Psychological adjustment following mechanical restraint in individuals with schizophrenia

AIM

While it is known that being mechanically restrained during hospitalization can, in severe cases, lead to PTSD in individuals with mental illness, less is known about why some develop posttraumatic stress reactions following restraint while others do not. This study examined whether the amount of exposure to mechanical restraint and patients' interpretations of the episodes' centrality to their identity were related to symptoms of PTSD in individuals with schizophrenia.

METHODS

We asked 20 individuals to recall mechanical restraint episodes and rate them on centrality to identity. They also completed scales measuring symptoms of posttraumatic stress, depression, trauma history, and were rated on positive and negative symptoms. Objective information about the number of times they had been restrained was obtained through Danish health registries.

RESULTS

Amount of exposure to mechanical restraint was not significantly related to PTSD symptoms, potentially due to limitations of our small sample. However, interpreting episodes as more central to identity was. This relationship remained significant when controlling for trauma history, positive symptoms, and depression.

CONCLUSION

The results suggest that clinically significant levels of PTSD are common in this population, and that considering patients' subjective interpretations of restraint episodes, and not merely the objective facts surrounding them is important for patients' psychological adjustment.

Psychological adjustment in care providers following restraint of psychiatric patients

Mental healthcare providers face many difficult interactions with patients that can be emotionally demanding and have adverse effects on their well-being. Recent theoretical models suggest that the interpretation of stressful episodes may be more important for psychological adjustment than the nature of the episodes. This study examined whether care providers' interpretations of mechanical restraint episodes were related to their adjustment. We asked 80 mental healthcare providers to recall mechanical restraint episodes and to rate them on centrality to identity and positive and negative influence on self-understanding. They also completed scales measuring current symptoms of post-traumatic stress, depression, life satisfaction, and well-being. The results showed that care providers who interpreted mechanical restraint episodes as having a central negative influence on their identity experienced more symptoms of post-traumatic stress. Care providers who gave higher ratings of positive self-change following episodes reported more well-being. Our findings suggest, that considering care providers' subjective interpretations of episodes and not merely the objective facts surrounding them is critical if we wish to mitigate the negative emotional impact of episodes.

Does event centrality mediate the effect of peritraumatic reactions on post-traumatic growth in survivors of a terrorist attack?

BACKGROUND

While self-reported post-traumatic growth (PTG) has been documented after a wide variety of potentially traumatic experiences, we need more knowledge on the mechanisms behind PTG to gain a better understanding of this phenomenon.

OBJECTIVE

We aimed to investigate the hypothesized mechanism of perceived event centrality as a mediator on the pathway between peritraumatic reactions and later PTG.

METHOD

In total, 204 survivors of the 2011 massacre on Utøya island, participated 4-5 months (T1), 14-15 months (T2), and 30-32 months (T3) post-terror. We applied counterfactually based causal mediation analysis to explore the potential mediating role of survivors' perceived centrality (T2) in linking their peritraumatic reactions (T1) and self-reported PTG (T3).

RESULTS

The vast majority of the survivors reported experiencing some positive changes post-terror, and we found a positive, significant association between survivor's peritraumatic reactions, perceived event centrality and self-reported growth. However, we did not find that centrality significantly mediated the longitudinal association between peritraumatic reactions and later PTG.

CONCLUSION

Reports of PTG are common post-terror, and peritraumatic reactions and perceptions of centrality may help explain individual differences in trauma survivors' level of PTG. Perceived event centrality about one year post-trauma does not appear to explain the relationship between initial reactions to trauma and subsequent PTG.

Exploring the potential moderating role of self-compassion on the relationships between event centrality and post-assault psychological outcomes

OBJECTIVE

The present study examined whether post-assault internal processes (i.e., present control, event centrality, and compassionate and uncompassionate self-responding) were associated with distress and resilience among women who have experienced adult sexual assault. The authors also tested whether compassionate and uncompassionate self-responses would moderate the relationships between event centrality and outcomes.

METHOD

A convenience sample of women who had experienced sexual assault during adulthood (N = 253) completed an anonymous online survey.

RESULTS

Regression analyses showed that lower present control, higher event centrality, and higher uncompassionate responses to the self were associated with posttraumatic stress disorder. Additionally, higher present control and higher compassionate responses to the self were associated with resilience. Moderation analyses were not significant.

CONCLUSIONS

Endorsing greater levels of uncompassionate responses was associated with greater distress while engaging in greater compassionate responses was associated with greater resilience, even when accounting for levels of present control and event centrality.

Event centrality, transitional impact and symptoms of posttraumatic stress in a clinical sample

Background and Objectives: There is growing research indicating that event centrality strongly predicts posttraumatic stress disorder (PTSD). However, there is not much research on what makes a traumatic event central to one's life story. One reason a traumatic memory becomes a reference point for one's life story is that it brings about significant changes in one's life. This study investigated the relationships between transitional impact of an event, event centrality, and PTSD symptoms. Specifically, it tested whether higher negative changes were associated with higher levels of event centrality and PTSD symptoms. It also investigated whether event centrality mediated the relationship between transitional impact and PTSD severity.Methods: 101 individuals diagnosed with PTSD completed the Transitional Impact Scale (TIS), Centrality of Event Scale, and Impact of Event Scale-Revised regarding their traumatic experiences. Furthermore, they responded to the Posttraumatic Stress Disorder Symptom Scale-Self Report (PSS-SR), Traumatic Events Checklist (TELC), and Beck Anxiety Inventory (BAI).Results and Conclusions: Results indicate that (a) the TIS had valid and reliable psychometric properties in a PTSD sample, (b) most of the traumatic events received high negative psychological and material change scores, and (c) event centrality mediated the relationship between transitional impact and PTSD severity.

Event centrality influences posttraumatic stress disorder symptoms via core beliefs in internally displaced older adults

OBJECTIVES

There is substantial evidence regarding the role of event centrality (EC) in posttraumatic stress disorder (PTSD) symptoms, but little research has examined the explanatory pathways linking EC with PTSD symptoms severity. The present study examined whether core beliefs (CB) mediates the relationship between EC and PTSD symptoms in internally displaced older adults.

METHOD

Internally displaced older adults (N = 279; mean age = 62 years) sheltered in two camps located in north-central Nigeria, completed Tiv language versions of self-report measures, namely, the Harvard Trauma Questionnaire, the Centrality of Event Scale, Core Beliefs Inventory, and provided relevant demographic information.

RESULTS

Analysis indicated that EC and CB were linked to greater PTSD symptoms as well as re-experiencing/intrusion, avoidance and hyperarousal symptoms severity. The mediator path was significant which implies that CB was a pathway through which EC influences PTSD symptoms clusters and overall PTSD symptomatology.

CONCLUSION

A traumatic event becoming more central in a person's identity and life story distorts entrenched beliefs about oneself, others and the world, thereby resulting in greater PTSD symptoms. Our findings suggest that considerations of disrupted world assumptions may be a salient target for prevention and treatment efforts.

Role of event centrality and emotion regulation in posttraumatic stress disorder symptoms among internally displaced persons

BACKGROUND

Event centrality and emotion regulation in relation to posttraumatic stress disorder (PTSD) have been documented in various global samples especially in Western cultures; but internally displaced persons (IDPs) still constitute an underrepresented population in psychotraumatology literature. This study tested the roles of event centrality and emotion regulation strategies (cognitive reappraisal and expressive suppression) in PTSD symptoms among IDPs in Nigeria.

DESIGN

The multi-group cross-sectional design was adopted.

METHODS

Tiv language versions of the Centrality of Events Scale, Emotion Regulation Questionnaire, and Harvard Trauma Questionnaire were completed by 859 IDPs in two camps located in Benue State, North-central region of Nigeria.

RESULTS

Hierarchical multiple linear regression results indicated that event centrality positively predicted PTSD symptoms. Cognitive reappraisal was a negative predictor of PTSD symptoms while expressive suppression was a positive predictor of PTSD symptoms. Bonferroni corrections indicated that expressive suppression was the strongest predictor of total PTSD symptoms, avoidance/numbing symptoms, and hyper-arousal symptoms; but event centrality was the most robust predictor of PTSD intrusion/re-experiencing symptoms.

CONCLUSION

The findings underscore recent developments in psychotraumatology indicating that the extent to which individual differences impact the development of PTSD is essential in clinical psychology research and practice.

Rumination, event centrality, and perceived control as predictors of post-traumatic growth and distress: The Cognitive Growth and Stress model

OBJECTIVES

The Cognitive Growth and Stress (CGAS) model draws together cognitive processing factors previously untested into a single model. Intrusive rumination, deliberate rumination, present and future perceptions of control, and event centrality were assessed as predictors of post-traumatic growth (PTG) and post-traumatic stress (PTS).

METHOD

The CGAS model is tested on a sample of survivors (N = 250) of a diverse range of adverse events using structural equation modelling techniques.

RESULTS

Overall, the best fitting model was supportive of the theorized relations between cognitive constructs and accounted for 30% of the variance in PTG and 68% of the variance in PTS across the sample.

CONCLUSIONS

Rumination, centrality, and perceived control factors are significant determinants of positive and negative psychological change across the wide spectrum of adversarial events. In its first phase of development, the CGAS model also provides further evidence of the distinct processes of growth and distress following adversity.

PRACTITIONER POINTS

Clinical implications People can experience positive change after adversity, regardless of life background or types of events experienced. While growth and distress are possible outcomes after adversity, they occur through distinct processes. Support or intervention should consider rumination, event centrality, and perceived control factors to enhance psychological well-being. Cautions/limitations Longitudinal research would further clarify the findings found in this study. Further extension of the model is recommended to include other viable cognitive processes implicated in the development of positive and negative changes after adversity.

Maladaptive trauma appraisals mediate the relation between attachment anxiety and PTSD symptom severity

OBJECTIVE

In a large sample of community-dwelling older adults with histories of exposure to a broad range of traumatic events, we examined the extent to which appraisals of traumatic events mediate the relations between insecure attachment styles and posttraumatic stress disorder (PTSD) symptom severity.

METHOD

Participants completed an assessment of adult attachment, in addition to measures of PTSD symptom severity, event centrality, event severity, and ratings of the A1 PTSD diagnostic criterion for the potentially traumatic life event that bothered them most at the time of the study.

RESULTS

Consistent with theoretical proposals and empirical studies indicating that individual differences in adult attachment systematically influence how individuals evaluate distressing events, individuals with higher attachment anxiety perceived their traumatic life events to be more central to their identity and more severe. Greater event centrality and event severity were each in turn related to higher PTSD symptom severity. In contrast, the relation between attachment avoidance and PTSD symptoms was not mediated by appraisals of event centrality or event severity. Furthermore, neither attachment anxiety nor attachment avoidance was related to participants' ratings of the A1 PTSD diagnostic criterion.

CONCLUSION

Our findings suggest that attachment anxiety contributes to greater PTSD symptom severity through heightened perceptions of traumatic events as central to identity and severe. (PsycINFO Database Record

The role of repetitive thought in determining posttraumatic growth and distress following interpersonal trauma

BACKGROUND AND OBJECTIVES

Repetitive thought (RT) strategies have been linked to a range of negative outcomes following traumatic interpersonal events but are proposed to serve an adaptive function under particular circumstances. This study examined outcomes following RT within a transdiagnostic framework, and explored the potentially adaptive nature of trait-like and event-related RT.

DESIGN

The centrality of a traumatic event to one's identity was explored as a context under which the adaptive nature of RT might change. Young adults with interpersonal violence experiences (N = 163) reported use of trait-like and event-related RT, centrality of the event, depressive, anxious, and posttraumatic stress symptoms (PTSS), posttraumatic depreciation and posttraumatic growth.

METHODS

Hierarchical multiple regression analyses were used to examine main and moderating effects of four types of RT and event centrality on outcome variables.

RESULTS

Centrality positively predicted depressive symptoms and PTSS, depreciation, and growth. Brooding RT positively predicted all negative outcomes. Reflecting RT positively predicted anxious symptoms and PTSS and depreciation. Only deliberate RT positively predicted growth. Centrality did not moderate any examined relationships.

CONCLUSIONS

Findings highlight the importance of addressing specific types of RT in interventions with survivors and of considering centrality as a robust contributor to outcomes following interpersonal violence.

(Re-)defining the self - Enhanced posttraumatic growth and event centrality in stroke survivors: A mixed-method approach and control comparison study

Growing evidences highlight the co-existence of negative and positive (e.g. posttraumatic growth) identity changes following stroke. Identity changes were assessed by comparing 42 survivors 21 months after stroke and healthy controls. A total of 26 stroke survivors participated in a semi-structured interview. Stroke survivors showed significantly higher posttraumatic growth (F(1, 75) = 9.79, p = .003) and integrated the critical life event to a higher extent into their identity (event centrality) (F(1, 74) = 37.54, p < .001). Qualitative analysis revealed increased appreciation of life and more intense/selective relationships as the most common positive changes. Considering positive changes might provide additional perspectives for rehabilitation.

Cumulative exposure to traumatic events in older adults

OBJECTIVES

The present study examined the impact of cumulative trauma exposure on current posttraumatic stress disorder (PTSD) symptom severity in a nonclinical sample of adults in their 60s. The predictive utility of cumulative trauma exposure was compared to other known predictors of PTSD, including trauma severity, personality traits, social support, and event centrality.

METHOD

Community-dwelling adults (n = 2515) from the crest of the Baby Boom generation completed the Traumatic Life Events Questionnaire, the PTSD Checklist, the NEO Personality Inventory, the Centrality of Event Scale, and rated their current social support.

RESULTS

Cumulative trauma exposure predicted greater PTSD symptom severity in hierarchical regression analyses consistent with a dose-response model. Neuroticism and event centrality also emerged as robust predictors of PTSD symptom severity. In contrast, the severity of individuals' single most distressing life event, as measured by self-report ratings of the A1 PTSD diagnostic criterion, did not add explanatory variance to the model. Analyses concerning event categories revealed that cumulative exposure to childhood violence and adulthood physical assaults were most strongly associated with PTSD symptom severity in older adulthood. Moreover, cumulative self-oriented events accounted for a larger percentage of variance in symptom severity compared to events directed at others.

CONCLUSION

Our findings suggest that the cumulative impact of exposure to traumatic events throughout the life course contributes significantly to posttraumatic stress in older adulthood above and beyond other known predictors of PTSD.

The Frequency and Impact of Exposure to Potentially Traumatic Events Over the Life Course

We examined the frequency and impact of exposure to potentially traumatic events among a nonclinical sample of older adults (n = 3,575), a population typically underrepresented in epidemiological research concerning the prevalence of traumatic events. Current PTSD symptom severity and the centrality of events to identity were assessed for events nominated as currently most distressing. Approximately 90% of participants experienced one or more potentially traumatic events. Events that occurred with greater frequency early in the life course were associated with more severe PTSD symptoms compared to events that occurred with greater frequency during later decades. Early life traumas, however, were not more central to identity. Results underscore the differential impact of traumatic events experienced throughout the life course. We conclude with suggestions for further research concerning mechanisms that promote the persistence of post-traumatic stress related to early life traumas and empirical evaluation of psychotherapeutic treatments for older adults with PTSD.

Perceived positive impact of cancer among long-term survivors of childhood cancer: a report from the childhood cancer survivor study

OBJECTIVE

Investigations examining psychosocial adjustment among childhood cancer survivors have focused primarily on negative effects and psychopathology. Emergent literature suggests the existence of positive impact or adjustment experienced after cancer, as well. The purpose of this study is to examine the distribution of Perceived Positive Impact (PPI) and its correlates in young adult survivors of childhood cancer.

METHODS

6425 survivors and 360 siblings completed a comprehensive health survey, inclusive of a modified version of the Post-traumatic Growth Inventory (PTGI) as a measure of PPI. Linear regression models were used to examine demographic, disease and treatment characteristics associated with PPI.

RESULTS

Survivors were significantly more likely than siblings to report PPI. Endorsement of PPI was significantly greater among female and non-white survivors, and among survivors exposed to at least one intense therapy, a second malignancy or cancer recurrence. Survivors diagnosed at older ages and fewer years since diagnosis were more likely to report PPI. Income, education and marital/relationship status appeared to have varied relationships to PPI depending upon the subscale being evaluated.

CONCLUSIONS

The existence and variability of PPI in survivors in this study suggest that individual characteristics, inclusive of race, gender, cancer type, intensity of treatment, age at diagnosis and time since diagnosis, have unique and specific associations with different aspects of perceived positive outcomes of childhood cancer.