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Shorer S, Weinberg M, Koko Y, Marom D. "My Scar": Posttraumatic Loneliness as a Source of Pain and Resource for Coping. QUALITATIVE HEALTH RESEARCH 2024; 34:649-661. [PMID: 38243742 PMCID: PMC11103923 DOI: 10.1177/10497323241226599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
Contemporary understanding of combat trauma's psychological effects emphasizes the interpersonal ways survivors process their experiences. Yet cases of incongruence between survivors who want to share their traumatic experience and close others who are not ready to take part in this challenging task are common. Hence, many trauma survivors are compelled to cope with the posttraumatic consequences mostly alone. The present study followed the interpretive phenomenological approach to examine the experience of loneliness, as described by 15 male combat veterans dealing with posttraumatic stress. Participants completed semistructured qualitative interviews in which they shared their knowledge regarding postservice distress, loneliness, coping, and growth. Two main themes emerged: "The Loneliness Complex," highlighting this phenomenon's multifaceted, layered, and cyclical nature; and "Emotional Growth after Loneliness," presenting the positive potential of loneliness. These findings emphasize the importance of interpersonal relations in trauma survivors' recovery process. Participants described how experiences with peers can serve as a pivotal point for coping with postservice distress and how internalization of positive interpersonal interactions seems to be a crucial psychological resource for further rehabilitation and growth. Being a multilayered and cyclical condition, loneliness might serve trauma survivors in their search of safety, while also bearing the potential to motivate them to act upon their condition and promote emotional growth. Clinicians should acknowledge the risks trauma survivors take by leaving their lonely yet safe place, as they are encouraged to process their traumatic experiences and share their inner world with others.
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Affiliation(s)
- Shai Shorer
- School of Social Work, Faculty of Social Welfare and Health studies, University of Haifa, Haifa, Israel
- B’Shvil, Or Yehuda, Israel
| | - Michael Weinberg
- School of Social Work, Faculty of Social Welfare and Health studies, University of Haifa, Haifa, Israel
| | - Yael Koko
- School of Social Work, Faculty of Social Welfare and Health studies, University of Haifa, Haifa, Israel
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Kim H, Kim O, Kim KA, Chu SH, Chung ML. The moderating role of neighborhood social cohesion in the mediation effects of the loneliness between acculturation stress and post-traumatic growth among female North Korean defectors. Sci Rep 2023; 13:16965. [PMID: 37806980 PMCID: PMC10560661 DOI: 10.1038/s41598-023-43741-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 09/27/2023] [Indexed: 10/10/2023] Open
Abstract
Loneliness negatively predicts post-traumatic growth (PTG) among North Korean defectors (NKD), one of the representative groups of refugees. Additionally, evidence also suggests that females, who account for 70% of NKDs entering South Korea, are vulnerable not only to past trauma but also to the current acculturation stress and loneliness affected by neighborhood social cohesion. This study explores whether the mediating effect of loneliness on the relationship between acculturation stress and PTG was moderated by the neighborhood social cohesion among female NKDs. In this study, the data of 166 female NKDs who completed an online survey regarding acculturation stress, PTG, loneliness, and neighborhood social cohesion were used. Moderated mediation analysis was conducted using SPSS PROCESS macro program. Loneliness was associated with PTG (B = - 1.896, p < 0.001), and mediated the association between acculturation stress and PTG (indirect effect = - 0.278, 95% LLCI - 0.403, 95% ULCI - 0.166). Neighborhood social cohesion moderated the mediation effect of loneliness on the association between acculturation stress and PTG (B = - 0.016, 95% LLCI 0.001, 95% ULCI 0.035). The indirect effect of acculturation stress on PTG through loneliness was notably high for those with low neighborhood social cohesion. Therefore, increasing neighborhood social cohesion would reduce loneliness caused by acculturation stress and support the positive growth among female NKDs. This represents the most effective approach to aiding female NKDs in achieving growth, even after suffering trauma.
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Affiliation(s)
- Hokon Kim
- College of Nursing and Brain Korea 21 FOUR project, Yonsei University, Seoul, Republic of Korea
| | - Ocksim Kim
- College of Nursing and Brain Korea 21 FOUR project, Yonsei University, Seoul, Republic of Korea
| | - Kyoung-A Kim
- Department of Nursing, Suwon Women's University, Suwon, Republic of Korea
| | - Sang Hui Chu
- College of Nursing, Yonsei University, Seoul, Republic of Korea.
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Republic of Korea.
| | - Misook L Chung
- College of Nursing, University of Kentucky, Lexington, KY, USA
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3
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Kokun O. The personal growth resources of the adult population following the first months of the war in Ukraine. INTERNATIONAL JOURNAL OF PSYCHOLOGY 2023; 58:407-414. [PMID: 37170661 DOI: 10.1002/ijop.12915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 04/22/2023] [Indexed: 05/13/2023]
Abstract
We aimed to determine the peculiarities of personal growth resources among the adult population following the first months of the war in Ukraine. The study, which included 1257 respondents (32.3% male and 67.7% female, aged 18-61+ years), used the Posttraumatic Growth Inventory-Expanded, the Brief Resilience Scale, the Professional Hardiness Questionnaire and the General Self-Efficacy Scale. We found the following descending sequence of expression of the components of personal growth: appreciation of life, spiritual and existential changes, relations to others, new possibilities and personal strengths. Personal resources included resilience, professional commitment, professional control, professional challenge acceptance and self-efficacy, of which the last two were the most important. All indicators of personal growth were significantly higher in women but were more closely related to personal resources in men. Our findings suggest directions interventions should take to promote the Ukrainian adult population's personal growth and prevent negative mental health consequences.
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Affiliation(s)
- Oleg Kokun
- G.S. Kostiuk Institute of Psychology of National Academy of Educational Sciences of Ukraine, Kyiv, Ukraine
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Best D, Hennessy EA. The science of recovery capital: where do we go from here? Addiction 2022; 117:1139-1145. [PMID: 34729852 PMCID: PMC9209877 DOI: 10.1111/add.15732] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 10/13/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND The concept of recovery capital (RC) has emerged in studies and discussions of the addiction recovery process and as a potential metric and marker for recovery gains. Although conceptual and applied development of the concept in the 20 years since the term was coined has increased, there remains insufficient clarity of key domains, factors and best practice research and applications for populations experiencing addiction. We aimed to review progress around the conceptualisation and operationalisation of RC and to consider future directions for a science of recovery capital. METHOD We provided a brief overview of theoretical foundations and advances, empirical measurement and application in treatment and continuing care settings. We next introduced four primary areas for addiction science to address, namely: (i) conceptual development (e.g. how RC domains are unique, but interrelated entities, valence of RC), (ii) empirical testing, adequacy of measurement and analysis, (iii) directions for novel application in treatment and recovery settings and (iv) dissemination and communication to policy, practice and lived experience groups. In this review, we also focussed on some of the challenges that must be addressed for a science of RC, which could produce long-term impact in treatment and policy. RESULTS Despite burgeoning empirical work on RC, its application and translation has been unsystematic. The field currently relies on self-report questionnaires for the development of the theory and quantification of RC. Therefore, there is an urgent need for rigorous and systematic conceptual and empirical development of RC. CONCLUSIONS A formal collaboration between scholars, practitioners and experts by experience worldwide would move recovery capital forward in an empirically driven and culturally appropriate manner, as would testing its applicability at individual, organisational and societal levels.
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Affiliation(s)
- David Best
- Criminology and Social Sciences, University of Derby, Derby, UK
| | - Emily A. Hennessy
- Recovery Research Institute, Center for Addiction Medicine, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts, USA
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Lau BHP, Chan CLW, Ng SM. Post-traumatic Growth in the First COVID Outbreak in Hong Kong. Front Psychol 2021; 12:675132. [PMID: 34603120 PMCID: PMC8481897 DOI: 10.3389/fpsyg.2021.675132] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 08/17/2021] [Indexed: 11/17/2022] Open
Abstract
Post-traumatic growth (PTG) emerges from highly stressful situations. The coronavirus (COVID) pandemic may qualify as one. This study investigated the PTG among Hong Kong citizens during the first outbreak in spring 2020, shortly after a large-scale social movement subsided. A longitudinal online survey was launched during the peak (Time 1) and the palliation (Time 2) of the outbreak. Among the 327 participants who completed both waves, 28.4% exhibited probable post-traumatic stress disorder (PTSD) in Time 1, while 18.0% reported significant PTG in at least one domain in Time 2. The interaction between the sense of coherence (SOC) and post-traumatic stress mediated the relationship between Time 1 perceived outbreak severity and Time 2 PTG, such that PTG was more likely among participants with higher post-traumatic stress and SOC. PTG was also associated with a weaker contingency between Time 1 and Time 2 perceived outbreak severity. Echoing the transformational model, our findings show that both experienced stress and coping resources are essential for PTG to emerge. We also demonstrated how PTG might lead to more flexible risk perceptions according to the development of the outbreak.
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Affiliation(s)
- Bobo Hi Po Lau
- Department of Counselling and Psychology, Hong Kong Shue Yan University, North Point, Hong Kong, SAR China.,Wan Chow Yuk Fan Centre for Interdisciplinary Evidence-Based Practice & Research, Hong Kong Shue Yan University, Hong Kong, Hong Kong, SAR China
| | - Cecilia Lai Wan Chan
- Centre on Behavioral Health, University of Hong Kong, Hong Kong, Hong Kong, SAR China.,Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, Hong Kong, SAR China
| | - Siu Man Ng
- Centre on Behavioral Health, University of Hong Kong, Hong Kong, Hong Kong, SAR China.,Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, Hong Kong, SAR China
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Pascual-Leone A, Bartres-Faz D. Human Brain Resilience: A Call to Action. Ann Neurol 2021; 90:336-349. [PMID: 34219268 DOI: 10.1002/ana.26157] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 07/03/2021] [Accepted: 07/03/2021] [Indexed: 01/01/2023]
Abstract
At present, resilience refers to a highly heterogeneous concept with ill-defined determinants, mechanisms, and outcomes. This call for action argues for the need to define resilience as a person-centered multidimensional metric, informed by a dynamic lifespan perspective and combining observational and interventional experimental studies to identify specific neural markers and correlated behavioral measures. The coronavirus disease 2019 (COVID-19) pandemic highlights the urgent need of such an effort with the ultimate goal of defining a new vital sign, an individual index of resilience, as a life-long metric with the capacity to predict an individual's risk for disability in the face of a stressor, insult, injury, or disease. ANN NEUROL 2021.
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Affiliation(s)
- Alvaro Pascual-Leone
- Department of Neurology, Harvard Medical School, Hinda and Arthur Marcus Institute for Aging Research and Deanna and Sidney Wolk Center for Memory Health at Hebrew SeniorLife, Boston, MA, USA.,Institut Guttmann de Neurorehabilitació, Guttmann Brain Health Institute, Barcelona, Spain
| | - David Bartres-Faz
- Institut Guttmann de Neurorehabilitació, Guttmann Brain Health Institute, Barcelona, Spain.,Department de Medicina, Facultat de Medicina i Ciències de la Salut - Campus Clínic, Universitat de Barcelona, Barcelona, Spain
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Ord AS, Stranahan KR, Hurley RA, Taber KH. Stress-Related Growth: Building a More Resilient Brain. J Neuropsychiatry Clin Neurosci 2021; 32:A4-212. [PMID: 32729793 DOI: 10.1176/appi.neuropsych.20050111] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Anna S Ord
- The Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center, and the Research and Academic Affairs Service Line, W.G. Hefner Veterans Affairs Medical Center, Salisbury, N.C. (Ord, Hurley, Taber); the Mental Health Service Line, W.G. Hefner Veterans Affairs Medical Center, Salisbury, N.C. (Stranahan); the Departments of Psychiatry and Radiology, Wake Forest School of Medicine, Winston-Salem, N.C. (Hurley); the Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston (Hurley); the Division of Biomedical Sciences, Via College of Osteopathic Medicine, Blacksburg, Va. (Taber); and the Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Taber)
| | - Kathryn R Stranahan
- The Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center, and the Research and Academic Affairs Service Line, W.G. Hefner Veterans Affairs Medical Center, Salisbury, N.C. (Ord, Hurley, Taber); the Mental Health Service Line, W.G. Hefner Veterans Affairs Medical Center, Salisbury, N.C. (Stranahan); the Departments of Psychiatry and Radiology, Wake Forest School of Medicine, Winston-Salem, N.C. (Hurley); the Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston (Hurley); the Division of Biomedical Sciences, Via College of Osteopathic Medicine, Blacksburg, Va. (Taber); and the Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Taber)
| | - Robin A Hurley
- The Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center, and the Research and Academic Affairs Service Line, W.G. Hefner Veterans Affairs Medical Center, Salisbury, N.C. (Ord, Hurley, Taber); the Mental Health Service Line, W.G. Hefner Veterans Affairs Medical Center, Salisbury, N.C. (Stranahan); the Departments of Psychiatry and Radiology, Wake Forest School of Medicine, Winston-Salem, N.C. (Hurley); the Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston (Hurley); the Division of Biomedical Sciences, Via College of Osteopathic Medicine, Blacksburg, Va. (Taber); and the Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Taber)
| | - Katherine H Taber
- The Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center, and the Research and Academic Affairs Service Line, W.G. Hefner Veterans Affairs Medical Center, Salisbury, N.C. (Ord, Hurley, Taber); the Mental Health Service Line, W.G. Hefner Veterans Affairs Medical Center, Salisbury, N.C. (Stranahan); the Departments of Psychiatry and Radiology, Wake Forest School of Medicine, Winston-Salem, N.C. (Hurley); the Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston (Hurley); the Division of Biomedical Sciences, Via College of Osteopathic Medicine, Blacksburg, Va. (Taber); and the Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Taber)
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Ypsilanti A, Gettings R, Lazuras L, Robson A, Powell PA, Overton PG. Self-Disgust Is Associated With Loneliness, Mental Health Difficulties, and Eye-Gaze Avoidance in War Veterans With PTSD. Front Psychol 2020; 11:559883. [PMID: 33192823 PMCID: PMC7662446 DOI: 10.3389/fpsyg.2020.559883] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 10/06/2020] [Indexed: 11/13/2022] Open
Abstract
In the present study, we examined, for the first time, the association between self-disgust, loneliness, and mental health difficulties in war veterans diagnosed with PTSD. For this purpose, we used a mixed methods design, incorporating surveys and a novel eye-tracking paradigm, and compared the findings from the PTSD veteran group (n = 19) to those from a general population group (n = 22). Our results showed that the PTSD veteran group reported almost three times higher scores in self-disgust, and significantly higher scores in loneliness and mental health difficulties (anxiety and depression), compared to the general population. Furthermore, self-disgust mediated the association between loneliness and anxiety symptoms in both groups. The results from the eye-tracking paradigm further showed that veterans with PTSD displayed a self-avoidance gaze pattern, by looking significantly more toward pictures of faces of unknown others and away from their own face—a pattern that was not replicated in the general population group. Higher self-disgust scores were significantly associated with longer total gaze to the pictures of others (vs. the self). Our findings have implications for the role of self-disgust in the mental health of war veterans.
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Affiliation(s)
- Antonia Ypsilanti
- Department of Psychology, Sociology and Politics, Sheffield Hallam University, Sheffield, United Kingdom
| | - Richard Gettings
- Department of Psychology, Sociology and Politics, Sheffield Hallam University, Sheffield, United Kingdom
| | - Lambros Lazuras
- Department of Psychology, Sociology and Politics, Sheffield Hallam University, Sheffield, United Kingdom
| | - Anna Robson
- Department of Psychology, Sociology and Politics, Sheffield Hallam University, Sheffield, United Kingdom
| | - Philip A Powell
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, United Kingdom
| | - Paul G Overton
- Department of Psychology, The University of Sheffield, Sheffield, United Kingdom
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Zerach G. Posttraumatic growth among combat veterans and their siblings: A dyadic approach. J Clin Psychol 2020; 76:1719-1735. [PMID: 32173865 DOI: 10.1002/jclp.22949] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES We aimed to use a dyadic approach to assess the effects of veterans' posttraumatic stress disorder symptoms (PTSS) and siblings' secondary PTSS, as well as veterans' and siblings' relationship quality, on primary and secondary posttraumatic growth (PTG). METHOD A volunteers' sample of 106 dyads of Israeli combat veterans and their close-in-age siblings responded to self-report questionnaires in a cross-sectional, dyadic design study. RESULTS Veterans' primary PTG was positively associated with siblings' secondary PTG. Veterans' PTSS and siblings' secondary PTSS were associated with higher levels of primary and secondary PTG, respectively. Furthermore, among veterans, warmth in siblings' relationships was associated with higher levels of primary PTG. However, among siblings, rivalry in sibling relationships was associated with lower levels of secondary PTG. CONCLUSIONS Both veterans' and siblings' PTSS are only related to their own PTG. Moreover, perception of siblings' relationship quality might have a differential effect on PTG among veterans and their siblings.
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Affiliation(s)
- Gadi Zerach
- Department of Behavioral Sciences and Psychology, Ariel University, Ariel, Israel
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Loneliness and subjective physical health among war veterans: Long term reciprocal effects. Soc Sci Med 2019; 234:112373. [DOI: 10.1016/j.socscimed.2019.112373] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 05/05/2019] [Accepted: 06/15/2019] [Indexed: 11/22/2022]
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Abstract
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.
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