high-income countries, the guidelines also incorporate actions of importance for Brazil, including the emphasis on the first aider's management of the person's subjective experiences. These guidelines may inform Mental Health First Aid training for Brazil and may also be used as standalone resources.

Changes in posttraumatic growth, core belief disruption, and social support over the first year of the COVID-19 pandemic

Post-traumatic Growth (PTG) is the positive psychological change that may occur after a highly stressful situation that shakes a person's core beliefs about the world. During 2020, the United States experienced the COVID-19 pandemic and a highly contentious political election, both of which have the potential to disrupt core beliefs and evoke perceptions of PTG. Post-traumatic growth, core belief disruption, perceived social support from humans and pets, coping strategies, and stressful events were assessed in 201 participants from the United States (Mage: 35.39, SD: 14.60) at four time points from April 2020 (T1) until April 2021 (T4). While total PTG did not significantly change from Time 1 to Time 4, perceptions of personal strength and new possibilities increased, as did core belief disruption, and the use of coping strategies decreased. Higher PTG was reported by those who owned pets, those who knew someone who had been hospitalized due to COVID-19, and those who knew someone who had died of COVID-19. While rating COVID-19 or politics as the most stressful event at Time 4 did not correspond to differences in PTG, those who perceived the event to be resolved had higher PTG than those who perceived the event to be ongoing. Having COVID-19 personally and vaccination status was not associated with differences in Post-traumatic Growth. PTG at Time 4 was predicted by core belief disruption and social support in the full sample and in the pet owners only sample, and by support from video conferencing for the full sample only. Time 4 PTG was also predicted by core belief disruption, problem-focused coping, and avoidance coping. Results are discussed in terms of the PTG theoretical model. Additionally, implications for interventions aimed at fostering psychological growth, including through non-traditional forms of social support (i.e., remote communication and perceived support from pets) are addressed.

Posttraumatic Growth and Posttraumatic Stress Symptoms in People with HIV

Receiving a diagnosis of HIV can be challenging. People with HIV (PWH) can experience high levels of distress, as well as some positive psychological changes associated with post-traumatic growth. However, the mechanisms which underlying the association of a highly stressful event (i.e., being diagnosed with HIV) and posttraumatic growth (PTG) and posttraumatic stress symptoms (PTSS) are under-explored, and this is the focus of the study. Cross-sectional survey data were provided by 77 PWH living in New Zealand. An analysis examined the roles of deliberate rumination and coping strategies as serial mediators of the associations between event centrality and PTG and PTSSs. The relationships between event centrality and PTG and PTSSs were found to be sequentially mediated by deliberate rumination and avoidance coping, but not by deliberate rumination and active coping. Further analyses explored active coping and deliberate rumination as parallel mediators, with avoidance coping as a subsequent mediator, between event centrality and PTG and PTSSs. However, these analyses were not supported. The findings indicate that the more participants appraised the HIV diagnosis as central, the greater PTG they perceived; however, the more they deliberately ruminated on it, and the more avoidance coping they adopted, the less PTG and greater PTSSs they perceived. Future studies need to explore the relationships of event centrality and coping and their associations with PTG and PTSSs.

The Mediating Role of Cognitive Processing in the Relationship Between Negative and Positive Effects of Trauma Among Female Victims of Domestic Violence

Exposure to domestic violence may lead not only to negative but also positive consequences of trauma. Negative effects are indicated by posttraumatic stress symptoms (PTSSs), and positive effects by posttraumatic growth (PTG) changes. PTG has been conceptualized to follow experiences of PTSSs. Therefore, the positive and negative effects of trauma appear to be related to one another. The cognitive processing may play a special role in determining whether the positive and negative consequences of trauma exposure are experienced. The aim of the study was to establish the mediating role of multiple patterns of cognitive processing, reflected by the cognitive strategies used to cope with trauma, in the relationship between negative and positive posttraumatic changes in women following domestic violence. Data were obtained from 63 Polish women who had experienced domestic violence. The age of the respondents ranged from 19 to 71 years (M = 42.25, SD = 14.81). The Polish versions of the following standardized tools were used: the Posttraumatic Stress Disorder Checklist (PCL-5), the Posttraumatic Growth Inventory (PTGI), and the Cognitive Processing of Trauma Scale (CPOTS). PTSS severity appeared to be negatively related to that of PTG. Negative coping strategies were positively related to the PTSS severity but negatively to PTG, while positive strategies were negatively related to the PTSS severity but positively to PTG. Cognitive strategies for coping with trauma, such as resolution/acceptance, downward comparison, and regret, appeared to play a mediating role in the relationship between PTSS severity and PTG. Positive coping strategies strengthen the occurrence of positive posttraumatic changes while strategy of regret weakens the PTG changes occurrence. The process of adaptation and human development among people who have experienced traumatic events is favored by the use of more frequent positive and less frequent negative strategies of dealing with trauma.

Post-traumatic stress, growth, and depreciation during the COVID-19 pandemic: evidence from Turkey

Background: A worldwide health threat, the COVID-19 pandemic, has highlighted the need to focus on its mental health impact. However, literature on mental health effects including post-traumatic consequences of the pandemic is scarce. Objective: The current study examined post-traumatic stress (PTS), growth (PTG), and depreciation (PTD) during the pandemic, and explored factors associated with these mental health outcomes in an adult community sample from Turkey. Method: A total of 685 participants responded to an online survey that gathered data on sociodemographic characteristics, financial loss during the pandemic, time spent at home and frequency of social media use, perception of COVID-related risks, stress, and event-related rumination. Data analysis included correlation and regression analyses. Results: Results showed that PTS, PTG, and PTD were positively correlated with each other. Younger age and being single were associated with higher PTS and PTD, and lower education levels predicted all three outcomes. Experiencing financial loss during the pandemic, more frequent social media use to follow COVID-related news and posts, and longer time spent at home during the pandemic were associated with higher PTS. Anticipating financial risks during the pandemic were associated with all outcomes while anticipating health-related risks due to COVID-19 and perceived stress levels predicted PTS and PTD but not PTG. Both intrusive and deliberate rumination were associated with higher levels of PTS and PTD, and PTG was predicted solely by deliberate rumination. Moreover, provisional PTSD was indicated in 47.9% of the participants. Membership to the provisional PTSD group was predicted by age, level of education, time spent on social media, anticipating COVID-19-related health risks, perceived stress, and event-related rumination. Conclusions: The current study provides empirical evidence for the short-term post-traumatic effects of the COVID-19 pandemic and related factors, which can help to guide mental health services during the pandemic.

Predictors of Posttraumatic Growth: Insights From a Comparison Between Assault Victims and Nonassault Victims

Posttraumatic growth (PTG) has been investigated in many different areas of trauma, including cancer, occupation-related injuries, and crimes. In the current study, we aimed to examine the effects of traumatic events on the victims' PTG. The current study was a survey study with group comparison. We recruited 143 victims of trauma (74 nonassault victims and 69 assault victims) and compared victims' PTG and its related factors according to the trauma type. Nonassault victims showed better outcomes in terms of adverse childhood experience, depression, anxiety, and acceptance than assault victims. Only for assault victims, PTG was predicted significantly by the individuals' resilience. For nonassault victims, anxiety showed significance in predicting PTG. Assault victims seemed to be at significantly higher risk for psychological issues in adaptation afterward than nonassault victims. The implications of the results, including more tailored support for assault victims, as well as future study suggestions, are discussed.

Culturally shared metaphors expand contemporary concepts of resilience and post-traumatic growth: contrasting an indigenous Brazilian community and a Swiss rural community

The metaphorical concepts resilience and post-traumatic growth (PTG) reflect the contemporary Western understanding of overcoming highly challenging life events. However, it is known that across different cultures, a broad range of metaphorical idioms for describing adaptive responses to severe adversity exists. This study aimed to explore and contrast two distinct cultural groups' culturally shared metaphors for overcoming severe adversities. Fieldwork was conducted in two rural communities: an indigenous Brazilian community that has experienced severe collective adversity and a mountain village in Switzerland that has survived a natural disaster. We carried out separate qualitative metaphor analyses of semistructured interview data from each community. There were some similarities in the metaphorical narratives of the two cultural groups, for example, in metaphors of balance, changed perspective, collective cohesion and life as a journey The main variations were found in metaphors of magical thinking, equilibrium and organic transformation used by the Brazilian group and metaphors of work, order and material transformation used by the Swiss group. Results from this study suggest that the Western-devised concepts of resilience and PTG can be further expanded, which is highlighted by the variety of culturally shared metaphors. Metaphorical idioms for overcoming severe adversity may be determined by the type of trauma as well as by the sociocultural and historical context. Our findings indicate potential approaches to the cultural adaptation of psychological interventions.

Loss in the Life Story: Remembering Death and Illness Across Adulthood

The experience of loss has not often been studied in the life story literature. Life disruption when loss of a loved one occurs may make loss events distinct, even from other challenges, when recalled. Optimally, individuals incorporate such events into their life story in a way that allows them to reflect positively on their life overall. We suggest that telling narratives that represent loss as leading to personal growth or as highlighting one’s connectedness to others may allow a positive view of life overall. In contrast, ruminating may signal a lack of meaningful integration of the event. The current study investigates personal growth from, communion in, and rumination about memories of past loss events. It also determines how these factors relate to positive reflection on one’s life overall. Age was explored as a moderator of these relations. Participants (29 younger adults, 40 older adults) narrated an autobiographical loss event and, for comparison, a non-loss challenging life event and a neutral event. Narratives were self-rated for rumination and extent of resultant personal growth, and reliably content-coded for themes of communion. Participants also completed a measure of positive reflection on their life. Loss narratives resulted in more personal growth and contained more communion themes than other challenging or neutral events. Greater loss-related personal growth predicted more positive life reflection for younger adults. How individuals recall and incorporate loss into their life story may relate differentially to psychosocial outcomes in different life phases.

Grief intensity, coping and psychological health among family members and friends following a terrorist attack

This study investigates the association of psychological health with grief intensity and coping style among family members and friends of terror victims. The data was collected from 164 bereaved individuals, on average, 18 months after the bombings occurred. The results demonstrated the significant role of problem-focused social support, and religious coping in dealing with grief intensity and contributing to the psychological health. The findings may be of considerable importance in therapeutic situations by providing direction for coping with both the effects of traumatic event and a traumatic loss, and for maintaining emotional stability through reworking relationships with the deceased.

Posttraumatic Growth in Complex PTSD

Objective: Although efforts have been made to study mechanisms and mediators of posttraumatic growth (PTG - positive sequelae of coping with trauma), little has been done to investigate PTG as a concept in the context of complex PTSD, a disorder recently delineated in ICD11. This article considers PTG in relation to complex PTSD, primarily as associated with childhood sexual abuse. Method: Using clinical case material and available literature, we explore the emergence of PTG in the treatment of patients with complex PTSD and examine factors contributing to its appearance. Results: Despite extensive early traumas, including those associated with histories of ongoing childhood sexual abuse, patients may be capable of PTG. While factors favoring PTG may include temperamental resilience and other as yet ill-defined personality traits, the presence of safe, supportive and enduring therapeutic and extra-therapeutic relationships, appear to address insecure attachments related to trauma and be of considerable importance in fostering possibilities for PTG. Conclusions: While much remains to be learned, encouraging and helping establish varieties of accepting, trusting and nurturing contacts in real world and psychotherapy and introducing and exploring the concept of PTG within therapy, can help patients suffering from complex PTSD address the underlying developmental deficiencies they have endured, facilitate treatment, and promote PTG.

Driving cognitions, rumination, and posttraumatic stress disorder in road traffic accidents survivors

This study evaluated the relationships between driving cognitions (i.e., panic-related cognitions, accident-related cognitions, and social-related cognitions), rumination, and posttraumatic stress disorder (PTSD) symptoms in a sample of road traffic accidents (RTAs) survivors. We also investigated the indirect effect of driving cognitions on PTSD symptoms through rumination. The sample included 633 drivers (62% were men; Mage = 36.09; standard deviation [SD] = 11.42 years). The participants completed scales measuring driving cognitions, rumination, and PTSD symptoms, as well as providing their demographic information. The results showed that all three types of driving cognitions assessed in the present study and rumination were significantly positively associated with PTSD symptoms. Furthermore, rumination mediated the relation between social-related cognitions and PTSD symptoms. The implications for PTSD treatment and future research are discussed.

Patterns of Posttraumatic Stress Disorder Symptoms and Posttraumatic Growth in an Epidemiological Sample of Chinese Earthquake Survivors: A Latent Profile Analysis

Background: Posttraumatic stress disorder (PTSD) and posttraumatic growth (PTG) are different psychological outcomes triggered by exposure to extraordinarily traumatic events. In this study, we aimed to examine patterns of co-occurrence between DSM-5 PTSD symptoms and PTG, among natural disaster survivors, and to clarify whether empirically-based subgroups differed by several specific predictors. Methods: Latent profile analysis was used to examine patterns of self-reported PTSD symptoms and PTG in an epidemiological sample of 1063 Chinese earthquake survivors. Results: Three distinct profiles were identified, involving high PTSD/high PTG, mild PTSD/mild PTG, and mild PTSD/high PTG. Class membership was predicted by several variables, especially different sources of perceived social support. Conclusion: Our findings contribute to the knowledge about the coexisting patterns of PTSD and PTG, and provide suggestions for identifying high-risk individuals and providing effective interventions in clinical practice.

The role of resiliency and coping strategies in occurrence of positive changes in medical rescue workers

BACKGROUND

Working in the emergency services entails exposure to traumatic events; however, their effects can be both negative and positive. Among the factors determining posttraumatic growth (PTG) after an experienced trauma are the personal resources and coping strategies. The purpose of the research was to investigate the role of resiliency and coping strategies with stress in posttraumatic growth in a group of medical rescue workers.

MATERIALS AND METHODS

Data of 80 male medical rescuers who have experienced traumatic event in their worksite were analyzed. The Posttraumatic Growth Inventory, Resiliency Measurement Scale and Inventory to Measure Coping Strategies with Stress - Brief-Cope were used in the study. Statistical tests such as t test, correlation and path analysis were used.

RESULTS

The tested medical rescue workers revealed the medium level of PTG. Active coping, planning, turning to religion, seeking of social support, both emotional and instrumental, and self-distraction positively correlated with posttraumatic growth. A more significant role in the process of PTG appeared to be played by avoidance and emotional-focused strategies Although resiliency does not directly affect posttraumatic growth, it may strengthen it through the choice of coping strategies.

CONCLUSIONS

In the process of posttraumatic growth avoidance strategies seem to play more important role than strategies focusing on the problem.

Direct and Indirect Effects of Perceived Stigma on Posttraumatic Growth in Gay Men and Lesbian Women in Chile

This study examined the direct and indirect effects of perceived stigma on posttraumatic growth (PTG) in a sample of gay men and lesbian women in Chile, with coping strategies (positive reappraisal, social support seeking, and active coping strategies) as intermediate variables. Data from 467 gay men (57.4%) and lesbian women (42.6%) were analyzed. A respondent-driven sampling (RDS) method was used. The hierarchical regression analysis indicated the important predictive role of active coping, β = .23, and positive reappraisal, β = .45, in PTG, R² = .31, p < .001, f2 = 0.16. Results revealed that, in the presence of positive reappraisal coping as an intermediate variable, partial indirect effects are detected between perceived stigma and PTG. Seeking instrumental social support did not produce indirect effects between perceived stigma and PTG, whereas active coping produced partial indirect effects. These findings suggest that the positive reappraisal of a traumatic experience is essential for reporting personal growth. Implications of these more complex relations for counseling interventions and further research are discussed.

Posttraumatic Stress Symptoms and Posttraumatic Growth in Children and Adolescents Following an Earthquake: A Latent Transition Analysis

This study examined the transitions in classes of posttraumatic stress symptoms and posttraumatic growth in a sample of children and adolescents (N = 757), between 8 and 20 months after the 2013 Ya'an earthquake in China. Using latent profile analysis, three classes of symptoms (resilient, thriving, and struggling) were identified at 8 and 20 months after the earthquake. Latent transition analysis indicated that the majority of survivors remained in the same class during the period, while others showed a transition between different classes over time. The transition was mainly characterized by three paths: from struggling to resilient, and from thriving to either resilient or struggling. Of the survivors who were classified as thriving at 8 months, those transitioning to the struggling class at 20 months were more likely to experience higher levels of loss and injury compared with those transitioning to the resilient class (Cohen's d = 0.72) or remaining in the thriving class (Cohen's d = 0.36) at 20 months postearthquake. Survivors who remained stable in the struggling class were older than those who remained stable in the thriving class (Cohen's d = 0.41) or those who moved from thriving at 8 months to resilient at 20 months after the earthquake (Cohen's d = 0.39). It is recommended that clinicians consider the classes of posttraumatic stress symptoms and posttraumatic growth, and the potential development paths and associated factors, when implementing interventions for children and adolescents after a natural disaster.