Posttraumatic Growth in Populations with Posttraumatic Stress Disorder-A Systematic Review on Growth-Related Psychological Constructs and Biological Variables

Wages and employment security following a major disaster: A 17-year population-based longitudinal comparative study

Objectives

The effects of disasters on mental health are well documented, but very little is known about the short to long-term effects of human-made disasters on wage and employment security careers of the affected residents.

Methods

Residents affected by a major fireworks disaster (May 13, 2000) in a Dutch residential area were all anonymously identified, based on postal codes of the affected area. To gain insight in these effects, data were derived from Statistics Netherlands that records all individual demographic, gross annual wages and employment security data of the entire Dutch population since 1999. A quasi-experimental matched control group design was used by constructing two pair-wise matched groups of non-affected residents of the city of Tilburg and the general Dutch population. Matching was based on nine demographic variables such as gender, age, education level and gross annual wage in 1999 (N^total = 12,648). The effects of the disaster on wage and employment security from 1999 to 2016 among the total group and among those with low wages in 1999, were assessed using fixed-effects panel regression analyses.

Results

Affected residents had significant lower gross annual wages in the medium and long term than the non-affected groups from the Netherlands, but differences were (very) small. Compared to the Tilburg group the significant differences were trivial in the medium term. Among the low-wage groups, no relevant differences were found between affected and non-affected residents. With respect to employment security, no or trivial differences were found between the total group of affected and matched comparison groups. Among those with low wages in 1999, in 2001 and especially 2002 affected residents worked fewer weeks per year than non-affected from Tilburg. In 2002 the difference with the Tilburg group was above moderate.

Conclusions

These results speak to the resilience of affected residents, given the mental health problems and PTSD-symptomatology they suffered from, as shown in previous research.

Social support moderates association between posttraumatic growth and trauma-related psychopathologies among victims of the Sewol Ferry Disaster

Disasters have numerous harmful effects on the mental health status of trauma-exposed people. We investigated the differences in the association between trauma-related psychopathologies and posttraumatic growth according to the perceived social support level among victims of the Sewol Ferry disaster on April 16, 2014, in South Korea. Data from 241 bereaved family members, survivors, and family members of survivors were used. The Duke-UNC Functional Social Support Questionnaire, Posttraumatic Growth Inventory, PTSD Checklist-5, Posttraumatic Embitterment Disorder Self-Rating Scale, Patient Health Questionnaire-9, and Generalized Anxiety Disorder-7 were used to evaluate perceived social support, posttraumatic growth, and trauma-related psychopathologies. We found that the severity of depression and anxiety showed inverse correlations with posttraumatic growth only in the low-social support group, while they did not demonstrate significant correlations in the high-social support group. The social support level had correlations with posttraumatic growth and the severity of posttraumatic stress disorder and posttraumatic embitterment disorder only in female respondents. Furthermore, there was a mediation pathway from social support level to posttraumatic growth through depressive symptoms. This study explored the complex relationship between social support, posttraumatic growth, trauma-related psychopathologies, and gender among trauma-exposed individuals in the aftermath of the Sewol Ferry disaster.

Effectiveness of a Multimodal, Day Clinic Group-Based Treatment Program for Trauma-Related Disorders: Differential Therapy Outcome for Complex PTSD vs. Non-Complex Trauma-Related Disorders

Background: The effectiveness of the psychotherapeutic treatment of posttraumatic stress disorder is evidence-based and generally considered proven. However, the effectiveness of multimodal, group-based day clinic treatment programs has rarely been investigated. Moreover, there is no consensus in the literature concerning the question whether psychotherapeutic approaches for trauma-related disorders are also applicable for patients with complex PTSD (cPTSD). The aim of the study was to evaluate our multimodal group-based treatment program regarding a change of psychiatric burden, a change of protective factors, and possible differences in therapy outcome for patients with or without cPTSD. Methods: The group-based treatment for patients with trauma-related disorders was examined in 66 patients who filled out the following questionnaires in the first and in the last week of treatment: Essen Trauma Inventory (ETI), Screening for complex PTSD (SkPTBS), Patient Health Questionnaire-somatization module (PHQ-15), Beck Depression Inventory-Revised (BDI-II), Posttraumatic Growth Inventory (PTGI), and Questionnaire on social support (F-SozU). Results: The treatment was shown to significantly reduce depressive symptoms (p < 0.001, d = -0.536) and increase posttraumatic growth (New Possibilities: p = 0.004, d = 0.405; Personal Strength: p = 0.005, d = 0.414). For patients with cPTSD, depressive (p = 0.010, d = -0.63) as well as cPTSD symptoms (p = 0.020, d = -0.796) were significantly reduced; perceived social support was increased after day clinic treatment (p = 0.003, d = 0.61). Contrary to our expectations, somatoform symptoms were increased after therapy. Conclusions: The present work expands previous research by demonstrating that multimodal group-based, day clinic treatment is effective in the treatment of trauma-related disorders, also in their complex form.

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.

Overview of measurement-based positive psychiatry

BACKGROUND

Psychiatry has traditionally focused on studying psychopathology and treating mental illnesses to relieve symptoms and prevent relapse. Positive psychiatry seeks to expand the scope of psychiatry to broader aspects of mental health and well-being among individuals with or without mental illnesses. Positive psychosocial factors such as well-being, resilience, optimism, wisdom, and social support are central to positive psychiatry.

AIM

To summarize the emerging science of positive psychiatry, emphasizing the use of measures of positive characteristics and outcomes relevant to mental health.

METHODS

Overview of recent research in positive psychiatry, focusing on measurements.

RESULTS

Positive psychosocial factors are associated with better mental and physical health in diverse populations. Among individuals with serious mental illnesses, levels of these factors vary considerably, but positive psychiatry interventions can improve well-being and rates of recovery in at least subsets of the patients. A number of measures of positive factors and outcomes are available; most of them are based on self-reports, which have advantages as well as limitations.

CONCLUSIONS

Positive psychiatry has the potential to improve the health and well-being of individuals with or without mental illnesses. Further research is needed to provide clinicians and investigators with a full tool-box of validated measures for positive psychosocial factors and outcomes. These measures should be subjected to rigorous psychometric evaluation across populations to help clarify mechanisms underlying positive factors, evaluate their longitudinal trajectories, and examine the impact of interventions on health and well-being over the lifespan in different clinical groups.

A Longitudinal Investigation of Posttraumatic Growth and Quality of Life in Liver Transplant Recipients

Background:

What does it mean to adjust to a liver transplant? Quality of life research has offered an impairment model, defining adjustment as the absence of diagnosed psychological disorder or of limitations in physical functioning. Recently emerging research on posttraumatic growth testifies the prevalence of positive life changes following the life-threatening illnesses. The present study aimed to verify the presence of the posttraumatic growth process in liver transplant patients and its relationship with traditional quality of life.

Methods:

The research was a longitudinally descriptive study. A sample of 233 liver transplant patients were assessed with the Posttraumatic Growth Inventory and the Functional Assessment of Chronic Illness Therapy General.

Results:

Over 50% of patients showed moderate-high levels in all dimensions of the Posttraumatic Growth Inventory. Further posttraumatic growth is correlated with the functional and social dimensions of quality of life construct and not with physical and emotional functioning.

Conclusion:

These results confirmed that posttraumatic growth is related to a different definition of well-being than the one traditionally used in the assessment of quality of life. Adjustment to liver transplant is a complex and systemic process, which requires a multidisciplinary approach to be able to support and encourages adaptation through all the needed functional elements. An interesting perspective is offered by the narrative medicine approach, that highlighted the importance to pay specific attention to the words and expression used by patients related to changes in life and not only to traditional words reporting physical status.

Emerging themes in coping with lifetime stress and implication for stress management education

BACKGROUND

Adults with adverse childhood experiences and exposure to adverse life events experience a diverse array of physical, mental, and social health problems across their lifespan. Adult exposure to emotional trauma, physical injury, or other adverse life events may result in the development of post-traumatic stress and post-traumatic stress disorder. Understanding individuals' response to stress and their coping strategies is as important as the stimulus or the causes of the stress for effective stress management interventions.

METHODS

This is a mixed quantitative and qualitative online survey study which explores the coping strategies to stress in adults with adverse childhood experiences and exposure to adverse life events through analysis of emerging themes from survey questionnaire responses of study participants.

RESULTS

Participants who respond to stress through adaptive coping focused either on problem-solving, 17.6% (32 out of 188), or on emotion-focused coping, 45.2% (85 out of 188). Participants engaged in problem-solving mainly through therapy such as counseling and other professional stress management, whereas those who chose emotion-focused coping used diverse strategies including practicing mindfulness, meditation, and yoga; using humor and jokes; seeking higher power or religious pursuits; engaging in physical or breathing exercises; and seeking social support. Participants who practiced maladaptive coping styles constituted 37.2% (70 out of 188) of respondents and resorted to avoidance of the stressful condition, withdrawal from a stressful environment, disengagement from stressful relationships, and use and abuse of drugs and/or alcohol.

CONCLUSION

An understanding of emerging themes in coping strategies calls for collaborative and multidisciplinary approaches in the design, implementation, and execution of health education and promotion programs tailored to meet the diverse needs of priority populations. Stress management educators need to take into account the vulnerabilities of individuals who resort to maladaptive coping and institute evidence-based behavioral and social service intervention strategies, including life skills training, to prevent the consequences of maladaptive coping and to enhance the self-efficacy of individuals to cope more effectively with stress and stressful life events.

Assessment and Management of Posttraumatic Stress Disorder

PURPOSE

The goal of this article is to increase clinicians' understanding of posttraumatic stress disorder (PTSD) and improve skills in assessing risk for and diagnosing PTSD. The importance and sequelae of lifetime trauma burden are discussed, with reference to trends in prevention, early intervention, and treatment.

RECENT FINDINGS

PTSD has different clinical phenotypes, which are reflected in the changes in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria. PTSD is almost always complicated by comorbidity. Treatment requires a multimodal approach, usually including medication, different therapeutic techniques, and management of comorbidity. Interest is growing in the neurobiology of childhood survivors of trauma, intergenerational transmission of trauma, and long-term impact of trauma on physical health. Mitigation of the risk of PTSD pretrauma in the military and first responders is gaining momentum, given concerns about the cost and disability associated with PTSD. Interest is also growing in screening for PTSD in medical populations, with evidence of improved clinical outcomes. Preliminary research supports the treatment of PTSD with repetitive transcranial magnetic stimulation.

SUMMARY

PTSD is a trauma-related disorder with features of fear and negative thinking about the trauma and the future. Untreated, it leads to ongoing disruption of life due to avoidance, impaired vocational and social functioning, and other symptoms, depending on the phenotype. Despite a theoretical understanding of underlying mechanisms, PTSD remains challenging to treat, although evidence exists for benefit of pharmacologic agents and trauma-focused therapies. A need still remains for treatments that are more effective and efficient, with faster onset.

Does prolonged grief treatment foster posttraumatic growth? Secondary results from a treatment study with long-term follow-up and mediation analysis

OBJECTIVES

Prolonged grief disorder (PGD) is a persistent and disabling kind of grief reaction that can be treated effectively with psychotherapeutic interventions. There has been limited investigation of whether these interventions can also enhance positive outcomes of bereavement, such as posttraumatic growth or benefit finding.

DESIGN

As part of secondary analyses in a randomized controlled trial evaluating integrative cognitive-behavioural therapy for PGD (PG-CBT), the posttraumatic growth trajectories in 51 outpatients with clinically relevant prolonged grief symptoms were followed up from baseline up to 1.5 years.

METHODS

Immediate treatment effects on posttraumatic growth in comparison with a waiting list control group were evaluated with univariate ANCOVA. Using mediation analysis, we examined the relation between symptom reduction and the short-term treatment effect on posttraumatic growth. For evaluating long-term outcome stability, the immediately treated group and the delayed treatment group were pooled.

RESULTS

PG-CBT significantly fostered growth in patients suffering from PGD, with a controlled medium effect size of Cohen's d = 0.60 (completer analysis). This effect remained stable up to the 1.5-year follow-up. Grief symptom reduction mediated short-term treatment effects on posttraumatic growth. However, growth also partially mediated treatment effects on prolonged grief symptoms.

CONCLUSIONS

Taken together, PG-CBT was effective in enhancing the participants' perception of posttraumatic growth, but the definite interaction between symptom reduction and posttraumatic growth remains unclear, as both seemed to influence each other's trajectory in the course of treatment.

PRACTITIONER POINTS

Integrative CBT for prolonged grief disorder also fostered posttraumatic growth. Post-treatment and 1.5-year follow-up effect sizes for posttraumatic growth were moderate. Whether growth-enhancing techniques are useful in grief treatment needs further research.

Challenges Associated With the Civilian Reintegration of Soldiers With Chronic PTSD: A New Approach Integrating Psychological Resources and Values in Action Reappropriation

Background: In light of the psychological changes in an individual suffering from chronic Posttraumatic Stress Disorder (PTSD), questions are being raised in order to understand and facilitate recovery and a return to work. This is particularly challenging for soldiers suffering from chronic PTSD, who are often young individuals suffering from moral conflicts. A French military rehabilitation program proposes the broadening of the relationships between recovery and reintegration by incorporating approaches from the field of positive psychology for soldiers with chronic PTSD. The aim of the study was to evaluate (i) the psychological resources which remain sustainable for these trauma exposed soldiers according to their PTSD symptoms, (ii) the dynamics of resource reappropriation after the military rehabilitation program, which focuses on values in action (VIA) as character strengths, and (iii) how these resources and their reappropriation facilitate civilian professional reintegration. Method: We conducted a prospective study with 56 trauma exposed soldiers with a clinical diagnosis of chronic PTSD. PTSD severity and psychological resources (optimism, mindfulness, well-being, motivation, self-esteem, and VIA) were assessed before and after the rehabilitation program. After the identification of resource profiles, we analyzed the impact of the program on resource levels and successful reintegration into a civilian job. Results: 3 profiles were identified based on the psychological resources of the soldiers. Profiles 1, 2, and 3 differed in terms of clinical severity (PCL5). Profile 1 exhibited both the highest level of resources and the lowest clinical severity of PTSD but did not modify its resources after the intervention program when compared to profile 3. Profile 3 was characterized by the lowest level of resources, the highest clinical severity of PTSD and the highest reappropriation in all VIAs. This profile was associated with the highest rate of reintegration success 1 year after the intervention. Conclusions: This paper aims to broaden the relationship between recovery and reintegration by incorporating approaches from the field of positive psychology for soldiers with PTSD. VIA appears to be an important factor for reintegration. Our results highlight the importance of taking into account the existing needs of the patient and the optimization of the modalities of individual, collective, and institutional rehabilitation for patients suffering from PTSD in order to better understand the dynamics of the recovery process of a chronically afflicted individual.