Posttraumatic stress response following the loss of significant close others in the Great East Japan Earthquake: Fukushima Health Management Survey

During the Great East Japan Earthquake, many people experienced the loss of family and friends, among other traumatic events. This study sought to clarify the impact of the loss of significant close others on posttraumatic stress symptoms (PTSS), as well as the factors associated with PTSS, among individuals who experienced the loss of significant close others (i.e., bereaved group). Self-administered questionnaires were mailed to men and women (N = 180,604) aged 16 years and older living in municipalities that included evacuated areas surrounding the Tokyo Electric Power Company's Fukushima Daiichi Nuclear Power Station, which was significantly damaged following an earthquake and tsunami in March 2011, causing subsequent radiation leakage; this mailing yielded a 40.7% response rate, with 57,388 valid responses, in 2012. We used the Posttraumatic Stress Disorder Checklist-Specific (PCL-S) to measure PTSS as the outcome variable. Loss of significant close others in the disaster and respondents' relationship with the deceased constituted the explanatory variables. Basic characteristics and disaster-related factors were the confounding variables. Data were analyzed using chi-square tests and logistic regression analyses. The bereaved group showed more severe PTSS than the nonbereaved group, aOR = 1.58, 95% CI [1.50, 1.67]. The risk of developing PTSS increased if the deceased was a respondent's spouse, aOR = 1.67, 95% CI [1.22, 2.29]; child, 1.51 [1.01, 2.25]; or friend, 1.33 [1.16, 1.53]. Individuals who lose significant close others, including both family and friends, in disasters require close mental health care and, if necessary, should be referred for psychiatric treatment.

Qualitative Exploration of the Nature of Grief-Related Beliefs and Expectations

Societal expectations of grief impact the experience of bereavement. The congruence of societal expectations with current scientific understanding of grief is unknown. Therefore two qualitative studies explored community perceptions of grief. In study one, three small focus groups ( N = 9) examined grief-related expectations associated with hypothetical scenarios of bereavement. In study two, the impact of grief-related perceptions on the lived experience of bereavement for 11 individuals was explored through semi-structured interviews. Across both studies, elements of a traditional stage model view of grief were evident, with participants viewing emotional expression of grief as important. An avoidant coping style in the bereaved was considered problematic. Findings of study two suggested that grief-related beliefs may impact the bereavement experience via appraisal of the grief response and willingness to support bereaved individuals. The studies suggested that stage model assumptions in the beliefs of the general population persist, although there was a recognition of diversity in the grief response.

Gender Differences in Grief Reactions following the Death of a Parent

This study examined gender differences in psychological functioning in a sample of college students who lost a parent to death. Male and female students ( n = 65) who had a parent that had died were asked to complete a series of self report questionnaires to assess psychological distress, feelings of grief and bereavement, and coping strategies. Overall, no gender differences were found between bereaved students on measures of psychological distress. However an avoidant coping style was related to symptoms of depression in females, but not in males. Students who lost a mother were more likely to report symptoms of depression, hopelessness, and suicidal ideation as compared to students who lost a father. Future research implications and the clinical importance of these findings are discussed.

Somatic aphasia: mismatch of body sensations with autonomic stress reactivity in psychopathy

BACKGROUND

Although one of the main characteristics of psychopaths is a deficit in emotion, it is unknown whether they show a fundamental impairment in appropriately recognizing their own body sensations during an emotion-inducing task.

METHOD

Skin conductance and heart rate were recorded in 138 males during a social stressor together with subjective reports of body sensations. Psychopathic traits were assessed using the Psychopathy Checklist-Revised (PCL-R) 2nd edition (Hare, 2003).

RESULTS

Nonpsychopathic controls who reported higher body sensations showed higher heart rate reactivity, but this verbal-autonomic consistency was not found in psychopathic individuals. This mind-body disconnection is particularly associated with the interpersonal-affective factor of psychopathy.

CONCLUSIONS

Findings are the first to document this body sensation-autonomic mismatch in psychopaths, and suggest that somatic aphasia - the inaccurate identification and recognition of one's own somatic states - may partly underlie the interpersonal-affective features of psychopathy.

Autobiographical integration of trauma memories and repressive coping predict post-traumatic stress symptoms in undergraduate students

What differentiates those who are able to adapt well to adverse life events (i.e., persons who are resilient) from those who are not (e.g., persons who develop post-traumatic stress symptoms)? Previous work suggests that enhanced autobiographical integration of trauma memories is associated with more severe post-traumatic stress symptoms. Extending this line of work, the present study looked at whether the integration of trauma memories, repressive coping and cognitive reactivity are related to post-traumatic stress symptomatology following negative life events among otherwise healthy young adults (N = 213). Results show that while enhanced integration of trauma memories and high levels of dissociation are related to elevated levels of post-traumatic stress, people who generally engage in repressive coping report fewer post-traumatic stress symptoms.

A Social Interactional Model of Bereavement Narrative Disclosure

According to recent bereavement research, disclosing the narrative of one's loss does not per se promote emotional recovery. At the same time, social, personality, and developmental research suggests that telling personal stories is an important means of building identity and relationships throughout adulthood. Drawing on this literature, this review illustrates how bereavement narrative disclosure may be instrumental in addressing psychosocial challenges associated with bereavement (e.g., relationship formation, identity reconstruction, and meaning making). Multiple individual and social factors may affect how successful bereavement narrative disclosure is these challenges. Applying a social interactional model of memory telling, this review examines the influence of the relationship of narrator and listener, their personality characteristics, the content and structure of the narrative, the type of loss, and the time since the loss in facilitating or disrupting the putative goals of bereavement narrative disclosure. The utility of this model for clinicians working with bereaved individuals is also explored.

Repressive coping, emotional adjustment, and cognition in people who have lost loved ones to suicide

Research indicates that a repressive coping style is psychologically protective against the stress of trauma, yet it is unclear whether this finding generalizes to suicide bereavement. Thus, we assessed cognitive ability and mental health among individuals who lost a loved one to suicide. The results indicate that repressive coping may be associated with greater emotional health during suicide bereavement. Interestingly, "repressors" also had lower scores on both cognitive tasks compared to "nonrepressors," but it is unclear whether their more recent loss accounts for this difference. These results are based on cross-sectional data, and should be interpreted with caution.

Verbal-autonomic response dissociations as traits?

Dissociations between subjective and physiological responses to stress are of central interest in coping research. However, little is known about their stability across situations and time. Two experimental sessions - separated by 1 year - were conducted to examine cross-situational consistency and longterm-stability of HR-derived and SCL-derived dissociation scores. In year 1, a speech stressor, the cold pressor and a video stressor (viewing of the speech video) were applied. In year 2, mental arithmetics, anagrams and a torture video were presented. Thirty-five students participated and HR, SCL and negative affect were recorded. For each stressor, standardized changes in negative affect were subtracted from changes in autonomic reactivity (HR and SCL, respectively). Dissociation scores were relatively consistent across the stressors with HR-derived scores exceeding SCL-derived scores. Longterm-stability proved acceptable (r=.61, P<.001 for HR-derived and r=.40, P<.05 for SCL-derived scores). In sum, verbal-autonomic response dissociations show considerable cross-situational and temporal stability and thus might be considered as traits.

Adaptation to bereavement

Much of the literature on the effects of conjugal bereavement has focused on the detrimental effects of losing a spouse. Although it is very important to be aware of the emotional, physical, and social problems often associated with bereavement, these difficulties are not universal accompaniments of grief. Accumulating evidence suggests that resilience in the face of bereavement is the norm rather than an exception. This article uses a multidimensional model of bereavement adaptation and reviews literature on multiple paths to resilience among bereaved individuals. Each dimension of adaptation is illustrated with quotes from participants of the San Diego Widowhood Study.

Self-Enhancement Among High-Exposure Survivors of the September 11th Terrorist Attack: Resilience or Social Maladjustment?

The authors examined self-enhancing bias as a predictor of adjustment among individuals in or near the World Trade Center during the September 11, 2001, terrorist attacks. Resilience was defined from categorical and continuous analyses of both participant self-report and friend and relative ratings of adjustment. Self-enhancement was associated with a resilient outcome, ratings of better adjustment prior to September 11th, greater positive affect, and reduced perceptions of social constraints. Additional analyses indicated that self-enhancers' reduced symptom levels were fully mediated by their low perceived social constraints. However, consistent with previous evidence suggesting a social cost to self-enhancement, at 18 months post-September 11th, self-enhancers' friends and relatives also rated them as decreasing in social adjustment and as being less honest.

Grief Processing and Deliberate Grief Avoidance: A Prospective Comparison of Bereaved Spouses and Parents in the United States and the People's Republic of China

In this study, the authors measured grief processing and deliberate grief avoidance and examined their relationship to adjustment at 4 and 18 months of bereavement for 2 types of losses (spouse, child) in 2 cultures (People's Republic of China, United States). Three hypotheses were compared: the traditional grief work assumption, a conditional grief work hypothesis, and a view of grief processing as a form of rumination absent among resilient individuals. Although cultural differences in grief processing and avoidance were observed, the factor structure of these measures proved invariant across cultures. Consistent with the grief work as rumination hypothesis, both grief processing and deliberate grief avoidance predicted poor long-term adjustment for U.S. participants. Furthermore, initial grief processing predicted later grief processing in both cultures. However, among the participants in the People's Republic of China, neither grief processing nor deliberate avoidance evidenced clear psychological consequences.

Attachment and loss: a test of three competing models on the association between attachment-related avoidance and adaptation to bereavement

It is widely assumed that emotionally avoidant or defensive individuals will have a difficult time adjusting to the loss of a loved one. However, recent research suggests that defensive individuals tend to adapt quite well to loss. Such findings pose a number of challenges to attachment theory--a theory that has traditionally held that emotional avoidance is indicative of poor psychological adjustment. In this article, the authors argue that contemporary models of individual differences in adult attachment allow the derivation of at least three competing hypotheses regarding the relationship between avoidant attachment and adaptation to loss. These hypotheses are tested using two-wave data on 59 bereaved adults. Results indicate that whereas some avoidant individuals (i.e., those who are fearfully avoidant) have a difficult time adapting to the loss of a loved one, other avoidant adults (i.e., those who are dismissingly avoidant) show a pattern of resilience to loss.

Predicting the willingness to disclose childhood sexual abuse from measures of repressive coping and dissociative tendencies

Although it is generally agreed that the verbal disclosure of past childhood sexual abuse (CSA) experiences can be beneficial, CSA survivors are often reluctant to reveal such experiences. Bonanno et al. found that women with documented CSA histories who did not disclose abuse when provided an opportunity to do so were more likely to show nonverbal expressions of shame and polite smiling, relative to disclosing CSA survivors or nonabused controls. Disclosing CSA survivors, in contrast, showed greater facial expressions of disgust. The current study extended this paradigm by showing that among the same participants, CSA disclosure was associated with chronic dissociative experiences, whereas nondisclosure was associated with repressive coping. Further, repressive coping and dissociative experiences were inversely related and showed opposite patterns of facial expressions and adjustment. Repressors expressed greater negative and positive emotion and were relatively better adjusted, whereas dissociators expressed little emotion and had relatively poorer adjustment.

Ethnic variation in the impact of negative affect and emotion inhibition on the health of older adults

The relations between patterns of emotional experience, emotion inhibition, and physical health have been little studied in older adults or ethnically diverse samples. Testing hypotheses derived from work on younger adults, the authors examined the relations between negative affect and emotion inhibition and that of illness (hypertension, respiratory disease, arthritis, and sleep disorder) in a sample (N = 1,118) of community-dwelling older adults from four ethnic groups: U.S.-born African Americans, African Caribbeans, U.S.-born European Americans, and Eastern European immigrants. Participants completed measures of stress, lifestyle risk factors, health, social support, trait negative emotion, and emotion inhibition. As expected, the interaction of ethnicity with emotion inhibition, and, to a lesser extent, negative affect, was significantly related to illness, even when other known risk factors were controlled for. However, the relations among these variables were complex, and the patterns did not hold for all types of illness or operate in the same direction across ethnic groups. Implications for emotion-health relationships in ethnically diverse samples are discussed.

Mourning parents: considering safeguards and their relation to health

This study investigated the emotional consequences for parents following the death of their child. Bereaved parents and age and gender-matched peers completed measures of physical health, depression, post-traumatic stress, and personal coping resources. To investigate the regulation of emotional reactions, the authors used a new instrument consisting of 4 scales: adaptive emotion regulation, confiding in others as a means to feeling better, avoiding and hiding emotions, and controlling the emotional impact by distorting awareness and communication. The bereaved parents were severely affected by the loss; they reported high distress levels. However, parents both in the bereavement group as well as in a comparison group who had experienced human loss showed better ability to control emotions adaptively compared with those who did not report such losses. The result is discussed in terms of lifespan development and personal growth.

Moderators of the Emotion Inhibition-Health Relationship: A Review and Research Agenda

The preponderance of a growing literature suggests that emotion inhibition is associated with poorer health. However, although inhibition and health are clearly related, the “inhibition hyhpothesis” has taken on the flavor of a contemporary dogma. Conceptual bases are accepted uncritically, and developments from other domains of psychology are incorporated in a selective, self-supporting, and unenlightening manner. Theories have been tested in homogenous samples, with little attention paid to possible contributions from ethnic diversity, developmental differences, or period effects. This article presents an evolutionary framework within which to consider these phenomena. It critiques the conceptual underpinnings of inhibition-health theories and provides a rationale for the expectation of moderator effects across cultures, individuals, and emotions. Directions for future empirical work are provided.

How and When Does Emotional Expression Help?

The paradox of distress expression is that expression of negative feelings is both a sign of distress and a possible means of coping with that distress. This article describes research illustrating the paradox of distress expression. It reviews evidence concerning 3 possible mechanisms by which expression might alleviate distress, focusing on the role of expression in (a) reducing distress about distress, (b) facilitating insight, and (c) affecting interpersonal relationships in a desired way. The authors conclude by highlighting the circumstances under which expression is most likely to be adaptive. Overall, the authors argue that expression of negative feelings is adaptive to the extent that it leads to some kind of resolution involving the source or significance of distress.

The varieties of grief experience

The bereavement literature has yet to show consensus on a clear definition of normal and abnormal or complicated grief reactions. According to DSM-IV, bereavement is a stressor event that warrants a clinical diagnosis only in extreme cases when other DSM categories of psychopathology (e.g., Major Depression) are evident. In contrast, bereavement theorists have proposed a number of different types of abnormal grief reactions, including those in which grief is masked or delayed. In this article, we review empirical evidence on the longitudinal course, phenomenological features, and possible diagnostic relevance of grief reactions. This evidence was generally consistent with the DSM-IV's view of bereavement and provided little support for more complicated taxonomies. Most bereaved individuals showed moderate disruptions in functioning during the first year after a loss, while more chronic symptoms were evidenced by a relatively small minority. Further, those individuals showing chronic grief reactions can be relatively easily accommodated by existing diagnostic categories. Finally, we found no evidence to support the proposed delayed grief category. We close by suggesting directions for subsequent research.